They can maintain operations as best possible while also people going to the command center to do this operation. Well, very clearly, it is a really challenging, and as other commissioners have indicated, really grateful that people like yourself have really stepped up and continue to do, as you say, the work that has to be done, along with the very key work, and congratulations on being head of this program. One question which is more technical has to do with the testing strategies. And your chart was great and sexu certainly keynoted on some of the areas that were concerned. On the other hand, you also pointed out that you were interested in reaching other vulnerable populations which are kind of a potential tinderbox, and im glad that you mentioned chinatown right now. Its a very low number, and some other asian populations out in the sunset which arent being tested, but we dont know that. What is your testing strategy to figure out a priority, and that came from one of the questions that we heard from the public that says you would allocate precious resources, knowing that it would go to high intensity areas that weve been talking about in the latino population. They could all go that way, and then, we would be in a fix, so what kind of prioritization allows you to say youre going to continue working across the board and make sure were testing prepare to make sure that some sort of outbreak is occurring that we dont know. So that was a good question, and i think im going to try it. We need to find the virus, isolate people to find the transmission. The second thing is to understand where the virus is, which is a little bit different, so that means were testing in places we dont necessarily already know we have a lot of cases, and we are very much trying to figure out how to do both, but our resources are not expansive . Despite doing 60 of the testing of the city, we definitely need to keep some kind focus just because we cant cover the board with resources equally even if that were the right thing to do. We just couldnt do it. We dont have the resources. In particular, in the last two weeks, i dont know if youve noticed the articles in the news about quest and labcor, the two biggest labs that lacked critical supplies. Well, that rolled onto the department because we have our own labs, because we did have the capacity to do our own tests, but then, everybody who wasnt able to do their tests somewhere else rolled into the county. So it was very hard to control the amount that went to our own labs, and we backed ourselves up by an enormous amount. So we cant always know what we have available, and sometimes what we thought we would have available suddenly is not available. Its just an unfortunately uncomfortably dynamic process of thinking you have things when you dont or not knowing where its coming from. But we absolutely have to get people in the communities where we know its the most commence to be in the conversation about where we test. What we need to do best i think is communicate what the total pot is . So the total pot that day was probably 1,000 tests all over the city for us, so we need to be able to tell people how were distributing those tests, and we need to get partners to do the testing. For example, weve had a partnership with Chinese Hospital to do testing at some of the s. R. O. S, and well be continuing that partnership. We had a Similar Partnership at bayview health, and that helps us extend our reach . We are covering the lab process for Chinese Hospital. We are delivering the supplies for bayview Childs Health and mission neighborhoods, so were trying to do what we can to make sure that someone is covering the needs of that area, and were getting the data that we need to understand where we should be. But its complicated, and the data is not always consistent from week to week. I appreciate that, and i appreciate the perspective that youve given us to talk about the challenge and obviously the reason why you calls this week for everyone to really step up and run it through their own channels. Although as you know, they are also backed up with the same thing, and we have this same complaint even locally of trying to get test results in the last five to seven days. I know you were very busy and hadnt been at that meeting, but had expressed the same frustration at the board meeting. I think its helpful to understand what youre facing, trying to allocate these tests. So again, thank you, and well continue to watch that with you, and hope that the curve started going down in positivity and hope that they [inaudible] it is here, so thank you. Thank you so much, dr. Chow. Commissioner christian would like to make ask a question, and shes on the phone, so im going to pop you up, dr. Bennett, on the visual, and commissioner christian, please feel free to speak. Thank you, mark. Dr. Bennett, im very pleased to be able to be here as a new commissioner to hear your presentation, particularly as it pertains to the equity aspects of all of work that you do, so im very much looking forward to learning more and working with you and hopefully being some assistance to you. I just have it may be an impossible question to answer, but what is the out loom frloo your perspective from seeing the availabili what we need to see in the availability of testing . My understanding is its constrained in large part by a lack of resources, a lack of testing kits and things like that, but what is your sense of the outlook for there to be some real improvement after the mayors call for private providers to be more involved . I am hopeful, but as commissioner chow said, they have challenges that are similar to ours . I think none of us fully understood how interdependent we were. I think in arizona, demanding tests would roll to be a problem for us in San Francisco, but that is exactly what has happened. Our National Infrastructure for the production of the things that we need is just not strong, and i dont know that we took advantage of the time between march and april when we were so desperate for swab. We