However, we are experiencing a marked increase in Community Spread, based on the most recent community transmission. As stated previously, we are our mission extends beyond physical health. We are surveying the other arms of our mission, working to provide food adequacy, rental and mortgage assistance, as well as expanded Mental Health the endemic address of social aggravation that comes social isolation that has, as a result of this virus. We have honored to serve thousands of families through our Community Health organization, care connect. And while we honor our past and our community mission, we have developed Innovative Technology to help businesses reopen safely, and worked actively to support the wellbeing of our local employers and their workforce. The bedrock of a healthy eat Healthy Community requires a vibrant economy. As i close, i want to emphasize we are experiencing Community Spread here in st. Johns county. We encourage everyone to wear masks and practice social distancing recommendations. Recently, we have seen some Health Systems that have had to postpone elective procedures to , ensure they have adequate resources to meet the demands of the virus. Gratefully, we are not at that point in st. Johns county. And we are starting to see that we have hit the apex. We are ever vigilant of this very fluid situation, both at an institutional level, as well as the broader community. Are a Community Health system we remain acutely aware , of our responsibility to make prudent decisions to ensure we meet the needs of our community. I would like to thank the governor for empowering us as Health Care Providers to make these critical decisions for the communities we serve. Thank you, governor. Gov. Desantis great. Do we want to go to dr. Machado . I want to concentrate on the fact that even though we are taking care of the Covid Patients, we are also taking care of the whole community. Are a Community Hospital and have the responsibility of taking care of every patient in. His county so i want to make sure Everybody Knows out there that we continue to serve every patient that comes to the hospital. 32 patientse have that are positive. Shower that nsus is almost 200. So we have 170 patients here for other causes. And our Community Needs to know that we are ready and able to serve them. A lot has been said about ventilators and how ventilators, at the beginning, you know, in new york, we used to hear about ventilators all the time. Well it turns out, of the 32 , patients we have, only seven are on ventilators. So our capacity for ventilators is great but we need to be , careful. We need to follow the guidance of the governor. We need to wear masks. We need to self distance. We need to wash our hands. That stays in place, and it is extremely important for all of us, and for our community. I want to thank the governor, not only for coming to the hospital, but also for being so informed and having so much information about our county and the people that we serve. Thank you, sir. Gov. Desantis thank you. We also have dr. Javier aduen, a Critical Care specialist here at Flagler Health. Dr. Aduen thank you, sir. , we need tondpoint these have been difficult times, but the way the patients have been handled so far has been satisfactory. To isolate Covid Patients from nonCovid Patients, therefore, we have been able to take care of both populations. From a medical standpoint, we have had the opportunity to provide the patient with a care that is good for the patient, particularly talking about covid19 patients. There are three treatments that are unique and have shown Better Outcomes for patients. Remdesivir, plasma, dexamethasone, plasma, and for those patients who require oxygen, we have been able to provide for those patients. So we have felt the support from the administration that nothing has been denied to us to take care of the patients. The result is that our mortality is way below the mortality in everywhere else. Gov. Desantis thank you. I think it should be said, i fatality said the case rate is, what,. 66 . But when you calculate that, we only capture a certain number of infections. There are obviously way more people that have an infection. So an infection fatality rate would be the fatalities divided by the estimated infections, which may mean that that is even lower, and i think that is a testament to, get up, the great work that you guys have been doing. Can you talk about the evolution of how these patients have been handled . I know you did not have as many in march and april as you have seen recently, but before people were doing plasma, before people were doing the remdesivir, if someone came in in late march, what was the protocol, and how has that involved . Dr. Aduen we have two different waves. At the beginning, we have the high wave. And we were fortunate. But after that, we have a decrease in the numbers, until two weeks ago, that we have a new surge. But the important thing for us is that, even that we were having a significant number of patients, still, the mortality 1 somained less than , down for us. At the beginning, we did not feel the high mortality that we did not have. Now, the other thing that i would like to take the opportunity, because you