Coffee or something. Lets maouts our microphones unless were talking. Hi, even. My name is mark morowitz, the Health Commission secretary. Im going to flash the side again to explain how to make Public Comment. The phone number is 8883634734. And the access code is 2241350. Once youre on that line, you will be able to listen in on the meeting and when you want to make Public Comment, you press 1 and 0 in order yes, 10 in order to get on to the line for a specific item. For those of you who are watching on sfgov tv, a reminder that there is a delay on what youre seing from what the live meeting is. So, i encourage you to get on the Public Comment line one item before you intend to speak so that youre on in time. That way there will be no timing issues. And, again, we apologize profusely for the issues at the last meeting. Commissioners, is it ok to go on to the next item, item 2, the minutes . Thank you, mark. If commissioners have had the opportunity to review the minutes, without does anyone have any revisions or do we have a motion to approve . Motion to approve. Second. There a second . Second. Mark . Ok. I have call the roll. [roll call] actually, lets break here for Public Comment. Im sorry. Is there anyone on the Public Comment line . Anyone there . There is no one here at this time. Ok. Thank you for that. I apologize, commissioners. We heard from commissioner bernal. [roll call] great. Thank you very much. The next item on the agenda is item 3, the directors report. Dr. Colfax. Good afternoon, commissioners, and a members of the public. Grant colfax, director of health. You have my directors report in front of you. I would like to read something that i sent out to the Health Department last night. Its alluded to but not directly in the directors report. If youll just give me a moment. The murder of george floyd has further exposed the ongoing systemic racism that drives injustice in our country. Our city is both reflected and acted, demanding change as we confront a pandemic that has disproportionately affected black African Americans. These two things, taking action for social justice and reducing the spread of covid19, are very much tied together. Both address significant and lasting inequities in our society and both affect vulnerable populations and people of color disproportionately. As a San Francisco department of Public Health, it is our mission to address Health Inequities and serve the most Vulnerable People in our community. Together, we at d. P. H. , have taken every step possible to prepare for continuing demonstrations in the city. We issued guidance to help keep people safe and readied our network for care and testing. It is important to remember that we support the right to protest injustice and remain aware that doing so safely is critically important. Especially as we continue to respond to the covid pandemic and do everything we can to stop the viruss spread. Our full dedication to the work is needed now more than ever. Commissioners, the remainder of the report goes into incredible detail around our covid19 response. And i think most of it will be brought forward in the presentations that you are about to see. Obviously im here to answer any specific questions with regard to things that you read in the report. Id like to call back commissioners. Do you have any questions . Would you raise your hand, please . Or make a comment or any statements . Ok. Im not seeing any. So with your permission, we can move on to the next item. Thank you, dr. Cold fox. Colfax. We can move on to item 4, the covid19 response, testing and recovery updates. And we go back to dr. Colfax. Yes. So, commissioners, as you can see in this presentation, im going to give you an overview of where we stand. Dr. Phillip will give you a review of our Testing Operations and then dr. Arragon will talk to you about our exciting next phase of reopening and detail about how we plan to move forward on that. So, to date, our response to covid19 has produced significant and i think fairly dramatic effects and just to say that this work is being done not only through the department, but through multiple city departments. And, of course, with the leadership and support of our mayor. The Emergency Operations center at the mosconi Convention Center has been literally filled with hundreds of people every day, not only from the Health Department but from departments across the city, including Human Services agency, almost in support of housing and others who are working literally day and night to ensure that we maintain a robust response. This has literally saved lives and flattened the curve consider blifm as we now enter this next phase, we are continuing our response. But also moving into a recovery phase. And we are doing so following the data, science and fact, being cautious as we continue to move forward to ensure that our gradual reopening can be done in a way that keeps everyone as safe as possible. Next slide. So this is where we stand today. You can see from the slide that weve had 2587 cases of covid19 diagnosed in San Francisco. And i just want to emphasize because i think sometimes there are a couple of things around these diagnoses that need to be clarified. Obviously these are only the people who have been tested. So we greatly expanlded our Testing Capacity and this is not representive of everyone who has been infected with covid19. The other thing is, for the most part, people have symptoms and are infectious for two weeks in general so just to emphasize that its only the people in the last two weeks of this who have been diagnosed here who are either infectious or, for the most part, symptomatic. Im generalizing here. There is some error on both sides ofs that twoweek window. But just to emphasize that. Unfortunately weve had 43 deaths in the city. Any deaths from covid19 is one too many. As you will see, we have compared to other communities, we have not experienced the same tragic outcomes that others