There are other parts that have access indie indiscernible . Operator you have three questions remaining. Speaker i would like to commend the sfmta on the slowstreets program. I think its great and particularly, i have frequently used the one on sanchez and if anything, thats to be extended even further and the slow street on 20th can be extended west, as well. I think that would be a great idea. I want to reiterate what everybody else said regarding the tenderloin, an equity standpoint in ten in terms of mg everyones lives better, its unfair they dont have slow streets. And people should take a step back and remember 30 of people in San Francisco dont even own a car and yet up until now, almost 100 of the streets where dedicated largely to cars and even now, 95 , so i think thats important perspective to keep in mind and just remember as we go forward, i think that this would be great to implement, especially after the pandemic and hopefully, make the city a better place to live in. Thank you. Thank you. Next speaker, please. Operator you have two questions remaining. Speaker i live in clipper street. And i get t have to be careful i leave my house at the wonderful slow street area. Im calling to share my support for the slowstreet program. I enjoy, likmostly, im excitede expansion in golden gate park. Im a rollerskater and i appreciate using the park as much as i can and as far as i can and we should be able to use the park from every side of the city and i think everyone should have access to the park and i think its really important. I think that this program and other programs like it can be the outreach that they need and we want and having space for people to create their own programs is more important than creating programs for people. When i was listening earlier and i heard people say when we get attack to real meetings, this is a real meeting and that can still happen. Between park and rec, its all real and were all here right now and i would like to thank the board of directors. I just found out while i was listening to this that theres a part of duncan that is why would you want to ride your bike or rollerskate or teach your kid how to skateboard on that . That doesnt make any sense. The tenderloin, the main thing we need is public toilets and so, public toilets and then we can talk about the closed streets. Pai indiscernible . Next speaker, please. Speaker im a richland district resident and im actually on cabrero street right now and just yielded to a jogger and i just want to say that im a big fan of the slow street getting implemented so far throughout the city, especially jfk drive and lake street, paige street and the great highway. I think that these should be part of the landmarks in the city. Until that time, which i know would require a lot of planning, i want to just say i applaud the staff that have been doing their outreactheiroutreach and to supr fewer, who i hope will take ownership and take walks on the slow street. Earlier, the caller mentioned about the third street avenue slow street and the cabrero intersection being a problem. I was there ten seconds ago, i think it could be worked out. I am in a car and i dont think it will be a problem for our neighborhood if we just treat each other with civility and share the space. Thank you. Thank you, and was that our last speaker, moderator . Operator you have one question remaining. If anyone else wishes to address the board, dial 10 now. Next speaker. Operator you have three questions remaining. Next speaker, please. Speaker this is Hayden Miller and just wanted to voice my support. I live a few blocks away from lake street, soon to be cabrio and excited to be on the slow street and i look forward to more. Thank you so much and im looking forward to golden gate park. So lets keep these streets going. Thank you. Next speaker, please. Operator you have two questions remaining. Speaker hi. Im asking you to remove duncan street from the safe street extension. It would be hazardous and the implementation would be impractical. It looks nice on the slow streets but on the ground it doesnt work and its dangerous. Duncan street is completely cut off and theres no way through for pedestrians. indiscernible . Operator you have one question remaining. Speaker i apol advis apoloe background noise but im picking my son up from school. Im on 20th street and i see people and their children walking back and forth in the little commercial district here. We heard from a lot of our residents and neighbors they wanted something in our neck of the woods and it seemed like a great idea. indiscernible . Speaker for my neighbors that have concerns, they go about their daytoday lives and safer if you wanted to do it by foot or by bicycle. So thank you for your consideration and we hope you pass this. Moderator, any additional questions or speakers . Operator you have zero questions remaining. So with that, we will close Public Comments and i know that some directors have questions. Director tumlin, maybe you could address this about the tenderloin. We would like more slow streets in the tenderloin neighborhood and can you talk about the limitations and the constraints given that its a much more dense area . That there are transit lines in the other sorts of considerations and maybe you could talk about those and work with the Fire Department, specifically around jones and other streets in that area. I would be happy to start and tom mcguire could add to this. The tenderloin has the greatest concentration of Vulnerable