we've stabilized the supply, that we have these other sites in place, to see how we can increase testing in other populations is to really understand what is it that will be needed in order to scale to do more screening? what are the barriers? what is required in order to do that? and what type of testing mechanism would be lowest barrier? is it on site testing? we can't test as often, is it better to have neighbor located facilities? i think there is planning around how this looks. in parallel, we're trying to think about nursing facilities, which are a priority, but require a different approach to supporting staff screening and testing. and sometimes requires our nurses to go there and do it physically ourselves. >> supervisor peskin: and if there is interest in a community that has volunteer and organizational and logistical

resources that want to replicate what is being done in the mission where asymptomatic people are being tested, and the university of california is participating, say in like chinatown, is there interest at the department of public health in replicating that setting in the community like chinatown, that obviously has a disproportionate number of congregate living situations? >> i think we're always interested in gaining more information. a project that happened with ucsf was largely organized and staffed and maintained by them, which is what made it possible, but we're certainly interested in gaining information about epidemiology of covid in our city. and we're particularly interested in understanding more vulnerable populations and more vulnerable living situations as to what epidemiology might be so we can better serve the public.

>> supervisor peskin: my last question, not to drag you into the friction that is existing between the executive branch of government and legislative branch of government around the acis zigs of hoe -- acquisition of hotels for vulnerable populations and isolation for people who cannot otherwise self-isola self-isolate, is there any concern that if these types of asymptomatic testing studies are undertaken that it will lead to containment strategies that require isolation in hotels or other settings that the city doesn't currently have sufficient access to? is that any way of a part of d.p.h.'s consideration. that has not been part of the discussion that i've been a part of.

not as a reason to not do testing. i think those are important considerations. i think that the ability to do case investigation and contact tracing on very large numbers of people as we are trying to build up the workforce and that capacity is another situation, but neither are reasons not to test people that would benefit from testing. >> supervisor peskin: what do you think the best containment strategy in s.r.o.s is? >> now you're asking me to go outside of the testing approach. i think that there are best practices. i know there are specialists and subject matter expert teams working closely with management and with community leaders to think about ways of structuring the environment, the physical environment, the ways of doing cleaning, the ways of trying to give people as best tools as possible to try to stay safe in

their own environment. we know that many people want to stay in their homes and stay safely in their homes. those are important approaches. as i said, we're continuing to learn about this virus and what is and is not sufficient. we'll have to continually evolve in the face of that knowledge. the resources are one issue, but i think the science and what we understand to be the public benefit of the approaches is also evolving over time. >> supervisor peskin: thank you, doctor. if you have a point person as to who that is who is linguistically and culturally competent as it relates to s.r.o. settings in chinatown, i would love to know who that point of contact is. >> thank you very much, supervisor. >> dr. phillip. we're fast approaching the 45-minute mark, but there are several more of my colleagues

that i can see on the roster. would you be open to getting to these questions? it would be helpful if you can stay beyond the time. >> yes. >> president yee: okay. supervisor walton. >> supervisor walton: thank you, president yee and thank you so much, dr. phillip, i'm going to be brief because a lot of questions i have you covered. the one thing you said -- first of all, let me thank you for being responsive to some of the questions we've had and some of the demands made to the department of public health because i have not received response from other leadership for the department, so i do appreciate you. the one question i do have, you showed a slide talking about you will start providing asymptomatic testing in communities affected disproportionately.

and i didn't get a clear sense of a timeline for that. and would love to know and try to lock in a date, something more specific, because this is important to community and i know that testing does not solve our problems, but it does tell us whether or not people need to be quarantined indefinitely, separated from other human beings? >> thank you, supervisor walton. yes, i agree with you that testing is a hugely important piece of the overall response and overall way we have to respond to this pandemic and this public health crisis. i have listed the groups that we're going to move to. and i want to iterate again -- reiterate that it's going to take us a while to get to the vision of universal access to testing for everyone. but we're focused as we think about next steps. i talked about this idea of where additional sources for

testing might occur. we're thinking as we think about what would potentially mobile sites in san francisco look like? starting to have those conversations. so the areas that represent -- 10 other areas that are disproportionately impacted -- >> president yee: excuse me. can somebody -- can people mute their mics? >>... would be the priority areas for those types of additional services, in addition to what has been laid out already. an improvement what we have before in terms of access, but not nearly where we need to go. i don't have an exact date for you, because this is relatively new. in the last week, we think we have a stable supply of the things we need to test, what is it going to look like to expand testing?

