Florida Governor Ron DeSantis June 23 COVID-19 Press Conference Transcript

Governor Rick DeSantis: (00:00) ... So we've been seeing, important to protect the vulnerable because that's where most of the clinical consequences are. And that's been our focus really from the beginning of this, both in terms of the longterm care facilities, but then also just advising our senior citizens not in those longterm care facilities to make sure they're avoiding crowds and maintaining appropriate social distance. What we've seen, particularly over the last week, is a real explosion in new cases amongst our younger demographics. Governor Rick DeSantis: (00:29) And so when we started this in March, the median age of people who tested positive was I think 65 as the testing ramped up that that went into the fifties, but it was pretty much in the fifties for most of the time. And then just recently has really plunged, to the last week the median age was 35 years old. So half of these positive tests are in that 34 and under age group. And the bulk of the tests that we're seeing are really the 25 to 34 year olds. They represent the largest share of all positive tests by pretty decent margin for anyone throughout the course of the pandemic. And they weren't even really being tested very much in March. And so that's a big, big change. Governor Rick DeSantis: (01:16) And then if you look here in central Florida, the median age of new cases for yesterday that was reported today is even younger, 32 in Orange, 32 in Seminole. Orange has even been younger over the last week. It's been, I think 29, 30. Seminole, I think has been as low as 27 or 26. So you see how this is kind of skewing. Now the good thing about that is if you look at any data set, the folks in that age group, unless they have a real serious underlying condition, do not suffer the same types of clinical consequences, whether hospitalization, or certainly COVID related fatalities that people in the older group would do. Governor Rick DeSantis: (01:57) And in fact, even though we had a lot of new tests at higher levels last week, we actually had fewer positive tests with our longterm care facilities than we had had. So that the cases there actually went down, which was a good sign. But what we're seeing is part of that is some of the contact tracing and some of the discrete outbreaks we've seen around the state, but really most of it is community transmission, particularly amongst the 20 and 30 year old group. And I think part of that is just natural. You kind of go and you want to be doing things you want to be more out and about. I think the folks who are a little older and would be more vulnerable have been a little bit more careful. So you're just seeing, I think, more contact and, and that's why you're seeing this. Governor Rick DeSantis: (02:46) I'm going to talk in a minute about what we're kind of going to do going forward. But clearly you're seeing this, this is real. Now they are testing more than they were for, but they're also testing positive at a higher rate than they were before. And so that would tell you, probably, it had been an escalation and transmission over the last seven to 10 days. So that's probably the number one thing that we're looking at right now and obviously increasing amount of the new positive cases. So the message is just stick with the basic program that we've advised a really from the beginning, but certainly since the beginning of may, when we went into phase one, it's still important to maintain the appropriate physical distance. It's very important to exercise good hygiene, wash your hands, do things like that. It makes a difference. Governor Rick DeSantis: (03:39) And then it's also important, which we advise at the beginning of May and reiterated recently with the surgeon general, when you can't socially distance and keep that six feet, wearing the face mask can help reduce transmission, very important. And also if you're in these face-to-face businesses, it's important that the employees are wearing the face masks. And by and large in Florida, I think I've seen that at the businesses. I think that they've really done a good job with this. Obviously, there's some need to improvement. Now our recovery plan, Dade, Broward and Palm Beach, where we're still having the most problems, particularly in Dade and Broward, they've been on a separate schedule this whole time, much slower. We've had the rest of the 64 counties went into phase one at the beginning of May. And obviously there were restrictions. Businesses would open, but they would have to abide by certain social distancing guidelines. And I think by and large, they did a really good job, whether it was the restaurants, whether it was some of the retail, obviously the theme parks here have done a lot. And so that's all a very good and sure enough, throughout all of May very steady as she goes a manageable caseload. Obviously people come and go from the hospitals. There were some nursing home outbreaks that we had to deal with, but the positivity rate was low and things went well. As we got in, and that's May and early June. Then as you get into the second week