Epidemiology, complex systems, and math in the school of Public Health of michigan. Professor andiate epidemiologist at the university of michigan. I want to start by thanking those of you who have attended these press conferences to get the facts and stay tuned what happening in our state and what we are thinking and sharing information with you. It is crucial to stay informed during this time. Im so proud we live in a state where so many people are choosing to do that and taking the precautions that are contributing to the flattening of the curve and saving lives. I want to thank the members of the press who have been reporting on this pandemic for over six weeks. It is a relentless job. Absolutely critical to keeping people informed. Ive held more than a dozen press conferences on this issue alone. Issued more than 50 executive orders to protect people from the virus. This is truly for an unprecedented time. Are dedicated reporters in michigan to make sure they get the information they need. Todays update on our cases. Have 33,966 positive cases. That is up 999 since yesterday. Michiganders2813 to covid19. That is up 113 since yesterday. Numbers are hard to look at and hard to take, but what they represent is a sign for cautious optimism. They show a vast majority in our state are doing their part. Andal distancing is working michiganders are doing well compared to other states. This is a map based on public data that shows how we are doing with regard to social distancing. We are taking this seriously. The vast majority of people in our state are doing their part. I know it has not been easy, i know it has been difficult for folks in our state, but we are getting through this. We will get through it together. Thank you for doing your part. We have good news. We are testing more people every day. The number of new cases is starting to go down as a percentage of that. We could do twice as much testing as we are currently doing, knowing we have that capacity is heartening. Making sure we have the supplies we need to execute is our challenge. All of the new testing sites i mentioned on monday are opening and ready to test people. Is now in south gate doing business as a testing site. Walgreens has opened a new detroit site. Cvs has opened a dearborn site. I want to thank congresswoman debby dingle for her help and commitment to expanding testing for citizens in dearborn. There are sites open in macomb, shorts creek, kentwood, and saginaw. I encourage you to go to test. Gan. Gov coronavirus more people need to get tested. Eithere have to have prioritize who has tested in the early phases, we want to make sure we are getting more people tested in michigan. Testing is the only way we will know where the virus is so we can appropriately deploy our resources to slow the spread. If you have symptoms and believe you came in contact with somebody who tested positive, find your nearest testing site and get tested. Covid19 symptoms include fever, cough, and shortness of breath. If you have any of these symptoms, call your health care visiter or visit get michigan. Gov coronavirustest to get a testing say near you. If you are an essential worker reporting to work in person, whether you have symptoms or not, get tested. Call your Health Care Provider or visit im doing it for a reason, michigan. Gov coronavirustest to contact a testing site near you. You dont need a prescription to get tested. You dont need a Health Care Provider to refer you. Supplies are still a constraint, all over the country, and we are working to ensure those labs and Health Care Providers have sufficient supplies of Staff Support to support the testing effort. We will continue to need help from the federal government to ensure we have and maintain and continue to have robust testing in place. An update on ppe, the personal protection equipment. A couple of weeks ago, we had less than a days worth in our hospital. With the help of large and Small Businesses in michigan, the federal government and our procurement office, we have secured enough ppe to last hospitals over a week. Even several weeks, in some cases. Dozens of businesses have stepped up. We are really grateful. Businesses like stormy in the Upper Peninsula who produces those phenomenal hats. They are making masks. They are making gowns. The victory automakers making ventilators and face shields. Whiskey,er brewery, tc mammoth distillery, all of whom are helping us produce more hand sanitizer. This has been an all hands on deck effort and it is working. We are rising to this challenge together. We still anticipate more deliveries of ppe and we will continue working until every hospital in michigan has the supplies they need. I want to thank our hospitals and Health Care Workers for doing your best to use ppe efficiently and safely. We appreciate it, and it has helped us get into this position where we are stronger today than we were a couple of weeks ago. The number of patients in the hospital with suspected or of about 10vid19 days ago. We have seen a 15 reduction. In the top no longer five states when it comes to positive cases. We dropped behind other states. Its because of our aggressive actions and measures. States without stayathome orders have seen an increase in cases recently. Shows our order is working. We are still in the top 10. We are still in the top five, in terms of number of deaths. It shows what we are doing is working, but we must keep staying safe if we will keep dropping numbers and saving lives. On mondayore graphs to where we are versus where we could have been. Hadnt taken aggressive action to fight this virus. Their partare doing in