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

first time using microsoft. please excuse us if we have any technology issues. this process may be different than we normally do. if i may, i may move on to item 2, the approval of the march 3rd, 2020 minutes. >> do we need to do a call to order and role call? >> yes, thank you. so i'll start with you, commissioner. (role call).

>> we'll move on to item 2, the approval of the march 2 minutes. reviewing the minutes of the previous meeting, does anybody have a motion to approve? >> so moved. >> second. >> all those i in favor? >> do we need to do a role call? (role call).

>> thank you. item 3, the director's report. >> the director's report is in front of you and i would ask that if you have any questions, of course, i'm happy to answer them, but given that the majority of our meeting with focus on covid-19, i will not need what's in front of you, but i'm happy to answer any questions you see fit to raise at the time. >> any commissioner questions? i'm not receivining a public comment request. >> commissioners, if not, we can move on to the next item. >> item 4, the coronavirus

update. >> so good afternoon, commissioners. i'm the director of health. >> hold on. >> everyone, please mute at this point, mute your microphones. >> i talked to dr. kovax and this is not coming over very clearly. >> ok, give us a second, please. >> and there's a delay. >> i think it's just the microphone distance. other things are clear. >> can you hear me commissioners? is that better? >> yes, thank you. >> thank you. >> so good afternoon, i'm the director of health and i want to say how much i appreciate the social distancing intervention we're approaching today and not

to make light of the historic moment we're in our country right now, including here in san francisco. two weeks seemed so long ago for when we were preparing to do our best to manage this epidemic and i will talk about the nine health officer orders that have been issued in the last ten days. and i also will ask dr. irwin from the san francisco general hospital, the lead on our plans going forward. i want to provide you with a little bit of perspective of where we are now. we are clearly in a state where we are looking at community spread and the gph team is working day and night to do

everything we can to bend the curve. when i say the curve, i'm talking about the number of new infections. the goal is to help us prepare as much as possible for eight more cases, and inevitably people dying from this disease. based on the data that's emerging from china and italy, we know that about 80% of people do well.

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

decreases the spread of the virus and we think it's important to emphasize this was done for the first time, to my knowledge, as a joint public health ordinance. it's across six counties, as well as the city of berkley. this is pivotal, because we know for the broader social interventions to work, it really needs to be original and preferably state-wide and nation-wide. as we've seen the virus increasing its spread in various communities and countries, the

direction has only been further escalation of efforts. i'm not aware of any jurisdiction that has decreased or frozen the efforts going forward. so going forward with these orders, we believe that we will be continual needing to be aggressive for not a period of weeks but months. right now our focus is on three key priority areas. number one, the social distancing as i talk to you about mitigation of the virus spread and number two is focusing on vulnerable populations, including those over the ages of 60, those with chronic disease conditions including cardiovascular disease, diabetes and renarl disease. the third is protecting the

healthcare worker staff. this is a key thing we're working on across the entire system and having ongoing conversations with human leadership about how to ensure we use the best evidence available to provide the best protection possible against our workforce. the number of challenges as we go forward, i am happy to talk about those challenges. i will also emphasize that given the patterns of the disease, given our region and given our state and country, this is not an issue that the health department or san francisco can solve alone and right now we're doing everything we can in our power to optimize what we have here today. i will also add that with some leadership of our mayor, our other city departments have come

to our aid to decrease the morbidity and mortality of this disease. so i will turn this over to dr dr. thomas to briefly summarize the health order. first, iand then to dr. irwin tk about the surge plan, but before that, i'm happy to answer any questions before dr. erogon goes forward. thank you. >> commissioners? >> commissioner, any questions? >> no. >> i think i want to hear the whole presentation before we ask questions. >> so i'm going move and dr. erogon will come in front of

the camera and we'll switch back again. does that make sense? >> yes. >> thank you, director. i'm going to be brief because there's way too many orders. we realized as we were doing these orders, we were learning on the spot. one of the things i learned most recently are two words which is hours matter. this is how fast we're having to make decisions, in a matter of hours. and so, what we have had to do is not just see what's happening

in other parts of the world but what's happening here regionally with the other counties. i would say this last order to shelter in place happened really quickly. i just want to draw a bigger picture and show you how this fits in. so hours matter. we make decisions and then when there's a little bit of time, you do a little bit of reading and i had the opportunity to read an article that influenced the federal response that was just published yesterday, to give you an idea of how fast it was moving. i do want to share that with you because i think it will help you understand our strategy and our strategy is more aggressive than community mitigation. sthere's isolation toronto and e

