Washington D.C. Mayor Muriel Bowser COVID-19 Briefing April 3

Speaker 1: (00:00) We're giving an update on DC's coronavirus situation. Muriel Bowser: (00:03) [crosstalk 00:00:03] who's the district's doctor and Christopher Geldart who is the leader of DC DPW but also serves in a leadership capacity in our operation section at Homeland Security for the emergency response. I also want to thank General Walker for his hospitality and having us here at the armory today and certainly for the support of the DC National Guard. And General I wanted to turn to you and ask you for any welcoming. General Walker: (00:38) Well ma'am, welcome to the historic district of Columbia National Guard. Ma'am, you have our full support. We are with you, are partners. We will not be late to need and that's all I wanted to say. You can count on the district of Columbia National Guard. Muriel Bowser: (00:51) Thank you General. So let's start, we have a few slides and then I'll turn to the council chairman for remarks and for questions from the members of the council. So we want to give you what we're calling kind of a situational update to let you know where we are in the district's response to Covid-19 and you probably remember that it was on March the seventh that we announced the very first Covid-19 case and over the course of the next week we adjusted our mass gatherings advisory until March 26. We went to gatherings of no more than 50 people and eventually two gatherings of no more than 10. Or March 16th we also made our bars and restaurants take out only. So we prohibited dining in all DC restaurants. And on March 24th we closed all nonessential businesses. And then this week on Monday, along with Maryland and Virginia, we issued a stay at home order. Muriel Bowser: (02:07) So before you, what you see is a chart of various district interventions up till now. And as you know, my first mayor's order we issued in February and it charged DC health and DC Homeland Security with coordinating the district's response to Covid- 19. Since Friday, March the 16th both our emergency operation center and our joint information center had been activated at the DC health building. And the slide before you just demonstrates the organization of our emergency operations center and also how the daily operations of the government interact with the EOC. This citywide effort, we have been very grateful to have the support of the council every step of the way. The council worked quickly to pass emergency legislation to support residents and local business. Muriel Bowser: (03:11) The office of the deputy mayor for planning and economic development worked quickly to establish the DC small business recovery micro grant program and over a week and in over a week and a half, we received 7,600 applications from local small businesses and nonprofits. And just what you see before you as just an example of a few of the provisions included in the emergency response legislation that included unemployment insurance provisions, public benefits protections for residents, support for local businesses and continuity of operations provisions. Muriel Bowser: (03:58) We know of course that Covid-19 has no borders or boundaries, so we are staying in constant communication with Maryland and Virginia and monitoring cases and actions taken across the entire region. We have reported out to you on a number of occasions and share it with you some of those calls and we have a very clear message when we talk nationally that the nation's capitol region is what should drive the discussion around our interaction with the federal government in the things that we need. So we have provided you update not only of what our cases look like in Washington DC, but what they look like in the entire region and those numbers are on slide six. Muriel Bowser: (04:55) This morning we announced 104 new cases in the district bringing our total to 757. We also sadly announced a three additional deaths. This week we also started sharing ward by ward information on positive cases and you can see before you a ward breakdown and the age groups of the people impacted by Covid-19. Dr. Nesbitt and her team of course have examined this data and they do not see anything remarkable about the ward representations they are and as we said, we asked that, no, we can't draw any particular conclusions. It is a reminder to us all that everyone, no matter where you live, need to take heed to the warnings and stay at home. Muriel Bowser: (05:58) We've... Excuse me, we've also ramped up our testing in just 10 days, testing has increased from about 300 tests per 1 million people. On March 18th to about 4,000 tests per 1 million people just 10 days later. And today is the first day of operations at the UMC derived through testing sites. Our priority, as I stated with resources like personal protective equipment remains, procuring it and getting it out to first responders and medical professionals who need it. We have shared on slide nine a sample of what we are procuring, the total order, the total received, what's been out, what's on hand and how much we think we are using of those materials and the rate at which we're using it. So now I want to share some data on the latest that we... I'm sorry. What we want to talk about now is medical surge and the latest data we have about what we might experience in the coming days and coming weeks. Muriel Bowser: (07:20) So what we're going to share is based on modeling and there are various models out there, certainly, and I know everybody has been following what we hear from the White House in various States about