City Council Meeting: December 14, 2020

We are live with thank you and welcome everyone. This is the meeting of the past the city council for December 14th 2020. And we'll begin with the pledge of allegiance and it's my honor to ask our newest council member council member police their willingness to lead us in the pledge of allegiance until ready for the day. I pledge allegiance to the flag of the united like hormone all the leadership one way shape said individual performance. I'm trying to fulfill this for all for thank you and welcome. Council member williamson, it's a tremendous honor to have you here at your first meeting and we all look forward to the staff and every member of the council and I look forward to working with you for for the next four years at least. So thank you mayor. I'm sorry. Go ahead. Roll call. Yes. So we'll we'll proceed to the roll call. James, I'm here. Council member hampton let's be here. >> council member kennedy there . Councilman In madison is not present at this time will come in later. Council member masuda yes. Yes. Council member williams. Vise mayor wilson here mayor. Gordo here there's a quorum of the council present. great. Thank you. And let me first begin by saying that the council and we apologize for being a little bit late. We the council did meet in closed session. Regarding item eight listed on the closed session agenda and there's no reportable action at this time and we'll move on to the public. Comments are there any public comments that we need that need to be read? Mr. City clerk. Mayor, this is a special meeting so there's no public comment on matters not on the agenda. We will be reading public comments on matters on the agenda at the time that they are taken. And I'll chime in when it's when we have those comments. Tripp, we have a pretty long agenda tonight. Everyone so I'm hoping we can do things along. But before we start on the consent calendar, we have some special items on the agenda involving kobe 19 and we're pleased to have Dr. Morgan from huntington hospital with us. And also our own health officer health director Dr. Goh present and I'll turn it over to the city manager. How would you like to proceed, Mr. City manager? Thank you, mayor. >> I think probably we would start off with Dr. Morgan. I also want to recognize Dr. Kimberly schreiner who's with us as well from our partners at huntington hospital. and then we have Dr. Go Dr. Go. Is it ok to proceed that order? Ok. Good to follow doctor's order. Well, thank you. I say counsel once again for inviting us back. First of all, congratulations to mayor gallardo and vise mayor wilson and council member felicia williams on your I guess we decided with installation the other day is that the that that distant installation that was quite interesting. Certainly we are happy to be here and once again I want to share how valuable our partnership has been with with the city with the pasadena health department with our go and her team their expertise has been invaluable and of course Dr. Schreiner as our infectious disease expert really guides helps to guide most of what we do at the hospital. I do not bring you tidings of great joy. I am sorry. Since we last spoke which was three weeks ago, we are really in a tsunami of cove 19 patients. We have five times the number of patients hospitalized that we had three weeks ago and this morning we had a total of one hundred and twenty one patients in the hospital with twenty two patients in our icu with carrying a coded diagnosis in the last 21 days. We have had 14 deaths from komen. We have devoted four more unit to colon patients. We are currently using about 41 percent of our total available ventilators but almost 90 percent of those in use are uncovered patients are able to use or currently 73 percent occupied. If you drive by the hospital we are adding tents outside of our E.R. For additional holding and trish space for our emergency room which has been extremely busy with long wait times to be seen as well as holding patients while we try to prepare beds for them stairs. Additionally, we are adding some lounge chairs into our auditorium to give us extra space where folks can be folks who have very limited needs or are ready for discharge. Can be can be managed. Currently our largest problem is staffing the percentage of staff who are getting cold and the community is only slightly lower than the community percentage that are getting it. We are currently limiting surgeries. We are obviously doing everything that is emergency surgery but we are looking at our surgical schedule on a daily basis to decide if we have enough beds to proceed with the cases on the on the list and we do have a triage priority system that we used based off of one that was recommended by the american college of surgeons last March . >> that is where we are and I assume doctor go and Dr. Shriner are going to talk about vaccine. So I'm happy to answer any questions that you have. Thank you, Dr. Morgan. welcome. Dr. Shroom steve or Dr. Go? Did you want to? Yes, I can proceed and provide some of our overall information. I've asked Dr. Scheiner to join us as the expert on what's her infectious diseases background. So good afternoon, mayor and vise mayor and council members. Unfortunately as Dr. Morgan demonstrated, we are in the most dire covered 19 situation since the start of the pandemic within the southern california region. An alarmingly low of four point two percent of icu capacity in the whole region with this severe strain on our health care resources. We all need to be extremely concerned about our access to medical care for any illness, not just cope at 19. If someone is in a car accident or has a fall has an asthma attack, a heart attack or anaphylaxis from a food allergy and they need intensive care, it might not be available to them. If someone who is among the over twelve thousand new people per day in L.A. County or 120 people per day in pasadena diagnosed with kobe 19 and needs intensive care, it might not be available. So let's take a moment to think about this that today in the united states of america in the city of pasadena. If you or I need medical care, we might not be able to be taken care of if there aren't enough staff or beds in the trajectory of kobe. Nineteen cases is still steep and upward. We are seeing ongoing disease spread related to activities around thanksgiving and additional holidays are coming up in pasadena. It took us three months to go from our very first confirmed kobe 19 case to 1000 cases two months to go from 1000 to 2000 cases reflecting the surge over the summer. A 3 additional months to add another 1000 cases to reach a total of 3000. In contrast to go from 3000 to 4000 cases, it didn't take two or three months. It took only three weeks and we are on track to reach 5000 cases this week adding an additional 1000 cases in less than two weeks. We had a stretch some weeks in October November with no kobe 19 associated deaths but now we are sadly losing pasadena to this virus again. So what can we do? We all have the personal responsibility for the next several weeks to stay home, minimize the number of encounters with people outside your household by leaving your home only for essential services like getting food and medical services or if you are working in an essential service. When you do leave for a central services wear a face covering at all times and keep six feet of distance from people who