Food and we want to make sure that is not a barrier to someones ability to be able to survive through this pandemic. Especially when so many people rely on places where folks go every day to get a meal because they may not have the facility in their home, or they may not have the ability to cook themselves because of a physical condition. So just being mindful that there are a lot of folks out there with these challenges and we want to be of service. So any questions, again, call 311, because there are a lot of great resources out there and we want to make sure we get folks connected to them. I also want to talk about the challenges that we continue to face with our homeless population. I really want to start by thanking Abigail Stuart khan for all of the work that this department, along with the hot team, the Homeless Outreach team and the folks working in shelters, the people on the front line, working with this population of folks in order to help keep them safe. But i will say that it continues to be a challenge. And although we have access to a number of hotel rooms and we have moved hundreds of people out of the shelter system, including every person who was msc cell out of the shelter system, there continue to be challenges. The bigger issue here is we have to make sure that we have aroundtheclock staffing because this is like nothing weve ever experienced before. So we are not always able to get access to staffing as quickly as we can. Yes, every city and county of San Francisco employee is technically a Disaster Service worker, but what is also happening is when we reach out to them, there are some challenges that some of them may be face. They may be part of the vulnerable population themselves. They may have kids at home that need to be cared for. Or in some instances, they may be fearful. They may be concerned about their own health if they decide to show up to work every single day in an environment where they think possibly they could be exposed. So any other time like an earthquake or other situations where something is transmitted like what were seeing with covid19, it would be a lot easier to staff the hotel rooms, to get people moved in, to have the 24hour support, meal delivery, cleaning service, social service and all the things that we need in order to manage the hotel rooms that we are providing for our homeless population, but it has not been easy. It has not been easy to provide adequate staff. Its been very challenging to get even some of the residents who are part of our shelter system in our hotels to comply with the orders to even wear masks. So its not as simple as what people would like to think. If i could open up every hotel room in this city and allow every Single Person to have a place to stay, knowing that will make a difference and keep everyone safe, its not even a question whether or not we would do it. But the reality is the problems that existed in this city with people who struggle with Substance Use disorder and who struggle with Mental Illness have not gone away because of this pandemic. In fact, its been so much harder to really care for this population, especially when they wont comply with simple directions or orders that were implementing. And we have no means in some cases to force them to comply, because Public Health is in jeopardy. So i just ask for understanding. I ask for patience. We know that sadly, sometimes leaders in our city put out information that is not entirely accurate. Its not as simple as we can do one thing versus another, because ultimately, when you think about what were trying to accomplish in San Francisco, we have the bus service, its still running, but we also have a number of bus drivers that have tested positive for covid19. And, therefore, the people who are showing up to drive muni, theyre fearful. And they want to know that were protecting them. We think about the Police Officers and the firefighters and the other folks who are trying to keep us safe. When firefighters answer a call, when our paramedics answer a call where someone has been physically injured, theyre putting their lives on the line to help care for that person. And so there is a lot that goes into making sure that our workforce is protected. That when they call in sick, we have a substitute for them to take their place. That were able to ensure that they will be safe. That they have the appropriate training, because we have people who work for the city, for example, either in the department of elections or another department now they, as Disaster Service workers, are the ones working at these hotels with the population that theyre not completely familiar with. Doing jobs they never have done before which requires training. And now, with social distancing, and now with this epidemic and what it is doing and the fear sometimes because of people and their health, its so important that we train people, that we make sure they have the p. P. E. That they need, which is whole other conversation, but ultimately, we in the city, all the departments, all the people who are continuing to show up for work every single day and put their lives on the line, we are doing everything we can to implement the right policies that will keep people safe. We see what happened at m. S. C. South with 70 people who were infected with the