Massachusetts Governor Charlie Baker COVID-19 Briefing Transcript April 23

Charlie Baker: (00:00) So good afternoon. Today we're joined by three CEOs from hospitals across the Commonwealth to discuss what they're seeing inside their facilities during the COVID-19 crisis and to deliver an important message to patients who need medical attention. First I want to give an update on testing. Yesterday the Commonwealth conducted over 5,000 new tests, that brings us to a total of over 180,000 tests so far. The state reported 1,745 new cases of COVID-19 for a total of nearly 43,000 cases tested positive statewide. The number of new positive cases has remained relatively stable over the past few days but as we've said before we're not drawing any conclusions from a few days worth of data. Charlie Baker: (00:48) Yesterday's report contained very sobering numbers on those who have lost their lives to the virus. These numbers are staggering and we must remember the people behind these numbers. They're our friends and our neighbors, and these people have families and loved ones whose worlds have been shattered by this ruthless virus. It's a good time to remember that all the sacrifice and disruption we're working through is to protect people's parents, grandparents, siblings, children, neighbors, friends and coworkers. Families are dealing with their loss in uncertain times unable to gather in person to say goodbye. Charlie Baker: (01:28) I know there's a lot of desire on the part of many of us to get back to some kind of a new normal but these numbers underscore the importance of continuing to do what we've been doing to push back against COVID-19. That means staying at home, pausing businesses in many cases, changing the way we live, covering our face in public, maintaining physical and social distance and cooperating with community tracing efforts. Our focus needs to be on doing everything we can to prevent and reduce the loss of life due to this virus. Charlie Baker: (02:05) I want to give a quick update as well on PPE. As of yesterday, we've delivered almost 5.5 million pieces of personal protective equipment this includes masks, gloves, gowns, and other items the command center has provided to hospitals, nursing homes, and other facilities on the front lines as well as first responders and emergency management personnel. Yesterday the state received and validated over 200,000 new testing swabs. The supply will be sent out to support our mobile testing program of nursing homes, rest homes, and assisted living facilities. And testing swabs will also be sent to several healthcare providers and underserved areas across the state to expand their daily testing capacity. The command center also recently sent 3,500 swabs and tubes to South Coast Health Systems who will increase their daily testing capacity by 400 tests a day and also sent 3,500 swabs to the Cambridge Health Alliance. Charlie Baker: (03:11) With respect to hospitalizations and hospital capacity which I know is an important issue for all of us. The command center is communicating daily with the hospitals across the Commonwealth as well as with medical professionals to monitor the capacity in our system. As of yesterday there were 3,977 patients hospitalized statewide for COVID-19 and that includes a little over a hundred new hospitalizations. In total 9% of the total number of COVID-19 cases are currently hospitalized, a number that's remained relatively stable over the past few days. Out of 18,000 available hospital beds statewide ranging from ICU beds to field hospital beds over half are empty and available for patients. These numbers mean that we continue to see a slight increase in the number of people needing medical attention due to COVID-19 but they also show that our healthcare system planned well and is managing through this crisis that's good news. Charlie Baker: (04:12) As we know, Massachusetts is the home to one of the strongest healthcare systems in the world. From our academic medical centers to our terrific regional and community hospitals across the Commonwealth these healthcare facilities have been well positioned to help us withstand the surge. We also planned for this, the command center worked with the healthcare community to model what this uptick in cases would look like and then we built a plan and we've been executing on it. We've worked with our academic medical centers, our community hospitals, and our medical teams to craft a plan that is flexible enough to dramatically increase ICU capacity, dramatically increase bed capacity, and at the same time create step down capacity so that patients who didn't need to be at an acute level anymore could be moved to a lower level setting. Charlie Baker: (05:05) All in all this process has given us the structure and the flexibility and the capacity that we need here in Massachusetts to work our way through the surge. It also means our hospitals are well positioned to deal with and take care of the other elements of care that are so fundamental to the work that they do every day. To some extent that's part of what we want to talk about today. Many hospitals have reported a reduction in patients seeking care for other serious medical conditions like heart problems, dialysis treatments, and cancer treatments. We know these medical conditions didn't stop when COVID-19 picked up and our hospitals and our healthcare providers have made accommodations for COVID-19 to ensure that they can also care for the other care problems that they come across every day and do it safely. The purpose of all that surge planning and response was to ensure that our health care system would not be overrun and could continue to respond to other emergency needs. People should still call their doctor to talk about their health needs and go to the hospital if they have an emergency. Charlie Baker: (06:18) People have worked