Florida Governor Ron DeSantis COVID-19 Briefing Transcript April 27

Ron DeSantis: (00:10) Well good, good. I guess it's just afternoon, so it's great to be in Tampa. I want to thank John Couris for hosting me. We had a great round table with John and some of his great physicians. I think it's appropriate to say in all the time of all the doom and gloom we've been hearing for weeks on end now, it seems, to be able to come to Hillsborough County and say that of any major County, this is one of the best performing counties, not just in the state of Florida, but probably in the country. Ron DeSantis: (00:44) If you look at, and John, we'll go into what they've seen with their peak and now their decline, but Hillsborough County, a state that has over a million people, right now, total number of people hospitalized for COVID-19 in Hillsborough County as of last night was 35. That's about a half hour in Brooklyn right now, in terms of people going in for hospitalizations. The peak hospitalization in Hillsborough County was 70 on April 8th, and so the current hospitalizations per 100,000 residents in Hillsborough County is 2.5. That is one of the lowest rates you are going to find anywhere. Ron DeSantis: (01:26) And I think that that's a testament to the people here who've done a great job and to folks like we see at Tampa General and some of our other health systems. So my hat's off to you. I think you guys have done a tremendous job and have really shown the way. And you look at some of the things where... We were told just six weeks ago that all the hospitals would be overrun, that people wouldn't be able to get care, and there were a lot of stories being put out about kind of almost the end of the world. People were really, understandably, when you hear that, very, very scared. You remember there was all the discussion about, "People are not going to have a ventilator. They're not going to be able to get the care they need." Ron DeSantis: (02:11) Well, in the state of Florida right now, we have 6408 ventilators that are just simply sitting idle. In fact, the total number of patients we have on ventilators for COVID-19 statewide is about 400 as of last night. So the fact of the matter is people are getting great care by people, like you see at Tampa General, and a lot of those doomsday scenarios have just simply not come to pass. And interesting, we have a state where you have almost 40% of the cases are in one county in Southern Florida, Miami-Dade, and I think they're probably up to close to 12,000 documented infections. They, along with Palm Beach and Broward, they're basically 60% of all the cases. They are more than 60% of hospitalizations, and I think the same with fatalities, but even Miami-Dade, which is the place that's seen the most in Florida, you talk about hospital resources, you talk about hospitals having a capacity and not being overrun. Ron DeSantis: (03:14) Miami-Dade, the available adult ICU beds, as of last night, 45% of their ICU beds are available. This is the part of the state that has seen the most cases. So I think that that's a testament to the fact that you go back six weeks, the predictions were that you'd have... and there were predictions for hundreds of thousands of hospitalizations in the state of Florida. Actually one said 465,000 hospitalizations. Statewide, we have a little bit under 2200 currently right now. But you've seen the hospital system hold up. There's been capacity. That has never been an issue at any time during this. And so I just think it's important for people to know that, and I think it's important for, particularly if you're in Hillsborough County, to look at the numbers and say, "Man, who would have predicted six weeks ago that they would have been able to weather it this well?" So my hat's off to folks. Ron DeSantis: (04:11) We talked a lot, and I'm going to let Dr. Lockwood and John and some of the others go into detail, but we're all very focused on testing. We've, of course, done a lot on testing in the state of Florida. The state has supplied the site that Tampa General runs by Raymond James stadium with swabs and a bunch of supplies, PPE throughout the last six weeks. The good thing is, is that they're able to see a lot of people, patients go through there. They don't always get the full demand, and maybe that means that there's not as many people that are symptomatic. Most of the people that are testing in the state of Florida, overwhelmingly are testing negative, which is a great thing. There's some jurisdictions in the country where you'll have 30, 40, even close to 50% of all test takers will come back positive. Ron DeSantis: (04:59) In Florida, the last, I think, four days, we've had 6%, 5%, 4.5%, and 6%, in terms of all the test results, the percentage of new cases, positive versus negative. And so that's been a downward trend. We were never that high, compared to some other parts of the country, but we've gone from kind of that 10% now down into a 5%-ish, 6% range, which is a good sign. I think Hillsborough County, certainly here, most of the tests they're doing, overwhelmingly are coming back negative. So Florida has done, there've been 357,000 tests reported to the Florida Department of Health thus far, since this endeavor. As I mentioned, South Florida is where the bulk of the cases are. There've been one test result for every 42 people who live in those three counties, and we're, as I said, happy about the positivity rate. Ron DeSantis: (05:56) The drive-through sites that we have, we're going to continue to do. I was talking with Dr. Lockwood, and initially when this started in March, the CDC had very narrow criteria about who could be tested. And just it's important for people to know, those days are gone. That's the past. You have access to testing. If you're somebody that wants to get tested, you have the ability to do it. Clearly, if you have any of the coronavirus symptoms, we would strongly recommend that you come to one of those sites or some other options and get tested. But even if you're somebody that may not have symptoms, maybe someone you know tested positive that you were with previously, you may want to come in. And so we are welcoming people to want to do that. We think it's important, not only for individual's health to know whether they're positive or not, but also for professionals, like we have up here, to understand the prevalence of this throughout the community. Ron DeSantis: (06:50) We're also doing things, and we're doing it in Hillsborough, as well some other counties around the state, the drive-through sites are good. The drive-through sites are convenient for a lot of people. But the fact of the matter is not every person in Florida owns a vehicle. Not every person had access to go to those drive-through sites, so we thought it was important, after we worked with the University of Florida, to do a walkthrough type concept, started at a public housing project in Jacksonville and are now going to different areas throughout Florida which may be underserved. We're getting into communities, offering testing on a walkup basis. Just in the last week and a half, when these have started to be done, they've already done 5000 tests, and we're going to continue to do many more. Ron DeSantis: (07:37) I had a chance to speak with Dr. Burks at the White House this morning about some of the things Florida's doing. She loves our website, loves the Department of Health. But she complimented Florida on, if you look, we publish... The Department of Health publishes the data, demographics, and you get to see different things. You don't see massive disparities on racial or ethnic grounds in Florida. It tracks pretty closely, and you may go up here or there, depending on the situation, but some of these areas is just overwhelmingly out of whack. But I think having some of these types of concepts, where you're getting into communities, particularly communities that may be underserved, will help us prevent seeing it go in that direction like we've seen in some other states. John and I early on, and I think John will talk about this, but we knew how this disease affected the elderly, really from the start. And it was really important to protect the vulnerable here in Florida. Ron DeSantis: (08:35) So we've done that with what we've done with nursing homes, a number of things, between limiting visitors, screening all the staff, requiring PPE, and we've sent a lot of PPE to these nursing homes. But we have emergency response teams. They're now partnering with the Florida National Guard. They're going in offensively, proactively to test in nursing homes because you know, if somebody is symptomatic, they shouldn't be allowed in the