Transcripts For SFGTV Health Commission 20240713

Welcome, everyone. Press mute if you come on to the phone. The first item on the agenda i dont want to be muted because the people need to speak. For those of you who are just joining you, this is the march 17th, 2020 Commission Meeting and were doing this for the first time using microsoft. Please excuse us if we have any technology issues. This process may be different than we normally do. If i may, i may move on to item 2, the approval of the march 3rd, 2020 minutes. Do we need to do a call to order and role call . Yes, thank you. So ill start with you, commissioner. role call . Well move on to item 2, the approval of the march 2 minutes. Reviewing the minutes of the previous meeting, does anybody have a motion to approve . So moved. Second. All those i in favor . Do we need to do a role call . role call . Thank you. Item 3, the directors report. The directors report is in front of you and i would ask that if you have any questions, of course, im happy to answer them, but given that the majority of our meeting with focus on covid19, i will not need whats in front of you, but im happy to answer any questions you see fit to raise at the time. Any commissioner questions . Im not receivining a Public Comment request. Commissioners, if not, we can move on to the next item. Item 4, the coronavirus update. So good afternoon, commissioners. Im the director of health. Hold on. Everyone, please mute at this point, mute your microphones. I talked to dr. Kovax and this is not coming over very clearly. Ok, give us a second, please. And theres a delay. I think its just the microphone distance. Other things are clear. Can you hear me commissioners . Is that better . Yes, thank you. Thank you. So good afternoon, im the director of health and i want to say how much i appreciate the social distancing intervention were approaching today and not to make light of the historic moment were in our country right now, including here in San Francisco. Two weeks seemed so long ago for when we were preparing to do our best to manage this epidemic and i will talk about the nine Health Officer orders that have been issued in the last ten days. And i also will ask dr. Irwin from the San Francisco general hospital, the lead on our plans Going Forward. I want to provide you with a little bit of perspective of where we are now. We are clearly in a state where we are looking at Community Spread and the gph team is working day and night to do everything we can to bend the curve. When i say the curve, im talking about the number of new infections. The goal is to help us prepare as much as possible for eight more cases, and inevitably people dying from this disease. Based on the data thats emerging from china and italy, we know that about 80 of people do well. I will say the patterns are what evacueweve seen in china with d to how this disease has spread. Dr. Erogon issued what is radical and it had to be. The shelter in place this decreases the spread of the virus and we think its important to emphasize this was done for the first time, to my knowledge, as a joint Public Health ordinance. Its across six counties, as well as the city of berkley. This is pivotal, because we know for the broader social interventions to work, it really needs to be original and preferably statewide and nationwide. As weve seen the virus increasing its spread in various communities and countries, the direction has only been further escalation of efforts. Im not aware of any jurisdiction that has decreased or frozen the efforts Going Forward. So Going Forward with these orders, we believe that we will be continual needing to be aggressive for not a period of weeks but months. Right now our focus is on three key priority areas. Number one, the social distancing as i talk to you about mitigation of the virus spread and number two is focusing on vulnerable populations, including those over the ages of 60, those with chronic disease conditions including cardiovascular disease, diabetes and renarl disease. The third is protecting the Healthcare Worker staff. This is a key thing were working on across the entire system and having ongoing conversations with human leadership about how to ensure we use the best evidence available to provide the best protection possible against our workforce. The number of challenges as we go forward, i am happy to talk about those challenges. I will also emphasize that given the patterns of the disease, given our region and given our state and country, this is not an issue that the Health Department or San Francisco can solve alone and right now were doing everything we can in our power to optimize what we have here today. I will also add that with some leadership of our mayor, our other city departments have come to our aid to decrease the morbidity and mortality of this disease. So i will turn this over to dr dr. Thomas to briefly summarize the health order. First, iand then to dr. Irwin tk about the surge plan, but before that, im happy to answer any questions before dr. Erogon goes forward. Thank you. Commissioners . Commissioner, any questions . No. I think i want to hear the whole presentation before we ask questions. So im going move and dr. Erogon will come in front of the camera and well switch back again. Does that make sense . Yes. Thank you, director. Im going to be brief because theres way too many orders. We realized as we were doing these orders, we were learning on the spot. One of the things i learned most recently are two words which is hours matter. This is how fast were having to make decisions, in a matter of hours. And so, what we have had to do is not just see whats happening in other parts of the world but whats happening here regionally with the other counties. I would say this last order to shelter in place happened really quickly. I just want to draw a Bigger Picture and show you how this fits in. So hours matter. We make decisions and then when theres a little bit of time, you do a little bit of reading and i had the opportunity to read an article that influenced the federal response that was just published yesterday, to give you an idea of how fast it was moving. I do