Ohio Gov. Mike DeWine COVID-19 Press Conference Transcript November 23

Mike DeWine: (04:49) Well, good afternoon, everyone. Mike DeWine: (05:05) Well, I want to first start off by wishing my friend, Mike Hartsock all the best. For almost four decades, he has been the sports voice of WHIO, Channel 7, in Dayton. Miami Valley viewers have tuned into him for all that time to hear about the Dayton Flyers, Cincinnati Reds, Ohio State Buckeyes, Browns, Bengals, and what he also does so very, very well is Friday night football. And there's been many, a high school athlete who has been thrilled by having Mike Hartsock at their games. So Mike, we wish you all the best. Mike DeWine: (05:49) Tonight we will, Fran and I will tune in for, I guess, what is your last broadcast and we'll look to seeing you. I know your mom, Phyllis, is a great, great fan, and she'll be tuning in as she always does, as well. So we wish you, Mike and your wife, Janet, all the best and thank you for a great run, bringing us all the sports and doing it in a way that made us feel like we were right there. Thanks a lot, Mike. Mike DeWine: (06:22) Today, this is a special press conference and the main purpose today is to give people of Ohio a better understanding, is this fast runaway freight train of this virus, is spreading around Ohio, but to give people an Ohio, a better understanding of what's going on in our hospitals. Mike DeWine: (06:46) I started my morning this morning, 6:30 call with the hospital's own leads around the state and I really feel this important that what they told me this morning, that they share directly with the people of Ohio. Mike DeWine: (06:59) So we're going to go in a moment to them and they're going to be the ones who will answer the questions. They'll be the ones who tell us exactly where we are in regard to our hospitals. Mike DeWine: (07:13) We had more good news today on the vaccine front. We learned this morning that AstraZeneca's vaccine is up to 90% effective. This comes on the heels of recent news of Pfizer and Moderna being about 95% effective. That is just great news. Later this afternoon, I will be on a call with the other governors in regard to the federal officials who are going to talk to us more about the distribution of the vaccine. So we are, again, very, very excited about that. It is coming. Rescue is on the way and we're very excited about that. Mike DeWine: (07:51) Let's go to our cases for today. Today we're reporting 11,885 cases. We are also reporting an additional 282 Ohioans have been hospitalized because of COVID. Sadly, we are reporting 24 more Ohioans who have died. So this is the data from today. Mike DeWine: (08:13) Now there has to be an asterisk by this and let me take a moment to explain it. The big, big picture is that the high volume of these cases is now overwhelming the system. It's not only overwhelming how the department of health system, but it's also causing some problems in regard to the laboratories and getting all this information through. Mike DeWine: (08:34) So there's two things going on. And once I explain it, you're not going to know exactly what the number is, but the number is high and this number has been averaging about 8,500 cases per day. Mike DeWine: (08:50) This particular jump is caused, at least in part, and maybe wholly, by something that happened two days back and that is two laboratories that were reporting in, two of our more bigger labs, that reporting did not go in for two days and so this is two days worth of those two labs added to this. And so as Mercy Health and the Cleveland Clinic, so both of these are big systems and so this is what results in this particular number; 11,885. Mike DeWine: (09:34) So it may be artificially high, but it has that involved in it. We still have the problem we talked to you about the other day, which is antigen testing. There is now about 15,000 of these backed up. We estimate, and it's an estimate, about three fourths of those were all ultimately be cleared in because many of those, or a good number of those, are antibody. They come together in the system. Mike DeWine: (09:59) Again, the point is that we are at a very high, certainly a very historically high, high level and we hope in the manner, in the next few days, to get all this cleared out so we can give you the exact numbers each and every day. Mike DeWine: (10:13) Today though, is about hospitals, and I think that if you really want to see exactly what's happening in Ohio, the best way to do it is look at the hospitals because these are numbers. This is a count. The number we report is what the hospitals report to us all throughout the state of Ohio, of what their COVID count is in every, every single day. Mike DeWine: (10:38) At the press conference on Thursday, I know that we had more than 3,800 COVID patients that were in the hospital, at that time. It was then the highest patient count we'd seen throughout the eight month of the pandemic. Unfortunately, the number has continued to go up. Mike DeWine: (10:54) The Ohio hospital Association is reporting that we are at 4,358 patients as of today; 4,3 58. This is, excuse me, a 59% increase from just two weeks ago. We also currently have 1,079 patients who were in the intensive care unit, which is again, far higher than we've seen so far during this pandemic and look at this chart again, which is, the blue is the number of people hospitalized from COVID. There is the number and this is the ICU. The ICU is obviously trending up as well. So this has been a dramatic change. Mike DeWine: (11:37) If you go back September 1, August 31st, right here, and you can just see the dramatic change. And even down here, as late as September 25th, we were still around here and we've seen what's happened. Mike DeWine: (11:52) Let me one more thing before we get to our doctors. Today, I'd like to share a newest social media graphic. We made it to remind Ohioans that when you gather together at Thanksgiving, if you have people outside your own circle, outside your own household, that people who come will be bringing other people with them and we've kind of done it in these ghost figures back here. It's basically that anybody who is at the table is bringing people with them who they've come in contact with the week before or so, and that is what again makes it dangerous. Mike DeWine: (12:34) So, Uncle Joe and Aunt Sally are coming over. You haven't seen him for a while. Not only are they coming over, but the people that they've been interacting with, but they may have got the virus from they're coming over as well. And so again, just one more way to kind of graphically illustrate exactly what our real concerns are in regard to Thanksgiving. Mike DeWine: (12:59) Let's go to our doctors. First, Doctor Robert Wiley and the Cleveland Clinic. Doctor Wiley, thank you very much for joining us again. We appreciate it and maybe if you could just give us kind of an outline of what you're seeing, in not only in the clinic system, but in Northern Ohio, basically everything from Youngstown, all the way over to Toledo. Dr. Robert Wiley: (13:23) Thank you, governor and Youngstown, Toledo, and south to Canton area. It's about 50% of the population of the state, in terms of the area covered. Dr. Robert Wiley: (13:33) So you heard the governor just say that there are 4,358 hospitalizations that were announced today. I want to put that in perspective. On September 23rd, two months ago, there were 600 