mentioned that, when we are talking about treatment, it is important to understand that the remdesivir and dexamethasone depend on the laboratories to make them. The convalescent plasma depends on the community, because that is the plasma patients obtain is from patients who have fully recovered from a current covid19 infection, so therefore the supply of the plasma will depend on the amount of patients that recover from covid19. Gov. Desantis what is the supply looking like right now for convalescent plasma . Dr. Aduen it is a very important point, because what the study has shown is that convalescent plasma, the potential, the beneficial effect is actually better when it is even in the early stages. So although we have it, sometimes there is a delay of a few days. Gov. Desantis now, if somebody wants to give, can they come to the hospital to give, or is it all through blood banks . Dr. Aduen Flagler Health has a blood bank. There is a link. Gov. Desantis people know that there are different entities that do the blood donations, but if they go to, like, your website, there will be something . Dr. Aduen correct. Gov. Desantis the steroid, you use all three, the convalescent plasma, the steroid, the dexamethasone dr. Aduen the dexamethasone is only for those patients who need oxygen, either on a vent. Studies have shown that mortality improves when we use that. Gov. Desantis and you were not using that in march . Dr. Aduen it is amazing, because there has been an evolving in the dynamic process. At the beginning, they were all saying it was not a good idea, then the next week, it was a good idea, and then finally a study came from europe, from england, that what the biggest studies show there wasnt a beneficial effect, that is what made the change. Gov. Desantis yep. All right, dr. Machado, i had that there was a beneficial effect, that is what made the change. Gov. Desantis yep. All right, dr. Machado, i had mentioned it, and we talked about it earlier, did you guys see a decline in visits for heart and stroke in march and april, like we saw through the rest of the state . And if so, or even if not, are some of the patients you are seeing now for things other than covid more critical because they are not seeking the care for things that could have potentially helped . Dr. Machado absolutely. What happened was all of a sudden, we were looking at each other and saying, what is so happening . Where are the stroke patients . Where are the cardiac patients . How come we are not seeing them in the emergency room . Well, a lot of people were having symptoms, they were just scared to come to the hospital. So all of a sudden we opened the surgeries, the elective procedures, and then we see an influx of patients coming into be tested and to be treated. And at this point, we are back to normal, but, yes, we did see an influx of patients coming back, i suppose you could say. Right now, we are full throttle with all of our cardiac procedures, all our interventional radiology. We are doing approximately 70 cases of elective surgery between our Surgery Department and our surgery center. So we are pretty much back to normal. The only thing that is not back to normal at this point is the visits to the emergency room. We are still seeing people scared of coming to the emergency room, which should not happen. I mean, we have a system that has now proven itself for the past five months, that we are able to keep patients separate, and we can treat safely the patients that need it. Gov. Desantis yeah, and i would just reiterate, the fear factor is a really, really, i think, negative influence on just the community, not just dealing with the virus, but just thriving as a community, having society function well. But when you have folks that still are fearful of coming to the hospital for chest pains or something, look, they take this is one of the safest places you can be. I mean, of course they are taking all kinds of efforts to make sure corona patients are appropriately isolated. They understand that, and probably better than ever. And these conditions are not going to get better if you do not seek the care. And i do not think we are going to know immediately, but eventually, we will be able to figure out that mortality increase linked to people being fearful from getting care. You know, as important as the coronavirus is, if you look at the number of people who die from heart every year, it is very, very significant. So by not getting care, the mortality will, unfortunately, likely increase there, and that is a big, big problem. I think what flagler is showing is, you know, they are dealing with the corona cases as they are coming in. It is an important part of what they do, but as dr. Machado said, most of the people in the hospital are not in the hospital because of coronavirus, they are dealing with all kinds of things, and the Mission Continues with all those patients. And im glad these elective procedures, we put those back at the beginning of march. It was recommended that they be delayed. You know, i do not think that was a terribly effective policy. That was recommended by the cdc. The fact of the matter is, they know how to manage their operations. So to say you cant do this