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From YouTube: House Health Committee- January 19, 2022
Description
House Health Committee- January 19, 2022- House Hearing Room I
A
A
We
have
rajul
bay
joy,
be
the
committee
attorney.
We
also
have
zach
brown,
the
back
that
will
be
our
committee
attorney
harris
king
is
our
research.
Analyst
megan
dicks,
be
our
committee
assistant,
and
then
we
have
two
committee
interns
we
have
joss
josh,
say
and
nick
jordan
and
josh
is
here,
but
nick
is
a
little
bit
under
the
weather,
but
he'll
be
joining
us.
I
believe
next
week
today
we
have.
We
do
not
have
any
bills
on
the
calendar,
but
we
do
have
a
a
couple
of
presentations.
We
have
dhs.
A
They
will
be
here
to
discuss
the
tanf
opportunity
act
and
then
later
on,
we
will
have
the
department
health
and
they
will
be
discussing
the
10
together
opioid
report
that
I
guess
came
out
in
november
and
give
us
a
status
update
on
covet
here
in
tennessee.
So
with
that,
I'd
like
to
bring
dhs
up
to
the
table
there
and
just
make
your
introductions
and
glad
to
have
you.
C
Yes,
that's
it
hello
hi.
How
is
everybody
I
will?
I
will
start
off
to
say
that
I
bought
some
really
cool
boots
for
such
an
occasion
like
this,
and
it
says
that
the
boots
are
waterproof
yeah,
so
right
after
this
we're
going
right
back
to
macy's,
because
that
is
not
the
case
with
these
wonderful
boots
that
I
have
on
right
now.
So
hello
and
I
bring
you
all
greetings
from
the
department
of
human
services.
My
name
is
sherelle
campbell
street.
I
serve
as
one
of
two
deputies
for
program
and
services.
C
I
am
joined
today
by
the
other
deputy
on
the
far
left.
That's
melissa,
hooks
and
she's
over
operations
at
the
department
and
then
our
wonderful
suzanne
carr,
who
is
senior
policy
advisor
to
the
commissioner's
office.
So
please
do
not
adjust
your
eyelashes
or
your
eyeglasses,
commissioner,
is
not
here
today
he
really
wanted
to,
but
unfortunately
he
is
not
feeling
well,
so
he
really
wanted
us
to
make
sure
you
know
that
he
really
wanted
to
be
here
and
he
all
wishes
you,
health
and
well
wellness.
C
So
shout
out
to
dhs
so
tanf
everything
that
you
want
to
know
in
1996,
then
the
clinton
administration
decided
to
redo
one
of
the
areas
in
the
safety
net,
and
that
was
the
public
assistance
cash
assistance
program.
Tanf
was
born.
It
was
designed
first
and
foremost
as
a
or
in
his
venue
of
this.
He
wanted
to
make
sure
he
being
the
president
at
that
time
and
his
leadership
wanted
to
ensure
that
not
just
we
would
not
just
give
out
cash
benefits,
but
now
really
wanted
to
tie
work
to
the
program.
C
So
one
of
the
first
things
that
was
really
implemented
as
a
part
of
tanf
is
the
work
components
you
will
see
on
in
back
of
me,
there
are
several
different
safety
net
programs
that
have
been
funded
and
implemented
by.
Our
federal
government
may
not
be
shocking
to
some
of
you,
but
believe
it
or
not
a
lot
of
them
do
the
exact
same
thing,
and
they
do
it
in
such
a
way
that
has
really
compromised
how
we
really
serve
our
citizens
here
in
our
country.
There
are
several
different,
I
believe,
last
count.
C
There
are
80
different
programs
that
are
departments
that
are
designed
to
support
the
safety
net
next
slide.
Thank
you,
suzanne.
So
one
of
the
things,
as
I
stated
that
is
lacking
currently
in
our
safety
net
environment,
is
a
lack
of
shared
vision,
each
one
of
the
departments
and
programs.
They
all
basically
do
the
same
thing,
but
they
have
little
nuances
in
terms
of
eligibility
and
really
what
are
we
trying
to
change.
C
C
You
should
have
just
let
me
click
right,
yep,
okay!
No,
I
don't
want
to
I'm
scared
of
those
things.
To
sum
it
all
up
the
what
we
have
before
us
right
now,
as
in
terms
of
on
a
federal
level,
is
transactional
interactions.
We
measure
outputs
and
not
necessarily
outcomes.
So
that's
really!
When
you
talk-
or
you
know
anything
about,
commissioner
carter,
he
really
talks
about
shaking
up
the
safety
net
on
a
national
level.
We
believe
that
the
tanf
opportunity
act
is
such
a
tree
to
be
shaken,
and
we
are
really
excited.
C
D
D
If
he
were
here,
he
would
probably
pontificate
for
quite
a
bit
longer
than
we
are
about
the
flaws
in
the
safety
net,
but
it's
government-centric
and
that's
what
we
have
right
now
and
so
our
vision,
using
the
tanf
opportunity
act
that
you
guys
passed
for
us
last
year,
is
to
redesign
this
and
think
differently
about
how
we
offer
these
services
to
individuals.
So
what
we
want
to
do
and
our
vision
is
to
grow
the
capacity
of
these
families
who
are
in
our
safety
net
programs,
so
that
we
can
reduce
their
dependency
on
these
programs.
D
We
believe
that
if
families
have
the
capacity
to
support
themselves
and
are
given
what
they
need
to
achieve,
that
that
they
won't
be
as
dependent
on
these
services,
and
so
we
also
want
to
redefine
success.
So
sherelle
said
currently
what
we
measure
are
outcome,
outputs
we,
how
many
people
did
we
serve?
How
many
benefits
did
you
get
out?
How
many
snap
cases
do
we
have,
and
that
doesn't
really
tell
you
a
measure
of
success
on
if
a
family
has
moved
past
their
need
for
those
services?
D
D
How
do
we
know
that
they
no
longer
need
these
services
and
so
to
start
on
this
journey
of
the
tanf
opportunity
act
last
year
you
guys
passed
that
bill
for
us
and
we
are
so
appreciative
we
started
soon
after
the
bill
was
passed,
engaging
the
different
sectors
of
tennessee,
explaining
this
vision
and
getting
input
from
them.
We
met
with
faith-based
organizations.
D
We've
met
with
the
business
community,
we've
talked
to
philanthropic
donors,
who
also
do
this
work
in
the
private
sector.
We've
engaged
other
state
agencies,
we've
talked
to
our
community
action
agencies
and
hras,
and
we've
looked
at
academic
and
other
non-governmental
organizations
and
really
tried
to
engage
the
whole
of
tennessee.
And
how
do
we
tackle
this
problem?.
D
So
just
as
a
refresher,
as
I
mentioned,
you
guys,
this
committee
specifically
was
one
of
the
first
stops
chairman
terry
carried
it
for
us,
the
tanf
opportunity
act,
so
it
has
several
parts
and
the
key
parts
that
we
refer
to.
Specifically
as
the
opportunity
act
pieces
we
are
seeking
a
research
partner
to
study
these
pilots.
D
After
those
planning
grants,
the
board
will
then
select
those
who
receive
the
six
opportunity.
Pilots
dhs
also
gets
to
pick
and
manage
one
and
through
that
we
hope
to
see
some
of
these
changes,
and
we
also
I'd
like
to
make
a
plug.
We
have
community
grants
that
were
established
by
the
bill.
