Thank you, commissioners. Thank you. Can i have a motion to ajourn . Motion to ajourn. Is there a second . Yes, second. All in favour . The meeting is adjourned at 10 40 a. M. Thank you, commissioners. Thank you, everyone. It may not be as seamless as we would like it to be. There may be gaps, or dead air, and the staff is trying to stay with the technology between the speakers. Please note were doing our very best, and we ask for your patience as were learning this new way to Work Together. Commissioners and presenters, if you have not already done so, please mute your microphones to minimize the background noise. When you speak, youll have to unmute yourselves. And the commissioners, raise your hand to ask a question. And we can switch presentation indescernable . And well ask everyone to please be patient as we make these adjustments. Lastly, we would like to thank all of the people who have been working very long hours to make this meeting possible. Starting, of course, with mr. Mark moore, and jeff burton, and d. P. H. Directors office staff, and s. F. Gov. Tv, and the board of supervisors, which drafted the best remote meeting practices. The commission is truly grateful for all of your great work. So thank you very much. Thank you, commissioner. This meeting is being televised this meeting is being televised by s. F. Gov. Tv, and for those of you watching live stream, please be aware there is a 30second to twominute delay. If youre watching the video at s. F. Gov. Tv, and youre interested in making a Public Comment, make sure that you call in at the beginning of the item called. For instance, if you were making general Public Comment, as soon as the item is called, call in so that youre sure to get in line for that. Let me post the number, so you can see it again. Give me one second. So the number is on the screen right now, for you all to call in. It will be in about three seconds. Here we go. The number to call in is 8883634734, and the access code is 2241310. If you would like to make compliPublic Comment any time during this meeting, call in any time. And you can listen to the meeting live without any delay, as we move forward. A couple of points about the Public Comment, since this is a new technology for us, every individual is able to make comments once per item. Even though technologically you could get back in line, if i recognize your number or hear your voice, i will disallow you from commenting more than once. Each individual can speak up to two minutes, as is our normal rule, and after two minutes, we will have to cut you off so we can take the next call. If youre on the phone line, using the number that i just gave you, you will press 10 to actually get in line for an item. 10 activates you to stand in line to be in for Public Comment, otherwise youre just listening into the meeting. If youre making Public Comment, make sure everything around you is muted and quiet, especially if youre watching on the computer because it will reverberate, and it is very difficult for us to hear you. I hope that information is helpful. And then i will repeat this information throughout the meeting, in case folks come in late for the meeting, i want to pacsure thamake sure that the pc understands how to make Public Comment. [indescernable] commissioners, i think we can move on to item 2. Let me get there. Thank you, mark. We have some Unfinished Business from our last meeting, a motion to disclose or not enclosed session in our march 24th, 2020, meeting. Do we have a motion to disclose or not to disclose . Motion to disclose. Second. Mr. Mar, would you do roll call . Yes. Actually, before we do that, i want to just note that the issues that the item that you all actually discussed and considered enclosed session was the s. F. G. Credentially support. Commissioner chung . Yes. [roll call] all right. Thank you very much. Item 3is the approval of the minutes of the march 24th, 2020, meeting. Upon reviewing the minutes, do commissioners have the amendments . I ask that you speak to the meeting being at 101 grove, is that correct, or are we supposed to put virtual or what . Commissioners, the meeting at a time was at 101 grove, and it felt thats fine. No problem. Motion to approve . So moved. Second. All right. So ill do roll call. [roll call] great. Thank you. The next item on the agenda is the directs report, and i am not sure if director kofax is with us . I am here. Oh, great. Can you see me . I can see me. I can see you. Okay. You have the commissioner indescernable . Do you have the directors report . [indescernable] the next item is going to focus on our covid19 response. I am not going to go into the detail, as described in the report, but i did want to mention that im very pleased that we have our new c. E. O. , who is in honda hospital, michael thorps. He has joined the v. P. H. Team in this unprecedented time, and has come up from southern california, and has lots of outstanding experience in Skilled Nursing facilities and other types of hospitals. He has jumped right in, and im very pleased that he has joined the team. He will continue to be working with actin the acting director, as he becomes on board and becomes familiar with the issues at hand with regards to honda, and the institution itself, and the amazing committee of residents and staff that work there. Great. Welcome. Commissioners, any questions . I believe, mr. Cofax, if there is any other else youre going to say . I was going to go into more detail of the directors report, in the next agenda item. As know, there have been a number of across the accounts and other information historically just for the commission that has been added to this report, but i dont have any additional details, unless the commission has questions from me. Commissioners, if you would like to ask any questions, could you raise your hand so we can recognize you . Commissioner chow. Thank you, dr. Cofax. I can see i was going to ask, on mr. Phillips, who is coming, to look in on honda. And you mentioned he would have it sounded like a transition period. About what period of time would you think that was, that we would have maggie still as our acting director, and are you looking at several weeks our months . What would be the thinking yes, commissioner. Sorry to interrupt. The im sorry, were you finished with your question . Yes. Okay. So the plan at this time is for them to act as a team, as michael gets up to speed on the complexities of the situation, and the full transition would be completed by june 1st. Okay. Very good. A second question would we be picking up during the discussion on the covid, the way of triaging and moving patients . And therefore i would save my questions for that. Okay. And i believe they are in attendance at this meeting. Mark, can you confirm that . Yes. Theyll actually be joining later. I thought they would be on here. Maggie, are you here . Yes. Both michael and i are present. Oh, great. So theyre available to answer more detailed questions as we go through the presentation. And commissioner chu, it seems that your questions might fit in with question five, which is the coronavirus update. That would be fine with me, to discuss the triaging and the outboarding of patients as we move them away from the acute hospital. Thank you. Thank you. Commissioners, any other questions . If youre not on video, please speak up. All right. Thank you very much, and thank you, maggie, for your help with the transition, and welcome to michael phillips. Your conference is now in question and answer mode. To summon each question, press one and then zero. Moderate, go ahead and put the first call through. Caller, are you on the line . Is there a caller on the line . You have two questions remaining. Caller, please start speaking. Caller yes, hi. This is michael petrellous calling in and im watching on your microsoft screen, but it doesnt tell me what agenda item were discussing. Yes. I verbally announced. Were on the directors report. Okay. On the directors report. Here are my two minutes of comment. I want to salute the department of Public Health for doing an excellent job of slowly and methodically rolling out the quarantine that we are living under. I also want to take this occasion to thank all San Francisco citizens, who are practicing physical distancing. I think it is terrific that we have flattened the curve, and that we are seeing the infection rates are not alarmingly high. I think it is very important that we, the citizens, who are observing physical distancing, continue to do this and continue to receive praise from the Health Department. And, finally, i want to say, i would have liked in dr. Cofaxs report here, a little bit more information about current coordination with other regional Public Health departments. Thank you. All right. Thank you. Next caller, please. Caller you have one questn remaining. Hi, welcome. Please say your name and your two minutes will begin. Caller hi, my name is Teresa Palmer, im a physician and a geri geriatrition. I feel like the lack of testing of asymptomatic contact at the nursing home is a form of rationing. It is a statement that nursing home patients lives are not worthwhile, and the lives of the is staff are not worthwhile. I would like some answers as to why were not ramping up testing at Nursing Homes, as