d.p.h. vaccine. remember that our other health care entities received over two-thirds of the vaccine supply. next slide. this is the vaccine heat map of the vaccine that has been administer by the d.p.h. san francisco health network, from mid-january to february 8th. so this is mapping those vaccines distributed by neighborhood in the city. and you can see here that within the health network, vaccine is going into arms in geographic locations where covid-19 is most prevalent in the southeastern part of the city. again this would still reflect that focus on healthcare workers and population 65 and over. next slide. so just to remind the commission, we have a three-pronged vaccination strategy with high-volume vaccinations, community-based

pods with novavax, community access sites, also known as hubs. then, of course our clinical participants including the care consortium and pharmacy partnerships for distribution of vaccines. just to emphasize the point is to build a vaccine ecosystem where every door is the right door to get a vaccine. an we just opened our third site today. i was there with mayor breed and board president supervisor walton at the produce market, which will have -- is in partnership with sutter health. that will have capacity to deliver at least 1,000 vaccine as day, when we have enough supply. we now have enough capacity in san francisco to well exceed our goal of delivering over 10,000 vaccines into arms every day. we just need more vaccines.

we need more vaccines to meet our goal of getting everybody in san francisco appear vaccine as quickly as possible. as you know, vaccine supply right now and for the foreseeable next few weeks is quite limited. but we have built a structure, we have staffed it up. we are ready to go. we can get 10,000 vaccines into arms a day. and most likely exceed that goal when we get enough vaccine to do so. next slide. so just with regard to covid vaccine resources, we have the general information about covid vaccines. and then the city and county of san francisco has created a new web page to make it easier for san franciscans, who are eligible to book an appointment to get vaccinated. it provides a number of options and links for people to receive vaccines. obviously this is very much dependent on supplies. i will say, just to provide the

commission with another key metric is at the beginning of last week, we were just under a third of people over 65 who had been vaccinated in san francisco. as of this weekend, we were at 50%. so we've made tremendous progress. obviously we have a considerable way to go. the fact that we've had to close our moscone site to new appointments at this time is concerning. our vaccination pace will slow down as a result of that. we're ready to go once we get adequate supplies of vaccines from the state. that's my presentation an our covid status. and i'm happy to take any questions now. thank you. >> president bernal: commissioners, any questions to director colfax on this portion of the presentation? okay.

commissioner chow. >> i thought it would be important, people have given me some feedback on our different vaccination sites that they have felt that it was very professional and received very good and prompt service in terms of moving through the large sites. i also think that the fact that we've been able to vaccinate the most vulnerable, in a place the department has actually been targeting that, because they are the most at-risk to end up in our i.c.u.s and hospitals, has been so successful. i'm not sure what the timing is for other states. well, i should say other cities in terms of getting that particular vulnerable population vaccinated. but to have reached already 50% when i think a month, a month and a half ago, we were still trying to find out how this was

going to be done. so i wanted to compliment the department for putting out the multiplicity of sites that they have actually implemented all the way from the large centers, that we just heard about, to even the small mobile centers and getting it out to some of our desperate and vulnerable populations. so i think they deserve credit for getting this far so rapidly and having a very efficient system. >> thank you, commissioner. and if i could just add another key point, on february 24th we had planned to ensure that teachers and emergency service workers, including agricultural workers, are also eligible for vaccines in san francisco. so that would be the next population that the state has

prioritized for vaccine. we plan to have that happen on february 24th. again the ability to actually vaccinate a large number of people number that group, as well as continuing with people 65 and over is contingent on available supply of vaccine. >> commissioners, any other comments or questions? okay. we'll move on to the next section of the presentation. this is where dr. nguyen comes in. >> i'll just share my screen. welcome, commissioners. thank you for this opportunity. i'm really humbled and proud to be able to come and represent for the guidance branch. i'm the assistant health officer and in pre-work times, the

specialist. so noncommunicable disease is usually what i do. i'm so going to talk you through who we are in information and guidance. we call ourselves i.n.g., how we do our work, disseminating contend and standard work and quality improvement had in that. in terms of what we created and where it can be found and the impact within and outside of san francisco. so who we are. so the information and guidance branch. for this organization it's been to provide and ensure accurate science-based stakeholder-informed information and guidance to prevent, contain and mitigate covid-19. and so we provide covid-19 guidance for all sectors, including childcare, schools, service providerses and businesses of all types and health care, as well as for the general public. we do this by writing guidance documents, f.a.q.s, tip sheets, framework and we work really closely with the city attorneys to inform health orders and directives that come out. and we really document from

other city departments and throughout the activision, when they write their documents to ensure alignment and consistency. we answer inquiries around covid-19. and we also inform and facilitate policy recommendations of how san francisco wants to react and make decisions around covid-19. and so within the organization structure, we're on the right-hand side. that's the information and guidance branch. our sister branch is the joint information center, which does a lot of the public-facing p.r. related elements. and so talking about how we're organized, so we're actually about a 50-person operation, of which 50% is d.p.h. and the other huge proportion is coming from the library. and so if you see the org chart, we have the assistant director dedicated to reopening. we have a number of project managers and content managers that help manage all of the projects that we have at any given time. what i like to call the secret

part is the content leads and subject matter expertise. they really make sure that everything we put out looks good, it's right and it's actually really hard to find these people who are so smart and so good at what they do. and then we have a branch around operations that oversees dissemination, cataloging of everything we create and translation. [ please stand by ]

>> i'm very proud of what we've created and i think it really helps ensure high-quality and consistency and so in terms of content generation, any product that is create, has the project manager making sure things are moving along and we're annanal, retentative group and we say on top of any request that comes our way so our p.m.s help with that. we have a first line content generating and most are librarians that are good at doing research and writeing and some are clinicians and doctors and our content lead, which are physician and environmental health. and so, part of this is first doing research and so, we make sure that we look at the cdc and the state and and we never write

something that exists. there's no point in just repeating what is the cdc or state says. it's because they're so broad and ambiguous we hear from stakeholders saying, what does it mean in san francisco so we try to fill in the nitty gretzky gritty.it's about doing researcd filling in the gaps. back and fourth iterative is input and engagement with other

we're not the decision makers. we'll put it forward based on sowe have a clinical policy gros and decisions are made by the health officer and we also have could toll ab rate with other bay area health officers if there's a coordinated response to something and for only 10 to 15% of our products are related to the city attorney. some folks think that we write directives and orders so we don't write those. we heavily inform them as specifically when there's like questions of what should be restricted and what makes scientific sense but the city attorney's write the directives and orders and we assist in that. and that's about 10 to 15% of what we do. a question came up of, you know, this is all very exhaustive and back and fourth and iterative and how can we do it quickly

when a variant arises so this morning when we wanted to get out some information and messaging around the it was send particular out for approval so there are ways that we do this much quicker. here is an example of what we've created which was the tip sheet for safer social interaction and it looks straight forward and clean but what went into it was engaging with stakeholders and every graph i can even remember all the dakal and fourth that went we went to bishop and the bayview to ask how perp phrasing

we worked to create graphics for this and they had to weigh in on what they said around contact tracing and policy decision ideas brought forward and so, although document might only be flee pages it's hours of collaborative work that goes into this. one thing i want to highlight how we've built equity into the process and embodied an equity lens for the work we do and much credit goes to my leadership and d.p.h. for all the race equity training that we have given. i feel like we've applied it throughout and it wasn't having one person in ing to think equity and we developed an a3 around equity for ing but always throughout it's been a value that's been held by all in ing so we work closely with the

community branch and the equity neighborhood advisory group to incorporate community concerns and we work with the hubs and sectors that exist and we have input and because i think the other piece about this humility. we recognize we have blind spots and there's unconscious bias and privilege is often hard to see and so although we all have a lens to it and try to catch it and bring it forward, we can't see what we're doing wrong. because ing host the clinical policy meetings everyday, and they work the work who help facilitate because they're bringing that and in terms of our internal process, it's very clear throughout the process and population that's are facing

verdicts and its impact and we embody a cultural and practice it and we've gotten better with reading level, i will admit at beginning our clinicians wrote like doctors and we actually have meeting weekly forever all our content generators and writers and workshopping it every week and i feel like the reading level has been more appropriate as the pandemic evolves and then making sure that our documents, essentially all our public facing documents are translated and making sure that the mode of content delivery is appropriate, because we know that posting on a website is not enough and that sort of step one and so we engage with our partners outside of ing to make sure that this is actually getting in front of the eyes of the people hearing it. and so, the other peace i want to speak about is our standard

work in quality improvement efforts. ing isn't just about brute force talent and overtime hours which we have it's also that building a system that ensures quality and sort of consist eastbound see of what we put out so we developed a tool too keep an eye on our sisters counties and the guidance they're putting out and other sectors are opening before we were so we read what they were doing trying to stay consistent and pushing further than what they did and answering questions we were hearing from the business community but what about this and that. they have helped upkeep up to date about evolving guidance and we go beyond the bay area so we have keeping an eye on southern california, king county and washington and york city and we also keep track of other countries that are doing really well and curious what they are doing right so we have our eyes on their guidance documents as

well. we have reporting and an let ticks so we track where our guidance documents are throughout the process and see where it often gets stuck. we have a staffing dashboard because at any given time our staff are between three and eight different items so when we get a new request, we assess who is at capacity and who can take on a new request and we have data that we track around our output every week of products and requests. we also have a document and website management so at this point, we have 453 documents we're actively managing and that includes translation. any time there's an update and as is learned with this pandemic, things are changing every week and we're having to update our guidance documents to be in line with what the cdc and the state is saying. so, we had a system that let's us know where we posted multiple

documents that we can update it and also, because we translate so many of our document and translations come in at dave times, we have a system to track all that have and make sure we're on top of it. and so, what have we done? so if you look at this chart, i'll bring your attention first to the green line, which is the number of projects we've had over the course of the pandemic. we only started recording towards the middle or end of march. and so that's where the date starts. these are projects we font countbecause it takes more thano or three days to do. we realize we field a lot more increase that we don't count because those things are either within like a one or two day turn around. that's what the dotted yellow line is. we were looking at an average of 77 projects per month and about 200 requests a month. that's about three to four per workday of projects that we're getting and it's eight to nine

requests a day and then we're generating about one to two documents a day and documents are a huge lift and so to think about it like everyday, we're putting out one to two documents that are updates or new entire documents and that's what the blue bar is actual documents we put out. on average, we've created about 37 per month so surprisingly it has stayed quite high despite the evolution of the pandemic. so folks will have a lot of questions. and so, what's available to the public? you can see the distribution and the types of documents we're writing. we have 453 and that's all the translations we have to manage and keep up-to-date. 125 are unique documents in english. so those are fresh topics that we're writing on. and in else it of ensuring language access so, we pretty much translate everything. we create into the threshold languages of spanish, chinese

and tagalog and english and the threshold languages is we don't translate things that are all internal or healthcare documents for providers. so in terms of san francisco leading the way, with the number of guidance document that's have influenced the bay area, including travel advisory and holiday guidance and what we've written around ventilation and the placard we required of businesses, in terms of state guidance, much credit to dr. janey lee who has led the way with our school guidance and much of which was adopted by the state, even down to how cohorts why initially defined early on in the pandemic. and then how screening should happen in schools and so she's in relation to ing. our ventilation guidance was the first in the nation that we were

aware of. we wrote this early on, late summer early autumn when folks why starting to worry about ventilation in the setting of covid-19 and much credit to environmental health for leading the way there and the state asked us for our guidance which they then adopted. we have influenced the state outdoor dining and barriers and our thought process behind that and we wrote the state guidance to reopening playgrounds actually and they just adopted it and they made changes but again, it led to the state opening playgrounds and then early on in the pandemic, we wrote ppe recommendations for shelter staff and serving persons experiencing homelessness during scarcity and this is last summer when no one in the country was writing anything in that department and i'm proud to say we're very health protective in recommending ppe first shelter staff and ed was the sme on that. and i also want to mention a colleague of mine actually

reached out to let me know that she's part of a nation wide study of covid-19 cadence and policy and her review is we were the most comprehensive of the 30 plus counties she evaluated in california such as a quote she e-mailed me i am covering the whole sate of california and i thought it might make you happy to say san francisco has by far the most comprehensive set of policies i have seen and i think it really speaks how hard and how much you and your colleagues at dph over the past year and i was just marveling how pleasant and the sf guidance assessment was to complete and my observation and the reason i reached out to say good job in the first someplace that clearly a great deal of thought and effort went into san francisco county having its own well laid out policies a huge and on going accomplishment i want to recognize my team for making this possible. this colleague of mine pound the

out we did well around childcare and schools and we, like the other counties that she evaluated had very clear guidance on open business activities when they were ol. they often just point to the state's blue print when the question arises of what is open and what's allowed but we tell people and the only one she saw that wrote anything about transportation and public transportation and we were able to see down loads and hits were coming from around the country so we had a lot of hits in the bay area in california and we also have a lot on the coast coast and some in the south and canada and also lights it up and we have it in the leather lands and dubai so with that, i just want to recognize the team for making this possible and it's an honor to really serve with them and to lead the information and

i'll also highlight justin highsmith for tracking our data that i rented today and making my slide beautiful. that's the end of it. if there are any questions or comments, i'm happy to take them. >> thank you. before we go to do we have anything on the presentation? >> folks in the public comment line, if you would like to make a comment, press star star 3 to raise your hand. star 3. sorry, ha just went away. it looks like we have no public comment. any questions or comments?

