 I think we are ready to do your countdown and then you you will hear music hold ended and that will be your cue to begin speaking. So have a wonderful event everybody and you'll be going live in three two one music hold ended. Good evening everyone thank you all for tuning in. This is the fourth telephone town hall meeting we have had since the start of the pandemic in March and each of our prior events has taken place at a key inflection point in our response to this virus and we're doing this because tonight we're at another one of those inflection points. With the cold weather forcing more and more activities indoors we are seeing virus levels rise here in Chittenden County in Burlington and really throughout Vermont levels that we haven't seen since April and I think we have a graph we'll put up to show you what we're talking about and all this this really makes it clear we're in a new phase in our response to this virus so thank you for joining us tonight and so we have a chance to talk about this. We are gonna share our perspective on what this stage means how you should be thinking about risk and what we all need to do to keep ourselves safe our loved ones safe and really the whole community safe. After some opening remarks from me and our guests who I'll introduce in a moment we will reserve as much time as possible tonight for your questions so now let me introduce our guests we are really honored to be joined by two of Vermont's great leaders in the response to this pandemic Vermont Department of Health Commissioner Dr. Mark Levine and UVM Medical Center president and chief operating officer Dr. Steven Leffler. I'm so appreciative that you both are able to join us tonight and really moreover appreciative for what you both have done working tirelessly since the beginning of this pandemic to really lead what has been a remarkable coordinated response so with that Dr. Levine welcome and I'll turn it over to you for any opening thoughts. Thank you mayor and it will just be a few thoughts because I do want to allow all of those on this call to ask questions that are meaningful to them. I will pick up on your theme though that this is an inflection point. There is a real change in what's happened in the last week or two. It does I believe pertain to migrating indoors. Also pertains to unfortunately pandemic fatigue and people letting their guard down a little bit but I'm not here to point fingers at anybody by any means it's just a matter of this is a natural human behavior kind of process. I will repeat one sentence that I said at the press conference today because to me it's poignant and it is that I cannot say this enough to stop the spread to protect each other. We need to act now. We are on the threshold. The decisions we make today will truly determine our future. We have seen a dramatic change for Vermont in the numbers of cases. Numbers of small clusters and outbreaks throughout the state. You know Chittenden County often looks as is looked at as a as the most populated part of the state and has often a large number of the cases but Chittenden County is actually not alone. They're accompanied by many other counties across the state where we've seen significant increase in cases and all I can say is the two major points that were take-home messages at our press conference today were number one the suspension of the travel map because Vermont is an island in a sea of red everywhere around us. The case loads everywhere nationally and regionally are just exponentially increasing if I may use that term. We still have some of the very few. There's only 30 counties in the US that most of whom nobody lives in that are green or yellow and Vermont has four of those still. So we truly are an island and for that reason we really do feel that travel while it should be reconsidered by everyone if it happens it is essential it be accompanied by a mandatory quarantine whether it's a visitor coming in for the holidays to see anyone here or whether it's a Vermont or leaving and then returning. Mandatory quarantine doesn't matter where you go. The second take home point is as the mayor was alluding to the the risk and I'll put that in quotes of small gatherings. We have recommended gatherings under 10 in size but the smaller the better and certainly the smaller the number of households the better. When the prevalence of virus in our communities gets great enough it doesn't mean that somebody's intentionally trying to infect you but you have no idea and they have no idea at that point in time that they may be in an infectious state without symptoms because they've acquired the virus because it's prevalent enough in the community. So if you limit your interaction socially to a small number of households even trusted households and family you will be much safer than if you try to exceed that. I'll stop there and move things along. Great thank you very much Dr. Levine. Now I'll turn it over to Dr. Lefler. Dr. Lefler thank you for again joining us for one of these town hall meetings as you have in the past. How are things with the hospital? I know you've been dealing with all sorts of challenges there virus related and not what's the latest. So I'll talk about the virus first. So we have three patients with COVID-19 in the hospital today. We have no one in the ICU today. Our ER has seen an increased number of cases now both rule out and positives. Some of the positives are requiring admission. Some of them are able to go home. We're starting to go back closer to our springtime procedures. We've increased the number of COVID beds we have set aside. We've set aside some ICU beds. So as we're seeing the state of Vermont start to ramp up in cases we're matching that with hospital capacity. I do want to echo something Dr. Levine said the health care system is as ready as it can be. What actually happens in Vermont now is up to Vermonters. If Vermonters make good decisions, if Vermonters mask socially distance are thoughtful about travel and how they interact with other Vermonters we can want this response. And if