That the public is aware of what is going on and the decisions that were making and what to expect. Theres so much uncertainty. This has been a very fluid situation and at any given time information can change. So we believe that it is critical that you understand how were making those decisions. And some of the experts who are leading these efforts are important people that i think that everyone should know and should hear directly from them. So today were going to dive into the statistics are and the criteria our Public Health officials are looking at and what they need to see for us to continue to reopen and advance our recovery efforts. Here in San Francisco, you all have been doing an amazing job. And as a result of following this order, and i would say maybe not everyone but for the most part a lot of folks are, because you have been following these social distancing requirements, you have made it possible for us to just move further into the stages that have been outlined for our reopening purposes. So we need to continue to do that. We have heard from many of you that this is one of your biggest questions. And so today to talk specifically about just whats happening in San Francisco with the curve and everything and how well we are doing, although that could change at any given moment, is dr. Grant colfax, the director of the department of Public Health. And dr. Colfax was a Public Health leader during the h. I. V. aids crisis and has been leading us through this pandemic. So we appreciate his leadership. Were also joined by dr. Susan philip, the director of the Disease Control and Prevention Branch in the department of Public Health. Shes been leading our testing and Contact Tracing efforts in response to the coronavirus. So what we want to do today is to talk specifically about the criteria related to ill start with the information related to where we are in terms of testing and hospitalizations and other information. And the criteria. Where do we need to be to begin to open up safely. And then also an outline of those phases. Phase one, phase two, a and b and so on and so forth as to what is possible if we continue to follow the social distancing requirements. It is possible that we can get things to a better place, sooner rather than later. So the goal is to also to go into depth with dr. Susan phillips around testing and where we are with testing as well as Contact Tracing and how those things are going to play such a Critical Role in helping us to get open sooner rather than later. So with that, i want to just start with dr. Colfax, just to talk a little bit, you know, about where we are in terms of the numbers. And then how fast the numbers can shift. But, more importantly, if we continue to follow the requirements that are put in place, what can we expect for the possibility to open up sooner rather than later . So dr. Colfax, i know that is a lot, but lets get started. Well, okay, thank you, thank you for your leadership during this really challenging time. And i just want to reiterate that what youre saying this is a really changing dynamic. A changing situation as we learn more about the virus and how the virus spreads. And i also want to extend my gratitude to San Franciscoians for their support of our shelterinplace order. The orders are one thing, but it really takes the community to come together and to support each other in doing this. And its been remarkable. Its about Public Health, but its more about community and how Community Supports one another. Our families and our neighborhoods, to to do our best during this really difficult time. And i think that everyone is doing their best right now. And its really been remarkable over the past few months. You know, it was just in february, mayor, where you declared a state of emergency before we even had a single case. We then went forward with a shelterinplace order and things have really evolved. Theres been scary moments when we were worried about having a situation like we saw on the east coast in new york where the Hospital System got overwhelmed. And where so many people got terribly sick. And, unfortunately, many passed. We have avoided that worstcase scenario in San Francisco and the bay area and im just grateful for your leadership and the support of the public in this work. I think that a couple of things. One is that we as we work to enter this new phase of a gradual reopening, its really important to emphasize while were hopeful that the situation can change quickly. When this virus takes off, it takes off really fast, right . And thats what we have seen, again, in jurisdictions. Thats what we saw in china, thats what we saw in italy, thats what we saw in new york. So we have to be cautious as well as optimistic and hopeful that the work that were doing now in terms of Wearing Masks, in terms of the social distancing, that that really needs to continue for us to be able to live together and also to live with the fact that the virus is in our community and will continue to be in the community for the foreseeable future. So far we are the gain is going relatively well but were only in the second inning of a long game. This is a situation that is going to last for probably 18 to 24 months. A vaccine is still a ways off. We saw hopeful news today but even the most optimistic experts think that vaccines will probably be at least 12 to 18 months off. So maybe i could just mayor, could i just show some of the i want to show a curve because we have talked a lot about flattening the curve. And i just want us to id like to show the curve that i look at when were talking about that. So this is this is our slide of people with the hospitalizations of people diagnosed with covid19 in the city. So its a bit of a complicated graph. So im going to explain