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

that's why this is so infectious is because there's pretty much 100% susceptiblity in the population. so the idea of flattening the curve is at the end of the day, you have a lot of morbidity and mortality and you're spreading it out so it doesn't overwhelm our healthcare system. the last strategy, which i just learned today from one of the premiere modelers in our country helping the cdc to guide the strategies. his name is neil ferguson. it's suppression and it turns out we're implementing suppression and implementing the most aggressive approach. and that's where we're trying to get the reproductive number less than one and the way -- (pause).

the way that we're doing is that by sheltering in place. the idea is that a lot of people have not been infected yet. by having people sheltered in place, they're reducing their opportunity to be exposed and by not getting exposed, they cannot get infected. but they have to go out to do essential activities like get their medicines, essential workers and then, i forgot the last category.

make sure you get your medicines, food, that was the other category. people have to eat. so you still have some risks and then among -- even though you're asking people to stay unexpose bid staying at hole, you'll have cases that need to be isolated d where our movement has been in the united states. santa clara was convincing in saying, you are one week behind

us and you don't want to be in our shoes. if you're going to do it, do it now. the challenge with any of these approaches, they have to be done over a series of months and so concept use usedually, you woulo pull back and to pull back, youe have to strengthen the public health infrastructure. we need a bigger workforce to shore our tracing and quarantine. if we pull back the suppression measures, we need to dial up the public health activity. otherwise, we won't be able contain. the last thing i want to say to give you a picture of how

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

it's been great in getting the support. we've been providing a lot of leadership and inspiration. i want to turn it over to dr. susan erlich. >> good afternoon, commissioners.

i just want to say that i know we're in an incredibly unusual time, very unpresprecedented iny professional carr career and i l grateful to be a part of the department because we're pulling together to do the right thing. i feel good about taking care of people we know to be ill. so moving on to hospitals, over the past month, i and dr. luke

john day have been meeting and dr. kolfax, we've been meeting regularly with the san francisco hospital council ceos and also with their medical nursing and operational leaders. there aren't other regional hospitals who are planning in this way and our efforts have been the supply and effect of

the utilization of our critical care beds. lately through these meetings is that every single hospital has really dramatically changed operations in order to plan ahead and meet the demand that we know will be coming. it's what we call puis, persons who have been tested and waiting for results. so, for example, that includes can celling all elective or nonelective surgeries, as well as nonurgent patient visits. and then what we're trying to do is redeploy the resources that were used in those services into more covid-related services.

and so an example of that is in my clinic, the primary care, each of us in spreading our schedules to identify people -- to be seeking telephone visits. that creates other kinds of duties. so right now, we're setting up a tracking system among all the hospitals and a joint surge plan to help us identify on a daily basis where all of the hospitals are with respect to capacity utilization. the system that we're setting up

is modeled after our surge plan which categorizes our state into green, yellow, orange, red and maroon categories, based on what percentage of our beds and our services are being used for puis relative to our total capacity. since we don't yet have the data for all of the hospitals, i can't tell you what that level is today. i have a pretty good idea, based on the discussions that we've been having and what our own level is. today, there's a yellow level and we entered the yellow category from the green category yesterday. what that means, we have more than nine positive, covid positive patients or puis in the hospital. ucfs more or less is at the same level we are. they're in the yellow range and then the other hospitals are

between green and yellow. so the good news about that today is that we all have plans for capacity, but we aren't yet filling it. so that's the question we are at now. tthe other thing i can tell you that's exciting, we're looking to see beyond the capacity, in our individual hospitals, what capacity we utilize in hospitals that have vacant beds that aren't staffed. and we've identified a unit, a full med surge unit and an old critical care unit at st. francis to use for that purpose. the capacity of the med surge unit is about 40 and the critical care unit is eight. and so we looked at that unit last night and now we're in the process of seeing what it would

cost to staff it. in general, we're looking at a model whereby the basic support services are covered by st. francis and we're looking at registries, essentially, to fill the nursing positions and then a shared model of provider services between dignity ucsf and ucsfg. i'm happy to answer any other questions. there's a lot of detail i haven't covered by i'm happy to answer questions. >> commissioners, how would you like to handle questions? would you like to do it person by person or topic by topic? this is a new way of doing the meeting. >> let's do person by person. dr. chow, you had some questions and would you like to start? >> thank you. i'm really appreciative of all of the work that's been done.

