DHHS secretary discusses coronavirus response with lawmakers
Dr. Mandy Cohen, secretary of the state Department of Health and Human Services, talks with members about the House Health committee about the state's coronavirus response effort.
I don't that I'm going on. I have not seen chance. Really? No running. It's okay, man. The photo acts to keep my room right in order to Yeah. Yeah. Okay. Yeah. The whole not very circumstances. You disappeared. Just so you'll know we've all learned are three W's wash weight. And where So we won't need to spend a lot of time on those today whether we do them or not. Maybe a different thing. But the three W's we have, we have mastered. So at this time, thank you for sending your presentation over. I recognize the sergeant at Arms nine. A lay age I send you and will have to learn to pronounce that. But where do you do it? Our best, Bill More Tom Terry and Jim Moran. Thank you all. It's always good to have a chief sergeant at arms here as well this time. Dr. Cohen, you're right. Recognized for your presentation. Up to 10 minutes, please. Thank you. Damn. Here. Hearing me say three. Take that. I started here. Appreciate everyone's support. I am here. My slides with you. Can you see my slides here, sir? Yes. We can see your slides in your volume is a little low, Dr Cohen. Okay, let me try. I will try to speak up, brother. This quickly. So, on the first life here, I didn't want to take the time trend for me on trend hair on fire. But I am concerned, our cases going on, you know, on the higher side where I like that your hospitalization, where are actually the highest number of hospitalizations that this morning in terms of hospitalizations you have against the worrisome signs. But I've been cheering that our fate is not field here and there's a lot we can dio and I wanted to start by just going back to some of the science. Have the fire spread that it matched you. Then what can we do together to prevent that spread? We've been looking at this science as we have been trying to make decisions about how we learn to live with this fire. So I just wanted to go back over what? For speeding in terms of what really tried a viral spread on the left hand, trying to see first different breakdown as indoor versus afterwards, stationary, moving. You know that our indoor at higher risk of spreading virus outdoor lower risk of spreading virus that has to do with a number of factors, including air flow, sunlight exposure, ability to social distancing, stationary and moving is also really important component. Because you're visionary for a longer period of time, you're gonna have more opportunity to be near someone's. Maybe shedding virus. The stationary is higher risk that if you are moving your transient wings walking by one some additional things we've always want to consider about viral spread it is Are those activities or is that then you gonna be something where you convince yourself from other people? How long is someone gonna be at one period of time? We know this virus is more likely to spread your in the proximity of where that virus is being spread over more than 10 minutes. So, again, are you walking by quickly? Are you sitting there or standing there for a long period of time? We're seeing air circulation is very important to this. This virus is a respiratory virus, meaning it is particles that come from your mouth and your nose that are the way that it's transmitted and so air circulation is important and so is heavy breathing. So what we're seeing is that activities that have shouting, singing have you breathing related to exercise where you're getting more expelling apartments from your mouth or your nose are places or activities that that will spread more virus we've heard before. Sunlight is something that is, that does kill the virus. So as we think about surfaces that that Chan has the virus on it, if they get direct sunlight that killed Myers and that's good again reducing risk in outdoor environments, temperature is actually something that were coming to understand better. It seems to be in your temperature right now. So when it is colder, the virus likes that the virus likes to be colder on. We see in colder indoor environments like a meat packing plant that have to be colder by the nature of its activity. Right has had more likely when the bars really likes that, and we'll stay on surfaces for longer and the last feature of viral spread that is becoming more evident and we're seeing more written on this in the scientific literature is about super spreader events. One of the hardest things I understand about this virus is that some people seem to infect Europe people, maybe one or maybe two. But we're receiving is that there are these super spreaders who can infect up to 75 8100 people in their vicinity in one in one shot. And we're not understanding why that is yet. What is it about that person or about their viral load or what they're doing in activities? We really haven't homed in on this, but what we are seeing is a lot. Big outbreaks are being driven by what's called super spreaders, but we don't know enough to say this is what makes a super spreader. So let's just isolate and you that event. But that is something I am following closely in the scientific glacier. And I know our scientists are trying to understand better as we go. So we thought about all of this data in terms of risk, right in or out or stationary, moving, lend up, time, air, circulate, reach right. All of these factors for trying to understand and we know that they that we cannot stay locked down forever. We knew this. We did not want this. We have to re ignite our economy. This has been incredibly challenging on. I'll say every decision has been excruciating in terms of how we make decisions Teoh to move over here because we know that people's economic livelihood is impacted by all the evidence that we've. We've really tried to stick as much as we can for the science and use what we call the dimmers, which approach? And this is something that is now being cited more more in the literature about easing restrictions on lower risk activities, first monitoring the viral spread and then trying to again these restrictions as you go and slowly go to some of the higher risk activities after you see how. How do we do with some of the lower risk attendees? So that's really they are our goal. And so we continue to assess that risk and try to understand our trends and look at that. But importantly, and I think Chairman Pots mentioned it. There are things that we can do to mitigate that viral spread that counteract some of those things. I just mentioned about how the virus spreads. Yes, it's it's the three W's and was becoming more and more evidence in the research is the effectiveness of face coverings. I will say we were using, you know, at the beginning of this when we didn't have experience Kobe 19. A lot of the data we were relying on with the was how to face coverings work in the setting of flu, for example. But now, just even in the last two weeks, the literature, the scientific research has really a lot here to show up. Is there truly real hard evidence that base covers work and the over our chancellor is? Yes. I'm not gonna go into the details here of citations here, but even just yesterday, really important study published in health affairs again appear of you journal that talked about three importance of face coverings and half, if you do all all of us do that together in