opinion adversity brings out the best adversity brings out the best in a strong community. it's about community i'd like to reiterate a few things i'm pleased when these crimes occur against the elderly members we have been able to solve them and bring them to justice we would like to prevent it in the first place. the violence prevention the mayor just made will do that this is about community. we have community leaders we

have the city administrator here. in the back we have businessmen measures pete walsh. how fitting they are in the back the police department is a part of the community. this is a strong community. sspdwill be here for you cyc will be here for you. self help with the elderly will be here for you. i can't be more pleased with the mayor's announcement with her vision i be leave this will make a difference in preventing the crimes from

occurring the backdrop behind community members we would like you to know, we have your back. we have your back and the city has your back. thank you for your leadership and to gets together we will make this work and make a difference. [foreign language] thank you so much chief scott. let me end it by saying thank you to everybody that joined us here today. i'd like to say to those who committed these acts in the first place. do me a favor and reach out

first. there is no reason to commit a violent resource. we would like to turn your lives around. we don't want to see the altercations continue. i'd like to take this opportunity to acknowledge james cold well reach out to him. shawn richard is here from brothers against guns. you probably know members of the street violence intervention program if you need help give us a chance to provide an opportunity oral turntive to someone that will cause hurt and pain to a person and members of their

family and community i old like to thank everyone that helped put the program together. thank you for scraping the resources together so, the work they do to get to this point is amazing i'd like to thank the neighborhood organizes and people who will be the boots on the ground we have been through a lot, everybody. we have been through a lot it's been hard on our senior, children, and community let's not make peoples lives worse by our actions. say a kind word or two to

someone else. let's lookout for one another i'd say let's smile to one another but mile with your eyes. thank you for the work you do and thank you for being here today at the point am i taking questions. yes.

>> thank you for sending it again in the last message. i didn't actually look at the corrections, but i wanted to know if you had taken into consideration my two issues. >> i'm not sure what you're talking about. >> on page 11, my comments on general public comments [inaudible] the community and public health committee. >> i'm so sorry sir, i did not capture that at all. >> okay. that was on the memo. and there's a small use of the word "to" i can show you later. but i think the paragraph or the comments doesn't make sense under general public comment. it would be under community and public health because of the comment relating to housing

conservetorship. >> yes, i apologize everyone. i missed that. >> okay. we have a motion on the floor. commissioner chung, do you accept those two changes from commissioner chow? >> commissioner chung: yes. i accept. >> and was that accepted by vice president green? >> vice president green: yes. >> clerk: all right do we want to vote? >> yes. >> clerk: [roll call] all right. the item passes. >> great, thank you, mark. we're switching up the agenda a little bit today before we go into the director's report. we wanted to address very early in the meeting a matter of utmost importance and that is a resolution from the san

francisco health commission in support of communities of asian in announcement of racism and violence against these communities. i would like to defer to our colleague commissioner tessie guillermo to introduce the item. >> commissioner guillermo: great. thank you president bernal. i'm for excited to speak to this agenda item. i know i don't have to detail the incidents that we have all heard about and watched around the country and in some cases witnessed in our own city things that have brought the public's attention to the acts of hate and violence perpetrated on the asian and pacific

commissioners commissioners. we have asian pacific islanders who themselves are afraid for their safety. they're afraid for the safety of their parents and grandparents and they are coming to work and taking care of other people and they are coming to work and taking care of those people in their own community who are afraid in the same way and their fear is legitimate. it's not unfounded. it is entirely possible.

so that service of speaking for staff that this is an issue that impacts them and is important enough that we should all be paying attention to i think is a really important one. we've been trying to do that to some degree. we have forums from staff to speak to each other and i think that was really useful to people. there were three other people there, but we hit the limit, but i do think that more formal and elevated pronouncements have an impact in telling people that what they're experiencing is important. the other thing i want to be sure about is that we look at this as yet another example in which we all have experiences of pain and persecution that should lead us to the empathy that really is the core of all the equity work that we're doing. that ability to see that

everyone is vulnerable, that everyone has a need for that connection to each other and that support of each other i think is something that if we learned it and learned it really well, we would be able to do something more substantial and feel better when these kinds of problems arise that we would know that we could come together and people would know they could lean on each other. i don't think we're quite there yet, but people want to be there and many people are pushing forward to make that true. like this kind of resolution where we're stating who we are and what we believe and what is wrong and what shouldn't be happening i think is really important. the last thing i'll say is that we deal with health and a lot of the time, that is a long, subtle process. it's something that takes months to be a problem for you. it's something for the community at large. these are individual stories of

dramatic, unexpected violence that is interrupting peoples' lives. it is just as much health even though it ends up being talked about that has some sensationalism to it as anything else. violence is like almost every other insult to the body. it shocks you. it changes you. so people are changed after having had to live in fear or watch someone injured and that affect, the reverberation of those mental burdens sometimes even the physical outcomes are something that we as a health department are going to be responsible for helping to deal with for many years to come and we need to be aware that these are things that are also our per view. these events that feel social and feel like the community, they are health in every way and i'm proud to see we're speaking to that.