don't live with do not gather with anyone you don't live with and that means canceling non-essential travel and social plans the same activities that you did in September that may have brought you in contact with others are much riskier now with the high case and positivity rates. The current california regional stay at home order which applies to everyone in pasadena and is in effect at a minimum for two more weeks but May be extended as needed and instructs us to stay at home as much as possible and stop mixing between households including a state travel advisory that's in place for avoiding non-essential travel. The sectors that are allowed to be open with public health protocols implement are critical infrastructure. When a remote option is not possible schools child care and pre-k in pasadena we have 12 schools with T.K. Your second grade waivers approved and 22 schools that have notified us of limited in-person services. They're offering non urgent medical and dental care outdoor recreational facilities including gyms and playgrounds allowed to be open retail at 20 percent capacity for standalone grocery stores that can be open at 35 percent capacity with entrance metering no eating or drinking in stores and special hours for seniors and others with chronic conditions or immune compromise. Hotels and lodging only for accommodation for essential workers or providing housing solutions to protect homeless populations. Restaurants open for takeout or delivery only offices open for critical infrastructure only so non-essential offices are to be all remote places of worship and political expression May have outdoor only events or gatherings. Entertainment production is allowed to go on without live audiences. The sectors that are closed are hair salons, barber shops, personal care services, museums, zoos, aquariums, movie theaters except drive in bars for and breweries except for production and retail sales for offsite consumption limited services and live audience sports. We do have some hopeful news while we battle this surge in cases hospitalizations and deaths by staying home wearing masks and social distancing. >> we are also at the beginning of a new phase of the pandemic one that will be made possible with protection of safe effective vaccines on December 11th. The food and drug administration issued an emergency use authorization for the pfizer beyond tech kobe 19 vaccine on December 12th. The advisory committee on immunization practices of the cdc issued an interim recommendation for use of the vaccine in persons ages 16 years and older. This vaccine consists of two doses administered intramuscular early three weeks apart. A large randomized double blind placebo controlled phase 2 3 clinical trial that enrolled more than 43000 participants showed high efficacy of more than 92 percent across age, sex, race and ethnicity categories and among persons with underlying medical underlying medical conditions. The most common reactions after receiving the vaccine were milder moderate such as fatigue, headache, muscle pain, chills and local injection site pain. Serious adverse events were observed in a similar proportion of vaccine and placebo recipients and encompassed medical events occurring at a frequency similar to that within the general population subgroup analysis by age race, ethnicity underlying medical conditions or previous stars kobe to infection did not show differences in safety concerns . So based on the cdc advisory committee immunization practices and the california department of public health prioritized in phase 1 a of the vaccine delivery effort will be focused on health care workers and residents and workers and long term care facilities for older or medically vulnerable individuals. Health care workers include not just nurses, doctors and the employees or paramedics but also anyone working in a facility providing food, environmental or administrative services. In one of these long term care facilities, future priority groups will be determined by the cdc and cdc h as vaccine supplies increase in our distributed to local jurisdictions with some examples of those groups are expected to be essential workers. the western states scientific safety review group a panel of nationally acclaimed scientists with expertise in immunization and public health completed their concurrent thorough and independent review of the federal process and confirmed that the pfizer copied 19 vaccine is safe and efficacious and provided their confirmation to the governors of california ,nevada, oregon and washington yesterday the pasadena public health department expects 1009 hundred and fifty doses of pfizer vaccine which we have allocated to be delivered directly to huntington hospital to arrive later this week, possibly thursday. >> additional doses have been requested and are expected to arrive weekly. In addition, the state has activated the federal pharmacy partnership which almost all of our skilled nursing facilities and many other congregate living facilities have enrolled in for cbs and walgreens to send teams into facilities to vaccinate staff and residents. In addition, we are planning dispensing sites and strike teams to provide vaccine for facilities health care workers not covered by this program. I wanted to mention in addition to vaccine technology and and the amazing the amazing unfortunate situation that we find ourselves in to have a safe and ethical effective vaccine. Now two other technology solutions that will augment our success in battling and ending this pandemic and we are asking for everyone's participation. the first one is california notify which is a free anonymous alert system to tell you if you have May have been in close contact to an infectious person. This is an app for your phone or smartphone and it uses bluetooth attenuation to determine proximity or distance to someone else and not a G.P.S. Tracking system so it does not identify your location or track you and there's no long term data storage. For more information you can look into california notify and you can sign up for that second is a platform called v safe after getting a cough and 19 vaccine. This this platform does real time tracking to to identify adverse effects and report adverse effects. This is in contrast but in addition to the system that we already have in place which is a passive vaccine adverse event reporting system that we use for all our regular vaccines. But this is an active a proactive monitoring system that will give us we're very hopeful would give us a lot of information on any side effects of any vaccine October 19 vaccine and that will help us help the scientists determine whether there are any any effects. And so we we want to ensure that people feel confident that this will be actively tracked. So that is all I have for my updates. I'd do you have to answer questions and Dr. Scheiner is here as well for any questions on vaccine preferring to do a come through if you'd like to address. I think that Dr. Goh really addressed them very effectively and this is probably our only way out of the situation. >> as Dr. Morgan has described, we are managing but just barely. This is a very dire situation in 30 years as an infectious disease specialist. I've never seen anything quite on this magnitude. So it's pretty daunting. The vaccines appear to be very, very safe. I think the one thing I would add is that although these are relatively new ways of making a