we've gone through our own crises over the years, from the age to the earthquakes. and this is obviously the largest response that affects every single person here we have and i think the person here has handled this extremely well. literally, i'm pleased that we've had such strong representatives.

i think this is wonderful. i have been hearing from the private practitioners that sometimes they are concerned that they may not actually have the resources needed in order to continue to work within their offices such as gowns or simple things like that, or swabs now that we've been able to use commercial lab. i know the medical society has been working with all of you about it and i just wanted to know, what are the challenges and resources and are there other things we can do?

we can't do it alone and i know the department is trying to respond to it and just was interested. that's a large segment of the potential medical providers that, if they don't have the resources, that we don't really have them able to take care of this. these populations. >> i would like to turn it over to dr. kolfax to address that. the basic answer is none of us have everything we need but i'll let dr. kolfax speak to that. >> commissioners, it might ask people in seat to ask all of the questions we have so we're not playing musical chairs. how about we ask dr. erlich call of the questions we have in her

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

>> you just went mute. >> who will make that decision for the supply beds and workforces to happen? >> right. so generally, what we're doing is that each hospital is doing the maximum it can to try to create capacity within its own walls. so, for example, canceling elective surgeries creates a capacity that we can use for covid-positive patients. and so we're all informing one another and talking about the measures that we're taking, which are pretty similar. with respect to that centralized

resource at st. francis, i think the idea is this three-pronged approached that i described, whereby st. francis is looking at what it's going to cost to provide the basic supplies and the basic support services like environmental services and food. and we're looking jointly at registry resources that we're trying to see if it can be made available to provide the nursing and clinical staff, non-provider staff and then we're looking at a shared service's model for the providers. the purpose of the joint surge plan is to identify the point at which we would start to trigger those things. so today, what i can tell you is that we have a plan, we're oing on seeing if we can get the resources available, putting aside the question of who's going to pay for them and figuring out how we can jointly

put providers in there for about 48 patients. this is really a day-by-day thing. so it's really the surge plan that will tell us when we're ready to occupy. the last part of -- we keep hearing the audio go in and out, so i didn't catch the last couple of sentences. >> i think what we're working on is the joint surge plan that would give us the indication of when it would be time to pull the trigger, to open the centralized resource. >> and who would pull that trigger? would it have to be an agreement amongst everybody or is there somebody that says, no, i'll pull that trigger. >> you know, we're really working that out. but the way we've been operating is it will be all of us together.

and i think we all, together, assume that eventually there will be some reimbursement made available that helps us because none of us can do it on our own. >> thank you. >> sure. >> dr. chow. >> yes, i did have some questions and i really find that that's innovative and forward-thinking. i also saw that we're preparing in certain areas for more like a mass cash thing. how does that all work out and are there other facilities being looked at as possible joint surge? because you're only talking about 40 or 50 beds. >> right. so the big question in all of our minds and the other thing we're working on right now is modeling with the best data we

have available, noting that nobody can do this perfectly. how many beds are we likely to need? over what period of time? and so all of the efforts that dr. erogon was describing about flatten the suffer i curve is go make it more likely that wit resources we have available to us, we'll be able to accommodate the people who need either med surge or ic beds. the more we can do to flatten that curve, the better able we're going to be to meet the demand with the resources we have. and so we are working with our colleagues at ucsf. they have an infectious disease strike team. we've asked them to model this question for us. how many beds will we need, of what type, what period of time? and so hopefully, i'll have an answer to that question or the best we can do in the next day or so.

