Too Soon to Tell

Elections & COVID-19: A Virtual Town Hall

On Tuesday April 28, at 6pm, please join me, State Representative Beth Moore, and Gwinnett County Commissioner Ben Ku, for a public online program entitled “Elections & COVID-19: A Gwinnett Virtual Town Hall.”

Coronavirus has changed a lot of things, including the ways we safely and securely conduct our elections. We’ll  provide you with important updates and recommendations for best practices in the 2020 election cycle. This is a non-partisan event, and all district residents are invited to watch and submit questions.

You can tune in one of two ways:
(1) Watch the Facebook Live broadcast from my Facebook page; or
(2) Listen in by calling (301) 715-8592 and entering Meeting ID 926 3171 1369.

You can submit questions in advance by clicking on this Google Form link.

We’ve Only Just Begun

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
–Winston Churchill

The Governor’s About-Face

Almost two weeks ago, a beleaguered Governor Kemp, just back from visiting tornado-ravaged north Georgia, stood in front of the press to address Georgia’s response to the COVID pandemic. He was asked when he thought the economy could open back up. With an overwhelmed expression he said, “On the back side of this we can focus on opening up, but not yet.”

Seven days later, standing in front of the same press, he announced the reopening of businesses including gyms, salons, dine-in restaurants, tattoo parlors, and massage spas — all before the end of his April 30th Shelter-in-Place and May 13th Declaration of Emergency Orders.

Why this About-Face? Was it his phone call with Vice President Mike Pence? Was it his conference call with other southern, Republican governors? Was it the threat of a “Reopen GA Protest” at Georgia’s Capitol? Or was he following his heart and thinking this is the right thing to do?

During times of crisis we need the steady hand of reliable leaders. Instead, Gov. Kemp’s About-Face leaves us feeling like we don’t know what’s around the corner. His premature decision to say “yes” to non-essential massages, tattoos and haircuts, while still telling most of us to stay home except for necessities, makes no sense and does not inspire the kind of trust we need in a leader right now.

Orders for Re-Opening

This week the Whitehouse released “Opening Up America Again,” a very reasonable roadmap for balancing the opening of the economy and the health of Americans, as we wait for a treatment or vaccine to be developed. Even before activating the first of three phases, the report advises certain “gateway” criteria including 14-day declines in flu-like and COVID-19 symptoms and cases, adequate hospital beds, as well as PPE and testing for health workers. Has Georgia met these? No. This question was asked during this week’s legislative conference call with the Governor’s office:

What numbers changed to support the re-opening of Georgia businesses that was announced on Monday? The President’s reopening guidelines include a 14-day drop in cases before re-opening. What is the reasoning in re-opening before this has taken place?

Answer: “As the Governor said in his press conference on Monday, the state is on its way to meeting the gating criteria into Phase 1 of the “Opening up America” plan. We are beginning to see a plateau and slight decline in new case notifications and a decline in total death notifications.”

“On its way” doesn’t cut it. Georgia does not meet the guidelines. And don’t be surprised if you see published graphs of declining cases to justify the Governor’s decision. According to the Atlanta Journal Constitution, new COVID-19 cases are now being recorded differently — instead of recording a new case when a test result comes back positive, the case is being recorded according to the date symptoms first appeared. This new way of documenting cases will result in a well-timed and misleading, temporary drop in case numbers. Many of us are relying on data to evaluate potential risks in venturing out — almost like looking at the weather forecast when planning trips. These changes in the numbers leave us feeling vulnerable and confused.

A Salute to Georgia’s Hospitals

Just a few weeks ago, we feared the United States would be “the next Italy” — that people would die because of a shortage of ventilators, and that a medical triage process would choose who lives and who dies. This did not happen in Georgia, due to the hard work of Georgia’s hospitals. Right now, possibly at the peak of our first COVID wave, we have over 900 available ICU units across Georgia. The cancellation of regularly scheduled procedures provided the necessary personnel, equipment and physical space so in-patient beds could be converted to ICU beds. Private healthcare systems worked cooperatively across healthcare systems to share resources, and a system of counting ER, ICU and in-patient beds was developed so the state could plan for the coming surge of patients. It all worked because of the sacrifices of so many people, from doctors who closed their businesses, to the healthcare workers who risked their own health to take care of others, to those of us who were staying home to slow down the spread, allowing our healthcare system the breathing room it needed. These numbers show that as long as there is not a resurgence of COVID-19 cases, hospitals can begin meeting pent up demand for elective procedures and surgeries. “Elective” in some cases means cancer treatments and people who are in disabling pain needing surgery.
April 24 Capacity In Use Available
ICU Beds 3,246 2,329 917
ER Beds 3,430 843 2,587
General Beds 14,727 9,169 5,558

source- Georgia Hospital Association

A Salute to Georgia’s National Guard

Forty percent of Georgia’s COVID-19 deaths are residents of long term care facilities. Over the course of the last three weeks, almost 3,000 soldiers, airmen, and State Defense Force personnel  have been deployed across Georgia to assist in the COVID-19 response. Most of these soldiers make up Infection Control Teams, who have visited 80% of the hundreds of nursing homes and long term care facilities in Georgia, doing deep cleaning, and training local staff on proper disinfection and infection control. General Tom Carden says that Georgia’s use of the National Guard in addressing the state’s COVID crisis is a model now being replicated in other states. Georgia’s National Guard is also assisting hospitals, food banks, school lunch delivery programs, and public health departments.