coordination, we really can solve the spread of this virus. And that's the whole idea. We need to live with this virus, and we want to continue to make progress on easing restrictions. So we need to do There's not that many tools, but let's just be honest, not there's not a vaccine, there's not a treatment. So the one truell that we know that literature is telling us A scientific lecture is telling us Work is his face covering. Apparently, we didn't pay our cable bills. They're either, but keep So what? What? We will get back to what the last three months been. You can see that clearly. We have three areas of work and see that on the left, hands on trying to prevent this bread. There's a pocket of work around testing and an above your work around tracing and isolation support. Really, what we were doing in April and May critically on the operational side is that preparing to respond, right? Remember the end of March? We had no protective equipment. We didn't have testing. We hadn't had a service plan. We needed to create a touch off waivers to create all those circling. So we really have used these months toe lay the groundwork, ramp up our testing ramp up our ability. Did you trace a We're not done yet. We have to still continue to build that infrastructure. This is incredibly challenging. And then you'll know we have have a decentralized public health system, a decentralized hospital system of and so leading to come together as a skate to fight this response, right? Takes a lot of effort to create that infrastructure. But now we're here in June and we are seeing our numbers increase, right? This is where we have to start drawing on those capacity that we've been building and in surging even further where we're seeing some of those issues. So I'm not gonna go through these details. But this is more for your reference of what we've been trying to do. April, May and June on Prevention of Spread obviously stayed home with a big tool used by yourself. Time today lay this infrastructure brand work, and now we're drawing upon it. So I believe that for for your reviewing and heavy answer questions one of the focus on the fact that we are surging resource is in nine counties that we're seeing our highest number of some of our highest never cases. Not surprising, these counties are open centers are, but it's also a few additional county. There were seeing higher rates of viral spread. So our teams are working very closely with local health departments Hospital systems at Q A cheese to work on that testing and tracing response as well as layering over additional communications. Help folks do the three W's, for example, and to understand the ongoing restrictions and why it's important and to tell them about the testing that is available and who we want to get tested. So trying to really ramp up efforts here and this is not something again that happens overnight. This is gonna be a process over a few weeks to surge additional capacity here. I'm sure that will be adding counties. Look at our gate and go further. Laugh, laugh. I'll just leave you with some additional details on our loan, Our support for long term care. This is incredibly important for off a huge area focused again. I won't go through all the details, but just know that we're thinking about prevention and protection of the folks who live in long term care of all of the staff, huge focused on testing in which we were already doing testing all residents or staff down the positive. But now we're taking the additional step to say we're going to do proactive periodic testing. I think we're still figuring out what at what frequency do we do that repetitive testing, saying both logistically very challenging as well as expensive. And I think that is something we need to talk through together as your leadership cheer and think through how we we work to pay for that kind of testing as we go. We've already completed that proactive testing in our stage skilled nursing facilities. And then we're going and we're working now on implementing playing with the rest of our skilled nursing well. And to support this again, you need financing and staffing assistance. The state has been providing additional financing, but we've also needed to build staff shortages. We need long term care facilities to stay open, and we've been partnering with the easy you school of nursing. I want to give them show that for being awesome during here and helping us use a matchmaking of finding people to go work at these loan from care centers so that they can stay open on day care or the people who are living in the thes facilities. So a lot of long term care, and I'm happy to answer questions, not just leave you were chairman happy to take your questions. Remember wash wearing Wait, Thank you for those online first thank you for having your my commuted. And secondly, if you have any questions, please send him the lore of all in. I thank you, Dr Cohen for agreed to some answer questions some like we receive each week when we go home. I can't see my elderly parent's or grandparent's and the Assisted living facility. I'm not sure that the cures, not the disease, is less bad than the cure. My family's out of work. We haven't received unemployment. I can't feed him about to lose my car. These are all questions that we're all faced each week when we return home. So, uh, I'm Alaska at you. Limit your questions and we'll be timing them to 90 seconds. Certainly you can ask a question in 90 seconds and if possible. Dr. Cole and I asked you answer in three to a maximum four minutes so we can allow these many members as possible to ask the questions this time to chair recognizes represented Szoka. Mr. Chairman Waas Most recently I don't hear a question it. Okay, sir, just, uh, start the timer. Just this morning I talked to the CEO of Cape Fear Valley Medical Center. Some descriptive statistics from him. He's got a total of 44. I see you beds at the most fill the covert patients at any one time since began was eight is dedicated. Another whole isolation floor. With 44 beds, he averages 16 to 21 patients a week. Today has nine in terms of testing at the beginning of this crisis to took days for a test to come back. Right now, they have the capability within the hospital. Teoh test results back in less than an hour, which, if other hospitals are doing the same thing. Certainly with account for the uptick, uptick in testing is in testing his biggest fears or his biggest concerns right now that testing has been solved, if you will, at least in Cumberland County, and that he is not being overwhelmed. He's concerned about getting his 800 follow world er workers back to work, and he's also concerned looking far into the future, about with multiple companies and businesses going out of work who have corporate health insurance, that that's gonna put them in the lower uh, paying plans such as Medicaid, Medicare and that Cape Fear is one of the has the worst mix of payers. Just looking at the overall situation of the health care system in the future. So again, I'm asking. It appears that in Cumberland County were not being overwhelmed. And I'm asking you what other hood hospital CEOs saying What is the start states criteria for determining when our hospital system is close to being overwhelmed? Because I still understand it. That's what we're trying to avoid. Thank you. Thank you, Representatives. Okay, Doctor, Tell him. Thank you, sir. And thank you. Everything is back. Things that those are fantastic