Gavin Newsom California Briefing Transcript April 14: Unveils Plan to Reopen State

Governor Gavin Newsom: (02:43) We've gone through a series of what I would refer to as pandemic response shifts since we started this journey together late January. The first strategy as a part of our strategy of containment began when we started to repatriate those first flights coming from mainland China from Wuhan and elsewhere. Governor Gavin Newsom: (03:06) The second phase was the mitigation phase, adopting strategies as we saw the first case of community spread, to advance stay-at-home orders for our seniors, to begin the process of closing down our schools, population-based strategies to mitigate spread that included at scale a statewide stay-at- home order and then the efforts to continue to practice physical distancing. Governor Gavin Newsom: (03:35) We then started to move into the third phase. A phase that could broadly be described as the phase of surging, surging our system, not only our hospital system but our alternative care system to meet a potential demand that required not only physical assets rooms but also people and protective gear, ventilators, masks, gowns, coveralls, and the like. Governor Gavin Newsom: (04:03) The next phase, the phase that I want to speak to all of you today about, is a phase a that I would frame as an optimistic phrase, that we move from surge and we begin to transition into suppression, ultimately on our way to herd immunity and ultimately to a vaccine. But in this transition where we do see light at the end of the tunnel, where there is a ray of optimism and hopefulness that this too shall pass, it's also perhaps the most difficult and challenging phase of all. And that's to say a lot because the last few weeks and months have been very challenging for all of us indeed. But this phase is one where science, where public health, not politics, must be the guide, where we must be open to argument interested in evidence, where we cannot be ideological in any way, shape or form in terms of how we approach a condition that changes on an hourly and daily basis, conditions that will ultimately determine what better decisions we make in terms of that transition. Governor Gavin Newsom: (05:15) Today we want to create a framework and pass forward a process that we've been having and that we've been engaged in for the last few weeks and basically pull back the curtain on those private conversations and make them public so you'll get a sense of the questions we're asking and the questions we need answered before we ultimately can move out of a population approach where we are asking everybody to stay at home to a more individual approach to addressing the issues of suppression in the state of California and ultimately get us back to that sense of normalcy that I know everybody watching so desperately looks forward to. We have a parameter and we have a framework that will guide our decision making, and we'll make that very public in just a moment when I asked Dr. Angell to come up and avail ourselves, of course, to questions not only from Dr. Angell but from Dr. Ghaly and others that are present here today. But the framework is predicated on the ability to do six things. Governor Gavin Newsom: (06:22) The most important framework is our capacity to expand our testing, to appropriately address the tracing and tracking of individuals, the isolation and the quarantine of individuals using technology and using a workforce that needs to be trained and an infrastructure that needs to be in place in order to begin the process to transition. I'll talk more about that and will be more prescriptive in terms of what that looks like. Governor Gavin Newsom: (06:55) The second phase is maintaining our vigilant, on protecting the most vulnerable populations in the state of California from infection and spread, primarily our seniors those with immune order issues and specific strategies and interventions around addressing the needs of our homeless as examples of addressing those vulnerable populations as a top priority. Governor Gavin Newsom: (07:22) Number three is addressing, again, the ongoing needs of our hospital and alternative care delivery system to meet the needs of potential surges as we adopt new strategies, as we loosen the stay-at-home orders ultimately and eventually the prospect of increase infections and spreads. We need to make sure that that infrastructure is protected and to make sure that those assets are well prepared, PPE, not just again, the masks and ventilators and gowns and shields, but also making sure that we have a myriad of other protective gear for that workforce and to make sure that we're capable from an ICU perspective and hospitalization perspective to meet any additional searches. Governor Gavin Newsom: (08:10) The fourth frame is to continue the work that we've been doing on a weekly basis and that is to engage academia, to engage our research partners, to engage those that are on the front lines. They happen disproportionately to be here in California, companies like Gilead, companies like Genentech, credible operations of support that are coming from our hospital systems, the UCs, Stanford, USC Scripps and others, including our national labs, to make sure that we're really advancing and continuing to promote more protocols on therapeutics, which are profoundly important as we bridge ultimately towards the herd immunity and a vaccine within, we hope, the next year or so. Governor Gavin Newsom: (08:59) Number five is the incredible importance of redrawing our floor plans and that is quite literally a responsibility if we are moving into a next phase of our businesses so that we can practice safe, physical distancing within the premise of a business within and around a school site and facilities large and small, public and private all throughout the state of California. Quite literal strategies, guidelines and expectations on what physical distancing would look like within those facilities, not just broadly out on the streets, our parks, playgrounds and in our coastlines. Governor Gavin Newsom: (09:43) Finally, our capacity always to turn on that faucet again and reinstate more vigorous controls, and that's just a process that will perhaps be the most challenging if indeed we lean in, but we have to then lean back out as we toggle from stricter to looser interventions, back and forth as things change, as data comes in, as health concerns make themselves real in terms of that data or at least more obvious our capacity to pull you back in and to encourage people to advance the social distancing, the stay-at-home and physical distancing that has gotten us to this point today. Governor Gavin Newsom: (10:30) That's the framework. Those are the six frames of focus that