Texas Governor Greg Abbott COVID-19 Briefing April 3

Governor Greg Abbott: (00:00) Access the healthcare they might need in the event they need to visit a hospital. We have been working to compile all of that information and we want to share it with you today. Before we do that, however, I want to provide you some updated information about where we stand in the state with regard to the Coronavirus and the updated numbers are this. As of today, this afternoon, more than 55,000 Texans have tested positive. Let me rephrase that. More than 55,000 Texans have been tested for COVID-19 of which 5,478 have tested positive. Governor Greg Abbott: (00:47) A couple of important numbers here. We continue to increase the number of people tested by more than 10% per day compounded daily. So we continue to see good growth in the number of people who are tested. Similarly, throughout the increase of testing or people whether or not they have COVID 19 we are seeing that the same percentage remains fairly constant in that only about 10% or less than 10% of those who are tested test positive for COVID 19. Stated otherwise more than 90% of the people tested for whether or not they have COVID 19 test negative, which means that they do not have it. Governor Greg Abbott: (01:34) We now have 91 confirmed fatalities as a result of COVID 19 around the state and we have about 827 people who have been hospitalized as a result of COVID 19 which is a rate of about 15% of those who have tested positive for COVID 19. In addition to those numbers, some other numbers that are very important. A lot of people wonder how many supplies we have available to respond to the Coronavirus. We have put together a strike force that's done a fabulous job of working to increase the supply chain of personal protection equipment, also known as PPEs. Governor Greg Abbott: (02:26) And here's what they have achieved over the last six days. In the past six days. They have provided across the state of Texas more than 1.4 million face masks, more than 190,000 face shields, more than 2 million gloves and more than 160,000 gowns. Another thing that has developed this week is a new test provided by a company named Abbott laboratories, is able to provide an immediate response result, meaning a result on those tests that's available in about 15 minutes. Governor Greg Abbott: (03:07) Right before coming out here, I was speaking with the CEO of Abbott labs to get the updated information about what is available here in the state of Texas. He said that they have shipped already 10,000 of these tests to Texas that should be available now and for us to be able to expect 20,000 tests to be made available each week. As of now, those tests were shipped to seven hospital locations around the state of Texas, but that number to increase to about 44 sites across the state of Texas. Governor Greg Abbott: (03:44) The primary goal, first and foremost with those Abbott laboratory quick turnaround tests is to be able to test the people who are on the front lines of addressing the Coronavirus outbreak. That would be our nurses, our doctors, our first responders who are dealing face to face with people who may be positive for COVID 19 those nurses and doctors, et cetera. They need to know immediately whether or not, they may have COVID 19 so they would be removed from a situation where they would be transmitting that disease to somebody else. Governor Greg Abbott: (04:19) With that said, and we'll be happy to take some questions about those later, but I want to move into what is being done in the state of Texas to ensure that we have the hospital capacity available to respond to go COVID 19. Governor Greg Abbott: (04:34) So on this first slide, what we're talking about here is strategies that have already been used to make sure that we increase the capacity of hospitals to care for those who need hospitalization because of COVID 19. One way that we were able to increase availability of hospital beds was with my executive order that required postponing non essential surgeries and procedures that are not immediately medically necessary. In addition to that, I've provided a waiver to hospitals that allows them to have a double occupancy as opposed to single occupancy in bedrooms that would accommodate such expansion. Governor Greg Abbott: (05:25) Also, I have made some waivers that will increase staffing. Just some of the examples would be waivers that will allow nurses and our doctors to come in from out of state and be able to provide their medical services here. Waivers that would allow those who are recently retired doctors or nurses to be able to get involved again. Other different types of waivers to ensure that we are expanding our medical staff as much as possible. Governor Greg Abbott: (05:55) The results of this is if you see that bottom line and then going to the next slide is a 142% increase in available beds in the state of Texas. So if you look at the far left column a that's dated March the 18th it shows as a that time in Texas we had 8,155 beds that were then available. As of today, we have 19,695 hospital beds available if they were all needed to treat people with COVID 19. Governor Greg Abbott: (06:35) And so on this next slide it shows the total available beds as we speak today. The total number of reported beds that exists across the state of Texas, the percentage of beds in Texas that are vacant right now in the event that they needed