Please
let
your
communities
know
those
are
currently
active
for
organizations
to
apply
that
application
cycle
ends
february
4th.
D
That
will
be
a
part
of
this
process
so
to
jump
into
where
we
are
today
as
an
update
for
you
guys.
So
the
legislation
said
that
we
could
award
up
to
5
million
dollars
to
up
to
50
planning
grantees
the
advisory
board
met
in
december.
They
had
we
had
approximately
80
applications
and
after
mandatory
review,
which
means
looking
through
all
the
federal
requirements
and
did
they
meet
the
correct.
D
D
So
in
west
tennessee
we
have
four
agape
child
and
family
services,
families
matter,
west
tennessee,
healthcare
foundation
and
the
university
of
memphis
and
their
focus
areas.
I
can
tell
you
there
are
these
broad
topics,
but
we
will
have
more
detail
when
the
organizations
submit
their
actual
proposal,
which
will
be
a
much
more
detailed,
30-page
proposal
at
the
end
of
march
in
middle
tennessee,
we
have
family
affair
ministries,
martha
o'brien,
center
goodwill,
industries,
upper
cumberland
human
resource
agency
and
persevere.
D
In
east
tennessee
we
have
the
city
of
chattanooga,
first
things:
first
knoxville
community
development
corporation,
the
united
way
of
greater
knoxville
and
the
first
tennessee
development
district,
and
then
statewide.
We
had
the
boys
and
girls
club,
the
tennessee
alliance
for
legal
services
and
east
tennessee
human
resource
agency.
So
these
applications
were
pulled
out
of
the
s
by
grand
division
because
they
are
touching
much
more
and
just
as
a
reminder.
D
The
legislation
said
that
the
board
had
to
select
a
minimum
of
two
pilots
in
each
grand
division,
or
at
least
two
pilots
that
are
touching
two
in
each
of
the
grand
division.
So
that's
why
we
split
them
out
that
way
to
ensure
for
the
board
that
when
they
pick
the
pilots,
they
have
that
statewide
coverage,
and
so
just
as
a
reminder,
dhs
also
gets
to
pick
one
per
the
legislation,
and
so
we
have
chosen
to
focus
ours
on
benefits
cliffs.
E
All
right
good
afternoon,
everyone,
my
name-
is
melissa.
Hux
deputy
commissioner
of
operations,
here
with
dhs,
just
to
give
you
two
quick
updates
on
two
competitive
procurements
that
are
ongoing.
We're
only
able
to
discuss
a
portion
of
that
publicly
as
they
are
out
for
bid
as
we
speak.
So
the
first
one,
as
you
see,
is
for
a
technical
assistance
partner.
This
will
be
a
partner
that
will
partner
with
dhs
and
with
the
pilots,
to
share
a
suite
of
services
to
the
grantees.
E
This
was
put
out
for
bid
in
december.
We
will
be
receiving
proposals
back
by
february
7th,
so
those
are
ongoing
and
active.
We
are
working
with
the
central
procurement
office
to
ensure
that
we
are
supporting
the
questions
and
the
responses
from
our
vendors
correctly.
The
goal
is
to
have
that
announced
and
contracts
signed
by
mid-march,
and
it
will
go
into
effect
june
1st.
E
The
second
competitive
rfp
that
is
out
is
a
researcher
contractor,
so
this
contractor
will
partner
with
us
and
with
the
pilot
for
scientific
research
data
analytics,
we'll
partner
with
our
data
analytics
team
internal
to
dhs
as
well.
That
went
out
for
a
bid
january
5th
and
we
are
hoping
to
have
that
contract
executed
by
the
end
of
march
with
a
start
date
of
august
1st.
D
D
Our
next
advisory
board
meeting
is
that
afternoon
and
you
can
direct
your
non-profit
organizations
and
any
other
organizations
eligible
for
tanf
to
visit
our
website
and
sign
up
and
get
email
updates
on
grant
opportunities
and
other
things
related
to
the
tanf
opportunity
act.
And
so
with
that,
mr
chairman,
we
are
happy
to
answer
any
questions
the
committee
might
have.
B
D
D
B
D
Yeah,
absolutely
representative,
hakeem,
no,
that
research
partner
will
be
working
with
them
in
an
ongoing
basis,
as
well
as
that
training
and
technical
assistance
partner
both
of
those
rfps.
Those
contract
partners
are
intended
to
work
with
those
pilots
and
ensure
ongoing
that
technical
assistance
can
be
offered
and
to
your
point,
things
can
be
altered
and
changed
if
we
find
out
things
aren't
working,
it's
not
meant
to
be
a
wait
until
three
years
have
ended
and
find
out.
None
of
this
worked
it's
not
at
all
intended
to
be
suzanne.
C
B
B
A
C
Thank
you.
Thank
you
for
the
question.
So
what
what?
What
what
we
mean
when
we
say
outputs
each
each
each
program,
the
main
programs,
they
measure
how
many
people
are
receiving
services.
What
we
hope
to
change
about
that
is
to
go
deeper
to
find
out.
Why
did
you
need
services
in
the
first
place
and
how
can
we
help
improve
your
your
position
or
what's
going
on
in
your
life,
so
you
don't
have
to
come
back
federally
speaking
what
what
is
being
measured.
C
We
do
not
believe
really
impacts
the
generational
poverty
stance
and
we
really
want
to
try
to
put
these
services
in
place
so
that
future
generations
do
not
have
to
come
to
dhs.
So
that's
kind
of
what
we're
talking
about,
not
just
measuring
the
number
of
people
that
we
are
serving,
but
how
many
families
are
we
impacting.
F
Okay
and
then
the
point
was
made
that
and
now
I'm
paraphrasing
here,
if
someone
has
the
ability
to
provide
for
themselves-
and
they
shouldn't
be
relying
on
these
services-
I
mean
that
was
general.
I
think
the
second
person
who
spoke
so
how
do
you
gauge
whether
or
not
somebody
needs
those
services?
Is
everybody
measured
on
the
same
plane,
because
certain
people
have
certain
opportunities
that
others
don't
some
people
start
out
ahead
of
others
and
if
you're
measuring
them
all
with
the
same
metrics,
it's
not
necessarily
equitable.
D
Yeah,
so
what
I
meant
by
that
was
that
we
are
looking
to
help
address
the
factors
that
cause
families
to
need
our
services
and
help
move
them
to
a
place
where
then
they
don't.
We
definitely
understand
that
people
start
in
different
places.
Come
to
us
with
issues
needing
our
services.
It's
just
sherelle's
point.
We
don't
want
to
just
provide
them
the
benefit
and
show
them
the
door.
C
That's,
why
am
I
on
nope
and
I
think
that's
why
this
our
tanf
opportunity
act
is
so
powerful,
because
to
your
point,
the
the
community
will
be
telling
us
based
on
the
needs
of
the
community,
what
are
needed
to
gauge
success
right
now,
as
you
mentioned,
if
you
show
up
and
you're
in
the
system
that
is
a
that
is
a
measure
of
success.
The
number
of
people
that
we
serve.
So
what
these
grants
will
help
us
to
determine
is
the
individuality
of
your
need,
and
so
we're
really
excited
about
that
part.
F
One
more
thanks,
mr
chairman,
yeah.
Well,
I
appreciate
you
elaborating
on
that.
I
just
don't
want
and
I'm
concerned,
in
addition
to
that
about
there
being
a
checklist
of
you
check
this
this
and
this
the
same
checklist
applies
to
everybody.
