Board of Supervisors — 2020-04-07

I'll call to order the April 7th, 2020 meeting of the Santa Barbara County Board of Supervisors. Will the clerk please call the roll?

Mr. Lavinino?

Here.

Mr. Williams, Ms. Hartman? Here. Mr. Adam?

Here.

Chair Hart?

The next item of business is approval of the minutes of March 24th and March 31st, 2020. Is there any discussion? Can I please get a motion?

I move approval.

Is there a second? Second. Motion's been made and seconded. Would we please have a roll call?

Mr. Lavinino. Mr. Lavinino.

Aye.

Aye. Ms. Hartman?

Aye.

Mr. Adam?

Aye, with an abstention on the last item.

And Chair Hart?

Aye. CEO Miyasato is there a CEO report today?

There's no report this morning, Chair Hart.

Thank you. Madam Clerk any announcements or changes to the agenda?

Chair Hart and members of the board, I do have a couple quick announcements this morning. We posted an addendum on Friday amending today's Board of Supervisors agenda correcting a case under conference with legal counsel existing litigation to reflect the correct name A dot C dot all the county of Santa Barbara at all United States District Court for the Central District of California case number 2.

18 CV 03694 SK in addition to that amendment we added an additional administrative agenda item a 23 this is from community services it is to consider recommendations regarding acceptance of state COVID-19 emergency homelessness funding in addition to Our addendum on Friday, I have a couple other quick announcements on item A5 from the County Executive Office. This is to consider recommendations regarding COVID-19 related appropriations and it is listed on our agenda as a forfeits vote required and this is actually a majority vote so just reflect that in our motion.

And last I did want to just remind the public again today The alternative methods of public participation in our Board of Supervisors meetings, which is posted on the Clerk of the Board website as well as page two of our agenda. And if the public wishes to make a general public comment or comment on a specific agenda item to submit an email to the Clerk of the Board's office at SBCOB at countyofsb.org and your comment will be placed into the record Additionally, if you would like your email to be read into the record to e-mail the clerk of the board office at SBCOB at countyofsb.org and state in your body of your email that you would like that to be read into the record.

And last method of participation is by phone. If you'd like to make a comment by phone please call our office 805-568-2240 and that is also scrolling on Top of the TV at the moment. State your name, your phone number and which item you'd like to speak on and The clerk will call you at the appropriate time Please make every effort to be available and mute all streaming devices once it is your turn to speak And that is all my announcements

Thank You Madam Clerk Next item is approval of the administrative agenda to any board members request to pull any items from the administrative agenda Seeing no one, does Madam Clerk, are there any members of the public that would like to request poll items on the administrative agenda?

Chair Hart and members of the board we have no requests to speak on the administrative agenda.

Okay can I please get a motion to approve the balance of the administrative agenda?

Move A1 through A23.

Motion's been made. Seconded. Roll call vote please.

Mr. Lavinino?

Aye.

Mr Williams? Ms. Hartman? Aye Mr. Adam?

Aye

Chair Hart? Aye Motion passes unanimously

Now is the time for members of

public comment today and it is a letter to be read into the record

Thank you very much

And this letter is from Bobby McGinnis. On March 24th, 2020 the Santa Barbara County Supervisors adopted an ordinance that supported Governor Gavin Newsom's statewide no eviction policy for tenants which expires on May 31st 2020 to support your local landlords and property owners who rely on tenants rents to pay their bills please close Treasurer Harry Hagan's office from April 10th until May 31 2020 we understand that Santa Barbara County cannot change the delinquent date for property taxes However, the County Board of Supervisors can shut down the Treasurer's Office for 60 days so that property taxes cannot be collected automatically. Extending the deliquid date without penalty.

Please give property owners and small businesses the same relief as tenants. This is equal protection under the law. Thank you. Bobbie McGinnis, Chairwoman of the Santa Barbara County Republican Party.

Thank You Ms. McGinnis. Next item is Department Item 1. Would the clerk please read the item into the record?

