Asa Hutchinson Arkansas April 23 Coronavirus Briefing Transcript

Gov. Asa Hutchinson: (00:00) Good afternoon, Eddie. Eddie: (03:02) Good afternoon Governor. Gov. Asa Hutchinson: (03:06) Thank you for join me for today's COVID-19 update. I'm joined of course by Dr. Nate Smith, secretary of the Department of Health, and today I'm also joined by Chancellor Cam Patterson of UAMS and I very much appreciate both of their leadership during this time of emergency in Arkansas. Yesterday as we reported there were 2,276 cases. Since yesterday, we've had an additional 189 cases that are added to the total, so today there's a total of 2,465 COVID-19 cases in the State. Of the 189 additional cases, 122 of those are in the Cummins Maximum Security Unit. Gov. Asa Hutchinson: (04:02) Terms of hospitalizations. Our hospitalizations have gone from 97 to 101 and the deaths have gone from 42 to 45. Let me go to the charts, which we've grown accustomed to, which... They got that further up than usual. But these of course are the number of new cases in Arkansas and it goes back to March 11 the first day that I declared the emergency, the first case that we had and as you can see where we are in the last 24 hours and with the peak and the differentiation between those in the Cummins Unit and those that are throughout the State. Gov. Asa Hutchinson: (04:51) If you go to the next chart, we have the seven day rolling average of new cases in Arkansas. This is all inclusive of all the cases, Cummins and everywhere and you can see how the flow goes there and then the next one of course is the seven day rolling average of new cases that exclude the correctional facilities and you can see under both circumstances you've had a couple of days of it's tending upwards just a little bit. Gov. Asa Hutchinson: (05:27) With that we see where we are in our cases in Arkansas. As you know I created the governor's advisory group on testing strategy in Arkansas. They have met, they've worked hard and they have given me an initial report and recommendations that I wanted to review and if we could go ahead and put up the next... this is first informative in terms of the statistics, I asked them Dr. Smith and his team and they worked very hard on this to give us a history of how much testing we've done each day in Arkansas and so what you see here is... The orange at the bottom is UAMS testing facilities and then the white is the Department of Health and then the red are the commercial labs. Gov. Asa Hutchinson: (06:32) Of course you can see how we started out and this is I guess a major point is that we have increased our testing capability in Arkansas in reality going from just a few tests, fewer than 200 for a significant period of time and then when the commercial labs took on and increased their capacity, you see the red lines skyrocketing and you see we got to a top a couple of days of over 1600 cases and then over time since that peak of 1600 tests that have been done, it's had a significant decline where now we are right at 1000 tests that we are performing in Arkansas. Gov. Asa Hutchinson: (07:23) Again the commercial labs has the bulk of it, Department of Health has focused on the hotspots and UAMS has had their mobile lab that has gone around and done work throughout the State. This is very informative though as to where we are in our testing reality in Arkansas. Then if you'll go now to the recommendations from our testing working group and they'd given me four strategies and four things that we need to concentrate on in Arkansas and let me just review those four points. Gov. Asa Hutchinson: (08:01) First we talk about we need to expand COVID-19 testing as a whole and this is, we need to increase it for all patients with symptoms and with a history of potential exposure. What has changed in the criteria is adding with a history of potential exposure, so it's broadens the category of people that can actually qualify and go into the clinic or the hospital to get a test. Gov. Asa Hutchinson: (08:32) The history of potential exposure is usually as a result of travel or contact with a COVID-19 patient. This new implementation and expansion will provide us the best statewide surveillance awareness to alert us as to any community that has a new outbreak or a new concern that we can take action in regard to this. Gov. Asa Hutchinson: (08:57) So it alert us to the introduction of new cases or any new cluster. This expansion will be accomplished by more fully utilizing the testing inventory of our hospitals and commercial labs that is already present with them. If you do the inventory among our hospitals, they already have a inventory of testing kits. We want to draw that down some and we want to expand what we're doing in testing. Gov. Asa Hutchinson: (09:22) The second recommendation and strategy is to expand testing for contact investigations. Currently we are primarily testing only contacts who are symptomatic and so if you have a COVID-19 positive, their trace down as to who they've been in contact with and then we test those who are positive or excuse me, those who are symptomatic and so we're expanding the testing to all contacts who are exposed to a case of COVID-19 and this will help us to identify infections more quickly and be a very useful tool in how we use our testing resources. Gov. Asa Hutchinson: (10:07) The expanded testing will be done primarily through the Department of Public Health lab because the focus of that lab has been the contact tracing that they've been very effective at doing. Gov. Asa