Hopefully we can get all of your questions answered at one time, so you can help share some of these really important messages with the public. We have three different folks who will be available to speak with you today. The first person is Chris King. He is the division director for our Division of Public Health here at Wake County. Also joining us is doctor Jose Companies. He is the director of MMS as well as our medical director, and then we also have Darshan Patel. He's a team leader with Wake County. Emergency management so mister Kevin will be starting us off today and then after he gives you a situational update, we will open it up to questions from all of you. Thank you. Good afternoon and thank you for joining us today for the past two and a half days. Our public health division has been monitoring a patient from Wake County with flu like symptoms who recently returned from a trip from the state of Washington since the patient has traveled to a long-term care facility with Coveted 19 where it has been detected. We tested that person for Corona virus around. Time yesterday, we received word from the state lab that the patient did test presumptive positive for the coveted 19. You'll notice I use the word presumptive. That's because the results are not considered final Those final results will come from the CDC. Is currently in isolation in home at Wake County to prevent potential spread of the virus our public health divisions communicable disease staff is monitoring the patient's condition closely and can share that the patient is doing well. What does this mean for residents? the North Carolina Division of Public Health in Wake County are treating this as an isolated incident. That's why we are not recommending that organizations make major changes like cancelling festivals, conferences or events in Wake County. At this time, there is no reason for the public to panic that energy can best be served with prevention efforts the best way. For residents to protect themselves from code, 19 or any virus like flu is to make sure that we are washing our hands staying home if we are ill and covering our mouths and nose when we are coughing and sneezing face mask are not recommended for general public. We certainly want you to stay updated with the latest information on Covered 19 by visiting the Center's. Disease Control and Prevention website at CDC dot Gov. Wake County has also created a Web page where we are putting updated information and tips about Covered 19. This website is Wake Gov dot com slash Covered 19 Residents with specific questions will be able to email a dedicated address to get answers from public health. We are also posting regular updates on our social media accounts and encourage you to share them. So what is the impact on Wake County services at this time risk of contact Contracting Covey 19 in Wake County is still low today. County programs or services have been disrupted. Wake County staff are dedicating more time to monitoring Covered 19 and its potential impact to our community. Staff from many of our departments are putting plans in place as they normally would for any emergent health-related situation. We know that the public and all of you have lots of questions. so at this time we would like to take your questions and do our best to answer them confidently with Cbs obviously. Came back and there was a few days. County is did they come up with the church or at the gym before they start. What are you saying to those people that has the County reach out to any of those people? So current guidelines from the CDC indicate that we need to be reaching out to individuals who are in conclusion contact with that person when they became symptomatic and what we mean by close contact at this time is individuals who were within six feet for around 10 minutes or more. so no one at the airport. Reach out to you on the flight with him or at the airport or any of those times when he was. that is that is correct we we are actively reaching out to individuals who fit that time frame in that distance requirement are you confident that nobody at the airport or nobody on that plane could have contracted this from this man based on our information that we have to date, we believe that we are reaching out to or have reached out to the individuals of public health concern people would that be. So this is still an evolving situation and so we're still continuing to gather that information. So at this time we don't have that exact number so this individual. HHS started showing symptoms on February. Tested positive for consumption yesterday, so we're talking about a week's time with this person was showing symptoms before testing. Do you. Public and your medical opinion deserves to know the where abouts of this person. This person does with Jim was on a treadmill go to the grocery store in an elevator in her office. Thank you for that question. so as I indicated before we have been in very close contact with this individual to understand where they're aware about were from the time that they became symptomatic until this point of time and we are happy to report that they limited their time out in the in the public and for those circumstances where they were out in the public, they provided us the. Information to do our appropriate public health Follow up with those individuals. so why not share that information without identifying this individual with. So so again, we are following the recommendations of of CDC and our state partners on the appropriate public health interventions that are being required and as I've described to you earlier, that's what we're doing. so we stayed in New York. I watched the governor. They talked about when this person was in the airport, taking a private vehicle kids are being tested at schools closed and the identifying the school of law office so that why not that level of transparency here Well, I can only tell you that we we do need to follow our state's plan and that's what we are doing. Word about the time in between when. Our local health care provider. Stay stay at home for an entire week. So as I stated earlier there are some pieces of information that we're following up on because they had reported some activity in terms of that time frame that you just described and we're doing that active outreach in terming what needs to be done for any individuals who would meet that close contact definition that I described earlier this person might have forgotten something. Left off their list Well, we certainly know that an individual may have difficulties remembering what the approach that we take allows us to be able to methodically ask questions so that way that opportunity is minimized. This time the only testing that has