to have someone occupy those bad who contracted positive for COVID 19. Importantly also, we have more than 2000 ICU beds that are available. And remember a lot of people have been interested in finding out about, we have identified 8,741 ventilators that are available to be used for those who may need them because of COVID 19. Now I want to pass the presentation over to Dr. Zerwas. Governor Greg Abbott: (07:27) So as I mentioned earlier, we have created this strike Strikeforce, this worked on supply chain, doing things like trying to procure masks and gloves and face guards, things like that, things that are identified as personal protection equipment. Governor Greg Abbott: (07:46) In addition to that, we needed to have a strike force, also work on the supply chain for hospital beds as well as doctors and nurses. And there's no one better to help do something like that than to bring in a doctor. And especially someone who is a former legislator, especially someone who was chair of house appropriations. And that is Dr. Zerwas. And so I would like to turn over the presentation to Dr. Zerwas to explain more about what he's been able to achieve and kind of where we are as a baseline right now and where we may be going. Doctor. Dr. Zerwas: (08:19) Thank you governor and thank you for the bold actions that you've taken because I think the numbers are going to reflect the fact that you're positioning Texas into a very good place. This slide kind of shows how we categorize the availability of beds out there. The beds that the governor has referred to already and that I will run through in this presentation are all in the level five green box. Dr. Zerwas: (08:42) If you were to walk into a hospital today, there would be beds there. There'd be equipment there and there would be staff there, nurses, other individuals who take care of the patients. That's what's in level five. That's what we have as today and it's actually in terms of an availability of that the over 19,000 number is exactly what we have now as a consequence of the actions that the governor is taking. Dr. Zerwas: (09:07) Level four is where we want to surge into. This is not a number that's reported anywhere and I want to do a shout out to the Texas Hospital Association and all their members for working with me to help get some of these numbers that would actually give us an idea of what other beds within the four walls of a hospital, if you will, that we could actually surge into. Dr. Zerwas: (09:29) We could open these beds up if we could provide staff, and if we could provide the actual hardware and things that needed to make that a bed, what would that number be? And today we kind of, we finally got that number. We can increase our bed capacity by 7,600 beds, just by doing that. These are beds that are ready to go. They just need people to staff them and they need some of the equipment to make them functional. Dr. Zerwas: (09:55) Also, within this same surge capacity is ICU. And as we know, a number of these patients develop a very severe type of pneumonia- Dr. Zerwas: (10:03) These patients develop a very severe type of pneumonia. It's called adult respiratory distress syndrome. They require ICU care at that point and we can actually add 2200 ICU beds by surging into certain areas that can be turned into that. And that doesn't include some of the areas that could function as an ICU that I'll mention in the level three there. And when you double up by virtue of the waiver that the governor granted, we can add another 2200 beds in that area. So you're looking right there and then there's a whole hospital up in El Paso that's ready to go, that's not occupied yet, that could add substantial number of beds. They're over 10,000 beds just in that category level four right there can be added. And if you've got a level three we start talking about, okay, we want to use beds differently. Dr. Zerwas: (10:53) And so if you look at a post anesthesia care unit, which is where I spend a lot of my life, of course those are essentially ICU beds. They function just like an intensive care unit would if the nurse is right there by the side taking care of them. It provides for all the invasive monitoring, all the ventilator equipment that you need can be functioning in that way and then addition an operating room frankly can be used the same way. All operating rooms have an anesthesia machine at them. Most anesthesia machines have a pretty sophisticated ventilator on them, which is not in the number that the governor mentioned and so those can be turned into capability also. That's not a number that I have right here at hand with me, but that is certainly something that can be advanced as you move forward. When you move into the next level. Dr. Zerwas: (11:42) Then we're talking about getting outside of the walls of the hospital. That's the ambulatory surgery centers, the freestanding ERs, the longterm acute care hospitals, LTCHs we call them. Even some of the nursing homes could be used. These are places where people are taking care of the equipment is there. A lot of times the staff is there also and so those are things that can be done and by virtue of some regulatory relief that was given, the hospitals can actually reach out to these places and run those under their license during this crisis period. And then finally, level one, and I'll mention that as I close up here, just a minute is the things that we'll look at that are