of June, you start to see some more cases pop up. And then by the third week of June you start to see more widespread transmission. Governor Rick DeSantis: (05:20) So what we want to do is just reiterate a couple things. With the restaurants, most of them have done well, but you have half capacity limitations indoors. And those tables got to be space for the six feet. That is the way that you can do that in a low risk way. And then recently now with pubs to be able to allow, they're treated the same as a restaurant. You go in, seated service, only you have a 50% occupancy limit and with the appropriate social distancing. And that is something that is low risk. And our view is obviously we want businesses to be able to operate if they can do it in a low risk environment. Now, there have been instances recently where that was not the case. The secretary suspended a liquor license from a place here in central Florida that was having really big parties, which again are just not following the guidelines and I'm going to kick it over to him in a minute. Governor Rick DeSantis: (06:21) But basically what I told him is this is very easy to understand. We're in a step by step process, as we've moved forward here. The guidelines are in place for a reason. You're not doing it just to do it. The reason that they're doing it is because you want to have environments that are not going to be huge risks for transmission. And if you don't follow the guidelines and you pack huge numbers of people in doors that are very close, you're creating an environment that you're going to see more spread. And I think we've seen that with some of the younger... And obviously I'm not harping only on a restaurant, because most of them have done a great job. And obviously the social contact that's going on is far beyond just that. I mean, people are hanging out at people's houses or doing all kinds of stuff. They're very active. Governor Rick DeSantis: (07:07) But it is important to follow the guidelines. And if people see a pub or a restaurant, if they're operating at 55%, okay, give them a warning, tell them, "Hey, 50." But if you go in and it's just mayhem, dance party USA, and it's packed to the rafters, that's just cut and dry. And that's not just an innocent mistake. And so I told him no tolerance for that, just suspend the license and then we'll move on. And then people will hopefully get the message that these guidelines are in place for a reason. Governor Rick DeSantis: (07:43) So we want to make sure people are continuing to follow the basic instructions, whether it's masks, social distancing, washing your hands. That stuff will help reduce the spread. And when we went through this in March and took different actions, March and April, the goal was to slow the spread. So- Governor Rick DeSantis: (08:03) ... actions, March and April. The goal was to slow the spread so that we could flatten the curve and have the hospital capacity to deal with the effects of the virus. That obviously worked. We had in April, we were projected by some of these models to have 460,000 people hospitalized. We had about 2200 at the date that they picked for that. And the hospitals were never threatened to go overboard. We were good. But we also knew that when you flatten the curve, you will have the infections spread out longer. If you don't flatten the curve, it goes up and then it crashes down. So a flatter curve means you're still going to have cases. We said that from the beginning, that the virus isn't gone. We want to be able to get people back to work in a way that is going to mitigate further spread. And so these guidelines are very, very important. So that's what we want to be doing. Governor Rick DeSantis: (08:53) I want to send it over to Secretary Beshears about the message for folks to, particularly the businesses, to make sure that they're following the guidelines. Secretary Beshears: (09:04) Thank you, governor. Good afternoon, everyone. Thank you for allowing me to be here with you, governor. I'll be very brief. After discovering that there were some flagrant violations with the Knight's Pub, based on contact tracing, it was very easy. 13 employees, we had 28 patrons that tested positive. And due to their advertisements, we pulled their liquor license last night. I have contacted several sheriffs. We want to continue to do that throughout the state. This is simple. Like the governor said, those that are in flagrant violation, we have ABT officers that are going to be out from now on from 5:00 PM to 1:00 AM checking on these bars and restaurants that are in violation of this. And we are going to issue a warning to those that are trying to do the best they can, but that's not what we're talking about. But like I said, those that were flagrant, we'll be suspending their license. We started this actually last week, and we're going to continue this until we get this right. Governor Rick DeSantis: (09:58) Thanks. Thanks, secretary. Look, it's just not worth it to try to just go totally beyond these guidelines. I mean, they're in place for a reason. They were done based on consultation with folks in the medical business communities, the