>> 2021, mark, would you please call the roll? re,, commissioner, present. commissioner green? >> present. >> commission chow? >> present. commissioner guillermo, present. i'll note the commissioners. >> thank you, mark. we'll move on to the next item, which is approval of the minutes from the last commission meeting on january 5th. commissioners, upon reviewing the minutes, are there any amendments? and if not, do we have a motion

to approve? >> before we go into the vote, i have to make sure there is nothing on the item. >> thank you. >> and this is a general instruction, but you will press star 3 if you'd like to raise your hand, and i'll say the same introduction over and over again. okay. so there is no comment at this time. we'll vote. commissioner chow. >> yes. >> commissioner green? >> yes. commissioner chong? >> yes. >> commissioner guillermo /* /tkpwhrerpl? >> /* guillermo. and. our next item is the director's report.

>> good afternoon, commissioners of health. this report focuses on covid-19, and i will be providing an update and as well with regards to the current status of covid-19 and our vaccination status. and so i will provide more details during those presentations. i did want to mention, too, additional highlights with regard to the department. the department has joined mayor breeds to combat and prevent teenage trafficking in san francisco, along with several other departments. starting this month and there should be a correction there on the board of january 2020. it's actually january 2021s our environmental health inspectors will begin incorporating new anti-human trafficking training in their inspection process. environmental health

approximately 100 inspectors who will conduct regular on site inspections of over 9,000 businesses, such as restaurants, bars, gas stations, establishments, and residential hotels. and all staff will be trained to recognize the red flags or the most common signs of human trafficking and make referrals to the san francisco police department for an investigation to investigate. so a key piece of work ongoing there. and then just to focus on another key healt-related issue, tobacco control. again, the environmental health branch, the department of justice grant for a total of roughly $1.8 million, and janine young submitted grant application in their efforts to educate minors about the harm of tobacco products and enforcing tobacco laws and conducting

enforcement. again, this is an ongoing combating tobacco aggressively particular among youth. and that is my report again to follow the update to follow. >> before we have any questions or questions from the commissioner, do we have any comments on the item? >> you can press star 3 if you'd like to make a comment on the director's report. star 3. no comments, commissioners. >> all right. any questions or comments for director before we move into the covid-19 update? >> all right. commissioner chow, thank you. >> billion, actually, if dr. colfax, i just noticed on the dpa about the moderna vaccine.

but if you still want to cover that, then that will be fine. >> okay. >> that is the plan, commissioner, thank you. >> thank you. >> all right, without any other questions or comments, we will move on to the next item, which is the covid-19 update. and i just want to acknowledge before we go into that, that our nation passed a very sad milestone today with 400,000 deaths to covid-19. there have been observances in washington, d.c. and around the country to honor who we've lost. it was 5:30 on the east coast and 5:30 tonight with a moment of silence. those who are watching, i encourage to you take a look at the lighting ceremony. it was really quite moving and our sympathies go to everyone who has lost a loved one or who has been impacted. so dr. colfax?

>> thank you, commissioner for that acknowledgement andit is indeed a somber time as we head to a year when the department and city organize to confront this virus. and i think it was unimaginable at the time that we would be faing a toll of 400,000 people who unfortunately died from this virus. so sill be providing an overview of our cases in san francisco, and then i will -- will be providing a vaccine update. >> so we have just over 29,000 cases of covid-19 diagnosed in san francisco, and unfortunately, 260 people have died of covid-19. this is the population characteristics of diagnosed covid-19 cases in san francisco. once again, we see the inequity

inequities with regard to overrepresentation of latinos and the pandemic. this number has -- this percentage has decreased somewhat proportionally from the summer and fall. it is now 42%. you see the age groups there with regard to the distribution of covid-19 by age, sexual orientation, and gender. next slide. looking at population characteristics by death. the race and ethnicity components are shown on the yellow bars. and again, the proportion of percentage of asians who have died of disease, we believe that's due to location in nursing facilities and older aged people who have been diagnosed. with regard to the age group -- and this is going to be very important during the vaccine presentation -- just to emphasize if you look at the percentage of deaths by age

group, over 83 percent of deaths due to covid-19 in san francisco have occurred among people 65 and older. and the if we could just go back to the prior slide please. you see that age group. you see the distribution of covid-19 among the age group. and then if we go to that slide i was just descriing, look at the disparities there. so just really important as we think about who to prioriize to get the vaccine. and then you'll notice in the red bars, the comorbidities. so nearly three quarters of people who have died of covid-19 in san francisco have had some comorbidity. next slide. this is our key health indicaor slide, the current state of where we are and what we've been following. our hospitalizations, the increase of hospitalizations have come down quite a bit.

we're now at negative one percent, so that is a positive indicaor. our icu capacity and hospital bed capacity remain strong, between 20 and 24 percent, as you can see in the next two boxes. a case -- our case rates has been /* remained high, 38.3. our summer surge. our high was about 100,000 so we're more than double that now. our only indicaor is a few days ago that average that's /* was about 40. so we may start to see a leveling off commensurate with post-december holiday and new year's. potential peak, testing numbers are nearly 9,000. 9,000 tests being done per day. our contact traing numbers percentages are improving somewhat, but with the large

number of cases we work tocatch up and our levels remain strong. >> dr. colfax, i'm sorry to interrupt you. let me know that they can't see the slides, which is an important part of this meeting. so i'm wondering and i apologize for stopping you. could you stop sharing and then restart? that might be a way to make them show up? >> i think that's an issue. we're having a lot of glitches. thank you for your patience. >> are you able to see that on tv now? >> i'm asking that of folks. still nothing. so go ahead and keep doing your thing.

i'm not sure what else to do. keep going and i'll work with kevin and see what we can do on our end. >> okay. >> mark, we can just note also that the slides will be available online, correct? >> yeah. >> i will post them so that they will be available after 5:00. >> okay. good. >> thank you, mark. >> so this is our trend from october to the beginning of the year with regard to cases per 100,000, running seven-day average. you can see that rapid rise after the thanksgiving holiday. then another rise after the december holiday and new year's and now we're starting to see what we hope is a decrease, a sustained decrease in new infection rates per 100,000. next slide. and this is our hospitalization curve since the beginning of the pandemic. you will notice again that we are more than double the number of people that the hospital compared to our summer surge.

and then starting over the last few days, we are seeing some hopeful signs that hospitalizations have leveled off. obviously, this is no cause for com /phraeupbsy. i think it's very important to emphasize we still have somewhere in the range of 250 people, depending on a given day, in the hospital suffering from covid-19 and our medical teams across the city are working very hard to give them the best care possible. next slide. this is the reproductive rate curve again since the beginning of the pandemic. you'll see on the far right here that this number continues to come down. as of january 17th, the reproductive rate we estimate to be 1.05. and you can see what the implications are with regard to hospitalizations over the next few months. but again, in the last couple weeks or so, we have seen a slow

but steady overall decrease in the reproductive rate of the virus. waiting for that number to get blow one, which means that the virus is not increasing throughout the city. reproductive rate below one will indicate that it's decreaing. neck slide. and then with regard to county comparison, i know this is of interest to the commission. with cases per 1,000, we are relatively, our numbers are relatively -- our numbers are smaller. cases are smaller compared to most other jurisdictions, with the exception of seattle. our deaths per 100,000 remain lower. and then our test per 1,000, you can see are higher than most other jurisdictions, with the exception of los angeles. next slide.

so that's the end of my portion of the presentation. and i also see that's dr. andy turner has joined and they will be providing the vaccine overview. happy to take questions on this portion or at the commission's request, if we do that after the vaccine overview. thank you. >> mark, we can do a quick public comment on this portion, and then commissioner questions before we go into the vaccine-specific. >> there is one set of public comment, commissioner. the commissioner has questions on each of them and the public usually has one time. >> okay, so if it's all right with director colfax, we will see if commissioners have any questions on this portion of the presentation. commissioner green. >> yes, thank you for distribuing the wonderful

information. i was wondering whether any projections have been made with the subtypes and muteation that's might be more aggressive. has there been any modeling of that? i know the subtype is currently 25% of the cases in california is more or less but i wonder which organizations are analyzing that, and at what point there will be either some modeling or projections so we can better understand where we might head in the future? >> thank you, commissioner green. we haven't done any specific local modeling in that regard. it's an assumption likely will be /* to be here and continue to as part of the natural evolution of the virus will continue to be here. our model is /* -- our models basically incorporates what the natural state looks like in the community. there are models that have predicted what the more dominant strains will be in the next few

months based on what is known about some of these variants. but we have basically taken the approach of looking at the characteristics of our trends and not specifically at the virus variants. >> okay, thank you. >> all right. director colfax, some key indicaors, ppe supplies remained at 100 percent steady. is there any indication that we may be faing any future shortages based on what we know and what we might have on hand? >> the ppe indicaors and we have not received any indication at this time that there is likely to be a shortage. >> all right, thank you. i don't see any more commissioner questions or comments, so we can move on to the vaccine portion of your presentation with mr. pickens. >> thank you. great.

