 with the Committee on Health and Welfare, the Senate Committee on Health and Welfare, the House Committee on Human Services, and the House Committee on Healthcare. And before we begin our meeting, talking about a very important issue on COVID-19, the coronavirus and learning what we can from the folks at the head of the table, we're going to introduce ourselves to you, the chairs that come to the table to introduce themselves, and the vice chairs that come to the table to introduce themselves. Good afternoon, and you, I'm the chair of House Human Services. Ginny Lyons, chair of Senate Health and Welfare. Representative Bill Lover, chair of the House of Health and Human Services. Sadie Hutz, vice chair of House Human Services. And you, vice chair of House Health and Welfare. And the vice chair of the Senate. It's Senator Westman, so thank you all for being here. Just a couple of housekeeping issues. One, this is being live streamed on Vermont Public Radio, VPR. So the question to us all is, don't say anything, you don't want your mother to hear. And I'm going to do one through as much time as we need up until around six o'clock to talk about this very important issue, thank you for the administration on planning and where we are and where we are going. So I think Representative Lippert was going to talk about questions that come from members. Given the numbers of us who are members of the three committees, we're going to recommend that if members of the committees or members in general have questions that you'd like to have asked, if you write it down, and we're going to take a break at some point in time, and we'll ask those who have questions to kind of indicate and collect the questions and bring them to the table and try to integrate them into our hearing. Terrific. So I would like to welcome our guests and ask you to please introduce yourselves. And I know you have a program laid out for us. We've put some of the questions on our agenda, but we're certainly welcome to hear as much as you can provide for us. So we've learned for them and so we can inform our constituents. Well, thank you Madam Chair. I'm just for the record, my name is Mike Smith. I am the Secretary of Human Services. I'll allow people to introduce themselves as we do for on a show here going through. Obviously the main character to this program will be Dr. Levine, but there's other things that we want to talk about. The EOC, the various, the Secretary of Education's here, the Commissioner of Dale, the Commissioner of DCF as well. And we'll talk about the various things that are happening because there's a wide variety. You can imagine the state has been very busy in our response to COVID-19, or as many people call it, the coronavirus. The bulk of the activity has taken place at the health department with much activity. I was trying to get a list of some of the things that with other agencies and by themselves, including healthcare providers, the elderly school officials. I won't go through the list, but it's extensive in terms of the communications that's been coming out of that department. In addition, you may have seen this on the roadways. We have asked people to go to the health department website. And the reason for that is, there is so much information about this virus, and it's updated daily in terms of what is going on in this virus and different things. The other thing I just want to briefly talk about is that to support the, and expand the capacity of the department, to update the state-run operation center to operate during the business hours. This is to support, as I said, the health department, the additional state agencies, departments in coordination with one another and in the headquarters of the state emergency management plan. And so I'll ask Mr. Shirley in a moment to talk about that as well as Director Gordon to talk about it. So I would like to sort of make sure that I don't sit here and on for a lot of time where I want to get right into it and first return to the office of the dean and talk about what is going on. Here today, the other part of that, I have to do a TV spot at 6 o'clock to report to the public. And so, I mean, I can hear all the waitresses, so I can't share any questions. Good luck to you. I believe in the context of the conference I've been hearing, the majority of all, at least I can answer this touch-up on that. So one of the areas that I know I just made sure requested with me was to sort of, a little bit about the role and to the human population this year. Much like two previous coronaviruses of some variety, the SARS epidemic and the MERS epidemic, some of the two previous majority syndrome and the Middle Eastern respiratory syndrome a number of years ago. But like that it causes fever, cough, and for those who are, I will say from the outset that we are worrying by a day-to-day basis more and more about this as it's been around a long time, probably been around a vast area of animals for a long time. So a lot of our information is coming from very recently published material from China, where as we know the original happy syndrome was. So I'll just sort of give you a little bit of a case series type of information that kind of crystallizes what we know. Me and the age of the people in China were till almost 59, so it involves an older population. In fact, they almost know about age 15 or less. The mean incubation period is about five days, we've got people four to seven days, but as you know when we do isolate people the rest of the MZs has to be presented as late as 14 days. If one is severe enough to be hospitalized, it's usually not to be very early to start the illness and the duration of the interval between the time that it'll to be hospitalized is in the 9 to 12 day range. As everybody knows, we have a positive case in Vermont listed as presumptive positive because every state case around the country that's positive needs confirmation by the Centers for Disease Control, the CDC. I'd say that we have one case, one of those cases is rather a severely ill, it's impossible. However, it's important to keep in context that 80 plus percent of people who get afflicted with COVID-19 will have a certainly more mild to body. 6% of the SHID series required to be there on the transfer to human intensive care even if the catapult ventilation or possibly died. In terms of how effective this virus is, there's a statistical number called the R not R0 and for the flu, that's a little over a run which means that one person with the flu probably can infect eight other person. With COVID-19, this is 2.2, so for each person who's ill, I have to give it to two other people who might get infected from having this case. One needs to generally be within six feet of the person who's ill to have the respiratory droplets afflict them. That's in comparison to a disease like measles, where you could even be on the field of pain and still contract measles if you were infected with the virus. Case-stakeality rate in China is about one point. We're thinking it's probably closer to one or slightly less than one percent of that experience. What does that mean when I give you several comparisons? The flu that evolves along the mirror this time of year is usually 0.1 percent, case-stakeality rate. The other coronavirus epidemics I've talked about have a much higher rate, so SARS at a 10 percent rate and MERS at a 30 percent rate. So let's talk about that, this coronavirus. So to us, it's scary. Something that could potentially culminate in death of a person hits much less powerful than the other experiences