Transcripts For SFGTV SFCTA Full Authority Board 20240713

And now is the best time to do it. We are doing a good job, but we could be doing much better and time is of the essence. And last week and is a bad time to be gutting the smta board when the decisions need to be made with quorum, with qualified advocates like director rubke who is a passionate advocate for disabled and the people with disabilities community. And last but not least i love for this making duty free for all. And to come up with funding structure and build ridership up and those who do not feel comfortable riding muni, we need to have space to use bikes to get around the city safely without conflicting with cars so we dont see a spike in deaths related to vehicle collisions. We continue to have vision zero in mind. Mr. President , it seems as though there are no other callers in the queue. Oops. Can you hear me . Yes, we can. Okay. All right. Seeing no other callers, then Public Comment is now closed. Madam clerk, lets call the for adoption without Committee Reference agenda items 26 through 33. Clerk items 26 through 33 were introduced for adoption without reference to committee. A unanimous vote is required for resolutions on First Reading today. Alternatively, any supervisor may require a resolution to go to committee. President okay. Would anybody like to sever any items . Supervisor manleman. Supervisor 28. President 28. Okay. And i would like to sever, madam clerk, number 33. Clerk thank you. I dont see anybody else mr. Peskin no, maam. Clerk all right. President okay. So for the remainder of the item sorry, president yee, i wanted to see if i could sever item number 30. President okay. Safai for 30. Clerk mr. President , that leaves 26, 27, 29, 31, and 32. Okay. Go ahead and call the roll on those items. Awe [calling of roll] there are 11 ayes. President okay. These resolutions pass unanimously. Lets go back to item number 28. Clerk item 28 is a resolution to commend the women and men of pedestrian public works and declaring may 28, 2020 through may 22, 2020 as public works week in the city and county of San Francisco. President supervisor mandelman. Supervisor thank you, president yee. Every year San Francisco honors the hardworking employees of the Public Works Department during National Public works week. This typically includes an awards ceremony, a pinning ceremony to recognize years work for the city and county and tours of public works projects to the public. Sadly, the Current Public Health emergency prevents us from celebrating our public works workers in the same way this year, so i would like to take a few minutes of the Board Meeting today to share our appreciation. Public works employees have been vital to the citys covid19 response. The public works paving crew supported by public works carpen terse and sheet Metal Workers grated the lot at the drive through testing center. Crews from the operations yard helped implement the closed Streets Initiative by closing off traffic lanes. The glass shop added sneeze guards to protect staff and public from the spread of covid19 in public works permit center. The Pit Stop Team in the operations yard administration and deployed 37 Covid Response public toilets in the castro, tenderloin, south of market, bayview, and cathedral neighborhood. The construction and management architecture teams at Building Design and construction support the citys efforts to create safe sleeping spaces. Many public works employees have been deployed as Factory Service workers working with staff from other departments to coordinate the covid19 response efforts at the Emergency Operation center. Those who can work remotely from home, landscape architects, current reviewer, analyst, finance, and i. T. Staff are keeping many important projects moving forward including the animal care and control center and ambulance facility. And every day public works employees provide essential services in the field. Street and sidewalk crews, bureau of staff responding to emergencies and to keep the green spaces and medians accessible. And the hardworking folks of public works have always been essential but are even more so. Colleague, i know you will join me in expressing heartfelt gratitude to 600 employees of San Francisco public works by supporting the resolution before you today. Thank you. President okay. Thank you, supervisor mandelman. Lets call roll on item 28. [calling of roll] there are 11 ayes. President with no objection, the resolution is adopted unanimously. Lets go to item 30. Clerk item 30, resolution to urge Governor Newsom to immediately release the cares act to urgent support to early care provideers to prevent permanent closure and to support families negatively impacted by the covid19 crisis. President supervisor safai. Supervisor thank you, madam clerk. Thank you, president. Really appreciate the hard work and effort that president yee has put into this issue over years. He and i had a conversation the other day and were going to redouble our efforts and do everything we can here locally to provide some help to some of these family and early child care providers working with the mayor to identify some gap funding. This money wont be released until july or august and we have hundred of Family Child Care providers that could potentially go over. Sure folks saw specialties go out of business and pier one imports go out of business. Businesses are going out permanently. And if we dont have child care and they dont have Family Child Care we wont have affordable child care options to help workers go back to work. I know this is something that president yee has dedicated his entire career toward. I am happy to be working with him and taking on the torch in this regard, so i just wanted to say were going to do everything we can to get this money released sooner but we have to find a way to provide funding for these Family Child Care providers and early child care providers so they stay in business as they start to open up the economy. We thank everyone for their support. Thank you, supervisor safai. Madam clerk, go ahead and call the roll. [roll call on item 30] there are 11 ayes. President this resolution passes unanimously. Madam clerk, call item number 33. Clerk item 33 is a motion to concur in actions taken by the mayor in the 13th supplement to the proclamation of emergency release and may 11, 2020 to meet the ongoing local emergency related to the Novel Coronavirus covid19 pandemic. President okay, colleagues. I asked ela to do a report on this particular item because i felt like it had some budget implications and since it didnt go to the budget committee, i thought that wed just do this report right now. I dont know if ms. Campbell is on. Yes, i am available, president yee. President would you give the report on item number 33 . Yes, let me pull that up quickly. This item was theres some main components to it, and some of the main components we looked at were this is the second of the supplements that covered the citys contracting procedures. The first supplement had the office of Contract Administration define the t. Ing procedures for emergency contracts. This one actually provides more detail in terms of the contracting procedure. Under the first supplement, the department requested to try to obtain three quotes. This language here more specifically says the departments are to obtain three quotes before entering into for the emergency contract. And if they