and so, if we need something more than that bee, i think we'l need to be looking at the state and federal government to provide more resources and i do know generally that the state is exploring this, but san francisco, if things get really bad, which we don't really know right now, we won't be able to solve it on our own. >> i would agree and i do think that dr. erogon's point of the models that seem to be occurring in different cities might give you, also -- i'm sure you're looking at that -- the idea of how many acute beds you need versus a less acute model. and the centre triage that you have been describing, which i think is great. how does that work? is that when one of the emergency areas become overwhelmed that they call a central number or you're having

meetings? i mean, obviously not in 24-hour communication each day. so just in terms of understanding how quickly it reacts if all of a sudden three cases show up over at cmtv. does that trigger something? >> so hospitals are managing their incoming demand pretty much on their own right now. so we've all tried to create capacity so that not only can our emergency department manage the incoming flow of patients, but we're also creating other resources that allow us to offload our emergency department. so, for example, at the sfg right now, we've expanded the hours of the urgent care clinic in order to be able to do more evaluation of patients on other sites. we've established a two-tiered

triage to cohort patients coming in with suspicious requirement symptoms. starting tomorrow, we're likely going to have another testing site on campus over in building 80 that will further allow us to spread the demand for people coming in to be evaluated. so at this point, hospitals are managing the incoming on their own and the planning we're doing is related to the hospital beds and the icu beds. and we've been meeting, really, twice a week to talk about this. so it's an unprecedented level of collaboration and frequency of collaboration between the hospitals. that being said, we are really making this up as we go along. so that this question of a trigger and when it goes, we're doing our best to create these rulerules as we go along.

>> thank you. that was an excellent answer in terms showing the thinking and the dedication you're all givi giving. >> commissioner, were you raising your hand? >> i think commissioner green. >> oh, commissioner green? >> yes. i've also raised my hand. >> i see you know, commissioner chung. would you like to ask your question? >> i have a couple of questions. thank you for sharing the information and some of the materials that have been ready, it's really unsettling for me. for instance, the number of dates that somebody can be transmitting the virus and how long it takes to shed the virus and when we think about that and

think of the capacity that you just mentioned, i think that is where i'm kind of wondering, what does that mean for us to keep those patients, for how long will we keep them? knowing how long it takes them to shed the virus and what kind of burden would that put on our existing staff? and the other part to this, because this is unchartered territory, i would imagine somebody who might have insurance would show up at csfgh and what do we do when they do that? do we take them on because this is the public health emergency? or do we actually redirect them to their own hospitals.

>> thosa lot of what happens tht people come in, we evaluate them and decide do they have requiremenrespiratory symptoms e start asking questions that evaluate whether they're high risk for being infected with

covid-19? even if we think they're high risk for covid-19, we don't hospitalize all of those people. a lot will send home with instructions to quarantine for 14 days and monitor their symptoms carefully. so we're trying to reduce the impact on the hospital as much as we can. the other thing i want to make sure, if i haven't already, is that the volume that we're seeing in the emergency department is no different than it typically is. any hospital that runs an

emergency department by federal law has to evaluate the person with a medical screening exam and make sure they're stable before they go, irrespective of their health insurance coverage. >> it seems like everything is defying common sense when we look at the mass hysteria and giigin begin to wonder how bad we're impacting the general public when they think they're

symptomatic and how they will respond to this. the other part to this, because it felt like there were gatherings that just happened in florida. so they know where to go. >> dr. kolfax just asked toss focus on questions dr. erlich has asked, in hospitals or what she talked about. i am trying to utilize her time because she has to go back to the hospital. so if anyone has questions specific to her.

dr. green? >> thank you. first of all, you all look slightly haggerred. so thank you for all of the incredible work you've done and the dedication. evacuee talked about howe want d healthy. great gratitude. i know you've been there all weekend and beyond that. all of the doctors feel like this is the internship you did 20 years ago before they loosened the hours. so i'm working in a hospital, as you know, and one of the concerns i have and i would like more information about, the extent to which, really, things can be directed by our dph as opposed to collaborative. we had an interesting call from