community as a whole, so that we would be able to have low risk environments operating. And if you're not willing to do that, then you're going to get a visit here from, I guess he'll be kind of the Grim Reaper in terms of business licenses, because there's not going to be any tolerance for it. And I will say, most of the folks have done a great job. Most of the citizens who've gone in have done a great job in exercising the appropriate restraint. So we really, really appreciate that. Governor Rick DeSantis: (10:40) I wanted to talk, I wanted to bring in the doctors, and I really appreciate both of them for being here. We have a Dr. Sunil Desai and Dr. George Ralls have been helping us understand what's going on from the very beginning. But I think it's interesting to discuss some of the trends that they've seen in terms of patient acuity treatments, how they're handling elective surgeries. And I think that folks would really, really appreciate it. So why don't you both weigh in? Maybe start with Dr. Desai. You guys have told me, pretty much every hospital that I've discussed it with, has said that there is a difference in the average patient's acuity who's coming in with COVID-19 between the patients you were seeing in March and April and some of the patients you're seeing now. Is that the case, and why do you think it's the case? Dr. Sunil Desai: (11:33) Thank you. I'm glad to answer that. First, Governor DeSantis, Secretary Beshears, thank you for having myself and Dr. Ralls here this afternoon. I'm glad to help in any way possible. First of all, you're right. We are seeing a different population right now. The population is skewing a little younger, as you demonstrated there earlier. Age 30 to 55 would be the age group. The acuity is less. A lot less folks using or requiring mechanical ventilation or the severe presentations of COVID. We're not seeing as much as that. There are a lot of reasons for that. I would say one of the biggest things is I think we're beginning to understand how to treat this disease, recognizing it in a better fashion and modifying as we go, the various treatment regimens. Dr. Sunil Desai: (12:36) One of the things I would like to stress, particularly to the media in general, is to never in my career have I seen so much science come out, and I use that term loosely. When I say science, there's a rush to be the first to publish, and I totally appreciate my academic colleagues who do this to publish data on new breakthrough and novel therapies, but we really have to vet those things well, and first do no harm. Not all of the things you hear that come out first, particularly in the late publications, are actually safe to use. So I just make that as a general case across the board. The disease, when it's at its severest, gives the acute respiratory distress syndrome, the adult respiratory stress syndrome, acronym is given to that clinical picture. It's been around for 50 years. We have a good handle on how to handle that and what works. Thankfully, we're not seeing as many of those right now. Governor Rick DeSantis: (13:44) So in March and April, what percentage of the COVID hospitalized patients required ventilation then, and then what percentages are requiring it now? Dr. Sunil Desai: (13:57) Our first peak, let's just call it, was in April. We had about 54 patients or so. Almost 50% were requiring mechanical ventilation. As of today in the health system, we've got, and Dr. Ralls can correct me, we've got about 108 patients across the system. Three are on ventilators. So a significant drop in acuity, which is of course welcome by all. Yeah. Governor Rick DeSantis: (14:24) Just one thing in terms of the COVID patients, because I think Dr. Ralls, can you talk about, in March and April we didn't have the elective procedures going on and starting at the beginning of March, or excuse me, beginning of May, started to allow elective procedures. Obviously people started coming in. When someone comes in, not only just for elective procedure, but even emergent, are you testing all those people for COVID-19? Dr. George Ralls: (14:50) Yes, sir. Yeah. So one of the big differences now is that anybody who comes into our health system for any type of a procedure to include labor and delivery, if it's a trauma patient, anybody who's going to require a procedure gets tested for COVID-19. So our testing is much, much broader than it was during the first wave. And we see a significant number of those patients test positive. So there was a snapshot, as an example, last week, where 20% of our COVID positive patients in the hospital were in the hospital for things completely unrelated to COVID. It could have been broken leg, it could have been a gunshot wound, those sort of things. So, that does contribute to our number some. Dr. George Ralls: (15:28) And in addition to that, we have some therapies in place. Remdesivir is a good example of one medication you may have heard about that we're using in the majority of our patients that are being admitted, and that medication actually does lengthen your time in the hospital. So there's an impact there to the numbers that accumulate, as