pretty nontraditional. These are your hotels and your motels. They are your hospitals that perhaps the federal government has come in with or the military has come with and stood up. Dr. Zerwas: (12:35) These are places where typically you'll send patients when they're either not requiring a whole lot of extra care or they're actually getting over an episode of Covid-19 and on the way out, but they don't require the extraordinary support that a hospital in this type of situation would require. So let's walk through a few of these. I just want to unpack the slide that the governor showed in terms of the whole statewide effort, these TSAs, or Trauma Service Areas, and we operationalize the Trauma Service Areas through something called racks and so they... These are the things that actually in different areas of the state that provide for the care that you're going to see here. And so as you can see, the percent available beds in the Dallas-Fort Worth Area is 33% the numbers are there, the details of the numbers are there. Dr. Zerwas: (13:22) I don't want to necessarily go over those, but the percent available beds is a third, not too surprising. Similarly, in the next slide, in Houston, 33% significant number of ICU beds. We move up to Tyler, about 37% of the beds are available right now to take a patient. So if it got kind of real busy with Covid patients up there, they'd have a significant number of beds available. Then move to El Paso, 63% of the beds are actually available there. And then in addition, there's some additional beds that I mentioned as I was going through the different categories. TSA, Amarillo has about half of their beds available, 51%, Abilene area, 64% similarly, quite a few beds available there and down the Laredo and Rio Grande Valley, just around 38% of the beds, 99 ICU beds are available. San Antonio, just under half of their beds are available and about 400 ICU beds are available. Dr. Zerwas: (14:27) And again, these are all as a consequence of the actions that the governor took in order to create that capacity. Initially the effort was to preserve PPE and by shutting down the elective procedures and the elective surgery, PPE is being preserved, but at the same time you're generating very, very significant capacity. So once again, that's the stuff that's in the green box and in Austin, about half of those beds are available also along with the 153 ICU beds. So let me just come back to the slide that I was showing the different categories in and just reiterate. In level five there, in the green box was all the stuff I just told you about. It didn't include level four, it didn't include level three where you're using things in a different way. Didn't include level two. We didn't speak to anything of the other alternative types of care sites that might be outside that we could actually move patients into to take care of them. Dr. Zerwas: (15:21) The level one is the area that there can be some very, very significant opportunities for us. These could be hospitals that perhaps have been closed up for some reason and they need to be sort of reinvigorated and brought back online for a short period of time. They can be the hospitals that are set up by the military. We've seen some of those in New York. We actually have about two of those set up. We have one up in the Dallas-Fort Worth Area called FMS, Federal Medical Stations, 250 beds that are up there in the Kay Bailey Hutchison Convention Center. There's actually similarly about that same number of beds set up in the Freeman Coliseum in San Antonio and then Houston will be setting one up in NRG. That doesn't include that the numerous number of hotels that are available out there. The hotel motel industry has really come forward and say and look, we're here to help you. Dr. Zerwas: (16:17) If you need to use our facilities, let's see what we can do to make those happen and so that's what you're going to see and kind of the level one, and again at least it's our vision that these are probably going to be settings for patients are getting over their condition. They don't require the really high level of care that you're going to see in the hospitals and in the intensive care unit settings. The next slide shows just kind of what are some of those potential care facilities that you see. There's over 100 of them marked on this map and they're separated out into eight regions that we use in terms of determining our hospital program preparedness. I put that up there just to show you these are... There is a lot that can be looked at out there. We utilize the core of engineers, Texas military to go and do an assessment on these things in terms of what it would take to actually bring them up. Dr. Zerwas: (17:04) And then if we look at the final slide there, the state and local search capacity, this is again the eight regions that are marked out in that previous slide that you have there and you see state and local, the state will work to set up some type of care in these level one facilities, typically a hotel and we would work with somebody to provide the necessary staffing in order to take care of patients in that study. Locally in your local health departments and other folks will also work in order to provide some of the care that's necessary there. And this is I believe back over governor about 3000 I believe is what this would ultimately result in, in terms of additional areas that people could be taken care