questions. And yes, I think that is what we are largely hearing from our hospital. I speak with the CEO of our largest systems every single week to make sure that I'm I'm not just looking at number, but I'm hearing directly from them will be texting in college, even in between those calls. So I'm keeping a sense of what is happening on the ground. And if you're right, we're seeing the never go up in hospitalizations. But we have capacity. We're monitoring, particularly in the things that we were that most are you capacity because that obviously more living and that our general capacity But we also have city there, and I think that you were asking the exact right question of how do we What is that trigger point? As you know, right now, our hospitals have no limitations on them doing elective surgeries right and and have been bringing boats back to do procedure on. I very much recognize a lot of important hair. You can often say the word elected, but this is here that people need and we want them to get down on. So I think it's important that are are getting their medical needs met and what we can't keep balancing this. We need to keep watching the number, the issue that I look at, other states that might be a little bit ahead of us and we'll get trend number. I look at states like Arizona that are seeing really rapid increases and the issue with hospitalizations. That's hard. It's what's called a lagging indicator. Great. It just if we just react to the hospitalization by the time we get potentially close to maxing out hospitalization, it's it could be too late, right that our party that you actually have to react to the three weeks before you get to the that that passing out, and that is the hard part of figuring out these trends here. And I know I know that that could be very frustrating. It's frustrating for me. I wish I had that first Asian What I would say even if he's not want modeling and just looking at growth rate increases in hospitalizations were going up right. If you keep going up even at a little race, at some point you get to the you get to the end of what you have to have before. We do have to do something to make sure that we stand the growth rate because at some point broke. It just keeps growing. There are only a limited number. So the question is one in the balance point. You're not hearing me say that today we need to go backwards or just staying home. Prices point and again, I check in with the hospitals to make sure that I think we need to be very careful, because I think that that we don't know how quickly we can get to that point, and I think that what we're trying to figure out and then lastly chairman and didn't answer So I can have the question about access to care and amateur, right? We know, with more people at work, I I definitely agree that this is incredibly challenging our hospitals. They're gonna see more uncompensated care. I will continue to say that we've done the analysis about Medicaid expansion and the importance of that getting people access to insurance coverage. I think it's now more important than ever and move forward with an option that can allow us to bring 90% federal match proposed to get insurance to our state. That's $4 billion we could be bringing in. That would go to our capital systems and other health care providers. Of course as well. If you are, are the book here. North Carolina don't have insurance. Thank you, Dr Cold. We have 10 people in the queue, so there was no follow up. Questions will move through quickest with plan represent. Szoka won over eight seconds on his question, but I don't mean to calling louder anything. Thank you, Representative handing You have floor for questions. Thank you, Mr Chairman. And thank you. Director Cohen for taking the time to answer questions for us today during yesterday's session represented Meyer raise concerns about more Carolina's ability to test it track cases, and he is not coupled with reopening until that happens. We all know it states in your coping 19 website. This is the best way to slow the curve. I see you hiring 450 tracers in June. Why the delay and can you speak to what? North Carolina's lag behind it? Such an important metric and what steps were being taken to bring us up to speed and keep us ahead of the curve? Understanding this is a very fluid situation. It seems we're being reactionary in our decisions versus being proactive, calling us to lag behind other states in our region. Thank you, Dr. Calling a vessel four part question. You can answer any part that you choose, so thank you so much for that. The question I think tracing and testing our core capabilities before we made the decision to ease restrictions even in phase one. We talked about needing those capabilities, but was that we didn't want to wait until we had the perfect test that we knew we had. This are using restriction to reignite the economy while we were still building some of the capabilities. The good thing about North Carolina, we didn't have a public health infrastructure that already had several 100 people doing tracing, but we knew that was no where near the scale that we needed to. We've gone from about 250 people doing tracing across our state and now north of 1100 folks. Some of those are just expanding the number of people at a local health departments doing that work. But we've also hired an additional 450 importantly, you needed higher tracer that, yeah, that came from the communities. Or at least we know that so much about picking up your phone is about the about frost and then knowing the communities that you're talking to use, that we've been very intentional about making sure that they are speak the language communities that they serve. As we wrap this up, you are your rent started, that there is more to do, and we look forward to working with with you in the General Assembly to make sure you have the funding and the people to be able to continue to respond. It's because more cases we see, the more tracing we need. Right? So early on, when we didn't have a lot of cases, we were started able to keep up. But now that her, except in cases, have 1000 cases a day, obviously we need more more tracers. We agree with you and we're working hard to do that. We're trying to both do that at the same time. Easing these restrictions were trying to do that is that the plane is as we build the here, insert our responses that we're trying. Teoh, I need all the demands can. But I we very much need your your health in that from the financing. A fine of that. And any close close their work that we need to do with our local health departments and other candy partners on that. Thank you. Follow up care No follows. Okay. Understanding that you're trying to find a perfect system alone. We wait for a perfect system longer. Our citizens are out of work. Longer are business owners aren't even able to open their businesses that they've invested their entire lives. Thank you. Yes, we agree. That's what we know. We have to work at this while we are are are using research represented County ham. You're recognized on the Internet. Thank you. Chairman. Secretary Colin. A couple of items off the hospital seem to be coming. Oh, well, even though they asked you big complicity, they're also expected to do a large amount of chest along with black. What other facilities, like farm shoes off other options in the community. Other hospitals and there have to do additional. Lady. I talked to the hospitals yesterday. Back here. Do