People in all of San Francisco and that covers all categories of vulnerability. Its also a neighborhood that historically has had threeway bound traffic through it and in this period of covid time, from mobility perspective in San Francisco, theres no need for routing freewaybound traffic through the tenderloin and for the entire tenderloin, south of ellis and east of hyde, streets where were currently running buses on, from a basic mobility functional perspective, theres no need for vehicular traffic. What there is a need for and its related to the fact that the tenderloin has the highest concentration of vulnerable populations in San Francisco, if therthere is a need for unimpedd emergency access and it has by far the highest call rate for the Fire Department and the building heights in the tenderloin all require the big fire trucks with the ladders and stabilizers in order to be able to operate in the tenderloin and its important that the fire trucks are not delayed, that they are not moving barriers out of the way. And so, for the issues strictly with the sfmta purview, there are no problems with the street closures of any kind in the tenderloin and we need to be respectful of the needs of our sister agencies. Particularly the San FranciscoFire Department and also the San FranciscoPolice Department which, of course, has a major Police Station in the tenderloin. We also have had some challenges in the covid period about decisionmaking. And so, up until recently, all of our streets projects that weve been doing are implemented under the Health Directive and therefore, we as sfmta dont get to do what we want. Our work needs to be approved through the channels that have been created under the emergency directive, which require a lot of input from a variety of departments, several of which have effective veto control over our work. And they also need to have a strong tie to positive Health Outcomes which include, also, Emergency Services. And so thats been part of our frustration in the ten tenderlo, that the simple techniques weve been able to deliver so quickly with some simple little barricades with sandbags in a neighborhood of low buildings. Therefore, not requiring the big fire trucks, low buildings, no overhead wires and no Traffic Signals and no commercial activity, those technics that we view ed this have been successful in places like the sunset dont work in the tenderloin and what were struggling with is to figure out what are the techniques that work and do we have the resources in order to procure those materials . So the tenderloin remains our highest priority. Its the place weve actually invested by far the most effort and were finally starting to see some results with jones street, turk and levinworth has not been mentioned, but it has been much slower because it has required collaboration with agencies that have a different mission than we do. And tom, perhaps, you could add more along with the recent success. One more thing, actually. In terms of i know we dont put on sunday streets, and i know weve sun sunday streets in the tenderloin. Were there any lessons from that to be applied to which streets we choose for this process . Yes, so another history with the tenderloin, of course, it requires a high level of management. Anything that we would do there needs to be carefully managed with Community Partners and so the small efforts we have done that have been successful have been in collaboration with Community Partners largely around accommodating through distribution, accommodatin and r communitybased partners have helped us. One thing we are trying to figure out doing resources for is doing more sunday streets like events, where we are managed play streets. The challenge there is getting through the Health Department restrictions against gatherings in this time. And so, for many of the ideas that weve tried to put forward, that conventional approach was denied to us. And so, again, were trying to make progress on figuring out what can we do to make it possible for children to be able to play safely in the street in the tenderloin but not actually have that be a public gathering that results in the kinds of activities that are not supposed to be happening during shelterinplace . I have one question about ha, because in my neighborhood last weekend, not this past weekend but last weekend, there was tents in the street and i thought it was a straight fare but istreet fare butit was a me. I dont understand how that stuff is allowed and then we cant figure out a way to slow streets which are legal, congregating of people. I dont know who approved that or how it happened. Thats not something that was sanctioned. The supervisors were there and others. So, again, i noticed it mostly because there were actually, like, tents, not expensive kind, but kind of the tents that you have at soccer fields kind of thing. But anyway, just kind of was trying to figure out how that happens and how we can figure out working with the city for recreation purposes, congregating opportunities. Because its not meant that necessarily there is playing all together. Its lots of people congregate to do whatever they do. So maybe thats something we can work through with the Health Department or whomever, because i see it all of the time and theyre in the public right away. And no one theres no it doesnt seem like a consistent policy. I feel for the people in the tenderloin, theyre so devastatedly impacted and there arent enough play spaces and they feel we cant justify not doing