California Gov. Gavin Newsom COVID-19 Press Conference Transcript November 23

Gov. Gavin Newsom: (04:14) ... others is to recognize that just because you got a test, that's episodic and the disease itself works in ways that require subsequent tests and we'll look forward to making public all of those tests over the course of the next many days. Certainly, over the course of the next number of weeks. I wanted to update you though on the last few weeks here as it relates to our COVID response. It goes without saying, and we updated you last week by noting that the week prior, and this is extended to this week as well, we've seen an unprecedented number and new rise in cases here in the state of California related to COVID. Obviously, this extends all across the United States and many parts of the world. We're not immune here in the state of California. You'll see on this slide, today's COVID case numbers. 8,337 cases in our latest report. This is on a basis of 220,000+ tests that were conducted. Just interestingly, we had a record number of tests that we collected on Saturday. Over 265,000 tests. I've said this many, many times. I'll repeat it again this afternoon: We are not ashamed or shy about testing, nor determining those that are positive. It's fundamental, it's foundational in our COVID response. And as one would expect, the more people we test, and testing is increasing, we expect to see these case numbers go up. Gov. Gavin Newsom: (05:45) But as always, in a moment, we'll focus on the essential importance of positivity rates. Again, the number of people that are tested that test positive. None the less, that 8,337 number appears relatively small compared to that seven day average. Always look at the seven and 14 day averages. That seven day average getting close to now 12,000 cases. We've simply not seen this since the beginning of the pandemic. That said, the number of people that are testing positive, the number of new cases in the state of California, the age cohort is something I wanted to highlight today. Gov. Gavin Newsom: (06:23) It's younger than 50 year olds. It's the 18 to 49 age cohort that's now representing 60% of all of our new cases. Back to the mythology that somehow this disease separates itself exclusively by age or vulnerabilities that are defined by preexisting conditions and the like. It transcends. It impacts all populations. Of course, not equally in terms of its ultimate impact. But none the less, the case numbers impact age cohorts across the spectrum. As you can see in this chart, disproportionately now are impacting 18 to 49 year olds. You'll hear from Dr. Galley in just a moment. He could talk more specifically about why he thinks that is the case. Common sense would dictate the why. But none the less, Dr. Galley will talk more substantively in more detailed terms about that. Gov. Gavin Newsom: (07:20) Back to positivity rate. As you can see here, the total average number of cases that we're bringing in each and every day is getting close to 200,000. I mentioned the 220, 000 yesterday. The 265,000 on Saturday. 240,000 on Friday. Those case rates are going up. More testing, but also more testing is occurring across the spectrum, across the state, and that is a very good thing. Averaging now over a seven day period, a little over 198,000 tests. You'll see a notation that the seven day positivity rate in the United States of America is approaching 10%. It's been around 9.8 to 10% in the last week. Gov. Gavin Newsom: (08:05) The state of California, you'll see in the lower right of this slide, our 14 day, not seven day positivity rate. This slide, we want to be consistent with previous slides [inaudible 00:08:16] but our 14 day positivity rate is at 5.5%. Our seven day positivity rate is at 5.8%. Seven day, 9.8% national positivity rate. Seven day California positivity rate, substantially lower at 5.8%. 14 day at 5.5%. Let's take a look though at that 14 day positivity rate. Just last week, when I updated you in the slide presentation, we were at 4.6% positivity rate. So, you see the rate of increase growing and that's the cause of obvious concern and the cause for some of the recent announcements that we've made in this state. I'll remind you of some of those announcements in a moment. Gov. Gavin Newsom: (09:03) But first, I just want to extend as we do, an understanding of where we are at this exact moment, not just as it relates to positivity rates and case rates, but always hospitalizations. A focus on hospitalizations and ICUs. Foundational when these numbers go back up, how prepared are we in our healthcare delivery system. You can see here from this slide, over the 14 day period, a 77% increase in hospitalizations. But take a look at this and this chart, hopefully familiar with many of you. Last week, we were at 5% of our healthcare system capacity, represented with people that have tested positive for COVID-19. It's 7% this week. 5% last week, 7% this week of the entire healthcare system capacity represented with COVID-19 positive patients. Gov. Gavin Newsom: (09:57) Not dissimilarly, as always, we experience an increase rate of growth, of hospitalizations, we'll expect the same with ICU admissions. We are seeing a 55% increase. A little more modest than that 77% on the hospitalization side. But none the less, 55% increase in ICU admissions over a two week period related to those that need and seek critical care. That critical care capacity last week was 17% of all of our ICU patients representing COVID-19 positive patients. Today, that ... 13% rather, is now 17%. So, up to 7% hospital capacity, 17% in our ICU capacity. Gov. Gavin Newsom: (10:49) I'll remind everyone, this slide we socialized last week. I'll remind you again this week and likely over the course of the next number of weeks, what we're doing to prepare outside our ICU critical care capacity and our traditional healthcare system capacity. We have 11 surge facilities that we have pre positioned all throughout the state of California. What we refer to as warm status. Porterville, Fairview, the Arco Arena up here in the Sacramento county area. Representing close to 2,000 beds that we can turn on and provide critical care capacity outside the healthcare delivery system within 24 hours, as long as 96 hours. None of these beds are currently occupied, it just gives you a sense of what we are prepared for if indeed we continue to see these trends extend for weeks and weeks, perhaps for many, many months. Gov. Gavin Newsom: (11:49) Again, we have not just been sitting on our hands. We have not been sitting back idly. We have been preparing for this winter. Quite literally, not just figuratively. Accordingly, and you'll see at the bottom of this slide, the represented sample of some of the PPE that we put in our cache, in our storage facilities. This is what the state of California currently has. Well over half a billion units of surgical masks, procedure masks, N95 masks, also face shields and gowns. In addition, of course, the healthcare delivery system, the hospitals, clinics, they have tens of millions, hundreds of millions more units of PPE themselves. This is just the backup that we have accrued over the course of many, many months when we boldly went to procure large scale PPE that we were able to draw down and address the past acuity of crisis and now prepare to move into the winter months. Gov. Gavin Newsom: (12:49) We, as I noted a moment ago, have done a number of things over the last few weeks, again, not to sit back idly. Not just in terms of preparing for the medium term and the longer term, but also addressing the recent increase in case rates and positivity rates. We refer to it as a limited stay at home order; just looking at the essential nature in these purple tiered counties. I'll go to those purple tiers in a moment. Exclusively in the purple tier counties, Dr. Galley announced a few days ago, on Friday, that we want to limit nonessential activities past 10:00 PM. The purpose of that is self evident, that people that are staying out congregating, mixing late, late at night, in those counties where you have a substantial amount of community