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COVID-19 Update from Yellowstone County Officials

good afternoon and thanks for joining us I'm Bruce Ricci growth occur ona virus outbreak continues to change by the minute with four Montana cases released last night three of those were right here in Yellowstone County there were all people in their 20s we're gonna go live now to Riverstone health where Yellowstone County Health Officer and Riverstone health president john Felton is meeting with the media after making some announcements of amendments let's go ahead listen to him right now including three more Yellowstone County residents bringing the total of Montana's testing positive to 15 and the total of Yellowstone County residents to five what makes today's announcement particularly sobering is that two of our community members who tested positive today or yesterday work in health care it is our understanding that these individuals were exposed to Coba 19 outside of the workplace they were not exposed in their health care settings in addition to the two people working in health care the third positive yesterday is a worker in the Yellowstone County Detention Facility as with everyone who test positive for Kovan 19 our public health nurses are following up with these individuals to learn more about where they've been their contacts and other pertinent information that will help us in tracking this disease everyone who's tested positive for Cova 19 in Yellowstone County is at home and we continue to wish them well as they're in their isolation period as they recover from their illness it is true that older people and those with underlying health conditions are more susceptible to the more severe cases and consequences of kovat 19 but most the people were seeing in Montana who tested positive are younger than 50 this disease is having serious ramifications across our entire nation not only is it affecting that the health of our our nation and its people it's also affecting our financial health the only thing that can bring us closer to the road to recovery is to slow the rate of infection and one of the ways that we can do this is by taking action to spread limit the spread of disease by limiting the contact between people in my capacity as y'all Stone County Health Officer I am announcing today the extension of the order I her this week on Monday March 16th the new order is effective 8:00 a.

m.

Mountain Standard Time tomorrow March 21st and it extends through 8 April 11th or April 10th sorry April 10th 2020 at 11:59 p.

m.

as always this order is subject to change based on change in our very dynamic situation in a review now the elements of the new order which again goes into effect tomorrow morning at 8 a.

m.

and will remain in effect through through April 10th all restaurants food courts cafes coffee houses bars brew pubs taverns breweries micro breweries distilleries wineries tasting rooms special licenses licensees clubs and casinos are subject to this disclosure all foodservice operations as before are subject to the closure with the following exceptions those restaurants that serve dine in customers food services may continue and are encouraged to continue to provide takeout and delivery services food service establishments that serve a population that depends on as one of their sole sources of food including university dining halls or cafeterias and hospitals of care facilities room service in hotels crisis shelters or similar institutions airport concessionaires and any facilities necessary the response to the emergency all of which may continue using necessary only personnel it's also significant expansion of the order all fitness operations having indoor group programs including but not limited to health clubs health spas aquatic centers hot springs fitness centers gyms fitness clubs dance studios gymnastic studios or schools yoga studios and the like this does not include personal one-on-one training or instruction in such locations provided that no more than five persons are present and there's faced at least six feet apart in any one operation at any one time in addition all massage and massage therapy establishments practices and centers all theaters and entertainment venues whether displaying film live video or other format of entertainment and whether indoor or outdoor all group activity and recreational centers including but not limited to indoor arenas bingo halls music halls bowling alleys and ice skating and roller skating rinks all indoor play areas including but not limited to trampoline parks indoor climbing centers discovery centers and other child related entertainment venues and activity activity areas present in other venues all church and religious services and group activities held in public venues including all congregations certain services at places of worship including churches synagogues cathedrals and the like and all funeral establishments and activities including graveside and memorial services I'm aware that the governor issued an executive order earlier today temporarily closing essentially the same list of establishment that my order does I respect the governor's decision as to when his executive order will end but in light of health care workers drink testing positive I have chosen even more aggressive in my actions to slow down the spread of kovat 19 I wish things were different there really is no way to help keep the community healthy and our health care system able to care for those who will become ill other than to spread earth slow the spread of this virus unfortunately temporarily temporarily closing places where people tend to gather in large numbers is the only way that we can help those who care for us to do so this is not business as usual I don't know when we'll get to our new normal but I know that we must get there temporarily closing businesses will help us recover we have provided guidance to the complex and fast-moving food service establishments about steps they must take now to be ready for the new normal when we can reopen dine in serve food services many other local businesses have already adopted new operating procedures to enhance social distancing and to protect themselves and their customers those businesses affected by today's order need to plan now for how they will change their operating processes so they can reopen in ways that protect their workers and their customers I applaud and thank our local businesses who take seriously and act to contain this threat unprecedented in our lifetime to our collective health and well-being before I ask our unified health command hospital partners to describe the seriousness of this situation not only for people infected with Cova 19 but also for the healthcare system I would like to introduce Gina larvik with the Yellowstone County Attorney's Office in the last week many of us how it is that a health officer can close businesses without those businesses violating rules Gina will help us understand the powers and duties of local health officers good afternoon my name is Gina larvik and I am the chief in-house counsel for Yellowstone County as mentioned I know there are a number of questions about public health officers how these orders come about and I'm going to attempt to address them as best I can I'm also going to attempt the feat of being the first attorney in the history of the world who actually means it when I say I'm going to be brief I promise state law very clearly provides for a public health officer and what that officers duties are these orders I will say are not done lightly and they're not done without a great deal of research and a great deal of authority that that is as I mentioned clearly laid out the legislature wanted the health officers to be wholly independent separate from elected officials and this is both to maintain independence but also efficiency as you know public elected officials have a great deal of process and procedure that they're obligated to take part in and so the legislature intended for this public health officer to be able to make fast intelligent decisions based on the needs of the public as a whole the public health officers duties and powers are specifically stated and for those who are particularly interested it's in Montana Code Annotated section 50 – to 118 there are five different duties and responsibilities that are laid out and generally they are that the Health Officer can inspect for conditions of Public Health importance and to order compliance with those to report communicable diseases and most importantly to us here to Ana quote take steps to limit contact between people in order to protect the public health from imminent threats including but not limited to or during the closure of buildings and facilities where people congregate and cancelling events the legislature very specifically provided for the types of orders that we're dealing with today the other duties and responsibilities of a public health official include reporting communicable diseases establishing quarantine and isolation measures and pursuing actions with the court if necessary and so here in Yellowstone County mr.