Hutchinson: (10:21) The third strategy is to screen for COVID-19 high risk in high risk settings. This is already being done as a result of the directive we issued yesterday for testing those that are coming in for elective procedures. We want them to be tested and that's an expansion of what we've done before. We want to be able to expand that even further so that as resources are available, we can do the in high risk settings perhaps in longterm care facilities or in human development centers to expand our testing screening in those areas. Gov. Asa Hutchinson: (11:02) The fourth recommendation or part of the strategy is to develop a strategy for statewide serologic or antibody testing. This is where you can test to know whether they have had COVID-19 in the past and they might've been asymptomatic. They might have gone through it without really being aware of it or think it's the regular flu and so this kind of tests will allow us to have a better understanding of who has had it in the State. It'll also give us an opportunity to utilize plasma from the Elmore others in terms of our preventative work. Gov. Asa Hutchinson: (11:50) This will be worked on by the Department of Health in partnership with UAMS and with the CDC all working on an effective antibody testing capability. They're not as reliable now as we know that they will be shortly and so that's a partnership that we'll continue to work on those. Gov. Asa Hutchinson: (12:11) Those are four strategies, recommendations from the group and I accept those strategies we're going to work and adopt those strategies. For the immediate plans. I'm announcing today a two day Arkansas surge campaign with a simple message. If you think you have symptoms, don't wait, get tested. The goal is to increase our testing over the next two days. If you go back to the other one first, I think there's one right before that, right here. Let's look at this for a second. Gov. Asa Hutchinson: (12:47) This will be accompanied by an advertising campaign, a marketing emphasizing to the public in general. If you have symptoms like fever, cough or shortness of breath, get tested for COVID-19 testing is available. We looked at the chart as to why the testing has gone down since the height of over, what was it, 1600 and part of it is there were lines. Part of it is they don't have the flu like symptoms that might've caused them to go in and get tested and so there's an inventory available out there for testing right now all across the state of Arkansas. Gov. Asa Hutchinson: (13:26) Arkansans were asking you over the next two days if you thought about it before, if you think you've got the symptoms or you've got flu like symptoms or at risk categories and you've been traveling, you want to get tested, go in there. Let's get tested over the next two days. It will help us to know better where we are here in the state of Arkansas. Gov. Asa Hutchinson: (13:49) Our goal is to increase the testing over the two day span from 1000 tests per day to 1500 tests each day over the next two days. Now, that's not something we can manageably do it ta... Gov. Asa Hutchinson: (14:03) Now that's not something we can magically do. It takes the consumer, it takes the patient out there to say, "Yes, I want to go in and get tested." It takes the cooperation of the hospitals and the clinics as well. And we solicit, we're working with them, but we want to be able to enhance that immediate surge in our testing results here in Arkansas. And then if you would go to the last slide, which is just the Arkansas Surge Campaign. If you think you have symptoms, don't wait, get tested. That's the message for today. And with that, Dr. Smith. Dr. Nate Smith: (14:41) Thank you, Governor. Thank you for your leadership in all of the aspects of this COVID-19 response, but particularly this one to increase testing. And as you can see from the Governor's graphs that he showed, we are currently not fully utilizing the testing capacity in our state. I know that a week or two ago, many people experienced frustration about our lack of capacity. But now if you consider the commercial sector, the UAMS lab, the Department of Health lab, and some other hospitals that are doing testing as well, we are not fully utilizing that capacity. And we need to know if people have symptoms of COVID-19. We need to have that answer both for their benefit and also for us to know as a state. In going over the numbers, as the governor has mentioned, we have 189 new cases. 122 of those are inmates from the Cummins Unit and 67 are what we consider community, but those also include some of the staff at Cummins. Dr. Nate Smith: (15:44) Overall from Cummins, we have a total of 687 inmates who have tested positive and 35 of the staff. We are continuing to test inmates, although we're almost finished with that, and we're also testing additional staff. So we'll have updates on that. While I'm talking about incarcerated settings, I'll also give a brief update on the FCI, the Federal Correctional Institute in Forrest City. The CDC team is implementing their testing strategy. At this point we only have 75 total inmates and 10 staff, but we'll expect some additional numbers over the next few days. We have, as the governor mentioned, 101 currently hospitalized patients. That's a net gain of four from yesterday. We have 24 currently on a ventilator. That's a net gain of one from yesterday. And we're up to 45 deaths, which is three additional deaths compared to yesterday. We have a 174 nursing home residents who have tested positive and that's