it, take a little bit of time to explain it. So this is looking from april 13th to may 16th. The vertical bars are the total number of people across our hospitals, across our nine hospitals in San Francisco, who have been diagnosed with covid19 on any given day. So you can see that on april 14th, on the far left of the slide, that there were a total of 88 people diagnosed with covid19 in our Hospital System. There were 63 people in acute care. And 25 people in the intensive care unit. So those are the people in our city who were sick enough with covid19 to need hospitalization. And we really want to follow also the numbers of people in the intensive care unit because those are the people that are sickest. And we want to make sure that were able to support them to the best of our ability in the medical setting. So this curve is important because it represents the sickest people. You can see over time that that curve this graph has been relatively been flat. If you just look over time between april 14th to about lets say may 5th. That if you drew a line across those bars on the top, that would be a flat it would be a flat curve. Right . So we have really flattened the curve in San Francisco, which means that we are having the situation of many people getting sick and many more people dying because of covid19. So the news also gets a little better right now, which is that if you look from may 5th, so look at that 80 number, may 5th to may 16th. You can see that those numbers have actually dropped. So whats really fantastic about this is that for right now that our curve is not only flat but its actually decreasing in terms of the number of hospitalizations in San Francisco. So this is very hopeful and its really good news. And as we go into these next stages of reopening we have to be very careful that we maintain our masking and our social distancing and our hygiene efforts in conjunction with the shelterinplace, because these numbers can change very, very quickly. So as we go into the next stage of the Curbside Pickup, we increase our commerce in the city, which is good news, and we have to make sure that as we move around that the virus doesnt move around more and actually get more people sick. And thats why were watching this curve very carefully. So if this curve starts going back up, and gets back to where we were at the end of april, you know, 90 or even above, that you would have to look at that very carefully and not only consider whether we dont go to the next stage, but whether we we are more conservative in actually closing things down to some extent again. So thats where, mayor, youre exactly right, this is a changing situation and we need to look at the data on a daily basis. Im hopeful that with the collaboration of San Franciscoians that we will continue to move forward to the next stages. But, again, this could change relatively quickly and were going to need to be watching these numbers so that we ensure that were protecting the health of San Franciscoians as possible. So how are we going to do that . Mayor london breed lets give the criteria of what youre going to be specifically looking at and how youre going to be making decisions to move . Because, i mean, we get questions people want to know when are we opening schools . When are we opening hair salons . When are we opening places where people will have direct contact with one another . So thats because we cant give people specific dates, this is what youre saying, that everything is contingent on what happens with these numbers. So i know that you want to talk about the criteria. And then you want to go into the phases and what we can expect in terms of a general timeline around these phases . Thats right. So im going to go to what were going to be watching Going Forward. To determine how soon and how quickly we can move on those stages that youre asking for, mayor. And then dr. Philip will talk in more detail about our scales of testing and the context. Does that make sense . Mayor london breed yes, lets do it. All right. Can we have the next slide up, please . So these are the basic five indicators that we will be looking at to assess our progress in reopening. Mayor london breed can we just show that slide on the screen, this one slide . I think that it is. Oh, i think that it was being shown. Mayor london breed it was shown but it was some other stuff on there too. I think theyre trying to mayor london breed there we go, all right. Yes. So we are looking these are the five areas that we will be looking at across the city. A number of cases of covid19. The Hospital Capacity across the city to take care of people who are the sickest from covid19. And our testing efforts to scale up our testing. We know that theyre so important for people that have access to timely testing for covid19. And our Contact Tracing. And the need for personal protective equipment. So, mayor, id like to talk a little more in detail about each of these before we get to the phases. Is that mayor london breed yeah, we want to do a brief overview and get into the phases because i think that we want to have dr. Philip talk about the Contact Tracing. So in the number of cases well watch that hospital curve, because those are the sickest people. And were also going to be looking at the case rates as we scale up testing. So this can be a little confusing because as we test more people we will find more pieces. So then the total number of cases are going to go up. But what were really looking at in that situation is the rate of positives. So are 10 of those testing positive . Or is it 5 , 1 . So as long as that rate is going down, well be comfortable with that number. The Hospital Capacity is really ensuring that we have enough capacity in the hospitals in the event that our numbers start to go up really quickly. And ill just give you a concrete example. Right now our covid19 cases are occupying about 6 of our Hospital Capacity right now. Which is really remarkable. 