hard to set up telehealth services which they've been using to help people talk to clinicians distantly using either video chats or phone conversations to determine whether or not in fact they need to be physically seen by somebody. We've also added the Bowie Health System which has tracked over 85,000 connections so far with people who have used it for self diagnostic purposes and if people based on their data and their submissions needed to speak directly to a clinician that's been made possible. And of course call 911 in an emergency to get to a hospital if you need immediate help. We don't want people getting sicker or exacerbating an illness or an injury and it's important that people are cared for when they're sick whether that's for COVID-19 or for something else. Charlie Baker: (07:11) Just a few days ago as part of the regular calls we have every day with hospital CEOs we discussed this concern over patients delaying lifesaving treatment out of fear and I asked the CEOs to do what they could to get the word out. Many of our facilities have worked together like never before since the beginning of this pandemic sharing innovative solutions and essential equipment and the Commonwealth and its people have benefited tremendously from this collaborative approach. And having been involved in the healthcare world for much of my professional career I can tell you that these hospitals and these organizations are typically well pretty competitive with one another. And it's been remarkable to see them work together to make sure that they, you and we have the capacity and the ability to serve both those who are dealing with COVID-19 and those who are dealing with the other issues in medicine that are much more traditional to what they see every day. Charlie Baker: (08:14) And it's terrific that the six Boston teaching hospitals participated in a series of TV public service announcements asking residents not to delay care. I want to thank Tufts Medical Center for taking the lead on the project and the local video production company Last Minute Productions for donating their time. The 60 and 30 minute PSAs will be played on all Boston TV stations starting today. Why don't you folks take a look at the video and then after it plays I want to ask Dr. Michael Apkon who's the CEO of Tufts Medical Center to come to the podium and share a few thoughts Speaker 1: (09:04) We want to talk to you about [inaudible 00:09:04] Michael Apkon: (10:01) Thank you Governor Baker. We're honored to be here with you and Secretary Sudder's today and we very much appreciate the partnership that the hospitals have had with both the state and the local government. It is true that we are quite busy caring for patients with COVID-19 but we have a growing concern about what we're not seeing. We're not seeing the same number of patients coming to our emergency departments with strokes, with heart attacks, with traumas. In fact, we're seeing about half of the activity that we would normally see during the month of April. We've seen a 60% reduction in the number of patients coming for care of symptoms related to stroke as one example. Michael Apkon: (10:42) This is in part explained by the fact that people aren't on the roads, they're not exerting themselves the way they normally do, but we also know that part of it is because people are afraid to come to the hospital and our concern is that that fear is leading to adverse outcomes. We've seen children coming to the hospital after having several days of abdominal pain and coming with a ruptured appendix. We've seen patients with symptoms of stroke that are staying at home long beyond the point at which medications that would markedly improve their outcome could safely be delivered. We've seen patients with kidney disease that are staying at home, coming to the hospital too sick to be cared for and survive. Michael Apkon: (11:28) We understand the fear that people have but what we want people to know is that we are keeping you safe at the hospital. We're decontaminating our surfaces, we're practicing social distancing, we're using masks and we're doing everything we can to keep you safe. If you are ill please call your physician to seek care. If you're the victim of violence or domestic abuse, if you're having chest pain, if you're having shortness of breath or if you're having weakness that might be a sign of a stroke, a heart attack, or a severe respiratory illness call 911 or visit your local emergency department. What we want you to know is that we're here to help you, we can keep you safe and please don't delay care that might be vitally important at this time. Thank you. Sure. I'd like to introduce Greg Meyer who is the chief clinical officer for Partners Healthcare. Greg Meyer: (12:28) Good afternoon. Thank you Governor Baker, thank you Lieutenant Governor Polito, thank you Secretary Sudders, and a very special thank you to my colleagues who joined me here this afternoon. COVID-19 is a horrible disease that is caused by a vicious virus that has extracted a horrible toll despite the incredible supportive care that our hospitals can offer. That is not always in our control but we need to avoid a second toll of the pandemic one for which we do have treatments that work, one that we can control. Greg Meyer: (13:03) As we focus our collective energies and resources on combating COVID-19, there has been a less-noticed but equally troubling development inside Massachusetts hospitals: the growing number of empty beds in our emergency departments. We are seeing evidence that many people are avoiding seeking medical attention for a variety of urgent issues, because they fear possible exposure to COVID-19, or they may not be aware that world-class care here in the Commonwealth is still available to them. At Newton-Wellesley Hospital, we treated 5,400 patients in our emergency room in January. In the last 