Board of Supervisors — 2020-05-19

Welcome to the board meeting.

I will call to order the May 19, 2020 meeting of the Santa Barbara County Board of Supervisors. Will the clerk please call the roll?

Mr. Adam? Mr Adam?

I am here.

Mr. Labanino?

Here,

here.

Mr Williams?

Here, here.

Ms Hartman? Here. Chair Hart?

Supervisor Hartman has an announcement.

Thank you Chair Hart. Gina Fisher of our third district office was supposed to start maternity leave next week, however yesterday at 125 at Cottage Hospital she gave birth to baby Carter he made his entrance So in this season of pandemics and COVID commencements, his birth really represents a new beginning. And we couldn't be more excited and congratulations to the new Fisher Anderson family and this new addition to our county family.

Thank you for sharing that wonderful news. What a great way to start the day.

Mr. Adam. Mr. Adams. Aye. Mr Lavinino.

Aye.

Mr Williams.

Aye

Ms Hartman. Aye Chair Hart.

Aye

Motion passes unanimously.

CEO Miyasato is there a CEO report today?

No report this morning chair.

And Madam Clerk, are there any announcements or changes to our agenda today?

Chair Hart and members of the board. I just have a few announcements to make this morning. I do want to remind members of the public who are participating in today's meeting if they'd like to speak on public comment whether that is general public comment or an item on our agenda today to please call the number that will be scrolling on the top of your screen 805-568-2240 and state your name, your phone number and which item you'd like to speak on. And we 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 Chair Hart, members of the board I do have a couple other announcements today. We received a memo from the department requesting a continuance of Item A29 And this is from Public Works, Board of Directors, Flood Control and Water Conservation District. It is to consider recommendations regarding a final subsequent environmental impact report for approval of the updated Carpinteria Salt Marsh Enhancement Plan. And this is in the first district and there is a four-fifths vote required on this item. The department is requesting a continuance of this item to our June 16th 2020 board meeting And we can include that in the balance of today's agenda.

Additionally, we posted an ex-agenda request yesterday amending departmental item number one. This is from the county executive office. It is a hearing to consider recommendations regarding a coronavirus disease 2019 COVID-19 update and we added an additional recommendation, recommendation D as seen on our revised agenda today Authorize and direct the chair to sign a letter of support of the County of Santa Barbara's health officers variants. To stage two of the state of California's pandemic roadmap, to modify the stay at home order COVID-19 county variance attestation form.

And Chair Hart members of the board if we can have a motion to approve the ex agenda request as a need to take immediate action. We added this to the agenda yesterday on an item that arose after the agenda was posted last week.

Thank you, Madam Clerk. Is there an agenda or excuse me a motion

for the ex-agenda item? I'll move that we add the ex-agenda item. Thank you Supervisor Williams.

Second.

The motion's been made and seconded. Any discussion?

All those in favor with the roll call vote?

Mr. Adam?

Aye.

Mr. Lavinino?

Aye.

Mr Williams?

Aye

Ms. Hartman?

Aye

Chair Hart?

Aye

Motion passes unanimously.

Thank you

And those are all my announcements this morning.

Wow multimedia public comment. This is impressive.

So I have a lot of affinity for nurses. This song is for you, it's called Nightingale's Lamp or They'll Be There For You. When

the way is dark and steep they'll be there for you when fear keeps you from your sleep they will guide you through Hold on tight, they'll hold onto you. Through the night, they'll be there with you. They'll be there for you. They wear their uniform with pride, Our love once was a nightingale's lamp still shines from somewhere deep inside. So hold on tight, they'll hold onto you through the night They'll be there with you, they're always Thank you, thank you nurses wherever you are and whoever you are.

Thank you.

Thank You Mr. Clayton what a great way to start the day we're on a roll today between Gina's news and Mr. Clayton's music anybody who ever wants to do that is more than welcome that's a great great way to make public comment there are no more public comments is that right Madam Clerk?

Yes Chair Hart members of the board that was our only request to speak on general public comment

The next item is departmental item number one. And would you please read that item into the record?

Chair Hart and 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 2019 COVID-19 update. And as a reminder to the board and the public we did post an ex agenda request to modify the recommendations for this item today. And there is an additional recommendation D that is posted online To authorize and direct the chair to sign a letter of support of the County of Santa Barbara's health officers variants, stage two of the state of California's pandemic roadmap to modify the stay at home order COVID-19 county variance attestation form. Thank you.

CEO Miyasato would you like to introduce us item?