we will monitor and that we will process as we make the determination through this process of architecting a next phase in this pandemic that we will be processing at least making more public here today. Governor Gavin Newsom: (10:52) With that, I want to ask Dr. Angell now to come up. She'll walk through a number of those steps and we'll try to answer and anticipate as many of your questions as we can in the outset. I'll come back up. I'll talk a little bit more about what normal may look like, because normal is anything but. I'll be honest and sober about that as it relates to that bridge ultimately towards the vaccine. Governor Gavin Newsom: (11:18) I'll just end before I ask the doctor by making this point, I recognize what you recognize, two things, that you individuals through the extraordinary behavior, millions of you, because you have practice physical distancing, the stay-at-home orders, you have bent the curve in the state of California. The models have changed because of your behavior and that puts us in a position to be able to socialize again, to make public these private conversations we've been having about this next phase. But number two, we do so soberly because today we had a record number of deaths that we are reporting 758 individual stories, families and lives torn apart. 71 individuals that lost their lives just since the last reporting that I gave you yesterday. We are sober about the fact we're still seeing an increase, modest though it may be, in hospitalizations but also the total number of individuals tested, that we are not out of the woods yet. We are not spiking the ball. But we also extend a recognition in that light that this can't be a permanent state. I want you to know it's not. It will not be a permanent state. Governor Gavin Newsom: (12:35) We recognize the consequences of the stay-at-home orders have a profound impact on the economy, your personal household budget, your personal prospects around your future. If you've just lost a job or you lost wages or you're struggling with your dream and that is to keep your dream afloat as a business person that may have put everything on the line and you were talking about the next five to ten years on that journey and how vulnerable because of the stay-at-home orders are those dreams are to this new reality. We recognize that the stay-at-home orders impact all of us differently, certainly impacts those of low income differently than people with means. It impacts communities differently depending on the resources within those communities and the capacity for community members to all come together and help support one another. It's limited in certain parts of our state and of course the impact to the healthcare system. Governor Gavin Newsom: (13:36) They've done such a magnificent job, not just anticipating a surge but decompressing their own system, creating slack, and that's had a profound economic consequence on our healthcare delivery system. Not just the hospitals but primary care physicians, surgical operations, community clinics and alike. If this were the new normal, those systems would be devastated in a way that would be difficult even if there's a strong V-shaped recovery to recover any time soon. It could actually create more health problems down the road as we continue to delay elected surgeries that no longer become elected surgeries or we're not doing our checkups and preventative work that ultimately become acute-care issues. Governor Gavin Newsom: (14:21) Again, all of these things we recognize require us to begin to at least make public our thinking as we transition from surge to suppression and ultimately bridging towards herd immunity and immunizations and so with that are vaccines. We look forward now to the presentation of Dr. Angell, and then, of course, all your questions. Dr. Sonia Angell: (14:49) Thank you, Governor. I'd like to start first, as we embark on this conversation about modifying where we are now, about a roadmap to modifying our stay-at-home orders, by first taking a look at where we've been, particularly with respect to our planning to date. Dr. Sonia Angell: (15:05) As we've discussed, Dr. Ghaly shared this with you this past week, our focus has really been on making sure that our care-delivery system is secure so that it's there if we need it, particularly in a time of surge. As we look at this side, so across the horizontal here is time and this is the number of hospitalizations. You'll see that, first of all, we had anticipated through forecasting that with no modifications, with no interventions, indeed our surge capacity would go far beyond what we could manage and cause excessive deaths. We have over time and because of all of you in California, because of people staying home, we've really started to, so to speak, "Bend the curve." Dr. Sonia Angell: (15:47) This line here shows where we would go if we had continued with our current interventions staying at home. You'll see that not only are we following that line, in fact, with respect to hospitalizations, we're doing even better. But that doesn't mean that we can just let- Dr. Angel: (16:03) ... we're doing even better. But that doesn't mean that we can just let open and send everybody back into the streets and resume life the way we were, because, indeed, if we remove all of our interventions, we again will expect this surge. The opportunity now, at this moment, is to talk about how we can modify, modify our existing orders in ways that makes it easier for all of us, but also continues to protect the health of Californians. Dr. Angel: (16:26) So our goals moving forward, as outlined by the governor, until we build immunity and can know that we're safe from COVID-19 in our communities, our actions will align to achieve the following. First of all, we need to ensure that we have the ability to care for the sick within our hospitals. This is something that we've worked hard for. We're confident that we're moving in that direction now, but we also have to be very thoughtful, because, as we change interventions, as we make it possible for people to move around more freely, we do know that infections could increase. Indeed, there may be more demands on our hospitals. So it is essential that we ensure our ability to care for the sick as we think and before we move rapidly along changes. Dr. Angel: (17:09) Secondly, a very important goal of ours is to prevent infection in people who are at high risk for severe disease. As you know, to date, everything that we've done has been to make sure that we can protect those who are most vulnerable from being exposed. That includes elderly in California, helping them stay at home safely, and particularly those who may be in congregate settings, helping to protect those settings, and also