San Diego's Vaccine Rollout Leaders Reflect On Progress, Look Ahead To Next Steps

Wooten: So far, it's gone very well. As you know we've gotten just over 28,000 doses and the vaccinations came into the county because this Pfizer vaccine had to be stored in ultra-low temperature freezers. And at the time when providers registered in the CDC platform, the COVIDReadi, they had to say whether or not they had that capacity. So the state identified three what we call prepositioned locations, which include UCSD, Rady's and the county, and the county accepted the vaccinations for those facilities or health care systems that did not have that freezer capacity. So so far, I've heard stories from many of the hospital systems they've gotten, the providers have obtained their vaccinations and things are going well. We started to vaccinate also at our psychiatric hospital, so, again, as of today, things are going well.

Macchione: I'll just add Tarryn in talking with some of the hospitals CMOs, talking to my own medical director, county psych hospital, just the amazing turnout. We didn't know are people going to show up and it's been done in a very calm and orderly way, but with great urgency. And so I can tell you, like for county psych hospital in our first day when we scheduled, I think with the exception of a handful of folks that we had to reschedule, almost everyone else was there and got their vaccine. And so I think that's a great indication thus far of the health care workers lining up, getting their vaccine and the understanding that we're going to have to do this in a phased approach obviously, as Dr. Wooten pointed out as we get more.

Wooten: And another encouraging word that I've heard health care providers say that the vaccines being available give them hope.

Wooten: We've received a small number of doses to date, so things so far have gone well. There are no particular challenges that I'm aware of, but we know that we are getting more vaccine. We anticipate that we will get vaccine after the Moderna vaccine goes through the various approval processes with the FDA and CDC. And then we will get — there are six different vaccines that will be coming down the pike. So we will be getting four other vaccinations. But I feel confident that we'll be able to manage that because we have the San Diego Immunization Registry and we can determine who's been vaccinated or not and what vaccine they've received. And providers will be checking that SDIR so that they make sure they give individuals the appropriate vaccine when they come in for vaccination.

Macchione: The challenge is that the way the vaccine arrives is for us, for our hospitals, 13 hospitals or so, four of them are getting it directly and then nine come through us. So it'd be nice if it was one air traffic control, but we have multiple. And so it requires that extra challenge of communicating to make sure that we're getting our fair share of vaccine into the region. And so that's communicating with our hospital partners, which has, again, has worked great because of the cooperation and collaboration we have. But that is a challenge right now as the vaccine comes in, the way comes in.

Wooten: Certainly that will make it easier, because if health care facilities have, they can store the medicine in their refrigerator. This ultra-low temperature or freezer was the issue for Pfizer because it had to be stored at -70 degrees centigrade in -94 degrees Fahrenheit. And very few people have those fridges. But again, we had enough space that we could accept the vaccines for those non-UCSD, non-Rady, Sharp and Tri-City locations and all others. We are working with them to deliver the vaccines to them when they are ready and they'll tell us when they want to get it.

Wooten: Actually, we do not determine any allocations. All of the health care systems must enroll in CDC's COVIDReadi platform. I enrolled as the physician of record for the county. All of the health care systems, whomever is the position of record had to enroll. And if you are not enrolled, you can't get your vaccine. So it's a CDC product. CDPH at the state work with us to make sure that all of our providers were appropriately enrolled and we even help people do troubleshooting if they had problems enrolling. CDPH also determines the number of vaccines to the local regions. If providers, say they need “X” that's in the COVIDReadi, but depending on how many vaccines come out at any one — or are available at any one period of time — the state then determines X percentage goes here and they do it in collaboration with us. And for this first allocation, that's the amount that was available was 72 percent of the total for the highest of the high risk. That's how everyone got 72 percent of what they asked for, for that category of providers.

Macchione: I'll just say that with the nine hospitals that we're working with, all have been very appreciative of the trusted distributor that the county role serves for those hospitals because of the requirements for the Pfizer vaccine. And in addition to that, obviously, we have a supplier of our own for our own use at psych hospital that I mentioned. So it's been again, it's been yes, we would like to all go to one place and distribute it, but it's worked well because of the coordination and cooperation we've had with our partners locally.

Wooten: Yeah. And I guess just to reiterate, Rady's and UCSD, they got shipments directly to them for their use, we got shipments for our psychiatric hospital and eight other external hospitals and then Sharp and Tri-City, they had shipments go directly to them, for this first dose.