vaccine, these are both mrsa vaccines the pfizer and madina, the science behind it has been around for a long time. It's been developed over the last 10 to 15 years and has really been awaiting, if you will, a pandemic in which to test them. And now we're we're at that point. The pfizer trial was quite thorough. As Dr. Goh mentioned, it was about 44000 people and the effectiveness of the vaccine was quite surprising actually we were hoping for a 60 to 70 percent to achieve 95 percent is really quite remarkable. It's going to be logistically a challenge to get this distributed and dispensed and administered to the entire population of the united states if not the world. But I think that we are going to start at the local level when we have the capabilities doing it. and again, I would just call out the public health department in pasadena for being such a wonderful collaborators with us and helping us protect our health care workers and then subsequently all of our population sector go mentioned the vaccine is very, very safe out of the 23000 some odd people who received the vaccine and not the placebo. Only about eighteen hundred experienced any type of side effect that was significant enough to report that the trial was never paused unlike the astrazeneca trial for any kind of medical reason. And so I think in the grand scheme of things and looking at the data that came out of a substantial trial, it appears to be very, very safe as we move forward using the vaccine over the next two years. All of the individuals who participated in the original trial will continue to be monitored and this doctor go pointed out we are going to keep track of other vector vaccine reactions or vaccine effects that perhaps we didn't see in the first part of the trial and monitoring those very closely. But I think that the data is quite robust. I think this is a very, very safe vaccine and is quite protective. We don't know how long the vaccine is going to be protective for but it does appear at least a year or two perhaps longer and that's encouraging because that will give us a chance to get this thing under control and hopefully assume some sort of a normal life thereafter. I'm happy to answer any questions from anybody. >> Mr. Kennedy raised his hand and then will medical council member peter williams. Thank you, mayor. In your presentation Dr. Go maybe who who mentioned that there would be strike teams to provide the vaccine? I did. The health department and we've also talked about collaboration with the depending on their availability of staff. >> okay. Thank you, Dr. Go. So my question is first of all, for those in the populations that were discussed that need the vaccine first, must they take the vaccination? >> no, I can certainly answer that from the hospital standpoint. In california you cannot mandate that workers get vaccines. So we are not able to do that. We certainly have begun a campaign with Dr. Shriners help to educate our staff about all the many reasons that we strongly believe that people should be vaccinated. And in fact we did send out a survey to our staff a very short one just to say when it's available will you be getting the vaccination? And actually about 81 percent said they were. Of those who responded said they were interested which is actually a little bit higher than our flu vaccination uptake. so I think people are quite interested in this vaccine. We'll have to see where the final numbers end up. The second question is for health providers in the city of pasadena. Is there any ordinance that you're aware of Dr. Goh or Mr. Mills city manager that would have any bearing on this subject? Council member I'm not aware of anything in our municipal code on point. Ok. So back to Dr. Morgan on my last question is and this is also to Dr. Go for the health providers in the city of pasadena. Who opted not or will often not to take the vaccines and will they be identified as in the case where I'd take my health care if you don't receive a flu shot, for example, that person is identified and you know that very quickly because they have more protective gear or ppe than someone who also asked tv. So can you just share briefly because it's an awesome responsibility. Can you just share briefly about what would actually take place? Yeah, we want to adjust our ppe requirements for quite for quite some time what we do with the flu shot is we have people have what we call a badge buddy. >> so you can tell at a glance whether they've had their flu shot or not. I'll be honest with you the vaccine came quite faster than we had expected and so our ability to have the badge buddies by the end of this week we might not be able to do. But we will figure out something with the sticker. But having said that, we aren't I think right now prepared to change how we are providing ppe . Kim, I don't know if you want to add anything to that or not. I just want to re-emphasize I think people maybe have the misunderstanding that if they get the vaccine they don't need to worry about transmitting the disease. We know that the vaccine protects you from the disease but it doesn't protect you from actually acquiring the virus. And it just keeps you from getting sick from it. So what we're concerned about is that those individuals will still continue have to have the capability transmitting the disease to someone who has not had the vaccine and is not immune. And so for that reason I absolutely echo Dr. Morgan's comment that we for many, many months we're going to and this applies to the entire country we're going to continue to recommend certain of our own hospital. We're to recommend normal ppe just assuming that you haven't been vaccinated and for the community to wear masks and pretend to protect us practice that kind of protection because you could. You might be able to transmit the virus. To other people in my loved to move to the city manager and Dr. Go and we identified a central or critical personnel who must come in contact with the community for example fire and police. But I suspect there are other professionals in with the allocation that we're receiving in the city of pasadena. Do we take part of that allocation to inoculate or vaccinate those individuals who are in those critical roles that are coming in constant? Contact with the public so those individuals will be in forthcoming tears but they will be in higher priority than other members of the general public. >> I think that's all my questions. Mayor, thank you very much. You remember williams and followed by Mr. Madison. >> thank you. So I have questions about the hospital capacity for Dr. Morgan when I do have one question on the vaccine for Dr. Go. So I have a bunch of numbers floating around and I want to just make sure that I had the correct numbers. What is the regular patient and icu capacity of of huntington hospital noncombat normally or icu? Is we have a 30 bed icu that we can get we can use and we have the. Have identified other areas where we can take care of critically ill patients to flex up to a much larger number than that. The issue is staffing so of the beds that we have open right now we are at about 75 percent of the capacity that we have that we have opened but we are well over 30 icu patients and in total ok. >> so if the icu capacity is 30 at a minimum and what is the what's the maximum? Well, if we had stepped up we potentially could go up to 80 to 86 and if we had to. That means we need additional