intersection. it's just not in the same place at that intersection. it's across cortland. >> how about the question about the dna lounge and bikes? >> can we get back to the cortland thing? so, just turning off -- i was more concerned with the parking issue. i thought you addressed that a little bit. more concerned with the bus issue you brought up just in term of the fact he said there were buses signing up already and that would create a problem because there would be a shorter amount of space maybe and also with the turning of the overhead wire issue, i mean, can you address those? sorry. >> yeah, so, as far as queueing goes and buses lining up there, you know, the bus bulb will be as long as it needs to be, 90 foot for the far side, which is enough for essentially two buses to line up. we're not anticipating any more line up. it's not going to go into cortland for example, there is enough room for the leading bus

to be ahead and then the bus right behind it. that was -- the overhead issue for the 24 was one of the reasons that we -- another reason that we are not pursuing a green zone around the corner on cortland. the idea was first we thought maybe we can cutback some of that bus zone and put a green zone in there. but because of overhead, turning issues to getting around that, we're not going to be able to do that. if we shave the corner of the bulb a little bit on bayshore as we're making that turn from cortland, there's no overhead wire issues or not problems with that within the turn templates and things. >> can i ask director reiskin a question? >> sure. >> because of potential problems we may have, it is possible to make that a temporary stop, not the bulb out yet, at the expense of the bulb out to see if operation can make that turn? is there a back-up? if it's true it does create

that problem, then we can back away as opposed to spending the money to put the bulb in there and find out there is a problem, these disappear. >> yeah, i think if the board were to legislate this today then we would have the authority to go ahead and do the bulb. we do look at doing it as a temporary bulb of some sort. we haven't found a good way to do temporary bulbs without incurring, incurring some costs. we looked at a number of different solutions, sidewalk extensions, somewhat akin to park lets, but we have some a-d-a issues we'd have to resolve. but for maybe a short-term trial we could see just through -- with paint and some delineation possibly doing some sort of temporary installation at that one location. we have -- so the answer is yes, we can at least look at doing -- i will say our traffic

engineers and our transit folks look at this stuff pretty carefully and would be bringing it forward if it wasn't a high degree of confidence that it would work. so, i don't think with pouring the concrete we would be presenting ourselves with a great risk or any real chance that we'd actually want to undo it at some point. in any case what the bus bulb does it shortens the crossing distance across bayshore. but it's something that we could look at doing and likewise for the safe head posts, not really i'd say connected with the project in terms of the bus bulb on 11th, but it's something we can ask our sustainable streets folks to look at. it real die pend in part how many curb cuts there are on that stretch of 11th which i can't picture at the moment. there aren't too many so it could be a candidate for safeness. i don't think there is enough space there for them, but we can look at that. >> what do you think?

>> seems like a reasonable thing to me to ask. ask the director to look at it. if you look at it seriously and see -- >> i don't want to commit here and find out for some safety or a-d-a reasons we can't do it. but if there is a way we can accommodate doing it on a trial basis before we actually execute a contract and pour the concrete, yeah, i think that could be a good thing. >> director? excuse me, director ellis. >> thank you, mr. chair. very quickly, i just wanted to acknowledge that a bus bulb to me doesn't seem like it's that removable and i would actually encourage we go forward with the program. if it doesn't workout, i don't see it as being irreversible. it's just a bulb out, right? to me it seems like it wouldn't -- it's not like we're laying rails down or anything to that effect. i acknowledge the benefits of a bulb out. the improvements that we're

talking about here would amatically improve the service, the reliability, the safety, and all of that good stuff. i do trust our engineers have looked at it and if for whatever reason we do have failings, what has been articulated by the gentleman here, i think we could easily go back. i mean, that's one of the things that i think is great about these improvements is that none of them are like really expensive hard to undo improvements. so, i would encourage us to consider it certainly like director lee was saying. [multiple voices] >> yeah, but to move forward with the legislation. >> [speaker not understood]. >> i guess i have more of an issue about the queueing more than anything. i mean there's a lines issue, but there is an issue about the queueing. is there a lot of queueing currently at that stop? >> definitely buses will show up at the same time due to bus benching. that's one thing we're trying to fix with all these projects along the corridor, is trying to spread out that best

