Iowa Governor Kim Reynolds Coronavirus Briefing Transcript March 31

Kim Reynolds: (00:13) Yeah. I'll wait until the sign. Speaker 1: (00:18) 10, nine. I'll just give you a thumbs up. Kim Reynolds: (01:00) Good afternoon. Thank you for joining us. We'll go ahead and start the press conference with the latest data and updates on the numbers. Today, we have 73 new positive cases for a total of 497 positive cases. We have 726 negative cases today for a total of 6,888 negative cases. We have 61 Iowans that are hospitalized as of last evening and we have 85 that have recovered. I am sorry to report that we have had one additional death, a middle-aged adult in Muscatine County and that brings our total to seven. Today, we have 1,761 tests available at the state hygienic lab for weeks. We have stressed the importance of people staying home and away from the public if they become sick, even with mild illnesses. About 80% of people who become infected with COVID-19 will experience only mild symptoms. They may feel physically well enough to go about their normal routine, but they should not. Kim Reynolds: (02:02) This type of behavior can put lives at risk. COVID-19 doesn't discriminate. It spreads quickly and easily, infecting young and old alike, but the virus is far more serious for older adults above the age of 60 with underlying health conditions. And that's why nursing homes and long term care facilities were identified early on as a high priority for mitigation efforts. Not only are they home to older and elderly adults likely to have one or more chronic health conditions, but residents who lived in close quarters and congregate for meals and activities, create an environment for the virus to spread rapidly from person to person. As we've seen in some United States cities, this can have devastating results. In Iowa, we've been putting in place mitigation efforts in the state longterm care facilities in the days following our first positive COVID-19 cases. On March 14th, the Iowa Veterans Home restricted all visitors and begin screening all staff before they entered the facility. Kim Reynolds: (03:04) The Department of Human Services also suspended in person visitation and implemented staff screenings at their six state run facilities. And DIA issued similar guidance for nursing homes, residential care facilities, assisted living facilities and adult day services, restricting visitors, suspending communal dining and group activities and screening staff. The department of public health has conducted outreach to the 444+ long term care facilities across Iowa and hosted webinars to educate them about the virus and provide guidance on mitigation planning. The department of public health also engaged Iowa's long term care associations in the planning and mitigation process. Here with me today are Brent [inaudible 00:03:52] from Iowa Healthcare Association and Shannon Strickler from LeadingAge, to share how their associations have helped to prepare and support their long term care members during this unprecedented time. Brent? Brent: (04:11) Thank you governor and thank you for your service to our state. You've marshaled a remarkable response to a generational public health challenge. We also appreciate the opportunity to collaborate with you and your team at the Iowa Department of Public Health, the Department of Human Services, Iowa Workforce Development and Iowa Department of Inspections and Appeals on solutions to protect our state's most vulnerable residents, as it relates to this virus. What we know about COVID-19 is that it presents the highest risk of serious illness and death to the elderly and people with preexisting medical conditions. Our association serves longterm care providers across the state, including nursing facilities, assisted living and home health agencies who provide care for Iowa's elderly and most vulnerable residents. We're committed to doing all we can to protect the health and wellbeing of Iowa's elderly and most vulnerable. As healthcare professionals who care for this population, infection prevention and control are core to what longterm care providers do every day and they have a number of tools they use to prevent and control infection on a daily basis. Brent: (05:16) In situations where there's a heightened risk, like now, one of those tools is to implement visitation protocols and procedures to protect those in our care and to utilize health screening protocols for anyone entering our facilities. Iowa providers have implemented national and state guidance regarding non-essential visits to longterm care facilities and allow entry to only individuals who need entry, restricting activities and visitors with potential for exposure and actively screen individuals who enter the building. These procedures also require all individuals to wash their hands at entry and for care providers to offer remote communication options for residents and their families to ensure residents' safety and quality of life. Brent: (05:58) We understand the challenges these visitation procedures have placed on families, however it is vitally important that we do everything that we can to protect the