pulmonologist in addition nursing staff to be able to be able to do that which we currently don't have. We have identified locations and we will do our very best to continue to expand capacity to meet the needs of our community . But it's it's going to be very difficult. What is the regular bed capacity of huntington? >> we can admit. Normally we can admit up to about 400 and 10 patients without without the storage capacity. Our surge is somewhere around 600. Currently we have one number I didn't look up this morning I think about 400 patients in the hospital. >> ok, and then one hundred and twenty one of them are public patients. Yeah, under him under ok. And then this is a little bit more of a difficult question but based on when you take those numbers and you use these staffing constraints, what is the actual capacity? Huntington the regular capacity and the icu capacity just given the staffing constraints constraints. >> like I said normally we could in total. Can we can get to by using extra staff we can go to about four hundred and ten beds to get to our stretch capacity. We have to go beyond state mandated nurse staffing ratios and positions that the physician staffing ratios aren't state mandated but but we have to ask people to take care of more patients than we would under normal conditions. Okay. So so just given the staffing constraints it would probably be for 10 would be the regular patient capacity in the lower end of already would be the icu capacity. Yes that would be snorkels. Okay. And then the overflow tent in the parking lot. What are the criteria for when you would use overflow to where it would? >> it really is going to become an issue of the capacity if all of the dead in our emergency room are full then we will start to use that as overflow. Okay. And then the last question has to do is for Dr. Go in it's wooded. What is the vaccine distribution criteria huntington versus cbs and walgreens and how since we do have our own health department ,how has that impacted or distribution of the vaccine so both the q care hospital and all our long term care facilities are in tier one a bit within that that slice of a tier with limited supply. >> we have some prioritization and so our top priority in the one a tier was the hospital and they have their needs total nearly five thousand doses so out of our almost 2000 sending the first tranche over there was made a lot of sense and this is the vaccine that requires ultra cold freezers. And so this is not something that's easy to distribute to anybody else or take out for very long. So we expect our next pfizer order to also go mostly to the hospital and at there have also agreed to help with some other populations they normally vaccinate like our employees and possibly some our community doctors. Some of our skilled nursing facilities. So we're going to work work through that. In addition, we have put in our request for over 6000 maternal vaccines. That vaccine has not been authorized yet by the fda. And so we are going day by day to understand exactly what the vaccine supply situation is and what the subsequent distribution will look like and that might be if it's approved that might arrive here in two weeks. As you can imagine, there're so many logistical factors including the manufacturing you know, if that's happened or not. But another one has been thrown into consent to the process which is we're very happy that they have activated the the federal pharmacy partnership but they state at the state level will have to maybe take away from our local health jurisdiction supplies in order to direct allocations in order to give some to the pharmacy program which we're happy about because we want them to be given to that program so they can vaccinate our facilities. So that's all being juggled and worked out at the state level and we're waiting to hear exactly what our numbers will be after they make those allocations. >> thank you. And just to be clear, is there a separate allocation for her health department as opposed to being a regular city in lake county? >> yes. And we have a to the pfizer vaccine comes in pizza boxes. That's the term they use of 975 which is quite a large number. So you can't split that down to less than that. So we got two pizza boxes so that's why we're almost at two thousand which is compared to long beach which got four and their population being three times our size. And similarly we have a disproportionately high number of vaccines here compared to L.A. County as well because we have a disproportionate healthcare worker. Population that works here. And so the way the state went about making that calculation has to do with the health care worker population, the people who work here no matter where they live are the people that will get vaccinated out of the supply. Thank you very much. That's it for me. Thank you, Mr. Thank you. >> Councilman Rooms council member madison. thank you, mayor and thank you. The doctors go morgan and shriner for your presentations . I. I had to come into town late so I'm hoping I won't be too repetitive here. But one thing in terms of to pick up the conversation about ,you know, as we move forward with this vaccination protocol . Will there be a way to or have we given thought to identifying persons who have received the vaccine? >> so every individual who receives this vaccine must be entered into the state registry immunization registry and so that vaccine registry already exists has existed for quite some time. I hope that the system is capable of managing all of this data but it's required by the state to enter all that information within a day of that person being vaccinated. That gives us the ability to follow up with these people and know which vaccine they had so that they can come back in three weeks or in the case of them or during a vaccine in four weeks. So you can see this is going to get really complicated as we try to notify people to get them back vaccine. We are hopeful that there will be a one dose vaccine option in the spring that might allow us to vaccinate the general public more a more easily logistically . So are the health care professionals who are administering vaccines responsible for reporting to the state for this registration ? Yes. And will the city pasadena be such an entity? Do you expect that you'll administering vaccine? Yes. So do you have custody right now of the two thousand two pizza boxes that we have? >> we are. We have arranged for direct shipments to the hospital. Okay. To h h. And we have not received them yet. Okay. Will do you anticipate that you Dr. Go our health department will be receiving and keeping vaccines itself. Yes. Okay. When do you expect that'll be like it'll be after we're able to get everyone huntington vaccinated. >> okay. So our first priority is each image and its new patient facing employees and broadly defined and others. You know, obviously I want to see our firefighters and our police officers vaccinated as soon as possible as well as you know, members of the hope team and all city employees that are potential patient facing well, it's been defined by the state and you know, this whole vaccine supply is purchased by the federal government and provided to the state and then provided to us. And so we follow those guidelines. the specifics as to how we implement vaccine delivery might come into play. You know who might be look at it first. What I'd like to see is overwhelming demand from