Transcripts For SFGTV Disability And Aging Services Commission 20240712

Public and staff. We ask for your patience during these unprecedented times. We respectfully ask the public to have patience in delays and gaps during the meeting particularly during Public Comment. Madam secretary, would you please call the roll . thank you commissioner. Please say present when i call your name. roll call and please note that executive director is present. We have a quorum. thank you. Commissioners the next item is item three, communications that wed like to provide further instructions for the Public Comment process. Callers can dial into the toll free number and wait for members to be announced. Three minutes to provide comment on each item. During each Public Comment period callers will be instructed to call 18774153612. You will hear a notification when your line is unmuted. It is best to call from a quawet location and turn your television or radio down. Are there any communications from the Commission Members . okay. Hearing none. Next agenda item four approving minutes from wednesday june 3 Commission Meeting. Any comment regarding the june 3 meeting . Hearing none, is there a motion to approve the wednesday june 3dos Commission Meeting minutes . so moved. moved and seconded. Madam, second, please take a roll call vote to approve the Commission Meeting minutes. roll call the vote is unanimous. thank you. Commissioners item five is executive directors report. good morning, commissioners. Great to see everybodys face. I just wanted to start with the federal level actions that are taking place. Following months of delay due to the pandemic, congressional appropriators kicked off the funding debates. House lawmakers are moving through the funding bills for next fiscal bills. However, regular appropriations discussions are occur inning the background of this unprecedented legislative year. Since covid 19 began congress has passed trillions of dollars in emergency funding including discretionary programs normally funded through the discretionary cycle. More than one billion for the Older Americans act programs to respond to increased need ses. S. Additional measures and changes to address the growing economic changes and disasters. We have benefited from the money coming out of the federal government so far and are very much advocating for more dollars. Advocating through c 4a the california area of aging and the National Association of aging. I know that members of our Advisory Council and some of you have advocated for those dollars as well. Thats something that were really going to need in the next year. Despite the continued need for emergency funding, lawmakers are advancing the annual Fund Proposals for all discretionary programs. This has just been a really complicated process. The debates were ultimately insufficient and the restricted budget caps that were established before the pandemic really caused a lot of confusion and problems with getting money out the door. Now congressional appropriators have little legal room to conduct adjustments in the spending bill. This is an on going budget. A lot of the money that is coming down is through emergency processes that they are working on. Hopefully we will find out in the very near future if were getting an infusion of cash for nutritious and Supportive Services for caregivers but we dont know yet. Theres just a lot of influx at the federal level. As we get information about with a we can advocate for well get that information out to you so that either you can decide as a commission or as individuals that you want to help advocate for these dollars to come out. At the state level, the state department of aging is coming out of with guidelines on reopening for organizations that serve over people with disabilities, they are saying that they think they shouldnt fully open up until stage four which is when arenas will open up and concerts and things like that and sports events. The reason they are saying that is the California Department of Public Health is maintaining that older adults are really at risk for covid 19 and given the surge that were in right now they are concerned about saying anything more than that. That said, they did build in some flexibility so that local triple as can figure out how to handle some of these issue with their providers. When talking with the state i like to give the example of Career Center which is open right now and is open right now because they feel they are serving such an at risk population, that population is more at risk if they are not open for them to come in and charge phones and get food and things like that. Im glad for the flexibility and well continue to work with our providers in the community to figure out what works best. Also at the state level there is a focus now on equity and aging. At the state level they have that echoed. The director of department of aging realized there was a lot happening with covid 19 and older adults are most likely to die from it. There were some strange decisions made around crisis care and things like that. The voices of older adults have gotten lost in a lot of the conversations. They are kicking off a series of anti age conversations and the state director of aging asked me and commissioner spears and kelly and katekelly with the ihss authority and kate with the community campaign. We had planned to present at the American Society on aging on the very same issues. They asked us to present to them and a wider audience on some of the work weve done. How agism is particularly prevalent during covid 19. Like weve talked a lot about in San Francisco. Its great were going to be part of that kick off but its a year long process, well have different ways to engage with that process. In addition to that, they are really looking at Digital Divide issues and social engagement. Were engaged with google to obtain a number of devices that i think there are echos that can go into the homes of older adults and help people engage with technology and other Community Using those devices. Now the California Association areas on aging is workingwhat the best way to get those out into communities. Having a pilot to really learn how we can bridge the Digital Divide. Maybe showing that into something bigger which is a partnership with more corporations and, you know, really addressing the Digital Divide knowing people are going to be at home at least for the near future. The other thing thats happening at the state level is the California Departmentsorry. I have all the acronym ns in my head. The state is thinking of proposing a new benefit, a new medical benefit called Long Term Care at home which will help people who need home care, Skilled Nursing care remain in community. A lot of people working on what this will look like. It will be an actual benefit. It will keep people from going into Nursing Homes and get the same services are home. Make a way for people to come out of Nursing Homes and do it safely. Theres been a number of people come out of Nursing Homes because their family is worried about them. The death rates in Nursing Homes and close to 50 of people who died in california as a result of covid 19 have died in Nursing Homes. This is a way of having people come out and live in community with whatever supports they have and added supports from this program so that its safe. Whats been happening is people have brought their family members out and they dont have alllet services and infrastructure at home. Its pretty exciting on one hand. There are a lot of other programs that the state already has that they can build upon. There are a lot of questions from the community about what it all means and who will qualify for it and all of that. Im involved in some of those conversations. Cindy has been really helpful with that. She has a lot of knowledge around programs at home like this. We will continue to have San Franciscos voice heard as that unfolds. Locally, the Emergency Operations center, i think most of you know i was working there for a number of months with the feeding unit. The Emergency Operations center for San Francisco has gone to a unified command for a covid 19 response. They haveessentially whats functioning is a new department called the covid 19 command center. Everything covid 19 related is run out of that center. Its still right now, at the center. A number of staff has been offered up from various departments to staff that department and were expecting that those staff deployments will be six months to a year while in the process to continuing to respond and moving into full recovery. Thats been really interesting to see that develop and build. Some of the major things were involved with still are continuing to ensure that people who are continuing to care due to covid 19 continue to get food and on the human side also includes our in home sup rtive e services program. People who are continuing to shelter in place in hotels until theres a Recovery Plan for them and move back out into the community. Thats what that looks like. Were very fortunate and grateful that we have some staff that stepped up to continue that work and who would be deployed at the covid 19 command center for the next six months or so. The next thing is the great plates program. Youve heard me talk about and hopefully heard about in the community. The governors plan to invest in restaurants but also to get meals out to older adults was extended to august 9th. That program is serving over two thousand people at this point and thats really impressive if we look at the other counties in california including la county, were doing really well. I think were the most aggressive in terms of getting people on that program in the county and state. Based on the size of our population. Thats exciting. We are working with the Mayors Office on disability and providing in place. Its with the ihss Public Authority to distribute personal protective equipment to the community starting next week. Thats been a really big effort. Its been a really Great Partnership with the Mayors Office and department of disability. One of the things through the covid 19 response ive noticed the departments have worked closely together to provide the best access and were thinking about how to breakdown silos and this is one way weve done that. Moving on were pleased that we added our new county Veterans Service Office Manager to the dos management team. He has a great history. He came out of the army. Has done a lot of work with hud and other programs, he is knowledgeable about Community Needs and veterans and specifically he has really great leadership skills. We were hoping that the board of supervisors would appoint him as a county veteran Service Officer. That process is a little bit kn fusing becausconfusing because t under the City Administrators Office back in the day, in the year 2000. A number of other offices came under, we never changed the local legislation around how appointment gets made. What happens is still the city administrator makes a recommendation to the board of supers. Were going through that process right now working closely with the City Administrators Office and the board. Were hoping very much that he will be the appointee from the board. That the county Veterans Service Office Manager and the kowpty cy Veterans Service officer will be one in the same person. From a policy point of view, the board of supervisors will agree to that sm wer. Were working to comply with the governors executive order which requires ihss to start conducting initial home visits starting august. We do this virtually when we can. Its very clear from the Governors Office that he would like us to begin going out and seeing people in person. Were working to make sure people are tested for all the equipment they need and they are ready to go in august. Were also working to bring our field based social workers into compliance with the new protective equipment guidance from the department of Human Resources and work with testing approximately one hundred field based social workerred within the next three to four weeks. Theres a lot going on. Its been really interesting to come out of the eo c and begin working remotely and try to make sure that were continuing to have some sort of continuity with our staff and that were having somewhere that were communing in the ways that we did before. It definitely feels different. For meits probably hard on all of us. Got very used to seeing staff in the elevators and lunch room and office, i do a lot of my work that way and engage with people that way. Its difficult getting used to this very different way as the department head. Im proud of our management team, all of our staff because people are just continuing to find new way it Work Together and communicate and to coordinate. I