up four from yesterday. We have 902 who have recovered total, and that's 39 more than yesterday. Dr. Nate Smith: (17:04) I want to talk a little bit more about the testing strategy. There's a lot in the media, a lot about test. We need more testing. We do need more testing. I agree with the governor 100% on that, but it's not just increasing the numbers. It's using our testing capacity strategically. The purpose of testing is to identify people who are infected, to stop the spread of COVID-19, and ultimately to save lives. And it is quite possible to do lots of testing without accomplishing any of those three goals. So the strategy that the governor has presented is designed to utilize our capacity very strategically so that we can identify those who are infected, interrupt or stop the spread of COVID-19, and ultimately save lives. Dr. Nate Smith: (17:53) Just to give you a picture, it's not just numbers. If I were to come in to my primary care doctor and he would say to me, "Nate, I haven't done a lot of breast cancer screening this week, so we're going to go ahead and screen you for breast cancer." That doesn't make any sense. So it's not just about the numbers. It's about utilizing our testing capacity to get actionable information to interrupt the spread of COVID-19 and to save lives. And with that, I'll turn it back over to the governor. Gov. Asa Hutchinson: (18:27) Thank you, Dr. Smith. And UAMS has been such a great partner, particularly in the testing arena. And I know they're working on a antibody test capability. And so I wanted Dr. Patterson to address that and any other comments. Dr. Cam Patterson: (18:45) Thank you, Governor Hutchinson. And I want to reiterate the importance of our partnership both with the Department of Health and Department of Emergency Management as we manage the situation in Arkansas. As we talk about the numbers, I think it's also important that we talk about predictions for the future. And as we've looked at predictive models, including the model at the University of Washington, where they probably have the most experience in developing these types of models. Week after week for the past three weeks, projections for total amount of hospital resources utilized and total numbers of deaths in the state of Arkansas have gone down. And I think that what that indicates is that the predicted surge that was anticipated to happen here in the state of Arkansas has not manifest itself. Now that doesn't mean that that gives us the liberty to let our guard down, but it causes us to think about the possibility that we will never have a surge, but we will end up with a steady state that we continue to work on through better testing and better treatment modalities. Dr. Cam Patterson: (19:55) So I think as we take the big picture into perspective, it's important to look at how the projections for the state of Arkansas have changed over time. And thankfully with the leadership of the governor and the work that people have done across the state, those projections have led to a decreasing predicted impact for the state of Arkansas continuously over the past several weeks. Part of the story is testing and Dr. Smith articulated well. It's not simply the total number of tests that we do, but it's doing the tests for the right patient populations. And Dr. Smith and Governor Hutchinson's task force have identified who needs to be tested. We at UAMS have worked on increasing the statewide testing capacity and also making sure that testing is available to you in the state of Arkansas no matter where you live. We'd love to have infinite resources to do this, but we continue to go into communities to offer testing services for people who live in those communities who may not otherwise have access to a readily available COVID-19 test. Dr. Cam Patterson: (21:04) This week, we've done testing and McGehee, Marianna, and Camden. We have testing lined up in Warren. All told, we have screened about 600 individuals in those communities, tested 248, and have identified six people who are COVID-19 positive in those communities. And I'd emphasize, it's not just identifying people who are COVID-19 positive, it's identifying people who are COVID-19 negative and which communities have low levels of transmission within those communities. All together, UAMS has screened about 15,000 individuals and we've tested 4,129 individuals. And as reagents have become available, we're committed to the two-day surge to make sure that we are contributing to a sustained increase in the amount of COVID-19 testing that is occurring. The task force also recommended developing serologic studies to assist in the management of this pandemic. The current screening that we do, the nasal swab screening, determines whether you're actively infected. Serologic screening, antibody tests, determine the probability that you have been infected in the past. Dr. Cam Patterson: (22:21) And those assays are routinely used. We all use them for many infectious diseases including measles, mumps, rubella, to determine whether people have previous exposures. And if we develop antibody tests that are reliable and marry those tests with what we know about the biology of COVID-19 infections, it can help us enormously in determining population prevalence and what needs to be done to manage communities that may have either very low or very high amounts of past exposure to COVID-19. Now there're two barriers to the serologic assays currently. One is that the assays themselves are, right now, as of this day in April, not as