>> sfgov-tv. we're ready to begin. >> president mccarthy: today is wednesday, march 18, 2020. this is the regular meeting of the building inspection committee. i remind everyone to turn off electronic devices and the first item on the agenda is roll call. president mccarthy? >> president mccarthy: here. >> clerk: commissioner moss? commissioner clinch. commissioner jacobo. commissioner tam. commissioner alexander-tut. we have a quorum and our item is item 2. president's announcements. >> president mccarthy: good morning, everybody. just moving -- everything is

moving parts here. i just wanted to have a few words to read into the comments and to my president's announcements. i'm confident and dedicated -- i am confident that the dedicated and hard-working staff throughout the department of building inspection are aware of the response to the people of san francisco and will continue to do their duty and uphold the public trust which they've been doing in the last week. as you know we're dealing with, you know, a public health emergency in our city. and our state and country, that we have never, never had to encounter before. on behalf of the commission, i urge all d.b.i. staff and customers to follow the instructions under public health officials and to do their part to prevent the spread of covid-19. i applaud the department for taking steps to limit the virus spread such as increase social distancing between the customers and d.b.i. staff, and the more frequent cleaning of commonly

shared public services. continue to pay attention to all of the public health instructions and take all of the possible precautions for your own health and your loved ones. be proactive and help to keep each other safe. and that concludes, madam secretary, my comments. >> clerk: is there any public comment on the president's announcement? seeing none, our next item, item 3, general public comment. matters within the commission that are not part of this agen agenda. >> good morning, my name is jerry grantler.

the resignation of tom huey in the march 12th stories about the city's expanding probe of former president and instructial engineer rodrigo santaz are clear indicators that an outside investigation of the department is long overdue. my interest in d.b.i. began in 2012 when i served on the civil grand jury that wrote a very unfavorable report on the department. i have attended b.i.c. meetings for the last seven years. it's difficult to monitor projects like the rodrigo santaz prctses mentioned in the city's lawsuit. this lack of transparency is by design. an outside investigation needs to focus on the department's lack of internal controls and weak building code enforcement

process. current code enforcement penalties are not a deterrent. 98% of the penalties issued are below $1,000. $1,000 is the cost of doing business. d.b.i.'s weak internal controls are present by design, not by accident or lack of funding. d.b.i. has sabotaged the installation of new computer systems that would have made the department's practice of favoring a few individuals more difficult and visible. d.b.i. failed to implement a system that would have eliminated the current process where contractors, expeditors and instructional engineers get to select the d.b.i. engineer to review and issue their building permit. if you had the choice, would you pick your buddy? humadic is similar to the process by the california d.m.v. to randomly assign customers to

counter employees. d.b.i. also sabotaged the implementation of asela. when you drill down into mr. santos' projects you find that it was the same small group of d.b.i. employees who should not have approved his building permit ove over-the-counter and field inspectors who should not have approved the final inspections. thank you very much. >> clerk: thank you. so president mccarthy, i believe that there needs to be -- >> president mccarthy: so because of the nature of this meeting today, we're going to remove some items from the calendar, if that's acceptable to all commissioners, please speak up if you have any concerns. do we do just a point of order -- do we still have to do

the commissioner's issues and matters, do we still do that, or just items on the calendar. looking for clarification? >> you asked whether it's required that we do. >> president mccarthy: that we remove that. >> you can move to remove it for today's meeting. >> president mccarthy: commissioners, do you want that to remain on the calendar to weigh in -- (indiscernible) okay. number five, i have a request to leave number five on and i wondered what you might have thought about that as a quick discussion and move that forward because of the calendar that's on. and then we can -- if i'm correct we could do public comment on this again if we needed to though we have moved it out of our commission, is that correct? >> city attorney rob capla. if you feel that you have enough time to move it forward, the

board of supervisors, where there would be more process, you could do that. and you can also schedule a time to take public comment on it in the future but you wouldn't be able to rescind the recommendation to move the item forward. >> president mccarthy: okay. so, obviously, 6 we'll take off the calendar and move to the next available hearing. and then, obviously, we would keep the closed session which we would do last. and then pretty much remove all of the business off the calendar, if the commissioners today have any comments? >> clerk: do we have a second? second? >> so there's a motion and a second to remove all of the items or -- >> president mccarthy: except for 5, we will leave 5 in which we discussed now and number -- where am i -- 5 and 9.

thank you, commissioner. >> clerk: so there's a motion and a second to remove -- except for items 5 and 9. do a roll call vote. president mccarthy. vice president moss. commissioner alexander-tut. commissioner clinch. commissioner jacobo. commissioner tam. that motion carries unanimously. i'm going to read item 5 just for the record. i initially thought that the item would be continued. but all of you have received all

of the correspondence and there was additional public comment that you have received as well. okay, so item 5, discussion and possible action regarding a proposed ordinance, repealing ordinance numbers 38-17 and 102-19, and re-enacting certain provisions by amending the administrative code to update the hotel conversion ordinance including adding a redefining of definitions of low-income household and procedures to convert units and harmonizing the fees in addition to other requirements. this is continued from the meeting. >> president mccarthy: do we need to discuss. >> i want to thank the commission for tabling it until

today or continuing it to today. i talked to the community group whose appreciated having time to review this and they're all in agreement with moving forward. thank you. >> president mccarthy: if i see no more comment on it, -- >> city attorney rob capla. there's a request to be read into the record. >> president mccarthy: is that the letter from mr. zach friedman? yeah, okay. >> this letter is from zach friedman and patterson, a public comment, dear president mccarthy and honorable members of the building inspection commission, our office represents the s.r.o. hotel coalition, hotels, and other individual owners of s.r.o.s who will be affected by this proposed ordinance. in light of yesterday's shelter in place order and the serious public health risk of covid-19

we reject to this hearing taking place without public participation as required by the ralph m. brown act. neither my clients nor attorneys or other concerned members of the public can violate the order and risk their health to attend this hearing. this hearing must be pro postponed. and including reacting the record in real-time and the statements by city staff and other members of the public. this is not an imminent matter. and this could be accomplished without the proposed new amendments contained within this ordinance. these amendments are not urgent and do not affect any government function as defined by the order. we respectfully request that this hearing be postponed until the shelter in place order is lifted and we reserve the right to have additional arguments and materials in advance of the final hearing on this matter. thank you, for your krrs, very truly yours.

so that was the public comment. and is there any additional public comment here? seeing none. is there a motion on this item? >> president mccarthy: we do need to make a motion to approve. i move to approve. >> clerk: a second? >> second. >> clerk: there is a motion and a second. i'll do a roll call vote. president mccarthy. yes. vice president moss. yes. commissioner alexander-tut. yes. commissioner clinch. yes. commissioner jacobo. yes. commissioner tam. yes. the motion carries unanimously. our next item is item 9, public employee appointment. director of building inspection. discussion and possible action to appoint director of building inspection. 9a, public comment on all

matters pertaining to the closed session. >> good morning, my name is dray grantler. if the commissioner is looking for an interim d.b.i. director my suggestion is the former deputy director rosemary vosk who is an attorney. and who is thoughtful and has good leadership skills and knows the department. thank you very much. >> clerk: thank you. there was also additional public comments submitted via email by last name of mr. white, mrs. white and i have submitted that to all of the commissioners. so they have all received it as well. our next item is item b,

possible action to convene a closed session. is there a motion to convene closed session? >> i'd like to make a motion to convene closed session. >> second. >> clerk: are all commissioners in favor? any opposed? we are now in closed session. it is 10:24

>> we should be back. >> hello, this is building inspection commission meeting resuming. we are on item 9(d), reconvened in open session to vote on whether to disclose any or all discussions held in closed sessi sessi session. there is a motion to reconvene. >> i move to reconvene. >> second. >> there is a motion and a second to reconvene in open session. we are now in open session. >> all in favour? >> aye. >> our next item, is there anything to disclose? >> absolutely. thanks for everybody's patience

here. we had a really good discussion here and a lot of commissioners' thoughts for the future were brought up and what's going to be needed, particularly for this department, which i concur for everything. obviously, mr. weir, we unanimously approved you to step in as acting director through this difficult period. as a commission, we thank you for stepping up and doing that. >> to be clear, we've acted to appoint mr. riddin interim director. >> we had a debate about interim and acting. interim director. so if you are acceptable, you can come to the mic. officially you could accept the position for us and that would satisfy us, correct. >> thank you.

