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FEATURE | ‘A major public health emergency requires an unprecedented response effort’

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The following is the testimony presented by the author to the House Special Committee on Federal Assistance and Disaster-Related Funding on July 27, 2020.

GOOD afternoon, Chairman Ralph Yumul, Vice Chairman JP Sablan, and distinguished Members of the Special Committee on Federal Assistance and Disaster Related Funding. My name is Patrick Guerrero, and I am the Governor’s Authorized Representative or GAR for the Covid-19 event. It is my pleasure to be here today to answer any questions that you may have on the ongoing response to Covid-19 as it relates to my duties and responsibilities as the GAR. 

On March 13, 2020, President Trump declared a nationwide emergency pursuant to section 501(b) of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act). Upon the President’s emergency declaration, all states, territories, and federally recognized tribes became immediately eligible for FEMA Public Assistance (PA) Category B, emergency protective measures as authorized by section 403 of the Stafford Act and funded by the Disaster Relief Fund.

On April 1, 2020, a Major Disaster Declaration was granted to the CNMI, further opening up the opportunity for additional programs and funding through reimbursements for as far back as January 20, 2020 (the start of the incident period). For the first time in the United States’ history, there are 114 concurrent Major Disaster Declarations—at least one in every single state, 5 territories, 1 tribal government, and the District of Columbia.

Covid-19 RESPONSE EFFORTS

In disaster events such as typhoons, the CNMI Homeland Security & Emergency Management is the pivot point for the response operations and coordinates all local agencies. In this pandemic, the activities are like no other disaster before. A major public health emergency requiring an unprecedented response effort, to say the least. The Governor’s Covid-19 Task Force, under the leadership of Mr. Warren Villagomez, Director of CHCC Public Health Emergency and Preparedness Program, became the fulcrum of interagency coordination efforts for all response activities working side by side with CHCC Chief Executive Officer, Ms. Esther Muna, as the Public Health Official. CHCC has been responding to the potential impact of the latest Coronavirus since its discovery in December and continues to drive our whole-of-government approach here in the CNMI with the help of the Task Force. Since then, together we have built an integrated system, a web, of protection and containment of the Covid-19 disease.

As of today, we have tested well over 13,000 of our residents and travellers entering the CNMI through the Community Based Testing, Port Arrival Testing, and Contact Tracing efforts. We will continue to find ways to reach out to more members of the community and help contain the spread of Covid-19 in the CNMI.

Critical Supplies in a Competing Global Environment

At the onset of this disaster, HSEM, the Covid-19 Task Force, and CHCC joined forces to quickly identify the resources required to respond to the threat of the Coronavirus disease. Whether it would be personal protective equipment and medical supplies, medical equipment, quarantine facilities, additional medical staff, additional operations personnel, or the need to increase capacity at our lone hospital, we worked as a unified coordination group to achieve what we could.

In early March and through June, guided by the Incident Command System and the established procurement procedures that both CHCC’s Agency Operations Center (AOC) and HSEM’s Emergency Operation Center (EOC) deploys during disaster response, the CNMI competed for scarce global resources. The State of New York at the time could not procure the quantity of PPEs  required to provide their frontline workers nor the ventilators to treat patients that were filling up hospitals across the State. It was a scary time for the CNMI. If New York was having challenges, what more could we expect for our islands in the middle of the Pacific and at the end of the Nation’s supply chain. Early on in this emergency, I spoke to my contacts at FEMA Region IX and the message they gave me was this…“you are on your own, get what you can, we’ll help you later with the reimbursement process.”

To quote FEMA Administrator, Mr. Pete Gaynor, in his recent testimony to the U.S. House of Representatives:

“During more common disasters, FEMA typically manages abundant resources to support a specific state, territory, or region. In responding to Covid-19, FEMA has met the more difficult task of managing shortages of critical medical supplies and equipment such as PPE, ventilators, swabs, and the chemical reagents required for testing. This effort alone has presented an historic challenge for FEMA and its federal partners. Covid-19 has been a global crisis—leaders across over 150 countries have simultaneously been competing for the same medical supplies…Concurrently, American medical professionals on the front lines of the pandemic have required an exponentially increased volume of PPE and other medical supplies. On average, the United States began consuming a year’s worth of PPE in a matter of weeks. FEMA worked closely with HHS to ensure that locations in danger of running out of supplies within 72 hours received life-saving equipment from the Federal government’s reserve within the Strategic National Stockpile (SNS), as administered by HHS.”

This is the reason why the CNMI went out on its own to build its own Stockpile of resources. In early March, before we had our first confirmed case, we were at the bottom of the list of states and territories that would receive any resources. We were often notified that certain quantities of PPEs, test kits, and other supplies were on their way here, only to see those numbers decrease or disappear as they got closer to our islands. Apparently, other states and territories needed our resources more than we needed them and was intercepted during its transit over to the CNMI.

Preparing for the Surge and Building Capacity 

One of the first priorities for FEMA and HHS was to increase the surge capacity of hospitals. In order to accomplish this objective and protect the safety of patients, health care providers, and the public, FEMA offered the services of the U.S. Army Corp of Engineers (USACE) to work closely with the CNMI to construct Alternate Care Sites (ACS). An ACS “is a building such as a civic convention center that is temporarily converted into a medical treatment facility during a public health emergency to provide additional space if traditional health care institutions are filled beyond capacity.” Here in the CNMI, we don’t have such indoor spaces available so we were further guided by an ACS Toolkit that was released by FEMA and HHS in early April 2020 to guide states and territories to build out hotels, converting them into either an acute care facility or general care facility depending of the need of the community and its current capacity. Our experience with USACE in the planning stages was through virtual meetings. They offered their planning services at no cost to the CNMI. However, by the time those virtual meetings took place, the Task Force was already past the planning stages with a local engineer group. The Task Force members took it upon themselves to push forward full steam ahead with local capacity and not avail of USACE’s services due to the fact that design and project management phases would be through a Mission Assignment and at a cost to the CNMI. In my experience with utilizing services of our federal partners, it comes at a high price tag, and therefore we opted to go with our local capacity for the engineering and construction of the ACS at the Kanoa Resort in Susupe, Saipan. Upon construction, the ACS will be locally managed, and eligible for FEMA Public Assistance Category B funding under the Stafford Act for both their construction costs and continued operations.

