California Gov. Gavin Newsom COVID-19 Press Conference Transcript November 30

Governor Gavin Newsom: (06:12) Well, good afternoon, everybody. Let me just jump right in since we have a lot to update you on as we continue to experience these record-high case rates, not just here again in the state of California, but we're experiencing all across the United States. Governor Gavin Newsom: (06:28) Just to put this in perspective, our seven-day average in terms of new case numbers is north of 14,000. 14,657 to be precise. The one-day case number that we are announcing today, roughly in line with that seven-day average, 14,034. Put that in perspective, the case numbers, when you look back to the peak period that we experienced since the beginning of this pandemic, that seven-day average during the peak, the previous peak, was 9,881 compared to the close to 15,000 cases that we're now experiencing over a seven-day period. We anticipate based upon what occurred over the course of the last number of days, that within the next number of weeks, one to two weeks, based upon Thanksgiving activities and all the efforts to educate people against those activities and gatherings, that we will see an increase in cases. Governor Gavin Newsom: (07:35) It is important to put in perspective, California as a state vis-a-vis other states, just for purposes of comparison, people have inquired, people have asked, how are we doing in case rate comparisons? For instance, our state versus, for example, fill in the blank, those with the highest cases per 100,000 population, as example in this slide, North Dakota, Wyoming and South Dakota. We are doing, relatively speaking, better than the overwhelming majority of states, ranking 39th in the country with 34.5 cases per 100,000 population. Governor Gavin Newsom: (08:17) But that said, the alarming concern, it's not just for our state, but you're seeing this in other states, is the rate of growth. And let's get to that before our nerves are calmed by being the 11th best of the 58, or the rather 50 states. So really, it's the positivity rate. You can see that our average number of daily tests continues to increase. We need to see that number increase much more still, and certainly with the new state lab that's come online and the fact that they're increasing their total number of daily cases, remember that lab is more like a flywheel. We're not getting to the 150,000 tests being conducted every single day just yet, but over the course of number of weeks, over the course of the next few months, we will indeed get there. Governor Gavin Newsom: (09:06) Capacity, by the way, at that lab exceeds 150,000, but 150,000 is our phase one goal. But nonetheless, total number of average daily tests, north of 223,000, just shy of 224,000. I always maintain the more tests we do, likely to find through that surveillance, more cases. Positivity rate then becomes the most important driver in terms of our understanding of where the community spread is occurring and how significant it is. That positivity rate is now at 6.2% over a 14-day period. Governor Gavin Newsom: (09:44) Slide you're very familiar with. It's the positivity rate. A few weeks back, it was at 4.5% when we updated you last week, now it's 6.2%. So that rate of growth on the cases, as well as positivity rate is of concern. Here's why. Roughly 12% of our new cases likely will be hospitalizations over a two-week period. Meaning once a case is reported, about 12% of the time, when you look at the aggregate, the cumulative number of cases, 12% of those are likely to be individuals then hospitalized. So you can start doing the math and you could start putting some specific projections, specific data that will guide decisions that you make today and over the next few days in anticipation of those rate increases. I'll get to that in more specificity in just a moment, but here's a similar trend line in terms of the hospitalization you've seen now for a little over six to eight weeks. We've seen a significant increase, 89% increase over the 14-day period of people that have been hospitalized that have tested positive for COVID-19, now 7,787 individuals. Governor Gavin Newsom: (11:08) At the current projections, this is the point I was just making a moment ago, the current projections, we are showing hospitalizations that without any additional interventions, change of behavior, or fundamental shifts in the way we are conducting ourselves as individuals in this state, that we could see an increase just in hospitalizations that are two to three times greater than the current census in just one calendar month. We will bear out more fruit to this argument and this point in a moment, but here's a slide, again, very familiar with. This is our total healthcare system capacity. You'll see here, 59% of all of our hospital beds are currently being utilized within the healthcare system itself. We'll talk about the surge capacity in a moment, but this is within the healthcare delivery system. 11% of that population is currently tested positive for COVID-19. Governor Gavin Newsom: (12:12) But here's a slide that we are using internally, and then I wanted to socialize with you externally, and that's our projections moving forward. So as I noted, California healthcare system, 59% of the total number of beds are currently occupied. You can see if we project out to Christmas Eve, 12/24, less than a month from today that we are projecting we'll get to 78% capacity. But that doesn't tell the whole story. That's in the aggregate, California as a state. But you break that down, the Bay Area, Greater Sacramento, Northern California, San Joaquin, you can see in San Joaquin Valley that we project upwards of 83% of the bed capacity being fully occupied just within the next month or so. We'll get to ICUs in just a moment. Governor Gavin Newsom: (13:09) In ICUs, you'll see that when we have someone hospitalized, anywhere from a low end of 10% to as high as 29, I'll round up to 30%, of hospitalizations will require ICU care or some form of respiratory support. So we base number of cases, 12%, likely end up in hospitals. Of those hospitalized, 10 to 30% may need respiratory support and ICU care. You can already see that trendline, this familiar slide of ICU admissions that have increased 67% in the last two weeks alone. 1,812 individuals now in the ICUs. That represents 23% of the total number of patients in our critical care system that have tested positive for COVID- 19. So 23% of those that are currently in our ICU care system currently have tested positive for COVID-19. But let's take a look at the overall ICU system that's being occupied by individuals, or rather is being utilized by individuals needing ICU support for non-COVID related admissions. That's 75% of all of the state's beds. Governor Gavin Newsom: (14:27) Here's a slide that should be sobering to everybody, and I'll keep it up for a moment so people can digest this and take a look at it. It's one thing to talk about where we might be in San Joaquin Valley by Christmas Eve at about 83% of the capacity in our hospitals being utilized, but take a look at the ICUs. If you start breaking things down, look how quickly we go from 75% statewide, 85% already in Northern California, of the ICU beds being occupied to 134% just in early December. That's in a week or two. You can see in mid-December, California, the ICU beds will be at 112% capacity. So you get a sense of where we may be, including in early January, just in the Bay Area, that is more robust in terms of its capacity based on current projections, but even in early January, they'll be stretched, getting close to 100% at 91%. Governor Gavin Newsom: (15:28) So that's the lay of the land in terms of the red flags that are flying. Not yellow flags, the red flags that are flying in terms of the trajectory and our projections of growth. And that's why we are making this point very loudly today. Dr. Ghaly will speak to it in the Q&A as well, and I may ask him before that to talk a little bit more. But if these trends continue, we're going to have to take much more dramatic, arguably drastic action, including taking a look at those purple tiered counties, and they are now 51 of the 58 counties. We had nine counties over the weekend move backwards. Remember, we're not waiting on our weekly cadence to make moves, we're doing it much more consistently, updating the moves. 