Orders extended, masks, mental health concerns and more in Friday’s state COVID-19 briefing

By: 
Staff Writer Kate Wehlann

Gov. Eric Holcomb

ISDH Commissioner Dr. Kristina Box

Indiana’s Adjutant General, Brigadier General Dale Lyles

Dr. Hani Ahmad, a psychiatrist at the Bowen Center in Warsaw

Secretary of Family and Social Services Administration Dr. Jennifer Sullivan

In his daily state briefing on Friday, Gov. Eric Holcomb announced he will be extending the state’s public health emergency order until May 5.

This renews more than 10 executive orders, including directing Hoosiers to stay home, the prohibition on in-house dining for restaurants, the allowance of carry-out consumption of alcohol, temporary prohibition on evictions and foreclosures, the postponement of non-essential surgical procedures, rules against price gouging, interventions in public healthcare and more.

Holcomb said his decision to only extend the stay-at-home order for two weeks was to allow for better means of changing the order and responding more quickly to changes developing over time.

He added he plans to sign another directive “tweaking” the stay-at-home, “Hunker Down, Hoosiers” order on Monday, and will release more information during Monday afternoon’s daily briefing.

Holcomb also reported the letter he sent the White House has been received and the President did approve Holcomb’s request for a major disaster declaration for all of Indiana.

Executive Director of Indiana Homeland Security Steve Cox said this means Indiana will receive public assistance money “to the tune of about 75% of costs incurred by the governmental entities within Indiana in response to the COVID-19 crisis.”

Cox said the state also requested individual assistance, but that portion of Holcomb’s request is still under White House review.

Curve update

“I know hearing bad news every day is really hard and I hate starting my part of these broadcasts with it, but it’s imperative that all Hoosiers understand the gravity we’re facing right now with COVID-19 across our state,” said ISDH Commissioner Dr. Kristina Box. “Today, we unfortunately reached a milestone and surpassed 100 deaths from COVID-19.”

In the past 24 hours, the state has received reports of 24 more Hoosiers dying from the disease, the highest number of deaths reported to date within a 24-hour period, and reflects the number of people who have died between March 29 and April 2.

Box had her team calculate a “very crude” mortality rate of 2.9%, with the best data they had available.

“What I want to make sure you understand is, in Indiana, we have done targeted testing, only for our highest-risk population, really only for those individuals who have been hospitalized,” said Box. “That 80% of individuals who were sick, we just asked you to stay home. We didn’t test. Consequently, this number is much higher than the real mortality rate.”

Box said it can take time for labs to report their findings so the state can update its data. This means that subtracting the number of positive cases from the overall number of people tested does not paint an accurate picture of the number of positive test results from the state’s testing efforts. Add to that not everyone who actually has COVID-19 has even been tested, as many who did not require hospitalization were told to just stay home and quarantine.

“When we look at our targeted testing percentages, it’s been, traditionally, anywhere from 13 to 15%,” said Box. “I think today’s was up to 17.8%.”

She said many patients who die from COVID-19 have multiple underlying conditions, including heart disease, lung disease or diabetes.

“Unfortunately, Indiana has a higher proportion of individuals who have these conditions as compared to other states,” said Box.

She said the state is also seeing deaths in younger individuals, including 2% each in the 30-39 and 40-49 age brackets. The highest percentage of deaths are in those 80 and older, at 35.3%
In Washington County, 34 people have been tested and 14 have been found to be positive so far.

Box said she knows this is a time when people are thinking about spring breaks and Easter gatherings, but said she wants Hoosiers to continue to take social distancing seriously.

“These are not normal times, and we can not act as if they are,” she said. “I know it’s hard to miss a family gathering, but the best thing we can do to protect our loved ones is follow the guidelines and flatten this curve as quickly as possible. The best way to not overload our hospital systems is to keep people healthy.”

Box later said ICU bed vacancy is still holding steady at about 40%.

The State’s Guard

“As we prepare for the surge [of COVID-19 cases coming into hospitals], the National Guard is a key partner in that planning,” said Box.

Indiana’s Adjutant General, Brigadier General Dale Lyles said the Indiana National Guard continues to be actively engaged in the COVID-19 response.

“We are supporting Gov. Holcomb’s strategy to mitigate the COVID-19 virus,” he said. “We are in support of the Indiana State Department of Health as we collectively work to flatten the curve and safeguard our fellow Hoosiers.”

He said Guardsmen have been busy across the state packing lunches and preparing meals at local food banks for distribution, sorting medical supplies and PPE for distribution, augmenting staff and assisting in planning operations, supporting the state’s emergency operations center, and using future modeling and predictive analytics skills to assist the governor’s executive planning team.

He said the Guard is helping with the surge-planning efforts by seeking sites for alternate care facilities (field hospitals), including closed hospital wings and establishing hospitals in large-scale facilities. He said no specific facilities have been established yet.