our employees and from our from our frontline workers. >> so anything you can do to help with that will be really important to protect them and everyone else. So there are know decisions on for example, if we stand up drive through clinic at huntington as a part of their their vaccination effort, they would include they indicated they would include our fire department or at least our emt is ok. So who's who owns that for the city? >> is that your self? Are you coordinating those arrangements with huntington and you'll be reporting to us and to the city manager about that. Yes. Ok, and that kind of segue ways back to the idea is the registry is one thing but and I'm very mindful of Dr. Shriners comments about the limits of you know, having vaccinated oneself and what that means and what it doesn't mean. But for example, if I'm trying to survive as a restaurant in pasadena, you know, have we given any thought to a wristband or something that we could issue that would have the force of municipal law that would indicate I've been vaccinated and so for example, a restaurant might decide and we might decide we're going to allow you to reopen the appropriate time and if you choose to only serve patrons who've been vaccinated, your lawfully allowed to do that. And here's a way to accomplish that. I have not. We have not talked about public policy and whether that is possible or even allowable. I think that employers May want to make that kind of consideration. We have talked about how someone might provide evidence of vaccination. It seems like it would not be it that it would be challenging to have a foolproof system where you could you could not have counterfeit documentation of some kind. So. So there is no system in place right now at any level that provides like a driver's license that can't be duplicated that would show that you're you're vaccinated so that that does not exist at this time. >> council member mary madison I would add that obviously we're operating under state orders. We haven't taken any action with the latest stay at home order that's more restrictive than the state. It'll be interesting to see how the state sort of rolls back or allows things to re-open once vaccines become more available. Their current stay at home orders really being driven by the number of people are in the hospital. What the icu capacity is. so using that metric if the state stays with that then as vaccines are out there and the numbers people in the hospital and the icu comes down and we could see the reopening of segments of the economy without having to get perhaps as granular as saying you know who could eat in a restaurant and who couldn't. Presumably the governor would say at some point restaurants could just simply reopen. >> well understood. >> but I think one advantage and I would argue obligation of having our own taxpayer funded city public health department is that we should be thinking about these things and maybe time step out ahead of the massive bureaucracy of the state. You know, I mean look I mean I yield nobody and my belief that we have to adhere to the medical science and the recommendations of the health care professionals. But there will come a point where we'll be able to start to resume normal life. And I want to make sure that pasadena we're doing that before those cities that chose not to invest in their own public health department. So I'd really like to see us study and discuss. I mean it's up to the council I suppose in terms of clear direction. But you know, having some city of pasadena id that you know, I've been vaccinated, I get there's no foolproof system even driver licenses are are regularly forged. But we shouldn't let the perfect be the enemy of the good. And you know, things like even the little stickers that we all get when we vote, you know, I vote. Those are tremendously popular and I would think if you had a way obviously not a sticker but if you had a way to carry with you something that showed it could help our businesses could help our residents by giving them some level assurance. Again, I don't want to get out in front of Dr. Scheiner but some level of assurance that well, I'm going to be an environment where we've all been vaccinated at least. So that shows a higher level of attentiveness and perhaps protection. So but I wanted to just quickly and mayor, you're being more than indulgent with me time so just I'll try to wrap up at I guess what I'm hearing from Dr. Morgan is that we wouldn't meet this state's criteria of having less than 15 percent available icu capacity presently for 75 percent. Does that imply that we could choose as a city to not be under the most rigorous shut down orders right now? No. And I can defer to Dr. Go to confirm that I'm correct that that capacity issue is a regional one that has been declared by the state. So it doesn't go by city. It goes by a region five which where in region five is well below. And just you know, again, it's all about numbers. But but going from our current 75 percent occupant or twenty three percent of available beds versus versus less than 15 that's a matter of three or four beds. Right. I mean it's not it's not like that means we have one hundred extra available beds. So but we we have to follow the regional math not this not the heart our hospital math that we have to follow and that's certainly been very confusing. You know, one month it's county by county the next month. It's region by region. One month it's tears. Are we still in that purple and orange red tier? Is that still being employed? We would be if our case rates were lower but we're well beyond that at this time. So this is sort of an override to that and we have both systems. We are multiple like ten times higher in terms of our case rate than the purple tier. >> so it's it's it's because we're in an emergency as I mentioned emergency break. We are in an emergency state now. >> right. That really wasn't my question. My question was are we using both systems then the purple tier and then this other regional tier regional model. So we can't use the purple. >> we can't use those tears because they don't apply anymore. We had to be more strict than the whole tearing system. So. So this overrides this overlays and overrides on top of it and then will we fall back to tears if you guys only get come off this emergency? >> yeah. Okay. And then Dr. Go I'd asked a couple of other questions I guess let just sum up by saying you know for my constituents who were asking me where am I going to get my vaccine? Is there a simple answer that we can provide and are we addressing that over a dashboard? >> well, we're not there yet. We need to have enough supply to get through this first tier which we estimate is well over 12000 people in pasadena. And as you can see it'll take a little bit a little bit of time and then and then we need second doses for those people. But in the future there I envision a combination of ways to get your vaccine. I hope that the private sector will be helping us. I hope that we could have targeted cbs and walgreens. I hope that our our hospital or our health care system will be helping us. So in your doctor's offices kaiser is getting an allocation of vaccine right now and is a public health department. We would be standing up and pointed medical points of dispensing to also allow people to access vaccine hopefully through a drive through or a walk up model. >> thanks so much. Thank you, Mr. Madison. Vise