spread, background rate of spread represented again in that purple tier specifically, we want to limit as much of that activity as possible. Gov. Gavin Newsom: (13:48) There is a lot of exemptions, and by the way, those that want to inquire what those exemptions are and our strategies in thinking around that, go to the covid19.ca.gov website, covid19.ca.gov website and learn more about what represents essential versus nonessential activities. Again, we want to extend this for a four week period and this is effective through 12-21. We're hoping that's all we'll need, but we'll see. We're open minded to the dynamics of this changing ... well, the conditions that are changing in real time. But that's the current hope and expectation, is a four week modification to that stay at home related to these non essential activities. Gov. Gavin Newsom: (14:36) Well, there's the specifics on the status of these tiers, I'll remind you that we updated our tiered status a little early last week. We traditionally do this every Tuesday. We did it last Monday, planned what we refer to as this emergency break, 40 counties moved backwards not forwards into more restrictive, not less restrictive tiers. I'll remind you we have four tiers. The most restrictive being the purple tier, the less restrictive red, least restrictive two tiers, the orange tier and the yellow tier. Unfortunately, now moving because of the rate and spread of this disease now to 41 of our 58 counties in that purple tier. With that, we also, last week or previous week, prior to the stay at home modifications announced the travel advisory, Dr. Galley will talk a little bit more about that in a moment when he updates you around holiday planning and our thinking and our encouragement and guidelines, at least recommendations around this thanksgiving week. Gov. Gavin Newsom: (15:40) But travel advisory was one of those that we put out a number of weeks back to, again, discourage nonessential travel. Not mandating, but discouraging it, reminding folks when they come back into the state, the importance of doing exactly what I'm doing as it relates to quarantining and making sure you get tested and avail yourself to thinking more locally in terms of trying to regionalize and trying to organize a construct to minimize the amount of spread outside of jurisdictions outside of regions. Again, I hesitate, but then again I don't. Repetition, as my coach used to say, is the mother of skill. So, let me repeat the original three-pronged strategy, now adding to the fourth prong, the vaccination. But the approach we've taken from the beginning of this pandemic, the three prong around prevention, testing, and this notion of quarantining and isolating. Gov. Gavin Newsom: (16:36) You'll recall the prevention strategies included California leading as the first state to do a statewide stay at home order. We moved forward a few months later with a state mask mandate. That's 600+ million mask units that have been distributed already. Again, this is not including what we have in storage that I referenced a moment ago. Of course, this 12th week, now 13th week almost of this tiered status that we put into effect. Testing has improved substantially since the beginning of this pandemic, represented in those 198,000 tests that we have improved upon recently. Forgive me, that's tea that I drank a moment ago that's got in my throat, nothing more. Of course, the substantial rate of increase [inaudible 00:17:30] gotten in terms of the testing [inaudible 00:17:31] to test a little over 22 million people. Gov. Gavin Newsom: (17:34) Again, not where we need to be per capita. I recognize that. That was all part and parcel of that PerkinElmer partnership and our commitment to substantially, again, continue to increase our testing capacity and our ability to get testing results in that window of 24 to 48 hours. The isolation we wanted to make easier through job protection and paid sick leave. Again, all the work that we've done that we've highlighted pretty consistently here to help agriculture workers, farm workers, homeless individuals, and others to provide supports. We're still about 95% of people, plus or minus, this number changes on a weekly basis, but plus or minus 95% of people that are testing positive that report in the local health officers, local jurisdictions working with some of the support coming from the state of California are contacting and beginning to do some of the tracing that is required at this moment within a 24 hour period. Gov. Gavin Newsom: (18:37) But again, let's talk about that fourth leg of the stool. That's what's on our minds. The vaccines. Now made more ... well, more focused today with the advent of potential third manufacturer of a vaccine that will be entering into the market. We expect on a weekly basis, maybe monthly basis, and eventually on a daily basis, more and more manufacturers to enter into this vaccine place. But I wanted to remind you all on where we've been on the vaccine. I wanted to disclose and provide more information. Basically, take the veil off of some of the work that we have been doing as it relates to our response plan, our vaccine planning. We've announced on multiple occasions, some of the work that we did as it relates to our micro planning, working as one of five jurisdictions with the federal government, working with the CDC and the department of defense on organizing our vaccination planning. Gov. Gavin Newsom: (19:40) We did so because of California's scale, our expertise, the incredible resource that we have here, human resource, and other physical resource we have for logistics and distribution. But perhaps more important than anything else, just the question of scale as it relates to our response plan. You'll recall the CDC put out their playbook in September. One- Gov. Gavin Newsom: (20:03) CDC put out their playbook in September. One month later, we put out our vaccination plan and we provided it to the CDC. The mass vaccination efforts come with experience in mind, and that's the work that we're doing at scale to vaccinate people through our annual flu vaccinations. The experience that we accrued and learned fro H1N1, Hepatitis A and others, we're building off an existing infrastructure at the state and local level, and a history of well organized partnerships that have been developed at all levels all across the state of California. I say this because I want folks to know we're not starting from scratch. There's a sense, and I watched some of the punditry on the national media, that this is something unprecedented, it's an unparalleled. It is and it isn't. Gov. Gavin Newsom: (20:59) I mean, at the end of the day just consider the fact that we provide, on an annual basis already, 19 million flu vaccinations. Those doses are administered within 90 to 120 days every single calendar year. This on top of the tens of millions of routine vaccinations that are administered on a yearly basis all throughout the state of California. I don't want to overstate this, but I don't want to understate that this is an area that we have developed strong relationships, strong partnerships. We're not starting from scratch when we start to get our arms around vaccination distribution and vaccination planning. We're really building off this very rich experience and contemporary engagement as it relates to what we do already on an annual basis related to vaccinations, not least of which the flu vaccination, but also just traditional vaccinations that all of us as parents are very, very familiar with. Gov. Gavin Newsom: (21:58) Again, those are being administered in settings that are also very familiar to individuals, these clinical settings, and have been proven in terms of building trust with partnerships with local health officers. And again, with H1N1 experience, we have more contemporary experience on something that was a little abnormal that allows us to learn some lessons in terms of that distribution plan. By the way, I'm not naive. The H1N1 didn't require as much masking, didn't require as much physical distancing, didn't require as much PPE as our current planning protocols require, but