want to share that with you because i think it will help you understand our strategy and our strategy is more aggressive than community mitigation. Stheres isolation toronto and e of contact. Youve been hearing about mitigation which is flattening the curve, dealing with workplaces social gatherings. pause . . This is called social distancing. The idea behind flattening the curve is that in general well get a a good proportion of the population will get infected and from the recent data up to 80 will become infected. Thats why this is so infectious is because theres pretty much 100 susceptiblity in the population. So the idea of flattening the curve is at the end of the day, you have a lot of morbidity and mortality and youre spreading it out so it doesnt overwhelm our healthcare system. The last strategy, which i just learned today from one of the premiere modelers in our country helping the cdc to guide the strategies. His name is neil ferguson. Its suppression and it turns out were implementing suppression and implementing the most aggressive approach. And thats where were trying to get the reproductive number less than one and the way pause . The way that were doing is that by sheltering in place. The idea is that a lot of people have not been infected yet. By having people sheltered in place, theyre reducing their opportunity to be exposed and by not getting exposed, they cannot get infected. But they have to go out to do essential activities like get their medicines, essential workers and then, i forgot the last category. Make sure you get your medicines, food, that was the other category. People have to eat. So you still have some risks and then among even though youre asking people to stay unexpose bid staying at hole, youll have cases that need to be isolated d where our movement has been in the United States. Santa clara was convincing in saying, you are one week behind us and you dont want to be in our shoes. If youre going to do it, do it now. The challenge with any of these approaches, they have to be done over a series of months and so concept use usedually, you woulo pull back and to pull back, youe have to strengthen the Public Health infrastructure. We need a bigger workforce to shore our tracing and quarantine. If we pull back the suppression measures, we need to dial up the Public Health activity. Otherwise, we wont be able contain. The last thing i want to say to give you a picture of how quickly this infection explodes. Imagine the hospitalization icu cases and deaths that youre seeing is just the tip of the iceberg. This iceberg, youre only seeing the tip and that iceberg doubles every six days. That iceberg doubles every six days and thats why you have this explosion. If nno one can see it coming and thats why we have to be aggressive and be ahead of the curve. Theres other orders in there that were tosse focused on lonm care facilities, sros, hospital visitation. We will be asking providers to cancel essential services and to delay elective surgeries and i think i covered most of them. And there will be more coming as we look at this more broadly and try to fine tune what we do and there will be more coming and its been great in getting the support. Weve been providing a lot of leadership and inspiration. I want to turn it over to dr. Susan erlich. Good afternoon, commissioners. I just want to say that i know were in an incredibly unusual time, very unpresprecedented iny professional carr career and i l grateful to be a part of the department because were pulling together to do the right thing. I feel good about taking care of people we know to be ill. So moving on to hospitals, over the past month, i and dr. Luke john day have been meeting and dr. Kolfax, weve been meeting regularly with the San Francisco Hospital Council ceos and also with their medical nursing and operational leaders. There arent other regional hospitals who are planning in this way and our efforts have been the supply and effect of the utilization of our Critical Care beds. Lately through these meetings is that every single hospital has really dramatically changed operations in order to plan ahead and meet the demand that we know will be coming. Its what we call puis, persons who have been tested and waiting for results. So, for example, that includes can celling all elective or nonelective surgeries, as well as nonurgent patient visits. And then what were trying to do is redeploy the resources that were used in those services into more covidrelated services. And so an example of that is in my clinic, the primary care, each of us in spreading our schedules to identify people to be seeking telephone visits. That creates other kinds of duties. So right now, were setting up a tracking system among all the hospitals and a joint surge plan to help us identify on a daily basis where all of the hospitals are with respect to capacity utilization. The system that were setting up is modeled after our surge plan which categorizes our state into green, yellow, orange, red and maroon categories, based on what percentage of our beds and our services are being used for puis relative to our total capacity. Since we dont yet have the data for all of the hospitals, i cant tell you what that level is today. I have a pretty good idea, based on the discussions that weve been having and what our own level is. Today, theres a yellow level and we entered the yellow category from the green category yesterday. What that means, we have more than nine positive, covid positive patients or puis in the hospital. Ucfs more or less is at the same level we are. Theyre in the yellow range and then the other hospitals are between green and yellow. So the good news about that today is that we all have plans for capacity, but we arent yet filling it. So thats the question we are at now. Tthe other thing i can tell you thats exciting, were looking to see beyond the capacity, in our individual hospitals, what capacity we utilize in hospitals that have vacant beds that arent staffed. And weve identified a unit, a full med surge unit and an old Critical Care unit at st. Francis to use for that purpose. The capacity of the med surge unit is about 40 and the Critical