of these. i will certainly vote to approve them. >> clerk: i apologize to interrupt. we have a late request for public comment and should take that caller. >> go ahead, caller. is the member of the public prepared to submit your testimony? you should mute the television or computer. there is a delayed broadcast. >> hello? >> a yes, i run val de cole. >> can you hear me? >> yes, we can hear you, sir. >> should i speak about the store or what should i say?

>> this is your opportunity to address any of the legacy business applications. ed you have less than two minutes. >> val de cole is one of the oldest wine store liquor stores in san francisco and i believe it started in the 30s and there was an older couple who always kept their newspapers and everybody loves our store and is always coming back. one year the american express called us a second store for repeat customers in the country

with the same people and the same customers. i started in 1977 and worked for a previous owner whose name was jacob and we learned all about wine and beer. the place is always respectful and we open holidays and we never close. i think it's a good addition to the community and in a different neighborhood. so there they really like us.

this is there for many, many years. >> you have 30 second, sir. >> that is why i am requesting for the legacy for the store to stay the way it is because it is very that is very classic. thank you. >> a commissioners, the mater is now before you. >> remind the commissioners to mute the mics when you are not speaking. next commissioner please. >> commissioner: i want to

congratulate all the legacy business applicants for this round. all of you spoke with great passion. i am so happy and proud to be added to the list. and i want to call out the comment by the san bruno store and with no communication and no real understanding with the landlord about how important the small business is and thank you for understanding the small business that is in your property and very happy that you understand and realize how important it is to keep small businesses alive in the city.

awe same thing as was already mentioned. i want to overall congratulate everybody and also welcome our new staff coming in. to do the application for us. i have a few to talk about and first the san bruno supermarket. i love that store and is always an anchor and to hop in and hop out with the ethnic food and is also a much needed grocery store with the minority and asian and other culture. i really applaud the landlord to

work so flexible and embrace to continue with the always changing district. congratulations. i fully support the application. farley's is my coffee shop. i really appreciate what farley's and ambience where i shop, too. i am proud to be able to sustain your business and have that legacy for the generation. and the society is amazing and i

hope you work with the neighborhood and their business to preserve and thank you for your application and your time today. i appreciate your stories and my pleasure to hear them again. >> absolutely. go ahead. i just wanted to congratulate and one of the comments i want to add is the legacy businesses donate so many dollars and goods and services to the schools and

charities to do that so generously. congratulations, all of you. >> i always was not on the list of commissioners -- >> commissioner johns, please go ahead. >> u a commissioner black and i share another thing in common, but after the wonderful and quite accurate comments that the commissioners have made, really the only thing left is to move that all these applications be approved and sent forward. >> second that motion.

>> very good, commissioners. there is a motion that is seconded to adopt approval for all the legacy and commissioner black? commissioner foeley? [roll call] so moved. commissioner, that motions passes unanimously 7-0 and concludes our hearing today. i will remind commissioners that

we have an officers meeting that we can join separately. great. thank you, all. all right. we are adjourned. stay well, everyone. >> thank you.

great. commissioner chung is here too. yes? mr. chung -- >> commissioner chung: thank you, i thought it was a statement. >> clerk: so all we're doing is waiting for commissioner christian but i spoke to her and she's on her way. so let's move on. move to item 2, commissioner? >> president bernal: yes, you have the minutes from the tuesday september 1st meeting in front of you, thanks again to dr. lloyd green for chairing that meeting in my absense be. and, commissioners, public comment? >> clerk: those of you on the public comment line press star, 3, to make a comment on the minutes. star, 3. all right, no hands raised.

so we can move on. >> president bernal: upon review of the minutes, commissioners, a motion to approve. >> so moved. >> second. >> clerk: i will do roll call vote. [roll call] great, the item passes. next is the report. i'm sorry? is it okay if i call out? >> president bernal: yes.

on the minutes. >> clerk: okay. so the next item, number 3, the director's report. >> good afternoon, commissioners. the director of health, and i will summarize and take any additional questions. there's a lot going on in the world of public health. some good news, september 9th the supreme court upheld proposition c, which will free up hundreds of millions of dollars for funding for homeless services, including a significant amount that will be dedicated to the behavioral health services for homeless individuals. so we are looking forward to hearing more on the legal opinion of that. but good news in terms of more resources for behavioral health issues where they intersect with people who are experiencing

homelessness. and we are currently gathering more information to determine how quickly those funds, if and how quickly those funds will be available. and i'm happy to report that to the commission when we have that information. with regard to 19, we are continuing on our gradual safer reopening based on the latest data and science. for instance, as of today, we have -- after opening up a number of places earlier this month, as of today we have indoor activities, including personal grooming services, very limited indoor gym and personal trainer activities, and then we -- museums may open potentially as soon as september 21st, obviously, with safety guidelines in place. we are also moving forward with

school reopenings. schools that were submitting safety plans and we'll start with a k-sixth grade and a move to middle school and then high school and a gradual reopening. and the team has been working very hard on that. we'll cover more covid-19 issues in detail further on in the agenda. good news on the front with regard to h.i.v. we released our h.i.v. report in 2019, and we achieved a record low of 166 cases of h.i.v. in the city. this is a 19% decrease in new diagnosis since the previous year and declines were seen across almost all groups, including among black african americans, people who are on drugs and people experiencing homelessness. there continue to be inequities

with in a spike of crimes and of our goal of getting to zero with other h.i.v. programs. in regard to work in the covid-19 pandemic with regard to research, we also were able to collaborate with with u.c. san francisco, the latino task force on covid-19, and d.p.h., and with supervisor hillary ronen and the biohub, which conducted testing in a transit hub, at 24th street mission plaza, found very high rates of positivity among the latino population at that -- at that site. consistent with the findings that we continue to see high inequities of covid-19 diagnoses among latinos who constitute 51%

of current cases. we are focusing to looking at our prevention and care response, including through increased access to testing. as i previously described we now have mobile pop-up sites with testing expanding to multiple neighborhoods with high rates of covid-19 infection, including the mission, and visitation valley. and i just wanted to share the data that with regard to contact tracing and case investigation, 89% of latino cases have been interviewed with more than 90% of contacts interviewed since june. this is actually higher than the overall average. and then in keeping with our isolation and quarantine availability and ensuring that people have opportunities to isolate and quarantine if they cannot do so at home, up 46% of the residents in isolation at home or in hotels have

identified as latino. i will stop there and -- well, actually, there's one other key issue that i do want to highlight in the director's report, which is that we have been working very diligently and in partnership at covid command with our partners at the department of emergency management with regard to air quality. and the intersection, obviously, of air quality and hit health, d ensuring that we are sending the messages that communities are being supported where necessary with facial coverings and that staff have the support they need in order to deal with what has been a very challenging couple weeks with regard to air quality. and also as of labor day with heat, unfortunately, given the effects of climate change, this is not the first time that we've had this, and because of covid

command we're more coordinated in our response than ever before. and other things in the director's report that i don't have time to read through today. there's a number of press links, that i'm happy to answer any questions about. thank you, commissioners. >> president bernal: any comments? >> yes, i have folks on the comment line. if you would like to make comment on this line, raise your hand by pressing star, 3, so we'll know. give you a few seconds. all right, it looks like there's no comments to this item. >> president bernal: all right. commissioners, any questions or comments? i don't see any hands raised, but does anyone want to chime in. >> clerk: commissioner christian raised her hand. >> commissioner christian: thank you.

director, i wanted to ask very quickly if there's -- in an ongoing way, if there's any guidance that you can give -- the department can give to san franciscans about how to protect ourselves from the smoke and chemicals in the air, from the wildfires when we are not able to use the medical grade res re. and we're not using them for smoke. there's so much toxicity in the air and even when we don't smell smoke or when we see smoke, and that, obviously, as the department tells us, weakens the pulmonary systems, makes people more vulnerable to covid and to flu and to everything else. so, you know, obviously there's a correlation but we don't have the protective measures that we would like to -- in order to

protect ourselves from that. given that we can't use the medical-grade re-respirators, is any guidance that you could give to us how we can fortify our masks, or our cloth masks, anything that we could do traveling to and from work or out by necessity to protect ourselves? thanks. >> thank you, commissioner. we do have guidance, it's somewhat complex given the air quality and different populations that are at risk, depending on the air quality. but i can certainly provide you with that link and we can make sure that we get it before this meeting is concluded to share with the commission in terms of exactly what you're asking for. so i'll make sure that we get that before the end of this meeting. >> commissioner christian: thank you. and also just continuing the great work that you're doing about getting information out to the community every day.

so, thank you so much. >> absolutely, thank you, commissioner. >> president bernal: commissioner chow. >> commissioner chow: yes, i just wanted to make a comment to commend the department and dr. colfax on the h.i.v. report. and i understand that we're going to hear it in our next meeting, but i didn't think that we should let that go without commending the work that's been done there. it's tremendous. and even though we haven't quite gotten to zero, at least for some of us who have been around for a while, this continues to be an amazing trend. and in the face of it getting harder as we get smaller and smaller numbers. so, again, kudos to the department and we really look forward to seeing the report next meeting. thank you. >> president bernal: commissioners, any other questions or comments? i just have two quickly.

director colfax, first of all, i wanted to second what commissioner chow had said about the h.i.v. report, it's a very promising development as we continue to see decreases year-over-year. and it's a testament to the excellent work that the commission and the department has been doing on an ongoing basis. seeing dr. buckbinder, susan buchbinder on the agenda to speak about our vaccine work reminds me not only of the wonderful work that the department across all areas does, but the additional burdens and the additional stress that's placed both on staff from the executive staff throughout all of our programs to our frontline workers. can you just sort of characterize how the staff is doing, are they experiencing, you know, fatigue? are there resources that the commission or support that the commission can offer in order to support them personally as they

do their critical work and network? >> well, thank you, commissioner bernal and i appreciate the question. i think that as you said this is a marathon. and i think that we're in a stage now where we're, i don't know, the 10th or 15th mile. and this is where, you know, some of the adrenalin, institution adrenalin, is starting to wear off and people are really, you know, i think that some people are dog tired, to be totally candid. we're digging deep. i think that there's resilience among the d.p.h. team, and as importantly, and more importantly, the community partnerships are in this response. and we are looking at -- i'm looking at what can we continue to do and what are some things that may need to be potentially delayed in the department just because we have so many different things going on.