something sooner. Tom, what did i miss in my statement . That was pretty comprehensive, jeff. I think just making it clear to this board that are four specific street reductions of traffic or removal of traffic from the streets projects in the tenderloin and theres the project we already did to reduce the capacity of golden gate avenue and that was done early in the shelterinplace and theres the jones street decision which doubles the amount of walking space on jones street and now today, well be able to get out in the streets in the next week or so. And then the other two were working on are converting and expanding the pedestrian space on turke and a similar kind of expanded pedestrian road on levinwortt and were working those through with the Fire Department right now. The sum total of those four will actually be a pretty Robust Network on four of the streets among the most dangerous for people simply trying to walk around in the sense of their exposure to traffic and so we have a breakthrough on jones and were hoping to have this shortly on levinworth and turke so that very soon, well actually see a network of carfree streets in the tenderloin. Great, with that, ill turn it over to director eakin because i know she has questions. Im sure other people have other questions. I wanted to pick up on a couple of things we heard through Public Comment. The comment about embarcadaro was a great reminder we had a conversation a couple months ago. We heard there wasnt enough and ill just hear staff respond to the pretty provocative suggestion about taking half of the street and making it a slow are street and or give us a status update on the other embarcadaro project. So embarcadaro is like the tenderloin where the traffic volumes out there right now are very low. From an sfmta perspective, we would have no problem converting the northbound lane into a twolane. Its not in our jurisdiction and the court right now is in a far worse financial position than even we are at sfmta. Their tenants are struggling a lot and very stron and have stra their market is. And so, the stakeholders want to maintain full traffic capacity in order to attract cars to the various destinations on embarcadaro. So maintaining the capacity while creating a bikeway is a longterm objective bu, but thas a very expensive project and we have not found a solution that can do both. Director mcguire . No, sorry. Great. And then, ill also just join director brinkman in expressing my sadness that broderick is coming off the list today. That was one my family was excited about. Weve heard from Public Commenters on that, as well. And strongly recommend that we come quickly with a substitute to meet that corridor need that was identified. And on that note of the Larger Network on the connections, weve spoken a few meetings ago, i think, of the idea of a Larger Network and i think the presenters spoke about how were taking steps toward the complete network, but how there are some significant gaps remaining and so im thinking about the next step after this process. Are we looking to create a network and will you be bringing back a next phase so the board can fill in some of the gaps . We have no idea how long shelterinplace will last. Given the health data from this week, it appears that it will be lasting for quite some time. You heard that muni will be suffering for many months to come. We have lost about 30 of our Service Hours and twothirds of remaining service and a total loss of 10 to 80 of munis capacity and in precovid terms that is preventing 3,000 people from using muni everyday. We have to focus on shifting focused to the most we are 10 off as part of the overall Street Network and so in order tor San Francisco to continue on the economic recovery, we have no choice but to accept the geometric limits of driving and emphasize the most significant modes of transportation. So in addition to providing safe space for outdoor exercising, it is directly related to the covid emergency that we need to allow for people in San Francisco to feel safe walking by cane, using wheelchairs and scooters and skateboards in order to get around. And s so there is to reason we cannot have a phase five or six and would love to continue getting direction from this board as well as policymaybers and the publimaybemakers on pols on what that would look like. Just echoing the concerns about the vizidaro street and the constraints there and that is one corridor but i think we have examples of that. How do we have safe access to Grocery Stores and restaurants. Weve been encouraging merchants to take advantage to move tables or other services out parking lane so that the narrow sidewalk space can accommodate people walking. Weve also used the parking lane to accommodate some queuing and key destinations along divizadaro and will continue with the merchants to help manage that. Having a couple of spaces taken over doesnt help with access destination and i was wondering what more proactively looking at spaces where we should be looking at a solution that will meet the need more directly. Yeah, i can response to that briefly, if you like. We are actively looking at streets parallel to create that northsouth connectivity that the caller talked about. Were bringing you this because this is what we had ready to go at our deadline for this meeting. But this is were talking about doing this in phases but its a continuous process and whether its shared spaces or slow streets, we are always looking to expand this network everywhere weve got interest