Maryland Governor Larry Hogan COVID-19 Briefing Transcript April 7

Larry Hogan: (00:00) ... against the COVID-19 pandemic. This facility will be a place where coronavirus patients who no longer require hospitalization can complete their care and fully recover. By providing additional 250 beds here, this field hospital expands the capacity of Baltimore City health care facilities, reduces the time that patients have to remain in our hospitals, and in turn will free up that critical capacity for other patients who need acute care more urgently. We have already assembled the physical facilities here in a very short period of time, and other elements including a 24/7 staffing plan are currently underway. We're ahead of schedule, and we will be able to take care of patients here as needed. Larry Hogan: (00:59) This is a huge undertaking involving many people, and I just want to take a moment to thank a few of them. First of all, I want to thank FEMA for delivering these hospital beds and other materials. I want to thank the Maryland National Guard and our Department of General Services team for working around the clock to basically build and stand up this site from scratch, and I also want to thank Johns Hopkins and the University of Maryland Medical System for their partnership on agreeing to staff and run this facility. Larry Hogan: (01:39) We're also continuing to make rapid progress on our other hospital surge efforts across the state to increase our capacity by thousands of beds. We have received ventilators from FEMA, which are now available for use at some of our hospitals around the state, and I want to thank Vice President Pence for his commitment last night about sending 200 ventilators to Maryland. The State of Maryland has, on an emergency basis, approved 27 newly licensed assisted living programs, 42 residential sites for individuals with developmental disabilities, six newly licensed residential service agencies to provide home-based services, and 14 newly licensed clinical laboratories to help handle surge capacity. Larry Hogan: (02:40) Nearly 12,000 Americans have died from the coronavirus, and this morning, Maryland now has 4,371 cases of COVID-19 which have been confirmed. This virus continues to spread in every jurisdiction in our state, but the concentration of Maryland cases has rapidly intensified, particularly in the Baltimore-Washington corridor. There are 459 positive cases here in Baltimore City, and so far 103 Marylanders, including nine Baltimore City residents, have lost their lives over the past 20 days to this deadly virus. There are now nearly 9,000 cases in Maryland, DC, and Virginia, and 189 people have died in the National Capital Region in the past 24 days. Larry Hogan: (03:44) Over the past two weeks, I have been sounding the alarm with the President, the Vice President, members of the President's task force, including Dr. Fauci, Dr. Birx, as well as a Admiral Giroir, the NIH director, FEMA administrators, and many other top administration officials about the emerging hotspot of the Baltimore-Washington corridor. And it was a significant focus of the discussion yesterday with the Vice President, top administration officials, and the nation's governors. Larry Hogan: (04:22) I'm pleased to report that we have succeeded in convincing the Trump Administration to designate the greater Baltimore-Washington corridor as a priority. This includes Maryland in general, and 12 Maryland jurisdictions in particular, including Baltimore City, Baltimore County, Carroll, Prince George's, Montgomery, Anne Arundel, Howard, Frederick, Harford, Queen Anne's, Calvert and Charles Counties as hotspots which demand urgent federal attention. In addition to being home to more than five million people and hundreds of thousands of federal workers, and nearly all federal agencies, the Baltimore-Washington corridor is also home to the NIH, the FDA, Fort Dietrich, critical health agencies which are on the front lines of the battle against the coronavirus, as well as Fort Meade, the NSA, the US Cyber Command, and other federal installations that are critical to the security of the nation. And I want to sincerely thank the Trump Administration for listening to our concerns, for responding to us and for designating the Baltimore-Washington corridor and these 12 Maryland jurisdictions as priority areas. As the COVID-19 crisis continues to escalate here in Baltimore City, we are continuing to work closely with Mayor Young and city leaders to help them respond effectively. With 10 confirmed positive cases within the Baltimore City Police Force and 211 BPD officers currently in quarantine, Maryland State Police Superintendent Colonel Jerry Jones has been in communication with Commissioner Harrison to offer additional state assistance. Maryland State Troopers, Maryland Transportation Authority Police and other state law enforcement agencies are continuing their increased assignments and visibility patrols in Baltimore City. Troopers are working in areas of need as requested by BPD command staff, and enhanced state criminal enforcement work continues in and around the city. We are also providing logistical support for the city's efforts to stand up a new community-based COVID-19 screening site at the Pimlico race course. In addition, I have directed the Maryland Department of Health, through its office of Minority Health and Health Disparities, to immediately take all actions necessary in order to provide further demographic breakdowns on race of all Maryland case data, including