Transcript

Maryland National Guard Surgeon General Discusses Maryland COVID-19 Response

April 22, 2020
Maryland National Guard State Surgeon Colonel Dr. Eric Allely

STAFF:  Good afternoon, ladies and gentlemen.  For those on the call, today's press conference will be on the record.

Today, we continue with our coronavirus response briefings.  And with us today on the line is Colonel Dr. Eric Allely, the state surgeon for the Maryland Army National Guard.

Following a short introduction, we'll take your questions.  Please identify yourself and your outlet before asking your question.

As a reminder, for those on the phone lines, please keep your phones muted unless you're asking a question, and please do not use the speaker function.

And with that, Dr. Allely, we will turn it over to you, sir.

COLONEL ERIC ALLELY:  Thank you.

Good afternoon, everyone.  I want to thank everybody for taking the time to -- to talk today about some of the many efforts that we're doing in the Maryland Army National Guard and the Maryland Air National Guard during the pandemic response.

As of today, we have over 1,400 members of the Maryland National Guard who are continuing to support the people of this great state and combat the spread of COVID-19.  In fact, in addition to that, we have 700 Maryland Guardsmen in enhanced readiness status that would be able to come on duty in a matter of hours, if needed by the governor.

So I -- what I -- I just wanted to -- to highlight a couple of the -- of the efforts that we are doing.

First, we have visited over 40 Maryland nursing homes so far, as -- as well as some children's facilities, with multidisciplined teams of health and medical specialists.  These teams are drawn from the Maryland National Guard's medical detachment, the 224th and 104th Area Support Medical Companies, and they are augmented by the Disaster Medical Assistance Teams from the Department of Health and Human Services.

Nearly 30 of the Maryland National Guard members and 23 DMAT team members are working together on these teams supporting the Maryland Department of Health and the state's COVID-19 mitigation and suppression efforts.  And we're -- in doing so, we're helping safeguard the citizens in nursing homes and the other skilled nursing facilities across the state.

Our -- our medical support -- our medical specialists that we have on duty are world-class professionals.  They live and work in the communities they serve.  And their medical support team's contributions to the National Guard that we're making in National Guard efforts are making a significant difference in combating the spread of COVID-19.

In another mission, our Maryland Guardsmen are supporting food and distribution missions throughout Baltimore, in Frederick County, Baltimore city, the Eastern Shore, and other sites.  For us, it's not about handing out food; it's about being there for our communities any way we can help.  These Maryland areas need us the most, and so we're going to be there for them.

We are also working cyber issues.  We have cyber specialists from the Maryland National Guard Defense Force and the Department of Information Technology.  They're all working together to protect the virtual communities that we have online and protecting the critical information related to COVID-19.

That joint task force is evaluating Maryland government websites to make sure that they're functioning properly, that the information presented is -- is accurate.  And our Maryland Air National Guard's cyber specialists, who are some of the best in the entire world, their day jobs are often at facilities that do that as -- from the national security standpoint as well.

So they are among the best in the entire world, and being -- and bringing them to the fight ensures that the cyberspace is secure and the Maryland agencies that we support have all the correct patches in place for any kinds of attacks in the cyber-event, cyber-realm.

We are also continuing to support Marylanders in our screening efforts.  I'm sure many of you are aware of the efforts we've done at FedEx Field, at Pimlico Race Course, the Rawlings Conservatory, the Maryland State Fairgrounds, and at four vehicle emissions centers -- these are drive-through and walk-up centers, where we're conducting both analysis and screening as well as some of the testing for COVID-19.

Our Maryland Air National Guard continues to process and distribute medical equipment and personal protective equipment from the Maryland Strategic National Stockpile.  These airmen have assisted in processing over 3 million essential pieces of medical supply and PPE so far.

Our dual status as Maryland National Guardsmen make us uniquely postured to aid civilian agencies in times and emergencies like these, conducting the kinds of support that I've outlined.  We've worked with our Maryland state agency partners for years.  We spent a lot of time building essential partnerships so we know that many of the -- we know what many of the capabilities are within the agencies in our state, and we can bring an understanding of those individual agencies, and we understand how to work together.

Overall, we are very proud to be National Guardsmen.  We have dedicated soldiers and airmen serving on the front lines in our communities.  Marylanders should know that the National Guard has their back during this crisis.  We are neighbors helping neighbors and we're in this together.  We'll get through it together.

And now as I conclude my opening remarks, thank you for -- again, for taking your time to talk with me today.  And I'm open to any questions you might have.