Q: Will that continue to be the case with Moderna?

Macchione: It may or may not. So right now I don't explicitly know that, but we'll know more next week.

Wooten: Well, if things go the same way that they went this past week with the approval process, we should get the Moderna early in next week. I'm not sure exactly when the second allocation for the highest risk of acute care and psychiatric hospital employees is coming. But we anticipate that in the coming weeks.

Wooten: Well, the most important thing is to know that we do not get all of the vaccines at one time, if that was the case, we could facilitate everyone being vaccinated in the various phases as well as the tiers. So there has to be prioritization of the priorities of the phases. And that's what locally, as we are working our way through the right now, we're in phase 1A and the tiers within 1A. The area where the advisory committee will or could or will help is with phase 1C, which is those individuals with underlying medical conditions and 65 years of age and older. And also when vaccines are to be delivered to young adults 30 years and younger and then the general population. So we will have discussions about that. Actually, the next meeting, I believe, is Tuesday. So we will have discussions about that.

Macchione: I would add so we do at every opportunity to use the health equity lens in our work, and so where there is discretion and thus far it's been pretty well prescribed by the California Department of Public Health and CDC. And there's some national bodies that are coming in to talk about that. We're looking at that. But it comes to a point when you get into some categories, even subcategories, depending on how much vaccine is available, to your point, how do we look at how the pandemic impacts place and people ? And it impacts place and people differently. We just have to look at South Bay to understand that and and I would add place, people and providers, because our hospitals are more adversely impacted in the South Bay. So where we have that discretion and I say we — our clinical advisory — and that's why it's fantastic to have leaders across the county, in the community, in public health systems coming together and saying how do we ensure that we get it as best to the right folks at the right time based on the limitations we have? And that's when you start talking about that we may not be seeing, as we go further in this distribution, a kind of cookie cutter approach because the pandemic is spread across, but it is impacting people and place and providers differently and using health equity lines to kind of guide you in those discussions. And that's, in fact, where I think more of the clinical advisory group will be having in the coming weeks.

Wooten: That is done in consultation with the state. The state really has assigned the numbers for all of these categories. And then it is our job to work with those entities locally and make sure that because they may have to prioritize within those various categories. So and that's what has happened with this first allocation of Pfizer vaccines within the acute care hospitals. They have determined, not us, but they determine who's the highest of the, who's at highest risk.

Q: With the hospitals, yes, being able to determine based on their own workforce who fits those four categories — are we going to see the same thing with different employers? You know education sector is one of those that's considered essential workers. Are each individual school district going to be able to identify their workforce? And then then beyond that, which school district would go first? Because as you mentioned earlier, we know we only got 72 percent of of the first phase.

Wooten: So I can tell you that at the state California Department of Public Health, they're one of their advisory group will be working on just like they did from the tiers for phase 1A, they will be doing the same thing for phase 1B and also for phase 1C so we are waiting on that guidance. And then once we get that guidance and the state determines what are the numbers that are aligned with those sub-tiers, then we utilize that information to work with those industry sectors locally to decide on how to further stratify. And then that's where the whole health equity lens could potentially come in using the Health Places Index. So but again, I'm not going to pre-empt that. The advisory committee will have those discussions and make those additional decisions based on the decisions that are made at the state level.

Macchione: So a great example would be, again, as a discussion point a case study. So we have 600,000 school age kids in San Diego. We have probably 11,000 school personnel or such. How do you you know who goes first? You say schools, right? Is it the kids? Teachers? Is it the principals? And then I think that's where we start getting into some of the advisory and the guidance. I mean, some would say, well, it's you know, as you use the analogy in the hospital, it's that front line nurse or doctor working with the patient. It's that in-classroom or teacher working with the kids. The principal may not be first, even when we get the schools, right? So there's prioritization on that. And I think I will say a little bit of common sense. But I think the issue here is: but what does the school districts, you know, when we start rolling it out, if we have ample vaccine, great, but if we don't, will there be certain schools we start first? And the answer would be yes. I mean, that would make a lot of sense where there's greatest risk. And so I think you're hitting it where we're getting to those cases and examples where that has to happen. We just haven't reached that point yet.

