Gov. Gavin Newsom California COVID-19 Briefing Transcript April 22

Gavin Newsom: (00:00) Those six key indicators that are informing our decision making as it relates to augmenting and modifying our stay at home order, and we'll dive deep into one of those indicators, specifically on the area of testing, tracking, tracing, isolation, and quarantine. Dr. Ghaly will make that presentation here just in a moment, but first, I wanted to set things up and create a context for this discussion. Gavin Newsom: (00:28) I deeply recognize, deeply understand the desire for people to hear directly from the administration, from the state and its leadership, about the answer to when. When can we go back to some semblance of normalcy? While a vast majority of you I think recognize that decision needs to be guided on the basis of the virus and its spread, decisions on the basis always first and foremost of public health, the pressure to answer that question, nonetheless, is very real. No one wants to be able to share that information more with you than I do, and I wish I could prescribe a specific date to say, "Well, we can turn out the light switch and go back to normalcy." Gavin Newsom: (01:12) We have tried to make it crystal clear that there is no light switch, and there is no date, in terms of our capacity to provide the kind of clarity that I know so many of you demand and deserve. The clarity, however, we are providing today, is the clarity of indicators that guide that decision making, and the transparency around those indicators, and that framework that allow us to organize around six specific themes and teams, to every single day, monitor conditions on the ground. It's driven not by ideology, but by argument, by evidence, and by the curation of best practices, not just across the state, across the country, but from around the rest of the world. Gavin Newsom: (02:01) We led with that first indicator that we'll talk about more in a moment around testing, tracking, tracing, isolation and quarantine, but we included five additional indicators, considerations that we must [inaudible 00:00:02:15], making sure we protect the most vulnerable Californians, our seniors in skilled nursing facilities, nursing homes, assisted living centers, those that are vulnerable out on the streets and sidewalk, the homeless, people with compromised immune systems, that laid out framework for our second indicator, how we protect the most vulnerable. Gavin Newsom: (02:35) The third indicator was around hospital capacity, health care delivery capacity, not only within the hospital system, but the creation and the opportunity to provide alternative care sites and facilities, to do so, not just with physical assets, but to make sure we have the human resources, the people, and the protective gear to make sure that the health workers are healthy and safe, at the same time. Gavin Newsom: (03:01) We had a fourth indicator around the issues of therapeutics. We talk a lot about herd immunity and vaccines. We, in California, are uniquely positioned because of the National Institute of Health, four of the top 10 funded NIH sites are in the State of California. We are blessed and endowed with some of the finest research institutions and hospitals doing therapeutic studies and advanced therapeutic partnerships in this state. Well, it's respectfully among the most robust of any state in this nation. So therapeutics also is a category that guides our decision making. Gavin Newsom: (03:42) The issue, obviously, of businesses. Issues related to schools, and physical facilities is another area that guides our consideration. That's indicator five. I've made it clear in the past that we won't just open things, we'll have to open things and modify how we conduct our business, how we educate our kids, how we take care of our children, and we talked about floor plans just a week ago, and what that looks like in terms of practicing physical distancing, as we begin to process the considerations for reopening the economic sectors in our society. Gavin Newsom: (04:23) And finally, the issue of what happens if we overcompensate, over tact? What happens if we get ahead of ourselves and we start to see a surge of new cases, hospitalizations, people in ICUs? What's our capacity to reinstate some of these conditions in hotspots, and our capacity to project some confidence in doing so, and confidence in you, that doing so is appropriate, and the old bide by those rules at the same time, because we are not lost on us, trust is the most important commodity in these conversations. Building that trust with you, 40 million Californians, to make sure we're continuing to practice physical distancing, social distancing, and abiding by these guidelines, recommendations and directives. But we recognize we're testing that trust every day, because of the deep desire for people to begin to know when they can get back to work, when they can go back out and recreate, and enjoy the beautiful parks and beaches in the State of California. Gavin Newsom: (05:28) And so today, we want to further that conversation. I want you to know you'll be left wanting if you woke up to this discussion, and were going to hear that we're reopening large sectors of our society, we're not prepared to do that today. I very much look forward to making those announcements, and we won't wait week to week to make those announcements. When we're ready, we'll make those announcements in real time. But I am ready today to make the following announcement. We have been working with our partners in Washington State and Oregon, guided by their experts and guided by their examples, and helping us to inform our own efforts here in the State of California. And based upon indicator three and the work that we have done together in providing alternative care sites, the incredible work that the hospitals have done to decompress their existing facilities and provide capacity to increase surge, and the incredible workforce that's been assembled, we are in a position today to begin to pull back and lean in, by beginning to schedule surgeries once again, throughout not only our hospital system, but our broader health care delivery system. Gavin Newsom: (06:45) These are surgeries that yes, are scheduled, but also are essential. Tumors, heart valves, the need for people to get the kind of care that they deserve. If it's delayed, it becomes ultimately denied, it gets delayed, becomes acute, and that's, fundamentally, is a health issue. And so, beyond just the issue of the virus, we are working with our health directors and throughout the health care delivery system, to reintroduce the capacity to get these scheduled surgeries up and running again. We will be very thoughtful and judicious about how we do that. We will not overload the system at peril of not being able to maintain our surge capacity, and we recognize anytime we begin to toggle back and start opening things back up, we have to look every day at the data, the dashboard of information coming back, to make sure that we are adjusting to these new decisions, and maintaining an understanding that we need to be vigilant about the intended consequences of these decisions, and the unintended consequences of