Transcripts For SFGTV MTA Board Of Directors 20240713

The only thing is that it doesnt necessarily if that is an area that youre concerned about additional outbreaks, and then, youre moving covidpositive patients into that facility, can you talk about the thinking kind of behind that. And then, the other thing, on the point of asymptomatic testing, you know, why wait until there could potentially be an outbreak in this facility . Because right now, the guidelines are only test people who show symptoms, but youve only had one case in that facility, and it would be good to, you know, in many peoples opinion to defendatest even its just a snapshot, you might get an idea of someone and intervene in advance before there could potentially be an outbreak in that facility . So i know thats a lot of things, but were going to have a town hall in the Jewish Community thursday night. Theyre trying to do everything they can to be as safe as they could be, but i know theres a lot of discussion around how they can have testing onsite when theres covid positive cases. Yeah. In longterm care facilities, youre going to begin to see a lot more testing, especially of staff, because what happens is staff bring the infections into the facilities. Supervisor safai right, and i think thats what happened in the case of the person that tested positive. Yeah. Youre going to be like i said, the strategys really evolving for all of these different populations. Longterm care facilities is tend to be a closed ecosystem with the exception of staff that come in and out. Supervisor safai yeah. So youre right, youre going to see more testing. What happens is when a facility or part of a facility commits to testing patients who are covid positive, what they do is they cohort those patients, they put them all together, and that way, theyre able to dedicate the service with the best p. P. E. The other thing thats beginning to happen is youll begin to see people, staff, who have recovered from covid or tested positive, theyll begin to take care of that unit. So youll begin to see the specialization, and youll begin to see facilities specialize in taking care or parttime taking care of patients. So relying on symptoms is not sufficient. If you relied on symptoms, you will miss most of the patients. Supervisor safai so when so when will we see i mean, youre saying youre going to see there is a case already, theyve tested that individual. So when are we going to see an increase in the testing, because this is the only licensed longterm care in the city. Theres a lot of family and patients of existing people that are concerned about this. As i said, were going to have this in two days. It would be wonderful if we can get increased testing in that facility as soon as possible. Yeah. Let me one thing we can do is, we do have a team that focused on longterm care facilities, and it would be good to have one of the people that focuses in these area explain how theyre focusing on longterm care facilities. So i can make sure that youre connected with our key person because i think it would be good basically, theyre spending all their time on this topic. Supervisor safai okay. Actually, im being called by the Health Commission right now because im supposed to be there to report to the Health Commission. Is that going to be okay . President yee well, if you have to i mean, if you have to do that, we cant hold you here, and this was, as you said, fairly last minute. Well try to moving forward, i mean, i think this is useful, and thank you, supervisor peskin, for making this happen. Ill try and figure out a way in which we can have something more regular so we can sort of anticipate, and ill speak to you in terms of whats a better time during meeting, after the meeting, that type of thing. Yeah. Let me know sort of ahead of time, so if theres if theres a subject matter expert, i can get the information that youre asking for, so that way, youll get more complete answers. President yee so if you have to leave, then, im sorry, supervisor preston and supervisor stefani, im going to skip you, but when we do this again, youll be first in line. Supervisor peskin, would you like to wrap it up . Supervisor peskin thank you, mr. President. I would like to wrap it up, and i would like to agendaize this as another briefing that the public can watch after next tuesdays Board Meeting or have this be an item on next tuesdays Board Meeting, whatever the council prefers. I think this has been incredibly productive. Im sorry. I had additional questions, as i know supervisor preston and stefani did, as well. This has been highly helpful, and i would like us to continue to have these discussions publicly, and would like to do so next tuesday with your indulgence, mr. President. President yee yes, well figure it out. Supervisor peskin okay. Thank you, sir. Okay. Thank you, everyone. Good luck. President yee okay. Thank you very much. Colleagues and anybody else thats listening, thanks for staying tuned, and as i mentioned, we will figure out a way to do this. So im going to go ahead and end this portion at this time, so i will if you want to get off now, that would be fine. Since this is not a meetingmeeting, im not going to hammer down, but say thank you for getting the work done. Clerk thank you, mr. President. Supervisor haney thank you, everyone. Parks and places of communicated and thanks to the mayor and the department of technology and supervisor farrell and google. We had a very very unique partnership that was able to bring wifi to our most heavily used parks and squares. Parks in particular are really important way of life and quality of life and so is connectivity. Bringing those two things together in a project like this is right on target with what San Francisco is and wants to be. Its all about breaking apart the divide. The people with expensive data plan can have access to information and economy. This is really breaking down the Digital Divide and giving people across the spectrum the opportunity to information and giving them mobility and freedom. Particularly by investing in connectivity in park spaces we are also ensuring the connection to Digital Inclusion opportunities and parks are designed for all neighborhoods. People are on the move. They are no longer chained to their desk tops at home. People can accomplish a lot and we prefer them being here an enjoying the outdoors and nature. Given all the mobile community and mobile information thats available. We thought it was important to make it for our parks acceptable for everyone and give everyone the opportunity to live and to work and be at the parks at the same time. Our full mission in life is to give them access to the internet, give them access to information. In San Francisco you dont have to be bottled up in an office. You can be around and enjoy your work anywhere. Its great for the local community here and it means a lot to me. In the park, you are people that can teach you about the trees in the park and you can go to parks and recreation. Org and having wifi in our parks makes it more accessible. If you want more information about how to enjoy wifi in he is a real leader that listens and knows how to bring people together. Brought this department together like never before. I am so excited to be swearing in the next chief of the San Francisco Fire Department, ladies and gentlemen, lets welcome, Jeanine Nicholson. applause . I grew up total tomboy, athlete. I loved a good crisis, a good challenge. I grew up across the street from the fire station. My dad used to take me there to vote. I never saw any female firefighters because there werent any in the 1970s. I didnt know i could be a fire fighter. When i moved to San Francisco in 1990, some things opened up. I saw women doing things they hadnt been doing when i was growing up. One thing was firefighting. A woman recruited me at the gaypride parade in 1991. It was a perfect fit. I liked using my brain, body, working as a team, figuring things out, troubleshooting and coming up with different ways to solve a problem. In terms of coming in after another female chief, i dont think anybody says that about men. You are coming in after another man, chief, what is that like. I understand