Care unit is eight. And so we looked at that unit last night and now were in the process of seeing what it would cost to staff it. In general, were looking at a model whereby the basic support services are covered by st. Francis and were looking at registries, essentially, to fill the nursing positions and then a shared model of Provider Services between dignity ucsf and ucsfg. Im happy to answer any other questions. Theres a lot of detail i havent covered by im happy to answer questions. Commissioners, how would you like to handle questions . Would you like to do it person by person or topic by topic . This is a new way of doing the meeting. Lets do person by person. Dr. Chow, you had some questions and would you like to start . Thank you. Im really appreciative of all of the work thats been done. Weve gone through our own crises over the years, from the age to the earthquakes. And this is obviously the largest response that affects every Single Person here we have and i think the person here has handled this extremely well. Literally, im pleased that weve had such strong representatives. I think this is wonderful. I have been hearing from the private practitioners that sometimes they are concerned that they may not actually have the resources needed in order to continue to work within their offices such as gowns or simple things like that, or swabs now that weve been able to use commercial lab. I know the medical society has been working with all of you about it and i just wanted to know, what are the challenges and resources and are there other things we can do . We cant do it alone and i know the department is trying to respond to it and just was interested. Thats a large segment of the potential medical providers that, if they dont have the resources, that we dont really have them able to take care of this. These populations. I would like to turn it over to dr. Kolfax to address that. The basic answer is none of us have everything we need but ill let dr. Kolfax speak to that. Commissioners, it might ask people in seat to ask all of the questions we have so were not playing musical chairs. How about we ask dr. Erlich call of the questions we have in her topic area, with your permission. Thats a good point. Dr. Chow, do you have anything specific to dr. Erlich or do others have questions . Commissioner guermo. Thank you, and i want to add my thanks and acknowledgement to dr. Chow in terms of how the department is handling this. Commissioner, hold on. Appreciate the example. Dr. Erlich, im not sure if this is a question for you or for the team, but with regard to the coordination, through the Hospital Council, are you also able to coordinate the beds that supplies the workforce . You just went mute. Who will make that decision for the supply beds and workforces to happen . Right. So generally, what were doing is that each hospital is doing the maximum it can to try to create capacity within its own walls. So, for example, canceling elective surgeries creates a capacity that we can use for covidpositive patients. And so were all informing one another and talking about the measures that were taking, which are pretty similar. With respect to that centralized resource at st. Francis, i think the idea is this threepronged approached that i described, whereby st. Francis is looking at what its going to cost to provide the basic supplies and the basic support Services Like Environmental Services and food. And were looking jointly at registry resources that were trying to see if it can be made available to provide the nursing and clinical staff, nonprovider staff and then were looking at a shared Services Model for the providers. The purpose of the joint surge plan is to identify the point at which we would start to trigger those things. So today, what i can tell you is that we have a plan, were oing on seeing if we can get the resources available, putting aside the question of whos going to pay for them and figuring out how we can jointly put providers in there for about 48 patients. This is really a daybyday thing. So its really the surge plan that will tell us when were ready to occupy. The last part of we keep hearing the audio go in and out, so i didnt catch the last couple of sentences. I think what were working on is the joint surge plan that would give us the indication of when it would be time to pull the trigger, to open the centralized resource. And who would pull that trigger . Would it have to be an agreement amongst everybody or is there somebody that says, no, ill pull that trigger. You know, were really working that out. But the way weve been operating is it will be all of us together. And i think we all, together, assume that eventually there will be some reimbursement made available that helps us because none of us can do it on our own. Thank you. Sure. Dr. Chow. Yes, i did have some questions and i really find that thats innovative and forwardthinking. I also saw that were preparing in certain areas for more like a mass cash thing. How does that all work out and are there other facilities being looked at as possible joint surge . Because youre only talking about 40 or 50 beds. Right. So the big question in all of our minds and the other thing were working on right now is modeling with the best data we have available, noting that nobody can do this perfectly. How many beds are we likely to need . Over what period of time . And so all of the efforts that dr. Erogon was describing about flatten the suffer i curve is go make it more likely that wit resources we have available to us, well be able to accommodate the people who need either med surge or ic beds. The more we can do to flatten that curve, the better able were going to be to meet the demand with the resources we have. And so we are working with our colleagues at ucsf. They have an Infectious Disease strike team. Weve asked them to model this question for us. How many beds will we need, of what type, what period of time . And so hopefully, ill have an answer to that question or the best we can do in the next day or so. And so, if we need something more than that bee, i think wel need to be looking at the state and federal government to provide