virus. And the sad reality is, you know, we have said from the very, very beginning, it is going to be very challenging to manage the congregate setting, places where there are singleroom occupancy hotels, where we have shelters systems, laguna hondaa rks thaeeyre but this is this is going to be challenging and we want to be realistic with the public. Not just about the systems we put in place, but also about the behavior of the population were trying to serve. It is not as simple as people would like to express that it is, but it doesnt mean that we arent trying every single day, that we dont have the tools and resources to try and make sure were complying with the order ourselves, and doing everything we can to protect Public Health and Public Safety. That is our number one goal. And every decision we make is toward that goal. So i want to talk a little bit about a couple of other items and a few other departments will be up shortly to go into more detail on some of the things that ive highlighted, including some of the challenges we continue to face, but also some of the things that weve put into place, including, again, we have hotel rooms for the homeless population, but we also have hotel rooms available to our workforce, the Health Care Professionals that are out there that may not want to go home because of their concern about their loved ones, Public Safety officials, including our muni drivers and other folks. So we are setting up a system for the most part that has been effectively serving people and we will continue to move in that direction. And as i said earlier, i was really grateful to folks who complied with the order. In fact, in just really Walking Around the city and examining some of the things myself, i really got to say that seeing people comply and also seeing folks out and about and social distancing and being responsible and Walking Around folks just so theyre not getting close, people are really getting the message. We do still have challenging areas, but for the most part, thank you to San Francisco for what youve done to help us get to a place that continues to be a model for the rest of the country. But i know that even though Easter Sunday was a challenge, we have another unsanctioned holiday coming up. 420. As many folks in the former district that i represented, district 5 and haight, this has been really a challenge for us for so many years. And last year or maybe even the year before last, we finally got it to a place where it was a lot more manageable. The fencing and the other things that we put into play has made it, i guess, tolerable for the community. But i want to be clear with people who come to San Francisco on 420 to Robin Williams meadow to celebrate 420, do not come to San Francisco on 420 to Robin Williams meadows. We will not allow this unsanctioned event to occur this year. Especially in the height of a pandemic. The area will be fenced off. There will be Police Officers patrolling the area. We will cite and if necessary arrest. We will not tolerate anyone coming to San Francisco for 420 this year. We have absorbed the cost and we have worked with the community to provide to allow this unsanctioned event to continue to occur despite a lot of the rules and regulations that are, you know, challenging to abide by when, for example, no smoking in a park, but it is what it is. And we have been very welcoming to people who have come here, but this year, we will be very, very strict with our policies. We will not allow it. So we want to just take this moment to put this message out there that we will be prepared if people start to show up to make sure that it doesnt happen. The area will be completely fenced off. There will be road blocks and other things that will make it difficult to get in the area. And so i just want to say, for your own health and safety, please do not come. Please do not try and identify another location. It is not safe for us to gather in large groups of people, especially during a pandemic, because the consequences could be deadly. Maybe not for you directly, but maybe for your mother, your grandmother, or any other relative. So just keep that in mind if youre having any thoughts about potentially pushing for a gathering or celebration. Not just in San Francisco, but anywhere else throughout the bay area. So i want to take this opportunity to really thank the police chief and to thank our City Attorney for working with us to pull this together. And we will continue all week to promote and make it clear that this, along with any other large gathering in San Francisco, is not possible at this time. And so please continue to comply with our order. All right. With that, you know, i know it feels like its been a long haul for each and every one of us, but, again, i cant thank the people of San Francisco enough, especially those who continue to comply with the order as difficult as it is. Because i know its difficult. I know its especially difficult for kids to not be able to hang out or see their friends. And yesterday when i was on the phone with a friend of mine, they talked about how they finally got their internet set up and they were able to get access to zoom, so they can go online and their friend they can basically talk to one another. I just you know, it really changed that kids attitude who