bunching so we don't get those two or three buses showing up at the same time. i definitely don't doubt that it happens today. >> one of the other questions raised about the bicycles around the dna lounge, can you speak to that? >> yeah, sure. so, i think director reiskin was talking about we look into that, too, a little bit more. we've been working with all of the streets, our friends to -- colleagues to understand that issue. a director reiskin was pointing out, there are other things right there on that block face. there's a couple other parking curb cuts and some delivery zone issues. so, we need to make sure we can accommodate all that and put in safe hits, but that's something we've been looking into with the livable streets colleagues, so. >> okay, thank you. okay, members, what is the pleasure of the board? seems to me we have a pretty reasonable program before us. especially the understanding is director lee has said,

possibility for the bikes as well. is there a motion on this? >> i'll move it. >> a motion. is there a eked >> second. >> all in favor say aye. >> aye. >> opposed no, the ayes have it. thank you very much. next item. >> item 12 [speaker not understood] conduct a closed session. >> motion? go into closed session. all in favor say aye. >> aye. aloe owe [speaker not understood]. >> thank you, mr. chair. >> [speaker not understood]. >> move on to disclose. >> aye. >> that completes the blitzness before you today. >> okay. [adjourned]

>> the health commission will come to order. call the roll. >> singer? >> present. >> taylor-mcghee. >> present. >> chow. >> present. >> chung. >> present. >> sanchez. >> present. >> the approval of the minutes of the september second and september 16th meeting, 2014. >> we will take each one in order, the first one will be the minutes of september second, is there a motion for acceptance of those minutes? >> so moved. >> and is there a second? are there any corrections to

the minutes? >> seeing no corrections, we will prepare for the vote. all of those in favor, say aye. >> aye. >> all of those opposed, the september seconds minutes have been accepted. >> the minutes of september 16th are before you. >> motion for acceptance. >> so moved. >> is there a second? >> second. >> is there any further discussion or any corrections? if not, we are prepared for the vote, all of those in favor, of the minutes of september 16th, please say aye. >> aye. >> all of those opposed? the minutes have been approved, for september 16th. >> thank you commissioners, item 3, is the director's report. >> good afternoon, commissioners, for the next several months, we are going to have a disease update for you and that will happen at the beginning of my report and today, dr. ogona and cougar will be providing you with

updates. >> good afternoon, commissioners today i am going to give you a quick update on the ebola situation, today, dr. hover will be joining me and also want to acknowledge other key people that are really working on the preparedness, dr. baba who runs our public health emergency preparedness and response branch and also rachel kegan who is our communication director who has been working closely with us. and what i am going to do today is i am going to go very in the next two to three minutes, go over it the document that says, communical update sxim going to focus on ebola and help you understand the conceptual challenges that we face, with a threat like ebola and then dr. hover is going to give you a detailed update of what is happening in san francisco with

respect it preparedness, on the first page here, you can see the summary of the data that is coming out of after cabsinger now this out break in 2014 is the largest out break that we have had in history to date, you will see that in the first table there, we have had over 7400 deaths, sorry, over 3400 deaths, and over 7400 cases in countries, the transmission that occurred in nigeria has been contained and we did have an imported case, of a person who flew back from libera was seen in dallas texas and is currently in critical condition, it gives you an idea of what is happening right now globally. what i want to do for you next is just to give you an idea of the challenges that we face with ebola and i want to present it to you in a framework that we use for containing the diseases and since we are going to give you an update, we give to give you

an idea of how we think about the diseases on the second page, you will see two on page 2, you will see two tables at the top, and you will see a diagram at the bottom and this is actually from a training that we have given to clinicians and also lay people on how we think about controlling the microbial threats, you will see the reservoir or source, right now what we know about ebola s the reservoir starts in the back and currently the source is infection in humans and those are the areas that we focus on, the areas that are bolded are the areas that we move forward and we think about those sources. in the next as you look at the diagram at the bottom there, you will see there under, the first circle you will see the portal of the exit and one of

the challenges that we have with ebola which is different from the other diseases is that pretty much, every body fluid is infected and we are talking about feces and bodily fluid and it is in the saliva and it is sweat and so every fluid becomes infected and they become violently ill, fever and vomit, and diarrhea and so a lot of fluids that expose other potential people. so that is actually one of the challenges that we have in a case appearing in the united states like what happened in texas. under the mode of transmission, column, you see how we think about this and so for ebola we are going to be focusing on the areas that are bolded and there is direct contact and so say that the people who are going to be most exposed to risk are going to be healthcare workers and family members that are taking care of patients who are sick. and the reason is, is because