we know we should in all congregate settings. Were setting ourselves up for a second wave, and were going to have massive dieoffs in Nursing Homes. Thank you. You have zero questions remaining. All right. Thank you. Those who made Public Comment. I think we can go on to the next item, item 5, the Coronavirus Preparedness update. Dr. Cofax, i cant see you. Can other folks see dr. Cofax . I can hear him he seems to have disappeared off the scene here. You can hear me, right . I can hear you. My video is on, and i can see oh oh, there we go. Hi, everyone. We can see you now. Hello. I had to share. Okay. Im sorry, im not able to see you. But just continue. Ill figure this stuff out later. Thank you. Okay. So good afternoon, commissioners, again, and secretary morris. Thank you for joining with regard to this report. Before we go to the slide, i just wanted to express my gratitude for the residents of San Francisco with regard to their collective response in addressing this unprecedented pandemic. From the beginning, we knew that our ability as a community to mitigate the spread of the virus was really dependent on our collective response. And thanks to the leadership of mayor breed and the aggressive actions that she supported, both locally and i think regionally as well, they continue to certainly mitigate the affects of this pandemic in San Francisco. So just to reinforce the gratitude, and also to acknowledge the tremendous effort and strength that this pandemic has put on the Health Department and the incredible work and efforts of people across the department with regard to particularly the last eight weeks in ensuring that we listen, are responsive based on data, science, and facts. And if we are flexible in our response, as more information comes in, and we do the right thing for our community. So this collective response is really focused on the priorities that i spoke to you about, which seems long ago, a very different time now, in february, with regard to slowing the spread of the coronavirus in communities, and that really is around flattening the curve. And i have provided some slides here for you just to remind us about where we have been and where we are going. But with regard to fightinflattening the curve, i think two things stand out. One is the declaration of a local Health Emergency after the mayor, in february, declared a city emergency. That really allowed us to prepare a city emergency declaration, which was done in february, which really helped us to harness our resources across the department, and, frankly, across the city, to be as prepared as possible. The shelterinplace order, which was put into affect march 16th, that initial order was key in terms of developing social distancing reinforcing the social distancing intervention, which was so key to slowing the spread of the virus. Other key things that we have done that i think remind you indescernable , just the emphasis on hygiene, with regard to washing ones hands, avoiding touching ones face. I think we all remember perhaps we remember the day or the person where we didnt shake hands for the first time, and we started practicing more triple hygiene with regard to reducing the spread of the risk of the virus. And then most recently, just the recommendations around facial coverings and the order that was just released last friday, that increased the requirement with regards to wearing fascial masks facial. I think they were all key, these socalled nonpharmaceutical interventions. You can see that we did it within the context of the broader population context, as well as, as you can see, from several of these orders, there is much focus being on vulnerable populations. And thats our second key priority, that, again, we started articulately months ago, really ensuring that were doing everything we can to protect the most vulnerable to this disease. We know, unfortunately, people over the age of 60, people with morbid health conditions, are more likely to die from this disease. We saw that happening internationally. Unfortunately, those patterns held in the u. S. , including here in San Francisco. So i will get into more details around that, but that certainly has been one of our key priorities Going Forward. As well as protecting Health Care Workers and first responders. The people on the frontlines, the people whos focus is on caring for people most at risk for covid19, making sure that they were able to protect themselves, so they are better protected and can help others. As well as protecting their families and their loved ones as much as possible. The First Priority is really around medical surge, ensuring that we brought forward capacity in order to meet, in essence, a surge. It is still very possible that a surge will be seen in San Francisco. So we remain vigilant in our focus on ensuring that there is Hospital Capacity to meet not only what were managing today, but in the event of a moderate surge, that we do have that capacity. And then also being clear, unfortunately, as happened in new york city, that there are scenarios where there were no there would not be plausible ways that a local response would be adequate. And we would need to be clear with state and federal partners that more help would be needed. I think the other key piece of our focus has been on testing and Contact Tracing. And the fundamental principle in Public Health, and something that has really come to the forefront as we have confronted this pandemic. And the testing pieces have been very challenging. But i think were making steady progress now. And then ill talk a bit about the Contact Tracing that we anticipate to be able to be affective in a relatively short future. Before we go on to the next slide, i want to also emphasize the help, the support, the collaboration with other City Departments and community partners. This is a truly citywide responsresponse. Not only do we have hundreds of d. P. H. Staff working on this, the department of operations center, the Emergency Operations center, which is headed by director Mary Ellen Carroll has been a remarkable partner, and has ensured that our response is more than just a department of Public Health response, it is truly a city response. The controllers office, the homeless department, housing department, and others really are coming together and working handinhand, and in many cases 2 24 7, to ensure were doing everything we can and to meet the needs of our citizens. Can we go to the next slide, please . Sure. Im sorry, i just got you on camera. Go to the beginning, dr. Cofax . On my drean th screen, the Health Orders are coming up. Would you like to go to the test cases . Yes. Give me one second. Sorry. Sorry, everybody. Im a little slow on the uptake on that. Okay, here we go. All right. Mark, may i just ask a process question . I have a i dont know if anyone can answer this question. Im having some challenges with this program whats wrong . The video is the bar that shows the microphone and the camera is super imposed on the eye, so i cant see the slide. I dont know if the other commissioners are having that problem. Jeff burton is on, who is an i. T. Guy. Jeff, is there any response you have to that to help dr. Kofax . Im not sure exactly what is happening, but it seems like something technical. Yeah. Mark, it appears that the control bar is obstructing the view of the dates along the bottom of the charts. Is that happening for other people, too . Well, on my screen, it doesnt. And then the control bar, you can actually it sort of disappears if youre not using it. And it would otherwise so i guess it depends on how it is being viewed. Because it sounds like for dr. C cofax, the control bar is in his way, and for me, it is below the slide. Mr. Kelly, if you move your mouse curse ser so curser y from the control bar, give it a second and it will disappear. You need to move your cursor off the control bar. Does that work, dr. Cofax . Im following the instructions, and it is not working all of the time. But i will as part yes, i will be flexible and work with what weve got, how is that . Okay. Sorry about that. Can everyone see the slide . Yes. Commissioner be careful to mute yourself because were hearing the conversation. Mr. Cofax, do you want to continue . Yes. Commissioners, i wanted to provide you with information about where weve been and where we are going. And just review data so that there is sort of an understanding of what things stand. This is our total number of diagnosed cases in San Francisco, 1231 total cases. And it represents the people who are positive who have been tested. So it doesnt represent all the cases because we know many people havent been tested. But of the people tested, weve had 1231 cases. Weve, unfortunately, have had 20 deaths. And you can see from early march, when our first cases were detected, weve had a steady increase in that number. Compared to other regional neighboring counties, we do have the highest prevalence rate of people who have been tested, testing positive. And i think that really reflects the greater density of San Francisco. Our relative death rate is still well within the surrounding counties, but our numbers are quite small and that could change very quickly. Go to the next slide. Okay. Give me one second. It takes a second to show up. Sorry. I