Gov. Gavin Newsom of California COVID-19 Press Conference Transcript March 30

Gavin Newsom: (00:00) Porterville and now working with the Army Corps of Engineers that has now looked at 15 high priority sites. They've got four more that they'll be looking at from the Sleep Train Center here in Sacramento to Oakland Coliseum to the LA Coliseum and other sites throughout the state of California. Looking at those sites as potential surge sites, all part of the plan to increase by 50,000 beds available capacity within our healthcare delivery system. We have distributed now some 32.6 million N95 masks in the state of California. We have our sights on getting that 101 million that we have locked up into the state, and every couple of days more of that PPE comes in, not just N95 masks but coveralls and shields and gowns and glove sets and the like and so soon as we get them in, we get them out. Yesterday we were getting in a number of ventilators in to Bloom Energy for refurbishing and reconfiguration. Gavin Newsom: (01:09) I'm very pleased the 150 that came from LA as part of the national stockpile, all of those have been completed and are done and are being sent back out into LA County. And I just want to encourage folks, if you have a line on ventilators, it doesn't matter if they're brand new, maybe you have a few pieces lying around your basement or the house, I don't mean to be flip here or flippant, we'll take them. We've got the folks here in Silicon Valley, they can do miracles with old equipment and refurbish that equipment. I just mentioned a few days ago that our community college system, they found 192 ventilators, not all of them in perfect shape. Some of them used for training and the like, but we'll take whatever we can get. And we currently have 4,252 ventilators that we've locked down, our goal is to get to 10,000 ventilators. Gavin Newsom: (02:03) We're looking to procure new ones from around the globe and we're hopeful that the federal government can assist us beyond the 170 that came into LA County, but if they don't, we'll be as resourceful as we possibly can. So on the physical asset side, that surge of 50,000 beds, we're making real progress. On PPE and lining up and identifying those needs, we're making progress but still more needs to be done, but as it relates to personnel and people, nothing more valuable and nothing more potent to meet this moment. And so if you're a nursing school student, medical school student, we need you. If you've just retired in the last few years, we need you. If you are looking to expand your scope of practice and have particular expertise in any particular capacity, we need you and we encourage you to take a look at that healthcorp.ca.gov website, five simple steps. Gavin Newsom: (03:02) We'll ask you basic questions and we'll help you with your relicensing. We'll help you with the protocols and processes to get you up and running and get you out the door so that you can support the needs of people in the state of California, all throughout our state. We've seen an increase modest 8.3% in terms of total number of positives last night, 5,763 total COVID-19 positives in the state of California, but it's those hospitalization numbers, it's those ICU numbers that we are most focused on and again, those numbers are starting to go back up again along the lines of our model. So the next few weeks are going to be critical in the state of California, in the next few weeks we're going to do more to flex and to surge and do more together to meet this moment. And before I turn it over to the doctor, I want to just remind people of how they can meet this moment. Gavin Newsom: (03:59) All of you that have the capacity to contribute can contribute most significantly by practicing physical distancing, by continuing the good work that we've done in this state, including over this weekend, we had to shut down all 280 parking lots in our state parks system. We saw a reduction in the surge of activity in our parks and our beaches compared to the previous weekend. But we want you to continue to do that. There's nothing more potent and powerful in terms of meeting this moment than practicing that physical distancing. Socially connected, let's be resourceful in addressing the needs of others and I couldn't be more proud of our partnership with Nextdoor and the volunteers, some 8 million people they were able to connect with to check in on our seniors, to check in on people that are struggling with social isolation and may need not just food and medicine, but also may need a person to call just check in and see how they're doing. Gavin Newsom: (05:00) So nothing more important for individuals if they want to contribute in this moment that continue to do the incredible work you have done in the nation's largest state to practice physical distancing. Number two, I just want to remind people that if you know anybody in the medical profession, if you know people that you think are willing to contribute their time and energy in a compensated way to go to this new website so we can meet the healthcare surge as well. So partners, well, across the spectrum, private sector, Facebook, the public sector with incredible contributions of nonprofits and civic minded individuals will continue to row in the same direction. Gavin Newsom: (05:45) Continue to meet this moment as we have in the state of California. In addition, and happy to answer questions, we are significantly increasing our efforts on homelessness. I'm to go into details around that, but I want to now turn it over to Dr. Constant who has been part of our partnership with