Transcripts For SFGTV Health Commission 20240712

For you. Mark, can we back up to the slides on the reproduction number. One second. Oh no, its okay. Give me just one second to back up to that. Those are very concerning numbers. We see if we reduce the reproductive number by a third, we hold steady at the same number of hospitalizations, but wed still see as many as four times of deaths here in San Francisco. But if we continue on this same scale, we could see deaths up to 800, and number of hospitalizations, 1,000 to over 3,000. That could clearly overwhelm our Hospital Systems. I know weve seen footage of people gathering in dolores park this weekend, and the possible impact that could have. Could you just speak to what kind of effect that behavior could have, not just on our people, but our ability to serve the health care needs. Yes [inaudible] i thi. Dr. Colfax i think its really important that we stay vigilant and do what we know works to stop the spread of the virus. That includes not going to large gatherings, and on beautiful days, when we all want to get out of the house and do things. You can get out of the house and do things, but you need to do it safely. Quite frankly, we all need to be thinking about a situation that could get dire very, very quickly. And, you know, if this curve is actually realized, will have signatu significant effects on the rest of our health care system. This is estimated covid19 possible hospitalizations and deaths. So certainly, we will see, and its been reported in new york, excess mortality, morbidity in other conditions, and i think the severity of these situations cannot be understated. We can still present the worse scenarios here, but again, if we all do our part how many times can you save a life as easily by wearing a mask, right . Wearing a Face Covering. Keep 6 feet away. Even if you get tested, dont get a test to decide if youre going to go to a barbecue or Birthday Party or to that friends house that you want to see close up. Leave that test for someone who really needs it, whether theyre going to work in a highrisk situation. We need to wait for everyone to have access to a vaccine before we go back to normal, and our new normal does need to mean keeping our distance, wearing the facial coverings, and the good hygiene that we talked to you about. I believe the mayor has been eloquent and outspoken about this, and i know that i and everyone join you and the mayor in your efforts to protect our community, so thank you. Commissioners, other questions . All right. So well go onto [inaudible] dr. Bennett, can you pop up your camera so we can see you . Great. I will populate you, and you can introduce yourself as he get your presentation. Hi, everybody. Everybody knows that she is our agency lead at the Emergency Command Center for covid, so thank you for joining us today. Thank you for having me. I think its very important that we stay connected with what the department is doing as a whole. This is part of the departments work, so i really appreciate the opportunity to share with you all. Mark, do i have control or do you have control . I have control, and i have your initial slide up. Hope you can see it, and yes, i did. Okay. I want to frame what were going to go over, and that is a sense of whats happening very briefly with covid. Dr. Colfax just did that. Then, what the unified structure is, and im going to be focusing on where d. P. H. Is in that structure, and fi fina, what were intending or trying to do. Was that to me . I couldnt hear. Its going in and out. I did not hear what that was, and theres a little bit of a background noise. Someone might have their someone might be listening watching and listening on the phone, and there might be two sounds, so if youre listening on the phone, please mute your phone so were not hearing background in your phone. Commissioner giraudo have had accessing, and weve had several people from the public indicate that theyre having trouble accessing. So if youre listening on the phone, please mute your phone, and thank you, dr. Bennett. You can continue, dr. Bennett. Can you see the slides on the screen . I can. Im ready. This slide, im going to skip past because youve already heard it. I just want to give the frame that we are, in fact, testing a lot, having a low death rate, having a much lower case rate than many, many of our compatriots in the rest of our country, and i want to be sure that thats the context with which this is going on because its very complicated, and weve been running at full speed, trying to make sure that we acknowledge for the staff who are listening and for you the effort we put in has been very successful. Go ahead, mark. So where we are, weve been working on making this philosophical shift and in our own minds within the Covid Command Center. But many of us starts in that early phase, somewhere between january and when we shutdown. As dr. Colfax said, we can see the tidal wave. It just hasnt hit us yet. And then moving past that, we moved past very intensive rapid work as we shut an American City down. That was an intensive effort, and it involved a lot of work from a lot of people, making sure that citizens would be okay in their homes, that they would get their food, making sure that the services we would not be delivering to people would be kept up in some way. So we were in that Emergency Response phase. At the same time as were leaving that, sort of, we thought we were leaving it, and now, the current the current increase puts that into question, but the city was ending the phased reopening of thinking that we were going to be, for the next several months, slowly reopening the economy and dealing with the implications of what that mean, what that meant for businesses, what would be available, what services would be spun up and spun down. While thats happening, were going to have to do a sustained response. That is why we restructured under a unified command. That is why we renamed it so that people could understand. In some ways, this is a construction a very Rapid Construction of a new interdisciplinary department, where lots and lots of people contribute, but we are we do have some independence of our own, about our own goals and the things that the command center is trying to do. So that sustained response is going to clearly go on for at least a year, probably longer, and before that, well be back with the needs of recovery, the needs of the city as covid goes up and down. So were entering a phase that covid is not so emergent and trying to enter a phase that is proactive, that is more thoughtful and sustained. Thank you, mark. Continue. So from the Operations Center to unified command. We had lots of Operations Centers for covid. There are Operations Centers in all of the departments. I think there was 21 at one point, but what that means is separate departments, and so to Work Together in such a sustained fashion, we needed to breakdown silos. So one of the things that were trying to do is eliminated duplicative areas, and last, improve areas of collaboration and resource use. We will never have enough resources to lavishly attack this problem. There arent enough tests in the world, there arent enough nurses in the world, and as our economy is slowly recover, its going to strain our resources, so we want to ensure were being judicious as well as being effective. Go forward, mark. So this is a look at our current indicators that youve seen a bit of . I just want to indicate that we are in a phase right this moment where it is still at that emergent level . In fact, this is at an old slide, so for emergent indicators, we are much worse. So we are slowly moving up on all of these, and we expect that we will be in the phase of having to rapidly increase testing, rapidly respond to outbreaks and increasing outbreaks for some time, and this is going to be in competition of a sustained system that were preparing to do. Go forward. So im going to skip some of these slides since youve seen them. Go forward. Go forward. So the unified command is a combination of three departments. So i am the representative from the department of Public Health. Theres a representative from Human Services agency, and also a representative from the department of emergency management. So each of those departments has a significant investment of staff in this response, but they are not the only departments that are involved. So if you look across the leadership, many of those leaders come from those departments, but this leadership would not be here without staff and some of the leadership staff from all over the department. So theres leadership from the police department, from the library, all city departments, who are part of this command. Go forward. The way the command center is structured is a little bit different than the attached department Operations Center . So we have the policy group, which involves Many Department heads across the city and some staff from the mayors office. We have the Department Heads who match those departments, and in addition to that, h. S. H. , because we are dealing with many, many issues around people who are experiencing homelessness, and that boils down to the unified command that i just described . That command structure comes with its own staff, including very prominently, an equity officer, which is an important position. The operation, which is where most of d. P. H. Is going to be, and then planning and logistics. All of those things need to Work Together, and so we are under one command structure so that we can see that integration. Continue forward. I apologize. Sorry for the loud place im in. Theres literally no private place in this building. Unified command includes lots of leadership staff, and that means were having commands from the outside world. The Health Services is led by jenna bolinski, whos from our dsfg quality staff. Community is led by tracey packer, who leads the equity and promotions staff within Population Health, and those folks are under this yellow block under operations, but that means that theyre also overseeing the Human Services, which is doing housing and feeding. [inaudible] within Population Health, and that modelling that theyre doing is both our normal work of taking in public results of Infectious Disease tests, but its also new work that i think is really an advancement of what we normally do in the department, working with outside assistance for modelling and making sure that we are able to project into the future. And that is led by jim marks, who is an anesthesiologist and many others in that structure. Go forward. Ill let you know that all of the guidance that comes out is part of the information and Guidance Group that is headed by reeta nguyen, dr. Rita nguyen, and she is part of Population Health and leads a team of doctors and physicians and they write all the research about what the current recommendations are. That group had been separate and part of the health bridge, and we had moved it over to the Public Information section to make sure that the Public Information that that group is meant to put out is informed by the medical and scientific information and information and guidance is gathering, and that the information and guidance that we want the community to have can be aided by the marketing and media knowledge that is in the joint information center, so were hoping that that increases the transparency and understanding of the publics about the issue that we have. Go forward. So briefly, these are our citywide priorities for this operations period . Our operations periods are a week long . This one started on saturday . We maintained similar objectives from week to week, and we have longerterm goals that we want to achieve, but the objectives for each week are really those of that week and what we want to complete by the end of that week. So these are our priorities that are the longer ones, and we can talk about what the priorities are. So we want to ensure the health and safety of vulnerable populations and essential workers . We want to reduce transmission of covid throughout San Francisco, and that is its own goal, and sometimes reducing transmission is different than some of the the actions that you do for that is different than the others. We used to say prepare for medical surge, but now, were in it, prioritize equity and represent Community Needs in response to planning and implementation. The fifth one is maintain strategic Public Education campaigns that data, response, and public expectations and requirements, coordinate with citywide reopening and recovery initiatives, and planning for and coordinate during multihazard events. The same