Thread by @CathJSweeney

I’m here today. Once I’m caught up some, I’ll start live tweeting.

Kary Cox is the director at Washington County Emergency Management, speaking to represent several local emergency managers. He said this is the worst disaster he's handled, but that mismanagement and poor communication has made it worse.

K. Cox: People and organizations were told that their local emergency management was their point of contact, but we were never told. It create a sense of distrust.

K. Cox: Procurement was a disaster. For example, at one point we requested from the state 500 N95 masks and we were delivered 100 surgical masks and some gowns.

K. Cox: Our state has some of the most experienced emergency managers in the country. We have some of the best incident command systems. "To my knowledge, none of those resources were used during this pandemic." We were seeing ad hoc versions instead.

In this thread, I'm referring to Washington County's emergency management director Kary Cox as K. Cox. There are other public-health relevant officials with the last name Cox.

Commissioner of Health Lance Frye is coming on now.

Frye: I'm not here to tell you how great the state department of health was when this started. "It was quite frankly a very dysfunction agency that had problems for years." We all came together, and the outcomes were better than expected "Overall, I think it was a success story."

Frye: I'm an OBGYN. I worked for OSU Tulsa. I got deployed down as the state air surgeon to be on the governor's task force. I then became appointed the joint surgeon for the guard, then through that response was eventually asked to be commissioner of health.

Frye: We saw what was happening in NY and Italy, we had to prepare for what we were seeing there. Original models showed 30,000 Oklahomans to be dead by summer. We expected the hospitals to be totally overrun. Army Corps came in to plan hospitals. We identified two sites.

Frye: We had no PPE. "You have to realize there was no PPE to be had. Everyone in the world was wanting it." You had to buy it and hope you could get it in 6 months. "I think we did incredibly well." The governor hired someone who 24 hours was researching, finding, vetting PPE.

Frye: When we were told we need to test every long term care facility, every employee and resident, "We didn't have the capacity to do that in the state so we had to reach out of the state." Others said they had the capacity, but then we overwhelmed the system.

Frye: The executive orders had to be done to stop nonessential businesses so we could flatten the curve and push it to the side to shore up resources in the health care system. Once we had PPE and a hospital plan, we opened the economy again.

Frye: Our state's HIPAA is more restrictive than federal law, so we couldn't share as much information and data at first. It limited what we could put on the dashboard, what we could share with emergency management locally. The AG issued an opinion that helped us loosen that.

Frye: There have been multiple issues that have come up. Sometimes issues fall between jurisdiction. For example, two students could be in the same school but live in different counties. Counties determine quarantine protocols, so they could have different mandates.

Frye: There are some problems that always exist in an emergency situation. "Communication is always a problem, and it's definitely been an issue in this response as well."

Nicole Nash, deputy general counsel OSDH: We needed the Catastrophic Health Emergency Powers Act because our privacy laws are so strict. It doesn't give explicit release permission to local public health agencies or responders. The CHE preempts the state privacy law.

Nash: We had questions about what data would could share with schools. We reached out to the AG. The CHE wasn't in effect yet. We were able to find a way to provide data and communication, but a law change would help.

Nash: One other area where we see some difficulty, the CHE requires us to interview infected, but there's no requirement for the infected to provide info. There could be some improvement in the law there. (Reminder this is a LEGISLATIVE study. They'd be the ones to change it)

Frye on the comment about not using the state's experienced emergency managers: "They probably would have responded well to a tornado or a storm." This is different. It is sustained. That's why we worked with the military and other officials to establish our own incident command

Deputy Commissioner Community Health Services Keith Reed: Instead of using temporary workers, we brought in the military. It was immediate capacity building. It helped us keep our heads above water at the beginning and continues to today.

Reed: My history is in biomedical terrorism and pandemic planning. In my experience, that planning has been centered on federal guidance. It all comes back to the Strategic National Stockpile.

Reed: "The SNS (Strategic National Stockpile), quite frankly, did not hold what we needed to respond. That threw our plans off." Those supply chain issues also contributed to challenges with communication between response agencies. So did having to short-notice pivot on policy

Reed: We put a lot of effort into our planning for influenza pandemic, but this event didn't fit the expectations in the plan. The supply network made it impossible to stick to the plan. We're not going to point any fingers. (Sounds like they could point to the feds but aren't)

(The feds manage the Strategic National Stockpile, and it was depleted. That is a central theme in Reed's testimony, that its depletion ruined a lot of the prior planning the state could have implemented.)

Reed: This has exceeded every emergency I've worked to respond to in my career. It's global. We've never had a global supply issue during an emergency. Demand on the other side of the world affected our ability to respond.

Frye: Hospital capacity is a relative term. Hospitals said they could plus up 40 percent. They said that they felt like they needed to save 30 percent of their capacity for noncovid patients. This was the first plan, when we thought we were going to be overrun like NYC

Frye: They told us then they could handle up to 70 percent of their beds being covid. Now it's about 20 percent. "You can see how we could feel, on our end, like we're not overrun."

Frye: Then we stopped using plain bed numbers in the plan and started using staffed beds. That wasn't perfect either. "A great day for a hospital is to be at full capacity. They don't want nurses staffing empty beds." And numbers look worse with less staff.

Frye: We want you to manage your own hospitals, but the people of Oklahoma want a guarantee you're going to do what you need to do to prevent overrun hospitals. That's why we implemented triggers.

Matt Stacy, who is overseeing the surge planning for OSDH: One of our biggest priorities is ensuring Oklahomans are treated in hospitals, not field hospitals. We have plans to put beds in the Cox Convention Center. "That's not optimal health care." We want people in hospitals.

Stacy: We are pushing back on the idea the state has to manage and explain hospital data. We see it but don't build it. They're self reported. We told hospitals, "You control the input, you control the data. Manage the data."

Stacy: Regions are important, but there is context there. As of Friday, 25 percent of the covid patients in OKC hospitals weren't from that region. Yes, 900 hospitalizations and a trend of growing, that's concerning. "But we see a lot of room in hospitals to cancel procedures."

Stacy: "I think you're going to see some of the messaging change." Hospitals are going to stop scaring Oklahomans and start encouraging them. They all said they haven't implanted their own internal surge plans. (Hospital Association Pres Patti Davis tells me the opposite.)

OK obviously that's over now.