i will certainly start by saying first of all, start by acknowledging your excellent work with chronic diseases within the department and longstanding great work but also, your team's excellent work in creating this enormous and comprehensive database and it hs been replicated throughout bay area and different parts of the country and perhaps the world. looking back at the presentation from director coalfax, you and your team are such an important part of what brought us to the place we are which is much better throughout the country and your presentation was excellent and i don't have any questions i just wanted to acknowledge your great work and that of your team and the other commissioners join me in that. >> ale pass it on to my team.

>> i believe the work that the department here and the covid to ccc have been outstanding of developing not just a framework but actually details and we've heard that maybe it's a little more detail but i think it's better to be trying to improve and give guidance and the ventilation guidelines, particularly i found very interesting and what i am interesting in, when we're trying to navigate through and you pointed out it's on the dph site and sf gov, it's not actually as clear to get to you and you have another website so, do you find it's me trying to navigate but we have so much information and have you found,

maybe the public doesn't have the same problem i do. or would find. i just find it's difficult to navigate to try to find the right information if you look for t the public would think, and this is sort of now, ban involved for the vaccine because it's on the front page of sfgov and so fourth. in sfdph we look at our website. i'm not sure i see where you are with all of your terms. >> i agree with you and it's not obvious to folks where the documents are and as a piece of history, one of the reasons why we can't use sf gov or sfgph.org they don't allow for the volume of content that we're needing to put out in an organized manner

so we had this other website and it's having our partners point to the ing document so that is not on going negotiation and different city department that's run the website so i agree with you and appreciate the observation that i wish it was' year to know where this is so we try to organize it fairly simply with these accordions that can you browse through and see the topic but there's a ton of information and it's hard to find out what you want all the time. i would hope that d.p.h. is going to be one of the easier departments to get to and this is a big flag and i'm not sure it's so easy. i encourage them to continue to work together and either point it to your area, which would be perhaps the he's easiest for

them rather than integrating it but if we had simple ways of pointing to it just like now, like now,your work is so importt would be helpful to the public if we were able, like you were saying, to really get tack access to it. thank you. >> commissioner green. >> thank you for this incredible presentation and the complexity in breadth of the work you are doing cannot be underestimated and i actually was going to echo what dr. chow said which is that, i think the more individuals that can get access to this, the better. it is very confusing to identify where this really ex at the present time work can be found,

especially for the public. i was a little worried as i looked at that the crushing amount of work and responsibility your team has to face and it's difficult to say no to certain people because you get these requests but it was great on the other hand to see when something important comes up can you turn it around in two hours and that is really heartening to hear. your team feels like it has enough support certainly, i think all the commissioners would agree that anything we can do to help facilitate access to this work would be something that we would fully support. i wonder how you are doing whether you have enough resources going forward and as things evolved do you feel comfortable that we're doing enough to help you and to publicize what you are doing? >> i appreciate your fronts and concern. it's an ongoing issue for us so we -- when we were staffed better we were at 55 people and

we're now at 45. even your comments will help me as i engage with folks and ask for activated staff. i appreciate the certain and sentiment and i will pass it along when i make my staffing request. the other piece is that, the quality of people we get is variable and i'm proud of the quality of people we have and i think asking from other department department can be hard to get through their top-level managers and analytic ability but we're doing our best and we're trying to get as many people as we can to stay up with the volume. >> are you using -- you mentioned the data that you collected and the places where the information is coming. are you able to utilize the data to term where you should focus most of your energy. in other words, if there's a

real interest in certain pages that you have are local compared to someone with europe, looking, for example, are you trying to utilize those data to figure out where to focus? >> that's a good question. we have ways to analyze which pages and which topics are getting more hits than others. as you imagine, not everyone is getting their information from our website necessarily. often times it's e-mailed directly so the community hub and other aspects of the c3 branches to get our documents out. you may not be stocking our page for every time we write something new but then our document about sro gets pushed to they're giving a pdf so we have data it's an undercount of hits because we know how it

happens in our products and in terms of how we prioritize it happens with the equity lens, what is the impact here. who is asking? is asking this question will protect the communities that needs that degree of guidance and i think that's mostly what drives our priorities and how many people are clicking something. can you imagine while resource sectors might be very interested in how they can be more protected and even about the clicking that we don't mean, we have spend a lot more time. >> as much as this information and it's excellent create efficiencies for your partner departments as well and i would think there's a win across the board as resource comes your way so thank you so much. in the chat i put a couple e-mails and if folks want to update it because every week

we're putting out of documents and updates and folks can getty mailed and added and i put the e-mail to repeat it. >> thank you, commissioner green. i'm sorry to interrupt, i'll share the e-mails with after the meeting. [please stand by]

-- and you've got two minutes. >> caller: i'm cynthia and a pharmacy student from ucsf. and i really appreciate the

progress that our city has been done with, like, the vaccine rollout and the policies like that. but i just wanted to touch base on some aspects regarding the mental health problems for covid-19. i learned that the new senate bill 855 was passed in september of last year and it was a great step towards expanding coverage for mental health and substance use disorder diagnosis and treatment in the state. especially with covid, which has brought a lot of mental health issues for many families and people who are isolated. and i was aware that sfpdh has increased a budget for covering more urgent care services to make it easier for people to use, including services like the street crisis response teams and the mobile response teams which are great resources. but in light of the increase in the demand for mental health services during this pandemic, i think that the city should

expand the accessibility of mental health service and its associated information especially to the elderly population. while these mobile response teams may be convenient to younger adults or college students, there might still be barriers for the elderly population. as much as the information and guidance is on covid and vaccines are important and readily available, i do think that mental health resources can also be included in those official information documents and they are distributed to nursing homes, assisted living facilities, and, you know, just other general public for them to reach out so that people can be aware of these mental health services being available to them. yeah, and that's all of my comments. thank you so much. >> clerk: thank you very much. all right, anyone else? this is the last call.

>> thank you for your comment. >> that is the last hand for general public. >> president bernal: thank you, mark. we'll move on to the next item which is a report from the community and public health committee. the chair commissioner suzanne dorado. commissioner? >> thank you. we have -- we had an excellent committee meeting and the -- we had two topics to discuss. and the first is the racial equity toolkit. this is a little different than what the committees have been asked to do in the past, which is to approve something that has been put together and then forwarded for commission approval. with the racial equity toolkit

and the -- not only the white paper but an example presented by dr. bennett, which was excellent, we are asked to, in fact, to choose it, work with the -- work with dr. bennett in going forward and then recommend it to the health commission. so it will be a little different. it's a work in progress. and we are excited to participate in putting the tools together. and what we have asked dr. bennett is to put together a worksheet for the -- for the tool. and it will be at this point based on the framework which is

the government alliance on race and equity framework, the gare. and that worksheet that would be part of any program or contract will be presented to the next month's finance and planning committee as part of the gare meeting. and commissioner christian and myself will join the committee at 3:00 for a further discussion of the tool. so that we are all together in working on it and any questions will be at that particular time. so that is -- that is exciting and going forward. our second item on the agenda

was the acknowledgement of the land in san francisco, and professor corderro was kind enough to help us and to talk us through it. and there was a wonderful job in putting together the acknowledgement document. we have asked with input that since this is the department of public health and the health commission, that, in fact, within the document as well as in the title will be referenced health equity. and what -- so it's more than just land acknowledgement, but also what we do is in health. so that will be reformatted with those changes and brought

forward to us. and then we will recommend it to the full commission. that was our -- it was a very -- a great committee meeting. so i don't know if any of the other commissioners would like to add to what we -- what i have stated. >> president bernal: anyone? mark, do we have any public comment on this item? >> clerk: folks, if you want to make comment on item 6, the report back from the public health committee, please press star, 3. no hands up, commissioners. >> president bernal: thank you, mark. and thank you commissioner giraudo and the members of the committee. i tried to attend the meeting today. i'm not a normal member of that committee and i was very interested in the topic. and i unfortunately had network

difficulties and i was fading in and out but i look further to getting more updates as it comes into the full commission. so, thank you. >> clerk: a hand has popped up. is it okay to go ahead and do that? so i will unmute you and let us know that you are there, please. >> caller: hello? >> clerk: yes, actually, before you begin i have to read a statement to make sure that we're all on the same page. the numbers have the opportunity to make comment for up to two minutes. the public comment process is designed to invite input and feedback from individuals in the community, however, the process does not allow questions to be answered in the meeting or for members of the public to engage in back-and-forth conversation with the commissioners. note that the commissions do consider comments from the members of public when discussing an item. i will put two minutes on the clock and you can begin your comment.

>> caller: yes, thank you. i'm calling about looking for policy to be written to protect tenants. the state has policy that was implemented starting january 1st to protect the employees. and my building has had several cases of covid and the employees, young and healthy people, were sent home the same day before the end of shift. but my building which is low-income people, but we have newborn babies to elders and english second language and all kinds of barriers and marginalized people, we have never been informed. you know, and the people with covid are not -- it's not enforced to be isolated and quarantined. and our manager in our building is without masks. so we're constantly at risk. and we only have one front door and two elevators and i'm a person that is at high risk

myself and i have it posted on my door. and they keep finding excuses to come in. so i was looking for some guidance from d.p.h. to protect -- and this is public money too -- it's subsidized -- to protect, especially -- well, all renters. and especially low-income renters whose rent is subsidized by the city of san francisco. so that's my concern, and i love the information guidance department. i think that they could probably find some good stuff out there, and models elsewhere, maybe, and even one that protects employees. i wish it applied to tenants, you spend more time at your residence than at your work site. so yeah, i would, you know, definitely an equity issue. this is low-income housing. and so, anyway, thank you. that's my concern. >> clerk: thank you, caller. i'm going to mute you.

