5, 4, 3, 2 , 1. Cut. We are here to celebrate the opening of this community garden. A place that used to look a lot darker and today is sun is shining and its beautiful and its been completely redone and been a Gathering Place for this community. I have been waiting for this garden for 3 decades. That is not a joke. I live in an Apartment Building three floors up and i have potted plants and have dreamt the whole time i have lived there to have some ability to build this dirt. Let me tell you handout you how to build a community garden. You start with a really good idea and add Community Support from echo media and levis and take management and water and sun and this is what we have. This is great. Its about environment and stewardship. Its also for the we implemented several practices in our successes of the site. That is made up of the pockets like wool but they are made of recycled plastic bottles. I dont know how they do it. There is acres and acres of parkland throughout golden gate park, but not necessarily through Golden Community garden. We have it right in the middle of Health Commission. Mark, would you please take the role. President bernal present. Commissioner green present. Commissioner chow here. Commissioner christian present. I saw her on here. I have unmuted you. Can you hear me . There are four of you and there is quorum, i will text the commissioner to see if she needs help. President bernal with the quorum present, we move on to the next item. The approval of the meetings of the minute of september 1st. Wrong date, im looking at the minutes. The minutes of the meeting of september 15. Upon reviewing the minutes and without amendment, do we have a motion to approve or any amendments from the commissioners . So moved. Second. Before you all vote there is nobody on the Public Comment line, so there is no need to take Public Comment. I can take a roll call vote, commissioner. President bernal yes. Commissioner green yes. Commissioner chung yes. Commissioner chow yes. And lets see if okay, i will call her as we move into the next item. That looks like the minutes passed. The next item is the directors report. Director colfax. Good afternoon. The director report, grant cocolfax. One item of note, september 30, state department of Public Health released details regarding a Health Equity metric to help continuing efforts to move effectively as to fight covid19. And really, in order to move to a tier of lower risk, county will need to meet an equity metric or disparities in covid transmission to advance to the next less restrictive tier. Counties with a population greater than 106,000, which obviously San Francisco is one of those rates in the most disadvantaged neighborhoods do not fall significantly behind the overall Positivity Rate and submit a plan that disproportionate populations. So were working with the state in regard to this. Were currently in the orange tier. Right now, were the only bay area county in the orange tier. And to the best of our ability, we determined that our Health Equity metric is also in the orange tier. In terms of other items related to covid and beyond, im pleased to confirm with the commission, the board of supervisors passed the fiscal year 2021 budget. Changes based on the budget that you saw here a number of meetings ago. Also with regard to equity investments, mayor london breed announced 28 million effort to expand covid19 support for San Franciscos Latino Community. This is work that will include the specific investments on the part of Public Health and also other city agencies. Regard to the Public Health investments, theyll include increasing testing, increasing more communitybased Contact Tracing and partner notification. And very importantly, prevention efforts, especially around important messages with regard to maskwearing and other steps, as well as letting people know that help is available, that no one in San Francisco will go without help, including and especially during this covid19 pandemic. And then we continue with the reopening process. I will provide some Additional Information with written detail with regard to that in my presentation. Finally, just to highlight as a followup with the school reopening. Open online dashboard that is available to School Administrators and to parents to determine so they can tell where their school stands in the process of the reopening approval process. Its called our reopening dashboard. That has been positively received by the School Administrators and parents. And finally, just to say that one of black africanamerican Health Initiatives film entitled working to eliminate health daas parities within the disparities has been excepted for screening during the Film Festival at the Virtual Meeting at the end of this month. At the end of the director report, there is a quite a bit of media coverage. Im available for any commissioners questions and again, there will be a more detailed covid19 update. The doctor is here to provide Additional Details with regard to that. Thank you. President bernal thank you, director colfax. Before we move on to commissioner questions, mark, any Public Comment on the directors report . There is no one on the line at all. Any questions or comments for the director . Commissioner chow yes. Thank you for your report, dr. Colfax. And i was curious that the bill that was signed by governor newsome about adult residential facilities named a number of facilities that here in San Francisco and your report was closed. How many remain in San Francisco that this might help protect or at least give about a halfyear warning about the changes that might occur . I dont have that number at my committed to