thank you, dr. colfax, and good afternoon going on evening, commissioners. it's my pleasure to be here with you, and i'm joined by my colleague, dr. andy titer, who is the medical operations branch and the city covid commander center and she's been part of the city's activation for covid since the very beginning and has been playing a key role in particularly in the vaccine effort but now has a larger role beyond vaccine, but for, including surge in the other medical operations related to covid. and so as you can imagine, this is a hurricaneane task that we are undertaking both in d /skph-fpls in the city. so in the words of hillary clint, it takes a village. so two members of our village will be with you this evening. so the goal of this evening's presentation is to try and

demystify what is our current distribution strategy within h and the city and to try and describe and clarify some of the roles and responsibilities. and then finally to provide you some of the data on distribution and allocation. next slide. okay. so as you can imagine, these are unprecedented times. we've begun the most ambitious vaccine distribution effort in our city's history. we've spent the last three months working to be ready for this moment. but however, so much of this process is unfortunately, out our control, but we don't let that deter us. we know we will do the best we can on behalf of all san franciscoans. as you can imagine, the chief obstacle we're faing is not enough doses, and we'll discuss that more. and one important fact to note

is, while there is not enough -- while there are not enough doses going around, the distribution, one of the key components of the way that operation warp speed was set up is that most of the vaccine, as it comes out, is going to what's called a multicounty entity. these are the large health systems within our city and state. so the u c system, the sutter system, the kaiser system, the dignity system, and also any large free-standing acute or hospitals like chinese hospital. so we all see these reports and we all know that the current process is slow and frustraing. and very confusing and most of the times overwhelming. however, we want you and the public to know that the vaccine is our ticket out. it's our ticket to be able to

hug our friends, for our grandparents to meet their new grand children, and to hopefully soon linger inside a san francisco restaurant again. so we pledge to be ready when more vaccine is available, to optimize our use of the current limited supply. and when that new supply is available, to be ready to get shots in arms immediately. next slide. okay. so to help ground us in our work for covid vaccine, we've established the following guiding principles. we want to ensure that capacity for the vaccine, that is limited in supply, is aligned both with the cdc and the state guidelines for priority. those were worked on for months by our nation's leaders and they

are which we administer our vaccines in the city of california and city and county of san francisco. another important principle is that we want to ensure equitable vaccine application and administration across our city in its many populations, particularly those vulnerable populations in underserved communities. we want to prioriize our rapid vaccine access, again in those communities with the highest covid prevalence, particularly those that do not have access to routine places for healthcare. we are operating under a principle of meritics and data -- metrics and that general information must be transparent and visible both to the public and to our healthcare delivery system partners. and then finally, to every extent possible, we feel it's important that we preserve th

dph staff and functions for those communities and populations that typically only dph serves. however, we are still partnering with other health systems in the city to employ their assistance in meeting some of these populations. so above all, what you should try and under is that, while we're operating under these guiding principles, the systems for distributing vaccine has been mandated at the federal and the state level. the guidance continues to shift, as well as making this morean even complicated problem than it normally would be. it doesn't take me to tell you that we have a highly fragmented system of care in this country, and because of that, we believe it's hampered much of the ro rollout for covid vaccine across the country and in our state.

however, we, many weeks ago began discussions with our health system partners in the city and are working swiftly to work collaboraively to make sure that the vaccine supply is made available to those who are eligible per the state and federal guidelines. so again, vaccine capacity is limited right now, and we are focused on presering, particularly for dph, vaccine for those prioriized, vulnerable populations. next slide. so this slide going from left to right, really represents our path to immunity. it represents where we are currently as of the middle of january and then where we plan our targets to be in june.

right now we're currently in phase 1a of the state plan, which is predominantly essential healthcare workers and residents of skilled nuring and other long-term care facilities. however, by the end of june, working with our major health system partners in the city and other community clinics, our goal by june 30th is to get our entire population of 900,000 plus individuals in san francisco vccinated with covid-19. so you know, as you can imagine, there will be several twists and turns along the road, but we are feeling confident that once the vaccine supply is made more readily available and reliable, we will be able to reach this goal based upon our current planning and collaboration. next slide.

so this slide, as i mentioned before, that the california department of public health has determined that the vaccine should be allocated in phases. and as i mentioned, we're currently in phase 1a, and that consists of healthcare workers, essential workers, and residents of skilled nuring facilities. however, you will also remember last week the state also gave guidance to open up the first level of phase 1b, which includes individuals who are 65 years and older. so as of middle of last week theytoo are now eligible for vaccine and are actually receiving vaccine right now. in san francisco, we continue to vccinate more than 210,000 people in phase 1a and that

includes those healthcare workers and individuals who are over 65 years of age. and even within our own san francisco health network, we last week began providing vaccination to our patients who are 65 years and older. and we /* if you look to the right of this chart, you will see dr. colfax highlighted this in his report, that when we follow the data, it shows that the distribution, age distribution for those dying in covid in san francisco, those who are 80 years and older, represent the highest, particularly those who are 65 years and older, represent 83% of the deaths in san francisco. so that's why we were so pleased that the state decided to open that limited part of phase 1b so thatwe could get to those most

in need. next slide. okay. so as i mentioned, in this presentation we want to share some data with you. so this is a data metric from our newly launched data tracker that's available online to the public. and so just to walk you through this -- and the current data source for this is the state -- what's called the care system. it's a system whereby all entities, physicians, clinics, hospitals, food -- immunization s must enter that into the state system. so for the number of vaccins aministered to san francisco as of today, there have been a total of 45,206 doses that have been aministered. it is important to note that

because this data comes from the state, the state database currently is missing the information from kaiser and southern and you can imagine why. those are two big state-wide systems. and the way that the database is currently set up, they don't disaggregate say kaiser vallejo from kaiser san francisco. it's just kaiser. so.state is aware that this is a problem, particularly for local health jurisdictions like us, as we try and get a handle on the data. and so they are working feverishly to try and correct that information. but the next line represents the number of after /* san franciscoans who are vccinated and that's 34,153. so you might be asking well, 45,000 vaccines were administered in san francisco. why are only 34,153 san franciscoans?

that's again because of the way the care database is -- the care database really focuses on the county of residents for an individual. so as you know, many of our employees, particularly in the healthcare systems in san francisco, don't live in san francisco. so unless they got their immunizations at work, which most of them did, so for example, in their counties, care system, the fact that they received the vaccination won't show up it. well, it will show up in their county, but it won't show up in terms of the number aministered by facilities in that county. okay, next slide. so this slide shows how we are doing with the vaccine that's have been allocated with the san francisco department of public health. and remember, so far we've only been allocated doses for those

limited populations in phase 1a, where our healthcare workers, emergency medical personnel, and key groups like in-home support services of people who are at high risk for covid within the healthcare sector. so other dose that's have been aministered to dph. on the left side of the pie it shows that we've aministered 49 percent of the -- of thoses -- doses that have been allocated to us. on the right side it shows that the remainder of those, while not aministered, have already been reserved for people who have been scheduled either for their first dose within the next two weeks or their second dose within the next two weeks. so the 49 percent are the shots or at least the first shots in arms and the 51 percent, the rest of the shots in arms that will be done within the next two

weeks. and you will /* /* you can see how we compare to other parts of california that are only 30% and have put shots in arms for 30% of their allocation and country-wide, 39%, roughly 40% have actually gotten shots in arms. and i will mention, as we-- for dph, the sites where we are administering vaccination are what's called our temporary healthcare worker vaccine site that's located at moscone center downtown. but we have sites in zuckerberg, who /* two sites in the wellness center. we're also doing vaccine administration at laguna hospital and maxine hall, health center and southeast health center. so that's where these vaccins are being aministered to those

phase 1a populations that are currently eligible. and as i said before, the allocation has been somewhat sporadic coming from the state. we don't know from week to week really how much we are going to get. and so as you can imagine, when you are trying to run an efficient operation based upon scheduling, that makes it difficult. but our philosophy is we are going to schedule based upon what we believe we're going to have and make sure that every dose gets into arms as quickly as possible. and you might wonder how -- how the issues with the moderna vaccine that was placed on pause by the state due to some an in factic shock occurrences in san diego. so we are waiting to hear back from the state and the cdc.

currently we, along with other providers who received allocations from that lot, have put those doses aside, and we are holding them on pause until we get further direction from the cdc as to whether or not those can be used. if not, they will have to be discarde. so we will keep you updated as we get information in that regard. next slide. and i know you have seen this slide before. in fact, i presented it last time i was here with you. if you read the slide, it really tries to describe those very complex ways that operation warp speed developed its allocation methodology. so if you start at the very left side in the blue box, it indicates that the federal covid-19 vaccine purpose is allocated to the state and to pharmaies and federal entities.

so the next step from coming from the state, it goes to one of three places. the top box is where most of the vaccine is being distributed. that's to again multicounty entities -- the kaisers, the sutters, the u cs, and chinese hospital. and also a small part comes to the l.a. state, the local health department. that's us. the next big bucket of federal allocation goes to the federal pharmacy partnerships. that's a partnerships with walgreen's and cvs, where they are going into long term facilities and long term residential facilities to immunize those members of the population. and finally there is a smaller bucket that goes to federal allocations to the va hospital system. they get their own carveout. they don't come to the local health jurisdiction or through the pharmacy partnership.

