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A
Feel
free
to
text
your
question:
if
you
have
one,
but
in
the
interest
of
time
we
are
going
to
have
to
try
to
streamline
some
of
those
questions,
so
just
make
sure
that
you,
you
know
you
can
reach
out
to
to
any
staff
members
or
put
your
question
in
the
chat.
If
you
are
on
zoom
today,
so
we
are
going
to
go
ahead
and
call
this
meeting
to
order
and
get
started.
If
you
could,
please
take
the
role.
B
D
B
Representative
fraser
president
in
the
room
representative
marzian
president
in
my
district.
Thank
you,
representative,
gibbons
prenty,
president
from
my
district.
Thank
you,
representative,
rayburn
president
in
the
room
representative
raymond,
I'm
here
from
my
district.
Thank
you,
representative,
riley,
here
from
my
district.
Thank
you,
representative,
sharp
here
in
the
room
representative,
sheldon.
B
A
Co-Chair
mosher,
president
of
the
room,
turn
my
microphone
back
on.
Thank
you
very
much.
We
have
established
a
quorum,
although
we
are
an
interim
and
we
will
go
ahead
with
our
first
pres
present
presentation.
Senator
danny
carroll
is
here
to
discuss
child
care
center.
Administrative
regs.
D
D
So
I
have
that
much
respect
for
her
and
the
quality
of
services
that
her
organization
provides,
and
I
think
it
is
one
of
the
best
in
the
entire
state,
and
I
think
she
is
one
of
the
foremost
experts
in
child
care
in
the
entire
state
and
it's
an
honor
to
be
here
with
her
today
over
the
past
year
and
a
half
through
the
pandemic,
child
care
has
fared
fairly
well
through.
All
of
this,
our
centers
are
already
regulated
in
relation
to
cleaning
and
sanitizing.
D
I
wish
I
had
better
numbers
as
far
as
breakdowns
of
cases
within
the
child
care
industry
within
the
regulated
industry,
still
working
on
trying
to
get
that
information
together.
So
we
know
in
a
more
accurate
breakdown
by
age
what
we
are
facing
in
child
care.
I
do
know
some
numbers
that
I
received
this
morning
to
date.
During
the
pandemic,
there
have
been
1019
regulated
child
care
programs
affected
with
positive
cases.
13
1
309
of
these
cases
were
children,
ages,
infant
through
13
or
213,
and
then
1379
of
these
cases
are
staff
cases.
D
We
have
had
zero
of
those
kids
end
up
being
positive
for
colby
19.,
so
we
without
question
have
found
that
our
kids
are
more
resilient,
more
resistant
to
covid
those
numbers
are
rising,
as
as
we
all
are
aware,
with
the
new
variant,
and
that
is
something
that
we
face
over
recent
weeks,
I
was
tasked
by
senate
leadership
to
help
come
up
with
a
piece
of
legislation
to
guide
child
care
centers,
as
we
move
forward
in
dealing
with
the
pandemic.
D
Over
the
last
couple
weeks,
I
have
spoken
with
numerous
directors
and
owners
throughout
the
state.
I've
spoken
to
medical
professionals,
I've
done
some
reading
and
I've
sought
feedback
from
parents,
and
we
have
made
an
effort
to
put
together
a
bill
that
will
allow
the
centers
to
continue
to
operate
in
a
safe
manner
and
an
efficient
manner
and
a
manner
that
will
help
to
allow
the
development
of
our
kids,
which
sometimes
during
this
entire
ordeal,
seems
to
have
been
overlooked,
and
we
do
need
to
make
that
more
of
a
priority
as
we
move
forward.
D
The
bill
that
has
been
drafted
has
been
based
on
previous
regulations
that
were
handed
down
by
the
cabinet
regulations
that
are
still
applicable
today
and
where
we
are
and
regulations
that
we
have
found
to
be
effective.
This
bill
is
still
open
to
input
open
to
change.
I'm
willing
to
listen
and
I'll
welcome
the
input
from
information
that
you
all
may
have
from
your
districts
from
owners
within
your
district,
medical
professionals
or
whatever
the
case
might
be.
So
it
is
still
very
much
a
work
in
progress.
D
However,
our
goal
is
to
set
a
set
of
rules
in
place
now
that
can
allow
some
stability
in
the
industry.
So
we
know
what
we're
going
to
be
facing,
at
least
until
january,
when
we're
back
in
session
that
will
allow
our
centers
to
continue
to
operate
in
an
efficient
and
effective
manner.
At
this
point,
I'm
going
to
turn
the
floor
over
to
jennifer
and
again
it
is
an
honor
to
be
here
with
her
and
and
we
will
take
questions
once
she
completes
her
testimony
and
thank
you,
madam
chair.
K
Thank
you,
members
of
the
joint
committee
on
health,
welfare
and
family
services.
I
want
to
thank
you,
first
of
all
for
giving
me
the
opportunity
to
share
my
experience
of
what
has
worked
and
what
has
not
worked
over
the
past
18
months
of
this
ongoing
battle
to
mitigate
covid
and
all
the
effects
in
the
child
care
industry.
K
My
program
has
been
in
operation
for
over
20
years
has
been
nac
accredited
for
15
of
those
20
years
is
five
star
rated
by
the
governor's
office
for
early
childhood
and
has
never
closed
even
when
child
care
centers
were
mandated
to
close
in
march
of
2020
as
we
were
granted
ldc
status
in
18
months.
I
have
had
one
adult
case
of
covid
in
my
space,
and
that
was
january
of
2020.
K
K
Please
know
that
we
credit
this
to
implementing
with
fidelity
some
very
important
health
and
safety
practices,
and
this
includes
strict
testing,
strict
temperature
checks
masking
of
adults
where
our
county
is
in
the
red
or
is
mandated
to
do
so
quarantining,
sanitizing
and
vaccinations
of
staff.
What
is
working
in
my
center?
We
still
conduct
temperature
checks
at
arrival
and
at
all
meal
times
we
all
know
of
children
who
may
arrive
at
the
center
fever-free
only
to
spike
a
temperature
four
hours
later,
because
likely
they
were
administered
tylenol
before
arrival.
K
We
have
found
great
success
with
continual
temperature
checks.
It
also
helps
the
parents
to
understand
that
their
child
will
be
checked
throughout
the
day,
helping
to
motivate
parents
to
not
mask
symptoms
with
medications.
In
my
center
we
have
maintained
the
heightened
cleaning
and
sanitization
practices
daily
cleaning
schedules
that
include
full
center
sanitizing
is
important.
K
K
K
Currently,
all
adults
and
t,
including
teachers
and
parents
are
fully
mask
wearing,
while
in
our
building
families
are
invited
into
the
building,
however,
are
encouraged
to
drop
the
child
off
at
the
threshold
of
the
classroom
door
and
spend
no
more
than
one
minute
talking
with
the
teacher
at
drop
off
or
pick
up.
We
do
encourage
parent-teacher,
brief
face-to-face
communication
so
that
that
quick
contact
can
be
maintained
as
important
to
family
child
care
connections.
K
K
We
have
strict
quarantine
guidelines
first
and
foremost,
if
anyone
in
the
household
is
in
quarantine,
even
if
they
are
negative,
the
child
or
children
may
not
attend
our
program.
Second,
if
anyone
in
the
household
is
waiting
for
a
covid
result,
the
child
may
not
attend
our
program.
The
same
same
rules
are
strictly
enforced
for
staff,
including
when
a
staff
complains
of
not
feeling
well
or
shows
any
symptom
of
covid.
They
must
submit
to
having
a
covet
test
and
quarantine
until
the
results
have
been
returned.
K
K
K
We,
I
kids,
are
nacy
accredited.
We
are
a
five-star
child
care
facility
because
of
this
we
chose
to
have
a
child-to-caregiver
ratio
in
our
two-year-old
classroom
of
one
caregiver
to
seven
children.
The
state
says
we
can
have
one
caregiver
to
10
children
because
of
covid.
We
have
an
enrollment
of
10
two-year-olds,
so
I
have
two
teachers
for
10
two-year-olds,
that's
double
the
teachers.
K
I
added
two
assistant
teachers
to
the
two-year-old
class:
that's
ten
children
and
four
teachers.
So
let
me
tell
you
how
that's
gone
on
any
given
day.
You
have
two-year-old
children,
throwing
their
mask
in
the
trash
or
on
the
floor
or
chewing
on
their
mask
or
picking
up
another
child's
mask
and
chewing
on
that
mask
teachers
are
continually
reminding
toddlers
mask
on
face
mask
on
face.
Where
is
your
mask
mask
on
face?
K
Teachers
are
continually
even
three
to
four
weeks
later,
struggling
with
keeping
the
masks
on
the
face
of
our
toddlers
of
our
two-year-olds
children.
24
to
36
months.
Do
not
have
the
fine
motor
skills
needed
to
put
a
face
mask
on
their
face.
They
can't
even
hold
a
pencil.
They
do
what's
called
this
this
grasp
and
it
is
hard
to
carry
a
mask
onto
your
face.
K
When
you
don't
have
the
proper
grasp,
they
can't
put
a
mask
on
their
face
or
fix
it
without
proper
assistance
from
an
adult,
and
please
remember
when
a
teacher
touches
a
mask,
they
must
immediately
sanitize
their
hands
between
each
friend.
That's
a
daunting
task.
Children
24
to
36
months
are
in
prime
developmental
stage
for
language
development.
To
date,
there
are
no
long-term,
scientifically
based
studies
on
the
effects
of
mask
wearing
in
this
age
to
language
development.
K
K
They
can't
see
children
with
small
faces
as
they
tilt
their
heads
are
blocked
from
seeing
the
item
with
which
they're
trying
to
play
because
of
their
mask,
resulting
in
it
taking
off,
resulting
in
the
teachers
saying
mask
on
face,
resulting
in
the
teacher
putting
the
mess
back
on
face
and
then
washing
their
hands.
Yet
again.
K
Three-Year-Old
children,
while
improving,
are
still
not
more
than
60
proficient
in
our
space
at
keeping
the
mask
fully
covering
the
nose
they
also
do
enjoy
chewing
on
the
mask
and
they're
struggling
still
with
communicating
articulating
their
needs
and
wants
in
an
intelligible
language
of
the
mascot.
Think
of
the
teacher
in
charlie
brown
and
think
of
a
bunch
of
three-year-olds
sounding
like
I
have
to
go
to
the
bathroom.
K
That's
a
really
hard
thing
to
do
in
a
class
of
ten
three-year-olds.
Currently,
the
emergency
regulation
does
not
allow
for
children
who
are
not
developmentally
able
to
not
wear
a
mask.
I
had
one
parent
of
a
child
who
has
the
diagnosis
of
a
speech
delay
and
she
requested
that
her
child
not
wear
a
mask.
He
is
two
and
he
turns
three.
K
In
two
weeks,
the
family
physician
notified
her
that
they
could
only
write
such
a
request
if
the
child
were
diagnosed
on
the
autism
spectrum
recall
our
class
sizes
are
significantly
lower
than
what
the
state
allows.
Our
three
and
fours
are
a
cohort
of
10
children,
and
one
teacher.
The
smaller
class
size
may
be
a
contributing
factor
for
our
success.
However,
the
majority
of
programs
cannot
financially
support
lower
class
ratios.
K
K
K
The
staffing
challenges
are
exhausting
without
the
investment
that
has
been
made
to
child
care
to
date
through
the
cares
and
crystal
relief
money.
I
can
definitely
say
that
my
program
would
not
be
open.
We
are
a
nac
accredited,
high
quality
five-star
program
and
the
investment
that
has
been
made
to
date.
The
stipends
that
have
been
provided
have
been
the
lifeblood
of
our
program.
K
I've
been
able
to
raise
teacher
pay
to
eleven
dollars
per
hour
and
we're
on
target
to
get
to
thirteen
dollars
by
november,
first
still,
not
quite
as
high
as
chick-fil-a,
when
that
money
is
no
longer
available.
When
that
investment
is
taken
away,
parents
will
be
asked
to
pay
more,
and
I
raised
my
rates
on
august
1st
of
this
year,
as
I've
said
before
we're
not
in
this
for
the
financial
reward.
We
chose
this
bill
because
we
are
compassionate
and
are
called
to
serve
our
youngest
citizens
and
the
families
who
love
them.
K
K
K
K
We
can
care
for
an
individual
child
8
to
11
hours
each
day,
5
days
a
week,
that's
more
time
spent
with
us
waking
hours
than
they
spend
with
their
parent,
and
it
has
become
increasingly
more
and
more
difficult
to
be
the
enforcer,
especially
of
our
twos
and
threes
of
mask.
Wearing
again,
I
do
appreciate
the
opportunity
to
share
what
has
worked
for
my
program.
Please
understand,
I
have
chosen
to
be
a
nac
accredited
high
quality
center.
K
I
have
had
access
and
success
because
of
the
resources
afforded
me
thanks
to
the
relationships,
accreditation
and
procedures
already
in
place
of
a
high
quality
center.
This
may
not
be
the
norm
for
other
child
care
programs.
What
I
can
attest
to
for
all
of
us
is,
we
all
need
continued
investment.
We
all
need
to
be
included
in
the
conversation
as
to
what
works
and
as
to
what
has
been
an
absolute
hardship
for
our
programs,
and
we
all
need
to
be
respected
as
essential
as
the
essential
industry
that
we
truly
are.
D
Madam
chair,
just
a
couple
other
issues
that
I
want
to
address,
and
first
I
want
to
mention
that
worked
fairly
extensively
with
dr
sarah
van
over
the
director
of
child
care
in
the
state,
and
she
does
an
excellent
job
and
she
is
always
very
open
and
providing
guidance,
and
I
think
we
are
fortunate
as
a
state
to
have
her
in
that
position.
Unfortunately,
she
was
not
able
to
be
here
today
to
testify
a
couple
other
issues
that
we
notice
from
time
to
time.
D
I
would
also
at
some
point
like
to
have
the
discussion
on
the
test
and
stay
option
that
we
discussed
yesterday
in
the
chairman,
wise
in
education
committee,
that
some
of
the
school
systems
are
using
if
this
might
possibly
be
an
option
for
child
care.
If
parents
opt
in
to
do
that
rather
than
quarantining,
if
they
they
have
been
exposed
in
a
classroom
having
the
option
to
test
the
child
daily
and
as
long
as
the
child
tests
negative,
the
child
is
able
to
remain
in
the
early
childhood
education
center.
D
A
Okay,
thank
you
very
much,
senator
carroll.
I
really
appreciate
all
of
your
work
through
the
pandemic
and
beyond
really-
and
I
know
that
you're
taking
a
a
long,
hard
look
at
the
regs
which
were
relaxed
and
and
looking
to
see
what
would
actually
create
stability.
A
A
Just
paying
attention
to
what's
developmentally
appropriate
for
your
children
and
working
with
parents
is
critical.
I
think
that
throughout
this
pandemic
we've
been
given
directives
and
we
certainly
know
how
to
keep
our
littlest
ones
safe
and
each
other
safe,
and
we
really
need
to
allow
our
our
businesses
to
put
those
in
place
and
decide
with
their
families
what's
best
for
their
centers.
So
I
look
forward
to
seeing
what
we
need
to
continue
and
work
on.
We
do
have
a
couple
of
questions.
E
Thank
you,
madam
chair
senator,
thank
you
very
much
for
for
bringing
your
guest
here,
ms
washburn.
Thank
you
very
much
for
your
testimony
and
and
giving
us
a
description
of
what's
going
on
in
your
environment,
because
I
know
it's
very
difficult
to
deal
with,
particularly
with
the
works
and
so
forth.
So
I
have
like
two
sort
of
disjointed
questions,
but
there's
a
method
to
my
madness
and
I'm
trying
to
do
some
other
research.
So
what
are
your
revenue
sources.
K
E
Okay,
second,
off
the
ball
off
the
wall.
Question
is
comparative
pay.
What's
in
in
your
in
your
area,
you
said
you
got
a
workforce
issue
and
so
forth.
What's
the
competitive
pay,
roughly
speaking,
that
you
have
versus
what
you,
what
you're
up
against.
K
K
My
teachers
being
an
accredited
facility,
our
teachers
have
their
degrees
early
childhood
credentials.
Cdas
many
of
them
have
been.
What
happens
is.
Is
we
become
a
stepping
stone?
They
work
through
my
facility
as
graduate
students
or
as
people
getting
their
cdas
and
then
just
as
soon
as
a
position
is
available
within
the
schools.
They
move
into
those
higher
paying
benefit-driven
positions
within
those
spaces
are.
E
Okay-
and
I
imagine
you're,
imagining
margin
is
pretty
thin.
There's
yeah
one
more
question,
madam
chair,
and
it
goes
back
to
my
friend
from
senator
wise
who
had
a
good,
robust
discussion
yesterday
in
the
education
committee
in
the
testimony
had
test
and
stay.
Are
you
familiar
with
that,
and
then
is
this?
Is
that
type
of
environment
or
application
applicable
to
into
your
environment?
And
then
I
don't
know
I'm
trying
to
think
on
senator
carroll
how
to
incorporate
that
into
the
regulations,
if
at
all
possible.
K
You
know,
I
would
think
for
me.
I
would
have
to
do
additional
research
on
that.
Some
questions
I
would
have
would
be
between
if
a
test
was
given
at
8
00
a.m.
K
For
example,
let
me
say
this:
if
a
child
comes
into
my
facility
at
seven
a.m
and-
and
I
take
a
temperature
check
and
their
temperature
is
normal-
we
know
that
fever-reducing
medication
can
typically
wear
off
within
four
to
six
hours.
