we're turning our attention to right now, we've achieved one, two -- the big areas right now is protecting vulnerable populations and expanding our testing, and i think that's one of the themes that i recognize that came through, and i think testing is really -- is really critical. initially, when testing was limited, we had to prioritize, and we focused on people kwwho had symptoms and people that were hospitalized, so we had the highest percentage of positive tested. we've moved to testing asymptomatic folks, and i would say that's really the area that there's a lot of movement -- a lot of movement that i'll mention in a second. then, we moved to testing all workers, anyone who works outside their home. so right now, we're telling -- if you work outside the home in

san francisco, you have free testing available to you. so people can either go to their health care provider, or they can go to citytestsf, and they can get tested. within our own free testing sites, in addition to the two s.f. testing sites, we have testing at southeast health center in the bayview, maxine health center, and then at ucsf. and then, there's a site that's going into the bayview that's being supported by the state health department. we have a link that has all of our protocols. every day, we spend time talking about -- we implement c.d.c. protocols, state protocols, but then, they get customized to the situation that we're facing here. i do want to announce a game changer that was just announced today by governor newsom that

pharmacies are now going to be allowed to do testing. so the fact that pharmacies are going to allow to do testing is going to be a game changer because we want to get to the place where, during your lunchtime, you have no symptoms, you're a food handler -- and we want food handlers to get tested because they work in close quarters with other workers. we want them to go on their lunch, walk in a pharmacy they go into on a regular basis, and get tested. i think that's going to become a part of our future, is that testing is going to become more available. so i think the thing that's coming out of testing is the testing of asymptomatics. we know that the information that we're seeing here in the city, for example, from the mission study, of everybody that tested positive, 53% of them did not have symptoms.

that's how the epidemiology of this virus is teaching us completely new lessons, so that's what we had was completely phenomenal, completely upside down. >> supervisor walton: thank you, dr. aragon. while we know that we're not testing every single person where we know that there's a high concentration of folks with covid-19, not just essential orders, but every single person in those areas of communities where we know that there are high concentrations of folks who contracted the virus. because you just said -- >> right, right, right, right, right, right, right. >> supervisor walton: because you just said you tested people without symptoms at 53%. >> you're absolutely correct, and that relates to some of the other questions that have been brought up, and that is testing of high risk settings and also communities. within the area of -- let me start off with congregate

settings. we're prioritizing -- we're prioritizing congregate settings because we know that's where the highest risk of transmission is, the highest risk of mortality, and so currently, we're starting with our long-term care facilities that was mentioned earlier, that almost half the deaths in california come from persons in long-term care facilities, and so we're going to start -- we're already started. we're testing at laguna honda, residents, close to 800, and staff, which is 1500. then, we're going to move to the next biggest one. we anticipate we're going to be able to test the jewish home in the next two weeks, and we're going to work through the other long-term care facilities. i'm sorry. go ahead. >> supervisor walton: just out of curiosity, what are the long-term numbers of testing at laguna honda and testing at other long-term care

facilities? what would you say is the number of people? >> so laguna honda is 800 residents and 1500 staff, so it's a lot of people. it's over 2,000 people, and it's very resource intensive for us to do the testing because it requires a team of people who have personal protective equipment, and so -- and -- and so we have -- currently, we have two mobile teams that are -- belong to d.p.h., and we're also bringing on board some private providers, private testers to help us with this. yes, it's a big -- one of the specific challenges with this specific virus is we have to retest. our goal is to retest, every two to four weeks, everybody. so it's a huge commitment, but that's how we're going to be able to prevent infection and save lives in the near future.

>> supervisor walton: so the answer to my question of why we're not doing testing of asymptomatic testing in every area that we see communication of the virus is because we don't have testing capacity? >> so right now, the capacity -- the capacity is increasing, so right now, when i mentioned that i've prioritized right now, is so anybody who works outside the home can go to any site, even if you do not have symptoms -- right now, you do not have to have symptoms to get tested. >> supervisor walton: so -- but you have to be an eventual worker. >> yeah. anybody that works outside the home -- that works outside the home. >> supervisor walton: correct. what does that do to our unhoused population or people who live in those areas of high concentrations of people who have contracted virus that don't go to work? >> yeah, and i agree with you.