>> good morning again, commissioners. thank you for appointing me as interim director. while i am deeply grateful for your expressed confidence in my leadership of d.b.i. during what can only be called extraordinary times, i want to assure you that ours will continue to be a team effort and will continue to involve indeed depend upon the supportive dedication, commitment of building safety and professionalism we are proud to have in our d.b.i. employees. we have terrific staff who work enthusiastically every day to ensure building and safety codes are observed in the letter of the laws behind them. thanks to our engineer reviewers and all the code enforcement inspectors. we know that structures are

built to constantly improving standards. and thus as these construction methods can deliver for everyone who lives, works, and recreates inside these buildings. i take this responsibility you're giving me and i will do everything i can to fulfill your expectations and to provide the department with the leadership needed during these times of public health challenges. we will continue to do everything we can as a department to meet the mayor and board of supervisors' ongoing leadership efforts to build more housing that is safely constructed for all, especially for our city's most vulnerable populations. thank you again for the honor to serve as department's interim director. i will certainly do my best to

work with the commission, all city departments, the mayor and board of supervisors and city employees and continue to provide energy, leadership, and professionalism in all areas of building safety in the city of san francisco. >> thank you. good luck. [ laughter ]. >> commissioner, please. >> just a quick thing here. i just want to thank our c.f.o. for stepping up to the plate in our time of need at that time as acting director. >> big second on that. >> i move to adjourn. >> second. >> go home, everyone. >> all in favour. >> aye. >> we're now adjourned. it's 11:46 a.m.

(role call) item 2 is pledge of allegiance. i pledge allegiance to the flag of the united states of america and to the republican for which it stands, one nation under god,

indivisible with liberty and justice for all. >> please be advised the ringing of and use of cell phones and pages are prohibited at this meeting. and be advised the chair may remove anybody using a cell cell phone or electronic device and the public has up to three minute to make pertinent comments unless the port commissioner dubs a shorter period. the moderator will instruct dial-in participants to use touch-tone phones to register any desire tor public comment. comments will be taken first from in-person participants and then dialed-in participants. audio prompts will signal to dial in when the input has been enabled for commenting.

the comply with the declaration for covid-19, that you remain an arm's length distance. we are not requiring speakers to fill out a card but speakers can go up to the podium one one at a time or queue up in line but please maintain the social distance. item 4, declaration of emergency port commission meeting. >> thank you, everyone, for joining us today whether in person or by phone. the mayor, the state of california and the federal government have declared that the coronavirus pandemic is a public health emergency and ask that the people stay at home, which is where i am. the mayor's office has determined that the port commission has an urgent need to

take action on the matter before us to ensure public health, safety and essential government operations and has authorized the port commission to meet on this matter. i move that we hold this emergency meeting because of the coronavirus pandemic as an emergency that severely impairs public health and safety and the matter before us demands prompt action and is necessary to ensure that there is no disruption or threaten disruption to the public facility. >> do i have a second? >> second. >> all in favour? >> thank you, commissioner. item 5a, requests approval of resolution authorizing the executive director to recommend the memorandum between the port and the department of homelessness in support of housing to expand the capacity of embarcadaro centre due to the

coronavirus outbreak. >> so moved. >> good morning. i am the director of the communications for the port of san francisco and i will make brief remarks and i will provide an overview of the proposed amendment to the port's mou with the department of homelessness and support of housing for operations at the embarcadaro centre on sea wall lot 330. the commission approved the existing agreement between the port and the department of homelessness in support of housing at the april 23rd, 2019 meeting. in declaring a local emergency in calling for all efforts to protect the health and safety of the public, the mayor's office is asking the port and hsh, the department of homeless housing to revisit the embarcaro centre,

the ramp-up. it calls for one change. the proposal is to change the ramp-up schedule articulated on page 10, section 11.1 of the agreement under permanent uses to allow hsh to expand bed capacity beyond the ramp-up limit to accommodate the city-wide coronavirus response. all other terms and conditions originally agreed to on april 23rd, 2019 would remain the same and not change. i have emily cohen here from the mayor's office who will provide a short presentation articulating the urgent need for the amendment, as well as un-update on the state navigation centre operation. after the proceedings, we will be available to anticipation any questions. answer any

questions. >> good morning. this is emily cohen, the mayor's policy advisor on homelessness and thank you for convening today and thank you to the members of the public who have joined either in person or via phone. can everyone hear me all right? >> yes. >> thank you. i'm going to walk you through a brief presentation as randy said and we are proposing an amendment to the mou between the port of san francisco and the department of homelessness and support of housing and i want to give a little background context to this. as many folks know, the safe navigation centre, which is operated by five keys opened the end of december. it is currently operating at a capacity of 130 people each night. during the first two months of operations, all placements into

space navigation centre were made by the homeless team working in the homeless zone in the immediate area of the navigation center. san francisco has two, two-person teams working in the outreach zones full-time and they have an additional two-person team working with one shift and one on the weekends and folks are invited into the navigation center. we've had a tremendous amount of success in engaging folks on the street in the area and inviting them indoors. as folks remember from the original mou, we designated both a safety zone and outreach zone within the safety zone which is smaller and immediately surrounds the center. sfpd has applied beat officers to the zone seven days a week, five keys have been mentioned as the operator and made a phone call available where neighbors

can call or text with concerns about the need area, the perimeter of the navigation center. as everyone in the room or on the call is well aware, we are facing a public health crisis, the covid-19 or coronavirus. in response, mayor breed declared a state of month in february. when i put this presentation together a few days ago, there were 23 positive cases in the city of san francisco but the course has continued to evolve. san francisco has taken serious steps to mitigate the impact of the coronavirus on our community, including the most recent shelter in-place ordinance issued by the health officer earlier this week, wellspan aaswell as declareing l emergency and one of the big areas has been focusing on, for

me and my work focusing on the impact, the potential impact of the coronavirus on people experiencing homelessness or living in other congregate facilities. so we've allocated funding to enhance services at drop-in centers, shelters, navigation centers and other congregate environments. as you can imagine, the coronavirus epidemic represents a significant health risk represents .people experiencings have limited access to preventative measures including hand washing, home isolation, avoiding high-touched surfaces and people experiencing homelessness may have more chronic conditions making them more vulnerable to the virus. as i mentioned before, we are

taking proactive steps to protect the vulnerable population within the homelessness population, including expanding cleaning, expanding hours of programs, enhancing meal delivery for people in supported housing and occupancy hotels who have been advised to not go out because of their conditions. and we're extending a lot of this operation not to the publically funded housing but to private owned sros and increasing or outreach. we've deployed 30 handwashing stations for people unsheltered and bringing online rvs and hotel rooms, places where people can isolate and self-quarantine if they've been exposed to the virus but don't have problems. so part of our need and part of our strategy for protecting people experiencing homelessness in san francisco is to expand our shelter capacity. we want to mechanic sure that

people experience homelessness have state places to be, abilit, hygiene, meals and other basic healthcare. as randy mentioned, there are currently 70 empty beds at the embarcadaro center due to what as lined up in the mou. as i mentioned earlier, there are 130 beds currently in operation and that was the agreement per month, one through three, of the navigation center and we're due to expand to 165 beds for months four through six anand 200 beds in july. we feel we cannot wait until jusjuly to have access to the b. so the court is requesting an amendment to the mou to allow hsh to expand the bed capacity beyond that ramp-up limit, to accommodate the city-wide

emergency coronavirus response. this is my brief presentation and i'm happy to take additional questions from commissioners. thank you very much for your time. >> thank you, randy and emily for your presentation. is there any public comment in the room? >> yes, commissioner. >> please state your name. >> i'm elgin rose and we do outreach with hundreds of homeless people i in the tenderloin community and outreach into tents. so the 70 beds opened that could

be filled with people and could get rest and take in information is very important. and i think just making people feel like they're a part of the population is a key to maybe making it better and taking this covid-19 thing serious. so definitely, i'm here to support just getting more people with those beds and if anything else the tenderloin could be supportive of, we are interested in doing it. thank you. >> thank you. >> hi, thank you for having me here today and also the people who are on the telephone. i'm the executive director for the tenderloin and since this crisis hit, we have not shut our doors. we have a serious crisis on the streets. people are out there that don't know what's going on. we've giving them soap and water

and hand sanitizer and a lot of these people are elder people, grandmothers, grandfathers and these are handicapped people in wheelchairs and they need some place go. i walked through the tenderloin this morning and i saw easily 100 in two blocks living on the streets, who are dirty and being exposed. i'm walking here through the farmer's market and if that's not a lot to say. like, we need to help these people and we need more beds. we had a young man who came to us, to our pop-up and said, you know what, i've been on the streets for three years but i'm scared right now and i want to go somewhere. where can i go? a 22-year-old man who finally had a revelation he wanted to change his life is still on the streets. so i'm here in support of expanding the beds and i hope we can move this forward.

everyone has that right. >> thank you. >> my name is joseph norez and i work for the co-tenderloin and i've lived in san francisco for 26 years. i think that on monday, i was asked to come to work to get materials so that i could work at home and on the way to work, at the corner of golden gate and hide, which is one block from the federal building, there were tents, there was a shooting gallery right on the street and so, anybody that's gone through the tenderloin in the last few years or along market street, bart stations know that san francisco has been the site of a national health crisis for quite some time and in the last couple of weeks, it's become exponentially worse.

so common sense says that if our most at-risk individuals who already have a compromised immune system, off on or barista, we're all vulnerable. we work with the most vulnerable and underserved people in our city and they need beds. canary in the coal mines at golden gate and hide is taylor and jones and the bart station and they need help. put to thank you. thank you. >> thank you.