why it is asked. It is unusual to have a woman in this position. I think San Francisco is a trailblazer in that way in terms of showing the world what can happen and what other people who may not look like what you think the fire chief should look like how they can be successful. Be asked me about being the first lbgq i have an understands because there are little queer kids that see me. I worked my way up. I came in january of 1994. I built relationships over the years, and i spent 24 years in the field, as we call it. Working out of firehouses. The Fire Department is a family. We live together, eat together, sleep in the same dorm together, go to crazy calls together, dangerous calls and we have to look out for one another. When i was burned in a fire years ago and i felt responsible, i felt awful. I didnt want to talk to any of my civilian friends. They couldnt understand what i was going through. The firefighters knew, they understood. They had been there. It is a different relationship. We have to rely on one another. In terms of me being the chief of the department, i am really trying to maintain an open relationship with all of our members in the field so myself and my deputy chiefs, one of the priorities i had was for each of us to go around to different fire stations to make sure we hit all within the first three or four months to start a conversation. That hasnt been there for a while. Part of the reason that i am getting along well with the field now is because i was there. I worked there. People know me and because i know what we need. I know what they need to be successful. I have known Jeanine Nicholson since we worked together at station 15. I have always held her in the highest regard. Since she is the chief she has infused the department with optimism. She is easy to approach and is concerned with the firefighters and paramedics. I appreciate that she is concerned with the issues relevant to the Fire Department today. There is a retired captain who started the Cancer Prevention foundation 10 years ago because he had cancer and he noticed fellow firefighters were getting cancer. He started looking into it. In 2012 i was diagnosed with breast canner, and some of my fellow firefighters noticed there are a lot of women in the San Francisco Fire Department, premenopausal in their 40s getting breast cancer. It was a higher rate than the general population. We were working with workers comp to make it flow more easily for our members so they didnt have to worry about the paper work when they go through chemo. The turnout gear was covered with suit. It was a badge to have that all over your coat and face and helmet. The dirtier you were the harder you worked. That is a cancer causeser. It casser. It is not cancer causer. There islassic everywhere. We had to reduce our exposure. We washed our gear more often, we didnt take gear where we were eating or sleeping. We started decontaminating ourselves at the fire scene after the fire was out. Going back to the fire station and then taking a shower. I have taught, worked on the decontamination policy to be sure that gets through. It is not if or when. It is who is the next person. It is like a cancer sniper out there. Who is going to get it next. One of the things i love about the Fire Department. It is always a team effort. You are my family. I love the city and department and i love being of service. I vow to work hard to work hard to carry out the vision of the San Francisco Fire Department and to move us forward in a positive way. If i were to give a little advice to women and queer kids, find people to support you. Keep putting one foot in front of the other and keep trying. You never know what door is going to open next. You really dont. [cheers and it may not be as seamless as we would like it to be. There may be gaps, or dead air, and the staff is trying to stay with the technology between the speakers. Please note were doing our very best, and we ask for your patience as were learning this new way to Work Together. Commissioners and presenters, if you have not already done so, please mute your microphones to minimize the background noise. When you speak, youll have to unmute yourselves. And the commissioners, raise your hand to ask a question. And we can switch presentation indescernable . And well ask everyone to please be patient as we make these adjustments. Lastly, we would like to thank all of the people who have been working very long hours to make this meeting possible. Starting, of course, with mr. Mark moore, and jeff burton, and d. P. H. Directors office staff, and s. F. Gov. Tv, and the board of supervisors, which drafted the best remote meeting practices. The commission is truly grateful for all of your great work. So thank you very much. Thank you, commissioner. This meeting is being televised this meeting is being televised by s. F. Gov. Tv, and for those of you watching live stream, please be aware there is a 30second to twominute delay. If youre watching the video at s. F. Gov. Tv, and youre interested in making a Public Comment, make sure that you call in at the beginning of the item called. For instance, if you were making general Public Comment, as soon as the item is called, call in so that youre sure to get in line for that. Let me post the number, so you can see it again. Give me one second. So the number is on the screen right now, for you all to call in. It will be in about three seconds. Here we go. The number to call in is 8883634734, and the access code is 2241310. If you would like to make compliPublic Comment any time during this meeting, call in any time. And you can listen to the meeting live without any delay, as we move forward. A couple of points about the Public Comment, since this is a new technology for us, every individual is able to make comments once per item. Even though technologically you could get back in line, if i recognize your number or hear your voice, i will disallow you from commenting more than once. Each individual can speak up to two minutes, as is our normal rule, and after two minutes, we will have to cut you off so we can take the next call. If youre on the phone line, using the number that i just gave you, you will press 10 to actually get in line for an item. 10 activates you to stand in line to be in for Public Comment, otherwise youre just listening into the meeting. If youre making Public Comment, make sure everything around you is muted and quiet, especially if youre watching on the computer because it will reverberate, and it is very difficult for us to hear you. I hope that information is helpful. And then i will repeat this information throughout the meeting, in case folks come in late for the meeting, i want to pacsure thamake sure that the pc understands how to make Public Comment. [indescernable] commissioners, i think we can move on to item 2. Let me get there. Thank you, mark. We have some Unfinished Business from our last meeting, a motion to disclose or not enclosed session in our march 24th, 2020, meeting. Do we have a motion to disclose or not to disclose . Motion to disclose. Second. Mr. Mar, would you do roll call . Yes. Actually, before we do that, i want to just note that the issues that the item that you all actually discussed and considered enclosed session was the s. F. G. Credentially support. Commissioner chung . Yes. [roll call] all right. Thank you very much. Item 3is the approval of the minutes of the march 24th, 2020, meeting. Upon reviewing the minutes, do commissioners have the amendments . I ask that you speak to the meeting being at 101 grove, is that correct, or are we supposed to put virtual or what . Commissioners, the meeting at a time was at 101 grove, and it felt thats fine. No problem. Motion to approve . So moved. Second. All right. So ill do roll call. [roll call] great. Thank you. The next item on the agenda is the directs report, and i am not sure if director kofax is with us . I am here. Oh, great. Can you see me . I can see me. I can see you. Okay. You have the commissioner indescernable . Do you have the directors report . [indescernable] the next item is going to focus on our covid19 response. I am not going to go into the detail, as described in the report, but i did