>> clerk: (roll call)

>> president bernal: we'll take some of the agenda items out of order. we'll be approving the minutes towards the end of the meeting. but before we get into the regular agenda, i wanted to take a moment to share with everyone an extraordinary video, a great video that the commissioners and i have put together to express our deep gratitude to every single member of our team and family here at san francisco department of public health for your extraordinary work in the face of these extraordinary times when we're facing a pandemic and national reckoning

with our history of institutional racism and wildfires that impacted all our neighbors in san francisco and everybody in the department as well. especially like to acknowledge our commission secretary for his creativity and hard work and organizational skills in getting this done with a bunch of commissioners with busy schedules and having it produced on a shoestring. thank you so much mark for producing this and given this is our last full commission meeting of the year, we thought it was important to share this with everybody on our meeting now and who might view it later and we'll get it to the entire department later. thank you again so much mark for producing this and commissioners for your participation and your really heartfelt remarks. let's watch it.

we can try later in the agenda. a resolution honoring michael brown and presenting that will be greg wagner our chief operating officer. >> good afternoon commissioners. honor to introduce this resolution honoring michael brown, michael brown has been our director of human resources at the department of public

health for quite an eventful year. he came in shortly -- right at the time -- of covid-19 and took on a leadership role. he's proud and his staff is proud of the work he has done. we went through some of the data at the last planning session with the health commission. and also, on a lot of other things, moving forward, the work of introducing a racial equity lens into our hr processes and integrating that work with everything going on in the department and we'll be talking about that today.

whereas michael brown held the position of public health

resources director since november 2019. in this position he's been responsible for all of the complex decisions and operations, management impacting employees and super vision of human resources employees and whereas under the -- to meet the increasing needs for the medical staff. the changes as a model in other high need areas such as hiring processes for a large group of behavioral health staff and launch in 2021 and whereas mr. brown's previous positions include executive officer and department heading the civil service position, dph director.

civil service commission, assistant personnel analyst and public utilities personnel analyst and whereas commissioner brown is a proud native of san francisco and a member of the family with a tradition of civil and military service to the community. now be it resolved that the san francisco health commission honors michael brown for his many years in outstanding service contributing to the health and wellbeing of all and wishes him well in his future endeavors. >> president bernal: thank you greg. before i hand it over to the commissioners for comment. do we have public combhement one

item? >> if you would like to make a comment on michael brown, please press star 3. no public comment. >> president bernal: i will start among my fellow commissioners. thank you michael brown certainly for your service. i know it's been a great concern to us over the many years some of the reforms we needed to see happen in our hiring practices and you moved the ball forward with us so all of which greg wagner mentioned shortening the period of time to fill critical positions and also responding so effectively to our hiring and personnel needs as the entire city and all of its departments respond to the covid pandemic, not just within our department but serving as a leader and example for other city departments as well. we can't thank you enough for your service. we're grateful for the time

we've had with you and really look forward to seeing what comes next for you. on behalf of the entire commission, thank you. commissioners before we hand it over to mr. brown? commissioner green. >> commissioner green: we haven't met in person but i have to say, in all the difficult news and challenges, when you presented to us a month or so ago, it was so apparent to me what kindness you demonstrated and what a wonderful person you are. and how you can be in this very difficult job with all of the incredible challenges as long as you have and maintain incredible

enthusiasm and it's apparent in the way you speak and do things and i just sat on the jcc to hear the barriers of hiring and frustrations and to be able to do that even with the pandemic, it takes leadership and a team behind you to be able to accomplish what you have, which is nothing short of remarkable. so i just wanted to say, i am so just impressed. i have watched you as you speak and taken some lessons i think from you in how to speak to people and lead and you ought to teach courses to us or something. i hope you don't stop, you have too much to give to not continue to show people how to lead and manage. thank you so much. >> president bernal: we're not

done with you yet. i have commissioner chow as well. >> commissioner chow: thank you and thank you michael for the work you did, especially during this period of time. but to continue to develop the human resources which had been so severe and understaffed for so many years and to move it to the position where i think it probably is one of the best department resources that we have in the city, and it was very clear and evident that you knew exactly how to then move the right levers in order for us to be able to do this extraordinary hiring of not just nurses but the personnel and i'm sure you are helping to fill out much of the covid help that we are currently in the process of now getting. i think you have set up our department resources -- human resources sufficiently so we can

meet the challenges of the mental health hiring. so it's not often that we would feel comfortable in having a department division leader leave us because there's much more to do but you have done so much already, that it looks like you're going to be able to leave a legacy and we wish you well in the future and i know that mr. wagner presented the resolution but i would like the privilege then of actually moving the resolution for consideration by the commission. thank you. >> thank you. >> president bernal: all right. let me see, well, mr. brown, certainly we are presenting this resolution to you with our appreciation, we wish we could be here in person to hand you a

nice framed copy of it and shake your hand and pose for photos and everything and while we can't do that, i know our commission secretary will arrange to get the physical resolution to you with our gratitude. is there anything you would like to say? >> i have it now. >> president bernal: see how fast he is? >> i want to say more than just thank you. i do want to thank you for the opportunity to come and work with the department again. and i think we talked a little bit going away thing we were doing today in a zoom meeting with other staff but there were challenges at the time we talked but we had no idea about covid-19 coming at the time i was asked to come to the department. so, you know, i always welcome a

challenge. the challenges have always been part of my employment. but this was one i was not prepared for. but i think that, i think i'm leaving it in good hands. i think we have a good hr staff that is prepared now to open their eyes and look at different ways of doing things as we hire and move forward in looking at -- with an equity lens. the work we put forward for the equity group, our hr staff was very involved in preparing the document and getting the information forward for what is to come in terms of equity work. i'm looking forward to hearing and seeing great things that come out of this department. i think it's going to be the next three years are going to be telling on how we move forward, not just out of covid but how we make working and hiring

different within the city process. so thank you. i feel i'm not leaving, even though -- this makes it better for me, i'm not actually gone. i'll be sticking around hopefully helping and doing whatever i can, whoever is coming on board or whatever is needed within this department. and you asked what are the things i'm looking forward to doing after this. i have been asked to apply for a commission job at the civil service commission for the city of oakland. we'll see what happens with that. but that still doesn't stop me from stopping with the city and county of san francisco in every way and any way i can. i appreciate the comments and my staff that have been instrumental in moving forward with the things we had to do. could not have done it without

them. >> president bernal: thank you. i would like to hand it over to director greg colfax. >> i just wanted to add my gratitude for your leadership, your accomplishments, your work, your courage to change things in this relatively short period of time and as you go back to that meeting, the conversation we had about the challenges that was within the health department and we have such a great team of people working to improve the health and our systems within the health department to improve the health of the community but there were a lot of challenges. we had no idea what this year was going to be like. none of us have.

>> thank you. thank you director colfax. >> president bernal: thank you so much to michael brown. we wish you a happy, restful and happy holidays and look forward to seeing what the future holds. >> mr. president may we take a formal vote to say we passed the resolution? i did move it --

>> president bernal: absolutely. thank you for that. we have a motion on the floor. did we get a second? everybody, okay. >> clerk: (roll call) the item passes. >> president bernal: all right, thank you to michael brown and to everyone. we'll move on to the next item which is the covid-19 update from director grant colfax and his team. >> clerk: before dr. colfax

goes, presenting as part of the covid, on the vaccine update. and dr. juliet stoltey, i gave you permission to share, i didn't know if you or dr. tenner were going to be doing it. it's all yours. >> can you see? >> clerk: looks great. >> are we doing the overview first -- >> clerk: they have a shift. >> dr. tenner has a shift at

5:00 p.m. >> one of the deputies of health services in the san francisco covid command center and i'll be presenting with dr. andrea tenn tenner. we are very excited to provide an update on our covid-19 vaccination planning. so, i really appreciate the opportunity to speak with you today about covid-19 vaccine and the hope that this is tied to in terms of being the first step towards reaching the end of the

pandemic. vaccines are coming, vaccines are here and were administered for the first time in san francisco this morning at san francisco general hospital and it really is a historic moment. we know there are many steps ahead of us as we get initially limited supplies of vaccines and roll it out. it is a very exciting time. san francisco department of public health and covid command center are committed to following state and national recommendations for allocation of doses with the goal of morbidity and mortality resulting from the disease. just briefly on the two leading vaccine candidates, the pfizer-biontech vaccine which is available and approved and moderna, which is up next, both have demonstrated high rates in

clinical trials, preventing the majority of vaccines in vaccine recipients and preventing severe disease. each of these have been tested in tens of thousands of recipients without significant safety concerns. and they are both planning for tens of millions of doses available in 2020 and up to a billion doses available in 2021. last thursday, the advisory committee to the fda met and approved and recommended that the fda issue an emergency use authorization for the pfizer-biontech vaccine and the fda did issue that e.u.a on

friday. on saturday, the cdc advisory commission issued their recommendations for use in individuals ages 16 and up and on that same day, the western states, which include california, scientific safety review work group made their recommendation that california adopt the safety recommendations in the vaccine. and moderna is up this week. so, the same advisory committee will be meeting this thursday to evaluate the moderna data and make recommendations to the fda regarding the u.s. this is the framework that the cdc has put out for the vaccine rollout. what that shows and what we're experiencing in phase 1, there

will be limited doses available and access will be targeted to critical populations and priority populations, essentially invite only for the vaccinations. but as those doses increase, there will be a broader expansion to other critical populations and as we continue to have larger number of doses available, we'll move into phase 2 where we will continue to reach the critical populations and start to be accessed for the general population. eventually when there is excess supply of vaccine, we'll move into phase 3 where we'll continue to focus on ensuring access to vaccines. these are the allegation

guidelines for the vaccine focused just on phase 1a. both the acip and cdph recommended that phase 1a allocation is focused on essentially healthcare workers, persons at risk of exposure through their work in any role in direct healthcare or long-term care settings and this includes the clinical and non clinical staff in healthcare settings and the other prioritized population for phase 1a, residents of skilled nursing facilities and other similar long-term care settings. they have additional guidance in the document for breaking down these populations to direct allocation of the initially limited doses. and the highest tier in the

state's guidance were acute care hospital workers. dph have been working with the clinical group and public health as we are practically implementing the state's guidance for priority. the federal government has their available doses to allocate, they are allocating directly to federal entities which include federal prisons, department of defense and va. and they're allocating to cvs and walgreens to vaccinate long-term care facility staff and residents.

