 Good morning. This is Senate Health and Welfare. It's January 14th, and this is our meeting today. We're picking up some testimony that we were unable to hear when we went through S74 initially, and then we are going to move on to our proposed bill that Katie McClinn has put together for us on mask requirements, masking policy. And then after that we'll hear from the Department of Health, Mark Levine and Patsy Kelso who are here, who are not here yet, and others. So, we may not get to S90 or S19, which are on the agenda for today. They will be preempted by our other discussions. If we do get to them, it will be at the end of the meeting. So, good morning, Mary. Thank you for being here with us this morning. And why don't you go ahead and introduce yourself in the record and then provide testimony. Well, good morning, Senator Lyons. Thank you for this opportunity and good morning to all the members of the Senate Health and Welfare Committee. I'm John Bearworth and I'm the executive director of the Vermont Right to Life Committee. So I apologize for delaying this testimony and I'll get right to it if that's all right with all of you. And I wish to also thank Aaron Dunhamor for his help with posting of materials. I do live remotely so I'm going to be reading from a different screen. I have no internet where I am. I'm going to get right to like joined with others to oppose passage of what is currently known as Act 39. Those organizations in opposition included the Vermont Alliance for Ethical Healthcare, an organization formed by Vermont healthcare professionals, along with some of the disability rights organizations. For those of you who may not be aware Vermont Right to Life's purpose and mission since 1974 has always included legal protection for the unborn. I'm currently born at risk for infanticide, especially the disabled newborn and the terminally ill and elderly at risk of assisted suicide and euthanasia. As a participant in the extensive debate over legalized assisted suicide that dates back at least a dozen years before being ultimately passed into law in 2013. I am familiar with the history. The proponents of Act 39 repeatedly assured this legislative body, the House and this committee, that legal safeguards were warranted and important. Yet today the same proponents of the safeguards are requesting that this committee strip most of them away. My concerns about S 74 include the following is this year the right timing for isolated depressed elderly sick and lonely Vermonters to have fewer safeguards is a phone conversation with a physician enough to ascertain whether reduced financial and personal circumstances are impacting the decision to hasten the end of life, or to discover if family members are pressuring that request. Is shortening the time period required to think things over, especially during COVID in the best interest of the patient making a request under Act 39 patients are increasingly unable to access healthcare services without delays for care. Does that pressure people into decisions that might not otherwise be made turning assisted suicide into an act of desperation, rather than desire. I have sent your committee assistant Aaron the case Cheney account for the committee. It's a short account of a case in Oregon. The documented story of Kate Cheney in Oregon where assisted suicide has been legal since 1997 is a case in point. According to several sources Kate's daughter went doctor shopping for a physician who would fill a prescription. Kate's own daughter declined to write the requested prescription out of his concern for her mental competence due to dementia. He then referred Kate to a psychiatrist as required by that law at that time. Kate was a company to that appointment by her daughter. The psychiatrist wrote in his report that she Kate the mother did not seem to be explicitly pushing for this and declined to author authorize the lethal prescription. Eventually a physician was found to write the prescription and Kate Cheney swallowed the lethal dose. Later, Kate's daughter told the reporter that she found the safeguards to be a roadblock. While VRLC vigorously opposes the underlying concept behind Act 39, the overriding concern for us is that Vermonters may not be making that serious decision free from coercion. Should S74 states in section C at the second page, no person shall be subject to civil or criminal liability or professional disciplinary action for acting in good faith compliance with the provisions of this chapter. Should S74 be enacted into law, will family members who pressure an elderly or ill person to die before their time and under duress be immune from liability? Also, there is the most public Vermont case to date of Maggie Lake. She was the third person to enter life under the new law Act 39 back in 2015. Importantly, her sister Katie Lesser told Seven Days in 2015 that her sister's experience led her to believe the requirements are appropriate. This is the direct quote. The longer she, and she's referring to Maggie, went through that process, the more doctors, the more meetings she became more rooted in knowing what she might want to do this, Lesser said. The Seven Days coverage also noted that not only did it take Maggie eight hours to die after ingesting the lethal dose, the family members became distraught and worried that the dose was wrong. In light of that account and others, I urge this committee to evaluate the available drugs currently in use under Act 39. Dr. Diana Barnard and Dr. Jaina Plow presented at the UVM Medical Center Grand Rounds on Act 39, and their own words are cause for deep concern. I have submitted the entire transcribed presentation to the committee, and I ask that you review it. But as it is 16 pages long, I would like to take a moment to just highlight a few paragraphs of concern. It's important to note that the drugs originally expected to be used to initiate death under Act 39 are no longer available. Instead, proponents of assisted suicide have been experimenting with various drugs and drug combinations and their attempts to find a lethal combination. The following are noteworthy comments made at the medicine, medicine ground rounds held on Friday, February 28 2020. Titled an update on Act 39 medical aid in dying. It was an hour long presentation by Dr. Diana Barnard and Jaina Clow, and I have four short quotes to four short paragraphs to read to you. The presenters promoted the acceptance of lethal medication for those who are not facing imminent end of their lives, and who are not suffering uncontrollable physical pain. As I said, they said that the time may be right for some people and they can no longer walk to the bathroom. Dr. Barnard discussed rectal administration of the lethal dose is an alternative to oral administration. In patients whose rude eye have been damaged by disease and treatment, and or treatment making it quote very hard to absorb. She admitted she personally had not used the method. So one question that needs to be asked is, can rectal administration be self administered. Next, the presentation revealed the experimental nature of the new techniques being used to end the person's life. Dr. Barnard bemoaned the fact that, and this is her word, lovely drugs such as secobarbital, secobarbital and pentobarbital that are very quote quick acting put you in a coma cause respiratory depression and death are no longer available in the United States due to terrible things like being used in executions you will see that on page 14. Dr. Barnard also presented new and experimental protocols, including a for dog cocktail called DD MP to as well as G tube insertion of the drugs and rectal insertion insertion. Dr. Klaus said complications that can arise that include regurgitation or prolonged dying, also on page 14. And finally, Dr. Janet cloud on page 16 made this comment. Because we are learning how to create sort of realistic expectations on the part of patients and families, and because the drug protocols are changing. And this is still such uncertain territory. We're all trying to evolve and adapt and create appropriate expectations. And I would say that complications of whether it's difficulty ingesting and getting the complete dose because of dysphagia, or the body not responding to the dose the way we would, would anticipate because of because, because sexia, or because they have ALS but their heart and lungs are very strong and may not be impacted by the doses. The experience of it kind of not going as planned is really the complication that causes the greatest stress for people. In conclusion, in light of the experimental nature of the drugs being used under act 39 BRLC does not believe that granting immunity to prescribing pharmacists is warranted, and especially in light of the risks of prolonged dying and regurgitation. Further, the potential for abuse and coercion granted by all involved immunity. By granting all involved immunity under S 74 raises alarming possibilities for vulnerable Vermonters. I had the opportunity to see the testimony submitted earlier by Dr. Margaret daily to this committee which can be found on your documents online. She works as an endocrinologist at the Rutland Regional Hospital, and I was gratified to see that her conclusion reflects mine. We, we agreed. I had already written Vermonters do not need fewer safeguards around act 39 but quite the opposite we need more. Thank you very much for your time. Thank you, Mary. And actually, I do not see your testimony on the web. Oh yes. No, it's not there yet. I'm sorry, Senator. It's not. So I have to, I have to create a hotspot. Now I'm going to try to drive to McDonald's for enough bandwidth to get to this testimony. I went on a mountain. Okay. Very soon. All right, not a problem as long as we have it will be going through as 74 again on Tuesday. So, but you know if we could have it before the weekend that would be very helpful. I will, I will make sure that happens. All right, thank you very much and questions from the committee for Mary. Okay. I think at this point I know David Englander is here and he does have some comments to make. David, do you want to do that today or can we should we wait until Tuesday I'm thinking about our time crunch this morning. Why don't we're going to take it up on Tuesday I'm happy to come back on Tuesday. Okay. Aaron you'll have to assure me that we'll have sufficient time for this on Tuesday but maybe could you give us a thumbnails of your comments. You, David sorry. So I haven't had a chance to review the testimony provided but I but I do what I just want to briefly say that the Department of Health has not received any complaints of potential abuse coercion or undue influence. Throughout the, the eight years we've been, we've been doing this. So that these, these are, you know, these are valid concerns raised by, by those various communities, but that hasn't been Vermont's experience. Okay, thank you. Why don't we do you have other specific comments that you would like to make on Tuesday. I would have to review that the testimony submitted. All right, well let's do that and then, because we will come back to this and greatly appreciate your being here and taking time with us. Thank you. Thank you. Yeah, both of you. Terrific. Okay. So we'll committee we will come back to this issue, and we'll have time for review of the bill, and then discussion on Tuesday, and hopefully without having a protracted floor session will get to do some of our work. We're going to start getting under the crunch as bills come up but we should be good. All right. Before Katie introduces the draft that we asked her to put together. I would like to share with you some of the work that I've been doing behind the scenes on the mask requirement bill, and share with you some information. I did spend a long time talking with colleagues about this across the country but one of those persons is Emily summers of University of Michigan, and her bio is at the end of the page to couple pages that are under my name go under her name. Ultimately I just for ease today it's under my name so you know, it's there. That's all. So you can read her background and bio and have some comfort in her ability to understand and present the information that is on the couple of pages that she sent to me after we've had conversations. You know, I think what was most encouraging was her and for all of the epidemiologist and infectious disease folks that I did speak with encouragement about going forward and understanding the issues around masking in our state. I did ask some very specific questions and I know that you'll have questions as well as we go through the bill with Katie, a number of the questions that you might have will be answered by the information that she has provided to us. And some of the information is kind of neat because it in every case she tries to communicate with lay people and also with kids because she has children of her own, and she's, she's quite young. I think you if you go out onto you Michigan you can see who she is. The first link that's there. Let's see which link is it. Well, I'm going to pull it up and show it to you at some point. Oh, yeah, it's it's the link the Swiss cheese model that's at the top of the page. I think you'll find interesting. If