Missouri Gov. Mike Parson Coronavirus Press Conference Transcript April 22

Mike Parson: (00:01) ... Billy Birmingham. His death is the first known COVID-19 line of duty death of a first responder in the state of Missouri. In the face of this public health crisis, Billy and our other first responders have repeatedly and without hesitation risked their own health and safety by responding to emergency calls. His death should serve as a reminder to appreciate all of our first responders and healthcare workers serving on the frontline of COVID-19. Throughout our COVID-19 response, we have been in constant communications with doctors, hospitals, healthcare providers, and public health experts across the state. Based on numerous conversations and recent data, the common theme is that Missouri is beginning to stabilize and flatten the curve of COVID-19. A couple of weeks ago, Dr. Whitt from the University of Missouri Healthcare joined us to share some positive news about our social distancing efforts. Dr. Whitt is one of the seven infectious disease and critical care doctors that are part of the COVID-19 advisory panel. Mike Parson: (01:22) Today we are happy to have another one of those doctors join us. Dr Robin Trotman, Medical Director of the Infectious Disease at CoxHealth in Springfield. Dr Trotman is here to share more of his positive trends that we are seeing across the state. I also want to say Dr. Trotman from the CoxHealth Center has been a leader when this all began a short time ago of about 40 days ago, 41 days ago when this all started. What they've done in Southwest Missouri is pretty incredible, so we're glad the doctor has taken time to come up here today to visit with you about the testing process. Dr Trotman. Dr. Trotman: (02:03) First, thank you governor for the opportunity to update you and the state more broadly on what we've been doing. I think it's important for people to know that this advisory group has been put together and we meet virtually on a regular basis. The suggestions and the observations that we've made over time have been heard by the state. We've seen these things implemented, we've seen policies come out of these discussions and it's something that I'm happy and proud to be part of. I think that this has afforded us time to prepare for a surge of patients. I know the other doctors on the call, maybe in St. Louis and Kansas City, have gone through more struggles than we have in Southwest Missouri, but what it's done across the state is it's afforded us some time to prepare both locally, regionally, and across the state. Dr. Trotman: (03:02) I believe that it's this preparation that we've done, statewide action, whether it be shelter at home ordinances, or whether it be restrictions on movement throughout the community, I think it's these groups of efforts, it's cooperation with the public ... I'm so enthusiastic about how the public has understood the consequences of these shelter at home ordinances and restriction across the community. It's been invaluable to afford us the time. We have literally bent this curve. We've flattened this curve because the models that would have predicted tens of thousands of deaths across the state, those models were informed based on data of how the virus usually would typically replicate if these interventions were in place. By putting these interventions in place and not letting infected patients expose as many other potential patients, we've reduced the number of cases and we've afforded the healthcare systems time to get prepared. Dr. Trotman: (04:11) It's been quite an effort. It's been a lot of work. We've made some discoveries. We've done some things that we wouldn't have thought we would have ever have to resort to. But I can tell you that we're prepared. Specifically in Southwest Missouri, I can say that we're prepared for almost any rational type of scenario, almost any surge. We're also prepared for people to reenter the medical systems for their routine medical care. I can tell you that now we have multiple test modalities, multiple platforms in place. We're working with several different labs. We're working on in house testing. We have ICU beds and we have capacity. We have ventilator capacity. We have the personal protective equipment, whether it be the masks, the face shields, the gowns. We have innovative ways to reprocess this equipment that never before would I have dreamed we would be reprocessing what is typically a disposable mask. But we have ways to validate these processes. We know they're safe. Dr. Trotman: (05:11) We also have treated our first patient with convalescent plasma. I'll talk a little bit about that. We've enrolled patients in clinical trials and we're working with other healthcare systems collaborating. Cox and Mercy in Southwest Missouri have worked with Green County Health Department to stand up a mobile testing unit. For about five weeks we're testing 60 to 80 patients per day, keeping them out of the healthcare system, providing quick, 24 to 48 hour results. It's this preparation that has allowed us the luxury of having conversations to even discuss reducing some of these restrictions, some of these statewide ordinances. It's because we've had this time and support to prepare. Dr. Trotman: (05:55) I know that our health departments are strong. Our state has great local health departments. I know we're going to be able to monitor this disease as we move forward, as we relax some of these restrictions. I'm working with our local health department to monitor hospital preparedness. The healthcare system's job is