hospitalizations. So we've gone from 600 to over 4,000 in 60 days. Dr. Robert Wiley: (13:51) So regardless of our ability to test, which has gone up substantially about 70 or 80% since that time, we've have a significantly outstripped that number, in terms of the number of people actually being infected. Dr. Robert Wiley: (14:04) I did this Zoom call at noon today. We talking to all the leaders of the hospitals throughout the Northern zone. All of us are starting to be stretched. We are trying to balance load as best we can. We're transferring within the systems. So whether that's in Cleveland, whether that's the Cleveland Clinic System, or university hospitals, or Metro, the same is true for the Summa Systems and Mercy Systems, et cetera, but now we're starting to transfer between systems to balance load as well. Dr. Robert Wiley: (14:33) In addition, what we've seen just in the last few days for the first time on Friday, governor, we saw for the first time that we were starting to transfer ventilators and high flow oxygen equipment, because people were actually running out. Dr. Robert Wiley: (14:45) My biggest concern today is what I'd like to share with the people who are on the Zoom and that is that the Cleveland Clinic System alone today, and this was echoed in the other systems, we have 970 caregivers out and they're out because they're either on quarantine or they have active COVID infection. Dr. Robert Wiley: (15:05) Want to emphasize that we look at each of these infections and they're not catching it in the hospital. Our caregivers are getting COVID and acquirement in the community and they parallel the community spread. So, as the community rates of positivity has gone up, the number of caregivers who have gotten COVID have gone up, exactly the same way within the Cleveland Clinic System. Dr. Robert Wiley: (15:27) When you have 970 caregivers plus who are out, that means it's starting to affect our ability to care for patients. What we do to accommodate that is we start closing down some services. So we started a couple of weeks ago about inpatient elective surgeries, and we took those patients who would've been doing... Those caregivers, excuse me, who would have been doing those procedures, and we'll put them back in the hospital floors and in the ICU to take care of people. Dr. Robert Wiley: (15:53) We also started coalescing our ambulatory surgery centers. It became busier, but we took those folks and when again, we put them back into inpatient care. Dr. Robert Wiley: (16:04) So our urge is that we need your help in terms of trying to prevent our caregivers from being sick and being off work. We need everybody to mask, do social distancing, particularly during the upcoming holidays and observe hand hygiene. Dr. Robert Wiley: (16:18) And governor with that, I'll turn it back to you. Mike DeWine: (16:20) Good. Doctor, thank you very, very much. 970 caregivers out. That's kind of a shocking number. Have you had anything like that before? You probably didn't have that in the spring? Dr. Robert Wiley: (16:35) No. This is by far the highest by several-fold. Mike DeWine: (16:41) Let's turn to Andy Thomas, Ohio State University Wexner Medical Center. Mike DeWine: (16:48) Andy, you want to tell us a little bit about what's going on at your hospital, but also in your whole zone. Andy Thomas: (16:57) Good afternoon, governor. Thank you for the opportunity to be here and I would echo everything that Bob just shared. We're seeing these... Andy Thomas: (17:03) ...echo everything that Bob just shared, we're seeing the same trends in zone two. And if you think back to where we were just earlier this month, we peaked in the spring and zone two at 356 patients in the hospital was our highest census back in that April, May time period. On November 2nd, we crossed 400 patients for the first time. Four days later on November sixth, we crossed 500 patients for the first time. Four days later on November 10th, we crossed 600 patients for the first time. A week later on the 17th, we crossed 700 patients for the first time. The next day on the 18th, we crossed 800 patients in the hospital, in the zone, at the same time. On the 21st, just on Saturday, we crossed 900 patients for the first time. So, on November 2nd, the day before election day, to cross 400 patients now we're crossing 900 patients, not even three weeks later. Andy Thomas: (17:59) And today we sit at 960 patients ready to cross a thousand over the next couple of days. I think what we've seen over the past four to six weeks is as cases go like this hospitalizations track right behind it. So until we see cases peak and start coming down in a sustained way, we're going to see hospitalizations continue to rise. So I think we can't sound the alarm bell loud enough to the people of the state of Ohio to change their behavior. With the Thanksgiving holiday, coming up the ability to make sure that you're keeping within your bubble, people that have been safe. If you have family coming over, hopefully they've been quarantining themselves away from others for 14 days prior to coming to your house, that's the best practice to make sure that they aren't bringing their whole bubble with them. And anything that might be unsafe to your point with the graphic earlier. Andy Thomas: (18:51) One of the other key points I want to make is our zone is 36 counties with over 40 hospitals and health systems throughout the zone. There's the more kind of metropolitan area in region four, but then a lot of rural areas, especially in region seven and eight, which represent the Southern Ohio and Southeastern Ohio parts of the state. What's very different this time around compared to the spring or even the summer surge is how this is spread really throughout the state, both region seven and region eight today are either at, or within a couple of patients of their highest census in those regions at any time during the pandemic, back in the spring, if you would have looked at the data about 50 to 60% of all the patients, I'm sorry, about 75 to 85% of all the patients in the hospital, in our entire zone, where just in hospitals in Franklin County for the past month, the two months that's been running closer to 50 to 60%. Andy Thomas: (19:47) So the patients are distributed much more broadly. Now the good news is those hospitals that are doing an amazing job. They're providing care at the local level for patients that they have the resources, the capability, the staffing to provide that care, but we're finding the same thing Bob's finding we're having to do what we're calling lateral transfers. So not a transfer for acuity for a high-end ICU care that maybe the patient has to come to Columbus for. What we're seeing are hospitals, Holzer and [inaudible 00:20:15] police and Edina and Chillicothe trading patients back and forth. Hocking Valley and Logan trading patients with Fairfield Medical Center in Lancaster. To the Northern side, Wyandot Memorial in upper Sandusky trading patients with Avita hospitals in Crawford County because frankly they just hit their capacity. One day it's one hospital, two days later, it's going to be the other hospital doing the favor back to the first hospital. Andy Thomas: (20:42) So, it's widespread broadly across the entire zone to the point where if you look, especially in region seven and eight in the ICUs, in those hospitals, 40 to 50% of all of the patients in the ICU and 50% of all the patients on a ventilator in region seven