51 counties now in the most restricted purple tiered status, six in the red status, just one in orange status, none now in yellow status. Governor Gavin Newsom: (16:32) If we see these trends continue, the potential for a stay-at-home order for those regions in purple, because of hospitalizations in ICUs, we're not just now looking at positivity rates, we're not now just looking at case rates, we are now looking in real-time at hospitalization numbers and ICU capacity in those regions. It will require, and we are assessing this in real-time over the next day or two, to make determinations of deep purple moves in those purple tiered status that is more equivalent, more in line with the stay-at-home order that folks were familiar with in the beginning of this year, with modifications in terms of the work that we are currently doing. Governor Gavin Newsom: (17:25) But we've been working with health officers up and down the state over the weekend, well aware of what's happening in LA County and parts of the Bay Area. And in turn, the health advisors, or rather the health officers themselves helping advise our team in terms of what they're expecting or hoping for from the state, and they're familiar with some of those. Well, some of the recommendations we took from them, some of the recommendations that we offered in return that they're being worked on in real-time. Governor Gavin Newsom: (17:56) Dr. Ghaly, just because I think this is an important point to reiterate, maybe you can talk just briefly before I move on in these slides, and I'll put up this current tiered status slide as you speak, just to talk perhaps a little bit more about your conversations over the weekend, over the last week, maybe provide some insight at what we may be looking at if these ICU and hospitalization numbers continue over the next few days. Dr. Ghaly: (18:23) Yeah, thank you, Governor. And as always, you did an excellent job sort of laying it out. But as you said, we've been in constant conversation, not just with local health officers and other leaders at the county level, but really with the healthcare delivery system leaders checking in, people on our team at this state checking in daily with the big systems but also smaller regional hospitals that maybe can't ramp up as quickly and as easily. Dr. Ghaly: (18:49) And again, remember, we are doing all that we can to anticipate the surge; building beds, adding staff, making sure equipment's available, working to make sure all of the different waivers and permissions are in place so hospitals can do all they can for the patients coming in their front doors. But we also need to address, as you pointed out, the incoming patients and making sure we're doing what we can on transmission. So focusing on what we talked about previously as non-pharmaceutical interventions, everything from where we are now with restrictions in the purple tier, 51 counties in that status, and looking at other things like all the way up to a stay-at-home order to determine how we really navigate what is a challenging time with case rates. Dr. Ghaly: (19:42) I remind you that the high case numbers that we've seen in the last week and 10 days have not even begun to impact hospitals yet. We know that it takes about two weeks. So a few days ago, when we had a case level of 18,000 plus cases in the state, what that tells us is that's not yet impacted the hospitals, the emergency rooms, the ICUs. So really working over the weekend, and frankly, day in and day out with healthcare leaders across the state to understand where their challenges are, making sure that staffing is strong. We know that staff are one of our most precious resources at this time. And they've been on that frontline for many, many months. They're tired out themselves. Their families are concerned about what these high rates of spread are. So doing all that we can in our communities to protect those healthcare workers. Dr. Ghaly: (20:36) So that's what's going on. Everything, as you know, Governor, is on the table in terms of considering how we effectively guide the state through this and working with our local partners to make sure what we do is both impactful and as time limited as possible. We know that this is hard for all Californians and making sure that we choose something that will make a difference, but that we can track that difference and give people some confidence that we will only do it as long as we need to, to bring the hospitals into a situation that they can handle the incoming patient numbers and provide high quality care in a way that protects our healthcare workforce as well. Governor Gavin Newsom: (21:19) No, I appreciate that. And I want to just pick up a little bit on what Dr. Ghaly was just saying as it relates to our preparedness, but also caution that some of the tools in the toolkit when we were at this in early part of the summer are not available to us, most notably because of the surge all across this country. The capacity of the federal government, the capacity for mutual aid coming, not only from the federal system, but from even other states is more limited. And as a consequence, we are thinking in that frame about ways we can be more creative and more proactive in terms of our preparedness. Governor Gavin Newsom: (21:57) I'll remind folks that of the work that we have done to prepare. In particular, it was interesting to note that California's current PPE stockpile is the largest in the United States. In fact, it's larger than the U.S. government's stockpile. The National Strategic Stockpile actually has 40 million less N95 masks than the state of California. So it's just an example of what we have been doing over the last number of months to truly be prepared. Governor Gavin Newsom: (22:28) Another thing we did to prepare, something that we had updated you on a relatively consistent basis, we'll start doing again very soon is our health corp. We went out a number of months ago and we asked people if they would submit their names and their unique skillset to a registry, make a determination based upon their active registration and their licensing and whether or not they can commit a certain amount of time in a certain area to a certain need, whether or not they matched. And right now we have 871 individuals that- Governor Gavin Newsom: (23:03) And right now we have 871 individuals that are active and registered as part of our health corps. We're going to be dusting that off and working harder to get a broader swath of opportunities to make those available to individuals that may have recently retired, or may have seen their license lapse, but now easily can enter back into the workforce as needed. Governor Gavin Newsom: (23:27) We also talked a lot about, in the past, I talked about at the beginning of this presentation, the work we did to secure our nation's first state testing lab scale and scope. The one that we have put together here in the state of California. Again, that could not have come at a better time in terms of securing our testing needs, not only to address the growing case rates across the state, but the sector specific needs, particularly for our schools to reopen quickly. Even in a challenging environment, the need to provide for the state-of-the-art PCR tests, these lab-based tests that are critical in terms of the sectoral reopening. And of course doing what we can to procure more ventilators, not only from the federal government, but getting more ventilators in our healthcare system. Governor Gavin Newsom: (24:17) The healthcare system itself has procured a substantial number of ventilators and rehabbed and refurbished older ventilators, and have been preparing themselves. In addition, of course, the state supplementing those efforts. So giving you just some bullet points of some examples, not a comprehensive list, but just a reminder of some of the work we've done. Including the 11 search facilities that we have pre-identified and pre-deployed all throughout the state of California. I'll remind you, Fairview and Porterville, places like the ARCO Arena up in Sacramento. In what we refer to as warm status. And that just simply means that we can convert those surge facilities in relatively short order, 24 to 96 hours. Governor Gavin Newsom: (25:05) I keep bringing this slide back up. Those of you who have tuned in on these presentations have seen this slide the last few weeks. There's a reason, and that is, based upon these projections and these trend lines are likely to begin to need to turn these from warm status and make these fully operational. And so we're just moving slowly in that direction, just give you a sense that this capacity, up to 2000 beds, 1,862, we have some additional capacity as needed, where we could go beyond these number. But nonetheless, this capacity has been formalized and organized in a way that we are prepared, if indeed, we need to be accessing these sites. Governor Gavin Newsom: (25:52) I'll remind you, if we need to access our PPE inventory again, over half a billion units of surgical/procedure mass, and N95 masks you'll see there on the slides, additional gowns and gloves, collection kits and the like, which we continue to procure. This is not a static number. We're updating these numbers consistently. And as I have reminded you in previous presentations, we've already distributed some 600 plus million masks already. This is just with am inventory that hasn't already been distributed. We've done the same with gowns and gloves and face shields and other PPE. But one of the things we need to talk more about in terms of preparedness is preparing our small businesses. If we're talking about more modifications, more restrictions, sectoral, and industry restrictions for non essential services, as you've seen in LA County, as you've seen in other parts of the state, as more and more counties move into this purple tier, and we look at our own modifications statewide, not just those modifications we are seeing at a local level. We have to be more mindful than ever about the economic impact and consequences of these further restrictions. Governor Gavin Newsom: (27:11) And it's why I want just to take this opportunity. I've shown many slides on many occasions, the work we've done in the past, what we proposed in our budget, what we did through executive orders, previous to the enactment of our budget in July, working collaboratively with the legislature. As well as previewing folks