Chair Hart, members of the board. Departmental item number one is from the county executive office. It is a hearing to consider recommendations regarding a coronavirus disease 2018 COVID-19 update.

Thank you. CEO Miyasato do you want to introduce this item?

Board members as you know, every board agenda we are providing the latest information we have on our COVID response. And so I'm going to hand it over to our public health director Dr. Yvonne Dorinoso and I think... Are you able to get the screen up? There you go. Thank

you. I was looking for the pointer. Okay.

Dr. Dorinoso thank you for being here.

Thank you good morning. My weekly update It's a little dense this week, so bear with me. I want to start off by again showcasing the new and improved data information site, and you can access that at publichealthsbc.org slash dashboard. And there we have graphics that captures total cases, active cases, cases by age groups, It's a really neat portal because for those who would like to calculate cases in terms of percentages, you can hover over the icon and you can get a percentage of testing that's positive, that's negative.

The situation status as of, oops the wrong date. But as of 4-6 at 12 PM. We have 192 cases confirmed, 34 hospitalization and unfortunately two deaths. And 42 fully recovered cases. I wanted to start by also giving the landscape of our current hospital beds So, right now in our county we have 376 med surge beds and 91 ICU beds. These are regularly licensed beds and we're operating at about 40% capacity.

And of the number of ventilators available meaning not in use, From our ReadyNet platform this morning, there are 50 still available. Regional characteristics relevant of COVID-19. We have an older population roughly 15% of our residents are over the age of 65. And so why this is important, older age groups we are seeing in literature are more likely to get COVID-19 and are more likely to have serious health impacts from that infection.

And a good thing, our county has lower population density as compared to say New York or San Francisco or LA and that will be a strength and asset as we manage COVID-19. Before I launch into our modeling, I want to give a word of caution. Whatever model you look at, they're really based on real-time data. And so the models that I'm about to show you were accessed with data from the six. And at any given time when you run models using real-time data, you get different results. So what I'm showing to you today looks a lot different than what I shared with you last week and will most likely look different next week. In terms of projections, this is a very fluid situation. Long-term projections may not give us the precise data that we're looking for because there's a lot of uncertainty around How COVID-19 infection rates happen, the transmission and even how do we gauge the social distancing measures?

So these are just caution as I share models with you that they are not engraved in stone. That they're fluid and they may change from day to day given our different number of cases and infections and hospitalization rates. So the Penn model is a model that we have been recommended by the California Department of Public Health. So these are the variables I'd like to walk you through, that we input into the model in order to get the graphics that I'll be showing you.

We input in the current number of people hospitalized due to COVID-19 And when we rent this model it was 27 doubling time. It's 6 to 7 current hospitalized patients, 27 social distancing. Is a gauge of what percentage reduction in social contacts moving forward hospitalization rate. The state recommends 5 to 20 were using 10% as a middle. ICU percent of total infections, state recommends 1% to 5%. And based upon our local clinical experts we are inputting 3% in. Ventilated percent meaning the number of people on ventilators anywhere from one to five percent and On local information are landing on 2%. Average length of stay in the hospital at the state recommends 7 days and it is a default of the model.

Average days in ICU is 9 days and that's a default of the model average days of the ventilator We have seen 11 days, but we're keeping an eye on that. Hospital market share, this is 100%. This is really assuming that everyone who gets sick in Santa Barbara County will seek care at a Santa Barbara County hospital. Regional population 450 and currently no regional infections. That's 174.

Okay.

So using the Penn model, this is a rough estimate of what we can anticipate. And again, typically this model is to be run at 100 days but to get a complete bell curve I ran it for 200 days so the preciseness of going beyond the 100 days may be a little off. So the first is 40%. So if we had 40% compliance with our social distancing, you get this nice brown curve that's pretty high. And here at 40% social distancing, we're anticipating that on June 25th, we will peak With our hospitalization census right here.

And on that day or a day after, on the 26th, the ICU census will peak at 768 with ventilation peaking needing 566 on June 27th. So the brown is if we assume that 45% of our county residents are adhering to our social distancing guidelines, we see a little bit more of a flattened curve as we anticipated. So here on the brown curve, hospitalization will peak at 682 on July 16th With census peaks at 438 on July 17th, with ventilated census peaking at 323 on July 18th.