Felton makes these decisions and does so with a great deal of resources he has of course and as you'll hear the resources of both hospitals as well as his own staff as he's CEO of Riverstone health a couple of brief things I did want to clarify about our public health officers orders they're not impacted or reliant in any way on the Yellowstone County or City emergency declarations those are specifically to allow our government to obtain funds if possible and if necessary and are wholly independent of any of the public health officers orders and the final note I wanted to touch on is mr.

Felton's orders are enforced by both the sheriff's office and the Billings Police Department and that it is a crime to violate them I want to specifically on my own be sure to thank Sheriff Linder and Chief st.

John and all of their employees for their tremendous efforts as this is uncharted territory and and they've been doing tremendous so I want to urge our community to remember that every one of these officials talking to you is also a member of the community and has families and friends here and does not address you lightly in any way so here to talk more about the virus itself dr.

Michaels hello I'm dr.

Michael blush I'm the chief medical officer at st.

Vincent healthcare as well as a almost 40 year career emergency physician first of all I would like to say that one of the things that I'm very proud of as we address this current medical pandemic is that we are working together in this community with Riverstone health with our public health department with the Billings Clinic and with st.

Vincent healthcare so that we know that all of us are working together to meet the medical needs of the community because none of us can handle this alone and so really appreciate that we are working staying in alignment in trying to manage this very unknown situation as we talk about the Kovan 19 or the novel coronavirus there's a lot of information and misinformation out in the public about what this thing really is and in fact I walked into my own Hospital had one of my own physician colleagues asked me just a week ago don't you think that this is all a result of this being in an election year and I was I was really kind of stunned because the issue really is this is a brand new virus that jumped from the animal world into the human population we have no immunity that we have developed over time to this so none of us in this room have immunity to this virus it is very likely that well over the majority of the people that are listening to me sitting in this room will contact this virus and will acquire the illness and I'll let dr.