apologize, something is stuck. Give me one second to try to unblock it. Scroll to the next. Okay. Here we go. Thank you. Yes, and then you can see here, this is our these are our data with regard to cases. Weve done nearly 12,000 tests. Our Positivity Rate does vary day to day. It has been ranging from about 11 to 15 overall, and then you can see the racial ethnic breakdown of the positive cases. We do see here that indescernable population is overrepresented, compared to the population of San Francisco as a whole, and the africanamerican. Again, these numbers are updated on a daily basis on your covid19 response tracker. Next slide, please. These are the data on the deaths. I will say that we see here that just as in other jurisdictions, we see a larger number of males, compared to females, who have died. You can see the deaths by each group. Weve had a preponderance of people over 16. The deaths by race and ethnicity show a higher proportion of asian deaths, and i can talk a little bit about that and why we think that is. That has been tied to a higher portion of older age, and then there are a couple of cases linked to indescernable . With regard to underlying conditions, this is an error in the slide. All 20 deaths have been associated with underlying conditions. So where you see the data on the 20 deaths that we have had, unfortunately the patterns of larger groups of deaths in other jurisdictions i would be very cautious about interpreting too much about the Race Ethnicity death rate here, especially because, again, this is a very small number of deaths, which is ae death is too many, but these numbers are quite small. I certainly hope that they stay this way, but, obviously, we dont know. Next slide, please. So this is a really key slide with regard to what were what we looked at in terms of the burden of covid19 in the hospital system. And the reason that this is very important is that we really need to ensure that our systems are have capacity to take care of the sickest people. And so this is the green the upper green row is data on the number of people confirmed positive across our nine Hospital Systems in the city. And you can see here, while the numbers substantially increase from the march 23rd, when we were first able to report this data, to the 19th, the latest data that has been available, this curve, starting around april 1st, is quite flat. So when we talk about flattening the curve, it is really the curve that were working to flatten is our ability to take care of the sickest people. And right now this curve is pretty flat. And i say that with all respect for the fact that this could change quickly. It could change if we have outbreaks in particularily vulnerable populations. But right now we need to look at the data, and were looking at the data, and here is where we are. The darker green shows the medical surgery beds occupied. And the lighter greens are the i. C. U. Beds, and those are the intensive care unit beds. And they remain relatively stable over the past 10 days. The blue im sorry. The purple area between the suspected covid19 patient count is also a key indicator to watch. Because these are people who who have tested positive for covid19, and are in the hospital. Those are the people in intensive care units, suspected of covid19. And those numbers have, again, remained relatively stable the last few weeks. You do see some increases in the numbers, for instance on april 5th and 6th, and we were testing a number of residents at honda for the c. D. C. Recommendations. Thankfully, not many of those cases were found covid19 positive. Next slide. So those are the key slides that i wanted to share with the commission. Commission as part of this report. I also wanted to emphasize, with regard to our medical surge planning, because of remarkable efforts across the city Health Systems and i really want to acknowledge dr. Susan ehrlich and the c. E. O. Of zuckerberg hospital, and the chief operating officer of the hospital. They really led our surgeplanning efforts, not only within the department, but across the city. And we made remarkable progress in ensuring that our hospitals were, as much as possible, not taking patients for nonessential surgeries, because that opened up capacity. That patients were discharged as appropriately appropriately discharged from the hospital to other facilities so we could free up beds. And then we greatly expanded our medical surge and intensive care unit capacity in additional ways, so that we had exceeded the states goal of increasing local capacity by 40 . Currently, we have 1252 acute care beds, and 460 i. C. U. Beds across the city to meet the demands of a surge. So really important and strong work there. So we do have that capacity now, and we continue to build out that capacity as we go forward. So i did want to talk a little bit about vulnerable populations, and provide the commission with an overview of our work in that area. We have very much focused on ill talk a little bit about the population experiencing homelessness. We know that that has been a key area of focus. And from the start, we have focused on people who are experiencing homelessness, who are most likely to have negative outcomes from the virus. And those are, again, the people over 60 or with comorbid conditions. And were working with our partners at h. S. A. And h. S. H. , and at this point, over 750 people have been placed in hotel rooms, with those chronic conditions, to help them social distance and so they can be monitored and observed for any symptoms and tested appropriately. The other thing that i think is important to emphasize is that we have developed and refined our system for People Living with covid19, or people under investigation, who cannot safely isolate or quarantine either because they are in a shelter or navigation center, an s. R. O. , or other such congregate settings, that we have stood up with multiple hotel rooms for those people. On any given day, we have approximately 200 people in those hotel rooms. So ensuring that people have what they need to stay either out of the hospital, if they do not need a hospital bed, which frees up a hospital bed for somebody else, or if they are not able to care for themselves or for reasons in such a way they can stay safe and also isolate from potentially contacting others. So we really set up a very good system there that is,again, working hard every day to even increase that capacity. Right now we have about 200 People Living with covid19 or under investigation for covid19, plus we have over 750 people who are experiencing homelessness, who have been placed in hotel rooms, to keep them as safe as possible. I also want to mention with regard to the outbreak we had at m. S. C. , one of our largest shelters. We had an outbreak there. As a result, we had 96 guests and 10 Staff Members who tested positive for covid19 there. All of the guests from that shelter have been moved to hotels, isolation, shelter, or quarantine in place, depending on their need. And all staff were also offered Isolation Hotel rooms if they needed them. And, again, we were preparing for this scenario, and we responded quickly. The staff the street medicine steam worked literally day and night to ensure that the people got the care that they needed. And that shelter has been closed and is being cleaned. Iwithin these highrisk settings, our response is driven by the best Public Health methods we have at our disposal to make an informed decision on how that response needs to be in the face of multiple other competing priorities. So i will also mention that at the Division Circle navigation center, where ive had a clinic, weve had a positive case there. An aggressive contact Case Investigation and contact investigation, there were people who were determined to be at risk were tested. And through that process, a decision was made, based on the information data that we had, that we would not close that navigation center. So my point here is that we are based on c. D. C. Guidelines, were testing vulnerable populations, providing them with care and support, ensuring that we are flexible and appropriate in our response. I also want to talk in more detail about the lag laguna honda hospital. We took a course of action with the leadership of mccowski and her team and staff early on. We ordered we issued a health order restricting visitors to the facility on march 6th. We practiced and we prepared a health order to restrict residents from leaving the building, and that went into affect march 15th, and we ensured we were screening staff for any signs or symptoms as they entered the facility. Despite those efforts, people will know there was an outbreak among residents in the 5 southward. We quarantined that ward. And we took aggressive additional infectioncontrol steps. At this time weve had 19 laguna honda cases 19 cases of covid19 at laguna honda. Four have been amongst residents. Those residents have all been located in the 5 south neighborhood. There have been staff at 4 south who have tested positive, but we have not had any residents in that neighborhood who have tested positive. And maggie mccowski and the laguna honda team can talk in more detail about that, if the commission has questions. The point is, after bringing in c. D. C. , we had a remarkable team