The blue line is the 50%, if 50% of our county were to adhere to social distancing measures, we see an even further flattening of the curve. So here, we see a peak at further out on August 20th. With hospitalized at 274, with census peaking at 176 and with ventilated census peaking at only 130. If we are really ambitious and we could see even a 5%, so what would a 5% increase in our social distancing gain?

Right here way low. It's it's practically invisible is this really flattened line below so I wanted to show this to demonstrate the really the power of social distancing and all our health officer orders and this is what we're attempting to do Later on, I'll show you why this is critical because this will be layered on top of our system's capacity at current time.

Again, breaking it down the graphs that I just shared with you. So that was the Penn model. So this is the University of Washington model, so this model is what we are seeing on the national level. This is the model that This is the model that frequently the White House will display in their press briefing, as well as multiple states will display in their press briefing. And again just to demonstrate this is what it looks like on the national front but even this was updated a couple days ago and from one rendition to the next as we get more data And as we fine-tune the model, we see an update representing a 46% decrease in hospital census. So what that tells me is that as we refine our models with more data We get better predictions and the resource requirement is not as great as when we anticipated at the beginning of the COVID-19 response a month ago.

I can't believe it's been a month, but it's been a month So what might be more interesting is looking at the University of Washington model and how it plays out in California. Again, this model runs states and national. So we see that on March 19th our governor issued a stay home order. Educational facilities closed on the 19th. Non-essential services closed on the 19th and travel was severely limited.

So this model anticipates that on April 14th or 15th, that's the peak need for resources. And given all the efforts that our state government has done we don't see in this model a need for bed shortage or ICU bed shortage but we do still see a need of ventilators So what does that mean for Santa Barbara County using this national and state model? Well, this model doesn't allow for the variables to be changed. So the best that we can do is estimate based on our percentage of population Compared to the state, so we have about a 1.13% population of the state. So if you calculate back the peaks hospitalized census, we're anticipating 140.

on roughly the 26th of Wednesday. I'm sorry, April 26 and this is similar to what we had predicted a week ago. Peak ICU census at 21, peak ventilator needs at 17 and anticipated number of deaths by August the 4th around 57. So this is extrapolation of a national and state model So what does this all mean, running models? Well we run models because we want to even though the data may not be precise. We wanna get a gauge on how these models can assist us in doing hospital surge planning, in standing up alternate care sites, in acquisition of medical equipment.

So the current surge capacity in our county, these are beds at the five hospitals in our county. And these all have been verified by the hospitals in question. So we're looking at, in terms of med surge capacity, Pre-existing means this is what the number of licensed beds there are in the county. So if we set aside 40% of the number, the 376 and the remaining 60% would then be available for COVID 19 response so we're looking then at the 226.

Similarly with ICU, we have 91 beds licensed for ICU. And if we take 60% of that, we get 55. So altogether including 60% of license beds and the capacity of the hospitals to turn different spaces in the hospitals for MedSearch or for ICU, we get a total of 699. So this number again has been verified by the CEOs And their staff at the three hospital systems. So, and that's a good thing. This was not what, we did not know this a week ago. So in close partnership, close conversations, multiple conversations were able to land at this number around 699.

And I'm anticipating this number to even go up a little bit more as the hospitals work to create space or bed space within their four walls. Okay, so remember the graph earlier? So I overlaid on top of this we just talked about beds. So the brown curve, this is the hospitalized census The next lower one is the ICU, and the lowest one is the ventilated census peak. So this is at 40%.

Going across, this is the number of hospital Beds, the MedSearch beds in our system. The red dotted line going across is the ICU beds and the purple dotted line is the number of ventilators in the system. So the difference that you may see, you've seen 84, 85 and now we're landing on 97. And again this is on behalf of the hospitals to take what we have given them to retrofit or to do preventive maintenance and this also includes pediatrics so we're at 97.

we will be exceeding this space right here, we will be exceeding the capacity for hospital beds. However at 45% that gap is much reduced and then at 50%, we are well within our current capacity of ICU beds However, not so much on the ventilation. So what this means is that we need as a community to really, really be diligent in messaging physical distancing and adhering to the social distancing orders that have been put into place.