So
that's
why
we
do
the
additional
temperature
checks
at
lunch,
breakfast
lunch
and
snack.
So
and
if
you
have
a
child
oftentimes,
they
will
raise
spika
attempt
at
three
o'clock
in
the
afternoon.
K
K
How
long
is
that
negative
test,
viable
20
minutes
five
hours
six
days,
and
the
reason
I
ask
this-
is
that
student
that
subbed
for
me
for
two
hours
on
that
that
friday
in
2020
did
not
show
symptoms
until
sunday
and
got
tested
on
that
sunday.
At
that
time
the
health
department
told
us
you.
There
was
a
48-hour
contagion
window
where
she
was
contagious
and
you
would
not
have
known
so.
I
had
to
close
that
classroom
because
of
the
friday
of
two
hours.
Does
that
make
sense.
D
To
give
you
an
idea
of
what
we
face,
we
have
spent
hours
watching
cameras
to
determine
if
a
staff
member
was
within
six
feet
of
another
person
for
15
minutes
within
an
eight
hour
day.
I
mean
that's,
that's
how
far
this
has
gone
in,
trying
to
comply
and
really
understanding
what
we're
doing
and
and
again
when
we've
had
to
close
down
classrooms.
We
it
we
haven't,
had
children
that
ended
up
being
positive.
D
Our
situation
would
be
a
little
bit
different.
We
have
nursing
staff
on
site
with
one
of
our
other
programs,
so
we're
able
to
use
nursing
staff
to
to
help
assess
children
throughout
the
day,
but
I
think
it's
something
that
we
could
look
at
and
it
obviously
be
an
opt-in
for
for
families
and
it.
D
I
wish
we
had
better
data
for
child
care
as
far
as
the
number
of
children
who
ended
up
in
hospitals
or
in
icus
still
trying
to
get
that,
I
don't
think
it's
there,
but
I
wish
we
did
have
it
and
I
think
it
would
help
us
to
better
plan
as
we
move
forward,
but
the
things
that
jennifer
said
it
has
been
a
struggle
staffing
in
our
center.
Our
staffing
is
getting
better,
we've
hired
five
people
within
the
last
two
weeks.
I
think
we're
still
maybe
two
or
three
short
and
we're
we're
a
larger
center.
D
We
have
when
we're
we're
full
capacity
with
our
kids
about
120
in
our
early
childhood
education
and
then
30
to
35
in
our
prescribed,
pediatric,
extended
care
program
and
those
are
all
under
the
same
roof.
So
staffing
has
gotten
gotten
better.
We've
gone
through
the
same
pay
issues.
We
just
raised
our
pay
up,
pretty
close
to
what
she's
she's
doing,
and
we
took
another
course
to
not
obligate
our
organization
to
a
15
an
hour
when
funding
is
going
to
go
away.
D
In
a
couple
years,
we
decided
to
give
conservative
raises
and
then
do
bonuses
as
we
as
we
move
forward,
and
that's
worked
well
for
us,
and
so
the
struggles
are
pretty
consistent
with
with
what
we
faced.
Okay,
thank
you.
A
Okay,
thank
you
and-
and
I
would
agree
that
the
test
and
stay
is
a
it's.
It's
a
good
idea.
It's
it.
It
sounds
like
a
good
idea,
but
you're
right.
It
does
not
address
the
incubation
period
and
it
really
doesn't
address
those
patients
or
folks
who
might
test
positive
three
months
down
the
road.
So
there
are
there's
some
work
to
be
done.
Senator
berg.
C
K
I
have
many
adults
that
are
still
struggling
with
that
that
issue
right
now,
as
we
speak
within
our
space.
I'll
answer
your
question
in
in
two
definitive
ways:
what
age
can
will
the
child
keep
the
mask
on
their
face
in
our
space?
Typically,
most
85
percent
of
our
four-year-olds
will
keep
it
on
their
face,
but
that
could
mean
that
it's
here
and
we're
saying
cover
your
nose.
K
Remember
the
coved
bugs
live
in
your
nose
and
when
you
sneeze
you
send
them
flying
and
when
they
fly,
they
infect
your
friends
so
all
day
long
we
are
a
sesame
street
commercial.
So
so,
yes,
keeping
it
on
their
face
and
and
having
the
the
ability
about.
85
percent
of
four-year-olds
have
now
remember
they're,
starting
to
write
their
name
and
get
that
pencil
grasp
beautifully
so
that
same
pencil
grasp
can
pinch
this
to
my
ear,
so
they're
starting
to
be
able
to
do
those
things
developmentally
for
as
you
track
into
five
the
part.
K
K
Now,
for
18
months
I
don't
know
yet
you
know,
and
so
we
have
to
at
this
point
choose
what's
safer
and
what
we
can
do
and
I
can
tell
you
it's
not
safe
for
a
two-year-old
to
pick
up
someone
else's
two-year-old
mask
if
you're
curious,
just
open
it
up
and
look
at
the
inside.
You
know
females.
You
think
that
your
your
makeup
is
on
your
mask,
imagine
snot
and
then
another
child
picks
it
up
and
puts
it
in
their
mouth.
C
K
K
We
are
a
compassionate
field,
a
compassionate
group
of
of
people
that
want
to
do
what
is
best
to
protect
our
children,
and
so
that
means
we
have
to
put
on
our
protections
our
armor
to
keep
ourselves
safe
so
that
our
children
can
then
be
safe,
and
so
the
staff
are
100
percent
vaccinated,
the
the
full-time
staff,
the
of
the
12
assistants,
four,
are
not
yet
vaccinated.
C
I
would
just
like
to
say
that
if
we
could
put
you
on
tv,
I'm
serious
with
explaining
exactly
how
you
explain
to
your
four-year-olds,
why
you
have
to
cover
your
nose
and
what
this
virus
does.
This
is
exactly
what
people
in
the
state
need
to
understand
and
your
answer
to
why
your
staff
is
vaccinated
because
you
care
and
you're
taking
care
of
other
people,
and
you
know
it's
important
if
we
could
put
your
message
statewide
and
let
people's
hearts
listen
to
it.
I
think
we
could
take
care
of
this.
C
D
And
I
did
have
her
available.
She
was
my
child's
first
teacher
daycare
center
and
I
knew
we
were
at
the
right
place
when
I
walked
in
the
door.
My
daughter
was
walking
with
a
walker,
and
the
first
thing
she
said
was:
how
do
I
need
to
change
this
building
for
your
daughter
and
been
sold
ever
since
then?
A
couple
things
I
want
to
add
the
the
development
issue
that
we
have
struggled
with
has
been
in
place
ever
since
our
staff
have
been
required
to
wear
masks
over
the
past
year.
D
We
have
seen
behavioral
issues
like
we
have
never
seen
in
the
11
years
that
I've
been
in
it
at
our
center
and
to
the
point
that
I
started
calling
other
centers,
because
I
thought
we
were
doing
something
wrong
and
I
found
out
that
this
was
across
the
state
that
these
issues
were
occurring.
So
that's
the
development
part
of
it
not
only
with
the
children
but
with
the
staff,
also
that
we
need
to
consider
and
as
we
talk
about
mask
issues
which
is
at
the
the
center
of
the
discussions
with
child
care,
it's
important
to
remember.
D
We.
We
want
people
to
wear
masks,
we
don't
know
the
level
of
effectiveness
for
a
mask,
but
we
do
know
that
whatever
level
there
is,
they
have
to
be
worn
properly.
To
get
that
protection,
you
can
say
that
it
to
and
above
within
a
child
care
center
can
wear
a
mask
safely,
but
do
they
really
accomplish?
Anything?
Is
the
question
and
I
think
without
question,
for
the
the
younger
two
three:
there
is
no
value
there.
D
There
is
no
protection
there
because
of
the
things
that
jennifer
mentioned,
and
I
think
we
have
to
consider
that
and
even
for
four
five-year-olds
and
six-year-olds
that
protection
is
still
minimal.
D
A
I
Just
really
briefly
on
that
issue-
and
we
mentioned
this
in
a
previous
committee
hearing
with
regulations,
world
health
organization
has
an
opinion
on
children.
Under
the
age
of
five
I
mean
a
lot
of
other
countries
have
established,
have
had
delta
variant
longer
than
we
have
they've.
They
have
recommendations,
they
say
emphatically.
I
Under
the
age
of
five,
children
should
not
be
wearing
masks
ages,
6
to
11,
depending
on
local
input,
from
teachers
from
parents
in
their
communities
12
and
up
they
recommend,
but
under
the
age
of
five
they
say
they
shouldn't
for
the
sake
of
really
psychosocial
and
in
their
development
as
well.
So
I
just
wanted
to
throw
that
out.
There.
D
And
I
you
know,
I
had
received
many
comments
in
in
asking
for
feedback
about
following
the
science
and
the
response
is
which
science
and
the
bill
that
we're
developing
does
follow
the
the
who
guidelines
and
it
will
give
local
control
to
these
decisions
and
that's
kind
of
the
direction
we're
heading
in
as
far
as
mask,
and
I
I
feel
it
very
important
that
parents
have
some
input
and
say
in
this,
because
I
I
think
in
in
the
case
of
the
younger
children.
D
It
is
more
of
a
personal
issue,
with
those
kids
and
and
with
the
controversy
and
the
mixed
messages
that
are
out.
I
think
it's
crucial
that
parents
have
a
significant
role
in
making
these
decisions
for
their
child.
D
There
is
no
one
who's
going
to
watch
out
for
the
best
interest
of
a
child
more
than
a
parent,
and
I
say
that
in
most
cases
I
know
there
are
exceptions
there
and
and
the
centers
are
always
watching
out
for
the
best
interests
of
children
and-
and
I
have
no
doubts
that
with
the
local
control
that
we're
proposing
that
the
quality
care
and
protection
for
our
kids
will
remain
in
place.
And
our
centers
will
continue
to
do
what
they've
always
done.
A
Okay,
thank
you
representative.
Tate
thank.
B
You,
madam
chair,
and
thank
you
very
much
for
this
testimony.
This
is
very
enlightening,
so
I've
got
one
short
question
and
a
longer
question
so
one
is,
is
what
is
the
average
age
of
your
staff,
and
that
was
before
covid
and
now
after
covid
and
then
also
you've
talked
a
little
bit
about
the
developmental
age
and
the
consequences
of
the
issues
with
children
wearing
masks,
but
as
a
grandmother
and
a
parent.
I
understand
that
children
are
very,
they
watch
your
facial
expressions,
etc.
So
what
is
the?
B
K
Certainly,
to
answer
your
first
question:
in
our
facility,
our
age
range,
the
gamut,
our
assistant,
teachers
are
going
to
be
our
younger
teachers,
but
in
in
my
facility,
specifically,
our
ages
run
the
gamut
of
who's
caring
for
our
children,
and
it's
simply
because
we
have
teachers
who
have
their
cdas,
who
have
their
associates,
who
have
their
bachelor's
degrees
and
who
have
committed
themselves
to
this
field
out
of
their
passion.
So
I
can't
speak
to
that
as
being
the
case
for
all
child
care
centers,
but
I
can
speak
to
what's
in
mine.
K
Prior
to
that,
however,
we
had
a
long
stint
in
child
care
where
we
were
requested
as
adults
to
wear
masks
the
for
a
very
long
time,
and
then
we
had
a
break
where
we
didn't
and
so
to
answer
your
question.
What
has
been
the
difference
when
the
teachers
had
their
masks
on
the
entire
time
in
our
younger
children,
we
again
were
seeing
an
increase
in
those
aggressive
behaviors,
because
when
you
started
to
speak
representative
tate,
your
voice
is
coming
from
many
places.
So
I
wasn't
sure
where
you
were,
and
so
I'm
looking
around
going.
K
Okay
and
then
this
nice
gentleman
with
the
camera
was
right
in
the
way.
So,
but
I'm
glad
you
moved
thank
you
so
much,
but
I'm
an
adult
and
I'm
using
visual
tracking
and
my
ability
to
hear
to
locate
you
by
now.
You've
probably
told
me
five
times:
don't
stand
on
the
table,
but
I'm
still
standing
on
the
table
because
you
might
not
be
talking
to
me.
So
that
is
very
hard
for
our
younger
children
because
they
have
to
visually
track
and
auditory
track.
Where
you
are,
what
you're
saying
to
know?
K
Are
you
talking
to
me
and
also,
if
you're
familiar
with
commercials,
if
you
listen
to
commercials
now
the
people
will
repeat
their
phone
number
three
times,
so
you
remember
it
in
your
head.
Most
teachers
will
give
a
command
three
times
before
the
child
can
respond,
but
if
the
child
can't
understand,
what's
being
said,
it's
taking
longer
for
the
response
and
it's
taking
longer
to
get
the
change
in
behavior.
So
that
is
something
that
we
are
seeing
with
our
younger
children.
K
K
That's
going
to
be
rough,
and
if
you
want
to
be
a
speech,
language,
pathology,
pathologist
right
now,
that
is
the
industry
to
get
into,
because
you
will
have
a
lot
of
business,
but
that's
sad.
So
I
have
to
articulate
you
have
to
see
my
mouth
as
an
early
childhood
person.
I
have
to
be
grover
and
elmo
and
use
an
entire
face
in
order
to
get
you
to
look
at
me.
There
are
studies
on
infants
and
masking
and
attachment.
K
There
are
studies
on
that,
but
it
doesn't
go
much
beyond
that
for
twos
and
three-year-olds,
because
how
long
have
we
had
to
be
doing
this
and
how
many
studies
are
there
so
again
to
answer
your
question?
It
is
harder,
yes,
when
adults
have
to
wear
them,
but
I
will
say
there
are
times
when
it's
necessary
that
we
do
and
then
I
put
it
back
on
parents
too,
when
you
as
a
beautiful
grandmother,
have
your
grandchildren.
K
It
becomes
an
additional
responsibility
on
you
to
engage
with
your
face
because
they
have
you
for
your
full
face,
moms
and
dads
too,
and
I
know
as
a
society.
We're
also
now
really
battling
technoference
and
that's
in
the
way,
meaning
your
phones
and
devices
and
tvs
are
what's
entertaining
our
children,
and
so
the
early
childhood
professional
is
that
person
that
mask
that
maskless
person,
that
is
helping
language
development,
helping
with
expression
helping
with
attachment
and
when
we
are
barriered
from
that
for
a
long
time
there
will
be
some
effects
that
I'm
slightly
worried
about.
A
Okay,
thank
you
so
much.
This
is
so
interesting
and
you
are
clearly
so
knowledgeable
about
this,
but
we
have
a
long.
L
A
So
I'm
gonna
I'm
going
to
allow
a
few
more
questions,
but
they,
if
you
could
keep
them
brief,
that
would
be
great
representative
sheldon.
K
G
L
G
About
sounds
to
me,
like
the
younger
children,
are
going
to
be
an
issue
that
we
probably
you
know
that
owners
should
be
allowed
to
make
those
decisions
of
those
childcare
centers
and
I'd
be
all
for
that.
G
But
one
thing
we
haven't
talked
about
I'd
like
to
maybe
suggest
that,
and
maybe
we
have
I
just
missed
it,
but
but
relaxing
some
of
the
quarantining
rules
may
also
be
a
big
part
of
what
I
think.
Maybe
senator
carroll
would
want
to
look
at
test
and
state
kind
of.
Does
that
I'm
I'm
in
the
same
boat
as
the
rest
of
these
folks.
G
I
don't
think
that
that's
ultimately
a
an
answer,
but
maybe
when
somebody
does
test
positive,
as
opposed
to
like,
for
instance,
it's
six
foot,
if
no
mask
right,
it's
three
foot.
If
we
have
a
mask,
I
would
maybe
even
propose
that
if
they
test
positive,
that
nobody
would
go
to
quarantine
unless
they
showed
symptoms
or
they
tested
positive.
So
other
states
have
tried
that
and-
and
I
think
that
keeps
every
we're
hearing-
that
90
plus
of
the
the
children
that
are
quarantined
are
not
coming
out
positive.
G
So
why
wouldn't
we
relax
the
quarantining
method
and
because
the
idea
is
to
keep
these
kids
in
child
care
and
and
because
it
starts
with
you,
you
were
talking
about
your
staffing
issues.
Well,
I
guess
child
care
has
got
staffing
issues.
Then
health
care,
education,
small
business.
This
is
all
across
our
state
and
so
we're
not
going
to
legislate
an
answer
to
all
that.
I
can
assure
you
that
we
won't
legislate
the
virus
away.
G
What
we
can
do-
and
I
think
what
we
should
be
doing-
is
giving
you
the
tools
and
giving
you
support
at
our
level,
I
think
getting
involved
in
us
handing
down
our
the
science
we
want
to
believe
in.
Let's
put
it
that
way
is
probably
not
the
case.
G
We
should
leave
it
with
the
child
care
owners,
and
I
trust
you
completely
and
I'm
sure
that
you'll
do
a
good
job
in
handing
out
these,
but
but
I
do
think,
quarantining
and
trying
to
change
some
of
those
rules
around
quarantining,
because
a
lot
of
people
thought
well
when
they
went
to
a
mask
they
their
quarantine.
G
G
G
G
I
think
we've
had
one
child
test
positive
and,
with
all
the
precautions
you
can
take,
it
can
happen
to
anybody
so
doing
our
due
diligence
and
asking
and
telling
the
parent
that
we
had
to
you
know,
keep
the
child
away
from
the
daycare
for
a
specific
period
of
time.
She
takes
out
all
four
of
her
children
and
goes
to
a
daycare
down
the
road.