to be prepared. The public health's job is to identify infected patients, do the tracings and isolate those, and hopefully mitigate subsequent transmission. Right now these processes are stood up and ready to go. We're communicating with the health departments on a daily basis. These are really exciting new developments that, before this pandemic, I was never part of. Knowing that we have excellent relationships with public health and the health care systems is encouraging. Dr. Trotman: (06:47) The other thing I want to emphasize is that we know that routine healthcare has to continue. There are going to be non-COVID based trickle-down consequences of people not seeking out their operations. These have been called elective procedures. I would prefer to call them medically necessary and time-sensitive. People are going to have to resume their standard medical care and we're aware of this. I want people to know that the healthcare systems are safe. We're taking exhaustive measures across the state to make these clinic offices safe, to make it safe for a patient to come in and have a procedure. People need to feel safe reentering the healthcare system. We're cautiously re-expanding our services. We're working with the health departments to monitor disease. We're monitoring our staff, our stuff, and our space. Those are the three S's that I like to use. Dr. Trotman: (07:39) What that means is our personal protective equipment, our assets as far as testing, making sure our healthcare workers are well. I want people to know that they don't need to be afraid to reintroduce the healthcare system. It'll be different. You might sit in your car and you might make a phone call before you enter. You might be called in instead of sitting in a crowded waiting room. The offices are clean. The health care workers are being screened for symptoms. I want people to be encouraged to reenter the routine medical care on a slow, calculated basis. Dr. Trotman: (08:10) Then there's three other things that I want people to understand. I want people to be flexible and understand this is a dynamic process. As we release some of these restrictions and as the healthcare system starts to normalize again, there may be bumps in the road. We may see blips in disease, but we're going to be aware of those and we're following those along with the health departments. We may even have to resume some minor restrictions in movement as we release some. If people will be patient with us, this is going to be a long haul. I know that lifting the shelter at home is going to be an answer to prayers, but this is all contingent on people around our state adhering to those same fundamental principles of keeping your distance from people, being aware of your surroundings, not going to work if you're sick. These little things like hand hygiene, maybe you still wear a mask in public, those are what are going to afford us the ability to continue to release these restrictions in our movement and will make it safer across the healthcare system. Dr. Trotman: (09:15) Then the last thing I wanted to talk about is for the people who've had resolved disease. We've had some hints, some little clues, that we might have an effective treatment in what's called convalescent plasma. That would be where, if a patient had Coronavirus infection, they had the COVID disease, after a few weeks when they're better, maybe three weeks, they might seek out a call to their primary care doctor or the blood bank or a local health care system and see if they would be a candidate to donate plasma. That would be like a standard plasma donation, except the thought is it has antibodies that might protect another patient. The next patient that we have that's critically ill in the hospital, it would be wonderful if we had these tools, this plasma that's banked. Dr. Williams and the Health Department issued a press release a while back. We're hoping people will start- Dr. Trotman: (10:03) Issued a press release a while back, and so we're hoping people will start to consider, once your disease is resolved, donating plasma. The other things that I wanted to talk about are the things that have made me excited to be part of this healthcare system, part of the statewide mission reprocessing personal protective equipment. Again, something I never thought we would do. We have support from the state. We're doing it locally. These were exciting new things that we're doing. We're making PPE. I think a lot of cities have brought in private business to make things like shields or gowns, and we're doing that in Springfield as well. And we're enrolling patients in novel drug studies, and we're learning as we go. Dr. Trotman: (10:41) So there is some hope. There are some exciting things that I think we're going to take on the back end of this. I'm encouraged about the humanity, and respect that's being given to healthcare providers with this. I want people to understand that on the end of this, it may be a bumpy road. Things are looking good. We have excellent statewide support, testing capacity, and I want people to know that there is going to be a brighter side on the end of this. That's all I had, governor. Mike Parson: (11:11) Thank you doctor. Thank you very much. Dr Trotman, when I was talking to him out in the hallway, he said that he's got some kids at home that are doing their homework today, but they was going to be watching dad up here give his presentation today. So for you children of Dr. Trotman's at home, you should be very proud of your dad. One for being up here today to speak to Missourians, but