those who are homeless and incarcerated and in other places where we know that, should the infection go, we need to be ready to respond. Therefore, as we think about modifying our interventions, we are still razor-sharp on this population and making sure that we protect their health. Dr. Angel: (17:50) Another goal in our actions as we move forward is to make sure that we build the capacity to protect the health and wellbeing of the general public in California. I'll go more into detail on that in just a bit, but as the governor spoke to special ways that we can think about increasing, enhancing the current contact tracing that we do to make sure that we identify people who may be sick or may have been exposed and make sure that we help them, support them in a place where they prevent the infection from spreading further. That is another essential area as we think about this work, because we know that protects all Californians. Dr. Angel: (18:28) Then, finally, we need to be clear that the actions that we do move forward and helping to reduce the social, emotional and economic disruptions that we know many of us are experiencing right now as a result of the stay-at-home orders. This is because we know particularly that where we are now, while exceedingly important, and it's why we are on this curve and why we have the luxury of being thoughtful about modifications, where we are now with the stay-at-home orders, they simply can't be sustained. They're very difficult to sustain for a long period of time. We know that they have an impact on the economy, we know that they have an impact on poverty, and we know that they have an impact on our healthcare. Dr. Angel: (19:10) Ultimately, as we think about changing modifications, we need to consider not only the direct impact that COVID-19 has on our health and wellbeing, but also realizing that, as we change modifications, we need to make sure that all of those other areas that impact health, like poverty, like accessing care, all of those other areas are addressed, too, so that we improve the overall health and wellbeing of Californians. Dr. Angel: (19:37) So I'm now going to talk with you about the six indicators for modifying a stay-at-home order here in California. To be very clear, this is not simply about a set of indicators where we check and we move on. This is not about a turnoff and a turnoff. This is a thoughtful process about how we modify our policies so that, ultimately, we protect the health of Californians, and I'll share with you now how we're thinking about each one of those indicators, which we'll be assessing over time and which we're working hard to make sure that we have all of the provisions in place that are necessary to make people healthy. Dr. Angel: (20:12) So, first of all, the first indicator that we're looking at is the ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed. A couple of the key questions we'll be asking ourself is, for example, "How prepared is our state to test everyone who is symptomatic?" This doesn't mean that we can't take action before we have entire testings available for everybody across every place in the state, but is something that is essential for us to understand as we think about what kind of modifications are appropriate. Dr. Angel: (20:46) Another example is do we have the ability to identify contacts of those who are positive to reduce further transmission? Again, this is talking about how we are able to contain the further spread of infection when we identify it in the community, as soon as we identify it in the community, and this will be essential and important as we think about creating more opportunities for movement in the community, more opportunities for infection, and, unfortunately, also more opportunities for potential movement of COVID-19. Dr. Angel: (21:16) Number two, the ability to prevent infection in people who are at risk for severe COVID-19. A couple of the key questions we'll be asking ourselves and assessing carefully in our decisions around this include are older Californians and the medically vulnerable living in their own homes supported so that they can continue appropriate physical distancing? Across the state, we have over six million older adults who are either isolating in their home or may be in congregate setting, and every one of them deserves the support they need to be able to stay safe in their own home. We're thinking carefully about how we, together, working with the state and counties have the ability to make sure that we assure that these older adults in their homes or who are medically at risk are kept safe as we move forward and think about modifications. Dr. Angel: (22:04) Have we developed a plan to quickly identify and contain outbreaks in facilities older Californians, those living with disabilities, and those currently incarcerated, and those with comorbidities? Specifically, again, this is congregate settings where we know people are living. We've done a lot to put programs in place that help identify when there are outbreaks, that help provide resources immediately to those settings, and also address some of the very difficult staffing questions. But there is more work to do, and, over the coming weeks, we'll be focusing heavily on that to make sure that, as we lift, again, and make it available for people to move, that that doesn't put these populations at greater risk. Dr. Angel: (22:44) The ability of the hospital health systems to handle surges. As I mentioned, as we start to loosen up, there is the possibility for more movement of COVID-19, and we need to make sure that our hospitals are prepared for that. Some of the key questions we'll be asking ourselves include do we have adequate bed capacity, staff, and supplies, such as ventilators and masks? Over the past few weeks, you've heard again and again all of the hard work we've been doing across the state, both locally but particularly here at the state, for procuring increased masks and making sure that we have the number of ventilators we need to make sure that, if we rely on our care delivery system and if we need those ventilators, they are available to us. We've made great progress. We will continue to watch this, however, because this is a very important area as we think about how we modify our interventions. Can our healthcare system adequately address COVID-19 and other critical healthcare needs? This reminds us once again that, while our care delivery system is very well-situated at this moment to deal with the amount of cases that we are seeing, it hasn't been necessarily providing the kind of care that we do for our regular healthcare maintenance over the time, because much of that excess capacity has been developed by canceling elective surgeries, for example, or putting off or