94 of our other hospital beds are filled with people who have other conditions. So we want to make sure that Hospital Capacity doesnt the People Living the people in the hospital who have covid19, that that Hospital Capacity which is currently at 6 , doesnt go above 20 . With regard to testing, dr. Philip will talk about this in more detail. We have scaled up testing dramatically in the last few weeks and over 1,000 tests a day and aiming to get to about 1,800 tests a day in San Francisco on a regular basis. Contact tracing, we want to make sure that were investigating the cases and supporting People Living with covid19. And also making sure that if theyve been in contact with people, that those people know that theyre supported and they get tested. Again, dr. Philip will talk about that. And then personal protective equipment, for us to do our work as medical advisors and First Responders we want to make sure that theres adequate personal protective equipment across the city, including masks and other facial coverings to protect ourselves and others from the virus. So, mayor, unless you have questions about this. Id like to go to the stages. Mayor london breed lets go to the stages. Thats what were here for. Okay. So this is the governors framework for reopening. So phase one we have completed. And right now for phase two today with the Curbside Pickup were now in phase 2a, where we are its exciting because of that curve. Were on Curbside Pickup. And also allowing manufacturing and logistics to support those businesses with Curbside Pickup. And in the next few weeks as we watch those data, we would hope to be able to relax restrictions in phase 2b. To adapt retail, and to reopen schools, offices and child care. Mayor, theres also were working hard to ensure that theres guidance and potential for camp, summer camps for kids. So this would be during that phase 2. Mayor london breed so you think that as long as for example, that the numbers either are stable or decline, that the possibility to maybe have summer camp is possible . I think that its a real possibility. Its going to be a little different than it was before because we have to be cautious about social distancing. So its going to be different. But i am cautiously optimistic that if these numbers hold up that we will be able to to go in that direction. Again, as you said, the situation could change. Mayor london breed can we pull that slide back up, the phase because i think that what is helpful is to just kind of getting a feel for the timing of these phases. So, for example, today we are in the 2a, right . Thats right. Mayor london breed so in order to get to 2b, the five criteria need to be met, number one. And then, number two, how like, if the five criteria are met and then were able to maintain them over a certain period of time, whether d time k that 2b would be able to go into effect, you know, based on just an estimate . I want to be clear this is not the city saying this is going to happen, but based on the trend and what we have seen happening based on the numbers, theres a possibility that we could get into 2b at what point . Or phase three at what point . Yeah. So i think that for phase 2b, and we wouldnt just open up all of 2b up at once, but i think that generally we would anticipate another two to four weeks of watching the data, learning from what we have learned in 2a, and ensuring that people are able to continue to follow the social distancing, the hygiene and the masking guidelines. But that generally in the next two weeks we would then be able to adapt to move to 2b if the data holds up. So somewhere in that two to fourweek window. Mayor london breed which means even longer for like hair salons and nail salons and churches . Thats right. So thats phase 3, yes. Mayor london breed so that were talking about, again, maintaining whatever these numbers are at a flat or a lower rate. And were still talking about those places even a month away . Oh, at least, yes. Mayor london breed i think that part of what is helpful in the course of this conversation is to also to provide people with some guidance so they know what to expect. So i think that and we wont get into it in this conversation, but get into it in a later conversation, you know, just the specifics of how we get people back to work. Because it has been i know very stressful for so many of our businesses and so many of our religious community and folks who are just desperate to come together. And also those who are struggling financially, which as you know as a doctor that this creates a whole other Health Challenge around Mental Health and a number of other issues. So we definitely got to make sure that we keep that in mind, although we know that this is one of the most important things that we need to focus on to prevent the rapid spread of the coronavirus, which even though our numbers may look good today that the fact is that those numbers can change at any given time and we could, sadly, be in a situation similar to how new york or italy or other places have experienced. I think that ultimately the goal is to get people used to the new normal as well, to get used to the masks and the social distancing and all of those other things that are going to help to get us through this. Not just today or tomorrow. But long term. So lets lets talk a little bit about, you know, dr. Colfax, can you tell us again, i know that we cant provide people with specifics. And i want to get to dr. Philip. We cant provide people with specifics as to when, but, you know, i guess how are we going to how do you propose that we make this