Governor's press conference talks surge updates, unemployment, COVID19 patient information and more

By: 
Staff Writer Kate Wehlann

Gov. Eric Holcomb

Indiana State Department of Health Commissioner Dr. Kristina Box

During a virtual press conference this afternoon, Gov. Eric Holcomb spoke further on the surge discussed in the previous day’s conference.

He discussed two new executive orders, the first of which extends the order directing restaurants and bars to function on a to-go only operation until April 6, and the other waives the statute to allow puts e-notary rules to take effect.

Those tracking the numbers on the IN.gov website saw a substantial increase in the number of cases and deaths over the past day or so — up 373 positive cases and 14 deaths overnight — and Indiana State Department of Health Commissioner Dr. Kristina Box said those numbers can be somewhat misleading.

“These numbers do not mean that all of these cases and deaths occurred in the same day,” she said. “The results we post every day are based on when the data are reported to us at the Indiana State Department of Health.”

For instance, she said, the deaths reported on Tuesday occurred sometime in the past two weeks prior, from March 21 to 30.

“The Indiana State Department of Health does not report death until we have a confirmed positive test for COVID-19,” said Box. “If testing is done at private labs, it can take up to two weeks for results to be reported to the State Department of Health.”

Once the Department gets those numbers, they go back into their records to match those results with the patients. Sometimes, a patient has died while those test results were pending.

“Deaths in the hospital or deaths outside of the hospital looked at by our coroners will not be reported until we have lab confirmation of COVID-19,” she said.

Box added, sometimes, the daily county reports have to be changed because a hospital system that treated a patient is not in the county where that person lived. The state is working to make sure the counts reflect the county of residence, rather than the county of death.

“It’s a very sad reality of this pandemic that our number of cases and number of deaths are going to continue to increase,” said Box. “I don’t want to minimize a single one of those losses. They are all someone’s spouse, grandparent, parent, child or friend. I do not want Hoosiers to see these rising numbers and think that means the peak has arrived. We have a long way to go before we reach the peak, and I can not say enough about how important it is for you to continue to stay home. If you won’t do it for yourself, do it for your loved ones, for your neighbors, for those 49 Hoosiers who have already died of this disease.”

She urged hospitals across the state to continue to update the state with their number of beds and EM resources daily, and soon, twice a day, in order to provide EMS with necessary information for where patients can go when hospital capacity is “stretched thin.”

“You may not see the value in this today, but in two to four weeks, you’re going to want that information at your fingertips,” she said.

Box said the state’s strike teams are continuing to be present in long-term care facilities, conducting tests, and the state is looking for ways to expand the teams to better cover the state. She said she hopes to have 11 teams available soon.

Box said several long-term care facilities are working to develop COVID-only units to help isolate those with the disease to keep it from spreading. She added the Army Corps of Engineers are working with the state to determine sites and plans for possible field hospitals as needed.

Box downplayed the use of chloroquine and hydroxychloroquine as a treatment or preventative for COVID-19.

“The data … is very limited and from very small studies,” she said. “There are a lot of studies that are much larger ongoing at this time … There is very limited evidence for the success of this in preventing an individual from getting COVID-19. Most importantly, hoarding these medications or usage that is not indicated severely limits the usage of these medications by individuals who have been using them for years for their autoimmune diseases, like rheumatoid arthritis or lupus. The decision to use hydroxychloroquine or chloroquine for an individual who is ill with or hospitalized with COVID-19 should come down to the provider and the patient.”

Box said she is grateful for the response from healthcare workers, including dentists, therapists, paramedics and even veterinarians, who have volunteered to help the state care for patients during the coming surge.

At 2:30 p.m. Monday, 5,300 healthcare workers had volunteered. By the time of the press conference just 24 hours later on Tuesday, that number had risen to 11,000, not including medical and nursing students.

“Every day, I hear of heroism displayed on the front lines and our healthcare and first responder workforce,” said Box. “Watching Hoosiers help Hoosiers, hearing these encouraging messages that so many people are sharing and watching communities banding together in this very difficult time is incredibly inspiring to me and our team and it gives me the confidence that we will emerge from this crisis stronger as a state.”

Holcomb said the counties and cities in the southwest portion of the state had been working on a COVID-19 response fund, with the hopes of raising $6 million to “help on the human services front.”

He also gave credit to the sewing groups and individuals across the state committed to making masks.

“It’s just incredible what you all are doing,” he said. “… This is just what folks who, maybe felt like they were on the sidelines, watching this all unfold, they are in the game and they are playing an MVP roll … Nothing is out of our grasp when we’re well-coordinated, well-conducted, and working toward that common goal.”

Holcomb continued to reiterate that elective procedures, including abortions at abortion clinics, are to be postponed unless a doctor has determined postponing a procedure would cause harm to a patient.

“The executive order I signed had the surge in mind,” he said. “That’s why I directed all health care facilities — hospitals, surgical centers, veterinarians, dental offices, dermatologists, and yes, abortion clinics — to postpone or cancel all elective or non-urgent procedures … Unless by doing so, would cause harm to the patient, which any case I would leave up to the doctor. Any and all medical expertise and PPE first needs to go toward, during this window, defeating COVID-19, and the sooner, the better for all of us.”

Holcomb said the numbers in Indiana will drive any decisions about extending the ongoing stay-at-home directive.

“We understand and are equally concerned about the pain that is being put upon all of us, both from a humanitarian and from an economic perspective. What we’re trying to do, one, is make sure our healthcare system doesn’t collapse under the weight of all these new cases, and to do that, we’ve had to change our behavior.”