>> good morning, i'm an education coordinator and i'm a pastor. i'm here to stay i support this for compassionate reasons. like donna mentioned earlier, walking through the tenderloin in general, having worked in this area for over a year and a half, i see a lot of disparities and a lot of crime and pain and hurt and i see a lot of people who want find a way into a better life and better situation and now with what's happening with covid-19, now they're in even further danger. every population, every culture -- and i feel the homeless situation in the tenderloin is a situation in itself and it's not just the tenderloin. you have people in the bayview where i grew up. i grew up in san francisco and people are hurting and right now covid is doin going after the ey

and i want to support this effort and say we should move forward with the expansion of the beds and with helping these people as much as possible. we need someone to know how it and how we can help this effort. thank you so much. >> thank you. >> that's the last speaker in the conference room. >> thank you, amy and thank you everyone from the tenderloin. any more public comment or in-person? >> no. >> so the in-person public comment is now closed. now we will open up the phone lines to take public comment from members of the public who are joining us on the phone.

>> thank you, president brandon. at this time, we'll open the queue for anyone on the phone who would like to make public comments. >> in question is now in question and answer mode. to alert the speaker you have a question, press one and then zero. >> please dial 1-0 on your phone and the system will add you. you will be entered into the system in the order you dialed 1-0. the system will let you know when it's ready and others will wait. public comments limited to three minutes per person. the queue is now open and please dial 1-0 if you wish to make a public comment. >> thank you. do we have anyone on the phone? >> there are five public comments via telephone. >> please open the line to the

first caller. >> hello, earn. everyone. i'm a community member in rinkton hill, and i'm an immunologieimimmunologist. from a human standpoint, i can be on board but my concern lies from a health standpoint, specifically, if someone tests positive, what is the containment plan? are all individuals contained to confinement and do they have an appropriate infrastructure? for example, like a pod or some sort of isolation tent? additionally, if these individuals test positive or have an exposure, how will they be kept inside and liable to say

inside of the navigation center or whatever facility they're in. they should not be able come and go as they please, specifically for drug use. this will add to vulnerabilities and put further strain on the immune system and i'm not aware of any data about how withdrawal would influence the course of the coronavirus infection or another respiratory virus infection. with that said, i agree that is a vulnerable population, but it could ultimately turn into more of a risk and potentially an epicenter of a new wave of infections in san francisco. so my question for the board or just in general is, what is your plan and how are you going to

mitigate any risk? thank you very much. >> thank you. >> does this new amendment allow the city to put more than 200 people in the navigation center or is it just to expand up to 200? thank you. oh, and one more thing, is there a sundown period? i guess it won't matter. if it's up to 200, it won't matter because it can stay up until 200, but if it goes over 200, is there a sundown period? in other words, does that end at a particular point in time? thank you.

>> please state your name. >> my name is bruce goldetski. >> thank you, bruce. >> moving on to the next caller. >> hi, commissioner and port. i'm florence and i have the same concern that the first caller had about the crowding situation in the navigation center. right now there's a lot of tents on main street, as you can see, and most residents are concerned about the virus spreading if they go into a shelter and i'm really concerned about their health situation if they were to be packed in even more and more beds were to be added. i would like to understand what kind of risk mitigations and

procedures will take place if there are beds that will be added. thank you. >> thank you. >> we'll continue to the next caller. >> my name is judy lynn and i'm a neighbor of the navigation center and i live at the watermark and i wanted to echo with the callers have stated already. i am all for expanding the shelter capability in general to help the homelessness but i think it's the department of the homelessness needs a plan to mitigate risk to the homeless population while they reside in these shelters, particularly for the navigation center. is it going to be reconfigured to keep the six-feet distance while they're sleeping or interacting and what are the

health checks that will take place to keep the residents and staff safe, to determine if they're trying to show symptoms. and also to echo the quarantine issue, if they do start to show symptoms, how will they be quarantined and kept separate from the other guests? and i just wanted to echo, what are we going to do about the 50% of the navigation center residents that are drug users, if they start exhibiting symptoms or need to be quarantined, does the staff have the kat capability to treat pose withdrawal symptoms? how are the rules in the navigation center going to change to comply with our current shelter-in-place order? earlier this week, we were seeing needles and people outside using drugs. and so those are my questions and i hope emily can address them.

>> thank you. >> we are moving on to the final phone-in of the caller here. >> hello, this is katie ladell and i sent a letter in yesterday and i do have some concerns that the previous speakers have, but in the meantime, we've got 130 people over there already, or 135 and we really do need to help these people out. i am also a neighbor. i walk by quite often and it's very quiet over there and i've been inside a couple of times because i've taken over some donations. it's been a very good neighbor. it's been well run. i do encourage you to let executive director forbes give her permission to up the ante to 200.

thank you very much. >> thank you. >> president brandon, at this time, there are no more members on the phone wishing to make public comment. >> thank you. seeing no more public comment, all public comment is closed. >> president brandon, if i may interject, i have an additional letter from wallace lee whom i would like to read into the public record with your permission. >> ok. >> the letter is dated march 18th, 2020 and it was presented to presen president b. i am writing on a safe embarcadaro for seawall lot 330 to allow for the accelerated expansion of the center. please support the actions the city believes to control the transmission of sars-cov-2 during this public health crisis

and we do not oppose the accelerated expansion of the navigation center given the circumstances. however, we would be remiss not to bring to the commission's attention the many problems the nav center has brought to the neighborhood, even at the current size. an increase in public drug use, frequent use of war for drug sales and new incantments from those who moved as well as they say have a space in the navigation center but prefer to sleep indoors. this can be found in the attached. it's www.safeembarcadaroforall. sincerely wallace lee. and attached to his letter are several pictures which have been provided to you and can be uploaded to the port's website

and that is the end of wallace's letter. >> thank you. >> so randy or emily, do you want to respond to any of the callers' comments or any of the public comment? >> yes, thank you, president bran ton. thibrandon. i'm happy to respond to questions. and i think there's excellent questions around the safety in the navigation center and i want to assure folks that the department of homelessness and supportive housing is working very closely with our department of emergency management and department of public health to improve the safety of all of our congregate facilities, including this navigation center. so what that looks like is certainly enhanced cleaning of the site, disinfecting of frequently touched surfaces, handwashing stations, encouragement of good hygiene within the facility. we're also working with the

department of public health to tea emplodeploy a health screenl for people coming into the navigation center and as folks come in, they will be asked a series of questions. if they answer question to a sensor numberacertain number, ar yes, they will be isolated in a certain area where they will ask for a health worker to come on site and do an assessment of their healthcare. if they distribute symptoms of the covid-19, they will not permitted into the facility but in a self-quarantine isolation area unless their symptoms warrant hospitalization. so we have procured some rvs, trailers for this self-quarantine, as well as procuring hotel rooms for people exposed to the virus. and so folks who live in congregate facilities like homeless shelters. so the intent is really follow

do everything we can to remove anybody from the navigation center displaying symptoms to have quarantine spaces available for them should they not warrant hospitalization and if somebody is exposed to the virus, similar precautions will be taken. so we hear that call and we share everybody's concern around the congregate environment. we are working on social distancing within the shelters across our shelter system and that will mean generally, that we could lose capacity in a number of shelters and that's why we're working to identify so many more facilities where we can spread people out, too. these are, of course, for folks who are asymptomatic not exposed to somebody with the virus. for those symptomatic or who have tested positive, we will have a positive intervention for them. again, the department of homelessness and support of housing is taking the lead from the department of public health on all of these protocols.

