►
Description
California Health and Human Services Secretary Dr. Mark Ghaly provides an update on the State of California's response to the COVID-19 pandemic.
Recorded December 29, 2020.
For more information regarding the impact of the COVID-19 outbreak in Cupertino, please visit https://www.cupertino.org/coronavirus.
B
Good
afternoon,
everyone,
and,
as
always
thanks
for
joining
us
today,
we
have
a
lot
of
information
to
get
through
I'll.
Just
tell
you
at
the
top
we're
gonna
try
to
describe,
as
we
always
do
our
daily
data
and
give
you
the
context
of
what's
happening
with
covet
across
the
state.
B
I'm
going
to
then
spend
some
time
on
crisis
care
and
the
crisis
care
continuum,
and
some
of
the
efforts
that
the
state
is
taking
to
work
with
our
counties
and
our
hospitals
to
be
prepared
and
do
all
we
can
to
support
patient
care
I'll,
be
joined
by
director
of
the
department
of
aging,
kim
mccoy
wade.
A
colleague
of
mine
who's
been
spectacular,
and
it's
going
to
help
me
talk
through
some
of
that
information.
B
We'll
then
go
to
the
regional
stay-at-home
order
and
what
we're
seeing
in
terms
of
projections
and
frankly,
dig
in
a
little
bit
to
how
we
make
the
projections
four
weeks
out.
So
many
of
you
can
understand
that
a
little
better
and
then
it
is
tuesday
after
all
and
tier
tuesday,
we're
going
to
talk
about
any
tier
updates
that
we
have
so
we'll
go
right
to
the
first
slide.
B
So
we've
talked
a
little
bit
about
this.
There
are
like
high
case
numbers
lower
than
we've
seen
before,
but
31
245
cases
reported
today
our
seven
day
average,
still
nearly
thirty
seven
thousand
500.
B
However,
our
test
positivity
has
been,
thankfully
not
going
up
too
much
but
stable
in
this
12
and
a
half
percent
range
today,
12.6
14
day
positivity
in
the
face
of
nearly
246
000
tests
remind
you
that
we've
been
averaging
over
300
000
tests
over
the
last
many
days.
Next
slide
again.
B
Our
day,
positivities
at
12
14
day
hanging
there
consistently
at
12.6
percent
again
a
lower
seven
day,
positivity
versus
the
14
day
shows
that
the
most
recent
days
have
been
slightly
lower
than
those
other
that
that
sort
of
first
week,
those
first
seven
days
in
that
14
day
range,
which,
from
this
standpoint
is
good
news.
That
said,
nearly
19
increase
over
the
past
two
weeks
in
our
test,
positivity,
which
is
something
we've
been
highlighting
for
all
of
you
over
the
last
many
days.
B
Next
slide
again,
we've
been
focused,
as
we
should
be
about
the
intense
critical
situation
in
our
hospitals
across
the
state,
we're
looking
at
the
numbers
over
20
000,
current
hospital
admissions
due
to
covid,
seeing
a
36
and
a
half
percent
increase
in
the
last
14
days.
This
is
a
tremendous
amount
of
work
for
these
hospital
systems.
Something
we'll
spend
a
little
bit
more
time
talking
about
in
a
moment.
Similarly,
in
the
intensive
care
units,
hospitalizations
have
increased
over
35
in
the
past
14
days
now,
over
4
300
total
icu
admissions
across
the
state.
B
Again,
a
theme
today
will
be-
and
this
is
not
evenly
distributed
across
the
state-
the
northern
part
of
the
state
still
seeing
capacity
that
the
hospitals
can
not
just
surge
into,
but
even
in
some
of
the
routine
capacity,
their
space
ability
to
deliver
routine
emergency
care
for
things
like
heart,
heart
issues,
heart
attacks,
strokes,
other
trauma,
car
accidents,
etc,
still
very
strong,
but
in
southern
california,
quite
a
different
story,
as
we
reflected
yesterday,
hospitals
that
are
running
out
of
staff
having
to
use
rooms
that
they
don't
traditionally
do
longer
than
normal,
much
longer
than
normal,
wait
times
in
emergency
departments,
etc.
B
Many
have
been
tracking
conversations
that
we
started
early
on
well
before
we
thought
we
needed
them
working
broadly
with
a
whole
number
of
people
in
the
state
to
talk
through
what
is
this
continuum
just
to
sort
of
level
set
and
give
you
a
little
sense
we
try
to
spend
and
in
normal
times
we're
our
hospitals
are
delivering
care
in
what
we
call
the
conventional
care
section
of
this
chart
you'll
see
that
the
space
is
usually
what
we'd
expect
single
bed
single
rooms
with
single
beds,
double
rooms
or
group
rooms,
with
appropriate
number
of
beds,
icus
with
patients
in
one
bay,
emergency
departments
who
aren't
boarding
and
keeping
patients
who
really
need
icu
care
nor
longer
than
normal
staff
used
in
the
sort
of
usual
complement
of
staff.
