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OFF-TOPIC: there is a disturbance set to move into the gulf | Spaghetti Models

Phase 3 Information:

• Businesses will have 75% occupancy.
• Mask Mandate.
• Parishes that have a 5% positivity rate for 2 weeks can opt-in to on-premise alcohol sales.
  • Bienville
  • Jefferson Davis
  • Orleans
  • St. John the Baptist
  • Plaquemines

Summary

• Storm entering the gulf (information is available above).
• Moment of remembrance for September 11th.
  • Asks that people remember the sense of unity that we had post 9/11 we should be able to gain that unity without having that tragedy.
• Restaurants, churches, salons, spas, gyms, and other businesses can open at 75% occupancy with social disgracing distancing required.
  • Bars have been closed for on-premises consumption. We have done what we can to help them realize revenue. Know there is still a number of them that are closed to on-premises consumption, want to provide a responsible framework for them to open as it is safe to do so. Looking at White House Taskforce guidance...
• Bars will remain closed in parishes with a high incidence of COVID-19
  • As recommended by Coronavirus Taskforce.
• Bars can open to on-premises consumption in.. parishes with a positivity rate of 5% or lower for 14 days if the parish gov opts-in. The two-week data is updated by the Dept of Health. The next update is on 9/16.
  • Bars can open with 25% capacity at 50 people total indoors.
  • Customers have to be seated for table-side only service.
  • Only 50 customers outdoors.
  • Social distancing required indoors and outdoors.
  • Outdoors have to be seated for service as well.
  • Live music still not allowed.
  • Sale and service of alcohol must end at 10 PM with patrons cleared by 11 PM.
  • Individuals younger than 21 are not allowed in a bar. 18-20-year-olds are not permitted in bars.
• Other social gatherings indoors will be limited to 50% capacity with a max of 250 people with social distancing requirements.
• Outdoor crowd sizes are limited to 50% capacity up to 250 people if people will be in close proximity and social distancing is not possible.
• Casino limitations will not change under the new order. Casinos remain at 50% capacity / 75% of the gaming positions.
• Sporting events will operate at 25% capacity with social distancing required and no alcohol sales.
• Alcohol consumption at all venues will end at 10 PM.
  • Include restaurants, event centers, weddings, and casinos.
• A statewide mask mandate remains in place.
• CDC Recommendations remain in place for those at high-risk
  • should not go out, are safer at home, and should avoid large crowds unless they need to get food or medical care.
• The order will be in place for 28 days expiring on Oct 9th.
• Nothing will change for nursing home visitations.
  • Nursing home population remains at high-risk.
  • 40% of all the fatalities in Louisiana from COVID-19 have occurred at nursing homes.
  • Congregate living --the type at nursing homes-- is where the virus spreads easier and these individuals with their age and comorbid health conditions are a higher risk of the virus and are more likely to have a poorer outcome.
  • LDH in consolation with CMS is working to finalize plans for a pilot program to see if we can allow for some visitation, specifically outdoor visitation. It would be a 28-day pilot program. Nursing homes will have to be located in parishes with 5% positivity or less and the home has to have 0 cases in the last 14 days to participate. Additional details to be provided.
  • People at the Department of Health are putting forth great effort to make sure we are doing this in a safe and effective way.

Dr. Billioux
I will upload a better version when I can

• Data we are looking at when we look at the upper left we see COVID-like illness (people presenting to an ER with symptoms of COVID), below is a graph showing the volume of testing and organs bars show the percent positivity gray line is the 10% line, upper right is the epi curve (new cases remove every day by collection date) black line is the average of incidence over time, bottom right blue line is the hospitalizations and the organ line shows the last 14 days.
• We always look at 14 days because that is the recommendation for the gating criteria from the White House.
• COVID-like illness has been on a steady decline across every region since we had the mask mandate.
• The testing graph shows the interruption that happened as a result of Marco and Laura, the state needed to redeploy its resources and its National Guard partners meaning we could not do community testing at the level we wanted. So you can see the decline from the week that represents the storm, and you are beginning to see a rebound from that due to our wonderful National Guardsmen redeploying our testing sites. However, we are not seeing the line come up very high very quickly.
• The people of Louisiana need to know:
  • Testing is widely available.
  • Get tested if you have symptoms.
  • Get tested if you've been exposed.
  • Get tested if you evacuated due to Hurricane Laura.
• As you can see the percent positivity has been declining, we are at about 6.79% right now, which is well below the 10% recommendation for the state.
• The epi curve shows we have been on a steady decline since the mask mandate and bar closures.
  • More recently there has been an uptick in the state. Some of that reflects a decrease in testing with a new increase in testing and some of that reflects quite frankly new cases that we know are evolving in settings like universities and schools, but not over a 14 day period. We have not made that criteria of a 14 day period.
• Hospitalizations have been on a steady decline since the new restrictions.
• Strictly speaking, looking at the data we have met the criteria for moving into Phase 3.
• However, there is data we don't see/know, that is what we need to be watching out for
  • Impact of Hurricane Laura
    • We had a week we didn't have visibility for because of decreased testing.
    • Frankly, there is not as much testing happening as we would like to see from shelterees and evacuees right now. We do not know if transmission of the virus has happened because we are not catching it because we not seeing people taking advantage of the testing.
    • Testing sites in Lake Charles and Sulphur.
    • Testing available at points of distribution.
    • Testing sites in New Orleans and Baton Rouge in hotels.
    • There is a significant amount of asymptomatic spread, please get tested and protect your family.
  • Schools reopening - the impact of K-12 going back to school and universities reopening. Part of that is because we paused testing and because people went back home and now they have returned to school.
    • We know not everyone has gone back to full in person.
    • Most have done hybrid learning.
  • Labor Day Weekend - because there hasn't been enough time.
    • Most people stayed home and celebrated with their household.
    • Some people didn't and we won't know the impacts until 2 weeks from now.
    • Hopefully, we will find people by large did what we asked. That cases and hospitalizations stay down because as you saw we have a very active Atlantic season right now. Not a good time for us to face multiple disasters as we have more COVID increase.
• Another trend we are focused on is the increase in cases in the 18-29-year-old age group.
  • The sharp uptick in 18-21-year-old age group.
    • The age group that has gone back to school.
    • Still seeing that group come up even with bars closed.
    • Watch this very carefully especially as we talk about gatherings and football.
  • Saw last time that as this age group leads other age groups followed.
• CDC released a report of childcare settings and infections of those that the child return home to.
• Under the age of 21 we really do not want you in the bar setting. You should not be there. You are not of drinking age, and it brings you into a setting where you are at high risk for exposure.
• COVID like illness is decreasing across the state. When we look at cases across the state it is a mixed bag. There are many regions across the state where we are seeing an uptick in cases but they do not meet the 14-day threshold.
• Note Region 5 is difficult because it is the SW Louisiana and it is difficult because all numbers plummeted because of evacuation and as they return we would expect to see increases.
• Concerned as we look at hospitalizations. Our biggest concern is being able to have adequate healthcare capacity to meet the needs of Louisiana.
  • Watching these trends closely.
• As we move into Phase 3 and there are greater capacity in restaurants and some bars and operate in limited services. It is critical to remember that everything that has gotten us to this point still needs to be in place.
  • The physical distancing of 6 ft or more is really important.
    • When we call you and ask if you have been in 6 ft of someone for greater than 15 minutes... you will still be a potential contact and need to quarantine for 14 days if you have been exposed to a known positive COVID case for more Thant 15 minutes.
  • Continue to wear a mask. More and more data shows that people who are shedding the virus mask usage reduces the risk you spread the tother people. You protect other people by wearing a mask and other people protect you by wearing their mask.