the California Medical Association working across the spectrum of healthcare professionals that helped us with guidance and was willing to again work with us to create the flexibility and to create the licensing reforms that temporarily are needed to meet this moment and I just want to thank Dr. Constant for that effort and her energy and ask her to come to the podium and talk a little bit more about what we're looking for on the medical side for this surge. Doctor. Dr. Constant: (06:42) Thank you. First, I wanted to take this moment to thank governor Newsom and California's public health leaders for the swift action that they've had in terms of our physical distancing and our sheltering in place because it is really helping the healthcare team. It's helping us, the time has really been crucial to help us learn about this new virus as healthcare providers, how best to treat it, and how to create the systems of care so that we're there and ready for the sickest when they need us. Today is National Doctor's Day, and I want to first extend my heartfelt gratitude to all my physician colleagues as well as everyone in the healthcare world taking care of our patients for your vital service at this time, for both our patients and our communities. This crisis is already impacting thousands of physicians across California, not just those who are directly taking care of COVID-19 patients, but also the thousands of others whose practices have been forced to close over the past several weeks. Dr. Constant: (07:43) But even admits this uncertainty and personal hardship, over 500 physicians have reached out to the California Medical Association to ask, how can they help during this time, either directly treating the sickest patients or stepping in to help fill in the gaps for the people that are taking care of our sickest patients. In fact, all members of our healthcare team are showing tremendous courage and bravery continuing to treat patients even though they worry about the personal protection equipment that they need to keep them safe. I am very grateful to governor Newsom for his intense focus on delivering the personal protective equipment to our workers who are on the front lines of this pandemic to ensure that California is doing everything that they can to protect our physicians, our nurses, and all members of the healthcare team. Many of us were drawn to careers in medicine because of the opportunity to truly help others. Dr. Constant: (08:41) This is the work that we've been called to do, now is our time. We're asking all medical professionals, physicians, nurses, physician assistants, and all members of the healthcare team to join us, to take care of Californians through this surge. For many of us, that means stepping outside of our comfort zone and leaning in to our inner strength. We're calling on the spirit of all healthcare workers across California to step up and help to serve the patients of our state. I've been humbled and deeply moved by the many stories of the physicians and others whose true selflessness has really led with compassion and heartwarming caring solidarity through this. I know we're going to hear many, many, many more stories of this true humanity in the weeks to come. So thank you to all of you who've already worked long hours and who will continue to work tirelessly to help our patients. We truly appreciate you and thank you in advance for your continued courage and your service. And please reach out to the healthcare, sorry, healthcorp.ca.gov to sign up to be here for our patients and our communities. Thank you. Gavin Newsom: (10:03) Thank you doctor. We're all struggling with the healthcorp.ca.gov site, but we just got it up and operationalized it. Look, I want to just make this point. I'm very proud, California has some of the... Well, the highest standards of personal protection, long champion by the medical association, long champion by the California Nurses Association in terms of ratios, in terms of protective gear and those are things that we are very, very proud of. And I recognize at this moment of anxiety, in order to meet this moment, we've got to temporarily suspend some components of some of the licensing and scope of practice as it relates to meeting the care needs of those Californians. Gavin Newsom: (10:48) And so it took a lot for those organizations to participate and step up, and I want to just thank them personally on behalf of millions of Californians. We're very grateful for your willingness to do so at this moment. And again I'll remind you, this is temporary, this is not permanent, no games are being played and we have deep admiration and respect for all of you and deep gratitude that you're willing to work with us to meet this moment. So with that broad strokes, that's the call to action today to all California healthcare professionals to help participate and go on this site and we look forward to any questions that anyone may have as well. Speaker 1: (11:29) [inaudible 00: 11:31]. Speaker 2: (11:34) Governor, we understand that the California Department of Health won't release the total number of hospitalizations County by County. Is that a number that you have? Do you have the statewide number of hospitalizations? And if so, will you make that more publicly available given how useful it is to track the disease? Gavin Newsom: (11:54) Yeah. Well, it's 1,432 as I said, that number substantially Gavin Newsom: (12:03) higher than the first number we gave you a couple of days ago, which was 746, as a consequence, roughly doubled in four days, and we'll provide more information on that as needed. The number