B
That
you'd
expect
in
each
unit
supplies
that
are
readily
available,
and
that
are
you
know
available
not
just
on
the
nursing
floor
or
the
the
medical
ward,
but
also
in
the
warehouses
of
each
hospital,
and
that
we're
sort
of
at
this
usual
level
of
care,
contingency
care
which,
frankly,
most
hospitals
in
california,
are
operating
today
in
contingency
care.
This
is
where
you
start
to
see
space
in
the
hospital
that
is
used
for
other
types
of
care.
B
Here's
an
example,
the
post-op
or
the
pre-op
beds
in
certain
hospitals
are
now
being
used
to
serve
covid
patients
or
non-coveted
patients
to
make
sure
that
we
have
all
the
care
spaces.
We
need
again
single
occupancy
rooms,
converted
to
double
or
even
more
occupancy
rooms,
staff
who
are
working
longer
shifts
in
different
staffing
configurations
with
different
levels
of
supervision
supplies
you're
in
this
mode
of
trying
to
conserve
them,
adapt
them
occasionally
reusing
supplies
that
you
would
otherwise
dispose
of
again
doing
that
safely
and
then
levels
of
care
functionally
equivalent,
but
they
may
be.
B
You
may
be
delaying
movement
of
patients
between
levels
of
care
for
some
rate,
limiting
steps
such
as
staff
or
space,
and
then
what
we
are
spending
so
much
of
our
time,
trying
to
avoid
across
the
state
making
sure
that
hospitals
don't
move
past
this
contingency
care
area,
avoiding
this
crisis
care
where
you're
seeing
space
used,
not
just
in
unusual
ways,
but
that
the
space
doesn't
have
all
that
it
needs
that
you're
using
cots
instead
of
hospital
beds.
B
That
units
where
you
normally
have
all
of
your
monitored
patients
on
on
different
important
monitors
to
keep
managing
care
that
they
are
in
other
parts
of
the
hospital
that
they
aren't
usually
found
in
staff,
are
working
significantly
in
different
configurations
supplies
and
I'm
going
to
use
the
word
here.
That
I
think,
is
it's
an
important
one
to
emphasize
that
in
crisis
care
you
are
in
situations
with.
B
Occasionally
you
have
to
ration
certain
supplies,
certain
therapies
and
even
in
a
case
where
you
may
have
to
ration
your
staff
that
there
might
be
situations
where
certainly
staff
are
stretched.
Pretty
thin
and
not
every
patient
gets
the
same
level
of
attention
that
we
would
hope
they
would
in
either
conventional
or
contingency
care
situations.
B
And
then
the
level
of
care
is
in
crisis.
You
may
have
to
triage
medical
care,
decide
how
you're
going
to
use
other
scarce
resources
again,
something
that
we
need
to
plan
for
be
prepared
around,
but
do
everything
in
our
power
today
to
keep
us
from
being
in
this
situation
across
the
state?
Not
just
you
know,
within
the
region,
but
every
single
facility
providing
care
to
covet
patients.
We're
working
hard
to
make
sure
we
can
keep
them
out
of
crisis
care
as
long
and
as
much
as
possible.
Next
slide,
please!
B
So
what's
our
current
situation
here,
you
know
certainly
with
the
current
surge.
B
That's
where
the
pharmacies
are.
That's
where
the
labs
are.
That's
where
the
personnel
are,
that
can
make
care
happen,
better,
smarter
and
more
efficiently,
efficiently
and
in
a
higher
quality
way.
So
we
continue
to
work
to
bring
as
much
care
at
those
in
those
existing
hospitals
as
possible,
but
we
do
have
to
acknowledge
that
we
need
to
be
prepared
for
the
possibility
that
some
hospitals
will
need
to
resort
to
crisis
care
that
in
which,
as
I
said,
medical
professionals
have
to
make
hard
choices
and
allocate
resources
different
than
we
usually
do
next
slide.
B
This
is
this
is
what
we've
spent
many
many
months
on
working
with
a
number
of
partners
and
kim
will
be
walking
us
through
that
in
just
a
minute,
but
it's
to
emphasize
that
this
care
needs
to
be
guided
by
ethics,
equity
and
in
a
transparent
way.
If
hospitals,
if
individual
hospitals
in
a
county
or
region
report
implementing
crisis
care
that
they've
moved
beyond
contingency
care,
then
other
hospitals
will
be
asked
to
share
their
resources
and
temporarily
change
their
operations.
B
This
is
something
we've
been
having
many
many
discussions.
Late
night
discussions
and
conversations
with
hospital
leaders,
association,
leaders
across
impacted
regions
to
make
sure
we
are
preparing
for
a
hospital
that
maybe
isn't
as
big
as
some
of
the
ones
we're
used
to
are
in
communities
where
there's
a
great
disproportionate
impact
that
have
had
a
hard
time,
keeping
their
staff.
You
know
healthy
and
in
in
the
hospitals,
working
that
we
may
need
to
call
upon
some
bigger
facilities
to
support
smaller
facilities,
less
impacted
facili
facilities
to
support
the
more
impacted
ones.
B
We
expect
to
do
that
with
a
great
deal
of
planning
and
to
do
it
with
haste
when
it
needs
to
happen
so
that
we
can
continue
to
save
as
many
lives
as
possible.