Good morning, board members. Today as a presentation on the COVID update we have many different parts to this. One will be a discussion about our new RISE plan and reopening in safe environment. Talk about actions that we've taken to date and what will happen in the future. Also you'll hear about what actions we've prepared for the board in regards to this ex-agenda item.

So there's a lot happening today it's a day to be hopeful As we look forward to what could happen in the future, thanks to the dedication of our community members and our great commitment of our public health staff. With that I'm going to hand it over to Nancy

Anderson. Thank you Ms. Anderson.

Good morning Mr. Chairman and Members of the Board. On behalf of the Public Health Department, the County published the Reopening and Safe Environment Guide or RISE guide to the public on Friday. The guide is a local supplement document to the state's four-stage resilience roadmap. It describes when the county may begin to reopen institutions and businesses safely while prioritizing public health and upon approval by the state. It is important to note that the state is the authority dictating what industries fall under each of these stages.

It provides how to limit the spread of COVID-19 and establishes tools and approaches to minimize future outbreaks once restrictions are loosened or lifted. And offers what decision points to identify how phase transitions occur, and local criteria that might inform decisions to loosen or tighten those restrictions. The guide is essentially a Santa Barbara County playbook for reopening. It is a living document comprised of three parts, a core framework, industry sector guidelines and the readiness and containment plan.

The guide has four main sources, the federal government guidelines opening up America again, the state of California roadmap And modify the stay at home order and update on the pandemic roadmap. Resolve to save lives, a global health initiative that describes the adaptive response to the pandemic and the San Luis start guide. The process to develop the guide was a marathon of meetings over the past three weeks. A project team was organized and we engaged reach to facilitate stakeholder outreach. We established an independent medical and public health expert panel.

We identified key stakeholder leaders to coordinate community and industry informal roundtable discussions, then the numerous panel meetings and roundtables ensued. In the middle of this, we had to incorporate the state's acceleration through stage two and add reference to state industry guidelines that was published for many sectors. Feedback from stakeholders was compiled and the document was developed. And finally, the guide was presented to our public health officer for approval. I would like to introduce our public health officer Dr. Henning Anzorg who will provide some insight into the panel's work.

Dr. Ansler, welcome. Thank you Supervisor and Nancy thank you. First of all I want to thank the CEO's office for their support in this endeavor. The REACH group who was instrumental in getting this together as well as San Luis Obispo County our neighbors to the north who functioned as trailblazers so to speak because they came out with us like a few weeks before us And we try to improve upon their plan. I hope we did.

In addition, I really want to thank the expert panel chaired by Dr. Melissa Smith from UCSB, Dr. Fitz Gibbons, infectious disease doctor at Cottage, Dr Therese Ritter, infectious disease doctor at Marion Hospital as well as Paige Batson from the public health department, deputy director and Dr. Kevin Ferguson, lab director at Marion Hospital They spent countless hours, weekends supporting the efforts of Public Health Department and the CEO's office to get people back to work basically safely. So greatly appreciated their input and it just shows again how collaboratively and supportive our local physician force and healthcare force really is, which is really greatly appreciated.

The slide that you see here is actually on two slides. It scrolls down a little more to the next one It was just too much information for one slide. It has three columns, one is epidemiology which is the statistics of medicine, the next is the healthcare ability and then the public health part of the endeavor. We wanted to identify what the goals, which goals would have to be met in order for us to be able to loosen up the restrictions that are in place.

And the first column says or shows the initial the numbers that were requested by the state. The Board of Supervisors did actually appeal those on May 13th and over the weekend, over the last weekend, the State Health Department actually revised those in our favor I would say so that we now are able to apply for attestation. In any event It shows that we have a need to show that in essence the disease burden of COVID is going down, it's trending down which we can and we have to obviously put in very measurable metrics in percentage and in days and so forth.

The state has taken out the necessity for fatality rates that is off the books now. Please be advised that this document that we are talking about is really a living document, it is fluid, changes are so frequent and so rapid in this time that no document is valid for longer than a week apparently. Anyway, before now we are matching all of these epidemiological factors to be able to reopen our hospital capacity and local health care ability equally.

We have capacity to accommodate a surge of 35% due to COVID cases in case we were to experience a surge. We have a very robust plan to protect the healthcare workforce with sufficient protective gear in place, we have enough ventilators for intensive care units, we can increase including staffing up to 30% alone in the intensive care unit, which is really great.