Does Georgia’s Testing Pass the Test?

Several constituents have been telling me from the beginning that it’s all about testing. Yet Georgia has been slow to get adequate testing rolled out. We’ve been told repetitively that testing will be “ramping” up, yet we continue to test less than 1% of Georgia’s population. In the last few weeks, we’ve slowly climbed from 45th to 43rd in the nation for people tested, as our daily testing numbers increased from around 3,000 to almost 7,000. Questions about testing came up in this week’s Governor’s conference call:

Will the testing the state is doing have both antibody testing and positive/negative test results? More information that we could share with constituents on this topic would be helpful.

Dr. Toomey responded: Initially, the tests that the state is administering are live virus tests run through PCR machines (positive/negative test). At this time, DPH is not administering antibody tests. This test shows exposure to COVID19 and may paint a better picture of the breadth of the virus at a time when access to adequate testing was limited. However, at this time we don’t know if the presence of antibodies necessarily shows immunity. The science isn’t there yet, so we wouldn’t rely on the presence of antibodies as firm evidence that a person is no longer at risk of being infected with COVID.

Dr. Toomey also referred to the CDC’s recent statement regarding the use of antibody testing: “The test is not currently designed to test individuals who want to know if they have been previously infected with COVID-19.”  (FDA letter to healthcare providers, and CDC Serology Testing)

During Monday’s press conference, Gen. Tom Carden was asked about the goals of Georgia’s testing program.

Gen. Carden responded: If you look at the rate of acceleration of our testing program during the last week (how much it has “ramped up”), Georgia is 28th out of 54 states and territories.  We are only limited by the supply of test kits and lab capacity. Our goal is to have enough testing to be able to make data driven decisions. We’re going to test what we can source for. “Trying to test almost 11 million people in the state of Georgia is about like trying to boil the ocean.”

When the press asked about measurable goals, Carden continued: The top two testing states in the country, Rhode Island and NY, have both been able to test a little over 3% of their populations. Georgia is at 0.71%. I’d love to say Georgia could test 10%, but that’s not realistic. “My goal is to drive it until the system breaks.” 

Wherever the Virus Goes, We Go

Dr. Kathleen Toomey has said repetitively that contact tracing is how we are going to keep this virus under control. Yet she admits that the logistics of setting up a tracing system for a disease that is spreading so quickly through the population is not something that anyone in our current public health system has experience with. One constituent told me recently that he was exposed to the virus in early March through the wife of one of the early COVID patients. He was never contacted by public health, even though a contact tracing program was supposedly up and running.

What is the state’s plan for getting contact tracing up and running?

Here is Toomey’s response: The DPH is finalizing its plans for substantially increasing their capacity for contact tracing by significantly increasing staffing through partnerships with our higher education institutions and leveraging technology through a partnership with Google – more details will be shared in the coming days. It will take a village. Every public health epidemiology team will serve as incident commanders. We will have videos to train staff in the districts, to train volunteers. Other states built teams using Master of Public Health students, and medical students who are not currently in classes. When a person is newly infected, we will reach out, talk to them, find out with whom they were in contact and where did they go? We will address the exposures. In the past, we have done this manually with staff. Now with the wonder of Google technology, a computer based app is being finalized. It will be customized to our own needs. This is the priority in months ahead. This is how we keep spread from occurring even as we open up the economy. 

Four Week Chunks

So if we are just now approaching the end of the beginning, what’s next? I think we continue to protect ourselves and our healthcare system while we evaluate the impact of the Governor’s decisions the best we can. I’m carefully tracking hospitalization data because I feel it’s a pretty good measure of virus activity, and it’s not easy to manipulate. This data indicates we may have reached a plateau, and conference calls with major hospital systems support this data. For the most part, hospitals are reporting that they are discharging the same number of people they admit each day.

I told my kids, who are wondering if they will have in-person college classes in the fall or not, “you need to plan, then make contingency plans.” My friend Michael Murphy-McCarthy said, “I do well with four-week chunks.” Let’s see where we are in a few weeks, then we’ll ask “what’s next?” once again. In the meantime, check on your neighbors, donate to your local food bank if you can, and do whatever makes you feel good, within limits, of course!
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Conflicting Messages

Conflicting Messages

Last week we were doing just fine focusing on preparations for Georgia’s COVID-19 peak. As Governor Kemp said, “On the back side of this we can focus on opening back up, but not yet.” Then, with the President’s release of his “Opening Up America Again” guidelines, the news cycle did a cartwheel, leading many Americans to believe it is now okay to go back to “normal.” After all, Easter Sunday has come and gone.