on what we may be doing in the next fiscal year with a budget that I'm working on as we speak that we will make public in January to the legislature. And that has been important. But let me now offer some additional insight on what we are doing immediately, more in this space, targeted at the most impacted sectors of our economy. Small businesses in particular. We are announcing today immediate release to provide billions of dollars of opportunity for small businesses that have collected sales taxes and owe sales taxes in this first line up to $1 million of sales tax that is owed, to get a three months extension. In essence, a float. That sales tax is collected by the business member. It is in a bank account, it's supposed to be sent to the state and the counties, cities for distribution. You can hold that money. You can use that money to float any obligations you have. It's a deferral and it's automatic for businesses that own up to a million dollars in sales tax. Governor Gavin Newsom: (28:45) We're going to expand interest-free for businesses that have $5 million in sales. I would change the language a little bit. So I want to clarify that second bullet point. Expanded interest payment agreements to larger companies with sales up to 5 million. Sales tax that is owed up to a million, but sales we're expanding for immediate relief up to $5 million in sales. You just have to fill out a form. It's automatic for those other businesses, fill out a form. The covid19.ca.gov website. It's a good first site, which will direct you to the appropriate agencies, the appropriate form. Covid19.ca.gov website. Covid19.ca.gov website to learn more about these programs. But that immediate relief, we worked with the legislature. Want to thank legislative leaders for their insight, for their council, for their support of these efforts. And also, we are expanding to those industries with operations that have been disproportionally impacted. And those are restaurants, hair salons, nail salons, bars, hospitality industry in particular, that has been impacted already by the tiered status. But likely to be impacted more or with regard to the prospect of additional restrictions over the next days and weeks. Governor Gavin Newsom: (30:13) Here's some additional supports we're providing for immediate relief. And this is emergency relief package also in partnership with the legislature. This is money that we're getting out right away, half a billion dollars. I want to thank legislative leaders over the weekend, working with our team to broadly tip the hat to support using our reserve counts, to get a half a billion dollars of additional grant money, up to $25,000 cash grants. Not just a small businesses in this case, but also cultural institutions and nonprofits. We cannot forget essential nature of our nonprofits, our community-based organizations, and in terms of addressing the most vulnerable and the needs rather of the most vulnerable in the state of California. Governor Gavin Newsom: (30:58) So these are grants up to $25,000. This program will be a bridge just over the next number of weeks to what we will work on with the legislature in the next legislative session. So I want folks to know this is not the end. This is just the beginning of a bridge. What we did in January, or rather what we accomplished in July together with the legislature and now a bridge through this emergency appropriation through our reserves to get us into conversations when the legislature returns and seeing what we can do with early action in terms of next year's budget. Governor Gavin Newsom: (31:38) In addition to that, we are increasing our investment in a California rebuilding fund. And by the way, I'm very proud of this fund. We've had an overwhelming response. This came from our economic task force. In fact, this was, full disclosure, interesting perhaps to some. This was the brainchild of Janet Yellen, the former Fed Chief, who was just announced today formerly by president elect Biden to be the next treasury secretary. She was a very active participant in our economic task force. And she talked about the importance of providing first loss funds and providing direct relief for businesses with this program. Governor Gavin Newsom: (32:25) This program immediately has generated a lot of support. The idea is to provide $125 million. We're looking to leverage these dollars. You can see what's already happened, just since we announced the first traunch of this fund a few months back, how the take-up has gone. We want to get an additional 12 and a half million that will leverage tens of millions more resources to get to 125 million of relief in this first fund. We're also reminding people that tomorrow, literally tomorrow, because of the work we did with the legislature. Again, thank you to legislative leadership Budget Chair Ting and Holly Mitchell, and their strong support of our Main Street Hiring Tax Credit, up to a $100 million. Governor Gavin Newsom: (33:10) Those dollars are now made available when you hire a qualified employee, a tax credit up to a thousand dollars, to $100,000 If you're a small business owner, that you can receive in tax credits. That program begins tomorrow, December 1st. And go to covid19.ca.gov website, just to provide basic information where you can go to learn more about this Main Street Hiring Tax Credit. That program goes live again, December 1st. We also have a program, and it's remarkable to me how little attention this has earned, and we'll all take responsibility for that, but I will be stubborn to continue to remind people about this. We have waived the franchise tax in the state of California for new business startups. A $100 million we set aside in July budget to encourage innovation, to encourage entrepreneurial-ism. I want to remind people of that program that was approved with great support of our legislature. Governor Gavin Newsom: (34:13) As well as excluding all the PPP loans from any state taxes, which is something just as a reminder that was done recently and is very important. And it was something, again came not only out of the legislature, but also supported by our economic task force. We also provided for disaster relief loan guarantees of now up to a $100 million. We did 50 million through an executive order. The legislature doubled that still, which was spectacular, $100 million. You can see already what these loan guarantees have done a $100 million of loan guarantees, where we are helping those that can't get traditional loans that are falling through the cracks. Governor Gavin Newsom: (34:59) We hear this all the time. It's one thing if you have long established credit and you have a loan long established banking relationship, or credit union relationship, or traditional capacity to get financing, but what about everybody else? And so that's why this program was created. And this goes through our IBank, $100 million, 83% of the loans that have already gone out, women and minority owned companies. And you can see we're leveraging, this is again, all about leveraging. It's not just the hundred million, it's leveraging tens of millions more. You could see just in one proponent of the two programs that total a hundred million, that we had 217 million loans approved that have already leveraged $109 million of additional support. Governor Gavin Newsom: (35:51) I'll talk about additional support. And we will wrap up here in just a moment, but I wanted to also remind folks of additional support. We are providing our restaurants. We announced a number of months back, a first in the nation program, working with FEMA and working with our federal partners called Great Plates. The idea of Great Plates was to have restaurants that otherwise are closed, or substantially impacted because of the restrictions pursuant to our guidelines, local and state, the COVID-19 restrictions. They simply cannot operate at capacity. We wanted to create a competitive and creative program that allows people able to serve the most vulnerable that are in need, three hot meals a day to seniors, that are wisely being cautious in terms of their own movement. And that otherwise have access to a lot of the Meals on Wheels programs, and other programs that are providing support. Governor Gavin Newsom: (36:49) That program, please, if you're a restaurateur, or no restaurateur, we encourage more utilization and access this program. This program supports counties to provide 75% reimbursement. The state provides additional reimbursements to the county, 25% pickup to provide 100% free meals, three hot meals a day to our seniors. And provide the opportunity for small businesses and restaurants to stay open, providing those meals and getting paid for providing those meals through the program reimbursement, through FEMA and the state, working with our counties. Already just shy of 10,000 food industry jobs have been supported since the initiation of this program. Almost 18 million meals have been provided. We want to get to this whole nother level. And if we continue to put more pressure on our restaurant industry, it is important that we share more information about the Great Plates program. Governor Gavin Newsom: (37:49) It's not a panacea. Nothing about it's perfect. I recognize that there are implementation challenges. Each county does it differently. Each county has different rules and regulations and different criteria as it relates to how they