Washington Governor Jay Inslee Coronavirus Press Briefing Transcript May 18

Jay Inslee: (00:00) Okay, how are we doing? Okay, good afternoon. We know that our healthcare system here is the first in the nation to be challenged by the COVID-19 when there was still much that we were learning about the coronavirus. And because of the great work of our healthcare professionals, the contributions of all Washingtonians who have remained true to the Stay Home, Stay Healthy initiative, we've managed the peak of the COVID-19 assault, without having our hospitals or medical systems absolutely overrun. And when we think about that, I hope people will think about the heroism of people in our healthcare system who made that possible. People like Dr. Ryan Padgett. Dr. Padgett was a doctor at Evergreen Medical Center at Kirkland. He contracted COVID-19 in March. He spent more than two weeks on a ventilator, during what he called, "A brush with death". And he's one of the many healthcare workers in our state who really put their lives on the line. And that's not a figure of speech; it is an absolute reality. And it's all of the medical professionals; the nurses, the phlebotomist, the maintenance workers, the ambulance drivers, everybody on these teams, we just want to think. And I think that we want to minimize the risk, and that's why we put limits on the amount of non-urgent medical care, so that we could preserve the personal protective equipment that these heroes needed. Jay Inslee: (01:44) We know right now that this virus remains a threat to our health and our way of life. And we know that PPE and testing capability remain challenges, but we believe now that with appropriate safety measures, we can now start the process of getting back to non-urgent medical and dental care. So today I'm issuing a proclamation that allows for the reopening of our healthcare services, including dentists, assuming they can comply with the new health and safety protocols that are necessary to keep everyone healthy. And the level of increase that this proclamation will allow, will depend on the ability to be prepared for a potential COVID onslaught, should this bite us again. Jay Inslee: (02:33) So we basically, this is one more step, and we think of this as a pacing item, how we are going to pace ourselves to reopen our economy. And one of the things we'll be looking at, is looking at our PPE capacity for contact tracing. We're going to see how these impact our plans going forward, but we're glad we can take this first step right now. This plan was developed with many people; partners in healthcare delivery system, nurses, surgeons, pediatricians, dentists, community health clinics, and hospitals, and they all worked together to come up with this new protocol. I like to think Sally Watkins, the Executive Director of the Washington State Nurses Association and Bill Robertson, CEO of MultiCare health system. They both provide excellent leadership, and many others in associations did as well. They're joining us remotely today to discuss a little bit of the plan. And also here to answer questions is retired Navy Vice Admiral Raquel [inaudible 00:03:39], who has been leading our healthcare preparedness efforts. And I think you'll see some of her handiwork in this discussion today. Jay Inslee: (03:49) So aside from being determined by the COVID-19 activity in different regions of our state, the re-opening of our healthcare system is going to be based on three standards of care. Readiness will be determined by the availability of PPE, hospital capacity, and more. As this graph shows, statewide, we feel good about the number of ICU beds, as well as the number of ventilators in our state to allow us to move forward in this regard. Under this plan, each healthcare or dental provider will need to meet certain criteria to be able to be doing a non-urgent procedures. Each provider evaluates their readiness to begin, and needs to maintain standards, to continue to see patients. Jay Inslee: (04:40) One of the most important requirements for any provider of course, is that they have appropriate personal protection equipment for their workers and their patients, and themselves. And if they cannot procure PPE, then they're just going to delay until that is satisfied. We've provided systems to help healthcare providers figure out whether they have the necessary PPE. We'll be providing this guidance on the screen to them, and providing it to media as well. It basically indicates when you've got enough to justify moving forward with these procedures. Now we recognize, unfortunately, it's still difficult to purchase certain types of PPE, and it's possible there'll be providers who have to adjust their reopening plans due to these limitations. And that's why it's critical that providers use good judgment in expanding access to elective care. Our state is doing everything humanly possible to increase PP options, and that's why we have been very determined and diligent in asking the federal government to be more effective in providing this needed equipment. So there are obviously other additional protocols while we're doing this involving limiting the number of people in the waiting room, physical distancing, temperature checks, frequent hand, washing and hygiene, and more, these are all good, common sense and medically necessary things right now and we've got to trust our folks to do them. Jay Inslee: (06:16) Another reason that we can reopen more of our healthcare system now is the completion of the state's centralized hospital