07112020 COVID-19 PC



GOVERNOR JON BEL EDWARDS: Good afternoon and thank you for coming out on a Saturday afternoon. As you can imagine, because this wasn't announced previously, we obviously have made some decisions. I've made some decisions about some things we can do as a state to better respond to the current situation as it relates to COVID19. I am joined today by Dr.?Joe Kanter of the Department of Health, Dr.?Catherine O'Neal, chief medical officer of Our Lady of the Lake hospital and assistant professor of infectious disease at LSU. Also, Dr.?Rani Whitfield, a sports medicine and family physician here in Baton Rouge. Obviously, Louisiana continues to experience COVID19case growth statewide. Positivity is increasing, the percentage of tests administered on a daily basis that come back positive. Those are increasing. And hospitalizations are increasing. So it's become clear to me, especially after the numbers that we saw yesterday, that our current restrictions are not enough. The appeal that we've been making to the people of Louisiana to do better by abiding with those restrictions and do better by complying with our mitigation measures just have not produced the results we've been hoping for and the results that we need. Yesterday, we had our highest date ever of new cases. I want to say that again. Yesterday, we reported the highest number of new cases to date. 2,642. Today, we announced 2,167 more. And positivity for the tests that we announced yesterday and today, both exceeded 10?percent. And over the last week, 10?percent? we've been over 10?percent, I think, every day except for two. Now, it is true that we are testing more people. And by the way that's a good thing. A test doesn't create a case. A test is going to tell you where you have cases, at least those cases that have tested, because we know we still have asymptomatic people out there who have been infected. They are contagious, but they are not being tested. But we are testing more, and as a result we are seeing more of the cases that are out there. And, in fact, I think it's a very good thing to tell you that thus far in the month of June? I'm sorry, month of July, we're 11?days in. We have almost met our monthly goal of 200,000 tests. We're at 195,536 tests that we're reporting in the month of July. Unfortunately, we also added 23 more deaths today, bringing the death total of 3 thousand 295. Now, there's a lot of different ways? and Dr.?Kanter's going to paint the picture in different ways in just a minute with some graphs so forth. There's a lot of ways to talk about what's happening in Louisiana, but one thing that I think we should all be cognizant of is that as recently as June the 19th, Louisiana was number?ten in the country per capita cases. Today, we're number three. So as you know, we've gotten as high as number two at one time. We made tremendous progress with the case growth has eclipsed. So it's not just higher here in Louisiana. It's at a rate that is higher than all the other states who were ahead of us. And so today we are number three, behind only New York and New Jersey. Obviously, we hope to avoid going backwards. We hope to avoid closing businesses again. But what we cannot do is go back to a time where we're running out of hospital beds and ventilators. We cannot risk losing our capacity to deliver life saving care. I'll talk about hospitals just a moment. Yesterday alone, we added 75 now in patients across the state of Louisiana for COVID19. Today was 65 more. Current total is 1,182 COVID patients in our hospitals across the state. And on June the 13th, that number was 542. So we took a hard look at the current order and how it could be modified to address some of our biggest concerns. Again, this is not an issue that's unique to Louisiana. What we're facing is is being experienced across the country, including in our neighboring states, many of whom are dealing with these very same issues. And I'm also mindful of some things that Dr.?Tony Fauci said this week. He said where we are as a country, we've got to focus on a lot of things, but primarily on three of them: Getting better compliance with mask usage, making sure people exercise physical distancing, and limiting crowd sizes. So obviously those are three of the things that we were thinking about. And so while, you know, that I've been extremely patient for the last few weeks when I have said we're going to do everything we can to get more compliance with current restrictions and mitigation measures, today we're going to have to move a little bit further than that. And we're trying very, very hard not to revert the Phase I or to Phase II because we're trying to balance the social? I'm sorry, the public health imperatives with the economy on the one happened, with the ability to open schools next month, and a whole a lot of other things that are going on. So today I'm going to announce that we're going to stay in Phase II as our current proclamation has us at least until July 24th, and we're going to examine what's going on at that time and figure out what happens after July?24th. But there are going to be some changes effective on Monday. I will sign an executive order today. The changes that I'm going to talk about will be effective on Monday. And by Monday, I mean, Monday morning, 1 minute after midnight on Sunday night. The changes. Masks are now mandated statewide for everyone age 8 and older unless they have a major health condition that makes it difficult to wear a mask. And by the way it is strongly recommended by the CDC and by us that children between 2 and 7 also wear a mask. The mandate won't apply to them, but the guidance still does. Parishes and municipalities may opt out of this mandate if they don't have a high incidence of COVID19. I'm going to get more into that in just a moment. Right now, there are only three parishes in the state that don't have that high incidence rate that the CDC has put forward. Also, I want to talk about the fact that all bars with and without food permits will be closed to on premises consumption. They may engage in curbside pickup. Indoor gatherings will be limited to 50 people total. Now, this does not? and I want to make sure this is very clear? this does not change what's in our proclamation for Phase II with respect to occupancy limits of businesses. Essential businesses have no business. Nonessential retail, places of worship, other places, have a 50?percent occupancy limit but with requirements for social distancing. These are social gatherings that we're talking about here. The limit will be 50 people indoors. And outdoors, there will just be a requirement that they have to properly and strictly physical distance. I do want to point out that what we have good reason to believe is a large contributor to the spread and growth of cases are informal back yard gatherings, if you will, so these are the birthday parties, the wedding showers and baby showers and those sorts of things where people are just