if you -- i'm actually getting a note from dr. noonan that there's a document and resources to help with them. i'm going to call and give you my work email and if you can write that down and email me i will try to get this information to you. mark.morewitz@sfdph.org and i will repeat that slower. mark.morewitz@sfdph.org. you can also find us on the health commission website, on the d.p.h. website under the health commission because i'd like to follow up. that's all of the comments, commissioners. >> president bernal: thank you, caller and thank you, mark. any other comments or questions before we move along to our next item for action? >> i did have one after

commissioner giraudo's report on the native indian -- the native peoples resolution. they are going to try to look at the issues of health equity and i wanted to know also what might be the process in which they would receive input into the resolution from other commissioners? >> president bernal: thank you, commissioner chow. >> we are aware of that, and with professor giraudo and with mark, we're reaching out to other native groups -- native american groups. so this is inclusive. and not as well. so this will -- again, it's a

work in progress. and well aware of the need for a reach out. and all agreed. and so the language has been worked on. >> president bernal: thank you, commissioner chow and giraudo. we can move to the next item for action which is a resolution to honor dr. tomas aragon who left us as the city to bring his leadership to the state level. and i would like to recognize director colfax. >> hello, directors, sorry. i was having some connectivity issues. so i just wanted to introduce this resolution to celebrate drd

a mentor and an incredibly wonderful leader with firm commitments to public health, his integrity has led us through this covid-19 pandemic locally. and i'm just slighted that he's gone on to be the health state director and also sad that he's left san francisco. but he's taking the san francisco approach and the san francisco values, which he in some part, in large part, helped to drive a culture of health in san francisco to the state. and i think that will be reflective of everything that he's going to do moving forward. so very excited and i'm honored that the commission is recognizing dr. aragon for his

visionary leadership and his commitment. >> president bernal: thank you, director colfax. mark, would you read the resolution. >> clerk: whereas tomas aragon has a thoughtful leader between 1996-2020, and dr. aragon's long tenure with the d.p.h., served in the following leadership roles. director of chronic disease epidemiology, director of community health epidemiology, and disease control. and the health center and urgent care physician, deputy health officer, and population division director and health officer. and whereas health officer dr. aragon led the design and implementation of public health programs and policies to ensure the effectiveness of the mandated functions of the local government and force the local health orders and ordnantses and

communicate it regularly with public health issues with the health commission, the board of supervisors, mayor and san francisco residents. and whereas director of the population health division, dr. aragon was responsible for the vision, the commission strategy, the leadership, and the administration of the division which implemented the core public health services across the city. this included successfully earning and maintaining the accreditation for the d.p.h. and whereas dr. argon also had a productive 29-year history with the university of california teaching faculty, the principal investigator and clinician. and during the covid-19 pandemic, dr. argon worked tirelessly with city and community leaders to shape san francisco's response through the development of health orders and ordinances and guidances, always striving to protect the health of all san franciscans. whereas dr. argon had humility and compassion during his d.p.h. tenure and whereas dr. argon is

known to have a deep understanding of public health theories and mathematical models in addition to a wealth of on-the-ground public health experience. and whereas dr. argon is a proud native san franciscan and also a proud father. and whereas the health commission congratulates dr. argon as being named with the california department of public health and with governor gavin newsome. therefore be it resolved that the health commission honors tomasj. argon for his many years of outstanding service krnting to the health and well-being of all san franciscos and wishes him well in all of his endeavors. >> president bernal: excellent job on the resolution, mark. before we move on to commissioner comments, do we have any public comment? >> clerk: folks on the public comment line, would you like to make public comment? press star, 3 no hands up, commissioners.

>> president bernal: all right, commissioners, any comments on the resolution? i will step in to take the privilege to say that we are so grateful to dr. aragon for his leadership. he really in response to the pandemic, set a foundation for san francisco that is based on data and aligned with our values and has really helped to bring us to the place that we are today as a leader in the nation in responding to the pandemic. and we also know that we are in -- continue to be in excellent hands with acting health officer dr. susan philip and dr. colfax and his entire team as well. but i have learned so much from dr. aragon during my time on the health commission. and i'm so grateful for that. and i look forward to continue working with him for many years to come. so thank you for that. commissioners, do we have other

comments? i see commissioner chow. >> commissioner chow: yes, thank you, and i echo everything that you have just said but i wanted to also personally thank dr. aragon for all of the years that we've been able to work together. and to be able to develop a strong population health division and to have accomplished within that division the accreditation agenda that we were all striving for and working for to show that we do meet all of the standards and exceed them. i think that he's exceeded expectations that i even had concerning how the division would function. he's always been very kind with that. i thank his own staff and with his approach to the management of his people and i really have admired that because i think that he's developed a division

there that i am hoping -- i know that will continue the work and honor that work that he has done. i think that nobody needs to reemphasize again that i think that much of what we have today have been successful in the data showing our low death rate. even lower -- and also the low infection rates, it was certainly a lot of work on his part. i think we should all also be very grateful for that. so thank you for your dedication, for your work to all of the san franciscans. and we wish you well. >> president bernal: thank you, commissioner chow.

commissioner green. >> commissioner green: everyone said it so eloquently but how grateful we are for the talents that you have brought to this city and this department. i remember that you gave me a 23-page paper that made my head spin. and you are able to approach any topic, this incredible breadth of information. and the expertise that you developed, you know, to the greatest of detail. and it's one thing to develop detail and understand it, and it's another thing to really operationalize it, tomas. you have done that beautifully. and especially in the context of this pandemic. i said before that you turned into an action hero. i think you not only exceeded expectation, but your tireless devotion when i know that you have family -- i don't know -- like i said before, i think that probably what you have gone

through for us. i hope that you will work that hard for the state. but in your humility, because you're so approachable and i understand why people work for you and enjoy it so much. you're so kind of humble and then i read your c.v. and i was really knocked over for all of the education talents and achievements. so i just wanted to, you know, personally thank you. and really, really miss you. but you have done an amazing job for all of us. so thank you so much. >> president bernal: thank you, commissioner green. commissioner chung. >> commissioner chung: yeah, i just want to join, you know, all of the commissioners and echo all that have said. and i also want to personally, you know, to let you know that you have been a great teacher. at least for me personally. i have learned so much, you know, like commissioner green says, you know, like the great examples. and the other great example is

really about collective impact. and i want you to know that your presentations have made such a great impression on me that i thought that it was all the work that we could do now. thinking about how we can all work and create an impact that we envision. so thank you so much for being such a great teacher and such a great -- we just have public health fun. i don't know how you do it, and listening to you, you make it fun. we'll miss you greatly and knowing that you have going to be leaving the health department for california -- you'll be still be working for the health department for california, i feel safer. thank you. >> president bernal: thank you, commissioner chung. commissioner christian. >> commissioner christian: thank you, president bernal. dr. araagon, going to miss you going forward, and i just wanted

to say thank you for your incredibly gentle generosity that you have shown me as a brand-new commissioner, not a position, but you answered my questions and you took them seriously. and you explained things in a way that was easy to understand. so i enjoyed your presence and i miss it. and i wish you best of luck with the state. and i know that -- i'm glad that at least we'll still benefit from your intelligence and your knowledge and your dedication. so best of luck. and maybe i'll see you on the street when we can go back out again. >> president bernal: thank you, commissioner christian. i would just like to echo my fellow commissioners and the thoughtfulness with which dr. aragon approached the matters of public health, even during the most uncertain timess with this pandemic. i would like to recognize dr. aragon, if you would like to say anything -- before we take

the vote on this resolution. >> yes, everyone, thank you very much. i have been incredibly grateful for everything that you're doing today. i do -- i miss everybody, i miss san francisco. i do drive there and i drive home on friday nights and i am in san francisco on the weekends so i get to enjoy the city. one thing that i want to say is that everything -- everything that happens, it's about teamwork. and i have been surrounded by amazing people. and san francisco really is really proud -- it should be incredibly proud for everything that it's accomplished. i tell some of my san francisco folks up here in sacramento, you know, that the state is so big and there's so many big issues to work on, in general we don't spend that much time worried about san francisco because san francisco is doing an incredible job. so everyone should feel very proud and thank you, commissioners, for everything.

and that's it. yeah, thank you, thank you, thank you. >> president bernal: thank you, dr. aragon. seeing no other comments from commissioners, mark, let's move to a vote. >> clerk: i think that we need motions first. >> president bernal: i'm sorry. a motion to approve? >> so moved. >> so moved. >> president bernal: and a second? >> second. >> president bernal: dr. aragon has a copy of the resolution there, and if not, i know that he'll have one soon. so let's move to a vote. >> clerk: [roll call vote] great. the item passes. >> president bernal: thank you, and thank you, dr. aragon. all right, our next item for discussion is food security in san francisco during covid-19 and food as medicine update.

we have a great team of folks who are going to make this presentation. so i will let them introduce themselves. >> thank you. >> clerk: before we begin, everyone, we're all very excited. i recommend that you all hold questions until the end of the presentation. it's going to be a long presentation. and to get through it so that we're cohesive, you note your questions and ask them all at the end. thank you. >> president bernal: thank you, mark. i believe that dr. paula jones is coming up first. >> good afternoon, commissioners. yes, my name is paula jones and i'm with population health. along with my colleagues we will provide an update on covid-19 and at the end, and we will provide an update on this. next slide, please. and we'll go through first how food insecurity negatively impacts health and how food is also a way to achieve all of our

priorities and then the steps on how covid-19 has an impact on food insecurity. and then an update on some of the department of public health's food security initiatives. next slide. and food insecurity means that you must have adequate food and other resources and it affects health in many ways. and it reduces risk of chronic diseases and likely to have larger babies. and an impact on child development. and mental health outcomes. all of this increases the health care costs and increasing human suffers. first of all, (indiscernible) it's not just one person. and food insecurity is not having money and, three, one food program is not enough to solve food insecurity. prior to covid-19, one in four

san franciscans were at risk for food insecurity and now the problem is much more widespread. so i want you to look to achieve our priorities, and to have (indiscernible) and supporting small businesses and economic recovery. and addressing inequities and health disparities. this is a call to action that is part of our health and health programs. one of the best examples of how food was the programs, one of the first to recognize the vital role of interventions of housing, transportation and especially nutritious food as a key determinant of health. this example must inform how we create food in all of our health interventions. next slide, please. and during covid-19, we had food insecurity locally and

nationally. it's more than doubled overall and tripled with households of children under 18 and if you can let that sink in. it has tripled for children under the age of 18. and we have seen an increase in food insecurity in san francisco, and during the pandemic, 44% of our workforce has filed for unemployment and leaving many families without a way to provide food. many food programs closed during the pandemic, including schools, and over half of our food pantries closed, leaving thousands of san franciscans without a source of food. and since covid-19, and the need to shelter in place, many residents didn't have access to food. a survey was done by the human service anxious in may and june of last year, showing that food was an immediate need, especially (indiscernible) for negative health outcomes from covid-19. latinx and pacific islanders and

native american families, for example. these were the families that were more likely to report not having enough food in the past few weeks. food insecurity, again, and local (indiscernible) that households with children had high rates of food insecurity. and also immigration status households. next slide. now data in the slide that is from the pandemic survey, and the survey was sent to over 150,000 households in manitoba, and jug link assistance. and they received a and on the zip code with the darkest brown color (please stand by) -- the

only issue with a priority was employment and 33% said this was the highest need. next slide, please. the department of public health as you have seen, has prioritized the health issues. in 2019, they supported to work to ensure that there's adequate food resources for all food insecure san franciscans. and also representing the critical role of health care on ensuring that san franciscans had food. and the department of public health also provides leadership to the council since 2005, and on the next slide i'll give an update on the work of that group. and after that the remainder of the presentation is our work across departments on food insecurity. next slide. the food security task force consists of city agencies and

organizations, and prior to covid-19, the task force had a strategic plan based on our 2018 food security assessment as well as stakeholder input. through this process, the recommendations were to enforce specific priorities. first, sustainability. that was the resources to enable the task force to deliver on the mandate to achieve a strategic priority. the next priority showed measurements and that was a common set of shared metrics to inspire action, track progress. and the third was adequate and appropriate community resources. this was appropriate for realizing all of the recommendations that are going forward in our 2018 assessment. and then referrals. this was (indiscernible) and a fully innovative system. we developed (indiscernible) and then covid hit.

