i'm hillary supervisor. i'm supervisor hillary ronen, chair of the committee. with me is vice chair supervisor catherine stefani and mr. kirk. mr. clerk, do you have announcements? >> clerk: yes. due to covid-19, city employees and public, the board of the supervisors room is lossed

however, committee members will be participating in the meeting remotely. this precaution on the authority conferred by governor newsom. >> sorry. i'm ruled into rules but have no audio. i'm not sure that i should hold up the meeting, because i'm not sure if there are amendments that require me. is there a way to let people know? >> continuing with my statement, the precaution taken on authority conferred by governor gavin newsom, and all proceeding and preceding local state and federal orders and directives. committee members will be atening the meeting through video conference and participating in the meeting to the same extent as if they were present. public comment will be available on this agenda, both channel 26

and sfgovtv.org are streaming on the screen and each member will be allowed two minutes to speak. comments during public comment period are available via telephone call, by calling

within the mission district and mission dolores neighborhood in an area that has been put up the boundaries for you to see. except, now, it's gone. why is it gone? sorry, guys. i practiced this before we started but let me try again. okay. let's see. there we go. that is, those are the boundaries of the american indian cultural district of san

francisco. this region holds unique conten trags of historic events and native american based programming and gathering spaces of significant present and miss store cal importance of the american indian community in the san francisco bay area, just to give you a sense of some of the incredible historical sites and programs in the district this, is not an exclusive list but this will give you a sense, is the native american health center at 160kat street, friendship house at 56 julian street, indian education programs at sanchez elementary school, international indian treaty council at 2940, 16th street and mission dolores where california native americans are buried onsite. that is a snap shot of the

currently existing programming in those boundaries that i just showed you. the region holds unique events and native american based programs, services and fathering space that are of significant presence and importance to the american indian community n light of the ongoing public health emergency facing our city, establishing the american indian cultural district will provide critical funding to support coordination of efforts to help ensure the american indian community of san francisco is connected to the resources and information necessary to navigate this crisis. that is why during this crisis, i am calling the item forward, because the community is waiting to access funds available to the cultural strict but can't until the cultural district is formed.

in a few months, as thing return to normal i plan to move the cultural district beyond what is brought forward in this legislation. there is broad support for the legislative process would delay our ability to disperse city funding if we change the boundaries at this time. we're bringing forward the originally proposed boundaries in order to provide the american indian cultural district with resources as quickly as possible. it's been such an honor to partner with many so incredible leaders to bring this important, and historical district to fruition. extra special thanks to andrew joelvet, helen walker from

central house and julian zabori. thanks ifs to paul hona to my office, i believe this might have been the first piece of legislation that he worked on and poured his heart and soul noochlt we n tomorrow.

can we take a roll call? >> on the call, calling kol. [ roll call r. [ roll calo. [ roll call. [ roll call. [ roll call ]. >> motion passes. this matter will be referred as a committee report as recommended to the board meeting. >> thank you so much. and there clerk are there any other items? ? >> clerk: that completes the agenda for today. >> thank you. the meeting is adjourned. thank you, everyone. >> thank you.

>> roughly five years, i was working as a high school teacher, and i decided to take my students on a surfing field trip. the light bulb went off in my head, and i realized i could do much more for my students taking them surfing than i could as their classroom teacher, and that is when the idea for the city surf project was born.

>> working with kids in the ocean that aren't familiar with this space is really special because you're dealing with a lot of fear and apprehension but at the same time, a lot of excitement. >> when i first did it, i was, like, really scared, but then, i did it again, and i liked it. >> we'll get a group of kids who have just never been to the beach, are terrified of the idea, who don't like the beach. it's too cold out, and it's those kid that are impossible to get back out of the water at the end of the day. >> over the last few years, i think we've had at least 40 of our students participate in the city surf project. >> surfing helped me with,

like, how to swim. >> we've start off with about two to four sessions in the pool before actually going out and surfing. >> swimming at the pool just helps us with, like, being, like, comfortable in the water and being calm and not being all -- not being anxious. >> so when we started the city surf project, one of the things we did was to say hey, this is the way to earn your p.e. credits. just getting kids to go try it was one of our initial challenges for the first year or two. but now that we've been doing it three or four years, we have a group of kids that's consistent, and the word has spread, that it's super fun, that you learn about the ocean. >> starting in the morning, you know, i get the vehicles ready, and then, i get all the gear together, and then, i drive and go get the kids, and we take them to a local beach.

>> we usually go to linda mar, and then occasionally ocean beach. we once did a special trip. we were in capitola last year, and it was really fun. >> we get in a circle and group stretch, and we talk about specific safety for the day, and then, we go down to the water. >> once we go to the beach, i don't want to go home. i can't change my circumstances at home, but i can change the way i approach them. >> our program has definitely been a way for our students to find community and build friends. >> i don't really talk to friends, so i guess when i started doing city surf, i started to, like, get to know people more than i did before, and people that i didn't think i'd like, like, ended up being

my best friends. >> it's a group sport the way we do it, and with, like, close camaraderie, but everybody's doing it for themselves. >> it's great, surfing around, finding new people and making new friendships with people throughout surfing. >> it can be highly developmental for students to have this time where they can learn a lot about themselves while negotiating the waves. >> i feel significantly, like, calmer. it definitely helps if i'm, like, feeling really stressed or, like, feeling really anxious about surfing, and i go surfing, and then, i just feel, like, i'm going to be okay. >> it gives them resiliency skills and helps them build self-confidence. and with that, they can use that in other parts of their lives. >> i went to bring amy family o

the beach and tell them what i did. >> i saw kids open up in the ocean, and i got to see them connect with other students, and i got to see them fail, you know, and get up and get back on the board and experience success, and really enjoy themselves and make a connection to nature at the same time. >> for some kids that are, like, resistant to, like, being in a mentorship program like this, it's they want to surf, and then later, they'll find out that they've, like, made this community connection. >> i think they provided level playing fields for kids to be themselves in an open environment. >> for kids to feel like i can go for it and take a chance that i might not have been willing to do on my own is really special. >> we go on 150 surf outings a year. that's year-round programming. we've seen a tremendous amount

of youth face their fears through surfing, and that has translated to growth in other facets of their lives. >> i just think the biggest thing is, like, that they feel like that they have something that is really cool, that they're engaged in, and that we, like, care about them and how they're doing, like, in general. >> what i like best is they really care about me, like, i'm not alone, and i have a group of people that i can go to, and, also, surfing is fun. >> we're creating surfers, and we're changing the face of surfing. >> the feeling is definitely akin to being on a roller coaster. it's definitely faster than i think you expect it to be, but it's definitely fun. >> it leaves you feeling really, really positive about what that kid's going to go out and do. >> i think it's really magical

almost. at least it was for me. >> it was really exciting when i caught my first wave. >> i felt like i was, like -- it was, like, magical, really. >> when they catch that first wave, and their first lights up, you know -- their face lights up, you know you have them hooked. >> i was on top of the world. it's amazing. i felt like i was on top of the world even though i was probably going two miles an hour. it was, like, the scariest thing i'd ever done, and i think it was when i got hooked on surfing after >> how i really started my advocacy was through my own

personal experiences with discrimination as a trans person. and when i came out as trans, you know, i experienced discrimination in the workplace. they refused to let me use the women's bathroom and fired me. there were so many barriers that other trans folks had in the workplace. and so when i finished college, i moved out to san francisco in the hopes of finding a safer community. >> and also, i want to recognize our amazing trans advisory committee who advises our office as well as the mayor, so our transadvisory community members, if they could raise their hands and you could give a little love to them. [applause] >> thank you so much for your

help. my leadership here at the office is engaging the mayor and leadership with our lgbt community. we also get to support, like, local policy and make sure that that is implemented, from all-gender bathrooms to making sure that there's lgbt data collection across the city. get to do a lot of great events in trans awareness month. >> transgender people really need representation in politics of all kinds, and i'm so grateful for clair farley because she represents us so intelligently. >> i would like to take a

moment of silence to honor all those folks that nicky mentioned that we've lost this year. >> i came out when i was 18 as trans and grew up as gay in missoula, montana. so as you can imagine, it wasn't the safest environment for lgbt folks. i had a pretty supportive family. i have an identical twin, and so we really were able to support each other. once i moved away from home and started college, i was really able to recognize my own value and what i had to offer, and i think that for me was one of the biggest challenges is kind of facing so many barriers, even with all the privilege and access that i had. it was how can i make sure that i transform those challenges into really helping other people. we're celebrating transgender awareness month, and within

that, we recognize transgender day of remembrance, which is a memorial of those that we have lost due to transgender violence, which within the last year, 2019, we've lost 22 transgender folks. think all but one are transgender women of color who have been murdered across the country. i think it's important because we get to lift up their stories, and bring attention to the attacks and violence that are still taking place. we push back against washington. that kind of impact is starting to impact trans black folks, so it's important for our office to advocate and recognize, and come together and really

remember our strength and resilience. as the only acting director of a city department in the country, i feel like there's a lot of pressure, but working through my own challenges and barriers and even my own self-doubt, i think i've been try to remember that the action is about helping our community, whether that's making sure the community is housed, making sure they have access to health care, and using kind of my access and privilege to make change. >> i would like to say something about clair farley. she has really inspired me. i was a nurse and became disabled. before i transitioned and after i transitioned, i didn't know what i wanted to do. i'm back at college, and clair farley has really impressed on me to have a voice and to have agency, you have to have an education. >> mayor breed has led this

effort. she made a $2.3 million investment into trans homes, and she spear headed this effort in partnership with my office and tony, and we're so proud to have a mayor who continues to commit and really make sure that everyone in this city can thrive. >> our community has the most resources, and i'm very happy to be here and to have a place finally to call home. thank you. [applause] >> one, two, three. [applause] >> even in those moments when i do feel kind of alone or unseen or doubt myself, i take a look at the community and the power of the supportive allies that are at the table that really help me to push past that. being yourself, it's the word of wisdom i would give anyone.

surely be patient with yourself and your dream. knowing that love, you may not always feel that from your family around you, but you can >> 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.