31 days, that number has dropped to just 2,800, and nearly half of those were COVID-19 cases. That's a 48% drop in emergency department volume in just a few months. Some of this is due to our social distancing. We're seeing fewer motor vehicle accidents because fewer cars are on the road. But we also know that there are many life-threatening conditions which do not respond to social distancing. Greg Meyer: (14:14) Last year, our hospital treated an average of 20 stroke cases each month. So far this month, we've seen only seven. Sadly, there's no medical reason that I can come up with that strokes should be drastically impacted by social distancing. We don't believe that this means fewer people need urgent care or are having strokes, but we think that it's because people are avoiding critical medical care necessary to treat and recover from those illnesses that we are ready and open to deal with. Greg Meyer: (14:50) Since the current pandemic began, we are seeing advanced vascular disease, such as leg ulcers and vascular insufficiency, that is leading to amputations. One of my surgeons said to me last week that he has done more amputations in the last few weeks than he can ever remember. The story of each of those patients was the same: They knew they had a significant problem, but they wanted to try to take care of it at home, because they really wanted to avoid coming into the hospital. Because of that, we were not able to provide them with limb-sparing treatment. Greg Meyer: (15:28) Providers are also seeing more cases of advanced cardiac and GI disease. In the Mass General Brigham system, we've seen a 37% reduction in the number of patients coming in with heart attacks, and we've seen a 14% reduction in appendicitis. Sadly, as with COVID, these reductions, which could signal delays in getting care, are impacting our most vulnerable populations in a disproportionate way. This delay or avoidance of emergency care is extremely concerning, as many seemingly minor symptoms can develop into much more serious illness when not treated. Greg Meyer: (16:05) For those of you who might be wary of visiting a hospital during these anxious times, let me assure you, Massachusetts hospitals are open for business. We have the beds, we have the physicians, we have the nurses, we have the specialists, we have the resources to treat you. Our healthcare system is effectively caring for COVID-19 patients, while also maintaining the capacity to treat any other patient who requires emergency medical care. Through a partnership with the governor, the mayor, Boston Healthcare for the Homeless, and area hospitals and health systems, Boston Hope, and their other facilities like it across the Commonwealth, are meant to ensure that our healthcare system has an ability to treat patients with acute care medical needs in our acute care hospitals. Please know that Newton-Wellesley hospital, and all Massachusetts hospitals, are taking comprehensive precautions and doing everything possible to keep our emergency departments and inpatient facilities safe. We have developed policies and procedures to ensure that for those who need it, the hospital is a safe place, despite the pandemic. Greg Meyer: (17:15) We've also vastly increased our ability to treat patients remotely, removing the need to see patients unless there's an immediate need to do so. Remote care through telehealth provides a convenient and rapid means to have what seems to be minor symptoms, assessed by professionals who can determine whether a trip to the emergency room or a face-to-face evaluation is necessary. Greg Meyer: (17:39) We're also reminding the public, if you experience chest pain and sweating, slurred speech and facial drooping, severe abdominal pain, an asthma attack, or suffer an accident like a fall or a deep cut, or any other symptom that causes you concern, we urge you to seek medical attention as soon as possible. Those are situations where remote care is not appropriate. Call 9-1-1 or go to your local emergency department. Please continue your social distancing, but do not let fear of COVID-19 keep you from the urgent care you need. Our doctors and nurses will be there for you to provide the world-class care that the Commonwealth is known for. Greg Meyer: (18:23) Thank you very much. Now we'll hear from my colleague from Baystate. Nancy Shendell-Falik: (18:32) Thank you all for the opportunity to be here with you. I am Nancy Shendell-Falik, president of Baystate Medical Center, and here to share what's happening in western Massachusetts, as the president of Baystate Medical Center, which is the tertiary academic medical center for the western part of the state, and the only one there. And I want to assure all of the citizens of the Commonwealth in the western part of the state, that our priority is patient safety. It always has been, and it always will be. Safety of our patients comes first. We have made necessary changes to ensure that safety, and want all to know that they should come to seek the needed care. Nancy Shendell-Falik: (19:20) Serious consequences of not getting care have been discussed by my colleagues, and I want to share a little bit more specifics about what we have seen. We have seen patients, an 80% decline, with stroke symptoms... meaning speech impairment, visual changes... wait at home and not see care. Nancy Shendell-Falik: (19:43) That was one month ago, a total of an 80% decline. Those patients are starting to arrive at Baystate Medical Center. They are seriously ill, and many of them have lifelong debilitating consequences to waiting. In our cardiac care areas, we have not seen a great decrease in numbers. However, we've had patients that have described having severe symptoms for three days. Patients that walk two miles a day, that are unable to walk up a flight of steps, that are afraid to come to the hospital. Decrease in blood flow