Concurrently with the buildout of Kanoa Resort to serve as an ACS and in coordination with CHCC, the Task Force also constructed the Medical Care and Treatment Site (MCATs) by repurposing classroom tents from the Northern Marianas College, container restroom facilities from Hopwood Middle School’s temporary campus, and constructing decontamination showers, among other facilities for the purpose of providing an alternate site for CHCC to keep Covid-19 out of our only hospital.

Sheltering/Quarantine for the Containment of Covid-19

On March 23, 2020, a request was made by CHCC CEO Esther Muna, the CNMI Public Health Official, seeking approval from FEMA Region IX Regional Administrator Robert Fenton for the use of a Non-congregate Shelter (NCS) for the containment of Covid-19. The NCS approved by FEMA was the Kanoa Resort in Susupe, Saipan, a hotel property with 224 guest rooms. This property has been serving as the CNMI’s quarantine facility for returning residents and qualified non-residents/essential workers and later served as an isolation facility as well for all confirmed positive cases and persons under investigation.

On April 1, 2020, with increased travelers arriving into the CNMI, a request to include the 308-room Pacific Islands Club hotel in San Antonio, Saipan, was made to the FEMA Region IX Regional Administrator and was approved as the CNMI’s second NCS site. By June 23, 2020, the Pacific Islands Club was no longer an NCS site due to the decreased need for rooms as a result of changes in the quarantine protocols for arriving travelers at the time.

However, as the response efforts and disease containment measures constantly evolve, the CNMI on July 9, 2020, implemented additional requirements for all inbound travelers due to the increase in Covid-19 cases in the U.S. mainland and Guam, where most of our inbound travelers originate from. The additional requirements translate to an increased need for NCS rooms once again. Currently, the Kanoa resort continues to serve as a non-congregate shelter, but may experience a shortage of rooms as we quarantine more inbound travelers.

Since late-March 2020, the CNMI Government has been actively engaged in the necessary renovation and repairs of the former Marianas Resort property in Marpi, Saipan, a government-owned facility, for the use of the facility as an NCS. The facility has not been utilized since December of 2018 and thus requires to be renovated and repaired. For this reason, the need for NCS facilities between late-March and late-June required contracts with Kanoa Resort and Pacific Islands Club. However, the efforts to restore the former Marianas Resort continues and is expected to be completed by the first week of August. Kanoa resort is still considered a quarantine/isolation facility and will be utilized as needed should quarantine efforts require more than the available rooms at the former Marianas Resort and for the continued use as an isolation facility for confirmed cases and persons under investigation.

COST REIMBURSEMENTS THROUGH FEMA*

Currently, FEMA will allocate funding to cover 75 percent of the costs of Public Assistance, and the CNMI will be responsible for the remaining 25 percent. However, current projections of eligible costs for reimbursements are well over the threshold for an increase in federal cost share and I will be making that request to FEMA at the appropriate time. In addition, the U.S. Department of Treasury recently announced that funds provided under the Coronavirus Aid, Relief, and Economic Security (CARES) Act may be used to pay for our cost share requirements.

*See FEMA Reimbursements Summary submitted via email to Chairman Yumul on 7/27/20.

 

OUTLOOK

Quarantine of incoming travelers will continue as we have seen the benefit of this protective measure. Approximately forty-three percent (43%) of the confirmed positive cases are as a result of testing inbound travelers.  We a system that is working. Part of an integrated system of protective measures that we continue to use through the Executive Orders and Directives of the Administration.

Testing will continue to be a huge part of our containment efforts in the CNMI until such time that a vaccine can be made available. CHCC has requested support to increase its Lab Testing capacity by building an extension of the current lab and/or purchasing a mobile lab unit. We are highly considering this request. 

Conclusion

In closing, I would like to thank the hardworking men and women of the CNMI government, the Covid-19 Task Force led by Warren Villagomez, Governor Ralph Torres and Lt. Governor Arnold Palacios, the Commonwealth Healthcare Corporation led by Esther Muna, CNMI Homeland Security & Emergency Management led by Gerald Guerrero, our federal partners in FEMA, HHS, and CDC, and our local private sector partners. Many have and continue to risk their health and safety during this unprecedented response and for that we should be grateful for and continue to support. Additionally, we are very appreciative of every single person that calls the Marianas their home. We thank them for their commitment to battling this virus by making so many sacrifices and following social distancing and practicing good hygiene. We shall continue to seek everyone’s cooperation in our mitigation efforts and we hope to continue following the latest public health experts’ guidelines and recommendations as one community. 

I would like to thank the Legislature for their understanding and support of our efforts. The challenges we will face in the months and years to come as a result of this pandemic is one that will be shared by all and you will be responsible to continue to lead this community into unchartered territory. Together we shall fight to contain the spread of this deadly disease today and move forward into economic recovery in the near future we hope. 

Chairman Yumul and distinguished Members of the Special Committee on Federal Assistance and Disaster Related Funding, thank you for this opportunity to be here before you. I look forward to any questions you may have for me.

 

 

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