Great. Well, i have the privilege of welcoming you all to the september 1, 2020 meeting of the Public Health commission. Welcome to the staff as well as members of the public, and i also have the pleasure of telling you im chairing the meeting today because it was commissioner bernals his 50th birthday, and i cant imagine why anyone would want to take their 50th birthday off. However, hes decided to do so, and so im sure youll join me in wishing him the very best for his birthday. So i guess the next agenda item is the minutes. Yes. Thank you, commissioner. Item 2 is the approval of the minutes of august 18, 2020, and i can check to see if anyone thats in Public Comment, please press star, three to raise your hands. I have a change to the minutes. The minutes show me as present, and i dont believe i was present at that meeting. Thank you. Commissioner, and i apologize for that mistake. That was me. And there was actually somebody with their hand raised, so im going to let me get my timer. Caller, im going to unmute you, and youve got, then, two minutes. All right. Caller, youve got two minutes on the clock. Hi. Im a little mixed up. Is this the time for general comment . Hi, dr. Palmer. No, this is not. This is the general comment on the minutes. Okay. I want to get back in line for general comment. Okay. No problem. I will take your hand down. I will explain to everyone, heres the deal. When youre making comment, when the item is called that youre making Public Comment on, you put your hand up, and you do that by pressing star, three, and you can do that for every item on the agenda, and youve got two minutes to talk. Commissioners, any other corrections on the minutes. With the exception of the correction that commissioner guillermo brought up, is there a motion to approve the minutes. Approved. Second. Clerk i will do the roll call. [roll call] clerk great. Item 3 is the directors report. Good afternoon, commissioners. Grant colfax, director of Public Health. In my report, i have a number of covid items, and we will be going over those in more detail in the covid update. But we have some important issues, and perhaps the most important issues, the d. P. H. Budget. After a number of rounds of conversations with the commission and the board of supervisors, the board and Budget Committee amended and passed the budget for the Health Department, and im pleased to say that our for the most part, our budget was was passed consistent with what you saw and very much consistent with the mayors priorities. Our budget remains at 2. 8 billion for 2021 and 2. 9 billion for 2122, with very mine i dont remembor cha budget itself. Id like to thank everyone who worked so hard on the budget in this unprecedented year in general, but it was an unprecedented year with many challenges. In addition to the pandemic response, weve had to deal with inclement weather and air quality, and we are taking appropriate action with the department of Emergency Management and other partners to ensure that people remain as informed about the air quality and take steps to mitigate potential impacts from the air. You will see a number of highlights with regard to the d. P. H. Work, and unless you have questions on the two items i just highlighted, we can cover the covid19 updates in the next item. We have updates even from just about two hours ago, so were very much on the cutting edge here. Myself, dr. Aragon are here to answer questions about that. And then, we do have a presentation specifically on some of the educational activity reopenings were doing. Clerk and commissioners, if i may, before we move to any other comments or questions, i see a hand up. Any member of the public, if you would like to make comment, press star, three. All right. Commissioners, it looks like theres no Public Comment, and with your help, commissioner green, ill help you with your Public Comment. Commissioner chow, it looks like your hand is up. Go ahead. Thank you. This is in reference to the air quality issue, and it is appropriate that the Health Department has put out advisories, and even on your website had marked out, if you go into the covid website right away, theres the whole issue of the air quality. However, im just wondering if we could make it easier for people because this air quality issue may certainly surface again over the next several weeks, if not months, that rather than having it would appear that in the first page, it references going to sf72. Org, but it doesnt work. It doesnt get you there. You have to hit the air quality reference in order to get to the air quality. But im wondering if we could actually show that more easily so you dont have to go point too many places to find out that that air quality for that day is such so that people would be able to understand that. But im not sure what the technical issues are, but certainly know that sf72. Org, ive tried it on two or three different computers, and it does not work, and thats what youve got to reference to get to the air quality. The air quality reference does, and its a very good website, but if we could make things easier where you dont have to have an additional click, it might make things easier for the public. But thats just my suggestion. Clerk so noted, commissioner, and well fix any of those noted issues. Thank you. Commissioners, i dont see anyone elses hand up. With your permission, commissioner green, can i move to the next item . Okay. So next item, number 4, is the covid19 update. Thank you. Grant colfax, director of health. We actually have three buckets of updates for you with regard to our covid19 response, and i know theres a full agenda, so i want to be respectful of your time. But i would i was going to review a few slides that that the standard slides that youre, at this point, familiar with seeing where we stand just in the epidemiology, and give you an update with reference to the state announcement on friday, and we do have an update, i believe, per the commissions request with regard to reopenings and our thinking around that. And [inaudible] is available to provide that information. So ill just go through these slides relatively quickly. Could we have the next slide, please. So were up to over 9300 cases of covid19 diagnosed in the city. You can see that our case count does continue to increase. Our deaths are unfortunately at 83 total deaths from covid19 in San Francisco. In terms of our testing, we continue to far exceed our testing goal which we set at 1800 tests a day. Our rolling tests a day are 3300 tests, and our sevenday rolling average is 2. 