you see a naturalization do do about 2000 years run? But there was a concern about the free agent that's required to be a part of that test. Lastly, I like you speak a little bit. I lost it yesterday when we were talking about those facilities for warranting locations for the long term care clients. A resident. Could you go over there a little bit or how many locations they were? Because that's one of the concerns where the highest rates are excused. Thank you. Represented Jackson. I say that your son our parish questions as well. Dr Cohen, you're recognized. Thank you, chairman. And that you have been putting him for that first, and in terms of who you are right, it needs to be a team member. We can't just be relying on the hospital or just the accuracy and local departments. Luckily, we have some of our the pharmacy Parker, CVS, Walgreens, Walmart. They are burning directly with the federal government to get Federal Resource is evil. But some of this, in addition of the state, put out a request for vendor that we want to purchase working with vendors directly. So that's what we're trying to assess Right now. We're checking these nine county working closing with Mecklenburg being understanding, what can local entities served you? What can they do on then? What do we need to do from a state perspective? To come behind that and fill in gaps and you go deeply into, like, very detailed sicko level and understand that go picture kept it matched where we're seeing cases. So we here are working on that for their other partners. But I do want to say that we talked to a tree and nearly daily, and I know our team just called yesterday want to talk about their issues with free agents. I think it's right to say, you know, the supply chains have improved greatly, but that does not mean that they are perfect and that there are still issues on supply chains and people Teoh some of those issues in various ways. We're working with them black that for the federal government was working on supply chain and well, but we're also working with atriums. Who's in the community knows their community to say, How can it means this? You might be with people or supplies or funding to be able to serve your capacity, and it's going to take it all hands on deck effort there and then on the long term care is you. Yes, there are a number off long term care facilities that have identified themselves proactively. People take discharges from the hospital because we're already doing the isolation and infection protocol. We can give you a list of who those are not. Is that a large number, but understandably it some of the larger one that already were isolating patients. But again that's existed. We need to have people come out of the hospital, but we want that hospital capacity to be there to opinionated for new newly six people, for whatever reason, whether it's over in a heart attack that we need to keep that cycle a movement off. But we also have to protect in our thank you. Thank you, Dr Back. We now have 14 people into cues so need to be precise in our questions, Dr Becker represent to make your next thank you, Chairman Pots. And thank you, Secretary Cohen, I wanna thank you for being with us today and for all the hard work over these many months that have been very demanding on you. So we appreciate that. And I appreciate, you know, as being a member of the health care task force, having heard your concerns early on about modeling and how, um, modeling was really limited to the data that we had. And we're trying to build a plane and fly the plane and, you know, came to a great point where we have prevented our hospitals from our our medical capacity from being overloaded so way have now more data. We've gotten to that point and thankfully have more data. And so we now, as you described earlier, very well we have a lot more data on the viral transmission. How that happens and who is most susceptible, which is which is very helpful. What I haven't heard as much on and I think would be particularly helpful is to understand that now that we know that, what is the data on interventions? So obviously, one of the interventions that's been very well validated is social distancing. But the other intervention that's being used quite a bit and fairly uniformly is stay at home or shutting down. And so I think, would be super helpful to understand better your take on the data that's out there. And I'm sure you have access to much more data than I do. But for instance, as an example, I would cite the recent M i T paper, the White Paper in May and updated in June that concluded that targeted policy with differential lockdowns based on risk achieves better outcomes compared with a uniform policy. So again, social distancing and lockdowns are not the same thing, and we have data now that we've had these many months on, How do you know how effective is social distancing? And but the other question is how effective is shut down and is it more effective health wise. And so, you know, if we do so this paper, for instance. But again, I'm sure you have a a lot of data on that, but I think it be really helpful to understand the data on interventions that is informing your policy decisions going forward. Thank you, Dr Cohen. You're recognized. Thank you. A really creative off a question about bringing up some of the evolving evidence. Really? Have you on my cheap paper. And I think it speaks to when I started to hear our first line. That's the dimmer switch approach where we are trying to say, How can we be more targeted with our are easing of restrictions and to really understand what is driving this virus? And can we just reduce risk at some of those really high risk activities and venues? We were able the super spreader right? That I was talking about is one of the drivers mass gathering load of those. So So I think that that is exactly the kind of data that people were looking at. What we were talking about this diverse, which approach to these restrictions on these low risk things. When you are out or you're in the sunlight, your your social distance. Those are things that we can get back to doing. I think the other data that has for me really shone a light on things that we can do. The face covering data that I was highlighting in my presentation. You see some of the references I get in there and there's more coming out every day that I can share. I think this is This is a space where we didn't have a much data before that was to Kobe. But now do and where I I need your help. Right now we're seeing this evidence that saying Hey, where in face coverings consistently and help us produce the viral spread and then we can make broader easing of restrictions and ensure that you are getting the economy and you could go back to your constituents that we have a way to go. But we're gonna have to feel that by airing it, these kinds of activities, like wearing a face covering and get all the time in all the situation. I think that those are the things that we're gonna have to work on together, and I really need your help on help us use this data. It use it in June that the policies and the way that you're doing it. I really need your help in sharing this back as leader than your community. That understanding are keeping up with the 90 day that like you are. Brake on on how? How Why this all is necessary and how the pieces fit together off looking at that data, wearing face coverings, staying heart needing to stay away from certain high risk getting