procedure, well, when that happened, by mid april, the hospitals were halfempty. So just because it is elective, it may mean you can schedule a different time, but these are things that need to be done as well. So they are continuing to do it. They have the ppe that they need. If they see a change in the covid census, then they can make appropriate changes here on the ground level, but that is a much better approach than kind of a hamfisted prohibition that was really, well, had been put in place nationwide, i think, and you do see some other areas, other parts of the state that have had more traffic in terms of Covid Patients in the hospitals. They have made different decisions and some of the , systems in florida, they had Covid Patients, but their overall census has remained the same over the last 30 days, that is how you manage all of this. But it is really important that the hospitals have the ability to meet the needs of the community, and i think you guys are doing a good job here. Do you have because ive number in march, just getting an n95 mask was a huge thing. The testing kits and everything, i was literally on the phone, like, the third week of march i remember, with my emergency manager, and i would talk to the ceos of hospitals, and i would say orlando needs 100 swabs, they need this, they need that, they were in such short supply, we need masks here, we need this. It seems like, from everyone i talked to, the ppe situation is much better than the supply, the supply lines are really fluid. Are you guys in a good spot with both the testing and ppe . Mr. Barrett the testing and the ppe, the issue continues to be , and the access to remdesivir, the staffing, as you mentioned, but from the standpoint of ppe resources, we have more than adequate supply. Dr. Machado we have, on a daily basis, we have incidents at 8 00 in the morning. That is one of the things we look at constantly, on hourbyhour basis. But our staff has been incredible, and, you know, ordering, making sure that we have everything we need, it has been now five months of being on top of it, and we plan to stay that way for a while longer. But so far, we have been able to take care of our patients. Gov. Desantis i know it is really, really important. I would also just like to say, earlier this week, the first lady and i were down in tampa, talking about Mental Health, because when you have a situation like this, you obviously, ive talked about the angst and the fear that a lot of people have felt, and part of that is concerned about what the virus may do. But quite frankly, we found that for a lot of people, it is concerned about some of the fallout that has happened, with some of the changes that have happened to our country since march. People concerned about making ends meet, putting food on the table, what is going to happen with their kids . What is going to happen with school . All of these very pressing things that really do weigh on a lot of people, and we cant forget that that is a huge part of what we are dealing with right now. And one of the things that has been tough, and i dont know what your policy is, but, you know, i know for a while, most of the hospitals were not allowing visitors. Where are you guys on that . Are you still not doing that . Mr. Barrett we are still restricting visitation at this point. And the challenge to covid, for those who are acutely ill, this is a very isolating virus. And we have made concerted efforts to make sure we engage the family members through technology. Now, of course, for extenuating four extenuating circumstances like a delivery or someone, you know, is terminal, we certainly make exceptions for folks. Because, you know, but i say one of the greatest casualties of this virus is isolation, and from the standpoint of what we have seen in terms of incidents, in terms of telehealth, Mental Health services, we have seen doubledigit increases dealing with concerns around social isolation. Desantis yeah, i think it has gov. Desantis yeah, i think it has been hard on a lot of families to have one of their loved ones and hospitals, and not just for corona but for other things, and then not be able to be there under certain circumstances. Those are, you know, really critical moments in life, and that has been a huge, huge negative affect of this. Another thing that we have seen is, very early on in the process, i think it was the middle of march, in the state of florida, we restricted visitation to our longterm care facilities. And the reason we did that was because, you know, we saw that this virus had a disproportionate impact on folks who were elderly, particularly those who had one or more comorbidities. And we were concerned about traffic in and out of there, bringing the virus in, and that that would lead to major outbreaks. Of course we also instituted mandatory screening of all the staff. Ff to wearquired the staff to ppe, and then we shipped, the state shipped huge amounts of ppe to all of our longterm care facilities, and then we have tested the resident and the staff, and now we do periodic testing of the staff to try to identify infections before they can bring it in there. So there has been a lot done to protect the vulnerable from having the virus go