thank you. >> commissioners, i'm going to show my screen. please keep yourself muted. i believe commissioner chung is going to begin reading the whereas clauses. >> commissioner chung: yes. go ahead. the words are too small for me so i just pulled up the pdf on my computer. this is in support of communities. >> [inaudible] perhaps. >> director: say that again, please.

>> i was asking you to do exactly what you just did. >> director: okay. thank you. >> commissioner chung: so that's still too small for me. in support of communities of individuals of asian and pacific islander dissent and denouncing racism and violence against these communities, whereas the terms "asian and pacific islander refer to individuals from a wide range of countries that cities and identities. a lot of the different communities within the asian and pacific islander labeled have their own unique histories, culture, challenges, and successes and whereas 20 million individuals of asian and pacific islander descent account for 6.1% of the u.s. population and whereas, the united states has a long history of institutionalized

discrimination and violence against individuals of asian and pacific islander descent. in 1854, the california supreme court ruled that individuals of asian descent could not testify against a white person in court, virtually guaranteeing that white people could escape punishment for violence and crime against individuals of asian descent. in 1871, 17 boys and men of asian descent were lynched in los angeles by a mob of white men in response to an unrelated murder of a white man. in 1875, congress passed the page act, which was the first federal policy to restrict immigration. it banned female immigrants from east asia due to racist stereotypes that all women immigrating from china were prostitutes. the absence of women from china

in the united states heavily impacted the ability of men from china in the united states to develop families. in 1882, congress passed the chinese exclusion nar act, which banned imof individuals from china for 20 years and prevented those immigrants from china and already in the united states from gaining citizenship. in 1885, 28 miners from china living in rock springs, wyoming, were killed and 79 homes housing members of the chinese immigrant community were burned. in 1900, a bubonic plague outbreak in san francisco was blamed on the chinese immigrant community because the first publicly known victim was an individual from china. the immigration act of 1924

banned immigrants from asian countries and set quotas for immigrants from the eastern hemisphere. many individuals of asian and pacific islander descent were deported due to this law. in 1933, california governor james rolph signed an aamendment to the state's anti-miscegenation laws, amending civil code section 60 to ensure that its law also covered members of the from interracial marriage. in 1946, congress inexplicably stripped veteran benefits, committed from president roosevelt from 250,000 filipino

soldiers who fought alongside u.s. troops as american nationals during world war ii. decades of efforts to return those full benefits to the very few remaining filipino vet strands still alive have yet to successfully overturn congress's discriminatory action. in response to japan bombing pearl harbor, the united states government forced approximately 130,000 individual the of japanese camps most of them lost their homes and businesses during the process. in 1983, congressional report indicated that the internment camp policy was based on racism rather than actual security risk concerns. between 1988 and 1983, 83, 290

survivors received z an apology and 20,$000 from the united states government. in 1982, a male chinese immigrant was beaten to death with a bat by two white men in detroit, michigan. the underlining motivation for the murder has been attributed to increasing fears that the japanese car industry was overtaking the united states car industry at that time. the murderers were only required to participate in three years of probation, with no jail time served. 1984, the ku klux klan set fire to zifrping boats owned by vietnamese immigrants due to resentment and fears of the white shrimp boat owners that

the vietnamese immigrants were taking their business. after the attacks on twin towers on september 11, 2001, hate crimes against those perceived to be muslim spiked, increasing dim in atory screening practices at airports and violence against in middle eastern and southeast asian communities. whereas over 2 million individuals of asian and pacific islander descent are working on the front lines of the covid-19 pandemic. and, whereas, according to the 2018 census bureau, 34% of san francisco residents are of asian and pacific islander descent. and whereas, the use of terminology is rhetoric against individuals of asian and pacific islander descent related to covid-19 by former president donald trump, other politicians, and some news media outlets has perpetrated stigma against individuals of

