Resume when the stayathome order expires. Other topics included guidelines for Meat Processing facilities in the state. Gov. Northam good afternoon and thank you for joining us today. Today, we have updates on our meet processing facilities and allowing our hospitals and outpatient providers to resume nonemergency procedures, allowing our dentists to start seeing nonemergency patients, and allowing veterinarians to see nonemergency pets and their patients. Yesterday, President Trump evoked the defense production act to require Meat Processing facilities to stay open to maintain our food supply chain. Last weekend, i joined the governors of maryland and delaware in sending a letter to President Trump, asking for federal help in coordinating our approach to rising numbers of cases in our poultry facilities. Trump, asking for federal help in coordinating our approach to rising numbers of cases in our poultry facilities. Deployings responded, teams to each of our three states to work with health officials. This team arrived on virginias Eastern Shore yesterday. They met with local health and worker safety teams. Assess theginning to plants and ensuring they are operating to assist safety guidelines that the cdc issued sunday in response to the request from me and the governors of maryland and delaware. Howe guidelines describe plants should reconfigure their spaces so that workers are able to be separated and protected from each other. I want to be clear that my number one concern here is our workers. Everyone is a human being who deserves our attraction. These factors place them at a high risk. We took important steps these years to help workers like these. We raised the minimum wage in virginia. We passed legislation to allow those who are not yet citizens to have drivers licenses and we are working to make sure that the expansion of medicaid helps as many virginians to get access to health care as possible. Easternp on virginias shore and i know how important these industries are. I fully understand the importance of me crossing meet processing facilities on the food chain and on virginias agriculture economy. I think the hardworking farmers, employees, truck drivers, Grocery Store workers, and all members of this complex supply chain for their work to make sure that all of us continue to have safe, nutritious food during the midst of this health crisis. I want to be clear that this depends on workers who are healthy and safe. If we declare that workers at meet Processing Plants are essential, it is imperative that we continue to support their health and wellbeing. Todayon a call earlier with agriculture secretary sonny perdue to raise this very issue. I hope with this executive order that the president is signaling that the federal government will play a much larger role in keeping these employees safe and will provide federal support to ensure that every worker has protection including adequate ppe. Im instructing virginias department of health and industry to work with the plants to make sure that they implement the cdc guidelines to protect our workers. They will work with the u. S. Department of agriculture, osha and the fda to work with state and local officials to affirm their following state and local guidance. About thelearn more state of virginia is cuba poultry plants in the next few virginias poultry plants in the next few days. We fully expect that all employees in these Food Processing plants will be tested, and that those who need medical care have adequate access and a safe place to go if they need to be isolated. Then we will have a much clearer idea of the thats time is of the essence to stop the spread and protect our workers. Now i would like to move to the issue of elective surgeries. Ago, the Virginia Health commissioner and i signed Public Health order to, which prohibited elective surgeries and limited dental procedures. I sincerely appreciate the cooperation of our Health Care Providers and health care facilities. Ppeid this to preserve our for our frontline workers and hospitals, and provide for a surge if that were to occur. I want everyone to remember six to eight we think of. Our hospitalization rates were rising. We were worried hospitals would be overwhelmed by a surge in cases like we were seeing in italy and new york. We were planning how to build alternative care facilities. Around the country, people were worried that we would one out of ppe and our nurses would have to resort to wearing trash bags. We found that totally unacceptable. Because everyone has worked together, we have avoided that. Our efforts to slow the spread of this virus are showing success. Our hospitals have not been overwhelmed. We have been able to get more ppe and develop ways to be contaminate test and decontaminate decontaminate masks and gowns. Results weret taking more than a week and now in most cases, it takes less than a day. Together, we took the right actions and they have been successful. We slowed the spread of this virus. For weeks, our teams have been in contact numerous times a day, working together. Now, hospitals and dental facilities are prepared to restart nonemergency procedures safely. They have worked for weeks to prepare to be open and they are ready and i want to emphasize and underline the word safely. On monday, our hospitals, clinics, dental offices, these are safe, these are clean places to go. While we have entered his pandemic, i want to encourage all virginians that your health care is important