they get a direct line. one of the benefits of being part of the federal government. you got direct access. but going back to that top bax for the nces where most of the vaccine is coming into california counties and the local health departments. so it's broken up again between what goes to the m cs, which is the predominant part. but then the local health departments. we talk about what we do with that vaccine. we vccinated the healthcare workers within our own delivery system at san francisco general and la gunda hospital. we've vccinated the local emergency medical service personnel, the ems ts -- the emt s it, the paramedics and we've vccinated the in-home support service workers, who are 22,000 of them in san francisco. so that's quite a bit of vaccination that's we've done at the local health.

there are over 80,000 healthcare workers in san francisco, and most of them do not work within the local health department. most of them work within those multicounty entities and so that's where the bulk of the vaccine that's gone. and then just finally getting over to the last column of boxes. starting with the local health department, that green box. so we get our allocations for those populations i just described, but we also are able to reallocate to those m ces like kaiser or u c, for example, if they haven't gotten enough allocations from their mother institution, they've asked us for assistance and we've been able to reallocate some of our allocation to them when they've gotten low. so again, it's truly a partnership and a collaboration in san francisco of how we're trying to make sure the vaccine gets where it needs to in order to fulfill the state mandate for

vccinaing those prioriized populations. next slide. so you know, this word "challenges" should be the border, top, the bottom, the marin and everything on this piece of paper when it comes to the tasks that lay before us with covid-19. as we said before, there are serious challenges at the federal and state level, that there is no unified system for vaccine delivery, for allocation, how much is going to come when. all those are changing evoling and are definitely not anything definite that we've seen so far. again, we talked about the problems with the state's care data system that's been a hindrance to our ability to get timely data from both healthcare delivery systems like kaiser and sutter.

it's important for me to say we established in san francisco in collaboration with the san francisco hospital council and those systems, and they have been very accommodaing and are willing to share those missing pieces of data that we're not getting from the state, and we expect to be able to share those on that data tracker dashboard that i showed you a few minutes ago. so we're optimistic that we will be able to overcome some of those data challenges. but as i've mentioned before, supply is our biggest challenge at this point. again, no last-minute approach to getting vaccines into arms, but we will continue to try to work with our local partners here in san francisco the way we've done on many different initiatives in the past on hi getting to zero, on our community health equity plan that comes out every three years

in san francisco. unlike many jurisdictions, we have a history of cooperation and collaboration among our health systems and we know that's going to serve to our advantage as we tackle covid-19 vaccine administration. next slide. so just want to take a few minutes to review our strategy for vaccine planning and delivery in san francisco. we, again, the state and federal government control the process of vaccine allocation and pass that down to each of the california counties. and in san francisco, particularly, we are depending upon our collaborations with the health systems and the hospitals to really vccinate most of our population, and we're setting up infrastructure in the way of

high-volume vaccination sites. in some communities what they're called high-vaccination sites but we're calling them high-volume vaccination sites. and you remember from the press conference the mayor announced last week some of those have been identified and we'll talk about them in a few minutes. and our strategy is to make sure we try and preserve the department of public health for those populations that others typically don't serve that may be hard to reach and that we are uniquely situated because of our partnerships with community-based organizations in different communities, to really make sure that those vulnerable populations get access to vaccines. next slide. so here is another way of looking at our strategy at the city and dph and covid command center level, we are we have adopted aid three-prong

strategy, again starting on the left with those high-volume vaccination sites. again, those were announced bilt mayor and we will talk about them on the next slide, but those are the sites where people can either drive up in a vehicle, and of course in san francisco, we'll also have walk-up lines because so many of us rely on public transportation in san francisco. but then we're also going to have community-based pods, points of distribution. and that's where we're really going to rely upon our strong partnerships with community-based organizations who really know segments of the populations that are typically hard to reach. so that's where we will be going out to every community in the city, to the mission, to chinatown, to any any place that will have a hard-to-reach population that may not be able to access either the current or the usual care for vaccination

or they may not be able to access the high-volume vaccination sites. and the partnership for those long-term care facilities. so that's our three-pronged approach. next slide. so getting a little bit into more of the detail of the high-volume sites. again, those sites have been selected. they are the moss county center. they are city college, the main campus down off of ocean af and frieda coler way. and the southeast section of bay view, not too far from where cal train comes across. and the approach for those high-volume sites is that it's really being coordinated at the city level through the city's covid command center, and that's where the department of emergency management, because they have expertise in manaing

large emergency events. they are taking the lead, but dph is working side by side with them, adviing and helping to coordinate, particularly the medical component of these high-volume sites. and part of the dph contribution is what we're calling the health systems vaccine collaboraive. that's a partnership between h and the san francisco hospital council, where each of the members of the council are working collaboraively with dh in terms of maximizing vaccine not only at their local sites at c pm c or at any of their campuses, but also offering up personnel to operate these high-volume sites. so the participating hospitals are ther -- kaiser, u c,

sutter, our own network and dignity. again, i mentioned chinese hospital is also participating, and they are focusing on the community-based pods, particularly in chinatown, so that's their contribution. next slide. and you will see collaboraors on the right side. you see chinese hospital, and our own network. and again, so these are those community-based sites that will be partnering with community-based organizations and again providers who have expertise in underserved communities like chinese hospital and like our own health network. and we will be really relying upon those community-based organizations to help us figure

out where to go and where to set up, similar to the way that they helped us with our testing strategy. testing truly was a community-based-driven strategy and we want to deploy the same thing for our community-based vaccine strategy. next slide. and so just to give you a strategy for rollout. so again, starting with the high-volume site. some of those have already started. again, all of our health systems, including our own, the network, sutter, kaiser, u c -- they all have fairly large, somewhat large, medium-sized vaccine sites on their current campuses. and you can imagine, san francisco is limited just by their foot print. but they have all committed to

being partners in those identified large-volume sites -- the mocone site, the city site and the produce market site. in fact, our first site is scheduled to go live this friday at city college, and right now we have confirmed u c, s f and dignity will be partnering on that site. we've heard from sutter. they are looking at the produce market site, and so again, we're really getting good traction in terms of coordination and collaboration with the health systems. and also the pharmacy partnership started two weeks ago and will continue. and on the community pod site, we've already got some of those up. chinese hospital has a very vibrant community pod in chinatown. our own network has' very vibrant community pod at the

mission over in zuckerberg and laguna and maxine hall and southeast south center. and we will be deploying some mobile covid-19 vaccine sites in the next few weeks and those will be coming out of our covid command center out at mosconey. and the overarching message is that we are adopting this three-pronged approach because /auz the vaccine becomes more readily available, we want to have every option available to us. we're not relying on just one path to success. we have tried to develop a roadmap that has many roads to that one goal of getting every san franciscoans immuized by june 30th of this year. next slide. and as i mentioned before, the city is operating the covid

commander center, and again, that's the department management at the lead agency and emergencies are what they do t we learn a great deal from them, particularly in incident command. although we've had the hospital center command, we're operating under what's called an incident command, which is that very structured process for manaing emergency operations. they are providing overall guidance at the city level, but again, dph is, along with human services agency and other city departments, are also providing assistance to dem as we roll out our covid operations. and next slide. and hopefully you heard today that we launched our vaccine notifications website, and this is a place where people who live and work in san francisco can go in and enter their information and be notified once they are he will gible to be vccinated, and

they can sign you up for vaccine notification. and next slide. and then we also got our public vaccine data tracker that started -- i think it was last week or the week before. and this is also readily available online. and i mentioned that we've gotten commitments from all of the health systems in the city to provide that data that's missing from the state care system. we will also be including that information on this public vaccine data tracker, so you can also see how much vaccine is going to kaiser, to sutter, to u c, how many shots in arms are being done at kaiser, u c, southern, et cetera. and next slide. and so i want to thank you for this opportunity to try to bring you up to speed on this constantly change, everevoling

process of covid vaccine administration planning, and we know we are not where we need to be, but we feel confident week by week that we are learning more and are enlisting other partners to really help make sure that san francisco is served well and fully v vaccinated. and if we can just get that supply coming from the fed to the state, we feel confident we'll meet our goal of vaccination by june 30, '21. and that concludes my formal presentation. and myself and dr. tenor are here to try to answer any questions you may have. >> thank you, mr. pickens. hello, dr. tenor as well. before we go into commissioner questions or comments, mark, do we have any public comments? >> yes, i see four hands. and before we begin, i want to just let the folks know on the public line that the commissioners do not respond or

engage in conversations with folks in the public comment. they are all hearing and you your message is going to be heard and take it to the appropriate people at the department. there won't be a back and forth. i see three hands, but if press star 3, i want to make sure i get everybody who wants to make comments. there we go. i will put two minutes on the clock for each of you. and i don't have any identiiers for most of you. just know that i'm going to click on your name and unmute you and i hopefully -- you will hear a message. can you hear me back there? can you let me know if you can talk? caller? caller 11? >> caller: yes, can you hear me? >> yes. i'm going to put two minutes on the clock. you've got two minutes ago. >> caller: hi, good afternoon. commissioner. my name is teresa rutherford. i'm with s c i u1021 and i come before you today to ask you to