happens to be a teenager and was being a bit difficult and challenging already, but i just think that if there are really small ways in which we can support young people knowing this is difficult for them, knowing that especially if youre a senior in high school, its almost like a rite of passage with the prom, graduation, and everything else, getting ready to go to college. Just be mindful of the challenges that our young people are facing and try to do more to be as supportive as we possibly can. And with that, i just want to say this has been hard and we know that there are still a number of weeks that we will be experiencing this. And as time goes on, its definitely going to be harder and harder to keep your spirits up, to not get frustrated, to want to do something different. And i just want to remind everyone how critical this is. It is life or death. We are doing okay, but, again, as you can see, especially with our shelters, the numbers can increase significantly and they can spread and this can be problematic overnight. People are talking about San Francisco because we shut down early, but ultimately, that can all change if this thing gets completely out of control. And what you have done to make it possible to get us to this place has been really absolutely incredible. We applaud your efforts. We applaud your kindness and many of you who are out there doing things to support and uplift one another, we appreciate those folks who are taking the opportunity, just coming outside and clapping and supporting the Health Care Workers at a certain time, social distancing. The extra things that you do while following the order to be kind and nice to one another is really what is going to get us through all of this. Remember, were all in this together. We all have to comply. It doesnt matter how much money you have, or how much money you dont have. Doesnt matter if youre celebrity or not. The fact is we all are experiencing this. We all are in the same boat. And so its important that we remember that with our actions and how we treat one another as we deal with something im sure many of us have never seen in our lifetime. But as i continue to say, im hopeful that there is a light at the end of the tunnel. Im hopeful that we will get through this and we will look back on our time and just realize how incredible and how resilient this city truly is. So thank you, all, so much. And at this time id like to ask dr. Grant colfax to come up and provide an update from the department of Public Health. Thank you, mayor breed. Good afternoon. Im grant colfax, director of health for the city and county of San Francisco. Its been about a month since we all began staying at home across the bay area to slow down the spread of the coronavirus. Now that weve been at it for a while, i want to start today with reflection. This past weekend was particularly difficult for many of us and challenging for the people of our city. Easter and passover celebrations could not take place in normal ways. Frontline workers and First Responders continued to care for people and address the concerns of an anxious community. More than 100 people experiencing homelessness were moved into hotels which was a major undertaking for them and for the staff who supported them in this transition. Children remained out of school and family schedules continue to be disrupted in both large and small ways. We are truly in unique circumstances that we have never seen in our lifetimes. I acknowledge the stress and discomfort that we see as a community and are feeling across our families and our neighborhoods. We are social beings and it is difficult to be isolated. And it is hard for all of us to deal with uncertainty. But i assure you that the steps that you, we, all of us, are taking are literally saving lives. Together, we are reducing the spread of the coronavirus in the community, in San Francisco, in the bay area. I know that it is not easy and i am grateful for every san franciscan for doing everything they can for the health and safety of our families and our community. When you stay home, when you wash your hands, when you resist unnecessary activity, and when you wear a facial covering, you are literally saving lives. As i have said from the start, we are most concerned about vulnerable populations at high risk for dying from coronavirus. This includes people in longterm care facilities. People who are 60 and over or have Underlying Health conditions. Congregate living situations are also at risk because of how easily it is for the virus to spread under these circumstances. We have been preparing for this. And we have seen it at laguna honda and msb south shelter and well see it in other places as well. Outbreaks like these were bound to happen. This is how coronavirus spreads. Our goal is to slow the spread down and to mitigate the bad outcomes that we see with this virus. As we reported last week, there was an outbreak of coronavirus at m. S. C. South, the citys largest homeless shelter. A total of 182 people there have been tested with 91 positive test results and 91 negative test results. The testing included 57 staff with 10 testing positive and 47 testing negative. This is unfortunate, but again, this is what this is the scenario that we have been preparing for. We have done and we will