nursing home. Unfortunately, there have been cases where sick workers have been able to go. It has caused outbreaks, and you've ended up having residents infected. There's also examples, though, of workers going in, staff going in, who did not have symptoms, but eventually spread it to the staff, and you'd have big outbreaks with the staff and eventually affect the residents. So they're going in testing, and they've already done over 6000 tests, trying to determine proactively whether you see any evidence of an outbreak in a nursing home. Ron DeSantis: (09:36) Those are obviously the most vulnerable parts of our society, and we've seen some of the other places around the country, all the problems that they've had with the nursing homes. I think Florida, because we focused on it, you look at the fatalities per 100,000 connected to longterm care facilities. You have places like New Jersey, New York, Massachusetts, they have 18 to 22 fatalities per 100,000, just from longterm care facilities. Florida is 1.2 fatalities per 100,000 for longterm care. So I think that's shows the emphasis on that was the right emphasis. Ron DeSantis: (10:15) We're also increasing testing capacity, so we have under contract two have these high throughput labs for an additional 18,000 samples per day. And we want to expand even further, and I think it's important, and I think the doctors think it's important, but I will say we currently do not exhaust our capacity just at our drive-through sites. We have the capacity to do more, even without any of these additional lab contracts. And so if people do want to be tested, the capacity's there, particularly at the drive-through sites, so please, please take advantage of that. Ron DeSantis: (10:48) But we did do that because some of the private labs were overwhelmed. When they raised the reimbursement from 50 to 100 dollars per test, some of these other big high throughput labs came online because it was economical for them to do so. And so we've contracted, hopefully, 24 to 48 hour return on those. But then we're also buying our own high throughput machines for our three state labs. That will, just the state labs, you're going to have the private contract 18,000 a day. And then when we get the high throughput, that'll be 10,000 samples a day at the state labs in the state of Florida. Ron DeSantis: (11:22) So that's another option, which will be great. And then we were discussing about allowing Walgreens and CVS, the licensed pharmacists, to be able to administer the test. I've waived all the regulations with that. They are authorized to do it. And so if those companies want to do it and they're willing to, I think that that would be very convenient for a lot of Floridians to be able to have access to that. Ron DeSantis: (11:45) And then we've also talked about the antibody testing and the and the seroprevalence studies. We're going to have our first big shipment of antibody tests on May 1st at the state lab down in Miami, based on what the Surgeon General's estimate. We also have other tests coming in, both from the federal government and some from private companies, but those antibody tests will be very helpful because if you have healthcare workers and they have the antibodies, then you know that they're at lower risk at that point for infection. Ron DeSantis: (12:16) If you are able to do a study about the society as a whole, determine what percentage has antibodies, that gives us a sense of how the virus has moved through a given community. The Miami study that was done suggested that they had, at the time, 10,000 documented cases. And it suggested that the antibodies would probably be about 160,000 people in the community already had the antibodies, and so that would suggest it was more widespread than people thought initially. Also suggests that the hospitalization and fatality rates are much lower than what we have, just based off the documented cases. I think it's important to know in communities throughout Florida the prevalence of antibodies. And then we of course will use it for staff at longterm care facilities because if you do have staff in a nursing home that has the antibodies, then that offers a level of protection for the residents. Ron DeSantis: (13:10) We've sent out a lot of supplies to Tampa, to other places, but particularly we've sent a lot of staff or a lot of supplies to just the longterm care facilities because we want them to wear the PPE. A lot of them don't have the PPE, so the Division of Emergency Management has sent almost seven million mass just to longterm care facilities, almost a million gloves, more than a half a million face shields, and 160,000 gowns. That is a huge amount of supplies, but I think that's directing supplies where the risk is greatest, and I think that that makes a lot of sense that we're doing that. Ron DeSantis: (13:47) Final thing I'd just like to say is, as you look about going forward, I think clearly, folks should see a light at the end of the tunnel for the state of Florida. Now it's not going to be something that a switch is going to be flipped. This is going to be slow and steady wins the race. It's going to be very methodical, very data driven, and there's going to be probably some people that think it's too slow, and I get that. But I think that the country has never gone through anything like this. You go back in 1918, the Spanish flu, they didn't have a national effective secession of a lot of economic activity like that. So this is unchartered territory. We use the data, we use the facts as best we can, but the fact is nobody knows what this will do or that will do. So you go slow, you measure, you go steady, and then you make the best decisions that you can. Ron DeSantis: (14:40) But I can just tell you, if you go back two months, and someone said by the last week in April there would be only 30 people or 35 people hospitalized in Hillsborough County from COVID-19, people would have said, "You're nuts." They would have said, "Hospitals will be packed with with patients, and and there'd be stressed, the system would be breaking down." So the fact that that didn't happen, the fact that we still have capacity, the fact that we have have been able to test and we see the positivity rates declining, that's a good thing, and I think people should be happy with that. So I will turn it over to John. I want to thank you again for having us and floor is yours. John Couris: (15:18) Thank you. Thank you, governor. Before I begin, I would like to thank the governor. He and I have been working on this, as he has been with healthcare executives across the state, from the very beginning. The state and his office and his leadership has been very consistent. It's been thoughtful. It's been measured, and it's been data-driven, which if you're sitting in my seat, is extremely important that we have that type of leadership. John Couris: (15:44) I'd also like to thank secretary Mary Mayhew who has provided lots of resources, has been a wonderful leader through this, has been convening executives and healthcare professionals around the state from the very beginning. And one of the first actions the governor took was to really limit access or shut down access to skilled nursing facilities, which we believe, excuse me, was critical for Tampa General and for all the health systems in the Tampa Bay region. John Couris: (16:20) What I'd like to do today is briefly go over four items with you. I'd like to talk about current trends, our preparedness, some of our regional collaboration, and then finally our readiness to open. When we look at current trends, and we look at the data, we looked at late March, early April is when we peaked at Tampa General Hospital and in the region. We saw a total at that peak of 14 cases. We currently have eight cases in the hospital today. We have had a total of 57 patients. We've admitted, we've recovered 52. We've discharged 50 from Tampa General Hospital. John Couris: (17:08) And so our trends are consistent with what the governor just briefed you all on. Dr. Lockwood will speak after me about some of our testing and some of the things that he's seeing as well. John Couris: (17:20) Our preparedness, we have three COVID units. We have 152 negative pressure rooms with vents. We have COVID teams, critical care teams, hospitalists, infectious disease, our ED teams, our pulmonary critical care, our cardiac COVID teams, along with every specialty has a COVID team that can respond to COVID positive patients that are in the hospital. Our lab testing, we can do 850 tests a day. Currently we've done over 7000 tests with 342 positives, as of this morning. So even though we're not seeing the surge and the peak that some