these decisions. Gavin Newsom: (08:01) So if you are asking yourself, "Well, how can we guarantee if we're bringing back all of these scheduled surgeries, that there'll be availability if we see a second wave or a large surge, as we start pulling back, that we have capacity?" We are monitoring that, and that's foundational in terms again, of this dimmer, not light switch, that we are advancing in terms of just beginning to shift things, but recognize that that shift, that dial could be turned up, or the dial can be turned back in real time. But this is, for us, a significant health first focused announcement today, to begin to augment the stay at home order, but to do it with an eye on public health, and making sure we secure the safety of our health care delivery system, and that includes the workers, making sure we always are providing care to the caregivers, keeping our health care workers healthy at the same time. Gavin Newsom: (09:04) So that is the announcement we wanted to make today, as it relates to a modification of that stay at home order, that is determined by adaptive decision making, that is foundationally focused on the indicators giving us that green light, informed by the indicators. Accordingly, we wanted to talk about another indicator, again, I referenced a moment ago the issues of testing and tracing, which will be foundational to our broader efforts to get to those other indicators, and when retail stores open, when recreational opportunities are made available again. The testing becomes foundational in that effort, the tracing becomes foundational in that effort. Gavin Newsom: (09:53) I have a number of things I want to add to that discussion, and while it is true that we have provided testing for 465,327 individuals, that number is still inadequate to meet the needs of all of you, and to meet our expectations, as it relates to our capacity to begin to move even further, in terms of augmenting and modifying the stay at home orders. So 465 plus thousand tests have been done. We went from 2,000 tests on average a day in March. Just a few weeks ago, we made announcements with the new testing task force that committed to advancing that number to 10,000 by April 14th. Just a few days ago, we announced we're actually at 14,500 tests a day. Right now, we're about 16,000 tests a day. Forgive me for [inaudible 00:10:54] all these numbers, perhaps confusing you, except to say from 2,000 at the end of March, to now a goal by the end of April, of 25,000 tests. 16,000 on average today, get to 25,000 by the end of this month. Gavin Newsom: (11:11) Our goal is north of 60,000 tests a day, and that's phase one goal. That's a short term goal. Over the next number of months, we want to have a minimum of 60,000 tests. We're hoping to get closer to 80,000. So it's 60 to 80,000 is the framework, the minimum being 60,000 tests a day. Our entire PCR tests, that's the swab-based test, capacity, the instruments that exist in the State of California, if 100% were at full throttle and everybody was being tested because we had all the supply chains intact and ready to go, it would be about 95,000 tests. Gavin Newsom: (11:53) We can conduct a PCR test. These are not the serological tests. I'll get to that in a moment. But the PCR test, the swab-based tests that many of you recognize, the instruments have the capacity to get up to 95,000. We believe that we can get not only to 25 shortly, but get to that 60 to 80,000 range within our existing framework of expectation of when supplies are coming in, when more equipment will avail themselves, and one more sites present themselves, in communities all across this state. And that's something else I wanted to share with you. We are significantly increasing the sites of availability. At the same time, we're increasing capacity within the existing system. There are hundreds and hundreds of testing sites in the State of California, well over an excess of 600, but there are 251 core sites that really make up the backbone of our testing system in the State of California. Gavin Newsom: (12:56) We did detailed surveys of those 251 sites about what they need to increase capacity. 50 to 55% of those that we surveyed said their number one need is swabs. Others suggested they need viral transport methods, and the old media that is used to take the swab and put it into a little kit, and send it off to be diagnosed. The diagnostic side, less stress, though always critical, the RNA extraction, the reagents, substantially, many of those roadblocks have been lifted. It's still an issue, but not as significant as half of those that were surveyed saying, it's really now getting the specimen. That's the bigger issue with our testing capacity. Gavin Newsom: (13:49) I just got off the phone with President Trump less than an hour ago. We had a very specific conversation about not just the survey, but the need for swabs, a very pointed and honest conversation, and the President secured and gave me the confidence that we will receive, just this week, a minimum of 100,000 swabs, and that's the ability to collect 100,000 specimen samples. That will be forthcoming to the State of California this week. He said then we will be provided 250,000 swabs next week, and he said THE third week, expect to see a substantial increase above the 250,000. That was a very good phone call. I want to thank the President, not only for being available for a phone call at a moment's notice, but being willing to directly commit to all of us in the State of California, to a substantial increase in supply of the swabs. That will go a long way to give us all more confidence that we can meet some of these testing goals, these stretch goals, and assuage the concerns around those 251 sites that have reported a need for more swabs. Gavin Newsom: (15:08) So that specifically is an advancement on our commitment to do more in this space, but we have a second commitment that we are making public today to do more, and that's a commitment to make sure all Californians are tested. What I mean by that is not all 40 million of us, that would be ideal, but in every part of the state, where we're not leaving communities behind. One of the big struggles we have had in the last few weeks of this pandemic, is getting to rural and remote parts of this state, and getting up testing sites and making them available. One of the other vexing and frustrating things is getting into our urban centers, and making sure that we're getting into black and brown communities, and doing justice to people that are also underserved, even in these remarkably enriched and robust, and well-resourced communities. Gavin Newsom: (16:06) And so today, we are announcing 86 new sites that will become operational, that are focused from a socioeconomic lens, focusing on black and brown communities, and focusing on rural communities. We've put together a heat map of the state where we define testing deserts, and we're going to begin to plug these programs into these sites. The two companies, Verily, they'll provide six of these sites, that's the partnership we announced a few weeks back with Google and then the other is OptumServe, and they're providing 80 specific new sites, end-to-end testing. These