of ICU beds today is at 597. You may recall four days ago it was at 200, so can't be more precise than that. We have a 19.9% increase overnight in the ICU bed capacity, and a 14.3% overnight increase in the hospitalization capacity. As it relates to your very specific component of question as it relates to the County level, we will provide that information. I'll make sure you get it. Operator: (12:41) Carla Marinucci, Politico. Carla Marinucci: (12:44) Hi, governor. Thanks for doing this. I have got a two part question. I hope that's okay. On the first one, we're two weeks into the Bay area shelter in place orders, and California as a whole is fairing better than a couple of other states, New York, New Jersey, Louisiana. Just your thoughts, do you think that those orders have flattened the curve in the Bay area as some UCSF doctors suggested over the weekend? And my second question is on the school closures, we're three weeks into those, and some of the schools are providing instruction in different ways. Some are giving video classroom lessons, others are pointing families to websites with worksheets. Does the state need to do more than just provide guidelines, and what do you think are the situations in which districts and teachers are engaged in dispute? I hope that's okay, but two part question. Gavin Newsom: (13:32) Thanks. Let me talk about the schools. At 2:00 today, all 58 County superintendents are getting on the phone and we'll have more detailed information to provide you after that conference call that goes deep into the issue, not only of distance learning, but special education and the issue related to food distribution. That's the agenda today. And then, a very sober conversation we're going to have about the expectations for the remainder of the school year. But the answer to your question is yes, we need to do more, and let me fill in the blank space on the details that come out of that call this afternoon. And by the way, on Thursday, we have another webinar specifically related to distance learning for special needs kids as well, which only reinforces my affirmation that yes, we need to do more, and we are trying to do that in real time. Gavin Newsom: (14:30) As it relates to the bending of the curve, we're in the middle of this. And I think it would be too easy for us to assert a belief at this moment about what has or has not worked except to say this: we know what does work, and that's physical distancing. And we believe very strongly the stay at home order has helped advance our efforts in reducing the stress on the system that we believe would have already materialized in more acute ways, had we not advanced those protocols when we did. Gavin Newsom: (15:06) We have not been sitting around over the last a week or two. We have been preparing over the last week or two, and that stay at home order has advanced that effort. It's bought us time to prepare, but I want to make this point. I made it from the outset. When you see a tripling of the ICU beds, when you see a doubling of hospitalizations just over a four day period, that's a point of not just consideration, it's a point of obvious concern as it relates to our ability to meet not only the physical needs of that surge, but the personal protective equipment that is required of it, and obviously the human capital that we're speaking of today. And so, I don't want to say that it's worked, but I will say I think we have benefited in terms of our capacity to prepare, but we're very sober about what these trendlines are looking to, looking or at least instructing over the next couple of weeks. Operator: (16:11) Adam Beam, associated press. Adam Beam: (16:14) Governor, you mentioned you wanted to increase the number of medical workers by about 37,000. That just seems like a really large logistical challenge. I'm wondering how the state can go about doing that in a short amount of time, and do you know where they would go? Would they go to field hospitals or existing hospitals or both? Gavin Newsom: (16:33) No, and thank you for the opportunity to clarify. That's just the universe of individuals that are retired or inactive licenses that we project are out there, so that's not the number that we're trying to bring in. That's the universe that we're trying to call from, so we're looking for thousands and thousands of individuals, and again, it depends on the expertise. It depends on the specific skillset. And we're parsing those out throughout the system, working very collaboratively with our entire hospital system as well as our skilled nursing facilities, our assisted living congregate facilities, and the like, it's all part of this larger system. And so, we're scoping a universe of 37,000, and those will break down in real time and it's geographic, it's system by system, it's capacity that we're looking for. Let me be specific. When we open up the sleep train center, it's a capacity we're looking for when we open up these vehicle field medical stations, that capacity differentiates itself on needs. In Riverside, they may have certain needs. Santa Clara County has different needs. Counties can absorb more, in these more resourced parts of the state, they can absorb less, so we have to supplement that in other parts of the state. So it's an interim process, but the universe is 37,000, and thousands is the number that we hope in very real terms in short order will present themselves and we can start making those matches. Operator: (18:12) Rachel Swan, SF Chronicle. Rachel Swan: (18:15) Hi, governor. I just wanted to clarify again about this 37,000. The nursing students you