Thread by @emily_hoeven

.@GavinNewsom: "Our strategy of containment began with repatriation flights from China. Then mitigation strategies with stay-at-home orders, physical distancing. We then started to move to phase 3, surging our hospital and alternative care systems to meet potential demand."

"This included protective gear and staff. The next phase, the phase I will speak about today, is the phase I would frame as an optimistic phase. We move from surge and we transition into suppression --> herd immunity --> vaccine. We do see light at the end of the tunnel."

"It's also the most difficult and challenging phase of all, and that says a lot. But this phase is one where science and public health, not politics, must be the guide. We must be open to argument, interested in evidence, not ideological in way, shape or form."

"Today we want to create a framework and pull back the curtain on those private conversations and make those public, so you get a sense of the questions we're asking before we can move out of the approach where everyone's staying at home, to a more individual approach."

"We have a framework that will guide our decisionmaking, and it's predicated on the ability to do 6 things. Most important is our capacity to expand our testing, and address tracing and tracking of individuals, and isolation and quarantine, using technology and workforce."

"Second: Maintaining our vigilance, protecting the most vulnerable from infection and spread, primarily our seniors and those with immune issues, and homeless. Three: addressing ongoing needs of hospitals and alternative care delivery system to meet potential surges."

"Four: Continue engaging academia, research partners, those on the frontlines, companies like Gilead and Genentech, hospital systems, to make sure we're advancing protocols on therapeutics, as we bridge towards herd immunity and vaccine within next year or so."

"Five: redrawing our floor plans. A responsibility of our businesses so that we can practice safe physical distancing within the premise of a business, around a school site, other facilities. Quite literal strategies, guidelines, expectations on physical distancing inside."

"Six: Our capacity to reinstate more vigorous controls. It's a process that will perhaps be the most challenging, if we lean in but then have to lean back out and toggle between stricter and looser interventions as data come in and health concerns become obvious."

"I'll talk more about what normal will look like, because normal is anything but, to be honest and sober. I recognize that you individuals - you have bent the curve in CA. The models have changed because of your behavior. That allows us to make public these private conversations"

"We do so soberly. Today, we had a record number of deaths. 758 individual stories torn apart, 71 lost their lives since yesterday. We are sober that we're still seeing an increase, modest though it may be, in hospitals. We're not out of the woods yet, we're not spiking the ball"

"But this can't be a permanent state, and it's not. We recognize the consequences of the stay-at-home orders have a profound impact on economy, your future prospects, your household, if you're struggling to reach your dreams. We recognize it impacts all of us differently."

"It impacts those with low income different than those of means, it impacts different communities differently. And of course, the impact to the health care system. They've decompressed their own system, and that's had a profound economic consequence for them."

"This could create more health problems down the road if we continue to delay elective surgeries that eventually become required surgeries, if we delay preventative care appointments and screenings."

Dr. Angell: "Our focus has been on making sure our care delivery system is there if we need it, especially in a time of surge. We've started to bend the curve, with respect to hospitalizations, we're below the line. But we can't just let everyone back into the streets."

"If we remove all interventions, we surge again. So how can we modify our existing orders to make it easier for all of us but also make it safe for all Californians?"

"1. We need to ensure ability to care for sick in hospitals. As we make it possible for ppl to move around more freely, infections could increase and raise demands on hospitals.
2. Prevent infection in people at high risk for severe disease."

"3. Build capacity to protect health and wellbeing of general public. Ie, enhancing contact tracing.
4. Reduce social, emotional and economic disruptions. Where we are now with stay at home orders, while important, they simply can't be sustained for a long period of time."

"They have an impact on economy, on poverty and on healthcare. We need to realize that as we change modifications, all the areas that impact health, those are addressed so we improve overall health and well being."

"6 indicators for modifying stay-at-home order. It's not just check it off and move on.
1. ability to monitor/protect communities through testing, tracing, isolating, support those who are positive or exposed. We need more testing for those who are symptomatic."

"And do we have ability to identify contacts of those who test positive, to reduce further transmission? More opportunities for movement --> more infection."

"2. Ability to prevent infection for those at risk for severe COVID-19 cases. There are over 6 million older adults, and everyone deserves support they need to stay safe. Do we have a plan to contain outbreaks in congregate facilities, like nursing homes and jails?"

"3. Ability of hospitals to handle surges. Do we have enough supplies, ventilators, beds, staff if there's a surge? Can health care system handle both COVID-19 and other critical needs? i.e. elective surgeries, postponing other appointments."

"4. Ability to develop therapeutics. Important for CA in particular bc so much innovation here. Unique opportunity to collaborate. Important especially in absence of vaccine, allows people to recover more quickly and not need to go to hospital."

"5. Ability for businesses, schools, child care centers to support physical distancing. Need to develop practices and guidelines for health checks when people enter. Is there enough supplies and equipment to keep workforce and customers safe?"

"6. Ability to determine if we need to reinstate stay-at-home orders. Are we tracking the right data, and can we quickly communicate need to reinstate these measures? We need to know if we need to take a step back."

"This is a conversation about modifying, transitioning, to a point in the future when COVID-19 no longer poses a threat. It's not about going back to how it was before, it's going forward, but it will not look the same. Different ways we do everyday work."

"Restaurants likely will reopen, but with less tables to keep people safe. Face coverings will likely become common in public. Need to use all interventions we have for added protection. New opportunities to support mitigation, like creating better contact tracing."