merchant talk a little bit more about the illness here in a minute but the fact is this is real and it becomes a numbers game for us and and the number of potential illness and so I did talk about this the last time I was up here and I want to reinforce that again today and I'm sorry this is you know there's not a good place for me to rest this here sorry but the fact is we still have a chance to prevent this overwhelming our health care system and the things that we're talking about making sure that we're doing the constant hand-washing making sure that you you take care of those things again as I said before if you sing sing through happy birthday to me twice that's a good 20 seconds of the soap and water and soap and water kill this virus we know that make sure you're cleaning the surfaces that you constantly touch when you're walking in hallways or in the stairwell stick your hands in your pocket carry things with you carry your clipboard carry things with you so you're not grabbing things and touching things use your hips to open doors where you can't the social distancing and staying away from other people and I know that's hard but those are things that really are important to limit the spread so we don't have overwhelming infection you do again still want to be covering your cough making sure that you are protecting others around you and then if yours LLL stay home and do the self monitoring the self quarantine isolation that's required another question that has come up is what are we as healthcare providers and healthcare institutions doing to protect the associates that work in our institutions and I would tell you that we are having these are associates monitoring for symptoms of illness fever cough shortness of breath ask him to stay home work through our occupational health departments to get appropriate testing and and recommendations of treatment the PPE use is strict and making sure that we're appropriately protecting them in the right situations and PPE you know both of all of us have been kind of conserving our PPE and doing things to make sure that we can get through any potential shortages as we come forward doing the cleaning that we need to do at home cohorting patients so we're trying to keep these patients and similar locations so same group of staff and other people that are very familiar with the processes to care for them the other thing I would tell you about is there would be things personal checklists that people can do and so as we're doing this as the associates are making sure that they're reviewing the appropriate donning and doffing instructions about how to apply the PPE how to put it on how to use it when they get into their vehicle at the end of the day before they touch anything inside the car have hand sanitizer there use that hand sanitizer before they start getting into the car and then there's actually jokes out there about stripping on the porch I'm not asking you to strip on the porch but I am asking you to strip as soon as you get inside your house and then take those clothes that used as your work clothes put them right in the washer so that they get washed right away with soap and water to kill them and those are things that our associates can do in terms of ways that they can can help protect themselves and things we're doing to help protect them there's a lot more involved in all these things but at this point I'd like to actually turn it over to dr.

Bob merchant Bob has been a colleague and a friend for 30 years currently he is the chief medical officer for Billings Clinic and he is as I am 30 plus years of pulmonology and critical care experienced physicians so so thank you in like like Mike said I'm pulmonary critical care that means I specialize in treating lung disease and also taking care of it people in the ICU I've lived here for almost 30 years now I can tell you this is a community that I love is just an absolutely phenomenal community and we are in unprecedented times in the past 30 years I've not seen threats to this community like we're seeing right now and I can't tell you how grateful that I am that we have the experts at our County Health Department our mayor who are willing to understand these issues and take the needed actions to help out our community to protect the people that we care about so much to protect you all to protect us I did want to share a little bit about what this virus is again this is covet 19 is the illness that we get some people call the virus kovin 19 also and it's it's a new illness it's a disease that first cropped up in December so this is something that we are just learning about live an incredible society that's been able to within a month we have the gene on identified we're mapping out we actually have a virus a vaccine that's been developed but there's gonna be a lot of testing six months a year before we know if this vaccine is works and is released to the public so it's important that we understand what this disease is there's confusion though because this disease can seem like the like a cold it can seem like the flu in fact the symptoms are very similar to a cold or flu and when you see patients that have disease you would think that yeah they've just got a cold they've got the flu it is more severe than that though and that's the problem that 80% of people do very well and they just have mild symptoms there are some people that don't have any symptoms at all but then there are some people unfortunately that get critically ill from this and others that get severe disease so we're talking maybe 5% of the people that come down with the illness end up in our ICU potentially on a ventilator and some people with even all our modern technologies some people sir come to it the rate of that happening is about 10 times influenza so influence as a disease we take very seriously this is something that's even more serious and that's why we're worried about combined with what Mike was talking about this is a new disease with none of us as of today have immunity this is what scares us in the medical community like I said we've been we're very fortunate in the society that we have that we're able to develop understanding of this as quickly as we can we're reaching out each of our our hospitals are reaching out to each other I've got Mike on speed dial we're constantly talking to each other learning from each other but we're also learning from our colleagues in Seattle in Italy in China who are further along in the epidemic and our understanding the consequences and what they're telling us is there if you don't take really aggressive measures to do the things that mike says to do the things that that the Public Health Department is doing to potentially quiet the virus down or an even if you do there's a chance that it could overwhelm the health systems and we are preparing for that we spent the past several weeks actually past a month or so anticipating this some of the majors that we're taking where we have closed our hospital to elective surgeries and st.