continue to do everything we can do to respond and protect health. This includes aggressive contact investigation, screening and testing people who are symptomatic, exposed or otherwise at high risk for coronavirus. Cleaning and heightened infectioncontrol practices across the city. Assistants from state and federal advisors and from San Franciscos top Infectious Disease and Public Health experts. Working together with city partners, we have developed a portfolio of options so that we can respond quickly and with flexibility as the situation changes and challenges us. For example, over the weekend the department of homelessness and Supportive Housing and the department of Public Health worked together to move all guests at m. S. C. South into hotels. Isolation, guarantee, or shelter in place sites, depending on guests needs. This was a monumental effort, moving about 100 people and im grateful for all the staff across the city and our partners who accomplished it and all the shelter guests who participated. The next step will be to clean the shelter and prepare it to serve as a Recovery Center for people experiencing homelessness who have coronavirus. A Recovery Center is designated to be a supportive environment staffed by Health Workers and other support workers for covidpositive patients who do not need hospital care, but for whom a hotel is not appropriate due to their health or other condition. I anticipate the possible need for more Recovery Centers as part of a portfolio of alternatives that include field care clinics and isolation and quarantine sites like the hotels. Were drawing on expertise of our Health Care Professionals who serve highneed patients in medical respite and permanent Supportive Housing and on covid19 recovery models developed in other locales. At the same time as we make these significant steps toward health and safety, i want to be clear. The population of people experiencing homelessness face many barriers to health and wellness in normal times and this pandemic will only exploit and amplify those problems. Other cities such as boston, los angeles and seattle are grappling with large numbers of cases of covid19 in homeless populations. And we expect to see the same. Unfortunately, not every person experiencing homelessness just like not every person in our Broader Community will be able or willing to follow the instructions that save lives. We know there are Behavioral Health issues, in particular, that can make it difficult to abide by the rules. I think of patients that ive cared for in shelter and Navigation Centers across the city. I think of joe not his real name a man in his 60s. A heavy drinker, an opiate user, who needs eight beers a day to keep from going into withdrawal. I think of all the work we are doing at the department of Public Health with our partners to keep people like joe safe. And yet i know due to multiple factors people like joe are not only particularly vulnerable to covid19, but maybe unable to fully adhere to physical distancing and Hotel Protocols implemented to keep people as safe as possible. Again, adhering to medical advice for joe was hard during normal times. Sometimes he would show up for his appointment, sometimes he wouldnt. Sometimes hed come in being able to respond appropriately, other times he came in drunk. These are not normal times. These are even harder times for joe. And it will be even harder to get him to provide to provide him with the care he needs to keep himself safe. While we are using Harm Reduction approaches and we have the best people on the front lines in our street medicine team, incredible people, like dr. Barry zevin, kate shouten. Incredible people like deb borne, who has done so much, for not only this epidemic but taking the learns from the h. I. V. Epidemic and applying it today to our response. People like liz enbert from ucsf who was up all night friday night at m. F. C. South helping people find a safe place. Overdose prevention and counseling for Substance Use and Mental Health disorders, we know that even during normal times people will still refuse care or cant adhere to all of our care recommendations. These times are different. They are even harder to manage for people suffering from these disorders. Some Vulnerable People will continue to take risk and, unfortunately, these people will be more likely to get sick, require hospitalization and are more likely to die. Were doing all we can to mitigate the delay to mitigate and delay what is likely to be a surge of serious covid19 cases in this population. In addition to hoteling the most vulnerable and sick from shelters and Navigation Centers, our Public Health priorities include moving as many people as we can quickly and efficiently who are elderly or with chronic conditions to hotel rooms or other sites to monitor their symptoms to keep them free from covid19 whenever possible. Our medical, Behavioral Health and Harm Reduction teams are offering supplies and support in the field. Outreach teams continue to go where people are, to provide information, resources and support. We are there every day. We are working lock step with our partners at h. S. A. And h. S. H. To ensure our efforts are optimized and were addressing the needs of as many people as possible, as quickly as possible. Now i would like to update