the human race has had each job from the animal population to humans. It's very important to know who's at the highest risk, and the highest risk population is labeled as over age 60 with or without chronic medical conditions. Part of these ones is these things, that's all the diabetes and with or without immunocompromise. And though I did say the case-stakeality rate is close to one percent, we need to keep in mind that that's an average across all ages. So if you look at the curve of it, when you get from childhood to the 50s, the case-stakeality rate is essentially just a little bit above zero, and then it has an asymptotic steep increase in the 70s and 80s so that for somebody older, even the 70s and 30s, that's why we're being so deliberately we say about the older population. Mentioned that in the transmission is buying these respiratory droplets, which is why we are also so attentive to the fact that any one in health care needs to have a full personal protective equipment, which is not just a mask, it will need higher attention as well. And again, we're going to close. And that's why when I get to it, we'll talk a little about the concept of social distancing. In terms of numbers, the numbers have changed rapidly, but worldwide we're talking in the 160,000 case range, death-wise we're talking 4,000 as of today. In the US, we're in the 800 case range, but if you want to watch these numbers, in this last week, which is one of the days that we've jumped in the market from day to day, 22 deaths in the US and the majority of those are related to California and Washington state cases, especially regarding the long-term care facility that was affected, but again, cameras won't be issued around the susceptible population. As I mentioned, we have one or something positive in Vermont, and we've gotten no deaths. We are currently following as a number of our 226 thermometers, a number that's gotten its eyes in the 240s, following these varying levels of surveillance and supervision, or at the same point, knowing what kind of contact I did have with others. We've actually completed the follow-up of 52 people. The majority of people who were trying to draw attention have been watching the highway signs to help with long-term care, where you can receive these numbers as an update every day of the week. They're updated until upon the website. The issue of testing has come up as of the concerns of the population. We are actually involved in much more liberalized and non-restricted testing protocol than we were required to follow by the CDC. The CDC required possibleization as a major criteria for being able to be tested. We have said we really need to do our health surveillance functions in public health, so one does not need to be possibleized to follow up. However, one should still have appropriate symptoms, appropriate travel extreme, or appropriate connection to a normal hospital case. The location of testing is an interesting topic because it's important that the healthcare system be protected. And so, airborne infection isolation rooms, maybe the pressure rooms are sort of the state of the art. We learned a little from South Korea where they pioneered the use of drive-through testing. Indeed, Southwestern Medical Center, where this first case has been called, as we all know, is now carrying that out successfully. I will keep the public in mind here that if one has just argued in the data of COVID-19 or has cold symptoms but nothing else, we don't expect that they will be driving through and getting a test. The test is still according to clinical judgment, which means that it is connected to a cold and it requires a clinician's order. It's not like just going through any other kind of drive-through. The volume of testing in the past escalated substantially. We probably did 40 tests total in the first week. Today, we are running 40 tests. Thus far, we have 40 negative tests drive-through today and one with some pressure to use in an epidemic like this have some terms that are called containment and mitigation. We're on the basis of what it says that if you discover a positive case, you do everything in your power to isolate that case, you contact tracing to make sure you know everyone who knows the fact. So that is the thrust of what we have done up until this point, both as a nation and as a state. As a nation now, though, within the nation's strategies, we in Vermont are still in tandem with nation. So the containment involves climate assessment and providing public health recommendations. A lot of boots on the ground and ears on the telephone work for our epidemiologists and public health. Mitigation really is more of a preventative and preemptive strategy to do well, knowing that the disease has achieved a level of person-to-person transmission in society and that containment while still potentially useful can't be one's entire strategy because the spread has already occurred. And that is where the country is so claiming we are now. We're hoping in Vermont we can still do a parallel strategy for a bit longer. So what is mitigation involved? It involves what are called NPI, which is non-pharmaceutical interventions. That implies that on the top of that, there aren't two pharmaceutical interventions. Indeed, we'll get to that. So there's three levels of this type of strategy. One is the one that we all are familiar with and that is individual strategies. All the advice we do is we came in, we weren't taking hands with each other. We were not hopefully here because we're still symptomatic of the respiratory illness. We stay home from work. We're avoiding others who are practicing to stop the respiratory etiquette, to stop the bleeding of sleeves and elbows and things where washing our hands as many times a day as possible. And if we're not having access to water or soap, we're using an anesthetizer. You can find that. If you've come off the plane from one of the... you've been told you should be going directly to your home and isolate you. And that kind of cooperation as a citizen, the second level is really environmental, which has to do with the traditional cleaning of rooms, disinfection of public facilities, et cetera. And I would tell you just that there's nothing super special out of the way we approach this virus compared to others. So all of the traditional cleaning, measurements in schools and in other buildings are arterial, sinusoidal, and virusoidal, are appropriate for COVID. And one doesn't require a special group if you will. And then the third level is really the tough one, which is how things at the table will start to see you now as we go around. It's the community strategies. When you reach the level where there's enough disease going around that you really say, we've done something much more dramatic. And dramatic, and close, I don't want to overplay that, is the potential for school closure where there's canceling meetings, conferences, mass gatherings, preventing people from being in close contact with one another. And that may involve really traveling, shooting travel, et cetera. And a lot of work on social distancing strategies, keeping ourselves more than six feet away from each other if you will. And that's work for a while, where disadvantage comes in, the task force that the governor has assembled and the EOCs. And we need to invest a lot of that on this. So what do we do if we get a positive case? Well, if you're in a medical system, you support the care. That's how much that is needed when it involves an additional hospital room. There are no medications. There