assume that we will continue to do that at the highest level possible as we move through this process over the next year or so. That is it for my report, im happy to answery questions that you may have. no. Thank you so much for that extensive and exhaustive report. I think that the commissioners are begin so grateful for the work that you are doing and the staff. I want to make sure that were expressing that. Especially doing that right now. My response to your report, i just know that you are all working triple what you usually have been. You are all essential. Making a huge difference in our population of San Francisco. Thank you very much. I think when you mentioned our helping in any way, we do get information from staff on how to advocate and what to sa advocate for. Please continue sending us that. The net works that we have, well definitely deploy and provide as much assistance as we can. Any other comments or questions from the other commissioners . Commissioner wong. thank you. Good morning. We appreciate the work that you are doing under such difficult circumstances. You mentioned that the county Service Officer appointment or recommendation has been sent to the board of supervisors. Is the appointment process under the purview of das or are we just a partner of . its interesting because the office thats with usthe responsibility for running the office. The county Veterans Service office itself. The appointment of the county veterans officer actually sits with the board of supervisors. For a number of yearsi have been with the department for 17 years next week. When i got here the officer actually wasnt part of the office, he actually was an employee of the city attorneys office. When he retired one of the things we talked to the city administrator and the board about was how nice it would be is if the office and officer were actually together. Thats what weve been working to do. It also is a fact that the money for the manager position sits with das. If they wanted somebody else to be appointed they would have to figure out a way to pay for that person. Its a little confusing. One of the things we need to do is fix the legislation. The City Administrators Office would like to be out of this because they dont really work with this office anymore. The office no longer sits under the City Administrators Office. We just never clean up that legislation. We cant do it immediately. Well be doing it hopefully in the next year, next few months. Its a little confusing commissioner. Its one of those city things that just hasnt gotten fixed yet and its not very clear. i appreciate the answer. I just wanted to let you know within the veteran community for veteran Affairs Commission here in San Francisco has registered a complien complaint that no Ven Organization has been considered for this process. And again, i just wanted to get clarification as to how thishow the hiring process actually works. Im being asked questions within the American Legion as to why is it they were never consulted. Not to say that the gentlemen being recommended is not qualified or anything like that. There was no consultation whatsoever. what has happened so far is that our hiring process is a process where we have to go through same Civil Service guideline thats we would normally go through for any hire. We are certainly kog distan cogf that to have somebody on the hiring panel. I think whats confusing is that the appointment process is separate. That hasnt happened yet. There actually is room for people to register any sort of feelings they have for the appointee who come frs from the City Administrators Office to the board. The board is where the appointee process happens. The way the legislation is written is that the city administrator comes up with somebody, they dont necessarilythe process isnt negatively that they go to the community first. They put the recommended person out to the board. Theres time for Public Comment and engagement for the board. Thats where that happens. Not that it couldnt be changed but thats the way its always been for this particular appointment and any board appointment. So when the board puts it forth at the rules committee, thats the time that the veterans organizations can come and say we like this person for this position or we think there should be somebody else. Thats the time when the community can do that. That will be counted very soon, i believe. Thats what i hear. thank you. does that make sense . Its confusing. He hasnt been appointed yet. Theres still room for public engagement. commissioner spears. i just wanted to add my thanks to the Department Chair and the Department Staff for all of the work thats been done for the community over in this very complicated and depressing times that we live in right now. Especially around the food service, i know how important that is for so many people in the community and to hear that great plates have been extended, thats great news. Hopefully it will be extended again. I just wanted to it thank you all for your diligent work in serving the most vulnerable here in San Francisco. okay. Thank you. Commissionerdid you have any comments or questions for the director . yeah. Again, huge compliments. Im curious as to staffing . Are you able to keep up and keep everybody at work . How is that working out . yes. We are. We definitely need all the staff we have. One of the things we know is that older adults and people with disabilities have been disproportionately affected by this. Its a very different working world for sure. One of the things they didnt go into detail about, we met last month. We know were facing a very big budget deficit at the local level. Were being asked to come up with some target reductions and at the same time we know were going to need all the dollars we have. Were working through what that looks like. The mayor said last week that shes going to need departments to give up a little bit more. We dont have any idea what those numbers are or even what it will look like for our particular agency because we have so many federal and state dollars flowing through hsa that were effected differently from some of the other departments. Were in a better position to retain our staff and to reallyand to continue to serve growing numbers of people who need things like food and home care and things like that. Its a little bit moreits actually hard for me to get my head around what the budget looks like this year because theres so many moving parts and state and federal revenues. Theres such a big receive sit at the federal level. Next time we meet well have a clearer picture going into the next fiscal year. That will impact, of course, our staffing potentialit will impact our staffing mostly in the way that it will be hard for us to hire people when we have vacancies. We need everyone we have. We have figured out how to work remotely to the extent we can. We have to prioritize some of the work were doing. Those will be tough questions. Weve been riding a high for a number of years. Community funds coming in. The dignity Fund Legislation and growth and dignity fund. The growth fund for other programs has been pretty amazing. Its been doing some exciting new things. We have to goin go back to our e values that we crafted pretty carefully. How will we measure up with everything were thinking about doing. What do we prioritize . How do we keep staff in the smartest way possible . its been amazing. Youve done a fabulous job. If any of us need to advocate for you in terms of jobs and the budget, please keep us informed. And thank you. thanks, commissioner. thank you commissioners. Having heard from all of the commissioners im going to move along to item number six which is the Advisory Council report. good morning, commissioners. Its nice to see all of you and speak you with you again. We met on june 19th. We hadnt met since february so we were excited to get back together. We had a very thorough engaged update much like she did this morning. The department has been doing and Council Members were able to ask questions and the advantage of the presentation. Our plans as many others have been thrownwhere to go from here sm th. The critical issue on the agenda this month is the area plan. It was the final presentation. In february of the last meeting we had, they presented the initial draft. Advisory council had a couple of recommendations. Incorporated those along with some changes, the Advisory Council unanimously approved the area plan. Were just waiting to sign off on it it. We also had some dignity funds updates, well followup on that at our next meeting next week. We also got caught up on our site visits. We had site visits on five locations. Were really pleased about three of the five veteran sites. There had been some concerns about thesome of the veteran services. We had a lively conversation about that. Council member rock land who had done these site visits put together a summary. Thats going to be given to michael to take back with his team to take a look at it. At our meeting next week well take a look at how do we do site visits going forward. Obviously there arent sites specifically to visits. We may be looking at getting the virtual programming thats being offered into some of the meal programs, were going to have a lively discussion im sure about that. Were still looking to have an update on the commission on aging as she is a member. On the California Master plan of which she is one of the advisors on the alzheimers group. Everything is focused on the budget. The budget is in the air. She did the Historic Supreme Court decision that prohibited discrimination against the lgbtq community. Theres a lot of concern locally and at the state level. No one is collecting gender and orientation data unless it relates to covid 19 pandemic. The membership communitythe appointment of i think three or four of us are up for reappointment and the advisory appointment. We have things moving and obviously due to the pandemic and shelter in place some of those were put on the back burner but were continuing to work there. The council has discussed further next week supporting the black lives matter and the n4a is looking to get support amongst u. S. Senators to focus on relations. Ive heard from the board out side of the aging and Disability Community but from the medical community about social isolation and concerns there. The Advisory Committee meetin meetingseptember provide an update on legislation. Are there any questions . thank you so much, diane. We appreciate all the work into making sure we have that initial meeting and how important it was to pass that area plan. I thank you for making sure that happened. Any other comenlts o other comms for commissioners . I. i really want to thank michael and rose. We met last fall and planned how we were going to handle this. When we came to february, we were ready to go. Their team was ready to go with the report and that really put us ahead of the game when things were shut down. I just want to compliment that team. We hope that we can continue that collaboration moving forward. It made the approval process so much easier. Job well done. great to hear that. Great to know that we got all of that input that is so important to having a good report. Please extend our thanks to the Advisory Committee for all the work they did. Any other comments or questions from the commissioners . I think we will good to item gom seven. item seven is Public Comment for items that are not on todays calendar. Please open the phone lines for the public. You may be dialed into to. In order to provide Public Comment. Please press pound two. If you have not yet dialed in, please call 17663695200. Once in the conference please press pound two to enter the question two. You will hear the notification when your line is unmuted. Well unmute you from the question queut. Its besqueue. Please turn up thn your phone. Please turn off the volume on your television or radio. We will wait thirty seconds for callers. hello. This is jessica from senior disability action. Im sure none of you are surprised to hear my voice. Its nice to see you online. Thank you for all your work that everyone is doing during this hard time. I wanted to comment on a couple things. There has been a lot of concern about care rationing. If hospitals get full and dont have enough beds or ventilators who gets treated. Sidgesince the beginning of the pandemic seniors would be the last. With this new surge it sounds like the area hospitals are starting to fill up. Theres some concern about that. Were trying to organize towe have a California Care rationing coalition and connect with different Hospital Systems about making sure that our lives are valued and protected. If youd like to get involved you can email me if you are interested. On