we started just now with saying, you know, any of these symptoms will allow us to test. and we know we have a ways to go in that and it's going to require planning as i said. and particularly for the asymptomatic test and getting the right message. and giving them information about when they should come back. the way we're going to be learning about that is starting first with health care workers because they have among the highest risk of being exposed to covid in their work and understanding in that way. starting there and going out to be able to offer that to other people as well. >> supervisor walton: for the second time, i want to state it's disheartening we don't have a time line and when we're going to provide asymptomatic test fogging -- testing for the vulnerable population that have

demonstrated higher numbers. especially since we've already admitted to having over 5,000 capacity and not testing more than 500 or so a day, but i won't belabor the point during this conversation and will continue to reach out to the department and push for us to do the right thing for people of color and for communities of disproportionately effected by the virus. >> thank you, supervisor. what i would also say, with the revised criteria, there likely are more people that would be able to be tested and the health center is a site where people can go and get testing. and there is capacity for testing there. thank you very much. i am taking to heart what you're saying and will take that back and continue to think about that and try to commit to time lines. this is very early in the process of thinking there. >> supervisor walton: thank you.

>> supervisor mar: thank you, president yee, and thank you also, dr. phillip, for joining us for this important discussion about testing our city's testing strategy. i'll try to keep it brief as well. just had some questions around the vision -- our vision for all san franciscans to have universal access to testing. i was wondering if you had any thoughts how far off we are from that? and what are some key benchmarks that we're going to need to -- that work towards in order to have that universal access to testing in san francisco? >> thank you very much, supervisor, for the question. i think it is a goal, it is a correct goal, it's also a large goal. it's a challenging goal. which it should be. and i think that we are a ways off as we've heard from the conversation.

there are still many populations, many settings in which we want to be able to expand testing and screening. we don't have all the information about the best way to do that in asymptomatic people. and we don't want to do harm. there is a risk, as a medical doctor, one of the first things we're taught is don't do any harm. we have to think through how do we message what a negative test means? we can do all those things. we need to understand that a negative test today doesn't mean they're at less risk tomorrow or less risk of transmitting if they develop an infection in the time between the specimen was collected and the time they got the test result back. i think there is lots we have to learn and figure out, but there are things we know that we need to be able to make sure, if people are not accessing the sites that we have, we need to understand what the barriers

are. and make the testing -- continue to work to make the testing more successful. everything we've been doing to expand testing has been done with an eye to reduce the barriers, improve their access to it and make sure the populations disproportionately impacted and our essential workers, throughout the city, many of whom i want to say are low-income people, people of color, think being staffing of grocery stores, delivering packages, that type of work, we have been taking steps and had a equity lens throughout all of it. we need to start looking at our data and measure the number of people coming through. we've seen increase of the number of tests over the last couple of days. we really need to see how can we continue to increase those numbers of tests that are performed? i think there is going to be a data feedback loop.

it's so early in thinking about how to expand, i don't have concrete benchmarks. i don't have concrete time lines, which i know is challenging. i will tell you that we're committed to continuing to work on that. and every expansion, even though it's seems incremental, every expansion is done with the eye to maintain that expansion and build on it for the next group of people. again, keeping an eye on making sure we're putting our person-power and our resources and supporting the people who are most vulnerable to severe illness and death if they become infected or most vulnerable to congregate settings and outbreaks and populations that are disproportionately impacted throughout the city. >> supervisor ronen: thank you.

i just wanted to start off on a comment. i don't know if you had the opportunity to talk to dr. have leer, but the test done in the mission was done with a lot of volunteers. so it was the community coming forward and partnering with ucsf. they don't even have a defined budget for the project because it was done so quickly and in such cooperation with my office and community that they were able to make it happen without a budget. i'm not sure if you've had a chance to talk to her. i would encourage you to, because i think it's an important test that is making the community feel like they're cared about and being given attention. it was right in their neighborhoods, the outreach that happened. it was a model that should be replicated in chinatown, soma,

tenderloin. bayview. there is no question in my mind. we encourage you to talk to her if you haven't already. >> thank you. we have been talking with her and we're eager to hear more about what their experience is. it's great to hear that from you as well. thank you. >> supervisor ronen: i don't know, just aside from the data, we'll have access to all of these strategies. the impact of the community being focused on and how that makes people feel cannot be calculated. i mean it's had profound impact on the mission. so i'll just leave it at that. i still don't understand -- you've given the best explanation to date on why for so long the entire division, navigation center wasn't tested after there were positive cases.