G
Where
is
the
consistency
that
you
know
locally,
that
another
daycare
or
some
sort
of
database
to
where
that
an
owner
such
as
yourself
can
tap
into
just
to
make
sure
you
know
those
things
are
kosher?
You
know
if
you
take
a
child,
have
they
been
excused
somewhere
else
for
another
reason,
and-
and
I
find
that
to
be
a
challenge
because
I
think
it's
happened
several
times
in
other
cases
as
well,
and
I
just
kind
of
want
your
input
on
that.
K
For
example,
our
schools
are
closed
tomorrow
and
tuesday,
and
so
I
had
to
make
sure
that
the
children
that
were
actually
able
to
get
in
in
the
lottery
system
that
we
had
are
not
children
that
are
supposed
to
be
quarantining
right,
and
so
I
had
to
reach
across
and
contact
school
and
say
hey.
You
know.
I
know
you
can't
give
me
much,
but
let's
figure
out
whose
classroom
is
quarantined
and
I
can
figure
out
who's
in
that
classroom.
It
takes
more
detective
work
on
my
part.
Yes,
is
there
a
simpler
way?
K
Maybe
could
that
be
helpful?
Possibly,
I
think
that
that
some
of
those
hurdles,
though,
can
be
helped
helping
one
another,
but
I
do
think
it's
important
to
communicate
because,
yes,
families,
hop
families,
skip
and
jump
to
get
their
family's
need
met.
K
Oh
I'd
have
to
go
into
the
hipaa
rules
that
school
can't
tell
me,
who's
been
asked
to
quarantine
and
who
is
positive
and
who's
negative
at
all,
and
I,
but
I
can
ask
you
at
your
center-
was
johnny
enrolled
there
last
week
and
just
like,
when
you
fill
out
a
list
of
places
that
you've
been
before
meaning
have
you
been
at
another
center?
That's
one
of
the
questions
we
ask
on
our
enrollment
form.
Has
your
child
been
in
any
other
child
care
facilities?
They
can
lie,
of
course.
K
So
when
that
happens,
temperature
checks,
wellness
checks,
your
due
diligence
on
making
sure
these
kids
are
okay.
When
they
come
into
your
space,
that's
going
to
be
equally
important.
The
same
kid
can
get
sick
when
they
go
to
awanas
on
wednesday
night
and
they
none
of
the
mask
at
sunday
school.
So
it's
not
just
going
from
center
to
center
it's.
A
Very
quickly
I
mean
we've
got
yeah,
we
have
a
lot
of
people.
K
G
Okay
and
the
reason
I'm
saying
that,
because
I
don't
want
anyone
to
think
that
someone
doesn't
care
if
they've
not
taken
the
vaccine
as
of
yet
because
we
have
centers
around
the
state,
we
have
people
who
are
considering
it
that
are
weighing
the
options
out.
So
I
just
want
people
to
know
that
we
don't
consider
you
inconsiderate
by
not
taking
the
vaccine
at
this
time.
Correct.
K
And
that's
how
my
four
staff
they're
just
not
there
yet.
E
Thank
you,
madam
chair
lady,
thank
you,
senator
and
thank
you
ma'am
for
coming
today
and
good
presentation.
You
know
back
before
the
civil
war.
When
we
had
chickenpox,
we
would
gather
all
the
girls
together
for
the
aesthetic
value
and
have
them
sleep
over
before
we
knew
that
chickenpox
would
spread
somehow
and
we
were
later
later
found.
It
was
respiratory
droplets.
E
E
E
Do
they
become
a
retainer
of
that
past
pathogen
a
pathogen
is
any
organism
that
causes
disease
for
people
don't
know,
are
large
droplets
captured
by
those
masks
and
later
evaporate
to
let
that
pathogen
stay
there
and
can
the
virus
escape
and
they
evaporate
in
droplet.
We
do
not
know
any
of
these
things.
Let
me
go
in
with
things
we
don't
know.
E
Are
there
dangers
of
bacterial
growth
on
a
used
or
a
loaded
mask?
How
do
pathogens
droplets
interact
with
our
environment,
environmental
dust
or
aerosols?
What
are
the
long-term
effects,
such
as
headaches,
arising
from
impeded
breathing?
So
there's
all
these
consequences,
there's
social
consequences,
which
you
just
talked
about
psychological
consequences.
E
E
A
E
A
Thank
you.
I
think
that
was
a
lot
of
questions
rolled
into
one.
Thank
you
very
much
all
right.
We're
going
to
move.
A
Okay,
thank
you
all
right.
Our
next
presentation
will
be
thank
you
so
much
for
for
all
of
this
and
for
putting
up
with
all
of
our
questions.
I
really
appreciate
all
all
of
your
work.
Our
next
presentation
is
on
covet
19
immunity,
and
we
have
senator
alvarado
and
dr
joseph
mcconnell
coming
to
the
table.
A
Please
go
ahead
and
introduce
yourselves
for
the
record
and
proceed
with
your
testimony.
I
I
We
could
probably
be
here
for
the
entire
day,
but
I
wanted
to
have
some
remarks
as
we're
trying
to
find
a
path
forward
is
how
we're
going
to
handle
things,
and
I
want
to
begin
with
a
few
remarks
in
the
practice
of
medicine.
I
Doctors
really
by
the
nature
of
their
training
and
their
experience
want
nothing
more
than
to
get
to
the
root
of
a
problem,
and
it
can
be
frustrating
for
medical
professionals
to
watch
how
the
world
of
politics
can
hinder
public
health,
and
that
is
certainly
true
for
me,
and
the
problem
of
politicization
of
public
health
issues
and
even
counterproductive.
Measures
by
officials
has
never
been
more
evident
than
it
has
been
for
this
past
year
and
a
half
through
the
past
18
months.
I
Medical
professionals
on
the
front
lines
have
been
steadfast
in
addressing
a
public
health
crisis
and
they've
encouraged
and
promoted
the
safety
and
efficacy
of
vaccinations.
They
have
personally
treated
those
who
become
ill.
It's
really
not
politics
for
them,
and,
however
government
bureaucrats,
officials
talking
heads,
have
made
matters
more
challenging
and
they're,
consistently
inconsistent
guidance
and
contradictory
information
at
times,
poor
messaging,
arbitrary,
edicts
and
narratives
that
have
caused
many
in
the
public
to
view
covet
19
politically
instead
of
the
health
issue
that
it
is.
I
I
hope
that
public
officials,
including
all
of
us,
can
start
to
recognize
when
our
messaging
has
reached
the
point
of
ineffectiveness
and
kentuckians
and
americans
really
don't
need
to
be
lectured
to
they
need
to
be
part
of
the
conversation
and
their
concerns
need
to
be
heard.
Much
like
they
would
be
in
a
conversation
with
a
good
doctor
who
would
guide
and
recommend
the
course
of
action
for
a
patient.
I
In
the
past
two
weeks,
I've
been
I've
been
very
busy.
I've
had
a
chance
to
call
and
speak
to
our
hospitals.
Our
physicians
nurses,
some
of
our
licensing
boards,
our
chief
medical
officers
for
our
hospital
systems
to
get
some
consensus
and
some
ideas
on
what
needs
to
be
done
moving
forward.
I
want
to
remind
the
members
that
we
are
a
state
that
has
an
urban
area
and
rural
area
that
often
that
divide
is,
is
real.
I
It
continues
to
be
real,
particularly
in
this
space,
and
I
think
when
we
started
this
journey
of
covid19,
there
was
a
lot
of
unknown.
We've
learned
a
lot.
I
think
what
we're
looking
at
now
is
prevention,
as
one
side
of
things
and
treatment
is
another
once
people
get
diagnosed
and
to
understand
that
we're
not
experts
in
kobe.
This
is
a
novel
virus.
It's
a
new
virus,
so
we're
learning
as
we
go.
Fortunately,
we've
got
some
experience
from
other
viruses
in
the
past,
but
we
continue
to
learn
things
as
we
move
forward.
I
I
remind
people
that
medicine
is
not
a
hundred
percent.
People
think
that
everything
is
somehow
black
and
white
and
there's
true
and
false,
and
a
lot
of
those
things.
Medicine
is
got
a
lot
of
art
to
it
too,
and
I
think
anyone
who
provides
care
to
patients
know
that
we
have
to
apply
what's
important
for
that
patient
and
that
in
medicine.
Sometimes
what
is
science
is
what
we
know
at
the
moment
and
that
we
learn
things
as
we
go.
I
What
might
be
true
today
may
not
be
true
in
six
months
or
a
year
or
in
ten
years
and
again,
people
think
that
we're
very
fancy
when
it
comes
to
health
care,
we're
fancier
than
we
were
when
the
spanish
flu
hit
a
hundred
years
ago,
but
we're
still
not
all
that
fancy
when
it
comes
to
other
diagnosis
and
treatment.
I
Again
I
compare
things
to
the
spanish
flu
which
we
talked
about
outbreaks
and
how
we
handled
things
back.
Then
we
didn't
have
concentrated
oxygen
at
that
time.
We
didn't
have
nebulizer
treatments,
monoclonal,
antibodies,
remdez,
severe
steroids,
things
that
you
have
all
heard
about
that
people
get
treated
with,
so
we've
come
a
long
way,
but
still
have
a
long
way
to
go.
And
again
we
remind
people
that
we're
talking
about
viruses.
Here
we
don't
have
a
cure
for
the
common
cold.
I
Yet
that's
been
around
since
the
beginning
of
time
and
that
we're
still
learning
as
we
go
one
of
the
things
I
wanted
to
talk
about-
and
I
have
dr
mcconnell
here
is:
we
continue
to
struggle
in
terms
of
getting
people
vaccinated
and
I
would
encourage
those
who
are
watching
if
you
have
not
gotten
vaccinated,
please
go
out
and
get
vaccinated.
You
don't
want
to
take
my
word
for
it
or
go
talk
to
your
doctor
or
medical
professional
and
have
a
discussion
with
them.
I
We
got
about
48
to
49
of
our
state
fully
vaccinated
in
about
57,
with
at
least
one
dose
and
we've
had
a
lot
of
attempts
to
encourage
people
to
get
vaccinated
things
like
lotteries
and
giveaways.
But
let's
remember
that
we're
not
trying
to
sell
a
car
here.
This
is
a
recommendation
by
government
and,
more
importantly,
by
health
care
providers
for
a
potentially
life-saving
preventative
measure.
There
are
many
things
that
doctors
recommend
to
help
save
our
lives
influenza
shots
which
only
about
half
of
our
population
takes
every
year.
I
We
have
to
remind
people
that
children
die
every
year
from
influenza,
adults,
young
adults
die
from
influenza
every
year.
Diabetes
management
exercise,
proper
diet,
tobacco
cessation
costs,
8
900
lives
in
this
state
every
year,
and
people
ignore
those
recommendations
by
our
doctors
every
day
and
physicians
are
not
successful
in
getting
people
to
comply
with
their
recommendations
by
forcing
patients
to
do
what
they
don't
want
to
do.
It's
done
with
education
and
reassurance
and
with
respect
for
patients
abilities
to
decide,
we
have
an
ethical
obligation,
at
least
by
the
american
medical
association.
I
The
doctors
do
to
respect
patients
when
they
don't
sometimes
agree
with
us,
but
we
don't
demean
them
or
call
them
names
or
say
things
about
them.
They're
negative.
We
try
to
ask
what
the
problem
is:
reassure
them,
provide
more
education
and
hope
that
our
influence
provides
them
a
better
path
in
the
decision.
They're
going
to
make
kobit
really
is
no
different
at
this
point,
and
I
would
encourage
all
of
us.
I
Let's
start
stop
judging
someone
else
on
whether
or
not
they're
wearing
a
mask
or
that
they're
not
wearing
a
mask
whether
they've
been
vaccinated
or
not
vaccinated.
Let's
not
make
judgments
about
one
another,
and
I
would
ask
that
from
all
of
us
and
from
the
people
that
are
out
there
watching
as
well.
I
The
first
topic
that
I'd
like
for
the
committee
to
contemplate
is
a
topic
of
immunization
status.
I
think
a
lot
of
patients
have
not
been
vaccinated,
but
many
have
had
the
virus,
perhaps
without
knowing
and
therefore
may
have
a
natural
immunity
for
now
see.
The
cdc
and
israeli
studies
have
also
confirmed
that
many
people
that
have
had
a
natural
infection
do
in
fact,
typically
have
a
stronger
antibody
response
that
is
higher
in
the
amount
of
antibody
and
longer
in
response
than
a
vaccination.
I
At
least
that's
what
we
know
again
for
now,
and
I
believe
that
patients
can
go
and
have
antibody
levels
checked
at
labs
right
now.
People
can
do
that,
but
we
get
what's
called
a
qualitative
just
to
know
if
you've
got
antibodies
present.
I
think
dr
mcconnell
is
going
to
address
a
bit
more
of
that.
We
talk
about
people
that
are
vaccinated
and
unvaccinated.
I
think
the
discussion
needs
to
start
being
about
immunized
and
not
immunized.
We
heard
about
chickenpox
earlier
if
a
six
month
old
came
to
my
office
and
had
chickenpox
you
know.
I
I
We
met
not
that
long
ago
really
to
talk
about
labs
and
opportunity
for
lab
work
here
in
the
state,
but
he's
a
scientist
works
for
a
company
that
he's
going
to
introduce
here
in
a
moment
at
a
text
which
was
established
by
dr
leonard
bailey,
a
former
professor
of
mine
at
loma,
linda
university,
where
I
got
my
medical
degree
who
has
passed
away,
who
did
baby
baboon
heart
transplants
back
in
the
1980s
and
had
to
deal
with
immunology
after
a
transplant
and
established
a
company
to
study
a
lot
of
these
things.
I
They're
doing
a
lot
of
quantitative
antibody
testing
to
help
guide
practitioners
on
the
proper
course
of
action,
and
I
think
his
presentation
may
help
explain
how
and
why
certain
patients
are
having
repeat
covet
infections
or
why
certain
vaccinated
patients
contract
covet
after
vaccinations
with
that,
dr
mcconnell.
If
you
want
to
introduce
yourself
and
begin
your
testimony.
J
Yeah,
thank
you
very
much,
dr
alvarado.
It's
a
pleasure
to
be
here,
madam
chairman,
and
the
rest
of
the
the
group.
It's
a
pleasure
to
be
here.
I
am
dr
joe
mcconnell
a
phd.
My
my
background
is
that
I
was
director
of
cardiovascular
laboratory
medicine
at
the
mayo
clinic
for
well.
Actually,
let
me
start
with
my
current
title:
I'm
the
senior
vp
of
laboratory
medicine
at
for
attitex
therapeutics.
J
I
previously
it
was
at
the
mayo
clinic
as
director
of
cardiovascular
laboratory
medicine,
and
I
was
also
a
director
of
the
clinical
and
translational
research
facility
at
the
mayo
clinic
where
we
really
looked
at
a
lot
of
different
biomarkers
for
various
diseases
and
disease
states,
and
we
try
to
translate
them
from
research
into
clinical
practice
and
that's
what
we're
looking
to
do
here
as
well
today
and
that's
why
I'm
so
excited.
Can
everybody
hear
me?
Okay,
sorry
about
that.
J
That's
that's
why
I
was
excited
to
meet
the
folks
at
attitex,
therapeutics,
and
so
they
have
attitudes.
Therapeutics
is,
is
an
immune
really
is,
is
is
involved
in
developing
the
health
and
understanding
the
health
of
an
individual's
immune
system,
and
they
have
both
a
reprogramming
division
and
a
monitoring
division
with
my
laboratory
medicine
background,
I'm
more
related
to
the
mod
to
the
monitoring
side,
but
the
reprogramming
division
is
very
exciting,
exciting
developed
as
between
stanford,
university
and
loma,
linda
university,
as
as
dr
alvarez
mentioned,
and
their
technology
is
apoptotic.
J
Dna
immunotherapy,
which
results
in
immuno
immune
tolerance
rather
than
immune
suppression,
so
you're
really
actually
able
to
do
things
like
organ
transplants
and
fight
autoimmune
diseases,
etc
by
tolerizing
the
immune
system
rather
than
suppressing.
So
you
keep
the
rest
of
the
immune
system
functioning.
While
you
allow
things
like
organ
transplants,
etc
to
be
done
very,
very
exciting.
The
the
monitoring
division
is
going
to
be
looking
at
developing
companion
diagnostics
for
all
of
those
particular
technologies
and,
of
course,
with
the
pandemic.
That's
been
going
on
right
now.
J
In
the
immune
system
status,
it
made
very
very
good
sense
to
start
out
with
covid19
testing,
so
the
technologies
that
were
developed
at
stanford
and
linda
university
were
licensed
by
aditects
and
we've
been
bringing
them
translating
those
technologies
into
clinical
practice
as
we
go
through
and
and
really
we're
looking
at
monitoring
immune
status,
and
I
think
dr
alvarado
already
covered
a
lot
of
my
opening
statements,
but
it
really
is
about
identifying
vulnerable
individuals
in
the
coveted
state.
What
is
their
immune
status,
particularly
related
to
cobit
19.?
J
I've
got
a
lot
of
slides
and
I
know
we
don't
have
a
lot
of
time
here
and
so
I'm
going
to
skip
through
multiple
of
the
slides,
but
just
to
show
you
that
we
spend
a
lot
of
time
and
we
do
that
at
all
times
in
order
to
bring
a
test
into
clinical
practice.
It
has
to
be
very
robust
and
withstand
multiple
tests
to
make
sure
that
we're
always
going
to
get
the
right
result
for
any
individual
patient.
That's
in
front
of
us,
and
so
we
did
all
the
things
like.