people that are working are the same people that would respond to a fire emergency, earthquake, so we want to make sure that there are people available to respond to many other events happening in San Francisco. Go forward. So the way those have been transported as very specific objectives and things to complete, and we complete those under the direction of the policy heads. Some of the most recently have been the surge play books which gives Different Levels of responding to the number of cases and hospitalizations within the command center . So it is a way of us being sure what we know at what level our Contact Tracers need to be staffed for the number of cases that were having, but we also make sure we know that for our housing group, our Community Group around communication, so we want to make sure that were prepared for things to both get better and to get worse, because this is going to be a dynamic process. Community neighborhood strategies, and that is how do we partner with communities to engage in services that will help reduce transmission, and how do we partner with community to make sure that they can help achieve the culture change in their neighborhood that needs to happen . So are people wear masks . Are people social distancing . What is need inded in that neighborhood to change that setting . Weve begun assessing last week Face Covering and social distancing compliance in key neighborhoods, showing, really, that were not at 80 in almost any neighborhood and some neighborhoods are quite low, which is good information to have because as we look at where our transmission is high, we can look at changing compliance or mask requirements in those areas would something to do. We need to fill our coffers with people who can respond. We were expecting to have surge somewhat in the future, so we thought we had time to address those into the futures, and the last is the testing strategy team, and we are building it with other clinicians and operational staff to help determine what the citywide strategy will be and to monitor that. D. P. H. Is doing quite a lot of the testing, but the Decision Making around that and who participates is going to have to expand in order to be effective. So how do we do that . Who is doing what, and who is needing to be encouraged, and what the state of the art is . How do we move to the next thing, how do we improve our responsiveness, and how do we stay aware of what the technological limits and opportunities are . One more. Go ahead. So i want to be sure well speak about equity. Well speak about it more when we have the resolution, but the things were trying to make sure were achieving is community collaboration, make sure its more than informing, where Community Voices are impacting the decision we make, and that is not just an altruistic act, its achieving behavior change and things that we need to participate in if the community is leading them. The neighborhood change has to be built with the community. We need community to be part of that, and that needs to be equitable, where were listening to the voices of the people most impacted. We need behavior change, so because were told by an authority that something has to happen, it has to happen within the culture, and then, we need that infrastructure within. Just as we decided we need infrastructure within the department of Public Health, the city has decided it needs infrastructure, and we need infrastructure here, so we need someone in equity, someone who is really responsive when Community Feels we are not keeping our eye on it. Last one. I just want to be sure that everybody understands that geography. At the above, youre seeing tests per 1,000, which is quite high for San Francisco. It does vary, but its quite high for some groups and quite low for others. There are some groups on the high end that have a high number of positivity, and those are the neighborhoods that we need to focus on. When everybody was sheltering in place, that was not as much of a priority. We have a risk of neighborhoods based on the covid geography that need special attention . And that is because of crowded housing, low rates to health access, food insecurity, transportation access. Those are all things that either make you live in a house where transmission is more likely to occur. All of those things make you more likely to get covid, and the existence of one or more of those things makes it more likely that people will get covid. I just wanted to give a little bit about equity of d. P. H. Since i am not there. I just want to show you that the office of equity does still exist. So we are adding a manager of Workplace Equity that was already planned, and we were continuing the learning series. The equity learning plan is on video, and were hearing its a positive things. Weve designated area leads in various areas of the department and still convening the equity champions . Planning virtual versions of the equity fellows, which was going to be the purpose of eng witness training for management. Announcing the equity learning department for h. R. Were going to have four hours of training required, and going to designate trainings that can be used for that requirement, and its over the whole year. The area equity leads are still there. Theyve just started a program. They are having specific area goals, and theyre continuing to develop programs. Today was the launch of the 21day equity challenge, which was asking people to learn a little bit of history or practice a thought or activity that might help them in their development of an equity lens, and then, we have an Online Training thats specific to the background of Health Equity that we think Everybody Needs to have. That should begin in the next month. Yes, we are at the end. Thank you very much, everyone. I am perfectly open to questions about both what i did say in the structure or perhaps things that i did not outline, perhaps questions about how the command center is functioning. And commissioners, if i may, you all went right to questions without asking for Public Comment, so commissioner bernal, is it okay if i check for Public Comment. Araceli, do we have Public Comment . Yes, we do. Ill go ahead and pump in the first call. Thank you. And callers, you have two minutes, so once you start talking, ill start the timer. Are you on . Hi, yes. My name is juliana morris. Im a doctor at San Francisco general. Im calling to ask the Health Commission to take action to support the growing movement to remove the s. F. Sheriffs department from the department of Public Health and the hospital. Law enforcement is not the appropriate Security Service for health care spaces . In fact, Security Services didnt even enter hospitals until the 50s and 60s, coinciding with backlash during the Civil Rights Movement and hospital desegregation. The racist roots of this practice are clear. We want deescalation Response Teams that are skilled in traumainformed care and are able to help people in crisis and not in need, not just eliminating the threat. We want the 20 million in the d. P. H. Budget for the sheriffs to be redirected to building these teams and into things like housing and Mental Health care that will reduce the number of crises at the d. P. H. Sites. Of course we realize that the department is dealing with a lot right now and multiple pandemics. We cannot wait to address the pandemic of racism, and if covid has taught us anything, its that we can make changes when we have an urgent need. So im asking the Health Commission to cancel the m. O. U. Between the d. P. H. And the sheriff, create a committee that will provide oversight and help develop these alternative systems, remove the funding from the sheriff and invest in True Community safety. Thank you so much. Thank you. Araceli, is there anyone else . Yes, we have four more. [inaudible] oh, welcome. My name is glenda barrows. I work at San Francisco general. So im calling in support of making racism basically a health issue because i believe it is, so im in total support with Diana Bennett and what shes putting forward. But the other thing that i want to talk about is i also was listening on the employees, and i was a little bit upset they want to talk about at the same time praising all the work were doing, what a wonderful job were doing, were all putting our livies at risk, bu at the same time, they want to pick our pockets. I want to let you know, im a union person. Thats the part they didnt tell you. There is no Employee Group that i know of that is willing to come in and give up our wages. Now some people are willing to talk about other things, but ywe dont want to calmly give up our wages. Also, on the covid and the testing, they saw your new policy that weve been doing that weve been getting complaints about, is that people getting tested, theyre not getting sent home, theyre being told to go back to work. And particularly at San Francisco general, people were testing positive, and then, they were exposing other people. The workers have a problem with that policy. We really want you to look at that and see if something can be done about that because we dont feel like if somebody gets tested, even if its random testing, they have an accurate test that can be done in 24 hours, theres no reason that person cant be sent home for those 24 hours. All right. Your times up. Thank you. Okay. Ill get the next caller. Thank you. My name is andre johnson. I am a social worker with the San Francisco department of Public Health. Im calling to declare my support before the Commission Im sorry. I apologize, i know your comments are important. This item is not the resolution. The resolution is going to come in two items, so if thats not your Public Comment, could you please hold it . This is about the covid update. Okay. Thank you. Okay. Ill take the next caller. Hello, caller . Is there someone there . I can just come back after the next caller, then. Great. Thank you. So just to make clear, this is a covid19 Public Comment. Theres general Public Comment coming up, where you can talk about anything, and then, the resolution is the item after that. Do we have a caller . Okay. Caller, are you there . Thank you so much. Hi. My name is camille, and im calling from Mission District 9. I listened closely to your earlier presentation, and i really appreciate that there is such a strong focus on community and neighborhood strategy and that there is so much equity work thats going to be done. But i am calling because i recently learned about the amusing efforts about the latino task force. Im not with them, and i dont represent them in any way, but they requested 1,000 tests, and they were given 100, and eventually given only 200. We are the center of the covid outbreak in San Francisco. How short on tests are we . I know it was mentioned earlier in the presentation that there was a shortage, but if were one of the most vulnerable neighborhoods and were being underserved by almost 80, 90 , i want to know why that is so. I also know when i go online to get testing from covid sites, many sites are slowly disappearing. The fillmore sites has disappeared. I know that Public Health is an initiative, but im looking for those initiatives especially as a part of the mission community, so id appreciate it if someone could address that, as well, today. Thank you. Generally, just for all of you to know, in terms of Public Comment, Public Comment is always welcome, and the commissioners truly take it to heart and listen to you. They dont always respond, but they will address the issues that they feel are appropriate in discussion and asking the d. P. H. Or other staff to address the issue in a future meeting. Is there another caller . Okay. Ive gone and muted the caller before, so caller, if youre there, your turn. Caller, not able to hear you. They are having some issue. Okay. So in that case, that is the end of the queue. Thank you so much, araceli. Commissioner bernal . Yes, thank you. Dr. Bennett rngsi apologize fo giving you three titles in this meeting. I have a question. The first one is in terms of operations. Although i understand its a coordinated command center where coordination is really key, there are some different roles that the agencies still play, and my question is for those not in housing or unsheltered . How is that delineated. I know that some are for health care and frontline workers, and others is for homeless. So how is that prioritized for hotel space and then helping them get into hotel rooms or whatever shelter is available . So Human Services is the department designated for Emergency Services . So it is h. S. A. That is in charge of housing. They are also undertaking feeding