I move to approve the minutes. Is there a second . Are there corrections to the minutes . All in favour say aye. All those opposed . The minutes are approved. Clerk there is no Public Comment for item 2. Item 3 is the directors report. Good afternoon, commissioners, grant colfax, director of health. You have the directors report in front of you. I am going to highlight our covid19 coronavirus response. Dr. Aragon will have more details. I wanted to acknowledge the Department Staff who have been working for over eight weeks in terms of our preparedness and our response in terms of dealing with the coronavirus. Last tuesday i am pleased to announce that mayor breed declared a state of emergency in the city, which was transformative in our ability to better prepare for the response. It allowed us to activate the department to be more focused on the response, coordinate better with other city departments. This is a shared responsibility in terms of our response doing that. We were able to also be eligible for potential federal responses within an emergency response. We were also able to position ourselves to better educate the community and the public about how best to prepare for coronavirus and when coronavirus does arrive in San Francisco. A key part of our message is that everyone can be a Good Public Health hero in this response. That includes not going to work or school if you are sick. Stay at home or seek medical attention. Avoid coughing into your hand. Cough into your elbow or sneeze into our elbow. We recommend to not shake hands, but do an elbow bump instead. A key piece moving forward. And also a reminder to get a flu shot, and a flu shot does not prevent coronavirus infection, but it prevents symptoms similar to a coronavirus infection. Get a flu shot to prevent getting symptoms. And, very importantly, wash your hands or use Hand Sanitizer frequently, especially after being in contact, close contact, with others, touching your face and so forth. Regular hand soap for 20 seconds is one of the most effective Public Health strategies that we have as well as Hand Sanitizer. Hand sanitizer is available outside with the commission materials. We also need to focus on the outcomes. Our department is working with other Healthcare Systems and other departments to focus on the most vulnerable. According to the w. H. O. Those include people over 60 and Additional Data shows people with chronic medical conditions, especially diabetes, kidney or renal disease, people who have autoimmune disorders and are on medications. Were focusing on those populations. Im pleased to say as of yesterday San Francisco has started testing for coronavirus covid19. This is a big step forward for us because until now weve had to send tests to the c. D. C. That turnaround time can be as much as seven days. We are now, because of our Laboratory Leadership who worked very hard to scale up and to be ready for testing, we started yesterday and that turnaround time is now between one and two days. We do not have a newly diagnosed case of covid19 in San Francisco diagnosed at this time, but i just want to emphasize that given the situation that were seeing in terms of Community Transmission in our surrounding areas, i think its a matter of not if but when. When there is a case, the departments will report it as quickly as possible to both you and of course the public at large. I will also emphasize that as we continue our collective response in this epidemic, we need to ensure that were following the science. Part of that scientific literature is that stigma discrimination and xenophobia is very much bad for individuals, its bad for community, and its bad for Public Health. We are working with communities across the message to ensure that stigma, discrimination, and xenophobia will not be tolerated and we must address this disease together using the best Scientific Evidence as possible. As part of that effort, we are having numerous communications, meetings, and engagements. Those efforts are being coordinated with the department of emergency management, which is leading all the areas of the response that are not directly Public Health or clinically related. Thats my focus on the directors report today. I am happy to answer any questions on the report. With regard to covid19 response, i would ask dr. Aragon to address more details in his report, which is the next agenda item. Thank you. Commissioners, before we go on to dr. Aragon, you had received the report previous. Are there questions on the other areas of the report that he has given us today . Most of these are areas to which are matters of interest. The joint commission is at zuckerberg general. Were actually going through the full survey at this point. Let the commission know if you had not seen that point sent to you earlier. Likewise, on workforce violence at zuckerberg we did address that during our joint conference committee. The information here in the directors report is very substanti substantial. We are continuing to address this message in a very serious matter, also at the joint conference. Commissioners, if i may add, i meant to say we have Public Health leadership here for the specific agenda items today. I have excused many as the executive staff who would typical be here because they are working on the coronavirus covid19 response. I want to acknowledge that fact going forward, but per these agenda items, we have the leadership that needs to be here today. Thank you, director, for the update in where we are. I think we will now hear dr. Aragon, who will give us further information as to the status in the city regarding our response and what the science is today. This is item 4. Good afternoon. My name is dr. Tomas aragon. Things