that provides a different strategy, and we're working -- we are working on doing a better job of meeting the needs of both the homeless population and also the areas like the mission district, like bayview, where there's crowded housing and also where people are at risk, and so those are areas that we're working onto do a better job. i absolutely agree with you, including in the homeless population. >> supervisor walton: so my last question, if we're about 5800 capacity, i'm asking specific numbers. you haven't hit 5800 yet, and i know we're not doing that every day, so i'm a little confused as to why we haven't tested everybody in your priority category, and that's focused in care, living in cares, and folks in laguna honda and other congregate settings.

those measures have been in place for a while. if my math is correct, we should have started testing of asymptomatic already. >> yeah. it's been harder. that's our capacity today, but it's really taken a while to get up to this capacity. i can just tell you, as of a week ago, we were debating on the types of swabs that we had access to. all of that is improving, and really, that's what i can communicate right now. i agree with you. believe me, i wish it can go faster. it just takes a long time. >> supervisor -- >> president yee: wait, wait, wait, wait, wait. i see two other people on the roster. >> go ahead. >> president yee: i'm sorry. who's talking? >> dr. colfax was just -- >> president yee: okay. go ahead. >> so our goal is to have universal access for testing

for covid-19, and i share your vision. >> okay. >> president yee: okay. dr. colfax, go ahead. >> our goal is to have universal access to testing for all. our capacity is the machine that can run the test, and you're exactly right. we do not have the operational aspects, all of the solid supply chains, the staffing, the p.p.e., the mechanisms all have to be worked out to reach that vision. so our goal is to get there not only through d.p.h. but our private partners, as well. so it's not like we can turn on a switch and get to that number overnight. that's why we're starting with laguna honda first, so we can improve our ability to do things faster and then move

onto the other s.n.f.s. >> supervisor walton: my apologies for jumping the roster, president yee. >> president yee: no problem. supervisor mandelman? >> supervisor mandelman: thank you, president yee. i guess i share my colleague's desire to understanding what capacity means. i'm gleaning that this means a workforce problem, but you never said that. i am assuming that to have teams of d.p.h. folks or folks under contract set up to go out to each nursing home in san francisco every two weeks is a project that requires people, and i'm wondering if d.p.h. has those people. and i'm wondering if layering

on top of that. maybe you can tell me if this is true. i imagine you'd like to do a similar exercise for every vulnerable population in a congregate living situation, and that there's also a capacity problem which i'm also imagining is sort of a, like, bodies or people problem, but i don't have a great sense of that. it would be great to have a sense of -- when you say capacity, it's not -- it doesn't sound like we're hitting up against the lab number capacity problem, it sounds like the materials problems are, you know, may or may not be getting resolved. but it does occur to me that lodge sticks and number of people that you need to manage -- and this is also probably true of contact tracing, you know, that there's a lot of people that need to get put into these roles, and

maybe i'm not completely understanding. >> yeah. so let me just briefly summarize that, and let me do it in two phases. one, my colleagues remind me that it's not just about testing because when you test, you're going to find staff and residents in long-term care facilities, some of whom are positive, and then, you have to figure out what to do with them. so there's this whole infectious control, training on how not to get infected, and then they have to go out to all of these facilities. so they have to mitigate what's happening in their site but also figure out a path forward how they're going to continue to operate, so it's a big challenge for them. you're absolutely right, and that's really why, for us right now, this is a transition period as we're trying to think about how do we begin to lift

shelter in place because of the health harms associated with shelter in place and the disrupting of the economy, but then, how do we build -- how do we do what we're currently doing? some people -- because we're activated right now, we're using disaster service workers. some of them are going to have to go back to do their regular operations. how do we backfill those positions? how do we expand in those areas that we're going to have to expand, and each one of those is very different. so what's required for a long-term care facility is very different than what's required for shelters, very different than what's required for s.r.o.s, different than what's required for contact investigation and training, so there's work issues across all of those that have to be scaled up, and we're going through -- we're going through intensive planning right now, figuring out how we're going to do that. and i don't know if dr. colfax wants to add anything, but yes, what you're describing is

absolutely -- is absolutely where we're at right now. >> supervisor mandelman: and who is in charge of all that? >> that's -- that's -- the way that -- right now, that's being done through the e.o.c., and the e.o.c., the d.o.c., all that infrastructure exists, that we depend on all that infrastructure for everything that we're doing. >> supervisor mandelman: so that's being governed by a committee? >> so our testing head on this is dr. amy lockwood, as well as dr. philip, who is leading the testing concept. >> president yee: supervisor haney? >> supervisor haney: thank you, president yee. i have just a couple of things that have been hard for me to understand. one of them is a thing that a lot of people are focusing on, which is why we seem to have a different strategy that we're stating compared to other