we've issued new policies and protocols to all of our shelter managers' organizations so they're aware of all of the resources that are available to them, how to interact somebody who demonstrates symptoms and how to get them the care that they need. of course, access to supplies remains a challenge. we're all moving as quickly as possible, but we have deployed handwashing stations on the streets, as well as to some of the shelters that don't have as many sinks and showers as we would like and we're trying to bring in supplemental services. i think that answers some of the questions. if commissioners have additional questions, i am happy to respond. >> one additional point to clarify some of the questions about the amendment and what it means. i wanted to rei reiterate the proposed amendment calls for only one change to the existing agreement and that's to change the ramp-up schedule as ar take

articulated in 11.1. in the presentation, emily eluded to what that ramp-up schedule would look like, existing agreement calls for 130 beds from months one through three and from months four through six, up to 165 and beginning in month seven, up to 200. the proposed amendment would change that ramp-up schedule so additional beds could be used now. no other terms or provisions of the existing mou would change. >> just to clarify, there would be no more than 200 beds. >> thank you, emily and randy. is there any other information that the staff would like to share before i open it up to the commissioners? >> one other point is as we've been moving quickly to put together huge thank you to the port staff for the emergency

meetings, i had the opportunity to talk with the vast majority of the state's navigation center advisory group members, letting them know about this amendment and everyone i spoke to was largely supportive of this work. >> i will open it up to the commissioners and for the record, i would like to state that commissioner wuho had a conflict and she would like to express her support for more ramp-ups in the capacity of a navigation center given the dire need to help the homeless

community in this crisis. so i just want to make sure that is a part of the record. commissioner gilman? >> thank you, commissioner brandon. first of all, i want to thank all of our front-line nonprofit workers who are continuing to go to work everyday, particularly our emergency service's staff. too often nonprofit workers are not thought of by the public as first responders, but they're the ones keeping our shelters and navigation centers and supportive housing everyday. i want to thank emily for your work. i am fully supportive of the item. but i have one question for emily. they want to procure hotels and for people who need to self-quarantine or symptomatic

but he called for the priorization for people vulnerable to the illness or folks over 60 in the homeless population to be sheltered first. my question is, are you looking at that population first for priorization into the navigation center or will you use coordinated entry? >> that's a great question. thank you, commissioner gillman. we are looking at the governor's guidance that came out yesterday and working with the department of public health to put together our priorization tool, but people with preexisting conditions, people over 65 are our priority to serve. >> thank you. that concludes my questions.

can you please speak into the microphone. >> i support this navigation center. >> vice president adams. >> i want to thank the community for coming out. i want to thank mayor breed for leadership and this is a situation we must act swiftly. we saw that this is coronavirus and the federal government removed in a swift manner and that's why we're behind the 8-ball. there was a lot of good questions and a lot of good concerns. but this coronavirus is an enemy, an enm enemy and we can'e it. this is a life and death matter. it's a national crisis and a

world crisis. we're talking about our community. we must act swiftly and i live a block from the navigation center and we must provide for the beds and we must move. if we don't, i think there will be a price to pay. so i support it and i would ask my fellow commissioners to support it unanimously. >> thank you. emily and randy, thank you again for this presentation and thank you for all of the the work you've done to bring it to this point. i would like to thank mayor breed for having the foresight to having this facility available for our very vulnerable population and to show the need for so many more beds. this is a crisis and hopefully, we can get out in front of this

and make sure this population is taken care of along with all of our other city residents and it's a small part that we can play and i want to thank the community. i want to thank our advisory group and i want to thank everyone supporting this item, because we really need it. so with that, all in favour? >> commissioner, we need to have a role call vote for resolution number 2016. (role call) all in favour, thank you, commissioners. >> so resolution 2016 has passed. >> thank you.

>> thank you, commissioners. >> thank you. >> can i have a motion to ajourn? >> motion to ajourn. >> is there a second? >> yes, second. >> all in favour? the meeting is adjourned at 10:40 a.m. >> thank you, commissioners. >> thank you, everyone.

>> welcome, everyone. press mute if you come on to the phone. the first item on the agenda -- i don't want to be muted because the people need to speak. for those of you who are just joining you, this is the march 17th, 2020 commission meeting and we're doing this for the first time using microsoft. please excuse us if we have any technology issues.

this process may be different than we normally do. if i may, i may move on to item 2, the approval of the march 3rd, 2020 minutes. >> do we need to do a call to order and role call? >> yes, thank you. so i'll start with you, commissioner. (role call). >> we'll move on to item 2, the approval of the march 2 minutes. reviewing the minutes of the previous meeting, does anybody have a motion to approve? >> so moved. >> second.

>> all those i in favor? >> do we need to do a role call? (role call). >> thank you. item 3, the director's report.

>> the director's report is in front of you and i would ask that if you have any questions, of course, i'm happy to answer them, but given that the majority of our meeting with focus on covid-19, i will not need what's in front of you, but i'm happy to answer any questions you see fit to raise at the time. >> any commissioner questions? i'm not receivining a public comment request. >> commissioners, if not, we can move on to the next item. >> item 4, the coronavirus update. >> so good afternoon, commissioners. i'm the director of health. >> hold on. >> everyone, please mute at this point, mute your microphones.

>> i talked to dr. kovax and this is not coming over very clearly. >> ok, give us a second, please. >> and there's a delay. >> i think it's just the microphone distance. other things are clear. >> can you hear me commissioners? is that better? >> yes, thank you. >> thank you. >> so good afternoon, i'm the director of health and i want to say how much i appreciate the social distancing intervention we're approaching today and not to make light of the historic moment we're in our country right now, including here in san francisco. two weeks seemed so long ago for when we were preparing to do our best to manage this epidemic and

i will talk about the nine health officer orders that have been issued in the last ten days. and i also will ask dr. irwin from the san francisco general hospital, the lead on our plans going forward. i want to provide you with a little bit of perspective of where we are now. we are clearly in a state where we are looking at community spread and the gph team is working day and night to do everything we can to bend the curve. when i say the curve, i'm talking about the number of new infections. the goal is to help us prepare

as much as possible for eight more cases, and inevitably people dying from this disease. based on the data that's emerging from china and italy, we know that about 80% of people do well.

i will say the patterns are what evacuewe've seen in china with d to how this disease has spread. dr. erogon issued what is radical and it had to be. the shelter in place -- this

decreases the spread of the virus and we think it's important to emphasize this was done for the first time, to my knowledge, as a joint public health ordinance. it's across six counties, as well as the city of berkley. this is pivotal, because we know for the broader social interventions to work, it really needs to be original and preferably state-wide and nation-wide. as we've seen the virus increasing its spread in various communities and countries, the direction has only been further escalation of efforts. i'm not aware of any jurisdiction that has decreased or frozen the efforts going forward. so going forward with these

orders, we believe that we will be continual needing to be aggressive for not a period of weeks but months. right now our focus is on three key priority areas. number one, the social distancing as i talk to you about mitigation of the virus spread and number two is focusing on vulnerable populations, including those over the ages of 60, those with chronic disease conditions including cardiovascular disease, diabetes and renarl disease. the third is protecting the healthcare worker staff. this is a key thing we're working on across the entire system and having ongoing conversations with human leadership about how to ensure we use the best evidence available to provide the best

protection possible against our workforce. the number of challenges as we go forward, i am happy to talk about those challenges. i will also emphasize that given the patterns of the disease, given our region and given our state and country, this is not an issue that the health department or san francisco can solve alone and right now we're doing everything we can in our power to optimize what we have here today. i will also add that with some leadership of our mayor, our other city departments have come to our aid to decrease the morbidity and mortality of this disease. so i will turn this over to dr

dr. thomas to briefly summarize the health order. first, iand then to dr. irwin tk about the surge plan, but before that, i'm happy to answer any questions before dr. erogon goes forward. thank you. >> commissioners? >> commissioner, any questions? >> no. >> i think i want to hear the whole presentation before we ask questions. >> so i'm going move and dr. erogon will come in front of the camera and we'll switch back again. does that make sense? >> yes. >> thank you, director.