want to mention that im very pleased that we have our new c. E. O. , who is in honda hospital, michael thorps. He has joined the v. P. H. Team in this unprecedented time, and has come up from southern california, and has lots of outstanding experience in Skilled Nursing facilities and other types of hospitals. He has jumped right in, and im very pleased that he has joined the team. He will continue to be working with actin the acting director, as he becomes on board and becomes familiar with the issues at hand with regards to honda, and the institution itself, and the amazing committee of residents and staff that work there. Great. Welcome. Commissioners, any questions . I believe, mr. Cofax, if there is any other else youre going to say . I was going to go into more detail of the directors report, in the next agenda item. As know, there have been a number of across the accounts and other information historically just for the commission that has been added to this report, but i dont have any additional details, unless the commission has questions from me. Commissioners, if you would like to ask any questions, could you raise your hand so we can recognize you . Commissioner chow. Thank you, dr. Cofax. I can see i was going to ask, on mr. Phillips, who is coming, to look in on honda. And you mentioned he would have it sounded like a transition period. About what period of time would you think that was, that we would have maggie still as our acting director, and are you looking at several weeks our months . What would be the thinking yes, commissioner. Sorry to interrupt. The im sorry, were you finished with your question . Yes. Okay. So the plan at this time is for them to act as a team, as michael gets up to speed on the complexities of the situation, and the full transition would be completed by june 1st. Okay. Very good. A second question would we be picking up during the discussion on the covid, the way of triaging and moving patients . And therefore i would save my questions for that. Okay. And i believe they are in attendance at this meeting. Mark, can you confirm that . Yes. Theyll actually be joining later. I thought they would be on here. Maggie, are you here . Yes. Both michael and i are present. Oh, great. So theyre available to answer more detailed questions as we go through the presentation. And commissioner chu, it seems that your questions might fit in with question five, which is the coronavirus update. That would be fine with me, to discuss the triaging and the outboarding of patients as we move them away from the acute hospital. Thank you. Thank you. Commissioners, any other questions . If youre not on video, please speak up. All right. Thank you very much, and thank you, maggie, for your help with the transition, and welcome to michael phillips. Your conference is now in question and answer mode. To summon each question, press one and then zero. Moderate, go ahead and put the first call through. Caller, are you on the line . Is there a caller on the line . You have two questions remaining. Caller, please start speaking. Caller yes, hi. This is michael petrellous calling in and im watching on your microsoft screen, but it doesnt tell me what agenda item were discussing. Yes. I verbally announced. Were on the directors report. Okay. On the directors report. Here are my two minutes of comment. I want to salute the department of Public Health for doing an excellent job of slowly and methodically rolling out the quarantine that we are living under. I also want to take this occasion to thank all San Francisco citizens, who are practicing physical distancing. I think it is terrific that we have flattened the curve, and that we are seeing the infection rates are not alarmingly high. I think it is very important that we, the citizens, who are observing physical distancing, continue to do this and continue to receive praise from the Health Department. And, finally, i want to say, i would have liked in dr. Cofaxs report here, a little bit more information about current coordination with other regional Public Health departments. Thank you. All right. Thank you. Next caller, please. Caller you have one questn remaining. Hi, welcome. Please say your name and your two minutes will begin. Caller hi, my name is Teresa Palmer, im a physician and a geri geriatrition. I feel like the lack of testing of asymptomatic contact at the nursing home is a form of rationing. It is a statement that nursing home patients lives are not worthwhile, and the lives of the is staff are not worthwhile. I would like some answers as to why were not ramping up testing at Nursing Homes, as we know we should in all congregate settings. Were setting ourselves up for a second wave, and were going to have massive dieoffs in Nursing Homes. Thank you. You have zero questions remaining. All right. Thank you. Those who made Public Comment. I think we can go on to the next item, item 5, the Coronavirus Preparedness update. Dr. Cofax, i cant see you. Can other folks see dr. Cofax . I can hear him he seems to have disappeared off the scene here. You can hear me, right . I can hear you. My video is on, and i can see oh oh, there we go. Hi, everyone. We can see you now. Hello. I had to share. Okay. Im sorry, im not able to see you. But just continue. Ill figure this stuff out later. Thank you. Okay. So good afternoon, commissioners, again, and secretary morris. Thank you for joining with regard to this report. Before we go to the slide, i just wanted to express my gratitude for the residents of San Francisco with regard to their collective response in addressing this unprecedented pandemic. From the beginning, we knew that our ability as a community to mitigate the spread of the virus was really dependent on our collective response. And thanks to the leadership of mayor breed and the aggressive actions that she supported, both locally and i think regionally as well, they continue to certainly mitigate the affects of this pandemic in San Francisco. So just to reinforce the gratitude, and also to acknowledge the tremendous effort and strength that this pandemic has put on the Health Department and the incredible work and efforts of people across the department with regard to particularly the last eight weeks in ensuring that we listen, are responsive based on data, science, and facts. And if we are flexible in our response, as more information comes in, and we do the right thing for our community. So this collective response is really focused on the priorities that i spoke to you about, which seems long ago, a very different time now, in february, with regard to slowing the spread of the coronavirus in communities, and that really is around flattening the curve. And i have provided some slides here for you just to remind us about where we have been and where we are going. But with regard to fightinflattening the curve, i think two things stand out. One is the declaration of a local Health Emergency after the mayor, in february, declared a city emergency. That really allowed us to prepare a city emergency declaration, which was done in february, which really helped us to harness our resources across the department, and, frankly, across the city, to be as prepared as possible. The shelterinplace order, which was put into affect march 16th, that initial order was key in terms of developing social distancing reinforcing the social distancing intervention, which was so key to slowing the spread of the virus. Other key things that we have done that i think remind you indescernable , just the emphasis on hygiene, with regard to washing ones hands, avoiding touching ones face. I think we all remember perhaps we remember the day or the person where we didnt shake hands for the first time, and we started practicing more triple hygiene with regard to reducing the spread of the risk of the virus. And then most recently, just the recommendations around facial coverings and the order that was just released last friday, that increased the requirement with regards to wearing fascial masks facial. I think they were all key, these socalled nonpharmaceutical interventions. You can see that we did it within the context of the broader population context, as well as, as you can see, from several of