been done is the testing that was reported yesterday at the governor's press conference just to follow up back to them, the guidelines that you gave a tenth with 10 six. 10 minutes 16, Have people been made aware that they were in his proximity. Person is there anyone you would. Yes, we have as I mentioned earlier based on us gathering that information from the case we have been actively reaching out to individuals and will continue to do so. as we learn more information, I love you. Well, basically, there's a standard assessment that the the CDC in the state health Department asks us to use so basically it's a series of questions for us to help understand more about an invalidate that time and distance relationship that I described to you earlier. We then ask them where they have been. We obviously talk to them. I wanna understand how they're feeling and then based on. That set of information they are then categorized into different risk levels that were developed by the CDC and that is important because then that allows us to determine what the appropriate public health action is so, for example, if someone is in a lower risk, that means that they may be doing self temperature monitoring so they'd be taking their temperature a couple times a day and they're instructed that if there are any changes they are supposed to reach out to their public health person that contacted. Other individuals they actively receive a call from public health officials on a daily basis, so it's a more active process and in again you can see these types of guidelines in these examples of public health interventions off of the CDC literature. Can you talk about the reasoning for their strategy? Are you trying to prevent public stereo because I think the public feels like. They have. Say you have acne. Whether or not, I was there. Now, if I'm showing symptoms, I can go to the proper medical issue. Ultimately do you feel like not informing the public is trying to keep the stereo down? Well. I don't feel that we're not informing the public. I'd like to think that this is an example of providing information to the public with each disease there are differences. so if this was a case of measles, for example, that is much more infectious in nature we would have to sometimes make some type of public and. That would say if you were at this location during this particular time frame on such and such date, we need to hear from you. That's not the situation for this particular disease. Why? Because the current recommendations do from from CDC in our state partners do not warrant that type of strategy at this time. Do you feel any need to exceed their recommendations? I think one of the things that we need to do as a as a public health system is to remain in lock step with one another as best as possible because I think that the challenge is that if people are doing things differently, it has the potential to cause confusion out in the public and we certainly don't want to be causing confusion, especially for something as serious of of this nature. We really wanna continue to spread facts not fear. Entirely within wait for your people, so thank you for that question. As part of that contact tracing that I described to you earlier, we do learn of other people who are involved that may not live in Wake County and so it's our responsibility to get in touch with those public health, Practic departments and personnel so that way they can conduct similar activities for the people that live in their area. But that that happens as a manner of course in this instance in instances of this type where you have situations where individuals who are involved in an incident don't always live in the same County or area, and as a result of that, it's an obligation of public health, both at the local state and federal level to work with one another to information share so that way the resources closest to that individual can assist with the proper public health response. About this. So at this time, I do not have that information to report out to you, but there are other counties that have been. There are counties across the across the state across the nation who are are working as a United Front to try to address this covered 19. I think we're talking about related to this incident. Yes, people outside that have been contacted yes, that is correct what is the threshold? These individuals who came in. Are you testing them now or you just watching them to see if they show symptoms? Thank you. Thank you for that question. so because the the testing resources and the supply chain it is still being developed. What we're doing is we're working in close consultation with our state partners and CDC to assess on a case by case basis, those individuals that would meet a criteria of person under investigation that would warrant. Additional testing so I've heard different explanations about. Doctor Collin today said. Look this person was on. Didn't show symptoms were not. According to the CDC throughout really sure that's possible that this could spread among people who are not showing symptoms. How do you address? Certainly with a situation such as an emerging and novel virus like Kobe 19, we learn new information on this every single day and as a result, we sometimes have to modify our recommendations based on information that we learn so as of today the current recommendations that we received from the state and working closely with CDC is that we need to be. conducting our our close contact tracing from those individuals who have come into contact with our case when the case became symptomatic and had spent 10 minutes within six feet of the individual. At this time, there has been no additional testing that has been conducted beyond the the case that was described in the governor's press conference. dozens of individuals. Experience how many people? I again don't want to get into the exact numbers of that part of our investigation, but again to your point where it's evolved, you're not really sure. Why not give the public as much information as possible? We act from there again. are you trying to prevent the stereo by not sharing all this information with you? Well again, I think our job is public health officials is to provide the the facts to be able to talk to the current recommendations in order to help reduce fear. So if we start talking about numbers, we have to put that information into context and sometimes that is challenging to translate to folks and we do don't want to. Caused panic as I stated earlier in my update. So one of the things that people might want to understand is the difference between isolation and quarantine as we sometimes get a lot of questions and and we know people sometimes use those