for all kinds of reasons that we're unable to do that we will have an increase in cases and will look red like many other states. So this really at this point this inflection point now we've really got as ready as we can be. So we're in good shape from the hospital. We have good supplies at PPE right now. We have good testing supplies. The biggest challenge the medical center right now is I think everyone knows we're day 14 into a cyber attack. I want to make sure people understand that we are open for business. Our ER is open. We're accepting trauma patients. We're delivering babies. We're taking care of heart attacks and strokes. But it has had a major impact on what we do. Our electronic medical record is still down. And while we have strong downtime procedures, it's more difficult to care for people when we don't have the record. And it's more labor intensive. So we're keeping the census of the hospital a little lower than normal by taking less transfers and doing some less surgical cases. And we know that has a big impact on people who need us. And we are making big progress every day. We're getting closer to having our EMR electronic medical record come back on board. But we're not quite there yet. We still have some days in front of us. But I do want people to know that even throughout this it downtime, we've been taking care of COVID 19 patients, we've been admitting the right one, the ones who need to be in the hospital in. And we've been upping our plan for as COVID 19 comes back, because it won't wait for us to manage our it issue. And I want to finish with some good news today. The AstraZeneca COVID 19 vaccine trial started today at the medical center. We enrolled three patients today. We're very proud of that. It'll be enrolling enrollment, people will be enrolling every day now for the next three or four weeks. And so that's really good news. Also the news yesterday with Pfizer's vaccine, which just showed a very strong immune response in people and does seem to protect against COVID is also great news. If we can keep people doing the right things here, until we get to a vaccine, we will save lives. So I'll stop there. Thank you, Mayor. Thank you, Dr. Lefler. It is really unfortunate that you're having to deal with that kind of attack in the middle of all this. Thank you for keeping us updated on the progress. And it sounds, you know, appreciate the communication and that you are open for business and that I want to know that. I just want to add a couple of thoughts to this. And then and then we'll go to questions. We have about almost 500 people have joined in tuned in tonight on these various platforms. And so we do want to get to your questions. Before that, I do just want to make sure for the Berlin Tonians who are listening in tonight. And I do believe most of the people with us are Berlin Tonians. When Dr. Levine and the governor are talking about elevated risk in the state, it's important that we all be clear that is an elevated risk here in Burlington. We have we have confirmation of that with the wastewater testing that we have been doing since August. This is a technology that we have been working with partners on since since the middle of the summer, and that really has been shown to be effective in being an early flag for rising really early indicator in rising infection levels in the community. And we have seen very little indications of positives in in Burlington in the wastewater until the last week at the end of last week, we started seeing rising caseloads, rising virus levels. We saw that confirmed with the next test on Saturday, and we put out a communication. This is positive. This is a rising level in the new North end in our North treatment plant. And, and it really is an indication, I think a very concrete specific indication that the virus is here and that these warnings from Dr. Levine and other public health officials that we need to be conducting ourselves differently, we need to be aware of elevated risk, we need to be considering quarantine if we've been in high risk activities. These, this is all guidance that is really directed at Burlingtonians and that we're calling on people to be mindful of right now. And to the points made by both the doctors, if we do this, this is our moment, if we can respond to these early flags, we can respond and take the steps that we know after eight months of living in this with this virus that we know work, we can stop the growth and get this back under control. I want to just speak to one more topic and then we're going to open it up. And that's the topic very much related to the shift of more activities indoors, the importance of ventilation. And Olivia, here from the mayor's office is going to try to put up a graphic that when I saw it, I really thought brought home the importance of good ventilation in a way that nothing else for me at least had fully communicated that this this is one, an example of a kind of social setting exactly the kind of small gathering that Dr. Levine is raising concerns about this graphic shows that if no precautions are being taken, and we're going to try to scroll through this as we work here. As you watch, if no precautions are taken over a four hour period, basically everyone in a small room like that, if there's not good ventilation and they're not good precautions, everyone will become infected. The next scenario is interesting. And that I think this, I think a lot of us have gotten very comfortable and confident in the idea of wearing face masks. And what this next graphic shows that if all you do is wear face masks, the and you are with other people and I can find space like this for sustained period of time. It really the mask really won't is unlikely to save you most people become infected in that kind of scenario. The last scenario here shows the significance of good ventilation. And if there is good ventilation in place and face masks, and and the duration of an event is reduced from in this case, four hours to two hours. Most people do not get the infection even with with that same