We
have
a
very
tech.
J
The
technology
is,
is
flow,
cytometry,
which
is
a
technical,
very
technical
piece
of
instrumentation.
We've
got
to
make
sure
that
all
the
instruments
work
correctly
together
and
give
you
the
same
results.
We've
got
to
do
things
like
establish
the
linearity
etc,
and
we
really
need
to
know
what
is
the
sensitivity
and
the
specificity.
That
is
the
not
the
the
positive
predicted
agreement
and
the
negative
predictive
agreement.
J
So
we
have
three
locations,
I'm
not
going
to
I'm
going
to
skip
through
this
a
little
bit
and
we
do
really
want
to
get
on
to
identifying
in
an
individual
what
is
their
immune
status
related
to
covet
19
so
that
they
can
make
the
right
decisions
for
themselves?
Sorry
from
drifting
away
from
the
microphone
I'm
trying
to
reach
over
here
and
advance
the
slides.
J
At
the
same
time,
and
as
I
said,
it's
a
multi-multiplex
methodology-
we
have
nine
different
analytes
three
different
isotypes
of
igg,
iga
and
igm
to
three
different
size,
cov2,
antigens
and
then
what's
really
important
is
that
we
have
a
method
that
which
you
develop
for
neutralizing
antibodies.
Those
are
the
antibodies
that
will
bind
to
the
receptor,
binding
domain
of
stars,
cov2
and
inhibit
it
from
actually
entering
the
host
cell
or
the
human
cell
and
then
beginning
to
replicate
into
shed
etc.
J
J
You
also
have
many
other
proteins
like
the
receptor
binding
domain,
which
is
a
part
of
the
spike
protein,
and
then
we
have
s1
and
s2
subunits
e
proteins
and
then
on
the
inside.
We
have
this
nucleocapsid
protein.
The
reason
I'm
taking
just
a
little
bit
of
time
to
talk
about
this
is
all
of
the
vaccines
which
are
out.
There
are
vaccines
to
the
spike
protein.
Only
the
mrna
related
vaccines
or
vaccines
to
the
spike
protein
only
and
they
they.
So
you
will
only
get
an
antibody
response
to
the
spike
protein.
J
You
won't
with
a
vaccine.
You
won't
get
a
response
to
the
nucleocapsid
protein
with
a
vaccine.
If
you
actually
are
exposed
to
the
virus,
then
you
will
see
all
of
those
various
antigens
that
are
on
the
surface
and
in
the
internal
workings
of
the
stars.
Cov2
and
you'll
develop
antibodies
to
all
of
those
things
so
like
the
s2
subunit,
the
e
protein,
which
is
the
envelope
protein
and
the
nucleocapsid
protein.
So
when
we
developed
the
methodology,
we
wanted
to
take
make
sure
that
we
were
really
getting
something
that
was
complete.
J
That
would
identify
the
vaccine
immunity
as
well
as
immunity
to
the
cysco
v2
virus
and
be
able
to
differentiate
between
those
and
that's
I'll.
I
won't
go
through
the
details,
but
these
are
the
the
neutralizing
antibodies
bind
to
that
receptor
binding
domain,
and
that's
why
they're?
So
important
you
can
make
regular
antibodies
to
other
areas
of
the
stars
cov2,
but
the
neutralizing
antibodies,
the
ones
that
actually
bind
to
the
rbd
and
inhibit
the
virus
from
entering
the
cell,
and
this
is
an
example
of
the
report.
J
So
I'm
not
sure
how
well
you
can
see
this
not
very
well,
but
there's
nine
different
antibodies
that
we're
looking
at
so
the
first
three
are
igg
igm
and
iga
to
the
receptor
binding
domain.
The
second
three
are
igg
igm
and
igg
or
iga
to
the
s1
subunit
of
the
spike
protein
and
the
last
three
are
igg
igm
and
iga
to
the
nucleocapsid
protein
or
np,
and
this
is
in
and
then
at
the
very
bottom.
That's
the
neutralizing
antibody
assay.
So
this
is
somebody
who's
had.
Actually
we
can
tell
by
this.
J
This
is
somebody
who's
been
exposed
to
the
virus
sometime
in
the
past
probably
longer
ago,
and
then
subsequently
gotten
the
vaccination.
We
can
tell
this
just
by
looking
at
these
results
and
they've
developed
a
very
strong
response,
because
they
have
neutralizing
antibodies
as
well
that
they
produced,
and
so
this
should
be
somebody
who
is
very
well
immunized
to
sars
kobe
2
had
both
a
infection
in
the
past
and
subsequently
a
immunization
with
the
vaccine.
J
Those
are
the
previous
infection,
but
no
vaccine
who
had
a
robust
response
and
those
would
be
likely
protected.
So
whether
the
two
on
the
left
are
likely
or
unprotected
individuals
and
the
three
on
the
right
are
individuals
are
likely
protected.
So
it's
we
can
identify
a
robust
immune
response
with
neutralizing
antibodies
to
either
vaccinated
infected
or
those
who
are
infected
and
vaccinated.
Like
the
previous
result
that
we
saw
I'm
not
going
to
spend
a
lot
of
time
on
this.
This
is
just
if
anybody
has
any
technical
questions.
J
This
is
just
the
the
validation,
the
robustness
testing
in
the
sensitivity
testing
that
we
did
for
setting
up
the
assay.
This
is
really
interesting
when
you
have
nine
different
acids.
If
you
have
just
a
single
assay
to
say
the
nucleocapsid
or
the
receptor
binding
domain,
you
either
have
to
sacrifice
sensitivity
or
specificity.
J
If
you
have
nine,
you
can
set
up
criterion
that
allows
you
to
improve
the
sensitivity
and
the
specificity,
and
so
we
set
criterion
to
allow
us
to
achieve
100
percent
sensitivity
and
100
specificity
with
the
methodology,
because
we
have
the
nine
different
antibodies.
This
is
just
showing
the
neutralizing
antibody
assay
and
a
happy.
They
don't
want
to
try
to
explain
that,
because
we'll
lose
a
time.
This
is
some
research.
That's
been
done
that
has
shown
that
the
neutralizing
antibody
activity
is
associated
with
protection
against
the
sars
kobe
2.
J
J
That's
just
that
same
slide
again,
and
so
I'm
going
to
go
through
two
really
quick
studies
and
then
we'll
open
up
the
questions.
So
this
is
a
first
study
that
we
did
30
participants.
This
was
a
client
staff
studies.
This
is
staff
of
a
abate
client
which
I
won't
disclose,
who
the
client
was,
but
the
blood
plasma
was
drawn
and
analyzed
we
quantified
the
nine
antibodies
and
then
we
qualified
the
neutralizing
antibodies.
J
The
age
group
here
is
22
to
79,
so
this
is
a
pretty
young
group,
average
age
of
44,
pretty
young
group
of
individuals
and
30
of
them,
and
what
we
found
is
we
some
of
them
had
a
response
like
this.
Basically,
you
see
everything's
gray
and
nothing's
green
everything
is
below
the
detection
limit
for
antibodies.
This
is
somebody
who's
not
been
exposed
and
has
not
been
vaccinated.
Okay,
there
were
two
so
out
of
the
30.
There
were
only
two
that
had
not
been
exposed
and
not
been
vaccinated.
J
Okay,
just
to
give
you
an
idea
that,
what's
going
on
here's
another
one
where
this
is
somebody
who
you
can
see,
there's
some
greens
now
and
the
greens
are
actually
to
the
the
igg
to
the
receptor
binding
domain
and
the
igg
to
the
s1.
So
this
is
somebody
who's
been
vaccinated
and
there's
no
nuclear
capsid,
so
they
haven't
been
exposed.
Previously
there
were
two
staff
members
these
are
vaccinated,
but
if
you
look
at
the
neutralizing
antibodies,
they're
negative
they're
not
detected
neutralizing
antibodies.
J
This
is
somebody
who's,
developed,
antibodies,
but
negative
neutralizing
antibodies,
a
vaccine,
and
this
these
individuals
obviously
were
vaccinated.
They
thought
they
were
protected.
These
are
pretty
young,
healthy
individuals
and
when
they
found
out
the
results
here
that
they
actually
aren't
protected,
then
they
had
to
make
some
decisions,
talk
to
their
physician
and
their
provider
and
make
the
best
decision
for
them
in
terms
of
what
to
do
to
really
improve
their
immune
status.
J
J
Okay,
this
is
an
individual.
There
were
seven
staff
members
that
were
previously
infected
with
stars,
cov2,
but
not
vaccinated,
so
we
know
they
weren't
vaccinated
because
they
told
us
they
weren't
vaccinated
in
this
particular
case.
But
you
can
see
the
nucleocapsid
protein
is
elevated,
as
well
as
the
rbd
and
the
s1
whoops.
J
One
too
far.
There,
if
you
look
at
the
the
nuclear
capsule,
the
last
two,
you
see,
the
gray,
the
igm
and
the
iga
are
gray
and
the
rest
of
them
are
green.
That's
an
indication
that
this
happened
a
long
time
ago,
because
igm
and
iga
will
go
up
and
then
they
begin
to
go
down
more
quickly
than
the
igg.
So
this
is
somebody
who
had
been
infected
infected
a
fairly
long
time
ago,
but
then
subsequently
was
vaccinated
and
you
can
see
that
the
igg
response
is
a
little
bit
lower
than
the
others.
J
So
no,
I
said
this
is
a
non-vaccine
individual.
Sorry
I
got
I
got
confused.
This
is
non-vaccinated.
Individual
who's
just
been
infected.
Oh
I
went
ahead
too
far.
I
didn't
get
back.
J
J
This
is
somebody
who's
been
vaccinated,
but
had
no
previous
infection
again.
The
nuclear
capsid
is
all
negative.
All
three
of
them
are
negative,
but
no
previous
infection
and
a
good
neutralizing
anybody.
So
this
is
somebody
who's
been
protected.
J
So
if
you
put
all
this
together,
this
is
what
we
see
we
see
likely
protected
individuals,
26
out
of
the
30,
are
likely
protected,
likely
unprotected
four
or
13
percent
were
likely
unprotected
in
this
group
of
individuals,
and
you
can
see
if
you
look
at
this.
The
the
first
group
is
no
vaccine
and
the
third
group
is
no
vaccine.
J
J
J
So
we
can
see
that
we
can,
by
looking
at
both
the
ability
to
see
whether
whether
they're
infected
or
their
head
vaccine,
we
might
be
able
to
see
that
there's
a
higher
percentage
of
individuals
who
are
actually
protected,
so
we
may
be
getting
more
close
to
that
overall
safety
that
group,
so
one
more
study
and
then
I'll
be
done
real
quickly
here,
99
adults
scheduled
to
receive
a
booster
vaccination.
So
this
is
an
adult
living
center.
99
individuals
all
have
been
previously
vaccinated,
all
ready
to
get
booster
shots
or
administration.
J
So
that's
that's
a
good
thing.
So
everybody's
going
to
be
getting
boosters
night
again,
the
neutralizing
antibodies
and
the
antibodies
were
formed.
The
age
was
63
to
99,
so
this
is
an
elderly
population.
The
average
age
was
85
years.
There
were
83
females
and
16
males.
So
just
that's
just
the
population
was
there.
So
this
is
predominantly
female
oriented
study,
but
here's
an
example
of
somebody
who's
unprotected.
Now
we
know
everybody's
vaccinated.
So
this
is
somebody
who
was
vaccinated
had
very
little
antibody
response
and
so
that
in
in
in
no
neutralizing
antibodies.
J
There
were
eight
eight
individuals
who
were
vaccinated
but
not
protected
in
this
group.
Okay,
no
response
not
just
not
protected,
they
really
had
no
immune
response
whatsoever.
So
those
are
people
that
go
back
and
look
and
say
what
is
going
on
that
they
don't
have
an
immune
response,
so
they
potentially
have
they
have
they
had
an
organ
transplant,
maybe
they're
on
an
immunosuppressant
drug,
maybe
they're
on
another
drug.
That
sort
of
thing
it's
really
important.
So
eight
individuals
in
that
group
there
were
25
individuals
in
the
next
category.
J
They
were
vaccinated
and
or
they
had
a
previous
infections.
I
group
these
together
because
all
of
them
were
vaccinated
and
or
previous
infection,
but
unprotected
and
you
can
see
again.
The
neutralizing
antibodies
here
are
way
well
below
the
cup
point.
So
these
are
non-detected
neutralized
antibodies
and
you
can
see
a
lot
of
antibodies
have
been
produced,
but
not
the
neutralizing
antibodies
have
been
produced
so
made
antibodies
to
everything,
but
not
those
neutralizing
antibodies
that
stop
the
virus
from
getting
into
the
cell.
That's
important
it's
important
thing
to
to
note.
J
Then
we
had
17
individuals
who
were
vaccinated
with
no
previous
infection,
and
you
can
see
that
again,
I'm
not
going
to
explain
that
again.
We
had
49
individuals
who
were
vaccinated
and
had
her
previous
infections.
So
this
adult
living
center
was
pretty
good
about
getting
individuals.
Well,
49
of
the
the
individuals
were
had
both
infection
and
previously
and
and
all
of
those
individuals
were
protected,
see
the
details
here.
So
this
is
the
results
in
the
summary
and
I'll
be
finished
up,
and
we
can.
J
J
33
percent
of
individuals
who
had
been
in
vaccinated
or
exposed
or
who
had
been
vaccinated
were
still
unprotected,
and
so
that's
what
we're
really
trying
to
get
to
is
identifying
the
unprotected
or
the
vulnerable
patients,
and
in
this
population
there
were
33
percent
of
them.
That
truly
did
need
to
have
a
booster
at
this
particular
point
in
time
or
to
be
looked
into
to
see
why
it
was
that
they
weren't
developing
a
robust
immune
response
and
we've
seen
this
across
multiple
populations.
J
A
Yeah,
this
is
really
interesting.
Thank
you
so
much
for
this
presentation.
I
think
that
we
could
all
probably
hear
this
three
or
four
times
and
and
finally,
you
know
have
some
clarity
on
this,
but
I
I
you
know,
I
I
understand
the
concept:
what
can
we
really
infer
from
this
this
data,
the
study?
What's
the
clinical
application.
J
J
You
know
a
number
of
individuals
have
been
vaccinated,
but
they
haven't
developed
a
robust
immune
response.
We
want
to
identify
those
individuals.
First
of
all,
there's
also
a
number
of
individuals
who
have
had
had
an
exposure
and
they
did
have
a
robust
response,
and
some
of
the
data
are
now
indicating
that
there
may
be
the
individuals,
especially
out
of
israel.
Data
coming
out
of
israel.
Individuals
that
are
exposed
may
be
even
better
protected
than
individuals
who
are
receiving
the
vaccine.
J
We
have
t
cell
response,
assays
we've
enrolled
now
about
450
patients
and
we're
we're
bringing
them
in
monthly
for
testing
we're
going
to
follow
them
over
time,
and
many
of
them
were
unvaccinated
as
we
we
picked
some
that
were
unvaccinated
and
not
exposed
and
we
moved
them
along.
What
we're
finding
is
that
when
we,
when
they
see
their
results
on
the
individuals
who
see
the
results
and
they
find
out
that
they're
completely
exposed
they're,
not
I
mean
they're
completely
susceptible
or
vulnerable.
J
A
Exactly
okay,
thank
you,
yeah
and
just
a
couple
more
things:
what's
the
method
of
testing
and
what's
the
cost,
and
how
widely
is
this
available.
J
Yeah,
that's
that's
a
great
question.
So
the
methodology
is
a
flow
cytometry
method,
and
so
we
have
flow
cytometry
beads
with
various
antigens
and
then
we
back
stain
with
the
various
antibodies.
The
cost
is
about
a
hundred
and
forty
nine
dollars
and
don't
I'm
the
scientist,
so
somebody's
gonna
really
not
be
happy
with
me
for
saying
that,
but
that's
what
that's,
what
the
the
the
list
price
is
and
and
there's
negotiations
around
that
and
that
sort
of
thing,
so
I
probably
shouldn't
have
even
said
a
number.
J
In
fact,
I
take
that
back,
we'll
we'll
let
others
answer
that
question
in
the
future,
because
that's
not
not
for
me
to
to
handle
I'm
really
on
the
the
science
and
medicine
side.
J
Right
now
we
have
the
capacity
to
do
several
thousand
tests
per
day
and
and
so
and
we
have
developed
partners
with
laboratories
in
the
area.
In
fact,
one
of
the
labs
here
is
sphere
diagnostics
that
we
partnered
with
and
they
so
we're
not
actually
going
out
and
promoting
we're
partnering
with
other
laboratories
who
are
pulling
in
the
testing
from
their
physicians
and
in
others,
and
then
sending
to
us,
the
in
the
central
facility
in
richmond
virginia
to
do
the
testing.
A
Very
good,
okay:
we
have
several
questions.
I'm
going
to
start
with
senator
burke.
C
Thank
you
again,
madam
chair,
and
thank
you
for
a
very
interesting
presentation.
I
have
a
myriad
of
questions,
most
of
which
I'm
not
going
to
be
able
to
ask
at
this
time
I'm
sure
because
of
of
time
restraints
I
am
assuming
and
that
you
know
what
they
say
about
assuming
never.
K
C
J
Yeah
well,
some
of
the
data
is
coming
through,
so
so
the
antibody
levels
have
been
measured
in
you
know
the
folks
who
developed
the
pfizer
vaccine
and
the
folks
who
developed
the
mardana
vaccine
and
the
others
have
been
monitoring
and
started
looking
at
the
antibody
levels
and
what
we're
finding
and
we
have
been
as
well
we're
finding
that
you
know
you
can't
really
say
every
individual
is
different,
and
so
some
individuals
may
not
have
a
response
at
all.