more resources and i do know generally that the state is exploring this, but San Francisco, if things get really bad, which we dont really know right now, we wont be able to solve it on our own. I would agree and i do think that dr. Erogons point of the models that seem to be occurring in different cities might give you, also im sure youre looking at that the idea of how many acute beds you need versus a less acute model. And the centre triage that you have been describing, which i think is great. How does that work . Is that when one of the emergency areas become overwhelmed that they call a central number or youre having meetings . I mean, obviously not in 24hour communication each day. So just in terms of understanding how quickly it reacts if all of a sudden three cases show up over at cmtv. Does that trigger something . So hospitals are managing their incoming demand pretty much on their own right now. So weve all tried to create capacity so that not only can our Emergency Department manage the incoming flow of patients, but were also creating other resources that allow us to offload our Emergency Department. So, for example, at the sfg right now, weve expanded the hours of the urgent care clinic in order to be able to do more evaluation of patients on other sites. Weve established a twotiered triage to cohort patients coming in with suspicious requirement symptoms. Starting tomorrow, were likely going to have another testing site on campus over in building 80 that will further allow us to spread the demand for people coming in to be evaluated. So at this point, hospitals are managing the incoming on their own and the planning were doing is related to the hospital beds and the icu beds. And weve been meeting, really, twice a week to talk about this. So its an unprecedented level of collaboration and frequency of collaboration between the hospitals. That being said, we are really making this up as we go along. So that this question of a trigger and when it goes, were doing our best to create these rulerules as we go along. Thank you. That was an excellent answer in terms showing the thinking and the dedication youre all givi giving. Commissioner, were you raising your hand . I think commissioner green. Oh, commissioner green . Yes. Ive also raised my hand. I see you know, commissioner chung. Would you like to ask your question . I have a couple of questions. Thank you for sharing the information and some of the materials that have been ready, its really unsettling for me. For instance, the number of dates that somebody can be transmitting the virus and how long it takes to shed the virus and when we think about that and think of the capacity that you just mentioned, i think that is where im kind of wondering, what does that mean for us to keep those patients, for how long will we keep them . Knowing how long it takes them to shed the virus and what kind of burden would that put on our existing staff . And the other part to this, because this is unchartered territory, i would imagine somebody who might have insurance would show up at csfgh and what do we do when they do that . Do we take them on because this is the Public Health emergency . Or do we actually redirect them to their own hospitals. Thosa lot of what happens tht people come in, we evaluate them and decide do they have requiremenrespiratory symptoms e start asking questions that evaluate whether theyre high risk for being infected with covid19 . Even if we think theyre high risk for covid19, we dont hospitalize all of those people. A lot will send home with instructions to quarantine for 14 days and monitor their symptoms carefully. So were trying to reduce the impact on the hospital as much as we can. The other thing i want to make sure, if i havent already, is that the volume that were seeing in the Emergency Department is no different than it typically is. Any hospital that runs an Emergency Department by federal law has to evaluate the person with a medical screening exam and make sure theyre stable before they go, irrespective of their Health Insurance coverage. It seems like everything is defying common sense when we look at the mass hysteria and giigin begin to wonder how bad were impacting the general public when they think theyre symptomatic and how they will respond to this. The other part to this, because it felt like there were gatherings that just happened in florida. So they know where to go. Dr. Kolfax just asked toss focus on questions dr. Erlich has asked, in hospitals or what she talked about. I am trying to utilize her time because she has to go back to the hospital. So if anyone has questions specific to her. Dr. Green . Thank you. First of all, you all look slightly haggerred. So thank you for all of the incredible work youve done and the dedication. Evacuee talked about howe want d healthy. Great gratitude. I know youve been there all weekend and beyond that. All of the doctors feel like this is the internship you did 20 years ago before they loosened the hours. So im working in a hospital, as you know, and one of the concerns i have and i would like more information about, the extent to which, really, things can be directed by our dph as opposed to collaborative. We had an interesting call from st. Francis people had with china. There were experts from wuhan, beijing and it was most instructive. What came through, there was a Hospital Council that had leadership and directed the others what to do and they worried about staffing. Im wondering how youre thinking that through because obviously testing is difficult to come by and we read about the hospital in connecticut that had 200 nursing hours and some incredible number with one exposure. So im wondering how you as a group are thinking about how were going to manage staffing . My personal experience is a lot of people call in sick for things that wouldnt necessarily be a sickness and now were encouraging them to and i can see some decimated by nurses being out on quarantine. Then if you could elaborate more about ppe, which i know you cant say much about or you may not know much about. But i know we certainly have inadequate ppe at our place. The Real Infrastructure of how