postponing things that aren't so immediate. We need to move back into a space where we can make sure that people's healthcare needs are regularly met effectively, as we think about titrating off some of these interventions. Dr. Angel: (24:12) Number four, the ability to develop therapeutics to meet the demand. We feel like this is an important place for California, of all states in particular, to be engaged in this, because there is so much innovation and advancements in our medical community here in California, so we have a unique opportunity to collaborate and make sure that these therapeutics continue to evolve. They're important, especially in the absence of vaccines, because they allow people, if they do get sick, to recover more quickly and also not to end up in our care delivery system and put more pressure on our care delivery system. This is an opportunity to save lives for individuals and make it safer for our community at large. Dr. Angel: (24:52) So some of the key questions and activities we'll be engaged in include have we built a coalition of private, public, and academic partners to accelerate the development of therapeutics, and have we identified potential therapeutics that have shown promise? We're already on our path here. We'll continue to do work here, and we'll continue to watch it as we assess changes. Dr. Angel: (25:11) The ability for businesses, schools and childcare facilities to support physical distancing. Some of the key questions as we think about enhancing this include have we worked with businesses to support physical distancing practices and introduced guidelines to provide health checks when employees or the general public enter the premises? These are opportunities to think about how are we shaping the physical environment, as we go out into those different places, from businesses to our school environment? How have we shaped it? So we've basically engineered in the opportunity to stay six feet apart. That means we can spend less time trying to avoid bumping into one another, trying to avoid potentially exposing one another to COVID-19, and more time focusing on getting our work done and going about our daily business. Dr. Angel: (25:57) Also, do we have supplies and equipment to keep the workforce and customers safe? These are areas that we'll continue to explore, particularly as we are more established in the resources that we need for the care delivery environment and to protect our frontline workers. These are opportunities that we have to shift in the future to focus more on these areas, to make sure that others can be safe in other places as well and that those resources can be broader as we begin to spend less time in the home. Dr. Angel: (26:25) The ability to determine when to re-institute certain measures, such as the stay- at-home orders, if necessary. This is the last, but an incredibly critical indicator for us. Some of the key questions that we'll be talking about: Are we tracking the right data to provide us an early warning system, and do we have the ability to quickly communicate the need to reinstate these measures? We need to have a clear process in place so that we understand not only when we're making great progress, but also when we need to take a step back, think about the interventions we have, modify them, and perhaps even institute broader recommendations once again. This will be an important point to moving forward in a way that's sustainable for California. Dr. Angel: (27:09) I just want to end noting that, as the governor had mentioned in his opening remarks, this is a conversation about modifying, about modifying, about transitioning from where we are now to a point in the future when COVID-19 no longer poses a threat to our population. That time period, this time period that we're entering, is not about going back to where we were before. It's about going forward in ways that are healthy for all of us, but it won't look the same. Different ways that we will think about the way we do our everyday work will mean that we'll be making changes. Dr. Angel: (27:44) So, for example, restaurants will be likely to reopen, but perhaps they'll have fewer tables, creating greater opportunity for physical distancing between one another when we're eating out, protecting one another as we spend more time in places like we used to enjoy. Dr. Angel: (27:59) Face coverings will likely become common in public. We've talked a lot about face coverings. Some areas are using them and have had much stronger recommendations about using them. But as we spend more time in the public, it becomes even more important that we use all of the different interventions that we have as added value. Face coverings are not a replacement for physical distancing, but they can add protection, and we'll think about that more broadly as more of us go into the public. Dr. Angel: (28:28) Then, finally, just recognizing that this will bring new opportunities. They'll be likely to arise that will help support our mitigation efforts. This includes things, as just discussed by the governor, like creating interventions that can help us improve effectively contact tracing in our communities and supporting individuals who then might need to be separated for some time, because they either have infection or they've been exposed. Programs like that will create new opportunities for work and will create new opportunities as we move into this new stage. So with that, I'll turn it back over to the governor. Thank you. Governor Gavin Newsom: (29:08) Thank you, Dr. Angel. So the question everyone has on their minds is when are we going to see some of these stay-at-home orders lifted? You just saw a framework for a process that will guide our decision-making, but that decision-making is predicated, again, on our ability to answer all of those questions in the appropriate manner, affirmatively in some cases, but also to adopt a protocol where those questions need to be asked and answered of others all throughout the state of California, because, at the end of the day, I've said this before, localism is determinative. We have a state vision, but it will be realized at the local level. Local governments, local counties, local health directors will have a profound and outsized influence on our capacity to deliver on this next iteration, in terms of our planning. Governor Gavin Newsom: (30:04) Let me thank those county health directors for helping us guide our decision tree, the one we just made public today. Let me also extend just ongoing appreciation for the governors of Washington State and Oregon for their guidance and support and collaboration through this process, also other Western state governors that are also likely to join on this broader regional protocol to go together so that we get