and eight are there because they have COVID. This is not something that's a Columbus, Cincinnati and Cleveland problem, it's a problem throughout the state. And I'll turn things back to you to go to Dr. Lofgren. But I think in the next few weeks, we are all, every hospital in the state, is going to have to start making tough decisions about how it will staff its beds, about what elective kind of non-urgent non-emergent things that's going to have to postpone even to the point potentially of postponing ambulatory and outpatient office visits. I'll turn things back to you, governor. Mike DeWine: (21:35) Dr. Thomas, thank you very much, Dr. Lofgren with the UC Health is joining us again from Cincinnati. Doctor, thank you for joining us and tell us again, not only about UC Health, but also what you're seeing throughout just your whole region. Dr. Lofgren: (21:51) Yeah. I'm just going to echo what my colleagues have said, because the point is that this virus is everywhere. And what we're seeing in zone three is that we have 1100, 1,121 patients in the hospital today, we have 253 individuals in the ICU and 171 of them on ventilators are patients with COVID. And our zone includes region three, the date and area in region six, the Cincinnati area. And we're seeing a proportional amount of spread throughout the entire regions, urban, suburban, and throughout the community. As mentioned before, in region six, we've seen between the 20 and 25% increase in the number of patients admitted with COVID week over week, last week, we had 517 hospitalized patients. Today we have 640. To put that in perspective, in the end of September, throughout the entire region, we had 90 individuals hospitalized. This was at a point in time when we were opening up our businesses. Dr. Lofgren: (22:51) People are going back to schools, which really speaks to us that we know actually how to keep this at bay, but this virus is now everywhere. And we anticipate by next week, we're going to have over 800 patients hospitalized. The growth is exponential at this point, and it's not that we're planning for the surge. The surge is here. Currently our systems have been able to accommodate the increase in volume over the last eight weeks. Just as my two colleagues have mentioned, we've been able to transfer patients between facilities within the same health center system. And we're starting to load balance between the accommodating patients between health systems within the region. But I can tell you we're quickly approaching that point where the influx of COVID patients will in fact displace some of our non COVID care, something that we learned in the spring that actually can have in and of itself, adverse effects. At UC Health we're working hard to actually actively manage the inflow of patients that require hospital beds. Dr. Lofgren: (23:51) As our colleagues mentioned, we are actively and much more selective about transferring patients to our ICUs who may need it and trying to help other hospitals maintain those patients in their current facilities. We're eliminating the number of non-emergent surgeries that might require a hospital stay. And this is a very real time data that we use. And others that I know in our region are expanding their PACU hours to make sure that patients can be discharged home rather than admitted overnight. Even though they may be discharged at 10, 11, 12 o'clock at night. But the key issue that I also want to say that makes sure that people understand that all of us throughout the entire state are feeling, as we try to meet this increasing demand is our lack of staffing or how much our staff is stretched. Especially the nursing staff. Dr. Lofgren: (24:40) In region three, for example, today, nearly half of the hospitals are reporting a nursing shortage. And I would tell you that the impact of these shortages on our workforce, can't be overstated. They've been working extra hours. They're really stressed to make sure that they really continue to provide the highest quality care for which they've been trained to do. And this issue around burnout is very real. If you go and talk to the... At this point, even in the early part of the surge that we're seeing, the workforce is exhausted, the exhaustion is actually palpable. Dr. Lofgren: (25:15) And the other thing I finally mentioned is that within our system where reactivating our crisis standard of care committee, as we consider the fact that we may need to think about the allocation of scarce resources, the one that's actually becoming more polite about that is something like ECMO and ECMO is a particular kind of bypass for heart lungs that we use for patients with the most severe kinds of respiratory failure. So, again, I'm just going to echo what my colleagues have said. We've seen the surge, it is here. We're responding to it, but I can tell you as the surge increases, we're going to need to make more and more decisions about how we triage and take care of patients appropriately. Mike DeWine: (25:56) Thank you very much. Finally, we'll go to Rhonda Layman with Mercy Health. How are you doing today? Rhonda Layman: (26:03) Hanging in there. Thanks for asking. Mike DeWine: (26:06) Where are you today? Rhonda Layman: (26:07) I'm here at St. Rita's medical center in Lima. Mike DeWine: (26:11) Tell us what's going on in Lima and what you're seeing, because you're really... You're a regional hospital for a lot of counties in Northwest Ohio, certainly. So tell us what you're seeing. Rhonda Layman: (26:23) Yeah, so the surrounding counties really rely on us and depend on us to be able to take those more critical patients. And that's exactly what we've been doing. Boy, it's a hard act to follow after those three, because truly each of the different levers that they're pulling and things that they are concerned about and seeing is exactly what we're seeing here at St. Rita's. So right now about a third of our inpatient census is COVID patients. And we are maxed out with the number of patients right now, in-house and patient that we even saw probably at our peak, all of last winter. So definitely concerning and something maybe I would add just kind of a nuance to think about. We are leveraging staff in different roles in different ways, but again, the number of patients that are presenting that need hospitalization are coming in at a faster rate than we are discharging them. Rhonda Layman: (27:14) And I think that that's something people can wrap their heads around. Yes, there are definite data to say that not as many people are expiring or passing away from COVID, but the mortality, the morbidity of that, and the ability to be able to discharge patients safely back to their homes and have oxygen set up and have home care setup, or have skilled nursing facility placement, those are all pieces of the healthcare puzzle that are also being very taxed and overburdened by this. So again, the inpatient side is filling up, but we're not able to discharge commensurate with the number of patients that are presenting to our EDs and urgent cares and needing services along with all of the non COVID patients, again, that are still occurring, the heart attacks, strokes, the traumas, those are all things we have to have enough resources to be able to care for. Mike DeWine: (28:09) Well, great. Thank you very much for that report. We appreciate you being back on. I know you're getting hit there and its throughout the state of Ohio. Eric, let's keep all four