asian and pacific islander descent in the united states; and, whereas, the use of rhetoric against individuals of asian and pacific islander descent has resulted in these groups being harassed, assaulted, and scapegoated for the covid-19 pandemic in the united states; and, whereas, stop aapi hate, a non-profit organization, reported that 3,800 incidents of hate and violence against individuals of asian and pacific islander descent have occurred during the covid-19 pandemic. and whereas, since january 2020, there has been a dramatic increase in reports of hate crimes and incidents against those of asian and pacific islander descent. and whereas, the surge in attacks against individuals of asian and pacific islander

descent have targeted predominately elderly victims; and whereas, on january 30th, 2021, an 84-year-old man from thailand died from injuries sustained during an unprovoked assault while on his routine morning walk in san francisco. and whereas a series of attacks occurred in oakland's chinatown targeting seniors of asian and pacific islander descent who were all violently shoved to the ground in separate incidents. and whereas, on march 16th two thousand twenty-one, eight people were murdered at three atlanta spas owned by women of asian descent, six of whom were women of asian descent; and whereas, these murders are emblem attic of the continued racism, my soj fi, violence, sexual stereotyping, and

exploitation perpetrated against of women of asian and pacific islander descent. and, whereas additional attacks on individuals of asian and pacific islander descent continue to occur in san francisco and through throughout the country and whereas, the world health organization and the centers of disease control and prevention recognized that naming the coronavirus disease 2019, or covid-19 by reference to a l geographic location or linking it to a specific ethnicity perpetrates stigma and whereas, racism has been demonstrated to be a demonstratable and whereas we are witnessing through local and national media reports, social media posts, and

anecdotal accounts from individuals throughout the country, the adverse impact of racism on physical and mental health of individuals of asian and pacific islander descent living in the united states and, whereas, also the last 12 months, 31% of individuals of asian and/or pacific islander descent have reported being subjected to racist slurs or jokes and 26% of these groups have feared that someone might threaten or harm them; and whereas, individuals of asian and pacific islander descent are the least likely racial group to seek help with mental health issues; and whereas, to encourage development of clinical environment which feels safe and welcoming to patients and staff who are of asian and pacific islander descent, the new england

journal of medicine offered the following suggestions: create a welcoming safe space by displaying culturally appropriate signage, posters, and literatures. create safe spaces for patients of color to separate them from anyone who makes discriminatory remarks. create safe space for staff through equity-oriented trainings addressing asian and pacific islander cultural issues. provide support to staff who face discriminatory remarks or hate-related violence at work through counseling, paid sick leave, and acknowledgement of the impact of these incidents on staff. ask about incidents of racism, discrimination, and other traumas while taking a patient's history. consider screening for depression, anxiety,

post-traumatic stress, and adverse childhood experiences and facilitate appropriate clinical treatment. >> director: thank you commissioner. commissioner chow, would you continue? >> commissioner chow: now therefore be it resolved, the san francisco health commission condemns and denounces all manifestations of expressionings of racism, xenophobia, discrimination ethic intolerance and other by gotted rhetoric against individuals of asian and pacific islander descent. further resolved the health commission recognizes that every individual regardless of their race, ethnicity, gender, sexual orientation, socio economic status, disability status, religion, country of

origin, or political party has the right to safety, respect, and well being. further resolved, the health commission expresses its heart felt solidarity with every individual of asian and pacific islander descent who has been attacked along with their families and communities in addition to sending condolences to the family and friends of those individuals who were murdered on march 16, 2021. and further resolved, the health commission acknowledges the impactful work by the san francisco department of public health in regards to addressing discrimination and violence towards individuals and communities of asian and pacific islander descent. the department's outreach to these communities early in the pandemic, in an effort to provide support and education, and later testing and vaccines, has been crucial to addressing their public health needs. in addition, the d.p.h. has provided ongoing consultation

to the mayor's office, board of supervisors, san francisco covid-19 command center, and the general san francisco community regarding covid-19 information, including the harm of stigmatizing any individual or group during the pandemic and mark can read the last certification secretary thank you commissioner, for reading. >> secretary: thank you, commissioner for reading. >> thank you commissioners. before we go any further into commissioner comments, do we have any public comment?