reporting system. We call it [inaudible 00:06:28]. [inaudible 00:06:28] allows for realtime tracking of capacity in our state hospitals, to ensure that the state can be ready in case there is new COVID-19 activity. I want to think Admiral [inaudible 00:06:41] particularly for helping build that tool for us. Jay Inslee: (06:45) The other thing I want to mention is that unfortunately, we have seen the presence of COVID-19 sometimes has deterred people from getting what really is necessary medical care. We really hope if you need care, you really need to contact your provider. Don't be afraid of fears of COVID-19; there's other health things that we need to take care of ourselves on. And ask your medical personnel telemedicine, you give him a call, and talk to them. They may be able to help you over the phone or the computer. And if you're concerned about your care, and the use of appropriate health protocols during treatment, you can share your concerns at coronavirus.wa. gov, that's coronavirus.wa.gov, under the business and workers page. And this can be done entirely anonymously by the way, to help us get a good information, to make sure we're doing the right thing. Jay Inslee: (07:44) If you missed some news this morning, our Department of Health has approved a variance for Asotin County to move into phase two of our recovery plan. This makes 10 counties that have been approved to move forward, and that means more business will be able to open up on our phase two in these counties, in our four-phase recovery plan. But again, I do want to caution, this is just not a moment to throw off all sense of doing the right thing and showing caution here. Without a vaccine or widely available treatments, we still live in the era of COVID-19. It remains a deadly foe. We just had the just such sad fact that we lost our 1000 Washingtonians a couple of days ago. And as I talked about the other day, this is not a number. These are people and each one of them is now being mourned by their families, and we should not think of this as a number. We should think of this as human hearts. And I know people do. Jay Inslee: (08:51) We are grateful. However, for the commitment of our health and dental partners who protected Washingtonians from a worse outcome. I have a lot of thanks to render. I want to particularly think the dental community, they really stepped up early, making a very difficult decision to defer some of their practices so that they could save the PPE for the folks who were going to be on the frontline in the hospitals. I want to thank them for that. And so, now I'm going to turn this over to Sally Watkins to make some comments. Sally. Sally Watkins: (09:28) It's nice to be here today, and I want to thank you for starting this proclamation off. [inaudible 00:09:42] First of all, I want to begin by thanking my partner Bill Robertson, who has been a great partner in this effort, and I sincerely appreciated his collaboration. I also want to thank all of those who participated as we had many, many voices with varied perspectives from multiple different practice settings, from large healthcare systems to single providers. The group recognized that health status is impacted both by social determinants of health, and untreated health conditions. They also felt that it is vital that public and private sector participants in the healthcare system work to enhance public health capabilities, and capacity, such as testing, contact tracing, and followup, and that access to appropriate therapy expanded as safely as possible. Sally Watkins: (10:26) The exercise of clinical judgment by healthcare and dental professionals is essential, but it's also essential that all our health and dental partners follow the same procedures as outlined in this proclamation, and work together to protect the health of all our residents. Expansion or contraction of care plans should be operationalized based on the standards of care that are in effect, and the practice settings relevant geography, as determined by that region's Emergency Healthcare Coalition. The three phases that we're recognizing are as follows: the Conventional Care Phase, meaning that all appropriate clinical care could be provided. Sally Watkins: (11:02) Contingency care phase, where all appropriate clinical care can be provided, so long as there's sufficient access to PPE. And for hospitals, search capacity is at least one person. Sally Watkins: (11:16) The crisis care phase. All emergent and urgent care shall be provided. Elective care at the post-ponement of which for more than 90 days would, of the judgment of the clinician, cause harm. The full suite of family planning services and procedures, new born care, their pediatric vaccinations, and other preventative care such as annual flu vaccinations can continue. Fortunately throughout Washington's COVID-19 journey, our healthcare system never had to move to the crisis care phase. Sally Watkins: (11:46) Today, most of our state's hospitals are operated in their contingency care phases. What this means for the healthcare system is that these guidelines will provide the needed framework to expand and perhaps contract the provisions of healthcare services. We support the need to ensure patient care needs are met with providers determining the sense of urgency to address those care needs. We also do not want to experience unintended public health consequences that can come from such issues as delayed administration of vaccines, lack of access to reproductive healthcare, or delayed diagnosis and treatment. Sally