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 FranciscoHospital 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 n