in, but we have to acknowledge, and i have certainly done it, that that is coming at a huge price. Because when you dont allow visitation and obviously the reason is because you cannot be sure if someone is going to come in, and they may spread it, but when you are not allowing visitation, that takes a huge, huge toll. And yes, the state has done stuff, the facilities have done stuff, to connect with technology the best that you can, but that is not a substitute for that inperson interaction. We had a story in northeast florida that was recently, you know, in the newspaper about mary daniel. Her husband is at a memory care center, and obviously the visitation is limited. And she was understandably, you know, very interested and very insistent on figuring out a way to be able to see her husband. So what she did was take a job as a dishwasher at that health care center, so she is screened just like every other staff member is, but then she is able to see her husband again. So that is an example of resilience in a face of a very difficult situation, and i just want people to know that i am sensitive to those. When we do a policy like the visitation, you know, ban on visitation, trust me, i know that that is not costfree, and if i could lift that tomorrow without fearing negative consequences, you know, we would do that and we look forward to a day when we can do that. But in the meantime, i think people like mary are finding ways to connect with their loved ones, and that is a really, really great thing. With that, i will take some questions. Governor, do you have a timetable of when you can see bards allowed to open back up again . Gov. Desantis no timetable. I think we are focusing on, you know, what we are trying to do right here. Like i said, i think people have responded very positively over the last couple of weeks, and that hopefully will be apparent in some of the numbers we will see going forward. But this is always a fluid process. Theres a lot of different issues at stake, and so we are we have got a task at hand, and that is what we will keep doing. You were talking about the preventative measures authorities can take. I did not hear anyone say anything about wearing a mask. Is there anything that would change her mind about a mask mandate in florida . Are you taking cues white now from the white house . Gov. Desantis no, i am not involved at all. So we put out at the end of april, when we did our phase 1, we advised that folks wear facial covering, particularly when they cannot socially distance. We also advised Senior Citizens to limit contact outside of the home, to avoid crowds, and then we also advised limiting large groups. Those are advisory. Those are not punitive. And i think if you look, we have, in most of the places that have most of the cases, like miamidade and broward, they have had compulsory mandates in place since april, so that has actually been in place. But we are doing advisory, and, you know, and we are not going to be prosecuting people. I have another question about saint augustine. We saw overnight representative john lewis passed away. He was a civil rights hero. There is a conversation in this country about race, monuments and flags. There is a monument downtown in San Augustine that was removed from the plaza downtown, a memorial to a confederate gov. Desantis i appreciate the question, but we are trying to focus on the coronavirus. I appreciate it. But i am going to let someone ask do you have a question about the topic at hand . Joe yes. You mentioned earlier on about some information that is floating around that is not in the proper context. Can you expound a little bit . Gov. Desantis i think, you know, for example, i think it was a week ago, it was like florida has recordshattering , cases, which is true. That was the most cases. That was 15,000. But i do not think the headline said that was out of 144,000 test results. So the percentage is a little higher than where we were in where we were in may and early june, obviously we would like to be 5 or less. But had some of the states that were having massive outbreaks test at 144,000 at the height of theirs, they would have had 50,000, 60,000, 70,000, so i think it is important to put that in context. Because a lot of people, when they see cases, they get really, really scared. My message is, fear is our enemy. And lets understand, there are obviously things that floridians are doing, that we are doing, whether it is working with hospitals and other stuff. But there is that and the other , thing that gets missed with the cases is the sheer number of people who are testing who are not sick. Because i think most people see, you know, cases, and they think that that many people are in the hospital or are going to go. , and the way this disease is, particularlyely, for people who are under 60, either asymptomatic or minimally symptomatic. And we are capturing a lot of those folks. When we were doing this in march, as many of our sites, you had to be symptomatic, and you had to be 65 or older when we first rolled out our drivethrough testing sites. And so, in late march, i mean, we were getting 1000, 1300 cases a day, out of maybe 7000 test that were administered. Part of the reason we did