This week’s conference call with the Governor added to the confusion. Mark Hamilton, the Governor’s Director of External Affairs, made it crystal clear — Georgia IS open to business. And two special guests from the Department of Economic Development, Commissioner Pat Wilson and COO Bert Brantley, echoed his message, “Georgia has not done a shut-down. This keeps us in line with the President. Our economy has continued to move.”

But before we panic too much about unleashing a pent-up virus, understand that much of this message was likely aimed at preventing a Michigan style “Freedom” protest on the steps of the Georgia Capitol. Obviously, it IS important to think about how we are going to open back up the economy. But as Governor Kemp said, “We must do this nimbly.”

Be Prepared

The lead group for restoring Georgia’s economy is the Economic Impact Committee of the Coronavirus Task Force. In addition, the Governor has spoken with the Lt. Governor and the Speaker about what comes next. And, there was a Governor’s conference call this week with the President about his guidelines. But for now, Governor Kemp’s message is, “Our focus is on the crisis at hand — PPE, support, staff, equipment, and flattening the spread of new cases.”

COO Brantley told us that many Georgia manufacturers whose markets have shut down are shifting to produce the things we need, such as personal protective equipment (PPE).  Many of our manufacturers will be ready to provide these items for the long-term.

The Economic Suffering is Real

Unfortunately, the stimulus package passed by Congress is struggling to get real cash to people in a timely way. The first round of stimulus checks are beginning to arrive, but employees laid off in mid-March will soon be faced with a second month’s rent. Georgia has not enacted any kind of state-wide stay of evictions or foreclosures, and Small Business Administration loans ran out of money this week, leaving many businesses high and dry. Georgia’s unemployment system is completely overwhelmed. If you are able, local food banks really need your help. Here’s a great database for looking up food banks in your neighborhood. Also, call Governor Kemp’s office at 404-656-1776 and ask him to enact a moratorium on evictions and foreclosures.

What About Testing?

Epidemiologists have made it clear. Georgia’s economy can only recover if it is accompanied by a massive expansion of testing. Dr. Kathleen Toomey, Commissioner of the Department of Public Health, answered legislator’s questions about testing and contact tracing.

Why is Georgia so far behind other states on testing and how can we catch up?

When we first started testing, there was only one kind of test, provided through the CDC, and two batches of those tests were defective. Although the CDC is located in Georgia, we were not chosen as a priority state. Our initial challenges were not unlike other states in terms of test and swab availability. But we have overcome these challenges.

Now we have 39 test sites and are processing thousands of tests a day, including a new lab in Sandy Springs that will provide 2100 tests a day. Shipments have gone out to the health districts. This week is an important surge week so we have set up additional sites M – F and some weekends. The National Guard is helping. We think we will be able to test many more people with our expanded criteria, including anyone who has symptoms, even the loss of smell/taste — any age — young, infants, and elderly. Also many asymptomatic people in nursing homes will be tested.

Can you update us on the status of our contact tracing ability? How are we doing contact tracing for people who were not “sick enough” to be tested?

Contact tracing becomes even more critical as conversations about “re-opening” the economy continue to occur at the national level. Early on when there were only a few cases, we did contact tracing aggressively. Now with thousands of cases we can’t do it with that intensity, although we are still doing it in nursing homes or areas with close contact. DPH is working to ramp up the system’s capability to scale-up contact tracing. We are developing a plan in partnership with Google (cell phone monitoring for possible exposures) and perhaps a University partner. Also, we’re looking at putting together teams like other states (CA, MA) using student volunteers, and people in the community to help with contact tracing.

Can you address the disparities in the information being reported from nursing home facilities and long-term care facilities with respect to reported positive cases and deaths, and the data reported to the Dept. of Public Health?

For nursing homes and Long Term Care (LTC) facilities, there is a data lag time. For example rapid tests were done but not reported back until weeks later. We are telling facilities to be more prompt. In the end, we get the same numbers but it takes longer than it seems it should. Right now we are posting these numbers weekly, but in the next 48 hours you’ll begin to see this data reported daily. Lastly, we must have good infection control in LTC facilities. Infection control is what’s going to stop the LTC outbreaks.

Is this Picture too Rosy?

The expansion of test sites and who can be tested all sounds great, but this week, the number of diagnostic tests processed in Georgia actually fell significantly. And I have heard reports of tests being rationed to five tests a day by long term care facilities. The kind of test expansion experts are saying we need to open up the economy is in the hundreds of thousands range — not the two to five thousand we have been seeing in Georgia. Also, contact tracing will require a couple thousand workers, or a budget of around $50 million. Is Georgia up to this? Is any state up to this?

Here’s the best analysis I’ve heard on what is wrong. All of the tests are privately owned, and instead of FEMA coming in and buying all the tests for the county and sending them out as needed, all 50 states and the federal government are competing for the same tests. So these private businesses, who have a very finite capacity to produce tests, are making promises to all 50 states that they can’t keep. The private companies then use the increased demand to make states bid against each other, driving up the price for each state. So the highest bidder gets the tests — which is probably not Georgia.