was one medication that disappeared. It's an antiviral. It's showing if I can say more problems. It's not actually been used a lot by the time yet, but things got very serious in this country. It was promise was sufficient. It's potential for adversity was low. I think you would start to see it being used to be sick as far as the population. As I've emphasized, since most of the population might get this hard to get a serious illness, they probably wouldn't need to take drugs now. And that's an interesting story. Because everyone always has a lot of vaccine. And Dr. Fauci, at the federal level, he's the director of the National Institutes for Allergy and Infectious Disease. He has on a gazillion occasions really told the population that we have a vaccine and won't be ready for general population for a year, two to a year and a half. He's the kind of testing that that needs to go through. That BBC stated that we're very focused on the vulnerable population and to be in hospital. Those things, those older, sicker people are in hospital. Some of our disability population have, so as the Secretary said, there's a lot of community we've done already with a number of vice-presidents and I can't be as helpful as we can. We've also developed these four questions screener so that facilities can screen visitors. And these questions are very common sense. They have to do with how you feel. Are you coming here today for a coffee fever? Shortness of breath? They have to do with having travels to a high-risk place. Hasn't been in contact with a positive person. A positive person. Have you made that deal with patients like this all the time? Did you wait to guess any of those questions? We will submit that we should stop with the law and proceed further on. Whether you're at a hospital, perhaps a baby or child care center, or you're in a hospital. And the last bit of guidance, the older and more frail group comes from the CDC Justice Week. And even though we do not have widespread COVID-19 in the United States, they have already said that if you were in one of the vulnerable groups, you would avoid travel as best you can. And they said you should start that. The last thing we've got to talk about is a little bit of a full-free interest that I may have left out and answer some of the questions. We sent a lot of communications out as I mentioned on these health awareness about the issues of the clinical world and explicit information they need to know about testing and protocols. We've sent out these kinds of questions free and advice to hospitals, health care facilities, long-term care facilities, nursing homes, etc. And we have weekly phone calls, various parts of all. That's out of the pool of something that already gave $2 billion. There are other billions of dollars based on pharmaceutical development, vaccine development, etc. But this is money I'm talking about in the States. And then finally, I can't stop my presentation about advertising at healthworld.gov to get a copy of this information to get the updates on a day-on-day basis. And everyone should realize that the nation is really following a lot of steps and incentives for disease control with CDC. So our website connects directly with the resources that are in their website. It's updated in March. It's automatically updated. So I will now set myself to move this on to the rest of our team. Thank you very much. I'd like to sort of move it now to the emergency operations center and Interviews Commissioner Sherman to start the presentation from that side. For the last several weeks, we've been updating plans for both in the company with the operations, emergency services, and most of other topics for the state government operations. As a matter of fact, both plans are in place for evolving events, as information comes in. Tomorrow will be the land opening of the emergency operations center with the partial activation of the Director of the Department to move into more detail about the event. The general overall and enhanced coordination on long resources, both on a state level and on a municipal and county level, using structures that are in place of the emergency operations center will provide additional support to the Department of Health including such things as tracing assistance, communication support, whatever else they may need. We will additionally begin to ramp up additional communications statewide. The key constituency has yet a bunch of that done for several weeks now to the Department of Health. We will bring some additional resources to the table to be able to assist with that. Those include first responders, emergency managers, legislators, municipal leaders, many types of organizations ranging from schools to others to agencies and institutions that will provide additional support to that role. We will also continue planning for responses to the situation's services perspective and including ensuring that we have the best plans for continuity of operations for first responders and emergency communications which are among the most important things to keep flowing so that's the over two emergencies. The operations center opens and Director Warren can bring a little more detail about what actually happens. Sure, thank you very much Director Warren on the same mention. I will speak by saying that the state of Vermont has a state representation plan that provides the overall response and recovery to all hazards including infectious diseases. So the state of Vermont's operations center is a physical location where that coordination happens and again we activate in preparation for a response to recovery from infectious diseases. If I was to another hazard that we would activate the state emergency operations center for in preparation it would be hard to come to Maryland where we might have to activate the state emergency operations center in preparation for the real good knowledge about what level of impact will actually be experience of the resources and how the information pathways open to so, as we mentioned the activities specifically selected for this event but if conditions on the ground are worse or are alleviated as we move through this, we get out on the response structure after the state EOC as necessary. And we have a number of agencies that will be representative there. But these are agencies that have the operational qualities such as the digital service of these national bar, education, fire safety, circumnaut, Congress community about maintaining resources. And we'll also have a federal representation in the state EOC with the federal emergency management agency representative that will be there. Just to give a little bit about the upon the governor's task force that was organized to deliver a certain set of actions. So one of the primary delivery goals of the emergency task force to the governor director of emergency management to assemble was to develop a COVID-19 statewide response plan. And of course we all under this emergency management plan as in so that the task force met last week and we'll meet again this week and we accept the outcome ready to go. Very shortly that will guide our actions or as we move through the presentations on the program as they move through this as well. We are also very close to providing some continuity back as any guidance to state agencies so that we can collectively ensure that we are maintaining the English and central functions of state governments and the services that our hunters rely on so that way. I'm going to ask one really simple question. So we were talking about first responders