operate this specifically. But it's important that we promote it nonetheless. And I want to encourage people again, to go to that covid19.ca.gov website. Covid19.ca.gov website. Learn more about Great Plates. See if it works for you. May not work for you, but if it does, this could be very, very helpful during the next six, to eight, to 10 weeks as we work through the most challenging period, since the beginning of this pandemic. Governor Gavin Newsom: (38:32) I'll remind people, we did an executive order on commercial eviction freezing. Those commercial evictions, through the end of March. We also provided over 16 million units of PPE, that's personal protective gear, to our small businessmen and women free, getting those out so that they weren't having to procure those directly and using precious resources to do that. We also have provided additional support. Again, I want to thank the legislature for their strong work in this to really amplify the work that's being done in our 86 small business centers. And I want to encourage small businessmen and women to use those small business centers. There's a treasure trove of resources, information, 86 of these, part of this broader network, all up and down the state of California, provided additional support, additional staff. Governor Gavin Newsom: (39:26) We did it as well to our economic program, our team called GO-Biz, all with an idea of getting you more information about how you can get more support. And that's what this slide here represents. These are existing supports. Small Business Association provides the economic injury disaster loans, as well as these loan advances. These small business centers have all the information. It's important to access, to get more information so you can get that support from the SBA. And as you may recall, we were the first state to act to get these, what we call EIDL loans. California was the first to move to get these disaster loans. And you can see we've already drawn down 549,000 businesses have received one portion of those loans. $34 billion has been received. These loan advances, $2.7 billion of grants have been received. Over 800, 000 businesses have taken advantage. If you haven't, please learn more about it. Again, go to covid19.ca.gov. Governor Gavin Newsom: (40:37) And another program that's so essential, so fundamental is the PPP program. This is just an update, 68, almost $69 billion has been drawn down in the state 623,000 businesses have taken advantage of it. So just giving you a sense of what the federal relief has been, the leveraging of those federal programs. We've been able to draw down in the state of California over a hundred billion dollars since the beginning of this pandemic. I recognize it's not even close to enough. Trust me. I recognize this as a former small business owner in the restaurant and the hotel businesses, that started retail right out of college with pen to paper, part-time employee, Pat Kelly. My passion for entrepreneurial-ism and my deep reverence, and also empathy for the stress and the travails of small businesses and what you are facing, particularly over the next few months as we work our way, now this sprint to the vaccine. More on that in a moment. Governor Gavin Newsom: (41:39) But as we work through this very difficult time, more restrictions placed on you, more businesses now vulnerable to being out of business permanently. We want to make sure we're taking advantage of all these federal programs. And that's why this PPP program was so important. And it is critical still that we get more support from the federal government. I'll talk about that, that in a second. But as well, we're going to need more support from the state and we recognize that we're going to need to do more working with the legislature to retain jobs, to expand jobs. We're going to talk a lot more about employment insurance, not just unemployment insurance. In January, we're going to talk about waiving more fees, related to industries that have been disproportionally impacted by this pandemic. A lot of great ideas have been brought to light by legislature. A lot. We worked on together and got done last year, but just not at the scale that we need to do it moving forward. Governor Gavin Newsom: (42:41) Just want folks to know we have a whole list things that we are actively engaged with leadership and legislature on. So that again, we could have early on action and we can move quickly in terms of additional relief to businesses. So again, all this work that we did in July now just ramping up money, going out. Now this interim relief, there's new grants, $500 million. These tax credits are now in effect for those essential businesses that are still open, but barely holding on. The ability to float those dollars on the sales tax, more information and access on the small business loans, as well as creation of our own state loans for those that fall through the cracks, and of course, work that we need to do the micro support for small businesses. And then that last line here. More infrastructure, more broader, medium and longterm economic development strategies, housing and larger infrastructure projects, and how we can accelerate even more of that infrastructure funding then we have already. All part and parcel of what we'll be moving into, into January. Governor Gavin Newsom: (43:52) But as I said, just a moment ago, let me just conclude in terms of this topic that we can't do this alone. Even though we are the fifth largest economy in the world, it's been 248 days since that CARES Act and the PPP money drying up, money across the spectrum drying up in terms of those reliefs, the individual relief checks, the UI checks, POA checks, all these other supports drying up. We need Congress to act with urgency. Urgency is not January, February and March and April of next year. Urgency is today. Urgency is tomorrow. Urgency is a 24 hour effort, seven days a week to figure this out and to get something done and meaningful. We are not capable. Even a state is rich and resourced as California, and that's saying something. We're enjoying revenue above projection. We're able to provide these supports, but it's not enough to do what we need to do to hold up the economy of this country, not just the state. Governor Gavin Newsom: (44:58) And no more bickering. Time for people to really just put aside their differences. Private thoughts I don't want to share, but start to put aside their differences, do the damn right thing, and not do it as Democrats or Republicans, but as Americans against first. And not wait, can't wait. We need to get moving on these supports to help these small businesses that have put everything on the line, to make the American dream possible, and to have their back at this critical moment. Governor Gavin Newsom: (45:28) Now forgive me, but this is just fundamental. And to that end, if you are wondering what we're doing to support that cause, I would point you to a series of correspondence we've had with legislative leaders and Congress. Speaker Pelosi, Mitch McConnell among others, while as minority leaders in the respected houses. We also just recently sent another letter, multiple page letter, specifically outlining what we believe are the most important supports in terms of a new CARES Act. And so we're not... Governor Gavin Newsom: (46:03) ... and supports in terms of a new CARES Act. And so we're not being sheepish or shy, just announcing this in a press conference. We've been working closely with Speaker Pelosi. We have publicly made our requests known for many, many months, not least of which the last few weeks. And we'll continue to work aggressively with the Biden administration, the incoming administration, the transition to do what we can to help them influence real action at the federal level. Speaking of action, and I'll just close with this and we'll open up to questions. Important, last week, I updated everybody on the vaccine plans and the three work groups that we created a number of weeks back. Some work that we had done task forces going many, many months back. Here's something that you may not have seen. We are anticipating 327,000 doses of the vaccine, Pfizer to come in, in the next few weeks, we have a specific date. Governor Gavin Newsom: (46:58) I don't want to give the specific date quite yet, because that date they gave us was within three days, I want to get the right dates. They said between this date and that date. But suffice it to say in the next few weeks, 327,000 doses, that will be California portion of the first distribution of vaccines. These are challenging vaccines, because these are the ultra low temperature stored vaccines. These vaccines also require a second dose, which we anticipate in three weeks. As I told you last week and I hope folks took a look. We now have these public meetings with our drafting guidelines working group, and there's this advisory committee. They met day after Thanksgiving. I think it was another two, three hours, where they met public forum on Friday, updating the latest plan. Now we get a better sense of what's available for the first round. Governor Gavin Newsom: (47:54) So what's the priority on 327,000 doses? Who are the people we're priority? It's one thing to say the healthcare sector. It's another to say those that are working in congregate facilities, those working with vulnerable populations. But how do you break that down