this right. Governor Gavin Newsom: (30:33) But, as Dr. Angel said, this is incredibly important, there is no light switch here. I would argue it's more like a dimmer, and that dimmer is about what I was talking about, this toggling back and forth between more restrictive and less restrictive measures, more individual accountability, more individual responsibility, as it relates to face coverings, as it relates to practicing physical distancing, more individual responsibility if you've been exposed to the virus, that we isolate you and that we trace those that also may have been exposed, quarantine those that have tested positive, more enforcement along those lines. Governor Gavin Newsom: (31:17) As we, again, move toward blending population-based solutions and incorporate individual-based solutions, it becomes incumbent upon all of us to increase our vigilance and our capacity to align in our strategies. Look. We got to this point where we did not, at least at the moment, manifest the worst case as it relates to the surge, because you all did it together. We moved not just quickly, but we moved thoughtfully as a state, 40 million strong. As we began to transition out of this, it's incumbent we take that same spirit of collaboration, cooperation, that guiding spirit of unity and common ... Governor Gavin Newsom: (32:03) ... cooperation. That guiding spirit of unity and commonwealth as we process into this next phase. But as I said, this is an imperfect science. There's no playbook that someone else has put together. There are examples from around the world. We are incorporating those best practices and those considerations and that last slide was a perfect example of that. We talk about what the new normal will look like. As I said, normal, it will not be, at least until we have herd immunity and we have a vaccine because as someone like yourself that looks forward to going back out and having dinner, as the doctor said, you may be having dinner with a waiter wearing gloves, maybe a face mask, a dinner where the menu is disposable, where the tables, half of the tables in that restaurant no longer appear, where your temperature is checked before you walk in to the establishment. Governor Gavin Newsom: (33:03) These are likely scenarios as we begin to process the next phase and next iteration for businesses. The same opportunity and responsibility resides to allow for their employees to practice a safe physical distancing, which means they have to redesign those businesses. Retailers have to redesign their protocols, processes, and procedures. You saw on that list, it also develops opportunities because we have a chance and Lincoln once said to think anew, and act anew, and to find new approaches, new strategies to get things done. More teleworking, more distance learning. Governor Gavin Newsom: (33:46) And speaking of learning, we want to get our kids back into school. That's why you saw that on the slide. We are committed to doing that. This school year for all intents and purposes, again is over, but as we look forward through the summer and into the fall, already beginning those conversations in detail with the superintendent, public education and others, what physically do those schools look like? Can you stagger the times that our students come in so you can propriate yourself differently within the existing physical environment by reducing physical contact if possible, reducing the congregate meal dressing issues related to PE and recess. Those are the kinds of things, those are kind of conversations we're all going to be having over the course of the next number of weeks and the next number of months. Governor Gavin Newsom: (34:39) Let me now anchor those conversations so you can understand them a little bit more formally. We intend to have those conversations with you publicly on a weekly basis. We have teams assembled in each of these six categories that are working to answer the questions Dr Angel posed and to ask and answer questions that we did not present here today, so that we can work through all of these things in real time. Governor Gavin Newsom: (35:06) The answer to the rhetorical question I opened with just a moment ago, when do we think we can start to experience a loosening of the stay at home order is predicated on two things. Continue to hold the line on our stay at home orders today, continue to practice physical distancing so that we could continue to see this curve bend. We want to see hospitalization numbers flatten and start to decline and we want to see ICU numbers flatten and start to decline. If we see that over the course of a few weeks and commensurate with that, we build this infrastructure that is required that we laid out in those six key categories, if we build that workforce to help us with tracing. Governor Gavin Newsom: (35:54) And by the way, we have an initiative called check-in, which is doing just that using technology and all of the apps, I'll say this about California, I love our state. It's so abundant when it comes to technology. The only challenges in that abundance is so much choice as it relates to who has the best app and the best technology. And so we are vetting all of these different apps, all these new technologies, all the announcements that you've heard publicly from companies like Google and Apple, and we're trying to figure out exactly what we believe is the best app for California, but we have to supplement that technology with the workforce and the check-in workforce we are training, it will be thousands of individuals working with AmeriCorps, working with Cal Volunteers. Thank you Josh Friday for your outstanding leadership, finding a volunteer corps and looking to reprioritize existing state staff that are willing to commit to tracing efforts. We're working with Julie Sue and our Department of Labor all in partnership as part of this check-in core that ultimately it will provide for thousands and thousands, tens, hundreds of thousands of points of contact in terms of our tracing capacity. Governor Gavin Newsom: (37:07) And I just want to say this, for those that think, that sounds challenging, it is, and it's not. We have tracing in the state of California because of the scale of our healthcare delivery system that predates this current crisis. We've done it on TB, we've done it on measles, we did it for Ebola. We did tracking when those first flights came in from mainland China. Tens of thousands of people were tracked appropriately and knowingly were tracked when they came in off commercial flights, not just those repatriated flights so that our health systems were aware of their movements and we're monitoring their health. So we have an infrastructure, a foundation that's already in place, and now we're just amplifying that and