Questions

Do you have any idea how many parishes are below 5% or less?
5 out of 64 parishes.
Mechanically does the 2 week period become effective today or does it become effective on the 16th?
As the governor noted we will be updating this, we have been providing these updates and will provide the next one on the 16th. First, the parish has to make 2 (2-week checks at 5% positivity or less so 4 weeks total, and then the parish government has to opt-in.
What does the nursing home pilot program look like?
What you will see us talking about, is decreasing becomes less relevant than what is going on in the community. The percent of positivity is especially important. What is the level of spread in your community? So for the nursing home pilot we are looking at a low community spread so probably 5% or less in the community. We are also working with nursing homes to establish protocols where people are outdoors. People are wearing PPE and it has to be a pretty nicely mandated visitation where you know who and when someone is coming, being symptomatic, isolated, or quarantined for COVID-19 will all be reasons to not see your loved one. Out of the 5,000 Louisianians, we have lost so far 40% have been from nursing homes. As we look to have families reunite we must do this in a way to not put your loved ones at risk. Not only your loved one but those in the rest of the facility as well.
John Bel Edwards

• A parish has to be eligible so they have to be at the 5% below the threshold for at least 2 weeks.
  • Data is publicly available on the LDH website.
• Parish has to opt-in.
• If at some point subsequent to opting in a parish gets to 10% or higher in positivity then those bars will close again. Then it starts over again and they will have to satisfy the gating criteria again.
  • Otherwise, you would reopening and closing bars within a few days or so, so this is a way to do this responsibly and safely under the control of the local government.
• Today's COVID-data
• We've had some positive trends that allowed just to make these moves but I have a concern about what isn't reflected in the data which is why this has been the most difficult decision I had to make with respect to applying the gating criteria to the phasing.
• Encourage people to take mitigation measures seriously.
• As we reopen more of the economy/our churches, to more occupancy, these things only really work if we continue to wear our masks. Wash your hands frequently. Stay home when sick. Socially distance from that outside for your household
• Outdoors is safer than indoors.
  • If you want to support restaurant pick up, get delivery, or eat outdoors.
• People need to understand there isn't a lot of room for movement forward beyond Phase 3 until we get past the pandemic.
  • Until such time social distancing isn't required how do you go to 100% occupancy?
  • We do not go from 75% to 100% until the pandemic is over.
• Hurricane Laura Info Mod note I am not covering this but if you would like me to please message me.

Questions

Missed question
I am concerned about the impact Labor Day will have. Experienced the beginning of the Summer with Memorial Day. We Know that is when we had a surge in cases driven by the younger population, particularly those in the 18-29-year-old group. I hope behavior would be different for Labor Day because everyone saw the impact that behavior had on our state. Dr. Birx was talking about, the White House was talking about it. I am hopeful that won't happen again. I am relieved we are increasing our testing numbers again and having more testing sites coming up and will be watching the data very closely. I am mindful that we have started school. Colleges' campuses have also opened to students. But am comforted that there is still a lot of virtual and hybrid learning occurring. We do not have a lot of school systems fully open for in-person instruction. I believe Louisiana will do what is needed to protect one another from having a repeat of what happened after Memorial Day.
Is there some scenario where we have those Labor Day numbers come in and they are so bad you change your mind and we go back?
There is always [that possibility], whether because of Labor Day or anything else, you watch the numbers. We will not put ourselves on a course where we lose the ability to deliver life-saving care in our hospitals. It didn't happen in the first or second surge and I will not let it happen going forward. Yeah it certainly remains possible, but I am hopeful we will not get anywhere close to that, but if we have to we will. I have said this all along. That is why we keep making the point -- it is not a theory anymore -- we had that huge surge in March and April and we were able to flatten the curve through a stay at home order but, we have shown reducing our curve is not reliant on having to have a stay at home order if people wear their masks, wash their hands, and social distance. You can have a larger portion of your economy open and have and much normalcy as possible without the cases skyrocketing if you adhere to the mitigation measures. It is up to the people of Louisiana to adhere to them. I have a lot of concerns. Anytime you announce you are going to the next phase people tune out all the info they are given that COVID is still here, that abiding by mitigation measures, protecting the vulnerable, all of that stuff and some people will say well we are going forward and that is all they think about. That mindset is what causes us to have real issues as well. Need people to mindful. I ask local leaders to set good examples so we can stay on top of this virus and keep trends going in the right direction.
Will Phase 3 have any impact on the state workforce in respect to the public sector
In order to make sure all sate employees are working where they can be most efficient and productive in the safest possible way. Where you have offices, for example, cannot be at 100% so some of those people will continue to be home. Some agencies work in office spaces that are less traditional where it is harder to work safer in that environment while people on wildlife and fisheries are on a boat and in a safer environment.