anticipated that- John: (18:03) Even though we're not seeing the surge and the peak that some anticipated that we would see, we will remain, we will have a state of readiness and we'll remain ready to take care of any patients that come in. John: (18:12) Our collaboration, I am very happy to report our collaboration with BayCare, the Advent Health and HCA has been wonderful. The governor mentioned the test site that we are collaborating on at Raymond James and it is a true collaboration between those health systems. John: (18:32) We're also sharing lots of data and lots of information of what's going on in each other's hospital. So if any one hospital were to get overwhelmed and it's great to know that no hospital has gotten overwhelmed, but hospitals could pick up and support each other in the event of a surge or if there was an outbreak in a skilled nursing facility, we would be able to support each other if necessary. John: (19:01) So these collaborations regionally are extremely, extremely important. We are ready to open and I not only speaking for Tampa General Hospital, but probably speaking for every hospital across the state. But I will spend a moment on a few things that we are doing here at TGH and what the public has to realize is we are a safe institution. There's lots of folks that are not coming to the hospital for chest pains or maybe stroke symptoms or other types of things that they should be coming to the hospital for. They need to know that they can come to the hospital and that they're in a safe environment. John: (19:47) So to underscore the safety piece of this, we are testing all patients coming into this institution. We're testing all surgical patients, all procedural patients, and we just completed testing all existing inpatients at this institution. John: (20:07) So we wanted to level set and create a baseline and we want to test all new patients being either admitted into the institution or coming in for an elective procedure so we are ready when the executive order expires on May 8th, we will be up and running on May 11th which is a Monday to start doing elective cases and one thing that we are doing is testing everyone. John: (20:33) We also have COVID teams that are ready in our ORs to deal with any COVID positive patients. We are going to continue to limit visitors into the institution for the time being and we'll keep you posted on that. John: (20:48) The other thing that I'd like to add before I turn it back over to the governor and Doctor Lockwood, the Dean of USF Masonic College of Medicine is the doc the governor talked about being very proactive and that's what we've been. We've quite frankly followed the governor's lead. John: (21:06) I'll give you one example of this. Every Friday we meet with skilled nursing facilities under my chief operating officer's leadership, Kelly Cullen and Pete Chang, Doctor Pete Chang. They meet with the skilled nursing facilities every week to proactively discuss what those facilities are seeing and this is in Hillsborough County. What they're seeing in their facilities, how can we help them with testing, how can we even help them with testing their own staff, bringing test kits if necessary to some of those nursing facilities that need it. John: (21:45) So we're taking a very proactive approach to working with some of the most vulnerable in our population. So TGH is ready. We have the teams, we have the processes, we have the systems in place to create a safe environment for our patients. John: (22:03) Thank you and I'll turn it over to Doctor Lockwood to add his comments around testing. Dr. Lockwood: (22:09) Well, first of all, welcome governor, and we are really proud of where Florida is. Considering how from the perspective of the entire state, if you look at Broward County and Miami-Dade and Palm Beach, and we feel terrible about the impact of the virus and those counties, even with that impact, the state has been remarkably unaffected. Every death is a tragedy but given the fact that we have 22 million people, we really have a relatively low number of cases, unfortunately [inaudible 00:22:44] of deaths, and I'm particularly proud of my county, Hillsborough County, although Pinellas is a close second, we've had in a population of 1.5 million, only a thousand cases, one of the lowest numbers of cases per capita in the United States. We've had 21 deaths, none recently, fortunately. That's one of the lowest case fatality rates in the United States, maybe in the world which we're very proud of. Dr. Lockwood: (23:09) That's a reflection I think of the remarkably good care that they've been provided by our great hospitals and our great docs, US of health and community docs and Tampa General medical docs and all the physicians in this wonderful county. Dr. Lockwood: (23:26) Well, we're in good position to start reopening our economy, but there are four preconditions that are required to be successful at that and what our goal is now to go from mitigation to reducing the impact of the epidemic, to actually containing it like we did successfully with things like SARS and MERS and really shut the epidemic down. Dr. Lockwood: (23:52) There'll be outbreaks and there'll be flares but it'll allow us to return to a much more normal state. Those four preconditions are basically that we can really access our data, that we have excellent data on testing density, case density per neighborhood and who's getting sick; syndromic surveillance networks. Our great college of public health has implemented those and we've been working with Tampa General and their GE control center to really map down to the level of the street where the cases are, who's at risk, and who's been tested. Dr. Lockwood: (24:29) The second is testing and tracing, I know everybody's sick of me saying this. We have to test a lot more folks, at least 150 people per day, per a hundred thousand population, again per day. So to do that in Hillsborough County we need to test 2,250 patients a day. We're testing between 500 and a thousand. So we need to test a lot more folks and we've been telling everybody not to be tested unless they have symptoms and because we were trying to preserve our PPE. Well now we have plenty of that. We need them to come in and be tested. Dr. Lockwood: (25:06) If you want to be tested, we have many, many different sites now to be tested. Come in and be tested. We are welcoming everyone to do that and that will give us critical data that we can use to move to that containment process. Dr. Lockwood: (25:19) Tracing. Everyone that's positive, we need to quarantine. We need to quarantine their exposures. We need folks to do that work. We have 60 right now. We need about 300 and we're ramping that up. Dr. Lockwood: (25:31) Then finally we can't overwhelm the capacity of our system. We'll clearly, we're not. We're all desperately in need of filling our hospitals, so we're in great shape there and then serology, antibody testing. We're working hard. We're going to start that test today here at Tampa General. We're going to be testing all of the USF and other physicians. So we think we're very close to meeting those four preconditions in Florida. We know we're there here in Hillsborough County and that will allow us to really be able to contain this epidemic. Dr. Lockwood: (26:08) There's still things that need to be addressed. We need to make sure the supply of reagents is adequate. We can't get too confident. We need to keep supplying ourselves with that personal protective equipment and we have to be sure that we can get funding for all these tests so that's going to be a critical part of our strategy. But we're in really good shape in Hillsborough County. We're in great shape in the state of Florida compared to many other areas of the United States and we've got a very clear, coherent strategy for being able to begin to reopening the economy without increasing the potential fatalities from this awful epidemic. John: (26:50) Wonderful. Doctor Lakshmi, do you want to spend a little bit of time on what we're doing from a clinical and research perspective and maybe Doctor Wilson can also add in on the work that we're doing in that space? Doctor Seetha Lakshmi: (27:04) Sure. Thank you. John. Governor DeSantis, Dean Lockwood and President Couris, my colleagues, my team members and the community at large. Doctor Seetha Lakshmi: (27:14) First I wanted to take a few moments to express from all of us in the healthcare, our sympathy and empathy for those affected by this terrible infection. Our hearts go out to you and our prayers are with you. Doctor Seetha Lakshmi: (27:28) We are here to serve and we will always give our community the finest care at Tampa General. We've