things get to that surge, and who will take charge would be helpful to understand. Well first let me say that today and so far, at the sfg, we have not had issues with staffing, thank goodness. Were keeping very close track of that and so every Department Reports in everyday about how many people are out and for what reason. And so were doing pretty well with that. I think were helped a lot by the fact that our department of Public Health workers are Disaster Services workers. We have tried hard to community katcommunicate that we need theo show up in spite of the shelter in place order and in spite of any other order, we need them to show up, if they can. We want them to take care of their families. We want them to take care of their health. Its been working and its been working with our provider Care Community so far. That being said, we community that people will get sick. We know that will happen or that they will be out for other reasons. And were working really hard to try to a, hire nurses and other staff more quickly and the mayor, theres another order today that, basically, waived all of the the charter positions, waived the Civil Service positions to make it easier to hire and thats a big relief. Weve electriweve been workingg nurses much faster than we typically do. Weve hired nurses. Weve reached out to our registries and utilizing those resources and were doing everything we can thats under our control to try to keep our staffing up to what it needs to be. Did i answer all of your questions, dr. Green . Im wondering what you foresee as infrastructure and leadership when and if this becomes an italy or wuhan and how you see, based on the interactions to date, how you see the hospitals working together . Well, as i mentioned, i think the hospitals have been working together really well. Within csfg, we have an incredible leadership team. People have been working around the clock to make sure that were as prepared as we can possibly be. And that leadership team, thankfully, has redundancy, as well, and i think thats working well. Where we have all of the ppe we need, will well have all of the supplies we need . Its tough to come by and were keeping it under lock and key to make sure that we have it available for the people who really need it. Its definitely not in abundant supply, but we have what we need so far. These are much bigger questions, the questions about testing kits and reagents and ppe, these are national issues. But were doing what we can to make sure that we have what we need. Im sorry to interrupt. Ive just been notified that dre board in ten minutes. And im wonder physician w wonde questions to him. Thats great. I did have a few questions for dr. Erogon and this is dan. First of all, thank you so much for your leadership to you and to dr. Kolfa examinatiox and dr. I understand we have 43 cases in San Francisco and how many are hospitalized and how many are in icu . I will tell you in one second. Thank you. We understand with the lack of testing kits what were doing is surveying what already exists out there to get a sense of what our Current Situation is and what is our outlook for our Testing Capacity in the coming weeks and how that would increase where we are today to hopefully a level well be able to do comprehensive surveillance . So im going to have to get bacback to you about the hospitalization. I know its a small number. Ill have to get the exact number. Im not sure. And theres room for both of you. Just to say that we are with other hospitals, working to get a daily count of how many patients are both covid positive and tuis and in what part of the hospital every single day. We arent quite there and i know we have two at csfg and one of whom is in the icu. Its a small fraction of the 43. I dont know the numbers from the other hospitals today, but in a couple of days, i will. And then just further to that, do we have a number for how many of our healthcare staff have tested positive . In San Francisco, im only aware of two people that have tested positive, is my understanding. Thank you. And then to the Testing Capacity and wer what the outlos before were at a place we need to be. Dr. Kolfax will answer that later because he has all of the details about testing. Thank you. Other questions for dr. Erogon before he has to leave . I just wanted to leave, doctor, in terms of, again, realizing supplies are in short, the working either with the state or the feds to bring enough supplies and then some means of distributing it to the various providers that may need it. That goes to the equipment supply and the guidance yesterday that allows Healthcare Workers to use whats called a droplet precaution caring for patients. Unless theres a procedure where there will be symptoms of virus and that will improve the ability to expand testing because they will have to use airborne precautions to collect specimens. Thank you, doctor. Thats county with what the cdc is recommending. I had one last question for dr. Erogon before he has to leave. Regarding the shelter in place order through april 7th thats being sort of jointly issued by all of the six counties, what is the criteria that you might use to determine whether that is something that needs to be extended or is that just something that youre going to have to determine as you were saying, on an hourbyhour or daybyday basis, depending how this is playing out . So we had chosen to do three weeks and i cant imagine that in three weeks i imagine if were moving if this epidemic continues to move in every placed its been introduced, it may be worse and i think at that point, were going to have to reassess both the city and the other counties to decide whether it needs to be extend. But that would be a decision well make closer to that time. Thank you. Thank you, doctor. I think dr. Kolfax will answer the testing question. I had a question before jail health and homeless population. There were a number of questions and please bear with me ibarebare withme. I wanted to talk about hospital control and i dont know if you use that term, commissioner green. But i think that was the justice of it. Gift of it. Gist of it. Im not so concerned about making