and i encourage you to resume that health care and we built together do it in a safe manner. That, im announcing elective surgery and dental procedures can resume when the public order expires at midnight tomorrow night. With guidelines in place to ensure safety for Health Care Workers and patients and to maintain an adequate supply of ppe. We know that dental issues can affect the rest of the body, so it is important that dental facilities are included in this. The Virginia Dental Association issued new guidelines to their members yesterday. I would like to introduce a doctor to discuss how dentists are planning to safely move forward and before she comes to the podium, we have had a great relationship working together to be able to get where we are on friday and i would like to thank elizabeth and all the dentists across virginia for their cooperation and for taking such great care of our fellow virginians. Thank you. Thank you, governor, and dr. Carey, or your administrations close contact with dentists and other Health Care Providers. I would also like to thank the dentists, dental hygienists, dental assistants, and office teams for their professionalism and dedication to patients as we continue to see our emergency patients here in the commonwealth. As you may remember, and as the governor mentioned, the Virginia Dental Association issued a recommendation on march 15 to postpone elective procedures. Our goals were to preserve the muchneeded ppe for our medical colleagues in hospitals, to keep our dental emergency patients out of the hospital system, and develop new guidelines to protect our patients and providers in a dental Office Setting amid this crisis. That said, as the governor alluded to earlier, we all recognize that the longer practices remain close do not emergency treatment, the more untreated patients dental diseases will progress. Ethicalsts, we have an responsibility to our patients and our dental teams. We have worked tirelessly over the last month and a half with the Governors OfficeGovernors Office for issues like liability to Health Care Workers. Thank you for your executive earlier executive order signed earlier this week. When the order is lifted at the end of the month, virginia dentists will be following detailed guidelines from the ada, bda, Virginia Department of health, and cdc to keep patients , dentists, and dental team members safe. The safety of patients and dental team members has been and always will be our utmost concern. As we begin to open our offices for nonemergency treatment, i encourage virginians to contact your Health Care Provider if you have an oral health need. Bee but not all offices will resuming regular operations at the start of may and they can work with you to make sure your needs are addressed. Please know that dental offices have always been leaders in Infection Control and our offices have new protocols in place to minimize the risk of transmission of the coronavirus. Those protocols will include measures like Wearing Masks to your visits, screening specific for covid19, adjusting appointment times and schedules to allow thorough cleaning between appointments, and minimizing or eliminating patients in the reception area. Weeks, bothcoming dental practices will be given who dental those needs may precipitate urgent or Emergent Care if not addressed sooner. They will be given special consideration to patients who are at high risk for covid19. They will minimize the use of air and water to minimize aerosols and we will wear different forms of protective equipment to minimize transmission. Access to certain ppe continued to be an issue for some practices. We continue to work with our suppliers and the Governors Administration to address these shortages. Toare excited and prepared open our offices and begin safely seeing our patients for comprehensive care. I encourage anyone who may have had to postpone dental treatments or maybe having a dental issue to call your dentist and wake and work with him or her to develop a plan. I speak for my colleagues when i go back tot wait to seeing our patients. Thank you again, governor, secretary, for your continued encouragement and engagement with the health care professions. We look forward to working with you and your office to be a part of the solution as we move forward with testing and a vaccine and eradication of the coronavirus. Thank you. Thank you, dr. Reynolds. In the past weeks, everyone in our Health Care System has stepped up. They preserve ppe and found new ways to decontaminate it. People have followed our stayathome order and we are flattening that curve that we often talk about. Our hospital census levels have remained steady. Now it is time for our hospitals to resume nonemergency activities. This is important because elective often means nonemergency. Elective surgeries include everything from knee replacements to some cancer treatments. These are procedures that can wait a wild, but not forever. I know ridge and yes hospitals are committed to our Ongoing Partnership and i want to usher virginians that if we begin to hospitalization rates rise again, we are prepared to take swift and necessary action. Dr. Michael to ask mcdermott, president and ceo of Mary Washington health care, to give more detail on how our hospitals will move forward. Thank you so much. Thank you, governor. Good afternoon. Mcdermott, the president and chief executive officer of Mary Washington health care in burke, virginia and im chairman of the