Connect. Again, the number the access code is 1466093005, press pound and then pound again to connect. You will hear the meeting in discussion, but you will be muted and in listening mode only when your item is addressed called dial star 3 to be added to the speaker line. Best practices are to call from a quiet location, speak clearly and slowly and turn down your television or radio. If when you dial star 3 before Public Comment is called, youll be added to the queue. When you are called through Public Comment, please mute the device you are listening to the meeting on when its your time to speak you will be prompted to do so. Public comment during the meeting is limited to three minutes per speaker unless otherwise established by the presiding officer of the meeting. Speakers are requested but not required to state their names. S. F. Gov tv, please show the Small Business office slide. Today we will begin with the reminder that the Small Business commission is the official public forum to voice your opinions and concerns about policies that affect the Economic Vitality of Small Businesses in San Francisco. The office of Small Business is the best place to get answers about doing business in San Francisco during the local emergency. If you need assistance with Small Business matters, particularly at this time, you can find us online or via telephone. As always, our services are free of charge. Before item no. 1 is called, id like to start by thanking Media Services and sf gov tv for coordinating this virtual hearing and livestream and special thanks to jim smith for assisting with the Public Comment line. Please call item no. 1. Item one, call to order and roll call. [roll call]. We have a quorum. Great, next time, please. Update and report on the San Franciscos reopening plan, strategy and local Public Health indicators, discuss in items. The presenter is dr. Thomas aradon, chief Health Officer of the city and county of San Francisco. Great. Dr. Aragon, welcome. Were so happy to have you back. Appreciate you spending some time with us. My goodness, a lot has happened since we last saw you, and its good to get the update. So were going to begin this item with your presentation, and then that will be followed by any questions we have and then any Public Comment and perhaps there may be a last round of discussion among the commissioners after that. Okay, great. Thank you for your time and please, you have the floor. Okay, thank you. Im assuming everybody can hear me fine. We can hear you just perfectly, thank you. Okay, great. So why dont we go ahead and go to the next slide. Yeah, if you can move it forward one. Madam clerk, are you in charge of the slides . I am, and it should be up. I dont know if my service is slow and thats why its not going. Right now its on the title card. I think hes looking to go to the next slide. I am on San Francisco covid19 data and report. So i think that my internet is slow. Hmm. And it might not be caught up. Do you want to give me access to can i have access to the yes, absolutely. I can just share from here. Okay, oh, great, i will try it. Sorry about that, dr. Aragon. I am a simple Civil Servant with simple Internet Access noo can you see it . Its kind of small. Okay, great. Lets see if this works. Hows that . Okay, so im going to cover four areas. I understand that i have up to 15, 20 minutes. Ill try to go through this insightfully, so im going to cover health indicators, talk about how Health Orders are done. Im going to mention some emerging health risks because i think its really important for everybody to really be up to date on the types of things we should be thinking about in terms of keeping things safe, and then im going to go ahead and address some of the questions that people send me. Lets just go quickly into health indicators. Right now we have almost 11,000 reported cases. Weve had 99 deaths, and weve done over 465,000 tests for covid. The types of things that we look at are going to be and im going to go into this a little bit later, is going to be the case rates, and then the tests percent positivity. Those two is what the state is using for its blueprint for a safer economy, which im going to cover, which is the new fourtiered system. You look at hospital trends, and then the other one we look at is going to be the effective reproductive number. We are and theres two areas of preparedness that were always concerned about, which is the Public Health and Health Care System readiness, and then of course businesses and School Readiness to be able to open up safely. So this slide here is a summary slide that compares San Francisco to other cities across the United States that are relatively comparable, and what youll see here for frisk is the case rate cases per thousand and then the other one is going to be death per thousand. So if you take the cumulative number of deaths, for example, and you divide by the total population, you get those metrics. And you can see that compared to other areas of the country, especially when you look at deaths per 100,000, that weve done better than other areas, and i may have mentioned last time that, you know, that our interventions prevented over 38,000 hospitalizations and close to 4,000 deaths. And so this is another way of looking at this historically. So the effective reproductive number is the average number of secondary cases thats produced by an infectious person. Any number greater than one means an epidemic is going to grow. Any number less than one means an epidemic is going to shrink. And so wed like to get it down to below one. Early on, early in march, you see that it was above 3. 