st. francis people had with china. there were experts from wuhan, beijing and it was most instructive. what came through, there was a hospital council that had leadership and directed the others what to do and they worried about staffing. i'm wondering how you're thinking that through because obviously testing is difficult to come by and we read about the hospital in connecticut that had 200 nursing hours and some incredible number with one exposure. so i'm wondering how you as a group are thinking about how we're going to manage staffing? my personal experience is a lot of people call in sick for

things that wouldn't necessarily be a sickness and now we're encouraging them to and i can see some decimated by nurses being out on quarantine. then if you could elaborate more about ppe, which i know you can't say much about or you may not know much about. but i know we certainly have inadequate ppe at our place. the real infrastructure of how things get to that surge, and who will take charge would be helpful to understand. >> we'll first let me say that today and so far, at the sfg, we have not had issues with staffing, thank goodness. we're keeping very close track of that and so every department reports in everyday about how many people are out and for what reason. and so we're doing pretty well with that. i think we're helped a lot by the fact that our department of

public health workers are disaster service's workers. we have tried hard to community katcommunicate that we need theo show up in spite of the shelter in place order and in spite of any other order, we need them to show up, if they can. we want them to take care of their families. we want them to take care of their health. it's been working and it's been working with our provider care community so far. that being said, we community that people will get sick. we know that will happen or that they will be out for other reasons. and we're working really hard to try to a, hire nurses and other staff more quickly and the mayor, there's another order today that, basically, waived all of the the charter positions, waived the civil service positions to make it easier to hire and that's a big

relief. we've electriwe've been workingg nurses much faster than we typically do. we've hired nurses. we've reached out to our registries and utilizing those resources and we're doing everything we can that's under our control to try to keep our staffing up to what it needs to be. did i answer all of your questions, dr. green? >> i'm wondering what you foresee as infrastructure and leadership when and if this becomes an italy or wuhan and how you see, based on the interactions to date, how you see the hospitals working together? >> well, as i mentioned, i think the hospitals have been working together really well. within csfg, we have an incredible leadership team. people have been working around the clock to make sure that

we're as prepared as we can possibly be. and that leadership team, thankfully, has redundancy, as well, and i think that's working well. where we have all of the ppe we need, will well have all of the supplies we need? it's tough to come by and we're keeping it under lock and key to make sure that we have it available for the people who really need it. it's definitely not in abundant supply, but we have what we need so far. these are much bigger questions, the questions about testing kits and reagents and ppe, these are national issues. but we're doing what we can to make sure that we have what we need. >> i'm sorry to interrupt. i've just been notified that dre board in ten minutes. and i'm wonder physician w wonde questions to him.

>> that's great. i did have a few questions for dr. erogon and this is dan. first of all, thank you so much for your leadership to you and to dr. kolfa examinatiox and dr. i understand we have 43 cases in san francisco and how many are hospitalized and how many are in icu? >> i will tell you in one second. >> thank you. we understand with the lack of testing kits what we're doing is surveying what already exists out there to get a sense of what our current situation is and what is our outlook for our testing capacity in the coming

weeks and how that would increase where we are today to hopefully a level we'll be able to do comprehensive surveillance? >> so i'm going to have to get bacback to you about the hospitalization. i know it's a small number. i'll have to get the exact number. i'm not sure. >> and there's room for both of you. >> just to say that we are with other hospitals, working to get a daily count of how many patients are both covid positive and tuis and in what part of the hospital every single day. we aren't quite there and i know we have two at csfg and one of whom is in the icu. it's a small fraction of the 43. i don't know the numbers from the other hospitals today, but in a couple of days, i will.

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

means of distributing it to the various providers that may need it. >> that goes to the equipment supply and the guidance yesterday that allows healthcare workers to use what's called a droplet precaution caring for patients. unless there's a procedure where there will be symptoms of virus and that will improve the ability to expand testing because they will have to use airborne precautions to collect specimens. >> thank you, doctor. >> that's county with what the cdc is recommending. >> i had one last question for dr. erogon before he has to leave. regarding the shelter in place order through april 7th that's

being sort of jointly issued by all of the six counties, what is the criteria that you might use to determine whether that is something that needs to be extended or is that just something that you're going to have to determine as you were saying, on an hour-by-hour or day-by-day basis, depending how this is playing out? >> so we had chosen to do three weeks and i can't imagine that in three weeks -- i imagine if we're moving -- if this epidemic continues to move in every placed it's been introduced, it may be worse and i think at that point, we're going to have to reassess both the city and the other counties to decide whether it needs to be extend. but that would be a decision we'll make closer to that time.

