Transcripts For SFGTV SFCTA Full Authority Board 20240713

These questions should be able to be answered and some of them certainly in terms of what the thinking is behind some of the actions that weve done in the city are pretty answerable. So with that by the way, colleagues, i realize also that were having different formats to ask these questions. We have, i guess, emailed questions in. Getting as many answers as possible. Well have the briefing monday, wednesday, friday, of the Board Members to ask specific questions. And so i actually heard dr. Philip do a briefing. Im glad you made time to come and answer these questions. By far, i felt like from listening to your presentation, i wanted to thank you. You seemed to have the most authority and was articulate about the issue of testing. So, dr. Phillip, would you like to get started . What i ask, at least a 45minute block of time where you can do the presentation. I know everybody is trying to get do a lot of work during this emergency, so well try to be as focused as possible. And within those minutes, the presentation, plus whatever additional questions that might give us a better understanding of testing in San Francisco. Dr. Phillip, youre on. So thank you very much. President yee and to the board for having me. I am happy to speak with you about testing. Its a very important topic. Im glad you were able to make the time to listen. I have about probably a 15minute presentation just to give an overview of testing and some of the background around how we have been approaching testing in San Francisco as the d. P. H. And then, yes, i know there are several questions, many questions we want to discuss and im happy to do that, but ill get started with the presentation. Im susan phillip, one of the Deputy Health officers at the San Francisco department of Public Health. So heres just the agenda. We said we were going to cover briefly some of these areas today and then leave plenty of time for q a. Just as background for testing, to recall that in the very beginning of this epidemic, before it was a pandemic, we were sending specimens from San Francisco to the cdc lab in atlanta and waiting anywhere from 47 days to get a result back. Weve been trying to expand our testing capability ever since we started testing at our own health lab, grove street, on march 2, 2020. Then between march 2 and april 26, 15,610 people in San Francisco have been tested for covid19 and our Positivity Rate is 11 of those tests returned positive. There are right now 26 locations that a person can go to have a specimen collected throughout the city and this includes city test s. F. Sites. Well talk about d. P. H. Alternative test sites and sites run by private providers and others. And then our vision overall and i think this is really important is for everyone in San Francisco to have access to testing. Universal access to testing. But, of course, were not going to get there overnight. And this is going to be a process to build up. And quite frankly, its only been in the last week that our supplies of some of the essential equipment that is needed to test, the swabs and the media that are needed for the collection have stabilized. Well talk about that as well. Happy to answer questions there. So when we think about testing, what most commonly comes to mind are the molecular tests. These are the direct tests that look for the genetic material of the virus. Viruss genetic material is r. N. A. , so these tests are looking for that genetic material. These are molecular tests looking for r. N. A. Of the virus. This is collected by a flexible swab that goes deep into the nose, all the way to the back of the nose near the throat, or are collected through the mouth, the back of the throat as well. Those are the most common sites of collection. There is a whole serious of processes that have about happen in the laboratory with these specimens. Basically, first to separate out everything that is virus from what is human. Get rid of all the extra material and then are machines called pcr machines and others that amplify, that take the specimen that might have a couple of copies of that r. N. A. And amplifies it to the point, and that is how the infection is diagnosed. These tests are very helpful if theyre positive. They tell us if a person has covid19 at the time that theyre being sampled and that leads to cascade of care, support services and identifying how we can support the person and isolate themselves at home so they dont infect other people. And then to find out about their contacts so those people with quarantine to prevent transmission. A negative test of this kind, however, is less definitive. There are a couple of reasons why. One is that there is no test that is completely perfect. This test or any other laboratorybased test. Meaning there is a potential that the test itself, because its not 100 sensitive to pick up every single infection, might be false negative. Sometimes its because of the specimen, or sometimes its early the infection and people are going to develop a viral load, but they dont have a sufficient amount at the time the sample is taken. Another reason a negative test can be misleading and not give us a full answer at one point in time, these tests are again just telling us what is going on in the body at the nasopharyngeal at the time the sample is collected. It doesnt tell us what is happening in the time between when the sample is collected and it may be in that interview, the i could have been exposed and received transmission. A single negative test shouldnt be reassuring. It is somewhat, but it does not tell us a lot of information going forward. For negative tests, that requires repeated testing, so that raises a whole area of questions which have not been fully elucidated. Thats a whole set of questions that need to be addressed about repeatedly screening people who are negative. Our capacity in San Francisco is quite good at the laboratory level. Wed always like it to be better, but right now, between our own lab tories and the Public Health, we can analyze up to 4300 specimens. The laboratories are 101 grove street, the zuckerberg General Hospital and then partnership with the laboratory. But this doesnt include the 4300 number, the 1500 a day that can be collected at our city test s. F. Site. These are done in clab wags collaboration with our s. F. This includes kaiser, sutter, brown and toland, 1 medical and there are others as well. The average number of tests returned that we can see, has been running about 500. Its gratifying to see in the last number of days, that number has increased, but there is a gap between that number and the capacity that i just talked about. That is a gap were trying to close. Were taking several approaches to trying do that and making sure were taking advantage of the laboratory and collection capacity we have. As i said, the supply chain for the products that are necessary for testing, the swabs that are necessary to do the nasopharyngeal and the oral sampling, the media we have to put the swabs in, has been very unsteady to get those supplies. Its only been in the past week that those numbers have stabilize and we feel what comfortable that for the moment we have the supplies necessary to try and ramp up testing to meet that laboratory capacity. There is no guarantee in the future this will continue. As we all heard, were competing against every other health department, every state in the country, because there is not an organized federal response to this. We continue to be hopeful these issues will resolve and we, right now, are doing everything we can to collect the specimens and buy the inventory out we have and we have great people working on doing that. Who are we testing . From the beginning, our goals for providing tests and doing tests have been to do several things that you see here. First to protect vulnerable populations and our essential workers. Health care workers, the city staff that really provide a public safety, the officers for fire and for police, for sheriff. And then also to understand there are other essential workers that are critical. City workers that do transportation through mta, but also the essential workers that make sure we get our groceries and deliveries come. All those are essential. Mitigating outbreaks, so trying to prevent outbreaks in vulnerable populations. Testing people we find as contacts as a result of talking to people. To identify their contacts and make sure theyre can be tested. And to make specific efforts to understand how much may be in the area. Because of our limited testing supply capability, we havent been able to fully branch into all of these groups as were doing now and planning to further do, but those have been the goals. And the testing has been to really prioritize those efforts. To protect those most vulnerable of sickness themselves and to protect those who are essential for health and safety of all the residents in San Francisco. So, in addition to those core groups, we have in the past week expanded our testing criteria. Previously we thought about symptoms as being sort of the core being fever, cough and shortness of breath. Thats what cdc said and we were following. Were learning more and more about the virus. I cant emphasize how much of a learning process this is. In the past 23 months weve learned a tremendous amount and well continue to adapt and refine our policies based on that. But there is much broader range of symptoms that warrant testing if a person has them. You can see here the list. Ranging from body aches to a loss of smell or taste. Fever and fatigue, congestion, runny nose. Theyre broad symptoms. Were encouraging people with these broad symptoms to seek testing. Weve always emphasized contact. But in the past weve emphasized symptomatic contact. Were expanding that. If youve been in close contact with someone who has covid19 for more than 10 minutes, we want to test you even if you dont have symptoms. This is understanding reports from other jurisdictions, looking at medical literature and the updated guidance from cdc and our Public Health colleagues. Congregate living is appropriately a concern. I know of this body it is a concern of d. P. H. And the doc as well. I dont have National Clear guidelines for testing in congregate settings, but as i said, as were gaining more experience from colleagues across the country and from our own experience here in San Francisco, were learning more and more about what that should look like and the need for thinking very broadly about testing. We have conducted mass testing as you all know in these environments as dictated about Case Investigation and Contact Tracing. And then were developing strategies. Were in the process of doing that in response to incoming data and the stabilization of our supply chain to meet the needs of the different communities who do live in congregate settings as listed there. So