Transcripts For SFGTV Health Commission 20240713

There . Commissioner guillermo im here. Clerk thank you. And is commissioner chow on the phone by chance . Commisioner chung yes, i am and i will try for the visual connection as the phone goes on. Clerk okay. And commissioner bernal, i believe that you have smgz to say . President bernal thank you to my chigdzers and welcome to all of the members of the public who may be viewing the Health Commission meeting for tuesday, may 19th. Before we begin i wanted to let everybody know that the commissioners and i have sought to with the support of the mayor, beginning in june to meet twice a month with remote meetings. So on the first and third at a new time at 3 00 p. M. The meeting on the first tuesday of the month will include a covid19 update and a d. P. H. Update and contract items and d. P. H. Program updates. And the meeting on the thursday tuesday of the month includes covid19 updates and well focus on the General Hospital and the laguna honda related issues. So with that lets move on to approval of the minutes. Clerk actually, commissioner, do you mind if i do my intro with the Public Comment line. Sure. So, hi, everybody, i am mark morewitz, the commission secretary. And were using Microsoft Teams which is a remote technology. And as everyone knows by now theres some glitches with these. These meetings dont run as smoothly as the inperson meetings do so please bear with us as we do our best. And the meetings are televised by sfgovtv and we thank them for their assistance today. But if youre watching at home, there will be a delay, and possibly 30 seconds to two minutes, and so know that. And if youre interested in making a Public Comment, im going to give you that information in a second. But, please call in the item before the item that you would like to make comment on to be sure that youre not missing out, depending on the delay of your visual experience. So heres the number and ill put it on the screen real quickly so that everyone can see. Give me one second. So if you would like to make Public Comment on any item, best thing to do is to call in soon or anytime before the item starts, and the number is 888 3634734. And theyll ask you for an access code which is 241350. And the instructions are listed here, and youre able to make one Public Comment per item. You are still going to be timed for two minutes so that you everyone can only get two minutes and ill cut you off after that. And once youre on the line you can listen in realtime to the meeting and if you would like to make Public Comment on the item you hear 0, 1, and youre in line for that item. And i will flash the slide several times and i know that this is tedious for everyone but its the best way that i know to make sure that everyone understands the process. To that, moving on to the next item. Thank you for your patience. President bernal and, thank you, mark, for keeping us all on track and facilitating our new meeting format. I very much appreciate. And item 2, the approval of the minutes from the Health Commission meeting of april 21st. Upon review for the minutes, commissioners, is there a motion to approve . So moved. Second. Clerk commissioners, before you call the vote, i want to note that based on commissioner chows review as i emailed you all, theres two corrections that have been posted online. One is item 11. I made a mistake of putting in laguna honda where it should not have been and i put the wrong resolution at the very end and it should acknowledge the fache contbecause to the Covid Response. So i want to make sure that everyone knows that youre voting on that. And before you vote we need to check to see if theres Public Comment. Public comment line, can you let us know if theres anyone on the line for this. It looks like theres no Public Comment. So you can all do a vote. President bernal mark, will you call the roll. Clerk yes. Commissioner bernal, yes. Commissioner green. Yes. Commissioner guillermo, yes. Commissioner giraudo. Yes. And commissioner giraudo can you keep your commissioners on while youre on the camera and commissioner chow . Yes. Great. Thank you. So that item passes and we can move on to the next item, the directors report. But dr. Colfax is having trouble logging in. So if we might because he has the next few items, if we may go to general Public Comment if thats okay with you all, commissioners . And lets give everyone a few minutes to make sure that they in case theyre watching and theres a lag time, that theyre able to see the instructions. And lets just pause and ge give mr. Colfax a chance to log in and to get Public Comments. Again, thank you for your patience. Public comment line, please let me know as people come on. Thank you. So, mark, commissioners, i will be on the phone and then watching your video. Clerk all right, thank you, thank you, commissioner. Mark, just give us a signal when ready. Clerk yes, sir. Im actually the Public Comment line is having a little trouble and were still waiting for dr. Colfax, so, again, please give us one minute. I apologize. President bernal thank you. No need to apologize. Clerk so i have suggestions since were waiting for these two the issues with the folks who cant log in. Is mr. Wagner on the line because we could move to item 6 and move forward and go back to Public Comment after that. Mr. Wagner, are you here . I am. Can you hear me . Clerk yes, i can. Are you on video or on just audio . Lets see. I am. Clerk you are . Fantastic. So, commissioners, is that okay, and commissioner bernal with a thumbs up . Fantastic. And ill put you on the screen to say hi before we put the slides on, okay. Okay. Clerk and, greg, im hearing double are you watching this indiscernible . No, i dont think so. Clerk okay. Im not hearing it anymore. Does that sound okay . Clerk yes. Ill mute myself. Commissioners, greg wagner, c. F. O. So we are just kind of lat latebreaking information coming out around the city budget and i dont think that any of this is a surprise. Theres been recognition for the city and county and state, etc. , and theres a Significant Impact on the economy and, therefore on the city budget of the covid19 pandemic. And were at the point now where the city is regrouping and reevaluating its budget process. And so all will recall that back in february that we brought under the normal timeline to the Health Commission Budget Proposal which you gave provided feedback to and approved and sent for in the Mayors Office. And that occurred about three weeks prior to everything really changing. So now that we have a little bit more visibility into whats going on in the economy, the Mayors Office and the Controllers Office and the board of supervisors and budget analysts have reevaluated the Financial Outlook and then published that and just as recently as yesterday afternoon issued new instructions to the department. So im going to just summarize a little bit where we are on that and then there will be more more coming as we go through the process. But its going to be a little different and its going to happen fast. Normally we would have had the mayors balanced budget submitted on june 1st to the board of supervisors and then the board would have gone through hearings in month of june. But because were in may and were just now kind of getting a handle on what the Financial Impacts of this is, the city is going to do an interim budget which allows the mayors balanced budget to be submitted on august 1st instead of june 1st. So an additional two months above the usual budget process and that will give us a bit of a time to advise the budget submissions and allowances. So the next slide, mark. So, again, the report came out last week and instructions just yesterday and today, looking at the shortfall for the current year and the coming year next slide. Next slide, please. And so in march the city had done an initial estimate of what the impact of the changes in the economy would look like and provided a range of 1. 1 billion to 1. 7 billion over the current year and the two coming budget years which would be our normal twoyear budget horizon. In the may projection that was issued last week, as that has solidified and it looks like its at the top of that range and a little over the 1. 7 billion. So definitely not a good scenario in the changes in the economy really are in addition to all of the other things that are going on in everybodys lives, their health and their economic situation, this will also affect the citys budget. Next slide. So this is a little bit of a look. This is the citys normal fiveyear financial projection format. And the negative numbers are deficits, so this is the general fund deficit. For the current year that will end on june 30th, there is a 246. 2 million shortfall and then in the coming four years of the Financial Planning horizon, you can see that number really jumps. Its at about 750 million per year over the next two years. And then growing in the out years. If you go to the next slide ill give you a little bit more information about whats underneath that. You can really see a couple of things that jump out on that first line, the general fund sources, negative 487 million in fiscal 20202021. And that is the result of the effects on the economy and we dont really need an economic projection. If you just take a walk around the city. But this is things like sales tax, hotel tax, property transfer tax, and it really has stopped very significantly with the changes in the lifestyle of the city and the bay area around the resulting Health Orders and the covid19 response. Theres also a decline projected for our revenues and the Public Health department. This is really driven by the reduced volume of outpatient, elective procedures, and outpatient visits. All of those things that would just be at our ambulatory care clinics and also our Behavioral Health clinics, where we have reduced visits and reduced reimbursement based on the fact that a lot of those visits that are occurring now are telehealth, etc. And so theres a revenue shortfall that is projected to recover at a moderately slow rate over the next several years. And then at the same time we have the growth as we did previously have projected in our ongoing operating cost, salaries and benefits, and other city operating costs. And so that is how we get to our projected shortfall. Next slide, please. Another piece of this which is actually not fully incorporated into the budget deficit because were all still working to get our minds around it is the Financial Impact of the response to the covid pandemic. We found an initial projection here and this is a citywide projection of 373 million that is likely to be spent or encumbered in the following fiscal year. And some of the big pieces on this are a lot of the response that the city is doing, so the city has been leasing and staffing hotel spaces for isolation and quarantine and for other populations to shelterinplace in. And weve been buying large amounts of personal protective equipment at elevated rates. And the Testing Program that is ramping up. So all of those things that we have been talking about in terms of the response, you have been hearing here and from other forums and beginning to get our mind around what the cost of that is. And it is a massive effort and it does come with a big price tag and it will be worth it but it has financial implications. We have been getting some reimbursement from the federal program. So in our financials for the current year, were projecting significant revenue to the hospital from the cares act. And then the city will is also in the process of developing and submitting claims for fema reimbursement. So that federal reimbursement will help to offset the costs and the revenue also associated with covid. Although there are questions about how long we can count on this and how those Funding Sources will match up for the duration of this. Next slide, please. So the priorities that the Mayors Office has made clear is that they understand that theres going to be some difficult choices associated with this economic downturn and the impact from the citys budget. So theyre asking us to meet reduction requirements which ill spell out in a moment. To prioritize core services. And then, of course, to evaluate how things are changing in the covid environment. I think that it is clear that from everything that i and you hear from dr. Colfax and the Public Health Leadership Team that this is going to be with us for some time and that our response is going to be with us for some time. And the city is certainly going to prioritize investing and all of those strategies and tactics that were going to need to to keep the city safe and healthy. But that is going to change things and its going to change what our priorities are. And other aspects of this is that the ongoing although there are incredit mental changes to it incremental changes to it, and the ongoing restrictions on how we will live will affect the city now that we have a Public Health crisis. And then lastly prioritizing the vulnerable populations and equity in what we do. And that is, of course, perfectly aligned with our mission and our approach precovid and during the Covid Response. Next slide. So the instructions from the Mayors Office are to make proposals that would reduce our general fund support by 10 for the first year of the twoyear budget. And then that grows to 15 in the second year plus an additional 5 contingency. And effectively at 10 in the first year and another 10 for a total of 20 in the second year. So that is a big budget target. It is significant portion of our general fund support. And this is also an instruction that is relative to its almost like were going to start again fresh on the budget. So in our previous proposal that went to the commission in february, we had balanced our budget around some initiatives that we prioritized as a department. But we will have to again to reevaluate and rebalance around those to the extent that were able to go firs forward with the initiatives in the new budget environment. Next slide. So the timelines the reduction plans are due to the mayors Budget Office by june 12, 2020. So its a very fast turnaround and that is driven by what i described before, the fact that weve got a short turnaround time and were very late in the budget process where weve had i dont think that we have or i have never been through a time where we had such a dramatic and unexpected change in the financial picture this late in the budget season. And so this is going to require us to do some fast planning and to turn around the ideas to the Mayors Office by midjune. And weve got to talk with internally and with you, commissioners, about what this looks like in terms of how we interact with the commission on our Budget Proposals. But we do want to make sure that we figure out how were going to keep you mostly involved and aligned with ideas and decisionmaking that goes into this process. Next slide, please. So then just a little bit further out on timelines so, again, here we are may 19th, weve had a lot of news as i have described in the last week on the local and state budget. And then we will be submitting our balancing plans in june. The Mayors Office will introduce an interim budget as i said to buy us two months of extra time to plan. And then submit on august 1st, the balanced budget to supervisors and budget and finance hearings in progress and then in september, just the budget will go out for approval and the mayors signature. And so everything is pushed out about two months. So ill just say lastly that we as i had mentioned that literally less than 24 hours into into getting this news and starting to digest it and weve known that some of this is coming, so we have been doing some thinking on it. Our budget targets, were waiting for the exact amount, but the ballpark estimate each 5 , well, 10 is about 70 million to 75 million. So that would be our first year. And then growing beyond that into the second year. And well have exact figures on those once weve gotten the exact targets from the Mayors Office. So we have been working on it, but this is going to be a challenge for the department of Public Health. And for the city. And it is a large it is a large deficit. A large one compared to even some of the prior recessionary periods and there will be some challenging decisions that we have to make. We are committed to making sure that we do what we need to to keep the city safe in terms of the Covid Response as we go into this budget and theres more to come from us. So im happy to answer the question to the extent that i can. Clerk commissioners, before we go on, is it okay to see if we have Public Comment on this item . President bernal okay. Your conference is in questionandanswer mode. Press 1, and then 0. Clerk do we have any callers on the line . Are there callers . Any comments for this item . Oh, no comments. Great. So, commissioners, go on to questions. Im sorry, greg, that you were on the screen the whole time. So could you raise your hand, commissioners. So commissioner barel in can see if you have any questions. I cannot see folks so they could just speak up. Clerk sure. Does anyone have questions . Oh, this is comigde commissir chow. Could i ask commissioner wagner would have any idea it sounds like the interim budget is just sort of a budget for appropriation, but that the real budget that youre talking about us all trying to have input into would be the one that goes into the august period, is that right . That is correct. As a matter of law and process, the charter has a june 1st deadline in it. And so june 1st theres a placeholder budget which is essentially continuing the current years budget. And so that it meets that charter requirement for the timing, but then it will buy two months of additional time to submit a budget that has kind of the substantive response to this covidinduced economic situation. So youre right, dr. Chow, it will be a place holder and the august 1 budget that were shooting for to make new decisions and address the new economic situation. Commissioner chow so do we have an approximate 2 billion budget. And i dont remember the exact fund let me put it the other way, nearly 2 billion shortfall were really talking about 20 of that being part of our cut in general funds. Woulwhat would that look like to give the commissioners an overview and how you would, as you said and i appreciate the offer there, to be part of the dialogue about this. But what does this actually mean in terms of dollars that we look like were cutting . I mean, 20 of what . Yeah, okay, so our base budget for if you look at last years twoyear budget, adopted budget for 2021, so next year, at about 750 million of general fund. So of our 2 billion plus, its a 2. 