i'm going to be brief because there's way too many orders. we realized as we were doing these orders, we were learning on the spot. one of the things i learned most recently are two words which is hours matter. this is how fast we're having to make decisions, in a matter of hours. and so, what we have had to do is not just see what's happening in other parts of the world but what's happening here regionally with the other counties. i would say this last order to shelter in place happened really quickly. i just want to draw a bigger picture and show you how this fits in.

so hours matter. we make decisions and then when there's a little bit of time, you do a little bit of reading and i had the opportunity to read an article that influenced the federal response that was just published yesterday, to give you an idea of how fast it was moving. i do want to share that with you because i think it will help you understand our strategy and our strategy is more aggressive than community mitigation. sthere's isolation toronto and e

of contact. you've been hearing about mitigation which is flattening the curve, dealing with workplaces social gatherings. (pause). (. >> this is called social distancing. the idea behind flattening the curve is that in general we'll get a -- a good proportion of the population will get infected and from the recent data up to 80% will become infected. that's why this is so infectious is because there's pretty much 100% susceptiblity in the population. so the idea of flattening the curve is at the end of the day,

you have a lot of morbidity and mortality and you're spreading it out so it doesn't overwhelm our healthcare system. the last strategy, which i just learned today from one of the premiere modelers in our country helping the cdc to guide the strategies. his name is neil ferguson. it's suppression and it turns out we're implementing suppression and implementing the most aggressive approach. and that's where we're trying to get the reproductive number less than one and the way -- (pause). the way that we're doing is that by sheltering in place. the idea is that a lot of people

have not been infected yet. by having people sheltered in place, they're reducing their opportunity to be exposed and by not getting exposed, they cannot get infected. but they have to go out to do essential activities like get their medicines, essential workers and then, i forgot the last category. make sure you get your medicines, food, that was the other category. people have to eat. so you still have some risks and then among -- even though you're asking people to stay unexpose bid staying at hole, you'll have cases that need to be isolated d

where our movement has been in the united states. santa clara was convincing in saying, you are one week behind us and you don't want to be in our shoes. if you're going to do it, do it now. the challenge with any of these approaches, they have to be done over a series of months and so concept use usedually, you woulo pull back and to pull back, youe

have to strengthen the public health infrastructure. we need a bigger workforce to shore our tracing and quarantine. if we pull back the suppression measures, we need to dial up the public health activity. otherwise, we won't be able contain. the last thing i want to say to give you a picture of how quickly this infection explodes. imagine the hospitalization icu cases and deaths that you're seeing is just the tip of the iceberg. this iceberg, you're only seeing

the tip and that iceberg doubles every six days. that iceberg doubles every six days and that's why you have this explosion. if nno one can see it coming and that's why we have to be aggressive and be ahead of the curve. there's other orders in there that we're tosse focused on lonm care facilities, sros, hospital visitation. we will be asking providers to cancel essential services and to delay elective surgeries and i think i covered most of them. and there will be more coming as we look at this more broadly and try to fine tune what we do and there will be more coming and it's been great in getting the support.

we've been providing a lot of leadership and inspiration. i want to turn it over to dr. susan erlich. >> good afternoon, commissioners. i just want to say that i know we're in an incredibly unusual

time, very unpresprecedented iny professional carr career and i l grateful to be a part of the department because we're pulling together to do the right thing. i feel good about taking care of people we know to be ill. so moving on to hospitals, over the past month, i and dr. luke john day have been meeting and dr. kolfax, we've been meeting regularly with the san francisco hospital council ceos and also

with their medical nursing and operational leaders. there aren't other regional hospitals who are planning in this way and our efforts have been the supply and effect of the utilization of our critical care beds. lately through these meetings is that every single hospital has really dramatically changed operations in order to plan

ahead and meet the demand that we know will be coming. it's what we call puis, persons who have been tested and waiting for results. so, for example, that includes can celling all elective or nonelective surgeries, as well as nonurgent patient visits. and then what we're trying to do is redeploy the resources that were used in those services into more covid-related services. and so an example of that is in my clinic, the primary care, each of us in spreading our schedules to identify people --

to be seeking telephone visits. that creates other kinds of duties. so right now, we're setting up a tracking system among all the hospitals and a joint surge plan to help us identify on a daily basis where all of the hospitals are with respect to capacity utilization. the system that we're setting up is modeled after our surge plan which categorizes our state into green, yellow, orange, red and maroon categories, based on what percentage of our beds and our services are being used for puis

relative to our total capacity. since we don't yet have the data for all of the hospitals, i can't tell you what that level is today. i have a pretty good idea, based on the discussions that we've been having and what our own level is. today, there's a yellow level and we entered the yellow category from the green category yesterday. what that means, we have more than nine positive, covid positive patients or puis in the hospital. ucfs more or less is at the same level we are. they're in the yellow range and then the other hospitals are between green and yellow. so the good news about that today is that we all have plans for capacity, but we aren't yet filling it. so that's the question we are at

now. tthe other thing i can tell you that's exciting, we're looking to see beyond the capacity, in our individual hospitals, what capacity we utilize in hospitals that have vacant beds that aren't staffed. and we've identified a unit, a full med surge unit and an old critical care unit at st. francis to use for that purpose. the capacity of the med surge unit is about 40 and the critical care unit is eight. and so we looked at that unit last night and now we're in the process of seeing what it would cost to staff it. in general, we're looking at a model whereby the basic support services are covered by st. francis and we're looking at registries, essentially, to fill the nursing positions and then a shared model of provider

services between dignity ucsf and ucsfg. i'm happy to answer any other questions. there's a lot of detail i haven't covered by i'm happy to answer questions. >> commissioners, how would you like to handle questions? would you like to do it person by person or topic by topic? this is a new way of doing the meeting. >> let's do person by person. dr. chow, you had some questions and would you like to start? >> thank you. i'm really appreciative of all of the work that's been done. we've gone through our own crises over the years, from the age to the earthquakes. and this is obviously the

largest response that affects every single person here we have and i think the person here has handled this extremely well. literally, i'm pleased that we've had such strong representatives. i think this is wonderful.

i have been hearing from the private practitioners that sometimes they are concerned that they may not actually have the resources needed in order to continue to work within their offices such as gowns or simple things like that, or swabs now that we've been able to use commercial lab. i know the medical society has been working with all of you about it and i just wanted to know, what are the challenges and resources and are there other things we can do? we can't do it alone and i know the department is trying to respond to it and just was interested. that's a large segment of the potential medical providers that, if they don't have the resources, that we don't really have them able to take care of

this. these populations. >> i would like to turn it over to dr. kolfax to address that. the basic answer is none of us have everything we need but i'll let dr. kolfax speak to that. >> commissioners, it might ask people in seat to ask all of the questions we have so we're not playing musical chairs. how about we ask dr. erlich call of the questions we have in her topic area, with your permission. >> that's a good point. dr. chow, do you have anything specific to dr. erlich or do others have questions?

>> commissioner guermo. >> thank you, and i want to add my thanks and acknowledgement to dr. chow in terms of how the department is handling this. >> commissioner, hold on. >> appreciate the example. dr. erlich, i'm not sure if this is a question for you or for the team, but with regard to the coordination, through the hospital council, are you also able to coordinate the beds that supplies the workforce?

>> you just went mute. >> who will make that decision for the supply beds and workforces to happen? >> right. so generally, what we're doing is that each hospital is doing the maximum it can to try to create capacity within its own walls. so, for example, canceling elective surgeries creates a capacity that we can use for covid-positive patients. and so we're all informing one another and talking about the measures that we're taking, which are pretty similar. with respect to that centralized resource at st. francis, i think the idea is this three-pronged approached that i described, whereby st. francis is looking at what it's going to cost to provide the basic supplies and

the basic support services like environmental services and food. and we're looking jointly at registry resources that we're trying to see if it can be made available to provide the nursing and clinical staff, non-provider staff and then we're looking at a shared service's model for the providers. the purpose of the joint surge plan is to identify the point at which we would start to trigger those things. so today, what i can tell you is that we have a plan, we're oing on seeing if we can get the resources available, putting aside the question of who's going to pay for them and figuring out how we can jointly put providers in there for about 48 patients. this is really a day-by-day thing. so it's really the surge plan that will tell us when we're ready to occupy.

the last part of -- we keep hearing the audio go in and out, so i didn't catch the last couple of sentences. >> i think what we're working on is the joint surge plan that would give us the indication of when it would be time to pull the trigger, to open the centralized resource. >> and who would pull that trigger? would it have to be an agreement amongst everybody or is there somebody that says, no, i'll pull that trigger. >> you know, we're really working that out. but the way we've been operating is it will be all of us together. and i think we all, together, assume that eventually there will be some reimbursement made available that helps us because none of us can do it on our own. >> thank you. >> sure.