and support. So we will definitely be looking at that specific corridor in phase four. Thank you. And i swale tha will say i hd from merchants about the speed of the traffic because the sidewalks are narrow and theres a narrow street and people are trying to speed around the bus and so, i mean, i think we should, maybe, think about portions of that street are transitonly and, like, we have the transit lane and the slow streets lane. We could have slow streets shared spaces and i think, like supervisor pekkin mentioned, how to create slow slow shared spaces and other people saying lets think about the parklet things because lots of businesses would like parklets but the sharedspaces program kind of prohibits them, which doesnt make sense because from a safety and security standpoint of sitting on the street where theres traffic, you know, you want something sturdier than a railing on corridors where traffic moves pretty fast. Directors, any additional comments . Seeing none. I will undertake a motion that i note that the motion needs to strike broad i know this is painful for a couple of you. I will sadly make the motion to remove broader street from the list of slow streets and i do this because i know that staff has worked so hard on this and i appreciate everything that all of you are doing and im sure that well find a way forward with all of this. So i will make the motion to strike. Is there a second . I will second it, but can i ask a question. Is lombard in or out . Madam chair, lomb remark rdat on the list of slow streets to be approved today and i understand that implementation, it was previously approved and please correct me if im wrong, but the board could only act on items that were noticed in the agenda so that the public had noticed that the board was taking action if lomb remarard t noticed and it would be improper to act. Is it clear to supervisor peskins office that that is our reality or is he expecting something different. Supervisor peskins office is aware of the brown act, the Public Meeting law. And weve bee made it clear e lonbard is not part of this action, it was a part of the earlier phase and were moving forward immediately with elementing it, ideally within the week. Great. So youre saying you dont need another action . Correct. Ok. Well, thats a good answer. Great. And so we have a motion and second on removing broderick street from the list and a role call vote. role call . If i do not vote for this broderick doesnt get removed. Is that correct . Yes. Fascinating. Ok, well, maybe someone can set up a conversation with someone from the Fire Department. I will vote very reluctantly and i think this is a mistake. With a neutral like that, i should vote no but ill vote aye. And madam chair, the motion to remove broderick street has been approved. So then, i need a motion on all of the remaining items the item is amended. Motion to approve the item is amended. Role call vote. role call . Madam chair, the motion is approved. This does include the business before you. We will ajourn our meeting and we we will b will be havingl meeting. There will be no meeting on august 4th and thank you all for joining today. Adjourned. Clerk the Health Commission to orde. The Health Commission to order. Mark, will you take the roll . Clerk yes. [roll call] clerk all right. So weve got three commissioners who are not on, but weve got quorum. Okay. Well move onto approving the minutes from the july 7, 2020. Do we have any amendments and, if not, a motion to approve. Motion to approve. Second. Clerk all right. And, commissioners, before we vote, araceli, can we check for Public Comment . Operator we have no one on Public Comment at this time. Clerk okay. We will do a roll call. [roll call] clerk item 3 is the directors report. Dr. Colfax . Great. Dr. Colfax hello. Good afternoon, commissioners. Grant colfax, director of health. Good to see you. I start the directors report with some very sad news. A long time member of the Health Department, sandy martinez, di Maria Martinez died on sunday. She worked at the Health Department for 23 years. She focused on building many initiatives and key models for the homeless that not only became models for our care here in San Francisco but models that were scared up nationally. She was a key member of d. P. H. Leadership for many years and served many rolls. Department director of community programs, senior staff to the director of health, chief integrity officer, and the director of whole person care. She continually strived to the equality and racial lens. I worked with her early in my tenure at the department, and since i returned. She was a really unique person with her own sense of wonderful style, was inspiring to meet with and engage. Ill miss her terribly, as will the department. The next item is with regard to an update on covid19 and the pandemic. I will be giving a presentation on the data a little bit later in this meeting, but i do want to articulate that we are seeing a surge in infections, a significant surge that started approximately two weeks ago, and as a result, we have paused our reopening steps, and were taking the our reopening of businesses in San Francisco, and were doing the following as we speak. Were following the states requirements. As many of you know, the state has become more conservative in its reopening, has put a number of counties on its watch list. We were put on the watch list as of friday because of our cases and hospitalizations. We were pretty conservative compared to other counties