Dr. Doronis, Supervisor Hartman has a question.

Does this assume then that the current social distancing measures continue through August, September, October?

Yes it does.

And

maybe at a future Maybe at a future update, I can show the models where if you let's assume that we are at the 50% and I'm really hoping and I'm seeing results that indicate we're around 50%. Let's say that right here. We think that we're doing great and then we let up there's there are models that can indicate As you loosen your social distancing guidelines and mandates, the curve does not complete the bell shape going downward but it actually can go back up.

So in

term-

Supervisor

Williams, I guess the question is How should people envision what 40% versus 55%, or 50% is? So you're saying, you're estimating that we are achieving 50%. What does that mean? Does that mean that 50% of people are occasionally drifting within six feet, 50% of the people are practicing the guidelines that you issue.

So, that's a great question what we have now in terms of Gauge on how successful we've been as a community is really looking at analytics. That's available via Google or via a unicast, I believe is another so there are apps out there that are tracking. I believe based on cell data usage and and sell I'm not sure I understand the science behind it, but it's cell usage.

And we have been looking at the data and it looks like We're anywhere between 40 and 60% depending upon the day. That given with anecdotal reports from both the sheriff's office as well as my staff who are driving around in the community looking at restaurants, looking at public spaces and not seeing the congregations, the masses of people as they typically would on any given day before COVID-19.

So earlier I mentioned that that's the lack of preciseness in modeling, we don't have a good hardcore gauge about is it 50%? Is it 60%? Is it 70% and how will we know?

Got it.

And so we talked about surge planning So I have to say, this is my favorite graph because it's simple and it shows the space that we're currently in. So again, the brown is 40%. If we are at 40%, we will look at a peak on June 25th. And this orange salmony space is the 500 bed We are well within our capacity. Our healthcare system may be challenged, but it will not get broken. And then if we go to the 50%, we can handle it And this is the low blue line, it's way down here. So you can see visually the effects of social distancing So with regards to the 40%, for me, for us, our team that's the worst case scenario. We're at 30-40%. So what do we do?

we can have that capacity, that 500 bed capacity in the worst case scenario. However before we get there what we are looking at is an immediate priority to acquire the 20 hotel rooms for the discharge patients meeting the criteria. So these are low acuity patients being discharged they may not have a home environment that's supportive or they may not have a congregate setting that's ready to take them back. So by mid-April, we are planning on acquiring 80 additional hotel rooms and building the capacity to stand up 400 additional beds We currently have the materials for 300. We're acquiring materials to stand up an additional 150.

We're looking at various sites throughout the county, and we have begun doing staff recruitment. So even at the 20 hotel bed capacity that we're needing right now, that means intensive staff that's outside of our current response, so that's what we've began to do. We've began recruiting medical professionals and paraprofessionals to assist us in that. Future daily data will guide us as I mentioned earlier the more fine-tuned numbers we input into the models and the modelers are constantly Every three or four days, fine tuning their tool as well. So as we progress I'm anticipating a more precise modeling and more precise results.

Our gauge, our lever is that when we reach 50% of our search capacity. Again that's when we reach the 699 half of that so that's 700. So around 350 we will ramp up high gear and stand up what we need to stand up to support our healthcare system and our community. In terms of medical equipment, so currently we have 97 ventilators. As I've shared previously, we have requested an additional 100 from the state.

I know that the hospitals are purchasing or pursuing the purchase of vents and we will continually ask for PPEs From our federal and state stockpile. In addition to that, we are supported by philanthropic partners and we are able to go out and explore potential vendors who may offer us PPEs. So the takeaways I'd like to share, I've shared with you two main models that everyone is using. There's great variations among these two models.