health and safety of their loved ones and our residents. In the event of a positive COVID test in a longterm care facility, we are working to ensure our providers have the tools that they need to respond quickly and effectively. Our association has sought waivers on behalf of skilled nursing facilities and home health agencies to temporarily provide flexibility to providers, to focus on patient care needed during this crisis. The waivers in CMS' current nationwide waivers process has allowed additional flexibilities necessary to take appropriate actions quickly and protect residents and staff such as moving COVID-19 positive patients into separate wings to receive care. Our association has developed a crisis response toolkit to assist providers with the steps to take if such a situation occurs, including action checklists, employee and patient screening protocols, PPE guidance and communications tools to help them communicate quickly with the Iowa Department of Public Health, family members and staff. Brent: (07:05) Providers are in communication with the Iowa Department of Public Health if they have a positive outbreak of COVID-19 as well as communicating with their staff, residents, families, and other agencies. We're also working to keep providers updated as information and guidance evolves and we learn more about COVID-19. We've established a COVID-19 website that's available to the public, specifically for longterm care providers, that is updated daily as well as we're hosting weekly provider calls and providing email updates to our members. Protecting the health and wellbeing of Iowa's longterm care residents and employees remains our top priority. We will continue to work with our members and state and federal health partners to share any new updates as the COVID-19 situation evolves. Thank them for what they're doing and work with them to ensure continued care for Iowa seniors at this very difficult time. Thank you. Shannon Strickler: (07:58) Good afternoon. My name is Shannon Strickler and I am president and CEO of LeadingAge Iowa, an association representing not for profit providers across the care continuum. Our members' priority every day remains helping to ensure the health and safety of the older adults that they serve and the team members who serve them. Much of their work during this challenging time revolves around safety and compliance. They have developed plans and protocols to respond to the various what if scenarios related to COVID-19 and are focused on following the guidance from IDPH, the CDC, CMS and DIA. They have not only implemented this guidance but are also self auditing to ensure that those safeguards are being followed for the health and safety of all those involved. They're working closely with their medical directors as well as county public health and emergency medical services when needed. Members are closely monitoring their PPE supply with the CDC calculator and applying the optimization protocols. Shannon Strickler: (09:09) There is a state plan in place to coordinate closely with public health if those supplies start getting low and the state emergency response team has been very responsive to longterm care needs. As Brent mentioned, members have implemented visitor restrictions except for the cases of end of life. Providers conduct daily medical screenings of all team members and residents to closely monitor health status pursuant to the CDC guidance and the governor's proclamation. All group activities and communal dining has been placed on hold and social distancing is being practiced. Providers are cross training their staff as part of their emergency staffing plans and connecting virtually with displaced workers interested in opportunities to work with older adults. Shannon Strickler: (10:03) In addition to their focus on health and safety, our members are also supporting the wellbeing of residents and communicating with residents and families, not only to educate, but also to reassure. They've been creative on strategies to keep residents engaged and connected, all while observing the recommended infection control guidance and social distancing. I'd like to commend and thank all the team members who are placing their own worries and needs aside to care for the residents who need them. They have been resolved, resilient, creative, and compassionate. Shannon Strickler: (10:38) To the public, we thank you for your understanding of these visitor restrictions and programming changes. We look forward to a time when this is no longer necessary. As the governor's indicated these past few weeks, the public is a key partner in keeping Iowans healthy and slowing the spread within the state. Thank you. Kim Reynolds: (11:04) Thank you Brent and Shannon, I appreciate your comments very much and everything that you're doing to take care of our elderly. I also wanted to acknowledge we have director Larry Johnson from the department of inspection and appeals with us today, so if you have any questions for him, Larry is here and happy to answer. Kim Reynolds: (11:20) And I too want to take just a moment to thank the doctors and the nurses and the assistants and the