in even more detail, more specificity? That plan, detailed plan will be out this week. That's what we referred to as the phase one distribution plan. They're reviewing, they have another meeting today on that plan, but we're working off the 327,000, first distribution of doses coming from Pfizer with Moderna right behind it. And quite literally, we are tracking hundreds of others that are in this space, working all across the globe, including dozens of others that are in advanced trials that are also part of our working group's sort of purview. Not of direct responsibility, but authority in terms of their calculus on when things to start arrive. Governor Gavin Newsom: (49:02) When we'll start to see significant increases at scale of doses of vaccine that will be made available more broadly to you and me and the broader general public. So that's just a quick update on the vaccines. As always, encourage you to do what we can to abide these health rules and all the critical non-pharmaceutical interventions that we have been talking about for many, many months. And with that, let's open it up to questions. Dr. Galley, obviously here to answer more specific questions about the vaccine and any other questions related to health area. And we're here as well to talk about other topics. Speaker 1: (49:43) Don Thompson, Associated Press. Don Thompson: (49:47) Governor, a couple of related topics here today. If I can ask on what do you think the hospital system can withstand this unprecedented surge without shutting down elective surgeries, as you did earlier in the year? And we're hearing some are already doing that. At the time, we expected that we'd need 66,000 more hospital beds, and asking what your models show now for what additional we might need. And then secondly, you're telegraphing that we might see it as more stay at home orders. What sort of thresholds are you using or expect to be using to determine when you will have those a county by county stay at home orders? Thank you. Governor Gavin Newsom: (50:30) Yeah. Don, all outstanding questions. So Dr. Galley, I'll pull you back in. I pulled up the slide again, just in terms of our healthcare system projections. So once again, people get a sense of what we're projecting to occur in the next few weeks. Don asks a number of very specific questions that move and move beyond the short-term projections. I think he was referring with that 66,000 number to some of this information that we provided earlier March and April. Give me a sense, Dr. Galley, where you anticipate the system capacity to really start to feel stressed? But also maybe break down that it's not just the Bay area in the aggregate, it's really, as you say, regional hospital specific hospitals, that may feel pressure points even sooner than that. Dr. Ghaly: (51:17) Yeah. Thank you. And thanks for really excellent questions. I'll tell you that it's important and the governor's used it a couple of times to talk about the regional aspect of hospital delivery systems. Some counties in California don't themselves have a hospital, certainly don't have many ICU beds. So they depend on regional networks of hospitals, different systems coming together. So we are looking at this from a regional basis first and foremost, because what matters is if a patient needs care and they can't get it in a hospital in their community, in their county, then we need to make sure that surrounding counties' hospitals are able to serve those individuals. So you see here on this slide, we have a number of various county regions or regions in California made up of multiple counties. And we look out at when their beds, their total hospital beds might be filled. Dr. Ghaly: (52:12) You might say, "Look, there's a little room in the hospitals. Even at the end of December." And much of the surge capacity that we have built up is able to take care of what we say are medical surgical beds. They are not ICU equivalent beds. What we worry about at this time is specifically the ICUs. The governor mentioned that cases today turn into hospitalizations at about 12% in two weeks. And then from there, we know that a number of those individuals will move on to need critical care intensive care units. What does that mean? Usually specialized space, specialized equipment and specialized staff. So in this slide, you'll see that around that same time, even when we might only be using 70% of our total hospital beds across the state, we're using over 100% of the projected current capacity of intensive care unit space. Dr. Ghaly: (53:08) Now hospitals have ability to build up some additional ICU space. We've done that in a long-term way in areas like Imperial County, you'll remember Imperial over the summer, had the need to move a lot of patients out of their County to get that high level of care in other counties. It's not that they couldn't deliver it for some, it's just they couldn't deliver it for the number of patients that needed it. We have sentenced worked with those hospitals to build ongoing intensive care unit capacity, so that not as many patients, hopefully no patients need to be transferred out. They have that internal capacity. We've been working that in other parts of the state as well to increase our ability to take care of individuals. But bottom line is we are looking at intensive care unit capacity as the primary trigger for deeper, more restrictive actions. Because when that capacity goes away or even when it gets stretched so far, that staffing is stretched, that we have to have set up space that isn't typically used for intensive care units. Dr. Ghaly: (54:18) We know that the quality of care, not because of anyone's fault, not because people aren't being attentive. To the contrary, they're working so hard, so fast that the quality of care sometimes takes a dip and we see outcomes we don't want to see. So we are doing all we can to see that coming, to anticipate that so that as you can see in this slide, the second half of December, when we anticipate if we don't make changes to how transmission is going today, we may have some limitations, some real concerns in certain regions and specific communities in certain regions of the state that we want to stay on in front of that. That's why we're working with the health center, health system partners now, those local health officers to anticipate what their unique models show in their own regions but statewide, we see that the second half of December could be pushing the limits in some areas, that we want to act sooner than that so that we can get transmission down and we can handle those potential high ICU surges. Governor Gavin Newsom: (55:26) And Dr. Galley, if I may just interject. What I think is important before everyone, and I say this respectfully, and before everyone runs with headlines saying, "This is what the state anticipates." We don't anticipate this. This is in the absence of making better decisions. This is a chart that says, "If we just sit back and we sort of are bystanders at this moment, and we don't subsequently improve upon our existing efforts, this is what we project might occur." And so I want folks to know that we intend to bend this proverbial curve and impact these statistics favorably. You specifically, Don, asked about elected surgeries. And it's important to note, many hospitals already are suspending elective surgeries, but Dr. Galley, perhaps you could talk more formally about elective surgeries, which in the beginning of this pandemic certainly were suspended all voluntarily, I should add in the beginning of this pandemic, but now increasingly are just beginning to be suspended based upon the input you've received from the system itself. Dr. Ghaly: (56:46) Yeah, yeah, governor. The reminder that it was voluntary in the beginning because people anticipated the need to prepare for surge. We didn't know nearly as much as we did then about COVID. And frankly, we saw that stopping some procedures earlier than we needed to created other health consequences beyond COVID. We always look at this, not just about COVID health, but about broad health and public health broadly speaking. So a number of hospitals have already made decisions because their systems are impacted enough to begin to decrease and even suspend entirely, some of those scheduled surgeries. And we're not talking scheduled surgeries like, " Oh, it's fine to do it today and we can wait six months." Some of these are very important procedures, things like inserting dialysis, catheters, heart valve replacements, certain procedures to make sure cancer care goes as well as it is. Dr. Ghaly: (57:45) It's not that it has to happen today for certain, but waiting weeks and weeks and weeks could have significant consequences. So it's this fine balance, but a number of systems and hospitals specifically, if you looked in the Central Valley, you looked in parts of Southern California and the Bay Area, I'm sure in Sacramento already, certain hospitals, certain systems are making the decision to reduce those in part and maybe even suspend them entirely until we see how the next few weeks plays out. The other thing to remind you that many of those services and surgeries can be stopped fairly quickly. So the next day or two days out. So they can keep those scheduled for now, but pretty quickly turn off that demand and really protect the rest of the healthcare delivery system. So we're working hard and hand in