To adapt to our new normal. Lets get started, dr. Colfax. Thank you and welcome. Can you fleacan you please prove where we are in San Francisco as it relates to the numbers. Thank you for your leadership during this time and really supporting all of us as we focus on the data, science and facts. I have a presentation with a lot of data i would like to go through. If there are questions that you would like to share during the presentation, please let me know. I will just give us a snapshot where we are today, talk about what we can all do to bend the curve, reduce infections across San Francisco and talk about what the future may hold if we do not wear face masks, practice social distancing and good hygiene. Can we go to the slide presentation, please. First slide is number of cases in San Francisco. All the way back, please. Okay. We have a preview. This is where we stand right now in San Francisco. Anybody can follow these data on a daily basis at our San Francisco data tracker sf. Gov and follow to see where we stand. Today we have nearly 4600 cases of covid19 diagnosed in San Francisco. I think it is important to also realize that nearly 1,000 cases have been diagnosed just in the last two weeks. We continue to see a high level of diagnosis. Two weeks is when people are infectious. 1,000 people in the last two weeks. 50 people have died of covid19 related illnesses in the city. While any one death from covid19 is too many, a few pieces of promising data here is that our death rate has leveled off for a number of weeks. Our clinicians are doing a better job using science how to manage the disease. This could change at any moment, especially if the Healthcare Systems are overwhelmed and people are not able to get the clinical medical attention they need. There is a lot of information on this slide. You can go to sf. Gov to see this. The big graph with the green line is number of tests done in San Francisco over june and into july. You can see those gray bars are the number of tests done every day. I will say that we have exceeded our goal in San Francisco. We set a goal of 1800 tests each day in San Francisco. For the last week we have been averaging 2600 tests each day in San Francisco. You can see from that jagged green line that is the Positivity Rate. That is of all of the people tested on that day what is the Positivity Rate . That has been gradually increasing over time. It is now 3 overall time. We have recently seen a large spike in the Positivity Rate, which is indicative of the virus spreading throughout the community. You can also see from the yellow bars in terms of cases in terms of race that we have a disproportionate number of people of color diagnosed with covid19 compared with the population in San Francisco overall. The latin x accounts for half of all the dyeagnosed cases. We also see large numbers from black Africanamerican Community and asian community. This is why we are working with stakeholders across neighborhoods to ensure that Community Leaders and neighborhoods and Community Members and families are actively engaged in the response, know where to get tested and care and where to access the other services needed during this very challenging time. Things like having access to food. Food security, behavioral and Mental Health services and counseling, is very important going forward. Mayor breed do you want me to talk specifically . I want to clarify something so we have about less than a 6 africanamerican population but seeing about 5. 4 of the cases africanamerican. We dont see disproportionately the number of cases in th the bk Community Like throughout the country. We clearly see disproportionat disproportionately the Latino Community cases. The question i have is because that in comparison to any other race in San Francisco is where the biggest challenge is. My question is what are we as the city doing . What is the department of Public Health doing to address this significant disparity . Thank you, mayor. We have been working from day one with regard to preparing and anticipating Health Inequities in the covid19 epidemic largely because we know that the virus spreads unconditions in which we have seen in San Francisco that have affected Health Inequities for a long time. With regard to the disproportionate impact in Latin X Community we have been working with your Latino Task Force on covid19 to ensure that education, community engagement, testing access is strong and also that we are ensuring that when people do test positive that they not only have access to the medical care but the Behavioral Health support, social services support, food access and not only they have that but their families have that. If people are not able to isolate and quarantine and not able to do that in their living situation we are also ensuring people have access at hotels as alternatives to their Living Conditions so they can isolate safely and not put others at risk for transmitting the disease, acquiring the disease. We are also ensuring with the Contact Tracing, which is such an important tool in this pandemic we have culturally appropriate Contact Tracing being done. Half of the Contact