Closing remarks

• Thank you for continuing to cover this.
• If you look at the Gulf of Mexico to the West Coast of Africa you will see a number of storm systems most of which do not pose a threat to Louisiana. The one off of the coast of Florida does, and too soon to know about the coast of Africa. It will be very difficult for our state if we have to go through another hurricane in our present posture where we have people already sheltered from the last storm which we are still trying to recover from.
• Lift each other in prayer.
• Be good neighbors.
• Do what is required of us to protect ourselves, family, and one another.
• Next press conference on Monday afternoon.

​
Made by Jeff Asher of the Times-Picayune
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For today's conference, Gov. Edwards will be accompanied by Lafayette-area hospital officials and Joe Kanter from the Louisiana Department of Health.

Summary

• Today Louisiana passes the 100,000 case benchmark with 101,650 cases being reported. These are only the cases we know about. These are cases with a positive test result. There are undoubtedly more cases out there, not everyone who is symptomatic has been tested, and we know that between 20-45% of people with COVID19 are asymptomatic and do not generally get tested. We know that there is more COVID out there than those that test positive.
• 2,408 new cases reported since yesterday.
• Today we report +16 new deaths, for a total of 3,574. Yesterday we reported 60 new deaths, the highest single-day report of COVID-19 deaths since May. We know deaths sometimes lag behind other numbers. No matter how you slice it up these numbers are very troubling.
• In the month of July, we have reported over 400,000+ tests and have greatly expanded our testing in Louisiana and are #1 for the month of July for testing per capita in the country.
• We know we have a high prevalence of COVID19 across the state of Louisiana.
• I hope that hitting the 100k benchmark shows people we are in a public health emergency, not one that was declared by the Governor himself on his own accord, but one that is happening. This number should be sobering.
• Cases are increasing across the state and this is why we are remaining in Phase 2. The mask mandate, limitation of bars, reduction of crowd size limitation to 50 people for social gatherings will continue.
• We are nowhere we want to be in Louisiana. We do not want to have to go back to Phase 1 or Phase 0. However, we cannot lose our capacity to provide life-saving healthcare in our hospitals, which his why we have restrictions in place.
• We have every reason to believe that if we can get universal compliance with face coverings, social distancing, washing hands, cutting down on travel, with people staying home more often, Lousiana can flatten the curve without having to go back into Phase 1 or Phase 0.
• You can recall how previously I said that 3 parishes met the were not considered an area of high-incidence of COVID-19 by CDC's standards, and thus met the qualifications to opt-out of the mask mandate? There are currently no parishes that are not in the high-incidence of COVID-19 category.
• The latest resurgence has impacted the ability of our healthcare systems.
• OLOL has taken a two-week pause in performing non-emergency medical procedures that require inpatient beds to makes sure they have the beds, and more importantly the staff, they need for COVID19 patients.
• Hospitalizations have increased all over the state in Louisiana there I, not one region where it decreasing. Especially concerned for Regions 4,5,6.
• Hospitalizations have increased by +4 for a total of 1,585 COVID-19 positive patients hospitalized across Louisiana.

Dr. Amanda Logue, chief medical officer at Lafayette General Health System

• Lafayette General Health is the largest healthcare provider for Acadiana but with the volume, they are seeing of COVID19 cases, they are not able to take care of their own community let alone expand services outside.
• Actively taking care of patients, and surging as they need to, but are quickly running out space.
• Had to transfers patients to Rapides, Baton Rouge, Northern Lousiana, even Mississippi.
• Had to decline 87% of requests of transfers into our health system. That is not normal. Do not have the capability or space to take care of them.
• Please come to the ER if you need to, do not be afraid to come to seek medical services. We will be here if you need us.
• Main campus, largest hospital, Lafayette General Medical Center 1/2 of ICU, and 1/3 of non-ICU beds have patients fighting COVID19.
• On May 27th we had 15 COVID 19 patients and yesterday we had 105.
• In our whole 5 acute hospital system, we have had 143 patients and that number was only 20 six weeks ago
• Seeing the rapid increase in community spread and hospitalizations that follows the community spread.
• Please to Acadiana to understand the impact of widespread community outbreaks impacts the hospital system.
• Moving elective surges off of the main campus and canceling some altogether. This is the last thing we want to do, some patients are still waiting for surgeries that were canceled in April.
• Hospitals are full and the ICU is full.
• Some beds are closed due to illnesses to staff.
• Do not have enough nurses to staff the beds right now.
• Thankful for the nursing teams but the level they are working at right now it unsustainable.
• COVID19 has not replaced the typical volume of pattens we normally have like health attacks, strokes, etc. but when you add COVID on top of that it is unsustainable. Normally we can do both, but not when there are surges to this degree.
• The only way to prevent recurring surges is to truly flatten the curve once and for all.
• Follow the guidelines. Wash your hands. Physically distance from one another. Avoid large crowds. Wear a mask when you leave the house
• If you are elder or high risk be especially careful and stay home if you don't have to be out.
• Impacting not only COVID19 patients but anyone who wants to seek care in Acadiana.