STAFF:  Thank you, sir.

We'll go to the phone lines.  First we'll go to Howard Altman with Military Times?

Q:  Thank you, Colonel.  Thanks for doing this.

So I've got, I guess, several related questions.  Let me lay them out, if I could.

So Title 32 wraps up May 8th in Maryland.  Will soldiers get an additional set of orders after that?  Or is the mission complete?  That's one question.

And then, related, when the mission ends, is there a quarantine plan for soldiers returning home, soldiers and airmen returning home?  Is there a gap in time when they're not doing missions, where they stay on orders?

And then, related, how many -- how many soldiers and airmen have been tested, how many positive cases and how do folks get a test?  So there's a bunch of related questions.

COL. ALLELY:  Yeah, I'm writing them down too.  I don't want to miss any of them.

So first of all, regarding the May 8th deadline -- date, our current orders under Title 32 are -- in general, for most of us, are for May 8th.  But we have already been in discussions about extending past that.  It may not be every single soldier and airman.  We need to regroup, resize, look at what we have to do.  But we are going to remain on -- one way or the other, we are going to remain on duty as long as we're needed, and moving forward.

As far as the -- the period you're talking about, a period of quarantine after active duty, we're certainly going to follow the CDC guidelines -- we're certainly going to follow the CDC guidelines.

I know there is some -- there is some discussion within the Defense Department about how to -- how to transition out of that from the active duty status to the civilian status.  We'll certainly follow along and comply with any guidelines that they may give us that are in addition to CDC.

But our first response -- my first response to you would be that we will certainly follow CDC guidelines in terms of protecting not only soldiers and airmen coming off-duty, but the -- the communities where they're going back to.

But -- and then the third, in terms of numbers tested, we're -- we're -- as I'm sure you're aware, Maryland Guard is -- is -- is a military organization and -- and as such, I -- we need to keep in mind operational security.  So the exact numbers, et cetera, I'm not free to -- to -- to discuss but we will certainly release aggregate numbers of -- announcing positive tests in the future.

It -- in addition to the OPSEC, basically we -- it's also very important I just protect the privacy of our service members, as I'm sure you are aware, as we move forward.  So does -- does that answer -- answer your question, sir?

Q:  -- clue -- yeah, one more, how do -- how do troops get their tests?

COL. ALLELY:  Well we --

(CROSSTALK)

COL. ALLELY:  -- typically going through the same channels -- we're typically going through the same channels they're going -- we're not -- we're not superhuman, we don't have a different set of rules, so we're following the same guidelines that CDC follows.

So we -- if someone comes up, you know, suspected because of symptoms or maybe they were in close proximity to someone who is definitely positive, they will be tested, but that's essentially the same as -- as any civilian individual might have.

Q:  All right.  Thanks so much, appreciate it.

STAFF:  Thanks, Howard.  We'll stay on the line with Rose Thayer from Stars and Stripes.

Q:  Hey there.  Thank you so much for taking the time today.

My question is somewhat related.  I wanted to ask, you know, do you feel like you have all of the -- the appropriate testing equipment that you need to make sure you're taking care of soldiers?

And then also, is there a good amount of PPE for the missions that -- the mission set that Maryland has and -- and -- and training to make sure that soldiers are trained how to properly put it on, take it off and interact with people at the screening sites?

Thank you.

COL. ALLELY:  OK, so thank you for the question.

So in terms of -- now let me just get this right, so there's the appropriate -- your first part of your question was whether or not we have the appropriate equipment and -- and supplies.  We -- we certainly are prepared to go out and take, you know, on a mission -- a medical mission and support, you know, the troops who are in the field, certainly.

With the PPE, I'm aware -- again, we don't have a special supply.  We've been -- we've been dealing with the same issues that anyone else in -- in the government and in the civilian space has been doing and that is making sure that we have enough protective equipment.

But from -- for the missions that we're executing, we are fully -- we are fully prepared and fully protected.  We're not running out there on -- in an unprotected mode.  So we're providing our soldiers and airmen with the level of personal protection that they need for the missions that they're undergoing.

Now, that -- that doesn't mean that they're all exactly outfitted the same.  The teams I send out to the skilled nursing facilities are clearly and obviously more protected or at a higher level of CDC protection equivalence than the people who might be working at a screening facility at -- at FedEx.  But they're all protected with appropriate protection, which includes masks, face shields, gowns when required, et cetera.

