New Mexico Gov. Michelle Lujan Grisham Coronavirus Briefing Transcript April 30

Michelle Lujan Grisham: (00:00) We still want you to stay at home. I know that that sounds like we give that message too often. But I drove to the capital today, I mentioned that I often do deliveries in Albuquerque to my family on the doorstep and I go see my mother via a window. A wave. I can see, everyone can see there's national aggregate data that shows you where people are traveling. People are traveling. A virus needs you to travel to transmit. You catch it, you give it. We don't want you to do that. We're staying the instruction to remain in place except for these essential services. Michelle Lujan Grisham: (00:43) All right. What else remains closed? Offices, workspaces and retailers, except for the exceptions. If you can't do curbside or delivery and it's not an appointment, only exception, they're still closed. Dining in restaurants and bars except for curbside delivery are also still closed. I'll tell you what we believe based on the contact and the time you spend there, which Dr. Scrase is going to talk about. We made these decisions not based on the business, but based on the safety of the public and the safety of the employees there. We'll show you how we did that using an evidence-based model. Michelle Lujan Grisham: (01:23) Here's what's still unsafe and closed, indoor malls, gyms, salons, theaters and casinos. Mass gatherings, still prohibited. And the 14-day quarantine order remains in place for all out of state airport arrivals. Next slide. Michelle Lujan Grisham: (01:46) So how do we then move to the next phase? Well, we're going to continue to use the modeling by the medical advisory team. So you're going to hear more about that, but we analyze the spread of the virus. Where is it? How quickly is it spreading? What are those rates and ratios? And that's how we'll keep making decisions. So can you help? You bet you can. The more you restrict, even with opening. And we do want to ease the relaxing of these restrictions, we hope is good for business. We hope it's good for individuals too. We have to marry these safe personal practices where we'll see a spike that's not anticipated. And that's when you're not prepared. Emergency preparedness means knowing what's going to happen. We are going to see more cases even without relaxing restrictions. We're still in that phase where we're going to see increased cases. Michelle Lujan Grisham: (02:41) We want to keep them below a certain percentage. We see how they're transmitting, what that rate is, where it is. As long as that curve statewide still is flattened, then we think that we can make these decisions safely, which is why we are. We have to continue having adequate and stable testing and that's measured by the department of health. Quite frankly, we have a lot of partners doing testing now, actual testing and running the tests. But the department of health is leading that effort. It's an incredible undertaking and they will have to continue to do that. Michelle Lujan Grisham: (03:13) Effective contact tracing plans and resources, that's going to be measured also by the department of health and they have a very specific division population, health experts, doctors and scientists, that's the epidemiology division. That division has to have ... They will tell us that they believe that we can do sufficient contact tracing and I know that that sounds easy. Michelle Lujan Grisham: (03:35) "I have COVID-19, I was identified as positive. Here's the family members I was around, I'm not working, and I went to this grocery store, I didn't touch anyone." We're done. No, you have to really think about if anybody else in the household, if you went for a walk, if you were in a car with someone else, what grocery store, where in that area, how close did you get to ... we have to do all of that work and while we're moving to that digitizing phase of this work, it is still a lot of personal contact. Michelle Lujan Grisham: (04:05) So it's incredibly time intensive, and for places in New Mexico without broadband and telephones, it is even more challenging for a rural, vulnerable minority population. So it's a huge undertaking, but we are well on our way. And the healthcare system capacity and personal protection equipment levels, that's also measured by the department of health and by the medical advisory team. Michelle Lujan Grisham: (04:31) I keep pointing to my two experts and leads that will be analyzed all of the time, if that doesn't stay stable. What does that mean? That the healthcare system can take it that we have enough equipment and support. Then we can't go to the next phase. So we'll have the phase one, more relaxing, phase two, more businesses, more economic recovery. Phase three means we're closing in on a vaccine and we feel like it's completely back to normal with this. Michelle Lujan Grisham: (05:05) Everyone on the globe has learned the lesson about a pandemic. They can strike again, likely will and we just have to start thinking about our own behaviors that will allow us to be as prepared as possible and to have our behaviors dictate the kind of responses that save as many lives as possible. I'm really proud of this work. I believe that based on the evidence it's a safe relaxation, begins to ease those pressures. Michelle Lujan Grisham: (05:42) The Northwest region of the state is going to require a lot more of our attention. They both deserve that attention and will get it, including bearing all of the resources we can muster to do everything we can to adequately reduce the rate of transmission, save more lives, and get through both the surge and the peak in that particular part of the state. Michelle Lujan Grisham: (06:08) Okay. I think I've run through all of my slides about the new order effective tomorrow, right. Current order expires midnight today and you should expect more announcements related to the preparation phase through the economic recovery council, the mayor's council tied to the chief of staff and business observations and input as we move through this process. Michelle Lujan Grisham: (06:33) I'm going to go to the secretary of health who's going to give us an update on testing strategies and information. And then we're going to move to Dr Scrase who will go through some of the modeling slides, and then we're going to be right back to answering questions. Michelle Lujan Grisham: (06:46) I want to make sure that KOAT is with us. We started about five minutes late. They were having some technical difficulties. I'm getting a good positive thumbs up, so I think all is well. Let's go to a secretary Kunkel. Kathy Kunkel: (06:59) Thank you, governor. Good afternoon everyone. I want to reiterate that we have a strong testing foundation both in our lab capacity as well as our test collection capacity. We have many partners as the governor said, and we continue to look for opportunities to increase that. As you know, we've moved on from testing just sick people to looking for different ways where we might find the virus. We are targeting special populations, as I talked about last week, particularly longterm care facilities, tribal communities, essential workers, childcare workers and some sub groups within them. Kathy Kunkel: (07:36) We are well on our way to testing every one of our longterm care facilities. We have a strike team or a rapid response team that will go in as soon as there is one positive response. When we have multiple positives in a longterm care facility, we have a different strategy looking at infection control techniques, and helping to isolate and separate the individuals in those homes. Kathy Kunkel: (08:01) As for essential workers, I want to say that there are many, many essential workers in the state. I don't want to say that nobody isn't. We are particularly focusing though on healthcare workers, grocery store workers and childcare. And the public health division in every region is going out and making those connections and continuing to look at that community. As we move forward, we're working with the different communities or the different organizations and committees that the governor referred to, to see how testing can inform and protect our attempts to reopen. And I'm looking forward to developing those strategies more in the future. Thank you. Michelle Lujan Grisham: (08:37) All right, Dr. Scrase. Dr. Scrase: (08:40) Good afternoon everybody. I will ... excuse me, take off my mask. I have a little bit more detail, a little bit more data. Today, we've been almost overwhelmed but not quite overwhelmed with requests for more modeling information, more data, more projections and I'm happy to report that as we promised last week, our modeling team data now and the regular presentation is online. So you can reach that and we'll be sending that out in the press release. Dr. Scrase: (09:10) After today, you can see the assumptions as they currently stand in the model. You can see a lot of detailed information about regions of the state and what we're looking at in terms of cases. And in fact almost all the slides, not all, but almost all the slides I'm going to show you today are coming from that presentation as well. So if I could have that first slide, please. Thank you very much. Dr. Scrase: (09:31) I wanted to just again thank the folks at Presbyterian who've really put a lot of time and effort into this modeling including Jason Mitchell, their chief medical officer. And many, many people at both Los Alamos National lab and Sandia, that are looking at different parts of this as well and working with us. Dr. Scrase: (09:49) There's a lot of numbers on this table, but basically what it shows is the weekly projected number of cases, and I'm going to focus on the middle column with a box around it. Because what we've been finding is these [lanel 00:10:02] predictions track very, very closely week to week with what we end up seeing in cases. So, for example, we're sort of between April 26th and May 3rd and our case numbers are between the two numbers you see there. We're at 34, 11, we're moving up quickly on the May 3rd number actually. Dr. Scrase: (10:23) And so I want to make sure people understand that when we talked about the fact that we were bending the curve, we did not mean that the cases are on their way down. What we meant was we're seeing a slowing in the number of new cases every day and that varies week to week. Dr. Scrase: (10:39) And I'll show you a better graphical representation of that. We were talking with the mayors today. I got a question from one of the mayors said, "If cases are increasing, well why are we even talking about opening things up when we want to keep everything closed?" And the answer to that really is, it's clear to all of us, all of us are spending our time at home, and those of you who aren't working right now that the current situation isn't something we can do for another year until a new vaccine comes out, and we've all been vaccinated. So we have to learn how to reopen and keep our economy going. Dr. Scrase: (11:16) While at the same time doing that in a COVID positive world, we may see a little bit of downturn in cases during the summer. Other forms of coronavirus tend to do that, but that we would naturally expect that the virus will still be among us. There will still be lots of cases, maybe 100 or more cases every day during this whole period and that we're just identifying those people and tracing them and the like. And so we have to learn how to live in a COVID positive world and take those steps, but we also have to do it slowly and carefully. Dr. Scrase: (11:48) If I could have the next slide please. Just some additional data. You can see that age distribution is about the same. The bell shaped curve is just a little higher and you can also see that we're continuing to see very, very high case fatality rates in older populations in particular. And that's something that's been seen all over the world. In fact, we're seeing a lot of fatalities in nursing homes, which is also something that's being seen all over the world, but that we're working very hard to control. And secretary Kunkel has just done an amazing job expanding testing week after week after week and the resources we're sending now into nursing homes are teaching us about how to control these epidemics. Dr. Scrase: (12:31) The literature also suggests that once you have one case you test everybody and all the residents, all the staff and that's what's happening now as well. So we're doing that. Next slide please. Dr. Scrase: (12:42) So I think some people will be mad at me. We've been talking about doubling time now for quite some time and that's the top number and you'll be all happy to hear that today at 6.1. So we went from a doubling