and covid-19 is, obviously, paramount in our need to respond. so i think we're looking at that. and that hearing that if there are certain components -- not so much service delivery, because you know, with the board support we are not cutting any services, even though it's a challenging budget environment. but other things that can be delayed in response to our covid-19 needs. we have hundreds of people working at covid command. all those people have very -- very busy jobs before they were put into covid command. and they are very busy there as well. but, certainly, i think that the capacity for the department to do everything at the same time is really challenging right now. again, we are used to working in

a scarce -- in an environment of scarcity and that's sort of where public health has been for many decades. so i think that we can be responsive and continue. but we really do need to be taking a look at other things that if they don't have to be done this week or this month, can we delay them without, obviously, harming the public health. i'll just give you a concrete example. as we enter the fall, in addition to the smoke, we're really looking at how do we ensure that we have a comprehensive response to the flu, right, you know, whether the flu vaccine and education efforts and outreach efforts. those efforts have always been incredibly important, but more important now than ever because we don't want a twindemic of covid-19 and flu. so we're pulling staff from other areas and actually working across other city departments through our emergency response to see if we can provide --

bring in more -- essentially more bodies with the right background, of course, but more capacity in order to address this very important issue. so, yeah, i think that as we saw with h.i.v. and i appreciate, obviously, dr. buchbinder is an international leader in this work and i think that our h.i.v. response is building into the institution's memory, which helped to respond to covid-19 in the way that we did, we can and we will get through this, but it's a long way to go. and i would just ask for the commission's support. obviously, you know, guidance, and also just ensuring that -- that people on the frontlines hear that what you care for you support, and most importantly that you understand. thank you. >> president bernal: and dr. colfax, i believe that i speak on behalf of the entire

commission in expressing our gratitude and support to all of the d.p.h. staff who have not only taken on dual roles during the pandemic, but keeping the department going in the midst of the pandemic. we'd like to make this an ongoing discussion, so please be sure to bring to us anything that we might need to know in how they might be supported in ways they can ensure that they know how grateful we are to them and how much we're cheering for them. and thank you, and thank you to everyone at d.p.h. dr. colfax, one more question, and you mentioned during your report the disparities that the latino communities are experiencing in the pandemic, certainly, in terms of our transmission in the community. we know that there are a lot of different factors that lead into it, whether it's being an essential worker, someone who cannot work at home, people living in congregate settings, can you tell us about the engagement that's been happening

with the community in order to address this and how we're moving forward with this? >> yes, so as the commission knows since the beginning of the pandemic, we have been focused on the communities most affected by covid-19 and we identified early on that the communities at greater risk for covid-19 would include the communities at greater risk for other poor health outcomes. and, of course, the stigma, the discrimination and the xenophobia and the environment in which we're living in, particularly with regard to including and perhaps particularly with regard to immigration, san francisco is obviously a sanctuary city and the department provides health care for everybody, regard regas of immigration status. but these are all factors that are contributing we believe to covid-19 spread. from the beginning at covid command, we had -- we had an

equity officer and efforts to engage across the city departments and not only at the department of public health but with h.r.c., and the department of emergency management and the human services agency and others that we were engaging with key stakeholders in different neighborhoods with c.v.o.s in order to strengthen our response. as we focused on getting testing initiated and scaled up, we ensured that testing was made available to anyone who was working in the city, including people who are not able to shelter in place for various economic or other reasons. the testing was available because we knew from early on that working during the pandemic is potentially a risk factor for infection. so our broader response, as i mentioned in my director's report, including -- have

included strengthening our contact tracing and partner notification in collaboration with really the organizations. providing those isolation and quarantine hotels. but it is also evident is that we must invest and strengthen our testing efforts in communities where covid-19 is most project. frequent. and we must do better. in fact, we are working with a member of key stakeholders and leaders in the latino community to develop a community-led community-focused strategy on how to more meaningfully and sustainably to address the fact -- the fact that 51% of our pandemic in san francisco is in

the latino community. all covid-19 response going forward must be a latino covid-19 response. >> clerk:. >> president bernal: thank you. i know that we'll hear more about this in upcoming meetings. commissioners, any other questions or comments for the director? i do not see any. so, thank you, director colfax. and we can move on to our next topic, covid-19 update. >> thank you, commissioners. and for this update we have i

believe a number of items. we have my update in terms of going through and describing the epidemiology and then i believe that our health officer dr. tomas aragon, and then dr. susan buchbinder with an update. and to provide you with the latest update since two weeks ago, our last meeting we have exceeded our number of 10,000 cases in san francisco. we're currently at 10,430 covid-19 cases with, unfortunately, 91 deaths due to covid-19. in terms of our testing and case numbers, our testing numbers were at 3,401, seven-day average test collected that. has dropped just slightly over the past week or so. we were almost to 4,000.

just a note here that we had to reschedule and sometimes cancel some testing events due to the incredibly poor air quality. so hopefully those numbers will continue -- we have capacity to expand beyond the average that you're seeing here provided that weather conditions improve. and we're also starting to strengthen our ability to support staff in increment levels in these testing situations. of course, the smoke is one thing, but as we hope that there will be rain, and we need to make sure that people have an ability to support those testing sites, even in inclement weather. our seven-day average percent positive is 2.36%. and then as we have talked about already, we see the distribution of cases and that inequity that is really highlighted here with regard to latino cases. i would also add that this

disparity is something that is being seen regionally across the state as well as nationally. next slide. so this is a slide that really i think that shows the commissioners how we are shifting our testing focus as we invest more in testing. our pop-up sites, these are sites that mayor breed announced a month or so ago -- actually six weeks ago now. the capacity up to 250 tests a day, and we have basically worked with community partners, neighborhood partners to establish the pop-up sites in different neighborhoods across the city. you can see the cumulative positivity is nearly 4%. and then again you can see the positivity among latino clients is very high -- in some cases higher than the average

positivity in all cases of these pop-up sites. and so as we continue to expand testing in these neighborhoods, particularly the southeastern part of the city, invest more testing resources, we do believe that we will be more responsive, increasingly responsive to the fact that we need to be doing more testing where the virus is actually concentrated. when you compare that to our numbers with regard to our site with the city test s.f. sites, you can see the numbers of tests that have been done there recently. and you can see that those positivity numbers are low. and, once again, the positivity among the latino clients is high -- higher than the average overall, but even there not as high as it is -- despite that they're not as high as they are at the pop-up sites. next slide.

this is the county covid-19 comparisons of similar size. at this point you can see our cases relatively low, with the exception of king county, the rate below san francisco. and the death reas rate thankfully is low compared to the other jurisdictions. and our testing numbers -- with the exception of new york city which in this iteration lags a bit higher than us, with many more tasks before the data is available. next slide. this is our hospitalization patterns since the beginning of the pandemic. you're familiar, obviously, that we lowered the curve through june. we had that surge starting in july. peaking in early august and

continuing into the beginning of september. we started to see a decrease down to 51. those numbers are slowly creeping up again as you can see that we're at 76 cases. and we are looking at that very carefully, especially with regard with the heat, the smoke, the labor day holiday and we saw a lot of crowds in a lot of areas. we're watching this. obviously, we know how to -- san francisco knows how to reduce the curve. we've done it twice now. with social distancing and the masking and the hygiene and avoiding gatherings, and the being outside. if people do gather instead of being inside are really, really key. we know that it works. and what is striking also about this chart is really that the virus is very responsive to our interventions. i think that sometimes in the context of how we are responding to and thinking about covid-19,

this gives hope because we hav have -- this can actually be -- be controlled. certainly, slowed, if not -- not stopped, but at this point certainly slowed. next slide. these are indicators. these are stats which go to high alert, red, for our increasing covid-19 hospitalizations. again, watching that very, very carefully. that is a concern. we will see how it goes over the next few days. our hospital capacity remains good. you can see that there's 28% and 37% numbers. our case rate remains stubbornly high. it's and down a little bit. and that number got significantly higher a number of weeks ago and we're now down to seven, so we're watching that. and our testing numbers have already went through and our contact tracing and partner notification numbers are creeping up in a positive direction now at 82% each. and then our personal protective

equipment, 30-day supply is at 100%. this is our -- this is a slide from dr. peterson and joshua saab at u.c. berkeley. and it tracks the reproductive rate of the virus with some of the key interventions. and the calendar dates that have happened since and you can see that shelter-in-place is associated with a steep decline and the reproductive rate. we went down then to a reproductive rate that was as low as .84%. and you can see that another slide there we saw, unfortunately, an increase in reproductive rate commensurate following that memorial day weekend. and then you see, again, that we reduced the reproductive rate

commensurate with that hospital slide that -- the hospital occupancy slide that i just showed you, going down through mid-august. and i will take you to the next slide, please. this is our reproductive rate through september 13th. we hit a reproductive estimate of lower at that point, at the lowest point .86%, but a few days ago that number is now creeping up and we're now at .88%. with just that at the very corner at the end of that slide, of -- of above 1%. so that reproductive rate, while going down is slowly rising again, commensurate with that increase in the rate of hospitalizations as well as -- as well as the estimate that we have here. so we're watching that

carefully. i will say that in relationship to some of the reopenings that we have announced and as of today that we have allowed, we at this time are comfortable moving forward on those, understanding that with more activity even though we are at low-risk activities, we're likely to see more cases and more hospitalizations. i believe that is the end of my presentation. i'm happy to answer any questions here or if the commission would prefer to go through the next few presentations, i obviously defer to your pleasure. >> president bernal: thank you, dr. colfax. for those following along in the agenda, [broken audio] at the conclusion of the third presentation we will do public comment and then commissioner questions additionally. so we can take questions or comments from commissioners now.