Again, the models in use give us varied results Ranging from no search bed need to high need. The Washington model is used by the federal government and provides only national and state level information. The Penn-Chime model is recommended by CDPH, and all models really rely on estimated social distancing compliance. I wholeheartedly from the hard work of all our county partners, all our county teams believe that we will be ready and prepared.

Our model show a range of bed search needs from zero in the best case scenario to high need in not so good social distancing model. Realistic range is about 40 to 50% of compliance. And this is why we need, everyone needs to adhere and not only adhere but really hold each other accountable and share publicly. Social distancing is the key driver in keeping the rates where it's at.

And knowing that again this is just modeling, we have a phased approach to address any of these scenarios and we are monitoring the number of hospitalization, the number of cases, the number of availability capacity on a daily basis and can adjust I want to point again everyone to our website, publichealthsbc.org for daily information about the coronavirus and our community call center at 833-688-5551 as well as our community wellness call center for emotional support 868-1649, 211 is available. And our two reference sites are www.cdc.gov and www.CDPH.gov.

And that concludes my update for this week.

Thank you very much, Dr. Durbin-Oson. Please extend our thanks to all your staff. I know everyone is working very, very hard long hours seven days a week and your effectiveness is really clear and obvious. And these numbers are really encouraging as long as folks continue doing what they need to do. Supervisor Williams and Supervisor Hartman and any questions from North County?

Yeah, I have a similar take away to the chair that this should be an impact. It should be from the public standpoint and empowering thing to see that people are making a difference by their level of social distancing Improve that level of social distancing, then the community will have the adequate resources to meet the need. And obviously more lives will be saved.

I have a part of my district that's way out there in Cuyama and I just wanted to understand if you or your folks can let us know If local folks believe they have the symptoms and meet one of the tiers in Cuyama, is there testing available at the little community clinic or are they counseled to go out to Marion? And so, or other locations in Santa Maria.

So we the county does not have a clinic out in Quiama it is by Central Coast. So what I would suggest is our system has the ability to do telephone consults as well as telemedicine and I would encourage that community member To tap into that cottage has a similar system. I'm not sure about Marion and if they meet the criteria, the arrangements can be made. So our clinics do offer testing for those that meet the criteria.

Sure, and I know I know that the clinic isn't a county clinic out there but it is a clinic and so we just so essentially they should call public health and not that clinic

Yes, and I can do follow up with that particular clinic if you'd like.

Great, that would be wonderful to understand their level of resources. Supervisor Hartman?

Thank you. I have a number of questions on the radio today, I heard that there's quite a difference in ethnicity and how the coven especially in places like Louisiana so I just wonder over time if we will keep those statistics as well.

Yes, when I saw the Louisiana, the first thing that came to my mind was also the high prevalence of chronic disease as well in Louisiana. But we will be diving deeper into our number of cases As well as our hospitalizations to see if we can spot any trends. With that, the goal is really to how do we step up or focus our prevention and intervention efforts from a policy level, from a clinical level, from a health education level in communities that might need that extra attention? So that's why we will be looking at all of our numbers.

Thank you.

I have a few more questions so basically we have to have the beds, we need to have the personnel and then we need to have the equipment it sounds like we're planning of course for all three and that the equipment the ventilators are the limiting factor but if we can flatten the curve more will be produced and available but we're looking largely at our county in isolation from How other counties throughout our country will be affected and how resources may be moved around. So as models get better, I guess that's something to be thinking about. How does our curve relate to other curves and resources?

That's a great comment. So I wonder as well, in particular, I'm curious about how SLO is doing or how Ventura County is doing and so those are our two closest allies and I have seen Ventura County's projections and they're very similar to ours.

And then, I mean we're trying to flatten the curve so we might get more testing. We might find out who's immune. We might have some actual treatment. I think you're giving us the model but we're thinking about up here social distancing through September-October and how Really difficult that would be So I think we're kind of waiting for a breakthrough and you're just giving us a model to How do you plan for health care beds and personnel and equipment?

