Sfdph to test all residents in an s. R. O. Within 48 hours of a single case. I would like to be clear that we are not asking to waterdown the legislation or relax rules for s. R. O. S. Our team, who exists to advocate and protect these residents, will continue to deploy onsite testing to a building, when there is concern for interbuilding transmission. And we do a lot of onsite testing in s. R. O. S. At the same time i want to try to explain again why this particular provision is just not an effective strategy. I know that testing is a hotbutton topic. Its a politicized topic, unfortunately, at the national level. And i really want to reiterate if we thought this particular testing strategy, testing all residents in a building after a single case, if we thought that would be effective at preventing outbreaks, we would be all for it. We are aligned in prioritizing and working to protect s. R. O. Residents. The challenge, though, is that s. R. O. S are not closed settings, like a Skilled Nursing facility. In a closed environment, like a smith, you can implement we can implement routine surveillance testing of staff and identify staff cases before residents become infected. And, of course, this is especially critical in the smith context, because the case fatality rate is so high among those living in those conditions. But s. R. O. S, as you know are not like smith. Theyre open. Residents come and go every day. They go to work, they go to the store, they go to visit their friends and family. And so a single case in a building, in a residence doesnt mean that theres an outbreak in the building. We do test and quarantine close contacts of all cases, including cases among s. R. O. Residents. Then if their contacts, including their household members, then their nextdoor neighbor, whoever they hang out with in the building, if they test positive, we continue to test and expanding circles. In the worstcase scenario, and this has happened, an s. R. O. Resident has covid, hasnt been tested and is symptomatic and has not been ice slating in the building. They think they have aler gees o allergies. By the time they get tested they may have exposed others in the building. At that point, though, testing is not prevention. Testing doesnt prevent anyone from getting infected. Theyve already been exposed. But what it does do it allows to us find cases. And we want to find those cases, because then we have the opportunity to intervene on those who are already infected. And so thats why we do deploy testing when we see multiple cases in a short period of time in a building. And so, you know, really i think to summarize here, what im trying to explain is that testing is important. It enables us to identify individuals who have covid when theyre still in thin infectious period, then we can support them in isolating. We identify their close contacts and support those close contacts with testing and quarantine. But mass testing at a single point in time, triggered by a single case, does not in and of itself prevent covid19. So in conclusion, building mas g is not a strategy in line with our citywide testing strategy or with supervisor peskin miss major, i think you may doctor orb someone may have hit a button that they shouldnt have hit . Clerk thank you, mr. Chair. Im checking with operations. It might be the bridge line. We will supervisor peskin the bridge line has become the bain of our existence. Go ahead. Thank you, dr. Cohen. My apologies. No problem. So really in summary, i think what im trying to make clear this particular strategy is not in line with cdph or c. D. C. Guidance. Its not the best use of our testing resources. And our investigative tools can really help us predict when and where to test. We really have to continue to push primary prevention approaches, the best way to protect everyone from covid. And thats, as you know, things like masking, social distancing and hand washing. Those are the critical things for mitigating spread in all settings. Thank you for giving me another opportunity to speak to you and for all of your work to protect these communities. Supervisor peskin thank you, dr. Cohen. And when that when you release your screen, well all be able to look at each other over our respective computers. And, dr. Cohen, i really want to thank you for your candor. And, indeed, this is an evolving situation. And i think collectively we are trying to, as nondoctors, address what we believe are the most vulnerable populations in the most transmissive settings. And i know that you and your colleagues are committed to that as well. And as i said earlier, we know that youre resourceconstrained, as we all are economically, Human Resource wise and relative to actual physical things that are reagents and swabs that are moving to hot spots in the United States of america, be it texas or florida. And, yes, this is an ordinance. And, yes, it is a law. But fundamentally and i have tried to communicate this to you and to the advocacy community. This is an admonition. And it is a shorttermed a mow s going to last for another two months. And i for one, unless you make not you personally, but the department is malfeasant and not going to go after you, so to speak, on. I think this is really trying to hold you to the highest standards for our most vulnerable populations. And