Commissioner green . Present. Commission chow . Present. Commissioner guillermo, present. Ill note the commissioners. Thank you, mark. Well move on to the next item, which is approval of the minutes from the last Commission Meeting on january 5th. Commissioners, upon reviewing the minutes, are there any amendments . And if not, do we have a motion to approve . Before we go into the vote, i have to make sure there is nothing on the item. Thank you. And this is a general instruction, but you will press star 3 if youd like to raise your hand, and ill say the same introduction over and over again. Okay. So there is no comment at this time. Well vote. Commissioner chow. Yes. Commissioner green . Yes. Commissioner chong . Yes. Commissioner guillermo tkpwhrerpl . guillermo. And. Our next item is the directors report. Good afternoon, commissioners of health. This report focuses on covid19, and i will be providing an update and as well with regards to the current status of covid19 and our vaccination status. And so i will provide more details during those presentations. I did want to mention, too, additional highlights with regard to the department. The department has joined mayor breeds to combat and prevent teenage trafficking in San Francisco, along with several other departments. Starting this month and there should be a correction there on the board of january 2020. Its actually january 2021s our Environmental Health inspectors will begin incorporating new antiHuman Trafficking training in their inspection process. EnvironMental Health approximately 100 inspectors who will conduct regular on site inspections of over 9,000 businesses, such as restaurants, bars, gas stations, establishments, and residential hotels. And all staff will be trained to recognize the red flags or the most common signs of Human Trafficking and make referrals to the San FranciscoPolice Department for an investigation to investigate. So a key piece of work ongoing there. And then just to focus on another key healtrelated issue, tobacco control. Again, the Environmental Health branch, the department of justice grant for a total of roughly 1. 8 million, and janine young submitted Grant Application in their efforts to educate minors about the harm of Tobacco Products and enforcing tobacco laws and conducting enforcement. Again, this is an ongoing combating tobacco aggressively particular among youth. And that is my report again to follow the update to follow. Before we have any questions or questions from the commissioner, do we have any comments on the item . You can press star 3 if youd like to make a comment on the directors report. Star 3. No comments, commissioners. All right. Any questions or comments for director before we move into the covid19 update . All right. Commissioner chow, thank you. Billion, actually, if dr. Colfax, i just noticed on the dpa about the Moderna Vaccine. But if you still want to cover that, then that will be fine. Okay. That is the plan, commissioner, thank you. Thank you. All right, without any other questions or comments, we will move on to the next item, which is the covid19 update. And i just want to acknowledge before we go into that, that our nation passed a very sad milestone today with 400,000 deaths to covid19. There have been observances in washington, d. C. And around the country to honor who weve lost. It was 5 30 on the east coast and 5 30 tonight with a moment of silence. Those who are watching, i encourage to you take a look at the lighting ceremony. It was really quite moving and our sympathies go to everyone who has lost a loved one or who has been impacted. So dr. Colfax . Thank you, commissioner for that acknowledgement andit is indeed a somber time as we head to a year when the department and city organize to confront this virus. And i think it was unimaginable at the time that we would be faing a toll of 400,000 people who unfortunately died from this virus. So sill be providing an overview of our cases in San Francisco, and then i will will be providing a vaccine update. So we have just over 29,000 cases of covid19 diagnosed in San Francisco, and unfortunately, 260 people have died of covid19. This is the population characteristics of diagnosed covid19 cases in San Francisco. Once again, we see the inequity inequities with regard to overrepresentation of latinos and the pandemic. This number has this percentage has decreased somewhat proportionally from the summer and fall. It is now 42 . You see the age groups there with regard to the distribution of covid19 by age, sexual orientation, and gender. Next slide. Looking at population characteristics by death. The race and ethnicity components are shown on the yellow bars. And again, the proportion of percentage of asians who have died of disease, we believe thats due to location in nursing facilities and older aged people who have been diagnosed. With regard to the age group and this is going to be very important during the vaccine presentation just to emphasize if you look at the percentage of deaths by age group, over 83 percent of deaths due to covid19 in San Francisco have occurred among people 65 and older. And the if we could just go back to the prior slide please. You see that age group. You see the distribution of covid19 among the age group. And then if we go to that slide i was just descriing, look at the disparities there. So just really important as we think about who to prioriize to get the vaccine. And then youll notice in the red bars, the comorbidities. So nearly three quarters of people who have died of covid19 in San Francisco have had some comorbidity. Next slide. This is our key health indicaor slide, the current state of where we are and what weve been following. Our hospitalizations, the increase of hospitalizations have come down quite a bit. Were now at negative one percent, so that is a positive indicaor. Our icu capacity and hospital bed capacity remain strong, between 20 and 24 percent, as you can see in the next two boxes. A case our case rates has been remained high, 38. 