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You submit Public Comment via email, it will be forwarded to the supervisors and it will be included as part of the official file. Finally items acted upon today will appear on the agenda on september 15th, unless otherwise stated. Supervisor peskin thank you, madam clerk. Can you please read the first item. Clerk yes. Item number 1, is the reenactment of emergency for protections of occupants of Residential Hotels or s. R. O. Residence during the covid19 pandemic. Supervisor peskin thank you, madam clerk. Colleagues, i want to thank my cosponsors for the original ordinance. Supervisors mainy , ronen, safai, fewer, preston, walton and yee. That emergency ordinance, that as the clerk said, established protections for occupants of s. R. O. Hotels in San Francisco that include some 18,000 to 19,000 individuals in congregate settings, passed by the board of supervisors as an emergency matter and lasts for 80 days. That required the department of Public Health to offer a number of provisions, including testing and i. N. Q. Provisions, isolation and quarantine for individuals that had tested positive, as well as implicit notice for residents of those s. R. O. S. These are individuals who live in congregate settings, where they share bathrooms and they share kitchens, a highly transmissive environment. And i want to thank the department of Public Health for not only taking that ordinance seriously, but already having done that job before we massed the emergency ordinance. And during the interim for starting to establish a dialogue with the residents of those communities that span the mission, into the tenderloin into chinatown into north beach, were the best of the rest of once were 40,000 or more s. R. O. Hotels once existed. So i want to thank and acknowledge d. P. H. For that. This has been really an admonition to d. P. H. And the community to step up the game. I want to thank and acknowledge the department of Public Health that on friday at approximately 518 in the afternoon, actually put up a web tool that shows the number of cases in s. R. O. S and the numbers of deaths, which thankfully tragically four deaths over 500 cases. So those buildings have been handed superbly, some less so. And i really want to thank d. P. H. , but more importantly the community for holding our feet to the fire as decision manned legislators and d. P. H. s feet to the fire, as the frontline implementers under the pandemic. And with that i believe that we have dr. Stephanie cohen. Colleagues, if you have no comments, i would like to hand this over to the department of Public Health and dr. Cohen. Thank you, supervisor safai, for joining to really present whats happened and fundamental, as i said in the newspaper the other way, i want to create the space for the department of Public Health to build trust amongst the s. R. O. Population in those communities that are very, very different communities. Some of them latinx communities, some of them chinese communities and predominantly cantonese amongo linguaamong mono lingl individuals. And those who reside in the arc that has s. R. O. S. With that ill turn it over to dr. Cohen. Thank you very much. Im going to share my screen and give a short update to what we discussed a couple of weeks ago. Are you able to see the presentation . Supervisor peskin yes, we are. Okay. Supervisor peskin, preston and safai, thank you for the opportunity to come back and speak to you again and update the committee on our ongoing work to prevent covid19 in s. R. O. S and to protect the residents who reside in these buildings. We met a couple of weeks. My name is stephanie cohen. Im an Infectious Disease physician and serving as the lead for the sscta covid19 s. R. O. Seeing none team since Response Team since april. As we discussed at the Committee Meeting on august 17th, we are committed to this population and we have a robust and proactive approach to prevention in these congregate settings. Our robust approach has produced results preponderates of covid19 testing among s. R. O. Residents are actually higher than the rate of testing in san franciscans overall. The proportion of s. R. O. Residents who test positive for covid19 is similar to that of nons. R. O. Residents who live in the same neighborhood. So a lot of what were seeing in s. R. O. S reflects the Community Prevalence in the communities where the s. R. O. S are. And lastly the case fatality rate among s. R. O. Residents is comparable to the overall case fatality rate at approximately. 8 . And this is one of the lowest covid case fatality rates nationwide. As supervisor peskin mentioned, one of the provisions in the ordinance was to launch a publicly available data tracker. And after much hard and diligent work on the part of our advanced planning, data s. F. And surveillance groups, that dashboard went live on august 28th. Its available its a u. R. L. That you see on the slide. This is just a snapshot from the data tracker to show you what it looks like, as required by the ordinance. It shows the number of residents who tested positive, the number of buildings that have had a case, numbers of deaths and number of residents who have gone to an isolation and Quarantine Hotel. It also shows these figures here which show over time the total number of cases and the total number of deaths, as well as the daily new cases and the sffd rolling average, which gives us a sense of where we are on some of our important surge metrics. We also, since our last meeting, are working on Community Engagement. Since the last meeting, we met with Chinatown Community leaders. We also have met with Chinese Hospital leadership and are excited to