time at the beginning of March of about 1.9 all the way up to 6.1 which is a really dramatic improvement in how ... it means we're slowing down the spread of the virus. Because we're learning how to open back up in a COVID positive world, we have another metric that we've been tracking that I wanted to introduce to you today and it's called the rate of spread. Dr. Scrase: (13:22) The technical name for it is the effective rate of transmission for that the epidemiologists in the office [inaudible 00:13:29] but for the rest of us we can just call it the rate of spread. And it really ... that number you can see actually started about 2.5 at the very beginning. It's the number of people that the average person infects. So if I have COVID, I would have affected on Saturday the 21st of May ... March, excuse me, about 2.5 people worldwide. That number is two and a half to three and a half. Dr. Scrase: (13:59) Generally we live in a less densely populated state, but we've seen on TV what happened in New York in close quarters. And so if you look at that orange line, it's gradually coming down, and we're actually down to 1.24 statewide. So just to repeat, that means that every person who is infected with COVID infects on average 1.24 people, and then those folks ... of course there's no such thing as 0.24 people. It's just an average. Those folks go on to infect others. As long as that number is greater than one, the epidemic continues to spread as long as people, infect more than one person. When it goes below one, then the epidemic begins to die out. But we're not really expecting the epidemic to be gone until everyone in New Mexico has been vaccinated or hopefully the alternative would be having COVID and having immunity, which I'll speak to in a minute. Dr. Scrase: (14:56) Our up heat maps, again on the left there you have the cumulative number of cases. We saw in the last week that McKinley County passed Bernalillo County where the total number of cases and cases are going up. Last week I told you that 71% of all the cases that prior week were from the Northwest part of the state. This week as of today, for the first three days of this week, that number is 77% of the cases. And then you can also see that the right side map is just a color representation of the relative infection rate in different counties and of course we can see right now McKinley is the highest. Dr. Scrase: (15:42) If I could please have the next slide. I think this slide tells the story better than any other slide. I want to thank our epidemiology department for producing this. It tells the story better than anything else of what's going on in the state, and why the numbers don't all seem to line up. And so the green line is every County in the state except for the three Northwest County, San Juan, McKinley and Cibola. Dr. Scrase: (16:11) That green line is the number of new cases per day. And they did an average, a moving average over a seven-day period. So if you have really good vision, you can see the graph add that the last data point is seven days ago because we take a cumulative seven-day average. And so last week when we talked about the fact that we were bending the curve, it was because we'd had a couple of weeks of this downward steady trend in cases in all but the Northwest, that green line. Dr. Scrase: (16:40) And so that's what we want to see. So now we know that the peak actually for all of New Mexico did really occur earlier in April. But we were monitoring the whole state and now we turn to the red line. You can see that that actually has a steady uphill slope. We're getting more and more cases every day, a much higher percentage of cases every day. And that affects the whole rest of the state as well because as we all know, people travel across county lines. I traveled across the County line to come here for this press conference. I'll travel across one the way back home today. And so when we move, when we contact other people that is how the spread occurs. Dr. Scrase: (17:24) But we believe that in general and particularly for those of us who live in the areas represented by the green line with extreme care, we may be able to safely begin to get out a little bit more as the governor described. Dr. Scrase: (17:41) And if I might please have the next slide. This is directly from our modeling. We've talked a lot about ICU beds and ventilators. This is McKinley County and as of this week that ... so let me just orient you to the graph. The blue line is the projected number of general medical beds we'll need. The orange line is the number of ICU beds we'll need. The red line is the number of ventilators we'll need in McKinley County, if everything keeps going the way it's going right now. Dr. Scrase: (18:16) I only put one capacity line in. That's ICU beds and as you can see at least as of yesterday, all 14 ICU beds in McKinley County were full. And so we've begun a process through the centralized call center that's now up and running to transfer people. We've had approximately 40 people last week and approximately 30 people so far this week transferred from the Northwest corner of the state to Albuquerque. And now in Albuquerque all of the major hospital ICUs are full to their normal capacity. And so they now are all busy shifting over to what we call surge capacity. In Albuquerque due to the extensive preparation and really, really hard work of our folks at the university and Loveless and Presbyterian, they have found a way to double ICU capacity in the state and so they're in the process of doing that. But now ICU beds are indeed over full. Dr. Scrase: (19:18) This slide is too complicated and I have it in here for all the reporters who've been calling me asking questions about the details of the gating criteria. They are in here. I'm not going to spend a lot of time on this slide, but just to reiterate a couple of things. That we've had an economic recovery council that's been very, very active in the past week. Governor appointed them and they have been emailing me examples of state, County and city plans about every 15 minutes over the past week. Dr. Scrase: (19:49) I've read almost all of them and working with our broad team we've poured through them and we're trying to pick the best things we can from every plan. The one thing that almost all the plans have in common is that they have gating criteria. Gating criteria to say, these are the four things we have to do or these are the things we have to do to open that gate to just begin to think about and plan for reopening. Dr. Scrase: (20:17) And like a car you can't drive on three tires, you can't really drive on two. If you've ever tried driving it on three tires with one of them flat, you know what happens to that other wheel of the car. So all four of the criteria have to be in place. We have set some preliminary targets for these that we're going to use. They're based on evidence and in the modeling the number of cases that would result from different levels, but you can see we talked about the spread rate earlier that we're aiming for 1.15 we think that's sustainable. Testing capacity, 3000 a day. We believe if we keep doing what we're doing with the unbelievable advances we've made, we'll be able to achieve that. Contact tracing and isolation capacity, quickly identifying people and their contacts and isolating them so they don't spread the virus. Very important. Dr. Scrase: (21:08) We believe that we can achieve that as well within the timeframes they are here, but we may have to expand staff in order to do that. And lastly, the governor already talked about statewide healthcare system capacity and that's critical as well. So you can see quite easily that if the whole hospital system is full, we can't reopen more things that will increase the spread of the disease. We have to go carefully, slowly, step by step. Dr. Scrase: (21:36) The main point though, if I could go back please just to the previous site. The main point though is, all of our behavior affect every single one of these criteria. If we're not practicing social distancing, there will be more spread. That will go up, we won't be able to progress in reopening. If we're sick and we're not going and getting tested, there'll be more spread, and that will drive the number of cases up. Contact tracing, if we're not cooperative as citizens with the calls from the public health department and thorough in our answers and very, very diligent about isolating ourselves if we're positive, that will affect it. Dr. Scrase: (22:19) And of course the hospital system, if we have more cases, we have more people in the hospital, more healthcare workers infected and an overflow of the delivery system. So we're really the critical part, every single citizen in doing this, whether or not we're able to reopen more every time is really going to be almost completely dependent on the behavior of the people of New Mexico. Dr. Scrase: (22:42) Now, next slide is the mobility data. And I think we're still doing well. This is that Sunday, Monday, Tuesday, Wednesday, Thursday, Friday Dots, where Saturday and Sunday are the lower parts of the curves and the weekdays of the higher. New Mexico has done a great job. We've brought mobility down by over a third. That helps. That's less people interacting with people, less spread of the disease. Dr. Scrase: (23:08) One thing that we need to be careful about though is that in February and March, the typical miles driven in the state is about 6.2 miles driven per person, but in April and May and June, that goes up. And so if this mobility continues to go up and more people are having contact, that will be an issue as well. I just wanted to say a couple more things about this. Just remember the virus spreads from one person to another. I believe that social distancing in the COVID positive reopening world is going to be way harder than social distancing if you're confined to your home. Dr. Scrase: (23:46) At home I have two other people there. If one of us gets the COVID, we'll probably all get it. We're a family. We eat dinner at the table together, but I'm not used to going out and making sure that I have my face mask in the car so that when I get out of my car I can put it on. I'm not used to monitoring everyone to make sure I'm six feet away from them, although I know I am today in this press conference. I'm not used to thinking about configurations in the car or thinking about the fact that GI can't really pick someone else up and drive them somewhere anymore. That's not part of my family. Dr. Scrase: (24:19) And so this is going to be a real, real challenge. And as the governor mentioned, as we slowly reopen, we're using the Johns Hopkins model that has three questions. One is, how many people are going to be there? I'm simplifying this, this is not what they said. Dr. Scrase: (24:34) How many people are going to be there? What's the intensity of that contact? Like how long are you going to be with that person or people, and how close will you be with that person or those people? And then the third variable is, can we fix that at all? Could we spread people out? Could only see people in restaurants, so they were six feet apart, things like that. Dr. Scrase: (24:55) And so that's the methodology we're using. We have a graph that John Bingaman has made and we have everything plotted out. And as we slowly progress, we're going to be thinking about those questions. Somebody asked me, well what about kids day camp? Well, lots of people, lots of really close intimate contact, and no possibility of keeping little kids six feet apart. Dr. Scrase: (25:19) So that'd be an example of something that would take a lot longer than curbside service with a business. Dr. Scrase: (25:25) So that's my little speech on social distancing and the fact that it's going to be harder than it is right now. We'll have a little more freedom, but this is going to be harder for everybody in the state. Dr. Scrase: (25:37) If I could have the next slide, we're almost done now I don't want to spend a lot of time in this slide. It is available online. But what we did is we asked our modeling team to model what would happen in the top graph first, if we just sent people back to school on May 1st. And this is a hospital sort of look, but you could take that top curve and just substitute it for the number of cases. But we get an immediate spike. Dr. Scrase: (26:11) And then at the top of that spike we'd have another press conference and we'd tell you we were closing everything down and everything would go back down. And then we would all get tired of that and we would try to reopen again. And if people didn't follow social distancing, we would have another spike and it would go back down. And I'm hoping you remember those two spikes there, because I