Holcomb and team provide updates on COVID-19 response

As a reminder of Friday’s announcement regarding the state’s two-week extension of the stay-at-home directive, Gov. Eric Holcomb clarified some items in the expanded order this afternoon during his daily briefing.

The directive will extend until 11:59 p.m. on Monday, April 20. The most notable changes to the order regard retailers. Retailers selling items “necessary for life” — including pharmacies, grocery stores, places that sell cleaning supplies, office supply stores allowing people to work from home or continue education at home, gas stations, convenience stores — may remain open. However, they must limit the number of customers allowed to be inside the store and should adjust hours to accommodate vulnerable population, and comply with all mitigation measures (sanitation, social distancing, hygiene, etc.) to protect employees and customers.

“Customers can still go inside to shop, they can pay and they can leave,” said Holcomb’s general counsel, Joe Heerens.

Retailers selling items that are not considered necessities of life — Heerens listed bookstores, floral shops, craft stores and beauty supply stores — will now offer only online and phone orders with curbside pick-up or delivery.

“These are not necessities of life, but we’ve created a way for them to continue operating under new conditions and restrictions, specifically, the inside of the store must be closed to customers,” said Heerens.

“We understand converting your business model is hard, but it’s hard to give these daily reports and it’s hard to realize what’s in store for us over the next two weeks,” said Holcomb. “Drastic times call for drastic measures. We’re all in this together and we’re going to get through these two weeks.”

Holcomb also said all campgrounds, including state park campgrounds, are closed. The state parks themselves will remain open, but there will be no overnight guests. The exception to this is those who live in RVs or cabins at campgrounds and have no other home, but those wouldn’t be at state parks.

“We kept those open with good intentions in mind, but it was meant for exercising,” he said. “We can’t have parking lots full of hundreds of folks taking in our beautiful state parks.”

Judge David Cook, the chairman of the Indiana Alcohol and Tobacco Commission will be overseeing the enforcement of the expanded executive order.

Testing

Indiana State Department of Health Commissioner Dr. Kristina Box said testing has been greatly expanded.

“In just over a month, our testing for COVID-19 has expanded with our addition of not only our State Department of Health lab, but Eli Lilly, IU Health, LabCorps and Quest Testing,” said Box. “As all of these labs have come onboard, we have been able to significantly increase our testing.”

She said on April 5, Indiana had the highest number of tests in one day — 3,548. The day before saw 2,860 people tested.

“This is just a little bit below what we deem our maximum capacity to be right now, which is 3,700 tests per day,” said Box.

She said this has allowed the state to expand its testing criteria. Box mentioned last week including symptomatic, pregnant women (“They’ve always been included in the testing, but we’re really underscoring the need to test any symptomatic, pregnant patient because they’re immune compromised,” she said), and today included individuals with high BMIs and those with underlying health concerns who are suspected of having COVID-19.

“Since we have more capacity for testing at this time, we’re really looking to our providers who are seeing patients in the hospital, in the emergency room or admitting, to make sure they are testing for COVID-19, especially in these high-risk populations,” said Box.

A reporter later asked Box if the state was now including those with high BMIs in the demographic of those more likely to be tested, would that not include about 60% of Hoosiers? Box clarified those with BMIs of 30 or more would fall into that category.

“Even though we are a fat state, I think we’re the 12th heaviest state in the nation, not everyone will qualify for that high-BMI requirement, but that does go hand-in-hand with incidence of diabetes when you’re that heavy, and that does put a lot of pressure on your chest in regards to breathing,” said Box. “I think that’s what we’ve seen with individuals who have not done well, specifically with younger individuals — the diabetes and the weight can be complications.”

She said she hopes the state will be able to process more than 6,300 tests a day across the state in the coming weeks, though obtaining swabs and media remains a concern. She said the state is researching alternate means of obtaining swabs.