and the needs that they will have as more perhaps more cases and more transportation needs, more rubber gloves, more sugar ale, whatever, the distribution of the $4.9 million bill that includes some of the increased needs that were as you might see or to say some of these apologies within the emergency preparedness budget. A little bit of both and perhaps you might speak to this more but we, there's still some I don't know about that funding and we're still kind of figuring that out. That's okay, I think that's just concerned that the first responder going out is traffic is where the ambulance want to make sure there's sufficient. Yeah, and certainly there is costs across the spectrum of response in hospitals, economic injury, for businesses that have multiple potential needs. Certainly for the response, our priority is to make sure that we can pay for that and make sure that we have the capabilities to not only care but also support those responders on the map and help your system. Let me just, I failed to mention in the beginning, this is a partnership, an online partnership with the Legislative Board of Partnerships with the federal delegation defending close contact with the federal delegation. They have been wonderful through this process. Some of those that were going to work out and we know that it could be in the three buckets that the commissioner talked about. We are still trying to explore what other needs will we need in order to fulfill this response. We also, in the next few days, expect to be talking to you about the various responses that we may need from the state legislature as well. I'd like to understand a lot upon me in the last couple of days, the documents that went out today to schools who are tenants, and that is like aspects of the guidance. Hi, I'm Dan Christ, Secretary of Education. As commissioner, our Secretary has said, we are working very closely with our school partners to implement the guidelines developed by both the Bar and the Health and the CDC. Dr. Dean mentioned the public health strategies that's been following two groups to contain education. The issue of school closure falls with that latter category of mitigation strategies, and that's emerged as noted in the media, and hopefully more frequently than last 40 hours. The issue of school closure falls with that second category of strategies on mitigation strategies. The, as I mentioned, was published today. It really is a literation of guidance that has been published by the CDC on school closure, I would say, as we actually finish one-on-one in some of our experiences with similar types of issues. The school closure, based on that guidance, falls into three categories. We have all selected school closures, reactive school closures, and pre-empted school closures. Selected school closures really pertain to the very small area of where students, schools have a very specific vulnerable student population. Students can be met at a practical, special consideration of their needs. This justifies the closure of that facility. Reactive school closures occur when a large number of students and faculty become ill and continue to operate the school becomes difficult. In my experience, when we saw that at the 30-H, 1-on-1 situation, and we had schools closed because the students were coming to the school to sit and being sent home or a large number of faculty were off. The last category of school closures is preempted school closure, and that's the one that's meaning more media attention. And this is when we close school in advance of the homelessness of the strategy to prevent further spread. We're not at that point in Vermont where preempted school closures we think are necessary, but we are making plans to do that. That was part of the strategy today to issue that guidance. We have had several schools over the weekend. They, I would say, following the categories of active school closures, as mentioned, we're still pursuing those containment strategies, even though school closures are mitigation strategies. So we had schools having to address very specific concerns around your faculty or student travel, potential homelessness, so forth, and praise for consistent from superintendents as the abundance of caution mentors. So they've been being proactive in closing schools like the abundance of caution, conducting basically disinfection activities. We started with a group of schools in the South West Supervision Union, basically the Benning area. We had, in their situation, students immediately crossing Massachusetts border and Clarksburg, Massachusetts, and Clarksburg was maddening for the significant school closure strategy, and that precipitated a need for a minimum Southwest value of a good situation. And that resulted in a closure of Stanford School, which was maddened across from Clarksburg, Halifax, Reedford, and the Twin Battle, which is a well-meaning one. Those schools remain closed today. They're working with staff to walk through the disinfection procedures, but also to implement better routines than hand washing, and some of those basic preventative things, and how to do this as individuals. As you know, the Wilson School was one of those very similar concepts that were addressing, you know, the lines of caution and information they had the same way before. I believe we also have the, you know, the river school for this similar situation. We've also had a number of situations where superintendents decided not to close schools based on the information they had, and we were working closely with the Department of Health, working closely with the RNC to determine the specifics of their very repeating situations. But at this point, we're not planning a larger strategy, but we're trying to do a school load coming at some point in the future, so we're developing those plans now. I would also say that our guidance were addressing issues related to school load, and school load can also be very destructive to communities. The issue of having feed children, for instance, we've been in contact with the U.S. Department of Education to obtain a waiver on the need to, there's a requirement for the U.S. to offer meals in a congregate setting, so we need a waiver to feed students, not all together in the cafeteria, when we're trying to enact a social, this is a pretty great distance between students. So we, yes, yesterday we repressed that with a waiver from the U.S. Department of Agriculture. Many of the states, I would say, are also pursuing these strategies, so we're not unique in that regard. We're working in a concert with our party to feed special needs to those programs that have to be addressed to certain standards of resolve the school load. We're also pursuing issues of funding, so we're also to our federal grants, you know, we rely on a lot of federal money to operate on school districts and issues of professional development, issues of conference participation and so forth. So we're working in a concert with other states to get a better understanding of how federal government will address those issues in case we ask anyone to apply to a school boarder. I have one question for you. Did the decision to close the school will remain the superintendent in the communication process? Yeah, essentially the superintendent retains that responsibility because I mentioned there's three essential and considerate levels of school closure, the preemptive being the most significant. Basically, depending on the significance of that closure, there's a requirement that a greater consultation with the department of all things