>> director: i don't see anyone on the line at this moment. one second. yeah. i don't see it. so no public comment at this time. >> president bernal: okay. commissioners, do we have any comments or questions on this item? commissioner chung. >> commissioner chung: thank you, president bernal. and thank you commissioner guillermo for leading this effort to draw out these resolutions really highlighting the long histories of discriminations against asians and pacific islanders. as an asian and an immigrant, i know too well how these intersections of discrimination really work in my community and, in fact, just on friday, when i was shopping at target,

you know, i got called names while i was doing grocery shopping unprovoked. and so i can only imagine the kind of pressure and stress that others are facing and i'm hoping that this will also become an opportunity for us to have some additional dialogs about communities among racial minorities and other communities of colors and immigrants because i think that, you know, we all have different stories to tell, but many of our stories also have similar kinds of aspects to that and this is an opportunity for us to instead of just talking about empathy, we can actually walk on that path, you know, and to hopefully in the long run transform the country into one that we really

deserve. with that, i also want to point out a tiny edit on the resolutions, if i may. >> director: sure. give me one second. can you guide me, commissioner, where you want to go. >> commissioner chung: yes. i'm trying to make sure that on the resolutions, i forgot which line that was, but there was a line that says "violence against womens of asian and pacific islander descent" but there was not a preposition

before that which was off and that was like an extra preposition. >> director: okay. was it the word "for" was on there twice? >> commissioner chung: no. that was another one. i didn't even see that one. >> director: i'll go down and read it slowly. >> commissioner chung: oh, here. that "whereas is these murder

are emblem attic of asian women and pacific islander descent" i believe the preposition "off" should be deleted. >> director: oh, here? >> commissioner chung: yes. >> director: yes. okay. >> commissioner chung: thank you. >> director: sure. thank you. is that your only comment, commissioner? >> commissioner chung: that i can remember. >> president bernal: thank you commissioner chung. commissioner chow. >> commissioner chow: yes. thank you. and i'd like to thank commissioner guillermo also and thank her for giving me the privilege of being able to read part of the resolution which i fully support. i think though, it is also important that in addition to supporting the communities for

anti--- denouncing racism and anti-asian rhetoric, it's important to look at what we can actually be able to do in order to help also with the underlying issues that created this. in the berkeway consortium program, professor russel general who started the anti-hate program which has gathered at least 3,000 and now he told me -- he told us in that seminar that it's over 8,000 reports they have now gotten, had mentioned that

anti-racism comes from both being an outsider and also being considered a monominority. and he was saying in his estimation, he was trying to simply speak to the minority does not answer the question. asians and pacific islanders, particularly the successful asian community are considered as models because they do their job and they don't complain, but to fight that, does not fight the real issues of racism and health and equity and he preferred to actually speak to the issue of we should be outsiders looking in to try to correct the problems so that we can all be together as insiders. i would prefer to actually speak to the fact that i

believe a root of the anti-racism comes from the fact that we continue to have health inequities that are not well-recognized imp because in part they represented in the past the very small number of people, but today there are millions of asian-americans and pacific islanders and that the fact that the lack of disaggregation has caused the inability to also understand the asian needs because it's oftened by mogul distribution based on also not only their own act iflt and background immigration status, but also their socio-economic status. and, particularly, this is really quite prominent within the a.a.p.i. community because

of the waves of immigrations that have come, these all merge together. our own city should really be a liter in looking at these issues and trying to move our agenda forward also for health equity within our racial community. i also wanted to actually acknowledge that commissioner guillermo was one of those who many years ago back in the 1980s actually worked on behalf of the asian american health forum to really create and discuss and bring to the federal government and to people like our congresswoman nancy pelosi the need to really address asians along with the other needs of our country. so very proud that we're able to speak to this. but i think that going beyond

just certainly supporting the community as a health department, we should also then try to also address the inequities of this. so while we have 30% of asian pacific islanders, i'm not sure that we're addressing all their needs. might mention historically also that this department has not been free of racism. that back in the 19 -- well, the late 1800s, chinese were banned from attending at the city hospital unless you had tuberculosis. and in 1925, but for that generation the city here officially actually considered

that the chinese were outsiders. so i think this resolution is very timely, very appropriate. i'm proud that i can be part of a commission that wishes to also speak out and, as i say, i believe we should also assist in improving the health equity that is needed here and that we have a department that is so capable of doing it that i would look forward to that opportunity in the future. thank you, president bernal. >> president bernal: thank you, commissioner chow. do we have any other comments or questions from commissioners? if not, just before we go forward, i would like to thank