of. We put some pretty conservative numbers in here, but this can actually ramp up pretty fast by people just opening up different facilities for people to be cared for- Governor Greg Abbott: (17:56) Right. Dr. Zerwas: (17:57) ... I'm sorry. Governor Greg Abbott: (17:57) Thank you doctor for the presentation, but also thank you for the work of you and your team that you put into, make sure that we would have all those resources available. Dr. Zerwas: (18:06) Absolutely. I just said commissioner Hellerstedt and department of state health services have been fantastic in doing this work, creating the organization around it and really deserve a great deal of credit for that. Governor Greg Abbott: (18:18) Speaking of which, I would like to turn things over to Dr. Hellerstedt. Dr. Hellerstedt: (18:22) Thank you, governor. I really wished that everyone out there could see the team of public health, emergency management experts, Texas military forces, the governor's strike force, and the many others who have come together to work around the clock seven days a week to prepare for and prevent Covid-19 in Texas. Dr. Hellerstedt: (18:41) I can assure you that our teams are thinking of you too. Protecting the people of Texas, our neighbors, our friends, and our families is the heart of our mission. I have a question. When is a disaster not like a hurricane? It's when you change its course and we absolutely have the ability to change the course. Preparation and you've heard about the amazing preparations that are out there from Dr. [inaudible 00:09:04]. Preparation is necessary but prevention is really the key and prevention is what will change the course of Covid-19 for the better. Dr. Hellerstedt: (19:14) We Texans are eager to prevent Covid-19. We see the evidence everywhere we look, we see the things we are doing to protect each other. We are looking for ways to measure the benefits of that cooperation and I believe that benefit will be large. We should reward each other for what I would call a random acts of compliance and we can always give the Corona wave to say thanks. Our success and the visible size of our community spirit should give us courage to continue to do what we must do to win this war. We must continue to both prepare and prevent until the crest of the wave has passed over us. Then we can figure out how with all due care, we can resume the life of liberty and prosperity that we will find waiting for us once the Corona virus has passed. Thank you, governor. Governor Greg Abbott: (20:03) Thank you doctor. Dr. Hellerstedt: (20:03) ... once the Coronavirus has passed. Thank you, Governor. Governor Greg Abbott: (20:03) Thank you, doctor. And now Nim Kidd. Nim Kidd: (20:05) Thank you, Governor. Three things to talk about today. One is personal protective equipment. We continue to work with our federal partners, our private suppliers, but really the most exciting piece for me right now is the innovators that are out there. We've had a lot of homegrown organizations come forward, private sector businesses with new ideas and new ways to produce personal protective equipment. We're looking at them working with our healthcare partners to see what matches and I think they'll have a big expansion to the way that we protect ourselves in the future. The second is, as Doctor Zerwas mentioned, is a surge capacity pieces. And I want to thank all of those that have offered their resources to us and I also want to share all of our local government partners. Nim Kidd: (20:40) We will be working on this with you. You will not see the state set up an organization in your community that has not been fully vetted and cooperated with your local elected officials and your local public health authorities. And third, is to continue to follow the rules and follow the plan. This is the best possible outcomes that we can achieve. Thank you, Governor. Governor Greg Abbott: (20:57) Thank you, Nim. To close it down before questions, a couple of quick comments. I want to pick up on a couple of things that you all mentioned. I do want to emphasize what Nim Kidd was talking about and that is we've been overwhelmed with offers of supplies and volunteers to help. And this is the way that Texans respond and we are so proud and so grateful for everything that is being offered up. And please know that your offers of help are being coordinated within everybody in these offices and keep your offers coming. Governor Greg Abbott: (21:25) Keep the supplies coming, keep your volunteers coming. They are needed at this time of the greatest challenge we've ever faced with regard to an infectious disease in the state of Texas or really perhaps globally. Second, I want to go back and emphasize that it is clear from what Dr. Zerwas was talking about, that we are fully prepared for the hospital needs of Texans as we continue to respond to the coronavirus in the state of Texas. We have the capacity to add even more beds as are needed in regions that may increase in patient needs. And our capacity should prevent us from facing the type of situation that New York is having to deal with today. Governor Greg Abbott: (22:11) Lastly, I want to emphasize that what Dr. Hellerstedt was talking about. Listen, we see that the COVID-19 disease continues to spread in the state of Texas. As a result, we as a state must ensure that everybody in our state is doing everything we possibly can to slow the spread of the coronavirus. What that