mayor wilson paul, what was it? >> thank you, mayor. I had a few questions here. i think I wanted to go back to a statement Dr. Schreiner made about the vaccine and I think it's critically important that I think there is an expectation that when you get this vaccine that means you can't get the virus. And what I've heard from Dr. Schreiner is that it basically assures that you would be asymptomatic, wouldn't sherman? Ninety five percent that you would be asymptomatic so you could still be a carrier. And I think the opportunity for people to be super spreaders and those are the things I worry about most is people who don't know it think they're fine and they're living their life normally. Dr. Schaffner, is that my interpretation is accurate based on what I heard you say? >> well, to be clear, we don't we don't actually know the the answer especially after you've been vaccinated and you have immunity for a while. But we do know that you can still actually harbor the virus in your nose and your upper respiratory tract. And so you could conceivably pass to a not immune person by coughing or sneezing, talking or singing or some sort of aerosolized nation event. We don't know whether people who've been vaccinated carry a high load of virus such as the sort of the classic asymptomatic spreaders that we worry so much about. Animal studies seem to show that the viral load is actually diminished in animals been vaccinated with stars kobe to vaccine. so we hope that that going forward the vaccines actually might prove to diminish your carrier state as well. But we don't have that data. There's been a little bit of data around the I believe one of the other vaccines that I can't recall which one it has not been yet approved that did seem to show a much lower viral load after the recipients were vaccinated. That is something that most of these places are going to be looking at. And so for now we just have to assume that you still can effectively carry it and transmit to someone who is vulnerable. So that's why we want people to continue to wear masks and not be careless. Obviously that's a key piece of information in terms of behavioral limitations that we need to understand and obviously we're thrilled that we're even having this conversation. >> I think most people expect the vaccine to be here for probably another six to four months. >> if I could make one more comment by sara wilson the other two things that might not be very clear to people is if you have had coded. If you have actually had the real disease. Yes. You May have some immunity but we do think the vaccine is more immunogenicity. So we are recommending the the cdc is recommending that individuals who had covered as long as there 90 days past their illness that they should indeed be vaccinated next month. >> thank you for clarifying that. That's helpful. Dr. Go you talked about this tier 1 and it sounds like there's you need 12000 doses for that. Is there a table that shows kind of what all this looks like that May be helpful. So we're getting lots of questions of, you know, when and what if there is some guidance that's been published that would be useful to all of us if you wouldn't mind circulating that to this group. If such a document exists, set the table looks like tier a and it lists the categories I listed and then everything else to tvt no. >> there is a I will provide to you. There is a national academy of medicine space structure that is a recommendation from outside outside body was requested I think from the cdc but so that's not what it's going to look like in the end. Possibly. And then the advisory committee asap has published two textual and not like a chart with the hearing system that has two articles that just tell you what the first priority is which is health care workers and long term care facilities. So the rest is is forthcoming. >> well, you can imagine that the public is going to be really interested to know where they you know, one b one c to a ,you know some of this it really depends and I've talked about this with my staff. >> it really depends on how much of it we have. So if we have a ton of vaccine we can fact we can cover tiers 2, 3 and 4 all the same time. Right. But it depends. The prioritization that hearing really just depends on limitation of supply. >> well I think helps remember kennedy mentioned this. Any information that there should be other cities curbing information is sort of you know what we know in terms of vaccine timing and phasing because people are very excited and concerned and eager. I think is the word. At what point and maybe this goes to you and Dr. Schreiner do we achieve herd immunity between unfortunately more people get it the closer we get to that and that suggesting we're anywhere close to it yet. But I imagine there's some combination between amount of people vaccinated, the number of people who've had it that actually maybe gets us to some point. Herd immunity or is that a kind of a flawed concept for herd immunity? Generally traditionally is about 60 to 70 percent of the population. It depends a little bit on the infectious ness of the particular pathogen and since this starts koby too is so infectious we'd like to see higher numbers to really try to squelch, you know, persistent outbreaks when you have a virus that's very, very infectious and also very dangerous and can cause high mortality and morbidity, then you want to try to achieve higher herd immunity. Classically it's around 60 70 percent. And yes, you can combine sort of what you achieved from natural immunity from people who have acquired the disease without with what you're with vaccination to try to begin to just eventually get to the point where the virus doesn't have any place to go. And that's when we see this go down because this is a very acute virus that only last for a couple of weeks that could happen pretty quickly. But I think it's going to take some time to get to that spot. >> it is one of the questions I had and you mentioned and I think Dr. Morgan in her own survey of, you know, 81 percent and health care professionals said they would be open to taking the vaccine as long as that number I guess is above their zero herd immunity number then you could see those thing you know, you could see a pathway to success if only half the people are going to take the vaccine and given immunity, you know, 90 percent, then you know, you don't see your way to the land of milk and honey. So I just wanted to make sure I was looking at that properly. Dr. Morgan. Dr. Go mentioned that in southern california in our district it's 4 percent icu availability and you stated we're at 73 percent occupied. It should be 27 percent unoccupied. So how many are those all icu beds or do you break them down? Are you talking about icu beds that you have earmarked for kobe patients that that is there? That's for all our icu beds and we right now have only divided about half and half but we keep expanding our cove in bed because that's the ok in that universe we're talking about 73 percent occupied and 27 percent available recall is run, 80 is the entirety of the number we're working with right now. >> again, no, it's it's a much lower number than that currently because it's based on staffing. >> can you tell us what that number is that you're using? I don't want to give you a wrong number so can I shoot that to an email? Sure. Absolutely. I do think it's moving along. It's a good time to remember