commissioner guillermo and commissioner chung and commissioner chow for all your leadership in crafting this resolution, for reading it for us and for the public. certainly acknowledge how difficult it is to go through the retelling of the horrific acts that we have all witnessed nationally and also here at home here in san francisco. so thank you for your contributions to this resolution and not only for your leadership in protecting and enhancing the health of all san franciscans, but the example you provide to all of us in our community. i also wanted to acknowledge dr. iona bennett for speaking to this commission has to support and to be there for our d.p.h. staff and family and how important that is to us and how seriously we take that responsibility. i do have one small or one amendment i would like to offer to the resolution, and, mark, i

don't think you need to scroll through, i can tell you where it is. in the first further resolved clause as it speaks about the health commission recognizing that every individual regardless of their race, ethnicity, gender, sexual orientation, after "sexual orientation" i would propose adding gender identity and expression before socio-economic status. commissioner chow, you were saying? >> commissioner chow: i was going to second. >> president bernal: thank you. all right. if we have no further discussion and i know we don't have public comment at this time, mark, can you bring us to a roll call.

>> secretary: [roll call] >> president bernal: thank you everyone. our next item is the director's report. i don't know if we've been joined by director colfax. if not we are pleased to have dr. anifa bawla. >> director: good afternoon. i am able to join and i appreciate passing the very resolution. so grant colfax director of health with director's report. there's a lot in the director's report this week, so just to

emphasize a couple of things. we're very pleased to see that the current administration reversed the public charge order that the prior administration had been implementing. the homeland security officially announced the reversal of the trump era public charge rule. public charge policies govern how use of public benefits impact individuals' immigration status and we are very concerned that the impact of the rule would have on particularly immigrants, but other underserved communities accessing. so we're very pleased to see this change. and, directly relevant to the resolution that you just passed, the san francisco department of public health, office of health equity

cohosted an anti-asian violence forum that was co-facilitated by dr. ianna bennett on march 24th. it was cosponsored by the office of health equity and the covid command center, equity and neighborhood sections, in collaboration with the joint information center. and the response was enthusiastic. nearly 500 staff registered for the forum and 300 participants attended. dr. richie rubio from behavioral health services led a session on recognizing the ongoing mental health needs of the asian p.i. community. so the forum that moved on to further discussions of facilitated by d.p.h. volunteers and covid command staff. so it was a productive forum. and, then, executive leadership in conjunction with partnering

with staff throughout sfdph had a number of discussions with regard to this issue including zuckerberg san francisco laguna hospital and support in solidarity and understand that discrimination will not be tolerated on our campuses or in any of our workplace environments. d.p.h. leaders also continue to meet with community based organizations and provide time to recognize the need for healing and availability of resources. so this resolution that you just passed is certainly in alignment with the current activity of the defendant and we will continue to reinforce and strengthen our work going forward in that regard. there's a lot in the director's report on vaccinations and covid-19. we will provide that with the update. i will give you a brief update

and i will and pickens will give more of an update on our vaccine status. i did want to point out a few other things in the director's report. including that the health department a mental health service act approved a new innovation project aims to improve overall wellness for black and american communities and this was our mental health service act proposal was proposed for new innovations to provide culturally congruent for black and afteran american. and this was a proposal that the state approved in the amount of $5.four million for five years and this was allowing our mental health service act team to better understand the needs of the community and incorporated their feedback through 19 community meetings for this innovative project and we can come back and report to the commission and more detail be

about what this project will do, but it's really focusing again on providing the culturally congruent and innovative practices for black african american communities and very much needed investment especially and including during this covid-19 pandemic. and then, i also wanted to highlight that the health department received three grants as part of the national initiative to end the h.i. vvmentd epidemic. we were awarded the three grants ending the h.i.v. epidemic federal funding program. and the goal of this program overall is to reduce the number of new h.i.v. infections in the united states by at least 90% by 2030. so this work will help us continue to focus on prevention and care that we know is necessary for san francisco to get to zero and this investment is going to help us very much

in terms of using the latest data, using innovative programs and most importantly collaborating with communities where h.i.v. risk continues to be high. and finally, i want to turn this over to dr. hally hammer who will be providing our acting behavioral health director marleau simmons with a public health hero award. marleau -- dr. simmons has been in the department for a number of years and has done an outstanding job and most recently as the commission knows as stepped up as acting behavioral health director has just been outstanding in that role during these unprecedented times where our ongoing behavioral health challenges were only reenforced with