sensitive and as reliable as we would like them to be. Meaning that our ability to detect either IgM antibodies, antibodies detecting an acute response, or IgG antibodies that detect a response in the more distant past are not as reliable as we want them to be. And if they're not reliable, then we can't use them as easily to make clinical decisions. Dr. Cam Patterson: (23:41) The other challenge is simply that we don't know yet enough about the biology of COVID-19 infection. And having an indication that someone has been infected in the past might not mean that much if a person can get reinfected regardless of a previous IgG response. Now these are questions that we need to answer and we are working to answer them. We have teams at UAMS working with the Department of Health, the CDC, to help to understand how these serologic tests are going to be used in the most reliable fashion. We at UAMS are investing heavily in developing abilities to assay different serologic tests but also to develop our own tests that might be more useful for the patient populations that we need to screen. And we know that given the task force's recommendations and the enthusiasm with which Governor Hutchinson has accepted the recommendations of those task forces, that time is of the essence and meeting the serologic needs that we have for assaying the COVID-19 infection. We're committed to making that happen. We're going to do it and share that information with you in a transparent fashion. And this will be, I think over the long term, probably the single most important piece of screening information that we can develop to ensure that we understand how to mitigate the COVID-19 pandemic, and more importantly to prevent a big second bump next fall when the respiratory season reappears. Gov. Asa Hutchinson: (25:18) Thank you, Cam. With that, we're happy to take any questions. Speaker 2: (25:25) The surge campaign, what happens if the numbers dramatically increase in positives? Are you going to slow down your plan, the dates that you had in terms of reopening? Gov. Asa Hutchinson: (25:39) There's a lot of data points that go into that decision. And so we will measure it day by day and make the best decision we can as we look at May 4th as it approaches. And so we'll wait. Whenever we look at this two-day surge campaign, we can market it, we can say this is important, but it really depends upon who is symptomatic out there and whether they feel the need to be tested. So we're going to learn a lot from the response. We might come in here next Monday and see that we had 1,700 that were tested, or we might come in here and there are only 1,200 tested. So we're going to learn a little bit about where the public is in terms of their demand, and their concern, and their symptoms. And so that's a data point, as well as the cases, as well as the hospitalizations. So we'll look at all of those as we make the decision. Speaker 3: (26:45) What should somebody do if they want to get tested but they don't have health insurance? Gov. Asa Hutchinson: (26:54) If they want to get tested but they don't have... Speaker 3: (26:55) Health insurance. Gov. Asa Hutchinson: (26:55) Health insurance. If they want to get a test, they get a test. Period. Dr. Cam Patterson: (26:59) From UAMS. Gov. Asa Hutchinson: (27:00) Yeah. Well UAMS, but any testing site should take them without any hesitation because that's a commitment that we have that there's not a cost. Obviously, you have insurance, they're going to charge the insurance. But that should not be a reason. There's Medicaid that covers it. But they will do the test if you meet the need to do the test. Speaker 3: (27:23) How is the state going to pay for that? Or who's going to pay for it if they don't have Medicaid or any health insurance? Dr. Nate Smith: (27:33) There are a variety of federal funding sources that are specifically for testing and it would depend really on the setting. Gov. Asa Hutchinson: (27:44) Yeah, go ahead. Dr. Cam Patterson: (27:47) I can say we and most of the facilities that have set up triage screening are not asking for payment at the time of testing. So there's no expectation that people need to come with a check or a guarantee of insurance. Dr. Cam Patterson: (28:03) Expectation that people need to come with a check or a guarantee of insurance. We just do the testing and if there's an opportunity to get the insurance companies to pay us back on the back end, obviously we will take advantage of that, but I would strongly urge everybody to have the expectation that a few, need to be tested and you asked to be tested, you ought to be tested. Speaker 4: (28:26) They're not charging the insurance now? Dr. Cam Patterson: (28:30) I can only speak for UAMS, but we're collecting insurance information, but we're not billing insurance and we're not charging patients directly. Gov.: (28:37) Yes ma'am. Speaker 5: (28:39) As the antibody tests become available to consumers, is there something consumer should know? Is there a type of tests that will be recommended to them? Gov.: (28:47) Okay. Dr. Nate Smith: (28:49) The antibody tests or serologic tests is the other name for it. There's a lot of confusion around that. On the one hand, if you read the newspaper, it sounds like the best thing since sliced bread. And if you talk to actual laboratory people, some of them say this is not ready for prime time. But you need to ask why people are in favor of it or against it. The people who are most in favor of it is because in some cases think that those tests can do things