nonetheless provided enormous amount of clues and examples that have allowed us to build a framework for our efforts and for our prioritizations. Gov. Gavin Newsom: (22:45) I'll remind everybody that the first traunch of vaccinations with Pfizer and Moderna and AstraZeneca, which we'll talk about just in a moment, will be extraordinarily limited. So we begin with a framework of scarcity. And as a consequence, we've been thinking through for many, many months, not just many weeks, but many, many months of making sure that we are aligned with the nation's leading ethniticians of sorts, forgive, I'm making up a word, but ethicists, as it relates to prioritization, as it relates to the federal guidance that's already been put out in broad strokes, and the work that the National Academy of Sciences has put out. We've been informed by world's experts, not just national experts on what the prioritization planning should be like. Gov. Gavin Newsom: (23:33) And so we have put out, and we put this out a few weeks ago, what we refer to as our phase one prioritizations. And it shouldn't surprise anybody that the phase one vaccination distribution plan in terms of prioritization is focusing first and foremost on our healthcare workers, these truly essential workers that are now experiencing even more stress after months and months of intense stress. Not only have they been on this marathon now, we're all on this sprint to a vaccine, and we're being called on to do now more than ever after this exhausting nine to 10 months. So we are prioritizing those healthcare workers. We're also prioritizing individuals in congregate care settings, those that are medically vulnerable, skilled nursing facilities, residential care facilities, assisted living facilities and the like, and of course our first responders and other critical infrastructure where we're making sure we're protecting those that are protecting the most vulnerable and the majority of California. So that's phase one of our planning. Gov. Gavin Newsom: (24:37) Let's get underneath that a little bit more and talk about the announcement today of AstraZeneca and about their third possible vaccine, may not have the same level of efficacy that the Pfizer, Moderna had, but nonetheless, encouraging news. We are waiting for this likely FDA approval of at least one or more of these vaccines to occur in a number of weeks. We're currently calendaring, but these calendars have changed in the past, but we're currently calendering early December. So for the planning purposes, we're anticipating that FDA approval in early December, and that hopefully will be Pfizer and Moderna, And we'll see what happens to AstraZeneca and any subsequent announcements that may follow suit thereafter, shortly thereafter. But I want to remind everybody that mass vaccination and the distribution available, a mass vaccinations, is unlikely to occur anytime soon. For the back of the envelope purposes, March, April, May, June, July, where we start to scale and we start getting into the subsequent phases, phase two, and phase three and prioritizations. I'll talk more about that in a moment as well. Gov. Gavin Newsom: (25:53) I want to remind you of some of the things that we have socialized in previous announcements. I'll remind you again of where we are on those critical efforts. One of the most important is scientific safety review committee that we put together, put together not only as a state, but in partnership with Governor Inslee and governor Brown in Oregon and Washington state. They are joining our efforts and that safety review working group has been working hard, and I'll let you know what they've been up to in a moment. We also created this drafting guidelines work group, which is around not just safety and efficacy of the vaccine, but those priorities and developing those phases and making sure that we are meeting the moment by providing for those that are most in need, most acute, most precious in terms of their importance in those congregate facilities of healthcare workers, making sure we're getting those vaccines in an equitable and timely manner out first. Gov. Gavin Newsom: (26:51) But in order to do that, we also have this advisory committee. So it's three committees, safety review committee, this prioritization drafting work group committee, and that committee will report to an advisory committee made up of non-profits, others that I'll talk about in a moment, that will help make sure that that work group on the drafting guidelines work group, the prioritizations are truly being done with that equity lens. We are just being stubborn on that because we're committed to getting that right. We don't want that to be a platitude. We want to drive real deliverable in that space. And again, that's why this advisory vaccine committee is so important. But let me break down a little bit of where we are in these three committees briefly, and then I'll turn it over to Dr. Galley, and of course, we're here to answer any questions that anyone may have on this. Gov. Gavin Newsom: (27:44) On the scientific safety review committee, they have reviewed phase one and phase two data. They've already reviewed that and they have no concerns so far. They are looking forward to gain and being able to access the phase three data when the FDA and the CDC receives that information. And we will expedite that review within 24 hours to avoid any delay. I just want to mitigate any concern that the creation of the seismic safety review in any way, shape or form will delay the access and distribution of the vaccine. It's about building trust, building capacity and partnership, and it's about moving as quickly and efficiently as possible to just have another set of eyes on these phase three data after reviewing phase one and two on phase three data, as it becomes available. Gov. Gavin Newsom: (28:42) I'll remind you on the guidelines working group that they've been meeting consistently over the last three weeks, every Friday. I think the last meeting was over three hours. They've averaged over three plus hours. That's neither here nor there except to say it's a very dynamic engaged group. And we have a really remarkable diverse group of individuals that are contributing their time and energy to make sure we get things right. They are the ones responsible for that phase one plan. But we break out phase one in phase one A, and phase one A again is targeting those 2.4 million healthcare workers. Now we're not naive. The ability to do what we hope we can do in phase one A will be limited based upon the availability, the doses of the first traunch of vaccines. There is some concern that we will not have, even when you combine the contributions of Moderna and Pfizer, the ability, depending on doses, and it just depends, to provide all phase one A distribution, or at least access to the distribution of those vaccines. Gov. Gavin Newsom: (29:56) And that's why this work group is breaking this down in more detail, in more specificity. It's not just a plan to identify 2.4 million people. We're breaking down a subset of who those 2.4 million healthcare workers are and breaking that down into subsets, and then providing not only a plan, but beginning to socialize that plan with our community advisory work group and making sure that we make that plan available to you, not just to me, but to all of us in this state. And I'll talk about where we will provide that information, where it will reside, and when we think that will happen. But know that the current planning for phase one A is being done. It's well along the way and will be provided to our community advisory committee as soon as the end of this month. Gov. Gavin Newsom: (30:55) The planning for phase two and three, that framework requires more time, more deliberation. And based upon where the targeted vaccination availability is, we believe it's best to roll out the beginning to mid-January. This community advisory committee, as I mentioned, and you see a sense of who they are, community groups, school leaders, school leaders, any vaccination plan has to also provide prioritization and will in those subsequent phases to our