mentioned, would they be granted provisional licenses to practice, and then what would happen after the pandemic is over? Would they go back to school, or what would happen? Gavin Newsom: (18:31) Yeah, let me ask Dr. Galley to come up. He can talk specifically about that. Dr. Galley: (18:36) Sure. Our goal is to recruit both retired, inactive folks, people who have part time roles now, who can increase their hours, and to your specific question about students, depending on where they are in their training, we're obviously looking to people who were near graduation and fulfilling their degrees. Many are not able to finish those last few months because schools are out because of the COVID-19 response. So, who better than those folks who are really close to being done, to bring into the workforce now, essentially continue their clinical training with the support of experienced nurses or other health professionals that are in the same line of work that they will be, and invite them into the work? And depending on where they were and how many months they are surging, we will have to work with our licensing boards to determine whether they've completed enough of their training to get fully licensed on an ongoing basis, or whether they need to return back to the classroom and their clinical rotations to finish up and get their license down the road. Gavin Newsom: (19:46) Next question. Operator: (19:48) Angela Heart, Kaiser health news. Angela Heart: (19:51) Hey governor, thank you for taking our questions. We wanted to ask, looking at your projections and the modeling that you all have done, when do they indicate that the state could be reaching the capacity in terms of the hospital beds needed? When can they be overwhelmed, roughly? If you can't provide a specific date, when roughly would that happen? And then just one more thing to tail on the end of that is, we're wondering if the state's plans to expand capacity are being done in addition to what individual hospitals and hospital systems might be doing, or is it spearheading the across the board response? Gavin Newsom: (20:30) Just on that, we are working hand in glove within the system. I'll remind you roughly 75,000 licensed beds in the state of California. We requested a surge of the system, 50,000 beds, 30,000 of those a requirement within the hospital system cells, which represents roughly a 40% surge and so that's actively being advanced within the hospital system itself. We are required for the additional 20,000 to go out and access and resource additional capacity. As I said, USNS Mercy is part of that. All of these field medical stations are part of that, and all of these other hospitals that we're bringing online, Fairview, Porterville, and these other assets that I referred to that the Army Corps of Engineers and others are looking towards are part of those 20,000. So that's an integrated strategy within and externally outside of that system, but all being coordinated through the folks here at the state operation center. As it relates to your other part of the question of when we're seeing peak, that's determined on the basis of our personal behavior. That's determined on the basis of abiding by the stay at home order, making sure essential versus non essential business is being conducted, and on the basis of our modeling and projections over the last weeks, not just this four day period that I gave you as a snapshot. Gavin Newsom: (21:59) I can just say this without getting into the specifics and showing you a chart of a worst case scenario or a best case scenario, and having people run with those things, that over the course of the next few weeks, we are very confident that in the aggregate, and that's a distinction, in the aggregate, that we will be able to resource the needs both physically, and if we're successful with the healthcorps.ca.gov efforts with the human resources. In addition, though, I continue to make the case that PPE and the supply side of this continues to be a challenge, despite the 32,600,095 masks we put out, tens of millions have already been requested of the state throughout our system and beyond the system. As you know, this is a huge issue for our grocers, big issues for those that deliver the groceries, and many others that are also looking for personal protective gear as well. So we need more work there, resource on the health and human service side. But over the course of the next few weeks, I have some confidence in our capacity to meet. At the moment, Dr. Galley can help fill in and amplify or redirect consideration to what I may have just said. Dr. Galley: (23:19) Governor, you hit it right on the nose. I think at the moment, the modeling that we show and where we are with our projections and actuals is that our current efforts around surge meet the moment, and that we're able to take care of anybody who needs a hospital bed today, anyone who needs a ICU bed or needs a ventilator, and our efforts to increase staff, increase beds, increase supplies, are on track to continue to meet that for weeks to come. And just to reiterate what the governor said, that as we continue our physical distancing efforts, that those are going to help us change what those curves and lines look like, so to continue supporting our neighbors and our communities to do that- Mark Ghaly: (24:03) well is of utmost importance. Gavin Newsom: (24:07) I know it's an old mantra. Decisions, not conditions, determine our fate and future. Decisions, not conditions. So, I don't live on the basis of economic forecasts any more than healthcare forecasts. I live on the basis of our capacity to bend