>> president bernal: this is our final meeting of 2021. we are very happy to be holding our annual laguna honda meeting virtually. we look forward to being in person next year if not before. please call the roll. [ roll call ] >> president bernal: i like to invite vice president laurie green to read the ramaytush ohlone land acknowledgement. >> vice president green: we're on the unseeded ancestral home of the ramaytush ohlone. as the indigenous stewards of this land, the ramaytush ohlone never seated, lost nor forgotten their responsibilities as the caretakers of this place as well as for all people who reside in their traditional territory. as guest, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors and elders of the ramaytush ohlone community and sovereign rights as first people. >> president bernal: thank you commissioner green. we will be moving on to what our favorite part of every meeting. which is the d.p.h. employer recognition award. health commission will be recognizing contributions to a number of teams at laguna honda hospital. we are very proud to be able to do this. secretary moritz kick us off. >> clerk: kenya thomas is sharing her screen to share the slides. once that pop up, we can go forward. the first commissioner to go is commissioner giraudo. can you do the one for staff recognition please? thank you. >> i have the privilege of speaking and giving the awards to the laguna honda pharmacy team. 2021 was the year of vaccines. the laguna honda hospital pharmacy team played a turnkey role for vaccines at the hospital for both residents and staff covid vaccinations. they also supported d.p.h. and the vaccine distribution. for laguna honda residents, they coordinated and posted walgreens pharmacists who provided services for three days and the first couple of weeks of the year tone sure all laguna honda residents were protected. the pharmacy staff provided supplies to residents. in the fall, the pharmacy staff coordinated vaccines during preparations individual supplemental and booster doses of vaccines for all residents who completed the initial dose series. the pharmacy is was key for the delicate mrna vaccines that received initial emergency use approval to the f.d.a. they supported the occupational health staff with the steady supply of vaccines throughout the year to facilitate staff vaccination. michelle fots director of pharmacy will make comments about the wonderful work of a fabulous team. >> clerk: i think you're muted. >> can you hear me now? >> clerk: yes. >> i will add that, first, and foremost, thank you for recognizing the pharmacy team for health commission award this year. 2021 was a year of hope. hope in the form of the vaccine for covid-19, the llh pharmacy team was noted, was privileged to be part of the important work of vaccinations rollout for laguna honda residents and staff. they responded as they always do. they rolled up their sleeves and juniored -- jumped in and did their part. they worked with colleagues, both inside and outside of laguna honda to make sure that every resident and staff member had access to vaccine. laguna honda pharmacy team are skilled, committed, resilient professionals. they are a co-do team. i'm honored and proud to work beside them. thank you. >> clerk: commissioners if you can hold for one second. the presentation we showed before was an older one. thank you all for your patience. we want to make sure that we have all the names showing on the screen. can we have round of applause for the pharmacy team? could you show the pharmacy folks? thank you. we see two slides. can we see one slide on the screen? commissioner chow is next. >> commissioner chow: thank you. can you hear me? >> clerk: yes. >> commissioner chow: i am honored to be able to present the patient flow team. it's a vital team for laguna honda. this team is responsible for all admissions, readmissions, transfers and discharges throughout the facility and in partnership with communities. through the covid pandemic this has required an extra measure of being aware of the infectious status of east unit, report the patient who was covid positive moving to and from their home unit and supporting admissions to the new observation unit. patient flow team has ensured that laguna honda hospital has been able to safely admit new patients. i'm pleased to present dr. donna hathaway to report this important work of this group. >> good morning. i'm honored to present to you this team of the laguna honda. there's three individuals to this team. irin blanco and maria chavez and hye shin-yang. it's quite a task to do it pre-pandemic. during the pandemic it's an added extra task to ensure that the virus is contained. they have to make sure that all of the cases are within one unit and not to expose any existing patients or any new patients. they allowed flow to allow patients to come into laguna and off load patients from the acute hospital allowing to be used for the appropriate population. they have -- they are more than capable of handling the storm. i'm very proud to be part of their team. thank you. >> clerk: let's give everyone on the team a round of applause. thank you. i believe commissioner chung is next. >> commissioner chung: i have the pleasure of giving this award to laguna honda social services team. the team has played an invaluable role throughout the pandemic. they have been the lifeline to families, caregivers and loved ones by providing psychosocial support. in addition, the team has coordinated safe community discharges, supported new admissions and play an active role on the resident care team. while the workload has changed through the pandemic, the team has not missed a beat. they continue to demonstrate tearless -- tireless dedication to their residents and family and loved ones at laguna honda. hospital. i like to introduce janet gillen director of social services at laguna honda. >> i want to thank you on behalf of the social services department. last year really required lot of workarounds for our department. the social workers spent their own hours buying personal items for residents who couldn't get out to give them a sense of normalcy. they also spent a lot of time arranging for face time and phone calls to help keep people connected during the many months. i so appreciate all the efforts they made in really making these things happen and preserving quality of life for residents and their families to the pandemic. i'm very proud to be part of the team. thank you again. thank you. [ applause ] >> president bernal: commissione r green will be next. >> vice president green: i get to honor the laguna honda hospital nursing operations team. as a member of the jcc, it's been such a privilege to watch your accomplishments in realtime. the collaboration every one of these teams is spectacular. i get to highlight the incredible work of the nursing team. the llh operations team, with all the challenges that occurred this year, this team has been i believe to provide consistent acy and support to all staff and residents. this pandemic brought changes and processes and monumental restrictions to ensure operations and nurses run smoothly. the leadership of nursing operation