virginia hospital and Health Care Association board of directors. During this pandemic, i have had the privilege of serving as chairman of the vha covid19 committee and as cochair of the joint Virginia Department of health vha covid19 committee. Today byike to start expressing my gratitude to the governor and the administration for the executive order addressing some of the liability issues that could arise in response to this covid19 crisis. Expressingtart by the Hospital Communitys gratitude to the governor and his administration for the incredible partnership and collaboration in this unified covid19 response in the commonwealth of virginia. This has been an inclusive process and it involves countless stakeholders and diverse perspectives as we Work Together to protect virginians from this contagious virus. Everyone involved in this effort recognizes that this pandemic has had a significant effect on the commonwealth, this nation, and the world. That includes the many patients and families that have been directly affected by covid19, and the front line Health Care Providers in First Responders who continue to give their all in the fight against this illness. But the effects of this serious situation also extend beyond that. It touched everyone in some way. Having worked closely with the governor and his team, i know the governors focus throughout these trying times has been exactly where it should be, on Public Safety and the health of our communities across virginia. As we have worked through the many challenges associated with this pandemic, from access to testing and personal protective equipment, to and sharing adequate treatment capacity and other issues, the governor has been a steadfast ally in this coordinated response effort. Because this is uncharted territory in many respects, we have had to make adjustments as this pandemic has unfolded and shifted on a daily basis. Early on in the process, virginia hospital took a precautionary step of postponing nonemergency medical procedures createerve ppe and to additional treatment capacity and our facilities. This step taken by the hospitals was consistent with the governors order calling for a halt to such procedures throughout the commonwealth. When we talk about nonemergency procedures, it is important to define what we mean. They include things like cancer surgeries and many other scheduled procedures and forms of Preventative Care that are important to the help health of patients who need these medical treatments. While those scheduled procedures have been on hold, region yes hospitals and Health Care Providers have been working diligently to care for covid19 patients and to secure the necessary supplies and resources such as ppe and expanded testing capability to support patient care during the response effort. Throughout this ordeal, the commonwealth and Health Care Providers have monitored the real world conditions and situational demands caused by covid19. As we consider the Current Situation and other medical needs of virginia patients, we believe the time is right to chart a path to begin providing nonemergency, scheduled procedures to people who need that care in inpatient and outpatient settings to improve their health outcomes. Virginia hospitals have more than 5000 available beds to meet patient needs and continue the care for those impacted by covid19. Access to expanded testing continues to be an area of focus for the governor and for Health Care Providers, as our ppe supplies. Our hospitals follow best practice care and infection protection prevention protocols and are safe facilities. It is important for all virginians to know that if you need care, please do not hesitate to receive care to improve your health outcome. The Hospital Community will work state, andfederal, state, Specialty Group framework to guide us as we prepare to move forward with resuming scheduled procedures. This framework positions us to safely and responsibly take these next steps in a manner that is consistent with health care best practices. Direction,ed in this we will continue to work closely with Governor Northam and his administration to monitor the number of patients hospitalized for covid19 and other conditions to track testing and ppe supplies and to protect the safety of our frontline caregivers as we work to slow the spread of this disease. Together, we will be ready to adjust our approach in response to new challenges we may be confronted worth with as we continue to fight this virus while meeting the health needs of our fellow virginians. Thank you. Gov. Northam thanks so much, dr. Mcdermott. Im grateful to our hospitals and dentists for their efforts to support Public Health during this difficult time. Im also grateful to our veterinarians. Many of them voluntarily stopped doing any surgeries that required ppe so that they could donate that to those on the front lines. Our veterinarians have continued to care for animals throughout virginia during this crisis, implementing social distancing, and i would like to thank them for their cooperation during this challenging time. On a side note, our two labrador s love their veterinarians and thank them as well for their cooperation. Virginia veterinarians are allowed to provide the full array of services their patients require while using Public Health best practices. I want to move to a different topic, but a good news topic, and that is our Student Loans. The federal cares act allowed many people with Student Loans to delay