had a few innovative approaches that we've been able to bring to the patients in Tampa Bay area suffering from COVID-19. We've had the ability to provide donor plasma to help patients recover faster and this was a huge multidisciplinary team effort. Doctor Seetha Lakshmi: (27:51) We also had ability to treat our patients, to block the inflammation, inflammation in the body early, to be able to provide them the best care and prevent further complications and with assistance of Governor DeSantis, we're hopeful of getting some antiviral treatments as well to move forward with treatment, more treatment options for our patients. Doctor Seetha Lakshmi: (28:15) The second big part of the treatment is we are, of course, we're very proud of everything we've been able to accomplish as a team to provide the best care for our COVID-19 patients, but also with the help of our USF health colleagues, Doctor Oxner, Doctor Perez and Doctor Menezes, we have been along with the Department of Public Health, we have been able to put together a group of the Cocoa Clinic that provides care even after the patients are discharged and have an avenue to answer their questions and provide the best care possible. Doctor Seetha Lakshmi: (28:48) Also, in terms of further antibody testing, as Doctor Lockwood mentioned, there have been many questions around how this will affect what are the take home messages around the antibody testing. Doctor Seetha Lakshmi: (29:01) There are many questions that remain unanswered and we want to be on the frontline of this to be able to provide the scientific knowledge that is necessary to advance this science moving forward which we're hoping will be a huge part of our reopening efforts. At this point in time, we have about 3,000 team members that are enrolled to be antibody tested. Doctor Seetha Lakshmi: (29:24) Also we want to highlight some of the infection prevention measures that we have taken and along the lines what President Couris mentioned is that we have the ability to screen everybody that comes into the hospital and this is absolutely important for us to be able to provide the most efficient and safe care to our patients. Doctor Seetha Lakshmi: (29:45) Also in terms of the screening processes that have in place, we also have other infection prevention protocols that Tampa General has always been the leader in being able to manage patients with infectious conditions for many, many years in applying UV light disinfection procedures and policies to take care of our patients effectively and safely. Doctor Seetha Lakshmi: (30:11) Lastly, I want to thank all my colleagues in the health care workers who've been on the front lines, braving all that comes with it and some of this we're learning as we go, rolling with the punches and doing the best they can every single day. I'm very proud to be part of this community moving forward and I'm very hopeful for the future. Doctor Seetha Lakshmi: (30:34) As always, we prepare for the worst and hope for the best and that's our hope looking forward as well. Lastly at USF and TGH, it's our honor and privilege to serve our community and our patients. Thank you. Doctor Wilson. Doctor Wilson: (30:49) Sure. Thank you, Seetha and thank you governor for coming and being so engaged and listening to all the work we're doing because it gives us the opportunity to share with the community what's going on here and I really do want the community understand that you have access to the best care in the world right now. Doctor Wilson: (31:05) We have taken a data driven approach from the very beginning of this crisis. We meet multiple times a day, Seetha and I and the whole team and the leadership team. We meet multiple times a day and we've not only developed our own internal models, you've seen models on television. We developed our own internal models, Pete Chang has helped a lot of that, our own analytic approaches. We take real data and we feed that back into the model. The decision to test at Tampa General Hospital really helped us in this whole community, keep hold of this virus and explain what this virus look like. Doctor Wilson: (31:36) Between Tampa General, USF, the proportion of tests in this community is over 30% so we test a lot of people through here and helped us understand, meaning 30% of all the patients tested, are tested here. It's helps us understand what this virus looks like, so better respond to things very quickly. Doctor Wilson: (31:54) What we're trying to do now is start to learn how we coexist with this virus. The first thing I think people should understand is that we've created a very safe atmosphere in our emergency department by starting early using a data driven approach, we've hardwired procedures now, so both PP procedures and how we see patients. The symptomatic patients going here for COVID, asymptomatic patients going over here. We've done that for quite a while now and test those patients linked in to carry to the outpatient clinic, running clinical trials at the same time, utilizing data that we're seeing. Doctor Wilson: (32:25) The newer part of this also is how to think about surveilling our employees, making sure that their health is a protected and we've had very few employees infected by the way. It's a very small number. So we've done a very good job at Tampa General of keeping people from getting sick who are there to take care of our community. But we want to make sure as we ramp back up, how do we figure out how do we keep employees safe? Doctor Wilson: (32:45) Then most importantly, is how do we keep patients safe? So even if you don't come in symptomatic for COVID, we definitely don't want to leave symptomatic for COVID either, right? We want to keep you safe the entire time you're here and keep this hospital safe and as John Couris mentioned, we are now, anybody who comes into the institution, past the emergency department, will be tested even if they're asymptomatic for COVID and we think that'll continue to drive that data-driven response for us to know how to act, know what's coming next before it comes, And then it started thinking about how to get ahold of things that contain them before they even happen. Doctor Wilson: (33:15) We think this gives us a really good position to be in to take care of everything that's not been here for a while. So I'm an emergency medicine doctor. I enjoy taking care of patients, being there for patients at their most vulnerable times. Certainly COVID is a vulnerable time but so are patients who are having heart attacks, so our patients who have just other types of pneumonia, so our patients who are having strokes and we have a team of experts here for that as well and I think we've demonstrated by this team up here and what we've done that we can safely take care of those patients too. John: (33:46) But just one last item, Doctor Padhya is our Chief of Staff. He also is the leader of what we have internally called [OR 00:33:54] governance and that's a lot of talk has been around elective surgery and procedures when the executive order is up on May 8th for those activities. Doctor Padhya, along with our Chief Operating Officer, Kelly Cullen, been leading a team of people to prepare us for that and would you mind saying a few words about our status? Thank you. Doctor Padhya: (34:17) I mean the six weeks ago when we had to make the hard decision and to be in compliance with Governor DeSantis order to effectively postpone elective surgeries, we really brought a whole team, a community together to try to put the process together. The key was how do we maintain safety and quality for our current patients, our current staff and then using that model, how do we expand it when we were to go live with our elective schedule. Doctor Padhya: (34:55) So having said that, over the last four weeks for all our emergency and urgent patients in-house and patients coming from other hospitals, we have had 100% in-house testing for these patients going forward and in conjunction with that, through Doctor Lakshmi and other team, all the current patients in-house have been tested and then put onto that, we will be serologically testing our team members. Doctor Padhya: (35:22) So again, as John said, we are getting ready to be open for business but we wanted to make sure that safety and quality were the key when we were ready to turn on the open sign. So moving forward, all patients that will have surgeries and peri procedural procedures here at Tampa General will be tested within 48 hours of their procedure and we're looking to start our full elective schedule starting Monday, May 11th. Ron DeSantis: (35:56) I want to thank everybody. Just a couple of discussion points. Ron DeSantis: (36:03) Thank