from the c. D. C. In the state. And i want to thank our local leaders, our federally and locallyelected leaders, who really helped ensure that the c. D. C. Deployed a team to laguna honda early in this outbreak, to help us and to reinforce our aggressive efforts. The c. D. C. Made a number of recommendations, and we were report that out. But after staying for two weeks and summarizing their recommendations, they emphasized that the aggressive actions that the staff took early on literally saved lives, and were likely to continue to mitigate the spread of the virus in the institution. And then were obviously, not obviously, but i should also say one of the other key issues at laguna honda was ensur ensuring that the staff was supported. It is an incredibly challenging time for staff across the departments, and we have ensured that staff across the department have access to Behavioral Health care and support, if and when needed. And we redoubled those efforts at laguna honda hospital, ensuring that there was access to the Behavioral Health services. For those staff, and also that those staff were communicating in an ongoing way about the status of the investigations. So the additional piece that i wanted to cover before i took questions from the commission was to talk a little bit about our testing. As you know, we have struggled as a nation, with regard the capacity at the beginning of the epidemic and Going Forward. I really want to acknowledge the laboratory under the leadership of dr. Susan, our Communicable Disease director. We were one of the first laboratories in the state to Start Testing for covid19. Right now we are focused on testing on people who have a number of symptoms consistent with covid19, Health Care Workers who are symptomatic, and who have come into sustained contact with covid19 positive cases, and on our contact investigation, people who are symptomatic and meet additional criteria. bia big issue has been our lack of supplies. We hav have developed a capacity in terms of running the actual tests, so we have enough machines to run the tests. Our limitations have been as basic as needing more swabs and Culture Media in order to do the testing. That supply chain, due to a lack of federal supply chain, has been very unstable. In the last few days, our supply chain has increased the stability. And the supply chain looks to be increasing. So we will be expanding our Testing Capacity and our testing eligibility. They are not close to the situation where testing is available on demand. And there are lots of reasons right now that we would expand our testing in an evidencebased way, in accordance with guidelines that the state recently issued around what the testing priorities should be. And ill be happy to share that with the commission when we release that information. The other key piece to testing is Contact Tracing. And we are building our Contact Tracing capacity, because that is not only important for now, but it is important as we enter the next phase of the epidemic. We need our Contact Tracing response to be robust. In the moment, as we look it up, as we investigate outbreaks and not only talk to the persons who are infected, but also to ensure we are able to follow up with contacts. And we have partnered with ucsf, to use an app with a Company Called demagi, which will allow us to build a team and data system that is really unprecedented in terms of our ability to do Contact Tracing in an efficient and affective and datadriven way, and also make available to the indexeindex case, the person diagnosed with covid19, and the people were contacting, making sure they have the support, the resources, and the knowledge necessary to protect themselves and their family. We are moving from a staff of contact investigators at the beginning of this epidemic. That number was in the single digits. So that was in the single digits. And we expect in the next couple of weeks that we will have a team in San Francisco of over 150 Contact Tracing investigators. So unprecedented expansion. And we will probably expand even further those numbers as needed. So, um in addition, i talked about the challenges around the testing supplies. I think in terms of worker safety and the need to protect workers, another huge chel challenge in this epidemic has been the need for a stable supply of personal protective equipment, or p. P. E. The lack of a centralized visible supply chain for local jurisdictions has created unprecedented. We have worked hard along particularly with the city administrator, to ensure that our workers, d. P. H. Workers and city workers, have the protection that they need per c. D. C. Recommendations to do their work. Im pleased to say that has been the case. We have done everything we can to ensure that people are getting the masks, the gowns, protective eyewear and facial shields. Weve come very close to running out of those, but we have found a way. At this time, those supply chains appear to be growing, despite the lack of a centralized and visible supply through the federal government. So i will i have one other piece to cover, because i do think the focus on vulnerable populations and equity is really key here. Go to the data tracker website, and you will see that we, yesterday the mayor announced that we released cases of covid19 diagnosed cases of covid19 by zip code. And, unfortunately, we are seeing maps that look very similar to other maps, with regard to health, that the commission has seen in the past. These maps generally overlay the maps with regard to health inequities, preterm birth, food insecurity. We knew this virus would fall on the fault shrine of other health inequities, including income, food insecurity, homelessness and housing insecurity. This is no different, but weve been vigilant in our response. And weve anticipated this, and we have a score of workers, community providers, and others doing everything we can to mitigate the inequities that this pandemic is continuing to expose in our community. I do just want to add, as another part of the vulnerable population, are the People Living in singleoccupancy buildings. [please stand by]. So i will stop there and i will also see if the commission has any questions and then if there is time, i would like to just provide a very brief summary of the general stage of what we need to think about. The next stage and in other words, what would be some of the things that we need to consider if and when the shelter in place order is lifted. But i know that is a lot of information. So i will stop for now and answer the commissioners questions. A commissioner, if i may, usually the procedure is to take Public Comment before we have questions. I would advise we continue with that if you are okay with that. Commissioners . Commissioner bernard, i think your mic is off. That is fine. Thank you. Moderator, could we start the public line call . You have three questions remaining. Great. So please state your name and i will start your two minutes. Hi, jessica. Can you hear me . Yes. Great, thank you. So i am with senior and disability action. First, i want to say i know that San Franciscos leadership has been aggressive on this and in a lot of ways and i really appreciate all the hard work. We have some concerns specific to seniors and people with disabilities living in congregate facilities, not only Nursing Homes, but boarding care homes and other longterm care facilities. And we have a few recommendations that we just put in a letter that we sent to the city yesterday, and were really hoping to have real conversation about how we can Work Together to make these things happen. So we have six recommendations that are to immediately test all staff and residents at any facility with any confirmed or suspected case of covid19. So that we can make sure that things dont spread as quickly as a place like Central Gardens. We think testing on demand at congregate settings is important. We know that on demand testing is not available everywhere, but congregate settings is particularly important. And transparency about this is so important to regularly post a list of all congregate facilities and details the cases and deaths of staff and residents. And were also interested in whether people can be housed with a Family Member or a friend during the crisis to reduce their risk of contracting covid19. And so for the city to make sure that they get all supports needed to be able to leave the facility temporarily. And of course, we want to see ppe for staff for all facilities. I dont believe that is happening yet. I was a little inclear on that in the report now. And when residents test positive for covid19, we are hoping that they get moved to a hospital since right now it looks like those beds are available, and we know that people in Nursing Homes and other facilities are at serious risk of death. So im not sure if that is happening yet. And again, senior disability action really looking forward to having more conversation with the department to make sure that our folks are as sauf as possible. Thank you. Thank you. Your time is up. Next call please. You have four questions remaining. Please state your name and your two minutes will begin. Yes. This is leticia with senior action. I just wanted to say that it is great that you are giving this