the past few months the task force has been viewing the strategic plan and which have been advanced and what is needed now. i will just note that also this task force is set to sunset in june and we're working on recommendations to extend the task the work of this task force or another convening body. next slide, please. now some have been announced with the creation of the food coordination group. from the beginning of the crisis, i was activated to work at the emergency operation center and also now embedded at the covid enforcement group. and at the beginning of the emergency, we heard that covid positive people were not able to quarantine because they didn't have enough food in their house for the entire isolation period. so that's one of the first things that i focused on, to

create a food program to support people with covid-19 to stay in isolation while they were infectious. and working at the e.o.c., we have a program to delivers meals and food to those with covid-19 and medical providers and contact tracers and people who can also call 311 to be connected to this program. the program provides food for the entire household for the entire period that they're isolated and quarantined. and it's with partners (indiscernible) and market on market. and i just want to share a story that as a client living alone that received support had a covid-19 outbreak in her s.o.r. building. she was also ill and she couldn't prepare food. so she called one of the intake worker she talked about the feelings of being isolated and

alone and giving up on things. she said that the food support programs for her and the support and the reliability (indiscernible) she talked about how it enabled her to get out and to get back to work. today this program has provided food for over 4,700 households and 16,500 people. the food group has created a public website for food resources. it has tracked data on some of the major food programs. it helped food programs at the community level and it's also helped the community partners to private funders. i want to make a point that this type of focused coordination around food has been immensely helpful and the enormous response of the city and it's very well appreciated, and we need to have continued coordination around food for many months and possibly years to come. next slide, please. and so the next slide will also

be some of the programs that we as a department are managing. the first is our healthy food supplement program. this is one that i oversee and it's grocery vouchers and vouchers for people to be able to buy healthy food. prior to covid-19 we supported fruits and vegetables vouchers for pregnant women, and older adults on fixed incomes. we also provided matching funds for the farmers' market. and in addition to this during covid-19, we have partnered with a vendor for the vouchers and many organizations to provide two types of vouchers. one was a fruit and vegetable vouchers that we normally did. and the second was a covid emergency (indiscernible) that you needed to purchase any food that you could use your pal fresh card with. these vouchers were worth $10 each and the fruit and vegetable vouchers were $5 each and that's around 30 retail food storers in san francisco that took them. so weeb able to provide 100,000

vouchers to 3,400 families and we focused on latino and latinx families. and we had boxes for families and the next slide we will tell you more about this program and more of the goals (indiscernible) next slide. >> thank you so much, paula. my name is prite rani, the director of nutrition. and since the pandemic hit back in march, the program has been providing benefits remotely and this includes the nutrition and breastfeeding counseling and as well as providing the benefits of the w.i.c. cards so that families can go grocery shopping. the other unique effort that we took on over the summer was the

delivery of produce boxes. and this helps to us meet the need of families that were sheltered in place and also helps to us utilize the farmers' market programming that we receive every summer. for this we partnered with population health and the farmers' market which was the heart of the city farmers' market and the alameda farmers' market. and the care.org and door dash to serve 3,000 families with organic produce over the summer. and with our equity approach, over 60% of the produce boxes were delivered to families in the tenderloin and the outer mission, excelsior and bayview and hunter's point neighbors. these are areas with the highest food insecurity. and those that are most impacted by covid. i do want to mention though that

if a family asked to receive a box, we were so grateful that we were able to provide them with one. and the majority of the families that received a box were really satisfied with the variety of produce. they tried to keep it culturally appropriate so that it appeals to a wide variety of different families, especially families with young children. and so box his berries and, you know, cucumber and lettuces and it would appeal to a variety of families with different cultural backgrounds. and we also have been acting to offer something like this again in the summer. in addition to utilizing the -- in addition to the funds in march and we'll distribute the -- some additional grocery vouchers that dr. paula had mentioned and we'll be distributing them to families in health programs and latina

families enrolled in w.i.c. but dr. paula mentioned before that it's important to keep in mind that vulnerable families with young children have been disproportionately impacted by this pandemic due to lost jobs and wages. food insecurity continues to be one of the biggest needs among this population. and we will pass it on to christina for the next part of the presentation. next slide, please. >> thank you. >> yeah, you can go to the next slide. >> thank you. good afternoon, commissioners. so my name is christina gata, and we are funding numerous community organizations to address chronic disease issues,

prevent chronic diseases and to increase (indiscernible) consumption. as we became aware of the deep needs that resulted from the covid pandemic, we did a number of different things. first, we started by allowing and asking our grand (indiscernible) to pivot to what they were doing to focus more on feeding people. and several of them did want to do that and were able to do that. and we also took a look at funding that we had not yet expended in the last fiscal year and we were able to allocate $1.6 million to eight different organizations. and with what paula and priti were speaking to, we're very much looking at equity as the

center of the work as we do with our grand distribution anyway. -- our grant distribution, anyway. so we wanted to make sure that the funding was going to the populations that were needing it. so we partnered with the wholesale produce market to get fresh produce into the hands of many, many different groups, large and small throughout san francisco. and they were able to set up a very simple straightforward easy process for community groups to access. i am very grateful to them for doing that. jan corederro helped to make that happen. and we funded seven other groups to increase their food distribution and you will hear from one of them from veronica in a moment. but we were able to reach black african american communities and latinx and pacific islander

populations in particular. i think that i'll leave it at that and i will pass it on to i believe veronica next. >> president bernal: thank you. >> clerk: are you with us? >> veronica, unmute yourself. >> can you hear me now? >> clerk: yes, thank you. >> thank you, sorry. my name is veronica shepherd and i'm the director of the office of anti-racism and equity and i have been doing a lot of work around food security for many years with dr. paula jones, dr. rita noonan and franny and pritie rain, we have been doing this together. but a lot of my focus is on the

african american faith-base the coalition. it begun in 2016 as they were not on our radar at the health department prior to 2016. and they came together and they are working to address health and wellness across the city. this network crosses multiple christian denominations and spans across the city in the mission, the excelsior and western addition and the bayview. if you look at the survey that the coalition took in 2019, hunger was their major issue, even pre-covid. as you can see, 50% were worried that their food will run out and they couldn't afford food and they had to cut of size of their meals and skip meals. next slide, please. excuse me. when covid hit, it was this coalition that had the

infrastructure, the manpower, and the people in place to immediately to respond to household food needs across san francisco. that partnership has just taken on a level of mass feeding to peaks unknown. but they have delivered meals and groceries as well as cooked meals within their churches for 3,000 households weekly. they have been directly delivering to about 1,400 households meals and groceries, primarily to our senior population. again, they came together across their network and they adjusted the demands and the needs that they knew that were impacting their community. in december, through partnership with the faith-based coalition and d.p.h., we were able to keep people safe in their homes and

brought community-based faith-based universities, plethora of agencies together to feed 5,000 households during the christmas holiday season. next slide. what we've learned this crisis continues and we know that we have to fund long term and not short term methodologies. what we have learned is to do this work that we have to do it through a health equity lens. because this lens, you will see a different population of people with the highest health needs. we also have learned that we must as i have heard a previous colleague say -- have a household level response. in our communities we live multi-generational. grandma could live in a house with six to eight other people in the household.

so if she gets that one food pantry bag, that bag will be gone by that evening. because all six or eight of those people will eat from that bag. we know that no matter someone's economic status, people want high quality and culturally appropriate food. therefore, as you will hear more from dr. rita and erin, food is medicine. we've learned that we at d.p.h. know this is crucial work to work in collaboration, focusing on a collective impact. we know that each area of our work targets many of the same vulnerable populations, so we within d.p.h. know that it's imperative that we realign our efforts for the best outcomes for the communities that we serve. we know that d.p.h. is the only city agency that understands the

role of food security city-wide and all of its interfaces. and as paula stated earlier, not enough food leads to all types of negative outcomes. so it's critical to look at this really health equity lens. we can't achieve our goals without integrating food security into everything that we do. we learned that we need to continue our departmental coordination, data tracking, information and referral. we must do this. we've learned that the health department needs to have a bigger role on food security. and should guide all of the city agencies' efforts around food. since this the area that we know and do very well. we've learned that your voice as commissioners is critical to amplifying the values of our department. and we need you to keep food

security in the forefront. thank you and i want to pass the next slide to my colleagues, drn frans. >> thank you, veronica. i just want to thank again all of my colleagues whom i miss personally and i miss working on this more closely with you while i have been in the covid hurricane. so i'm going to shift gears a little bit and we're still talking about food insecurity. in answer to one of the commissioners who wanted to hear about the collaborative, and we will focus for 10 minutes on that and to look at their social determinant of health. by actually caring about the public health issues. and this issue around social determinants of health. so what drives this body of work is the patients that i've had is taking care of chronic diseases such as diabetes and hypertension. and the frustration of being

able to write prescription upon prescription of pills for my patients and yet they have come back with elevated blood glucose and all i could do was to write another prescription. as a health care system we weren't doing anything with the other half of the equation which was food security. and so that's really what inspires this work is, like, how can we get help to be a partner in this work. and i have been inspired by the author who says that people are fed by the food industry which pays no attention to health. and actually by the health industry which pays no attention to food. so the food is medicine collaborative is to try to get exactly this -- how do we bridge the health care systems and food systems to address food insecurity and support behavioral change and advance health equity? it's a collaboration of 20 organizations that have health systems and not profits and is backed by d.p.h. and myself and erin freney, my program manager. we have on-site food programming

which is tangible entity that is co-locating food in health care settings so that clinicians and businesses can see the impact of linking food security and health outcomes. by scaling that, we were able to provide culture change, so they see that food insecurity is not just a public health issue but it's truly a health care issue they need to tackle. and finally, being able to then to leverage that culture and change for a wider scale policy change and actually getting the same resources of funding to veronica's point to get ongoing funding to pay for food insecurity. and with the elements so co-locating food within health care systems. so having the prescription of healthy foods to chronic disease patients and to fill those prescriptions on-site. we know that food access in and of itself is not often adequate to enable people to be able to eat well.

so we have paired it with knowledge and skills. so most of our sites have a registered dietician on site doing cooking demos -- this is pre-covid and a lot of patients don't even have kitchens so we give them tools like crockpots and spices and measuring cups and knives and that sort of thing. and then importantly, connecting them back to the community connections and the food-based unit. and it's not to convert clinics into food pantries or to grocery stores, but to leverage the power of health care to marry this message between food and medicine. and then to create the best community clinical linkages, and the idea with these focused efforts paired with health care that we could have the improved health outcomes. in 2015, the first pilot was underway at zuckerberg's wellness center for pregnant women with diabetes. this expanded to a pilot at maxim hall center for diabetic

patients. they received funding to apply human-centered designed empathy to the work. what we see with outcomes is that 92% to 93% of the patients have healthier practices and they feel part of a community, which was by design. we recognized that creating a sense of relationship and community is really important in creating experiences for patients that they want to come back to. as a result, 83% of patients felt they were more likely to seek care after attending these. and importantly we saw statistically significant decline in blood pressure among the participants. so this 5 mm mercury of decline in the blood pressure is the same effect that you would see if the patient lost 11 pounds of weight or changed their medication from a less effective to a more effective medication. the same year we aligned with the health network to -- the net

metrics where we shifted to how to embed this in a culture change. so as many of you know back in 2015 there was an 8% disparity gap with bloom pressure gaps between all americans and black and african american americans. and so, again, culture change around equity. and through that we were then to able to outreach to black african american populations for the interventions that were pursued. so on the health network side, it was health interventions with medications and nurse and chronic care visits. but then how do we address the determinants of health that lead to hypertension, which is one which is food insecurity. and the food pharmacies came in and to address the need that you have heard from the prior speakers around food security of being a major barrier to health. in 2017, we were funded by the helman foundation and able to hire background support. and so we started three clinics

and health networks in that year and it went to six clinics in 2019, and this year we have 16 clinics with food programming and co-relocating across five systems between san francisco and morin. so what we then saw is that when you scale an intervention like this and you create change is that we can actually see the changes in blood pressure for the entire system. so this is the san francisco health network data, and it was surpassed as it relates to food pharmacies, 71% of the attendees were black or african american, and, again, we're not claiming that it was all because of the food farms. we had amazing partners in the clinical interventions but it's hard to ignore how the outcomes with looking at the determinants of health. so this decline in the blood pressure control is about a 30% decrease of black african americans with uncontrolled

hyper tension. so the literature shows that even a 10% decrease in the u.s. population for black african americans leads to about 1,100 strokes and 1,700 heart failure events that could have been avoided. so if we were able to see all of this impact. you can see what happens when race equity is part of a culture and a system, in the same way that food security becomes part of a problem that health field takes care of. and we have been lucky to dissystem neat this work in a -- disseminate this work at a number of systems. they've reached out proactively and asked us how to get health care and traditionally what is thought of as a public health problem or a problem of a non-profit space. so moving on to what we were able to do with that culture change, that moved on to perceived policy aims. so many of you are probably

familiar with the fact that the u.s. spends disproportionate amount of our g.d.p. on health care relative to social care, compared to other developed country. we're about the same when you add up the investment but it's a flip inverse investment. and you are probably familiar with the data that the u.s. falls off the chart for how much money we spend in health care, yet we're appallingly low in terms of life expectancy or mortality and a number of other indicators. so it begs the question -- is this really the right investment with health investment and preventative measures. so for three years, they administered medicaids and it includes a slew of new covered benefits. and so this time around, they included home delivered meals upon discharge. so it would pay for food but only if you had already been hospitalized. so the ask of the collaborative was to expand the services to cover medically supportive food

and nutrition, so asking for health care and health insurance to pay for food in the same way that you pay for prescription pills. and so we drafted a position paper and we had over a hundred sign ons, including a number of health care associations, including the california association of public hospitals and health systems. and the american heart association and a number of community clinic associations across northern and southern california. i'm thrilled to report that as of january 8th of this year, food actually got included in the medi-cal waiver. it's a huge deal. as long as they just leave it in there. when it gets sent to the federal government and approved, medi-cal now pays for food and so interventions like the food pharmacy or the supplement that dr. janice mentioned can now be paid for by health insurance. in terms of covid-19, i think this speaks to the systems and the investment in health care that a lot of the health clinics

said that we want to continue to do this work and so we have been able to serve over 700 patients a week at the clinics. and our partners have been able to leverage $1.7 million this year in terms of food. in terms of future directions and in culture assistance change and policy,... (please stand by)