memory, commissioner, but we can certainly provide you with that information. I dont know if dr. Hammer is present and we can follow up with that number very soon. Thank you. We can get that number to you. President bernal commissioners, any other questions . Director colfax, one question. I know we had heard from you and dr. Aragon in previous presentations even though we meet the criteria here in the state, that some of the numbers such as our really high degree of testing and the formula that the state use indicate that perhaps we should be taking more of a cautious approach than what is allowed in the state tier were in. Are we still in that posture . Yes, thats right. And we can talk about that more in the update, but were using the local data to determine how to report. Weve been very much focused on what is needed based on our data. What is the state provide the framework, but remember we can be more restrictive than the state. And in general, weve been more cautious than the state has necessarily permitted. President bernal great. Thank you. Commissioners, any other questions before we move on . All right. If not, well move on to the covid19 update. Are we ready with slides. Thank you. Grant colfax. Director of health. Dr. Aragon is available for additional any questions and obviously, its welcome if he would like to add more details. Apparently 11,57 cases of covid19 in the city. Unfortunately, 111 deaths. This is a population characteristics of our positive cases and, again, highlighting the inequities that i describe in the directors report with regard to the latino population representing 50 of cases. The age group you can see here that this has been somewhat of a shift. Weve been getting increasing number of younger people diagnosed with covid19. I will say that particularly with regard to the less than 18 age group, we may see increases in this one, because children will be returning to school. So there could be more transmission as well as more testing as a result of that. And this week we also announced that our city test sf, popup sites testing children under the age of 13, thats been positively received by the community members. So well continue to watch those numbers. You see the other characteristics of the cases. A little bit higher among male prevalence and so far in the homeless in the population experiencing homelessness, a relatively small proportion, 3 . And about 5050 between Community Transmission and known contact. Then the Sexual Orientation of cases. Its here on the far right bottom of the slide. Next slide. Again, this is the data comparing our jurisdiction to other similar jurisdictions in terms of cases, death rates per 100,000, testing rates. San francisco continues to do very well. Near the top in the things that wed like to be doing well in terms of tests and near the bottom in terms of deaths compared to other jurisdictions. Our key indicators, these are local health indicators. As of this morning, you can see the hospital indicators, the first three, Hospital Capacity are low rate of covid19 hospitalizations. Our case rate which has stubbornly high for many weeks, in the red zone, is now down to orange. Thats a very much growing in the right direction. Testing numbers, 4500 tests over the last seven day average. Our Contact Tracing, this has been slowly climbing. Were at 83 and 85 . Then our p. P. E. And d. P. H. Remains strong at 100 capacity for 30day supply. This is our hospital occupancy curve for people with covid19. The darker blue lines are the intensive care unit on that given day. The light blue lines are the medical surge beds and the total is located at the top of that. The curve flattened in may and june. We had a peak in late july. Were starting to go down again. Things levelled off in september. Were bouncing between 65 and 75. Im rounding here, cases. And were seeing a decrease again, so were watching this carefully. And as we enter the fall and winter, were concerned about transmission and were opening more activities, the more permissive in terms of businesses opening with protocols in place, including the masking, social distancing, masking when possible, but at the same time we know this virus increases when activity increases. So were watching these metrics carefully. Were also concerned about flu season and ensuring our hospital capaci capacity. I will say in the southern hemisphere, what has been interesting, some of the flu the data from the flu has been less concerning than other years and thats because with more precautions that people with taking to prevent covid19, there is less flu transmission. We are telling everybody, this is certainly the year to get a flu shot. Every year, but this year is more important than ever. So this is our reproductive rate slide. This is again the number for the reproductive rate, if the reproductive rate is two, that means for every one person infected, two people become infected. 