In terms of the training up, some of it is just in time training, certainly.  Our medical people are very well -- highly skilled.  In fact, a lot of the people that we draw under these teams work full time in, you know, sites like Johns Hopkins, University of Maryland, Highly Infectious Disease, you know, Centers, et cetera.  They're very comfortable in that space.  They are properly fit-tested, et cetera, before they go into the skilled nursing facilities.

And as for the donning and doffing for the other individuals, we're, you know, giving just in time training to those if they've never done it before but we -- making -- making sure that they are wearing the -- the equipment properly.  We have safety officers on site, you know, making sure that people are doing all of the right things, including wearing the appropriate PPE, social distancing and keeping their hands clean as they go through the day.

Does that answer your question, ma'am?

Q:  It does, yes, thank you.

STAFF:  OK, thanks, Rose.

We'll go to Christina Anderson.

Q:  I'll pass.  Thank you.

STAFF:  OK.  Is there anyone else on the phone line who has a question today?

Q:  I'd like to -- this is Howard Altman, I'd like to ask another question.

STAFF:  Go ahead, Howard.

Q:  Can you -- can you give me some details about what it is that you're doing in the -- in the skilled nursing homes?  And the children's facilities, a little more detail about that, as well?

COL. ALLELY:  Sure, I'd be happy to.

So in both -- in both cases, we're talking about groups of people who, for, you know, primarily medical reasons, are, you know, in a -- in a confined space or in a facility, whether they're, you know, fragile children in some of the children's facilities or it's nursing homes or -- or epicenters we're looking at.

We have -- we've worked Department of Health -- I mean, again, this is not -- this is not the National Guard going out and doing this, this is the National Guard as a resource for the state.  So we work very closely with the Maryland Department of Health.  In working with them, we set up three types of teams.  The governor -- governor announced these a week or so ago.

These medical support teams that we send out, we have a team that does assessment, we have a team that does testing and education, and then we have care teams.  So the first two -- the -- the National Guard is leading the effort on the first two types of teams.

So when a skilled nursing facility is -- reaches out through their county health department to the state, we get a notification of their request to have an assessment done or have some assistance.  We give that facility a call, we have a set of questions that we go through with them to make sure that we understand what's on -- what's going on at the facility in terms of the -- in terms of positive cases and -- and what the staff issues are, what the PPE issues are, et cetera.  We then launch a team out to the site and we conduct an extensive interview with the staff and the administration and the medical director, we take a short tour to the site to evaluate the site overall.

And basically, we're helping these nursing facilities -- these skilled nursing facilities fine tune what they're doing, reassure them, you know, in the areas that they're working, you know, in getting it -- you know, getting it done, identify, you know, short term and long term shortages they may have so that we can turn around and go back and make the requests for them, et cetera.

In terms of the -- the testing teams, we are able to go out and bring the testing kits to the site, assist the skilled nursing -- assist the nurses at the facility in the collection of the tests, and these tests can be done both on the -- the residents in the skilled nursing facility or on the staff themselves, where -- where it's needed.  We return those tests back to the state.

We also take a fit-testing team because sometimes the PPE that these nursing facilities are getting in aren't the same brand or type that they normally work with, and to be properly fitted with a N95 mask is not simply to wear it but you need to be fit-tested to make sure it's the right size for, you know, your -- your face.

So we take a -- a fit-testing team with us, as well, so we can help them through that if they're working with PPE that they haven't seen before.  We have educational materials for them, making sure they are totally up to speed on everything that's going on.

I'd -- I'd take a moment here to just kind of stop -- make a point here and that is we have to remember that these skilled nursing facilities, for the most part, they're not set up to be, you know, individual cells where the person never moves, you know, from their bedroom and never interacts with the others.

Most of these nursing homes are set up to be communities, so that the architecture itself, the way the buildings are laid out, are not meant to isolate everyone from everybody else, but they're meant to bring people -- people together and give them a reasonable quality of life while they're there, whether it's temporary or long-term.

So one of the issues that we can help them with, and have been helping them with, is figuring out ways to cohort their communities, basically separating the people who are positive from the people who are -- who have not tested positive.  So that's a piece that we bring to that -- that fight as well.

And then finally the care teams is sort of the hand-off portion.  So what we've been doing there is working with the Department of Health and a number of the major hospitals:  Johns Hopkins, Shock Trauma, University of Maryland, LifeBridge, et cetera.