Tracing is done in spanish right now. We have culturally competent contact tasers. It is not just about ensuring that people feel comfortable talking to us about who they may have been in contact with and put at risk for disease. We want to support the individual. Supporting the individual, linking to those services. We ensure people get access to care for covid19 and medical care in general. Under no circumstances will people be identified by immigration status. This process is very confidential. Some challenging around the inequities that exist with the city respond. From day one we operated an equity team through Emergency Operations center but unfortunately what we are seeing in San Francisco is significant number of people diagnosed with covid19 are mostly in the southeast, eastern part of the city. The Testing Capacity is in the center of the city, and we are seeing disparity in terms of Testing Capacity. Why havent we done more other than pop up locations on a regular basis in the various neighborhoods. Why have we not done more for stationary locations so it is easier to access testing . From day one when we scaled up the Testing Centers we had Southeast Health center first. Then we established a testing site outside the zuckerberg hospital as well as the Mission Neighborhood health center. We are also expanding testing sites in sunnydale, potrero hill and we have just recently started testing at the hub and mission. It is a key priority of ours to continue to ensure people have access to testing, particularly if they are in the neighborhoods where we see the highest prevalence of covid19. The one opened in the mission this weekend they expected 100 people and tested over 200. We have to take the testing where people are. I will turn it back to you to finish up your presentation. Thank you, maam. Mayor, you talked about equity and Covid Response. I will reinforce this slide emphasizes we had our equity front and center of our Covid Response from beginning and continue to ensure we make investments as we move forward. I also wanted just to point out where San Francisco is relative to other communities that are dealing with this pandemic. This is looking at San Francisco compared to other cities and jurisdictions across the country. As you can see so far our case rate is relatively low to other places. Our death rate is quite a bit lower at 5. 8 per 100,000 people. Compared to other jurisdictions we are significantly lower than other places. Our testing rates while we continue to expand testing, our testing average is 2. 92 tests per 1,000 and that compares to other places. We needsh to expand testing. Thithis is a regional and natiol issue. There is a lot of demand for testing now and delays in test results. I would emphasize here in San Francisco our Public Health lab was one of the first to offer testing. We continue to expand that and work with private providers, kaiser and others to ensure low barrier testing is available to people. Promising news. We are in a vulnerable situation. The mayor spoke about indicators right now. This is the slide looking at the hospitalizations in the city from march into july. You can see that our hospitalization rates are starting to increase. The dark bars are the number of patients in intensive care. Light are the people in acute care, medical surgical beds that are sick enough to be in the hospital. Those numbers are significantly increasing. This is very concerning. We got up to a high of 94 in april in terms of hospitalization rate. That was the first surge. Thanks to everybody in San Francisco we flattened the curve and crushed it. Now it is going up. We in another surge. We are in another surge and we expect to see these hospitalization numbers to continue to go up. The yellow bars in this graph also show the number of people in the hospital who have been transferred from other jurisdictions because other jurisdictions are in serious trouble as well. Many of these include patients transferred from the outbreak in san quentin. We are in a surge even taking into account those transfers. You talked about indicators. This is one of the key indicators in the city. People can go to sf. Gov to see the indicators. This is the change in covid hospitalizations by week. This is number of people in the hospital with covid 19. That rate of change. As you can see for a long period of time we were doing really well in the city. We were in the green zone. That is the green dots here. That increase was less than 10 . Then we saw a big jump consistent with the surge in the graph i just showed you. We continue to be in the red zone with a double rate of 20 compared to our target rate of 10 . This is reflective of the surge. This is why we made the very difficult decision to put reopenings on pause. Similarly, we are seeing a big increase in the Positivity Rates of people who are testing. This is the number of cases diagnosed per 100,000 population over seven days. You can see we were in the yellow zone for a long time, and our goal was to get to 1. 8 per 100,000. We are now above 6 per 100,000. You can see that on the right. This slide is updated to july 11. We are at 7. 