san franciscan s on the data. Todays data shows there are 957 San Francisco residents with confirmed cases of coronavirus. And, unfortunately, i expect to see our numbers in San Francisco climb to above 1,000 soon. Todays numbers are significantly higher than friday. And this is in large part due to the large numbers of testing we have done in the Homeless Community and the positive cases we have found. We are up to nearly 8,000 tests across the city. Sadly, 15 san franciscans to date have died from covid19related illness. And, again, i send my condolences to their families, loved ones and friends. There are currently 93 patients with coronavirus hospitalized across the city and about 30 of them are in the intensive care unit. Our hospitalization numbers have been holding relatively steady fort past few days which is welcome news and a success. But this success could change rapidly at any time, especially as we see expected outbreaks in vulnerable populations. In order to give a fuller picture of the impact on hospitals, we have added some new elements to our data tracker. Starting today we have included new data about hospitalizations and hospital capacity. On the tracker, you can now see hospitalized patients who may have covid19 and are awaiting test results. This allows us to have a more complete picture of the potential spread of the virus and the amounts of people impacted and how our Hospital Systems are being impacted on a daily basis. On saturday, in addition to the 93 patients with confirmed coronavirus in hospitals, there were also 44 hospital patients who were awaiting test results. These numbers will be updated on a regular basis on the data tracker. Were also sharing new data that helps us better understand the availability of San Francisco hospital beds for patients with covid19. We regularly monitor this information as it indicates our systems ability to care for a suspected surge. On saturday, we had a total of 1229 acute care beds and 441 i. C. U. Beds available to meet the demands of the surge. So as you can tell, at this time, our San FranciscoHospital Systems have enough beds to care for all current coronavirus patients and people who may have coronavirus as well as patients who are hospitalized for other reasons. We will continue to make progress expanding hospital bed capacity for an expected surge. Now i would like to provide a brief update on the outbreak at laguna hospital and the steps we are taking to protect the health of residents and staff. We continue to have 17 confirmed cases of coronavirus. That number has remained the same since april 7, which was the last time we had a new case confirmed. 13 of the confirmed cases are among staff and 4 are among residents. Of the staff, 10 have been in patient care positions and three have not. All four positive resident cases are in the south 5 neighborhood. Overall, to date, 303 laguna honda hospital staff have been tested either by d. P. H. Or their own provider. As part of the ongoing outbreak response we continue to assess staff and patients throughout the hospital that have been identified as being exposed from contact investigation or have other risk factors like showing symptoms of the virus. While i do expect more positive cases, we continue to take actions informed by facts and evidence to protect health and mitigate the further spread of the viruses at the facility, both among staff and among residents. I am thankful that laguna honda continues to receive support from cdc, centers for Disease Control experts, who remain on site and continue to help advise and guide our efforts. These recommendations are also informing efforts to be applied to protect staff and residents at other nursing home facilities across the city. As we continue to fight the coronavirus pandemic together, i would like to remind you that our priorities continue to be reducing the spread of the virus in the community, protecting vulnerable populations, Health Care Workers and First Responders, preparing our system for an expected surge in hospital patients, and expanding testing capability. In all of this work, we must continue to follow science, data and fact. We seek to continually do better as we incorporate this information into our actions and recommendations. We are working quickly to integrate new information all the time and adjust our recommendations accordingly, so that we are providing the very best most uptodate advice to you, the public, that we can. Thank you. Next up is director stuart khan, the director of homelessness and Supportive Housing to provide an update. Thank you, dr. Colfax, and mayor breed for your leadership during this crisis. The city and our nonprofit partners are battling two simultaneous Public Health emergencies, homelessness and all of its complexity and the compounding issue of the covid pandemic. We know that everyones health is intertwined and when people do not have homes to reside in, it is more challenging for them to take care of themselves. And for some, as the mayor noted and dr. Colfax talked about joe, their lives are complex and that makes it harder, even harder for them to accept help. As a clinical social worker we all know people like joe. And myself and all of my colleagues have dedicated our lives to their care and empowerment. We know they need to say yes