these orders, there is much focus being on vulnerable populations. And thats our second key priority, that, again, we started articulately months ago, really ensuring that were doing everything we can to protect the most vulnerable to this disease. We know, unfortunately, people over the age of 60, people with morbid health conditions, are more likely to die from this disease. We saw that happening internationally. Unfortunately, those patterns held in the u. S. , including here in San Francisco. So i will get into more details around that, but that certainly has been one of our key priorities going forward. As well as protecting Health Care Workers and first responders. The people on the frontlines, the people whos focus is on caring for people most at risk for covid19, making sure that they were able to protect themselves, so they are better protected and can help others. As well as protecting their families and their loved ones as much as possible. The First Priority is really around medical surge, ensuring that we brought forward capacity in order to meet, in essence, a surge. It is still very possible that a surge will be seen in San Francisco. So we remain vigilant in our focus on ensuring that there is Hospital Capacity to meet not only what were managing today, but in the event of a moderate surge, that we do have that capacity. And then also being clear, unfortunately, as happened in new york city, that there are scenarios where there were no there would not be plausible ways that a local response would be adequate. And we would need to be clear with state and federal partners that more help would be needed. I think the other key piece of our focus has been on testing and Contact Tracing. And the fundamental principle in Public Health, and something that has really come to the forefront as we have confronted this pandemic. And the testing pieces have been very challenging. But i think were making steady progress now. And then ill talk a bit about the Contact Tracing that we anticipate to be able to be affective in a relatively short future. Before we go on to the next slide, i want to also emphasize the help, the support, the collaboration with other city departments and community partners. This is a truly citywide responsresponse. Not only do we have hundreds of d. P. H. Staff working on this, the department of operations center, the Emergency Operations center, which is headed by director Mary Ellen Carroll has been a remarkable partner, and has ensured that our response is more than just a department of Public Health response, it is truly a city response. The controllers office, the homeless department, housing department, and others really are coming together and working handinhand, and in many cases 2 24 7, to ensure were doing everything we can and to meet the needs of our citizens. Can we go to the next slide, please . Sure. Im sorry, i just got you on camera. Go to the beginning, dr. Cofax . On my drean th screen, the Health Orders are coming up. Would you like to go to the test cases . Yes. Give me one second. Sorry. Sorry, everybody. Im a little slow on the uptake on that. Okay, here we go. All right. Mark, may i just ask a process question . I have a i dont know if anyone can answer this question. Im having some challenges with this program whats wrong . The video is the bar that shows the microphone and the camera is super imposed on the eye, so i cant see the slide. I dont know if the other commissioners are having that problem. Jeff burton is on, who is an i. T. Guy. Jeff, is there any response you have to that to help dr. Kofax . Im not sure exactly what is happening, but it seems like something technical. Yeah. Mark, it appears that the control bar is obstructing the view of the dates along the bottom of the charts. Is that happening for other people, too . Well, on my screen, it doesnt. And then the control bar, you can actually it sort of disappears if youre not using it. And it would otherwise so i guess it depends on how it is being viewed. Because it sounds like for dr. C cofax, the control bar is in his way, and for me, it is below the slide. Mr. Kelly, if you move your mouse curse ser so curser y from the control bar, give it a second and it will disappear. You need to move your cursor off the control bar. Does that work, dr. Cofax . Im following the instructions, and it is not working all of the time. But i will as part yes, i will be flexible and work with what weve got, how is that . Okay. Sorry about that. Can everyone see the slide . Yes. Commissioner be careful to mute yourself because were hearing the conversation. Mr. Cofax, do you want to continue . Yes. Commissioners, i wanted to provide you with information about where weve been and where we are going. And just review data so that there is sort of an understanding of what things stand. This is our total number of diagnosed cases in San Francisco, 1231 total cases. And it represents the people who are positive who have been tested. So it doesnt represent all the cases because we know many people havent been tested. But of the people tested, weve had 1231 cases. Weve, unfortunately, have had 20 deaths. And you can see from early march, when our first cases were detected, weve had a steady increase in that number. Compared to other regional neighboring counties, we do have the highest prevalence rate of people who have been tested, testing positive. And i think that really reflects the greater density of San Francisco. Our relative death rate is still well within the surrounding counties, but our numbers are quite small and that could change very quickly. Go to the next slide. Okay. Give me one second. It takes a second to show up. Sorry. I apologize, something is stuck. Give me one second to try to unblock it. Scroll to the next. Okay. Here we go. Thank you. Yes, and then you can see here, this is our these are our data with regard to cases. Weve done nearly 12,000 tests. Our Positivity Rate does vary day to day. It has been ranging from about 11 to 15 overall, and then you can see the racial ethnic breakdown of the positive cases. We do see here that indescernable population is overrepresented, compared to the population of San Francisco as a whole, and the africanamerican. Again, these numbers are updated on a daily basis on your covid19 response tracker. Next slide, please. These are the data on the deaths. I will say that we see here that just as in other jurisdictions, we see a larger number of males, compared to females, who have died. You can see the deaths by each group. Weve had a preponderance of people over 16. The deaths by race and ethnicity show a higher proportion of asian deaths, and i can talk a little bit about that and why we think that is. That has been tied to a higher portion of older age, and then there are a couple of cases linked to indescernable . With regard to underlying conditions, this is an error in the slide. All 20 deaths have been associated with underlying conditions. So where you see the data on the 20 deaths that we have had, unfortunately the patterns of larger groups of deaths in other jurisdictions i would be very cautious about interpreting too much about the Race Ethnicity death rate here, especially because, again, this is a very small number of deaths, which is ae death is too many, but these numbers are quite small. I certainly hope that they stay this way, but, obviously, we dont know. Next slide, please. So this is a really key slide with regard to what were what we looked at in terms of the burden of covid19 in the hospital system. And the reason that this is very important is that we really need to ensure that our systems are have capacity to take care of the sickest people. And so this is the green the upper green row is data on the number of people confirmed positive across our nine Hospital Systems in the city. And you can see here, while the numbers substantially increase from the march 23rd, when we were first able to report this data, to the 19th, the latest data that has been available, this curve, starting around april 1st, is quite flat. So when we talk about flattening the curve, it is really the curve that were working to flatten is our ability to take care of the sickest people. And