patient zero sitting in the circle there. So I really wanted to reinforce this point. The city has a couple programs in place to help people who are responsible for spaces, indoor spaces, building owners, operators, we do have micro grants available and some larger financing available through the Burlington Electric Department at 0% interest rates. And if you are calling in and you might benefit from a program like this, we urge you to check out the city's website and we can help you take steps to improve ventilation in your spaces. With that, let's go to some questions. There are three ways to ask questions. For those of you who are calling in, you can press star six and and then you will be connected with one of our assistants here and they will try to get you on the air and get your question at least. We are also attempting to monitor the Facebook comments and as well as the Q&A function on Zoom. And why don't we start with the Q&A function I saw that Lauren very quickly got a question in that had to do with something I know is on the minds of many and that is the elementary schools. She says I noticed that kids aren't distancing at PE and the hand sanitizer has been removed from the playground. The kids are going to start eating together in the cafeteria. Given rising levels, should we be putting some of the restrictions that were in place earlier in the schools? Dr. Levine, the question is should we be kind of moving back to those kind of phase two precautions? Yeah, so I think rather than move back to phase two precautions, we should look at the things Lauren is saying and say, what's going on? And how can we correct that in the moment? So the distancing, the hand sanitizer, those are fixable problems. The cafeteria is a different issue. And schools are trying to meet that in different ways. It's a very challenging issue. But they do have a lot of students still eating in their classroom all sort of facing the same direction. Mass off only when they're eating and then back on again. So I think these are solvable issues. And I'm sure that's just the short list, there may be more. And I wouldn't want to penalize both the school and the students and their parents by moving backwards that can wait till cases develop, etc. Because I do think we are seeing more cases in schools. There's no question. It's usually just one or two or three, to be honest. It's not a game changer for most schools. Sometimes a class may be shut down because of the number of contacts. Sometimes the school may be shut down, not because of the level of infection, but because of staffing issues brought about by the need for different staff to quarantine. So we're not at that point yet. But I do understand where she's coming from. And though I've been sounding an alarm here in my opening comments, I don't want to sound an alarm so loud that we lose some of the ground we've gained in opening up so much, bringing kids back for in person learning, etc. So I think there are ways at the level of the agency of education and superintendents to make sure that all of the guidance that's been provided gets it here too. Excellent. So again, for people on the phones, it is star three. I miss both people are star three to ask questions. And we will go to the phone lines in a moment. But first, I believe we have Mara on the zoom that Mara go ahead. I'm seeing you have some questions about restaurants. Hi, can you hear me okay? We can go ahead. Yeah. Hi, I was just curious if there are any plans to institute any more capacity limitations in restaurants based on the new COVID activity. So I'll take a first shot at that because Dr. Levine and I have talked about exactly this question in recent days, new limitations on restaurants, new limitations on bars. We considered, for example, reinstituting the limitations on bar hours that we had in place for some of the fall. And at this point, I think the Vermont approach really for months now has been to try to be as surgical and direct with our interventions as possible, targeted at the areas that we are seeing problems. And at this point, we what my understanding from the Department of Health and again, happy to have Dr. Levine, you can hear from him directly in a moment, where we are seeing the growth is through travel. It is through these small social events, the regulated spaces of bars and restaurants, which have many rules in place and precautions have not been at least until very recent days where we have been seeing a significant number of new infections spread and so we are not taking new steps at this point. That is certainly something that could change if we see the risks starting to change. Do you want to add anything to that, Dr. Levine? You said it really well. You know, today I said we had about 20 outbreaks and 60 situations we were following. I can candidly say that none of them are really related to bars or restaurants. People let their guards down so much more in familiar settings like their home or their friend's home. And they don't do it in the more regulated settings, as the mayor was saying. So it is something to put in the reserve. It's on the table, but nothing to act on at this time. So I see a question from Barbara about what the wastewater testing is showing in the downtown and south end. And it's a stoop question. We have these three different wastewater treatment facilities and we are testing in all three. Up until this point, where we are seeing a clear pattern of rising infections is in the north plant. And that's why we've been specifically speaking to that. We will get more readings from this testing. We are testing three times a week now and the next test is expected Thursday. But regardless of that, we're a small community. Certainly, if there is rising, if there are rising infections in the new north end, or that is just I think something that all Boron Tony should take seriously and experience as a confirmation that this virus is here, that we are experiencing elevated levels. We're in a new phase of this as Dr. Levine said. And I don't think those of us who