What we do is we work with the local hospital that supports this nursing facility, and in most cases we get support through physical -- I mean on-premise support from that hospital, in an attempt to identify residents in those facilities that might be -- might be served in the residence rather than at the emergency room to reduce the number of transports that we would do in a normal time.

That reduces the risk to the resident on -- just the transportation alone can be a risk.  Reduces the risk that a resident might have by, you know, being in the emergency room and around other COVID-positive people.  But it also helps reduce the impact of -- you know, of maybe surge of individuals coming from those facilities to the emergency room at a time when, you know, we're trying to make sure that we're maintaining those resources.

And that's gone extremely well, because we're bring -- basically bringing care -- you know, a higher level of care, more advanced care that the facilities aren't designed to do.  I mean, they're designed to be skilled nursing facilities; they're not designed to be emergency departments.  So we basically raise the level of care in a number of cases for those facilities by doing that.

So that's a long description.

(CROSSTALK)

Q:  What are -- what are you seeing at these nursing homes?  Any basically bad clusters of COVID patients, anything -- are you seeing problems with any of the nursing homes?

COL. ALLELY:  Well, they're -- they're no different than any other medical facility, whether it's a private practice, a hospital, or elsewhere.  I mean, there are COVID-positive -- COVID-19-positive patients.  I mean, it's certainly been reported in the press.

The thing I -- I'll tell you what I have seen and been amazed by repeatedly at every site we've visited is the dedication of the -- of the staff there.

And these people -- I mean, we see it in the press and in social media about the dedication of people in the hospitals and the emergency rooms, et cetera, which is all true.  But I can tell you from experience standing in those facilities, the people who are going to work every day at these facilities are defending their -- they are defending the people that they are charged with caring for at -- you know, in an amazing way.

They're -- they're in there every day, they're wearing their PPE, they're doing everything they're supposed to be doing and they're fighting, you know, the good fight.  I -- I have -- at least once have made a remark at these facilities that -- I mean, we talked about that with the facility directors and the staff members as well.

So -- and just that -- that needs to get out.  That's a word that needs to get out.

And -- and one -- I will add one extra little piece about that is -- you know, something else that I guess I forgot on the teams portion of it -- from the very beginning, from the very first team that we sent out, we tried to send out behavior health support as well, and that's a -- that's from a lesson that we've learned in the military in terms of, you know, dealing with stress, dealing in, you know, basically high-vigilant, you know, environments for long periods of time that people need to be reassured.  They need to be -- they need to -- some resilience care and training.

So we've been able to bring some of our specialists that we have in the Guard that are expert at, you know, post-traumatic stress-kinds of things we -- on the battlefield.  We can bring that to the nursing homes and those skilled nursing facilities and assist their staff with that, as well.  And that has been extremely well-received, just having someone coming in, reassuring them that they're doing the right thing, you know, talking to them about the stress, talking to them about the stress in their lives, et cetera, has been a -- has been a big win for us as well, and a big positive, a significant contribution, I think, that we've made in the whole effort.

Q:  Thank you very much.

Q:  Christina Anderson.  I -- I do have a question now.

STAFF:  OK, Christina, go ahead.

Q:  So how are you seeing the stress level and fatigue within the National Guard at this stage, or how are they holding up?

COL. ALLELY:  That's an excellent question, and one of my very first -- one of my very first concerns as the state surgeon.

The, you know, the -- the old Army medical model was changed a few years back, but the old model -- Army medical model was to conserve the fighting strength, and that's basically why we exist.  So if I wasn't paying attention to the health and welfare of my soldiers and airmen, then I wouldn't deserve to be sitting in the chair I'm in.

So we have force health protection.  That's the phrase we use in the military.  So we have force health protection efforts, and that is -- that that's not just monitoring the illness, you know, or injuries of the individuals, but the stress levels, as well.  So I have, in addition to those 30 people I talked about that are going out on these missions, we have -- I think we have 73 right now total medical people on active duty today, Army and Air National Guard, who are dedicated to the overall mission.  Some of those are handing out, you know -- or working with the testing at the testing sites.  Some of them are going to those skilled nursing facilities, but some of them have "the rose pinned on them," to use the phrase, to make sure that we have -- that we're safe, that we're doing it correctly, that people aren't working too long hours.  We're making sure people are taking days off.  This is not seven days a week, 24 -- you know.  This not a sprint; this is a marathon, so we need to gauge ourselves that way, and I take that very seriously as a measure of whether I'm successful or not, about whether or not, you know, the Army Guardsmen and -- that are -- and Air Guardsman under -- and are under my purview, as it were, are doing the job properly.

