Ralph Northam Virginia COVID-19 Press Conference Transcript April 15

Ralph Northam: (00:00) Commonwealth and then COVID-19 arrived, but I want to reassure you that as we recover, early childhood education will continue to be a top priority of ours. So, Pam, to you and your staff, I thank you so much for all of your work for our children and welcome. Pam Northam: (00:18) Thank you. Good afternoon. As the governor said, over the past two years, I've traveled over 5,000 miles visiting early childhood educators and families across the Commonwealth to highlight the critical importance of those first few years of life. It has been abundantly clear that the most important part of Virginia's early learning system is our talented superhero educators and these past few weeks have made that more evident than ever. I know these are challenging and unprecedented times, which is why we fought so hard to get this additional 70 million to you as quickly as possible. Providers, please visit childcareva.com for more information on these new resources. We also ask that all providers share their most up to date hours and availability with Child Care Aware of Virginia at 866-KIDS-TLC or vachildcare.org. Parents, you are a child's first and most important teacher. You know your children best and we know you are courageously and tirelessly working to support and reassure your children during this time, even when you may be feeling overwhelmed yourself. Pam Northam: (01:42) We thank you for the sacrifices you are making to keep your family and your community safe. If you need childcare because you have to work whether as a healthcare worker, first responder or in other essential industries such as food and grocery, sanitation and cleaning, transportation, utilities, or government, please know that we are so grateful to you and invite you to also visit child care aware at vachildcare.org or call, 1-866-KIDS-TLC for an up-to-date list of where you can get quality childcare in your area. Thank you for everything you do to give us hope each day. The Commonwealth is strong. Our children are resilient and together we will get through this. Together we will continue to work to lead the nation in early childhood care and education, the cornerstone to building a better, brighter future for our young people and our nation. Thank you so much. Ralph Northam: (02:51) While we are focused on the COVID outbreak, we also cannot forget that tomorrow April the 16th the anniversary of the tragic mass shooting at Virginia Tech in 2007. I have ordered all flags across the state to be lowered to half staff in memory of the 32 people who were killed that day. Our thoughts are always with their families and loved ones. Now, I'll ask our health commissioner, Dr. Norm Oliver, to give you a health update and then we'll be glad to take your questions. Dr. Oliver, welcome. Dr. Norm Oliver: (03:29) Thank you, Governor. Good afternoon. The numbers today for the impact of this pandemic here in the Commonwealth, we now have a total number of cases of 6,500. That's 329 new cases in the last 24-hour period. The deaths now total 195. That's an increase of 41. Just a word on that. That's a big jump from the last time it was reported and I think it's important to understand that disease surveillance, including death surveillance, is not done in real-time. It involves several steps and at each of those steps, human beings are involved. We don't know about someone's death in the moment that it happens. In small outbreaks, that means that we can catch up pretty quickly. In the situation of a pandemic, it takes longer time and that gets reflected in this lag in numbers and in periodic jumps in those numbers in our dashboard. Dr. Norm Oliver: (04:48) The health department has an obligation to ensure that you get high quality, accurate data in as timely a fashion as is possible, but it's important that we vet that data and make sure that it's really high quality and accurate. So, we would like to thank you all for your patience and your support as we carry out this important work. And also thank you for communicating this information to the public. Dr. Norm Oliver: (05:19) The data that we have on the racial and ethnic categories in the cases and deaths continues to have problems with some missing data. Of the 6,500 cases, we only have 3,904 that have the data on race and ethnicity. Given that the 1,158 cases of COVID-19 among African Americans, means that that population in our state has 30% of the cases. In terms of deaths, with 59 deaths among African Americans and with the race and ethnicity data available on 168 of our total of 195, that means 35% of the deaths are African American. Thank you. Ralph Northam: (06:17) Thank you, Dr. Oliver. We'd be glad to take your questions. Speaker 1: (06:23) Yeah. This morning, the outbreak at Canterbury Rehab was declared by the New York Times to be the worst at a longterm care facility in the U.S. Given that and what we know now, could the state have done anything differently to respond or direct resources to that facility? Ralph Northam: (06:41) I think the state