the patients are not infectious until they become severely ill and, so the healthcare workers are the one that are the highest risk and so we contact precaution and we also focus on droplets and developed with a concern of the virus being arosolised when you have the procedures and they are also help to implement the precautions and i put the vehicle born there because we are concerned about the contaminated equip and this is an issue in africa and that covers the modes of transmission that we think about and then on the right-hand side is what we used to sort of to educate the lay public and we call it the 7 habits of unfekted people, the 7 habits that you can think about how to protect yourself from any inif disease, personal hygiene and focusing

on the hand hygiene and hand awareness and covering any portal of exit, coughing, any wound that you have and using protection in the clothes there and because it turns out that the ebola virus is also in semen if any patient were to come here and continue to excrete the virus it continues to exist in semen something as important of wearing condom ss going to be issued and reducing risks and focusing on close contact on healthcare workers and the last one is infection control and the last thing that i want to cover before it i turn it over to hover is for all diseases that are transmissable person to person including ebola. and there is six core strategis that we use to contain the diseases, and the first core strategy that we use is try to reduce the contact from the people who are infectious and the people who are susceptible

and you are going to see a lot is to reduce the contact of the people who are infected and susceptible, the core areas that you will see the people using and the first one sheltering, those are the people who are unexposed and often times, families will tell and keep people at home, for example, keeping children at home and don't send them out because they don't want to get them exposed the second one is quarantine, a worker or anyone else that we monitor them to see if they develop symptoms and the third area is case isolation and, identifying people who are ill and isolating them, so a lot of the contact tracing in the news and this with unof the biggest challenging is the contact tracing because we want to identify them, so that you can quarantine them, or if they are sick, so that you can isolate them, the dallas case had 140 contacts, and that was just one case, and you can begin to see the amount of person time and

man power it takes to do all of that contact tracing. and that is one of the challenges that we have. and then in the last one, there, and in amendment number five, is interrupt transmission, which is transmission control and so as you hear our disease reports in the future, we are always going to be going back to the core concepts because they are the foundation for everything that we do, whether we are transporting a patient or caring for a patient in the hospital. now the last thing that i want to show you is on the last page and you see the incident command system and it is a diagram that looks like this, this is how we mobilize the health department to respond to a public health emergency. what is really important for us is that the operation section and those are all of the things that we are preparing for, and when we, when we were responding to a disaster or any public health emergency. and there is a lot of details

and i am not going to go through all of the details and that is what we are working on and we are fortunate that we have a commitment of the director to mobilize the resource to offer the health department to really help us, because it is and there is a lot of person power involved. and everyone around the country is working on this and this is a challenge, and hopefully nothing will happen but if something does happen in san francisco, we absolutely want to and we will be prepared. i am going to turn to over to dr. hover and he will give you more detail of what is happening in san francisco. >> thank you. i'm dr. cora hover and i am the director of disease control and prevention in the population health division. and i am going to, and i have some copies of my slides here.

so, first of all, just to state although you all know this, we don't have any cases here in san francisco at this time. we have seen is that many communities across the country have had individual in whom a concern of ebola has been raised and testing has been done, and ebola has been ruled out. and then, in the dallas texas case, unfortunately the person did have ebola but there have been a number of these real out ebola situations in various communities. and i think that it is... he was saying, that it is very important for us to think

through how we will respond and are ready for that if we do have a patient in whom ebola is suspected or confirmed. so, the first thing that i am going to talk with all of you about is communication. and this really is i think of it as kind of aa three part strategy and what you see here on the slide is an accounting of what has happened so far. from our departments, so, cdc and also, the state department of public health have been pushing out increasing by detailed and comprehensive guidance about how to handle a potential ebola case and how to prepare and we have been sharing those as they become available. with medical providers and hospitals. we sent out a couple of health advisories to medical providers here in san francisco. one was sent out in early august and the other one was

sent out at the end of last week. we are also in dialogue with the hospital to ascertain the level of preparedness, and for a case and, we have provided resources and information from medical providers on hour programs, website. and this really builds for the other pathways that we use and we have the shared information with 311 and also, made a more information about ebola that is more targeted to the general population such as a fact sheet, available on our website. and in addition, with a great deal of really wonderful, from