the nursing home issue that director mentioned about the concern about so many people that are getting sick and dying in Nursing Homes and assisted living facilities, were doing a gathering for residents of care facilities who are isolated right now to join by video. Just a chance for people to talk to each other and share their experiences. Thats this thursday july 16th from three to four. I sent the information to you. Hopefully you can share that with people you know who may be interest. Lastly, one of the things were trying to do during the pandemic to reduce isolation and honori dont know if it was mentioned. Were celebrating the 30th anniversary of the americans with disabilities ability. Its harder to do during pandemic times. Book theories. Its an on going thing. We have four different book readings coming up in the next couple months. The book the pretty one. You dont have to have read the book. I hope we can connect in that way and i know that the office of disabilities is going to put other events on their website. I hope to seech oach other on you have no callers remaining. the next item is item eight. Old business. Please raise your hand if there is any old business that you would like to discuss. Seeing none ill call the next item. Item number nine, at this time the commission will elect the president and Vice President. I willis there a motion to discuss . so moved. second. i will now call a roll call vote. roll call . so moved. second. I will now call a roll call vote. roll call the vote is unanimous. The next agenda item are action items that require a vote by the commission. if i could just take a moment before we start our real work here. Thank you so much for everyones support and its an absolute honor for me to be with this commission. A little odd doing this from my dining room table. Im very very happy and pleased and know that i am very active from my dining room table. Whatever i can do to help the staff and other commissioners, i do. I am very very happy to be serving along with Vice President janet spears. So welcoming and look forward to working with you even if its through phone and zoom calls. I think well be good partners together. Im very very happy to work with all of you commissioners very qualified commissioners and very pleased to work with you as we gain more commissioners which im looking forward to. I think were going to be a great team. Again, in these unprecedented times committed to these communities that we serve especially now knowing how important it is. I look forward to all of that. Well work very hard from my apartment for all of that until im final able to Work Together with you physically. I dont know if Vice President spears wanted to say anything at this time or go ahead with the agenda. Between the allocation of last year and this year. Programs with area plan money include the court of services, home delivered nutrition, disease prevention, Family Caregiver support programs, elder abuse prevention as well as administration for these programs. The Supportive Service budget includes Meal Services, transportation, information and referral and emergency shortterm home care. Please note that local funds supporting these programs are not included in this table. As mentioned in the commission memo, increased funding for 2021 is largely attributable to state funding in congregate nutrition, home delivered meals and the ombudsman program. The contract, 202160 details the various requirements tied to funding. The approval of this item, staff may make contract modifications as needed. Please let me know if you have any questions. Thank you. Thank you. I do not have any questions at this time because we have gone through this before and i think we asked questions at that point, but now that weve seen it again, and its time for the final decision, of course, are there any comments of questions from the other commissioners . Anything additional . Hearing none, commissioner any questions. Commissioner sklar no. Great. Madame secretary, anybody from the public who wishes to comment . Secretary moderator, please open the phone line for Public Comment. Those who wish to provide Public Comment under this item press pound 2 to enter the question queue. Do we have any callers in the queue . Announcer there are currently no callers in the queue. Commissioner knutzen hearing none, no request to speak on the item, well close Public Comment. Is there a motion . To pass the area plan 20212024 . You mean the budget . Commissioner knutzen yes, im sorry, the budget. I saw a motion from commissioner spears Vice President spears, yes . Commissioner spears yes. Commissioner knutzen and a second from commissioner lum. Thank you. Can you please take a roll call vote on agenda a. President knutzen, how do you vote . Yes. Spears, yes. Commissioner lum yes. Commissioner sklar yes. Secretary the vote is unanimous. Commissioner knutzen okay, great, thank you. Commissioners, the next item is item b, review and approval of the fiscal year 20212024 area plan for the California Department of aging. And i think well have from our staff, rose johns and our director Shireen Mcspadden speak to this along with a slide, so please carry on. Thank you. Good morning, commissioners. Can you hear me . Commissioner knutzen yes. My name is rose johns, im planning analyst with the Human Services agency. Im here before you today to present the area plan 20212024 for approval with director mcspadden. And we have a simple agenda for this presentation. Were going to highlight updates weve made to the area plan. You may recall that we came and presented more extensively to you a review of the plan before covid came to us. And then well open it up for any discussion that you have. One of the most notable and interesting updates to the plan is a letter that weve added from director mcspadden that acknowledges the current context that were in. And i believe that director mcspadden is going to take a moment to read this letter to you now. Yeah, thanks, rose. It was roses idea to add this letter talking about the current context that were in. And so ill just quickly read it. Dear friends and colleagues, this area plan was completed in the early months of 2020. With the on set of coronavirus, our National State landscapes have been upended. Government and community sprang into action in response to this crisis. Together were working to reimagine and restructure our services and meet new and existing needs of older people and people with disabilities and to do so safely in compliance with Public Health and social distancing guidelines. Our department is charged with coordinated Responsive Network of aging Disability Services is all the more important. At this time conditions continue to evolve and the state budget is not finalized. This plan represents our aspirations for a Cohesive Network but meets the need of the population. In this current state of flux we recognize these plans may need be to adjusted as we transition from a new state of emergency to the new normal. Im thankful for the flexibility of the staff and partners. Im proud of the work weve done together and im looking forward to supporting our Older Community members. Thank you. Thank you. So what this letter is communicating, well, everything that you just heard. One thing i want to highlight for you is that while the California Department of aging extended a deadline for this plan, it typically is due may 1st. That extension, i believe, was really just to reflect that most of our realities were completely overturned and that staff working on the area plan and advisory bodies and governing bodies such as yourself were likely unable to meet as scheduled. And so the California Department of aging did not add new requests or ask us to restructure the plan at this time. And so im going to now highlight the key updates that weve made to the plan and youll see we havent deviateded or made too many revisions to what we did previously. Section 7 is where we summarize public hearings. That includes our presentation at the Advisory Council and before the commission. We noted in section 7, there were four topics brought up and discussed. The definition of disability was an item at the Advisory Council. Discussion of who is eligible for d. A. S. Services under the umbrella of disability. And we also discussed senior homelessness and how d. A. S. Works to support older adults who are unhoused. We also spent time talking about assistedliving facilities and residents and their eligibility to participate in d. A. S. Services. Essentially, as long as its not a duplication of support that a resident is receiving those riding in assistedliving facilities are able to participate in d. A. S. Services. And then there was discussion about Racial Equity and how d. A. S. Approaches this and how d. A. S. s efforts align with the mayors directives. We also updated two of our narrative objectives in section 9 which is the golden objection section. We updated the existing item, 1c, about nutrition because we wanted to acknowledge in the coming years over the time period covered by this plan, that d. A. S. Will be working with the providers to ensure the continuity of existing services. And to support providers to adapt their Service Models to safely provide them within this covid19 context. We also added a new objective which is our covid19 response objective and in this, the department outlines that it will be supporting consumers to meet their needs safely during the coronavirus emergency and recovery. So in coordination with the citys emergency response, d. A. S. Will provide adapted, enhanced and new resources to support older and disabled adults in meeting their needs safely during the immediate Pandemic Response and longterm recovery, well ensure services are accessible and tailored to meet the needs of the community members. And all new refers to that, this is an entire new objective, because we couldnt conceptize this while working on the goals and objectives earlier this year. Then we also updated section 12, the d. A. S. Preparedness to add some content about the departments role and response in responding to covid19. Where we note that d. A. S. Has driven the development of new resources and systems in key areas, including food security, home care, social engagement and other critical needs that older adults and adults with disabilities have. That is maintaining these efforts and remain vigilant and responsive as our experience with this virus and Public Health crisis will likely fluctuate. And with that, happy to open it up to discussion and answer any questions that you have. Commissioner knutzen thank you so much for all the additional work and incorporating all the feedback you got. So thank you to both of you. Are there any comments or questions from the commission . All right. Vice president spears . Commissioner spears i just wanted to say that i really appreciated the thoroughness of the report. I had an opportunity to read the entire thing and it really sets the course for what were up to over the next several years and i found it quite easy to follow. And kudos to the team who put it together because i thought it was a fabulous report. Commissioner knutzen all right. Any other commissioner comments . Sklar . Commissioner sklar no. Commissioner knutzen can you open the phone line for Public Comment, or do we have anybody who wishes the comment . Secretary members of the public that wish to provide comment [inaudible] to the question do we have any callers in the queue . Im not showing any callers at this time. Secretary thank you. Commissioner knutzen okay, great. Hearing no request to speak on the item, we close Public Comment. Is there a motion to approve the area plan 2021, commissioners . All right, i see moved by commissioner lum and second by Vice President spears. Madame secretary, will you please take the roll on agenda item b . Commissioner knutzen yes. Commissioner spears yes. Commissioner lum yes. Commissioner sklar yes. Secretary the vote is unanimous. Commissioner knutzen okay, thank you. Commissioners, your next item is agenda c. That is requesting authorization to modify the economisting Grant Agreement with the self help for the elderly for the provision of elder nutrition program, e. N. P. , congregate meals during the period of july 1, 2019 through june 30, 2020 in the additional amount of 1,333,669, plus a 10 contingency for revised total modification amount not to exceed 1,945,121. Staff Tiffany Kearny will present the item. Thank you, can you hear me . Commissioner knutzen yes. My name is Tiffany Kearny, i am the Program Analyst and lead nutritionist for d. A. S. And im here today to present the modification for selfhelp congregate meal grant. Providers have experienced a significant demand in Meal Services