having these rather informal gatherings and they think well I'm only inviting my close relatives and my close friends. Well, guess what, many of your close relatives and close friends are going to have COVID. And what you have to do is make sure that you are following these rules too with anybody who is not part of your immediate household. So if you're going to have these informal gatherings, we really, really encourage you to keep them as small as you can, make sure that you wear masks and that you physically distance and have them outdoors if you possibly can. That's the safe way to do that. As I mention, the changes are going to go into effect on Monday night, right after midnight, because we did want to give business owners and the public time to comply. These orders will stay in place at least until July the 24th, which is when the current proclamation is set to expire. We will continue to look at the data and decide later what happens after July?24th. I do want everybody to understand: We have been extremely patient, but we're making these decisions today because of the data that we have and the recommendations of public health experts. We're also following White House guidance which bases reopening gating criteria, including declining new cases and hospitalization and positivity, and right now we don't have any of those. In addition, the White House, including vice president pence, who leads the White House coronavirus task force? and by the way we look forward to hosting him in Baton Rouge here on Tuesday. But they've encouraged the public to follow state and local orders regarding face masks and encouraged that government consider face mask mandates where cases and positivity are increasing, and certainly that is the case here in Louisiana. Face masks and cloth facial coverings are easy. They're an effective way for people to protect each other from the spread of illness. And I've got three doctors here with me today who agree with that. And you're going to hear from them in just a few moments. So just to get back to the face masks a little bit. The order includes CDC guidance and requires face coverings for everyone ages 8 and older except for those with medical conditions that prevent the wearing of the face mask, anyone consuming drink or food, anyone who is trying to communicate with a person who is hearing impaired, anyone who is giving a speech for broadcast or to an audience, anyone temporarily removing his or her face covering for identification purposes, and anyone who is a resident of a parish without a high COVID incidence rate that has opted out of the masking mandate. Now, we looked to CDC for guidance here, and high incidence of COVID are considered those areas with more than 100 new cases per 100,000 people over a twoweek period. So that's, again, those areas where you have more than 100 new cases per 100,000 people over a twoweek period. Those areas with a high incidence of COVID19 with respect to the CDC guidance. Three parishes are below that threshold. They are Grant Parish, Red River Parish, and West Feliciana Parish. And so we have set up so that the parish governing authorities can, with a communication, a letter, to GOHSEP here, can opt out of the face mask mandate. Now, let me tell you, whether they opt out or not is going to be a decision for them, but it is still strongly encouraged that everyone who can do so to wear a face mask when they are outside of the home and interacting with people who are not part of their immediate household. Because while these parishes may be the least affected in Louisiana, there is COVID currently in every single one of those parishes as well. I would also remind people that if you have a health condition that makes it where you shouldn't wear a mask because you have breathing difficulties, then you have a health condition that makes you vulnerable to COVID19, and you need to exercise extreme caution under any circumstances. And remember you are also safer at home. If you are vulnerable, if you are 65 and older, if you have diabetes, hypertension, kidney disease, heart disease, if you are obese, you are better off at home. And certainly you shouldn't be out there without a mask because you have a breathing difficulty any more often than is necessary. So just understand that. So at the end of the day, while I know that this is going to be unpopular with some and controversial with some, we know that face masks work. It really is that simple. The vast majority of the spread of this disease comes from people talking, breathing, sneezing, coughing, and that face mask limits the distance that those particles containing that virus are going to be sprayed to neighbors. None of these steps that I'm announcing today were steps that I wanted to take. I have mentioned that over and over. None of them are easy, but I do think they're all essential, and I think you are seeing these steps that I'm announcing today being taken in more and more places across the country and I look for that to continue. And I do want to remind everybody that there's typically a 14day lag between any change in behavior and when that change starts to show up in the numbers, whether it's the number of positives or the number of hospitalizations. And it's even a longer lag time after that before there's a change in the number of deaths. So we're not going to see any changes in the very near future. And I want people to understand: We have no reason to believe that the numbers that we've been reporting over the last few days are going to get any better over the next couple of weeks. In fact, they are likely to get worse. That's the unfortunate reality, and that's why we are taking the action that we're taking today. Obviously closing bars is not a step I wanted to take, but the reality is, here in Louisiana and elsewhere, bars have proven to be hot spots for the spread of coronavirus. And it's probably not true for every bar, but we know that it's true for many of them. And I want to thank all of those bar owners who did work hard to comply with the current restrictions. And understand, nothing I'm announcing today is designed to punish anyone, especially bar owners, but it's a simple acknowledgement of the reality of the situation. You know, through our limited contact tracing results that we've gotten, we've identified at least 36 outbreaks, impacting at least 405 people from bars since the start of the outbreak. And we know that that number in reality is much higher than that. And if you'll remember during phase 0 and Phase I, bars were closed. So all this has happened in Phase II. And we also know that leading the spread over the recent weeks has been a younger age group, those who are much more likely to frequent bars. And by the way they continue to be a big driver of cases, and I think Dr.?Kanter's going to tell you more about this in just a moment, but it's pretty clear that younger people are spreading? we thought? we were fearful that they were. We're very confident