presentation, but i would like to see more on a numbers because when you said there is no capacity to have the tests on demand, i would like to see what the capacity is really because we see that the only country that is managing this is because they are doing more testing on demand in germany. We would like to see what that capacity is in San Francisco so we can expect how we can see how the city is going to be managing this crisis. Thank you. Thank you for your call. Next call please. You have three questions remaining. Please state your name. This is Teresa Palmer and again, i am a doctor and i agree with senior and disability action. And if we dont have Testing Capacity in Nursing Homes, what are we doing opening up a covid ward at the jewish home of San Francisco . We cant test if they are exposing the vulnerable population there. It doesnt make any sense to me. And it is like says those lives are not worthwhile and we just want to get these covid people out of the hospital to someplace else. It is just totally irrational and i would like director of Public Health to stop admissions to the covid ward at the jewish home until you can expand the capacity for testing there. Were not even testing the contacts of the one infected staff member that has been found at the jewish home. It doesnt make any sense. Families are frantic. We cant visit our parents. And youre jeopardizing them. And please act on this. Please stop covid positive admissions from the outside if you cant test on the inside. Thanks a lot. Thank you for your call, dr. Palmer. Next call please. You have two questions remaining. Please start with your name. Hi. Just let me turn on my timer. Hi, Michael Petrellis here. I am interested in talking about a question i keep asking. Where are the tests . Especially where are the tests for folks like my husband and i. We are in the vulnerable populations. We are both over 60. We are both h. I. V. Positive. And we both have Underlying Health challenges. And i believe that an effort must be made for folks over 60 in the vulnerable population to be a higher priority for covid19 testing. I also want to point out that in addition to those things, we also live in the 94103 zip code, which according to the d. P. H. Data shows that this zip code has the highest concentration of positive test results and cases, so we are very nervous and very much want to get tested. Finally, regarding this information that dr. Grant has presented, i believe it is time for and to hold regular town Hall Meetings on zoom for citizens to pose questions to you. It is good, dr. Grant, that you participate in those briefings, but you dont take questions from we, the people, at those briefings. So a zoom town hall please. Thank you. Thank you for your call. You have two questions remaining. Please state your name. Sorry. This is michael. I am with senior with disability action and highly support all of the recommendations in the letter which you have gotten. Covering Covid Patients in Nursing Homes is just uncredibly dangerous. Is incredibly dangerous. I cant imagine what you are thinking of. Jewish home is already said they cant assure that there is separate staff or separation that would be needed. And the issues with regard to Quality Assurance are not being allowed into Nursing Homes. The governor is considering immunizing the Nursing Homes from covidrelated liability, so theyre already trying to get out from under the responsibility of this. In covering Covid Patients absolutely need separate facilities and i have to say the Health Commission bears some responsibility for this for letting the hospitals reduce this and all the locations where covering Covid Patients could have been housed. And it was it resolved and became acute care. Once again, it is the thats all. Thank you for your call. You have one question remaining. Please start with your name and your two minutes will start. Hello. This is betty trainer. I am a resident of the western addition, and only live about a block from Central Gardens convalescent where i was shocked to find out this weekend that they had 36 residents tested positive and 26 staff, and there are now even more. I think its just imperative as others before me have said that we test this very vulnerable population of seniors and the other care facilities and it seems like they have been a forgotten population, so i urge dr. Colfax to make them a highest priority in testing for the virus because this is the population as shown on the charts that are going to be dieing from this. So please make them the top priority. Thank you very much. Thank you for your call. You have zero questions remaining. An all right, commissioners. That is the last item. And i believe just as a point of information that the longterm care facilities such as a jewish home are under the jurisdiction of the state and not the city. And not that thats something that you will get into, but just as a point of reference for you. Commissioner bernard, i am not sure how you want to proceed. A commissioner, if you have questions, please either raise your hand or indicate by voice. A commissioner chung has a question. Yes, i have a couple of questions, and thank you, dr. Colfax. I think that is a very detailed report that you just gave. It seemed that the public has some misunderstanding of the positions of the Health Department and the relationship with some of the private convalescent homes. Maybe i will start there and see if we can address that a little bit. I believe that central garden is a private nursing home, and i was wondering how do we as Public HealthDepartment Help keep them accountable . For not waiting so long to communicate with us about the situation. And there is a second question but i would like you to address that one first. Thank you, commissioner, for your question. So we have been first of all, i think its important to state, again, that residents of Skilled Nursing facilities and other people in congregate settings and particularly people over the age of 60. I spoke about the position of covid19 and certainly before we had a case and the priority and so we have been working very closely with Key Stakeholders in terms of doing everything that we can informed by data, science, and facts to help protect the vulnerable population including those in Skilled Nursing homes and other congregate settings. This virus is very transmissable. Some of the settings as we have seen, unfortunately, it goes through the settings very quickly. And particularly in the population over 60. It causes great morbidity and often great fatal tis. The state has jurisdiction over the homes. We obviously have jurisdiction over the largest Skilled Nursing facility in the city, and one of the largest, if not the largest, within the honda hospital. And one of the key things that we have been doing is taking the information, the work that we have done at laguna honda in ensuring that the other Skilled Nursing fail fails and Nursing Homes in the city are able to take the recommendations that we made and that the c. D. C. Made in response to the laguna honda investigation and applying it to both keeping their staff safe and their residents as safe as possible. The c. D. C. Issued a number of recommendations including aggressive symptoms, screening for staff, and ensuring and reinforcing to staff that they need to just stay at home if they were sick, ensuring that staff had available ppe to protect patients to mask residents whenever possible and tolerated, and to do targeted testing based on potential outbreaks in the facility. The c. D. C. Did not make recommendations to do widespread testing of staff, and they really focused on how to mitigate and prevent the outbreaks Going Forward. The state has sent inspectors to the Nursing Homes with outbreaks in the city. We have been in close collaboration with the residents and with that with the residences and with the findings of what those inspectors have made and we have been working with those nursing home, but the state really has the authority there, and we are providing a supportive role. And when there is a case, we do have the jurisdiction of doing the Case Investigation and Contact Tracing. That is our role as the Health Department and we will continue in that role. As in any contact investigation situation as we do with covid19 cases and across the city, we make recommendations about who should be testing specific to that Contact Tracing investigation. Commissioner looking at the data that there is a High Percentage of folks in the hispanic and Latino Community being tested positive for covid19 and setting up hot spot testing in the mission area to, like you said, trying to follow the data and do more targeted intervention. About the Contact Tracing and with immigration issues and nothing like the fear of being with the security and privacy issues among the Latino Community. And we are telling the community that we assure them that it is completely safe and even with the Contact Tracing it is completely confidential. Yes. So we have been very foes kued on Community Outreach and engagement from the beginning of the epidemic. There is a whole group that is the e. O. C. , the Emergency Operations center, and the d. O. C. , department of operations center, focussing specifically on this issue. They have