this, too, shall evolve. Ultimately i hope this becomes a permanent ordinance, which doesnt mean that we cant tweak it going forward. But i think the most important thing, and ive been very clear with you and the community and my former colleague, who has become a liaison between the board and your department, former supervisor katie tang, that i really want to create the space to build trust between the department of Public Health and the community. And the community has been abundantly clear in the last several days and while i think i dont want to put words in their mouth, that theyre thankful for the transparency that now comes with the additional tool on the tracker site. That trust is earned through hard work and relationships. And you are working now to build them. These were relationships that didnt exist before the pandemic, that have to be built very, very quickly. And i hope over the weeks and a couple months ahead, before this becomes a permanent, albeit flexible piece of legislation, that those relationships and that trust will start to be built. So i just wanted to share those thoughts some that you know where im coming from. As you know and as said in the paper 48 hours ago, i actually originally didnt want to have this debate. But i fundamentally have to honor the community that is are in these s. R. O. S. And i think we all collectively, the people, the decisionmakers and the department of Public Health really also have to delve down into and make very transparent what is confidential and why and what is not confidential and to whom and why or why not. And i think h hippa which is a huge privacy law, needs to be weighed and balanced for Public Health. I think we have to delve down into that, maybe in closed session, subject to attorneyclient privilege advice. But ultimately in open session, where we can all ask those questions and understand where we balance privacy. As i have said to the deputy city attorney, that is on this in this meeting and to counsel for d. P. H. , it strikes me as odd that we can be transparent with a Building Owner or a building manager, that theres a covid case in a particular building with a particular address, but we cannot tell the rest of the tenants that one of their neighbors, that they share a kitchen or a bathroom with,s that covid. And i dont want to freak people out. I just want to make sure that they have the opportunities to be tested, to be isolated, to be quarantined, to be given a meal in a comfortable, confident way. Thats whats driving this. This is not a, you know, board, you know, being you know demeaning to d. P. H. Its not at all. Its an evolving conversation. I know you understand that. So i appreciate that. Are there and dr. Cohen, if you have anything you want to add or subtract from that, youre welcome to do so. No. Thank you very much for your comments. And just for the opportunity to continue to have a dialogue. The science is evolving and the diagnostics are evolving. I know well continue to work to figure out the best way to do this. And really appreciate that weve gotten the chance over these months to try to think about that together. Thank you. Supervisor peskin i really appreciate that youre taking this legislation seriously and that you are spending moments of your precious time, as youre triaging and stratifying, to actually engage with the board seriously. It would be easy enough for you to say, thats the thing, were going to blow it off, because were resourceconstrained. So thank you for that. With that to my colleagues, hold on, let me press a button. Either one of you have any questions or comments . I did, chair peskin. Thank you. And just concur with your the remarks you just made. I did have just a question from the d. P. H. Perspective what does trigger, under the current understanding of the mass testing, in a particular building. I understand what youre saying, dr. Cohen, about the difference between the setting and the s. R. O. Congregate living situation. Im curious. I understand from the perspective of the department at this point in time, some disagreement around whether one case should trigger that or not. And this legislation addresses that. But what is two cases in the site, what are the set of circumstances from your perspective . And i think to chair peskins point, to me its less relevant for what the Community Wants is clear. But as chair peskin notes, i think well 30, 60, however many days be out once again looking at this issue. And it will be helpful from my perspective just to know from d. P. H. s perspective what does, from your perspective, trigger mass testing in an s. R. O. Context. Well, the California Department of Public Health definition of an outbreak in a Congregate Community setting is three cases in three separate households within 14 days. So we would always define that as an outbreak and report that as an outbreak in terms of not the specific address, not the privacy thing nourishments terms of how many outbreaks we have in s. R. O. S and we would test. The threshold is lower than that. Our threshold is two cases in two separate households within 14 days. And some risk criteria for interbuilding transmission. When we have two cases in two separate households, we either go on site. We may have already gone on site previously, which may give