sites will provide the kind of continuity that we need to ultimately advance our collective goals in this state, to reach these testing goals. So I want to just thank those two companies- Gavin Newsom: (17:03) ... for the robust conversations we've had in the negotiations and I'm very pleased today to make that announcement that we are moving in that direction. In addition to that, we [inaudible 00:17:14] with Abbott laboratories for 1.5 million serological tests, and 130 facilities in the state of California. I caution people in this space as I've been cautioned in this space around a serology broadly defined the focus on antibodies in immunities and immunity. I know that it's been a point of real attention. Typically, the work that was done recently on Cerro surveillance, which is serology tests with a community surveillance mindset that was done in early April 1st by Stanford university in Santa Clara, 3,300 or so tests and then on April 10th and 11th in partnership down in Southern California at USC. Those tests got a lot of attention, but they also generated a little bit of controversy about what they are and what they're not. Gavin Newsom: (18:09) We don't use serological tests for diagnostics, still traditional PCR against swab based tests. There's still some open ended questions around serology and antibodies in immunity and I just want to caution people in this space. A lot of energy, a lot of enthusiasm in the space. I share that energy and share that enthusiasm demonstrably so with the deal we made with Abbott just on the 1.5 million tests with them alone. But I caution all of us as that information comes in as a more peer review is being done in this space that all of us start to understand. While it can be extraordinarily helpful in terms of guiding our framework and indicators for reopening, it's not at this moment of panacea, but it could be profoundly significant and we are certainly going to do our part in addition to procuring PCR tests. We will do the same to provide the serology tests to people all across this state. Gavin Newsom: (19:11) Much easier test of these bloodborne based tests and much more capacity to deliver those tests. But again, our testing numbers are predicated on more traditional PCR tests at the moment and that's the foundation to which we will build. Accordingly, our foundation in terms of testing doesn't mean much unless you can begin protocols to track and trace. We in the state of California have a long history of testing and tracking and tracing patients the history of TB, measles, the health departments all throughout the state of California County health departments have been running, testing, tracking, and tracing protocols for some time. STDs, gonorrhea, very robust tracing that's been done throughout the state of California and that's base HIV, a lot of testing and tracing and tracking has done in that space. I say all that to make this point, we're not starting our tracing program from scratch. Gavin Newsom: (20:15) Quite the contrary. You have trained professional workers and local health departments that do this every single day. The question that's asked of us now is to do it at a scale that we have not seen, but the good news again is all of that resource is enriched and exist and persist all across the state. So we want to build bottom up on that work. And what we've been doing is serving not only the local capacity and workforce, but the ability to retrain and re-prioritize the state workforce. We have a governmental group called GovOps. They've been doing surveys of state workers to see if they're willing to do different work and help support our tracing and tracking efforts. The good news is we believe we have the capacity to build a army of tracers beginning with a goal of 10,000 and that is now our stated goal to train these tracers and get 10,000 folks up and operational. Gavin Newsom: (21:23) Again, building off the local infrastructure, supplementing it as we can at the state level and supporting it to the extent with any volunteer workforce, but we want the professionals first to guide these efforts as these tracing is not just about numbers, it's about quality and that quality again is about enriching the work that's been done at the local level. We've got a new training academy that we'll be putting up online in this space to help support that work of those 10,000 individuals and we'll get an aggregated data set that will allow us to track the trackers, track the tracing that's done throughout the state of California. Currently. Again, decentralized and we'll begin to organize it in a more centralized manner. So 86 new sites, testing sites in rural California and deep in urban California to make sure we are truly culturally competent in our testing capacity to increase our testing by multiples aided and supported by the support today that the president offered in terms of our specimen collections. Gavin Newsom: (22:37) The capacity, again to support that tracing that ultimately will lead to questions of isolation, which has to be regionalized and quarantine, which is an economic issue as well, which is part and parcel of what Dr. Ghaly is here to talk a bit more about and so he'll dive deeper into this space, but I want you to know this space is one of six, not all six are equally important indicators. All of them are important, but this one may be among the most important in terms of our capacity to make subsequent announcements in terms of how we're starting to loosen up our stay-at-home order. And so that's why we felt today it deserved a little bit more attention and a little more intentionality in terms of not just our focus but socializing that focus here with you. So with that, forgive a long-windedness by the way of that opening comment, with that, I introduce Dr. Ghaly. Dr. Mark Ghaly: (23:45) Thank you governor and good afternoon. It's a pleasure to be back with you today. I want to spend a moment building upon the explanation the governor gave again, reminder of our six indicators and to say just a couple of additional things to reemphasize this concept of it's not a switch, it's a dimmer. That we are constantly looking at how quickly we move that dimmer, understanding where we are with our data, where we are with our preparedness and making sure that we have all of our partners including our local County partners, our city partners and our industry partners to make sure that we all move together and that we continue to look at different ways to build upon that information so that we in a responsible but swift way move the dimmer. So we focus broadly on health that we know the impact is great as we stay at home, the economic impact and making sure that we do this great balance between protecting around COVID health and focusing on broad health for our communities and our citizens of California. Dr. Mark Ghaly: (24:57) We also know that there are a couple of issues in our indicators that are must haves. You have heard us talk on a daily, at least weekly basis about the pursuit of protective equipment, PPE. We know that we need to have significant amounts before we can move forward with any of our plans to modify our stay at home order. The governors spoke