engaged Community Stakeholders and done a number of Virtual Events with regard to involving Community Stakeholder rs and Community Leaders in this collective response. We have been clear thatment u great lakes status certainly does not that immigration status certainly does not Effect People and the information collected is confidential. And through a health lens and also a socioeconomic lens and insuring a need for food, need for other pieces that are being supported. And the marriage has been very clear about needing to wrap around services for the vulnerable populations. Specific to the Contact Tracing and the app that i described earlier, that will be done in multiple languages including spanish. We have also provided materials in indigenous languages, particularly in the mission and in order to reach native speakers. The last thing i wanted to clarify is the study that i think you referenced with regard to testing in the mission and that is a ucsf study. It is not a program that will be done over a series of days and that is a study being led by ucsf. Thank you for the clarification. I did get confused because of my other information floating around. Commissioner, other questions . Mark, just to clarify, i cant always see all the commissioners on the screen, so i will leave it to you to let us know. It looks like everyone has a question, by the way, so two down and everyone has raised their hand, so call by order. Commissioner guillermo. Thank you. And thank you, dr. Colfax, for your report. I think there is a new information that was released today that the state department of health has now loosened its requirements for testing of asymptomatic or nonsymptomatic persons that will be starting in los angeles county. That is information that was released today and that is an indication, i think, of the fact that there is more widespread Testing Available and coming online particularly with the private labs and counties being able to use their own labs. If that is information that you have available to you, do you know whether this roll out of testing, which is going to focus i think primarily first on Nursing Homes and prisons, will that be rolled out based on the supply or ability of counties to respond . Or is there some other criteria . And i will ask a second question at the same time. You had shown on your data that number of deaths in the Asian Community was higher than any other population, and you said that you had some information about why that might be, and it might have to do with the age of the population or something related to the the cruise ships that were based here. Those are the two questions i have at this time. So with regard to the report on l. A. I cant speculate on that because i havent seen that report. But it certainly is something we will look into and have conversations with the l. A. Leaders and with the state about. The state did, i believe it was yesterday, release recommendations for prioritizing of testing asymptomatic members of the general public were on the list but they were pretty far down on the list in terms of when one would test. I can certainly get more information about that. Again, as i said as our supply chain stabilizes in terms of testing, we will be expanding Testing Capacity but doing so in a way that is consistent with the needs of the most vulnerable population and our Health Care Workers. With regard to the deaths that unfortunately we have had and i may not has been as clear as i should have been. If one death is too many t numbers are not small, and so i dont think we can draw any statistical conclusions from what we are seeing there. Because the number of deaths among people who identified as asian was higher, i did ask for a little more information there about why that might be. This is qualitative information and shouldnt be seen as a statistical analysis. But compared to the other people who died, and deaths among asians, several were linked to having taken a cruise. That was not the case for the other deaths. And then the death among the asians and people tended to have on older age compared to the other deaths overall. Thank you. Commissioner green. You for the exhaustive report and all the incredible work you have done and the multiple eventualties that you so thoughtfully considered and planned for. And i wondered if you might elaborate a little bit more about the manpower. And will definitely be prioritizing vulnerable populations especially those in congregate living situations and those may require testing more than once within the settings and if you have concerns about the manpower to be able to really focus on those living situations and also the volume of tests and correlate to that how we are bringing some of these testing opportunities that, for example, are pro proprietary into the system. We are continuing to build that out. I think where we are now and where we need to be in the future, the answer is we need more people in the future, so were building that out. I anticipate no snare joe where we would basically if were fortunate enough, and i dont know whether we will be or not, but if were fortunate enough to make it into june or july and can start considering what it would look like to focus more on easing the i dont know when this would be, but easing the shelter in place orders, right . And thinking through how one needs to emphasize the testing and Contract Tracing there. We will need a robust work force built out in order to do that. I think nationally i have been seen 300,000 to 500,000 people need to be trained for that. And we are ahead to that curve in San Francisco, but i think youre not going to return back to the prior days with a small team of incredibly hardworking people. We will have an incredibly large team and that will take substantial investment and sustainability over the long term. I think in terms of the expansion of testing, there are lots of possibilities and one can think about the ability to rapidly test people and what indications that would be with very, very few in San Francisco and very few to use. But over time as those become more available and one does one need to get a test result quickly to make a decision about where that person goes in the hospital or where that is that person can that person go and work with highly vulnerable populations . And not expose them. I think we also, though, have to be very careful about thinking about the idea that a negative test is gives one a false sense of security. That negative test in the current environment in which we live in, that negative test is only if you get up in the morning and you are somehow able to get a test and you are negative, it is probably reasonable until you have some other exposure, right . So we have to be very thoughtful about that. The other big testing claim that has not been fully understood and there is a lot of topics and the quality is very question sbl the antibody test. And the the antibodies truly going to last and what does that mean . Those can be potential game changeers and the third question was with regard to the populations and where they go after being in the hospital. One of our focuses has been, again, on moving the population back to congregate setting to place them in hotel rooms with some support. Our Street Medicine Team is making rounds in the buildings where the most medically vulnerable and are placed and they have a large capacity to respond to Behavioral Health needs. I will say as we iterate and learn more about needs that we have to the covid19 responses and the commissioner knows our i will say baseline Behavioral Health challenges within the city. Those are only reinforced again by covid19. We are looking to use the hotels now and then we are also working with h. S. And h. S. H. To set people up in a shelter with broader support and more capacity to take care of people who are covid positive who are also lean towards developing capacity and facilities to care for people who are covid recovered. And once people move through the covid positive recovery and it is important to emphasize 80 of people do okay. So in the congregate setting, this percentage will vary depending on the population. The bottom line is we need to also support people who are in the covid19 recovery past the infectious period. And that is something that we have been keeping hard on with the Housing Agency and those are support questions and those questions. I have two questions with the manpower of the Contact Tracing and when you stated that you are hoping to get up to a capacity of 150 people of being able to do the Contact Tracing and when do you see that might be possible . Is question one. Question two, one of my concerns as we are Going Forward is you had just mentioned Behavioral Health issues not only during the crisis and as things ease up and longterm in the aftermath. With relooking at increasing xas within the Department Training . What are the is there planning now going on to be able to address these needs which are rather significant across all age groups . Thank you, commissioner. And we do have people identified to the City Attorneys Office has made available scores of investigators who will be training this with a way that is culturally appropriate and we have had remarkable interest in this program with scores of