and had to modify how they provide meals. They have been steadfast in meeting the increased demand and in changing their Food Service Operations to ensure the health and safety of clients and staff. All have transitioned their programs to meals to go, Meal Delivery or both. Early on, selfhelp for the elderly recognized the need to deliver meals to their clients who relied on them as a primary source for daily nutrition and shifted their program to Meal Delivery shortly after the citys shelterinplace order. Staff and volunteers delivered average of 100,000 meals per month, serving around 3500 clients a week starting in april through june, which is five times their Monthly Average before covid. Selfhelp served about 453,000 congregate meals in 1920 and the requested funding help covered the cost of 176,000 of those meals. Thank you and im happy to answer any questions you may have at this time. Commissioner knutzen yes, i just cant fail to notice, begin the comments, this is such a huge increase in what they anticipated doing which was in the tens of thousands of meals to over 100,000 meals. If i have that correctly . Reading this document. And i think nothing nothing shows more [laughter] whats happened to us other than reading this request. I didnt have a question, but i think i needed to note that. It was quite a thing to even read. Is there any other comments or questions from commissioners before we vote . Yes, commissioner lum . Commissioner lum thank you. My question, really, is to get a clarification for myself. Normally, a budget its requested and we approve the budget for whatever the request was. In this case, needless to say, there is this tremendous increase. Is it understood that these organizations can always increase the budget . And then come back and ask us to fund it later . Or, you know what i really want to know is if there is this implied approval ahead of time . Are you going to answer that . Yeah, so ill answer it. Thanks, tiffany. So this is an unprecedented time and one of the things that we did know was that we would have increased need for Nutrition Services and increased need for people to get homedelivered meals. One of the things that ive been doing is working closely with the c. E. O. S of the organizations that we work with to try to understand what their increased needs are. And to try to help our staff be prepared to respond to those needs. Fortunately, we did get dollars from the federal government in the two stimulus packages that we got to help offset the general fund cost of these, but the city, i think, is just aware that we have increased Food Insecurity due to covid19 and the city is prepared to make sure that were figuring out how to answer those answer that need. Its complicated because, you know, we dont always have new monies coming in. We were able to shift some dollars over from dignity fund to help cover this. We were able to get the federal dollars, et cetera, but its just an ongoing conversation. I dont think we can ultimately say up front were going to be able to meet all the needs and yet we know that we need to try to the extent that we can because Food Insecurity is such an awful thing for the population that we serve. Does that answer your question, commissioner . Commissioner lum yes, it does. You know, just being new, it seems very difficult for us to approve a budget not knowing whether or not that budget is going to be sufficient and then obviously, where are we going to get the additional money . Right. Its an ongoing concern. Fortunately, budgets are a planning tool and when we try to adhere to them as much as we can, but we really are we have to work within that budget and then were also very hopeful there will be other dollars come in and help us increase to continue the increased Service Level that we have right now. Commissioner lum thank you. Thanks. Commissioner knutzen thank you. Commissioner sklar, any questions . Commissioner sklar no. Commissioner knutzen anyone from the public who wishes to comment on the item . Secretary moderator, please open the phone lines for Public Comment. Members who wish to provide Public Comment press pound 2 to enter the question queue. Do we have callers in the queue . Yes, we do. Yes, commissioners. Hello . Hello, caller, can you give us a name . Annie chung. And im the c. E. O. Of selfhelp for the elderly and i would like to comment. Great, your three minutes begin now. Thank you, bridgett. Commissioners, good morning. This is annie with selfhelp for the elderly. Thank you very, very much for questions, commissioner lum, as well as for director mcspadden and tiffany for recommended this very huge amount to kind of fill the gap that selfhelp for the elderly has provided as the commissioner said, almost 300,000 meals during the covid months from march to end of june. It is really unexpected, but as we close all of our nine and ten congregate sites, we realize that those are 1500 elderly that normally come to our Senior Centers who immediately have the need to go on to Home Delivery. So we worked with our cater and our staff to make it possible so that no senior go hungry. I want to thank shireen and her staff. We worked actually very closely together since the shelterinplace. So as the number increased, we cannot really stop because the elderly were calling us in panic mode. They couldnt go out of the building. Many lived in s. R. O. S and senior buildings and we dont really want them to go out and get sick. So in hindsight, we really have to continue feeding our seniors as much as we can so that we keep them safe at home. Its kind of like a leap of faith. And at the end of june, when we have to close down the covid19 Meal Delivery, we open six of our congregate sites for togo meals and we also refer about 500 of the assisting seniors to the greater plates program. Were continuing monitoring our Seniors Health and for those very, very frail and disabled seniors who are still going to bring a hot meal Home Delivery style to them, but not to the extent of closure, about 4,000 meals during the day during the peak. We were happy to have a lot of volunteers help us. We had over 350 volunteer drivers that came from the neighborhood. We were delivering all over San Francisco. And many of them, really, live in Senior Housing and s. R. O. S and in the western part of the city. And we give a big thank you to all our volunteers, director mcspadden was present to help us honor a number of these neighborhood groups. Sfpd offices have helped us, the lyft drivers and the Community Initiatives have consistently sent volunteers to help us. So i would like the commission to support this budget modification so that our budget is kept whole and we will continue to try our best to meet the needs of our seniors during this pandemic. Winston churchill said it is no use saying were trying to our best, we just need to succeed doing what is necessary. During the covid months we did what was necessary to keep our seniors safe and we couldnt have done it without all of your support. And particularly yours, shireen. Youve kept me kind of sane during our conversations, working out options and really the best support for our seniors. Tiffany, shireen, cindy, michael, thank you very much on behalf of all the seniors. Secretary thank you. There are no other callers at this time. Secretary thank you. Commissioner knutzen can i just compliment selfhelp for the elderly for years of being at the front line and helping when help is needed. Annie does a great job and totally in support of all theyre doing. Thank you. Great, thank you. Hearing no other requests to speak from the public, we will close Public Comment and id like to ask the commissioners for a motion . Commissioner knutzen so moved. Looks like one from commissioner sklar and then a second from commissioner lum. Yes, thank you. Commissioner knutzen yes. Commissioner spears yes. Commissioner lum yes. Commissioner sklar yes. The vote is unanimous. Commissioner knutzen thank you very much. Commissioner, your next item is agenda d, requesting authorization to enter into a new grant are agreement with swords to plow shares for provision of Legal Assistance for veterans with Mental Health claims. During the period of july 1, 2020 through june 30, 2020 in the amount of 236,060, plus a 10 contingency not to exceed 259666. Staff well present the item. Good morning, president knutzen, fellow commissioners and executive director mcspadden. Im the benefits and director of d. A. S. The item before you is to provide Legal Assistance for veterans with Mental Health claims. The San Francisco office was awarded this funding in partnership with swords to Employee Shares by the department of Veterans Affairs. Weve partnered to streamline Service Coordination and expand the ability of Legal Assistance for veterans across San Francisco. Swords to Employee Shares provides legal counseling up to full representation by an attorney to underserved veterans of complex v. A. Mental Health Disability claims. These veterans are often not receiving the benefits which they are entitled due to barriers. In this grant, the department of Veterans Affairs requires that the Program Target underserved veterans. Theyre considered those that are other than honorably discharged, lgbtq, women, students. San francisco county veteran service will collaborate with swords to Employee Shares to provide formal and informal outreach to veterans. Outreach will focus on lowincome and Homeless Veterans with Mental Health disabilities who reside in San Francisco. Compared nationally, San Francisco has the eighth highest number of Homeless Veterans and third highest rate of unsheltered veterans. During the inkind count of homeless individuals, we discovered there were 608 Homeless Veterans and 81 of them are unsheltered. This provides outreach to the vet center and other locations where underserved veterans seek support. Theyll pilot legal clinics at the college of San Francisco to reach out to the transitioning student veterans and the San Francisco veterans county office will reach out to veterans sheltering in place. Its anticipated that this grant will have a dramatic impact by ensuring that more underserved veterans with Mental Health abilities will increase their access to v. A. Mental health and health care. They will seek out and qualify for Housing Assistance to support their reintegration to civilian life. I also request your approval for this contract. Im happy to answer any questions the commission may have. Thank you. Any questions or comments from the commissioners . On this request . Then hearing commissioner sklar no, i dont. Commissioner knutzen i wanted to show i know from my advocacy in the lgbtq community, how complicated it is when you are dishonorably discharged to get benefits. So this is the trickiest legal work that can be done to try to get people who are challenged assistance to prove that they do deserve these benefits. So i just wanted to acknowledge that and i know how complicated that kind of case is. And so, anyway, hearing no other requests for the commission to speak, so do we have any Public Comment . Secretary moderator, please open the phone lines for Public Comment. Members of the public that have dialled in and wish to provide Public Comment under this item, please press pound 2 to enter the question queue. Any callers in the queue . I am not showing any callers at this time. Commissioner knutzen hearing no request to speak on the item, we will close Public Comment. Motion to approve . Commissioner lum. Second from Vice President spears. Madame secretary, please take a roll call vote for agenda item d. How do you vote . Commissioner knutzen yes. Commissioner spears yes. Commissioner lum yes. Commissioner sklar yes. Secretary president , the vote is unanimous. Commissioner knutzen great. Thank you so much. Commissioners, your next item is e, reway and approval of California Department of aging Health Insurance counseling and advocacy program, hicap, contract hi202106, the associated budget and all subsequent amendments. I think were going to hear from staff member Michael Zaugg who is ready to present. Good morning, commissioners. Executive director mcfadden. Again, yes, this items seeks your approval as part of the completion of the certification process. Approval of this contract allows us to receive funding that we use for the operation of our Health Insurance counseling and advocacy program, or as its commonly known, the hicap. The hicap is a medicare focused Program Providing community, education, one to one tt counseling and Advocacy Services for folks who are Medicare Beneficiaries or eligible for medicare. We actually take the funds in through a separate contracting process and contract out with selfhelp for the elderly, who administer the program in the