then they are allocating to the states based on population. the california department of public health receives allocation from the federal government directly to state hospitals and prisons. and they're allocating directly to multi county entities, which span three or more counties and can essentially operate and handle vaccines without local health department. however the allocation framework is the same as other allocations. the remainder of the allocation has been coming from the state to local health jurisdictions to allocate to other facilities based on the state health department allocation guidelines. i'll turn it over to dr. tenner. >> thank you so much. so for the pharmacy partnership,

this is a federal program working with cvs and walgreens to offer end to end services for the vulnerable skilled nursing facilities and residential care facilities for the elderly. the pharmacies will do all of the steps involved in vaccination, including scheduling, the on site clinic dates, ordering vaccines and supplies and making sure the vaccines are stored appropriately, providing the staff to administer on site and then there's a lot of as you would imagine reporting requirements around the vaccine. they will manage all of those reporting requirements. and remember, this is a two dose vaccine. it requires going back to the sites a second time to administer the second dose. these pharmacies are taking care of all of the elements of this for the residents and staff of

the facilities. our skilled nursing facilities are all enrolled and we anticipate i think julie just had a conversation with the state and we have a conversation with walgreens tomorrow. the plan is they would start the week of december 28th and starting with the skilled nursing facilities. because the allocation comes out of the state allocation, we -- the state is staggering the skilled nursing facilities and residential care facilities to ensure there's adequate supplies for the first tier hospitals. next slide. obviously heavily involved in this, we have been joking through this that we are building the plane while flying it. cdph is trying to keep up with

the work to support all the local health. the first element was a scientific safety review work group. that was convened to evaluate the fda application for the first vaccine that was just given an emergency use authorization and recommended the doses be given in california. it was washington, oregon and california to add an additional review to the fda review. that is just helping to support and make sure there are a lot of eyes on this and there are -- you know, the data is holding up to be administering the vaccines. additionally there's a guidelines work group to try to help draft in california specific guidance for the allocation of the vaccine and

that's the guidance we're using and there's community advisory vaccine committee and that's to make sure safety, equity and transparency are all key elements to the vaccine distribution and allocation within the state. and then finally, the cdph is administering a system and we have a system called covid ready that all providers of covid vaccinations have to register through and it helps to get our allocations. next slide, please. the first vaccine all indication to san francisco is 13 boxes of the pfizer vaccine that is essentially being delivered this week. san francisco general where the first vaccine was administered is one of the pre-positioning sites for vaccine, which is why

they received the vaccine early. but our other hospitals that have cold storage will receive their supplies throughout the rest of this week. we are anticipating -- we just got notification to put in a request for the second part of the pfizer vaccine but we're waiting to hear from the state about the amount of that. and there's been a request for the moderna vaccine, the second vaccine once that gets the emergency use authorization. moving forward, health systems that are considered multi entities, kaiser, dignity, university of california will receive allocations directly from cdph. the first allocation, we helped to disseminate because as multi county entities we're not set

up. now the agreements are in place they'll get it directly. va is getting theirs from the federal government and as i mentioned, about 6,000 doses of moderna in addition to the 12,000 of pfizer vaccine will be arriving in a week. next slide please. so obviously this is an exciting time but there are a lot of challenges around this. both of the vaccines that are currently -- the first vaccine that has the e.u.a and the second which we anticipate coming soon, both require two doses and you have to get the same type both times. you couldn't get pfizer the first time and moderna the second time. as you imagine, it involves a lot of logistics. we have to track who got what dose to make sure when they come back in three to four weeks, they get their second dose and

reminders are going to be important. making sure people remember they have to come back to get that dose within the time frame. additionally, this type of vaccine, the m-rna vaccine requires special cold storage. the first vaccine approved requires ultra cold storage. it's a special type of freezer. and so we do have at the department of public health we purchased three of the freezers and have them throughout the city. we have storage just with the freezers for about 600,000 doses and additionally our hospital partners, many of our hospital partners were able to acquire ultra low temperature freezers. the second vaccine that is coming through requires freezing temperatures. not ultra cold but it still requires a freezer which is different from most to require.

there are complications to managing those. the other thing that will be challenging is the phased distribution. we are thinking we'll have weekly or biweekly distributions but we're at the mercy of the production line. this is something not done before in our lifetimes and producing -- the amount we need in the u.s. alone is incredible and you think about the whole world needing this, it's an incredible production challenge. we're not sure how much we'll receive within the allocations and we know that people -- these vaccines have shown so far good studies and so people want the vaccine. it creates some scaresty.

we want to make sure there's transparency from the structure and we have clear widespread messaging around when people are going to get the vaccines and how the priority works. we have been giving vaccine in san francisco for seven hours and i have already received text messages about people wanting to know where they stand in those lines. there's a certain level of anxiety around this and we want to alleviate that as much as possible. we are working on with our communications group making sure the messaging for that is clear. and then there's a lot of data management requirements for the multi dose vaccine and making sure we are able to manage the data well is something that we are making sure we are addressing and we have the plan

in place for that. next slide please. so the strategies that we have used to approach this challenge. the storage, making sure we have appropriate storage for the different types of vaccines. there are a couple of potentials that could be regular fridge. these vaccines really run the gamut. and also the allocation, making sure we have a plan for allocating through the state's priority framework and that right now, the only allocation through phase 1a what julie described earlier. we don't know the exact priority from the state. as that information comes in, being ready to act on that. working with our partners, this

really is -- it's a massive effort to vaccinate everyone who wants it in san francisco. planning for our health systems to work with us and inside dph and outside of dph. this really is a city-wide effort and communicating is absolutely key. our communications groups are working on the messaging to go out broadly and as well as we start to get community vaccination, eventually, making sure our community partners are engaged, aware, kept informed and we have the opportunity to receive feedback and input from the community as well. we are making sure we have the

data support to monitor. and making sure we have access. we know it's going to take some time and the supply chain issues are going to -- the vast amount of vaccine that has to be produced is going to cause us to be getting the vaccine in kind of small allocations but we want to make sure everybody in san francisco who wants a vaccine can get one and we ensure access to the vaccine as we're moving through this process. so we are working with ems and fire to develop a mobile vaccination team and we have been able to cross train the emt's in vaccination and swabbing and testing. so we have a very flexible field team that can disseminate covid

vaccine and can also support that work as we are surging. and thinking about supplemental clinics. if space is an issue in a time we have to social distance and wear masks and observe someone for a minimum of 15 minutes after getting the vaccine. if we need to create pop-up clinics, what does that look like and how do we support that. this really is all hands on deck. this is an effort across the city at the covid command center, we are trying to bring all of the right people together to be able to do this well and make sure that we are able to disseminate the vaccine efficiently in a fair, equitable manner and transparent way.

it's important to remember there are challenges but this is such an important time. even though it feels like a decade, it really has been a very short amount of time to actually have a vaccine and this is not -- this is unprecedented. we have never done this before. while we're trying to figure this out, we really are making history together and it's an exciting .time for us to be able to act and protect our citizens. so i think we are looking forward to working with everybody on this effort and making history. so thank you very much. a >> president bernal: thank you. knowing dr. tenner has a shift coming up at the general very soon. we're going to take public comment on this portion of the presentation and then

commissioner questions or comments before we move on to the next portion. mark, do we have public comment? >> clerk: if you want to make public comment, press star 3. star 3 to raise your hand. no public comment. >> president bernal: do we have questions or comments commissioners? you mentioned data management, are we utilizing the ethics system in determining to meet the requirements. is it useful in that regard or do we have to use a system that is the state or federal system, how are we tackling that? >> that's a great question. so we looked, there are a couple of -- there's a platform that

the state has purchased i think through the state of maryland. it was called prep mod. but we ended up deciding to go with our epic platform. we had the same functionality. its interface is within epic. we want to make sure as we think a year in the future with this, we want to make sure the providers can see. we were able to work with the epic team to have the functionality we needed. so, as of right now, epic will be able to fulfill those needs. we are also working with the city administrator's office because there's a digital design group helping with testing sites and we are -- they're helping us to go through essentially a