words interchangeably so let me take the opportunity to address that When we're talking about isolation, we're talking about having someone who has the disease and telling them that they need to stay put when we're talking about a. Situation of corn team, What we're saying is that an individual may have been exposed to someone who has disease and therefore they need to stay put in this particular situation 14 days is the window that we're using so when when someone goes underneath a quarantine orders for this they have to stay put for 14 days. Go back to my original point. Is the person's Members or are they? Yes, so what what happens? you can imagine based on the definition that I described earlier about close contacts household members would be considered close contacts and therefore by protocol they are put into quarantine. Can you give us a penny more on the timeline notice the 20 second and then how many days after that they were. So I I don't have those specific details in front of me right now, I'd have to get back with you on that just to be. Who's contracted this the man in Wake County and his family members are all corn for 14 days is that correct No so recall that the individual who has the disease is in isolation. Just a minute. Close contact with the employer. So household members would be put into quarantine. okay individuals who may have had a contact with them. We go through that process that I was describing earlier kind of that low risk. medium risk high risk. It really is situationally dependent. It's for us to be able to understand their risk exposure. Once we do that, we are then able to know what type of public. Recommendations such as a 14 day quarantine such as self monitoring etcetera, It is appropriate for that situation, so Isolation is a step further than. But they're isolated from that that's correct they have to move their House or whatever but individual isolated room. That that in general terms, that's that's a good description of it in in the home setting these individuals who came in. This particular person they have contact with other individuals. Concerned about that aspect where you feel like since they're not get something showing symptoms, you're not worried about other people that that's correct and that's what kinda goes into. it being very important that we understand each situation because if they had a contact with the individual and that individual, then is symptomatic at all and they have contact with other individuals. There isn't that same love. Of risk there because again the key right now based on what we know about this disease is you have to be symptomatic. That is the point that's kind of that trigger point along with that time and distance requirement. How confident are you personally about that? Assessment that you have to be some. Again, I believe that this is gonna be an evolving situation and that this is the current set of information that we have to work with and that is what we are doing here Locally. We are following the current recommendations. So are you concerned at all that maybe this is the right approach and that later on we'll find out we should've contacted people further down the line. Well, my my preference is to focus in on the information we do know about and and I think that. that's important because we can't get into the the what if because they may or may not happen the information that we learn every single day about this will only continue to refine our our approach to managing the situation, but but in terms of contains if you go with this strategy and The CDC, it appears to be a lower risk, but it's possible that it could spread from people who are not showing symptoms and. In contact with this person are coming in contact with a lot of other people and then they start showing symptoms and they haven't been informed Ohio I may. Exposed to this, so I guess the question becomes if people don't know they've come in contact with this person or someone who else is coming. contact. And they start showing symptoms. How would they even know? well? I I think if we run into a situation that you describe that implies that the information has changed in our actions and our recommendations would be different at that time. Based on that information, we have to really focus in on the information that we have available to us now and the recommendations that we have available to us now. How many total people are under isolation for quality? Again, we're we're not going to get into the specific numbers of those particular activities. Obviously we talked about the the the familial unit directly involved and that case is an isolation and their household members are in quarantine. so we're getting numbers the only people in isolation the only person in isolation isolation as the man. Quarantine that is correct. Want them to keep track of their symptoms that is correct as part of our job with this, we inform the individuals what signs and symptoms they need to be looking for. We instruct them on how often they should be taking their temperatures. We instruct them on whether or not we would have a staff member that would be actively calling them or whether or not they would be hmm. Passively calling us if they were to have a concern and so again it all comes down to that risk stratification the way that we group that exposure risk determines the type of public health recommendation action as well as the activities and the level of those activities. So basically again we we follow the CDC recommendations if we were going to sample an individual, there are PPE recommendations for airborne and and respiratory precautions that they would take a personal protective equipment and if Doctor Cabanas wants to address any follow up on that he would be available to do. So, in fact, I would like to ask a question. Sure, yeah sure Your your personality are the people most likely to come into contact with sick individuals in Wake County are they expressing any concerns and have you taken any extra precautions for sure? Thank you so much for all. you've been here for asking that question. So it's part of our Standard preparedness plans. One of our key goals is to make sure that we're sharing information across our system with our first responders and EMS personnel and we've been pushing communication and information and guidance that is align with recommendation from the CC and public health to make sure that our personnel as well inform and and and understand sort of the. Process of what's happening in you know with with this virus obviously as Chris mentioned, you know Center precautions that apply here, you know it's the same recommendations that the FCC had, which is a 90 - five respirator gowns gloves and eye