now. Younger people are spreading COVID19 to older people who are getting this disease again in growing numbers. So public health officials believe going to bars is a higher public risk than that visiting other types of businesses simply because you go to a bar to socialize, and when you're drinking, you're not wearing a mask. And when you drink, you lose your inhibitions. And when you're listening to music, you have to speak louder to be heard and you have to move closer to other people to hear them. And there's just nothing about that environment that is conducive to slowing the spread of COVID19. And that's the unfortunate reality of the situation. Before I turn this over to our doctors, I'm going to just say this one more time. I know that some of what I'm announcing today is going to be challenging for some, unpopular with others. It is the necessary thing to do. It is the right thing to do under the circumstances. That's why we're going to do it. And we cannot let this illness win. And if you, like me, are interested in keeping as much of our economy open as possible, if you don't want to have to regress and go back to Phase I or phase zero in order to preserve capacity at our hospitals, if you want to open schools next month and higher education next month, these really, in the grand scheme of thing are minor prices to pay, especially those people who don't like the inconvenience of putting on a face cover. Now, I don't like it, but at the end of the day, I know it's the right thing to do. Should not be a political issue either, and for some reason in this country and in the state of Louisiana, there's been a political dynamic that has kind of emerged around the whole issue of masks. That just doesn't make any sense to me. And I think, people, if you will pay attention even to the national scene, you have started to see? and you're going to continue to see? people of both parties who are going to be stressing the absolute importance of wearing a mask. So I'm going to turn this over to Dr.?Joe Kanter from the department of health. He's going to highlight some data and some trends that kind of get into a little more granular detail than what I've talked about thus far. He'll be followed by Dr.?Katie O'Neal, and then Dr.?Whitfield will come up and talk about some thing that they're seeing in their practices. And then I'm going to come back and answer a few questions at the conclusion of our three doctors. Dr.?Kanter.DR. JOSEPH KANTER: Good afternoon. Thank you, governor, for the leadership you've shown all of us throughout this challenging ordeal. And I did want to send a special thanks to Drs. O'Neal and Whitfield for taking some time out of your clinical responsibilities to come join us and share some additional perspective. This has been a challenging couple weeks in the Office of Public Health and in the state, as we've seen regression of some of the progress that we made earlier on. And that's certainly frustrating. I'd like to take you through some data to show where we are now and paint the picture of what is necessitating the measures that were just described. And I'll say, at the end of the day, this is about the preservation of human life. It's as simple as that. The masking requirement will apply to parishes that have a twoweek case incidence of 100?cases per 100,000 residents or greater. That is the measure defined by the CDC as high incidence. As you can see from the map to my left, it's a good part of the state. It's 61 out of 64 parishes. Grant, red river, and West Feliciana don't make the cut, but the other 61 parishes do, and this is representative of the degree of geographic spread this virus now enjoys throughout the state. It literally touches every corner of the state. This map will be revised every two weeks with new data, and we will make that data publicly available on the Louisiana Department of Health dashboard online. But, again, it is clear to us? and now clear to everyone else? that the level of COVID incidence is high in the overwhelming majority, 61 out of 64 parishes throughout the state of Louisiana. Of course, a lot has been discussed about what happens when you do more testing. Now, when you're battling a disease, or anything else, you have to have visibility. You have to know what you're fighting and where it is, and that's what testing does. And certainly when you do more tests, you'll find more positives. When we look at where the epidemic? excuse me, pandemic? is, we take in a number of merges. So in addition to the number of new cases increasing day on day, the percent positivity of all testing done is increasing. That's what this graph shows. And I'll just point out that the large spike at the end of March and early April of percent positivity, where it goes up to the mid 30s percent, that was back when we were highly restrictive in tests. We were testing really individuals who were sick or had significant risk factors, so that artificially inflated the percent positivity. The last week, the week of June?22nd through July?5th, as measured by date of collection, percent positivity for the state of Louisiana was 15.3 percent. That is a highly concerning number. Very, very concerning. A lot of those people that test positive are asymptomatic. They have no symptoms at all. They have no indicator to themselves that they are infected and infectious, but yet they are, and likely spreading it to friends, family, and other community members. We talked a lot the past couple weeks of the changing age demographics of our outbreak here. And young adults aged 18 through 29 constitute the largest grouping now for COVID cases. You can see that the light gray line goes up quite dramatically. Over the past week or two, we are seeing what we fear that we would see, which is further spread from younger adults to older individuals, and this is highly concerning. COVID has a real tendency to spread, and we had talked about this a couple weeks ago. We had no expectation that the virus would stay within the 18 through 29 age bracket. We had concern for individuals' family members, their parents, their grandparents a grocery clerk a bus driver, anyone they come in contact with, who might be on average more vulnerable. And that's what the most recent data is showing us. It's showing us that the virus is now spreading from those younger adults into older individuals. Now, as the governor mentioned, we still firmly believe in Phase II that if you have vulnerabilities, if you are increasing in age, if you have serious underlying medical conditions, the risk to you, to your personal health, is greater. And you need to think twice about the risks that you take on. You know, I counsel my patients and my friends and family who are old or have medical vulnerabilities not to go out if at all possible, to have someone else make groceries for them and so forth. The older individuals that the virus is reaching now need to be very careful about the risks that they take on, and I'd like families to help