harms organs. We want you to know that you can mitigate these consequences. And as described by my colleague, we have seen more amputations as well, due to the fact patients cannot have limb-sparing procedures. They have waited at home. Nancy Shendell-Falik: (20:42) When we look at surgery across the Commonwealth, we deliberately postponed needed elective surgery. It is now six weeks later, and some patients are saying they see a change in their condition, and they think they stay on perpetual hold until we call them. Some patients have described that... and have been advised to come to our hospital. And they fear, doing so, that they might get COVID, even more than treating their serious illness. So if your provider recommends that you come to the hospital, please heed that warning. We are safe, and we are here for you. We know that things that seem like a simple hernia or a gall bladder with pancreatitis might be able to wait. Yet four or five weeks later, there can be serious complications from surgery. As the only full-service children's hospital at Baystate Medical Center and the only full-service in western Massachusetts, our pediatric emergency department normally sees 120 children per day. Now with the arrival of COVID, we are seeing 25 to 30 children per day. And what we know is that chronic care and chronic diseases do not wait for this pandemic to subside. Nancy Shendell-Falik: (22:04) We have seen children that have diabetes, who have fever and fatigue that lasts for days, whose families are absolutely frightened to seek necessary care. And we unfortunately have seen some with consequences that cannot be reversed. We know, like was described, others where belly pain leads into appendicitis and an appendix that is now ruptured, that could have been more easily treated had a patient arrived earlier. Nancy Shendell-Falik: (22:35) We are also seeing 20% fewer patients in our behavioral health emergency department. And we know that patients suffer from anxiety and depression, and we want them to know to call their primary care provider or their psychiatrist, and if they are recommended to come to the emergency department, to please do so. We want to care for you. We are here for you. The Baystate Health hospitals have over 1,000 beds. Today we are caring for approximately 150 COVID patients and 400 non-COVID patients. So we have plenty of capacity. We have space. We have changed our processes to ensure your safety, and encourage you to seek necessary care. Nancy Shendell-Falik: (23:26) Thank you. I will turn it back to Governor Baker. Charlie Baker: (23:29) [inaudible 00:23:29] just stay there for a second. [inaudible 00:23:43] and they're experts and authorities on these issues. I just want to start by saying that if you have questions for these folks, let's just start with them. They're all over there. And then [inaudible 00:23:49] talk about other stuff. If you have questions for them, go for it. Speaker 3: (23:48) Can you describe what it's like going into the ER right now? I think a lot of people at home think they're going to come in and it's going to be overwhelmed by COVID patients in the waiting room. Can you describe how you kind of separate it and keep it clean and safe? Nancy Shendell-Falik: (24:04) Well, I certainly will start. At Baystate Medical Center, for example, we are blessed with a 92-bed private room emergency department. I think one thing that is different is you see care providers in masks and in gowns and in protective equipment, so that we are ensuring that they are personally protected. We have focused today on patients. I know all of us care deeply about our healthcare providers and keeping them safe. That said, we triage patients, and they are immediately moved into a private room. And we co-locate, meaning that we have pods. We put certain patients in pods to make sure that those with respiratory symptoms are separated from those that I would consider non-COVID. Nancy Shendell-Falik: (24:50) I don't know if anyone- Michael Apkon: (24:57) At Tufts Medical Center, we're taking similar precautions. And in those areas of the hospital where people may wait for a few minutes in order to be seen, we're spacing out patients so that they are quite far from each other. People are wearing masks. The main difference that people will see is our caregivers are using the personal protective equipment. But our emergency department, and all of our other diagnostic areas, are far less busy than they typically would be, because of the reduction in our elective cases, and because people are just not coming. So the main experience difference will be really around the use of the masks. Greg Meyer: (25:40) My only addition to the excellent comments of my colleagues is that what you will see, is I think you will see that the healthcare workers are all wearing PPE and going about their business in a very, very diligent, courageous manner. And the other thing that I think that's notable, as was stated previously, is that sometimes it seems eerily quiet. The truth of the matter is that the volumes- Greg Meyer: (26:03) ... volumes are generally down for the reasons that we spoke about here today and that's why this public service announcement and what we're discussing this morning is so very, very important. Speaker 7: (26:13) Would you say stroke is one of the primary conditions you're not seeing, suddenly? Greg Meyer: (26:17) Well, I don't think that frankly, sadly, I don't think there's anything special about stroke. I think stroke is something that we can easily measure. I think it is one that we can recognize, but I think it is actually just a marker of what is a much broader phenomenon. So it's not just stroke, it's vascular disease, it's heart attacks, it's abdominal infections, it really runs the gamut. So yes, stroke is important, we are seeing it. But I think it's a marker of something much, much