4 billion, so were at about about high 20s, and low 30s percent general fund. And the rest is made up with revenue. So the percentage reduction, the 10 in the first year and the 15 plus 5 contingency in the second year are a percent of that 750. And the 10 is about 75 million and then that grows in the second year. The other piece which probably sounds technical but is also very important is that that that target is after we have taken into account all of these things that were on these charts that drive the costs. So we have salary and benefits increases. And we have operating cost increases. Those are going to grow. And then theyre asking us to trim back against that, against that increased budget amount. So its not that we will have a 10 target against what were spending now. It will be a reduction but it will be partially offsetting that growth that youre seeing in the budget that is driving some of the deficit. So that will be our approximate target in the first year. And then growing by 50 in the second year. Commissioner chow okay, thank you. Clerk i believe that commissioner green had a hand and then commissioner giraudo. In that order. Vicepresident green given the presentations that you and your team have done in the past i have great confidence that this will be thought out and a welldone proposal. I have two questions, and one is probably quite naive. But is everything on the table . We have all of these longterm contracts with various c. B. O. S and is there any flexibility there . I mean, some programs may not be able to proceed because of social distancing and it may continue and so forth. So im wondering how all of that fits into this. And then the second question is, given that a lot of the additional expenses do fall under the Public Health umbrella and yet all of these various departments are supposed to be cut by 10 . Is there a recognition Going Forward of the additional cost burden on doing everything that we need to do from Contact Tracing to testing to so forth, and the manpower that would be required. Has the salary increases that youve been looking at taken into account this very likely longterm group of individuals and teams that we need to work on on this pandemic and its long tale of aftermath . Yeah, thank you. Thats a good question. And ill take that second part of that first. It absolutely is the case that the city, both the department and the city, need to understand that because of the situation that were in that there are necessary investments that are going to have to continue our progress on the Covid Response and also to be prepared in case we do have additional surge. So some of those activities are the things that we have been talking about at our previous presentations on that. But it is epidemiology and surveillance. It is Contact Tracing. Testing. And then its surge response preparedness. So we have been setting up excess hospital and postacute capacity in the event that we do have a large medical surge. So well have all of those initiatives and well be moving forward and i think that there is a recognition that we are going to do that and that is going to take investment from the city. So it will not be the case that the department is being asked to cut 10 and then do everything with that reduced budget. But we are going to have to make reductions in our general fund support in order to make that possible. So theres not an unlimited tolerance within the city budget for making all of those investments and i think that if everybody had the choice and they to some extent do, they understand that is a priority. But theres just the arithmetic of the citys balanced budget requirement. So i think that part of the way to view our Budget Reduction target is were being asked to cut back on some of the areas where we use general fund and to allow that savings to be invested in some of these Covid Response programs. So i would expect at the end of the day that our budget is not going to be 10 or 15 smaller. But there is going to be significant realignment in how we use the resources that we have that will shift a lot of the way that we do business. And to gear it so that we are better prepared for the ongoing response and the potential surge. And that goes with the first part of your question, i think, that, yes, everything is with a deficit of this size and i think that everything is on the table. And we do have options. Some which are not going to be pleasant. But i do think that a big piece of this as i said is going to be thinking about the resources that we have and how can we kind of get double mileage out of those resources by having them serve a function that is aligned with or associated with the Covid Response activities. So how can we use our our existing staff to beef up some of that epidemiology work . How can we use some of our existing staff to strengthen the services that were providing in the hotels who are leasing, etc. So i think that is a lot of what the budget conversation is, reevaluating our current responses and thinking how it can be aligned with the needs of the present day. Clerk commissioner green, does that take care of your question, can we move on to commissioner giraudo. Great. Commissioner giraudo, youre up. Commissioner giraudo thank you for this presentation. Its a little frightening to look at Going Forward, and what youre facing. I know that you have a very short timeline to look at the to do this realignment. Will you be able to give us an idea prior to your submission our next meeting is june 3r june 3rd of what your realignment is going to look like so that were aware of this upfront before it goes out into the Mayors Office or the public . Yeah, thats the goal. And this is as you say the timeline here that is really tough. Because 3 1 2 weeks to do this is extremely, extremely challenging. This would be extremely challenge figure we had the usual threemonth timeframe. So i think that what were going to have to do is to have a few conversations between dr. Colfax, mark, and commissioners about what does this look like in terms of kind of timing and process, because we, you know, we obviously want to make sure that the commission is understanding where were headed and weighing in on it. I think that the question there is just procedureally how and when do we do that and what was the process for that. And we will have that june i forget exactly june 13th or whatever that deadline is, that will have to submit to the Mayors Office. And then after that point there will also be continued back and forth over the subsequent month also before the mayors budget submission is finalized. And so part of this is the role of issuing these general fund targets to the departments is to cause the departments to put ideas on the table which can then be evaluated and weighed and prioritized against other considerations or other options that have been put on the table by other departments. So in addition to what kind of whatever the process i dont know what it is today about how well communicate with the commission, there will be ongoing conversations beyond june 13th before the budget is finalized. So between the two of those, we will work out what the best way is to make sure that youre informed and giving us oversight and direction. Commissioner giraudo great. Thank you very much, and good luck. Thank you. Clerk commissioner bernal . President bernal yes. First of all, thank you so much for your presentation and for sharing this with us so quickly after receiving instructions from the mayor. It is a frightening scenario. Given the cuts that wed see from general fund revenue as well as the outpatient and a lot of outpatient with visits and procedures and ambulatory care, are there any areas in which you might anticipate increased revenue from any existing sources or even some new sources of revenue that could emerge . Yeah, good question. So a couple of things that come to mind. Of the negative impacts of this epidemic, there are probably some i guess you could say Silver Linings. One for our Health System is that we are likely to see increased medical revenues as more people are pushed down to medical because of the economic environment. And we would rather not see that. But if it is going to happen, that revenue will help us to offset reductions and to be able to better care for that population when they come into our system. I think that the other big pieces out there are going to we do have some continued work to do on evaluating what we think that revenue impact is going to be from covid and were revising it and making sure that were not too conservative or aggressive. But i think that the other big category is going to be on the state and the federal level and what interaction between those levels and the counties looks like. So big pieces of that is our the state is obviously in a very difficult situation. Theyve got a projected 54 billion deficit. And so some of the areas where they have been able to help i think are probably constrained. And that includes previous to all of this happening, we were in the process of negotiating a new replacement section 1115 waiver. And the successor programs which are a big chunk of our state and federal funding. One of the key pieces is going to be to figure out what is since those plans have been thrown off track by the change in the circumstances, what is the interim Program Going to be and at what funding level. That is potentially the opportunity for some shortterm relief at least. And the other is the larger federal contact. So talked about the fact that there are questions around fema reimbursement, the duration of that, and the level. And then, of course, there are the potential actions by the congress to offer additional relief and there is discussion active right now as you all know about democratic proposal to do another funding package which would include the support for state and county governments. That is not a slamdunk by any means. Its a controversy around that. We read it in the papers every day. But to the extent that there are the opportunities for further federal support for some of this response, that could be a big issue. And to the extent that offsets either the losses that we have or it offsets the general fund cost of all of those investments that we talked about that we need to be able to sustain the gains that weve made on our response, that would help the picture. So i think that those are a couple areas and there are some opportunities out there, but a short timeline and a lot of Hope Associated with some of them. Clerk welcome commissioner guillermo. I wonder if you have any questions since you just joined . Commissioner guillermo no. A number of the questions that i had were asked by the other commissioners. So i just thats my concern is, as others, that, you know, this is a pretty dire situation for us. Especially since the end is not near and so i just feel like we need to be able to follow with you and to get as much information as things develop as is possible to share. Understood, thank you. Thank you, commissioner. Clerk dr. Colfax, any comments on this before we go to the other item . Well, just to thank greg for his amazing turnaround time and his team. Theres a great deal of work ahead, commissioners. I appreciate the concerns that you have expressed and that, again and greg may have said this, im sorry, i had difficulties getting online here. But i think that one of the key things as we face this pandemic, at least through the medium term is how to ensure that our programs adjust, not only to the new normal for what they would have otherwise provided before the pandemic, but if were able to deliver the services that were delivered before the pandemic as well as address the pandemic concerns. That is certainly an intersection that were going to be looking at as we think through our priorities. For instance, some on the Behavioral Health side, were already seeing the challenges of Behavioral Health overlaid on top of the challenges around both preventing covid19 and preventing covid19 from spreading among populations with serious behav Behavioral Health issues. So that would be a place, for instance, to look not only at the ongoing need that weve always had, but foreseeing that the pandemic has only made those needs more apparent. And very specific in a way that wasnt happening before, obviously, with regard to pandemic control. So where there is that intersection of the needs that we had before that only continue, and then in some cases are made more apparent by the pandemic, i think that is where well prioritize our resources Going Forward. Mark, could i just have two more comments after dr. Colfax here. Clerk sure. Im done. Clerk yes, commissioner . Yes, thank you. And im just reflecting on the processes and the fact that as we move forward that we know that in the past when weve had to make significant cuts, there have been a need to really reach out to the communities and obviously to our own employees about what needs to be done. I think that requires really a very strong message from our director and a need you know, to have the commission to define what are those priorities. So im not sure how within this very tight timeframe that we could do all of that and try to also to get the public to understand why these are being, you know, done at this point. Obviously, the state tried that already with having put out that state employees would have potential cuts if it actually gets through the entire legislature. But i think that its important that everybody try to be on board to try to work the best we can out of this very large budget cut. Those of us who have been through budget cuts before know that there are very, very passionate and vocal advocates, rightly so, for their populations. And were going to just have to Work Together on seeing that theres understanding as to what is the priorities needed because of this significant hit to the finances of the city. Clerk thank you, commissioner chow. Any response from mr. Wagner or dr. Colfax . Well, i think that, dr. Chow, thats exactly right. And in this compressed timeline and in this time of social distancing, and the many challenges that we have, your comments are even more salient. And certainly youre committed to achieving the goals within the timeline but also getting as much input as were able to during this period. Clerk all right, thank you. Commissioner bernal, is it okay to go back to item 3 to the directors report . Oh, youre muted, commissioner bernal. President bernal yes, thats okay. Clerk dr. Colfax, and the directors report . Yes, and, again, i apologize for my delayed participation in the meeting. We were having challenge with Microsoft Teams. And so good afternoon, commissioners, grant colfax, director of health. You have the directors report in front of you. And much of what im going to talk about in the covid19 response is going to be covered in that discussion. So there are some details here that i would i would leave in the interest of time for you to ask any questions about. And then the covid19 presentation to provide a high level perspective of where we stand and wh where were headedn regards to the pandemic. I did want to highlight one piece of welcome news. In terms of a new key staff person on the team, a new member of our executive leadership is dr. Clara horton. Some of you know dr. Horton already from her role at zuckerberg hospital. But she has been at zuckerberg, San Francisco hospital, since 2008 as a faculty member. At the department of medicine. And over the past 12 years shes served as associate medical director and then the medical director of the Peoples Clinic. And then since 2018, shes served as the then elected position of chief of staff for zzfg. And shes a dedicated educator and she focuses a lot on the Health Care System and change management. She has a tremendous amount of skills. I can say personally they worked with clare over a decade ago now, maybe at any rate when she was an intern and i i attended the Peoples Clinic, she has political acumen that helps her to be a better administrator. And i always learned as much from her as she learned from me. So im justice delighted to have her join just delighted to have her join the department. So its a great announcement to make to you all today. And then i, again, i will go through the covid19 update as the next. The agenda item and i am prepared to take any questions. Clerk thank you, dr. Colfax. Commissioners, before you might have any questions. Number one, can i ask everyone except actually everyone to mute themselves except for dr. Colfax right now. I see a lot of microphones on and were hearing someone typing. So everyone would please mute yourselves. And then the Public Comment line, any Public Comment for the directors report . Lets give it one second. Im going to share the Public Comment line info real quickly. Okay. There are no questions from the public. Im going to put this line up quickly for that in case number is watching. Commissioners, if you have any questions for dr. Colfax on the directors report, please raise your hand. Commissioner chow this is dr. Chow. I cant raise your hand. I wanted to congratulate you on having dr. Horton selected and in spite of everything that is going on that we havent lost sight of keeping our eye on trying to get key administrative people to fit into our department. So thank you very much. And congratulations to dr. Horton. I dont know if you can hear me but thank you so much and thank you for the nice introduction. Clerk thank you, dr. Horton. Hi, dr. Horton. Hi, dr. Horton. Thank you. Clerk great. Shall we move to the next item, commissioners . Okay. So let me pull this up quickly. Item 4 is a Coronavirus Preparedness update and, again, this is dr. Colfax. Hi. Good afternoon, commissioners. I think that the slides are up. Clerk actually, no, give me one second dr. Colfax. Okay, now theyre up. Great. So good afternoon, commissioners. This is my this is the covid19 update. I would say that its a preparedness response and recovery update. I think that one thing that i would like to share with the commissioners is that not only have we been in this unprecedented preparedness and response mode now since february, but now we are the department is also simultaneou simultaneously doing the recovery part as well as our ongoing response part. So youll recall that in those situations that theres a more linear flow from the response and then one goes into recovery. Were both remaining vigilant in our response while we simultaneously enter at least a partial recovery phase. On top of that recovery phase as we just heard were facing a very challenging budget situation as we also want to help to assist the city to recover in terms of providing the best Public Health guidance and assure acing that investmene made in public are health, and providing guidance and advice. As we also look to have our own ber surprise for what the new normal looks like. So multiple challenges in the department right now. I am confident that we will be flexible, be resilient, and realize the care and services that we are committed to delivering, to reinforce the fact that the things that were doing, the recovery, response, Budget Adjustments and then our fire service is adjusting to this as well. So lots of work ahead in the next in the next era of Public Health. Next slide, please. So this is where we currently stand in San Francisco. And some of these slides look familiar in terms of the format. And i have updated them obviously from the last time that you saw these. But we currently have 2179 people diagnosed with covid19. Unfortunately, there have been 36 deaths. I will say that, you know, clearly one death is too many and it is terrible that we have lost these San Franciscoians due to covid19. It must be said though that our death