curves, to change expectations by changing behavior, and that's why what Dr. Galley said is so foundational, so incredibly important. Gavin Newsom: (24:33) The power and potency we have as individuals to radically change these projections that resides in each and every one of us and each and every decision we make each and every day. And that social pressure we're seeing out there for people to do the right thing is the most powerful enforcement tool we have and we will continue to use that as our moral authority has advanced all throughout the state of California. Gavin Newsom: (24:59) And to the extent we have to exercise our formal authority as it relates to licensing and business revocation because people abuse it in law enforcement, we will. But again, I'm just incredibly blessed and pleased to live in a state where so many people get it and increasingly are getting it done. Next question please. Speaker 3: (25:18) [inaudible 00:25:18] Los Angeles Times. Speaker 4: (25:21) Hi Gavin. I have a two part question. So one is based on your community surveillance testing, in your modeling that you've done today, how many people do you think are infected with the virus in California? And then the second part kind of adds on to what Angela asks, but I'm curious why you're reluctant to give a peak state and why Californians you shouldn't know the date that the administration is working off of right now. Gavin Newsom: (25:45) Well, because first of all, I'd just on that, it's a dynamic model and it radically is different. I can assure you that it was just four or five days ago. And if we had a model that I can more confidently say based on all of these conditions and everything being static, then we would provide it to you. But I can assure you we are running those models in real time. Gavin Newsom: (26:09) And remember, these models aren't just on the basis of current infection rates or the community surveillance and the testing. It's also on the basis of movement. It's based on all these inputs. We mentioned this a few weeks ago working with Esri, working with Blue Dot, working with Facebook, Apple and others. We have our modeling that is done on a daily basis based upon these patterns as well as patterns across the rest of the country and around the rest of the world. More specifically though, Dr. Ghaly can fill in a little bit more in terms of making sure that you're satisfied that we are providing that information in real time and give you a sense of preview of our thinking as it relates to making more public those best and worst case scenarios. Mark Ghaly: (26:59) Sure. I'll come back to the number that the governor uses frequently, which is our 50,000 additional beds. That number is based on the model, so we are preparing it. We call it our phase one number because we know that depending on how we perform with our physical distancing efforts across the state, that that number is tracked towards an expectation that we meet this moment with physical distancing and that's what we're going to need based on our models. We project that we will need that towards the second half of the month of May. So we are very busy trying to build towards that. That includes at least an additional 10,000 beds in an ICU setting with ventilators to be able to support that number of patients. So those are the numbers we are certainly working towards. It does not mention the total number of people who are infected or who tests positive because that is highly dependent on our increasing work to bring on testing. Mark Ghaly: (27:59) But the lives and people in emergency rooms and hospital beds and in ICUs requiring ventilation support do not lie. We have good intel until those numbers on a daily basis with all of our healthcare partners and we believe that will continue to guide us on this road that we've been on towards that middle of May target. And we are constantly reassessing, as the governor has said. These numbers are very dynamic. We know that every single day we get additional information about what the actuals are that help us adjust that model and we hope because of our great performance here in California with physical distancing that we will continue to tell positive stories of where that's going. That said, we continue to prepare for a situation where we'll need at least 50,000 beds and if we need to adjust that and say we need more down the road, I'm confident and the governor will be communicating that to all of you in real time. Gavin Newsom: (28:57) I should just note on on the modeling, one of the areas that is also dynamic is not just on the surge modeling but the slack within the system. Meaning the hospitals have done a magnificent job as it relates to reducing the number of elected surgeries and reducing the total census within the hospital system. To a degree that candidly in our original models we did not anticipate. It just goes to the incredible capacity within this system to prepare for this moment. And so as a consequence on the surge that slack, that number phase one still remains around 50,000 despite all the other changing conditions in and around our modeling. Speaker 3: (29:40) [inaudible 00:29:42]. Speaker 5: (29:47) Hi governor, thanks for taking questions. Can you more explicitly explain how far the executive order goes in terms of suspending the rules? What exactly are you waiting with respect to staffing ratios and scope of practice? Gavin Newsom: (30:04) Good. And I'll let Dr Ghaly who helped prepare it answer that in more detail. Mark Ghaly: (30:11) So essentially we, on two fronts, I'll mention it does mention the ratios and allows