Colfax, director of department of Public Health to dive into one of the most complicated issues that we have focused on including information about the data. Today dr. Colfax and i are going to talk about the data the department of Public Health is tracking and what it means for San Francisco in our ongoing response to covid. We know there are a lot of numbers out there. Like the Key Health IndicatorsAvailable Online and it can be difficult to keep track what it all means. I know at the end of the day Everyone Wants to understand exactly what this means and when will we open . This is so fundamental to the decisions we make forral of you every day. We want to explain it to make it easier to understand. The data shows where we have been in San Francisco. It gives us insight into where we are going. It gives us the ability to change course if we see a concerning spike like recently. We had to pause the reopening activities and businesses as a result. With data we can model what the future might look like if we take action or dont take action. By makes decisions on data, science and fax, we will make decisions that slow the spread of the virus and save lives. We know that we are going to be living with covid for some time and the goal is to use this data to adapt to our new normal. Lets get started, dr. Colfax. Thank you and welcome. Can you fleacan you please prove where we are in San Francisco as it relates to the numbers. Thank you for your leadership during this time and really supporting all of us as we focus on the data, science and facts. I have a presentation with a lot of data i would like to go through. If there are questions that you would like to share during the presentation, please let me know. I will just give us a snapshot where we are today, talk about what we can all do to bend the curve, reduce infections across San Francisco and talk about what the future may hold if we do not wear face masks, practice social distancing and good hygiene. Can we go to the slide presentation, please. First slide is number of cases in San Francisco. All the way back, please. Okay. We have a preview. This is where we stand right now in San Francisco. Anybody can follow these data on a daily basis at our San Francisco data tracker sf. Gov and follow to see where we stand. Today we have nearly 4600 cases of covid19 diagnosed in San Francisco. I think it is important to also realize that nearly 1,000 cases have been diagnosed just in the last two weeks. We continue to see a high level of diagnosis. Two weeks is when people are infectious. 1,000 people in the last two weeks. 50 people have died of covid19 related illnesses in the city. While any one death from covid19 is too many, a few pieces of promising data here is that our death rate has leveled off for a number of weeks. Our clinicians are doing a better job using science how to manage the disease. This could change at any moment, especially if the Healthcare Systems are overwhelmed and people are not able to get the clinical medical attention they need. There is a lot of information on this slide. You can go to sf. Gov to see this. The big graph with the green line is number of tests done in San Francisco over june and into july. You can see those gray bars are the number of tests done every day. I will say that we have exceeded our goal in San Francisco. We set a goal of 1800 tests each day in San Francisco. For the last week we have been averaging 2600 tests each day in San Francisco. You can see from that jagged green line that is the Positivity Rate. That is of all of the people tested on that day what is the Positivity Rate . That has been gradually increasing over time. It is now 3 overall time. We have recently seen a large spike in the Positivity Rate, which is indicative of the virus spreading throughout the community. You can also see from the yellow bars in terms of cases in terms of race that we have a disproportionate number of people of color diagnosed with covid19 compared with the population in San Francisco overall. The latin x accounts for half of all the dyeagnosed cases. We also see large numbers from black Africanamerican Community and asian community. This is why we are working with stakeholders across neighborhoods to ensure that Community Leaders and neighborhoods and Community Members and families are actively engaged in the response, know where to get tested and care and where to access the other services needed during this very challenging time. Things like having access to food. Food security, behavioral and Mental Health services and counseling, is very important going forward. Mayor breed do you want me to talk specifically . I want to clarify something so we have about less than a 6 africanamerican population but seeing about 5. 