larger. Speaker 8: (26:51) Can I ask you how you're feeling about your stock of ventilators, all three of you, and also whether you're providing mental health counseling to your frontline workers, who are under such tremendous stress? Greg Meyer: (27:00) I'll answer quickly and I'll step over for my colleagues. We are quite comfortable right now in terms of our ability to provide ventilators for patients that need them. We are not concerned that we will be running out of ventilators at this moment. I would remind all of us that the only thing that doesn't change with COVID-19 is that things are constantly changing, but for right now we feel quite comfortable. We, I think, like all of our colleagues around the city, around the state and around the country, are doing our best to offer all of that support. I think it's important to note that this does indeed take a dramatic toll on our caregivers. Part of this is just dealing with the incredibly sick patients that are coming through the door, with higher rates of death than we're used to seeing in our hospitals. Greg Meyer: (27:42) In Newton-Wellesley, I can tell you that it's over twice what we normally experience. But it's also compounded by the fact that all that we've done over the last three decades to promote patient and family-centered care and bringing families to the bedside, all that's gone away because of the vicious virus. That we no longer are able to bring in families to be with patients in their times in need and many of them are dying and what are relatively lonely circumstances, despite our best efforts with telecommunications and others to bring the family into it. So, we are offering support to them in every possible way that we can. Greg Meyer: (28:16) Yesterday at Newton-Wellesley, we held a moment of silence for all the patients that we lost with our caregiver team. I thought it was an important thing to do, but as I walked through the door this morning, I was surprised by the number of folks who came up to me and just thanked me saying how important that was. Speaker 8: (28:31) Just raising financial concerns at hospitals as well. Obviously, if less patients are coming in, can't get the treatment, there's less [inaudible 00:28:39] for the hospital. There's obviously the public health component here, but is there a financial concern for hospitals [inaudible 00:28:48]? Michael Apkon: (28:47) There's absolutely a financial concern. There is a significant decrease in activity that would generally provide revenue to hospitals. I think we're all working with both state and federal government to take advantage of the relief programs that have been put in place. Right now, the first priority is providing safe patient care and the decisions that we're making are not financially based so much is ensuring that we have the capacity to care for the patients that need our services. Michael Apkon: (29:16) I would say that there has been an unprecedented level of collaboration and coordination across the Commonwealth. Within our healthcare systems. We're moving PPE, we're moving ventilators, if necessary, we're moving patients and we're doing so really between the systems to ensure that no hospital is really put in the position of having to get to crisis standards of care or not having the capacity to care for either patients with COVID-19, or patients that don't have COVID-19. Michael Apkon: (29:45) I believe our industry is going to be changed in many ways for the better, but in ways that have a very significant financial impact, and we're all working through what that future will look like. Right now ,the main priority is keeping people safe and delivering the care that patients are requiring. Speaker 10: (30:02) Could you speak to, or elaborate, on some of the typical either check-ins or types of ongoing treatment that's given to children with chronic conditions? I think one of you guys mentioned diabetes? What's not easily being shifted to the telehealth side or what are some of those examples of typical check-ins that are not happening? Speaker 11: (30:25) We have utilized a lot of telehealth and remote monitoring of patients everywhere possible across our system similar to our colleagues across the Commonwealth. In a case of diabetes, when a child demonstrates fever, fatigue, difficulty eating over time and does not get better, parents are encouraged to bring their child in to be seen. Whether it's at a physician practice or in the emergency department, it's essential that they go, and what we see is that people are so scared that they're going to get COVID that they wait it out until it is so far down the road of the child being really so ill that they have consequences. Speaker 11: (31:12) So I think the message is, if your child has been seen remotely and is not improving, it is time to reach out, once again, to the physician, and if you are recommended to come to the ED or you cannot reach your physician, we want you to come. We want to be able to see the child in real time to be able to provide the necessary care. Speaker 12: (31:34) Do you think the [inaudible 00:31:43]? Speaker 11: (31:47) Well I would say that we are seeing a leveling of our cases in the Western part of the state and specifically, at Bay State Medical Center, our peak was on April 8th. I know that it's more than a single point in time, so it's something that we're watching closely, and I will leave it to the governor about when to open things up. We recognize our health care and the health of our citizens is extremely important and we want to be sure that as we move forward that we do it safely and we will. We will use social distancing and the like and what we've learned to be better after this pandemic has subsided. Speaker 13: (32:25) Are any of you concerned about, since routine checkups are really happening right now, a lot of this stuff, at least some of it, mammograms, et