Next.
C
B
Please
so
now
I'll
ask
kim
mccoy
wade
to
go
over
the
next
few
few
slides
thanks.
D
E
Thank
you
secretary,
and
thank
you
so
much
for
including
the
department
of
aging.
In
this
conversation
of
great
importance
to
californians
of
all
ages.
We
wanted
to
start
with
how
we
are
taking
our
commitment
to
be
a
california
for
all
to
meet
this
challenging
moment
and
really
just
lay
out
the
state's
high
level
goals.
First
and
foremost,
as
the
secretary
said,
that
hospitals
are
able
to
remain
in
that
conventional,
that
normal
operational
state
of
business
or
contingent
care,
if
need
be,
but
stay
in
those
two
zones
for
as
long
as
possible.
E
E
Next
slide,
please.
So
to
do
that,
we
always
try
to
be
person-centered
and
data-driven
and
begin
by
listening.
So
this
winter
and
spring
we
were
able-
and
I
want
to
just
commend
my
colleagues
at
the
department
of
public
health
for
their
great
leadership
and
partnership
in
this
effort
in
listening
to
hospitals
to
health
systems
to
local
health
jurisdictions,
emergency
services,
the
aging
community,
disability
community
and
more
to
hear
from
those
members
of
our
california
community
about
what
was
needed
to
do
effective
crisis
care
continuum
planning.
E
We
this
spring
formed
an
advisory
group
with
some
of
california's
leading
doctors,
medical
ethicists,
aging,
disability
and
health
equity
leaders
to
advise
us
to
be
that
sounding
board
to
work
through
these
issues
in
an
expert
in
an
expert
in
collaborative
way
and
throughout
again
we
are
monitoring
this
field
for
state
and
national
guidelines
and,
in
fact,
even
international
looking
at
other
examples
leading
california,
health
systems
have
been
models
to
us
as
well,
in
continuing
evolving
literature,
as
we
all
face
the
covet
moment
together
just
to
drill
down
on
my
next
and
last
slide,
I
want
to
be
very
specific
about
what
it
means
to
be
a
california
for
all
in
the
crisis
care
moment
next
slide.
E
What
is
the
approach
that
california
is
taking
and
is
recommended
in
our
guidelines
in
june,
and
reiterated
in
our
implementation
guidance
this
week
is
that
medical
decisions
primarily
are
grounded
in
the
likelihood
of
surviving
in
the
near
term.
That
is
the
appropriate
basis
for
these
decisions.
These
other
factors
are
not
so
with
that
baseline.
I
want
to
hand
it
back
to
our
secretary
for
the
way
forward.
B
Thank
you
kim
and
thank
you
for
your
tremendous
leadership
on
this
topic,
but
so
many
in
the
department
of
aging
your
work
on
the
master
plan
for
aging
and
a
number
of
other
efforts.
California,
is
better
because
of
your
leadership,
and
so
thank
you
and
grateful
for
all.
You've
done
next
slide.
B
Please
so
just
to
bring
this
section
to
a
close.
I
know
there'll
be
questions
in
the
q
a
and
happy
to
take
them,
but
just
to
be
clear,
our
our
role,
the
state's
role
in
crisis
care,
is
to
help
hospitals
prevent
moving
into
crisis
care.
That's
first
and
foremost,
that
means
getting
a
good
sense
of
what's
happening
on
the
ground,
communicating
with
our
local
leaders
and
our
hospital
leaders
ensuring
that
also
that
hospitals
are
planning
for
crisis
care.
No
one
wants
to
have
crisis
care
situations
sneak
up
on
them.
B
We've
tried
to
give
time
to
plan
that
each
hospital
can
create
their
committees
of
experts
trained
professionals,
not
just
in
providing
care,
but
thinking
about
crisis
care,
so
they
make
decisions
based
on
the
equity
principles,
the
transparency
principles,
the
fairness
principles
that
we
have
outlined
outlined
earlier
and
that
we
also
help
hospitals
remain
in
crisis
care
for
as
little
time
as
possible
that
they
quickly
returned
to
contingency
or
conventional
care.
B
What
the
state
does
not
do
is
determine
facility
by
facility
when
they
resort
to
crisis
care
standards,
that's
determined
by
the
hospital
based
on
the
need
for
hospitalization
and
the
available
resources.
We
have
worked.
The
final
statement
I
may
I
will
make
is
we
have
worked
as
a
state
so
hard
and
so
long
to
be
ready.
We
did
so
much
early
on
in
this
pandemic
response.
B
Maybe
maybe
you
don't
have
access
to
the
same
level
of
resources.
We
want
to
do
all
that.
We
can
that
we
make
sure
patients
in
underserved
lower
resource
communities
places
where
hospitals
are
overwhelmed,
that
we
give
some
of
those
patients
as
many
as
possible
a
chance
to
get
care
in
areas
that
have
capacity
even
though
they're
stretched.
They
may
not
be
stretched
as
far
and
making
sure
we
work
to
do
that
with
our
hospital
partners,
and
other
leaders
is
a
top
priority
right
now
for
california
and
it's
in
play
in
southern
california.