cannot, there is to be the Department Head is to determine in writing that that is feasible to obtain the multiple quotes and clarifies the role of the citys departments in approving contracts and it waives the original first supplement it waived some of the citys standard contracting language and this 13th supplement provides more detail on waiving the supplements. There is other provisions of the 13th supplement. It does extend pi another 60 days into july 11, 2020 and cut off the water and utilities and the other major areas and this is the waiver of contacting procedures sand not emergency contracts and contracts in place on may 11 of this year. If they are to be extending for mo later than that area and without the competitive process and that is for nonemergency contracts. And we make a couple of recommendations based on this 13th supplement. And one of them is to codify the existing procedures of the board for hearing supplements that insure they are calendared to the next board of supervisors meeting iffer which no calendar has yet been introduced. For instance, the 14th and 15th supplements have been introduced this week. They should be calendared at the june 3 Board Meeting under our recommendation that will be codified. The other one is the contracting procedures be more specific about waiving competitive solicitation to extend contracts that are intake on may 11 of this year. It is basically more specifically states the controllers should adopt policies on modifying these agreements to extend them for six months or no later than june 30, 2021. And our recommendation that is that the board of supervisors request of the controller and more information on what the departments would be and what the contracts might be. And the department now and between july 11 and the period and could look at the contracts and if they believe they could extend them without going to competitive solicitation and that be an end date after that date that normal procedures would resume. I am available for any questions you may have of our report. President thank you for your report. Any questions, colleagues . When you recommend those to codify, are you saying we should have language in this . In terms of the scheduling of the supplements to the emergency proclamation, right now there is no provision saying creating a deadline for when they need to be considered by the board. The board has the option to concur or reject the action to be taken, but there is no deadline in terms of when the events should happen. And were basically a policy recommendation that the board could consider an admin code provision or other legislative act to clarify when these supplements to the proclamation should be heard at the board. This does not change existing procedure. It merely codifies it in legislation. President okay. Thank you. All right. I dont see anybody else. I will look into some language on that for some maybe to come in the next meeting. For now lets take the roll on this particular item number 33. [roll call on item 33] there are 11 ayes. This resolution passes unanimously. Take care of your grandkid. Madam clerk, please read the in memoriams. Yes, todays meeting will be adjourned on behalf of supervisor mandelman, mr. Kamal mike omar. And on behalf of supervisor stephanie and peskin for the late Miss Elizabeth glass. Madam clerk, this brings us to the end of the agenda. Is there any further business for us today . That concludes our business for today. Okay. So meeting adjourned but i want to also just have a there will be a briefing right after this meeting, so in which the Public Health folks will be coming to the briefing, dr. Aragon, and i believe dr. Baba will be at the briefing. So why dont we take a fiveminute cause and come back to the meeting. Clerk mr. President , for the public, that briefing will be aired on channel 26 for members of the public who are interested in watching it. President okay. Thank you very much. At the end of the meeting we will have a briefing. Right now it is 5 06. I would like to have this briefing continue into the hour, so speakers, when you speak, use your time wisely and we will zoom through this to get through in an hour. Today the director of the department of Public Health dr. Grant colfax may not be coming to this one. Dr. Aragon and Deputy Director of health will get started in a second. Then the other thing that i would like to say is this is a continuation of the briefing we had last week. We didnt get to many of the questions that were provided in writing. And we get certain questions and to remind my colleagues that if you had smithed questions, dont jump ahead of questions being answered because then it becomes random in term of what we are talking about. Lets get started here. Dr. Baba . Yes. Thank you, president yee and thank you to member of the board. There were questions last week about homelessness, so i will be very brief and quick with my comments and i will also answer some of the questions that were related to this population that were put to dr. Aragon and then turn it over to him. So just from a high level perspective, our approach to the Homeless Population comes kind of in three buckets. The first is the hotel response, and d. H. P. Has really taken the lead and isolation and Quarantine Hotel units so that people who have symptoms of covid are covid positive can and safely isolate the quarantine for the period of time that they need to. The second place where we have been working in partnership with h. S. H. And h. S. A. Is the shelter in place hotels that the city has been running. That is the party from national, state, and local guidance that really the party there is the people that are most vulnerable to severe disease. So thats people over 60 and people with chronic medical conditions. And all of our teams and multiple other teams touching people in the street and shelter rs and getting them into the shelter in place rooms. And there have been a lot of efforts and adequate social distancing and increased hygiene happening and increased cleaning and masking. And syndromic screening which is they are getting screened for symptoms with staff as well as clients on a regular basis. And people are isolated and tested right away. And through that we have had a few shelters that have tested positive that i am sure you are aware of. And the other thing with shelters is that we other going to Start Testing in the shelters. And yesterday we started that out with the bryant street navigation center. And we tested all the residents and staff there. And to bayshore and we will work through the shelter system and Start Testing there. As has been mentioned in the fast by dr. Phillip, there is no strategy around congregate settings so this is us taking the best science and looking at the paper and data and developing a strategy around the shelter population. Finally the unsheltered population. We have developed guidance on how to safely shelter in place on the street. That includes the distances between the tents and hygiene and what supplies need to be in someplace, what kind of bathroom supplies. Our teams have gone out with h. S. A. Team and other streetbased teams to give out masks, to give out sanitation or Hand Sanitizer as well as Harm Reduction and there continues to be huge demand for narcan and needles. And we are as i think supervisor haney mentioned earlier, we are working with the city on the tenderloin plan, and there already