what models suggest. So there are multiple models that cities States in the White House are looking at. In our model that people... Might be one model that people might be familiar with from the internet and national news is the IHME model. Muriel Bowser: (07:57) Our concern is that this model may overestimate the impact of social distancing, thus underestimating infections. We are using a different model, the CHIME model or C-H-I-M-E model, which makes projections based on total infections and assumes a certain level of random mixing of infected people. What is important to remember is that the models just help us plan for the future, but we are constantly assessing what is actually happening. So using the CHIME model, we expect that over the course of this public health emergency, and this is a tough number to have to report, but we think that we rather be on the side of underestimating the impacts of social distancing than presenting too rosy a picture. We... Muriel Bowser: (09:02) ...model that approximately 93,000 people in our city could get infected with COVID-19. And I want to be clear that this number is cumulative and does not mean that on any specific day that 93,000 residents have COVID-19 at the same time. So this number represents those people who have been affected and recovered as well. So in this graph, the 93,000 represents all of the people who fall under the curve. Muriel Bowser: (09:37) Of course, we expect that many, most of these 93,000 people will be affected with the virus and then recover. Sadly though, we know and we see our fellow Americans in states around the country, we know that there will be many people who don't survive. And again, based on the CHIME model, we expect that we could experience a range of loss of life in our city. The mild estimate is that 220 people would succumb to the disease. A moderate would be 440. And the severe estimate would be more than 1,000 people. So as we look at these numbers, I cannot emphasize enough the importance of everyone staying at home. We know that it flattens the curve and it will save lives. Muriel Bowser: (10:32) Our collective goal of course is to mitigate the spread of the virus and save as many lives as possible. And like I said, what these models help us do is plan for the future. And one of the key differences between the CHIME model and the IHME model is the projections for resources needed. So we want to be as prepared as possible, so again, we are using CHIME. And this has us reaching our peak cases and hospitalizations somewhere around the end of June and the beginning of July. So we have talked a lot over the past few weeks about the need to flatten the curve. And so this slide shows how we expect that curve to play out. Muriel Bowser: (11:22) This prediction is based on a six day doubling rate. You can see at our peak, the demand for hospital beds will be greater than our current supply. At our peak, we will need 3,000 acute care beds and about 2,800 ICU beds. This is our current supply. So we're working with our healthcare providers to create additional bed space, and our healthcare providers have been answering the call. On Wednesday I sent a letter to our hospitals and they responded immediately. This of course has been after several weeks of planning and meeting with our department of health professionals and our Homeland Security professionals about how each system will plan to meet the surge demand. We confirmed with them that we need to increase our capacity to 125% of our current beds, and we already have identified over three-quarters of that needed capacity. And I want to thank our healthcare providers and everyone who works for them for stepping up to the challenge. Muriel Bowser: (12:42) We expect that at our peak, our city and healthcare system will need 5,500 beds, and here's how we're going to get there. Number one, we're going to increase hospital space by postponing elective procedures, and that's already happened. Number two, we're going to maximize existing hospital space, expand capacity in existing healthcare facilities by using other available space and adding beds. Number three, by reopening facilities, open furloughed healthcare facilities. We are working with the US Army Corps of Engineers to do exactly that. Number four, by adding new beds. This means establish alternate care sites outside of hospitals. And number five, adding staff by coordinating with the DC National Guard and FEMA for necessary workforce. Muriel Bowser: (13:44) Of course, more hospitalizations and more beds means a need for more supplies. We continue to work all of our supply chains to get the supplies our hospitals and healthcare providers need. What we know is, to support the added 5,000 beds, we will need to procure an additional 1,000 ventilators, 600,000 N95 masks, 5.6 million surgical masks, 1.4 million gowns, 350,000 face shields, and 40 million gloves. So when we look at those numbers, it bears repeating that everybody needs to stay home because we can drive down the number of infections, hospitalizations, and demand for very, very precious PPE. Muriel Bowser: (14:47) So we will continue through all of our media channels with all of the leaders in our communities emphasizing social distancing, only leaving home for essential activities. And as time goes on, this will of course be more challenging. For me and all of us, we are affected by this in all different kinds of ways. In my own personal circumstances, me and my daughter and my senior parents that I am making sure that we have a safe plan for. Muriel Bowser: (15:25) But if you are at home and feeling