making an impact. Youre the reason we have enough ppe for our First Responders. Ourare the reason hospitalization rate is decreasing. In the end, you will be the reason we can safely begin to phase back in to our new normal. I want to highlight the hard work of our brothers and sisters in labor and what they have done through this crisis. Being able to speak with a number of our dedicated Union Members over the phone, i know the heart you are putting in on our behalf. I want to thank the teamsters for delivering ppe and supplies for healthcare workers, First Responders, and family. Uaw for faceank the shields and more. I want to thank the alternate care facilities. And for working on roads projects during this crisis to keep our roads safe for drivers and First Responders. I want to think the ame mie and aft members for educating our students from a distance over zoom, over the phone, through the mail. Ufcw workersnk the making sure the shelves are stocked at our Grocery Stores and helping michiganders put food on the table. To think the Michigan Nurses association for providing Critical Health care and Janitorial Services to protect our families. Healtha you members, care profession, department of corrections, and those working aroundtheclock to process unemployment claims. The frontline workers from the michigan professional firefighters union, the association of police, and all of our incredible First Responders working to keep our families safe. And the laborers working with the Air National Guard and servicing vehicles to keep up the supply chain. The list goes on. Working people built this state. Im proud to have them in our corner protecting families and helping us heal. Today, i outlined several things michigan is doing in our battle against covid19. There are reasons for cautious optimism. We need to keep it up. Im hoping to say more when we can start loosening restrictions as soon as friday of this week. I will continue this conversation and share more information. We will likely need another shortterm extension of the stayathome stay safe order. When we do reengage, it will have to be very thoughtful and precise mitigating risk to all and risk of a second wave. We will start to reengage. We will have a plan, and we will start to share that in more depth as we get closer to next week. Michiganders will still need to stay home unless they are doing things permitted by the order. We have to get this right. Thats the most important thing. As i have talked to business leaders, families, those who have lost a loved one to covid19, we all recognize, even if we might disagree on the we all and the timeline, recognize a second wave would be devastating to our state, to our people, and our economy. We have seen proof loosening restrictions too fast can lead to a second peak. It happened during the flu pandemic of 1918, and its happening in some countries around the world today. As hard as this is, a second wave would be devastating. When i say i am hoping to loosen some restrictions, i mean i will only loosen them based on what the facts and data are telling us when and how it is safe to do so. I will work with the best experts, like the ones we had from the university of michigan and our epidemiologists to make sure we get this right. The data we have seen in the past week has led me to believe it is time to reevaluate the stay home, stay safe order. Directly to speak those who serve our state every single day. They have hard jobs and to show up, and they serve the public. They have a special place in my heart. I had the privilege of serving with the thousands of state employees. I am proud to serve alongside our state employees now as the governor and as we navigate this crisis. You are a crucial part of this team and you have done your part to help protect families in the wake of covid19. Weeks, we have faced an unprecedented challenge that has led to serious budget implications for our state. In order to ensure the essential services we provide every day to the people of michigan continue, i have made the difficult choice to approve a temporary layoff in departments across state government. Employees who have been laid off will retain their Health Insurance and other benefits and will be automatically enrolled into the unemployment process to help ensure they have the help they need during this challenging time. These layoffs will last for 10 workdays. I have made a lot of hard choices in the past six weeks. This was one of the hardest. This is the right thing to do to ensure we can continue providing Critical Services to the people of michigan. I know how important it is for leaders to lead by example, which is why announced i would a pay cut and am telling my executive team to take one, as well. The actions we have taken in the past six weeks are working. Because of the hard work of our state employees, we see the curve start to fly and and we are saving lives. To my fellow state employees, i am proud to serve the state of michigan alongside each of you every day. I monitored to be amongst your ranks. I will do everything i can to make sure you get the support you need during this challenging time. In the coming days, i will share to discuss plans to phase in sectors of our economy. I will work with a Bipartisan Group of midwestern governors to make sure we get this right and avoid a second wave, like we have seen in other countries around the world. You will hear more on this in the coming weeks. Today, you will hear from experts from the university of michigan who have been helping me ensure we take a fact based approach to fighting this virus and saving lives. First, im going to pass it off to my partner, dr. Jenae calderon, our chief medical exec it of. Executive. 