live who are served by different treatment plants should feel that the precautions that we're talking about here, the urgency is not directed at us. I think this is really something that all, frankly, all, not just all Boron Tony and all Chittany County residents, but all Vermonters were calling on to be aware what's going on here and take new steps. Okay. Star three again is the way to ask questions from the phone lines. And we do have a caller on the phone. Bob, welcome. How are you? Very good. Yes. Thank you for joining us. Okay. Thank you. Thank you for having me. Listen, I just want to start off by saying number one, Mayor and Dr. Levine, and especially Phil Scott, our governor, I want to say thank you very much to all three of you. Okay, I've been very impressed. Obviously, we've done very well. So I just needed to say that because it's real important to me. I'm very proud to be up and monitoring Boron Tony. And so thank you. Okay, my question is this. So on Thanksgiving, my wife and I, and we have a four bedroom house, but it's just the two of us now because the kids have gone. Our daughter and son-in-law who live in New York City want to come up for Thanksgiving. Now, obviously, we're following everything. And their question is this or mine is they're planning to get a quick response test before leaving New York. And I mean, within the day before leaving, and they will have their results the same day. Okay, if it's negative, they want to come up and they'll be driving, they're not getting in an airplane or something. So they'll drive up. Now, my question is, how safe are we? My wife and I would probably, you know, would plan to get tested, you know, somewhat after when they leave after four days or whatever. But this is the question. When Dr. Levine mentioned quarantining, how long is that quarantine for once they once they get here? Because the last one we had was a two week quarantine. Has that changed or are there any new regulations about it? And now that you see what's happening? That's my question. Them coming up? How safe is it for them? How safe is it for us and our community? Planning not to go out anywhere either. We're planning to stay right here at our home. Maybe go for a walk with masks on after eating Thanksgiving. There it is. That's the question. Thanks for asking that. Great. That's great. So let me make some general points. Testing on the day of travel is a great strategy for a lot of things, but it is not totally protective. The day you test negative is the day you are negative. But it doesn't mean coming from a very high prevalence area that you are actually free of virus. It just means you were not infectious at that time. And you could still within the window of time, which is a 14 day incubation period test positive at any time during the next 14 days. So you could be coming to Vermont having just acquired the virus, but not yet able to test positive. And in an asymptomatic state, start to infect people during the time you were here. With regard to the quarantine, it is 14 days, but we are very, very eager to have people quarantine for only seven days, get a test on the seventh day. And if they feel well, and the test is negative, they're out of quarantine at that time. The other thing is quarantine is much stricter than people realize. So it really doesn't involve letting people come into your house and sit at the table and converse with you and eat a meal with you, etc. It really does mean they are on their own in their own bedroom, hopefully with their own bathroom. And they're not interacting socially with a lot of people. And I think that's really important to get across. Now, one opportunity I would ask you to ask them about, I don't know what their situation is, but it is fine to actually do a seven day quarantine in New York, obtain a reliable PCR test on the seventh day, have that result be negative. And if they truly were adhering to the quarantine, and then driving straight to Vermont, that would be acceptable. And it would keep you safe, as well as all of the state safe. There's nothing wrong with doing that. Or coming to Vermont for a week before Thanksgiving, quarantining in your spacious house, which is just begging to have people in those extra bedrooms, and then test out on the seventh day, and then enjoy Thanksgiving with you. So there are options. Okay, now we have a couple of questions. Dr. Levine about further questions about testing. One is about says, should New North End residents consider getting tested even if they don't have any symptoms? Should we consider closing schools in New North End, because of these wastewater levels? Glenn asked my there was an announcement that testing will be ramped up. In the past weeks, getting tested without symptoms has been difficult, if not impossible for those coming back to this to the state from out of state, what is getting what is being done? What is recommended in terms of getting a test right now? Do you want to take a first shot at that? And I have some updates on that too. Yeah. And I think, Mayor, you'd agree with me that the wastewater testing, we're very enthusiastic about this program. But we also recognize its limitations. And we do recognize partially what we're doing is in a research capacity. And we are learning and others are learning as much as we are about what this means. We know that the fact that SARS-CoV-2 was found at all is significant. And we know that the trend is significant. So not only did we have a low level, then a really high level compared to the low level and then confirm that on a subsequent specimen, we have a trend that is going in the wrong direction. What do you do with that information is the next question. So clearly, one of the things you do with that information is message, as I know the city has done already, to citizens that this is what we have found, which will allow, again, a more vigilant approach on the part of residents of Burlington to really focus on the fundamentals of public health guidance that we tell you all the time. The other thing it would do