i want to talk about general testing sites and access and how were looking at this. I heard several times during the meeting today that emphasis on equity and emphasis on looking at where the infections are and making sure that there is low barriers allowing people to be tested, we completely agree with that and those are principles were following as well. There are 26 locations that a person can go to have specimens collected throughout the city. This includes city test s. F. , s. F. G. , u. C. S. F. , kaiser, chinese hospital, dignity health. And then d. P. H. Has Community Testing sites open to the public. A as z. S. F. G. , Castro Mission Health Center, Southeast Health center and maxine Health Center. San francisco residents and essential workers who are experiencing any of covid19 symptoms who arent able to get into their own provider can make an appointment online at city test using the link below to get a test. And just to show you, there are two sites now for city test s. F. And its a great collaboration between many parts of the city, the port and the company of color and Carbon Health and one medical in order to do this testing. So heres a photo of the sites at piers 30 and 32. We can test a thousand people a day. Soma site is 500 a day. I want to emphasize that testing is so important. Weve been spending a lot of time and energy at the doc and e. O. C. To thinking about testing, improving how people can access it and ramp it up, but it alone is not sufficient. It is one part of an entire strategy. In fact, we can sometimes think of testing as telling us how good a job are we doing at preventing infection in the first place . Those things include staying at home as much as possible. Distancing, staying six feet apart, covering our facings, washing our hands frequently. All the core things we need to do. And i think that testing tells us, are we able to do those things . We know its much harder for certain populations to do those things needed. We need to think about how we enter and exit public places. How are we supporting environmental cleaning . How are we supporting spacing . In a way, testing tells us how good have we done at those things to support prevention for populations in the first place. And we have conducted mass testing as indicated by contact investigation in the past. We do believe there is a key role to testing. And in fact, testing, again, is one part along the continuum of response. After testing we want to have a robust response in terms of Case Investigation and then reaching out with Contact Tracing and we are actively working on building that capacity. We think that is going to be another key core requirement that is tied into testing in order for us to be successful. The next phase of our testing will be to expand to people without symptoms and that is going to include testing in congregate settings, testing of Health Care Workers, First Responders and essential workers and testing in communities impacted by disparity. I want to pause to note that what i said before is important. One of the things we dont know here is how often should we test . So as we do this work, we want to work with u. C. S. F. And other partners and staff, Research Staff and epidemiology staff, to be able to evaluate different intervals and find an optimal interval for testing. And then finally, its important to understand that our discussion about testing will be evolution, just like testing on the whole response. Im certain in two or three weeks from now, if we had the same conversation, id have additional pieces of information to share. We do incorporate feedback about the ways in which the city is doing its work, particularly communities most impacted. The testing science and technology is rapidly evolving. Wed love to have rapid tests for covid19. And that technology does exist, but its incredibly difficult to purchase and get those tests, although were continuing to work on it. We think of congregate facilities, such as the hospital where it would be incredible to have that technology. These things are going to continue to inform our response and strategy. I want to make one quick note about serology tests. I didnt speak about them in the slides for the sake of time. These are the tests that are not a direct test for the virus, but theyre blood tests looking for antibodies to see if someone has been exposed to the virus and potentially recovered from it. There has been a lot of talk about this potentially being a way to understand if someone could have what people have called immunity passports or ways they could go back into the workforce or public safely. I want to make it clear that the f. D. A. Had said that these tests, the blood tests, cannot be used to diagnose covid19. And its very unclear what having a positive test would mean in terms of it being safe for a person to go back out in society. W. H. O. And other Public Health and scientific bodies are warning that not its not clear that having antibodies are going to clear us for immunity from a second infect. Where they can be useful is understanding what has been the exposure of the population to covid . Who has seen the virus . I think it will be helpful in describing what might have been going on, but i think well get a little bit of that information from testing. And the large Testing Program that supervisor ronen described in the mission is another way, another type of evaluation to get at some of that same information. All that is really important, testing is important for individual care, but its also important for planning and response as well. So i think that is all i had for prepared remarks. I know we have questions to talk through. Happy to do that. But i wanted to turn it over to you all to lead that discussion. Im happy to participate. Thank you for your time. President yee thank you, dr. Phillip. I have questions. But go ahead, supervisor haney. Supervisor haney thank you. And thank you, dr. Phillip. I have a few questions. Just so im clear now, were not, as a city doing asymptomatic testing i think somebodys mic is on also were not doing asymptomatic testing except as part of Contact Tracing or in more oneoff ways . There is not a larger effort to do asymptomatic testing currently among any populations . You didnt speak that much about the mission project, but other than the mission, have we taken on any largerscale asymptomatic testing . And when do you believe that we are going to start to do more testing that is asymptomatic. I listed priority populations. What will that look like . Yes. Right now, consistently, who we are testing is asymptomatic is our contacts to cases. And we do have plans to roll out asymptomatic screening and we know that phase that out to make sure we do that in a responsible way and we have everything in place for really supporting that work and supporting the ongoing work. Because as i said, if we find people are negative, that means we have to plan for repeated waves of testing. That requires thinking in a different way, building a large infrastructure. All of these things we can do, but our first area of focus in thinking about that big picture, is looking at which populations are most vulnerable to dying from covid19 if they contract it. So were trying to focus first on Skilled Nursing facilities and what it would mean to do that for staff and patients there. Supervisor haney im not finished. Sorry. There is a cdc report that suggests that if testing is easily accessible, regular testing in shelters before identifying clusters should be considered and testing all persons can facilitate isolation. Other cities have tested all or most of people who are in shelters, including people who are asymptomatic. When will we have a similar effort to test everybody who is in a congregate setting like a shelter, Navigation Center, mental health, drug treatment . Thank you, supervisor. Yes, i think those populations are also priority and we will have to again think of how we phase in, how we do that work. They are populations we know will turn to, will be screening. And were going to have to sit down. As i said, its only a week since weve stabilized our supply chain to understand how we do that and not fear if i dont keep testing in reserve were going to not have testing to deal with large outbreaks. So now that happened, we can really turn to these other sorry about that echo. Supervisor haney so, as i read, the Testing Capacity, we have a capacity of at least 5800 a day ourselves, likely many thousands more than that when we include the private hospitals. And yet were testing just 500 a day as a city. What exactly is the barrier to testing much more larger numbers of people quicker, for example, everyone in the shelters, people in vulnerable neighborhoods, look the bayview or the tenderloin or soma . It seems we do have a Testing Capacity for that. Where is the barrier to do that immediately . Well, we could do that immediately if people are able to access the sites. I think some of the challenge has been making sure that we have people that could go and do the specimen collection. We have a core group of nurses, field nurses that have gone out and done this work and done the bulk of it. Were building that capability and that team, but for people who can transport and go to the site, such as city test s. F. , those are options and were hoping we see utilization of those sites by anyone who meets the criteria which is very broad right now. That they are able to use those and we see the numbers increasing. Weve seen the number of tests increase in the past few days, but youre correct, there is a large gap still we need to try to close between the number of tests were doing and the number of tests we could be doing. So i agree with you. And for the tests where were going and trying to provide assistance to the site, thats where we need to figure out, where do we put our power and were did starting with nursing facilities, but there are other important sites as well that you mentioned. Supervisor haney right now, people are still hearing they need to have symptoms to be tested. They have to make an appointment that involves before it involved having a health care provider, now it involves the city test site which requires having Internet Access and all of that. People in shelters, on the streets, in soma and tenderloin, this is not yet accessible or widely known about or broadcasted, they can have these opportunities. Even in the city test sites, my understanding is theyre greatly under testing their capacity, so we seem to have an outreach issue because there are a lot of people who want to be tested but dont yet know about the opportunities and are able to access them in the opportunity. In addition to what i talked about with the congregate sites, communities that are having a hard time like you mentioned like keeping the six feet, avoiding large number of people, need to have onsite accessible Testing Available