>> good morning, everyone and thank you all for being here today. my name is london breed, the mayor of san francisco and i'm joined by the president of board of supervisors, norman yee, as well as the department of public health, dr. grant colfax and we are joined by police chief bill scott, the director of emergency management, mary ellen carol and thank you to the press for accommodating this virtual rest conference in order to maintain social distancing during this very challenging time.

i also want to take the opportunity to thank the people of san francisco. this weekend, things looked like somewhat of a success in terms of social distancing for the most part and definitely an improvement from last weekend. the streets are pretty clear and there were some definite hot spot areas that we'll be focusing on, but the beaches and some of the parks and other places, people were practicing social distancing and we very much appreciate your cooperation. it will make a world of difference and, in fact, we already have made a difference in really saving lives. we may not realize the impacts this until this is all over, but eventually, we will learn, i'm sure, that because of what we have done and how we all have participated in complying with social distancing, it truly has saved lives.

as of today, we have 374 confirmed cases with six deaths and that is six people who have passed away because of the coronavirus. and my heart goes out to the family members expect friends e have lost in san francisco. one person is too much of a loss and as we have said before, this is a very deadly virus, as you are seeing, not just in san francisco but throughout the country. and the reason we have taken significant steps has everything to do with saving lives and protecting public health. because we know that there will be challenges on our healthcare system and we know that people are anxious to know about the stay-at-home order and whether that will be extended. i know that our county health officers will be making an

announcement tomorrow to talk about the specifics of extending the stay-at-home order until mar the sake of planning and everyone can begin to know this continue to have an impact, you should definitely plan to stay at home and this process and what we're doing here will continue until at least may 1st. if anything changes, we will definitely notify the public. so i want to just talk a little bit about some of the challenges that we have having and will continue to have and what we're doing to prepare for those challenges. we've said from the very beginning we knew that our vulnerable populations, not only consisting of our ederly but those living in congregate

settings and sadly those on our streets would be a part of that vulnerable population and so we would have to move quickly to make sure that in places where we have single-room occupancy hotels, where our shelter systems are and places like ga laguna honda, we had a plan and would keep people safe. from the very beginning, we knew this would be a challenge. we have learn ed this nine employees at laguna honda hospital have tested positive,

as well as two patients, and we are still testing people a at at laguna hospital and we'll have more information once that comes in. we knew the situation would be challenging and so immediately last week, i sent a letter to the federal department of human services asking for significant support so that we could not only focus on making sure we provide the resources and support to this hospital and we don't continue to drain other services, but we have the expertise and the testing on side and other things needed in order to prevent something from happening that we know has happened in other places throughout the country, including in washington, that house hav a significant populatn

of ederly patients. laguna ha honda is one of the largest hospitals of its kind in the country, housing over 750 very, very vulnerable residents who cannot take care of themselves. and this is basically their home and this is where they eat. this is where they live. this is where they're cared for. and so we have been taken immediate steps in order to help support this hospital and support the people and the staff who are part of it. we were fortunate in that the cdc on friday, after sending that urgent request to the u.s. department of health and human services, the cdc has sent two infectious disease doctors and two epidemiologists and the department of health has sent two prevention nurses to help assess the situation at laguna honda and make recommendations and we also have a dedicated

staff member at the cdc in atlanta to help monitor and facilitate the situation specifically at l laguna honda because we know that, again, this is a very vulnerable population and more testing needs to be done and it's going to be important that we have the resources and we have the support necessary to protect and save lives. it's just a start and i'm grateful for what we've received, but i want to be clear, it's not nearly enough to get us to a better place specifically concentrating on la golaguna honda hospital. we'll definitely be reaching out to federal and state partners to ask for additional support for the residents and the staff at laguna honda hospital. i also want to be clear that the situation will escalate at laguna honda and it will escalate here in san francisco.

the fact that we are taking such drastic steps to, in essence, pretty much shut down san francisco has everything to do with how serious this is. i can't reiterate enough how important it is for all of us to continue to comply, for all of us to continue to be good citizens, to continue to cooperate. this weekend, i received a note from one of my neighbors. the note basically had the email address expect phone number of one of my neighbors on the block who said they were the block captain. so if i needed anything, whether its grocery shopping or pharmacy pick-ups or what have you, or even someone to take to, they were available. and i got really emotional when i received that note because it made me think about how amazing people are in this city and how

i've heard so many stories about people reaching out to their neighbors, people identifying ederly people that they know need help and just dropping off groceries, folks just stepping up and being there for one another. because we know that it's not just about the physical health and what we need to do to combat the coronavirus. we also understand that as human beings, there's an emotional toll that this will take on so many of us. so it's so important that we continue to uplift one another and be there for one another as much as we possibly can. my thoughts and prayers go out to the team at laguna honda. i want to thank them for all they continue to do to give dignity to so many elderly patients who may not have family visits or support and resources to do anything just to be there and to know the nurses and those

doctors and those social workers continue to put a smile on the face of those patients. they show up everyday and they just really deserve our respect, our support and we will do everything we can to continue to do just that. so at this time, i would like to introduce dr. grant colfax to provide us with more detail specifically what's happening at laguna honda, what we're doing to prepare for the inevitable and how, together, we will do everything we can to save and change lives and get through this. so thank you all so much. and let me wipe this mic down.

>> good afternoon, i'm gra grant colfax, director of health. thank you, mayor. today i'm saddened to report to the san francisco community that laguna honda hospital has a growing outbreak of coronavirus. we've prepared for since the start of the pandemic and we will continue to do everything we can to protect laguna honda

hospital and staff. i want the community and all of the families to know how much i care, we care about them and they are our top priority. we are intensely focused on doing everything we can to protect everyone at laguna honda from harm, but i also need to be realistic and forthright. as we look at the data and the patterns around the world and in our country, we know that long-term care facilities are at most risk for coronavirus outbreaks. therefore, we expect the situation to, unfortunately, get worse. across the united states, many long-term care facilities have been hit hard by the coronavirus, including in california, washington, colorado, minnesota, new york and many other states.

no local community is equipped to manage this escalating crisis alone. and that is why we have asked for help from the state and federal government and, i am thankful that some of our requests are starting to be answered. as of today, infection control nurses from the california department of health and infectious disease physicians and e epidemiologists from the c are on la go laguna honda exper. they will make decisions for management that is expected to escalate and will work with leaders at the department of public health to develop a prospective response plan for long-term care facilities in

addition to l laguna honda. i am grateful for this help and we need more. from the beginning of the global outbreak, efforts by the city to prepare for the coronavirus have prepared the most vulnerable population. residents who are over 60 years old and those with certain underlying health conditions and chronic diseases. the residents of laguna honda hospital are in the most vulnerable of these groups. laguna honda has a total of 11 confirmed cases of coronavirus. nine are amongst staff and two are among residents. all are in good condition. since march 26th, 158 staff and 54 residents were tested for the virus. among residents, two have tested positive and 51 negative and one

result is still pending. among staff, 156 have tested negative and 25 more tests are underway. and i expect more cases of coronavirus in the laguna honda community among both staff and residents because it is now spreading throughout the bay area. we are drawing on all of the resources we can muster at the local state and federal level to strengthen our response. laguna honda has been and remains a top priority in the city's preparation and response to coronavirus. the first health officer order after declaring a local health emergency in early march was to restrict visitors from laguna honda to protect the institution's residents. laguna honda leadership has worked actively and diligently to train staff on coronavirus

including the use of personal protective equipment, ppe, for all cleaning of common spaces of resident rooms and other prevention technique. here is what is happening on campus right now to respond to the outbreak. first, the hospital incident command system is activated to manage the crisis and the incident commander, troy williams, is here to answer further details about that process. the state infection control nurses are creating expanded protocols on environmental cleaning, ppe, and staff safety. the cdc is intensifying the information to look for sources of infection and the pathway of spread and this will prevent a plan that taking the coronavirus situation fully into account.

the two units where the cases have been diagnosed, south 4 and south 5, are under an extensive quarantine order. each of these units houses approximately 60 residents. within these units, doors have been secured, sheriffs are at the doors preventing residents from leaving and only allowing appropriate staff to enter and residents are being assessed for symptoms on every shift and staff are being screened twice for symptoms at every shift. testing of all staff on south 4 and south 5 where staff cases have been found is almost complete. to date, nine positive cases have been confirmed. and testing of all patients on south 5 where patient cases have been found is complete and results are pending. to date, two positive cases have been confirmed.

all nonessential personnel are restricted from entering the facility. all essential visitors, staff and residents are medically screened and all laguna honda staff are screened at the start of each shift. in addition, laguna honda is setting up a field care clinic on its grounds as a precaution in case there is a need to separate groups of patients. we are continuing to assess the situation and adapt our response accordingly. working with our state and federal partners. however, even best efforts are no guarantee against the spread of the virus. there are currently 374 cases and six deaths due to coronavirus in san francisco. in addition to our focused, rapid response efforts at laguna

honda hospital, they are preparing for the expected surge of hospital patients. i remind all of sanfrancisco to do your part in slowing down the virus. by decreasing community spread, you will help protect vulnerable groups like the very residents of laguna honda and other long-term care facility residents across the country, other ederly people and those with underlying he health conditions. this is the time to come together as a community while we stay home whenever possible. i cannot stress that enough. unfortunately, we will be seeing more cases and deaths in the coming days and weeks. please do your part to keep those numbers as low as possible. thank you.

and i would like to introduce mr. yee, board of supervisors. >> good morning. i'm t norman yee, president of e

board of supervisors and i'm in district 7 in which laguna honda is located. i want to thank dr. colfax and mayor breed in taking a stand with these vulnerable populations we're dealing with. we knew that at some point somebody was going to be infected. so as tough as it's been to say no visitors coming to laguna honda, it's something we had to do. think about it. the people that are there in the hospital are now not with their families, not with their friends visiting. and the love that the family and the friends want to provide for them, they can't. so a tough decision, it was very difficult to make, but think it

was the right decision. problem, in fact, it delayed any infection there. it probably, in fact, reduced the numbers that we're seeing today. what i'm saying is probably reiterating what dr. colfax was saying, that we need to take an aggressive stance. we need to attack this aggressively and do everything we can to slow it down, to minimize how many people are going to be infected, whether it's staff or the seniors themselves. one thing that we could do even more aggressively if we have the tools is to start testing everybody there, everybody. we can't be working in a vacuum. we can't be guessing oh, where is the next person that will be positive? we have to get ahead of that. so as dr. colfax and mayor breed

were saying, we're reaching out to the state and federal government and please respond because we need your help. that's all i have to say today and thank you very much to the residents who are behaving the right way, social distancing, stay at home as much as you can and enjoy whatever you can at home and if you have to go out, make sure you are staying away from people, at least six feet and to continue washing your hands. thank you very much.