would have given anything for swab from anyone, and it was really hampering our efforts. Im not sure that anything was done between that period and this period, except that fewer people were needing tests in some places because now, it feels like were very much in the same place, where there arent just the strengths of procurement that you would want. We are at a much better place internally. We have good systems, we have multiple suppliers. Were certainly not standing in the place we were before, but i dont think its been fixed, and im not sure how much we ourselves can fix about where reagent is produced or not produced. What weve done is expand our capacity so that were less dependent on other people . Weve increased lab staff and lab hours, but even that will have its limits, you know . Theres only so much available to buy, even if you have the increment funding to buy it. So im hopeful that there were improvements made, but as entire states have tens of thousands of cases a day, i dont know that the system can withstand that happening so many different places. You know what . Thank you. I understand what youre saying, and its helpful to know a little bit deeper, have a deeper answer. Is there and again, this may be something that you cant answer, but is there any capacity for california as a state to reach internationally to places that may have more maybe producing more testing kits or are we already doing that . Do you have any sense of that . We were definitely attempting to do that as much as possible earlier in the pandemic, when we had the most critical shortages. I actually dont know the answer to that from the states perspective. Dr. Colfax, do you have an update on that . I dont have an update from the states perspective. I know what they were saying earlier. Thank you both. We should all advocate for them to do that, though. I see that commissioner guillermo has a question. Thank you, and thank you, dr. Bennett, for your presentation. Im adding my gratitude and concern for everything that you and your colleagues in the department are doing. Just listening to the answer to the last question, you know, brings, mo brings more detail to some of the generalized challenges that get reported in the news and such. And so i think the level of detail around all the things that need to be coordinated, and all the things monitored is something that the public needs to understand better, particularly with these relationships between the department and other providers in the city as well as other relationships to the state. So it goes to one of my questions around it, your indicator chart in your presentation. So when we talk about different things, the p. P. E. At 89 , is that a a number that includes all of San Franciscos Work Health Care workers or is that particular to what you know about that exists within San Franciscos own network, and is that the case with some of these other indicators . I know in terms of populations and some of these other things, thats citywide, but i wasnt quite sure about some of these other indicators. So some of the indicators are particular to not not always the department of Public Health but to the city and county. So the Contact Traces are ours. We dont know we dont count whether or not other people are doing Contact Tracing because, for the most part, we are where the buck stops on that. The same is true for the p. P. E. , except to expand it. It is absolutely the p. P. E. For our hospitals, and we are clear that has to be tracked very closely. We got down to very low numbers at some point during this pandemic that no one was comfortable we would have what we needed, but were not there. We have really good supply lines, and weve managed to stay above 90 until recently, when things have started to become a little harder, and i assume for the same reason, we see hospitals in texas and arizona and florida increasing their demand. We are only tracking the p. P. E. Thats being used at our own hospitals and clinics and what is being used by all the other city and county employees because we have masks and gloves and other p. P. E. On all of the people in our hotels for isolation and quarantine, for our police officers. We have p. P. E. Needs all over the city and county as City Employees interact with the public . And so the command center does hold all of that. Thank you. And so, you know, just in response to that, when i think about the concerns we have about the decreasing supply of p. P. E. Or the decreasing supplies that we need in order to be able to see the testing and such, whether sharing the data with other providers in the city, somehow coordinating that, if its possible, through the department or in association with the Hospitals Council or is that just beyond something that we can do . And i ask it because similar to or related to the question that commissioner giraudo asked, private schools having a different messaging than Public Schools in San Francisco, those residents of San Francisco who are more in tuned with the private sector supervisors versus the Public Health, we are all still living in the same city and subject to the same risks, and so i just dont know whether thats something, a centralized command, whether the department is telephone is able to get a better handle on it. I think i understand your question, but correctly if i answer it incorrectly. So we have had, i think, really remarkably close connection with the other Hospital Systems throughout this pandemic and some of the community providers, and one of the things that i think is great evidence of that is that we have been able to support each other through what were the critical days of p. P. E. For everybody. When we ran slow, d. P. S. Gave us some, and when we had extra, we helped other departments. So that has really saved us from some bad outcomes that would have happened at some of our sites, and thats going to be true as hospitals get more and more full. Our surgery capacity is shared, and i think thats an advantage that San Francisco has. In terms of being able to coordinate