critical staff, our teachers, paraprofessionals, and make available as parents want to our kids in order to prioritize getting our schools reopened in a safe manner. But that's why we include school leaders in this advisory committee, and we have others on that committee that will also provide guidance and feedbacks to that work group. And again, we expect they'll have that first traunch recommendation as early as the end of the month, December 1st. Gov. Gavin Newsom: (32:00) We also then we'll make it available on the COVID19.ca.gov website. The goal is to have this website available, the portal, for everybody to be able to access information of when their accessing opportunities present themselves. So as we review, as we sign off on these drafts, we make them final. We'll get them up as soon as we possibly can, again, on the COVID19. ca.gov website. Gov. Gavin Newsom: (32:32) I want to go back just briefly now to Pfizer and McKesson. And you say Pfizer and McKesson, why not Pfizer and Moderna? Well, here's an interesting fact that not everybody has been privy to. Some of the reported it, others have not. Pfizer has one distribution strategy. Moderna has a separate and distinct distribution strategy. So we're working to tailor two approaches in terms of basically parallel and supportive strategies for both Pfizer and Moderna. Pfizer is doing direct provider distribution based upon a pre-existing network of well-established groups, clinics, hospital settings, plans, and the like. Moderna is working with an intermediary, McKesson. McKesson is well-known to Californians, used to be a California based headquarter company, used to be a San Francisco based headquarter company. They're at scale and they're the intermediary we're working directly with that's working with Moderna on their distribution plan. Gov. Gavin Newsom: (33:44) ut remember, they're not sending the vaccines to the state for the state to redistribute these vaccines. They're sending these vaccines directly to providers. So let's take a look at what that means. Well, we know with Pfizer, that means that the vaccine that they have requires these ultra low temperatures, these temperatures that make distribution, transportation of the vaccine, particularly challenging. These require these ULT freezers. They require some dry ice accessibility that can be made more challenging in rural parts of the state, more remote parts of the state. And that's why we currently are working to substitute, not substitute dare I say to supplement, forgive me, to supplement the efforts that Pfizer is advancing with their providers by providing additional supports. And we've identified the need to purchase and procure some 16 ultra low temperature freezers, to provide transport containers, and this is the most challenging particularly with Pfizer, the most challenging issue with their unique vaccine as a state backup plan. Gov. Gavin Newsom: (35:04) And then 61 smaller freezers that we will pre-distribute. We've identified regions and locations across the state. We're going to amplify with more detail and specificity the exact locations, but we have regions we've identified throughout the state. You think Mono County, you think Siskiyou, you think parts of the state where it's more challenging, more difficult, where Pfizer may not have the traditional provider network, we have got to supplement and support to get these vaccines out, or even within dense urban environments to make sure again, an equity lens is our focus. And that's why these smaller freezers and these other transport containers are also part of our planning and our current procurement strategy. Gov. Gavin Newsom: (35:49) Moderna, again, doesn't require these ultra low freezers and they're more easily stored, more easily transported. So getting two different strategies, two different plans. People have asked, well, how do you pay for all this? Seeing some governors say, "Well, we just don't have the money." And oftentimes that leaves people wondering, well, what the heck does that mean? Are they just giving up? Are they just waiting for the Biden administration to come in to office? We're not waiting for anything. We'll be creative. We'll find the resources. We maintain a resourceful mindset. We obviously need more support from the federal government, particularly as we get into phase two and three, but for the purposes of phase one planning, I want folks to know what is represented here in this slide. Gov. Gavin Newsom: (36:33) To date, the CDC has provided the state of California $28 million for our vaccine distribution. $10 million has gone for planning to our local health jurisdictions. $6 million will go for staffing. Staffing remains, for us, the top focus and priority. $28 million is simply inadequate. We've received 16 or rather distributed 16. We're hoping to receive the rest and distribute the rest. But the commitment total is $28 million. Again, second round of funding needs to be substantially greater. And we have worked very closely. We've brought this up on many, many occasions, no greater partnership than Speaker Nancy Pelosi working very collaboratively with her, working with minority leader and other California represented McCarthy, working with our California delegation, and working with the transition team, including Vice President-elect Kamala Harris, to make sure that we are getting our asks in. And we're being more specific on what those asks may look like as it relates to getting new CARES Act money or more specific targeted funding for vaccine distributions. Gov. Gavin Newsom: (37:48) But again, we're not just sitting on our hands. That's what we need. That's what we've receive from the federal government. That's what we need more from the federal government. Still, the state also looking to work with the legislature. We are collectively working with the legislature, and we will be submitting to the legislature, a new budget. I'm working on the state budget for the next fiscal year. We'll be submitting that budget in January with more detailed, specific prescriptive asks for support, for concurrence with the legislature. We'll try to draw as many dollars as we can from the federal government down, and then we look forward to the next stimulus. But we're not going to wait for that next stimulus to keep the momentum and do what we need to do to get these vaccines out. Gov. Gavin Newsom: (38:37) And that includes, by the way, a public awareness and media campaign. That's tens of millions of dollars. We're developing the PSAs. That's a multifaceted effort, not just traditional TV broadcast, broadcast radio, but more culturally competent messaging and messengers that are trusted messengers and diverse communities to develop. Again, trust vaccine will be distributed at the speed of trust and develop some momentum as these vaccines become available so people know when, where, and how to access these vaccines. Gov. Gavin Newsom: (39:10) Supplies remain perhaps the most costly of all of the requests that we have made of the federal government, PPE and the like. That's tens of millions plus plus plus. I'll remind you, H1N1 didn't require the masking, didn't require the PPE that this distribution plan will require, the physical distancing, all of that will require sanitation and protocols that will indeed be costly. And we need to supplement what our providers are getting in terms of their support and make sure that we are hitting that issue head on. Of course data, and we can talk for hours and hours about large-scale procurement of IT, the state, and we are turning the page on some of those efforts. And we have a lot more to say on that topic in the next months, and certainly next year's budget but- Gov. Gavin Newsom: (40:03) ... more to say on that topic in the next months and certainly next year's budget, but the issue of IT in data management is critical, and I'll just end on this and pass it over to Dr. Ghaly, because I think it's important because it's always been a stubborn point of concern as it relates to anything we do at scale and our ability for existing systems to manage at the scale of a pandemic. I'll remind you that there