supervisor pray support for louisiana la hospital 700 plus residents. they resolved issues and safety, not mention safety of staff and visitors through collaborations. the nursing office staffers manages staffing daily which is incredibly deal during the pandemic. staffing has been very limited and scarce especially during times when the units are put on quarantine. both teams have demonstrated perseverance to keep operations afloat. l.a. laguna honda was able to obtain 5-star rating throughout the pandemic. this rating is public benchmark to all skilled nurses in the country. the impact the nursing operation team has made is unavailable to the laguna honda hospital and contributed to the well-being of our residents, patients and staff. it's my pleasure to introduce edward guina, he's the director of laguna honda nurses operation. >> it's a wonderful honor and a recognition that we honor this team, our nursing operations team that comprise of supervisors and staff. you can see, we have many people. i couldn't thank them enough for their contributions. i want to say to the rest of our supervisors that -- [ indiscernible ] we are deeply committed to making sure residents are safe it makes even harder to perform our duties. we actually have done it just with compassion and making sure that all of our services are being carried on. these are the heroes that we have and i look forward to recognizing them on a daily basis. i want to express my appreciation for supervisors for recognizing a wonderful nursing operations team. thank you. [ applause ] >> clerk: commissioner guillermo? >> commissioner guillermo: thank you. very honored to be able to present this award to the core super user team. the epic super user team have been involved in the laguna honda journey before the hospital go live date. after the implementation, leadership identified a need for super users to support the front line staff. before nurses continues to work and develop work flows to better serve the end users which includes patient care and safety. the team members complement each other strength and work together. the nursing experience has enhanced their efforts that are guided by best practices. they demonstrate understanding when working with end users which allows them the ability to identify gaps and determine the need to the end user in order to provide education. during the last two years, the team's commitment is evidence in numerous changes they have submitted. that has been successfully implemented. they are trusted resources with their advance knowledge of the epic system including providing support to multiple disciplines and as well as providing support during regulatory survey. i like to introduce -- [ indiscernible ] >> good afternoon commissioners and laguna honda community. i'm reading the remarks from irin blanco. the epic core supper users continue to support front line staff from positions to nurses with work flows to maintain safety. they ensure any standard practices may negatively impact patient care are identified in realtime education. these are extraordinary individuals who dedicate their leadership and support to ensure best practices. thank you. >> commissioner guillermo: nursi ng has the ourselves and functional tools to perform their work and contribute to the success of laguna honda. they provide technical support for various care delivery systems. in response to covid-19, the laguna honda hospital team created a system that allowed the residents to see their loved ones and surrogate decision makers. they saw the need and took action while practicing financial stewardship. the team found old equipment that was no longer used. and repurposed them to enhance quality of life of laguna honda residents. amazing to be able to do that. >> thank you, commissioner. i'm very proud to work with such a small group and dedicated group of individuals of the laguna honda informatics team. there's only three of them. they lost one registered nurse. this was christian navarro. informatics team work behind the scene. this team ensures that we have the tools we need to keep our residents safe. it's no easy feat. the laguna honda nursing informatics teams, they make our work seemless. i like to really congratulate the informatics team led by monique decharat. thank you and congratulations to the team. applause >> president bernal: i want to acknowledge mr. navarro and hope we can add him to the official record of the minute so he can be recognized. thank you for including him in your presentation. the final employee recognition award we have this evening during our laguna honda hospital meeting is the laguna honda department of education and training. which is recognized for their dedication educating training and on boarding all 1800 staff at laguna honda hospital. this includes non-licensed, licensed to medical staff. the team only has six and a half f.t.e.s, last year training focused on regulatory standards and codes, policy and procedures, plans of correction, urgent departmental request and required staff development models. during the pandemic, this team has been tasked with training preparing the laguna honda staff to implement the covid mitigation plan which is a model for the country in how laguna honda was able to mitigate outbreaks. health commission is grateful to have such a great group of educators to care for residents, patients. it's my pleasure to invite back crystal figlietti. >> this team is the first point of contact anyone coming to laguna honda will experience with onboarding and welcoming. department of education and training they work every day to empower laguna honda staff. they meet every challenge and they develop solutions, educate staff on a mandatory and required training and materials. they contribute greatly to laguna honda. we really appreciate the recognition. i'm so proud to be part of this team. i really want to congratulate them for a job well done. thank you. >> clerk: one last round of applause for this team and everybody. >> president bernal: thank you, team. as we wrap up the employee recognition award, i like to recognize dr. grant colfax, director of health. >> i wanted to celebrate these teams for the well deserved awards. as you know, laguna honda has been a model for nursing facilities across the country. many lives were saved. i want to express my deep and ongoing appreciation for everything these teams has done not only related to covid but other aspects of improving residents lives and support. thank you so much to everyone who was recognized today and look forward to continuing the work to provide the high quality level of care that laguna honda is so committed to. thank you. >> president bernal: thank you director colfax. detector moritz, do we have any public comment? >> clerk: folks on the line if you like to make a comment please press star 3 so we can acknowledge you. i don't see any. >> president bernal: thank you very much. our next item is approval of the minutes of the health commission meeting of december 7, 2021. commissioners, you have the minutes before you. are there any amendment or if not a motion to approve? >> motion to approve. >> second. >> clerk: let's check public