President. County terry, administer. South, the doctor here at the Medical Center. We will have interesting talks. Thank you for being here. We will go over some things we are doing in terms of covid response. Our mission focuses on protecting vulnerable, expanding testing. We are doing that. Yesterday, 95,000 tests. Today, over 80,000 tests. Taiwan has done 78,000 tests the entire pandemic, 23 million people. We are doing a lot of testing. Practicing social distancing. Supporting hospital and health care workers. Today,updates on things hospitals throughout florida will be getting additional shipments of therapeutic remdesivir, something a lot of physicians have been using. We got positive responses. Developed andtic given in emergency use authorization by fda. We are scheduled to get more later in the month. There was a need to expedite that. President ith the vice and secretary a czar to get that expedited secretary azar to get that expedited. Today and be obtained hopefully we will be able to needs. Patients we have 1000 Contract Personnel deployed around the state to offer support for services undertaken, longterm care covid only facilities, some of them supporting normal medical operations, some may be supporting testing. When we talk to people around state, particularly hospital systems, a lot of it is making sure there is enough personnel. Covid is laborintensive. There are a lot of procedures in terms of isolation. They have personnel involved in testing. Those who come into the hospital and people who are participating in drivethrough or walkup test sites. Personnel is significant. Were doing a lot of that. If you look at kind of where we have been now with testing, you know, when we started out, the tests were very scarce nationwide. Florida had more results in one day yesterday than the country did as a whole and the beginning of march. In the beginning of march. We had a 10 point a Positivity Rate, in0. 8 positivity may. We had a good stretch from the end of april through june 13, where we were 5. 1 or under, sometimes we were at 3 in terms of positivity. Expanded, positivity was manageable. You have more cases. That is what you would expect. Rate,00,000 people at 3 you will get more cases than if you test 100,000 people at that. When we started to see more cases, yes, we have been testing more last three weeks by far than we had before, but you see 620 , positivity goes up to 9. 6 , next week in june, 12 , then 14. 8 , for the last part of june getting of july beginning of july. 5 . Days, quote 12. 5 . Seen areas consistently 20 range, like miamidade. Humanity, 10 the last two days. Manatee, 10 the last two days. Sarasota is reporting 5. 2 of tests positive. Yesterday was 9. 5 . I think some of the folks here will attest we may be seeing decline in this part of the tampa bay area. Some other areas, north, like pascoe, you may be seeing more positivity. This is something we are looking at seriously. We will get test results. We will be over 400,000 tests easily the week so that is a huge amount tests and a lot of obviouslytivity rate, going to be some prevalence, in the single digits, that is something much more manageable. We increased from the end of june into july. It has been plateaued the last two weeks which is a good sign. We would rather be plateaued at 4 but we did not want to see it continue to go up. We have tested 2. 4 million people. That is one for every nine people in florida. Interesting to see what other things have been tested at this level in our country, in modern times but this is something as a whole, the country has done tests. Obviously florida, we are doing a lot, particularly in the last however many weeks since demand has been i. If you look at where cases have been coming from, a lot of cases 15 and 54, between which as you can see, those are not the groups producing significant fatalities. You dont under 55, have significant comorbidities, the tally rate is incredibly low. Mortality rate is incredibly low. Of, those are where the bulk the case fatalities are in terms of those who are positive cases. A lot of that is Nursing Homes. I will talk about that. 65 and up agese group are at increased risk and we are continuing to advise to limit close contact outside the home and to avoid crowds as much as possible. This is a dramatic picture of showing how this virus operates and who tends to bear the brunt when they get infected. If we were going back six weeks, it would not have been anything special on this map in terms of how many tests there have been positive tests but that has been a dramatic increase in terms of the number of positive cases in that age group. Part away now, they are the number one age cohort, 25 to 34yearolds. If you look to see each individual age, still 21 is the number one age that has the most cases. Absent of significant comorbidity, is likely to be asymptomatic or mild illness. When we look at cases, i know people like to talk, it gets reported, but when cases are reported to the state, that is a positive test that could have been taken seven days ago. There are all these companies. They report. When that occurred is not even clear. Infection may have occurred two weeks ago when a test gets reported to a state from a private lab. One of the things you look at is ok, i can get a certain amount of results reported today, next week, all kind of ways you can look at that, all kind of ways data may not always come in, in a coherent fashion. Visitsu look at ed because they have influenza or covid like illnesses, that is evidence of what is going on. The more people doing that, you know, the more prevalence you have. If you look at what we have seen in the last few weeks, throughout may, it was flat. Statewide, under 500 visits per day. Peopletate of 21 million influenzalike illness, 250 or below, pretty much four weeks and as we got into june it was still low. As we get into the third week of june, 614, it goes up. We start to see more visits. The following week, it escalates. At the end of june, it escalated more than 2000 ed visits per day. Going to the ed doesnt mean you will be