to people beyond people who are only symptomatic. Thank you. Yes. President yee supervisor preston i believe. Supervisor preston thank you, president yee. Thank you, dr. Phillip for our all work. I wanted to just follow up. You touched on some of this, but just go into the nursing facilities a little more and try to better understand that. My district includes Central Gardens Convalescent Home where four people died and as you know there was an outbreak there. And weve been struggling to get more information from both the state the department of Public Health and locally about that. So in terms of testing, i understand that there is no protocol nationally it sounds like for testing in congregate facilities. And i also understand some of the practical limits around the supply chain and being able to do testing, but im curious if either from the state, d. P. H. , or locally, is there a proposal or plan for how one decides when and whom to test at Skilled Nursing facilities. Again, assuming that you dont face the supply chain issue . Is it the Contact Tracing or is it universal, every so often . What are we striving toward in those facilities . Is there a plan that exists or a proposal . Thank you, supervisor. I think that the key thing im glad were talking about Skilled Nursing facilities. Again as i said, this is a key priority for outbreak prevention work at the doc and the e. O. C. I think the key thing, i know we want to talk about testing, we will get there, but the key thing we found from experience at laguna honda and having our cdc team coming out and work with us, the key things that make a difference are really try to prevent introduction of virus into a facility like a Skilled Nursing facility. And doing a lot of environmental controls, really making sure that staff dont come when theyre sick. There are ways of doing environmental cleaning and separation, having a plan to be able to isolate people. So all of those things have to be in place. So really working with Skilled Nursing facilities starts prior to testing of being able to understand all those things. And i think youre right, by the time there are cases, thats the point at which we generally will need to test everyone because were not sure what is going on. That speaks to a need of upstream interventions to try to support the staff, the administrators, the residents there to be as protected as possible. Before that is needed. And your question of how often should testing happen . Is it a result of testing investigation or done on a regular interval . We dont know that exactly. We dont know what the optimal approach is. But given the vulnerability of the residents and the likelihood of it to spread inadvertently through staff and other contact, most likely it will be some type of a regular routine screening of residents and staff. Now what frequency . We dont know. We have 21 Skilled Nursing facilities in San Francisco. Our efforts are to reach out to all of them, assess where they are on the spectrum of doing the preventative work and the best practices and supporting them as we try to gear up and think were the testing and screening efforts. Again, the outcomes of those also have to be managed, of trying to safely identify places where we can house people who are positive until they cover recover. Make sure the facilities stay staffed safely. There is a lot of consideration so no one is scrambling at the last minute. Supervisor preston who makes the decision right now like just as a hypothetical i run a Skilled Nursing facility, i have one positive person there, i Call Department of Public Health and i report that, is the current protocol either from the state or locally to do universal testing . Is it to do Contact Tracing . What would happen right now if i ran one of these facilities and reported that today . What would happen is we have skilled Public Health nurses, we have skilled m. D. S and people that do outbreak response and theyve been doing this even prior to covid, so we have relationships with the Skilled Nursing facilities because there is a flu season every year. And a lot of the protections were trying to do now are done then. Its very different because weve got flu vaccine, we have an intervention there we dont have now. But to say that people are used to doing this. What they do is talk with the administration, talk with the Infection Control that they are required to have. And understand where was the resident housed, who are the safe that took care of them and were the facilities following the best practices and guidance that has come out from the state around trying to limit how staff roam meaning how are things situated . Is that person rooming by themselves . Rooming with other people . It wouldnt necessarily lend to screening and testing. It might. But in the instance of laguna honda, theyre blocked off into neighborhoods and they have a staffing regiment that means that people are really only on one or two neighborhoods. And they really tightened that up even since covid. So there are lots of things that are facility dependent, so it requires a strong amount of engagement with the subject matter and the facility to understand how to proceed. But we have a very low threshold for saying, lets just do this, test all the staff and the residents. Supervisor preston so all of those decisions are made locally . Im trying to understand the interaction with California Department of Public Health. The decision would all be made locally . We generally will were on the ones on the ground. We have the jurisdiction. Were there to assist and have the relationship with the facilities. Most of the time what were doing is talking with the state as well. The administrators are also talking about their state contacts and licensing. And were talking about the Health Care Associated Infections Group at the California Department of Public Health. So were making sure that the state is staying informed and theyve been supportive of the actions around these things. Supervisor preston thank you. What im hearing is that its still a Contact Tracing approach from what you described. I understand that when there is a severe lack of supply of tessing. I just hope our policy keeps up with the growth in tests so were able to perform universal testing when we have a case given the deadly consequences in these facilities. One last question which was about if someone tests positive, are people who test positive being transferred into Nursing Homes . And if so, are there additional weve heard reports there are and im wondering if there are additional precautions or testing that is occurring for folks who are covidpositive being transferred into Nursing Homes . Are you saying they didnt start out in a nursing home, but were newly admitted to the nursing home . I believe thats the situation. I know from senior advocates had raised the concern about the possibility where folks who were positive that someone who was positive was being transferred and i dont know if they were a previous resident. What i would say to that, the state is really helping take the lead there on which facilities have the capability, the staff, the plan, the space set up to be able to potentially do that. And there are potentially facilities that are able to safely house a person who has covid19 in their period of recovery if theyre medically stable and dont need to be in acute care hospital. I think were going to have to balance the factors and make sure its never done in a way that poses a risk to other residents, to staff. And that facilities that take the responsibility of caring for covidpositive patients are fully supported to do so. We think this plays an Important Role in our Overall Health care infrastructure, because we want to make sure our acute care beds, that someone does not acquire acute care, we need to make sure theyre available for people who need that level of care. This is something were thinking about. And were doing this in conjunction with the state. And making sure that its done safely when it does happen. Supervisor preston thank you, doctor. I see many colleagues have questions. I will wrap up. Supervisor peskin thank you, president yee. And thank you for indulging me last week and thank you, dr. Phillip, for being here today, not only from the board but any member of the public who wishes to partake of this. I have four questions. Ill try to ask them as quickly as i can. Our public Testing Capacity is 5800 a day . Our supply constraints have been lessened, we dont know how long, but it will become less constrained. And the constraint youre speaking to is a testing is a constraint around staff capacity if we cannot actually deliver people or people do not selfpresent at the testing sites. Do i have that right . Because right now were using about a tenth of our total Testing Capacity . Do i have that right . Youre correct, were using about a tenth of the capacity, yes. Supervisor peskin and you indicated that there is a universal desire that im sure we all share to lessen the barriers to entry for testing and that those barriers have been liberalized and im now looking at your slide. And they expanded the expanded criteria, its kind of everything. Why, if we want to lessen the barriers, why not just say anybody who wants to come down can come down . Well, i think that we are doing this incrementally. Thats a going question. Thank you, supervisor peskin. Thats a good question. Were trying to do it incrementally because were not 100 certain of maintaining supply chain. Its unlikely if we just opened it up to anyone to come at any time for a test we would be overwhelmed as youre pointing out, but what i dont know is the ability to maintain that over time. I dont know our ability to enhance preferentially for the population that we feel most need the test. So i think that will be a balance. Were taking a trial approach. As you said, those symptoms are very liberal. I dont know any of us that are not experiencing some level of fatigue at this moment, so people would be able to get a test if they really wanted one. And we want to see what the uptake is at those sites using those criteria. I think the other thing is that, you know, this is the start, but were thinking about other sites in conjunction with the state that would be helpful. Were always thinking about placing sites where priority population can access them with minimal barriers as you said. And were thinking about what it would take to have mobile sites. We know that is an interest of the board, its an interest of us as well, in trying to see what we can do to have access more freely available. The city test s. F. Sites are wonderful and theyre there now and there for people to access, but we know theyre not sufficient. Supervisor peskin so this is not one of my questions. Does that mean that would be less constraint in the supply chain that were continuing to accumulate more swabs and apply caters on a