I
like
to
hear
what
you
said
about
the
specific
individual
needs
of
each
family.
That's
that's
important
to
me
so
I'll
move
unless
you
want
to
elaborate
a
little
bit
further
I'll
move
on
to
the
next
question.
I.
D
Would
just
say
that
part
of
the
application
process
for
the
planning
grants
was
to
form
collaboratives.
So
you
know
multiple
organizations
in
a
community
and
give
us
a
community-based
solution,
because
we
know
what
works
in
rural
tennessee
is
not
the
same
as
what
works
in
shelby,
county
or
hamilton
county
and
so
to
sherrell's
point.
We
really
wanted
these
to
be
community
driven
proposals
on
how
they
would
address
the
issues
affecting
their
community.
So
absolutely
we
don't
intend
for
this
at
all
to
be
a
check
check,
check
all
strictly
uniform.
A
If
let
me
interrupt
and
interject
that
might
help
you
up
to
to
your
point,
great
questions,
the
meeting
yesterday
and
the
slides
yesterday
actually
brought
out
some
of
that
and
and
in
your
slide
here
about
the
benefits
cliff,
which
I'm
glad
to
see
that
you
focusing
on
that
part
of
it
is
some
people
start
here
before
they
get
to
the
cliff.
Some
people
are
here.
Some
people
are
here,
and
so
you
have
to
individualize
that
with
them
and
determine
their
needs.
A
E
F
D
G
Thank
you,
mr
chairman,
and
thank
you
all
for
what
you've
done.
I
do
want
to
recognize
the
fact
that
chairman
hawk
and
chairman
watson
in
the
senate
took
the
work
from
the
working
group
appointed
by
both
the
speakers
and
worked
with
you
all,
and
this
has
been
the
final
product.
So
thank
you
for
everyone
for
your
leadership
and
making
it
a
a
an
outcomes-based
workforce
development
agency,
rather
than
a
benefits
agency.
So
thank
you
for
that.
One
question
I
do
have
back
to
the.
G
Of
course
I'm
gonna
be
very
interested
in
east
tennessee
and
I
can't
see
the
I
know:
we've
got
the
slides.
I
just
can't
get
them
open.
Could
you
go
back
to
those
three
groups
and
and
kind
of
walk
us
through?
You
know
how
those
were
selected.
I
mean
how
could
because
you
know
back
when
we
had
the
tennessee
cares.
G
I
know
that
the
united
way
was
selected
and
I
understand
the
criteria
there
was
that
a
similar
process
on
the
on
the
choosing
these
again,
not
pitting
anyone
against
the
others
just
wanting
to
understand.
So
I
could
because
we're
going
to
go
back
home
and
we're
going
to
we're
going
to
be
asked.
Well,
how
did
they
get
selected
and
we
didn't.
D
So
we
did
develop
a
evaluation
rubric
for
the
board,
but
I
am
going
to
put
a
little
bit
to
say
that
dhs
did
not
select
any
of
these.
It
was
the
board
21
member
board
evaluated
all
of
them
using
the
rubric,
and
then
they
held
a
meeting
to
deliberate
and
discuss
and
make
the
selection.
So
truly
it
was
the
selection
of
the
board
that
I
can
tell
you
that
they
did
ensure
statewide
coverage,
equitable
coverage
and
ensuring
that
we
had
organizations
doing
different
types
of
work.
D
F
A
A
We
got
those
back
really
quick
and
it
was
very
thorough
and
I,
when
I
looked
at
him,
I
know
that
the
way
that
I
graded
it
I
might
had-
I
mean
I
had
a
spreadsheet
and
all
this
for,
but
it
was,
it
was
very
thorough,
I
think,
from
the
process,
and
then
there
was
a
meeting
for
discussion.
They
narrowed
those
down,
but
ribson
smith,
you're
recognized
all
I.
B
D
Yes,
so,
yes,
representative
mitchell,
our
office
of
inspector
general
went
through
the
entire
list
of
applicants
and
ensured
they
were
cleared
to
do
business
both
with
the
state
and
with
the
federal
government.
Our
program
team
also
went
through
and
did
a
check
of
what
they
were
proposing
to
ensure
that
it
at
a
baseline
met
the
requirements
of
tanf
and
could
be
something
funded
with
tanf,
and
so,
as
I
mentioned
earlier,
we
had
80
applicants
but
going
through
all
of
those
processes
we
weeded
out
and
only
passed
along
47
to
the
board.
A
D
D
A
H
H
A
H
Well,
that
covets
up
front
up
first:
okay:
let's
do
that.
Mr
chairman,
thank
you
for
having
me
today.
I'm
lisa
pearcy
with
the
department
of
health
to
my
right
is
dr
morgan.
Mcdonald
who's,
our
deputy
commissioner,
but
the
most
special
person
in
the
room
is
beth
maples,
who
will
indicate
herself
by
waving.
H
Beth
is
in
town
today,
because
she
is
our
department
of
health
governors,
excellence
in
service
award
recipient.
She
came
in
for
lunch
today.
She
is
the
office
supervisor
at
our
severe
county
health
department
and
has
been
with
us
for
15
years,
so
she
is
representing
the
entire
department
today
and
we're
glad
to
have
her,
and
I
thank
you.
A
H
Declined,
thank
you.
Thank
you
committee
glad
to
be
here
with
you
today.
Can
you
be
my
thank
you,
so
I
wanted
to
provide
you
with
a
pretty
substantive
update
today,
because
I
know
you
guys
are
getting
lots
of
questions
and
you
may
have
questions
yourself
yourselves.
That
haven't
been
answered
publicly,
so
I
wanted
to
give
you
an
opportunity
to
do
that,
so
I
know
you're
familiar
with
this
curve.
This
is
what
we
call
our
epi
curve.
H
The
thing
you
will
notice
here
is
that
this
most
recent
surge,
all
the
way
to
the
right
of
the
screen
is
right.
Now
it
is
an
order
of
magnitude
higher
than
the
highest
surge
before
maybe
one
and
a
half
times
the
the
previous
high.
So
let
me
let
me
also
give
you
some
good
news.
I
think
oh
look
at
there
thanks
we're
starting
to
plateau
and
starting
to
drop
off
in
our
metro
areas,
so
that
is
a
good
sign.
H
Our
rural
areas
aren't
quite
there
yet,
but
historically
speaking,
when
we've
seen
these
patterns
with
case
trends,
the
rural
areas
generally
follow
a
week
or
two
sometimes
three
weeks
later,
but
essentially
all
of
our
metro
areas
are
now
in
a
plateau
or
in
a
downslope.
So
that's
a
good
thing.
The
reason
when
you
go
back
to
looking
at
the
magnitude
of
the
current
spike
compared
to
others
is
because
of
the
very
very
high
transmissibility
or
contagiousness.
If
you
will
of
the
omicron
variant,
the
omicron
variant
nationally
now
accounts
for
about
98
of
all
infections.
H
H
The
other
thing
that
I
want
you
to
keep
in
mind
when
you
look
at
a
graph
like
this
is
even
as
high
as
this
spike
is
it's
a
significant
underestimate
of
what
the
actual
disease
burden
is
for
a
couple
of
reasons,
one
because
there
is
some
level
of
both
natural
and
acquired
immunity
in
our
population.
We
think
that
there
are.
H
H
So
now,
let's
talk
about
hospitalizations,
because
this
is
something
that's
also
shifted
from
the
last
surge
or
all
of
this
urges
before
now
and
versus
now.