payments during this crisis. Thatll be applied to people with certain u. S. Government owned loans. Virginia is joining several toer states in an initiative add an additional 200,000 loannians with education programs. Perkins loans are privately held Student Loans. Lenders will provide a minimum of 90 days forbearance on loans and waive late payment fees among other actions. This is great news for the 200,000 virginians that are affected. I want to close by talking about our resource challenges. A few weeks ago, we were concerned about whether we would one out of hospital beds and ppe. We had very limited Testing Capacity, so we focused on testing the highest priority patients in our hospitals. To help us manage capacity and ensure that doctors and nurses and other caregivers were not burning through ppe with patients who might be negative for covid19. Now, we have more Testing Capacity and we are able to ramp up our testing of moderate and low risk patients, as well as priority groups like Nursing Homes and First Responders. On karen remley will be here friday with a more comprehensive update on our testing strategies and capacity. I would like to turn this over to dr. Oliver, but before i do, i will remind all of you that we receive input from various forms, individuals, through various means. One of the things that has been requested is that our data be reported via zip code in virginia. Im pleased to report dr. Oliver will address this as well that from here on, data will be reported via zip code. Dr. Oliver, welcome. Thank you, governor. Thank you, governor. Good afternoon. We will be presenting the data at the zip code level. Going forward, it will take us a few days to do the data transformation that will be necessary to present that. It wont happen immediately but you should see that in the next few days. Some statistics on the current numbers regarding covid19. To 14,961, now come that is 622 new cases in the last 24 hour reporting period. 522, that is 30 new cases in the last 24 hour period. We have 206 outbreaks of covid19, we consider an outbreak two or more cases in any given site. Outbreaks, 116 are in Nursing Homes across the state. Actually, longterm care facilities. That would include assisted living facilities. Outbreaks in16 longterm care facilities, 1407 cases are accounted for their and 111 deaths. We continue to try to give reports on the racial and ethnic breakdown on cases and deaths. We have had challenges over the weeks in getting complete data on that for both the cases and the deaths, the number of cases for which we do not have that information is 4751, the number of deaths without the racial and 68, a percentage of 32 of cases, about 13 for the deaths. Africanamericans, the cases the proportion of cases we have where it has been reported. S 27 for latino population, we are working on that as well. I expect by the beginning of next week, on our website and here at the pressers, we will be able to report that to you. Thank you very much. Gov. Northam we will be glad to take your questions. Joairst question from dubya from wjoa. You were talking to Business Leaders about doing a regional reopening, opening sections one at a time. Would that be by county health, health district, or Something Else . Gov. Northam the question is about when we ease restrictions and allow businesses to reopen that have been unopened and how we will look at that if we look at regionally, bill that be health care districts, like counties . What i will say to answer your question is we are still working through a plan to do that. Not to be a broken record, but we are looking at data to virginiahe cases in every day, the number of hospitalizations, icu beds, our ability to have ppe to those that need it, our ability to test. I will say that there have been great discussions, our last meeting formally was on monday so individuals know that have not seen that list of businesses, we have businesses that represent polasky, we have another business in abington, we have another business that a statewide, walmart, who has stores throughout virginia. We are getting some good information, some good feedback. Not only from the rural part of virginia, but other examples like virginia beach, which is where im from, or where i lived for the last 20 years before coming to richmond, how we reopen our beaches safely. Owners,to restaurant hospitality industry, i could go on. Just great information. That is a longwinded answer, but we are working through the planning stages. We have one more formal meeting. I would also emphasize that ,here are numerous businesses both small, leading, medium, and larger sized businesses that want to provide input. We have heard from those businesses when we were not having formal meetings. I encourage you to continue to provide input. We are as excited as anybody else in virginia to ease these restrictions to get our businesses back open and get our economy back up and running. We certainly need to do it responsibly and we need to do it safely. Thats what this group is focused on. Regarding the reopening, either the four checkpoints you mentioned was the ppe at hospital bed capacity. Dr. Mcdermott said we had 4000 now and there is enough ppe for elective surgeries. Does that mean those two thresholds have been met for the phase i reopening . Can you savor save every are with those checkpoints . Gov. Northam dr. Mcdermott might want to comment. The question is, the criteria that have been looking at to reopen