commissioners, if you have a question or a comment, please raise your hand. commissioner giraudo. >> commissioner giraudo ed.d: my question is in our last presentation on primary care clinics, for the positive cases from the zuckerberg child health center, there were 284 kids that were positive. so did we have any other statistics for the positive rate for children in throughout the city? is it on the rise? or do we -- do we know? i was just a little surprised with the number. >> commissioner, thank you for

the question. we do have those numbers available. i will get them for you. there has been a shift to a younger age group with covid-19. especially with schools reopening, i wouldn't be surprised to see with the increased monitoring and potentially testing that we would continue to see increase. we can get you those numbers and i'll be sure to include those in my next update. >> commissioner giraudo ed.d: thank you very much. >> president bernal: commissioners, any other questions? director colfax, i did have a question with regard to the state's new blueprint for a safer economy. we know that at the end of last month the state had moved away from the launch list and had moved to various risk levels and we were put in this substantial category, which is the second highest after widespread. we had seen that some of the data would suggest that we -- we

should have remained in the widespread category, but the state had put us in a lower one. have there been discrepancies in the data, or is that all been resolved? >> thank you, commissioner and dr. aragon i'm sure can fill in any additional information that i leave on the table here. but just i guess that the way that i think about it is that the god news is that we're doing a lot of testing in san francisco. we're doing far more testing than any of our surrounding counties and very possibly than any other county in the state. when the state came up with our color-coded system, and purple being the highest risk category, and red being the next highest risk, it basically discounted -- based on testing rates. so if counties were doing high amounts of testing, they adjusted to the amount of testing. they overadjusted for us. so they basically take our k3

and multiply it by .65 and when we do the analysis, though we're doing a lot of testing, our discount rate is more appropriate to be .85. so 20% over adjustment based on the case. so bottom line is that we have a higher disease burden than is reflected in our determination of the state that we are a red zone. we are more like a purple county in terms of our disease burden. and so we have to continue to be cautious as we reopen, which is one of the reasons that we are not at this time comfortable moving forward with reopening all of the potential activities that could be reopened in the red zone. obviously, the state had to come up with a scheme that fits the entire state and, of course, because we're san francisco, we are different and we are looking

at our local data and local epidemiology. and, again, in our situation the adjustment of the state overcompensated for our testing rate, the disease burden is more of -- is more in keeping with a purple county. then, again, i'll dr. adnan pachachi aragon to provide more context. he and others in the department have done extensive analysis on this. >> president bernal: and then just one last quick question. the recent increases that we have seen in hospitalization, we believe that it's too early for that to be attributed to gatherings over labor day, that if we see any impacts on that it would be a little further down the road? >> it's plausible that some of that is, but at this point we expect to see increases in cases first with the hospitalizations. and the hospitalizations would typically occur 10 to two weeks after. remember, hospitalizations are basically a reflection of where

the virus was two weeks ago. so it's too early to determine what the effects of labor day are going to be. >> president bernal: thank you, director colfax. commissioners, any questions or comments for director colfax before we move on to the next part of the presentation. all right, we can move on to dr. susan buchbinder. >> thank you. so i'm going to talk to you about covid vaccine studies that we are sort of more looking at globally about what is happening nationally and internationally, as well what we are planning to do here. next slide. so what is it that we're hoping that a covid vaccine could do? well, we're hoping that it would benefit the individual by maybe preventing all infection in addition to just the sevirrity f

illness and to create healthier communities. next slide. so this is an electron micrograph of the covid -- the virus that causes covid. it's called a coronavirus because it has this crown or circle of light that is made up of these spiked proteins that you can see illustrated on the right. and virtually -- most of the vaccines that are being developed are really being targeted against this pro fine. and i'll show you why in just a moment. next slide. so this is a virus shown on the lefthand side of the slide and the human receptor shown on the right hand of the slide, a human cell. the receptor is the lock that keeps things out and the spiked protein has a key that opens up that lock. and so if you go to the next slide you can see that the --

when the virus attaches with the spiked protein inserting itself into the receptor, it opens up the cells to become infected. next slide. so what we're trying to do is to create -- to teach the body to make antibodies and cells that will help to prevent that from happening. so the green and the purple y-shaped molecules that are attaching to the spiked protein are the antibodies that we would be developing against the spiked protein. you can see they prevent the spike protein from docking in the 82-receptor by binding to the spike protein and protecting it against infection. so that's the way that vaccines might work. they could either train the immune system to create those antibodies, or we could just infuse antibodies by themselves. and i'll get into that in a moment as well. next slide, please.

so this is how we test vaccines and other drugs. there's a pre-clinical phase that is done in animals that isn't even showing up on this slide. and then by the time you get into human studies, you go through three stages of studies before a product is licensed. phase one is where you're testing safety and the tolderrabilittolerabilityof tho. and that is usually smaller studies, less than a hundred people. and you get to phase two and you're looking at the best dosing schedule and what the immune system's response is like to the vaccine. and that is usually a few hundred to a few thousand people. and then phase three is where you're actually testing to see whether or not it provides protection against infection or severe disease. so what we need to do is to go through all three phases and what you have all heard about

"operation warp speed" and how much this process has been accelerated. but i wanted to emphasize that the phases are not being skipped. what is happening is that the gaps between the phases are being shortened or eliminated. in some situations we're doing joint phase one/two studies or joint phase two/three studies and some of the bureaucracy that happens between the phases is being removed. so that, for instance, we go to an institutional review board for review of our protocols, usually those sit there for weeks while we're waiting for them to be reviewed. now they're going to the top of the queue. and so they're being reviewed very rapidly. so it's not -- there's no skipping on phases. and there's no skipping on the safety measures that we build into the trial. and i'll get into that also in a moment when we talk about the astrazeneca trial. next slide, please. so this was the coronavirus vaccine tracker as of

september 10th. if you look at it today you will see that the numbers have actually been bumped up even more. you've got phase 25, and phase 1, 14, and phase three, that have been limited vaccine -- limited approval for use. actually in today's tracker, there are five that have been given limited approval for use. two of them are in china, one in russia, and two in the united arab emirates. all of those vaccines which have limited approval have not gone through phase two testing yet. so we don't have any data yet on whether or not these vaccines will survive protection. and we need phase three in order to make that determination. but you can see that there are nine vaccines in large-scale ethicity testing. next slide. so the way that we're testing this is through the covid

prevention network or the co-vt.m. and it was formed by n.i.h. that is pulling together a variety of different sites that many of which were part of the h.i.v. prevention and treatment network to form this new massive network of sites across the world. and we have three sites currently in the bay area. we have our site at the san francisco department of public health and h.i.v. and there's a site over at zuckerberg san francisco general. and ebac, the center has a site in oakland and there's a site at in san francisco that may come on board soon. the mission of is to have ethicity studies to study covid 19 disease. and the plan is to open up 5

phase three vaccine efficacy trials in 2020. each roughly 30,000. they're very large studies. and infusing the antibodies themselves without using a vaccine but just jumping right to creating antibodies and infusing those directly into people. those are smaller studies and they're also currently underway. next slide, please. so this is a map of the co-v.p.n. and we have sites in soutsouth america and in africa. next slide, please. and these are the five vaccine trials that are planned to be tested in the co-vpn by the end of the year. and i have highlighted the co-vpn astrazeneca trial because that's the first one that we'll be testing in san francisco. next slide, please. so what is the astrazeneca

vaccine in well, it's taking a chimpanzee virus, that causes a common cold in chimpanzees and it's altered so it can't cause infection or disease in humans. what it's used at is a carrier -- it's a carrier device for bringing in genetic information about that spike protein. so that the cells in somebody who is vaccinated will create some snippets of the spike protein and train the immune system, if you see this in the future, and it would be that you see it as part of sars co-2 infection, to fight this off and eliminate this. so it's a way to train the system to eliminate the virus if it's later -- if you're later exposed to the virus. we have seen that it triggers a strong immune response in individuals, both antibodies and

immunicipaimmune cells. this is an older phase, and in phase one and two trials it's been safe. you may have heard in the news that we're on a pause right now because a participant in a phase two/three trial in the u.k. developed an unexpected illness that could be associated with the vaccine. it's not entirely clear whether it is or not. the evaluation is currently underway. the regulators in the u.k. have reviewed the data and have made a determination that it's safe to reopen the study, so it's been reopened in the u.k. it's reopened in brazil and in south africa. but we have -- we're still under review at the f.d.a. and with the monitoring board in the u.s. so we're not open currently. it just opened in late august when it got shut down on september 6th. but this vaccine platform, the

chimp virus that has been used in 14 different studies against a wide variety of infectious diseases. next slide, please. so the astrazeneca trial is a phase three study. and it launched on august 28th of 2020. and recruitment was planned for eight weeks. we'll be enrolling 30,000 participants, 20,000 will get the vaccine and 10,000 will get a saline placebo and a salt water placebo. we targeted 250 to be enrolled in each of the san francisco sites and 250 in oakland. it's going to be recruiting people who are at risk for covid-19 disease. it's generally otherwise fairly broad eligibility criteria, but excluded are children, pregnant and breastfeeding women, and people with prior or known

infection with the sars or covid virus. people will get two doses of the vaccine, one month apart. and there's a final visit at two years. and they get weekly text reminders to report any symptoms so that if they develop covid at any time during the trial that we bring them in immediately, we test them to see if they do actually have covid. and then we do very, very close monitoring to be sure that they're not getting sick. and we do that for both the vaccine and the placebo because we obviously want to take the best care we can of people who develop covid. next slide, please. so we do have a number of challenges. including anti-vaccine sentiments. and some of this is anti-vaccine in general, and you can see this person has anti-covid vaccine sentiment. and has a sign tha, which,

unfortunately, it doesn't appear to. so next slide. we do have a substantial concerns on the part of people about getting covid vaccine. this is from an n.p.r. pbs poll done in early to mid-august. if a vaccine for the coronavirus is made available to you, will you choose to be vaccinated or not? and what you can see on the left is that 60% of all adults said yes, but 35% said no. and the rest were undecided. but there were differences based on political affiliation with democrats being more likely to say they would get the vaccine than the republicans. next slide. of concern is that there are also these racial and ethnic differences in people's willingness to get the vaccine. we have heard from director colfax about the disproportionate impact that we have of covid-19 disease in the

latin-x community and nationally as well in black african americans. and so we do have real concerns that there may be considerably hesitancy about getting a vaccine from the very populations that may well benefit from a vaccine. next slide, please. so we're doing a lot of community engagement and we have a series of listening sessions and town halls with community members. we have launched a local website called "wecanbeatcovid.org" and we have a spanish version of it. nationally we have the coronavirus prevention network website that people can sign up to be part of the study. and they are launching campaigns now with people in advertising and they have a faith-based initiative. next slide, please. so we do want to ensure that the recruited population requests the local and national epidemic

and that is true by race and ethnicity as well as by age. there's a target of at least 25% of the population should be five years of age or older. but we'll be -- we'll be enrolling people with all kinds of exposures to sars co-v-2. next slide. this is the co--vpn website. they have a registry, and already over 9,000 people signed up just for the san francisco bay area and that distribute include the east bay that had another 11,000 people sign up. this was a couple weeks ago. and people continue to sign up. so we are using that as a way of doing outreach to individuals who may be interested in participating in the study. and because we have the demographics of the individuals that are signing up, we can specifically select for our priority population. next slide, please. and this is the last slide. this is our website. i encourage you all to go to it.