>> thank you. >> thank you, doctor. >> i think dr. kolfax will answer the testing question. >> i had a question before jail health and homeless population. >> there were a number of questions and please bear with me ibarebare withme. i wanted to talk about hospital control and i don't know if you

use that term, commissioner green. but i think that was the justice of it. gift of it. gist of it. i'm not so concerned about making sure that we're all reaching -- that we're all working together to reach our capacity as a community. what i'm concerned about when and if we exceed that capacity. i think that would take more of a -- if we reach that point, i would hope that before that, that the federal state authorities would have brought in assistance and whether that assistance could look something like the national guard or a military operation. we don't have the capacity right now to run something like that. that's not our mission. with regard to that level of response

and engagement. i just think those resources would be vital to that. and we do everything we can with our partners to do that in the interim. but i hope that we don't get to that situation. and i don't know commissioner green or others if you had any response to my response. >> i think when you think of things like we have two empty hospitals in our midst and if we ever needed one of these kind of mid-level quarantine sites as they used in china, the national guard and others might come and help us. but within our walls, we could know some of the resources, resterespirators and i'm curiouw we can work together if it got

to that. , whether that would be something that would fall under the hospital or elsewhere. there's other resources we might know about that they may not. >> we're looking at all of those option. i was thinking more of a massive icu means, which, i think we would have to look at hospitals in the bay or something like that. so again, i don't want to create an alarming scenario, but in terms of looking at other places where people who are not acutely ill but are symptomatic and stay, that's something we're looking at, not only with other hospitals but other key participanteners in the city. ps in the city. there was a question around testing. so the testing capacity is a key issue for us. it's a key issue, as you know, across the country right now

within our public health lab under the direction of dr. susan philip and they've done an amazing job of implementing testing. our capacity is relatively small and they're having to prioritize testing the people who are most in need of testing, requirementy symptoms in the hospital, at high risk for first-degree exposures and then healthcare workers. so we're really focusing on those flee populations '03 thre. to give you an idea of how our day-to-day is going right now, we're injecting a capacity of a day's worth of test or at the best, a week's worth. and so we're getting tests delivered to us by the cdc in the very challenging fashion because we're simply not able to

be assure ed this either w assuh tests to last for months or to expand our capacity to run 24 hours a day. so that's within the dph side. within our public health lab side. we're also working with private labs including quest diagnostics in our health network and that, again, is a dynamic in challenging. quest lab turn-around is three to four days and we're working to ensure that we get people tested who need to be tested. other test companies are telling us they don't have the capacity to except other tests and so forth. another part of this that we're

working on are the partners with the ucsf, they're developing their own tests and it's exciting and i think it's a key part of the puzzle. they're working with global limitations with reagents. so, for example, on friday, i was informed that ucsf was going to be able to perform hundreds of tests a day, not just for gph, but through the ucsf system but then today, i'm told they can't get started because they don't have sufficient reagents. so they have the tools. so there are multiple different strains of testing and each strain has its own inherent challenges. we have such a national shortage of supplies and i have to say that we were short of things

like swabs. we're short of things like swabs. so i have asked not only within the health department but assistants from the controller's office. we brought ito develop a city-wa city-wide approach so that we're actually able to have a full visibility in terms of what tests are available, who they're available to, that we have a shared tracking mechanism and we know how many tests are done, not just the number of positives and we move forward in a coordinated way and there's still support from the city to ensure that we're moving forward in any fashion that helps us all

to do better for the people of san francisco. so that's our fourth priority which i added to our list this morning. >> is the city-wide testing plan you're trying to develop, would that include the private sector hospitals, as well, or just the county and ucsf? >> no, we're trying to -- so right now we're doing a rapid assessment of what is happening across the city because what happened was, some tests became available. there's activity and different groups are doing different things and everyone is trying to solve the problem, or how they're trying to solve it and we're doing a whole needs assessment across the city of all institutions. we're looking at privates. we're doing an assessment of whatfwhat philanthropy can inved