businesses, have they been met by our hospital . Asre were challenges as far it and when we will have a surge, they were challenges with ppe, challenges with the ability to test as needed. The answer to your question, they have been met. I think if you go back and look at one of the curves, the charts we gave, we dont have charts today, they have not changed that significantly. You will see that hospitalizations nicu admissions and need and icu admission and need for ventilators have remained essentially flat throughout this. Think what up, i virginia to have done and what the hospitals and Health Care Providers and dentists and veterinarians have done has allowed us to keep that curve a point not get to where our capacity was overburdened. Any additional thoughts on that . I would just say, i think you did a great job in going back in time a little bit and kind of recounting where we were at different points in time. I think that is important to do. These have changed rapidly and we have gone through this covid19 crisis. With important that we act reality, how it is today, not how it was in the past, certainly not how we hope it will be in the future, but act based on data as it is today. I think the governor and his administration have done a great job doing that. If we were to go back three weeks ago i will give my example in fredericksburg we had patients presenting to our hospital facility and we had a certain capacity to test, we might be able to do 30 tests a day, but we might have 60 patients presenting to our facilities that we think should have been tested. We had to allocate those tests to the most serious patients at that point, and maybe 30 of the patients who did not require hospitalization and bright going to get sent home, we have to send them home without a test. They might have been positive, they are not going to be counted in the numbers that we have in our testing, they recovered on their own. Now, when you come into our hospitals, our Testing Capacity has improved. We test every patient that comes into Mary Washington today if they have signs and symptoms of covid19. We have the availability to perform testing. We also have the availability to extend that to our communities, even patients in their private physicians. We have ways where they can safely come in and have that testing performed. We might see more covid19 positive cases happening in the commonwealth of virginia, but looking at our hospitalization numbers, i numbers throughout the commonwealth, we can see that those have stabilized. That can lead to some of the variations and looking at some of the data. The next question is from the subject news herald. Efforts inioned efforts altering Processing Plants. Do these efforts apply to all Processing Plant in the state, including those for pork products, or is it only for poultry . If only for poultry, when will efforts for other Processing Plants be on the way . Gov. Northam great question. I just happen to have our secretary of agriculture with us today. Welcome. Thank you, governor. Thank you for that question. The cdc guidelines that were toeased this weekend applied meat and poultry processing facilities. I think the additional measures that the federal government is putting in place, the additional assistance, both of our processing facilities are actually inspected at the state level, they are staying inspected, but the additional assistance is going to allow us to look at those practices and apply those across the state. Thank you. There have been a number of reports about private labs in virginia who say they have on youth capacity for covid19 testing. I was wondering if the state has contracted with any of those labs and if not, why not . Gov. Northam i will allow dr. Brimley to answer that. Thank you for the question. Excellent question. Some of those labs do not pick insurance, they want to build the patient directly. Some other labs are ready to go. We are making a database of all those labs so we can make sure everyone who orders tests, whether it be Hospital Systems, doctors offices, working with health centers, free clinics, we will talk about this on friday, to make sure we use every amount of capacity began in the state and make sure we are taking care of virginia businesses. I think i talked to you six days ago, tomorrow will be the seventh day. The governor gave me a heavy lift but we will make it work. Trying to get that information together in one place so we can together in one place so we can maximize the use of every test that might be available for virginians. The state has contracted with those labs to perform testing for virginia and have the state of virginia help fund that testing . Dr. Remley those labs were not available to test. For or five weeks ago. Ago,our or five weeks everyone was struggling to bring up their laboratories be read the Public Health labs, which include not just the cls, dr. Cls, dr. N charge tori is in charge of uva, anson virginia tech, have a large capacity that we can use, but many of the Hospital Systems have their own laboratories now. Im happy to say there are no hospitals to our knowledge that are using Public Health labs anymore. They are able to use their own system, partnering with uva, or commercial laboratory to do testing. Thats why we are able to expand , say to doctors throughout the commonwealth, there is testing available, lets get those patients tested. We will talk more about that on friday. There is a plan to get that moving. Virginia