comment. folks on the line if you like to make comment on item 3, the minutes, please press star 3. i do not see any hands. i'll do a roll call vote. [roll call vote]. thank you. the item passes. >> president bernal: next item is general public comment. >> clerk: folks on the line if you like to make comment about something not on the agenda, please press star 3 now to comment. actually, commissioners, something happened where i'm not able to use my mouse to see. can someone see if there's hands up. i'm not able to use my mouse. >> president bernal: i do see one hand up. it's a call-in user 18. >> clerk: great. at this time, members of the public may address the commission that are within the jurisdiction that are not on the agenda. each member of the public may address the commission up to two minutes. the brown act forbids the commission from discussing items not on the agenda. please note that each individual allows one opportunity to speak for one agenda item. person on the line, i'm going to unmute you. your two minutes is going right now. >> caller: thank you for the opportunity to speak. this is dr. victoria, i think you will remember that my colleague spoke during the public comment section on november 2nd. we wanted to alert you at that time privacy breaches that are happening at epic. we were concerned about the easily availability of employee private medical data and easily availability of private demographic data such as social security numbers. i will be happy to demonstrate to you guys to show you examples what can be seen just by searching for an employee's name without even opening the chart. you can search by social security, date of birth, home address and phone number. our worst fears have been realized as nine doctors who work for d.p.h. have had their identities stolen. it's clear that this occurred during work related vulnerability. their private data is easily found in d.p.h. epic. our union would like to hire a cybercrime investigator to get to the bottom of these crimes. we also like to request that our occupational health decorates be on paper rather than in d.p.h. epic. thank you. >> clerk: that's the only hand that i see. that's the only general public comment. >> clerk: thank you. the next item is the laguna honda annual report. we have michael phillips here to present. >> good evening commissioners. we are so much looking forward to presenting our report this afternoon. i want to introduce my very leadership team. w.h.o. all -- who all of you know. chief nursing officer monica biley. our chief operations officer is -- each of my senior team members will be assisting the presentation this evening. i thought it was very important for all of us on the same team who participate. here is our organizational chart. as you can see, laguna honda is just a small part of a very large department of public health. although, we just a small component, we really play an important role in caring for some of the san francisco's most vulnerable residents. our mission vision and values represent the identity. they exemplify our commitment to providing therapeutic, a therapeutic environment. in terms of who we serve, you can see, we serve a very diverse patient population. some residents are two thirds male and one third female. our largest resident representation by race consist of asian, african-american, hispanic and caucasian residents. while these four racial groups represent the majority, we serve many residents with the primary languages other than english. we really prayed ourselves on the rich diversity of our staff. this is a quick look of our year in review. we had a very productive 2021. although our volumes were lower due to the pandemic, we still were able to accomplish a great deal. for example, we successfully reopened our facility to the public. really perhaps, our most important accomplishment was a very successful vaccination campaign. we were able to vaccinate 100% of our staff and 93% of our residents. that is in terms of the two doses. currently, with omicron being the dominant variant, we will fully under way with our effort to have all our staff proceed the booster. currently 84s. of our residents and 60% of our staff has received a booster. we'll continue with our campaign to push up our staff members during the coming days and weeks. for financials, in comparison to our prior fiscal year, our total operating revenue increased from $206 million to $250 million. our total operating expenses increased by $11 million to $296 million. we had a increase in our general fund from $67 million to approximately $33 million. despite having another challenging year due to covid. we ended the year with $23.7 million surplus. this was essentially higher with the higher year settlements. our expenditures were essentially on budget. we had roughly 4% increase in our expenditures due to salary and adjustments and other emergency responses. i know that everyone is familiar with true north. this slide reinforces our commitment to trashes of share e commitment provide the basis for delivering on this commitment. here are our actual our metrics performance for the year. despite a challenging 2021, we made good strides in true north. we still have significant work to do particularly in the area of recommending working at laguna honda and our equity initiatives. these two areas of the opportunities are very important to us as an organization. we'll continue to to focus on improving the performance. with that, i'm going to hand off to the next presenter who -- michael biley. >> good evening commissioners. it's my privilege to share with you which is called the laguna honda way. we had several accomplishments in year. some of our key qualities of accomplish has to do with reduction in pressure. we reduced our pressure ulcers -- our cms who retired this mop it's because of her leadership that we were able to implement through -- we had tremendous results. we launched an improvement team which also had some results. we look corporated work. this is our focus at laguna honda for the has -- the purpose of the bar code administration is to really reduce medication errors. we increased the target from greater than 90% to creator that 90 percent. we cruel clue -- this bar code initiative has been a collaborative effort between nursing and pharmacy. it's that collaboration that got us to where we are toe. there were two nursing managers that really led this project. they should be recognized as well. some additional key accomplishments, we have 1800 18 18 --hundred work. laguna honda focuses on obtaining the little like recommend laguna honda. other workforce and compliment. this is really important. i want to due attacks to this. our epic courses has been instrumental in this work. i want to acknowledge dr. michelle fouts she works with our epic transition and programming. we've been able to stabilize epic align with d.p.h.'s response to covid-19. for the covid-19 response we may update to allow tracking of covid tests and vaccination status as well as upgraded changes in resident status which was extremely important for nursing. data collection, reports of data to assist departments looking for opportunities and