so that we can open and ease restrictions and other other places. Thank you. Dr Cohen. Representative Adcock Online. Yes, sir. Mr. Chair and Search. Right. I heard you say recent. You'll need to speak. You'll need to speak up a little bit. Representative Adcock were having difficulty here. You can hear me better now, Mr Chair. Thank you. I'm sorry. Thank you very much, Secretary. When I heard you say recent restaurant that you can't chance to trace our way out, right? What do you think about that? All right. Represented Bo. I think your mike is open. Okay, Dr. Colin, Hopefully you can respond now. Thank German and thank you, Representative. I for that question. I think that that comment that we can't trace our way out of that. I think those are important, really important things that we need to do to help us get our arms around once the virus is spreading. But ultimately, I think we need to make a connection between how this virus spreads in our everyday activities. Have that life impact someone in for people are wrong from care setting. I know we all are seeing the death stating numbers in our our long term care facility that we want to do everything we can and we are throwing everything cannibal testing and tracing and protective and isolation. But even even doing the hard part that chair convention about stopping visitation, which is which is breaks my heart over for throwing all that at that from here. But what the issue is, as you imagine, the worker Apple terms that belong from here, a nurse, a guy's dietary there in their community. You're going to church. They're going to a restaurant, their phone in the grocery store, and if there is more virus bringing in the community, they are more likely to get that up and again When you when you have open 19 hoping for the first number of days. You don't even know that you had that worker who who serves the meals are are people, right? Perfectly following. You know that the guidance, Yes, you can go to a restaurant gets you go first resort. But we know there was no risk out there. The more virus means more risk And in the gloom that back to your care setting and then we could, you know, test everyone, and we can We can do all the infection control. But I think understanding that connection going is really important that all of our actions, whether it's wearing a days covering or or an abiding by the guidance that we have put out house all of the book to maybe in high risk for this virus. And so we're gonna do all the testing you all the tracing, but it come back to those fundamentals of how do these spread of this virus Overall community And I learned a little unfortunately, with this virus. And so we have. Thank you. Dr. Gordon represented Jones. Thank you. Chairman Pots and Senator Cohen appreciate your time here. this morning. Earlier this week, I received a letter from a physician affiliated with a congregant living facility here in North Carolina. It was addressed and sent to you approximately three weeks ago, and I know you've been busy, so the lack of response on your part is certainly understandable. Let me take a moment to sum it up for you right now. The letter describes a couple in their eighties moving in two wings of the same facility, the husband and assistant living the wife and independent care. They have been separated, unable to see each other for 13 weeks because of DHS regulations. This couple has been married for over 50 years. The husband voice to his caregiver, a desire to hurry this up and die because he could not see or touch his wife. He has been clinically depressed since the start of covert 19 because of the deprivation of sexual contact. When they were finally allowed to see one another last week, they were forbidden to touch and had to view one another through a glass divider. The husband sob for 30 minutes before saying a word to his wife. This couple has been deprived of 1/4 of a year together as they near the end of their lots. DHS regulations are responsible not only for higher concentrations of Kobe, 19 in congregant facilities, they're causing significant heartbreak for their residents. The story I just shared with you is almost certainly not the only one, and it extends beyond marriage. Children, grandchildren and siblings are now cut out of interaction with one another. Apparently, as a state, we have moved beyond simply may saying that certain occupations are essential and non essential. We're now experiencing DHS regulations that are tearing asunder some of the most essential bonds in human life bonds that have lasted between people for 45 and even six decades. What do you propose now to do to rectify the inhumane consequences of our state's public health policies as it relates to this group and help bring these couples and their families back together? Thank you, Dr Cohen. Thank you. Well, Jones, I really appreciate you bringing that story. T this committee. And the other thing is, it's unbelievably heartbreaking that the this virus has caused so much heartbreak on the mosque. I go there, I'm just speaking. Teoh family, the other day that lost their loved one in a long term care facility because of a we weren't able to be with them. I mean, we could go on about the devastation. You know, that this virus is taking a toll on families, and it is awful, and it breaks my heart. And don't think for a second that it keeps me up every single night thinking about this and how could you better? You know, I think about that. We're really find this balance point. Obviously have some of those visitation rules that those are set by the federal government and way obviously the state and his arm candy at school. But they are are set by the federal government. What you're trying to move to now is thinking about Is there a way that we can use periodic proactiv some additional proactive testing, the buying a way to start to ease restrictions to your point on that visitation because that confidence only hope when we know it. You know, in the beginning, we didn't know a lot about this virus. We have to just throw everything we possibly could in this protect lives. Yeah, we through some very crude matter there, I'd like to see us get to a place where we can be more new ones. The issue is this virus isn't just incredibly vicious on deadly for boats in our nursing facilities that we're trying to find that right balance. I very much look, you know that you read that they just like I welcome suggestions on how we can do this better. This is incredibly challenging, and it's heartbreaking. And so we'll try to do our best of all the federal rules. Think about how we can do maybe additional test dates and then you some of the restrictions around invitation. But it is still it is still an incredible challenge. And I don't think that I think you're right in pointing out that we do not have all of the solutions here and welcome your additional suggestions on how we can and do this better. Is it brief? Probably. I appreciate the answer, and I appreciate the time that you are putting into this. I do think that this is an issue that needs a result and needs it soon. This is not something that we can eat it put into a panel discussion unnecessarily and come out with a solution to 34 weeks from now. These air people that are truly dying from depression. Right now, this is an issue that needs to be addressed now. Thank you. Represented Lambeth and represented Farmer Better Field. Thank you. Thank you, Secretary Cohen, and send to