so i appreciate that, but i still don't understand when people are using shared shower and bathroom facilities, and given what we've learned about how covid is passed through the community, how they can't be considered in close contact where they're already a vulnerable community and they weren't prioritized for testing. i still haven't gotten that. can you explain that a little more? >> previously at division circle, we can view that as an example, the feeling was that in talking with the person that was the case, there was an ability to understand who was in close contact at that time. and so that -- and that there were environmental controls and other ways that the facility was set up to try and limit the

contact that might occur with other people. so that was a decision at that time. but as you know, with the more recent case, there was a different decision to actually move people out to do a thorough cleaning and to offer testing more broadly to people. and i know that seems like it doesn't make sense. i think some of it is, again, we are learning about the virus. we're learning about what is and is not necessary as we are learning from our experiences at division circle, m.f.c. south here and colleagues in seattle and elsewhere across the country. i think that there will be an evolution of how we look at response to this. and i think we will not always be perfect in the approach, but we're working with the best data we have. and we need to take into account

the opinions of advocates, community members. so i don't know that i'm giving you a better explanation, but i'm telling you that i think that thinking evolves as the overall understanding of infection and transmission, what is and what is not a best practice evolves over time as well. >> supervisor ronen: i'm not asking this to belabor the point, but what is close contact for tracing purposes? how that is defined and understood by the department. if the individual just arrived at division circle, maybe never took a bath or shower. maybe every time someone uses the bathroom, it's so thoroughly cleaned before another person that is the reason. but to me, the shared bathroom

scenario alone -- i mean division circle, very close you know facilities, people use the same chairs to hang out on and eat their mails, et cetera. but that shared bathroom, is that considered in and of itself a risk for contact tracing? i know you said being within six feet of someone who is positive for 10 minutes, right? is what you're considering. so using the bathroom that someone who is positive uses regularly is not considered a person that should be tested for contact tracing purposes? >> not necessarily. i can't speak to the particular case. i i don't have all of the details of that, but the situation you described, if there were hypotheticalfully, if there were environmental controls in place where the

resident or the staff were wiping down surfaces between uses, et cetera, then that would potentially not constitute a risk of using the same facility. i don't know if that was in place. but we've had very experienced m.d. and nursing experts sort of ask these questions. do these interviews and try to understand what was going on, we are very interested also in trying to minimize ongoing transmission. that is our whole reason that we exist as a department, the whole reason we do this work. so, again, i have to trust in the investigation that happened at that point. and i will say to acknowledge your point, i completely agree. i understand why it would be a confusing thing. i think there could be specific pieces of that particular investigation that led to that decision. and i think that we're evolving

our understanding over time about how we should think about testing or screening or offering that in those situations. >> supervisor ronen: again, i just want to be able to share this with my constituents, so i'm trying to get clear, accurate information. sharing bathrooms and showers, then, is not something that would lead to someone getting tested through contact tracing if someone who was positive used that same shower and bathroom? >> it possibly could be. i'm giving you a very unsatisfying answer. it depends on the situation. i think in a congregate living -- >> supervisor ronen: in a congregate living scenario. >> i think we have a lower threshold now than we did several weeks ago because our knowledge is evolving. which is appropriate. i think we should worry if our

public health knowledge was not improving. we should consider testing the people in contact there. i don't want to spend a lot of time defending what wassed decided before, because i don't know the information and second because i think we have a different mindset now and framework now. i think that is incorporating scientific information and also incorporating feedback from you all as a board, feedback from community, all of which is important and valid. >> supervisor ronen: two more questions. in congregate settings, where do people wait after they've been tested before they get their results? >> that's a good question. so we want people as they're being tested and awaiting results, we want them to be as much as possible in a safe setting. that's why in congregate settings, navigation center, we have moved people out to await the test result. and we prioritize getting their

tests done in the fastest way possible. luckily, we've come a long way in waiting for commercial laboratories to get results back. it's generally not a long amount of time we have to have people wait, but you're correct, we'd like them to be in their own space while waiting. if we're worried enough to test, we should consider them a potential person who has covid until we can get the test. again, it's not a complete relief when we get the negative test. it's only guard that point in time -- good for that point in time, but we have to make a plan for how we repeat this. i want to say to the board, it's not a simple matter of testing everyone once. it's a plan to do this repeatedly and support the people necessary after the test comes back, which is what we need to do as a city and will take work. >> supervisor ronen: last question.