>> we'll open it up to some question. >> madam mayor, this is a question from abc7. what is the city doing to help small businesses during this crisis. >> so one of the first things that we announced early on, because we knew there would be some real challenges with our small business community, is a fund to provide a million dollars in grants right away and that money has dried up and we provided a delay in business taxes until 2021 so that businesses here can hold off on paying taxes until next year. we put a delay on a number of fees that businesses get charged and we also provided a

$10 million fund for employees where you have businesses who have sick leave and, for example, if an employee only has two weeks of sick leave, we could provide an additional week of sick leave through a fund that is available and we've tried to make sure that we provided all of these options to small businesses. they can check out the website oewd.com for more information on how they can get additional assistance. the governor added additional -- there are others other actually before did not qualify for unemployment insurance that now qualify for unemployment insurance. and so state unemployment insurance is available to a lot more people than it hav ever has

before. so it's important that people apply because you may not think you're qualified, but you are. i'm working to develop a no-interest loan fund where we've partnered with a number of nonprofit agencies -- excuse me, folks in the private sector to contribute money along with public dollars and we're hoping to make that fund available to businesses sooner rather than later. we understand that businesses are suffering and there's some real challenges with paying bills, but i think our commercial moratoriums on convictions and a number of other things we're doing to really slow down or hold off on extreme responses to the lack of our business community and their inability to pay bills because of the resources that they're no longer able to regenerate, i

think that some of the measures we put in place will be helpful. i know they won't be enough so we'll continue to add a number of resources to help support our small business community and i just want to be clear, there's a lot of folks who are hurting out there and we'r we're going to do everything we can but this is a problem that doesn't exist in san francisco. it's all over the country, all over the world and it will be difficult to help every single person, but we'll do our very best. >> question from sin singh tao. for affordable housing, but what about luxury home building? >> the fact is in san francisco, costle building anything is so expensive, the fact we don't build is a problem. it doesn't matter what sort of

housing gets built. the fact is, when this is all over, people are going to need places to live and so i'm not going to pit between one housing versus another. housing is essential, period. and what we don't want to happen is what happened, especially when we started to focus on job opportunities between 2010 and 2015 during the time when we were attracting a number of tech companies and other businesses to sanfrancisco. for every eight jobs we created, we created only one unit of housing. you had people lining you in the western housing community where i grew up, where you would never see anything like this for one apartment, which i think drives up prices. so the fact is, all housing is essential. and we don't need to pick one over the other. the fact is, when this is all over, just think about it, we have thousandscs of people on streets. you think we'll able to afford thousands of units to house

them? this will require every single unit that we can get on the market, no matter what kind of unit it is. >> thank you, madam mayor. the next questions are for dr. colfax. this is from reedasm lbergati from the washington "washington? what date are you used to make your posts positive? what's the view of using modeling to predict what will happen with the virus and are

you relying on any models? >> thank you. we have some of the best people in the help department helping us pull in data from all sources, both locally, nationally and internationally to make an informed response. some of the key things we're looking at, obviously, are the number of cases and very importantly, the number of people who are hospitalized, including people in the intensive care unit, following numbers carefully, and using other data from china, italy and now new york t of what to be prepared for in worse case scenarios and updating the numbers to see where we stand. so in terms of what we're missing, you know that there's

clear testing deficiencies across the country and we're working to expand our testing capacity in san francisco. we still do not have an accurate prevalence number and, in other words, we not know overall per thousand people in san francisco what the rate of the virus infection is and we are working, again, with the uc berkley and ucsf colleagues to determine that number as quickly as possible to get the estimates and those will be very important in informing our models. with regard to whether models are helpful, yes, i think they are very helpful and they provide a number of plausible scenarios and they certainly do not provide certainty about where we're headed but provide plausible scenarios to help us plan our response going forward. >> the next question is from jamie harr of the associated press. the department of public health is sending health inspectors to conduct inspections at sros.

how many are checking and what are you looking for or not looking for? >> so we are focus on a number of things, but particularly with regard to hygiene, making sure that the procedures are being followed and making sure that we're doing outreach and education to the community, around the social distancing order and making sure that people have the information they need and, also, making sure that people have the information they need in the event they need care. they know who to call, when to call and to get the help from the public health department, their community and other healthcare providers and systems across the city. >> and this is a followup, if there are unsafe conditions, what will you do? will you move people out? >> we're looking at focusing on the conditions are as safe as possible and if peopl symptoms, they are protected and that they're provided with resources and physical spaces that allows

them to self-quarantine from their community and other people that they may come into close contact with. >> and the next question is from shannon lim of kqed. there's a question and followup. what are san francisco's plans to start testing hopeless people for the coronavirus? do they have a protocol for who they will be testing and when this will begin. >> so i appreciate the question and i'm emphasized that we are expanding our testing and it's a key priority of the department's. i just want to be transparent, though, what we're doing. to give you an example, when we send our request up to state with regard to asking for more help and responding to the laguna honda situation, part of that request was the request for more swabs, testing swabs. therthis is not just limited ton francisco but a national shortage and we are struggling to get swabs in order to test

and so along the supply chain for testing, there are severe limitations. while we are working to expand testing capacity, my public health lab is expected to triple its potential capacity starting today and we are still struggling along that supply chain to ramp up testing as long as possible. so anything from the specimen collection you need for swabs, from the processing reagents that are needed, our supply chains are episodic and hard to determine. so with regard to testing people who are tendernessin experiencig homelessness, we will focus on people who are symptomatic and people with high-risk exposures. >> miss lin's followup and similar to question from dan simon from cnn. the medical director of the er at ucsf believes there's a flattening of the curve and

credits the state-at-home order and not seeing a surge

5, 4.eeing a surge . great. good afternoon, everyone. the meeting will come to order. welcome to monday, march 30th special meeting of the government audit and oversight committee. i am supervisor gordon mar and supervisor peskin. and i'd like to thank sfgovtv.

>> thank you. i have an announcement. due to the covid-19 health emergency and protecting board members, the committee rooms are closed at this time. members will be participating today's meeting remotely pursuant to the statewide home order and will go declarations and directives. committee members will participate to the same extent as if they're present. public comment will be available on channel 26 and sfgovtv.org are streaming the call in number near the top of the screen. each speaker will be allowed two minutes to speak. comments and opportunities to speak are available via voen foen by calling

. >> are there any comments or

questi questions for my colleagues? >> mr. chairman, this is aaron peskin. i want to you know i have read the materials supplied by the city attorney and concur there is no need foreclosed session and sublt to public comment i'm ready to move these items to the full board of supervisors. >> thank you. are there members of the public on the line that wish to testify? speakers will have two minutes. please speak your first and last name clearly and speak into the phone. for those who called in to public comment line, please dial 1, 0, to be added to the

speaker's queue. is someone from the clerk's office able to call? >> operations are checking to see if there are comments in the queue ready. >> there are no callers wishing to speak. >> great. well, thank you. mr. ku. if there is no one from the public who wishes to testify on these

[ roll call ]. >> is there any further business? >> no. >> thank you, mr. clerk, we are adjourned.

>> we're here to raise awareness and money and fork for a good accuse. we have this incredible gift probably the widest range of restaurant and count ii destines in any district in the city right here in the mission intricate why don't we capture

that to support the mission youths going to college that's for the food for thought. we didn't have a signature font for our orientation that's a 40-year-old organization. mission graduates have helped me to develop special as an individual they've helped me figure out and provide the tools for me that i need i feel successful in life >> their core above emission and goal is in line with our values. the ferraris yes, we made 48 thousand >> they were on top of that it's a no-brainer for us. >> we're in and fifth year and be able to expand out and tonight is your ungrammatical

truck food for thought. food truck for thought is an opportunity to eat from a variety of different vendor that are supporting the mission graduates by coming and representing at the parks >> we're giving a prude of our to give people the opportunity to get an education. people come back and can you tell me and enjoy our food. all the vendor are xooment a portion of their precedes the money is going back in >> what's the best thing to do in terms of moving the needle for the folks we thought higher education is the tool to move

young people. >> i'm also a college student i go to berkley and 90 percent of our folks are staying in college that's 40 percent hire than the afternoon. >> i'm politically to clemdz and ucla. >> just knowing we're giving back to the community. >> especially the spanish speaking population it hits home. >> people get hungry why not >> people get hungry why not eat and give

this is my computer? this is your computer. let's go on the internet. let's go. click it? yes. ok.

i cursor in between the r and the e. when i say dot, i want you to just push the period. she's going to love me all over again now. that's it! jamaica here you come! here we go. all right. good job. thank you. thank you. i did it. by myself. feel smarter.

>> mayor breed: good morning. are we still in the morning? good morning, everyone. thank you all for joining us today. i am san francisco mayor, london breed. i am joined by a member of the board of supervisors, supervisor aaron peskin as well as doctor grant coa colfax, police chief t and fire chief nicholson as well as other officials. we are definitely practicing social distancing by having at least six feet apart from one another in this location, but also this virtual press conference is an opportunity to demonstrate the kind of behavior we want to see happening all over the city. we want to thank members of the

press for their patience and for accommodating the change in order to help protect and keep them safe as well. we also want to thank members of the public because we know for the most part so many in san francisco have really stepped up and really focused on social distancing and also helping to support and educate neighbors and other people as to what is most appropriate to do during this time. i know that we often times refer to social distancing as saving lives. i want to be clear that it will save lives. if we continue to practice social distancing every single day during this stay at home order, we will get to a better place.

as doctor colfax has said it is a challenging time. the numbers are increasing as we do more testing. we know as we said in the last press conference that we will need more beds and more ventilators ashmore support. what you are doing by socially distancing and staying at home and only going out for essential services you are reducing the number of people infected. thank you all for everything that you have done to help us get this far. i know it hasn't been easy. we still have a lot more time ahead of us than we do behind us. your patience during this very challenging time is definitely appreciated. i want to start by providing an update on some real positive information that we just

received because, sadly, we know testing is very limited in san francisco. the department of public health have been able to administer now 150 tests each day. that did not include the private hospitals, and this is information we will receive sooner rather than later. we expect to increase the number significantly. doctor colfax will provide an update on testing and how we expect to extend our testing efforts more significantly than we have in the past. the good news on that front is now thanks to kaiser and blue shield, we will be able to provide testing for the healthcare workers on the front line working with patients who have been infected as well as many public safety officials,

firefighters and police officers and those on the front line. we will prioritize them for testing. we know so many of them are very concerned they are doing the work in the community. they are trying their best to save lives. they live in fear if they have the virus and they are concerned with going home to spread that virus to the family. getting the ease of knowing if they have the virus is critical to protecting public health and safety. we will prioritize public health and safety officials for testing. the doctor will talk about that more as well. i want to just also mention to the public that although we want to be tested. i know everyone wants to be tested to know and think that could put an end to what we are

experiencing, and i want to be clear that in light of having sufficient testing for all san franciscans, social distances is the key. i keep mentioning it, but i can't mention it enough because regardless of how many tests or who we are able to test, that at the end of the day is going to make the most impact. please continue to practice social distancing. i want to talk about, since this is friday and the weekend is approaching. we know what happened last weekend. what happened last weekend, you did see people out, of course, enjoying the fresh air, walking dogs, walking with families, and kids and practicing social distancing. sadly, we saw a number of areas in the city just jam-packed.