sure that were all reaching that were all working together to reach our capacity as a community. What im concerned about when and if we exceed that capacity. I think that would take more of a if we reach that point, i would hope that before that, that the federal state authorities would have brought in assistance and whether that assistance could look Something Like the National Guard or a military operation. We dont have the capacity right now to run Something Like that. Thats not our mission. With regard to that level of response and engagement. I just think those resources would be vital to that. And we do everything we can with our partners to do that in the interim. But i hope that we dont get to that situation. And i dont know commissioner green or others if you had any response to my response. I think when you think of things like we have two empty hospitals in our midst and if we ever needed one of these kind of midlevel quarantine sites as they used in china, the National Guard and others might come and help us. But within our walls, we could know some of the resources, resterespirators and im curiouw we can Work Together if it got to that. , whether that would be something that would fall under the hospital or elsewhere. Theres other resources we might know about that they may not. Were looking at all of those option. I was thinking more of a massive icu means, which, i think we would have to look at hospitals in the bay or Something Like that. So again, i dont want to create an alarming scenario, but in terms of looking at other places where people who are not acutely ill but are symptomatic and stay, thats something were looking at, not only with other hospitals but other key participanteners in the city. Ps in the city. There was a question around testing. So the Testing Capacity is a key issue for us. Its a key issue, as you know, across the country right now within our Public Health lab under the direction of dr. Susan philip and theyve done an amazing job of implementing testing. Our capacity is relatively small and theyre having to prioritize testing the people who are most in need of testing, requirementy symptoms in the hospital, at high risk for firstdegree exposures and then Healthcare Workers. So were really focusing on those flee populations 03 thre. To give you an idea of how our daytoday is going right now, were injecting a capacity of a days worth of test or at the best, a weeks worth. And so were getting tests delivered to us by the cdc in the very challenging fashion because were simply not able to be assure ed this either w assuh tests to last for months or to expand our capacity to run 24 hours a day. So thats within the dph side. Within our Public Health lab side. Were also working with private labs including Quest Diagnostics in our Health Network and that, again, is a dynamic in challenging. Quest lab turnaround is three to four days and were working to ensure that we get people tested who need to be tested. Other Test Companies are telling us they dont have the capacity to except other tests and so forth. Another part of this that were working on are the partners with the ucsf, theyre developing their own tests and its exciting and i think its a key part of the puzzle. Theyre working with global limitations with reagents. So, for example, on friday, i was informed that ucsf was going to be able to perform hundreds of tests a day, not just for gph, but through the ucsf system but then today, im told they cant get started because they dont have sufficient reagents. So they have the tools. So there are multiple different strains of testing and each strain has its own inherent challenges. We have such a National Shortage of supplies and i have to say that we were short of things like swabs. Were short of things like swabs. So i have asked not only within the Health Department but assistants from the controllers office. We brought ito develop a citywa citywide approach so that were actually able to have a full visibility in terms of what tests are available, who theyre available to, that we have a shared tracking mechanism and we know how many tests are done, not just the number of positives and we move forward in a coordinated way and theres still support from the city to ensure that were moving forward in any fashion that helps us all to do better for the people of San Francisco. So thats our fourth priority which i added to our list this morning. Is the citywide testing plan youre trying to develop, would that include the private sector hospitals, as well, or just the county and ucsf . No, were trying to so right now were doing a Rapid Assessment of what is happening across the city because what happened was, some tests became available. Theres activity and different groups are doing Different Things and everyone is trying to solve the problem, or how theyre trying to solve it and were doing a whole Needs Assessment across the city of all institutions. Were looking at privates. Were doing an assessment of whatfwhat philanthropy can inved were trying to decide is it scaling something up or is it because they dont have basic supplies in order do the testing and so on and so forth. If we can, were trying to get to a point were trying to determine who gets tested and thats a real challenge, right . But we know that if we could test everybody, that would be in a way thats meaningful and systematic, i think that would be the ideal setting and thats what im calling the south korea model, right, because theyve just rolled out testing in a huge way. We are the city that essentially has done so much of that with hiv. So thats our model. Ive brought in a Key Global Health expert and her first day was today who has worked with the Clinton Foundation and w. H. O. On pediatric testing in africa and this is her full focus and shes working not only with gph again because i knew the gph people on the ground doing the work, but shes working with other city departments. She would bring in analysts and managers, project managers and people go out and find this information. Dr. Green. Thank you so much, grant. Do you have any sense of timing on this . Because a lot of patients have heard about the kaiser