Box said the state is also working to increase testing in the northern and southern regions of Indiana, specifically for emergency responders, long-term care facility workers and health care employees.

She showed a slide with a graph showing how Indiana’s testing compares to neighboring states. Indiana had the lowest number of tests per 100,000 residents out of all its neighbors and the overall nation.

Still the numbers of positive tests don’t paint an accurate picture of the real number of cases in the state.

“I think our testing definitely limits us in knowing how many individuals in the state are sick,” said Box. “… We’re all bandaid patching it together to make sure we can get as many tests done as we can.”

She said she reported the state was lined up to receive 15 point-of-care test machines from Abbott through FEMA, but was later told the actual number the state was going to receive was only five.

“I don’t know when I’ll get those,” said Box. “I do know that each machine will come with one cassette that lets us test 100 people. We’ve already tried to jump on it and order cassettes ahead of time and they’re already on back-order.”

PPEs

Box said when the state began planning for the COVID-19 pandemic, they calculated how many masks healthcare workers would need if they were as conservative as possible.

“The best-case scenario, when we are using very strict conservation, we would use about 50,000 masks a day,” said Box.

She said the state has received enough from the Strategic National Stockpile to, conservatively, cover about 13 days. Fortunately, hospitals and health care facilities have other means of obtaining PPEs, the way they did when they weren’t needing to dip into the SNS. Box said hospitals have noticed a slowing in their receiving of their regular supplies and some decreased amounts, especially at independent hospitals, but stressed hospitals are continuing to get PPE from their regular providers.

The state has distributed 80% of what they have received to hospitals and local health departments, and have “very limited supplies remaining for emergencies, and we will prioritize our hospitals, our EMS and our long-term care facilities.”

She said it’s now more important than ever for people to donate any PPE they have to local health care facilities and EMS departments.

“If your business has the ability to make these products, then fire up your lines, because we’re ready for it,” said Box. “And if you’re not conserving your PPE, the time to start was actually several weeks ago, but definitely start it now.”

She reiterated that the SNS was never meant to be a safety net for all 50 states at once with all of their PPE needs.

“Likewise, state health departments were never built to supply PPE needed in every hospital, every local health department, every EMS, every long-term care facility,” said Box.

She said the state doesn’t know if it will be receiving any additional supplies from the SNS.

“We are continuing to make requests through FEMA and we will work to buy personal protective equipment anywhere we can,” she said. “Until I have those supplies actually in my hand, I can not promise that we can replenish anyone’s PPE.

“As a health care provider, that is incredibly hard for me to say,” she continued. “I know as a health care provider and a first responder, that’s even harder to hear, but that’s the reality every state across the United States is facing at this time.”

She said this is another reason every Hoosiers needs to “hunker down,” and stay home unless they actively need to be out.

“We can’t have you sick and in our hospitals and have you being carried in our ambulances or taking it into our long-term care facilities,” she said.

Box said the state has ordered PPEs and ventilators, and have been given PPEs, but the state has yet to be able to purchase ventilators “with the concept that we would not be able to get them within the time we would need them in the next seven to 14 days.”

ICU bed and ventilators

“We know that, across the state, 1,000 people are currently hospitalized with COVID-like illness,” said Box.

Box reported that on March 1, the state had 1,177 ventilators available in hospitals. By Monday, it had 2,642, with another 455 that have been identified for potential use as needed. That’s a 124% increase in the numbers of ventilators reported between March 1 and April 4.

She showed another slide that showed 27% of all ventilators were in use in hospitals, with 17% of those ventilators for COVID-19 patients, leaving 62% of ventilators ready for service.

When it comes to ICU beds, on March 1, the state had identified 1,132 beds. By April 1, that number had risen to 2,188, thanks to hospitals converting every possible room into an ICU room. In just a few days, that number went up again, to 2,964.

About 58% of those beds are occupied, with 31% of them being used by COVID-19 patients. That leaves 41.9% of ICU beds vacant and ready for patients.