Vincent's is also doing the same we are also deferring elective clinic visits we want to be able to do that for two reasons one provide social isolation not bring people into areas of disease where I'm sure where disease can spread but also to make sure that resources can be reallocated what we're doing is we're taking those professionals that are would have been doing that work and assigning them other jobs we are getting ready to expand our ICU we've got increased ventilators availability Mike tells me they're doing exactly the same thing we're trying to match and make sure that we're achieving the same goal so that we can care for the entire community together so there's been a lot of work that we've been doing to prepare for this we're hoping we're going to be able to flatten the curves so that we don't see the type of illnesses that type of overwhelming eye effects on the health system that have been seen in Seattle that have been seeing it that are being seen currently in New York that are seeing in Italy but we need to work collaboratively together so yeah this is really unprecedented times I don't it's definitely not a time to panic because we've got a lot of information that were we have that gives us insights as how to manage this but it is time to take this very seriously and I can't tell you again how appreciative I am that our public health department is taking this seriously that our mayor our city is taking this seriously and our the entire medical community is working collaboratively so what I'd like to do now is open up for questions I'm sorry sorry my apologies I didn't know the sequence so thank you all so I think what you just heard from from dr.

Bush and dr.

Murkin is really that the option of doing nothing is cannot be an option we can't rewind the clock we can't go back to before this novel coronavirus is identified and and pretend like it's not going to happen all we can do is do the very best we can to slow the rate of infection one of the ways that we can do this is to extend the Health Officer order until April 10th of 2020 like the initial order that I issued on Monday this order is subject to change as we go through the situation and and the dynamics change this is not easy it is not lost on me that the consequences of this order affect not only your friends and neighbors they affect my friends and neighbors were a community and we're all being impacted by this virus and by the response to try and prevent its its widespread I applaud and appreciate governor Bullock's leadership and in waiving the waiting time for unemployment benefits and for making available low-interest loans for affected businesses and we also know that aid from the federal government is is forthcoming if conditions change and and I'm able to lift this order I will do so in the meantime I urge everyone to stay home as much as you can to wash your hands thoroughly and often avoid touching your face avoid handshakes and hugs cover your cough and sneeze with the tissue and frequently clean those high-touch surfaces like desks and tabletops and things like that with the disinfectant on behalf of our entire unified health command I wish all those Montanans infected with Cova 19 especially our fellow health care workers a speedy recovery as I've said many times from from here this situation is truly unprecedented we are in uncharted waters but all of us need to remember one thing this will end we're among the most resilient people and I'm the most resilient nation on the planet we survived civil war world wars pandemics economic disaster and terrorist attacks by working together we will survive and we will again one day no a life dominated by family and friends and activities that are not related to covert 19 I'm confident that one day we will look back at this time and remember how we came together as a community to protect and preserve the way of life that we all love with that will now open it up for questions Kaleigh you had one so the question was how are we confident that the exposure for the two health care workers was outside the the health care setting the process of following up on a confirmed infectious disease is to identify contacts that a person had and when we identify the a contact with a known infectious source then the the far and away likelihood is that is the source of this infection you also look at the time line between when that contact happened and when symptoms begin to arise so all those factors together clearly indicate that these two individuals were infected outside their work setting they appear to be connected with the board of regents meeting that several others have also been associated with you know as a matter of privacy we're not going to get into where these individuals work what they do it's a it's a pretty small town and and everyone deserves their privacy so we all get into any details ever about about patients beyond the most generalized details the schools are currently under governor Bullock's order and will continue to work closely with them to determine what happens when that order expires much depends on what the governor chooses to do as March 27th Rises so we're in very close contact with the school we work closely with them but in terms of what I'm six that's really at this point it's a governor's question the temperature raised in the spring I think really at this point we don't know this is a virus that as as was said by doctor merchant and dr.