testing, hospitalizations, and mortality rates. I have also directed them to be as proactive as anyone in the nation on this, with respect to the private labs across the country that are not currently tracking or providing this data. Beginning this week, on the Maryland Department of Health website, I have directed them to publish everything that is available to us with respect to racial and ethnic demographic breakdowns on coronavirus cases, with instructions to update as new data becomes available. However, I want to caution that 90% of the testing is being done by doctors and hospitals who are sending tests to private labs outside of the state, which have not been keeping such data, and so we do anticipate having significant gaps in the initial data that will be available to us. Larry Hogan: (08:41) Our top concern continues to be the fact that we now have cases and-or clusters of cases at 90 nursing homes and longterm care facilities across the state. We were one of the first states in the nation nearly a month ago to issue strong directives to state nursing home facilities, to restrict visitor access, to update infection control protocols, and to limit all staff travel. Two days ago I enacted an additional executive order to further bolster mitigation and suppression efforts at Maryland nursing homes. All longterm care facilities are required to direct all staff who interact with residents to wear personal protective equipment. All nursing homes are required to create separate observation and isolation areas for residents and to expedite all testing through the Maryland State Public Health Laboratory in order to get results in 24 hours rather than waiting up to seven days to get results from private labs. Larry Hogan: (09:55) In addition, today we are launching statewide strike teams composed of members of the National Guard, representatives of local and state health departments, the Maryland Institute for Emergency Medical Services Systems, and hospital systems, to bring triage, emergency care, supplies and equipment to overburdened nursing homes. We're the first state in the nation to launch such a coordinated response effort. Larry Hogan: (10:29) We are activating three distinct types of strike teams. First, testing teams which will identify those in close contact with a confirmed case, collect and send out specimens for the fastest test available, and provide expert instruction on how to keep confirmed and suspected cases of staff separated. Second, assistance teams made up of members of the National Guard who will quickly assess the situation on site, determine equipment and supply needs, and triage residents. And third, clinical teams, which will include doctors, nurse practitioners, and registered nurses from major hospital systems who will be tasked with providing on-site medical triage and stabilizing residents in the nursing home in order to avoid unnecessary transport to hospitals. The goal here is not to replace the nursing home's medical and clinical team, but to provide immediate support and assistance to help protect residents of these facilities. Larry Hogan: (11:40) The state teams will provide assistance and care to patients immediately in order to slow the spread of this virus among our most vulnerable Marylanders. These strike teams will be activated in response to requests from nursing homes, local health departments, and Maryland Department of Health infectious disease experts. 15 days ago- Larry Hogan: (12:03) ... infectious disease experts. 15 days ago, I issued an executive order which closed all nonessential businesses, organizations and facilities in Maryland. Eight days ago, I issued a stay at home directive. I want to thank the overwhelming majority of our citizens who have remained at home, avoided crowds and practiced much needed social distancing, which is the single most important thing that each and every citizen can do right now to help save lives. And we have already seen that these actions and sacrifices are making a huge difference. I also want to thank all the businesses that have complied with these orders, and those who have found ways to provide much needed services while also observing social distancing guidelines. Larry Hogan: (12:58) However, there are reports of a few businesses that are failing to comply with the law and who are potentially putting their customers and their staff at risk. As a result, I issued an additional executive order which directs that any local health department which determines that any business organization, establishment, facility or construction site in their jurisdiction that is unable or unwilling to cooperate in a manner consistent with social distancing protocols and that in their judgment poses an unreasonable risk of exacerbating the spread of COVID-19, then that jurisdiction shall have the power to require that unsafe facility to A, immediately modify its operations, B, severely limit any movement to or from that facility or C, they can shut them down altogether. This new order also empowers state and local law enforcement agencies to assist local health officers in the enforcement of this order. Failure to obey the order may be punishable by up to a year in jail or up to a $5,000 fine or both. Larry Hogan: (14:23) While social distancing is keeping us physically isolated from one another, there are so many examples in so many ways that this crisis is actually bringing Marylanders closer together with compassion and generosity. Stories like Cavanaugh Bell, a seven year old boy in Gaithersburg