>> they consider comments from members of the public when discussing an item and making a request to dph. all right, so we've got several requests and i'll take them in the order i see. each of you have two minutes. caller, i'm going to unmute you. let us know you are there. >> hi, my name is filice and i'm the executive director of it book center in the omi. our seniors were benefactors of several of the programs

discussed today and most importantly, food is medicine, working with gianna we were able to access fresh fruits and verge tees and we got to pick greens and collar greens and mustard groans and okara for our african american seniors, which was dear to their heart, especially around the holidays. working with ms. veronica shepherd we got dairy products in additional food bags and the $25 gift cards they were able to use to help compliment their thanksgiving meals like being able to buy aluminum pans and foil and things that you can't buy with food stamps. we have heard from our seniors time and time again that these culturally competent high-quality fruits and veggies they're receiving have not only changed their health but changed their spirit in this time of covid.

in the oemi there's no access to a grocery store. minimal fresh fruits and veggies and there's whole food and mcdonald and you have to take your pick on what your budget is. so we've been on a weekly basis, able to give our seniors competent, high-quality value fruit and veggies, dairy, bread, and things that they would have not normally had access to. this program is vital, vital. it makes a huge difference. not only does it provide us an opportunity to give our seniors fresh fruits and veggies but we used the opportunity as a wellness check. we were doing wellness calls but what we get to see with our eye, to deep our eye on our seniors sheltering in place was invaluable and i believe it helped stabilize versus neutrally and physically. i thank you for your support and

please continue to fund and keep these programs. the staff at department public-health have their fingers and pulse on the heartbeat of marginalized communities. thank you. caller, please let us know that you are there. >> caller: hello, can you hear me? tony kelly at bayview hunters point community. we're one of the smallest recipients of the soda tax money. you may have seen us on the list. this isn't our core mission. our core mission under this grant is to develop a co-op grocery in bayview. with the lock down in the beginning of the pandemic, we were drafted to provide food support and one reason because we were getting calls in the community at one of the mornings from families needing food that were falling through the gaps.

and in that case, support to other circles and not being able to order groceries online. so we started with the six-week pilot funded by the public of public-health. it provided high-quality food at a low cost and we're happy with funding to keep that program going as long as we could. the funded ended then because a lot of private funding that was dedicated to the emergency and the pandemic, ran out at the end of last year between october and december of the year. and a lot of that private funding was dedicated to an emergency in the hopes that public funds and other funders would step up after that. well, here we are for the past three or four months, a lot of food security programs in the neighborhood and bayview have stopped and aid is not getting to the community. we're beginning to get calls again. from families in those kinds of gaps and right now we have nothing to tell them. i know that there's been a lot of talk about the budget right now, both for the current year and for next year and talk about getting funds from other sources

and getting funds into bayview and getting funds for black communities and black and brown communities, and so far it's not getting to the families. i just wanted to thank you for the funding that's been there so far but also a small challenge because we're getting those calls again and we need to know what you at the city can tell these folks who still continue to need food as the pandemic goes on. thank you for your support and please pay attention to it in the future. >> thank you so much for your comments. caller, can you let us know you are there. >> i can hear you and you have two two minutes. >> i work with the foreign farm and shelter in place were early march foreign was forced to shut down our food distribution services to local families and thankfully in late april we formed a new partnership with

the san francisco produce market and we were able to launch our food decision and delivery services for every friday thanks to $1,000 budget provided by the sf produce markets emergency food fund and supported by the soda tax initiative. we were able to work with venders such as new city fruit and co produce and everything was created through sf produce market program manager and we purchased sf markets food recovery with program coordinator carolyn lizard. every friday morning, executive is east ant alicia fung, that's me and a few other volunteers helped pick up waste recovery food donations from wholesale merchants like what a tomato, washington and great risk gourmet for the waste recovery donations we were able to inspect the quality of the pro before bringing them to the

farm. at the farm, they helped divide the food including fresh produce on the farm. they are shared with each family that come to pick up with the farm and we deliver to them if they have mobility problems. our volunteers short out the vegetables and fruits and use them for soil and we check off the volunteers names when they received the box. each week we distribute to low income seniors thanks to the support of the sf market. our volunteers youth and families were happy when they received their food. they distributed $75,000 in 30 pounds of foods and we

served. >> please begin, you have two minutes. >> caller: i'm also from the community farm and i'm one of the founders of the farm and thank you for just saying a couple of words and the food oven tee program in the department of public and tax initiative has been a great as set in feeding people and not just feeding 800 people who really need it in the bayview right now, i think it's vitally important and i also want to touch on the longer term impact on social determinants of help benefited by this program.

and also, we have programs that focus local on black youth growing up they help to bring these people together so that in the community, we can be growing not just strong communities and not just healthy communities but diversity and diverse communities as well and we started with a community garden on one side and we have black organic farming on the other side and everybody works side by side together when there's a lot of calls to stop the crime, hate and there's a place for that and there's also a place for doing positive good and making a difference with positive good.

it's not just feeding people it's growing communities and it's cultivating diversity and this is a great public-health commission as the carried out by the department of public-health. >> thank you, very much. please let us know that you are there. >> you have two minutes, please. >> my name is january see and i work for produce at the san francisco market and we are really grateful with the city for all the efforts that you guys are doing and supporting the community groups and we were able to groups developing fruits and vegetables to families and i want to point out the city should work with the small and medium in the area and

especially those that can stay behind the quality of the produce and being able to customize the needs of every community. not only will help all the the small businesses and in the san francisco but also the employees and the families. and we have seen that one standard box of food will not satisfy the needs of everyone. so priorities should be on providing access of quality, choice and appropriate food to every family and it would give food the families want to eat and we should be really proud of the many community groups and clinics that are stepping out and helping. we should back it up with quality and healthy items from the small and medium businesses to recover the economy and especially see the families with respect and care. thank you. >> thank you. >> all right. please let us know that you are

there. >> i'm here. when the covid-19 pandemic started, i had a program for household necessities and medical supplies and most importantly healthy food in the families and through this program we stop about eight dph affiliated clinics in the hardest hit neighborhoods and as well as the sfg where families go home with those bundles of joy and with healthy food and we take the nutritionist, healthcare, casework and he is when i started it was just be for a couple months until covid is over and that really shows how ignorant i was but the

impact i've seen on the health of our families is far beyond anything i could have done with my medical training and we had a pregnant patient with diabetes who was having a hard time controlling her blood sugar and when a woman goes on insulin her risk of lifelong problems for the baby obesity increases substantially but we were able to deliver her the food she needed to manage her diabetes and it was our food through the sf market and she was able to avoid not only being on insulin and having to come in multiple times during pregnancy but also, a lifelong of health to come. the other important thing is the quality of the food that we give. we got, we lost our funding and from sf wholesale and we had to

throw out 30% of food that we were getting and i'm so grateful for the food bank and and it's critical. thank you. >> thank you. >> caller, please let us know that you are there. >> hello, this is antoni kaleo. >> clerk: you have two minutes. >> caller: i'm grateful to have this opportunity to address this commission and give my gratitude. i'm here representing being a family and providers here and san francisco but also professionally working with community-based organizations specifically in district 10 and bayview hunters point community advocates addressing not only this food insecurity crisis but

this publicity of pandemic and understanding that something that you all have grappled with throughout the months, since that time back around march, you know, friday the 13th, to be exact, coming up on a year of proper and understanding how we've been responding to this pandemic specifically in regions of our city it's been impacted exponentially and thinking about how those have not exacerbated the current conditions of folks living in those areas but specifically around food security. when we understand that food security is a right and the city's response to ensuring the responsibility to address those

matters, we only in the form of delivering food to the store steps of people in need but we understand that this crisis and this pandemic of not only food insecurity, but the environmental justice insecurities that we face on a daily has effected -- >> clerk: please finish your statement. >> caller: has affected us beyond and just understanding that the investment to continue this must continue. thank you, very much. >> thank you.

>> hi, this is jana cordero the program manager at the sf market. can you all hear me? yes, so, i think you've just experienced what my life has been like for the last year. which is working hand and hand with both the beautiful people from the department of public-health who do their work with so much heart and also these incredible folks out in the community working with all kinds of people but in particular those that are most impacted by covid and this all started to working with aren and rita to buy california grown organic produce from the southeast health center ex then when covid hit, christina called me and asked if we could scale up this program and work with not just clinics but non profits

and i worked with over 20 groups and including some food pharmacies that were still allowed to operate because i would like to say that the health department shut down all food services at their clinics when covid hit. and i hope in the future, we don't do that because we see that food is actually very essential to the health of folks. and then, 400 soda tax money. we can have small companies and nancy who called in earlier and encouraged you to support small businesses and we were able to supply 15,000 grocery bags and 50,000 meals in a short two and a half month period and they

were going to give us $1.32 million to continue the program for another six months. we expanded and i was able to work with over 35 community groups, some all volunteer and and dr. misa does it all volunteer. i see my team is up but were distributed 60,000 grocery bags and 160,000 meals. i want you to implore to support money for food in the clinics to supply them with a healthy, good quality, culturally appropriate bag or box of food. consider that, thank you. >> let us know that you are there. >> caller: yes, i'm so glad to

be going after all these amazing speakers. my name is the legislative aid for the district 11 office. food insecurity has definitely impacted it's really been exacerbated so just let me give you a history of me in this work and is that prior to coming over to supervisor safai's office, i was the chief equity officer at our covid command center and jana, paula jones, dr. nguyen, veronica shepherd are all real champions. the prosecute is deeply invested in this issue and also sustaining it. we continue to have food problems, we can identify over 700 residents that are in secure

with our offers is working on comprehensive legislation that will probably be introduced in march and so i just want to be here and to support everyone and that has presented because this is the one of the unintended blessing is now people can get food they eat. people deserve food that's not bruised. that is not beat up and thrown away. the informed that we give people that the most vulnerable should be the best quality and that is paula jones words, that's not my words in veronica shepherd. i just wanted to speak on this because this is imperative, this

work, and -- for us to really make comprehensive legislation. thank you. >> clerk: thank you, ms. morris. >> you have two minutes, thank you. >> caller: thank you. my name is (inaudible) and i am a constituent here in d-11 and i have been a member of a team delivering food to our community here in the omi. it's so imperative we give our community our families food that is culturally appropriate that can nourish them and build their immune system as we continue in this pandemic.

we are spending time at home and it's crucial that we just continue to invest in a sustainability plan. we'll be in this for quite a while. we're about to hear our one-year of shelter in place and it's so important that we just continue to invest in good quality food, continue to our city have our city continue to invest in just sustainability plan. we're coming in a year, we have a few more years so dph, set aside plans and make food access easy. we have two more callers, commissioners. caller, please let us know that you are there. >> caller: yes.