33,966y, we announced cases and 2813 deaths. We are proactively fighting this disease using the best Public Health tools we have. Distancing is the most important thing we can do to stop the spread of this disease. It means people not coming out of the house unless they have to. Food, medicine, Critical Infrastructure work. It is working. Cases,r rise in new hospitals who felt the biggest burden and a surge are now leveling off. Discharging more covid19 patients than they are admitting. There are fewer people in intensive care in our hospitals. State mayparts of the see cases of covid19 rise at different times. We are not yet out of the woods. Were closely monitoring the entire state, making sure we are ready for any surge in cases and getting ready to support our hospitals, particularly the ones in rural areas, so they have capacity to be able to care for people if they need to. We have also heard some people are not seeking care for very important medical concerns, such as severe chest pain or difficulty breathing, or delaying diagnostic and treatment procedures for cancer. It is really important that everyone knows they should still seek care if they need it. If you think you are having a medical emergency, please do not delay seeking treatment. Testing and treatment for things like advance Heart Disease and cancer should still move forward. Andt wait for treatment, talk to your doctor about how you can get testing and treatment in the safest way possible. We have also focused a lot on expanding access to testing again, a very important part of our Public Health strategy. We have announced over 21 new cases over the past two weeks. We continue to see arise in the number of tests that are done. We have also expanded our testing criteria. Right now, anyone who has symptoms can get a test. Anyone who is a health care worker, first responder, or needing to come out of their home to do any work during this crisis, can get a test done at a testing site that has the supplies. We are encouraging everyone who should get a test to get one. You can go to our website, www. Tohigan. Gov coronavirustest find the site nearest you. We have to protect our most vulnerable, especially those who are elderly and living in nursing facilities across the state. Monday, we announced Skilled Nursing facilities are required to report any case of covid19 to the Michigan Department of health and Human Services. We are analyzing and collecting that data now. We expect to share that information with the public on our website in the coming days. Monday, we also announced the creation of new teams that will work with local Health Department staff, epidemiologists, and clinicians, longterm care facilities, making sure they are following the best prevention protocols and testing residents appropriately for the disease. Im pleased to announce we can provide a total of 3. 8 million to our local Health Department across the state to be able to do this important work. We are all doing the right thing. We are seeing a slowing in cases, testing is increasing, and people are recovering from the disease. We can beat this virus. Life is not going to go back to exactly the way it was before for a while. We will have to be patient and cautious. I encourage everyone to stay the course. We can do it together. I will turn it over to dr. Eisenberg and dr. Martin. Thank you. Id like to start by introducing myself. I am an associate professor of epidemiology, complex systems in math at the school of Public Health university of michigan. Im here with dr. Martin, an assistant professor of epidemiology. Our Modeling Team is a combination of researchers in Public Health, medicine, math, and other folks, other departments. I wanted to talk about some of the modeling we have in working on. Looking at different scenarios for resurgence, if social distancing is lifted. We have developed this model based on regional and statewide data from michigan to help with forecasting, planning, and scenarios. I wanted to start a little bit by saying all models have limitations. Nd models are a very useful tool for reasoning and planning, but they are not crystal balls. I want to note and acknowledge at the forefront that there is a lot of uncertainty that goes into these models, both in the data and the parameters and how they are built. I wanted to mention that briefly. With that, i wanted to show a couple of things. Heres some hypothetical scenarios where social distancing is lifted over a two week period starting may 1. This scenario is lifted completely by the time that two weeks is up. There are a wide range of outcomes. Going from a very small or even no resurgence up to quite a large second peak in transmission. While we cant say from the model which of this shaded range of scenarios might happen, it just means a secondit means thaa real possibility that we need to consider if social distancing is lifted. This range of outcomes really comes from the fact that theres a lot of uncertainty right now in terms of the proportion of the population that is susceptible or immune to the disease. So that ends up meaning that a wide range of potential scenarios for a second peak are consistent with the data we have seen so far. Note for important to these simulations that, while i showed the graphic for all of michigan, if you run the models for different regional areas, you get a lot of different potential second peaks or resurgence is that you can see region by region. In southeast michigan, and places that have seen more cases, we have more data and it lets