Watkins: (12:22) For the nursing profession, this means the stakeholders and participants in development of this new guidance. The Washington State Nurses Association recognizes the need to make procedures and screenings that may have been delayed available to patients to address their health needs and wellbeing. We support the restart of these procedures in a safe manner that recognizes the ongoing national shortage of PPE, the need to maintain the safety of nurses and other healthcare workers, and approve of maintenance of search capacity for a potential resurgence of COVID-19. Sally Watkins: (12:54) At the same time, WSNA remains concerned about the limited availability, cleaning procedures, and reuse of personal protective equipment, such as surgical masks, N95 respirators, and face shields. The contingency care phase guidelines, which allow for the extended use and reuse of protective equipment intended for single use, must not become the new normal for the safety of healthcare workers and patients alike. We continue to urge the federal government to employ all available needs, to produce and secure PPE so that we can return to the science based infection control guidelines at the foundation of the conventional care phase at all healthcare facilities. Sally Watkins: (13:32) Embedded in this proclamation is the requirement that practice settings develop a formal employee feedback process to obtain direct input regarding care delivery processes. PPE and technology availability related to the expansion of care. We will continue to monitor many of these issues as identified in the proclamation, such as testing capabilities, contact tracing as that evolves, PPE, etcetera. We've nurses laid off or furloughed and are eager to see them to be able to return to work, but we want them to do so safely with the right amount of PPE and other supplies. Sally Watkins: (14:09) Nurses and other healthcare workers have cared for patients through COVID-19 crisis, despite the lack of appropriate protective equipment needed for their own safety, as well as that of their patients and families. It's our duty and responsibility to honor their dedication by ensuring their safety and returning to conventional infection control protocols as quickly as possible. And I can't close without recognizing that 2020 has been designated as the year of the nurse and the midwife. And what a year it has been. Thank you. Jay Inslee: (14:40) Thanks, Sally. I think it should be the decade of the nurse and the midwife. I'll get my vote in for that. Bill Robertson. Bill Robertson: (14:50) Yes. Good afternoon. Thank you, Governor. First. I want to thank Sally for her excellent partnership in the work we were privileged to do in collaboration with the outstanding participants in the work group. I'm looking forward to meeting Sally in person one of these days when COVID-19 journey is at a place when in person meetings or again something we do. Bill Robertson: (15:10) Also a big thank you to all the participants in the work group for your engaged participation, unique perspectives, and wise counsel. The work we did together will help healthcare organizations, team members, and clinicians be well positioned to effectively and safely care for our patients and communities. And a huge thank you to the clinicians and other healthcare team members who every day show up to care for our patients with professionalism, excellence, and compassion. You are heroes to me, and we are deeply grateful for your outstanding service in the face of challenging times. Bill Robertson: (15:48) Finally, my thanks to the governor for his collaborative approach to safely expanding access to needed healthcare services. We're moving forward with the safe start of our economy to mitigate the impact of the state of emergency on social determinants of health. For his recognition of and appreciation for the excellent capabilities and performance of the Washington healthcare system and our team members and clinicians, and for involving a broad array of health system participants in shaping the guidance in his proclamation today. Bill Robertson: (16:20) During our state's COVID journey, the collaboration between Washington's many healthcare system provider organizations and clinical professionals and the public and private sector has been crucial to effectively caring for the people affected by the disease. I'm grateful that working with the governor, Department of Health, and other government agencies, we have successfully moderated the impact of the disease on the people and the communities of our state. Bill Robertson: (16:48) Washington has an excellent healthcare system with a wide array of excellent clinical professionals, healthcare team members, and highly developed healthcare organizations and hospitals. This healthcare system has decades of experience safely and effectively caring for people in an ever changing environment where there are regular flu seasons and occasional epidemics. And now a pandemic. We are here to ably serve our patients and communities and have always been, and are now capable of safely providing the full range of healthcare that people need and deserve. Bill Robertson: (17:26) The healthcare system of Washington is safe and people should not forego needed care because they are concerned that we are not equipped and staffed to care for you. The majority of care provided during the COVID-19 pandemic has been for people not afflicted by the disease. And we have provided this care safely and exceptionally well. The full array