5, which is a very high reproductive number which means that during an infectious period every case was producing between three to four additional cases, and you could just imagine that this iceberg was growing rapidly. Youll see that that started going down. We had started canceling large gatherings. The shelterinplace was initiated on march 17, and then you can see that continued to climb. And then youll see the other interventions that were done. After memorial day, you can see a few weeks later, San Francisco, like other parts of the country, and in california, had an increase in cases, and now were down over here in august, and see weve got our reproductive number less than one. We want to get it lower, but its right now its less than one, and thats good news. And then just a summary on the lefthand side is our epidemic curve of cases. So you see on the lefthand side we flattened the curve, and then you see there the increase in cases in july, started in mid june and then july, and you can see that it has been going down. So right now we have about 56 cases per day, and on the righthand side you see our hospitalization curve, the dark blue is the i. C. U. Admissions, and you can see our second surge that we have that peaked there at 114. The key difference between both of these curves is that we know a lot more about the virus now. We were able to manage the second hospitalization curve without shutting down the economy again, and thats the big difference. On the lefthand side, we didnt know how to control the virus. We learned how to manage it without shutting down. Thats important information. So now what the state has done, they used to have what they call the watch list, but they now have changed it and theyre looking at the case rate which is then adjusted, which ill say in a second, and then the percent positivity for the tests. So if the case rate after adjustment is greater than seven, or if the percent positivity is greater than eight, you will be in tier one, which is the purple tier. And that tier is basically the equivalent of the prior watch list. If you have metrics that are lower than that, you get assigned to three potential other tiers. One thing the state has done is that a case rate is we have our actual case rate, which i just call our epidemiologic case rate, and the state adjusts that down if youre doing a lot of testing. However, the actual risk in the community is really based on our actual rate. The reason why they had this adjustment is they wanted to discourage other counties from undertesting, because you can imagine some other counties may say, well, if i test less, im going to detect less cases and my case rate have going to be lower and theyre going to put me in a better tier. So they wanted to discourage that. So it turns out what theyre doing is that if your case rate is if youre testing im sorry, if youre doing a high testing, they will weight it down, and if youre doing low testing, they will rate it up. So in other words, you will stay in a higher tier if youre not doing sufficient testing, and thats an incentive to get counties to do more testing. So we were classified epidemiologically, we were in the purple tier, but we were assigned the red tier, tier two, because we were doing extra testing. So when you look at this is now the current map. Youll see the current map is here that were red. Even though epidemiologically were purple, and thats been really part of our strategy. Ill show that in the coming slides. So given that were epidemiologically purple but assigned to red, it means that we have more things available to us to open up. And what we did was that we looked to the purple tier and we said were just going to open up everything in the purple tier, and then within the red tier were going to be more selective by focusing on lowerrisk activities first and the higherrisk activities were going to push down to one tier, one tier, so we opened those up when its going to be safer. So we started out with outdoor activities, lowrisk indoor activities, which is a lot of the personal services. We have a highrisk indoor activities, which is going to be Indoor Dining that im going to get into some detail. Im going to focus on Indoor Dining, but conceptually the things im going to talk about really apply to other highrisk areas, with the exception of the need to remove a facial covering to eat or drink. And then we have the highestrisk indoor activities that right now nobodys really for example, the symphony, the opera, sort of these big events with mass gatherings. There are things that are so high risk right now that we dont see it really happening until things either change dramatically, we have a vaccine or we have much better cheaper tests where we can mitigate that ri risk. So i will briefly cover Health Officer orders and then i will get back into the Indoor Dining. Im putting that under the category of emerging health risk. So how the Health Officer heres how it works. So the federal government can collect taxes, wage wars and regulate interstate commerce. All other powers are vested in the states, and the state Police Powers are used for Public Health authority. So what happens in california is state Police Powers for health are dedicated down to the counties. We have 58 