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.
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?
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)
Too Soon to Tell