rate is significantly lower than other jurisdictions. Again, i think that is that we are remarkably 37 times lower than new york. Weryork. And our rate is lower than many other local jurisdictions as well. So i point that out not to minimize the suffering that the city and the community has in San Francisco has had, but to also to reinforce the fact that the actions of San Franciscoians and the community with the shelterinplace has literally saved lives and i cant overemphasize that. Next slide. These are the San Francisco cases by zip code. And this really, again, rreinforces our commitment from the beginning. The reinforcement of the need to protect the most vulnerable and recognizing that the pandemic exploits the fault lines of other inequities and including social and economic inequities. And these maps as you know look very similar to maps that other both Chronic Health conditions and Infectious Disease patterns in San Francisco with the greater concentration of covid19 in the tenderloin and the mission and the bayview neighborhood. And as we go forward you will see some of the work that were doing in order to address these concerns. Next slide. So these are our this is our covid19 response so far to testing. And im sorry, im having a challenge with my Microsoft Teams indiscernible sorr sorry. Oh, okay, one way. So this is now looking at our both our cases and our testing data since april 15th to may 18th. You can see a couple of things. I want to call your attention to the testing data, the covid19 test reported to the Health Department and the proportion of positive results daily. You will see that we have escalated our testing since the end of april. Our numbers in the last few days always look a little behind because not all test reports have been reported for that day. But you can see in general that we have been testing over 1,000 a day. And we are on track to reach our goal of testing between 1,600 and 2,000 within the next month or so. A couple of bar bars that do std out that i think is worth noting on may first that very large number of almost 4,000 tests. We had the tests that we have done as part of the mission study. And the latino commission. The Health Department. And partnering with them on that. And then you also see on this graph the Positivity Rates of our tests. And you can see that for the most part theres been a drop in that Positivity Rate. And you can see in midapril, it was up somewhere between 11 and 12 . Its now decreased dramatically to the range of 2 to 3 . And that really reflects the broadening of our Eligibility Criteria as our Testing Capacity has decreased. So remember that early on in the epidemic we were focused on testing folks who work in the hospital and those symptomatic. And the eligibility extended to people with close contacts and new positives. Were now testing not only that continue to test that group, of course, but testing people im sorry testing essential workers, regardless of whether they have symptoms or not. And so as we assess eligibility, our Positivity Rate decreases because were testing with the goal of finding as many covid19 positive cases as possible. And in terms of our cases, well see on the yellow bars here on the top left of the slide, striking a number with regard to the disproportionate rate of diagnosis with the latin populations, 43 and are among the latin ex population. And reinforcing our efforts in the Mission Neighborhood an ande population. And then you will see a large portion of cases are Race Ethnicity unknown, likely due to the refusal of the testee to reporter on a lack of caution of information by the testing agency. These are tests across the city and not just the Health Department, but by other Health Care Providers, private entities and so forth. Just to remind you that we support the health order that require all covid19 tests to be done through the department. We have done almost 46,000 tests and a percent positive of 7 . Again, thats the average at the time. Next slide. So this is our hospital these are our hospital numbers. And when we talk about flattening the curve, this is what i look like because these are the people who are sick in the hospital with no diagnosed covid19 and since were not able to test everyone, we count on this curve to help us to understand where we are in terms of the virus in the city. And you can see this is the top bars are the hospitalization numbers. Again, from april 15th to may 17th. This curve is not really a curve, which is a good thing, its a flat curve. This is what we had been aiming for since the beginning of our preparedness in february. And you can see, if anything, starting starting may 2, that we have seen a city decrease. And the curve is not only flat but it appears to be decreasing. On the 16th we were down to 53 cases and we saw that decrease a bit. And on the 17th, that line over the past number days is statistically significant. So im really delighted that not only are we able to say that this curve is flat but that in the past few days we have been able to say that it is decreasing. So thats very good news. And then youll see on the purple bars that those are, again, the number of people who are in the San Francisco Hospital System who are suspected to potentially to have covid19 based on symptoms. But are awaiting a test result. And these numbers have remained fairly stable and just to remind you that when you see these blips like on may sixth, that is generally due to testing suspected cases at the laguna honda hospital. So those cases get counted as indiscernible in our database. So overall, very positive picture right now. We know, of course, that this could change, especially as we gradually decrease shelterinplace restrictions. Ill get to that in a minute. But the graph right now looks positive. Its something to be thankful for. While also, obviously, reflecting on the fact that we still have a number of people in the hospital receiving care. Some of them in very serious condition. And as you can see in the light green bars, the number of people in the intensive care units. Either the light green bars or in the light purple bars. Next slide. So this is looking at a Hospital Capacity with regard to hospital beds available for covid19 patients and you can see theres a lot to take in on this slide. Im not going to go into a tremendous amount of detail here. But to say that we have adequate Hospital Capacity in our system. We have 419 i. C. U. Beds available and 866 acute care beds available at this time. And overall that covid19 patients have represented in the last few days about 6 total of our hospital patients. So lots of capacity available. On the lefthand column under Hospital Capacity as of 51720, for instance, you could see that 9 of the i. C. U. Capacity with covid19 patients, 53 are taken up by other conditions and then 38 are capacity with the intensive care beds. And then our intensive care Surge Capacity is up at 100 . So basically this reflects indiscernible . And i do think that its important though as we go to the next phase and ill show you some models on it that this could change very rapidly. And we expect this capacity to change independent of actual covid19 cases. As hospitals go back to more routine surgeries. As people who have been staying out of the hospital do need to get care. So those green bars in the nonsurge areas will likely increase. As you know our own hospitals with San Francisco general which, by the way, have had about half of the covid19 cases recently, and i expect that the capacity of that hospital to increase rather dramatically over the next two to four weeks. Next slide. So i mentioned our Testing Capacity has increased rather dramatically as well has our analytic capacity. These are maps that were just compiled a few days ago. And on the left of the slide are all tests done in San Francisco across all providers in the last seven days. So this is not where the test was done, and this is where the people reported their zip code of residence. And i have to just say this is a tremendous amount of work by the testing and the Data Analytics team to be able to literally take every test done in the last seven days and to geomap it on to San Francisco. And then you can see the positive test results in the past seven days. So i think that theres a couple key points on this slide. We are testing a broad segment of the population in San Francisco based on where they are living. And also you can see that our testing density actually does correspond with the density of the virus. So were basically testing where the virus is most concentrated. You can see the darker oranges in the areas of the bayview and the mission and the tenderloin. And then, again, you can see that those positive tests do tratracksomewhat in the last se. This slide is not just a graphic to report to you, but it will also help us to iterate on our testing mobilization, especially as we increase our low barrier testing. As we execute on developing more mobilebased testing. And as we think about especially in this challenging environment where ongoing Testing Services are provided. Next slide. So this is a complex slide and im going to take a minute to explain it. This is really focusing on the past two months with regard to the propagation of covid19 through the community graphed on the activity of San Francisco overall. When i mean with activity, how much people are indiscernible . So the y axis on this slide is the mobility index. That mobility index is a method that is used to determine mobility in populations based on cellphone movements on any given day. And the blue line, the blue jagged line going from march first to may first, shows that mobility in that through time. And you can see quite dramatic decreases in that mobility. And that is starting in that first week of march and dropping dramatically with our shelterinplace order which went into effect on march 16t 16th. You can see that mobility index was very low for the past month and a half as shelterinplace orders have been in place. So this is not so much this is about the order, but its also about the fact that people stopped moving around because of the order. We are on this chart with the reproductive rates of the virus. The estimated reproductive rate of the virus. And this is been calculated this is an estimate, theres no way to know the reproductive rate of a virus exactly in the population. But dr. Peterson developed this slide and super imposed the rate estimate that she has developed based on looking at the data in San Francisco. The reproductive rate of the virus, remember, is the rate at which the virus propagates through a population. And r1 means that for every case, every person living with covid19, that person passes the infection on to one person. And at r2, every person infected with covid19, that person passes the virus on to two people. And a reproductive rate of. 5 means that for every two people infected with the virus that they pass that infection on to an average of only one person. So you can see that the estimate by dr. Peterson is with the reproductive rate of the virus was a very, very high reproductive rate number of 3. 5 in early march because of the really aggressive actions and supported and directed by mayor london breed, and our medical Health Officer and other Health Officers, that reproductive rate dropped to 2. 6 by midmarch. And then the reproductive rate, they estimate that it dropped to about 0. 94 with the shelterinplace order. This is incredibly important because it shows that the more that we move, the more that people move around, that the more that the virus moves around. You can see that when we stop moving, the virus stops. And the other key concept here is that we need to in order to prevent a surge of hospital numbers and in order to keep that curve flat and going down that the reproductive rate needs to stay below one. We have a narrow window here based on these estimates. That reproductive rate is. 9. Im going to stop here because that was a lot of information and i just wondered if there were any specific questions about this slide and theres more to come. Clerk commissioners, raise your hand if you have any questions at this point. Commissioner bernal . President bernal george colfax, first of all, thank you and your team for the stats. Its very informative. Is there anything that we have seen from the jurisdictions that may have loosened some of their shelterinplace orders that suggest that their replication rate is increasing with more mobility . Well, thank you, commissioner. Yes, we are seeing some of that. As we have seen recently we have sent out outbreaks internationally in some countries that have reduced their restrictions and tracked and seen outbreaks. In the United States theres foreseen increased cases in texas, maybe due to the relaxation of shelterinplace or other restrictions. We have not seen a dramatic increase in cases or deaths in georgia which was one of the earlier states to relax shelterinplace. But i would say that theres more data coming in now but certainly well be obviously be watching this. President bernal thank you. So ill go to the next slide. Unless there are other questions. Clerk other commissioners have questions, dr. Chow, anyone . Okay. So this is, again, a model that was developed by dr. Peterson. This is, you know, data that is projecting into the future. Obviously, we dont have data into the future. So i just want to make sure that everybody understands that this is a model. But it really shows what could happen if the reproductive rate goes to 1. 1 . You will notice on the y axis here that these are the number of covid19 patients in the hospital over time. So this is based on being at. 94 right now. And then shelterinplace being lifted on may 15th. Now it wasnt lifted, just to be clear. Its been theres been more activity allowed so its not as though shelterinplace was lifted. But the key point here is that the reproductive rate just increases by 20 , which is not a lot. From. 94 to 1. 1. And the reproductive rate of this virus is very high. So its somewhere in the range of 3 . So if Nothing Happened and every person infected would pass the virus on to three people. So a reproductive rate of 1. 1 is pushing the virus down to, you know, three times lower than it would otherwise propagate. So that still takes a lot of control. What you can see here is that the number of covid19 patients in the hospital by august 1, is 250. Which is right now over six times the number that we have right now in the hospital. So this just emphasizes the need for us to continue to be vigilant, to be gradual in our reopening, and to look at two and fourweek windows, and one or two incubation periods with the virus as we relax our restrictions on activities. And i also think that we continue to emphasize the need to mask, to socially distance, to implement a strong hygienic measures as we move forward. Next slide. This is what happens if the reproductive rate increases by 50 to 1. 4 . Which doesnt sound like a reproductive rate of 1. 4 , it makes all the difference between. 9 and 1. 1 . And then 1. 4 we get into very serious very serious challenges. You can see here that on the patients on the hospital, note the change in the y axis where we have a thousand patients in the hospital. Off a hous thousand patients ine hospital by august 1. So we have narrow windows and we need to stay vigilant and the key concept is that we want to keep our numbers low as much as possible. These are general population estimates. These do not account for outbreaks which are almost surely going to keep occurring in certain settings. We will be vigilant in trying to manage and control those outbreaks. This is a reproductive rate that would be generalized across the city, just to clarify. Next slide. So the other component to this is that we are in this for a substantial amount of time. Most scientific experts believe that we are in this for an 18 to 24month period at least based on prior flu outbreaks. I think that its unrealistic to expect a vaccine anytime soon. And these are plausible future scenarios based on a Public Health policy think group, cidr18 which happens to be directed by a world famous epidemiologist who directed many Public Health programs in minnesota for many years. And you can see that these are plausible scenarios based on other flu pandemics that we may see unfold with covid19. A peak and valley response, a fall peak response where we have there is a seasonal variation and we see a fall peak much reflective of our flu challenges. And then a slow burn where we may have an initial peak and then indiscernible we dont know which of these will happen. But this does help us to conceptually as we can report about our preparedness and the capacity to respond. I think that our need to be flexible and resilient in our response. Next slide. So these are the key indicators that we will be watching in our covid19 response. We will be looking at our covid in terms of cases and the number of cases and our covid positive test results rate. You saw that has been going down, which is good. And the daily count of confirmed positive patients admitted to all hospitals. That in many ways is our best indicator of the status of covid19 in the city because thats where people will come and we have as you know a robust Hospital System so its unlikely that people who are very sick would not come to the hospitals for care. That also gives theres a delay in that in terms of where covid19 is in terms of the surge because it takes anywhere typically to take a week, even who weeks, for people who have covid19 to get sick enough to maybe come into the hospital. Were continuing to manage to watch our Hospital Capacity. The goal is that fewer than 20 of our nonSurge Capacity with covid19 and you can see that were at 6 pr 6 now. And our goal is to get as high as 2,000 tests per day. And were approaching that goal rapidly. You can see our Contact Tracing and these numbers have dramatically even in the last week and were now reaching 80 of covid positive cases and 68 of contacts. And then our supply of personal protective equipment or p. P. E. And we need to make sure that we than we have a 30day supply Going Forward in order to protect our Health Care Workers and first responders. Next slide. So as we move towards this next phase of reopening, i think that, again, its important to remember that the virus doesnt have a timetable. I think theres been a little bit of i dont know if its a misunderstanding but perhaps the cadence of the Health Orders which was on a 30day period sort of psychologically adjusted us to thinking in 30 days, in a period of epidemic, that the virus doesnt have that timetable. And we are in i think the second inning of a long game. Im not usually one for many sports analogy, but i think that a second inning of at least a nine inning game is appropriate to think of here. And we have we are in phase 2a now of opening up lower risk workplaces. We announced yesterday with the health order, issued a Curbside Pickup would now be permitted and that the manufacturing and logistics change that allow that to happen will also be opened. I would just remind the commission that on may third that the health order allowed construction to to restart as well as outdoor businesses. And in