before help can come. Today i wanted to provide an update on m. S. C. South which dr. Colfax already touched on. Division circle and hamilton shelter, our progress is thinning and information on the hotels which director will share more information on after me. As dr. Colfax noted, we, through a heroic effort of the department of Public Health and our own organization, have moved everybody out of m. S. C. South. It is in the process of being cleaned and repurposed for future need. This was a massive, massive task. Scott walton from our department and st. Vincent de paul, our partner, worked through the night with the department of Public Health and all of our colleagues working at hotels to receive individuals from m. S. C. South. We have two other positives which weve already provided updates on at press conferences, but i want to provide a continuing update here. As you know, Division Circle was our first site that had a positive covid test that is a navigation center. That remains with one positive test. Vulnerable individuals have been moved offsite and were already in the process when that positive test occurred. All steps toward shelterthinning and distancing, allowing for physical distancing, even within a congregate setting, have been completed in that site. Hamilton shelter that has families in one room had one positive test. That family was already offsite and vulnerable individuals are moving off site. Hamilton family is a longtime provider of family care in our city. Theyve gone above and beyond just like st. Vincent de paul to implement guidance from our department and the department of Public Health long before these positive cases occurred. And theyve gone even further since positives have been reported. At a system level, we have been working tirelessly to create what is called shelterthinning or shelter equilibrium. Shelter thinning, shelters are dense places, places that we know people should not reside for long periods of time, but they do. Equilibrium to me means that the vulnerable individuals have been moved out as part of thinning so we know they can be taken care of in hotel rooms. As of yesterday, approximately 750 people experiencing homelessness are in isolation, quarantine and shelter in place Hotels Across our city. This is a massive, massive task and accomplishment. As the mayor noted, we cannot simply open the doors of hotel rooms and invite people in. Where that is happening, we have care. We have to we have to care for every single step in the process. Ill talk about that next. In order to accomplish full shelter equilibrium with the vulnerable populations moving out, we estimate we have somewhere between 100 and 200 more who are in motion today. This will allow us to know that the vulnerable individuals who have accepted our offer of a hotel room have moved from those rooms. Not all are accepting. It is scary to move into an isolation, quarantine or shelter in place room for some individuals with complex lives. For joe, it is a near impossibility. Without significant care and help. Those are all the things that our system of care is standing up now. We will keep working. We will keep working to support people like joe and the clients we all dedicated our lives to serving. Director ror will provide an update on the big picture where we are in hotel rooms, but i wanted to provide additional context on what it takes to open a single hotel and move vulnerable, or nonvulnerable individuals in. Securing leases is only the first step and is managed by h. S. A. At great speed. There are several additional factors that must come together, including staffing. We have to conduct wellness checks multiple times a day. We have to enforce social distancing and shelter in place tt orders without significant Legal Recourse because we dont want to cite people at these locations. We must deliver three meals a day. We must manage crisis. Our staff and partners manage crisis every day in all of our places and they manage it beautifully without incident. When people are picked up and moved away from their environments, we expect that crisis will only become exacerbated. We have to plan for that with our staffing, yet the staff were asking to do this, many of whom have never done this before. We want to thank the Disaster Service workers, the nonprofit partners, h. S. A. Staff, and all of the partners, sheriffs, police, everyone turning up at these hotels around the clock to make it possible. We have to conduct screening for ability to selfcare. And when someone is not able to selfcare, we have to put additional staffing in place beyond wellness checks and feeding. We need to work on transportation and we want to thank our colleagues at ems, private ambulances and mta who are making this possible. If you think about physical distancing in a bus, you can imagine how many buses it takes to move 750 people over the course of a few days. This is a slow process. We are also working hard on Harm Reduction in each of these locations to ensure people can have their needs met and they can say where they are. Then we focus on discharge planning and reinstatement to shelter. These are some of the steps required and were working tirelessly to open more in the coming days. Director rohr is the director of the Human Services agency and will speak now. Thank you