of health issues and disease that existed before COVID continues to be present in our communities and affect people. Stroke, heart attacks, cancer, trauma, and much more. And all of this can and should be treated, along with the necessary diagnostic and preventative care. Bill Robertson: (18:04) With many of these health issues and diseases, time is of the essence and waiting to obtain needed care can have permanent negative consequences up to and including death. So again, my thanks to the governor for creating a path forward that reduces restrictions on and allows for the safe expansion of non-urgent medical and dental procedure. Jay Inslee: (18:29) Thank you, Bill. Thanks for everybody you work with. We appreciate it. Be healthy. Happy to stay in for questions. Speaker 1: (18:38) First question comes from Rachel with AP. Rachel: (18:42) Governor, what was your main takeaway from today's call between the governors and President Trump? And did you receive any specific information as it pertains to taking supplies? And then also, do you anticipate lifting the stay at home order on May 31st? Jay Inslee: (18:57) I was not on the call today. I was engaged with some other emergency issues, but if there's anything significant, I'll try to get you some information from that call. As far as June 1, we would really like to move to a phase two, but we cannot guarantee when that will happen. That will depend on the status of the virus. It will depend on our ability to set up a very strong testing, contact tracing, and isolation protocol. And it will depend on our ability to make sure that those two things we have confidence will continue and we will be able to make those decisions in the days leading up to that period of time and not before unfortunately, and I wish it were otherwise. There would be no greater desire that any of us would have including myself maybe first in line to be able to announce a date today, but that would not be responsible because we have to look at the course of this disease. Jay Inslee: (20:01) We have to make smart decisions based on science and data and the status of this virus. And the reason we need to do that is if we were to make the wrong decision, a premature decision, this thing could just bounce right back up. And we would be right back in the soup where we were a couple of months ago. So we are hopeful. There have been some signs of progress recently. We had some good numbers yesterday as to the percentage of new admissions to our hospitals. That was good news, but we're going to have to monitor this on a daily basis in the next several weeks. Speaker 1: (20:42) Question comes from Joe with the Seattle Times. Joe: (20:44) Governor, the Freedom Foundation put out an analysis today on COVID-19 deaths in Washington. They're claiming that as many as 13% of the fatalities are not necessarily related to COVID-19 and the information they cite is death certificates, where COVID-19 wasn't listed as the main factor or contributing factor. I'm curious to get your response to that. And what sort of criteria are being used to mark these fatalities? Jay Inslee: (21:12) Well, it's from the official documents, the best information we have from the local health officials. That's the best information we have. I'm not sure the relevance of what that group... I guess they're saying that that would make it 887 dead, that's okay. And we should not act responsibly if there's only 887 people instead of a 1,000 people. I'm not sure I understand that logic. I don't think anybody does understand it Who knows any of these families Who've lost a loved one. So I don't think that's a particularly persuasive argument, even if it was true, but we're making decisions based on the best data that is available. We've been very transparent in the state. And I do have to say this. Jay Inslee: (22:03) I think one of the difficulties in this is that the conspiracy theories that are fanning people's efforts to go out and do what this group did and argue that 887 deaths is just not something to you're worried about, is really disappointing to me. I've heard people say things that are from a different planet, and it's very unfortunate that some folks in public life have fanned the flames of misinformation in that regard, because it's dangerous. It's dangerous to people's health. So they become unwilling to protect themselves and their loved ones. So, not impressed by what is barely an argument. Speaker 2: (22:53) Next question comes from Essex with Kyra. Speaker 3: (22:56) Yes Governor, first question for you, and then a question for Mr. Robertson. For you, Governor, you changed your mind on requiring restaurant customers to mandatorily leave their information such as their phone number and name when they go into the restaurant. What led you to make that voluntary and to take that risk that there might not be the necessary contact tracing? And for Mr. Robertson, looking at hospital budgets, how important is it that elective medical procedures now be allowed to continue? Jay Inslee: (23:31) Bill, you want to go ahead? Bill Robertson: (23:36) Certainly. Thank you. So the impact of COVID and our collective response as a society to COVID on the economic viability of healthcare systems has been immense. It is immense in the state of Washington, but it's immense across the United States. And our business models do rely on elective type procedures to create revenue streams for the support of the healthcare delivery system. We cannot go very long with the level of income that we currently have as