The Medical Center for hosting, randy curran, ceo of the Medical Center and also my friend, bill, for being here. We have representative robinson, dr. Chari, Florida Division president. I want to thank him for being here. We have sherry, county administer. We have dr. South, the doctor here at the Medical Center. We will have interesting talks. Thank you for being here. Cal 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. Of course, our mission focuses on protecting vulnerable, expanding testing. We are doing that. Yesterday, 95,000 tests. Today, over 80,000 tests. Put that in perspective. Taiwan has done 78,000 tests the pandemic, and there are 23 Million People. We are doing a lot of testing. Practicing social distancing. Supporting hospital and Health Care Workers. A couple updates on things today, hospitals throughout florida will be getting additional shipments of therapeutic remdesivir, something a lot of physicians have been using. We got positive responses. That is a new therapeutic developed and given in emergency use authorization by fda. We are scheduled to get more later in the month. There was a need to expedite that. I worked with the Vice President and secretary azar to get that expedited. He said there would not be a gap in treatment. Today and thatve will be a lot of vials and hopefully we will be able to serve patients needs. We have 1000 Contract Personnel who will be deployed around the state to offer support for services undertaken. Some of it will be 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. Obviously 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 test results in one day yesterday than the country did as a whole in the beginning of march. Positivity rate in may. That went down. 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. As testing expanded, positivity was manageable. You have more cases. That is what you would expect. If you test 200,000 people at 3 rate, 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 that 6. 2 , positivity goes up to 9. 6 , next week in june, 12 , then 14. 8 , for the last part of june, beginning of july. This week so far did take down a little bit. Last two days, about 12. 5 . We have seen areas consistently 20 range, like miamidade. Here in manatee, 10 the last two days. Majority of new cases have been under the age of 45 sarasota is. 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 some 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 very 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 it is positivity rate, obviously going to be some prevalence, in prevalence, but if it gets into 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 a lot of tests. Obviously florida, we are doing a lot, particularly in the last however many weeks since demand has been high. If you look at where cases have been coming from, a lot of cases are in that between 15 and 54, which as you can see, those are not the groups producing significant fatalities. If you are under 55, you dont have significant comorbidities, the mortality rate is incredibly low. Plus, and plus, 85 and those are where the bulk of the case fatalities are in terms of those who are positive cases. A lot of that is Nursing Homes. We will talk about that in a minute. We believe those 65 and up age 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. 25 to 34, 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. If you look, far and 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. Obviously, 21, 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 it. When that infection 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. When you look at ed visits , people showing up to the 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, we were under 500 visits per day. For a state of 21 Million People influenzalike illness, 250 or below, pretty much four weeks and as we got into june it was still low. You start to see it inch up as , we get into the third week of june, 614. 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 symptomatic, 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 continue 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 dramatic surveillance and looking to see that is very 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, in the middle of it is may, 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 lead to 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, you have an 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 folks under 65 or 50, the ones that have things like diabetes, morbid obesity, those of the ones that typically have a harder time with coronavirus. Just understand that. Take whatever precautions you can. We talked before coming out here about longterm care facilities, a 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 the middle of march. That is a tough thing for 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. We required ppe, n95 masks, sent we sent 10 Million Masks plus two lawncare facilities, face shields and gloves. We required them to use ppe, but we provided it because we understood that was important to minimize its spread. We also understood as we started to get into april, even with doing all those precautions, you have it get in with a staff member. The ppe righting or it was not as effective. You would see cases. We sent the National Guard to do testing because we understood we needed to identify cases before they could spread like wildfire. We understood there was a need for some of these folks, if you test positive, you had to be isolated appropriately so you did not spread it to other residents. Some of these Nursing Homes and longterm care facilities, they are not set up to do appropriate isolation. We said you need to transfer those folks. Some of that was to the hospital where they are boarding because they are medically stable. We felt that was not the best use of hospital resources. So we have established 13 covid dedicated nursing facilities. Of theiracilities, all patients are covid positive. If you have somebody that tests them to, you can send charlotte. We are working on bringing on a couple more of these facilities. This way they are able to be isolated. And not spread it into their home facility. Miamidade care center last week. We think that is going to be filled within a couple of days. We have a number of south florida and central florida. Tampa bay, they have dealt with a lot of nursing home outbreaks. That has been a concern. So while this carrington place wegood, we want to see if can expand the footprint. This is an important tool to protect residents that are vulnerable. If someone is stable or asymptomatic, having a place where they can go where they are not going to infect other people and they can be cared for. I want to thank the secretary for working on that. We talked about the additional beds we are bringing on every day for this. Just to show why this is important. Yesterdayve had as of 100 38 covid related deaths. Related tohave been longterm care facilities. 