Shes served with the San FranciscoDistrict Attorney since 2005 and bridges a wealth of knowledge and experience to the commission with regards to bee hair youral health and equity. She served on the San FranciscoHuman Rights Commission for eight years including as president of that commission. Were so happy to have you on board. Ive had the privilege of knowing and working with you for many years so welcome. Would you like to say anything upon your first meeting . I just want to say thank you, dan, for that introduction. Its a privilege and a thrill to be here. Im very much looking forward to being able to join this work on behalf of the city and the people that live in our community. So thank you, its good to be here. Good, good. Thank you to mayor breed foray r appointing you. The approval of the minutes from the last meeting of june 23rd. Upon review of the minutes, commissioners, do you have any edits or if not, we can have a motion to approve and also check to see if we have any Public Comments. Move to adopt the minutes. Second. Im not opposed to adopting the minutes. Im just trying to understand for fourman purposes do we need to write down this was virtual or we dont have to . Thats not necessary but thank you for that question. Thank you. No problem. Thank you. Second. Secretary marwits do we have any comments. Do we have any Public Comments . We have callers but no one has their hands raised at this time. Thank you. Mark, would you please do a roll call vote. [roll call] could you all mute your microphones. Were hearing some background noise. Can i go ahead and call the next item. Yes, please. Great. Give me one second to. Were going to skip item 3 and come back to it because the doctor is having trouble signing. We can move to item 4 which is the covid19 update and we have dr. Seuss an phillip to provide an update on Contact Tracing. And other things too. Hello. Hello. Good afternoon. Thank you. Im happy to be here. Secretary moore you would be able to help me with the slides. Can you give me 30 seconds to load it up. I apologize. And what were doing now, and how were continuing to improve the work. I want to start with just doing a quick overview and contact the tracing and how we think it can help in reducing covid19 transmission. The approach that were taking, what the status is of the work right now and then some of the challenges and the strategies in Counter Measure for thinking about going into our coming weeks and months. Next slide, please. Just to quickly go over key definition and i realize this is old hat for many of you but to level set us all, so when we talk about a case and we talk about Case Investigation, a case is a person who has tested positive for covid19. A contact is someone who is within six feet of an infectious person. Im sorry, this is a little bit outdated. We say its within 10 minutes of someone, within six feet of a case. And then, we have heard the term isolation and quarantine. Isolation is for the case. So that is the person who has tested positive and isolation means having them restrict their activities so that they are staying away from others to prevent on going transmission. Quarantine is what we ask the contacts to do. They themselves have not tested positive but we want them to stay away from others during that period of time in which they may actually end up developing infection so they dont unwhittingly infect other people during that period in which they might be infectious. So thats called quarantine. The infectious period is when that person who are is the case, is considered infectious to others contagious and we believe and we understand the data that that is 48 hours before any symptoms develop up until 10 days after that. Next slide, please. So the whole purpose of the Contact Tracing is to have data, have information that we can act on and to help support members of our community to keep themselves healthy and others healthy as well. This work, whether were doing it here for covid19 or the other core work we do even pre covid, which can be for measles, for tuberculosis, h. I. V. , syphilis and the whole focus is for our trained staff to communicate the people who might have an infectious disease, the cases such as covid19, to ask them about people they may have come into close contact with. We call these people the contacts. To recommend to the cases strategies to reduce further transmission, meaning staying home until they pass the period where they might be infectious to others and improve that Way Community and population helps. So, we are trying to improve and support the health of the not individual case. We are also trying time prove community and Population Health by breaking the cycle of transmission. Next slide, please. And no matter what condition were doing this for, we hold the same principle here as a dph. We believe all of this work has to be very clientcentered. So, we start with asking the case and what is it that you need and stay home safely. And that might range from medical care, it might mean support in food and inhousing in some situation and were recently we have heard about the right to recover programs that supervisor ronen and we have these services as confidential and we dont share peoples information, even with their contacts. We do not release the name of the original case to anyone else. These services are voluntary. People are not compelled to work with us but were hoping that were