planning process to try to poke holes in our theories and operations and see if there are gaps we need to fill or if there are areas where we need to -- where we might have challenges with our system. so far so good. and it looks like we should be able to use epic for this moving forward. >> president bernal: great. thank you. commissioner chow. >> commissioner chow: thank you. i was wondering because of the potential -- well clearly there will be two or three or four or five, from a patient standpoint, what is the process in which patient -- in delivery of the vaccine, which vaccine they may have received. are you going to rely simply on the data base or also ask the patients to maybe remember that

this is red or green or yellow? like sometimes we kind of remember which allergy pills according to the label or is there some mechanism. i think the concern will be how the public remembers which shot they get. a double check on the whole process. that's in the next phase because currently the phase you're looking at are currently pretty well controlled system. but potentially not everybody is on epic. >> so one of the things, we are going to learn a lot from this phase 1a as we roll this out and in some ways it is beneficial

that it is our own healthcare staff as we're learning about how does our system work, how -- what are the challenges with this. our understanding is that these -- that the vaccine is coming with some cards and some sort of -- so a way to notify people what type of vaccine they got. there will be that secondary check but just knowing -- i have the same problem on my shift i'm about to go into, i'd be willing to bet at least one person will say i'm allergic to the white pill but i can't remember which one it is. having epic and the digital data and alerting the patients. so i think as we go through phase 1a, we'll see how the

process is working and if we need to adjust, we will. in the kind of mind mapping with the digital service design group as well to think through other things we need to be doing to try to help make sure that people are getting the appropriate second dose. >> and the state immunization, they will all be reported in there. >> thank you dr. tenner for your work and the confidence we have with you there leading -- both of you leading this effort. thank you. >> president bernal: i see hands

raised by commissioner green and commissioner giraudo. commissioner green? >> commissioner green: you are making history. i recall the h1n1 vaccines when they arrived and the organization and forethought you put into this is so superior to what went on then and this is far more complex. there have been vaccines where notices have been sent to patients because it wasn't kept cold enough and i'm wondering if you have concerns about removing -- i don't know enough about the vaccine to know if you have -- and if you're going to offer guidance about staffing.

some people may be imcompass taited for a day or two and here we are in the midst of this. and i wondered if you were going to offer help so they're not hit with a bunch of staff reacting to the vaccine. >> the first question was the interval between the vaccines? >> commissioner green: when you take it out of cold storage if you have concerns about it. and then the other question if you're offering guidance to institutions because of the vaccine reactions people are supposed to have and how they should adjust their staffing including rolling the vaccines out slowly so you don't end up short staffed because people have reactions to the vaccines. >> regarding the first question, we'll follow the guidance, which

there continues to be updates to how to handle it in terms of the pfizer vaccine and we anticipate it happening with the subsequent vaccines as well. they have given defined guida e guidance. when it's thawed, you have 120 hours to use it. that is the period of time to use it. so moderna is longer. it's not ultra cold storage but you can have 30 days in the refrigerator. these are the parameters we'll operate under when administering the vaccine and providing guidance on the administration of the vaccine. regarding the other question around staffing. it is definitely a consideration. i think the organizations who have rfreceived vaccines, we ar

reinforcing the cdc guidance that they should consider staggering, it seems it is greater after the second dose than the first dose so that's when they can think about giving doses on friday's so people have their potential symptoms -- if they have any over the weekend and staggering them among different departments. >> president bernal: commissioner guillermo. >> commissioner guillermo: thank you.

and i know the priority of the vaccine for direct healthcare workers, people at the hospitals but i'm wondering about on the care clinics that we've had -- related to dr. green's question, how taxing is the administration of the vaccine going to be in terms of the staffing it will take to actually administer the vaccine across -- not just the phase 1a but once we start rolling it out to other facilities, what we need to be concerned about in terms of staffi staffing abilities. >> the first question. healthcare workers are basically

entirely included in phase 1a. they're in priority. the state's allocation guidelines does go through different tiers of priority and outpatient care clinics are in the second tier. in the first tier is acute care, psychiatric hospitals, long-term care, skilled nursing, paramedics and emt and dialysis. and then the second is more outpatient settings. the second question was around -- can you repeat the second question please? >> commissioner guillermo: it had to do with the amount of staffing required.

to administer the vaccine. is that something to be concerned about in terms of whether it's -- >> there are considerations, there is a requirement that any vaccine recipient is monitored for 15 minutes after receiving the vaccine. and if they had a prior allergy to any vaccine or injectable vaccine -- >> commissioner guillermo: i was less concerned about this -- medical staff away from critical other duties in order to be able to do the vaccine administrat n

administration. >> i think it depends on the overall prioritization of the individual time depending on what is happening in terms of surge and who is able to step away to do the vaccination. i don't know it's going to require so many additional staff beyond giving a flu vaccine or other vaccine. it will be a large effort because it will involve almost the entire staff of anyone interested in getting it once prioritized for vaccination. >> president bernal: all right. seeing no other questions or comments, thank you. very informative and helped us and the public understand much better what the path forward is

from here. thank you for your excellent presentation and for your time and we can move on to the next portion of our covid-19 update from dr. colfax. >> hello commissioners. my presentation will provide an overview of the status of covid-19 in the city of san francisco. i want to emphasize that today is a truly historic day in our city. this morning, we provided the first vaccine in san francisco to dr. antonio gomez, the director of critical care

services at general hospital. a truly historic occasion at a historic hospital. cause for hope and optimism despite the fact that we are facing a severe surge. as you just heard in the prior presentations, tremendous work to do as we go forward. the vaccine in limited supplies and more is on the way. so can we have the next slide, please. so just to update you on our cases, we have nearly 19,000 cases of covid-19 diagnosed in san francisco with unfortunately 167 deaths. next slide. with regard to our key health indicators, you have seen this slide many times now but just to emphasize on the far right we

have reached a level of high alert with regard to the rate of increase, covid-19 hospitalizations and our case rate which is now 26.9 and our cut off, we're getting into the lev level. so 26.9 per 100,000. next slide. so across california, transmission continues to grow. intensive care units become less. nearly 100% of the state is widespread transmission by the state health department and very concerning across the state is the limited intensive care unit bed capacity that we have. there are your regions.

15.8%. greater sacramento region just at 15% and then you see extremely limited capacity in southern california region. simply put, if and when we run out of icu bed capacity across the state, there will be a severe shortage and lack of ability to provide people with the best medical care. because of this projection on the barrier region, we took action in san francisco with neighboring counties to implement the state's shelter in place order, modified shelter in place order. the state's criteria for that was to have the regions be at less than 15% icu capacity. because we saw the high case rates and icu rapidly decreas g decreasing, we and other neighboring regions proactively

implemented the order to help with the spread of covid-19. next slide. so these are our covid-19 cases from october through to earlier this month. you can see our rapidly skyrocketing case numbers. there's a little fluctuation every five days or so, that's typically a decrease of lab results typically on the weekend. but the trend in the orange line is up. we had 50% increase in covid-19 case diagnosis after thanksgiving. we are in the middle of our third surge with no indication that things are slowing down at this time.

if things do not get worse but stay where they are, we'll be well over 200 hospitalizations very soon. and i just think it's important to emphasize this. the case rates will translate into more hospitalizations and unfortunately very high risk for shortage of intensive care unit beds. next slide. this is work that has been done by our advanced planning team at the covid command center. this is a bit of a complicated

slide. i'll take a moment to explain it. this is the forecasting the remaining intensive care unit beds in our san francisco system. you'll see based on the projection at the current rate of use of beds shown on the left, by the red x's over the blue line if we model this out, we're projected to run out of current icu beds on january 5th, sorry, that should be 2021. and then we have some capacity to surge to accommodate an additional just over 300 patients and barely keep from running out of these very important beds in february of -- around the end of february of next year. this is a model, i would

certainly not be confident we will not be running out of beds at this point based on this projection, you can see we are very close. if things get worse, we will almost certainly be below the red dash line at the bottom of the slide. so we are in a very serious situation and balancing that incredible hope represented by the vaccine, we think it's really important to emphasize that the vaccine is not going to get us out of the current surge and the stay at home orders are incredibly important to adhere to and our messaging to the public is please do not travel for this upcoming holiday. please stay with immediate members over your household and don't gather in groups. we cannot afford to have increase in cases like we saw after thanksgiving.

next slide. so this is our reproductive rate, you have seen this multiple times now but we are unfortunately with the rate well above one at this time. we are currently estimated to be about 1.4 and things could be -- the reproductive rate could possibly be as high as 1.59. with no change in this, in this reproductive rate we estimate peak hospitalization and deaths by march 1st about multi fold deaths than we've had in the past nine months because of the pandemic. there are ways to slow the spread of this virus that we know work. we have beaten back two curves. if we're able as a community in

san francisco to beat back the virus, slow the spread of the virus, a 40% reduction in that reproductive number by not gathering in groups, social distancing and wearing those masks, this is not accounting for the vaccine because there's not going to be enough in time. we will have multi fold fewer hospitalizations as a result. let's hope of what we can do right now to save hundreds of lives by using the same methods that beat back the last two surges. if we wait for two more weeks to see that reproductive number increase, we'll make a difference but not nearly the same if we start today and then of course, if we see increases

in cases like we did thanksgiving holiday, the situation gets far more dire. regional icu capacity has fallen to 16% in less than a week. several other counties in the region are in very serious situations, including santa clara county. we have more people in the hospital today in san francisco than we ever have before. the vaccine is an unprecedented event but not save us from the third surge and you see below that the ask, the requirements, please stay at home, do not gather, wear a mask, do not travel for the holidays. let's all be here, let's all be here for the vaccine.