us do better at restricting the range of what could happen. In areas that have not seen as many cases so far or where the epidemic started later and may still be increasing, we have less data. It ends up meaning that the range of potential second peaks is wider. That is just something to be aware of. It means that those regions may be more careful monitoring. Theres a lot of uncertainty in terms of what could happen. The other thing i want to note about these simulations is that we are running the models where you relax social distancing entirely and leave it off. That means that the simulations that we are showing, the second peaks are in the circumstance where you dont intervene further. Of course in reality, if you started to see Something Like that, people would take action and intervene. Im not saying that that is what we would actually see. Thats just what the model projects forward if you were to release social distancing and let it go. That is one thing to note. Is that, piece to note as we move forward and get more data and s testing continues to ramp up, we will have more information and we will be better able to see what scenario we are in. We t happens and as three engagement starts, projections will tighten. Theof this is to underscore point that it is really important to think about staged the engagement and to do careful monitoring so we can track and handle any increases in epidemic spread that might happen. That brings me to the last point which is about the kinds of indicators that will be important to monitor as we start to think about reengagement. The first here tier are the epidemic spread indicators. These are things like symptom , andoring, cases, deaths trying to get a regional picture of transmission. Different parts of the state have different epidemic patterns going on. The second here is Health Care System capacity. This is emphasizing that, if you are to have a resurgence, it becomes important to major that you have the Health Care System capacity in place to handle that and be able to diagnose and treat patients. So this is really all about personnel, beds, ventilators, personal protective equipment, those kinds of things. The last one which is really critical is Public Health capacity. This is making sure that we have both the Testing Capacity and the Contact Tracing capacity to be able to detect resurgence in epidemic spread if it should happen. That is everything i wanted to talk about. Thank you. I appreciate it. Thank you for being here. I think that it is important to have the opportunity for my friends from the press to ask questions. That, happy to open it up. Yesterday, you canceled a contract for Contact Tracing. Do you know who made that decision, to contract with those companies . How do you expect to restore public trust in Contact Tracing, considering this . Contact tracing is a critical component to ensuring that we understand where spread is, that we isolate the appropriate people so we avoid a second point. Wave. The effort to go forward with Contact Tracing is something we take very seriously. With regard to this contract, the department thought that vendor was the best one for some reason. I know that the department of health and Human Services does not have a political bone in her body. They moved forward with the vendor. They should have gone through the sclc, the state of Emergency Operation center. It is the clearinghouse for all of this work. When it was brought to my attention, it i told them to cancel it. It was an unnecessary distraction. Leadership is about solving problems. The correct process was not followed. We are fixing it because it is important we get this right. This work is incredibly important. So this is an essential part of how we will save lives and start to reboot the economy. I made that decision. Were moving forward. We theat appropriate people understand the flaw and that will not be repeated. Need amentioned we will shortterm extension of the stayathome order. Do you have a window updates you are looking at for that extension . Willoughby statewide or based on region . Look are going to have to at the process every engaging sectors of our economy. The Trump Administration likes to call them faces. Some people refer to them as stages. I like the thought of waves. Maybe it is the water. Everything is about water here in michigan. The great lakes. Regardless, it will not happen overnight. We know that there will be a need for an extension of some sort. Even when we get to a stable moment, people who are compromised, vulnerable to covid19 are still going to need to stay home. Some version will be in effect for a while. Is thatknow right now we are seeing a trend where our numbers look pretty good. We know that we still need to do more robust testing. Once we get our hands on swabs and reagents, we can double or triple the amount we are conducting in michigan. That will be essential. And know thatigns we can start to take some small steps forward. I will articulate that with more clarity when we return on friday for the briefing. I think that now is the appropriate time to reassess the breadth of the current stayathome order to assess the scope of what the next one might look like. Im as eager as anyone to start reengaging sectors of our economy. We all know we have to be really smart about what that looks like. It will be in waves. There will be some form of a stayathome order in effect for a long time. When i say that, everyone will speculate what that means. It simply means that for the near future, we know that its not going to be safe from honorable populations for vulnerable populations to be out and