they can't do. Some people think that those tests, those antibody tests will tell them that they're no longer infectious and so they can go back in public. Well, people will start developing antibodies even while they still have virus that's shedding. And so it really doesn't tell you that. And other people think, well, it's going to tell me that I'm now immune, I'm protected. Dr. Nate Smith: (29:42) And we don't know that either. We know that some antibodies are protective and other antibodies just show that the immune system has been exposed. And so just having a positive antibody test doesn't mean that you're necessarily protected from COVID-19 in the future. So that kind of brings down a little bit of the kind of euphoria about it. When you talk to the people who don't like it, the laboratory people, it's because it's not reliable for picking up acute infections or new infections. And that is true, but we were not suggesting using it for that. We're suggesting using it for finding out who's been infected in the past. And then the other reason that laboratory people don't like it is because a lot of the tests don't work very well and we don't really know how well even the best tests work. Well, you know, we're not going to have a perfect test. Dr. Nate Smith: (30:36) We'll pick the best of the ones that are out there and we'll utilize them to get an idea of what's going on in the community. Now it may miss some cases, some people who actually were infected in the past may not have enough antibody to detect and there may be some cross-reactivity. So it may pick up someone who wasn't actually infected in the past. But overall it will give us a picture. And we're doing this in partnership with UAMS and then CDC has announced their strategy for doing serologic testing, antibody testing to find out some information about how COVID-19 has spread in communities. That's information we don't fully have right now. Speaker 5: (31:20) Do you have a test that you would recommend or? Dr. Nate Smith: (31:23) There are a handful of tests that have received FDA's emergency use authorization and I really don't have information on which of those is better than the other, but we have put out a directive saying if you're going to do antibody testing, you need to either choose one of these or choose one that we've been able to establish its accuracy and has a written approval for me. And for example, if you UAMS develops one and they can show that it's highly sensitive and specific than I'm happy to endorse it. Speaker 6: (32:00) Dr. Patterson, is UAMS doing any further research into the virus itself or even other treatment options? Dr. Cam Patterson: (32:08) The answer to that question is yes and in fact we have fast tracked a substantial number of clinical studies to help us to understand this virus. And I'll give you one example. We have an investigator at UAMS who has been looking at the structure of the COVID-19 virus and then screening compounds virtually to determine drugs that we might be able to pull off the shelf that will be effective as antivirals and the treatment of COVID-19 so, we're actually in conversations with the person with whom that drug sits on the shelf to talk about clinical studies. But that's just one example of many different trials that we're doing to understand the COVID-19 virus and its impact. Another major area of focus for us is the differential impact of COVID-19 virus in different communities. So there's data nationwide about differences in African-Americans and their response to COVID-19 we have a number of special populations in the state of Arkansas that we need to be mindful of. And so we're doing the work on those communities as well. Gov.: (33:20) Is there a question remotely? Jacquelyn T: (33:23) Governor, Jacquelyn [Troller 00:33:25] with Public Radio KUAF. Gov.: (33:26) Yes. Jacquelyn T: (33:27) I have a question regarding the lawsuit filed by ACLU and [inaudible 00:33:33] and other civil rights groups regarding the COVID outbreak and our physical distancing masks and cleansing practices is now in place in all the barracks, sir? Gov.: (33:45) Yes. In terms of the public health requirements, Dr. Smith and his team has worked closely with secretary Kelly and Director Payne they have all the inmates have masks that are available. They have opportunities to cleanse and the equipment to cleanse the facilities and so they're working very closely and taking every precaution that they can to avoid the spread and to make sure that the inmates are properly taken care of. Jacquelyn T: (34:25) Follow up question. I covered a protest at a Tyson slaughterhouse yesterday where workers' rights advocates say there's no transparency on coronavirus cases in that work force is the state tracking cases in meat packing facilities in Arkansas, sir? Gov.: (34:45) I want to ask Dr. Smith to a comment on that. Jacquelyn T: (34:47) Thank you. Dr. Nate Smith: (34:51) That's an area that we're very concerned about. For obvious reasons, we've been working, interacting with particularly the poultry industry. I'm not aware of any outbreaks in any of our meat processing facilities. Jacquelyn T: (35:08) Thank you. Melissa Z: (35:12) Hi, this is Melissa Zygowicz for channel 11. Our neighboring state, Oklahoma and Tennessee are starting to lift restrictions tomorrow. Do you believe this will happen in fact here in Arkansas? Gov.: (35:25) Well, in terms of lifting restrictions, every state looks at their own data and they look at where they are in terms of COVID-19 and they make the judgment