and make be make sure we have adequate PPE around in case there was a true outbreak. And it would inform us to allow more testing to occur. We already have testing set up all week in Burlington. And we've been working with the city. So that at their informing of us, we would actually open that up even further if that were necessary. We don't think this kind of information is the kind that would make you look at a school and say, gee, these students are capable of transmitting this virus and infecting others. We should just slow down, send them home, have them stay home and stay safe, and keep everybody else safe. Because we don't really know that that's the way we should use this kind of data. So we have to be a little careful about that. That's, that's what I'll say about that part. And just to finish up on the testing, what we did announce at the press conference today is we are contracting with a Boston organization that will allow us to do pretty much on demand testing throughout the state of Vermont. When a Vermonter wants it, meaning whatever day of the week, they feel they have that need for testing based on whatever aspect of their history warrants that they should be able to get it. That's something that we really, really feel as necessary to confront this new direction we're going in. The other part of testing we're going to be doing more of is what's term surveillance testing. It's just having a sense, a finger on the pulse of how much virus is in the community at any one time. And you can choose whatever population you want to do surveillance on as long as they represent their community. And in this case, we've selected teachers and staff at schools who have wanted to have this anyways. It's not mandatory. So certainly they're not required to do it, but we feel there'll be a big uptake of it. And throughout the state, on a weekly basis, we will have sampled all the relevant parts of the state through the school system. In addition to some of the other surveillance we're already doing in long term care facilities, correctional facilities, health care facilities, etc. So I'll stop there so I can leave more time for you, Mayor, and for other questions. Thank you for that, Dr. Lameen. I would just let me I do just want to be clear. I think that Burlington testing Dr. Lameen was referencing there is there has been one of the known outbreaks going on in Chittenden County has implicated some specific households in Burlington and people that were in close contact with them. And so there has been some very targeted focused supplemental testing that the state has deployed. We are very close. We have been in conversations through the last couple days about what can be done to go beyond that and have something more like the pop up testing that people remember from this past summer when we had prior outbreaks. And I'm looking to have new details about that released likely tomorrow about what is being done there that would expand the amount of testing available to people in the new north end. The focus as I've understood the guidance is the state is encouraging people not necessarily asymptomatic testing for everyone right now so much as if you have been since Halloween in a high risk if you were at an indoor party, if you were at one of these high risk social gatherings, you should be considering quarantining and getting testing if you can. I do want to point out the resource that we do have here in this community that's in addition to all of the other Department of Health resources, the airport garnet facility does have on demand testing now and we are talking about with them about possible expansion of that service. So let's shift gears. Dr. Lunean, there's an old patient of yours who's joined us tonight named Jackie who I think, you know, asks a question about what should people who have special health conditions, respiratory conditions or obesity, what do you recommend for people who have kind of these known risk factors? What should they be thinking about right now when we are seeing these this elevated risk? You know, the reality is they shouldn't be thinking anything different today than they were thinking all through the last eight months. Because the guidance hasn't changed. The guidance is wear your mask, physically distance, wash your hands, stay away from others when you're sick. None of that is different. And at all, as your graphics before pointed out, it all works together as a package. You can't just say, I wore the mask, so I don't need to worry about anything else. You need to do it all at once. And the only wrinkle we've added to it is the power that small gatherings seem to be having right now on the spread of virus. So we've added that dimension, letting people know that they not only do all the things as usual, but really be thoughtful about all the things you do in the course of any given day. And ask yourself, can I be physically distanced? Can I have a mask? Will others have their mask on? And will there be too much of a crowd? And I would add, based on the graphics we just saw, what's the ventilation like? And of course, you don't have to have a PhD to figure the ventilation out. We're not asking that. We're just asking you get a sense. Is this a crowded room without windows and without ceiling fans? And there's not a lot of air movement going on? Or is this something where you feel really safe? Because it's got all of the above. So those are the thoughts. And hello, Jackie, good to hear from you. I know exactly who you are. And the bottom line is just do everything you've been doing to keep yourself as safe as you've been thus far. Only in Vermont does the Commissioner of Health know all the patients who are right in. Dr. Lefler, a couple of questions, I think it'd be great to get your perspective on. There's a question, again, testing related, but has to do with primary care physicians. And people, the question suggests some people aren't able to get test referrals from their PCPs. How should people, this is often part of what we urge people to do, get in touch with your