admitted to the hospital but youre showing up and if you are symptomatically, they are testing you. We have seen statewide this start to trend down but look at a couple days and sometimes that can be more noise than signal. We want to look at that. We will talk about here, the ed visits have skewed younger, 35yearold range, which obviously, is a different kind of clinical cohort then 55 and up. That is verye disruptive in terms of what were doing or what is going on in florida. Protecting the vulnerable, you see the fatalities skew 65 and really 75 when you think about it. This is something that is a priority. Given that you see more prevalence of this in the Community Today than we did, say, middle may, it is important for those in at risk groups to avoid crowds and minimize close contact with people they do not live with. We are in a multigenerational living arrangement, there are risks with that. We have seen that in different parts of florida where you have multigenerational housing, crowded housing, more outbreaks, but obviously, there is only so much you can do. We understand that. There is the risk in the 65 and up category. Underlying conditions, obviously, if you are 65 or up, elevated risk. Really, any age with some of these conditions, you need to take similar steps and avoid crowds, minimize close contact outside the home. One of the things, when you have ones under 65 or 50, the that have things like diabetes, morbid obesity, those of the ones that typically have a harder time with coronavirus. Understand that. Take whatever precautions you can. We talked before coming out here about longterm care facilities, really a significant component of this, when, when we started this in march, we knew the Nursing Homes were going to be ground zero because you have the most vulnerable population there. We did things like prohibiting visitors, we havent had visitors in Nursing Homes since midmarch. That is tougher people. We feared you would see more introduction of the virus if you allowed that. We prohibited hospitals from discharging covid positive patients back into Nursing Homes. When that was done in other states, that really had negative consequences. We felt that was the better course of action. Masks, sentppe, n95 10 Million Masks plus to longterm care facilities, face shields, gowns, gloves, all that. We provided ppe because we understood that was important to minimize spread in facilities. We also understood as we got into april that even with doing all those precautions, you still have it get in with a staff member maybe not wearing ppe right, maybe it was not as effective as you wanted it to be, so you can see cases. We sent the National Guard to do testing in Nursing Homes because we understood we needed to identify cases before they could spread like wildfire. We understood there was need for folks, if you test positive and you are a resident of a longterm care facility, you had to be isolated appropriately so you did not spread it to other residents. Some of these facilities, they are just not set up to do appropriate isolation. We said, transfer those folks. Some of that was saying to hospitals, basically just boarding, because they are medically stable but we felt that was probably not the best use of hospital resources if we could help it. Covidestablished 13 dedicated nursing facilities in the state. These are facilities, all the patients are covid positive. If you have somebody who tests positive in a nursing home in Manatee County, you can send them to one of these places. We are working on a couple more facilities. This way they can be isolated and not spread it into their home facilities. We started the miamidade care center last week. We think that will be filled, probably within a couple days. Florida,rs in South Central florida, we are working on the tampa bay area. They have dealt with a lot of nursing home outbreaks. That has been concerning. While care is good, we want to see if there is ways to expand that. This is an important tool to protect residents of longterm care facilities who are the most ifable but also someone is stable or a symptomatically, having a place where they can go where they will not infect other people and they can be cared for. I want to thank the secretary for working hard on that. We talk about the new facilities and the additional beds we are bringing on every day. Important, this is here in Manatee County, they have had, as of yesterday or this morning, 138 covid related deaths, 91 of them related to longterm care facilities. Fatalitiesna related linked to longterm facilities. But 55 anding 65 residents of these facilities. Sarasota county, close by, 100 fatalities, 65 of them related to residents of longterm facilities. 65 . This is a significant. Part of this fight. Social distancing. We have a much better idea now than in march about what the virus likes and does not like. Closed spaces and you are seeing a lot of this activity throughout the sunbelt, some people have said it is because when it is hot, people would rather be inside in enclosed ac spaces. The point is, if you are in an area where you have a crowd of people endorsed, in a party or something, their conditioning, it is going to be a better vector for transmission. No doubt about it. Most people get infected from family members or friends. That will be a good vector. The outdoor transmission has not been as significant. Sunshine, pete and humidity are your friends heat and humidity are your friends when it comes to this virus, which does not like it and would prefer to be in enclosed environments. Big crowds provide more risk. Close contact, sustained, with people, you dont even need to sneeze or cough, at this point. If you are talking and you are there for a long time really the social distancing is significant. If you maintain appropriate distancing, you are not going to probably infect anyone or get infected. Facial covering, if you cannot do that, there is a way to mitigate the particles you may cough or sneeze or talk with and could reduce transmission. If you are not in a situation where you can avoid the three