>> clerk: you've got two minutes, thank you. >> caller: ok. yeah, i think the amount quoted earlier it's not a significant amount. it's less than the we will continue to invest in this program. however, i have some concerns that perhaps this program does not adequately meet the needs of residents at my local food pantry, they often request donations from the community for culturally appropriate foods and

foods for specific populations such as seniors and in san francisco we have a diverse community. we have people with various diets and people who might have and the few times i'll volunteered at the pantry, there didn't seem to be segregation of food it was sure things were packed into bags without any special consideration of special diets and so people might have special needs like say religious diets. they are kind of out of luck.

whether they were medical diets and it would be appropriate. seeing into the needs of people on special diets whether they're religious or ethical or medical. thank you. >> clerk: thank you for your comments. >> i'm here. you have two minutes. >> caller: thank you commissioners for hearing my public comment. my name is suzie and i'm the executive director of vouchers of veggies eat sf. i just want to say thank you to dph for partnering with us to serve emergency grocery vouchers

to low income folks across the city. in particular, you've heard it so much from the other callers so i won't go too far into it. cul actually competent quality food and when we were working with the clinics distributing these grocery vouchers, such appreciation we had so many folks say that this is a lifeline and their ability to purchase the foods of their choice in the neighborhoods where they live and when they felt like it was safe for them to go out was just critical. i double down on what all of you have heard and the wonderful program with the food is medicine and the food pharmacies. to just really support food, especially in clinic environments. thank you for your time. >> clerk: thank you. and our final comment, commissioners, is from -- oh. actually, we do have that person anymore. we're done, commissioners. public comment is complete.

>> thank you, mark. let's see, let's go to commissioners questions and comments. commissioner christian. >> thank you, president bernal. to the presenters, i just want to say thank you so much for this brilliant work, this incredible work. when we first got this presentation in our public-health subcommittee and i was intrigued by the idea that the concept of food as medicine -- [please stand by]

are solving some problems that are bubbling up now in these multiple pandemics. so i just wanted to let you know how deeply you're appreciated that i certainly look forward to trying to be a part of helping you to do more what you're doing. so, thank you so much. >> president bernal: thank you, commissioner christian. commissioner green. >> commissioner green: as the commissioner christian so eloquently said, your work is absolutely exceptional.

the last time that you presented, the wonderful book that you gave us, i had so many cases to share with others and got so much positive feedback. as commissioner christian said, not only does your leadership and commitment show, but this is just the perfect example of how community and the department of public health can work together along with the medical profession. it's really astonishing to me in a way, you know, a lot of us know that they said let food to be your medicine and let medicine to be your food. so it's astonishing that here we are, a century or more later and we still have to make such an effort to help there to be a better global understanding of the importance of food to health. how it absolutely impacts the differential life expectancy between, you know, individuals and poverty and individuals who are better off and the need to really expand. so i hope that i had really two questions. i'm wondering if you can

elaborate more on reaching people in need, whether we're doing a good job of that and the w.i.c. programs are well known and have been around for a while. but in 2019, people with supplemental security became qualified for cal fresh and i'm wonder wag your abilities wondering what your assessments are to raise awareness to reach people who can qualify to participate in the program. and the second thing is collaboration and coordination amongst the various organizations. because, clearly, you know, as i saw in your slide, there are organizations at many levels and what i heard today is the incredible work done in san francisco and with our, you know, our local produce and so forth. and yet there's the food industry. and there are national organizations such as feeding america. there's so many. and i'm wondering whether you have a comment on how you -- whether it's just overwhelming or whether there is a way to really to get the best and the

most perspective of funding but also collaboration and best practices. although you're setting the best practices, you know, with the organizations that are national in the state and then non-profit level, how that all works and how we can really do the best possible job to help people. >> i'll take that one. thank you, commissioner green so much for your question and for all of your support. first of all, reaching people in need i would say that through the program we have seen an increase from previous years. so a lot more people are signing up for cal fresh. we're seeing that there are some programs that there's been flexibility allotted to some of the federal nutrition programs as priti talked about, being able to do remotely and getting people signed up for w.i.c. and the same with cal fresh. so that is an extension to getting more people on.

there's a program that has also gotten rolled out across country and it was only piloted at several states before the pandemic and it's for schoolchildren. and ones that are qualified for free and reduced. we do need some help in getting the word out around that, so families are signing up for that. it provides money for parents to buy food that -- like, assuming that the children would have eaten during school lunch, it's giving debit cards to children. and it's been amazing. and what is talked about through the relief efforts, the federal relief efforts, there's going to be hopefully an increase in the amount of money that people get through the cal fresh cards. so that will help. but in general what we see is what i said from the beginning, one program is not enough, right? there's very few programs

that -- some of these during the pandemic have been innovative in terms of providing for households. but that's generally been the innovations and generally privately funded. so i think that we're fixing gaps, especially among households with kids, which is very, very heartbreaking. so we are trying to really push out all of these federal and essential programs and take advantage of all of the waivers that are in place. the school districts have gotten waivers to serve all of the children. we need more -- definitely need more people signing up for some of these things, but, at the same time, being with cal fresh is wonderful, but it's not enough. so i think that there is those gaps and as a pandemic, you know, continues and the impacts of it, we will have to sustain the hurts that we are seeing and that we'll talk about. and the question and your

question around coordination, one thing that i have heard of from city partners as well as the community partners and the food task force is that the food coordination that emerged with covid with the creation of the food group, e.o.c., and later the covid food coordination at the t.c.c., has been to be sustained. this has never happened in this way where there is a coordination among the community groups and the city. i mean, certainly, we can always do more, but that kind of coordination is going to be -- we know that it's filling a gap that will need to be sustained. and i'm so thankful for the call from supervisor safai's office, and she's definitely leading the charge and with supervisor safai to try to figure out how to sustain some of these innovations and structural change that we have seen through covid-19.

>> one last thing. i know that kaiser has done a large program and i'm wondering how they have contributed to your efforts? you mentioned that it benefits people. but just having a huge program that they developed, it's in the last few years. >> that's -- >> i can help with that and erin can assist. so we have worked with kaiser on the food pharmacy concept and we have partners in the east bay doing things in alameda as well. but we as a entire system have not fully engaged with them. but, erin, am i missing anything? i'll just say that erin has pretty held this torch for me while i've been in covid. so she's been amazing. to your question about accessing different communities, i think that where i want to uplift my

colleagues with veronica shepard and christina on the sugary drinks where we're trying to put money into the community to directly to access the community leaders and trusted members. because w.i.c. and the government is one aspect and very important, but, again, what we have learned in d.p.h. is that it's really about getting into community with the community members to access the populations. >> i would like to jump in and to add to what rita and my colleagues have said. there has never been enough food for many of the populations that we serve. even with the programs that have been existing, amongst us on this panel we have worked outside of some of the boxes just to get people, families, seniors, our most vulnerable populations with high quality food. you have heard janet cordero and

felicia, and many people who got on this call that are our community partners. a lot of this happens through word of mouth. people hear about what programs and how they can get help, or i'm a patient at southeast, and i already know who they can contact. it's a huge word of mouth network, but i know that we can do better, particularly for the populations that we are serving. so we just need to do more and provide more food. people, as we are on this call, are hungry. and my phone blows up regularly with people looking for food and they want -- as you have heard from everyone -- high quality culturally appropriate food. thanks, everyone. >> president bernal: thank you. commissioner chow. >> commissioner chow: thank you, and thank you for this amazing presentation and when we pass the social determinants and food

as one of the important aspects of medicine, or i should say health, i think that we weren't aware that this type of work could be done so quickly. and perhaps the pandemic has pushed that in order to bring everybody about. and so i'm looking to see if we can enhance the information that we're getting and particularly through our health equity lens. and, certainly, all of the populations that you're serving, i think that we aren't able to see exactly what about the other parts of the city and particularly the asian and the -- the asian population that has over 35% also of food inequity. and i'm sure that they are part

of this. i think that with the garden, they have helped in a small way to try to answer that. and i think in a presentation of this nature or any other nature, where we are looking at trying to target vulnerable populations, then we should not forget that there are other vulnerable populations. and i'm curious, therefore, that you're talking about culturally appropriate foods and, certainly, this is not only important in the latino population and the black population, but extremely important in the asian population. so i think that the presentation could have been enhanced with describe wag you're doing within that -- describing what you're doing within that population. and we're looking at health equity and i'm seeing that is one of the inequitable areas. and saying that it would be not

just at this presentation, but other presentations being made that are showing the work that the department is doing. and that the work should should also be broken down so we can understand the good work that you're doing within the asian and the chinese communities. >> president bernal: thank you, dr. chow. director colfax, i believe, wanted to say something. >> thank you, president bernal. and i just wanted to express my gratitude for the presentation and the work that the people presented and that the teams are doing. if anything, the covid-19 pandemic has reinforced the commitment, resilience and the effectiveness of the work. and just to acknowledge and to appreciate that this group and their teams have been on the front lines from the beginning

of the covid pandemic and really have the -- in addition to ensuring that healthy food is provided to communities most in need, it really helped us to build the broader infrastructure in our covid-19 response. i think that a key example of that is the intersection of the provision of food with wrap around services, including with testing. so this has been a remarkable response, a remarkable group of people. i want to express my gratitude. this will need to be strengthened and sustained as we go beyond the acute stages of the pandemic. but just as covid-19 has exposed other fault lines among health inequity in our cities and our community, so has it done with food insecurity. but this team has just been remarkable and i want to thank them for their leadership, their commitment and their fortitude, and being there every day to help people in san francisco.

>> president bernal: thank you, director co fax. i would like to associate myself with the comments from my fellow commissioners and thank you for the entire team and we'll look forward to continuing to work with you through the remainder of the pandemic and into the future. so thank you very much. we can go on to our next item, which is an epic update with our chief information officer. >> yes, and i'm giving you permission right now, i apologize for giving you permission to share your screen. >> thank you. >> got it. just coming up. okay, good evening, president bernal and commissioners,

secretary, and i understand that i may be the only thing standing between you and the evening meal so i'll try to move swiftly, but do let me know at the end if i can follow-up with more detail. this is our regular standing ethic update. i would like to acknowledge my co-contributors on the bottom of the screen and i'm not able to pull this together without them. so the take home message for this evening in three parts. the epic my chart tool has been absolutely essential to our pandemic response and we'll talk a little bit about that. i want to revisit our information exchange, how epic receives and sends information with other health care systems across country and how that's benefitting us. especially as we're now starting to look at vaccine records. that is a picture of a roller coaster on the far right to

symbolize that the epic schedule is moving to adjust to all of these twists and turns and ups and downs that we are working within with our pandemic response. this slide is probably getting familiar to you. we remain in our get better phase, which is where we want to stay with epic. i mentioned the last time that we met that we're in wave 2a. and we split 2 into two pieces, a and b, because of our response to covid-19. so we've added covid-19 response as part of our getting better, because we're learning a lot about things and capabilities within epic that we didn't know before the pandemic. so we're trying to learn as much as we can on our epic journey, even as we are responding very quickly to a lot of demands for the services that this software platform provides to us. and then we've added one more category here, which i will just

call it spread. now as it was inspired by the last presentation and immediately, you know, my head began thinking about all of the ways that we can coordinate in ways that i don't think that most people understand that even exist. but i know that they do in epic and i can't wait to follow up with the leaders who just spoke with us about how we might be able to partner and to contribute to continuing getting better. certainly business not just with epic, but with all of the work that we're doing in d.p.h. we're going to spend a little more time talking about my chart today. there were a few questions that the commission had about my chart. so we'll zip right in. as a reminder, this is what my chart, the personal health record for d.p.h. patients, this is what is on screen, a quick reminder. so one page is statistics. you can see some rapidly growing lines as you look over time from april 2020 on the left side of the screen until the end of this