Wooten: We find out by reviewing the applications for emergency use authorization discovering much like the entire world, and we know that Pfizer is approved for 16 and older. Moderna is 18 and older. So as there are more clinical trials, even for Pfizer, they will be looking at additional pediatric populations -- and in their 16 and older, they only had 163 children 16 and 17 years of age. So that's why one of the -- there were four people that voted against it, but that was the rationale for at least one of them, that they did that as to why they didn't vote for it. Not that it wasn't, that they didn't have faith in the vaccine, but it was just that information specifically about the pediatric population. There may be other vaccines coming down the pike that did include a large number of pediatric populations, but I just don't have that information right now.

Q: I know we're kind of getting in a little bit of crystal ball territory right now, but it seems like the hope is that being communicated to you all from the people making these decisions at the state and federal government that we'll have something by then.

Wooten: I don't know when the "by then" is, it could be next year, it could be the following year. But what we do know, we do have vaccines. We have six different manufacturers that are working on vaccines. So we have Pfizer, there's Moderna, there's AstraZeneca, Johnson and Johnson, and there are at least two more. And at least one of those is going to be a single shot as opposed to two doses.

Macchione: There's tremendous amount of work. You know, when we get it for the for 16 and younger, we'll be ready. But there's sure enough work to get to the rest of the population. And but, yeah, in a perfect world, we would have that already and rolling it out and and but with the sense of urgency to get out there, we're going to roll it out and we're going to have to pivot as it's provided to us along the way.

Wooten: The CDC has partnered with pharmaceutical industries, particularly CVS and Walgreens, to provide vaccinations at long term care facilities, including SNFs. So that is a contract between CDC and those two pharmaceutical companies. And then the state then works with those entities and their states, so CDPH is working with those two entities in California. And and then those entities will be contacting the long term care facilities, and if there is support that is needed by the county, then we will provide that additional support.

Macchione: We have a whole group. This is where we're fortunate in San Diego because we're not standing up the connection with the over 1,000 long term care facilities in this region, not just the 87 SNFs which have been critical and got a lot of attention early on in the pandemic and rightly so, we have to go protect. But we have a lot of wonderful adults and others in these facilities. So we stood up back in February as part of our response connecting with all thousands, literally all thousand plus of these long term care facilities. And we've been doing it since February, literally in March. I think when it's early March, we set that up. And so that that sector is strong, the communication. And so we're what we're what we're literally doing is ensuring that no one is left behind. And what I mean by that is working with the list that we get from the state, working with the Walgreens and CVS of who they have covered so that the remaining are the ones we immediately focus on. They are our highest priority. I mean, as you follow the tiers, right in the roll out.

Reaching all facilities

Macchione: So as we speak, we have a whole team focusing on and trying to get to determine who is remaining that's not covered by the pharmacies so that we can then reach -- and then this is an in-reach because in these facilities, they can't come to a site right? We have to go into them. And so this is a kind of a unprecedented effort to get to this sector, to this magnitude in a in a rapid way. So we're working on and will be releasing pretty soon really novel approaches, activating our workforce that, remember, can only be licensed physicians or nurses or paramedics or so forth. So being as creative in our ways of the workforce that we have to get into these facilities, many of which you do not have a nurse —skilled nursing facilities are different, and yet they still need assistance from the retail pharmacies. The long-term care facility, assisted living facilities, some of them may not have a nurse as readily available to the SNFs. So tremendous amount of thought has been going on into how do we get to them throughout our county. We've already mapped them out. And then that's kind of that's the work that's happening as we speak and as vaccine comes in and we know who is again, not already canvassed, that's when we start getting into those facilities.

Q: Can you be a little bit more specific about the leftover group that you may need to reach?

Macchione: So as Dr. Wooten said, we're getting the list as the states determine with the feds really of what CVS and Walgreens are covering. They've had to register the facilities, the ones that have not registered are the ones — if you want to think about it, the four hospitals who got direct vaccine — the rest we're helping. For the long-term care facilities, those that are not being assisted directly by retail pharmacy, then that's our role to help them in that vaccination. And we'll do it in many forms. Some they may have some capabilities, others, we're going to have to go in there and organize and help them get vaccinated.

Wooten: And I think about 96 to 98 percent of the facilities are registered in COVIDReadi. But there might be some that aren't. So it would also be our role to help them to ensure that they get registered so that they can receive that well, so that they can get vaccinated, whether it's through the pharmaceutical program or through our assistance and efforts.

Q: Is there one particular reason why they either wouldn't be COVIDReadi enrolled, or why they would need your assistance? What's the reason behind some not being able to work with the retail pharmacies?

Wooten: They may not have just whatever for any reason on their side not enrolled.