Other Public Health Research

While we focus on hospital bed availability, PPE and diagnostic testing, scientists around the country are working on treatment, vaccines and large scale research. In other late-breaking news, Dr. Toomey mentioned Georgia is developing a partnership with Universities and the NIH to do serological testing to pick up on how many cases have been occurring throughout Georgia’s population. CDC is also studying hospitalized patients and the role of underlying conditions. These will be published in the next 1 – 2 weeks. Floyd Medical Center is utilizing plasma with antibody treatments and seeing good outcomes.

How Many ICU Beds are Available?

While ICU utilization is up by 98 beds since Tuesday 4/14, more ICU beds have come on-line, so we have a net positive of 58 ICU beds! Plus the 200 general bed facility at the World Congress Center is now open. Last week models predicted Georgia’s peak will be May 1st, but the IHME model is now saying we may have passed our peak. It’s hard to tell what will actually happen. As General Carden said, “The World Congress Center is our relief valve … pray we don’t need it, but it will be there.”
April 18 Capacity In Use Available
ICU Beds 3,054 2,142 912
ER Beds 3,446 798 2,648
General Beds 14,517 8,616 5,901

 
Judy Fitzgerald, Commissioner, Dept. of Behavioral Health & Developmental Disabilities (DBHDD)

State Hospitals: All visitation at State Hospitals has been suspended.

There have been significant workforce impacts at Georgia Regional Hospital (Atlanta) and Central State Hospital (Milledgeville). The Georgia National Guard has done decontamination, and batch testing of people and staff has been conducted at these facilities. There have been two staff deaths in Milledgeville (died at the local acute care hospital) and 20 plus positive cases. Confirmed cases are in quarantine units at both these hospitals. Additional PPE has been delivered to Central State in Milledgeville. Possible COVID positive people at the Savannah and Columbus facilities have been isolated.

Behavioral Health: A COVID-19 Emotional Support Line has been established. 866-399-8938. This statewide line provides free and confidential assistance to callers needing support and behavioral health resource information during the COVID crisis.

In addition, the Dept. of Behavior Health & Development Disabilities has implemented Wellness, Self-Care Tips and Support for Health Care and Emergency Response Workers. Requests have been made to extend this service to other state employees as well.

Developmental Disabilities: The Dept (DBHDD) has implemented increased communication channels to respond to individual, family and stakeholder questions and concerns. In addition, DBHDD has worked with the Dept. of Community Health to develop Appendix K (emergency preparedness and response) for needed changes to NOW/COMP waivers. Educational webinars have been prepared for Stakeholders, Providers and families.
Homer Bryson, Director of Georgia Emergency Management

In rural Georgia, private practitioners are the first line of defense against COVID-19. Many offices have been using the same PPE for 3 – 4 weeks. How can we help these private practices purchase PPE?

First priority must go to acute care hospitals, long term care facilities and first responders. The state has ordered several million pieces of PPE that will be sent to the GEMA/DPH warehouse and sent out to areas of greatest need. We also understand that the PPE supply chains internationally are slowly opening back up, and private practices and other facilities are encouraged to reach out to their existing suppliers initially to acquire PPE.

Miscellaneous Questions & Answers

The 2021 Budget. What action is being taken by the Executive branch in terms of plan/changes? Are the House & Senate budget offices being engaged to prepare for what will need to be done?

OPB Director Kelly Farr and the Governor’s Senior staff are in constant contact with House & Senate Appropriations. Actual revenue reports are reported with a lag so we are still reviewing what actual numbers will look like. We have a one-hour call today.

Should we just change the revenue estimate now? 

The impact on the economy is being assessed. We still just don’t know. The state is evaluating all options and keeping all courses of action open.

According to an April 10 CNN Report, the largest known concentration of CV cases outside of hospitals is in the nation’s prisons. What are the conditions of Georgia correctional facilities and what is being done to protect them?  Are correctional officers being tested? 

The Dept. of Corrections publishes a daily report at http://www.gdc.ga.gov/content/cases  The Georgia National Guard has been involved in training as well as sanitizing for both Corrections and the Dept. of Juvenile Justice. There have been no positive cases for any youth within the DJJ, though there have been a few staff positive.

Will Georgia’s public secondary schools and University System of Georgia schools move to a pass/fail grading system rather than letter grades or allow students to choose which they prefer?

This is a decision for the Board of Regents.

School systems are homeschooling students with the assistance of the internet. Can the state provide assistance to systems or parents to obtain internet access where it is unavailable?

Two weeks ago the Governor and the Department of Community Affairs put out a release connecting Georgians who do not have internet access to resources where they can receive internet access. http://broadband.georgia.gov/georgia-internet-access-covid-19-update

When do you think enough masks will be available for grocery store employees and even for the general public to order and receive? Can the Governor mandate food service workers to wear masks? If they are available?

The Governor did not make it mandatory, but there is guidance from the Federal Government. The global supply chain for PPE is slowly starting to re-open.