really for what he does for a living about saving lives across Missouri. And it was his action that did save lives across our state. So I want to personally thank him, and thank you for being part of that family, that done that. We are encouraged by the recent data, which is why we feel we're in a place to move forward with our recovery plans, and begin reopening our economy. As I said, our Show Me Strong recovery plan will be deliberate, and data-driven. Mike Parson: (11:59) It will rest on four main pillars including expanding our reserves of PPE. The PPE shortage has been a top concern in Missouri, and nationwide, as health professionals and first responders respond to COVID-19. Today I am pleased to announce the deployment of a decontamination system in Missouri to assist with the N95 mass shortage. Starting next week, hospitals, healthcare providers, and first responders will have the opportunity to utilize the Battelle Critical Care Decontamination System to safely decontaminate N95 masks. Through this system, we will have the maximum capacity to decontaminate up to 80,000 N95 masks per day if needed. By helping conserve PPE, this will be a huge benefit to our overall recovery plan. Today, Director Richardson is here again to give us an initial update on our recovery efforts. Todd. Todd R.: (13:15) Thank you Governor, and thank you Dr. Trotman for making the trip to Jefferson City. Your insights have been incredibly helpful to the state as we've responded to this event. I'm excited today to talk about a few things that we're doing to tangibly aid not only in the fight against COVID-19, but also in how we get to a recovery. In the past a week, major strides have been made to prepare Missouri for that safe and phased reopening of the economy. In alignment with Governor Parson's pillars of a Show Me Strong recovery, we are actively responding to the nationwide PPE shortage with innovative and new technology. As the Governor mentioned, next week we will be receiving a decontamination system from Battelle Laboratories at no cost to the state of Missouri. The decontamination system is the result of two decades of research, and it's received approval through the Food and Drug Administration. The Battelle system is a hundred percent federally funded through a FEMA and US Department of Health and Human Services grant. Todd R.: (14:23) This system uses hydrogen peroxide vapor to sanitize N95 masks up to 20 times per mask, and as the governor mentioned is capable of decontaminating 80,000 masks per day. The Battelle Decontamination System will bolster our supply of necessary PPE, and will be a critical component of allowing our healthcare system to gradually began to perform postponed and non-emergent procedures. Most excitingly, this system will be functional next week. Additionally, on Monday, the Department of Economic Development in consultation with a wide array of state government employees and private partners has launched a personal protective equipment marketplace. The marketplace can be accessed at DED's website at DED.MO.gov. It will allow public and private sellers of PPE to connect with buyers, and will help the state to determine supply and demand of all types of personal protective equipment. Todd R.: (15:28) The marketplace will also help the state to project those critical shortages, and where necessary, purchase and distribute PPE to public and private healthcare providers. We're also working along with the governor's pillars of a Show Me Strong recovery to improve our testing capabilities and volume. We've partnered with Microsoft to launch a public facing platform that will help screen Missourians for symptoms, and connect them to nearby testing locations. Microsoft has provided this platform to the state of Missouri free of charge for the next six months. Together with community partners, public health experts, private sector leaders, your state government is building a foundation that will allow Missouri to effectively manage COVID-19 in the near and long term, and most importantly will ensure a robust economic recovery. Mike Parson: (16:24) Todd, thank you very much. I also want to mention today on the Battelle machine that I want to thank the federal delegation for their part in that, trying to make sure they're keeping supply. I talked to Senator Blunt, Senator Hawley yesterday and the entire federal delegation. I just want to make sure people know that they're working up there every day to try to help us here back home, and I want to thank them for their part of what they're doing. Another essential pillar of the recovery plan is expanding testing capacity. And we are rapidly working towards this go. Today, the state public health lab is implementing new testing criteria, so that we can expand our testing even more in the state of Missouri to meet the guidelines and the goals we've set out. Dr. Williams is here to provide more details, and also to give an update on the WIC, and the Department of Health Summer Food Service Program. Dr. Williams. Dr. Williams: (17:20) Thank you Governor. First, I'd like to discuss some of the changes we have issued to providers today related to our testing criteria at the Missouri State Public Health Laboratory. DHSS has expanded the criteria for people who can be tested through the Missouri State Public Health Laboratory. This expansion recognizes our increased availability of tests, and reflects our strategies moving forward as we move out of the acute phase to box in new outbreaks as they arise, and to give doctors and other providers like Dr. Trotman a