Some
individuals
may
respond
quickly.
J
Other
individuals
may
their
antibodies
may
go
up
more
slowly
and
then
their
antibodies
may
come
down
faster
or
slower.
I
can
tell
you
that
we've
had
you
know
several
individuals
who
had
had
exposure
to
sars
cov2
more
than
a
year
ago
that
still
have
elevated,
immunoglobulins
antibodies
to
the
rbd
and
the
s1
and
the
nucleocapsid,
and
also
still
have
you
know
very
robust
levels
of
of
neutralizing
antibodies.
But
not
everybody.
J
Yeah
that
data
that
data
is
being
generated
and-
and
actually
I
brought
a
a
paper
here
and
sorry-
I've
only
got
seven
copies,
so
I
don't
think
it's
going
to
be
enough
to
go
around,
but
it
those
of
you
who
would
like
this
paper.
It
was
published
in
nature
medicine,
which
is
a
very,
very
reputable
journal,
and
it's
a
study
out
of
australia
where
they
were
looking
at
neutralizing
antibodies
and
how
well
neutralizing
antibodies
protect
and
what
they
find.
J
Is
that
that
you
have
that
if
you're
in
the
20th
percentile,
so
they
looked
at
the
population
distribution,
it's
hard
to
explain,
look
at
that
population,
distribution
of
those
immunized
patients
and
what
they
found
was
if
you're
at
the
20th
percentile
in
that
group,
that's
associated
with
protection,
if
you're,
even
at
your
third
percentile
in
the
group,
it's
associated
with
less
severe
disease.
If
you
get
a
breakthrough
infection,
I
hope
that
answers
the
question.
So
that's.
C
That's
that
does
what
we're
shooting
for,
and
my
I
think
my
most
important
question
is:
does
your
antibody
levels
do
your
antibody
levels
correlate
I
mean.
Obviously
we
think
they
correlate
with
your
ability
to
get
a
infection.
C
J
Actually,
you
know
I
was
listening
to
dr
alvarado
spree
speak
when
I,
when
I
presented
this
to
him,
and
he
gave
a
very
good
response.
So
that's
a
really
hard
question
to
answer,
because
we
don't
really
have
the
data
we
we
don't
know
for
certain
somebody.
Who's
would
have
a
protective
status.
Do
we
know
we
don't
know
enough
about
individuals
who
have
a
protective
status.
So
it's
it's
hard
to
say,
but
dr
dr
alvarez
did
you
want
to?
Would
you
want
to
try
to
address
that
at
all?
I
think
it's
possible
that
they
could.
I
Yeah
I
mean
so
the
the
and
that's
a
good
question.
I
mean
in
terms
of
how
much
does
that
help
protect.
I
mean
if
you've
got
iga,
which
we
know
is
kind
of
it's
one
of
the
immunoglobulins.
That's
all
mucosal
protection
if
your
iga
levels
are
high
with
standard
reason
that
would
be
probably
obliterated
in
that
area.
So
the
big,
the
big
purpose
of
having
dr
mcconnell
come
and
present
on.
I
This
really
is
mostly
to
to
educate
a
lot
of
our
members
to
think
that
people
say
how
come
if
you're
getting
a
vaccine,
how
come
they're
getting
infections,
how
come
they're
getting
on
top
of
that?
How
come
if
somebody's
you
know
had
a
previous
infection?
Why
are
they
getting
another
infection?
Maybe
you're
not
producing
enough
neutralizing
antibodies.
I
Lots
of
reasons
for
that,
but
I
think
we
need
to
be
educated
because
we're
thinking
on
vaccine
on
vaccine
that's
easy
for
government
to
track
it's
easy
for
health
departments
to
track,
but
really
when
we
talk
about
immunity,
if
you're
immunized
against
something,
then
you
have
protection
against
that
and
you'll
be
able
to
and
more
people
have
it
the
better
off.
We
are
as
a
society,
and
so
I
think
that's
the
point
of
me.
Bringing
this
forward
is
really
to
say:
hey,
listen,
there's
people
out
there
that
probably
have
protection
that
don't
know
it.
I
People
who
think
they're
protected
and
are
running
around
like
superman
and
are
not
protected.
That
becomes
a
concern
in
lots
of
aspects,
so
you
know
we
encourage
people
to
get
vaccinated
if
they
haven't
had
it.
I
There
are
some
countries
that
if
you
want
to
go
in
and
pay
a
visit,
they
said
we
need
to
see
your
vaccination
card
or
proof
of
immunity.
We
want
to
see
your
previous
infection
and
what
your
level
of
antibody
is
and
we'll
let
you
in
so
for
some
governmental
bodies
around
the
world
are
looking
at
that
and
considering
that
adequate
or
equal
to
a
vaccination.
I
I
think
that's
what
we
need
to
start
considering
and
start
talking
about,
because
I
know
there's
a
lot
of
a
lot
of
you
know
tension.
I
guess
around
this
topic
that
we
have
there's
obviously
employers
who
are
requiring
some
of
these
things
for
folks
a
what,
if
an
employee,
I
think
there
was
an
employer,
but
one
of
the
universities
we
were
talking
about
who
a
professor
said:
listen.
I've
already
had
the
infection,
I
don't
want
to
take
a
vaccine
and
they
allowed
him
to
bring
proof
and
let
him
to
keep
his
job.
I
They
required
masks
and
other
things
at
his
point
of
employment,
but
he
didn't
have
to
get
one
because
he
had
proof
of
that.
How
long
does
this
last?
For
we
don't
know,
I
mean
obviously
flu.
We
recommend
flu
vaccines
every
year.
Why?
Because
you
may
have
had
the
flu
a
year
ago
or
10
years
ago.
It
may
not
cover
next
year's
mutations.
We
recommend
a
booster
every
year
and
that
will
likely
be
the
case
with
this
going
forward.
I
suspect,
when
it
comes
to
copics.
I
I
don't
think
it's
here
to
stay,
but
we're
going
to
have
recurring
infections.
So
how
long
does
that
immunity?
We
don't
know
those
answers
is
all
brand
new
for
us,
but
I
think
for
the
here
and
now
for
the
moment
of
what
we
know
there's
a
lot
of
folks
who
have
a
good
amount
of
antibodies,
that's
protected
for
them
from
actually
being
infected
or
having
an
issue
that
we
need
to
start
considering,
and
I
mean
that's
that
that's
been
broaching
talked
about.
I
C
C
C
H
A
Have
a
long
list
of
people
who
want
to
chime
in
so
thank
you,
representative
prunty.
Do
you
have
a
question.
B
I
I
want
to
thank
you
for
the
work,
and
I
want
to
thank
you
for
bringing
this
senator
alvarado,
because
I
know
that
there
I
think
this.
This
information
will
go
a
long
way
to
educate
young
adults
who
are
resisting
getting
vaccinated
because
they
feel
like
do
as
I
say,
not
as
I
do,
and
I
think
they
need
to
know
this
science.
B
The
question
I
have
is:
if
someone
has
had
the
virus
has
been
fully
vaccinated
and
then
has
to
go
into
some
sort
of
treatment
for
cancer.
That
sort
of
thing
would
it
be
wise
to
get
this
test
prior
to
starting
treatment?
Would
it
be
wise
to
get
it
after?
How
would
this
test
be
beneficial
to
someone
in
that
scenario,.
J
Yeah,
that's
a
really
good
question.
I
I
in,
and
it's
not
one
that
I've
even
thought
about
before,
but
but
yeah
it's
a
great
question.
I
think
it
would
be.
It
would
behoove
them
to
get
the
test
before
they
go
in
and
then
after
as
well
to
see,
because
we
do
know
that
that
many
of
the
the
drugs
will
will
cause
some
immunosuppression
to
occur
now
once
you've
already
made
the
antibodies.
J
This
would
be
a
great
study
as
a
matter
of
fact,
I'm
sure
that
somebody
is
studying
it
as
a
matter
of
fact.
So
you
know
the
antibodies
that
you
make
are
stable
for
a
fairly
long
period
of
time,
and
so
does
the
immune
you
know:
does
the
whatever
immunosuppressant
drug
or
cancer
drug
caused
those
antibodies
to
diminish?
I
wouldn't
think
so
because
they're
pretty
stable,
but
you
know
we
really
need
to
get
some
data
around
this.
J
J
Yes,
it
is
so
there
we
have
a
partner
lab
here,
sphere
diagnostics-
that
is
right
here
in
kentucky
and
in
lexington,
in
in
in
multiple
locations
and
so
through
them
and
the
the
physicians
that
they
serve
and
the
institutions
that
they
serve.
You
can
get
ordering
a
physician
to
order
the
lab
testing
and
it
will
be
available
and
it
could
be
superb.
Thank.
A
J
That
is,
that
is
correct,
so
we
could
go
on
our
website,
which
is
www,
and
you
can
put
in
your
zip
code,
and
we
can
tell
you
where
a
location
is
is
near.
You
we're
really
building
this
out
right
now,
so
there
are
some
locations
that
we're
not
going
to
have
a
presence,
but
we're
trying
to
build
out
all
of
the
united
states
right
now
and
even
abroad,
and
we've
got
some
really
good.
Networking
partners
that
are
developing
this
with
this
we'll
be
able
to
make
it
available.
J
J
Yeah,
that's
a
good
question
because
we
hear
now
a
lot
of
people
initially
said.
You
know
you
can't
use
antibody
testing
to
assess
immune
status
and
a
lot
this
for
several
reasons.
Actually
some
of
the
original
tests
were
only
for
the
nuclear
capsid
protein.
So
if
you
had
an
igg
say
to
nucleocapsid
protein,
which
is
one
that
we
have,
then
you
would
be
able
to
detect
natural
infections
but
you'd
never
detect
somebody's
immune
response
to
a
vaccination.
J
So
that's
one
problem.
The
other
problem
is
a
lot
of
the
first
tests
that
were
developed
were,
you
know,
very,
were
lateral
flow
analysis
and
you
form
a
little
bar
there's
no
quantitation
associated
with
that
you
get
a
positive
or
a
negative,
and,
and
it's
and
where's
that
cut
point
said
set
a
lot
of
folks.
We
it's
one
thing
that
we
do
is
really.
A
N
C
N
J
N
We
know
it's
about
60
70,
effective,
so
is
that
a
fair,
side-by-side
comparison.
J
Yeah,
I
think
I
think
it
is,
I
think,
we're
probably
talking
about
you,
know,
individuals
that
aren't
protected
for
whatever
reason
and
the
reasons
that
they're
not
protected
against
the
flu
may
be
the
same
reasons
that
they're
not
protected
against
the
sars
cov2
virus,
and
so
seeing
those
similarities
is,
is
not
too
surprising.
I
remember
that
was
an
elderly
population
and
in
the
younger
population
we
saw
a
more
more
protective
status,
and
so
it
really
is
related
to
to
to
age
as
well.
Well,.
N
I
think
it's
important
to
communicate
that,
and
not
only
for
the
coveted
vaccine
with
the
flu
vaccine.
A
lot
of
people
don't
understand.
N
Think
they
have
100
protection,
but
ironically
I
don't,
if
you
saw
it
today
or
not,
but
there
was
an
article
in
usa
today,
the
headline
was
antibody
tests
can't
confirm
if
you
have
covert
protection-
and
you
just
spoke
to
that
just
a
second
ago,
but
just
curious
if
you've
seen
that
article
and
if
you
were
in
agreement
with
it.
Obviously.
J
I
haven't
seen
the
article
and
the
answer
is:
you
know
the
antibody
tests
do
correlate
to
neutralizing
antibodies,
pretty
well,
and
we've
seen
multiple
papers
that
have
been
out
there.
That
say
that
antibody
testings
have
been
associated
with
protection,
but
it
really
is
as
important
that
you
develop
those
neutralizing
antibodies
that
are
going
to
bind
to
the
receptor,
binding
domain
and
inhibit
the
virus
from
invading
the
host
cells.
That's
that's
the
important
part,
so
you
can.
J
As
you
saw,
I
showed
some
examples
and
I
know
it
came
through
very
fast,
but
I
showed
some
examples
where
an
individual
had
elevated
antibodies
but
did
not
have
elevated
neutralizing
antibodies
and
therefore
those
would
be
the
individuals
that
probably
are
not
protected
despite
having
antibodies.
So
it's
not
100.
There
is
good
correlation
between
the
neutralizing
antibodies
and
the
antibodies,
but
we
can't
always
nail
it
down
with
just
the
antibody
test.
N
O
N
A
E
J
Yeah,
those
are
other
immunoglobulins
out
there
and
the
ig
igd
is
not
what
is
well
studied
and
typically
isn't
used
in
in
laboratory
monitoring.
The
ige
is,
and
that's
one
that's
going
to
establish
an
allergic
response,
and
so
we're
really
not
interested
in
in
those
that
are
establishing
allergic
responses
to
the
cysco
v2.
What
we're
really
looking
for
is
what
the
normal
immune
response
is
and
that's
why
we've
elected
not
to
include
the
igge.
E
J
J
You
know
ace
inhibitors
potentially,
could
they
could
they
block
the
site
or
could
they
be
useful,
and
I
think
some
of
the
early
data
suggested
that
maybe
so-
and
I
don't
think-
that's
really
been
borne
out.
I
said,
but
it's
not
an
area
that
I
don't
want
to
go
out
too
far
and
try
to
make
an
answer
here,
but
I
think
there's
a
possibility
that
you
know
you
could,
if
you're
altering
the
ac2
receptor
you
potentially
could
could
be
mechanism
other
than
blocking
it
with
antibodies.
J
Yeah,
I
don't
know
if
I
could
answer
that
question.
Did
you
want
to
comment
on
that.
I
No
way
for
us
to
know
necessarily,
I
mean
that's
going
to
be
everybody's
different.
There
are,
I
mean,
there's
a
lot
of
factors
to
the
immune
system.
Like
I
said
we
can
spend
a
day.
I
can
give
you
kind
of
a
quick
version
of
how
it
works,
but
you
have
t
cells,
natural
killer
cells.
You
have
you
know,
b
cells,
part
of
its
memory,
so
what
you
get
exposed
to
when
your
body
gets
introduced,
a
new
virus,
your
body
recognizes
it
as
something
form
doesn't
know.
I
If
it's,
if
it's
part
of
me
or
not
part
of
me
in
the
meantime,
the
virus
is
infecting
you
as
you're,
trying
to
identify
it
or
find
some
way
to
put
an
antibody
on
it.
You
start
to
try
to
crank
that
out
b
memory
cells
are
going
to
take
several
weeks
for
that
to
produce
enough,
you
know
of
igg
you're
getting
igm
initial,
but
it's
very
slow,
so
your
antibody
response
is
slow.
To
begin
with.
That's
why
you
get
infections
to
know.
I
If
you
have
enough
t
cells
or
not
again,
it
could
be
from
lower
immune.
You
don't
have
enough
antibodies
floating
around
to
really
block
these
and
to
knock
them
out
as
a
possibility.
Somebody
could
have
lower
natural
killer
cells,
t
cells,
lots
of
factors,
but
I'd
be
going
into
an
immunology
lesson
for
everybody
here.
It
would
take
us
quite
a
while
to
go
through
an
explanation.
So
it's.
E
Kind
of
unknown,
just
one
more
short,
one
from
someone
they
asked
me
with
the
engineered
virus-
was
that
the
guanine
guanine
attitude,
addison
adesinagisin,
foci.
I
I
A
Course,
representative
wilner
thank.
B
B
Our
focus,
of
course,
is
on
population
health
and
improving
the
health
and
safety
for
all
kentuckians
and
really
what
I'm
hearing
in
this
technique
from
your
presentation
is
that
there's
a
strong
argument
to
be
made
in
defense
of
the
vaccine
and
why
people
should
get
the
vaccine,
and
I
wonder
if
you
could
maybe
help
translate
for
us
for
this
committee?
What
do
you
think
the
message
is
you
know
from
from
technology,
from
your
findings
of
your
studies,
of
what
the
message
is
to
help
people
understand
the
importance
of
the
vaccination
to
increase
their
immunity.
I
Thanks
for
preserving
I'll
I'll,
take
that,
if
you
don't
mind,
I
mean
really
the
purpose
of
having
dr
mcconnell
come
and
present.
This
is
really
to
provide
that
information.
It's
different
for
different
individuals,
like
I
said,
there's
people
out
there.
I
think
that
are
vaccinated,
who
think
they've
got
great
protection.
Most
do
and
may
not
have
it
we're
talking
about
having
people
get
boosters
and
people
are
saying
how
come
if
it's
worked
so
well.
Why
am
I
getting
a
booster?
I
This
is
part
of
the
reason
why
people
out
there
who
have
had
natural
and
don't
even
know
they've,
been
infected
and
may
have
a
really
adequate
antibody
response
and
don't
even
know
it,
and
so
I
think
it
has
multiple
applications.
I
think
it
does
bolster
the
idea
that
people
should
get
vaccinated.
I
think
people
realize
they
don't
have
any
protection
they're
at
high
risk.
We
know
this
delta
variant
is
very
aggressive
and
so
we're
trying
to
convince
people
that
are
out
there
if
they
think
they
have
an
antibody
level.
I
Oh
I've
tested
I've
got
a
qualitative
test,
the
little
lime
that
says
I've
got
antibodies
here.