make a correction on something that is glaring and is really an equity issue. we have nurses who are call 2103s, temporary workers who have /* are literally working more as full-time workers right now. they work 40-hour shifts. they do training, on boarding. they have help with new hires. they act as charge nurses. however, they do not have access to the 40-hour covid -- i'm sorry, the 80-hour covid hours extra that we give in san francisco. these are frontline workers who are as susceptible as any other nurse on the floor to covid, and therefore, there is no reason that they are not getting the covid hours. they must have these covid hours to be able to protect themselves, as they work in the field and protect the community

and as well as protect their own co-workers. as roland pickens said a while ago it takes a village. well, the village cannot pick and choose when to protect and who to take care of. it needs to take care of everyone. thank you. so please, give the covid hours to the frontline 3103 nurses. thank you. >> thank you. all right. next caller. caller 12. you are unmuted. please speak. let us know that you are there. caller 12? i'll try that again. caller 12, are you there? okay, we'll come back to you. hopefully -- >> caller: yeah. >> okay, there you go. you've got two minutes. >> caller: hello, i just want to say i'm a former 3103 nurse. that was very fortunate to receive a 2320 permanent

full-time position and 80 hours of covid tick /* sick leave. i'm here to support other nurses to receive the same benefit. most of these nurses are taking care of the most vulnerable population without this extra security, and now we're going to be asking them to be helping with the high-volume vaccination in the community. and as we said earlier, it takes a village, and i say please support that village of nurses. thank you. >> thank you. all right. all right, caller 14, i've unmuted there /* you. >> caller: hi, i'm a nurse at san francisco general hospital. i'm with many nurses not able to have these covid leave hours that are offered to full-time employees and i'm also working through the pandemic, often picking up shifts when needed and also trying to keep my patients and my family safe too.

when it comes to the pandemic, i don't understand why i would not be offered these covid leave hours when everybody is affected the same way. it makes me feel undervalued and i hope to see this change soon. thank you. >> thank you. all right. caller 15, please let us know that you're there. >> caller: hello, can you hear me? >> yeah, you've got two minutes. >> caller: yes, i work for zuckerberg as well and i'm currently a 3103 there and i just want to touch on the same subject that i just feel is completely unfair. when i for instance, work in the covid testing people day after day and was not afforded the same benefits for the 80 hours of covid sick leave as my

permanent counterparts. i don't understand why that is, but i do know that i do a lot of off site testing, testing for the n95 masks, tb testing and covid testing and also working on the /* at the clinic there. at the same time it just comes down to us p-103 nurses. until we get sick or get covid, we're just out of work for two weeks, three weeks with no pay and i think that's completely unfair and i just want to touch on that issue, and i hope that this can be introduced for us as well. thank you. >> thank you. all right. caller 5, i've unmuted you. please let us know that you're there. >> caller: hi. thanks so much. my name is tan lee. i'm a nurse with integrated care

and the outreach team. i've been a per diem 3-103 nurse for five years. i'm under the weather today, but i felt it's extraordinaily important for my voice to be heard especially when my colleagues were not able to be here due to their responsibilities as frontline nurses. and as a frontline nurse working with the population, my colleagues and i are directly responsible for preventing the spread of covid throughout the city. we place people in place and shelter in place in quaranine and /holts. i have taken on the incredibly challening role of caring for our unhoused pregnant population. i do this work because i'm committed to the well-being of the most vulnerable people in our community n doing this working, i put myself at risk every time i outreach a client at their tent, their hotel room or in clinic. as a p-103 nurse categoized as temporary, i'm doing the same

work with the same risk at permanent nurse and should be treated at such. i work for the city without the security of health insurance benefits, aequate sick leave or the safety net of covid sick time afforded permanent nurses. have having been specifically left out of the city's emergency sick time response during this unprecedented pandemic puts my own health, the health of my loved ones, and the heal of the entire work force at risk. to be denied this basic protection during a time when we have stepped up to work above and beyond what we were ever expected to do is unjust and demoralizeing. this is about safety and quity. p-103s are the backbone of frontline workers, filling in gaps and it is unconscionable we are treated. we must be provided with sicktime protection immediately. thank you. >> thank you. and the last hand that i see. i've unmuted you, caller 8.

please let us know that you're there. >> caller: hi. thank you so much for this presentation today. and for taking my call. i really miss being able to see everyone in person. my name is jennifer. i'm a registered nurse employed with the city and county of san francisco. i also represent the work force, as a vice president organiing and i am calling in today because i think it is a matter of equity and safety that our registered nurses who happen to be per diem are not afforded the exact same protections as all of the other city workers. covid is not going anywhere.

-- april last year only benefited nurses that the city paid 80 hours of covid sick leave allocation as a one-time emergency response for job

safety and some security. this is extended through 2021. september last year h.r. wrote that per diems don't get this because they earn a highly hourly rate in lieu of benefits and get sick time. these are facts. and they are earned by non-per diem nurses who earn a lowly rate. and a per diem earns one hour sick time for every 30 hour of work. and a benefit nurse earns one hour sick time for 20 hours of work. and the only thing is to be a regularly scheduled employee, but per diems that make up 50% of the d.p.h. nurses should get this allocation. this is not fair and not safe to exclude per diems when we node d to be able to stay home sick without worry iing about paying the bills. this exclusion can worsen the chronic understaffing of nurses and the financial well of being of the local government and businesses.

it's incomprehensible why and how h.r. can get away with not implementing the mayor's authorizations to include the regularly scheduled per diem nurses. we need to have commission to reach out to the mayor, the board of supervisors, in order to compel to include per diem nurses in this sick pay and tha] >> clerk: thank you. all right, commissioners, that is all of the hands that i see. >> president bernal: thank you, mark, and i didn't get everyone's name but thank you to trees and lauren and teresa and others who offered a public comment. before we move into commissioner questions or comments, i just wanted to underscore a few things. first of all, acknowledge the extraordinary work of both the executive sponsor of the vaccine, and the work of dr. tanner and so many others within d.p.h. and the city for really taking on this enormous task that is so necessary for us to get back to where we need to

be. and for setting a goal of june 30th for vaccinations this year. there's a lot of uncertainty and guidance that is coming from the federal and the state levels with regards to vaccine distribution and supply, the priorities and phases of the data as you've all laid out and, really, really the most that we can do at this point is to be ready. and to communicate clearly. and i think that this presentation has gone a long way in doing that. i have had a number of questions, most of them were answered during your presentation, so, thank you. but i did just have two quickly. mr. pickens or dr. tener, can you clarify the mass vaccination sites or the high volume vaccination sites -- what is the -- what populations are those intended for? >> yes. so those are for everyone, anyone who is eligible by the state guidelines. so right now phase 1a, and then the 65 year and older.

but as the state opens up its status and tiers, they will be for everyone. >> president bernal: but we're starting with the most vulnerable populationings and the providers, is that correct? >> and just the second question -- i know that in the news you have seen news about the moderna vaccine and the worries about the adverse effects. what is the impact of that on san francisco's supply, coupled with the -- with certainly the lower allocations than we had hoped to be receiving. where does that leave us? >> i'll let dr. tener answer that one. >> thank you. >> thanks. so -- as of right now we have pulled those lots out of an abundance of caution until further investigations can be conducted. and if we are not allowed to -- if it's determined that those lots are unsafe and we are asked

to destroy them, that would put this week's planned vaccinations in serious jeopardy. so we would be short several thousand doses of vaccines if that happens. and so we would have to reschedule -- we would have to reschedule appointments and try to get people back in whenever we have the allocations. we have put out requests through the state -- the mohawk, the area coordinator program, as well as directly to state for additional vaccine, because we have the capacity to give it. but so far that's been unsuccessful. so we are keeping our fingers crossed and hoping that we can get a little bit more supply so that we can try to vaccinate as many san franciscans as possible. >> president bernal: thank you. thank you, dr. tener. we have a number of questions and comments from commissioners. let's start with commissioner

giraudo. >> commissioner giraudo: thank you so much for this excellent presentation, and your tireless work in trying to get all of us vaccinated. my question for the mass vaccination sites, at city college that may be open this week -- are appointments needed? is there going to be media communication? i mean, it has been in the media about these sites, but there hasn't been follow-up communication from the department on just what -- if you're 65 and older -- i have a 97-year-old uncle who is trying to get a vaccine. and so do i need to make him an appointment? please, i think that communication to the public would be so helpful but also to me now as well. >> right, right. i can try and am sure that

dr. tener can jump in. so as you can imagine that while we've been planning for these mass vaccination sites, we just announced some last friday with the goal of having that first one open at city college this coming friday. couple that with the moderna problems and having to fit those aside and it's really put a crutch in our vaccine availability. so we're trying to be measured, we don't want to say come one, come all on friday at city college and then not have enough vaccine for people who show up. so that site on friday will be staffed by ucff and dignity. and so -- because this is our first trial run, we're going to do the appointments -- we'll do appointment scheduling through

those two institutions. but as the underlying other sites at the market and musconi come online we'll move towards a centralized system that will be on our website, where you can go there and there will be more media and public service announcements that say to go to that website to get an appointment at any of those three sites. i'm not sure if you have anything else to share? >> no, i think that you have hit the nail on the head there. i think that the biggest issue right now is that we don't know -- our vaccine supply is so spotty that we don't want set up a site -- or we don't want to start advertising the site and then not have it available. but we are -- we do have -- as of today there is on the sfgov-tv site there is a site where you can go and register. and to give -- you give some information -- so your 97-year-old uncle, we have got to get him vaccinated asap. so with that website, you can go

in there and enter information and as soon as we kind of hit that tier that we have availability, we'll send that messaging to -- to your uncle. and then as far as the site -- so we would like to open it -- if we can get vaccine, if any of our begging and pleading for the vaccine works, then we have vaccine by the end of the week and we will do widespread media. so it will be on local news -- we'll be advertising to let people know if -- if we have enough vaccine to have a site open. so we are trying to communicate as much as we can. >> i totally understand. so just that the communication is clear, let's say that all works well, and that city college sites open up, then the people that make appointments have to be patient of either dignity or uscf, right? you have to be a medicare

patient -- my uncle -- that's what i'm asking -- >> oh, yeah, yeah, i'm sorry -- a perfect question. so these sites are designed to be health plan neutral. they're not -- you don't have to be a uscf or dignity patient to get those services. once these are up and running. now, because this is our first -- our first run, more than likely a lot of these people on friday will be because they've got the closest access right now. until we, number one, get more vaccine. and until we get the city-wide sites set up where anyone can go in. but all of the systems have committed, they will vaccinate anyone who shows up at these sites. it doesn't have to be one of their members, it can be anybody. again, in that eligibility tier that's been authorized by the state.