So,
when
you
first
look
at
this
curve,
so
overall
on
the
far
right,
you
will
see
that
the
hospitalization
number
almost
approximates
that
of
the
highest
peak,
that
we
had
back
in
the
summertime
surge
and
and
is
about
equal
to
that
of
last
winter
surge,
and
I'm
going
to
tell
you
that
there
is
a
big
asterisk
by
that,
because
it
is
not
necessarily
an
apples-to-apples
comparison
in
the
past.
H
Hospitalization
numbers
have
essentially
been
used
as
a
proxy
for
virulence.
So
what
that
means
is
if
hospital
numbers
go
up
in
relation
to
case
numbers,
it
can
mean.
Oh,
this
strain
is
making
people
really
really
sick
and
they're
going
to
be
in
the
hospital.
More
often
that's
what
happened
in
july
and
august
with
the
with
the
bad
delta
wave.
H
This
one
is
a
good
bit
different
because
and
you've
probably
read
about
it
nationally
of
what
we
call
incidental
findings.
So
before
I
talk
about
that,
I
want
to
make
clear
there
are
some
really
sick
people
in
the
hospital
with
coving.
I
do
not
want
to
diminish
that
at
all,
and
a
majority
of
people
that
are
in
the
hospital
with
covet
are
there
because
of
coven
and
they're,
very
sick
and
and
should
be
taken
very
seriously,
largely
still
unchanged.
H
Those
are
unvaccinated
folks
for
the
most
part,
what
is
different
is
that
nationally
speaking
about
30
to
50
percent
of
hospitalizations
with
coveted
right
now
are
what
we
call
incidental
findings,
which
means
they're
there
for
some
other
reason,
and
they
happen
to
have
a
positive
cova
test.
So
you
know
we
heard
lots
of
rumors
about
that
early
on
of
oh
you're,
counting
it
as
coveted,
if
you
know
they're
in
for
a
car
wreck
or
whatever
that
didn't
happen.
H
H
H
So
some
hospitals
don't
test
you
unless
you
come
in
for
with
symptoms
for
that
process,
there
are
other
hospitals
that
test
every
person
that
walks
through
the
door,
and
so
you
might
be
there
with
chest,
pain
or
gi
bleed,
but
if
you're
positive
for
coven
you're
marked
as
that
and
then
everywhere
in
the
middle,
so
some
of
them
just
do
it
for
pre-ops
some
do
it.
You
know
all
different
kinds
of
ways.
So
it's
a
very
I'm
oftentimes
asked
the
question.
H
H
Individual
facilities
will
likely
have
that
information
and
what
we
have
heard
from
the
facilities
that
measure
that
here
in
tennessee
is
pretty
consistent
with
the
national
average,
so
between
30
and
50
of
hospitalizations
are
there
for
something
else.
The
other
way
that
you
can
tell
that
is
when
you
look
at
the
icu
curves
and
if
you
can
see
on
the
bottom,
those
those
bottom
two
curves
are
icu
and
mechanical
ventilation,
curves
in
proportion
to
the
overall
cases,
they're
relatively
quite
small.
So
this
is
another
way
that
we
contains.
H
So
I
I
wanted
to
cover
that
to
to
explain
why
this
looks
the
way
it
does
at
the
end
of
the
day,
hospitals,
really
it
doesn't
change
what
they
do
if
you're
positive
for,
if
you're
there
for
covet
or
if
you're
there.
For
some
other
reason
it
takes
the
same
amount
of
ppe,
it
takes
the
same
type
of
isolation.
It
takes
the
same
type
of
special
precautions
and
so
from
a
hospital
standpoint.
H
It
really
doesn't
matter,
but
I
just
wanted
you
to
be
aware
that
this
no
longer
is
a
proxy
for
virulence
and
and
people.
It
might
not
be
quite
as
bad
as
it
looks
on
the
screen.
Let
me
tell
you
the
other
part
of
hospitalization.
That
is
a
little
bit
different
or
hospital
situation
than
it
was.
We
are
having
significant
problems
with
staffing
hospitals
right
now,
and
it's
because
just
like
every
other
industry,
employees
are
getting
sick
and
you
know
they
have
to
be
out
for
five
days
or
ten
days
or
whatever.
You
know.
H
The
guidelines
that
apply
to
them
are,
and
so
we've
got
hospitals
and
health
systems
across
the
state
that
have
500
700
800
employees
out
at
any
one
given
time
that
creates
significant
strain
on
any
business
to
have
8
or
10
or
15
percent
of
your
workforce
out.
So
I
just
want
to
tune
you
to
the
fact
that
if
you're
reading
reports
that
oh
my
gosh,
this
is
higher
than
it's
ever
been-
and
this
is
worse
than
it's
ever
been,
you
need
to
take
it
with
that
grain
of
salt.
H
Again,
I
do
not
in
any
shape
form
or
fashion,
want
to
diminish
what
is
actually
happening,
because
there
are
bad
things
that
are
happening
out
there,
but
it's
not
the
same
as
it
was
in
the
summer
or
last
winter.
That's
probably
enough
on
that.
I'm
happy
to
answer
more
questions
if
you
have
them
in
a
minute.
H
Here's
the
other
thing
that
I
bet
you're
getting
a
bunch
of
questions
about,
and
the
thing
that
has
probably
seen
the
most
movement
in
the
last
30
days
or
so,
and
it's
a
broad
category
that
we
call
therapeutics
and
that's
basically
everything
that
you
can
do
after
you
already
have
the
infection
to
get
better.
So
I've
split
them
out
into
sort
of
two
big
categories
here:
antivirals
and
monoclonal
antibodies,
but
they're
different
little
nuances
of
those.
H
So
on
the
antivirals
there
is
an
iv
antiviral
called
rem,
desevere
that
one's
been
out
since
november
of
2020..
It
is
now-
and
I
think,
has
been
for
almost
a
year
now
commercially
available.
That,
thankfully,
is
the
only
thing,
not
thankfully
the
only
thing,
but
thankfully
that
one
is
commercially
available.
H
We
don't
have
to
allocate
that
from
a
state
standpoint.
We
don't
have
to
order
it
that
is
available
on
the
commercial
market.
Hospitals
do
that
directly.
You
probably
haven't
even
heard
the
term
rem
deserve
in
several
months,
because
it's
pretty
readily
available
and
hospitals
can
get
it.
That
is
what
you
get
once
you're
already
in
the
hospital
from
an
iv
standpoint.
H
So
and
I've
got
a
number
slide
coming
up
next,
so
just
hold
that
in
your
head,
but
the
these
are
products
that
are
being
allocated
directly
from
the
federal
government
where
we
have
to
direct
where
they're
going
to
so.
If
this
sounds
familiar
to
you
you'll,
remember
that's
how
what
happened
when
we
had
very
small
quantities
of
vaccine
at
first,
so
we
had
to
say:
okay,
the
the
feds
give
it
to
the
state
and
the
state
says
or
the
or
they
ask
the
state.
H
Where
do
you
want
this
to
go,
and
so
we
have
to
pick
some
place
that
can
geographically
cover
pretty
much
the
whole
state,
at
least
within
a
certain
distance.
We
have
to
be
mindful
that
it
is
accessible
to
all
patients,
so
not
give
it
to
a
certain
entity
that
excludes
some
other
type
of
patient
type
or
whatever
we
have
to
be
mindful,
or
we
want
to
be
mindful
of
what
we
call
the
social
vulnerability
index,
which
means
equitable
access
for
those
most
vulnerable
populations
and
just
like
vaccine.