We have hospital facilities that with great plans in place with as I mentioned sufficient protective gear and even sufficient face masks to cover patients that come in also in the outpatient setting our healthcare clinics are all endowed by now with telemedicine and we have We are meeting all of those criteria. From the public health perspective, we need staffing for trained staffing for contact tracing which is in place. The state requests 15 staff per 100,000 county population so we have more than 65 already and more are in training at the moment So, we are set there.

We have temporary housing units in place to a degree that we could house 15% of the county's homeless population if needed. Our skilled nursing facilities have sufficient protective gear in place and we are able to contact I'm proud to say that we contact 100% of cases, not just 90%, which is required. Within 24 hours all of our symptomatic contacts will be able to undergo testing.

Testing in general has been upscaled significantly with our new three sites that we are able to test large number of patients per day now. So I'm very happy to report that we are meeting all these requirements at this point, and Dr. Vando Reynoso will later present the attestation to this. The other part in for the medical team or the expert panel was to... Dr.

Nesurk, I'm sorry we're having some technical difficulties with the streaming of the meeting so if we could just take a five-minute break and see if we can work out those technical difficulties and we'll get right back to your presentation thank you

you

you Welcome. We'll resume the Board of Supervisors meeting for May 19th, and Dr. Ansorg was in the middle of his presentation. Apologize profusely for stopping your flow but please resume thank you.

Thank You supervisor Hart. The next slide speaks to mitigation measures that Hopefully it will never be necessary. In case we were to see an uptick in cases, have like a sudden change from a stable amount of cases to significant increase over more than 10% and so forth, then that would be a trigger to think about tightening up again. Unfortunately there are some healthcare triggers instability to scale up to the 35% ICU care ability or if we would not be able to screen larger numbers of people If we ran out of PPE or didn't have enough PPE for our healthcare workers to support and protect them, if our health services could not expand and if healthcare facilities were no longer able to work without exposing their staff.

And public health triggers that would One of the triggers that would lead us to consider tightening up the restrictions would be if we could not find contacts for 20% of more cases or if we were unable to test 10% or more of those contacts within 24 hours. Inability to test large numbers of people and two per 1,000 residents per day. That would be an equivalent of 900 in Santa Barbara County which we are able to do right now.

One trigger would be to have 7% or greater test positivity over the last seven days. At the moment we are running around 4%. if the test positivity were to increase over seven days. Now, those are just guidelines and they are as I mentioned before very fluid because the state is coming out with new guidelines national guidelines are coming out on a regular basis so We will update this as time goes on, but we need to have a plan in place for our attestation and this is fantastic framework that we will utilize in the attestation.

Thank you Dr. Anser. Are there questions for Dr. Anser? Okay

thank you. Next Ms. Anderson. I do have one question. Yes Supervisor Williams. Do you, in the contact tracing, because it raises a lot of civil liberty questions. Do you have any sort of kind of input and is the department interested in input from say a human rights organization or something? They don't need to be paid or anything but I think The questions of contact tracing definitely get more invasive than government normally is, and I do think that there's some questions that get raised. And is the department open to having such advice from a reputable human rights organization or affiliate?

Well, contact tracing is in place for a multitude of highly contagious diseases already per our health section codes and so forth. And I think we are Absolutely in line with, we are also in contact with county council on these issues and we are not doing this any different from a TB case for instance or a measles case. So this question hasn't really come up because we're not doing anything different from our routine really it's just a different disease.

Thank you. Ms. Anderson, are you

next? We would like to echo Dr. Answorg's thanks to our expert panel. We have Dr. Melissa Smith, Dr. Therese Ritter, Dr Lynn Fitzgibbons, Dr Kevin Ferguson and Paige Batson the Public Health Deputy Director for their time and professional expertise on this project. I would now like to introduce Melissa James and Andrew Hackleman of REACH, who are our project partners to talk about our reopening project and stakeholder project outreach process.

Thank you, Nancy and good morning Chairman Hart and members of the board. It's wonderful to be here with you this morning and I'm excited to share with you just a little bit about the process that we worked through to develop the RISE Guide and share a couple of details with you and for the public of what they're seeing in the guide. So I think this first slide that you see before you shares a little bit about the project structure, and it's important to kind of know and understand who was involved and how we all worked in coordination to get to the product of the RISE Guide. What we know is that the best interest of public health as we move into a phase reopening is going to require government, healthcare, public health businesses and individuals all to play a part In, you know changing behaviors or shifting protocols to protect the health of their clients or patrons or neighbors.