counties and some cities also have decided to become Health Jurisdictions and operate Health Departments. So we have 61 Health Jurisdictions. By law, every county or Health Jurisdiction must have a physician Health Officer to implement local health authority, and thats me. So the bottom line is you can look at the second bullet point here, is Health Officers are authorized to control contagious, infectious or Communicable Diseases and may take measures as may be necessary to prevent and control the spread of disease within the territory under their jurisdiction. Health officers have the Broad Authority to give us the flexibility to do what we think might be necessary to control a communicable disease. Of course the power is not unlimited, and this is why we work with a City Attorney to make sure that what were doing can be is were doing the least restrictive that we think can get the job done but still be within our larger Legal Framework of the constitution. We want to minimize doing anything that goes against the broader laws of the land and that can be defended legal ly. So the way we do the Health Orders is first we start with the california blueprint for a safer economy, and we start with what the state allows us. Ultimate authority is at the state level. So the state Health Officer can actually overturn anything thats done locally. It rarely happens, but they have the ultimate authority. We consult with subject Matter Experts and nail down what are the key Public Health principles that were going to be using. We work with the City Attorney to make sure that we have we can do we have the appropriate Legal Framework to implement our intent, and the legal attorneys will draft an order, and then we have directives. And think of directives as guidance but with legal authority. And the directives are more flexible because those get updated as new science becomes available, but the orders tend to be constant and points to the directive. And then we work with information and guidance where we have more subject Matter Experts that focus on developing guidance and tip sheets. Its really the combination of all these levels working together is how it all functions, and in general we tend to be more health protective than other counties. Some counties will just say, okay, the state has come up with guidance. Go for it. Just implement that guidance. We take the extra step of reviewing that guidance, looking at other guidances from across the country and really making sure that were implementing the most uptodate science, and then we translate that into directive. Emerging health risk. So this table here has risk factors for transmission of the coronavirus. I want you to focus on really column two. Youll see 14 different risks that are itemized mobility, network, contacts, and were thinking about people having close contact, so youre thinking about not just the number of people but the rate of contact, the distance, the duration, what activity is happening, eating, drinking, talking, singing, whether a Face Covering needs to be removed, handwashing. Indoor setting and then and then ventilation if youre in an indoor setting, and fomites are just inanimate objects. I went ahead and just itemized in the third column those things that are very specific to Indoor Dining. And so youll see that out of 14, nine of them apply to Indoor Dining. So mixing number of persons and frequency of contact. We now know that aerosols, whenever we actually just breathe, it creates aerosols. And the way to think about aerosols is that if you can smell smoke, if somebodys smoking and they are exhaling the smoke and you can smell it, youre breathing what they just exhaled. Thats how far aerosols can travel, and you know that you can smell smoke from quite a distance. Prolonged duration, as ive just mentioned, aerosol generation. The Face Covering prevents 75 to 85 of aerosols from being released. It really decreases it. Thats why its important for everybody to have Face Coverings on, and even then its not 100 that it prevents all aerosols. So even if everybody in the room is wearing a Face Covering, you still have aerosols as being generated and put into the air, so ventilation is really, really critical. And thats why doing Things Outdoor is very important. And if we think about whos going to be most at risk, its truly going to be the workers indoors who are seeing multiple customers over the day, day in and day out. Thinking about ventilation, air exchange and filtration is really critical. Indoor dining, indoor setting with possible poor ventilation, mixing with persons outside the household, Face Covering removal to eat and drink, physical distancing less than six feet when youre sitting at a table with people who may be outside your household, and then the duration of close contacts. So in one of the challenges that we have in the science of coronaviruses, we have been with this pandemic for six months, so theres still a lot of things we dont know. So study what the drivers of infection are really requires specialized studies, and basically the type of specialized study thats done in an epidemic setting is comparing people who became cases and people who did not become cases, and then identifying what risk factors are associated with becoming a case versus not becoming a case. And so and this is one of the first case control studies that has been done, done by the cdc, and if you can see there on the third, the third item where you