healthcare systems and have a viable healthcare system ... Have a viable healthcare system for very long. But I know that most of the healthcare systems in the state of Washington are finding ways forward. And we are receiving some level of federal support in this, but not nearly filling the gap that has been created as by the slowing down of access to elective care. And I should say, elective care didn't go away. Just a very significant piece of it did. So it's very important to have the economic revenue streams come back in order to have healthcare [inaudible 00:24:52] system to take care of our communities. Jay Inslee: (24:56) Yeah, [Essick 00:00:24:57], on this decision, we thought about it for a couple of days and basically concluded that we think we'll get enough compliance to make this really beneficial. That people voluntary, just leave a phone number, one person per table. We think that the majority of people want to do that for their own protection, because if there is an infection that came in the restaurant, they probably would want to be alerted to that so that they could check out their own health. May not be 100%, but we think it'll be enough to really help people. And we just figured that we're going to get enough compliance voluntarily not to be worth it of having disagreements at the reservation counter. So I think this can work out just fine. And this is like a lot of things as we go through this. Look, there's no playbook for fighting a pandemic like this. This is a new experience for all our organizations, all our families, certainly the state of Washington. And I think we can expect that there will be changes as we learn and react. I mentioned Starbucks has a principal, they're using their recovery plan. They call it monitor and adapt. Meaning, be agile, look at what you learn and adapt. I think that's what we did here. Speaker 2: (26:13) Next question comes from Jim with the Spokesman Review. Jim: (26:17) Governor, when will [inaudible 00:26:20] for counties with people with more than 75,000 people like Spokane to open up into phase two ahead of the rest of the state? And I noticed your map there as the slides went through has a classification for applied, but not eligible for the counties. Shouldn't Spokane have been listed that way on a map? Jay Inslee: (26:43) Well, I think what that meant is the ones that were eligible to apply, and Spokane was too large to be eligible to apply. I think that's what the shading was. And we hope to have more clarity on this in the next couple of days. We were putting the finishing touches on it this afternoon. So I hope in the next couple of days we'll be able to share that with you. And there's been a lot of thought given to it to make sure that we have the right pace to keep people healthy as we reopen. And we want to do that obviously. So I hope next couple of days we'll have an in depth discussion about that. Speaker 2: (27:18) Next question comes from Keith was Comma. Keith: (27:20) Hi Governor, the president wants to return to large football games. When you look at your four phases, if all goes well, you could be into phase four by mid July. Do you see a return to large football games, baseball games, soccer matches at that point? Jay Inslee: (27:37) We don't know. And I think the honest answer by anybody in public life is we don't know, because we're going to have to look what the status is then as to the virus. The status of our efforts to do testing and contact tracing, and to what extent people are responding to the need to isolate. And we need to look at all those issues and to say anything, yes or no, black or white at this point, it's really not helpful because we have to remain vigilant and make the right decisions. We need to make the decisions when we have enough information to make the decisions, and not just make sort of ideological statements that then give people either false confidence or false pessimism. And I think so far we've done well because we have made decisions based on data in the real time when they need to be made. Jay Inslee: (28:26) I do want to mention one thing too. In this regard, I mentioned that one of the things that will be important in the next several months is our ability for people who have positive COVID to isolate, to make sure they don't go out and infect more people. Whether we can open football games or when we do, we know we will at some point, depends in no small measure of the ability of families to isolate and make those decisions to stay home for 14 days. The whole family. And I mentioned this because it's going to be, I think, one of the great determinants of how successful we are in the next couple months, and it's some of the hardest work that Washingtonians have to do, to stay home for 14 days. So I mentioned this, the more that we follow this health advice to isolate, the fastest we'll get back to baseball and football games where we can watch in person. Maybe that's an incentive. I hope so. Speaker 2: (29:29) Next question comes from Jim with the News Tribune. Jim: (29:33) Governor, I was wondering if you could provide an update on testing. If you see any evidence of a national strategy on this, and also does Washington have excess capacity? More capacity for testing than it needs, or do you think that at some point we'll reach the 22,000 a day? Jay Inslee: (29:56) Well, we do not have excess capacity today. We have one half of the equation in pretty good shape, and that's the machines that analyzed the test samples. And we've got capacity and a good day that might