>> commissioner giraudo: but it's still unclear to me and i don't mean to but how would i sign him up, you know, then? do you know what i'm saying? if he's not on my chart online or whatever it is, how would i do that? i mean -- >> so one of the requests that we made of each of the hospital systems and one of the things they have been working on is having a centralized site for people to go to sign up for appointments. because for a site like this, you know, as well we mentioned ucsf and dignity run, but they have committed to vaccinating anybody. so having that availability. so by the time -- if we can get vaccine in and get it set up, we'll have those sign-ups ready, recognizing that it will be a small -- it will be a small proportion of vaccines that we'll have administered. and then the other piece that roland mentioned as well is that

the central website to be able to sign up for some of these events that we have been in discussion with developers on. and so that will be rolled out, again, once we have the supply and we know that we can move forward. so i hope -- >> commissioner giraudo: i totally understand and i appreciate it, but it's just for the general public -- i just want to make sure that it's really simple. >> yes. >> commissioner giraudo: and it's a one-two-three-four, and in fifth grade language -- very simple. >> yes, thank you. >> commissioner giraudo: that is just my concern. >> no, we appreciate that. and i think that is something that we are -- we're, you know, this is the same -- i think that i used it last time that we're building the plane while flying it. and we're trying to sort of being ready and also not knowing what our supply looks like. but i think that your point is very well taken and we want to make sure that the communications are clear, that we try to minimize with as few

steps as possible when we get to that point. so, thank you very much. >> yeah, it's a great question, and, again, it highlights that you know, our goal is to be ready when the supply is ready. and not having that supply really happens to us because one of the worst things that you can do is to set someone up for disappointment, and to make a big announcement to come to city college and then not have the vaccine. so the vaccine is our limiting factor. but, again, we're not waiting on it, because if that were the case we might not perhaps be starting on friday, but we're not taking that as a defeat. we're saying let's get this site up and running, let's go through the work flow, start the process, so that when that vaccine supply is more steady, we'll be ready to get those other sites up and going. >> yeah, thank you. and just one quick point to -- one quick thing to point out for this first site -- because it is

the first site, we will ask people to have appointments because otherwise it could get overwhelmed. so we want to make sure that it would be for ucsf and dignity, as things move forward that we'll communicate out the way to -- to get appointments and as we move forward with additional sites we'll make sure that that messaging goes out to the people, so they know how to get into those appointments. >> president bernal: great. thank you very much, and next is commissioner guillermo. >> commissioner guillermo: thank you, and, again, thanks to dr. tener and to mr. pickens for taking this time to be as comprehensive as you can in answering these questions. so i just want to, again, to, you know, i don't think that it could be emphasized enough what commissioner giraudo was saying about the communications and

messaging. given that the majority of individuals in san francisco, as has been said by many folks, are covered by private insurance, there is a lot of confusion about who they should be calling to find out where they can either get an appointment, where they can line up, where do they go, and you have their primary provider telling them that we're not giving vaccines, call the city, or the insurance plans are saying call your provider, you know, or not knowing what phase that we're in. and, again, so i think that there is a huge effort that has to be put -- not just in the flow of the communications from the department to the public, but also to those individual providers and anybody who may be

a target for a question from their patient or from the public as to what to do, when to do it, how to do it, and so on. it sounds elementary, but this is the kind of thing that could really, really either go as smoothly as we could possibly make it, particularly if we have partnerships with all of these facilities, or it could be as confusing as it possibly could be. so i just implore you to not -- to leave no stone unturned in terms of the communication around this. to not just the general public, but to all of the partners and all of the providers that are going to be participating in the vaccination program. and particularly that we don't

know what the supply is going to be. so the more that folks know about that, i think that it's going to be protective for the city and for the residents as well. just one quick question i had -- i understand that multistate systems -- let me know if i'm wrong -- are also able to contract directly with some of the pharmacy -- they are under contract with the pharmacies, either through the federal program or through the state programs. if that is the case, is that allocation included in the state numbers of vaccines? even though they're not directly coming from the state. >> so, um, for -- so we have what we call multicounty entities and those are -- >> commissioner guillermo: i'm asking like a multistate, like a kaiser or dignity and they have

separate contracts with distribution contracts with pharmacies, the big pharmacies. >> you know, i'm not familiar with that, but we can certainly investigate it and inquire. so the multistate entities and you're asking about them contracting with those large chains -- >> commissioner guillermo: my understanding is that particularly if they are medicaid or medicare providers, they have -- they have a direct allocation from the federal government. and i may be wrong, but that is what my understanding was also. so i just didn't know. and it's the multistate system. >> okay, we'll look into that, i haven't heard that before, but thanks for raising the question. >> president bernal: thank you, commissioner guillermo. commissioner chow.

>> commissioner chow: yes, thank you. and i join my fellow commissioners with recognizing the work that all of our staff have put in, and i think that mr. pickens hit the same word that i was thinking of, this is really a herculean task which is in evolution. and, clearly, you've been able to help describe in more detail the city, the civic and the partnerships that have been put together. just piggybacking on a little bit first for a moment on commissioner guillermo question about pharmacies. i'm also wondering why other -- the pharmacies did have contracts with long-term care and many other states they also seemed to be doing direct

delivery. and what the issue is here in california or in san francisco, asking a local pharmacist, they don't know anything about it in terms of working directly with patients. and, as you know, a lot of the immunizations are actually given by way of the pharmacy so they become a third or a fourth partner that could really be very valuable and help to decompress some of these clinics that we have to set up. it isn't that they also can do a large volumes, because there is a problem of waiting and so forth. but other states, the pharmacies are already onboard. and i think in some of the other counties also in california. so that's kind of my first question and maybe i should stop there first and then discuss more in a problem that i think that commissioner -- well, that i think that is an issue from a

patient standpoint. but i'm very curious as to why we have not been able to access the pharmacy chains. >> sure. that's a great question, commissioner chow. so i'll start -- as you know, we at the local level don't control the process of who is authorized to receive vaccine. that's done through the state. the good news is that the pharmacies in san francisco have submitted their requests to be able to do just what you described, to be able to provide vaccine at their retail pharmacies. and so they are in the process of being authorized by the state and will begin to be a source of vaccine for individuals just like people go to walgreens and c.v.s. for flu shots, they'll be able to go there for covid shots. so we're expecting that to come through any day now for those san francisco pharmacies that submitted.

we know that walgreens have submitted and i believe c.v.s. also. >> commissioner chow: thank you, because i think that will be of great help. i do think as commissioner giraudo was pointing out and waa very important personal issue, because i think that transparency and an understanding of how the system will work becomes better and is left -- there's less anxiousness. so while we had announced the three big sites, we didn't really get into the detail which would help to decompress i think some of the anxiety that this will be by way of appointments. we're not going to have to wait. i'll just give you the example that honolulu just set up two, and they're a city and a county comparable to our size. they set up two major sites.