4 of the cases africanamerican. We dont see disproportionately the number of cases in th the bk Community Like throughout the country. We clearly see disproportionat disproportionately the Latino Community cases. The question i have is because that in comparison to any other race in San Francisco is where the biggest challenge is. My question is what are we as the city doing . What is the department of Public Health doing to address this significant disparity . Thank you, mayor. We have been working from day one with regard to preparing and anticipating Health Inequities in the covid19 epidemic largely because we know that the virus spreads unconditions in which we have seen in San Francisco that have affected Health Inequities for a long time. With regard to the disproportionate impact in Latin X Community we have been working with your Latino Task Force on covid19 to ensure that education, community engagement, testing access is strong and also that we are ensuring that when people do test positive that they not only have access to the medical care but the Behavioral Health support, social services support, food access and not only they have that but their families have that. If people are not able to isolate and quarantine and not able to do that in their living situation we are also ensuring people have access at hotels as alternatives to their Living Conditions so they can isolate safely and not put others at risk for transmitting the disease, acquiring the disease. We are also ensuring with the Contact Tracing, which is such an important tool in this pandemic we have culturally appropriate Contact Tracing being done. Half of the Contact Tracing is done in spanish right now. We have culturally competent contact tasers. It is not just about ensuring that people feel comfortable talking to us about who they may have been in contact with and put at risk for disease. We want to support the individual. Supporting the individual, linking to those services. We ensure people get access to care for covid19 and medical care in general. Under no circumstances will people be identified by immigration status. This process is very confidential. Some challenging around the inequities that exist with the city respond. From day one we operated an equity team through Emergency Operations center but unfortunately what we are seeing in San Francisco is significant number of people diagnosed with covid19 are mostly in the southeast, eastern part of the city. The Testing Capacity is in the center of the city, and we are seeing disparity in terms of Testing Capacity. Why havent we done more other than pop up locations on a regular basis in the various neighborhoods. Why have we not done more for stationary locations so it is easier to access testing . From day one when we scaled up the Testing Centers we had Southeast Health center first. Then we established a testing site outside the zuckerberg hospital as well as the Mission Neighborhood health center. We are also expanding testing sites in sunnydale, potrero hill and we have just recently started testing at the hub and mission. It is a key priority of ours to continue to ensure people have access to testing, particularly if they are in the neighborhoods where we see the highest prevalence of covid19. The one opened in the mission this weekend they expected 100 people and tested over 200. We have to take the testing where people are. I will turn it back to you to finish up your presentation. Thank you, maam. Mayor, you talked about equity and Covid Response. I will reinforce this slide emphasizes we had our equity front and center of our Covid Response from beginning and continue to ensure we make investments as we move forward. I also wanted just to point out where San Francisco is relative to other communities that are dealing with this pandemic. This is looking at San Francisco compared to other cities and jurisdictions across the country. As you can see so far our case rate is relatively low to other places. Our death rate is quite a bit lower at 5. 8 per 100,000 people. Compared to other jurisdictions we are significantly lower than other places. Our testing rates while we continue to expand testing, our testing average is 2. 92 tests per 1,000 and that compares to other places. We needsh to expand testing. Thithis is a regional and natiol issue. There is a lot of demand for testing now and delays in test results. I would emphasize here in San Francisco our Public Health lab was one of the first to offer testing. We continue to expand that and work with private providers, kaiser and others to ensure low barrier testing is available to people. Promising news. We are in a vulnerable situation. The mayor spoke about indicators right now. This is the slide looking at the hospitalizations in the city from march into july. You can see that our hospitalization rates are starting to increase. The dark bars are the number of patients in intensive care. Light are the people in acute care, medical surgical beds that are sick enough to be in the hospital. Those numbers are significantly increasing. This is very concerning. We got up to a high of 94 in april in terms of hospitalization rate. That was the first surge. Thanks to everybody in San Francisco we flattened the curve and crushed it. Now it is going up. We in another surge. We are in another surge and we expect to see these hospitalization numbers to continue to go up. The yellow bars in this graph also show the number of people in the hospital who have been transferred from other jurisdictions because other jurisdictions are in serious trouble as well. Many of these include patients transferred from the outbreak in san quentin. We are in a surge even taking into account those transfers. You talked about indicators. This is one of the key indicators in the city. People can go to sf. Gov to see the indicators. This is the change in covid hospitalizations by week. This is number of people in the hospital with covid 19. That rate of change. As you can see for a long period of time we were doing really well in the city. We were in the green zone. That is the green dots here. That increase was less than 10 . Then we saw a big jump consistent with the surge in the graph i just showed you. We continue to be in the red zone with a double rate of 20 compared to our target rate of 10 . This is reflective of the surge. This is why we made the very difficult decision to put reopenings on pause. Similarly, we are seeing a big increase in the Positivity Rates of people who are testing. This is the number of cases diagnosed per 100,000 population over seven days. You can see we were in the yellow zone for a long time, and our goal was to get to 1. 