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 separate households within 14 days. And some risk criteria for interbuilding transmission. When we have two cases in two separate households, we either go on site. We may have already gone on site previously, which may give us a sense of what the building is like and whether theres risk. We havent gone on site, we would go on site and there are things that contribute to that risk stratification. Things like crowded households. Is this a building with a lot of family or a lot of we see a lot of buildings ra theres multiple young men sharing one room, who are all frontline workers. We know in shows settings covid starts very quickly. Did we learn that the case was actually infectious on site for more than seven days total, between the two cases. Maybe one person was three days, one person was four days. Thats concerning. Thats a lot of days of potential spread. We know that theres certain communities that are disproportionately impacted in San Francisco. Are those folks highly represented in the building. And we also look at the risk of morbidity. Are there a lot of elders in the building, people over the age of 60, a lot of comorbidities. So those are some of the criteria we do have the matrix that we use. But basically has to be two cases in two separate households in 14 days and at least two of those several criteria that i mentioned. Supervisor preston, i really appreciate that comment. I think what dr. Cohen just told us is that we, in this case d. P. H. , can actually have Higher Standards than the state does, which say lute i salute and appreciate. Everything that dr. Cohen just said, relative to assessing risk is absolutely right. Do you have higher comorbidity factors. Do you have, you know, folks who are living 10 to a room instead of two to a room. Are they more likely to have to go to work than be retired or on a fixed income. All of those things could lead to a spread. But i think where the rubber hits the road is, and i mean no professional offense to d. P. H. Is how well do they know the residents in that building. How do they know what i have come to learn or have knowledge access to on and off in my 20 years, as to who lives in that building or what Community Members know then. I dont think that d. P. H. Can figure that out in 24 hours, unless they start working with the community to quickly under then do triage. Because you cant triage unless you know what the whether the victim is about to be in deep trouble or not. But this is very helpful conversation to me at least. Supervisor preston, do you have any more comments . Supervisor preston i dont. Thank you, dr. Cohen. I just want to echo really the point you made, chair peskin, really thank you for your leadership on this. Proud to be cosponsoring this this time, as well as last time. And i think that, you know, where we have really proactive and engaged communities representing and Community Groups representing some of the most Vulnerable People in the city, i see this kind of legislation as really honoring their expertise around the community their serving. But also as you say, but facilitating and trying to deepen the conversation between d. P. H. And those Community Groups, so that as we sort of in some ways the beauty of having these emergency ordinances as ways to sort of temporarily deal with things, but not cement them permanently and look forward to it sounds like ongoing discussions happening to arrive at whatever makes sense on a more permanent basis. It certainly resonates with me that where theres doubt, being more careful, preventative and, you know, we have for whatever reasons avoided certainly outbreaks that would have otherwise occurred through taking proactive steps. So certainly i appreciate that this, you know, we continue i hope to err on the side of over testing and overly taking precautions, rather than the opposite. But understanding that theres further conversation to figure out what that, you know, what should be in place on the longerterm basis. Supervisor peskin thank you, supervisor preston. Supervisor safai, anything to add . Supervisor safai something who is a city planner by training, you know, not many cities have this type of housing that remains. It is one of the things that makes San Francisco unique, to have a Single Room Occupancy Hotel and being used obviously in a different way than they were originally built. You know, we have multiple families, multiple generations, many members of the same family sharing space. And some for me it makes sense, under these circumstances, that we would want to err on the side of extreme caution. Because as we know and as we learn from the assisted living facilities, that was where this virus really began in the United States, in multiple cities. In new york, and in washington and all over. I dont want the same to happen. And i know supervisor peskin has been out in front of this. We had conversations in the very beginning of this pandemic about individuals and their patterns of travel and their patterns of obtaining medicine and going actually in many ways to the heart of where this pandemic began in the world, into wuhan, china. And so that is no longer a risk. But the risk is this massive amount of people in these buildings living in very close settings. And so im proud to be a cosponsor of this legislation. I think if it pushes sfdph to work aggressively with advocate communities, that is on the ground working with individuals in these settings, i think its a positive thing. And in the end if we dont have an outbreak, good. And we put the resources in the right place. So i appreciate your leadership on this and being a part of this conversation, supervisor peskin, along with the advocates from the community. And thank you, ms. Cohen, as well. Supervisor peskin thank you, colleagues and cosponsors. Before we open this up to Public Comment, while this is a reenactment of the emergency ordinance, i do have a couple of nonsubstantive tweaks perform before i open it up to Public Comment, i want colleagues to go through that. Youre both in receipt of those, as is the clerk of this committee ms. Major. On page 2, section 2, at line 22 insert and amend section 3 of such emergency ordinance to read as follows, even though both ordinance no. 8420 and this reenactment emergency ordinance are uncodified, for purposes of clarity, the respective fontses for additions and deletions of the municipal code as stated in the note that appears at the beginning of this ordinance are used to show the amendments to section 3 of ordinance number 8420. Thats the original source ordinance. In the tweaks to the original ordinance, in section 3, would be in subsection g to insert a new subsection 5. And that so let me just take you to the top of that subsection g, which is already in the existing law that we are reenacting, upon confirming that an s. R. O. Resident has tested positive for covid19, d. P. H. Shall to the extent consistent with state and federal laws governing the confidentiality of medical information and heres the new subsection 5. As soon as feasible, but not more than 12 hours after receiving such confirmation, promptly post in common areas of the residential hotel, where fire Safety Information is required to be posted, a notice to advise s. R. O. Residents of their rights under this emergency ordinance to access i q, isolation Quarantine Hotel rooms and face coverings. Such notice shall include, but not be limited to, the number of the language accessible hotline for s. R. O. Residents, that residents may call to access those resources. This is making the implicit notice requirements explicit. That was my insertion. And in sub l, under sub 2, the total number of confirmed positive covid19 cases, this is under what data d. P. H. Shall produce, the total number of confirmed positive covid19 cases in San Francisco insert residential hotels, delete at the rate of cases by population size in San Francisco. So that the sentence now reads,