Period of time. Today, i am identifying houses of worship, churches, asagogues, and mosques, essential places that provide essential services. Some governors have deemed Liquor Stores and abortion clinics is essential, but have left out churches and other houses of worship, its not right. So i am correcting this injustice am calling houses of worship essential. I call upon governors to allow churches and places of worship to open right now. If there is any question, they will have to call me, but they are not going to be successful in that call. These are places that hold our society together and keep our people united. The people are demanding to go to church and synagogues, for a mosque. Or a mosque. Worship as an essential part of life. The ministers, pastors, rabbis, and other faith leaders will make sure that their congregations are safe as they gather and pray. I know them well. They love their congregations. They love their people. They dont want anything bad to happen to them or to anybody else. The governors need to do the right thing and allow these very important, essential places of faith to open right now. For this weekend. If they do not do it, i will override the governors. The governors. In america, we need more prayer, not less. Thank you very much. Thank you. [indiscernible] alright, everyone. It is a pleasure to join you today. That was a great announcement from President Trump that i would like to introduce dr. Birx right now. She has a wonderful presentation pursuant to reopening america. It. Ll let her take dr. Birx i wanted to start out with a summary of the number of americans we have lost to date. The exciting thing for all of us is those decreasing mortalities overtime. I think it is a real aspect of the Amazing Health care workers on the frontline. The ability of people to share at the frontline how best to care for the patients. And the continuous decrease in mortality overtime. Next slide. The other thing that has theeased significantly over last month is new hospitalizations. We can see now there is over 50 a 50 decline in hospitalizations. Although every region of the country is different. We are encouraged to see these hospitalizations declining. I talked before about the extensive surveillance the cdc has made available to this country. This is looking at their central mexico from emergency rooms. You can see both syndromic surveillance from emergency rooms. You can see significant declines week over week. It goes along with new hospitalizations. What we like to do is triangulate data, but data together from multiple sources to see if we are seeing the same trends so that we can ensure that we are making progress together. This is the influenzalike illness Surveillance System that has been up and running for more than a decade now. You can see it just the this lastpeaks of year. That is very important to remind people of, because we have influenza a, b, and covidlike illness. What we really find encouraging his across the country, is across the country, we are below baseline. These are reported statebystate, county by county. Each county will be able to see precisely where they are. If there are changes, it becomes yet again an early alert system. One of them as emergencys visit based on our syndromic qualification the cdc has up on their website, than the influenza like illness. For the American People, all of these are available on the cdc website under covid19 cases and surveillance. I want to show you these very quickly. This is where we started. This is influenzalike illness. The red, and the darker the red, the more significant the influenzalike illness is in that state. So you want to get to green. This is the week ending march 28. I think many of us can remember what that week was. This was at the very beginning of our acceleration. This is april 4. You are starting to see some of the states already turn green. The country. April 18th. April 25th. See there is an orange area on this slide. You can see it is the maryland area. Wee been calling about have been calling it out for a while. You can see minnesota, wisconsin. You can see maryland in yellow. I want to turn just a moment. I know that took you through a lot of slides quickly, but i think we can see as a country, we have decreasing amounts of illness both in the emergency to thed reported Surveillance Systems at the cdc. These come from the state, the counties, and many other states have these also on their website. We talked earlier about how we had prioritized testing to the area that had the most significant disease. You can see now, rhode island has led all of the states, testing 12 of all of their citizens. York,s followed by new the north dakota. Then north dakota. You could see that most of the high burdened areas of the United States had more than 6 testing. Admiralyou heard from gerard, we wanted every state to test at least 2 of the population during may. You can see 100 of the states now are over 2 . [no audio] ensure they have adequate transport media and slobs. Of theencouraged progress made. It is also what we to be opportunity to encourage governors and encourage governors to test 100 of the nursing home residents and staff , because many of our our outbreaks have started in Nursing Homes. Is a conjugated slide this is a complicated slide. I took you through our Surveillance System. I am taking you now into the start of how we use Laboratory Data to really understand what is happening both in the metros and at the state level. This is every single state. You can see the triangles, the top part that you can see, the of theey pieces diamonds, that is where the states were in the name of positive tests, the nucleic acid tests, diagnosing virus in your nose. You can see where it was 30 days ago and where it is now by the red square. You can see a dramatic decline across the states, and indeed, new york city six weeks ago was almost 40 . ,t is now for the first time as a states, under 10 . This is the progress we are making in both expanding testing, finding more people, but ensuring that we are getting testing rates at about 10 . 