Motion to approve. Second. Second. Theres no one on the Public Comment line so far today. President bernal all right. Clerk [roll call] thank you. That passes. Item three is the directors report. Commissioners, grant colfax, the health director. A few things in the directors report. We had the pleasure of participating in an announcement with senator scott wiener and mayor breed with reintroducing the Safe Injection Sites. The senator plans to reintroduce this bill in december. As you know that Safe Injection Sites have been a priority for the department and in alignment with mayor breeds priorities. We need these evidencebased proven interventions more than ever as fentanyl continues its uncrease in San Francisco and we have estimated that weve had more than 470 Overdose Deaths in the first month of 2020. And so this is a muchneeded intervention and it remains a priority and able to participate with the senator and the mayor in announcing the fact that that the bill will be reintroduced. We continue to encourage everyone in the city to get a flu shot now more than ever. This is certainly not the year to skip on a flu shot. We know that flu shots are safe, theyre effective, they prevent flu and they prevent serious cases of the flu. We want to ensure that everyone stays as healthy as possible during this unprecedented season, especially with covid19. So were encouraging people to get their flu shot more than ever this year and working with a number of partners across the city on that as well as it being a priority in covid command. And then another thing that i did this past week, which was very enjoyable, which is to participate with mayor breed and directors of park and rec, and the reopening of playgrounds in San Francisco. Its been a long time coming. But we believe that with our covid19 case rates in San Francisco, playgrounds can be opened in a safer way. Its with important guidelines that must be followed in order for playgrounds to open. So we did that this past week. And then just in terms of the amount of work thats going on, i wouldnt say in the background, but, certainly, to highlight with regard to our work in covid19 in these covid19 times. The Environmental Health team is just done an amazing amount of work in terms of ensuring that the food facilities are following guidelines and safe for people to dine in and to receive food from. And just to give you some numbers. During covid19, the Environmental Health statues was done and over 2,800 food facility inspections had responded and had over 3,700 phone calls to food facility operators. And have distributed 43,000 informational emails with regard to food safety practices. So e. H. B. Is incredibly doing incredible work during this time and also incredibly busy. So just to highlight some numbers for the commission there. And then the rest of the directors report is there for you to read. Im available for any questions and, of course, in the news theres been quite a bit of news lately and thats in the report. I will follow up with more details on covid19 in my update as i believe as give to the next agenda item. Thank you, commissioners. It looks like commissioner chow has a question. Yes, thank you, dr. Colfax. Im wondering that i thought we had closed most restaurants that would have been a lot of activity in regards to how indiscernible but there werent that many inspections. But im glad to hear that we have been because we have a lot of pickup and delivery. Is that what is really happening so that after covid we spend a lot of the activity to make sure that our restaurants are safe . Thats right, commissioner. So a couple of things restaurants were able to remain open for takeout and delivery, right, so i think that is a worker safety component of this is really important. We know from data that food workers are a risk group for acquiring covid19. So really ensuring that proper protocols are being followed. We had Outdoor Dining for some time now in the city. So responding to the concerns and issues there. And then more recently we have opened up restaurants to 25 indoor capacity for dining. So theres a lot of work that has gone into this. And as you can see the Environmental Health branch has been very busy. Thank you. I think that is a really wonderful report and very good work on the part of our department. And since you did mention staff, it sounds like from all of the Different Cases that were seeing that a lot of the Safety Measures are being taken for staff, and that there has not really been any outbreak amongst the workers, many of whom we know that have to be fairly cleese to each other . So overall the Food Industry has been very collaborative and cooperative in regard to aligning with the orders and complying with the orders. And its really been an effort on the part of our Health Officer dr. Tim aragon and the others in the industry, so that people understand what is necessary. And as in other parts of the city we have had instances where there have been staff who have tested positive. Thats certainly to be expected, given the activity and the overall presence of covid19. But we havent seen an unexpected increase in covid19 cases given what we know about the risk in this situation, in these settings. And now with the Outdoor Dining and being able to have perhaps more than the expected types of positives that might come out of that in terms of our tracing over the last, what, nearly a month i guess of having some outdoor activity. Thats correct. And, you know, again, there have been cases that have been detected among the Food Industry staff, but we havent seen an increase beyond expectations of the cases, certainly, in patrons or staff in the Food Industry beyond, you know, what we know would be expected with the risk factors of covid19. Which is why its