other parts of the city including the mission to look at a similar type of plan and really execute that to make the streets more safe for the people on them as well as people who have to get into their buildings and interact in the neighborhood. So those are high level and happy to answer any questions around that. Im going to answer three specific questions, and i will b very brief on these. Question 16 was really about congregate settings and hot spots and what our approach is there. And congregate setting is a range of different settings from Nursing Homes and longterm care facilities to the jail, to shelters to s. R. O. S and each deserve their own approach because there is a little bit different way that things flow in and out of those settings. But in general there is a lot of prevention measures and mitigation measures occurring at all the settings. Screening for symptoms. Protecting individuals by masking and cleaning and if there is a case discovered and intense case contact investigation and potentially testing to go to mass testing if needed of all those situations. And with the referral to isolation and quarantine rooms. And the question eluded if there is a lot of positives in congregate settings it could overwell the system and completely agree with that, and we need to be very vigilant and much more surveillance around the congregate such as the sniff testing and shelter testing as well. This next question around homelessness was question 23. And it talked about homelessness and Behavior Health and the citys plan for addressing this issue because it was an issue prior to pandemic and it is probably going to be much more strained given the pandemic. I think all of us know that covid19 and the issues of isolation are going to lead to a lot of Mental Health issues. We do expect to see surge in this need. Our Behavior Health services are open and they are considered essential. And they are actually taking more referrals on. Were doing a lot of tele health as another modality, but our services on the street continue. So all of the Outreach Services including crisis and including Harm Reduction, street medicine, behavioral health, are all interacting with those on the street to try to provide services in a timely manner. And we do know that that will be a place that we need to expand and improve especially if the pandemic lost much lasts if ar long period of time. And then the final question was question 28. It was what is written Public Health plan for addressing homeless encampments. And i think one of the things that we showed through the tenderloin plan is this really does require a whole city wide effort for encampments. And so we in Public Health will provide guidance and the Health Aspects but we are working very closely with h. S. A. , h. S. H. And a lot of Partner Agencies to address encampments and including safe sleeping sites and mentioned as well and working as a city wide team to bring those online. I am going to stop there and happy to answer any questions related to the issues. President for what dr. Baba presented, are there questions . I see supervisor mandelman is on the list. Supervisor thanks for being their, dr. Baba. I want to talk about how the department is thinking about the Behavior Health response over the next six months, year, whatever this period is. My understanding is psych emergency is now down to no more than 18. I am certainly seeing a lot of folks who need to be with psych assistance on the streets and certain certainly intoxicated. I dont imagine there would be answers right now, but i would imagine in the next month or two its going to be important to to thinking through strategies and intoxication on the street. And leaving folks outside seems not like the best answer. How is that i know there is people focused on halfway focused on the covid19 response, but also seems like Behavior Health crisis has certainly gotten worse over the last couple of months. Thank you for that, and you are right, supervisor. We know the Behavior Health crisis has gotten worse on the streets an we are anticipating there will be in general more Behavior Health needs across the population. I think one of the things that we have to look at is we dont have access and to stabilize and to open the gates and more of a neat. And getting our teams to have a lot more about overdose and the age of the pandemic. And we are ruling on tele health. And it will be an ongoing evolution as the science of the disease gets more clarity. I think its going to be urgent. It was bad and it is getting worse. Absolutely agree. Sorry. I had technical difficulty here. Are you finished, supervisor mandelman . Im sorry. I guess you are. An i am finished. Supervisor ronen. Supervisor yes, thank you. Welcome, dr. Baba. A few questions. You know, i am in the middle of creating a mission plan and this is after learning about the tenderloin plan and today supervisor haney introduced a hearing request on the tenderloin plan because he hasnt noticed a ton of change. It is impossible to have change unless we have places for people to go. I learned today that had department of health and as a covid positive site and originally i thought that was because you were going to place people there that couldnt selfcare and they couldnt go into hotels, but then learned from abigal that is just going to be a congregate site for individuals that are positive. And there is no clear plans for it. No timeline for it. So as i develop this mission plan with the tent encampments and reopen the Division Center in the appropriate socially distanced way to move people from the that area and can you talk about d. P. H. s position on reopening and Division Circle is close and are refusing to open hotels and with any sort of haste. What are the purpose of the plans if we have nowhere to move people to . Thank you for that. I know for the hotels and this is secondhand that they are opening this as fast as possible and more hotels coming online this week. Congregate settings do need to be considered. And after what we saw at embassy south, we are being very thoughtful about how these can be open in a way that really ensures that there is no disease spread. And to talk about Division Circle and what the best use of that to be and happy to have that discussion. An i guess originally there was some talk about being safer on the treats than the congregate living facilities that have bathrooms and showers and staff run and are socially distanced. I dont know if you have been around, but it cant get worse than that. There is no water. There is no bathrooms. There is no social distancing. So it just cant possibly get worse and they are in front of peoples homes and businesses. And i just you are leaving us all between a rock and a hard place and not moving at a reasonable space for hotels and dr. Aragon has refused to open any real timeline or present any real goals. You wont allow the city to reopen the congregate living spaces, and so we have over 300 people sleeping under the most dangerous circumstances you could possibly imagine with residents unable to walk outside of the house or enter businesses because of it, and no matter what we do and whether we introduce ordinances that pass unanimously, partner to make the plan, we were left scratching our heads and growing increasingly frustrated. Where is the leadership from the department of Public Health to provide realistic guidance and demand of the city to keep