.@GavinNewsom: "When will some of these orders be lifted? You saw the framework for guiding our decisionmaking. We have a state vision, but will be realized at the local level, counties and health directors have a profound and outsize influence on our ability to deliver."

"Other Western state governors will likely join our broader regional protocol so we can go together and get things right. But there's no light switch here. It's a dimmer, toggling between more and less restrictive measures, more individual responsibility."

"Up to individuals to wear face coverings and physically distance, quarantine if you test positive. More enforcement along those lines as we blend population and individual-based solutions. It becomes incumbent upon all of us to increase our vigilance and align our strategies."

"We did not manifest the worst case because we all did it together. We moved quickly and thoughtfully as a state. As we transition out of this, we need to take same spirit of collaboration and unity as we process into this next phase. But this is an imperfect science."

"There's no playbook. There are examples, we're incorporating those best practices and considerations. The new normal: Normal it will not be, at least until we have herd immunity and a vaccine. You may have dinner out, but with a waiter wearing gloves and face masks."

"Where the menu is disposable, where there are half the tables as normal, where your temperature is checked before you enter the establishment. These are likely scenarios. Same for other businesses. Retailers will have to redesign businesses and procedures."

"But we have a chance to think anew and act anew and find new approaches and strategies to get things done. More teleworking, more distance learning. We want to get kids back into schools. We're committed to doing that. This school year is over, but the fall, beginning convos"

"Can you stagger times kids come in so you can reduce physical contact? Reduce congregate meals? Dressing issues related to PE and recess? These are the conversations we'll all have over next months. We intend to have them publicly with you on a weekly basis."

"So when will we experience a loosening of the stay at home order? For today: continue to hold the line on the stay at home order so we can see the curve continue to bend. If we see this over the course of next few weeks, and see infrastructure develop we laid out..."

"We're creating and training Check In staff to tracing efforts, to create a Check In Corps that will provide thousands of points of contact in terms of tracing capacity. With AmeriCorps, and other programs. It's challenging, but it's not. We did on TB, measles, ebola."

"That's part of the infrastructure that's required, not just trendlines, to loosen orders in a precise and targeted way, using data and science on a daily basis to toggle that dimmer and get exactly the appropriate lighting and transition to herd immunity and get economy roaring"

"We are this week going to announce our new economic team. You'll hear more about how we will jumpstart every sector of our economy and expand the definition of essential businesses and expand our capacity to scale down stay at home order."

"In 2 weeks, if we see a continued decline in hospitalizations and ICUs, and we see this workforce and infrastructure and PPE needs, in the first week of May, ask me the question then and we'll be in a very different place about timelines. We can't get ahead of ourselves."

"I don't want to make a political decision that puts people's lives at risk and ultimately puts the economy at even more risk. That's the sober reality, but it's a reality that provides a little bit of light and a little bit of optimism that it's not a permanent state."

"Total ICUs yesterday declined by 0.1%, 1177 individuals total. Modest increase of 3.6% in hospitalizations. These numbers guide most of our decisions. The number of PUIs - person under investigation - also start to come down. It's a combo of factors that's encouraging."

What about Trump saying power rests with him? Will people be complacent?
"I'm not going there, we just want to get stuff done. And I don't want to have private conversations with friends and family that I don't have with you. I want your trust, I may not have it yet with all..."

"...But I want to share these conversations with you. It's important to let folks know we're not in a permanent state, as long as we don't make the decision to pull back too soon. I want to caution everyone of importance of staying at home to get thru next few weeks."

"Not just the curve flattening, but declining, and give us a few weeks to get this infrastructure in place, and then I can be much more specific about a blended approach to rolling back stay at home order."

Will public health be different now?
"I haven't been timid about desire to make investments in health care delivery system. This has only reinforced the importance of that system. Ppl that came into pandemic and didn't have quality care aren't well served thru pandemic."

"If there's any lesson in all of this, a big smile, a big thanks, a how are you doing, to the frontline health care workforce for their incredible heroism. And an appreciation for the importance of rebuilding our health care delivery system."

How does summer look different for Californians, and school year in fall?
"The prospect of mass gatherings is negligible at best until we get herd immunity and a vaccine. That's not in the cards based on current expectations. Things can change, but Jun, July, Aug, unlikely."

"The school year: we need to get our kids back to school, educated, and deal with their mental health and parents' mental health. We need to do it in a safe way. We will build out a robust team for schools to answer the question. We hypothesize different scenarios for meals, PE"

"And deep sanitization of schools, park benches, businesses, sanitation within building systems."

How much testing do we need to meet the threshold?
Ghaly: "We're beginning to move beyond just having tests available for the sickest people and front line workers, beginning to expand community testing sites throughout the state. Don't have a clear target number."

"At the end of the month, we want 10s of 1000s of tests per day. We hope serological testing will be available soon. Once we hit that level, and we know individuals w/ symptoms can be tested and have rapid results, we can begin to modify orders responsibly."

"There are other things beyond testing that can help us. Hospitals have info, people on call lines, etc. So the concept of testing, tracking, tracing, isolating, quarantine, we have other methods to expand our ability. The next few weeks, we can talk about serological testing"

.@GavinNewsom: "That's our roadmap, our thresholds for reaction. I hope we're all sober about the reality, but have some optimism. I certainly am feeling more optimistic bc of all of you. No politics, no partisanship, just neighbor to neighbor. You've met this moment."

"But it's all conditioned on us staying the course on the current road we're on. Stay at home, and practice physical distancing, and never forget that you're not alone. Reach out to one another and stay safe, be healthy, continue to practice physical distancing."