42 states are now now have less than 10 test positive on a rolling sevenday average. Again, i am going to call your attention to the top three states. The top three states with the largest percentage, so you can all make your decisions about going outside and social distancing, potentially playing golf, if youre very careful and you do not touch the flags and all those issues, playing tennis with marked balls so you are only touching your balls. People who enjoy sports have been able to really adjust to social distancing, but you can see the top three states are maryland, the district, and virginia. So there is still significant virus circulating here. That is followed by nebraska, illinois, because of chicago, and what we have talked about before about minnesota. Those are our top states as far as still having high numbers of tests positive. When i say that, they are all under 20 . Slidead shown you the four weeks ago, half of the country would have been over 20 . This also shows progress, but also very clearly about the region we are leaving in right now living in right now with this disease. I wanted you to see this as a metro. We look at this and multiple different ways. The number one metro with the highest Positivity Rate is the district of columbia, which includes Northern Virginia and maryland, montgomery county, etc. , followed by baltimore, chicago, and minneapolis. These are the places where we have seen a stalling or an increase of cases, you can see all of the other metros are almost exclusively below 10 . So we see this is great progress across the board in metro areas. We also look at daily cases and daily case numbers. You all know that is erratic. It depends sometimes on how the tests were reported and how cases were reported. You have to look over three to seven days. This is looking at daily cases on a seven day rolling average. You can see the top peak that has now come down dramatically, is new york metro area. That, you can see our concerns about chicago. And our concern and the yellow line of the washington, d. C. Area. These are two areas that went through their logarithmic phase,nd are now at a high plateau with an unchanging number of cases day over day. That is the orange line and the yellow line. You can see the daily case numbers per one her thousand are 100,000 are below the yellow line and the orange line of washington, d. C. And chicago. That is new york, boston and many others. 100,dence is also up per 000. When we look at it like that we can understand it, in relation to population. The other groups that have low levels which once have a piece a peek, this is detroit. This is boston. That had a peak. And you see atlanta and miami. Recently there have been publications about where the world was before we started to stop the spread and before many states shut down. To take you back to that moment, on march 14, before stop the spread, this is showing new york. I did not put march 14 on there because new york on march 14 had less than 50 cases reported. Chicago had less than 10. Washington had less than 10. Los angeles had less than 20. That had a significant number of cases was the washington state, which had 100 cases. On march 14, we had 500 cases in the United States. Hotspot, butatic the majority of cases in the hotspot of the moment was washington state. The new york metro area, including northern new jersey and northern pennsylvania and parts of connecticut and rhode island, and the dramatic decline had in the number of cases. Also mortality has started to decrease in the northern new jersey and new york area. I wanted you to see how we bring this information together on a daily basis. The redline in this graphic are the emergency room visits. Line is that test positive. It is erratic because of the reporting of when cases sometimes from the entire weekend are added on a monday morning. Then you can see the actual case numbers in the black bars. That is how we bring everything together. What we want to see is all of the items trending down. We want to see the number of positives you find, because we have states now looking for nonsymptomatically is. We want to make sure that asymp tomatic cases and symptomatic cases are declining. That emergency room visits arctic lining in that case numbers are declining emergency visits and case numbers are declining. And the mortality is declining. This is the washington area. You can see there has not been that dramatic decline in the blue line or in the black bars of cases. And there has not been a dramatic decline in the emergency room visits with covid illnesses. Even though washington, d. C. Has her main closed and l. A. Has made closed and chicago has are made closed, we see these ongoing cases. Isave asked cdc and cdc working with the local areas in chicago and this area and l. A. , to understand where are these new cases coming from . And what do we need to do to prevent them in the future . Again, to show, you going up and to the high plateau and that has been persistent. Angeles, see you can get a flavor of what we have concerns. Were cities have remained closed and metros have remained close but still have persistent high numbers of cases. I want to talk to about outbreaks. There has been a large part of america that has in many states been fighting there outbreaks, containing us outbreaks by testing everyone, and doing contact tracing. And stopping them. Stopping those outbreaks in their tracks. What we have been talking about everyone being able to do across the United States. This illustrates the counties with a hundred percent increase in new cases over the last feud three days. Oute more and more graphics there that talk about cases going up versus cases going down. To give you an example of , and many have wyoming has a red state with cases going up. Wyoming three days ago had five cases and yesterday had nine. So they qualify almost an show up as this large increase. It is a good alert for us and we immediately look to see what is happening at the state website. But you can see when you have very low numbers of cases you can have a doubling, from five 100 cases, and show up as increase. So each has to be investigated separately to really understand what this is. It is the way we find outbreaks in prisons and the way we have been finding out brixon Nursing Homes. Finding outbreaks in Nursing Homes. This is one states. Analysis the analysis by one state. They have never defined their outbreaks, containing there brakes and close the outbreaks to closed cases. The dark blue is community spread. 