regulatory compliance. then development for long-term care. we recommended upgrades and several recommendations have been implemented into the epic production build for other guilts that will be going live with epic in the future. i'm going to turn it over to my colleague to talk about some of the highlights that we had in fiscal year 2020-2021. thank you. >> thank you. next slide please. good evening i wanted to cover some wonderful highlights for the past fiscal year. laguna honda has much to celebrate and be proud of during this unprecedented time. i have the honor of sharing with you some of those highlights. in september, we opened our doors to resume visitation for our residents and their loved ones. these visits were held outdoors with limited time but brought lot of folks to all of those who are able to participate. in december, we were able to be some of the first in the country to receive the covid vaccine and we're able to provide this on site for our 1800 staff. in january, we're able to provide that for over 700 residents. in april of this year, laguna honda hospital was able to expand our visitation to seven days a week. we were able to resume resident activity to increase the quality of life for our residents during the year, laguna honda celebrated various awards and accomplishments. i want to highlight is that one of our nurse directors, had his research published in the journal of american association of nurse practitioners. on his own research the accessibility of prep for young people at risk for hiv. in november laguna honda received the top honor for the 2020 quality leaders award from the california association of public hospitals and health system for our covid-19 outbreak response and management. in february of this year, one of our nurse managers was featured the rainbow bush coalition covid-19 event for her service top support the community during the pandemic. throughout the pandemic, the hospital has made great efforts to hold space to celebrate and honor our staff for their dedication to the facility. laguna honda hosted back to school class appreciation day and delivered meal and celebrated nurse's week with only 200 nominations. another one of our staff was profiled one-year anniversary of the pandemic for her work on the front line of the staff member of the team that did all of our laguna honda positive patients. thank you for your time. i want to pass to my colleague, our chief operation officer who will share with you some of our covid-19 highlights. >> next slide please. good afternoon commissioners. i'm the chief operations officer. i'm the commander for covid incident response. i'll be covering the next slide. i like to slide because of the first bullet and folks how see here. it speaks to the unprecedented number of new breakthrough treatments on the horizon for covid. when i think about this, i think about what we're faced with a year ago. really so humbled. often, i do these presentations with our team. we talk about how many deaths that have been as a result of covid. i remember last year, there were 14,000 deaths in southern california, half of those were in long-term care facilities. that was something that really rocked us and motivated us to do the work that we were doing. i remember early in this disease, the hospital was solely reliant on our infection prevention protocols, we ask a lot of our residents and staff. it really brought home the fact that those were scary times. our resident and staff are heroes, they gone above and beyond and sacrifices. they each rose to the challenge. we ask our residents not to leave the hospital. so far nearly or over a year, they were isolated from their family, friends and rest of the outside world. we never heard a complaint from the residents or the families. we also ask lot of our staff, we've asked them to enter the hospital in two entrances when they used dome in multiple doors. we've asked them to submit to weekly and sometimes it twice a week covid testing. at times we restricted folks from going into the new hospital. in the early days, i remember us carrying p.p.e. and there was shortage. i remember the difficulty securing isolation gowns. these sacrifices have been great. we are starting to see some differences in our numbers. i like this slide. i'm looking at medications that were reduced, negative effects and horrible outcomes of covid. it's such a nice swing to us and something that we really waiting to see. we're 90% of the fatalities due to covid can be changed. what a game changer. last, on this particular slide, what i really appreciate, for all the hard work that the staff has done. we received top honor from the california association of public hospitals and health systems. really helped us emerge as a national model. we were pleased when the vaccines started early last year. they separated one-year anniversary. our staff understood the importance of vaccines. we saw over 90% of our staff vaccinated before there was a mandate. as you know, the staff that we have in the hospital now are all currently vaccinated. we're working on boosters for staff and the residents and working hard to ghost -- get those numbers up. for us, we began our vaccines january 4, 2020. we partnered with pharmacies like walgreens and soon after great medical clinic took over those vaccines and we're doing a wonderful job. we watched vaccination rates increase overtime. what was impressive to me is the commitment that the staff showed getting their vaccines. they knew that our population was some of the most vulnerable in the city, wanting to perspective not only their families but colleagues and residents. we are not 92% of our residents who have been fully vaccinated within the initial series. as you all know, all of our staff has been vaccinated. what i'm really proud, we haven't had a covid positive resident in the last six weeks. michael shared these numbers, about 60% of our staff had boosters and over 84% of the residents have had boosters. we are happy with those numbers. but not resting on those. we will still do a lot. i want to thank the staff and residents for the last vote that we see. very few positive residents and fatalities. when i quoted those numbers earlier, we had six fatalities that was last christmas. we were really working our harders to not see that happen again. thank you for your time. i will turn it over to dr. hathaway. >> thanks, john. good evening again. i like to highlight a few key accomplishments with respect to our covid-19 response. rapid testing. i remember when this was started back on january 1, 2021. we were able to recognize and identify cases early on in the game and look to mitigate and separate folks that test positive. we're making sure that the resident who are exposed undergoing rapid testing. later on in the year, in octobeo implement the monoclonal antibody treatment despite the f.d.a., c.d.c. recommendations of the result the delta variant. we were able to provide treatment for residents who tested positive. we were able to implement that. it's worth mentioning again, we did start our booster rollout. this is another key accomplishment. especially the omicron variant. because of the