showed you a slide a lot like that last week. And I'm going to show it again to you in a minute. Dr. Scrase: (26:35) What we're trying to do is a slow, gradual reopening, which we've also modeled on the bottom graph where we slowly re-enter society. We slowly learned to balance the things we're used to doing, but doing them in a more safe way, in a COVID positive world. And we keep those hospital resource needs and the number of cases and the number of deaths below our capacity. So those two slide represent the extremes of what could happen and the people in New Mexico are the ones who really are going to make that happen by being extra careful with social distancing. Dr. Scrase: (27:15) I think my last side here is just ... Anyway, so I don't have that slide in there, but last week I showed you what happened in the pandemic of 1918 and the H1N1 one pandemic in 2009 exactly those same double spike curves. We don't want that. I think the second most popular question I've been getting this past week is what about antibody tests. It's all over the news. If you're like me here, you need to set up a special email filter to just filter out all the advertisements and please to buy antibody tests. And the thing we all need to know is that almost all of them have not even been proven to be reliable yet. We don't have enough data to know that we should even be using them. There are three documents- Dr. David Scrase: (28:03) ... know that we should even be using them. There are three documents that are available online on the website under the MAT, Medical Advisory Team, website on antibody testing. There's the scientific paper that was written by the team. There's some guidance for physicians, and there's even one for the public, so if you're interested and wondering whether you should get an antibody test or not, please read this. There's a lot of valuable information in here. Because of the rush to do testing, I think the FDA has relaxed its standards a little bit and let a few things through, but we plan on testing all of these in New Mexico and verifying that they're accurate before we have people take them, because if you take an antibody test ... So let me walk through this first, and then I'll be done. Dr. David Scrase: (28:47) Blood antibody tests are very different than the viral swab tests that everyone's been getting. The swab tests tell if you're infected right now with COVID and you could be out infecting other people. I'm making this a little simpler than it is, but I think this is generally 95% true. The blood antibody test mainly don't tell you anything about whether you're infected right now, and ,in fact, if you are actively infected and spreading the virus right now, they're likely to be negative. They tell you if you have had a COVID infection in the past, so obviously in the last three or four months. The problem is with the newer antibody tests that are coming out, that they can tell you that you have been infected when you haven't or vice versa, so you won't really know anything differently once you get the result, and there's nothing really different you do when you get the results. Dr. David Scrase: (29:41) We're still working on that. Everything I said will be different in another month or two when more research comes out. Be patient, and we will continue to provide information on that. We have identified five different manufacturers who run these tests in a laboratory setting, like you'd see in a hospital or a major reference lab. We have those in the state that are highly reliable, and we're just starting to introduce those, and our epidemiologists will be using those in the population of New Mexico to determine what the true infection rate is. Dr. David Scrase: (30:17) If you're like me and you don't want to have a COVID infection, please still stay at home. Go slow with the reopening, be extra careful if you go out, extra, extra careful if you go out. Remember about the face covering. Remember about six feet distance. Remember about all those other 10 things we've told you about washing your hands and coughing into a Kleenex and throwing it away or into your elbow, keeping surfaces clean. By the way, if you're cleaning surfaces, make absolutely certain that those cleaning products are out of the reach of small kids. It's very important, and there was actually an uptick in cleansing product poisonings in kids in March. That was March, not April, but it's something to really watch out for. As we're being more thorough and more industrious about keeping things clean, let's be more thorough about keeping those products well out of the reach of small kids. Dr. David Scrase: (31:17) With that, I know that was a long report today, but I wanted to try to create some context and help you understand the major issues that we'll be facing as we learn how to live in a COVID positive world. Thank you. Governor? Michelle Lujan Grisham: (31:34) Thank you, Dr. Scrase. I want to do a couple more slides before we take questions. In this effort, I want to talk about some of the phases, and I also want to talk about what the practices of the different businesses, as we're expanding the retailers that can operate. So phase one, we are hoping to, mid-May, look at all retailers, so not just the ones in the current order which I went over earlier, could operate according to a retail COVID-safe practice, and that looks at a 20% occupancy. We use the fire code to determine how many people that is. The dine-in service at restaurants and bars could be permitted up to 50% occupancy and can't have bar stool or standing services. Why is that? Well, you talked. We heard a little bit about the Johns Hopkins model that I referenced, which is you look at the duration of that contact as well as the number of individuals you contact, and we know that those are high contact, high duration activities. Michelle Lujan Grisham: (32:44) Gyms and salons and hotels and houses of worship could operate also in a limited fashion according to COVID-safe practices. The reason I want people to see this is effort we're making to provide information about how we're preparing, how we're looking at some of these phases, and an opportunity, again, to reiterate, it really depends on New Mexico. How well we do this means how safely we can introduce this, and we do want access to these services, and as importantly, if we do this productively, it means that we can save more of these businesses. Michelle Lujan Grisham: (33:29) I'd love to say in this press conference that if we do this, we can save all of them. The reality is we've lost some of our incredible New Mexico small business partners because of this public health global pandemic emergency, so we really have to be cautious about how we do that, and you see that we wrote it right on the slide. Your personal decisions will make or break the ability for New Mexico to both parallel our efforts for economic recovery and to support our local business partners in the state. I know that I'm going to do my part and absolutely all of us are expecting you to do yours. Michelle Lujan Grisham: (34:06) Next slide. All right, so here are the COVID-safe practices for every New Mexican. I'm going to keep hitting this hard, because we can do better. We do well. If we weren't doing well, we wouldn't be having a preparation phase. We wouldn't have an economic recovery council, we wouldn't be protecting our healthcare providers, but it's not perfect, and we can always do better. So let's talk about that one more time. Avoid unnecessary travel just because new businesses are open. It seems like it's a bit contradictory. Don't go gratuitously, but yes, as we're opening up, go to that curbside delivery. Support a local retailer. Support another local business, all right? Michelle Lujan Grisham: (34:50) Always unequivocally do not go anywhere when you are sick, except for medical emergencies. I want to do everything we can to stop that confusion where people aren't getting, seeking medical attention. Two things are happening. People who know they need it or afraid to go to a hospital because of COVID-19. That's a productive aspect about, "I've got to be really careful. I don't want to introduce it to myself," but you cannot limit yourself to necessary medical services and emergencies, and the hospitals are prepared. This is not their first effort at dealing with infections. They know how to do this. They will keep you safe. We cannot have you not garnering and providing access to important medical emergency, so don't feel like you can't do that. Of course you can, and you should. We're there for you. Michelle Lujan Grisham: (35:45) Wash your hands frequently. Everyone needs to keep doing that. We said it at every press conference. We haven't been saying it. I'm saying it again. This is incredibly powerful for limiting infection spread. This is our best control mechanism. Let's use it. Avoid touching your eyes, your nose, your mouth with unwashed hands. Frankly, if you can learn not to touch your face. I will say this is the biggest challenge for me is not touching my face. It's allergy season. I'm compelled to do it, and I've really had to think about it. We can all do better. I can do better, all right? You need to clean and disinfect frequently touched objects, phones, surfaces. We do that every day. It's a practice I require by the staff that I have to come in to some contact with that we can't do over the telephone. They require it of me. You need to require it of your family and your coworkers. Michelle Lujan Grisham: (36:44) Only you can help us make sure that we're doing this effectively. Again, Dr. Scrase, let's do everything in our power to keep that out of the hands of children. Now watch for the symptoms of COVID-19, because with cold season, with allergy season, people get confused and say, "Well, I have a cough but not a fever. I have a fever but not a cough." One of these, with the testing capacity that we have, we know that because there was no federal testing strategy. Today, there are still some States that without a doctor's referral or without all of these symptoms, you can't get tested. We have the opportunity to keep expanding our testing. It's not universal. It's not. I don't have two million viral test kits at my disposal in a week, and I don't have the capacity to even test two million, but we can do an incredible job, and frankly not enough New Mexicans are getting tested, so come get tested. Michelle Lujan Grisham: (37:43) We're going to keep expanding out to our high risk areas like grocery store workers, childcare centers, nursing homes, and the like, all the essential workers, first responders, but we want you to also come to us. Any of these: fever, cough, shortness of breath, chills, repeated shaking with chills, muscle pain, headache, sore throat, and here's one that was talked about for a long time nationally, and I haven't heard about it much anymore. It's still a valid review. Have you lost your taste or smell? Do not go out if you have any of those things, all of those things, and let us test you. Do not under any circumstances go to work. If you must go out these can mitigate, all right? We've talked about the difference between a respirator and the healthcare workers making sure that they cannot pass that virus on to a patient, but this mitigates spread. Wear these. Michelle Lujan Grisham: (38:47) If you don't have access to a face covering, you make sure you call our non-health line. We'll help you get access. So many businesses are working and so many individuals across the state, just like my mask was made for me, and thank you Santa Fe Opera. We think we can get you incredible access, and we've got inmates in corrections who are making masks. They made them for themselves. They're making them for as many people as we can. We will get you one, and it doesn't have to be this. Just a multilayered face covering in public makes a huge difference. Michelle Lujan Grisham: (39:18) Six foot distancing. Do not be near anybody else. We can do that. Avoid gatherings. That means if you go to one of our state parks that we're opening and there are 50 people there, turn around. We'll find a way to make sure that you get access to a really great outdoor activity, but it gets too hard to do that six months this distancing. Do whatever you can to keep protecting vulnerable populations. Do everything you can. Do not connect with them. In fact, if you're a caregiver in your home, you have to do everything you can to limit where you're going, and if you need our help to support you with meals or any other essential services, please reach out and we will deliver food and services to you. That's the best way to safeguard the person you're caring for. Michelle Lujan Grisham: (40:13) Next slide. All right, here's what employers