broader decision making ability as to who gets tested. The new criteria allows us to do comprehensive testing. In other words, testing everyone, staff and patients, in congregate facilities for both staff, the patients both symptomatic and asymptomatic. It also expands the criteria so that we can test more first responders. To not only increase the amount of testing that can be done, but also to increase access to those tests. Dr. Williams: (18:22) More than a hundred sites can be found throughout the state now, and we've added an interactive map of those locations to our website at DHSS. We are also in the process of validating serological test, and hope to make that available to the citizens of Missouri in the next few weeks. We will then have the capacity to do 175 tests an hour that's obtained by a simple blood prick of your finger. This type of test collects the blood, and it detects the antibodies of a person and tells whether or not they've been infected, even if they know it, with COVID-19. This test will be in specially important for people who are symptomatic but didn't get tested at the time, such as first responders, and others who are potentially around multiple patients who may have had COVID-19, and become infected without knowing it. I also want to take an opportunity to provide an update on WIC, and dispel any myths that are out there during this pandemic. Dr. Williams: (19:19) The supplemental nutrition program for women, infants, and children, known as WIC is still running strong, and actively supporting current participants and enrolling new participants, who may now be income eligible due to job loss related to the COVID-19 pandemic. In fact, the WIC program served about a hundred thousand women, infants, and children in the month of March, enrolled 3,500 new participants. The WIC program not only offers nutritious food items to meet participants' specific needs, but also provides valuable nutrition education, and breastfeeding support. Over 36,000 sessions of nutrition education were provided in March. And the United States Department of Agriculture approved a waiver to remove the federal requirement... Dr. Williams: (20:03) The United States Department of Agriculture approved a waiver to remove the federal requirement that participants have to visit the clinics in person through May 31st. This waiver allows local agencies to maintain social distancing and to serve participants who may be quarantined and unable to visit the clinic. Dr. Williams: (20:18) Pregnant women, new mothers and families with children from birth through fifth birthday can learn more about enrolling in the Missouri WIC program by visiting the Missouri WIC website at wic.mo.gov or by calling participant support line at 1-800--392-8209. Dr. Williams: (20:41) At the Department of Health and Senior Services, we also have our Bureau of Community Food and Nutrition assistance working diligently to ensure children have access to meals during school closures. This bureau is approved for waivers by the United States Department of Agriculture to allow schools and other community organizations to begin operating the summer food service program earlier this year in March to provide children with much needed meals. In addition these waivers are allowing children to have the meals delivered directly to their homes or be taken and consumed off site rather than eaten in a group setting. There are over 800 meal sites available in communities throughout the state, and we're incredibly thankful to all of those hosting those meals for Missouri's kids. A map of meals can also be found on our website. Thank you, Governor. Mike Parson: (21:33) Thank you Dr. Williams. I appreciate it very much. Kelly, let's go to questions. Kelly: (21:38) All right, thank you, Governor. The first question is from John O'Sullivan, KMOV. On May 4th, what limitations on which business can reopen will be in place? Mike Parson: (21:47) We're working on the policy and the guidelines for that, but all I will tell you, almost every business in the state of Missouri will be able to open their doors. People will go back to work. There will be some guidelines we'll have with that, but the majority of them will be open. Kelly: (21:59) Do you see, Governor, limitations on the number of people that can gather at one time? Mike Parson: (22:05) I think we will. I think there'll be guidelines for that of how many people can be in groups. Again, we're going to allow people to go there, but social distancing is going to be important, just what you heard the doctor say and you're the expert in that. That's going to be a key road to how we move forward, and I think it's going to be important that we maintain that social distancing for some time. So there'll be guidelines we're going to give to the cities, the counties across the state for state policy, and it will be where people can get out again. Kelly: (22:30) All right, thank you Governor. This question also is from John O'Sullivan. Franklin County announced last night it will be opening up several businesses starting this weekend. Are you okay with that, knowing that its mortality rate based on number of cases and population is one of the highest in the state right now? Mike Parson: (22:45) Well, number one, Franklin County has to make some of their own decisions, and we've always focused on those local level decisions to be made. However, the state order is still in effect until May the third, so whatever those orders they had can be more stricter than what we had, but it can't be less. So Franklin County is still under the state