it's wecanbeatcovid.org. this is artwork done by a local latino artist. so, thank you very much for your attention. i'm happy to take any questions. >> president bernal: thank you, dr. buchbinder. commissioners, any questions or comments. commissioner green. >> commissioner green m.d.: well, first of all, this was an absolutely fantastic presentation. i have to compliment you on making it so easy to understand, really clear. it's really, really wonderful. and i am so grateful to you. and i hope that it be shared maybe for a broader audience, because it really helps people to understand what you're trying to do. i guess that i had three questions. one would be, and more science-based -- we've always

had issues with the older population not responding to at least the flu vaccine. and what the thinking is about these particular vaccines? because i don't know enough about the platforms to know whether the flu vaccine --... or the issue is the virus that people have been exposed to so they don't respond. and the second would be whether this person that got this, it could be an autoimmune response to the component and what the thinking is among the scientist there is and what the tolerance really is for that type of, you know, what is the denominator that is tolerable for that? and then the third would be -- and this is more in terms of public communication, you know, there's been so many articles written by people about how the anti-vaccine movement is really well organized, national, and kind of ready with their, you know, their prepared effort to

kind of discourage people from undergoing vaccination. so i'm wondering what your sense is of the tools that we have, the incident to which the national response to encouraging vaccination when we haven't really had a national response to the disease in general. how that will happen. and, if so, where will it come from? we were so good in the bay area to have our counties working together and we do have unique populations that we have to focus on. but i'd really love to understand what your perspective is and what is going on there. so if you don't want to answer on the medical end, that's fine, but i'm curious from the commission's perspective of the communication component. >> sure, so i'm happy to take all three questions. in terms of the older population, we don't know whether there's going to be diminished response in the part of older people. we don't have as much data on the immune response yet from the earlier phase trials, because

they started in younger people and then moved to older people. so that's why we want to be sure that at least 25% of the population enrolled in the study are over the age of 65 or older, so that we can be sure that the vaccine works in that group. because there's a diminished immune response in people who are older. probably irrespective of what the platform is. the second question that you asked was about the transverse myolitis, the illness in the woman that became ill as part of this phase two pre-trial in the u.k. it is potentially an immune response. it is seen very rarely in vaccinations, and seeing a variety of different viral infections. we don't know whether there's something about this particular platform that might increase somebody's risk. that's part of what the

investigation is about, is to try to dig in and see if there are any other potential cases that have been reported as that in the press. although we don't have a final diagnosis yet. it'that has been reported to us. and then the anti-vaccine one is a challenging one. and the co-vpn has created a beautiful ad campaign, doing outreach, particularly to communities of color and to older communities. and also more broadly as part of a movement to try to encourage people to get vaccines and to do this as a way of really affecting the trajectory that we have of the covid pandemic. they're also doing outreach to the faith-based initiative, to faith leaders, to try to again, to encourage the trusted members

of different groups to support vaccine science. but it's going to be an uphill battle because there is really a strong anti-vaccine message. some of which is general against all vaccines and some of which is covid vaccines specific. >> president bernal: commissioner guillermo. >> commissioner guillermo: thank you, and thank you very much, dr. buchbinder. i want to add my -- my compliments to dr. green for your presentation and the work that is being done in san francisco in regards to the vaccine trials. i want to dig just a little bit deeper on the make-up of the participants in the trial. you have indicated there is about 9,000 volunteers already signed up. and i was wondering if there is

a way that you could share with us the data on the breakdown by race ethnicity and if there's any data on language and socioeconomic status for that data. because it's one thing to have an intent and an outreach effort, but to actually to have the participants in the trial reflect that outreach is really, really important, and not just for the covid-19 vaccine, but sort of beyond this. so we can learn something in recruiting for these trials or for other trials in the future. so i wanted to know if you could share that data with us and if there are lessons that can be learned in terms of the outreach and targeting. and then the other question that i had was, with this network, this is a network of

n.i.h.-funded trials. do you have information about trials that are being invested in privately outside of the funding. will that have an impact on what you learn or any coordination with the research that's going on that san francisco is part of. and how might that be connected? because it's quite possible that we would have san franciscos participating in other practice files and that information can be confusing to those who are -- we're trying to recruit for san francisco, or does it matter? so if you could answer both of those that would be great. >> sure. so what we see is not unexpected that the demographics of the people who have signed up are heavily skewed white. and skewed towards english

speakers. although they have the co-vpn website in spani spanish as welo people can sign up in both english and spanish language. the good thing is that because there's over 9,000 people and we're only enrolling 250, we can specifically prioritize those populations who we think that should have first dibs at the trial. and so we have been doing outreach to communities of color in particular and in particular to the latin-x community. and we've gotten really quite a favorable response from many of the people. not everybody, but many people are really eager to participate. we have all of our materials available in english and spanish at both our site and the zuckerberg san francisco general site so that we can enroll

spanish speakers as well as english speakers. unfortunately, we only have it in those two languages. but it does at least broaden our ability to recruit into the trial. and we're doing our own outreach in the mission, we've got a number of -- we're doing a presentation with district 10. we're doing as much outreach as we can in our local communities and have our own website so that people can sign on by ourselves. i don't have more data on the socioeconomic status of the people who have signed up, but i do have the race ethnicity data. >> do we know that pacific islanders are also recruited? >> yes. >> because the data on pacific islanders in particular is something that is of concern. >> yeah. >> i understand that we have

limited resources, but trying to get to populations that are most affected, then to leave out -- >> yeah. >> and elderly is probably -- not probably, would definitely be important. >> i completely agree. and we see the death rates in the older asian population is particularly high in san francisco. but we need to be sure that we get a really diverse group of people who are offered enrollment in the vaccine and then they can make the decision whether or not they want to enroll. your second question had to do with non-n.i.h. funded trial. there's the pfizer trial that is done outside of the co-vpn network, so that's a large ethicity study that's being done. there is a site in the south bay and in sacramento for that particular trial. what we're trying to do is to do outreach to all of the local trials. so, for instance, we already have been working very closely

with the site at zuckerberg san francisco general and at evac and we have weekly calls where we do all of our coordination and a lot of outreach in between. we're doing a lot of outreach to the v.a. site, and we don't want to cause confusion on the part of participants and it will be critical. because the v.a. site will be enrolling in a different trial. they're looking at a different trial. so we want to ensure that all of our community outreach and messaging is unified, rather than fragmented. >> president bernal: commissioner chow. >> commissioner chow: yes, thank you so much for this information. i love the pictures and the spikes on the antibodies. but i was also following up on commissioner guillermo's questions on a little more broader basis. it looks like the network that

we're all working with here is a network on your map that excludes a large part of the world in terms of studies. and i'm surprised, you mentioned england as one of the sites for the astrazeneca and yet they're apparently not part of this. i think that this whole thing says, how do we really coordinate. and then we're hearing that the federal government has already -- that by presumably by mid-october you should be ready to receive vaccines. so i think this is, again, part of a public trust. how do we then respond to the fact that we're doing studies here, and, you know, it looks like this is something that we should (indiscernible) and we're hearing about the western

studies, but how do we know which vaccines then are going to be available through this process? and a third thing that we heard, which i'm not sthaw sure that is correct, is that distribution was not going to be through a private -- through doctors and their channels, but apparently, supposedly in commercial sites. and that i'm not even sure of. you know, these are all kind of what is floating around. so how do we gain back trust? this is one part of the presentation and, clearly, a very important part. and we've got at least as you say probably about half a dozen vaccines ready to go. but they're all in different little pockets like this. so which of the six are we going to want to take? >> yes, i think that this is a huge question. what i've described is really just a small microcosm, that's just testing the vaccine to see

which ones work. we're not the only game in town. so i mentioned the pfizer vaccine because that's taking place in the united states, but there's a lot of vaccine trials in south africa and brazil and in the u.k. that are being done currently outside of the co-vpn. and there are studies happening in the united arab emirates and in indonesia, you know, so there are trials going on all around the world, the different countries response. and i was talking about what the co-vpn was responsible for. and in terms of distribution of vaccines, that's really going to be quite challenging. and i think that there are a lot of unanswered questions about exactly how that is going to happen. so i'm really at the earlier stage of all of this, which is just the testing to see whether or not we have a vaccine that is worthy of distribution but once we get one or more then there's also going to be the question,

who gets which one. because we won't have enough vaccine of type a for everyone, but we might have tap type a, bd and do they have different ethicity in different populations and we should prioritize type b for the elderly? or prioritize type b for younger people? we just don't know at this point. so i think that it's going to be a much more complex landscape as we move forward. i hope that answered it. >> commissioner chow: well, no, you've helped to frame the questions. and yet if these are going on at this time, at what levels then will our own local health department be involved? either working with the state on how the state distributes, similar to i guess what the state did -- or thinking of

doing with testing and has done with, you know, p.t.e., although somewhat late. and if they're really saying this is going to occur, whether it be october, november or december, that's not very long from now. this is early september. if we haven't been able to answer these questions or possibly i should say -- who is going to answer these questions? and maybe, you know, i don't want to lay this right on you and in your lap, but perhaps we could move that question also to the department's leadership if you felt that would be more appropriate. >> yeah, i think -- my hope is that it is going to come through the states and then through the city health departments. because i think that we have an important role to play in prioritizing who gets vaccine first. we need to be sure that we're getting it to the populations at

highest risk. >> commissioner chow: so i guess that i will save the question to dr. aragon to what levels we are at the moment involved in this dialogue. but i do want to compliment you on really being part of -- us all in this community being part of the studies that are going on. and the fact that so much has been done so rapidly and i think that is directly related greatly to the work that was done on h.i.v. and the ability to be able to identify these things. and now we're really going at warp speed on these things. and much faster than 20 or 30 30 years ago and every step seemed to take about a year before we moved to the next step. >> right, that's right. >> commissioner chow: it's wonderful and congratulations and great to have you right there on board. i'll want your vaccine, i think. [laughter]. >> well, i'll be sure to save some for you. >> commissioner chow: thank you very much. >> okay, thank you. >> president bernal: thank

you, commissioner chow. commissioners, any other questions or comments for dr. buchbinder? >> i want to say to dr. buchbinder i echo my colleagues' congratulations for making this so -- this information so accessible. i am not a medical person and i could understand it clearly. and it's beautifully done. so thank you for the way that you're communicating it. >> thank you. >> president bernal: thank you. i think that we all agree, thank you, commissioner christian. okay, if we don't have any other questions, dr. buchbinder, thank you so much for your excellent and as said, thorough easy-to-understand presentation and thank you to your whole team as well. we love learning about and supporting your work. >> thank you. >> president bernal: already, our third presentation, from

dr. tomas aragon, our county health officer. >> clerk: before we go, commissioners, those who raised your hands before, if you could press the same button to lower your hand so we know when they are raised for folks on the public comment line. thank you very much. >> president bernal: thanks, mark. >> okay, god afternoon, commissioners. today i'm going to talk to you about the health officer orders and the process. so we can go on to the next slide. so the first thing that i'll do is to give you a couple slides i had to present recently because someone had a similar question about health officer orders. so the federal government collects taxes, can wage wars and can regulate commerce, all of the powers are vested in the states. so the state's police powers are used for public health authority. in california, police powers are delegated to the counties.

we have 58 counties of the 61 health jurisdictions. by law every county must have a physician health officer for this purpose. next slide. so health officers must provide communicable disease control, including the adequate isolation facilities and the control of the key communicable diseases based on provision of appropriate prevention measures for the particular communicable disease hazard in the community. health officers are authorized to take control of contagious infectious or communicable diseases and may take measures as may be necessary to prevent and to control the spread of disease within the territory under their jurisdiction. so that phrase there "takes measures as may be necessary," is very broad authority. and so that what gives us the flexibility to be able to do the different interventions to interrupt transmission.