has really stepped up and done everything possible. As I have said Kate, the nursing homes where our elderly, our most vulnerable patients, are a real challenge. They are at risk because of their age. As I've said, a lot of them are non-ambulatory. A lot of them don't communicate normally and so to have an outbreak at a nursing home when that virus is introduced in that type of environment is a challenge. We're doing everything that we can and I think the response was totally appropriate. We continue to have challenges with our PPE. We are directing that to go toward our nursing homes so they don't have a shortage. We continue to have financial issues. As you know, we have made some changes in our budget to increase the rate that nursing homes get reimbursed per Medicaid patient. Ralph Northam: (07:45) We also continue to have a challenge with staffing. Through the volunteer corp, we are training individuals and allowing them to help with the staffing at our nursing homes. Finally, Kate Todd, just the challenge of testing. Remember when we started this process, the turnaround time, especially for some of our commercial labs, was five to seven to sometimes nine days. So, that in of itself presents a tremendous challenge, but Dr. Forlano is overseeing that process and we're doing everything that we can to support our nursing homes knowing that's where some of our most vulnerable individuals in Virginia are. Marissa: (08:29) [inaudible 00:08:29] question is from Tom [Mathews 00:08:33]. Tom, are you on the line? All right. We'll move to Max Smith with WTOP. Max Smith: (08:47) Hi. Yes. I was wondering about ... you mentioned the volunteers again, Governor. Where does the 30,000 number that put out this morning for the volunteers needed come from and then also if those people are out there and they're needed, why not just hire them to do these jobs rather than ask for volunteers? Ralph Northam: (09:06) The question ... [Marissa 00:00:09:08], I didn't hear the initial number. Marissa: (09:10) 30,000. Ralph Northam: (09:12) 30,000 that are needed. Dan, do you want to comment on the need for staffing? Dan: (09:18) Yeah. Ralph Northam: (09:19) Thanks. Dan: (09:20) Sure thing. Be glad to, Governor. The number 30,000 was really taking into account the duration of this and that these are volunteers and that they would not be indefinite staff. So, spending a week at a facility, including working through the details of helping out in the longterm care environment, was where that number came to be. So, that was the number. We'd rather have more people available and registered rather than few. And I'll just give the example of my wife, Kim, is a registered nurse and she is in a clinical research position and she was furloughed. So, yesterday she has volunteered in the Richmond health district and was assigned and they're taking them on a weekly basis. Dan: (10:06) Now, she is working more on reporting results than in other environments, but she is an example of folks that now we know who they are, they've had basic training, we know what their skill sets are, and we are in a position to deploy them as needed. So, that's where that very large number. We wanted to take advantage of all of the trained medical personnel whether they're nurses or physicians or respiratory therapists that aren't in full-time positions on the front line now that could be tapped. So, that's where that number came from and there's an example of how they're being used and how we're moving through Dr. Forlano's efforts to make them available in longterm care settings and other settings in addition to acute care hospitals. Speaker 2: (10:56) Governor, in addition to Canterbury, we're also following the situation at Beth Sholom in Henrico. What can you tell us about that and what the task force may be doing to help make sure that doesn't become as bad as Canterbury? Ralph Northam: (11:08) So, great question and if it's okay, I'm going to let Dr. Forlano address that. Dr. Forlano? Dr. Forlano: (11:14) Sure. Hi there. The question was about a facility in Henrico? So, I don't have specific details on that particular facility today, but I can speak generally about the task force. So, the task force, the way I think I would describe it is that this body is bringing together a lot of subject matter experts, providers, leaders here in state government, to develop a more systems-level approach so we can strategically respond to all of these outbreaks, not just ones that pop up here and there. I think the governor spoke really eloquently about many of the components that we're focusing on. Staffing, testing, PPE, coordination between the hospital setting and the nursing facility settings. So, all of those things are being developed in partnership. Megan Healy is helping us with workforce issues, so I'd say what's been described is the approach we're taking. Speaker 2: (12:16) But Beth Sholom is on your radar at this point? Dr. Forlano: (12:19) Yes. I just don't have details, so I don't want to misspeak. Thanks. Ralph Northam: (12:32) Thank you. Marissa: (12:33) The last question is from [inaudible 00:12:33] at the Associated Press. Speaker 3: (12:33) Hello, Governor. I wanted to see if you or Dr. Oliver could spend more time addressing the 41 new deaths reported since Tuesday. I know Dr. Oliver spoke of some lag time in reporting, and sometimes a large uptick can be deceiving, but I wonder if you can address the number of deaths. It seems like that is the biggest one day jump since this hit Virginia. I'm wondering if you can give us an overview on whether the 41 deaths, how many of those people had underlying health. Speaker 3: (13:03) ... 