B
B
So
today
I
want
to
walk
through
what
we're
projecting
to
see
for
those
first,
two
regions
that
are
eligible
to
exit
the
regional
state
home
order
and
then
spend
a
few
minutes
explaining
the
details
of
how
we
set
those
projections
so
to
remind
you,
five
regions
across
the
state,
currently
four
of
these
regions
all
but
the
northern
california
region,
27.9
available,
icu
capacity
there
today,
all
but
that
region,
the
northern
california
region,
are
under
the
regional
stay-at-home
order.
B
The
first
two
regions
to
enter
that
regional
stay-at-home
order
were
san
joaquin
valley
and
southern
california,
as
you
can
see
here
that
our
calculations
show
a
zero
percent
icu
capacity
available
today.
Really
what
that
means
isn't
that
there
isn't
a
single
bed
open
hospitals
that
we
just
described
are
doing
all
that
they
can
to
staff
up
and
create
space
for
beds.
B
What
it
means
is
that
these
two
regions
are
in
their
surge
capacity
in
the
aggregate,
so
one
hospital,
one
community,
one
part
of
a
county
one
whole
county-
may
actually
be
only
all
of
their
hospitals
in
surge
capacity,
while
other
parts
of
the
region
still
have
capacity.
So
the
point
of
a
regional
approach
is
to
make
sure
that
we
take
care
of
as
many
californians
with
those
regional
assets
as
possible,
and
this
is
what
we're
doing
in
southern
california
and
the
san
joaquin
valley
next
slide.
B
So
again,
the
reminder
is
that
we
set
the
regional
stay-at-home
order,
and
regions
must
remain
under
the
order
for
at
least
three
weeks
and
shall
continue
in
that
order
until
the
icu
projections
are
above
or
equal
to
15
percent.
B
So
today
the
order
will
remain
because
those
projections
do
not
show
that
san
joaquin
valley
and
southern
california
have
projected
four
weeks
out
icu
capacity
over
15
percent.
So
they
will
remain
under
the
order.
For
the
time
being,
we
essentially
are
projecting
that
the
icu
capacity
is
not
improving
in
southern
california,
in
san
joaquin
valley,
and
that
demand
will
continue
to
exceed
capacity,
and
we
will
continue
to
run
these
assessments
as
we've
committed
to
on
a
daily
basis
and
update
them
daily
to
the
public.
Next
slide.
Please.
B
B
Again,
we
want
that
to
be
under
one,
ideally,
certainly
at
one
to
make
sure
that
we
aren't
continuing
to
increase
our
transmission
in
a
community
or
an
area,
but
here
1.13
still
means
that
we
are
still
seeing
increased
rates
of
transmission,
so
the
icu
demand
exceeds
capacity
for
san
joaquin
valley
at
four
weeks.
Similarly,
southern
california
130.1
case
rate
per
100
000
per
day
population,
a
slightly
lower,
are
effective,
but
still
well
above
one
and
then
similarly,
the
icu
projection
four
weeks
out
is
demand
exceeds
capacity.
B
A
B
B
So
I've
highlighted
a
bit
of
this
already,
but
I
wanted
to
share
some
information
on
how
these
projections
are
made,
and
you
saw
some
of
the
inputs
on
the
prior
slide,
but
I'll
go
a
little
deeper
here.
So,
as
I
said,
these
projections
are
going
to
be
run
by
the
california
department
of
public
health
data
team.
B
Pretty
incredible
scientists,
statisticians
epidemiologists
folks,
who've
been
thinking
hard,
even
individuals
who
are
spending
time
working
themselves
in
hospitals
and
understand
the
where
the
rubber
meets
the
road
with
these
calculations
from
doing
this
on
a
daily
basis
and
updating
us
and
the
public
regularly.
B
These
projections
are
really
based
on
four
regional
inputs,
so
factors
that
are
regionally
based
that
come
into
our
projections.
The
first
one
and
and
much
of
this
won't
be
a
surprise,
but
it's
important
to
walk
through
the
current
icu
capacity
in
any
region
is
the
first
detail
that
that
we
start
with
the
second
one
is
that
current
seven
day
average
case
rate?
B
These
four
factors
come
together
and
certainly
I'll
just
walk
through
a
little
bit
of
the
more
specifics
to
understand
the
projections.
So
if
you
are
already
at
quite
a
significant
deficit
with
your
current
icu
capacity,
the
likelihood
that
your
four-week
projection
is
going
to
be
above
15
is
going
to
be
much
smaller.
B
Then,
of
course,
it's
about
transmission
rate.
How
fast
is
the
virus
spreading
in
your
neck
of
the
woods
in
the
region
that
is
under
the
stay-at-home
order?
The
higher
it
is,
the
less
likely
a
projection
is
going
to
be
above
15,
considering
moving
forward
that
are
effective,
takes
into
account
actual
rates
of
transmission,
as
well
as
factors
around
our
stay-at-home
order,
our
ability
to
keep
and
be
compliant
with
masks,
etc.
B
As
a
related
point,
we
have
seen
that
the
average
age
of
those
admitted
with
covid
has
risen
over
the
past
couple
of
weeks.