8 per 100,000. This indicates that the virus is spreading throughout the city. Particularly in the areas that you mentioned southeast part of the city. This is a complicated slide. I will take a minute to describe it. This is looking at the reproductive number of the virus. What is the reproductive number of the virus . That is how fast the virus is is transmitting through the population. Reproductive rate of two means for every person infected with the virus, two people get infected with the virus. That is a very high transmission rate. Reproductive rate of. 5 so half means for every two people infected with the virus, only one new person gets infected. That is really good. For every two people infected only one new person is infected. That means is virus is going down in the population. Reproductive rate of one in the dotted line across this graph means for everyone person infected with the virus, one more person is getting infected. What we really want in a situation we are this is get that reproductive number below one, which means for every person infected with the virus less than one other person is getting infected. That is key. What does this graph actually show . These are scenarios modeled at u c berkeley. We asked given the dates take we gave you to analyze what are the best estimates for the reproductive rate. That is shown o on blue across time. We were doing well in San Francisco. The rate was below one as low as. 85. If that had stayed the virus would have burned out in the city. Unfortunately, you can see here that starting in early june we started to cross that one. Right now we estimate that reproductive rate of virus is as high as on average 1. 25. It could be even higher. That is what the blue fuzzy leans. They are estimates of the model. Most likely it is 1 point 25. It could be higher or lower. Right now our best estimate is 1. 25. That doesnt sound like that much different, right . That is half a decimal point from where we were. Why is that a big deal . This is what keeps me up at night. This is what happens if the reproductive rate stays at 11point owes 1. 25 with the current surge. That dark line most likely scenario if everything is the same at 1. 25 we would hit 830 hospitalizations in the city. Think about that for a minute. In april we peaked at 94. Thanks to all of the work people did in San Francisco we sheltered in place, drove that number down. It is now plausible that we hit hospitalizations at 830 if we do not do more to stop the spread. Those lighter blue peaks are plausible scenarios as well. We could get up to 6,000 hospitalizations. It reflects the challenges that new york had. We hope this doesnt happen. It is so key here. We have a window to do better. B. Next slide. And again, another very concerning situation. This related to the reproductive rate of 1. 25, so this means that we will have more people die, and if you follow that blue line, this means we would average, excuse me, 890 deaths from covid19 in 2020. Were at 50 right now, and by the end of the year, we could be at 890 with a reproductive rate of 1. 25, and again, unfortunately, those white shaded blue lines show we could get much higher scenarios, approaching 2,000, and even 3,000. So this is this is serious. This is a we are in a very concerning time right now with this reproductive rate of 1. 25, and we need to drive down below 1 as soon as possible. Next slide. But there is hope, and this is looking as of july 4, because we were looking at the july 4 weekend and asking everyone to do their part. If we could reduce that rate by half, we could dramatically reduce our hospitalizations and our death. We could go from the hundreds that we talked about to as few as 50 and 70. And even the scenarios that i showed you with those light blue shaded areas, we could see more deaths through 2020. So if we do our part, we could save lives and keep people out of the hospital. Again, even in the next two weeks, if we could all do our part, we could really make a difference. You see in the next two weeks, we wait for the reproductive number to reduce by 50 , we still have peak hospitalization at 340 and an estimated 220 deaths in 2020, so time really makes a difference. Next slide. So key introduction to reducing r. P. E. This the reproductive rate. This has real socioeconomic and other consequences, as well. Discouraging gatherings, especially inside, and i just want to emphasize right now that, really, please do not gather with people outside of your immediate household, and especially do not gather indoors, it is very dangerous to do that. Please, it is literally saving lives. And then, continuing to offer testing, expanding our testing, and Contact Tracing. Such key tools to our efforts going forward. Next slide. So i alluded to this, but really, riskiness of the activity, we know that outdoors is safer than indoors. Its at this point that, based on the latest data, its 10 to 20 times safer than being indoors. Its risking out to be involved in gatherings with people outside of your immediate household. Half of the people who transmit covid19 are asymptomatic. And you can get covid19 right after you test. So dont