us a sense of what the building is like and whether theres risk. We havent gone on site, we would go on site and there are things that contribute to that risk stratification. Things like crowded households. Is this a building with a lot of family or a lot of we see a lot of buildings ra theres multiple young men sharing one room, who are all frontline workers. We know in shows settings covid starts very quickly. Did we learn that the case was actually infectious on site for more than seven days total, between the two cases. Maybe one person was three days, one person was four days. Thats concerning. Thats a lot of days of potential spread. We know that theres certain communities that are disproportionately impacted in San Francisco. Are those folks highly represented in the building. And we also look at the risk of morbidity. Are there a lot of elders in the building, people over the age of 60, a lot of comorbidities. So those are some of the criteria we do have the matrix that we use. But basically has to be two cases in two separate households in 14 days and at least two of those several criteria that i mentioned. Supervisor preston, i really appreciate that comment. I think what dr. Cohen just told us is that we, in this case d. P. H. , can actually have Higher Standards than the state does, which say lute i salute and appreciate. Everything that dr. Cohen just said, relative to assessing risk is absolutely right. Do you have higher comorbidity factors. Do you have, you know, folks who are living 10 to a room instead of two to a room. Are they more likely to have to go to work than be retired or on a fixed income. All of those things could lead to a spread. But i think where the rubber hits the road is, and i mean no professional offense to d. P. H. Is how well do they know the residents in that building. How do they know what i have come to learn or have knowledge access to on and off in my 20 years, as to who lives in that building or what Community Members know then. I dont think that d. P. H. Can figure that out in 24 hours, unless they start working with the community to quickly under then do triage. Because you cant triage unless you know what the whether the victim is about to be in deep trouble or not. But this is very helpful conversation to me at least. Supervisor preston, do you have any more comments . Supervisor preston i dont. Thank you, dr. Cohen. I just want to echo really the point you made, chair peskin, really thank you for your leadership on this. Proud to be cosponsoring this this time, as well as last time. And i think that, you know, where we have really proactive and engaged communities representing and Community Groups representing some of the most Vulnerable People in the city, i see this kind of legislation as really honoring their expertise around the community their serving. But also as you say, but facilitating and trying to deepen the conversation between d. P. H. And those Community Groups, so that as we sort of in some ways the beauty of having these emergency ordinances as ways to sort of temporarily deal with things, but not cement them permanently and look forward to it sounds like ongoing discussions happening to arrive at whatever makes sense on a more permanent basis. It certainly resonates with me that where theres doubt, being more careful, preventative and, you know, we have for whatever reasons avoided certainly outbreaks that would have otherwise occurred through taking proactive steps. So certainly i appreciate that this, you know, we continue i hope to err on the side of over testing and overly taking precautions, rather than the opposite. But understanding that theres further conversation to figure out what that, you know, what should be in place on the longerterm basis. Supervisor peskin thank you, supervisor preston. Supervisor safai, anything to add . Supervisor safai something who is a city planner by training, you know, not many cities have this type of housing that remains. It is one of the things that makes San Francisco unique, to have a Single Room Occupancy Hotel and being used obviously in a different way than they were originally built. You know, we have multiple families, multiple generations, many members of the same family sharing space. And some for me it makes sense, under these circumstances, that we would want to err on the side of extreme caution. Because as we know and as we learn from the assisted living facilities, that was where this virus really began in the United States, in multiple cities. In new york, and in washington and all over. I dont want the same to happen. And i know supervisor peskin has been out in front of this. We had conversations in the very beginning of this pandemic about individuals and their patterns of travel and their patterns of obtaining medicine and going actually in many ways to the heart of where this pandemic began in the world, into wuhan, china. And so that is no longer a risk. But the risk is this massive amount of people in these buildings living in very close settings. And so im proud to be a cosponsor of this legislation. I think if it pushes sfdph to work aggressively with advocate communities, that is on the ground working with individuals in these settings, i think its a positive thing. And in the end if we dont have an outbreak, good. And we