adjustment . You know, this has been hard already and its been, you know, like over two months. And it is a struggle for just the average person, but especially those who are dealing with financial challenges. And those with kids. And elderly who are already isolated as it is. How are we going to get through this . Yeah. Well, i think that its a really important question, mayor. I think that theres a couple of key things. One is to make sure that people that Mental Health and social supports that are needed and i think that were going to continue to work on connecting emotionally and socially in ways that allow us to social distance. So i think that is a really key piece. And if people need or are asking for Mental Health, Behavioral Health support, they can go to our we website and find those resources. I also think that one of the key things, mayor, in how we support this Going Forward is that the more that we can adhere to the social distancing and masking and hygiene, the faster that were going to get to those different phases, right . So, you know, one thing that i really emphasize is that, you know, wearing a mask is something that is really important because it protects others, right . And so we create a community where Wearing Masks and social distancing is respected and well get to these phases sooner. Because we know that is what slows the virus. As we go back to the workplace, we are working with your departments leadership and others across the city and in the Business Community to really to as quickly as possible and as safely as possible to develop what the new workplace will look like, right . So people who cant commute from home, will work at home. And to ensure that the workplace offices are safe as possible and that workplace transportation is as safe as possible. And that people get the information that they need so they know when they go back to work that they can be as safe as possible. And the other part of this is the testing, right . So that people have access to testing. Because we want to make sure that people can get the cure they need both for themselves and to ensure that theyre as safe as possible. Mayor london breed so, dr. Philip, lets get into some testing and also Contact Tracing and how important that is to helping us to transition into these phases sooner rather than later so that we can get our city open. Yes, thank you, mayor. As you were saying and as dr. Colfax was saying that testing and Contact Tracing are pillars, they are key indicators of moving forward. Mayor london breed dr. Philip, i want sorry to interrupt. I want people to know that if you exhibi exhibit exhibit, you. If you are an essential worker and you have no symptoms, you can be tested. Call 311 or go to sfgov. Org. And whether you have insurance or not, whether youre documented or not, it does not matter. Well test anyone. And so anytime that you need to be tested and that you are tested, but more importantly its not as if one time youre tested and all of a sudden everything is okay. So i want you to talk a little bit about the opportunities and also explain how Contact Tracing is important to helping us to really flatten continue to flatten the curve. Yes, mayor, thank you. Yes, very correct. Go to sf gov to see what the symptoms are. And anyone that works in San Francisco as well, because theyre equally important to the health of our residents. So testing is really important. We need Public Engagement in testing. And were continuing to open up sites in areas to make it more accessible for people to get testing in their neighborhood as announced today. And that the testing in the tenderloin and at city college and a new location in bayview. And so we continue to emphasize making testing accessible. Testing alone is not going to solve the problem. A big point of testing is to get care to people who test positive. But then also to work with people to make sure they have what they need to stay at home so they dont transmit to anyone else. And then to voluntarily ask them who else they may have been in contact with so that we can reach out to those people to support them too. Thats what is Contact Tracing. Its voluntary and its confidential and it has nothing to do with immigration status or any other type of law enforcement. So we want to engage as partners just as the public has partnered with us to shelterinplace and to get us to where we are today and to make us safer and to move closer to the next phases of reopening. We need the same engagement with testing and with Contact Tracing. And were continuing to build our capacity in those areas in partnership with every resident and worker in San Francisco and in partnership with the rest of the city and all of the teams continuing to do that work. Mayor london breed can you tell us what we can expect for Contact Trace somethin tracing . What are the questions they get asked if they test positive . And if im contacted by someone, how should i respond to that . Yes, thank you. When we find out that someone has tested positive, and by California Law all of those tests get reported to the Health Department and we reach out. And the first thing that we want to do, does that person have what they need to be healthy and to be safe . Thats our number one priority. We assist with food and housing and other resources they may need to stay home and to stay isolated. Then we ask them about the other people in their lives they may have come into contact with at work or at home. And we talk to those people separately. So when you are contacted because you have either tested positive or because youve been in contact with someone who has, please engage with the staff that do that. We are working very hard to have language capability. 