6 . You can see we continue to have the inequities in the covid19 response, particularly for the Latino Community who continue to account for over half of cases. And i just want to emphasize that we are strategically evaluating our efforts specifically in the Latino Community. Im happy to come back to the commission to report back on those efforts. Weve done a lot, and its clear that we need to continue to do more. This inequity has been with us since the beginning of the pandemic. We are focusing more testing and more testing resources and working more with the Latino Community providing lowbarrier testing. Our Contact Tracing and Case Investigation teams have expanded dramatically, and including providing culturally appropriate services and also providing Wraparound Services in Broader Health care needs and Behavioral Health needs, and youll be happy to know that we continue to offer isolation and quarantine options for people who are not able to safely quarantine at home. But theres certainly more to invest there, and im happy to return to the commission to report specifically on our efforts in the Latino Community going forward. Next slide, please. In terms of age distribution, you can see that we have a relatively young our cases are concentrated in a cohort of basically young adults, with nearly half of our cases between the ages of 18 and 40, and you can see that is very different in terms of mortality, where nearly threequarters of our cases are in people who have been diagnosed with covid19 over 70, and over half have been 81 years or older age. Next slide. So these are data compared to the other jurisdictions. Again, youre familiar with this information, but thankfully, our death per 1,000 is much lower compared to other jurisdictions, and weve been fortunate in that regard. Our testing rate is quite high, exceeded only by a few other jurisdictions across the county across the country, excuse me, and our case rate is also relatively low compared to other jurisdictions. And again, i think this is in a city that is seven by seven i believe that San Francisco is the second densest city in the country, after new york city. And we know that in denser settings and more crowded, where theres more opportunity for more crowded conditions, unfortunately, covid19 does spread more easily. Next slide. So this is our hospitalization rate, and we have been in a surgery since july, where we started to see that increase in hospitalizations. Were down to 26 total cases in the hospital. At the end of june, we started to see that incline. Were now down to a slight decline, down to 72 total hospitalizations in San Francisco. You can see the i. C. U. Bed the people in i. C. U. Beds, the white lines represent the patients in the medical surgery beds. So in this slide, it shows that things are moving in a more positive direction i believe than the last time i reported back to the commission. So in terms of our key Health Indicators, this is the these are the indicators where were assessing the status of covid19 across the city. Our hospitalization our Health Care System indicators, which are really indicators of our hospitals, are in the green zone. Growth of covid19 cases are in the negative zone, so thats good. You can see here that acute hospital bed capacity and our i. C. U. Bed capacity here across San Francisco remains in relatively good shape with 27 and 35 respectively. Whats been up for sometime now and is concerning is our case rate. The running sevenday average at this time is 8. 5. That has come down substantially over the past few weeks, but we are still at the high rate, indicating a relatively high burden of disease in the city. Our testing numbers i referred to, over 3500 a day. Progress has been made on Case Investigation and Contact Tracing, these numbers became particularly concerns as there was a lag in our testing and followup time. Just want to acknowledge the Contact Tracing and Case Investigation team expanding capacity, doing this work every day in a culturally appropriate manner, meeting people where they are. Were now at 87 of cases reached, and making progress. Mean goal, in yellow, and moving toward our goal of 89 . And p. P. E. , 30 , 100day supply for our health care staff. We require next slide. [inaudible] every one person infected new person infected is less than one. For every new person, less than one gets infected. Greater than one, more than one person gets infected at baseline. Youll recall that in july, we started to see an increase in june, we started to see an increase, and we our reproductive rate got up to as high as 1. 35, as you can see by that solid blue line, after being about. 85 in the spring. Im happy to say thanks to the great efforts of San Francisco, we are down to 0. 