on the watch list in terms of what we had reopened, so it did result in some changes. We closed indoor malls yesterday, as well as nonessential offices. Were also focusing on behavior changes and preventions is really key to this pandemic. Were not going to test our way out of this pandemic. We really need to focus not only on scaling up testing where possible for the people who need it most, but focusing on the prevention activities that we know work and help flatten the curve. Facial coverings, social distancing, adherence to social distancing, good hygiene, and avoiding social gatherings and staying at home whenever possible. We continue, as we did as we have from day one, focusing on equity and the most impacted communities in the city, and we will continue to focus on reaching out and working directly with take holders and leadership in the Latinx Community, and residents of the eastern and southeastern neighborhoods of the city where the greatest number of cases are now being diagnosed. This includes expanding prevention and testing access to these communities. Well also focus on testing. You can see in the presentation coming up, weve far exceeded our testing goals, and at the same time, demand for testing has now exceeded our capacity to meet it at the city and Health Department levels. We did issue a health order dr. Aragon is issuing a health order to ask private providers to also do their part at testing. This order will require providers to offer systematic and people in close contact diagnosed with covid19, to offer them a test in an expedited manner. So i will give more details on the covid19 pandemic during the presentation, but a little previous in the directors report. So i also just wanted to go through, at the end of your report here as an addendum, theres some budgetary news that i felt needed to be shared with the commission as quickly as possible. Youll recall that we presented our Budget Proposal to you recently. However, in terms of the budget outlook, one of the strategies in terms of meeting the citys overall budget goals has been to add the citys labor partners to defer upcoming base wage increases for city employees. Delays these increases would decrease the funding. And on july 13, the mayor instructed departments to provide additional directions for reducing the deficit. For the Health Department, these new targets are an additional 15. 1 million for fiscal year 2021 and 62. 5 million for fiscal year 2122. Proposals for reductions are due on july 27, and the Health Department is continuing to work with the Mayors Office, controllers office, and other City Partners to meet this goal, as well as to meet our budget plan for covid19 and in response to Mental Health sf. So these will be included in the Mayors Office directive for the budget. So we will continue to inform on the status of these initiatives as soon as possible, and that concludes my directors report. And with regard to that last part, chief medical officer greg wagner is also available to answer questions. Thank you, commissioners. Okay. Commissioners, before we get to you, id like to go to Public Comment. I know we have callers, but i dont know if they want to offer Public Comment. Operator we do have publ listeners, but they dont have their hands raised for Public Comment. Okay. Commissioner chow . In terms of this 15 million and later, 62 million, will you need to [inaudible] i assume that youre going to submit those, and i guess our next meeting is Something Like august 4, so i just want to sort of figure out the timeline, which is certainly something thats [inaudible] yes, and thank you, commissioner, and i will have greg wagner, our c. F. O. , answer your question. I will say maybe ill speak for greg initially, that greg said to me, this is the most challenging budget situation hes seen ever, and greg has been with the department for a while, and the city for even longer, through some big challenges, but ill let him respond in detail to your question. Hi, commissioners. Greg wagner, chief financial officer. So thanks for the question, and yeah, grant got it right. Theres a lot of moving parts to this budget, and so were kind of looking at it as we go. Obviously, because of the timing of this one, were on a very short timeline to respond. And i think part of the context of this direction is theyre trying to close a large deficit, and its affecting department reductions but also tools that they use to close the biggest part of the deficit. Mr. Wagner . Greg . Greg . Greg . Im sorry. Im sorry to interrupt you. Theres feedback. Theres a weird sound. Im trying to cause we cant hear you. Araceli, is there something on the Public Comment line that the loop needs to change, because im concerned about feedback. Theres nothing theres nothing from this end that would be causing that. Do you have maybe an open mic that may not need to stay open, because i only have the bridge line open, and theres nothing feeding into it. Commissioners, could you raise your hand if youre having issues on your end. All right. So greg, can you hold for one second . Im going to just try to okay. Im going to try again, and im sorry, everybody, if we cant fix it, but go ahead, greg, if you can. Oh, now we cant hear you at all. Did you mute yourself, by any chance . Yes, i did. Okay. Is that better . Yes. Okay. I was going to attempt to call in via phone. So i was starting to say that, you know, i think part of the context here is that the Mayors Office, theres obviously a big budget deficit and a lot of