requires is what everybody has been talking about over the past week, and that is that if you're not involved in providing an essential service in the state of Texas, it is in your best interest, for your own life and for your own health, for you to stay at home. Governor Greg Abbott: (22:49) Staying at home will ensure that you reduce the possibility of you contracting COVID-19. It will reduce the possibility of COVID-19 spreading in the state of Texas. It will ensure that Texas is working to dramatically slow the spread of the disease. Now, I know that this is a strategy that's been in place in different locations for a while and I know that we are asking you to do this through the remainder of April. Governor Greg Abbott: (23:16) That is a tall task to ask you to do that, but we're doing it for your own benefit, for your own health, for your own safety. Knowing that between now and the end of April, more lives will be lost because of COVID-19. I want you to make sure that yours is not one of those lives. You have the ultimate control and the ultimate ability to make sure you protect your life and in doing so, make sure that we slow the spread of the coronavirus in Texas. With that, we'll be able to take a few questions. Speaker 4: (23:51) Hey guys, we're going to do one question per person to start, and then we'll go from there. We're going to start right here. Speaker 5: (24:03) Considering everything that you're doing for hospitals, and you're expanding the capacity, are you considering ways in your [inaudible 00:24:03] increase in primary care? And if so, how? Governor Greg Abbott: (24:14) Well, the first task that we face and that we're focused on right now is making sure that whether it be hospitals or other healthcare facilities, they have the capacity to deal with COVID-19 patients. Then what we deal with is the tidal wave of financial support that has been delivered from Washington, DC. There are multiple tranches of funds available to help respond to things like what you're talking about, about let's say lost income by some who are responding to COVID-19. Governor Greg Abbott: (24:50) We will get to those as those money tranches begin to come into the state of Texas. And once we learn more about exactly how they work. I do know that there is tranche funds set aside separately for hospitals in every state, including in the state of Texas and we'll learn the fine print details about how and under what circumstances those funds can be used. The bottom line is, the good news is Washington responded more robustly than ever before in the response to anything like this. And to ensure that hospitals as well as individuals are going to have the capacity to be able to recover from any downturn as a result of COVID-19. Speaker 6: (25:33) Thank you, Governor. You mentioned how many ventilators we have. Do you know how many we need going forward, or might need? Do you intend to ask the federal government to release some of its national stockpile to the state of Texas? Governor Greg Abbott: (25:49) So I'm going to let the doctors answer this, but I'm going to tell you information that I have, which is not based upon me being a doctor, but based upon studies that I have seen. Based upon studies, and if you would prognostications, that I have seen including the one that was issued by the University of Washington that has been utilized by Dr. Burks at the White House. It looks as though Texas should have the capability of being able to provide ventilators as the need may arise. Governor Greg Abbott: (26:26) That said, we need to understand a couple of things. One, is that we're dealing with a very unknown and uncertain facts about where we may be. As a result, as we speak, we have people and teams working on strategies to increase our ability to bring in even more ventilators. Having seen exactly what New York is going through. New York is going through a situation where they may have thought they had enough ventilators, but they needed more. And so we're trying to get ahead of the game, making sure that we will have more than enough ventilators to address the needs of Texas. Now again, that's based upon studies that I've seen. I would like to turn over to the doctors for them to provide their answers. We'll go with a Dr. Hellerstedt first and then Dr. Zerwas. Dr. Hellerstedt: (27:11) I agree with the governor. We have lots of ventilators. Don't forget that this is a future that we can control with the kinds of activities that we're engaging in right now. So the things that we're doing in terms of social distancing, hygiene, cleanliness and sanitation of our environment, and we see people practicing this everywhere, all over the state, that can alter the course of what the future is like and that can decrease the demand for those ventilators to the point where at any point in time, anybody who needs hospital care or needs to be in an ICU or on a ventilator, they'll be plenty to go around. So yes, preparation of the kind that you've seen that is very extraordinary and unprecedented is absolutely necessary. We need to be prepared, but we can alter that future. We can shape that future by the kind of preventive measures that are part of the policies that the governor has articulated in his executive orders and then the behaviors that we see all around us. Dr. Zerwas: (28:10) Right. I would just say I think I feel very comfortable about where we are in terms of the whole ventilation