“That about 60% occupancy has stayed very stable over the past week,” said Box.

A reporter later asked Box if she was more concerned about having enough hardware or manpower to manage the crisis.

“I’m concerned about all of them,” said Box. “I have a lot of Hoosiers who have stepped up. I think our volunteer line is up to 1,400 individuals now. We have over 300 medical students. The medical school is graduating their fourth-year medical students early. Nursing students have volunteered. I feel like we have less experienced, but definitely good hands that can be made part of a team and work as part of a team, and that’s what we’ve seen some hospitals do. The PPE is a concern, but I believe the federal government is trying to buy PPE and distribute that to states. We individually are trying to buy more, and I’m looking forward to the potential of people here in the state of Indiana firing up their manufacturing companies and making us some PPE also.”

Nursing home outbreak

Box informed press conference attendees that the state has a serious outbreak in a long-term care facility in Madison County.

Bethany Pointe Health Campus in Anderson has seen 11 residents die from COVID-19

“You asked me on Day 1, what was my biggest fear as a state health officer, and that was that we would have an outbreak in a nursing home, like the one we witnessed in the state of Washington,” said Box. “Unfortunately, we here in Indiana have had a significant outbreak in a nursing home that has taken, to date, the lives of 11 residents from COVID-19.”

Box said the ISDH has been working with Bethany Pointe since March 26, when they first requested the state’s strike team. The next day, the strike team and a nurse surveyor visited and tested symptomatic individuals. At that time, they found three positive residents. What followed was many conversations and more visits to discuss infection control and isolation, and to do further testing.

“Unfortunately, the situation quickly escalated,” said Box.

When ISDH representatives visited Friday, 20 residents were in isolation and nine had succumbed to the disease. Two more residents died between then and now and three employees are hospitalized, two of whom are critically ill.

The ISDH is facilitating the transfer of asymptomatic residents from that part of the facility to another skilled nursing facility.

On Sunday, the ISDH tested all residents in that part of the Bethany Pointe facility to ensure that even residents who might be asymptomatic but test positive will remain quarantined in the facility.

“This is a heartbreaking situation and illustrates what a brutal toll COVID-19 can take on our most vulnerable populations,” said Box. “Unfortunately, this will not be the last outbreak of this kind.”

She pleaded with those controlling long-term care facilities to abide by the guidelines and best practices handed down by the ISDH and to reach out to the ISDH should anyone appear to show symptoms.

“We will come out,” said Box. “We will test all of your symptomatic individuals. We will test other individuals who are in and near and live close to them, in the residential facility. We will test any employee that appears ill, and we will make sure you are following the proper infection control procedures and isolating these individuals.

“I can’t emphasize enough we are here to help you,” continued Box. “It doesn’t matter if we were just there yesterday, we will come again today. If the situation changes, we will come again and again and again to help you, because we know you want to protect this population and we want to help you to do that.

“These are our grandparents and our parents,” she said. “These are our friends, our neighbors, our church relatives. They are individuals we care about and want to protect, so please help us do that.”

Unemployment

Department of Workforce Development Commissioner Fred Payne updated listeners on the CARES Act and what it means for Hoosiers.

He said there are two provisions of the CARES — the Pandemic Unemployment Compensation portion and the Pandemic Unemployment Assistance portion.

The PUC provides an additional weekly benefit of $600 to those eligible to receive regular unemployment benefits under state law. He said the state has received guidance over the weekend from the US Department of Labor and said, due to working to make sure Indiana was at “the front of the line” when this benefit was rolled out, Hoosiers can anticipate these benefits to be retroactive to March 29 and will be in effect until July 31, 2020.

“We’ve been working to revise our system so these additional benefits can be sent electronically in the same manner of a claimant’s current unemployment benefits,” said Payne.