addition to the lower risk workplaces on phase 2a here, we have also issued orders allowing nonessential surgeries and other health care to resume. And then you can see over this next period that we will be looking to move into phase 2b. Allowing retail to potentially to adapt and allowing the reopening of schools, offices and child care. And i would just say that as part of that work that we are working closely with the city stakeholders to determine the safest way to potentially to reopen summer camps for children. We then move on to phase three and phase four. So this is the state, the california stages of reopening and well obviously adapt this for local use. And dr. Eregon, and the office of workforce development, and the city controller, and the city assessor, and other key business stakeholders to to ensure that not only are we looking at this through a Public Health lens but theres a True Partnership developed with the Business Partners so that we can provide insight, guidance, data, to help them open as safely as possible. And then we will also, obviously, look at those key metrics Going Forward to ensure that this these relaxations are not associated with dramatic increases in covid19. Again, i think it needs to be said while were hopeful that the masking and social distancing and hygiene will be effective in preventing that, if in the event that we see concerning data that suggests that a surge is imminent, we potentially would need to go back to restrictions on activity and possibly businesses as well. I think that is the last slide of the presentation. And im obviously happy to entertain any questions that the commission may have. Clerk commissioners, before we move forward with any questions from you, we should go to the Public Comment, all right . Public comment line, can you let me know if there are any callers on the line . No callers. Okay, great. So, commissioners, any questions, raise your hand. Commissioner guillermo. Commissioner guillermo thank you. And thank you dr. Colfax, for the very comprehensive report. Very informative. I had a question that goes back to that mobility projection set of slides. And im wondering theres two parts to it. One is how does that model incorporate or could that model incorporate and modify to incorporate the types of activity . Because as informative as it is, given the mobility information from the cellphones, does the type of activity that people are doing change the model projections in any way . And if so, even if not, how do those projections fit into how we are going to in San Francisco to make the decisions about moving from any one of these phases to the next. And is the data that were going to try to gather related to th that . Yes, thank you, commissioner. Thats a great question. And ill talk to dr. Peterson about whether she can provide more specific whether there are databases that allow for more specificity in terms of that activity. I do think that the question is also i mean, i think that one of the key issues is whether as the activity increases and whether people will still move around by themselves with their cellphones and that curve will go back up. But because theyre Wearing Masks and because theyre soarg distancing and because social distancing and because theyre washing their hands and cleaning surfaces appropriately, that we would hope to see that activity level will go up, right . So thats one of the key questions Going Forward. I think that the indicators will be what we will really need to use. The models are really helpful for us to think through what the implications are of our increasing. And the r is very its only an estimate. And its not something that we can rely on on a daily basis or even a weekly basis. It takes a very large data set to make r. And so wed look at the numbers in terms of our testing and our hospitalizations to determine whether in our Surge Capacity to determine whether these are moving to further restrictions Going Forward. And just determining, you know, whether people are able to adhere to some of the social distancing. Thats going to be a huge determiner of whether we can keep the r below one, the masking and the social distancing piece. Does that answer your question, commissioner . Commissioner guillermo yes, it helps and i wanted to just say first to thank you and the department and the cooperation that you have been having and leading with all of the other departments in the city. Because i think that that leadership and that model of cooperation has really helped the residents of San Francisco to more easily to take on the types of behavior that we need in order to keep the numbers as low. And the infection rates and all of that as positive, relatively positive as they have been. And so just looking for more of that exemplary leadership and information that the department and all of the sort of visible evidence of that throughout the city, i think is very, very comforting. And it is helpful. I think that it is an important piece of, again, why San Francisco county has been able to weather at least to date this pandemic to the extent that we have. Thank you. Clerk commissioner giraudo you had a question . So looking at the projections for what might happen with the replication rates, two questions about as we enter into phase two. I do understand that when youre looking at curbside retail were not requiring applications or filing of plans or anything for the smaller employers. But do we have an indication of the extent to which retailers are opening up or intend to at this point . And then the second question, perhaps you can answer these at the same time theres been press coverage about predictions that we may move to phase b2 in two to four weeks time and is that something that should be father qualified than what has been in the press . Thank you, commissioner. So with regard to the indicator, i dont have a metric that i can share with you about how many retailers have started Curbside Pickup. I do think that theres been, you know, a qualitative feel that has had activity in the last couple weeks. And dr. Peterson emphasized is getting that mobility table to track Going Forward as well. So it will be key for us to look at that. With regard to entering into phase 2b, these are the state phases for reopening and our phases, again, will be tailored to the local conditions around this. And we will need, again, to look at the data over particularly the next two to four weeks to determine whether we are ready to move into the next phase of db. So i 2b. So the balance here is for us to be resilient and to be reasonably hopeful, but also not to be rash. And, again, to realize that the virus does not have a timeline, right . So i think that theres a question if we can stage this, is this going to be appropriately gated so that people can feel comfortable and safe going about their activities in a way that is not going to create an unmanageable surge in the virus. So i think that two to fourweek cycle, because two weeks is one incubation cycle and its going to be vital to determining whether we can go on to phase 2b. If a week from now that hospital surge is ramping up instead of down, were going to have to take a hard look and to better understand that and to take aggressive action, depending if, you know, why we think that is happening before we would be comfortable in moving to phase 2b. And just to be clear, any discussion of a twoweek to fourweek period of time has more to do with incubation intervals, the point where wed have more data to make the determination . Thats right. Thats right. I said that the virus doesnt have a timeline, it does have a calendar in fact that it has a twoweek incubation period. But remember that the other thing that we have to think about is that these are added steps, right. So can we keep the reproductive rate below 1, with Curbside Pickup. Can we continue to keep it below when we enter phase 2b. And i think that its also important to emphasize that i and the department have recognized the negative Health Consequences of, you know, a prolonged shelterinplace and the economic crisis that were entering. There are profound Health Effects to that as well. Obviously, widespread covid19 pandemic on top of that makes things that much worse. But i also want to emphasize that we understand and have a Delivery System or seeing Behavioral Health issues and Chronic Health issues and other things that are happening that are associated i think with this these prevention and aggressive efforts that we have taken to prevent covid19s spread. So were trying to, again, to balance the increase in activity with the fact that we want to make sure that as we increase our current activity that the virus doesnt as much as possible. Thank you. Clerk any other questions commissioners . Mark, yeah, i have several if i can. Clerk yes, please. And to thank dr. Colfax for really an excellent summary of all of the things happening in the last several weeks. Theres several questions that i had and one was simply technically in terms when you share a 30day p. P. E. For this, and i wonder if youre considering that as a need for the other elements of our coalition, including the hospitals and practitioners . Or and, if so, how you measure that. And the second question had to do with the longterm care facilities. I throa note to say that they sd be testing but your reports seem to indicate that we were doing this seqently first at laguna and then reading on. And maybe its a misreading of that because it seemed to me that once we put in the orders, that ought to be done at the other facilities on whatever resources that they have. And not wait sequentially. And i think that, thirdly, more of an overall philosophic issue i should say third is that you did mention restaurants and the state guideline. And in San Francisco this is a very real issue. And, you know, we dont have a lot of outdoor space at a number of places that can be used for being able to spread out more. And im just wondering how we are working with the restaurant people in trying to see what was viable for them. And i guess that, fourthly, is more as the different counties are in different phases, how do we think that that will affect this county which is sort of the center of where the office is and the commerce are being done, right . Its one of the places. So if one county said that you can do offices, do we do that . But then people often travel to those areas which also might be potentially more, you know, prone to covid, right . So im sorry to give you those questions but i thought that if you could answer those, id appreciate it. Yes, thank you, dr. Chow, commissioner chow. I appreciate those questions. With regard to the p. P. E. Issue, as you know that we have worked very closely with the Hospital Council throughout this throughout this pandemic and coordinated the efforts very well. And has been a remarkable leader in that work. And our p. P. E. Issues in some ways were the most challenging across the network of providers and they assured us that their p. P. E. Concerns have diminished quite a bit. And we think that as long as our supply chain is strong, theirs is probably even stronger. So we basically have developed a system where we dont require them to certify they have 30day supply, but we have regular checkins with them to make sure that they are able to have that 30 days. That hasnt been a major concern recently. With regard to the longterm care facility, i appreciate you pointing that out. And just to be clear, we issued not to be clear, but to remind the commission that we issued and they issued a Health Care Order requiring longterm care facilities to test patients and staff for covid19. Basically screening every two weeks. Those numbers i do not believe that are reflected this those purple lines. And that would be if theres a patient at, laguna honda, for example, who might have covid or something who is symptomatic. And our testing has increased dramatically in regard to testing. And im trying to bring up those numbers. Let me just tell you this is routine testing at laguna honda as part of that effort. In the last few weeks we have tested 2,087 residents and staff at laguna honda hospital. This is the routine screening so not symptomatic. And 718 residents, 1369 staff. And as a result of universal testing we did detect four new positives who are asymptomatic. So that type of routine screening is yielding the desired well, its yielding results. Obviously, we prefer to not find any cases but the fact that we found a number of cases that were asymptomatic ensures that we are able to then do contact investigation and tests, close contacts, and hopefully contain the virus. We are assisting other nursing home facilities across the city in implementing this routine testing. Weve already worked with numerous entities over the past few weeks and were continuing to scale that up. So i hope that answers your question about the longterm care facilities. Its a change for them in this new era. And our expectation is that they will make investments in getting their staff and their residents routinely tested with a twoweek cadence in that regard. And another question that you had was about restaurants i believe. And, again, that is obviously a key industry in San Francisco. And i have to say from a personal note i really miss our restaurants. And, certainly, we are working the Health Officer and his team is working with businesses to look at the guidelines from the state and other jurisdictions with regard to safer dining practices. But there is a lot of work that still needs to be done there to determine what would be a safer environment for people to dine beyond the pickup and takeout that we currently have. And then the last issue that we have in place excuse me i could take out and pickup, yes. And so the last question was with regard to the regional approach. I think that one of the things that is really remarkable and should be celebrated is the way that the Health Officers across the region have come together and aligned our pandemic response. And we know that theres a lot of flow back and forth across the region. I think that theres been a lot of theres been a perception that that coalition may be less cohesive than it was previously. And i dont know that is the case. I think that for the most part that we are continuing to focus on the data, science and facts and overall the cautious optimism is aligned. Again, were going to be looking at very similar indicators Going Forward. And i think that well continue to learn and to work with each other to ensure that not only the jurisdictions are directly accountable as much as possible but that were working lockstep in regions because our focus continues to be on fighting the curve and to especially protect the most vulnerable who are most likely to die from the virus. Thank you very much, i appreciate your responses. Clerk commissioners, any other questions, raise your hand. Commissioner green. Vicepresident green oops i muted again. Clerk youre on, youre good. Now youre off. Now youre muted. Vicepresident green there i am. Thank you so much. And commissioner guillermo said it so eloquently and the other commissioners with our gratitude for you and the teamwork that you have demonstrated across all sectors has been remarkable. And nationally, now nationally acknowledge and publicize which i think is a great celebration of your work. I had two questions. One is there any worry that Testing Capacity we talk a lot about having enough p. P. E. Is there enough worry about having enough test kits as we try to expand the questioning . And the other question that i had is theres a lot talk about things coming back and that second graph that you showed and a lot of indicat inds what would be what youre following to indicate that we might have to roll back some of our phases. So im wondering what your vision of that in other words, not only are there certain parameters that you would weigh more than others, but do you think that theres regional consensus if that came to be, especially in the winter. What would be the lagtime if it were necessary between the gathering of data and the institution of a potential rollback of some of these or a reinstitution of restrictions . Thank you, commissioner, for those insightful questions. With regard to the testing challenges that we continue to face, our supply chains for testing have strengthened considerably. I think that where we are facing challenges is in a couple of ways, in a couple ways. We have a vision of universal access to covid19 testing for the city. And that has sometimes been translated into the Health Department is going to test everybody in the city on a regular basis. That is not feasible. So i think that from our Population Health approach, we will be supporting various entities to supply Technical Assistance and to help them to invest in testing and think about if youre a business, for instance, what is your health plan under the covid19 response. And how do you encourage and help your employees to get tested by their health care provider. So i think that theres that broader component where we set our goal and focus and in some cases the requirements for testing but dont necessarily conduct the test. And the other key component of this is as we look at data coming in from the communities that we have historically served, the vulnerable communities, underserved communities and so forth, how do we not only provide testing sites, but were ensuring that were providing low barrier culturally relevant, appropriate testing and services, right . And this clearly has a history of both challenges and successes in the h. I. V. World and i think that we really need to draw and accelerate on that work and not ry learned the lessons of hard way on that. But take the lessons from the epidemic and apply them as quickly and effectively as possible. There is a lot of demand for testing in some communities and among some stakeholders. And then i think that theres real barriers that people have about being concerned about testing. For instance, now that we know that there are a significant to portion of cases that are asymptomatic, how do we ensure that workers, particularly workers who may not have paid sick leave, or who are on, you know, episodic employment and are already struggling to make ends meet before the epidemic, and how do we determine what policies need to be implemented to protect them, to encourage them to get tested and ensure that the consequences of the public test results are not the loss of a job or economic downturn. So we are going to be working with communities and listening and partnering to develop, again, robust lowbarrier testing that really meets the need of the population that is most in need. And also applying this broader Population Health perspective that are with testing and asking other Health Care Providers in the city to do their part and to support testing for not only their patients but also with their workforce and then, again, extending that effort to the Business Community and other stakeholders as well. And then i think that you were asking about the indicators and how we would how we would respond in a way regionally if the indicators started to go up. I think that would just probably be a process where the communication