support them. Again, just because we're in Phase II, if one is able to stay inside, able to distance, that's always going to be the safer thing to do. The other thing to mention is? and the governor mentioned this as well? we have leading measures, and we have lagging measures. And cases are on the leading side of that. Fatalities are a lagging measure. And we know on average in Louisiana, for individuals who will eventually die from COVID19, on average, they became symptomatic 16?days prior to that fatality. The fear that we have now is, as the virus is spreading again to older and more vulnerable individuals, we will continue to see increasing hospitalizations, and in time, we will see, unfortunately, increasing deaths. We have to turn this around. We've already doubled the number of patients hospitalized with COVID from the middle of June. We have to turn this around. This graph represents the number of new cases day on day, and the blue line is a sevenday rolling average. I'd like to point out that at this point in time, we have more cases coming in every day than we did when we were at the peak of the first part of this. And a lot has been said about the differences in our two peaks, and the first time around it was focused mostly in the Greater New Orleans area. This graph takes out New Orleans. This is a representation of every region in the state, minus the greater New Orleans region. And I'd like to point out that this is a Louisiana outbreak. It is not a New Orleans problem. It is no longer a New Orleans issue. It is a Louisiana problem. And the shape of this looks frighteningly similar to other states: Texas, Arizona, Florida. We're not as far along as they are, thankfully, but we will if we don't turn it around, and we have to turn it around. The good news is we've already beaten this once. I'll tell you, we know how to do this. We've flattened the curve, and we've stomped down the spread of COVID once very effectively, and I know that we'll be able to do it again. Dr.?O'Neal.DR. CATHERINE O'NEAL: Thank you, Dr.?Kanter. The governor asked me to give you an update on how we're doing in the hospitals. We knew that when we went to Phase II that we would see a little bit more community spread and that community spread would result in a few more admissions to the hospital. And we were prepared for that because we had been through this before. What we weren't prepared for was a steep escalation in hospitalizations that started about ten days ago. We have quadrupled the number of patients in our own hospital, and we've seen similar numbers throughout the state. This massive increase in admissions was not expected. What we expected was to see a slow community spread because people were still socially distancing and masking, but that wasn't occurring. And now we are overwhelmed. We have too many people in the hospital. Our hospitals are full. When our hospitals get full, just like we talked about before, it is incredibly hard to provide care for everybody. I want to give you a glimpse of the people that we're seeing in the hospital today. Of our patients with COVID19a third of them are in the ICU. Our youngest patient is 25, and he had no medical conditions when he entered the hospital. As you see those age ranges increase and the number of community cases, we see those same admissions increase in that age group, and that's what we're seeing today. We have patients in their 20s. We have patients in their 30s and in their 40s and in their '50s in the ICU. And they're struggling for their life. Those patients require a tremendous amount of care. When you admit them, they look pretty good, and they need some oxygen. And when they get to their bed on the floor, they're fighting for their life and we're rushing them into the ICU. And this is a nightly occurrence in the hospital. It takes a tremendous team to do that work, and that team can no longer offer care to everybody else who needs care. Those people who are waiting for a bypass surgery because they have heart disease; those people who are waiting for a joint replacement because they haven't been able to walk in six months and we've already put off their surgery once. And those people who have a mask and are waiting for a diagnosis of malignancy. One of our doctors shared with me this week that she saw a patient in clinic this week whose surgery was put off in February and again in March and again in April. And by the time that patient was diagnosed, they had metastatic disease and they are no longer capable of having a cure for their cancer. We can't allow this in the community anymore. We have to be better stewards so that the whole community is healthier from all of their illnesses and not just COVID19. But to do that, we have to do things like masking, and we all have to wear a mask. I have to wear a mask, and I have to demand that if I'm going to have a conversation with you, you also have a mask on. And by doing that, we protect our community. We protect each other. We protect our families. And that's how we end up safe at our homes and not also patients in the hospital with COVID19. The medical community asks the citizens of Louisiana, our community members, to help us to decrease the spread by thinking about each and every interaction you have socially with another individual, whether it's in your back yard, whether it's at work, whether it's passing people in the hall. Keep your distance. Try to have that interaction on Zoom or by phone if you can, and keep your mask on and ask them to put their mask on. We've seen this have huge implications in the hospital with keeping our patients safe, and so we know that it works. And we be that if you do it, we can continue to provide everybody the expected quality of care that we expect to give people every day. We appreciate your participation for the community and for the safety of our patients. Thank you, governor.DR. RANI WHITFIELD: Good afternoon, everyone. First I'd like to thank governor Edwards for not only his leadership but for allowing me to participate in this event, and for my colleagues and all the thing that they're doing to save lives in the state of Louisiana. I've been practicing, guys, for over 20?years, and never in my wildest dreams did I think we would be here, in a situation where people are losing their lives to something that actually is quite scary because we don't really know a lot about this virus. We're learning more and more each day, but we still don't know much about the virus. And to be very transparent, no one that I know personally can be trained in family medicine, trained to practice medicine during a pandemic. Our outpatient volume, and that's what I'm here today to speak to you guys about, is the outpatient situation as it relates to inpatient scenarios, but our outpatient volume has not decreased or declined at all. We've been quite busy. And thank goodness for telehealth and telemedicine where I'm able to see patients virtually or over the phone. And sometimes