can do to help us. The more employers that can do this, the easier it is to go from that preparation phase into these next phases that we identified earlier in the slides and presentation. So for workers, limit your operations to remote work to the greatest extent possible, and we're going to keep doing that in government. We're hoping our local government partners will continue to follow suit. To the degree that private business can do this, I need you to keep doing it. If you can't, you need to arrange your workplace to provide for six feet distancing between the individuals who work there. You need to close common areas where personnel at the workplace are likely to congregate, break rooms, lunch rooms. We need to find a way for folks to get their lunches and their breaks at their desks or an area outside where you can do this distancing, and also remember we don't want people to be around each other for long periods of time. That means an hour lunchtime. We need to figure that out. Michelle Lujan Grisham: (41:20) We need to provide for all meetings to take place remotely whenever possible. I see all over social media where people are having meetings. Even local leaders in our state still, in violation of the public health orders, are coming together in groups of 10 or 20, and we will hold you accountable. These are not allowable, and if you don't provide for meetings to take place remotely, you are creating risk and you are transmitting COVID-19. All employees should be provided with appropriate face coverings and should wear them in the workplace, and I want to be really cautious about this. Michelle Lujan Grisham: (41:56) While we are seeing some general easing of access to medical PPE supplies, those supplies in large part need to be reserved to medical and first responder personnel and high risk essential businesses like grocery stores, childcare workers. We need to be really careful about this. If you're a business and you've got access, many of them are telling me they can, they do to a surgical mask, fine, but do not work to try to interfere in making sure that every state, every healthcare worker, and every first responder gets the first line of PPE that they really need. That's why largely you see us in these do-it-yourself masks, because we're not providing direct healthcare or first responding services. You've got to train all of your employees on daily cleaning and disinfecting protocols, hygiene and respiratory etiquette. That means coughing in to your arm and, again, trying to have on these face coverings. Okay, next slide. Michelle Lujan Grisham: (43:06) You need to be prepared if you're an employer for making sure that hand washing and sanitizer and other hygiene support is readily available to employees. We continue to hear even for essential workers. That's becoming stressful. As we open up, this absolutely has to be one of those required aspects. If you can, we are highly encouraging folks to screen employees before they enter the workplace each day verbally or with written forms or apps so that you're reminding employees to ask themselves, "Before I come to work, do I then have these symptoms?" Is it loss of smell or taste? Is it anything else, because we know unequivocally that in some of our high risk areas, some of the COVID-19 issues were brought in both by individuals who were sick and also individuals who might've been asymptomatic but maybe knew that they'd been exposed, so we've got to do a better job reminding employees that they have a responsibility before they enter the workplace to do everything they can to safeguard everybody else. Michelle Lujan Grisham: (44:15) Again, most importantly, you must prohibit employees. I sort of leaned in there, but if they have known close contact, they're living in a house with someone who's COVID-19 and they're still coming to work, this is problematic. The likelihood that they're shedding the virus is high. Everyone can't return to work without a 14-day self-isolation period. It's critical. Workers, employers need to ask these questions. Minimize non-essential travel by your employees. Adhere to all CDC guidelines and state orders regarding isolation. If you need to travel for work, you're 14 days when you come back in before you can return to work. I can tell you our bases are adhering to that, and I need everybody else to adhere to the same CDC guidelines, and again, just generally anything I have talked about, this is the CDC or OSHA guideline. I need employers to lean in and meet them all. This is how you keep New Mexico safe. Michelle Lujan Grisham: (45:10) Next slide. All right. This is the best practice for all employers, all right? And this is harder, all right? This is particularly for those employers that might have higher risk environments that we will look at later in our phases. If you can install large Plexiglass sneeze guards at cash registers, this is incredibly meaningful. These are the best practices, and I want employers to see them. Today's not the day. We're not mandating, but I want you to get a sense about what we know makes a difference, okay? Plexiglass sneeze guards, cash registers in particular. Arrange for contactless payment and receipt options to the greatest extent possible. I know some folks aren't going to use credit cards and use cash for payment. We can't do. We want to make sure that our consumers can access this, but if you can do this to a large extent, this will really mitigate transmission. Michelle Lujan Grisham: (46:11) Again, screen employees and customers with a no contact thermometer, if you can do that. Individuals with a temperature reading above 99.1, frankly, for all businesses should be denied entry. I don't know that every business can manage this aspect, but I want you to know what the best practices are. Those of you who could achieve this will be making a difference in New Mexico. Again, because not everyone has access, not everyone's going to ask state government to provide them or their local faith-based organization to make them and get them to them, offer face coverings and gloves to customers entering your place of business. Again, these best practices go a long way to safeguard the state and to lower transmission rates. Michelle Lujan Grisham: (46:56) All right, I think this may be ... Oh, do your part. Okay. We're relaxing restrictions, we're trying to move safely, productively, prudently, and quickly. Quickly, open to interpretation, must be tied to evidence-based work modeling, but if you do your part, if consumers work to support businesses on these reopening standards and best practices guidelines, then we can really do this. If the data shows that we are backsliding, then we have to take another course. Now, I would not just open up business or relax restrictions, and neither would the recovery council just because another state is doing it or because, frankly, we haven't even met the White House's, the president's 14-day declining case standards, right? There's a lot of different standards that you could apply. Michelle Lujan Grisham: (47:58) Flattening of the curve, protecting our healthcare workforce and surge, making sure we have enough healthcare services to meet new Mexico's needs. That's what we said we would use. That's what we're using, but if that begins to shift and we have to take another course. That course causes more economic damage than the prudent, steady course we're proposing today. All depends on New Mexicans. This again requires discipline. It isn't easier; now it's harder, and I just don't think that people, as I watch what's going on around the country, are hearing that message. They hear, "We're open." They don't hear that you have a higher burden to bear because you're responsible in this social contract to mitigate spread. Michelle Lujan Grisham: (48:47) I know that you can do it. I know that we can do it. We're demonstrating. I'm proud of the state. We're concerned about our Northwest region and our neighbors. We're going to continue to lean in to support them and help them through their higher transmission rates, and we believe we can also do incredible work there still to mitigate transmission and to save lives. I know this was a longer press conference. When we have a huge new shift in where we are and where we're going, you should expect that to occur. I'm grateful that it gets this coverage and that people tune in and watch. It's really important. We're all in this together, New Mexico. Thank you, and we are ready, Nora, to take questions. Speaker 1: (49:34) Thank you, Governor. First, we're going to go to Michael McDevitt with the Los Cruces Sun News. Michael, you are unmuted. Go ahead and ask your question. Michael McDevitt: (49:43) I wanted to ask about the liquor stores and if the state would ever consider an emergency measure to early allow alcohol delivery, as has been done in some other states. Michelle Lujan Grisham: (50:00) Absolutely I would consider that, but our legal review indicates pretty unequivocally, I just don't have the power to do it. There has to be the ability. I can't construct a statute, and the statute doesn't for regular businesses, so I'll say grocery stores and convenience stores, it doesn't restrict them from curbside or delivery service. The statute for liquor stores specifically prohibits that, so I can't create it. I think it's something that, given that this virus lives among us, we've got nine months or longer before we have a vaccine, I think it is something that we really should consider and I'm not opposed to that, but I want New Mexicans and our partners, our liquor stores to know I don't have the power to give them that ability in the construct of the current statutory requirements. Michelle Lujan Grisham: (50:59) But I personally think that that would be the same as curbside pickup and delivery by other retailers and grocery stores and restaurants, so I wish we could do that so it's clear to everyone about where you can go, how you can get it. Curbside pickup and delivery, you're safer than going into a grocery store. I'm clear about that, right? Person to person. I just don't have that authority under new Mexico's emergency powers. Next question. Speaker 1: (51:29) Thank you, Governor. Next we're going to go to Matt Grimes with New Mexico PBS. Matt, you are unmuted. Go ahead and ask your question. Matt Grimes: (51:37) Thank you. Governor, you all seem to be taking masks seriously out in public. A fair number of people are not. I'm wondering if you're going mandate them. Secondly, eight days ago you told us the state's capacity for testing was 5,000 to 6,000. It doesn't appear that we're testing to capacity. If not, why not? Michelle Lujan Grisham: (51:56) Okay, so mandating and enforcing everyone to wear masks is incredibly challenging, and we take seriously enforcing. Our goal today is to get people to accept behaviors because they're willing to do it. There actually might be some individuals on oxygen, though that's a vulnerable population. I hate to see them out, but if they're living alone and driving and have to get to a medical appointment, requiring them to wear a face covering could actually interfere with good public health, so I don't think it's likely that this state or frankly any state will mandate that, but you should expect that we will push hard. Michelle Lujan Grisham: (52:37) We're going to push employers hard that they need to help us give this message out, and that they really ought to be asking and requiring their consumers to wear masks, because what do they do when they do that? Not only are they protecting the state, they're protecting their employees, and their employees want these safeguards and protections in place. They don't want to bring COVID-19 home. They don't want to be exposed unnecessarily, so I really think that we can do that together and that's the most effective way to change behaviors is to get people to embrace them, and we'll keep role modeling. Michelle Lujan Grisham: (53:14) We are not testing to capacity. You're correct. We did that 5,000, and now we're getting closer, tomorrow for sure about 3,000, a little bit more. I will tell you that's because we aren't seeing as many folks come to us. I actually might have to defer to Dr. Scrase. I don't know if somewhere in the life of the virus and in transmission, you sort of shift. Now we know unequivocally that you can have this virus and be asymptomatic, so when people had ... We said if you're a traveler. We said if you have any of the core symptoms early on, fever, cough, shortness of breath, we insisted that you come get tested, and people were desperate around the country and in New Mexico to get tested. Everyone remembers the long lines at our drive-up testing centers. Well, now we don't have long lines. People aren't coming