community. While its not central to this item, i would be remiss not to do a quick report on how the hicap has fared through all these changes. Theyve done quite well, actually. You know when the shelterinplace went into effect, hicap halted operations and then kind of watched to see how things were evolving. Their program does not do a lot of walkup services, a lot of the services are driven through a 1800 number or online avenues in order to schedule appointments, which usually do take place in the community, one to one. So many of these appointments were primarily moved to phone appointments with some web one to one counseling sessions as well. When i look at the statistics, theyre pretty impressive. In 1819, two years ago, this program the noncovid year i guess, this program served over 2000 provided counseling to 2000 clients. When i look at the stats for this year, theyre on pace to get close to that again. As of this moment theyve provided services to about 1887 clients with i know that they have a couple more files to go to finalize. So i think theyre going to get another 100 added onto that number for the fiscal year 1920, the fiscal year we just completed. The last thing i would note on this item providing a little bit of context. The dollar amount here in this contract, essentially keeps the Hicap Program funded at its previous years funding level for the year ahead of us. So with that, im happy to answer any questions that the commissioners may have. Commissioner knutzen thank you very much, mr. Zaugg. And that was precisely my question, how are they adapting to the current times, but it sounds like theyve adapted quickly. Yeah. Commissioner knutzen and successfully. Thats good. I know that everybody has a question as they go on medicare. Sure. Commissioner knutzen the program has been accessed by many, many of my friends and ive heard about it a lot, so i know its very useful. Are there any other comments or questions from the other commissioners . Okay. Then could we please do we have anyone from the public who wishes to comment on this item . Secretary moderator, please open the line for Public Comment. Members of the public that have dialled in to provide Public Comment under this item, please press pound 2 to enter the question queue. Do we have any callers in the queue . Im not showing any callers at this time. Commissioner knutzen okay, hearing no requests to speak on the item, we close Public Comment. Is there a motion to pass this item . Commissioners . Do we have a motion from commissioners . So moved. Thank you, from Vice President spears. A second . Commissioner knutzen second from commissioner sklar. Madame secretary, please take the roll call. Secretary how do you vote . Commissioner knutzen yes. Commissioner spears yes. Commissioner lum yes. Commissioner sklar yes. The vote is unanimous. Commissioner knutzen great, thank you very much. Commissioners, your next agenda item is f, it is review and approval of California Department of aging, dignity at home Fall Prevention contract fp192006 associated budget and all subsequent amendments. Again, staff person, Michael Zaugg, will present. Mr. Zaugg . Hello again, commissioners. This item similar to the one before is another approval of a contract between the California Department of aging and the department of disability and aging services. This is to access new funding for a new program type. The state has allocated funding in last years budget for Fall Prevention programs. It got off to a rocky start as it was launched just as covid hit, so it has been a little bit bringing this to commission for execution. With your approval, we are hoping to actually use these funds to partner with an existing program in the Citys Department of Public Health. That is their community and Home Injury Prevention Program for seniors. The acronym is chip. What were trying to accomplish there is to link in our network of providers and our network of clients with the department of Public Health and look at where theyre able to serve and where they might not already be reaching and see if we can bring more clients into the program for for services. Were going to work with the Current Program to explore the inhome assessment process and seek evolving and innovative ways to continue that Program Function in the new shelters in place and Public Health order world. Then i think the big thing that is going to happen here is there is a great demand within their program for home modifications and purchase of equipment in order to approve the safety of people at home. The funding there runs out usually by the Third Quarter of each fiscal year, so we think bringing this additional funding would help serve more clients as well as be able to Fund Additional home modifications and purchases of home modification equipment. With that then, im happy to answer any questions the commission may have. Commissioner knutzen Vice President spears . Commissioner spears thank you, michael. I just have one question. I love the fact that there is a partnership with the department of Public Health and the existing program. With this particular contract, the responsibility for reporting back to the state will be the responsibility of d. A. S. , although were partnering with the department of Public Health, is that how this will work . Yeah, that is correct. So that is something were going to were going to have to work through as we develop this partnership with Public Health as to how that data is going to come back to us not only for reporting up to the California Department of aging, but for our own purposes of understanding its effectiveness and impact. Commissioner spears and just a followup question. So the existing program, is that in the department of Public Health is that funded by the state also or is it funded by the city . I actually do not know. I can check on that and get back to you. It does not i mean i can rule out it does not come from the California Department of aging, if that helps. But ill get a more complete answer for you. Commissioner spears im curious where the information will be held, is it in two different databases . That is my whole reporting question. You know, in all likelihood that is probably a scenario were going to have to navigate. Commissioner spears okay. Commissioner knutzen any other questions from the commissioners on this item . Great. Okay, thats fine. Then i think that the difficulties we have with this is because we had a Model Program already that im sure, you know, served as a model for the state to expand that program and now we need to make it more efficient, but its a great question for people to understand how that happened. Lets see, can we open the madame secretary, anyone from the public who wishes to comment on this item . Secretary moderator, please open the line for Public Comment. Members of the public that have dialed in and wish to provide Public Comment under this item please press pound 2 to answer the question queue. Do we have any callers in the queue. Announcer im not showing any callers at this time. Commissioner knutzen thank you. All right. Hearing no further requests to speak on the item, we will close Public Comment. Is there a motion to pass this item . So moved. Commissioner knutzen moved by commissioner sklar and i saw a second there from commissioner lum. Yes, i did. Madame secretary, please take roll call for agenda f. Secretary how do you vote . Commissioner knutzen yes. Commissioner spears yes. Commissioner lum yes. Commissioner sklar yes. Secretary president , the vote is unanimous. Commissioner knutzen thank you. Commissioner, your next item is g, requesting authorization to enter into a new contract with cotchett, Pitre Mccarthy, llp for the provision of Legal Services for the San Francisco guardian and the San Francisco public conservator through june 1, 2020 through may 31, 2021 not to exceed 60,000. Carrie wong will present the item, is that correct . Or do we have someone else . There you go. Janet. Your audio. Yeah. I cant hear her audio. Please dial pound 2. Your line is live. Check to see if your phone is muted. How we doing now . Yep. All good . Okay. Good morning, commissioners and director mcfadden. Were presenting in carrie wongs absence. Im the head attorney for the Public Guardian. Apologies for the technical difficulties getting started. The Public Guardian and the public conservator seek approval to enter into a contract with cotchett, Pitre Mccarthy to provide Legal Services for the Public Guardian and the public conservator regarding individuals under conservatorship by these two programs. These are two separate and distinct offices operated by the department. So the Public Guardian serves a Court Appointed conservator of vulnerable San Francisco residents who are unable to take care of their health, medical care, unable to manage their finances or they may be subject to undue influence and unable to resist fraud. Most of the individuals that San Francisco has in their program are persons with deteriorating forms of dementia. On the other hand, the San Francisco public conservator serves as Mental Health conservator for San Francisco residents. So also vulnerable, but theyre gravely disabled. Most of the individuals in the public conservator, so they have Mental Illness and have been found by a court unable or unwilling to accept voluntary treatment. The Public Guardian and public conservator are to act in the best interest of their conserveties. At time, our office encounters where specialized the need for specialized Legal Services arise. This may be due to complex legal issues or serious issues that their assigned counsel are not experts at. That is the case here. That is why were before you. So, we need to obtain the Public Guardian and the public conservator need to pay them for legal advice and if appropriate litigation services. So im not able to speak to confidential matters impacting the conserveties, happy to address questions you might have. Commissioner spears im curious, where are most of the conservatees located . What kind of facilities are they located in . Nursing homes . I have no idea. Right. There is a variety of facilities primarily we do have conservatees who live in their own residences, they may be assistedliving, they may be in Skilled Nursing and theyre pretty much spread out among the nine bay area counties given the housing crisis we have. Commissioner spears okay. Thank you. Commissioner knutzen any other questions from the other commissioners . Okay. I just wanted to clarify just a little. This is a contract for 60,000 and if we get into litigation, it looked like they were going to take that on contingency and then they would be charging per hour and does that go only up to 60,000 . Its not an openended contract, right . It isnt. If it goes into litigation, the idea is that a decision will be made and a contingency fee contract would be arranged. So the 60,000 is a cap. Commissioner knutzen okay. Thank you very much for clarifying that. Okay. Thank you for that. All right, then shall we is there any Public Comment on this item . Secretary moderator, please open the phone lines to Public Comment . Members of the public that have dialed in and wish to provide Public Comment under this item, please press pound 2 to enter the question queue. Do we have any callers in the queue . Not showing any at this time. Secretary thank you. Commissioner knutzen hearing no request to speak on this item, we will close Public Comment. Is there a motion for the commissioners to approve this item . So moved. Commissioner knutzen okay. I saw commissioner lum, he is the person who moved and there was a second, Vice President spears, thank you. Madame secretary, can you take the roll call for agenda item g. Secretary how do you vote . Commissioner knutzen yes. Commissioner spears yes. Commissioner lum yes. Commissioner sklar yes. Secretary president , the vote is unanimous. Commissioner knutzen great, thank you very much. And that concludes our agenda for today. Are there any announcements . Hearing none, ill move along. Is there a motion to adjourn our meeting today . Commissioner lum and a second from Vice President spears. Then on behalf of the commission, i want to adjourn the meeting. Thank you so much for everyones work. Again, well see you next month probably from the same time and place. Everyone please take care. Stay safe. Thank you. Thank you for being patient with me. Thank you. I still cant figure it out. [ ] the hon. London breed good morning, everyone. Im San Francisco mayor london breed. Im joined here today with the director of the department of Public Health, dr. Grant colfax, as well as the director of the department of economic and Workforce Development to talk about the citys effort around covid19, whats happening with our reopening, and