order and it'll have to follow those guidelines. Kelly: (23:07) Thank you Governor. This question is from Jason Hancock, Kansas City Star. Governor Parson, Senate Majority Leader McConnell said today that he'd rather let states financially squeezed by COVID-19 declare bankruptcy instead of extending the federal aid that would require further deficit spending. Do you agree that the federal government shouldn't step in to provide direct aid to states facing budget shortfalls? Mike Parson: (23:31) Well, several parts to that question. Number one, I don't believe the states should file bankruptcy. I think the states should be responsible for how you spend your money and because you did a poor job of managing it, whatever those states may be, I don't think the federal government should come and bail you out. So that part I agree with what Senator McConnell said. I don't think the state should file bankruptcy. I think if you get your position into bad management, then the people in that state's going to have to understand, they're going to have to do without a few things to get back to where you control it. Mike Parson: (24:00) It is one of the good things, one of the great things that I like about this state. Regardless of what party you're with, we all know you have to balance the budget every year. You can only spend what you have. You can't spend more, and I think other states need to focus on that same responsibility, but it's not right for them to get bailed out and then other states like Missouri that does it right, ends up bailing other states out. That's not what the federal government should be doing. Kelly: (24:24) All right, Governor, thank you. This question is from Brian Hauswirth, Missourinet. Governor Parson, Missouri lawmakers returned here to Jefferson City on Monday and have just three weeks to finish their work. From your perspective, what are the top issues they should focus on when they return? Mike Parson: (24:39) Well, I'm just going to tell you one, but they come here to do the budget by May the eighth. That's what they're coming back here for. That's their main objective. My understanding of that and that's the one thing that we really need to focus on if that's what they're coming back for. We need to try to get that budget done, if that's what their plans are. Kelly: (24:54) All right. Thank you Governor. This question is from Dick Aldrich, KJLU radio. This week, the University of Washington study estimated that we had reached the peak of COVID-19 infections and deaths last week and that the curve of both should now start trending down. Does that go along with the metrics you are looking at and are we trending down on new infections and death? Mike Parson: (25:16) With all due respect, we made that decision over a week ago here in Missouri, and I'm going to go back to what I originally said that I thought was critical for our state and for all states, but I'll just say Missouri having our own data to understand what's really happened in our state to be accurate. I get the predictions of a lot of people across the country that wanted to make predictions or wanted to make forecast or models. I get all that. And I'm thankful that there was other doctors in other areas. I talked to Dr. Trotman before we come in here to give him some advice. But the reality of it is, I'm going to go back to what I said a week, two weeks ago. It is Missouri data that I'm going to make decisions on, not some prediction. We believe we were headed in the right direction over a week ago when we decided to lift some of the regulations we have and open the state back up. Kelly: (26:02) All right, thank you Governor. This question is from [Ashley Byrd 00:00:26:08] from Learfield. Yesterday Governor you signed house bill 1511 and 1452. Can you talk a little bit about that bill? Mike Parson: (26:14) Yeah. That was the military reciprocity bill that we did yesterday was one of the priorities that I had going in this year, and it was a fortunate enough to be one of the things that got done early in the session and one of the very few things that got done this year, but for our military families that come through the state, whether it's Fort Leonard Wood, Whiteman, wherever it might be, it was for the spouses of those [inaudible 00:26:35] go to work when they get here so they don't have to. Mike Parson: (26:38) Especially right now let's just talk about nurses for example. If you're a certified nurse, you could come into Missouri and start that job tomorrow for the military family, where before, it would require maybe trainings or the license process or it would cost money just simply to do that. The whole concept os when they come here, the number one concern of spouses of military families had is are they going to be able to go into the workforce as soon as they get here? And Missouri has always been a military friendly state, and I thought that was something that we really needed to do to have that full reciprocity. So if that spouse comes here, whether it's teaching school, whether it's a medical profession, whether it's the engineer, whatever it might be, that they can go to work in our state and I'm proud that we got that done. I'm thankful for the legislatures for their work, getting that done, but it's a good day for Missouri and it's a good day for supporting our military when we do that. Kelly: (27:23) All right. Thank you Governor. This question is from Alisa Nelson, Missourinet. Do you plan to select others to join your stimulus money informal working group to make it more of a bipartisan and diverse group? Mike