we're building that and I'm very pleased that's already underway. So again, that's part of the infrastructure that's required. So not just trend lines that go down that become headlines of good news, but an infrastructure to support a loosening of the stay at home orders in a precise and targeted, and gradual way, where we're using data, using science, using real examples on a daily basis to iterate and again to toggle that dimmer so we get exactly the appropriate lighting so that we can ultimately transition to herd immunity and that vaccine, and then get this economy roaring again. Governor Gavin Newsom: (38:39) Let me just speak to that without just being pollyannish and we're not just blithely being a cheerleader. We are, this week, going to announce our new economic team. We have some remarkable leaders that are already working with us very collaboratively. We'll make public that team, that task force, and you'll hear more about every sector of our economy, how we're looking to jumpstart it when we are in a position where we can expand the definition of essential and we can expand our capacity to, again, scale down this stay at home order. Governor Gavin Newsom: (39:22) And so that's broad strokes what we wanted to communicate with you here today. That's the framework. I know there's going to be dozens of questions more specific. Tell us exactly when. Let me just answer that question. In two weeks, if we see a continued decline, not just flattening but a decline in hospitalizations and ICUs, and we see this workforce and the infrastructure and PPE needs met as we anticipate around May, first week in May to start seeing the benefits and fruits of that, ask me the question then and we will be in a very different place where we can be more prescriptive on giving people timelines. I know you want the timeline, but we can't get ahead of ourselves and dream of regretting. Let's not make the mistake of pulling the plug too early as much as we all want to. I don't want to make a political decision that puts people's lives at risk and puts the economy at even more risk by extending the period of time before we can ultimately transition and get people moving again. Governor Gavin Newsom: (40:32) So that's the sober reality, but it's also a reality that I think provides a little bit of light and a little bit of optimism that this is not a permanent state. And we're finally seeing some ray of sunshine on the horizon and I just wanted to share that with you and let you know that. Governor Gavin Newsom: (40:51) And let me just briefly before we open up to questions, just further that by letting you know that the total number of ICU bed yesterday actually declined modestly. And when I say modest, by 0.1%, but 1,177 individuals in our ICU. We saw a modest increase of 3.6% in our hospitalization numbers. But again, those ICU numbers, those hospitalization numbers, are the ones I look at every single morning and they guide so many of the decisions that we make on a daily basis. Governor Gavin Newsom: (41:28) But there was another subset of that I want to just share before we turn it over to questions. And that was the number of PUIs. If you have followed these press conferences, you may vaguely recall what a PUI is. That's a person under investigation. We're also seeing the number of people under investigation, hospitalized and in the ICUs, also start to come down. So it's a combination, the blend of all of those factors. That's encouraging, but for one reason, because you practice social distancing, you are practicing physical distancing, and you're abiding by the stay at home order. Governor Gavin Newsom: (42:04) If you take from this presentation that all of a sudden that should be lifted, I promise you, tragically, I will be back and we will be expressing a very different message. So again, please it's accumbent upon all of us to continue to do the incredible work that you've done. I peril that we pull the trigger and pull the plug too early and no we won't do that. To the extent we're guided by these principles and we truly hold the line and makes sure the principles advance this call and cause. Again, not politics. Governor Gavin Newsom: (42:41) With that, happy to answer any questions. Speaker 1: (42:44) Jeremy White, Politico. Jeremy White: (42:48) I'm curious to know how this was going to play out in terms of the interplay between the state and public health authorities. Given that the virus is playing out differently in different communities as you referenced, are there going to be these statewide guidelines then disseminated to county health officers who will make the decisions themselves? Is the state going to have a prescriptive role given that you have a sort of bird's eye view of where the outbreak is worse or better? How is that interplay going away? Governor Gavin Newsom: (43:13) All right. Jeremy, that's an outstanding question and that's why I said localism is determinative. At the end of the day, we recognize in California, and forgive me, this nation state frame which I've used for years, it's taken on a life of its own, but because the scale and scope of California, because of the geographic distances, because the rural and urban construct, because of density of population and also density of spread being so distinct and unique in different parts of the state, yes, we'll be guided by local decision making, but there'll be baseline recommendations and guidance that'll come out that will create the foundation and the floor of expectation. And then we'll continue to work with these extraordinary leaders, just extraordinary leaders, these local health officials to help us guide more prescriptive strategies that are tailored to their unique needs and expectations. Speaker 1: (44:13) Doug Sovern, KCBS. Doug Sovern: (44:15) Hi governor. A couple of questions. Obviously quite a few, but two in particular. One is, why now? I mean given that we're at least two weeks from me even being able to ask you about a timeline and these six steps could take many weeks beyond that, are you at all concerned that people might react to this with a little bit of complacency or unbridled optimism? Oh, it's almost over and might let down their guard a little bit. And then the other thing is, you mentioned localism being determinative. I know we all want your reaction to the president declaring yesterday that his authority is total and that it's up to him when states reopen and what they do. Clearly what you've laid out today is not consistent with his opinion. I know you don't want to get drawn into a political fight, but we'd all like to hear your take on what he had to say. Governor Gavin Newsom: (45:01) No, I appreciate that Doug, and please appreciate, I'm not going there. We just want to get stuff done in the