Lyles said the Guard is also working on how to best expand the state’s hospital bed capacity if needed.

“I’m very proud of the work our Guardsmen are doing and we are proud to serve the governor and our fellow Hoosiers,” he said. “We will continue to provide support to Hoosiers as needs arise.”

Lyles said, due to Indiana receiving a major disaster declaration, the Army and Air National Guard will receive full reimbursement for the missions conducted in response to COVID-19 mitigation, more rapidly.

He said the ISDH has identified specific areas throughout the state that look likely for a surge in the number of cases where alternative care facilities will be needed and that is where the Guard is starting to focus its efforts regarding field hospitals.

Box said the state is starting to see increased numbers of positive cases in the southeaster part of the state, nearer to Louisville and Cincinnati, along with parts of southwestern Indiana.

Substance Abuse and Mental Healthcare

Secretary of Family and Social Services Administration Dr. Jennifer Sullivan said the Division of Mental Health and Addiction has “gone into overdrive” to support Hoosiers battling addiction, substance abuse and mental illness during the COVID-19 crisis.

She said the DMHA has seen numbers that are “indicative that our collective psyche is increasingly fragile.”

Gambling hotlines, which she said typically average 30 calls a month, have had more than 200 calls this past week alone. Addiction hotlines, which average about 20 calls a week, are now averaging 20 calls a day. Two agencies in southwest Indiana have reported a 50% increase in crisis calls. The state’s 2-1-1 help line, which Sullivan said usually gets between a 1,000 and 1,100 calls on “a big day,” has been getting around 25,000 calls a day, many related to mental health and suicidal ideations.

The sale of alcohol, nationwide, went up 55% since the start of the outbreak. Holcomb said he is always concerned about Hoosiers developing unhealthy habits around alcohol.

“That’s a concern for me 356 days a year,” he said. “Today is no different. That’s why I think it’s critically important and this will not be the first time you hear about our efforts to connect people with the help they need during the unprecedented time we find ourselves in right now.”

Sullivan said tobacco use and alcohol misuse remain the state’s most common addiction disorders, and there is “no greater example of that expanding than during a crisis like this.”

She said all substance abuse disorders are a high priority for the FSSA, alcohol notwithstanding, and said the state will continue to support those who are in recovery.

“While the bulk of our focus is rightly been on the heroic public healthcare efforts to combat this pandemic,” Sullivan said, there are three areas the state is looking at addressing during the fight against COVID and the recovery efforts afterward, “and yes, there will be a recovery,” she added.

Adults and children with existing mental and behavioral health issues have a higher risk for developing a major mental health crisis during a time of increased stress, like a pandemic.

“We’ve been working closely to provide maximum flexibility, including using telehealth to our treatment providers to ensure crucial services for this population can continue,” said Sullivan. “They’ve responded with amazing creativity and innovation. The ability to access mental health services without barriers like transportation or standard office hours while still being able to maintain social distancing has been one of the highlights of this response thusfar.”

Crucially, this has taught the FSSA administration another lesson in caring for those with mental health needs in the state.

“We’ve learned this type of access should be available to Hoosiers, public health crisis or not,” said Sullivan.

She said another area the FSSA is focusing on is the psychological wellbeing of people who are otherwise mentally healthy.

“We know many Hoosiers … are currently suffering from an increase of adverse mental health symptoms, caused not only by the social distancing that has disrupted so much of our daily lives, but also the uncertainty of the time to come,” she said. “Normally, to the extent that anything in a disaster can be normal, in a disaster, the survivors suffer a terrible loss and then work to build back from it. This slowly unfolding, constantly changing, life- and livelihood-disrupting crisis is unlike anything we have ever seen, and is going to cause many people to experience increased anxiety and depression.”

She said the FSSA message to Hoosiers is two-fold: it’s normal to feel this way, and help and help that works is available.

“If you find yourself experiencing these symptoms, please seek help,” said Sullivan. She said people can call 2-1-1 to be connected to resources, along with your insurance company to find access to telehealth providers, and talk to your general care doctor about if medical treatment may be helpful for you.

The third area the FSSA is focusing on is those with substance abuse disorders.

“For those with a substance abuse disorder, this can be an especially scary time,” said Sullivan. “They say the opposite of addiction is not sobriety, but connection, and it’s very easy to be disconnected right now. However, we have been blown away by the resiliency and treatment and recovery communities and we have been honored to support them during this time.”

She said recovery programs have moved into digital spaces, residential services have kept their doors open and the DMHA has also continued to offer pharmaceutically assisted treatment in Indiana.

Sullivan introduced Dr. Hani Ahmad, a psychiatrist at the Bowen Center in Warsaw, who gave some advice on how people can keep their minds healthy during this time.

“Even people who are generally calm will feel worried when they are surrounded by so much uncertainty,” said Ahmad. “For those of us who are already prone to anxiety, news of a disease outbreak can significantly increase the symptoms we are already learning to manage.”