who used his savings to buy care packs for the elderly and to start a community pantry. And there's a group of more than 100 crafters who came together through Facebook with a mission of sewing masks for healthcare workers and first responders, or the thousands of meals that local restaurants have made and volunteers have delivered to the doctors, nurses and staff at Howard County General Hospital. Places like Sailing Specialties Inc., a Marine parts factory in Hollywood, that's Hollywood, Maryland in St. Mary's County, not Hollywood, California, which has converted its operations to produce 500,000 face shields for medical workers treating coronavirus patients, and Hardwire Inc., which is a an armor manufacturer in Pocomoke city on the Eastern Shore, which in the span of one week went from building armor to protect soldiers, to making face shields to protect healthcare workers on the front lines of a different kind of battle. Larry Hogan: (16:06) There are everyday heroes just like this stepping up all across our state. Since we launched our Maryland Unites initiative three weeks ago, we've had an overwhelming response of volunteers and donations, but we still need a lot more help. We need more people volunteering to step up while the doctors, nurses and others are out there risking their lives on the front lines fighting this virus for us. You can sign up to volunteer in all kinds of ways that are safe and effective, like helping the Maryland Food Bank or giving blood through the Red Cross by going to governor.maryland.gov/marylandunites. Larry Hogan: (16:58) Each of the hundreds of unprecedented actions that we have taken over the past 32 days since I declared a state of emergency have been to protect the health, the safety and the lives of Marylanders and they have all been guided by a coronavirus response team. And we were proud to have a new member join our team just this morning, Dr. Scott Gottlieb, who most recently served as the US FDA Commissioner. We have an incredible coronavirus team that is made up of some of the smartest leading doctors and public health experts, not just in the state of Maryland, but in my opinion, frankly in the world. And I've asked a few of them to join us here today to talk directly with Marylanders about where we are in this fight right now, what we are doing and what we must continue doing in order to stop the spread of this deadly virus. So I'm going to start by turning it over to Dr. Tom Inglesby, the Director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health. Thank you. Doctor. Dr. Tom Inglesby: (18:27) Well thank you, Governor Hogan. It's good to be with you and your team and to see the truly impressive work that has gone on here in this facility. I have a few comments that are about the importance of social distancing that has been put in place in Maryland. This COVID virus has the ability to spread rapidly and widely in society and in our state. Without social distancing measures in place, on average one person can infect two to three others, and each of those two to three can infect two to three more and so on. New generations of cases could occur every five to seven days without social distancing measures. Without a vaccine or a therapy to stop this disease, the only way to slow this virus down is through the social distancing measures that the governor has put in place in Maryland. Dr. Tom Inglesby: (19:19) If this virus were left to spread without social distancing on this scale, then the number of sick people, especially the critically ill, could overwhelm our health system. This pattern is the same around the world. The health systems of the major city of Wuhan in China were driven into complete crisis by this virus, but social distancing measures put in place reduced the spread to now a very low level in that city and in other places in China. Other places in the world like Singapore and Taiwan and South Korea have also used social distancing to keep their epidemics under relatively better control than we're seeing in most places in the world. If our health systems were to become overwhelmed, the mortality of this virus would go sharply up and hospitals would have a difficult time providing the usual lifesaving medical care that they do on a daily basis. Dr. Tom Inglesby: (20:15) We are hopeful that the peak day of our epidemic in Maryland is sometime soon, given how early and aggressive the social distancing measures were put in place. One model that the White House uses has our peak occurring about 10 days from now. And some other models have the peak coming a bit later, but models are only best estimates and models don't necessarily take into account how seriously Maryland has put social distancing measures in place. So we do hope our peak day will be sooner, and there are some encouraging signs. Elsewhere in the world, in Italy where the epidemic has been quite serious and grave for that country, we have seen daily case counts begin to gradually come down in recent days, believed to be the result of social distancing efforts. In Washington state and in New York and in California, the numbers of new cases daily seems to be leveling off. It's too soon to say, but it may be a trend, again driven by social distancing. Dr. Tom Inglesby: (21:14) And in Maryland in the last 24 hours, I know we're going to hear more about this in a moment, we have seen lower numbers of new cases and lower numbers of hospitalization. It's only one day of data, but if confirmed over time, it would be a very good move in the right