was one of the first states to close k12 schools. Is it your understanding that in part because of that and other social distancing measures that fema and federal agencies prioritize getting testing supplies to other states where outbreaks were more severe . Maybe partly explaining why testing in virginia has been Lower Per Capita than elsewhere . Gov. Northam i appreciate the question. Regarding closing schools, and did that direct fema to give supplies to other states, i dont know if i would go that far. I will say a couple good things. One is we were notified yesterday that fema will be sending virginia 200,000 additional swabs, which will help us significantly. The other thing that i think is important to say, we took an aggressive step at the beginning of this pandemic when we saw the numbers going up in virginia to close our schools for the rest of the year. That was probably one of the most difficult decisions ive had to make. It affects our children and their families, but i think it has been important as we have tried to flatten this curve as much as we can and ive heard a lot of people say, the kids are better than it be grandparents, greatgrandparents, so if a chil affects grandparents, greatgrandparents, that is where we have problems with the surges and increase in cases every day. That is another longwinded answer, but that was some of the thought process that went into doing what we did to close the schools and we wanted to give virginians consistency and let them be able to plan because we knew this virus was going to be with us for a couple months. I think the other question i often get and i wish i had a crystal ball, but i am a class is half full person, is whether our children really back in schools in the fall. If we continue to do what we are doing and the assistance we have had for our superintendents, teachers, secretary of education, we are working as hard as we can to make sure that your children, our children, are back in school in late august, early september. Florida, you guys were tracking the percentage of positive cases and you want to see that 14 day decline. Yesterday, some of us are looking at data and there was a 17 increase. Does that mean we are not going to be ready for phase one by may 8 as you suggested . Or are you looking more at trajectory as in, can one day of increase disrupt a 14 day otherwise pretty good picture . Gov. Northam great question. Im not going to give you a lesson in statistics, i a the question, but was, are we looking at this trend, 14 days, if there is one day where we get a lift in the numbers, does that mean we start over . The answer is we are looking at trends. I think that is important for everyone to understand. The other thing that is important to understand, when we do more testing, as we have ramped up our tests, you are going to have more positive results. That affect the numbers. It also depends on the turnaround time. Ouruple weeks ago, turnaround time was sometimes 5, 7, 9 days. That those another variable into how to follow this trend. Finally, who are we testing . If we are testing individuals ,hat are in the emergency room and our chicken Processing Plants, our Nursing Homes, your positive rate is going to be higher than if you went out and tested the general population. Not to get into a lesson on statistics, but it is not white as straightforward as the average person it is not quite as straightforward as the average boston guest person might think. We are looking at these different models and answer to your question is, nothing is set in stone, but we are focusing on the trends. Are you on possibility on track for the possibility of the may reopening . Gov. Northam right now, our numbers continue to take in all those variables and factors that i mentioned. Our numbers have not flattened out yet. Question that i is, what aboute is, what about in some other areas of virginia . It is not the same. There are certain counties that dont have any cases right now. That is why we are trying to think through this with thoughtfulness and reason and fairness and at the end of the day, doing everything began to keep virginians safe. A lot of discussions are going on behind the scenes and we are trying to take evidence into account. [inaudible] gov. Northam you said it, not me. [laughter] hi, governor. With so many labs doing different types of testing, how confident are you in the accuracy of these tests . We were hearing people who had been told to expect false negatives. What does this mean act out what value is this information . Gov. Northam im going to ask dr. Tony to come up, regarding the false negatives, false positive, and i think she will thatle to elaborate on different tests, the antigen test, the pcr test that most people are using, versus the antibody test. Im sure you have heard the same report that we have. With thee inaccuracies antibody tests have been promoted so far. Any further thought . Thanks. About thestion is performance of the different tests and people performing different types of tests. Are i can say is when you looking at the different types of tests, as the governor said, there are molecular tests that perform amplification and look for the presence of the virus, then and there are serological tests that dont look for the virus, but they look for the bodys immune response. Both of these tests are important tasks, they provide Important Information that help us understand the course of the disease. When we are thinking about