a matter of discussion of evidence vaccination as Dr. Go something we need to think about what the policy issues are and what did the application that I don't have a strong feeling one way or another. But I do think it's something we need to explore. The good news is I called the bad news is we have time to figure that out before enough people will be vaccinated unless it falls from the heavens. But I do think that comes no madison's question about how do we track this? What the implications are that is important. You mentioned doctor go california notify it isn't an app. I don't know about others but I got notified on my iphone that something called from apple called exposure notification got loaded on my phone if anyone else got that automatically loaded in the update. Are you familiar with that at all? >> I believe that that's that's the california notify app. I think my husband got in his phone. I haven't looked at it closely but I think that the governor mentioned that they had a partnership with apple and maybe google they were going to try and be proactive about giving getting it to people, getting it automatically. You know, you got loaded unless you denied it. It would be good to know that we have already if people are on an iow device. Then finally I know you went through Dr. Go initially the essential services that are still allowed to operate. I know I've had a number of calls to my office that filming which doesn't quite seem essential. It's a little hard to explain to some of our neighbors especially on larger film shoots where you see large numbers people I don't know whether there's especially during this really critical period. Is it something that we should take local action on? Do you think there's meaningful health risks or is it just bad pr for us in the film industry that they're operating, you know, per usual given current circumstances? >> well, I certainly hope they're not operating per usual and we would accept any reports and and try to to reach out to those productions that are not following health protocols. They are they and sports I think are two areas that you could argue there's gathering and introduce risk to the population because these are not people who are a bubble. Even the nba is not bubbling anymore and it's causing a lot of concern among public health. The it's difficult for these two industries for local action to be effective because usually that just drives people somewhere else to do the same activity and then contribute to our overall rates anyway. I think as close adherence to the testing and the restrictions that are in the protocols that we can achieve the better off we'll be unless there was unified statewide action that was going to be taken. >> and vise mayor wilson I would point out that locally we do have a moratorium on filming that will go into effect December 18th and last until January 7th. Consistent with the moratoriums we have on doing work in the street around this time year. So that might provide some relief for people who are at home and have concerns about filming. I'd also mention that I also mentioned we've issued 83 permits between the period of August 1st and December 11th. >> that covers ninety nine filming days. And as far as I'm aware we've only had complaints about one film shoot which happens to be in my district. >> so that's what I would ask steve to go if we could just be extra vigilant. With those filming scenes to make sure that code enforcement and protocols are being monitored, I think people mean it's irritating in the sense that they can't it's hard to explain themselves where they can't go to work and film shoots are going on again. The governor had a nice dinner at french laundry apparently with the lobbyist of in the entertainment industries. Rumor has it but also people are stuck at home. So the impact to neighbors and people who are now in their homes by a local neighborhood filming is amplified. So I'd ask that we see the action the joint that once again. Thank you, Dr. Moore. Thank you, Dr. Schreiner. And thank you, Dr. Go. This is kind of the heat of the battle and we're behind you 100 10 percent don't remember masuda. Thank you, mayor. Thank you, Dr. Morgan to the golden Dr. Scheiner and our energy is on vaccines obviously . And I know you said that there's no foolproof system but what I'm concerned about is that first of all it's two parts to two shots and I think he said three weeks apart for the pfizer. how would this be monitored by patient and by the providers? The the the two parts. And so there's no confusion. Well. So right now we're working through health care employers and as employers they in addition to the state registry they would be tracking you know ,who got what shot and when they got it. >> and then providing reminders and providing the second dose. And when we get to a point where this is being done in the community, we would do the same. Just answer the question. Yes, Dr. Morgan, the last time you were with us you were talking about the convention center being used for overflow. I know. I think we're getting to the point that it's a very serious possibility now is that. Are you in the city manager's talking about that again. We we did have a conversation in which was back to a request made by the county that the real issue council member do that is staffing. I do. We have everybody deployed and people that we don't have at the hospital right now. So there's no way that I can think of at least currently that we would be able to stop that the county didn't make a blanket request of who could stand an alternate care site. And with after discussion with steve, I did let the county know that you know, the pasadena convention center is there. We could. we've done all the logistics. We know how to do that. We could provide oversight but they would have to figure out how to provide the funds and the staffing to do that and have not yet I have not yet heard back from them. I'm not sure if steve has had any or Mr. Mahmoud has had any contact with them or not count Councilman Or masuda as Dr. Morgan indicated, we advise that city pasadena stands ready to assist if necessary. >> but we haven't had any further discussion. And again the key issue is is the staffing thinking there? >> thank you that council member. Captain. Yes. >> I had a very I'll be very brief. I want to go to the vaccines and maybe you have mentioned this already. Dr. Doe. Are you sure that there will state criteria of how they would be implemented? Well, I mean who's at the top list? I know that it sounds like. Which rightfully so health providers are at the top of the list here in the state. But who would be second if all the nursing homes everyone who were good localism in nursing homes and after that would be we've got other health care workers like emt and paramedics and some of our public health staff who are going to be vaccinating everybody. >> and then we can move into possibly there to two other cats. i mean there's so many categories but bordering if water obstacles are always wondering where in this list of so there are people that interact with people every single day and the people I can think of right now on the outside of the health care workers who are in there active and with people that are sick every single they are the next most impacted is of course our singers because they are most most at risk to this disease. >> but is the grocery store worker the grocery store worker