across the different regions would continue and there were signals in adjacent regions that suggested that there was a surge either there or that there was a surge coming, that we would have to look at the data and to make a decision about whether that would require the immediate or the medium term response. And some of those similar conversations that happened in february when as you know that the first outbreaks were really being focused concentrated in santa clara. And so we would just need to continue to look at that information and to determine whether a targeted shift would be needed or a more regional shift would be appropriate. I hope that answers your questions. That was a long answer. Vicepresident green very much appreciated. Thank you so much. Clerk any other questions, commissioners . Okay. So before we move on to the next item, which is going to be item 7, the d. P. H. Human resources update. Im posting the comment Information Online and ill keep up it for 30 seconds and mr. Brown and karen hill, would you turn on your microphones and cameras. Before i go i wanted to acknowledge the incredible effort ever the d. P. H. Team. We literally continued to have hundreds of people at the Operation Center and people have been working 18hour longer days on the ground and anywhere from working in the hotels where were placing people who have covid19, to dealing with treating people for Substance Use disorders and Behavioral Health issues. And setting up testing policies and studies and Testing Programs like overnight. And working on these data analyses like that geomap that i showed. Its just been an incredible effort the part of the team and its very inspiring for me to be able to support so many people in the department. And also across the city. And i just want to thank the commission for their support. I know that you supported and delivered some support to us directly and theyre not in the room but the team thats on the line and far beyond that team, the literally hundreds i think that thousands of people in the department, who are doing this work every day across the city to support our pandemic response. And its just been a remarkable effort, unprecedented. I think we always you know, it reflects our core values and principles, but, certainly, its been realized more than ever before. So, thank you. I want to express my gratitude for that and the commission. President bernal thank you. And no expression of gratitude is enough for the extraordinary work of you and your team and every Single Person in the department of Public Health and our other city agencies to help to address this pandemic. So thank you, again, and well continue to seek opportunities to say thank you and express our gratitude whenever possible. Clerk thank you. So now we move on to item 7 which is the d. P. H. Human resources update. And im going to host mr. Michael brown, the director of h. R. On the screen. Mr. Brown, welcome. Thank you. Commissioners, thank you for allowing me to speak with you today. And, you know, since i have been here since november 4th, i remember the exact date in 2019, and this has been a whirlwind of events that has been going on. I am pleased to present to you some data in terms of what we have been doing in terms of hiring. And with me on the call is karen hill who is my director of merit and staffing. And can explain some of data that we have already provided you. I think that there were some questions and were here to answer those questions if you have any. Karen, are you on . Yes, im here, can you hear me . Yes. Yes, im here. So wed like to start with the questions that you may have unless you want to go through the data on the forms and explaining it to you. Clerk commissioners, you received a report in your packet and i emailed you some responses to questions that commissioner green had sent in a few hours ago. So does anyone have any questions or would you prefer that miss hill and mr. Brown go through the data they have given you already or do you want to start with questions . Commissioner giraudo looks like she has a question. Commissioner giraudo hello. I have one economy following commissioner greens request about the lease indiscernible across d. P. H. And those were answered as far as percentages. Do you have information on the type of leave that has been requested by the employees . Is it family, rather its medical, on what the kind of i know that you dont have that percentage data, but what is the breakdown or what you see as the possible breakdown of the within the leave request . Hi, commissioners. This is karen hill. So the majority of the leaves are fmla. So regardless if theyre covid related, covid leaves run concurrently with fmla. And so the breakdown of the type of leave that an individual would request, whether its covid related, child care related, if its their dependent or their spouse or their parent that theyre requesting a leave for, it will run it would be identified as an fmla leave. But their benefits would be tied to covid. Clerk can you turn on your camera, please . It should be on. Can you not see me . No. Oh, you know what, there we go. Sorry. Clerk thank you. Miss giraudo, any followups to that or did that suffice to answer your questions . Commissioner giraudo no, that answers my question. I assume that is what it was. I didnt know if you had a further breakdown out of the fmla leave, whether or not it was more child care i mean, if you had any subgroupings of family leave . We can break that down if you want us to do a further breakdown, you know it would take some time based on the amount of leaves that we have. But were working on a system where wed be able to break down a type of leave because theres different categories now associated with covid and we never had to go into that granular level. And now that we are we are working on a process. Commissioner giraudo okay, dont do it just for my question the answer to my question. But as youre Going Forward with your own data, i would be interested just because i have the same issues with my staff in looking at the number the different categories of family leave. So it would be of interest as you are crunching your data to please share it. Thank you. Sure, sure. Clerk any other questions, commissioners . Im not seeing commissioner green, could you let me know that youre on here . I think that we might have lost her. Vicepresident green im here, sorry. Commissioner chow here. Im impressed with how well were able to move our hiring process and we have been struggling with this for a number of years literally. So, mr. Brown, what do you see in the future if we can do this in an emergent situation which almost sounds like a normal way of doing hiring, how are we going to ensure that in the future and im taking you at your word that by may 31st that you actually have filled your vacancies. How do we keep them filled . Because if we go back to our way of taking up to a year, if not more, to try to hire people well be back in the same situation. So how do we take advantage of knowing new processes and work to see if these new processes or whatever the processes would be, for a more permanent way of making sure that hiring is really more effective as you have shown . Thank you, commissioner, for that question. Just so you know that part of what we did is that we dismantled some of the norm processees that we used in hiring. But even with that, if you looked at just the nursing, for instance, that theres some things that we did which we can keep as we go forward. And im hoping that it will also blend and lend into the rest of the type of hiring that we do. With the directive from the mayor we were able to bypass some of the Civil Service rule processes in terms of hiring. But what we did specifically is to start looking at with the nurses and hiring without having to wait for the supervisor who is doing the clinical work to do the interviews and the processing. And h. R. Took control of that. And those are some of the things that we can do and to look at in the future as we start in our hiring process. One of the key things to make that work is to have a strong background in terms of the qualifications when you are putting someone on an eligible list so that we can just go down the list. And we dont have to really start looking at interviewing. If theyre qualified by the minimum qualifications, those are the things that will be when you create that eligible list, anybody on there is ready to come on board and we can just go down the list. Those are things that we can work in on the process. But we have to rely on the nurse managers to give us the right information on what were creating to create that list. We have not done that. I think were about 10 years or so before looking at the m. Q. S so theres a bit of intertwining and working that we need to do and working with d. H. R. And thats still in the process for the long run. Some of the lessons learned, we can also look at trying to expand it to other classifications other than nurses. What we were able to do this particular time is because of the directive from the mayor and we can look at old eligible lists and hire people. Were not able to do that in the normal process. But we can use other things in terms of expediting the process and making sure that we have eligible lists that are going to be available or doing examination processes that will be more expeditious in terms of creating an eligible list. Those are things that well look at in the future and whatever we can come out from this process and try to extend it so that we dont have long periods of 260 days for hires, yes, to me that is unacceptable. And hopefully were not going back to that. Commissioner chow i think that as we progress we should know that were going to be putting those in, you know, some of the things that will then help to reduce to a reasonable hiring plan and well just continue to monitor the work that youre doing. Thank you very much for getting the staff on board. First of all, thank you for this presentation and thank you to our colleague, commissioner green for the thoughtful questions which she had asked and your responses. Im just looking at the data that you have here specifically as this and looking at the division indiscernible and the patient eligibility. And just wondering what the impact is of that on the ground in terms of providing services . It seems that these might be positions related for example, keeping capacity for a potential surge. So i guess that is all to say are the divisions on which theres more people on leave are they necessarily people who, you know, wouldnt have as heavy a workload now because of the capacity of keeping open or is it creating an issue on the ground and in being able to perform the work . So in some of these areas like e. V. S. And food, Nutrition Services particularly, we know that theres been impact because based on now what the requirements are for the porters to have to clean, i think that it takes double the time. So since based on the leaves and the expectations and the surge from this, we have hired temporary covid related porters. I believe that we hired close to 80 porters across d. P. H. I think that our goal is 10 more, which is 90. And those should be completed processing by the end of this month. So across d. P. H. We have an additional 90 that is covid related. And the same for food Nutrition Services. We dont have 90 but were working on about 20 positions to support the leave issue for zuk areberg. And those zuckerberg. And those should be filled by the end of this month. President bernal thank you for that clarification. Clerk any other questions, commissioners . All right, thank you very much to mr. Brown and miss hill. We appreciate your information. Thank you. Clerk so i lets see, the next item is item 8, the resolution authorizing the department of Public Health to recommend to the board of supervisors the assessments of 125,652 to the l. H. H. Gift fund from the friends of laguna honda. And mr. William fraser should be on. William i see and hear, can you unmute and get on camera . So what im going to do is to pause for a second and put on the Public Comment line i was testing as well to say, you know, to add that we needed resources in order to sustain this. Clerk so youre on the microphone so make sure that you mute yourself. Is anyone on the line with laguna honda who can try to get William Fraser on . All right, so since im not hearing anything, with your permission can we move to the next item and try to come back to this . Is that okay, commissioner bernal . President bernal yes. Clerk okay. I see you. So, everyone, well move to item 9 which is the laguna honda c. E. O. Report and hopefully mr. Phillips is on. Yes, i see you. Thats great. And, mark, before i begin id like to take the opportunity on behalf of the comeation to welcome Michael Phillips as youre presenting as the laguna honda hospital c. E. O. For the first time. Welcome. Were looking forward to your presentation. In addition we would like to acknowledge and maggie racowski as the acting c. E. O. At laguna honda and during an important time and as well as the work that you have done together, both of you, to sunday t respons pandemic. And really putting laguna honda on solid footing, compared to where we see other longterm care facilities. So thank you to both of you for your fantastic work and welcome Michael Phillips. Thank you very much, commissioner, and thank you to the entire commission for allowing us to present to you this afternoon. I am pleased to be here. And im going to try to do an abbreviated report to just allow sufficient time for questions and to speed along the agenda. Our fixed team has been actively engaged in the effort to ensure that the health and safety of our residents and to minimize the spread of covid19 among our staff and residents and to support the staff and to provide the necessary equipment and resources. And also in supporting the staffs Mental Health and wellbeing. And weve really been focused and engaged in those efforts. We meet twice a day as a leadership group. There are some 20 or 30 of us and all are actually focused on achieving those goals in addition to the daily meetings, we also have two calls on saturday and sunday. And to continue that effort. In terms of the new admissions, so we as you probably know, have not been accepting new admissions since march. That was after the facility went on quarantine. The we received guidance from the c. D. C. That indicated that we should refrain from taking new admissions until the quarantine is lifted. But despite the fact that weve not been taking new admissions, weve maintained an occupancy rate of 98 . In addition, regarding our census, earlier in the year laguna honda hospital implemented a goal of increasing our average census in both acute rehab and acute medical. And that effort was going really well until we went into quarantine. So we will continue that effort after quarantine is lifted. Laguna honda hospital also implemented or requested a program flex to flex our acute beds to smith beds. This is an effort to assist San Francisco General Hospital in Surge Capacity and limiting the Surge Capacity. In terms of our Human Resources and staffing, staffing and efficient on boarding continue to be a priority while the quarantine remains in effect. Our vacancy rate was 6. 5 . And we expedited the filling of nurse positions and thats one of our main focuses. Dr. Colfax talked a little bit about our covid19 cases earlier. As of today, we have had a total of 28 im sorry 29 positive covid tests. Of those 29 positives, 18 are staff related. And 11 are among residents. 13 of the 18 cases on the staff side have recovered while five of the 11 resident cases have recovered. We began universal testing during the week of may fourth. Thus far we have tested 1,369 staff. And with 1,207 tests, testing negative, and so we are pending 160 tests to see what the results will be with those particular tests. Only two staff have tested positive as a result of the universal testing. And we continue we completed testing on 13 residents and on all 13 of our resident units. And thus far only five new residents have tested positive. We anticipate the completion of universal testing towards the end of this week. And we will wait for further guidance on the frequency of universal testing Going Forward. We believe that it will be probably be a month, testing frequency on a monthly basis but that hasnt been determined as of yet so we wait for guidance on that. So ill pause here and see if there are any questions. Clerk commissioners, before we actually ask you for questions, may i go to Public Comment . Okay. Public comment line, can you let us know . No calls from the public. Commissioners, any questions, please raise your hands. Or dr. Chow you could speak up if youre on. Yes, i wanted to also commend our team for coming together and getting back our medicare status. And also to report that the reporting on the months for the aowl over the past year. And thats been something that we normally have asked for and thank you very much for providing that in this report. And i know that youre going to have other segments that ill comment on later. Clerk thank you, commissioner. Mr. Phillips, you can continue. So thats the end of my report. Unless there are more specific questions regarding it. Clerk great, thank you. Any other comments or questions, commissioners . Okay. Thank you very much, mr. Phillips. And, again, thank you for your help and assistance during the past month. We can move back and hopefully go back to item 8, is mr. Fraser able to unmute himself . Testing, do you hear me . Clerk yes, yes. Hello, nice to hear you. Okay, thank you very much. Clerk actually i was going to say to call the item again to make sure that the public understands what were doing. So moving to item 8, a resolution authorizing the department of Public Health to recommend to the board of supervisors to accept and expend a gift of 125,652 to the laguna honda gift fund from the friends of laguna honda. Thank you. All right. Good afternoon, commissioners. Thank you for having me at your meeting, especially in such a busy time. My name is William Fraser. I am the gift Fund Program Manager at laguna honda hospital. Laguna honda report requests that the Health Commission passes a resolution recommending to the board of supervisors that they authorize the acceptance and the expenditure of a donation from the friends of laguna honda totaling 125,652 to the laguna honda gift fund. The friends of laguna honda is a private Nonprofit Organization Whose Mission is to benefit the general wellbeing and the quality of life of laguna honda residents. And theyve been supporters of our communities for over 60 years. Give me a breakdown of their donation, again, 125,652. 