false positives and false negatives, the molecular tests are the highest performing test. Sensitivity, high the highest specificity, and most of the tests that are being performed had been approved and authorized by the food and Drug Administration for meeting a level of performance that is of High Performance and high acceptability, so these are highperforming tests and they meet a threshold of acceptability and comparability across all of the different tests. What is more important is the timing at which these tests are being performed. When you are looking at the virus, you have to think about the course of the disease. If you test too early, you will get a false negative because you have not had time for the virus to grow to a point where you can detect a test. If you test the antigen test at the wrong time, you will get false results as well. It is important that these tests are used during the right time, during the right course of the disease, to get the most accurate result and that you can make the best prediction as to what the test result means. With respect to the molecular tests, i think the ones being performed at our clinical hospitals, the ones performed at the state lab, and even the commercial, private laboratories, are highperforming, high accuracy, so they are high confidence tests. [inaudible] be a generalg to trend over 14 days, can you keep us updated on where we are in that 14 day period as we go on . About the fiscal impact of having paused elective surgeries for hospitals as well as dental practices . Gov. Northam the first question, as far as giving you the daytoday data that we are following, we do have those graphs. We chose not to use them today, but on friday, i will promise i will bring them and let you know and see where we are. I think this is very helpful. That is number one. I will let the hospitals and dentists answer it as well. But i will tell you before i let them comment, the question was, how has the closing or discontinuing elective surgeries and procedures in the hospitals and dental office and veterinarian office, how has that affected them . It has been significant. Office general dental office or hospital or veterinarian clinic is like a business. You have to look at where your revenue as coming from and elective surgeries are part of that revenue. Beds are being occupied . How many dental chairs are being occupied . Discontinue those elective procedures, that are beds that are empty there are beds that are empty. We have gotten past that stage, but not being able to do the procedures, which i would call im a physician, i own a practice in Hampton Roads that is some of our breadandbutter. That all affects the bottom line. To answer your question, it does affect them fiscally. The thing i would close by saying is this was not about money for anybody. This was about safety for virginians and making sure that we were ready for that surge. I think the hospitals, i think the outpatient clinics, the providers, the dentist, i thank them because they sacrificed to do the right things. If you have any further thoughts. Thatjust want to echo statement by the governor, the decision to stop nonemergent medical procedures was the right decision at the time it was made. We needed to build capacity within our Health System to handle a potential surge of virginians that would need intensive care and we need to do that and nobody is saying that was the wrong decision, it was the right decision to be made. But as we have gone to the covid crisis and as virginians have worked so well to follow the stayathome orders, social distancing, we have been to the curb. We have not seen the type of surge they experienced in italy or new york and that is fantastic news. It brings us to this moment and we look at our data in every thing that is happening to say, now is the time to make sure, if you are a patient in virginia that has an unmet medical need, it is safe for you to have that need met at this point a red the Financial Impact is well over 200 million at this point, but that is insignificant. The more important thing to do is build the capacity within our hospital to make sure we are able to care for virginians if they need it due to the covid19 crisis. [inaudible] this question is for dr. Oliver but i would also be interested in hearing what the governor might say given his medical background. You are talking about granular data. Of columbiahe city heights announced its first covid case, the numbers reflected that the citys total has gone up to 49 in a three week period while surrounding counties thats all reported cases earlier had not experienced such a spike. Two of the four deaths were at a nosing home. A nursing home. The question i have is two parts. Is that increased considered more normal than alarming and the process of reporting the cases . Debt myl raise the second part would be, my second question two questions, one, whether the bison cases in colonial one, whether the bison cases in Colonial Heights would qualify that jurisdiction as a place that would need special attention in the Public Health efforts that response tond our covid19, and the second whether the Health Department has broken down the steps in Colonial Heights to consider whether the nursing particularlyarea, contribute to this rise. On the first question, i think Colonial Heights and a number of other areas across richmond, years bird area, as well as across the commonwealth, there are any number of areas where people see