we also saw people who were playing things like volleyball and basketball and other sports together that are not thinks that we are able to do at this time as a result of the order. just to make it clear, we are going to have to make some changes. the last thing i want to do, as i said on monday, is to basically close parks. we need to shift our behavior and make adjustments so that people are not doing the kinds of things that are going to lead to the spread. as we go into this weekend, i just want to appreciate the fact that we have been able to close places like acataz, four point and lands end look at. the federal government announced parking closures including baker

and ocean beach. if you are going to try to go to baker beach or ocean beach, the parking will not be available. we will monitor the neighborhood to make sure there isn't an influx of vehicles that are impacting the parking in those particular neighborhoods. we don't want people to get in their cars and drive to ocean beach. we want people to stay at home. when they need air, walk outside, go to a park within the proximity of your neighborhood. don't get in your cars and drive to ocean beach or other places. we are going to be closing parking lots in chrissy field and the lots in the marina and ocean beach and specifically near the beach chalet. we hope by closing the area to

cars, people will get the message why we are pushing folks to really try to stay, get your fresh air, walk your dogs, but don't get in cars to drive to specific locations to play volleyball with friends, have picnics, wine parties, zoom is a great tool for parties and connections with friends and family. i discovered that as a great tool for socializing. the last thing we want to do, as i said, is to start to close the last bit of fresh air that we are able to get during this very difficult time. parks, we know, are essential. other places have chosen to just close parks and other places down. we don't want to get to that place. if we see more people placing in basketball courts or playing

volleyball and baseball and the sports more team related, we will have no other choice. it is still okay to go out and walk and okay to ride your bike and run. i just want to give a message to the runners. i had an experience walking yesterday in a narrow area. the runners decided to run close next to me. it would have taken three seconds for the runner to wait until i crossed the bridge area to get by so we could maintain six feet. i am asking people to be considerate of one another. i am not asking you to get in the street and risk getting hit by a car. wait a minute or two to allow people to pass within a safe distance. we all can play a role in making sure that social distances is practiced by everyone. the fact is we are in this for

the long haul. there is no need for us to be in a hurry. i want to also talk a little bit about what is happening with our homeless population. because we know that there are so many people that are very concerned what this could mean not just for the people sadly sleeping outdoors. what does this mean in people in settings like single room occupancy hotels and other places? we have been working on a number of things. i want to talk a little bit what we have done and what we will continue to do. hopefully, this will give people an update on where we actually need to get to as well. starting next week, moscone west will open up and supplies are

delivered this weekend. we are going to use that as a place to thin out shelters so we can start to have places so that people who are living in congregate settings like shelters can be spread out. moscone west will play an important role. i want to talk about hotel rooms. we put out an r.f.p. for hotel rooms to be used for people who are in congregate living settings, homeless as well as first responders and healthcare workers and those who may not want to go home because of concerns around impacting families. we have been able to -- because there is even with the declaration of emergency, there

is still insurance to be worked out, staffing needs and security needs and support and resources. so far we have been able to this week secure at least 300 hotel rooms for self-isolating or quarantine for folks in the sro or those who are homeless. we estimate by next week we will secure at least another 3,000. bringing on some much needed hotel rooms, and we will keep working towards making sure that those people who are in congregate settings and other places have a space to themselves so that we can reduce the transmission of the virus. that is the update that we have so far. i want to take this opportunity to especially thank the people who are here at moscone south,

those working every day in the emergency operations center and doing the hard work, coordinating, the hospitals and ppe and testing. the stuff we are doing, the small things. like making sure the shelters are getting food, we are getting food to seniors and other people, that we are reaching out to those businesses who still have remained open or have some real challenges financially and need help. so many people here at the emergency operations center have stepped up to do their part in providing information and resources to the public, and we really also want to express appreciation because we have gotten a lot of great ideas from members of the public through social media. people have made a lot of great recommendations. we take those to heart because

we are all in this together, and no one is in charge or responsible for all of the great ideas. it is going to take a team effort, it will take all of us looking out for one another. i want to really express appreciation to so many people in the city because i notice that on places like next door and some of these chat rooms where neighbors are communicating with one another, i notice that so many neighbors are looking out for neighbors who are seniors and people who can't necessarily get out to get groceries or medications. there have been so many great numbers running errands for so many people who can't get out. it is just, you know, a challenging time for all of us. it is bringing out the best in us. i want to express my appreciation for so many people not only doing their part to stay at home and only go out for

essential needs but also what you have done to help touch the lives of other people who can't take care of themselves in the same way. that is where we are. that is our update. a lot more work to do, but as i keep saying over and over, we are in the midst of this. it may feel like this is very challenges for all of us and how much longer can we take it? the fact is we are going to have to take it a little bit longer because it does mean that we save lives. we appreciate your patience and cooperation. we will do everything we can to provide updates as we receive them with the most accurate information so that the public knows what to expect because, as i said before, the last thing we want to do if someone is facing

a medical emergency, the last thing we want to do is turn them away because we don't have enough beds. let's keep that in mind as we go into the weekend, and let's try to remember that and do our very best to get through this. i am cheering for all of you. i am cheering for our city and our country. thank you all so much for your cooperation. at this time i would like to introduce grant colfax, the department of public health director, to provide an update on the latest numbers, testing and other information i just touched on briefly.

>> thank you, mayor. good morning. i am doctor grant colfax, director of health. today i am bringing several important updates. i will talk about the situation at laguna hospital protecting healthcare workers and new expansions of testing. first, let me remind everyone. we need san franciscans to stay home to save lives. i understand some of us are essential workers and cannot stay home right now. however, if i could stay at home right now, i would be staying home for our first responders

and healthcare workers on the front lines. as we continue to respond to this rapidly evolving outbreak, we are always thinking about what is ahead and what is about to come next. in february, we had zero cases of coronavirus. we realized we were in an emergency situation and immediately strengthened the planning and preparedness capabilities. the day after the first confirmed cases in early march. we made aggressive social distancing recommendations. we have continued to tighten that up as we move forward with the entire bay area in shelter-in-place for all residents. that was just last week. we issued 13 health orders in the last three weeks. each one was designed to protect the most vulnerable populations and healthcare workers and take

pressures off hospitals so they can handle an expected surge of new patients. each one was designed to keep the community safe and slowdown the spread of the coronavirus. each one was grounded in data, science and facts. as we continue to plan, predict and respond, sometimes we are ahead, sometimes we are on time and sometimes we may be a beat behind, but so far we have been preparing for just what is happening now. we will continue to use data, science and facts to be as proactive as possible to protect our community and reduce the harm that the coronavirus causes. i want to turn to the hospitals, particularly laguna honda hospital. yesterday there was quite a bit

of news in our own public healthcare system. coronavirus has arrived at laguna honda. unfortunately, this was not a surprise. the pattern of the disease clearly shows that long-term care facilities and residents are particularly vulnerable to the disease and the spread. from the start, we have taken many steps to protect the patients and staff and we will continue to do so. earlier this week th the entire campus was quarantined to protect residents and staff and reduce harm. i must say, and i am sad to say this, we do expect an outbreak. our plan for the outbreak including testing affected staff and residents, which is already underway. we have begun bringing in

additional resources including staff and expertise on long-term care infection control and infection disease from our own system but also reaching out to key partners, including u.c.s.f. and sutter health to strengthen our response. this will continue over the next few days and weeks. with things moving so quickly, i want to make sure you get the facts straight from the source. as of yesterday there are six staff members and one patient at the hospital that tested positive for coronavirus. contact investigations are underway including testing and those units have been quarantined. yesterday brought news of a confirmed case of a staff member at zuckerberg san francisco

genhospital. this person provides patient care in the emergency department and is now self-isolating at home. we are conducting a thorough contact investigation. it is concerning to hear about these cases. it will continue to be concerning as the cases in san francisco grow. we now have almost 300 confirmed cases in san francisco. each person is someone with family, friends and community who care very much about them. the health department cares very much about them. with regard to testing. as the mayor and i have said over and over again. expect to see an increase in positive cases, and with regard to the increase in sections, do not be surprised because we have been increasing testing capacity throughout the city.

simply put, the more testing we can do, the more cases we will find. we have also taken steps to make sure we are getting the data we need to be successful as possible in our fight against the virus. on march 24th, bay area health officers issued a joint health order requiring all labs to report all test results to the state and local health authority. this will help us be more precise and know across san francisco, across our community how many tests are being done and what is the positivity rate. we need to know where we are to better understand where we may be going. this increase in data will be used to refine our models and strategies to mitigate virus

spread, we are working with experts to enhance our modeling capabilities. we truly have some of the world experts on viology and disease epidemiology nationally and internationally working with us every day. as availability of commercial and academic labs have grown we are boosting our own testing capabilities. from when we started testing on march 2 until today we have increased testing capacity by three times through automation of certain processes. we are now running 150 tests each day, up from 50 when we began testing. i am pleased to say that by next week we are hopeful that we will surge that testing to as many as 450 tests each day in our public health lab alone. our plan is to keep improving

testing capacity further in the next few weeks. we are also continuing to work with private partners to expand more testing for the public. we have great partners as kaiser, u.c.s.f. that have been offering drive through testing. next week, thanks to mayor breed, we are excited to add three new drive through centers through our partnerships. however, let me be clear that even today if you are a public health laboratory or commercial lab anywhere in the nation, there are still severe shortages of components needed in the covid-19 testing process. supplieses are in a bottleneck to increased testing. i am sad to say that from swabs

to ppe, the lack of testing supplies across the nation simply means we must prioritize our testing for those who need it most. at the public health laboratory we have been prioritizing the limiting testing resources for those most at risk for spreading the disease, severe medical conditions and front line healthcare and first responders. today we have issued instruction to all labs that they must prioritize their tests in the same way. tests should not be available for those -- tests should not be more available for those with resources. they must be for those on the front line saving lives and those at high risk groups that need care.

please help us prioritize those tests for those who need it most. their lives depend on it, and to the prevention and reduction of the spread of coronavirus in our community depends on it. i now want to talk a little bit about additional steps we are taking aggressively to protect healthcare workers. our front line workers and staff are certainly and members of our community. as the coronavirus circulates in the bay area we expect there will be more positive cases in san francisco, including, unfortunately, among city workers, dph staff and healthcare workers at public and private facilities. our top priority is the health of our patients, community and those who fight for them and support them. we are doing the very best we can to be as prepared as we can

to fight the disease. healthcare workers and first responders are on the front lines every day. yesterday we took additional steps to respond to the impact of the virus on the dph work force. because of their jobs on the front lines, many healthcare workers cannot abide by the stay at home order. they are essential, and in some cases their workplaces do not allow for social distancing. in fact, quite the opposite. several jobs in our healthcare system involve close contact with other staff members and vulnerable populations. for example, emergency room. psychiatric emergency services and urgent care center at zuckerberg hospital andlugana honda hospital and other settings where staff have prolonged contact with each other and high risk patients.