approaching them in a clientcentered way and well talk more about how we are taking communitybased approaches to doing this. People will understand and will have heard through the media and other ways how Case Investigation and Contact Tracing reduces infections with covid19 and San Francisco and well be willing to its evidence based and these are a proven publichealth interventions to reduce transmission but then trying to make sure that they get such good results in the as they could and and then were working very hard to make sure that we have a culturally and a linguistically and concorded for people and well talk about that as we go on. Next slide, please. So, we are reaching out to people and this slide shows a little bit of a cartoon and you see the case investigator who is speaking to the case, that individual silhouette and who did we come into contact with for six feet and those are the lists of contacts. Theres a Contact Tracer that reaches out to and our teams were together in integrated units and as you can imagine, there are also events that have to happen before the case when the investigate reached including testing and giving them people results and et cetera. In a moment, of prevention and diagnosis ser visions and get tested themselves and their tests may be positive in which case, we then consider them a case and we have the same voluntary interview with them as we did with the original case. And we try and connect people to medical and other Wraparound Support Services to enable these actions and allow them to get medical care if they need it. Allow to safely isolate and quarantine and to allow them to get covid testing, if they are a contact. Next slide, please. What had enabled you us in San Francisco to do this in San Francisco when we announced the first cases in San Francisco in very early on in the epidemic, in march, beginning of march, we have been able to do Case Investigation and Contact Tracing without interruption. Which is not true elsewhere in the state and elsewhere in the bay area. The reason we have been able to do that is because we very early on started using a centralized data case system on this system itself is called com care its by a Software Company which has a lot of International Experience in working and in Data Collection. And, all stages and in terms of understanding and importing test results, importing and putting into our data case our Case Investigations data and Contact Traceing and our isolation and quarantine support. This is been really a key tool that has enabled us to do this work and also go back and measure our outcomes with this work. Theres a different solution the state has started using now for Case Investigation and Contact Tracing that is a stale sports based platform with a company that is helping bring that on board and doing a lot of the training for that. That system is about four to five weeks behind us with our and we continue to look those systems and were constantly value waiting on a regular basis and when it might make sense to move over to the state system. One has been integrated a lot sms messaging and text people that are contact and send them a daily text where they can tell us and if they have need for Additional Services and we can followup. And then we used internetbased phone systems to allow consistency in the phone numbers people call back to speak with us on and allowed us to do a lot of work sharing across our teams and the other thing that it has done is allow us remote and the size and the scale of the team that are doing this work are really unprecedented and this is a very, very largescale effort and it works because we are able to have people working remotely with close communication with the team lead and supervisors. So this kind of Tech Infrastructure is really been needed to do work with our own staff and also to try and move the workout into communities by bringing on cbos to be trained to do with work within communities and neighborhoods that are most impacted with covid19 as well. Next slide, please. So, you know, speaking of working with cbos and also within our own staff, we know that working with community and making sure we are sitting our competencies and our abilities to best meet the needs of community is so important. This is a continuous cycle of improvements that were trying to do. But the Language Skills are critical here you see a pie graph from a middle of april until the end of june and of the langs that were pre verdict in r the interviews for the case thats are positive. 52. 8 were in spanish and 42 english. A very large percent of people who are Spanish Speaking are prefered as the language for their Case Interview. The Case Investigation and Contact Tracing very clearly has to respond to the disproportional Cultural Impact of covid19 and be reflective and appropriate for the neighborhoods and communities that are most effected. So, i think the language concordance is one piece of that and we work as a team to get better at that and also to engage the cbos and the Community Based organizations and agencies that know their neighborhoods and communities best. Next slide. In terms of the actual structure of how our core dpa team and we have 142 total frontline staff. You see the numbers there. 