we're trying to decide is it scaling something up or is it because they don't have basic supplies in order do the testing and so on and so forth. if we can, we're trying to get to a point we're trying to determine who gets tested and that's a real challenge, right? but we know that if we could test everybody, that would be -- in a way that's meaningful and systematic, i think that would be the ideal setting and that's what i'm calling the south korea model, right, because they've just rolled out testing in a huge way. we are the city that essentially has done so much of that with hiv. so that's our model. i've brought in a key global health expert and her first day was today who has worked with the clinton foundation and w.h.o. on pediatric testing in

africa and this is her full focus and she's working not only with gph again because i knew the gph people on the ground doing the work, but she's working with other city departments. she would bring in analysts and managers, project managers and people go out and find this information. >> dr. green. >> thank you so much, grant. do you have any sense of timing on this? because a lot of patients have heard about the kaiser drive-through and think there's something else or they can go to kaiser and i think there's a similar programme that you know better than i. but at this point, cpmc has been vocal, they're not in the outpatient business and some of their physician's staff are not employed and they don't know where to get tests. we're getting really deluged

with questions and some, perhaps, do deserve to be tested. in general, think, the primary care people who aren't in a system like kaiser could really use some advice and some directives from the dph, because the systems have been very nonspecific in the recommendations and even in their guidance. all of people are showing up in emergency rooms, at least in ours, and the mixes with people may be positive which makes you worry about spreading the disease further. i know that was a lot of question comments. but what do you see and how would you recommend that practitioners get information and talk to the patients as they see the numbers mounting? >> so as we're working to get

full visibility and who they're testing across the city right now. evacuee been very clear at dph that if people have questions about -- have symptoms or questions about getting tested for covid-19, they should call their healthcare provider. those healthcare providers have act eaccess to information abouw to get tested. how to find out information about testing. the healthcare providers will get counseled whether the patient their calling for, whether that patient qualifies for dph testing. they would have to fit into the three categories because we have to prioritize who gets tested. that is the reason we're developing this broader testing plan, is in order to address the questions that you have.

i'm concerned about people going to emergency rooms or urgent care centers who are not sick to get tested. the other message we keep putting out, please do not go to emergency room or urgent care unless you have an illness and need to go. evacuee been pushing that out ad we're committed to working with our partners to make sure they have that message pushed out, as well. >> in keeping with dr. erogon's advice, i would like to ask we wrap up with the last one or two questions here. is there a commissioner who has not posed a question that would like to ask something? >> i have one question and this is commissioner gerato. if any of thin any of the figure

there been children or adolescents who have tested as positive? >> i have not heard of that case in pediatric and i don't have numbers in terms of young adults but we can provide that for you. >> director kolfax, speaking of children, for parents with children who are out of school and may have questions about the safety of child-care settings or, also, whether or not it's advisable for them to schedule play dates and anything like that, is there specific guidance we're offering? >> yeah, there's specific guidance on our website around that. >> dr. chow, you had one more question briefly? >> yes. it was more -- actually a compliment to the department and website and to reemphasize that

dr. kolfax's point that the department has a great deal of information and evacuee been wen making use in our medical group and we've been encouraging that patients be able to look it up and i want to compliment the department for having put out clear directives and keeping it very up to date. so those that may be watching and listening, that those are important resources and to, again, emphasize as it does, that you don't rush off to the emergency room and you don't necessarily have to get tested and there's some really good documents on that website about the issues of how to care for people on the provider's side and then how to actually be cared for on the consumer's side. and so i want to thank the department for that, too. it's been very useful. >> thank you. i think we all associate ourselves with dr. chow's

remarks. dr. kolfax, anything to add before we move on to the next item? >> there was a question before the homeless population. i want to emphasize that that is a big concern of the department. we are working with our partners at hsa and hsh at the department of homelessness in support of housing to do everything that we can to best protect and care for the homeless population. they obviousl are part of the ve population to covid-19. i'm in th not aware of any experiencing homelessness. we know from data from dr. margo and others that the physical -- that the medical age of people who are chronically homeless is 20 years older than their chron