emails who want to join this effort. We will meet the 150 threshold fairly quickly. The other City Department wills go back to their other work. And we are doing aggressive recruitment and will fill that out. I meant to say in the presentation we are this pandemic has forced us to do things in new ways and build new teams and capacity faster than was even imaginable. And one of the things to acknowledge with the department of Human Resources and our new h. R. Director is we hire as many as 200 nurses in the last four weeks to strengthen the medical approach and applying it to the Contact Tracing, staffing and thinking that through. And also with regard to Behavioral Health, the acting director are the leads and thinking through not only what we need now and with the shelter in place which is, lets face it,s treatmently challenging and also what do we need to think through what is the intersection of the Pandemic Response so that should be part of one of the key colors that we build out. Thank you. I am most interested in the Behavioral Health because in my work the need is increasing significantly. Commissioners, any other questions . Hi. I had actually one or two questions and first, of course, i want to thank dr. Colfax who and with the show he does with the Mayors Office and the press conferences which he handles so very well. And thank you. I think you help show a very thoughtful and very compassionate department. Obviously also grounded as you continue to say. And the chronicle notes that you always have science right there and that is the type of image we all want in this type of crisis, so i appreciate that. I understood when there was a request of the jewish home that this was going to be a fairly selfcontained unit, so that might just be a simple yes, no, or thats not the way it works. And the new guidelines have seemed to come down also from the president ial task force and seem to ls a talk about as you are moving towards having, lets say, less Surge Capacity, would there be the opportunity to then other areas in an acute hospital that would be sort of selfcontained . Or perhaps certainly covid that is selfcontained. And second question since we are all giving two questions actually does relate to the sros and i wont get into the article that you i am sure have seen in the examiner that discussed the issue of a particular family in china town that was trying to reach some sort of accommodation by way of also the sro and all and that clearly operational level becomes sometimes very problematic with regards to how we would like to do things. I would like to know if what you mentioned and to help try to answer some of the questions with the patient privacy which is true on p. H. I. A with patients permission and it may well relate to how a patient then relates late we are their being discharged and needing to go home, or the patients relatives can certainly be some sort of way in which there is a dialogue because those patients would be interested in that. And the approach being taken and made it appear our department was not working together to protect those sros along with the availability of the housing that you have put together so well. So i didnt know if you would be able to give some comments on those. And i wanted to certainly have you have enough time to give us an insight into the future, whatever that may be. The information that i have is that the state, again, the state came out and visited the home. Did an assessment. And from my understanding from my understanding made the assessment that the home was meeting infection Disease Control guidelines and so forth for the state. And they authorized i want to be cautious with the words i am using but my understanding is they basically authorized the jewish homes plan and thought it was adequate to protect residents. Im sorry. I am running out of the battery. And in any case, thats the information i have with regard to the jewish home and the state with regard to their plans for covid positive. With regard to the sros, we have been very active as i iterated in my review with the community [inaudible] can you hear me okay . I think your wifi was going in and out, so like the last minute we didnt hear you. It was going in and out. Now we see and hear you. Director colfax, perhaps where you were standing earlier had better reception if you would like to move your plug. Well, also you can take off video to use less bandwidth if you want to do that. Is that better . Yes. We can hear you. Thank you. I was going back to i was responding to commissioner chows second question with regard to the sro work. Again, we have from te beginning identified sros as a key vulnerable population with regard to ensuring they get their resources to help mitigate the spread of the virus. We have an sro task force which is not only made up of Public Health teams and also other City Departments. We have been with the health order and with inspections and we have been effectively enforcing the sro order. And we reached out to the residents in multiple languages and offer people hotel rooms where they can stay and be supported with food and other basic necessity if they so choose to go into the hotel rooms. So were doing everything that we can as a system. And as quickly as we learn about that, we iterate the system and that can improve. And there are specific examples. I am sorry for that, and we will continue that those are rare. And they get the services to take care of themselves and mid gait the spread of the virus to mitigate the spread of the virus. I think that is a reasonable response that these occurred within about, oh, two weeks ago and obviously everything was still moving and trying to get that under control. But i appreciate your last response there that if such did occur or had occurred, it is not our routine and we are looking to try to ensure they are all accommodated. Thank you. And to give you an opportunity to talk about there is no need to go back to the slide, but the data and number of covid positive patients who are both in who are in intensive care versus nonintensive care, do we know what percentage are currently on ventilators . And my second question regarding that data is, to what do you attribute the redubs in the number of p. U. I. S . That expanded testing or is it something happening in the hospital setting . Can you hear me okay . I am getting an echo. In general, the i. C. U. Patients, about 3 4 of those are on ventilators. Its challenging to update that data on a regular basis because the ventilator status can change rapidly and this is from nine different hospitals. But just on sort of a monitoring level, the real question is whats our i. C. U. Capacity . And in those i. C. U. S, most of those represent beds with more capacity. We expanhandled the i. C. U. And Ventilator Capacity as part of the surge planning by 91 , so we almost doubled the capacity there. And that was a key concern as we looked at the situation in new york. And again, people really responded tremendously to that. Commissioner, im sorry, i forgot your second question. The reduction in the number of p. U. I. The p. U. I. Number is one that i watch with caution in terms of interpretation about what will happen in the next coup of days. And likely that will depend on things like a neighborhood in laguna honda is all being tested and it is when the c. D. C. Was here or if there is specific things that certain hospitals are doing where they may be testing a large number of people for a very specific reason. There are so many heterogenuous reasons why the p. U. I. Can go up and down that i have been focused on the hospitalizations of confirmed positives. Unless i start seeing a consistent trend in the p. U. I. And i think you can see as from that graphic it is hard to see that yet. Director colfax, would you like to go into possible future steps or defer that to another meeting . I know you do have a hard stop. Well, i think that i just as we think through where we would go from this stage, and i think its important, one, to emphasize the importance of physical distancing, wearing the mask, the shelter in place, compared to where we started march, there is more covid19 circulating in the community. So even though to some extent while its been a month, over a month, and it is challenging, but i want to emphasize that those pharmaceutical, Public Health interventions remain really key in addition to basic hygiene. But as were looking at our approach Going Forward, we really need to think about what are the key and we are starting to think about with other partners across the region and the state and what are the key things we need to be looking at for potential relaxation of some of the social distancing protocols. Where would that be most necessary . What is the balance in terms of the risk and benefits of that . And i think there are real Health Questions as well that need to be considered because we know the aggressive shelter in place that we have done while its been the right thing, there are certainly Health Consequences including of that. And what are the key things we need to be looking at in terms of expansion of our Contact Tracing capabilities, a change in not just a flattening of the curve but a potential decrease in the curve, and then how do we develop a system