Parson: (27:34) I think we have. My understanding is, I was briefed by the administration earlier, I think we're going to put, there's going to be a couple more Democrats on there. I think there'll be somebody from the Senate and somebody from the House that'll be on that. Mike Parson: (27:46) Here's the important thing [inaudible 00:27:48] because we had this advisory group that come in here, I think people all of a sudden thought that they were going to have a say over where this money goes or how it's divided up or anything. That's not really the case. We picked the state treasurer because our money's going to flow through the treasurer's office, but this is really taking a look at the federal guidelines is going to tell us what we do with the money. They're just helping us get through the process of the guidelines, but they're not going to have the ability to be able to say we can send this money wherever we want to send it. That's not the purpose of that. Mike Parson: (28:17) For whatever reason, I think somebody had the kind of the... it got put out there, maybe the media put it out there thinking they were going to have the ability to do that, but they really don't. It's an advisory role is, is what they're at. So we're going to open that up to public meetings. There was some concerns about that. So we'll open it up and we'll put some more people on there. But again, I want to clarify what the role is. Kelly: (28:34) All right, and the final question today for you, Governor, is from Alex Smith, KCUR. Fewer people are currently being tested in Missouri each day than were being tested earlier in the month. With testing numbers declining, how can we expect to reach the 40-50,000 tests per week that you said we needed to do by the end of the stay home order in May? Mike Parson: (28:54) Yeah, because I think everybody in this room, Dr. Williams, Director Richardson, knows how important this is to me, and it's not about just the testing. As of today, we got to be able to test large volumes of people across this state and we're going to get to that point. The reason the numbers are low right now is because the criteria itself, and it's why I announced today and Dr. Williams did, we're expanding that criteria where we can do more and more testing, where now we're going to give the providers the ability to just actually, if somebody walks in there, say if you want to test them, you can test them. They don't have to meet the criteria. We have to open that up to go to different segments across the state so we can kind of check whatever areas we might be, whether that's Springfield, Missouri, or maybe that's small town Missouri, we can do it as sample testing. Mike Parson: (29:37) The other thing is so important why we got to be able to do more testing when we do have a outbreak or a hot spot, we call it a nursing home. We've got to be able to have the resources and the testing capacity to go in there and isolate that right away and to be able to figure out who the employees are, who the people are in those homes and to be able to test that. And by doing that, we're going to be able to test a lot more people. And at the end of the day, we're on track to meet those testing guidelines, and I believe we will get there, and every day- Dr Trotman: (30:03) ... testing guidelines and I believe we will get there and every day I want to push these directors as far as I can push them to make sure we're moving on those testing numbers. Reporter: (30:08) Thank you Governor. I have a couple of questions now for Doctor [Trotman 00:00:15]. This question is from [Phillip Sitter 00:00:21], the Jefferson City News Tribune. "Doctor, COVID-19 can obviously be fatal, but there probably are people who may not understand all of the nuances of this disease or of the pandemic generally even as they have lived with the consequences of social distancing. Can you summarize why unmitigated spread of COVID-19 is dangerous for everyone?" Dr Trotman: (30:39) Thank you. That is a very good question and I welcome that question because it helps us understand what a contagious diseases, what an infectious disease is. The person who is asymptomatic, who transmits the disease to the next person may not suffer severe consequences. That person transmits it to a therapist that goes into three different nursing homes in a week and you have very sick elderly patients. So what we look at is we look at number one, the impact on the healthcare system from those people who may have mild disease. Some of them, some small fraction, maybe 10, 20% may end up in the hospital. Some of those may end up on the ventilator and some may die despite not being at end stage or having multiple comorbid conditions. So this is one of those diseases where when the person thinks they are young and invincible, there is a small fraction of those people that will have severe consequences. Dr Trotman: (31:48) Those people also move about immunity the most. Oftentimes people who are asymptomatic shed the most virus. So it is not about looking at whether or not that one person will have severe consequences as it is. How much can they move about the community and spread it and the odds are they will spread it to someone who would be more vulnerable. So I think it's important that people understand, that I know for healthcare workers, we've had to change our paradigm completely. We now look at ourselves as the potential source. Now healthcare workers in the hospital where masks. So now I look at my patient as being susceptible to me where I'd have the infection and not transmit it. So