ill, we want you to remember the symptoms of COVID-19, to contact your medical professionals, and to strictly follow their advice. If you're feeling ill, stay home, isolate yourself. And I want to end by saying that with all that is going on, there have been so many people who are stepping up in our communities. I want to thank all the frontline workers who are out there in all of our essential businesses, but especially our grocery stores and the people who are providing essential supplies to the residents of the District of Columbia. Muriel Bowser: (16:10) I want to thank all of our government workers who are working at home in some cases, but in other cases their essential work involves them going to a workplace. So I want to thank them for everything that they are doing. From our DPW workers, to the folks in our unemployment office, to our first responders at FIMS, at MPD, to the folks at our correctional facility, the people who are working in our shelters, even people that you might not think about who are crunching data and putting out all of the materials that we are presenting to you each and every day, I want to say thank you. I also want to say thank you to folks who are doing acts of kindness outside of their normal work, like Jose Andres, who called me early on saying that he was devising a plan to make sure that World Central Kitchen can keep feeding people in Washington DC. So I want to say thank you to him. Muriel Bowser: (17:14) I wanted to say thank you to the philanthropies who stepped up to help fund our DC Education Equity Fund, because that is going to make a huge, huge difference for people in Washington DC. I also want to say thank you to the volunteers. We had a call last night with 1,800 medical professionals that called in to ask questions. And one person said on that call, "I volunteered and I've been training for the Medical Reserve Corps, when can I start?" So I just want to say thank you to all the people of Washington. This is certainly a global pandemic of proportions that none of us could have predicted, but we will get through this and we will- Muriel Bowser: (18:03) ...get on the other side of this and we will get back to life in our beautiful thriving city. With that, I want to turn to the Chairman. Dr Nesbitt, do you want to add anything at this stage? Should we wait for questions? Okay, thank you, Mr. Chairman. Dr. Nesbitt: (18:21) Oh, thank you Muriel Bowser and, as you noted, council member Gray who's the Chair of the Health Committee is also here. Many of the council members are participating online although I believe there's some technical issues and I don't know that they all have gotten the deck and I'm just mentioning that because I've texted most of the members and asked if they have questions to convey them to me so that I can ask you. And I'm going to try to keep those questions related to the issue before us in this press conference, which is surge related. Muriel Bowser: (18:54) Absolutely. Dr. Nesbitt: (18:55) This is a concern that council members have raised. I appreciate that we've had these daily briefing calls with you or with your staff and as you know concerns about the surge have been conveyed or expressed by a number of council members. And so, we appreciate this briefing today. That really is the most critical public health issue as I see it, is how we manage with the increase in infections, the increase that we know will be coming from those, the percentage that need hospitalization, and how are we going to handle that? So, again, I appreciate your addressing that. Let me turn to Council Member Gray, if you have questions, and I'm going to be looking to see if any council members text me. Council Member Gray: (19:43) You go right ahead, Mr. Chairman. I'm delighted to be here. Mayor, I want to thank you very much for your leadership and that of your team in working with something that we've never ever seen in the history of the city and you are absolutely right, we're going to get through this with flying colors. Muriel Bowser: (20:03) Thank you. Dr. Nesbitt: (20:07) I do not have any questions yet from members. Muriel Bowser: (20:09) Okay. So, I would like to ask Dr Nesbitt to talk about a little bit more about the strategies to get to the additional beds and if we could go back to the slide that shows the chart with the bed need. Yes, that chart and if you would talk a little bit and I think Chris Skelter, you may want to jump in a little bit because you have been working with the providers, the core and our own internal teams about how we get to that capacity. Speaker 4: (20:45) Sure. Thank you, madam mayor. As you all could observe from the model itself, we have a need to identify capacity both for acute care hospitalizations and ICU beds and we also do a calculation that looks at the number of ventilators that we will need in the district of Columbia. We look at it as it relates to the peak, but we also recognize that we will have a period of time as we are approaching our peak. Speaker 4: (21:16) The strategy is for us to be able to work with all of our healthcare partners in the district of Columbia to help them leverage the capacity or the infrastructure that is within the acute care system so that care can be provided in hospitals for patients who are the most severely ill and impacted by COVID-19. And then, that any alternate care facilities that we establish would be for those individuals who require what we call post acute care services and then looking at our infrastructure for individuals who may have non COVID-19 related illnesses who could be cared for in alternate care