He said while some worry is perfectly normal under these circumstances, some people will feel their anxiety or depression become overwhelming and make it difficult for people to function. He listed a series of questions people can use to screen themselves to determine if they need to reach out for help.

• Are you spending most of your time feeling worried?

• Do you feel like you can’t control your worry, despite actively trying to do so?

• Are you experiencing panic-like symptoms, such as shortness of breath, chest pain or muscle tightness?

• Are you avoiding talking to your friends and family due to your worry?

• Are you having trouble falling or staying asleep?

• Do you feel emotionally out of control or burnt out?

• Are your family and friends shown concern about your worry?

If you answered ‘yes’ to these questions, it is likely time to consult someone for help.

“The good news is, there are a lot of options out there to help you,” said Ahmad. “Some people feel a lot better when they are able to find a support group to manage their stress and anxiety. These can be found online or organized by telehealth and organized through a faith group or counseling center. Some people like to read self-help books to learn techniques to help control their worries. Others find counseling with someone like me to be incredibly helpful. Therapists are highly trained to help people learn how to sort through their thoughts and organize them in a way that feels less overwhelming.”

He said another option would be to consult a primary care doctor to see if non-addictive medication may help you feel less overwhelmed.

“You have the choice to participate in any or all of these options,” said Ahmad. “All of them are available through the phone or internet. You don’t even have to leave your house. A community health center has many options for care.”

He suggested some things people can do at home that could be helpful.

• Make a list of things that are worrying you, circle the things you can control, and then list the top three things you can do to move toward a more positive outcome.

• When you find yourself focusing on the worst possible outcome, force yourself to list the best possible outcomes as well and remind yourself that those are also possible, and the most likely outcome is likely somewhere in the middle.

• Step away from your to-do list, even if it’s just for a moment. Take a shower, go for a walk, listen to some music, read, call a loved one, whatever you can do to take your mind off of your worries for a few minutes.

“Being task-oriented has a place, but that doesn’t always have to take priority,” said Ahmad.

He said if basic family needs are your concern, call 2-1-1 for help with getting put into contact with resources to meet those needs.

“The future feels a lot less overwhelming when we have options,” he said. “Give yourself a treat — anything you love. This can be a dessert, a moment of quiet without your family present, permission to go to bed early, waking up early. Practice setting boundaries. Say no to helping others if you’re struggling to stay afloat yourself. Move your body. Try a home workout. There are tons of free online options out there.”

Masks

During the press conference, Box fielded a question about the efficacy of homemade masks and the material being used to make them.

“Cloth masks tend to hold moisture better than other masks, so oftentimes, we tend to look for a moisture-wicking barrier that keeps the moisture away from our face,” she said. “Ideally, if you can have something that opposes the moisture getting in, that’s what we want to have.”

She said healthcare workers are using homemade cloth masks on the outside of their N95 masks to keep them from getting dirty or wet, which greatly decreases their effectiveness.

Following the press conference, the CDC did release an advisory that people should wear the cloth masks in public to prevent asymptomatic or pre-symptomatic spread.

“We now know from recent studies that a significant portion of individuals with coronavirus lack symptoms, and that even those who eventually develop symptoms can transmit the virus to others before showing symptoms,” the directive said. “This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms. In light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”

Unemployment benefits

Department of Workforce Development Commissioner Fred Payne said the state is still waiting until May to distribute the additional $600 unemployment benefit ensured in the CARES Act. He said the US Department of Labor has set down distinct guidelines for how states should handle those payments.

“We’re strictly following the guidelines that have been laid out for us and we’re working on through the US Department of Labor,” said Payne. “… We’re really trying to make sure we follow those guidelines so we can ensure those payments are made as quickly as possible without any hitches.”

Homeless population

Sullivan said she was pleased that the state has been able to provide shelter for homeless individuals recovering from coronavirus.

“We are keeping the location of that particular facility here in Indianapolis to ourselves for their safety as they recover, but we are so thrilled with the collaboration between multiple partners to make this project happen,” she said. “We have active guests who are safe and comfortable and being fed and housed as they feel better and we are working with multiple communities to replicate that process throughout the state.”

COVID in prisons

The Department of Corrections Chief Medical Officer, Dr. Kristen Dauss, confirmed that five inmates had tested positive for COVID-19 — two in the Indiana Women’s Prison and three at the Plainfield Correctional Institution.

Dauss said there are no other confirmed cases in other facilities, though they are continually monitoring for illnesses in other facilities.

“We are also encouraging hand-washing, soap, cough hygiene, providing them with hand sanitizer, deep-cleaning the facilities, so I can assure you we are doing all that we can for those we serve,” said Dauss.

Department of Corrections Commissioner Rob Carter confirmed that staff members have been tested and found positive.

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