right now this curve is pretty flat. And i say that with all respect for the fact that this could change quickly. It could change if we have outbreaks in particularily vulnerable populations. But right now we need to look at the data, and were looking at the data, and here is where we are. The darker green shows the medical surgery beds occupied. And the lighter greens are the i. C. U. Beds, and those are the intensive care unit beds. And they remain relatively stable over the past 10 days. The blue im sorry. The purple area between the suspected covid19 patient count is also a key indicator to watch. Because these are people who who have tested positive for covid19, and are in the hospital. Those are the people in intensive care units, suspected of covid19. And those numbers have, again, remained relatively stable the last few weeks. You do see some increases in the numbers, for instance on april 5th and 6th, and we were testing a number of residents at honda for the c. D. C. Recommendations. Thankfully, not many of those cases were found covid19 positive. Next slide. So those are the key slides that i wanted to share with the commission. Commission as part of this report. I also wanted to emphasize, with regard to our medical surge planning, because of remarkable efforts across the city Health Systems and i really want to acknowledge dr. Susan ehrlich and the c. E. O. Of zuckerberg hospital, and the chief operating officer of the hospital. They really led our surgeplanning efforts, not only within the department, but across the city. And we made remarkable progress in ensuring that our hospitals were, as much as possible, not taking patients for nonessential surgeries, because that opened up capacity. That patients were discharged as appropriately appropriately discharged from the hospital to other facilities so we could free up beds. And then we greatly expanded our medical surge and intensive care unit capacity in additional ways, so that we had exceeded the states goal of increasing local capacity by 40 . Currently, we have 1252 acute care beds, and 460 i. C. U. Beds across the city to meet the demands of a surge. So really important and strong work there. So we do have that capacity now, and we continue to build out that capacity as we go forward. So i did want to talk a little bit about vulnerable populations, and provide the commission with an overview of our work in that area. We have very much focused on ill talk a little bit about the population experiencing homelessness. We know that that has been a key area of focus. And from the start, we have focused on people who are experiencing homelessness, who are most likely to have negative outcomes from the virus. And those are, again, the people over 60 or with comorbid conditions. And were working with our partners at h. S. A. And h. S. H. , and at this point, over 750 people have been placed in hotel rooms, with those chronic conditions, to help them social distance and so they can be monitored and observed for any symptoms and tested appropriately. The other thing that i think is important to emphasize is that we have developed and refined our system for People Living with covid19, or people under investigation, who cannot safely isolate or quarantine either because they are in a shelter or navigation center, an s. R. O. , or other such congregate settings, that we have stood up with multiple hotel rooms for those people. On any given day, we have approximately 200 people in those hotel rooms. So ensuring that people have what they need to stay either out of the hospital, if they do not need a hospital bed, which frees up a hospital bed for somebody else, or if they are not able to care for themselves or for reasons in such a way they can stay safe and also isolate from potentially contacting others. So we really set up a very good system there that is,again, working hard every day to even increase that capacity. Right now we have about 200 People Living with covid19 or under investigation for covid19, plus we have over 750 people who are experiencing homelessness, who have been placed in hotel rooms, to keep them as safe as possible. I also want to mention with regard to the outbreak we had at m. S. C. , one of our largest shelters. We had an outbreak there. As a result, we had 96 guests and 10 Staff Members who tested positive for covid19 there. All of the guests from that shelter have been moved to hotels, isolation, shelter, or quarantine in place, depending on their need. And all staff were also offered Isolation Hotel rooms if they needed them. And, again, we were preparing for this scenario, and we responded quickly. The staff the street medicine steam worked literally day and night to ensure that the people got the care that they needed. And that shelter has been closed and is being cleaned. Iwithin these highrisk settings, our response is driven by the best Public Health methods we have at our disposal to make an informed decision on how that response needs to be in the face of multiple other competing priorities. So i will also mention that at the Division Circle navigation center, where ive had a clinic, weve had a positive case there. An aggressive contact Case Investigation and contact investigation, there were people who were determined to be at risk were tested. And through that process, a decision was made, based on the information data that we had, that we would not close that navigation center. So my point here is that we are based on c. D. C. Guidelines, were testing vulnerable populations, providing them with care and support, ensuring that we are flexible and appropriate in our response. I also want to talk in more detail about the lag laguna honda hospital. We took a course of action with the leadership of mccowski and her team and staff early on. We ordered we issued a health order restricting visitors to the facility on march 6th. We practiced and we prepared a health order to restrict residents from leaving the building, and that went into affect march 15th, and we ensured we were screening staff for any signs or symptoms as they entered the facility. Despite those efforts, people will know there was an outbreak among residents in the 5 southward. We quarantined that ward. And we took aggressive additional infectioncontrol steps. At this time weve had 19 laguna honda cases 19 cases of covid19 at laguna honda. Four have been amongst residents. Those residents have all been located in the 5 south neighborhood. There have been staff at 4 south who have tested positive, but we have not had any residents in that neighborhood who have tested positive. And maggie mccowski and the laguna honda team can talk in more detail about that, if the commission has questions. The point is, after bringing in c. D. C. , we had a remarkable team from the c. D. C. In the state. And i want to thank our local leaders, our federally and locallyelected leaders, who really helped ensure that the c. D. C. Deployed a team to laguna honda early in this outbreak, to help us and to reinforce our aggressive efforts. The c. D. C. Made a number of recommendations, and we were report that out. But after staying for two weeks and summarizing their recommendations, they emphasized that the aggressive actions that the staff took early on literally saved lives, and were likely to continue to mitigate the spread of the virus in the institution. And then were obviously, not obviously, but i should also say one of the other key issues at laguna honda was ensur ensuring that the staff was supported. It is an incredibly challenging time for staff across the departments, and we have ensured that staff across the department have access to Behavioral Health care and support, if and when needed. And we redoubled those efforts at laguna honda hospital, ensuring that there was access to the Behavioral Health services. For those staff, and also that those staff were communicating in an ongoing way about the status of the investigations. So the additional piece that i wanted to cover before i took questions from the commission was to talk a little bit about our testing. As you know, we have struggled as a nation, with regard the capacity at the beginning of the epidemic and going forward. I really want to