on for a moment. And let me ask any of you who want to jump in here. We don't know frankly, what people are going to do in regard to Thanksgiving, but when would we see the results of the Thanksgiving weekend for many families, it's Thursday, Friday, Saturday, Sunday, in good times, that's what it would be for the Dwayne family, a great time to get together, but if we don't tamp down Thanksgiving, when we normally see the of that in the hospital? Dr. Robert Wiley: (28:56) Governor, there's typically a delay of about one week for people to become symptomatic, if they're going to become symptomatic. And there's about another week before they require hospitalization because their symptoms are relatively severe. So we would expect to see the hospitalizations following two weeks. Dr. Lofgren: (29:14) And I would just add that you start to see then the cascade of sick, the hospitalizations to ICU, and then the later, most lagging is death. So that whole cycle is probably usually about four weeks. Mike DeWine: (29:28) So, irrespective of Thanksgiving, we have not yet seen a plateau of these cases. So, we're not hitting a plateau yet, and we're certainly not hitting a plateau for the hospitals, but based on what we are seeing now, I mean, what you project, where we're going to be if in two weeks, and then maybe three weeks and four weeks, if we don't turn this thing down a little bit, anybody? [crosstalk 00:29:58]. Andy Thomas: (29:57) ...take that one? With the modeling where we'll be in two weeks and four weeks, you want to take that one? Dr. Lofgren: (30:05) Yeah, I think that, one of the things that we're looking at our information more real time, and I think the point with that is saying is that it really is we're seeing about a 25% increase in terms of week over week. So, I think you could anticipate that at the rate we're doing that you'd see at least a 50% increase in the number of hospitalizations that we'd have. So we expect that within the week period of time, we're going to go from 640 to 800. The short-term modeling has been very accurate for us in terms of really anticipating. And it's part of what we are using for our own planning in terms of staffing and capacity building. Mike DeWine: (30:45) And again, if we don't slow this down, what are the other, you've touched upon the other consequences, but I know you can't predict what day something will happen, but again, the recap of what you mentioned cutting down on elective surgeries, and one of you talked about a scarcity of resources beyond people. So, like [crosstalk 00:31:10] that's a little worrisome there. So, I... Andy Thomas: (31:14) In zone two just today on our 9:00 AM surge call, we reviewed a new kind of nomenclature, a new kind of three level system for what people are postponing. We already have seven hospitals in our zone that are postponing some sort of outpatient surgery where patients may still need to spend a night in the hospital in order to free up beds and free up staff. That seven out of the 40 plus hospitals. So, what we've done is create almost a scoring system, a level one, a level two, and level three that will allow us to have transparency across all the hospitals, so that people have a understanding of kind of what stage people are at. I think in a way this week being a being a holiday week, our operating room schedules are a little bit lighter, just because there's only three days in the OR instead of five. I think a lot of hospitals are hoping they can make it through this week without... Just because demand will be down a little bit for routine care. But I think moving into next week, you'll see more and more hospitals making that tough decision to start postponing first kind of outpatient procedures. Those tend to be less related to cancer, less related to [inaudible 00:32:21] ...as was mentioned earlier, we will keep taking care of heart attacks and strokes as best we can, but for those routine surgeries that can be put off for two weeks, four weeks, six weeks, we're going to have to start putting those off. Andy Thomas: (32:34) The second step up is delaying inpatient surgeries, where people are going to stay in the hospital for three, four, five, six days. The third level is looking at our ambulatory surgery sites mainly to redeploy those staff to work in the hospital and potentially even ambulatory clinics. So, outside of emergency visits, really taking primary care doctors, taking nurse practitioners from outpatient ambulatory sites and asking them to come back and work shifts in the hospital is really going to be the only kind of trigger we have left to pull to help with our staffing needs. If this continues to just go up unabated over the next month. Rhonda Layman: (33:13) And similar to what Andy was just describing, we have actually in Lima started redeploying those nurse practitioners from the ambulatory settings in the acute side. Unfortunately, we are shortchanging those ambulatory patients needs as well, because there's a definite role for our ambulatory providers to help us keep patients that could have COVID safely at home managing at home, so they don't have to come to the hospital. So it's a real catch 22, bringing some of those providers in and not having the adequate ambulatory resources to manage out in the community. Andy Thomas: (33:44) Yeah, Rhonda, I would agree. We started about two weeks ago, pulling in general internist, rheumatologists, cardiologists, gastroenterologists, even our palliative care staff that normally would be an outpatient clinic are taking turns on rotations, and we still have a lot of ambulatory providers seeing patients. It's not like every appointment's canceled, however it's so it's been selected so far- Andy Thomas: (34:03) It's not like every appointment is canceled, however, and so it's been selected so far, but as this continues to ramp up, we're going to have to call on those folks for extra help. Dr. Lofgren: (34:13) I would just echo that, in the spring, when we really didn't know much about the virus, we really didn't have a lot of information. We really were flying blind, sort of without instruments. And at that point in time, all of us got caught off guard with not having adequate PPE, not really sure where we had in terms of the supply [inaudible 00:34:31] . We've really improved dramatically, in that regard. Our data sources are rich. We really have an idea of what our other resources are, where our capacity resides. The real difference now, what really is limiting, is having the people available to take care of patients. Pulling people from their usual jobs into these new makeshift jobs just adds stress to the environment. But we work hard to try to accommodate as many patients as we can. We're also fully aware that, not only does it have an impact on people who have COVID, but also people who come for significant healthcare reasons, that really have non COVID care issues and that there is consequences in not being able to accommodate them. Dr. Lofgren: (35:16) And so making the selection about how we delay some care, in light of the surge, it's really an ongoing battle and a difficult responsibility. And one of which I know that all the zone leaders and physician leads throughout the entire state are coming together to make sure that we are really consistent and using our best and brightest minds to think about how we do this most effectively. Dr. Robert Wiley: (35:39) Governor, within the Cleveland Clinic, to give