because they're not sick. We then pushed out the testing to essential workers. We want to do more. Michelle Lujan Grisham: (54:15) It's a perfect question, Matt. We are encouraging new Mexicans to tell us. We'll tell you where. Check that website. Please, please come. We're going to do more messaging. Here's the hard squishy part. If everybody tomorrow shows up at one of our open sites, we'll be overwhelmed. Some people won't be able to get a test. We only have those collection samples up to that magic number, and we are pushing out getting to every high risk area, primarily nursing homes, but not exclusively. But we aren't seeing the kind of response we would like to see by New Mexicans. We have access. We want to do it. It gives us that surveillance. It also allows us to do better by asymptomatic individuals. So you're right, and it was a great place for me to say please come get tested. Michelle Lujan Grisham: (55:07) And, before I go to Dr. Scrase really quick, states are beginning to advertise all over the country. We're the first in the country to mandate testing for nursing homes. We can do it universally, or we can ... Again, this should not be a competition to do good public health work and to save lives, but we were really fortunate we got in it early. We set up sites early. We had partners who stood them up with us early, and I was dogged about getting test kits. I still am. I spend some part of every day chasing what we call the consumables, right? The sampling on the one end, the swab and the medium and the reagents on the other, but we can do more and we would like to do more. About whether or not we just are seeing more asymptomatic, I don't know if there's any evidence about that, Dr. Scrase, or not. Dr. David Scrase: (56:01) Yeah. Just a couple things, Governor. Dr. David Scrase: (56:03) Yeah, just a couple of things. Governor, you previously went through the newer symptoms just this week outlined by the CDC, and so when we were just focused on fever, cough and shortness of breath, I think people were coming in for those, with the expansion, as for the research is being done and more testing is being done, people without fever, cough, shortness of breath, but with chills, or shaking chills, or muscle pain, or headaches, or sore throat, and loss of taste or smell, that there are more reasons now and more symptoms to prompt a New Mexicans to get tested, and providers to suggest testing to their patients. Dr. David Scrase: (56:39) Further, as we do that asymptomatic testing, there's a lot in the medical literature this past week in particular, as this proactive epidemiologic testing to vulnerable populations, nursing homes, the homeless shelters, and even other groups like healthcare workers. Particularly, we're finding a lot of people that are asymptomatic. In homeless shelters, there are three studies this past week, up to 50% of people, both staff and patrons of the homeless shelters were positive. 80% were asymptomatic. Also in the past two weeks, new evidence from China that when they really did careful contract tracing and found when each person contacted a COVID positive person, that up to 44% of the transmission of the virus was actually from people who did not have any symptoms. Dr. David Scrase: (57:39) And I think the last comment I have about a mandatory face masks, there are many ways to do this, and I have my own personal plan, and that is I don't plan on going anywhere or into any establishment where everyone isn't wearing a face covering. And I think if every New Mexican took that point of view, there would be a very rapid adoption across the whole state, where it would just become the norm to do that, because I'm wearing a face covering because I want to keep you safe and you're wearing a face covering because you want to keep me safe. That's the social compact here I think. Michelle Lujan Grisham: (58:13) Fair enough. I also want Secretary Kunkel who knows everything about testing. Secretary Kunkel: (58:19) Thank you governor, and thank you Matt for that question. I really appreciate the governor explaining the core issue is that we were able to do significantly more testing when we had those established sites, and we had huge volumes of people. It says shifting our strategy to going out to places requires me to have a larger team on the ground and we're continuing to look at better strategies to do that. But it would be better if people came to the sites that are still open, still there for you. We will test you. You don't have to have the old criteria. So I would just want to reiterate that. We can test more. We want to test more. Please come out to us. Thank you. Michelle Lujan Grisham: (58:57) And I know we need to take another question, but Matt, it's a very interesting dichotomy here. Again, we do not have 2 million tests. I wish frankly we did. And all of the scientific evidence would suggest that's too many people to be testing. So fair enough. But where most of the world and certainly most of the countries to really exacerbated by not having access to tests, and just now announcing what I would refer to as expanded, or what they're calling more universal aspects of trying to test in certain areas. Surveillance, we've been doing and now we have more we've got more samples that we could collect than we can get done because people aren't coming to us. So we want to close that gap. You helped us get that message across by asking that question, so thank you. Speaker 2: (59:51) Thank you governor and secretaries. Next we're going to Julia Goldberg with the Santa Fe Reporter. Julia, you are unmuted. Go ahead and ask your question. Julia Goldberg: (59:59) Thank you very much. I had a question, two unrelated questions. I noticed in the modeling that the state is looking at a 20 days out, what the impact might be on New Mexico from border States, Texas and Arizona, and possible policies to address that. I was wondering what the results were, what policies? And secondly, just wondering if this news about antiviral would come into play with any of the preparations, if it would maybe change how the state is thinking about life in COVID prior to the vaccine. I think that's it. Thank you. Michelle Lujan Grisham: (01:00:35) I didn't really hear the last part of the question. The news about- Dr. David Scrase: (01:00:39) The antiviral. Michelle Lujan Grisham: (01:00:40) Oh, the antiviral. I'm going to go to Doctor Scrase. I'm going to do the antiviral just quickly. We know that we have incredible expertise in the state. I'd like to thank every New Mexican who thanks me, and also tell the New Mexicans who are concerned about our policies and positions, who respectfully tell me and give me other strategies. I expect both and appreciate that kind of respectful discourse. It's powerful and it helps us stay balanced and informed. But there is value, which I don't think that Dr. Scrase intended not to do. I'm going to torture him a bit. Michelle Lujan Grisham: (01:01:25) We want antibody tests, and we want to do that surveillance. There's a lot of scientific evidence even using that to think about the vaccine, using some of those strategies and aspects, and trying to figure out immunity. So if we tested one person several times over a course and they didn't get COVID again, that gives us information. What we want to be careful about is that there's no evidence today that suggests that doing antibody gives us the information to slow the spread of the transmission of COVID-19, and that we can't stop doing. Michelle Lujan Grisham: (01:02:06) So we are going to engage in both. And in fact when he talked about we've identified the right products, the right strategies, and that the medical advisory team will keep doing that. As you know it's already happening in New Mexico, in a couple of hospital settings, it will expand, and we've gotten commitments for antibody tests and kits coming to New Mexico. The first validation of some of those because you... For me it was a hard thing to learn, and I hope New Mexicans will forgive me before I go to the expert, and he is in fact the expert. Michelle Lujan Grisham: (01:02:47) There are all kinds of laboratory instruments that run all kinds of blood tests and viral tests every day. We do that all day, need to, still check for flu and any number of other infections. But when you add a new test, so we're looking for... We can pull out COVID-19 and they were looking for COVID-19 antibodies. That requires a way to take your laboratory instruments, validate that they can actually do that with these new kits, and then you have to have an FDA approved, once you validated it, it takes software, and run, then you can do it for the general public. I made it sound incredibly easy for these laboratory leaders. It is incredibly complicated, so complicated that many universities and labs on the country actually can't do it. Couldn't do it. New Mexico had several labs, several experts, and a shout out to all of our molecular biologists who can actually really effectively do this work. So we've been kind of a place where when I make the case to get those, they know we have the capacity to do it. Michelle Lujan Grisham: (01:04:04) So May 1st tomorrow, I know that we've got a laboratory that will have access to that testing phase for antibodies, and then we will get material in the next five to 14 days so that we can expand what we're doing. I'm not going to make those decisions about where, how, and how we use that evidence without the medical advisory team and our medical experts. And that's Dr. Scrase. Do you want to elaborate? Dr. David Scrase: (01:04:34) Yeah, I can. I can say a couple of things about both questions. Thanks to the initiative of a friend of mine and a great colleague, Christoph Lambert at the university of New Mexico. Those of us on the MAT Leadership Team get a summary every night of, I don't know, approximately 50 to a hundred things that have come out that day in the medical literature and the news are, it's a wide variety, and a wide variety of topics. And so there's a therapeutic section of that. We have a therapeutic section of the Medical Advisory Team, which has now grown to 150 different positions and PhDs, and other kinds of providers, constantly looking at what's new and figuring out what's important. Dr. David Scrase: (01:05:17) One thing is that if you click on those links for each article, almost every single article has a very large warning at the top of it that says this has not been subject to the peer review process. Normally all articles are subject, and research, are subject to a very intense peer review process. I've been through it. It's hard and so what's happening is in the rush to get information out, these things are being published. Dr. David Scrase: (01:05:46) So the MAT therapeutics team with respect to all the anti-virals, not just from [inaudible 00:09:50], they are looking at each one. They're reviewing. Usually it takes a couple, three, four articles to give us a sense that it's working. A great example was hydroxychloroquine, where there was a big push for that, and one or two articles, one from France looked promising, and then somebody took the time to combine all the little tiny studies together with all those numbers into one big one. And now the scientific opinion is, "Well, maybe." So we backed off our recommendation from using it to consider using it, understanding that the data isn't available. And all those papers are on the DOH website under MAT. Dr. David Scrase: (01:06:35) The last thing is about 20 day modeling and border spread. So somebody's already gotten on the website and looked up at the site presentation. So thank you for doing it and raising the question, because it brings up a really important topic that I was hoping someone would ask about, and that is, "Hey, other States are opening up. We can just drive from Las Cruces to El Paso, go to a restaurant, go bowling, catch a movie and come back." And my specific medical advice to anybody who's thinking about that, is do not do that, you're just going to go substantially increase your risk of getting COVID and substantially increase the risk to other people you come in contact with after that. Dr. David Scrase: (01:07:19) And so we don't have the ability that we're not blocking off the borders. Traveling, interacting with other people is what spreads the disease. And we're already seeing in other countries that people who have opened up like this are now backpedaling and having to close down again, and finding out that they had a big uptick in cases like the curves I've showed you last week and this week. Number one and two, it's only going to be a matter of time. We know that as people congregate more, there'll be more cases, there'll be more hospitalizations, there would