>> dr. chow. >> yes, i did have some questions and i really find that that's innovative and forward-thinking. i also saw that we're preparing in certain areas for more like a mass cash thing. how does that all work out and are there other facilities being looked at as possible joint surge? because you're only talking about 40 or 50 beds. >> right. so the big question in all of our minds and the other thing we're working on right now is modeling with the best data we have available, noting that nobody can do this perfectly. how many beds are we likely to need? over what period of time? and so all of the efforts that dr. erogon was describing about

flatten the suffer i curve is go make it more likely that wit resources we have available to us, we'll be able to accommodate the people who need either med surge or ic beds. the more we can do to flatten that curve, the better able we're going to be to meet the demand with the resources we have. and so we are working with our colleagues at ucsf. they have an infectious disease strike team. we've asked them to model this question for us. how many beds will we need, of what type, what period of time? and so hopefully, i'll have an answer to that question or the best we can do in the next day or so. and so, if we need something more than that bee, i think we'l need to be looking at the state and federal government to provide more resources and i do know generally that the state is exploring this, but san

francisco, if things get really bad, which we don't really know right now, we won't be able to solve it on our own. >> i would agree and i do think that dr. erogon's point of the models that seem to be occurring in different cities might give you, also -- i'm sure you're looking at that -- the idea of how many acute beds you need versus a less acute model. and the centre triage that you have been describing, which i think is great. how does that work? is that when one of the emergency areas become overwhelmed that they call a central number or you're having meetings? i mean, obviously not in 24-hour communication each day. so just in terms of understanding how quickly it reacts if all of a sudden three cases show up over at cmtv.

does that trigger something? >> so hospitals are managing their incoming demand pretty much on their own right now. so we've all tried to create capacity so that not only can our emergency department manage the incoming flow of patients, but we're also creating other resources that allow us to offload our emergency department. so, for example, at the sfg right now, we've expanded the hours of the urgent care clinic in order to be able to do more evaluation of patients on other sites. we've established a two-tiered triage to cohort patients coming in with suspicious requirement symptoms. starting tomorrow, we're likely going to have another testing site on campus over in building 80 that will further allow us to spread the demand for people

coming in to be evaluated. so at this point, hospitals are managing the incoming on their own and the planning we're doing is related to the hospital beds and the icu beds. and we've been meeting, really, twice a week to talk about this. so it's an unprecedented level of collaboration and frequency of collaboration between the hospitals. that being said, we are really making this up as we go along. so that this question of a trigger and when it goes, we're doing our best to create these rulerules as we go along. >> thank you. that was an excellent answer in terms showing the thinking and the dedication you're all givi giving. >> commissioner, were you raising your hand?

>> i think commissioner green. >> oh, commissioner green? >> yes. i've also raised my hand. >> i see you know, commissioner chung. would you like to ask your question? >> i have a couple of questions. thank you for sharing the information and some of the materials that have been ready, it's really unsettling for me. for instance, the number of dates that somebody can be transmitting the virus and how long it takes to shed the virus and when we think about that and think of the capacity that you just mentioned, i think that is where i'm kind of wondering, what does that mean for us to keep those patients, for how long will we keep them?

knowing how long it takes them to shed the virus and what kind of burden would that put on our existing staff? and the other part to this, because this is unchartered territory, i would imagine somebody who might have insurance would show up at csfgh and what do we do when they do that? do we take them on because this is the public health emergency? or do we actually redirect them to their own hospitals.

>> thosa lot of what happens tht people come in, we evaluate them and decide do they have requiremenrespiratory symptoms e start asking questions that evaluate whether they're high risk for being infected with covid-19? even if we think they're high risk for covid-19, we don't hospitalize all of those people. a lot will send home with instructions to quarantine for 14 days and monitor their symptoms carefully. so we're trying to reduce the

impact on the hospital as much as we can. the other thing i want to make sure, if i haven't already, is that the volume that we're seeing in the emergency department is no different than it typically is. any hospital that runs an emergency department by federal law has to evaluate the person with a medical screening exam and make sure they're stable before they go, irrespective of their health insurance coverage.

>> it seems like everything is defying common sense when we look at the mass hysteria and giigin begin to wonder how bad we're impacting the general public when they think they're symptomatic and how they will respond to this. the other part to this, because it felt like there were gatherings that just happened in florida.

so they know where to go. >> dr. kolfax just asked toss focus on questions dr. erlich has asked, in hospitals or what she talked about. i am trying to utilize her time because she has to go back to the hospital. so if anyone has questions specific to her. dr. green? >> thank you. first of all, you all look slightly haggerred. so thank you for all of the incredible work you've done and the dedication.

evacuee talked about howe want d healthy. great gratitude. i know you've been there all weekend and beyond that. all of the doctors feel like this is the internship you did 20 years ago before they loosened the hours. so i'm working in a hospital, as you know, and one of the concerns i have and i would like more information about, the extent to which, really, things can be directed by our dph as opposed to collaborative. we had an interesting call from st. francis people had with china. there were experts from wuhan, beijing and it was most

instructive. what came through, there was a hospital council that had leadership and directed the others what to do and they worried about staffing. i'm wondering how you're thinking that through because obviously testing is difficult to come by and we read about the hospital in connecticut that had 200 nursing hours and some incredible number with one exposure. so i'm wondering how you as a group are thinking about how we're going to manage staffing? my personal experience is a lot of people call in sick for things that wouldn't necessarily be a sickness and now we're encouraging them to and i can see some decimated by nurses being out on quarantine. then if you could elaborate more about ppe, which i know you can't say much about or you may

not know much about. but i know we certainly have inadequate ppe at our place. the real infrastructure of how things get to that surge, and who will take charge would be helpful to understand. >> we'll first let me say that today and so far, at the sfg, we have not had issues with staffing, thank goodness. we're keeping very close track of that and so every department reports in everyday about how many people are out and for what reason. and so we're doing pretty well with that. i think we're helped a lot by the fact that our department of public health workers are disaster service's workers. we have tried hard to community katcommunicate that we need theo show up in spite of the shelter in place order and in spite of any other order, we need them to

show up, if they can. we want them to take care of their families. we want them to take care of their health. it's been working and it's been working with our provider care community so far. that being said, we community that people will get sick. we know that will happen or that they will be out for other reasons. and we're working really hard to try to a, hire nurses and other staff more quickly and the mayor, there's another order today that, basically, waived all of the the charter positions, waived the civil service positions to make it easier to hire and that's a big relief. we've electriwe've been workingg nurses much faster than we typically do. we've hired nurses. we've reached out to our registries and utilizing those

resources and we're doing everything we can that's under our control to try to keep our staffing up to what it needs to be. did i answer all of your questions, dr. green? >> i'm wondering what you foresee as infrastructure and leadership when and if this becomes an italy or wuhan and how you see, based on the interactions to date, how you see the hospitals working together? >> well, as i mentioned, i think the hospitals have been working together really well. within csfg, we have an incredible leadership team. people have been working around the clock to make sure that we're as prepared as we can possibly be. and that leadership team, thankfully, has redundancy, as well, and i think that's working well. where we have all of the ppe we need, will well have all of the

supplies we need? it's tough to come by and we're keeping it under lock and key to make sure that we have it available for the people who really need it. it's definitely not in abundant supply, but we have what we need so far. these are much bigger questions, the questions about testing kits and reagents and ppe, these are national issues. but we're doing what we can to make sure that we have what we need. >> i'm sorry to interrupt. i've just been notified that dre board in ten minutes. and i'm wonder physician w wonde questions to him. >> that's great. i did have a few questions for dr. erogon and this is dan. first of all, thank you so much for your leadership to you and to dr. kolfa examinatiox and dr.

i understand we have 43 cases in san francisco and how many are hospitalized and how many are in icu? >> i will tell you in one second. >> thank you. we understand with the lack of testing kits what we're doing is surveying what already exists out there to get a sense of what our current situation is and what is our outlook for our testing capacity in the coming weeks and how that would increase where we are today to hopefully a level we'll be able to do comprehensive surveillance? >> so i'm going to have to get bacback to you about the hospitalization. i know it's a small number. i'll have to get the exact

number. i'm not sure. >> and there's room for both of you. >> just to say that we are with other hospitals, working to get a daily count of how many patients are both covid positive and tuis and in what part of the hospital every single day. we aren't quite there and i know we have two at csfg and one of whom is in the icu. it's a small fraction of the 43. i don't know the numbers from the other hospitals today, but in a couple of days, i will. >> and then just further to that, do we have a number for how many of our healthcare staff have tested positive?