have with regard to a larger number of deaths. Next slide. So this slide, unfortunately, probably looks familiar to many of you. This is covid19 cases by zip code and im not necessarily saying it looks familiar to you because of covid19. You sieve anne a slide youve seen a slide at this at the Health Commission for h. I. V. Cases, and for the chronic diseases like diabetes and hypertension. Youve seen a slide like this for h. I. V. Covid19 is, unfortunately, exploiting the socioeconomic factors, the structural factors that permeates our society and allows a situation where Infectious Diseases spread in communitis that are the most underresourced and are stigmatized and are affected by Structural Racism and other factors that have not only socioeconomic consequences, but [inaudible]. So you can see here that particularly the bayview [inaudible] areas are heavily affected by covid19. And well talk a little bit more about our efforts to work with communities in those settings with other partners to ensure that there is [inaudible]. And very importantly, that [inaudible] are provided and prevention tools are provided, prevention education is provided to slow the spread of the virus. Next slide. Next. Yeah. So this is our data from our whoops. I think i just lost myself. Sorry. My fault. Youre there. Youre there. Ieb. Im trying to move my teams bar which is blocking the side. You have to bear with me. It is our testing data with regard to covid19 and you can see from this slide weve done almost 70,000 tests in the city, which obviously we always want to do more. But weve come a long way from those early days in march where we were watching every swab and being very, very careful and unfortunately not scaling up our testing as much as we would have liked to. But we made steady progress in that. You can see that our overall test positive rate is now 5 and that overall our numbers the last day on the slide in terms of the number of tests reported each day, that last number always lags. But you can see overall that we have done very well and dr. Phillip will talk in more detail about this. But were certainly hitting our lower average mark of 1500 tests per day in the city and are rapidly approaching a mark of between 1800 and 2,000 tests a day. And in terms of cases, this is showing the yellow bars by Race Ethnicity, really something that is jammed out here is the latin x population that accounts for really half, half of our cases. Again, something that we saw early on at zuckerberg hospital when the majority of covid19 cases at zuckerberg were latin and you can see other prevalence of prevalence of covid19 cases by other Race Ethnicity. African americans have a higher rate of diagnosis. And then we still have a relatively high rate of unknowns. Cases in terms of race and ethnicity. But that number appears to be going down over time. Next slide. Next slide, please. So this is, again, a remarkable curve that i look at when we talk about flattening the curve. This is our hospitalization rate of covid19 patients across our nine hospital systems. The green bars are the covid19 patient counts. The purple bars are the people in the hospital with covid19 and you can see here that we hit this is from april 29 to may 31 and you can see that weve gone from a high of 98 patient steadily decrease in a way that, again, is pretty remarkable to just 51 cases on may 31. Again, you can see that those cases have really halved. Not only a flat curve, decreasing curve in really two substantial reductions from a [inaudible] in the 90s to the 70s and then the subsequent drop of 70s to the mid 50s. So really important to realize that this has to do with the work of so many across the city and the support of San Francisco for these interveptions. This is not the Health Department, this is not even though the city department, this is really the leadership of mayor breed and other policymakers ensuring that they have the support of the Community Moving Forward to shementser in place on a way that really slowed this virus spread and saved lives. Next slide. So this is an update on the slide that i showed you a couple of weeks ago. Its a little bit complicated. So i will orient you to the slide. This was developed by dr. Maya peterson who we have been working with since early march to track the epidemic. She has been an incredible partner. Even though this is just one slide, i have to say that it was a tremendous amount of work. This tells an important story, though. This is looking at mobility [inaudible]. Just to the end of may. So, the blue line that the jagged line that goes up and down until about the end of march is basically the mobility index and this is a rough estimate of how much people are moving. So the r. E. , you see an r. E. Of 3. 3, r. E. Of 1 30i8 and r. E. Of. 84 is the viruss reproductsive rate. And the reproductive rate, again, is how many cases the virus infects per case. For every one person infected, another person becomes infected. A reproductsive rate of two means that for every one person infected, two additional people get infected. A reproductsive rate of 0. 5 means that for every two people who are infected, only one person becomes infected. And the whole part of this and we talk about flattening the curve, our goal in Public Health has been to reduce the virus reproductsive rate to below 0. It means that fewer than one person is getting infected. And you can see here that because of shelter in place orders, mobility for medics decreased at the end of march. It started decreasing mid march when we started doing our social some of our recommendations about reducing crowd size and so forthful and then you see that it really went very far down into into just about early may. And the reproductsive rate of the virus. These are estimates, not things that can be updated on a daily basis or weekly basis. This is based on many pieces of data and hundreds of it rations of computer stimulations of these data. But dr. Petersons best estimate was a reproductive rate of 3. 