regard to the intersection of behavioral health issues and covid-19. i want to thank marleau for her incredible leadership, her spirit, and her wisdom during her service and i do want to turn it over to dr. hammer who will say a few words. thank you dr. simmons and dr. hammer. please >> thank you very much dr. colfax. marleau, i'm going to ask you if we were in person, i would ask you to join me at the podium. but, instead, i'm going to ask you to turn your video on while we present to you the public health hero award. but first, i do want to say a couple words. marleau, you exemplify the best of public health improving the health and lives of san

franciscans. you have an incredible and unparalleled ability to prioritize the health needs of the people we serve and balance those needs with the work experience of the people who do this really hard work. system needs and really the needs of the city as a whole. so, personally, i will say to you marlo, if you're one of my 2020 silver linings, having the opportunity to work closely with you and support your good work was really a highlight of the last year for me. i appreciate all you've done for san franciscans, for our clients, for our behavioral health staff, and really for the city as a whole. so now i'll read the public health hero award. so marlo simmons is acting director of behavioral health services. you have led with grace with perseverance with a strategic vision which reflects the direction articulated by key

stakeholders. the behavioral health executive team and staff are always prioritizing the health needs of our clients. in recognition of your devoted service and commitment to the people of san francisco and the department of public health, you are presented a san francisco department of health public health hero award. >> thank you so much. really, really, it's an honor. i've seen a lot of really amazing people receive that acknowledgement over the years, so it's very humbling and i, hali, have to thank you so much. i would not have come through if it were not for the support you have given. i am very excited after hillary cubbens had joined us. it's just like the greatest thing that's ever happened. so i'm really excited to be part of the department and

thank you for the recognition. i really appreciate it. >> let's all give a round of applause for marlo. >> president bernal: congratulations. and very well deserved. thank you. thank you, marlo. thank you, dr. hammer. >> and, commissioners, i just also wanted to introduce you to two new additions to the health department. welcome additions. welcome leaders who come withoutstanding reputations and records. so luenna kim who is our new human resources director and comes back to the health department. we're just delighted to after a

national search. i know it's a priority for the commission and really pleased after michael brown spent over a year in the h.r. director and again, she will be in front of has moved from new york city where she was deputy health officer and including and especially overdose prevention and interventions. and, again, has been on the job for six days now is getting up to speed with the help of dr. simmons and so many others in the community, but i just

wanted to call your attention to those two new leaders joining the department. we're delighted to have them and i look forward to see whag they will do and how they will help improve public health in san francisco. that's my report. thank you. >> president bernal: and, director colfax, can we invite them both to turn on their cameras and say hello. >> director: of course. i think that they're here. so let's see. >> president bernal: don't mean to put anyone on the spot. >> hello, everyone. this is hillary kunens. a pleasure to be here and to work with the fantastic marlo simmons and hali hammer and of course, director colfax. so thanks for the welcome. >> president bernal: welcome. look forward to working with

you. >> hello, commissioners and dr. colfax. thank you so much for the warm welcome. i am really deeply honored to be back at d.p.h.. i've always been very committed to the mission of public health and i'm a child of immigrants who came to this country in the 60s and so i just appreciate all the work and i'm really looking forward very much to having an hr team that supports all the work that you do. so thank you so much for the welcome. >> president bernal: thank you. welcome. all right. thank you for that update, dr. colfax, director colfax. we will move on to the next item which is our covid-19 update. >> director: thank you, commissioners. grant colfax director of health. i'm going to give an update and

then, our executive sponsor for our vaccine across the city will provide a more in-depth perspective on how the vaccine roll-out is continuing. next slide, please. so we have over 35,000 cases of covid-19 diagnosed in san francisco. unfortunately, we've had 482 deaths. you can see the commence rate with our dramatic inlen kiese. both these numbers have levelled off and we expect with our vaccine rates increasing, that these numbers will hopefully not go up as we've seen in prior surges. that's still a plausible scenario, so i want to emphasize caution there. but, right now, we believe things are continuing to move in a hopeful direction. next slide. so this is our cases with

regard to the time from mid october to april 1st. and you can see we are having some trends after it being flat for much of march. you can see in the purple line here that our cases have gone up somewhat over the last ten days or so. they've actually increased about 20%. we're still obviously much lower than we were during our winter surge. in fact, our cases have decreased by the rate is tenfold. we have moved from the red tier into the orange tier. we are watching our case rates very carefully to determine if and when we move into the yellow tier. the earliest that would happen at this time is april 21st. but with more activity and more openings which result in more activity, we have seen a slight uptick, or a 20% uptick in cases over the past couple weeks.