Macchione: And remember, if California did this, we would have done this a far different than how the federal government did this. And that's not a criticism, but it's reality that this is done, and you think about it just unprecedented, right, for the entire nation at one time, all these long term care facilities, probably in the millions, right, as a nation. So for us, you know, we understand that. We just don't want to make sure, we want to make sure that there's no one, there's no gaps. And that's and that's really our safety net role. And that's our commitment, as we've been doing, Tarryn, with testing as we've been doing and the support for the facilities on how they keep their facilities safe. So, again, it's not like we're restarting a relationship. We have been there and so we've been priming that and getting them ready for us when to come in to do those vaccinations.

Live Well partners

Macchione: Yeah, we're passionate about this one, so we will both add to this. Again, something that differentiates us than maybe most other jurisdictions in the state is that when we stood up on Valentine's Day and Dr. Wooten declared the public health emergency and a local emergency, literally that same day, we activated our LiveWell sectors. I can't underscore how important this has been because we knew back then it was more flu-like messages that keep people safe— we didn't even know about masks, remember, of the real importance on Valentine's Day. But what we did is we branched out with our sectors and this was to communicate, not to be unidirectional, but to really have an opportunity to communicate information, by taking questions, those sector calls. And I believe if I'm right, now we had 10 that broke into 13 sub-sectors, there's just a huge number and how they have maintained -- and we have Dr. Wooten, Dr. Sayone, we have our doctors, we've had weeklies but what we've done is it's a force multiplier. We knew that they needed they have the relationships with their communities. You know, when we did our work in National City, Mayor Alejandra Sotelo-Solis, who has a huge passion and connection with her constituents in National City was the voice helping carry our message. And she even yesterday, she held an event where Paradise Valley on promoting vaccination in health care workers — Paradise Valley, the highest rate of people who were getting it. She was there to communicate to her city the importance of when it's ready to get the vaccine. It's hundreds and thousands of examples of this, of the 500 Live Well partners, funding millions of dollars that we have funded, knowing that we have people to do full time work with, when you think about the Latino coalition, led by the Chicano Federation with 10 other groups working in a community that really needed, we need it to have a deeper reach or the field workers. If you look at that level of work, that's why San Diego is kind of always being held up of we don't talk about health equity, we do it.

Building on testing, flu shot strategy

Macchione: But we do it in a way with our partners, and what they've been doing this for T3 was the T3 message about testing and the NPIs. Right. So we're now still doing testing. That's why we're getting up to like 28,000 tested day. Right. We're still doing the importance of NPIs. We added the importance of seasonal flu. And the reason for that is we know someone is has the affinity and the connection to get a flu shot. Well, guess what? They're probably going to be likely to get the COVID vaccination shot. So we've been very intentional and thoughtful, but it's no one size. It's the whole cultural responsive way through our partners that are making those connections. And it's about those relationships. And so our words will be tested in our deeds. We'll see how many vaccinate. But I have a really, I am optimistic. I have a high degree of optimism that in San Diego we're going to do fairly well because we've been working at it long and we've been doing it with our community partners -- not to the community partners -- in a way that matters and it really matters. And I can go on and on and on, because this is really this speaks to our health equity work and our whole design of T3 and our public health response and really the passion led by Dr. Wooten in this regard. So, Dr. Wooten, anything to add.

Wooten: Basically they got it right in terms of how we leveraged our LiveWell partners. That is one thing that has really exponentially, allows us to get information out to the community. But even with that, some people still, you know, don't or say they haven't heard about it and I saw one of the questions on the list that you provided us. We have we've resumed and now Dr. Yphantides has resumed the town hall meeting with providers so we can push information out. And we have the health care sector as part of the Live Well, various sectors that we push information out. And also I'd like to share we received a Kresge Foundation grant in 2018 where we engage city managers. So it's to increase the collaboration, communication and coordination between the county and city managers. And that is one of the things that we are looking to do going forward, is to utilize them as that trusted partner so that they can drive information out to their employees as well as to the individuals that live in their various municipalities.