acknowledge the laboratory under the leadership of dr. Susan, our Communicable Disease director. We were one of the first laboratories in the state to Start Testing for covid19. Right now we are focused on testing on people who have a number of symptoms consistent with covid19, Health Care Workers who are symptomatic, and who have come into sustained contact with covid19 positive cases, and on our contact investigation, people who are symptomatic and meet additional criteria. bia big issue has been our lack of supplies. We hav have developed a capacity in terms of running the actual tests, so we have enough machines to run the tests. Our limitations have been as basic as needing more swabs and Culture Media in order to do the testing. That supply chain, due to a lack of federal supply chain, has been very unstable. In the last few days, our supply chain has increased the stability. And the supply chain looks to be increasing. So we will be expanding our Testing Capacity and our testing eligibility. They are not close to the situation where testing is available on demand. And there are lots of reasons right now that we would expand our testing in an evidencebased way, in accordance with guidelines that the state recently issued around what the testing priorities should be. And ill be happy to share that with the commission when we release that information. The other key piece to testing is Contact Tracing. And we are building our Contact Tracing capacity, because that is not only important for now, but it is important as we enter the next phase of the epidemic. We need our Contact Tracing response to be robust. In the moment, as we look it up, as we investigate outbreaks and not only talk to the persons who are infected, but also to ensure we are able to follow up with contacts. And we have partnered with ucsf, to use an app with a Company Called demagi, which will allow us to build a team and data system that is really unprecedented in terms of our ability to do Contact Tracing in an efficient and affective and datadriven way, and also make available to the indexeindex case, the person diagnosed with covid19, and the people were contacting, making sure they have the support, the resources, and the knowledge necessary to protect themselves and their family. We are moving from a staff of contact investigators at the beginning of this epidemic. That number was in the single digits. So that was in the single digits. And we expect in the next couple of weeks that we will have a team in San Francisco of over 150 Contact Tracing investigators. So unprecedented expansion. And we will probably expand even further those numbers as needed. So, um in addition, i talked about the challenges around the testing supplies. I think in terms of worker safety and the need to protect workers, another huge chel challenge in this epidemic has been the need for a stable supply of personal protective equipment, or p. P. E. The lack of a centralized visible supply chain for local jurisdictions has created unprecedented. We have worked hard along particularly with the city administrator, to ensure that our workers, d. P. H. Workers and city workers, have the protection that they need per c. D. C. Recommendations to do their work. Im pleased to say that has been the case. We have done everything we can to ensure that people are getting the masks, the gowns, protective eyewear and facial shields. Weve come very close to running out of those, but we have found a way. At this time, those supply chains appear to be growing, despite the lack of a centralized and visible supply through the federal government. So i will i have one other piece to cover, because i do think the focus on vulnerable populations and equity is really key here. Go to the data tracker website, and you will see that we, yesterday the mayor announced that we released cases of covid19 diagnosed cases of covid19 by zip code. And, unfortunately, we are seeing maps that look very similar to other maps, with regard to health, that the commission has seen in the past. These maps generally overlay the maps with regard to health inequities, preterm birth, food insecurity. We knew this virus would fall on the fault shrine of other health inequities, including income, food insecurity, homelessness and housing insecurity. This is no different, but weve been vigilant in our response. And weve anticipated this, and we have a score of workers, community providers, and others doing everything we can to mitigate the inequities that this pandemic is continuing to expose in our community. I do just want to add, as another part of the vulnerable population, are the People Living in singleoccupancy buildings. [please stand by]. So i will stop there and i will also see if the commission has any questions and then if there is time, i would like to just provide a very brief summary of the general stage of what we need to think about. The next stage and in other words, what would be some of the things that we need to consider if and when the shelter in place order is lifted. But i know that is a lot of information. So i will stop for now and answer the commissioners questions. A commissioner, if i may, usually the procedure is to take Public Comment before we have questions. I would advise we continue with that if you are okay with that. Commissioners . Commissioner bernard, i think your mic is off. That is fine. Thank you. Moderator, could we start the public line call . You have three questions remaining. Great. So please state your name and i will start your two minutes. Hi, jessica. Can you hear me . Yes. Great, thank you. So i am with senior and disability action. First, i want to say i know that San Franciscos leadership has been aggressive on this and in a lot of ways and i really appreciate all the hard work. We have some concerns specific to seniors and people with disabilities living in congregate facilities, not only Nursing Homes, but boarding care homes and other longterm care facilities. And we have a few recommendations that we just put in a letter that we sent to the city yesterday, and were really hoping to have real conversation about how we can Work Together to make these things happen. So we have six recommendations that are to immediately test all staff and residents at any facility with any confirmed or suspected case of covid19. So that we can make sure that things dont spread as quickly as a place like Central Gardens. We think testing on demand at congregate settings is important. We know that on demand testing is not available everywhere, but congregate settings is particularly important. And transparency about this is so important to regularly post a list of all congregate facilities and details the cases and deaths of staff and residents. And were also interested in whether people can be housed with a Family Member or a friend during the crisis to reduce their risk of contracting covid19. And so for the city to make sure that they get all supports needed to be able to leave the facility temporarily. And of course, we want to see ppe for staff for all facilities. I dont believe that is happening yet. I was a little inclear on that in the report now. And when residents test positive for covid19, we are hoping that they get moved to a hospital since right now it looks like those beds are available, and we know that people in Nursing Homes and other facilities are at serious risk of death. So im not sure if that is happening yet. And again, senior disability action really looking forward to having more conversation with the department to make sure that our folks are as sauf as possible. Thank you. Thank you. Your time is up. Next call please. You have four questions remaining. Please state your name and your two minutes will begin. Yes. This is leticia with senior action. I just wanted to say that it is great that you are giving this presentation, but i would like to see more on a numbers because when you said there is no capacity to have the tests on demand, i would like to see what the capacity is really because we see that the only country that is managing this is because they are doing more testing on demand in germany. We would like to see what that capacity is in San Francisco so we can expect