interpretation. And particularly, you can get the public dialogue information to help inform the decision. My involvement certainly used to provide this research to help them implement the guidance, but also I asked the director of responsibility to waiving calendar days and student attendance requirements and so forth. So that's why it's important both to consult all of us in the process. But the decision being that we resided the superintendent model going with the ABC application of the department of health is to give it for the more significant types of school boarders. One of the things you've heard about being here throughout this presentation is the concentration, you can see in terms of the strategy on those that are elderly frail, on those that may be older or senior with underlying medical. And therefore, we didn't bring, and we wanted to, but we didn't bring data as well to, you know, there are similar strategies that are going out. And I just thought that it would be good to hear from Monica. Good afternoon, Monica. I'm the commissioner of the department of disabilities, aging and independent. We heard Dr. Wilbita already speak to this that the populations that are folks at risk when we think about COVID-19 are those older grand launchers and grand launchers with underlying health conditions. When I think about the population and they health, certainly I feel like we need support among those in the office services to explain how things work. So especially considering as well those individuals with disabilities with underlying stress and conditions and complicated profiles. So in terms of that, we have worked really hard to amplify and leverage to make sure it was already happening across the Vermont Department of Health. They have tremendous assistance in place. They've got community communications. We push that out to our providers across the board. Vermont is unique in that we certainly do have one for the care facilities and I'll give you a quick list of all of those. But I think it's important for us to remember that most of our older grand launchers, most of our grand launchers with disabilities are serving the community as well. And so we have to consider the role and the strategies and communications that we can to push out the door. And we need to be tremendous in working with us to really tailor community communications as much as we can. I do have some things that I'll need for the community to look out for just a couple of things that are specific to launching care. So when I think about our launching care facilities, we certainly think about nursing homes. But we also have residential care homes. We have therapeutic care residences, assisted living facilities. We have one ICF, the Developmental Services down in the Rotman area, two day off. But the Department of Mental Health, they have some ICF. We also have micro-residential. So the caring for individuals who are living in the park even when we're talking about launching care are not exclusively living in only about our nursing home operation. But all of those different entities. And when we're pushing out communications, we are pushing out the state of Vermont. There's enormous population of individuals in shared living and individuals living with a family or a care provider. So we've got foster care as well. So again, trying to consider the needs of all those populations and identify what kind of information is precautionary and preventive and how do we get that information to them in a way that's easy to understand and is quick. We also have a lot of one-to-one supports happening across the state of Vermont. Again, not only today, I'll hand the shocker to Seattle and then some solutions. So again, consider all of those populations. And what we need to tell them to continue to work as adult day programs, vary agencies on aging, all of our designated agencies and specialized service agencies that are planning for Vermont to have every single day of the week. So again, trying to get information to them at a youth school that is valuable and talks about really practical strategies is what's been most important for us. And the VDH has been, I can't say enough, about the kind of department that they've been in designing things for us. And I keep feeling like I'm raising my hand and saying, hey, what about me? I think it's actually for me that they've been tremendous about doing that. So I'm very grateful as a part of it. I wanna just tell you a couple of things that we're doing right now. I'm gonna then move it over to Canon and move it over to some questions. So I've already got the ongoing coordination of why those go there first, that leads directly to the VDH website, which has been so open to our ID is updated very quickly with CDC information. The two policies that I have to leave on that just talking about basic prevention. Most of our facilities are all contingent and illness. They know what they're doing. We wanted to get them updated information about COVID-19, which we don't already have. So that went out last week. And again, we share across the agency. We developed, as a commissioner, we spoke to various screening guidance for people to just use and suggest it strongly that they use that guidance in terms of visitors coming in, how it was important to, again, in the case of preventive as we could with this. And not by the time commissioner Lee was able to host and think about support from the day off, well over 250 invitations that went out to that. And it was a very large group of people that attended that conference call. And again, that's when we represented our long-term care facilities through Sean's, but also the down-represented Japanese services providers across the state, designated agencies, residential care homes, anybody that wanted to call in and call in in addition to being able to walk through a lot of really practical information and answer questions. Our survey, the certification license in unit was also part of that call. And they are collecting additional questions and we'll get responses from the public department in order to push those out on some sort of the frequently asked questions part of our website page. Just today, part of the press, and I don't have it for you, but we developed the VDH guidelines for independent support workers. Anybody who's working one-on-one with an individual could include foster parents, certainly could include first-class population, certainly all of our ARS workers, the independent support workers. That guidance is approved just today. That would be on our website, and we'll push that out to all of the agencies as well. And I found in Japan, this is where there's a lot of initial offering to staff as much information as possible. And finally, we sent out the items to the area in conversation about how to address this issue of crucial nutrition for older homeowners as often as possible. So we have sent out guidelines today to our area agencies on aging in terms of to build meals and stocking up on a freezer, or frozen and shock-ready meals, and the kind of guidance that they give to their volunteer drivers and deliveries and volunteers who deliver home deliveries. We have within the federal government right now to ship some of that hungry meals, those hungry meals to go back so that people can still get the nutrition that doesn't necessarily enter the company. If any of the folks in the room have questions, if you'd like to ask them, please write them down and there's a piece of paper up and you'll be able to comment. Things about the website that we keep