>> in san francisco, i'm only aware of two people that have tested positive, is my understanding. >> thank you. >> and then to the testing capacity and wer what the outlos before we're at a place we need to be. >> dr. kolfax will answer that later because he has all of the details about testing. >> thank you. other questions for dr. erogon before he has to leave? >> i just wanted to leave, doctor, in terms of, again, realizing supplies are in short, the working either with the state or the feds to bring enough supplies and then some means of distributing it to the various providers that may need it. >> that goes to the equipment

supply and the guidance yesterday that allows healthcare workers to use what's called a droplet precaution caring for patients. unless there's a procedure where there will be symptoms of virus and that will improve the ability to expand testing because they will have to use airborne precautions to collect specimens. >> thank you, doctor. >> that's county with what the cdc is recommending. >> i had one last question for dr. erogon before he has to leave. regarding the shelter in place order through april 7th that's being sort of jointly issued by all of the six counties, what is the criteria that you might use to determine whether that is something that needs to be extended or is that just

something that you're going to have to determine as you were saying, on an hour-by-hour or day-by-day basis, depending how this is playing out? >> so we had chosen to do three weeks and i can't imagine that in three weeks -- i imagine if we're moving -- if this epidemic continues to move in every placed it's been introduced, it may be worse and i think at that point, we're going to have to reassess both the city and the other counties to decide whether it needs to be extend. but that would be a decision we'll make closer to that time. >> thank you. >> thank you, doctor. >> i think dr. kolfax will answer the testing question.

>> i had a question before jail health and homeless population. >> there were a number of questions and please bear with me ibarebare withme. i wanted to talk about hospital control and i don't know if you use that term, commissioner green. but i think that was the justice of it. gift of it. gist of it. i'm not so concerned about making sure that we're all

reaching -- that we're all working together to reach our capacity as a community. what i'm concerned about when and if we exceed that capacity. i think that would take more of a -- if we reach that point, i would hope that before that, that the federal state authorities would have brought in assistance and whether that assistance could look something like the national guard or a military operation. we don't have the capacity right now to run something like that. that's not our mission. with regard to that level of response and engagement. i just think those resources would be vital to that. and we do everything we can with our partners to do that in the interim. but i hope that we don't get to that situation.

and i don't know commissioner green or others if you had any response to my response. >> i think when you think of things like we have two empty hospitals in our midst and if we ever needed one of these kind of mid-level quarantine sites as they used in china, the national guard and others might come and help us. but within our walls, we could know some of the resources, resterespirators and i'm curiouw we can work together if it got to that. , whether that would be something that would fall under the hospital or elsewhere. there's other resources we might know about that they may not.

>> we're looking at all of those option. i was thinking more of a massive icu means, which, i think we would have to look at hospitals in the bay or something like that. so again, i don't want to create an alarming scenario, but in terms of looking at other places where people who are not acutely ill but are symptomatic and stay, that's something we're looking at, not only with other hospitals but other key participanteners in the city. ps in the city. there was a question around testing. so the testing capacity is a key issue for us. it's a key issue, as you know, across the country right now within our public health lab under the direction of dr. susan philip and they've done an amazing job of implementing testing. our capacity is relatively small and they're having to prioritize

testing the people who are most in need of testing, requirementy symptoms in the hospital, at high risk for first-degree exposures and then healthcare workers. so we're really focusing on those flee populations '03 thre. to give you an idea of how our day-to-day is going right now, we're injecting a capacity of a day's worth of test or at the best, a week's worth. and so we're getting tests delivered to us by the cdc in the very challenging fashion because we're simply not able to be assure ed this either w assuh tests to last for months or to expand our capacity to run 24 hours a day. so that's within the dph side.

within our public health lab side. we're also working with private labs including quest diagnostics in our health network and that, again, is a dynamic in challenging. quest lab turn-around is three to four days and we're working to ensure that we get people tested who need to be tested. other test companies are telling us they don't have the capacity to except other tests and so forth. another part of this that we're working on are the partners with the ucsf, they're developing their own tests and it's exciting and i think it's a key part of the puzzle. they're working with global limitations with reagents. so, for example, on friday, i

was informed that ucsf was going to be able to perform hundreds of tests a day, not just for gph, but through the ucsf system but then today, i'm told they can't get started because they don't have sufficient reagents. so they have the tools. so there are multiple different strains of testing and each strain has its own inherent challenges. we have such a national shortage of supplies and i have to say that we were short of things like swabs. we're short of things like swabs. so i have asked not only within the health department but assistants from the controller's

office. we brought ito develop a city-wa city-wide approach so that we're actually able to have a full visibility in terms of what tests are available, who they're available to, that we have a shared tracking mechanism and we know how many tests are done, not just the number of positives and we move forward in a coordinated way and there's still support from the city to ensure that we're moving forward in any fashion that helps us all to do better for the people of san francisco. so that's our fourth priority which i added to our list this morning.

>> is the city-wide testing plan you're trying to develop, would that include the private sector hospitals, as well, or just the county and ucsf? >> no, we're trying to -- so right now we're doing a rapid assessment of what is happening across the city because what happened was, some tests became available. there's activity and different groups are doing different things and everyone is trying to solve the problem, or how they're trying to solve it and we're doing a whole needs assessment across the city of all institutions. we're looking at privates. we're doing an assessment of whatfwhat philanthropy can inved we're trying to decide is it scaling something up or is it because they don't have basic supplies in order do the testing and so on and so forth. if we can, we're trying to get to a point we're trying to

determine who gets tested and that's a real challenge, right? but we know that if we could test everybody, that would be -- in a way that's meaningful and systematic, i think that would be the ideal setting and that's what i'm calling the south korea model, right, because they've just rolled out testing in a huge way. we are the city that essentially has done so much of that with hiv. so that's our model. i've brought in a key global health expert and her first day was today who has worked with the clinton foundation and w.h.o. on pediatric testing in africa and this is her full focus and she's working not only with gph again because i knew the gph people on the ground doing the work, but she's working with other city departments. she would bring in analysts and

managers, project managers and people go out and find this information. >> dr. green. >> thank you so much, grant. do you have any sense of timing on this? because a lot of patients have heard about the kaiser drive-through and think there's something else or they can go to kaiser and i think there's a similar programme that you know better than i. but at this point, cpmc has been vocal, they're not in the outpatient business and some of their physician's staff are not employed and they don't know where to get tests. we're getting really deluged with questions and some, perhaps, do deserve to be tested. in general, think, the primary care people who aren't in a system like kaiser could really use some advice and some directives from the dph, because

the systems have been very nonspecific in the recommendations and even in their guidance. all of people are showing up in emergency rooms, at least in ours, and the mixes with people may be positive which makes you worry about spreading the disease further. i know that was a lot of question comments. but what do you see and how would you recommend that practitioners get information and talk to the patients as they see the numbers mounting? >> so as we're working to get full visibility and who they're testing across the city right now. evacuee been very clear at dph that if people have questions about -- have symptoms or questions about getting tested

for covid-19, they should call their healthcare provider. those healthcare providers have act eaccess to information abouw to get tested. how to find out information about testing. the healthcare providers will get counseled whether the patient their calling for, whether that patient qualifies for dph testing. they would have to fit into the three categories because we have to prioritize who gets tested. that is the reason we're developing this broader testing plan, is in order to address the questions that you have. i'm concerned about people going to emergency rooms or urgent care centers who are not sick to get tested. the other message we keep putting out, please do not go to emergency room or urgent care

unless you have an illness and need to go. evacuee been pushing that out ad we're committed to working with our partners to make sure they have that message pushed out, as well. >> in keeping with dr. erogon's advice, i would like to ask we wrap up with the last one or two questions here. is there a commissioner who has not posed a question that would like to ask something? >> i have one question and this is commissioner gerato. if any of thin any of the figure there been children or adolescents who have tested as