26 in Case Investigations, 85 in Contact Tracing and in Contact Tracing, that is where i think we have, you have seen in the media that there are staff that are other Disaster Service workers that come into our team and been able to learn this work under the supervision of the doctors from ucsf so we have people from the City Attorneys Office and the Assessors Office and many people from the library who have been great at doing that Contact Tracing work. Our Case Investigation staff are dph staff because that Case Investigation stakes some Clinical Skills and knowledge that some of our more experiences dif have and clinicians and retired clinicians have been able to do as well. This client support is so important. These are people that have the social work background and are able to understand and provide linkage and warm hand offs to resource and services that are available to help people including housing, if theyre unable to isolate or quarantine where they currently live, food and even funds and dollars through their right to recover program. So this is our frontline staff and these are often the people that poem want to hear about but theres a backbone. A really important Core Management data support staff, staff that are always trying to look about Quality Improvements and how we do the work. There are additional fts that do that. For these frontline staff its a very involved process. Theres 30 hours of hands on and role playing training that happens even before they start doing their tandem calls or taking calls with a more experienced case investigator or Contact Tracer. The team operates seven days a week. 25 of our current staff are bilingual or multi lingual when you look back to see the distribution of language preferences were trying to do it. The time required is about an hour for Case Investigation and about 20 to 30 minutes for contact casing interviews. And then the interviews can require twice as long. If its done through interpreters and so that is why we really want to make sure that the language concord cannes i ca priority. Next slide, please. And this is what the team has been able to accomplish through the middle of april when all the teams got on to com care through the 21st of june. 1867 were completed and of that 20968 contacts were identified and then 2,285 of those were able to be notified. Next slide, please. So these outcomes and how well do are one of the five key caters for our status as a city in San Francisco and updated regularly on our cater in the covid data base and the data tracker. And these data there were some data issues when i checked today they were not updated this morning but they likely will be later this week. These are slightly outdated data. Just to get an idea and to see where you can find the most recent data, on the left is the percent of case thats have been reached over the prior two weeks and thats 82 . Ideally, our goal is to be above 90 and were 82 at this point in time and then for the percent of named contacts, of the cases who were reached and the named contacts, what percent of those contacts were we able to reach and this was 88 as well. For this again, as well, we would like that to be 90 . It was agreed upon all the bay area counties and i think we are still trying to understand what is the over all percent that must be reached in order to be successful with Case Investigation and Contact Tracing but having that 90 is a good aspirational goal. The terms are working hard to get to the levels, continue to improve those levels. Next slide, please. I think we are doing a lot of Program Improvement and pdsas with the parts of these steps that we control but we talked a little earlier about how this entire process is a continuum and there are parts that have to do with testing and pieces that have to do with people recognizing symptoms so, these are data that were analyzed out of our data base and when you look here, you see day zero. This is a person that has symptoms and again, the infectious period, when we know that they might be infectious to others begins two days earlier. On average, what we found, from the people we talked to, is they have a test three days after their symptoms came on and then got the results two days after that. Once we get the test result back, we are able to, within 24 hours, generally, reach out and do the Case Interview and the contacts are notified usually the same day or within 24 hours. So, you know, that last part there, about from getting the test result on day five, doing their interview on day six, thats strictly speaking the work of the Case Investigation and Contact Tracing team but for us to be successful as a city. We have to look at this entire span of time as a whole and try to see what we can do to shorten the entirety of it so theres work that is happening among all of our teams within the unified command to try and do just that and again we know 40 to 50 of people are not developing a symptom at the time they become positive. They might develop one later or they dont develop symptoms at all. We have to look at our data, published literature and understand who is most at risk for inspection and recommend testing for those people even if they do not have symptoms. Next slide. People will have more contact with other people. We are trying to continue to reinforce the message of covering our distance and washing our hands and they will all reduce the number of contact that could come out of a positive case if we do all those preventative measures. There are significant as we know, structural barriers to doing the Case Investigation and Contact Tracing w