it that way is because we were concerned, or just were limited in that there was not a lot of , testing compared to what we have now. So i think that just with cases, people should just put it in the context. You know, you look and see, it seems like the u. S. Has more cases now than i did in march or april, not just including florida, but the whole country. But if they were testing like we are now, in march and april, it would have been way, way more throughout the country. So that is just something that i think people should understand, put it in the proper context. But the idea that, you know, when we are testing 100,000 people a day, and the majority of the positive tests are people who were either asymptomatic or minimally symptomatic, that is something that is important for people to know. Joe a lot of people are wondering about the recovery, the recovery numbers. Can you speak to why the department of health is not releasing gov. Desantis i do not think it is that they are not releasing. It is just that not all states have done that, and they just havent been doing that. I think that the view is basically, you know, you look at , the cases, you have a case for rate, so inlity florida, i think ours is about 1. 5 . Nationwide, i think is about 4 . So you do the deduction that the folks, you know, once they get a certain part, they kind of clear the illness. I know texas is. I know another one is. And i kind of wish we would do that, but that is just not something they have done from the very beginning, but i do think that is important to point out to people. I mean, you guys have somebody in the hospital and you give them treatment and you discharge them, you know, they are likely recovered at that point, or they certainly will. Most of the people who probably test positive at your walkup site here, you send them home and tell them to isolate, and then they recover. So that is a good thing for people to know, that people do clear the illness, and, you know, obviously have the ability to donate convalescent plasma to be able to help folks who may be suffering more. That is another issue with just kind of our what we have seen since our testing really started to go up in terms of the number of positives, the Positivity Rate, is the huge number of ands between the ages of 20 44. And that is obviously a very lowrisk group. If you look at the case fatality rate, it is really small. If you take out comorbidity, it would probably be close to zero. But they test at a higher rate. 2030, thereat Positivity Rate for, i think the , whole pandemic, is close to 17 , whereas the Senior Citizens, they are at single digits. That matters. I would say from a clinical perspective, the number of cases are not as important as where they are following on the spectrum. In other words if you had 1000 , cases for people in their 20s, that is probably going to have less clinical impact than if you had 100 cases at a longterm care facility. Joe i have one more quick thing. And i am joe mclean with news for jacksonville, by the way. Can you quickly comment on the letter that your office received on the florida chapter of American Academy on pediatrics . I believe the letter was sent last thursday, and it speaks about School Reopening and the aap. Chapter of the are you were you able gov. Desantis i have not had a chance to review it yet, but i know that the general view of pediatricians that kids should be in school could obviously, there is a lot that goes along with that, but particularly, i would say the Primary School kids. But if you look at that, the evidence in terms of we obviously know for the illness, but their transmissibility, there is very little transmissibility from the Primary School to adults. Which, when we talk about kids safety, that is paramount, but you have adults, teachers, people who work in the cafeteria, all of this other stuff. What risk would they be . And i think it is pretty clear from all the studies that have been done, particularly in europe, if you are somebody who is an adult in a Primary School, the chance of you getting infected is almost entirely from another adult, rather than from one of the younger kids. So i think that is something we are going to do. But im going to be doing a lot more personally getting involved , just to help some of the school districts. Because we have different parts of the state that are dealing with a different type of epidemic. And so you look at, like, a miamidade versus a st. Johns county, that is a big difference in terms of what you are seeing. I think the one thing that is really important is, you know, parents should be able to make the decision that is best for their kid. So if they believe their child would be better off doing Distance Learning, if they are not comfortable with her kid going back to a School Setting, i think they should have a right to make that choice. But i also think that theres a lot of parents who have seen regression in academics and have seen their kids miss some of the great things about being in school who want to have that back. Ity to get them and i know, i think the vast majority of folks really want to see, you know, kids prosper. And we just have to look at this honestly, in terms of their