put the resources in the right place. So i appreciate your leadership on this and being a part of this conversation, supervisor peskin, along with the advocates from the community. And thank you, ms. Cohen, as well. Supervisor peskin thank you, colleagues and cosponsors. Before we open this up to Public Comment, while this is a reenactment of the emergency ordinance, i do have a couple of nonsubstantive tweaks perform before i open it up to Public Comment, i want colleagues to go through that. Youre both in receipt of those, as is the clerk of this committee ms. Major. On page 2, section 2, at line 22 insert and amend section 3 of such emergency ordinance to read as follows, even though both ordinance no. 8420 and this reenactment emergency ordinance are uncodified, for purposes of clarity, the respective fontses for additions and deletions of the municipal code as stated in the note that appears at the beginning of this ordinance are used to show the amendments to section 3 of ordinance number 8420. Thats the original source ordinance. In the tweaks to the original ordinance, in section 3, would be in subsection g to insert a new subsection 5. And that so let me just take you to the top of that subsection g, which is already in the existing law that we are reenacting, upon confirming that an s. R. O. Resident has tested positive for covid19, d. P. H. Shall to the extent consistent with state and federal laws governing the confidentiality of medical information and heres the new subsection 5. As soon as feasible, but not more than 12 hours after receiving such confirmation, promptly post in common areas of the residential hotel, where fire Safety Information is required to be posted, a notice to advise s. R. O. Residents of their rights under this emergency ordinance to access i q, isolation Quarantine Hotel rooms and face coverings. Such notice shall include, but not be limited to, the number of the language accessible hotline for s. R. O. Residents, that residents may call to access those resources. This is making the implicit notice requirements explicit. That was my insertion. And in sub l, under sub 2, the total number of confirmed positive covid19 cases, this is under what data d. P. H. Shall produce, the total number of confirmed positive covid19 cases in San Francisco insert residential hotels, delete at the rate of cases by population size in San Francisco. So that the sentence now reads, the total number of confirmed positive covid19 cases in San Francisco residential hotels, organized by zip code. So those are the amendments that i would like to make, subject to Public Comment. And with that, are there any members of the public who would like to comment on this item number 1 . Madam clerk. Clerk thank you. Thank you, mr. Chair. Operations is checking to see if there are any callers in queue. Noting that we have nine listeners. Arthur, please let us know how many we have in queue. There are currently five callers in the queue. Supervisor peskin first speaker, please. Caller thank you so much to d. P. H. And the board for giving time and attention to this ordinance. My name is tria. Im a tenant organizer with the mission s. R. O. Collaborative of the dolores street. We want to address the Landuse Committee to shed light on the practices of d. P. H. , in accordance with the emergency ordinance that was adopted on may 19th. Im here to ask that the land use and Transportation Committee renew the s. R. O. Emergency ordinance and not dilute any of the protections. In San Francisco, s. R. O. S provide homes for over 18,000 extremely lowincome seniors and families, people of color, people with disabilities and formerly homeless people. Many of the people we serve are also immigrants and some identify as undocumented. We believe that the impact of covid19 should not only be measured in terms of the number of deaths, but the impacts that the virus has on income and mental health. From the time the emergency ordinance was enacted, d. P. H. Has only implemented a portion of the elements and we call on them to recognize that the tenants have a right to receive a notice if theres a confirmed covid19 case in their building, the right to full and Accurate Information about the rights to recovery program, that for tenants that test positive and the general location of i. N. Q. Housing available to them. We have worked directly with tenants, for example, from tenants in the grand southern that in the last 50 days the legislation has been active, that health and sanitary measures have not been implemented, despite tenants contacting d. P. H. And shes been struggling with test problems and rats and cockroaches and ticks on top of the pandemic for the past 50 days, to the point to which she had to replace her own sink becausest inaction and unresponsiveness. And in another case, an s. R. O. Tenant at the albert struggled with the affordability of the living situation, as hes unable to pay rent monthtomonth. 