Okay. we are going to go ahead and begin Doctor Aaron off. take it away. Thank you very much and thanks everybody for joining me. my name is David and off. I'm the director of the Division of Infectious Diseases at Vanderbilt University Medical Center. I hope that everybody can see the slides that are being injected. I'm gonna go ahead and get started the next slide so the goals for this briefing are to here in Tennessee and looking trends that are informed. Tactic that experts like myself and others are recommending next slide. So one lights that are being projected I'm gonna go ahead and get started with the next work one second so the goals for this briefing or to really review the latest cobo up night from here in Tennessee, get some trends that are informing meeting. Hey, we'll give that another go Doctor and off take it. We thank you very much for joining me today. I'm David the director of the divisions diseases at Vanderbilt University Medical Center and we can go to the next line so the goals briefing our view the latest coaching data from the state of Tennessee and look at some trends that are informing our recognition around mitigating this pan in our States like the. Basic is to think some of the data that when we're thinking about ways to mitigate the threat, endemic tactics that we can get the state and and then look at what about where we to go so talk about what the data show our standard physical simple and have some time for closing Antonio briefly right now, we have nearly a dozen case documented in Tennessee and here we are at the end of March the very days in our state noticed on March as of yesterday had 13 fatalities reported that. Nashville Department ported 500 pieces of Cove in 19 and County, which was an increase of 440 -, three cases reported just yesterday as we know the vast majority of infected either have mild symptoms or are asymptomatic and about people will be more severely ill and may need hospitalization and we're learning that maybe around one of every 100 people will guy of the infectious diseases because There are no vaccines and there are no effective therapies beyond hospital supportive against this demic so a lot of what we're focused on our efforts so the spread of this so that our health care exit do that to block transition is really to separate from one another where people can be transmitting virus A symptomatic of the virus is submitted through Roy droughts that we had when we speak or particularly when we caught to knees and that drives our recommendations out social dating, but we can also get the virus. On our hand, touch our eyes our nose our faith and get get infected that we hand hygiene is a really important of prevention, so the two keys are physical, didn't sing and handing and what's happening the curve to spread of the virus to slide. This lawn piled with publicly available data and it was made on March nineteenth, so this is about two to the very first case with documented to DC. You can see on the left the cumulative cases where the time has grown steadily its nineteenth faces that day had been day by day have been reported graph and what we eat map of state of Tennessee, which the identity of cases clear that it was mostly centered a time in data in Asheville and they're to most. Made or tactic around social distancing a few on March sixteenth the White 15 -day guideline and spread by letting transmission warning to get the message out there about social distancing if we can take a look at the next side, so this nestor day day and it's a little but on the left upper is the same or of cases also seeing cases of hospitalized patients and people who have died for 13 that was reported yet at the map in the Were new cases just reported. That's 20 - four hours, but I want you to focus on bottom heat map that state of Tennessee and looking at humility have, he says reported in the state and not only is Davidson continuing to be an epic Center. But now we're seeing Shelby County, which is where men and other rebate involved. It's high and they a County that's needed by Covered 19 and that's seven days of growth from March nineteenth to March thirtieth fun to the next slide we show both of these man. To each other much compared to March thirtieth and see a pretty dramatic bread of the virus across if we go and it shows these accumulates again starting in early March, the bottom of the end of the graph are the number of cases and you can see the steady persistent rise in cases March 20 -third we had Governor Lee delivered I could order 17 really focused on emphasizing of social and having. Limb gatherings so 10 people of wedding destroy wants and bars essentially you're suggesting to close just centers and recommending the use of takeout delivery teen was about limiting elective medical and dental procedures today we heard after there were 13 more 1800 cases executive order too, which is actually a safer at home order to urge people at home and urge the contention businesses urging people to world and you know not with. Yesterday, but yesterday, we can see just persistent and modern cases despite having some advice about staying at home and and participating in social discuss, there's more that we can do as individuals to flat curve and stop the spread of virus If we look slide these are data from a National source and looking specifically at Tennessee and the access on bottom meats, black bars bases of over 19 pillar today. we're just looking at it around Mark. What's missing from Eventually the data are complete, but it's on that squiggly orange and that is the change in average mobility of people based on I believe cellphone data and you can there is a gradual decrease starting at about March, six or so of social actions or social movement they sell phones, but our state grades nationally Sea level, which means there's 20 to 30 decrease in average traveled by people these days granular. they don't tell us about what the purpose for them. Movement was there's more we can do in this space if we go to the next slide. This is a model, and there are many models out there similar that it's that we health care capacity if we're on to limit the infections overtime in our the solid blue lines looking at our limit of our beds and which starts to really go line in mid April is the actual needed to care for patients. There's a Green line. bottom of this graph. It's horizontal and show the number of ICU would get overtaken if we don't do more in mid to late. April similar could happen where part of equipment for health cares for our ventilators, for example, if we're not able to flatten these, we could face and really important. spital beds, ventilators personal protective equipment and all of them power. all persons in Tennessee ask for being sick and not being able to get the care that they really next. Takeaways from what I just showed comparing the month heat map of again interventions and tax like public urging of so without of the March thirtieth suggest we haven't gained the kind of mitigation we in the spread of covid- 19, despite all activity it seems that the problem is still getting data us to want to do more so tactic we know guarantees the disease doing what we can to separate Bowl and we're also in hand Stay at home order got really important. They send a very important message and only one important message that I have is that our the person's living in Tennessee who are watching or or able to do everything they can to be to really take the executive order to very seriously and to continue to improvement leaders health policy makers to be pretty attuned to the data and asking what more can do to help save lives and it's the end of my sex and I'm happy to take some time. Alright Doctor Aaron Off it looks like our freshen is from Brett Kelman had Brett. Hey, can