thank you. that's my update. >> president bernal: thank you director colfax. before commissioner comments or questions, mark, do we have public comment? >> clerk: folks on the phone lines press star 3 if you want to make a comment or raise your hand. no public comment commissioners. >> president bernal: commissioner green. >> commissioner green: thank you so much for this sobering information. and for the excellent job you and your team has done communicating this to the public. i think your press conferences and the information you have shared is quite effective. i guess i had two questions looking for a ray of hope. one would be are there any trends indicating that the individuals currently positive are younger and therefore it might indicate that even though the number of positives is rising, maybe the

hospitalizations won't go in lock-step. and then the second question, do we have data about length of stay in the icu. when we first started this pandemic, we didn't have the knowledge that we have now about how to treat most effectively. has there been change there for the time that the individuals are occupying beds and icu's based on improved treatments? >> thank you for the questions. we have seen some variation in the length of icu stay across the hospital systems during the pandemic. we are monitoring that carefully. i can get the information around the trends overall. we know care has improved substantially but i would have to refer to dr. marks if the length of stay for the average patient in the icu has changed.

with regards to the positivity rate and the shift of the virus in the different populations, we are seeing a more generalized pandemic. the numbers we have been seeing are not necessarily attributed to outbreaks -- there certainly have been outbreaks in vulnerable populations in congregate settings like skilled nursing facilities but i think our concern is a more generalized pandemic while the overall numbers might be shifting to continue to be concentrated among a younger population, which they have been since the beginning of the pandemic, by virtual of the spread of the virus and how quickly it spreads, we can't adequately protect the most vulnerable. that's one of the key numbers the hospitalization numbers will continue to climb. >> commissioner green: thank

you. >> president bernal: thank you commissioner green. director colfax, i just had a few questions. for those of us who obsessively look at the data it seems san francisco just passed 1 million tests over the course of the pandemic. i think it's a great accomplishment in our testing work compared to other jurisdictions. when you look at the key health indicators we have been using for some time now, the icu beds available, 15% is the low range of the level two out of four. will we adjust, do you think any of the local measures to align more with the state?

>> the local measures give us a more granular ability to plan at the covid command and the state measures allow us to understand from a regional perspective where different counties stand. we have discussed that quite a bit but how i would think about it is the state is sort of the broader guidelines and criteria and then we use the dashboard, the local dashboard as a way to be very granular in terms of planning. >> president bernal: great. thank you. and my second question is with regard to hospital admissions. if you look at the chart it

seems as though the proportion of icu admissions compared to total hospitalizations is getting smaller overtime, i don't know if it's the lagging indicator we expect icu to grow as a total of hospitalizations or are we perhaps offering more confident interventions that keep people out of the icu once admitted to the hospital? >> i think the latter is true. i think the former is very plausible as well. we are watching to see if potentially -- people often go into the medical surge beds before they get into the icu. the rate of this increase has been so sudden that we're going to see unfortunately if we have

an ability to care for people in a robust way so they don't -- not robust but protective way. but so far we're watching and very concerned that the numbers in the med surge beds will translate into high numbers in the icu beds as well. >> president bernal: thank you. commissioner chow. >> commissioner chow: thank you dr. colfax. i had several questions. in regards the the hospitals, are the hospitals asked at this time to reduce their elective type of services in order to provide potentially more beds? and then number two would be with the recent promotion of dr. tomas aragon to the state level

and so many covid directives have come from him and his guidance, what is the department's intent in terms of our medical officer and how is that going to be transitioned since i think he takes office in january. >> thank you commissioner chow. with regard to the first question on elective surgery, we are working closely with the chief executive officers and chief medical officers in hospitals across the city to ensure that elective surgeries will be reduced such that beds are made available so we will not have in the city, hospitals will not have people occupying

hospital beds for surgeries that could be postponed. we're working very closely with them to develop the criteria to any cancelling of elective surgeries would be done with capacity in the hospital. the beds that would otherwise be used for elective surgery would be made available for covid positive patients. with regard to transition of dr. tomas aragon, he with city policy he has appointed dr. susan phillips as acting health officer and that -- once he transitioned to the state the board of supervisors will

appoint a new officer. >> president bernal: seeing no other questions or comments from commissioners on the covid update, director colfax, director's update, much of which we have probably covered. >> much of the director's report has been covered given the vaccine news. and the presentations that the commissioners saw. i did want to take a moment to highlight that dr. tomas aragon who has been at the department for decades has been a tremendous leader and mentor to me and others will be transitioning to be the state health officer, which is a tremendous benefit to the state,

great opportunity for him and i think in the short and long-term, a benefit for san francisco given that his leadership will be there but he's also quite familiar with the needs of local health department. i'm very grateful. there may be a time we come back to talk more about his leadership and he's on a well-deserved break, which i know for a fact, it's probably the first time he's had 24-hours, hopefully not checking his e-mail for 10-11 months. he's probably checking his e-mail anyway. he's going to be starting at the state in january and has appointed dr. susan phillip as acting officer. the deputy director of population health will be the acting director of population health and we will embark on a

search for a population health director as time permits. that's the high priority obviously for the department. i'm available to answer questions at your pleasure, but just a few high points. with regards the the covid-19 response, i want to emphasize the department focused today on the hospitalizations and vaccine, which are obviously key, we also understand the pandemic has multiple other facts and are in coalition with the african american faith based coalition and we address the issue of food insecurity just last week. it's one of the many efforts we

have been working on with other city partners, distributing food through cal palace drive-thru event that distributed to over 5,000 families. the other piece in addition to the news we reached a million tests, we continue to rapidly expand our pop-up testing sites in communities most affected by the pandemic including in the southeastern part of the city. and then on the behavior health side, i wanted to emphasize despite the surge and all the work going on at the department, we were able to launch the first street crisis response team, this is a pilot project consistent with mental health sf, collaborative with the emergency of medicine and fire department. you have heard about this in the past. that launched on december 1st and going quite well.

those are just key points in the director's report and i'm available to answer any questions. thank you. >> president bernal: mark, do we have public comment? >> clerk: press star 3 if you want to make comment on this item. no comments. >> president bernal: we can move on to general public comment. >> clerk: if you'd like to make general public comment, you can raise your hand or press star 3. no comment commissioners. >> president bernal: moving on to item 6, racial equity action plan by ayanna bennett. >> clerk: i need 30 seconds for

the item to show. if you need help, i can walk you through it. >> just a moment. . >> i would have to quit to give

permission -- >> clerk: i just need 30 seconds. feel free to begin to introduce. >> so i want to start by setting a little context for this. we did talk about this recently but i want to be able to say what we talked about so everybody can catch up and give context for the racial equity office of equity and racial equity and things that have happened in the last year that some of the newer commissionerincommissioners may not have been a part of. we're going to talk about the racial equity action plan, required by the ordinance of the office that created racial equity last year in october 2019. that ordinance requires that departments file a racial equity action plan. the plan covers three years,

this will be 2021 to 23. it's calendar years and has an annual update where we will update on the progress and successes and challenges of the plan every april to the board of supervisors. we expect that this plan will have some activity in 2021 and 22 and 23. the first year i think is less secure because we don't actually know what the pace or disruption of covid will be but we'll have all of these activities done at some point over the three years. that is what the plan is you're looking at. mostly it is a list of activities that the office of racial equity has asked us to do and our plan for how we plan to go about those activities. the other thing i want to onna

about, allowing us to really respond to this requirement in the last few years, we've made a lot of progress in this area. we had been using the government alliance on race and equity which is a national organization, we have been using their framework, to operate, to organize and operationallize and one of the things we have done is organize a lot of roles and budget. the office of health equity has six staff. i was a solo act for some time. there's six staff and we have equity leads, most of whom are full time in this role and some of them smaller parts of the department are only part-time, but we are able to take these activities and requirements and then push them out to the

various parts of the department through those people. and then the last is that we now have on board a director of work force equity within the office of health equity and this racial equity action plan is dominated by work force equity concerns. we're in a really good position for all of those things to be able to implement this in the best possible way. this is not our first annual plan as many of you have seen. we do the annual equity, this is somewhat different and had it doesn't cover all of the areas. this is not asking for a lot in terms of community engagement but gives us a lot of structure and support for the work force equity which has been really important but not as successful -- at least not as primary part of our work so far.

next slide mark. thank you. what you're looking at is the beginning of what is in the beginning of the report for context. where we are as the department. nearly 75% of our staff are white or asian. we have two large groups that dominate. filipinos about 40% of that, asian, half of the department, that does not exactly reflect the way the city is but having two large groups is how san francisco looks generally. white residents of san francisco about 40% from the 2019 estimates and asian residents are about 36%. you can see in our staff, asian employees are overrepresented a bit and white employees are

underrepresented. more of those employees in those two groups are in the professional classes, most managers above and two smaller groups, black and latino are about 13%, larger than our population of african americans in the state and about the same size as latino. we have other small groups that are less than 1%, native americans, pacific islanders and native hawaiians but those groups are very small in the department as well. we have some similarities to the city, we're not all that similar to patient population. we have a lot more latinx patients than staff and a lot more african american patients than staff and both of those groups tend to have lower paid service positions instead of our

upper management or providers. a little context of what we have done in the past couple of years to show you where we have moved. work force reports, the work force reports on employee engagement survey, they overall like their jobs but we have a lot of indicators of stress and unmet needs. black staff in particular are recording negative experiences and judgments about their work experience. we have about 90% of the question -- 90% with the questions on the engagement survey our black african american employees scored them less favorably than other employees. we need a lot of training in terms of racial equity concepts.