for their state. In terms of Arkansas, we've set a very clear timeline that we have. We're looking at May 4th to examine where we can lift restrictions. We've set some very specific dates, the first one, next Wednesday, April 29th to determine whether we can lift any restrictions in regard to dining restaurants. So that's our timetable. Working very hard to make the right decision. As I know the other governors are working with their public health team and their respective states. We're not going to be stampeded into doing it. We weren't stampeded into sheltering in place, we're not going to be stampeded into making too quick of a decision or a decision just because it seems to be the national mood. We're going to do what's right for Arkansas based upon what we see here and the direction we need to go. Speaker 7: (36:41) How much consideration is going to be taken with those prison numbers in terms of reopening and maybe lifting some of those restrictions, I mean obviously that's a different category, but knowing what's happened in that close environment, how is that going to play into the restaurant, things like that? Gov.: (37:01) I mean, it's a fact and we care about the inmates, we want to make sure that they have the proper care and they were doing everything to prevent the spread within that city. But the prison system itself is like a, not a governmental unit. But it is a city. It is a congregation. It's a body of people separate and apart from the entire state. What we watch and what I watch is the correlation between the prison setting and the community and the guards and the personnel, the staff at the prison facility and how that impacts the community. I think that is a very relevant fact. And so there's a lot of factors that go into the decisions, but the most important fact is where we're going as a state in each of our different communities. Dr. Smith. Dr. Nate Smith: (38:07) I agree with everything the Governor has said. Now we've made the decision not to include workers at those facilities in those separate categories. So they're included in the community numbers because they go home to their families and they interact with the community. Once they know that they are infected, of course we expect them to take the same measures of home isolation that anyone else would. But those numbers are included in our numbers. So we'll watch those carefully. But those who are in that closed system of a prison, they don't impact our community transmission in the same way that other cases would. Speaker 8: (38:55) The four steps that you laid out for testing, do you have a timeline for when those are going to be implemented and also on the serologic testing. How would those samples actually be collected? Gov.: (39:11) In terms of the strategy, we could start implementing the broader category of those that can be tested immediately, so that can be implemented. Expanding the testing for contact investigation, that is an immediate implementation. It's a change in our guidelines so that can be done. The screening for COVID-19 in high risk settings has already started with the directee for elective procedures, that will continue to grow based upon available resources that we have in other high settings. The fourth one on the antibody testing, we'll probably move a little bit slower because we're waiting for the right to kind of test and I think the rest of it you'll have to answer, Dr. Smith. Dr. Nate Smith: (40:07) Yeah, the Governor's outlined it a very well. The first three have already started and you'll hear more pertinent to each of those strategies as we go on the last one, the strategy developing a strategy for serologic testing. That's not an urgent priority. It's important, but it's not something we need to do. We start right today because the CDC is rolling out their strategy. We really want to partner with them and be doing something that corresponds with what other states are doing. So we have comparable data. There are also research projects that we'll be doing, serosurveillance in specific communities and we'll encourage those, but we just want them to all be coordinated so that we can put the pieces together. Those tests are generally blood tests. Oftentimes they can be done as a point of care, as a rapid test, but the key is to get all the information, all the data together so we can make that make sense. Speaker 9: (41:08) Specific criteria for the antibody testing or is that kind of become one cabal? Dr. Nate Smith: (41:15) Well, for the antibody testing, it's really going to depend on the strategy we use. We'll probably choose some specific communities, some specific populations. Again, since we're not using it to detect new infections, we're not looking for people who feel sick. Those we would want to use the PCR test for. Dr. Cam Patterson: (41:40) Yeah, I would agree with that. And- Speaker 10: (41:46) Do you have planned for the surge and testing, is that something that starts today, is that a Friday, Saturday thing, or is it early next week? When are the two days when everybody should get tested? Gov.: (41:54) Okay, I'm going to come back to that, Cam won't you finish your answer, then I'll answer that one. Dr. Cam Patterson: (42:00) Yeah. So I think to address the question, who's. Speaker 11: (42:03) Yeah, to address the question, "Who's going to get serologic testing?" Part of that is going to depend on how we determine it can be utilized. It may be that we develop good assays for IgG antibodies, not IgM antibodies. It may be that some antibodies are