measures we have set in place, we were able to resume visitation beginning with outdoor visits only. now it's expanding to in room visit. we have started -- [ indiscernible ] residents are able to go off campus to spend time with family, or just be off site. we went from one patient per unit per day now we are social -- essentially open with mitigation. we are able to contain and keep the virus down. there's not been positive cases associated with visitation or positive cases associated with folks going out on time. we were able to increase and relax measures depending as needed to keep residents safe and deliver excellent care. as a result, because of the process that we have made, the health officer sent two health orders this past month. we were doing so well. switching gears, i don't have to say too much as to why working at laguna honda is such a wonderful place to be at. there's always room for improvement. as mentioned earlier, we developed and disseminated a staff survey. we have extended our staff appreciation event with meals, giveaways, appreciation events. a big kudos to -- [ indiscernible ] of course communication, communication is key. we've maintained our daily situation status to go about every day. in summary, fiscal year 2020-2021, we have continued to adjust to the way of the pandemic while still continuing to ensure quality care and patient safety and also continuing to invest in our staff. [ indiscernible ] >> at this time we'll be happy to answer any questions if there are any. in the meantime, i want to reiterate how proud i am to serve as c.e.o. of laguna honda hospital. i have a wonderful leadership team. really, every aspect of laguna honda from our evs team to our nursing team, we're so filled with heroes throughout this building. that's evident that, the careness we've been able to exhibit. i'm proud this team has put in place. obviously, there are many different days. it can be very challenging and stressful. the team show up every day and do a wonderful job for our residents. i couldn't be more proud of this organization. >> president bernal: thank you michael phillips and your entire team. secretary morewitz, do we have public comment? >> clerk: folks on the line if you like to make comment on item 5, the laguna honda annual report. please press star 3 to raise your hand. >> president bernal: i like to go to commissioner tessie guillermo who serve as chair of laguna honda and helping to guide commission's work related to laguna honda. >> commissioner guillermo: thank you. i can't say enough about what you all have just heard from the team at laguna honda. the facts and figures tell a story that i think is unprecedented in unmatched across the nation. the thing that makes it possible are the folks you just heard from michael phillips, chief nursing officer, michael biley and chief operations officer -- they have provided the example and leadership for all of the folks that work and dedicated themselves to laguna honda to follow. we think about it, not only is one of the largest facility of its kind in the country, it serves among the most vulnerable, the most advantaged and challenged of resident. to be able to do that successfully, we cannot take this for granted at all. someone congratulate the team, i want to congratulate everybody at laguna honda. i want to congratulate the residents and residents family their guardian and caretakers for really contributing to this story of success. i want to say happy holidays and stay safe. thank you. >> president bernal: thank you again, commissioner guillermo. i see hand by commissioner chow. >> commissioner chow: thank you president bernal. i wanted to make a few comments from even greater historical perspective. i'm very reminded before i joined the health commission, i was involved with the blue ribbon commission for the review of laguna honda under mayor feinstein. it was my first opportunity to work with the city. we came up with a set of recommendations at that time. laguna honda's operations, they carried out almost all of those. it was nowhere in the last few years that laguna honda has done. we have moved quality of care beyond housing and respectful housing but housing nevertheless, seniors to actually a truly dynamic outstanding facility that the city can be very proud of. out of adversity can come opportunity. certainly true here from several years ago when we had some serious privacy breaches. it was certainly a one of the low points that laguna honda faced. it was certainly not the values that all of us had and hold to. especially in terms of respecting quality for the life of our residents. out that has come even more dynamic program of quality and service to the community. i think it shows, also, what the study found that are showing increasing satisfaction to our staff so that you implemented more guidelines for our staff, staff appears to appreciate that. sees the value and actually improves their own work. i wanted to congratulate all of you that. i wanted to reflect that it is also something that many years ago, we said, laguna could be a national model. you're able it show the publications that come out recently. not just on covid. we have talked about that. years ago. i want to make one comment from -- the comments that were made several weeks ago here, definitely we do not want another privacy breach. we heard comments previously. i'm aware of that the department is working hard to respond to that. i think the commission would appreciate a reasonable period of time. we tray to answer the concerns of our staff and assure that we're doing everything to protect their privacy. again, thank you everybody at laguna. wonderful work. for those of us who reflect what we had before, we can see the change. we can congratulate you on the services you are providing to our most vulnerable residents here in san francisco. thank you. >> president bernal: thank you vice president green? >> vice president green: thank you so much. i can say more eloquently than my colleagues here have. it's been nothing but extraordinary, the accomplishments you've had and the way you stabilized the culture and improve the culture at the institution. in addition to the privacy concerns, i remember the first thought at the start of the pandemic, will laguna be the place where covid strikes. other thing that comes across is the sense of collaboration, of value, of every individual on your staff. there's a feeling of professionalism. i felt certainly. you show us at your meetings whether someone is working in nursing or physician. it's so apparent. i don't think we can be more grateful to you. you are a model. i know as a -- i really value and appreciate what you done and recognize how difficult it is to make she's kinds of accomplishments. congratulations to all of you. great deal of gratitude from us all. >> president bernal: i like to associate myself with the comments of members of laguna honda j.c.c. i like to recognize dr. grant colfax, director of health. >> thank you. i wanted to reiterate and share -- reinforce my support for the comments that the commissioners made. i continue to encourage the commissioners at laguna honda to talk with the residents