direction. Once we're able to bring cases down to smaller numbers in our state, it will be time to consider how to begin to ease social distancing. We'll need to have expanded diagnostics to the point where even the mildest possible COVID cases can be diagnosed on the same day, if possible. We're going to need to make sure our healthcare workers have all the masks and equipment that they need to take care of future potential surges of COVID patients should they occur, and we're going to need to make sure our health departments have hired the people and gotten the technology to closely track and isolate all cases and their close contacts. Dr. Tom Inglesby: (22:09) In the meantime, in the short term, the kind of medical surge capacity that has been built in this conference center is an important way to expand our state's capacity to provide medical care for COVID patients in the time ahead. Thanks very much. Fran: (22:29) Thank you. And just to introduce two more members of the governor's task force, the coronavirus strike team. We'll start with Dr. David Marcozzi, who is Associate Professor and Associate Dean, Associate Director at University of Maryland Department of Emergency Management, followed by Dr. Mitch Schwartz. Dr. Schwartz is the President and Chief Medical Officer at Luminis Health System. Dr. Marcozzi. Dr. Marcozzi: (22:59) Thank you, Fran. Governor, thank you very much for allowing us to speak here today. I think under your leadership, Maryland is a safer state as a result of the significant actions you put in place, the early actions you put in place to protect our state from this virus. I'm here to talk to you about how the healthcare delivery system is working aggressively to ready ourselves for this virus and the potential surge of patients that we may be seeing. Governor, you asked us to build 6,000 beds and we're working and we're standing in one of those federal medical facilities that Johns Hopkins and the University of Maryland Medical System work together in partnership with the Maryland Department of Health, the National Guard, the Baltimore City Emergency Medical Services to stand this up, to make sure it's ready when and if we do have the surge of patients. Dr. Marcozzi: (23:54) Other health care systems across our state continue to have readiness built in to what they're doing on a daily basis. Lumeris, MedStar, all of us are- Dr. Marcozzi: (24:03) Basis. Lumeris, MedStar, all of us are working in collaborative efforts to address the potential capacity limitations that we may feel as a result of the burden of disease and the illness that may be presenting to us over the course of the next few weeks. Now is a time for readiness and I think governor, as a result of your leadership, you've demonstrated to us the actions that we need to put in place now to make sure our state, our healthcare system responds optimally to this event and to this crisis. Dr. Marcozzi: (24:35) Three specific things we're putting in place. One of them is building surge capacity within our hospitals. The second is sites like this which are external to hospitals but allow us to decant our hospitals so that the lower acuity patients can be move to facilities like this so we as hospitals can make sure we have the capacity to meet the demands of those who are severely ill. And lastly governor, you asked us to meet these strike teams and we are building right now efforts to make sure a doctor, a nurse, a team, can go out when you request them to make sure that we can stabilize patients right at location to make sure, number one, we can test, we can do the right assessments and number three we can provide the right medical care onsite to the folks who may need a longterm care facilities and sniffs. So thank you very much governor for your leadership and we look forward to partnering with you throughout the rest of this response to this crisis. Mitch Schwartz: (25:40) Thank you everyone and specifically thank you governor for allowing us to stand by you as you manage this pandemic across the state of Maryland. My name is Mitch Schwartz. I'm the president of the Luminis Health Clinical Enterprise and I come here to speak about a pandemic based on a virus that is cruel, that impacts all of us, whether you're working at a hospital, you're staying at home or you're an essential worker in our workforce. It is times like this when we need to coordinate care with our government, local, state and federal partners. At Luminis, we have critical priority and that is to safely staff supply and equip our hospitals to provide care to our communities. We were formed last July, the merger of two hospitals, Doctors Community Hospital in Prince George's County and the Anne Arundel Medical Center in Southern Anne Arundel County. We have 9,000 employees and hundreds of physician offices throughout the area. Mitch Schwartz: (26:55) We'd like to actually give you three specific ways we're managing care in the community during this pandemic. First, we have scaled our tele-health abilities dramatically. All of our patients were told to stay at home and it's our priority to provide access to them during this pandemic. We still have access when face to face interactions are required, but we have scaled tele-health now doing thousands of visits a day. Mitch Schwartz: (27:28) Secondly, we are closely working with local, state and federal government and partners to prepare for what we believe to be a massive surge in volume over the next weeks. We have looked throughout our hospital facilities to develop space