pushing here, there's a daily update for there that is really informative and pushes out to sending your account at this site for everybody to go to the website. And I appreciate Dr. Levine and for this situation. I also appreciate Monica's approach and providing the nutrition that is her problem from her presentation, bringing the things she talked about and directly applicable to the populations that DCS serves. So we really appreciate that approach. We are specifically working with the Health Department to develop a guidance for childcare programs that has been reviewed and has not now or is about to go out momentarily, so that's certainly good news. We've also shared the basic information and guidance from the Health Department, certainly with all of our staff, so that as we have one-on-one conversations with a variety of constituencies that we can provide and share that information, we're mindful of the Polish others that we support throughout the state and want to make sure that we provide them with appropriate guidance about having to ask appropriate questions for screening but also frankly having to deal with those challenging situations that might arise as we go forward. And so in addition, we obviously have a substantial number of children in foster care in residential programs and so to that end, again, we provide our staff with a wealth of information and we're working with Monica and the Department of Health in developing a caregiver guidance and protocol that's close to being ready. When that is finalized, we will send it out to our foster parents and to our residential programs, both in-state and out-of-state, to make sure they have that level of guidance from us. In addition, we do make it clear because we're talking about a lot of different stakeholders and constituencies that our staff are available to help support them on a one-to-one basis. So I do want you to know that we are mindful that every situation should be a little bit different. Every person who has concern, we need to be respectful of that and do our best. And oftentimes, obviously, we do a lot of follow-up department help but to the extent we can help support our foster parents who obviously serve an incredibly important role for our children and our community that we want to support them on a case-by-case basis. So we're continuing this effort and let me sort of close there. Thank you very much. Madam Chair, we'll take any questions. I do want to just reiterate between Erica and her team members. And I don't admit that Leigh-Marc was getting in. I haven't asked, but he has really set up under this so-called business department and also Erica and what she's been doing now to attract her to all the information going on. I'm trying to do it in a way where the lanes aren't disrupted. You know, I'm not a commissioner of the public safety but I'm going to speak as a commissioner. I am just delighted with the response that has transpired between all the entities here and the coordination that has gone on. There has been no sort of, you know, this is not the perfect way to get into it at all and the repression. Thank you. First of all, before we get into the questions I just want to say thank you for very comprehensive report to us. And I understand this is typical of you guys. But at least it has covered a lot of different areas that we can now look at further. And I don't have a whole question to think about this, but as Winston Churchill said, maintain calm, carry on. So how is it that you feel that that's happening out in the broader community? So I just ask you to think about that. But there are some questions that we have for the day at home. There's been certain that nursing homes that screening should be done on the farm floor not at the nursing station. And that visitors are shaking hands along the way in the nursing homes. So that's a concern and a fact. There should be no engine. Okay. Once an hour. And I can speak to the nursing station versus the acquisition. Each facility is laid out physically. So I think we are certainly relying on each facility to make the best decisions about where that's where you should happen. I will say that I can try to visit further mental care homes. It's pretty much not at the farm floor. You have a series of questions and then we're waiting at the monitor to answer yes. I would have had my time at your meeting. But I was incredibly grateful for that response. I thought that was just as proactive as I was hoping to be. And I think that I feel like that is the way to deal with this. So we will continue to message out just in case there's any lack of clarity about the visitors. There is another question related to the Bennington area and nursing long-term care facilities in that area. That there should be a limit on visitation apparently the CDC proposal reading recommendations from the CDC that there should be a limit on visitation in facilities in the southwestern part of the state. LTC long-term care facilities is that something that is happening or not happening? So the CDC guidance has been my understanding that it changes quite rapidly and fairly quickly. I know that we had long-term care facilities in the Bennington area on call today because they asked a few questions. So again, we have been encouraged to respond to our amendment to the visitors since last week. I don't know. Krishna? I would say that we will be using generic, if you will, CDC guidance. The CDC has not tried to provide for visitors in the case. They provide a specific opinion question. So I don't need to provide that. Krishna? As a sort of follow-up around these questions that people are having around nursing homes and all of the residential facilities under the ground. Why? Under these staff who actually have access to surveying, certification, who actually can be responding and providing guidance. And then you can give us a number of community facilities they are actually responsible for doing. Yes. So there are 34 nursing homes. 34 and I think to not discriminate about a hundred and thirty-eight across one hundred and thirty-eight or 140 residential care homes. So those are the licensed facilities and that includes the system of the nursing two members. We have gosh, I just did my budget testing. Do you think I would do this? Yeah. I'm sure you, as you were speaking about all of the places that a vulnerable adult community and a older community reside from a shared living from home with personal care that is coming in through a nursing home and all of the incredible work that your staff is trying to do to provide guidance I've heard from some of which I share that is there sufficient staff to carry out these activities. Well certainly this is a very unusual time and so everybody is stretched at this moment in time I think. In terms of our, the number of surveyors that we have surveyors which is you are most of the licensing parents I believe. We have 115 first surveyors for the facilities that I mentioned earlier. And that is the current flu shots help with all of the virus. Not to my knowledge however the flu is widespread across the world today and if you put down a little symptoms on your convention you're more likely to have. It's, um, a response. So any organizing preparedness response training, education volunteer to home and have it delivered to medicine through the support. So, so far the primary guidance to the partner health guidance and the CDC guidance in the we're drafting additional contingency guidance to get more substantial number one and different names if you will on how we roll