across the board, i think it gets more and more difficult the more actors were talking about . It is very difficult on the private provider side, and that is just bandwidth . Theres only so much in the command center partly because of what dr. Chow pointed out. We are trying to put people back in the department to run the department, and the same is tr true, now that were open, for all the other departments. So we are having to prioritize and marshal resources to the places that have the highest priority and the biggest impact, and that has been the hospitals and other entities around the city that are doing health care. The s. N. F. S, we helped them when they ran low because it would be devastating if they ran out. Those things have been done, but it hasnt been across the board. Thank you for that. You know, i ask the questions because its that level of detail that were not as aware of, and i do know we have through the command center and through the hospital council, done as much we can to coordinate. But the longer this lasts and the more complex it gets, the harder it is, so its maybe just more of an update of what else can be done to continue to update and Work Together very closely, so thank you. Thank you. We do have calls with all those entities, so we do have regular communication . I think establishing those lines and structures will serve us. Itll get more complicated, but i think weve put some things in place thatll help us weather that. Any additional questions, commissioners . Commissioner giraudo or christian, any other questions, because we know that we cant see you. This is susan christian. I do have another question. You know, for dr. Bennett and dr. Colfax, are there things i am very sorry. This is i just got an emergency text. Something has happened to my son. I have to go. Im sorry, grant. Can you thank you. Yes. Absolutely. Dr. Bennett, please let us know if everythings okay. Thank you. Okay. Thank you. So just a quick question. Are there things that the city and the department can do to help san franciscans focus on some of the things that we that are within our control about things that related to our health that bear upon being vulnerable to covid and other respiratory illnesses, i things that we do that at least help us try to be a little bit healthier . I dont know if theres p. S. A. S that the city is doing or positive Health Behaviors that we can, you know, encourage that we can educate ourselves about and encourage all of us to do . So thank you, commissioner. I do think that the things that we can do to slow the epidemic are the prevention activities. The facial coverings, the social distancing, avoiding crowds. The other piece in terms of the testing challenges that we have is supporting a message that, you know, people shouldnt get tested in terms of something thats not necessary when were sheltering in place. I think people may be testing, you know, to go to that party or engage with other people in ways that are not safe. We know if a test is negative, you can catch covid19 right after that and transmit. I also think that theres some positive messages aboin commun engagement in social distancing and facial coverings, and we all need to do our part. And i also hear the broader issues around health interventions, and thats something that people need to know, that its always a good time to quit smoking, and this is an even better time. Were also really aware of the Behavioral Health effect of the shelter in place and the pandemic. As the commission heard i believe the last time we met, theres work going on on the Behavioral Health side, as well. I think that the the key pieces are really ensuring that we are supporting people in these prevention activities that we know work, and also acknowledging the fact that some people cannot take these precautions, and that is that in some ways, the inequities that we see where people have to go to work to make a living, that we protect workers, and that we support the workers and their employers in terms of making sure that there are Safe Environments for people to work, and Safe Environments for these preventions to work and thats sustainable over time. Im not sure that that answers your question, but let me know, commissioner, if theres more details that you require. Thank you, dr. Colfax. Dr. Christian inadvertently hung up, but she did let me know that she had no further comments. Dr. Tong has her hand in the window. Thank you, dr. Colfax, for this important update. One questions that popped into my head right now, its about medication refills, like, for our population to have, like, different Chronic Health conditions. Do we know if they have trouble, like, going to a pharmacy to fill their medication or do we actually have other megnism in place to make sure that, you know, they you know, like, they get their refills on time . So absolutely, commissioner. So i dont know if dr. Hammer she was with us earlier, and she can talk a lot she can add detail to what the ambulatory care people are doing to ensure that people are getting the medications that they need. Dr. Hammer, are you still yeah. Hi, this is holly hammer. Are you able to hear me . Perfectly sk. Okay. Hello, commissioners. Commissioner tong, in answer to your question, right from the beginning, we have been doing outreach to vulnerable communities that put them in at risk of covid. Weve had teams within our clinics, both the primary care providers and their teams, and even some teams at ucsf working with faculty and csfg doing outreach to make sure that people are getting their medications. The pharmacy, notably the csfg pharmacies, and other Community Pharmacies sprung into action to bump up their ability to do deliveries for people so they dont even have to go out of their home during shelter in place, they dont have to go out of their homes to pick up their medications. Weve been getting them their prescriptions in, even if were not seeing them in person, and their medications to them. Thank you, dr. Hammer. I have a second part to the question. Like, for s