next slide. and so i'm going to go ahead and i received some questions. i'm going to take each one of these questions and i'll give you a brief summary. the first was the processes for developing health officer orders and making decisions for reopening in various business entities if sa in san francisco. first we start off with what the state blueprint for a safer economy, which is the new framework that the state is using for reopening. there's another slide that we'll review some of that for you. so we start off with what the state allows us, and then we look at the department of public health priorities. and then we work closely with the city attorney to help us to craft orders and then directive. and i want to distinguish between the orders and directive. the directives you can think of guidelines or guidance, that is very practical and flexible.

but it has the force of law. so think of a guidance with a force of law. that's a directive. and the order -- the order usually -- usually points to the directive. so the order stays constant, mostly constant, and then we adapt the directive because things are changing all the time, the knowledge-based -- the scientific evidence is changing. so we want to go ahead and adapt our directive. the reason that i spent time on this is that most counties do not do directives. and as far as i know, we may be one of the few counties in california to do directives. because most counties are doing is an order will come out -- actually, some counties will do just do what state says. when the state comes out and gives guidance and lets counties do it, and the county will say, go ahead and do it. and some may tweak orders and say go ahead and do it. we go through the extra step of droppindeveloping directives.

and then we work with guidance to actually provide guidance or tip sheets to complement the directives. so those things that we think that are good ideas, but it doesn't have the force of law behind them. next slide. so the california's blueprint for a safer economy. so this is the new framework that was developed and you will see there that on the lefthand side, you will see it says "adjusted case rate for assignment" and "testing positivity." so they're using two metrics. the one is case count per 100,000. if you do a lot of testing, they multiply it down, they weight it down. so you have a suggested rate. so you look at that suggested rate and then the second one they do is testing for positivity. like, right now ours is about 2.3% i believe.

so it's relatively low. whichever one is higher, that's what your assignment is. so as director colfax pointed out, epidemiologically we're in tier one, the purple tier. but because they weighted us down, we're placed in the red tier. so epidemiologic communicable disease perspective, that does not make sense. we would never say, for example, h.i.v. is a good example -- if we're out there testing h.i.v. and we're finding more disease, guess what, if i see more h.i.v. infection, i need more intervention. i don't need less intervention. we would not be down weighting those rates just because -- just because we're doing more h.i.v. testing. so it actually -- it doesn't make a rational basis. their explanation for doing this was is that they wanted to discourage counties from undertesting because some

counties have a different approach and they want to undertest to find less disease because they want a lower rate. so they balanced their motivation but it doesn't make sense from an epidemiologic perspective. so the way that we're approaching this, saying, okay, epidemiologically we're purple and we look at what we can open up under purple. and then we look at what is available to us under red and how to use risk-based criteria to open up those things that we believe that can be done safely. that's a risk-based approach that we're doing. so we started with outdoor activities and then lower-risk indoor activities that we're opening up just on monday. we're taking a rational approach. so in a sense it's the best of both worlds because we're taking advantage of what is available to us and doing it safely. next slide. how does the health officer know that the city leadership and impact the stakeholders when decisions are made on health

orders and reopening decisions. so we consult with subject matter experts. and so that happens -- that happens quite a bit, actually, just over the past few days we were consulting with genentologist around skilled nursing facilities and people who understand the implications of what we're going to do. we work with the office of economic and work first development. they're fantastic at connects us to the different business entities in the community, especially the small businesses, and to work with them so when the directives are coming out we actually distribute them. we ask them is this going to work for you. give us feedback, are we totally missing it? the other thing that happens is that the mayor's office and the board of supervisors also gets feedback from constituents. they're sending them email. so they pass on all of this

information. and then -- and then others -- others as needed. so we end up interacting with different business entities, depending what it is. so early on, for example, we interacted a lot with people who do -- tattoo artists, people who run gyms, restaurants. one thing about san francisco is that everything is very personal. and so there's just a lot -- a lot of advocacy so there's a lot of interaction. next slide. how concerns from the public are incorporated into revisions of the existing health officer orders and the decisions regarding reopening. so, again, the same -- basically almost the same answer which is the office of economic workforce development, the board of supervisors, the mayor's office, gives us input from their constituents. as i mentioned before we meet with the stakeholders. when i'm at public -- i'm a public hearing, so, for example

at the last health commission hearing i stayed for all of the public comments and i listened to all of that fee feedback. so it's important to get that feedback. i get so many emails. i don't have time to respond to them, but i do -- i do try to read as many as i can. and that gives me some insight of what people -- people are thinking. and we try to incorporate this into our decisions, because people come up with really, really -- they'll see aspects of an issue that we don't see. next slide. and since economic recovery task force and subsidy, how will the health officer continue to interact with the business community. so -- so starting with our blueprint, we'll start with -- we start with our blueprint. that gives us access to what we can open. so that gives us an idea of what business entity we're going to be working with. and, again, the office of

economic workforce development, they've been a really important partner with us. and then -- then i have here specific industry-specific engagements. so i pretty much -- i get contacted by all kinds of people. and sometimes, for example, oewd will say, you know, do you have time to meet with this group of people or that group of people. and i usually, you know, if i can fit it in, i do it. and so, for example, you know, i have met with unions, associations, coalition of small businesses. there's all different ways that people are mobilizing and interacting. so that's been -- it's very useful, especially when they're organized, just because it's efficient for them and it's efficient for me when you get on a webinar and there's a whole bunch and they can give you a lot of feed back. they ask really tough questions that are difficult to answer. i don't always have the best answer. but i think that it is a good

process to have that. i feel fortunatel fortunate fort reason. next slide. since there are so many issues to consider, how are topics prioritized for both health orders and reopening decisions. i would say that, first, we really start with the science and public health principles. and so we start really with the health commission. and the director of health and the department of public health strategic priorities. that's really -- that's -- we start with those values, values and principles. we start with those. and then we interact with the covid command center. so the covid command center brings everybody together from the whole city. as dr. colfax mentioned earlier, we have hundreds of people here in the covid command center and it really -- it really requires the mobilization of not just our

network, but h.s.a., the homelessness department, it's just so complex the amount of work and thought that goes into this is just amazing. i get to interact with a lot of other counties. and most counties do not have the level of involvement that we have. sometimes it tends to be mostly around public health. we really have -- ours is a total city response. which is -- which is pretty amazing. so i learned a tremendous amount. and then, of course, you know, i'm going to just share with you something that i've -- i made this up but it's actually very intuitive when you think about this. i call it a "how to" checklist. and the first on health equity are true north colors from our

quality improvement. as we're processing different decisions, this is like a checklist to just make you think of things from a different perspective. it makes sure that we're complete. so, obviously, we're focusing on the health benefits and we're focusing on equity issues. ethical issues are really important. and a few years ago i gave you a presentation on public health ethics and how we use them. so that's really a critical issue when we're making decisions. we're trying to make sure that we're doing what is ethical. efficiency issues are really important because we have limited resources and there's an opportunity cost, and to do one thing and not doing something else. issues around legal exposures and then, of course, there's also logistical issues and then political support and then public -- building public trust. and so a lot of the interaction with the community is building

the public trust. this is really important around vaccines and i just wanted to share that with you because it's coming in handy over the years. who is supporting the health officers orders, etc.? is there one consistent team or does it vary? so, obviously, the health department subject matter experts, administrative support, the city attorney has been phenomenal. i have -- i have a bumper sticker outside of my office that says "i love public health lawyers" and the love is in the form of a heart. i picked it up at a conference several years ago. because a lot of public health is done through law.

but i could have never worked around it as i do now. most is around tuberculosis or isolating specific cases. but we've had the opportunity to really work intensely with the city attorney around covid. and i have to just say that they're phenomenal. working seven days a week and working night and day and their attention to detail. so it's a great synergy working with them. and i auswant to mention that the covid command center, the information and guidance has been amazing. it's a juggernaut of a machine of processing, scientific information, and they have developed -- like, whenever we're working on a work order, they're working on guidance, they have a whole spreadsheet of what's available across the country. and they keep track of what is being produced across the country. and they systematically have a

way of going through this and getting ideas and making sure that we're really bringing the best practices as they develop guidance. at some point it would be great for them to give you a presentation. next slide. and there's complex legalese. how do you make it easier to understand? i think this is a gap area for us. you know, information and guidance does try to make it more understandable, but it's not at the level that it should be. it's still -- it still is -- it still has quite a bit of jargon. and everything gets translated, and everything is translated i believe into six languages. and then what happens is that the joint information center will take those high priority areas and then where this gets made more user friendly.

and there's quite a bit of activity. and it's not enough. and it may have been presented last time and there's a campaign that came out -- that just came out for different ethnic communities. so there's a lot more work in that area. it's these different areas where the concepts of visitation are really critical.

and you have vulner adults. and the attorneys are trying to understand what is available under the constitution, especially around first amendment rights and what the see wag we do locally. and we have guidances from other areas and we do consultation with subject matter x. and i put here for a non-complex topic it might take one to two weeks. the first week is sort of doing the work. and then we take about five days just to get it reviewed by everybody. because we need to understand that it's coming to give concrete feedback if we need to

adjust things. so there's this process that happens before it gets released. for a complex topic, i said two to four weeks and the reference is the long-term facility. so emergencies two to four days, there was one exception and the march 16th shelter-in-place order happened even faster than that. next slide. can you provide additional information about reopening of schools, including commenting on whether we have available resources to conduct the necessary testing and contact tracing? so currently we have 75 waiver letters of intent for elementary schools to open. 28 applications have been submitted. site assessments have started this week and so we expect the approved elementary schools to begin opening at the start of next week. and our covid command is developing an operational

playbook. that actually puts all of this together that is going to include all of the issues around contact tracing and testing. and i just spoke to them today and they feel confident based on the experience learned in the summer with summer camps that they have a process that they'll be able to deploy with schools. i am not aware of any other county in the united states that is doing site assessments. we're doing a site assessment for every single school before they open. and we really want -- i also want to mention to you is that for us this is an equity issue. and we feel we're very committed to not only getting kids into school safely. and we're getting ready for the spring when the school district hopefully opens up because the -- those lower-income

communities, communities of color, their schools are going to need a tremendous amount of support and so we're gearing up to provide that support. and that includes health and safety plans, site visits, looking at ventilation, everything. so we're being very comprehensive. and we have an amazing team. they are just -- i think you had a presentation that was phenomenal. and that's it. i just want to say that the number of people that are actually -- actually last friday they surprised me -- they asked me to give a talk with the health officer does and i did that and then it's surprising but it's just everybody. it's just -- i was just blown away by the amount of talent, commitment. this past weekend, the city attorney i.n.g., some of them were working to 4:00 in the

morning to get everything ready for monday. so that we could issue orders and so businesses can open up. and they were just -- they've said that on monday they were brain dead because they worked so hard over the weekend, but we got the job done. so, anyways, i just want to give a big thanks to them. that's it. >> president bernal: thank you, dr. aragon, and to your whole team and everyone that you mentioned for your excellent presentation and being so specifically responsive to questions from commissioners. i understand that director colfax would like to say something before we move to public comments. director colfax. >> thank you, commissioner bernal. and health commissioners. i wanted to just add my gratitude and to acknowledge dr. aragon's leadership during this time. he's not only brilliant, but humble. and he's been working right alongside all of the people that he mentioned.

and i have to say that he was committed to doing his best and he has been working day and night from february on in addressing this pandemic. and not only the work that he's doing but across the region in regard to other health officers and the work that they're doing. and he's also -- i don't believe that he mentioned it on this presentation but working in engagement with that.