they'll come into the office now to have to be seen physically and touched. So we're very thankful for the technology that we have to be able to take care of our patients. But the community spread of COVID, guys, is wide, and we're seeing that some folks got a little complacent and thought that things were okay. I discussed with the governor earlier today that when Phase II opened, I could look out my window as I'm doing telemedicine and see that the car volume increased significantly within several days of him opening up the state. So I'm not sure if everybody fully understood what that meant. But there are increasing numbers, as we know, across the country, but particularly in the state that I love. And I'm a native of Louisiana, born in Baton Rouge. These patients that I see as outpatients when they get sick? and I'm seeing a sicker patient, and I'm seeing more patients that are sicker, dealing with COVID19 are trickling into the hospital. And as Dr.?O'Neal said, that is affecting the beds that we have in the hospital. And we're truly concerned about overwhelming the healthcare system as it exists today. I've seen COVID in all demographics: Black, white, Hispanic, young/old, men, women, and children. The symptoms of the virus have evolved from three symptoms initially? fever, cough, shortness of breath? and now the CDC says they have nine. There's an article that came out yesterday or a couple days ago that talks about new symptoms in our millennials and young people where they're having severe migraines and headaches and bowel symptoms, nausea, vomiting, and diarrhea. And we're also seeing an increase in exacerbation in the mental health problems in the community. A lot of people with anxiety and depression, and that's something that really hits home for me, because many of these folks who don't have the luxury of working from home, living paycheck to paycheck, don't have paid time off. There are essential workers that are having to go to work that are dealing with anxiety and depression, and I can't give them time off. They have to go to work to keep our stores and the limited things that we have opened up as well. I can assure you, however, that our healthcare system, the healthcare providers, the individuals that I work with closely? and, actually, I've talked with more people in the healthcare system. We kind of? we don't know these guys, but I've been talking to my colleagues a little bit more because of the pandemic. We chose this profession and we're here to help, but we cannot be successful in Louisiana without you guys playing your part. We've got to social distance. We've got to wash our hands. But more importantly, we've got to mask. There are studies now showing that masking works. Me without my mask on, these respiratory droplets can go maybe up to 12?feet. And so you having a mask on, it not only protects you, but it protects the people that are around you. So if you got to mask. The governor said earlier, he really didn't want to do this, but we're in a position now that we are losing lives to something that actually can be prevented. So, guys, I hope that you're taking this message as seriously as we all are. I'm prayerful that all of us will hear what's going on and thank you so much again, governor, for all that you're doing. GOVERNOR JON BEL EDWARDS: Thank you, Doctor. Okay. So I'll take questions in just a minute. I think I might have been either unclear or I misspoke. The order will be signed today. It will be effective at 1 minute after midnight on Sunday night, Monday morning. So Monday, this is in effect. That was what I was trying to communicate. I think I may have said something different. I apologize for that. Having been preceded by three medical professionals, I did want to just comment about how much I appreciate, and the people of Louisiana, all of our medical professionals. There has been nobody who has stepped up the way that they have during this public health emergency, often at great risk to themselves and so forth. And it runs the whole gamut of the medical profession. It's the respiratory therapists, the doctors, the nurses. It's the EMTs and the paramedics. It's just everybody involved. And I know as soon as you start naming particular groups, you're going to leave some out. So I want to say how much I appreciate them. But I will also say, as Louisianians, we owe to to them to not overburden them again if we can help it, not to flood our hospitals and cause the kind of problems that we've seen in Louisiana before, especially in the New Orleans region, and then what we've seen around the country. And the simple fact of the matter is we can prevent it. We've done it. And quite frankly the fact of the matter is, we don't have to go back to Phase I or phase 0 in order to prevent it. If we will do the things the CDC has recommended, that the White House coronavirus task force has recommended, those things that we put in our proclamations, then we know that this disease, the transmission rate, will slow. We know that that will happen. So let's be good neighbors to one another, realize we all have a role to play. And I have confidence in Louisiana, just like we did it before, we'll do it again. And we should take advantage of this community we have. And by the way this opportunity isn't going to last forever. If we want to bend the curve again and get this back under control without having to go back to Phase I or to phase 0, now is our time. Don't wait until tomorrow. Don't wait until next week or next month because we won't have any time left at that point. So I would encourage people to continue to pray for all of us and for our medical professionals especially. Join your prayers to mine that we will get through this as best we possibly can and as soon as we possibly can, but nobody should think it's going to be real soon. We have a new normal, and we will until such time as there's enough herd immunity, and that's going to likely not happen until there's a vaccine out there that, combined with those individuals who have the antibodies because they actually have COVID, reaches that level that's necessary in order to cause this to dissipate and to get under control. And that's not going to be anytime really soon. So I would encourage everybody to be patient. With that, I will take your questions. Sam?AUDIENCE MEMBER: Governor, can you talk more about? so the mask mandate, is it just if you're inside an establishment? Is it effective outdoors?GOVERNOR JON BEL EDWARDS: No, it's effective outdoors too?AUDIENCE MEMBER: And how do you enforce that? What are the penalties associated with that?GOVERNOR JON BEL EDWARDS: Thank you for the question. So it's indoors and outdoors when you cannot be physically distant from others. And I will tell you, when you're going to go into an office building or into a retail establishment or a restaurant, those sorts of things, until you meet one of those exceptions, that mask needs to be on. When you are outside and in close proximity to