daily and weekly basis . Yes, our stockpile is continuing to grow. I think we have to expand and we have to see what the reaction of the public is. We have to continue our plans for expanding other sites for access as well and our routes for access as you said. Given the delta day to day, which is about 5,000. I mean basically on a daily basis, are we accumulating 5,000 a day . How many swabs and am caters. Previously, when it was a much smaller number, we were concerned about a large outbreak at laguna honda or other settings that might need a large amount of testing and keeping things in reserve. Trying to be conservative. We dont have to conservative in that way, but i think we have to expand responsibly and see what the uptake will be. Understand the characteristics of the people taking advantage of testing and augment to make sure were reaching priority populations. Supervisor peskin that leads me to the second question. As it relates to priority populations and areas that are higher in transmission, is it safer from Infectious Disease stoint, do you think, to live in and test in s. R. O. Congregate settings where restroom and Kitchen Facilities are shared or in populations that live on the street . And the Health Orders are unclear about that. Were trying to expand. We think both of those populations are a priority. I dont know that we would pick one over the other. I think both population are ones that need access to testing and to screening when needed. So those are both populations that were focused on. Supervisor peskin what are the nearterm plans for that focus . I think the nearterm plans are to really now again that weve stabilized the supply, that we have these other sites in place, to see how we can increase testing in other populations is to really understand what is it that will be needed in order to scale to do more screening . What are the barriers . What is required in order to do that . And what type of testing mechanism would be lowest barrier . Is it on site testing . We cant test as often, is it better to have neighbor located facilities . I think there is planning around how this looks. In parallel, were trying to think about nursing facilities, which are a priority, but require a different approach to supporting staff screening and testing. And sometimes requires our nurses to go there and do it physically ourselves. Supervisor peskin and if there is interest in a community that has volunteer and organizational and logistical resources that want to replicate what is being done in the mission where asymptomatic people are being tested, and the university of california is participating, say in like chinatown, is there interest at the department of Public Health in replicating that setting in the Community Like chinatown, that obviously has a disproportionate number of congregate living situations . I think were always interested in gaining more information. A project that happened with ucsf was largely organized and staffed and maintained by them, which is what made it possible, but were certainly interested in gaining information about epidemiology of covid in our city. And were particularly interested in understanding more vulnerable populations and more vulnerable living situations as to what epidemiology might be so we can better serve the public. Supervisor peskin my last question, not to drag you into the friction that is existing between the executive branch of government and legislative branch of government around the acis zigs of hoe acquisition of hotels for vulnerable populations and isolation for people who cannot otherwise selfisola selfisolate, is there any concern that if these types of asymptomatic testing studies are undertaken that it will lead to containment strategies that require isolation in hotels or other settings that the city doesnt currently have sufficient access to . Is that any way of a part of d. P. H. s consideration. That has not been part of the discussion that ive been a part of. Not as a reason to not do testing. I think those are important considerations. I think that the ability to do Case Investigation and Contact Tracing on very large numbers of people as we are trying to build up the workforce and that capacity is another situation, but neither are reasons not to test people that would benefit from testing. Supervisor peskin what do you think the best containment strategy in s. R. O. S is . Now youre asking me to go outside of the testing approach. I think that there are best practices. I know there are specialists and subject Matter Expert teams working closely with management and with Community Leaders to think about ways of structuring the environment, the physical environment, the ways of doing cleaning, the ways of trying to give people as best tools as possible to try to stay safe in their own environment. We know that many people want to stay in their homes and stay safely in their homes. Those are important approaches. As i said, were continuing to learn about this virus and what is and is not sufficient. Well have to continually evolve in the face of that knowledge. The resources are one issue, but i think the science and what we understand to be the Public Benefit of the approaches is also evolving over time. Supervisor peskin thank you, doctor. If you have a point person as to who that is who is linguistically and culturally competent as it relates to s. R. O. Settings in chinatown, i would love to know who that point of contact is. Thank you very much, supervisor. Dr. Phillip. Were fast approaching the 45minute mark, but there are several more of my colleagues that i can see on the roster. Would you be open to getting to these questions . It would be helpful if you can stay beyond the time. Yes. President yee okay. Supervisor walton. Supervisor walton thank you, president yee and thank you so much, dr. Phillip, im going to be brief because a lot of questions i have you covered. The one thing you said first of all, let me thank you for being responsive to some of the questions weve had and some of the demands made to the department of Public Health because i have not received response from other leadership for the department, so i do appreciate you. The one question i do have, you showed a slide talking about you will start providing asymptomatic testing in communities affected disproportionately. And i didnt get a clear sense of a timeline for that. And would love to know and try to lock in a date, something more specific, because this is important to community and i know that testing does not solve our problems, but it does tell us whether or not people need to be quarantined indefinitely, separated from other human beings . Thank you, supervisor walton. Yes, i agree with you that testing is a hugely important piece of the overall response and overall way we have to respond to this pandemic and this Public Health crisis. I have listed the groups that were going to move to. And i want to iterate again reiterate that its going to take us a while to get to the vision of universal access to testing for everyone. But were focused as we think about next steps. I talked about this idea of where additional sources for testing might occur. Were thinking as we think about what would potentially mobile sites in San Francisco look like . Starting to have those conversations. So the areas that represent 10 other areas that are disproportionately impacted president yee excuse me. Can somebody can people mute their mics . Would be the Priority Areas for those types of additional services, in addition to what has been laid out already. An improvement what we have before in terms of access, but not nearly where we need to go. I dont have an exact date for you, because this is relatively new. In the last week, we think we have a stable supply of the things we need to test, what is it going to look like to expand testing . We started just now with saying, you know, any of these symptoms will allow us to test. And we know we have a ways to go in that and its going to require planning as i said. And particularly for the asymptomatic test and getting the right message. And giving them information about when they should come back. The way were going to be learning about that is starting first with Health Care Workers because they have among the highest risk of being exposed to covid in their work and understanding in that way. Starting there and going out to be able to offer that to other people as well. Supervisor walton for the second time, i want to state its disheartening we dont have a time line and when were going to provide asymptomatic test fogging testing for the vulnerable population that have demonstrated higher numbers. Especially since weve already admitted to having over 5,000 capacity and not testing more than 500 or so a day, but i wont belabor the point during this conversation and will continue to reach out to the department and push for us to do the right thing for people of color and for communities of disproportionately effected by the virus. Thank you, supervisor. What i would also say, with the revised criteria, there likely are more people that would be able to be tested and the Health Center is a site where people can go and get testing. And there is capacity for testing there. Thank you very much. I am taking to heart what youre saying and will take that back and continue to think about that and try to commit to time lines. This is very early in the process of thinking there. Supervisor walton thank you. Supervisor mar thank you, president yee, and thank you also, dr. Phillip, for joining us for this important discussion about testing our citys testing strategy. Ill try to keep it brief as well. Just had some questions around the vision our vision for all san franciscans to have universal access to testing. I was wondering if you had any thoughts how far off we are from that . And what are some key benchmarks that were going to need to that work towards in order to have that universal access to testing in San Francisco . Thank you very much, supervisor, for the question. I think it is a goal, it is a correct goal, its also a large goal. Its a challenging goal. Which it should be. And i think that we are a ways off as weve heard from the conversation. There are still many populations, many settings in which we want to be able to expand testing and screening. We dont have all the information about the best way to do that in asymptomatic people. And we dont want to do harm. There is a risk, as a medical doctor, one of the first things were taught is dont do any harm. We have to think through how do we message what a negative test means . We can do all those things. We need to understand that a negative test today doesnt mean theyre at less risk tomorrow or less risk of transmitting if they develop an infection in the time between the specimen was collected and the time they got the test result back. I think there is lots we have to learn