Dr. Henry Kaufman, chief medical officer at Our Lady of Lourdes

• OLOL the hospital is full and ICU is near complete capacity.
• This significantly affects normal operations.
  • for 2 weeks OLOL has almost completely eliminated elective surgeries.
  • This means if your cardiologist recommends you need a heart bypass or early-stage cancer those operations will be deferred.
• Still dealing with the aftermath of people coming in with later stages of diseases due to having to wait from the first surge.
  • Some people weren't able to get tests they would have, like mammograms, and now they are at later stages than what they would have been caught if these elective procedures weren't postponed.
  • 100s if not 1,000s of women have not been able to get their mammograms and he is worried there is the hidden impact completely unrelated to COVID that we haven't appreciated yet.
• This is a real and present danger, the secondary effects of COVID, but how it affects our hospitals and community.
• Physicians and team members are doing an amazing job, but they are getting burned out from overwork. Fatigue is a very real problem and this current wave is taxing our abilities for us to provide services.
• Thought the second wave would come in the Fall and that there was more time to prepare.
• The community needs to realize how compelling and dangerous of an issue this is.
• This affects not only the people who are seeking treatment for COVID but also those seeking normal medical services for other needs.
• OLOL has 19-20-year-old healthy kids in the ICU without any comorbidities.
• Also seeing an increase of 50-60-year-olds without comorbidities in the ICU.
• There is no way to tell who it will affect in a severe way. Fortunately, it doesn't affect most people, but it is a very real problem.
• Wear your mask. Be smart. Good hygiene. Do not expose yourself to unnecessary risk. Avoid large crowds. Physically distance. It is extremely important right now.

Gov. John Bel Edwards

• Testing available in EBR, no symptoms needed, no exposure needed. Please take advantage of the FREE test while testing the available.
  • You can pre-register at DoINeedACovid19Test.com - please do not register multiple times.
  • Thanks to the WH Taskforce for putting surge testing in Louisiana.
• Working to establish a new surge testing site in the New Orleans area.
• Deliberate misinformation campaign about the state inflating numbers by counting every positive test as a positive case. That is not the case, only your first test is counted. Every individual who tests positive only counts as one case regardless of the number of positive test results they may get.
• If you have COVID19 in your state you will see cases go up, then hospitalizations, then deaths. It doesn't make sense that you would have hospitalizations and deaths going up without cases having gone up as well.
• We have people being irresponsible and we are asking them to stop. No one should pay attention to what these individuals are saying.
• We are not perfect, but we've put in multiple redundant systems to make sure the data is accurate, timely, and that we are sharing in a manner to be as transparent as possible.
• Encouraged today by the vast majority of businesses and local leaders who are taking this seriously and masking up to protect their loved ones, employees, and the state of Louisiana to make sure we get back on top of the virus as soon as we can.
• Asking everyone to take this virus seriously and do his or her part.
• No one wants to go back to Phase 1. It shouldn't be necessary to go backward, but the only way to keep us from doing that is if everyone wears their mask when they are outside their home. It is a small price to pay. Be a good neighbor. If nothing else has respect for our healthcare workers who are working months on end.
• There is not a safer place than at home. If you go out do so as little as possible. You do not need to go to the grocery store 3 times. Just go one once. If you go do not bring your entire family
• If when you'd o go out you practice social distancing, washing your hands, and do not go out when you are sick. We will turn this around.

Comment on the weather

• Watching the tropics. We're in hurricane season.
• TP 8 is moving across the Gulf Coast towards Texas but there is a risk of heavy rainfall in the S, SW, and Central parts of the state.
• Areas south of I-10 could receive between 2-4" of rain and tides are running higher than normal.
• Flash flooding is a possibility. Do not drive on any street that could be underwater.
• Will monitor Storm Gonzales.
• Go to GetAGamePlan.org and prepare for a hurricane.
• Preparing for a hurricane is different this season because of COVID19. Encourage everyone to check GetAGamePlan.org to get prepared.