think that just because you test negative, you can get it from people that you hangout with or you can transmit it back to older people in your household. We continue to emphasize wearing face coverings, 6 feet of social distancing, and washing your hands. The frequency, the more people go out, the more they are putting themselves and their loved ones at risk. The duration, the longer people spend time together, the more risk it is for transmission, and then, the distance. This is why we are focused on the social distancing and the importance of that going forward. Next slide. And then, i did want to talk a little bit about hope going forward, and talk about vaccines are being looked at and developed, and unfortunately, theres not likely to be any vaccines soon. Key experts estimate it could be 12 to 18 months before a vaccine is widely available. Thats very different from saying a vaccine is going to be available in six months to a year. But im hopeful, according to mayor breed, that we will be testing extensively across the city and also at zuckerberg San Francisco general hospital, and we will be focusing on engaging communities most at risk for covid19 to support them in participating in vaccine trials as soon as august. Thank you, mayor, and thats my completed presentation. The hon. London breed well, thank you, dr. Colfax. I know were at the end of our time here, but i do want to take this opportunity to just speak to the people in San Francisco who are struggling. There are some people who are struggling, who have no paychecks coming in, and its really hard. And what happens, in addition to the loss of your financial ability to take care of yourself and even your family, Mental Health becomes a whole other issue. And it seems as without our churches, our religious services, our ability to congregate and come together with one another, our spirituality as well as our coming together in the world, and our ability to socialize as we do on a regular basis, its almost as if were trading one Public Health crisis for another. We know, for example, Domestic Violence has gone up, suicides have gone up, people are more stressed in trying to figure out what to do with their lives. We see some of the Violent Crimes going up in the city. How do we justify that . The fact is you and i know were going to be living with covid for the 12 to 18 months or even longer, and so this is hitting in various ways as we try and keep people safe and try to prevent the surge in the hospitals and even deaths. But theres only so much we can emotionally handle as human beings, so ktell us how were supposed to deal with all of that . Thank you, mayor. I appreciate this, and again, this is such a challenging time, i would say the risks the downsides to the shelter in place and the slow reopening are very real and very concerning from a health standpoint and an economic standpoint. I think the Counter Point is no one has said, were going to go ahead and open quickly. As you see across the country, the Mental Health consequences of opening and having a surge, many people are struggling in San Francisco, but if we have a surge like we saw in new york or unfortunately like we saw in houston and parts of florida, we would have all of those concerns that youre talking about on top of the overwhelming the Hospital Systems due to covid19 plus the covid19 pandemic and everything that were dealing with and managing today. Unfortunately, theres downsides to where we are today, but theyre even worse. And we just want people to understand that these times are hard, but we have a pandemic in our city, and it could be much worse. Mayor, i have some numbers, and id like to give them. May i give them . The hon. London breed yes. So our warm number is 8558457415. And then, we also have mobile crisis, so for acute situations. Our number is 4159704000, and the last thing is if you see businesses that are violating the Health Orders around social distancing and good hygiene, please let us know. Please call 311. We will send inspectors out, and if people are violating those orders, we will take steps to aggressively make sure that they do. The hon. London breed and also, i want to push back a little bit. Outdoor activities are permissible in certain circumstances with guidelines, and i do think with regards to religious services, if people have the ability to have Outdoor Services or if there are ways that we can get creative with allowing other things to happen because i know your religion plays a role in things like this. I think its going to be important as we see changes in the number, we want to provide people with opportunities to deal with the challenges of what were facing over the next 12 to 18 months at least. Just think about whats going to happen with our kids and the schools and a number of other things. The fact that we have all of these playgrounds, and kids cant even play in playgrounds. It is heartbreaking for me that we cant even provide these opportunities, so i do want to think of these creative ways that we can support people. If youre one of these people that need help, mental help, testing, please call 311. We have a lot of city