so important that e. H. B. , the Environmental Health branch, works and collaborates and educates the industry about the importance of it now, and social distancing when possible and other safety precautions. And establishments must take it to remain open. So i say again congratulations. And it might that be that kind of information and the Public Information that having followed a safe activity reasonably a reasonably safe activity to be undertaken could be helpful in our economic recovery. Yes, commissioner. Were using the term safer because we have to be i think that we know from the data that outdoors is safer than indoors. So i think that people also need to make decisions based on their own risk and the risk of the people they may live with in regards to being older or having chronic conditions in terms of how much engagement they are willing to take. So things these steps are actually helping us to be safer moving forward and its commensurate with the data that ill show you in a bit about the declines in infections in San Francisco. So overall good news. Thank you very much. Commissioners, any other questions . Dr. Colfax, i did have a question following up on commissioner chows question. Recent National Studies were done showing that people who were testing positive for covid were twice as likely to have dined in a restaurant. I understand that even though i know that you will talk about this later that the state has moved us into the yellow tier or the lowest tier, that were Still Holding back a little bit in terms of what were allowing in Indoor Dining and other things. Is that the case . And is this a factor and a concern . The increased risk. Yes, i think that study was done by the c. D. C. And it certainly is one of our greatest concerns about dining. It also doesnt allow us to distinguish to a degree that we really would like to be able to in terms of, you know, the safer practices, to institute safer practices, what is the risk, right . And i believe that dr. Aragon has joined us and i know that he has reviewed the study and may have comment in terms of how its affected his thinking in terms of reopening food establishments. Dr. Aragon. Hi, good afternoon, commissioners. Yeah, that study came out shortly after the state had already come up with its tiered system that included restaurants. So that study was incorporated into their thinking. I think that for us it verified what we knew, with what we expected, in that we expected we expected dining to be associated with becoming a case because people do not have face coverings. So that Study Associated it didnt distinguish between indoor and Outdoor Dining. So whatever was shown in the study its probably an underestimate of the actual risk. So i think that is why everybody is taking it very, very seriously. And so though we were assigned the yellow tier, right now were not going beyond what is permitted in the orange tier for Indoor Dining. Thank you, dr. Aragon. I see commissioner christian has a question or a comment. Yes, dr. Aragon, did you say that it did or did not distinguish between the indoor and the Outdoor Dining . It did not distinguish between indoor and Outdoor Dining. So if anything its the underestimate of a true risk. And i didnt read this study and i would hope that the answer to my question would be yes, but was the study specific enough to, you know, to to show that it was the dining that was the factor . Or could it possibly be that somebody people who are more likely to go back to dining are also more likely to be a little less careful . I mean, from time to time Walking Around the city to and from restaurants i see people like just the other day we were going to dine outdoors and there was a couple that had a couple of young children. The children had masks on, but the couple did not. Here they were walking down the street towards a restaurant, towards us within feet and didnt even bother to try to put on a mask. So i think that there are i wonder if the study left room for there to be some other correlation or some other cause . Yeah, so youre asking you think like an epidemiologist. Yes, it was an observational case control study. So, yeah, the case control observational studies are going to always have problems with residual confounding. They did ask about mask usage. They tried to control it for other factors that would be associated because presumably somebody who is risky and may go to a restaurant may also be more risky in terms of their mask usage. So the control was for those factors to the extent they could. But youre absolutely right, there could be some unidentified confounding that might explain it. So its always an issue with observational studies. But it is it looked at a lot of different factors. And this was the only one theres only two factors associated. One is that you live with somebody who has a case. That one made sense. And then Indoor Dining. Everything else they asked about was not associated. And that Indoor Dining has the mechanism. So at least it was consistent. And hopefully there will be more of these case control studies. Thank you. I appreciate that. President bernal commissioners, while you were making your comments, there are commenters. Can we check . Clerk so if theres anyone on the Public Comment line to make a comment on this item, which is the directors report, i believe that it is item 3, please press star, 3, and i can have you raise your hand and i will know that you want to speak. It doesnt look like we have any comments. So commissioner, now you are muted, sir. Thank you, mr. Morowitz. We can move on to the covid19 update again with dr. Colfax. Thank you, commissioners, grant colfax, director of health. I will provide you with a brief update on covid19. Dr. Aragon as you know is here to answer any additional