aides and others across the state who care for Iowa seniors, whether it's a residential facility or it's in their own homes. And this is an especially challenging time and your work is so important. So please be safe and take care of yourself so that you can continue to serve Iowans who need you. Again, thank you, a heartfelt thanks for all you do. Kim Reynolds: (11:45) And in closing today, I want Iowans to know about an additional resource that's available if they need legal advice. So we've been working on this and we have this set up. So the COVID-19 legal information hotline will help by ones who have questions or are experiencing legal problems due to this crisis. So you can call them toll free at 1-800-332-0419 again, that is 1-800-332-0419. And the service is being provided by Iowa Legal Aid in partnership with the Iowa State Bar Association and the Polk County Volunteer Lawyer Project, so thank you to all of those who are helping provide this important service during this time. And with that, we'll go ahead and open it up for questions. Catarina: (12:35) Governor, the CDC director said in an interview yesterday that up to 25% of COVID-19 carriers may show no symptoms, but can still spread the disease. Again and again, you've said, if you're sick, even mildly stick, stay home, but is that really enough and is it time for more aggressive messaging to let people know that they might have the disease even if they're not showing any symptoms? Kim Reynolds: (12:53) Yeah, I think we have been very aggressive in our messaging and we've said over and over, whether it's Dr. [inaudible 00:12:57] or whether it's Sarah or it's myself, if you're feeling ill, stay home. If you have mild symptoms, stay home. If you are experiencing symptoms that are related to COVID-19 such as a fever, cough, or some respiratory illness, please call your doctor first. They will walk you through a series of questions like the doctors do and make the decision if they think that you should come in, how you should proceed forward with that, and what necessary steps need to be taken. If you do a test that's outside of the state hygienic lab, a lot of times it's a couple of days before you get those results back, so they're telling their patients to stay at home until we get the results. Kim Reynolds: (13:36) So I think we've been consistent in the messaging that we've been delivering to Iowans. We all have a role to help keep our most vulnerable Iowans safe and healthy. And it's also, we've tried to put metrics in place that would start to flatten the curve so that we don't overwhelm our hospital systems, that we make sure that we have the beds and the PPE, and the equipment, that we need to take care of Iowans. We're also working with the Department of Public Health as they're putting together metrics that will help us identify potentially what that peak may look like for Iowa and when that may occur, so that we can start to monitor that and be prepared. Kim Reynolds: (14:19) We have, across the state, we have different coalitions, whether it's the County EMAs, the healthcare providers, the hospitals, and the Iowa National Guard that are meeting in our healthcare coalitions to talk about, from a regional perspective, how we be ready for a potential surge. They're planning for the worst, hoping that we can, by the steps that we've taken, mitigate that, bend the curve, and not overwhelm our hospital system, but we have to be ready for that. So they're looking at bed capacity, they're looking at ICU beds, they're looking at vents, they're looking at PPE, they're looking at what happens if one certain hospital reaches their capacity of beds, what is the follow through and where do we move and how do we address that within the various regions. And those discussions are happening on a daily basis almost. And so we'll hope to get a report from that by this Thursday. Kim Reynolds: (15:14) Sarah, do you have anything to add to that? Sarah: (15:17) I think the only other thing I would add to that is, and I think this is consistent with what I said yesterday, is that we do know the virus is circulating within our state at this particular point in time. So if you do need to leave your home, you should really practice social distancing because if somebody is ill, but they're asymptomatic, you can protect yourself by making sure that when you do need to leave the home, that you stay at least six feet apart, that you avoid large gatherings. Certainly gatherings more than 10 people should be avoided and you should really stay home as much as possible if you don't have to be out and about. Speaker 3: (15:58) To tag on to that, Governor, in your response to [Catarina's 00:16:01] question, you were saying, reiterating your message of stay home when you're sick, when you're showing symptoms, but that runs counter to the notion that asymptomatic people could still be spreading it. So how do we find a common ground with the messaging that maybe Iowans need to be doing more, even if they aren't showing symptoms. Kim Reynolds: (16:19) But I think it goes back to what Sarah said. If you go out, practice social distancing, limit the amount of your