unfortunately, we now know happens even with a relatively cautious and deliberate re-opening. next slide. so in terms of our positive cases, not a large change in shifts here overall. we continue to see a disproportionate impact on people of color including and especially among latinos representing 40.9% of cases. i will say that disparity is down from latinos accounting for over half of cases a number of months ago. our age distribution again, younger people tend to -- or are more commonly make up a larger proportion of covid-19 cases 16 and over.

despite the fact they make up a smaller number of cases. and then you see the sexual orientation and gender percentages here as well. next slide. our key health indicators, hospital capacity, and rate of increase in hospitalizations are in the green territory, very favorable. our case rate at 4.3 in the moderate alert zone. that had dropped down to a low of 3.3% into the low alert yellow zone now back up to 4.3%. our testing numbers rate with the rest of the country has decreased since november and december. we're still doing over 5,000 tests today. our contract tracing numbers are increasing as the team has a greater ability to reach all

cases. 88% and 85% and our ppe supply remains robust. next slide. hospitalizations, dramatic decrease in hospitalizations. yesterday, we hit a new low of 20 people in the hospital due to covid-nineteen and just three in the intensive care unit. this is actually the lowest number we've been able to track since last spring. during the very beginning of that spring surge, so a very positive. remember that hospitalizations lag cases by about two weeks, so we may see some increase in these numbers even with our relatively robust vaccine efforts. next slide. i'll just give a few general vaccine numbers and mr. pickens will go into more detail. i'm really pleased to say that

fifty% of san franciscans have received at least one vaccine dose at this time. 30% nearly 1/3 has completed a vaccine series. so this is great news. and you see on this chart here how rapidly our vaccine numbers have improved. i will say that right now, we are averaging about 12,000 vaccines a day going into arms. remember, we had set the goal of 10,000 a day initially. we now have capacity to do over 20,000 vaccines. so we are continuing to work to get more vaccine into the city. you can see our numbers are significantly better than in the u.s. or california overall. are 50% and 30% compared to about 42% and 24%. and, again, our rolling day average is approved even since

this slide was prepared last week. some other land marcs is that we have surpassed 200,000 vaccinations at moscone site. with that health network, we have surpassed 100,000 vaccines in getting those vaccines into arms and communities most affected by covid-19 and mr. pickens will provide more detail of that. i believe that's my last slide. i am happy to take questions or turn it over to mr. pickens for a deeper dive into the vaccine work. >> president bernal: before we go into commissioners' questions or comments on the director's report or update report, mark,

>> good evening commissioners. it's my pleasure to present this update on covid-19 vaccinations within san francisco. and i'll start by saying i am here representing a whole codre of workers, the department of public health, other city departments. many of our c.b.o.s and other health systems and clinics throughout the city. this is truly a collaborative

effort while d.p.h. is the main convener and organizer, we are not doing this work alone and it's truly a reflection of the partnership of all of san francisco that we've achieved the results that you heard a little bit about already and hopefully we'll be able to share with you throughout the rest of this presentation. so, next slide. so as we began our work on vaccine in late november and december, we felt it was very important that we be as transparent as possible with the public in terms of the available data that was available at the time that would be coming forward. so this is just a small snapshot of one of the pieces of public data that is available on our website that any member of the public may access at any time.

next slide. so you'll remember when we come to you in the past, you know, our goal from the very beginning is to make sure that we vaccinate 100% of the san francisco population. so we've set that goal at 900,000 individuals representing, of course, san francisco residents and then those that who are not residents, but spend a lot of time within the city. as you heard from dr. colfax, we just through the data run yesterday achieved having had 50% of our population of eligible individuals and, at this time, that is individuals over sixteen years of age who've received at least one dose of vaccine. so, again, this is a result of the herculean efforts of many

individuals, organizations, and communities across san francisco. in this slide, this gives you an indication of the number of vaccines that have been administered to date in san francisco. a little over 600,000. and, in terms of vaccines administered to san francisco residents, almost 400,zero residents have received one dose and of those almost 400,000, about 70,000 of those were administered by the department of public health through our network and our clinics at moscone. and, just to remember, the reason you see a difrnts between those numbers, vaccines administered in san francisco includes not only our residents, but also individuals who work in san francisco, for example, those who work in health care and who are some of the very first to be

vaccinated. next slide. so, again, in terms of what's been some of our progress to date, we are really having to report that we've made progress in the percentage of individuals who are 65 years and older who've completed vaccination. so we've got 82% of those 65 and older who've had at least one dose and 64% who have completed their series either having two doses or the one dose of j&j vaccines. next slide. so as you can imagine, as the department of public health, we made it very an intentional focus that equity be at the forefront of all of our activities as it relates to