3. Our summer surge. Our high was about 100,000 so were more than double that now. Our only indicaor is a few days ago that average thats was about 40. So we may start to see a leveling off commensurate with postdecember holiday and new years. Potential peak, testing numbers are nearly 9,000. 9,000 tests being done per day. Our contact traing numbers percentages are improving somewhat, but with the large number of cases we work tocatch up and our levels remain strong. Dr. Colfax, im sorry to interrupt you. Let me know that they cant see the slides, which is an important part of this meeting. So im wondering and i apologize for stopping you. Could you stop sharing and then restart . That might be a way to make them show up . I think thats an issue. Were having a lot of glitches. Thank you for your patience. Are you able to see that on tv now . Im asking that of folks. Still nothing. So go ahead and keep doing your thing. Im not sure what else to do. Keep going and ill work with kevin and see what we can do on our end. Okay. Mark, we can just note also that the slides will be Available Online, correct . Yeah. I will post them so that they will be available after 5 00. Okay. Good. Thank you, mark. So this is our trend from october to the beginning of the year with regard to cases per 100,000, running sevenday average. You can see that rapid rise after the thanksgiving holiday. Then another rise after the december holiday and new years and now were starting to see what we hope is a decrease, a sustained decrease in new infection rates per 100,000. Next slide. And this is our hospitalization curve since the beginning of the pandemic. You will notice again that we are more than double the number of people that the hospital compared to our summer surge. And then starting over the last few days, we are seeing some hopeful signs that hospitalizations have leveled off. Obviously, this is no cause for com phraeupbsy. I think its very important to emphasize we still have somewhere in the range of 250 people, depending on a given day, in the hospital suffering from covid19 and our medical teams across the city are working very hard to give them the best care possible. Next slide. This is the reproductive rate curve again since the beginning of the pandemic. Youll see on the far right here that this number continues to come down. As of january 17th, the reproductive rate we estimate to be 1. 05. And you can see what the implications are with regard to hospitalizations over the next few months. But again, in the last couple weeks or so, we have seen a slow but steady overall decrease in the reproductive rate of the virus. Waiting for that number to get blow one, which means that the virus is not increasing throughout the city. Reproductive rate below one will indicate that its decreaing. Neck slide. And then with regard to county comparison, i know this is of interest to the commission. With cases per 1,000, we are relatively, our numbers are relatively our numbers are smaller. Cases are smaller compared to most other jurisdictions, with the exception of seattle. Our deaths per 100,000 remain lower. And then our test per 1,000, you can see are higher than most other jurisdictions, with the exception of los angeles. Next slide. So thats the end of my portion of the presentation. And i also see thats dr. Andy turner has joined and they will be providing the vaccine overview. Happy to take questions on this portion or at the commissions request, if we do that after the vaccine overview. Thank you. Mark, we can do a quick Public Comment on this portion, and then commissioner questions before we go into the vaccinespecific. There is one set of Public Comment, commissioner. The commissioner has questions on each of them and the public usually has one time. Okay, so if its all right with director colfax, we will see if commissioners have any questions on this portion of the presentation. Commissioner green. Yes, thank you for distribuing the wonderful information. I was wondering whether any projections have been made with the subtypes and muteation thats might be more aggressive. Has there been any modeling of that . I know the subtype is currently 25 of the cases in california is more or less but i wonder which organizations are analyzing that, and at what point there will be either some modeling or projections so we can better understand where we might head in the future . Thank you, commissioner green. We havent done any specific local modeling in that regard. Its an assumption likely will be to be here and continue to as part of the Natural Evolution of the virus will continue to be here. Our model is our models basically incorporates what the natural state looks like in the community. There are models that have predicted what the more dominant strains will be in the next few months based on what is known about some of these variants. But we have basically taken the approach of looking at the characteristics of our trends and not specifically at the virus variants. Okay, thank you. All right. Director colfax, some key indicaors, ppe supplies remained at 100 percent steady. Is there any indication that we may be faing any future shortages based on what we know and what we might have on hand . The ppe indicaors and we have not received any indication at this time that there is likely to be a shortage. All right, thank you. I dont see any more commissioner questions or comments, so we can move on to the vaccine portion of your presentation with mr. Pickens. Thank you. Great. Thank you, dr. Colfax, and good afternoon