23 latinx have tested positive for covid19, including the grand southern clerk thank you. Next speaker, please. Caller hello. Clerk hi. Youre on the line. Yes. You may speak. You have two minutes. Caller okay. My name is eric markoo. Im a member of senior disability action in soma neighborhood residence council. Im just saying that testing s. R. O. S should be made for the entire building in a place thats been infected. I heard other speakers in other days say that some of these rooms have, you know, selfcontaining bathrooms and kitchens. But the vast majority of them dont. And when if someone gets infected in these places, it could spread like wildfire, especially in crowded communities like the mission and tenderloin and chinatown. It just seems i mean, unimaginable to me that when we consider scaling this back at this time, when we have such an epidemic. I mean, we need people that are infected or exposed to be put into hotel rooms, selfcontained hotel rooms, not in a congregate area. Thank you kindly. Clerk again youll be notified if you have been unmuted and you can begin your comments. Hi, my name is dana foot. Im with the mission s. R. O. Collaborative program for Lotus Community services. I wanted to first say that theres currently a demand for testing in San Francisco. And through our outreach and education work, the need for the continuation of the s. R. O. Emergency ordinance. Testing allowing us to connect with services and to the programs that we have also asked. Our main concerns is that currently were assessing the impact of this pandemic in the number of cumulative deaths. And thats not an accurate number of what were hearing, tests in high levels of stress, depression, and general anxiety. We know that currently theres a timeline and challenges to the turnaround to Access Programs such as [indiscernible] we also know the importance of having transparent information about what are the services connections, Community Organizations on the ground can link people to. We know that theres a flu season approaching us and we cannot actually afford to water down any of the provisions of the legislation. We are committed, however, to continue to figure out how we support proactively testing communities and accurately investigate those possible thinks to spread. And understand the use of i. N. Q. Thank you again for the time youve given this morning. Supervisor peskin thank you. Next speaker, please. Hello. This is anna stage. A member of San Francisco tenants union, an antidisplacement coalition. I really appreciate this conversation the supervisors had today, with d. P. H. And dr. Cohen. I am encouraged with the doctor and the d. P. H. Staff are going to kind of make some overtures and steps to work with the s. R. O. Collaborative communities, that are in there doing the work with the tenants. Its the only way this program will work. And as previous speakers have said and supervisor peskin has said, not knowing that your fellow residents have someone has a case of covid is really scary. So if there could be some information that tenants could have of where to go to get tested, and then what to do once they test positive, so that theyre not afraid to go to the d. P. H. Staff or to do what they have to do or to tell their worker that,. Commissioner haney , i hey, i got tested and i have covid. If dr. Cohen cant do it or they dont have the resources to do it, these people need to be tested. Thank you. Supervisor peskin thank you. Next speaker, please. Caller supervisors, director of policy at the Community Development center. I want to thank you for working on behalf of s. R. O. Residents, not only in chinatown and district 3, but citywide. This is really important legislation. And while we are reassured by dr. Cohens words to reflect that they dont support a wartingdown of the legislation, we do continue to insist on testing being a critical need. We have seen that testing, when its done at the building, is effective. We have also seen in many neighborhoods when testing is offered offsite, it is less effective and people are less interested in being tested. We really want to frame this as a tenants righ righttoknow perspective. This ordinance is about what the tenant needs to know in terms of the citys covid response. And what the city and what the tenants, you know, has a right to know in terms of what is going on in their buildings. We have testimony a little bit later, thats going to show you that, of course, when d. P. H. Comes around and does outreef and says that, you know, theres covidwide testing, kind of sounds stupid. They know that that means that theres an outbreak or there are cases. So we hope that we can get behind, get beyond the concerns and really look at what is best to protect those communities and our s. R. O. Residents. I look forward to working with d. P. H. In the coming weeks and months, you know, relationship that builds decades back when the s. R. O. Collaborative was first funded by the department of Public Health. So were looking forward to working together and continue to strength our defense of our s. R. O. Residents. Thank you very much. Supervisor peskin thank you, mattias. Any other members of the public who would like to testify on item number 1 . Yes. Two additional callers. Ill unmute the next caller. Supervisor peskin next speaker, please. Caller hello. Can you hear me . Supervisor peskin yes, i can. Please proceed. Oh. This is trudy. Im calling from center city collaborative, part of the housing clinic. Thank you, supervisor peskin, to extend this legislation for another 90 days or more. One thing i do agree with all the speakers who spoke in front of me before me about