about the great work we've done in our healthcare systems to prepare with beds, ventilators, people, supplies that that is secure is a very important thing that we continue to maintain. So that we can safely and responsibly move forward with modifying some of our stay-at-home orders according to our indicators. I also want to say that deep thank you to our local public health departments, the directors, the public health officers in those regions for their great communication and effort working with us so that we have all the local data, all the local thoughts on how we build forward and modify the stay-at-home order. Dr. Mark Ghaly: (26:09) We have put, as the governor directed us to do, a work group for each of the indicators, those have been formed. Those are meeting regularly and reporting and each one of those work groups has presence from our local public health leaders to make sure we take all of the information from across the state and informs our decision making. So it's been wonderful week of progress and now I want to spend a little bit more time talking about that first indicator, our ability to monitor and protect our communities through our testing, our ability to do contact tracing, isolating and supporting those who are positive or who've been exposed. So, one last reminder that we built these indicators around a goal, four goals really, and I want to remind you what they are. We want to ensure our ability to care for the sick within our hospitals. We want to prevent infection of those who are high risk for severe disease. We want to build the capacity to protect the health and wellbeing of the public and we want to reduce the social, emotional and economic disruptions that many of us are facing. Dr. Mark Ghaly: (27:27) So these indicators are really formed around these four goals. I want to spend a moment a little bit on our data. We have been telling you day over day our numbers in hospitals in ICUs and as we look at these over the last many weeks, especially since we've instituted the statewide stay-at-home order. We see ourselves tracking in what we call our range of stability and this lower line is the number of ICU beds and vents that we are using across our system. This upper line is our total number of hospitalizations, both of those who have been confirmed to have COVID and those who we've suspected. And as we look at this trend line, you see we've had small peaks along the way, but we have generally stayed. This is since March 27th, we've stayed in this zone of stability, range of stability that give us confidence that we are prepared to move forward with some of our modifications. And as you hear in the national media conversations about where are your cases, where are your hospitalizations going? Dr. Mark Ghaly: (28:45) We really wanted to share with all of Californians the data we've seen across the state that gives us confidence in moving in the directions that the governor laid out moments ago. I want to remind you a little bit more of the detail of our indicator one. Two of the key questions that we ask ourselves is how prepared is our state to test everyone who is symptomatic and do we have the ability to identify contacts of those who are positive to reduce their further transmission? So what is contact tracing? When someone tests positive for COVID-19, we want to be able to identify those who've been in close contact with that person. And for each of those persons that we are contact tracing, we want to be able to contact them first. We want to be able to check their symptoms, offer testing, and recommend isolation to start or quarantine to start, and isolation as necessary if they indeed test positive. So why is this important? It enables us to suppress the spread of the virus to avoid outbreaks. Dr. Mark Ghaly: (29:53) It is very important that as we identify somebody who's positive, we meet and contact their close contacts that we're able to limit their chance of spreading COVID-19 in case they in fact are infected. And that being able to do that gives us the ability to first maintain the surge capacity that we've worked hard with our healthcare delivery partners, our labor partners over weeks to maintain so that if we do have an increased number of people who are COVID, positive that our systems are prepared and able to care for them. It also allows us to modify our stay-at-home order because we have more confidence that when somebody is infected or when somebody is exposed in our community that they are going to join us in trying to limit the spread by staying home and isolating or quarantining. So we have looked at many of these indicators and we've developed a series of work streams. For indicator one, we first talk about accelerating equitable COVID- 19 testing. Dr. Mark Ghaly: (31:01) The governor laid out many, many great strides we've taken on testing. We've made improvements on our ability to obtain the supplies, whether it's swabs or viral transport media, our ability to work with partners. The governor mentioned Abbott. We've been in great conversations with LabCore and Quest as important national commercial lab leaders to ensure that capacity that they have today is available to Californians. We are at the state level through our testing task force coordinating the connection of those supplies with the new testing sites that the governor mentioned and many more that we hope to stand up both at the local level and with state leadership to ensure that we have all the places available that those who need a test and even those who want to test can be tested to provide not just the public health reassurance but also the personal reassurance that we can continue and resume certain activities that we have delayed up until now. Dr. Mark Ghaly: (32:07) We know that the governor mentioned the number 60,000 to 80,000. The way we get to that number is both through national conversations on a number of tests per 100,000 people. The governor mentioned 152 tests per 100,000 Californians gets us just above 60,000 tests a day that we would need. We additionally look at it from the perspective of, well, if we expect a slight increase in the number of cases to somewhere between two and 3000 per day, that then we understand that on average each of those has 10 close contacts that we need to create the capacity to test nearly 30,000 people, maybe even more, 35,000 people as a result of our contact tracing. And then additionally, to establish 25,000 tests to maintain and support the healthcare delivery system. Dr. Mark Ghaly: (33:06) Our clinics and many of those who are working in essential areas across the state, whether those are healthcare delivery sectors like skilled nursing facilities or our grocery stores and our transportation efforts. We want to make sure that those folks, those who go in to serve our communities are protected and we know we're able to tell them on a regular basis whether they're positive, whether they've been exposed, so they can not only do their job in a responsible and confident way, but they can also protect their families when they go home. And then we know that every year around fall, winter, and early spring, we experience a surge of symptoms of the common cold and the