50,000 of which goes to the wish list. Let me tell you a little bit about the wish list. Its a longstanding tradition of funding by the friends of laguna honda that allows the departments and the nursing units to request materials, equipment and supply that would be used directly to benefit the residents and to be used directly by our residents. Some examples of that are ipads and computers, large flatscreen tvs and electric pianos and homelike furnishings and those types of things. And then our next category is 5,000 for farm program, our farm is what we affectionately call our animal assisted therapy program. And the 5,000 would be used mostly to pay for veterinarian service. However, our farm program is much bigger than that. But the 5,000, again, would go to just veterinary services. And next category is 20,000, thats been enthusiastically embraced by the friends of laguna honda. We asked for much less than that and they said that were giving you more. So they wish to donate 20,000 for that for discharge packs. And discharge packs would allow us to buy supplies for residents as theyre discharging with the success of that discharge and to maintain that discharge. Some of the items that we would purchase with them would be toiletries and clothing and were hoping that we also can add to that Grocery Store Gift Certificates and to help them to tide over from the hospital to the Community Setting as the services are getting ramped up, it would help to tide that over. Wellness programs, 15,340. We have our Wellness Center at the hospital, its quite nice. And in the Wellness Center we have classes for our residents, including tai chi and yoga. And 17,000 of the donation would be for music programs. And that allows us to bring in professional or semiprofessional musicians to perform live music for our residents. And then the last one is for our voices choir, 18,312. And the choir is a collaboration with the Community Music center. We have a contract with them. This would pay for the next contract year. And i know that a question was submitted by the commissioners about that program continuing. Generally the latin voices choir runs from september to about may of the following year. So we will have to see what the outcome of the Current Situation will be to see if that would continue on. I know that the Controllers Office instructed us to continue to pay our nonprofit providers, but i think that thats a limited time period. So i have contacted the Controllers Office and our contract staff at d. P. H. To get clarification on that. However, again, the normal contract year runs from september to approximately may, 36 weeks, which includes weekly rehearsals and at least two performances by our residents. And as you may understand that its primarily focused on our spanishspeaking residents. And id like to take any questions that you may have at this time. Clerk before we do that i want to check to see if we have any Public Comment. Public comment line, could you let me know if theres anyone on the line for this item. Okay, no Public Comment. Commissioners, do you have any questions or comments . Commissioner bernal . President bernal yes, first of all, thank you soap for this presentation so much for this presentation and thank you to the friends of laguna honda, mr. Fraser, for these generous contributions. The programs that are being funded through this contribution i think are really critical to you know, maintaining and enhancing morale and also creating community and connectedness among the residents there. Given the Current Situation in particular, are these programs able to function currently with this lockdown and with the response to the pandemic . Well, im going to try to give you my best answer on that. The wish list again is the procurement of equipment, supplies, and so those things can easily be brought to the resident units. Many of the residents are having to remain on their units so that is a big challenge for us. But, again, this funding would be focused on the next fiscal year. So we can hope for the best for that. And i cant tell you whether or not the farm programs are continuing. I know that it is normal for them the Therapy Department to bring in animals into the hospital. But i dont know if thats continuing at this time. Discharge packs would certainly continue because it is always to be our goal to get residents in the least lowest level of care and that continues where possible and its just a beautiful program, the discharge packs. And the wellness programs, yes, are not currently happening because theyre communal and they have been in our Wellness Center. And the music programs are not continuing to happen as were restricting nonessential personnel, but, again, i say that the hope is that we be able to use that money with less restrictions on our population next year. President bernal great. Thank you. We all look forward to the day when these programs can continue to the benefit of everyone at laguna honda and the community. So thank you for that and thank you again for the generosity of the friends of laguna honda. Clerk commissioners, it turned out that there was someone on Public Comment so with your permission lets take that now. Caller, are you on . Caller, are you there . My understanding is that theres one person on the line. Caller, you can hear us or hear me . Ill announce one more time, anyone there for Public Comment . Okay. So commissioners, its time to move on to a vote. I will note that commissioner guillermo had to leave the meeting temporarily so theres four of you. Commissioner bernal. Commissioner bernal . Undo your microphone to vote so that we can hear you. President bernal yes. Clerk commissioner green, yes. Commissioner giraudo, yes. And commissioner chow. Yes. Great, thank you very much. We can move on to let me see we move on to item 10 which is the laguna honda Regulatory Affairs report. Mr. Smith. Hi there. Its Troy Williams first before we have adrian come on. And i just wanted to report that and to acknowledge the work that adrian has been doing here as the acting chief quality officer for laguna honda. Hell be transitioned back to zuckerberg San Francisco general on june 1. And since this will be his last laguna honda regulatory report, i just wanted to take the opportunity to thank him for all of his work over the last year and really helping to stabilize the Quality Program here at laguna honda. We were working on transitioning him back in february, and then our Covid Response began and as usual adrian stepped up to the plate when we were asked to stay and to be the Incident Commander and the deputy Incident Commander for our structure. So i just really want to personally thank adrian for all of his work. I know that here at laguna honda that there is soa so much gratie for everything that hes brought to this team and, you know, hell still be available to, you know, to consult on regulatory issues as they come up, but i really just wanted to take this opportunity before he reported out to you to acknowledge all of his work here at laguna honda. So with that i turn it over to adrian. Thank you, commissioners. Clerk thank you, troy. Im embarrassed so ill try to not trip over my words. Thank you, commissioners, for giving me time on the agenda to bring you up to speed with the regulatory report. And i will give you a summary and have time for questions. If we look at the first page i wanted to point out that we had a slight reduction in the amount of cases that are reported. And a significant reduction in the residenttoresident allegations and that really speaks to me about the family that we have here at laguna honda. Our residents have been as much a part of the wave that we have responded to shelterinplace as the staff and providers have been. And theyve really coped with this containment in their neighborhoods incredibly well and thats reflected in the reduction of the residenttoresident cases. And we also had some great news. As part of the waivers submitted to the California Department of Public Health and to the center for medicaid and medicare services, we asked if our first survey could be reviewed as a desk review instead of requiring a reset and revisit survey. And that waiver was accepted. And the District Office of the California Department of Public Health really asked for a lot of information and a lot of data that have been collected regarding the plan of correction. So it was a fairly stringent desk review and they found us to be in substantial compliance with all of the conditions of participation on april 24th. And the denial of payment from new admissions and the daily Civil Penalties seized a ceasede 23rd of march. Which was a huge achievement for the operational side of laguna honda because these changes really showed a significant amount of work and improvement and focus on the patient and resident safety. So i wanted to celebrate that. And i also wanted to acknowledge that we as we move forward in this process that the continual survey and readiness and educational update, that we would normally do on an ongoing basis have been entirely focused on covid and our response to covid. But the state an have asked thae adjust our plan or Quality Assurance and Performance Improvement plans to focus on covid. These two things really have put us in a good place to move forward with our plan because we have a phenomenal amount of data and we have a phenomenal amount of evidence to demonstrate how we have been nimble in the way that we have delivered care to our residents and how we have maintained our Infection Prevention practices here at laguna honda. Thats the high level summary. But i want to give time for any questions that there might be about the material. Clerk commissioners, lets check to see if theres any Public Comments before we are taking questions that you might have or comments. Any Public Comments on the line . Im still waiting. Anything there . Lets go ahead and take your commissioners. I havent heard back and i think were having trouble with the line. Any comments or questions, raise your hand. Dr. Chow. Commissioner chow i want to congratulate dr. Smith and his work and look forward to seeing you again at general. But i particularly wanted to comment on the manner in which the Regulatory Affairs report has been given in terms of the status bars and it helps to summarize whats been going on. When he said that the numbers have gone down, this is really very helpful to allow us to see how each of these are being answered all participants are now commissioner chow to compliment this is something that we have been looking for for quite a while and i appreciate it. Clerk thank you, dr. Chow. Looks like commissioner green, yes. Vicepresident green yes. I just wanted to echo commissioner chow and mr. Williams comments, adrian, about the work that both you and maggie have done. You came in with insurmountable challenges and a huge agenda and an environment where you really hadnt worked before, just like maggie. I think that the way that you not only led the two of you working together but the way that you engendered the confidence of the team on the ground. And it was remar remarkable to u come together to address these challenges and to do so in such a positive manner. And i think that you have created a culture that there that since i joined the j. C. C. I have seen evolve in a positive way and the data that were getting are much easier to understand. But i think that the idea that you and maggie came in and you were able to accomplish so much both culturally and statistically and the effect that you had on the whole profile of the l. H. H. Community with the cdph, is really quite remarkable. And so i just cant quantify how grateful i think we all are to the way that you have all worked together and to your contributions in particular. Thank you, commissioner. Clerk any other comments or questions . So commissioners, we had an issue with the comment line so i want to make go ahead and activate it and let everyone know who might be listening to call in again if somehow they were dropped. Your conference is now in questionandanswer mode. To summon each question press 1, and then 0. Clerk great. Do we have any callers . Michael, this is grant, can i make clerk sure. Can i make a comment . Clerk sure. I just wanted to thank the laguna honda team and, again, to add my appreciation for adrian. And also to troys remarkable work and maggies work with the support of roland. And to the endeavor, i think that its really we have made great progress at laguna honda. And the strength of laguna honda have been reinforced where there were challenges and quite frankly some problems. I think that work has made significant progress and i think that while the pandemic is challenging the Institution Even further that we were fortunate to be able to have the team do the work that theyve done and the staff at laguna honda to do the work that theyve done across the neighborhoods to improve. And as a result were in a much better place for the pandemic and i just wanted to express gratitude to the teams for the incredible improvements they have made and the hard work that that has taken them to do. Clerk thank you, dr. Colfax. Commissioners, we may move on to item 11 which is the action item and another item action, laguna honda hospitalwide policies and procedures. All so, distancing appropriate. Good evening, commissioners. Laguna honda hospital is the hospitalwide policies and procedures for approval. And included in the list are one new hospitalwide policy. One revised hospitalwide. Two revised e. V. S. Or environmental services. And one revised medical staff policy. And two revised nursing. One revised pharmacy. Approval is requested unless there are any questions. Clerk so, lena, i forwarded some questions from commissioner green. Im wondering if they got to you . I think that one was specifically around the environMental Health the e. V. S. Policy, a concern about bleach. Im not sure that, commissioners, if you want to articulate anything else. And if i checked in and out of hospitals with temp checks and so forth, depending what youre cleaning the surfaces with, theres a duration that the material has to be in contact, especially with viruses and bleaches is about a fiveminute window. So i didnt know if in light of covid19 whether there should be detail there depending on the product about how long it must be in contact with the surfaces to be effective . We have notes from the reviser of this policy in response to your question. And it says that there are many different clorox products. Clorox pro is a fiveminute contact time. But we have Clorox Health care and for the cleaners they are both oneminute contact time or kill time. For covid and three minutes for cdiff. Vicepresident green thats great. Clerk im sorry, any other questions . Were talking about cleaning and chemical products. It seems to me that are these the only ones being used . And or are we then having to add each time another product . And i think that you mentioned several other products that dont seem to be listed here. Actually, the reviser of the policy did reach out to me just yesterday and they mentioned that they forgot to make a little note. And if its fine, we will be adding a little note in the policy to state that, you know, when we run out of a product that it will be replaced. And so this was caught but not in time to make it into the version that youre looking at. So if thats okay, we will add that little note so that we dont have to keep revising the policy. Yes, because it seems that with it would be better in general to be well, to be more general by saying that, you know, you need to follow the product time and in this certificate of limiting you, right. So are you suggesting that as we pass this that note to be added to the approval of the changes here . Yes, we would like to do that. Okay, so youre recommending that a note that will indicate that these are sort of examples and not limited to only these, right . Yes, thats correct. Clerk and if you would send the final policy with that note to me i can forward it to the commissioners. Sure, no problem. Okay, that would be helpful. So does this help i dont know if there any other comments but i can make a motion to accept these otherwise. Clerk please do, commissioner. So moved. Second. Second. Clerk great. I will do a roll call. Commissioner bernal. Yes. Commissioner green. Yes. Commissioner giraudo yes. And commissioner chow. Yes. And thank you all very much and thank you for presenting and well say goodbye to the laguna honda folks. Thank you very much. And the next item can we also again commend maggie for the amount of work that shes done and keeping her eye on the ball along with responding to covid in such a very positive manner really. So id like to see if the commission can commend her for that. Clerk absolutely. Thank you very much, miss racowski. Item 12 is the zsfg c. E. O. Report. And i wonder if dr. Ehrlich can pop on. I am here. Clerk great. Now youre on. Great. So commissioners, thank you so much for having me here to do this report. I thought a lot about this report because there is so much to say and ill try to be as succinct as possible and to invite your questions. I wanted to start by talking about our staff because i just cant say enough about how incredible our team here has been. And the thing that came to mind for me was in this definition of heroes. A person who in the face of danger combats adversity through ingenuity and courage and strength. I think that says it all about our team here because they have really done it all. And as i go through this description of what we have been doing with covid, its really hard to overstate how much things have changed here. The buildings look the same, but everything inside them and all around them has really changed so much with covid. And thats been just a huge lift for our team. And theyve done remarkably well. To start were part of the Overall Department Operations Center and we have our hospital incident command systems that meets here now once a day, every day at 10 00. And its basically an expanded executive team meeting that we have that explores every aspect of our operations in detail. And we went from meeting twice a day now to once a day because of the situation that we have. And thats led by our chief of Clinical Operations jeff schmidt who has been an amazing leader through all of this. And our work is led by a surge plan that we created as well as a desurge plan which were in the process of being operational under now and that work has been led by our chief medical officer, and not only has that plan been really been instructive for us and guided us through our operations here, but its also been a model for other hospitals in the city. Weve shared it with them and theyve adopted similar plans and we have, in fact, have a citywide plan that guides our work and has been very helpful in the paradigm that dr. Colfax described. And three people that i want to call out for their contribution and that is our Infection Control nurse Elaine Decker and our feInfectious Disease specia. They have been our guides and leaders on all things clinical and every question that you can possibly imagine having to do with pretty much everything that were dealing with right now. So theyve been front and center in everything that we do. And they have daily clinical rounds and consulting with teams on the patients who are in the hospital and then to the rest of us on various topics and issues. And the other thing that has changed quite dramatically with the entry of patients into our facility. I would say that is a combined effort of the Emergency Department, of course, and psych Emergency Service and our urgent care clinic and the richard fine Peoples Clinic. And im going to show you walk you through data but the data really tell a picture about who how that has changed by necessity as the types of patients have changed quite a bit and as well as the way that we see them and we need to cohort them both in terms of patients presenting with respiratory symptoms and nonrespiratory symptoms and then for what theyre presenti presenting. And the other issue has to do with staff and patient and visitor screening. So as dr. Green mentioned, anybody who comes into the building is screened. We screen staff every day and using temperatures. And we have an online tool and also asked questions when they present. And we are screening patients and visitors and its a very complex way that we have screened them. We have the urgent care clinic set up in the lobby of building five to address patients who have respiratory complaints. And then we have tents set up where people get tested. Those patients as well as staff who present with symptoms. And we have various types and brent and andrew, our chief Communications Officer is the leader on that but we had couldnt biewgzs from other members of our team, including iona johnson who led the screening work. And to address the spiritual issues and the wellness issues that we will try to work with the staff on. And then last but not least we had a huge outpouring of gratitude from the community through the San Francisco General Hospital foundation and the philanthropy they have bought in, totaling 4. 