are moving at a fast pace. Im going to try to complement the things to dr. Colfax summarized. As he mentioned february 25 mayor breed declared a local emergency. I want to clarify that its called a local emergency versus a local health emergency. So local emergency is more encompasses and gives us broader powers and more authority to mobilize resources for the city. So thats really important to say. The other counties are asking us why we didnt declare a health emergency, and we said no, were declaring a local emergency which gives us more power and authority. On february 26 Solano County announced the first case of communityacquired coronavirus. As of today the chronicles are reporting we now have 12 communityacquired cases. Each day the number is picking up. If you imagine, if you have 12 cases, theres really an iceberg of people who are infected. We know that most people have mild illness. So that means that infection is circulating in the community. He also mentioned that on february 29 the first death was reported in Washington State. The number of deaths now in Washington State is up to nine, and six of those are connected to a longterm healthcare facility. So theres been a big pivot in the way that were now focusing on the epidemic. This week has really been a big transition week for us. So we have three highpriority areas that were really focused on. Dr. Grant had mentioned number one is focusing on the most vulnerable, medically fragile persons. We know with what were seeing is especially with people who are older and chronic medical conditions that we saw in those longterm care facilities, that the mortality rate is high. The second one is protecting our healthcare workers. Healthcare workers have a unique situation that their cumulative risk of infection is higher than the general public because theyre seeing lots of patients that could be infected and those are the ones we need to protect from becoming ill. The third is focusing on mitigating community spread. There the focus is on how do we interrupt transmission so we can reduce illness and severe disease, thereby reducing demands on our Healthcare System and also reducing the social and Economic Impacts of our community. As of this afternoon, the c. D. C. Is reporting a total of 60 cases across the country. The chronicle is reporting a total when you look at the whole area including travellers. And as well the community acquired, there is 12. The total number in the bay area is 29. San francisco continues to have zero cases at the moment. Santa clara county is up to 11 cases and berkeley just reported a case this afternoon. By focusing on the most vulnerable populations, were asking people who plan large events or Mass Gatherings to really think through about the most vulnerable populations, to really take that into planning and to consider how they can adjust. Just to let you know the Health Department did adjust project homeless connect. Were going to make sure when we bring it back that we address the issues so that people are safe. The c. D. C. As well as d. P. H. Just released our longterm facility guidelines so we have a real rigorous focus on protecting persons in longterm care facilities. Within that, we have the focus on condegree gat settings. Today dr. Baba met with the s. R. O. Committee to focus on what we can do around s. R. O. S where we have a high concentration of persons who are not just older but share facilities. Another major area were making progress reason is dr. Colfax and dr. Baba are working through the Hospital Council to identify and mobilize resources and figure out how the city will handle medical surge, but not just in the system, but if the systems get overwhelmed, do we end up designating specific hospitals to take over where care can be provided. As already mentioned, we have started our testing in San Francisco. I understand that the testing is going to be increasing dramatically at the national level. Unfortunately the c. D. C. Was very slow initially, but thats changing. Two more things i want to mention. Just this afternoon, the California Department of Public Health just got permission to release from the stockpile that they have, its in the millions, its a large number of n95 for healthcare workers. So thats really good news. So were going to have n95 res pirators for our healthcare workers in california. Thats important for us to recognize. The last thing i want to mention is for Community Mitigation which is interrupting transmission in the community, we think of personal measures. Dr. Colfax mentioned the personal measures because they are critical, its the foundation. The community measures, i mentioned the issue of how to think about Mass Gatherings and large events. The third area is environmental measures. Thats really cleaning and disinfecting our environment. And dr. Colfax referred me to olga miranda who is a union lead for the porters in San Francisco. And i believe its 5,000, a large number of porters that we have that clean all the buildings in San Francisco. So i mention this because they are really the they are part of the frontlines of fighting this epidemic and they need our support because theres a lot of issues around their working conditions that we can work on together to make it better for them. So i do want to mention that. I do want to thank dr. Colfax for referring me to her. Its an area where we would not notice it if it werent for the epidemic. They came to us. I think its a great opportunity for us to have a strong partnership. We dont see them. Theyre cleaning at night. They make a big difference in keeping us safe. I do want to acknowledge them and to thank dr. Colfax. Thats the end of my report. Thank you, dr. Aragon. Commissioners, questions