predictive of the potential for re-infection and others aren't. Speaker 11: (42:25) There's not an answer to that question right now because there's more work that needs to be done. But obviously we're interested in answering those questions as quickly as possible. Gov. Asa Hutchinson: (42:35) In terms of the two day surge for testing in Arkansas, I'm looking at Friday, which is tomorrow and Saturday. That's the two day timeframe. I think those are the best opportunities. And then we'll see where we are next Monday. And we'll see what kind of adjustments that we need to make. Gov. Asa Hutchinson: (42:57) But we want to urge all Arkans to take advantage of the inventory that we have on test in our different medical community facilities across Arkansas. If you think you need a test, go in and get a test in the next two days. Audience Member: (43:15) Is there still a problem with the supply of swabs and materials that are needed to actually collect the- Gov. Asa Hutchinson: (43:21) In my discussions with the hospitals, they're in good shape right now. It's something they always worry about for the future. And that's why you don't want to completely deplete their inventory of PPE and swabs. Because as they move into elective procedures, they have to do testing then too. Gov. Asa Hutchinson: (43:41) Som they've got to keep a level of inventory that they're comfortable with. But it's a high inventory now in most of them that they can do this surge very comfortably and still have that inventory that's needed. And we're continuing, again, director Gary is here working every day on making sure that supply chain continues into the future. Yes? Audience Member 2: (44:06) When testing patients before those elective procedures, who will be doing that testing? Will it be the doctor's offices themselves and will test be made available to them? Speaker 11: (44:15) I don't think that there is a single standard yet. I know the Department of Health is going to provide us with more guidance about what we need to do, but I can tell you that at UAMS, our plan right now is for a test for someone who has an elective procedure to be done at UAMS, that they will need a negative swab within 48 hours before a procedure is done 100% of the time. And we'll do those all ourselves. Dr. Nate Smith: (44:54) Just to clarify, for one, the rural hospitals that were excluded from the original restriction on elective surgery, they're not included in that requirement. But those who have been restricted, there are a variety of ways that they can accomplish that. If it's a hospital that does that testing in house, then they can just test on site. Dr. Nate Smith: (45:21) Some of the hospitals that are not currently doing testing for COVID-19 in their own lab, I'd really like to encourage them to seriously consider bringing that capability on board. We're going to need it as time goes on. I think if you want to be able to offer the full range of services to your patients, that's something that should be an expectation in the future. Dr. Nate Smith: (45:45) There are commercial labs though that can give a rapid turnaround. We've found commercial labs that can assist us in our case investigations doing large volumes with turnaround times of 24 hours. So, even if a hospital may have struggled with that a week or two ago, if they make some phone calls, I think they'll find commercial labs that can assist them in getting that 48 hour turnaround. Dr. Nate Smith: (46:10) Ideally, we would like that testing to be done on the day of surgery, or at least within 24 hours, but understanding the practicalities that not all hospitals do have that within their laboratory capability, we've extended out to 48 hours, but we really don't want to go longer than that because someone easily could have become infected in that period of time. Nick Camper: (46:31) This is a followup question to the elective surgeries. This is Nick Camper with KFSM in Northwest Arkansas on Fort Smith. I just wanted to know, for those clinics and hospitals that do perform elective surgeries, you've talked about that there is ways to get a response in 48 or even 24 hours. Do they have enough tests to give to everyone that is looking for an elective surgery? Gov. Asa Hutchinson: (46:52) Well, I think that's similar to what I said a moment ago, that in the inventory of the hospitals and clinics, that they do have that inventory of testing capability. And they're prepared for that. They know that this requirement was coming. So they've reserved and they have their own flow of testing kits from their commercial labs. Gov. Asa Hutchinson: (47:25) They have those relationships. We believe we're prepared for that, that they are prepared for that. We will continue to monitor it. Question here. Audience Member 3: (47:33) Yes. Do you have any guidance on when dental offices and places like that will open? Gov. Asa Hutchinson: (47:40) Which offices? Audience Member 3: (47:41) Dental offices. Gov. Asa Hutchinson: (47:42) Okay. Audience Member 3: (47:44) And as May 4th comes around and you begin to lift the restrictions, are you going to require Arkansans to where math and other social distancing measures? Gov. Asa Hutchinson: (47:56) I'm going to let Dr. Smith answer the question on the dental side. But in terms of the mask, we have consistently encouraged Arkansans to wear a mask when you cannot socially distance. We try to practice that everywhere we go. Gov. Asa Hutchinson: (48:15) In terms of as you look to May 4th, and phase one and onto the future, both the White House