5 means for two people infected, only one person becomes infected, so the infection slows down. Reproductive rate of 1 means youre in neutral territory for every new person infected, a new person is infected. Remember the goal of covid19 control is to get that reproductive rate less than one. Youve seen from other data how important that is. Were at. 92. Right now, our best estimate remember this is an estimate. This is based on thousands of data that we provide to our colleagues at ucsf and u. C. Berkeley. That is the average estimate that those simulations come up with. The lighter blue lines are the intervals, you can see up to the 95 conference interval. Its possibly were slightly above 1 right now, but its more possible were at. 92. Next slide. In terms of our reopening, i just want to make note that dr. Aragon and the outstanding team, including the city attorney, the info and guidance people. One of the things that i do want to emphasize here, were not dealing with the hospital surge, thank goodness, that we were so concerned about early on. That is certainly a plausible scenario still, but the reopening work is also a tremendous amount of work for the department, for the many people who go through the info, the guidance, the lepehel helpe directives. Its good were focused on this right now, but it takes hours of time. I would say that the Health Orders are very detailed and very much based on the best evidence that we have available. So these are some of the highlights with regard to reopening the indoor dining, indoor bars with food. The indoor movies, houses of worship, indoor malls and then we do hope that we will be opening playgrounds in mid october as well. But you will see that there are a number of activities still to be determined and, again, per commissioner bernals comment earlier, we are reopening more slowly than the state would currently permit, so were taking a cautious approach and were looking carefully for signs of a surge that may overwhelm our health care system. There is a lot of focus on testing. I wanted to give a visual representation of the city and county s. F. Testing sites that we expanded. This map looks similar to the map i showed you in terms of the prevalence of covid19 in the city. Really being concentrated in the tenderloin, the mission and then in the southeastern part of the city. Youll see that we have expanded our Testing Capacity along those corridors. We have the two city test websites, embarcadero and soma, those have been established since april. We have Community Clinics in green that many of them do popup testing. They have varying capacities. They are not only d. P. H. Clinics, but there are other partners in the clinic core consortium. We have our mobile sites. These purple dots on the map do not represent sites that are up every day, but they show where we go during the week. We have two sites that have total capacity of doing 500 tests a day in this regard. So quite an expansion of testing and an expansion of testing where the virus is most prevalent, including in the Latino Community and neighborhoods. They have high numbers of latino residents. Next slide. So i believe youve seen this slide before, but this is data from august. Well provide you with data from september once its analyzed, but this is just looking at the popup sites, the purple dots on the map, compared to the sick sites. Youll see high rates of participation and positivity among the latino clients at our popups and thats significantly different from the fixed sites in embarcadero and soma. Remember, the fixed sites were established early on in the pandemic. The goal was for them to provide barrier testing, especially for city workers and other people who were working during shelter in place, so they continue to serve a purpose, but the Positivity Rate is at these two sites and you can see were focusing our efforts into the popup to concentrate our testing efforts Going Forward in populations with the high Positivity Rate. And with this is also data. These are data from our alternative testing sites. So these are at d. P. H. Clinics. Youll recall we set up these sites early on in the pandemic. You see march 7 was when we started the testing sites. And these include the Southeast Health center, maxine hall health center, San Francisco hospital and well see that theyve done a number of tests over over 21,000 tests and 34 of those clients have identified as latinx. You can see here that our Positivity Rate is high among our latinx clients and they are we are reaching the population most affected by covid19 at our alternative testing sites. These sites are for the most part, dropins. People can make appointments. They can for the most part tested children from the pandemic. Im pleased to say were expanding capacity at these sites very soon, so we will be able to serve even more patients and clients than weve had previously. This is data that do show that within the d. P. H. System we are reaching populations most at risk for covid19. And this is just emphasizing that with regard to over time, at our alternate testing sites at d. P. H. , our average Positivity Rate has been 13. 5 . You can see its a bit of a lot going on. The lines are the number of tests done a day. The jagged lines are the Positivity Rate on any given rate. And the blue line is the Positivity Rate over a 7day average. Youll notice that in april we had a very high Positivity Rate that was likely because we were really focusing on people testing who had symptoms, so we obviously had a higher yield there. But you can see that the Positivity Rates still remains pretty high going into almost the beginning of this month. Next slide. And then i did want to one of the big efforts that weve focused on is isolation and quarantine sites. And providing people isolation and quarantine opportunities because we all know, despite the fact that some people in this country are not doing this, isolation and quarantine is very key to ensuring that the person gets the support they need. These are people so who have availed themselves of the hotels free of charge. And nearly half of the clients have of the isolation and Quarantine Hotels have been identified as latino or latina. A number of people avail themselves of these hotels. Nearly half of them had an apartment or home, suggesting they werent able to isolate or quarantine safely in their residence. So just what i hope is Interesting Data for the co