your staff that's working hard and long hours that we appreciate the work they're doing. We never have, sometimes difficult. This can be. I have a long question that short question. The longer question. I won't drill down into nursing home issue that you brought up. We've received a fairly significant request for money to fund casting of all employees in the nursing homes. And we're really gonna need your guidance and thoughts on how and what we should be doing and what we should be funding. You alluded to this earlier, but we know that the nursing home long term care facilities are a site where there are a lot of potential risk. What? What is your God? It's in terms of what is a reasonable approach to test employees. The request we got was a weekly test of all employees in those settings. Stuart thoughts on that then I have a short question. I could tell it. Thank you, Chairman Levin for them. I think it's perfectly that tail with representative Joan Waas that we are already working towards doing periodic testing. Remove turn care. I never cease to me blood around the issues. I'm sure whoever brought that issue it is a huge financial investment banking, protesting every single week. And I tell you, a lot of these deaths do not have insurance. So the the the expense needs to be born somewhere. And how do we think about that? We have number that we can share with. You find about the run rate of what? Just folks in nursing homes. That's not even all off her hair, just nursing home and doing their staff once a week in terms of testing costs. It is it. I want to say I want to give you the number of anybody in the multi millions of dollars. Every everything is the right there. So we should work together on that and I will say that the scientific literature is not here. You're on. How often is testing needed for for these help? How do we think about how to keep up that level, asking what you really need to go give on some of the other left expensive interventions, like a universal protective equipment that we at the state have pushed out. Proactive. Keep he to all of our nursing home. But that was a huge effort. Get so that multiple weeks against you, 35 under nurse single. We need to do that. I think testing is one thing to do what we have to think about all the pieces. I think it's testing is one of the most expensive things that we can do, but I think it has a hole. But the science is not clear about whether about you be a week. Is that the right place to be putting our time and resources? But I go back to represent Jones. Question. Didn't you something thinking to figure this out right away because even both not being in others is detrimental to their health and you want to solve this. So I got to work together with you wanted. I think testing and getting a resource for that. Certainly, in the short term, I think, quite what is a longer term solution. I think you need to put our heads together. Some of our scientists figure that, thank you. Short, short. A question unrelated. I also got a call with an example of individual who called and say that her husband had died of a heart attack in the emergency room. But when she received the death certificate it had on the death certificate covert 19. And so she was asking and she said she called to check it out. They said what they were told to put that on deaths that occurred in the merchant room and related cove it necessarily. But is there a hotline for all type hotline or investigation that you have to go in and look at some of these examples? We're hearing this fairly frequently that a lot of the deaths that happened or are identified its covert when they in fact may not be. And again, I don't know all the facts, but this is the way it was represented to me, that the individual was hundreds certain her husband died from a heart attack. But the death certificate reporters a covert 19 days. Well, please. So a couple things, one I would say, definitely send, said those things long and last. Blood is investigating but its foreign. How we collect debts and report that back, you know, from an aggregate perspective of the state. It is not by death certificate. It has to be a physician reporting that for another clinician reporting that death directly to us saying it was Kogan 19 related So the death certificate data It is not what what is dropped driving our reporting numbers, but But I think it's important for us to understand. And the other thing that I've invention is that we're learning so much about over 19 and being more than a respiratory illness, we're seeing that it causes inflammatory responses in someone's body. We're seeing people with severe Kogan that chimney failure forgave, overseeing a lot of need for dialysis. And we're seeing more heart disease because it and heart attacks are actually an environment for it of your heart. You get an interruption of a so heart attacks is on Syria. No, is he is a heart attack or mark early function, but that be a representation off. A severe reaction to it. Unclear? I'm not saying maybe I don't know if that was the reason in this case that that link together. But we certainly happy to look into any individual case. You know where we can actually collect. Our damn great is his physician or clinician recorded to loss of not death certificate. And then lovely. There are other. We should byline you're seeing from, like, kidney disease, heart disease, you know, related. So I think it has been a mixed picture. Thank you. Dr. Korn represented Farmer Butterfield. Mr. Cheer, I want to come in the secretary, understand? Also work that they've been doing this a chance as conferencing is. I'm sure my questions are simple. One is heard recently on national news programs. That study was then, which revealed that social desisting of six was not sufficient that it really should be double this amount. Can you respond to that Dr calling Thank you, representative, about her field. So I think you have to understand the 60 this in the context of the activity, there are certain activities that I said it particularly still more respite. Three singing, shouting, breathing like 30 exercise where he probably would want to be further than six feet. I think 60 short can from most activity that is, if you use you for me, it's sort of I think, that is lively wanting. Even here are taking more care with certain activities that have a higher risk because other factors on by need even more social distancing. Because if it's loud and you're shouting, then 60 baby just the minimum and you want to do even more and again the precision of this isn't great, like Airflow matters online, that all these things kind of work working in hand, hands up. But be you need one and sixties a second part to your first question represented. Former Battlefield. This is a different German industry regards to, I think You see in in the Dancing and the and Relates to a Harry Stale. Is it possible that they could read? Visit some of their screening processes for hiring? Understand? Is the insert parts of that screen process to expedite hiring. This is just the bulk is something to think about. It doesn't have to be responding to Dylan engine. Thank you, Representative Jarvis. Thank you, Mr Chairman. And thank you, Secretary Cohen, for all the work tireless sires you've been putting in, my question relates around. Do we know how many positive cases are asymptomatic If you don't have the day that, can you get this data and and it to the website data? I believe