91 and trending down. We are have been moving in the right direction for a number of weeks now, and hopefully with the em if a seu emphasizing, social distancing, limiting crowds and interactions with large numbers of people, we will, as a city, will continue our success in slowing the spread of covid19. So im going to stop there and turn it over to dr. Tomas aragon who will now talk a little bit around the states announcement of reopening and the steps that we are taking to gradually reopen lowrisk activities over the next couple of weeks. Dr. Aragon . Good afternoon. So last friday, the state came out with a new framework for how theyre going to both measure the disease and also to categorize different counties. Prior, they used to have what was called the watch list, and it was basically two categories. And theres several ways you can get on the watch list. Case rates, hospitalization, as well as some other metrics, and if you got on the watch list, you were on it for a period of time. You had to close down activities and thats what happened to us in late june, where we had to close down nonessential offices, malls, and we had to postpone our openings of personal services. So the new framework now is only using two metrics. Theyre using the case rate, and then, theyre using the test person positivity. And based on those two metrics, theyre classifying people into counties into four tiers. Tier one, or the purple the purple tier, is is the highest, and whatever whatever number is worse, you end up in that you end up in that category. The second tier is called red, and the word theyre using to describe that is substantial. The third tier is orange, and the last tier is yellow, minimal. So if youre in purple, its very similar to have been on the old watch list. If you end up in one of the lower tiers, as you move into the different tiers, you can open up more. One of the things the other things they did was they wanted to discourage counties from undertesting, and so counties that were doing more testing had their case rate downweighted. So for San Francisco, because we do a significant amount of testing, they downweighted our case rate, and so we were classified into the red category. And so basically, that means that we had more things available for us to open, and that was really the basis of a of the plan that was announced today by the mayor and dr. Colfax. And there was between friday and today, there was a tremendous amount of work. People really working like crazy to get all of this in time to be able to move forward. And ill give you just the general themes. Im not going to go into the details or specifics unless you have some questions. And basically, what were doing we sort of approaches it this way. We looked at our Health Indicators. Can we move forward . Are hospitalizations flat or moving down . Are our case rates flot or going down, and is our testing in the appropriate range . And dr. Colfax indicated that were moving in the right direction. And the next question is what does the state permit us to do, and then, we apply a riskbased framework, and we move forward in those areas that we feel is going to be safe. And the other thing thats right around the corner, youre going to be hearing about them, and thats going to be schools. So the first body of activity really focuses on allowing activities to happen outdoors. So personal Services Like hair salons, outdoor gyms. Other Recreational Activities to happen outdoors, one, thats safer, but it also allows a business to adapt to serving outdoors. Just to give you an example, so today, my wife, the first thing she did was she washed her hair, and she went and got her haircut outdoors. She was very happy that she got her first haircut since the pandemic started. She did it outdoors not too far from our house, and the person who cut it was very excited to cut her hair, so that was outdoors. Just a couple of things that were going to be addressing. Outdoor worshipping, increasing the amount of outdoor worship and some other categories. The other big area is this next body of activity which is really schools and education. Its very big. Anas going to talk to you shortly about it. Shell give you an update in this area and how important it is that we succeed in this area. And the other area is lowerrisk indoor activities, and thats looking at those activities that really involve oneonone services, where if somebody were to be infected, the risk of a lot of people being infected were much lower. These services are going to be primarily personal services, and well be looking at other areas, but thatll be the primary focus. So im going to go ahead and stop there because youre going to get a lot from ana, because youre going to get schools, which is going to be a big category. That said, do you have any questions . Are there any questions from commissioners or should we continue . It looks like commissioner dorado has a question. I do have one question. When you had mentioned noncontact outside activities, i thought you were referring to sports activities. Can you maybe explain that. Does that mean that the kids cant have practices, no competitive games . Ive been asked this question multiple times. Yeah. They they yeah. Theres two ways of thinking about it. What can be asked it how can be done with is what can be done with schools opening up, and then no contact. When you think of activities that we dont want people to do, you can just think theres close physical contact between people is what we dont want. If theres nonphysical contact, shared equipment, thats okay, as well as people really are careful, but we kept that category nonspecific because theres activities such as pickle ball i did not know about pickle ball but adults let us know about all these activities, so theres guidance for all these activities, i should say. Welthank you. Its just that i get soccer practice, can we have, you know, hockey . Its just these sort of things, and thats where we need eventually probably clear guidelines so that we dont have, you know, confused people would be yeah. It is a little complex. Ill tell you, so soccer is a contact sport, and it really depends on how its designed. So and ana will go into this. One of the ways we try to minimize risks is to have cohorts. So if you have kids that stay in that cohort for an extended period of time, then, we allow riskier activities because theyre in the cohort. But what we dont want is people from all parts of the city coming together to play Something