primary care physician. Can you talk about that guidance and what people are likely to experience if they do reach out to their doctor? So our capacity for our primary care physicians to get people on demand testing has varied throughout the pandemic, depending on how much testing resources we had. But we've worked diligently with the state of Vermont with Dr. Levine. And we actually have reasonably good capacity right now. So if you're a provider as a UVM health network provider, and you need to get a test, if you call your doctor, they should be able to get you in. Now we're having some IT challenges right now on top of that. So it's been hard to contact your providers and we're so sorry for that. But the phone systems came up yesterday and showed that should be getting better. And many of the things that Dr. Levine talked about with on demand testing, we're partnering with them to do that. So I think we're going to see a big increase in the ability for people to get testing when they want it, either with the Department of Health, the Medical Center or other partners in the state, there's a lot of work going on that right now. And our testing actually is getting better and easier to do also, which has helped. So if you need a test right now, and your providers are UVM health network provider, you should contact them and they should be able to set it up for you. We have capacity right now. Great. Star three again, if you're on the phone lines, I got another question for you, Dr. Levine. This is a really interesting one. And I think we should talk more about the really exciting news this week that I believe was Pfizer has shown some pretty remarkable early results with their vaccine. There's a question on the chat that says if Pfizer's vaccine gets approved by the end of the year, is UVM Medical Center binded to the AstraZeneca vaccine? Or how will that, will there be any, how, you know, I think you kind of get the implications of that question. What can you say about your test and how this could impact or not impact to kind of roll out of vaccine in this region? So the vaccine that we're using is similar to the Pfizer vaccine, but not identical. There is a huge trial going on across the country for many different vaccines. And we could actually enroll in other trials if we wanted to. And it's very possible that as vaccines start rolling out, people may get one dose of an AstraZeneca vaccine and it's possible get a Pfizer dose. So we actually want to be able to study that too. So I still think there's really important reasons to continue the trial that we're in. But our vaccine trial space that we're using, you'll brickyard in Essex, I think Dr. Levine knows it well. Will we have that all the way for the next over a year set up basically to do vaccine trials and other trials that are appropriate for COVID patients. So we will continue our trial that we're enrolled in. And we're actively looking at other ones that we may actually bring to Vermonters as well. So I see here's another kind of theme for either one of you. Great questions. I know this is on a lot of people's minds. We've had such a great summer and even the last few days has been great. People have been able to get outdoors, play tennis, play basketball. Now there's a question. Indoor tennis courts are is that a safe activity indoor basketball for kids? How would you talk to people about the risks of those kind of activities? I'll take a crack. So indoor tennis courts, I have enthusiasm for actually that idea, because the way they would follow the guidance would be very strict adherence to the right number of people at any one time. No people just waiting in the court or spectating. And as you know, you've got to have pretty high ceilings to have tennis indoors. So there's a lot of space, a lot of air movement and a minimum of two people, probably a maximum of four people on that court at any one time. And even if there are a couple of courts joining one another, there's a lot of distance. So I'm fine with that. Indoor basketball is a little bit more of an issue. As you know, the school and recreational sports guidance just came out. And to be honest, basketball and hockey were the most controversial topics. And we are on the side right now of having those be played, but under still very strict circumstances, with regards to spectators, the number of people in the arena, the need to be masked, just like we've done with soccer outdoors, successfully, I might add. So there's a possibility for indoor basketball. In the context of some of these leagues, I'm not sure, you know, for people just wanting to go to a facility and do that, the facility would have to be adhering to all of the right guidance. But basketball is a little tricky because people do get pretty close together. So the masking is really essential. Three on three is better than five on five, because it does spread people out a lot more. That's the kind of guidance I would give people. We find that with sports in general, most of the problem is not the playing of the sport. Most of the problem is those team binding activities or bonding activities that actually occur before or after the sport. So whatever it might be, cook out in the parking lot, you know, carpooling together with a number of other kids, somebody who may have traveled, not told anybody, and then they're with a group of people who are a team. So it's not in the playing of the sport most often. It's in the sort of extracurricular activities. Alright, we're going to go to the phone lines now. You know, these are great, really practical questions that people are graphing with right now. I believe we have Linda on the line to ask a question about Dennis, Linda, go ahead. Yeah, hi, I just had a question about doctor visits. And are we at the point where I should reconsider going to the dentist for a cleaning or going to the hospital for kind of routine tests? So this question is because of the elevated levels of virus, should we be rethinking these kind of we've been signaling for months, we people should resume these