Questions

What's the plan if we run out of space, is the plan to shift them to Morial?
First off, we are going to make sure that doesn't happen that we don't run into a situation where we cannot provide healthcare. We still have 250 beds at the Morial Convention Center with staffing for 60 with 28 beds currently being filled. We can expand to 60 more beds quickly. Further, much of the investments we made early on created new permanent surge capacity at various hospitals around the state. So we are in better shape than we were before.
Frankly, my bigger concern is not about beds, but about staffing. We believe we will be able to make the adjustments necessary and open the surge units, but the bigger challenge is around staffing. It is bigger this time because the surge we are seeing is happening in multiple parts of the country at one time. Hard to draw upon out-of-state staff because of those areas and not willing to give them up because they need them too. We discussed it with the VP last week after a phone email with hospital staff prior. Submitted a request through FEMA and it is currently pending. Looking to us the existing footprints of our hospitals, because it is easier to solve the staffing challenges than open up a new facility that isn't part of the existing footprint. No plan to currently create new facilities, but are working to fill staffing shortages.
How much did you request from the FEMA
As best as I can recall it was 300 Request to FEMA ranged from phlebotomists, ICU nurses, respiratory therapists, and so forth. I will get you the exact information.
Some people in Acadiana and Lafayette, in particular, feel the local agencies and parish governments are not doing their parts to enforce the mandates. What can we do on the state level to drive home how important it is to follow the mandates
When you watch Fauci or Birx speak and see what is coming out the CDC, that speak to you about the importance of these mitigations measures and you accompany it with the numbers we are seeing in Louisiana right now, not just cases but hospitalizations and deaths, you would hope the people would be responsible enough, take that into consideration, and they will comply because they understand it is important for those who are valuable, to help the medical community. Even if for some strange reason that is totally incomprehensible that you don't care about COVID you should care about there being capacity in the hospital if you get into a car accident or a family member has a stroke, you want that care to be available. We just need people to focus on the task at hand, do their part, be good neighbors. It is not that we won't force these things but if the people of Louisiana are going to make us enforce all of this we will not be successful. There are 4.6 million people in Louisiana, 10s of 1,000s of businesses if the people of Louisiana are going to sit back and say we will make you enforce every part of this we are doomed. As I mentioned the vast majority of businesses and people are being responsible but there are still too many that are not. So I am directing these comments to those individuals. IF you want to be mad at me, and disagree with me be mad and disagree but do so with a mask when you are outside of your house.
Where do you think the deliberate misinformation campaign is coming from?
I do not know. I am not personally investigating it. I am doing what I can to make sure no one attaches any credibility to it. This not just happening in Louisiana. This is happening in all of the other states that are having this tremendous resurgence. No one is out there "cooking the books". One thing we would do, if it was safe to do, is open our hospitals up so they could see with their own eyes the people who are fighting for their lives. They would know this is not a made-up number. This is grossly negligent and irresponsible. I am asking people not to do it and for others not to believe it.
Are you surprised that bars are the top location for an outbreak of COVID
I cannot say I'm surprised, bars were one of the last things opened because we knew the environment is not the easiest to control so people do things safely. It's just the nature of that establishment. Many people go to a bar to stay for several hours, have multiple drinks, and relax their inhibitions. They may have one mindset going in and another coming out. Then there is loud music and so you need to speak louder and release more particles if you happen to have COVID19. Then if you're listening you tend to get closer to hear than you should be. We were hopeful restrictions would work, but for the vast majority of bars, it proved to be too much. This is not just here in Louisiana. It is a WH Taskforce recommendation for our state and other states with high rates of COVID-19. It is also a worldwide recommendation. Once South Korea came out of its lockdown they had to shut down every bar in Seoul because they had a similar experience.
With staffing being an issue is the Morial Convention center a viable option as a field hospital
Dr. Henry Kaufman, chief medical officer at Our Lady of Lourdes: We have physical space, we have beds that are used during the day for outpatient surges. Those can be converted into hospital rooms. We have beds that are typically used for other purposes, and those have been converted to rooms. However, as we see an increasing number of transferrable cases in the community we see our nurses become infected. When a nurse becomes infected the quickest they return to work is 10 days. As a result, there is a huge pool of nurses who are currently out right now. This puts a strain on other nurses and staff in the hospital. So far it is working out, but our nurses are tired. The problem is not needing physical space, it is having enough people in our community to staff those beds to keep our nurses healthy. One way you can prevent yourself from getting COVID is to stay active and healthy, well-rested, and that your immune system is working well. Nurses, physicians, and staff are tired and not taking care of themselves as well as they need. This is a vicious cycle. Everyone is looking for staff right now. We are not at the point of reaching out to non-traditional areas for staffing. We have disucssed calling in retired nurses or those who have moved to other careers who still hold their licenses who could help.
Have you thought of reaching out of state for staffing?
Dr. Henry Kaufman, chief medical officer at Our Lady of Lourdes: We have contacted local staffing agencies, not many people available, anyone who is employable is employed. Everyone across the country is seeking nursing right now. Yes, we have considered that.
Governor John Bel Edwards
I've had requests to take national guard soldiers in a medical unit and have them available at the hospitals. But guess where the national guard soldiers in our medical unit work? In our hospitals. So I would be pulling them from one hospital to send them to another hospital around the state. The first thing we did was put out an EMAC request to all other states to see if they had anyone they could offer to address what we need. Exactly zero states offered any staffing. So then you start looking at staffing contractors and we are working that angle now. That is proving to be difficult as well, which is why we continue to work with FEMA on staffing.
In regards to the Morial Convention Center, remember that facility is for the less acute patients to allow hospitals to free up space sooner than they would. So once a patient reaches that level of care where they don't need an acute bed, but can't go home, they can go to the Morial Convention Center for care. Having hospitals sending their less severe patients to the convention center is something we are considering.
With the testing shortage issue in terms of a turnaround..
I just want to be clear we are doing an extraordinary amount of tests, but it is not a shortage of collection kits. There are reagent issues in the lab that are contributed to longer turnaround times, as well as the sure volume of tests. So of all the tests, we reported today 65% were within the last week. 30% were from the week before. That gives you an idea of the percentage of tests. This greatly impacts our ability to fight COVID-19. If someone waits 7-10 days to find out they are positive and did not curtail their activities, we know they are out there spreading that disease. Plus if it takes too long to get a test result back the contact tracing is too hard. So the turnaround time at the labs is the current challenge, not the testing supplies itself.
with turnaround times does this challenge testing congregate settings
In congregate settings, we are testing 100% of residents and staff every 2 weeks. We are seeing some delays in getting those results back. Anytime you see that it interferes with our ability to quickly get on top of the situation and appropriately quarantining patients. It is also true for the staff member who goes home at night and interacts with their family.
Over the next approx 8-12 weeks it is the goal of the Federal Government to send a rapid point of care tests to every nursing home. We are starting to see those machines arrive in small numbers this week and that will continue. That way tests are administered with results being known within 24 hours. It sounds too good to be true, so we need to make sure the machines come and we have all the testing materials that are needed.
Why are casinos not facing additional restrictions?
I'm not going to tell you we haven't experienced any issues at casinos but I can say they have been few in number and much more easily removed because you only have only a small number of them operating. Plus it is the most regulated industry in Louisiana so if you go in there and tell them a problem the corrections get made. We know they have been very responsive to any remedial measures we have told them to take. That is why they are open. We believe they can safely operate at the level of occupancy we have described. We want as much of our economy opened as possible consistent with public safety and the health of our people. Where we can operate a business safely we want to do that. Under the limitations, we currently have in place with casinos they can operate safely.

Closing Remarks

We have flattened the curve before and we can do it once again. We can do it without going back to Phase 1. But everyone must do their part. So if you want the economy open then we must all do our part. Please wear a face covering. Social distance. Stay home when you are sick. Wash your hands often. Watch out for the most valuable. The safest place you can be is at home. Lift one another upon prayer and focus on our blessings. If nothing else let's be thankful for our healthcare workers. Everyone has a healthy and safe weekend. God bless.
👉 NEXT PRESS CONFERENCES Will be Tuesday and Thursday next week at the Capital. If there is a reason to meet at other times, whether related to weather or COVID19, I will let you know.