moving parts, and each year, the Mayors Office addresses the deficit through a combination of the reduction targets it gives to departments and other solutions that are citywide in nature, and those may include things like changes to the Capital Expenditure budget, revenue initiatives, working with labor, and in this case, all of those pieces. And because of all of these moving parts and the fact that there has not been progress on working with labor on the issue of delaying increases in wages for city employees, i think theres still a commitment to working on that and other solutions, but what the Mayors Office needs is to have some options on the table so that they have choices available to them to make as they go to close the budget. So i think whats going to happen is because of the very short timeline, because dr. Colfax said, these targets will be due on monday, so theyre occurring in an even shorter turnaround than the last phase of the budget cycle. Well put together some highlevel options, and probably not at the level of detail that you all are used to seeing in your normal budget packets that we submit to you as part of our Commission Budget process. That will occur, as you said, dr. Chow, in between meetings of the commission. And then, well come back and report to you as soon as we can on what that looks like. And then, i would also anticipate that should the Mayors Office need to use that additional said of proposed reductions to balance, there would be a further period of refinement where we would have to determine at a more detailed level what those proposals would look like and what the impacts would be, and at that point, we would bring those to the commission at the level of detail that youre used to. So itll be, i think, an iterative process where we wont have time for our usual level of detail, but we wanted to make sure that youre aware that this is happening, that this activity is going to be occurring in between commission meetings, and then well bring to you as much detail as we can at the earliest time possible. I definitely appreciate the process that you have outlined, and, if necessary, there would be more detailed conversation, so thank you. Thank you. Commissioners, any other questions . Greg, i did have one question. In terms of this and next fiscal year, weve gotten dollar reductions. What does that number represent in terms of the departments budget . You know, i have not done the math, but off the top of my head, it is probably in the neighborhood of 10 , but we just got the dollar value and did not ask. Thank you, greg. Commissioners, other questions . So commissioners, would you like to move forward to the next item . Yes, general Public Comment. Actually, item 4 is the covid19 update, and its dr. Colfax again, and hell be joined by dr. Bennett after he presents. Dr. Colfax, please give me ten seconds to get your presentation up. Dr. Colfax thank you, commissioners. While mark is getting the presentation up, im going to give an over yall update in terms of what were seeing, and then dr. Bennett will present in terms of how were running [inaudible] your sound is going out, dr. Colfax. Your sound is maybe going in and out. Im not sure whats happening with you and greg on your end. Nothing has changed since i last spoke. Now its [inaudible] i cant hear you at all now. You know now, im speaking. Okay. It sounds clear, now. Right now. Is your door open, sir . No, sir. Well, i tried. Go ahead, and ill let you know if you go in and out, but right now, you sound clear. Okay. So i will go through with the covid19 update. Next slide, please. So as you can see, were now over 5,000 cases of covid19 in San Francisco diagnosed. Weve had a steady increase, and you can see the numbers here. Weve increased our time, from going to 3,000 to 4,000 and 4,000 to 5,000 quite quickly. Weve had a total of 15 deaths. Sad 50 deaths. Sad to see people dying, but its not what other jurisdictions are seeing. Next slide. This is with regards to testing and case demographics. Lots on this slide, but just to reiterate, weve done nearly 250,000 tests in San Francisco. Our overall Positivity Rate is 3 . The jagged line is the productivity rate, which varies, to some degree. The lighter gray bars are a little bit unstable because lab reports labs do not always report the immediately report their results to us, but you can see that overall, our Positivity Rate has remained unstable over a period of time, but 3 overall. So daytoday, its really important to look at the trend in this graph overtime. In terms of cases, race, ethnicity, continue to see the epidemic among the Latinx Community, representing nearly half of all cases, so very concerning there, and we are reinforcing our work in the Latinx Community and latinx neighborhoods, working with the Latino Task Force as well as other neighborhoods within the city to ensure that people are getting testing as soon as possible, particularly those that are symptomatic, that we are providing support services and contact tracing. Next slide. I think its important, given the pandemic and the situation that were here in locally, certainly during this in the surge, theres lots of concerns and lots of competing needs, and i will just say that our Testing Capacity is increased in terms of demand. I also think its important to look at how San Francisco is doing compared to other jurisdictions. Were working with similar limitations. You can see here in terms of our case rate, with the exception of seattle, our case rate is significantly