us to work with our facilities and our labor partners to move beyond our current ratios whether that's for nurses or other staff positions so that we can meet the demand and our surge facilities and existing hospitals. Mark Ghaly: (30:33) So it is not specifically outlined to the number, but it does give us the flexibility and room to work within reasonable measures with the conditions we expect. In regards to who we are inviting back into the workforce or accelerating them into the workforce, there are a number of things that have to do with who can get licensed, how they can reinstate their license and being flexible and waiving some of those tried and true conditions that allow us to, for example, somebody who's been out of the workforce for just under five years or five years and less to allow them to come in immediately to meet the surge demand on health workforce. Mark Ghaly: (31:19) So, it's both in the areas of staffing ratios as well as allowing individuals to come into the workforce that are currently not there, but do have the capability of being licensed very quickly. Speaker 3: (31:36) Jonathan [inaudible 00:31:37]. Jonathan: (31:41) Well governor, thanks for taking questions. Wanted to see if there were any updates on numbers for testing kits as far as how many are available to the State for those testing for Covid-19. How many are needed and what the backlog is for pending tests right now? Gavin Newsom: (31:57) Well, the biggest backlog is swabs. It's now the principle limiting factor of our ability to increase tests throughout the State of California. Swabs as well as the media to transport the swabs. We continue to need ... though this becomes less of a restrictive reality, the reagents, the RNA extraction kits, but for some of the other older protocols, old by standards of days, not just weeks, we obviously see the need for more of those reagents and RNA extraction. That said the new throughput technology that's coming on, all of the announcements you've heard in the last 24, 48 hours including this morning, there is not a company that has been referenced either by your own reporting or someone else's that hasn't been in contact with us, that we're not in contact with, but I want to caution folks on this. The scale ability of some of these promoted testing protocols, 10 minute home test, 45 minutes, whatever it is, the scalability is not there as advertised, and I say this because we are practitioners of this, we have the resources and we are deeply engaged with these companies. Gavin Newsom: (33:14) They have many parts but they are missing some others in order to adopt and strategize the kind of scale that is being promoted and people are demanding and deserving of. To answer your question is we need exponentially more testing throughout the State of California and we've been looking at advanced conversations, looking at blood-based tests, looking at the antibody frame which is all part of our strategy to get people back and move from dealing with this crisis head on to coming back into some semblance of normalcy and those protocols and those processes, those negotiations are happening in real time. I mentioned just yesterday we were down, or day before, at Bloom Energy right next door to us was one well known ... at least, well, discussed company in that space. They're a California-based company. We're engaging them along with many, many others. I don't know if doctor you want to amplify this a little bit more but this is in real time 90% of what I think Dr. Ghaly is doing. Mark Ghaly: (34:18) That is the case. We are working with just about every testing entity that we can reach out to to figure out what they can provide California. We know that it's not going to be a single solution. As the governor said, there's not one company or one strategy that's going to make a difference. We continue to work on the PCR tests, which are the ones that I think many people are familiar with and now moving into the serologic testing zone to allow us to bring on another modality to meet our testing needs across the State. Mark Ghaly: (34:55) We continue to work very hard to make sure that people on the front lines, our healthcare workforce, our first responders get the testing they need to feel safe and confident that they can be with their families and continue to work. And additionally that we get patients in the hospital who we aren't sure if they are Covid-19 positive, but we suspect they are based on their symptoms, to test so that we can take care of them in the safest, most efficient way. Mark Ghaly: (35:22) So all of those priorities, not withstanding, we continue to grow our testing capacity, both that that's sponsored and supported by the State, but those efforts that are happening locally, County by County, system by system, and we're here to fill in those gaps, supporting those systems to be able to scale on their own. So that together, the local story with the state story lifts up an enormous amount of testing available to all Californians so that our projections can be validated and we can look into the future with a little bit more information. Gavin Newsom: (35:57) and just to provide a little bit more information. It's not just the specimen samples, it's not just the- Gavin Newsom: (36:03) diagnostics, it's how long a diagnostic process is taking. The number of pending tests out there is extraordinarily frustrating because of the delay in getting that information back into the system, into the patient's inbox, and so tens of thousands of tests have been conducted but we do not have the results yet and that's the number of