we have needed training about how to talk about race. if you look at the graph beside you, the first question is i understand government action and policy contributes to differences of racial groups. that's essentially the definitions of workings of institutional racism and every group essentially increased their agreement that that was true, so that means we're really getting the definition across to our staff. the next is that people are comfortable talking about race in the work place. that is not as high but everyone has increased. we have made inroads with the training we have done and the exposure. we have normalized in other words. we have done a lot of organizing that i think has impacted this.

next slide mark. as we -- this has tiny text. so we have done a lot of organization, we have champions program and fellowship program. people have seen a lot of activities and about 10% more reported that they agreed a that the department was active on the issue and about 10% agreed they are active on this issue. people are doing more and we're receiving all of these required activities to a group that has been fairly unactivated. this graph is talking about respect. so managers show staff respect is the first set of bars and staff showing patients and clients respect is the second set. both of these did not move as much as some of our knowledge and attitude indicators and that makes sense.

we normalized and got people in conversation and gave them information. that's not the same as changing behavior. that's pushing us to where you actually do things that change culture. so the institutional action and policy change in this document will help us move the culture and move the way people behave. hiring, salaries, promotion, all of those things that were unmet needs will be addressed in the other parts of the documents. next slide. just to how the document runs. it's very long. the activities fall into seven categories, seven sections and then different kinds of activities in each section. some request for policy change, trainings and data and

monitoring and fundings for entirely new programs. not as many of those. so we have the seven sections of hiring and recruitment. discipline and separation. diverse and equitable leadership, mobility and professional development and boards and commissions. so all of those areas have many parts and we're going to talk about key activities to focus on. hiring and recruitment, looking at recruitment strategies to get more diverse pools. looking for where we can get the candidates which has to be different from where we're getting them now. we'll have to move new ground on that. looking at being able to monitor for bias and hiring practices. just like everything we're doing

in quality improvement, you can't improve what you can't measure. we have to start monitoring these things and looking for patterns and that will allow us to move toward policy and accountbility. training for managers and standard practices among their decisions for hiring and for probation and other parts that keep people in the department. equitable best practices for how you go through the process of picking someone and hiring policies for clinical services in particular. those are disparities for the patient population that providers don't match them as much as we would like. next slide. retention and promotion we have changes around hiring and

promotions. racial impact analysis tool to monitor for possible bias in the way staff is moving through the department. doing some communications. a lot of what we think may be a root of differences in promotion, staff had different levels of soft skill knowledge. knowing how to apply, how to find the jobs, even finding out things are opening, some of that is word of mouth and word of mouth is vulnerable to bias. some of it is informal support and that is subjective and vulnerable to bias. levelling the playing field on those is going to be a key strategy. next slide. so discipline and separation is an issue for us and the rest of the city. so the hearings that we had in the past few years with black and brown employees complaining

and letting us know about the kind of treatment they received, a lot of interest went into documenting what our separation and discipline disparities could be and they are there. in our department and in most of the others. so in trying to get equitable treatment in discipline, it's going to take quite a lot of awareness building, we're going to have to have new policies in the beginning at least we're going to have to have a process where there's some review of what managers are doing in terms of discipline. right now it's a little bit dependent on how the manager wants to proceed and we neat to get more start standardized practices in there. one is employee complaint process so employees have a way to tell us about how they're experiencing their work place and how their manager is doing

so there's a little correction of the power imbalance so they have a way of altering the situation. so equity leads are going to be really important in that. a lot of those are personal relationships that you need a person on the site to do anything about. next slide. we all know that leadership is an important part of how this works. this means both leadership at your level, we'll get to that in one of the future sections. it means the executive and leadership level and it means the middle management level. middle management is one of the places we have dramatically less diversity at the bottom or the top. and that is where a lot of our disparities and hiring are centered. those are the hiring managers and people in charge of

discipline. training in that area, standardizing the procedures and getting more consultation in that area will be really important. and making sure that all of those things are tailored to the needs and challenges of being a manager. having manager training around equity. how to manage equitably. how to create policies, all of those things are things we're going to try to get to relatively quickly. we were doing something like that with equity fellowship.

the people most often being held in the dead end positions are people who started at a very low level. that doesn't necessarily happen in other parts of our department. getting those log jams cleared is an act that will benefit everyone but disproportionately benefit our black, latinx and

pacific islander staff. getting better performance management, getting better tracking again, releasing job opportunities in communication and getting training for staff about how to move to the next level so we don't have training available and everybody's union but we have training needs that people will have in order to progress. that's true for ebs who wants to become the manager and true for someone in the kitchen as much as it is for physician who wants to become the cmo. next slide. organizational culture, it's a very complicated thing. it's not simply going to change because we institute a policy or two. it will take a lot of influence

and slow work. but there are activities in this plan that i think will give us some progress. we're being asked to develop resource groups which means we'll have staff do something that is common in corporate america and the rest of the country, african american staff getting together to run a volunteer group that they used to mentor, to give information and do supportive activities. it's the kind of group that employees create themselves and they can be supported in that with structure or small amounts over funding but really giving people the space and time to get together in the way they need to. so we're being asked to help support putting those together and we have been talking about it for many years and a request from many, many staff. i think that's going to be a positive move and then we just

need to start more enforcement of acceptable work place behavior. as you might remember, we put in place respectful behavior policy into the employee handbook but it entered the handbook just as covid was hitting so we never got to the point where we did the trainings about it. we never got any cases that we could use as test cases for conflict resolution. so we're going to have to reenergize that process into next year. and continuing to do what we have done with the staff engagement survey, to measure the climate and look at how people are feeling and how they feel they're being treated and the treatment they're seeing around them. and how comfortable they feel with the issues in the work place. so far i think we have made good progress there but we'll have to push that further as well. next slide. so this one -- it is changes

are being asked of all of the boards and commissions around the city and the activities that mark the secretary has put together with you all are really responsive to the kinds of oversight that i think you already are striving to provide. it is to ask speakers how they determine it is being done equitably or the contract they're proposing is equitable and providing for the people they need it the most. that kind of structure helps us standardize something -- it is happening right now to some degree in the questions that you ask, but in this way it makes it much more the responsibility of

staff to be doing that from the beginning, not simply being able to answer your questions but using a process of development that ensures the equity to be reported back to you. there's going to be training in equity for you all and orientation specifically for new commissioners and we're going to look at -- you're going to put into the health director's performance evaluation some measures of health equity that is essentially a mirror of what we're trying to do down the line in leadership. we want to make accountability for making health and work place equity a priority. for all senior leaders, managers, everyone who supervises someone has the responsibility to make sure people are getting the positive experience they should have and people are being treated

equitably. accountability is going to be important at the lowest and highest level. that's the bulk of it. next slide. are there any questions. this is a very long document, it didn't cover it in a large way and we have things to add to the narrative you have seen but i would like to -- i'm happy to get a little bit in the weeds if you have specific but any questions i'm happy to answer. >> clerk: may i add a point? in the plan for commissions it states that you the department will bring quarterly updates to the commission. this will be an ongoing process and the document itself is a living document. >> president bernal: thank you dr. bennett for this presentation and for all of the

work that went into it from you and your team. in addition to the course of all your regular duties and your work at the covid command center. this is very good and comprehensive report. before i go to questions or comments from fellow commissioners, i had a question about employment survey, seeing in the difference between racial and ethnic groups. was there a qualitative aspect to that. more so that institutional policy gaps that we -- problems we see to diminish health outcomes or was there recognition of the ability that government policies can have to enhance health among certain racial and ethnic groups? >> that is a question that i

borrowed from a different jurisdiction. i wanted some ability to compare across. that's why it's worded that way. at this point it is not specific to whether or not people understand -- >> president bernal: we're losing you a little bit. >> it's not specific about people understanding the negative and positive disparity. it's in both directions. there's overenforcement and diminished access and resources but there's the overresourcing and its advance access for more resources on the other side. i would say the diminished is the one people understand first. i'm content -- at some point we will get people to the level of sophistication to understand that it is both.