the information out as well. Was your question worth funding support for those that are actually trained about people and I see that the K-Home found and the plan is to maybe connect with that and yeah. It's also important to point out that every town has a emergency management director who is charged with needing emergency management functions within that jurisdiction internship with the SLR board and so there's a number of resources that are available to them and we will be starting to communicate with them on board spaces, homes and everything on the basis as well as with elected officials on a recording week as a basis and there's a number of different resources out there that are that exist across the state government so I just don't want to spend a lot of time talking about all of you I would recommend that that all of the emergency management directors communicate with us if they have a necessary resource and we'll be able to communicate with them but they think that they're all volunteers there's no formal system for me and others to be in views our whole state is dependent on volunteers and the secretary's the star of the show if there are any questions or do you have to get to the staff and you have been doing an incredible job I've been reading the daily updates and your staff so I'm going to ask the same questions that I asked the commissioner of how many staff do you actually have right now that are able to answer any one of the calls day to day and do versus balance and do all of the things that are necessary I'm thinking of my self-operative staff who they store or their technology staff and how we dare say 50, 60 people and that study was pulled from our health event preparedness and injury prevention staff our leadership and it goes on and on is there a benchmark nationally in terms of population or a band in terms of how many do staff for population or things like that to respond to something like this you know I'm not familiar with one of the reasons and literally it's all exactly and I'm very impressed with what folks have been doing and I'm just trying to make sure that there there needs to be more staff if there needs to be more resources 90 dollars that hold that so that we can make that happen thank you guys we do have some of the routine of the most work that happens every day those individuals are doing this more intensive work that we have been able to shed some of our human resources to recover the routine work we even have people coming in from our vision health offices to do some of that people should understand that the level of our central office work goes on a lot of contact tracing goes on and on and on and on and that actually comes down to assisting the owners who we have told we need to self-isolate self-watering and whatnot that goes down to the vision health office level of which there are several hundred of our employees doing that on and on and on and on I just also mentioned that because the commissioner for today leads back I'll just say eat and to speed during those sort of getting at it we'll provide the resources that are needed if we just don't know yet what is on the scale and what is happening but right now what we've done so far is instrumental and then if I may I know you need to go I want to first acknowledge that from the health care committee's point of view just to be moving any financial barriers to testing which has been communicated through the department of health but I'm not sure everyone knows that information and I think it's important for anyone listening to know that there will be no cost sharing to homeowners who work on commercial insurance cost sharing or Medicare and that if you're uninsured there will be no cost to the state as made as a decision and through emergency both through the department of financial regulation and I think all the logic should be aware that the cost should not be a barrier to seeking testing for treatment with regard to COVID-19 if you believe that's the issue separately I wanted to ask over a period of time I came to the state yesterday it's like oh I'm just going to be back from Seattle and it's like oh Seattle and frankly I think you raised the question of people who are from China etc. are being asked to self-quarantine Seattle is the hotspot in the United States where there's very real concern for widespread transmission etc. Is there any guidance at this point for folks who are coming back from other parts of our country such as Seattle or is it not at the point where we're prepared to say anything more about it? So there's currently no guidance for anyone in the country to be treated like to be trafficked from some of the qualifications but rest assured if you think we're working hard you can imagine what the health department in Washington state is doing and they have a great friendship with us so they are doing all of the same work I mentioned so if there are positive cases and more care facilities they're interviewing and working with all the visitors to that facility and doing the contact tracing which is exhausting because they've been doing this work for weeks and weeks and new cases that are popping up in care facilities which cameras follow the message and the attention from the most vulnerable population who are prone to that knowing that we have 8 plus percent and the rest of the population who might have a heart or a nervous and won't have a heart. I think we should button the 7 and thank you very much for the hours and hours and hours and the work they put into this we greatly appreciate your expertise and what you brought to us. Thanks a lot. Thank you. What are any particular information that's coming up to the business community I think? Sarah has been in communication by the agency of commerce going to the business community that mirrors as much of the same communications and the vast going out to as well if you have an employee that has traveled from these countries and telling the south foreign business community as well. There are some of the aspects of it there are some businesses that are doing the exact same things not just their facilities but actually those facilities questions that add a lot to the other congregate settings that the government mentions is the Department of Corrections I want to repeat someone trust me. I'll be back I spoke with Secretary Baker just a moment and they are screening processes at the entry they actually do screening processes and of course they take care of the screening process to their facilities they are monitoring including facilities to the same process that's happening in that facility just to give you some sense of what procedure they're working on all their plans in terms of isolation we've done a program on this with the country with the food that's happening in the chicken in the few weeks or maybe three weeks ago we had to operate that chicken so we stopped the spread of the food in that facility so we take that very seriously the Department of Corrections does in terms of what they're doing right now so we have a queue and this might be a question for you in terms of economic services and housing what are the housing options for people who need to be vaccinated or quarantine and I can't stay calm there are some of our development matters for visitors or people so what are our housing options for them so as some of this of course is a working project we're starting from the premise of those programs that currently support what we're operating and making sure that we're working constructively with them so in response to your