hand with California Hospital Association specific systems to make sure that we time it correctly, to make sure that capacity's available when we need it. Governor Gavin Newsom: (58:51) And Don, just the last part of your question about just the previewing more restrictive measures. I can assure you, those are being assessed in real time. Do not anticipate again, week by week announcements in this space. There are many moving parts as it relates to any subsequent movement by the state. One size again, does not fit all. We have many different local health officers, very different points of view. And so we're working with our counties, working with our cities, not just the healthcare system itself, as well as local health officers, all in an effort to basically land where we think is appropriate based upon these projections that we are making public today. Speaker 1: (59:40) Stephanie Olam, CNN. Stephanie Olam: (59:43) Hi, governor and Dr. Galley. My question is about the fact that California is one of the most strict when it comes to the COVID restrictions that we're seeing, and yet we still have this case explosion here. And I would love to hear why you think that is, is it just, people are tired of dealing with the pandemic? And if so, does that mean as you're looking at these more strict stay at home orders like we have here in Los Angeles County starting today, does that mean that perhaps there will also be more of an intensity on having some of these restrictions followed, the reinforcement of that? Could you speak to that too, please? Thank you. Governor Gavin Newsom: (01:00:20) Thank you. Thank you for the question. I want to go back to the slide on case rates and positivity rates, because I want to put it in perspective. When we talk about surges, so often is the case, particularly as I read the headlines, is that people lead with case numbers. I want to remind people, California's equivalent population of 21 States combined in this country. So I think for California, and I would ask this for consideration. I don't have any great expectation, but just for consideration, when we do report in California, that it's a different level of reporting in the context of the size and scale of this state. Not only are we testing more and more people as is the case, now over 200 plus thousand people a day, we have to do a lot more, and I'm very cognizant that. Governor Gavin Newsom: (01:01:12) We should expect those case numbers to be high in a state this large. The positivity rate, again, is the number and this slide that I think is incredibly important to track. And you're absolutely correct and I appreciate the frame of your question. We have certainly seen an increase in the last number of weeks in not only the case rates, but also more importantly, perhaps the positivity rate. And that positivity rate, just in the last few weeks, 4.7 to 6.2 is disconcerting. We know that that will impact our healthcare system and the hospitals which we talked about. And we obviously recognize the impact that will have in terms of our ICUs. But I do want just to note that that 6.2% is not the highest this state has seen, but the projected rate of increase is at a level that we haven't seen. And so you're correct to refer to this as a surge, as of late. Now, all of that was a preamble, not an answer to your question. Governor Gavin Newsom: (01:02:16) You specifically asked why. Why have we experienced this increase as of late? And for that, I have very strong opinions, but they're primarily formed by my team and notably by Dr. Galley. Best to have Dr. Galley come back up and talk about the mixing we have seen, the broader fatigue as it relates to COVID fatigue, that's been well considered. But he can talk more specifically about the areas we are seeing an increase in transmission, be it our congregate facilities, be it at restaurants, be it simply perhaps, outstandingly, notably in households and in gatherings outside of our household as well. Doctor? Dr. Ghaly: (01:03:06) Yeah, I think really excellent question. One that we are answering constantly these days. And I will just start by saying that so many Californians continue to do the right things. They do have their guard up. It's easy to drop it and no one can blame you after months and months of messages about masking and physical distancing and staying at home, we get it. We know that it's hard, but those are the tools that are going to carry us through. Certainly some of this has to do with that COVID fatigue, that COVID resentment sometimes I like to call it. People just want to be done with this, but it doesn't take a break just because we're tired of it. And that's why we continue to support Californians with messages to add some of these additional supports that the governor mentioned today, and really with the hope of some of the news around vaccine, that our most vulnerable could be getting vaccinated. Dr. Ghaly: (01:04:04) Our frontline healthcare workers could be getting vaccinated in just a matter of weeks, opening the gateway to so many more receiving this important tool to protect us. The other fact is that people you see the map of the US and it's as though the weather's moving from the East to the West. COVID is moving in that direction. It had been sort of in the Eastern part of the Midwest now moving to the Western part of the Midwest, really knocking on California's door with a number of people returning from trips and travel. Hopefully they take the advisory on quarantining very seriously, and they protect themselves, their family and their communities. By doing that right thing that could help reduce transmission a bit, but we know that that travel and that mixing that's happening do drive transmission. And that's going to be an important piece of it. With the level of cases transmitting, this slide here, 34.5 cases per 100,000 people, I'll remind you that that's roughly four times higher than it was many weeks ago. Dr. Ghaly: (01:05:11) And that means that activities that people thought a month ago were safe and lower risk, today are higher risk. So part of this is we need to recalibrate for a short period of time, what we do to keep this transmission down. Protect those who could become sick and hospitalized and need that care. And frankly, to keep the death toll in California, as low as we can, given what we've seen in the past many months. And with that hope of the news of the vaccine, I think California can do it. But we are really in a different situation with transmission than we've ever faced before. And it is every activity a month ago, lower risk, this month, higher risk than ever before. Governor Gavin Newsom: (01:05:57) And just to note, and it's important and forgive me for not having noted it earlier. We've lost on average 59 people a day over the last seven days. We're starting to see the death rate begin to go back up, not significantly yet, though modestly. It was going down on a pretty consistent basis. It started to flatten and now we're starting to see those numbers go back up. This is exactly the trendline we most feared and one we most fear going forward. Speaker 1: (01:06:30) Brittany Johnson, KCRA. Brittany Johnson: (01:06:34) Hi, my name's Brittany Johnson. I'm with KCRA. Thank you for taking my questions here. I have two questions today. One about California testing data protocol and the question about self quarantining. On testing, is California going to wait for FDA approval before doing its own vaccine data testing? Or will the state start doing data on its own to speed up distribution? And then a question about self quarantining. People who traveled out of state being asked to self quarantine, especially over this Thanksgiving holiday. How can we be sure that people are taking it upon themselves to self quarantine? Is this on the honor system, or if there's some sort of watchdog group that's going to be out, making sure people are self quarantining and what exactly is self quarantining? Meaning if you are to self quarantine, how they do that, what is expected of you if you self quarantine? Governor Gavin Newsom: (01:07:27) I feel like I can answer the latter part of your question since it's precisely what I'm doing and why I'm talking to you from my home and not our state operation center, which is typical. But let me back up a little bit. Last week and I encourage you to the extent you could take a look at the presentation I made last week, as it relates to vaccines specifically. In that presentation, in that deck that we made public, we talked about the scientific safety committee that we have organized. It's purpose is basically a stamp of approval, not taking anyone's or for it, but also not necessarily trying to undermine any existing protocols and processes, particularly protocols and process that we've been directly engaged in for many, many months. I'll remind you and others that California was one of five jurisdictions doing micro planning with the federal government, with the CDC and the Department of Defense in terms of the vaccine distribution. Governor Gavin Newsom: (01:08:29) We created a scientific safety committee and we have two other states that joined us in a regional partnership to review the trials. Trials that have been already made public and submitted by the FDA. They reviewed two of those trials. We're waiting for the details of the third trial to come forward and quickly the Scientific Safety Review