41 deaths. How many of those people had underlying health conditions and how many, what areas of the state those people are from? Dr. Norm Oliver: (13:14) So the question as I understand it is to explain in more detail the jump in the number of deaths, particularly this most recent number of 41. And I think the thing that I explained earlier is the most important aspect toward understanding this. This is a correction in a data reporting on our dashboard, and doesn't mean that that many deaths occurred in that 24 hour period. Many of those deaths were in fact from a prior time. And what was happening was that information was finally being entered for example, into the database or death certificates arrived and then that was entered into the database. So that's why we had that big jump for that particular number. Dr. Norm Oliver: (14:14) And that may occur from time to time. As I mentioned, there's many steps in the process here. The people who are doing the case center investigations and the contact tracing of those cases are the same people who are doing the data entry. And while they're busily tracing and tracking down hundreds and hundreds of contacts of cases, there may be a lapse of a few days in which they haven't sat down at the computer to do data entry. And when they do, the numbers will increase. But that represents prior history, not necessarily what happened that day. Ralph Northam: (14:56) And I think a part of the question was did these individuals have preexisting conditions and what were those? And without getting into the specifics, as I mentioned earlier, individuals that reside in our nursing homes and chronic care facilities, most of them are elderly, a lot of them are nonambulatory, they don't walk. A lot of them are unable to communicate. And obviously in that age group, a lot of individuals have underlying medical conditions such as heart disease, lung disease, things like asthma, renal disease and diabetes. And, we know that all of these preexisting conditions put these individuals in addition to their age at risk. So it's a very vulnerable population. Speaker 5: (15:51) [inaudible 00:15:51] what we're seeing from the UVA peak and that potentially happening in late August. So with this stay at home order currently being until June 10th, are you sitting here today currently considering extending that based on that new peak, and if you're not going to extend it, can you speak more specifically to what life might look like after that June 10th deadline? Will we completely go back to normal, or are we going to continue to see restrictions into the summer of any kind? Ralph Northam: (16:21) Yeah, so the question is, as far as the UVA data and our stay at home order, I don't have any intentions as of today extending that. As I've said all along, the best news would be to continue the social distancing, to see our curve flatten and then start decreasing, and even to be able to move that June 10th date back. But as I've said each day here, this is such a dynamic situation. It is fluid. It literally changes every day. The data that are being put into these models changes. And so we make our decisions really on a day to day basis. So for me to sit here or stand here two months, almost two months before June the 10th and say what we're going to do at that time, it's really difficult to say. And I know that's frustrating. I love data and I love to be exact, and I want to be able to give Virginians exact answers, but I would just ask all of you and our viewers to be patient, and again, these things change day to day. Ralph Northam: (17:27) I will tell you that, and I mentioned this earlier, a lot of our energy right now is being focused on how we help our economy recover from where we are today. And again, I thank the businesses out there that are really being creative, being innovative. And this recovery is not so much a government driven recovery. It's going to be a business and consumer driven recovery. In other words, when will our consumers, when will you and I be comfortable going into the places of business? And so our businesses are really working with our strike force group to really make those determinations and come up with a plan. And I think part of your question are we just going to go back on one day to being normal again? I don't think that's going to happen in the near future. Ralph Northam: (18:19) And the reason that it's not going to happen, we have a novel virus as you know, we're learning more about it every day. We don't have a vaccination, we don't have a treatment