i think even understanding the first is an important step for people to understand the role in fixing those deficiencies. >> president bernal: thank you. any other comments or questions on the presentation? i do not see -- dr. bennett, thank you, we look forward to seeing -- sorry, commissioner chow. >> commissioner chow: i had my hand and then it disappeared. thank you, i remember she has been working at this for a year, well, she has been doing the covid work. she has put together i think a wonderful document that really describes where we are and the

work i think overall of the department is trying to do to answer this very complex issue. by separating it into the segments, i think she has captured exactly all of the issues that we are facing. that which within our own work force and those of us working with sf general for example and with the equity program was very aware of how they were trying to work within their own culture to answer these questions and i'm sure that was factoring in many of the other branches. i think it brings together all the different elements of this and then allows the commission which is in your section seven to really see and have an ability to really view the process for the entire department rather than just distinctly in each of the other

sections. so really want to commend you for laying out the ground work, the base upon which then others -- so much we could do and i like that -- i know i saw the flyer before of the difference between one year and appears to be some movement internally. but a lot more to be done within our own staff. the question of disparities within the different categories and management and where some of our lower level manager -- lower level employees seem to rise and i think to work with hr and others and the managers themselves, i think in an overall department banner is

going to i hope change what was more of an individual within each of the divisions trying to often push the agenda when they felt it was necessary. i think this comprehensive approach will lend us to some success. on one of the pages and that's what i was looking for, the need to be sensitive in terms of interns and residents and if that was actually referring to those at general. they are an incredible group of diverse people, if you look at the awards that come out of the internship program, you can just see that it's an extremely talented group. i wasn't quite sure if that

really meant that or meant that you had other interns and fellows within the department. maybe we should clarify that. >> the internships that are being requested, and i will give that framing, the activities that are listed there have been given to us and every other department by the office of racial equity. we can -- the right side of the document saying how we'll go about that, meeting that need is up to us. but instituting an internship program, participating in opportunities, all of those things are required by the office of racial equity and what we determine in how we do it. they are intending that to mean interns from the community who are interning as entree way to getting jobs in the department. they mean non clinically. they could be environmental health inspectors.

the system they put together that we're doing the same activities that hsa is doing and those are our cohort partners, people doing similar work, so we'll be working with them to see how we can overlap on some of these and sherri sources and you'll see some of that as we go forward and try to really maximize resources and take lessons from them. >> commissioner chow: thank you for that clarification. i know we don't select the interns and residents that come, but they are by themselves quite a diverse group. i understand this would be the city intern program. i liked the comments to

retention goals there. and health commission goals are ones that all of our commissioners would support and in particularly the quarterly reports. this would help maintain the focus on this. so there's the internal staff that we all have to work with and that's where principally i think much of our work has been. the external, certainly hiring the nurses and so forth, we were trying to do the outreach and did those outreaches into different communities and different areas as barbara first started before in terms of trying to expand our pool of candidates. and then i think trying to breakdown the great barriers, length of time to try to get --

been working on greatly. all of that has been contributing to this. i had just a final comment about -- and i do like that on the program side then, we talked about staff and improving that and the idea of the racial equity lens is very important for all of us, for the communities at large and i just wonder if within that lens because often then the asian population becomes sort of monolific. often as you know, the asian population gets diluted in its real needs because it's affected also by -- because of the large immigrant population before,

which is imbalanced by the third and fourth generation that have become quite desimulated and we come out as kind of immediate and those issues are not well highlighted. breaking down all the programs we have that the appropriate emphasis has been placed upon the asian disparities. either it be the issue that the programs for which we are one of the big focal points in the nation and -- or it be the need that the community needs to

bring to the attention of the department in terms of hepatitis b crises it had before and the department has room. i don't see that in the listing anymore of us supporting hepatitis b for example. and lastly, the disproportionate diabetes in the community that is not diagnosed because of the issues of the bmi in asians. it's not meant to be specific but as i look through the lists and i turn to 1% of this and 2% of that. i don't see that these particular disparities in the community are highlighted and i'm not sure how we sort of tackle that. it seems to me it should be a

focus when a third are affected by the issues. i think there are other disparities seen not to get within our document -- maybe it is, but it isn't as evident as i found. >> president bernal: dr. bennett -- >> we don't always track our programs by population in that way. we don't track them. there are programs that serve the various parts of the asian

community. we're doing a better job breaking it down and actually some of the data from our employees as well as being better broken down. the emphasis on the list was really brought together by the office of equity. they're not looking at it from a health lens. they're looking at it from a total city lens. so it is the same kind of emphasis given to other groups and we have listed as much as we could in the time frame given. but it is not meant in any way to be comprehensive of the entire department. we are going to have to be better about keeping a list of what activities go for which area of the city and which population in the city. but that has not traditionally been how the department has looked at itself. we have a bit of a hard time

especially in the land of covid getting all of that information together. we'll look for those and if i can, i will insert them. i think it's important and it's a living document and i plan to change it once or twice a year. and thank you for the history. we benefit by not coming new to the issue. we have done a lot about work force over the years and people are open to the idea of making changes. we just haven't always done the most effective thing and taken care of everyone's problems. now we're trying to be more comprehensive about it, but with infrastructure in place and a history behind us. i think we're in a good position because of the work that you and the rest of department did years ago. >> commissioner chow: thank you for the comprehensive document and we couldn't comment on it if

you haven't put it together, to put it together in the face of your efforts really is extraordinary and we thank you for the work you're doing. thank you. >> president bernal: thank you commissioner chow. commissioner christian. >> commissioner christian: thank you. i certainly echo commissioner chow's comments and praise. i just want to thank you for what is clearly a lot of work and you put it together in a very useful way. so i want to thank you for that and let you know we are all here to do anything we can to move this work forward and assist you. i hope you know that and you will always reach out to us. and i just have a question about on the organizational culture of inclusion and belonging. the development of resource groups to support staff and marginalized groups, are there

human resource challenges around developing the groups. how will they and can they be created without running into issues like that. >> so, we have been asking about them for about two or three years and that has always been a sticking point. there are other parts of the city family that have been able to do resource groups and you would think we're all under the same employment restrictions and laws. it does seem there's a way to do it. and it's the way that i think corporate america has done it and other departments around the world have done it. portland and other cities as part of the equity work have created the groups. the way it is done, it's not exclusive. if you are a latinx person who wants to support african american employees and african americans in your city, feel free to join the group and be

supportive and help advertise their work and support their work. the groups are about who you're supporting, not necessarily who you are allowing into it. they're voluntarily put together by staff and voluntarily attended and set their own schedule. they're not mandated by the department or controlled by the department and they cannot be exclusive. or should be really because everyone needs to be on board for all of the changes. >> this is donte king, our new equity work force director. he's an expert on these issues having worked in these areas.

>> clerk: in the chat room he asked to comment. i have unmuted you mr. king. you should be able to speak. sorry. maybe continue and i'll work with him to continue what is going on. >> it's a problem with the system. >> appreciate the document. >> i look forward to your questions as we go through the racial equity assessment tool. i think it will really add an exciting and important element to everyone's presentations and we're going to be working on our end to train staff to be able to do that successfully and working with you on how you can approach that in terms of your questions and structure of people's presentations. really looking forward to that.

>> president bernal: thank you commissioner christian and dr. bennett. i don't see additional questions -- sorry commissioner guillermo. >> commissioner guillermo: yeah -- read the whole report. we received it a little late. one of the things that struck me, i was just even going through the slides and knowing all of the work that has gone into this prior and then the implementations challenge that is going to happen, what i am both excited and anxious about is to see how what we're doing here in san francisco could be something that is not just best practices for us but really could be something that would be

a job, a modified sponsored in other -- just in other environments. other public health departments or in other areas where the issues of racial equity are emer emerging as a priority in large systems and really need to be able to find opportunity for success and really measures, you know, in which to implement and standardize for at least incorporate into what these other environments. it is exciting. it is sort of in some ways -- i was feeling like i don't know

where to focus because so much work needs to be done and i'm sure once we are able to bring resources back into the implementation and focus on this, that it will take off in a way that we can't even anticipate. just so sort of -- again, share with you the excitement that i have and anticipation that happens often in san francisco doesn't stay in san francisco and offer support that i think we all feel about what you're doing. >> it is a 2 way street. we benefit from other cities that have approached it and

we're going to benefit from what we end up doing and we're in a lot of networks to make that happ happen. i've talked to people in cities, and we're in the internal network of the different agencies working on this at the same time. that flow of information back and forth is going to happen in real time. we're not going to do an experiment and tell people about it later. they're going to hear in real time how we're doing and implement at the same time. >> president bernal: all right. seeing no other commissioner comments, director colfax? >> thank you. just to reiterate the department's commitment to the work, i thank dr. bennett and

the team for what this document took during these unprecedented times and the people across the department that contributed to the document. and just to reinforce it's a living document, we will be held accountable to it as a department going forward and look forward to reporting back to you on a quarterly basis on our progress and some of the difficulties that we'll likely have in achieving the goals. this is hard work that will take time. >> president bernal: thank you director colfax. mark have we had luck getting mr. king's audio up? mr. king, let's see if he can speak on camera. >> hi everyone can you hear me? okay great. thank you. well hello i'm so excited to be here.