We’re in a Liminal Space Now

We’re prepared for the surge, but we’re not quite sure when we will reach it, or if we already have. We want to get to the other side, but we’re not sure what life will look like when we do. Some who have lost loved ones will go on with life but feel a void. We make plans, and then we make contingency plans. That’s our new normal.

As we ponder moving past our first COVID-19 milestone, let us remember, in this single blossom, the many recently departed souls who have left this world as we know it. (photo credit: Marc Merlin)
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Reaching the Peak – Covid-19

Reaching the Peak

There’s so much stress in the world right now. My kids are stressed; my family and my friends are stressed. We’re all hurting and worried.

Georgia Hospitals are Climbing Mountains

Last week I had the chance to hear from leaders of WellStar, one of the largest healthcare systems in Georgia. Here’s what they, and other state leaders, had to say.

Expanding Capacity: Expansion of ICU beds by converting and upgrading other units has been the hospital system’s focus. The creation of a non-ICU hospital at the Georgia World Congress Center helps make this possible. Redeployment of doctors and staff freed up from their usual jobs is helping to staff ICU rooms. There are contingency plans to double ventilator capacity — shifting equipment around to different hospitals, purchasing vents, and converting anesthesia equipment. Also, since COVID is hard on kidneys, more CRRT machines have been ordered (continuous renal replacement therapy).

How Staying at Home has Helped: Every single hospital administrator on the conference call said having people stay at home has helped. They sent you their thanks, and said keep it up! Dr. Carlos del Rio, chair of the Hubert Department of Global Health at Emory University’s Rollins School of Public Health, has the data to back this up. In the AJC, he states, “Instead of seeing one day 10 patients, and the next day 20, and the next day 40, and the next day 80, we are seeing one day 10, the next 12, and the next 14, and the next day 16. That makes a huge difference.”

Amazing things: Hospitals, including Grady, are reporting that access to PPE (personal protection equipment) is better now for healthcare workers. This has helped to achieve lower virus transmission rates among healthcare workers. Since many healthcare workers work 7am – 7pm they can’t get to the grocery stores. So, hospitals have created mini-convenience stores within the hospitals for healthcare workers, stocked with things like PBJs, paper towels and, of course, toilet paper! They have a constant supply of donated meals. They have organized small groups to care for other people’s children. Last but not least, healthcare workers are uplifted by the success stories of COVID survivors, and really appreciate all the thank you notes from family members.

Current Bed Availability: Brand New Data!

Capacity

In Use

Available

ER Beds

3.429

839

2,592

ICU Beds

2,898

2,044

854

General Beds

14,242

8,670

5,575

“We are constantly comparing hospital capacity with surge numbers. Looking at models is good guidance but not foolproof. When it comes to looking at the median numbers, we are in good shape by more than 1000 beds. But if you look at the high numbers, we are not in good shape. The World Congress Center is our relief valve should we run north of our surge capacity. Pray we don’t need it. But it will be there.” 
–Major General Tom Carden, Adjutant General, Georgia Department of Defense

Testing: According to Dr. Kathleen Toomey, testing is still inadequate, and the status quo is not acceptable. We are 45th out of the 50 states in terms of numbers tested. Though many hospitals report they are beginning to do their own testing, Dr. Toomey says don’t show up at an ER for a test — call your health department instead. “We made it too hard to get tested because it required a referral from a physician. That was too hard a barrier. Now you can call your health department directly.” There are 34 testing sites in the state, including the new GA Tech site. In addition, there is a new lab in Sandy Springs, and Georgia Universities are processing 1000 tests a day. Expansion of testing criteria is beginning to open up. Dr. Toomey says that asymptomatic people who have had direct contact with a COVID positive person can now get tested.

What Goes Up, Must Come Down

The following are answers to questions submitted by legislators and answered by the Governor during the April 8th conference call:

After the “Peak” how will opening the economy back up be approached? Is diagnostic testing being expanded? Will an antibody test be used? How available is antibody testing? 1) IHME now estimates the peak in Georgia to occur on or around May 1st, when current projections show the state will have a deficit of 218 ICU beds. More capacity is coming on-line. 2) Two companies have released rapid tests nationally. Hospitals across the state that have partnerships with these companies now have machines and are actively testing. 3) IgG antibody testing is currently entering the market and once available will be deployed by the State.4) Antibody response indicates exposure, but does not imply immunity. There are other factors of immunity including cellular immunity and no one knows about immunity to SARSCoV-2, yet.

What Metrics will be used to trigger reopening the economy? Dr. Toomey, Commissioner of Public Health, says we will look at the numbers. “Right now we continue to see widespread community transmission. It is still too early to see the impact of the Governor’s Stay at Home Order — this takes several weeks. Hopefully we will see a flattening of the curve. If we open everything up too soon we will get a rebound with a second peak — we need to keep outbreaks from occurring even after we open things back up.”

A Roof over One’s Head

Will there be a statewide freeze on evictions and foreclosures during the Emergency? No. No specific action.

What is being done to support unsheltered homeless people? We have established the Displaced Individuals Sub-Committee, which is chaired by Mayor Bottoms. Look to her and her sub-committee. We are now working with a local hotel which will open today for 200 people who test positive but require no hospitalization. This will be monitored by public health.