you click on it it'll isolate after you click on the Twitter page you can click on the Swiss cheese, and you'll see the link that I have not just one but multiple protections in place, but she was very enthusiastic about masking because it's so critical to protect the people around us. And then she also has provided information about type of mask, and knowing that a surgical mask needs to fit. That's drooping all over. And some of the things that we might be asking about so I'm not going to talk forever about what is here. But I do encourage you to go out and look at this and as we go through I'll try to remember the things that are here and that will help us as we go through the bill. We did not talk about significantly about enforcement, but she did say that was an issue that would probably need discussion. And that that's not her area of expertise by any means but certainly something that she's thought about. So that's it. And then the one that I other one I like is little infograph under infographic under masks, and it's for kids. And it shows kids the, well it can show adults to the importance of masking. You can click on that and see it. And the comment that I may I have made in the Education Committee and in other areas is, it's how it's what we do outside of school for children, adults and children that protects kids when they're in school. So masking outside of school going different places will decrease transmission. Anyway, that's that. So I will leave that for your reading and enjoyment. And Katie is here. Katie, thank you for the work that you did so quickly and bringing us a bill. I think, you know, I think the best thing for us to do right now is to go through the bill that you have. I think the more difficult part of the bill is going to be enforcement, and you've highlighted that for us but let's just go through the whole thing and and committee what I'm going to suggest is because it's a committee bill. And we have, we do have information that will help us make decisions along the way Katie maybe you can point us to some decision making points, and then we can, we can go ahead and make those decisions, if we're comfortable. And then Office of Legislative Council, I will pull up the document. Okay, great. Um, so this version of this document was pulled in part from a bill that was introduced on the House side. And as you might imagine from the time the drafting request originally came in to now there have been some changes, just in the public health requirements that we're seeing particularly around the types of mass used. So I will try to flag for you different places as I walk through the bill, where the committee might want to make just give additional consideration or different decision points on that the committee might want to focus on. The first subsection of this bill subsection a of the masking requirement lays out the general requirement that individuals are masked subsection B, which will look at following a list different exceptions to the general requirement and subsection a. And as you might imagine a lot of this bill turns on the definitions of different terms so there's a whole definition section that will look at. So just to start. One of the pieces to flag is this language mass or facial coverings cloth facial coverings. So I might hold off on flagging that for discussion until we get to the definition piece but that is a conversation that the committee may choose to have. The first subdivision reads that masks or cloth facial covering shall be worn by all individuals five years of age or older, regardless of vaccination status, who are present in a public indoor space, where there are members of more than one household present. Another decision point that the committee may wish to consider is the age of five, there's sort of a mix and the states that have enacted as statewide masking requirement. Some states have the two years of age cut off. Some states have, I think I've seen up to nine years of age, at least one or two states fall around five so this this draft has five that doesn't mean it can't be changed but it's just something that the committee might want to have further discussion on. And then let's go through the whole bill and unless there's an instant reply on this let's let's do our decisions afterwards. Okay. So the next subdivision subdivision to gives a recommendation since subdivision a one has the mask requirement, applying to individuals five years of age or older. And then two says that children who are between the ages of two and four are strongly recommended to wear a mask or cloth facial covering under close adult supervision when present in a public indoor space, where there are members of more than one household present. And then there's a caveat to that. In subdivision be that children in a childcare facility are not to wear a mask or cloth facial covering while napping and I think that's probably self explanatory. So next subsection be we get into the exceptions to the requirement that was just laid out. And there are a series of them. And so this language has not withstanding a an individual or in the case of a minor the individuals parent or guardian may choose not to have the mask or cloth facial covering worn under the following circumstances. So I'll walk you through each of these. First, the individual has a physical or mental condition or disability that prevents the individual from wearing a mask or cloth facial covering, including individuals with a medical condition for whom wearing a mask or cloth facial covering could obstruct breathing or who are unconscious incapacitated or otherwise unable to remove a mask or cloth facial covering without assistance. Second, the individual is receiving routine or preventative medical treatment that requires the healthcare provider to access the portion of the individuals face that is otherwise covered by the mask or cloth facial covering. And what comes to mind here is the oral surgeon needing to access somebody's mouth to perform the procedure. Subdivision three. The individual is hearing impaired, or communicating with the, or communicating with an individual who is hearing impaired where the ability to see the mouth is essential for communication, and a transparent mask is either not available, or its use is not available. In subdivision four. The exception applies for a limited time to enable the individual to participate in a religious activity that would otherwise be restricted by the use of a mask or cloth facial covering in subdivision five. The exception would apply for a limited time, while the individual is eating or drinking, or for identification purposes and compliance with safety and security requirements. Subdivision six when the individual is wearing a respirator and subdivision seven, where an employee has determined that an employee's use of a mask or cloth facial covering is infeasible or creates a greater hazard. Subdivision seven is when it's important to see the employee's mouth for reasons related to job duties, or when the work requires the use of the employee's uncovered mouth, or when the use of a mask or cloth facial covering presents a risk of serious injury or death to the employee. Subdivision seven is when we move into subsections and then we move into subsection C. And as I said, so much of this bill is made up by the definitions of these terms that we're using. So in subdivision one, we have the definition of a mask or cloth facial covering. We weren't receiving the recommendations to move to the medical grade masks. So this underlying language, mask or cloth facial covering means a medical or non medical face covering worn over an individual's nose or mouth that complies with the recommendations of the CDC. But last night I pulled out some of the language that was approved yesterday for the state house with regard to the, the mass policy in effect in the state house. And just highlighted that to give you some additional language to consider. I'm sorry, yeah, that's great Katie I just make a comment here that one of the things that Dr summers indicated was that the those masks that have the ventilators in them really don't work they're inappropriate because they allow for the breath to go out through the ventilators. So a lot of some people have been using those. Anyway, thank you for putting that in. Okay, so the three types of masks that were in this state house mass policy were medical procedure surgical type mask made of multiple layers of non woven polypropylene material. The N95 KN95 or kf 94 similar grade mask and also language a more protective grade mask. So I have a question. I'm going to interrupt again sorry. One of the things we've heard is that having a surgical grade mask, then with a cloth mask over it is also appropriate. And maybe we should add that clarity. And now just because people will wonder, well if I have this cloth mask on. Nobody can see my surgical mask is that a problem. I don't know committee can decide yes or no on that one. I'm going to incorporate that in if the committee chooses to move in that direction. And then there's this last sentence in this definition in the case of individuals with a medical condition complicated or irritated by a mask or cloth facial covering a translucent shield or sneeze guard is acceptable in lieu of the mask or other cloth facial covering. So again all points for consideration. Public indoor space where this requirement would apply. Under this draft it means an enclosed indoor area that is publicly or privately owned managed operated to which individuals have access by right or by invitation, express or implied, and that is accessible to the public serves as a place of employment or is an entity providing services. A public indoor space includes public transportation conveyances such as buses trains and ride services, and when in a mass transportation station, or terminal including airports, a public indoor space does not mean an individuals residents, including a room in a motel or residence provided through a public or independent school or public or private post secondary educational institution that operates in the state. So a dorm. And it doesn't mean a single or double occupancy cell at a correctional facility. It doesn't include a temporary structure. This temporary structure is a defined term so I might just jump down and cover what that means. Well we're talking about it so temporary structure means a structure that is designed to be easily transported or dismantled after its function has been fulfilled and is not permanently attached to the ground are connected to utilities such as water sewer electricity. There is something like an events tent that is put up for a particular tent maybe has flaps so you feel sort of like you're enclosed but it's a temporary structure. And that wouldn't mean meet the definition of an indoor space as defined in this definition. Next the term respirators defined in subdivision three meaning a type of personal protective equipment that is certified by the National Institute for Occupational Safety and Health, or is authorized under the emergency use authorization by the US, the FDA. The purpose of respirators include filtering facepiece respirators less elasto metric Merrick respirators and powered air purifying respirators. And then lastly, on page five line three we have the definition of vaccination status in the subsection a in the requirement portion of the bill. This requirement applies regardless of somebody's vaccination status. And by that term we mean individuals history as it relates to having or not having received the vaccination for coven 19. I was asked in subsection D to add language of what a penalty provision might look like that's something that's not in the house version of the bill so I've added that here and subsection D. In this read an individual or in the case of a minor the parent or guardian of an individual who violates this section may be assessed a civil penalty not to exceed $250 a day for each day in which the individual is in violation. The judicial bureau shall have jurisdiction over violations of the subsection relating to refusal to wear a mask or cloth facial covering. And so this would be sort of, since this is organized under the judicial bureau. This would look like receiving a ticket like if you were stopped for speeding or having a headlight out receiving a ticket and having to pay the fine. So it'd be very similar to that. And then in subsection E. The question is, how long is this requirement in effect, and instead of linking it to a date certain the version that the house introduced linked it to how the CDC ranks community transmission in a particular county. And then, as you'll see highlighted below your conversation. I can't remember if it was yesterday or two days ago, generated some other ideas of sort of triggers for ending the requirement so we can cover those as well. Beginning on line 10 compliance with the section shall be required in each county indicated to have high or substantial community transmission by the CDC until the county's community transmission level is below substantial for two continuous weeks. On a daily basis, the health department is to post on its website the masking requirements for each county, based on