be more people on ventilators, and there'll be more fatalities. And so that's not an experiment. That is the behavior of the virus. Dr. David Scrase: (01:07:57) So I think we're just calling on New Mexicans again, to use good judgment. If you live near a border where things are more open than they are on the New Mexico side of the border, think of your people in your family, think of the people you meet every day and stay safe. Thank you. Michelle Lujan Grisham: (01:08:14) And the last thing, support New Mexico. This is painful that we have such grave economic losses and impacts. Incredibly painful. I'll bet there's not a one of us who isn't personally concerned about economic security, and then quite frankly, really concerned about our neighbors and friends who've lost their businesses and their jobs. We are at a critical phase in this country. All the national reports are showing that with the increases to unemployment we're at depression era levels. Michelle Lujan Grisham: (01:08:49) So this is an incredibly serious issue that must be addressed and it doesn't have to be addressed at the expense of public health and safety. They impact one another. We're clear about that. We're going to do this in a safe way, but when we don't stand together, altogether in New Mexico and support New Mexico businesses who have supported us. There are many, many, many, many businesses who have restricted, who did what we call metering, few people in at a time, well before there was a public health order declaring that they had to do that. They just did it. Or introduced protective covering, face coverings, and gloves for their employees. Michelle Lujan Grisham: (01:09:31) We've done a really effective job. We can do better, but when we start crossing borders, and it's one of the reasons these regional plans have been so tough on state, and I'm participating, but they're trying to figure out. So Arizona opened, but they're really struggling with some areas, and some counties in Arizona. Same thing with Utah, and they're doing a slower approach. Same thing in Colorado, they have certain regions and counties that they're really struggling with and not struggling with, but they're not sure. Same with Texas who has seen an uptick in cases in the Dallas and Houston area. And in another week or so we're going to see some impact on the country, which will impact all the other States. Michelle Lujan Grisham: (01:10:12) So we're all trying to manage the information, and to do it as safely as possible, because not having an economic effort and investment in a safe way is not sustainable until we get a vaccine. Everyone in the United States, I believe, is clear about that. This governor is clear about that. And so we're hoping that your participation helps us, to maintain these efforts in a progressive, productive manner, and I believe that we can. So we appreciate these questions. Speaker 2: (01:10:47) Thank you Governor. Next we're going to go to Brandon Evans with KLAT. Brandon, you are unmuted. Go ahead and ask your question. Brandon Evan: (01:10:55) Good afternoon everyone. So two things. First, does the easing of the restrictions this phase change anything with what constitutes mass gatherings and the amount of people that can legally hang out at the same place? That's the first question. The second question involves nursing homes, specifically looking at two of them, one of them, The Genesis One in uptown as the highest COVID rates in assisted living. And then the other one, there have been a lot of deaths at the one in a care center in Farmington. What is the state doing about that? Michelle Lujan Grisham: (01:11:33) So the new order continues to mandate that no mass gatherings, so no more than five people in any one place. We recognize that we have a different metering component for occupancy when we're going to our essential businesses. So all of that stays the same. The mass gatherings is the toughest because people stay together for long periods of time when they're in close contact. That's why that's problematic. But if you looked at how I identified some of the other work from a preparation phase to phase one, phase two, phase three is we're looking at that. That's going to be the most difficult aspect to determine safe, practical, prudent practices until you have a vaccine. Because when people are in close contact, so a concert, that's when it gets really hard to manage or mitigate transmission. So the mass gatherings order is exactly the same as it was. And I know that that is tough particularly for a family events, funerals and weddings. And I am sensitive to that fact. I have a family that would like to engage in those respectful celebrations of life, and those just incredible celebrations that we can't. And so that's tough, but I know that it's too early to do that. And given how we've analyzed using the John Hopkins as a source for productive, evidence-based look at these things, the number of people, how close in contact, and how long they're in contact, mass gatherings is the toughest thing for us to figure out how we safely do. Michelle Lujan Grisham: (01:13:15) Nursing homes. Nursing homes are an incredible challenge in New Mexico and around the country. And it is an area that I find incredibly disturbing because it's all vulnerable populations, and it is one of the reasons that we are going in, and they are too now, they're getting their own test kits, and deploying them. So we've got 71 facilities, we want all of them to recover who currently have COVID-19, and we want the ones who are COVID-19 free to stay COVID-19 free. Michelle Lujan Grisham: (01:13:52) The facilities that have widespread COVID-19 infection rates are incredibly challenging. A team goes in, led by the department of health and other experts. They immediately follow state criteria for infection control. And they do that. If they don't do that, they're accountable. It's a really tough set of circumstances. And I know that I'm probably harping, but we need these caregivers. I mean they are champions, they're incredible, and they're asymptomatic. They have no idea. Michelle Lujan Grisham: (01:14:28) So we get tests, and I think that if we'd had a hundred point of care tests, if I had been responsible in the Federal Government for testing, I would have provided rapid point of care tests to nursing homes and hospitals, and I would have deployed them all over the country, because then you could test people as they were coming in and ask people to come in an hour before shift change, test them all. And it would take a little bit longer to go home, test them all. And we could have done that. And would it have prevented every case? Probably not. But it would have prevented a great deal of them all across the country. Michelle Lujan Grisham: (01:15:03) And I hope it's a lesson this country learns. We have the expertise to do that. Just to give you an example, there are two different kinds of products that were deployed by the Federal Government to States like this one, like the Mexico, us included, Abbots and Sofia that are rapid, what they call point of care, it means that you can run a test, takes about 45 minutes. It's one at a time. We do have an instrument in New Mexico that could run several at a time, but they didn't give us the right commodities or supplies to do that. This is why governors are so upset about the testing strategy. Michelle Lujan Grisham: (01:15:39) So we're going to go out, it's a partnership. We're doing the surveillance. It's incredibly aggressive by the secretary of health and our entire team, all the nursing homes and family members should expect us to get to all 71. A great majority of our testing now is directed at nursing homes, and the nursing homes, the life care in Farmington and uptown Genesis are high risk areas. We are well aware, we're in, and it's painful, but they are required now to go to their direct infection control. Even for one, they're required to do that. Michelle Lujan Grisham: (01:16:19) We actually have, to your question, we have six facilities that have 10 cases or more. These are our highest risk cases. They get what the secretary referred to as the SWAT team interventions, and we've got 27, I think, facilities with one case to 10 cases, and we're paying close attention to them, but it is a high risk area for sure, and the best thing I can say is we're devastated, and don't want any more transmission in any more longterm care facilities or healthcare facilities, which again gets right back to the social contract with New Mexicans to the highest degree that we can. Secretary, have I missed anything about that? Secretary Kunkel: (01:17:03) Only I would say in addition to, thank you governor for everything that you did say about that. The testing team run by a public health physician, Dr Sansoni, many of you have met her. She's been everywhere in the State. This was an area of focus for us right from the start. This was a very sad, very troubling development for us. I can tell you that the Division of Health Improvement, who's responsible for surveying and licensing longterm care facilities, long before there was COVID in New Mexico, reviewed every single nursing home's infection control protocols with the CMS tightened security. Secretary Kunkel: (01:17:40) Even today they assign surveyors to every single nursing home, and they do daily calls and video reviews of their infection protocols. We encouraged, did not mandate, but I believe we encouraged 15% surveillance of every nursing home a week or two ago. Even with all of our precautions, when an asymptomatic person comes encounters with this very vulnerable group, it's almost impossible to stop. And so we mourn that and continue. Secretary Kunkel: (01:18:09) So we do have aggressive interventions. We go in, the testing team, physician nurses and experts from the public health department, go in and evaluate their ability to isolate, attempt to get isolated wards, and review again, infection control, do everything they can to improve the situation, but it is extremely difficult to arrest. So our other intervention is to get in quickly when there's one positive, and try to keep it at that. And I think Dr. Scrase you have something? Dr. David Scrase: (01:18:40) I just wanted to add, I think the aggressive testing is going to help us here in New Mexico. But just to give a broader context for everyone listening, this is a world wide problem, and the majority greater than 50% of COVID deaths in Europe occurred in people living in nursing facilities. And I think the governor pointed out this is a very, very vulnerable population. And now that we're understanding better that we did not, the science didn't know eight weeks ago how prevalent asymptomatic spread can be, it's very difficult to... I mean, you could literally test every worker and every resident every hour. And you wouldn't know where to stop that surveillance. But I feel like the aggressive approach Secretary Kunkel has taken and her team, they really are out there. I hear reports every day about multiple numbers of nursing homes being completely screened and tested. Michelle Lujan Grisham: (01:19:42) And I know that you didn't ask this, but every single death is a tragedy, which is why a vaccine is crucial, and every state needs to do their part to make sure that the evidence and scientific work is aggressive but safe in getting a vaccine out. But as a caregiver it's incredibly painful when there are statements both in this state and out of the state that this is a population that's vulnerable anyway, that dies from the flu, that dies from falls, or swallowing disorders, and they're all in their nineties. Michelle Lujan Grisham: (01:20:24) These are human beings that are brothers and sisters, and our mothers and fathers, and our grandfathers and grandmothers. These are valuable members of our community who depend on us for their care and support. They are incredible tragic losses, and it is an outrage that anyone anywhere in the country or in this state would cavalierly suggest that our resources should not be placed there, and that our restrictions and social contracts should be avoided because that's a population we can't really manage. Michelle Lujan Grisham: (01:20:59) And I think your question was, are you doing everything? We think we are. Can we do more? We are working to do more. Are we outraged that every time we lose someone because of this vicious virus? We are. And I'm just compelled to say that. Every single one of those individuals is a loved beloved family member who deserves our attention and our support, and we're going to do everything we can as a State, and we believe that we can still do more even in the six facilities that have more than 10 cases, and are very high risk, we'll just keep doing more, and