H
H
H
How
did
you
end
up
picking
walmart
and
it
had
to
do
with
geographic
distribution
and
and
equitable
access
across
the
state,
so
those
oral
antivirals
are
being
allocated
to
us
on
a
bi-weekly
basis
and
I'll
show
you
the
projections
in
just
a
second,
the
other
two
therapeutics
one
you're
familiar
with
one.
You
may
not
be
the
one
you
may
not
be
familiar
with,
and
this
is
a
mouthful.
It's
called
a
pre-exposure
prophylaxis,
monoclonal
antibody,
which
is
maybe
something
that
you'd
never
put
those
terms
together.
H
So
everybody's
pretty
familiar
with
what
a
monoclonal
antibody
is.
That's
the
iv
infusion
that,
after
you
test
positive,
if
you
get
within
10
days,
it
significantly
reduces
your
chances
and
is
wonder
drug
significantly
reduce
your
chances
of
going
in
the
hospital.
They
now
have
a
product
that
you
can
get
before
you
get
infected.
H
You
can
give
them
a
vaccine
all
day
long
and
they
won't
mount
a
response,
but
they
will
be
offered
about
six
months
of
protection
if
you
give
them
one
of
these
iv.
Infusions
of
this
combination-
monoclonal
antibody
product,
was
brand
name
evushield
about
once
every
six
months,
so
we've
also
been
getting
those.
I
bet
that
one's
flown
under
your
radar,
because
that
one
is
a
pretty
unique
product
for
special
populations.
H
It's
also
in
very
limited
supply
and
again
we
will
expand
that
out
when
supply
allows,
but
in
those
eight
major
medical
centers,
which
are
listed
on
our
website,
people
who
have
those
kind
of
conditions
are
likely
being
treated
at
those
larger
medical
centers
anyway.
So
if
you
or
your
family
or
your
constituents
fall
into
one
of
those
special
categories
and
their
doctor,
their
oncologist
their
transplant
surgeon
hasn't
reached
out
and
said:
hey,
you
really
need
this.
H
You
need
to
be
reaching
out
to
the
doctor
and
say
I
can't
take
a
vaccine
because
of
my
immunocompromised
state.
Can
I
get
this
ebu
shield
infusion,
so
that's
one
you
may
not
have
heard
of,
but
the
one
that
everybody's
heard
of
is
just
the
standard,
post-exposure
monoclonal
antibody,
and
that's
the
infusion
that
you
get
after
you're
positive
well
for
months.
H
So
that
gets
us
down
to
one
monoclonal
antibody
product,
that
is,
that
works
against
omicron.
This
is
a
product
called
cetrovomab
which
is
manufactured
by
glaxosmithkline
or
gsk,
and
this
was
one
that
was
not
initially
procured
by
the
feds
and
allocated
to
the
states.
It
was
just
on
the
open
market
that
created
a
lot
of
demand,
and
so
it
was.
There
was
sort
of
a
shortage
scenario
even
before
we
knew
about
the
omicron
resistance.
H
H
Unfortunately,
since
probably
the
week
before
christmas,
we've
only
been
getting
between
600
and
800
doses
a
week
for
the
entire
state
that
does
not
go
very
far
when
we
had
sites
that
were
sometimes
infusing
up
to
a
hundred
patients
per
day
at
one
site.
So
we're
talking
about
a
max
of
800
doses
for
the
entire
state,
so
your
constituents
very
likely
can't
find
monoclonal
antibody,
that's
essentially
the
same
everywhere
in
the
nation
right
now.
H
H
I
think
this
week
we
got
720
doses.
Last
week
we
got
600
and
something
so.
Unfortunately,
I
don't
expect
an
increase
in
that,
for
the
foreseeable
future,
hopefully
february
will
bring
better
news,
but
that
that
is
our
projected
allocation.
Through
the
end
of
the
month.
You
can
see.
We've
got
plenty
of
regeneron
and
bam
eddie,
but
I've
already
told
you
that's
kind
of
a
moot
point,
and
then
you
can
see
that
the
oral
antivirals
are
being
allocated
on
a
bi-weekly
basis.
H
H
It's
just
there's
just
very
little
to
be
to
be
had
the
good
news
is
we've
got
plenty
of
vaccine
and
vaccine
is
still
the
most
effective
way
you
can
prevent
disease
and
particularly
progression
to
severe
disease.
To
orient
you
a
little
bit
to
this
slide.
The
orange
bars
on
the
right
side
are
the
proportion
of
booster
shots
of
all
of
the
vaccines
being
given.
So
we
have
had
some
pretty
decent
uptake
of
boosters
over
the
last
several
weeks
and
then
my
last
slide
on
covid
is
just
to
remind
you
of
booster
eligibility.
H
The
bottom
line
is
essentially
everybody.
Age,
12
and
up
is
eligible
for
a
booster
five
months
after
an
mrna
which
is
faster
moderna
or
two
months
after
a
jnj
all
right,
a
few
slides
on
tennessee,
together,
which
totally
shifting
gears
to
we
all
like
to
talk
about
non-covered
things.
So
this
is
something
that
chairman
and
others
spearheaded
in
2018
is
that
right,
chairman
2017-18,
we'll
go
with
that.
H
Oh
there,
it
is
right
there
enacted
in
july
of
18,
so
it
would
have
been
prior
to
that
which
reduces
the
number
and
amount
of
opioids
short-term
opioids
that
are
prescribed.
We
were
talking
about
this
over
at
the
office
this
morning.
I'm
sure
each
of
you
can
recall
a
time
in
the
distant
past,
hopefully
very
distant
past,
where
you
would
have
a
routine
procedure,
a
tooth
pulled.
You
know
a
minor
some
kind
of
minor
procedure
and
you
might
be
given
30
or
40
or
60
hydrocodone
tablets,
and
what
we
learned
over
time.
H
So
what
it
did
was
this
placed
a
limit
on
how
many
days
you
could
write
that
prescription
for
and
what
your
morphe
milligram
equivalence
or
basically,
how
strong
of
a
drug
you
could
write
and
it
didn't
it
didn't
get
in
the
middle
of
doctors
making
their
own
judgments
and
it
didn't
have
anything
to
do
with
chronic
pain
patients
who
relied
upon
these
on
an
ongoing
basis.
But
I
think
this
is
a
very
illustrative
graph
that
shows
you
the
impact
of
that.
H
So
in
case
you
can't
see
the
labels
there
that
first
or
that
top
line
shows
you
the
overall
decline
in
opioid
prescribing
now
you
will
know
the
shaded
part
on
the
right
side
is,
since
the
legislation
was
enacted.
It
was
going
down
before
that,
but
the
legislation
continued
that
acceleration.
So
there
were
more,
I
should
say
there
were
less
patients
receiving
prescriptions
for
opioids
and
when
they
did,
they
were
shorter
in
duration.
H
So
that's
what
you
see
the
three
lines
on
the
bottom
is
the
duration.
You've
got
the
categories
of
one
to
three
days,
four
to
ten
days
and
then
10
plus
days,
and
that
line
that
starts
out
in
the
middle
and
then
crosses
up
and
over
once
the
legislation
takes
effect
in
the
shaded
area.
Is
you
will
see
that
the
proportion
of
prescriptions
written
for
a
duration
of
one
to
three
days
went
up
and
the
proportion
of
prescriptions
that
were
four
to
ten
days
in
duration
went
down?