really move forward in a collaborative response with Chinese Hospitals to covid19 cases in s. R. O. S in chinatown. And were working on setting up recurring meetings with the s. R. O. Collaboratives. And we want to hear their concerns. We also want to provide them information and updates and we want to strategize together how we can optimize covid19 prevention for s. R. O. S residents and other disproportionately impacted by covid19. We have an amazing team in our group of social workers, nurse practitioners, nurses, Health Workers who have been in the field in s. R. O. S every day since really the pandemic started, talking to residents. And we want to share the stories that we have heard, bus we know there are a lot of up stream factors and social determinants of health that are affecting these communities and we can only figure out how to address them if we work together. We do want to continue to request that the committee reevaluate the provision in the legislation, that requires sfdph to test all residents in an s. R. O. Within 48 hours of a single case. I would like to be clear that we are not asking to waterdown the legislation or relax rules for s. R. O. S. Our team, who exists to advocate and protect these residents, will continue to deploy onsite testing to a building, when there is concern for interbuilding transmission. And we do a lot of onsite testing in s. R. O. S. At the same time i want to try to explain again why this particular provision is just not an effective strategy. I know that testing is a hotbutton topic. Its a politicized topic, unfortunately, at the national level. And i really want to reiterate if we thought this particular testing strategy, testing all residents in a building after a single case, if we thought that would be effective at preventing outbreaks, we would be all for it. We are aligned in prioritizing and working to protect s. R. O. Residents. The challenge, though, is that s. R. O. S are not closed settings, like a Skilled Nursing facility. In a closed environment, like a smith, you can implement we can implement routine surveillance testing of staff and identify staff cases before residents become infected. And, of course, this is especially critical in the smith context, because the case fatality rate is so high among those living in those conditions. But s. R. O. S, as you know are not like smith. Theyre open. Residents come and go every day. They go to work, they go to the store, they go to visit their friends and family. And so a single case in a building, in a residence doesnt mean that theres an outbreak in the building. We do test and quarantine close contacts of all cases, including cases among s. R. O. Residents. Then if their contacts, including their household members, then their nextdoor neighbor, whoever they hang out with in the building, if they test positive, we continue to test and expanding circles. In the worstcase scenario, and this has happened, an s. R. O. Resident has covid, hasnt been tested and is symptomatic and has not been ice slating in the building. They think they have aler gees o allergies. By the time they get tested they may have exposed others in the building. At that point, though, testing is not prevention. Testing doesnt prevent anyone from getting infected. Theyve already been exposed. But what it does do it allows to us find cases. And we want to find those cases, because then we have the opportunity to intervene on those who are already infected. And so thats why we do deploy testing when we see multiple cases in a short period of time in a building. And so, you know, really i think to summarize here, what im trying to explain is that testing is important. It enables us to identify individuals who have covid when theyre still in thin infectious period, then we can support them in isolating. We identify their close contacts and support those close contacts with testing and quarantine. But mass testing at a single point in time, triggered by a single case, does not in and of itself prevent covid19. So in conclusion, building mas g is not a strategy in line with our citywide testing strategy or with supervisor peskin miss major, i think you may doctor orb someone may have hit a button that they shouldnt have hit . Clerk thank you, mr. Chair. Im checking with operations. It might be the bridge line. We will supervisor peskin the bridge line has become the bain of our existence. Go ahead. Thank you, dr. Cohen. My apologies. No problem. So really in summary, i think what im trying to make clear this particular strategy is not in line with cdph or c. D. C. Guidance. Its not the best use of our testing resources. And our investigative tools can really help us predict when and where to test. We really have to continue to push primary prevention approaches, the best way to protect everyone from covid. And thats, as you know, things like masking, social distancing and hand washing. Those are the critical things for mitigating spread in all settings. Thank you for giving me another opportunity to speak to you and for all of your work to protect these communities. Supervisor peskin thank you, dr. Cohen. And when that when you release your screen, well all be able to look at each other over our respective computers. And, dr. Cohen, i really want to thank you for your candor. And, indeed, this is an evolving situation. And i think collectively we are trying to, as nondoctors, address what we believe are the most vulnerable populations in the most transmissive settings. And i know that you and your colleagues are committed to that as well. And as i said earlier, we know that youre resourceconstrained, as we all are economically, Human Resource wise and relative to actual