devices that we have in our inventory right now. We do have more that are on the horizon to come. And I would just say it's also during crises that you see some great ingenuity arise, and some things that have been done to try to create some very simple devices, but very effective devices that can actually be produced fairly quickly and at a pretty low cost. Dr. Zerwas: (28:37) So I think we're going to be in a good place. We're fortunate that we're seeing what's going on elsewhere across the world and in our own country and it has given us that opportunity to, as the commissioner has said, to incorporate these practices that I believe they're going to blunt the curve significantly. And with that, hopefully blunt any extraordinary need that we're going to have for ventilation devices. But, I feel good about where we are with that. But, I also know that we plan for the worst and then we'll get some more on board here just in case we need to add some. Governor Greg Abbott: (29:11) So in summation, we start ahead of the curve, but we are sprinting to stay ahead of the curve. Speaker 7: (29:16) All right, Governor. Thank you. Having all these sites is definitely something very important for federal [inaudible 00:09:22], but I know that a lot of healthcare workers are also concerned like in rural areas, in Swisher County, a doctor [inaudible 00:29:29] because they're obviously self quarantined, and that knocked out 10% of their staff, because they have such a small area. What's kind of the plan in place for these rural areas especially when their staff gets sick? Governor Greg Abbott: (29:42) So there are multiple strands that we look at as it concerns the supply chain. One is for PPE. The other is for hospital beds. The other is for personnel and staff. And again, that is an issue that Dr. Zerwas has been working on. So, I would like to have him respond to your question. Dr. Zerwas: (30:02) Absolutely- Governor Greg Abbott: (30:02) I would like to have him respond to your question. Dr. Zerwat: (30:02) Yeah, absolutely. Yeah. All these beds and things that we can create don't matter if you can't put somebody there to actually take care of them and stuff. And the rurals are somewhat of a challenge. There's no doubt about that. We're very, very focused on wanting to keep the rurals up and running, but when somebody does get knocked down by contracting the illness and so forth, then we have to look at being able to have a pipeline of people that could come in and help. And so we've been working on that along with the whole inventory of of beds, it's a bed surge, but it's also manpower surge. And so we've created a ... There was a texas.gov website that was created to solicit volunteers to participate in the crisis. The department of state health service has already had one of those in place. Dr. Zerwat: (30:49) So we merged them and there's a been a very, very robust response to that. And so we're doing on the other side of this now is trying to connect facilities up with potential volunteers. And that's the part that we're testing right now is to make sure when you know the hospital that has a need that you just articulated can reach out and see, okay, does that work? Is that going to result in somebody being available? And so a great deal of our effort right now is in fact developing a very, very robust pipeline of volunteers or professionals that just retired for whatever reason, and decided they want to come back in. The governor passed a waiver that would allow these licenses to be re-instated and put the back in the profession for the next several months or weeks of this crisis. Governor Greg Abbott: (31:38) Dr Hellerstedt, you want to offer anything or Tim? Dr. Hellerstedt: (31:41) I think Dr. Zerwat said at all. It's absolutely true that we need those professionals to keep the care flowing. And we do have a plan to be able to particularly add volunteers to that mix. Governor Greg Abbott: (31:56) The volunteers are a tremendous source and there have been so many people who've volunteered their services. And some of these people understand this and that is because elective surgeries are now not allowed, there are a lot of doctors and nurses who are idle right now who are available to assist. Some may be in that region, some may be in other regions. A strategy that we have available to us is, let's say that there are an abundance of doctors and nurses in the Dallas area or some other urban area that are not in that rural area. We have access to hotel and motel rooms in those other areas that we can occupy for weeks upon time to accommodate those doctors and nurses who may be able to be mobilized out there. We're also in the process of assessing the capabilities of the members of the current National Guard who have the capability of providing nursing care or any other type of medical care to assist in those types of situations. Dr. Zerwat: (32:51) And I'll add just one other part on this. When you saw the map kind of divided up into those different pieces of puzzle pieces and so forth. Those are actually functional areas, and one of the things that a hospital would do is to reach out to that functional area, one of the regional advisory councils or to the hospital preparedness program and say, "Hey, we've got somebody down, we need some help here." That would be one of the first places you would go to to kind of get access to that. And then that council, that group body that would