And so this process really looked at all of those stakeholders and their voices and perspectives to be at the table rather than creating a plan that you put on people it was how can we work together to create this In partnership, so this project structure shows all of those players on the table. Of course you see that the state kind of at the top they are developing out what the framework looks like and they're thinking about the interests of 40 million people in the state and protecting public health. Of course we have the County Board of Supervisors and county health officer in the Department of Public Health is looking at those same types of criteria here for Santa Barbara County. And so what we've done here with the Rise Guide is we've engaged, where you've heard from an expert panel to be looking at the framework necessary to advise the County Public Health Officer and the Board of Supervisors on the criteria for when and how reopening takes place under the Governor's Framework.

And really getting into some of the community stakeholder engagements is really related to the guidelines and how we go about reopening and entering back into our And so along those lines, we brought together community and industry leads. There's about 50 in total that each facilitated roundtable meetings. So there was eight community roundtable meetings across every city, facilitated by city managers and mayors. And then there was 19 different industries sector We had a number of teams as well that came together from all various types of industry, from faith sectors, from non-profits discussing what guidelines would look like and what safe reopening would look like in their environment. Within that we also had about 1,000 unique survey comments that came in so there was just a tremendous amount of conversation, of dialogue, What you are seeing in the rise guide and now we're at a point of extending that out where the public has the opportunity as well to be providing input.

As we know, it's a living document that will continue to change as we move forward and it's really very much in the interest of the county and the process and engaging the public as well. So now I think we'll shift to the next slide. What I want to kind of share here that I think is really important for the public in understanding how this Rise Guide intersects with the California Resilience Roadmap So what you see here is what the governor and the state has kind of detailed for us about what the phased reopening is going to look like across the state in its four-stage process. And the state has determined which industry sectors are allowed to reopen within each of these different stages, so what the RISE Guide really does is it helps The county of Santa Barbara and how do we move through the stages of the governor's resilience roadmap.

What's important to note is that when we embarked on this process, we didn't know what the governor's intention was going to be With the resilience roadmap, he kept talking about localism as being determinative. And we had all been thinking, planning, preparing for such a time when the governor may lift his state order and kind of transition authority back to the counties. And so proactive planning ensued for what that might look like. What we've learned since is that the governor is not intending to lift his state order. He is going to keep that state order and use that to move counties through this four-stage process.

And within that process, you can see. What industry sectors are allowed to open where and how that kind of fits into the guide is at this time, the state has put out guidance for all stage one and all stage two sectors. So we have integrated that guidance from the state so that our businesses all have that clarity and understanding but the state has not yet put out any guidelines for stage three and for stage four.

I think you've heard and we all know that Santa Barbara County is now In a really great position to be moving from stage two to stage 2B. And thanks to a lot of the proactive and collaborative work that your board has engaged in with the state, the shifting of criteria that the governor announced yesterday is allowing up to 53 of the 58 counties are now in a position where they can We've had a number of meetings over the last couple of weeks and we've been applying it for this at a station and moving forward. As of today, there's only 23 counties that have moved into stage to be which is allowing for in person dining and so forth. One thing I would want to note kind of looking forward as it's been come up. It's come There are industries or sectors that are in stage 3 and not able to move forward yet.

And there's some considerations moving forward about what that will look like and when that's going to happen, and those things are determined by the state. And the state has not yet put their timing for that process. And that impacts, as you can see, our wineries, Our churches, our gyms, our nail and hair salons. Those types of sectors are in stage three. And so as we think about the governor saying localism is determinative and we had hoped and anticipated that at some point he would be transitioning that local authority back. What we're now seeing is that the localism is determinative. It's playing out in a different way. It really playing out with counties engaging with the state For the best interest of their county, and we're seeing that the governor is making adjustments along the way.

And so I just highlight some of these industries in stage three that really have some pain points there. So now I think I'm going to shift into the next slide just to share a little bit about the stakeholder feedback. You know, these 27 different roundtable meetings and there was over 350 people engaged. And there's a tremendous amount of feedback and conversation. I'm just going to kind of skim the top and share with you the things that really surfaced across many different sectors. Some of the big ideas that folks had, things that we could be thinking about beyond just what goes into guidelines.

Really observed from the people of Santa Barbara County is that there's a tremendous collaborative spirit across the community of people wanting to work together and wanting to protect public health and open in a really thoughtful manner. And so some of the ideas are what are the ways in which we can expand our space for physical distancing, potentially for restaurants being able to be outside?