are two IT strategies. You have the interface with the public, which is our current California immunization registry. It's an existing platform called the Care System. That's already in place. It's a relatively, relatively good system, but it's not good enough, we believe, to address all of the needs in the state. That's why we have been going through an advanced procurement process. We're looking as early as the next 10 days to get a finalist signed off to do an end-to-end IT strategy. Gov. Gavin Newsom: (40:58) That's why you see in this slide, two phases of IT development both as early as December 1st and January, but also it's critical that we lock in with our providers, and that's the clinics and the hospitals, et cetera, the distribution that eventually will be out into many of the pharmacies in the state that we have provider registration, reporting, tracking, ordering. All of that needs to feed into our state system and not just that direct interface with users through the Care System. So all of that we've been working on, all of that is nearing critical decision-making in the next few weeks and in the next few months. So that's an update on where we are on vaccinations. We are making real progress. I'm very proud of the teams we have preassembled. We're not reacting to this moment. We've leaned into it. Gov. Gavin Newsom: (41:54) We've been proactive, and in closing, before I turn it over to Dr. Ghaly, we also are blessed to be supported by the new COVID advisory committee that Vice President-elect, now President rather Elect Joe Biden has organized that included who is, by the way, one of our scientific safety review committee members that the president-elect took to be part of the national advisory committee. This in addition to those other Californians that are also on that national advisory committee, so we're very blessed to have strong relationships with the current administration vis-a-vis this vaccination strategy, and even stronger still with the incoming administration. Gov. Gavin Newsom: (42:37) But with that, I want to now turn it over to Dr. Ghaly and talk about incoming, and that is the number of inquiries that he has received around gatherings for Thanksgiving and the likelihood that we will see an increase in spread of transmissions as we see more and more mixing and what we are doing to prepare for that. Some of the messaging that predates today on the travel advisories and some of the issues related to that 10:00 to 5:00 AM non-essential activities that will lead into being more safe and working our way through this holiday season. With that, Dr. Ghaly. Dr. Ghaly: (43:15) Great. Thank you, Governor, and thank you all for tuning in. Governor, you as always did a tremendous job explaining where we are on what is a really hopeful topic, which is vaccinations. California is preparing, has been preparing and is ready to work with our local partners, our federal partners, to make sure that vaccines, which are really weeks away for some populations, are ready, and we use it as the important tool that they are. But now more than ever with that hopeful news, it's important that we keep our guard up and we keep doing the things that we've been talking about over the last many months. It's not that there's a promise that everyone will get the vaccine in the first few months of the year, but some of our most vulnerable individuals, those who are working on the front lines of our hospitals that are exposed almost every day to COVID-19 will be protected. Dr. Ghaly: (44:21) That's great news for our communities, and it tells me and tells us that the dependence on continuing to keep our guard up, we can make it. We can do this as a state, and we've done it before and we need to continue doing that. With this Thanksgiving holiday coming up, it's an important week to emphasize all of those protective factors. The governor mentioned on an earlier slide that just 60% of our cases or a full 60% of our cases are among those 19 to 49 years old, so a vast majority of the cases or those who we test who are infected are in that age category yet they make up only 7% of those who have the worst outcome in death in this state. So let me say that again. 60% of the cases, yet only 7% of our deaths. Dr. Ghaly: (45:20) The real story in that is where are all the deaths happening, and that is because although it's only 10% of our cases for those over the age of 65, a full 75% of California's deaths have been in that older age group. So what does it mean for our traditional Thanksgiving celebrations or celebrations in the many weeks to come when we bring together many generations for traditions and celebration and a great time together? That those younger individuals who many are not sick or not very sick, not sick at all. They're the asymptomatic or presymptomatic individuals, folks who will never need to go into an urgent care center or an emergency room or be admitted, that they are exactly the individuals. We are the individuals who can spread COVID-19 to our older family members, our older friends, our own older loved ones, and in that risk, we need to just be very careful. Dr. Ghaly: (46:23) We know that our hospitals already are seeing levels of surge that they've never seen before, even at the height of our June and July peak of cases. We now have hospitals across the state that are telling us that their census, the number of people with COVID-19 in their hospitals is higher than it's ever been, and we know that cases are still rising and that the overall average number of cases over a seven-day period is a lot higher than what it used to be. So what that means is we need to do our part. We need to help stop the spread and recognize that the days to come are really important what our decisions are. Dr. Ghaly: (47:04) I've had countless conversations with friends and family, but a lot of Californians who've reached out and said, "We've decided to change what our Thanksgiving meal looks like. Instead of doing it later in the day, we're going to move it up. We're going to try to move it outside to catch a little bit of the warmer weather." Thankfully, it looks like we'll have some sun on that day. There are some options even at this day, just a few days ahead, to change that plan and maybe do something slightly differently. So we know that this is all part of stopping the spread, doing our part, and hopefully helping get California through the next many weeks, as we anticipate parts of our communities getting the vaccine. Next slide. Dr. Ghaly: (47:51) So the clearest guidance is celebrate with your own household. There's lots of ways to connect with those that you love. I know that we're going to be Zooming with loved ones, my mom, in particular a lot of the day on Thursday. Traditionally, she'd come and visit us and be with our family, but we're going to keep it safe and Zoom and interact with her that way. Of course, we know that some people are not able to prepare a meal, and maybe that's the urge to gather with them, but there's other ways to support those individuals, to make that connection dropping off a meal, and then sharing it when you Zoom together. These are all options that give us opportunities to lower our risk, lower the risk of others, but hopefully still have that important connection that we all look forward to during these upcoming holidays. Dr. Ghaly: (48:47) So as we end every time and before I kick it back over to the governor and open it up for questions, just remind you of these four basic things. Even as I put it up, I really want to push forward this idea that, yeah, you've heard wear the mask, and many of you are tired of wearing it, but we ask you as much as he can to keep it on. We put out the guidance. We let you know how and where to use your mask, but it's really a choice that each of us has to make, and not just make in the morning but something we have to make throughout the day. Physically distance. That's an important thing. Hard to do when we're keeping our distance from loved ones, but all the more important now. Washing our hands and minimizing the mixing, and this really comes back to in the days to come keeping