what you need to know. Today as of today, we have 4,020 new cases total cases, 68 hospitalizations, and 16 transfers from other counties, and 50 people have sadly lost their lives to covid19 in San Francisco. I want to take this moment, first of all, to really thank the people of San Francisco because we know that it is because of many people in this city the fact that you have been wearing your mask, social distancing, washing your hands, and staying home in most cases, even though i know it has been challenging. Because you have done that, we have not seen San Franciscos numbers increase like some other cities that are experiencing significant challenges. But i also want to be clear that we are seeing an increase. Our numbers, along with numbers all over the country, are going up, and we are not out of the woods yet. I have said in the past, dr. Colfax has said in the past, the covid19 virus, this covid19 is with us for at least anywhere between 12 to 18 months, and what we are trying to do is adapt to our new normal, and part of adapting to our new normal is that we not only want to keep ourselves safe, we want to keep the people around us safe. I cant express enough how important it is to wear your mask whenever possible, especially when youre around other people. Its not just about protecting you, its about protecting them, as well. And we, as you all know, are still having a number of challenges, and i want to talk a little bit today about our reopening efforts because i know that thats really been at the top of everyones mind is what is happening. Last month, i made an announcement about a timeline specifically when San Francisco was planning to reopen, and we were doing well in terms of our numbers. As we said, we will look at the data, we will look at whats happening in our city as far as hospitalizations and make decisions. So we moved up our timeline once the state provided us with the variance. We were planning to allow businesses to reopen as early as june 29, and then, something changed. We saw a spike, one that we have not seen in a very long time, and as a result, we had to put a pause on the opening of those businesses, and i know that it was very detrimental, especially since its already been so challenging for so many hair salons and nahair salons d a number of other businesses that were planning to reopen. And i know this was very challenging, but this was definitely a matter of Public Health. I know it was hard to make that decision on that pause for reopening, and the original variance was scheduled to be granted july 13. So i must say that as of today, on july 13, we will not be able to allow restaurants to be able to operate indoors, as we had planned, nor will we be able to allow bars to open outdoors on july 13. And we continue to evaluate and to make the decision. If we see the numbers stablize or decline in any way, we will reevaluate the reopen. But at this point, we have no choice. We are living in covid, and i think what i want to reiterate is the fact that we are all in this together. What you do or what you dont do impacts someone else, whether you know it or not, and thats why its so important that we follow the guidelines of the city to wear our masks, to socially distance, to wash our hands, to do everything we can to stay apart from one another during this time, especially as we see the numbers increase. So i want to, at this time, introduce dr. Grant colfax, who will talk a little bit more about whats happening. And i also as i said, Joaquin Torres is here because we know that our Small Businesses in San Francisco who have already been struggling continue to struggle. We started a number of funds and a number of things to try and help support these businesses. I know its not enough, but i want to be clear that, you know, this is not a decision that we are approaching lightly. We know that in order to protect Public Health, we are creating other challenges for Small Businesses. Were creating other challenges because we know that over 153,000 san franciscans have filed for unemployment. We dont make these decisions lightly, and this is why we want to reiterate how important it is for us to listen to the guidelines and to do our part. We need these numbers to go down. We need these numbers to go down, so we need not just people in San Francisco, but the folks who are also coming from other places to San Francisco, the people who are working in San Francisco. Folks who work for our nonprofit agencies, serving our homeless population, are coming from cities all over the bay area. People who are working in our hospitals, our Public Safety officials. What impacts one impacts us all, so this is not just about San Francisco, this is about the entire bay area, and our need to take this virus seriously and to all do our part to keep one another safe. And in San Francisco, as soon as we can allow things to reopen, we will be the first to do so safely. So i thank you all for your cooperation, and at this time, i want to turn it over to dr. Grant colfax. Well, thank you, mayor. Im dr. Grant colfax, the director of Public Health for the city and county of San Francisco. I want to thank all san franciscans for their sacrifices during this unprecedented time. The psychological, physical, and economic toll wrought by the pandemic are severe and continue to have major impacts across the city and region, particularly among communities already facing socioeconomic and health inequities. The virus has further exploited these fault lines, and so far, for the most part, we have managed to avoid the worst consequences of the virus and the pandemic, but that could change at any time. Today in San Francisco, we have 4,020 diagnosed cases of covid19, and unfortunately, 50 people have died of the disease. In the bay area region, there are over 30,000 cases and just over 600 deaths. In the state, nearly 250,000 cases, and nearly 6500 people have died. And nationally, we continue to see the pandemic surge, with nearly 3 million cases and an astounding 130,000 deaths. Leading up to the holiday weekend, we did everything we could to make sure that we all knew the safest way to celebrate, and that was to stay home this year. For those who did go out, we asked that people avoid gathering wherever possible, wear face coverings, stay 6 feet apart, and wash their hands frequently. Over the weekend, the city handed out over 12,000 face masks to organizations in the Latinx Community in recognition of the disproportionate burden of disease affecting the latinx population, and we are continuing to expand low barrier testing to communities most affected by covid19. And you may have received a phone call or a text from the city encouraging you to do your part to keep your Community Healthy and safe. Unfortunately, there were still dozens of gatherings throughout the city, and many people were not wearing face coverings or masks. But i want to thank everyone who did take precautions. You are literally saving lives and keeping covid19 from spreading rapidly in the city. And i especially want to thank everyone who skipped the usual july 4 fun and made sacrifices this weekend. We are in a period, we have been in a period, and we continue to be in a period of uncertainty, and i want to acknowledge that this is a really hard place for all of us to be. And yet we know what works, and we need to continue to do what works. We flattened, and some would say we crushed the curve once, and we can do it again. If we do not, the consequences could be dire. My commitment to you is that we will continue to follow the science, data, and facts. The results of the july 4 weekend behavior wont be known for at least two or three weeks, but we must continue to do all we can to flatten that curve again. Dont let your guard down. The virus is still out there, and its out there more than ever before. It is spreading throughout our community and the bay area region. We are working with scientists, researchers who are seeing that the reproductive rate of the virus is climbing above 1. That means that for each person infected with the virus, the virus is infecting more than one person going forward. The virus is increasing in our community. At this rate, it could potentially overwhelm our Health Care System and cause many deaths if we dont get a handle on this right away. I want to make sure that san franciscans, that you understand how serious and precarious our situation is. Lets look at our health ska indicators. They are published daily on the San Francisco Health Tracker that you can reach on the San Francisco health website. I invite you all to follow along with how the virus is impacting our community. The indicators are scored by green, yellow, orange, and red to understand where we stand. Todays indicators show that, unfortunately, we have reason to be concerned. Our case indicator is red. We are currently diagnosing on average 6. 1 cases per 100,000 new cases per day. Our goal is to keep that number to 1. 8, so rather than 1. 8, were at 6. 1. That is red. That is a serious situation that requires us to pause. Hospitalizations for people diagnosed with covid19 have seen a 25 increase over the past week. Our goal is to keep that increase less than 10 . Our hospital capacity, unfortunately, remains good. 35 of acute beds are available, and 30 of i. C. U. Beds are available for covid19 and other patients, but again, that could change at any time, and we know, when this virus takes off, it takes off fast. Testing, we continue to expand testing. Were currently conducting an average of 1762 tests over a sevenday average. Our contact tracing, we continue to follow up with 82 reaching 82 of cases, and 88 of their contacts, and our protective personal protective equipment or p. P. E. Is at 89 supply, status yellow. Now lets look at the bay area perspective. As we all know, San Francisco is not alone. We are a part of an interdependent region where people live, work, go to school and play across many counties at once. There are cases surging in communities across the region. For examp marin, 1774 cases in the past two weeks. They were put on the state watch list. Solano, 1662 cases in the last two weeks alone. They have been put on the sate watch list, and we see similar numbering increasing across the region. This pandemic does not, the virus does not know county lines, and we must respect that it is increasing across the bay area. So where does that leave us . Our reopening is still on pause as of june 29 as we work to bring the latest surge of cases under control. We can do it. Weve done it before, and its up to us. I know that this is an unsettling situation, and there are a lot of unknowns. I know and appreciate that businesses are and need to be able to plan, and that residents need to be able to get back to work. While it is so difficult, so difficult, as the mayor alluded to, to slow down the reopening that we all want so badly, the price we pay for moving too quickly is extremely high. Remember, this virus has no timeline. Across the country, the virus is surging back in florida, arizona, and texas. In california and right across the bridge the golden gate bridge, marin is slowing down reopening, and in Imperial County to the south, the hospitals there are full and patients are being transferred to other counties. In fact here in San Francisco, we have 13 patients have other counties that we are caring for in our intensive care units. At this point, we are not dialing back any of the activities or businesses that have reopened, but we are not going to rush it further ahead, either. I know that it is confusing to keep track of all these lists and schedules, especially when they may change. Here are some of the Public Health principles that we are using. You can use them, too, to guide your decisions. Again, everyone in San Francisco and, indeed, in the bay area has a responsibility and an opportunity to protect the communitys health. When you think about the risk of exposure and transmission, keep these things in mind. How risky is the activity . First, is the activity indoors or outdoors . Outdoors is much safer. Second, does it involve gatherings with people outside of your immediate household . That is riskier and should be avoided. Three, can you hear face coverings at all times during the activity . Four, can you maintain, and i mean can you really maintain at least 6 feet of physical distancing . I think some of us have found that harder than we expect in certain situations. Fifth, can you easily wash your hands and is the environment properly cleaned. Think about any activity in terms of the following four characteristics number, frequency, duration, and distance. Number. The more people who are together, the more interactions take place. This is riskier. Frequency. The more often people