Macchione: I'll just quickly add one more thing that I think is powerful as an example, when we started, we launched T3, we were all with limited lab supplies and testing. We're just trying to stand it up. But there was already a great amount of distrust even through the testing. People didn't want to know. They were worried if they found out was insurance — remember this was the whole issue with the federal government also weighing in against folks that are newcomers in our community. There was a lot going on. If you look to where we started and accelerated those partnerships, you could see just the increased number of Latinos taking testing in the various communities of color where we were not where we wanted to be. We are now, and I think that's illustrated by the amazing help of our partners promoting that and the participation in our disease investigation and the use of our public health forums. Now, if you look at our public health assistance areas, there is a large number of Latinos. It was a slow uptake on that, it was a worry — it's the trust. So we're hoping all these efforts that we have been doing lead to the very communities accepting the COVID vaccination when it rolls out.

Wooten: And I think as the public sees that people are getting vaccinated and there are no really major issues — now, we know that developing fever, muscle aches and so on is that is to be expected. But I think as more people become vaccinated, the general public will also be more accepting.

Wooten: I am not aware of any major anaphylactic responses, but we do know that anyone that has any type of adverse reaction will be required to, there's a CDC website, and we do this for all of our vaccines (inaudible) exactly. So they will document any type of reaction in that database so that we can collect this information to really know — the clinical trial was done on about 30,000, the third level trial. So 30,000 compared to what ultimately will be hundreds of thousands. We will gather new information over the next several months and over the next year as people are vaccinated.

Wooten: Yes, it is still the answer. And I should be in phase 1B for critical workers. So when it's my turn and, you know, I've had this discussion with our health officers across the state, we have to wait. We have to show leadership, wait for our turn and then be vaccinated. So that's what we plan to do.

Macchione: And I'll be in the same category and you'll see me publicly getting mine, probably. But I want to make sure that, again, anyone who's even with a greater exposure to people, we’re serving. That was my point, Tarryn, is I want to make sure that we protect them. But, yes, the public and we hope will cover that when Dr. Wooten gets hers. And I know at our psych hospital by the way, we had our physician and nurses rolling up their sleeves, getting their COVID vaccine. And I think it's important when the public sees our amazing clinicians and leaders that we trust, that we follow and they follow their lead. So I think it was a great question. And I'm excited that I think across our county I haven't heard of a single clinician — maybe there's one that exists — but I haven't heard a single one yet said they wouldn't.

Wooten: I'd like to just point out that this would not be a precedent. We do this with the flu shot, where myself or some of our other doctors will be involved in a public education campaign to show that we are getting our flu shot. So this is something that we have done before and we will do this with the COVID-19.

Macchione: Well, I don't believe we're going to be mandating it for county employees. We're going to be strongly encouraging it. We're going to be role modeling it. We're going to be making it available for those employees at the phases when they're eligible for it. And I can tell you from our — at least the subcommittee, Chairman Cox, Supervisor Fletcher, they, too, will be role modeling it. Our Chief Administrative Officer will be role modeling it. I mean, from full leadership we'll be promoting it. But I think it is an issue with some employee rights and labor groups and so forth. And we hope to work with labor groups and help them promote it as well. So we will do everything within our authority to do that. And I hope that whether we mandate or not, I would hope the people that the majority of our employees would, that are eligible, that we lead by example on that. And particularly I can only speak for my group, the Health Human Service Agency, the nearly 7,000 employees with Health and Human Services. I'll be making that plea that we are also ambassadors and role models, as well as protecting ourselves and our families. So that is my commitment on that. Your question as it relates to business, I'll turn it to Dr. Wooten.

Wooten: For businesses, I can tell you the only mandated vaccination or that the only vaccine that I have mandated to date is the flu. And that's based on a state requirement for all acute care hospitals to require their employees or their health care personnel, which is not just doctors and nurses, it includes anyone that is potentially exposed to patients that might have influenza. So we did that in 2014. You either get influenza vaccination or you wear a mask. So it's an either or and we have seen influenza vaccination rates increase across the state as a result of that. So at this point, I have no plan to mandate that. And in the general public, we can't mandate. People will have the right to make their own decisions. They have the right to make their own decisions. We will educate them and ensure that they understand the rationale for the recommendations. But at the end of the day, if they don't want to be vaccinating — there, and for some, there might be reasons why, medical reasons why they can't. But at this point, no plan for mandating the vaccination.

Wooten: Well I sleep. I do Netflix, so but yeah, sometimes it's good to unwind with the information that is not stressful, no medical shows.

Q: I have to ask what show are you binge watching these days when you get the few moments to do that?

Wooten: I've watched the Queen's Gambit. I watched the Sherlock, the Sherlock Holmes, the relative, the sister. I mean, I look for things like that. Mysteries are good things to for me to watch. Those are the types of shows that I watch. But I also sleep. I catch up on my sleep on the weekend.