residents safe . If were scared another msc southlike outbreak. Well, thats happening on the streets. There is no way it isnt. It feels like we lack a plan, urgency, goals, and even guidance that makes any sense. And every week i say the same thing. I dont know why i bother wasting my breath and a new face and a few person and maybe new answers. Sure. So i do appreciate the frustration and i live in the city as well and do see what is happening on the street and it is not fast enough and trying to get more hotels and to open some with h. S. A. And putting out guidance on the safe sleeping on the street and what is required around documents and hygiene. And i know that we havent gotten there and this is the important issue including your sport and so sitting down with time to figure hout how to do this better and to appreciate that as well as working with supervisor haney in the tenderloin and a large group of people in the tenderloin and frustration there as well. So this is very difficult in the emergency to figure out the right thing and protect the health of people and with the social issues and we are trying to do better with your input. Supervisor i guess that i would just say that having that resource and with the l huge, horrible encampments that are right next to them makes no sense to me. And is like making me want to pull my hair out, but i will continue to advocate because i dont get anywhere. Another question is about really glad to hear you are starting to test in congregate living facilities because when over half people dont have symptoms when they are covid19 positive to use symptoms a z the way to test and contract trace. So with that has changed and regular testing in congregate homeless facilities and s. R. O. S. We just passed a law and the laws have been ignored in the past, i want to make sure that will continue. We are starting to test in shelters and we will have to work with the shelters and depend on the testing results, so yes. Supervisor haney. Thank you. You mentioned the tenderloin plan a few times and i have trouble understanding that area and i know we have the testing site here. Is there a broader set of goals that you have around who is going to be tested in the tenderloin and what levels of priority and we have an increase of 300 of People Living in tents. Are we going to be going out and testing them . What is the d. P. H. Strategy for the tenderloin . D. P. H. Has weve contracted to work with the community and will be involved in outreach and testing and large positives will be a combination and strategy and to come in as well as other unsheltered people to with the role of who will be tested and the focus around that is something that could lose a little more clarity. And i do just want to pick up on one piece of what supervisor ronen brought up around the shelters and the navigation centers. I have continued to be cold that there are districts that are closing or used as a post covid site. I asked dr. Argon this last meeting and i havent heard a strong argument of why to put them into a congregate setting. Are we certain they under no circumstance could contract the virus again . Is the immune system more vulnerable because they just survived this illness . The shelter guidelines are still in effect and is social distancing with the precautions to take in any shelter and this is a way to get people indoors into a place where they could stay and not necessarily have to have shelter. So were taking all the precautions and to make sure they get the screening and this is based and the c. D. C. Guidance and how long the disease is culturalable and it appears after nine to 10 days it approaches zero. While that is still needs more Research Behind it, they have changed the guidance space on that and a lot of the nation is looking at that as a marker. So people are going from the hotels to the shelter. Potentially they could be. Yes. And last question, and similar to what supervisor mandelman was saying around Behavior Health if somebody is wanting to go into detox, into treatment related to substance use, to exit a hotel and go into treatment, what sort of opportunities are there for that . I have come across people who want to go to detox and treatment and unclear on what we can offer them. Because of covid, theres been limitations in admissions and if there was room and to the quarantine of the area and get tested. And is negative and does not guarantee and quarantine this time and join the general detox population. And supervisor peskin . Thank you, president yee. Doctor, thank you for all your work. And i am probably frustrated as expressed and supervisor ronen and others and i think that the statement around their lack of a real strategy and seeing more broadly on homelessness and Homeless People and the covid crisis is quite evident to all of us. And i want to say the contract between the way in which the department of health and looked to other cities and other countries for the best practices in how to prevent the spread of covid19. Apparently and maybe i should say this as a question and not a comment. It seems as if that exercise has not been done with respect to how we are addressing homelessness. I appreciate the efforts you identified, but my question for you, has we done this . Has the department of Public Health looked at other cities and other countries . What is the Gold Standard here . What is the with the effort that has comprehensively addressed the homelessness and Homeless People in the context of the crisis we are following and who is responsible . Is it department of Public Health . Is it elsewhere . And i am not interested for the point of assigning blame but looking forward with who is the Department Responsible for creating that more comprehensive plan for congregate settings and within the Public Health crisis. And it is a great question and we have absolutely been talking to our colleagues and not an easy solution to come to and in close communication and the exper cease around homelessness. And a lot of places seattle, l. A. , boston, new york, atlanta, baltimore, and been discussing with all of them the strategies. And is talking about this as Public Health experts coming together and really talk about what has worked and what hasnt and what our experiences have been. So what we have noticed on the west coast is we have moved towards hoteling and that hasnt happened in other parts of the country. And that is the nature of how they house the homeless given the winters. And so taking some of the learnings that they have experienced from congregate settings and boston has had multiple positives and multiple shelters when they started testing. To figure out a safe way for congregate settings and h. S. H. And h. S. A. In term of who is responsible, it is a city wide response, but we most closely work with h. S. H. And h. S. A. To provide them guidance and working as a team to get that guidance implemented. Supervisor if i could follow up on the first part and i appreciate that you are in toech with a lot of different cities and whether nationally or internationally, is there a city or multiple cities that you would point to and adopting best practices or is it a matter of piecing together the different strategys . Right now it is piecing together and on the west coast we have been in close touch with seattle on the forefront and a lot of Lessons Learned from their shelter experience as well as their nursing Home Experience