interact, the higher their risk of transmission. Duration. The longer the amount of time spent together, the higher risk of virus transmission. Distance. The closer together people are, the higher risk of virus transmission. Keep these principles in mind. Use your common use common sense. Use our common sense. Facial coverings, social distancing, think about the number, frequency, duration, and distance as you make decisions about how, when, and even if to engage. When we apply these principles and examine the Health Indicators and incorporate what we are learning about the virus and its reproductive rate in San Francisco and the region, we are forced to conclude that it will not be responsible to allow Indoor Dining or outdoor bars to begin on july 13. Indoor dining is an activity where people typically gather with those outside of their households, takedown their face masks, and spend time in close proximity. The simple pleasure of going to an indoor restaurant is something that we, and certainly i, all miss, and it is certainly a vital part of our cultures economy. I know from experience what it means to wait tables and live by the service tips that are provided. But for now, unfortunately, Indoor Dining is an opportunity for the virus to spread. If we let that happen, it will further delay our chances of getting back sooner to the things we love to do. We are not alone. New york city also has put Indoor Dining on hold and, eve west virginias governor has issued an order making indoor masks mandated when social distancing isnt possible. They are taking aim at the same things that we are. As for outdoor bars, they are currently restricted for 23 counties on the watch list. And although San Francisco is not on that list today, that could change. As i said, several bay area counties are on the watch list, and if any county in the bay area is in such trouble, we are all in trouble. In keeping with our regional approach, we are going to abide by that restriction since outdoor bars are an occasion for gathering, removing a facial mask, and can be a difficult environment to maintain adequate physical distance. Meanwhile, Outdoor Dining at restaurants and bars that serve food will continue to be allowed as long as everyone follows the precautions and the virus remains under control. We are continuing to evaluate the data and reconsider the reopening of indoor museums, zoos, aquariums, gyms, real estate open houses, and personal services. We will have an update on those activities by the end of the week. I cant emphasize enough how important it is that we do our part, that each of us does our part. Remember, even if you do not have symptoms, you could be carrying the virus, or your friend could be carrying the virus. Even though this virus has greatest consequences in general for people who are older, it can also have severe consequences for younger people. We must all do our part to keep as many people as possible from contracting the virus. Do not gather if possible, and not in large groups. Continue to stay home as much as possible. If you leave the house, wear a mask or a face covering, stay 6 feet apart, and wash your hands. These actions save lives. We have time. There is a window now for course correction, but if we dont do it, and we dont do it quickly, we could be looking at a surge of illness that goes well beyond what we are prepared to handle. We saw in march that our Rapid Actions mattered. Just a few days made a huge difference. The power to make things better is indeed in our hands. We can get this right. We know what to do. We need to support each other in doing it. We can have a thriving economy in San Francisco with a healthy population and a renewed economy if, if we Work Together, remain vigilant, and hold our ground. Thank you. And it is my pleasure to introduce Joaquin Torres, the director of oewd, who will make additional comments with regard to where we stand with the pandemic and business and recovery. Thank you. Well, thank you very much for your leadership, mayor breed, and thank you very much for keeping us all safe and healthy during this time, dr. Colfax. I know that so many individuals in the business community, whether the businesses or their workers are happy that were doing so much to keep them safe and their families. We all know that these practices are what are allowing the businesses to move forward. We know that this is a very difficult time for you, for your employees, and for our city, but so much appreciate what you all have done for us to keep our city strong, lively, and our Economic Activity continuing. The issue for us right now around wanting to ensure that you have clarity is a commitment that our office of economic and Workforce Development brings. You can visit our website at oewd. Org to learn more about partnerships that we are providing with the city and Public Health so that you can continue to have best practices around measures, guidances, and reopening. That is your source for information to grants and loans that we are providing here in the city and county of San Francisco for all of you. We know that all of you are deeply excited about getting back to work. Please do stay in contact with us. We look forward to working with you to making that happen. As mayor breed and dr. Colfax said, the basics are what matter right now. Please do, when businesses are asking for your support, please be patient with them. Please continue to support them. They are looking at for your interests and our entire citys interest by asking you to wear your mask, maintain social distancing, use the sanitizer that they have at the front door when you come in. Please be respectful of that. We all need your support, and they all need your support in continuing to work to move forward to benefit our economy. Thank you to our Small Businesses, and thank you to the workers who continue to come in day in and day out who make sure that we can continue to provide for ourselves and our families. Thank you for all that you do and we look forward to working with you. Please visit our website, oewd. Org so we can provide you information on reopening and answer any questions that you may have whether youre a worker, a business, or a nonprofit in San Francisco. Thank you. Director torres, if you can stay at the podium, the first question will be for you. Okay. The first question is from chris reyes, abc 7. What can you tell the restaurants about the first goal of reopening . Are you working with the restaurants for the first phase of reopening . Yes. The answer is we are working very closely with the restaurants. Our staff are talking daily, if not every other hour, with the Industry Leaders and also individual businesses to make sure that were up to date on information and needs that people have. As you heard dr. Colfax mention, the realities right now are that we are not ready to provide a timeline in terms of when these next steps can be taken. This is contingent on what the data tells us. We look forward to more and to communicating more by the end of this week, but for the Golden Gate Restaurant Association and others, we will continue to work with you and continue to provide you up to date information. Thank you, dr. Torres. The next set of questions are for dr. Grant colfax, the director of Public Health. Dr. Colfax, your first question is from marco siler gonzalez, kesq news. Do you have a total number of patients that have been taken from san quentin to hospitals . Our latest number is 70, and that number has remained stable the last couple of days. Our last question is from [inaudible] on the virus spread in hospitalizations in the bay area, including San Francisco . Well, im certainly very concerned about the outbreak at san quentin, and we are working with our state and local partners to coordinate efforts to ensure that people, both the inmates and the staff of san quentin are getting access to care and the best care possible. That is being coordinated by the state. As i said in my opening statements, hospital beds in San Francisco looks good, so at this point, we will continue to support care for inmates and staff in necessary here in the if necessary here in the city and ensure that all patients inmates and staff get the care that they need. Follow up from kathy novak. Do you think that the crisis specifically is contributing to the delay in reopening . I think that there are multiple factors contributing to the delay. I truly cant draw a cause from the san quentin outbreak to our decision here in San Francisco to delay. I do think that we are increasingly looking across the region. As i said, if one countys in trouble, we are all in trouble. Were looking at both our local indicators here in San Francisco as well as indicators from our neighboring counties to make the decision that we did make to pause, and our indicators will continue to drive those decisions, along with the context of what other counties are experiencing. The next question is from heather knight, San Francisco chronic chronicle. San francisco families with children are frustrated that zoos, aquariums, and other places arent reopening. Do you have any date on when programs will restart . Its really this unprecedented challenging time where were trying to balance the need to protect children, their families, their grandparents with with the very issues that youre raising here. We have done a number of things that we hope will mitigate some of the concerns you raise. Camps are open with certain restrictions. We have child care guidelines out, and child care can open. The slow streets closing on jfk drive so families have more ability to get outside and exercise and get those kids out, and then were looking and working with the School District and private schools, as well, to potentially issue School Guidance soon. Still uncertainty still a lot of uncertainty, but really trying to balance the fact that kids need to get out, kids need exercise, their parents need a break with the fact that were in this unprecedented pandemic situation. And the final question is from felipe from kron 4. How close is the city from having to revert back to full place shelter in place in march that ultimately resulted in the curve being flattened . So were not at that point today. We are not rolling back what we have opened at this point. We will continue to follow the indicators and see. Again, i am hopeful, and i am even optimistic that if we all do our part, follow the guidelines, that we that we wont have to get to that point. Now certainly, its possible, but im hopeful that weve done the right thing in San Francisco by following the data, science, and facts. Moving congruent with the data, well be reviewing the data and indicators and will be issuing the facts this week. Thank you, dr. Colfax. This concludes our press conference for today. We are definitely pioneers in airport concession world a world of nationally if not entirely or internationally everybody is cop us right now. The people that were in charge of the retail this is where that began. I didnt think we would have a location at the airport. Weve set the bar higher with the customer commerce. Telling me about the operator and how you go about finding them and they get from being in the city to being in the airport. So first, we actually find a table and once we know what we want a sitdown we go to the neighborhoods in San Francisco and other people seminary of the retail let us know about the rain water and are excited to have the local operators in the airport. We have to go going through the conceive selective process and they award a lease to the restaurant. They are planning on extending. We that you could out the china and the length evens and the travel serve and fourth your minds and its all good. How long for a vendor to move through the process. I would say it could take 80 up to a year from the time we go out to bid until they actually open a restaurant. I dont know what we signed up for but the airport is happy to have us here. And, you know, even taking out the track simple things theres a learning curve with once were here they are helpful. Its an awardwinning program. Were prude of your awards we have won 11 awards the latest for the best overall food address Beverage Program and. Like the oscars laughter . The professional world. Tell me about the future food. All the sb national leases are xooirz and were hoping to bring newer concepts out in San Francisco and what your passengers want. Well, i look forward to the future laughter 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 announcer youre watching coping with covid19. Todays special guest is dr. Steven getnick. Hi, im chris man us and youre watching coping with covid19. Today my guest is the director of the Behavior Therapy Center of San Francisco and Professor Emeritus