questions that you might have. And lets just go to the next slide. Thank you. There were up to nearly 12,000 covid19 cases diagnosed in San Francisco, with 133 deaths. Next slide. And the population of our characteristics, relatively stable to what you have seen in prior presentations. The inequity among the latino population which, again, is consistent with, unfortunately, what were seeing across the region and across state and across the nation. Latinos account for just nearly half of covid positive cases. And we see gender distribution which, again, is consistent with regional and national data. I do think that its worth pointing out that we still have a relatively small number of people experiencing homelessness who have been diagnosed with covid19 at 3 . Next slide. I did want to highlight the cases that weve had of covid19 by race ethnicity. That there had been questions that the commission had around the relatively high higher mortality rate among asians diagnosed with covid19. And just a couple of points. Its not shown on this slide. That asians who are diagnosed with covid19 are on average eight years older than the average case diagnosed with covid19. So eight years older. And you can see here that in the situation of looking at covid cases over 65 by race ethnicity, arbians have a higher percentage of cases diagnosed in this age group. We know that this age group is particularly vulnerable to covid19. And, indeed, we believe that this is what mainly accounts for the discrepancy with what were seeing with 38 of deaths due to covid19 being among the asian population. This is also supported by data looking at our congregate setting facilities, where half of the asian deaths have occurred in those facilities. So a combination of older age and a residence at a congregate setting, very much explaining that 38 mortality rate in asians in San Francisco with regard to covid19. I would add that the case rate among the diagnosis rate among asians overall in San Francisco remains relatively low compared to the proportion represented in the population overall. Next slide. And then this is looking at San Francisco compared to other similar jurisdictions across the country. You are familiar with the slide, but just to emphasize that king county and peel are cases per 1,000 is lower than other jurisdictions. Deaths per 100,000 remains low. And our testing rate is quite high compared to other jurisdictions where those data are available. Next slide. And this can we go back one slide . Oh, okay. I think that maybe this is looking at our key health indicators. You will see some good news here. Very good news with regard to our hospitalizations, in the green. So covid19 18 , and the next two boxes there are also in the green with good capacity. And really the next metric down, the disease situation with regard to the number of new cases per 100,000 population, down to 3. 5 . And the commission will recall that in july and august, that number actually got up as high as 12. And we have seen a significant decrease in our cases. Again, despite that high testing rate. And look at the testing number here where its at, 4,954 average tests. Running that sevenday average in San Francisco. So nearly 5,000 tests per day. So were testing even more but our case rate has come down very significantly over the past few weeks. Our Contact Tracing numbers, percentages, are improving. 86 of cases are reached and 81 of the contacts are of the case sorry, the contacts for cases are providing or are being contacted. And our p. P. E. In the Health Department remains at 100 , 30day supply. Next slide. Here we go. So this is more good news for San Francisco and its commensurate with us moving to the safety yellow tier today, it was announced today. You can see that weve had a steep decline in hospitalizations across the city due to covid19 in the two weeks since the Commission Last got this update. Today were down to 25 hospitalizations with covid19. Patients are in the hospital. So, again, were back to the plateauing that we saw in late june. And a situation that before that we hadnt had since early april. So really tremendous progress and not only in flattening the second surge but now really crushing that curve the second time. I just want to take a moment to acknowledge the remarkable work that all san franciscans have done with regard to ensuring that we slow the spread of the virus. This is just a remarkable graph and i think that it really reflects the leadership of all san franciscans in terms of how we have responded to this pandemic. We certainly hope that things continue to stabilize and maintain this way. And as you will see in the following slides we are as a result of these very positive numbers, the hospitalization rate, and the the cases per 100,000, we are reopening more. And its even more important for us to now redouble our efforts with masking and about social distancing. About the protecting of the vulnerable populations. And making informed decisions what we choose to do as individuals and with our families in a way that is safer and, again, slows the spread of the virus. Next slide. This is our reproductive rate of the virus. And you can see again remember in june and early july that i was i became very concerned about the reproductive rate, and going up about. 8 , and the hospitalizations that could result in that as a result of a surge. We have seen a steady increase, particularly now with a steep decrease in september. We are down to a reproductive rate estimate of 0. 8 again. So that risk cub, that reproductive rate certainly has followed that hospital curve and its consistent with the decreases in the cases that were seeing in that indicator slide that i showed you a couple minutes ago. Next slide. So additionally, good news with regard