environments. So, we've done some things like work with Children's National Health System for example, because we are having some observations nationally and globally where the pediatric population may not be impacted as most or have severe illness that requires hospitalization. Speaker 4: (22:12) And so, as the census or the need for hospitalization in a pediatric care environment decreases, how can the other hospitals in our healthcare system partner with Children's National to use them for inpatient admissions above what they traditionally admit, which is pediatric patients. So, increasing their ability to admit patients up to ages 29 for example. So, older individuals being able to be safely admitted into Children's National. So, part of our strategy is looking at hospitals such as George Washington University Hospital for example, with 421 beds. That type of facility being used exclusively for ICU and ventilation capacity and more severe illness, and then alternate care facilities being used for post acute care needs, such as individuals who are in more of a convalescent state, may require things like maybe IV hydration but not as much of intensive care services. And so, our model is built on working with the healthcare facilities to understand if they have any additional capacity within their healthcare facility, how can they use their operational space such as typical observation units, recovery rooms outside of surgical suites, cafeteria space that could be converted. Those types of spaces to get more beds within the hospital walls, and then any adjacent facilities around their properties that they have partnerships with to turn those into alternate care facilities. Speaker 4: (23:49) And that's how we increase the medical surge capacity in the district. So, as the mayor has highlighted, we've already identified three quarters of the additional capacity that we need and we'll be able to deliver the first 1000 of the beds that we have working with Mr [inaudible 00:24:08] and the team, the Army Corps of Engineers, the National Guard. Those additional FEMA resources that we have to bring those first 1000 beds online by April 15th. One of the things in the two models that the mayor mentioned that people often talk about is when will those surge hit? So, will the surge occur in April, will the surge occur in June? But we are also following what happens in the real world. So, if the surge is actually lower and occurs in April, our planning assumptions allows us to be prepared for a lower surge happening in April and delivering those first 1000 beds by that time. Do you want to add anything? Speaker 5: (24:48) No. The only thing I think I would add to Dr. Nesbitt's assessment which was right on, is we are watching what's happening in other cities and across the world, so that we can best assess, not only as Dr. Nesbitt said how many beds we need when. But then also as we're doing that to ensure that we're constantly looking at the total amount that we need, so that we can react and be prepared in our worst cases or in the actual cases. So, we're really paying attention to this as we go. We're not going to let it get in front of us to all extent we can, but make sure we have what we need as we need it and stay ahead of as we're going up our curve. Speaker 4: (25:32) And the last thing that I will add is that, again referencing the mayor's opening comments, is that the models help us to plan for the future. We observe what happens in the real world and our data scientists are able to make revisions to the model based on the things that we are observing in real time. So, we can make adjustments to the model as we have more information about, as chairman Mendelson mentioned, what proportion of our individuals are requiring hospitalization, how long people are staying in the hospital, how many days do people spend in the intensive care unit? As we have more and more information about what is happening in the district, we can make revisions to the model. Speaker 5: (26:15) And I think what you see through that is a thoughtful process as we go through this, instead of standing up big, large aggregate centers right away with a whole lot of stuff and taking up a lot of necessary resources that not only us but our partners may need. We're taking a very thoughtful approach on this, getting the things we know we're going to need ordered and in, but doing it in a thoughtful way. Many of the questions are going to be around where will these sites be and all of that and Dr. Nesbitt hit on a little of that. I'll just put out there that we've assessed over 39 facilities from across the district of Columbia, and that's everything from large facilities like this one that you're in right now all the way down to smaller facilities like hotels and smaller spaces. So, we've done a lot of research to see where we want to be- Speaker 6: (27:03) ... be when we need to do this. Muriel Bowser: (27:08) Chris Rodriguez, do you want to talk a little bit more about the supply work we're doing? Chris Rodriguez: (27:14) Yep. Thank you Madam Mayor. So, in addition to what Dr. Nesbitt and Director Geldar were talking about, we have been very proactive in terms of not only requesting federal assistance from FEMA in terms of our supplies, whether they be masks, ventilators and some of the other supplies you're looking at here on the screen, but also through other means and private manufacturers through our office of contract procurement. So, as we look towards medical surge, we're also looking to fill in some of the staffing and some of the supply needs that we know we're going to