You
may
not
have
enough,
and
so
you
may
still
be
at
risk,
and
you
probably
should
go
get
a
vaccine,
so
there's
people
out
there
that
have
had
it
who
may
need
a
vaccine
booster
people
that
have
had
the
vaccine,
who
probably
need
a
booster
at
some
point
as
well.
I
People
who
don't
even
know
if
they've
had
an
infection
who
might
actually
be
protected
and
we've
got
a
lot
of
people
trying
to
tell
others
what
to
do
not
to
do.
I
think
this
is
another
opportunity
that
if
we
can
find
that
someone
is
actually
immunized
that
they're
protected
something
for
our
employers
to
consider
for
the
state
to
consider
moving
forward.
That's
really
it's
more
or
less
to
provide
some
information
and
kind
of
keep
it
out
of
the
political
realm
and
really
from
someone
who's.
J
I
just
one
little
thing
is
that
that
we're
trying
to
really
see
what's
happening
in
communities
so
as
we
get
more
and
more
data
from
varying
communities
we're
pulling
the
data
in
from
the
variant
community,
so
we
could
say
you
know
what's
happening
in
in
lexington
kentucky.
J
Let's
take
a
look
at
all
of
the
results
from
lexington
kentucky.
What
is
the
immune
status
of
the
individuals
that
we're
seeing
from
lexington
kentucky
versus
from
you
know
miami
florida?
Let's
we're
as
the
data
is
coming
in
we're
putting
these
into
large.
You
know
de-identified
groups
of
communities
to
try
to
get
an
idea
of
what's
happening
in
individual
communities
across
the
country.
A
B
Thank
you,
madam
chair,
fascinating
stuff
here,
so
I
want
a
little
clarification.
B
J
Not
not
a
week
or
a
month,
but
you
know
in
some
time
and
again
I
I
we
said
it
a
lot:
it's
it's
based
on
the
individual.
Some
individuals
can
last
their
their
antibody
response,
can
last
for
a
year
or
maybe
longer.
We
know
we
know
some
longer
than
a
year,
others
a
shorter
time
period.
I
haven't
really
seen
anybody
have
a
response
and
go
down
within
two
or
three
months,
it's
typically
at
least
six
months
or
eight
months
or
even
or
longer
before
we
see
individuals
with
a
good
response.
J
B
And
then
do
you
know
if
this
is
covered
at
the
doctor's
office
by
medicare
or
insurance
and
have
you
looked
at
partnering
with
our
two
major
universities
who
I
think
uofl
is
able
to
provide
this
test?
Have
you
looked
into
a
partnership
with
our
universities.
J
Yeah
we
would
love
to
partner
with
universities.
I
think
I
think
we
have
a
pretty
comprehensive
test
both
for
in
terms
of
the
way
we
do,
the
testing
for
the
antibodies
and
the
neutralizing
antibodies,
but
it'd
be
great
to
be
able
to
do
comparisons
to
other
methods
if
they
wanted
to
do
that,
we'd
be
happy
to
to
try
to
to
address
that.
J
Yeah,
sorry,
sorry,
man
so
yeah.
The
answer
is
that
medicare
medicare
does
have
cpt
codes
both
for
the
antibodies
and
for
the
neutralizing
antibodies
it
can
be
utilized
and
billed
against.
A
Thank
you,
I'm
sorry,
I
didn't
mean
to
cut
you
off.
I
thought
you
were
finished
very
interesting
discussion.
Obviously
everyone
is
very
interested
in
this.
It
sounds
like
there
are
great
great
opportunities
and
probably
a
great
opportunity
for
some
good
longitudinal
studies,
and
you
know
to
really
see
how
long
our
immunity
lasts.
A
A
A
A
A
I
don't
know
if
you're
here
in
person
or
if
you
are,
I
think
you're
remote
and
dr
joseph
flynn
is
with
the
norton
medical
group,
and
tim
vino
is
also
here.
So
please
make
your
way
to
the
table,
introduce
yourselves
and
go
ahead
and
begin.
Your
presentation.
I
Thank
you,
I'm
gonna,
I'm
a
few
more
remarks.
As
we
talk
about
this
topic
as
well.
I
just
want
to
throw
a
couple
of
things
out
before
we
dive
into
this.
That
we've
heard
about
vaccinations
the
importance
of
that
the
remaining
population
we
have
out
there
right
now
is
going
to
be
tough
to
vaccinate.
We
know
that
we
had
an
initial
surge
people
who
wanted
to
get
it
got
it
done
it's
getting
more
difficult.
I
I
It's
time
to
start
getting
non-political
medical
people,
people
that
people
trust
to
start
discussing
vaccinations.
I
think
all
the
physicians
I've
spoke
to
agree
that
vaccines
need
to
be
in
doctors,
offices
for
administration.
We
haven't
done
a
very
good
job
of
that
in
this
state
I
mean
there's
places
where
you
can
go.
You
can
get
to
walgreens
or
pharmacies,
hospitals
and
health
departments,
but
really
a
lot
of
our
physician
offices.
Don't
have
it
because
of
bureaucracy
and
forms
that
have
to
be
filled
out.
I
We
got
to
be
able
to
find
a
way
to
expedite
that,
to
make
it
easier
to
get
into
doctor's
offices
where,
if
they
have
a
one-on-one
conversation,
can
convince
someone
to
get
a
vaccine,
they
can
administer
it
right
there.
Someone
mentioned
earlier
public
service
announcements.
Again,
politicians
were
no
longer
effective
on
this
front.
For
us
to
be
the
ones
who
carry
the
message.
I
They're
going
to
look
at
you,
whatever
the
letter
is
after
your
name,
people
are
going
to
make
a
decision
based
on
that
we've
got
a
the
spotlight,
I
think,
should
have
been
with
our
medical
providers
from
the
very
beginning,
and
we
need
something.
That's
also
going
to
start
getting
our
young
people
aware,
I
think
a
lot
of
times.
I
think
young
people
think
that
they're
indestructible
that
this
can
affect
them.
I
We've
got
to
start
engaging
athletes
who
are
willing,
coaches
again,
our
physicians,
our
nurses,
even
patients,
who
might
be
struggling
at
the
point
of
their
worst
moment
of
the
illness
before
they
get
put
on
a
ventilator
to
beg
people
to
do
this
again.
Those
can
be
graphic
images,
graphic
messages,
but
we
need
them,
and
I
think
we
know
the
more
immediate
problem
right
now
is
right
in
front
of
us.
I
I
L
Thank
you
so
much
senator
alvarado.
Can
everybody
hear
me?
L
Okay,
thank
you
so
again,
thank
you
so
much
chairman
alvarado
and
chairwoman
mosher
for
having
kha
here
to
speak
with
you
today
to
update
you
on
the
latest
situation,
with
our
kentucky
hospitals
and,
as
was
mentioned
like
so
many
other
states,
kentucky's
facing
an
unprecedented
surge
in
covid19
hospitalizations
caused
by
this
delta
variant.
L
The
number
of
covet
hospitalizations
is
now
higher
than
what
we
saw
at
the
previous
peak
last
november
and
december,
and
I
hate
to
say,
with
each
passing
day.
The
situation
is
getting
worse.
In
fact,
in
just
about
a
four
week
period.
From
the
end
of
july,
to
the
end
of
august,
we
have
seen
a
three
hundred
and
forty
percent
increase
in
covet
hospitalizations
growing
from
just
over
five
hundred
patients.
To
now
more
than
two
thousand
coveted
patients
are
now
occupying
one
half
of
all
icu
beds
in
the
state.
L
L
L
Yesterday,
there
were
only
17
percent
of
staffed
med,
surg
beds,
available
statewide
to
treat
covet
and
non-covered
patients
who
need
hospital
care.
17
hospitals
had
no
open
med,
surg
beds,
another
36
had
fewer
than
10.
our
ed's
are
being
overwhelmed.
There
are
patients
waiting
to
get
into
a
bed
almost
the
minute.
One
opens
up.
Fifty
percent
of
patients
in
the
hospital
eds
are
waiting
for
a
room
to
become
available.
L
The
pressure
for
beds
being
caused
by
coven
19
patients
is
causing
hospitals
to
postpone
medically
necessary
procedures
for
non-covet
patients,
sometimes
called
elective
procedures.
These
are
not
a
nose
job
or
a
tummy.
Tuck.
An
elective
procedure
is
a
surgery
that
can
be
safely
postponed,
but
only
for
a
short
period
of
time.
L
Postponing
elective
procedures
not
only
hurts
the
patients
who
need
them,
but
it
hurts
the
hospitals
financially,
because
the
revenue
from
elective
procedures
that
hospitals
provide
helps
cover
the
cost
of
other
services,
that
hospitals
provided
a
loss,
and
we
want
everyone
to
understand
that
hospitals
do
not
profit
from
coven
19
patients.
These
patients
tend
to
be
sicker,
they
require
more
ppe,
more
treatments
and
more
staff,
and
they
tend
to
be
hospitalized
longer.
All
of
that
adds
to
the
hospital's
costs,
not
their
bottom
line.
L
L
L
This
puts
our
hospitals
at
a
distinct
disadvantage,
because
we
are
competing
with
new
york.
California,
connecticut
the
other,
wealthier
states
that
receive
far
more
in
federal
and
commercial
reimbursement
to
pay.
For
those
traveling
nurses
to
help
fill
the
gaps,
those
traveling
nurses
are
able
to
command
pay
rates
between
150
and
200
an
hour.
L
There
are
no
discount
rates
for
poor
states
or
financially
strapped
hospitals,
even
hospitals
with
reserves
are
burning
through
them
in
an
effort
to
serve
our
patients.
Your
constituents,
hospitals,
without
those
kinds
of
reserves,
simply
cannot
compete
for
trained
staff.
There
are
several
things
that
the
general
assembly
can
do
to
help
our
hospitals
in
this
time
of
crisis.
L
L
The
addition
of
even
one
or
two
nurses
in
a
small
facility
could
quite
literally
mean
the
difference
between
life
and
death.
For
one
of
our
sick
friends,
neighbors
or
family
members,
we
also
want
to
publicly
thank
the
department
for
medicaid
services
and
several
insurers
for
waiving
prior
authorizations.
L
During
this
crucial
moment
in
the
pandemic,
those
actions
are
very
much
appreciated
and
critical
to
serving
our
patients.
The
future
good
health
of
our
people
depends
on
us
working
together
and
we
at
kha
are
ready
to
help
do
whatever
we
need
to
do,
and
we
will
do
our
part
and
I'm
happy
to
take
any
questions.
Thank
you.
I
We
might
want
to
let
dr
flynn,
if
you're
there,
if
you'd,
like
to
talk
a
little
bit
about
we've,
had
a
lot
of
discussions
on
regeneron
and
monoclonal
antibodies.
If
you
could
talk
about
some
of
the
work
you're
doing
at
norton's,.
O
Yes,
sir,
thank
you
thank
you,
senator
senator
alvarado
for
inviting
me
and
the
committee.
I
appreciate
all
you're
doing.
I
think
this
is
important.
It's
been
a
fascinating
afternoon,
thus
far.
So
hopefully,
what
we're
going
to
talk
about
really
aligns
with
what's
been
talked
about
more
globally.
I
think
stepping
back
a
little
bit
if
we
think
about
the
crunch
on
hospitals
in
the
health
care
system.
We
have
two
options.
O
One
is
you
expand
the
capacity
of
the
hospitals
or
we
try
to
find
ways
to
prevent
those
most
in
need
of
hospitalization
to
keep
them
well
enough
to
not
be
admitted
so
the
first
way,
and
that
was
brought
up
earlier-
is
vaccination.
There's
no
doubt
vaccinations
work.
The
data
has
been
shown,
and
I
I'm
not
here
to
discuss
that
at
length
other
than
say
we
have
some
other
tools
in
our
armamentarium.
First
of
all,
since
november
of
last
year,
there
was
an
emergency
use,
authorization
granted
for
monoclonal
antibodies
against
covid.
O
Now
dr
mcconnell
and
senator
alvarado
spoke
to
some
of
the
biology
behind
antibodies,
but
suffice
to
say
these
antibodies
were
developed
designed
by
identifying
neutralizing,
antibodies
and
people
that
have
battled
covid
and
then
synthetically
developing
these
antibodies,
where
you
can
actually
administer
it
to
other
patients.
The
difference
between
this
and
say
a
vaccine.
I
look
at
the
vaccine
as
putting
sprinklers
in
your
house.
So
if
there's
a
fire,
you
automatically
put
out
the
fire
before
it's
damaging
and
I'd
say
that
the
monoclonal
antibodies
are
more.
You
have
a
fire
breaking
out.
O
You
can
call
the
fire
department,
they
come
over
and
put
the
fire
out.
You
hope
that
it's
not
at
a
point
where
you're
causing
too
much
damage
to
the
home,
but
you
do
have
that
ability
to
put
out
the
fire
and
that's
what
these
antibodies
do,
the
originally
it
was
bamlanevumab
that
was
available
and
that
because
of
these
mutations
is
no
longer
offered
within
the
eua,
and
now
we
talk
about
regeneron,
which
is
a
combination,
monoclonal
antibody
of
catarizumab
and
endemab,
and
these
two
antibodies
target.
O
We
know
in
preclinical
studies
and
other
studies
that
this
does
actually
work
in
the
delta
variant.
Originally,
these
antibodies
were
designed
around
and
got
the
eua
for
treatment
of
people
that
were
symptomatic
and
fell
into
some
high
risk
categories.
So,
if
you
remember
the
early
days
of
covid,
we
all
studied
at
great
length
who
was
most
at
risk
of
being
hospitalized
and,
more
importantly,
who
was
most
at
risk
of
dying
and
it
fell
into
those
categories
of
the
people
that
were
older
age
over
age
65,
those
who
were
overweight.
O
We
consider
obese,
pregnant
people,
chronic
kidney
disease,
diabetes,
those
on
immunosuppression
and
for
the
reasons
we
talked
about
in
the
last
segment:
cardiovascular
disease,
chronic
lung
disease,
sickle
cell
disease,
neurodevelopment
disorders
and
people
that
are
on
chronic
medical
equipment.
So
they
have
ostomies
or
tracheostomies
that
need
to
be
managed.
So
those
group
those
people
as
a
as
a
whole,
tended
to
do
worse
and
what
we
found
with
the
utilization
of
the
antibody.
It
had
a
significant
benefit
of
keeping
people
out
of
the
hospital
and
decreasing
mortality.
O
Now
we
were
part
of
the
study
early
on
that
looked
at
more
broadly,
when
do
you
give
these
antibodies,
and
we
looked
at
the
hospitalized
patient,
those
in
the
icu.
We
found
that
people
that
once
they're
hospitalized
or
on
oxygen,
they
tended
to
do
worse
and
they
didn't
gain
benefit
from
being
on
the
antibodies.
This
was
truly
one
of
those
opportunities
to
give
patients
that
are
high
risk
antibodies
to
prevent
bad
outcome.
O
O
So
back
in
november,
we
spent
considerable
time
trying
to
prepare
for
the
eua
coming
out.
As
I
said,
we
have
a
lot
of
background
in
this
type
of
drug.
I
spent
my
career
in
drug
development,
specifically
monoclonal,
antibodies
and
molecular
therapies,
and
we
developed
within
our
infusion
centers
mechanism,
by
which
we
could
rapidly
identify
people
and
treat
them
in
our
locations.
O
We've
treated
around
4
000
people
thus
far,
and
it's
had
a
profound
impact.
Several
people,
I
know
personally
that
had
fallen
into
the
category
both
within
kentucky
and
outside,
have
been
treated
with
these
antibodies.
We
do
know
that
the
people
at
the
first
day
so
they
may
have
the
reaction,
because
the
antibodies
are
working
and
they're
killing
the
virus
and
isolating
the
virus
and
decreasing
the
ability
to
be
taken
up
in
the
body.
But
within
a
couple
days
patients
see
marked
improvement.
O
So
it's
another
opportunity
for
us
to
really
have
a
multi-pronged
attack
against
kobit
and
to
really
single
out
those
people
that
are
high
risk
and
give
them
hope
that
there's
something
to
do-
and
I
would
say,
having
listened
to
a
lot
of
the
testimony
today,
I
think
that
while
we
have
a
lot
to
learn,
I
would
say
that
probably
every
physician
in
the
room
there-
and
I
know,
there's
several
and
that
are
on
the
the
the
zoom
meeting-
would
agree
that
we've
never
seen
such
rapidity
about
being
able
to
identify
key
targets,
to
identify
patients
at
great
risk
and
to
be
able
to
bring
to
bear
treatments
and
prevention
to
actually
impact
upon,
not
only
within
kentucky,
but
we've
been
able
to
impact
across
the
country
with
a
lot
of
the
work.
O
That's
being
done
here.
So
some
nancy
was
talking
about
the
heroes
we
work
with.
I
work
with
17
000
heroes
that
I
am
I
blessed.
I
say
a
prayer
every
day
of
thanks
to
work
for
such
great
people,
they're
taking
great
risks
every
day
on
the
behalf
of
all
of
our
our
friends,
neighbors
and
colleagues,
and
I'm
grateful
for
you
all
for
giving
us
this
time
to
present
some
of
the
work
that's
being
done.
M
Thank
you
excuse
me.
I
want
to
thank
both
the
chairs
representative,
moser
and
dr
alvarado
for
inviting
us
today
to
give
an
update
about
where
we
are,
since
the
pandemic
started
almost
18
months
ago
and
informed
this
committee
as
to
our
needs.
First,
I
want
to
say
we
stand
in
partnership
with
nancy
and
the
kha,
and
I
adopt
all
dr
flynn's
comments
as
well
as
nancy's.