physical things that are reagents and swabs that are moving to hot spots in the United States of america, be it texas or florida. And, yes, this is an ordinance. And, yes, it is a law. But fundamentally and i have tried to communicate this to you and to the advocacy community. This is an admonition. And it is a shorttermed a mow s going to last for another two months. And i for one, unless you make not you personally, but the department is malfeasant and not going to go after you, so to speak, on. I think this is really trying to hold you to the highest standards for our most vulnerable populations. And this, too, shall evolve. Ultimately i hope this becomes a permanent ordinance, which doesnt mean that we cant tweak it Going Forward. But i think the most important thing, and ive been very clear with you and the community and my former colleague, who has become a liaison between the board and your department, former supervisor katie tang, that i really want to create the space to build trust between the department of Public Health and the community. And the community has been abundantly clear in the last several days and while i think i dont want to put words in their mouth, that theyre thankful for the transparency that now comes with the additional tool on the tracker site. That trust is earned through hard work and relationships. And you are working now to build them. These were relationships that didnt exist before the pandemic, that have to be built very, very quickly. And i hope over the weeks and a couple months ahead, before this becomes a permanent, albeit flexible piece of legislation, that those relationships and that trust will start to be built. So i just wanted to share those thoughts some that you know where im coming from. As you know and as said in the paper 48 hours ago, i actually originally didnt want to have this debate. But i fundamentally have to honor the community that is are in these s. R. O. S. And i think we all collectively, the people, the decisionmakers and the department of Public Health really also have to delve down into and make very transparent what is confidential and why and what is not confidential and to whom and why or why not. And i think h hippa which is a huge privacy law, needs to be weighed and balanced for Public Health. I think we have to delve down into that, maybe in closed session, subject to attorneyclient privilege advice. But ultimately in open session, where we can all ask those questions and understand where we balance privacy. As i have said to the deputy City Attorney, that is on this in this meeting and to counsel for d. P. H. , it strikes me as odd that we can be transparent with a Building Owner or a building manager, that theres a covid case in a particular building with a particular address, but we cannot tell the rest of the tenants that one of their neighbors, that they share a kitchen or a bathroom with,s that covid. And i dont want to freak people out. I just want to make sure that they have the opportunities to be tested, to be isolated, to be quarantined, to be given a meal in a comfortable, confident way. Thats whats driving this. This is not a, you know, board, you know, being you know demeaning to d. P. H. Its not at all. Its an evolving conversation. I know you understand that. So i appreciate that. Are there and dr. Cohen, if you have anything you want to add or subtract from that, youre welcome to do so. No. Thank you very much for your comments. And just for the opportunity to continue to have a dialogue. The science is evolving and the diagnostics are evolving. I know well continue to work to figure out the best way to do this. And really appreciate that weve gotten the chance over these months to try to think about that together. Thank you. Supervisor peskin i really appreciate that youre taking this legislation seriously and that you are spending moments of your precious time, as youre triaging and stratifying, to actually engage with the board seriously. It would be easy enough for you to say, thats the thing, were going to blow it off, because were resourceconstrained. So thank you for that. With that to my colleagues, hold on, let me press a button. Either one of you have any questions or comments . I did, chair peskin. Thank you. And just concur with your the remarks you just made. I did have just a question from the d. P. H. Perspective what does trigger, under the current understanding of the mass testing, in a particular building. I understand what youre saying, dr. Cohen, about the difference between the setting and the s. R. O. Congregate living situation. Im curious. I understand from the perspective of the department at this point in time, some disagreement around whether one case should trigger that or not. And this legislation addresses that. But what is two cases in the site, what are the set of circumstances from your perspective . And i think to chair peskins point, to me its less relevant for what the Community Wants is clear. But as chair peskin notes, i think well 30, 60, however many days be out once again looking at this issue. And it will be helpful from my perspective just to know from d. P. H. s perspective what does, from your perspective, trigger mass testing in an s. R. O. Context. Well, the California Department of Public Health definition of an outbreak in a Congregate Community setting is three cases in three separate households within 14 days. So we would always define that as an outbreak and report that as an outbreak in terms of not the specific address, not the privacy thing nourishments terms of how many outbreaks we have in s. R. O. S and we would test. The threshold is lower than that. Our threshold is two cases in two separ