Bush the first cases were identified three months ago so we don't have a history of what happens when when temperatures change when seasons change we don't know how seasonal it is and I think that's that is really part of the understanding of what it means to be in a truly unprecedented situation is this is something that is brand-new and there is no experience to tell us there was a question here yes so I'll speak to the the second question of my hospital colleagues speak to the first as the unified health command we all work closely and we share information to understand what our capacities are what our resources are and we view those as a community and so that's how we keep that that's how we try to maintain a community basis of understanding in terms of specifics related to capacity I'll turn that over to my hospital colleagues so the capacity question is an excellent question but I'm going to reframe it a little bit because really what we're doing at both our facilities and around this region is preparing for caring for respiratory problems we are in the process of the reason that we're closing two elective surgeries and other cases is so that we can really have that capacity for these respiratory problems and so it's really I think we've got plenty of Hospital capacity it's more of the ICU beds and both our organizations are looking at potentially more than doubling or tripling our ICU bed capacity and then we are also looking at our regional partners our critical access Hospital partners to take care of more of the non respiratory problems that can be taken care of at those other facilities and just to build a little bit on what what bob was talking about it's not just the physical capacity or the number of ventilators we have but it's the capacity of our staff and again this is unprecedented times and I think we're creating different care models so that people that wouldn't normally be taking care of these patients actually have what they need to take care of them under a team setting other kinds of ways of looking at it and that's something that we're all doing and talking about so that we can add actually manage the needs of our community so again it that's a function of universe of the unified health command we have a an overall inventory the key pieces of personal protective equipment that are available through our our three major organizations we also monitor if you will the burn rate how quickly are we going through that those materials with the the county declaration of the emergency that has allowed us to get into the process of identifying the state stock stocks that are available and so we're working through the process of obtaining those providing information to obtain those additional resources it's really important to to remember that we need to look at this from a long-term perspective much as doctors merchants and Bush have talked about hospital beds the question really isn't do we have enough beds and ICU beds and personal protective equipment for today the real question is how do we how do we have enough to last through the long term and the answer to that is we have got to slow down the spread of infection so that we don't have mass numbers of patients requiring hospitalization and extensive use of those materials time is our friend in this and so our efforts throughout the community through the unified health command are really intended and designed to slow down that spread we are not going to stop the spread we need to slow it down and avoid those high high peaks of mass disease as we move forward is there a chance your order could be modified to address retail specifically grocery stores I would you know grocery stores are clearly an essential service people have to be able to get food so there there's some possibility that we may there may be you need to modify certain things but I don't see that we'd be in a situation of actually closing grocery stores that would that would really disrupt the food supply so dramatically that it would be untenable John a question I know you don't have a crystal ball but other communities have seen a consistent rate of increase and so there's sort of distance sitting in other measures and then that create an increase search the chronolock as best you can in the next week or two what would you expect would you expect to see a consistent rate of increase you know we we don't have much more than what we what other communities have observed and and there's some variability in that deep that depends somewhat on how aggressively you address these these prevention and measures their containment measures to reduce the spread what we would absolutely expect to see is more cases more confirmed cases we're doing more testing the virus is circulating we know that well the the two things that we need to watch very carefully are what is the total number of positive cases and in the radiant ratio of positive cases but also what's the burden on inpatient service we really need to watch those two things the pretty much every community ahead of us that will tell us that we have more cases coming we just need to expect that our goal here again is not to get to zero cases which would be wonderful it's not going to happen the real goal is to slow down that spread and avoid overwhelming our system and our resources like right now preparing for these patients so I'm going to larger than that over to to my hospital colleagues because they're the ones that need to make those patient decisions from a public health perspective we are working with the the governor's office in the State Health Department to ease that process to make it a little faster and a little simpler but in terms of the actual movement of patients my colleagues here can handle that one so a few different things that that play into that number one is a lot of these patients by the time they need to come to Billings to the care either of the hospitals here very well may be very sick and and need to be on breathing machine something like that and so you know we do have flight resources medical evacuation teams we have worked through FAA concerns and none of us own the aircraft that we fly and so we had to work with the vendors but those things have all been resolved so that we can transport patients with with aircraft ground transport again resources are limited in rural Montana and we'll have to work through that we've got some things we're discussing and talking about and then again I think doctor merchant was talking about this earlier that we have to be working with our rural partners so that we can support the work that they can do for certain patients in their own communities and then how do we support that and and make sure we're doing our best to take care of central and eastern Montana if there are no more questions from the media actually I have crooked 19 the British is meeting that you were talking about before the meeting is that the thing on a deal is that yes it is okay thank you all for coming we'll continue to keep you apprised as this situation changes all right we just heard from Yellowstone County Health Officer John Felton and two other doctors from each of our hospitals some very strong words they're the updated us on the corona of virus outbreak here in Yellowstone County five people have tested positive here in Yellowstone County two of those work in health care they were exposed outside the workplace we're told the third is a detention officer there at the Yellowstone County Detention Center Felton saying that the only way that we can get back to recovery is to slow the spread of this he says it is going to spread but it is imperative that we stop the the slow the spread of it he's so he's extended some closures with establishments and everything that now goes until April 10th gyms are included in that church services are now included in that as well so we're going to have much more on that coming up today at 5:30 on Q 2 News stay tuned for that and also for the CBS Evening News at 5 o'clock.

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