typically not used for patient care and redefine care process to enable our staff to care for all of those patients safely. Mitch Schwartz: (27:57) And third, we have developed a massive plan of redeployment for our medical staff, nurse practitioners, physician assistants and nurses, retraining them to provide care for that patient population that we believe is coming. So in summary, we have a plan, we are executing that plan and we want to safely provide patient care with appropriate supplies and equipment at our hospitals. So I want to thank you governor for allowing us to support you and I also want to thank all the healthcare workers throughout the state, all those workers who care for patients and more importantly who care about them as well. Thank you very much. Larry Hogan: (28:46) I just want again to thank all three of these great doctors and their healthcare systems, but all the others that also serve on our response team. There are a number of other ones that aren't represented here today, but they've been incredible. We also have, obviously we have deputy secretary Fran Phillips who's been a leader. You've seen her at every one of these press conferences and we have major general Timothy Gowen from the National Guard here with us as well. Our team at the state level has done an incredible job and I talk to our state leaders every day. I talk with these smart doctors from all the hospitals. We talk to a bunch of other folks, but you don't see all this stuff going on behind the scenes, but let me tell you, every one of these folks is a superstar and they've been stepping up and all the people that work for them are incredible and we want to just appreciate their teams and all the folks at the hospitals, the doctors and nurses and technicians, all the people on the front lines. But there's awful lot of other folks too. Larry Hogan: (29:39) Our citizen soldiers, the National Guard, all the people that work in the health department, every one of our agencies, the folks from DGS and all of our other agencies that work so hard to put up this facility and everybody else. I just want to say thank you to them. With that, I'll take a few questions. Speaker 3: (29:56) How do we know [inaudible 00:30:00] not when, how? Larry Hogan: (30:02) Well maybe I'll let one of the experts like Tom come back and answer that hard question, but that's going to be the hardest question of all. And what we've got to do is do a lot more testing and we're going to have to really study the numbers day to day. Look, we're anxious to get everybody back to their normal lives as quickly as we can. But the last thing we want to do is bring them back too fast where we just ramp this thing back up and have the virus spread. So we're going to rely on those experts. I don't know if it's Tom, you or Marco. Any of you guys want to touch on this? There's a lot of smart guys that can probably give you a better answer, but it's going to be a really hard decision based on the data and we can't really give you a specific time yet, but maybe, any of you guys want to take a shot at that one? We have these smart doctors, you might as well get a good answer out of them even though none of them want to give you the answer. Dr. Tom Inglesby: (30:53) Well, I certainly agree with what the governor just said. I think in other countries there are beginning to experiment with using social distancing where they've had measures in place, for example, in China, they're now beginning to reopen public transportation and have people travel around more than they were allowed to before. I think one of the preconditions is getting numbers down quite low, never to zero probably, but to a very low and manageable number so that public health departments can be aware of all the cases in the state and can try to manage them, can isolate them, track their contacts. So it depends on the capacity that we're able to build in the state to try and get control of that. We also have to have, as the governor was saying, really really available diagnostic testing so that people even with mild symptoms can be diagnosed quickly and can be put into isolation. Dr. Tom Inglesby: (31:43) That's not quite possible yet, but that is being ramped up in the state and finally we really need to prepare our healthcare system so that if there is a surge in the future, that they're never in this position where they are so short on masks and short on space and ventilators. So we have to be ready for that too. Dr. Tom Inglesby: (32:17) Mark, why don't you answer that question [crosstalk 00:32:19]. Dr. Marcozzi: (32:25) Thank you for the easy question. So I think it's all of those. I think that we have a limitation with regard to how our nation, the importing and the ability to actually get the personal protective equipment. We're looking at across our, whether or not we have the national capacity to be able to have that or as far as being able to produce it and or import it into our nation. There are all limiting steps with regard to it. In addition to that, the healthcare delivery system has to respond to a surge of patients. So obviously the burn rate is higher to be able to respond to an event like this. All those factors cascade into making sure we have enough personal protective equipment for our nurses, our respiratory therapists, our doctors, our frontline EMS providers, to make sure that they are the right people who have the right personal protective equipment when they do need to respond. So it's all of those pieces go into factoring to making sure