for it. And so until we have a vaccination, and we can say that well the virus has gone and or not necessarily gone, but everybody now is safe and they're not going to contract the virus, then it's difficult to say we're going to go back to a totally normal life. So as we move forward, things like wearing the mask, the social distancing, all of these things will continue I really think as part of the way our society acts on a day to day basis. Speaker 7: (19:08) Thank you. My question is regarding testing. The Johns Hopkins COVID19 dashboard shows Virginia has the second lowest rate of testing in the nation after California. Yet Virginia is the 18th highest rate in, or the 18th highest state in confirmed cases. So are our testing criteria too rigid, or do we have fewer tests than other States, or how else do you account for the relatively low rate of testing, and could more help? Could more testing help slow the rate of community transmission? Dan: (19:40) Sure. Thank you. Governor. The question was that looking at the criteria we have tested what 44,000 Virginians, but the Johns Hopkins data that per 100,000 or some metric that normalizes for population that we are amongst the lowest, and that's something we're addressing. We are trying to understand how do we optimize the capacity we have, whether it's in the state lab or academic labs as well as in commercial labs. Also, we've been in touch with our provider community. What I've learned is that many of our providers who, unless it's going to influence where folks are cared for, namely in the hospital, often they think that they can and rightly care for patients with COVID19 on a practical basis with presuming that they have it. But from a epidemiological point of view there's many advantages to have more people tested. Dan: (20:39) So I think that we need to as the state through our developing a task force which will have more be able to report out in the days ahead is looking at that capacity how to synchronize that with the criteria that we use. Right now we've got across the nation, there's three categories from the CDC. There's the group one, the group two and group three, and we have been focusing on those that are hospitalized and those that have healthcare workers with symptoms. We've expanded that to include, and this is work from the health department together with the state lab focused on those within the longterm care facilities. And that's where we focused additional testing capacity to make sure that when there was an outbreak, whether it was coming from the state lab or from UVA or from the VCU lab or other academic labs around the state, that that capacity was there. Dan: (21:35) What we are evaluating now is how to make sure that we broaden that testing criteria with our clinical community so that we can have more testing, and a better sense of where this is happening. And there's two real goals, one is outbreak intervention that Dr. [Falana 00:21:54] has discussed. The second is how our providers, that's the nurse practitioners, our doctors, the PAs that are caring for patients one at a time, and then also our public health surveillance to make sure that we have the right capacity for those different missions. And clearly we need more, more testing available here in Virginia. So I think we certainly understand that data, and we know that it needs to be improved. And I've outlined how we're going to go about improving it. So thank you. Speaker 9: (22:25) Thank you Governor. Some of those owners of these barbershops and salons have asked if you could make any special consideration. They said if they could work by appointment, also maybe have one or two people in their shops at a time spaced out so they won't watch their life work go down the drain. Secondly, you've always talked about this virus having no respect for the person. Some people are wondering if you are reaching out to your Republican counterparts to help come up with solutions. Are they involved, are you talking to them, and if so, who are they and what are they suggesting? Ralph Northam: (23:07) Two questions and I'll address the second one first. Am I talking to my Republican counterparts and yes, my door is open, my phone line is open, internet, whatever. And I hear not from all Republicans, but certainly a lot of them that I have worked with in both the House and the Senate over the years. And as I've said all along, I appreciate everybody's input. So, I listen to that, and then obviously we make decisions based on what's going on on a day to day basis. I think your first question is really a good question as well. And his first question was regarding barbershops. And this is one of the questions and comments that I hear most frequently because for a couple of reasons, I suspect one people's hair continues to grow and they're wondering where and when they can get a haircut. Ralph Northam: (24:01) And probably even more importantly, these are businesses, and these are people that need to be working. And so when I talked earlier about the input from the business community, we've had a number of barbers and