5 million and thats gone for all things directed at patients and staff. And so i will pause there. And theres an update and i wont go through in detail and it was prepared by our amazing chief medical Information Officer dr. Nita. And you can review that and im happy to answer questions on that. And ill pause for a minute before i go through the data which i wanted to go through in a little bit of detail as well. Clerk any questions, commissioners . This is dr. Chow again. And on the update could you see us running down and how they are used in this setting and whether it extends into your exterior efforts. You can see in the report that is written both in terms of optimizing surge, so the epic team has been front and center with planning for the alternative care sites and we they have been very involved with testing or preparing reports so this is not just a cfgsc, but throughout the Health Network and the department. And also with the command center. So there isnt as this report goes through, there really isnt anything that the team and i. T. Hasnt been involved with from terms of helping us to understand the Patient Population and to delivering the data reports which are really been phenomenal and what is going on internally and helping to explain what is happening with the public. So its what we would have hoped, the e. H. R. System could do for us then, is that right . And its really fulfilling the promises that we are hoping for from this type of electronic records . Yes, absolutely. And the other thing that i just want to comment on because you might not notice it but recall that almost exactly four years ago we moved into our new acute care tower. And almost every day i think about how critically important that building has been to us being able to meet the demand of this pandemic. And that starts with the Emergency Department that was quite a bit larger than previously and had individual patient rooms. Our whole inpatient area that has single occupancy rooms. We have an additional i. C. U. Unit that has enabled us to meet the surge in that demand. And so i just am grateful every day that this community and our foundation built that building, because i dont know where we would be without it. Thanks. Clerk any other questions, commissioners, before we move to data. Go ahead, dr. Ehrlich. Okay, great. So, you know, we have reviewed these charts every month at the j. C. C. And they are really different now than theyve ever been and so i think that theyre a great representation of how much things have changed here. So i wanted to just walk you through some of the changes and to give you a chance to reflect on that and to ask questions. And so first of all, you can see right away with the Emergency Department that our average daily volume has dropped by about 30 . And we dont know exactly why. And its probably due to a few things, one, that theres fewer city in the people now. And as dr. Colfax showed you, people are moving around a lot less and theyre clearly moving less into the Emergency Department. Also dr. Green, i wanted to respond to your questions about how what are the people presenting for. And as we look at in epic and we see both the chief complaints and the diagnoses that people are presenting with they have shifted and so the top diagnoses precovid were falls and headaches and chest pains. And now the three most common diagnoses are shortness of breath, cough and suicidal iraq ideation, interesting enough. And we have still coughs and headaches and chest pains but lower on the list. And so and along with your Emergency Department being down, the volume being down, so have our average daily admissions gone down which is not surprising because most of our admission comes from the Emergency Department. You will notice though that they are down by as much and thats because the percentage of admissions from the Emergency Department have gone way up. For as long as anybody can remember that percentage has been about 15 . And now its somewhere between 20 and 25 . Reflecting that the people who do show up in the e. V. Are sicker than they were before. On the next graph we can see some really dramatic and positive changes that have come as a result of covid. And one is that our leave without being triaged numbers are almost nonexistent. And ambulance diversion which was commonly thought to be an intractable problem is suddenly solved by covid, which is fascinating. This is not just because the volumes are lower. We also simultaneously have an experiment, if you will, going on in the city called cave. Which is run out of our Emergency Medical Services agency. And its basically a project that was envisioned for long before it happened this month. And very fortunately coincided with this pandemic. And the idea is to ambulance load traffic throughout this. And its with the ambulances calling in to the physician to get destination advice. And what has this has resulted in is that its a level loading. So were not experiencing the same ambulances that we did prior to the experiment. And, fortunately, everyone sees how valuable this has been and so now the experiment is going to continue i believe through july at least, which is great. Urgent care has also gone down and now part of this is because the urgent care volume is split between urgent care which is seeing all of the respiratory urgent patients and the Peoples Clinic that is now seeing the nonurgent patients. And were reducing the care in r. C. C. That is combined back with the urgent care clinic and thats a workload that were working on. And the other thing that i will say is that you will notice that the psychiatry volume has not changed much at all. And there are some slight changes that belie some of the big changes that we have made in that volume. So a while back now we decided that every Single Person going into p. E. S. Needed a test for covid. I can explain more about why we made that decision a while back. But if you see the p. E. S. Encounters going down, part of that is because all of these patients are going first to the Emergency Department where they get tested. And theyre also being evaluated there in some cases by a psychiatrist and so more people i believe are being discharged from the Emergency Department before they even make it to the p. E. S. And the admissions to 7b and 7c dont include the fact that we now have covid positive patients who are admitted just for psychiatric admissions on h52. Which you will recall is the forensic unit that we never used but now thanks to the Sheriffs Department being flexible with us that we can use that unit for these patients who would otherwise really not have a safe place to be at. And i think that i will stop there and because i have been talking a long time and see what other questions that you have about the data or any other aspect of our operations which as i think that you can see have changed pretty dramatically in the last few months. Clerk and dr. Hammer is here after to answer questions that dr. Green had. I dont want to leave her out. Commissioners, any questions . Yes, commissioner green. Vicepresident green well, first of all, you and your team are to be commended for your work. Its remarkable. And i know that you had a lot to do with bringing the Hospital Council together. When you stepped up to lead i saw big changes in the leadership of my own institution every day. Im so grateful to you because i can see your invisible hand guiding them. Thank you. Thank you. Vicepresident green and know that you will see us through regardless of the future in this epidemic hold. One of the things that was brought up at the last meeting and maybe dr. Hammer can talk about this, and the primary care clinics that we have recruited some staff from those clinics and im wondering where you stand on the analysis this sort of postsurge aftermath where we have untreated conditions. please stand by oh, dr. Ehrlich . I think she may have had some connectivity issues. Can you hear me . Yes. Could you speak up . You sound very faint. Thank you. Is that better . Yes, thank you. Good afternoon, commissioners, and i just want to this is hallie hameran, director of ambulatory care for the San Francisco health care network, d. P. H. , and also the outpatient well, the outgoing outpatient lead in the medical branch of the d. F. D. , and id be happy to answer commissioner greens question about ambulatory care and particular the primary care in our plans for reopening. I just want to add my recommendation to the leadership that you all have commendation to the leadership that you all have recognized at the start of this meeting. Its been great to be a part of this department, citywide activation, and starting with mayor breed and certainly our leaders, dr. Colfax and dr. Aragon, and then, just really want to call out Susan Ehrlich and her team and s. F. G. And the service that i get to witness each day when i call in to the meeting. Its been an incredible operation, and i think we have a lot to be proud of in San Francisco, and a lot to be grateful know, and our staff know or at least i hope they know that theyve been part of saving lives every day. As far as ambulatory care, and just to remind you, ambulatory care includes jail care, maternal care, integrated health, and the whole person care, which brings together a number of nontraditional services which serve people experiencing homelessness across the city. So across ambulatory care, we basically deployed a huge number of staff from three of those five sections. Those three sections being primary care, Behavioral Health, and m. C. H. Which in response to the health order to limit our ambulatory care services, those three sections really stripped down their staff and their services to just the most Urgent Services being provided in staff, and in so doing, we were able to deploy 200 ambulatory care staff to the d. O. C. , and then even more to our Clinical Services that grew in response to the covid pandemic. And so so so three services really stayed the same because we had to prevent outbreaks in the jail, so jail health, we really maintained our staff there. And then, particularly integrated care, as attention shifted to the impact of the covid19 on the people experiencing homelessness and living in supportive housing, we shifted a lot of ambulatory care staff to whole person integrated care. As as weve been realize that were in this fortunate place to start looking to phase 2 and phase 2 planning, weve been planning on resumption of some ambulatory care in those areas where we really had to reduce our services. Many of them will have to stay in the d. O. C. Where theyre continuing to provide care. The areas of the d. O. C. That we will really continue to support with ambulatory care staff and ambulatory care leaders are the hotels where over 1,000, now about 1400 people experiencing homelessness who could not who could not do so safely on the street have been housed. Weve also been supporting the isolation and quarantine hotels, both in terms of leadership, administrative support, and frontline clinical sites. So we have some testing attached to care clinics in areas of the city where we really wanted to focus on low barrier testing for our San Francisco Health Network and other safety net patients. So those are the areas of the d. O. C. That well continue to support as we move to resumption of ambulatory care services. Commissioner green, weve been working with with ambulatory care providers throughout the city, especially in the safety net, to help give guidance to provide resumption of ambulatory care services, particularly in ambulatory care. A lot of this is dependent on facilities, so theres a lot of variability in our facilities, which which will dictate how we treat this and the number of patients well be able to call back for inperson visits. Our expectation is across ambulatory care, along, with a lot of variability, and including, i should also mention, specialty care, that we will shoot for going back to about 30 of our visits being in person and continue to provide the majority of our care with telehealth visits, so telephone visits and some video visits. Our Behavioral Health services has done a phenomenal job in converting a lot of their routine Outpatient Services to telehealth. Id like to call outline dr. Hamilton holtz who is the medical director for primary care Behavioral Health and has been the lead for Mental Health Behavioral Services in implementing telehealth, and telehealth has been able to engage approximately 85 of their patients through limited very limited in person visits and then a lot of telehealth. So as we as we move to phase 2, to some limiting of restrictions and sheltering in place, we will be moving to some things that we cant do with telehealth. Childhood immunization, the kind of things that we need to be facetoface, clinical exams, and also visits for those people who are hard to engage over the phone, so people with serious Behavioral Health issues, those with limited english proficiency, and those with Severe Health concerns. Were working with Occupational Safety and health to assess the physical spaces and work with teams on their workloads to make sure that they can do that safely. I think ill stop there. Ive been talking a lot, and then, im happy to answer questions if there are more questions about ambulatory care. Im not sure if theres any follow up questions. Commissioner green . Yeah. I was wondering if you had an assessment of the Financial Health of some of the clinics because we know that telehealth appointments arent compensated very well, and i wonder if youve talked to clinics about their ability to stay open and their ability to maintain staff . Yeah, and thats a big concern and has been a concern right from the beginning. Weve been fortunate among the safety net clinics, that most of our telemedicine, its been reimbursable. Behavioral health, were also fortunate that we can bill for much of the telehealth. Our biggest concern is the safety net clinics that rely a lot procedural procedure procedural care, so, for instance, those San Francisco Community Clinic consortiums, clinics which have a large dental have large dental services and rely, in large part, on their dental revenues. I think those clinics have taken a large hit. Yeah, i mean, this has been really, really devastating for, i think especially some of the small providers of throughout the city, small primary care providers throughout the city. I think fortunately, for a lot of the Behavior Health providers, theyve been able to pivot very well to telehealth, which is great, but i think the what were going to see as we move into phase 2 is not just as as mr. Wagner mentioned earlier, that well be having a lot of people who have lost their employerbased Health Insurance and will be enrolling in medical, but i think well see some real impacts in terms of access because of some some of the some of the providers of care not being able to stay afloat. Thank you. It would be great to follow up on that. I think theres National Concern about it. Commissioners, i believe that theres a longterm plan maybe in september to have a primary care update, and i will talk to dr. Hammer and talk to shan and dr. Pickens. Are there any questions for dr. Ehrlich. Well, i just wanted to ask dr. Hammer one question, which is as youre trying to move towards having additional inperson visits, what is your time frame for that, and how does that affect our phase 2, you know, program . Our San Francisco Health Network clinics primary care clinics have been planning they were instructed at the beginning or at the end of april to look at may as their planning month, so theyre really planning now for early june to be resuming some inperson and inhome care. Well be looking to make sure we can do that safely, so screening everybody that enters the clinic, making sure that everybodys masked, making sure that we really limit the number of people in waiting rooms and nursing stations, etc. , so theres a lot of work that needs to be done to be able to do that safely. But i think what well begin to see in most of our clinics some some return to inperson care at the beginning of june. And before we shift the questions to dr. Ehrlich, i wanted to make sure that the question that i was asked was primary care, and im the director of ambulatory care. Primary care is part of ambulatory care, but the director of ambulatory care will come back to report to you, and thats ana behr. Shes been working 80hour weeks since the beginning of the activation in the d. O. C. While also running ambulatory care, so just want to commend her for her incredible leadership. So dr. Hamer, thank you also for your services these years. And since, as you reminded us at uhir about ambulatory care, jail is actually part of that. Can you tell us if jail is actually able to cope with the issues of social distancing and so forth thats necessary within the jail . And actually, dr. Hamer, before we answer, commissioner chow, just so you know, therell be a jail update at your june 2 meeting, so the next hearing, youll get an update on jail health. Well, ill wait to hear the report, and thats perfectly fine with me. Ill just say briefly, like the rest of us, that we have the gift of time that a lot of municipalities did not have at the beginning of the covid outbreak across across the nation. We were i think it was midmarch before we had our first positive case of covid of a person in custody, and and before that time, dr. Pratt was observing, really learning from the experience of other county jails across california and the country and in touch with jail Health Directors all over the place and used that experience to develop a really, really comprehensive prevention and mitigation plan. It was right after we started testing all people in custody