Committee, an 11 member body will review that data independently to certify it. It's all about building trust, and it's also about speed to determination. This is not intended to delay in any way, shape or form, the- Governor Gavin Newsom: (01:09:03) ...Termination. This is not intended to delay in any way, shape, or form the distribution, quite the contrary, of the vaccine. It's basically to support trust building and to provide a next set of eyes from some of the world's leading experts that just happen to reside here in the state of California. Governor Gavin Newsom: (01:09:17) As you also may have noted from the presentation that I provided just a few moments ago, and you can see in this slide that we put up, the California Vaccine Update, that we have another work group. This is the Drafting Guidelines Workgroup that will make the determination from an equity lens on how to prioritize the distribution of the vaccine. So you have the Safety Committee and you have the Guidelines Workgroup, and they are working with a community advisory body that meets today, that met on Friday. And those meetings are public, and I encourage you and others to tune in and learn more about these plans. Governor Gavin Newsom: (01:09:57) I noted that our Phase 1A Distribution, which is these 327,000 doses that we anticipate receiving within the next two weeks, that we will be providing allocation strategy and plan in a very public way later this week, pursuant to the commitments we made when we established the Guidelines Working Group and the Community Advisory Committee, and so that, you should anticipate, and I would encourage people to learn more by tuning in to their advisory meetings, again, that are public. Governor Gavin Newsom: (01:10:34) As it relates to additional comments about vaccines, Dr. Ghaly, why don't you jump in and perhaps amplify a little bit more fully the vaccination protocols, and then maybe talk a little bit about the guidelines that we have posted relating to self quarantine. And I'll just fill in some personal points as a point of privilege as someone now on day eight or nine of my own home quarantine. Dr. Ghaly: (01:11:03) Yeah, thanks. So just building upon what you said, Governor, with the vaccines, that Scientific Safety Committee is not doing its own trials or doing its own original work. They really are reviewing the same information that the FDA has, just from a California perspective. We wanted people who are familiar with California, who live across our state, who look like California and speak languages of California and can really endorse that this is something that is safe, that they would take themselves, they would ask their families to take, so that stamp of approval is strong and that Californians can benefit from that tool, with that bit of extra trust and trustworthiness that we intend to build up as we go along. Dr. Ghaly: (01:11:51) As the governor has said to me, the vaccine's implementation will happen at the speed of trust. And that is part of the reason why we have built a set of committees, a set of actions, and a set of communications with each of you so that we can build that trust, share our concerns, as well, because that is part of building trust, so that when those vaccines come, not just in the middle of December, but throughout the beginning of next year, that as we make them available, a number of individuals will avail themselves of it and have that additional tool to protect themselves and their community. Dr. Ghaly: (01:12:26) So that's coming. The governor laid out exactly the timeline. We're working really quickly and hard with so many Californians. And I'll just add my gratitude to them, who volunteered their time to make this a success. Those counties, those hospital systems that are getting prepared to administer first to frontline healthcare workers and then to others across the state. So not only do we build up a body of evidence and endorsement, but we really have the boots on the ground and the tools to do this, like no other state, so that everybody in California who's interested, who builds up a sense of this is for me, this will add to my ability to protect myself and my family, that it's available without haste to all of them. Dr. Ghaly: (01:13:15) As it goes to quarantine, Governor, you and I have talked a little bit about this because of your own experience and what you and your family are going through. And I'm grateful to all Californians who are coming back, if they did end up traveling, that they take this seriously, that they look at the quarantine guidance, really asking them to take the next two weeks, 14 days at home, not mixing beyond their household, not mixing beyond those they traveled with, so that we reduce the opportunities to have further transmission. It isn't easy, I'll acknowledge. I think the governor explains that these are challenging things to do, but we need all Californians to consider doing it and doing it completely. Dr. Ghaly: (01:14:01) So we don't do it part of the way. You've said it, Governor, we don't want to run the 90 yard dash when we've got to get to 100 yards in any aspect of this, and that goes together with quarantine. We are working hard, actually with our federal partners, to look at some of the quarantine guidance. And I know a number of articles in the national press have been looking at the timeframe for quarantine. And when we think that it's appropriate to update that, working with our CDC partners and experts, we will do that. But for now, it's 14 days recommended. No enforcement necessarily, no group that is going to be tracking whether you do or don't do it. You may call it the honor system. I call it Californians continuing to do the right thing as it relates to COVID, getting us through the next many weeks, not years more of this, not even necessarily the same intensity over many, many more months, but really as we move into this second half of our response, doing things that we know will protect our families and communities and ourselves as it relates to quarantine. Governor Gavin Newsom: (01:15:11) And we, I think, belabored this and I won't belabor you with my personal experience with this, except to say deep empathy and moral or deep respect, particularly for families, particularly for those that do not have any support, may not even have a spouse in terms of the work they have to do in that environment. And so I just want to extend a deep level of appreciation, increased level of understanding what we're asking people to do for this quarantine period. But I hope people understand the magnitude of this moment and why we are asking people to do that. And so I encourage folks that have come back from the holidays, come back from Thanksgiving week or weekend, to consider very, very seriously the moment we're in, the difficulty and challenges we will face as a state, as a nation, over the next few weeks, perhaps a few months, as we sprint with light, very bright light, at the end of the tunnel. Not a marathon, but a sprint to the vaccine. Speaker 2: (01:16:21) Sophia Bollag, Sacramento Bee. Sophia Bollag: (01:16:26) Hi, Governor. Early in the pandemic, you issued a number of executive orders related to the state's healthcare workforce. And as Dr. Ghaly mentioned just a little bit ago, those workers are becoming overwhelmed and exhausted, and I'm wondering if there are any executive orders or other types of actions that you are considering or can take, related to our healthcare workforce, like if you're considering suspending any rules relating to stocking ratios or anything like that, to help healthcare workers meet the surge. Governor Gavin Newsom: (01:17:02) Yeah. I appreciate the question. It's a good question. And a lot of the hospitals have been requesting one-off. I think there's, Dr. Ghaly, close to 200 hospitals with waivers. And so those waiver processes are well-established, as it relates to providing care for caregivers. We also have new rules and regulations relating to testing that just went into effect, to provide additional support and comfort to the critical workforce, in addition to all the other supports that we had advanced, either through executive order or through philanthropy. We talked a lot about, last week, the philanthropic supports that have been made in the last year in this state. A particular number of them were supporting those critical workers, providing for relief, providing specific funds for emergencies, so people had the ability to take care of their loved ones with actual debit cards that were provided for skilled nursing and residential care workers. Governor Gavin Newsom: (01:18:02) We provided hotel rooms, so people didn't feel they had to go back home and potentially expose their loved ones, or didn't have to sleep in their car, as was the case. The paid sick leave that we provided statewide, which was a codification of a strategy we advanced through an executive order that was done with the concurrence and leadership of the California legislature, all part and parcel of some of the strategies and efforts to support this critical workforce. But you're absolutely right, and I cannot underscore the significance of your question in terms of the stress and pressure these frontline workers have been under, and now are asked to endure still more over this next few months, and how sensitive we all are to that and how deeply well, how we recognize the deep responsibility