8 per 100,000. We are now above 6 per 100,000. You can see that on the right. This slide is updated to july 11. We are at 7. 8 per 100,000. This indicates that the virus is spreading throughout the city. Particularly in the areas that you mentioned southeast part of the city. This is a complicated slide. I will take a minute to describe it. This is looking at the reproductive number of the virus. What is the reproductive number of the virus . That is how fast the virus is is transmitting through the population. Reproductive rate of two means for every person infected with the virus, two people get infected with the virus. That is a very high transmission rate. Reproductive rate of. 5 so half means for every two people infected with the virus, only one new person gets infected. That is really good. For every two people infected only one new person is infected. That means is virus is going down in the population. Reproductive rate of one in the dotted line across this graph means for everyone person infected with the virus, one more person is getting infected. What we really want in a situation we are this is get that reproductive number below one, which means for every person infected with the virus less than one other person is getting infected. That is key. What does this graph actually show . These are scenarios modeled at u c berkeley. We asked given the dates take we gave you to analyze what are the best estimates for the reproductive rate. That is shown o on blue across time. We were doing well in San Francisco. The rate was below one as low as. 85. If that had stayed the virus would have burned out in the city. Unfortunately, you can see here that starting in early june we started to cross that one. Right now we estimate that reproductive rate of virus is as high as on average 1. 25. It could be even higher. That is what the blue fuzzy leans. They are estimates of the model. Most likely it is 1 point 25. It could be higher or lower. Right now our best estimate is 1. 25. That doesnt sound like that much different, right . That is half a decimal point from where we were. Why is that a big deal . This is what keeps me up at night. This is what happens if the reproductive rate stays at 11point owes 1. 25 with the current surge. That dark line most likely scenario if everything is the same at 1. 25 we would hit 830 hospitalizations in the city. Think about that for a minute. In april we peaked at 94. Thanks to all of the work people did in San Francisco we sheltered in place, drove that number down. It is now plausible that we hit hospitalizations at 830 if we do not do more to stop the spread. Those lighter blue peaks are plausible scenarios as well. We could get up to 6,000 hospitalizations. It reflects the challenges that new york had. We hope this doesnt happen. It is so key here. We have a window to do better. B. Next slide. And again, another very concerning situation. This related to the reproductive rate of 1. 25, so this means that we will have more people die, and if you follow that blue line, this means we would average, excuse me, 890 deaths from covid19 in 2020. Were at 50 right now, and by the end of the year, we could be at 890 with a reproductive rate of 1. 25, and again, unfortunately, those white shaded blue lines show we could get much higher scenarios, approaching 2,000, and even 3,000. So this is this is serious. This is a we are in a very concerning time right now with this reproductive rate of 1. 25, and we need to drive down below 1 as soon as possible. Next slide. But there is hope, and this is looking as of july 4, because we were looking at the july 4 weekend and asking everyone to do their part. If we could reduce that rate by half, we could dramatically reduce our hospitalizations and our death. We could go from the hundreds that we talked about to as few as 50 and 70. And even the scenarios that i showed you with those light blue shaded areas, we could see more deaths through 2020. So if we do our part, we could save lives and keep people out of the hospital. Again, even in the next two weeks, if we could all do our part, we could really make a difference. You see in the next two weeks, we wait for the reproductive number to reduce by 50 , we still have peak hospitalization at 340 and an estimated 220 deaths in 2020, so time really makes a difference. Next slide. So key introduction to reducing r. P. E. This the reproductive rate. This has real socioeconomic and other consequences, as well. Discouraging gatherings, especially inside, and i just want to emphasize right now that, really, please do not gather with people outside of your immediate household, and especially do not gather indoors, it is very dangerous to do that. Please, it is literally saving lives. And then, continuing to offer testing, expanding our testing, and Contact Tracing. Such key tools to our efforts going forward. Next slide. So i alluded to this, but really, riskiness of the activity, we know that outdoors is safer than indoors. Its at this point that, based on the latest data, its 10 to 20 times safer than being indoors. Its risking out to be involved in ga