this disease has flipped the paradigm quite a bit. It's not just about preventing sick or people with comorbidities from going in the hospital. What we've done and we've done it in an excellent fashion is we've prevented asymptomatic transmissions and presymptomatic transmissions in the community. Reporter: (32:50) Hi, thank you. Doctor Trotman, this one is [Lucas Geisler 00:32:53] From ABC 17. "What challenges has hospitals faced in getting a hold of PPE?" Dr Trotman: (33:00) So that is seven weeks of work, full time work by a whole team at our healthcare system working with the local health department. I know Mercy's done the same. I'm talking to doctors in St Louis and Kansas City. We've all weathered the same crisis in being prepared with PPE. We have not personally in my hospital, we haven't had a critical shortage whereabout we weren't able to use standards care PPE, but what we know is that there's a market and any time there's a market there's going to be people selling things that may be inferior, marking up prices. So we've seen price gouging. We've seen items not exactly what they were intended. So N-95 masks that wouldn't meet strict fitting criteria. We've struggled with testing rates. When you hear about testing kits, that's all the way from the molecular machine in the lab and the reagents to the tube, to the transport tube all the way to the swab. Dr Trotman: (34:00) And so part of that supply chain has been effected. Even the labs that can do thousands of tests per day may run out of one simple little pipette, one little tube to draw up reagents could stop their production. So we have an entire team at our hospital that just works on the supply side of things. So again, we haven't had those crisis level deficiencies, but we're prepared for it. Reporter: (34:27) Part of anther question for you, Doctor Trotman. You may have to help me with this, the pronunciation of this drug, but have doctors at your hospital prescribed the hydroxychloroquine? Dr Trotman: (34:36) Hydroxychloroquine, so- Reporter: (34:37) Thank you. To COVID-19 patients and have you seen any hoarding in that industry? Dr Trotman: (34:44) That's a great question and that's a timely question today because people will have seen the news that some preliminary data that haven't been published in print, haven't been peer reviewed, show that drug not as effective as we would have hoped. It could be harmful. We've known all along that hydroxychloroquine plus azithromycin can work or make new cardiac arrhythmia even leading to death. So slowly in our system we've used hydroxychloroquine sparingly because I was informed of the original data. I looked at the data out of France. Those were not very compelling to me and knowing the side effects, the problem is it's a desperation and so yes, we saw hoarding of the drug. We saw people buying drug off shelves. We saw it in short supply. Dr Trotman: (35:29) Fortunately we haven't prescribed a whole lot of it. We've tried it in desperation, but yes that drug was a victim of some hoarding. Doctors, healthcare providers wanted to use it prophylactively, which it's not indicated. There's some new guidance from, that's out there from the federal government on actually saying not to use that for prophylactus, meaning just taking it every day to prevent COVID. There's no evidence and we shouldn't be taking it just because we're exposed. Reporter: (36:01) Thank you. Doctor Williams, I have a few questions for you. This question is also from Lucas Geisler, ABC 17, "What does the state need to make It's boxing in testing strategy? What do they have to do to make it work? Dr Williams: (36:14) Thank you Lucas. What we need to do is to have the testing capability and we were actually doing this as we speak. I was at the state lab last night and just to give you an idea of just how spread this is to meet a group of couriers that came in from way down in the Boot Hill as the National Guard was taking testing sites to very [missing audio 00:36:40] and so a rural COVID-19 is different in the way we approach it probably than urban. Thank you for the question though. Reporter: (36:49) All right, thank you. Doctor Williams, this question is from Rudy Keller, Columbia Tribune. "Last week Governor Parson said Missouri must increase testing to 10000 a day and that the state was performing about 3000 tests today and that the numbers would "double" our capacity right now in the next week and I think that is doable to do on that." Actually the state hasn't reported more than 2000 tests on any day in the past week and has fallen behind Arkansas, Illinois and Oklahoma in testing per capita. What is keeping Missouri from meeting the goal that was set last week? Dr Williams: (37:23) Well right now we have the capacity in Missouri to put out, to do 50000 tests a week. We can do that. There are 16 labs if we needed to do that. What you're seeing is you're seeing a division here in that, let's take Illinois. We were doing more tests per capita than Illinois, but Illinois's curve continues to go up. They continue to have more sick people. And so the numbers you're looking at reflects symptomatic people. Those are people who are sick and so the numbers you're mentioning are a great reflection that we don't have as many sick people, but to the governor's point earlier, we've now, as of today about three hours ago, broadened our criteria and we are now going to be looking at broader scopes of people other than people who just have [inaudible 00:38:11] and as we do that and we do more boxed in and what we call sentinel testing and other-