July 21, 2020. Before we begin with this item on maf o behalf of my fellow commissioners we approved to help equity resolution declari declaringit was based by the Human Rights Commission during their june 25th meeting. Ours had the addition of some resolved statements that were tailored to health and programs. On behalf of my fellow commissioners i want to acknowledge the critical work of the commission and their staff along with members of the Community Group mega black sf. And develop the resolution of the same name that was approved of the commission and all the hard work and energy they put in to creating that resolution. The commission is very proud of the resolution that contains some measurable outcomes to achieve equity and combatant eye black racism. It was apparent that there were some issues with respect to the development of the resolution and the process by which the commission approached the discussion of this item. Last week the secretary and Staff Department of Public Health and Human Rights Commission meant to resolve were committed to developing a process and protocols for our continued Work Together to address anti black racism and other crisis effecting San Francisco and discussion of these critical issues. I speak on behalf of any fellow commissioners saying well continue to address anti black racism and advance other Health Related issues at our meetings and in consideration of future resolutions. During the covid 19 pandemic and were grateful for all the hard work being done to combat the pandemic. Everyone is doing their best to conduct all of the necessary work. We can do better and will work collaboratively on developing a strong process moving forward. Thank you for your attention and commissioners do we have a motion to approve the minutes of july 21 . So moved. Is there a second . Let me check to see if theres Public Comment. Give me one second. If you wanted to make Public Comment on this item, press star three right now. I doapt se dont see any publict on this item. Okay. We do have a motion, is there a second . Second. Please call the roll. roll call . Just a reminder to all the folks who arent speaking, please mute yourself if youre not speaking so theres no background noise. Its a little hard to focus. Good afternoon, commissioners. Director of health. The details where we stand with regard to our covid 19 response and budget. Those follow on agenda items. Im happy to take questions on any additional questions that you see on the directors report. I recommend we go to the covid 19 update in the budget that will answer many of those questions. Its fine to proceed. Folks if you would like to make Public Comment on the directors report, please press star three. I actually had a question on the Behavioral Health dhr. Yes. Please go ahead, commissioner. It was only a question of clarification. The dhr being developed for Behavioral Health would it be compatible or is this also developing a Mental Health ehr. This has been a long standing controversy about whether or not well have merging ehr. I turned this over to dr. Hammer who oversees Behavioral Health. Could you provide answers to the questions. Could you clarify what youre referring to. I dont know what is in the directors report that you are referring to. Ill try to clarify. Its the new dhr thats being developed. The question is whether or not this is consistent, compatible with ethic or would one still need to use two different ehrs to be able to get a complete record . The plan is that we will bring Behavioral Health services onto epicim not sure if its not. Were currently in early wave two. We had our anniversaryim not sure exactly what you are referring to. We will not have any interim new Electronic Health record for Behavioral Health. Well continue to use avatar. I guess perhaps im miss reading the item. It seems Behavioral Health services Electronic Health record is here. Perhaps we can d do this of line in terms of trying to clarify that. Sure. That sounds great. Ill look to see what you are referring to and get back to you on a more comprehensive answer. And congratulations on one year. Were looking forward to many more things with our present pandemic. And i have to say, it has been, i think a lot of us have been feeling so grateful that we have epic and that we passed the immediate post school live period before the pandemic hit and had to put it to the test. We have really benefited from being able to use epic to coordinate care and access testing results. Its been such an important tool in our Covid Response. Great. Thank you. Well move onto item four which is the covid 19 update. Thank you commissioners. Here to provide you with a covid 19 update. Have some data to present updated information and i believe some time for discussion. You see the deeper curve on that right side of the graph. Next slide. In terms of our testing. We have far exceeding our testing goals. Our average is thirty one hundred eighteen tests. I will note that demand for testing has out stripped supply not within city and Health Department sites but we are far exceeding our testing goal. Our positivity rate, our rolling seven day average you can see here running from april to early august is currently nearly four percent and consistent with a high number of cases were currently diagnosing. As the commission is aware, we have inequities within the pandemic particularly in the Latin X Community. Weve been working with key stake holders to address the pan emipandemic in that community. We continue to do well on many aspects of our