going on evening, commissioners. Its my pleasure to be here with you, and im joined by my colleague, dr. Andy titer, who is the medical Operations Branch and the city covid Commander Center and shes been part of the citys activation for covid since the very beginning and has been playing a key role in particularly in the vaccine effort but now has a larger role beyond vaccine, but for, including surge in the other medical operations related to covid. And so as you can imagine, this is a hurricaneane task that we are undertaking both in d skphfpls in the city. So in the words of hillary clint, it takes a village. So two members of our village will be with you this evening. So the goal of this evenings presentation is to try and demystify what is our current Distribution Strategy within h and the city and to try and describe and clarify some of the roles and responsibilities. And then finally to provide you some of the data on distribution and allocation. Next slide. Okay. So as you can imagine, these are unprecedented times. Weve begun the most ambitious Vaccine Distribution effort in our citys history. Weve spent the last three months working to be ready for this moment. But however, so much of this process is unfortunately, out our control, but we dont let that deter us. We know we will do the best we can on behalf of all San Franciscoans. As you can imagine, the chief obstacle were faing is not enough doses, and well discuss that more. And one important fact to note is, while there is not enough while there are not enough doses going around, the distribution, one of the key components of the way that operation warp speed was set up is that most of the vaccine, as it comes out, is going to whats called a multicounty entity. These are the Large Health Systems within our city and state. So the u c system, the sutter system, the kaiser system, the dignity system, and also any large freestanding acute or hospitals like Chinese Hospital. So we all see these reports and we all know that the current process is slow and frustraing. And very confusing and most of the times overwhelming. However, we want you and the public to know that the vaccine is our ticket out. Its our ticket to be able to hug our friends, for our grandparents to meet their new grand children, and to hopefully soon linger inside a San Francisco restaurant again. So we pledge to be ready when more vaccine is available, to optimize our use of the Current Limited supply. And when that new supply is available, to be ready to get shots in arms immediately. Next slide. Okay. So to help ground us in our work for Covid Vaccine, weve established the following guiding principles. We want to ensure that capacity for the vaccine, that is limited in supply, is aligned both with the cdc and the state guidelines for priority. Those were worked on for months by our nations leaders and they are which we administer our vaccines in the city of california and city and county of San Francisco. Another important principle is that we want to ensure equitable vaccine application and administration across our city in its many populations, particularly those vulnerable populations in underserved communities. We want to prioriize our rapid vaccine access, again in those communities with the highest covid prevalence, particularly those that do not have access to routine places for healthcare. We are operating under a principle of meritics and data metrics and that General Information must be transparent and visible both to the public and to our Healthcare Delivery system partners. And then finally, to every extent possible, we feel its important that we preserve th dph staff and functions for those communities and populations that typically only dph serves. However, we are still partnering with other Health Systems in the city to employ their assistance in meeting some of these populations. So above all, what you should try and under is that, while were operating under these guiding principles, the systems for distributing vaccine has been mandated at the federal and the state level. The guidance continues to shift, as well as making this morean even complicated problem than it normally would be. It doesnt take me to tell you that we have a highly fragmented system of care in this country, and because of that, we believe its hampered much of the ro rollout for Covid Vaccine across the country and in our state. However, we, many weeks ago began discussions with our Health System partners in the city and are working swiftly to work collaboraively to make sure that the vaccine supply is made available to those who are eligible per the state and federal guidelines. So again, vaccine capacity is limited right now, and we are focused on presering, particularly for dph, vaccine for those prioriized, vulnerable populations. Next slide. So this slide going from left to right, really represents our path to immunity. It represents where we are currently as of the middle of january and then where we plan our targets to be in june. Right now were currently in phase 1a of the state plan, which is predominantly essential Healthcare Workers and residents of skilled nuring and other longterm care facilities. However, by the end of june, working with our major Health System partners in the city and other Community Clinics, our goal by june 30th is to get our entire population of 900,000 plus individuals in San Francisco vccinated with covid19. So you know, as you can imagine, there will be several twists and turns along the road, but we are feeling confident that once the vaccine supply is made more readily available and reliable, we will be able to reach this goal based upon our current planning and collaboration. Next slide. So this slide, as i mentioned before, that the California Department of Public Health