you a specific example, we have nearly 600 patients with COVID in our hospitals, in Ohio. We're planning to move up capacity to 900, a 50% increase, by the second week of December. If nothing changes, that's the numbers that we... Now that's worst case scenario, but that's the only worst case scenario for three weeks. That's not saying what could happen after that, but the first step is just to prepare for three or four weeks ahead. Mike DeWine: (36:12) Okay. We'll go to questions in just a moment. This actually is Thank a Public Health Worker Day, so I want to thank everyone who is out there, who's making a difference. Doctors, nurses, therapists, techs, aids, first responders. So many other people of the medical community who are out there taking care of us each day. So we appreciate very, very much all that you do. We know you're at the front line and we appreciate it. We know that we've asked you to run a marathon, and now we're asking you to do another one. So we were very, very grateful and we're going to try and do everything we can to slow the number of people going through the system, the number of people who are getting the COVID and need to be treated. Thank you very much. We'll go to the questions, anybody in the media for questions? Speaker 1: (37:11) Governor, question from Josh Rutenberg at Spectrum News. Josh Rutenberg: (37:17) Good afternoon, governor, how are you? Mike DeWine: (37:18) Hey, Josh. Josh Rutenberg: (37:20) You had a nurse last week who came on, who got really emotional about the fight that they are struggling to keep up with in the hospitals. And you just had your doctors today say that they can't sound the alarm loud enough. So is it time to admit that the curfew is not working and then stronger measures, like a full stay at home order, are needed? Mike DeWine: (37:38) The curfew hasn't been in very long. And I think the doctors will tell you that you don't see the impact in such a short period of time. It's true. What we do in the next few days, particularly what we do on Thursday and Friday and Saturday and Sunday, is going to determine whether the world that they have described, how that's going to turn out, whether it's going to be better, or whether it's going to be worse. We know that these cases are kind of baked in now for the next several weeks, as they have described. There's always this lag that is here, but we have the ability to change the future. I've said I'm a big fan of the Back to the Future movies. You can have an alternative future. We can change it. We have the ability to do that. So we are starting to see more mass compliance. Mike DeWine: (38:26) The reports that I'm getting back from my team show that even in our rural communities, where it's been tougher, in retail establishments, the mass compliance is up. But again, the most important thing, the most important thing, that every one of these doctors will tell you is what individuals do in their own lives. And this comes down to personal responsibility. It comes down to what each and every one of us decision we make it. The future is going to be determined by frankly, how many people we have at Thanksgiving. If they're in our bubble, are they from our household? Or are they people that have not been inside that before? What's going to happen not just a Thanksgiving, but every day that's what's determined. It's personal responsibility. I'm not ruled out anything, but we've got to give people in Ohio a chance to turn this around. Because I think we can turn it around. Mike DeWine: (39:28) We've got to give the curfew time to work. We've got to get the mask order, that's now being enforced vigorously in retail, time to work. But mostly what we have to do is let people soak in what the reality is of this. Early on, it was easy to say "I didn't know anybody who has COVID" or "It doesn't come to my County". Nobody can say that it doesn't come to their County now. I mean, the high incident rate of every single County and those numbers, I look at him every day and I just almost choke. They get worse and worse every single day. Cause every day you go back 14 days and look at how many cases you've had during that period of time. Speaker 1: (40:08) Next question is from Shane Stegmiller, at Hannah News Service. Shane Stegmiller: (40:15) Hi, governor. Thanks for taking my question. Back in the spring, there was a big deal made out of all the convention centers being set up as possible alternative hospital sites, are we reaching the point where we're going to have to start using those? Are those prepped? Did they shut those down? Where are we at with possibly having to open up alternative hospital sites? Mike DeWine: (40:36) Yeah, I'll refer to our three doctors who have the lead on this. And what they've expressed to me is the biggest concern is about people, but I'll let them answer the question. Andy Thomas: (40:47) Yeah. Thank you, governor. In Columbus, as many folks know, we had a plan and actually had cots and piping and draping set up at the Greater Columbus Convention Center. That has all been stored and put away. We have a playbook in place to be able to have that back online within seven to 14 days. I get the question a lot, both from people at my work, as well as docs from across the zone and patients and others. So it's a good question to ask. Our hope is we will not need that. Our hope is, by doing events like this and getting people to understand the impact of this, we will not need that. That being said, if we do need it, it is there. But what I think you'll see, and prior to being able to open the Convention Center, because that's nice that it provides space, it provides beds, it provides a place for people to recover, however, I need people to work there. Andy Thomas: (41:40) And right now I would have to generate those people to work there by essentially closing down nearly everything else that our system does, that's not taking care of patients in the hospital, to generate enough doctors and nurses to care for hundreds of patients, not just for my hospital, but for OhioHealth and Mount Carmel, at the Convention Center. So we're hoping against hope that we will not need that. That being said, we have a group that meets weekly, essentially continuing to work through "What would our triggers be? How's it looking at your place? Do we think we need just get a contract for the electrical setup?". Whatever it is. We are assessing that on a week by week basis, knowing that within seven days to 14 days, we could have that up and running. But if we need to open those, then we will be in a far more dire circumstances than even we are today. Mike DeWine: (42:31) Anybody else? Mike DeWine: (42:33) I'll take a little different tack. It's a great question. And we all get it fairly often as is Andy said. But it's all about the people. So right now we have hospitals within the Cleveland Clinic system and we don't have all the beds open because simply we lack staffing, in terms of putting the people in it. People are treated best where the are people providing the care are familiar with its surroundings, and know where everything is and know who to call on. Once you take them out of that environment, the care becomes much less efficient. Mike DeWine: (43:02) So we had the whole hospital, which was the Medical Education Campus, beautiful building, turned it into a thousand bed hospital. That's been taken down, but right now we, even if we wanted to stand it back up, we don't