flu. And in this day and age, we have to ask the question, is that the common cold or is it COVID-19 and ensuring that we have increased- Dr. Mark Ghaly: (34:03) ... capacity during those months to test more people, gives us our range between 60 and 80,000 a day. Those are the PCR tests. Dr. Mark Ghaly: (34:13) As the governor mentioned, we are learning more and more about serologic testing. We are confident that as that technology and modality develops that California will be one of the first to adapt it and scale it across our state, first to use it for our surveillance efforts to understand how many people in our communities have been infected and then later as we are more confident that the antibodies that we're testing for actually neutralize, if they do, neutralize the virus to be able to say somebody has been exposed and they're protected to a certain degree. But I caution you that we are not there yet, that we are working with our academic partners and our lab partners to move that forward in responsible and yet accelerated ways. As soon as we are confident with how to use that modality in California, we will communicate that clearly and assertively. Dr. Mark Ghaly: (35:11) We also talked a bit about establishing our contact-tracing workforce, develop the isolation and quarantine poorer protocols and supports and deploy our data management system and tools. These are our four work streams for indicator one. Dr. Mark Ghaly: (35:26) To go just one level deeper, accelerate equitable testing. Today you heard the governor re-articulate our goal for the end of April to hit 25,000 tests a day. We are at 16,000 just a little bit north of 16,000 a day at the moment, with the goal and our confidence that we will be able to accelerate towards 25,000. That is on our way to getting to that 60 to 80,000 a day. Dr. Mark Ghaly: (35:52) Establish between 80 and a hundred new testing sites, and these are sites not in the common areas, not in the places where we already have a significant degree of testing, but in what we're calling testing deserts. Places that because they're a bit more remote, don't have as many testing sites that have come together at the local level and then also from a very strong equity lens that we put these in communities that have shouldered the burden of COVID-19 in a disproportionately high way. Those are our Brown and black communities. Those are lower-income communities where people are still going to essential work and maybe don't have as much of the PPE that we wish they had to ensure that A, that they are knowledgeable of their status with COVID- 19 and that they can continue to do their job and protect their family well. Dr. Mark Ghaly: (36:47) Then we are continuing to work with our new high throughput sites, our hubs, so that their capacity on their instruments is shared broadly, not just with their hospitals and clinics, but beyond with the skilled-nursing facilities that surround them, whether that's in San Diego or in the Sacramento area, really connecting all of these facilities to one of these testing hubs so that those specimens can be processed. Dr. Mark Ghaly: (37:15) It is no small announcement that we have a promise to have swabs here this week. Those 100,000 swabs are 100,000 tests, that's 100,000 people who can hopefully receive confidence of their status and understanding how we support our communities as we consider modifying that stay-at-home order. Dr. Mark Ghaly: (37:38) Establish our contact-tracing workforce. The governor mentioned that we have a rich base to build upon in each of our counties, that we are working with them to understand what they have today, what they expect they'll need in the future to keep up with the demand of COVID-19 contact-tracing efforts, that we are going to be developing the statewide training academy with their help. This will be an online training so that individuals who, as the governor mentioned, maybe it's our state workforce who is being redeployed and retrained to do this, there'll be a simple way for them to gain the skills and the knowledge of how to do this new job well. Dr. Mark Ghaly: (38:18) Our goal of having 10,000 public health connectors. Nice round number, but based on our assessment that as we modify our stay-at-home order, we expect that number between 2- and 3000 individuals to maybe be positive on a daily basis. If they each have 10 close contacts that need to be traced, that this is the workforce that we will need to supplement our existing foundation of contact traces across the state in order to meet that demand. If we see that go up, we are confident that California, a big state, a can-do state, that we will recruit additional people to join this fight. In terms of developing isolation protocols and supports, we are working with our local partners to develop those guidelines for isolation. We know that this is not straightforward for many, many populations and people. We talk about it not just can we find the place for you to isolate safely, but can we support you during those times of isolation. That is a very important piece of work for us that we are deep into and working not just with our local county partners on how to develop those protocols and guidelines, but many in the philanthropic community, and we appreciate the support. Dr. Mark Ghaly: (39:38) I was on earlier in the week with over 300 members of our philanthropic community talking about exactly this issue: How do we support our communities who may experience the undue burden of quarantine and isolation so they can do it safely and we can suppress COVID-19 and allow us to continue to modify that stay-at- home order? Dr. Mark Ghaly: (40:01) The last thing I'll talk about is deploying our data management system and tools. We know and many of you have maybe heard about tools that help us understand who is moving where. When we think about the data tools we're going to use first, it really flows into two main areas. Dr. Mark Ghaly: (40:18) First, we want to look at not just testing but leading indicators. Where are we seeing, for example, a really big surge in the number of people calling in with cold and flu-like symptoms? Where are we seeing even the number of over-the-counter medications for cold and flu going up? How do we look to that data to inform us and identify communities that might be experiencing a surge and bring our contact-tracing workforce, our testing capabilities into that community to not just protect that community but to ensure that if we are indeed seeing COVID-19 in higher levels that we prevent it's broader spread? We also will be working to ensure that we get all of that contact-tracing information in a easy to follow dashboard that tells us how many people are we contact tracing today, how many folks have we contact traced in the past and where are our trends heading, so we can continue to manage not just our workforce needs but also understanding what our testing capacity might need to move to so we can move beyond 60 to 80,000 if that's what the data and information tells us. Dr. Mark Ghaly: (41:36) I just want to end by, again, reiterating our thanks to so many different partners who have helped us get to this point, to the leaders here at the state, across state government who've come to build these six indicator work groups and the armies of people that are going to continue to inform our work as we thoughtfully consider how we modify the stay-at-home order and bring back many of the experiences you guys, people on the other side of this camera are wondering when we'll be able to do different things than we are today. I look forward to continuing to share where we are and where we're going in the days to come. Gavin Newsom: (42:20) Thank you, Doctor. Of course, Dr. Ghaly's available for questions, as am I, in a moment. But stability is the operative word. The indicators show stability, particularly in hospitalization numbers and ICU numbers. I've been commenting the last few days, weeks that those are the two numbers that are the biggest focus of our attention in addition, of course, to the tragic number of lives lost. 86 lives lost again yesterday. Not numbers, I'll remind you stories, real human beings, loved ones that have been torn and our heart continues to break for those that have lost loved ones to this virus. 