It
had
been
below
16
now
it
is
above
the
age
of
60..
B
We
also
know
that
most
of
the
individuals
who
have
the
worst
outcomes
and
pass
away
because
of
kovid
are
in
fact
our
oldest
californians
and
those
with
underlying
conditions,
and
that
is
another
important
factor
of
our
ability
to
protect
those
most
vulnerable
to
not
just
serve
and
support
them
and
their
families,
but
also
to
support
the
overall
healthcare
delivery
system
that
we
are
looking
after
now
again.
If
these
projections
are
above
that
15
at
any
day
or
time,
then
the
region
is
released
from
the
order.
B
This
is
not
when
I
say
its
remains
in
southern
california.
The
order
remains
in
san
joaquin
valley.
It
is
not
to
say
that
it
is
there
again
for
at
least
another
three
weeks.
It
could
be
shorter
than
that,
depending
on
how
these
four
factors
come
together
on
a
day
over
day
basis
and
again,
if
the
projection
is
below
15,
that
region
remains
next
slide
please.
B
So
we
will
end
with
this.
It's
been
a
number
of
weeks
since
we've
had
a
conversation
about
our
blueprint.
You'll
remember.
At
the
end
of
august,
we
unveiled
our
blueprint
for
a
safer
economy.
B
Four
tiers
purple,
red
orange
and
yellow
early
on
many
many
counties
were
in
purple
and
we
spent
the
better
of
two
months
moving
counties
through
these
various
tiers,
which
allowed
for
fewer
restrictions,
more
business
sectors
to
operate
at
higher
percentages
of
their
normal
business,
even
had
a
relation
to
everything
from
worship
and
schools
and
sort
of
many
of
the
things
that
we
we
normally
enjoy
and
participate
in.
B
But
it's
been
many
weeks
since
really
we've
had
anything
to
update
the
biggest
updates
have
been
county
by
county
moving
into
the
purple
tier
across
the
state,
but
today
there
is
one
county
humboldt
county
that
is
met
the
threshold,
the
same
thresholds
that
we've
always
used
under
the
blueprint
to
move
from
purple
to
red
tier.
So
today,
54
counties
remain
in
purple
three
in
red,
with
this
edition
of
humboldt
one
in
orange
and
zero
in
yellow
next
slide.
Please
so
as
always,
it's
a
reminder
that
together
we
can
stop
this
surge.
B
B
Much
of
what
we
are
seeing
can
be
stopped
if
we
collectively
make
decisions
to
stop
it
and
those
decisions
are
to
wear
our
mask
to
stay
at
home
as
much
as
we
can
at
this
critical
time
and
when
we
do
go
out
to
make
sure
that
we
keep
physically
distanced
that
we
don't
mix
with
anybody
outside
of
our
household
for
the
time
being
and
that
we
do
as
much
as
we
can
to
keep
our
mask
on
those
simple
tools.
I
know
we've
talked
about
it
for
so
long.
B
B
Maybe
they
are
in
our
community
or
maybe
they're
far
away,
but
still,
nonetheless,
a
californian
shoulder
to
shoulder
with
us,
and
we
want
to
continue
to
be
about
supporting
and
saving
lives
as
much
as
we
can
as
we
get
through
this
winter
search.
I
know
we've
just
gone
through
an
important
holiday
period.
B
We
brace
to
see
what
levels
of
transmission
we
see
coming
out
of
these
important
moments
of
celebration,
but
I'll
remind
you,
as
we
go
into
the
new
year's
weekend,
do
as
much
as
you
can
decide
to
celebrate,
virtually
make
a
decision
to
protect
yourself
and
your
fellow
californians
and
help
us
stop
this
search.
C
C
There
can
you
please
explain
in
plain
language
and
in
more
detail
how
the
icu
capacity
itself
is
calculated.
You
did
some
of
that,
but
how
does
that
explain?
Data
that
shows
the
county
has
hundreds
of
beds
available,
like
los
angeles
county
and
yet
that
region
is
still
listed
as
having
zero
percent
capacity.
How
is
that?
How
is
that
possible?
Thank
you.
B
Sure
so
from
the
beginning,
we
have
looked
to
make
sure
that
our
icus
our
whole
healthcare
delivery
system
is
not
just
available
to
take
care
of
covet
patients,
but
for
all
our
patients,
and
so
when
we
have
seen
hospitals
with
icu
capacity
used
up
for
covid
above
30
percent.
B
We
consider
that
icu
in
that
facility
or
that
region's
icu
capacity
really
ill
prepared
to
serve
and
support
individuals
with
other
sorts
of
urgent
and
emergent
needs,
like
heart
attack,
strokes
other
trauma,
so
we
do
essentially
protect
some
of
that
capacity.
To
make
sure
we
can
take
care
of
other
much
needed
services
in
those
facilities,
and
so
in
some
ways
we
adjust
that
rate
to
make
sure
that
we
have
that
capacity,
not
just
for
covid
but
for
others,
and
so
whatever
we
take
as
the
actual
capacity
in
a
specific
facility
or
in
a
specific
region.