>> yerks i see four hands m i'll remind folk on the line, if kwr50*ud like to make a public comment right now, press "*3" i'll go in order of the hands i see. so i will unmute you. you should hear from your line. caller 6, i've unmuted you. can you hear me? >> yes. i can. >> so i've got two minute on the clock for each of you.

when the buzzer buzzings, please know your time is up. we're a san francisco legacy. which is 115 years old. we have 12 full-time employees. i'm also a board member of the district of merchants, a merchants association, made up of all the neighborhood merchants. a vibrant district business is good for the whole city. we provide great, stable jobs, health benefits, support full-time jobs and it becomes a place for the community to congregate. every decision the health department makes has an enormous effect and of course, our employees and all of our community. again, we are all part of the public health.

we want to be at table with you making decisions. this week's new openings brought great opportunity. we're really happy about t. but most of us heard about it through the media, not through the city. this is not very good. we'd like to hear about it earlier. the guidelines, in many cases, weren't issued until yesterday morning, the day of opening. we want to do the right thing. we want to be reasonable ask have reasonable procedures for everything. for our benefit and for everybody's benefit. we can't learn about what has to be done at the very last minute. guidelines should be easy to follow with an outline to go along with them because there are multiple [indiscernible] that can understand. and are very difficult. time lines, of course, have to be outlined, too. and i'm talking about the outlines.

the distribution of materials will be -- (beeping). >> please finish your sentence and your time is up, sir. >> we look forward to work wealth departmen-- workingwith . >> thank you very much. caller, i've unmuted you. >> i can hear you. >> great. you've got two minutes on the clock, sir. >> thank you. i'll be less than that want my name is al wil will yams. president of the bayview merchants association and vice president of the district council of merchants. i won't go over the points steesk just made, but we certainly say, that bayview has particularly been hard hit by covid and suffered the effects of social disparities over time. bayview merchants, represent not

only the business in the third street corridor in the southeast section, but all business interest in the bayview area. greatly appreciate the work the department has been doing and working with supervisor walton and others around the covid issues. i'm particularly impressed with dr. buck finder's report. the commissioners indicated, it was so, it was presented in a way that i could understand finally, what the whole thing was about. i would really encouraging in terms of working with stakeholders, if you would make that report available to groups like bayview merchants, and other merchant associations so we can get that information out, not only to our members but through them, they can give question that is come to them by their customers.

members of the community, in wanting to r to earn public trust. one way to do that is working through institutions and organizations like bayview merchants association and it is other merchants associations. we also talked about wanting to group the african-american community more effectively. i think it's important to precede the fact that a lot us are a little -- remember the tragedies of the experiments and the like, so keeping those historical circumstances in mind and using those to help educate would be very appropriate. thank you very much. >> thank you for your comments, sir and the presentation is on line on sfhc.org. so the next caller. we have got a few more callers, commissioner. let us know if you can speak.

>> yes. >> okay. great. you've got two minutes on the clock. >> caller: thank you. i am the president of the san francisco council of district merchants associations. we ad for 43,500 70 tiny businesses that are in san francisco. tiny businesses that we consider to be 10 businesses more or less and sad to say, it is declining dramatically. we're reaching out to you, today, to thank you for your tireless efforts in these unprecedented times. we are today, to find the city's recovery and you'll be remembered for these efforts so i really want to thank you again. a few small points but they were already highlighted and made by the previous callers. is that, you know, all of us small bees, 45,005 70 of us, i'm going to guess that about

$75,000 of us are store front properties with relationships and confidence with our customers. we are a tool and an asset that we can use. please bring us into the discussion. i also want to reemphasize that a healthy economy is also symbiotic with a medically healthy environment. think about t. people that are employed have a higher self-esteem, have a better outlook on life. probably have better medical benefits and a greater income of what they would get if they were on unemploy m and typically, will be able to seek medical help much earlier before things get bad or be more proactive and preventative in the medication because the that disposable inc. economic health and medical health are symbiotic relationships. they cannot be siloed into two separate parts. they need to work together. i believe that if you reach out to the smaller groups, through

the council of district menshants or directly through the merchantses yourself. you will find a receptive organization, that will be not just receptive, but an asset. >> thank you. all right commissioners, a few more calls. i've unmuted you want please let us know if you can hear me. >> yes. i can her. >> you've got two minutes on the clock . >> i'm co-owner of the fitness, board member of the castro association and san francisco fitness studio coalition. i want to applaud the city for the work to get some aspects, to get it reopen at 10%. too many small neighborhood fitness studios t can mean the difference between the life and death of the business. to have substantive conversations with their landlords and employees and

provide an additional ongz for san francisco's residents for poor air quality and those who have fitness options simply don't work. but dph. dr. coleson's and dr. air

considered an essential service to help our citizen fight covid. in many cases, it's no different than physical therapy, as dr. air gone has noted. as this pandemic evolves, including the potential [indiscernible] iindisthepotent, please don't forget that. >> thank you very much for your comments. we have got one more caller, commissioners. all right, caller, you are unmuted. >> hi. my name is tracy sylvester, owner of espiladi, in san francisco, on valencia street for over 28 years. i'm on the board of mission menshants association, a delegate with the san francisco council of district menshants and a member of the san

francisco independent fitness studio coalition. i've been advocating for small business for over 10 years. i want to first thank you all for your effort and i look forward to becoming a partner in communications. so i'm grateful to reopen the business. it has been devastate for example our clients who are in severe physical decline, and are desperate for our services. as david had just said, whether in person, online, we know that it's an important part, movement is an important part of well-being. and we'd love to see more communication from the department of public health, promoting exercise and wellness, especially during the pandemic. five reasons for staying active during the pandemic include relieving stress and anxiety, supporting immune system upon managing weight, improving bone

and muscle strength, increased flexibility. you have an remembery of people out here in the community, that are interested in the wellness and well-being of our citizens. secondly, i wanted to talk about contact tracing. everybody coming into our businesses. we have the ability to contact and know exactly what the flow is in our building. we don't really have any guidelines qhaf it would take for us, if we found that one of our employees, members or staff were around somebody that had covid or if there was somebody that tested positive within our environment. how far do we go to public trace, who do we communicate this to, and how do we help become part of your army, in order to help mitigate the spread of the pandemic. thank you. >> commissioners, we have one more. caller. you are unmuted.

>> i'm a member of the san francisco independent fitness studio coalition. i'm a previous owner of a brick and noter that had to closed, due to the extended shelter in place industry, some of my points of course mentioned already so i'll try and be brief. i'll reiterate what was said about the plan to commune occasion for open guidelines. left a lot of owners scrambling, so the exiewnication about guidelines, and the time frame would be instrumental in allowing them to properly prepare and open effectively. secondly, now that we are

allowing indoor fitness, we greatly need the department's health support, dr. colfax, i know you mentioned a few weeks ago at a press conference that you wouldn't mind exercising indoors. currently, we're at 10% capacity, allowed with the next stage being 25%. we need to know if san francisco will follow ute suet with that. of course, that's dependent on cases. one of the greatest travels over the past 6 months while we have been closed was not knowing what was planned. i know dr. air gone mentioned, communicating with different business sectors, we did have a lot of frustration of our coalition in communication.

we did not necessarily know their occurrence. so again, we applaud your efforts. thank you, but please help us communicate as much as you can. thank you for your time. >> thank you very much. -- >> i think dr. colfax, director colfax mentioned thad dr. air gone is in communication if

these discussions are already going on, on a state level, it seems to me that it would be just as important that the counties have a greater awareness of what is going on. apparently, there is no real plan yet, but i do think it's important that the county department have some sort of role in understanding on how

vaccines are going to be distributed to the population. they haven't engaged a local health office yet but the bay area health official on the monday call are going to start bidding up on this very topic this thursday. so at least in the bay area, we're we're going to start talking about t. the other thing i want to point out is we're taking advantage of influenza season, as the opportunity not to just vaccinate people with influ ens a but to really exercise the distribution operations to deliver a vaccine. so for example, we're going to be offering influenza vaccine at the covid testing sites so we're beginning to operationally, what is it going to take to vaccinate a lot people, people qhosk driving, come in and have driewf

through vaccine. so we aren't thinking about it. we'll be able to give you an update action soon as we have more to present. >> a bay area [indiscernible] >> i know you made the comment about trying to make the health orders a little more readable for that general public. i would just highly recommend that in going forward, you really try to have maybe a summary at the end at the fifth

grade reading level, which is what is considered what the general public can read. so i would highly encouraging you to have that happen. but thank you, thank you, for all of your hard work and i'm sure you haven't had a day off and we so appreciate your your work. thank you. >> commissioner green. >> >> first off, i would like to echo gratitude, for every in the command center, and everyone and what the dph have been doob, and the hours dr. air gone sure makes internship seem like a part-time job. i also want to recognize how many members the department have

had to pivot, not to develop new skill set bus also operationallize them. i know with your job in particular, involved, you know, going from a lot of lean management and longitudinal thinking to immediate action hero type activities and i think you've done a spectacular job of making that pivot, as have supported everyone else in the department. it's such a pleas tower hear the el qens, taw thoughtfulness and intellectual capital and really caring that's gone into the work you've done. i know you've touch bod it and i think this echos with both commissioner duradohad said. the communication part is so important. i hate to see these incredible efforts be misunderstood or not actualized because we're not doing a good job of communicating to the public. and there's a lot behind what

you're doing. it'so important for people to understand. i think when you look at the vaccine as well, we're being to especially have san francisco more pro vaccine or perhaps other municipalities around the country, if we're not only going to have them avail thepgzs of vaccines, but also, especially some of our communities of color ensure that people understand and understand the logic. i think we're so -- it's so important to focus on those resources. personally, i found some of the orders for hospitals confusing to me personally, like [indiscernible] during care. so i was wondering if you could think out loud or elaborate a little bit more on what you foresee could you talk -- any

insight can you give, any reassurance about clarity would be really helpful. >> i used to run the cdc public health preparedness training center. resource center. one of the things we learned about disaster ises is in the after action reports, the three top areas where you need improvement is communication, communication, communication it's just so big and it's so important it is an area where we can be really creative. i'll give you a concrete example. yesterday, i was asked to speak at a training, these are

monolingual spanish-speaking women who are learning how to engage the community around covid. really what we have to do, i think the communication, we really have to do it in a way that engages people. in a way that they really understand i enjoyed working with them. i said please, invite me back to speak again but can i only do so much. we have to figure out how to tap into the injen yewity, and community, really around the communication strategies. we communicate through our channel that is we are accustomed to, in the language that we are accustomed to. and i can actual, i know it's not reaching the community that is need it the most.

it made me think right now, we have to do a lot more of that so actually, dr. colfax may have mentioned we're going to be working with the latino pastors, to train them to do the contact tracing. so they are going to be actually doing all of that and i think we have to do more of that mobile life so it gets translated as a level that really mobilizes the community, much better than we could ever do it. >> what leams of the city,. >> yeah, so we do have a joint information center. a joint information center brings in the communication people from all the different departments so they have, a few doors down, they have this big

room. this whole, there's an army of them working on this. but even with the army, it's not enough. it's not enough. and i think we're getting better. we're getting better, and i think this is where i think we may have to bring in some outside resources, engage more with communities, firms that are actually working in the community around us to really do a better job. but we do have a team of people. again, at some point, maybe have some of them come and show you how their process of developing materials. >> i think it's wonderful to hear back how it's going. what kind of resources you're bringingbringing and innovatiod the whole fear of public communication. >> we can do that.