it with our households and reaching out to loved ones in a different way than we normally do. So with that, look forward to the questions, and, Governor, back to you. Gov. Gavin Newsom: (49:53) Great. Thank you. Thank you. Of course, now we're happy to take any questions. Speaker 1: (50:09) The messenger has been compromised since we last saw you [crosstalk 00:50:14]. Gov. Gavin Newsom: (50:12) I'm assuming the silence means we're having a bit of technical difficulties, and so look forward to figuring that out. Dr. Ghaly, just because the awkward silence, maybe I'll just ask you as we figure out the calls, question about the issue of travel advisory, what that means vis-a-vis Thanksgiving. Obviously, so much of the national attention has been focused on airports and people traveling all across this country, coming back into the state of California after traveling and other parts of the country. Perhaps you can give us a sense of your reason we put out that advisory and your concerns in that space. Dr. Ghaly: (51:05) Yeah. Thanks, Governor, and like many other parts of the nation, we're concerned about people traveling during the holiday season, that they go and they're in an environment maybe where transmission rates are much, much higher. Much of the country's experiencing higher rates of transmission than California, and visiting even just a few friends, keeping it short and coming back, just those travels expose you to a level of COVID-19 that as you come back into the state, we're really encouraging you to do what you're doing, Governor, which is quarantine. Make sure that you weren't infected, that you don't end up inadvertently passing it on to other members of your community, and we can keep the spread low. So we know that even across the state, we're asking you to keep as local as you can. Don't travel beyond just a couple of few hours from your home so that you can also keep the spread down in our state. Dr. Ghaly: (52:05) That isn't an unusual thing. A lot of states have pushed travel advisories, travel restrictions, and we're among those and have done it with our partners around the West Coast to make sure that we all keep ourselves protected, keep transmission as low as possible. It makes a key difference, that 14 days that people come in, a lot of folks are looking at that closely, making sure that it's the right amount of time. For now, that's what we understand to be the incubation period, the time by which somebody might be exposed and by the time they're no longer infectious. So that's why we have that 14-day number as well, Governor. Gov. Gavin Newsom: (52:47) Doctor, last week, and sort of anticipating a question as we figure this out, you announced on Friday this non-essential recommendation. People past 10:00 PM to 5:00 AM for non essential activities, and on Monday basically implied that we were not only looking at it, but that we were looking at the studies, the efficacy of these efforts around the world. I think you referred to three specific studies last Monday that we had reviewed that you had provided your team and reviewed, et cetera, the work that was done in Virginia relating to alcohol consumption, Massachusetts, other parts of the country that have limited versions, including many cities, not just states. Maybe you can give folks that may not have tuned in Friday an overview of what the thinking was in terms of that recommendation and why you think it's important at this stage. Dr. Ghaly: (53:38) Sure. I think, I mean, two very important ones. One is, really, we want to continue to communicate and provide information to all of Californians that where we are right now is different than where we were before. We're in a point of surge that we have to take out all of the tools in our toolbox and apply them here, and it is in part a symbol and a message to all of our public that what we're facing every little bit matters. I was asked why is it the 10:00 to 5:00 that's special? One reporter said, "Can COVID tell time?" And I said handily, "No." Of course, there's no reason why between 10:00 and 5:00 AM doing the exact same things done at 10:00 in the morning that COVID will behave any differently. Dr. Ghaly: (54:32) But what we do know, and what you alluded to is that oftentimes during that time period, nonessential gatherings, non-essential coming together really does happen without the best protective tools. People take off their masks. They come a little closer than they should. They celebrate and do certain things that allow transmission to go pretty quickly. I say that COVID goes from zero to 60 in no time, and that happens when all those protective factors are down. So this is a tool for us across California and our purple counties that are facing the worst of our surge to be additive with all the other tools that we have. We hope and we're looking closely at our data to see if that begins to turn the tide on these impressive case numbers, and hopefully in time to keep our hospitals in good shape so we can continue to provide care to those who need it and who are sick. Gov. Gavin Newsom: (55:35) And before we open up the questions, and it looks like we finally figured that out, I just want to just ask you one additional question in anticipation. It's a question that's been brought up a number of times, and we made the point last week that we were putting this emergency brake on as it relates to our tiered status, rather than waiting till traditional Tuesday announcement. Your Tuesday at noon announcement on new tiers we moved on Monday. We made the point that we will in real time continue to assess if we were going to move tiers based upon the epidemiology, based upon the spread. On Friday, there was a review. You made the determination that we were not moving forward. Just preview a little bit tomorrow, you will be making announcements updating based upon the data that we're getting this weekend. Maybe you can just preview a little bit about what you expect to be saying tomorrow. Dr. Ghaly: (56:30) Yeah. So thanks, Governor. Yes, so just to reiterate, we did, as you promised, looked at the data at the end of last week and ran it like we do every week, and indeed no additional counties made tier movements, so we didn't. We agreed that if a County needed to move, we would move them quickly so that we could begin to stem the tide on the surge in those areas. Tomorrow, we anticipate that there will be some tier movement, handful of counties likely moving to a more restrictive tier, and maybe even a county or two that are showing that they are getting containment on the virus and potentially meeting that one week mark to move forward. Dr. Ghaly: (57:11) So again, a mixed picture across California. We are always looking at the data, trying to be as current as we can, and we report it as such, and we treat counties as such. You have said that California shouldn't be treated in the aggregate, that we have regions, we have counties, we have differences between the Northern and the Southern parts of our state, the inland and the coastal. Indeed, that's what we see with all of these numbers. So tomorrow we will have an update on our tier status and more specifics tomorrow at noon. Gov. Gavin Newsom: (57:43) Excellent. Happy now to answer any questions. Speaker 1: (57:45) Sophia Bollag with Sacramento Bee. Sophia Bollag: (57:50) Hi, Governor. Can you hear me? Gov. Gavin Newsom: (57:50) Perfectly. Sophia Bollag: (58:00) Great. I'm going to go ahead and ask the question that my colleague, Adam Beam of the AP tried to ask. We can hear him on the line, but it sounds like you couldn't. He wanted to know if you have lost credibility after photos circulated of you at the birthday party earlier this month. You weren't wearing a mask in those photos, and yet you were talking very closely with other people. Can you speak to that and tell us what precautions you were taking at that party? You said you had taken precautions, but it was not clear that that was happening in those photos. Gov. Gavin Newsom: (58:34) Yeah. No, I made a mistake. I apologized. We had a 4:00 dinner in an orange tiered County. We're not telling people they can't eat, but