G
Hi,
dr
galley,
thanks
for
taking
our
questions
and
giving
us
this
important
information
today,
I
wonder
if
it
might
be
appropriate
as
we're
approaching
the
end
of
the
year
to
look
back
at
the
last
couple
of
months,
the
last
nine
months.
G
I
wonder
if
you
could
share
what
you
feel
california
has
done
really
well
and
maybe
what
lessons
the
state
has
learned
during
this
pandemic
and
maybe
were
there
things
that
the
state
didn't
anticipate
that
was
simply
out
of
the
control
of
public
health
officials.
Thank
you.
B
Yeah,
I
mean
it's
a
it's
an
incredibly
important
question
and
I
I
do
save
some
time
and
with
the
team
and
with
others
that
I
trust
and
value
to
reflect
on
what
the
last
10
months
has
looked
like
for
us
and
I'll
remind
you.
We
started
this
in
january,
talking
about
repatriation
flights
and
and
cruise
ships
and
really
how
we
were
going
to
prepare
for
those
first
cases.
B
In
those
first
few
months,
we
could
have
easily
had
a
tremendous
level
of
spread
had
we
not
had
local
leaders
and
state
leaders
that
made
the
decisions
that
they
did
and
we
wouldn't
be
talking
about
this
one
necessarily
as
our
hardest
or
worst
surge
we
might
have.
But
we
would
have
certainly
had
a
significant
degree
of
lives
lost
early
on
and
we
didn't
in
california.
B
Because
of
the
actions
we
had
a
chance
to
prepare
and
learn
about
different
therapies,
about
things
like
when
to
put
a
patient
on
a
ventilator
when
to
just
use
different,
less
invasive
forms
of
respiratory
support,
how
to
staff
up
our
clinics
and
our
hospitals.
How
to
use
different
medications
that
we've
used
in
other
disorders
and
diseases
successfully
with
covet
as
well.
So
all
of
those
tools
have
literally
given
us
time
to
learn
and
save
many
many
lives
across
the
state.
B
The
level
of
impact
on
our
day-to-day
lives
has
been
tremendous
and
wherein
we
might
have
been
able
to
do
it
for
three
four
five,
six
seven
months
getting
to
this
point.
It
feels
long
for
many
people
and
acknowledging
that
and
trying
to
work
with
our
communities
to
find
ways
to
hold
on
a
little
longer
to
get
through
this
period
of
extreme
difficulty,
where
we're
losing
californians
day
over
day
in
in
large
numbers.
Because
of
some
of
the
actions
that
I
know
most
are
not.
B
B
So
those
are
some
of
the
highlights
that
I
think
about
often-
and
I
reflect
on
with
a
number
of
our
other
leaders
and
continuing
to
try
to
do
all
we
can
to
get
through
this
difficult
time,
but
also
prepare
for
a
time
when
we
do
have
a
wide
scale,
distribution
of
the
vaccines
that
we
do
bring
back
certain
things
that
we've
had
to
defer
for
quite
some
time,
and
we
start
doing
those
again.
How
do
we
do
those
safely?
B
How
do
the
lessons
of
the
last
many
months
help
us
do
those
in
the
best
way
possible,
while
making
sure
that
we
stay
safe,
and
we
get
to
the
other
side
of
this,
with,
as
many
californians
and
much
of
california
standing
strong
standing
stronger
actually
than
we
were
before
this
pandemic?.
F
G
F
Hospitals
that
have
had
to
begin
to
ration
care
or
declare
they
are
in
crisis
care
and,
if
so,
in
what
counties,
and
will
this
be
publicly
disclosed
when
it
happens?
Second,
I'm
hearing
about
er
so
cool
that
emergency
doctors
are
assigned
16
patients
per
hour.
Do
you
believe
the
quality
of
care
has
deteriorated
to
the
point
that
the
likelihood
of
dying
is
now
greater?
Finally,
there's
a
problem
with
supplies
that
hospital
patients
in
l.a
county,
at
least
one
hospital
in
gardena,
have
told.
B
Thanks
so
much
yeah,
so
I
I
heard
a
few.
I
heard
most
of
your
question
that
you
were
cutting
in
and
out,
but
I
believe
I
have
the
three
parts
so
I'll
start
with
them
and
if
I
miss
them,
somebody
can
remind
me
and
I'll
try
to
pick
it
up
later.
But
to
your
first
question:
there's
no
doubt
this
is
a
continuum.
B
B
They
happen
with
our
emergency
services
systems
and
how,
even
as
we
have
set
protocols
in
the
county,
I
live
in
in
los
angeles
county,
where
our
ems
providers
are,
you
know,
assessing
patients
and
releasing
them
to
stay
at
home,
because
they
aren't
quite
sick
enough
to
need
hospital
level
care
that
if
they
did
come
to
the
hospital,
they
may
not
get
the
type
of
attention
that
they
might
expect
and
they
continue
to
be
monitored
in
some
ways.
That
is
certainly
an
example
of
doing
something.