that the personal protective that the responder has on is right and they have it throughout the entirety of the event. Larry Hogan: (33:52) So it's a really difficult question. The question is how bad is it going to get? Are we going to need all of those things that. So FEMA put in those requests based on, I believe what they felt was a worst case scenario and they're taking steps. Had we not instituted all of the dramatic and unprecedented actions we've taken over the past 32 days based on the models that we were hearing about from smart people like Dr. Birx and Dr. Fauci and all of the modeling. If we just let this run its course and we had the spike and overloaded the healthcare system, then we would need those kinds of numbers and the death rates and the infection rates would be astronomical. Larry Hogan: (34:40) We believe, and I think these smart doctors would agree, although we don't have exact numbers, that we have dramatically lowered the potential for that both hopefully in America but particularly here in Maryland so that that worst case scenario is not going to happen. We don't know exactly how many people are going to be infected. We don't know how many people are going to be hospitalized or how many deaths, but at least my hope is that we're not going to get near the worst case scenario, that it's going to be hopefully a lot closer to a best case scenario. But I don't know if any of you want to take a shot at that. Handle that one. It's your turn. We'll take one, two, three. Mitch Schwartz: (35:21) Thank you governor. So I think all the actions taken by the governor have depressed the peak of case volume and that saves lives, particularly when hospitals could have been overwhelmed in a way we hopefully won't. But I think we have to recognize that when the peak is lower, the spread of time is still significant and the resilience of hospital workers, healthcare workers is going to be called to the table. And- Mitch Schwartz: (36:00) [inaudible 00:36:00] going to be necessary? Larry Hogan: (36:07) Yeah, actually I am not sure the validity of that report. There have not been two ice rinks that have been leased. I know that was a possible consideration, but there are no leases signed on any ice rinks. I know that's a possibility of maybe one, but it's not actually ... it has not happened yet. But that has happened in other places around the world. And so it's just something that is being considered, but it was a false report to say that two ice rinks had been leased. Speaker 9: (36:34) What about random testing? [crosstalk 00:36:35] Larry Hogan: (36:35) Well, let me follow up on what the doctor just said. It's important. Had we spiked and had all of this stuff right away, it would have been overloading the system, but it also would have happened faster. So people are saying, "How fast can we get over this?" The fact that we've dampened down and flattened this curve means it's a longer period of time and we have this longer plateau. So while we're going to not have this overload of the system, it also means it's going to take a while for us to be able to get back where it's going to take a longer period of time, but not be as bad, which people are going to have to get ready for that. Speaker 9: (37:04) Are there any facilities in Maryland that will do random testing? Larry Hogan: (37:11) The testing continues to be the primary frustration. Our state lab turns around the testing within 24 hours. Many of the other labs have had a backlog and they were taking up to a week. I think they're now catching up to speed. Maybe Fran can address this. But the rapid testing that you keep hearing about being announced, about 45 minute testing and 5 minute testing or 15 minute testing is coming, but has not come to either Maryland or just about anywhere else, I don't think. Speaker 10: (37:38) Governor, in your conversation with the Vice President, what was it that convinced him that this was a top priority? And who made your mask? And for Marylanders, what advice do you have and then what's it like to wear one? Larry Hogan: (37:50) So the mask that I was wearing was made by prisoners at the Maryland Correctional Facility. And they're very happy to be doing this and to be a part of the solution and excited to be in some way helping their fellow Marylanders. So this was something that Secretary Green announced at our last press conference. And he gave me one of these masks, and I wore it today. I just took it off so I could talk because you can't hear very well when you're muffled, but I'm going to continue to wear that. It's just a cloth mask. It's not the N-95. It doesn't take away from healthcare workers, but it does do some of the basic protections that you hear about. Larry Hogan: (38:23) How did we convince the Vice President? I can just say that beginning about almost two weeks ago, I started placing calls to everyone in Washington and ringing every alarm bell that I could ring about what all of us were talking about and the numbers we were starting to see and that while we they were focused on New York and New Orleans and other places, that don't forget about this right here. Larry Hogan: (38:47) And my argument was that the Baltimore-Washington corridor and that we were so critical to the nation's defense, that it was not just the fact that we had numbers, but that they should pay attention to the fact that I included Maryland, DC, and Virginia together because it's 400 and some thousand federal workers that they relied on and it was surrounding all of them. But I placed