Vulnerability. We had a few cases at laguna honda. We brought in the c. D. C. And the state health department, and they really helped us how to figure out how to manage how to manage a longterm care facility as big and as complex as laguna honda, so we learned a big part how to do that. How to confine big parts of the hospital and to do mass testing of the hospital staff and residents. We learned a lot from that, and what we need to do is replicate that across a lot of longterm care facilities throughout San Francisco. Other longterm care facilities dont have the training, experience, and capacity that laguna honda has, and so our longterm care facilities need a tremendous amount of support not only in p. P. E. , in helping them develop a task of testing, components, screening, that component. We need to build out im just going to call it a strike team teams that can be deployed to help the longterm care if a similarities. And were learning at our hotels and our s. R. O. S. Its the same situation, especially as testing becomes more available, how were going to do surveillance in s. R. O. S, how were going to do targeted testing should any cases appear, and how were going to do targeted availability. So when have a room, and a person goes ahead, how were going to be able to place that person into both isolation and quarantine. The shelters were in the same situation in that were better learning how to manage that, as well. Youll be hearing some of this has been in the news, but youll be hearing more about how were learning how to shelter in place Homeless People who are covid positive, who are recovering or recovered, where they can be all in one location where we have the staff, the personal protective equipment, the training, we have everything in place so that can happen safely. And we have we still have more we have more capacity that we have to build up so that we can do that better, more efficiently, and so that we can do that quickly. President yee dr. Aragon, particularly in regards to this strike team that youre talking about that would be available if something happens, if this strike team is there, why wouldnt we send them to these Nursing Homes now and maybe have some prevention instead of waiting until something happens . Yeah. What im calling a strike team is more than responding to an outbreak, its focused on inspection. We want them to be inspecting the longterm care facilities before and when and if an outbreak occurs. So were calling them an outbreak prevention and response team. So we sort of realize the way Communicable Disease control capacity started is it started with a team of people who were trained to focus on a specific Communicable Diseases in the community, and now, we realize is that not only do we take that team, and now, they have to be specialized in longterm care facilities, s. R. O. S, homeless, and now jails. Each one of those requires a different strategy, so now, we have to replicate we have to build out more teams, and so within that, we have to build more capacity. So right now, we dont have that capacity, so were looking to were looking to hire more staff. Right now, were working with San Francisco state, u. S. F. , u. C. Berkeley. Were trying to bring in staff, working with c. B. O. S so that we can hire staff to do all of this work that can extend the expertise that we have at the health department. President yee thank you. Supervisor haney . Supervisor haney thank you. Thank you, president yee. Dr. Aragon, i wonder if you could speak to Testing Capacity. We spoke if we have enough tests in San Francisco. It seems like we have a lot of priority populations that we should be testing that we arent testing. Theres been some announcements from ucsf that theyre able to help with testing for a period of time. How much testing are we doing citywide, and what are the limitations for us to do more . Yeah. I dont have the statistics on me right now. If you go to the website, it tells us the Testing Capacity that were doing, and the Testing Capacity is finally beginning to open up and finally beginning to increase. The one thing that held up testing was the supply chain of things like swabs. Initially, it was reagents. All of that is beginning to improve, and p. P. E. , personal protective equipment. It was not really the labs, but all of that is improving, so were beginning to gear up so that we can do more we can take the Public Health capacity and focus on the most vulnerable populations. And then, the public sector, were going to hope that theyre going to take care of more of the general population so that collectively, we should be able to do more testing. So youre youre going to see youll see dramatic improvements in the testing. Its taken a while to get to this capacity, and also, in the technology of testing. So there are the development of rapid tests that can now, within an hour, tell you whether youre positive positive or not. As i mentioned before, theres a saliva test, and theres a home test that will be available soon if it hasnt already been approved. Supervisor haney when there was the cases at m. S. C. South, they tested that entire shelter, and it seemed like there was good reason to assume that there may be other shelters that have, you know, large outbreaks, as well. Right. Right. Supervisor haney but the policy of the Navigation Centers and the s. R. O. S and people on the street is the symptomatic get tested, but if youre none symptomatic, you dont nonsymptomatic, you dont get tested, even if youre in this highly dangerous environment. What is your stance on that . So i would say were moving towards developing a deal testing people who are asymptomatic. I think theres going to be a number of people that are asymptomatic, probably like 25 . Thats resulted in a real change and shift. Were trying to figure out what would be the appropriate interval, and what is the appropriate setting for it to be most effective, and thats one of the reasons why we went to universal face coverings is because we know that there are people who are asymptomatic, and so thats an important part of that