cs or appropriately social distance, wearing a Face Covering will help you. Low risk versus highrisk. This is well documented at this point. When we talked about flattening the curve in march, part of the main reason was to make sure hospitals could cope with whatever happens in terms of effects of the virus and in march, this was a very new virus. We kind of knew in january it was out there. They were testing people as they came back from asia. Almost all of them were negative throughout february. There was much more widespread than we thought. The testing criteria was limited. There were problems with ppe, testing, all these issues. Wheree are in a situation we have a lot of test sites around florida, the hospitals are testing. You have private companies testing. Are testing. In march it was difficult to figure out how to test. Now it is easier, which is a good thing for people. We have drivethru sites, walk up sites, all kinds of ways people can test. Federal government did three sites into ball county, 3000 tests per day, they will not do it for very long. They are moving around the country doing different things. That has been good. We have three Antibody Testing three Antibody Testing at drivethru sites, marlins stadium, jacksonville, at the jaguar stadium, Orlando Convention center and the West Palm Beach site where the spring training site is. If youre not symptomatic and you think you may have gotten this, Antibody Testing may be better because if you got it one month ago, you most likely have antibodies. At least you will know you have it. You could have been infected one month ago, still positive, even though you would no longer be infected. Take advantage of the antibody. It is not as easy as the ppr because it is a blood draw and it takes more time but you get the results in 15 minutes and it is instructive because it if you have antibodies, it is important to know. The ppe situation has improved. We speak with hospitals every day. Ppeve not heard anyone say is an issue anymore. There is a huge amount of ppe, particularly in the longterm facilities and around the state. That is significant. The remdesivir. We did not have any of that in march. We now have remdesivir. We are using dexamethasone steroids. Some of the doctors say that has been good. Convalescence has gotten good reviews. These are now tools in the toolbox that if someone comes in, they can be treated for this and hopefully improve their success. Reagents;sue is Lab Chemicals involved when you test. The problem is, the u. S. Is testing more on a daily basis than any country by far and the Lab Resources are backed up. Some of these turnaround times, supposed to be 48 hours, some of the big commercial labs are running four days behind that. Some of the supplies are starting to run low. I am working with the white house to get some more reagents down. Ive spoken to a number of hospitals who are concerned about this. Part of the reason we are testing asymptomatic and healthy people, those numbers add up quickly. Is yousequence of that have seen supplies dwindle across the country. The lab reagents are something we are really concerned about and we are thinking about. I mentioned before and hopefully we will announce at the beginning of the week, we are sensitive to getting test results back as quickly as possible. When we did our contracts to the private labs, they were guaranteeing 48 hour turnaround. That is just not in the cards anywhere in the country. We have some companies that have the ability for us to do swab say 36 tof swab, they 72 hours, that is what we are doing with longterm care testing. Once we tested the residents of facilities, we tested the staff, we said ok, going forward, we need to test the staff every two weeks. If they are a symptomatically, they bring it in and infect, it can spread in these facilities and we have seen that happen. We have an arrangement where we do these tests every two weeks. So far, they sent in 130,000 tests, 6000 results. For staffivity rate and longterm facilities, which is surprising, because you see the prevalence in other parts of the state. Some places are at 20 prevalence. With ppr testing. 2. 8 , that was quite frankly a surprise, a good sign. We are getting in 190,000, roughly, test results every two weeks just from staff at longterm facilities. This has been a good model. We want to try to figure out how to get people results back as quickly as possible. We are focusing that unsystematic people. Most people coming to test dont have symptoms, they just want to know if they have it. If someone has symptoms, we are dedicating drivethrough lanes for those people, then, having them do the self swab, and Companies May be able to turn it around quicker. That would really make a difference. The thing about testing the a symptomatic people was ok, if you are a symptomatic, you can spread it, get tested, then you can isolate. The problem is you dont get results back for seven days. What are you supposed to do . People are just isolating . Most people are not doing that. It makes sense in theory but given resources with commercial labs and Contact Tracing, if you are a symptomatic and you get results in seven days, that will be harder than to go back and Contact Tracing who you are with two weeks ago. It is different if you get a quick result and you can say, two days ago i was here. Because ofng down the massive amount testing being done on a daily basis. That is not just in florida, that is nationwide. I want to thank everyone for coming. We will pass it around. Folks can make comments. We will have a discussion. We will open it to questions. Bill, the floor is yours. Thank you very much, governor. Welcome. Manatee county, we really appreciate you being here. Here atu for having us Blake Medical Center this morning. I remember clearly, several months ago, we were in session and you, governor, called me, bill, we have our first recorded cases of covid19 in florida. One of those is here in Manatee County. Began. We tried to navigate what has been a changing landscape, a onelenging landscape but that is very serious and has chan