a call to the President and multiple calls that the Vice President. I talked to Admiral Giroir. I talked to the head of NIH. I talked to a Fauci. I talked to Dr. Birx. I mean, I was calling all weekend, late into the night, almost every day for a solid week. Larry Hogan: (39:25) In our last call, the Vice President started the thing by talking about where he called me this past weekend and said, "We're going to make Maryland and DC a priority." He started the meeting with the governors yesterday saying, "Maryland is a priority." Dr. Birx then went into a 10-minute discussion with all the governors about each of our counties and what they were going to do. Larry Hogan: (39:46) So I think they were looking at the numbers and the numbers justified what I was telling them, but there was no question. And then Dr. Fauci I had a conversation with, and he said, "I'm leaving right from ... as soon as ... I'm in the parking lot at the White House about to walk into my coronavirus thing. I promise you I'm going to raise this again." And he hung up the phone as he was parking his car and went in. And I must've made 30, 40 phone calls about this, spent the weekend, a couple of weekends, doing it. Speaker 12: (40:17) Governor, [inaudible 00:40:17] state revenues, do we anticipate large cuts to state government or layoffs? Larry Hogan: (40:27) We're going to be talking with our budget folks. I don't anticipate, I'm hoping we're going to avoid major layoffs. But there's going to be massive budget problems. I mean, I imagine we're going to ... I think we're already at the point where we've spent probably somewhere in the neighborhood of a billion to $2 billion, which is a pretty big number. So yeah, there's going to be massive budget problems for us, for every state in America, just like there are major budget problems for individuals and small businesses and large businesses and for the federal government. Speaker 13: (41:02) [inaudible 00:05:10]. Larry Hogan: (41:05) Yep. Speaker 13: (41:05) The elective surgeries at hospitals [inaudible 00:41:11]? Speaker 14: (41:22) I can verify that all of us have limited elective surgery in a dramatic way. We are not doing purely elective surgery. I can also tell you, as I described, that we are planning for a substantial surgeon volume, and we are redeploying and retraining all of those employees to provide care during that search. Speaker 13: (41:48) [inaudible 00:05:54]. Speaker 14: (41:51) No. Erin: (41:59) Governor, I have a follow up on your budget comment? Larry Hogan: (41:59) You got a lot of questions, Erin. Erin: (42:01) I always do, sir. Where did most of that money go? Larry Hogan: (42:05) I mean, I can't ... I mean we've spent money everywhere and every single agency, but I can't really tell you exactly where it went. We could probably follow up at a later date, but right now the idea is to keep hundreds of thousands of people from getting infected and stop 10,000 people from dying. So we're not counting every dollar that's being spent. Speaker 15: (42:26) Governor, could we get some insight into the decisions as to why the ratio of the breakdown of tests, why do we take those? [inaudible 00:42:36] done? Larry Hogan: (42:36) Well, no, the federal government does not do it. The CDC doesn't do it. None of the national testing labs do it. And just in the past day or two, a couple of cities have said they would do it, but they aren't really doing it. I think DC said yesterday, they would do it, a tiny portion of their numbers they are doing, which is ... but we'd be happy to do it. We do about 500 of our tests. We can do that easily. But the other 25,000 tests, doctors send them to national labs that aren't in the state of Maryland, who don't keep that kind of information, that aren't required in their state to keep the information, that aren't required by the CDC to keep the information. And so it's hard for us to gather the information. We're going to try to do that. Larry Hogan: (43:20) But the last thing I would want to do is to have all these tests. People say, "We're not going to go to Maryland because they make us do something we don't do anywhere else." And then people would start dying. So we're going to do our best to keep track of the information without killing people. Erin: (43:37) Last question please? Larry Hogan: (43:40) No, I think you're done. Anybody else? Luke got one, you got that. Speaker 16: (43:51) If and when we do lift up on social distancing, what's the likelihood that we would end up having to return to it? Larry Hogan: (43:53) That's a good question. We talked with the doctors today about that. Look, I think if you notice the way we did it over 32 or 33 days, so we ratcheted it up. We took this step and then that step and then the next step and the next step. I think we will ease back into things. It won't be like, we'll flip a switch and now everything's back to normal. We'll have to slowly start to make decisions based on the facts. But it's not going to be like everything's great tomorrow. When we get back, we're still going to be careful. We're still going to limit ... we're still going to have to institute social distancing. As a good idea, people will still be wearing masks. We're still ... And so, but we want to make sure we don't go back to it becoming a problem again. So we're going to be really cautious. The decisions on reopening and getting back are going to be even more difficult than the ones that we made to close things down, which were extremely difficult. Larry Hogan: (44:47) Yeah. Thank you. All