but they told the people right away that it will all be by appointments. we will have to sometimes limit that because of the vaccine availability. and that here was a site that you could start signing up on. i'm not saying that we could do it quite as swiftly, but apparently within one or two weeks -- i do follow how they're doing in terms of their vaccinations. they actually have started it already this week that have shown whether they're able to even have set up their area zones. so you already have that set up, but we haven't told the public, but you just told us, okay, these will be by appointment and here's how you make the appointment. so i check in on your notification site and the notification site could also be helpful in the sense of saying, we'll notify you and then also we will let you know how you

will make your appointment for these vaccines. otherwise, it sounds like i'm going to get told that i am age x.x. and so, therefore, i'm qualified now and now you can go anywhere, or call your provider. and so i think that's another level of information that could be given so that whoever actually is going on that site just doesn't have to wonder, okay, what comes after notification. because it sounded like we were going to give information to you on how you were going to get your vaccines. >> right. >> commissioner chow: so i think that this would be very helpful and help to allay the fears of the public, a public that is, you know, just trying in our cases right here in the city to really get vaccinated, right? i mean, we have our private doctors also calling me or telling me that, you know, every day that they're getting these calls. and i'm sure that you have heard

from chinese already, their switchboards are really kind of overrun. i think that -- and i really appreciate that you have actually have incorporated chinese into the community clinics because that's really what they are, as you know. that very vulnerable and difficult-to-access population when you're trying to get them to a mass site. or even to the doctor office. here though i think the same thing -- if you in chinese were able to announce to the public that we are going to open the center, it would be there, but we can't tell you exactly when, it would help to reduce the society. because right now they can't see anything. i talked to, you know, dr. zhang, and she says, well, i can't say anything because we don't even know if we have the vaccines coming. >> right. >> commissioner chow: again, i

think that it's a matter of saying it's our intent to open it -- just like you announced today. and it would help the community to know, okay, we're going to have another center here. and we know that we'll also have our own clinic hopefully, the department of health clinic. and so then i would get to the private practitioners and where they are. as you know, you did set up a site for them to try to let you know that what you are able to do. >> yeah. >> commissioner chow: so now that these new guidelines have come out, people are calling the offices and several of these offices did sign up, but they've not heard from you or the department of what we're going to do. sort of the same thing that i have also pointed out is that is what we heard. some of this information needs to go out. i think that there may be some

misunderstanding that while you're counting on the hospitals and the health systems and you are also saying that because you're insured, please call your provider, because you do have coverage. there's no question that the plans are covering it? they do not provide through our independent providers any materials -- >> um-hmm. >> commissioner chow: so our providers, if we're going to give tetanus shots or anything else, that we have a source to get it. >> yeah. >> commissioner chow: if you don't have a source, your website is telling them to call the provider only to just compound the confusion. because then they say like you had said earlier that people are saying -- and as was just said -- people are saying, well, call the public health department. and that's what they've got to say because they haven't heard from you.

are we going to get it or not? because we haven't heard that the community clinics are coming up online and how to get to those, we have had three public ones, so we could say that. and you responded very quickly and i want to compliment you for getting the doctors' staffs taking care by way of the partnerships that you have set up. and that these other hospitals are willing to accept the (indiscernible) from the staff. we know that you can do it, you're going to do it. i just wanted to point out that, you know, our doctors cannot throughout the city just magically have vaccine. there's nowhere to order it really. you have to order from the state, right? i think that those are some of the anxieties out there and what i'm just expressing is that the public have really gotten to

some of us also about what is going on. and i always say, you know, i know that we can do it, because look at the work that we're doing. i know that we're going to do it. and these were just sort of trying to help us to walk through with you and the more transparency to our public -- i think they would understand. >> um-hmm. >> commissioner chow: there is a shortage of vaccine. that does point to the fact that you have set up -- and i compliment you on setting up the vaccine dashboard. i would ask that the commissioners get a copy of that every day because that can really help us. i think that as that becomes more known to the public, that also tells us how much vaccine is coming in. and while it's not an entire pot, it does show that there's a limit, and that's one of the

limiting factors. i think that a very understanding public -- you can see how cooperative they've been through this whole year. and i think that if we give them more information about all that we are doing and you've done it and i think that this is obviously for us the first time to hear it. and that's because you've just put it together in the last week or two. but, you know, it's a good a point as other people have had. but also i am here to compliment you, but also to plead that our public needs to understand better the work that you're doing, the effort being made by the department to get this vaccine out. we've got to have the vaccine. we're setting up systems. these systems will be easy for you to access. we've opened up big public ones.

we're going to have them in the communities. we're working with the providers. but then you have to talk to the providers and tell them how they'll get it. >> thank you. thank you, commissioner chow. we have a number of commissioners who would like to make comments or ask questions. commissioner chung? >> commissioner chung: thank you, commissioner bernal. and i just want to join the echo chamber and complimenting, you know, all of the work that you all have done. it's not easy. and, you know, i can only imagine, you know, what it's like managing under this model and not knowing when more vaccines will be coming in. and having so many people inundate you with, like, questions and, you know, demands. i think that, you know, we

should also look at, you know, some of the silver linings here. like after tomorrow, you know, that we know that incoming administration has tasked a national covid strategy that they are going to implement. and also, you know, like one of our own colleagues, you know, dr. alagon, just assumed the job of the health officer for the state health department. i think that is just -- well, this is a glitch, and i'm pretty sure that i -- i'm not just sure, but i have absolute confidence in you and your team, you know, that this will be resolved quickly. so, thanks again for all of the work. and we really appreciate you. >> president bernal: thank you very much. thank you commissioner chung. commissioner green. >> vice-president green: as well, this has been a really terrific presentation for its detail and clarity.

and i would echo what commissioner bernal said, that this work is extraordinary. but as the others said, i don't think that you're getting adequate credit for the planning and the foresight that's gone into this. and, you know, likewise, i don't think that the multicounty entities have either, because anecdotally i know patients who never set foot in sutter are getting vaccinated by sutter, and those who are not part of kaiser are getting vaccinated by kaiser. so there's work going on here that i think that we haven't seen before. and part of the communication strategy has to be giving credit for the work that you have done as well as the amazing kind of coming together of these systems who are all really trying to get the people who need to be vaccinated taken care of. so, you know, kudos to you for this work for sure. i have a few questions. one is, do you have any predictions about vaccine

availability with the new administration? the second is -- do you have any sense for what vaccine supply might be among the multicounty entities? because i know that they're still signing people up. and, of course, one of the problems with sign-up is that it's a real hodgepodge. it's really interesting. once you find your way in, i mean, people are getting appointments and it's quite remarkable. so i am wondering, you know, how ultimately -- it was touched on by commissioner guillermo -- how, you know, with these systems having different sign-up arrangements, whether there would be kind of an overarching way that people can just find their way into vaccination. i know that we haven't been able to do it for testing because different entities run the testing. so i'm wondering where you are on that. and also mainly what we know about both the administration changes and the potential for vaccine supply among our collaborators and multicounty

entities and the remarkable work that you're doing. >> our entire team thanks you. it's a really dedicated team. i have only been with them for a little less than a month now, but i can tell you that they're doing great work with a small, mighty team down at the covid command center at musconi. and i'll start with the last part of your question and then probably dr. tener will have more insight at the new administration level. but in terms of the multicounty entities, we already talked about the fact that most of the vaccines in san francisco will come through them, but it's also important to remember that they are -- they are in competition with our sister institutions throughout the state. and i will tell you that it's very clear that more vaccine is going to southern california m.c.e.s than in northern

california m.c.e.s so that's a big hindrance to what is happening in san francisco. dr. tener, i don't know if you have insight on the new administration that you want to share? >> yeah, i -- so i think it will be better -- i think that it's probably going to take some time to untangle some of what they're inheriting. but i know that the strategy is to hit the ground running. and we have several members -- actually from san francisco that are part of that planning process. i think that three from ucsf, and one from my department, and dr. robert rodriguez. so i think that -- i am very hopeful that that process will get better. and i just also wanted to echo, thank you so much for bringing up the appreciation for the work from the team. they have worked very hard on this. but also for the work for all of the groups and the collaboration within the health system.

so we have -- mr. pickens and dr. mercer have worked very hard with the -- with the -- to coordinate with the health system. as well as working to try to make sure -- you know, as 1a has unrolled, i think that the people who work at the hospitals, that was the part that was relatively easy, because we know how to get to those people. but when we're looking at private providers and we're looking at some of these independent contractors, that is where some of the elements were. and the health systems have really stepped up, given the fact as well that they, you know, they're trying to cover their members but also anecdotally we are seeing that their supplies for vaccine are getting diverted to southern california. so they're getting much less than we would have anticipated. so that has been another challenge. but i know, you know, kaiser and sutter and all of our partners

have worked very well -- worked very hard to try to include -- to try to get vaccines to as many people as possible. and our groups have been having daily meetings with that -- with the partners, to try to help to coordinate and smooth out some of these wrinkles that we're encountering. so just really recognizing their work as well. and i think that we are -- i appreciate all the comments on the communication and we are going to try to -- to take all of those in and to try to improve the communications as much as we can. because i think we all know the anxiety -- i mean, we're all feeling it, whether it's for our own family members or, you know, friends -- trying to alleviate that anxiety as much as possible. i think that it is one of our goals as well as getting the vaccines out to people. so, thank you. >> vice-president green: thank you so much. >> president bernal: thank you

dr. tener and mr. pickens. things that i think that are important to emphasize that we have heard here, number one, we need a lot of vaccines and we need them now. that everyone is subject to the staging and the priorities set forth by the federal and the state government in terms of when they will get their vaccine. and i also wanted to acknowledge really the san francisco hospital council which i know that has partnered with the department of public health and others and it's really a recognition that all of the other systems in the city need to step up and to be a really strong and important part of this effort to ensure that vaccines get into arms. so i think that is just a critical, critical partnership. and i'm pleased that those conversations are happening. i know that director colfax wanted to say a few words. and then i believe after that we have one public comment that we missed that we'll go back to. >> thank you, president bernal, and thank you, commissioners.