H
And
that's
that's
what
I
want
you
to
remember
that
five
to
seven
or
five
to
ten
days
is
the
magic
number
where
people
who
are
opioid
naive
can
tip
the
scales
into
becoming
physiologically
addicted.
And
so
this
is
a
graph
of
those
opioid
naive
patients
again
on
the
right
side.
Is
the
shaded
portion
where
the
legislation
was
impacted.
You
can
see
that
the
number
of
opioid
naive
patients
that
became
dependent
on
these
went
from
four
percent
to
three
percent.
H
Because
of
that,
and
then
finally,
as
I
mentioned
a
minute
ago,
this
did
not
impact
chronic
pain,
patients,
chronic
pain
patients
who
rely
on
that
on
an
ongoing
basis
and
are
under
appropriate
care
for
chronic
opioids
were
still
able
to
do
that
and
and
didn't
see
any
significant
change
chairman.
I
hope
that
answered
your
questions.
Okay,.
A
A
So,
obviously
I
work
in
a
hospital
and
I
track
these
things
with
our
hospital
as
well
and
during
the
second
peak
there,
our
hospitals,
I
think,
358
beds.
The
second
peak
we
got
up
to
147
of
patients
were
covid
patients
and
the
bottom
line.
The
icu
39
of
the
42
critical
care
patients
we
had
were
coveted
patients
in
our
icu,
they're,
ventilated
or
struggling
in
some
form
or
fashion
or
long-term
ventilator.
A
As
that
peak
went
down,
we
got
down,
I
think
the
lowest
number
we
got
was
23
patients
total
in
our
hospital.
We
got
down,
I
believe
two
one
or
two
patients
in
the
unit,
and
that
has
since
gone
up-
and
I
think
we've
got
up
gotten
up
to
around
this
past
week
or
so
in
the
90s
in
our
hospital,
and
it's
like
you,
said
it's
kind
of
plateaued.
A
At
least
this
week
knock
on
wood
and
our
hospitalizations
or
icu
hospitalizations
got
up
to
around
17
16
17
and
that's
knock
on
wood
again
right
at
that.
So
from
a
virulence
standpoint
tracking
the
icu,
I
think
that's
something
from
a
real
world
world
ex.
You
can
see
that
here
and
I
just
wanted
to.
Let
people
know
that.
I
I
see
that
I've
tracked
that
this
is
something
when
I
I
see
it.
A
F
F
H
Sure
that's
a
great
question
leader
gant
and
the
answer
is,
it
depends.
It
depends
on
a
lot
of
things.
So,
first
and
foremost,
it
depends
on
what
kind
of
test
you're
doing
so
a
pcr
test
will
remain
positive
for
a
lot
much
longer
time
than
a
rapid
antigen
test
rapid
antigen
tests.
What
you
have
at
home,
that's
a
quick
one.
The
pcr
is
sort
of
the
first,
the
old
school,
not
kind
of
the
first
one
we
had.
You
know
that
goes
pretty
far
up
your
nose
and
is
run
through
a
traditional
lab.
H
Pcr
test
generally
will
stay
positive
from
anywhere
two
to
four
two
to
five
weeks
in
a
normal.
In
a
normal
scenario,
there
are
some
people
that
can
keep
a
positive
pcr
test
for
seven,
eight,
nine
plus
weeks.
Now,
as
you
mentioned,
that
does
not
necessarily-
or
it
absolutely
does
not
mean
that
they
are
infectious
for
that
long.
We
know
that,
except
in
very
rare
circumstances,
most
people
are
infectious
for
about
the
same
amount
of
time.
H
Five
to
ten
days
and
after
about
the
fifth
day,
the
viral
load
or
how
infectious
you
are
drops
off
pretty
precipitously.
I
think
you'll
see
that's
that
was
some
of
the
science
behind
the
recent
cdc
change
in
isolation
on
the
rapid
antigen
test.
Rapid
antigen
tests
are
a
better
indicator
of
infectiousness
or
how
contagious
you
are
to
others.
Now
we
get
a
lot
of
questions
about.
F
H
That's
right
for
the
oral
antivirals.
Those
are
now
available
or
approved
under
an
eua
remdesavir
already
has
full
approval
of
the
iv
form,
and
so
over
a
certain
period
of
time
months.
Usually
that
eua
does
convert
to
a
full
approval.
I
believe
the
first
round
of
vaccines
have
that
now,
and
maybe
some
of
maybe
regeneron
one
of
the
older
monoclonal
antibodies,
but
the
new
oral
antivirals.
The
two
that
I
mentioned,
those
are
still
under
eua.
F
H
To
be
honest,
most
of
the
time
is
what's
available
and
what's
available
nearby,
the
oral
antivirals
are
effective
in
reducing
progression
to
severe
disease.
I
did
mention
that
one
is
more
effective
than
the
other
and
we
leave
that
all
up
to
the
clinical
judgment
of
the
provider,
so
the
higher
the
more
high-risk
individuals,
the
elderly,
those
with
immunocompromising
conditions,
people
with
things
like
obesity,
hypertension,
diabetes,
the
things
that
we
know
make
you
at
higher
risk
for
severe
disease.
H
So
the
oral
antivirals
these
particular
ones,
are
relatively
new.
The
concept
of
oral
antivirals
is
not
new
and
in
fact
the
pax
lavid
is
a
combination
product
and
one
of
those
products
is
a
drug.
That's
been
used
to
treat
other
viruses
in
the
past
and
that
one
I
think
it's
been
around
quite
some
time,
so
there
may
be
some
more
long-term
data
on
that.
One.
F
F
H
H
For
me,
the
most
important
part
as
a
physician
and
state
health
official
is,
I
haven't,
heard
any
science
any
robust
science
behind
it.
Nor
have
I
seen
any
official
recommendations
or
approvals
of
it,
and
so
I
don't
know
if
that's
coming
in
the
future
or
not,
but
right
now,
while
it's
not,
we
don't
recommend
it.
F
B
H
H
Yeah,
I
bet
so
no
sir,
that
is
a
common
rumor
or
myth
that
we
hear
is
that
hospitals
get
paid
more
for
covered
patients
or
that
they
get
paid
more.
If
there's
a
coveted
death
or
whatever.
That's
not
true.
What
is
true
is
that
with
any
condition.
So,
as
you
know,
when
people
go
into
the
hospital,
they
very
rarely
just
have
one
thing
wrong
with
them,
so
they're
there
and
they
have
pneumonia,
but
maybe
their
diabetes
is
also
out
of
control,
and
maybe
they
also
have
the
flu.
H
There
is
a
provision
like
with
any
other
condition
for
a
hospital
to
add,
what's
called
a
modifier,
because
hospitals
are
actually
in
my
health
care
counterparts
in
the
room,
particularly
the
hospital
based.
One
know
that
hospitals
can
be
penalized
if
their
length
of
stay
or
financially
penalized
if
their
length
of
stay
exceeds
what
that
condition
is
supposed
to
have
so,
for
example,
if
the
insurance
company
says
well,
you've
had
a
heart
attack.
H
We'll
pay
you
for
three
days,
that's
different
than
if
you
have
a
heart
attack
with
covid,
with
diabetes
with
something
else,
and
so
those
are
modifiers
that
do
allow
for
a
higher
acuity
and
and
more
resource
coverage.