particularly high pockets of disease incidence. We have spoken about the fact that communities of color have been particularly hardhit and i believe that communities of color and other areas that have been epicenters of incidence for we disease, one of the areas want to focus on as we expand our Testing Capacity, our case identification, contact tracing, and so on. That would be my answer to the first question. To the second question, i would have to say that our chesterfield office, chesterfield Health Department, which has a local Health Department it Colonial Heights, has been following closely the situation there. They are the ones who lead the process of contact tracing. While we dont post all the numbers on that on our website, i can assure you that we are completely on top of where those cases are, who the contacts are of those cases, and doing our utmost to try to contain the spread of the disease. The department of corrections is releasing inmates that have tested positive for covid19. The policy says Early Release must be compatible with the interest of Public Safety. Many are concerned about these inmates possibly spreading the virus. Could you respond . Thank you for the question. The question is, department of corrections releasing with covid virus. Is that a part of the governors Early Release program . The answer is no. There are individuals being released from the department of corrections based on their release dates. The department of corrections cannot keep someone pass their mandatory release date, regardless of their health considerations. But the Early Release program that has gone quite well, the corrections has reviewed about 100 inmates for Early Release and that is going well. They would not be released if they had the covid19 virus. [inaudible] they that is correct. The question is, some are being released with long terms left on their sentences. The governors Early Release program that the legislature did act favorably on its going well. The process and procedures that isdirected corrections to do less than one year left on their year,ce, less than one then they prioritize nonviolent offenses, those with home health plans, and those with low risk assessments. A low risk to commit another offense. Those are the procedures that they are following and based on those procedures, they have approved 100 inmates and released approximately 62. Not25 year sentences would be the governors Early Release program, no. Thanks to all of you for being here today and hopefully some good news from folks, whether it was through the loans or our hospitals and dental offices and veterinary offices being able to run again. I want to follow up on the want to follow up on the question about when. I thought it was a great question, when we will be able to lift these restrictions. We are going to do it as soon as we can, as soon as it can be done safely. Lets get back to the basics. Minimizehat works to the spread of this virus and as we leave, i want to encourage you to continue to follow the guidelines of social distancing, physical distancing, staying six feet or farther apart, staying in crowds that are less than 10, frequent handwashing, we know that works, covering your face if you sneeze or cough, all of these things these are basic, but that is what has allowed us to get to where we are today. Even when we ease these restrictions, we need to continue to follow those guidelines. It is wednesday, we appreciate all of you listening and watching today, we look forward to being with you on friday and as always, we appreciate your input. Thank you very much. Day with news and policy issues that impact you. Coming up, a discussion of oshas role in protecting workers during the pandemic. Then we will talk with North Carolina republican congressman about the affect the pandemic is having on the nations food supply and Meat Processing industry. And why some people who contract the virus get sicker than others. Day. Every sunday at 9 00h a. M. For eight look back 50 years to the antiwar protest at kent state, which erected into a deadly competition between students in the Ohio National guard. Cspan has roundtheclock coverage of the federal response to the coronavirus pandemic. It is all available on demand on our website. Watch white house briefings, update from governors and state officials, track the spread throughout the u. S. And world with interactive maps, watch ondemand anytime, unfiltered, at our website. Live every day with news and policy issues that impact you. Of oshup, a discussion as role in protecting workers. We will talk with a North Carolina congressman about the effects the pandemic is having on the food supply. Will discuss why some people who contract the virus get sicker than others. Live at 7 00 eastern. Be sure to watch this sunday at 9 00 a. M. For a look back 50 years to the antiwar protests at kent state [no audio] which erupted into a deadly confrontation between students and the Ohio National guard. Your questions and comments about the coronavirus epidemic start now. Host we welcome you to this edition of the washington journal primetime. As the number of states begin the process of gradually easing their stayathome restrictions, the number of confirmed deaths in the u. S. Has surpassed 60,000. We will focus on the psychological impact this pandemic is having on you, your family, and loved ones. Later, we turn our attention to how it has and will affect developing nations. We will begin with your phone