trips. Only go out for essential things. Go to the grocery store, medical, check on a loved one that may need to stay home. Don't go out in a group, rotate. One of you go to the grocery store, go every two weeks. Don't buy two months worth of supplies, buy two weeks where it's so... I mean, when you go out, be conscientious. Practice personal hygiene, I can't lock the state down. I can't lock everybody in their home. We have to make sure the supply chain is up and going. We have an essential workforce that has to be available. And so people also have to be responsible for themselves. And when we limit the amount of times that we're going out and what we're going out for, and where we're going, and minimizing the number of people we're around, we will start to accomplish, hopefully, what we're trying to do. And that is to flatten the curve and to get through this and get things back to normal and stand this economy back up. Speaker 4: (17:24) Can you maybe give some advice to Iowans who maybe think that just because they're outside, they can't... Because just based on recent days I'm walking my dog, I'm seeing groups of people outside standing close together. Do you have any advice for those people who- Kim Reynolds: (17:37) Don't stand close together. It's kind of what we've been saying. Practice social distancing. We're trying to do it here, get about six feet apart. Try to be aware of your surroundings. We all have a role to play and we're all experiencing some significant inconveniences. As I said the other day, the impact of these decisions that it has on our businesses, our small businesses, our families and individuals, it's significant. We're asking a lot of Iowans, but I am saying and we are saying, based on data, that if we can really do our part, each and every one of us, hopefully we can get through this sooner rather than later. Kim Reynolds: (18:19) Every day new things are coming online. Just like that testing machine that I talked about yesterday from Abbott, where I can get a result in five minutes. We're getting 15 of them and we'll get more, but originally, we'll get 15. It's mobile. We can get this into some of our longterm care facilities. We can make sure that our healthcare workforce is healthy and not testing positive. We can make sure... And every day, they're increasing the number of people that we can test, so we have a better idea of who tests positive, who's not, how we can keep them at home. Kim Reynolds: (18:51) We were able to report today 82. Was that to... 85. Yeah, 85 recovered. So as those numbers continue to increase, that's a potential group of individuals that we can move back into the workforce. They're talking about a test now that we can see if you've had COVID-19 and you weren't aware of it. And so the more information that we're able to gather, the better informed we'll be. And it will help, I think drive us in the metrics that we're using to make the decisions we make moving forward. Speaker 5: (19:24) Governor, I think you've touched on this a little bit, but I wanted to ask you, there's a projection out there from a University of Washington program and it's been cited by several government officials, so it's a legit program projection, looking at hospital information across states. And according to their projection, Iowa will have enough beds to cover hospitalizations, but will maybe just not quite have enough for ICU patients. So I'm just wondering, but just backing off from that more broadly, what is going on? This is what I talk about. I think you touched on a little bit, but what is going on specifically with ICU beds and availability in different regions of the state? Kim Reynolds: (20:02) Yeah. Yeah. So those regions that are... Kim Reynolds: (20:03) So I- Speaker 6: (20:03) ... and availability and in different regions of the state. Kim Reynolds: (20:03) Yeah. So those regions that I talked about, we're getting that information. I want to thank the Iowa Hospital Association. They have been a tremendous partner, because we are asking for a lot of information for our hospitals. Not only are we asking for it from the Department of Public Health, but some of our local public health providers and their EOC teams are asking for that information. Now we have the federal administration that is wanting to gather that data so they can incorporate that into the metrics that they have. And so, we're working diligently. We have 118 hospitals across the state. So again, thank you to the Iowa Hospital Association for helping us gather this information. Kim Reynolds: (20:37) Right now, they've been able to identify 1500 vents and anesthesia machines. We have, I said the other day, a bed capacity of about 12,000. We have probably the capacity to staff 9,000 of that right now with the recent information that we've received, and we'll continue to monitor that. We have about 600 ICU beds, and then there are some that are not adult beds that we could potentially utilize as well, whether it's NICU or the PICU. And then in addition to that with the anesthesia vents, then sometimes we can use two off of those, but that's if we really need to, that's also an option, and