questions we obviously do have shelters as I mentioned earlier where we are trying to provide guidance including the capacity in some of those shelters to potentially have areas where people who are having symptoms can be separated from the rest of the population if there's no other alternatives we plan to provide guidance to our, as I said earlier to our other residential programs for children but in terms of other families and businesses including hotels my thought is we will also provide some guidance with respect to a particular mental health program and that's the project that I understand correctly that we have a program for that does provide housing for people who are homes and the question that you're posing with respect to whether this situation will evolve so that many people need to move into other settings to protect them from becoming real themselves it's honestly something that we have to work forward to work with emergency management and others to figure out how do we respond based on the scale we've ever seen or on the visitor who has just come from somewhere else and I wonder what we've seen and I guess so it's not just the understood and that's where we again need to work together with our other communities to have resources available to make sure that we do take care of our community members is that injustice as I said I just want to reiterate someone presents themselves that is sick and has the symptoms that Dr. Neal was talking about we want them to call the health department as quickly as possible so that we can figure out what to do and how to move them okay so I'm going to ask this question as a double question that begins with Dr. and that is but if the school is closed and employees or teachers are not able to work and how are we looking at compensation that we're looking at in extended budgets but any thoughts there it's not going to last for the next part it's a little early we're having those conversations we do have a distinction the CDC does between a school closure and a school dismissal and I should mention one of the schools in the state did that exactly and actually the second day of the closure in South West they did a dismissal dismissal is when students are not in session with the staff or working so the CDC would recommend that as a possible strategy because a lot of the staff would be available to provide services we have the ability in any locations to provide online learning but to have staff available food services so the court too so so so but the school officials are asking this question so a related question is suppose the school is closed but people still need to work and they don't have childcare and how are we communicating with businesses about that kind of situation and that is a very good question and one that we're really looking at also look at right now we've had that we've reached out there's a couple of ways how do we provide assistance to those people that say that they're employed right now I can't afford for you to be home so I can't pay you we're looking at that right now we've reached out for these federal changes in whether there's an on-point insurance law that you may or may not have to do okay I have two more questions one is pretty rare to the two on one and the calls that are coming in do we have sufficient resources for people to respond to those calls yes we do Eric if you want to do these the law needs to let me check me under the table if I'm wrong but those two on one are remarkably lower than what we expected on the other hand the hit to the website has been quite robust as we which is we want to be honest we want people to visit that website to get it to the end of the latest information possible unless you wake me up the recent numbers that I saw 31 numbers that I saw for last week it may increase as concern increases but it hasn't been overwhelming to the system we have we are close to the two on one service and they are making some planning for anticipating additional to look for additional volunteers to staff on the call center so they are actively planning for that directly last question is what legally can be done if an individual has decided that he or she is not going to self-quarantine even if it's cold to do so if you stop that from traveling around a community or two events I think that's been on the minds of a lot of people since the recent event there has been an incident that we sort of I remember as you again taking under the table and lost being able to quarantine if possible I think it came to be confirmed to people I remember it said he had traveled to Africa and had not was not self-quarantine he I think we did some research I wasn't in the state government at the time I was the only guy in the state government but it was it was something we do have at the end we do have we do have laws it is on the books it's very old it's still valid we use an update but it's there but it's there it's there so the decision on the health has the authority to to mandate quarantine and we would work with partners to enforce that quarantine if that person but we would want to work with that person through mediation to understand why they want to quarantine or why they thought they couldn't so it's like the vast majority of volunteers want to protect their monitors around them and that's a pretty strong location we do get the one-off situation and that's why we have a state emergency activity and when we meet those challenges we can make sure we're within that in an important fashion we ask a general question we have 108 legislators who reach, represent our communities and we're reached out to a variety of basic circumstances of concerns and questions that we're looking for in trying to provide information in general we've been encouraged over the years to call the agency or department to go directly to the commissioner's office and get our questions directed properly is there any further or different guidance is there a single point of contact that you would like to recommend that we use or how can we like best proceed we met with leadership this morning and they said that is not the broadest so all of them are going to answer that question so we're working with the administration to make sure that we get some guidance to understand the leadership about a single point of contact because we do recognize that we have many consistent questions that come in and I would say this is a guidance for all of your constituents it's how you visit the LPR website because there's a lot of great information there and we're all 2-1-1 if you have a general question but often at this point if those are coming to you I would suggest that they have some people get unstuck and so I think what we're going to do is we're going to have the primary contact to those questions but we're also going to be sure to get that communicated in a formal way and as the microphone transits by this is also an opportunity for my to subscribe to the vtealer we began doing that today as a mechanism just to get general information and to remind us how it looks like the signboards that are out that the transits using as well can you give us just an explanation of how to subscribe to vteals yes and go to the Department of Public Safety this is a website where you just google vtealer or go to vtealer.gov and you can subscribe to the minister's e-mail as well terrific, so that's gone out now on live streaming so I hope that some folks have heard of that any other questions? thank you thank you all you said one last thing about the point of contact that's a simple point