that this is very important information for making decisions as we move forward to open the state. Dr. Code. Thank you for visiting Jarvis from the question. So right now, we are not collecting systematic data on whether someone has symptoms at the time of the sample collection. What we have are some research studies. Try to understand whether someone is asymptomatic or not. And I believe that those are close to being published. Berber Asymptomatic spread here in North Carolina. So get June for those studies that are here. But we do not report symptomatic spread on a routine basis. That is not a data point that that we are collecting again. You wouldn't research studies and I believe our partner that you, you and see you get others are wake up back there working through those studies right now. But I can voice you are some other states than the studies that they have done that I'd be happy to share with you. There's a meta analysis which essentially tries to put together as many research studies that they can together. When they're seeing is that there's a very widespread asymptomatic friends. Some studies show little doesn't lock 20% up to 70% of the asymptomatic got huge spread on average is thinking about that in the high 40% 50% could be asymptomatic. And what I mean when I say that things they're not showing symptoms at the time of the chest, then I mean, they don't developed symptoms ultimately, but at the time of the attack, they're not showing symptoms. I think you're getting at the heart of one of the big challenges of is a long length of time. You could go having symptoms, but you could be spreading your the virus to other people again. That's going back to what the's coverage has become even more important that you our work here, is the second part. I would just like to ask it. Would it not be a just a simple check of a box to check it at that time and track that data if other states are doing it? I don't understand why North Carolina is not ahead of the curve Thank you. We have three more questions, Dr Cohen, if you're able to stay represented, Shepherd. Thank you, Mr Chair. And the doctor couldn't. I just got a text from a constituent. Their question was about wearing mask that they've been reading some reports from OSHA that say that not all masks are gonna be receptive for doing what we would like for them to do, depending on what they're made of and so forth. So they're questioning whether the mask you're gonna be effective or not. I like to hear your response today. And it also I'd like to concur with up with what Dr Karen Jones said about the nursing facilities. My mother is in one. Last month, her sister passed away and we were not able to go in and sit with her and consoler and talk with her about it. And she was pretty upset. So I see that that's something we need to address. And the sooner we do it, the better. And thank you for all that you do, Dr Cohen. Well, first start, I'm so sorry to hear about your your sister. And then that loss like this has been incredible, comparatively hard and I look forward to working with you on this. We want to solve that. That issued. You look forward to working on it. Now you have forgotten your other face covering. Sorry, I got it. So I think that I don't the constituent. That question is right that different face coverings have different abilities. Your filter out particles, which is lying in medical settings right in a hospital setting. We have different protocols for different kinds of masks. When when doctors and nurses are working in the highest risk setting, when they're doing something, that cold air is alive and maybe giving a nebulizer, intimating someone and respiratory droplets can get into the air a lot, you have to wear something called in 95 that filters out the vertical most of the time in health care settings, you Can we withhold a surgical or procedure mask. It has special material that does not there apart. Well, we're recommending for the general public right when you are out in a in a cold like studying, you are going to Lowe's or Home Depot. You want to be wearing a face covering now. It doesn't filter the particles in the same way a surgical mask or face master in in 95. But what it does, it doesn't reduce the amount of respiratory droplets that leave you and go out into the world. It is not as good as a surgical map, right, but that this is where the supply chain of the different things was. What has been challenging continues to be challenging. We want to make sure that those mats are available from health care worker that have to be exposed to Kobe. 19. We've been asking the general public for clock face ever. But I think you're consistent, right? From an OSHA perspective, right? That that is not an asset is gonna filter out particles. But the issue is, is everyone wearing it? And that some of the studies I shared with you in my presentation you should click on the issues If everyone wears it together, we're all doing it. You get, you get extra protection. So it's not just the person who have hope in 19 wearing it, but someone who doesn't have it where that and it's the double layer of protection is not perfect doesn't mean there's no risk, but it definitely decreases risk a lot. And that's again. Why? While we're tryingto recommend a low cost, highly accessible intervention, like a face covering for for the general public, which is different than the recommendation, you might have in particular businesses that are high risk for a health care setting. Thank you. We have three left. Represented Dixon Austen. Our favorite questioner represented Blackwell. Last represented Dixon. Thank you, Mr Chair. I'm going to, uh, not ask a question. I'm gonna make a brief statement, and then I'd like to make a suggestion to the chairs. This is my statement, Uh, those precious couples across this state that Representative Jones referenced. They do not need protection from themselves. And I offer some common sense advice. If I were in Dr Cohen. See, I could solve that this afternoon. I could help identify those couples across the state across this state. And I would say, let those precious people visit together, but questions my suggestion to the food chairs. This You know, this is an excellent meeting. I think it's been a very good lead, but obviously there many, many questions. I would suggest that the chairs that you consider forming a subcommittee bipartisan subcommittee smaller in number to see if Dr Cohen would be amenable to that subcommittee meeting with her and her staff in person and that subcommittee reporting back to this community justic and say just a suggestion. Thank you. Thank you. Represented off. Thank you, Mr Chair. I also just They want a statement than a question. I just can't help but share. I think my perspective closer to my car. I don't hear that. Some people are a lot over here. Enough. I appreciate all the comments from my colleagues. Andi, just wanna just note that in this conversation we're talking about dimmer switches were talking about the impacts of indoor temperature and the scaling of our testing capacity. We're talking about strategic deployment of testing and tracing. Resource is and urban areas that are densely populated and also in rural areas, some of which are not complying with their mitigation efforts, were talking about successful partnerships that the test is launched to respond to the issues in our long term care facilities. We're talking about mental health impacts which