kind of activities has that changed? So that's a great question. So what I can tell you is first off, I would have a conversation with your provider, but we're screening every person who comes into the hospital doors. We are doing strict social distancing, masking everyone, hand cleaning. And so the hospital is a very safe place right now. Our doctor's offices are very safe places. So if if there's care you need, you should be able to access it. We're also doing about 25 to 30% of our visits as video visits right now. So it may be more appropriate for you to have a video visit, if that would make you comfortable. And I would contact your doctor and have a conversation. In terms of dental appointments, I'll defer a little bit to Dr. Levine, but I know some people need to get dental care. And they're also doing things to do everything in their power to keep people safe. The same thing masking when appropriate, cleaning your hands, extra mouthwash, which I've seen has an impact on COVID-19 transmission. So I think it's a good conversation to have with your provider. Dr. Levine, do you feel differently? I don't feel differently at all. I tend to agree completely. You know, throughout this pandemic, health care settings have been amongst the safest places to be. The track record is just so good. Yes, there have been an occasional infection in a dental office, usually in a staff person. And it probably has to do more with the life they lead in their community more than being in a dental office to be honest. But these conversations that Dr. Lefler is talking about are critical. And timing is everything. So some things need to be handled and you should not delay them. Other things may be more elective and you can put off in time. Okay, I think we have another caller, Kristen, are you still with us? You have a question? We're trying to find Kristen. Sorry about that technical problem. We'll come back to Kristen. How about Amanda on the phone line? Amanda, welcome. Hi, can you hear me? We can go ahead. I wanted to thank you, Mayor Weinberger, for organizing this meeting and for doctors, Levine and Lefler, for taking the time out of your really busy schedules to join. My questions are sort of follows up on a was you talked about a little bit as an answer to an earlier question. But my question is about the different tests for SARS-CoV-2. I know there's PCR tests and there's quick tests, which are maybe 15 minute tests. Or I don't know if those are the same thing. And I was wondering what the appropriate use for each type of test is. And when it's okay to get a quick test. And then just if there's any hope for antibody tests in the future, I know they're not available yet. I guess I'll take the first crack. So we still consider the PCR test the gold standard test. But as you've pointed out, it's not going to return a result immediately. The other type of test that is the 15 minute test is the antigen test. And the one that you're talking about 15 minutes might well be the one the federal government has been shipping to states all over the place, which is a card that actually doesn't even require much of a machine. It's almost like doing a pregnancy test and looking for the color change. So antigen tests at a time when there's more virus around. Are actually fine, especially if the person has symptoms. So if the person has COVID 19 symptoms, and they're in an area where there's an uptick in the amount of virus in the community, that is a great test to do doesn't mean it shouldn't be confirmed with the PCR test subsequently. But also if there's enough going on, it doesn't need to be confirmed, you would assume it was a true positive and treat the patient appropriately. So those are the two kind of tests for diagnosing acute infection. The PCR looks at the RNA, the nucleic acid of the virus, the antigen test looks at some of those proteins that you've seen in the diagrams and these spikes that are coming out of the viral particle. The antibody test is a blood test. The previous two we talked about are the nasal swabs, but the antibody test is a blood test. We still don't find that to be exceedingly useful because we're trying to manage an epidemic real time and put people in their proper place, uninfected, infected needing isolation, or asymptomatically infected and needing quarantine and what have you. So to do that kind of management, you need a test that's going to tell you what's active in infection. The antibody test only tells you that the person may have been exposed. And if the person has a positive antibody test, it doesn't tell you how long those antibodies will be lasting and effective. And will the person be immune forever? Will they be immune for two or three months or something in between? The antibody tests originally were not considered very reliable. But more recently, there's about four of them that have actually gotten more distinction, if you will, and thought to be much more valid and clinicians know which ones those are. And if they were to use them, they would use them wisely. I just don't see they have a tremendous role right now, especially in this country, never mind Vermont, where the case rates are just soaring and there's so much disease around. We don't need to know who's been exposed. We need to know who's ill now and to potentially make somebody more vulnerable ill and have bad outcomes. Steve? Dr. Lean, that's why you're such a great commissioner of health. I think you nailed it. I agree completely. So we're coming up almost to the hour mark here. I want to go to Tyler for a last question on on the phones. Yeah, hi, can you hear me? Yes, we can go ahead Tyler. OK, regarding the increase in ventilation to keep everyone safe, we can increase ventilation only so much because as we come into the cold months, our heating systems that haven't been designed for such increase in ventilation won't be able to heat the cold air coming in from outside that's trying to ventilate the building. So we can only increase ventilation so much in the winter months. So what is the plan for buildings