counties like los angeles, who have been very open that they're able to and willing to test anyone who wants to be tested? i have a district where we have many s.r.o.s where there were positive cases, and people who live in those buildings want to be tested, but they don't currently fit into the categories where they're tested, so they're not being tested. it seems like you're explaining a lot of what our plans are and what we're doing, but we seem to be doing different and having a more limited approach than even places like san joaquin county who has taken a similar stance as los angeles. can you just quickly explain why aren't we saying exactly what los angeles is saying right now on testing? >> yeah. so i'm sorry, was someone going to say something?

i -- so the way -- the way that we're saying this, as dr. colfax is saying, we're moving in the direction of universal testing. and given the limitations that we nshlinitially had, we have prioritizing, and we started off in a prioritized way with the asymptomatics, focusing on outbreak detection, and so right now, for example, if we have -- in a shelter, if one person has developed symptoms that's positive, we're treating that as an outbreak. and so -- and we -- and we absolutely need to move beyond that, and that's exactly the direction that we're moving into, is going to be the universal access. and i completely agree with you. i don't know -- and i think what we need to do is because we -- because we received these questions last night, i think -- and i know dr. phil --

dr. phillips came last week. it's a complex problem, but i think we would be able to go more into these questions in detail by having the people in this work explaining what's been done. >> supervisor haney: any thing that i'm trying to understand is your approach at the department of public health to spechl people that are homelesare -- specifically people that are homeless, in shelters, and h.s.a.s. we've heard presentations on that, etc. it seems to me that because of how vulnerable these individuals continue to be -- and i can tell you, from my experience, from what i can see, very little has changed with regards to the number of people who are on the streets in very vulnerable situations. there -- it's basically the same as it was, if not worse

than two months ago. so as we begin to go to these next set of phases around opening back up, and nothing has changed to put these people in any sort of greater level of protection, and nothing looks like it's -- going to happen any time soon, considering the rate at which people are going into hotels, how can we be confident that there won't be spread, rapid spread among these populations as we start to open up for everyone else who has some protection while we have done very little to protect those that are most vulnerable? i just don't see how we're going to drop the metrics when we haven't helped people who haven't had any change in their vulnerability? >> yeah. we appreciate your comments,

and we realize that that is one area that we need to build up our early warning systems, and that's one of the focus that we have, as you're exactly describing. i think one of the things that would be useful, at a future time, in addition to coming back and talking about testing, to have folks that do the community hub, that do the work on the ground and work with these community populations. you can learn about how they're adapting testing to the population that have mental health and substance use challenges. so it's a work in progress, and i think it would be useful for us to come back and report to you on how that is going. it's not an area that i'm spending -- i'm spending more of my time on a higher level, but i think it would be great for them to come back and speak to you. >> supervisor haney: yes. we've heard from h.s.a. a number of times, but this is an

issue of public health and how we're meeting certain metrics and how we're controlling the spread. last question i want to ask, because i know that other people want to ask questions, it's related to the vulnerable population and homeless population. so the plan, as i understand it, is for people who are positive to go into an isolation and quarantine, and once they are negative again, they are spent back to a shelter where they are in a congregate living environment. i've asked h.s.a. before, but again, i feel this is a public health question. what does it say to the people that are "post covid"? it seems to me that these people are still in danger because their immune systems are way compromised, having

just survived a deadly virus, or from everything that i've read, i don't feel 100% confident that they cannot catch covid again, that we are putting them into a knowingly vulnerable environment, a congregate shelter environment, in some cases on a floor, having just survived this deadly virus. can you please justify that from a public health perspective? >> yeah, and again, we can have somebody come and tell you more details on how they're setting up those sites. you're absolutely right. there's a lot we don't know. we know that persons who have -- for example, health care workers that have recovered do go back to work, z and so as long as they've recovered, they can go back to doing what they've done in the past. but of course, you're right. we don't know -- in terms --

there are some people that may excrete the virus for a longer period of time, and people may get reinfected, and that's why we continue to practice distancing with face coverings because that is an unknown. so to the extent that people can recover, that they should be able to go back and deserve to go back to do what they've done before, but we do have to be extra cautious and recognize that we don't know, and that people still need to practice social distancing, facial masking, washing hands, etc. >> supervisor haney: and if i could just add, the concerns that you've raised are obviously importan --