resources. Weve developed a lot of publicprivate partnerships to provide support you want. We know its not going to be everything that you want, but we do our best to support folks that are struggling in San Francisco. And the sad reality is its not just San Francisco, but its all over the country where we see this impacting our country, we see it impacting our economy, and the goal is to keep everybody safe, so this is our new normal. So thank you, dr. Colfax, and hopefully, well be able to have more conversations in the future. If you have any questions, please reach out to us at 311. Thank you, everyone. Thank you, mayor. [ ] i just dont know that you can find a neighborhood in the city where you can hear music stands and take a ride on the low rider down the street. It is an experience that you cant have anywhere else in San Francisco. [ ] [ ] district nine is a in the southeast portion of the city. We have four neighborhoods that i represent. St. Marys park has a completely unique architecture. Very distinct feel, and it is a very close to holly park which is another beautiful park in San Francisco. The Bernal Heights district is unique in that we have the hell which has one of the best views in all of San Francisco. There is a swinging hanging from a tree at the top. It is as if you are swinging over the entire city. There are two unique aspects. It is considered the fourth chinatown in San Francisco. Sixty of the residents are of chinese ancestry. The second unique, and fun aspect about this area is it is the garden district. There is a lot of urban agriculture and it was where the city grew the majority of the flowers. Not only for San Francisco but for the region. And of course, it is the location in mclaren park which is the citys second biggest park after golden gate. Many people dont know the neighborhood in the first place if they havent been there. We call it the best neighborhood nobody has ever heard our. Every neighborhood in district nine has a very special aspect. Where we are right now is the Mission District. The Mission District is a very special part of our city. You smell the tacos at the [speaking spanish] and they have the best latin pastries. They have these shortbread cookies with caramel in the middle. And then you walk further down and you have sunrise cafe. It is a place that you come for the incredible food, but also to learn about what is happening in the neighborhood and how you can help and support your community. Twentyfourth street is the birthplace of the movement. We have over 620 murals. It is the largest outdoor Public Gallery in the country and possibly the world. You can find so much Political Engagement park next to so much incredible art. Its another reason why we think this is a cultural district that we must preserve. [ ] it was formed in 2014. We had been an organization that had been around for over 20 years. We worked a lot in the neighborhood around life issues. Most recently, in 2012, there were issues around gentrification in the neighborhood. So the idea of forming the cultural district was to help preserve the history and the culture that is in this neighborhood for the future of families and generations. In the past decade, 8,000 latino residents in the Mission District have been displaced from their community. We all know that the rising cost of living in San Francisco has led to many people being displaced. Lower and middle income all over the city. Because it there is richness in this neighborhood that i also mentioned the fact it is flat and so accessible by trip public transportation, has, has made it very popular. Its a struggle for us right now, you know, when you get a lot of development coming to an area, a lot of new people coming to the area with different sets of values and different culture. There is a lot of struggle between the existing community and the newness coming in. There are some things that we do to try to slow it down so it doesnt completely erase the communities. We try to have developments that is more in tune with the community and more Equitable Development in the area. You need to meet with and gain the support and find out the needs of the neighborhoods. The people on the businesses that came before you. You need to dialogue and show respect. And then figure out how to bring in the new, without displacing the old. [ ] i hope we can reset a lot of the mission that we have lost in the last 20 years. So we will be bringing in a lot of folks into the neighborhoods pick when we do that, there is a demand or, you know, certain types of services that pertain more to the local community and workingclass. Back in the day, we looked at mission street, and now it does not look and feel anything like mission street. This is the last stand of the latino concentrated arts, culture and cuisine and people. We created a cultural district to do our best to conserve that feeling. That is what makes our city so cosmopolitan and diverse and makes us the envy of the world. We have these unique neighborhoods with so much cultural presence and learnings, that we want to preserve. [ ] good afternoon and welcome to the San Francisco planning