like schools and everything that have only so much heating capacity? So I apologize, Tyler. I got something else going on here, too. Are either understanding the question about ventilation or are you able to answer the question about ventilation? Yeah, so I think, you know, the point of the ventilation is try to control your risk. Try and keep the ventilation to the max a can for the building that you're in. Control the numbers of people based on ventilation. So a very small and closed room with no ventilation is high risk. Don't go in there if you don't have to. If you are in there, go with the least number of people possible in bigger rooms in schools where you can run some fans or things like that to improve the ventilation that's going to keep people a little safer. There's not an exact number. Like if you move the air this much, no one will catch it. But I think it's just a way to try to help minimize the risk, like wearing a mask, physically distancing, washing your hands, improve ventilation in spaces that we can do it. We'll help a little more. I think you have to look at the situation you're in and see if you can optimize it a little bit, is what I would say. And I would just add to that, I do think in situations where there's nothing more that can be done to optimize the air flow there's increasingly confidence and support for the use of these HEPA filters that just circulate the air and clean the air as they circulate, if they aren't actually exchanging it with outdoor air and these kind of filters are relatively inexpensive and we have been buying them for public buildings and working with other in this micro grant program we have for Burlington organizations. People have been able to get access to these relatively quickly. If Tyler, you have more specific questions. We do have a ventilation section on the city website, the resource and recovery page. If you can't find your answer there easily, feel free to email, email the RRC. We for this question, and I do want everyone on the that's still with us to know that this is a service. The city of Burlington is continuing to provide. We try to get back to people within 48 hours if they have any pandemic related question, whether it's a public health question or it's a recovery, economic recovery and relief question. We can get you one on one personalized help through the through the RRC and you can email them, you can phone them. That information is all there right in the city's home page. Wow. Thank you. Everyone who participated, these are great questions. And I really hope everyone who's tuned in is able is leaving with some actionable information and that you've had your question answered. If you haven't, again, let me just repeat that point. You can reach out straight to the city and we can try to get you direct answers to any questions you have through the RRC. Dr. Leffler, Dr. Levine, any final thoughts you'd like to leave us with? Just to build on what you just said, the final thought would be a public health thought, and that is that our schools, whatever their ventilation status, are still just representations of what our greater communities look like. So if you're working in the cafeteria in the school or you're the principal or a teacher or you're a student or a parent of a student, whatever happens in that school is really just representative of the community that everyone comes from. So the more we can do to protect that greater community, the safer that school will be no matter what its ventilation status because it won't have a high likelihood of having someone enter it who is infectious with the virus. Thank you all for your attention tonight. It's been a pleasure talking to you. Dr. Leffler. Hey, Vermont can continue to lead the country in our COVID-19 response. We were relying on Vermonters to do the right thing. If Vermonters do really be thoughtful about this, we can keep our infection rates down. We can save lives. We can get through to the vaccine is here. And the sooner we do that, the sooner we're back to normal, which all of us want. So thank you all for listening and being thoughtful about this. And we're in this together. We'll get through it. Thank you. Thank you, Dr. Leffler. And again, our thoughts are with you and your team as you're battling through the cyber attack. I know there were a couple more questions on the chat about the situation with the cyber attack that we didn't get to. I do just want everyone to know that you can go to the UVM Medical Center website for all the details that they're able to share at this point about that attack and the implications for it and where things are they're expecting to go from here. So thank you to your both. I have a while we've been talking, we had someone come on to the Facebook page and make a pretty remarkable post. And I think this is this is an important note to close on. This is a statement from Michael Burdick. And he says, hello, you know, I'm from North Burlington. My mother was the 59th death from COVID reported from the state this weekend. I want to mention that her care at UVM was amazing. That institution is a civic treasure, much gratitude. So amazing. We wear our masks so much more here than my hometown. And thank you, Burlington, for that. So not a statement, a plea. Please don't let down your guard. We all have the fatigue and that's reasonable. Me too. What is what is your adherence worth to you? Please, Burlington, stay vigilant. Let's keep ahead of this. We can do this. Thank you. Michael, thank you. What it in in a moment when you're going through so much personal pain to be looking out for the rest of us is quite something. Thank you for participating. Thank you, everyone who joined in tonight. We can do this. Let's let's keep it up. We'll continue to share updates about this. The pandemic as it happens this week and the elevated levels. And we you can track a lot of information at the city website, at the city dashboard, as well as the state website. Thank you all for tuning in tonight and we'll we'll talk to you again soon. Right. Good night.