thank you dr. bennett for putting together great work and for all of the work you have been doing over the last several years that at least i've observed this work at the department of health. the one thing i wanted to underscore that commissioner chow highlighted, impacting the asian community and kind of amplifying that there's a phase 2 of this racial equity action plan that will further amplify all of the disparities across various communities and i wanted to amplify, i came from the san francisco municipal transportation where i instituted a framework of various affinity groups and the ways in which they were -- they did span across racial and

ethnic groups. they also included, there was a group dedicated primarily for targeting issues primarily regarding women which was a change that was started by women in that agency who had specific issues around transportation needs for women and also systemic issues in the organization that serve to actually disenfranchise women that were there. i'm sharing this to say that we have a model in the city that has been established that we can pull from where we have done this at the city and county of san francisco and it served a great purpose in terms of amplifying the voices of employees who don't necessarily have the opportunities to be heard and or raise issues to the

leadership to inform and influence decisions that are made at the organization on institutional levels. i'm very thankful to be a part of this team and i look forward to supporting the phase 1 and phase 2 of this plan. >> president bernal: thank you mr. king. and welcome. we look forward to continuing to work with you and dr. bennett on the racial equity action plan. thank you to dr. bennett particularly for including as well all the ways that we as commissioners can and must step up to put this plan into action. i do not see further -- >> i just want to be able to thank the team. while i was working at the covid command, i was not working on this. the leadership was done with the

equity lead for hr and other equity leads who attended the meetings and started the writing and moved this quite close to the finish line before i ever got out. i'm pulling things together and talking about it, but they did most of the work and i want to appreciate them for that. thank you to the group. >> president bernal: thank you for acknowledging them and we join you in doing so. i apologize mark, did we not go to public comment before commissioner comments or -- >> clerk: we did not. there's no one on the comment line. i don't believe we have any comments. >> president bernal: apologies for taking it out of order. thank you dr. bennett. we can move on to our next item for discussion. the fourth quarter annual

report. >> good evening commissioners. i hope you can see this -- can you see my power point slides that i'm sharing? >> clerk: i think your bandwidth is low. can you turnoff your camera and show it again? yes, now it's beginning to show. >> okay. excellent. great. so it's my pleasure to present to you probably the most complex set of financials i've ever seen since i have been at the department. and it's really as a result of covid like everything else but of course as you know, covid was a phenomenon that happened in

the middle of this year in 1920. so midway through the year working with the controllers office to best sort of determine how to appropriate expenditures for the response and looking at ways to track the cost and facilitate for reporting, the controller's office created a new covid division to reflect our portion of the cost for the response. and so how the 19-20 financials present, we're looking at all including the covid product to determine the end. i think this slide best summarizes, gives you the best view of how we split out our regular operations which is at the top here and then we have the covid project expenditures

down below that we worked with the controller in terms of developing the expenditures for the revenues as well as the expenditures and what you'll see, our year-end balance is 126.4 million. and i'll just note that of this 126.4 million -- apologies

commissioners. what you see here, positive revenues and expenditures on the operating side, we see additional covid-related revenues within the covid project. this off sets the expenditure for net positive but still positive 4.7 million ending balance on the expenditure side and the one time revenues we recognize create a positive year-end close. this specifically is what we're seeing in -- about a $20 million loss on the net patient revenue side driven due to reduced productivity as a result of covid-19.

it was off set on the revenue side by a significant one time initiative -- sorry one time revenue sources we had. there are details in the memo and they include increases in prime and quality incentive program and enhanced programs. we had a $36 million settlement reserved and released under the program. and then 40.5 million of retroactive payments for the newly improved program. then on the expenditure side, we had minor operating surpluses of 300,000 and we had negative on contracts, materials and supplies of 2.7 and 1.9

respectively. so ending the year with 10.3 million surplus in net patient revenue, primarily due to a rate increase we were notified of in the fall. we got an overall rate increase that was higher than budgeted and we had a slight favorable salary of 1.3 million. so primary care, it is a similar story where we had a loss in productivity related to covid that is off set by 1.7 million in one time cares provider relief funding that helped to off set some of the losses we were expecting.

behavior health, we are showing positive, about 15.1 million mainly due to prior year, one time revenues that we're seeing. we saw an increase of 4.1 million state realignment and then 3 million in non personal services. minimal variances on expenditures and revenues. for health network, we had lower than expected revenues for healthy san francisco programs and patient employer fees as well as the reduction in the city option funds dispersement and on the public health division, we experienced a

$4.8 million expected loss in revenues, primarily related to reduced economic activity related to covid that resulted in a reduction in the number of applications we get for fees and had reduced level of inspection work, we weren't sending all of our inspectors as we normally would. there was a revenue loss. we had savings of 29.3 million of savings on the salaries side is really related to the fact that we are -- we were -- reallocating operating costs and documenting existing salary and personnel costs and putting them

towards our covid response efforts. again, if you saw there was sort of a negative expenditure in the covid project, this was the offsetting good news we had in part from the operating side that we put towards that effort. and lastly we had savings with work orders with other departments and this is due to the fact that it was not business as usual and we did not use all of the services that we may have used with other city departments. so the covid project, overall we have 94.5 million in increased revenue. these revenues we worked with the controller's office and some of these assumptions they wanted to recognize within dph's budget. so there is -- we have cares county relief of 2.4 million,

we're expecting fema reimbursement for some of the covid costs and ppe donation, there was 7.7 million of donation of personal protection equipment that we received, because it was a gift we recognized it as a revenue but not exactly cash in hand as you can imagine. and finally for transfer in from operating, this is sort of like a little bit of a footprint of the beginning of how we approached our response to covid. in the early months as controller was determining the best way to allow for new expenditures, basically it allowed for a transfer of expenditures using savings or unused expenditures in january and february and moving into it

the new covid projects so we can begin spending the dollars as part of our response. but on the flip side, sort of once we got appropriate allocations from the controllers, they wanted to correct that and so transferred it back out to operating, these two entrees do off set each other so it's really just a net $3.5 million difference but because of the nature of like we have this expenditure, this is the accounting treatment of these two transactions. also on the expenditure side, cost of 33.7 million. contracts and non personnel costs and this includes cleaning contracts, leases for hotels and other services and then

materials and supplies, represents mostly ppe purchases and other city departments. as i mentioned before, 90.6 million of the projected fund balance that we do see is the same in the adopted budget for fiscal year 20-21 and applied to off set the projected deficit. and also we like to brief you on the position of our management reserves and in the current year -- sorry, in 19-20 we released 40 million of prior year settlements, these were dollars we budgeted and expected in 19-20, but as we did the budget, the dollars came in sooner than expected so we received it in 18-19 but because we planned around it, we put it into the reserve to carry it into 19-20

and then appropriately when 19-20 came we recognized the 40 million at the same time, we are assuming additional unrelated to the disproportionate share of -- it's a year over year reduction of 9.7 million and still the management reserve ends with $11.1 million balance. i believe that is all i have for you. that was a lot of information. i'm happy to answer any questions you might have. >> president bernal: thank you. before we go to questions, is there public comment? >> clerk: there's no one to make public comment. >> president bernal: thank you. commissioner chow. >> commissioner chow: thank you.

it's amazing for such a complex year and complexity of all of the accounts that you have, you made it simple enough that we think we understand. would the surplus make up for the deficit or because we budgeted the revenues that we could not take funds from that

pot or maybe i'm in the wrong pot of money. >> you're in the correct pot of money. it really in part due to 12.7 million of lower than expected patient employer fees as a result of reduced healthy san francisco enrollment and just in general, it tends to be a good thing and trends we had seen in prior years, people with affordable care act and ability for people to opt for cover california which is insurance, better than healthy san francisco, we saw a reduction in the enrollment and associated fees we would ordinarily see. we're going to watch this closely because with economic downturn it's possible that healthy san francisco may be a necessary option for some. in addition, there was 5.5 million in unrealized revenue related to the city

option. we are putting the transfer of deactivated funds on hold working with the san francisco health plan and city as allowable treatment of the funds. until we actually get advice on what is the best way to move forward, we'll hold on recognizing any drawdowns from the program. >> commissioner chow: thank you. and so i assume that when you go to our first quarter coming up that we could take a look at that, too. thank you. >> the finance committee for the commissioners around the finance committee, i know we've had a number of accommodations there about the changes that jenny was describing about the programs and how the dollars flow through. we've had several of the

modified contracts with the health plan and change in the structure for the health plan and that is in progress. we are as jenny described, in the process of changing the treatment of those refunds held by the health plan and how the money flows from the health plan to the city in addition to the process of bringing accounts from the health plan into the city's financial system. so those that are on the committee, we have been through this a couple of times and it's an extraordinarily complex but may be about some of the conversations we've had with the office of managed care and health plan. you're seeing some of the changes reflected in the financials until they go through the process that jenny described. >> president bernal: commissioner green.

>> commissioner green: so excellent and so appreciated in the way you distill all of the complexities into the documents is incredible. i guess i wondered, this may be for the future or the question about all these uncertainties, everything from fema reimbursement and new administration in washington combined with certain programs sunsetting this year and then the eroding tax base for the state and the city, so i'm wondering, as you look at all these potential increased expenses along with revenue shortfalls and programs that are uncertain, when do you think you'll have the sense for how that affects your future projections and when it might be so -- i guess affected that you might want to revisit the budget or revisit the projections. do you have a sense for the timeline on this since there's so many changes right now?

>> sure. in the current year we are working with the mayor and controller's office to project out what they actually believe will be within the five year financials. there's so much uncertainty about what exactly will happen but we are sort of working with the controller to have a consistent view of the world, you don't want one city department saying it's going to be horrible for five years as a result of covid and then another city department projecting that we'll bounce right back after a year or two.