And that's not just the medical teams, and that's the 73 that I have on active duty.  That's the 1,400 that are on active duty with the Maryland National Guard writ large.

Q:  So this is Mike --

STAFF:  Go ahead.

Q:  So this is Mike Kunzleman from the Associated Press.  Thanks for the time.

STAFF:  Yeah, go ahead, Mike.

Q:  A question getting back to nursing homes.  Have you seen any cases or know of any cases where the lack of available testing or delays in exacerbated an outbreak?  And conversely, have you seen any cases where getting tested has helped nursing homes avoid a wider outbreak or catastrophe?

COL. ALLELY:  Well, I'll start -- I'll start to answering the question a little -- maybe a little differently than asked.

And that is, you know, the testing itself doesn't, you know, obviously drive the spread of the -- of COVID-19.  I -- I know you know that.  And so the real -- the major muscle movement, as it were, that we do and the skilled nursing facilities have been doing from the beginning is about, you know, identifying people as they become sick, whether -- and even before they've been tested, and then trying to quarantine them, separate them, or isolate them from others.  And in that -- in that realm that -- that's precisely what they've been doing, and they've been -- and some of them have -- have had extremely good success -- success with that.

The testing is definitely helpful because sometimes it means that we can pick up someone who may be asymptomatic or -- and otherwise spreading the disease.  So it -- we get better at it, and if it's not just a skilled nursing facility thing, it's, you know, it's the CDC's game, right?  If they were able to test larger numbers of people they would have better -- better idea of how to cohort people and how to distance people.

So I -- I -- again, I think they've done a remarkable job.  I mean, I've seen the -- I've seen what's been reported in the press about the skilled nursing facilities and to be honest with you, I think the story needs to be steered a little bit differently because it's like, you know, they're responding to a major disaster like everybody else is.  It's like blaming them for the, you know, for the earthquake or something, or the -- or the tornado.  They didn't make it, but they're doing a -- a damn good job at handling themselves as they go through this.

Does that answer your question?

Q:  I guess.  I mean, are any of these facilities doing testing preemptively before your teams show up?

COL. ALLELY:  Oh yeah.  Oh, yes, yes, yes.  Yes.  Yeah, that's -- OK, I'm sorry.

Yeah, there’re two -- there are 220 just the -- just the nursing homes alone, not the children's facilities and adapt -- and the assisted living, but just focusing on the nursing homes.  There are 227 nursing homes in the state of Maryland, and we have not had phone calls from 227 of them, and the reason is in large part because they have been able to, you know, get -- weather through the storm, get the PPE they needed a timely manner.  And they -- they've been doing that through their county Department of Health and the state Department of Health.  It's only when, you know, maybe a shipment is late, or there might be, you know, some particular need at one of these facilities that we would be asked to come in and -- and help out.  So they're not sitting still waiting, trust me.  They're -- they are, you know, they're -- they've been watching the news too.

And you've got to remember, these -- these are skilled nursing facilities.  That means the -- the people in them, working in those facilities are medically-trained, you know, and they're held to a standard by the state, and they meet that standard.

And so, you know, you know, at one of the facilities, you know, they were just -- one of the nurses, you know, was just talking about the residents and they -- she was talking about them as if they were her family.  And you know, this is not like a hospital where you go in and, you know, you know, a nurse might know you for three or four days.  This is a facility where you go in and you're there for long-term care, and the nurse staff that's there become your friends.  They become your -- you know, they -- they share -- they share stories.  They know each other perfectly well, so it's a -- it's that kind of an environment.  It's a -- it's a very dedicated group of people working in those nursing facilities.

Q:  And I don't want to belabor the point, but are any of these facilities are having problems getting access to testing or test results in a -- in a timely fashion, or is that not an issue, from what you've heard?

COL. ALLELY:  Well, it's because -- it's because -- it's -- well, it's -- it's an issue, but it's no more of an issue there than it is anywhere else, right?  You know, it's getting better.  We all -- we know that the test kits were, you know, we didn't have enough of them.  We're just starting to get them.  We know about the delays.  It might take four days or seven days or something to get a test back from a national lab, et cetera.

But with the skilled -- what Governor Hogan's done for the state of Maryland is we are working directly with the Department of Health, so we have our own little supply line from that Department of Health, so when we need to go into a facility to test, we pick up those tests from the state lab.  We drive them to the facility.  We help them with the testing.  We then turn around and return those back to the state lab.  The state lab runs the tests every day at 10 o'clock in the morning.  And so by that -- late that afternoon, the results are back.  So the worst it can be is if you -- you know, you get the test in there after -- after 10 a.m., you don't -- you don't get your result back until the next afternoon.