far as our inpatient count, but very, very different right now than it was during the first wave in terms of how we're testing and what that inpatient population looks like. Not to say that the testing isn't useful. It's actually very, very useful for us because that's one of the best ways that we can mitigate spread within a hospital and maintain- Dr. George Ralls: (16:03) ... useful for us because that's one of the best ways that we can mitigate the spread within a hospital and maintain the safe environment we're trying to maintain here. Governor Rick DeSantis: (16:06) Are you guys doing any antibody testing? Dr. George Ralls: (16:09) Yeah. So antibody testing is an interesting sort of conundrum. What do you actually do with antibody testing? We do have the ability to do antibody testing in our system. We use it in very, very selected scenarios. Because if you look at any of the algorithms for antibody testing, whether you have antibodies or not, the decision about whether you can be contagious is based on the nasal swab. So we don't usually antibody test people, that tell them anything about infectivity. It's really more information if you will. Dr. George Ralls: (16:39) We are testing some people, both nasal swab and antibody testing on the same day and seeing some interesting results there. But it's available. Not heavily being utilized right now for the day-to-day decision-making in a hospital. Dr. Sunil Desai: (16:52) If I could just add, with the antibody testing, one of the things we have to keep in mind is the implication is that someone has had COVID, one. Two, that they're immune. Right now, the latter is not confirmed. We don't know to what level of immunity someone has, how long it lasts. So there is a danger of giving a false sense of, "Hey, I've got an antibody. I'm immune. I can go out and do whatever I want to," or for that matter, that you're not infected. You're not infectious, or you won't be able to spread it. So those are two different things altogether. And the science is still trying to sort that out. Governor Rick DeSantis: (17:28) In terms of the more recent testing, I think you guys, when you've been testing and you're typically, I think the number of people that would test positive would be what? Like 2, 3, 4% range? Dr. George Ralls: (17:40) It was right around 2% when we were in the first wave. Governor Rick DeSantis: (17:43) And then now I think, what? In the last seven days mostly, you've seen that that increase? Dr. George Ralls: (17:48) Yeah. Governor Rick DeSantis: (17:48) What do you attribute that to? I know some people have talked about, well, with the businesses opening and stuff. I mean, do you think it's because businesses are open? Do you think it's more social interaction? Dr. George Ralls: (17:59) I would say what we've seen in our percent positive rates, so the number of tests that we run, what percentage of those are positive, looks exactly like what we're seeing in the community. I mean, it's the exact same trend that you see in the state numbers for the county, as well as the state. Dr. George Ralls: (18:13) It really has to do with the fact that there's been more widespread community transmission, as we know. We've discussed. And that's translated into the patients that we're seeing. So we have pretty consistently been seeing percent positive rates that were just above 2% for several weeks through first wave. Even when we got into this sort of early part of the reopenings, we didn't really see a big jump there. It's really been in the last 10 days, and most concentrated in the last seven days, where we've seen that percent positive jump into the double digits now, sort of 10, 11, 12%. Again, very similar to what we've seen in the community numbers. Dr. Sunil Desai: (18:55) There's a lot of reasons potentially for that. Some speculation on my part, but if you'll see what's happening, it's hard to change behavior. It's hard to get folks to do what we need to do. But I think on the slide that you showed earlier, hand hygiene, social distancing, and wearing your mask, still the basics, they're shown to work and that's what we need to be doing. Human nature, it's hard to do. So I would attribute our rising numbers and greater testing is why we're seeing that. Governor Rick DeSantis: (19:30) But do you think it's rooted more in the fact that more businesses are opening? Or do you think it's more of on the social side? Dr. Sunil Desai: (19:35) It's on the social side. In fact, one thing about businesses opening, they've actually... We're working with businesses in central Florida, Orlando Health is. We actually have a whole group doing just that, helping them open safely, which is what we need to do. However, most businesses are using folks who are rooted in evidence-based medicine to basically implement these initiatives, and there's someone to answer to. So those employees actually, when they're at work, behave pretty well. It is the social where we, "Hey, we're with friends and family," and all of a sudden you're at a party and the guard goes down right, as opposed to in a business. So again, anecdotally, it's less likely pure offices opening. It's