and figure out, but there are things we know that we need to be able to make sure, if people are not accessing the sites that we have, we need to understand what the barriers are. And make the testing continue to work to make the testing more successful. Everything weve been doing to expand testing has been done with an eye to reduce the barriers, improve their access to it and make sure the populations disproportionately impacted and our essential workers, throughout the city, many of whom i want to say are lowincome people, people of color, think being staffing of grocery stores, delivering packages, that type of work, we have been taking steps and had a equity lens throughout all of it. We need to start looking at our data and measure the number of people coming through. Weve seen increase of the number of tests over the last couple of days. We really need to see how can we continue to increase those numbers of tests that are performed . I think there is going to be a data feedback loop. Its so early in thinking about how to expand, i dont have concrete benchmarks. I dont have concrete time lines, which i know is challenging. I will tell you that were committed to continuing to work on that. And every expansion, even though its seems incremental, every expansion is done with the eye to maintain that expansion and build on it for the next group of people. Again, keeping an eye on making sure were putting our personpower and our resources and supporting the people who are most vulnerable to severe illness and death if they become infected or most vulnerable to congregate settings and outbreaks and populations that are disproportionately impacted throughout the city. Supervisor ronen thank you. I just wanted to start off on a comment. I dont know if you had the opportunity to talk to dr. Have leer, but the test done in the mission was done with a lot of volunteers. So it was the Community Coming forward and partnering with ucsf. They dont even have a defined budget for the project because it was done so quickly and in such cooperation with my office and community that they were able to make it happen without a budget. Im not sure if youve had a chance to talk to her. I would encourage you to, because i think its an important test that is making the community feel like theyre cared about and being given attention. It was right in their neighborhoods, the outreach that happened. It was a model that should be replicated in chinatown, soma, tenderloin. Bayview. There is no question in my mind. We encourage you to talk to her if you havent already. Thank you. We have been talking with her and were eager to hear more about what their experience is. Its great to hear that from you as well. Thank you. Supervisor ronen i dont know, just aside from the data, well have access to all of these strategies. The impact of the community being focused on and how that makes people feel cannot be calculated. I mean its had profound impact on the mission. So ill just leave it at that. I still dont understand youve given the best explanation to date on why for so long the entire division, Navigation Center wasnt tested after there were positive cases. So i appreciate that, but i still dont understand when people are using shared shower and bathroom facilities, and given what weve learned about how covid is passed through the community, how they cant be considered in close contact where theyre already a Vulnerable Community and they werent prioritized for testing. I still havent gotten that. Can you explain that a little more . Previously at division circle, we can view that as an example, the feeling was that in talking with the person that was the case, there was an ability to understand who was in close contact at that time. And so that and that there were environmental controls and other ways that the facility was set up to try and limit the contact that might occur with other people. So that was a decision at that time. But as you know, with the more recent case, there was a different decision to actually move people out to do a thorough cleaning and to offer testing more broadly to people. And i know that seems like it doesnt make sense. I think some of it is, again, we are learning about the virus. Were learning about what is and is not necessary as we are learning from our experiences at division circle, m. F. C. South here and colleagues in seattle and elsewhere across the country. I think that there will be an evolution of how we look at response to this. And i think we will not always be perfect in the approach, but were working with the best data we have. And we need to take into account the opinions of advocates, Community Members. So i dont know that im giving you a better explanation, but im telling you that i think that thinking evolves as the overall understanding of infection and transmission, what is and what is not a best practice evolves over time as well. Supervisor ronen im not asking this to belabor the point, but what is close contact for tracing purposes . How that is defined and understood by the department. If the individual just arrived at division circle, maybe never took a bath or shower. Maybe every time someone uses the bathroom, its so thoroughly cleaned before another person that is the reason. But to me, the shared bathroom scenario alone i mean division circle, very close you know facilities, people use the same chairs to hang out on and eat their mails, et cetera. But that shared bathroom, is that considered in and of itself a risk for Contact Tracing . I know you said being within six feet of someone who is positive for 10 minutes, right . Is what youre considering. So using the bathroom that someone who is positive uses regularly is not considered a person that should be tested for Contact Tracing purposes . Not necessarily. I cant speak to the particular case. I i dont have all of the details of that, but the situation you described, if there were hypotheticalfully, if there were environmental controls in place where the resident or the staff were wiping down surfaces between uses, et cetera, then that would potentially not constitute a risk of using the same facility. I dont know if that was in place. But weve had very experienced m. D. And nursing experts sort of ask these questions. Do these interviews and try to understand what was going on, we are very interested also in trying to minimize ongoing transmission. That is our whole reason that we exist as a department, the whole reason we do this work. So, again, i have to trust in the investigation that happened at that point. And i will say to acknowledge your point, i completely agree. I understand why it would be a confusing thing. I think there could be specific pieces of that particular investigation that led to that decision. And i think that were evolving our understanding over time about how we should think about testing or screening or offering that in those situations. Supervisor ronen again, i just want to be able to share this with my constituents, so im trying to get clear, accurate information. Sharing bathrooms and showers, then, is not something that would lead to someone getting tested through Contact Tracing if someone who was positive used that same shower and bathroom . It possibly could be. Im giving you a very unsatisfying answer. It depends on the situation. I think in a congregate living supervisor ronen in a congregate living scenario. I think we have a lower threshold now than we did several weeks ago because our knowledge is evolving. Which is appropriate. I think we should worry if our Public Health knowledge was not improving. We should consider testing the people in contact there. I dont want to spend a lot of time defending what wassed decided before, because i dont know the information and second because i think we have a different mindset now and framework now. I think that is incorporating scientific information and also incorporating feedback from you all as a board, feedback from community, all of which is important and valid. Supervisor ronen two more questions. In congregate settings, where do people wait after theyve been tested before they get their results . Thats a good question. So we want people as theyre being tested and awaiting results, we want them to be as much as possible in a safe setting. Thats why in congregate settings, Navigation Center, we have moved people out to await the test result. And we prioritize getting their tests done in the fastest way possible. Luckily, weve come a long way in waiting for commercial laboratories to get results back. Its generally not a long amount of time we have to have people wait, but youre correct, wed like them to be in their own space while waiting. If were worried enough to test, we should consider them a potential person who has covid until we can get the test. Again, its not a complete relief when we get the negative test. Its only guard that point in time good for that point in time, but we have to make a plan for how we repeat this. I want to say to the board, its not a simple matter of testing everyone once. Its a plan to do this repeatedly and support the people necessary after the test comes back, which is what we need to do as a city and will take work. Supervisor ronen last question. Who is making decisions about who to test . There is a policy team o. E. C. And doc. I am part of that, dr. Baba and some of the other e. O. C. , dr. Bennett, the commander flight. There is a group of people that think through the issues and think through what are the policies that incorporate the Public Health data, the science data and what we are learning as we go through this pandemic and incorporating new evidence and new data. We will make recommendations, but clearly its dr. Colfax, the director of health, hears these things and he a has a group as well of his leadership that he works with. There is process of getting input from all levels and bringing it up to have the discussions. This is no different than what d. P. H. Usually does in terms of trying to have a data focused approach as dr. Colfax says, looking at the data, facts and science and also having a Strong Equity focus in how we try and increase our access to testing an response capability. Supervisor ronen one more question. Have you tested anyone on the street . Meaning being able to just collect the specimen on the street . Supervisor ronen yes. You know any doctor gone to were probably getting close to 100 camps that are growing on the streets. Has any doctor gone and tested anyone in those encampments . I dont want to say know, because were working with street medicine and others. I dont know the exact answer to that, but i will find out. Supervisor ronen okay. That would be great. Its hard to get answers when there is not a group. It doesnt seem like there is a clear i dont know place to get all the answers. But appreciate it. Thank you. President yee supervisor safai . Supervisor safai thank