cetera, can catch these things and then they start seeking more care. Are you concerned about what's not being caught in these routine checkups since they're not happening? Speaker 11: (32:43) Well, we are still taking appointments for routine care and we are looking now so that we're hopeful that by June we'll be able to start. So we encourage people to make their appointments. If people have missed appointments, we are reaching out to them to reschedule. I would say that what we want is to be as timely as possible and what we know is that if a condition changes, we need people to call us, ask for health, share what's different than it was a month ago, so that we can get them in because perhaps what was elective in early March is now urgent or emergent. Speaker 10: (33:23) What would you say to people who are in that boat, perhaps waiting too long, but who either were recently laid off or whose relatives were laid off, people who supported them, and who feel like they may not be able to take the additional financial burden of dealing with medical costs after the fact? What advice or response would you give to those potential prospective patients? Speaker 11: (33:48) Well I think certainly we know in the Commonwealth that we treat all that come to us, and we would hope that people know that we are working with them, and we certainly want them. It's hard to take care of the other parts of your life if you are not feeling well. So what we want people to know is come in, let us help you, and we will work together to figure out the financial struggles that patients face. Yet we also know that there is care for anyone that is suspected of COVID, or respiratory illness. They are covered. We cover everyone in our emergency department regardless of ability to pay. Charlie Baker: (34:36) Let me follow up a little bit on this. This started as a conversation a few days ago with a number of the folks in the healthcare community and we did some outreach to discover if there was a sense amongst the emergency management community or some of the folks who are part of this process about whether or not they had seen something. What we got back from most of them was commentary, not just on what was going on here, where they said they thought they were starting to see a little of it, but they hadn't seen that much. But many of them have operations and colleagues in other places and they talked a lot about what they'd seen or heard from other places. Charlie Baker: (35:18) Even a Google search will show you that this issue has been an issue almost everywhere that COVID's been. In some cases it's because the healthcare system has been overrun and it doesn't have the capacity or the ability to serve, which is part of why we all work so hard to make sure that wouldn't be an issue here. But I can't express how important it is for people to understand that a lot of work was done by a lot of people to make sure that when people had non-COVID healthcare issues that the capacity and the talent would be there to take care of them. That's exactly what this message is about today. Speaker 15: (36:02) When do you expect to resume elective surgery procedures [inaudible 00:10:06]? Charlie Baker: (36:06) I think that's going to be a function of how we deal with the daily count on hospitalizations and some of the other measures we're following. We've said for the past several days that we believe we're in, what we would call sort of the top of the surge, and when we get over the top of it we'll start talking with folks in the healthcare community about that. Speaker 15: (36:28) Do you think that once you resume that, that will signal to people that it's okay to go back to the hospital? Charlie Baker: (36:34) Well, I'm kind of hoping that what's going on here today would be part of that signal. I mean, you listen to these folks, they talk about ... I think the numbers at Bay State, where you have 150 COVID-folks and 400 others, that means they have almost three times as many people in the hospital that have nothing to do with COVID. All right? And they have extra capacity that goes way beyond that. These are great institutions, they thought a lot about infection control, they've learned a lot about it over the course of the past five, six, eight, 10 weeks, and I think it's really important that people not presume that either the system can't take them or there won't be a bed for them or there won't be a doc for them because there is and there will be. That's exactly what we spent a lot of time making sure would be the case. Speaker 10: (37:24) Governor, one thing I was wondering about, and I don't know if this is something that would be more so regarding the partnership with community health centers or also hospitals, but are there any plans to increase testing in Western Massachusetts? Similarly, to the announcement that you made yesterday with regard to the community health centers around here? Charlie Baker: (37:44) Do you want to speak to that? Secretary Sudders: (37:50) So actually I'm thinking of the email I just got from Dr. Keroack out of Bay State. We worked with Dr. Keroack and Thermo Fisher to actually, I think it's almost like quadruple, the amount of testing available in Springfield, and Caring Group is a Western Mass community health center, which is one of the health centers that we expanded testing at. Plus, as you know we have The Big E, in Springfield, which is a drive in. So we continue, and earlier today I was on a call with the Western Mass legislators around continuing to expand testing. Secretary Sudders: (38:22) We've worked with a couple of ambulance companies to do our mobile testing, and asked if there was a particular EMS out in Western Mass where we could do mobile testing through one of the EMSs out there, that we would continue to do that. So we are continuing to push out testing cost across the Commonwealth. Speaker 