and we are in deep touch with them to learn what they had learned after testing and Contract Tracing in the populations but we are all struggling with the same thing how to make congregate settings safe and to get the unsheltered homeless in this period of covid. This last question and for asking multiple questions, be u this discussion in happening now to figure this out, i assume this is not just started. Has the discussion evolved . We knew there was a Homeless Population and that covid19 would likely spread here and i realize that it is not that you are wasting time, but it does not appear other than moving forward to get Additional Hotel rooms and launching safe sleeping sites in terms of a comprehensive stage, i am understanding how we are in the early stages months in and what is the barrier to a development of a strategy, not implementation but the development of a strategy. That is the last question. Thank you. I think one of the big things as testing has come online and thinking about how we implement testing to ensure that we are providing a safe space and a safe area to people in congregate settings, it hasnt come online enough to test everybody and we are having to roll it out based on risk of death. And that is why we started with the Nursing Homes because that is where we definitely see the most death, but we are moving quickly as quickly as we can to the shelter system because we know that is another place where there is a huge need. But there is also been some incredible cases of a lot of spread. And so using testing as a tool to potentially ensure that we can have safe congregate settings and part of this will be learning because there is some point testing happening across the nation, but it is spotty. And a lot of this will be data that were collecting with our colleagues across the nation to figure out the best strategy. President okay. Thank you. Supervisor peskin. Supervisor thank you, president yee, and thank you, doctor, for joining us this afternoon. As we actually just unanimously passed a piece of legislation with regard to one typology of congregate settings and singles and occupancy hotels. So there was a little bit of a struggle i referenced over the weekend with your colleagues at d. P. H. Which didnt come from a bad place but i think really came from a fundamental concern about supply train constraints as it relates to the ever evolving loosening amount of testing that is available in this and other cities. And one of the things that as we all want to do as much isolation and hoteling as you call it as possible in congregate settings, and as Speaker Pelosi said testing, testing, testing in congregate settings. I know as a City Employee and we all see as City Employees that any City Employee can go down and get tested at any time, and i know of several City Employees personally that have been tested multiple times. Is there relative to and maybe we can drill down into numbers a reason why City Employee cans be tested repeatedly and i understand they are front line workers. I am not saying they shouldnt be tested repeatedly, but we dont or have not spread out that testing resource for individuals in s. R. O. S where there have been hot spots to be tested once. Can you help me understand that . I think part of it, supervisor peskin, is figuring out the resource and matching it. So we are trying to expand our Testing Capacity as supervisor haney mentioned, there is going to be a testing resource in the tenderloin, and it will hopefully be a mobile resource. But part of it is we have these stand alone entities and how do we then figure out how we can get better access to testing in Certain Community where is we know people are potentially understood served and dont have great access to testing. I think the other thing i really want to point out here is we need the Health Care System to come along with us and for any of you that belong to any other Health Care System, it is much harder actually to get a test compared to what d. P. H. Is doing. And so we need to figure out because we as a city cannot bear the burden of trying to test almost a Million People on a regular basis. That would be untenable. So really the strategy of what our mission has always been is to the people that we know have poor access to medical care. We know because of cultural language, other barriers, have poor health outcomes. How do we match these upcoming resources to those places . And i will say for the essential workforce, one of the reasons that that has been pushed is we saw in the Mission Study that actually essential workers that are having to go to work are turning positive. And a lot of them dont have the ability to say no to their jobs because that would be a lost paycheck. So we really do want to try to make testing very accessible to that work force because they are taking on more risk than the general population sheltering in place. Supervisor and one followup question and i will relinquish the floor. But in so far as the chief Health Officer has truly extraordinary powers, has there been any talk of mandating the testing behavior of private, noncity, nond. P. H. Entities to harness them towards the congregate, vulnerable population that we all agree should be should have access to the most amount of testing . Those people whether they are the folks from the Mission Study or folks who live in s. R. O. S or shelters. Is there any im sorry to use the word, but discussion about commandeering private testing resources . We havent gone down that road yet. I think were still looking into discussing with the Health Care System how they can open up their testing supplies. I think one of the things that we all know is with the shelter in place starts to lift and we will need testing not just in San Francisco and across the bay because it is such an interconnected area. If we really do want to protect our workerses and the People Living here. We also need to make sure that the surrounding counties have the same capacity and capability as us because once that starts happening if we are not in sync it really doesnt actually matter what we do in San Francisco. Disease will continue to be introduced. Especially with the regional partners and the regional Health Care Systems, it is a discussion that we really need to push as a region. And as you are saying some of the most essential workers. Supervisor peskin . Im done. President thank you. Dr. Baba, what i would like to do now is maybe turn it over to dr. Aragon and dr. Aragon, you have approximately 20 minutes. If you could maybe revise your discussion and where you are answering for maybe 10 minutes less than 10 minutes of whatever you can answer. And leave the other 10 minutes where my colleagues could ask you questions. Okay . Okay. Can everyone hear me . Yes. Fantastic. I am going to go ahead briefly and in just cover some of the key questions. The first question 14 was on asymptomatic testing. And when you look at the state guidelines we have actually made progress on most of the them, and as the discussions just shows, we still have room to go. I am going to skip question 15 at this point because we already talked about the testing sites. But i think what you will find is that if you go online, the testing is increasing. Question 17 asked about what was the rationale behind requiring health order for the Skilled Nursing facilities. And really the key there and the key concept there that were applying is that because