at the time of intake . Right after that, i think it was within a few days that we had our first person test positive, and and they already had in place a protocol for keeping people as distant as possible from the rest of the population until their test came back . Unfortunately, thats its not really possible to completely isolate everybody coming into the jail, nor would we want to, so it s been very very challenging. Dr. Pratt did work with the investigation team. When that person tested positive within about a day of admission into the jail, and unfortunately, weve had no within the jail transmissions, as far as i know, and im really, really pleased to say that, and its a testament to the planning that dr. Pratt and her team did. Weve had, i think, about five positive cases of people in custody in the jail, not staff. There have been some positive cases among the Sheriffs Department staff, and those cases of people testing positive in the jail have been up up you know, managed appropriately. Dr. Pratt can share with you more details. Some have come as transfers from other county jails. Like, last week, we had one from santa rita. Its been really challenging to make sure we stay on top of everybody coming in, but i think so far were doing an excellent job in the jails. All right. Thank you very much. All right. Commissioners, any final questions for dr. Ehrlich before we move on . You know, the treatment in the jails, is that something that can be continued on an emergent situation . Would we be able to continue to find ways in which we would continue these lower levels of lower levels . Hi, dr. Chow. So one of the things that really helped us a lot was the contract that we had with Chinese Hospital. Right after laguna honda closed to admissions, we had a big spike in cases waiting for Skilled Nursing care. And now, Chinese Hospital has 23 of our patients, and theres been a little bit of turnover with that group, but but mostly, its the same patients kbho who were there from the beginning. We have patients who require Skilled Nursing care, especially custodial care, and so that is an asset that concerns us, the lack of that asset, especially because laguna honda, for very good reasons, is going to be closed to admissions to us probably at least until june. So even though the numbers look really good right now, we we are concerned about them staying as low as they are, and we have an amazing skilled and resourceful team who manages placement of people and patients in all kinds of settings, so its something were keeping a very close eye on right now. Thank you. Thank you, dr. Ehrlich. Were going to move onto the next item. Mark, before we move onto the next item, i want to reinforce my gratitude for dr. Ehrlich and dr. Hamer for their incredible leadership. Their teams have been engaged in not only doing the work that theyve been responsible for for several years now, but especially at the Department Operations center, their teams, their leadership, their detailing of the membership of the d. O. C. Has been fantastic, so i just want to collectively thank them. They themselves have been working sevenhour and many hours every day, and i just want to express my gratitude to them, and to their families for supporting them during this time. Thank you, dr. Colfax. So everyone, the next item will be item 13, zuckerberg generals family hospital. [inaudible] good evening, everyone. Thank you for giving us time to present the regulatory status report from San Francisco general. The status of this report, we had three high stakes surveys still scheduled for this year. The joint commission surveys remains suspended, but my understanding from speaking to the administrator of the joint commission, for the rest of 2020, the focus will be on the Infection Prevention and control. I think that will put us in a great place to address when that happens later in the year. The commission on cancer, granted, all of their accredited facilities are oneyear extensions, so we now have that survey scheduled for 2021. Also, the biggest piece of new in there is the calosha Workplace Violence Emergency Department complaint, and we submitted an appeal today around some of those citations because we really have requested some more information so that we can address the complaints more fully. In the background, the workplace Compliance Committee led by frontline staff have been doing a lot of work to to abade many of the things that were discovered, and were definitely moving in the right direction with that piece. Of the open site visits, the three or 8, 9, and 10, we have ongoing investigations into those three events, and weve seen a different methodology from the California Department of Public Health, with a lot of the investigation being done remotely by via document requests and interviews done over the phone. So that has enabled us to continue with those investigations. And we only have one new facility reported incidents to bring to the committee today. And we have submitted the preliminary investigation into the last one. The last allegation, we were unable to substantiate that. Those cases, when investigated, we have a lot of data to present to the investigators when they come from California Department of Public Health. Im looking forward to being fulltime again at s. F. G. So i can work in collaboration with the executive team there and the rest of Quality Management so we can really shape the way that we focus on the infection contro control kra controls more regulatory response to covid. Is there any questions or comments . Commissioners, there are no Public Comment items. Commissioners, questions from you . I dont know if you are itching, but i dont think any of you have your hands up. Thank you very much, mr. Smith. Thank you, commissioners. Thank you. Okay. Dr. Borden horton, the video is not on, so shes just on by phone. Dr. Horton . Lets see. Lets give them one second. Im going to text her. Dr. Horton . All right. So shes having trouble being heard. Give me one second. Im going to ask her to hang up and call back. Dr. Horton is going to have to hang up and call back, so give us another 30 seconds. Hello . Can you hear me now . Yes. Can you hear me now . Yes. Okay. Great. Wonderful. So i will go ahead and launch into my achievement staff report. Thank you very much for the welcome for my new role earlier. The one thing thats not listed on the chief of staff report that i wanted to comment on is we are doing a virtual med staff dinner, which is not surprising that wed have to go virtual on. It is on june 8. Most of the business we covered at m. E. C. Were similar to all the reports youve heard. Tonight, weve been discussing p. P. E. , weve been trying to keep leadership up to date on all of those issues as well as working on staffing the surge areas and the potential surge areas. There was no p. I. P. S. Meeting, but there will be in june. We did send out documents to commissioners that presented the results of the committee that was led by dr. Jack chase, chair of our Ethics Committee that really took a deep dive and laid out some key priorities and worked towards how we will proceed if we hit a time of critical resource scarcity during the time of covid. So i believe those were in the documents that we sent around, but i did want to commend the codirectors of the unit that worked on this, as well as dr. Chase and his whole committee for bringing such thoughtfulness and getting such work into these documents because we have so successfully flattened the curve and have not overwhelmed our medical system. Im very grateful to have them in place so that if anything should happen quickly, we have we can have a really thoughtful approach to it. So im going to pause for a second and find out if anyone has any questions for dr. Chase from those documents that we sent around . Commissioners, any questions . These are about the resource allocation during crises . This is dr. Chow. On the color coding, is that the color coding thats traditionally used in triage . Thanks, dr. Chow, for the question. This is jack chase. That color coding that we use is consistent with the main published guidelines on the topic most specifically from the university of pittsburgh allocation criteria, which was set up by doug white and bernie lowe, who are two experts in the field. No, thank you, because i know in the military, of course, we had different colors, and i couldnt remember what the colors were. So just when i think okay. So red is the highest priority, and this comes from the standards that were using. Thats great. Thank you. I also see that commissioner green has a question. Oh, i just wanted to thank you and commend you for these documents. Theyre so thoughtful, so well written, so compassionate. The letter is so well written, and i just want to thank the team for coming together and coming up with such an excellent template and guidelines. Thank you, commissioner. Well definitely convey that to the committee, as well. [inaudible] procedures were actually called out as special privileges that required individual doctoring, and so we have simplified that. The division of cardiology has simplified that and lumped those that are more considered to be core cardiology privileges into the core section and only are falling out four special privileges which require individual proctoring as opposed to proctoring for a general type of procedure. Are there any questions about the cardiology privileges . Dr. Horton, i think my only question, and its actually my ignorance is the prerequisites, is that these are the specialty boards from abim and not not the primary board, then, is that right, that were asking for . Its the specialty boards for interventional cardiology. Is that your question . Yes. As the thing for specialty board for cardiovascular disease, which is different from just getting a regular abim, right . Right. Thats my understanding is specifically, its the interventional cardiology board. Right, right. No, thats what i was trying to clarify. Right. Because if i remember now, they have a number of different specialties which are added boards, right, on top of the regular boards. Yes. Yes, thank you. I have no problem. Move for acceptance. Theres no one on the Public Comment line for this item. Any other questions on this, commissioners . Okay. So theres a motion. Is there a second . Second. Second. Thank you. Any other discussion . All right. So i will do a roll call vote. [roll call] all right. Thank you very much, dr. Horton. Youre welcome. Commissioners, item 15 is other business. Yeah. Any other okay. Theres no Public Comment on this item, so we can move onto item 16. Sorry that agenda item is incorrectly done on that slide. 16 is a consideration for a closed session. Is there a motion to move into closed session . So moved. Second. Mark, we need Public Comment . Yeah. Theres no Public Comment on this item. Ill do a roll call vote. [roll call] okay. So just a reminder to everybody, laguna honda folks, youre going to be first, so dr. Hu, please sign out of this. Everyone has to go to the closed session. S. F. G. Folks, please stay out im going to notify kim and dr. Ehrlich that were done, and they can join the announcer youre watching coping with covid19. Todays special guest is dr. Steven getnick. Hi, im chris man us and youre watching coping with covid19. Today my guest is the director of the Behavior Therapy Center of San Francisco and Professor Emeritus in counseling psychology at the university of San Francisco. Doctor, welcome to the show. Thank you. Lets talk about managing anxieties during this pandemic. What types of issues are people facing at the moment . There are a number of issues and i really want to point out that this is affecting everyone and has come on very quickly. So it is normal. If you are not experiencing some anxiety, something is a touch off because this affects us all. I think some of the main ones are our health and worried about getting the virus and our developing serious complications. I think for a lot of people who are single, living alone, in isolation, has been very difficult. I think being in close quarters with people who we normally have some space from now are together 24 7. Thats produced a lot of stress and anxiety. That loss of connection with others. We already addressed. And having kids home. For a lot of people. Yes, absolutely. What are the other problems that they might have . I think without that dynamic, the good things are not a problem. It is the difficulties we have. And when were together 24 7, again its like hooking everything up to an amplifier. So, what kind of problems could be created from working home from home, perhaps for the first time in your career . A lot of people are not used to working at home and a working at home just isnt the same. For one thing, there is a lack of social interaction. Some people find that that affects them greatly. Some people are actually finding theyre getting more work done at home without distractions from work. The lack of structure is probably the most common. We see it here with work at the office. People are kind of watching. We know that our schedule is, suddenly youre at home and you are on your own. Absolutely. If those are some of the issues people are facing, what are some of the techniques people can use to overcome their anxiety . Caller i think there are many. One of the first is how managing and keeping track of your thinking, we think and talk to ourselves a lot. Thats normal. We have a dialogue with ourselves often and we need to monitor that a bit. People tend to ruminate versus problemsolve. That is they tend to worry about all the things that might go wrong. And what i suggest is, look, there are things that can go wrong, but ruminating about the worstcase scenario is not going to be very productive. Sit down, figure out what the things are that you have to deal with and try to problemsolve. I think any of the selfcontrol techniques for anxiety can be helpful. And there are dozens of them. The common ones are meditation, relaxation techniques, yoga, for example and another is diaphragmattic breathing. If you google that, you can learn diaphragmattic breathing in about 10 minutes online. Its incredibly simple and it is a really nice way to reduce anxiety in the moment. Selfcontrol procedures, exercise. Whether if youre fortunate enough to have equipment at home, thats great. If youre not, get outside and go for a walk, keep your safe distance, of course. But you need to be active. Thats helpful. I think people marry be dealing with information overload at the moment. How do you suggest people manage that . I was just going to say that. I think it is really important to kind of limit the information you get. Not in terms of accuracy. I think in terms of accuracy, you want to identify a few sites where people are coming with evidencebased information and scientific information so you can form yourself well. Once youve informed yourself, you need to not be watching all day long. Ive talked to people who are mesmerized from the tv and a it keeps that anxiety going so you need to limit your viewing for sure. This can be stress for people who have economic concerns and worried about their family and friends and loved ones who are essential workers. What would you suggest they do to help manage anxiety and stress . There is a number of things. One of major ones for depression is behavioral activation. Simply, it really means that people will tend to not be depressed as a number of reinforcing activities to engage in. Whether it is hobbies, you read, you listen to music, you crochet, you whatever. These kinds of things are very important so you want to make sure that youre engaging in activities that literally make you feel better as opposed to sitting around ruminating, worrying about the worstcase scenarios that might happen. What about trying to do some selfdevelopment . Yeah. Its a very interesting time. Ive talked to a couple of my own clients who are finding, in a very positive way, that this isolation, while at first can generate a lot of anxiety, particularly if youre just not good at living alone. For a number of people, its giving them a chance to sit back and really think about what is important in their lives, what are the priorities. I think that maybe if there is any Silver Lining in this epidemic, its really forcing all of us to kind of rethink whats really important. Indeed. You know, though, at the same time, there are people who are feeling very lonely at home. How would you encourage them to overcome that . You get online. Facetime, skype, zoom, like what were doing right now. You can stay connected. Its very possible. Most connections are important. We are social critters and we need that connection. I think for people who dont have those options, pull up photos, take a look at pictures of family. You need to stay connected. And its very important. And finally, do you have any suggestions that are specifically for families . Yeah. Well, again, i think one of the interesting things thats come about from all of this, is i talked to families on video is theyre obviously spending more time together. While its a bit awkward, particularly for parents who are in the house working a lot. Its a chance to really deepen relationships and spend more good, quality time together. I think parents really need to step back and kind of plan their day a little bit. Not micro manage it, but have some ideas. Can the family play games together . A lot of people i talked to, theyre even together as a family for the first time. So i think there are a number of things that people can do. I think it is qulaouzful for the families to take five, 10 minutes and say how did the day go . I talked to someone in the phone book before we started who said they noticed what time of day all their anxiety kind of comes together and they start sniping at each other. Now theyre taking a few minutes at tend of the day to say, ok, how are we doing . I think they need modeling good behavior, something you can do within the family, too, to try to thats right. I think thats relevant. Very relevant to how children are going to do. Most of the research from crises, particularly things we cant control showed that children do as well as their parents do. So i think it is important for parents to think about how theyre react aing and they stay calm because whatever they do is modeling, coping for their children. So, that can be very useful. It can also be problematic. When we talked earlier, you mentioned that acknowledging that your kids are afraid is important. Yes. I think that ties to your last question. I think modeling you know, its not incompatible with saying, yeah, you know, mom or dad is a little nervous, too. It means a lot of stuff is going on, but were going to be ok. Were going to stay together. We have our time together. Were going to be safe. Well fill in the blank. So you can do both. You can reassure but in a realistic way that once the kids know its normal to be anxious in these times. Thank you for coming ton show, doctor. I really appreciate the time youve given us. Youre welcome. Thank you for having me. And that is it for this episode. Well be back with more covid19 related information shortly. You have been coping with covid19. Thank you for watching