they come to work every day at risk for transmitting the virus to each other and exposing the high risk population they serve. we have issued new guidance above and beyond cdc recommendations to provide isolation masks for people working in these settings in our healthcare system. we will provide isolation masks to workers and patients in many at risk settings. this is another way to protect both groups. we are doing our best to balance keeping the workers safe in the high risk areas and being constrained by a limited supply of masks. we will continue to advocate on many fronts for more masks and other personal protective equipment or ppe. i feel it is essential to move forward with these additional protections today.

i can't stress enough that every healthcare provider in the city from hospital c.e.o.s to doctors and nurses wants there to be enough ppe for the patients and the healthcare staff. ppe is in short supply everywhere. we are working hard to make sure supplies are here when we need them. that includes state and federal advocacy working with large donors to secure the ppe we all need. our top priority is the health of our patience and the -- patients and the people who care for them and ppe is important to do it right. finally, i want to remind all san franciscans of the importance of following the stay home order to protect yourself, your loved ones and our entire community. if you aren't be performing an

essential task to keep the city running right now, then you only have one job. stay home and keep yourself safe. thank you, and i would like to introduce commander scott -- chief scott, excuse me, who is a great partner in this work, a great partner with his team on the front lines helping us keep our city safe. chief scott, thank you for your leadership, partnership, and please we look forward to your remarks.

>> good afternoon. first of all, i want to thank our mayor london breed for her leadership during this public health crisis. i speak on behalf of the men and women of the san francisco police department we are extremely grateful to mayor london breed and doctor grant colfax that they made us a priority. our city's police officers, sheriff deputies, firefighters and first responders provide the first line of public safety in san francisco, and we need to keep them safe and keep them healthy. i want to thank mayor breed and doctor colfax for making first responders a priority in testing for covid-19. we are constantly on the front lines. we are expected to always be

there. by providing the testing, we can help slow the spread of covid-19 among our first responders so they can continue to provide public safety and protect the health of the public at-large. i would also like to thank the city's hotels who stepped forward to offer rooms to first responders who may have to quarantine because of the covid-19 virus. with the support from the leaderses and the city at-large strengthens moral and health and resolve. we know that we will need to have resolve during this crisis. we don't know how long we will be in this position. the mayor mentioned some of the areas where we have seen gatherings over the past week. i want to lay out what you will be expected to see this weekend

from us, from law enforcement. this weekend we will have people out that there probably be a lot of people outside, as there were last weekend. please be smart and go by the social distancing. i cannot emphasize that enough. use common sense, be smart and expect to see us out there. it doesn't make sense for people to be out and not pay attention to the social distancing requirement six feet as laid out by our health officials. we have seen in other cities that are having a harder time than we are. we have seen gatherings in this industry putting others at risk. we need everyone to think who you are putting at risk when you do not adhere to public health warnings. think of your grandfather, grandmother, sick child. think of the people you are

putting at risk by not adhering to this public health order. we will be out this weekend. places where we had issues with gatherings the embarcadero and the marina green, panhandle, stern grove, exercise facilities in the park will likely be closed in many of your parks. we have seen by and large excellent compliance from the people in san francisco. we want that to continue. as we have laid out in previous press conferences we have enforcement protocols for those interested you can find them on the san francisco police department website. our approach is progressive. we started with education and we will still educate the public. when this public health was put

out on march 16th. we had a lot of people who didn't get the message. as we have educated that number has gotten smaller and smaller with the people who have not complied. we do think that education has worked. however, education can only go so far. there will come a time where we will have to enforce. our officers have been very patient. they understand what is at stake here. they understand we are looking at the end game of compliance. this is not a count of how manyy tickets we write or how many people re-arrest. we don't want to create problems by enforcing the law. the sheriff is charged with reducing the jail population. we don't want to make the problem worse. please, i can't emphasize

enough. please listen to the public health officials. social distancing, stay six feet apart. we want people to go out to get air. officers will engage. they will communicate for those warned repeatedly, there will come a time where we have to enforce. that is a fact of life. we hope we can avoid that, and by and large people have been compliant. please listen to the public health orders. i cannot emphasize that enough. we want everyone to use common sense, stay six feet apart. if you are going to exercise have respect for others around you. if you are going to go to the grocery store or wherever you need to go to keep essential items in your household, practice those same protocols. if you have to wait to get in the market or grocery store,

stay six feet away. we have been putting out photos on our website of people who have done just that. we want to show that by and large san francisco's population, our residents we get it. we understand what is at stake. we want to catch you doing something right, not wrong. this weekend you will see us out there. from the bottom of my heart to our mayor, doctor colfax and the city leaders, on behalf of the first responders, we appreciate what you have done as far as prioritizing testing for first responders. we also understand that community leadership the a big part of getting compliance from the people in our city. with that said, i would like to introduce one of our community

leaders, marcia contrairra, director of mission housing. thank you. >> hello. i am deputy executive director for mission housing and community leader answer have been o -- servant. my message will be in spanish. [speaking spanish]

[speaking spanish] >> i would like to introduce another community leader.

>> i am executive director at community youth center. i am going to say the message in cantonese. speakin [speaking]

>> thank you. >> we will open it up to questions people may have. >> first question for mayor breed from ktsf. how can the federal stimulus bill help the city and people in san francisco? >> mayor breed: well, we are hopeful that it will start helping the people of san francisco sooner rather than later. we have been told that we can expect some of the individual checks that will go to those

qualified, hopefully, in the next couple weeks. we expect the same to happen with the funding support to go to the state and distributed down to various counties, including san francisco. we are working closely with our speaker nancy pelosi to speed up that process. there are people suffering financially right now. >> second question. mayor breed, can you describe how the city is approaching using public or private spaces to confront covid-19? >> mayor breed: part of what we are doing is reaching out and looking at existing inventory. we are able to open moscone west next year has everything to do with having access to this particular facility. we will take the opportunity in every instance to use our public

resources at our disposal and any other private resources that could be available including the one that we are doing by developing a relationship with the hotel council and issuing r.f.p. for hotel rooms. quarantining people in rv or hotels or other spaces we need to prepare for any situation including conversations around where other hospital beds might go and how we might be able to address this challenge as it rises. >> follow-up question. as the city braces for a sungar of new cases, do you think you will be aggressive about allocating public or private spaces. >> mayor breed: what?

>> aggressive about public and private spaces? >> allocating? >> read it again. as the city braces for the surge of new cases, do you think the city will be aggressive allocating public or private spaces for the cause? >> mayor breed: what we are doing now is preparing to use those spaces. there is a lot that goes into any space that we have. we have to make sure that they are not only staffed but that the people who are providing the support have the protections that they need as well, that we have the appropriate security, appropriate systems in place, but getting access to spaces, i don't think is the difficult part. we are going to have to make sure we have the resources necessary to accommodate whatever the need is for thetic space. we will do everything we can to get hold of as many spaces as we

possibly can. >> next question from abc 7. earlier this week you talked about addressing the crisis to help homeless populations what is being done? >> abigail hill is here from hsa to answer more in detail. i think i have made it clear in my earlier comments in terms of getting access to hotel rooms. i want to add to my earlier comments. first of all, as i said, we put out request for proposal to get access to hotel rooms and working with hotel council, the contracting process allowed us to have 300 now and we expect to have another 3,000 by next week. there is a process that has to be worked out including issues of insurance as well as who is going to staff, the security to

make sure people obey the order, especially if quarantined, what kind of wraparound supportive services the people housed in these locations need. we want to be clear. one of the biggest challenges we will face is not necessarily finding locations. sadly, for people who are homeless, but people who suffer from substance abuse disorder and people with mental illness the difficulty we have as the city in keeping them in quarantine or keeping them on an order to shelter-in-place is going to be difficult. we have to make sure we have the resources necessary to do that. we also have to make sure that we protect the people that we are asking to put lives on the line to basically staff these places and provide supportive services. it is more than just we have all of these hotel rooms. it requires a lot of work for

many of the folks that we are going to work with who are currently homeless, probably less so for people who are, for example, housed in the sros, but it requires a lot of coordination. it requires the need to increase capacity to manage it. the last thing we will do is rent the hotel, put people in the homes and chaos breaks out and we have no plan to address it or control the situation. what i mean by chaos, people transmit the coronavirus or people who basically need supportive services or who are difficult to talk to or to work with who need other things, we will potentially have real struggles. be honest, people who substance from substance abuse disorder,

this is a challenge. we need systems in place to deal with that. i think abigail is here. she may have things to add to that as well. >> hello, i am with the department of homelessness and supportive housing. echoing others. thank you, mayor breed and doctor colfax for your courageous leadership to our city partners and our nonprofit service providers. i want to focus on the steps we are taking to help prevent the spread of covid-19 in our shelter population. we have taken steps in constant communication with shelter providers. we extended the stay of people

at navigation centers and shelters to fix the population and allow people inside to continue to shelter-in-place. we have made the extremely difficult decision with the guidance of the department of public health to pause shelter intakes. this allows us to pause people coming inside and potentially bringing the virus with them. it allows us to create space for social and physical distancing within our shelters. we increased shelter hours. they are coming online for 24/7 with increased meal service, staffing and cleaning and a lot of hard and creative work. we are recommending or the department of public health recommended the shelters follow cdc guidance around physical distancing. i appreciate the opportunity to

clarify here. those who care about the homeless population know people in shelters do not have enough space. they are close together. we have taken the steps outlined and we are corking cre-- working with direct service providers to create more space whenever possible. for example, if we close a drop in center and that allows us to move beds an part. we are working on a site by site basis. to get to the six feet, we are working through the human services agency, which is responsible for mass care and shelter, to bring on sites such as moscone west and others to allow further social distancing. thank you. >> next questions for public health. doctor grant colfax.