Long Term Care (LTC) Facilities:  There are currently 80 LTC facilities statewide with positive COVID cases. Every LTC facility is a high risk place. Dr. Toomey stated the need to get ahead of the issue and work with ALL facilities, not just those reporting a positive case. Infection control work should be part of routine care. Training on infection control should be a priority, not just testing and reporting. Sixty Georgia National Guard Infection Control Teams have sanitized 249 facilities.

Miscellaneous Questions from Legislators:

Funeral Home viewings continue to occur. Will the Governor issue additional Orders to limit these to 10 people or immediate family? The Governor’s Order prohibits gatherings of more than 10 people if the 6-ft social distancing cannot be achieved.

Will the Governor continue to allow beaches and State Parks to be open? Georgians are obeying the Order and the Order is being enforced. The closing of State Parks and beaches is not necessary. St. Simon’s last weekend had only just over 100 people on the entire beach. That’s some of the best social distancing in the state. Neighborhood block parties are a bigger problem.

What will the budget impact be? How will Federal funds help? Tax revenues were actually up for March, but we expect the rest of the months in the 2019/20 fiscal year to be down. We have established a Sub-Committee on Economic Impact, chaired by the State Economist. It is premature yet to guess. We are keeping key people updated.

Will there be direction from the Board of Education to local school systems regarding virtual learning, at-home work for students and food distribution? Superintendent Woods will partner with the Governor’s office to launch working groups and guidelines for best practices for these areas plus facilities, equipment, mental health and professional learning.

Why is DPH keeping vital information from local elected officials to include the disposition of infected persons within their community (i.e., whether the cases are located in nursing homes/prisons and/or are hospitalized)? This is inaccurate – DPH is reporting long-term care facilities with positive cases and total hospitalizations – and the Department of Corrections is putting out information regularly on confirmed cases in their facilities. As we discussed yesterday, the DPH data is the “final authority” so there may be a lag in what you read on a press release, social media, or a post from a hospital – before DPH has the ability to confirm the data as valid.

Updates from Homer Bryson, Director, GEMA

Are first responders getting the supplies they need? Yes, we are in much better shape now than we were last week. The warehouse operation is impressive. We have streamlined the process to match the large scale needed. We order one day, pull the next, then ship the third day. Hospitals, nursing homes and first responders order every other day. Sunday is inventory day, when we assess where we are. We continue to deliver urgent orders every day when we get reports of shortages. We have shipped out 86 ventilators, 871,000 N95 masks, 1.2 million surgical masks, 201,000 face shields, and 3 million gloves.

Updates from General Tom Carden, Georgia National Guard:

The Georgia National Guard has deployed 2000 soldiers and personnel.

Infection Control Teams: The GA National Guard now has 60 active Infection Control Teams (The first team was organized and put to work on March 31st). These teams are made up of 913 personnel. They have cleaned 249 Long Term Care facilities.

Medical Support Teams: The Georgia National Guard now has 17 active  Medical Support Teams (The first team was deployed to Grady on March 25th). 200 personnel are deployed to 17 hospitals. These teams are made up of doctors, PAs and nurses, doing medical care and administrative support.

Hospital Entry Control Teams: 72 GA National Guard members are at hospitals doing patient screening. This frees up healthcare workers to tend to other needs.

Food Bank Support: GA National Guard has 180 personnel assigned to nine food banks.

Public Health: GA National Guard is assisting Public Health as drivers and couriers.

Updates from Dr. Kathleen Toomey, Commissioner of Public Health

Demographics on Public Health Website: Public Health is continuing to collect data that is not posted on the website because with some of the data there are so many variables that are still missing. For example, providers doing lab tests do not always provide all the demographic information. Public Health is working proactively to correct this. For right now, 65% of positive test results lack race/ethnicity data. This is a problem because we know that the cases in Albany are disproportionately affecting African Americans.

Anti-Malarials. The National Stockpile is providing anti-malarials to the states. The window for who gets this drug, and when, is very narrow. Dr. Toomey expressed grave concerns about how physicians are prescribing these drugs across the state, and how this is leaving people without their medication who continually need this drug to live. She has sent out a letter to doctors.

The Bird’s Eye View

 “This virus will change how we function now and in the future. We are a culture that embraces and shakes hands. This will change. Things that were routine will need to be modified because of the virus and how it transmits so easily. We will look for trends, but until we see that, I cannot give a prediction as to a date or how that decision (to open the economy back up) will be made. First we must see what community spread looks like and how our hospitals are doing.”
–Dr. Kathleen Toomey, Commissioner, Dept. of Public Health

Governor Kemp, in his 4/13 press conference said, “I don’t want to speculate yet. The peak day keeps moving. … We are seeing some good signs. Keep hunkering down. Keep doing what you are doing. … We must be very nimble in dealing with what comes after … On the back side of this, we can focus on opening up but not yet.”
Sally at Red River Gorge
Sally climbing sandstone cliffs in Red River Gorge, Kentucky one year ago this April.
“Every mountain top is within reach if you just keep climbing.“
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Georgia Hospital Association Call Notes On Covid-19

Sunny Days Cast Shadows

Another week has passed as we anticipate “the surge.” The words of Nathaniel Hawthorne seem written for our time: “Time flows over us, but leaves its shadow behind.”