applying the CDC guidelines to Vermont data. Well, I was preparing to come to me with you this morning. I took a look no Nevada is doing something very similar to this, and they have a chart that they're I don't know if it's their health department or, but their, their government is posting a chart every day that is when a certain county has met the required threshold and can kind of come off the masking requirement list so if that committee is interested I could share what Nevada's kind of chart looks like so you could get a sense for what how that might be implemented. I'll just, I'll just insert here that Dr summers is responsible for doing the same thing in Michigan and has county and town dashboard information. Similarly, so, but Nevada I think is has been a bit ahead on masking who'd be good to see what they do. And another question I have for the committee which is a decision point for me is whether or not in the state of Vermont it's county or state. So, just a question alternative ways to look at this kind of trigger for when the mandate wouldn't the requirement wouldn't apply anymore is the days above 100% capacity and the ICUs, perhaps death rates hospitalization utilization hospital utilization rates. I noticed that the ICU is closed, and then to try to get to Senator alliance point of having more of a broader look at the state as a whole instead of county by county. When 12 of 14 counties are below the substantial level for community transmission, because the CDC data is is broken down by county. You know, having maybe some percentage or a majority of the counties coming within a certain level would maybe be the trigger for the requirement to end. So, certainly a point for further discussion but those are some ideas to get the committee thinking. Because of the, the timeframe. This act would take effect on passage versus July one 2022 of course. Okay. Why don't why don't we do this questions for Katie clarification questions initially. Senator Hooker. Thank you. Thank you, Katie for doing this. Did I miss or is there not anything in the bill that looks at what kind of verification somebody would have to have for the exemptions. I don't have any built in verifications for example you wouldn't need a doctor's note to say I have a condition that, you know, doesn't require me to have a mask. That's something the committee could talk about but it's not considered in this draft. Okay. Thank you. Senator Cummings. And Senator, we would love to hear your voice. So good. You mentioned exemption for take a religious taking part in a religious service. Some religions have communion, which is very quick you can drop the mask put it back on. But there's also some extensive preaching. Some religions there's extensive singing. How broad is that if the entire congregation is singing. Are they are they required to wear a mask is the choir required to wear a mask. Because that we're that's one hot button I think will get us some reaction. So the language itself is a bit narrow in that it's only for a limited time that the exception applies to enable the individual to participate in a religious activity that would otherwise be restricted by the use of a mask or cloth facial covering. So if it's an activity you could do with the mask on like singing or like speaking. But the language suggests that the mask would have to stay on. If it's something where, you know, to, to accept communion, you'd have to take the mass down if you have to kiss the Torah, you'd have to take the mass down. But to sing or to speak this language suggests that the mask would have to stay on because the activity can be done with a mask on. Thank you, Senator Lyons. I have quite a few comments or thoughts and concerns around the bill. So I don't know if you want to me to address us now. Senator lines or you want me to hold off. Well, I you know if they're going to be about the bill as we go through it we're going to walk through it, and then look at the decision points and so it may be that you have comments at that time. Yeah, and I will, I will say, with all due respect, I think this is probably going to be a four person bill not a committee bill because I don't think I'll be voting for it so. That's okay. Okay, I mean, it can still be a committee bill with a with a vote that is not unanimous. Okay, all right. All right, I'll hold my thoughts for now I just have a half page of notes here I took so. Okay, good. That's good. So as we go through the bill we can hear each person's thoughts I think that's important. Katie I do have a question, and I beat you to a roof. Is that okay. The question is, is so should we be silent. If we were silent on enforcement. What are the consequences of that enforcement mechanism. In practice. There, there wouldn't be this sort of ticketing system. If you, you chose not to wear a mask. And it could be proven that because you did not wear a mask that somebody else, maybe got sick and suffered some type of serious damage there could be. There could be an action based on that. There would. You'd have to be able, you'd have to be able to prove that. Yeah, it does get complicated. Okay. Thank you. I think that that helps. Senator Hardy. I can wait for Senator and Xenia, if he had a question specific to this. Just be quick. I thank you, Senator Hardy. I would just say to that point, what Katie just said, I mean, you know, the schools for example have stopped contact tracing because the virus is so so widespread with community spread I don't. How would you ever prove that I gave it to someone in the community who had to be put on a ventilator because of me being reckless for example so I think that's that is going down a really dangerous slope of, you know, he said she said I got it from this person that person you could get it from. Well, I'll give you an example I, we don't ever leave this house without a mask on we're all fully backs. My kids are eligible and three of my five three of my kids have covered right now and they don't leave the house without a mask so I, I think it's just so widespread that we could never say, geez I gave it to my neighbor and they died and now I'm going to get sued or be held legally liable because I passed on I think that's really a dangerous precedent. Okay, yep, thanks and that that'll that'll be part of the enforcement discussion. I just want I wanted to ask that question up front so we had a kind of a picture of the complexity that might arise. Senator Hardy. Thank you, Senator Alliance. So, Katie on the when when we did have the statewide mask mandate under the state of emergency. When there was a state of emergency. Did we have was that what were the enforcement mechanisms at that time. Is it was it different because it's a state of emergency I assume but I have to go back and look at the executive order to see what was built in I don't think I have an answer for you. I'd want to, I'd want to do a little more research before I get there. Yeah, but that's a good question. And, and the issue. I understand there were two major enforcement, enforcement and that took place one was in Rutland and I think the other one was. It could have been in my district but it was the exercise workout fitness place that. Yeah, I think there was one in Newport I had a couple more. I mean, I agree with Senator Terenzini that sort of like trying to track how anyone gets it these days is is really, really difficult and I wouldn't want to have the ability for someone to bring suit off out of, you know, something But I think that enforce I'm not as concerned about enforcement I'm more concerned about saying we have us statewide mass mate mass mandate during this particular requirement or requirement during this particularly troubling time and that it be as simple and clear as possible without all the like bells and whistles but just saying that Okay, just to some of the question points that Katie had throughout the bill. If we're at that point to go through them I have some thoughts on some of them. Okay, hold on to those. We're going to go through the bill as soon as we've had our questions of clarification and kind of concerns. Okay, good. Senator Cummings. Okay. And the last argument when this came up in the fall was, will it do when it will it change anything the two that were businesses that did not, you know, point blank refused to have a mass mandate refuse to require their employees to be masked and refuse they, and they got hauled in. The average person on the street, who goes in to a store. At this point in time, when anyone who is hasn't gotten their head stuck in the sand or hasn't been on Mars for the last year, knows that you should wear a mask that it protects you it protects your neighbors. And there is debate, according to my emails and I get a lot of them about whether or not mass actually work, but will having a mandate cause people who don't wear masks now to wear them, or will it just set up conflict points and it's a you know it's a balancing the, the positives versus the negatives and the negatives are the risks we're putting people at who will have to say you need to leave my store, because you're not wearing a mask. And I think that that you know why why do we think this will do something more. So, Senator that's a longer conversation but we have heard from I have in particular heard from retail establishments that they would like to see a statewide mass requirement would which would help them with their mask requirements in their stores. And then also remember that all the information you hear about well we had a mask on and yet we still got coven or son, and I had a man we all had mask on and coven was still transmitted. And remember that the mask itself limits the size of the viral exchange, so that the more virus you get exposed to the greater your illness in many cases so what happens when you put a mask on is you limit that virus that's going out into the world. The mask do that exceedingly well so nothing goes out. Then the, the more virus you have the greater virulence and the greater the possibly the greater the case, depending on all the other things that have to do with you and your health. So, masks do help period I mean there's no question about it and then the other thing that we haven't that we did talk about we heard testimony on we can go back and look at it if you'd like but is the, you know, 3% of the people in our, in our population are people compromised and they're the ones who need the greatest protection that all those protected categories benefit when we have a mask requirement, especially going into stores so I'm, you know, well, we can continue to look at that data as we need to but I think the time now is to go through the bill with Katie and look at the questions, the decision points, how we're going to finalize this proposal, and then we'll have the Department of Health and the comment, whether they can comment directly on the bill at this point I don't know but they certainly can offer their comments on masks as we've asked them. So Katie, I'm turning it back to you. We probably should put it back up on the screen and then, as we go through let's try to make some decisions. I know we want to have a lot of conversation, but let's see if you can come to a decision on these things. I got I have another suggestion. You're probably going to say it too but should we start with the definition of masks. Because I think then that influences the rest of it. We have language that includes a cloth facial covering in addition to kind of a medical grade covering. That definition specifies that it would be worn over the person's nose and mouth. We also have language from the the State House masking policy, and there is also a proposal to have to allow the cloth facial covering if it's used in conjunction with more of the medical grade covering. So there are a couple different options that the committee could discuss. Committee. Anybody want to make a definitive statement on this. Go ahead, Ruth. Okay, it seems to me that based on the testimony that we got about masks and their efficacy on Wednesday and the different types of masks. I think that we should. And I don't know how to do this Katie so I'm just going to say what I'm thinking and and you can see if you can figure out how to draft it but that. I wouldn't want to say that cloth facial coverings are not acceptable because that may be what somebody only only has a cloth face facial covering because so many of us have them from the early days. That we clearly heard that that is better than nothing, but I would want to have language that says that we prioritize the, the, the, the language from the State House mask mandate those masks the KN 95s etc are what we what is the best option. And that a cloth mask is acceptable if nothing else is available kind of thing. I wouldn't say that I have to disagree with that. I'm sorry. I wasn't finished Jenny. Okay, go ahead. And the sneeze guard, I, I'm a little concerned about that when you already have a exception for people who are not able to wear masks and those sneeze guards are, I think have been proven to be not, not effective. So I wouldn't even want to say that those are okay, but that we, you know, would like the surgical and KN 95 masks and that that complies with CDC, the cloth