the emphasis of testing and the outreach. One thing that i definitely felt that is terribly lacking and im hoping and willing to work with d. P. H. On it is like the reaching out to the communitybased organizations thats already working with tenants in various buildings. Because we bring the relationship, we bring the approach. So im hopingle this legislation will push d. P. H. To partner with many of us, so that we can make this legislation effective. Thank you very much. Supervisor peskin thank you. Next speaker. Yes, please go ahead. Hi. Madam clerk, im a staff person with chinatown c. D. C. I have a recorded testimony by a witness speaking in cantonese and i will be playing ard roing and then translating. This is a tenant who lives in the chinatown s. R. O. With the present outbreak. [speaking cantonese] [caller speaking cantonese] hello, im a chinatown s. R. O. Tenant. We are among the affected families in the pandemic. Recently my husband got the virus. At that time he developed a fever in the evening, after taking the pills and sweating all over his body. The fever got lowered. It was later that we found out that someone had been infected in our building. People in the building were not notified of this virus infection. Everyone was kept in the dark and so the virus spread to others. This was frightening because our household included grandparents and children. Thank you. Madam clerk, ill be submitting the written translated version of the entire statement for the record. Thank you. Supervisor peskin thank you. Any other members of the public who would like to testify on this item . Caller i would like to thank the last speaker for providing that testimony. And i find it unfortunate that we seem to have so few actual s. R. O. Residents speaking today. It seems very paternalistic to have these decisions made by people who, you know, dont actually live in s. R. O. S and, you know, some input from the people who are on various boards and stuff. So im wondering like, you know, was were s. R. O. Residents notified that this meeting was being held . And there arent any interpreters at the meeting, as far as i can tell. So the residents of s. R. O. S are very linguistically diverse. There should have been more outreach to s. R. O. Residents to get their input on these decisions, instead of the topdown manner. Supervisor peskin are there any other members of the public who would like to testify under Public Comment . Yes, hello. This is theresa with senior disability action. I so appreciate all of your work on this, supervisor peskin. I also hope it will not be diluted. I am also thinking of a resident in an s. R. O. That i visited and the issuing about that he had only recently come home from the hospital, is having an occupational therapist go in to visit him. And so when d. P. H. Talks about, you know, people, indeed, do come and go out of s. R. O. S, that may be the difference. However, it is the difference that makes it even more important for people to be tested. People are going out and working and getting their groceries, et cetera. So they may not know that they have been exposed and they need to know that. They need to protect themselves. And protect the people outside that they may encounter. So i just want to support this. Again he is a resident who could not speak today. And so i am speaking for him. Thank you very much. Supervisor peskin thank you. Are there any other members of the public who want to ite itemr 1 . Hi, yes. My name is freddie. Im with senior disability action as a housing organizer. And since covid broke out, i have been doing a lot of work with tenants that live in s. R. O. S and participating and facilitating several tenant groups and meetings within the community, within s. R. O. Working groups and collaboratives. And there is a fear of the emergency protections being through the somehow and i appreciate and im glad of the fact that that doesnt appear to be happening. And supportive of these protections that are in place will be reenacted fully. There is a fear amongst people that live in the s. R. O. S, that i have spoken with, that if they dont know that someone is infected, that they wouldnt be able to adequately protect themselves. So just one person getting it has the potential to affect so many people. Just, for example in the building im living in, its not an s. R. O. Building. It is partially subsidized. There was one tenant that was that came up positive and the entire building received notices on their doors. And for those that were nervous about being in just the hallways or the elevators, because we dont share public areas, other than the hallways and the lobby, there was several people that were able to get tested, because of that. Had they not known and been exposed, there potentially could have been many more cases. So it is important to fully reenact this and thank you for your support. Supervisor peskin thank you. Next speaker, please. Are there any more speakers . Mr. Chair, that completes the queue. Supervisor peskin all right. Public comment is closed. And to the speaker three speakers ago, let me say theres definitely a difference between dilution and delusion. Every once in a while we get speakers on the Land Use Committee meetings that dont identify themselves and they dont have to. [ please stand by ]