athe staff and it's an incredible place and amazing community of people who really care for one another. i want to thank the entire laguna honda team for their share of leadership to what's been a challenging 24 months. the foundational aspects of the commitment were there. focused on doing everything we can to support and help our residents at laguna honda. i want to express gratitude and expression and appreciation for the commission's recognition for all the work that continues to into supporting laguna honda. thank you. >> president bernal: thank you director colfax. seeing no other commissioner comments or questions, we like to thank again michael phillips ahis team for an excellent report and for an extraordinary year of hard work and leadership in very challenging circumstances. thank you again. once more, we look in our to being with you in person next year i'm hoping sooner. next item for discussion is the director's report back to dr. grant colfax. director of health. >> good afternoon commissioners. grant colfax. thank you. i will skip through the covid-19 updates. i have couple of things to highlight. good news with regard to our behavioral health system of care. we have acquired two new properties to expand our behavior health services it's part of our expansion of treatment beds. the sites will provide a more opportunities more options for people suffering from behavioral health disorders to avail themselves supportive services. in expansion of our behavioral health system there. then, with regard to a very -- wonderful event on december 11th, the holiday giveaway which was in partnership with the african-american faith based coalition, another community-based organization. staff and volunteers, including many from volunteers from d.p.h., distributed food across the city to community and faith-based organizations. it's called feeding 5000. i was told, there were at least 6500 allocations of food. really great work there. i want to acknowledge very -- veronica shepard. d.p.h. won the caph quality leaders award for san francisco safe return to in person learning during the covid-19 pandemic as an innovation award. really great to be recognized by the california public hospital association with regard to this work. just a few highlights from the director's report and i'm happy to take any additional questions. thank you. >> president bernal: commissione rs, are there any questions? do we have any public comment? >> clerk: folks on the line if you like to make comment on item 6, please press star 3. >> president bernal: commissione rs, any questions or comments for director colfax before we move into our covid-19 update? i don't see any hands. welcome back, director colfax. >> thank you very much. i will provide the update. i wanted to alert the commission with regard to omicron surge. yesterday, i said we were on the brink very large increases in omicron cases. we are experiencing the surge that we have anticipated was coming. we are seeing a very large, expect to be sustained increase in cases. i'll show you a slide which reflects realtime data with regard to that increase. from what we're seeing across the country, we expect omicron cases to be doubling every two to three days. if that's not already occurring. overall, covid records are the highest since the start of the pandemic in many parts of the country and the world. i think we all seen what's happening in places like such the u.k. and in new york city. just to be clear here, the second bullet refers to other places. we expect to see this in san francisco very likely very soon. timeline for omicron spread is days, not weeks like it was for delta. just emphasize that. the reproductive rate of the virus, ability is of the virus to infect the -- it's estimated to be 10. that is a phenomenally high infection much higher than delta. there are multiple unknowns about omicron still. there's a lot that is still being studied across other jurisdictions as omicron continues to dominate. we are looking at south africa, denmark, united kingdom and new york city with regard to hospitalization rates. there's an error on the slide. we'll correct. this third bullet, if omicron is half as serious as delta, the model shows 500 plus hospitalizations. 500 hospitalizations in san francisco, even if omicron is causes as much serious illness as the delta, the reason for that is because it is so infectious and it will infect so many more people. i think it's important to take a step back and take a deep breath and realize this is not time to panic. it's time to be vigilant. we have over 80% of people that's fully vaccinated in our city. we have a relatively high booster rate. 48% of san francisco residents boosted. we have 54 boosters going into arms each day. one the key here is ensuring as many people get boosted as possible. the boosters are so important for omicron. this is really place importance boosters even from where they were a few weeks ago. this is showing our -- dramatic increase in cases on the far right here. this is high variability in the data. this is even with incompletely reporting of possible cases in the last seven days. you can see that vertical line on the far right of the slide. this is how we've gone from just 10 cases per 100,000 a day, to 21 per 10 million in -- 100,000 per five days. this really emphasizes the importance of the boosters with regard to vaccine efficacy. i want to point out on the left side of the slide, the efficacy of the mrna vaccines was symptomatic disease. with this omicron surge, we are going to see many more people become infected with omicron across the country and in san francisco. you'll know here while the vaccines are still protected against omicron, you see that difference, 48% versus 93%. even among boosted people. i think that's something we really need to understand and realize in terms of our messaging to the public about what the greatest concern right now, which is really with regard to hospitalization. you see again on the right side of this slade, the graph that if people are fully vaccinated but they've had waning immunity, the efficacy of the mrna vaccines falls to 67%. we are watching the rate of increases as we see with the omicron. we believe we're probably somewhere two weeks behind the u.k., may be a week behind new york in terms of these increases. we're watching our hospital numbers very carefully. i think one of the key questions is how serious disease does omicron cause. this is the -- trend in the united states. you don't get nearly the sense of urgency and speed by which omicron is moving through our community. just to also add, you may have seen last night that the c.d.c. announced the omicron is accounting for 73% of cases across the united states when it had very low percentage case a few weeks ago. just to emphasize that fact. with regard to hospitalization, we have not seen increase in hospitalizations. that is to be expected. it takes 10 days to two weeks increase in cases to be reflected in the hospitalization numbers. we're waiting to see that increase but again, compared to where we might have been otherwise, other parts of the country have huge numbers of hospitalizations with