masks are acceptable if the others are not available. So I, I, you know, I think the question is the cloth mask and one of the things we know is, it's the fit of the mask is so critical. So if you're going to say cloth mask. If you're going to say cloth mask. Yeah, there it is. I mean you a knitted mask does not work. It is extremely porous and allows for high transmission. The goal here is to limit viral transmission. So you want something that is effective in doing that. So, I think that the language that we got from in the state house that we're that we're going to be responsible for in the state house is a good is a good language. And then adding in the surgical type mask with the cloth mask. These masks are going to be available and they are available so I'm, you know, I just I think that limiting the viral transmission is absolutely key in this. So, share, Senator Hooker. Thank you. I guess I have a question about the availability of the masks certainly in the state house are going to be available but does this suppose that every public space has masks available for people who don't have the surgical masks. And how do we I mean, most of the places that I've gone into including retail establishments have a little stand with surgical masks. But we can, if, if, if the committee wants to include cloth facial coverings that I think we should qualify it and say closely fitting cloth face cloth facial coverings. When you put a bandana on that's not good. And I've seen some folks with bandanas wrapped around and that doesn't work. They're, they're leaky all over the place so. Senator Cummings, you're muted. You're muted Senator. And you're muted muted and I'm hanging around Senator Sirotkin too often. I'm concerned about my ski mask. There's all kinds of ski masks that cover your nose in your mouth, but that's very porous but there are some that aren't. I still like my three layer with so mesh in between cloth masks. And perhaps we could say a cloth mask that is at least two to three layers thick. No single layer cloth mask which means no cowboy bandanas. That's the thing I see most often or sometimes they're just the. Yeah. Yeah, that's what I was thinking of. Yeah, I got a turtle fur thing that pulls up over my nose I don't think that works. It does the word secure help. You know a massive fit securely actually surgical masks. They don't terrible fit their square. I don't know if the K and nine fives I bought a really K and nine fives. What they are, I don't know. Yeah, I know it's hard. You got to read the fine print. I did want to flag that there is language in the state house policy. I'm not sure if I'll be able to switch documents. But it did have some language around like a mask having. Loups and that would kind of eliminate the bandana type situation. Ask. I don't know if it did the document switch for you. Yes. So there's this language. So this we're looking at the state house policy right now. And there was this language. And, oh, and four or two. Let me highlight it. Secured with head ties or ear loops, elastic bands that go behind the individual's heads, fit snugly over nose, mouth, and chin with no large gaps at the sides of the face. If you like this language, I could incorporate that in or if you, I mean, it's up to you, but it seems like the concern is using something for a mask that, you know, it wasn't originally intended to serve that purpose. I think that's a good question. What do you think? Yeah. Go ahead. I don't want to get ahead of myself here a little bit because I know we're going to talk about enforcement, but. This, this conversation around what masks are acceptable and which masks aren't. Once again, who is going to enforce this in the state of this passes because I can see tremendous conflict coming from this. If we ask law enforcement officers throughout the state to go on and enforce this. Number one, we are short. We know we are short hundreds of law enforcement officers as it is right now. And number two, they're not going to go in and approach someone in a store and say, sir, can I, can I inspect what type of mask you're wearing? It's just not realistic and it's not going to happen. So regardless of what we decide this three ply or that cloth doesn't work or this or that, I just don't, I think we're, we're going down a rabbit hole here that's not going to be enforced. I know law enforcement officers and in, in our community, my town has a mask ordinance right now and they're not enforcing it. There are big box retailers in my town that I go into and 50% of the people aren't wearing masks and no one's saying anything about it. So I'm not trying to be negative because as I said earlier, I don't go anywhere without a mask. People in Rutland County haven't seen my face in two years because I wear a mask everywhere I go and I'm fully boosted and I think it's foolish not to wear a face covering. But at the end of the day, I mean, we're like, you know, I think we're just getting down a rabbit hole here that we're just. So Senator Tarenzini, I know you're, you're very excited about talking about enforcement. Let's, let's finish the mask, the type of mask that we would want to see in place and then I hear you about enforcement and we'll make sure that we have a time to talk about that. Senator Hardy. Thank you, Madam chair. Although Senator Tarenzini and I will ultimately vote differently on this bill. I agree that we need to keep this as simple as possible. And that that going down the rabbit hole of what kind of mask and whether it has ear loops and how many layers it has is we need to keep it simple and practical. The state house policy is a specific policy that covers specific people in a specific instance where we know masks are available, where we all know each other, where it's a small place and it's much more enforceable. Out in the, you know, big box store or the grocery store or wherever, it's less enforceable. So I think we should say, like I said before, the medical masks, the KN95s are what is preferable and what we hope everyone will wear. Cloth masks are acceptable if surgical and KN95 masks are not available. Can you add snugly fit? Fine. Add a descriptor like that. But please keep it simple so that people are not, you know, being jerky to each other and are wearing whatever masks they can because no mask, any mask is better than no mask. Exactly. I want to say this is the best mask. If you have it, please wear it. But if all you have is that cloth mask that your neighbor made for you in March of 2020, wear that because it's better than no mask at all. So keeping it simple, straightforward, easy to comply with and I think is the best thing we could do at this point. Okay. All right. You've argued it well, Senator, but as long as we can say snugly fit. Because you're right. No, one, any kind of mask is better than no mask and preventing transmission, but we want to educate through this that surgical masks and KN95 masks are preferred. Preferred. Absolutely. I'm fine with saying that. I just don't want to go down as, as Senator Terrence, you said the rabbit hole of. Oh, darn. Okay. Katie, let's, let's bring it back up to masks. But I'm, I, the question is snugly fit. We won't. Senator Cummings had mentioned two layers. We're not going to say two layers. We will restrain ourselves. This is a hard one for me, but we'll do it. So you do want the inclusion of at least two layers or no. Do we want to say two layers or no. Hello. I think we can say recommend, you know, snugly fit two layered. Looped mask is preferred. But, you know, I think we can say. Regardless, regardless of what the cloth mask is, it needs to be snugly fit. We need to eliminate those bandanas that I see the guys in the hardware store wearing. Sorry. Anyway, that's not just the hardware store. It's other places. I just want it to be as, as clear and simple as possible. So there's, you know, what we want to make sure it's clear, simple, concise, and that's effective. So that's what we want to make sure it's clear. So that's what we want to make sure it's clear. You don't want to give people the wrong impression. Well, also, there's not as much availability out there as, as, as you think it's, it's hard to get map some types of masks still. I've done a lot of research on that, but we'll see what happens when we hear from the department of health. Okay. So Katie, where are we? We're going to talk about the age that the requirement applies to. Let's leave it at five unless people have. Concerned about that age and we'll hear from others on that. Madam chair, I, I guess I would prefer to use two. When we had guidance back in the day, when we actually had clear guidance for schools, it was two and up. And especially because under five year olds are not able to be vaccinated yet in many ways, they're the most vulnerable for transmission purposes at this point. So I would say I would prefer saying two and up. But knowing that nobody's going to go and ask how old your kid is in the grocery store, hopefully not. But that's my preference. I'm going to go with five, but I'll listen to others. Anybody else? So I would, I would look at something younger because kids are in, you know, they're in school. They're in daycare and at a much younger age. And frankly, I've seen more kids with masks than adults at times. Oh, they love them. I know. They do a good job. And I know it's difficult to find masks that fit for kids. But I think making it, yeah, you make them. So are you, you want to go down to the age of two is what I'm hearing then? I would say, I would say two and up or maybe three and up, two and up, I think, because kids are at school, you know, they're at daycares. Yeah. And they can wear them. I've seen that. I've been to childcare centers. Oh, I know they love them. So two and up, I think makes more sense. I've seen them since under two is difficult to get them to keep them on, but. All right, let's go with two. Katie. Got it. All right. And we'll make that change. And then you've got this between two and four strongly recommended. So we'll get rid of that to be consistent with the decision that committee just made. And I'll probably still leave this carve out that. Well, children are, are napping. They're not required to wear them. Yeah. Yeah. Okay. So the other big, I mean, we can go through each of these sections, but the other big, big decision that the committee needed to make on this was the kind of trigger for when the requirement was no longer in effect. So if you'd like, I'll scroll down to the bottom of the bill. Yep. Are we going to the trigger? And then we can come back to the penalty if you like, but. Yeah. I'm not seeing the trigger. Where's the trigger? Oh, there it is. Subsection. Yeah. Yeah. So the, the highest. Substantial and highest. Transmission as reported by the CDC and then the timeline for. And then the day. Okay. Go, go ahead. I got it. Okay. Go ahead. Let Katie go through it first. Oh, go ahead. Oh, okay. So like I mentioned, the version that is on the house side is the language that's not highlighted. So this is the CDC. Categorizes each county in the U S. Yeah. Regarding the community transmission in that county. And the two highest categories are higher substantial. So the language in the house is that. If it dips below higher substantial and that. It's remains that category for two continuous weeks. Then that county is no, the mass requirement no longer applies to that county. And then there's also language that the health department is would be posting. So if it's not available on its website, the requirements for each county based on this data, so it's accessible to folks who are curious if it's still in effect in their county. But I think it was yesterday. There were a lot of alternatives that were also discussed. And those are highlighted in yellow. So. Let's go. Everything is sort of together here. So. I think that's the, I think that's the most substantial. Community transmissions by CDC as the. Trigger that I think is what is used. Across the board and recommended. And then the moderate is a much level. That's the next, that's a lower level. And I think it's like 10 people per. Period of time per thousand or whatever. So. Can we agree to that? High and substantial. Okay. So. Madam chair. I, I'm concerned about the county by county thing in ours. Yeah, well out there yet. Well, this is related. So I, I, I think. The, the substantial spread on a county basis. What, what. My main concern for having a mask mandate is I'm, is the, the capacity of our hospitals. And our capacity of our schools and their ability to function. So the. I would really strongly like to have some kind of measures that are about the hospital capacity. The, the transmission rate with Omicron is less of a, it less of a. Measure because it's so highly transmissible. And I think that's a good thing. Um, so I, I Katie has in here a suggestion of 12 of 14 counties below substantial. And I, I think that actually. That's what we were getting too next, but you let, you want to, you want to put that on the table and I would. Yeah, I want to put that on the table because I'm concerned about a county by county. I mean, everybody's going to have to look in the morning. Oh, is Rutland County or Addison County or whatever. On the, and no, we