then I don't know if the 1500 includes the National Guard had some vents also... It does include that, okay, that we had access to as well. Kim Reynolds: (21:25) So we're working every day to streamline the way that we get the information from hospitals whose health care workers and administrators are working around the clock, to make sure that they can take care of Iowans, that we're prepared as we start to move into the peak, and there's a lot of moving parts, and everyday I think we get a little bit better about how we're streamlining that process, to make sure that we have the most up to date information, as we plan with the metrics that the Department of Public Health is making available to us, to make the decisions that we're making. Speaker 7: (21:57) Governor, do you- Speaker 8: (21:58) We're going to go the phones, actually. Kim Reynolds: (21:58) Oh, I don't... have you asked a question? Speaker 7: (21:58) I have. Can I- Kim Reynolds: (22:01) Oh, you can ask another one. Of course, that next time, I'm not going to let you ask any. No. Speaker 7: (22:08) The $20 million that you have authorized by the legislature to spend, I know 2 million went to the Small Grant Program. Have you made any other allocations of that funding and do you plan to ask for more? Kim Reynolds: (22:20) So I have not yet, but your question is timely. I am sitting down with the Department of Management and Director Roederer today, as well as Joel and my team, to take a look at what Debbie is requesting. We'll look at the numbers. I anticipate allocating additional funding through that Small Business Grant program that the Department of Economic Development Authority put together, and then we'll take a look at... We're really, David has been looking at the CARES Act to see how that fits in to what we're doing, and the more information as we are able to go through that and look what we're able to provide, that'll decide what we're looking at going forward. Speaker 8: (22:56) All right. First question on the phone, Eric, go ahead. Eric: (22:59) Hello, yes. I just wanted to ask you, Governor, there's a lot of talk about essential and non-essential businesses going around. I'm just wondering, in your mindset, what do you believe is an essential business? Kim Reynolds: (23:18) Well, we haven't really addressed that specifically, in any orders that we have put in place. We have outlined businesses that we, based on data, fit into a criteria that would be non-essential at this point. If we do start to make that determination, the place that I would start is with kind of the recommendations from the U.S. Homeland Security. So they have laid out and actually even broadened some of their criteria for what are essential workforce. But as especially in a state that we feed the world, and when we look at the health care system and the health care providers that we have in our state, and the manufacturing base that we have in our state, and when we talk about the supply chain, I wouldn't be surprised if we would be similar to what Minnesota's seen, that after they issued their order, almost 80% of their available workforce tied into the essential workforce category. So, we're still walking through what that may look like, but that would be a place that I would start, if we decided to really lay out what that would entail. Speaker 8: (24:26) Dave [Brice 00:00:24:27], next question. Go ahead. Dave: (24:30) Good afternoon, Governor. Can we talk specifically about the testing kits? Right now, if you look at the numbers, it's somewhere between 600 and 800 a day here recently, of these results that you're releasing. How many people ideally do you want tested every day, and have you asked President Trump for help in getting more testing supplies? Kim Reynolds: (24:54) Oh, we all have asked the administration for additional testing supplies. So I've talked often about being on the call weekly with the vice president and the corona task force. Many times, the president is on there is as well. So not only have we been able to work through the National Governors Association and have the chair really issue some of the requests on behalf of governors all across the country, but we also each have an opportunity to put in, or to talk, and bring up specific requests, or issues or problems that we may have. Kim Reynolds: (25:27) So we've got that as a channel to do that, but we're also able anytime that I feel like I need to get a message into the administration, the communication and coordination has been really, really good. And so, I can talk about what we do at the State Hygienic Lab and what their capacity is, and then we also have the other labs that are testing as well, and we continue to see the numbers, I think increase all the time. Do you want to talk about the potential numbers at the State Hygienic Lab, or do you know that, or? Sarah: (26:01) Yeah. Sarah: (26:01) Yes, right. So, I have mentioned previously that there are a number of different components that go into a test, and so it's not just test kits, there are also reagents, there's PCR, it's been described to us as you need flour, salt, and pepper, and you need some sugar