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 th