all know, but he's going to do that. I mean, there are some people are going to do it, but most people are not going to do it. So I think it needs to be a statewide thing. And if we want to do any kind of county transmission thing, I would say the, you know, 12 or 14 or something like that. Okay. So having things in there about hospital capacity. All right, Senator. The high and substantial County is the way the CDC does it. And then our, we can look at it as 12 out of 14 for a period of time. So the period of time becomes important. Is it 12 or 14 days? Is it seven days? Some recommendations by public health experts indicate seven days of below substantial. So that's another decision point. And then I know that Devon green of the vase has weighed in on the hospital issue. And maybe Katie could talk about that. We'll actually have to pull up that email. So there you go. Let me stop sharing and I will. So, you know, while you're doing that, I think the point is that we're a small state and having it county really doesn't make sense, especially when people from our traveling for jobs in every single county. So if it were 12 or 14, I think that's a, that's a good suggestion. And then the question is for how long is it for 14 days? Is it seven days? Senator Cummings. I'm not muted. If your two counties that remain high are in the Northeast kingdom. And have small populations, that's one thing. If your two counties that remain high. Are chitin in Franklin or chitin in Washington. You've got a substantial portion of your state's population. In those two counties. And I think there's studies is a Denver that ended things early and the flu epidemic that. I'd say it's all or nothing. So the state. Yeah. Okay. Yeah, that, that obviates all those little idiots. You get sick in the kingdom and you're really sick. You're going to UVM. Yeah. Or Connecticut. That makes a lot of sense. What do we think about that? Yeah. Yeah. I'm sorry. I'm sorry, Ann. Did you just say you, you think it should be statewide? Not. Okay. I just want to make sure I heard you correctly. I'm okay with that. I think a county by county just gets too complicated. County by county is, is, is deadly. And it, I mean, all of this is based on the assumption, which is false. That people have access. And I don't know if it's true, but I don't know if it's true. And even if it's the work in broadband know that a substantial. Amount of Vermont does not have access. And. That's an issue. So which, which raises a question, but I will hold my question. I'm going to save it because we're not there yet. Okay. Katie. Do you want me to read Devon's email? Yeah, please. Okay. Thank you. Thank you. I've been a lot of time with the CDC guidelines, meaning people wear masks in areas of substantial or high transmission. It was hard to figure out a clear threshold using hospital data and ICU data, particularly due to staff shortages. Here is the CDC guidance and she said she's happy to discuss further. So everyone two years or older who was not fully vaccinated to wear a mask and indoor public places. a high number of cases where a mask and crowded outdoor settings and for activities with close contact with others who are not fully vaccinated. People who have a condition or who are taking medications that weaken their immune systems may not be fully protected even if they are fully vaccinated. They should continue to take all precautions recommended for unvaccinated people including well-fitted masks until advised otherwise by a provider and if you are fully vaccinated to maximize protection and prevent possibly spreading COVID to others where a mask indoors and public if you are in an area of substantial or high transmission. So she is pulling that from the CDC. Right. Katie, can I just ask a clarifying question about that? So Devin is speaking on behalf of VAZ and she's saying the hospitals don't want to use hospital capacity data. They just want to use transmission data. I don't think she said they don't want to. She said it was hard to figure out a clear threshold using hospital capacity and ICU data particularly due to staff shortages. Yeah. I can seize some problems and trying to put all that together and making a final decision. I think it's easier if we're trying to get some clear cut guidelines concise guidelines. So I could empathize with what she was saying about not being able to have instant data and on a daily basis. Can we put her email on the website just because I mean if we're going to not go with hospital data from Dr. Leahy on Wednesday was he thought using some kind of hospital capacity measurement was potentially a good idea. But if Devin is speaking on behalf of hospitals and saying we can't come up with that I want that to be on the record because it seemed to me that having some measurement of hospital capacity was helpful. But if it's too complicated I will stand by my let's keep it simple mantra and I'm fine with that but I also just want to make sure that's what the hospital's official. I will also say that the infectious and epidemiologists and public health folks I spoke with including Dr. Summers also concurred that hospital data was kind of an impossibility and adds a complexity that's probably not necessary and that utilizing CDC guidelines for highest and substantial is more appropriate. So I think we all it all sugars off you know going to other states but then coming back to Vermont and and looking at that is supportive information. So I would Katie you could put that up with Devin's approval put that email up. I mean she may want to I see you I see you Senator Hardy she may want to modify that into testimony. So before we put it up we need to just contact her briefly. She may just say yes but listen now Senator Hardy. Thank you. I guess the the time the number of days you were talking about that seven days ten days whatever because as we know after two years of horrible experience with this the death rates and the hospital rates trail behind the the case rates. So if we're using a measure of case rates or transmission rates and we stop we might stop too soon given that we know that deaths are going to be a couple weeks behind or or hospitalizations are going to be a week behind. So that that may that may be true. The what we're you have to put this all into context. So the peak for Omicron which is just terrible right now the hospitals are full they they can't handle what's coming in but the peak is going to be in two to four weeks and so the next two to six weeks as we've talked with folks is critical and we've heard that from a number of people in our committee and then we've also heard in education in the education committee and then we've heard it from experts outside of our state. So the CDC data does come in pretty regularly and the goal is masking is to mitigate the spread so that the a we don't get mutations happening and that we don't get really sick people there are sick people there are children who are affected and that we keep people out of the health care system. The the health care system is as much a part of this discussion from a public health perspective as our individual patients. So you know we talked about flattening the curve I think we remember that well right now we're talking about getting rid of the peak keeping it from happening and and then we don't know what's coming next so we want to keep that whatever bad thing might happen that from happening. So so anyway let's go so on the on the Katie put it back up so we can see where we are with that I think we got to statewide we're going to we'll we'll hold it at highest substantial unless we hear back from hospitals that they can give us something on the dot and that will help with decision making. We'll hold that thought because that's what we wanted to do we originally wanted to do that. So I was writing an email during the very last part of your conversation but what I where I think you landed and correct me if I'm wrong is that you want language where the kind of end trigger for the requirement would be that the whole state the requirement would end for the whole state once each county in the state has been under the substantial level for was it two weeks? Well that you know two continuous weeks is a long time I wonder if uh I don't know the answer to this I was told that seven days maybe the seven to fourteen days is sufficient so how do you say seven to fourteen days? Or do you just say fourteen days? What does the committee think? Senator Hardy? I think we need fourteen days to my point of death rates trailing by about two weeks and hospitalizations trailing by about a week so if we have fourteen days that would get us to I guess the death. I mean it does it does the you know it's the it's probably the optimal so yeah let's leave it the way it is. Hello did someone have a comment? I just said I've got it. Oh it's you you come in very quietly in the beginning and then go ahead. Oh yeah I've heard that that my audio takes a second to pick up. If you'd like to keep moving on another piece that you kind of put a flag in for later is whether how to address a penalty whether to have a penalty or to be silent if you do want to include a penalty do you want it to be this judicial bureau ticketing structure? I you know I think I like the ticketing structure I'm not sure I like $250 uh I don't know what we can say. So they don't put signatures on those memos anymore and Ted. Hello it's Dr. Levine you should mute yourself there he did. Yeah who Ruth? Senator Hardy. That's okay sometimes first names are just easier. The I think we should just be silent on it. I think it becomes more complicated when we have a violation and I think it become yeah I just think it becomes more complicated I think we should be silent on it. I think it should be what you know a requirement that says this is the requirement and you know like last time we had a mass mandate the vast majority of people followed it there will be people who don't but I think it's going to get complicated if we have fines and penalties etc. That's a recommendation Senator Hooker. I'm just thinking about you know who's going to enforce this and in this it says the judicial bureau shall have jurisdiction but what what does that mean and how do we define that? So the judicial bureau they have a statue with a whole list of activities that they currently have jurisdiction over but this would be sort of like a ticketing system so I'm picturing it as like a law enforcement officer would give you a ticket if your headlight is out. I think it would be a similar process. And I'm still wondering you know at the grocery store who's that person that's going to hand out the ticket? It's Clark. Walmart is it you know. I'm just thinking I don't you know suppose you ran into the grocery store you forgot your mask and you were being held while your ice cream melted. Yeah fine. Okay Senator Cummings and then Senator Taranzini. Okay I'm conflicted. I think everyone should wear a mask. I think we would have some ability to give store owners a mask you know the ability to say you know the state requires you wear a mask inside. We would also expose them to some possible violence given the tenor of the present world without a penalty. Somebody can just flip you the bird and say so what are you going to do about it? But with a penalty only the police can give you a ticket and I think we know most towns in the state don't have a police force and the ones that do have been very clear that this is not you know they're struggling to keep up with the drug overdoses and everything else so that doesn't work. And I'm also concerned you used you know you could tie a bandana and get away with it. Didn't do much but we are now requiring that people purchase masks. You can't whip your own up on your sewing machine. We put that back in. We put that back in. You can do a cloth mask. We did a cloth mask. We are requiring people who are now on sale. Okay well I'll get my sewing machine back out but okay because that does away with my concern that we are forcing people to purchase masks. It's one thing to say it in the state house and we're providing them but to ask downtown merchants who are struggling to provide masks is not reasonable and to ask people who are having trouble affording food. Senator get to the enforcement comment. Okay thank you. I think without enforcement it's not it's just feel good it's okay. You're wanting to have language that says this enforcement. I don't think it's I'm not sure it's possible to enforce. I don't assume I'm a yes on this when I'm struggling. Are we going to do more harm than good? Well I don't know that we're I think we're going to do more good than harm. I think the question is probably if enforcement is in at all is it what is it and judicial bureau is the place probably it goes the question is how extensive do we get into the judicial bureau do we just give it to them and say do something you can do something? Well to get to judicial bureau somebody has to give you a ticket yeah and that is a law enforcement officer it could be your local constable in Canaan if you have one but there. Here's what I'm going to suggest I would like to hear from Senator Taranzini then I'd like to kind of put this one on the back burner just the this