be able to help them with that. Speaker 9: (33:24) What are specific facilities here in [inaudible 00:33:32] surge facilities planned? What would it take to [inaudible 00:33:36]? Dr. Zerwat: (33:37) Well, I mean, it's a work in progress. So we've identified a hotel, I wish I could remember the name of it, but I can't, but it's actually been identified and reviewed and is considered to be suitable for taking care of patients on the lower end, either early on when they're having the early evidence of disease, but not enough support that they would need to be in a hospital, or on the tail end where they seem to be getting better and they're convalescing and they just need a little bit more help in terms of completing that recovery and stuff. But places that we do look to sometimes, there's some big open areas. The military is very good about coming in and setting up in those types of locations. Convention centers work very well for that type of a thing, and all those things are kind of being assessed right now. Governor Greg Abbott: (34:24) So one thing ... And I'll let you ... Why don't you go ahead [inaudible 00:34:30]? Dr. Nem: (34:28) The other thing is it's a conversation that I've also had with the county judge here and your local public health authority, Dr. Rescott in between the judge and their health authority, they really need to be the ones to determine which facilities would be used first. Our job is to help them find those locations and help find staff if needed. But Judge Eckhart and Dr. Rescott Would be the ones to answer your specific questions about where are they looking right now in Austin and Travis County. Governor Greg Abbott: (34:50) So to follow up on both of those, our first strategy is to look at what Dr. Zerwat was talking about earlier and that is expansion internally within a hospital facility or a facility that is similar to a hospital type setting, and many of those have been identified. Separate from that along the lines of what they're talking about, we did establish our first location in the state of Texas for what I'll call an ancillary facility, the Kay Bailey Hutchison Convention Center in Dallas where the United States Army Corps of Engineers worked with the National Guard to set that up. Governor Greg Abbott: (35:23) I was impressed and really stunned in a way how quickly they were able to set that up. Already capable of having 250 beds in there even though it's not needed right now, with the capacity to expand that facility up to 2,500 beds almost immediately. What both doctors Zerwat and Nem were talking about and that is, as we speak, the United States Army Corps of Engineers is working with the National Guard, going to other regions around the state of Texas to identify similar locations in those regions in the event that we need to expand beyond the walls of existing health care facilities. Speaker 10: (36:02) The CDC is expected to recommend that all Americans [inaudible 00:36:12]. Governor Greg Abbott: (36:13) Well, we, as governors, we remain in conversations with the CDC, with the president, the vice president, Dr. Birx, Dr. Fauci, As well as CDC advisors. And we will have an upcoming telephone conference with them where they bring us up to date on where we are going. So we look forward to hearing from them about that conversation about what their thoughts are, what maybe their requests are, and we'll respond to their requests or thoughts at the time they articulate them. As I understand it it's still a process in work right now. Speaker 10: (36:44) [inaudible 00:36:48]. Governor Greg Abbott: (37:11) So more's coming ... I'm going to have Nem answer this and I'm recalling from what I think you said that Texas may be number one in the nation in those drive through facilities, so why don't you let them know what you know and- Dr. Nem: (37:21) Yes sir. That's correct. When we were in the planning phases with the health and human services, and this was really before FEMA was even involved in the drive through lanes, they said they could support six sites in Texas. We worked with our local officials to first identify the sites, but then Harris County and Houston decided they wanted to split their two sites into four sites, and San Antonio offered up sites to Austin and El Paso out of their site. So you have about 10 different lanes across the state right now that are on the federal funding side. Based on information I received yesterday afternoon from FEMA, Texas is leading the nation and the number of lanes as well as the number of tests that are being administered through those lanes. But I think the other pieces is, as you've asked about Taryn County and others, we're seeing almost a doubling now of the federally funded or supported lanes coming out of our local government partners and our private sector pieces, and I really think that's where we're going to get the biggest growth of the largest bank in this case is by continuing to support that mission instead of just the federally funded lanes. I think at some point the feds have announced that they plan to withdraw their staff so they can shift them to other missions. So eventually we will see only locally supported lanes that the state will continue our best to operate with PPE supplies and test results. Governor Greg Abbott: (38:33) If I could explain this and understand this kind of structure of the way that it works, there are three primary providers of tests. There are-