positive? >> i have not heard of that case in pediatric and i don't have numbers in terms of young adults but we can provide that for you. >> director kolfax, speaking of children, for parents with children who are out of school and may have questions about the safety of child-care settings or, also, whether or not it's advisable for them to schedule play dates and anything like that, is there specific guidance we're offering? >> yeah, there's specific guidance on our website around that. >> dr. chow, you had one more question briefly? >> yes. it was more -- actually a compliment to the department and website and to reemphasize that dr. kolfax's point that the department has a great deal of information and evacuee been wen making use in our medical group and we've been encouraging that patients be able to look it up and i want to compliment the

department for having put out clear directives and keeping it very up to date. so those that may be watching and listening, that those are important resources and to, again, emphasize as it does, that you don't rush off to the emergency room and you don't necessarily have to get tested and there's some really good documents on that website about the issues of how to care for people on the provider's side and then how to actually be cared for on the consumer's side. and so i want to thank the department for that, too. it's been very useful. >> thank you. i think we all associate ourselves with dr. chow's remarks. dr. kolfax, anything to add before we move on to the next item? >> there was a question before the homeless population. i want to emphasize that that is a big concern of the department. we are working with our partners

at hsa and hsh at the department of homelessness in support of housing to do everything that we can to best protect and care for the homeless population. they obviousl are part of the ve population to covid-19. i'm in th not aware of any experiencing homelessness. we know from data from dr. margo and others that the physical -- that the medical age of people who are chronically homeless is 20 years older than their chron logical age. we are establishing places for people who are experiencing

homelessness who are under investigation or covid-19 positive i just wanted to go back to commissioner green about the providers. i wanted to assure you all that we have a liaison to the san francisco medical society ensuring that private providers are getting the information they need about testing and how to manage their patients and work with their patients going forward.

we're also issuing a health order this afternoon that will ensure that only people who need the most urgent or emergent care will be seen in offices going forward. >> is there specific guidance we're offering to people who are hiv positive in terms of their being a part of a vulnerable population that needs to take specific measures? >> so we don't know how covid-19 interacts with hiv and whether it's additional risk factor, especially for people living

with hiv who are suppressed versus people living with hiv who are immunosuppressed. we're following cdc guidance gus and fits into the vulnerable population going for other chronic diseases. >> thank you, director colfax. >> commissioners, if we could move on to the next item, which is the joint conference committee that occurred today.

>> we met before this meeting and we got an update from the administrator on the situation and status around the coronavirus orders and things that are being taken that seemed quite comprehensive and very well put in place. so we were glad to hear about that. and i believe that can be shared. if others are looking for that information, particularly the

information. (pause) we asked for a flex status which asked for the reclassifications of some of the beds to accommodate the population needs there. there were rehab beds and dismiss beds and the rest of the time we spent on reviewing the

regulatory report which included the recertification survey that happened recently at laguna honda and other facility-reported incident events that have been surveyed. i wouldn't necessarily go into the detail but that information is available to the other commissioners. >> any questions for the commissioner filiarmo. >> i skipped the item 6, which is the health commissioner elections which are important to your leadership. so let's go to that, please.

>> to the office of president, do we have nominations? dr. ch o chow? >> i would move dr. dan grenell. >> i second that. >> mark, would you like to call a role call? (role call). >> and that's it. >> movinmoving on to the electif

vice president, a mo nominationf vice president? >> i would like to nominate dr. laurie green. >> i'll second it. >> second. >> ok, i will need a role call. (role call). >> thank you to my fellow commissioners for your support and the faith you placed in dr. green and myself as your officers. these are extraordinary times that we hadn't foreseen and i am certainly grateful for your leadership and the expertise you bring to the commission. also, i would like to thank

mayor breed for her decisive leadership to keep us ahead of the curve to the extent possible, certainly calling on our city's experience with many other public health challenges, very proud of the decisive actions that san francisco has taken to help stem this crisis. also, very grateful for the leadership of director colfax, dr. etcand others we've been heg from and want to provide whatever support they need to do their jobs to confront this challenge and then, also, a special thank you to our excellent commission secretary, mark moorewitz for his leadership and work to keep our commission operating, as well as working with our technological team. thank you to you for making this meeting possible to be virtual.

and finally, just thank you to our commissioners for, of course, modeling good public health citizen behaviour and joining here virtually and also thank you to the people of san francisco for your abiding by the orders being put out by the city to ensure we all ban together to keep san francisco as safe and healthy as we can. dr. green, is there anything you would like to say? >> well, you said that so eloquently. of course, it's a huge honor to be a part of the executive group and i would echo all of the thanks. i just can't imagine what it's like to be in the shoes or population health division. i know people are being redeployed in areas that they haven't been working in. everyone is being so diligent and i think we will be an example for the nation of how to do this right and hopefully, we will save many, many lives and continue to respect our entire population, the equity of san

francisco and really be the shining example for the country and we may be under-resourced in items, but overly abundantly resourced in still of our individuals and the people part of this department expect citizens of this city. it's a real honor to be a part of this and i'm so grateful. >> thank you, dr. green. >> i look forward to working with both of you. item 9 is a consideration for a closed session. >> second. >> thank you. i will go through a role call vote for the closed session. role call (. (role call). >> because this is the first

time we're doing this, we will not be coming back to say goodbye, but after the closed session, we will simply ajourn and in the future, we'll have this worked out better but thank you for your patience. so everyone online, please push n and commissioners, you are invited to the closed session meeting and you can use that phone number to call in to that and the code. text me if you have any questions. thank you all. >> thank you, mark.

>> good morning, everyone. welcome to the march 12, 2020, regular meeting of the public safety and neighborhood services committee. i'm supervisor mandelman. our clerk is john carroll, and i want to thank s.f. gov. tv for staffing this meeting. mr. clerk, do you have any announcements? >> yes. please silence all electronic devices. your completed speaker cards and documents as part of the file will be submitted today as to the clerk. items acted upon today will appear on the march 21st, 2020, board of supervisors agenda, unless other stated. and related to the coronavirus disease, we are asking all attend decees of this meeting to maintain at least four feet between themselves and others, regularly wash your hands for 20 seconds at a time, and try to

avoid touching high-volume services as much as possible. >> thank you for that, mr. clerk. for reasons related to the current public health crisis, we are likely to continue items 3 and 4. so if anyone is here for those, you should be aware of that. so mr. clerk, can you please call the first item. >> item 1is a hearing to consider that the issuance of a type 57 special on-sale beer and wine liquor license to the owners association, doing business as the four seasons private residences, will serve the public convenience or necessity of the city and county. >> thank you. >> good morning members of the board. you have before you p.c.m. for 607 mission, residence owner association.

they have applied for a type 57 license, and if approved, it should allow them to sell special on-sale general. there are zero protests, zero items of support. they're located on plot 212, consider a high-crime area, and a high saturation area. the southern station has no opposition, and a.l.u. recommendation is to approve the license without recommending any new conditions. >> chairman: great, thank you. is the applicant here, or a representative? >> yes. good morning. i'm beth hopalofia, representing the applicant. we understand that the supervisor's office has requested a continuance of this item and would like to meet with the project sponsor. so we're making plans to do that prior to the next meeting date. >> chairman: fantastic. thank you. if there are no comments or questions, we'll open this up for public

comment. are there any members of the public who would like to testify on this item? seeing none, public comment is now closed. as the applicant's representative said, supervisor haney has requested with continue this item to allow additional time for his office and the applicant to meet. we can continue this item to the march 26th regular meeting and still not go past our 90-day period during which we're trying to make action. i will move we continue this to the march 26th regular meeting. we can take that without objection. mr. clerk, please call the next item? >> item 2 is the hearing to consider that the transfer of a type 48 on-sale liquor license to buzz works incorporated, at 365 11th street will serve the convenience and necessity of the city and county. >> you have before you

p.c.m. for buzz works. if approved, this would allow them to operate an on-sale. there are zero letters of protest. i understand there are letters of support. they are located on plot 242, considered a high crime area. on census track 1082, considered a high saturation. and a.l.u. recommendation is to approve this license without any new conditions. >> chairman: great. thank you. is the applicant here? >> members of the board, distinguished chair, i'm ladd coupe, and i'm the owner and operator of buzz works. i've been in san francisco and owning a variety of nightclubs and restaurants during the last 30 years. i own "butter," a legacy venue, that has been there for quite a while. i opened up buzz works about four years ago. and we've had