drivethrough and think theres Something Else or they can go to kaiser and i think theres a Similar Programme that you know better than i. But at this point, cpmc has been vocal, theyre not in the outpatient business and some of their physicians staff are not employed and they dont know where to get tests. Were getting really deluged with questions and some, perhaps, do deserve to be tested. In general, think, the primary care people who arent in a system like kaiser could really use some advice and some directives from the dph, because the systems have been very nonspecific in the recommendations and even in their guidance. All of people are showing up in Emergency Rooms, at least in ours, and the mixes with people may be positive which makes you worry about spreading the disease further. I know that was a lot of question comments. But what do you see and how would you recommend that practitioners get information and talk to the patients as they see the numbers mounting . So as were working to get full visibility and who theyre testing across the city right now. Evacuee been very clear at dph that if people have questions about have symptoms or questions about getting tested for covid19, they should call their healthcare provider. Those Healthcare Providers have act eaccess to information abouw to get tested. How to find out information about testing. The Healthcare Providers will get counseled whether the patient their calling for, whether that patient qualifies for dph testing. They would have to fit into the three categories because we have to prioritize who gets tested. That is the reason were developing this broader testing plan, is in order to address the questions that you have. Im concerned about people going to Emergency Rooms or Urgent Care Centers who are not sick to get tested. The other message we keep putting out, please do not go to emergency room or urgent care unless you have an illness and need to go. Evacuee been pushing that out ad were committed to working with our partners to make sure they have that message pushed out, as well. In keeping with dr. Erogons advice, i would like to ask we wrap up with the last one or two questions here. Is there a commissioner who has not posed a question that would like to ask something . I have one question and this is commissioner gerato. If any of thin any of the figure there been children or adolescents who have tested as positive . I have not heard of that case in pediatric and i dont have numbers in terms of young adults but we can provide that for you. Director kolfax, speaking of children, for parents with children who are out of school and may have questions about the safety of childcare settings or, also, whether or not its advisable for them to schedule play dates and anything like that, is there specific guidance were offering . Yeah, theres specific guidance on our website around that. Dr. Chow, you had one more question briefly . Yes. It was more actually a compliment to the department and website and to reemphasize that dr. Kolfaxs point that the department has a great deal of information and evacuee been wen making use in our medical group and weve been encouraging that patients be able to look it up and i want to compliment the department for having put out clear directives and keeping it very up to date. So those that may be watching and listening, that those are important resources and to, again, emphasize as it does, that you dont rush off to the emergency room and you dont necessarily have to get tested and theres some really good documents on that website about the issues of how to care for people on the providers side and then how to actually be cared for on the consumers side. And so i want to thank the department for that, too. Its been very useful. Thank you. I think we all associate ourselves with dr. Chows remarks. Dr. Kolfax, anything to add before we move on to the next item . There was a question before the homeless population. I want to emphasize that that is a big concern of the department. We are working with our partners at hsa and hsh at the department of homelessness in support of housing to do everything that we can to best protect and care for the homeless population. They obviousl are part of the ve population to covid19. Im in th not aware of any experiencing homelessness. We know from data from dr. Margo and others that the physical that the medical age of people who are chronically homeless is 20 years older than their chron logical age. We are establishing places for people who are experiencing homelessness who are under investigation or covid19 positive i just wanted to go back to commissioner green about the providers. I wanted to assure you all that we have a liaison to the San Francisco medical society ensuring that private providers are getting the information they need about testing and how to manage their patients and work with their patients Going Forward. Were also issuing a health order this afternoon that will ensure that only people who need the most urgent or Emergent Care will be seen in offices Going Forward. Is there specific guidance were offering to people who are hiv positive in terms of their being a part of a vulnerable population that needs to take specific measures . So we dont know how covid19 interacts with hiv and whether its additional risk factor, especially for People Living with hiv who are suppressed versus People Living with hiv who are immunosuppressed. Were following cdc guidance gus and fits into the vulnerable population going for other chronic diseases. Thank you, director colfax. Commissioners, if we could move on to the next item, which is the joint Conference Committee that occurred today. We met before this meeting and we got an update from the administrator on the situation and status around the coronavirus orders and things that are being taken that seemed quite comprehensive and very well put in place. So we were glad to hear about that. And i believe that can be shared. If others are looking for that information, particularly the information. pause we asked for a flex status which asked for the reclassifications of some of the beds to accommodate the population needs