have anybody to put there right now. So that's why we really need the cooperation of the public. As the governor said, we need the public to do its part, in terms of reducing the load. So we will manage whatever's thrown at us to the best of our ability, but we need this load and this burden reduced so that we can manage it all well. Dr. Lofgren: (43:36) I would just echo exactly what my two colleagues ahead. We set up the Duke Energy Center, we put up 150 beds. We have a playbook all ready to go. It could be reactivating in a relatively short period of time, probably about seven days. But there are two things that I would say. One is that, I think that most of our physicians and leaders understand that finding and expanding our footprint within the walls of our hospital is a much better answer to take care of patients than putting them in an alternative site, where all the resources are not really immediately available to take care of patients. So we are definitely focusing on what we can do to take care of the most amount of patients within our footprint. Dr. Lofgren: (44:15) The other thing is that we could set it up, but we really honestly don't know who would we pull to actually staff it. So we're focusing on expanding our footprint within our health systems and optimizing our care teams is where we've seen moving forward. But exactly to both Bob and Andy said, if need be we're prepared to open it. And if that were the case, we would be in particularly dire straits. Mike DeWine: (44:43) Rhonda Lewman? Rhonda Layman: (44:46) I agree with all of those things, they put a nice bow on it. Again, it's best to care for patients where the caregivers have their supplies, have the ancillaries that support them. And so keeping them on this footprint on this campus is really what we would strive to do. However, we possibly can make that work. Mike DeWine: (45:06) Okay. Well, the next question, thank you. Speaker 1: (45:09) Next question is from Max Filby, at The Columbus Dispatch. Max Filby: (45:13) Hey, governor, Max. I've got sort of a two-parter today. For the doctors: how close are we to having to consider rationing care for COVID patients? And then for the governor: will the state issue any plans or guidelines if it were to come to something like that? Mike DeWine: (45:31) I'll take that. I think the doctors will tell you that they have a sophisticated plan in place, they always have in case of carers ration. But I'll let them answer the question. How close to that we are. Andy Thomas: (45:49) It really depends, Max, on which resource you're talking about. For example, I know the zone today to the best, we are not at risk of running out of ventilators across the zone. That being said, any one hospital might be at risk of running out of ventilators. So we have had, similar to what Bob described, some hospitals that have run short on equipment, that other hospitals that they partner with have been now able to supply them. That's terrific. We've actually been working under an allocation of scarce medical resources principle for a good bit of the summer around the medication remdesivir. I remember when we first got our first allocation of medications, we got less than half the doses we would need to treat the patients we had in the hospital at that time. So we had to prioritize who were the patients that would benefit the most from the medication versus the ones that wouldn't. Similarly, there are the monoclonal and the antibody treatments that have been approved in the last week or two. We're getting a limited amount of those as a state, less than half of one day's worth of cases at this rate. Andy Thomas: (46:52) So all of us are working together to come up with the prioritization methods. And frankly, the biggest case for allocation of scarce medical resources is coming up here in the next two weeks, four weeks, it's going to be the COVID vaccine. We are not going to have enough vaccine on day one to vaccinate all healthcare workers, much less, even a substantial portion of the state of Ohio. So, even though we may not be like you saw in Northern Italy where you had two ventilators left for three patients, we're not as a state in that situation right now. Andy Thomas: (47:23) We do see when you have to appoint where one out of every four patients in the hospital today in the state has COVID, and one out of every three patients in an ICU has COVID, it doesn't take a whole lot of growth to figure out there's going to be somebody who's going to be shortchanged here from either their attention, their care, or the resources we have to take care of them. So it's a great question to ask right now. I think we're doing okay when it comes to that. I don't know Bob or Rick, anything else? Dr. Lofgren: (47:51) We have a [inaudible 00:47:53] group that actually thinks about the rational and the crisis standards. And, as Andy mentioned before, early on, there was real concerned about allocation of ventilators. I think those supplies and things are under good supply. It's a couple of elements. I think the prioritization that we're outlining for vaccines isn't really an example about how we use it effectively. And as I mentioned before, a few specialized services like ECMO or bypass machines could become scarce resources. But it is something that the ethicist and medical leaders actually are working on a regular basis, they have been from really since the spring. Dr. Robert Wiley: (48:37) We've certainly all been load balancing. And that's what we're talking about, about transfers between hospitals and within systems. That's the, that's the load balance max and make sure we have adequate resources. And I think we can do that moving into the future. But beyond that, we have a vaccine coming. So there's a light at the end of the tunnel. What we need to get to is we need to start to curb the rate of infection so that we don't have to excessively load balance and put some people at risk because we've got a vaccine with insight. The first vaccine will be available to those most in need and healthcare workers. So we'll keep them on the floors in the ICU, that will be available next month. And in January, there'll be another [inaudible 00:49:18] of vaccine which comes out and we have multiple vaccine makers. Now not only Pfizer [inaudible 00:49:23] is going to apply for the emergency youth authorization soon, and we'll have both of those available. So I think there's hope we just need to get there. Mike DeWine: (49:36) Next question. Speaker 1: (49:37) Next question is from John Reed, at Gongwer News Service. Dr. Robert Wiley: (49:39) Good afternoon, governor. Mike DeWine: (49:41) John. Dr. Robert Wiley: (49:42) Quick question for you. The legislature last week passed a Senate bill 89 changes to the ed choice scholarship program school vouchers. Do you agree with those changes? And do you plan on signing that bill? Mike DeWine: (49:55) Yeah. I'm still looking at it and we'll get back to you on that. Speaker 1: (50:00) Next question is from Andrew Tobias, at Cleveland.com Andrew Tobias: (50:07) Hi, governor. Mike DeWine: (50:08) Andrew. Andrew Tobias: (50:10) Our question is, the people who opposed the face mask orders and other coronavirus precautions get a lot of attention, but it's maybe a minority of the population. So we've had the question from our readers, whether you've considered doing anything to encourage people who believe in the precautious to show their support and an "I voted