logical age. we are establishing places for people who are experiencing homelessness who are under investigation or covid-19 positive i just wanted to go back to commissioner green about the providers. i wanted to assure you all that

we have a liaison to the san francisco medical society ensuring that private providers are getting the information they need about testing and how to manage their patients and work with their patients going forward. we're also issuing a health order this afternoon that will ensure that only people who need the most urgent or emergent care will be seen in offices going forward. >> is there specific guidance we're offering to people who are hiv positive in terms of their being a part of a vulnerable

population that needs to take specific measures? >> so we don't know how covid-19 interacts with hiv and whether it's additional risk factor, especially for people living with hiv who are suppressed versus people living with hiv who are immunosuppressed. we're following cdc guidance gus and fits into the vulnerable population going for other chronic diseases. >> thank you, director colfax. >> commissioners, if we could move on to the next item, which

is the joint conference committee that occurred today. >> we met before this meeting and we got an update from the administrator on the situation and status around the coronavirus orders and things that are being taken that seemed quite comprehensive and very well put in place. so we were glad to hear about

that. and i believe that can be shared. if others are looking for that information, particularly the information. (pause) we asked for a flex status which asked for the reclassifications of some of the beds to accommodate the population needs there.

there were rehab beds and dismiss beds and the rest of the time we spent on reviewing the regulatory report which included the recertification survey that happened recently at laguna honda and other facility-reported incident events that have been surveyed. i wouldn't necessarily go into the detail but that information is available to the other commissioners. >> any questions for the

commissioner filiarmo. >> i skipped the item 6, which is the health commissioner elections which are important to your leadership. so let's go to that, please. >> to the office of president, do we have nominations? dr. ch o chow? >> i would move dr. dan grenell. >> i second that. >> mark, would you like to call a role call? (role call).

>> and that's it. >> movinmoving on to the electif vice president, a mo nominationf vice president? >> i would like to nominate dr. laurie green. >> i'll second it. >> second. >> ok, i will need a role call. (role call). >> thank you to my fellow

commissioners for your support and the faith you placed in dr. green and myself as your officers. these are extraordinary times that we hadn't foreseen and i am certainly grateful for your leadership and the expertise you bring to the commission. also, i would like to thank mayor breed for her decisive leadership to keep us ahead of the curve to the extent possible, certainly calling on our city's experience with many other public health challenges, very proud of the decisive actions that san francisco has taken to help stem this crisis. also, very grateful for the leadership of director colfax, dr. etcand others we've been heg from and want to provide whatever support they need to do their jobs to confront this challenge and then, also, a special thank you to our excellent commission secretary,

mark moorewitz for his leadership and work to keep our commission operating, as well as working with our technological team. thank you to you for making this meeting possible to be virtual. and finally, just thank you to our commissioners for, of course, modeling good public health citizen behaviour and joining here virtually and also thank you to the people of san francisco for your abiding by the orders being put out by the city to ensure we all ban together to keep san francisco as safe and healthy as we can. dr. green, is there anything you would like to say? >> well, you said that so eloquently. of course, it's a huge honor to be a part of the executive group and i would echo all of the thanks. i just can't imagine what it's like to be in the shoes or population health division. i know people are being redeployed in areas that they

haven't been working in. everyone is being so diligent and i think we will be an example for the nation of how to do this right and hopefully, we will save many, many lives and continue to respect our entire population, the equity of san francisco and really be the shining example for the country and we may be under-resourced in items, but overly abundantly resourced in still of our individuals and the people part of this department expect citizens of this city. it's a real honor to be a part of this and i'm so grateful. >> thank you, dr. green. >> i look forward to working with both of you. item 9 is a consideration for a closed session. >> second. >> thank you. i will go through a role call vote for the closed session. role call (.

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

>> good morning, i am san francisco's director of transportation. we're here today to have a conversation about our budget. even though that you have a lot of other things on your minds. these are unprecedented times. many of you are having to deal with children unexpectedly being at home and you are having to deal with worrying about how you will pay your rent or how to keep your families safe. we really appreciate that you've joined us here to talk about something that should be seemingly minor which is a government bureaucracy budget. but for us, nothing is more important than our