>> first question. from the "washington post." do you think the bay area's early action to shelter-in-place reduced the load on the hospital system? do you expect the strain has been delayed or permanently flat tenned? >> well, look. here are the facts. i hope that is the case. we simply do not know yet. it is too early to tell. based on the science and data and what is successful in flattening the curve in other countries we are hopeful. we must prepare for a less flattened curve. if we look across the country to new york right now, it is

plausible we could be in that situation in the near future. we are watching the data. i think what is important is that this was a regional approach, shelter-in-place approach, for it to work, people need to follow the orders. with the help of people in this room, across the city, individual community members, chief scott and his team, we are hopeful that this aggressive early action will have an effect in flattening the curve and save lives. >> next question or follow-up. what early steps did the bay area take to ensure there are enough resources for hospitals and to increase capacity? >> in almost every major urban center, hospitals at baseline before this happened are full and often loafer flowing --

overflowing. we took steps to ensure greater capacity to manage the initial suffer of coronavirus infections. we took steps early on. first, we escalatessed hiring staff so we would have more staff to manage an official surge. we asked people to only use emergency rooms as a last resorts if they were very, very sick and could not get the help they needed from their primary care provider. this created important space in emergency rooms for handling the people who are sickest. we issued a public health order to prohibit all but essential medical procedures, including effective surgeries. this freed up operating rooms and staff to better prepare for the surge. we are coordinating across the healthcare system in an unprecedented way for complete

visibilities in terms of the number of i c .u. beds and ventilatestor beds in the city. we are taking steps t to ensure people discharged from the hospital who could not be discharged because they didn't have a place to go now have a place to go per the vast expansion of hotel rooms available. people who have health that allows them to leave the hospital we have the option to place them in a place that is safe and secure and best for their health. these multiple steps increased our hospital capacity to manage an initial surge, and it is plausible that even with these steps our local capacity will be exceeded and we will need state and federal assistance to manage the influx of patients just as we see in new york right now. >> next question. ktsf. would cases in san francisco

escalating when do you anticipate the peak will come? how bad will it be? will the situation in new york happen in san francisco? >> we said fro from the beginnig this situation changes hour by hour, day-by-day. if i could predict the future, i would give you those answers. i cannot. all i can say is that every day we depend on data, science and facts to guide our preparation efforts. the shelter-in-place over time we hope has the effect to have the effect to optimize the effect. people need to follow the shelter-in-place order. we look at all of the data that we have available on every day to best estimate if and when that surge will occur. we are as prepared as we can be at the local level right now. we are constantly reiter rating

our efforts based on data, science and facts so our preparedness continues to the future. thank you. >> question from the san francisco concle. how many staff residents have been tested how will you keep them updated. have any residents been transferred to another medical facility due to covid-19? >> i shared in my remarks that six staff members at laguna honda tested positive for covid-19. we had one resident that tested positive. that resident is in good condition. we are expanding testing right now in the wards where there were covid-19 positive staff and the patients.

i don't have exact numbers right now because we are escalating that testing capacity as we do it today. >> how will you keep staff, residents and the public updated? >> from the very beginning i focused on the data, science and facts and being as transparent as we can be with where we stand in our specific care systems. we will communicate the information to the staff as soon as we have it about the status of lagoonna honda. our focus at the health department is to ensure that staff and residents' safety is maintained and their health is paramount. >> final follow-up. have any residents a at laguna

honda been transferred? >> one resident was transferred to an outside medical facility who has been returned to the hospital. i can't comment on the further details with regard to that question. >> thank you. the next questions are for san francisco police department chief william scott. question from kpix. plenty of crowds on corners in the tenderloin, some with

nowhere to go and others dealing drugs. are there plans to address this crowding? >> yes, and that is why it is important to work with city partners. it is a difficult issue. crowds on the tenderloin. i have been out there with officers and seen it firsthand. some comply and some don't. we have to keep going back and trying. the drug dealers, there is space in the jails. i want to emphasize for those committing serious crimes, those out selling drugs and causing gatherings to be worse because people are gathering to buy drugs, that is a public health problem. we have room in the jails for those type of individuals. officers have been out. we are trying to educate people to give them an opportunity to comply, but as i said earlier, there is a time what enforcement

is appropriate. we want to save our jail space for people that are committing those serious crimes like three homicide suspects we arrested this week. we have room in the jails for those individuals. we still have to do that job as well. we know it is a difficult task, but we are working with every partner in the city to make the situation better. >> question from ktbu. wondering if there are planned road closures to prevent congregating? >> we the san francisco police department have not closed roads. all options are on the table in terms what we need to do to protect the health of the public in the city. at this point we have not closed any roads. >> mayor breed is going to

address this topic. >> mayor breed: i just want to be clear that -- hold on. i want to be clear, as i said earlier, that we are making adjustments based on what we have seen over the past weekend and the past couple of days. we have made recommendations to close a number of parking lots and certain locations, especially where there is out door workouts equipment and play browns -- playgrounds. we closed those. we made those based on discussions from the department of public health. what is going to happen we will make decisions, especially this weekend if we notice that behavior continues to be a

challenge in particular areas. we will make those determinations. it could happen at a moment's notice. there probably won't be a press conference. there will probably just be a closure and conversation with people in the area to leave immediately. we are going to make adjustments and we will be out, as the chief said, paying close attention to those areas and making recommendations. as it relatings to owes and other streets, we don't have any plans at this time. every decision we will make to close anything would have everything to do with recommendations from our public health department in order to focus on protecting public health. >> one final question for doctor colfax. >> this question is from the la

times. could doctor colfax explain why the surge would come in the next week or two and is that still plausible? >> right now we have 279 cases of diagnosed covid-19 patients in san francisco. we have had three deaths. i cannot predict when the surge will come and how high the surge will be. our efforts are to flatten the

curve. we have taken early aggressive and science informed efforts to flatten the curve as much as possible. over the next two weeks using the data from our community, the expertise of the scientists that we are working with, we will have a better sense where we are in that curve. i cannot speculate. if i could see the future, i would tell you right now what we need, where we need to be, where we will be in two weeks and what we will need to do to address that in two weeks. again, from what we know today we are as prepared as we can be. we will continue to mon for the -- monitor the situation, respond to the rapidly changing situation based on public health priorities. that is where we stand today, and that is continuing to be where we will stand tomorrow

with following the science and data and facts and being as prepared as possible. thank you. >> thank you that is the final question. this concludes our press conference. thank you.

>> good morning, everyone and thank you all for being here today. my name is london breed, the mayor of san francisco and i'm joined by the president of board of supervisors, norman yee, as well as the department of public health, dr. grant colfax and we

are joined by police chief bill scott, the director of emergency management, mary ellen carol and thank you to the press for accommodating this virtual rest conference in order to maintain social distancing during this very challenging time. i also want to take the opportunity to thank the people of san francisco. this weekend, things looked like somewhat of a success in terms of social distancing for the most part and definitely an improvement from last weekend. the streets are pretty clear and there were some definite hot spot areas that we'll be focusing on, but the beaches and some of the parks and other places, people were practicing social distancing and we very much appreciate your cooperation. it will make a world of difference and, in fact, we

already have made a difference in really saving lives. we may not realize the impacts this until this is all over, but eventually, we will learn, i'm sure, that because of what we have done and how we all have participated in complying with social distancing, it truly has saved lives. as of today, we have 374 confirmed cases with six deaths and that is six people who have passed away because of the coronavirus. and my heart goes out to the family members expect friends e have lost in san francisco. one person is too much of a loss and as we have said before, this is a very deadly virus, as you are seeing, not just in san francisco but throughout the country. and the reason we have taken significant steps has everything to do with saving lives and

protecting public health. because we know that there will be challenges on our healthcare system and we know that people are anxious to know about the stay-at-home order and whether that will be extended. i know that our county health officers will be making an announcement tomorrow to talk about the specifics of extending the stay-at-home order until mar the sake of planning and everyone can begin to know this continue to have an impact, you should definitely plan to stay at home and this process and what we're doing here will continue until at least may 1st. if anything changes, we will definitely notify the public. so i want to just talk a little

bit about some of the challenges that we have having and will continue to have and what we're doing to prepare for those challenges. we've said from the very beginning we knew that our vulnerable populations, not only consisting of our ederly but those living in congregate settings and sadly those on our streets would be a part of that vulnerable population and so we would have to move quickly to make sure that in places where we have single-room occupancy hotels, where our shelter systems are and places like ga laguna honda, we had a plan and would keep people safe. from the very beginning, we knew this would be a challenge.

we have learn ed this nine employees at laguna honda hospital have tested positive, as well as two patients, and we are still testing people a at at laguna hospital and we'll have more information once that comes in. we knew the situation would be challenging and so immediately last week, i sent a letter to the federal department of human services asking for significant support so that we could not only focus on making sure we provide the resources and support to this hospital and we don't continue to drain other services, but we have the

expertise and the testing on side and other things needed in order to prevent something from happening that we know has happened in other places throughout the country, including in washington, that house hav a significant populatn of ederly patients. laguna ha honda is one of the largest hospitals of its kind in the country, housing over 750 very, very vulnerable residents who cannot take care of themselves. and this is basically their home and this is where they eat. this is where they live. this is where they're cared for. and so we have been taken immediate steps in order to help support this hospital and support the people and the staff who are part of it. we were fortunate in that the cdc on friday, after sending that urgent request to the u.s.

department of health and human services, the cdc has sent two infectious disease doctors and two epidemiologists and the department of health has sent two prevention nurses to help assess the situation at laguna honda and make recommendations and we also have a dedicated staff member at the cdc in atlanta to help monitor and facilitate the situation specifically at l laguna honda because we know that, again, this is a very vulnerable population and more testing needs to be done and it's going to be important that we have the resources and we have the support necessary to protect and save lives. it's just a start and i'm grateful for what we've received, but i want to be clear, it's not nearly enough to get us to a better place specifically concentrating on la golaguna honda hospital.

we'll definitely be reaching out to federal and state partners to ask for additional support for the residents and the staff at laguna honda hospital. i also want to be clear that the situation will escalate at laguna honda and it will escalate here in san francisco. the fact that we are taking such drastic steps to, in essence, pretty much shut down san francisco has everything to do with how serious this is. i can't reiterate enough how important it is for all of us to continue to comply, for all of us to continue to be good citizens, to continue to cooperate. this weekend, i received a note from one of my neighbors. the note basically had the email address expect phone number of one of my neighbors on the block who said they were the block captain. so if i needed anything, whether

its grocery shopping or pharmacy pick-ups or what have you, or even someone to take to, they were available. and i got really emotional when i received that note because it made me think about how amazing people are in this city and how i've heard so many stories about people reaching out to their neighbors, people identifying ederly people that they know need help and just dropping off groceries, folks just stepping up and being there for one another. because we know that it's not just about the physical health and what we need to do to combat the coronavirus. we also understand that as human beings, there's an emotional toll that this will take on so many of us. so it's so important that we continue to uplift one another and be there for one another as much as we possibly can. my thoughts and prayers go out

to the team at laguna honda. i want to thank them for all they continue to do to give dignity to so many elderly patients who may not have family visits or support and resources to do anything just to be there and to know the nurses and those doctors and those social workers continue to put a smile on the face of those patients. they show up everyday and they just really deserve our respect, our support and we will do everything we can to continue to do just that. so at this time, i would like to introduce dr. grant colfax to provide us with more detail specifically what's happening at laguna honda, what we're doing to prepare for the inevitable and how, together, we will do everything we can to save and

change lives and get through this. so thank you all so much. and let me wipe this mic down. >> good afternoon, i'm gra grant colfax, director of health. thank you, mayor.