54 of our case reviews have been in spanish. So were working with communities and organizations that have that ability to bring on more staff to do that work in a culturally appropriate way. So we want to engage. We want to support people who have been exposed and people who test positive. In doing that were going to be able to reduce the transmissions throughout the city and get us to the next phase. Mayor london breed yes, thank you. Well, i just want to go back to reiterate to folks because i think this information is really helpful because im not a doctor and i think that most people who are not doctors may not completely understand exactly why. Because you know that im always asking you, well, why cant we do this, why cant we do that. And im very concerned, of course, like we all are about the future of our city. And the Financial Health of our city. And as well as, you know, Public Health in general. So, for example, when we talk i want to go back to kids in particular because we know that the parents are probably had it up to here. And i just think about when i was a kid how i probably would have drove my grandmother insane with 21 questions. And the fact that i couldnt play with my friends. Or like my nephew saw a slide and cooperate slide dow couldne slide and started crying. Its just the emotional issues associated with trying to explain to children why they cant play together. And i think that what we have to keep in mind of course is the challenges that we face, but we also have to think about human nature. And if were talking about opening camps for the summer, im excited about that. Any kid would be excited. But at the same time weve got to be realistic. To expect kids to have to wear masks and gloves and to not, you know, to interact you know how kids are. They touch each other. To expect that, thats going to be difficult. So i think that when were thinking about criteria, i mean, this will be our normal as you said for at least, you know, the next 18 months. So theres an adjustment, of course, that we need to make. And its a lot easier for adults to maybe make that adjustment. And harder for kids who deserve and need to interact with one another. So i do think that what is great about where we are as a city is because the majority of the people in the city are complying and following the orders and going out of their way to, you know, to be a part of the solution although we know that theres a few people out there breaking the rules and not doing what theyre supposed to be doing but thats a whole other conversation. But the fact is that because we have so many San Franciscoians, it gives us the opportunity to go further. I know that its not happening as fast as people want it to happen. Trust me, i am desperate to see more happen faster because i am concerned about, you know, the longer that were in this situation, the worse off that its going to be for a lot of people. So i hope that you are getting creative and taking these things under consideration because its not just about the data and the science, its about peoples lives and their livelihoods. So how do we theres a way for example, if this is going to be with us for two years, the hairdressers and the barbershops, you know, they already, you know, are prepared with systems in place and theyre going to be able to open im sure eventually, theyll have to wear masks and gloves when theyre working with their clients. And just quickly, why not sooner rather than later . Because i think that thats what people are trying to understand. Why cant we do this, or why cant we do that . I get that it is about, you know, limiting Human Interaction but for the most part you can tell that people are, you know, they are hungry for more, but theyre also willing to follow the rules as theyre given more. You know, so lets talk a little bit about that and what we can do to maybe even move this along faster because, you know, we appreciate that theres Curbside Pickup at retail, but, you know, for most of us, like when i go buy my candles im going to walk in there and im going to walk around even if i cant touch something. Lets talk a bit and then wrap up the conversation because i know that theres so much that we can talk about and we wanted to try to keep these to 30 minutes. But how can we move this faster . How can we get better prepared for reopening as an everyday citizen . Yep. So i think that, mayor, so really important thank you for emphasizing the need to move forward and to get creative and innovative as we go forward to this new normal. I think that one of the key things is that we need to ensure that as much as possible that were masking and social distancing because if we can keep the virus under control in this stage, the next phase will come sooner. So thats one important piece of information. And the other piece is that were working across businesses to ensure that were getting out information as quickly as possible about what people can anticipate. So theyll be ready, right . So that rather than saying oh, now were ready to open and these are all of the things that you have to do, that we have guidance in advance so that people can be more prepared, right . So that as we think about these camps, for instance, that theres guidance being developed in a scientific way, but also in a way that is responsible and accountable to what youre saying. You know, that kids you know what kids do, right . So realistic items, that is responsive both to the situation but also addressing the new normal that were going to be in. And i also think that ensuring that were working with community in an equitable way, including around testing and partnering with other organizations and that were engaging with the businesses on the ground to better understand what they need and what theyre asking, so that we can ensure that the testing