strategy. And so were were learning how to do this together with the state. The state just recently, two days ago, published guidelines for testing, and we can make sure that youll have those guidelines for testing. It includes both symptomatic and asymptomatic testing. Supervisor haney yeah, because it seems there could be a need for asymptomatic testing in places where it seems like it would spread quickly. Just last thing, when you were in front of us, i think about five weeks ago, just a month ago, we asked a number of questions about Homeless Individuals in different environments, and five weeks later, for the most part, as far as i can tell, not much at all has changed for people who are currently on the streets. They are still largely out there in environments where theyre not receiving services or not in a safe place, and i know theres a lot thats been said about people who are in shelters and Navigation Centers, and the very slow pace in moving them into hotels. But for people on the streets, what is your view of what we should be doing right now to prevent the spread in light of the fact that its been over a month, and as far as i can tell, in my district at least, not much has changed at all in terms of what their reality is and the potential for spread of people that are currently on the streets . Yeah. Youre asking a really good question. I believe most people in general the c. D. C. Guidelines are pretty good about what they recommend in terms of guidelines around shelters, homeless, housing. Observing just how much work it takes to just do that logistically and i have the opportunity to do that because i get to interact with people around other parts of the state. I believe that San Francisco is doing more than other parts of the state, and of course, theres more that we can do. What i see as the biggest barrier is just having all the components in place. Just the Rapid Response and all the things that we need to make that successful, as well as having options options for sometimes either a a a person is unable to go to a hotel room for selfcare for personal reasons or otherwise they dont want to go there, so we need to have many options that will accommodate the needs of the option. I im needs of the population. Im sorry. Im getting a text here. Supervisor haney im sorry. Ill let other people ask questions here. I know were getting data regarding other populations, but if our goal is to get people into a place where they can isolate or shelter in place or not have contact with other people in that, its not happening. And the Small Movement of people weve seen in shelters and Navigation Centers, i havent seen any improvement in people who are homeless, so i just want to flag that as something that needs your attention. President yee supervisor ronen . Supervisor ronen thank you. I just wanted to follow up on a little bit of the same topics that supervisor haney brought up. In terms of testing right now, i have been trying to get the entire Division CircleNavigation Center, residents and staff, tests for about three weeks now, ever since the first person tested positive. And its just been one excuse after another, and they havent been tested. And this morning, i learned in another congregate well, in an s. R. O. Like housing unit in my district, that 25 people tested right, and those individuals have separate rooms, so they do share bathrooms, but not living space, unlike Division Circle. Why havent all of the residents in shelters and Navigation Centers been tested . I just havent received a satisfactory answer from anyone about that yet. Youre asking a really good question. I can tell you from from where i sit, i havent been involved in those specific decisions. What i can share with you is our approach continues to evolve, and casa quesada is a good example. Were learning that mass detection and targeted screening is a good approach, and youll see more of that as we move forward . I think what youre describing is a direction that were moving in, and as more testing becomes available, were trying to figure out what is the best way to do that. So i think stay tuned. Youll see changes as testing becomes more available and as our strategy becomes more liberal in terms of testing. Supervisor ronen okay. Its impossible to get i have so much respect for you, dr. Aragon, but i have yet to get a satisfactory answer. Everyone says oh, youll wait and see, we dont feel its necessary. Hopefully, itll move in that direction, but its been weeks now, and the staff and residents are terrified. And in other congregate living facilities, weve found that its very widespread, and i just cant get a clear answer from anyone. Im just wondering if youre willing to issue an order i think there should be testing of every congregate living facility completely. I do not its not a resource issue at this point. We have the materials so why wouldnt we do that . Im just really confused and just looking for a clear answer. Is it just that we dont want to find out that so many people are testing positive because then we dont have the resources to deal with it . I mean, what is the real reason that were not testing people in congregate settings . Yeah. Its a real good question. Ill just tell you the way that i see it. I just the way that i see it is one, we have the band width of all of the things that were trying to do, and as were prioritizing our activities, at this moment, we havent been able to do as much as we would like to do . What i can tell you is that as testing improves as testing improves and i think you will see changing because were really getting a better handle on how to deal with the congregate living situations and asymptomatic infections. And i i i understand understand your frustration and concern and perspective, which is very valid, and i will personally communicate. And i know you havent you havent you havent gotten the answers you desire, but ill try and find that out for you. Supervisor ronen i asked the question to the mayors assistant, and he said he would get back to me, and he hasnt got back to me. Im asking our chief