owners of salons that have given suggestions on how we can do this safely. And so while we expanded the gatherings of less than 10 and the businesses, the entertainment business, recreational businesses, as we move forward and plan as far as how to start opening up these businesses, barbershops is going to be at the top of my list. I can promise you that, but we're not there quite yet. Ralph Northam: (24:50) But I think there are ways that we can do it safely by making sure that we wear masks, making sure that we continue the social distance, not having more than 10 people in a place of business, et cetera. So, we're working on that. We are discussing it on a day to day basis. And so for those individuals that are in need of a haircut and more importantly the barbers, it's at the top of my priority list. Thank you for the question. Speaker 10: (25:19) [inaudible 00:25:19] for the governor. Have you made any consideration to extending the filing or payment deadlines for taxes as being April 15th? And for Secretary Miranda, I think I saw over there wondering if you might address the letter sent by several of the Commonwealth's attorneys asking for the release of incarcerated youth and men among the pandemic. Ralph Northam: (25:41) The first question was about extension of filing deadlines for our taxes. So as you all know, the normal date actually for federal taxes is today, April 15th. I don't have any control over that obviously, but that has been extended for three months to July 15th regarding- Ralph Northam: (26:03) ... Virginia's taxes, our taxes are due on May the 1st, and we have extended that to, June the 1st. I think, Secretary Elaine or Secretary of Finances, has already kind of explained why that is, we're on different cycles at the state level than we are at the national level. The other reason for not being able to extend it past June the 1st, is... Our cycle, our budget cycle, ends on June the 30th, we need to continue to keep our essential services open. And unlike, I think you all know this as well, unlike the national level, we can't print money here in Virginia. And so, we need to balance our budget. And so, those guidelines extending the state taxes to... For a month and the federal taxes for three months, will stay in place. And your second question is for- Speaker 11: (27:02) Secretary [inaudible 00:27:02]. Ralph Northam: (27:03) Okay. Secretary: (27:08) The question having... With respect to a letter sent by a handful of prosecutors regarding our juvenile justice population, and happy to respond to that letter and their inquiries. Juvenile justice transformation has been one of the real successes of this administration and the preceding administration. We have reduced the population from 600 to 200 residents. We've closed the Beaumont facility, we now only have one residential facility operated by the state at Bon Air. And so, a great deal has been done with respect to placing these young people in the community so that they can obtain community services and reintegrate into their community. So, what is left though, is some of the kids that frankly need some of the most intensive services. These are young people who have been traumatized either physically or mentally or both, emotionally, and they require a great deal of services. Services that can be provided at the Bon Air facility. Secretary: (28:26) Now despite all that, we are working diligently, Director Boykin and her team, are reviewing each and every one of those 200 kids. Some are there based on determinant sentences, and... I suspect those prosecutors know what that means having... That means the judge has given a sentence that is required to be served. Then there... About 70% of the kids there are determinant, the other 30% are indeterminate. And those kids, the juvenile... Department of Juvenile Justice has more discretion over each and every one of them, are being reviewed to see if there is a plan for success to send them back into the community or some community based placement. And so, yes, reviewed it. Yes, very well informed with respect to what DJJ is doing with those kids. And Director Boykin and her team, have just been... I mean, they work with these kids very closely and will do what is in their best interest. Speaker 13: (29:38) David McGee with the Bristol Herald Courier. David McGee: (29:41) Thank you, governor. I wanted to ask, as you deliberate trying to get Virginia back toward normal, how much will you consider the actions of neighboring States so that businesses in border areas aren't adversely affected? Ralph Northam: (29:56) It's an excellent question. The question is, as we get back to our new normal, if you will, how much will we be working with our neighboring states so that there is consistency? And... We have a really good relationship. And back to your question about reaching out to Republican's, Governor Hogan, from the State of Maryland, who's the chair of our National Governors Association, I work closely with him. And as you know, our vice president and president are Republicans, so we're in communication with them as well. But, as