As cities and counties across Georgia took the lead to enact their own Stay-at-Home ordinances, pressure mounted on Governor Kemp to do what the majority of Governor’s across the nation had already done — order people to stay home to slow the spread of the virus.

Last weekend, prior to the Governor’s Order, I shared photos with the Governor’s office of large raft-up boat parties on Lake Sinclair, pleading with him to order a shelter-in-place. My Facebook post with these pictures had gone viral and clearly people were alarmed by the callousness of the boaters.  By the end of the weekend, the Governor signed an Order requiring the Department of Natural Resources to break up large gatherings on and around lakes throughout the state.

After issuing his Stay-at-Home Order, I received calls from a number of city leaders in the district. Governor Kemp’s Order nullified their more strict ordinances, leaving them confused about how the Order affected their communities, and whether their local police had the authority to enforce the new order.

Again, I communicated these concerns with the Governor’s office, and again, the Governor released another “clarifying” Order.

Beyond the Shadow of a Doubt: After clarifying his intent, there is no doubt that reopening beaches, which had been ordered closed by local governments, was a purposeful preemption of local control. Churches, golf courses, and businesses (specifically including gun stores), remain open as long as they follow certain CDC guidelines, including keeping six feet of distance between people. Businesses such as  gyms, salons, entertainment venues, and bars/nightclubs were ordered closed. Restaurants are limited to carry-out only. Citizens must stay in their homes except for essential activities such as grocery shopping, medical care, exercise, and taking care of family members.

Dark Before the Dawn

Is Georgia ready for the “surge”? The US national average for hospital beds per capita (per 1000) is 2.8. Georgia is below the national average at 2.5.  Contrast this to Japan at 13.1; Germany 8.0; and Italy 3.2.

Most of us want to know if Georgia has enough ventilators and hospital beds to meet the need. I have been trying to get this data, but it is difficult, if not impossible, to obtain. According to the COVID Tracking Project, only 15 states are collecting data specific to ICU admissions and of those, only seven are tracking ventilator use. Rough averages of this data indicate that 32% of all hospital admissions require intensive care, and 28% require ventilators. To date in Georgia, 1332 COVID-19 patients have been hospitalized.

The following is information obtained from a conference call with the Georgia Hospital Association:

Available Bed Space: Georgia has 26,578 hospital beds. 2200 of those are ICU beds (8%). Certificate of Need (CON) has been waived so that other types of beds can be used for ICU.

New Bed Space: More bed space will be needed as the surge approaches. The State is working with the Georgia Hospital Association to identify hospitals that have extra, old, or empty space that can be brought on-line ASAP.  Opening up this space is VERY costly — the state has allocated 72 million dollars to expand space for 300 extra beds (including ICU space). Many hospitals simply cannot afford to do this. In addition, this extra space must be staffed. Georgia is already facing a severe nursing shortage right now.

Previously closed hospital space is being re-opened in Albany & Snellville to provide an additional 208 beds.

Four mobile medical units will be deployed. Twenty bed units will be sent to Rome & Albany. A 24 bed unit will stay in Atlanta, and a second 24 bed unit will be on stand-by.

Licensing rules are being suspended in order to hire nurses whose licenses have lapsed five years or less, and some scope of practice is being opened up.

Most of Georgia’s ambulatory surgery centers have been closed because elective surgeries have been cancelled. These centers can offer additional bedspace, laid off employees for hiring, and use of idle equipment. We need healthcare workers to stay in Georgia! Unfortunately, NY is offering nurses $10,000/week for temporary work.

Ventilators: Data from the National Hospital Questionnaire says we have 3387 ventilators in Georgia. 1200 more have been requested from the national stockpile and those are being shipped in week by week. Cpap and anesthesia machines can be repurposed to substitute for ventilators. Inquiries are being made with private vendors about ventilator loans. IV pumps and portable negative pressure rooms are also needed.

Personal Protective Equipment (PPE): There is still a huge need for masks, gloves, gowns, and face shields. The mask shortage in particular has caused the most concern. The State of Georgia has received some help from the national stockpile. According to protocols, each patient contact burns through one set of PPE, but nurses are now wearing masks for longer periods of time instead of with every patient.

The State of the Hospital Community: Scientists are predicting that the surge of Georgia’s coronavirus outbreak will occur sometime around April 23rd. That gives Georgia less than three weeks to build out extra bed space, recruit healthcare staff, and purchase needed equipment and supplies.

Atlanta hospitals are very busy. Albany, GA is the #4 hotspot in the world, measured by infected per capita (behind Wuhan, Italy, NY)

Healthcare Worker Morale: Many businesses are helping healthcare workers, such as restaurants and dry-cleaners. Any support you can give is appreciated. Please help if you can. Be creative. Even just supportive social media posts help.