50 of their cases have been coming from outbreaks they have been able to contain. The largest groups and this is meatpacking plants. They have been going in and it testing 100 of the individuals in the meatpacking plants, and also finding one that percent of the individuals associated with those individuals in the meatpacking plant. They have been able to go into group housing, social gatherings. As we discussed this and when you go out for this weekend, memorial day and you want to do some kind of social gathering, it is important to maintain that six feet distance and to have your mask with you in case a sixfoot difference cannot distance cannot be maintained. It also talks about longterm care facilities. 50 of their total cases since they have been tracking, came from these outbreaks. And 76 of their mortality came from these outbreaks. This is why we have been pushing in the original open up america again, in the testing blueprint, we talk about proactive surveillance. Proactive monitoring and a testing in testing in areas you know are susceptible to outbreaks. Every state has this knowledge now, and this type of analysis. Kinds ofhey have these analysis we ask them to proactively go and attach everyone in meatpacking plants. And testtively go everyone in meatpacking plants. And to follow up with workers and everything a longterm care facility. Tics is to find the asymptoma cases. Yesterday cdc released it was 35 and we started with the knowledge we thought was 11 to 15 based on the experience with one of the princesses. Now we know it is at least 35 and maybe greater than that. It may be so age dependent that there may be a lot of people under 30 that have the virus at our setting the virus and are not aware they have the virus. Who are shedding the virus. Proactive testing will become absolutely critical to find these asymptomatic cases. This is my last slide, to show you what an outbreak looks like. If you look at this access it is normalized to 100,000 population. You can see, this is what we want to see, very low case numbers and that they have identified an outbreak and tested 100 and they have contain 100 and then they do not find anymore cases. This is what is happening across the country, county by county. This is a county map. To show you the work that is going on. In the last two months we have gone from less than 4000 contact tracers to 50,000 contact tracers. This is what it has been happening behind the scenes. I want to applaud the governors ended states and the Health Commissioners and the local Health Departments who have really been working quietly, in an unassuming way, to really find these cases. To track these cases, isolate these cases, and ensure there is no additional spread. In many of these instances, they have gone two weeks without any additional spread. So this is what we are hoping goes across the United States. We all have to admit it is going to be more difficult in metro areas, because you have to really identify where are those asymptomatic cases and how you find them . That is why there has been a lot of Additional Resources going into this advantaged areas and to the federal community clinics, two proactively to proactively test for the virus and find asymptomatic individuals. When someone gets sick with covid19, you have heard the cases. Some of them have very high fevers so they are not out walking around. They may have been shedding virus for onetwo days, before they got significantly ill and had to be in bed because they felt so terrible. Soy were maybe out two days. If they are 50 of the cases, they are only out for two of the days they may be spreading virus. Individual whoc does not know that they have covid, they may be spreading and shutting the entire time that they are in the community. Shedding. Instead of two days and maybe it may be seven days. 35 of those who are asymptomatic and out in the community is much more opportunity for transmission, then someone who is getting sick and is only out in the community for two days. We know that we have to find both and we have been working with states about what proactive surveillance will look like, to find people who are a symptomatically. Who are asymptomatic. It is also why we recommend to the public clearly that we cannot tell who is infected so you have to continue to social distance. That is why you need to continue to maintain six feet apart. I remember in the early days of hiv, people told me all the time that they knew who was infected, and i would say you do not know who was infected. I could be infected. You are just saying you do not think i am infected because i look healthy. There are a lot of Healthy People that look healthy with covid. So we are asking continuously for you to be outside and enjoy your memorial day weekend, to play golf, to hike, as dr. Fauci said, to play tennis with marked balls, and to be out with your families in the household with and to consider sharing social distance space, as long as you have utensils that belong to individuals, and that maybe can be thrown out immediately. I know you can do this. I know the American People can do this. Please, as you go out this weekend, understand that you can be outside and you can play golf , and you can play tennis with marked balls. You can go to the beaches if you stay six feet apart. But remember that is your space. And that is the space you need to protect to ensure you are social distancing for others. Thank you. Dr. Birx, could you stay here a moment or two . I believe we have a question about Nursing Homes and testing . Week, two weeks ago, you and the Vice President said you want 100 of nursing home residents and staff tested within two weeks. Most states are not going to meet that so two weeks later how do you respond about this and are you disappointed in what are the conseq