lower than other urban jurisdictions. Our death rate is certainly significantly lower, and while our testing across d. P. H. And other city support systems is not able to fully keep up with demand as much as we would like right now, we are at a higher rate of testing per 1,000 than other jurisdictions. I would also say weve far exceeded our goal of 1800 tests a day in the city and are now doing over 3,000 tests a day across all our city systems. And in general, the city and the Health Department has sponsored has supported most of this testing. Over 60 of the tests in San Francisco are being done through d. P. H. And other citysupported systems. Next slide. So this slide is the slope of the epidemic, the curve, so to speak, based on hospitalization, and the commission will recall that we used hospitalizations because it is the most reliable indicator of where the disease how the disease is affecting residents in the city. But remember, because of the course of the disease, were two weeks behind in terms of the spread of the epidemic if we just look at hospitalizations because generally, the hospitalization rate is two weeks behind the spread of the virus overall because it takes a while for people to develop systems and then have to be hospitalized if theyre hospitalized for covid19. You can see going into late june, early july, we had really made dramatic accomplishments in not only flattening the curve, but some people said crushing the curve down to as few as 26 people in the hospital, and you can see that weve seen a rapid increase in our cases. The dark blue bars are people in the intensive care unit, and the bright blue bars are people in acute care, and i fully expect us to pass the acute surge that we saw in april, and we have no indication that this rate will decrease any time soon. You can see that curve going from early july to where we are now. Thats a pretty steep increase, and very serious in terms of our spread, what this is saying about the spread of covid19 in the city, which is why weve had to pause any reopening. Weve really brought a message to the people to shelter in place as much as possible and to do the prevention activities, including facial masking and social distancing, that this is no time to let our guard up. Next slide. So this is looking at our change this is one of our key indicators that, again, as you know, commissioners, you can follow on our website. Theyre updated on a regular basis. This is one of our key health indicators. The percent change in covid hospitalizations by week, and you can see, again, that we were doing quite well in terms of the disease, and so again sorry. Im having some trouble with my pings bars, so i cant see quite to the bottom of the slide. But any way, you can see there was an increase. It was either late june or early july. I cant see the bottom of the slide due to microsoft teams. The red trigger was a 20 increase, and we remain at high increase in our rate of hospitalization. This is our running average over time, and you can see right now were at 27. 6 , still very much in the red zone, and a dramatic shift of where we were in late juneearly july. Next slide. So weve also seen changes in in our sevenday running average of covid positive cases, and we are our goal was to be below 1. 8, and you can see here, were seeing a dramatic increase. Since june 14, weve had a very high rate of covid19 infections detected per 11,000. That increase has been sharp, and shows no sign of abating. Next slide. So in working with our colleagues at California State University berkeley, the team weve been working with since the beginning of the pandemic, this is their estimates of the reproductive number. A reproductive number is how quickly or slowly a pathogen runs through a community. A reproductive rate of one means that for every 100 people, more than 1 person infected. A reproductive rate less than 1 means that every 100 persons, less than one is infected. We did that as a city very effectively early on. You can see in april and into late may, early june, our reproductive number was low, and in some of these numbers, we got it to around. 8, and you can see it was consistent with covid19 cases and hospitalizations. We crossed 1 in the first week of june and are now at approximately 1. 32. The number 1. 32 that im demonstrated is represented by the solid blue line in this graph. The shadings around that solid blue line represent the statistical estimates of probability with regard to what the reproductive number actually is. Remember, these are models. We cant actually measure the reproductive rate directly, so this takes lots of data and lots of modelling to get this estimate, so the average probability most likely reproductive probabilities is 1. 32, but again, up to. 5 in either direction, as demonstrated by the shadings. So 1. 