But
there
is
no
differential
or
bonus
or
anything
like
that
that
hospitals
get
for
covet
patients.
It's
just.
H
B
H
I'm
glad
you
asked
that
one
too,
so
when
we
talked
about
that
very
first,
the
very
first
curve
and
as
high
as
that
last
surge
is
that
is
such
a
significant
underestimate
of
what
the
actual
disease
burden
is,
because
these
numbers
are
less
and
less
accurate
as
each
with
each
passing
week.
Our
daily
case
numbers
are
less
and
less
useful,
so
what
we
do
find
useful
are
trends
over
time
and
we're
starting
to
see
the
move
away
from
daily
numbers
spread
all
over
the
nation.
H
I
can't
remember
the
exact
number
last
time
I
heard
it
was
20.
Something
states
are
no
longer
reporting
daily.
The
associated
press
has
asked
their
reporters
to
stop
reporting
daily
case
counts
because
they're
inaccurate
and
you
may
have
seen
in
your
ncsl
newsletter
on
monday.
That
was
the
lead
article
about
the
the
declining
usefulness
of
daily
reporting.
So
we
now
report
weekly
that
doesn't
mean
that
we're
not
watching
things
like
hospitalizations
and
deaths
on
a
daily
basis,
but
we're
reporting
publicly
weekly
now.
H
The
other
reason,
frankly,
is
that,
oh,
it's
pretty
clear,
we're
not
going
to
get
over
this
anytime.
Soon
we're
going
to
be
dealing
with
this
for
a
while,
and
we
have
got
to
normalize
this
into
typical
operations,
and
so
we
are
making
it
like
every
other
condition
that
we
report.
We
report
flu
weekly.
We
report
other
infectious
diseases
that
way,
and
so
we
are
normalizing
this
into
our
daily
operation.
B
H
B
H
Yes,
sir,
and
actually
that's
a
good
point
that
I
didn't
mention,
there
are
a
couple
of
provisions
that
that
physicians
have
to
keep
in
mind
with
these
oral
antivirals
they're,
not
one,
I
can't
remember
which
one,
but
at
least
one,
if
not,
both,
cannot
be
used
in
pregnancy
or
lactation,
and
then
one
of
them
does
have
some
significant
drug
drug
interactions
and
so
have
to
have
a
lot
of
cognizance
of
those
risks
when
prescribing
these
drugs.
Okay,
thank
you.
A
Thank
you
before
we
get
to
the
next
person.
I
just
wanted
to
follow
up
on
one
of
your
comments
about
modifiers
and
costs,
and
I
don't
think
a
lot
of
people
know
that
like
says,
if
there's
like
a
covered
ward,
or
at
least
you
know
over
the
summer
when
they
had
those
and
you're,
you
know
it's
not
apples
to
apples,
people
going
to
the
hospital
and
you
get
paid
for
this
hospitalization
versus
this
hospitalization.
A
A
You
have
to
incentivize
them,
and
so
the
costs
go
up
for
that,
so
so
having
modifiers
for
the
hospital
at
least
to
break
even
or
cover
those
costs
are
part
of
that,
and
that's
something
not
just
for
this,
but
other
in
anesthesia
we
have
modifiers
sicker
patients
are
the
more
we
have
to
do
it
in
icus.
When
we
talk
about
that,
when
patients
from
the
icus
oftentimes
the
their
ivs,
you
know
normally,
you
have
your
ib
hanging
at
bedside
and
it's
right
there
next
to
them
covered
patients.
A
The
tubing
goes
out
the
door
oftentimes
and
it's
outside
and
you're
changing
the
bags
outside.
So
you
don't
have
to
go
in
and
out
and
potentially
spread
spread
coven,
so
there's
more
cost
to
that
they're
wearing
the
different
masks
that
they
have.
So
just
keep
that
in
mind.
When
you
talk
about
costs,
representative
smith,
you
recognize.
G
Thank
you,
mr
chairman.
If
you
would
indulge
me
for
a
couple
of
questions,
thank
you,
dr
piercy
and
team.
I
don't
want
to
misrepresent
your
words
and
just
for
a
point
of
clarity.
You
had
mentioned
on
the
hospitalizations
that
and-
and
let's
see,
if
I
phrase
this
correctly,
that
the
the
latest
data
does
not
reflect
hospitalizations,
based
on
a
primary
diagnosis
for
admittance
for
covid,
rather
they're
there
for
another
primary
diagnosis
and
while
they're
there
they're
testing
positive.
Would
that
be
a
fair
assumption?
H
It
does
not
differentiate
if
they
were
admitted
because
of
covid
or
with
covet,
because
it
is
so
prevalent
in
the
community
right
now.
It
would
be
really
common
for
somebody
who's
there
with
some
other
condition
to
have
covet,
but
it's
also
prevalent
in
the
community
right
now
and
particularly
amongst
some
vaccinated
people.
So
it's
more
common
for
people
with
covet
to
be
admitted,
so
I
may
have
confused
you
more,
but
it's
it's
both
ma'am.
G
Thank
you,
mr
chairman,
and
and
thank
you
for
the
clarity,
because
I
think
the
the
the
safest
way
to
say
is:
there's
no
distinction
right
for
the
primary
diagnosis.
If
you
would
just
for
a
moment
of
public
service,
could
you
speak
to
the
definition
of
endemic
we're
hearing
that
in
the
reporting
that
we're
now
seeing
covet
at
endemic
levels?
And
I
take
that
to
be
a
good
thing
and
some
people
react
to
that.
But
but
would
you
offer
your
professional
opinion
on
what
endemic
means
to
the
public,
so
we
can
watch
this
back
home?
G
H
Will
be
glad
to
try.
I
wish
I
had
an
epidemiologist
with
me
because
there
is
an
official
definition
of
that,
but,
generally
speaking,
it
has
to
do
with
scale
and
and
how
many
people
are
being
infected
and
how
widespread
it
is
so
right
now
it
is
at
a
pandemic
level.
You
will
remember
a
hundred
years
ago.
H
Excuse
me
y'all,
don't
remember
nobody
in
this
room
remembers,
but
you
will
remember
historically
that
a
hundred
years
ago,
flu
was
a
pandemic,
and
over
time
excuse
me
over
time,
as
the
population's
immunity
builds
both
in
in
our
situation
now,
both
naturally
through
infection
and
acquired
through
vaccine,
it
becomes
less
and
less
of
a
disease
burden
over
time,
and
so
there
is
an
official
definition
of
when
it
shifts.
That's
the
part
that
an
epidemiologist
would
have
to
tell
you,
but
over
time
it
will
become.
H
One
of
these
things
that
we
just
live
with
flu
is
now
endemic.
It's
hard
to
imagine
that
a
hundred
years
ago
they
were
feeling
the
same
way
about
flu
as
we
feel
about
cobia.
Now
and
now
you
know
how
we
feel
about
flu.
It's
like
well,
it's
dangerous
to
some
people,
but
it's
always
there
and
we're
going
to
take.
H
You
know
the
mitigation
measures
that
we
can
but
we're
going
to
go
ahead
and
live
our
normal
lives,
and
so
that
is
what
we
are
quickly
getting
to
with
this
there's
a
lot
of
speculation
that
this
will
be
sort
of
our
last
bad
surge.
Until
we
transition
into
that,
I
will
say
that
there
is
no
magic
number.
There
is
no
magic
date
that
was
okay.
If
you
get
this,
then
it's
you
know
it's
going
to
flip
the
switch,
but
we
are
moving
very
quickly
towards
that
point.