>> qhish nears, any other public or comments for dr. air gone? i just want to thank you again. this presentation helped us understand the enormity of your work. know san francisco has stood across and that is due in large part, to your extraordinary leadership and i don't think that we as a commission can over state our gratitude to you for your leadership, for your thoughtfulness in how you approach your work chuck neb niche near green, i'll add that action once it's available. i know i speak for the entire commission. thank you.

>> we'll be moving on to general public comment. >> yes. if you would like to make a general public comment, which means you're commenting on something that is not on the agenda, a topic not listed on any other item on the agenda, please raise your hand now. i see one hand. >> my name is christine galloso. i'm a small business owner in the adult recreational sports space in san francisco. this summer, you guys allowed use pods to play with approximately like, lessening children at a stayed in those

pods and thrirp a throwed scrimmage and play soccer and have exercise and recreation with each other. but the conditions have been [indiscernible] for adults recreational sports on a state level or a local level and now, children's pods of course reduced to fitness where they have to stay 6 feet a art part from each other. i'd like to know the reasoning to the switch, august to september, that kids can no longer participate in scrimmage activities and pods and why adult recreational spoarpts have not been considered in the return to participation i think it's an area that the health department -- i thank you for your time. >> thank you for your comment. >> commissioner, that is the only call that we have got.

>> yes. we'll move on. to the community and public health committee update. >> we had two items on our agenda, the first was the hepatitis c update which was an excellent report. and there was a pause in moving forward because of covid. the street medicine team are back. they have been in operation and going forward. the second one was a very intense presentation on the primary health clinics within

the city qat duty, and complex, as well as specific challenges with covid and what their plans are going forward. it was an interesting meeting. secretary do we have any public comment? >> i don't see anyone. if you'd like to make a public comment on the side, please press * 3. this is commissioner dorado's fist meeting at chair. any. >> any questions or comments for commissioner durado? commissioner chaothey spoke

about when thri might get back to their scorecard, that has more than just samples of the primary care were doing. realizing, covid has disrupted, obviously, a lot of quality measures at this point. but i think it would be appropriate to have the scorecard reviewed again. at an appropriate time as we give them some distance to get back in order. it's going to take time, many of the staff have been deployed for

covid. many are on leave so they are moving as quickly as possible and will be reporting back to yous, as things did forward. >> it is something that even the hospital and managed care, they are actually retooling again, and starting to activate the processes for assuring quality. so i'm not look for example something immediately, but i

don't think it should be dropped. we had a process in play before covid arrived, and they were really making progress and i'd hate to see that sort of lost. >> in our presentations, it will not be lost and data is continuing to be collected. as much as possible. and the presentation was excellent with the database, especially as they are operating with covid. >> thank you. any other questions or comments on this item? if not, thank you again, commissioner duradofor that report and for taking on the chair of the community public health committee. we'll move on. to the next item. epic update with erik raffin.

not yet. can you maximize your screen. there we go. i'm the chief information officer and i'm pleased to provide a quarterly update on our epic comprehensive electronic health record

program. i have some cocontributors to thank for some information i shared today. dr. [indiscernible] mr. sarapia. mr. upchurch. really, all contributors for what we'll go through and i'll try and expedite because i i know the meeting is rung a little long. i adopt to say that most of the material you see today, is in response to your questions from last time i'm looking forward to sharing answers and keeping us moving forward with how we're doing having a voice with our patient and important aspect of providing a big software program. i think it's so much more than

epic. two short vignettes here. the first is from one of our patients. but i'd like to draw your attention to the second one. the software, with the ability to access your health record fist you're on a computer or on a mobile device. you'll see them in the second vignette. an elderly patient with dementia, has proxy access to his mother's electronic health records. this is an extremely important point i want to make right up front about the power of being able to gain sages to electronic health records as a parent, i benefited from having assets to my children's records as they got older. i know if indicates such as the one you see here on your screen. it's really important to understand that patients who are unable to gain access to work

within this tool, someone that they trust, we have rebooted our governance program, we're beginning optimization work in some of our domains and we are in the midst of working through our second implementation leg. my take home message is 4 parts. the reflections about the security of the epic system, and i hope we leave today, with the understanding it is a secure environment. we're going to talk about my chart, and adoption is on the rise. i'm here to talk about revenue cycle and how those operations have stabilized and we'll conclude with an update on the

alignment with the spend, through the first three years of our project, and how that aligns with the rest of our epic experience through 20 twesk. so very quickly on secure and health information another not just about ethic, it's really about everything we do here at dph as well. while there are plenty of very technical things that go on in the middle two sections of this slide. i really like to focus on the book ends. so on the left people, are the primary means of deterring private security threats. it's so easy for social engineering and other types of human behavior, to result in compromises and breaches to information that is really important to not just a policy, but to have at least annual reminders, so that we're also vigilant. the city has adopted a new

studio awareness training program which is now mandatory for everyone who works in city and county of san francisco. on the far right, just as a reminder, all of the good work we do to protect our environment, it's never perfect. and i do want to mention that we are externally audited every year through the controller's office and there by, auditor. we are working through findings from the current lead leader's odd r audit in a significant plan of action. and our goal to do use techniques of understanding causality of the findings and making sure we can prevent their reoccurrence. on the epic side -- on the ethic side of securing our information another really about authentic occasion and authorize ah, thenication. how are we communicating back and forth and how are those communications

threatening, and that, in all of the laws, that govern break the glass, both at the state and the federal level, allow this emergency use case to occur.

working can your medication and managing your appointment. i believe there was a question are we able to manage telehealth appointments yet. through my chart, the answer is not just yet. when we do that, we'll be obviously, greatly improving expanding and unifying our telehealth experience and we hope to be able to then offer more enhanced scheduling for those appointments. most appointment management today, through the my chart tool is for primary care. for our activation rate for my chart, basically, how many patient dos we have, we consider

active. a little over 10,000. 10 percent to 11 percent zone. not surprising to see most of our my chart users by h cohort are between 18 and 65 years of age. i was actually really pleased to see, that 60% of my chart users are over the age of 65. some of those include some of the residents. we move to the right, and look at preferred language, just a reminder that perved language is something expressed english is their preferred language, although 9% spanish, and 7% cantonese also made it on our list, as well as all other languages. and if you want to take a slice by race and ethnicity. we request see across the board, can you look at the horizontal

access. those are the rates, categories that are in - -- if you look at the map, 10,288. that allows us to record patients who express that they are multi racial. when you look at the bar. you will see two colors, orange, being an indicator, ethnicity of non-hispanic or unknown and blue being hispanic ethnicity. so this is the way to look at our initial first-year view of epic my chart user byes rates and ethnicity. the things that we have done so far, that are most important on the left, are that my chart wasn't something that was just

deployed. my chart, just like the rest involved a lot of input and in this case, input from pates. from patient advisers, who are involved with many decisions about the design and look and feel and functionality of my chart. my chart is currently available in english and spanish only. more languages should be written in and coded in to the softwares that support the my chart capability. but i think that's the flip side of that concern is this is a

proxy consent, much like the [indiscernible] that shares the beginning is important. because if somebody is unable. because they are not fluent in english or spanish and they have someone they trust, they can grant that person proxy access to their record and that can really help the engagen't with the patient. and to help navigate the health care experience. on the right side, what are we planning to do, we're really trying to understand where we have disparities and how we go about closing the gaps. i was reminded this afternoon. just before this meeting started, my chart is a piece of software. and is assumes you have access to a computer or smartphone, and the internet and that you can actually afford to do those things and that's doesn't compete with food, shelter or

education or going else. ensure more people with take more command of their healthcare experience with us, with the understanding that not everyone has access to a computer, and the internet and a smartphone. arcr, after a lot of challenges at go live and of course, challenges with covid-19 as with our dramatic decrease in operations, which means we weren't collecting as much revenue. the ways i know that we're stabilize side that we are now starting to collect more per month for services rendered than we did prior to having epic.

i think it's a little later than we all wanted it to be. but we are starting to see those collections trend in a favorable direction. and epic actually recognized the folks with access and revenue cycle in dph with recognition for basically, a solid install called the automaticimation pulse recognition. i had a hard time understanding what that meantime, too. but essentially, what it means is that we have completed a very thorough employment of capability that allows us to do access and revenue cycle and we are allowing claims to go out the door. we also know there is still a lot of opportunities to collect more revenue. and some of the reasons we know that are because of the analytical capability that is epic provides us. where it sundays us lots of

signals and gives us a lot of intelligence about where we should be looking to understand where we may not be capitalizing on this opportunity. so that's our way forward is to use the analytics to make sure that we can improve whether it be the human processes or technological workflows to maximize all the collection opportunities before us. in 2019, followed by a stabilization period that took us to the beginning of 2020. what we haven't talked about is when you implement new software, you usually have to free the version of the software that you're on so you don't change it as you're training thousands of

users and making lots of configurations. so we were no different than any other organization and in the early part of 2020, we flished three upgrade it's one time, which was a fantastic accomplishment. it resulted in a very short amount of down time for all of our epic users. >> if we move forward with wave 2, which we reset our expectations. by nature of how you see all of the subparts of what make up wave 2. everything from integrative care, and coordination of care, all the way down at the bottom where you can see the last row where we have integrated video visits and interpreter services.