everybody. Just a couple of discussion points. John, you and I were obviously working from the beginning. When we went from, initially we knew there was a virus in January. Even though World Health Organization said it wasn't transmissible person to person, it was obvious that was not true at the time. We were hoping that it just wouldn't come to the United States. There were flight stuff from China and everything, but then it became apparent that this thing was just here. You started to see cases in February, the beginning of March. The fear was that if those cases were allowed to spike, if this is the hospital resources, it would just overwhelm it. You'd have more people going to the hospital than you could handle. That obviously is bad for a COVID patient that can't get care, but then there's all these other things people need care for too. Ron DeSantis: (36:48) So it was potentially going to be a massive stress on the system. As we sit here now, this is the capacity. I mean we've managed not only to keep it very much under, which is a good thing. But just looking forward, you guys may be using more hospital beds to do elective surgeries. As we move into another phase with the economy, if a cluster develops somewhere, is there any doubt in your mind that you would have the healthcare capacity to handle any type of COVID patients in the foreseeable future? Speaker 4: (37:17) No, there's no doubt. We will be ready to handle. As the economy starts to slowly, methodically and thoughtfully open up, if we do see a surge or a cluster here or there, this institution ... and I know my sister institutions [inaudible 00:37:34] and Advent, and HCA, and others will be ready and prepared to handle anything that comes our way. Ron DeSantis: (37:42) I want to thank you guys here at Tampa General and many other hospital systems across the state. I was at Cleveland Clinic down in Broward County a couple of days ago and Orlando Health as well. They will work proactively with the assisted living facilities and the nursing homes. Because one, we just recognize that is the number one most vulnerable population to this disease. But two, if an outbreak were to happen unabated, then all of a sudden you're going to have a flood of people coming in. So it will stress the resources, so they understand it's in their interest for all their patients to be really proactive in that. If there's any problem with the staff trying to isolate, we are obviously testing a lot of the residents. We're going to give the antibody tests for the nursing homes, not just for staff, but for the residents. Ron DeSantis: (38:29) I mean some of the residents may have had this. Not everybody who's old ends up being hospitalized, just some people's ... but I think that that's really important. As we go on to have more elective procedures, people should understand these are important procedures. They were stopped at the recommendation of the CDC because we wanted to make sure there was enough hospital space. But I think even more importantly than that, people were really scared about a shortage of personal protective equipment. While I think clearly on the hospital space, we're in good shape. The PPE has really started to shake loose and so that looks good as well. But also, just understanding that as there's more procedures going on there, the more we can be really proactive in protecting those seniors in those facilities. That is really going to obviate any type of a surge that could come. Ron DeSantis: (39:19) That really, I think, is probably the biggest threat for that. Dr Lockwood, what would you say, just for the psychology of this virus? At first, it seemed like in February a lot of folks in the media downplayed it. They said it was less than the flu, don't worry about it. As we got into late February, early March, they became different. I think a lot of people were really, really scared. I have friends and family that were really, really scared unlike anything that I've ever seen. I think that, that has translated into things that some of you have mentioned where you actually have people that have chest pains. They'll have stroke like symptoms and they don't want to go anywhere near a hospital because they're scared of catching the virus and developing COVID 19. Can you speak to the fear factor out there and how people should view it, particularly those people that may have a need for medical attention? Dr. Lockwood: (40:15) Well first of all, this is as safe a spot as you can be. I was out with my wife yesterday. We took our boat out and I was looking at some of the people on other boats. There were like 20 people on a boat. That is much, much, much, much more dangerous than coming to your hospital. Really this is the safest spot you can be. There have been, to my knowledge, no community acquired cases within the hospital. Some staff have gotten sick because a lot of them actually traveled to New York early in the infection, but this is a remarkably safe place. If you are having chest pain, if you're having symptoms of a stroke, weakness that you can't speak, come immediately to the emergency room. So this is a remarkably safe environment. The US of health physician offices are remarkably safe environment. Almost all physician offices are remarkably safe environments. So do not wait if you're having symptoms or if your blood pressure is out of control or if your diabetes hasn't been managed. See your doctor. Really, I cannot emphasize that enough. Ron DeSantis: (41:23) Can you also speak about the different risk profiles with this virus? I think when it first came out, a lot of people ... it was novel. There's no real treatment for it. I know a lot of parents were concerned for their kids. What's the age groups that this affects? What's the different risk levels depending on health status and age? Dr. Lockwood: (41:42) Well, we're learning more every day. The big unknown still is the asymptomatic group. Some of the initial studies with antibodies have suggested a wildly greater number of asymptomatic cases than we thought. Maybe 50 full greater, I'm not sure I believe that, but it is certainly much greater than we anticipated. A very good paper from science suggested that 85% of the cases in Wuhan were undocumented or asymptomatic. So clearly a lot of folks have had the virus that we don't know about, which suggests that in fact the case fatality rate is much lower than we think. Now, I still think it's much higher than the flu. If I had to give you an estimate, it's probably between 0.6 and 0.9%. well, the flu is 0.1 to 0.2, so it's still really dangerous. This is a naive immunological population, unlike the flu where a lot of us get it every year. Dr. Lockwood: (42:40) Hopefully we get the vaccine every year. This hasn't occurred with this particular virus. So the group that does seem to be at greater risk is the same group we've been talking about for the last six weeks. Older folks, particularly very older folks and folks with comorbidities, hypertension, heart disease, lung disease and diabetes, and especially a combination. Now you see these 90 year olds do great and they come home from the hospital. They were probably in really good shape to begin with. The things you can do to prepare now beside all the social distancing and wearing face gear, and washing your hands, and using hand sanitizer is stay fit. Go outside, walk an appropriate distance, but outside's a very safe environment to be in; lots of UV light. Eat right. Make sure when we get into flu season that you get your flu vaccine. Dr. Lockwood: (43:36) If you're at all skeptical about that, do it this year because you may die from influenza and not from COVID. In fact, you may have a higher probability of that. So get your flu vaccine. That's something you can do. We're learning more and more. We focus a lot on young folks and we should because if they get infected, they're much more likely to be asymptomatic and to come home, and infect their mom and dads, or more importantly in my case, their grandfather. So that's important too. But generally speaking, young healthy folks do particularly well. Very rarely they won't, but that's also true of influenza. Ron DeSantis: (44:19) Well great. Dr. [inaudible 00:44:22] Can you talk about some of the ... when you first started seeing patients for COVID-19, what you've learned in the process. I know there've been different views on oxygen, ventilator prone, all these things that physicians have done. So can you explain what you guys have done here? Speaker 6: (44:39) Yes. So I think I have to preface that question a little bit about how much we learn everyday, how much knowledge has exploded on this front, and truly how this has