mostly social. Dr. George Ralls: (20:27) Governor, if I could just add, I think that's just a really, really important point to hit that. I think the community needs to think about where the risk really is, and it's where we let our guard down. If you're going into a business that's got great practices in place... We know there were some, as we heard from Secretary [inaudible 00:00:20:40], that aren't doing everything they should be doing. For the ones that are doing the right thing, you can maintain a safe environment and open a business. Where we're letting our guard down are the pool parties, or the social gatherings, or the places where we are not thinking about transmission, where we're not wearing our masks, where we're not thinking about social distancing. So it is completely compatible to have business reopenings and maintain a safe community. We just got to be really, really thoughtful about the way we interact in the rest of the times that we are around each other. Governor Rick DeSantis: (21:10) Great. Well, I really just commend here, Orlando Health and then Orange County, generally. I think if you look around the state, they have probably one of the lowest hospitalization rates per case. And obviously, as we noted today, they said, now with elective procedures, some of those are hospitalized with COVID, not necessarily hospitalized because of it. But still, that's happening all over, so it's not like it would only affect them. Governor Rick DeSantis: (21:35) If you look at their nursing home outbreaks, very few cases in nursing homes, here in Orange County. That's made a huge, huge difference, the fact that they have a lower per capita fatality rate compared to some of the other places. And I would say, if you look around the state, the counties that tended to have higher per capita fatality rates, it's almost always linked to having more cases in longterm care facilities. And so I think that they've done a good job. Governor Rick DeSantis: (22:03) And then also here, they do a good job contact tracing, so that when you have somebody, you're identifying outbreaks. And they've done a number of different outbreaks that they've been able to identify here. The positivity is because, I think you are seeing more contact community transmission. I do think part of it, it's probably a smaller part, but I do think it's a part is, when you're doing effective contact tracing, if I test 10 people off the street, the positivity is going to be one thing. But if I test 10 people who I've contact traced, that have been in close sustained contact with someone that just tested positive, well, guess what? They're going to be a little bit more likely to have cases of that cohort, and I think you're seeing some of that as well. But that's good work. That's what you want to be doing, to be able to identify an outbreak and then contain it. Governor Rick DeSantis: (22:48) In March, it was almost like you're flying blind because there was a limited amount of testing capacity. That testing capacity was really limited to the people who were symptomatic. And even beyond that, to people who were 65 and plus, 60-plus. If you are 20-year-old and healthy, in March, you weren't going to come here and get a test. That just wasn't the way it went. If you were symptomatic and younger, you still may not have gotten it. Now, we're in a situation where if you identify a potential cluster, you don't have to tell them to just... I mean, you can go test people, and we have that capacity to do it. So that really does make a difference. Governor Rick DeSantis: (23:29) We've seen this trend over the last a week or so. That'll be a part of helping to turn it back. I'm less concerned about the number of cases. I mean, obviously, you're going to have cases. For every case, there's probably 10 to 20 times as many infections in terms of the infection fatality rate, the way that's calculated. That's just the reality of the situation. But I do think that that infrastructure is very, very important to have, in terms of the testing. And then also, just to reiterate what some of the physicians said, you do have things like Remdesivir now. We worked hard to get that down... Governor Rick DeSantis: (24:03) You do have things like remdesivir now. We worked hard to get that down here with HHS, working with, I think Gilead was the company. That has been, that's gotten high marks throughout the state in terms of giving it to patients particularly early. And then as well, the convalescent plasma. We continue to ask people if you do have the antibodies consider going in to give blood, make a blood donation because they can use that to treat patients going forward. So I want to thank them for what they're doing. Governor Rick DeSantis: (24:26) Oh, a couple of things just about hospital capacity. We throughout the course of the pan ... so before the pandemic began, I think Florida's hospitals were running about 88, 89%. The census probably 88, 89%. Is that a pretty normal way a hospital would run? Dr. Sunil Desai: (24:45) Generally speaking, that would be normal. Yeah. Okay. Volumes took a big hit in the last six weeks and suffice it to