There was a lot of input about having goodwill ambassadors who can support education and guideline adherence. And from across these stakeholder groups many people volunteering Ambassadors are partners with the county in helping to communicate and educate their peers and their industry sectors. And there's, of course, PPE is a really important guideline for keeping folks safe. Many businesses are looking to procure PPE. And so there's conversations about community consortiums, how you can get better bulk rates if we're doing those things together. So those are just some of the ideas that were coming up. Of course, there was some challenges that came up as well.

The uncertainty in the approach and the timeline from the state, what we know is that we're getting pieces of the puzzle and we're moving along. We don't have the whole picture, and that creates a lot of angst for people not understanding When things are going to happen or how those decisions are made. So that was something that came up quite a lot. And then, of course, there's financial impacts to the guidelines for businesses being closed or being able to operate only in a 50% capacity has tremendous stress on some of our businesses. That was something that was consistently coming up and then the guidelines not necessarily being equitable across sectors so real Real concern for a lot of those sectors that the governor has placed in phase three.

So, a classic example of that would be our wine industry which is robust across the Central Coast and Santa Barbara County and San Luis Obispo County. Unlike restaurants, they're not allowed to move forward in phase two. And that creates a lot of pain points for them and not understanding why a winery is treated differently than Those types of conversations came up quite frequently.

So I wanted to just highlight that. I think I have maybe one more slide to share with you. Oh, maybe that was it. So where I'll leave you off here, very much appreciate the partnership with the county. I want to acknowledge the leadership of the Board of Supervisors and kind of facilitating this collaborative approach in partnership with industry and community, and greatly appreciate the work that you have done in engaging proactively and collaboratively with state in the policy making of how the resilience roadmap is coming together. And just encourage that continued productive dialogue Staged and phased reopenings are going to be with us for some time, and I appreciate your leadership. And thanks so much for the opportunity to join you today.

Thank you very much Ms. James for the great presentation and all of the incredible work that went into this, all of the team that was involved. In fact, this is really incredible. CEO Mia Sato, to Alt Nibbs-Anderson, Terry Mosnisch, all of the other folks, Ms. James and Mr. Hackleman The expert medical panel, Dr. Anzorg and Dr. Smith and all of the hundreds of stakeholders that were involved in this is an extraordinary achievement in an incredibly short period of time. In fact I can say with certainty nothing like this has ever been accomplished in our community. Normally our community dialogue outreach processes oftentimes bog down and take years to bring to a resolution so I don't think it's an accident that this was achieved so quickly Well, you know this is a moment that everybody is stepping into in extraordinary ways and putting aside some of the old drama that comes with those dialogues and really working together in a unique and special way.

But I really want to thank all the county staff who really dug into this and spent an enormous amount of time to make this happen. And the timing couldn't possibly be better. Here we are exactly the day after the governor gives us the go-ahead ready to go. That can't be said for a lot of counties around the state who were not prepared in advance and didn't do this work in advance and didn't get the community buy-in that I think helps persuade the governor and his team that we really were ready, that we had done our homework and we had prepared.

Are there questions for staff? Is there more to the presentation? Okay sorry.

Thank you, Mr. Chairman. It certainly was a tremendous team effort. We did want to take this moment and sincerely thank the stakeholders. They are truly our economic cornerstone for all of their time and their effort that they put into this. There were 27 roundtables over 350 participants And the roundtables included 10 cities and community service districts, 14 business and industry sectors, a thought leaders group, and two community-based and labor organization groups. We are very thankful for the time that they provided us.

Okay, the third and final section of the guide is the readiness and containment plan. The plan is critical in showing the state that Santa Barbara is prepared and ready to accelerate through reopening and to support the county's attestation. This details how the county plans to consider the following testing contact tracing protecting their vulnerable acute care surge essential workers community engagement and a relationship to surrounding counties The guide is available and feedback can be submitted online at the ReadySBC.org website, and as a reminder the guide is a living document and will be updated online as needed to conform to state and local orders.

The recommended action for this item is to receive and file the RISE Guide. We would be happy to answer any questions you have. Thank you.

Thank You Ms. Anderson. Are there questions?

Supervisor Williams Well, I think that one of them that's most important for businesses that are trying to prepare to reopen is whether we will have on SBC the self-certification and when we will have that up so that at least if they're not ready, if we're not ready to have it submitted, at least they're ready to walk through the steps because in some cases there will be need to be alterations to the business to comply with the guidance. So we want them to be able to walk through the steps today or tomorrow or as soon as we can.