they have and the deep emotional stress that's placed on not only them, but their loved ones. Governor Gavin Newsom: (01:19:01) Dr. Ghaly, I know this is an area of obvious concern for you, and you are in constant contact with our hospital association, not only those representing the workers, in order to find some common ground here. And we are looking at those staffing issues and we continue to process and pursue waivers as appropriate, but perhaps you can fill in the blanks to more specific examples that you anticipate us taking over the next few weeks. Dr. Ghaly: (01:19:32) Yeah. Thanks, Governor, and Sophia, thank you for the thoughtful and important question to lift up just the reality on the ground that so many people are facing. And when I talk to the California Medical Association members and fellow physicians, or SEIU, or California Nurses Association, and learn what the conditions feel like on the ground for members, you know, we're in this together is really the big message, and different groups need different things. Our hospital partners through the California Hospital Association, speaking to some of those big systems, you talk about permission around staffing ratios and waivers, and a number of hospitals already have asked for those, working under those waivers because they can't find the staff as we found in the summer and the spring to cover shifts. We need to make sure that all of the things that the governor mentioned, that many are available today, that those continue to be used effectively to support individuals, so we can keep doing the good job that we have. Dr. Ghaly: (01:20:33) Specifically as it relates to some of the staffing ratio questions, we're in active conversations with a number of people to make sure in the fall, sorry, in the spring and summer, we didn't know as much about what our situation was going to be like. We certainly put into action things immediately to make sure we were prepared. Today, in a more balanced way, we're having those conversations, making sure that we continue to move forward with strong staffing provisions, while also recognizing the pressures that people are under when a number of COVID positive patients come in through the emergency room overnight or over the course of weeks, to make sure that they have that staffing. So we'll be making some important announcements in this space, posting some additional guidance, so hospitals know how to act, that they have the support and the protection they need to care for patients, and that staff have the support that they need. The governor mentioned some provisions put out last week around staff testing, but these things all go hand in hand as a package of things to support us to do what we need to do. Dr. Ghaly: (01:21:45) All of that said, this does not diminish the ongoing need for us as community members and as individuals in California to do our part to make sure transmission is reduced as far as possible, so those frontline workers, those systems that are there to care for you for COVID and beyond, heart attacks, strokes, et cetera, that it's available and they can do the best job that they can. So all of those provisions that you mentioned, Sophia, can only really make the difference if we continue to push that front end work, those non-pharmaceutical interventions, those things that we know can keep transmission low across the state. Speaker 2: (01:22:28) Final question, Elex Michaelson, Fox 11. Elex Michaelson: (01:22:34) Thank you, Governor. I'm wondering, a return to a potential stay at home order, what we've learned since March and April that may be able to be applied now, things that might not need to have the same sort of restrictions as before, things that might need more restrictions. What are some of the key lessons you've learned in the interim that might change and modify what may be restricted in the next few weeks? Governor Gavin Newsom: (01:22:59) I really appreciate that question, because it's exactly the question we're asking everybody, not just ourselves, and really working with industry, working by sector, working specifically with our health teams to look at the data and let the data guide that, not emotion, not past practices, but really get a sense of what's driving any of those decisions. And that's exactly what we've been doing candidly for almost the last full week from a day or two prior to Thanksgiving, when we started to have these conversations with local health officers and really looking at what's working, what's not, including with some of our federal partners. Governor Gavin Newsom: (01:23:44) So we are trying to be much more specific, more surgical, to use a frame, a medical frame term, and more prescriptive in terms of looking at the efficacy and looking at where the data leads us, and making those determinations sector by sector, and looking county by county, region by region, as well. Dr. Ghaly, I know we have some very contemporary conversations, just moments before we got on air today, on this very topic, not least of which over the weekend with local health officers. Perhaps you can talk a little bit more about some of those, maybe some things that you're willing and ready to socialize, maybe specific examples of lessons learned, so we may not need to do as much in terms of being blunt with the stay at home, and more surgical. Dr. Ghaly: (01:24:36) Yeah. Thanks, Governor. And you highlighted so many of the things that we've been talking about, and not just on our own team, but experts across the nation, trying to learn from lessons that others have had the opportunity to learn, and then our local partners about what they're seeing and what they're doing themselves, really working together as one California on this. I would say a couple of high level things first. Everybody wants us to identify the sector where spread is happening. And the truth is, when you have this level of community spread, it's happening in our communities first and foremost. So the minute you walk in the door of any entity indoors, the chance of encountering someone with COVID who can actually transmit it is higher than it's ever been. And we know indoors is the kind of scenario where COVID does transmit and pretty easily. Dr. Ghaly: (01:25:28) When you take down your mask, when you close that distance between you and others who aren't in your household, all of those things that we've been talking about for months are only amplified today because of the level of transmission. So although people want us to identify the sector or the sectors where we see transmission the most, the truth is right now, it's just all around our communities, and everyone is somewhat vulnerable to having an encounter with somebody who's infected. They themselves may be asymptomatic and/or pre-symptomatic and could transmit it to others. So there's this broad sense that it's really community transmission, which is our number one focus at the moment. Secondly... Governor Gavin Newsom: (01:26:13) Oh, sorry, doctor. Dr. Ghaly: (01:26:14) Sorry, just two last things, Governor. The second thing is just general mixing, right? We know that with some of the stay at home are really changing how we move and mix, that that can make a pretty big difference and pretty quickly. So that's the last thing, that one of the most important things we've learned is we can be not just more surgical with what we do, but we can really prescribe it for a shorter or a different amount of time. Early on, some of those orders really were open-ended. We weren't sure. Today we know that we can get impact from certain interventions in a reliable way more quickly, and that's part of what we're considering. So all of that's going to be built in, and I'll leave it at that, because I know we have more conversations to have and certainly a number of other data points to look at. Governor Gavin Newsom: (01:27:04) Yeah. I think that the point you just made, Dr. Ghaly, is so important. It's time to implementation and the socialization of these strategies, meaning the marketing and support around them, to make sure that the public understands them, the businesses and the sectors that are impacted by these restrictions understand them, that we are monitoring the level of connection, association with the rules, so that they're meaningful. So time, and then the issue of indoor versus outdoor. That's just fundamental. Of course, that's not particularly novel, new. That's pretty self-evident to anyone that's been paying attention. But more activity outdoor. The challenge now, as Dr. Ghaly says, it gets colder and colder, the more difficult it is to maintain the level of activities that we've experienced outdoors, as more and more pressure's now being placed on people coming back indoors. Governor Gavin Newsom: (01:27:59) Nonetheless, let's just end, not only the response to your question, but end this presentation, except to say this, we'll be seeing a lot more of you all this week. This is a dynamic week. This is an incredibly important week in the history of this pandemic for this nation, not just this state, and I can assure you that we will be coming out with some additional information, some additional recommendations in the very, very near future. We look forward to taking more questions. We look forward to being more responsive, and we look forward to being more ubiquitous in the coming days. Take care, everybody, and thank you very much for tuning in.