best interest. If the Distance Learning just as good, i mean, i would acknowledge that. We take pride in our distancelearning in florida. We put a lot of effort into it. A lot of the states, when we went to distance in march, they were calling our Education Minister saying how did you do , this . So they fall behind. I mean, that is just the reality of the situation. So we have got to be cognizant of some of the harm. I mean, i have seen some stories across the country in some major areas, where, you know, you have 30 to 40 of the kids did not even log on or have not logged on, and im just thinking, wow, that is going to be something that society is going to be dealing with for a long time. So i think just approaching it by saying, what are the bona fide risks of having the kids in school . Fortunately, the risk from the virus to their health is minimal more minimal than seasonable , influenza. What role do they play in transmission . I think almost certainly, the younger kids play almost zero role in transmission. I know you have seen maybe some high school. I think that would be something you would look at, but i think that is pretty clear. How would you have an environment that protects adults . And from our very beginning, from when we announced phase 1 in april, every employer has to make accommodations for folks who may be at risk from corona. So whether that is age, whether that is for Health Status and that would apply, obviously, in a School Setting as well. Of course you do that. Thatact of the matter is, statistics we see every day show us 65 and up, 85 of the covid related fatalities in florida and across the country, when you are in the 40, 50, under 65 in that 40 and 50, it is usually linked to one or more significant comorbidities. So taking that into account, of course, it is something that you should do. So i just think it is a really important issue. I am a huge believer in just giving parents a choice. But i do think that they should be reassured on this. Comese when a novel virus , it is a fear of the unknown. It is a natural human response. But i can tell you, having dealt with this every day since february, and looked at the data in u. S. , florida, across the world, and as the father of three young kids, i do not fear this virus effect on my kids. I think the risk is incredibly low. I fear way more things in terms of their health and safety, but i would not have any problem having them in school. They are not schoolaged, but if they were, i would absolutely do that, and i think it would be safe for them. And that is just as somebody who has looked at this and looked at this and looked at this. And the one thing, i mean, the spanish flu, you know, you would have kids, you would have soldiers who were very healthy, it could just knock people out. Hell, h1n1, if you look at that compared to corona, much more. Kids bore the brunt of it. So for whatever reason, it has tended to not have the greatest impact on our kids. And i think that is in spite of being a very difficult situation, a very harmful virus to some groups. That is something that some parents should have a sigh of relief on, because i think some of the other pathogens we have seen have targeted kids more acutely. Thank you. [indistinct conversations] governor, do you want to comment on the statues at all . Sure. Yes. [indistinct conversations] cspan has unfiltered coverage of congress, the white house, the Supreme Court and Public Policy events. You can watch all of cspans Public Affairs programming on television, online, or listen on our free radio app, and to be part of the National Conversation through cspans daily washington journal program, or through our social media feeds. Cspan, created by americas Television CableTelevision Companies as a Public Service and brought to you today by your television provider. The house and Senate Return to legislative business before the august recess. On monday and tuesday, the house takes up the fiscal year 2021 National Defense authorization act. The bill establishes policies for Defense Department programs. Votes are expected early on monday. Wednesday, the house will consider a bill to remove the justicecheese chief roger b tawney, the author of the 1854 dred scott ruling, and address statues on to play on display in the u. S. Capitol. The Senate Discusses director of the office of management and budget and the Senate Continues work on the 2021 defenseillion authorization act. Watch live coverage of the house on cspan, live coverage of the senate on cspan2, watch any time on cspan. Org or listen on the go the free cspan radio app. Watch our live, daily, unfiltered coverage of congress, the white house, our countries are linked by trade and travel. On issues that matter to you, our Ongoing Mission to save lives and meet the needs of our health care workers. On theg with briefings coronavirus pandemic, Supreme Court arguments and decisions, thanks for coming out to say hello, everybody. And a latest on campaign 2020. Be part of the conversation every day with our live, callin Program Washington journal. And if you missed any of our live coverage, watch anytime on demand on cspan. Org or listen on the go with the free cspan radio app. Joining us is tom