Supervisor Williams to the Chair, thank you. Excellent question and if you could just hold on for a few minutes Dr. DiRenoso and Terry Mosnick have answers to all those questions And

if

there's no more questions on this, Dr. DeRinosa and Terry have another presentation to talk about the attestation and then to answer Supervisor Williams' specific

questions. I don't

know where this one comes in so it's in the RISE document so I just kind of want to ask this question. One of the preventative strategies was quarantining travelers from high infection areas And I was just curious how we plan on doing that or who would monitor that?

Welcome Dr. DeRuonoso, you didn't even get a chance to sit down and the questions are coming already.

Supervisor Lovenino through the chair so that would be something that the Public Health Department would do similarly when the pandemic started we were notified by CDC as well as CDPH when we had travelers coming in to our area from China, from Italy, from all the hot spots we get notified. And so when we get notified, we start the quarantining contact tracing process and we monitor them until they have gone through the quarantine period.

Wow! I didn't know that. So if somebody is let's say traveling from Italy and they want to come to Santa Barbara When they purchase a ticket or whatever, somehow you get notified?

So yes. We get notified through the CDC and through CDPH. Wow. So you can't travel unnoticed.

Okay. So then we would quarantine them here or we just check them out here?

So typically, we get the contact information. We trace them and we interview them, ask where they're staying, make sure that it's a safe environment free from further exposure and we monitor them during that 14-day quarantine period.

Okay is there a federal Is there a ban right now on travel from those areas to us?

I don't believe so.

Okay, thank you that was very informative.

Any other questions before we begin the second part of the presentation? Okay Dr. Duranosa

So I know the exciting thing is you want to hear about the attestation plan. However, if I could take a few minutes to set the context and go through the numbers locally before we get to the exciting part.

It's all exciting.

And so to begin with, I'd like to talk about the COVID-19 numbers in our county. Typical slide that you've seen week to week as of today, as of Monday we have 1496 total cases and of that, 64% are active and 35% are recovered at the rough number of 526. So again, the bottom two lines are hospitalization and death. And it is very minimal. Hospitalization at 43 cases still hovers around 2.8%, and death at 11 cases is less than 1% at 0.7%.

This is a graph that describes the disease in our community. So I want to just pause and explain this because I think that it may not be as clear. So on the x-axis, when we look at 518 and we see the 74, so this light red line is a two week, reference two week experience in Santa Maria. So when we look at 5-18 that does not mean that it 74 is the number of new cases on that date. It is two weeks from the 18th back and so on and so forth. So this is a really good picture of the history of the disease in our county And what is worrisome is again the top significantly, the presence of disease in Santa Maria. So what this means is that we are now going to pivot and work with the Santa Maria community Santa Maria elected officials and residents to understand why the high incidence of disease in Santa Maria, and come up with some creative solutions.

Whether that be increase in health messaging, looking at the policies in place, looking at the systems in place, looking at the environment really towards the goal of decreasing This ever-increasing slope. The other three heavy hitters are the light blue line is Lompoc at 18 and the dark red down here is Santa Barbara at 16. The remaining geographic areas down here, at the bottom range from 0 to 4.

This is a depiction of our hospital census. And of the 43 COVID-19 patients hospitalized, 29 are in medical surgical beds and 14 are in ICU. So in comparison this is a fairly stable environment. 43 cases may seem a lot but within the context of our hospital capacity we are well within The management of hospitalized cases. This is a reminder that this is part of the governor's resilience roadmap, we are in stage two with lower risk workplaces, with curbside retail happening several weeks ago, with manufacturing and logistics already opened. And the rest remains to be seen with our attestation process.

Stage three, you've heard this morning is a higher risk workplace environment such as religious services, movie theaters, more personal services. And at the stage four is the end with the reopening of the highest risk workplaces and environments such as concerts, conventions and sports arenas. As I mentioned, we started with the state in stage two. We can move quickly through the initial stage two if we meet the state's readiness criteria. However, really wanting to underscore that we have to stay in stage two if we get attestation. We cannot absolutely cannot move into stage three until the governor moves the state into stage three.

So exciting news, we meet the variance criteria and so if we through the process get approved or get posted I should say it's not an approval process is a posting process. We will have destination retail including shopping malls and swap meets reopening. Personal services, such as car washes and tanning facilities. We can have increasing office-based businesses reopening and dine in restaurants reopening but however bars and gaming areas are still not permitted in stage two. And then lastly schools and childcare facilities. Childcare facilities expanding beyond just for the essential workers.