january. and what you're looking at, the yellow bar on top, is the total number of log-ins to the my chart application. whether that's on a mobile device or a regular computer. in january, we had over almost 112,000 log-ons, whereas if we look back to april we were only at 18,800. so there's been a lot of changes in how folks are becoming dependent on my chart. and as you might imagine and we will show in a minute, a lot has to do with messaging securely with providers as well as look up results, results for things such as covid tests as well as now vaccinations. and those vaccination records. we're offering my chart to patients about 95% of the time at every opportunity, whether it's discharge from the hospital or the conclusion of a clinic

session. you can see the enormous growth rate. it's harder to see the scale at the bottom of the chart, but if you look at the total number of users, the top line, the dark blue -- i'm sorry, the second line down, the blue line -- you will see in april 2020, we had about 7,500 my chart users and of january, we have 36,000. so folks, our patients, are have being access to health records in a way that they did not have access before we had epic. quickly about epic and my chart and covid-19, the fastest way that i can say it is if the san francisco health network is vaccinating someone, those vaccination activities ride in epic. we have worked to respond to a lot of requests to establish unionization clinic options and we have used my chart and

extended it even out to the internet where we're -- we are enabling our patients and clients to schedule for their vaccination appointments, opening up the schedule which a lot of folks don't understand in epic and my chart, but that's exactly how we're using my chart to ensure that we can get folks who have access and have successfully crossed the digital divide and have a way to reach our electronic presence on the internet. to be able to do the important work of getting ready and getting scheduled for vaccine appointments. and then another quick reminder, all of the vaccine records are being kept in epic. and they are all sharable, as we will talk about in another couple of minutes, across to other health systems where our patients and clients can be co-managed. we're vaccinating also the

d.p.h. staff. we're not quite fully ready to move all of the occupational health functions. one of the epic implementation two-way projects into production. we're getting close. however, we did move and activate the immunization clinic capability for the d.p.h. staff. so what's important there is that while d.p.h. vaccinates you and maintains the record, thanks to robust information exchange, wherever our staff are receiving their health care, whether that's kaiser or sutter or ucsf or dignity health, it doesn't matter. they're all connected to a large information exchange network. and those vaccination records are making it to the e.h.r.s where our staff are getting their health care regularly. this is a list in most popular order of the favorite features in my chart as defined by how frequently they're accessed by our my chart users. in the top five, it shouldn't

surprise you, these usually pop up and looking for your care team and following up on requesting appointments. and results and secure messaging. and my suggestion at number seven, checking your own immunization record may grow and supersede and pop up into the top three or four as more and more of our patients want to be sure that they can prove that they have that record of their immunizations for covid-19. a quick revisiting on my chart and digital literacy and equity and i think that i would make the comment that i don't think that i made when we talked about this last time. but my whole team is very aware that no matter how much software and access that we can provide, it doesn't necessarily get us across the finish line if the digital divide has not been crossed successfully.

which means both having access to a computer or a phone and having data on that phone or a wifi network that you can be connected to, to access these features. we're really glad that the city has such a strong digital equity team and we're excited because we think that this is one of a handful of services that the city provides. they can provide immediate benefit, because you can actually take care of scheduling and even having an encounter with a provider with the same piece of software. so this is a reminder. my chart is available in english and spanish. we have taken some careful steps over the course of starting to use epic for coronavirus vaccine, and then we have just about finished translating the workloads that a patient or a client would see when they're working to schedule their vaccination appointments into

the city's -- all seven of the city's threshold languages. it's exciting and it's not something that we expected to be able to do, but great minds got together and in accordination with the joint information center at the c.c.c., they made it happen. and all of the materials are multilingual and proxy accessed. so a loved one, or someone else that the patient trusts, for them to be the person who accesses the patient information via my chart is yet another way where we can help to bridge the gap that can be presented if somebody has not been able to get online. or does not speak english or spanish fluently. i wanted to address one of the commission's questions that i received in advance of this evening about the grade level of

text in my chart. that's actually a great question. what i can tell you is that i ran some of these scripts that patients see in my chart through a number of tools this morning. and i can tell that you on average the grade level that comes out is 7th grade. so it's not quite fifth grade, and i think we can continue to work with other partners in the city to see how we can bring that language to that fifth grade standard. i know that san francisco digital services program highlights that all materials on sf.gov are at the fifth grade reading level and we'll take that away and see if we can update you next time on how we're doing. thank goodness that we don't have time to read the entire 21st century act this evening. it would definitely make you hungrier. the 21st century act has all sorts of provisions for actually

working on cures. everything from diagnostics to therapeutics, but there's a portion of the cures act that is very specific to the exchange of information in health care. and it's important right now because it actually has been implemented during covid-19. so officially on november 2, 2020, the cures act was enacted in adherence or in compliance with that act with regard to something that is called information blocking, and it has been withheld to the fifth of april. but in preparation to be compliant with the cures act we have taken a number of steps that really represent positive changes for our patients and clients. and they're on the left side of your screen. most importantly, that when there are patient results available, we are releasing those into my chart in near real time. so there's no delay in patients getting access to their

diagnostic test results as well as other studies. we also have begun the process of making notes available, whether that's a history and a physical or a consult and a whole other host of note types. those are now available to the patient. traditionally you might get an after-visit summary that has a very brief summary about what went on and the fact that you might have a new prescription or something like that, and to follow-up, you know, see me in a year. this is not that information. as the commission knows, this is a full component for that visit that the provider recorded in epic. and they are now being made available to patients. we also are looking at how we can make even more available -- the information available from the client's record. and that will probably be in about a year, to a year and a half. there was a question from your

commission about smart phrases and how they might be linked to information such as this. so the reminder, all patients and proxies can at any time ask that their provider not share this information. and so if a patient or their proxy asks for that, the provider has to take a couple of steps in epic. one of them involves making a number of selections in epic to not share a certain note type with -- outside of our epic environment. and the use of a smart phrase is part of that process. i know that is a technical thing to talk about, but i wanted to try to answer your question effectively. the smart phrase is do not share note, that is all one big phrase. what it does is that it prompts

the provider to choose the reason why the information is not going to be shared with the patient. and in this case it would be at the request for patient privacy by the patient. so i wanted to make sure that i could share this information with you as this is work going on that has a direct impact on what our patients and clients see in their my chart. so i'm not going to read this to you, but they are all about information sharing. the top vignette is about a cantonese-speaking patient who actually was seen for a traumatic injury and didn't even know the extent of the injury until he came in for a follow-up appointment. when he came in for the follow-up appointment, the provider was able to see all of the records and able to have a meaningful conversation and inform the patient about what actually had happened. so thankfully this information exchange between the hospitals

and health systems is in this case really came to the rescue for this gentleman. the success vignette is from a filipino-speaking patient specialist about a concern with lab results. and in this case we were able to use a secure messaging back and forth with the patient's daughter, who was his proxy in the my chart tool to get this patient in for a referral in a timely manner. so ways that we're getting information from outside of the d.p.h. environment has become really essential in our world. this is a big screen with a lot of numbers on it and we're not going to talk about all of them. but we'll start with the text on the left. as a reminder, information moves both into and out of our epic to other health care systems around the country. and that includes epic systems,

but it also includes all sorts of different electronic health record platforms, including our partners here in san francisco, dignity health, and chinese hospital, that both run a platform and we were able to exchange information successfully with them. as you might expect the top trading partners are our partners in the city. and they are listed on the right side of your screen. ucsf, and kaiser and dignity and stanford round out the top end of that list. and the providers do not have to do anything to share this information. your commission had questions, do you need a password to move the information back and forth and i interpreted the question correctly, my answer is that it is automatic. every health care system that participates in this information-sharing network signs a data-use and reciprocal

shares agreement called a dersa for short, that's a really long term. but all parties agree to the same data-sharing rules which have been blessed by many groups of attorneys. and that is how we're able to successfully to move information automatically both information coming in about patients who we have providers, who have had a patient experience with, and also the same going out to where our patients have had experiences in other health care organizations. and i did want to mention briefly that there have been questions about, well, how do we know that names match, names with hyphenated last names, for example. and basically the way that it works is that this information-sharing network that all of our -- all of these health care systems across the country participate in, they use a matching tool that looks at a

number of demographic attributes in our electronic health records. and does a pretty reasonable job of matching up patients. so that we can -- we are able to see most of the time when a patient has had a health care experience in a different organization. your commission also had a question about searching epic for patients with hyphenated last names. and i have spoken with two or three different providers as well with our epic program manager, and some of his team, and i have seen the search for hyphenated names. and i haven't seen a problem with being able to identify them. but i would be happy to follow-up in more detail with searching for individuals that have hyphenated names. there was also another question about lost records. i want to address that. it doesn't deal with information

exchange between the d.p.h. epic environment and any other health system. i think that (please stand by). -- it is possible that they say, gosh, i just don't see that person in here and a duplicate record can be created. but have no fear. this happens and it's been happening since the dawning of electronic health records and we have a team that works in an organization called health information management. this is one of their core

responsibilities is to make sure that any potentially -- any potential duplicate records can be evaluated and we have the ability to actually to merge those records together if they are truly one and the same person. so that we don't lose any information. but it may not be ready right at the instant that a duplicate record is created. and we're hoping that answers that question that your commission had. and, finally, this is the epic schedule. you will notice that the blob in the middle that looks like a sideways letter l, which is where we created buffer in our schedule to handle both covid-19 vaccination programs as well as the ramp-up of the mental health san francisco program. and we have eaten into that blob a bit with our work with the occupational health program and for the t.b. clinic. so we're glad that we have created the head room and as i said at the beginning that it's been a bit of a roller coaster.

and we're still adjusting and we're happy to talk about any of that's programs whenever you would like to get an update on these. and that wraps up my update on epic for this evening. happy to take your questions. >> president bernal: thank you. before we go to commissioner questions or comments, mark, do we have any public comment on this item? >> clerk: folks on the public comment line, if you would like to comment, please press star, 3, to raise your hand. star 3, to raise your hand. there are no comments, commissioners and i hope that we all thank him for staying so late. this was an unexpected late meeting and he's doing a great job. >> president bernal: yes, thank you. we do have commissioner chow. >> commissioner chow: yes, thank you. a wonderful presentation and you

obviously are continuing to move and covid, certainly, is challenging. and i think that your timeline still is amazing for all of the work that you all have to do. my two questions, actually are related to basically to the records. and i really am pleased, by the way, to see the uptake on the part of the clients as you call them, our patients, who actually seem to be using my chart a lot more. so this is more back to the question of searching for records and being sure that we were able to find the record. one is within our own system, it may be possible that people -- and i just use chinese as an example -- may, in fact, have two ways of having their name. for example,... because it

depends on which way that somebody might actually put it down. and the chinese names are often with the first name -- the sirname first and then the first name. but it can sometimes get reversed. so is there a way that the recommended search is able to take that into account? i understand about the hyphenated and that sounds fine. you might have a similar problem, where it's not quite as likely. but definitely, for example, asian names that have this and i think that the koreans may also have it, if it was translated into the korean language. or could also be three names. but again the sirname is first and this happens a lot with different races, for example. so records are really important.

and the access to it is really -- it's not good if it's not timely and particularly in an emergency room where you're trying to search for it. so not sure -- first of all, if our own system can accommodate that and then what happens when you're reaching out to the other hospitals? that's one question. secondly really is related to private practitioners and how would they -- well, you had described systems but not everybody is (indiscernible) on these systems. so the hospitals have a good way to connect with your emergency rooms and so forth, which is prime importance. but what about private practical sessioners out with their -- practitioners with their own network, how do they get access to the records and that's more important under the government who wants a seamless exchange of

records. so those two questions. and i realize that the hour is late. if you want to answer it later, that would be perfectly be fine. >> let me answer the second one because i have an immediate answer. the first one is more challenging for obvious reasons. if names are entered differently in different fields it can be a challenge. for accessing records outside of a hospital like a big enterprise d.h.r., there's two ways. the first way is that there's dozens of companies who run smaller systems that you may find in a medical practice. and they can actually connect to the very same framework. so that's one way. and the other way is that epic offers a read only view into the record and so this is definitely something that is used today.