The PUA creates a new, temporary unemployment insurance program for people who would not normally qualify for unemployment insurance, but who would be working if not for COVID-19 — people who are self-employed, independent contractors, gig economy workers, or those who have a limited work history.

These workers will also be eligible for the $600 weekly benefit.

Payne said the state is working to modify current systems and create entirely new systems to cover this new class of workers.

“There’s a huge difference between modifying our current unemployment system or process to include an additional $600 benefit for those who are already eligible, and creating an entirely new system for an entirely new class of covered workers,” he said.

He said multiple agencies will be involved to create a way to systematically confirm earnings in a way the DWD’s current system does not.

This also means the timeframe for people receiving benefits will be different. Those who would be eligible before the CARES Act went into effect, the PUC workers, can expect to see their complete benefits by April 20, but Payne said those under the PUA portion will wait “a bit longer.”

Payne also said the volume of calls to the DWD has been causing problems for people trying to get through to apply for unemployment and reach DWD staff. He said the department’s IT is working on this, but also that 77 new employees were being phased in on Monday and starting the next day, a contracted call bank of 100 people will also be taking DWD calls.

“This moment in time is unique and it is presenting us with facts and circumstances that are changing rapidly,” he said. “We are putting new systems in place in a matter of days and weeks, when in normal times, it would take months or even years to put these processes into place. That’s why we must remain nimble enough to make sure we can have the changes needed on a quick basis while providing system stability for the transfer of the necessary benefits for those in need.”

Still, Payne said the DWD doesn’t have a long backlog.

“In taking a look over the weekend at just how quickly claims were coming out, we still are on track,” said Payne. “There isn’t a huge backlog right now, so we anticipate that to stay, and we hope it stays that way. We’ll continue to monitor it.”

Early cases

Box said it’s possible that cases of COVID-19 were cropping up before it was known.

“As we look at our tests, we can start to see an increase in individuals who had pneumonia and who died of pneumonia or an influenza-like illness in our state as early as February,” she said. “Because we had no testing, there wasn’t a way to find out what was going on there.”

She said another factor that made it difficult to determine if COVID came early to Indiana was that the state had three waves of influenza this year.

“Those are very difficult to sort out, but those are some of the data points I’ve been looking at recently with my epi team.”

Recovery rate

Box said the recovery rate for COVID-19 is at least 97 or 98%.

“Because our testing has been limited, we’re only testing our most significantly, severely ill individuals who fall into this high-risk category, so all of these individuals with a mild case or minimal symptoms and we asked them to just stay home and make sure they got well and isolated themselves, we’ll never know if they were positive for COVID-19, until maybe down the line, we’ll have a serum test we can do of their blood that will show they have antibodies that will show they’re now immune to COVID-19 and we’ll be able to confirm.”

But what about Easter?

On Palm Sunday this past weekend, a church in Hammond was cited for holding services with around 30 people inside in defiance of the governor’s executive order. Church leaders insisted they were essential and some states have considered religious services essential.

Holcomb said he wasn’t considering a change allowing churches to hold services, even during Holy Week, while the COVID-19 pandemic was in progress.

“My message to pastors is ‘Thank you for understanding that this Holy Week for many of us is the exact right time to connect with the Word and the truth and the truth of the matter is that COVID-19 does not discriminate. It does not care what crowd you’re in and we have to take every responsible measure from preventing those connections from occurring,’” he said. “I’m so thankful for pastors who are sending me their live-streaming sermons and messages of hope and perseverance and determination and that we’ll see our way through.”

Holcomb said many Hoosiers are dependent on the church — not the building and gathering, but those who are part of the Christian faith.

“We’re putting out this guidance for all of our goods, and you may unknowingly transmit this to someone you’ve never met, know or someone you love and I don’t think that’s on anyone’s heart,” he said. “The way to prevent that from happening is to prevent yourself from being in large gatherings … As tough as this week … is, this disease … will prey on the vulnerable and large gatherings. We have it within us to prevent that.”