just to express my gratitude to the vaccine team that's working on this, d.p.h. covid command across the city. and mr. pickens is the executive sponsor of this work and, of course, dr. tener, dr. mary mercer, and their teams, the people that have been working on this constantly. i think that you can see the progress that we've made. i think that commissioner bernal, your point exactly -- we need vaccine and we need it now. and we will be ready for as much as we get to getting up to 10,000 vaccines administered in san francisco a day. in partnership with the hospital council that has been strengthened throughout this pandemic. as you know we have worked tirelessly with them in terms of surge planning and data monitoring and oversight that is being rapidly adapted here. so we are going to be ready for more vaccines as soon as it comes and we are hopeful and optimistic with the changes in the federal leadership in d.c. that that will happen sooner

than later. we don't have it definitely yet, but we hope to have it soon. >> president bernal: thank you, dr. colfax. we can go back to the call tary we missed. >> clerk: i was notified that we missed somebody and if that person could press star, 3, so i can identify you, because i don't have -- i don't know who that would be. press star, 3. all right, we might have missed the opportunity. i will just note that there's general public comment coming up and this is on the same topic that everyone is talking about, and that would go on the line item that we're having later. so hopefully the person will understand that it was unintentional. thank you for your patience. >> president bernal: thank you, mark. and, thank you again to dr. 10er and to mr. pickens, the scoutive sponsor for vaccine in san francisco. -- executive sponsor for vaccine

in san francisco. for an excellent presentation. we will look forward to more as it will roll out. and i signed up at sfgov/vaccinenotify, so maybe repeat that a few times over the course of this meeting sfgo v/vaccinenotify. we'll move on to the next item, which is general public comment. >> clerk: i apologize. so folks on the line, if you would like to make a general public comment, please press star, 3. and you can speak about anything that is not on the agenda. give it a few more seconds. all right, not seeing any hands, commissioners. >> president bernal: thank you, mark. our income item of discussion is the community and public health committee that met today. commissioner giraudo?

i think that you're maybe on mute. >> commissioner giraudo: okay, i'm unmuted now. we had two excellent presentations. the first was on jail cells and it was extremely interesting in a number of facts that were presented that the number of incarcerated individuals has decreased. they reviewed in-depth the behavioral health information for the jailed population and noted that there were 53.9% of

the incarcerated individuals that are under behavioral health services. that include group counselling, medication, etc. and it is a very impressive operation. and they have gone at length to contain the number of covid positive -- both incarcerated individuals and staff. as well as the sheriff's department. it seemed that the sheriff's department was a bit higher with 54 of those who had tested covid positive. but it was -- it was an excellent conversation. and we did not quite have enough time, but i think that we learned a lot about the excellent work that dr. pratt

and her team are doing. the second presentation was behavioral health services. it was presented to us about the closure of juvenile hall. and within that presentation, the goal is for the board of supervisors to close juvenile hall on woodside, by the end of this year. with the juveniles who are going to more community programs that are yet to be determined. and that was a concern that both commissioner chung and i surfaced. the staff reviewed the current services that are offered, as far as both behavioral health and the medical, dental as well

as partnership with sfsud. and currently to date, they have 20 juveniles that are on woodside, which is a significant decrease. many who have partially due to covid and to partnerships that are within the community. i think that the bottom line is that in all of their work groups, which are multiple, that are going forward to determine the services where, what -- those services will be -- it is required or they're supposed to have a plan submitted june 1st to the mayor's office of what the services will look like as of the closure at the end of the year. we have asked the department to

come back to us with a draft of what the -- of what the plan is prior to the june 1st presentation. and hope to schedule that at one of our committee meetings. it's quite a bit up in the air, to speak, and that was our concern. if there's anything else to add? >> i don't have anything to add. thanks, commissioner. >> president bernal: thank you, commissioners giraudo and chung. mark, do we have any public comment on this item? >> clerk: folks, if you would like to make public comment, please press star, 3. no public comment, commissioners. >> president bernal: commissioners, any questions for commissioner giraudo or members of the community or the public

health committee? all right, i do not see any. thank you for that report. and thank you all, the presenters from the meeting that happened just before this one. next we'll move on to our next item for discussion which is d.p.h.'s proposed budget for fiscal year 2021-2022, and for fiscal year 2022-2023. we have our chief operating officer greg wagner and our acting c.f.o. jen louis. >> thanks, commissioners. good evening. greg wagner. i'll try -- i know that it's late so i will try to get this expedited. and i'll just give a couple of kind of framing comments and then turn it over to jenny. so as many of you know, having been through this cycle multiple times before, we do a series of hearings over the course of the budget season. and this is our first.

we at our first hearing as we will do today, as we have in the past, is to look at the context of the budget, including the mayor's budget instruction, and the projection for the deficit, and the target and instructions from the mayor's office. so this will be kind of a framing conversation to set the stage and talk about priorities. at the next hearing in two weeks we'll come back with a set of initiatives, the more detailed initiatives, intended to meet the target and then we will have a series of hearings over the course of the budget process, even after the commission submits its project or approves the submission of the budget to the mayor's office in february. one of the things that is going to be a little bit different this year and i know that jenny will talk about it -- we have two of our major initiatives that are in a sense going on a

separate track. those are the covid-19 budget, and the mental health s.f. budget as funded under proposition c. and because those are both city-wide initiatives and those are being coordinated across multiple departments, multiple stakeholder groups, those are proceeding on a different track than the budget initiative -- or the budget proposal that we're going to talk about today. we'll be back to talk to you about those later in the spring as we proceed with the enrollment of those. so we won't be talking about those today, but rest assured, you will have plenty of time in the future to talk about those. so now i'll turn it over to jen tow go through our presentation -- jenny to go through our presentation. >> okay, good evening, commissioners. so i'll kick it off with the budget overview. this slide shows us our 2021-2022 base budget. a few commissioners had asked,

well, what about 2021, which is our current year budget. so just the background is that, like, we do two-year budgeting in san francisco. we call it a rolling two-year budget. so we're sort of always revisiting that second year of the budget the following year. so we always have another shot at the apple in terms of updating that budget. and we joke that we have to do the work twice. we do the budget for the second year over every year. so last year we completed the 2021 budget as well as the base budget for 2021-2022. and this year we'll revisit fiscal year 2022, and also start planning for 2022-2023. and in terms of how we approach budgeting in a deficit, we use the base approved budget for 2021-2022 as our starting point. and, you know, all of the

changes that were approved there, are they there and we assume that they are happening and we lay on updates to projections and initiatives on top of our base budget. and so just sort of by division what you see something similar in years past in zuckerberg san francisco general is that our largest position -- behavioral health with the support of proposition c dollars has actually grown to half a billion dollars. you know, laguna honda hospital, some of our ambulatory divisions, and i won't read the numbers to you but i'm happy to answer any questions that you may have. and one commissioner is interested in understanding well, how does this sort of base 2021-2022 budget compare to the current year budget of 2021. and one thing that commissioners may recall is that actually that there was a one-time spike in

our budget with the assumption of one-year covid operations. so our current year budget is actually about $200 million larger than this proposed base. and so while there's a lot of things moving around in it, the big thing that really changed year-over-year between the two budgets that was approved as part of the last budget cycle really ran with that assumption of sort of one year of covid response. and i'll talk a little bit about how we're going to approach covid later on in this presentation. and expenditures by type -- salaries and benefits really represent the lions share of our overall operating budget, which is over a billion in salary and fringe. non-personnel services is the most significant second. again, these are contracted services, but it includes all of our non-profit partners,

particularly within behavioral health as well as primary care population health, and other divisions, as well as the affiliation agreement that provides a significant portion of our clinical services at zuckerberg san francisco general. in terms of revenues, we continue to leverage revenue for almost all of our divisions. and so what you see on this graph here is these blue bars represent the revenue that we draw down. and then we sort of layer on general fund. and it comes through to sort of cover the costs that are uncompensated from other sources. as one commissioner noted, jail health -- just because of the nature of our patients there aren't eligible for medi-cal and medicare, unlike patients at our hospitals or in our ambulatory care clinics, so there's some small grants that the jailhouse

receives that essentially remains a county function. specifically in terms of the break out of the revenues, medi-cal is the most significant portion of these revenues. i apologize, i was pulling these slides together, i'm not sure that i have the actual values here in the right order of magnitude. but i think proportionally i think this is $847 million of medi-cal, $930 million of city general fund that we see here. those are our two largest sources. but, again, as you see sort of two-thirds of this pie is really related to our revenues that we generate ourselves. and we continue to draw down 65% of our revenue. but, again, like keeping in mind that since our overall general fund revenues are around $930 million, and it's still very

significant number and one that we need to continue to watch as it represents a very significant portion of the city's general fund support. specifically, i wanted to include a presentation about our salary spending projections. and the point three, our operating budget of $1.1 billion for the current year is expected to be on budget at this point. we do update the commission regularly as part of our quarterly financials and so we're going to continue to do so. and we also continue to aggressively hire the permanent staff to replace the per diem, and focusing on supporting hospitalizations and our covid-19 response and our behavioral health expansion. so the projections may change and we will keep you updated. in terms of the mayor's budget instructions -- basically this is a table that you have seen in the years past. this first row here shows

changes between sources. basically, revenue assumptions that the city is expecting. and as you can see it's projecting a negative revenue source here in the first year of proposed budget. but it becomes positive in the out years. so basically the assumption that you're seeing is that you sort of have this sort of continued sort of one-time drop in the first year of the budget. but then with the economic recovery, revenues are projected to increase and to become positive again. the as you may be aware, the city has a number of baseline and reserve requirements. so when the revenues do come in, a portion of them have to be set aside to be put towards this baseline and reserves. and so there's a portion that is already accounted for in terms of an additional expenditure.