you. I just wanted to end on the conversation around longterm care facilities. We have the second largest longterm care facility in the city and our district at the jewish home. Weve been in a couple weeks, a long conversation about testing of front line staff. Can you talk to me as you said about the changes and the think being testing staff and front line workers in these facilities . Can you talk about that . And then secondly, can you talk about, is there training happening for the people that are actually doing the testing . We say testing as though we all have an agreed upon standard, but is the d. P. H. , are you training your nurses, are you having people doing the training going through a proper quick procedure to have them understand what the procedures are for train . Those are my two questions, but mainly wanted to start with the longterm care facilities. And we had dr. Louie come to a town hall. Shes been in those conversations. And to answer supervisor prestons question, the jewish home has been ordered by the state, a lot of the longterm care facilities, have been ordered to accept covidpositive patients that are not current residents and its currently happened and theyre licensed to do that in a different wing, different staff, but is the city changing its thinking around testing the workforce there . Thank you very much for the question. Yes, stilled nursing facilities as ive been saying is an emphasized area. Its a priority. And we are trying to think through ways of what would it look like to increase screening . Of residents and staff . And because there is 21 facilities and several of them are quite large, laguna honda and jewish home being the largest, it will take some operational and logistical thinking in collaboration with the facilities to see also what works best for them in doing this. But we do think this is a priority area. Its a focus area. So were working to do work in that area. Dr. Louie, who came and spoke to you, is one of the leaders in that work. Supervisor safai that sounds like the answer is yes, youre changing your thinking and testing is going to happen, its just matter of how its going to happen. Yes. Big picture, were moving to doing that to support the residents and the staff. And, yes, it is more of a question how its going to happen, not if. Supervisor safai my second question, are you training people that are doing the testing . When i talked to front line understands nurses and different people, you get a broad range of the testing. Whether its one swab, three swabs. Is the department thinking about doing a simple training to have the people that are actually doing the testing understand the process and kind of standardizing that . Yes. And it is confusing because there are lots of different ways that the cdc says we can collect the swabs. And nasopharyngeal is the preferred, but if thats not available for whatever reason, people can do oral swabs, they can do midnose swabs, they can interior nostril swabs as well. So it can be confusing. Weve had guidance since the beginning of the epidemic how to do the collection, which evolved as the cdc has evolved. And there are written documents for providers to look at on the website, the health department, the communicable disease, prevention and control have those instructions. But could we do teaching . Thats a really good one. I think as were thinking about going to Skilled Nursing facilities and doing screening, it would be great to have the provider there do their own screening for their residents and staff. They have medical staff, so there is no reason. Thats a good place to start in supporting staff to get comfortable with the procedure for doing the screening. And then we would support that testing in our Public Health laboratory. I think that is a really good idea. Well have to think of other ways to support providers. Perhaps a video or Something Like that, inperson instruction is not possible right now. Supervisor safai i think thats kind of the subset. I just want to overemphasize that i think it would be really important for d. P. H. To have standardized testing in the way that you all are training people do to do the test. The second part, we are going to need more people to be involved in that and to volunteer and participate. So then having standardization of the process and whether its video, that will also be very helpful. Thank you. President yee okay. I think thats it in terms of my colleagues having questions. In terms of the questions that i sent ahead of time, you seem to have covered everything on there. Really appreciate it. I know not one person will have all the answers, but you have most of the answers in trying to explain the thinking, rationale behind every decision that you guys make. And it sound like youre the the rationale you have may be different next week as we see things evolve, in particular, the capacity to make sure that the supply chain is going to be stable. One quick question. I heard that the soma site was a walkin and that had a closed dome, so was is closed down. Was it closed down. It is open now. It was open as of yesterday. And i think it was there was no particular reason other than just trying to stand up a new site quickly and the logistical kind of opening issues that had to get worked out. There were no problems that were insurmountable and they were able to quickly resolve them and open it again for people to be tested again yesterday. So we really want people to try out those sites. And we hear and understand and completely agree with the concerns this may not be accessible to people who cant sign up online. So were trying to figure out ways to support people and being able to access the sites even if they dont have access to the online resources to sign up. President yee are there any plans right now and this is my last question are there any plans to work with h. S. H. In maybe some of the workers that generally interact with the homeless on the street . Whether or not they could go around with computer or laptop or something and maybe perhaps sign people up . They could assist them in signing up in the meantime before you figure out other ways do this . Yeah. I think that is a really good idea to consider. We have been working really closely, as you know, with h. S. A. And h. S. H. And want to continue that work. And employ the people or rope in the people on the hot team and others that know communities well, know populations well that might be unsheltered and offer that service to them as well. Well definitely explore ways to get a lot of people access. I think thats a great one to explore. So thank you very much, president yee. President yee sure. I want to thank you again on behalf of all my colleagues for coming here today and getting to everybodys questions. At this point id like to let you go. And i know you have other things to do. And deeply appreciate your time. So i guess, colleagues, im going to go ahead and end this meeting. Thanks for the questions. I will be in contact with you to see what we could put together for next week, okay . Thank you very much. Byebye now. Working with kids, they keep you young. They keep you on your tones on your toes. Teaching them, at the same time, us learning from them, everything is fulfilling. Ready . Go. [ ] we really wanted to find a way to support Women Entrepreneurs in particular in San Francisco. It was very important for the mayor, as well as the Safety Support the dreams that people want to realize, and provide them with an opportunity to receive funding to support improvements for their business so they could grow and thrive in their neighborhoods and in their industry. Three, two, one because i am one of the consultants for two nonprofits here for entrepreneurship, i knew about the grand through the renaissance entrepreneur center, and through the Small Business development center. I thought they were going to be perfect candidate because of their strong values in the community. They really give back to the neighborhood. They are from this neighborhood, and they care about the kids in the community here. When molly molly first told us about the grant because she works with Small Businesses. She has been a tremendous help for us here. She brought us to the attention of the grand just because a lot of things here were outdated, and need to be uptodate and redone totally. Hands in front. Recite the creed. My oldest is jt, he is seven, and my youngest is ryan, he is almost six. It instills discipline and the boys, but they show a lot of care. We think it is great. The moves are fantastic. The women both are great teachers. What is the next one . My son goes to fd k. He has been attending for about two years now. They also have a summer program, and last summer was our first year participating in it. They took the kids everywhere around San Francisco. This year, owner talking about placing them in summer camps, all he wanted to do was spend the entire summer with them. He has strong women in his life, so he really appreciates it. I think that carries through and i appreciate the fact that there are more strong women in the world like that. I met dandrea 25 years ago, and we met through our interest in karate. Our professor started on cortland years ago, so we grew up here at this location, we out he outgrew the space and he moved ten years later. He decided to reopen this location after he moved. Initially, i came back to say, hey, because it might have been 15 years since i even put on a uniform. My Business Partner was here basically by herself, and the person she was supposed to run the studio with said great, you are here, i started new Nursing School so you can take over. And she said wait, that is not what i am here for i was by myself before for a month before she came through. She was technically here as a secretary, but we insisted, just put on the uniform, and help her teach. I was struggling a little bit. And she has been here. One thing led to another and now we are coowners. You think a lot more about safety after having children and i wanted to not live in fear so much, and so i just took advantage of the opportunity, and i found it very powerful to hit something, to get some relief, but also having the knowledge one you might be in a situation of how to take care of yourself. The selfdefence class is a new thing that we are doing. We started with a group of women last year as a trial run to see how it felt. Theres a difference between selfdefence and doing a karate class. We didnt want them to do an actual karate class. We wanted to learn the fundamentals of how to defend yourself versus, you know, going through all the forms and techniques that we teaching a karate class and how to break that down. Then i was approached by my old high school. One once a semester, the kids get to pick an extra curricular activity to take outside of the school walls. My old biology teacher is now the principle. She