far as our neighbors, Governor Hogan in Maryland, Mayor Bowser in DC, and then Governor Roy Cooper, in North Carolina, either myself or my staff is in daily communication with their staff or other governors and mayor on a daily basis. And we have tried to work together and I think done a good job with that to be consistent. Ralph Northam: (30:52) And I think all of us agree that as we move forward and return to our new normal, the closer we can be, the more consistent we can be, the better. And I'll just give you a quick example. If we were to open restaurants, for example, in Virginia, a week before they do in Maryland, the only thing that separates us is the Potomac River, and so that would be inconsistent and it would be confusing for people. So, as we move forward and reopen our businesses and get back into that new normal mode, we'll work as close as we can with our neighbors. Speaker 13: (31:29) [inaudible 00:31:29] the next question will be from [inaudible 00:31:31] with The Roanoke Times. Speaker 14: (31:37) Yes. Physicians, I understand are now reporting clinical diagnosis of COVID cases to the health department. When will these cases show up on the VDH dashboard and what are they telling you so far about the spread of the disease that the testing hasn't captured? Ralph Northam: (31:57) I didn't catch the first part of the question. I'm going to let, Dr. [inaudible 00:32:00], but could you start your question over again please? Dr. Norm Oliver: (32:06) Actually- Speaker 14: (32:07) Can you hear me? I'm having a really hard time hearing you. So, I understand that physicians are now also reporting clinical diagnosis of COVID without a test confirmation of the disease to the health department. So, we wanted to know when these cases will be reported publicly on the VDH dashboard, and what the number of these cases that are being reported to the health department are telling you so far about the spread of the disease that testing so far hasn't captured. Dr. Norm Oliver: (32:44) I will let, Dr. Forlano, who in addition to being our Deputy Commissioner for Population Health, prior to that was our State Epidemiologist. So, I think she'll have some expertise here. Dr. Forlano: (32:59) Hi, thanks. The question is about clinical diagnoses, so those are diagnoses that doctors and other healthcare providers can make in absence of a lab test. So, we are trying to... We have encouraged providers to report clinical diagnoses through our electronic portal online, so we're collecting that information. I'll have to verify this, but my understanding is that a national case definition for those... What we would otherwise call a suspect case, has not been established. But if it has been, there is some time that it takes to go through all those reports. I don't have a clear date as to when that would show up on our dashboard. It would be important that we would collect that data and then vet it against a case definition, so we're sure to count everything the same way. So, I'll talk to the staff and can be happy to get that information to you at a later time. Speaker 13: (33:59) [inaudible 00:08: 01]. Kate: (34:04) [inaudible 00:34:04] for Dr. [inaudible 00:34:05] on testing. I know that this week we've tested fewer people. I think last week, we were averaging about 2,200/300 per day, and then this year... This week we've tested, I think, today 1,400, yesterday, 1,300. Do you know why we're trusting fewer people? Is that part of what you're still investigating? Dan: (34:28) Thank you. The question is that... If you look at the numbers, the results, we get them when they're resulted and report it to Virginia Department of Health, not when they're ordered or when they're actually collected. So, there is a lag time. But the question was that if you look at the incremental daily, that it was 1500 from yesterday, today and probably 2000, the previous day, were there some days... Last week there were 3000 or 2,500, so a little bit on the... Higher than this week. And the answer is, I think that, we're testing... There's about 1300 individuals in the hospitals in Virginia, and that's where we've been focusing the effort of getting them diagnosed with a relatively rapid test, whether at the state lab or at one of the newer labs, UVA, VCU, Sentara, and now at at Carilion, that they have in house testing. Dan: (35:22) So that's where the focus was initially, because you were burning PBE and you needed to know whether they've truly had the disease, because it would influence the care that they received. So, the number of tests that have been ordered, I don't think has grown. We're definitely focusing on the long-term care. But, I think it really reflects, I can't say from a systematic survey of all providers in Virginia, but of a sample that we've had contact with. Is that, when tests were really hard to get, practitioners went forward with clinical diagnoses and the like, for folks who are at low risk and would do well at home. Now that we have more testing capacity, we need to adjust our criteria as well as our instruction and recommendations to providers to take