protection and and we have specific procedures that we teach our providers to on how to apply that equipment and how to use it when they encounter somebody who has overall general infectious disease process Symptoms of that sound like so if so, if a paramedic goes sure he gets called to some anything yeah, and they have a person who seems like they have. I guess flew like insurance. do they immediately done this year? Yeah. they have they have Center directive precautions and they they're trained and equipped to approach any influence like illness presentation with the appropriate personal protective equipment and has any of you three personally been to the. I I would just stay that we have no provider that has been you know think care of of the individual in the scenario. Was mentioned that this person is doing well. What is this individual showing right now? Electrical in the sense when they are doing their regular follow up communication with the individual and the patient, they ask specific questions that to sort of moderate symptoms signs and those kind of things. Showing symptoms fever having difficulty breathing person getting constant medical care. I don't have to go through the case, so I have to defer to Chris. We're not gonna get into the specifical medical information of our case. What I can tell you is by by us indicating that they're doing well is that they're resting comfortably in the home environment. Okay when when an individual is I'm sure you've experienced yourself starts to worsen in whatever symptoms they're dealing with sometimes that requires more immediate medical attention and we're very happy to report at this time that the person is. Doing well and resting comfortably at home. Contact with this individual. Corn Are you telling them to avoid? So as part of those public health recommendations number one, we wanna make sure that they're aware of the the signs and symptoms of illness and secondly, we encourage them to actively monitor their temperatures at least twice a day. Even though they're not in isolation or being quarantined, the people who have had contact with this individual and or his family members are those people asked to be limit their travel their where they go or report those places and so one of other activity that public health has been conducting for for several weeks. Now, it is monitoring other individuals who may have had traveled for example to no mainland China or some of the other affected areas early on in. Particular instances we are asking them to do more of a a self corn team because that is the current recommendation so that would include limiting their exposure out in public places limiting the number of visitors that they have in their home and so those are what we generally term as a more voluntary type of quarantine process, But it falls a very simple. type of approach, it's just doesn't have that legal serve document when when we talk about isolation, orders or quarantine orders. That you have have reached out to to say we understand you may have been in contact with this victim and or family members they're being asked to self quarantine by limiting their travel outside the home and their contact with other people that is correct and again it it all comes down to once we get a hold of that individual and we understand their specific situation and circumstances that allows us to then align the appropriate recommendations and. Interventions that are necessary to help manage the situation testing capabilities. Would you like to do more testing and would you do more testing if you have that capability? I certainly think that the nation is trying to ramp up the ability to do more testing and hopefully that will learn more about that supply chain in the next week to two weeks to see where we can when the circumstance calls for it to conduct additional testing to help us with this situation. would you rather be able to do it yourself to ask the state? Well, I I think that the The answer to that question is varies on each local entities ability to process those samples because you know there's very specific guidelines that are required. so first of all you need to make sure that you have the adequate supplies the appropriate supplies you then need to make sure that you have staff who are adequately trained to be able to conduct that testing. So so it's it's really comes down to you know what's. Type of abilities you have to be able to know if you can ramp up or would it be more appropriate to be able to kind of outsource the the the testing happy ability if you have to analyze it. I would have to check with our lab personnel to be able to understand and answer that question better right now. We gotta get back into the nature of handling the situation even as we're sitting here. Obviously, people are listening. I'm asking for more information about the whereabouts of this person. I know you've addressed it. Interest of public health is there any way? Just to use some of the fears people. Right now sure so with respect to the flight again, the there is not any additional information that we need with from individuals who shared a flight with our case. So. For their information, they're not for them to tell you what what I mean by that is that based on when our person become became symptomatic, we know that we're no longer needing to pursue any information on the people that were in the airport that were on the flight with our case. To follow up on that because we're hearing from those same people that. Out there. Information they want to know more about where this person was that they may have come in. Don't need that information or what is your answer to those people who? I'm very sympathetic to people needing different levels of information. I wanna make that clear one of the best things that we can do as a public right now is to do in do things that are within our control and those things are to frequently wash our hands to cover our coughs and sneezes to stay home when we're not. Feeling well, these are all things that can help us not only for this virus, but for flu that is still circulating another thing that we would ask the public to do at this time is that we will contact you based on a definitional information that we obtain as we go through this contact tracing process work with us to answer our questions to the best of your ability and know that we are far. The current recommendations that this is an emerging situations and that recommendations could change in the future as we learn more. Thank you everyone for coming out today if you have any follow-up questions, please write those through me. I think all of you have my contact information. but if you don't I'll see you over there. thank you.