offsetting some of the revenue losses. most significantly in terms of the city's expenditure costs is really around salaries and benefits which grow to be about $565 million by year two. there's city-wide operating budget costs and that includes capital, equipment, and some ancillary costs and some departmental costs which does include d.p.h.'s costs for inflationary. primarily at the hospitals. but if you add up all of the changes in the expenditures what you will see is that the expenditure growth is much more negative while the sources are not growing at a rate that is consistent with it. so what you see is a deficit here of 411 in the first year and 442 in the second year with that sustained economic recovery. and the two-year deficit is $356

million. slight good news about the $653 million is that if you sort of look back to the last several forecasts that the mayor's office has done -- while in may when the mayor reissued the budget instructions they were projecting $1.4 billion over two years. so they have done some significant work in terms of sort of reducing some of the impact in the out years, but, still there's some work that needs to get done. the instructions for the departments are to support -- or to provide proposals that reduce the general fund support by 7.5% with the 2.5% contingency for both years. and they're asking the departments to emphasize racial equitiy in their proposals, describe the proposals through an equity lens.

and then also absorb any internal racial equity work within the existing budget that we have. so what this means for d.p.h.? and before i get into that, i also just want to provide a little bit of context for the budget which greg mentioned earlier, but just due to the number of pending processes outside of d.p.h., there's a lower level -- i mean, i'm not sure that "uncertainty" is the right word, but development of some of the initiatives that we have compared to prior year submissions. ordinarily we'd be working internally to develop revenue projections and budget initiatives, but because of the sort of collaborative nature of some of the work that we're doing, some of -- we are still in the process of developing initiatives. i think that overall they do represent opportunities for the

department or potential upside. but we are still working through that. and so just some of the things that we're working through is just on the revenue side, the development of the successor plan to the medi-cal waiver. there was a one-year extension to the existing waiver to the county through a year of covid, but now they have submitted the initial proposal and are working over the next several months to identify it. there's also a federal stimulus package proposed by the president-elect, and we are still waiting for additional details for that. and there's potential refunding -- from the government budget. so significant potential there, but allocations unknown. and then on the expenditure initiatives, i will talk a little bit more about this, but the covid response that we have developed centrally, the behavioral initiatives will have

involvement with stakeholder groups. so both of these major initiatives, as greg mentioned earlier, would be delayed until the spring. and so our general fund reduction and target strategy is to -- our initial target is $59.5 million to get to the first 7.5%, and an additional $19.9 million to get to a 2.5% contingency. we're going to continue to evaluate our revenue opportunities to meet reduction targets and we'll make every effort to avoid service reductions. it's something that we have done for the past several years. and we hope to be able to do the same, but, again, we'll have to continue to evaluate the revenue opportunities that we have. and then we sort of limit the number of new initiatives to ensure that we're focusing on the existing strategic priorities that i will discuss

here. so the mayoral priorities align closely with those of d.p.h. so, obviously, the first and foremost is continuing to respond to covid-19. and, secondly, her priorities are around prioritizing equity programs. and there's the focus on homelessness and developing programming. and then small important business and economic recovery, which is also tied to our covid-19 response. in addition, d.p.h. will also be focusing on the development of the new medi-cal waiver. so specifically in terms of responding to covid-19, as i have mentioned earlier, as part of the two-year budgeting that we put in sort of one year of covid response operations. we had about $205 million of expenditures related to covid that was budgeted for one year.

so we're going to be working centrally to look at tailoring our existing response to ensure that we have sufficient resources for testing, outreach, investigation, tracing, hospital capacity, outbreak management, including isolation and quarantine and, of course, as we just discussed the vaccinations. and the mayor's office will be running this through central covid command and take place through this spring. so we will not have details for february's submission, but as soon as we complete this process with the mayor's office we'll bring forward our proposal to the commission. in terms of equity, we'll be continuing to focus on the work that we have done before in terms of new trainings and data collection that will support equity inclusion in hiring as outlined in d.p.h. racial equity plan that was presented to the

commission in december. we want to look to establish community engagement standards and resources to increase the communication, particularly in the time of covid. and we'll continue to look at the work flows and the resources to improve the quality of care and to really address the health disparities. in addition, in last year's budget we received $36 million of new ongoing programming from dollars that was reallocated from -- reinvested from public safety departments budgeted and we'll continue to roll those our as well as the following year. in terms of behavioral health reform -- as the commissioners may remember that in last year's budget we programmed about $47 million of proposition c dollars to support expansion of treatment capacity, including site acquisition, establishing an office of coordinated care, and expanding case management

and a new street crisis response team. expanding the hours at our behavioral health access center and pharmacy and increasing our services and shelter and permanent supportive housing. this is sort of the first phase that we had budgeted in to address some of the initial requirements of the mental health s.f. legislation. but for the next year, and we have started and established a governance and project management structure for the program. and, in addition, the implementation working group, which is part of the legislation, was established and convened for the first time in december. this group has been -- is tasked with sort of making recommendations to d.p.h. regarding designs and services, and in addition the "our city, our home" committee will be providing oversight over

proposition c dollars which funds some of these initiatives. and so these are two committees that we will continue to work with this spring. i understand that the timeline for developing recommendations to the departments will be around april and so we'll be working with them, taking their feedback, and then developing behavioral health initiatives with consideration to the recommendations that they've made. in the meantime, we'll begin the hiring of new vacant positions and we'll continue that program development for that remaining allocation of dollars. so we have programmed $47 million and we believe that there's about $40 million left on programs allocated that we want to work with our community stakeholder partners on. and then, finally, the aims for the department. as i mentioned before the waiver

expires at the end of 2021, and the state is developing a successor program that sort of really focuses on managing member risk and need and increasing flexibility in the medi-cal system, and improving quality outcomes and driving system delivery and transformation through value-based initiatives and modernized systems and reform. in january, the department of health care services released an update to the proposal along with the government budget. we understand that we'll build on the prior incentive payment program and the redesign -- i'm sorry -- i'm forgetting what the acronym stands for. but incentive-based performance, value-based programs under medi-cal. and because that these really

are value-based programming, unlike fee-for-service where there's a simple rate change, our revenues are based on the performance that we provide and the outcomes that we achieve. and so additional planning is needed to ensure that we are well positioned to maximize the revenue. i'll include a further update on the waiver process. we are still learning details about what this new post-waiver world might look like. and we understand that it will probably still take a month or two to really understand the additional -- what specifically those programs might include. so for our next meeting we plan on presenting our balancing plan to meet our general fund reduction target. we will request -- have a

proposal to be released with the governor's budget office. and we'll have proposal of the behavioral health and covid-19 response until later this spring. with that, that concludes my presentation and i'm happy to answer any questions that you may have. >> president bernal: thank you, as well as mr. wagner. before we go into commissioner questions or comments, do we have any public comment? >> clerk: folks on the public comment line, please press star, 3, to make a comment on the budget item. star, 3. no hands, commissioners. >> president bernal: great. well, mr. wagner and miss louis, thank you so much for your fantastic work on this budget. i just want to remind everybody that last year you had to go through this process twice because of the pandemic and the change and the budget timeline. so, certainly, grateful to all of your work to get us to where we are now and know that this budget was just as challenging

to put together. and it's also a good reminder with the mayor's priorities and equity and behavioral and mental health, how much they align with the priorities of the department. and how critical is the work that the department continues to do every day, even outside of the pandemic. so, thank you for bringing that all to us as well. commissioners, do we have any questions or comments on this presentation? i don't see any. all right. thank you very much. we'll look forward to seeing you at the next meeting. >> okay, thank you, commissioners. >> president bernal: all right. moving on to our next item, which is other business. do we have any other business? and no public comment on this item i imagine.

>> clerk: we'll make sure. any public comment on item 8? other business. press star, 3. no comment, commissioners. >> president bernal: we did not have a meeting of the joint conference committees since our last meeting, so there's no report here. which brings us to the next item which is consideration for going into a closed session. do we have a motion to go -- or, mark, do we do public comment first? >> clerk: yes, actually, that's the right procedure. thank you. any comment on the closed session, please press star, 3. no comment, sir. >> president bernal: all right. do we have a motion to go to closed session? >> so moved. >> second. >> clerk: i'm do a roll call vote. [roll call vote] all right, the item passes.

if you all give me 30 seconds, i need to switch over. anyone who does not belong in the closed session which is going to be the laguna >> president bernal: i would like that we adjourn in remembrance of the 400,000 americans who have been lost with the pandemic and for the city to having participated in the remembrance today and lighting up the city buildings. so i would ask that we adjourn

in memory of all of those that we have lost and their families and loved ones and we hope that our -- today's ceremony brings some comfort during these difficult times. do we have a motion to adjourn. >> so moved. >> second. >> clerk: a roll call vote. [roll call vote] all right, thank you, everyone. >> president bernal: thank you. to brighter days ahead. >> thank you, commissioners.