32 doesnt sound like much, but dramatic implications for our Health Care System and populations. If theres no change in the reproduction rate of the virus, our models indicate we would have a peak hospitalization rate of 990 in midoctober, with a total of 820 deaths added, which includes the 53 that have already been reported, and you can also see that there are plauzible scenarios where we get into peak hospitalizations of of over 3,000, and 1900 deaths in 2020. So very concerning data here. A surge of the level of what we saw in april. Next slide. But we can make a difference, and if we take if we are successful in reducing the reproductive number by 30 , we would have a dramatic reduction in both hospitalizations and deaths, as demonstrated on this slide. So really, the power is in our hands, and it is possible that we could see change and bend the curve again, but we would have to all do our part and support our communities especially vulnerable to the virus as well as the communities that need the information and support to take action to, again, flatten the curve. Next slide. So our Health Orders continue to be revised and issued consistent with the evidence and the situations that were seeing with regard to the data. You can see here we did allow a few things to reopen since early july, Outdoor Activities and boating. The data does show that Outdoor Activities are safer than indoor activities, but we paused on the original plan that we had for july 13 in reopening some key businesses. As i mentioned in my update, we were added to the state watch list as of friday, and this requires some additional shifts, and we will continue to follow and determine what next steps need to be taken, consistent with where the data are guiding our actions. Next slide. I do want to say in addition to, really, a lot of work thats being done at the Covid Command Center in terms of preparing for a greater surge in the increase of the number of hospitalizations, there is some hope on the horizon. Many of you are aware that a number of vaccines are being developed and tested. Im proud to say that the Health Department is currently scheduled to be one of the places where vaccine trials will be run, both at the Bridge Research at 25 vanness, under the direction of dr. Susan buckbinder, taking all the research thats been done with regard to hiv trials and applying those to covid19 trials. Zuckerberg San Francisco general is also anticipated to be another site. And i think just as we have worked with ensuring that prevention messages and support and care are provided to communities most vulnerable, to both the getting infected with the virus and poor outcomes to the virus, so we will be ensuring that we will be working with communities to ensure that they get the education, the support, and access to participating in these very important vaccine trials going forward, and happy to return to the commission with more details about this work in the near future. Thats my update, and i can take questions now, or we could turn it over to dr. Bennett, and she can give you an overview of the covid command. This is commissioner giradeau. I have a giraudo. A number of families that i have worked with have told me that their private schools have told them in communication this week that their schools would be opened. So at this point, schools need to remain closed, given that we are on the watch list, we did issue Health Guidelines for school to potentially reopen if and when the Health Officer makes the determination that it is potentially safer to reopen schools. At this time, schools cannot reopen, and there are ongoing conversations with the state about what may be plausible situations where that may happen. Thank you. That was the information i received, so thank you for clarifying. Thank you. Commissioner chow . Yes, thank you. In follow up, all that were talking about schools, what about colleges or universities . Not quite sure theyre coming under all of these edicts or are they under another type of rubrick . Yeah, theyre under another type of rubrick, but we can certainly get the information to you with regards to the dynamics of exempt education institutions. As you know, theres a number of institutions that are taking different approaches to this, but we will check in and ensure that we get that answer back to you. Thank you. Commissioner chung . Thank you, dr. Colfax, for the informative presentation. This is not a question, but more of a comment and thank you to all of the staff at d. P. H. Who are doing their best. Its unusual circumstances. With all the things that are happening this is my question like, of all the things that we are doing to support staff, that their Emotional Wellbeing get prioritized . Yes, thank you for that. I think dr. Bennett can talk a little bit about what that support is like at the covid command. Ill tell you, first of all, in terms of what youre doing in terms of expressing appreciation is great news. We are in our sixth month of this, so there is a lot of need for people to take breaks, to take care of themselves, and weve been focusing on that. This is a mayrathon, and you cant run a marathon without taking care of yourself. Weve been making sure they get the Employee Support if they need it in terms of Behavioral Health and those needs. I do appreciate it. The other component that i think is important to acknowledge is all the staff thats trying to get things together during this trying time. You heard about greg wagner and the budget challenges. And then, there are many people in Mental Health that are seeing unprecedented demands and needs. So while we focus our work around covid19, the rest of the work of the Department Needs to continue, and thats conducted under very challenging fiscal challenges as well as sort of delivery circumstances. And many of our Community Providers are in the same situation, so i appreciate it, and were doing everything we can to support employees as much as possible, even as we see the surge and focus on trying to do everything we can to support the community, but to support the community, we also need to support each other. So director colfax, question 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, th