>> it seems no one is certain especially with the tax base how this is going to come together

in the future and with all the businesses closing in a dynamic way, it would be helpful to get your sense of where you're going to be heading. >> we will do that. we'll have in january we'll have hearings as we go into the budget process and commission and the hearings we'll report to you on what the consensus city projections are included in the deficit as much as we can know them. >> president bernal: all right. thank you. i'm sorry. do we have one more comment? >> commissioner chow: i actually thought we should acknowledge that the department did end up in the black again and that the work of finance and work of dr. colfax and his whole team even

in spite of covid really that is an accomplishment i think that the commission should take note of. it's one of our functions to be sure that we are financially responsible and i think in this extraordinary year shows that we continue to be faithful managers of our resources. thank you. >> president bernal: thank you commissioner chow. i know we all agree with your sentiment and thank you. i believe we can move on to the next item which is the fy-20-21 financial report. >> great. okay. so now that we're moving into a brand new fiscal year where we actually were expecting covid costs, you can forget everything i just said about creating a new

covid project and balancing around it. our approach to financials are different than what had shown for 19-20 and this is the result of the fact that we had the foresight to project additional costs related to covid. we set up a central covid command center jointly managed through departments but really managing the response of the entire city and how the controller created the covid project in 2021, it creates a lot of flexibility for the covid command, should be able to move dollars around within departments as the command saw appropriately. perhaps there were some dollars in dph and others in department

of homelessness, supportive housing or emergency management. we have the ability to flex dollars within departments. you know, so long as it's within the same program as covid. what we did, the tracking involved to city-wide approach and managed by the mayor's office and controller's office and it's reported separately from dph. while there are technically dollars in the budget for a response, we are excludeing them from our financials this year. basically they're held levels so we can isolate the changes on the operating side. this is because, again, because there may be savings in dph's response in covid, it doesn't mean we get to recognize that savings or good news on the operating side. it's a market departure.

it is also we have incredibly simple set of financials to show you for this year. there's really only two major variances we're projecting. the first related to better than expected supplemental funding, this is in part one time because a portion of this we expected in 19-20 but due to timing delays, it was recognized in fiscal year 2021 and we have a $600,000 short fall due to the delay of implementing epic which is resulting in billing. other than that, we are not expecting -- we are currently not projecting any other changes and one could say that it was our incredible foresight and my incredible budgeting skills

enabling us to have that happen, but unfortunately that's not necessarily the case. as commissioners may recall, the mayor and controller's office this year made the unprecedented year to delay the development of the budget to what takes place in june and july into august and september. as we were developing the mayor's proposed budgets for august 1st we had the benefit of month of the first quarter under our belt. we had a little more visibility than we normally would in a typical year but in general for the first quarter report, given there's so much change nine months ahead, we do tend not to sort of make significant projections in terms of the variances until we get later into the fiscal year and have a

better sense of how our expenditures will shake out. so at this point right now, for fiscal year 2021, we're just projecting a small revenue surplus of 3.3 million. so the covid on the covid side, this is managed centrally by the mayor and controller but i just want to gibb you a sense of the dph portion of the cost we have here and you're seeing significant fluctuations on revenue and expenditures and on or about all the city as a whole in the first quarter expects that -- department of homelessness and supportive housing and service agencieses expected to remain on budget as

part of the covid response. specific variances within dph, we're projecting 29.2 in under spending for ppe. we required a significant amount in 19-20. we had 52 million in materials and supplies and the bulk of that was related to ppe and i think there are some projections where when we were developing the budget, we were at the height of the ppe purchasing frenzy. there were significant supply chain disruptions and increases in demand that created price inflection that impacted the projections. we are expecting to underspend in ppe. we are expecting to go over on our testing due to higher than anticipated number of -- this

should just say higher than anticipated number of testing and not so much reimbursement. we have been increasing our testing at pop-ups and other locations sort of where we see the most prevalence of the virus. we received positive news in terms of additional cares provider relief funding that is something we can recognize within the covid project and then 2.9 million in unfavorable variance in the isolation and quarantine hotels due to an increase in operating and staffing costs and this increase really marks the change of the assumption and practice we had previously of staffing isolation and quarantine hotels with cities deployed disaster service workers and starting in november we shifted to a contract to

provide the service for us 24/7 to redeploy our staff back to their home departments and support their operations. this is a cost that is increasing there. of course there is some uncertainty as we assume that fema reimbursements will continue through the year. they are contingent on the state continuing through. this is one of the things we'll be watching closely with the controller's office. that is all i have >> president bernal: is there anybody on the public comment line? >> clerk: we do. if you want to make a comment press star 3.

no comments commissioners. >> president bernal: any comments or questions commissioners? >> president bernal: i do not see any comments or questions. thank you very much for both of the reports. we look forward to continuing to follow as we go along with all of the uncertainty ahead of us and appreciate all of your work to put us in as good of a position as possible moving into that phase. >> thank you commissioners. >> president bernal: thank you. all right. we can move on to our next item which is hold over from the beginning of the agenda, the approval of the minutes from our meeting of tuesday december 1st. commissioners, upon review of the minutes, do we have any amendments or a motion to

approve? >> so move. >> second. >> clerk: i will do a vote. (roll call) it's passed. >> president bernal: next item, community and commissioner update. commissioner giraudo. >> commissioner giraudo: the first was the bridge h.i.v. research which was excellent and fascinating. and focused on the increased

prevention strategies with innovations that are currently being researched that studies are looking at possible injectables, an implant and monthly pill. that's all within what they are studying at the various companies. the other part that was presented is they are currently have a research project going on with covid in the astrazeneca vaccine trial. they are embarking on that. the next part of the meeting, presentation in response to previous questions about aces in the clinics, adverse childhood

experience trauma questionnaire that had been showcased in the office of the surgeon general in the state and dr. hammer spoke about the implementation in the pediatric clinic in children's health at csfg. it requires really behavioral health in the primary care clinic to be able to implement it. and the hope is and it's in the planning stage to have aces in epic so it can be easily scored and then resources given to the families. there is as i mentioned to dr. hammer, i have been on an epic work group in trying to do this on a nationwide basis. hopefully they do it first

before we have to spend resources doing it ourselves. the other part of our presentation was from behavioral health staff and updating us on questions we had asked at the previous meeting, really focusing on the understanding of the internship possibilities in post covid with a goal of developing a pipeline for hiring behavioral health employees that we direly need within our system. we also -- the other item is we discussed a calendar for our committee meetings and future presentations. that's my report. >> president bernal: thank you commissioner giraudo. anybody on the public comment line who wants to make a

comment. >> clerk: press star 3 if you would like to comment on the item. no comments commissioners. >> president bernal: any comments or questions for commissioner giraudo? all right thank you commissioner giraudo. i wish i could have joined you for the meeting. these are all critical matters and ones very important to me personally. thank you for your leadership on the committee. all right. we'll move on to the next item which is new business. -- other business, excuse me. >> clerk: if i could point out the first meeting in january will be the focus on -- hospital. >> president bernal: thank you mark. any public comment or commissioner comments on this item? >> clerk: no public comment.

>> president bernal: joint conference committee -- >> clerk: commissioner chow chaired that meeting. >> commissioner chow: the committee reviewed the chief executive report and regulatory affairs report. during discussions, the committee discussed with staff the covid testing and plans of vaccinations for the staff and residents. the staff let us know visitations are currently on hold but due to the surge in the community. being closed session, the committee approved the credentials report, discussed the quality improvement reports. if there are questions i'll be

happy to try to answer them. >> clerk: and commissioner christian filled in and attended for the first time due to quorum issues so thank you to her. >> commissioner christian: i want want -- >> thank you very much. >> commissioner christian: my pleasure. it was interesting and i learned a lot. >> president bernal: great. thank you so much. okay that is it for the agenda. this is the last meeting of 2020. quite a year it's been with our commission and our agency at the middle of everything. so again on behalf of the commission we can't express enough our gratitude to the staff and emily at dph for

leadership and extraordinary work for the people of san francisco making the sacrifices that are necessary. and i wish you all a very safe and healthy and peaceful holiday season and new year. do we have a motion to adjourn? >> i motion to adjourn. >> second. >> clerk: if i may piggy back on your comment. there's a five minute video where you all express your gratitude at dph. (roll call) >> president bernal: thank you. happy holidays.

>> we broke ground in december of last year. we broke ground the day after sandy hook connecticut and had a moment of silence here. it's really great to see the silence that we experienced then and we've experienced over the years in

this playground is now filled with these voices. >> 321, okay. [ applause ] >> the park was kind of bleak. it was scary and over grown. we started to help maclaren park when we found there wasn't any money in the bond for this park maclaren. we spent time for funding. it was expensive to raise money for this and there were a lot of delays. a lot of it was just the mural, the sprinklers and we didn't have any grass. it was that bad. we worked on sprinkler heads and grass and we fixed everything. we worked hard collecting everything.

we had about 400 group members. every a little bit helped and now the park is busy all week. there is people with kids using the park and using strollers and now it's safer by utilizing it. >> maclaren park being the largest second park one of the best kept secrets. what's exciting about this activation in particular is that it's the first of many. it's also representation of our city coming together but not only on the bureaucratic side of things. but also our neighbors, neighbors helped this happen. we are thrilled that today we are seeing the fruition of all that work in this city's open space. >> when we got involved with this park there was a broken swing set and half of -- for

me, one thing i really like to point out to other groups is that when you are competing for funding in a hole on the ground, you need to articulate what you need for your park. i always point as this sight as a model for other communities. >> i hope we continue to work on the other empty pits that are here. there are still a lot of areas that need help at maclaren park. we hope grants and money will be available to continue to improve this park to make it shine. it's a really hidden jewel. a lot of people don't know it's here.

>> president yee: good morning and welcome to the december 22, 2020 transportation authority meeting -- oh, no, it's not. it's 10:00. threw me off a little bit. sorry about that, chair peskin. so this is the meeting of the san francisco board of supervisors. roll call. >> clerk: thank you, mr. president. [roll call]