approached us into doing a selfdefence class. The girls have been really proactive and really sweet. They step out of of the comfort zone, but they have been willing to step out and that hasnt been any pushback. It is really great. It is respect. You have to learn it. When we first came in, they knew us as those girls. They didnt know who we were. Finally, we came enough for them to realize, okay, they are in the business now. It took a while for us to gain that respect from our peers, our male peers. Since receiving the grant, it has ignited us even more, and put a fire underneath our butts even more. We were doing our summer camp and we are in a movie theatre, and we just finished watching a film and she stepped out to receive a phone call. She came in and she screamed, hey, we got the grant. And i said what . Martial arts is a passion for us. It is passion driven. There are days where we are dead tired and the kids come and they have the biggest smiles on their faces and it is contagious. We have been operating this program for a little over a year all Women Entrepreneurs. It is an extraordinary benefit for us. We have had the Mayors Office investing in our program so we can continue doing this work. It has been so impactful across a diversity of communities throughout the city. We hope that we are making some type of impact in these kids lives outside of just learning karate. Having selfconfidence, having discipline, learning to know when its okay to stand up for yourself versus you just being a bully in school. These are the values we want the kids to take away from this. Not just, i learned how to kick and i learned how to punch. We want the kids to have more values when they walk outside of these doors. [ ] hi, im chris manus is sfgov tv and youre watching coping with covid19. Today im going to the gas station. [music playing] now, these are just my stories. Im not a medical professional of any kind. Im a video guy. And the reason im getting gas so we can go to the doctors. If you want to get the most uptodate and definitive information about the coronavirus pandemic, i highly recommend the f. A. Q. That is available at sfgov. Theres great info there. Today im taking two plastic bags and a hair tie and following the new bay area guidelines and im wearing a mask. Im taking the smallest number of items with me. Just my car key, credit card, i. D. , the bags and the hair tie. I dont want too many items to wipe down later. As aleave, i put on the outside shoes ive left on the porch. Can i track the virus inside with my shoes . I honestly dont know. But my floors are cleaner now. When i get to the gas station, i get out of the car, remove the gas cap and put the big plastic bag on my right hand and secure it with a hair tie. There are three main share surfaces here im concerned about touching. The p. I. N. Pad, the pump handle and the button to select my gas. After i use my card, i put it into the smaller bag and stash it. Most gas stations have a paper towel dispenser or maybe there is a piece of paper already in your car that you can use. Once i fill my tank and replace the pump, i walk to the trash can, roll the hair tie up my arm and let the plastic bag fall into the can. On my drive home, im careful not to touch my face. I leave my outside shoes on the porch and as soon as i get through the door, i wash my hands for at least 20 seconds. Next i wipe down my credit card, i. D. And my car key and, as an extra precaution, i wipe down the front door nob and clean the sink taps. Finally, wash my hands again. Thats it for this episode, i hope you found it helpful. Thank you for watching. Mayor breed im mayor london breed, mayor of San Francisco. I am joined by the director of Public Health, grant cofax, trent roar, the director of homelessness and housing abigail stewartkhan, the police chief, and the director of emergency management. Today wed like to provide an update and of course answer questions to the press during this Virtual Press conference. As of today, we have 1,216 confirmed cases of covid19 in San Francisco. Sadly, we have 20 people who passed away as a result of the virus. As a reminder, datasf. Org covid19 is where you can find details to find out who is actually infected as well as those who have been tested. I want to be clear from the very beginning when we heard about what was happening with the coronavir coronavirus, specifically in wuhan, china, sadly there were a lot of xenophobia of those in our asian community. This virus is not discriminating on the basis of race. Sadly, the xenophobia continues. We want our community to know we are here to provide the resources and the support necessary to deal with the challenges around discrimination. So its not tolerated here in San Francisco. In fact, as we look at the data and the inequities as it relates to covid19, we are seeing the disparities, true disparities around income and inequality and other things that have sadly been a part of our environment and our climate for so many years, that when there is a pandemic, those issues are heightened and made work and exacerbated as a result of this pandemic. Specifically people who might not have access to Good Health Care or conditions or outcomes are those most impacted. We see that people who live in crowded settings and congregate situations since day one, those are the most challenging as they are the most impacted by the virus. The data is what is helping to shape our understanding of this virus, as it relates to San Francisco. But it is also playing itself out throughout the country. Im really proud of this city because not only do we have an office of racial equity, from the very beginning when we operated this Emergency Operations center right here, from day one we put into effect an equity team, a team comprised of people who are familiar with various cultures and communities, with the sole purpose of providing the necessary support to educate people about the virus, the impacts, and also provide access to services. An example is from the very beginning when we were asking nonessential businesses to close and we had a number of nail salon that were still open where there was a language barrier. This particular team was a team that outreached to that particular business, to not only explain why it was necessary to close, but what other Small Business services are available. Our Public Housing and the residents of Public Housing who already are dealing with challenges around income and equality but also access to resources, to reach out to the neighborhood nonprofit organizations that work with residents of Public Housing and Affordable Housing to provide resources to food and an understanding about employment insurance and all of the resources available, it takes a lot of work. Typically you would walk up and fill out the paperwork with someone online, and now that work is a lot harder to do, requiring us to be creative and requiring more volunteers for outrea outreach. Maybe sure that those who are not connected to the internet or know how to use it, that we are supporting them so no one is left out. We are focused on if anything sure and director davis from the Human Rights Commission will talk more about some of the incredible things they are doing to help underserved communities in San Francisco. Some of the simple things, providing gift cards to families with food, providing help for filling out Unemployment Insurance applications. Providing assistance and understanding of some of the laws and things weve implemented in the city and making sure people are connected, informed, and supported through basic services. Its really key to supporting all of our residents and we have been doing this since day one. I want to take this opportunity to thank the nonprofit organizations and our faith leaders, because they are on the frontlines, communicating with their congregations, providing support and Delivery Services informally and on the ground doing everything they can to support their residents. I want to express my appreciation to so Many Community members who have taken it on themselves to ask Community Members who they may need, especially the people we know who are in isolation, their neighbors and everyone in this. This means we have to continue the acts of kindness and support for our neighbors. Speaking of neighbors, i want to talk a little bit about some additional things that we are going to be adding to our data tracker. People are of course interested in learning about this virus, not only by race and health disparities, but also by location. So today on the tracker well have information by zip code of where people are sadly who are diagnosed with coronavirus, what particular neighborhoods they live in. Again, it goes back to some of the disparity disparities we knew. We are seeing more cases, which is consistent with our findings that about 25 of those people who are infected in this city are latino. And the Latino Community represents 15 of the population. So there is a huge disparity there. We also see a large part of Homeless Population in sonoma being infected. I want to be clear what this map reveals information that helps us to understand where the cases are, but it in no way indicates that some parts of our city are safer than others. So i dont want us to get the idea that that is the case in any of our neighborhoods. This is really about gathering more information and doing everything we can to provide the public with everything we have just so that you are aware and so that you understand how important it is to continue to take the precautions we are asking you to do. Whether its wearing a face covering, whether its socially distancing yourself from anyone who is not a part of your household, and staying inside as much as you possibly can, except for essential services or to take a walk and get some fresh air. These steps are critical to doing exactly what we need to do to continue to flatten this curve in San Francisco. I also want to talk about many of the challenges that people continue to face. We early on put a moratorium on evictions for residents and our commercial businesses. We know that the water and the power will not be turned off as a result of this pandemic, which is i know helpful to help ease peoples minds just a little bit as we go through this real challenge. But ultimately we know that the biggest challenge will be access to food. Access to food in general, but also healthy food. And we know that communities where we have a lot of lowincome families, where people have lost their jobs, where in some cases they might not qualify for Unemployment Insurance, where our immigrant communities are afraid to maybe interact with the government in various communities. Here in San Francisco, i am so proud of the work we have done to really identify such a significant need to help provide a adverse population of people with food. I just want to talk a little bit about some of the things we are doing. Basically we recently launched a Pilot Program with the Salvation Army to make and deliver meals to people who are experiencing homelessness and those that are living in encampments. I know people are not necessarily happy with the encampments, but we realize those are people who also need food too. The Salvation Army will be partnering with us to make sure they get fed and that feels are delivered to them. As well as working with us on important programs to provide to those who are without a home. Thanks to their work, well be able to deliver 1300 meals daily to people across 40 locations in San Francisco. This is just one part of our massive undertaking to help get food to our vulnerable populations. Were also providing three meals a day to the people who are not only in our shelters but are in hotel rooms who we moved out of the shelters for the purposes of keeping people separated from one another so the virus doesnt continue to spread. I want to talk about the San Francisco unified school district. 