6.8% increase over the previous day. Gavin Newsom: (43:04) Those hospitalization numbers, however, and the ICU numbers haven't been increasing as much. In fact, we saw today a modest decrease over the last 24 hours in terms of the number of hospitalized patients. 0.2% down compared to previous day. Our ICU numbers went down 1.8%, down 1.8%. Seeing slight increases, slight decreases. Again, thus this framework of a line that's beginning to straighten, to flatten instability. That is the predicate of that third indicator in terms of our hospital and healthcare delivery system's capacity to meet surge that allows us today to move more formerly with our partners at the local level and throughout the healthcare delivery system to once again schedule surgeries that are necessary but do again require more traditional scheduling. These are not plastic surgeries, these are not surgeries that are cosmetic. These are important medical procedures that if not attended to could become crisis and ultimately burden the rest of the healthcare system. Gavin Newsom: (44:21) That's the first significant effort to begin to modify that stay-at-home order and all the others are again, predicated on what Dr. Ghaly was laying out, a more robust testing regime that's more inclusive, more comprehensive, and the capacity to build this army of tracers and ultimately begin the very hard work of isolating individuals and then potentially quarantine individuals and addressing from a socioeconomic perspective, what Dr. Ghaly was referring to, their needs. If you're going to demand quarantine, someone then does not have the capacity not only to spend time with loved ones and families by definition, but also there's resource issues that have to be addressed and our task force is working diligently in that space. That was the reference Dr. Ghaly made a moment ago. Gavin Newsom: (45:15) I continue again to recognize your desire, my desire, our collective desire to hear more about when fill in the blank, when this opens, fill in the blank. I imagine there may be many questions about this specific city, this specific county. We've talked a lot about Ventura and San Luis Obispo and others. We're getting those calls, calls that haven't been made public yet about cities and counties that just want to make sure that we're being thoughtful, that we're rowing in the same direction. Interesting, the vast majority of calls are to caution us from taking the parachute off before we land. I appreciate that framework of caution, and that's why we are thoughtfully and deliberatively, though cautiously, moving in to expand capacity in the healthcare system as a framework of our first announcement and look forward in subsequent announcements to have a health-first framework backing up those decisions. Gavin Newsom: (46:17) I can assure you those decisions will be forthcoming and based upon science data and the spread of the virus based upon your individual actions that have led to this point where stability is the cause that we advanced today because of the physical distancing you have practiced for now well over a month in the state of California. Gavin Newsom: (46:40) Just briefly, I want to compliment and thank everybody that went to our CaliforniansForAll.ca.gov website that have expressed a desire and willingness to volunteer in this state. We were overwhelmed, humbled by the response to that volunteer portal and the capacity for people that can do more and give more of their time, their money, and their attention to help support others in this crisis was extraordinary and continues to be extraordinary. I just want to encourage those of you that have not yet availed yourself to that site to consider going to CaliforniansForAll.ca.gov where you can attach your talent and your passion with particular action at the local level to help folks that are struggling, help folks in need. Gavin Newsom: (47:31) With that, I know there are people struggling to ask questions and so let us avail ourselves to any questions on a myriad of topics, not least of which the ones we've laid out today. Speaker 1: (47:42) Kathleen [Romaine 00:47:42], AP. Kathleen Romaine: (47:46) Hi, Governor. We learned overnight about what are now the earliest known deaths in the US from the virus. Santa Clara County officials say that they had suspicions back in early February that the disease was already much more widespread, but they didn't have a way to measure it. Should we have known sooner that there were community transmissions and deaths in California? What decisions would you have made differently if we knew that sooner? How does this new info affect us going forward? Gavin Newsom: (48:12) Well, we've actually directed beyond just Santa Clara, go back as far as December, to request the coroners autopsy to dig even deeper. We are very pleased with the work that was done in Santa Clara County to make public that information, and know that we are doing the same across the state and other counties as well to ultimately help guide a deeper understanding of when this pandemic really started to impact California directly. Gavin Newsom: (48:46) Look, the hospitalization numbers, the deaths, number of people in ICUs, those are tracked on a daily basis. When this occurred is important forensic information, profoundly significant in terms of understanding of the epidemiology of this disease. All of those things are brought to bear with more clarity and light, not only because of this specific announcement, but I imagine subsequent announcements that may be made by similar efforts all across the state of California. Gavin Newsom: (49:15) But, again, we compliment the outstanding work and leadership. Santa Clara's has been the forefront of this from the beginning of this process. It wasn't where the first community spread, but the biggest flare up in the state first occurred in Santa Clara County. This guides a deeper understanding of that as well. Speaker 1: (49:34) Renee Santos, CBS 13. Renee Santos: (49:38) Hi, Governor. When it comes to loosening the stay-at-home order, when will you be able to give people a sort of timeline or an estimated timeframe? The second part to that question is what do you say to the people that are really struggling right now mentally and financially? Gavin Newsom: (49:54) Well, I'll take those in a reverse order. Gavin Newsom: (49:57) The state of California has been very aggressive in its unemployment insurance claims, very aggressive in terms of trying to provide supports for businesses to keep people employed, to draw down the federal PPP money, to make sure that this new round of PPP money is made available to small businesses, minority and women-owned businesses. We created a $50 million supplemental fund at our state i-bank targeted at micro-loans. We've already distributed loans. 