and other things to serve people, but the housing does live there. The h. S. H. , they have services for people experiencing homelessness in particular, or a combination of h. S. A. Or h. S. H. , so the combination of those two agencies together collaborate make sure thats happening. Theres efforts happening on a larger city level. It is happening within the command center, and there are two balances to that. One is sheltering in place so they cant be outdoors, and the second is the vulnerability to covid so that is how that prioritization has been made. If youve been noticing, the c. D. C. Has changed their prioritization more than one time as the information about who is vulnerable to covid has changed over time as we learn more . And so the Health Departments role is to help the other Agency Social security understand whos at risk and how much risk, and the ways to do whatever theyre going to do as safely as they can. Were not the Decision Maker about how housing is done or who gets housed, but i think were a very important collaborator in making sure that it is done in a way that is promoting the overall goal of protecting people from covid. And those priorities also include workers who are frontline workers or essential workers or are risking exposure and then might be at risk of exposing members of their household, correct, for housing or hotel rooms or other things. Hello . Dr. Ayanna dr. Bennett. There are testing for health care workers. Those things are advised by the department of Public Health. Testing is something that we have much more control over. The housing is done by h. S. A. And done with other things that theyve been asked to provide, so i cant speak exactly to that program, but yes, that is one of the higher priorities is protection of essential workers. And then just one other question with regards to the mask compliance study, which seems to be a critically important effort. Once you gathered the numbers, what kind of strategy would you engage the communities in which were not seeing the level of compliance that we would like to see . So that is one of the things that we need to build communication in levels of communities for. Knowing that people arent wearing their masks, is it selfprotection, is it family protection, is it something at their work thats preventing them, is it cost thats preventing them . We cant always answer those without real collaboration from people who are part of that community. The second reason we need community is to find out how to reach the people bho need to be reached both with the messages that we need help with the effective messaging, but those are things we need to understand, perhaps theyre not getting our messaging, and then providing the mask, providing policy around workplaces, and that is the problem. So understanding the problem and then using all of our levers, communication, policy, legal resources, and all of the various things that the community can provide. Thank you. Commissioners . Mark, do you see anybody . I cant see. Dr. Chow. Dr. Chow. Yes, thank you, dr. Bennett, and a very excellent discussion, also, of the operations. So i have two questions. One, as you have people who are from the people who are like yourself, also critical to the mission of the department, is this a fulltime type of allocation and then, you have other people and youre working double time . How do we cover key people who you have listed who are really great, and thats probably why theyre selected for the covid collaboration . So the really difficult job of finding out how to do an entirely new operation while continuing our operations, which are critical, we do things that just cant be stopped and it has been a challenge. It has not been an easy thing to figure out, but i do think we have struck a balance between maintaining operations, and that has been done by returning people who were here and replacing them with contractors or others or shifting that work to another department, but also by integrating the work of covid that people are doing in continuing operations . So for example, environMental Health has people here, and the work that theyve been doing has been added back to their work. Other people are being backfilled. Like myself, the manager that im almost done hiring will be carrying a lot of the office of Health Equity, and that is similar for other departments . It is very unusual for somebody to be doing more than this job. It is not only all consuming, and we have gaps that still havent been filled, so we dont have more staff than we can use, but the other is things change so fast. If youre off doing Something Else for a few days, we have made critical decisions that you are very behind on at that point, and just the circumstances change. We have resources, and then, the lab doesnt have resources anymore because we cant get reagents. So various things happen that are out of our control that we need to respond to. When we need someone, they need to be there. They cant be dipping in and out. There are some that are doing other things, but that is not common. We are mostly making arrangements with the network, with Population Health on how they can maintain operations as best possible while also people going to the command center to do this operation. Well, very clearly, it is a really challenging, and as other commissioners have indicated, really grateful that people like yourself have really stepped up and continue to do, as you say, the work that has to be done, along with the very key work, and congratulations on being head of this program. One question which is more technical has to do with the testing strategies. And your chart was great and sexu certainly keynoted on some of the areas that were concerned. On the other hand, you also pointed out that you were interested in reaching other vulnerable populations which are kind of a potential tinderbox, and im glad that you mentioned chinatown right now. Its a very low number, and some other asian populations out in the sunset which arent being tested, but we dont know that. What is your testing strategy to figure out a priority, and that came from one of the questions that we heard from the public that says you would allocate precious resources, knowing that it would go to high intensity areas that weve been talking about in the latino population. They could all go that way, and then, we would be in a fix, so what kind of prioritization allows you to say youre going to continue working across the board and make sure were testing prepare to make sure that some sort of outbreak is occurring that we dont know. So that was a good question, and i think im going to try it. We need to find the virus, isolate people to find the transmission. The second thing is to understand where the virus is, which is a little bit different, so that means were testing in places we dont necessarily already know we have a lot of cases, and we are very much trying to figure out how to do both, but our resources are not expansive . Despite doing 60 of the testing of the city, we definitely need to keep some kind focus just because we cant cover the board with resources equally even if that were the right thing to do. We just couldnt do it. We dont have the resources. In particular, in the last two weeks, i dont know if youve noticed the articles in the news about quest and labcor, the two biggest labs that lacked critical supplies. Well, that rolled onto the department because we have our own labs, because we did have the capacity to do our own tests, but then, everybody who wasnt able to do their tests somewhere else rolled into the county. So it was very hard to control the amount that went to our own labs, and we backed ourselves up by an enormous amount. So we cant always know what we have available, and sometimes what we thought we would have available suddenly is not available. Its just an unfortunately uncomfortably dynamic process of thinking you have things when you dont or not knowing where its coming from. But we absolutely have to get people in the communities where we know its the most commence to be in the conversation about where we test. What we need to do best i think is communicate what the total pot is . So the total pot that day was probably 1,000 tests all over the city for us, so we need to be able to tell people how were distributing those tests, and we need to get partners to do the testing. For example, weve had a partnership with Chinese Hospital to do testing at some of the s. R. O. S, and well be continuing that partnership. We had a Similar Partnership at bayview health, and that helps us extend our reach . We are covering the lab process for Chinese Hospital. We are delivering the supplies for bayview Childs Health and mission neighborhoods, so were trying to do what we can to make sure that someone is covering the needs of that area, and were getting the data that we need to understand where we should be. But its complicated, and the data is not always consistent from week to week. I appreciate that, and i appreciate the perspective that youve given us to talk about the challenge and obviously the reason why you calls this week for everyone to really step up and run it through their own channels. Although as you know, they are also backed up with the same thing, and we have this same complaint even locally of trying to get test results in the last five to seven days. I know you were very busy and hadnt been at that meeting, but had expressed the same frustration at the board meeting. I think its helpful to understand what youre facing, trying to allocate these tests. So again, thank you, and well continue to watch that with you, and hope that the curve started going down in positivity and hope that they [inaudible] it is here, so thank you. Thank you so much, dr. Chow. Commissioner christian would like to make ask a question, and shes on the phone, so im going to pop you up, dr. Bennett, on the visual, and commissioner christian, please feel free to speak. Thank you, mark. Dr. Bennett, im very pleased to be able to be here as a new commissioner to hear your presentation, particularly as it pertains to the equity aspects of all of work that you do, so im very much looking forward to learning more and working with you and hopefully being some assistance to you. I just have it may be an impossible question to answer, but what is the out loom frloo your perspective from seeing the availabili what we need to see in the availability of testing . My understanding is its constrained in large part by a lack of resources, a lack of testing kits and things like that, but what is your sense of the outlook for there to be some real improvement after the mayors call for private providers to be more involved . I am hopeful, but as commissioner chow said, they have challenges that are similar to ours . I think none of us fully understood how interdependent we were. I think in arizona, demanding tests would roll to be a problem for us in San Francisco, but that is exactly what has happened. Our National Infrastructure for the production of the things that we need is just not strong, and i dont know that we took advantage of the time between march and april when we were so desperate for swab. We would have given anything for swab from anyone, and it was really hampering our efforts. Im not sure that anything was done between that period and this period, except that fewer people were needing tests in some places because now, it feels like were very much in the same place, where there arent just the strengths of procurement that you would want. We are at a much better place internally. We have good systems, we have multiple suppliers. Were certainly not standing in the place we were before, but i dont think its been fixed, and im not sure how much we ourselves can fix about where reagent is produced or not produced. What weve done is expand our capacity so that were less dependent on other people . Weve increased lab staff and lab hours, but even that will have its limits, you know . Theres only so much available to buy, even if you have the increment funding to buy it. So im hopeful that there were improvements made, but as entire states have tens of thousands of cases a day, i dont know that the system can withstand that happening so many different places. You know what . Thank you. I understand what youre saying, and its helpful to know a little bit deeper, have a deeper answer. Is there and again, this may be something that you cant answer, but is there any capacity for california as a state to reach internationally to places that may have more maybe producing more testing kits or are we already doing that . Do you have any sense of