B
Now
there
are
emergency
room,
physicians
and
icu,
clinicians
and
nurses
looking
at
how
they
stretch
themselves
effectively
to
so
many
different
patients
and,
of
course,
as
I
was
sort
of
describing
in
the
rubber
band
analogy
that
if
you
stretch
far
enough,
certainly
the
ability
to
address
all
of
a
patient's
needs
to
address
the
demands
of
new
patients
becomes
harder
and
certainly
care
can
and
is
suffering
because
of
the
level
of
overwhelm
some
of
these
facilities
have
taken.
On.
B
With
regard
to
your
question
about
transparency,
we
have
asked
and
part
of
what
director
kim
mccoy
wade
was
describing
was
a
a
new
newly
released
and
frankly,
a
lot
of.
It
is
a
reminder
by
the
california
department
of
public
health
to
all
facilities,
all
acute
care
hospitals
in
the
state
about
their
obligation
to
be
prepared
to
think
through
crisis
care
ahead
of
time.
B
To
do
all
they
can
a
checklist
released
to
make
sure
that
facilities
are
doing
what
they
can
to
prevent
going
into
crisis
care
and
when
they
do
cross,
that
sort
of
continuum
and
they're
moving
towards
more
crisis
care
decision
making
to
have
a
notification
made
to
both
the
local
public
health
department,
as
well
as
the
california
department
of
public
health.
To
your
last
question
on
oxygen,
we
have
been
for
many
weeks
looking
at
issues
around
oxygen,
not
just
the
availability
of
oxygen.
B
The
containers
that
might
be
mobile
wall
based
oxygen,
not
just
the
availability
of
oxygen,
but
actually
the
ability
for
hospitals
in
in
spaces
where
they
aren't
usual,
used
to
delivering
oxygen,
to
be
able
to
do
it
in
facilities
where
you
know,
they've
been
able
to
handle
a
degree
of
delivery
of
oxygen
at
one
level,
but
that
we
surpass
it
because
so
many
patients
need
high
flow
oxygen
or
are
on
ventilators
that
the
capacity
of
the
building
is
stretched
to
a
point
where
they
can't
effectively
deliver
oxygen.
B
Cal
oes,
who
are
working
to
make
sure
we
meet
all
of
those
needs.
We
have
been
reached
out
to
by
specific
hospitals
around
oxygen
needs
and
we're
doing
all
that
we
can
to
not
just
meet
those
needs
from
a
state
and
local
resource
effort,
but
also
helping
support
partnering
through
nearby
facilities
to
make
sure
the
needs
for
those
patients
are
met.
As.
G
Hi
journal
galley.
Thank
you
so
much
for
taking
our
questions.
I
have
three
questions.
First
of
all,
I
just
wanted
to
clarify
a
follow-up
to
ron's
question.
G
Just
now,
are
you
saying
that
you're
not
aware
of
any
hospitals
throughout
california
that
are
in
the
crisis
care
category
already
I
mean
you
mentioned
kind
of
some
of
those
decisions,
difficult
assessments
that
are
being
made
already,
but
you
kind
of
related
that
to
contingency
care
versus
crisis
care,
some
of
the
things
that
we're
hearing
from
doctors
in
southern
california-
including
you
know,
ambulances
having
to
circle
before
they
can
drop
off
patients
at
hospitals
or
patients
being
treated
in
the
ambulance
or
in
you
know,
beds
or
in
gift
shops
or
whatever
have
you.
G
It
sounds
a
little
bit
like
the
crisis
care
that
you
described
so
if
you
could
clarify
that.
Secondly,
if
you
could
go
into
more
detail
about
what
is
happening
in
southern
california
right
now,
that
makes
it
so
concerning.
I
know
that
there's
been
a
little
bit
of
a
pause,
a
flattening
of
new
cases
and
elsewhere
in
the
state,
but
you
know
what
is
it
about
southern
california,
the
hospital
situation
and
capacity
situation
right
now
that
really
concerns
statewide
officials
and
then.
G
Thirdly,
I
know
that
governor
newsom
referenced
a
team
of
state
folks
who
are
going
to
be
coming
down
to
los
angeles.
I
don't
know
if
they're
here,
yet,
if
you
could,
if
you
could
clarify
that
and
what
exactly
they'll
be
doing
operationally,
I
wonder
if
the
capacity
to
coordinate
hospital
capacity
didn't
exist
already
or
that
it
wasn't
it
needed
to
be
strengthened.
Somehow
you
could
go
into
more
detail
about
what
those
folks
will
be
doing.
Thank
you.
B
Sure
yeah,
thank
you
for
the
question
and
opportunity
to
clarify,
so
we
have
not
been
noticed
by
a
facility
that
they
are
in
crisis
care
that
they
have
instituted
their
crisis
care
guidelines.
That
said,
it's
absolutely
true
and
let
me
just
be
crystal
clear
that
some
hospitals
in
southern
california
have
put
in
place
some
practices
that
would
be
part
of
crisis
care,
whether
those
are
decisions
about
how
ambulances
are
received
into
the
facility
or
how
stretched
staff
become
to
care
for
patients.
B
Looking
at
the
effectiveness
of
certain
treatments
for
certain
patients
who
are
unlikely
to
survive
or
do
well,
that
is
happening
in
facilities
in
southern
california.