LINKS TO WATCH

• https://gov.louisiana.gov/
• Facebook - LouisianaGov 👉 Direct Video Link
• YouTube - Louisiana Public Broadcast 👉 Direct Video Link
• WWLTV

Summary

Gov. John Bel Edwards

• Cases that come back positive hospitalizations are increasing.
• Clear to me that the current restrictions are not enough. The appeal to the Louisiana citizens is not producing the results that are needed.
• Yesterday was the highest day of new cases.
• Today we report 2,166 new cases and a case positivity of 11.3%
• Both yesterday and today exceeded 10% for case positivity.
• Yes, we are testing more people. This is good, a test does not create a case it tells you where you have cases. So yes we are seeing more of the cases that are out there.
• Thus far in the month of July, we are 11 days in, and we have almost met our monthly goal of 200,000 tests with over 195,000 tests reported as of today.
• As recently as June the 19th we were 10th in the country for cases per capita now we are number 3.
• Our rate is not just higher for Louisiana but for all of those states that were previously ahead of us.
  • We are number 3 behind New York and New Jersey.
• We cannot go back to a time where we are running out hospitals and ventilators.
• Yesterday alone we added 75 new inpatients today was 65 more.
• June the 13th we had 532 people in the hospital today we have [____].
• Fauci says we need better compliance with mask usage, physical distancing, and limiting crowd sizes.
• We have been extremely patient to have compliance from the community but we are moving a little further.
• Trying not to ever move back to Phase 2 or Phase 1.
  • Need to balance between the virus, the economy, and opening up schools.
• Staying in Phase 2 until at least July 24th with some changes starting Monday.
  • Masks are mandated statewide for 8 years of age or older unless they have a health condition that prevents them from wearing a mask.
  • Strongly suggested that children between 2-7 wear them
  • Parishes can opt-out of this mandate if they do not have a high incidence of COVID-19 only 3 parishes currently qualify:

1. Grant
2. Red River
3. West Feliciana

• All bars closed to on-premises consumption but may do curbside pickup.
• Indoor social gatherings are limited to 50 people.
• 50% occupancy remains for businesses.
• Informal backyard gatherings are the largest contributor to spread think birthdays, baby showers, weddings, etc. Instances where you only invite your close relatives and close friends. But your close relatives and friends may have COVID-19 and they are not part of your immediate household.
  • If you have these types of events you need to keep them as small as you can, wear masks, physical distance, and try to hold them outdoors.
• Changes go into effect Monday night right after midnight so there is time to comply. Orders will stay in place until at least July 24th.
  • Mod Note: Monday at midnight for this instance means 12:01 AM Monday, so it will start right after midnight today.
• These decisions are based on White House guidance and guidance from public health experts.
• Vice President Pence will be coming Tuesday and the White House Task Force been encoring the public to follow local and state orders to follow mask mandate. They encourage mask mandates for where cases are increasing rapidly [like here in Louisiana].
• Face masks order follow CDC guidance. Masks are mandated statewide for anyone 8 years of age or older.
• Exemptions to mask-wearing:
  • Have a health condition that prevents you from wearing a mask.
  • Anyone eating or drinking.
  • Anyone communicating to the speech impaired.
  • Anyone who is giving a public speech.
  • Anyone removing face covering for identification purposes.
  • And anyone who is part of a parish who has opted out of the mandate.
• High incidence of COVID = 100 new cases per 100,000 people per 2 week period.
• 3 parishes are below that threshold, Grant, Red River, West Feliciana Parish.
• Even if your parish opts out it is strongly encouraged that everyone wears a mask when outside the household. Just because these are the least affected parishes does not mean there is not COVID there. There is COVID-19 in every parish.
• If you have are vulnerable you are always safest at home. (Those over 65, diabetes, obesity, etc.)
• At the end of the day, while I know this will be unpopular and controversial with some, we know face masks work. It is that simple. The vast majority of the spread of this disease comes from people talking, sneezing, coughing, and the mask helps contain the virus from being spread to neighbors.
• None of these steps were ones that I wanted to take, but they are essential.
• Typically there is a 14-day lag between a change in behavior and when that change shows up in the numbers and there is an even longer lag time for the change in deaths. So we will not see any changes [from mandating masks or closing bars] in the near future.
• (We have no reason to believe the numbers we have been reporting are going to get any better, they are likely to get worse.)
• Bars have been proven to be hotspots for the spread of coronavirus. It may not be true for every bar, but it is true for many of them. Thanks to the many bar owners for complying with restrictions, this is not meant to punish anyone.
• Identified at least 36 outbreaks from bars impacting over 400 people. We know that number is much higher. All of this has happened in Phase 2 when bars were opened. We also know that leading the spread in recent weeks has been a younger age group more likely to frequent bars. This age group continues to be a big driver of cases.
• Younger people are spreading COVID19 to older people who are becoming ill in growing numbers.
• Public health officials believe that bars have a higher risk than other businesses due to the social aspect, having to speak louder over music, keeping the mask off to drink, etc. Alcohol diminishes decision making.
• I know this will be challenging and unpopular but it is necessary and the right thing to do under these circumstances. We cannot let this illness win. If you, like me, are interested in keeping most of our economy opened and not regrew back in phases, or open schools next month, these things (wearing a mask or closing bars) is a minor price to pay.
• This should not be a political issue. Someone how there has been a political issue that has come up around masks. You will see that people of both parties will be stressing the absolute importance of wearing a mask.