are very, very serious. I touch a lot of people's lives on. We're picking apart science, but we're not talking about is the worst case scenario that we're facing just in March. We're not talking about, you know, the please to volunteer for volunteers who have CPR experience to go help out of hospitals. We're not begging late people with broken CPAP machines to donate them so they could be turned into ventilators. And hospitals on our hospitals are not overrun, which was a very real threat in just a few months ago. Eso the consequences of all the efforts from being to chest and our project partners or serious. Some of them are some of the reminder for folks in this room. Some of them are dire for elderly for business owners, but there needed these measures were needed on they kept us from the worst case scenario on. I just can't help but be reminded of that. In this situation and conversation. I want to thank Secretary Cohen for the presentation and for all her work. Thank you. Think your last Dr Cohen will be represented? Blackwell. My favorite question. Thank you, Mr Chairman. I'll try not to disappoint you. A quick comment to start to sort of follow on the heels of Dr Jones's question, and comment on the coming is this there is currently pending in the Senate Senate bill 7 30 The note. Patient Left Alone Act, which would go a long way towards dealing with some of these people who are left alone, whether in the hospital, in circumstances where they can't be their own advocate or in nursing homes. And I heard about him secretary that the department will find its way clear to support that legislation and work with us on it. My first question out to short ones. 1st 1 and I was 30 minutes late because I had another meeting. So if this has already been dealt with, please tell me and I'll ask someone else what you said. But I've gotten the impression of the last week's from news reports that Florida has dealt rather successfully, comparatively, with avoiding as significant an impact on its elderly population and senior citizens. If you don't dispute that, I wonder if you could comment on what is different in Florida that has been done or demographically. That would explain if, in fact, it is the case that elderly in nursing homes there have not been as negatively impacted by the virus. Dr. Going to recognize? Well, thank you. Ever been in walk All I appreciate the questions on course on the visitation bill. I'm sure mind my team has shared this is that there are our federal rules on law that are conflicting with that piece of legislation and so that here's an issue there in addition to some of the infection control things that I'm sure you've been hearing and wanted to make sure that we're not bringing virus into a place the starting in and how care set things. But I do want to reiterate what I hear. All of the issues these days are wrenching hard Howard issue. Want to work with you on trying to find the right solution? You think about Florida? I have not seen data that the North Carolina are any different in terms of the impact to our nursing homes. Please feel free to share as well. If they're doing something that we are not doing. They were all all years. We want to bring the best solutions here to North Carolina. We know we're in a pandemic. We're trying to learn a fast we can that there is something that they are doing that We are. And I love to break it here T. J. North Carolina, about to work with you on other solutions that there's something else that they that we are are missing to work with you on that we feel like we are are looking around the country and trying to throw everything we can and because such a critical issue. But door is always open to work with my team on on additional ways beginning quick response on that. You guys are the experts, and I would normally think, especially in dealing with a new pandemics, such as we are, that you all would be looking to see what other states are doing rather than asking members of the House to tell you about something good that may be happening somewhere else. But my second question is this, Um, and maybe you can correct me if my misunderstanding is correct or incorrect. Currently, with the shutdown in North Carolina and over the course of the shutdown since the governor announced it, I am not aware that you all have made any kind of allowance for geographical differences in the state related to incidents of cases, deaths um, been laters, PP. Whatever. And I'm wondering if that's the case. Why we have to keep Avery County shut down. Because we've got serious problems in Burke County. Let us say, or we have to keep a county on the coast. Let's say hi County shut down because of problems that we may have in Johnston County. Can we not take into consideration that one size doesn't fit? All is the old cliche goes and make some give some greater opportunities to those areas of the state that aren't experiencing the type of problems that are, uh, likely to overwhelm Dr Going. You're recognized for the answer in any final comments you have. Thank you. Thank you. Within a block. I apologize. I didn't realize I was speaking when you were still speaking star quality for that. So back on the flagging of issues, obviously the 50 states giving 15 everything so But that team is constantly scouring the literature in the research and we will continue to do that to bring best practices here to this game. But But we there were always things that are coming out every day. So if you see something and they're using to be represents something in in Florida that you might not be aware. We have two dads here about it, but as far as trying to tailor our actions to be more regionally specific, I think you can see that in our surging of resource. It is when I said that we were surging capacity for testing and tracing in nine counties, so we are definitely trying to tailor our response. I think we know that this virus doesn't respect any borders and frankly, doesn't even respect skateboarders. And so we're trying to do the best that reaching in no challenge border. You know, people live in one place, one county working another. They shop in 1/3. And so it's really challenging to think about any individual county making own decisions. The governor has that most occasions we continue to look for opportunities potentially Taylor regionally. But you can see for me happened. I didn't go through all the data today, but it's on our dashboard. You look in both our chase counts and lost per capita. This virus is really everywhere in our stage and we are having challenges in all parts of our state, and that's why I think it's a collective actions that we're gonna do together no matter where you are, that they're going to really help keep this virus level low. And I I you know, I wanted to just end chairman thoughts by saying, You know, I really appreciate this dialogue. I think really good questions be there. So incredibly hard issues, particularly the ones that were brought up around long term care. Keep this virus level low, but still let us reignite the economy. I think it was acting the three W's doesn't labour that one more time, particularly that the work to do face coverings and wait six feet a car wash her hands. All of that is gonna be really important for us to keep this virus level low and still continue to make progress. Thank you. Thank you, Dr Cohen. Thank you. All the committee members is Would you like your plug your three W's before we leave? Dr. Cole