sticker" or something like that? Mike DeWine: (50:33) Well, I think they show their support every day when they wear the mask, when they keep a distance. And I think it's pretty visible. If they want to do something else, that would be great. I do think that the people who are the anti-mask people now, after all the evidence is in about the mask are certainly a minority in Ohio. And we, I think- Mike DeWine: (51:03) I think people show their support for this by what they do, and that's all we ask. I'm not asking for support for me. I'm asking for support for what will move the ball here, which will reduce the number of cases, the number of people who get infected, which will reduce the number of people who go into the hospital, which will reduce the number of people who all may die. That's what we need. Andy Thomas: (51:26) Governor, could I add something on there? Mike DeWine: (51:29) Sure. Andy Thomas: (51:29) So one of the calls that you had with local county leadership, school superintendents, mayors, county commissioners, that I was able to dial in on in my zone, a really poignant story I think by a school superintendent who described in his community that support for masking wasn't great, but people were willing to do it to come watch their daughter play soccer or their son play football and sit in the stands and watch the game. But then after the game, six of the seniors on the team and their parents would all go over to one of the kids' houses and sit and have pizza and everyone took their mask off in the basement and sat around together. Andy Thomas: (52:05) So it's even a little more subtle than I think the way that last question was asked about people that are pro-mask or anti-mask. I think there's a group that we want to make sure that our pro-mask, frankly, that are wearing them at work, they're wearing them at school, they're wearing them when they go to the grocery store, but it's that subtle sense of, and that's where Thanksgiving comes in, |I know these people. This is my cousin. This is my friend from out of town who's coming to visit me. I know him. He's safe," or, "She's safe." That's where I think we really need people to change their personal behavior and their thinking around how they're going to do not just this holiday, but the December holidays and New Year's, people that in their daily life, workaday life or school life, they're wearing masks, they're keeping their distance, but then they kind of let their guard down when it comes to the holidays or social events. And that's, I think, just an important message to remember. Mike DeWine: (52:55) Thanks. Thanks, [inaudible 00:52:56] Rhonda Layman: (52:57) [crosstalk 00:52:57] I think that we underestimate the size of each of our bubbles, the people that we interact with, and then we also certainly get a false sense of security when we're in our own homes or someone else's home. And it's that false sense of security that we're trying to overcome. Basically, if you don't live in my house, then I need you to not come over. If you come, you have to wear a mask. I'll be wearing a mask as well. Dr. Lofgren: (53:21) Yeah. I think that this idea about thinking about your bubble and the point that Dr. Thomas makes is spot on. It's like somehow if I know you, you must not be infected. And I think the other thing that we see is that we all consider our home safe, and so the idea about wearing a mask inside your home seems really an anthemum of what we should do. And yet, if there's somebody new into your bubble, that's the right answer. And it's those kind of subtleties above and beyond what we're doing in the public setting in terms of retail and shopping which I think, in many respects, it's going well. And that's why we're concerned that this spread is really happening in those social private events which is so widespread. Mike DeWine: (54:04) Okay. Next question. Dan: (54:06) Next question is from Bruce Schoenfeld at The New York Times magazine. Mike DeWine: (54:16) Hey, Bruce. Bruce Schoenfeld: (54:20) How's this? Unmuted? Dan: (54:21) Yes. Mike DeWine: (54:21) You're unmuted. You're good. You got it. Bruce Schoenfeld: (54:25) Thank you, Governor. Thank you, Dan. A lot of evidences being placed understandably on Thanksgiving, but every Saturday afternoon when there's an Ohio state game, it's almost like a mini version of Thanksgiving with people, out of force of habit and an interest gathering to watch the games, maybe people who might've attended games or people from Toledo to Dayton, and all around the state who have an interest in the games. Bruce Schoenfeld: (54:51) I know that the university and the state have both very strongly urged people to watch games, college football games, and other games on their own, to not gather, but there seems to be in an ingrained behavior almost to the level of Thanksgiving, where people are just accustomed to doing it and they feel like this is a small consolation for the sacrifices they've been going through. Bruce Schoenfeld: (55:14) My question is will there perhaps come a time where you have to take a stronger stand and go beyond urging people, and at some point even see if voluntarily or not voluntarily there could be a pause in college football to avoid these super spreader or mini super spreader events? Mike DeWine: (55:35) Well, again, you've got a lot of different leagues, and if they're not watching Ohio State, I know for most Ohioans, most of us, Ohio State is the most important thing, but people will watch other games as well. So you would have to have something to do it, to change that. Mike DeWine: (55:58) I think, again, I'll go back to what I've said and I think what the doctors would say, and I invite them for any comments, but this is personal behavior. This is individual responsibility. This is an area where the government can't really do a whole lot. I can impact who you have over to eat pizza and watch the Ohio State game or the LSU game or any other game. So therein lies individual responsibility in Ohioans to grab hold of this. Mike DeWine: (56:26) And look, Ohioans did well in the spring. We flattened the curve, knocked this thing down. They did well in the summer. We knocked it down with a lot more people wearing masks in the urban areas, which is where we were seeing the spread. So we can do this again. I feel better what I'm seeing as far as people are starting to really focus on this. And frankly, we have the doctors on here today because they're the ones who have to deal with this. They're the ones who have to take care of us, they and the other health workers. So I don't know if any of the doctors to comment on that or not, or Rhonda, anybody. Rhonda Layman: (57:01) I would add one thing. One of the things that I hear from different people is that they are going to live their lives because they don't want to live in fear. And they actually use their faith as this support of I'm not going to live in fear and just God's will in my life. Rhonda Layman: (57:15) And I guess as a faith-based person myself, I would look at this as my faith directs me to pay attention to the facts and my faith directs me to help my neighbor. And right now, I think all of us on this call are your neighbors. We are the people that are trying to care for you and help you live, not just stay alive, but to truly live a wonderful and fruitful and productive life. And so I say it's not faith over fear, it's my faith informs my life and it informs me to look at the facts