that . We were definitely attempting to do that as much as possible earlier in the pandemic, when we had the most critical shortages. I actually dont know the answer to that from the states perspective. Dr. Colfax, do you have an update on that . I dont have an update from the states perspective. I know what they were saying earlier. Thank you both. We should all advocate for them to do that, though. I see that commissioner guillermo has a question. Thank you, and thank you, dr. Bennett, for your presentation. Im adding my gratitude and concern for everything that you and your colleagues in the department are doing. Just listening to the answer to the last question, you know, brings, mo brings more detail to some of the generalized challenges that get reported in the news and such. And so i think the level of detail around all the things that need to be coordinated, and all the things monitored is something that the public needs to understand better, particularly with these relationships between the department and other providers in the city as well as other relationships to the state. So it goes to one of my questions around it, your indicator chart in your presentation. So when we talk about different things, the p. P. E. At 89 , is that a a number that includes all of San Franciscos Work Health Care workers or is that particular to what you know about that exists within San Franciscos own network, and is that the case with some of these other indicators . I know in terms of populations and some of these other things, thats citywide, but i wasnt quite sure about some of these other indicators. So some of the indicators are particular to not not always the department of Public Health but to the city and county. So the Contact Traces are ours. We dont know we dont count whether or not other people are doing Contact Tracing because, for the most part, we are where the buck stops on that. The same is true for the p. P. E. , except to expand it. It is absolutely the p. P. E. For our hospitals, and we are clear that has to be tracked very closely. We got down to very low numbers at some point during this pandemic that no one was comfortable we would have what we needed, but were not there. We have really good supply lines, and weve managed to stay above 90 until recently, when things have started to become a little harder, and i assume for the same reason, we see hospitals in texas and arizona and florida increasing their demand. We are only tracking the p. P. E. Thats being used at our own hospitals and clinics and what is being used by all the other city and county employees because we have masks and gloves and other p. P. E. On all of the people in our hotels for isolation and quarantine, for our police officers. We have p. P. E. Needs all over the city and county as City Employees interact with the public . And so the command center does hold all of that. Thank you. And so, you know, just in response to that, when i think about the concerns we have about the decreasing supply of p. P. E. Or the decreasing supplies that we need in order to be able to see the testing and such, whether sharing the data with other providers in the city, somehow coordinating that, if its possible, through the department or in association with the Hospitals Council or is that just beyond something that we can do . And i ask it because similar to or related to the question that commissioner giraudo asked, private schools having a different messaging than Public Schools in San Francisco, those residents of San Francisco who are more in tuned with the private sector supervisors versus the Public Health, we are all still living in the same city and subject to the same risks, and so i just dont know whether thats something, a centralized command, whether the department is telephone is able to get a better handle on it. I think i understand your question, but correctly if i answer it incorrectly. So we have had, i think, really remarkably close connection with the other Hospital Systems throughout this pandemic and some of the community providers, and one of the things that i think is great evidence of that is that we have been able to support each other through what were the critical days of p. P. E. For everybody. When we ran slow, d. P. S. Gave us some, and when we had extra, we helped other departments. So that has really saved us from some bad outcomes that would have happened at some of our sites, and thats going to be true as hospitals get more and more full. Our surgery capacity is shared, and i think thats an advantage that San Francisco has. In terms of being able to coordinate across the board, i think it gets more and more difficult the more actors were talking about . It is very difficult on the private provider side, and that is just bandwidth . Theres only so much in the command center partly because of what dr. Chow pointed out. We are trying to put people back in the department to run the department, and the same is tr true, now that were open, for all the other departments. So we are having to prioritize and marshal resources to the places that have the highest priority and the biggest impact, and that has been the hospitals and other entities around the city that are doing health care. The s. N. F. S, we helped them when they ran low because it would be devastating if they ran out. Those things have been done, but it hasnt been across the board. Thank you for that. You know, i ask the questions because its that level of detail that were not as aware of, and i do know we have through the command center and through the hospital council, done as much we can to coordinate. But the longer this lasts and the more complex it gets, the harder it is, so its maybe just more of an update of what else can be done to continue to update and Work Together very closely, so thank you. Thank you. We do have calls with all those entities, so we do have regular communication . I think establishing those lines and structures will serve us. Itll get more complicated, but i think weve put some things in place thatll help us weather that. Any additional questions, commissioners . Commissioner giraudo or christian, any other questions, because we know that we cant see you. This is susan christian. I do have another question. You know, for dr. Bennett and dr. Colfax, are there things i am very sorry. This is i just got an emergency text. Something has happened to my son. I have to go. Im sorry, grant. Can you thank you. Yes. Absolutely. Dr. Bennett, please let us know if everythings okay. Thank you. Okay. Thank you. So just a quick question. Are there things that the city and the department can do to help san franciscans focus on some of the things that we that are within our control about things that related to our health that bear upon being vulnerable to covid and other respiratory illnesses, i things that we do that at least help us try to be a little bit healthier . I dont know if theres p. S. A. S that the city is doing or positive Health Behaviors that we can, you know, encourage that we can educate ourselves about and encourage all of us to do . So thank you, commissioner. I do think that the things that we can do to slow the epidemic are the prevention activities. The facial coverings, the social distancing, avoiding crowds. The other piece in terms of the testing challenges that we have is supporting a message that, you know, people shouldnt get tested in terms of something thats not necessary when were sheltering in place. I think people may be testing, you know, to go to that party or engage with other people in ways that are not safe. We know if a test is negative, you can catch covid19 right after that and transmit. I also think that theres some positive messages aboin commun engagement in social distancing and facial coverings, and we all need to do our part. And i also hear the broader issues around health interventions, and thats something that people need to know, that its always a good time to quit smoking, and this is an even better time. Were also really aware of the Behavioral Health effect of the shelter in place and the pandemic. As the commission heard i believe the last time we met, theres work going on on the Behavioral Health side, as well. I think that the the key pieces are really ensuring that we are supporting people in these prevention activities that we know work, and also acknowledging the fact that some people cannot take these precautions, and that is that in some ways, the inequities that we see where people have to go to work to make a living, that we protect workers, and that we support the workers and their employers in terms of making sure that there are Safe Environments for people to work, and Safe Environments for these preventions to work and thats sustainable over time. Im not sure that that answers your question, but let me know, commissioner, if theres more details that you require. Thank you, dr. Colfax. Dr. Christian inadvertently hung up, but she did let me know that she had no further comments. Dr. Tong has her hand in the window. Thank you, dr. Colfax, for this important update. One questions that popped into my head right now, its about medication refills, like, for our population to have, like, different Chronic Health conditions. Do we know if they have trouble, like, going to a pharmacy to fill their medication or do we actually have other megnism in place to make sure that, you know, they you know, like, they get their refills on time . So absolutely, commissioner. So i dont know if dr. Hammer she was with us earlier, and she can talk a lot she can add detail to what the ambulatory care people are doing to ensure that people are getting the medications that they need. Dr. Hammer, are you still yeah. Hi, this is holly hammer. Are you able to hear me . Perfectly sk. Okay. Hello, commissioners. Commissioner tong, in answer to your question, right from the beginning, we have been doing outreach to vulnerable communities that put them in at risk of covid. Weve had teams within our clinics, both the primary care providers and their teams, and even some teams at ucsf working with faculty and csfg doing outreach to make sure that people are getting their medications. The pharmacy, notably the csfg pharmacies, and other Community Pharmacies sprung into action to bump up their ability to do deliveries for people so they dont even have to go out of their home during shelter in place, they dont have to go out of their homes to pick up their medications. Weve been getting them their prescriptions in, even if were not seeing them in person, and their medications to them. Thank you, dr. Hammer. I have a second part to the question. Like, for some of our patients who have, like, Chronic Health conditions, like, hypertension, how do they actually get their Blood Pressure monitored at this particular time . Would you like me to take that, as well, dr. Colfax . Yes, please. Okay. Yeah, and here i am. Sorry. I thought you were able to see me, yes. So as far as selfmonitoring, and most notably for those things that we can give people equipment so they can selfmonitor at home. Blood pressure or a sugar monitor for people with diabetes. Weve had a big push over the past number of years as part of our Population Health management work to get Blood Pressure cuffs in the hands of our people who have uncontrolled Blood Pressure or people such as our black and African American patients who are at risk for coronary Artery Disease related to their high Blood Pressure and other things. So we have gotten and working with the San Francisco health plan, weve had pretty good access to Blood Pressure cuffs, and then, we have teams that will periodically take their Blood Pressure and periodically check in with them to get their results. I wouldnt say thats the majority of people with high Blood Pressure, diabetes. We just cant get the machines or the teaching into enough peoples hands. But for those who are checking their sugars or their pressures, i know that thats just routinely part of our telehealth work. [please stand by] f [please stand by] caller. Are you there . Hello . Yes. Ill start the clock. Hi. My name is alicia and i am a nurse. I am calling in to first urge you to adopt the Health Equity resolutions to declare antiblack racism a Public Health crisis. I also wanted to advocate for an even more concrete measure, and thats to remove the Sheriffs Department from the San Francisco General Hospital. The need for this really struck me personally when i was facetoface with one of the sheriffs deputy who verbally abused and pointed a taser at a black patient while they were interacting with their care team simply because they entered the clinic