Macchione: Yeah, I appreciate the question. Yeah, it's heavy on everyone, all of our minds because we — Dr. Wooten said best — it's instilling hope at a time when people are weary and tired and exhausted and our nurses and doctors and our county staff here. But it just doesn't lend to the health care responders. It's everybody, right? And yet we are in our deepest, darkest hour of the pandemic of what the devastation that's happening to our hospitals and yet what's still to come. And I think for me, that sense of hope has to be there to keep you, to drive you. We have to role model to our teams that have this tireless energy. But I always get back to right now happens to be the Christmas holidays. And I have two adult children, but who still seem to like when Santa Claus Comes to Town and other old favorites. So really escaping to childhood with my kids who are going through an immense anxiety themselves as I think all children are, among young adults and all of us. So spending — being present, being present with them, those cherished moments where we don't have enough time, but when doing so is trying to bring a little normalcy back. That and knowing that we'll come back to those joyous, joyful kind of holiday times, they'll come again, will come again. So those moments, Tarryn, is what I used to first for my respite when I get home.

Q: And just to have a laugh, can you guys settle the ongoing Twitter debate as is Die Hard a Christmas movie?

Wooten: It's during the Christmas season, so make maybe for guys and people that like what is that, that type of adventure? It does — Netflix has it as a Christmas movie.

Macchione: Yeah, and so I won't embarrass myself, but I watched every episode of Bruce Willis in Die Hard so to me, I think it's it is a holiday series and year round. So I can say that much.

Wooten: We launched a COVID-19 vaccine web page on the overall website, and for anyone who wants to know what's next, that's a great place to find out what the process is. So all of the phases of Phase 1A, B and C, phase two and three, and then the tiers under currently phase 1A, all of that information is there. So as we are rolling out or letting people know we don't have a crystal ball, so we can't say exactly when the general public is going to be offered the vaccine, but we know it'll be next year, that's for sure. And as we know more information, we will communicate that info to the public.

Q: Last time we talked you said you would be posting information about vaccinations. Is that coming or is that more when we reach other priority groups?

Wooten: We just got the vaccine this week, remember? So we do have a COVID watch, just like we have influenza watch. There's a COVID watch. We haven't decided if information will go in there. But hopefully in the next coming weeks we will have and we've already been planning for what that is going to look like. So expect that that's coming in the next couple of weeks.

Macchione: You have to balance the data. There are requirements you have to do to register for a vaccine. We'd love to have as much data and information versus the urgency to vaccinate. And when you right now are dealing with the highest risk health care employees, the very last thing I want to do is bog them down with a 30 minute questionnaire. I mean, as much cause you and I would have 30 minutes of questions for them, maybe more so, you know, we're going to be probably somewhat limited on this. Yeah, we'll know we took care of 82,000 health care workers in San Diego. And we may have some information, but we probably with all candor we may not going to have a lot a ton of other information because we — our urgency is getting, learning as much, but getting out to folks to vaccinate.

Public’s role

Macchione: So I want to circle back to the other question and ask and that is so what can the public do? And I got to come always back to that Supervisor Jacob said it, which was pretty powerful at our last board meeting. And she said what we could all do is look in the mirror. We are our own solution or our own detriment. And so, Dr. Wooten, I stopped counting but the times and pressers and Zooms and forums about really promoting what we continue to talk about and modeling the behaviors of wearing a mask and our distance and staying home when sick and the big one, now, with the holidays, the social gatherings, we will be announcing next week some of the data analysis we did. And so it hasn't just been confirmed or I’d share it. But Dr. Wooten asked what is the percent of cases we're dealing today contributed as a result of Thanksgiving holiday? And I think you may be startled when we share that. And so, you know,we know our behavior, and now coming into it at a dire situation with the holidays, is that the call to action that because we don't have vaccine, right? We'll have two or three million doses of vaccine. But the call to action is all the things we continue to talk about, what people can do and the social gatherings is going to be a real big one. So what can San Diegans do? They can be COVID safe. And that's our campaign. So the best, and we appreciate you promoting be COVID safe because I think it does resonate with people who watch KPBS and the promotion and listen to you. And if it touches one life, that's one life saved, it could touch many more. So appreciate you promoting that and your help. And as I said, our collective efforts really in keeping San Diego safe. So thank you.