state of California for 40 million Americans that happen to reside in California. Specifically though to your first part of your question, which is very thoughtful. Look, we want to make this point and I've made it on multiple occasions. I don't want to be having private conversations with friends and family that I'm not having with you and the public. I owe that to you. All I have is your trust. Some folks, I haven't earned it yet. Others, I may be earning it, but it's conditioned on me being forthright and as honest as I possibly can be under the circumstances. And there's all kinds of issues around circumstance. HIPAA concerns, issues related to [inaudible 00:13:52], all these issues where we have to also be thoughtful in terms of how we process information. Governor Gavin Newsom: (45:59) But these are the conversations we've been having the last few weeks as we saw that curve begin to bend because of everyone's outstanding work and I just think it's important to let folks know that we're not in a permanent state, as long as we don't make the decision to ultimately pull back too soon. And so that's why, again, I appreciate your question and I want to caution everybody watching, the incredible importance of the stay at home orders so that we can get through the next few weeks and really see if these trends, this curve, is not just flattening, but is declining, and give us a few weeks to really build this infrastructure and answer all those tough questions. And then I can come out and be much more specific about when and how we see a blended approach to the stay at home order. Speaker 1: (46:49) John Myers, LA Times. John Myers: (46:53) Governor, one of the things that your presentation seems to hint that is a pretty radical rethinking of public health in California. And I know we're early in this, but could you just give me some thoughts about that? And I think primarily in terms of funding. As you know, public health has not been well funded through the years in this state. An enormous burden falls on the locals. You talk about the tracking and investigations of cases. That is done by local public health officials. Can you talk at all about the commitment you've got to make to substantial money from the states and into public health in the state going forward? Governor Gavin Newsom: (47:27) Well, John, that's a consequential question and profoundly significant. Look, let me just offer a few thoughts on that. I've been, as you know, not a timid in terms of my desire to make investments in the healthcare delivery system in the state of California. We've been aggressive on pharmaceutical drugs, creating a single purchasing authority. We've been socializing some of the work. We just announced a few months ago, seems like a year ago on looking at total costs within the system and looking at more areas of transparency related to costs. Governor Gavin Newsom: (48:02) And look into more areas of transparency related to costs. We also have expanded our subsidies, deepen them, not just expanded them to the middle class to help them support the work of every Californian in our exchange. And as you know, we've also expanded coverage regardless of your status as immigrant or non-immigrant, and that gives you a sense of our commitment as a state, my commitment as an administration or in our administration to advance that cause through this process, because to your question, this has only reinforced the importance of our healthcare delivery system. People that came into this pandemic that did not have quality care are not well served through this pandemic and they're the most vulnerable because they fall through the cracks. Governor Gavin Newsom: (48:48) That's why if there's any lesson in all of this, it's to, when this is all said and done, a big smile, a big thanks, how are you doing? To all the frontline healthcare workforce for incredible heroism day in and day out, that's so often taken for granted and under-recognized. And also an appreciation of the importance of rebuilding our healthcare delivery system and really looking a new at how we could do that so that we don't have the kind of scattered shot support that we've seen across this nation as different systems are struggling to make things work. Speaker 2: (49:31) Kathleen Ronayne AP. Kathleen Ronayne: (49:34) Hi governor. So I understand that you're not giving a key timeline of when these things are going to change, but more broadly you've outlined pretty radical changes in what our daily life looks like in California, even as we start to lift these orders. So we've got some pretty big holidays coming up into the summer, Memorial day, July 4th, I mean, walk me through, if things go to plan, if we're able to meet some of these measures, how do those big holidays, how does the summer look different for Californians? And following on that how does the school year in the fall look different for California students if we meet all these measures and we're able to start doing some of what you've talked about? Governor Gavin Newsom: (50:17) I appreciate it. Thank you for the question because you've also offered me an opportunity to say something that I wasn't clear about in the initial presentation, and that is as it relates to mass gatherings. The prospect of mass gatherings is negligible at best until we get to herd immunity and we get to a vaccine. So large scale events that bring in hundreds, thousands, tens of thousands of strangers all together across every conceivable difference, health and otherwise is not in the cards based upon our current guidelines and current expectations, things can change radically, and we of course can have therapeutics at scale, the kind of community testing at scale, the serology tests at scale and capacity to get vaccines earlier than we anticipated. That can change that dynamic. So I want to caution my own words in that context, but when you suggest June, July, August, it is unlikely. Governor Gavin Newsom: (51:23) That said, as it relates to the school year, we need to get our kids back to school. I need to get my kids back to school. We need to get our kids educated. We need to deal with their mental health and the parents' mental health. It's hard to educate your kids and then take care of everybody else that parents are required to taking care of, at least with each other, and other responsibilities within the household. And we just need to do it in a safe way so that those kids are not going to school, getting infected and then coming back home and infecting grandma or grandpa. So we have to be very, very vigilant in that respect. Governor Gavin Newsom: (52:03) As I mentioned to you, we've got these teams of people and some of them are more built out than others. The area that we will be building out much more