10: (38:38) Do you remember what towns or which EMS companies? I'm sorry. Secretary Sudders: (38:43) The ones that we currently are working with are Brewster and Cataldo, in the more Eastern part of the state, but as they go everywhere, as does our national guard. Speaker 8: (38:52) Secretary Sudders, could I ask you a question before you sneak off? Secretary Sudders: (38:55) I'm getting my steps in. Speaker 8: (38:57) I've heard from advocates for seniors that they're concerned about the level of testing for Assisted Living ... Speaker 16: (39:03) ... that are not licensed by the state like a nursing home, yet you've got a lot of older people, COVID-19 [crosstalk 00:39:10] spreading through. Are you giving enough attention to the 17,000 residents of Assisted Living? Secretary Sudders: (39:16) Yes sir. Speaker 16: (39:17) And others, but they're kind of a different category. Secretary Sudders: (39:22) So as you know, first when we started to roll out the mobile testing, it was nursing homes and rest homes and we have now expanded it to Assisted Living and continuing care communities, because continuing care communities often have assisted living nursing home and independent living. And so we were starting to do nursing homes and assisted living and then the people who were living in independent living weren't included. So we've just actually sent out a communication reminding people like the entire community care community can be tested. Speaker 26: (40:03) Governor, [inaudible 00:40:02]. Charlie Baker: (40:06) [inaudible 00:00:40:04]. Some of those 200,000 new test swabs that we just validated are going to be used to support testing at Assisted Living facilities as well. Speaker 18: (40:14) Governor, according to these concerns that came out show that two of the [inaudible 00:40:20] 2000 cases of Coronavirus as of March 1st, and that's the day we recorded the first case in the state. I guess your reaction to this, and if anything, should have been done sooner if not [inaudible 00:40:32]? Charlie Baker: (40:32) What I would say is that we were working with the guidance and advice we got from the experts in the public health and the healthcare community here. And we were one of the first States in the country to do many things with respect to the Coronavirus. And I think what I would say at this point is we are going to continue to take our guidance and advice from the folks in the public health world and the healthcare community. That's part of why we're here today talking about this concern we have, which has been born out in other places where the Coronavirus was before it came here, about accessing health care for non-COVID related services. Charlie Baker: (41:09) But I think in many ways this is an unprecedented virus and we are all learning as we go here, and making what we consider to be the best decisions we can on behalf of the people of the Commonwealth. And once again, we recognize and understand the burden and the difficulty that that creates for people. But the flip side of that is because of all that work that people did, we have a healthcare system that's in a position where it can both take care of people who are dealing with COVID and take care of people who have other medical conditions, which is something that hasn't necessarily been true in many other places that are dealing with this. Speaker 19: (41:46) Next question. Speaker 20: (41:47) I was just curious. Almost every day I had some lawsuit against the state or advocates are calling for increasing prisoner [inaudible 00:41:55], more testing for prison [inaudible 00:41:59]. How do you think it's going? I see there are seven death and several hundred positive cases, but in the [inaudible 00:42:01] of the nursing home situation, it doesn't seem, at 8000 inmates, it doesn't seem as severe as [inaudible 00:42:16]. How do you think [inaudible 00:42:20]? Charlie Baker: (42:22) Well the state prison system spent a tremendous amount of time with the public health folks in developing their strategies, both for what went on inside the prisons and what went on outside the prisons as well, before people showed up for work and all the rest. I think the long story short is they are in constant contact with the department of public health around the policies and protocols that they're using, whether it's related to hand sanitizer or testing protocols or almost everything they're doing with respect to disinfectant and visitation and everything else. And I think that's going to continue to be the way they go about doing their work. Charlie Baker: (43:08) But this was obviously something that from the very beginning we took really seriously. The conversations between public health and the department of corrections literally started, those might have started in early March. Right? Speaker 20: (43:25) Do you think they're handling it pretty well? Charlie Baker: (43:28) I think generally speaking, they are following the guidance that they're getting and have benefited from that. But there's always going to be room for improvement on all this stuff. And I think we constantly try to make adjustments based on the data and the information that we gather as we go. Speaker 21: (43:49) Governor, we have heard some reports of some hair salons deciding to try to reopen using safety precautions and CDC guidelines. Is it just too soon for those types of businesses to open, because of the nature of what they do? Charlie Baker: (44:02) Well, we've said many times that we think it's important for people to find a way to get back to something and it looks like a new normal, but it's got to be done safely. And the timing on this, and I can't emphasize this enough, the timing on this needs to be based on data. And there's several pieces of data that almost everybody in every country who's talked about this has relied on. Charlie Baker: (44:28) One has to do with