brought the entire medical community, the scientists together to share the knowledge that we have created. It's truly heartwarming to see the progress we have made. There was a lot of uncertainties in the beginning part of the epidemic as to how fast this progress is. That's a big concern. As a physician watching this coming in and Jason, you've been on the front lines. You see this and you're like, how fast are people going to get worse? Are they going to get better? Now I think we have a better sense based on all the algorithms we have created and collected the data on our patients to say, these parameters, we should probably watch you very closely. And follow these parameters, you're okay. Speaker 6: (45:32) That's been incredibly helpful for managing our patients safely. The second part, which I'm very proud of is the amount of support we have received for all the trials to study and get more knowledge on this front. I have to say that leadership has been very, very helpful in bringing the community together, getting the regulatory hurdles passed and getting us some of the things that we need right now to study and understand more about the virus as things change every day. So at this point in Tampa General and USF combined, we have plenty of trials that are state of the art. For example, we have a hero trial, which we are one of the 16 sites in the country to be able to look at how we can protect our healthcare workers. Also, trials that look at how we can block the inflammation in the body faster, how we can fight the virus, perhaps bring it together, block the virus and fight the inflammation together. Speaker 6: (46:27) So there are many interesting avenues to it and so many groups. Our physicians, our team members have been actively involved in looking at more data to learn and understand some of the things that we do need moving forward as to how we can decrease the complications. So those two main aspects have been really eyeopening. How fast things change and how we can effectively intervene and prevent complications from happening even in the highest risk groups are cancer patients, transplant patients. How can we actually decrease you getting any complications, prevent you getting on the ventilator? So things like that have been upfront and we've learned a lot as we go. We're grateful for the support we have received from our community in participating in the research, as well as support we have received from our medical community as well. Jason, anything? Speaker 7: (47:20) No, I echo all of that. The collaboration in the different departments and groups has been amazing. I want to echo again, we have innovative trials and the best treatment here. We've worked hard to come up with ... strategies are changing often about how we treat patients with COVID. Part of that's how we protect our staff when they're taking care of patients with COVID, but also can make sure to safely take care of patients with COVID. So we might intubate earlier at first and maybe we wait a little while. We might use high flow nasal [inaudible 00:47:46] oxygen, so some heated oxygen going through the nose to try to help patients get more oxygen to their bodies. Keep those lungs open a little longer before we put them on ventilators. Thinking, do we need to conserve ventilators early on in this outbreak? Did patients really benefit from being on ventilators? So we've thought all about all those things. We continuously have an infrastructure here because of university where we can look at data. So we've looked at the data of our own patients to try to feed back that data in real time to make decisions for the next patient to even do better. Ron DeSantis: (48:15) What was your conclusion about early intubation? Was that helpful? Because there's a lot of data out of New York that was saying almost 90% of the people that were intubated would die. I was at the Cleveland Clinic a couple of days ago and they said they were doing it early and they would have 60% of their patients on vents, would get off the vents. So that was much different than what we had been seeing out of New York. Speaker 7: (48:40) The vast majority of our patients who've been intubated have now come off of the ventilator. We actually have had very good success rates. Mostly what we're doing now [inaudible 00:48:47] could help me with this as well. But we try not to intubate the patient if possible. They can tolerate high flow nasal cannula oxygen. We've had some very good success with that. Dr. [Kim Kao 00:00:48:56] who runs our ICU here, our pulmonary critical care doctor, has really helped us build those pathways out. So we use those pathways starting at the emergency department all the way through the inpatient stay and in the ICU. Intubate when we have to, but you utilize oxygen support when we can. It's been a little difficult because some of the ways we'd normally do oxygen support may aerosolized the virus, and we don't want to do that because we can get the virus everywhere. So things like some people might have C-PAP at home. We have something similar to that we can use here, but that mask can make virus go other places. But this high flow oxygen has seemed to really benefit people, I think from what we've seen so far. Ron DeSantis: (49:38) Well great. Well, I want to thank all the docs. I want to thank John for everything that you guys have done a really good job. Very professional, very data-driven. When I was going through this, we were obviously in touch with everyone around the state. John was very level headed, understood the data, understood what they needed. I had some people in some hospitals say, "I need 600 ventilators." I'm like, "Well how many people do you have intubated right now?" "Three. But it's coming, I need it." I'm like, "Okay, what's that based off of?" If you need it, it's one thing, but what's it based off of? I think TGH, they were always very calm, cool, collected, never panicked, never hair on fire. Let's follow the facts, follow the science and do it. I think that they've done an outstanding job. So thank you guys for all you've done. With that, I think we'll open up for questions. I'm happy to take some. I think they'll probably be willing to as well. Yes ma'am. Ron DeSantis: (50:49) All those facilities are required to inform if a staff is infected. They need to inform all staff, all residents, and all families. That is required to do. So if they're not doing it, they're not following the regulations. Then the list, I need to see the form that they've put it out in. It's not in the reports that I'm getting in the morning yet. So I'll take a look at that and let you know. Questioners: (51:14) [inaudible 00:15:16]. Ron DeSantis: (51:16) I'm going to take a look at it and let you know. Like I said, I'm happy to take a look at it. I'm happy to review it and then see what would make the most sense. My view is, is they're required to be informed. If they're not going to be informed, then having the stuff that they can look up on the website or however it's made public may be good for a family member at that point. Yes sir. Ron DeSantis: (51:45) So let me just address that. So what happens is obviously this is a system that the state paid a lot of money for five, six, seven years ago; whenever they did that. It's got a lot of architectural problems and quite frankly, a capacity issue given that this is an unprecedented number of claims. So the system is deliberately put down in order to use it just to process. So we were able to, this weekend, process I believe another 300,000 claims and payments. So that's going to be hitting people's bank accounts today and tomorrow. Some of them are debit cards. So this is now we will have done a total of almost 500. Actually, I think over 500,000 payments now. To put that in perspective, all of last year I think there was 300 some thousand, some claimants. So there was huge problems with this thing. Ron DeSantis: (52:39) We've had people working 24/7, surging the workforce to be able to do it. But I think that a lot of times when people are going on the system, like this weekend. Some people wanted to go on, but they had it off of that so that you would be able to process more. A lot of that's to check status and all. I get people are antsy, they want the money. But I think having it down so you can process the money, at the end of the day people want to see the checks cut, and so that was what was done. People though, if you're just newly unemployed, you can still apply through the Pega website. That is always running. That Pega data does get run through this connect system. But there's been a lot of payments. Ron DeSantis: (53:19) There's going to be a lot of payments made