there is such a high risk of transmission and high vulnerability and is also an area we know that across actually, across the world almost half the cases are due to persons in Skilled Nursing facilities, so we knew that was an area that we could have the big benefit in terms of prevents deaths. That is one of the reasons with the Skilled Nursing facilities. And mandatory orders and basically core Public Health activities and things that we would mandate and we already do that across a lot of other different Communicable Diseases. I am going to jump to the questions near the end that ask asked about my Health Officer authority because sorry, theres a lot of questions. Question 29, what is the plan for reallocating Public Health resources that were being warehoused or surged in case of the Public Department of health nonessential employees. Right now the city and the city through the e. O. C. Is going through a planning process because we realize right now at the e. O. C. We have over 500 staff that are on site with the amount of work to do all this work around covid is very, very large and we have to go back to that work and figure out how to back fill those positions and scale up in those areas that will be really, really important. And the areas that you have already mentioned some of the areas and that is testing is really key. The Testing Capacity has to increase even beyond what the goal is for the region. So right now the goal and if first goal is with the scale up to two per 1,000 and will meet that relatively easily based on the current activity and when you look at the amount of testing that has to be done across all the areas of vulnerable, its going to be much more than that. And so you will be hearing more about that and were also working with state Health Department and ucsf around Case Investigation and Contact Tracing and the other areas is with the better Surveillance System with dr. Coal fax that we need to have an Early Warning system to see whether the activities puts us at risk for a large outbreak and we dont move backwards. Question 30 asked a question about future emergency such as poor air quality and heat wave with issues of cloudy sky t ma change and we have activated a unit that is focussing on the i am hearing an echo. Okay. So we did develop a unit to focus on the specific types of threats. And i think the fact that we are activated is going to make it easier for us to do deal with that and just because we have more resources that are activated across the city for those types of activities. And okay, question 33 and gets specifically to issues of the Health Officer authority. It says here how many times have you been contacted by a representative of the Mayors Office . I am actually rarely contacted by the Mayors Office directly. They usually go through the director of health and director of policy and planning. Dr. Baban is the Deputy Director of health and the policy and planning is under her, so if they need to contact me, they go to them. How many sometimes have you been contacted by a supervisor . Rarely contacted by boards and supervisors, although that has changed more since the covid outbreak. In general they go through the director of health and policy and planning. On january 21, i operated the Departmental Center for covid and was the Incident Commander and briefed the boardover supervisors and the staff three times a week. When the role shifted to Regional Health orders, i stopped providing the briefings to the board of supervisors and the briefings were taken over by the e. O. C. I report to the director of health and take policy direction from the San Francisco Health Commission and the director of health. Question 34, how do you make determinations to what is essential and what is nonessential. I am assuming meant the businesses. Those started with published guidelines on where to consider essential infrastructure and Critical Services so when we initially started meeting with primarily it was led by santa clara and their council. They had already done a lot of background work on identifies what is considered critical infrastructure, and they started with that list in terms of identifying what would be essential. The state had a similar list that was broader than ours, but thats how we started. I am not an expertise in that area and i are elied on the council across the region to consider whatevers considered essential. What is the process that you understood take with the City Attorney undertake with the City Attorneys office to define what is in the best interest of Public Health . That really varies depending on what the Public Health issue is. With respect to Communicable Diseases, thats actually an area of expertise for me. I started my residency in 1988 and 1993 is where i first started working in Communicable Diseases with the h. I. V. Aids epidemic at San Francisco general hospital. In 1996 i became the Communicable Disease controller, and i was since my Health Officer role in 2011 i had been involved and early on i was involved in sars, h1n1 pandemic, and mers and ebola preparation here in the city and also zika. So a lot of it really comes with the expertise that i have and the expertise at the Health Department and where were deep in term of people who have a lot of experience in Communicable Diseases. So really thats really, i would say thats really what is driven most of our activities. And i can provide more detailed information. We have published documents and guide sheets on how we approach Communicable Diseases. So basically i just want to make sure i cover this. So when we meet with the City Attorney, we basically the way that we have been working with the City Attorney and for me this has been a the last time i work this in depth with the City Attorney was with ebola preparation. During ebola we updated all our Health Orders around isolation and quarantine and so this is the next opportunity that i had to work closely with them. Basically what we do is we describe to them what we want to achieve, which is really basically interrupting transmission and saving lives. Those are the two key things that we try to figure out what to do. And how we want to achieve it and what are the different interventions, so we had moved and we had moved to sheltering in place as really a big Public Health strategy to interrupt transmission by shutting down and shutting everything down. And then why, the rationale, so core intervention for control and Communicable Diseases and other interventions are failing. And with the intentions and is a back and forth. And it is an iterative process and what we think is going to work. And the work criteria, what are the criteria and how are they weighed against greater good or through the equity lens . And that is actually a really good question from the Equity Perspective and i can tell you how i approached it and so i would say in general and this is in general what we know from large disasters, large disasters will amplify existing racial and social inequities. And so what we have focused on was how can we, the first focus is on how can we interrupt transmission broadly and avert a large catastrophe. At that time we were seeing what was happening in italy, and we felt that we had to do Something Big to prevent italy because we knew that if we started to become like italy, it was going to make everything worse for everybody including those who are most marginalized. And then the second one