of dr. Aragon. I think its important to acknowledge how hard the department has been working and the fact that much of our usual staff who was at the meetings to help answer some of our questions are not here because they are busy, as dr. Aragon described, doing all the different work that will be necessary in order to respond to whatever happens with this as we move through this Community Phase of the problem of the infecti infection. So i do want to express on behalf of the commission the gratitude for the very fine work that were doing, which is not only protecting our city, but also being able to address the anxieties of our City Residents as to what it is that this virus is all about and what needs to be done. I think the success so far of the information that you have put out is indicated by the fact that people are appropriately using the techniques. I notice that hand wash materials are actually very squares to find in scores. And even though it appears you cant really buy a mask out in the public areas for the fact that the city does not have everybody wearing a mask i think indicates that i think weve heard the message. Its important to have that if we believe that we have some sort of infection, but that very importantly that Health Workers need it because of the exposure that theyre going to get. I think your last information that Health Workers are going to be able to access this is very importa importa important. I believe that we want to once again express our thanks to the department and the mayor for actually getting ahead of this. Although, i guess it was in the hour that the government also declared with the c. D. C. That there was a real need on a nationtonation basis to be mobilized. We were there also to mobilize the city. Our timing was very good. I described it to a coworker. Were like riding a wave and were on the right part of the wave, not wiping out but just ahead of the curve. I feel confident in what were doing. Commissioners, some specific questions that you may have. Thank you, dr. Aragon, for your report. I want to add my thanks to commissioner chow for the swift action and the comprehensiveness of the work thats being done in riding the wave quite well. I had a question about the testing. The test kits, the c. D. C. Tests, are they state tests or what the current tests that were sent out came from right as of today, all the testing are c. D. C. Kits. So the state Health Department has them and then selected local Health Departments got some of them. We got just over the ability to test 100 people. That still is limited to people who meet the requirements for testing. The f. D. A. Just approved the ability for hospitals and private labs, as far as they can meet the full laboratory requirements, they can go ahead and start testing. I think over the next week or two youll see a lot more positive tests. Can i also state and reinforce the fact that current testing recommendations are to test people who are at highest risk for coronavirus infection. Theres no ondemand testing in San Francisco. Im not aware that theres anywhere at this time, but just to emphasize that. The test has to be if people are correspond, they need to discuss this with their healthcare provider, who will contact the healthcare department, and they will make an assessment with the c. D. C. Guidelines whether a test will be done. Thats correct. Thank you as well. My question is of all the cases reported in the United States, are any of them children and adolescents . None are children that im aware of in the United States right now. I know from china the number of children involved is really, really small, very small. Thank you. Commissioner green. Thank you so much. I was wondering if you could elaborate on how youre interacting with Hospital Councils. I work in the sudder system and most of what were getting is from sudder corporate. So many of our hospitals are getting things systemwide. Im going to refer to dr. Colfax because thats an area hes spending time with. If you could elaborate with, that would be great. Using the Hospital Council, we have brought together the Healthcare Systems to have shared conversations to make sure we have the best understanding of how we are preparing together, focusing on the same priorities and the same populations and also ensuring that we are potentially being able to share resources, particularly with regard to the medical staffing and staffing up in the event we need more capacity to respond to an epidemic. So lots of planning going on on an ongoing basis with regular and structured calls, on a regular basis to ensure that point people are identified, leadership is activated, and that were moving forward as consistently and as rapidly as possible. Thank you. I did want to thank dr. Aragon also for responding to my question last time in regards to the s. R. O. S and that the d. E. M. Is working with them in order to be able to help respond to another vulnerable area which i think especially in this city is very pertinent. Commissioner, if i may add something else. The most uptodate information on coronavirus and local guidance, sfdph. Org and then the c. D. C. Website also has uptodate information. Given there are multiple sources of information, some are more reliable than others. I want to encourage the public to go to sfdph. Org for the most uptodate information. Thank you very much. Thats information, then, dr. Colfax, that will be for laypeople also or for yes. Okay. In multiple languages for San Francisco. Okay. And that would be through the departments website . Yes. Okay. Very good. Okay. Any further questions . If not, once again the commission is very appreciative of all the hard work that youre all doing and