others, so let's just say you're at a park but for some reason you're not 6 feet away from others? which, by the way, you should be. You shouldn't really go to a park if you can't be 6 feet away from others who are not from your immediate household? you're going to need to have your mask on. And this mandate applies to all of those locations. And there are those exemptions for individuals, and there's those exemptions that are possible for those three parishes for now, if they choose to opt out. Again, even if they opt out, the CDC guidance doesn't change, and I'm encouraging everybody to wear masks or face coverings if they possibly can. With respect to enforcement, we are going to require businesses to tell people they have to have a mask on. Now, the businesses are? and organizations, they're going to be allowed to accept a representation from someone that they meet one of those categories of exemption, but, you know, other than placing law enforcement officers at every business or at every office building and so forth, there's just no other way to do it. And we're not going to be out there with a goal to write citations. We really want people, obviously, to comply with the mandate. We want businesses to make a real effort to put signs up, encourage people to put the mask on if you want to be there. And then if someone doesn't meet one of the exemptions and refuses to wear a mask, they should be asked to leave. And at that point in time if they don't leave, they're trespassing. And so that's how we look to enforce this. I will tell you, the mandate, in short, it does apply to churches, but we are not going to be enforcing it in churches. We're not going to be citing pastors. We're not going to be doing those things, but we are? I am encouraging them to understand that that particular setting, because you have people there often for an hour or longer, it really is important that they wear that mask?AUDIENCE MEMBER: If you were to cite a business, what would the penalty be if you wrote a ticket, in a sense? Is it a fine? If so, how much. GOVERNOR JON BEL EDWARDS: Yeah. But understand, that wouldn't? that wouldn't? I'll get that answer to you. That's not going to be a first resort. When we go to a business, we remind them what the requirements are, make sure that they understand, because sometimes people have a genuine misunderstanding of what the requirements are and so forth. The first efforts are always going to be to secure compliance, not on enforcement via a fine and so forth. But I will get back with you on that. Understand that the individuals, if they won't leave, it's just a simple trespass at that point in time. Yes, sir?AUDIENCE MEMBER: Going off of that, I have another question. Would the citations be for the business owners or the regular people?GOVERNOR JON BEL EDWARDS: Business owners?AUDIENCE MEMBER: And then I know some of the medical professionals they mentioned elective surgeries. Kind of where are you on possibly, you know, maybe going back to cutting off elective surgeries. GOVERNOR JON BEL EDWARDS: Well, the Office of Public Health has not told me that that's something they're recommending now. I will tell you that you have some hospitals around the state who are different places in terms of their staffing availability to deal with COVID19, and I know that some of them are making decisions for themselves as to whether they're going to curtail certain types of nonemergency medical and surgical procedures in order to have that staff to deal with their COVID patients. And so it hasn't risen to the level of a statewide issue yet where we've? where I've even advised that we should consider doing that, but I do know, because time gets away from me? But the other morning I had a call with about 20 CEOs and medical directors of hospitals from around the state, and there were three major issues. One involves tests. And not the availability of test collection kits like we had before. That's available. It's the turnaround time at the commercial labs primarily. Second was remdesivir, making sure that the allocations of that were sufficient, because they're being allocated based upon what previous patient counts were and some hospitals have seen large increases but they weren't necessarily getting the remdesivir that they needed. And thirdly was around staffing. And so I know that there are some hospitals that have already decided to make some changes about how they operate in order to free up some folks. We haven't been asked to do that at a state level yet. Yes, sir?AUDIENCE MEMBER: So as far as those medical exemptions from wearing a mask, firstly, if you can kind of elaborate on what those exemptions would be. And secondly, if somebody does fall under that, do they have to carry a doctor's note or what's that look like. GOVERNOR JON BEL EDWARDS: Well, first of all, if, as I mentioned, that businessowner? if that were you and you walk into my business, I may ask you, say, sir, would you mind putting a mask on and you say, well, I do because I'm exempt from it because I have a medical condition, whatever. That business owner is allowed to accept your representation. So, now, if you had something that would document that, I would think it would be in your interest to have it on your person. We're not going to require the businessowner to ask you for that. And at that point in time, you're allowed to be in that store without a mask and so forth. As far as what those conditions are, I'm going to ask for one of my physicians to come up. I don't know whether Dr.?Captor or Katie, whoever, wants to come up and talk, on which conditions it would be that would mean you don't have to wear a mask.DR. JOSEPH KANTER: Thanks for the question.And, I mean, to be clear, it's a tiny, tiny minority of the patient base out there. Some people have respiratory function that is so diminished that putting a mask on can cause anxiety and really their window is so narrow that that's enough to put them over. Obviously, kids younger than 2 are not? don't do well with wearing masks. And then it's a case by case basis. But there's a larger point to be made here, and it's that? and I counsel patients on this too. If you have a condition that you think makes it untenable to wear a mask, it is also likely the case that you are at an increased vulnerability for COVID exacerbations in the first place. You are a vulnerable individual, and I don't want you putting yourself in a position to be at risk and to get sick. And that's the larger message to convey to people. Is that if you really do have a condition that puts you? that you feel you're not able to wear a mask, you really need to look at your own risk profile and is it worth doing the activities that you like to do. GOVERNOR JON BEL EDWARDS: Yes, ma'am?AUDIENCE MEMBER: Okay. So in terms of casinos, will they be limited considering they're only allowed to have 50 people in there?GOVERNOR JON BEL EDWARDS: No, that 50 person limit has to do with social gatherings, as I mentioned. All