in counseling psychology at the university of San Francisco. Doctor, welcome to the show. Thank you. Lets talk about managing anxieties during this pandemic. What types of issues are people facing at the moment . There are a number of issues and i really want to point out that this is affecting everyone and has come on very quickly. So it is normal. If you are not experiencing some anxiety, something is a touch off because this affects us all. I think some of the main ones are our health and worried about getting the virus and our developing serious complications. I think for a lot of people who are single, living alone, in isolation, has been very difficult. I think being in close quarters with people who we normally have some space from now are together 24 7. Thats produced a lot of stress and anxiety. That loss of connection with others. We already addressed. And having kids home. For a lot of people. Yes, absolutely. What are the other problems that they might have . I think without that dynamic, the good things are not a problem. It is the difficulties we have. And when were together 24 7, again its like hooking everything up to an amplifier. So, what kind of problems could be created from working home from home, perhaps for the first time in your career . A lot of people are not used to working at home and a working at home just isnt the same. For one thing, there is a lack of social interaction. Some people find that that affects them greatly. Some people are actually finding theyre getting more work done at home without distractions from work. The lack of structure is probably the most common. We see it here with work at the office. People are kind of watching. We know that our schedule is, suddenly youre at home and you are on your own. Absolutely. If those are some of the issues people are facing, what are some of the techniques people can use to overcome their anxiety . Caller i think there are many. One of the first is how managing and keeping track of your thinking, we think and talk to ourselves a lot. Thats normal. We have a dialogue with ourselves often and we need to monitor that a bit. People tend to ruminate versus problemsolve. That is they tend to worry about all the things that might go wrong. And what i suggest is, look, there are things that can go wrong, but ruminating about the worstcase scenario is not going to be very productive. Sit down, figure out what the things are that you have to deal with and try to problemsolve. I think any of the selfcontrol techniques for anxiety can be helpful. And there are dozens of them. The common ones are meditation, relaxation techniques, yoga, for example and another is diaphragmattic breathing. If you google that, you can learn diaphragmattic breathing in about 10 minutes online. Its incredibly simple and it is a really nice way to reduce anxiety in the moment. Selfcontrol procedures, exercise. Whether if youre fortunate enough to have equipment at home, thats great. If youre not, get outside and go for a walk, keep your safe distance, of course. But you need to be active. Thats helpful. I think people marry be dealing with information overload at the moment. How do you suggest people manage that . I was just going to say that. I think it is really important to kind of limit the information you get. Not in terms of accuracy. I think in terms of accuracy, you want to identify a few sites where people are coming with evidencebased information and scientific information so you can form yourself well. Once youve informed yourself, you need to not be watching all day long. Ive talked to people who are mesmerized from the tv and a it keeps that anxiety going so you need to limit your viewing for sure. This can be stress for people who have economic concerns and worried about their family and friends and loved ones who are essential workers. What would you suggest they do to help manage anxiety and stress . There is a number of things. One of major ones for depression is behavioral activation. Simply, it really means that people will tend to not be depressed as a number of reinforcing activities to engage in. Whether it is hobbies, you read, you listen to music, you crochet, you whatever. These kinds of things are very important so you want to make sure that youre engaging in activities that literally make you feel better as opposed to sitting around ruminating, worrying about the worstcase scenarios that might happen. What about trying to do some selfdevelopment . Yeah. Its a very interesting time. Ive talked to a couple of my own clients who are finding, in a very positive way, that this isolation, while at first can generate a lot of anxiety, particularly if youre just not good at living alone. For a number of people, its giving them a chance to sit back and really think about what is important in their lives, what are the priorities. I think that maybe if there is any Silver Lining in this epidemic, its really forcing all of us to kind of rethink whats really important. Indeed. You know, though, at the same time, there are people who are feeling very lonely at home. How would you encourage them to overcome that . You get online. Facetime, skype, zoom, like what were doing right now. You can stay connected. Its very possible. Most connections are important. We are social critters and we need that connection. I think for people who dont have those options, pull up photos, take a look at pictures of family. You need to stay connected. And its very important. And finally, do you have any suggestions that are specifically for families . Yeah. Well, again, i think one of the interesting things thats come about from all of this, is i talked to families on video is theyre obviously spending more time together. While its a bit awkward, particularly for parents who are in the house working a lot. Its a chance to really deepen relationships and spend more good, quality time together. I think parents really need to step back and kind of plan their day a little bit. Not micro manage it, but have some ideas. Can the family play games together . A lot of people i talked to, theyre even together as a family for the first time. So i think there are a number of things that people can do. I think it is qulaouzful for the families to take five, 10 minutes and say how did the day go . I talked to someone in the phone book before we started who said they noticed what time of day all their anxiety kind of comes together and they start sniping at each other. Now theyre taking a few minutes at tend of the day to say, ok, how are we doing . I think they need modeling good behavior, something you can do within the family, too, to try to thats right. I think thats relevant. Very relevant to how children are going to do. Most of the research from crises, particularly things we cant control showed that children do as well as their parents do. So i think it is important for parents to think about how theyre react aing and they stay calm because whatever they do is modeling, coping for their children. So, that can be very useful. It can also be problematic. When we talked earlier, you mentioned that acknowledging that your kids are afraid is important. Yes. I think that ties to your last question. I think modeling you know, its not incompatible with saying, yeah, you know, mom or dad is a little nervous, too. It means a lot of stuff is going on, but were going to be ok. Were going to stay together. We have our time together. Were going to be safe. Well fill in the blank. So you can do both. You can reassure but in a realistic way that once the kids know its normal to be anxious in these times. Thank you for coming ton show, doctor. I really appreciate the time youve given us. Youre welcome. Thank you for having me. And that is it for this episode. Well be back with more covid19 related information shortly. You have been coping with covid19. Thank you for watching. It is so key here. We have a window to do better. Next slide. And again, another very concerning situation. This related to the reproductive rate of 1. 25, so this means that we will have more people die, and if you follow that blue line, this means we would average, excuse me, 890 deaths from covid19 in 2020. Were at 50 right now, and by the end of the year, we could be at 890 with a reproductive rate of 1. 25, and again, unfortunately, those white shaded blue lines show we could get much higher scenarios, approaching 2,000, and even 3,000. So this is this is serious. This is a we are in a very concerning time right now with this reproductive rate of 1. 25, and we need to drive down below 1 as soon as possible. Next slide. But there is hope, and this is looking as of july 4, because we were looking at the july 4 weekend and asking everyone to do their part. If we could reduce that rate by half, we could dramatically reduce our hospitalizations and our death. We could go from the hundreds that we talked about to as few as 50 and 70. And even the scenarios that i showed you with those light blue shaded areas, we could see more deaths through 2020. So if we do our part, we could save lives and keep people out of the hospital. Again, even in the next two weeks, if we could all do our part, we could really make a difference. You see in the next two weeks, we wait for the reproductive number to reduce by 50 , we still have peak hospitalization at 340 and an estimated 220 deaths in 2020, so time really makes a difference. Next slide. So key introduction to reducing r. P. E. This the reproductive rate. This has real socioeconomic and other consequences, as well. Discouraging gatherings, especially inside, and i just want to emphasize right now that, really, please do not gather with people outside of your immediate household, and especially do not gather indoors, it is very dangerous to do that. Please, it is literally saving lives. And then, continuing to offer testing, expanding our testing, and contact tracing. Such key tools to our efforts going forward. Next slide. So i alluded to this, but really, riskiness of the activity, we know that outdoors is safer than indoors. Its at this point that, based on the latest data, its 10 to 20 times safer than being indoors. Its risking out to be involved in gatherings with people outside of your immediate household. Half of the people who transmit covid19 are asymptomatic. And you can get covid19 right after you test. So dont think that just because you test negative, you can get it from people that you hangout with or you can transmit it back to older people in your household. We continue to emphasize wearing face coverings, 6 feet of social distancing, and washing your hands. The frequency, the more people go out, the more they are putting themselves and their loved ones at risk. The duration, the longer people spend time together, the more risk it is for transmission, and then, the distance. This is why we are focused on the social distancing and the importance of that going forward. Next slide. And then, i did want to talk a little bit about hope going forward, and talk about vaccines are being looked at and developed, and unfortunately, theres not likely to be any vaccines soon. Key experts estimate it could be 12 to 18 months before a vaccine is widely available. Thats very different from saying a vaccine is going to be available in six months to a year. But im hopeful, according to mayor breed, that we will be testing extensively across the city and also at zuckerberg San Francisco general hospital, and we will be focusing on engaging communities most at risk for covid19 to support them in participating in vaccine trials as soon as august. Thank you, mayor, and thats my completed presentation. The hon. London breed well, thank you, dr. Colfax. I know were at the end of our time here, but i do want to take this opportunity to just speak to the people in San Francisco who are struggling. There are some people who are struggling, who have no paychecks coming in, and its really hard. And what happens, in addition to the loss of your financial ability to take care of yourself and even your family, Mental Health becomes a whole other issue. And it seems as without our churches, our religious services, our ability to congregate and come together with one another, our spirituality as well as our coming together in the world, and our ability to socialize as we do on a regular basis, its almost as if were trading one Public Health crisis for another. We know, for example, Domestic Violence has gone up, suicides have gone up, people are more stressed in trying to figure out what to do with their lives. We see some of the Violent Crimes going up in the city. How do we justify that . The fact is you and i know were going to be living with covid for the 12 to 18 months or even longer, and so this is hitting in various ways as we try and keep people safe