say, we've seen that pent up demand come through with elective surgeries and folks hopefully not delaying their care and reiterating that we are safe. We're doing things in a thoughtful manner. So we are seeing those volumes go back up. One of the things I would want to reassure the entire Central Florida community is, particularly for Orlando Health, not only do we have capacity to take care of all of our community and patients, not only just COVID patients, but we have not even tapped into the surge capability should we ever need that. And we do have that, and that's a 30 to 40% capacity above our base so. Governor Rick DeSantis: (25:34) But I mean, so when you didn't have the elective surgeries a lot of the hospitals were running 60% full, which is totally abnormal makes it more difficult. Then we put the elective surgeries in, people started coming back for that. So the increase in the census from May 1st until now has primarily been driven, not necessarily by COVID, but by the elective procedures and then people going in to get more comfortable getting care again. Right? Dr. George Ralls: (25:58) Yeah. Probably one of the most important things to point out is the elective procedures are one thing, but there are a lot of medical needs that were put off as we had talked about the last time we were together. That has thankfully come back. People have come back to the hospital, they've come back to the primary care doctors, they've come back to the ERs with those really serious conditions that we saw them put off. And we saw some of the tragic outcomes last time. So thankfully they're back and that means volumes are up. But when you're looking at numbers, that 80, 85% capacity number again, had you looked at that number a year ago it would have looked the same. That is pretty much the way we look most of the time and we have a great capacity to surge in different directions, whether it's ICU or regular med surg beds as needed, depending what the volumes look like. Governor Rick DeSantis: (26:44) And I mean, I think statewide ... I mean, we've been between 25 and 30% for the last month ever since the elective procedures went on of available beds. I mean, so that's more than what you would normally have in the high season and obviously have the ability to be able to do different things. Because sometimes you see saying, "Oh, there's only 24% of ICU beds in Duval County." And it's like, "Okay? Well that's usually how they run it. It's not like that because there's COVID patients overflowing the ICU." So we just wanted to make that clear, but I want to thank them for all they're doing. I want to thank Halsy. Hopefully he won't need to be doing a lot of suspensions, but I reckon he's probably going to need to do a few more to really send a message. And so we'll all be waiting for that. And with that, I'm happy to answer any questions. Speaker 1: (27:33) Just like back on June 3rd and, I'm sorry, June 5th and June 6th, it was for observed at [inaudible 00:27:40] that they weren't following the rules, that they were packed [inaudible 00:27:43] as you have described it. Why did it take until whole now if it was observed by folks within the state that they weren't following the rules? Why wait until you got all those positive COVID tests? Secretary Beshears: (27:56) Well, thank you. The phase two actually wasn't hooked up until June 5th, which was that Friday. And so I don't know about the June 3rd, June 4th complainants. Governor Rick DeSantis: (28:04) They were doing that though. That wasn't authorized by any of our- Speaker 1: (28:07) I misspoke. I said June 5th and June 6th. So June 5th and June 6th, why wait? Secretary Beshears: (28:12) Well, when we received the complaint, I mean, we acted on it, that's it. So we've only received 106 complaints throughout the state since June 5th since phase two started. And every one of those we've acted on. And let me be, I want to make a point about that, the message that we pass down to our ABT agents, were everyone remembers when they were 25. I was 25 and I was 30 to remember that these people were, everyone's been locked at home. They want to get out. They want to just get some fresh air and stretch their wings a little bit. Secretary Beshears: (28:39) So to remember that, that everyone was going to do the best they could. These restaurants and these bars to allow people back in and try and maintain the governor's orders. There were going to be a few bad apples, we recognize that and we wanted to warn them originally and go back. Everyone that we visited and gave them a warning too. We went back, they complied. So we never got the complaint on them, that was through our original portal. We never received a phone call. As soon as I knew about it, we acted on it. Speaker 2: (29:05) Governor, I have a question when it comes to Orange County Mayors last week putting in a mass mandate here. He also mentioned that he had sent you a copy of his executive order and had suggested we have one statewide because the city of Tampa has done this as well. Why haven't we seen a statewide mass mandate? Governor Rick DeSantis: (29:21) Well, we recommended advice from the-