M
M
We
represent
the
entire
continuum
of
care,
skilled
nursing
facilities,
personal
care
and
assisted
living
communities.
We
represent
non-profits
and
for-profits
due
to
the
constraints
in
time.
I
will
start
with
how
things
are
going
today
and
then
focus
on
our
primary
need,
and
again
I
adopt
a
lot
of
what
nancy
said.
So
don't
forget
what
she
said
as
well,
but
our
primary
need-
and
the
reason
we're
here
today
is
to
ask
for
support
to
build
back
our
workforce.
M
So
where
are
we?
I
guess
it's
best
summed
up
we're
exhausted
since
may
of
2020.
There
have
been
approximately
14
624
skilled
nursing
facility
residents,
who
have
had
coven
19
and
we've
had
hundred
and
residents
die
from
covert
19..
M
That
is,
according
to
the
data
from
the
american
health
care
association.
The
good
news
is
that
the
vaccine
is
working
as
most
of
these
cases
and
deaths
were
before
the
cova.
19
vaccine
was
rolled
out
to
long-term
care
facilities.
We
do
appreciate
governor
bashir
for
prioritizing
long-term
care
in
the
vaccine.
Rollout
today,
with
the
community
infections,
continuing
to
rise
and
our
hospitals
being
overwhelmed,
one
of
the
safest
place
to
be
is
long-term
care
facilities.
M
That
is
because
our
elders,
the
greatest
generation,
stepped
up
and
received
the
vaccine.
In
kentucky,
approximately
85
percent
of
our
residents
have
received
the
vaccine.
However,
we
are
seriously
lagging
behind
with
our
long-term
care
workforce
vaccination
rates.
As
of
august
8th,
only
51
percent
of
our
skilled
nursing
facility
workforce
is
vaccinated,
and
I
echo
what
dr
alvarado
says.
We
cannot
shame
them.
They
are
people
first,
we
have
to
understand
where
they're
coming
from,
and
it
really
does
take
people
with
all
due
respect.
M
Change
the
slide,
so
the
cover
19
pandemic
has
only
made
our
workforce
issues
even
worse.
They
were
bad
before
coven,
19
and
now
they're
they're
in
dire
straits.
For
over
a
year,
our
long-term
care,
nurses,
nurse
aides
and
staff
have
been
the
primary
care
for
our
residents,
because
many
of
you
all
know
we
were
on
lockdown
right,
so
our
residents
could
not
receive
any
visitors,
so
our
workforce
had
to
step
up
and
become
family
as
well
in
a
workforce.
Shortage
and
long-term
care
is
not
same
as
a
workforce
shortage.
M
M
We
value
our
long-term
care
workforce
and
we
want
them
to
be
supported
and
fulfilled
in
the
work
that
they
do
when
they
are
not
and
when
they
leave
the
long-term
care
workforce.
The
individuals
that
suffer
the
most
are
the
elders.
The
woman
in
this
picture
cannot
walk
by
herself.
She
needs
assistance.
We
need
a
vibrant
and
well-trained
workforce
to
care
for
our
elders.
M
M
M
M
And
then
this
is
just
another
summary
of
that.
You
know
what
do
we
do
if
we
we
lose
this,
and
you
also
see,
I
think,
thought
this
was
interesting
about
four
percent
said
that
they
will
leave
not
only
health
care
or
to
join
another
profession,
but
some
of
them
up
to
four
percent
will
stay
unemployed.
M
M
The
twenty
nine
dollars
that
was
approved
by
the
general
assembly
and
again,
thank
you
will
not.
We
will
not
have
access
to
that
money
after
december
31st
of
2021,
so
we
need
your
help
due
to
staffing
shortages.
Some
of
our
members
are
reporting
reporting
that
they're
shuttering
their
beds
due
to
staffing
concerns
and
are
unable
to
accept
transfers
from
our
overwhelmed
hospital
systems.
M
We
have
laid
out.
We
have
laid
out
some
of
our
workforce
investment
ideas
in
our
american
rescue
plan
act
letter
that
is
referenced
here
on
the
slide
I'll
be
happy
to
share
that
with
anybody,
but
it
it
is
with
both
house
and
senate
leadership,
as
well
as
governor
bashir
beshear.
M
However,
other
states
have
have
already
provided
funding
for
long-term
care
workforce
initiatives,
nancy
mentioned
arkansas.
I
know
dr
alvarado
has
been
studying
arkansas,
but
there
are
other
states,
as
we
list
here,
that
have
invested
in
their
long-term
care
workforce
using
those
rescue
plan
dollars
and
some
other
ideas
include
covering
travel
and
relocation
costs
for
new
hires
and
covering
staff
agency
use
costs
which
have
skyrocketed
during
the
pandemic,
again
we're
having
to
turn
to
agency
staff
and
those
costs
have
skyrock
rocketed
and
those
are
medicaid
dollars
that
we're
using
to
pay
for
that
staff.
M
H
Thank
you,
chair,
lady
chairman,
can
you
hear
me
I
can
thank
you
all
and
thank
you
for
having
me
here.
My
name
is
tim
vino
and
I'm
the
president
of
leading
age
kentucky
leading
age
kentucky
is
based
in
louisville
kentucky
and
we
are
affiliated
with
leading
age.
National
headquartered
in
washington,
d.c
leading
age.
Kentucky
also
represents
the
full
continuum
of
service
providers
for
the
elderly
and
firm
and
the
disabled.
H
Our
members
consist
of
nursing
facilities,
both
hospital
based
and
free
standing,
personal
care
providers,
assisted
living
communities
and
other
long-term
health
care
providers
for
the
elderly
and
disabled.
The
vast
majority
of
our
members
are
non-profit
community,
supported
and
governed
by
volunteer
community
leaders.
H
H
This
funding
will
stabilize
and
support
kentucky's
long-term
care,
caregiver,
workforce
and
coven
modernization
costs
incurred.
Unexpectedly
by
our
members.
There
will
be
numerous
and
valid
requests
for
support
and
funding
with
arpa
money,
but
we
know
our
profession
was
disproportionately
affected
by
covid
covid19
and
remains
vulnerable
to
it
and
other
diseases
if
investments
are
not
made
quickly.
H
Other
states
are
addressing
these
needs
and
challenges
in
different
ways,
and
we
have
several
ideas
on
how
kentucky
could
pro
prioritize
arpa
funds
for
long-term
care
workforce
is
the
big
huge
issue
I
think,
for
all
health
care
providers
right
now.
A
stable
workforce
continues
to
be
a
struggle
for
all
long-term
care
facilities
in
the
commonwealth.
H
H
Investing
in
these
programs
would
improve
the
long-term
care
workforce
throughout
the
state
and,
in
turn,
provide
the
best
possible
care
for
kentucky's
most
vulnerable
staffing
levels.
I
don't
know
any
way
to
sugarcoat
it.
It
is
at
a
crisis
point
members
are
struggling
to
provide
sufficient
staff
to
cover
bed
capacity
and
we
specifically
have
the
following
ideas:
to
stabilize
this
workforce:
we're
rapid,
deploy,
strike
teams.
H
H
H
It
just
doesn't
work
in
an
infectious
disease
environment,
automated
temperature
screening.
I
think
there
were
some
grants
that
were
given
to
certified
nursing
facilities
through
cms,
but
there
are
many
providers
that
do
not
receive
medicare
and
medicaid
funding
and
therefore
was
not
offered
that
opportunity
for
free
temperature
screening.
H
We
thank
the
general
assembly
and
the
work
that
they've
done,
particularly
through
providing
enhanced
rates.
Those
as
betsy
intimated
has
been
a
life-saving
lifeblood
for
some
members
in
order
to
help
with
these
increased
staffing,
ppe
and
other
costs
that
they
did
not
anticipate
again.
There
are
a
lot
of
other
providers
that
aren't
medicaid
that
are
struggling
without
this
extra
bonus.
A
H
A
If
I
could
ask
you
to
just
wrap
it
up,.
H
Some
of
the
emergency
provisions
extend
certificate
of
need,
a
bed
hold
relaxation,
pharmacists,
dispensing
30
days,
etc,
etc.
We
would
like
to
say,
but
we
appreciate
your
all's
thoughtful
approach
in
vetting
these
issues
and
hearing
our
concerns
and
happy
to
answer
any
questions
or
elaborate
on
any
of
my
presentation.
A
A
Just
that
paramedics
are
willing
to
work
in
the
hospitals
and
really
do
some
relief
shift
work.
Is
this
something
the
hospitals
would
be
open
to?
Yes,.
L
F
Thank
you,
madam
chair.
This
question,
I
guess
is
for
the
hospital
association.
F
I've
spoken
with
several
rural
hospitals
around
my
area
and
and
to
my
the
hospital
located
in
rock
castle
county
right
now,
they're
down
20
percent
in
rns,
40
in
snras
and
25
and
respiratory
therapists,
and
what
that's
done
they've
had
to
close
22
licensed
ventilator
beds,
because
they
don't
have
the
staff
to
to
maintain
it
and
what
they've
used.
Those
beds
for
in
the
past
was,
as
kind
of
an
induction
unit
to
take
covered
patients
off
other
hospitals.
F
L
It's
all
because
of
staff.
You
know,
there's
only
72
percent
of
our
licensed
icu
beds
that
are
open
because
of
staff,
there's
only
65
of
our
licensed
med
surg
beds
that
are
open
because
of
staff.
It's
all
related
to
not
having
enough
staff
hospitals.
You
know,
certainly
have
wings
that
are
shut
down.
So
what
rockcastle's
telling
you
is
is
absolutely
the
case.
Hospitals
can
always
you
know
they
can
surge
their
beds.
They
could
they
could
use
non-patient
care
space
to
create
additional
bed
capacity,
but
the
limiting
factor
in
all
of
this
is
staff.
F
If
I
may,
we've
heard
of
several
large
hospitals
throughout
the
state
that
are
mandating
back
the
vaccination
for
their
employees
and
there
are
thousands
of
employees
who
are
currently
willing
to
work
who
are
in
jeopardy
of
losing
their
job.
L
So
the
hospitals
that
are
adding
the
coveted
vaccine
to
their
existing
vaccination
policies,
so
hospitals,
because
we
have
very
sick
people
in
them,
they
have
long
had
requirements
for
vaccinations,
there's
all
sorts
of
other
requirements,
other
types
of
vaccines
that
are
required-
that's
really
not
something
new
fda
has
approved
the
coven
vaccine,
so
those
hospitals
are
adding
that
to
their
existing
requirements.
For
other
vaccinations,
you
know
a
large
part.
L
I
mean
it's
not
the
only
thing
but
part
of
the
problem
with
staffing
is
we
have
a
lot
of
staff
that
are
out
on
quarantine,
so
you
know
they're,
taking
all
that
into
consideration.
If
your
staff
is
vaccinated,
then
your
staff
is
available
to
work
not
off
on
quarantine
and
also
they're.
Looking
at
how
is
you
know,
how
can
we
best
protect
our
patients
as
well?
L
F
Okay
and
then
one
final
really
quick.
Last
last
year
we
passed
senate
bill
5,
which
was
liability
protection
for,
among
other
things,
hospital
hospitals.
The
version
we
passed
was
watered
down
quite
a
bit
from
what
came
out
of
the
senate.
I
know
in
a
hospital
surrounding
us
surrounding
rock
castle
county
right
now.
They
just
this
past
week,
had
to
perform
a
surgery
that
ordinarily
wouldn't
have
undergone
in
that
facility,
but
the
choice
they
couldn't
find
any
place
to
take
the
patient,
and
so
the
choice
was
either.
F
Let
him
bleed
out
or
perform
a
high-risk
surgery
in
a
facility
that
doesn't
ordinarily
do
that
which
posed
you
know
the
biggest
issue
in
their
mind,
was
what
kind
of
liability
are
we
opening
ourselves
up
to?
In
your
opinion,
based
on
what
we
passed
in
senate
bill,
5
are
additional
liability
protection
measures
needed?
L
We're
very
thankful-
and
we
want
to
thank
the
members
of
the
general
assembly
for
passing
senate
bill
5..
Of
course
you
know
as
you
as
you
point
out,
it
was
a
stronger
version
in
the
senate,
but
we
are
very
thankful
for
the
protection
that's
out
there
and,
and
we
very
much
need
it.
It's
important
that
it
be
tied
to
you
know
the
emergency.
Maybe
even
the
federal
emergency,
because
where
we
are
right
now,
is
that
we
are
in
sort
of
crisis
standards
of
care.
L
L
So
our
hospitals
are
having
to
treat
patients
that
they
would
not
normally
treat,
and
that's
just
the
reality
where
we
are,
but
it's
very
important
for
to
protect
our
health
care
providers
that
they
are
not
sued
because
they're
operating
in
a
crisis
in
an
emergency
under
you
know
not
what
is
you
know
the
normal
routine
level
of
care?
That's
out
there,
so
we
absolutely
have
to
have
those
protections.
A
Thank
you,
representative,
prunty.
B
Thank
you,
madam
chair.
This
question
is
for
dr
flynn
in
the
hospital
presentation
I
was
thinking
about.
You
know
how
do
you
keep
them
out
of
the
hospital
and
you
address
the
issue
of
infusions.
What
I
think
I
heard
was
that
bam
was
effective
initially,
but
now
regeneron
is.
My
question
is
how
readily
available
is
that
across
the
commonwealth
I
live
in
rural
kentucky.
I
live
in
western
kentucky,
I
know
you're
in
louisville,
and
can
you
clarify
again
what
the
window
of
opportunity
is
for
that
to
be
effective.
O
Sure,
thank
you
for
the
question.
The
first
part,
I
can't
speak
for
the
availability
across
the
state
and
there
may
be
others
in
the
room
that
are
better
than
I,
as
as
far
as
the
other
aspects
for
people
that
are
symptomatic.
They
need
to
have
been
symptomatic
within
the
last
10
days.
O
The
sooner
I
can
get
that
regeneron,
the
better
off
I'll,
be,
I
think,
there's
other
just
more
broadly
there's
other
efforts
that
can
be
made.
There's
you
see
the
addition
of
virtual
hospitals,
so
those
the
ability
to
follow
people
from
a
day-to-day
basis
more
closely,
using
remote
testing
and
remote
monitoring
capabilities
to
have
to
really
work
as
systems
and
inter
interconnect
is
really
important,
and
I
think
that
we're
seeing
a
lot
of
these
go
up
across
the
commonwealth.
I
How
can
I
find
that
out?
Thank
you
yeah.
So
I
we've
been
having
a
lot
of
discussions.
There
have
been
a
few
of
our
hospitals
that
have
been
doing
this
work
all
along.
I
know
in
pikeville
and
norton's
has
been
doing
quite
a
bit
of
administration
of
regeneron.
You
have
to
be
able
to
give
it
before
they
become
acutely
ill
once
you're
in
the
hospital
with
hypoxia
and
you're
acutely
ill.
It
doesn't
serve
the
purpose.
At
that
point,
we've
got.
I
I
think
a
lot
of
hospitals
have
regeneron
or
they
have
monoclonal
antibody
therapy
available.
It's
just.
It
requires
a
physician's
order
and
doctors
are
right
now
overwhelmed
if
you're
trying
to
get
into
a
doctor's
office
for
an
acute
visit.
Good
luck,
you'll
be
waiting
well
over
a
week
or
more
for
an
acute
visit
so
and
to
say:
hey,
listen,
doc!
I
just
got
tested
positive.
Can
you
send
in
an
order?
It's
not
going
to
be
done
for
several
days
by
then
you
might
be
acutely
ill
and
you
wind
up
in
the
hospital.
I
I
You're
gonna
probably
expect
some
language
in
the
next
few
days
whenever,
if
we
get
called
into
a
special
session
of
trying
to
set
up
regional
regeneron
clinics
and
be
able
to
have
our
hospitals
work
in
conjunction
with
the
cabinet
to
start
seeing
if
we
can
set
up
areas,
at
least
in
every
area,
development
district
to
consider
them
to
start
pooling
their
resources
together
to
get
some
kind
of
a
uniform
protocol
both
on
the
people
that
would
qualify
for
it
and
how
it
would
be
administered
and
be
able
to
expedite
that
process
for
folks
that
are
high
risk
to
get
them
that
therapy
and
hopefully
help
give
our
ers
a
bit
of
relief.
I
So
if
someone
tests
positive
and
they
meet
that
criteria,
they
can
go
in
and
get
that
done.
We'd
like
to
see
that
done
everywhere
in
the
state
and
again
there's
areas
in
rural
and
urban
kentucky
that
are
doing
a
good
job,
but
we've
got
to
do
it
everywhere
and
again,
pull
our
resources
together.
We've
been
having
meetings
with
our
chief
medical
officers
in
hopes
that
they
can
help
us
get
that
accomplished.
I
So
part
of
the
problem,
too,
is
as
we
use
this
there's
talk
now
that
there
might
be
some
rationing
of
that
from
the
federal
government
from
hhs.
I
hope
that's
not
the
case.
I
know
several
states
like
florida
and
texas
have
already
taken
upon
themselves
to
do
this.
I
just
got
win
today.
I
think
that
arizona
is
committing
60
million
dollars
towards
doing
the
same
thing
in
their
state,
so
others
are
already
trying
to
do
this
and
we've
got.
I
B
Thank
you.
Thank
you,
so
much
for
that
work
and
and
betsy
just
I
just
want
to
tell
you
that
I
will
advocate
to
our
federal
folks
about
making
a
consistent
policy
on
vaccinated
employees.
Thank
you,
madam
chair.
A
Thank
you,
senator
meredith.
N
N
M
Yeah
we
talk
about
that
a
lot
senator
meredith.