is to work with racial and ethnic groups that would be more impacted. Er early on in the pandemic i worked extensively with the department of Emergency Management to conduct outreach to the Chinese Community including working with supervisor fewer and yee. I worked with the latinix community including primarily doing media interviews and work with supervisor ronen in the mission doing a town hall. And theres others here that i wont have time to mention. A couple of days ago we actually, yesterday, we met with the latino task force. I am going to go ahead and stop there and realize the amount of time. And i am happy to provide these in writing to you, but i wanted to leave time for questions. President thank you, dr. Aragon. Any followup questions . Supervisor preston. Thank you. Dr. Aragon, i wanted to ask you about where we left the meeting last week. I think last one to ask you question. I think i was noting that in contrast to the very detailed orders that you have issued on so many aspect of life, everything from what kind of construction can happen in San Francisco, what kind of business can be open or not, what kind of sport can be played, you name it, in a range of very appropriate orders for the most part, we have not had your orders around anything addressing the unhoused population. And my question last week and my question again this week was, why have there been no orders specifically around unhoused people . And do you have a plan to issue any orders . Last week you wanted to confer with folks and come back with an answer. We are almost out of time here. And i think we need to answer to those questions. You are asking a really good question. And i would say in general the way that i think about this is that generally we do orders when were and actually, i did and i remember i did cover some of the concepts last time. We usually do orders when were requiring assets and people that we do not control, so generally the general population when we are restricting movement. So isolation and quarantine, for example. That is different than, for example, us, me giving orders to the Health Department which is an asset which is under the mayor and i work for the mayor. I work for the department of Public Health. And so it seems to me that i would to me those are policy decisions, Strategic Policy decisions how that department and other departments and the mayor and the board of supervisors Work Together to make policy and to implement policy. To me that is very different than requiring activity across a whole city where were asking and taking away individual persons rights and asking them to shelter in place. So the orders are focused on broad things that impact the whole population. But not specifically directing policy choices and strategic choices by departments that i work for. I think these are really good questions. So somebody show me an example where a Health Official has issued an orreder to require their department to do something. I think thats a policy choice. And i think that is where the decisions lie. I dont want to belabor it, but i respectively disagree. I think there may be aspects that are policies and that are left to the political realm. There is a range of things that are core Health Issues and that because homelessness issues can be politicized and are a bit of a hot potato in San Francisco, it appears that you have categorically avoided them. Let me contrast. Your Health Orders make clear to a business that opens up how they operate, how close, how many employees, how close can they operate. What they have to wear. And yet you say nothing about lets say, tents on the street. You just leave it to the c. D. C. Guidelines about how far things need to be apart. There seems to be my impression and i will close with my impression is that you have put anything related to homelessness into a category that you have decided is a policy matter for someone else to deal with rather than a Public Health issue. And i am telling as a District Supervisor and shared by some others on this board that that is creating, that lack of guidance is creating enormous confusion in the streets. It is creating confusion among the Police Department who are not sure what they are enforcing out there in the district. It is created really complete chaos in the streets. We are all trying to deal with it, but were not the folks who have the power to issue Public Health orders tomorrow like you do. So i would just urge you, in fact, beg you, to not categorically leave all this to the political realm and to take aspects of how we are dealing with homelessness in San Francisco that aspects that are clearly Public Health issues and show the leadership and issue orders we need to let what roles are playing by. And i know my colleagues are happy to work with you to develop the orders as quickly as possible. Thank you, supervisor pressson. By the way, there is thank you, supervisor preston. There are three more supervisors that are on the roster to ask questions. But i just want to this is probably not even a question. I dont remember the specific question that we had last at the end of last weeks session briefing. And you didnt have to answer at the time. It was about plan and that you would two back and ask h. S. H. And the relevant departments and you said that you would come up and give us a sense of a plan. I am not getting any sense at all. Supervisor fewer. Supervisor thank you very much. Hello, dr. Aragon. Thank you for being here. I want to echo and my question mirrors very much what supervisor preston said because actually we were made to believe that every policy complements or in accordance with a Public Health issue, order. So when we are telling the constituents also we are saying really the department of Public Health and that Public Health orders take precedence over everything because we do agree that this is Public Health takes precedence over everything now. Over peoples right to go outside and socialize, like we are monitoring all those things. But there is a lack of policy around homelessness, and actually if i could just politely correct you, you actually work, i think, for the board of supervisors. And so i am wondering if we were to bring a health order to you that we think should be implemented and should be actually addressed, so do you think this is somebody that you would be open to that the supervisors would say that because i actually think there needs to be a health order around homelessness. I said last week that everything that we are doing is through this middle class paradigm. It is not addressing the real issues that are on the street. And actually i think as i said last week, it was a little disingenuous that we come to a meeting months ago and the first thing you say is, homelessness is the First Priority and yet we see no orders around homelessness. It is frustrating and i think actually it is causing confusion. But more than that, quite frank linn this is putting lives at risk. We are floundering here and we dont know what is the best situation for them and we are trying to give defense to them and we have a conversation planned for thursday. So i put this question out to you. When the feds stop reimbursing for hotel rooms and we can only fit 50 or 30 of the capacity of unhoused people into our congregate shelters again because it could be a Public Health issue, what is the plan . What is the plan . What are we working towards . We will still be dealing