late after hours, and so for me that really drove home the need for an alternate Security System that is not the sheriffs or sfpd. Increased access and extension of an already existing behavioural Emergency Response team that can provide skilled appropriate response to behavioural incidents. I think this can make a big difference for Racial Justice and quality patient care at the clinics, and i think its better for safer alternatives. Thank you. Thank you. That concludes the queue. Great. So lets just check in. Commissioner brown, shall we skip item six as we get organized and go to ems or go ahead to the resolution . Umm, i would suggest that we ensure that time is taken to do whats needed and we could go to ems if staff needs dr. Bennett or staff need to come back a little later. All right. Can i just dr. Bennett is getting more information and is hoping to be able to rejoin the meeting. Were not certain yet. So it may i just wanted to give you all of that information. I also just wanted to acknowledge the leadership at the Covid Command Center and the rest of the dph team that are there every day going into this six months. Its been really inspirational and also acknowledge the people across the department who are doing things like commissioner chung was mentioning, making sure people are getting their results, doing things like commissioner christian was essentially making sure we continue our prevention activities, and i just want to acknowledge the work thats being done across the department, but also within this new integrated almost not officially but acting in this new integrated system for pandemic response. The center is really a great place to visit and i would encourage the commissioners to stop by in a socially distanced way if you would like to do so. Thank you. All right, thank you. Dr. Colfax. So i have heard here im going to put myself on camera so that you all can see. I have heard from dr. Bennett, and shes actually not going to be able to join us. Shes going to be driving. We have instead underwood who is going to introduce item six, the Health Equity resolution declaring a human right and Public Health crisis in San Francisco. Welcome. Thank you. Mark, and before we go to her and welcome niesha, i just wanted to quickly state that the Health Commission considers this health res laugs of the utmost importance and we are pleased to consider this after action that had already been taken by the Human Rights Commission in San Francisco and the chair to address structural racism. In keeping with the commission and the departments mission, we have focused our resolution and most of the resolved statements on Public Healthrelated actions and activities within the dph that could be monitored over time. The Health Commission will continue to address other Health Equity issues throughout the year through discussions, relevant issues at our meetings and considerations of future resolutions, and i would like to offer special thanks to our commissioners for their thoughtful review and contribution to this resolution as well as sfdph staff, dr. Bennett, director colfax and the city attorneys office. So thank you very much. Thank you, commissioner. Thank you, commissioners. Id like to take the opportunity to introduce myself. My name is niesha underwood. I work for Population Health division for the community Health Equity and Promotion Branch where i lead our branchs Quality Improvement work and some of our integrated hiv, std and hep c work. I am also going to introduce someone from the Human Rights Commission, the acting chief of staff there, and we are both members of megablack ss. Im going to turn it over to her to give a little more context around how this resolution was born, and then ill speak a little bit more after her. Brittany . Thank you so much, niesha. Good afternoon, everyone. Thank you for the Health Commissioners for considering this resolution. My name is brittany and i serve as the acting chief of staff at [indiscernible] Human Rights Commission. Im also a proud Founding Member of megablack ss which is a collective of black individuals and black organizations serving black san franciscans. Initially it started off as a Covid Response group for the black San Francisco community because black people were being erased from the public narrative of covid. [indiscernible] populations that 10 of covidrelated deaths is in fact getting a lot of air time, so [indiscernible] amplify this and other truths of covid as it relates to the impact on the black community of south africa. Megablack sites visibility, [indiscernible] dignity and justice for san franciscans under the banners of housing, economic power and health. One way that were doing this work is by amplifying the many ways in which antiblack racism manifests in San Francisco, from antiblack racism in the workplace and overpolicing and racial violence against black people. Im here today with my colleague as coauthors of the resolution before you. Ive noted in the resolution antiblack racism is hostility towards, prejudice towards black people and culture manifested through individual internalized interpersonal and systemic interactions, decisions, processes and outcomes. This resolution is an [indiscernible] yet not exhaustive list of the many ways in which San Francisco has harmed and failed black people through bias, racist systemic practices with disparate impacts. Its intended, the resolution is intended to uplift the truth that racism, not race, is the driving force of many of the outcomes and indicators that government and particularly Public Health bodies have attributed to individuals and demographics for so long, and its past time that we acknowledge our role in creating and perpetuating the experiences for such a small slice of our population. Ill hand it back over to niesha. Thank you. Thank you, brittany. As brittany stated, that this resolution was born out of megablack ss, and so megablack ss has is made up of many subcommittees of which Public Health is one, and i am one of the leads in that committee, and we thought it was important to act on this right away and be very explicit around what we were putting forward. So not just to say racism is a Public Health issue but to really be forward and be explicit around antiblack racism is a human right in Public Health crisis. It was important to do so in the climate and do it now due to the pandemic as well as Police Brutality which affects black people gravely. We are dying at disproportionate rates of both. This resolution includes data pertaining to all of the social determinants of health and how black people in San Francisco have been impacted, how racism is a driving force behind the social determinants of health, and a huge barrier to Health Equity. This resolution, as the commissioner has already stated, discusses what dph has done and activities planned moving forward. The data in this resolution only touches the surface of what could have been included, which is very disheartening. Our mission as a department of Public Health is to promote and protect the health of all san franciscans, and we strive to continuously answer this question, are we better off. Until the narrative shifts for the black people in San Francisco, and until black people are better off, no one is. Lastly we know that this resolution will not dismantle the systemic racism that exists, but let this resolution not just be rhetoric. Let the resolution be a way to hold us accountable, to do better and to be intentional around the health and wellbeing of the black people here in San Francisco. Thank you. Thank you, ms. Underwood. My understanding is that director davis from the Human Rights Commission would also like to speak. Im not sure if thats audio or visual. Im not sure how that connection is happening. It would be audio. Im trying to determine which of the numbers shes calling from. Im sorry, everybody. Were doing this kind of haphazardly because of dr. Bennetts emergency. So thank you for your patience. Mark actually dr. Bennett is on the line with us, everyone. Hi, dr. Bennett. Hi, dr. Bennett. I feel like a celebrity. Welcome back. Thank you. I am really happy that director davis is calling in. I really just want to punctuate, and im not sure the way that i intended to, that this is a connection between many different entities that are going to be needed to make this effective. So the department of Public Health absolutely plays a role. Weve been on this journey for a while with the initiative and with our own office of Health Equity and the various Health Equity infrastructure weve put in. That is only going to have so much impact because the reason we know racism impacts black people in particular is because it is part of the structure of the way our society works, so being able to have all of those things, like housing, wealth, education, paid attention to while we focus on health is the only way were going to make forward motion, and that needs someone like director davis at the Health Commission sorry, the Human Rights Commission, along with other staff, brittany it also takes all of the Community Members to move this along. We need the things to change the impacts of health. We have a limited on what we can actually impact, and so we need to do our part, but we also need to partner with all of these other actors in the field to say that we want systemic change, that we can only partly do within the department. We can do that, but we need to be a partner for getting the community thats really going to affect things. Is director davis there yet . Well be right with you. Thank you for your patience, everyone. I want to say one thing while were waiting for her. I was on the phone at the beginning when naiesha was speaking, but i want to acknowledge all the Staff Members that participated in this. That includes a large number of people who have been working on equity for a long time. I want to acknowledge vincent who has been a real link between the department and this work and i think has really carried the departments role in this. I just wanted him and brittany to be acknowledged for speaking for a large number of us in order to make sure that we were included in this. And i also want to acknowledge listing names for the work that we did with covid, but sort of informs this as well. While dr. Davis is calling in, i wanted to actually ask for the commissioners to please consider an amendment, so on page 1, paragraph 5, the whereas clause on intersectionality was not in our original document. It was put in without our advice or consent, and so if its going to stay in, we ask that you please remove the word may after black individuals on the third line. I wanted to call in and recognize brittany and naiesha for their work and elevating the Community Voice. And just want to thank the department of Public Health for the ability to partner and collaborate and to take it another step. We initially just thought about doing a joint resolution, but really grateful that dph and the commission is really interested in going deeper, and i know brittany and others have had conversation with community as well as supervisor waltons office, and im just really excited about the movement and the ability for city systems and system leaders to really step aside and support Community Voice and thoughts and to really start to name and call out the challenges that are impacting health and safety and wellbeing here in San Francisco as well as around the country and even the world. So thank you all so, so much. Im really, really grateful, and just kudos to naisha and brittany and for their leadership and taking this on and really just pushing it forward. Thank you so much. Thank you. I forgot one person whos been instrumental for all of the equity work at dph but was actually involved in this as well. Veronica shepherd is our link to our stay safe community, to all of our work with the black African American i just want to make sure that she gets acknowledged too. Were pleased to welcome you to the commission, dr. Davis, so thank you for joining us. Truly, truly my pleasure, and you all have our former chair who we miss very much on the commission now, and so congratulations, commissioner. And to all of you, its great to hear your voice. I was like, is that dan vernal . Thats amazing. Good to hear your voice too. I know we go to Public Comment before commissioner questions, but procedurally a commissioner needs to offer that amendment to remove the word may from the fifth clause, i will offer that amendment. Thank you, sir, and it would be best procedurally to go to Public Comment before you get into action, but we can note, unless you want to