need that might not necessarily come from some of the hospitals themselves or from our traditional healthcare providers. So, we're looking to also plus up in that respect. Muriel Bowser: (28:01) Okay. And I can't emphasize how important that is. I was looking at one of our fellow Americans, Governor Cuomo, recently was talking about the federal support for some of these alternate care facilities that they've experienced in New York and he made the comment, "This is great. We appreciate the support with standing up these facilities, but we still need help with staffing and supplies." And the hospitals also emphasize that getting to the beds, getting to the real estate is one aspect of it, but the bigger thing that our procurement teams are working on is how can we not only get to the supplies that you see listed there, but the people supplies, the people resources, the nurses and the doctors that we are really working hard to try to get those commitments to be in DC for the surge. Mr. Chairman? Chairman: (29:03) Yes, thank you Mayor. I have about a half dozen questions from council members and I'm going to just ask them as I got them. The first is from Charles Allen. As we plan for surge capacity, what sites have we identified, such as the armory, should we find the need to add bed capacity for treatment and isolation? Speaker 6: (29:25) Okay. As I mentioned earlier, we've assessed 39 sites. We're looking at a couple of different models for it. I will say in council member Alan's area, Bridgepoint, who is in his area and others, also East of the river, has stepped up for us in allowing space within their facilities to move patients within the system. And I know that the hospitals are talking about that now on how to move load around within the system right now so that we can have, as Dr. Nesbitt said earlier, the right care for the right people at the right places. So, we're still assessing facilities. We know areas where we will like to go, but right now as I said, we really want to be smart about where we're putting things and when we're putting them so that we're effective and that we're not using up resources that we don't need to, too early on. Speaker 7: (30:18) So, there might be some concentration of COVID capacity at certain hospitals, for example. I think I had heard the example of George Washington, whether that's in fact or just illustrative- Muriel Bowser: (30:30) So, one of the things that we know is that some hospitals, for example, were not operating at full capacity and they had empty floors for example, that had not been used in a couple of years. So, our initial strategy is to be able to look at how they can bring those floors back online and create respiratory units on those floors. Muriel Bowser: (30:50) United Medical Center for example, has been a tremendous partner in identifying ways to increase capacity in our system by reactivating floors in that facility and adding an additional 150 beds to our system just by looking at the under utilization of that facility. So, they are able to identify brand new floor floors and additional beds that can serve as respiratory units, ICU capacity within that facility because the census and that facility has been low. So, that's just one example. So, it's not to illustrate just that GW has a lot of capacity in it's hospital just by reimagining how to use the PACU and the observation unit and operating rooms as places of care, but we have hospitals in the district that have had a low census for a number of years that can now increase its ability to provide care to COVID patients. Chris Rodriguez: (31:44) And many of the assessments that we're doing is how do we help in that arena with helping them get those up rapidly and equipped and staffing as the Mayor mentioned, which is definitely is what's going to be needed across the board. Muriel Bowser: (31:58) So, I think what you heard Chairman, is that a number of the hospitals, can I go back to the chart? Have identified space within. Others have identified space close to their facility that could operate as a surge space. And we are still evaluating the need and the timing and the location if we had a mass open facility and which hospital would support that. Chairman: (32:26) A mass open facility meaning, I'm going to call the facility offsite from a hospital. Muriel Bowser: (32:32) Yes. Correct. Chairman: (32:32) So, part of the strategy is to have expanded capacity at or near, meaning on the grounds of, for example, a hospital- Muriel Bowser: (32:41) Or close by. Chairman: (32:42) So, that they're taking staff one geographic location as opposed to disparate sites. Muriel Bowser: (32:51) Right. Let me say it another way. What we should think about this surge capacity is the surge from a hospital. Folks are going to go to a hospital and how will that hospital accommodate their need for more space? And so that's how we have approached that because these folks who are in the hospital business and they know what they're doing and they know how to manage their surge and so that going to be very critical because by that extension they will be administering it, managing it and we will be helping with the supplies and helping to find the staff that are needed for additional beds. So, that is what largely you see here in making up the 75% of the beds that have been identified. And the last part of it is this mass care if needed. Chairman: (33:49) Council member Tran White asked what is the process for someone who feels that they have contracted the virus to get tested at UMC? Muriel Bowser: (33:57) Dr Nesbitt? Dr. Nesbitt: (33:58) Yes, so we have.