robustly is the school space to very specifically answer that question. We have hypothecated, since you want to offer that lens perhaps of imagination, let me hypothecate with you scenarios where in physically constrained environments where practicing physical distancing within the school come this fall may be challenged, we can conceivably stagger the individual students to come in as cohorts in the morning, some in the afternoon. Governor Gavin Newsom: (52:47) We have to work of course with our unions and others and management to figure something like that out, but those are the conversations that we're already having, as it said assemblies, PE, recess, looking at how you provide meals to our kids. All of those things would have to be reconsidered. Deep sensitization, massive deep cleaning. A predicate, by the way, not just in our schools but disinfecting our parks, our playgrounds, benches, our swings, our sidewalks, our streets, all common areas for businesses, for office building managers. The idea that we are still pushing to get to floor 10 and floor 11 to make sure that there are wipes, make sure that there is the kind of sanitation within those building systems. All of that is guidance that likely will be put out, which will again be predicate for reintroducing, again, a semblance of normalcy, that again, I recognize as anything not in the short run. Speaker 2: (53:57) Final question. David Baker, Bloomberg News. David Baker: (54:02) Governor, you're talking about ramping up, quite radically, the state's ability to test, track, trace new cases as they pop up. We all have been watching the state trying to ramp up testing today and it's struggled to do so. What level of testing would you need in order to be comfortable relaxing some of these orders in terms of how many thousands of tests or tens of thousands we could process per week? Governor Gavin Newsom: (54:27) I'm going to ask Dr. Galley to come up because we've been having those conversations. As you know, Dr. Galley put together a testing task force a few weeks back and we are seeing some improvement in our total testing capacity. More importantly on our throughput on getting the diagnostic results back. We had that 59,500 number of tests that were in arrears where the test results hadn't come back. We've gotten that down consistently to about 13,000, we need to reduce it still. We also are very close to meeting our phase one goal in terms of getting normal number of tests into the tens of thousands a day, but Dr. Galley can talk more specifically about what he anticipates and expects as it relates to a threshold of comfort not only on testing, point of care testing, serological testing, but also the kind of community surveillance that is needed on the testing side in order to make this data and make these decisions much easier. Dr. Galley: (55:33) Thank you governor, and thank you for the question. As the governor said, our testing task force continues to make progress on advancing testing across the state. We are beginning to move beyond just having tests available for the sickest people within hospitals for healthcare workers as well. Frontline workers period. Looking to expand the number of sites across the state that have community testing, for those who may be early with their symptoms or may have been exposed to somebody who either was symptomatic or tested positive. Dr. Galley: (56:07) So those are beginning to be planned across the state. We are looking to do those in a very equitable way, consistent with the principles across California, making sure that we don't just have certain communities have testing available, that it's available to everyone across the state, and we're committed to building that capacity. We don't have a clear target number. We all hope that at the end of this month that we have tens of thousands of tests a day. Our numbers are encouraging to show that through the typical PCR tests, even before we have serologic tests that we hope will be available in the next many days, next couple of weeks really at a scale that we don't have today that we'll be able to do tens, thousands of tests, not just for the sickest but all throughout. Dr. Galley: (56:58) I think once we hit that level and we know that individuals who have symptoms can get tested and the results available rapidly, we'll be able to think about modifying these orders, as Dr. Angel and the governor have laid out, in a way that is responsible across the state. We know that there's other things besides just testing that will help us think about this. A number of our health systems look at those who are coming forward on the call lines in the emergency room, in the urgent care as part of an indicator that maybe communities are experiencing some level of COVID penetration and transmission that we have to look at very closely and determine how we support those communities so we don't have rapid spread. Dr. Galley: (57:45) So this concept of test, track, trace, isolate and quarantine. We have other tools that augment our ability. So yes, testing becomes a very focal point, something that we are improving as we go along. And as I said, I think the next couple of weeks we'll be able to talk about serologic testing and its use in our tests testing continuum in a much more sophisticated way. But we are also looking at other strategies to ensure that we keep Californians safe as we look at modifying some of the stay at home orders we have today. Governor Gavin Newsom: (58:23) So that's our roadmap. Those are thresholds for action. I hope all of us are sobered by the reality of the moment, but also left with a little optimism that this is not a permanent state and there is some light at the end of the tunnel. I certainly am feeling more optimistic because of all of you, the incredible spirit of people coming together again across every conceivable difference working together, no politics, no partisanship, just neighbor and neighbor saying, "You know what? We could do a lot more to meet this moment." And you've met this moment in remarkable ways and it's put us as a state in a position where we can lay out this roadmap, but again, it is all conditioned on us continuing to stay the course on the current road that we're on. Governor Gavin Newsom: (59:14) Stay at home, practice appropriate social distancing and make sure that we are physically distance from one another and never forget you're not alone. Even with the stay at home orders, you're not alone. And we want to encourage people that want to volunteer, go to Cal Volunteers, go to serve.ca.gov contribute their time and energy, and make sure we're doing everything we can to reach out to loved ones, reach out to one another and stay safe, be healthy, and continue to practice physical distancing. Thank you all.