advantage of that increased capacity. So I think that's what we're working on and that's what we have to share today. Thank you. Kate: (36:19) [inaudible 00:36:19] regarding the lag in reporting deaths. When you do find out when somebody has died and that they have died of COVID-19, could you give us back data? So tell us, this is a death that happened on this day. And then even though we're seeing the spikes per day, we can kind of shift our own internal data and tell people this is what the graph ideally should look like and this is the true number per day of people who died of COVID-19. Dr. Norm Oliver: (36:50) So, if I understand your question correctly, you wanted to know, would it be possible for VDH to give data about the date of death so that it would be possible to backtrack and be able to discern that lag? The health department is giving lots of data around COVID-19 and many other diseases, by age, gender, race. We're one of the few states that actually give that race and ethnicity data and we will continue to figure out ways to improve that. Within that context, so it's important to understand that by a Virginia Code, we are required to protect the anonymity of the people that we conduct surveillance of. And there are certain things like date of death for example, that might make it possible to identify an individual in certain circumstances. So, we haven't as a general rule, released date of death as part of that data. We've been releasing it in terms of district and we'll continue to do that, but we haven't done date. Kate: (38:16) Given that the doctors are now making so many clinical diagnoses, given the absence of tests, I mean, can you speak at all to how much weight people should be putting in the daily numbers reported on the VDH dashboard that only report lab confirmed cases? I mean, if there's widespread clinical diagnoses coming on, what number of cases do we actually have? Dr. Forlano: (38:43) Hi. Thanks Kate, for the question. So the question is about, the data that we report versus the data that may be a true perfection of reality of what's going on there. So I think what's really important to understand about disease surveillance is that, it's not... Dr. Forlano: (39:03) ... intended to count every single solitary case public health surveillance. Unless it's an unusually rare condition. So for example, Ebola in the United States it's pretty easy to count one case because there's only one case every 20 years or hopefully never again. With something like influenza or a viral illness like coronavirus, the goal is to establish a trend, the goal is to establish an understanding of what populations are being impacted by the disease. And we can do that with the data we got, we always aim to count as many as we can, but that does take time to receive the reports. And as something with a new condition it takes even more time. So I have confidence in the data that we have received, I have confidence in what we are reporting and I have confidence in the trend that it's illustrating, understanding the limitations that we can only display the data that we get. Dr. Forlano: (40:11) So I hope in time we'll be able to reflect a little bit more on some of the clinical diagnoses that we're getting per previous question. And our weekly reports that are published every Monday are getting more and more detailed with time as the numbers go up. So you'll be able to have an appreciation of racial and ethnic data a little bit more granular with hospitalizations et cetera. So I think in time you'll see more detail, but public health surveillance, the key word in epidemiology is trend. So I think that what we're giving is as good as we can get right now. Speaker 18: (40:51) Thank you. Dr. Forlano: (40:51) Thanks. Ralph Northam: (40:52) Just in closing, again thanks to all of you for being with us today and as we return to our new normal, I would just encourage and remind you that things will be different as we move forward. We will continue I think to put a lot of emphasis on our social distancing our frequent hand washing our not bringing our hands to our face or covering our face when we cough or sneeze. These things will continue. Another thing that will continue is the wearing of facial protection. And so I would really encourage all of you, especially if you have to go out from your home for essential purposes, if you're around other people to wear a mask. It's to protect yourself, it's to protect your family and loved ones, it's also to protect other individuals in the event that you may have been exposed to COVID-19. Ralph Northam: (41:49) So I've seen a lot of creative mask as I have looked around. And again they're not difficult to make. We certainly don't want to take away from the N95s that are important for our healthcare providers and other frontline workers. But I really strongly encourage all of you as Virginians to get a mask and to get comfortable with it because I think you're going to need to continue to wear it in the upcoming months as we move forward. So thank you all again and we look forward to being with you on Friday.