that is flexibility so that if there are outbreaks that we are able to turn certain switches on and off. That is a general answer to a complex question and the Health Commission and may want to add a few words to this because hes been thinking a lot about this with some of the other health officers. I dont know if you have anything else to add from my general interview and i know we only have a few more minutes. Thank you very much. Can everyone hear me . Yes. Yes, so let me just summarize it and just really quickly the big ideas. Dr. Colfax covered most of it. There are basically three phases the way this is being thought about in the country. We are currently in phase one which is slow down the infectionened, prevent hospital surge, and start preparing for the next phase. The next phase is when we begin to open up and pull back on the shelter in place. To do that we have to have all the systems in place that dr. Colfax mentioned. We need to have a good testing system, Case Investigations, Contact Tracing, being able to deal with all our vulnerable populations. Having all that in place. The third phase is far off and that is going to be when we have good therapeutics and we have a vaccine. So that is probably were not going to have a vaccine for probably a year and a half, so thats at the highest level, that is how were thinking about it. And were also waiting for the state. The state has given us some initial guidance in how they are thinking about it, but we need more specifics because we want to align as much as possible to the state so that were able to focus on the Public Health role and less about the challenges of picking and doing the sheltering in place the sheltering in place which affects so many different businesses. Thank you. Move on to the next item on the agenda. A give me one second to put a slide up, if you wouldnt mind. Certainly. Were going to move on to item 6 which is general Public Comment. Before we begin, i want to put the slide up so people have the information. Just give me a second to get there. I will work on it, but moderator, we can start the Public Comment. Do we have any calls on general Public Comment, item six . Moderator . Are you still with us . Oh, i see. No calls. There is nothing on this for item six. We can move on to item seven which is an action item and resolution honoring the San Francisco department of Public Health for its ongoing response to the covid19 health crisis. And commissioner, i will read the draft resolution and i will include and note the clause that commissioner chow is going to suggest through an amendment. And excuse me if this is long. Those of you who are in the d. P. H. Executive team, take this in because this is a time of gratitude. Whereas dr. Grant colfax, San Francisco department of health, director of health, initiating d. H. P. Planning efforts to respond to covid19 in late january 2020 and began reporting to Health Commission on covid19 related activities at that time. And whereas, on february 25, 2020, ma mayor breed with input from dr. Colfax and dr. Aragon was one of the first cities in the United States to declare a local emergency due to the threat posed by covid19. The San Francisco board of supervisors concluded and in the mayors emergency proclamation on. And whereas, march 4, 2020, the california Governor Newsom declared a state of emergency due to covid19. And whereas, march 6, 2020, dr. Aragon declared a local emergency and board of supervisors con curd. And whereas, on march 6t city issued Public Health guidance to encourage social distancing to disrupt the spread of covid19. And whereas, march 7, 2020, dr. Aragon ordered city facilities to cancel nonessential group events of more than 50 people and prohibited visitors z lagun hospital. And whereas on march 11, an order was issued of 1,000 people or more in public gatherings. March 13, 2020, he issued and order prohibiting gathering of 100 people or more. And whereas dr. Colfax and dr. Arrgon worked closely with several counties to align the area in a uniquely coordinated covid19 prevention and response effort. And whereas, on march 16, 2020, dr. Aragon issued an order coordinated with five other bay area counties for residents to stay at home through april 7, 2020. And on march 31, 2020, dr. Aragon expended to may 3, 2020. And whereas on march 19, 2020, Governor Newsom following the leadership of San Francisco and five other bay areas counties issued an executive orreder to require californians to stay at home and whereas, dr. Aragon continued to put forth a series of innovative Health Orders to outline necessary measures to protect the health and well being of all San Francisco residents and to focus on the most Vulnerable Health population. And whereas dr. Colfax and other d. H. P. Leadership have worked closely with state and local leaders in the complex procurement to expand the hospital and medical shelter capacity and purchasing personal protective equipment and testing supplies. And whereas, dr. Colfax, dr. Aragon and other d. P. H. Leadership has coordinated with nonprofit organizations and businesses to develop the San Francisco community of care including sharing of medical staff and precious resources to increase medical Surge Capacity and resources devoted to the covid19 responses. And whereas the effort to provide transparency and keep the public informed, dr. Colfax and dr. Aragon and others continue to lead the pace to coordinate important covid19 case data, testing data and give updates on the Public Health response. Now, therefore, be it resolved that the San FranciscoHealth Commission commends dr. Grant colfax for his steadfast and compassionate leadership during the covid19 pandemic. He continues to lead the d. P. H. Through the ultimate challenge of temporarily repurposing 2 billion department to respond to the Ongoing Health crisis. And further more, we extend our gratitude to dr. Aragon whose orders having progressive and clear for residents to protect their health and save their lives. Therefore, be it resolved, that the Health Commission acknowledges the staff of d. H. P. And Incident Managers and the Emergency Operation center and include d. P. H. Director of health, dr. Susan phillip, Deputy Health officer, and director of d. P. H. Prevention and control. And others. Zuckerberg San FranciscoGeneral Hospital chief operating officer. And further resolve that the Health Commissioner recognizes the leadership of dr. Susan urlich, chief executive officer of zuckerberg San FranciscoGeneral Hospital. We thank them for their inkrenl leadership and hard work to ensure each object continues to implement covid19 response. And further, we express our deep gratitude for every Health Employee for the final contributions made each day to benefit the health and well being of all San Francisco residents. And in labs, and testing center, shelter, hotels and on the street. And further resolve that the Health Commission thanks the staff of all d. P. H. Partner, especially other department, local hospitals and special appreciation to ucsf, and communitybased organizations for the ongoing work implemented each day to impact and save live. The next clause is suggested by commissioner chow. Further be it resolved that the Commission Urges the department to continue their collaboration to successfully combat the pandemic and further resolve that the Health Commission thank members for their requirements and protecting the most vulnerable individuals in San Francisco. And further resolve that the Health Commission expresses deep appreciation to mayor breed for her bravery and skill in leading the city during the crisis. And to the San Francisco board of supervisors for their support on Public Health related issues and leading us during this time. I hereby certify this Health Commission at the meeting of april 21, 2020. Commissioners, the resolution is put before you. Thank you, mark. Before we go, i understand that members of the department of executive team may have another pressing item they need to attend to. If that is indeed the case, would it be appropriate to give them an opportunity or for us to thank them specifically for their fantastic work and allow them to move on to where they need to be. Director colfax . Absolutely. Yes, i will stay, but other staff should feel free to attend other matters. Mark, i would like to offer one quick amendment in the second whereas clause to follow consistency and acknowledge the extraordinary leadership of mayor breed in the bold, early, and aggressive action. Later in the sen ten, mayor london breed was one of the first mayors rather than cities in the United States to declare a local emergency. Great. Thank you. I will note that. Thank you. And before opening the floor do we need a motion first, mark . You can get all of the amendments and then do a motion per amendment or take it one by one. That is up to you, commissioner. Commissioner i think we can do them all together. Are there any and is this an appropriate time for comments from other commissioners . You should go well, if you are going to do amendments, you can do that now. And then in terms of comments and discussion, wait until we see if there is Public Comment first. Are there amendments and if not, does someone have a motion to approve as amended . So moved. Second