about. People who have copd, over the age of 65 are going to have to continue to stay at home. The vast majority of people. Daysll loosen that up as get closer and as time goes on. We know that the chat feature on the unemployment website is down for the rest of the week. People have had issues getting through, making phone calls, getting online. You mentioned that state employees will be automatically enrolled in the unemployment system. Is that fair for the people who have been waiting for weeks without a paycheck . What about those people who cant get through . It doesnt mean that they jump the queue. It means that they wont have to go out of their way to sign up. We are asking the sacrifice of our state employees we want to take that as one stressor off of their plate is they are ,rying to figure out next steps the action we had to take now. Unemployment, around 825 million in payments have gone out. Thats more than 800,000 claimants that have been affected by covid19. Those numbers are continuing to increase every single day. Weve gotten over one million unemployment claims since march 15. Thats a quarter of our state workforce and nearly 5000 increase over that fourweek pe riod. More than 90 of people filing online. It only takes 25 minutes to do so. We are encouraging people to continue doing that. Steps,avigate our next thatssage to everyone is we continue to navigate the process. You will get paid what is due. What you have earned and unemployment. You will get penalized for lateness. We will continue to ramp up our efforts. Weve made Great Strides but its not perfect. The department is working toward getting there. Anything less means we have work to do. We recognize that. A automakers have expressed desire to 25 capacity by may 4. Have executives contacted you to ask for that . Are you open to that possibility . Ive been talking with the heads of the big three. Uaw,iers, the head of the conversations with each of the ceos of the big three just today. I talked with the head of the uaw today. I know that there are a lot of pieces to the discussion that they are having. I am monitoring it to know what their protocols are. The Economic Recovery Group that is helping to it five my work, that is also being scored by the university of michigan for risk area risk. I understand that they have some issues to work through. At the appropriate time, im hopeful that we could analyze what the protocols are and start to engage in a safe manner. Im very close to the conversations that are being had. Were taking it very seriously and trying to make sure that workers will be safe if and when certain parts of the business start to reengage. Many times that this virus doesnt observe county lines. Youve also talked about a regional reopening approach. How do you reconcile those statements . That areve regions contenders for eventual reopening . We cant make the assumption that just because part of our state has not seen covid19 when it was really growing so exponentially in detroit, that it meant that those parts of the state were immune. As i work with my colleagues from wisconsin and indiana and states, that we have to understand what their thought processes are two major we are staring data. We are all smarter as we make these decisions. We also recognize that we are watching trends as they play out regionally across the state of michigan. Onew of the slides i showed monday showed that the southeast michigan part of the state has started to cool down. Yet there are places in rural michigan that are heating up that we are watching very closely. What we know about if we are county at alpena or kent which is not room michigan. It is the west side of the state. It has not been as concerning a southeast michigan. While they have got plans and we are working closely with them, as this fire is continues to spread, not each of those other places are as well equipped as kent county is if they covid19 a covid19 spark starts to happen. As we determine and associate risk with various sectors of our economy, we also associate geography as a part of that risk analysis. Thats a part of the determination about where we need to mitigate risk and where we need to be mindful about the sequencing of different sectors of our economy starting to reengage. Any questions for the epidemiologist . I dont know if they will know the answer to budget questions. How confident are you that there wont be more layoffs coming for state employees . The budget shortfall is estimated to be 2. 5 billion. The layoffs are about 5 million. Is that enough . What else can the state to . Are you confident that we will get enough money from the federal government to offset this . This crisis has taken an economic toll on household budgets, local government budgets, the state budget, business budgets. We are all going to have to navigate this to the best of our ability and protect as many people in the process. The federal kazakh dollars care act dollars have a lot of restrictions. They do not meet the eu needs of issues we will feel. That being said, continuing to work with our bipartisan congressional delegation to ensure that the next supplemental they are talking about another one. Recognizing the incredible strain on state budgets and gives us the flexibility we need to really make sure that we shore up the Core Functions of state government. I think about our children who will be going, hopefully, back to school in the fall in a traditional sense. And who will need wraparound support to make up for the challenges that they have confronted as a result of covid19. We need to have the flexibility to do right by them and their teachers