the delta surge. we are in a much better place because of all the commitment and hard work san franciscans has gone getting fully vaccinated and getting boosted when they are eligible for a booster. that's the administration. we're 80% of vaccination completed. we're nearly two thirds of children between ages 5 and 11 getting it at least one dose of the vaccine by age. we're at about 33% of 5 to 11 years completing that vaccine. i think this is really going to be the new goal standard for people receiving a vaccine. the boosters are affording you the most protection you can get at this time. most protection you can get at this time. we are almost 50%. this data has a last week of the good news among 65 and over, we expect to be over 70% of those eligible for booster receive a booster. you can see the other percentages here. we are working hard with all of our partners to continue to expand access to boosters. there's booster capacity expanding as we speak. we're very much emphasizing laguna honda presentation, across our hospital systems that staff eligible for a booster get a booster as quickly as possible in order to ensure that our healthcare teams and staff are able to continue working during what is going to likely be a challenging time. that's my last slide. with regard to the holiday, get your initial vaccine. get your booster if you're eligible and layer -- use other methods that slow spread of virus and mask and testing and layering that on top of the boosting and initial vaccine to mitigate the effects of this omicron surge. i will take any questions. we will make sure that one slide gets corrected before it goes into the archives. thank you. >> president bernal: any public comments? >> clerk: folks online if you like to make public comment on the covid-19 update, please press star 3. no hands. >> president bernal: vice president green. >> vice president green: thank you for that sobering information. i had three questions. they are little bit disconnected. i heard so many people that they understand that california exempted san francisco in a mask mandate statewide. there's a reasonable amount of confusion on that. the second question is what kind of direction we're giving in particular hospital systems about boosters? as a relatively recently, it wasn't required and wasn't aggressively offered at least in the system in which i work. i'm concerned that we will have beds without people to staff them. that kind of backs in this whole idea of ten days of quarantine. which for healthcare workers when we need them, could create huge problems with the staffing webs. -- if you can comment to get credible information if you have a positive test, what to do if you really want to find a vaccine. >> just to emphasize. we're currently doing about 5500 boosters a day in our city. we're working to increase that capacity. i think for people who are looking for a booster, best thing to do is to go to the d.p.h. website, see where drop-ins are available. for the most up to date information, we are going to be tweeting out where vaccines are available for people. on a daily basis, we'll be updating that information. some of the challenges are, the pharmacy, some pharmacies are offering drop-ins for boosters. which is great. it's very hard to navigate some of the situations because they provide a certain level of drop-in capacity. i'm speaking theoretically, they might offer 30 drop-ins at one site. if you come in 35, it's a challenge. we are working with our other healthcare system partners. i would say kaiser has been working closely with us to expand booster capacity for the public. with regard to the hospital systems and the direction we're giving with regard to boosters. as i said in the presentation, we are focusing on making sure that all the hospitals understand the importance of this. the medical officers, the chief executive officers are focused on this now in terms of inshor -- ensuring that the staff gets to it as quickly as possible. we're asking them to present the percentage that have received the booster and getting information on their immediate plans to expand booster capacity as quickly as possible. with regards to the mask mountain, dr. susan philip is online. has been responding to lots of questions that are related to what you have. >> thank you, thank you commissioner green. it'sed to -- i wanted to clarify. some of the reporting said that san francisco was allowed an exemption. what the state said, any jurisdiction that had previously had place its own masking requirements will be required to keep those requirements. san francisco has a general indoor masking requirement. we have made certain exemptions for stable cohorts with other protections in place including ventilation. we were allowed to keep those in place. >> president bernal: thank you dr. philip. thank you for your hard work and leadership and the confidence you inspire among san franciscans and how we've been able to navigate the pandemic. commissioner chow. >> commissioner chow: thank you dr. colfax. that was very alarming but enlightening and helpful to understand the data that we're seeing. i know that there's been a lot of discussion about home kits or doing testing just before going into vulnerable situations. i think that's helping to ask the public to be able to identify themselves. we talked about that last time. my question actually is, to me, it doesn't seem clear, exactly, what one does after -- if you are positive. is it 10 days quarantine, is it 5? is it going to see your doctor, calling your doctor. that's why i think the messaging is mixed. therefore, unclear to -- are people going to start using this? one test is positive. what would you really do? it says call your doctor. what should the doctor say? >> thank you commissioner chow. i agree there's been lot of moving parts on this. i think the person who's following this is dr. philip. i'm going to ask her to respond to this question. >> i think the issue of rapid tests is a challenge and testing in general. administration is going to increase access to rapid testing. we are also working with the state to get tests out as well. we know that testing as close as possible to the time of the event is what's important. than way the rapid test are ideal. it is challenging that they are not equally available. if they are valuable, then a p.c.r. test as close as possible to get the results back before gathering. >> commissioner chow: if it's a rapid positive, are you suggesting one should get the definitive test? some of the messaging seems to be don't go to the event and stay home and quarantine yourself for a few days. basically, the guess the idea is not to overwhelm the system for mild cases. what is the advice that we're getting? if we say call the doctor. i don't think they are clear either what the science says one should do. if you're positive with a rapid test, should we tell them to get a regular p.c.r. test or if it's mild and we tell them to stay home, how long would they stay? do they stay until the test turn negative >> those are really god questions. the issue about a person testing positive on a rapid test, we know that more and more, we're encouraging the use