of the Phase II requirements with respect to occupancy will remain in place for commercial businesses, whether they're essential, nonessential, for? so that is not the situation with respect to casinos. There's nothing in today's order that changes Phase II for churches, for essential retail, nonessential retail, including casinos. The change with respect to commercial establishments is limited to bars and perhaps to a commercial establishment that would offer an indoor venue for some type of a gathering. Yes?AUDIENCE MEMBER: Can you talk about indoor restaurants that are not bars but do serve alcohol? I know New Orleans stopped any sale of, you know, at the bar itself. Can you talk about what if anything is changing at indoor dining establishment. And if nothing is changing, I guess why not take on indoor dining at restaurants as well as bars. GOVERNOR JON BEL EDWARDS: Well, because the information that we have from contact tracing and otherwise is that the restaurants are not posing the same type of risk of transmission as bars. I think typically people are in a restaurant for a shorter period of time than bars. They're more likely to go in and come out wearing a mask and only not wear masks while they're seated at the table and that sort of thing. Now, I am aware that there are restaurants that have bars in them. They're going to be allowed to seat patrons at the bars and serve them food, and while they are consuming food, they can have a drink as they normally would, just as they could at a table, by the way. But the bars in a restaurant will not function as a bar. They'll function as an extension of the seating area. Yes, sir?AUDIENCE MEMBER: Yes. Will a guidance be provided to state agencies for state employees. GOVERNOR JON BEL EDWARDS: Well, yeah. First of all, this applies entirely to state employees as well, and all of whom are going? and by the way for the general public coming into a building, a public building, whether it's state or whatever, it's going to apply to them too. So state employees will be wearing masks, yes?AUDIENCE MEMBER: Texas has taken a sort of different tact to enforcement than you have. They've sent out their alcohol and tobacco control arm and essentially shut businesses down if they found they're violating the rules. I'm wondering if you think what we're doing here, is you haven't issued any penalties, it's more of a warning system, do you think that's working? Why not just go out there? don't they know the rules at this point? Why not just suspend the license for 30?days?GOVERNOR JON BEL EDWARDS: Yeah. Well, I've just announced we're closing every bar.AUDIENCE MEMBER: Yeah, but I guess? GOVERNOR JON BEL EDWARDS: I don't know how to be more categorical than that. But secondly?AUDIENCE MEMBER: Well, especially with the mask mandate too, I guess I'm just curious because this is another enforcement mechanism that you're going to work on gaining compliance. I guess why not be stricter when it comes to enforcing this stuff?GOVERNOR JON BEL EDWARDS: Well, and what I can tell you is? and I didn't get an update today on what the number is. The last time I got an update, we had visited more than 3,100 commercial establishments. That was restaurants, bars, and retail all together. And that's Office of Public Health and primarily the state fire marshal's office. What I can tell you is that the vast majority of those were not out of compliance, that those that were, the vast majority of very quickly got into compliance because it was something relatively simple in almost every instance. The employees know they have to have a mask because they've got one around their neck. They're just not wearing it. And when you go in and you tell them to wear it, they put it on. So what we're trying very hard to do is make sure that we're going in because we're doing compliance checks or because we're responding to a complaint and quite? and y'all might be surprised at the number of individuals who will either leave or choose not to go into a commercial establishment because they don't believe that the individuals are wearing masks. And then they will call the fire marshal's office, make a complaint, and we go out there. And very, very quickly, that individual puts the mask back on. And typically it's an employee who, for some momentary lapse, they take it off, they don't put it back on. And for whatever reason, there's not a close enough supervision to get that mask back on them very quickly. But we're going out there and we're working with those individuals. Now, I have instructed our fire marshal's office that on repeat visits to the same establishments for the same problems to start issuing citations. So I do believe you're going to see that going forward. But I'm going to repeat something here. And I hesitate to do it, but I'm going to do it anyway. I've said from the very beginning, a public health emergency of this nature, if the people of Louisiana are going to insist that we enforce our way through it, we're not going to be successful and we're going to continue to have people unnecessarily spreading this disease, and then other people who, through no fault of their own, because they might be wearing a mask, they might be the most responsible citizen out there, but they will contract it because someone in their close vicinity chose not to be a good neighbor. And then those individuals are going to go to the hospital and fill that bed and cause all the problems for our hospital systems and our medical providers, and not just to the COVID community but to anybody who needs a medical service. And if the people of Louisiana are going to say well, we're just not going to listen to any of that and we're going to make them enforce our way through it, well, we're going to be unsuccessful. But, you know, what, I believe in Louisiana. We're better than that. Our people have always been good and resilient. We're a faithful people. We know what it means to be a good neighbor. And now it is important to be a good neighbor. And if you don't like the mask mandate, then don't like it, but wear your mask anyway if you're going to be out in public. If you want to criticize me, criticize me. This isn't an easy thing to do. It's hard. And I understand it's going to be controversial, and I know that because we've already seen some wild and crazy things being said about masks and mask mandates. So be it. It's the right thing to do. It's the essential thing to do. But don't sit back and say we're only going to be successful if you enforce our way through this. That is just the wrong attitude. Yes, sir?AUDIENCE MEMBER: Since you mentioned the vice president's visit, I talked a little bit about Dr.?Kanter last night about some of the testing issues that y'all may discuss next week with the feds, including turnaround time for test results and then the reagents. Can you kind of talk about how the decision for the vice president to come to Baton Rouge specifically and then about those testing issues that may be