carry through and get a second on that so at least have it there. I will second it. Thank you. I have another question, mark, procedurally. If i actually have additional amendments to that particular whereas, should i offer it as a friendly amendment or should i wait . So i think this is a bit of a soft procedural issue. I would recommend that you all take Public Comment just so you can honor the fact that people are there and that may inform your discussion and your possible amendments. Not that you dont have [indiscernible] but that could help you all strengthen how you move forward. Does that sound okay to you all . Yes, mark, thank you. Okay. Is there Public Comment . Yes, we have five callers currently. If you wish to speak, please press star 3. Ill take the first one now. Welcome. Yes, hello . Hello. Im going to start the timer. I just want to say yeah, i just wanted to express my support for the resolution to declare antiblack racism as a Public Health crisis. I think its well overdue that this at least gets some recognition, and i would like to point out,this issue intersects with the homelessness crisis thats rampant in the city. Just sort of, you know, increasing all over the country. I would like to express my dismay with how the dph has handled in specifically commissioner jaragone has been able to hotel rooms when he had it. Unfortunately thats expired, from what i understand. You know, i think we should still pursue whatever means we can to put our unhoused neighbors into those rooms, Contact Trace where we can, and really nip this pandemic in the bud where we can, especially for our most vulnerable. San francisco is watching, the whole bay area is watching, so please address this issue with the importance and the gravity it deserves, especially, you know, with our neighbors in the streets. I mean, this virus is jumping around, and we have people who are just there who are targets, you know, to this airborne virus. Thats it. I yield my time. Thank you. Thank you. Is the next caller on . Yes, hi. I am calling from district 7. I want to just reiterate what the last caller said. I completely agree with the resolution to declare antiblack racism. This is very small stuff. This is the lowesthanging fruit that we can take. In condemning systemic racism. Of course its not nearly enough, but i really dont see why this is not a common resolution, and again, [indiscernible] this ties in neatly with so many other bigger issues hah affect black communities and communities of color, such as housing insecurity, and i am also [indiscernible] the fact that the director has this awesome power to commandeer hotel rooms and institute some of the most Vulnerable People off of the streets, and you know, house and whats happened with the virus. Right now were seeing [indiscernible] nobody doing anything about this. I think covid, not just people with titles in their name. There are people who [indiscernible] its for everybody. Public servants, its your duty to ensure that [indiscernible] people continue to be in the path of this virus, the rest of us are [indiscernible]. I really hope that they will do the right thing and use the powers to [indiscernible] i yield my time to the next caller. Thank you. Is there a next caller . Thank you, listeners, for this opportunity thank you, commissioners, for this opportunity to speak. I am a social worker San Francisco department of Public Health. Im calling today to voice my support for the resolution before this committee to declare antiblack racism a Public Health crisis. The problems must be addressed by a fundamental redistribution of resources in all portions of society, including health care. If this committee is committed to ending antiblack racism and the department of Public Health and the racist institution of policing and invest in the health and safety of black san franciscans. In 2002 this Health Commission passed a resolution. The commission cannot continue to address antiblack racism while spending 20 million a year by paying a department to intimidate and terrorize our patients. [please stand by]. Hello . Okay. I can move onto the next caller. Okay. Thanks, araceli. Hello. Hi. Ill start the timer. Hi. Yes, my names brenda, and im calling again, and im calling representing the San Francisco black leadership forum, and we are 100 behind the resolution. The only thing we ask, i know its going to get sounds like its going to get talked about. We just hope that all of the good things in it dont get watered down to the point to where its not useable because we intend to use it to hold everyone accountable. Thank you. Okay. Ill move on. Hi. My name is camille. Im just calling from district 9 in the miss, aion, and im calling to share my support. I echo all of the sentiments from the previous callers as well as the sponsors who offered this. Its been a Long Time Coming as well as the intent that setts g this to be a focus, and i hope to see a followup, you know, agenda, and, you know, on the suggestion about removing the Sheriffs Office from our hospital and health offices. I hope for continued transparency from the commission and the Public Health department to see this through. Thank you. All black lives matter. Thank you. Okay. Ill take the next one. Hello . Hello, caller . Hi. Go ahead. Hi. Ill start the timer. Please start speaking. Hi. My name is kristin, and im an employee at San Francisco General Hospital. Im calling in support of the resolution by dr. Bennett, and i hope that the commission passes it, and theres more to follow. We definitely need more resolutions like this, and i yield my time. Thank you very much. Okay. Thank you. Next caller. Is there anyone there . Caller, are you there . Next caller. Okay. Move on. Good afternoon, commissioners. Thank you for the opportunity to address this resolution coming before you today. I, too, am in support of the [inaudible] its also the attitude of who can be invited into the human experience, who can actually be a part of living as a full human life in San Francisco. Thank you very much for all the sponsors and all the work that went into this resolution. Thank you. Thank you for your call. Next caller. Hi. My name is alexis, and i live in district 11, and im proud to be a resident of San Francisco. I urge you to adopt the Health Equity resolution to declare antiblack racism a Public Health crisis and address this Public Health crisis by removing the s. F. Sheriff from the department of health and San Francisco General Hospital. Covid19 is killing our black and Brown Community at a higher rate than the White Community partly due to White Supremacy and the lack of black people in the medical industry. Antiblackness is a Public Health crisis. I join my community and the department of Public Health must divest coalition and urge them to invest in the black community of San Francisco. The department of Public Health must be held accountable to divest from the Sheriffs Department. All black lives matter. Fund health care, not cost. I yie not cops. I yield my time to other callers. Hi. Next caller. My name is lindsey jones, born and raised in San Francisco. And i am calling to firmly declare my support as antiblack racism is a Public Health crisis, and i believe that this resolution is firmly begin to address the actions that are necessary to begin to really look at the issues of race and equity that have been far permeated in our communities. As i think about my grandparents and im Third Generation san franciscans, how a lot of issues that they faced, we are currently facing 30, 40, 50 years later. As a mother of three children, its not something that i want them to be able to say that theyre still impacted by 30 years later. We need to look at how this crisis needs to be addressed because the decisions that you make now will impact our future in San Francisco because all of our lives matter, and i urge you to look at this resolution and adopt it as a Public Health crisis. Thank you. Thank you for your comments. Okay. Next caller. Hello. My name is nick giles, he and him, and i live in district 6 in San Francisco. Im calling in with many others in the d. P. H. Must divest and urge you to adopt the resolution that declares antiblack racism a Public Health crisis and remove the San Francisco sheriff from San Francisco hospitals. Targeted communities that have been overpoliced are traumatized. We should make sure that hospitals are a safe space for all, not just white people. The housing crisis, the health care crisis, the coronavirus pandemic, and silent Police Coming to our cities, we must take all efforts to untangle from racism and antiblackness. Black trans lives matter. Thank you. I yield my time. Thank you. Commissioners, ive been told there are nine additional Public Comments. Next caller . Hello. Hi. My name is jessica. Im a physician at San Francisco General Hospital, and im calling in support of the resolution to declare antiblack racism a Public Health crisis and to demand the commission take action to remove the sheriff from San Francisco General Hospital and the department of Public Health. Hospitals are a safe space and the presence of sheriff affects that safe space and black people who are disproportionately affected by law enforcement. [inaudible] i ask you to recognize her and countless others, black, indigenous and persons of color who arent safe in our Hospital Systems as long as sheriffs are present. Thank you, and i yield my time. Thank you for your time. Hi. Im a ph. D. Candidate at ucsf, and i live in d6 and work in d10. Bipoc patients fear seeing Health Providers due to the presence of our sheriffs at our hospitals and clinics. Sheriffs routinely run background checks on patients, arresting them when theyre seeking care, and theyre called to respond to matters in the hospitals in which theyre untrained. Sheriffs have escalated countless moments of crisis, further traumatizing and injuring a patient. I join my community in asking the commission to adopt the resolution and divest the hospital from the Sheriffs Office, and i yield my time. Thank you. I wanted to call upon the committee to adopt the resolution to declare antiblack racism a Public Health crisis, which is only more exacerbated by the current covid19 health crisis. Im asking as part of that effort that the sheriff gets removed from San Francisco general as well as Community Health clinics. I hope that as part of this measure, we divest from the sheriff. Thanks very much. I yield my time. Thank you very much. Next caller. Hi. My names maria. Im a physician working [inaudible] at San Francisco General Hospital and other d. P. H. Clinics [inaudible] and i also wanted to ask that we immediately work to address this crisis and remove the Sheriffs Department from the department of Public Health and San Francisco general. Like so many of the others. Ive seen patients harassed on the campus of San Francisco general by the sheriffs. The situations were really traumatic for patients and staff, as well. I think we should be divesting from the Sheriffs Department and reinvesting those funds into Mental Health and social services that can really help our patients feel instead of spending [inaudible] so thank you for your time. Black lives matter. Thank you. Hello. My name is sarah, and im a resident of district 11. Im calling to urge you to adopt the Health Equity resolution to declare antiblack ra racism a Public Health crisis and remove the sheriff from the department of Public Health and San Francisco General Hospital. I started studying to be a doula not that long ago, and i already knew that antiblackness was a Public Health crisis in our streets. I knew that the police were a huge part of that, and i am embarrassed to say that i didnt know to the extent of our medical professionals, who also serve dont serve our black community as they could. Pregnant black women are four times more likely to have a baa die in childbirth, and there is no corner in which black people are safe. [inaudible] i yield the rest of my time to the rest of the callers. Thank you. Thank you. Hi. Next caller. Caller, are you there . [inaudible] im calling in support of declaring antiblack racism a Public Health crisis. I believe this is a great step in the right direction for the Health Commission, and it should give this board and the staff the ability to allocate Critical Resources to address racism. I think every department across all 95 departments in the city of San Francisco should enact resolutions of this nature, particularly for antiblack racism. Black San Francisco came to the city in mass numbers to support the war efforts in the 50s and 40s and 50s, and upon arriving, the only neighborhoods