too, to be able to put the whole test framework together that's being used currently at the State Hygienic Lab. And so, we have conversations with the State Hygienic Lab on a daily basis to check in with them to see what supplies that they need, and we offer any support that we can to provide any assistance that they might need in gathering additional supplies. And so, in addition to supplies, there's a staffing resource component, and we continue to offer support to the State Hygienic Lab, so that they can ramp up and be as effective as possible in conducting as many tests as they have access to, and staffing to support. Kim Reynolds: (26:56) I forgot, I actually did send a letter last week, I think, to the administration requesting additional test for the State Hygienic Lab, since we were the only one in the state that was providing that testing. So I did send that request, I think my weeks and days are starting to run together, but I think that was last week, when? Speaker 9: (27:12) Saturday. Kim Reynolds: (27:12) Oh, it was Saturday. Okay. Saturday that I did send that request in, but it's kind of been a constant request, and we're continually updating the materials that we need in order to do that. And again, there just are additional ways that we're testing that continue to come on. I think I said yesterday that Abbott indicated that they would be able to make 50,000 a day for the next 30 days, and so they really are cranking up this new testing device that they have, and that is tests, that is the machine and the kits to do the testing. So the more that we can get those out in the States, I think it'll be helpful. Speaker 8: (27:48) Next question, Ron Steele, KWWL. Ron Steele: (27:52) Good afternoon, Governor. Thanks for taking my two part question here real quickly. Every briefing you mention the metrics, that data that you are using to base your decisions daily. So based on your data and based on Iowa's population, do you consider 497 positive cases and seven deaths more or less than the number of cases and deaths that you might've anticipated by this date of March 31st, and do you have a potential peak or worst case scenario built into those projections for Iowa? Kim Reynolds: (28:21) Yeah, so we are actually, I talked about that, we're working with the Department of Public Health that is putting those metrics together so we can start to monitor when we think we will reach that peak, but I'm going to let Sarah talk a little bit about some of the data that they're looking at, or when they anticipate that, maybe. Sarah: (28:38) Yeah. So, I think I said on Sunday that we would anticipate to see a peak in Iowa sometime within the next two to three weeks, which would put us towards the middle, or mid to late April is when we, based on the current information that we have about the way that our case counts are increasing, in addition to considering the mitigation efforts that have been put in place by Governor Reynolds, which include recommending closure of schools, in addition to closure of bars and restaurants, and other stores, limiting mass gatherings and those sorts of things. Sarah: (29:11) And so, based on all of those measures that have been taken in our state, based on the case counts that we see, the severity of the case counts that we see, the average age of our population, we're looking at all of those things, and that's why we think at this particular point in time and based on the experience in other states, that we could see that peak within the next two to three weeks. Speaker 8: (29:36) And then- Kim Reynolds: (29:36) So the other thing is too, yesterday, the CDC and the administration talked about new metrics that they were going to make available to states that we can use in some of the modeling that we're doing as well, so we start to be consistent in what we're using for metrics. Speaker 8: (29:50) [Lynn 00:29:50] with the Capital Dispatch, go ahead. Lynn: (29:53) Yes, Governor, so it was announced today that two of the cannabidiol dispensaries... Lynn: (30:03) ..will be permanently closed. I was just wondering what the reasoning was behind that and if it's related at all to the pandemic? Kim Reynolds: (30:07) No, I do not believe that it was related to the pandemic, but I am not 100% sure about that. We are working with the Department of Public Health since finding out that they have closed down. I know they're committed to providing patient access and they're working to license new dispensaries. So they will issue an RFP and then we'll move forward with that. And I can have my communications team follow up, maybe give you some additional information. I don't believe it was tied to that, but I'm not 100% sure, so I'll have them follow up and get you an answer to your specific question. Speaker 11: (30:43) Governor, can I just verify real quick, that wasn't a state recommendation, that was a business decision- Kim Reynolds: (30:47) Yeah. Speaker 11: (30:47) That those places made, right? Kim Reynolds: (30:48) Yeah. Yeah. Yeah. Yeah. Speaker 12: (30:51) Nick [inaudible 00:30:51] Register, go ahead. Nick: (30:54) All right, thank you Governor. So we quoted a doctor today