how we can see how the city is going to be managing this crisis. Thank you. Thank you for your call. Next call please. You have three questions remaining. Please state your name. This is Teresa Palmer and again, i am a doctor and i agree with senior and disability action. And if we dont have Testing Capacity in Nursing Homes, what are we doing opening up a covid ward at the jewish home of San Francisco . We cant test if they are exposing the vulnerable population there. It doesnt make any sense to me. And it is like says those lives are not worthwhile and we just want to get these covid people out of the hospital to someplace else. It is just totally irrational and i would like director of Public Health to stop admissions to the covid ward at the jewish home until you can expand the capacity for testing there. Were not even testing the contacts of the one infected staff member that has been found at the jewish home. It doesnt make any sense. Families are frantic. We cant visit our parents. And youre jeopardizing them. And please act on this. Please stop covid positive admissions from the outside if you cant test on the inside. Thanks a lot. Thank you for your call, dr. Palmer. Next call please. You have two questions remaining. Please start with your name. Hi. Just let me turn on my timer. Hi, Michael Petrellis here. I am interested in talking about a question i keep asking. Where are the tests . Especially where are the tests for folks like my husband and i. We are in the vulnerable populations. We are both over 60. We are both h. I. V. Positive. And we both have Underlying Health challenges. And i believe that an effort must be made for folks over 60 in the vulnerable population to be a higher priority for covid19 testing. I also want to point out that in addition to those things, we also live in the 94103 zip code, which according to the d. P. H. Data shows that this zip code has the highest concentration of positive test results and cases, so we are very nervous and very much want to get tested. Finally, regarding this information that dr. Grant has presented, i believe it is time for and to hold regular town Hall Meetings on zoom for citizens to pose questions to you. It is good, dr. Grant, that you participate in those briefings, but you dont take questions from we, the people, at those briefings. So a zoom town hall please. Thank you. Thank you for your call. You have two questions remaining. Please state your name. Sorry. This is michael. I am with senior with disability action and highly support all of the recommendations in the letter which you have gotten. Covering Covid Patients in Nursing Homes is just uncredibly dangerous. Is incredibly dangerous. I cant imagine what you are thinking of. Jewish home is already said they cant assure that there is separate staff or separation that would be needed. And the issues with regard to Quality Assurance are not being allowed into Nursing Homes. The governor is considering immunizing the Nursing Homes from covidrelated liability, so theyre already trying to get out from under the responsibility of this. In covering Covid Patients absolutely need separate facilities and i have to say the Health Commission bears some responsibility for this for letting the hospitals reduce this and all the locations where covering Covid Patients could have been housed. And it was it resolved and became acute care. Once again, it is the thats all. Thank you for your call. You have one question remaining. Please start with your name and your two minutes will start. Hello. This is betty trainer. I am a resident of the western addition, and only live about a block from Central Gardens convalescent where i was shocked to find out this weekend that they had 36 residents tested positive and 26 staff, and there are now even more. I think its just imperative as others before me have said that we test this very vulnerable population of seniors and the other care facilities and it seems like they have been a forgotten population, so i urge dr. Colfax to make them a highest priority in testing for the virus because this is the population as shown on the charts that are going to be dieing from this. So please make them the top priority. Thank you very much. Thank you for your call. You have zero questions remaining. An all right, commissioners. That is the last item. And i believe just as a point of information that the longterm care facilities such as a jewish home are under the jurisdiction of the state and not the city. And not that thats something that you will get into, but just as a point of reference for you. Commissioner bernard, i am not sure how you want to proceed. A commissioner, if you have questions, please either raise your hand or indicate by voice. A commissioner chung has a question. Yes, i have a couple of questions, and thank you, dr. Colfax. I think that is a very detailed report that you just gave. It seemed that the public has some misunderstanding of the positions of the Health Department and the relationship with some of the private convalescent homes. Maybe i will start there and see if we can address that a little bit. I believe that central garden is a private nursing home, and i was wondering how do we as Public Health Department Help keep them accountable . For not waiting so long to communicate with us about the situation. And there is a second question but i would like you to address that one first. Thank you, commissioner, for your question. So we have been first of all, i think its important to state, again, that residents of Skilled Nursing facilities and other people in congregate settings and particularly people over the age of 60. I spoke about the position of covid19 and certainly before we had a case and the priority and so we have been working very closely with Key Stakeholders in terms of doing everything that we can informed by data, science, and facts to help protect the vulnerable population including those in Skilled Nursing homes and other congregate settings. This virus is very transmissable. Some of the settings as we have seen, unfortunately, it goes through the settings very quickly. And particularly in the population over 60. It causes great morbidity and often great fatal tis. The state has jurisdiction over the homes. We obviously have jurisdiction over the largest Skilled Nursing facility in the city, and one of the largest, if not the largest, within the honda hospital. And one of the key things that we have been doing is taking the information, the work that we have done at laguna honda in ensuring that the other Skilled Nursing fail fails and Nursing Homes in the city are able to take the recommendations that we made and that the c. D. C. Made in response to the laguna honda investigation and applying it to both keeping their staff safe and their residents as safe as possible. The c. D. C. Issued a number of recommendations including aggressive symptoms, screening for staff, and ensuring and reinforcing to staff that they need to just stay at home if they were sick, ensuring that staff had available ppe to protect patients to mask residents whenever possible and tolerated, and to do targeted testing based on potential outbreaks in the facility. The c. D. C. Did not make recommendations to do widespread testing of staff, and they really focused on how to mitigate and prevent the outbreaks going forward. The state has sent inspectors to the Nursing Homes with outbreaks in the city. We have been in close collaboration with the residents and with that with the residences and with the findings of what those inspectors have made and we have been working with those nursing home, but the state really has the authority there, and we are providing a supportive role. And when there is a case, we do have the jurisdiction of doing the Case Investigation and Contact Tracing. That is our role as the Health Department and we will continue in that role. As in any contact investigation situation as we do with covid19 cases and across the city, we make recommendations about who should be testing specific to that Contact Tracing investigation. Commissioner looking at the data that there is a High Percentage of folks in the hispanic and Latino Community being tested positive for