requirements that are likely to go forward and the social distancing and the hygiene, that those are things that people are ready for and support. We dont want to be in a situation where, you know, were saying this is what you have to do an, right . So those are key points Going Forward. And to keep moving it faster, part is scaling up our testing and our partner notification, because the faster that we do that, the faster well know where we are moving forward. And when we know where we are in terms of the epidemic, that will help us to know where we are in terms of the stages that we want to move as quickly as possible. Because certainly there are Health Consequences to the shelterinplace order and Mental Health consequences and physical onc consequences. And its not like coronavirus is over here and Everything Else is in business, we need to make sure that were doing a balance of being as prepared and responsive to the pandemic. But also supporting the economy, which is necessary for supporting peoples health, especially in communities that struggle every day and are struggling now. Mayor london breed yes, and dr. Colfax, i appreciate that because im being aggressive because, you know, as much as i want science to guide us and the data, im focused on that i dont continue to bring up the hair salons and the nail salons and places like that because im tired of doing my hair. I dont bring it up because of that. But if these people are not working theyre not making money. They cant pay their rent. Not just their rent at their homes but their rent in their commercial spaces. And in some cases, being harassed about getting their bills paid when they have no money and theres no way that theyre possibly going to be able to pay it back. So if were going to be living in corona, right, how is it that we allow these people to open up sooner rather than later safely . Because, you know, it is thats what im most concerned about. You know, are these kinds of businesses that theres direct contact, whether its a masseuse or barbers or whether its nail or hair salons and places where youre a little bit closer to people than anticipated. Again, because people are so anxious to get going and to get their businesses started, to cover their bills, that, you know, theyre going to be even extra careful when doing this. So the sooner the better and i know that im being pushy and i know that we have these conversations on a regular basis, but i really appreciate both of you and your leadership and the role that you play in helping to lead us. I know that there have been lives saved because of the efforts of the department of Public Health. And so we are grateful to you, your team, and the nurses and the people on the frontlines every single day. Yes, i have pushed, pushed, pushed, but i also appreciate your creativity. Were going to eventually get over this hump and get to a better place and i want to thank everyone for joining us. Again, this is the a first in a series of conversations that will continue to happen around the reopening and whether its issues around equity or around economic recovery and those will be the kinds of conversations that well be having over the next few weeks just to really to try and to get to the point of whats important or why decisions are being made. Im San Francisco mayor london breed and i thank you for joining us here today and thank you for allowing us the opportunity. We know that people have sent in questions and we will be working to respond to those questions directly. Thank you again dr. Colfax. Thank you dr. Philip for your work. And we appreciate you all for continuing to cooperate with the Public Health orders. And we hope that you have a wonderful week. Thank you, everyone. Thank you, san hi, youre watching coping with covid19. Today im going to the pharmacy. [music playing] now im not a medical professional or a doctor of any kind. Sorry, mom. Im a video guy. And this is my personal story. I have a Family Member whos in the atrisk group so im the one going to the pharmacy. To get the most detailed and uptodate information about the virus, go to sfgov. Org. Theres a really good f. A. Q. There. Ive been taking a plastic bag from the house and putting a sanitizing wipe and for this trip, i feel safer wearing latex gloves. Im taking the smallest number of items with me. My debit card, i. D. , the gloves and the wipes. And that means therell be fewer items to wipe down later if they come into contact with shared services. When i get to the pharmacy, i put on my gloves. My goal while im inside is to not touch any common surfaces and try to keep at least six feet away from anybody else. This is my second visit of the day. The first time i came, there was a huge line so i just left. This time there is no lineup. Im very careful after i use the p. I. N. Pad to pay for my purchases. This is a point of contact that many people have touched, which is why im wearing the gloves today. I thank the pharmacist for her important work and leave. On my short walk home from the pharmacy, im careful not to touch my face. I keep the gloves on and until i get to my recycling and trash containers, where i remove the packaging from the medicines and i put them in the recycling. Now we dont need the instruction for these particular insulin medications because were already very familiar. As soon as i get through the door, i wash my hands for at least 20 seconds. Then ill wipe down my debit card and i. D. And, as an extra precaution, i wipe down the medicines packaging and anywhere where they have touched indoors. Then i wipe down the front doorknob and, finally, i wash my hands again. That is it for this episode. I hope you enjoyed my story. Good afternoon. Welcome to the San Francisco board of supervisors. Role call, please. role call