73%, by the way, of those micro-loans have been distributed to women and minority-owned businesses. Just last week, $2 billion of UI claims were dispersed just in one week in the state of California to help support the financial needs of those individuals that have been directly impacted by COVID-19. We've made a series of other announcements to help support people in times of need that otherwise aren't availing themselves to unemployment insurance, including people regardless of their immigration status in disaster relief grants that are made available in that space as well. Gavin Newsom: (51:01) As it relates to the issues of mental health, we laid out- Gavin Newsom: (51:03) ... a few weeks ago with our Surgeon General, Nadine Burke Harris, specific guidelines and playbooks that were targeted to the mental health needs, not just of adults but children. How we speak to our children, the language they use, often physical language because they can't advance verbally what you and I are able to advance in terms of our symptoms and our needs. We made available a website, covid19.ca.gov, covid19. ca.gov. To make available all of those resources, again with an eye on cultural competency, specific resources for behavioral health issues, for the LGBTQ community, specific resources for teens in crisis. You get a sense, we broke those things down in very specific terms and again I'm very grateful that we have a Surgeon General and very grateful we have the one we have that put out all those peer reviewed efforts. And really perhaps the most comprehensive resources that had been available in this state and perhaps in the country, and I'm very proud of that work in that space. Gavin Newsom: (52:08) Let me just make one final point on that. We have been working with Listos and others to build a volunteer corps specifically focused on reaching out to seniors that are struggling with social isolation, as another top priority to address not just their physical health needs but as you suggest, their mental health needs. These are check in calls and that army of volunteers is taking shape, and we have already seen a lot of work done in that space. Gavin Newsom: (52:37) As it relates to the when, as I began this conversation, I'll end the conversation by saying there's no date. If there's a date then we're denying the facts on the ground, we're denying the reality of the spread of the virus which is dynamic. We need to be adaptive in our decision making. We don't want to debate a date. We want to focus on science and health as a predicate for all our decision making, and recognizing we need to understand prevalence and we have to understand spread and that's why these community surveillance efforts, these additional testing sites and our testing capacity is so foundational, as well as tracing. Those are the things we advanced today with a little bit more specificity than in the past. Gavin Newsom: (53:17) That will guide us in subsequent indicators giving us green lights to make decisions. And as I say, I look forward to those decisions in the next days, not just weeks and months, as it relates to further announcements in addition to the health announcements we made today. As we toggle back and we adjust, modify, our stay at home order. Speaker 2: (53:39) Ben Christopher CalMatters. Ben Christopher: (53:42) Hey Governor, thanks for taking the time. Two quick questions for you if you have a second. You mentioned the massive number of swabs that will be coming in from the federal government. I'm wondering if you could put those numbers in perspective. Will that be sufficient to meet the state's needs going forward? And also you mentioned in the past, the collaboration between Google and Apple and the idea of developing a smartphone app for automatic instantaneous contact tracing. Does the state plan on either promoting or cautioning against or facilitating the development of something like that? Gavin Newsom: (54:15) Thank you for that question, and an important question. It's one we're asking ourselves. I think I mentioned this a few days ago, and let me reinforce it, an abundance of resources in this space that reside within the state of California, meaning we have some of the best and brightest, some of the leading edge technology and technology companies headquartered here in this state. As a consequence, we have been provided all kinds of platforms and apps in the space of tracing. Also, the development of symptom tracking. You heard Dr Galley talk about symptom tracking technologies also being a very important tool in our toolkit. We have a team of people including Todd Park and DJ Patil, who worked in the Obama administration, that are advising us in that space. Gavin Newsom: (55:05) And so the answer your question is yes, we will avail what we believe are our recommendations for apps, and not only in terms of tracing technology and platforms along the lines of what Google's trying to do with their Android platform and the iPhone platform that Apple is trying to advance and creating some continuity of connectivity with those platforms and APIs, but also for other apps that we'll be promoting including a new website, an application that we'll be laying out and previewing this Friday that more broadly avails sources of information that we think will be valuable to people. Gavin Newsom: (55:44) Forgive me, longwindedness on that. Let me be more specific on the swabs. 100,000 is significant. Each swab represents a test. You can do the math. 100,000 this week and President mentioned 250,000 next week and substantially more in the third week. So, the answer to your question is yes, if those swabs keep coming, and if we get to a level of four or 500,000 swabs every week, I believe that will substantially address that specific supply issue. But I caution everybody in this space. The bottlenecks on testing, as soon as you solve for reagents, then you got to solve for RNA extraction. Then you got to solve for swabs. Then you've got to solve for viral transport media, and then you've got to solve for diagnostic timelines to getting results. Is it four days, seven days, 10 days, and backlogs. Gavin Newsom: (56:35) All of these issues remain dynamic and that's why, one, I think all of us, every governor across this country recognizes this space is one of constant iteration, and so I don't want to suggest definitively that even hundreds of thousands, even millions in the aggregate of swabs alone will solve "the testing issues." It will solve the swab issue. Speaker 2: (57:01) Alexei Koseff, SF Chronicle. Alexei