with this deadly disease for a year, year and a half and what is the plan and the health order to guide this plan around the unhoused population . President president go ahead, doctor aragon. Thank you. And of course, i am always willing to talk and meet and to discuss and to take ideas. And the way the process works for me, me as an individual really have to work with a team of experts to sort of really understand what is the best thing and what is the best action that were going to take next. And so i am willing to and absolutely willing to listen and talk about that. But i will have to work with the folks here at the department of Public Health because that is the resources that i depend on to try to make the best decisions in cooperation with all the departments here in the city as well as the board of supervisors. And to give me ideas and something to make progress on and consistent with our departmental policies, i do try to make sure we are clear about that. I was weighed down about this thing and predicted for years and i said to you, do we have enough sites. You said to me, yes, we do. I said, well, where are they . And how many do you have . And you said to me we are confident we have enough quarantine sites for everyone that would need it. You told me that yourself. Im sorry, dr. Aragon. I think its a little disingenuous. I think what we want are real answers. I look forward to our conversation on thursday. Thank you. President supervisor peskin. Supervisor thank you, president yee. I think supervisors fewer and preston touched on everything i was going to ask. I do want to clarify one thing which is the law. The law is every board of supervisors and we talked a thbt last week in the 58 counties of the state of california appoint the chief Health Officer. It is also true that dr. Aragon is an employee of the department of Public Health in his capacity as a doctor. So both of these things are true. Im not suggesting anything. I just want my colleagues and anybody who is watching and the good doctor to actually be very clear. The designation as this very extraordinarily powerful position is done by and serves at the pleasure of the 58 boards of supervisors in the state of california. I just want to state that on the record. Everything else has been asked and not really answered. President supervisor ronen, you are the last one on the roster and we will end with yours. Go ahead. Supervisor i would also say that supervisors preston and fewer mostly made the comments i was going to make. I wanted to clarify, though, slightly. So dr. Aragon, what happens for your position when this board of supervisors pass adieu nan mouse ordinance requiring that the city immediately open 8,250 hotels and the mayor responds that she wont do it. Dont you need to intervene from a Public Health perspective . And do something . I have not thought about that specific question. I dont have an answer for that question right now. Supervisor okay. That is often the case. I will say that we asked a lot of questions last week you didnt have the answers to and were going to come back this week and we havent gotten those answers. I guess this will be another one we add to the list. And then correct me if im wrong, but one of your earliest orders was not to prevent gatherings of over a certain amount of people on city property. That was correct. Supervisor there is an example of you making a Health Decision for something that is completely under our control, is it not . That is true. Supervisor so why wont you do that when it comes to the most important population that is most at risk in our city other than the Nursing Homes that i really appreciate the work you have done there, but for the Homeless Population that you and i have been talking about on the phone several times and in these public hearings for eight weeks now. And you just wont budge on it. I really, really dont understand it. And the answers. So let me explain how that worked out. We were doing orders for the city, and we had decided the more rigorous we actually applied to our properties, but that wasnt me in isolation telling the city what to do. It was just like we are having now, it was a collaborative process of everyone coming together and saying whats the right thing that we can do to also set an example to the rest of the city about restricting gathering. And that is also true for the big issues. And not like i can in isolation tell all the departments to do something. It has to be something that is going to be achievable and doable and that theres consensus that this is the way we need to move forward, and that is the way that one moved forward. Every time we do one of the principals we apply in Public Health is we try to do the least restrictive option because we also realize that people dont always comply and we try to sort of figure out what can people actually accomplish. So that was an example where the city came together and decided with the broader strategy and town stricter and we didnt build that common vision and making sure that happens. The challenges that i faced in the position that i have. And i think Something Like that to need all of us have to develop a consensus and is the consensus and provision and strategy that gets enacted if the order would not be required. Supervisor i would just second supervisor fewers request. We passed a unanimous ordinance requiring that hotel rooms be made available for every homeless individual who was able to selfcare. And i would ask or second supervisor fewers request that you draft a health order reflecting that unanimous legislation. President any response . Can you put that to me in writing. Again, i think that it is really hard to get that kind of request and to have an answer right on the spot. Like i said, for any of these Big Decisions i really need to consult with a lot of folks and sort of make sure that this is the right thing to do. And i will please put in writing and i will take it under consideration. Supervisor i will do that. President supervisor peskin is only going to take 30 seconds. Supervisor yes. This is really more of a comment. Dr. Aragon, i think all 11 of us and if i may say the mayor are united in not wanting to second guess or micromanage our Health Experts in a pandemic or any other medical situation, and i was a little disappointed when you said that you are rarely contacted precovid19 by members of the board or during covid19 by members of the board. I have contacted you over everything from 5g cell emissions to during the pandemic i know that supervisor ronen has personally spoken with you, i have spoke within you on many occasions. I really hope that you would say to me and my colleagues in the public that yes, you do receive calls from us precisely over the issues that we are talking about, which by way of i dont want to talk tales out of school, be u you agreed with the supervisor as a doctor over issues of reducing transmission in congregate settings, with they shelters, s. O. R. S or on the street. You agreed with this supervisor. You agree with supervisor ronen. You actually expressed to us your concerns that if you made those decisions, your job might be jeopardized. And i actually said to you, that we would protect your job because you serve as the board of supervisors appointee. And we want the best medical advice that you can give and given your powers under state law as the Health Officer, we want you to implement those. As i said