today i'm saddened to report to the san francisco community that laguna honda hospital has a growing outbreak of coronavirus. we've prepared for since the start of the pandemic and we will continue to do everything we can to protect laguna honda hospital and staff. i want the community and all of the families to know how much i care, we care about them and they are our top priority. we are intensely focused on doing everything we can to protect everyone at laguna honda from harm, but i also need to be realistic and forthright. as we look at the data and the patterns around the world and in our country, we know that long-term care facilities are at most risk for coronavirus outbreaks.

therefore, we expect the situation to, unfortunately, get worse. across the united states, many long-term care facilities have been hit hard by the coronavirus, including in california, washington, colorado, minnesota, new york and many other states. no local community is equipped to manage this escalating crisis alone. and that is why we have asked for help from the state and federal government and, i am thankful that some of our requests are starting to be answered. as of today, infection control nurses from the california department of health and infectious disease physicians and e epidemiologists from the c are on la go laguna honda exper.

they will make decisions for management that is expected to escalate and will work with leaders at the department of public health to develop a prospective response plan for long-term care facilities in addition to l laguna honda. i am grateful for this help and we need more. from the beginning of the global outbreak, efforts by the city to prepare for the coronavirus have prepared the most vulnerable population. residents who are over 60 years old and those with certain underlying health conditions and chronic diseases. the residents of laguna honda hospital are in the most vulnerable of these groups. laguna honda has a total of 11 confirmed cases of coronavirus.

nine are amongst staff and two are among residents. all are in good condition. since march 26th, 158 staff and 54 residents were tested for the virus. among residents, two have tested positive and 51 negative and one result is still pending. among staff, 156 have tested negative and 25 more tests are underway. and i expect more cases of coronavirus in the laguna honda community among both staff and residents because it is now spreading throughout the bay area. we are drawing on all of the resources we can muster at the local state and federal level to strengthen our response. laguna honda has been and remains a top priority in the city's preparation and response to coronavirus.

the first health officer order after declaring a local health emergency in early march was to restrict visitors from laguna honda to protect the institution's residents. laguna honda leadership has worked actively and diligently to train staff on coronavirus including the use of personal protective equipment, ppe, for all cleaning of common spaces of resident rooms and other prevention technique. here is what is happening on campus right now to respond to the outbreak. first, the hospital incident command system is activated to manage the crisis and the incident commander, troy williams, is here to answer further details about that process. the state infection control nurses are creating expanded protocols on environmental cleaning, ppe, and staff safety.

the cdc is intensifying the information to look for sources of infection and the pathway of spread and this will prevent a plan that taking the coronavirus situation fully into account. the two units where the cases have been diagnosed, south 4 and south 5, are under an extensive quarantine order. each of these units houses approximately 60 residents. within these units, doors have been secured, sheriffs are at the doors preventing residents from leaving and only allowing appropriate staff to enter and residents are being assessed for symptoms on every shift and staff are being screened twice for symptoms at every shift. testing of all staff on south 4

and south 5 where staff cases have been found is almost complete. to date, nine positive cases have been confirmed. and testing of all patients on south 5 where patient cases have been found is complete and results are pending. to date, two positive cases have been confirmed. all nonessential personnel are restricted from entering the facility. all essential visitors, staff and residents are medically screened and all laguna honda staff are screened at the start of each shift. in addition, laguna honda is setting up a field care clinic on its grounds as a precaution in case there is a need to separate groups of patients. we are continuing to assess the situation and adapt our response accordingly. working with our state and federal partners.

however, even best efforts are no guarantee against the spread of the virus. there are currently 374 cases and six deaths due to coronavirus in san francisco. in addition to our focused, rapid response efforts at laguna honda hospital, they are preparing for the expected surge of hospital patients. i remind all of sanfrancisco to do your part in slowing down the virus. by decreasing community spread, you will help protect vulnerable groups like the very residents of laguna honda and other long-term care facility residents across the country, other ederly people and those with underlying he health conditions. this is the time to come together as a community while we

stay home whenever possible. i cannot stress that enough. unfortunately, we will be seeing more cases and deaths in the coming days and weeks. please do your part to keep those numbers as low as possible. thank you. and i would like to introduce mr. yee, board of supervisors.

>> good morning. i'm t norman yee, president of e board of supervisors and i'm in district 7 in which laguna honda is located. i want to thank dr. colfax and mayor breed in taking a stand with these vulnerable populations we're dealing with. we knew that at some point somebody was going to be infected. so as tough as it's been to say no visitors coming to laguna honda, it's something we had to do. think about it. the people that are there in the

hospital are now not with their families, not with their friends visiting. and the love that the family and the friends want to provide for them, they can't. so a tough decision, it was very difficult to make, but think it was the right decision. problem, in fact, it delayed any infection there. it probably, in fact, reduced the numbers that we're seeing today. what i'm saying is probably reiterating what dr. colfax was saying, that we need to take an aggressive stance. we need to attack this aggressively and do everything we can to slow it down, to minimize how many people are going to be infected, whether it's staff or the seniors themselves. one thing that we could do even

more aggressively if we have the tools is to start testing everybody there, everybody. we can't be working in a vacuum. we can't be guessing oh, where is the next person that will be positive? we have to get ahead of that. so as dr. colfax and mayor breed were saying, we're reaching out to the state and federal government and please respond because we need your help. that's all i have to say today and thank you very much to the residents who are behaving the right way, social distancing, stay at home as much as you can and enjoy whatever you can at home and if you have to go out, make sure you are staying away from people, at least six feet and to continue washing your hands. thank you very much.

>> we'll open it up to some question. >> madam mayor, this is a question from abc7. what is the city doing to help small businesses during this crisis. >> so one of the first things that we announced early on, because we knew there would be some real challenges with our small business community, is a fund to provide a million dollars in grants right away and that money has dried up and we

provided a delay in business taxes until 2021 so that businesses here can hold off on paying taxes until next year. we put a delay on a number of fees that businesses get charged and we also provided a $10 million fund for employees where you have businesses who have sick leave and, for example, if an employee only has two weeks of sick leave, we could provide an additional week of sick leave through a fund that is available and we've tried to make sure that we provided all of these options to small businesses. they can check out the website oewd.com for more information on how they can get additional assistance. the governor added additional --

there are others other actually before did not qualify for unemployment insurance that now qualify for unemployment insurance. and so state unemployment insurance is available to a lot more people than it hav ever has before. so it's important that people apply because you may not think you're qualified, but you are. i'm working to develop a no-interest loan fund where we've partnered with a number of nonprofit agencies -- excuse me, folks in the private sector to contribute money along with public dollars and we're hoping to make that fund available to businesses sooner rather than later. we understand that businesses are suffering and there's some real challenges with paying

bills, but i think our commercial moratoriums on convictions and a number of other things we're doing to really slow down or hold off on extreme responses to the lack of our business community and their inability to pay bills because of the resources that they're no longer able to regenerate, i think that some of the measures we put in place will be helpful. i know they won't be enough so we'll continue to add a number of resources to help support our small business community and i just want to be clear, there's a lot of folks who are hurting out there and we'r we're going to do everything we can but this is a problem that doesn't exist in san francisco. it's all over the country, all over the world and it will be difficult to help every single person, but we'll do our very best. >> question from sin singh tao.

for affordable housing, but what about luxury home building? >> the fact is in san francisco, costle building anything is so expensive, the fact we don't build is a problem. it doesn't matter what sort of housing gets built. the fact is, when this is all over, people are going to need places to live and so i'm not going to pit between one housing versus another. housing is essential, period. and what we don't want to happen is what happened, especially when we started to focus on job opportunities between 2010 and 2015 during the time when we were attracting a number of tech companies and other businesses to sanfrancisco. for every eight jobs we created, we created only one unit of housing. you had people lining you in the western housing community where i grew up, where you would never see anything like this for one

apartment, which i think drives up prices. so the fact is, all housing is essential. and we don't need to pick one over the other. the fact is, when this is all over, just think about it, we have thousandscs of people on streets. you think we'll able to afford thousands of units to house them? this will require every single unit that we can get on the market, no matter what kind of unit it is. >> thank you, madam mayor. the next questions are for dr. colfax.

this is from reedasm lbergati from the washington "washington? what date are you used to make your posts positive? what's the view of using modeling to predict what will happen with the virus and are you relying on any models? >> thank you. we have some of the best people in the help department helping us pull in data from all sources, both locally, nationally and internationally to make an informed response. some of the key things we're looking at, obviously, are the number of cases and very importantly, the number of people who are hospitalized, including people in the intensive care unit, following numbers carefully, and using

other data from china, italy and now new york t of what to be prepared for in worse case scenarios and updating the numbers to see where we stand. so in terms of what we're missing, you know that there's clear testing deficiencies across the country and we're working to expand our testing capacity in san francisco. we still do not have an accurate prevalence number and, in other words, we not know overall per thousand people in san francisco what the rate of the virus infection is and we are working, again, with the uc berkley and ucsf colleagues to determine that number as quickly as possible to get the estimates and those will be very important in informing our models. with regard to whether models are helpful, yes, i think they are very helpful and they provide a number of plausible scenarios and they certainly do

not provide certainty about where we're headed but provide plausible scenarios to help us plan our response going forward. >> the next question is from jamie harr of the associated press. the department of public health is sending health inspectors to conduct inspections at sros. how many are checking and what are you looking for or not looking for? >> so we are focus on a number of things, but particularly with regard to hygiene, making sure that the procedures are being followed and making sure that we're doing outreach and education to the community, around the social distancing order and making sure that people have the information they need and, also, making sure that people have the information they need in the event they need care. they know who to call, when to call and to get the help from the public health department, their community and other healthcare providers and systems across the city. >> and this is a followup, if

there are unsafe conditions, what will you do? will you move people out? >> we're looking at focusing on the conditions are as safe as possible and if peopl symptoms, they are protected and that they're provided with resources and physical spaces that allows them to self-quarantine from their community and other people that they may come into close contact with. >> and the next question is from shannon lim of kqed. there's a question and followup. what are san francisco's plans to start testing hopeless people for the coronavirus? do they have a protocol for who they will be testing and when this will begin. >> so i appreciate the question and i'm emphasized that we are expanding our testing and it's a key priority of the department's. i just want to be transparent, though, what we're doing. to give you an example, when we