rachel, and we have been responding to media inquiries and in addition, there is now a media call-in hot line that has been set up, so that if there are any critical updates, that will be another avenue whereby, the members of the media can call in and get the information. the partners that we and the department of public health work with, and would be working with within an ebola response, include, occupational health and safety. ems and first responders. hospitals and medical providers. let me, move you to the next. and hospitals and medical providers. law enforcement, and potentially, and also, the dem,

the issue of a returning traveler, potentially being the means by which ebola would arrive here in san francisco, points to the importance of our dialogue, and work with the quarantine station and we are always receiving information and also seeking guidance. i wanted to just talk with you briefly about contact investigation and monitoring. that is kind of the bread and butter work of what the disease control program does, on a daily basis, and we investigate, rather usually

rather common diseases, examples would be pertusiss, and those are the kind of things that we are working on every day. and really, the principles that we use in that day-to-day work with would be the same principals that will be applied and are being applied for example in texas to follow up potential contact of any ebola case and really this public health follow up is what is going to help insure that sustained transmission of ebola does not occur in the united states and we really do not expect the transmission of the ebola to occur in the united states because of the excellent infection control precautions in the medical settings and also, excellent public health follow up.

and so obviously were we to have and if we don't have a case in san francisco if we were to have such a case, we would marshal the resources that we need to in order to augment our current staffing and personnel in order to do the appropriate contact investigation and monitoring. and to accomplish that follow up. and so i am going to stop there. and i am happy to answer any questions if there might be. >> was there any public comment? >> and i received all of the comments for this item. >> commissioners, questions? doctor? >> first of all i thank you very much for this presentation. and i like to hear a comment and i love the department's disease fax, and i look forward to it every week on my machine and through the season f we are in or out of flu season and it is various and director garcia

was saying that we need to think about something... (inaudible) likely first. >> okay, and we are a transitioning to do communication by e-mail as well. so... >> so i am really happy that you brought this up and i want to be sure that there is preparedness and you have done your due diligence and the whole ems system is up and running i want to be is that youer this is an isolation unit available and seeing this case, how fast, in texas that it spread, and you can see that you have one case, but it sounds like you would rue craout for your contact tracing a bunch of people as many as you need, and you just pull in everyone from i am unworking commissioners to everyone that needs to contact tracing and i think that the isolation is... whether you will have enough spaces and the last question that i would have is the flu season and we are going to get

a false alerts. and we can separate what is real from what might be a lot of work. and maybe i will just talk about the false alert question really quickly and then i will have nadina boba can speak to the isolation room issue. you know, the really important thing and the key point i think when thinking about ebola in a patient is their travel history. >> and so i think that once the history of whether a person has traveled to an ebola affected area or has contact with an ebola infected patient, is ascertained and there is... where the ebola infection needs to be ruled out. >> just to be asked for your question about isolation units,

there is 102 isolation units in san francisco hospital and so we have a robust system and that might be suspect in a lot of cases. so that is not just like one capacity, every hospital will come on line. >> absolutely, yes. >> >> commissioner singer? >> dr. aragon a couple of comments and questions. one is that it sounds like we have done a terrific job in pushing the information out and getting information in from the federal, and world health organizations, pushing it out to our community, and it sounds like we have a terrific response ready. it seems to me in these situations that identifying the event, it is critical to linking those two work streams. >> and i was at the general on friday, and it was clear to me

that, they really have quite an education system, at least in the er and i am sure that it is in other places where people are aware of it where they have the daily briefing and the staff takes it very seriously and how confidence are you that that attention and connection that we have here at the department is equally (inaudible) with all of the other providers that may end up at a place where there is a sentinal mode in the city that are not dph institution and kind of talk about that type one and type two errors. >> yeah, so what, and wait that the cdc is thinking about those, is that they want every hospital, every critical facility to be prepared to screen a patient, initially, and then decide where to send that patient next. if it is out of sight that is well prepared to take care of

the patient and the patient should stay there, if there is a better location and a hospital that patient should be transported. right now the cdc is in the process of developing some screening tool, and to help hospitals assess how well prepared they are. and the dallas example is for us a event because all of us have a lot of capacity and a lot of capability, with the details that matter and so the texas case sort of got the people thinking they started to see some of the details, one of the things that we are learning from the patients that are being cured, in the u.s. hospitals is the amount of waste that has to be disposed and the amount of infection control equipment and the amount of training and doing things appropriately because you don't want the workers to become infected and so we are realizing that this is from the cdc now is that it is not practical to expect every single hospital, in the u.s. to have the highest level of