today. This has not been an easy thing. But I can tell you this has been worked on 24/7. So to be able to see the progress this weekend, I'm probably going to do ... I think we're going to try to get the full numbers because they were still doing it all through the night. But it is leaps and bounds where they were three or four weeks ago. I mean three or four weeks ago, people couldn't even ... I mean it was crashing because you had hundreds of thousands of people trying to get on. It was processing 1500 payments a day. Well when you have hundreds of thousands of people, that ain't going to cut it. So this has been good. I would also just let people know if you see the number of people who've applied, not all everybody is eligible. Ron DeSantis: (54:03) ... you see the number of people who've applied, not everybody is eligible. I mean, if you had a job and lost it, obviously you're eligible, but there's some people applying who haven't been working for quite some time and so there's other forms of relief given the situation that we see ourselves in, but some of those numbers are inflated in terms of the folks who are actually qualified for unemployment. Yes, ma'am. Speaker 8: (54:22) Just to follow up, because I got an email just this morning from somebody who applied six weeks ago, I know you think that's intolerable as I do, but when can they expect their check? Ron DeSantis: (54:32) Well, I'd have to see the individual and see when they applied, what their eligibility was and all that stuff. If you give me the individual, well we could definitely look at it and see what the issue is. Yes, ma'am. Speaker 9: (54:45) Governor DeSantis, so I wanted to clarify if you can get tested. You're saying everybody can get tested now, but I know there are still people who are reporting that they're going to some of these drive-through sites since they don't meet that CDC- Ron DeSantis: (54:56) Our drive-through sites, where we put out the word on is if you want to get tested, get tested. Now there's all kinds of drive-through sites throughout the state that we don't have anything to do about. But my view would be, we've worked hard at getting the supplies, we have a lot of collection kits and collection swabs and I think it's good that if people feel that they should be tested. Now if you have- Speaker 9: (55:20) [crosstalk 00:55:20] a change in policy for [inaudible 00:55:21]. Ron DeSantis: (55:22) No. If you go to like the Jacksonville site, for example, and you show up and you say, "I don't really have a symptom, but I think I may have been exposed to someone." They're going to test you. If you do that in Orlando, the same thing, the one in Miami and so that's what we've done. I think Tampa, they want to do that too. They're encouraging people to be tested. Ron DeSantis: (55:42) This has been wide open for a couple of weeks now and I think that that's the best way to do it. Initially, quite frankly, CDC didn't have enough tests and so they wanted to make sure the sickest people were definitely getting tested, but then I think they also believe that this thing was coming in from China and it wasn't already here. Well, that is obviously wasn't the case. Ron DeSantis: (56:03) We're in a situation now we're identifying as many people as we can and some of this stuff when you have new cases is, the U.S., I think we had the same number of cases in one of the more recent days as we did like two weeks prior and people are like, "Oh, it's the curves not flattening. The U.S. is still ..." The difference was, I think there were twice as many tests conducted recently compared to two weeks ago. So, as you expand testing, you will identify more positive cases. That's a good thing because the cases are out there. This way you can isolate those individuals and you can look at their contacts and so we want to continue to do that. Then when we're doing the nursing home, the National Guard and these strike teams, we're looking for asymptomatic. Ron DeSantis: (56:50) I mean, that's kind of the name of the game with what you're doing as we start to get into the next phase. Surveillance testing is going to be something that is going to be important. The Department of Health has already started doing that. I know some, locally, people are doing that. You can do it. I mean, some of it's just looking at symptoms as people come in, but some of it is testing, like you would test for the flu to try to get a sense of how this may or may not be circulating at a given time. That will give us information to know whether you may be seeing an outbreak in a given area or not. One good thing about a lot of the numbers that we're seeing, is even as you've expanded testing, the percent positive has gone down. Ron DeSantis: (57:33) Even people that are symptomatic, the vast majority of them are testing negative. Folks who are healthcare workers mostly tested negative. I mean, I think as they pointed out, they had workers who had the virus, but they didn't get it in the hospital, they didn't even get it in this community, I think most of the time. They got it in New York City because it was really running rampant there. Ron DeSantis: (57:52) I think that's, from an epidemiological perspective, somebody comes from New York, tests positive, well then you figure out who in Hillsborough, or who you've had contact with, then you can go do that. If they just randomly get it in the community and we have no idea how they did it, well that's an indication maybe it's being spread more aggressively throughout the community. These are all things, I think, that are very, very important. Speaker 9: (58:15) Just to follow up on that, Dr. Lockwood, you suggested that we should be testing 150 per 100,000 population. Do you agree with that assessment? Ron DeSantis: (58:25) Like I said, we have these lab contracts. We're doing a huge expansion, but I would say the fact is right now our capacity exceeds the demand. Like at that Jacksonville site, at their site, you won't have it at filled and look, some of that may be that people just should be tested, but they don't feel like doing it. Obviously, we want them to do it, but I do think if you look at the surveillance data, if you look at the ILI activity, I think it is the case that if you're in a Jacksonville, for example, when you may only have 75 or 100 people go through this drive-through site, I mean, I do think it's the case that you just have fewer people right now that have symptoms and that is a good thing. We have more capacity than we're able to. Ron DeSantis: (59:09) But I think what Dr. Lockwood's talking about, what I'm talking about and others, is being more proactive on the testing. Really, like when they're testing every single expectant mother, every single person coming in for surgery, you really wouldn't need to do that unless they had symptoms, if you didn't want to, but they're being very proactive, ensuring it's a safe environment, making sure that their workers are protected. Ron DeSantis: (59:34) The Orlando, they're doing the same thing, Orlando Health. They've tested 250 expected mothers, zero have come back positive out of 250. Those are things that I think are all really, really good. We though have, if you'll look at the ratio, Florida's tested, I don't know, whatever we are for number of tests right now, but in Southeast Florida, the ratio is much better because the outbreak was more serious there. Ron DeSantis: (01:00:02) So, we've had more testings sites. There've been more demand for tests down there and you've seen that. So, the ratio there is a pretty aggressive ratio. Now we'll continue to do better, but I would say even in Broward County, the first site we set up in West Broward County with the National Guard, we are getting 750, 800 people that would process through a day and then it would go to six and then five and then sometimes it go up and then go down. The demand definitely has changed over the past five or six weeks. That's just the reality. Yes. Speaker 10: (01:00:39) Governor DeSantis, Governor DeSantis. Speaker 11: (01:00:40) [inaudible 01:00:40] Miami-Dade, Broward, Palm Beach, and if so, will one metropolitan area opening [inaudible 00:06:52]. Ron DeSantis: (01:00:54) Those are all factors that we're considering right now. If you look at the gating criteria and I spoke with Dr. Birx about this too this morning, Florida satisfies the gating criteria state-wide, even including Miami, Palm Beach and Broward. It's the decline in ILI activity. It's the decline in the syndromic surveillance, which you can look on the CDC website for the ILI, you can look at department of health reports. We have the surveillance data every day, a decline in the number of the positive test