that's what we were tbawsmght integrating services into the my chart experience. each one of these can be a justed and moved around and they've been as a result of our heroic response to covid-19. >> so we have adjusted so that we can accommodate when our line of business appearance are ready. there are a lot of people chomping at the bit to move into the epic environment. so we are flexing and adjusting to make that possible. so it's committing to see that we're able to actually still maintain our covid response and take on components of our epic program thra if you ask me back

in march, with the time of shelter in place. i think i would have said, i don't think we're going to do anything with wave 2. but this is an amazing organization and we are continuing with our work. finally, to talk a little bit about our h.r. budget, some knowns and unknowns when i spoke in early july, we have wrapped up. we have learned a lot about what we actually spent, against what was predicted, against what was budgeted and that has helped us predict, spend for the remaining years of our epic experience. we also know after reconciling many, many contracts and purchase agreements that consulting cost consist bring up a big bill.

we are going to take a more surgical approach, as we need a boost or as we need expertise that we simply don't have, that we need to get us over the bump of design or implementation and we become and save the owners of the work. i think it's important to comment that we have really very few consulting resources right now, as weesk operating over the course of this calendar year. we will start bringing in ray few here and there, as we start moving through more wave 2. top right, something we don't really know, are all of the subordinate contracts for epic. epic is huge. we all know that, but we have about 5 dozen other contracts that help support all the different aspects that we epic

do themselves. enhancing our telehealth capability. in order to do that, we have to partner and have an agreement with an organization that can do sort of the audio visual part of the work. and that has the right linkages into the epic software so woo! y wee can combine epic with the partner solution so we can have an experience in my chart, with the video visit. we have a number of these contracts that are still yet to be awarded and several of them haven't even been through the rfp process. we have done our best to provide good estimates the future year costs through 20 twesk of both contract you and our staffing for epic were under separated. so i'm going to move to the numbers to see how that actually pans out.

fist line is proposed budget, which is what your comitionz saw from some years back request that was assembled. what you can see beneath that is what we believe to be our actual ehr spend for that period of time. when i met with you last, we had predicted that we might have to dip into our project contingency. as it turns out, request we reconciled all of our contracts at the close-out of this fiscal year, which was obviously a really big one, it was our go-live year, we ended with a positive variance. that was important. as we move to the next column to the right, fy21-twesk which is our estimated budget, you'll see the proposed budget was about $140 million. we're actually estimating that our ehr spend is going to be closer to 211 -- apply our

project contingency, which we have not had to touch. and apply our net balance from our first three years of work on epic. you'll see that we are just slightly positive. and so i'm glad to report that's our current status. i think my take away from that is being responsible for ensuring that we stick to both our targets and our budget is that we will be paying close attention to have we have enhanced our estimates and understand variances on a more frequent basis, now that we are in regular and normal operation with this solution, but also, we're still i. implementing. ask i leave you with this quote from president john quincy adams but it explains a lot of what is going on in our organization. so much perseverance and patients and i'm pleased to take your questions.

>> thank you, mr. raffin. do we have any public comment? those of you on the public comment line, please press "* 3" if you'd like to raise your hand and make a comment. i'll give you a few seconds. i do not see any. so we can move on. with commissioner's comment. >> commissioner green. >> fist, thank you for the presentation. i think we all feel from implementation othe epic project has really succeeded beyond our expectations. so congratulations to you and the team and also to the seamless transition and leadership which i think came at a very difficult time. and i applaud you for having done that so well. i had one question about my chart. are you gathering any data? you know, there are four areas you can use my chart for prescriptions, appointments, test results and for contacting your doctor. i was wondering if you were

keeping any roarsd as to proportion of which those 4 possibilities are being used and also, knowing that our system means that doctors may not, we have many people that aren't in clinic every day and so as people start to want to contact their doctor, what kind of guard rails are we putting there. so ask, people will send something vee at website, thinking it will be read in 5 minutes and i just wonder, especially in our system. what kind of guard rails we might be putting in],the communicate withing your doctor component on this. >> i don't have the data, i'm confident, i know that we have a guard rail on what to expect when you send the message to your provider, as far as a response and a reminder even before you sign up for my chart of what tox peck as well. so we can get you exact

information. to your first question on the data i'm sure that we have that available. again, i don't have it at my fingertips. i'll be happy to get it and break that out in as much detail as we can. >> somebody responds to you right away, it's going to be very confusing to patients to figure out what the best modality is of reaching out if they get so fatigue and next thing, you'll find something. i mean, that happens to me. i'm in labor. oh, god. you sent me an e-mail. you know, that kind, how we're going to go forward with that. >> yeah, it's no trouble to get that information. >> i can answer that so hi,

commissioners. it's clerc and i've been really pleased pleaseh how it's rolled out in primary care. we don't have that many my chart user bus my patients of course very pleased with t. and i think holly and robert have done a great job setting it up, we have the call center the and nurse advice line so we can knock off all the issue that is can get taken care of by a team-based care and patients are informed that they are sometimes a bit more of a way for us to get back to them. but it really takes care of soy many issues. we have a protocol for cuing up prescription refill when is that comes in by call.

getting paicialghts on my chart, and i think that can help them across a digital divide and i'd love to be a part that have solution to them. too. >> l thank you for the presentation. i'm really excited about number to begin with as a data geek. and with what dr. horton just mentioned, i was wondering if we as a commission would be looking forward to like, future reports that actually indicate how the adoption improve user experience and lead to better outcomes and like, improve streement

strategies we're just coming out of the first year using the tool. so that's always luck to use data from your first year. but i do think we're going to be able to provide extensive information that we can track in a number of dash boards about how well we're doing. it's really the first time that we have that face where we have the capability to see what we're doing scrks share that information with others, such as this commission, in a way that is more unified and complete than i think we have probably been ever able to do. so with a year's worth of data, we are starting to understand, that's how, for instance, othe revenue cycle side, we're feeling much more confident about where we are as weesk able to seat trends. week by week and month by month and it's really no different to

look at how we're operating medically as well. where we can see a lot of our measures and key performance indicators. it's something we can start bringing forward and encouraging folks to ask us more questions so that we can bring you those answers and show you exactly what it looks like. >> thank you, i look forward to it, dana. >> thank you for the updated implementation sequence. i would imagine that knowing all the things that have happened, one, which you've englished already, we can follow. two as the road maps that you have. so i was thinking that we might be able to get is seeing the new

budget, essentially that you have for the coming 6 years in terms of what you're look at to spend, to build out the rest of wave 2. in the past, when these contracts came before the commission and they were enormously complex with multiple contracts as i know mr. wagner was aware of, we were able to put them into context because they were broken out into buckets and we could tie them to buckets so that we could feel that tarpn't just that you went and today was september 15. this is the one we'd like to present to you. but we'd like to sort of see this at the budget commit easy part of the whole. what is the whole that we're doing? so maybe we're not prepared to do that right now, although you do have some estimates perhaps a

presentation as to what this new build out over the next six years are going to look like. and how you're going to be bringing subcontract ors in. so when the contract ors actually hit the committee, they can be slotted in and be seen as as part the schemes that have been worked out. >> those linkages will not be terribly difficult and i think it will help ground everyone in how to spend capability that is we're adding to the epic program. >> the model used during phase 1, really, i don't want what the chair budget things but i thought that actually worked out quite well as we saw the different component parts.

>> not at this moment, but thank you for bringing that up. >> any other detail ?'s all right want thank you very much for your excellent presentation, it's been exciting to see how this has come along over the years and how useful this tool has been as we also navigate a pandemic at the same time. i think we will not be be in as good as we are in now, without epic and the state that is it is in. thank you. >> this is grant colfax. can i just add my gratitude to erik, mr. r affin and his team. it's just been a year since we have implemented, a year and a

month. seeps loppinger than that and the culture of epic has really taken root root in the department and also with our covid-19 response, we are now planning link other epic for us to be able to better monitor the pandemic. so, so much progress in just a year and a month and just appreciative of all the work that's happened. so thank you. >> all right, thank you, mr. raffin. we'll move on. to our next item which is other business. commissioners. any other business? okay. we'll move on. to joint conference committee reports. >> commissioner guillermo, had some issues. >> yeah want i can hear you and

i pulses. somehow i got frozen out of the meet expghts webex so i'm calling in. >> we received a report from michael phillips qhorks is still relatively new to honed a. as unfortunate we have not had a chance to meet him in person, he jumped right into the position and gave us a thorough report on the status of things like niguna honda and a finance report which we have not been able to get updated last time. which was good news because it appears that we're doing quite

well at la gunna honed a. one of the things that committee members are always interested in is the data on residents who leave the hospital without being discharged, i guess awol residents and patients and although the data has improved, in the situation has improved with regard to those residents, and the ability to follow up on them, the committee member commissioners who are interested in just getting a better understanding of those awols and how social services follow up. if conducted with them. so we'll be getting more information on that in a future report. we again, reviewed the regulatory affairs report, those are still pretty much on hold

because of covid and so there is not a lot of information that we were able to get, with regards to status of the number of facilities reported incidents. we did have a good presentation on the culture of saist. a survey that was implemented last year at la gunna honda in october, was supposed to be retaken in may of this year, but again, because of covid-19, it was postponed until august the sponse rate was much smaller to last year, it did show throofs a slight improvement from staff in terms of the sense of safety, s, but there are still a few areas that need more outreach, more

follow-up and more data that we will be hearing about in particular, probably in november because the survey will be taken again in october of this year. and they'll be doing a conservative outreach to make surety response rate is as close to, the response rate as we had last year. then we wante we went into closd session where the committee reviewed the quality improvement report patient safety group minutes and we approved the staff credentialing report and that is the extent of my report. >> thank you, commissioner guillermo. do we have any other other questions about the laguna honda jcc meet ?g seeing none, we can

move on. to our next item which is adjournment. do we have a motion to adjourn? >> so moved. >> is there a second? >> second. >> i will do the roll call commissioners. >> commissioner guiellermo: yes. >> commissioner dorado: yes. >> commissioner christian: yes. >> commissioner green: yes. >> commissioner bernall: yes. >> commissioner. >> commissioner chung: yes. >> commissioner chao(no response). >> i think you're muted. >> i forgot to unmute. yes. >> all right, thank you much. thank you much to the team at dph for your excellent work. we're so grail for you and proud

of the work that you're doing. hang in there and we'll see you all in two weeks. thank you, commissioners. >> thank you. (adjouradjournment 6:50 p.m. pd.

>> the meeting will come to order. we welcome to the thursday, august 20 meeting of the government audit and oversight committee. i'm gordon mar, the chairman of this committee. joining me is supervisor aaron peskin and matt haney. mr. clerk, do you have any announcements? >> clerk: yes. thank you, mr.