and to abide by those as well. Bruce Schoenfeld: (57:48) But can I ask, Dr. Lehman, as a matter of public health policy, does there come a point where the community of doctors say, "Boy, this has become a real negative, these weekly gathering points, and as public policy, maybe there's something we can all get together and do about it," or is that just, as the Governor says, it's something un-legislative? Rhonda Layman: (58:13) So as a healthcare worker, I don't create public policy. I'm here to provide information and help people understand what our current reality is. Dan: (58:24) Next question is from Tom Jackson at the Sandusky Register. Mike DeWine: (58:28) Hey, Tom. Tom Jackson: (58:32) Hi, Governor. Thanks for taking my question. Governor, I read a article the other day that said public health experts have not been recommending curfews. And the article quoted a Kent State University professor, public health professor Derek Smith as saying, "I've seen no evidence it helps anything. I've not seen a single public health person recommend this as intervention. I'm mystified at their popularity." Governor, can you clarify why you went with the curfew and who recommended that you do this? Mike DeWine: (59:08) Yeah, absolutely, and I'm going to let the doctors comment on it as well, but I'll start. Mike DeWine: (59:13) Now, first of all, this has been reported as a, I saw it the other night, reported as a business curfew. This is not a business curfew, this is a curfew. So the whole idea is that things shut down except something that's an emergency. We want people to go home. We want people to stop interacting with other people and go home at 10 o'clock. Mike DeWine: (59:35) What we do know, and it can't be refuted at this point, is what every expert tells us is that personal contact between two people or groups of people drives up the rate of infection. Now, we know you can cut that down with wearing a mask and there are other things that you can do to mitigate that, but if people are not coming together, they're not going to spread. And so, at least for that period of time, you're seeing retail closed, you're seeing people go home, and that will make a difference. Mike DeWine: (01:00:07) We've never said that the curfew is the end all, be all, the only thing. It's a lot of different things, but this demonstrates the gravity of it. And by closing things at 10 o'clock and by getting people separated, we at least buy that amount of time that we're not seeing that intermixing of people. So I don't know if any of the doctors want to comment on that or not. Andy Thomas: (01:00:38) No, I think from a public health perspective, Governor, I think you're exactly right, that reducing the interactions between two people will reduce their risk of transmission of the virus. So that just happens to be one way to do that and it has probably the least negative impact on people's livelihoods and jobs and our overall health and wellness of our society and communities. So I think it's certainly worth a shot to see if it will have the impact we'd like. In fact, if you go back and look to the 1918-1919 pandemic, there's actually a great website that has the responses of the 50 largest metropolitan cities to that pandemic, and this right out of their playbook. They had staggered closures of businesses. Back then, they were looking at how many people were on a trolley, all sorts of things that they did. And curfews and getting people home earlier was a part of their tactics a hundred years ago. Andy Thomas: (01:01:31) So it's one tactic to take and I think it avoids a lot of the downsides of what we saw in the spring, which were obviously the closure of a variety of businesses that we'd like to avoid. Mike DeWine: (01:01:44) Next question. Oh [crosstalk 01:01:46] Dr. Robert Wiley: (01:01:45) The other thing, Tom, and it's a great question, is what the Governor did I think is appropriate because we don't have time to wait two or three weeks to see what each single intervention does. We need to bring this under control within the next three to four weeks if it's going to be effective in aborting some of the things that we're talking about and distrust from the healthcare system. So limiting gatherings, the curfew, and a reinforced mask order I think are things which are needed to try to do whatever you can do along with public cooperation to bring the numbers down. Dan: (01:02:24) Governor, next question is the last question for today and it belongs to Steve Alberton of WLWT in Cincinnati. Mike DeWine: (01:02:33) Hi, Steve. Steve Alberton: (01:02:36) Hey, Governor, can you hear me? Mike DeWine: (01:02:38) I can hear you. Steve Alberton: (01:02:39) Okay, great. My question is, first of all, we've seen a lot of people going to get COVID tests these days trying to make sure they have a negative test before Thanksgiving I'm guessing. For the doctors, it's probably too late to be getting a COVID test considering how long that you incubate the virus. Steve Alberton: (01:02:56) And also, a second question, is there going to be a site built to let people know what tier they're in for when a vaccine comes around? Thank you. Mike DeWine: (01:03:05) Yeah, I'll take the second part and then I'll refer to the doctors on the first question. Yeah, we're going to lay this out, what the tiers... We're going to make it public. So how we do it with a website or whether we announce it, I don't know, but we're certainly going to make that public. Let me go the doctor [crosstalk 01:03:20] negative test before you go do something. Dr. Lofgren: (01:03:28) I'll jump in first. I think that one of the things that testing does is that it is simply a snapshot in time. So that day, you know that you're not infected. You don't know if you've been exposed and are just starting to build up virus and so that the next day you can become positive. It does, at some level, give you some information about your status at that moment, but I think the biggest concern you'll hear from any healthcare provider is the concern of false security, meaning that I've gotten a test today, it's negative, I must be fine, therefore I can do X, Y, and Z, and that I can somehow abandon the practices we know that work. Dr. Lofgren: (01:04:11) It has some information, albeit limited, and it's very time sensitive. There's no reason to believe if I got tested today, that three days from now I might not be positive shedding the virus to my family members. So it is only a snapshot in time, and the concern I most have is that people think it's now safe to drop their guard, and it's simply not. Mike DeWine: (01:04:33) Anybody else. Okay, we'll [inaudible 00:13:35]. Go ahead. Andy Thomas: (01:04:38) [inaudible 01:04:38] agree with Rick, Governor. I think if the person hasn't been really safe for the last 14 days in what they're doing, they could test negative today and be positive by Thursday. So it's really a combination. The testing is fine, but if you've been out at friends' parties and in large group settings last weekend, it doesn't matter if you're negative today or not. Mike DeWine: (01:05:02) All right. Well, thank you all. We appreciate our... I know all four of you are very busy. Thank you for taking your time. We are very, very grateful. I think it's important to inform people of what you're seeing out there and what the hospital situation is. So we thank everybody. We look forward to being back here at two o'clock tomorrow. Good day, everybody.