send our request up to state with regard to asking for more help and responding to the laguna honda situation, part of that request was the request for more swabs, testing swabs. therthis is not just limited ton francisco but a national shortage and we are struggling to get swabs in order to test and so along the supply chain for testing, there are severe limitations. while we are working to expand testing capacity, my public health lab is expected to triple its potential capacity starting today and we are still struggling along that supply chain to ramp up testing as long as possible. so anything from the specimen collection you need for swabs, from the processing reagents that are needed, our supply chains are episodic and hard to determine. so with regard to testing people who are tendernessin experiencig homelessness, we will focus on people who are symptomatic and

people with high-risk exposures. >> miss lin's followup and similar to question from dan simon from cnn. the medical director of the er at ucsf believes there's a flattening of the curve and credits the state-at-home order and not seeing a surge of expected of patients. do you believe this is so? >> i haven't spoken to the er directly. i think it's still too early to tell. we are monitoring the numbers. the thing is when this disease takes off, if it takes off, it takes of rapidly in communities just like new york, the escalation, the curve is very upsloping very quickly. it's what we call a logrythmic increase. we need people to stay at home

and we are expanding the stay-at-home order and more details will follow. we are watching the data very carefully and i do not know whether the aggressive actions early on have had the tentative effect but we need data to confirm that. >> from the l.a. times, a similar question, asking to clarify how many people with the virus are hospitalized in san francisco right now. and the sheltered place in terms of flatten the curve, if that's not happening now, when do you think we might see that happening? >> so to answer the first question with regard to hospitalizations from the latest data i have from the city systems, we have 58 people hospitalized with confirmed covid-19 in the hospital systems across san francisco. again, that number could rapidly

change. and it's too early for me to speculate whether we're succeeding in flattening the curve. >> the next question, may i ask if san francisco or dr. colfax are coordinating with any other bay area counties in the city -- excuse me counties, cities or the state of california on how long to extend the stay-at-home order? >> yes. certainly i am in regular contact with health directors across the region, as well as direct contact with state health leaders and the response to this pandemic and confrontatio yard e healthhealth order. this is far more effective from a regional approach.

the order that will be released tomorrow will be another regional approach going forward and it is essential that we collaborate, share information and react to reduce the pandemic spread. >> and the final question is from dominick vercasa of the chronicle. will any activities currently permitted, like housing construction be prohibited under the extended order? >> so the order will be released tomorrow and those details will follow. >> thank you. >> that concludes our press conference. thank you.

>> roughly five years, i was working as a high school teacher, and i decided to take my students on a surfing field trip. the light bulb went off in my head, and i realized i could do much more for my students taking them surfing than i could as their classroom teacher, and that is when the idea for the city surf project was born. >> working with kids in the

ocean that aren't familiar with this space is really special because you're dealing with a lot of fear and apprehension but at the same time, a lot of excitement. >> when i first did it, i was, like, really scared, but then, i did it again, and i liked it. >> we'll get a group of kids who have just never been to the beach, are terrified of the idea, who don't like the beach. it's too cold out, and it's those kid that are impossible to get back out of the water at the end of the day. >> over the last few years, i think we've had at least 40 of our students participate in the city surf project. >> surfing helped me with, like, how to swim. >> we've start off with about two to four sessions in the pool before actually going out and surfing.

>> swimming at the pool just helps us with, like, being, like, comfortable in the water and being calm and not being all -- not being anxious. >> so when we started the city surf project, one of the things we did was to say hey, this is the way to earn your p.e. credits. just getting kids to go try it was one of our initial challenges for the first year or two. but now that we've been doing it three or four years, we have a group of kids that's consistent, and the word has spread, that it's super fun, that you learn about the ocean. >> starting in the morning, you know, i get the vehicles ready, and then, i get all the gear together, and then, i drive and go get the kids, and we take them to a local beach. >> we usually go to linda mar, and then occasionally ocean beach. we once did a special trip.

we were in capitola last year, and it was really fun. >> we get in a circle and group stretch, and we talk about specific safety for the day, and then, we go down to the water. >> once we go to the beach, i don't want to go home. i can't change my circumstances at home, but i can change the way i approach them. >> our program has definitely been a way for our students to find community and build friends. >> i don't really talk to friends, so i guess when i started doing city surf, i started to, like, get to know people more than i did before, and people that i didn't think i'd like, like, ended up being my best friends. >> it's a group sport the way we do it, and with, like, close camaraderie, but everybody's doing it for themselves. >> it's great, surfing around,

finding new people and making new friendships with people throughout surfing. >> it can be highly developmental for students to have this time where they can learn a lot about themselves while negotiating the waves. >> i feel significantly, like, calmer. it definitely helps if i'm, like, feeling really stressed or, like, feeling really anxious about surfing, and i go surfing, and then, i just feel, like, i'm going to be okay. >> it gives them resiliency skills and helps them build self-confidence. and with that, they can use that in other parts of their lives. >> i went to bring amy family o the beach and tell them what i did. >> i saw kids open up in the ocean, and i got to see them connect with other students,

and i got to see them fail, you know, and get up and get back on the board and experience success, and really enjoy themselves and make a connection to nature at the same time. >> for some kids that are, like, resistant to, like, being in a mentorship program like this, it's they want to surf, and then later, they'll find out that they've, like, made this community connection. >> i think they provided level playing fields for kids to be themselves in an open environment. >> for kids to feel like i can go for it and take a chance that i might not have been willing to do on my own is really special. >> we go on 150 surf outings a year. that's year-round programming. we've seen a tremendous amount of youth face their fears through surfing, and that has translated to growth in other facets of their lives. >> i just think the biggest

thing is, like, that they feel like that they have something that is really cool, that they're engaged in, and that we, like, care about them and how they're doing, like, in general. >> what i like best is they really care about me, like, i'm not alone, and i have a group of people that i can go to, and, also, surfing is fun. >> we're creating surfers, and we're changing the face of surfing. >> the feeling is definitely akin to being on a roller coaster. it's definitely faster than i think you expect it to be, but it's definitely fun. >> it leaves you feeling really, really positive about what that kid's going to go out and do. >> i think it's really magical almost. at least it was for me. >> it was really exciting when i caught my first wave. >> i felt like i was, like --

it was, like, magical, really. >> when they catch that first wave, and their first lights up, you know -- their face lights up, you know you have them hooked. >> i was on top of the world. it's amazing. i felt like i was on top of the world even though i was probably going two miles an hour. it was, like, the scariest thing i'd ever done, and i think it was when i got hooked on surfing after >> working with kids, they keep you young. they keep you on your tones --

on your toes. >> teaching them, at the same time, us learning from them, everything is fulfilling. >> ready? go. [♪] >> we really wanted to find a way to support women entrepreneurs in particular in san francisco. it was very important for the mayor, as well as the safety support the dreams that people want to realize, and provide them with an opportunity to receive funding to support improvements for their business so they could grow and thrive in their neighborhoods and in their industry. >> three, two, one! >> because i am one of the consultants for two nonprofits here for entrepreneurship, i

knew about the grand through the renaissance entrepreneur center, and through the small business development center. i thought they were going to be perfect candidate because of their strong values in the community. they really give back to the neighborhood. they are from this neighborhood, and they care about the kids in the community here. >> when molly -- molly first told us about the grant because she works with small businesses. she has been a tremendous help for us here. she brought us to the attention of the grand just because a lot of things here were outdated, and need to be up-to-date and redone totally. >> hands in front. recite the creed. >> my oldest is jt, he is seven, and my youngest is ryan, he is almost six. it instills discipline and the boys, but they show a lot of care. we think it is great. the moves are fantastic. the women both are great teachers.

>> what is the next one? >> my son goes to fd k. he has been attending for about two years now. they also have a summer program, and last summer was our first year participating in it. they took the kids everywhere around san francisco. this year, owner talking about placing them in summer camps, all he wanted to do was spend the entire summer with them. >> he has strong women in his life, so he really appreciates it. i think that carries through and i appreciate the fact that there are more strong women in the world like that. >> i met d'andrea 25 years ago, and we met through our interest in karate. our professor started on cortland years ago, so we grew up here at this location, we out -- he outgrew the space and he

moved ten years later. he decided to reopen this location after he moved. initially, i came back to say, hey, because it might have been 15 years since i even put on a uniform. my business partner was here basically by herself, and the person she was supposed to run the studio with said great, you are here, i started new -- nursing school so you can take over. and she said wait, that is not what i am here for i was by myself before -- for a month before she came through. she was technically here as a secretary, but we insisted, just put on the uniform, and help her teach. i was struggling a little bit. and she has been here. one thing led to another and now we are co-owners. you think a lot more about safety after having children and i wanted to not live in fear so much, and so i just took advantage of the opportunity, and i found it very powerful to hit something, to get some

relief, but also having the knowledge one you might be in a situation of how to take care of yourself. >> the self-defence class is a new thing that we are doing. we started with a group of women last year as a trial run to see how it felt. there's a difference between self-defence and doing a karate class. we didn't want them to do an actual karate class. we wanted to learn the fundamentals of how to defend yourself versus, you know, going through all the forms and techniques that we teaching a karate class and how to break that down. then i was approached by my old high school. one -- once a semester, the kids get to pick an extra curricular activity to take outside of the school walls. my old biology teacher is now the principle. she approached us into doing a self-defence class. the girls have been really proactive and really sweet. they step out of of the comfort

zone, but they have been willing to step out and that hasn't been any pushback. it is really great. >> it is respect. you have to learn it. when we first came in, they knew us as those girls. they didn't know who we were. finally, we came enough for them to realize, okay, they are in the business now. it took a while for us to gain that respect from our peers, our male peers. >> since receiving the grant, it has ignited us even more, and put a fire underneath our butts even more. >> we were doing our summer camp and we are in a movie theatre, and we just finished watching a film and she stepped out to receive a phone call. she came in and she screamed, hey, we got the grant. and i said what? >> martial arts is a passion for us. it is passion driven. there are days where we are dead tired and the kids come and they have the biggest smiles on their

faces and it is contagious. >> we have been operating this program for a little over a year all women entrepreneurs. it is an extraordinary benefit for us. we have had the mayor's office investing in our program so we can continue doing this work. it has been so impactful across a diversity of communities throughout the city. >> we hope that we are making some type of impact in these kids' lives outside of just learning karate. having self-confidence, having discipline, learning to know when it's okay to stand up for yourself versus you just being a bully in school. these are the values we want the kids to take away from this. not just, i learned how to kick and i learned how to punch. we want the kids to have more values when they walk outside of these doors. [♪]