there. There were rehab beds and dismiss beds and the rest of the time we spent on reviewing the regulatory report which included the recertification survey that happened recently at laguna honda and other facilityreported incident events that have been surveyed. I wouldnt necessarily go into the detail but that information is available to the other commissioners. Any questions for the commissioner filiarmo. I skipped the item 6, which is the Health Commissioner elections which are important to your leadership. So lets go to that, please. To the office of president , do we have nominations . Dr. Ch o chow . I would move dr. Dan grenell. I second that. Mark, would you like to call a role call . role call . And thats it. Movinmoving on to the electif Vice President , a mo nominationf Vice President . I would like to nominate dr. Laurie green. Ill second it. Second. Ok, i will need a role call. role call . Thank you to my fellow commissioners for your support and the faith you placed in dr. Green and myself as your officers. These are extraordinary times that we hadnt foreseen and i am certainly grateful for your leadership and the expertise you bring to the commission. Also, i would like to thank mayor breed for her decisive leadership to keep us ahead of the curve to the extent possible, certainly calling on our citys experience with many other Public Health challenges, very proud of the decisive actions that San Francisco has taken to help stem this crisis. Also, very grateful for the leadership of director colfax, dr. Etcand others weve been heg from and want to provide whatever support they need to do their jobs to confront this challenge and then, also, a special thank you to our Excellent Commission secretary, mark moorewitz for his leadership and work to keep our commission operating, as well as working with our technological team. Thank you to you for making this meeting possible to be virtual. And finally, just thank you to our commissioners for, of course, modeling good Public Health citizen behaviour and joining here virtually and also thank you to the people of San Francisco for your abiding by the orders being put out by the city to ensure we all ban together to keep San Francisco as safe and healthy as we can. Dr. Green, is there anything you would like to say . Well, you said that so eloquently. Of course, its a huge honor to be a part of the executive group and i would echo all of the thanks. I just cant imagine what its like to be in the shoes or Population Health division. I know people are being redeployed in areas that they havent been working in. Everyone is being so diligent and i think we will be an example for the nation of how to do this right and hopefully, we will save many, many lives and continue to respect our entire population, the equity of San Francisco and really be the shining example for the country and we may be underresourced in items, but overly abundantly resourced in still of our individuals and the people part of this department expect citizens of this city. Its a real honor to be a part of this and im so grateful. Thank you, dr. Green. I look forward to working with both of you. Item 9 is a consideration for a closed session. Second. Thank you. I will go through a role call vote for the closed session. Role call . role call . Because this is the first time were doing this, we will not be coming back to say goodbye, but after the closed session, we will simply ajourn and in the future, well have this worked out better but thank you for your patience. So everyone online, please push n and commissioners, you are invited to the closed session meeting and you can use that phone number to call in to that and the code. Text me if you have any questions. Thank you all. Thank you, mark. Neighborhood in San Francisco are also diverse and fascist as the people that inhabitable them were in north beach about supervisor peskin will give us a tour and introduce is to what think of i i his favorite district 5 e 3 is in the northwest surrounded by the San Francisco bay the district is the boosting chinatown oar embarcadero financial district Fishermans Wharf exhibit no. North beach Telegraph Hill and part of union square. All of San Francisco districts are remarkable im honored and delighted to represent really whereas with an the most intact district got chinatown, north beach Fishermans Wharf russian hill and knob hill and the northwest waterfront some of the most wealthier and inning e impoverished people in San Francisco obgyn siding it is ethically exists a bunch of tightknit neighborhoods people know he each other by name a wonderful placed physically and socially to be all of the neighborhoods north beach and chinatown the i try to be out in the community as much as and i think, being a the cafe eating at the neighborhood lunch place people come up and talk to you, you never have time alone but really it is fun hi, im one the owners and is ceo of cafe trespassing in north beach many people refer to cafe trees as a the living room of north beach most of the clients are local and living up the hill come and meet with each other just the way the United States been since 1956 opposed by the grandfather a big people person people had people coming since the day we opened. It is of is first place on the west that that exposito 6 years ago but anyone was doing that starbucks exists and it created a really welcoming pot. It is truly a legacy business but more importantly it really at the take care of their community my father from it was formally italy a fisherman and that town very rich in culture and music was a big part of it guitars and sank and combart in the evening that tradition they brought this to the cafe so many characters around here everything has incredible stories by famous folks last week the cafe that paul carr tennessee take care from the Jefferson Starship hung out the cafe are the famous poet Lawrence William getty and jack herb man go hung out. They work worked at a play with the god fathers and photos he had his typewriter i wish i were here back there it theres a lot of moving parts the meeting spot rich in culture and artists and musicians epic people would talk with you