But there's no four days of waiting or seven days of waiting, like some of these crazy anecdotes you've heard about, you know -- or lost tests, you've heard about.

And since we're doing kind of concierge direct support to these nursing facilities, you know, we take -- we take custody of those tests, we deliver them, they're all banded, they're all -- you know, scanned, et cetera.  So this is a, you know, very tightly organized supply chain.

But it -- what it does is, it provides, to the nursing homes particularly, you know, a -- you know, higher level of almost concierge-level of care and testing.

Q:  Thank you, sir.

Q:  -- Colonel Allely --

STAFF:  All right, thank you, sir.

Q:  -- Colonel Allely, this is J.J. Green, WTOP.

What can you say about what your biggest challenge is that you face right now?

COL. ALLELY:  Well, it's -- I would say, you know, it's just keeping with everything that's going on, right?  Just -- we have -- we have a lot of -- a lot of places to support, it's not just the skilled nursing facilities.

We have -- I have an amazing staff.  I certainly don't have a shortage of staff, or the general, our leadership all the way up the governor has been very supportive.  So we get what we want, and we get what we need.  They realize this is a medical crisis, and so they're -- they're supplying us with what we need.

So it's just a matter of -- you know, of keeping up with everything and making sure that we're attending to all the -- all the plates that are spinning at the same time.  But I think we're doing it successfully.  I'm very -- I'm very happy with the way that the team is working.  And it's not just the Maryland Guard, it's the whole state infrastructure.

I mean, I've had -- I've had the opportunity in a way that I -- I mean, I had some, you know, cursory conversations or connections with some of the -- of the people I'm working with now.  But now that I'm working with them on a daily basis, you know, whether it's the county health departments or the emergency operating centers in those counties or the state, or it's NIMS, or you know, you know.

Everything that we're working together, is working together as a team.  And it's actually -- it's actually one of the great things about being in an organization like the Guard or anything else, it becomes a -- you know, a group of people working together for the same effort, you know, focused on the same goal.

We've still got a lot of hard work in front of us.  Like I say, it's a marathon, still.  We need to make sure that we get everything done, but I'm very proud to be part of the -- a team, you know, that's doing this.

I said it before, you know, in another -- in another venue, that you know, the reason that I joined -- the reason I went into medicine is the same reason that I went into the National Guard.  And that is to help other people.  And so just to be working side-by-side with a whole bunch of people whose mission is to help a lot of other people, that's something I can get up out of bed every day and get to work on.

So long answer to your question.

Q:  Just one -- just one quick follow-up.  Is there anything that you have observed that you believe can be done better?

COL. ALLELY:  I -- I think, given the circumstances, we're doing a pretty great job.  I think that if you're talking about some future event that is somewhat similar, you know, there -- I think the lessons are pretty clear, you know, just in terms of, you know, readiness and personal protective equipment, et cetera.

You know, I -- I think that we're -- given the circumstances, I think that we're handling -- we're doing a pretty good job at this.  We're -- you know, people don't know when -- you know, the models are models, right?  They're not predictions, they're -- they are predictions of the future, they're not guaranteed future.

So we're handling -- handling the problem that is unfolding in front of us.  And we react to it, we adapt and overcome, to use an old Army phrase.  So I -- I think that though there certainly will be after action reports written about how we can do this better, but I think that right now, we're in the middle of it, I think that we're doing a fairly good job at handling it.

I will say, I did have to put -- give a shout-out to the governor about the early response that he made, the early call-up that he made.  It made a huge difference for us because that -- that went from the process of getting the National Guard on-duty and all the way through and getting ready, you know, that takes some time, it's not instantaneous.

It can take, depending on the size of the force you call out, it can take some days because we have to medically screen people, we have to bring them on duty, we have to get them outfitted.  You don't snap your fingers and make that happen.  But because he leaned into it and -- and kept a number of us on this emergency readiness posture, it made it very straightforward for us to bring people on very quickly and adapt very quickly to, you know, the changing requirements over the last several weeks.

Q:  Thank you, Doctor.

STAFF:  OK.  Thank you, ladies and gentlemen, for participating today.

Thank you, Dr. Allely, for your comments today.

Ladies and gentlemen, this will conclude our press conference today.  Thank you very much.