who is making decisions about who to test? >> there is a policy team o.e.c. and doc. i am part of that, dr. baba and some of the other e.o.c., dr. bennett, the commander flight. there is a group of people that think through the issues and think through what are the policies that incorporate the public health data, the science data and what we are learning as we go through this pandemic and incorporating new evidence and new data. we will make recommendations, but clearly it's dr. colfax, the director of health, hears these things and he a has a group as

well of his leadership that he works with. there is process of getting input from all levels and bringing it up to have the discussions. this is no different than what d.p.h. usually does in terms of trying to have a data focused approach as dr. colfax says, looking at the data, facts and science and also having a strong equity focus in how we try and increase our access to testing an response capability. >> supervisor ronen: one more question. have you tested anyone on the street? >> meaning being able to just collect the specimen on the street? >> supervisor ronen: yes. >> you know any doctor gone to -- we're probably getting close to 100 camps that are growing on the streets. has any doctor gone and tested

anyone in those encampments? >> i don't want to say know, because we're working with street medicine and others. i don't know the exact answer to that, but i will find out. >> supervisor ronen: okay. that would be great. it's hard to get answers when there is not a group. it doesn't seem like there is a clear -- i don't know -- place to get all the answers. but appreciate it. thank you. >> president yee: supervisor safai? >> supervisor safai: thank you. i just wanted to end on the conversation around long-term care facilities. we have the second largest long-term care facility in the city and our district at the jewish home. we've been in a couple weeks, a

long conversation about testing of front line staff. can you talk to me as you said about the changes and the think being testing staff and front line workers in these facilities? can you talk about that? and then secondly, can you talk about, is there training happening for the people that are actually doing the testing? we say testing as though we all have an agreed upon standard, but is the d.p.h., are you training your nurses, are you having people doing the training going through a proper quick procedure to have them understand what the procedures are for train? those are my two questions, but mainly wanted to start with the long-term care facilities. and we had dr. louie come to a town hall. she's been in those conversations. and to answer supervisor

preston's question, the jewish home has been ordered by the state, a lot of the long-term care facilities, have been ordered to accept covid-positive patients that are not current residents and it's currently happened and they're licensed to do that in a different wing, different staff, but is the city changing its thinking around testing the workforce there? thank you very much for the question. yes, stilled nursing facilities as i've been saying is an emphasized area. it's a priority. and we are trying to think through ways of what would it look like to increase screening? of residents and staff? and because there is 21 facilities and several of them are quite large, laguna honda and jewish home being the largest, it will take some operational and logistical

thinking in collaboration with the facilities to see also what works best for them in doing this. but we do think this is a priority area. it's a focus area. so we're working to do work in that area. dr. louie, who came and spoke to you, is one of the leaders in that work. >> supervisor safai: that sounds like the answer is yes, you're changing your thinking and testing is going to happen, it's just matter of how it's going to happen. >> yes. big picture, we're moving to doing that to support the residents and the staff. and, yes, it is more of a question how it's going to happen, not if. >> supervisor safai: my second question, are you training people that are doing the testing? when i talked to front line understands -- nurses and different people, you get a broad range of the testing. whether it's one swab, three swabs. is the department thinking about doing a simple training to have

the people that are actually doing the testing understand the process and kind of standardizing that? >> yes. and it is confusing because there are lots of different ways that the cdc says we can collect the swabs. and nasopharyngeal is the preferred, but if that's not available for whatever reason, people can do oral swabs, they can do mid-nose swabs, they can interior nostril swabs as well. so it can be confusing. we've had guidance since the beginning of the epidemic how to do the collection, which evolved as the cdc has evolved. and there are written documents for providers to look at on the website, the health department, the communicable disease, prevention and control have those instructions. but could we do teaching? that's a really good one. i think as w