you guys hear me very much dock for that presentation? But some of that data I had not seen. I thought was particular statement decided to dig into most of what I just saw you go over was publicly available to buy this new health over the last two weeks and it looks like you have done a lot of the same with it that some of the journalists at the Tennessee and it will have as well. what I wanted to ask you feel like anything critical missing as you were building. This presentation is publicly available data and wanted to say important important than me things about break in Tennessee either anything didn't. Felt you should with our gaps sustainable that you thought was important. Well, I think something that certainly the minds of a lot of people in power and in terms of being is knowing where deaths are, for example at the County level, I think that would be helpful. I think Doc I think falls down for the first happy moment. Would you mind starting the name of your sentence for me? No sorry can you hear me right now? I can okay. I think a little more granular detail about being of your outcomes like death level could be helpful as well. Why well, I think again, it helps us to a better idea of where we may be up against healthier resource utility, give us more idea of where I still needed or being it may help in terms of thinking employment houses. for example, I think it just provides more context as the as to the disease and convey some understanding about what they should prevent the spread. Alright next question from Stacey basis Stacey. I should be a muted now. alright. Stacey. We'll come back to Stacey and it looks like White go ahead. Peter Okay, myself. Can you hear me so thank you very much for doing this. I sent your office some questions I've I'm on deadline today. I wanna actually step back everything that you've said I use important than I think the journalist story are doing us to get pieces of advice about social and everything, but I wanted to try out your specialty a bit so I'm. Consider that we're still testing, but not the way you as a sign for only testing sick people and I understand that capacity so I I kinda wanna ask about why is that important to still do I mean supposing we find the curve is as we can right and at some point capacity that we start doing your testing for people that are care show that sort of thing. Why is that important? What you do with that information and really like you just with presentation slides that you just knowing about. Dynamics of virus in our country, Indiana, our local community while a lot as we win the Coast and we can start DJ sizing these recommendations. It is very to me that asking people alter at home people not go to restaurants. ours is devastating to the economy and particularly here in nowhere, musicians or can restaurants or heard and a very nice to have the best understanding we can as to when we think it's assist to tell people that this club. You can get back to work and I think our public of experts ready to tell us when that point will be will depend on how good our bar in terms of knowing where the viruses are people still symptomatic from the virus versus allergies or others as the problems only if we see looks like a new outbreak somewhere, we didn't expect it'll be really impaired that will need to help guy next question is from William you're needed good afternoon doctor. I have a question you had the slide showing hospital can be ICU capacity mentally from from what you can see from the Is it inevitable that we are going to recently and it's a question of how much we can stay close to that cuz what what do you think the future holds for us right now? What would that be well? I don't make those self and I depend on a lot of people who are making give us warnings about maybe in for if we're not stack. Favor as we can to try to submit a surge of to the health care system at or around the same time with severe Cove at 19, What works is really social thing about and so us in the health care provider or are nerves that we could run ages on a hospital bed ICU later or personal equipment and part of that is driven by the fact that we've actually seen that in parts of the United States and other parts of the world. I don't I certain that we end up in that space in Tennessee. don't know it sir. That will happen because I still have a lot of optimism about our ability right now, engage do the things that we as individuals do to flatten the curve to slow the spread. that may be the best answer. I can give you some uncertainty, though, do you think the the state that the Lee administration is fully aware how bad it could get in you have I think so I think they're very plugged local and statewide departments of how looking at data for and they're. Concerned about I think we acceleration of Governor Lee putting in executors that are more and more urging people to stay at home and shelter at home soon it easy to do of course to ways to enforce or sheltering in place or step congregating and been staying off of playgrounds and preventing large religious groups getting together and things like that. I think there's definitely room to do more. but I really do believe that Calif experts government for the local level of our communicating quite like this. Alright next. 80. I'm where I'm headed there doctor so I'm in West Tennessee in Memphis and I'm one of the biggest consumer is that we up against two States that have issued a shelter in place and to look at this modeling. I mean it doesn't necessarily it captures it on as a state level to to communities like Shelby County. We are really dependent on our Green state like how closely when to be impacted by so their orders. I think you hit a very important question and I'm glad asked because you're living in an area that is very sensitive to what's going on in other States. The jurisdiction of our state level and I think if the virus doesn't really look order and virus transmitted from person to person and you know, I think this is a bitch so the things that be done of course would be to either suggest or multiple for people. The state of Tennessee, from other come in from a National travel. For example, we are really in many respects in this country of of depending on surrender States to do the right thing and all that to be collecting data on their own. that States are even test. Rates they have different capacities and that creates a challenge when you have a pandemic that sweeping the country. I'm curious, though, have you any model that sort of cuz I think the modeling that I've seen so far has been on level. Have you seen anything that takes into more account? It's like Shelby County would be more impacted by be as opposed to maybe even a good question and I think and I couldn't eat challenge to look at but I personally haven't another shot here as Stacey case you needed. Thank you doctor. Do we need a shelter order an actual order rather than favorite home suggestion. It can be yesterday, for example, in Kentucky resonates. Tennessee doing enough Well, I've been a champion place. I think it is a good idea ring this time where we're seeing really an increase in amazing really dramatic overtime here would be prudent to do that. you know certainly give Governor credit for doing the kinds of things that he's saying. But I do think there's more than we do and I think that a shelter in place to send a very strong message, give the state the capacity to enforce sure that you know we like to have the people will do things but sunny day. And and they play sports together, Nice and we're young and healthy, and we forget that these things matter when it comes to a pandemic. Alright. Darren Thank you. everyone for joining will circulate the video and and and presentation after the call. Thank you. Thank you all.