impacts with people and no one else is seeing that many people on a day to day. And I just want to figure out where do they land on this list? >> so they're at the next summit? Yes. Some to another in the next phase. There are many essential workers including including restore workers, transit workers, other city staff like water and power people who have to be out in public. We even have kindergarten teachers. Teachers are a k through 12 teachers and child care providers there. These are our our central workforce that have been working throughout this pandemic that we want to get protected with vaccine. Ok, this was drawn I understand that because I've heard a lot of you know, as much as I want to make sure that our first responders receive this vaccine is I want to say that the people that are actually most impacted by seeing people on a day to day are getting this. So I appreciate answer the question. The other question is because of our numbers and I understand council members madison's questioning as well about you know, if you already had covered or you or you have gotten the vaccine, could you be able to go into a business? I definitely get that because it kind of seems like, you know, all these tiers and the way things are getting down. >> I understood. I don't I really don't understand the rationale behind a lot of it. But you know, if it is really bad then why are we still letting elective surgeries happen? I know that it's really bad. I'm just saying why is the state not said no more elective surgeries at this point? Well, my answer to that would be that that in general what we found in March when all the elective when everything was shut down except for absolute emergencies, car crashes, things like that is that there were so many delays in health care that when those things that were elected the came non elective and then people presented more sex than ever with more complications requiring more resources and requiring icu bed. >> so you know, those are delays in cancer diagnosis delays and cancer operation diverticulitis becomes severe and perforated et cetera, et cetera. so I think what we found was that blanket just saying you can't do x, y or z actually ended up putting patients in a far worse position. So I'm not sure if you heard earlier but we are we're trying to do anything we can that our patients so that people can continue to get their health care and not be at risk for more complication. And then are looking at our schedule on a daily basis using a tiered system based on urgency to decide whether we can proceed with with surgeries or not. So I would say that we have curtailed performing surgeries fairly significantly certainly compared to three weeks ago. But the blanket orders did not serve our patients and our community well thank you Dr. Morgan. >> actually that question was for Dr. Gross but a since I understand the governor's rationale behind it but I do appreciate your thorough response to the elective surgery. So like the surgeons I was the one I didn't know that if you had a life threatening or potentially a life threatening emergency that that was not considered. I didn't know that that was considered elective at the time. So that's good information to have. But I'm talking about the elective surgeries that are cosmetic in nature, the elective surgery that you really don't need right now. Those are the elective surgeries referencing I didn't know that the state would shut down elective surgeries that were in dire health concerns or dire need. That's really sad to hear that the state did that originally. Yeah, the first time I I just to be clear I'm sure emergency surgery we were able to do but but we did have significant delays. And for example, cancer surgeries. Dr. Go I don't know if you want to add to that or not. You know, I think that what I've heard of the discussion with the state we have local public health has asked whether when and whether they would provide guidance to hospitals throughout the state on what procedures to pause on and when to do that and the what I've heard from the state is that they've had an ongoing dialog just like what we heard with Dr. Morgan about with hospitals to determine what and when to stop doing. And what we are seeing is are our hospitals making the hard choices as searches surge happens to stop other procedures so that they can provide care to the other people that the with kobe 19. So I think you'd have to ask the state for a specific answer. But that's that's the part of the conversation that I've heard. >> you've got to go in my question. My last question to you is how many citations have been issued for large gatherings as well as I guess people that are not practicing go with protocols within the city at best. Nina council member hampton before Dr. Go answers. >> we do have our next item on the agenda in fact is an update on our efforts regarding enforcement of the health protocols and we have some stats on that presentation if if you'd like to maybe hold your question for that presentation. >> oh, that's totally fine. I just trying to get all my answers all my questions out now so that I don't have to wait for the solely but I thank you. Council member willing to do everything. An additional question. So I just had a quick follow up question for Dr. Morgan. >> what is the average length of stay for a regular bed versus the icu beds and how is that different and probably say six or eight months? >> I think I know what you're asking. I'm not going to answer it quite the way you did. Our average length of stay previously for all of our hospital is was about four point two days and we are currently sitting at about five point six days. So we've added almost two days which is really being driven by our cove admissions because the patients are quite ill. I mean I was I was trying to get at the antiviral treatments and what impact that has had with all of the increased testing and identification it almost sounds like that hasn't made a difference. yeah I know. >> I'm going to ask Dr. Shriner who is actively treating these patients. Answer that question. >> yeah. >> so the issue really is that we don't have good treatment for this disease. A remedy is severe which is the only available antiviral May shorten the hospitalization course a bit but it doesn't routinely do that. And what we've what we're trying to do now is there's been some consensus on the part of clinicians and actually also gilliard which makes roamed as aggressively as doing a trial looking at all only three days of the drug you have to give it for five days. We used to go for and it was very clear that that didn't make a difference. It probably doesn't make any difference in a critically ill patient. And I would say that although clinically I've seen some improvement in patients. It isn't that dramatic by using that drug the other monoclonal antibody medications that are coming out have not proven to be very effective either. And in fact the infectious disease society of america does not recommend those right now. They've been used largely in outpatient settings. The regeneration trial is still progress and they've been kind of disappointing. So our best solution at this point is to use a bit of room desert. They're certainly used x samantha zone for those patients that require it and then sort of conventional antibiotics. I think that this also speaks to the acuity of the patients that are actually coming to the hospital. A l