indeed I made a mistake being with a few extra people beyond the guidelines that I've been promoting, which is outside the household. So that was a mistake, and I let my guard down and I apologize for it, and we're moving to correct that in terms of working hard, working harder every single day. Never made that mistake before. I haven't made it since, and I won't make it again. Period. Full stop. Speaker 1: (59:10) Emily Hoven, Cal Matters. Emily Hoven: (59:16) Hi, Governor. As you know, the state controller, Betty Yee, has been saying for months that the secretary of state's office doesn't have budgetary authority to pay for a $35 million contract for this [inaudible 00:59:29]. Do you think the controller should approve payment of the contracts, and do you think it was appropriate for the secretary of state to award such a big contract to a firm involved in Joe Biden's presidential campaign? Gov. Gavin Newsom: (59:43) The controller's perfectly situated. First of all, deep admiration for our controller and her character, her competency and her judgment. The controller's reviewing that. She will make an independent assessment, and I look forward to that review and to her counsel. I will ... Gov. Gavin Newsom: (01:00:03) I look forward to that review and to her counsel. I will happily answer that question after I have the benefit of her review and independent analysis. Speaker 2: (01:00:14) Elex Michaelson, Fox 11. Elex Michaelson: (01:00:17) Thank you governor. First off, nice bookcase. Secondly, I'm wondering, how does this experience for you of quarantining at home maybe change the way you think about this experience that so many Californians have gone through? A follow-up to the question about the curfew, which I appreciate you asking Dr. Ghaly a few moments ago, but I talked on Friday with Dr. Birx at the White House about the science behind curfew. She said she didn't want to second guess your decision, but pointed to Miami, where they get a curfew, and they found that it didn't really work because it drove a lot of people to go to house parties, which ended up spreading the virus more. I'm wondering if you can expand upon the science of the curfew decision and that concern that it might lead to other worst behavior. Gov. Gavin Newsom: (01:01:06) No, and I really appreciate that question. I'll let Dr. Ghaly answer that more specificity. You may recall last Monday, I implied my own hesitancy as it relates to being open to argument, interested in evidence based upon the studies that have been conducted. We have the benefit of three studies, and some show some very positive behavioral changes, others a little more inconclusive. I'm very aware of that in the context of this ongoing debate. We, based upon not only the analysis and review of those studies, but based upon our engagement with our colleagues across this country, how the officers across the country, other governors and their review, based upon all of that, we made the assessment that we wanted to give this a go. Dr. Ghaly could talk more specifically about his independent analysis, not just the analysis that was conducted in those three studies that we were referring to. Dr. Ghaly: (01:02:04) Yeah. Thank you for the question. I'll tell you one of the things that we did, I believe, differently than some other states with a curfew. Remember we called ours a limited stay-at-home because part of the entire approach and concept was not just to ask business sectors to stop operating between those times of 10:00 and 5:00 AM, but also that household gathering shouldn't occur. The guidance isn't just a let's not do it in the businesses, and the restaurants, and the bars, and the other areas, or even outside in the open, and although really difficult to enforce or regulate, the signal and the message is, don't take these same activities indoors because that's exactly where a spread could occur. It was meant to compliment the other affects of curfews from other areas, and enhance it with an additional restriction for the time limited period of about four weeks, 30 days in the purple counties. It was really that one, two punch to try to reduce transmission across our state. Gov. Gavin Newsom: (01:03:21) Yeah. I mean, the bottom line is none of us are ideological about this in the spirit of your question. We are open to argument interested in evidence. We've committed to a four-week process based upon the significant increase in transmission rates. We believe in a more targeted and effective strategy than just going back to a full lockdown in the state of California, based upon where we are today. That was the determination. We're leaning into that, and we will be very cognizant of its cause and effect. We are very, very open about it, not stubborn about that analysis and review. That said, let me answer the first part of your question. Clearly, anyone that's prone to be with their kids, isolated or quarantined, for many, many days, it is a very challenging and trying time. It's certainly something that is now been brought home quite literally in terms of my own experience, just over the course of the last couple of days. Gov. Gavin Newsom: (01:04:26) That said, I have deep empathy and respect for people that don't have the support, so people that are in my position that don't have the resources. The people in my position, and those that are struggling. I can't even imagine being a day away from work, or a day or two away from loved ones that need to be in their care. At the same time, we are encouraging them to isolate and quarantine. That's why we have put out many, many different supports over the course of many, many months, either through executive order and/or the leadership that demonstrably was exampled by the legislature this year, that they provided in terms of providing economic stipends, providing additional supports and protections, legal and otherwise, and why it's absolutely essential that as we move forward, not just as a state, but as a nation, that the federal government wake up and recognize this moment. We can simply no longer wait for a new stimulus. Gov. Gavin Newsom: (01:05:24) Days are becoming weeks, weeks becoming months. We are at peril at the end of this calendar year, putting people's lives quite literally at risk, the economy, much, much more harm, and families in positions that would be much more vulnerable. All of that is brought in clear unambiguous focus as it relates to one's personal experience, but also recognizing the experience that millions of Americans have, hundreds of thousands that are struggling in even more dire and difficult circumstances. Speaker 2: (01:06:01) John Myers, LA Times. John Myers: (01:06:04) Thank you, Governor. Can you hear me clearly before I begin? Gov. Gavin Newsom: (01:06:09) Yes, I can. John Myers: (01:06:09) Governor, can you hear me? Gov. Gavin Newsom: (01:06:10) Yes. John Myers: (01:06:12) Okay. Thank you very much. I just wanted to check because we don't have the ability to do follow-up questions for this. I wanted to know because the beginning of your presentation was muted. We could not hear it. If you talk about what's going on with your family, can you talk about that? Here's what I'd like to have you focus on if you could. If you could tell us what your family knew and when they knew it. Give us a little bit more information about when did you have information about the CHP officer who had tested positive. Are there additional officers in that team who tested positive? Then also, trying to understand the universe that your family operates in. You mentioned that other families are not as fortunate, but could we understand the sense of, for lack of a better term, the pod that your family lives in? Do you have other support people, house cleaners, or childcare assistants that help with your children? Are you considering sending the children back to school when they're done, or does this give you second thought if one of your children was exposed by a classmate? Gov. Gavin Newsom: (01:07:08) Yeah. The school made that decision independently, and they have paused, so that was determined by the school itself. As it relates to my three