and it's called carelink, all one word. and they support an external provider's look into the d.p.h. records. before epic was here, we had plenty of providers here on staff who could then look into, say, the ucsf records using the same technology. so that is definitely an option if that particular provider or the provider organization is not connected to this national framework. >> commissioner chow: good. so perhaps you could send us that so we could inform some of the doctors who have been asking about this. >> yeah. >> commissioner chow: i would really appreciate that. and i appreciate that if you would just take the time and research, but i think that the asian name it is often could be mistaken as you say, and -- i would like to know what we could

potentially do. i mean, i would like to know what you're doing. thank you. >> we'll definitely dive into that. thank you for the questions. >> president bernal: thank you, commissioner chow. any other commissioner questions or comments? seeing none, thank you again for staying with us so late and for your excellent presentation as always. it's always a very positive experience to learn about our epic updates and where we are at and how we continue to progress and you always frame them so well. so thank you again for your presentation. >> thank you. >> president bernal: okay. our next item is other business. do we have other business from anyone on the commission? seeing none --

>> clerk: i will check the public comment line. if you would like to make public comment on other business, please press star 3. no comments. >> president bernal: and the next is the brief update on the laguna honda hospital -- >> clerk: i believe that commissioner green who chairs the meeting can give an update? >> commissioner diamond: i don't have minutes -- >> commissioner green: , i don't have remarks. >> commissioner chow: how about if i read the thing that i emailed you. i will read what i read and you can jump in. >> commissioner green: great. >> commissioner chow: give me one second, everybody. so at the february la geunda honda committee meeting they looked at the c.e.o. report and the regulatory report. and the c.e.o. report included data showing the effective vaccine rollout at the hospital

and the c.e.o. michael phillips announced that dr. hathaway was selected as the new chief medical officer. and incredible work of both of these physicians is well known to the committee members. during the discussion of the regulator to are affairs reports, they heard that six surveyors noted no deficiencies in the conference. and the whole report will come in weeks to come. and in closed session they approved the report and discussed. >> commissioner green: i would just say that it was a really excellent meeting and the success they've had at laguna honda is quite remarkable, especially with the way they've been able to vaccinate close to 90% of the residents and upwards of 80% of the staff. and, you know, you go there and the collaboration and the spirit and the teamwork are just quite remarkable. so everything about the meeting

i think was very positive news, even in the face of the cases of covid-19 that have occurred among the staff and the residents. i think that the team there is very well grounded and doing a superb job in leading, with the fact that there's no deficiencies when they looked at the covid set-up in itself is a testament to how things are working. and it's a seamless transition in leadership so it was a pleasure to be there. >> commissioner and secretary, could i add good news today. we do not have a resident within laguna honda with covid-19. that's the first time in a month that we've been able to say that so it's very good news. >> president bernal: thank you for that good news, director colfax. that is a continuation of the excellent work at laguna honda

in controlling and preventing outbreaking. very good news indeed. do we have any commissioner comments or questions? seeing none we can move to our next item of business which is adjournment. does someone have a motion to adjourn? >> so moved. >> second. >> clerk: i'll do the roll call vote. [roll call vote] have i got everybody? i think that i got everybody. commissioner giraudo says yes. >> clerk: i apologize. i'm blurry tonight. >> president bernal: all right, and thank you to the staff for the presentations tonight and for the late hour and for the commissioners as well. we will see each other in two weeks. >> good night, everyone.

>> president bernal:good night, everyone. bye-bye. >> this is the meeting of the san francisco puc commission. i'm president maxwell. madame secretary, will you take the roll, please. >> president maxwell: here. >> vice president moran: here. commissioner paulson will be arriving later. >> commissioner harrington: here. >> commissioner ajami: here. >> we have a quorum. before we start, madame

president, due to the covid-19 health emergency and given the public health recommendations issued by the san francisco department of public health, and given that governor newsome and mayor breed have lifted restrictions on teleconference, this is held via teleconference and televised by sfgovtv. please realize there is a brief delay between the meeting and what is viewed on sfgovtv. i would like to extend our thanks to sfgovtv and puc staff for their assistance during the meeting. if you would like to make public comment, dial 1-415-655-0001, meeting i.d., 146 350 2017 # #. raise your hand to speak, press star 3. please note you must limit to your comments to the topic of the agenda item, unless you're speaking under general public comment.

if you do not stay on the topic, the chair can interrupt and ask you to limit your comments to the agenda item. please address your remarks to the commission as a whole, not to an individual commissioner or staff. i'd like to announce that closed session number 8 and regular business item 14, audited financial statements and 19, have been removed from the agenda and will be rescheduled. the first order of business is closed session. item number 5, threat to public service or facilities requires that members of the law enforcement be present. to allow for the attendance of sfpd, closed session has been moved for this meeting only as the first order of business. we'll return to the regular order of commission. the items to be heard during closed session are number 5, threat to public service

facilities, number 6, conference with legal counsel, anticipated litigation as petitioner. item 7, conference with legal counsel, unlitigated claim, sharon eastman versus san francisco. again, item 8 has been removed from the consent calendar. >> president maxwell: thank you. madame secretary, please call for public comment. >> if you wish to make public comment on closed session items 5, 6, 7, please dial 1-415-655-0001. meeting i.d., 146 350 2017 # #. to raise your hand to speak, press star 3. please note you must limit your comments to the topic of the agenda item being discussed and remind you if you do not stay on topic, the chair can interrupt and ask that you stay on comment. we ask that the public comment

be made in a respectful manner and refrain from profanity. address your remarks to the commission as a whole. mr. moderator, do we have callers? >> there is one caller wishing to be recognized. >> secretary: thank you. >> caller, we've opened your line. you have two minutes. caller, can you hear us? >> going to closed session? put yourself in the shoes of we at home. so you're all going into closed session and trying to tell us something about nothing and then we're supposed to make public comment.

i hope that when you go into closed session, that you all have your hearts in the right place and that you all do the right things. we know that this investigation is going into a situation that some of us know about. but we're not privy to talk about it. so all i'm asking you commissioners at this time is, yes, speak truth to power. sufficient damage has been done. it's going to take years to get back on track. thank you very much. >> madame secretary, there are no more callers in the queue.

>> secretary: that's closes public comment on closed session items. >> next item please. item 4 is a motion on whether to assert the attorney client privilege regarding the matters listed below as conference with legal counsel. >> moved. >> second. >> president maxwell: thank you. roll call, please. >> commissioner maxwell? >> president maxwell: aye. >> vice president moran: aye. >> commissioner paulson: aye. >> commissioner harrington: aye. >> commissioner ajami: aye. >> secretary: you have five ayes. >> president maxwell: thank you. now we will be going into closed session. >> thank you. we are now back in open session. it is 2:54. madame secretary, please read

the next item. >> secretary: -- >> president maxwell: i will announce it. the commission has recommends that the board of supervisors resolve and settle the unlitigated claim on item 7. >> madame secretary, you might be muted. >> secretary: thank you. may we have a motion whether to disclose the discussions in closed session pursuant to 57.12a. >> president maxwell: a motion and a second on whether to disclose discussions during closed session? >> move not to disclose. >> second. >> president maxwell: the motion and seconded. roll call vote, please. >> president maxwell: aye. >> vice president moran: aye. >> commissioner paulson: aye. >> commissioner harrington: aye.

>> commissioner ajami: aye. >> secretary: would have five ayes. >> president maxwell: next item. >> before i read the next item, i would like to announce for those joining the meeting, that items 14 and 19 have been removed from the agenda and will be rescheduled. the next order of business is item 11, approval 0 the minutes of february 5, 2021 and february 9, 021. >> commissioners, any discussion on those minutes? seeing none, then open public comment, please. >> secretary: members of the public who wish to make two minutes of public comment on item 11, the minutes, dial 1-415-655-0001, meeting 146 350 2017 # # to raise your hand to speak, press star 3. you must limit your comments to the topic of the agenda item being discussed. reminder if you do not stay on

the topic, the chair can interrupt. we ask that the public comment be made a civil and respectful manner and that you refrain from the use of profanity. please address your remarks to the commission as a whole, not to individual commissioners or staff. mr. moderator, do we have any callers. >> madame secretary, there are no -- excuse me, there is one caller to be recognized. >> secretary: thank you. >> we've opened your line, caller. you have two minutes. hello, caller, are you there? caller, we're having difficulty hearing your audio. give you one more chance.

madame secretary, no audio from that caller and no more callers in the queue. >> secretary: thank you. public comment on item 11 is closed. >> president maxwell: may have a motion and a second to approve the minutes of february 5 and february 9? >> so moved. >> i'll second that. >> president maxwell: thank you. so moved and seconded. roll call vote, please. >> president maxwell? >> president maxwell: aye. >> vice president moran: aye. >> commissioner paulson: aye. >> commissioner harrington: aye. >> commissioner ajami: aye. >> secretary: you have five ayes. >> thank you. madame clerk, before we move to public comment, i'd like to say a few words about public comment. and in my years on the board of supervisors, i don't remember having any project that was not made better because of public

discourse. and i think it's, in my mind, it is a part of democracy and why it works. and it's very fragile. and we have to be extremely careful of it. and i think it's built on respect and being civil to one -- each other and to listen. i believe that from the bottom of my heart and i think we can see when we take it for granted. january 6th was a prime example of us letting go of civility and listening and respecting each other. and so to that end, i have another thing -- we're very fortunate at the puc commission to have public that when they call, they really know what they're talking about. they are knowledgeable and the dialogue is at a high level. we want to make sure we keep it there. we are respectful of each other

and our differences and that is what is so important about public comment and about what we do here. so, again, to that end, i've asked the secretary just to remind us of that after every item before public comment on every item. [please stand by] [please stand by]

-- not to individual commissioners or staff. mr. moderator, do we have callers in the queue? >> madam secretary, there are three callers in the queue. first caller, i've opened your line. >> good afternoon, peter drunkmeyer from the quality river trust. reconsideration with the state water board demanding they rescind the water quality from project, emphasizes potential economic impacts which i think we all know now have been inflated. shortly after the s.a.d. was

released in 2016, there was an op ed in the "chronicle" and cited numbers from a 2009 economic impact study, despite the fact the study had been updated in 2014 and the 2009 numbers were more than twice those of 2014 report. explanation was 2009 study had been finalized, the 2014 study which was prepared on the same group had not. but when the 2014 study was finalized in 2018, the numbers were virtually the same, never corrected the prior statements. petition claims the present day demand is 230, and we know it's 198, and that under the 238 demand scenario could be greater than 95%, imagine that. and another serious question provided to the agencies to help

them prepare the urban water management plans. among other things, conflated supply with demand, it has to be corrected as soon as possible to compare the urgent water management plans. i request you put it on the agenda for the next meeting. the draft will be released next month, so we need to act quickly on this. thank you, and thank you chair maxwell for your comments about public comment. >> thank you for your comments. >> next caller, you've have two minutes as well. >> coalition for san francisco neighborhood, on april 18, 2019, p.u.c. for water gave a

presentation, the bay delta and the future of our water supplies. since there is no audio or video of this presentation, i would strongly urge the commission to schedule a hearing on this subject. a copy of the power point is in the packet. in the introductory remarks, they said it's not a supply problem but a plumbing problem. this is the first time i heard about the plumbing problem. slide 18 of the power point is titled acwd transfer partnership and potential transfer pipeline. slide 19, brackish water in contra costa, also shows potential plumbing fixes. it also shows potential desal

plant in eastern contra costa. however, the water subcommittee has stated despite the study in 2007, the project has not moved forward and it's unlikely that it will move forward into issues of handling waste. it should be noted also studied the ocean site facility for the desal plant but was not part of the presentation. if the water supply issue is a plumbing problem, this brings us back to a recurring theme. is it the plumbing problem, why is the p.u.c. hearing the water resource board stating that it's unable to move 40% unrestricted flowage, thank you. >> thank you for your comments. next caller, your line is open. you have two minutes to speak to item 12.

>> commission i don't know what's happening over here, i see the number 12 for the agenda items. i see the number 12 for all the agenda items. so, ever since this meeting began there's confusion. start the meeting, go into closed session, you come out and start barking at us about some nuances which i have read one of your commission used the f-word. and no apology. i have read one of your commission used the f-word with no apology. now, i know sometimes following the shenanigans for years i'm fed up with you all, and then we are forced to say