hospitalizations, one has to do with positive testing, and one has to do with other data associated with some of their surveillance work than in countries that are really ramped tracing up in a big way are doing there. And trying to get down to the point where you have a one to one relationship between new cases and cases caused by that new case. Charlie Baker: (44:53) We are tracking a lot of that data just as other States are and other countries are. We're going to make a decision about changing our current strategy when we see a change in the data. And we said we were going to be in the surge around now and we are, and thankfully our surge is manageable. And our surge is manageable because we did a lot of work to prepare for it and that's why we're here today saying how important it is if you have a medical condition, you need to make sure you get it treated. I can't say this enough. There's plenty of evidence out there that shows that in other places this didn't happen. It's really important if you have a medical condition other than COVID that you listen to what the experts who are here today had to say about the fact that they have capacity and the skillset to safely treat you. And I think it's really important that everybody understand that. Speaker 22: (45:47) Governor, Mitch McConnell has suggested that States be allowed to file for bankruptcy in place of continued federal funding or bailouts, I guess. Is that any way in the cards for Massachusetts? That's something the state should or could even consider? Charlie Baker: (46:04) Well, as I've said before, I think the federal support we got out of a number of the pieces of legislation that had passed so far is very helpful. And I'm anxious to see what they do with this fourth piece of legislation, because it does have some very important elements around testing and treatments, which I think all of us believe the federal government has a hugely important role to play in. But I think one of the things we benefit from as we think about all this stuff is we have a very significant stabilization fund that people worked really hard to put together. And I believe that will help us in many ways work our way through downturn. Speaker 23: (46:42) Governor, can you tell us what the state is doing to ensure that the number of deaths aren't being under counted? With people dying at home, I know there is some concern that hospital numbers are [inaudible 00:00:46:55]. Charlie Baker: (46:55) There's a lot of what I would describe as retroactive review, not just going on here but going on in practically every state in the country with regard to that. For the primary reason that a lot of people didn't really know that COVID was in their community until after a little bit of time had gone by. But that's something that I think our folks take pretty seriously both on a go forward basis and on the look back. Speaker 24: (47:20) An analysis of the state's COVID-19 data shows that the per capita cases for Latin X residents were more than three times that of white residents and for black residents is two and a half times. Any idea why that disparity, and what are you specifically doing to address that? Charlie Baker: (47:38) Well we said all along that distancing is a big part of how you manage this issue, and virtually everybody who has studied this issue said density in many respects is one of the biggest challenges people have with respect to with COVID-19 because of its contagion. And that's part of the reason why in the Plain States, for example, you don't see anywhere near the same kinds of traction with respect to COVID that you see in places like New York City or places like Massachusetts, which tend to be a lot more dense than other parts of the country. And I think in particular on the issue that you raised, that has a lot to do with density. And it's part of the reason why we've been so aggressive about expanding our program with the community health centers, because they are, in many cases, the most important care asset in many of those communities. And it's who we're going to work with to try to see if we can't do everything we can to to make sure people know where to go, know what their standing is and how to access care. Speaker 19: (48:41) Thank you. Speaker 25: (48:42) [crosstalk 00:48:42] unemployment numbers for these two days, like generally from last week's, still a huge number in the downturn. Charlie Baker: (48:49) So our big objective on unemployment has been two fold. Number one, to move the enormous number of people who applied. And literally, we've talked about this before, it's been anywhere from 10 to 15 times as many per week as we've ever seen through the system. And that's translated into hundreds of thousands of people on traditional unemployment insurance assistance here in Massachusetts, and a constant back and forth between people who are applying in our call center, which used to have 50 people in it and now has 850 people in it. And they've done hundreds of thousands of outreach calls, and a town hall basically every day in English and Spanish for the past three weeks that had been attended by 175,000 people. Charlie Baker: (49:38) We also set up an electronic application for the so called gig workers who don't qualify for traditional unemployment insurance. And I got to give a lot of credit to the team on that one. They put that up in two weeks and we're one of the very few number of States that's actually accepting online applications for gig workers and has the program integrity that needs to be in place to ensure that we pay appropriately to people who apply. And those folks in many cases are probably going to start getting their checks next week, which is a great thing because that's a big part of the community that I think we all wanted to make sure that we got resources out to as quickly as we could. Speaker 19: (50:20) [crosstalk 00:50:28].