But how we plan for the rest of it is is a really big question. Thank you. Yes

Are there questions from Santa Maria

Yeah, I got a couple Dr. Doronoso, do you expect to maintain the level of social distancing that we're talking about here in these graphs as long as the graph goes out to November?

Personally I know that I struggle with it I have a family that struggles with it, so I fully understand how difficult it may be especially for members of our community who live in a high density situation. However, I'm also seeing what worries me is seeing where there is no social distancing and the impact it has on the community in terms of severe hospitalizations, deaths.

And a healthcare system that is so overwhelmed that healthy people are also affected. So do I think that Is it sustainable all the way out to November? I'm not sure. I think that it's a conversation that needs to happen in a variety of contexts and in a variety of settings so land on a solution that is doable, that protects the vulnerable members of our community as well as safeguarding our healthcare system.

Well it's interesting you say that because I get the general sense here that there's two competing overarching strategy considerations. One is the deaths and the illnesses, and the other's economic. And the economic impacts of this are getting overwhelmed by Physical or the health impacts at this point, but I'll tell you if we go on until November one. You just said it yourself there's people that are going to be injured that don't get sick and I don't think we're balancing The needs of those people that are trying to make a living out there very well.

Seems like we're over focused, and maybe rightly so. And I don't want to act like I have any answers because I don't but There's a tremendous amount of pain being loaded into the system at this time. And it's largely undetectable because everybody is sequestered in their own homes and out there in their essential businesses and stuff, and other than that there's not much going on.

And obviously it's very difficult for people to come and give us Public comment and stuff, and I suspect if it were easier we'd be hearing more. And I think as time goes on this is going to start wearing on people more and more. And I think we're going to be subject to a lot of more demands to lift these social distancing guidelines and Find the people who are at the highest risk and try to protect them rather than getting Everybody, you know, okay. We're kind of throwing the baby out with the bathwater At this point and I think that the damage is gonna be really deep If we try and go until November doing the same thing we're doing now I mean I and I think that We should start those discussions sooner than later, until we just sort of run into failure or rebellion or whatever.

At some point people are going to stop cooperating and I don't think it's going to last till November. And then if we get to the point where we have to start arresting It's not. America. And I realize these are extraordinary circumstances and you can keep this up for a while, but when you start showing people charts like this that under the best case scenario we don't even get down to zero again until after November 1 and that's with 50% social distancing which we're assuming we're doing now That's not very encouraging to me, from an economic perspective of the whole community here.

Supervisor Lavonite, do you know?

Thank you, I have a question about slide ten. It's the U of W implications for Santa Barbara County. My question was just on the ratios. We show that our projection would be like 140 in the census for the hospital with ICUs at 21. So, I'm just trying to figure out how that correlates to what we have right now where the ratio seems to be a lot higher where we only have 34 hospitalized but 19 are in ICU.

So I'm curious how our ICU numbers look like they'll get significantly better even as we get more patients?

Right, so I would. Sorry. So the University of Washington model again is a state, it's a national model and it's four states. And the preciseness is difficult because we are one huge state with 58 very diverse counties so when they lumped all the 58 counties into the California model It isn't precise when we extrapolated purely using a percentage of population.

So that's why I, but it is a model that is frequently used by the states as well as our federal government so I thought I would put it in there. Okay

thank you. You

know what? The percentage of hospital beds that are being reserved for regular hospital patients, that is being held as a 40% reserve capacity. And I think that makes sense, it's very conservative smart thing to do but I'm wondering if that is the experience that we're having in the hospitals? It seems like anecdotally around the country as people are staying at home that there is much less demand for

hospital beds. The 40% number we landed based upon our conversations with all of our hospital partners. And again, when we were able to get their license beds and their search capacity, the big question was but how much do you need to set aside for day-to-day normal healthcare needs? And we all agreed on the 40%. So it was validated by the hospitals.