we could move into was the ones that were considered the most polluted. The fillmore was considered polluted because it was a trend to move to the suburbs, and so all the cars would drive through the fillmore to get to their home and back. Bayviewhunters point was considered polluted from the bayview war industry, and so it acts as the wholesale red lining of blacks from the whole community. The emotional and physical impact of disturbing communities is real. I do believe this is a positive step in the right direction, and i know that i and many other communities will be watching to see if the Health Commission passes and utilizes this powerful tool. Thank you. Thank you very much for your comments. Hi, next caller. Hello. Can you hear me . Yes. Hello. My name is veronica shepard, and i work for the department of Public Health. I support the African American Safe Space Community in regards to Racial Equity and food security. My family has been in the bayviewhunters Point Community since the 1940s. I have personally witnessed and experienced how the structure of racism and violences has impacted the black community most of my life. I join in support to declare that antiblack racism is a Public Health crisis and ask the Health Commission to vote on this resolution. Thank you, and ill give up my time for the rest of the speakers. Thank you for your comments. Hi. My name is karen, and i am a Mental Health clinician living and working in San Francisco. I am calling in today to ask that you adopt the Health Equity resolution to declare antiblack racism a Public Health crisis. Im asking that you remove the San Francisco Sheriffs Department from d. P. H. And San Francisco general. Thank you. I yield my time. Thank you. Next caller . Hi, everyone. This is tracey packer. I work for the health department. Im the director of community Health Equity and promotion, and at this time, im working in the Community Branch on covid19, and i want to thank you for putting this Health Equity resolution on. As we know, black African Americans are affected disproportionately by Health Issues that we are addressing in this branch. We know that black and African Americans are affected by aids and hiv, diabetes, and other Health Issues, and we know that at the root of this is racism. This resolution that youre lo looking at highlights antiblack racism as a challenge that we have in this city and something that we need to work on, and its so important that it highlights the action necessary to make change, looking at the root cause. The focus on equity in our work, the resolution supports the focus on equity in our work, which i really appreciate, including looking at the budget, and that will support the work that we know that we need to do in this branch and the work that we want to do. I hope the Commission Adopts the resolution as it is as it lifts the voices of the community that we all hear every day. Thank you so much. Thank you for your comments, tracey. I think theres one more person. Yes, we have two more after this call. They keep calling in. Okay. Well, welcome. Hi. I live in district 11, and im calling to support the resolution to declare antiblack racism a Public Health crisis, and i hope if you pass the resolution, you divest the sheriffs out of San Francisco general and d. P. H. Thank you very much. Hello. Next person, please. Hi. My name is michelle and im a recent new graduate nursery siding in district 1. Im calling in support of the resolution concerning declaring antiblack racism a Public Health emergency. I think it is time for us to address d. P. H. S relationship to sfsd and the impact they have on our most vulnerable patients. I yield my time. Thank you for your comments. Araceli, is there anyone else . Theres one last caller. Okay. Welcome, caller. Hello . Yes, hi. Please start your comments. Yes, youre on. That was me saying hi, mark. This caller called in several times and so far, weve been unsuccessful in getting them on the line. If you want just to end Public Comment . Yes, and i just want to acknowledge that must be very frustrating for that caller, so thank you for trying, and hopefully, that will work out again. All right. Okay. All right. Thank you, araceli, and thank you, mark, and thank you for everyone who called in in support of this resolution. We thank you very much. Commissioners, do you have any comments, questions, or things youd like to offer . Yes, im not seeing any hands raised. Anyone . Commissioner tong . Hi. So i can make my comment . Yes. Okay, cause i yeah, i got distracted because i was trying to look up some additional numbers. So there are several amendments that i would like to offer. Of course, i need to, like, first say that i am not expert around antiblack racism because i dont think that any of us who are not part of the black community can understand the range of the extent of the racism they face generation after generation. I continue to learn from many of my black colleagues, and so some of these languages that im offering were also part of what i have been, like, taught throughout the years. The First Amendment that i would like to after is in the second whereas, antiblack racism, i would like to add erasure of and discrimination to what black people and culture and shall we do it one by one or would you like me to just add all of them . Im sorry. Go ahead, commissioner. I think we can take them en masse. Okay. And then, the second one is the whereas intersectionality is the paradigm on that one, such as racism. I would like to add colorism, cissexism, and then, also, underneath in the religionBehavioral Health status, i would like to add immigration status, country of origin, and or other elements. And im sorry, commissioner. Are those is this what you emailed to me earlier or are these new . These are what i emailed you, i believe. Okay. I just want to make sure i get it down so that im noting it for you all. Thank you. Yeah, and i apologize for, like i should have done this sooner. And then, i have a few whereases that i would like to offer. Commissioner tong . Yes . Perhaps im looking at your proposed amendments now. Perhaps we should take the proposed amendments as one and then the additions as another . Yes, please do. Okay. So we have an amendment marked procedurally. Do we need a second . Yes. Well, i think procedurally, we first need to move the motion move the resolution so that we can make amendments, and then, we can take up also president bernals amendment to remove the word may, for example. But i think we first should move the motion as we have been presented so that we can make all the amendments. Yes, of course, youre correct, commissioner chow. And so therefore, i move the resolution, and im hopeful we have a second so that we can proceed to discuss and add additions to the amendments. Ill second. Thank you. So now you all can begin to discuss and consider commissioner chungs suggestion. So if we can discuss commissioner chungs amendment on that intersectionality. Im somewhat concerned that there is a reference that the statement [inaudible] out of the reference, and therefore, if adding a reference, we would have to eliminate any reference because reference no longer would be in quotes. Wed have to [inaudible] commissioner chow, your sound is going in and out. Is there something covering your speaker . Theres nothing covering mine. Okay. So you were concerned about the the addition would take away the quotes . You would have to take away the quotes by adding the additions and the reference because it no longer would actually be a quote from the reference which is the way it was written. Thats all im saying. All those items seem to make sense, but it would actually modify that amendment. Yes. The quotations could not stand if the sentence is altered. Yes. So would you like to add that to your amendment, commissioner chung . S. Yes, id be happy to. I also want to ensure that the original authors are happy with my amendment, so im actually the original author of that clause. Oh, okay. So if youre comfortable okay. As noted before, there was no permission to add that. That was something that i thought was added, so commissioner bernal, would you like to continue with the amendment of this the vote on this particular amendment . How would you like to proceed . Yes, and just to clarify, mark, so given that that is a cited definition, the quotes and the citation would have to be removed. Well, the citation, i think, would not have to be removed because it still covers the same idea. Its no longer the exact quote, but it still encompasses the same idea. Okay, yeah, lets proceed with the consideration of the amended clauses. Im sorry. I have to speak up. This is not directed at commissioner chung or any of the commissioners, but his tone has been completely disrespectful in this process, encapsulated by his statement. I just need to focus on the fact that he continues to talk around us, condescending in a way he feels necessary to put this forward. Commissioners . Dr. Colfax or anyone . This is commissioner christian. So first, i just wanted to make sure that i know that commissioner chung has three whereas amendments as she has proposed them, and has been circulated to the commissioners, but i wanted to make sure that people listened know what they are. First, i want to take a brief moment to say that i am thrilled that this resolution has been brought to d. P. H. Its a part of all the work that needs to be done in the city, and certainly, peoples health, all of our individual health and the health of our families over our generations and the health of our community have to over come the systemic nature of antiblack racism and inequality in order to begin to address the health of people, so this is a critical resolution, and the work that will that is already being done that the department is doing, and dr. Bennett is doing is critical. And the work that we talk about in this resolution that has been brought to us through the h. R. C. And other Community Groups will be critical to actually carried outgoing forward, and i believe the commission is strongly committed to that. But i also want to make it clear that i dont believe that anything we do today should take the focus off the antiblack nature of the resolution, and i dont believe that anything that is put forward is meant to do that. And so i think its important for people who are listening to understand what is being proposed as an amendment so that we can make certain that the thursday of the resolution and the energy and the thrust of t that we can make certain that the thrust of the resolution and the energy is as it was brought to us. Its my understanding thats whats being brought forward is specific to the work that the department of Public Health can do in furtherance of the charge that were discussing today. So ill stop talking, and with that, i think its important that the proposed amendments get read into the record so that everyone knows. I would just like to commissioner . Commissioner, youre muted. Sorry. I would just like to speak to what commissioner christian had just mentioned, as well, and just remind the commission that this is a resolution that was brought forward to the commission our commission from the Human Rights Commission specifically to address structural antiblack racism and acting on this is very important, and it does not preclude the commission from taking up matters and resolutions related to other forms of structural discrimination. So by moving forward with the resolution, it specifically addresses antiblack structural racism. It does not preclude addressing other kinds of discrimination or racism, and that is something that we will certainly be considering in coming meetings and will be acting on accordingly, as well. Commissioner chung . Youre on mute, commissioner. Okay. Thank you, commissioner christian and bernal for your comment. And in the interest of transparencies to Human Rights Commission as well as, you know, with the commissioners on this panel, i have actually forwarded my drafted amendments to mark, and if mark dont mind, just sending that to everyone so that, you know, they can follow my my amendment, you know, and give feedback on that. Thank you. That would preclude us from reading them out loud, as commissioner christian said. Im setting up now. Absolutely. Per the commission, i dont know if its procedurally acceptable this is sheryl davis. You were on mute commissioner bernal, director davis is asking to speak. I apologize. Yes, i would like to recognize director davis. Thank you, director davis. Thank you, and i just i want to just take a step back, and i just really want to say a lot