I
appreciate
the
question
it's
hard,
it's
hard
to
tell
like
I
said,
they're
already,
shuttering
down
beds,
which
causes
a
clog
in
the
system
and
dr
alvarado's
shaking
his
head.
I
mean,
I
know,
we've
already
had
some
hospitals
are
having
difficulty
discharging
folks
to
our
school
nursing
facilities
when
they
need
beds.
M
So
that's
just
a
problem,
but
we
already
had
a
closure
during
covet
in
oldham
county,
so
that
was
one
closure
and
that
now
that
the
workforce
shortage
is
happening
and
with
the
mandated
vaccine
from
the
federal
government,
I
mean
it
it.
I
don't
want
to
guess,
but
it's
it's
definitely
a
possibility
and
it's
something
that
we
should
all
be
worried
about,
because
we're
just
aging
as
a
country
and
these
services
are
definitely
needed.
N
Well,
there's
been
a
shortage
for
some
time
to
begin
with,
so
this
just
exasperates
it,
but
I
hope,
with
whatever
plan
we
come
up
with,
we
understand
that
it's
all
interconnected
with
each
other
and
there's
a
rippling
effect
to
this.
You
know
what
we
haven't
talked
about
today
is
mandates
for
vaccinations,
that's
a
conversation
another
day
and
time,
but
people
need
to
understand,
particularly
since
louisville
hospitals
are
taking
that
step,
that
they're
going
to
lose
people
right
now.
Our
issue
right
now
is
shortage
of
personnel.
N
You
have
to
address
that
and
while
yes,
we
require
vaccinations
for
other
things
in
in
our
health
care
facilities.
I'm
not
sure.
Now
is
the
time
to
do
that
and
if
louisville
loses
additional
personnel,
that
means
they're
going
to
get
them
from
your
facilities,
they're
going
to
get
them
from
our
rural
hospitals,
because
there's
there's
just
that
type
of
impact
on
this.
One
of
the
things
I
suspect
will
happen
is
we'll
see
a
hyper
increase
in
wages
for
nursing
personnel
in
the
metro
areas
and
rural
areas
can't
afford
to
do
that.
N
So
it's
going
to
draw
those
people
away
from
there
and
I
think
we'll
be
at
risk
for
closer
your
facilities,
but
also
closer
of
rural
hospitals.
So
we
need
to
understand
we're
all
in
this
together
and
there's
got
to
be
kind
of
a
symbiotic
relationship
here,
and
it
can't
just
be
everybody
for
themselves.
So
we
just
need
to
be
careful
where
we
go
with
these
things,
but
I
certainly
understand
your
situation
and
wish
you
the
best.
Thank
you.
Thank
you.
I
Thank
you
for
senator
there's.
You
know
some
of
the
wages
people
are
talking
about
are
150
an
hour
for
nurses
and
good
for
them.
I
mean
these
hard-working
nurses.
They
do
god's
work,
they
do
tremendous
work,
but
what's
happening
now
is
as
soon
as
we
lose
them.
They've
gotten
recruited
away,
because
other
states
have
already
done
this.
A
year
ago,
they've
been
devoting
cares
money
which
we
didn't.
Do
we
devoted
70
million
dollars
towards
contact
tracing?
I
We
devoted
a
million
dollars
towards
lotteries,
but
not
towards
retention
and
recruitment
of
nursing
staff,
which
is
really
critical.
What
we've
got
is
150
an
hour
husband
and
wife.
Both
nurses
have
two
kids,
hey,
listen,
we'll
move
you
to
another
state,
we'll
pay
for
your
housing,
we'll
pay
you
that
kind
of
wages
and
you
sign
a
two-year
contract
and
they're
gone.
So
we
have
a
surge
right
now.
I
It's
gonna,
probably
peak
here
in
a
bit
and
probably
drop
back,
we'll
probably
have
another
surge
in
the
future
and
that's
gonna
happen
in
four
months
or
six
months,
and
those
staff
aren't
coming
back,
they're
gone
and
they
may
be
gone
permanently.
At
this
point,
we've
got
to
use
these
monies
to
really
to
retain
a
lot
of
the
nursing
staff
we
have
because
they're
being
poached
by
other
states
and
it's
it
really
is
a
crisis
situation.
It's
not
just
nurses.
It's
nurses,
aides,
it's
respiratory,
therapists,
it's
paramedics
and
ems.
I
I
I
went
to
do
rounds
last
night,
pretty
late,
but
I
went
to
one
of
my
nursing
homes
to
see
folks.
40
of
those
folks
are
vaccinated
of
the
staff.
So
if
a
lot
of
them
wind
up
leaving
again,
you
lose
one
shift,
you
shut
the
nursing
home
down.
Imagine
if
you
have
100
people,
where
do
they
go
and
they're
all
elderly,
our
hospitals
can't
take
them
folks
at
home,
can't
take
them
because
they'd
be
there.
I
I
I
mean
I
get,
I
mean
honestly
and
good
for
them.
I
don't
I
don't
harp
anybody
for
making
as
much
as
they
can
and
they're
skilled
employees
and
our
nurses
work
very
hard
in
this
state,
and
this
covet
is
the
camel
that
broke
the
camel's
back
liability
we're
one
of
the
worst
states
as
far
as
lawsuits
and
medical
malpractice
in
the
country.
That's
part
of
the
problem,
part
of
it
also
for
our
nurses,
the
bureaucracy
they're
doing
more
paperwork
than
they
are
seeing
patients.
I
It's
a
burnout
situation
just
from
electronic
medical
records
to
government,
to
insurance,
to
liability,
and
here
comes
covet
on
top
of
it
and
someone's
saying
hey
I'll,
double
your
wages.
If
you
move
away
they'll
say
you
know
what
it
might
be
greener
over
there
and
they're
willing
to
move
away
once
you
lose
them,
they
don't
come
back.
We've
got
to
find
a
way
to
recruit
and
retain
the
stuff
that
we,
the
staff
that
we
already
have
and.
N
That's
one
of
the
reasons.
I
would
hope
that
maybe
we
could
put
this
vaccination
mandate
on
the
back
burner
for
the
time
being,
because
we
forget
that
that
people
in
our
health
care
facilities
have
been
dealing
with
covert
for
almost
two
years
now.
Without
this
mandate,
we've
asked
them
to
put
their
lives
on
the
line
before
there's
even
a
covert
vaccine
available
and
now
we're
telling
them.
You
know
you've
done
this
for
year
year
and
a
half
now
we're
gonna.
Let
you
go.
That's
just
not
the
right
way
to
treat
people.
N
It's
not
respectful
and
I
think,
there's
some
real
arguments
to
be
made
about
the
cost-benefit
analysis
of
doing
it.
This
way
got
a
text
from
a
patient
last
night,
a
family
member
that
he's
got
stage
four
cancer
and
he
can't
get
his
surgery
scheduled
because
the
current
shortage,
well
reducing
the
number
of
personnel
by
forcing
a
mandate
is
not
going
to
help
that
situation
at
all.
So
again,
let's
focus
on
the
issue
at
hand,
it's
the
shortage
of
personnel,
whatever
we
do,
it
makes
it
better.
N
C
C
It
is
not
a
choice.
I
have
no
option
but
to
do
this
and
have
never
had
an
option
but
to
be
tested
and
vaccinated.
So
why?
All
of
a
sudden
are
we
making
exceptions
for
healthcare
personnel
when
we
have
one
of
the
safest,
documented,
safest
and
most
effective
vaccines
that
have
ever
been
developed,
and
you
had
to
have
a
tb
test
to
take
that
job?
Your
healthcare
workers
did
not
walk
into
that
facility
without
getting
a
tb
test
if
they
are
willing
to
get
a
tb
test
on
the
for
a
basis
of
their
employment.
C
C
C
We
are
one
nurse
for
seven
to
nine
med,
surg
patients
in
the
state
right
now,
which
basically
means
if
you're
in
the
hospital-
and
you
just
had
surgery
you're
one
of
nine
patients
that
that
one
nurse
is
taking
care
of.
Essentially,
you
don't
have
a
nurse.
I
have
a
big
concern
that
we're
going
to
put
lower
level
educated
health
care
employees
like
paramedics,
put
nurses
in
charge
of
overseeing
them,
who
are
so
busy
taking
care
of
patients
that
they
have
no
ability
to
oversee
those
patients.
C
D
M
Right
so,
under
the
current
rules,
if,
if
facilities
in
a
red
county
which,
unfortunately
most
of
our
counties
are
currently
read,
those
staff
are
getting
the
unvaccinated
staff
are
getting
tested
twice
a
week.
So
that's
happening,
you
know
one
thing
we
had
to
learn
at
the
beginning
of
the
pandemic,
which
we're
not
used
to
because
we're
not
a
hospital-like
setting,
but
ppe
is
being
worn,
constantly,
there's
isolation
wings.
M
So
all
those
protections
are
still
in
place
and
and
we're
still
working
every
day
to
encourage
the
vaccine
among
our
members
to
send
one
of
senator
meredith's
points
about
workforce
and
mandates.
You
know
we
supported
all
our
members
that
mandated
it
I
mean
they
stepped
up
as
an
employer.
They
decided
was
the
right
decision
for
them
to
make.
I
have
an
independent
owner
in
louisa
kentucky
who
was
one
of
the
first
facilities
to
get
over
75
of
his
staff
vaccinated.
M
But
even
with
this,
with
this
federal
mandate
he's
concerned
that
he'll
lose
his
entire
third
shift
because
they
are
the
unvaccinated
workers
and,
as
I
said
in
my
presentation,
we
are
24
7
operations.
So
again,
I
I
hope
we
can
all
work
together,
because
our
health
care
workers
are
human
beings.
We
have
to
fight
misinformation,
I
so
admire
representative
moser
and
dr
alvarado,
and
and
many
of
you
all
who
have
been
out
there,
trying
to
explain
the
importance
of
the
vaccine,
but
we're
taking
all
those
precautions.
M
I
mean
we
were
doing
that
during
the
flu
season
too.
Covet
is
different,
but
you
know
we
are
working
24
7
to
keep
our
residents
safe
and
we're
doing
a
good
job.
We
really
are.
I
mean
if,
if
you
see
the
the
graph,
it
went
way
down
after
the
vaccines
and
we're
doing
everything
we
can
to
protect
them.
M
It's
not
recommended
by
the
cdc
we,
we
are
testing
people
that
haven't
been
vaccinated.
M
A
Thank
you
senator
wise.
E
Thank
you,
madam
chair.
Yesterday,
in
the
education
committee,
we
talked
at
length
about
quarantining
for
for
young
people
k
through
12
and
a
large
portion
of
this
quarantine,
we're
not
positive,
but
because
of
contact
tracing.
I
don't
know
if
this
is
for
dr
flynn
or
for
nancy.
E
Where
are
we
right
now
in
that
age
group
in
icu
or
hospitalization?
Do
we
have
any
of
that
data?
We
really
couldn't
find
the
data
yesterday
of
how
many
of
those
statewide
k-12
and
quarantine
are
truly
positive
or
just
because
of
contact
tracing.
So
I
didn't
know
if
there's
any
data
or
information
showing
specifically
for
k-12
as
it
relates
to
icu
or
just
hospitalizations,.
O
I
don't
have
it
broken
down
by
age,
but
I
can
say
that
we've
seen
a
horrific
spike
in
children
being
admitted
to
our
icu
in
the
in
the
norton
children's
hospital.
If
you
look
at
the
initial
spike
of
covid,
we
really
it
was
rare
to
see
a
child
other
than
misc.
O
E
O
No
so
you're
exactly
right,
rsv
had
a
summer
peak,
which
we
typically
don't
see.
Normally
we
see
it
in
in
the
winter
months
and
we
have
seen
a
spike,
so
we
have
seen
an
increase
in
rsv,
but
also
in
covid.
B
B
Can
you
tell
me
what
is
the
current
protocol
for
hospi
that
hospitals
are
using
to
quarantine
staff
and
also
are
we
quarantining
staff
members
that
have
already
received
the
vaccine
as
well.
L
So
I
want
to
clarify
that
is
part
of
the
problem.
That
is
not
the
only
problem
we
have
had
people
resign.
We
have
less
staff
now
at
this
dealing
with
this
delta
variant
than
we
had
at
the
prior
peak
of
the
pandemic.
We've
lost
nurses
because
of
resignations,
because
people
have
decided
they
want
to
do
something
else,
but
part
of
the
problem
is
staff
who
have
had
an
exposure.
L
You
know
on
quarantine,
and
you
know
I
can't
tell
you
the
exact
we're,
following
whatever
the
cdc
requirements
are
with
regard
to
quarantine,
doc,
dr
flynn
might
know
more.
O
We
are
following
the
cdc
guidelines
and
the
guidelines
state
that
individuals
that
are
vaccinated,
there's
a
different
level
of
of
thresholds
for
bringing
back
typically
you'll,
get
tested
at
three
to
five
days
and
with
a
negative
test.
They
can
come
back
to
work,
those
that
are
unvaccinated
because
of
the
trajectory
of
what
happens
with
the
virus
and
their
potential
for
actually
having
symptoms
day,
10
to
14
or
later
that
it's
a
slightly
different
with
with
them
and
if
I
could
just
add
one
things
that
I've
kind
of
been
watching
the
discussion.
O
If
you
don't
mind
you
know,
I
think
we
have
to
understand.
I
I
think
senator
alvarado
said
it
nicely
when
he
talked
about
there's,
there's
a
whole
slew
of
issues
and
it's
easy.
We
focus
on
one
aspect
of
it
and
and
whether
it's
quarantine
or
people
going
to
other
states,
but
there's
been
a
lot
of
people
that
have
retired.
O
That
just
said,
I
can't
do
this
any
longer
and
the
longer
this
coveted
pandemic
goes
on
and
impacts
people
you're
going
to
see
people
just
leaving
healthcare,
because
it
is
a
very
for
for
those
of
us
who
have
been
in
healthcare
a
long
time
I
served
in
the
military.
O
I
was
at
a
number
of
different
things
and
seen
a
similar
type
of
episode,
with
just
the
just
constant
onslaught
of
sick
people
and
people
dying,
and
if
you
haven't
experienced
that
it
does
have
injury
to
all
of
us,
and
I
think
we
need
to
understand
that
this
is
more
than
just
one
simple
solution.
This
is
taking
a
multi-tiered
approach
and
trying
to
make
sure
that
we
keep
people
at
the
center.
A
Thank
you,
dr
flynn.
Thank
you
to
all
of
our
presenters
today.
This
has
been
a
really
crucial
conversation
that
we
we
have
to
have
and
rest
assured.
We
are
looking
very
carefully
at
all
of
the
regulations
that
we
need
to
keep
in
place
to
really
support
our
health
care
workers,
our
hospitals,
our
long-term
care
facilities.
A
All
of
these
folks
who
have
been
called
heroes-
and
they
are
all
throughout
this
entire
pandemic,
and
I
believe
well,
I
could
say
a
lot
of
things.
I
think
everything
really
has
been
said.
I
I
just
really
appreciate
all
of
the
all
of
your
work
and
dr
alvarado.
Do
you
have
some
final
parting
words
for
us.
I
Just
briefly,
for
those
who
are
gonna
be
wondering
what
we're
gonna
see
based
on
the
testimony
today,
I
think
you
can
expect
us
to
be
looking
at
the
funding
to
help
with
retention
of
staff
and
recruitment
of
staff,
both
within
long-term
care.
I
I
We're
also
looking
at
a
lot
of
the
things
that
we
did
in
senate
bill
150
in
2020
house
bill
1
this
past
year
house
joint
resolution
77
for
a
lot
of
the
executive
orders
regulations
for
all
of
our
boards
to
try
to
help
extend
that
at
least
for
a
period
of
time,
and
maybe
even
until
we
get
back
into
a
general
session
to
make
sure
that
a
lot
of
them
can
still
have
the
liberties
to
help
recruit,
people
that
might
be
retired.
I
People
are
willing
to
come
in
and
help
in
terms
of
providing
care.
We're
also
looking
at
liability.
That
was
still
a
big
issue
and
and
to
representative
bray's
point.
I
mean
a
lot
of
our
hospitals
are
concerned
about
having
to
do
more.
We
need
to
be
able
to
extend
that
that
protection
for
folks,
as
well
so
just
watch
for
that
in
the
in
the
days
to
come.
Thank
you,
madam
chair.
D
Personal
physician
administration
of
the
vaccine,
you
said,
there's
a
lot
of
red
tape
involved
in
that.
Why
is
that
different
from
a
flu
vaccine.
I
Yeah,
it's
exactly
right.
So
johnson
johnson
is
the
one
that
we
can
be
stored
in
the
doctor's
office
easily
with
no
issue.
The
other
ones
require
much
colder
temperatures,
but
even
to
get
those
they
have
to
apparently
there's
a
lot
of
different
forms.
They
have
to
fill
out
to
get,
and
most
physicians,
I
know,
are
pretty
averse
to
more
paperwork.
The
worst
words
that
doctor
wants
to
hear
is
doctor.
All
you
have
to
do
is
and
fill
in
the
blank
you
hear
that
you're.
I
Like
oh
another
thing
I
got
to
do
so
a
lot
of
them
aren't
doing
it.
We're
going
to
be
asking
probably
for
an
easier
way
to
be
able
to
get
those
into
doctor's
offices,
because
that
one-on-one
conversation
happens,
and
somebody
says
okay
I'll
take
it.
You
can
give
it
right
then,
and
there,
instead
of
setting
them
someplace
else
where
they
might
lose
their
courage
or
change
their
mind.