section because I think we've made decisions throughout the bill we'll and so that we can move to Dr. Levine and Dr. Kelso we'll hear first of all hear Josh's Senator Taranzini's comments then we're going to move to our next two folks and we'll come back to this Senator Cummings for a discussion so Senator Taranzini. Yeah thanks Senator Lines I'll just very briefly hit on a few facts that I that I mentioned earlier I think with respect the entire enforcement section of this bill should be stripped out I don't think that number one you're going to see many local officers or departments enforce it number two we are short hundreds of law enforcement officers across the state as we know and a lot of departments are down and out right now because they have officers that have COVID and they're struggling enough to respond to 911 calls not you know a scuffle in a grocery store over fighting over if this person had a mask on or not I also think that we're coming up on town meeting day and I could see that if a department aggressively went around started to find people masks they could find their police budget being voted down from the local people who they just find for not wearing a mask so I think there's a lot of precedent that would be said if we started going around finding people for not wearing a mask I think education has been a the best approach all along I think Dr. Levine and and Governor Scott have done a fantastic job of encouraging those to wear masks and get vaccinated and I just think that especially this section should be absolutely axed out of this bill and not even considered. Okay so we'll come back to this discussion Katie for now it's it's there it's in and will my my concern is the fine 250 bucks is a lot of money. Senator Hardy last comment or question quick. I again on this particular point I agree with Senator Charanzini even though I know we're going to vote differently on this bill I think we should just get rid of this provision I think it causes too many complications I think the enforcement of the the previous mask requirement was implied it doesn't need to be a very specific thing like this and it will cause more problems than than benefit. All right Senator Hooker do you want to make a comment before we go everybody else? I do because I'm looking at this and thinking if there's no consequence what is this going to provide and I guess I go back to Senator Cummings questions about you know how and I'm way anxious to hear from the health department about how this will actually make things better for us in the state you know at the point that we are we're in in the pandemic so I'm having some difficulty you know coming to grips with you know how I'm going to look at this and whether or not it's it's actually going to be necessary because the outcome may not be any different from what we're seeing now. Okay so let us thank you all for that this is a energetic conversation throughout the day I appreciate it I would like now to invite our commissioner of health and our state epidemiologist to join us thank you very much for being here you've gotten in on some of the conversation that we've been having about a proposal for a mask requirement statewide mask requirement and heard some of the complexities and I'm sure you have comments to make so Dr. Levine please introduce yourself for the record and then I'll turn it over to you and thinking that you and Patsy Kelso may want to testify together I don't know how you have this organized you are still muted yes thank you very much for inviting us commissioner of health Mark Levine I did have a small slide presentation which I would like to show that deals with the topic of mitigation can you give me a sense of our time frame I have time beyond 11 so I'm not worried about that but in terms of the committee so I'll know if I need to truncate some of the presentation so we have discussion time that's ample yeah I mean if you could if you could provide your slides within a 10 15 minute time frame okay as long as I go through the sharing process successfully do I have sharing capability you do okay okay we see it we have your notes there it is okay now are you good now we're good okay I'm going to go very briskly on the very beginning parts because it's very old history but what I do want to take you through is mitigation as it applied to what I'm going to call the four phases of the pandemic obviously the phase one was the beginning and a very novel virus but there are some themes that are very relevant obviously we very quickly reacted to everything on the ground you kind of know the history we didn't have a great playbook but we had a pandemic flu flu playbook which we try to apply we had much like now abundant community spread of virus and somewhat similar to the realization we're coming to now containment wasn't going to work but for different reasons back then we didn't have any testing so we couldn't identify cases accurately we didn't know much about asymptomatic spread didn't know much about incubation periods infectious periods etc so we needed to take more drastic actions which of course came in the form of sequential application of community mitigation strategies and you know how those played out in terms of closing various sectors of society and eventually getting to the point not only of decreasing gathering size but having people stay home and stay safe the governor was instrumental in all of this as you're all aware and thank goodness we have a governor who prioritizes health and safety and science and data this was the curve that we kind of lived by and it's interesting we're back to that situation again where we're looking at that dotted line which is the capacity of the health care system and trying to make sure that we have enough protective measures in place so that we can not adversely have this viral outbreak really impair the ability of the health care system to take care of patients so we want to be on the blue and not the red part of the curve I won't go through this slide as much because it basically just shows we learned a lot about how to keep the virus suppressed how to open in a very phased gradual sequential manner and gain the trust and cooperation of Vermonters which was critical that has always been critical then we entered the next variant the UK variant B117 in the beginning of 2021 and that's the story of where variants began so every time we see a variant we want to know is it more transmissible it's generally going to be or wouldn't become successful as a variant does it cause more severe illness can the variant evade the vaccine or for people who've already had a case of the disease can it evade infection induced immunity as well and we learn a lot about natural selection and evolution real time as you just heard most variant strains are going to be more transmissible if they are capable of becoming dominant as we've seen from the UK to Delta to now Omicron we never know real time how much they impact the health care system and the severity of disease we learn that as we go along but all indications are that that learning generally proves to be true over time and we know that even if something is called less severe if there are abundant more cases of it you will still see the health care system be stressed because there will be more cases even if the rate of getting hospitalized doesn't change the abundance of numbers will impact that system and we've learned that other strains get out competed quickly so we dealt with the UK variant very differently than we dealt with the original onset of the pandemic and we used our data very effectively to zero in hone in on travel and gathering size for household gatherings we have learned and continued to learn that we didn't need to impact the business sector in as adverse away as early on whether it would be retail whether it be one-on-one contact like hair dresses or health care or dentistry whether it be teleworking we knew we could get away with a lot of that and function as a society outdoors was always going to be better than indoors and that's been proven time after time and restaurants at that time we didn't feel they were totally unsafe but they needed to be restricted somewhat and bars we still felt very uncomfortable with and had closed we had a wonderful early part of summer last year and then phase three began right in July the term is objected to by many but it truly has been the pandemic of the unvaccinated the delta surge if you will the everything I mentioned on the previous slides holds for delta with regard to transmissibility etc like like every phase we've had learning done by other countries being impact first and in some cases other states having more severe impacts that we could learn from we felt I think appropriately that being the highest fully vaccinated state we would be much more protected from delta delta than we ended up being and with the science developing learned that it's not only important to have your full two doses of vaccine but it's critical you have your booster dose as well people ask constantly why did vermont end up with so many cases being such a highly vaccinated state and I bucket these into three buckets the first being the virus itself and its increased contagiousness and other aspects of it secondly the population in vermont we had had maybe three percent of our population to be generous infected in the preceding year and a half so a very low rate of natural so-called immunity or infection mediated and we learned very quickly that six months was too long to wait to get a booster and so vaccine mediated immunity was waning because we were the most early and successful state very efficiently vaccinating all of our highest risk population and then lastly population factors the virus is very adept and successful at identifying who's unvaccinated the social clusters they operate within and even rural pockets of our society where vaccination wasn't as prevalent the virus finds it very effectively plus we have a very mobile population by the time we got to last summer people had started getting used to taking their mask off to gathering together again we living the lives that they had lost before so attention to mitigation was not as strong and there was some public fatigue and decreased appetite for returning to a more restrictive stance to be clear our vaccination strategy remained the primary mitigation strategy as it needs to be in this era where we have the gift of vaccines and they are highly effective as we continue to see we learned about boosting in all of that terms like fully protected up to date became more important we still continued all of the traditional strategies masking indoors hygiene whether that's respiratory etiquette or washing your hands and of course staying home and sick I've already mentioned recognition of where the public was at but in addition understanding some of those issues that make more restrictions challenging for much of the public when there's a parallel course of issues of mental health social isolation increase in suicide rates increase in opioid overdose rates increase in setbacks to kids education and the need to attend to their recovery and then something I've called health debt which is really chronic diseases that are getting out of control because people were afraid to go back to the health care system or chronic diseases that weren't even yet diagnosed because people were not connected with the health care system and the reality of what we're seeing today which is abundant admissions to hospitals for non-covid reasons but they are filling up those beds and requiring a lot of resources and then of course we now had with Delta the onset of monoclonal antibody an actual therapy for the disease I'm always hesitant to refer to that because people in the anti-vaccination community use that as an excuse for not getting vaccinated which still is not a valid way of thinking and here we are now finally at Omicron place most of the world didn't think it would get to it's only been here a few weeks and it's made quite a statement as we all know I do believe that though more transmissible its severity probably is lower than Delta and that comes from some experiences nationally and around the world the ability to evade the vaccine is true but again even very very recent data shows that even though you may have a higher probability of becoming what's called a breakthrough case meaning become infected or just test positive you are very highly protected still against the severe outcomes and we've shown lots of data to that effect you know recently a 24-fold increase in hospitalization and death rate if you're not fully vaccinated versus if you're fully vaccinated and boosted I've already alluded to the impact on our healthcare system and we're seeing not the influence on taking up a lot more beds because we have bed capacity it's much more the health of the healthcare workforce and for that matter even emergency and other infrastructure vital infrastructure personnel so it has a major impact on society and schools as we've all seen it probably will help us in our march towards when this becomes endemic so mitigation at this point in time again continues to be the hygiene basics the masking indoors being strongly