be able to analyze as much as 20,000 samples. So we're in pretty good condition on that. However, the other half, which is the front half, which has the ability to collect the samples. And as you know, that has to be done through a FDA approved process of the kind of swabs one uses, and who takes the sample and how they're treated and conveyed to the laboratory. On that, we have not had satisfactory help from the federal government and still have not despite months of urging the federal government to be more productive in this regard. And I have to tell you, it's extremely frustrating. Jay Inslee: (30:48) Just one small example, I don't know if I mentioned this to you the other day or not, but we were told a couple of weeks ago that the federal government would ship us about a half million swabs in May. Well, we'd received I think 10% as of the 13th or 14th. And then we got this big bulk package and it said, "Cotton swabs." Well, you can't use cotton swabs, it's not allowed. Then we find out they just put them in the wrong packages. And then we found out they didn't individually package them, so they're not sterile. So there's some very convoluted system we're going to have to go through to hopefully be able to use the next 100,000 plus that they've sent us. This is more than maddening. And so we've been told that there will be an accelerated contingent that will come to us in the next week or two. That's great, but we need to significantly stabilize that supply chain of the swabs and the transport medium so we get this job done. Jay Inslee: (31:54) Now, it's been a good thing. We were told the FDA has approved a new type of swab that can be self administered. That'll help families we hope, as long as we have the supply moving forward. So we continue to hope that that sampling kit will become more available, so we can actually do the testing that is necessary. And we need more testing in our state. There's no question about that. We have a plan to do that. I heard somebody say, "We don't have a plan." We have a plan, we just don't have the swabs. And that's why I've been so urgently requesting the president to make this a high national priority. And he continues to say he doesn't like being a supply clerk. So that's been disappointing. Speaker 2: (32:41) Next question comes from Hannah with Kyra radio. Hannah: (32:44) Hi Governor. One, I'm wondering if you can share with us- Jay Inslee: (32:48) May I stop you just for a moment? Can I stop you just for a moment. Because I have to get this off my chest. When I heard Donald Trump say that testing was overrated, I about went through the roof. Our ability to open up the economy of the state of Washington depends on our ability- Jay Inslee: (33:03) ... to open up the economy of the State of Washington, depends on our ability to get testing. It depends on the ability of the federal government to fulfill its responsibility to the American people, to get these swabs in million numbers. And to see the president of United States diminish the importance of this, which is critical, not only to the health of people, but the ability to open up our economy, it is more than disappointing. We need the full force and effect of the federal government here, and we deserve it. I hope it comes. Thank you. Hannah: (33:35) Okay governor, I wanted to ask a couple of questions. One, can you share with us when you expect to know when you'll be making the decision on whether or not we'll advance to phase two as a state by June 1st? And then also what specific criteria are you going to have to see. Is it how many [inaudible 00:33:53] deaths, how many testing supplies we have, can you go over that for us? Jay Inslee: (33:56) Yeah. We'll presumably make the decision in the days leading up to June 1st, we want to have the right data. If we had enough data four days before, to allow that to go to June 1st, we would certainly announce it. If we knew we weren't going to, we would announce that as well. Jay Inslee: (34:13) We know people are frustrated by this. We know people are so anxious. The people who've lost their jobs because of this, the people whose small businesses are in question, the people who are trying to telecommute and has a beautiful two year old pulling on your leg when you're trying to do business... Look, the desire for this is huge. And we'll make a decision when we have that data. Jay Inslee: (34:38) Now, the data, and forgive me if I've talked with you about this before, but it continues to be about a dozen pieces of information that we collect and monitor on ongoing basis, on a daily basis. We look at the percentage of tests that are positive. If that goes down, that's a good sign. We look at the number of tests that we can do a day, it gives us a better idea, and this is why testing is so important, to be able to determine what the virus is really doing in our community. Jay Inslee: (35:13) We look at the date of onset of hospitalizations, of people with COVID-19 symptoms, and the date of onset of people who are hospitalized who actually have COVID-19. We look at the current status of the number of people in our hospitals that have COVID-19. We look at our fatalities, the number of fatalities on that date. And for all of these things, we look at the trends obviously to see which way they're trending. We look at the mobility data to determine how much people are moving around, because movement is sort of a proxy for physical interaction. The more movement, the more likelihood that you have transmission of the disease. Jay Inslee: (35:59) We