response compared to other jurisdictions. Our case counts per one thousand is relatively low compared to other jurisdictions with respect to king county. A death rate low, a total of sixty one deaths. Rate of one every ten thousand. Our testing is not meeting the full demand but is certainly a success compared with other jurisdictions. Baltimore is the one jurisdiction thats close to our total. D c is somewhat higher at a rate of four point one three per one thousand. Next slide. This is our rate of hospitalizations and the commission recall that we are in a surge scenario. You can see that in april we peaked at a tole of ninet totale hospitalizations. It declined in mid june to twenty six hospitalizations sm that number saidly cloimed in s. You can see the light blue lines represent the medical surgical beds. A slight decline over the last few days. We are watching these numbers very very carefully. Because it takes about two weeks from someones dates of infection to being hospitalizations, the hospitalization was about two weeks ago. A little bit of hopeful data with regard to the declines you see there. Watching it very carefully. Next slide. Our key Health Indicators, these were updated as of this morning. Our hospitalization rate which exceeded the 20 was level four in red. Just a week or so ago because of that decline and a negative three point six percent rate. We remained at good capacity. Its twenty three percent and twenty seven percent for medical and icu beds. The testing numbers that i described earlier, their one hundred and eighteen. Our Contract Tracing had fallen behind. This is due to a number of fact yores including the increase in keasecases and delay in test re. Locally and nationally the labs have not been able to keep up with the testing numbers. Weve currently experienced delays of seven to ten days as lab corp. And other commercial labs are waiting as long as two weekweeks. City test sf to get results turned around more quickly. Our Public Health lab is catching back up. We expect returned results within 72 hours. With regard to our personal protective equipment were at 8l protective equipment has a thirty day supply in the city. This is our r reproductive rate. These are estimates through about august 1. You remember reproductive rate over the line is more than one person i is infected. We really need that reproductive rate less than one. The veer us had a reproductive rate of eight point five. You see that increase in estimates starting around june 15th. We went above one and went to about as high as one point three. This created a situation where we paused our reopening and took aggressive actions with regard to education around prevention activities that were needed to tract the reproductive rate down. We see some hopeful signs that reproductive rate is tbing down again. Its wu one point five. This is still a high number. Were concerned that were still above one with the reproductive rate. If theres no change in the reproductive rate even at one point one five we would estimate that peak hospitalizations would be three hundred seventy with three hundred ninety deaths in 2020. That is marked by the followup blue line going from the august fall through the end of year. More vair eations in the reproduckive number can cause a difference in estimates in the fought youre. The plausible number that can be in the hospital which is neen tean hundred on ct 30th, 440 deaths. These are models and estimates. This is all about probablity. The shading of leans represents the probability of zero to 95 . Certainly we have a window of opportunity as we hope fle can ten to drive this reproductive rate down dramatically. If were able to reduce by 30 , you can see a dramatic shif in our future. An update on our testing approaches Going Forward. We have set up across the city and this is not just e ph but across the city theres a total of 29 testing sites throughout the city that has performed nearly a quarter of a million tests. We have achieved more testing access than any other surrounding county. We early on tested surrounding city sites and exceeded our testing goals. We expanded our access to anybody who requests to test. We have had to set priorities to challenges we have had locally and state wide and nationwide in regard to steadily supply of testing and unified testing strategy for the nation. We have prioritized san franciscans testing with symptoms of covi covid 19, foret line Disaster Service workers. This is a slide that marks our relative success in addressing concerns about spread of covid 19 in our skill nursing facilities sm these arfacilitie . These are dataits a little hard to read. The numbers of infected Health Care Workers are shown in the blue line. Infected residents with the orange line. Hospitalled patients shown in the gray line. Deaths in Skilled Nursing facilities across the city has been relatively low compared to other Testing Facilities across the state and nation. This is due to the fact that we have a scaled up testing in these facilities. We are testing all patients and all staff every two weeks. This takes about three hundred tests a day. We have issued orders requiring other nursing facilities to do the same. Obviously its not just about testing. Ive said repeatedly were not going to test our way out of this pandemic. Other resolutions have to do with good infection control, mask wearing and good hygiene. Youll see he on the far right an uptick in positivity rates among the Health Care Workers and that is certainly consistent with more Community Spread