319,000 people have been fed to date because even though, unfortunately, the schools had to close, there have been a number of people who showed up, folks making sure people had access to meals. More than 12,000 meals have been delivered by open hand, self help for the elderly, and our isolating and quarantining hotline. So what we announced last week was the ability for anyone who might experience isolation or no access to food to go to sfgov. Org or to call 311 so we can make sure groceries are delivered to families to our elderly or disabled residents who might not be able to get out and get food. I want to appreciate the food bank. Theyve set up 13 popup locations in the bayview and excelcior communities that are struggling. Some of the lowincome communities, theyve had a lot of volunteers. I visited one location where they are handing out food boxes and providing resources and they are doing that on a regular basis. Meals on wheels is a program that continues to deliver food to those who are disabled and elderly. Also, i want to take a moment to appreciate the countless san franciscans who are shopping for their neighborhoods, who are reaching out to people they know that need help. I know that one of my Staff Members here in the city has five seniors that she specifically shops for every single week. Those are the seniors shes committed to. I think it does absolutely amazing when people take on the responsibility of supporting their neighbors and doing what you can to make sure they have the resources that they need. The incredible people of this city who continue to reach out and do all that they can. So i think its clear that our goal is to make sure that no one is deprived of food during this pandemic. I just want to take a moment to appreciate the private sector. The people who have given to givesf. Weve collected almost 8 million in private money and partnered that with money from the city and county of San Francisco to provide support for people to access food. Its been absolutely incredible. Thank you to the San Francisco foundation and to give to sf. Ill talk about that more this week to acknowledge the contributors who have gone above and beyond to help with food and security around our city. I have to say, San Francisco has been a model in providing access to food to people all over this city. So if you know anyone you think needs help for any reason, please call 311 or go to our website sfgov. Org. Lets make sure no one goes hungry as a result of this pandemic. Jeff humlin is here to talk about some updates with regards to muni. I am really excited about his announcement today to add certain lines back into the fold, some new adjustments. I want to thank the transit operators, our muni operators. The folks who are cleaning the buses. The folks who are showing up every single day, putting their lives on the line, in order to get our essential workforce to their destinations. The hospitals, grocery stores, or places folks are making themselves available to the public because we know that people still need food, they need access to the hospitals, they need their medication and other things. People on the frontline getting folks without access to transportation any other way are our muni drivers. I want to take this moment to really appreciate them so much for their hard work and their dedication. And also the number of drivers who are coming back to work. Some were out sick. Some had concerns about their family members. I want to make it clear that the program we have for First Responders includes our muni drivers and those who are working every single day. So if youre concerned about your families and you want to come to work, which we desperately want you to come to work, and you want to stay here in San Francisco at a hotel room because you are concerned that you interact with thousands of members of the public and you dont want to put your families at risk, we are here for you because we need you and we appreciate all that you continue to do to support the people of this city. Jeff humlin will talk more about that in terms of an increase in service. I also want to remind people because as far as the face coverings, i want to be clear with people, you are not required to wear a mask specifically. Just anything that can cover your nose and your mouth when you are standing in line or in any location that provides an essential service. If youre out riding your bike, running, walking your dog, basically that is not necessarily a requirement to wear a face covering, but doing anything else where youre around other people, number one, it does not take the place of social distancing. Number two, youre required to wear a face covering. I want to reiterate that. Please follow our guidelines. Please use common sense so that we can keep you safe and others around you safe as well. Last but not least, today is april 20, 4 20. Its a time when in the past there would be a celebration with those who are marijuana enthusiastics at golden gate park. We made it clear that it is canceled today. I want to express my appreciation to the ambassador of the bay e40, a rap artist who has been really a part of the fabric of our rap culture here in the bay area since i was in high school and so many people love and admire him. We appreciate his message of love and his expression to ask people to stay home this year. We hope you heed our message to stay home today and to not come to golden gate park. So far, so good. We want to thank you for abiding by our direction on 4 20. We know its difficult because you want to celebrate. We want to celebrate so many things right now, but it is a matter of life and death. This is why were asking people in this city and everywhere to continue to not gather in large groups, to stay at home for the most part except for essential services, to use face coverings and common sense. Take care of yourselves and your family members so we can get through this as safely as possible. With that, i want to take this opportunity to introduce dr. Grant colfax to provide an update from the department of Public Health. Thank you, mayor breed. Good afternoon. Im dr. Grant colfax, director of health for the city and county of San Francisco. Today i am glad to bring forward more data on the effect of coronavirus in our community. I have consistently stressed the need to follow data, science, and facts in our collective response. Today is another step forward in that philosophy. The online tracker the online data tracker now includes a map that shows the approximately 1,200 people who have tested positive in the city, the number of these cases per zip code, as well as the rate at each location. This map shows us that some areas have higher rates than the rest of the city based on the testing that we have done so far. The map affirms what we already know about how this virus spreads. The population and locations in our city that are most affected by health disparities, by income inequality, and by structural rates of them are also going to be the areas most affected by this pandemic. Unfortunately, Health Emergencies exploit the inequalities in society. People with chronic illnesses, Underlying Health conditions, and from communities who have experienced institutionalized stigma and discrimination are going to be more at risk for getting sick. This map is sobering, but unfortunately it is not surprising. Unfortunately, it looks like many other maps in San Francisco, including those that depict health disparities, income inequality, and racial and ethnic inequities. And yet, this map also supports our focus on equity in vulnerable population in our collective response to this pandemic. We must make progress in reducing the spread of coronavirus everywhere, everywhere, in our city or we will not emerge from this pandemic. Even though our rates of the data are still incomplete because about a third of test results we receive do not include this information, i still felt it was important to start sharing the emerging picture now. Let me walk through the map and explain what it does and does not tell us. The map shows confirmed cases of coronavirus in San Francisco by zip code. It is based and this is very important it is based on the number of people we have tested. As you know, we have not testing nearly everyone. As of today, there are about 11,250 tests that had been reported in San Francisco. About 1,200 are positive. The citywide rate of the tests of the positive tests of the tests that had been done is 14. 07 per 10,000 people. Again, this is important. The map does not show the prevalence or the total number of covid19 cases in the zip code because most people have not been tested. And i want to stress that no zip code or neighborhood is inherently safer than another. Every san franciscan should continue to exercise precautions. This map should not make anyone feel more relaxed or, at the same time, more fearful. The number of cases diagnosed in the city, just over 1,200, are small compared to the overall San Francisco population, which is over 800,000. All san franciscans have been doing a tremendous job of slowing the spread of the virus. The map itself does not answer questions about why there are more cases in some areas than others. It is descriptive data based on the zip codes of people with positive test results. The map shows case counts and simple rates based on dividing the positive cases of those tested by the total population of each zip code. When we look to explain these data, we think of factors that are associated with being diagnosed with covid19. The risk factors for getting sick include circumstances such as whether people are living in crowded conditions and whether they have sufficient support to stay at home and reduce their outings. The risk factors for becoming seriously ill or dying after getting sick include reasons such as age and Underlying Health