we'll require the experts, that's my job to get every bit of evidence-based strategic efforts underway, and quite frankly, it's why we have a Navajo Nation Rapid Response Team. Michelle Lujan Grisham: (01:21:53) We can do more, we must do more. There's got to be other strategies that really do reduce the rate of transmission and save lives. I just can't believe otherwise. So we'll keep fighting for every single New Mexican, and I appreciate you raising that question, and it is a very painful effort and a very painful reality of what this virus can do to a community. Speaker 2: (01:22:16) Thank you governor and secretaries. Next, we will go to Dan Boyd with the Albuquerque Journal. Dan, you are unmuted. Go ahead and ask your question. Dan Boyd: (01:22:26) Yeah, thank you. Good afternoon Governor, Cabinet Secretaries. You've mentioned the high infection rates and McKinley and San Juan Counties in the Northwest part of the state. As part of the approach to dealing that, are you considering additional isolation and quarantine orders and perhaps other of drastic action in the Gallup area? Michelle Lujan Grisham: (01:22:46) In fact, Dan, we are. Now, the way to make that most effective is to be working with all of the partners, so every sovereign nation in the Northwest corner, corridor of the state, those counties, those three counties in particular San Juan, McKinley and Cebolla. We are getting requests, and I don't know the full extent right this minute, but we'll get right back to you when we do. It seems to me that those localities are looking at ways for us to be more assertive in restricting access into those communities and not relaxing restrictions, but actually doing the opposite of that, recognizing that they need to save more lives and we need to be working together in a concentrated effort. Michelle Lujan Grisham: (01:23:35) And it really speaks to that whole preparedness preparation phase. We've got areas of the state that just aren't ready to be relaxing, and need more support by the entire state, which is why we transport patients, why we have a statewide medical advisory team. We didn't make it so that you have one physician or one person who just works on it for a city or a County, but New Mexicans should expect that the relaxing of restrictions will not apply to the Northwest region. Michelle Lujan Grisham: (01:24:03) That the relaxing of restrictions will not apply to the Northwest region of the state. You should expect that order to be very clear about that and you should expect that there will be broader restrictions in some communities in a full partnership with those communities. And those details are being worked out right now and they would be effective tomorrow. Yes, Dr. Scrase. David Scrase: (01:24:21) Two other quick comments, Governor. Number one, yesterday I believe it was or the day before, physicians, intensivists from Albuquerque reached out in a teleconference with the folks in Gallup to try to find ways to support them. They're really running it over full volume and they agreed to start transferring more patients into Albuquerque to give them some breathing room there. And then the other thing I wanted to mention is just to remind us all that any intervention we make, no matter what it is we do, it takes 8 to 10 to 14 days to see a difference. Because remember there are already people who during this press conference have infected others. They're going to take three to five days to have symptoms. They may spread that to other people before that period. David Scrase: (01:25:15) And so it really isn't, it would be like trying to adjust the temperature of your shower when there was a two minute delay between when you turn the knob and the change in the temperature of the water. And so there's a long lead time on these things and that's why the modeling is so important also to try to do the best we can to look out ahead and see what we expect based on all of New Mexico data. So I just wanted to add those two things because those will come into play in the coming weeks in the Northwest part of the state. Nora: (01:25:43) Thank you governor and secretary. Next we're going to go to Chris McKee with care QE. Chris, you are unmuted. Go ahead and ask your question. Chris Mckee: (01:25:53) Thank you very much. I wanted to ask a question to that question about the Northwest region. We understand that the mayor of the city of Gallup wrote a letter to the governor's office today. It's posted on Gallup's website, gallupnm.gov right now requesting that the governor's office declare a "State of emergency pursuant within the boundaries of the city of Gallup." They're saying that the virus has caused many deaths, stretched medical facilities and resources to their capacity and impacted the welfare of the City of Gallup. And the letter goes on. But simply put, I wanted to ask, will you declare a state of emergency in Gallup and what more specifically is going to happen there because clearly the numbers are continuing to go up there? Michelle Lujan Grisham: (01:26:41) So I referenced that there was actions being taken by local leaders in McKinley County, specifically the city of Gallup. There is a potential for more of those requests and declarations. So I'm waiting for those, that potential. But absolutely, this is a partnership to save lives. It is something that I want to thank the leadership. These are hard decisions to make for your community. I think it takes incredible leadership and we want to support that. Finding the tool to do that effectively and really thinking about ways to collapse our services and supports so that we're limiting access and transmission into Gallup is being worked out as I referenced earlier. Michelle Lujan Grisham: (01:27:25) You should expect Chris to get more information about that shortly. I just want to make sure that as we identify the vehicle, the legal vehicle and we're clear about all of the supports that we'll take from the state which we will provide and that it will be in effect I believe tomorrow. So kind of a long answer but yes, we accept that declaration. We'll respond with an enactment and I'm just waiting for a couple more details from other like community leaders who are trying to get their arms around this and I want to make sure that they have our full support. To say that publicly they have our full support. Nora: (01:28:05) Thank you governor. Next we're going to go to Jeff Proctor with New Mexico in depth. Jeff, you're unmuted. Go right ahead. Jeff Proctor: (01:28:14) Thanks Nora. This question is for the governor. We had seen reports from all over the nation, Ohio, Louisiana, Illinois, New York, and more that when wide-scale COVID-19 testing is performed in jails and prisons significant portions of those incarcerated populations and the guards who supervise them have the virus. As of today here in New Mexico eight inmates and 33 staff members have been tested, with one staff testing positive. For context, there are nearly 6,600 inmates in the state's prisons with about 1800 staff. My question is in two parts. Why hasn't more testing been performed on inmates and staff in the prisons? And part two, as you are ramping up sentinel and surveillance testing around the state, do you intend to include the prisons in those efforts? If not, why not? Thank you. Michelle Lujan Grisham: (01:29:12) Yeah, thank you for the question. Again, high risk area, we're clear and appreciate the question. Our efforts have just started in the surveillance aspect and given the issues with nursing homes, jails, first responders and hospitals, we haven't been as robust in getting to all of the corrections site. But in fact you might remember that we are part of a pilot and we've been negotiating with the white house about exactly still believe it or not what that means, but I can give you this specificity. They've now said tell us how much surveillance you have the capacity to do. There was some dancing around that with the nine States. We are providing that some CDC personnel tied to the pilot are already on the ground in New Mexico already working on the contact tracing, already implementing some of the recommendations for those digitized or software strategies already identifying. Michelle Lujan Grisham: (01:30:13) Because it's a lot of personnel, for really effective contact tracing it's like 670 people doing just that work at a very cohesive manner and being trained to do that. So that's already happening because I'm surprised I haven't been asked about what the progress is. But the next thing that will be delivered and my goal is mid tomorrow, that was a hint to the folks who were working on finishing up that proposal. There will be leads in the state for surveillance testing. Corrections is one of those lead areas so that we can get to all of them. We agree any of these high risk areas must be part of serious surveillance and testing and we are on it. I wish that that aspect by the federal government and the CDC had materialized a bit faster. You can see that we rolled out the healthcare workers and the nursing homes. Michelle Lujan Grisham: (01:31:08) We didn't not go to any corrections facilities, looked at risk areas and symptomatic personnel. But yes, in our plan should be in the plan, should be part of your high risk strategy, should be part of your surveillance. We did the same thing that we did also to other high risk. They had to do all the mitigation strategies, temperatures in right before you come to work you have to have face coverings, gloves and infection control strategies. Inmates must have masks, they made them. That happened in phases because we were making them, but we've really tried to employ every single strategy we want available everywhere else. We also know that in federal corrections facilities, detention centers, there have also been positive COVID-19 cases. Michelle Lujan Grisham: (01:31:56) I have certainly made it clear that they should be utilizing the same standards that the state is requiring and have made that clear. I can't say today that it's meeting our satisfaction but we'll keep working on that. But I appreciate the question and yes, New Mexicans should expect that they will have the same priority with all the testing that's coming in in our CDC pilot effort. They should be. Did I miss anything? Yep. Secretary Kunkel. Kathy Kunkel: (01:32:27) Thank you governor. Yeah, I apologize if I did not identify correctional facilities as one of our congregate settings that we are focusing on because we are. Our responses to date have been more reactive where we had, if we had a positive or even a PUI as we call them. We did significant testing in one facility up to 70 inmates and we have been recently in another. We evaluate them carefully because there is somewhat of a supply chain, we are somewhat limited and we are careful. But they will become one of the surveillance testing as we are in other congregate facilities. And there is a lead attached already. Thank you. Michelle Lujan Grisham: (01:33:05) And a high priority for that. I mean I want to make that really clear. I think there are some individuals around the world and in the country that don't see this as a high risk or that it should be a public priority response. We disagree, it should be. It will be. It is and we are securing the resources that we can fully execute those efforts. Nora: (01:33:27) Thank you governor and secretaries. Next we're going to go to Morgan Lee with the AP. Morgan, you're unmuted. Go ahead and ask your question. Morgan Lee: (01:33:39) Good afternoon governor and secretaries. The Indian health service today said that it appears from their modeling that the peak on the Navajo nation is headed for around May 10th. I wonder if you have sort of a similar estimate. Michelle Lujan Grisham: (01:33:59) Sorry. Morgan Lee: (01:34:00) And I also wanted to ask, president Trump said he plans to visit Arizona next week. I wonder if you think that's appropriate given the situation if you'd like to see him here in New Mexico as any kind of gesture? Thank you. Michelle Lujan Grisham: (01:34:18) So I'm going to go to Dr. Scrase for the modeling and we identified that we would see surges right around now and we have. That we identified the peaks for later in May. Given the transmission issues we think that peak area may not be such a huge spike but rather too high, too long. Could go into later in May and early June and I'm going to defer to Dr. Scrase about that. We do compare that and try to make sure that we're on the same page with our modeling strategies. And again for folks who think that we just use some basic data and some population and then mix it up, these are incredibly sophisticated strategies based on sound epidemiological modeling and we have many public and private