of rapid tests. as is the federal government and the state. when people test positive on those, we are not always going to be able to get their information into our system. we don't have a routine reflect now. we tell people go ahead and get a lab-based test so we can get the report of that positive. we want people to respond and behave in that test is positive. the test is quite good for symptomatic people. if someone has symptom and test positive, the sensitivity is good. on a population level, it's a good tool to use. we want them to isolate. on our website we have instructions for people how best to do it. we'll be waiting to hear more guidance from the state and science. that's an important policy question which the c.d.c. is hearing a lot of about and considering. >> commissioner chow: thank you for bringing us up to date. i know it's dynamic and moving and even with the potential new treatments lot of this will change. really appreciate the update. thank you. you can keep us up to date as we go along. i think that will be quite helpful to be able to understand where we are with the science. >> thank you, commissioner. you are right, the anti-viral treatments which we're hearing news might be on the cusp of authorization of those really will be game changers, .we're hopeful we'll hear good news. thank you. >> president bernal: thank you commissioner chow. i had one question for dr. philip. could you just remind us what the current instructions are for someone who learns of an exposure? we're all hearing now about friends who -- family members learned of exposure to somebody or group of people that tested possess. -- positive. what's the guide. what should folks remember if they learned they have an exposure? >> unfortunately, more of russ going to be getting these notices from people we are around. the current recommendation, the people meet the definition of their primary series and not necessarily a booster. if they remain symptomatic, they do not need to quarantine. the general population. she should be -- they should be watching closely for symptoms. they are at higher risk just so start with, having been exposed to someone was confirmed to be a case of covid-19. they should get testing. that's the current recommendation. this is an area of change. >> president bernal: if you have a confirmed exposure and remain asymptomatic, is there a window of time buffer wait seeking a test or should you seek a test if you're asymptomatic? >> there's so much more omicron. the virus has a lower short intubation period and can be picked up sooner. if you're asymptomatic, it's still reasonable to say within 5 days of the potential exposure. it really is based on symptoms, development for the most part for the general public. >> president bernal: thank you. vice president green, is that a new hand up? >> vice president green: i wanted to hear, if you can reiterate where on our website people can find the information about what to do if you have a positive test. i searched there, when you look at coronavirus stats, it's difficult to find. i want to make sure. i got seven calls before 9:30 this morning, three pregnant patients, four exposures. i'm one dr. grant colfax. -- we're asked this question. there's a lot of confusion out there. we should be easy to access source of credible accurate information. i think people go to web page, they search twice, they don't hear what they want, they get frustrated and go to apple news or something. >> i agree. i will take a look. we migrated our pages to the sfgov site. we'll make sure it's highlighted so that people can understand what they might need to do if they test positive or they have been exposed. >> president bernal: thank you. i do not see any other hands. thank you again director colfax and dr. phil for that very good and sobering information where with we are headed. san francisco continues to be situated because leader of our mayor and people of san francisco. we want to say thank you and hang in there. we can move on to our next item. which is the community and public health committee update. we have commissioner giraudo. >> commissioner giraudo: thank you very much. the excellent presentation today was food insecurity. very interesting facts. the rate for in california, particularly with families and children has risen to about 25%. which is even higher in the city and county of san francisco. another fact was the mental health issue of the increase of anxiety is increased more with food insecurity, more so than the loss of a job. the d.p.h. funded programs for purchasing of food. we were given the numbers for the e.s.f. vouchers of about 3000 families, 1500 families are pregnant people and w.i.c., qualified for w.i.c. with the market match, there's about 7000 people with 1500 using cal fresh. in particular the alameda farmers mark. last year, over 15,000 folks were counted in the match program. as director colfax noted, the feeding 5000 that was a partnership on december 11th of this year at city college, over 5700 households were served. in the presentation, food as medicine collaborative with the food pharmacies program over 2700 patients have been served. in the policy information, one of the big pushes it's getting to pay for food as coveraged medical benefit, particularly under the medicaid waiver. anthem as already been -- signed up as pat of this. the negotiations continue with the san francisco health plan. we asked for since the presentation was excellent, there were lots of facts and figures throughout a variety of programs. we'll get a full picture of the data and need. we also requested specific goals of the food insecurity programs for 2022. it was parents doing a good job. there's lots more to do. as the food prices increase and the child tax credit sunsets, there's much more concern for food insecurity among the residents of the city. excellent presentation. sobering presentation as well a concern. more concise data was requested and will be forwarded to all the commissioners. that's my report. thank you. >> president bernal: thank you commissioner giraudo. do we have any comments on this item? >> clerk: people on line if you like to comment on item 8, please press star 3. no hands. >> president bernal: thank you for your report. our next item on the agenda is other business. is there any other business? do we have any public comment on this item? >> clerk: if you like to make comment on item 9 please press star 3. no hands. >> president bernal: our next item is closed session. do we have a motion to enter closed session? >> so moved to enter closed session. >> second. >> clerk: before i do the roll call vote, just to note to the sfgov people this will be short. anybody also in the meeting and staff, who doesn't need to be in the meeting, you're welcome to say good-bye and we thank you for your attendance. >> president bernal: for those who may be dropping off, thank you to everyone, laguna honda hospital who joined us for the meeting today. we're looking much forward to being with you in person next time. [roll call vote] >> clerk: all right, give me 30 seconds to move this over. [closed session]

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