had achieved, we thought maybe 50% reduced reduction in mobility. That's down to maybe 30% at this point, as people are now reopening the economy and more people are moving around. We look at the surge capacity in our hospitals. I talked about a few minutes ago, what type of additional capacity we have in our hospitals to move forward. Obviously that entails ventilator capacity, and capacity for hospital beds and ICU beds. We look at our PPE capacity. What, what kind of PPE do we have to be able to handle a surge in fact, if it comes? So I may have left out a couple of the metrics, but those are all important in this assessment. And it would be so easy if any one of those numbers could be dispositive, but that would be irresponsible to pick any one of those numbers, because any one of those numbers could be dangerously incongruent with what's really happening. Jay Inslee: (37:03) So we will look at those as we have in the past and make judgments based on medical advice, scientific data, and the best epidemiologist that we can talk to. And fortunately we have some good modelers to help us on this. I did leave out one very important number, and that is the R naught number. It's an R with a symbol zero in the right hand corner. That basically reflects how many people one person infects. Jay Inslee: (37:32) So if the R naught number is one, that means one person infects one other person. When we started this, that R naught number was three, one person was infecting three people. We have now, again, because of the tremendous work of Washingtonians, we'd driven that down to maybe around one. But it was creeping back up a week or two ago. And obviously if it gets above one, the number of people who are infected begins to grow. Jay Inslee: (38:02) We want to look at that very, very carefully. And we have multiple modelers to help us model that. Fortunately in Washington, we've got not only the smartest people who know why social distancing works, but some of the best geneticists, and epidemiologists, and modelers in the world are right here in the State of Washington. Speaker 5: (38:22) Next question comes from Jerry with the Everett Herald. Jay Inslee: (38:29) Jerry Jerry? Jerry: (38:32) There I am. Jerry: (38:33) Okay. Governor first, two things, the first why is the state changing its process for billing counties for PPE that's I believe headed for the healthcare workers and first responders that are looking at changing in the next two weeks? And then second, I just wanted to follow up on the issue raised earlier about the toll loss of life from COVID-19. And I don't think anyone would dispute that 887 deaths is horrific, but given the importance of metrics in your decision making, if one number is inaccurate, and it's a very prominent number in our reporting, are you not concerned it undermines the data and the confidence the public will have in your reliance on the data? Would you review that process and consider changing how deaths are determined in this state? Jay Inslee: (39:31) Well, I haven't seen this assertion. I have no reason to believe there's any validity to it whatsoever. So at the moment I have confidence in the numbers that we've put forward. They come from a variety of sources. I see no reason at the moment to believe that the fatality numbers are not consistent with reality. Jay Inslee: (39:52) Now, there are cases obviously, where if someone makes the wrong report, that could happen, but there's no reason to believe it's not on the lower number as opposed to a higher number. So I just want to make sure the record is clear. I have no reason to doubt the fatality numbers that we're using in the State of Washington right now. Jay Inslee: (40:11) The problem is you got some people out there who are fanning these conspiracy claims from the planet Pluto. And it's just disgusting what they're trying to say of all these crazy deep state malarkey, who kind of suggest that this is not a problem in our state. I find that hard to accept with the number of dead in our state. So that's a problem, and I hope it gets resolved. Jay Inslee: (40:36) Your first question, as far as about billing counties, there is a question about this. We're working through it, talking to the counties. I don't think any final decisions have been made. As far as consideration, there has been since this whole thing started, significant federal money that has got, and we'll be going to cities, and so the question is a convoluted algebraic equation how this is done. But the long and short of it, we're talking to the cities, and we're going to see if we can work something out. It hasn't been resolved yet. Speaker 5: (41:13) Final question goes to Kate with KUOW. Speaker 5: (41:25) Kate, are you there? Jay Inslee: (41:26) Kate, KUOW? Speaker 6: (41:26) All right. I guess you can wrap it up. Jay Inslee: (41:40) Kate we'll try to get you back, we missed you. Jay Inslee: (41:41) Thank you very much. Again, I just want to say how much we appreciate the medical people, and I'm glad that we're in a position to allow them to start to work their magic again. And I know all of us are grateful, but I just, I don't think we can express it enough, they're the people who've walked into harm's way. And I know they've been really eager to get back to do all their work. And I do hope that people now will go back and see them at times where it's appropriate. Your health counts for all of your issues, not just COVID. And we hope you'll be willing to do that. Jay Inslee: (42:18) And with that, please wash your hands. Thank you.