56 of the corona related fatalities have been linked to longterm care facilities. Up. Only 65 and and then residents of these facilities. Close by theyve had 100 corona related fatalities. 65 of them related to residents of longterm care facilities. 65 . This is really a significant part of this fight. Distancing. We have a better idea now then in march about what the virus likes and doesnt like. Close close spaces, you see this activity throughout the sunbelt. Some have said when it is hot, people would rather be inside. You are in anf area where you have people indoors, in a party or something. It is going to be a better vector for transmission. Theres no doubt. Homes. Most people get infected from family members or friends. Going toonditioning is be a good vector. The outdoor transmission has not been as significant. The sunshine and heat are generally your friend when it comes to this virus. The virus does not like that. It would preferred to be in the enclosed environment. Crowds provide more risk and close contact. When you are and sustain close contact with people. You dont even need to cough or sneeze. If you are talking repeatedly and you are there for a long time. Veryy social distancing is significant. If you maintain appropriate social distancing, you are not going to get infected. Facial covering, if you cant do some ofu can mitigate the particles that you may cough or sneeze or talk with and could reduce some of the transmission. If you are not in a situation to social distancing, low risk versus high risk. This is pretty well documented at this point. When we talked about flattening the curve in march. The main reason was to make sure the Hospital System could cope with whatever happens in terms of the effects of the coronavirus. In march, this was a new virus. January. F knew in in florida, we were texting people as they came back from asia. Endot our first case at the of february. We now know it was much more widespread than we thought. The testing criteria was limited. Ande was problems with ppe testing. There were all these issues. So now we are in a situation where weve got a lot of test sites. Hospitals are testing. Private companies are testing. Cvs is testing. Difficult towas figure out how to test. Now it is easier, which is a good thing. And we have drivethrough sites, walk up. Weve got all kinds of different ways people can test. The federal government did three sites. 3000 tests per day. They are not going to do it for very long. They are moving around the country. That is good. Antibody testing at five drivethru sites. Two in miami, the hard rock stadium. Marlon stadium. The one in jacksonville at the jaguar stadium. The Orlando Convention center and West Palm Beach at the spring training complex. If you are not symptomatic. You think you may have gotten this, the Antibody Testing may be better. If you got it a month ago, you will pop for the antibodies. You will know you have it. Could havet, you been infected a month ago. Even though you would no longer be infectious. Take advantage of the antibody. It is a blood draw. It takes more time. You get the results in 15 minutes. Its instructive. If you have the antibodies, thats important to know. The ppe situation is improved. We speak with hospitals every day. Ive not had anyone say ppe is an issue. The Florida Department has sent ppe to the longterm care facilities and also around the state. That is very significant. I mentioned remdesivir. We did not have any of that in march. We now have remdesivir. They are using this steroid. Some of the doctors think that is good. The convalescent plasma has good reviews. Tools in the toolbox so if someone comes in, they can be treated. And hopefully improve their success. Another issue we are working on is the lab reagents. The chemicals when you test the stuff. The u. S. Is testing more on a daily basis than any country. Resources are backed up. Some of these turnaround times, some of the commercial labs are running three or four days behind. Some of the supplies are starting to run low. Im working with the white house to get some more reagents for hospitals. I have spoken to a number of them. We are testing a lot of asymptomatic and healthy people. Those numbers add up. The consequence of that is you have seen some of these supplies dwindle across the country. The lab reagents are something we are concerned about and thinking about. Ive mentioned before. Sensitive to getting these results back as quickly as possible. Our contracts, they were guaranteeing 48 hours. In the not in the cards country. For what we see. We do have some companies that have the ability to do self swab test. They can turn it around. They say 3672 hours. That is what were doing with longterm care testing. Residents,t all the we tested the staff. We said Going Forward we need to test staff every two weeks. If they are asymptomatic and they bring it in, it can spread. We have seen that happen. We have an arrangement where we do these tests every two weeks. So far they have sent in 130,000. 86,000 results. Rate2. 8 percent positivity. Which is surprising because if you see the prevalence and other parts of the state, some places are at 15 or 20 . 2. 8, that was somewhat of a surprise. It is a good sign. We are going to get 190,000 test results every two weeks from staff of longterm care facilities. This has been a good model. We want to figure out how we can get people results as quickly as possible. We are focusing on symptomatic people. Most of the people dont necessarily have symptoms. They want to know if they have it. If somebody have symptoms, we are going to dedicate the drivethrough lanes for those people and have them do the self swab test send it to companies to turn it around. That is something that would make a difference. The thing about testing asymptomatic people, you can spread it. Get tested. You can isolate. You dont get your results back for seven days. What are you supposed to do . Most people are doing that. It made sense in theory. Given the resources with what we see with commercial labs, and contact tracing, if you get a result after seven days, it will be harder to Contact Trace who you are with two weeks ago. It is different if you get a quick result and you can say i was here. Are running down because the total amount of testing being done on a daily basis. That is not just in florida. That is nationwide. I want to thank everyone for coming. We are going to pass it around and then we are going to have a discussion and then open it up for questions. The floor is yours. I remember we were together and our firstill, we have recorded cases of covid19 in the state of florida. One of those was in this county. The other was in hillsboro north of here. And so it began. From there we had to navigate what has been a changing landscape and a challenging landscape. Serious and isy going to change the way of our lives and the way we conduct business. I would like to thank you, governor. Youve been very measured and patient in terms of what we have done to respond.