both in San Francisco in the region. We inspect to see this as theres more Community Spread and that would obviously effect the people working at these facilities sm we also continue to focus on testing with regard to out breaks and Residential Care facilities, shelters, and sros. And being aggressive with our testing in the jail. In collaboration with our dph data teams is with u c sf. We continue to file the data with regard to our testing priorities. These maps of importance. The green and orange map is prevalence of diagnosed covid 19 cases. You can see the darker orange census tracks represent where theres a higher prifl ens of covid 1prevalence ofcovid 19 in. The lighter green or some color between orange awnd green tha ai dont know the name of, those are the wider census tracks. The second map shows where testing is available in the city. Theres a mismatch where testing is available and where covid 19 is being diagnosed. This is not just dph or city test sites this is Health Care Providers across the city providing covid 19 testing. You can see the testing rate per capita is hardly surprising that people are getting tested in the neighborhoods where there is testing availability. Theres a pretty clear match there. Our testing strategy Going Forward will be an adaptive testing strategy that will focus on where cases are being diagnosed and scaling up where those are census tracks. Our new testing goal is five thousand tests a day by Early September of twep 2020. Pushing ourselves beyond that thirty five hundred to five thousand. Really focusing on our neighborhood strategy and concentrating neighborhoods most impacted. I would remind the commission that because of our Health Clinics across the city we impleimplemented multiple test s early on in the pandemic including south east Health Center and also in the parking lot of zuckerberg General Hospital where the Research Building is supposed to go in the future. We did extend testing availability in those neighborhoods. We are also looking to expand capacity and speed of lab process to shorten turn around times. Were looking to ensure that private providers do their part. Ill show you data in response stto that. We have more cases so they can manage up to two hundred cases a day. Were incorporating Emergency Technology into our time line for expanding testing. I dont have the private providers data. Ill provide the commissionwith regard to the private providers and working with them to do their part. Many of our larger Health Care Systems. Actually, if you could pre vied thaprovidethat slide so the comn see the relative number of tests that other health care sif ems s have done. While waiting to bring the data up, ill remind the commission that our Health Officer issued a health order two weeks ago that requires Health Care Providers to test certain people who are at high risk for covid 19 within the 48 hour period of presenting to the system. This is data with regard to other Health Care Providers and their contribution to covid 19 testing. Just to say that our city supported systems and Health Department system has done a total ofrelatively smaller contributions of certain key private providers in the city, seven point six percent, four point six percent, some of our larger Health Care Systems. I would iterate that these systems have been incredible partners during the pandemic. They are very committed to working with us and other key stake holders to ensure more testing is available for their patients and staff. With regard to our neighborhood strategy, the mayor announced also just last week, i believe, that well be expanding our testing options for people. Well be working to scale up two new mobile test sites that will be able to go to various parts of the city. Especially where covid 19 is highly preflen. Highly prevalent. Those are on the dprownd now as wground now aswe speak. There will be a permanent site, were working to select a permanent site in the southeastern part of the city which will have an additional ability to test five hundred people a day and be in addition to the city test sf sites which now have the ability to test approximately two thousand people a day, fifteen hundred at the site. I would also emphasize that in addition to the testing that we are ensure thag right now we all need to behave as though were carrying covid 19. Which is why we advise not to use a test as a way to indicate. You need to use a facial mask and good hygiene. Thats key to flatten the curve and key to getting that reproductive rate closer and hopefully below one. Thats all i have for the commissioners and i will stand by to answer any questions. Im not seeing any Public Comment. If you wish to make Public Comment press star three. Seeing no Public Comment, commissioners. You can continue with your comments. I do have a comment and a question. Going back to the long term hospitalization projection slide with regard to the reproduction number, i want to under score that if youre looking at the four months since the beginning of the pandemic. Weve suffered the loss of 61 lives. Looking forward to november first, that number if we follow the median at the same reproduction number could be six and a half behind that. I know the mayor has spoken out about that and frustration with not wearing masks. This should say more than anything about lowering those numbers. We have six and a half times as many deaths in the next four months as we have had in the last four months. I hope everybody is taking that to heart. In regard to the testing priorities, i kno