Holcomb said the state wants to make sure actions aren’t taken too quickly to create a problem after the surge peaks. He said the state is working to put together an economic response package that takes small businesses into account.

“We just have to get through this together and get through this as fast as we humanly can,” said Holcomb.

Members of the public are concerned the local health departments aren’t giving out enough information regarding the past whereabouts of confirmed COVID-positive cases.

“It’s a fine line we walk because we know individuals who have been exposed, especially in a setting where there were a lot of individuals who were crowded together, we do need to trace those contacts who were most closely related or in closest contact for a certain period of time with someone to let them know they also need to quarantine themselves in case they show up with symptoms,” said Box. “That’s part of public health, that we do that on a bit-by-bit basis. Sometimes, we don’t have the knowledge of everyone who was in a particular setting, so sometimes we have to come out and actually say, ‘This particular setting,’ or ‘this particular event, there was someone who tested positive’ and if you were at event or at that setting, you may want to contact your local health department and we can give you some direction. It is a fine balance we do to protect people’s privacy, but also the general public.”

Box said the decisions of what to release is up to the local health departments, but the ISDH is involved as well in many of these cases.

“I have seen counties that have listed every single place in the county because someone with COVID-19 was there, even if it was to run in and get a gallon of milk or to fill up their car with gas,” said Box. “That becomes a list of pretty much every business, every facility, every spot in the county and doesn’t really help anybody going forward.”

Box said the health departments try to decipher how long the person was there and how deeply their contact with that location went.

Holcomb didn’t appear to specifically answer a question regarding a possibly-infected person’s legal obligaion to disclose their status to their employer, and if that employer had an obligation to disclose that information to other employees. Holcomb said he hoped people who were sick would inform both their employer and healthcare provider so they could be tested. Box said employers in this situation would work with local health departments to determine who should be notified and monitored for symptoms.

A reporter asked if masks should be worn in public in general, and Box repeated information already released about the efficacy of masks, saying they were not necessary.

On Monday, Kentucky Governor Andy Beschear issued an order banning travel between Kentucky and other states, including Indiana. Holcomb declined to comment on that and said he was not currently planning to put Hoosiers under such an order. He did caution people who are currently in a hotspot of COVID-19 activity to stay where they are to reduce the risk of spreading the virus.

Box spoke as to how the state will know when the peak of the COVID-19 surge has begun.

“Do I think the surge is starting?” she asked. “I really do, but are we at the peak? In no way, shape or form. Knowing when that peak is is kind of an after effect. We’re looking at the data and we see the numbers continue to go up and up and up and up and we eventually reach a point where we see the numbers go down. We don’t celebrate that too much. We say, ‘Let’s see what happens in the next day.’ We start to watch that trend and start to know if we’ve potentially hit the peak. Other states and other countries have seen peaks come and go, like waves of this, so we’ll have to be on the lookout for that as we go forward also.”

Holcomb also said he has not considered a moratorium on rent or mortgage payments, but that one of his executive orders forbids evictions and foreclosures at this time.

Box said a test completed in hospitals today will be reported out within 24 hours if done at a state lab. However, she said some of the non-hospital tests are being sent to out-of-state labs, which are backlogged by the sheer number of tests. She said there are discussions with other labs in the state.

The numbers of people applying for unemployment are not going down yet — nearly 175,00 in the past two weeks — and the Office of Workforce Development is bringing in extra help to get applications processed.

“We’ve increased our staff and we’ve increased the number of people answering calls, we’ve made sure we’ve had a greater bandwidth on our internet system put in place and we have a new system we’re working on in terms of how people can apply for unemployment insurance and that is the over-the-phone system and that should take care of some of the backlog,” said Fred Payne, the Indiana Department of Workforce Development commissioner.

In another response, he addressed those in “gig” fields — delivery drivers, Uber and Lyft drivers, etc. — and the self-employed who were previously not eligible for unemployment, but who now have access to unemployment insurance.

“It’s very new and we’re still working with our federal partners on how to administer that,” said Payne.

He said the first phase was getting the stimulus package passed and now they are working on implementation. He said they are working with sister agencies within the state to determine what previous wages were because these workers will have 10-99 wages and they must be treated differently than other workers.

He said his department will know what they will be doing within a few weeks.

In other states, scientists are working to test for antibodies to determine who might be able to go back to work and also the possibility of a treatment.

“We have a full research team that is continuously looking at all this data and information and the latest studies,” said Box. “To date, there’s not a reliable way to check antibodies to determine if someone has immunity to this.”

She said scientists are currently working on and studying the possibilities for that, however.

Box also spoke as to any projected numbers of Hoosiers who may die from COVID-19. She said the state has not modeled that number yet, but acknowledged there is a higher percentage of people at risk, due to a large number of elderly people and smokers.

Holcomb said when it comes to pulling out of the protective measures, such as the stay-at-home directive or school closures or carry-out only restaurant restrictions, he doesn’t want to be hasty.

“We don’t want to be premature and reflexively jumping back after we hit that peak and the numbers come down and appear to be because, as we’ve seen around the world, they can go back up,” he said. “The numbers I’m looking at are a gradual, methodical way of — we’ll always be in this new normal. Things will be different going forward for obvious reasons, but the numbers will drive these decisions.”

“I would also say it will depend on where our health care systems are at that time,” said Box. “We may need to give our hospitals time to recuperate, to make sure they’ve been able to replenish their PPE, that our healthcare personnel are able to get a break in the action. We would not want to release anything too soon and have another large surge into our hospital system at a time when they’re trying to recover.”

Holcomb said the public can expect more information about how schools will be affected later this week.

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