>> and if i could just add, the concerns that you've raised are legitimate, and are key in getting policies moving forward, so we've working in the health department and making sure that things are aligned with experts in infectious disease and people who have been in homeless medicine as much as possible. >> president yee: so are you done, supervisor haney? i'm sure you have many others. >> supervisor haney: no, i can ask another question, but i just want to say. i appreciate that, but i do want to be clear that i have not seen any public health guidance that says it makes sense to take somebody that has just survived this deadly virus and all its unknowns, and take them and put them back in a congregate living environment. >> president yee: no. it doesn't seem that we're going to get to all the questions, obviously, and we're

going to make sure that they come back. i know that you're about 20 minutes more than what i asked you to do, dr. aragon, but i want to stay at least ten more minutes because there's three more people in the roster. so whoever comes first -- >> i will try to answer them, and then dr. colfax will back me up if i cannot answer them. >> president yee: so i'm going to go by this order. supervisor ronen, then safai, and walton, i know that you're before safai, but i want to give them a chance first. supervisor ronen. >> supervisor ronen: thank you, president yee, and director -- dr. colfax, and dr. aragon. i want to say thank you very much for your work. i know you've both been just working nonstop and have done a tremendous job at flattening

the curve and not overwhelming the hospitals during this time, and i'm so appreciative to both of you. but i just want to follow up on some of the supervisor haney's question because as you know, the place that we've been having a really hard time understanding the strategy around the department of public health has been with the homeless population. so we are now about seven weeks into the shelter in place order. i know, you know, that, like so many other san franciscans that are blessed to be housed, we are getting antsy. i know this weekend, the parks were filled and people had no

masks and we're trying to inform them that we're not out of this yet, and that in order to keep the curve flat, it isn't a done deal; that we have to continue to shelter in place in order to do that. but what's so hard for me when i talk to my housed constituents is that outside they door, they see massive, massive tent encampments where people are out in the streets without masks, they're clearly interacting, sharing equipment, have no access to showers, no access to water, have no access to food or very little access to food. they're going to work, some of them, because despite the stereotypes, many unhoused members of our city are working. and i've just been frankly shocked that there has not been

one health order issued yet directly related to this population. and it seems like you've operated with two separate standards: a standard of protection, an expectation for the housed population, and a standard of care and expectations for the unhoused population, and it's been really upsetting to me the entire time. and i'll finally get to my question. why haven't you issued a health order requiring shelter or some sort of setup where people are safe and distancing and have access to showers, water, and hygiene for the massive unhoused population of this

city during this crisis? >> and i'm sorry, supervisors. i just -- per president yee, i let him know that i unfortunately had a hard stop at 6:00, and supervisor ronen, dr. aragon will answer your question. i do want to emphasize, though, that from the beginning, the population experiencing homelessness was an acute priority of ours. in working with h.s.a. and h.s.h., we have housed in hotels hundreds of people that are particularly vulnerable. in doing that, we've saved many saves, and the isolation and quarantine hotels, we currently have 200, and we have a capacity of 500. i hear your concerns, very much appreciate them, but i do want to emphasize that this is a population that the health department and other departments have been focused on during this pandemic.

so unfortunately, i do have to leave at this point, but i'll turn it over to dr. aragon. >> president yee: dr. aragon? >> yes, thank you for that question. i know when i started looking into this, we did consult with the city attorney of what -- of just the whole topic of commandeering property. and one of the things that i learned -- there's actually two things that i learned, and that is in order -- in order to commandeer property, we would have to show that persons are not cooperating in our -- in our attempt to secure hotel rooms. and the other thing i learned is that because of due process, it could take longer. >> supervisor ronen: can you repeat your first statement? i missed that. >> so the communication that i have from the city attorney was that we would have to show that we were unable -- exhausted all resources -- all resources to get hotel rooms, and as long --

as long as the city can secure hotel rooms, that that should go forward. so that was -- that was my understanding. so it didn't seem to me to make sense to do an order if the city has the capacity to negotiate and get hotel rooms as the board of supervisors has also passed an ordinance, as well. >> supervisor ronen: well, dr. arag aragon, i completely disagree with your statement. but