and all the educators in our schools. On our watch will have an impact on the budget issues we have in the current fiscal year which ends in september. Or the next budget year that against them. Begins then. We will have to make tough decisions. Obviously, these layoffs dont fix the problem. It is important to show that we are serious about tightening our belts where we can in a way that does not undermine the critical work that we still have to do in this moment. Returning to the Contact Tracing contact contract. Securing a new vendor for that, how much will that delayed the efforts . Considering the efforts that your administration has placed on that tool in particular. Every administration in the nation. Thats really important to our ability to mitigate the potential second wave and to protect lives. Make an announcement when a contract has been awarded. They are moving posthaste. This is something that came to my attention recently. I took the action and now we are moving forward quickly to try to make sure that weve got a vendor that can do the job and well and ramp up quickly. Do you know how much data that other contractor had access to prior to termination of that contract . I will have to followup with you on that. I dont believe that much had gotten started it all, frankly. Im glad it came to my attention as early as it did. As i said, the department is not political. What outfitking at they thought could do the job well. I know that its important to take out any speculation, any concern. I think it was appropriate to cancel it. Thats what i did. We will move forward. Place to makeiate the determination, they will make an announcement. A question for the epidemiologists. What the governor mentioned on monday that we had the capacity to do over 11,000 test but were limited based on the number of reagents and swaps available. What level of testing realistically do we need to be at to start considering these waves of reopening . I will start. Think, based on talking to experts, that we need to get to 15,000 test in the state to be able to really get a good understanding of who has the disease. Theres a lot of reasons we are thinking through those as to why we are not at the capacity. Reagents, swabs. Weve increased testing significantly in the past week. Part of that has been extending expanding our criteria. People with mild symptoms are people who dont have any symptoms at all, healthcare workers, frontline workers. We will be able to expand our capacity as quickly as possible. Weve heard that we will start to see more data reported from Nursing Homes and facilities across the state. When specifically will we see that information . How is the state providing any guidance on pbe for those employees and people inside the facilities as well as keeping patients that are currently healthy, healthy and separate . You are actually right. Theres a couple things that are incredibly reporting to this in spot report incredibly important for this response. It is wanting to be as transparent as possible with the data. Our systems, our Public Health data systems are outdated. They have not been funded. This is throughout the entire country. Oftentimes we want to do something but the system doesnt allow us to do it. By nexto be able week, we will have accurate data. I dont want to put anything out there that is wrong. We are working through that. We expect to be able to do that next week. As far as making sure our nursing facilities are doing the right thing, that is the concept behind the. Capacity. N more we help the city of detroit get an epidemiology aid to be able to do that. Will continue to work to expand capacity and make sure these nursing facilities have the support that they need. Will we see the names of the facilities released from the state that have covid19 confirmed cases . Thats our goal. Reporting information daily as a whole, the numbers are fluctuating as time goes on. Is that a transparency issue . Can people trust the information that the state is putting out each day . Great question. Some of these Systems People are putting things in automatically. Others are doing it manually. We figured out there are some labs that weight to send us test and they dont have workers on the weekend so they dont send us anything over the weekend. All of a sudden, we have an increase on a monday. We want to be transparent. Things may fluctuate. Data may change. We want to get the data out that we can as quickly as we can. Thank you. Journal,s washington live every day with news and policy issues that impact you. Coming up thursday morning, we look at the u. S. Response to the covid19 pandemic with assistant professor of epidemiology at the yield school of Public Health. The federal response to coronavirus with Washington Examiner senior commentary writer tim carney and tennessee democratic punishment steve on the impact of the coronavirus in his district and recent relief legislation into congress. Be sure to watch cspans washington journal, live at 7 00 eastern thursday morning. Join the discussion. For the first time in four weeks, the u. S. House meets for legislative work thursday to debate and vote on nearly 500 billion more for coronavirus pandemic response. This fourth round of funding would go to the Small Business loan program, hospitals, and virus testing. Watch live coverage of the house beginning at 10 00 eastern on cspan. New Jersey Governor Phil Murphy says there needs to be a steady decline in the number of coronavirus cases before the state considers implementing a strategy to reopen the economy. He also announced the signing of legislation that requires hospital