Koseff: (57:05) Hi Governor, could you tell us a little bit more about this change that you're making to allow more surgeries to take place? You suggested essential surgeries would be allowed. What does that mean to you? What kind of surgeries are and aren't allowed? Is it up to the hospitals and is this something that is going to be taking effect immediately? Gavin Newsom: (57:26) The guidelines are effective immediately. We've been working within the healthcare delivery system, broadly defined, not just the hospitals and working with health departments all across the state of California, getting their feedback and getting their buy in. Also, critical that we have the workforce to be assembled in this space. I'll be even more clear and I appreciate the opportunity to clarify scheduled surgeries. What a scheduled surgery means, so those are the surgeries that someone that- Kathryn Barger: (57:56) Good afternoon and thank you for joining us here today. I'm supervisor Kathryn Barger, chair of the Los Angeles County Board of Supervisors. Dr Christina Galley, Director of Department of Health Services will share an update on the modeling data for our hospital capacity, which she previewed last week. This critically important analysis will help the county and state assess our ability to gradually reduce our safer at home orders. We remain committed with our health partners to safely ease restrictions so people can return to work and reunite with loved ones. Keep in mind, science and data will guide our decisions. Kathryn Barger: (58:36) Meanwhile, many are still coping with stress because of the complete uncertainty this crisis has caused. For example, there are those who have pets who have the added burden of wondering where animals will go if we get sick. Los Angeles County Department of Animal and Care Control, along with our animal care advocates have provided some suggestions for pet owners to eliminate this uncertainty. These guidelines encourage careful planning, not just because of COVID-19, but in case of an emergency. Pet owners should identify at least two trusted people who can care for your pet when you can't. Ideally someone that your pet is familiar with. Post the contact information for your appointed caretakers in a place where it can be easily found by emergency personnel when they arrive at your home. Kathryn Barger: (59:28) Otherwise, in the moment of an emergency, your pet may get taken to a shelter instead of to a trusted caretaker. Also, carry a copy of the contact information with you at all times so this information is always accessible and even when you leave home. Make sure to create a document for your designated caretakers that list your pet's daily care instructions, special needs, vaccination records, and the veterinary contact information. This is also a good reminder to microchip your pet and include the microchip registry in those documents. Kathryn Barger: (01:00:03) At all times have at least two weeks worth of your pet supplies, including food, treats and medication. Finally, always have a license tag and an identification tag on your pet so they can make it home safely. These are critical steps to keep pets in safe and loving homes, even if you are unexpectedly unable to care for them. The Department of Animal Care and Control has created a video with these reminders and more information to keep our furry friends safe and well cared for throughout this crisis. Please visit COVID19.lacounty.gov to learn more. Again, COVID19.lacounty.gov. And with that, I would now like to invite Dr Barbara Ferrer up, our director of public health to give you the latest numbers. Thank you. Barbara Ferrer: (01:01:08) Good afternoon everyone, and thank you so much Supervisor Barger, and I want to thank the entire board of supervisors as well. These are unprecedented times and I know I'm grateful and I know that the entire county is grateful that we have such tremendously powerful leadership that's been extraordinary about creating a path forward for all of us. So I'm grateful that I work for you, but I'm also grateful that as somebody who lives in Los Angeles, we have these amazing leaders that are really setting forward a course that will get us to the other side. Barbara Ferrer: (01:01:45) I do want to update you today on our current status. I'm sad to report an additional 66 deaths. 48 of the people who died were over the age of 65, and 38 people who were over the age of 65 and passed away had underlying health conditions. 13 people are between the ages of 41 and 65, and nine of these people also had underlying health conditions. There are two people who were between the ages of 18 and 40 and both had underlying health conditions. We do not have this information for the three cases that are being reported by the city of Pasadena. Barbara Ferrer: (01:02:25) This brings the total number of deaths across LA County to 729 people. 89% of the persons who have died from COVID-19 did have underlying health conditions, and this underscores the need for all of us to do the best job possible in making sure that people who have serious health conditions are able to stay home and be safe, avoiding close contact with others as much as possible. For the 646 deaths where race and ethnicity has been identified, 15% were African American, 18% were Asian, 37% were Latinx, 27% were white and 2% of the people who passed away identified with another race or ethnicity. Barbara Ferrer: (01:03:14) As more people in our County lose their loved ones to COVID-19 please know that the county family mourns with you and we keep you in our prayers every day. We're reporting 1,318 new cases today. This brings the total number of cases in LA County to 16,435 cases. These cases include 477 people reported by our partners in the city of Long Beach and 261 people reported by the city of Pasadena, both of which have independent city health departments. We're also confirming that there were 100 cases amongst the positive cases that are among people experiencing homelessness. 55 of the people who were experiencing homelessness were sheltered and they are now appropriately isolated and their close contacts are all quarantined. Barbara Ferrer: (01:04:11) As a reminder, the large increase in the number of persons experiencing homelessness who were residing in a shelter were because of the outbreak that we have at the Union Rescue Mission. And again, I want to thank everybody who's working, Housing for Health and Andy Bales and his entire team, for really making sure that the space at the Union Rescue Mission remains safe for the people who are quarantining and isolating in place. We are conducting investigations at eight different shelters, seven additional shelters, and in those shelters we also are identifying staff and guests that need to be tested, isolated and quarantined. Barbara Ferrer: (01:04:55) There are 3,902 people who are positive for COVID-19 who at some point have been hospitalized. This remains at 24% of all of our positive cases. There are 1,791 people currently hospitalized and 30% of the hospitalized patients are in the ICU and 19% are on ventilators. We're currently investigating 275 institutional settings with at least one confirmed case.