estimating that the actual spread of coronavirus is five to ten times greater than what current testing shows. So with greater testing capacity coming to our mind, will it be a priority of the state to kind of capture that whole picture of the spread of the virus? Kim Reynolds: (31:14) That's our intent, right? Shannon Strickler: (31:17) Yeah. I mean, I think as increased testing becomes available, certainly there will be access for more Iowans to testing. But at this point in time, it doesn't necessarily change the treatment for somebody who's been diagnosed with the coronavirus. Shannon Strickler: (31:32) So at this point in time, there are no specific therapeutics or medication. There isn't a vaccine for the virus. And so, for our patients that are mildly ill, the treatment for them and the recommendation for them would be to go home and to stay home while they're ill. And then they would stay home for at least seven days after the onset of symptoms and for at least three days after the symptoms resolved, including their fever. And so that would be the recommendation. Whether people are tested or not, if they're feeling ill, that's the advice that everybody should be following. And then if you do need to see your doctor, then you need to call ahead before you visit the office. Speaker 12: (32:17) We're going to take two more questions. Rod is the second to last. Go ahead. Rod: (32:23) Yes, Governor. Linn County's had a significant number of positive tests in two days. Kim Reynolds: (32:28) Right. Rod: (32:28) You talked about the outbreak at the care facility yesterday, but there's another significant jump today. How close are you to dialing up additional protective measures there? And are you thinking of putting additional measures in the eastern regions of the state where the cases are growing faster than others or do you want all your emergency measures to be statewide? Kim Reynolds: (32:50) No. In fact, I've said with the metrics that we put in place, actually by not doing a statewide, that allows us to identify where some of the hotspots may be, whether it's from a regional perspective or maybe county, community, whatever that may be. Kim Reynolds: (33:04) So Linn County now has 90 positive cases and 30 of those are tied to the Heritage longterm care facilities, so a third of the cases. And the Department of Public Health has been working with them just every day, morning, noon and night, really making sure that they have the resources that they need and making sure that they're there in case they need any additional support. They have done a lot of outreach with them as well as a lot of the other longterm care facilities as well. Kim Reynolds: (33:31) So Rod, we meet in the morning and we meet in the evening. And so I meet at 9:30, and then we end our day with a wrap up meeting to review again what's transpired during the day, what some of the metrics are, what we're looking at and what we're basing those decisions on. Kim Reynolds: (33:47) So we're going to continue to do that and we'll adjust based on the recommendations that are given to me by the Department of Public Health, utilizing the CDC, other resources. They're taking into account what other states are seeing happen. So they're bringing in a lot of different metrics and additional resources to help them give me the recommendations that they have given me that really has driven all of the decisions I've made up until this point and will be what I use moving forward. Speaker 12: (34:22) Last question, KCCI. Go ahead. Speaker 14: (34:27) [inaudible 00:34:27] anywhere around the Des Moines metro area and you'll see kids with nice weather playing outside, hordes of them, clearly unrelated. Obviously it'd be a good thing normally, but not now. No parental supervision, not social distancing. Is there anything that can be done outside of a shelter in place order to keep these kids from being people who spread this disease around, especially now that we have cases of kids getting this? Kim Reynolds: (34:53) So come on parents, get out there and help me get those kids minding. So I would ask for that. But if you look at most of the stay at home orders that have been put in place, they are still are letting kids, you know, you can still go outside, but they are asking them to be smart. And when they're going outside, to practice social distancing, to not gather in groups of more than 10. Kim Reynolds: (35:17) So the information remains the same and we just need to keep telling them that they need to practice the measures that have been put in place. So we'll continue to drive the message, and hopefully... I mean, people are hearing it and so I don't know if I said this yesterday, but they did a passenger traffic count this weekend and it actually was down 55% from a year ago. So people are getting the message and they are staying home, and we just need it... You can go outside and go for a walk and be active, you just have to practice social distancing and don't gather in groups because that's how we're going to get through this and get through this sooner rather than later. So thank you. Speaker 15: (36:09) You are the only participant.