rate, which we've had a really nice decline there. Then, making sure the hospitals have enough capacity. Ron DeSantis: (01:01:31) That's true. It's true in Miami as it is true in Tampa. They could qualify at the same time. You look at it and the numbers are just so much different there. I think, I mean, Dr. Lockwood pointed out, look, Miami compared to some of these other places has fared much better than some of these other places across the country. Nevertheless, for Florida, it really is a different ball game when you compare Southeast Florida to the rest. I mean, I think pretty much the rest of the state has really handled this very well. There's never been even close to a stress on capacity of healthcare resources. Ron DeSantis: (01:02:07) I think if you look at the cases per 100,000 and fatalities per 100,000 and hospitalizations per 100,000 in Florida, they're all low compared to a lot of these other states anyways. But if you took out Southeast Florida and did it, I mean it would be really, really, I mean almost historic low, like no one would have predicted that. I think that is something that you take into consideration. I said from the beginning on all this, I mean they say, "Oh, you're going to work with South Carolina and Georgia and Alabama on a regional thing." I'm like, "I mean, I'll work with them as their friends, they're good neighbors, but I have five states in one pretty much here already." Ron DeSantis: (01:02:42) I said, "This is a bottom-up deal. We're going to work with Miami and Broward and Palm beach a little bit differently than the panhandle or then Jacksonville," and the outbreaks have been very different in those areas. I think understanding that makes it makes a good bit of sense. I also believe in being collaborative. If those three counties, and look, this Phase I is a baby step. I mean, we are deliberately going to be very methodical, slow and data-driven on this because I think that if people want to have confidence that things are going in a good direction, it gives us the ability to do things if we need, if we see something somewhere. Ron DeSantis: (01:03:20) Even for those counties it's really not that much different than what we're doing now. If you really look at it, not a huge difference, but at the same time we're going to work with them and see whether their timeframe would be a little bit different but, but clearly, a place like the Tampa Bay area, Northeast Florida, Orlando, I mean, Orlando had a similar story peak in cases probably April 2nd, hospitalizations the 7th and they never had a lot. I think they had maybe 120 in that whole area and then really down very similar to Hillsborough County. We, obviously, want to recognize that and appreciate that Speaker 10: (01:03:55) Governor DeSantis, just to clarify that first question about nursing homes and long-term care centers. Do you support the release of [crosstalk 01:04:04]- Ron DeSantis: (01:04:02) I told him to release that. What you're telling me is the form isn't in a way that's as helpful, so I'm going to look at that. I don't know exactly the form it is, but I gave specific instructions to say if there's cases in specific facilities, put those facilities out there and the date that these cases are arising and I think that that's very important. Speaker 11: (01:04:23) Then the number of cases and the number of deaths at the specific facilities do support that kind of detailed information? Ron DeSantis: (01:04:27) Yeah, I think so. Speaker 11: (01:04:28) When do you expect this information to be released? Ron DeSantis: (01:04:32) I'll repeat what I just told her earlier. I am going to look at it, I am going to review it and I'm going to see what format it's in and what format makes the most sense and that's what we will do. I'm going to do it. Speaker 11: (01:04:48) I appreciate it. Ron DeSantis: (01:04:48) Do you understand what I am going to look at it and then do something means? I mean I've said that three ... With all due respect, I've said that three times and we're talking about a lot of things. We're doing all this stuff with the nursing homes. You look at our rates in these long-term care facilities compared ... New York's had like 3,000, 4,000 deaths just in long-term care facilities. This has been a big priority for us from the beginning. I ordered him to release it. He did not want to do it because he was worried about patient privacy and how media may descend on a nursing home. Ron DeSantis: (01:05:20) I think that that's a legitimate concern because I know how irresponsible some people can be, but at the same time I was concerned if one nursing home didn't inform the family like they were required to do and we could have just simply put it out, then maybe it's better to just put it out. That's what I told them to do and then that's how we're going to be able to handle it. I'm going to look exactly what form they're putting it out for everybody and if it's inadequate and then we're going to address it. Ron DeSantis: (01:05:52) Excuse me? Speaker 12: (01:05:53) [inaudible 01:05:54]. Ron DeSantis: (01:05:59) Obviously, I mean, so this was before I was governor. The state paid $77 million for this thing. There's a lot of architectural problems with it, there's no question about it, totally not worth $77 million. At the same time, I've talked with these engineers and you would not build a system with in mind that the economy would just basically stop voluntarily and you'd go from 500 claims a day to a 1,000,000. There would be a capacity issue, I think, no matter what. Ron DeSantis: (01:06:25) I think it is something that should be looked at, right now though- Speaker 12: (01:06:28) [inaudible 00:12: 29]- Ron DeSantis: (01:06:30) ... right now, my issue is I'm not going to cry over spilled milk right now because my number one concern outside of health is to get the checks out. We're putting a 100% of the effort on this as we do the checks and as we get ... I'm going to have the full numbers, but I mean, you're talking about from where it was a month ago till now. Ron DeSantis: (01:06:53) This thing is now paying out people, we got more to do. Don't get me wrong, but given how bad the system was to be able to do it, I think these engineers have done a really good job and I was thinking this was going to take three months knowing how this stuff works. I said we wanted the checks out, they have responded and I think we're going to continue to have more. Ron DeSantis: (01:07:14) Once that dust has settled, then I do think it would be appropriate to just go and look and see what went on. Why did they pay so much? The one thing I would say having talked to the engineers is this is not just like, "Hey, apply online and we'll cut you a check." When you design a program, this is like dozens of laws and regulations and it's got to be able to ping and all that to make sure that people are eligible or to make sure the state's doing it if we're administering federal dollars. Ron DeSantis: (01:07:43) There is a lot that goes into it and it is a very complicated architecture. Now, it could have been done, I think, obviously better. But at the end of the day, my job is to fix problems when they arise. The agency said this was a good system a month ago. Obviously, that was not accurate and I wish that they would have been more proactive, but we've got to fix it. That's what we're doing. Ron DeSantis: (01:08:07) I'm going to give a more fuller update probably later today on it, but I think that the folks who have been, understandably, very concerned about when they're getting the money, I think today when more people start seeing money hit, I think they're going to appreciate it. Ron DeSantis: (01:08:21) I also think the way unemployment works is you're not usually even eligible to apply for a certain amount of time. I've waived all that to try to get it all in the system so that we can get the checks out quicker and I think that that's really important. Ron DeSantis: (01:08:34) All right, well I got to run back to Tallahassee and keep working on things like this, but I want to thank Tampa General for having us here today. I want to thank you all for your really great work. You've really served the community well. This is a community that I don't think could have done any better battling this virus. Ron DeSantis: (01:08:52) I just hope that we can continue to progress slowly but surely. But if we can get far enough along where we can watch the new quarterback of the Bucks play and host a Super Bowl and have the first home game for a super bowl host team, I think, in probably NFL history, I think we all would. We'd like to see that and hey, I grew up in Dunedin and so I'm a lifetime Bucks fan, so thank you guys.