health officer, the chief of staff for the city and county of San Francisco and i cannot get a clear answer. Meanwhile, the residents of the Division CircleNavigation Center live in fear. It sounds to me like what youre saying its an equipment and staff issue. I just have to get an answer. Its really the most frustrating thing. Yeah, yeah, yeah. I understand what youre saying, and i think youll see as our our practice of how were dealing with this epidemic is evolving, and what youre describing is something that everybody is moving towards. For example, in the jail, were screening everybody that comes into the jail, and they found two persons that were positive, so thats the direction that were moving into is this focus on asymptomatic screening. So youre absolutely right to ask that question, and i would say that in general, thats where everybody is moving towards. I think, as i said, as testing becomes more available, p. P. E. Becomes more available, we have more staff, youll see more testing. Supervisor ronen okay. So moving on, the second question is almost the same as supervisor haney asked about the people on the streets. The situation on the streets, its getting worse, not better. In encampments that weve had for years on the streets, we have more people. We sort of encourage those encampments by putting por porta potties by them. This is a population that weve tried for years to get them indoors, so you can imagine the frustration of individuals that dont feel safe going outside their front door and the situation of people on the streets . We hear that slowly but sure youre getting to people on the streets, but none of us have seen it. All over the east side of the city, there are massive tent encampments all over again. Theyre not small, like they used to be, theyre massive, and those were incredibly dangerous prior to covid19. Now, theyre just out of control, and and and and its its its just not that things are getting better, theyre getting worse. So can you talk a little bit more about timelines and strategies and moving people off the street or a different strategy for the street . You know, i think possibly the best thing is that im not working in that specific area. As you know, our Emergency Operation center is very large. Im not working specifically in that area, but what i can do is i can work with dr. Colfax and to bring maybe well use one of these briefings to answer those questions directly so they can get you the information directly. Thats probably the best way to get you the information you deserve. Supervisor ronen okay. Thank you. President yee supervisor walton . Supervisor walton thank you, dr. Aragon, for taking the time to answer questions this afternoon. Just a couple of, like my previous colleagues questions. People told us they would be pulling people off the streets and placing them into hotels . Yeah. I do not have this information. Just to let you know, i learned about this meeting yesterday, and it all got arranged today, but what i can do, i will follow up with these specific questions and work with dr. Colfax to make sure that we have the information that youre requesting. Supervisor walton well, i know that youve been mentioning some of the conversation that has been happening at the state level, and the scientific response to whats happening. I know youve seen the latest numbers in terms of whos been contracting the virus kbi zby code. Half of the cases are in my district, and the other half are in areas where we have the most vulnerable populations. Do you believe that mass testing in these zip codes should be taking place immediately . I think whats going to happen is is that you will see, were were right now, were adopting the guidelines from the state on testing, and there is a component what i will do this evening is i will send you the guidelines, and theres definitely a component around asymptomatic testing. I think were going to have to do more in the areas that are impacted. I think the challenge is you know about some of these challenges. In some ways, its easier to focus on the congregate living situations. We know, for example, in the bayview, the mission, we have a lot of families that live in really crowded conditions, so we have to figure out how we work with that those people that are exposed to crowded living conditions, as well as the people who are exposed to crowding and in congregate conditions. Were it tending to focus on those that are in congregate because we know that more people can get exposed, so i think the longer term strategy that youll see evolving is we want to have low barrier testing. We want to improve our surveillance system, and then, were going to be extending were going to be starting by testing asymptomatic persons who are close contacts because thats where the biggest risk is. So that whole strategy is really developing around that testing and containment. Supervisor walton well, as San Francisco chief medical officer, i want to ask you is it your opinion that we should begin mass testing in areas where we see a disproportionate amount of covid19 cases . Thats a very interesting question. I spent a lot of time thinking about this issue. I think we need to come back with the state guidelines and our impact in those areas and how it impacts the testing. Supervisor walton i wouldnt belabor the point, but i will get with you offline regarding that because we are suffering in disproportionate areas, and we need to step up in areas that we can and prevent the spread of the virus. I know that asymptomatic testing is one way we can do that so we can address some of these disproportionalities. Also, by chance, do you have an update on the number of covid deaths by district . Do you have the zip codes . No, i dont have those. I dont have those with me, no. But i i i was listening in early on, and i know thats of interest. Supervisor walton and so my last question, just and i sent an email to dr. Colfax, leadership of some of our key city departments, h. S. A. , h. S. H. , to know the key things that are happening since we know that a large number of contracted