3 early on. That is an incredibly rapid rate for the virus. It then reduced to 1. 8 and then weve been down to 0. 84. So, again, the data and the hospitalization numbers really reflect these estimates. You can also see here now, starting in midday, were starting to see activity tick up a little bit. So, well be watching that very carefully. Of course, the goal here is masking requirements with social distancing and better hygiene. As we increase our activity, we hope that the increase in activity will not be as directly correlated with an increase in the reproductsive rate. Right . So it would be nice if a month from now i could come back and show you that this line did actually increase significantly, but the reproductsive rates stayed below one. Well be watching this very carefully. Next slide. I also think that it is helpful for the commission to see how San Francisco has performed in relationship to other jurisdictions across the nation. These are jurisdictions, some would similarly [inaudible] as city of San Francisco, were one of those jurisdictions and you can see the cases by thousand, the deaths by per hundred thousand and our testing numbers. Were at a higher level of testing rate per 1,000 than this shows. At this point. But the death numbers are really, i think, important to point out the death rate. You can see that San Francisco is lower in terms of its death rate than los angeles and significantly lower than every other jurisdiction on here. And even if even given our density. So, again, saying that were saving lives is certainly born out by this data. And then the cases by 1,000, this is obviously varying a libby testing. But most of these jurisdictions have relatively good testing at this point. You can also see that even in places where they had less testing than we did, they had a higher rate of covid19 diagnosis. You can see, for instance, both philadelphia and new york. And even los angelesful even though they were testing fewer people, that they had a higher testing average than we did. So just important to provide some context here. Next slide. And this is looking at alameda, san mateo and santa clara. Our Health Officer working with his colleagues, leading together with his colleagues across the region, the implement of the shoelter in place order and the alignment in terms of focusing on ensuring that were looking at the data as we go into this phased reopening. And just to emphasize here that San Francisco actually if you look at their rate cases per 100,000 population, you can see that we have one of the higher rates has the highest rate on this sly. 292. 88 per 100,000. That is different than santa clara which, as you recall, was one of i think [inaudible] county in the state with regard to widespread cases and a case rate of just 144. 77 we believe that, indied, santa clara has an overall lower rate. And then you can allegation see the percent of confirmed cases have died compared to some other jurisdictions, our rate has been lower. We think again, this is a hypothesis at this point. But we do believe that is likely because of the early infections in these counties. We had some outbreaks in those facilities and a significant number of death but not to the level that unfortunately other counties experience in an early phase, if you will, of an earlier stage of the epidemic in march. And april. Next slide. And this is now looking at cumulative covid19 cases. This is influenced by testing, of course. But the trend and the curves is important to look at as the county continues to test and monitor their local epidemic, our local epidemics while we have taken a regional approach. There are starting to be some significant differences can which may influence how different counties or even thousand the region adjusts. You can see here that starting in and all these are going up. All these lines are going up in counties. But it is really the acceleration of the curve that is the one to watch here. Right . So the slope of the curve. The steeper the curve, but more increasing cases youre getting. The rate is increasing. Unfortunately you can see here that alameda has had a market uptick. Since may 22, the red curve. How you can see it is coming steeper. You can see, for instance, santa clara, while it hasnt had a lot of cases, its curve is relatively flat. I shouldnt say its flat. Its not had a pronounced change and that is similar to San Francisco in the darker blue line. You can see those two blue lines are very similar in terms of their subs and san mateo, were watching carefully. It seems to have a little bit of uptick at the end of may again and watching that as well. Just some comparisons here. To give you a perspective on how we are doing compared to other jurisdictions in the country, how were doing specifically locally and some of our obstacle data and testing and comparing other county, neighboring countis to our work. And this is very important for what you will hear for contact setting for what you will hear from dr. Phillips. And dr. Arragon. I believe thats my last slide. See, were going backwards here. I dont know if, commissioners, youd like to take questions now or wait until the end. [inaudible]. Im sorry. Go ahead. I think wed like to take questions as we go along. So, first, do commissioners have any questions for [inaudible] if you have a question or like to make a comment . Ok. I see commissioner green yeah. Make sure you unmaouts. Obviously thank you all for this remarkable work. I was wondering whether you had anymore granular information about the demographic of the people who have been tested and maybe youll discuss this later. Everyone talks about the denominator and especially as it relates to hospitalizations and deaths from the disease. I know there have been certain campaigns in certain neighborhoods. I know ucsf has done research with different populations. People who are already members with place like one