guidelines and our guidelines emphasize that even as we lift some restrictions on businesses, that the guidelines for wearing masks, and social distancing, and the gatherings, we want those to stay in place. So, we have to discipline ourselves to use those as protective measures for ourself and for others. Dr. Nate Smith: (48:52) With regard to dental offices, we are [crosstalk 00:48:55]- Gov. Asa Hutchinson: (48:56) Just one second, we'll come back to you. Dr. Nate Smith: (48:58) With regard to dental offices, we are working on some guidance to help open those offices as quickly and as safely as possible. We hope to have something fairly soon. I know that the work that dentists do is very important. But we also know that it's a potentially very high risk if it's not done safely. Dr. Nate Smith: (49:26) With regard to the masks, there may be some businesses where it does make sense for them to require their employees, and in some cases their customers to wear those face masks. And that would be very reasonable. You have no shirt, no shoes, no service. Well, no shirt, no shoes, no mask, no service. I'd be fully supportive of that. Gov. Asa Hutchinson: (49:50) One final question from remotely, I heard someone speak up. Neal Gladner: (49:55) [crosstalk 00:49:55] this is Neal Gladner, KZNG in Hot Springs. Could you re-explain the May 4th? Because the guidelines for the gating as outlined by the White House calls for a 14 day downward trajectory. And if I saw the chart correctly, it looks like we had a little uptick even discounting the numbers out of [inaudible 00:50:17]. So, can you help us understand that better as we get closer to May 4th? Gov. Asa Hutchinson: (50:21) That's a very good question, Neal. The short answer is that when the White House announced those guidelines, they emphasized these are guidelines and the states have flexibility to determine their own criteria and what makes sense in their state. So, we shouldn't look at that as the end all in terms of that's the only criteria we should look at. Gov. Asa Hutchinson: (50:49) There's multiple different criteria as part of entering into phase one. In terms of where we are in the 14 day decline in the number of cases, you're right, May 4th is closer than 14 days. And we've had a couple of days in which our cases have gone up. We're going to look at the multitude of factors there as we make that decision. Gov. Asa Hutchinson: (51:16) I'm going to rely upon our public health experts as we make those final decisions. The first one being next week. Then there's one more question that I heard remotely. We'll take one more because I heard somebody's voice. Garrett Fergeson: (51:34) Yes. Thank you governor. This is Garrett Fergeson KWA Fox 24 News. The Washington County Coroner said that there were two deaths reported here in Northwest Arkansas. He said one was Marshallese and one was Hispanic. Are these particular concerning to the Arkansas Department of Health? Gov. Asa Hutchinson: (51:53) Just one moment. Dr. Nate Smith: (51:59) First, I'd like to say that any death in Arkansas is one to many. So, each of these are concerns to us. We're particularly concerned about infections, hospitalizations, deaths in some of our harder to reach communities where there may be barriers of language or culture. So, we're looking at that very carefully. Dr. Nate Smith: (52:24) We have already been working with the Latino community, with the Marshallese community, preparing messages that are culturally adapted and in the appropriate language. And we'll continue to do that. But we'll also make sure that we're doing adequate testing in those communities as well. So yes, those are a concern to us and we're already taking action. Gov. Asa Hutchinson: (52:53) All right, one final question from the table here. If there is one. Audience Member 5: (52:58) Some people are going to be a little skeptical about the surge in testing. So, does the bartender in Mena, do they get priority over a state senator who might have symptoms, or who gets the priority? Gov. Asa Hutchinson: (53:16) Well, no one should get a priority. They should get. They should meet the criteria for testing, which is flexible in the sense that if you're symptomatic, if you are have done some at-risk travel, or the physician determines that there is a broader need, then they should be tested whether it's a bartender or whether it's a state senator. And then was there another question? Audience Member 6: (53:49) [crosstalk 00:53:49] self employed unemployed benefits? Gov. Asa Hutchinson: (53:53) Yes. First that's a good segue into ending this because tomorrow I will have a Secretary Preston here. We're going to delve into a number of things in terms of the economic situation here in Arkansas. Gov. Asa Hutchinson: (54:12) But in terms of the pandemic unemployment assistance for the self employed, that system is being built, the money is available. And we're hoping, I believe it's the first week of May, hopefully that will be available. Audience Member 7: (54:26) So, is the reopening of some of these things, like I would assume the barbershops, things like that. Is that going to affect if they can tap into any of that resource? Gov. Asa Hutchinson: (54:41) It's my understanding that they will be able to go back to the point that they were unemployed. And that they would be able to recover that, even though they're going to go back on employment perhaps in the future. Because they should not be penalized because we've had to build a system in order for that to work. Thank you very much today.