We
have
not
heard
yet
that
any
hospital
is
at
the
point
where
they
need
to
make
a
decision
between
two
patients
who
both
need
a
ventilator,
and
they
only
have
one
ventilator.
We
have
not
heard
or
been
alerted
to
any
of
those
sort
of
situations
so
again
across
the
continuum.
B
In
terms
of
your
second
question,
the
specifics
around
what's
happening
in
la
certainly
wherein
the
rest
of
the
state
has
seen.
Potentially,
we
hope,
a
trend
of
reduced
transmission,
fewer
cases
today
than
yesterday-
hopefully
fewer
cases
tomorrow
than
today,
a
reduction
in
test
positivity
and
hopefully
in
the
next
10
to
12
days,
a
reduction
of
demand
by
covid
patients
with
covid
for
hospitalization
in
icu.
We
are
not
seeing
that
story
necessarily
in
the
southern
part
of
the
state.
B
We
still
see,
as
I
shared
earlier
in
our
effective
rate
above
one
lower
than
it
was
before.
So
maybe
the
transmission,
the
rate
of
rise
is
still
low.
It
has
come
down,
but
the
fact
that
it
still
is
rising
is
concerning,
and
with
that
in
mind,
we
should
expect
that
the
hospitals
that
are
under
duress
that
are
in
crisis
already
will
continue
to
see
a
high
number
of
patients
knocking
on
the
door
asking
for
care
ambulances
that
still
need
to
find
a
place
just
to
to
drop
off
a
patient.
B
So
they
can
get
back
into
the
field
to
support
other
patients
who
need
care.
We
described
yesterday
that
a
significant
number
over
95
of
la's
hospitals
have
been
on
diversion
in
the
last
24
hours
that
changes
day
over
day,
but
it's
probably
somewhere
between
90
and
95
percent,
and
not
only
are
they
spending
two
hours
on
diversion,
but
they're
spending
a
majority
of
the
day
on
diversion.
B
So
all
of
those
trends
tell
me
and
give
me
continued
concern
that
we
need
to
continue
to
work,
to
prepare
for
next
holiday
surge
of
cases
into
the
early
part
of
next
year
and
that
likely
projections
that,
in
the
middle
of
january,
we
will
see
a
significant
higher
number
of
cases
than
we
have
today
of
individuals
with
covet
who
need
hospitals,
hospital
level
care.
And
what
is
the?
What
is
the
driver?
It
is
what
I
said
earlier
that
we
can
change
this.
D
Thank
you.
You
know
on
the
point
of
of
what
we're
going
to
be
seeing
in
a
couple
of
weeks,
given
what
we
know
about
incubation
periods
for
the
virus.
Is
there
a
concern,
obviously
we're
in
this
week
between
christmas
and
new
year's,
that
you
can
see
some
level
of
kind
of
compounded
spread
where
people
may
be
gone
infected
during
a
gathering
at
christmas
to
been
spread
that
they're
also
gathering
it
new
years,
they're,
pre-symptomatic
or
asymptomatic
or
is
the?
D
B
Fish
yeah,
it's
a
great
question
and
it's
both.
We
know
that
a
number
of
people
are
going
to
be
newly
exposed
over
the
next
over
the
weekend
that
the
urge
of
many
californians
to
gather
and
do
so
in
ways
that
really
aren't
coveted
safe,
are
going
to
lead
to
some
transmission.
We
hope
the
pleas
over
these
last
few
days
before
the
new
year's
and
the
celebrations
that
are
planned.
We
hope
some
are
cancelled.
B
Some
are
done
differently
so
that
we
can
maintain
and
bring
down
this
spread,
but
we
know
and
expect
that
some
of
that
will
happen,
and
it
is
both.
It's
people
who
are
newly
exposed
there
and
others
who
had
been
exposed
infected
are
still
asymptomatic,
may
always
be
asymptomatic,
pre-symptomatic
to
decide
to
gather
and
spread
at
these
other
at
these
other
events.
So
absolutely
this
sort
of
concept
of
a
surge
upon
a
surge
or
exposure
upon
exposure
is
real.
B
I
think
you
and
your
question
articulated
it
really
well
that
the
christmas
gathering
and
infection
becomes
amplified
a
bit
more
exponential
over
the
new
year's
new
year's
celebrations,
and
we
could
see
the
worst
of
it
in
early
january
and,
frankly,
many
of
the
hospital
leaders
that
I've
talked
to
in
southern
california
are
bracing
for
exactly
that.
A
significant
surge,
a
significant
need
to
not
only
deal
with
what
we've
seen
up
until
now,
but
in
even
more
extreme
condition
in
the
middle
and
second
part
of
january.
B
B
I
I
know
that
we're
continuing
to
move
through
a
tough
time,
but
I
plead
with
each
of
you,
ask
you
and
your
reporting
and
your
your
articulation
of
the
story
that
that
you
do
ask
all
californians
to
consider
the
decisions
over
the
next
many
days
and
many
weeks
as
we
work
our
way
through
this
surge
and
a
pretty
tough
time
for
not
not
just
a
handful
but
hundreds
thousands
of
californians
who
are
dealing
with
loved
ones
or
themselves
infected
with
cove.