recommended the highest quality masks being I think much more fiercely advocated for now than ever before in the pandemic and real attention to protecting the most vulnerable as you've learned from our school guidance we're back to where we were in that early slide in the beginning of the presentation traditional contact tracing is very labor intensive it can be very delayed it relies on traditional PCR testing which isn't a rapid response system by and large and so containment becomes more of a fleeting hopeful thing to achieve as opposed to something that we can actually count on like we did earlier in the pandemic we have got new isolation and quarantine guidance which we've derived from the CDC guidance but we have made more protective in Vermont with testing options and that does balance I think the need for aspects of the workforce to get back to work and not adhere to the older longer days of isolation and quarantine rapid at home testing is an important strategy right now to manage life what do I do today go to work go to school go to an event as well as to manage spread and it's much more effective than traditional surveillance testing could ever hope to be you're hearing things from even dr. Fauci and all national leaders now the question is not if you will get infected with Omicron it is wet that sounds very grim but again if you're fully vaccinated and boosted it shouldn't be something to fear to a great extreme we continue to have the imperative to maintain in-person learning and continue to see evidence for pandemic fatigue though certainly I don't want to over generalize that gathering size limitations are still important we haven't set strict numbers but we've been very clear through Thanksgiving Christmas New Year's about the fact that you're best off with one household multi households are getting more dangerous and certainly a 25 person Christmas or Thanksgiving table was ill advised we will never relent on providing pressure but also pairing that with opportunity to vaccinate and boost travel restrictions I think you'll all agree looking at the colors of maps around the world and in the country don't make sense very much at this time people are still thinking they've reached endemic and I have had to constantly remind people for months now that we are not there yet so they shouldn't necessarily behave in that manner and then we've made obviously we've done with state employees vaccine mandates with testing out options there are issues that the Supreme Court just brought up again about mandates for vaccine or at least mandates about proof of vaccination for the ability to attend certain activities and have certain freedoms in society I'll close with just sort of the public health toolkit of what is out there it's all the things I've just mentioned so I won't belabor the point on the personal and the distancing and the stay home of sick obviously this is a time we don't give up the masks and the issue there is of course recommendations versus mandates there's testing which is still a prime part of everything and the population clearly has bought into that very broadly and we are making daily more rapid at home options available vaccination as talked about just on the previous slide gathering size stay home stay safe is obviously an option though I would never invoke that at this point in the tail end of the pandemic but that's the public health toolkit and let me stop there I think I did 10 minutes hopefully and we'll give us plenty of time for questions for myself and importantly from Dr. Kelso thank you very much I will stop sharing so we yeah that's good that was great timing you've given us a lot of information we appreciate a little bit of the history and then coming forward I would like to ask once we get the screen down I will have some questions stop screen sharing I don't know I know you start you start asking while I work on it it's you did it okay terrific thank you Dr. Levine thank you and just for both you and Dr. Kelso a really a very profuse thank you for all the work that you have done and you continue to do during this pandemic is greatly appreciated I am going to start with the question of course that we all have in our minds and that is I know it's this is probably a question you can't answer but the bill we have before us is a mass requirement for the state in public places and your opinion position on that policy do you want me to give you a chance to talk first I've certainly answered the question as well thank you I'm Patsy Kelso the state epidemiologist at the Department of Health you know we we were talking Dr. Levine and I about some data this morning in in other states that are starting perhaps to see their Omicron surge plateau and start to decline you know we need a bit more data to confirm that but you know thinking about whether they currently have or have in the past had mask mandates and from what we can tell it doesn't seem that mask requirements are tied to what Omicron is doing Omicron is highly transmissible the reality is it's going to burn through populations fairly quickly it's what we've seen in South Africa and to some extent UK and other states in the US and it's going to infect a lot of people and then go away and with Vermont's high vaccination rates we do expect that's what we'll see in Vermont because we are highly protected there's fewer places for the virus to reach but it's going to reach a lot of people and then burn out and I don't know of any evidence that a mask requirement will impact that to any great extent so and I can just piggyback onto that don't get us wrong there is great medical literature that shows that mask mandates work okay however that's almost exclusively pre-delta and definitely pre Omicron these are faster moving highly transmissible variants the health state health officers and all of the states that have had mandates I have talked with some of them have been very successful some of them have had no impact all of the state health officers have commented on the impact on the population and the discourse that occurred and the fact that it was very challenging to obtain compliance I heard you talking about enforcement and compliance and issues like that and that they thought that it was aggravating the polarizations that were occurring in their state now we know Vermont is very different of course but the reality is it's not a simple thing as saying this is an evidence based thing and it works and go for it my fear right now to be honest is that Omicron is out of the bag and if you invoke and mandate now you may actually be able to show that in two or three weeks cases go down but they probably will go down in two or three weeks anyways maybe sooner based on some of the southern New England data that we're looking at so it's going to be a challenge to demonstrate the intervention is associated with the outcome so thank you for that I'm I'm going to finish my questioning and then we'll move on to other members the the prediction of a peak in two to four weeks in some places to some have said two to six weeks for the Omicron variant means that other people are going to get sick that the health care system is going to be inundated and that so much greater pressure and stress will be placed on hospitals providers and patients and so the I always get the sense I get the sense when I hear comments that it's going to go through our population that we're relaxing about this and allowing for that to happen and yet we know that there are going to be chronic cases resulting and we know that masks can prevent the spread and the size of the of a viral spread that goes from one individual to the other and that would then limit the virulence of the disease going forward so I you know I hear what you're saying Dr. Levine I think it's important but when 58% of the folks in the state of Vermont want a mask requirement then that that for me that kind of limits and obviates the social behavioral concern that we're talking about the the other thing I've heard in Dr. Kelso you can help me with this I've heard a few things that the antibodies are not as effective with Omicron I've heard that I've heard that others well I also I put my observation that other states where vaccines have not been in place or are going through the same we're we're seeing the same thing we're seeing vaccine vaccinated not vaccinated and the more this virus spreads you can help us with this as well the greater it evolves and mutates and so don't we want to stop the spread of the viral particles so that we're we're maybe attenuating that evolutionary change and the infection rate and potential chronic condition and infection of the 3% of the population who is susceptible because of their autoimmunity or other so a lot of the questions in there for you to ponder on and answer thank you I can address some of them I think your your question about about this burning through the population and what other states are seeing versus what we'll see you know we are more much more highly vaccinated than most other states and this is definitely a pandemic of the unvaccinated while we are seeing breakthrough cases when you look at the rates of infection in Vermont compared to other states and the rates of hospitalization and the rates of death Vermont's rates are significantly lower than just about everywhere in the US so I do think that the high vaccination rate is making a difference in Vermont whether it will mean that our our peak and decline that is sharper or not we'll have to see but I do think the vaccination rates are making a difference as far as the mutation and the possibility for more variants there will always be additional variants because that's what respiratory viruses do is they you know infect people and swap genetic material and mutate all the time until we have very high vaccination rates worldwide we're we're now going to do away with new variants and I don't think we have population numbers in Vermont susceptible population numbers in Vermont large enough to really think that we'll have new variants emerging here that can you know impact on a larger scale I think we're going to see that happen elsewhere but probably not in Vermont and then my last question my my first question was the use of antibody against Omicron and its effectiveness as compared with others well I'll let Dr. Levine speak to that so we are not advising the use of any of the monoclonal antibodies that we've been standing by all along anymore because delta is now such a tiny tiny percentage of the cases there's only one new monoclonal antibody that is effective Satrova map which unfortunately is not being manufactured at high rates yet so we have literally 160 doses coming into the state so it's not a lot my second I'll just make two other quick bullet points the second bullet point is the fear you have about the variants you should continue to have but not because of Vermont because of the global picture so I continue to worry that not only in the United States where literally you could draw a line and we have the southern half of the country that has a markedly different vaccination rate than the northeast but then the rest of the world where some countries in Africa are maybe 3% vaccinated fertile ground for variant strains that could eventually come back to haunt us here but not because of what's going on with vaccination here I'll make one one comment and then I think Senator Taranzini and Senator Hardy each have questions but my comment is regardless of the number of people who are unvaccinated in our state a it's important to protect them and and having a mask requirement may well protect them from further transmission to them then the other comment oh it just went out of my head it'll come back I'm sorry but just to say that that the protective measure oh and then having in place some kind of requirement that is based on a trigger that is well known so the CDC substantial and highest transmission and then moving to a level that is comfortable for the state with the moderate level over a period of time would seem to me having that in place is a model that we can use should we see another more contagious or more devastating virus yeah and I do believe that it's sort of a toggle off toggle on policy which is which if you're going to do a mandate is an appropriate way to utilize it so that it's not constantly in place I do want to say one other thing that may make you all feel uncomfortable but the reality of transmission of this virus and and we know this throughout the pandemic the probably highest risk place once there is a case established is in your own household you're going to see cases transmitted within households and I doubt you're going to see people masking in those settings until they know somebody has become ill and then the unfortunate result with abacron is that person they become so quickly infectious that there isn't time to actually follow through on masking within your own household so it is just a reality which I hope I'm not going out too much on a limb Dr. Kelso with that we understand that and we're we're also concerned about protection outside of school where parents and children might you know take it home so senator tarenzini thank you Dr. Levine Dr. Kelso for your comments I was sharing