G
G
Do
you
believe
and
again
that
if
you
don't
feel
comfortable
answering
this
question,
I
don't
want
to
put
you
on
the
spot,
but
do
you
believe
that
the
state
of
tennessee
is
receiving
its
fair
share
of
allocation
of
all
of
these
critical
therapeutics?
And
do
you
believe
that
there's
any
sort
of
I
don't
want
to
call
it
punishment,
but
but
clearly
you
know
retribution
something
like
that.
G
H
It's
a
legitimate
question
and
I'm
glad
you
asked-
and
I
want
you
to
know
that
I
watch
that
very
very
closely,
because
if
there's
any
indication
that
we're
not
getting
our
fair
share
I'll
be
calling
that
same
day
and
to
our
federal
partners,
credit,
they
are
being
very
transparent
about
what
every
state
gets.
And
so
I
can
see
the
breakdown
of
all
of
these
products
for
every
state
and
whereas
they
don't
produce
the
exact
algorithm
of
how
they
come
up
with
the
calculations.
H
They
do
generally
tie
it
to
both
population
and
disease
burden,
and
when
you
look
at
the
allocations
and
how
they
change
week
over
week,
you
can
see
that,
regardless
of
whether
the
state
is
red
or
blue,
you
are
starting
to
see
more
go
to
states
that
have
a
higher
disease
burden
and
and
vice
versa.
And
so
the
short
answer.
Your
question
is
no.
I
haven't
identified
that,
but
I'm
keeping
a
close
eye.
F
H
H
No
sir,
that
was
a
long
explanation
that
that
we
went
through
in
december.
I'm
happy
to
send
you
the
media
briefing
I
did
on
december.
22Nd
has
a
very
long
explanation
of
the
data
lag
and
the
2700
deaths
that
were
identified
through
the
delta
surge
that
were
added
in
late
december,
but
those
were
from
dates
of
death
in
july
and
august.
F
H
H
F
Yeah,
so
I
think
last
time
you
were
here,
you
were
generous
enough
to
answer
this
question
so
now,
with
the
benefit
of
multiple
peaks
behind
us:
multiple
variants,
almost
two
years
of
this
pandemic
behind
us
in
moorhead.
Unfortunately,
what
are
you
or
what
is
the
department
or
the
administration
doing
differently
now
than
you
were
doing
early
on
and
looking
forward?
What
would
you
do
differently?
H
Sure,
that's
a
very
large
question
I'll
try
to
unpack
a
little
bit
of
it.
You
know
in
some
instances
this
answer
may
surprise
you
in
some
instances,
I'm
not
sure
a
whole
lot
has
changed.
That
is
not
to
say
we
haven't
learned
things
or
we
haven't
we're
not
doing
things
better
than
we
used
to,
but
the
same
things
that
we
knew
worked
a
year
ago.
Work
today
and
there's
really
not
a
whole
lot
new
under
the
sun,
when
you're
sick
stay
at
home,
wash
your
hands
get
a
vaccine.
H
H
Physical
health
is
not
the
single
important
thing:
economic,
mental
health,
health
and
welfare
of
children
and
safety
of
children.
There
are
a
lot
of
things
to
consider
other
than
physical
health,
and
I
think
that's
something
that
we've
been
able
to
improve
over
time
and
not
certainly
not
unique
to
tennessee
across
the
nation.
I
think
people
are
seeing
that
yeah.
H
It
pops
up
somewhere
else
and
we're
seeing
that
right
now
and
dr
mcdonald
could
talk
for
an
hour
about
the
mental
health
crisis,
we're
seeing
in
children
and
in
adults
and
and
the
drug
overdoses
and
all
of
the
things
that
we're
seeing.
So
I
think,
if
we've
learned
anything
throughout,
we
as
a
nation
as
a
society
have
learned
that.
Yes,
this
is
a
serious
physical
health
threat.
But
it's
not
the
only
thing
that
matters.
F
I
won't
go
on
that
ramp,
mr,
but
that's
for
another
day,
but
you
raised
an
interesting
point
about
children
and
their
mental
health.
I've
got
three
small
children.
I
watched
what
happened
with
different
age
groups,
because
I've
got
three
different
ages
and
the
impact
that
it
had
on
them,
and
I
made
the
point
last
year
in
a
different
committee,
I
happened
to
serve
an
education
meeting
as
well
that
we're
going
to
see
this
for
years
and
we've
got
to
address
that.
F
I
mean
we're
going
to
see
the
impact
of
on
those
children
and
our
students
in
the
schools
for
years-
and
you
know
it's
another
time
for
another
committee
about
what
we
should
do
to
address,
that
in
our
schools-
and
I
hopefully
that'll
be
discussed
this
year.
But
what
is
what
do
you
think?
Since
you
raised
that
point?
H
B
There's
a
lot
of
work
going
on
in
pediatricians
offices
around
identifying
those
stressors
making
early
referrals
to
community-based
entities
to
relieve
the
stress
on
parents
and
home
situations,
as
well
as
to
treat
mental
health
disorders.
So
you
know
kind
of
a
to
z.
Looking
at
your
aces,
which
we
have
lived
for
the
last
two
years
for
kids
all
the
way
to
treatment
of
conditions,
so
I
think
there's
a
very
cross
cross-cutting
need
there
for
sure.
F
F
You
will
come
to
the
k-12
education
committee
and
and
share
these
same
views
both
of
you,
because
this
is
gonna
be
an
ongoing
discussion
this
year
and
I
think
it's
very
important
and
then
just
finally,
I
think
you've
already
spoken
to
the
vaccination
and
the
importance
of
vaccination,
and
but
I'm
going
to
ask
you
a
question.
I
think
it's
probably
got
an
obvious
answer
or
maybe
more
detail
than
I'm
expecting,
but
to
my
colleagues
point
from
chattanooga.
A
You,
mr
chairman,
thank
you,
we're
coming
up
on
our
time
here
and
we
did
have
a
few
more
questions,
but
before
we
go,
I
did
want
you
to
answer
some
things
that
wasn't
in
your
slides.
As
far
as
covet
19
in
the
report
that
came
out,
did
you
were
you
guys
able
to
discern
any
impact
that
it
has
had
on
the
opioid
crisis?
A
H
One
is
with
all
the
interruptions
and
the
lockdowns
people's
suppliers
and
the
supply
chain
of
their
illicit
drugs
had
to
necessarily
shift
so
they
were
getting
supplies
or
street
drugs
from
places
that
they
typically
didn't
get,
and
the
potency
and
and
the
composition
of
those
were
different,
and
so
you
saw
a
big
spike.
Likewise,
that
was
also
the
time
where
money
was
coming
into
the
pockets
of
of
individual
tennesseans
in
the
form
of
stimulus
payments.
H
So
they
were
flush
with
cash
and
combined
with
the
stresses
of
the
pandemic,
drove
a
lot
of
people
out
to
purchase
street
drugs
that
that
normally,
don't
or
or
in
different
quantities,
and
so
overdose
deaths
really
spiked.
In
those
first
few
months
of
the
pandemic,
since
that
time,
they've
remained
high
and
we're
actually
starting
to
see
some
demographic
shifts
in
drug
overdoses,
but
as
it
pertains
to
tn
together,
they
are
not
by
and
large
prescription
drugs,
they
are
illicit
drugs,
essentially
fentanyl.
In
most
cases,
all
right.