PUIs that we referenced, people under investigation within the hospital system in our ICUs that we have made public over the course of the last few days and we'll continue to make public, but also more broadly men and women that are watching first line, first responders and frontline employees that deserve to know those test results. You're hearing six, seven, eight, I heard an example of 12 days one case to get those test results. We need to see that improved as well. Speaker 6: (37:02) Final question, Elizabeth Aguilera, Cal Matters. Elizabeth Aguilera: (37:07) Thank you. I wanted to ask just if I could do a two part question. The first question is the Health Corps site that you're talking about says that this is going to be paid for and that physicians or other healthcare professionals who sign up will be paid malpractice insurance will be covered. Can you discuss if the state's going to be covering that, if the entity that you send folks to is covering that and what is the estimated cost or the budget line for that at least now not knowing who or how many people might sign up. And then on the second question maybe for Dr. Ghaly is, can you be more specific regarding changes to scope of practice, especially regarding nurse practitioners and physician's assistants? Because other states have been giving independence to those professionals and there's also been discussion in the legislature for several years regarding that as well. Gavin Newsom: (37:55) Yeah. Well, we're providing the temporary flex in that space through June 30th and those conversations we're all intimately familiar with in the state of California, particularly with our nurse practitioners, but this order does provide that flex through June 30th. Let me speak about the costs. The costs are being born in a myriad of ways within the system by the state as well as the federal government, FEMA and their reimbursement processes. Obviously the federal support that we're receiving will help us with those efforts. The cost, though, we will address and is being processed in real time and I can assure you cost is not the issue. From my humble perspective, we are always mindful of cost and we do not believe in waste or abuse. And by the way, let me talk about abuse. When it comes to procuring PPE, the scams out there are real. People are being investigated, not just for price gouging, but investigated by FBI and others. Gavin Newsom: (38:59) I just caution individuals again and this is a time individually, not just for large institutions like states and hospital systems to be very, very wary. People that over promise and don't deliver at all, let alone under deliver and people that are scamming individuals at the moment. But we are not in that business. And we will provide appropriate compensation for individuals, and that comes through the traditional system that provides those support. The Medicaid system, Medi-Cal in California, Medicare, a myriad of other supports that come through the federal government as well as the state government and Dr. Ghaly, you want to amplify the nurse practitioners. But I think that question was answered June 30th temporary and ratios along the same lines as well. Dr. Ghaly: (39:55) The only thing I would amplify is that we set dates around this and we are always looking at whether those are the right dates based on the conditions on the ground, and as the governor said, this is not ... There is no effort here to extend beyond our surge need any of these flexes or rule changes because we are sensitive to the ongoing conversations with a number of people who are here with us now and haven't been as much in recent days that these are decisions that Californians take very seriously, that we work hand in glove with our legislators and our trade organizations to make in this unique situation where we are prepared to meet the needs of thousands of Californians. Tens and thousands of Californians needs this now, and we will be looking at it over the weeks and months to come. Gavin Newsom: (40:47) Thank you. So that that concludes this conversation. Look forward to many more in the next couple of days. Let me just make one closing statement. I just want to thank our partners at the county level and the city level. Darrell Steinberg and many others, Marilyn Cardo and Mayor Garcetti, Mayor Libby Schaff, I can continue. Mayor London Breed, others that have been active in trying to get resourced through the state's procurement of hotel rooms for homeless individuals. We're up to over 5,000 hotel rooms now that are available at the county level, at the city level. We recognize we need to do a lot more, some 5,491 rooms to be precise. We're getting those trailers out but we don't want to get them out until we have the support services overlaid. We'll be meeting with CSAC on the phone, teleconference today to talk more to our counties about how they can continue to support the most vulnerable Californians out on the streets and sidewalks. Gavin Newsom: (41:55) Again, top priority for us, and we recognize we have a lot more work to do in that space as well. I'll just close by reminding everybody at home, we also have a lot more work to do to continue as patiently as we can to extend the stay at home order and recognize that if you've ever gone skydiving, worst thing a human being can do is cut the parachute when you're not even close to the ground. We're not yet close to the ground, so let us not run that 90 yard dash. Let's continue to follow through on the incredible work that's been done and the commitment that we all have to meet this moment head on. Take care everybody.