The Governor Sheds Some Light

Once a week, members of the legislature join a 30-minute conference call with the Governor.  Questions are submitted by the House & Senate caucuses. To a large extent, the quality of the information we receive depends on the quality of the questions. If you have a question, please let me know by responding to this email.

Is Georgia considering shutting down at the state borders?:
No. Not at this time. No state has shut down its borders. Florida is doing some screening at its borders.

Can we add data to Public Health daily reports? 1) hospital bed capacity 2) number of nursing home cases 3) number of recovered cases 4) number of cases in correctional facilities?
Tracking of hospital bed capacities is being developed. The number of cases along with locations in Long Term Care facilities has been released. There are not enough resources at this point to track recoveries. Number of cases in correctional facilities is available at: http://www.dcor.state.ga.us/content/cases

Will there be change in election dates?
The Governor’s office says that election dates can only be changed by the General Assembly and the Secretary of State’s office. The Governor’s Emergency Order does not grant this authority to the Governor.

Is Public Health still using a contact tracing plan?
Yes, contact tracing has been in place since the beginning. Contact tracing will continue to be used in areas where the numbers are still small. Also, in areas where clear community transmission is happening, contact tracing will be used to notify potentially exposed people.

What is the rate of testing: What is our lag compared to other states?
The state didn’t get good test kits from the CDC until the last batch was sent to the states. Testing has really ramped up with the establishment of partnerships — universities and public/private. A new rapid test (results in 30 minutes) drive thru site has been set up at Georgia Tech for those who have been pre-screened, through a partnership with CVS.

Georgia Emergency Management (GEMA) Update:

Medical supplies are being routed through the Dept. of Public Health warehouse, utilizing the same team across various agencies who have managed distribution during hurricanes.

Getting supplies is still a struggle but less so now. The supplies are being pushed out to hospitals, Long Term Care facilities, and first responders.

Can we get protective supplies out to retail employees? PPE must be used for the highest need and right now that is for Long Term Care, hospital workers, and first responders.

GA National Guard Update

Newly formed Infection Control Teams are helping with Assisted Living, Nursing Homes and Long Term Care. Local Emergency Management agencies, legislators, and concerned citizens request help. Also, Public Health’s epidemiological team provides reports with numbers of cases so high need facilities can be targeted.

The Infection Control Teams are brand new. The GA National Guard has subject matter experts and has trained hundreds of soldiers within the last week. Adjutant General Tom Carden says, “We are learning as they go. We are adjusting protocols. We are building a plane while flying it.”

The GA National Guard has set up military triages in the state’s hotspots. They have 14 medical support teams that are new.  They recruited nurses, and other healthcare workers who weren’t already working and built teams. They trained, tailored and deployed. They have two teams in Albany. Carden says, “We will not tie ourselves to what we have on our books. We will build what is needed. We have hundreds of soldiers working.”

Between Stimulus and Response, There is a Space

Slowing the spread of the virus and “flattening the curve” is being implemented at a great cost to workers and businesses throughout the state. The Georgia Department of Labor has been hard at work rolling out the CARES (Coronavirus Aid, Relief, and Economic Security) ACT and responding to a record volume of Unemployment Insurance applications. The economic impact of the pandemic is devastating.

Too many people are having to live paycheck-to-paycheck, and stimulus efforts to put cash into these people’s hands have been slow to roll out. Community Food banks, short on volunteers and money, are responding to record numbers of people needing assistance. Their inventory is down by as much as a third because retail grocery store donations, which they typically depend on, are down. If you are able to donate cash to your local food bank, now is the time to do so. Many families are running out of food and cash.

Small Business Loans (SBA): Small businesses (under 500 employees including non-profits, sole proprietors, independent contractors, Tribal businesses and Veterans organizations) can obtain forgivable loans through the Paycheck Protection Program if they maintain payroll through the crisis. Low-interest loans can be obtained through Economic Injury Disaster Loans, including cash advance emergency grants of $10,000.

If you have applied for any of these SBA assistance options, please let me know how the process went. There have been reports of problems.

Unemployment Insurance: Chances are, someone you know has applied for Unemployment Insurance. Last week, the Georgia Department of Labor processed ten times the normal number of applications. As a result of Federal legislation, recipients will receive an additional 13 weeks of benefits, for a total of 39 weeks, and $600 extra per week. Recipients can earn up to $300 per week in wages without it impacting benefits. When laid off, the employer should apply for benefits through a “partial claim.” Applications can be submitted by individuals, but it will take much longer. Part-time workers qualify for Unemployment Insurance. Contractors, self-employed and gig workers also qualify, but this new part of Unemployment Insurance has not been rolled out yet.

The Light at the End of the Tunnel
This photo of a pink-sorrel, by photographer Marc Merlin of Atlanta, captures the play of light and shadow I am feeling in my own life right now. Marc is posting his wildflower photography on his Facebook page each day, so when I scroll through my feed, his artwork brightens my mood.
“Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
–Viktor Frankl
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