partners. Let's talk about president Trump. I think that Arizona and New Mexico, what I will welcome president Trump with open arms in New Mexico if he is masked, he's wearing gloves for anything that we're going to attend. Michelle Lujan Grisham: (01:35:25) There are no mass gatherings or rallies and he's bringing air force one with the supplies that we need in the state of New Mexico. It is clear to me that they are recognizing that we need more and they are real risks. I haven't spoken to the white house about their plans and his travel plans. All I've seen is responses that make it appear that he's working on political stuff, which it's a political season and that's you have to. I really hope that Arizona and other states don't engage in those mass gatherings. I can tell you that there are New Mexicans who may want to go and they should get to go from the context of making your own decision, following the laws in another state. There are people, we're not all like minded politically all fair, but that travel and that mass gathering creates risk. Michelle Lujan Grisham: (01:36:23) The Navajo nation is in Arizona, creates risk. All of it enhances risk in New Mexico. I would not embrace in any context and political organizations, all parties are not exempt from the mass gatherings. So I would not support that effort in New Mexico. But again, anyone in the federal government or the white house that is working to help New Mexico do the best job and working to bring supplies is welcome here. And in fact, many members of the federal government are already in New Mexico and we're grateful and they're using the right protocols. So if he meets the CDC protocols I know long answer, absolutely. Dr. Scrase you want to talk about modeling? David Scrase: (01:37:11) Yeah, I'm looking in my computer here for the exact peak date from McKinley County. We do most of our modeling and report our data by region and the print is really tiny. But I think that number one, the cases are still increasing. But they're increasing in more of a linear fashion than an exponential fashion. So that's a good sign. But I would say that based on the data we have that this could go on for awhile and that the peak may push all the way into June or even late June. So we don't have enough data. We're seeing a very initial sign of the fact that it's not increasing exponentially. That's good. But we don't have enough data to pin down an exact date. But I would say I would love it, I would be so happy if it peaked on May 10th and started coming back down. That would be wonderful for the state and for that part of the state. Nora: (01:38:13) Thank you governor and secretaries. There'll be our last question to Michael Gerson with the Santa Fe New Mexican. Michael you're unmuted. Go right ahead. Michael Gerson: (01:38:22) Hi. Thank you governor. You mentioned reopening some businesses again at limited capacity by mid May. How do we know that that won't result in another spike in cases? And my second question is regarding the leveling off somewhat that we're seeing in cases, how do we know that that's not simply because not enough people are getting tests? Michelle Lujan Grisham: (01:38:50) Both good questions. Actually we do know that as we ease the restrictions and open up businesses we'll see more cases. The question that we have to be able to answer productively to safeguard New Mexicans is that increase still keeping us within that below healthcare capacity? So that's what we'll test. And if we can't sustain that, then you have to make other decisions. And the hard part about those decisions as Dr. Scrase has indicated and secretary Kunkel that you don't see the results of those right away. So in two weeks if we see the results are poor, so poor that we're getting to a non flattening and we're breaching that hospital capacity, then you got to restrict again and then it takes two weeks before you can solve that problem for the healthcare providers and the healthcare industry. So that's why it is slow, steady, viable, prudent and we have to maintain our social contract. Michelle Lujan Grisham: (01:39:51) Otherwise, to your point, yes. And we're going to keep seeing increases in cases while we do that. There's no question with the number of asymptomatic individuals that we believe there's more prevalence of the virus in our community, so to your point. And since I can't test everyone, then you have to behave as if you have the virus. And that is the only strategy given those restrictions that we don't have everything that we need for us to mitigate. Everyone should behave as if they have this virus only go out when you need to, only go to businesses that you need to, when you need to go to businesses support New Mexico businesses, buy from them online, get delivery. And to make sure that it's curbside, do that all the work so that you're prepaying and you don't have to touch anything. I mean that is really how we maintain it. Michelle Lujan Grisham: (01:40:45) Again, you've heard me say and I'll say it again and I appreciate that you've given me an opportunity, the focus in December by the federal government should have been on testing and figuring out exactly how states could get to 25% or beyond potentially of their total populations for testing. Because then our isolation strategies could have been swifter, more strategic and specific in high risk areas. We're doing what we can and again, I'm very, very, very proud of the team and the secretary of health and the medical advisory team and the rest of the cabinet. You only see a couple of us, but there are several teams who work tirelessly to put it together because we have to find other ways to keep New Mexicans safe because we're not going to get access before there's a vaccine I don't think to have enough to get to my surveillance goal. Which isn't totally supported by the science so I don't ask for it, but I would take it. Michelle Lujan Grisham: (01:41:59) I think more information and more data is a good thing. I would try and in fact folks here will tell you I wanted to identify a way early to get to 50% of New Mexico's population and to have them all tested if we could get supplies by May 1st. So a million people and then we sort of scale back half a million people quarter of a thousand and it really is tied to supplies. I think we've demonstrated that we have the ability in rapid because we've got good private partners, hospitals and medical schools and healthcare Corps and the reserve Corps and the national guard and other students and private partners and private labs and the MCO and the hospitals, everyone pulled together in New Mexico. Michelle Lujan Grisham: (01:42:47) I mean I remember governor Cuomo saying, we focused on the hospitals. We have control over the public hospitals now we're asking the private hospitals to come together in a partnership, New Mexico because we have such scarce resources, we have to work together like that all the time. And it really put us in an incredible position, an incredible position in a matter of days really to go from two drive by testing sites in the state to 50 to 60 and to get to all 33 counties. So I would do more and we're not going to be able to get 500,000 by the time May 15th rolls around. Michelle Lujan Grisham: (01:43:25) We're at 63,000, it's a little under that 62, 879 I think is the exact number as of today. But we'll keep testing more and maybe someone will hear this response to this question and gratuitously send us 200,000 testing kits and I can drive the secretary of health over the edge and tell her to get 250,000 New Mexicans tested by Sunday. Dr. Scrase anything to add? David Scrase: (01:43:54) I have something on another topic but not this one. Michelle Lujan Grisham: (01:43:56) All right, but that was our last question. Nora: (01:43:58) It was our last question. I am going to kick it to Dr. Scrase who had an important announcement. Michelle Lujan Grisham: (01:44:03) Got it. David Scrase: (01:44:04) Yeah. One additional thing that I wanted to make sure was available on the website, but as part of this preparation phase, we are going to allow hospitals and inpatient outpatient freestanding surgical centers to increase operations for medically necessary surgeries. You recall there was an order probably over a month ago now to limit elective surgeries. Elective surgeries is an unfortunate term because it makes it sound like you can do it or not you need it or not. Most all surgeries really are needed and so our provider network has been good about limiting face to face contact and limiting surgeries. There was an initial concern about PPE supply that we think we are on top of now and we were not before. So there'll be an order coming up from secretary Kunkel today about that and basically it is already the guidance related to the order is available on the mat team website. David Scrase: (01:45:05) Mike Richards, our leader of mat put together a great team. They looked at national surgery guidelines to put together a plan for New Mexico and the only other couple of things I'll say about it is number one, we're asking folks as they resume to go no more than half capacity for a couple of weeks to make sure that all the necessary policies and procedures for patient safety, staff safety, medical staff safety are in place and working well. And the second thing is that it really does require in order to restart these surgical procedures, absolute and complete compliance with all DOH guidelines and particularly those related to the emergency. And so almost every hospital reports on their PPE every day. Almost every hospital is sending necessary information in, all those hospitals will along with the other guidelines DOH has put out, assuming compliance be able to restart. David Scrase: (01:46:09) But there is a gate for this as well and those details will be in the order. You can go to the bat website to see the way that the team has recommended re expansion, same for physician and other practitioner offices want to relax those criteria a little bit as well. Keep seeing people in phone visits whenever that works and doesn't degrade the quality of your care. That's really important and thank you so much for being so forthcoming in doing that. It's been great. But something that is elective in February can be a big emergency in May. And so immunizations, kidney kids need to be immunized and the like just, and there's guidelines online about how to do that and minimal contact approaches and another document both are dated April 28th. So we're pleased to announce that and look forward to conversing with you more about getting that started again. Thank you. Michelle Lujan Grisham: (01:47:11) I really appreciate that Dr. Scrase. We really are trying to address all of the concerns in a restricted restrictive environment and the social contract with each other to save lives, to reduce the transmission to protect healthcare workers. And we do, we need folks to keep helping us and for the vast majority of businesses, hospitals and New Mexicans who have really worked hard to do this and the results are proven, we flattened. There are others who haven't and Dr. Scrase's point is really important. A couple press conferences ago I was a bit dismayed and disappointed at some of the actions by our healthcare providers and hospitals to furlough and reduce staffing with layoffs sort of I think shift that over to unemployment. And these are hospitals that in addition to increased Medicaid rates, which is not the only resource that hospitals need, but a big one in New Mexico. Michelle Lujan Grisham: (01:48:09) We're receiving that in recent days of collectively around the state have got another $131 million and have increased rates and they should to protect their workers. As we deal with COVID-19. And we got hospitals who have not adhered to the order as we understand it. Some hospitals gave tours about how were not doing enough, sort of showing to the community we're open. That is in direct violation of the gatherings limits and it puts our hospital in real jeopardy with you got asymptomatic individuals you invited into a place I need to be the safest place to treat and support patients with or without COVID-19. Michelle Lujan Grisham: (01:48:56) So we want our communities and our businesses. I need that minority to make sure that the majority of New Mexicans and businesses and healthcare providers can do the things that meet the needs of New Mexicans by complying with the public health orders and allowing us to continue to do the work that saves lives. We've lost far too many New Mexicans and to safeguard our health care capacity and our healthcare workers. So you can do it New Mexico. We all can. We're in it together, all together New Mexico. Thank you for tuning in. We appreciate you.