Dr. Joe Canter (LDH)

• At the end of the day this I about the perseveration fo human life.

https://preview.redd.it/4lpn6sazqaa51.png?width=400&format=png&auto=webp&s=d9d78df91b813a2b08fd21ca825da7b2959c554c

• Mask mandate follows CDC guidelines for high incidence.
  • High incidence of COVID = 100 new cases per 100,000 people per 2 week period
• 61 out of 64 parishes currently meet this definition.
  • 3 parishes are below that threshold, Grant, Red River, West Feliciana Parish.
• The level of COVID incidence is high in the overwhelming amount of parishes of Louisiana.
• If you are battling a disease you need to know what you are fighting and where it is, which his what testing does. If you do more tests you will find more positives. When we look at cases we look at multiple measurements like percent positivity, which is increasing. The large spike at the end of March and April when CPR increases to 30% is when we were highly restrictive in who we tested which artificially inflated the percent positivity.
• Over the last week, (Jun 22-July 5th as measured by date of collection, the percent of positivity was 15.3%. Highly concerning number.)
• A lot of people who test positive are asymptomatic and spread it to their community or other family members.
• Young adults aged 18-29 accounts for the largest grouping of COVID cases.
• Over the past week or 2, we are seeing what we feared we would see which is further spread from younger adults to older individuals.
• COVID has a real propensity to spread, we had no expectation it would stay within the 18-29 age bracket. The most recent data is now showing us that the virus is indeed spreading from those younger adults to older individuals.
• **(In Phase 2 if you have a vulnerability, are increasing in age, or have a serious underlying medication condition, the risk to you and your personal health is greater and you need to think twice about the risk you take on.
  • Maybe you shouldn't go out. Maybe someone should make food for you.
  • Families should support these individuals.
  • Staying inside and distancing is the safer thing to do.)**
• We have leading signs and lagging measures. Cases are on the leading sign and fatalities are on a lagging measure. We know that in Louisiana individuals who will die from COVID-19 become symptomatic 16 days before that fatality.
• Concerned we will see increasing hospitalization and increasing deaths.
• We have already doubled the number of patients hospitalized with COVID from the middle of June.
• We have to turn this around.

https://preview.redd.it/wzilyxarqaa51.png?width=782&format=png&auto=webp&s=258ed61fa170b381fe2798e5117373ea0d2c37cd

• At this point in time, we have more cases coming in than when we were at our peak.

https://preview.redd.it/almgtmluqaa51.png?width=698&format=png&auto=webp&s=c3874bc749bd0bb65162f65fe27b9b465231720b

• Differences between these two peaks are the first time around it was focused on New Orleans, shows the case growth to date without New Orleans. This is a statewide problem and we look similar to Florida or Texas were. We are not as far along but we need to turn this around.
• The good news is we have already beaten this once we can do it again.

Dr. Neal of OLOL Regional Medical Center

• We knew when we went to Phase 2 we would see a little more community spread resulting in a few more admissions so we were prepared for that.
• We were not prepared for the steep escalation in hospitalizations we began to see 10 days ago and cases have not quadrupled.
• We have too many people in our hospitals.
• When our hospitals get full it is incredibly hard to care for everyone.
• Of our patients that are in the hospital, 1/3 are in the ICU.
• The youngest is 25 and had no medical conditions when they entered the hospital.
• Patients in their 20s, 30s, 40s are in the ICU struggling for their lives.
• This is a nightly occurrence in the hospital.
• **(This takes a tremendous team to do that work and that team can no longer offer care to all those who need it.
  • Those that need for bypass surgery, joint replacement -- they haven't been able to walk in 6 months, or those that have a mass that may be a malignancy.)**
• We cannot allow this in the community anymore, we have to be better stewards so the whole community is healthier from all of their illnesses, and not just COVID19.
• We all need to wear masks by doing that we protect our community, each other, and our families. This is how we continue being safe in our homes and not wind up in the hospital as patients with COVID19.
• Think about each and every interaction you have with another individual, keep your distance, try to have that interaction by Zoom, or by phone.
• We know that this works, and we know that if you do it we can continue to provide everyone the continued quality of care we expect every day.

Dr. Rainey Winfield Sports Medicine Physician

• Truly concerned about overwhelming the healthcare system as it exists today.
• Seen COVID in all demographics.
• Symptoms have evolved from 3 symptoms to 9 symptoms.
• New symptoms in the Millenials of migraines headaches, stomach issues, and diarrhea.
• Increased mental health issues in the community are being seen as well.
• Assure you that the healthcare system cannot be successful unless the public plays its part by socially distancing, washing hands, and WEARING YOUR MASK
• Mask wearing works. Respiratory droplets can go up to 12 ft so if you wear wearing a mask it protects those around you. We are in a position now that we are losing lives by something that can be prevented.
• Take this seriously and listen to what is going on.

Gov. John Bel Edwards

• Misspoke, this is in effect Monday morning not Tuesday as previously stated. It goes into effect at 12:01 AM Monday morning.
• Shout out to the medical professionals. There has been no one who has stepped up as tremendously and it runs the entire gamut of the medical profession.
• As Louisiana, we owe it to them to not overburden them.
• We can prevent it, we have done it before. We do not need to go back to other Phases to do it. We need to follow the CDC and White House Guidelines to slow the virus.
• Let's be good neighbors and realize we all have a role to play.
• This opportunity will not last forever, now is our time. You cannot. wait till next week or next month or there will not be time left by then.

Questions

Is mask mandate for indoors only or outdoors as well. How will be it be enforced
It is indoors and outdoors when you cannot be physically distanced from others. When you go into an office building or retail establish or restaurant etc unless you meet one of those exceptions that mask needs to be on. If you are outside and are in close proximity with others you need to have a mask on. This mandate applies to all locations. There are exemptions for individuals and those 3 parishes if they choose to opt-out. If they were to opt-out, CDC guidance does not change and everyone is encouraged to wear masks if they can.
Businesses will be required to tell people they need to have a mask on. Businesses can accept a representation from someone saying they meet one of those categories of exceptions. Other than placing law enforcement officers at every building there is no way to do it. There is not a goal to go out there and write citations. We want people to comply. We want businesses to make the effort to put up the signs and if someone does not meet the exception and refuses to wear a mask and if they don't leave they are trespassing. The mandate applies to churches but we will not be enforcing it in churches. WE will not be writing up pastors or doing those things. They are encouraged to understand that that setting where people are there for over an hour it is important for those individuals to wear a mask.
If you were to cite a business what would the penalty be? Is it a fine? If so how much?
I'll get that answer to you. That will not be the first resort. When we go to a business we remind them of the requirements. The first efforts are always going to be to pressure compliance and not a fine.
Will citations be for business owners or..
The owners.
Will you be pulling back on elective surgeries
The office of public health has not told me that that is something they are recommending right now. There are hospitals around the state who have different staffing issues and they may choose to make a different decision for themselves. This has not been raised to a statewide level where I, the governor, would need to consider that.
There are 3 major issues hospitals are facing:

1. Testing turnaround times.
2. Remdesivir availability.
3. Staffing.

Medical exemptions for earring a mask. DO people need to carry a doctors note if they meet one of the exemptions
Business owners have the right to ask you to put on the mask so if you have someone that can document that it would be good to have it on your person but owners are not required to ask you for that.
Conditions that meet exemption for mask-wearing. Tiny minority fo people meet these.

1. Respiratory issues where wearing a mask puts you in danger.
2. Children are younger than 2.
3. Case by case basis.

**The larger point to be made, 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 increased vulnerability for COVID. You really need to look at your own risk profile and if it is worth doing the activities that you would like to do. [(Mod note: aka why are you going out if your respiratory function is that comprised that you cannot wear a mask)]
In terms of casinos will they be limited
Limitations only have to do with social gatherings, not businesses. Phase 2 occupancy requirements remain in place for commercial businesses. The only businesses that are affected by the new occupancy limitations are bars and event spaces.
Why bars and not restaurants
Data we have shows that restaurants do not pose the same risk of transmission as bars. Restaurants with bars in them can seat people at the bar as an extension of the seating area for the consumption of food.
Does guidance apply to State employees
Yes, both to employees and the general public entering a public building.
Texas has begun to send ATF out to shut down businesses. We haven't issued any penalties it's more a warning system. Do you think this is working? Why not be stricter with enforcement
Well, I just announced I am closing every bar. I do not know how to be more categorical than that. Last time I got an update we visited more than 3,100 commercial establishments. What I can tell you is that the vast majority of those were not out of compliance and if they were they got into compliance quickly. Likely it was something simple like employees wearing masks around their necks and not their faces. I have instructed that for repeat business offenders to start issuing citations so I believe you will start seeing that going forward.
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 will not be successful. We will continue to have people unnecessarily spreading this disease and then other people through no fault of their own, they may be the most responsible citizen out there, they may contract it because someone in their vicinity is choosing not to be a good neighbor. Then these individuals will go to the hospital and fill that bed and cause all of the problems for the hospital system and its providers, affecting not only the COVID community but anyone that's in need of medical service. To those people of Louisiana who say "well, we are not going to listen to any of that and we are going to make them enforce our way through it. Then we will be unsuccessful but I believe in Louisiana, we are better than that. Our people have always been good and resilient. We are faithful people. We know what it means to be a good neighbor. Now is a good time to be a good neighbor. If you don't like the mask mandate then don't like it, but wear your mask anyway if you are going to be out in public. If you want to criticize me, then criticize me. I understand this is going to be controversial. So be it. It the right thing to do. It's the essential thing to do. But don't sit back and say we will only be successful if we enforce our way through it. That is the wrong attitude.
Can you talk about how the decision for the VP to come to Baton Rouge came to be and the testing issues that may be discussed?
Many things made Louisiana an obvious place to come. We are back to #3 in the country for COVID19 cases per capita. They picked BR specific to do surge testing, one of 3 areas around the country to get above our baseline of 5,000 people. We haven't met that yet, but we are working towards it. Because of the steep increase in cases in BR but even steeper increase in positivity in BR. Louisiana has been on radar front and center for the White House Coronavirus Taskforce since the beginning. We have never come off their radar. I think that is. why he is coming here.
While he is here he will talk about higher education and what we are doing to safely resume on-campus in-person instruction on time. What that mix of education of in-person and distance learning will look like. Plus LSU is the current national champion and he gets to come down be on that fine university. We will meet in a large space in the club on the south end of the stadium.
Did you talk to Clay about the new mandate or the petition gaining speed because of this?
I speak to lawmakers frequently and had the opportunity to talk to them specifically about the proclamation I am signing today. I make sure they are getting regular updates and they see the number and trajectory they are on. So by the time we make these decisions, it is in their mind that this is something we may do. Yes, I had the opportunity to speak with them.
The first time we have a surge in the state there was an awful lot of people who said that only affected Orleans or Jefferson Parish and not us, but that is not the case today. This is literally statewide. The hottest area in the state is in Lake Charles and the second hottest is in Lafayette.
I think the petition would be a tremendous mistake. For us to be the only state without a public health emergency when we are number 3 in the country cases per capita, our positivity is over 15%, we have the highest case growth we've had in the entire public health emergency, our hospitals are filling up again, and all the coordination and resources we need to make available, and all of the coordination we need to do with the Federal government, not to mention making sure we are able to take advantage that they can only send to Louisiana IF we have a declared public health emergency, and the ability to take advantage of the Stafford act? All that would be threatened by a silly partisan petition. They can do if they want but that would be a tremendous mistake and the people of Louisiana will pay a higher price. I urge members not to sign it and if they did sign it to have their names taken off of it.

Final Comments

• We've been here before, we can get back on top of this and start driving cases down.
• We all have a role to play.
• Be a good neighbor.
• Being a good neighbor means do not make that personal visit. You wear your face mask when you re outside your home and are in proximity to others who are in your household. Wash your hands often. Stay home when you're sick. Take care of those people whoa re especially most vulnerable.
• You are safer at home always.
• If you re out and about do not patronize a business that is not operating safely.
• Pray for our state and our country.
• Confident we will get through this.
• It'll be easier and quicker if more people comply with what we are asking you to do.