covid19 and setting up hot spot testing in the mission area to, like you said, trying to follow the data and do more targeted intervention. About the Contact Tracing and with immigration issues and nothing like the fear of being with the security and privacy issues among the Latino Community. And we are telling the community that we assure them that it is completely safe and even with the Contact Tracing it is completely confidential. Yes. So we have been very foes kued on Community Outreach and engagement from the beginning of the epidemic. There is a whole group that is the e. O. C. , the Emergency Operations center, and the d. O. C. , department of operations center, focussing specifically on this issue. They have engaged Community Stakeholders and done a number of Virtual Events with regard to involving Community Stakeholder rs and Community Leaders in this collective response. We have been clear thatment u great lakes status certainly does not that immigration status certainly does not Effect People and the information collected is confidential. And through a health lens and also a socioeconomic lens and insuring a need for food, need for other pieces that are being supported. And the marriage has been very clear about needing to wrap around services for the vulnerable populations. Specific to the Contact Tracing and the app that i described earlier, that will be done in multiple languages including spanish. We have also provided materials in indigenous languages, particularly in the mission and in order to reach native speakers. The last thing i wanted to clarify is the study that i think you referenced with regard to testing in the mission and that is a ucsf study. It is not a program that will be done over a series of days and that is a study being led by ucsf. Thank you for the clarification. I did get confused because of my other information floating around. Commissioner, other questions . Mark, just to clarify, i cant always see all the commissioners on the screen, so i will leave it to you to let us know. It looks like everyone has a question, by the way, so two down and everyone has raised their hand, so call by order. Commissioner guillermo. Thank you. And thank you, dr. Colfax, for your report. I think there is a new information that was released today that the state department of health has now loosened its requirements for testing of asymptomatic or nonsymptomatic persons that will be starting in los angeles county. That is information that was released today and that is an indication, i think, of the fact that there is more widespread Testing Available and coming online particularly with the private labs and counties being able to use their own labs. If that is information that you have available to you, do you know whether this roll out of testing, which is going to focus i think primarily first on Nursing Homes and prisons, will that be rolled out based on the supply or ability of counties to respond . Or is there some other criteria . And i will ask a second question at the same time. You had shown on your data that number of deaths in the Asian Community was higher than any other population, and you said that you had some information about why that might be, and it might have to do with the age of the population or something related to the the cruise ships that were based here. Those are the two questions i have at this time. So with regard to the report on l. A. I cant speculate on that because i havent seen that report. But it certainly is something we will look into and have conversations with the l. A. Leaders and with the state about. The state did, i believe it was yesterday, release recommendations for prioritizing of testing asymptomatic members of the general public were on the list but they were pretty far down on the list in terms of when one would test. I can certainly get more information about that. Again, as i said as our supply chain stabilizes in terms of testing, we will be expanding Testing Capacity but doing so in a way that is consistent with the needs of the most vulnerable population and our Health Care Workers. With regard to the deaths that unfortunately we have had and i may not has been as clear as i should have been. If one death is too many t numbers are not small, and so i dont think we can draw any statistical conclusions from what we are seeing there. Because the number of deaths among people who identified as asian was higher, i did ask for a little more information there about why that might be. This is qualitative information and shouldnt be seen as a statistical analysis. But compared to the other people who died, and deaths among asians, several were linked to having taken a cruise. That was not the case for the other deaths. And then the death among the asians and people tended to have on older age compared to the other deaths overall. Thank you. Commissioner green. You for the exhaustive report and all the incredible work you have done and the multiple eventualties that you so thoughtfully considered and planned for. And i wondered if you might elaborate a little bit more about the manpower. And will definitely be prioritizing vulnerable populations especially those in congregate living situations and those may require testing more than once within the settings and if you have concerns about the manpower to be able to really focus on those living situations and also the volume of tests and correlate to that how we are bringing some of these testing opportunities that, for example, are pro proprietary into the system. We are continuing to build that out. I think where we are now and where we need to be in the future, the answer is we need more people in the future, so were building that out. I anticipate no snare joe where we would basically if were fortunate enough, and i dont know whether we will be or not, but if were fortunate enough to make it into june or july and can start considering what it would look like to focus more on easing the i dont know when this would be, but easing the shelter in place orders, right . And thinking through how one needs to emphasize the testing and Contract Tracing there. We will need a robust work force built out in order to do that. I think nationally i have been seen 300,000 to 500,000 people need to be trained for that. And we are ahead to that curve in San Francisco, but i think youre not going to return back to the prior days with a small team of incredibly hardworking people. We will have an incredibly large team and that will take substantial investment and sustainability over the long term. I think in terms of the expansion of testing, there are lots of possibilities and one can think about the ability to rapidly test people and what indications that would be with very, very few in San Francisco and very few to use. But over time as those become more available and one does one need to get a test result quickly to make a decision about where that person goes in the hospital or where that is that person can that person go and work with highly vulnerable populations . And not expose them. I think we also, though, have to be very careful about thinking about the idea that a negative test is gives one a false sense of security. That negative test in the current environment in which we live in, that negative test is only if you get up in the morning and you are somehow able to get a test and you are negative, it is probably reasonable until you have some other exposure, right . So we have to be very thoughtful about that. The other big testing claim that has not been fully understood and there is a lot of topics and the quality is very question sbl the antibody test. And the the antibodies truly going to last and what does that mean . Those can be potential game changeers and the third question was with regard to the populations and where they go after being in the hospital. One of our focuses has been, again, on moving the population back to congregate setting to place them in hotel rooms with some support. Our Street Medicine Team is making rounds in the buildings where the most medically vulnerable and are placed and they have a large capacity to respond to Behavioral Health needs. I will say as we iterate and learn more about needs that we