of the reason why this came forward, if we think about whats happening locally and nationally was just the passion and the feeling and the sense that black people really do feel invisible, even more so in San Francisco, and there seems to be a challenge, and there seems to be a difficulty to own and be able to challenge and be able to say point blank, there are heavy outcomes and differences for black folks. If we go through San Francisco, less than 6 of the population is African American, but we know that our prison population is five, six, seven times that. We know that a third of the School Suspensions for high school and middle School Students are African American. So i just really want to give a little backdrop to the frustration and passion of folks around this and just say, you know, that weve been doing, over the last couple of weeks, with on behalf of mayor breed and supervisor walton, convening Community Groups. Weve seen over 600 people in the last week or so. And the common theme is that we do not feel comfortable saying that black people are disproportionately impacted by racism. And so the impetus for this resolution was really for San Francisco to own and to recognize and to give paths for black folks. So i want to say were going to deal in intersectionality. Being black and poor or being black and trans or being black and other, other, other, in some ways, it triggers for folks, and just to be very clear, that this is intersectionality is wrapped up into all of this, so we know the gender and folks that are coming from different places that are black will also feel that, but we do not want to dilute the intent to really call out antiblackness. Youre still on camera, commissioner chung. Okay. Well, thank you, director cheryl or director davis. I think thats really important, what you just said, and i hope that, you know, like, the amendment that im offering could also reflect on those, like, intersectional issues that faced by the black community, especially those with, like, multiple intersectional identities that they have to face every day in terms of discrimination and violence and hate. And mark, i would like to address directly the comment that miss underwood had made at the introduction of this, that there were some changes made to the initial resolution to tailor had to measurable outcomes that could be achieved by the department through their work. If miss underwood and others do take issue with that clause, the fifth one related to intersectionality, i would be amenable to removing that clause without objection from other commissioners. Without objection . Your recommendation this is suzanne cerato. Your intention is to remove the intersectional clause completely out of the document . Correct. Okay. Mark. What i have to offer is an amendment and a second . Yes. Okay. I would offer that as an amendment. Is there a second . [inaudible] im sorry. So commissioner chung . So we talking about the entire whereas clause fifth whereas clause or are we talking about the quote specifically . So the issue that was raised was the that whole clause was added. Okay. Okay. This is commissioner christian. I second the motion. Thank you. Mark, can we take that to a vote, then . Okay. Is there any discussion about that or okay. [roll call] okay. And can i ask a question . Like, ive offered a few more amendments, and i want to make sure that im not overstepping my my privilege and you know, and to make sure that director davis and miss underwood think its appropriate before i start reading all the stuff. Commissioner chung, if i may, with respect, and certainly not overstepping your prerogative, but i would suggest in your partnership with Human Rights Commission, you brought this forward to us as well as in support of the people who had called in to express their support for this resolution, that we refrain from from adding to it and consider some of the very many important issues that you have raised in a separate resolution at a future meeting, and i would gladly support and work with you in drafting that. I i appreciate that, and, you know, like, one of my concerns is thats exactly how you erase your work. Its like you saying you work for the immigrant community. Its li but you erase the immigrant community. And its like saying that we work for the Trans Community and erasing that from the altd amendme from the amendment. I hope im not overstepping my privilege, and just offering what ive learned from my black colleagues. Certainly, commissioner chung. Please then go forward and offer your amendments if youd like to do so oh. Would commissioner guillermo seeking to be recognized . Yeah. I just want to express [inaudible] if this is correctly expressed because i am torn between really respecting the work that has gone beyond gone into the resolution that we are considering as such. Not just the work, but all of the things that director davis has described to us in terms of the background of history, the Community Sentiment that has gone into the resolution as such, and the very important justification for commissioner chungs amendments. I dont know whether, at this point, if we i dont feel like i have enough education around all the background to be able to vote with confidence on either not considering commissioner chungs amendments or considering them into a resolution that may not be fully acceptable or fully understood by the resolution authors. So im just expressing my hope or my sincere desire to be better equipped to make a decision or to take a vote on changing things that have been very carefully thought out and brought to this to this commission in terms of the resolution. This is commissioner christian. May i comment . So i think that commissioner chungs desire to speak about the multiplicity of experiences that black and African American people have across different categories is one that is a good one, and i dont know that its one that anyone would quarrel with. I think perhaps the way that that is accomplished is the critical thing always, but especially at this point when were talking about a resolution on antiblackness and antiblack racism. One of the things that came to mind when i was looking over the proposed whereas amendments that commissioner chung submitted to us was whether it would be useful to outline and delineate the black and afterri can American Experience in these different categories as oppose and African American experience in these different categories as opposed to intersectionality if we wanted to bring out how black and African American people experience racism in all of these arenas, in gender orientation, in economic situations, that we do some of the specifically talking about black people and African Americans as opposed to everyone else in those categories. I dont know whether that is gets that what the speakers who are here with us today from outside of the commission are saying or not, but that is one thought that i have. Thank you, commissioner christian. That was my intention, is to really highlight how the black identity actually exacerbate the harm that they experience, you know, like in when we intersect that with, like, other types of oppression. Black trans women face more harm than other women, and black immigrant women often gets erased from all the immigrant conversations. So my intention was to offer that as part of the insights. And this is commissioner christian again. And it may be that for purposes of this resolution, it is it may or may not be the time to disaggregate all the ways in which black people suffer greater harm across every category that we belong to, which is every category that exists. Im not sure what the desire of the authors of the original resolution, how they feel about that, whether it is what theyre wanting to bring to us now and highlight at this moment is talking about black and African American people as a category without disaggregating all of our other identities and pointing on you how in each of those other identities, we are also disproportionately advantaged. So perhaps it would be useful to hear from president bernal or or our guests about that question. Would director davis or mr. Cuato or miss underwood, would you like to add to the conversation at this time . So i will jump in, and im not sure if miss underwood or miss chiquata would like to comment on this. The main for me, to me, even though these are small, they are rather substantial amendments. We did this as a community process. I would like to include community in that, but i also dont think that i dont think that its meant to kind of get the conversation going in that that is another layer, another level, and whether it all has to be encompassed in this particular resolution, im not sure. I will say that, from the outside looking in, that i would imagine that some people are saying that it is not that complicated, and we try to advance something for black people, it takes on much more. We thought it would be simpler to get it passed, but i appreciate the conversation and the debate. [please stand by]. So first comment would be that, number one, i said during my initial comments that this is an extensive list, but that it is not an exhaustive list of all the ways structurally we are harming black people in San Francisco. Secondly, i want to make clear that my earlier comments about paragraph five on page [inaudible] i feel like as far as talking about intersectionality, that this is captured in clause number two on page 1, which is why i dont understand why your Commission Secretary said what he was adding was substantially additive, but ill let my colleague comment what they wants to say. Thanks, brittany. This is nyesha underwood, and without repeating everything that brittany and everyone just said, i would second everything that everyone just said. Thank you. Commissioners, in beiknowin was brought forward by the Human Rights Commission and the way that its been tailored, i would encourage the commission to consider this resolution as it is, understanding that it does not preclude further action at an upcoming meeting; that i would be very happy to work with commissioner chung and others on bringing forth a resolution that addresses many of the critical intersectional issues that she has raised, and i would direct that to commissioner chung. Yeah, im open to that. Thank you, commissioner bernal. Im open to that idea. The part that im really struggling with is i thought this was a practicseparate resolutions, you know, and it speaks to Health Equity. I dont believe that any of my points that i make would take away, you know, that focus whatsoever. In fact, i actually have included the data to every single one of the whereases that im including. I just want to make sure that i do my communities i do good by my communities, which is trans people of color, immigrants, and hiv, to make sure that, you know, that antiblackness within those particular communities are also reflected somewhere. So if it means that you know, for me, when we talk about community process, it would be helpful for me to know that there was more than just one black trans person participated in this process or there was more than one black immigrant who had participated in this process. Commissioner chung, i know you to be a very effective advocate for your communities, and it would be my privilege to work with you on a separate resolution that we could bring forward at the next meeting if we are prepared or a meeting very soon in the future. And with that, i would like to and mark, would you please help me procedurally move that the commission approve the the current resolution as amended with a removal of that one clause . Yes. So i think commissioner chow has been trying to get recognized, sorry. Oh, i havent been able to see him. Thank you, commissioner gilliam. Commissioner chow . Yes, i only actually wanted to actually try to weighin to see, definitely, i think the issue that has been raised and there seems to be a little misunderstanding because i think that i thought that we went through the issue of actually removing the intersectionality, and commissioner chungs point in here, whereas was very well documented in terms of just simply the data. But i understand in terms of the community, the community would really want to keep the focus simply on the issue of antiblack. And i think for us as a commission, that focus is well described in the very well documented whereas, but that most important for us in this resolution is what we are going to carry out in order to do our part to make sure that the issues raised and that has obviously historically been, very sadly, happening here in San Francisco and for