children that were exposed, it was a CHP officer, and they were exposed. A four-year-old was exposed first, so forgive me, I don't have the ability to acquire when he knew and how he knew it because of his age. All of them below the age of 11 years old. When we discovered, or rather we were told of the positive case, and the fact that the CHP officer was in close contact with those three kids, we immediately went through the process of protocols and reviews that are well-established by the state, and also went to greater lengths to get more specificity about local guidelines as well, to make sure that we were abiding by those as well. Gov. Gavin Newsom: (01:08:01) We chose to wait based upon the review, or rather based upon the recommendation of a local health officer, and in my case, folks that work on our team. They were required, well, they were encouraged rather, not required, that we wait 48 hours to be tested because they didn't want a false sense of negative test to come in. We tested officially yesterday after we discovered this on Friday. Friday, waited until Sunday to be tested. Test results came back late on Sunday. Came back negative. We officially started the quarantine clock on Sunday though it was informal through the weekend. Gov. Gavin Newsom: (01:08:44) As it relates to the house, I'm blessed because we have many rooms. I'm able to do this without kids jumping on top of me. I'm in an office. I can assure you, this is the first time I've ever had an office. I used a smaller room and an office that was used for many other things in the past. That's a blessing. I recognize that many people don't even have the ability to do what I'm doing right here. That's number one. Number two, no one else is in the household. We have someone that has been with us that comes from overseas. She's been living with us for many, many months. She's part of the pod. That's it. She was tested. Tested negative as well. Speaker 2: (01:09:27) Jeremy White, Politico. Jeremy White: (01:09:30) Thank you so much for taking my question. I would like to first quickly follow up on John's question and to get any more detail on when your children came into contact with the infected officer, was he driving them somewhere, et cetera. I hate to be the reporter, just a few questions, but it's been a couple weeks now since the judge issued an injunction telling you to no longer alter state law with executive orders, I'm hoping you can tell us about what that injunction if it is upheld it might be for your ability to deal with the pandemic through executive action. Gov. Gavin Newsom: (01:10:00) Yeah, well, we are appealing that decision, and it will be adjudicated by the appellate court. We're confident in our legal standing and legal position, it's foundational in terms of governing a state in a time of crisis. It's a profoundly important decision that will ultimately be made through the deliberative process and independent judication by the California court of appeals, or at least the appellate level and based upon their jurisdiction. That said, it's relates to the impact. Yes, the officer was in close contact with three of our kids, not one of our kids, three of our kids, and based upon the fact that we're in close contact, and they tested positive. When we learned that, we went through a series of protocols that I just laid out and gave to John. Those protocols led to test all family members including my youngest, a four-year-old, which was an episode itself, just trying to encourage a four-year-old to sit and get tested with nasal swab. Gov. Gavin Newsom: (01:11:05) Fortunately, all of us in the household, currently in this household, all tested negative. We will do subsequent tests, and we will abide by not just state guidelines, but the county guidelines as well. That quarantine process began this weekend and will continue for 14 days. Speaker 2: (01:11:26) Final question, Ashley Zavala, Nexstar Media Group. Ashley Zavala: (01:11:32) Hi Governor, I did want to ask just a couple of simple questions about your quarantine. One, how are you feeling? Two, have you been tested today? I know your communications office said that you'd be tested every day, and I just wanted to see if that test came back negative. Gov. Gavin Newsom: (01:11:46) No. Well, I've been tested a lot in the last few weeks, on multiple occasions the last few weeks. I feel perfectly healthy. I tested negative yesterday, and I have no expectation that I'll test any differently in subsequent days as we abide by these quarantine protocols. We'll let you know as we get these subsequent tests, the extent you're interested, but currently those last, well, we've never had a positive test. I've been tested many, many times. I was stubborn, you may recall, in the beginning of this pandemic. I did not get tested for many, many months. I made it clear as to why I made that determination because so many others were not afforded that privilege. I wasn't going to extend it. Now, with the availability of much more testing, more widespread testing, and the fact, you may recall, that I visited prisons. Gov. Gavin Newsom: (01:12:39) I felt upon me at that point to begin the testing protocols, and we've had fairly consistent tests. Not just the PCR tests, those are the ones that are the tests we make public, but also these antigen tests, which I've taken on many occasions as well. I don't have as much confidence, candidly, in those results. We always have the backup PCR tests, which are foundational PCR tests, the ones the entire family took yesterday. PCR tests was what I took the previous week as well, and on multiple previous occasions. We'll continue to do all of that and more. We'll continue also to keep you and others informed on what we're doing and where we're going. I want to acknowledge those that may have inquired about where we are on Senate choice picks, that that determination has not yet been made, but progress has been made in terms of getting closer to that determination. Gov. Gavin Newsom: (01:13:36) There's no timeline that we have advanced or considered. Obviously, we'll need to get it done before Vice-President Elect Kamala Harris is sworn in as the next vice president of the United States, but that process continues. We continue to work very, very hard on the budget. Those of you that may have had a question in the queue about the budget, I am very aware, and we've been working overtime, including over the course of this last week in particular, to work to get this budget done, which has to be at least to the printers in the middle of December. Cognizant and mindful of the myriad of needs throughout the state of California, but none more important than public health and economic recovery, the needs of our small business men and women all up and down the state of California. I said that last week, and I'd be remiss of not repeating that today. You'll hear me repeat that over and over and over again. Gov. Gavin Newsom: (01:14:36) I am deeply mindful with 41 counties in these purple restrictive tiers, the impact that's had on small businesses, in particular, and all of the uncertainty around a new PPP, distinguished from PPE, as it relates to small business supports, which must be a top priority of a new Cares Act, a new stimulus in this country. We're going to do what we can to do more for our small businesses in this state. That is a top priority with the budget team. It will be a top priority, I know, with the California legislature, based upon the conversations we've had. I'm grateful that they recognize that imperative as well. Public health, public safety, continue to monitor these counties and the transmission rates in real time. Gov. Gavin Newsom: (01:15:21) We will maintain our engagement, not only with you on a consistent basis, but tomorrow, just further incidence of that, Dr. Ghaly will be updating on the tiered status. We will likely be making additional announcements through the week and into next week. This virus does not take holidays off. Quite the contrary. Take care everybody. Thank you for tuning in at least to this rather unusual, but increasingly familiar setting here at home. Take care.