Okay. And then you did at the beginning of your presentation have a number of caveats about the reliability and the predictability and the precision of the model as time goes on. You mentioned that there's more confidence in a shorter horizon of predictability, so...and that these models are being refined all the time and new data is coming into the equation In real time integrating that information so it's probably premature to be talking about September and October November we're trying to concentrate on people today what they're doing now and from the information that you have.

which is proxy information, it isn't precise. It is the cell phone data as you mentioned primarily from Google and Unicast that tells the relative amount of distance that has been reduced traveling distance doesn't speak to how close people are together whether they're adhering to a six foot social distancing practice but it's a tool and it's the only tool that we have. And it's encouraging and it's telling us that we're doing a good job and that every 5% additional Effectiveness in social distancing has a huge impact on flattening the curve. So I think that is really the most important message I heard today, is that social distancing works and it can work even better if we do a little bit better job. Everybody individually doing a little bit more can make a huge difference on the impacts of the capacity of the medical system to absorb patients.

Is that all?

Yes, so very aptly summarized. Thank you. My only addition to that would be yes these models are tools and what I'm seeing is that the next eight to ten days will tell us a lot about what we need to do differently in terms of modeling and in terms of planning

And I know another tool that you are looking at is the practical real life experience that's happening in the Bay Area. They're ahead of us and we're seeing in real time what it is that they're experiencing, and the early indications are that that experience is consistent with what you're seeing with the modeling and the effectiveness of social distancing. So that's another data point that is encouraging and gives us insight into what We might be looking at in the future.

Yes, okay So maybe we'll bring that slide at our next update

Thank You supervisor Williams and then supervisor Hartman

Well III agree that it's premature to talk about November And that the most important information That these models reveal is what a huge difference can take place between different levels of social distancing However, I do think Supervisor Adam is right that at some level it is a policy question because destroying an economy kills people too. It does so at some level you have to work out as a policy matter where to balance this And it is not just a realm for public health, it is a realm for the people that the voters elect.

So I do think it is important to have that discussion at some point. My view is that if workplaces were properly equipped, if preparation were made, that more people could go back to work while maintaining a certain amount of social distancing And that of course would be an important job for public health to advise employers on how that would make. And obviously, that has to do with a policy call by the state as well since we are in their shelter-in-place order.

But it is a fact Economic collapse and poverty also kills people. So there is a question, an outstanding question of how long you could close most businesses? And I think we can do it for longer. I think we should do it for longer but the question is how long you can People and I don't mean hurting people like making them lose a little bit of their income. I mean, hurting people as in ruining their lives

supervisor Hartman

I have two points, I think. The first is we do now have an additional social distancing recommendation and that is face covering. And I commend my fellow supervisor Williams and Yash for showing us as well as some people in the public today. But I think that is saying I'm a good citizen, I'm here, I am wearing my face covering so that I can protect other people.

And so when I'm out in public, I've started to do that and I understand there's we didn't do that initially because we didn't want people to be confused with medical masks. And take resources away from our medical personnel. But that's a beautiful color, Supervisor Williams and we're seeing more and more of those. So I know it's for our culture it's a difficult thing for many people but we have to make this something that is socially commended. Because it is an additional strategy that may bring that curve down faster.

So, so that's one point. The second point is I think we're holding on for more testing and ultimately being able to see who's immune? Who can go back to work safely without getting sick? I know we have a three-tier testing strategy. Could you comment on the supplies for testing and where you see that going in our county?

Sure, so the supply for testing... We do not have an issue with testing anyone who needs to be tested on Tier 1. However, I do understand that there are tier two. We're beginning to do tier two and I know that there are members of our community in tier three that would like to be tested. So the only thing about the testing that I worry about is that when you get the test and you get the results that's negative. That doesn't mean that tomorrow you won't So we are really sticking to our message that social distancing, good hand hygiene and being self-isolating.

All of that face mask, face coverings all of those will really be more protective than taking a test when you are Not symptomatic on the flip side with regards to what our efforts so I mentioned. I think it's been maybe 3 weeks now that we were in pursuit of a rapid testing and Our lab director excitedly told me yesterday that he has a FedEx tracking number. So we are getting 200 rapid tests in the public health department to be able to do Tier 1 quicker turnaround times.