with my committee members before you got on that just this morning three of our four kids have tested positive for covid and there are nine six three and one so us the older two are vaccinated the two younger ones weren't eligible but so covid has never been so real to me of course now that's in our house and like you said Dr. Levine I just I'm vaccinated my worst accident I think that there's you know it's in the house and I don't think I'm going to escape it so I'm in my office with the door shut so we'll see how that works but I wanted to ask a question when we were using the monoclonal antibodies for Delta were we finding you know really positive results with it or what was sort of the effective rate and I agree with you Dr. Levine I think that the excuse out there for the unvaccinated to say well I can get those I think it's sort of a weak excuse not to be vaccinated as well but so what was the success rate of of those if you would yeah so we were using pretty much as many of the doses we got into the state as possible and anecdotally having great success the the final litmus test is knowing out of the I guess right now thousands of people that got monoclonal antibodies what impact that had on their hospitalization because the goal of giving the antibodies is to prevent hospitalization and that I don't have an answer for at this point in time it's a little harder for us to get that data aggregated together but that's going to be the litmus test because that's what the antibodies are for obviously you treat somebody with antibodies and they don't get hospitalized you go wow that's great but you don't know that that person would have got hospitalized if you hadn't treated them you're trying to treat them very early in their course because they have a high risk of a bad outcome thank you senator hardy thank you senator lions and thank you doctors living in kelso for being here with us today um I you know I appreciated your you know your look back of the last two kind of horrible years um I'm I'm frankly amazed that the two of you are still standing I guess you're sitting but um that you're still with it um but I think that uh it seems to me that over the last five to six months one of the reasons that vermont has has had this the incidence rate that it has is because we were caught a little flat-footed and that you know delta snuck up on us and we didn't do everything early on that we could have done and now we're in this situation um and I I understand all the reasons you laid out and everything but you yourself have said you yourselves that masking works and that masking is an important mitigation standard and that one of the problems that we're seeing right now is that people are not focusing as closely on mitigation you said um less attention to mitigation strategies was one of your bullet points um and what we're seeing is is the thing that I'm the most concerned about we can talk about individual types of people in our our population and how how susceptible they may be um but I'm most concerned about our hospitals and our health care system and the impact on on that and a lot of our frontline you know EMS and etc and our schools um our schools are in crisis right now and I agree that we want to do everything possible to keep our kids in in-person education and it seems nearly impossible at this point it's just increasingly difficult for schools and for health care providers so where I'm at right now is that we need to be doing everything possible to support those institutions and most importantly the people who are in those institutions the doctors the nurses the school teachers the kids my kids are in school today and you know every time I send them off I get a little worried and a little teary and I want to make sure that what we're doing is is supporting them with good policy and also saying we've got your back as much as possible and I haven't seen the state doing that as much as possible and that's why I'm in favor of doing a statewide mask requirement at this point um because we should be doing everything we can masking does work you both have said it everybody in your position is saying it across the country and the world and um so I want to make sure we have a clear mask mandate that's simple to follow and that shows that we're doing everything we can and one of the things you did say Dr. Levine is that if we do have a mask mandate one that sort of comes on and off with certain trigger points would be the most helpful and I agree so that we aren't aren't here every or you're not up there every week trying to figure out if we should keep it or not um so one of the discussions we were having earlier was what those trigger points should be um we've heard from healthcare professionals who are working on the front lines that they want us to have a mask mandate we've heard from doctors nurses nurse practitioners etc um what what trigger points would you recommend knowing that you're not recommending I hear you you're not recommending a statewide mask mate but mask uh requirement but if we were to have one what would you recommend as the trigger point I think Senator Lyons articulated it pretty well would she refer to the CDC uh levels of community transmission being substantial or high okay um that's a pretty well accepted metric if you will okay so not anything about capacity in hospital because that was suggested to us the other day so hospital capacity or anything you think would be less either clear or easy or whatever well you know that's that's a delayed metric as well so it makes it a little harder to use real time okay and then how long if we did go with the CDC's high um transmission how long would should we keep it in place how many days after we we go down so we were talking seven 10 14 days of you know what what do you recommend uh Dr. Kelso typically um we talk about two incubation periods um you you would wait two incubation periods before lessening any mitigation measures or calling an outbreak over for example so if we're still saying that the potential incubation period for amicron is 14 days that would be 28 days is what I would recommend 28 days of being beyond high transmission rates okay um thank you um thank you both and I appreciate you being here okay any other questions of clarification or information from our our department of health folks uh really glad you're here the information that you provided is helpful and the questions that you've answered about our bill is also extremely helpful and we greatly appreciate it and thank you for the good work that you're doing I you know I think we all feel that um you hear that from us and we'll continue to work together with you as much as possible and we appreciate your time thanks for having us all right well we'll be back don't you worry so let's move on Katie we'd like to come back to the discussion on the bill we have left we have 12 minutes until we're on the floor let's spend five minutes talking about the enforcement piece and the more I hear the the more I think based on who we are in our state that if we took it out it might not be a problem so I'm putting a suggestion on the table to eliminate that enforcement section and I'm I'm I'm totally open to discussion here let's do it go ahead I think both senator Taranzini and I suggested that beforehand and so I I can't speak for him but I can speak for myself and saying I think we should just remove that paragraph D and be silent to it are any anyone who would like to speak differently to that I know senator Hooker I guess I just go back to the idea that if we have no enforcement mechanism what is this law going to do it seems to me you have a law and you have consequences for breaking the law and I I certainly agree that we need to be doing everything we can to mitigate the transmission of this of this virus but I'm just you know are we doing everything we can aren't we doing everything we can and I wish it were coming from another place rather than a law yeah you know exactly and that's the thing that I'm really struggling with let me let me ask this question if I mean when you read that enforcement section for me the the thing that struck me was the $250 a day I my question is how about putting something like $10 in an incident if that were in there would that assuage people's feelings or no that wouldn't I'm looking at no just yes yes or no I think it's it's not necessarily about the fine for me it's about the you know if we have a specific language about enforcement then the presumption is is that our law enforcement agencies have to be literally policing it when we had the statewide mask requirement under the state of emergency enforcement was more implied and there were instances where it was enforced but on an individual basis in the grocery store you didn't have you know police officers going up and serving people tickets there the the instances where it was enforced were more across an institution a business that wasn't enforcing it or you know an event that wasn't enforcing it and so I think that okay I get it implied got it okay so Senator Hardy you understand that this reduces the revenue of the state I'm not you're on finance I'm not you're on finance I'm concerned about reducing the transmission of COVID so okay if you put a fine in it'll have to go to judiciary oh I know so I'm I'm fine with taking it out that's why I asked the question at the beginning of this day what would happen if that were out and because I was thinking that maybe it shouldn't be there so you have affirmed that position Senator Hooker we couldn't reach a compromise on that one so there we go I'm fine with taking it out because I don't know that it's going to make a difference either way all right so here's my suggestion committee Katie have we have we responded to all the questions decision-making questions that we had I believe at this point yes I'm ready to put together a new draft all right here's my suggestion here's what I would like for you to do if you don't mind to put together a final draft for us and it will be a committee bill even though there might be some votes of no it's a committee bill and if it's a majority vote of no then it's not a bill at all um and then I would like to ask for Erin if you could put together a very short Zoom meeting with our committee when we are off the floor and is that acceptable to committee members five minutes what time do you start to make a decision on this in five minutes oh you don't want to vote on it no not yet what do you want to vote later this afternoon can we do that I mean our alternative is to wait and vote on it we could get together on Monday what's the matter with Tuesday oh because then there's a whole floor time that escapes us if we could advance it on the calendar this look at the time for this moving is very short so I know that this is pressure I know that we have worked a short time on it but we have talked a great deal about COVID and masking and all the other mitigation procedures so I am I don't usually do this I think we usually need time and I agree with you senator but this is uh we've been through this a lot senator hardy yeah two things I completely agree senator lions I think we should I hear you a senator Cummings it's it it's a hard decision and this is a public health crisis right now and we really need to if we're going to have any kind of impact with with this we need to move it as quickly as possible um the one issue is I asked Dr. Kelso for that that the time we had 14 days in there she six she suggested 28 um so I just wanted to flag that as as a suggestion from the epidemiologist that 28 would be a more appropriate timeline um but I yeah we should move this as quickly as possible I think I think either 14 or 28 is fine I guess I've committed 28 or 14 raise your hand for 28 raise your hand for 14 yeah I'm okay let's do 14 leave it at that uh this does have to go to the house uh so I'm looking for uh the committee agreeing to get together before Tuesday we could do that Monday we could get uh have no I'll come in for five minutes you're impeding my health but that's fine five minutes uh this is the first day I've had a break all week and I was looking forward to getting a walk in but I will give that up for you well you can go on the telephone and walk not on the bike path oh yeah and you can't vote okay so all right Erin can you put together a short a short meeting um right after uh we are off the floor a zoom and send it out to us and Katie will you have something for us by then so you're looking to meet me today now um I have a meeting at 11 30 to 12 and then I can turn to this perfect so if we need to well can we postpone our zoom to a time certain this afternoon and everyone takes a break from their meeting at three o'clock that is going to be hard we have testimony scheduled in finance that would be hard right okay Katie we're we'll we'll we'll try it after the floor um and let's let's make a time certain uh let's make a time of 12 30 and does that get in the middle of your walk yes but that's fine let's make it 12 45 no I need make it right after the floor okay or I don't get time all right Erin's going to send the zoom out right after the floor Katie let's keep our fingers crossed there's time for you to complete that