discussed. GOVERNOR JON BEL EDWARDS: Well, I think there are a number of things happening all at one time that made Louisiana an obvious place to come. Number 1, as I just mentioned, we're back to number 3 per capita in the country for COVID cases. You'll recall, it was just about ten days ago that we announced that the federal government at the direction of Dr.?Burkes and the folks at HHS and the office of public? not the Office of Public Health? but anyway, they picked Baton Rouge specifically to do surge testing, one of three manuscript areas around the country to do surge testing to get above our baseline by what we were hoping would be 5,000 people per day. By the way, we haven't met that. We are increasing every day, but we haven't gotten to 5,000 yet because of the steep increases in cases but the even steeper increases in positivity in Baton Rouge. So Louisiana has been on the radar, literally front and center, of the White House coronavirus task force since the very beginning, when we had to highest case loads in the country. We've never come off of that radar. And so I think that's a big reason why the vice president chose to come to Baton Rouge and to Louisiana. While he's here, he's going to talk about higher education and what we're doing to safely resume, hopefully, on campus, in person instruction on time, what that mix of education is going to be like between in person and perhaps distance learning, and those sorts of things. And I also think LSU is a tempting target for anybody because it's LSU and we're the current national champions, and he gets an opportunity to come down and be on that fine university. And we're going to actually meet in a large space in the club room on the south end of the state. So for all of those reasons, I think he picked Louisiana. One more question. You get it?AUDIENCE MEMBER: Governor, Clay Schexnayder sent a note to republican members, sort of warning them of some of the dangers of signing this petition as some of the more conservative members going forward. Have you talked to Clay Schexnayder about this new mandate? And are you worried about the petition at all gaining steam on this?GOVERNOR JON BEL EDWARDS: So I speak frequently with the speaker and with the president of the senate and really lawmakers regardless of whether they're in leadership. I speak to them frequently. I did have an opportunity to talk to them specifically about the proclamation I'm going to be signing today. But what I try to make sure is that they're getting regular updates and they're seeing the same numbers that we're seeing and they know the trajectory that we're on and so that hopefully by the time we make a decision, it's something that they probably have already envisioned that we're likely to do. But, yeah, I have had an opportunity to speak to them about this. I made sure that they understood? and this is one of the differences. And Dr.?Kanter got into this, I think, really well. The first time we had a surge of coronavirus in the state, there were an awful a lot of people who said well that's a problem for Orleans and Jefferson Parish. It's not a problem for us. That is obviously not true today. And, in fact, New Orleans, that is not a driver of our current increase in cases. Now, that could turnaround and it might be the case tomorrow, but this is literally statewide. The hottest area in the state for case transmission is in Lake Charles, Louisiana, right now. The second hottest is in Lafayette. So there's a big difference here, and I really think that some of the legislators who signed on to the petition? which, by the way, I think would be a tremendous mistake? for us to be I think the only state in the nation without a public health emergency at a time when we're number three in the country in per capita cases, our positivity is over 15?percent and we've got the highest case growth that we've had the entire public health emergency, our hospitals are filling up again and all the coordination that we need to do, all the resources we need to make available to our hospital and to our parish governments and other political subdivisions, all the coordination we have to do with the federal government, not to mention making sure that we're able to take advantage of all of the resources that they can only send to Louisiana if we have a declared public health emergency and the ability to make sure that we can take advantage of the Stafford Act which allows FEMA to pay for 75?percent of reimbursable expenses, all of that would be overridden by some sort of a silly partisan petition. Look, it's? they can do it if they want. That would be a tremendous mistake, and the people of Louisiana would pay an even higher price from this pandemic if that happens. And I'm going to encourage, as sincerely as I know how, any members who haven't yet signed it, not to sign it. And I'm going to remind those who have signed it that they can have their name taken off of it. But it would be a tremendous mistake. Look, thank you all for coming today to this press briefing. Obviously these are not the kind of briefing or decisions that I look forward to. They're not easy, but they're essential. And our ability to communicate them to the people of Louisiana, really, you all play a huge role in that. And so for the people in this room today, I want to thank you for the work you're doing, and I want to wrap up with some comments directed directly to the people of Louisiana. We've been here before. We can get back on top of this, and we can start driving cases down. And we can do that if we would just understand we all have a role to play. That role is simply being a good neighbor under these circumstances. And it's different to be a good neighbor than it was before, because being a good neighbor today means you don't go pay that person a visit but you call somebody, you text them, you Zoom with them, whatever. But it also means that you wear your face mask. You physically distance when you're outside of your home and people? in proximity to people that are not part of your immediate household, that you wash your hands frequently, that you stay home when you're sick, and that you take of people that are most especially most vulnerable. And if you're out and about? first of all, understand you're safer at home, always. But if you're out and about, don't patronize a business that isn't operating safely because if you will do that, then we know that businesses will, in fact, operate safely. And then the last thing I would ask people to do is to make sure that they are praying for our state and our country. This is a very difficult time. So I'd ask you to join your prayers to mine. And I'm absolutely confident we're going to get through this. It won't be easy. It won't be quick. But we're going to get through this. But it will be quicker and it'll be easier if more people will comply with what we're asking them to do.Thank you all very much. ................
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