vaccine. within d.p.h., the department of public health, we're committed to using our limited supply of vaccine that we received from the state really to focus on our most vulnerable communities knowing that most other san franciscans typically have health insurance and will be able to get their vaccine through their health care providers. this graphic gives you a sense of where within the city a vaccine has been administered on a neighborhood basis by the department of public health. again, just to show that the d.p.h., we are focusing on the most impacted and vulnerable communities. and the darker the blue this graph shows, the higher percentage of individuals in those areas who receive their vaccine from the department of

public health as opposed to another nond.p.h. provider. at the heart of our focus on equity, again, we've relied on our own health network having vaccine sites of many of our health network clinics, but also as important, we've partnered with a lot of community-based organizations to really get into the various neighborhoods and help us identify opportunities for vaccine roll-outs. next slide. so this is a slide that we've shared with you before and it really represents the one stop shop for looking at what we call our three-pronged approach for vaccination strategy across san francisco and going from left to right, we start with our high volume sites and these are the sites that received a lot of attention very early on in our vaccine efforts where we

partnered with major health systems within the city to form what we call the health system vaccine collaborative which is the partnership between the department of public health and the san francisco hospital counsel. and, with this partnership, you'll recall, we have three main sites. the site at city college where ucsf is the main provider and have included dignity health and other providers like one medical. then we've got moscone center side where kaiser has been the lead who's brought in inventicel. and our center pacific medical foundation is the lead agency. and, in addition, there's a federal large volume site over in oakland at the coliseum. so this represented a lot of

our early work, working with the health systems because again just to reiterate the way that the state set up the vaccine allocation process, most of the vaccine was and has gone to these large systems with only a smaller proportion of vaccine coming to local health jurisdictions like the san francisco department of public health. i really want to give a shout-out to the health systems who really stepped up and we have a lot of great success with our high volume sites and really the only limitation has just been the continued flow trickle of vaccines. but even despite that, we've had great success and i think our numbers and stats reflect that. as we move to the middle section, the light blue, this represents our community focus away from the high-volume

sites, but into more localized neighborhood sites and community sites. existing clinics around the city, both our own clinics, clinics that are part of the san francisco community consortium and others. and also some neighborhood sites, for example, the mission site at 24th and cap are run by ucsf. so, again, this represents the value of working with others to really have the greatest impact on vaccine roll-out across the city. another part of our community strategy is the use of mobile units. our mobile units, our teams, paramedics or e.m.t.s and other health professionals who will go out to various facilities

like homebound adults, people who are at home or some other behavioral health programs where they're not able to leave and actually provide in-home or on site vaccination services. and then finally, the third prong of our strategy was the collaboration with pharmacies both at the federal level with nursing facilities and now at the local level where vaccine is being made available to local pharmacies throughout neighborhoods. next slide. so as we begin to look forward to a time of peak vaccine distribution which we based upon our latest information think will occur around may and june, we are predicting that we'll continue to see about 70% of the vaccine in san francisco

would be administered out of our high volume sites. again, remember, those high volume sites are from our major health systems and they're the ones who are giving most of the vaccine. so we're looking forward to the collaboration through the hospital counsel and with the systems to keep those sites open so that we can have maximum penetration through those sites, but we also know that has we get more people vaccinated, it's going to become increasingly more challenging to make incremental improvements in overall vaccination rates and that's where we're going to really rely on our community strategy.

and you'll see where we expect to be at peak vaccine distribution, we expect to be able to be doing somewhere between 17,000 and 20,000 vaccines a day and you see an approximation of what the maximum volume is expected within the various sites. so about 12,000 a day at the high-volume sites going down to 500 a day through our mobile teams. and we're going to talk more about the mobile teams later on in the presentation. next slide. again, you know, we started this process back in december and january. really focusing on our high volume sites, getting them up and running because we knew that's where the biggest bang for the buck was both in terms of vaccine source going to those other health systems, but also throughput in the ability to get a lot of people through

a site at one time. but now, as vaccine is becoming a little more available and as we're maturing in our planning, we're moving more to our community vaccine strategy and within this strategy, our mantra is outreach, referral, and navigation and that there's no wrong door for access to vaccine and we know that's going to be critical again as we look into neighborhoods and areas that continued to have lower vaccination rates compared to the overall rates within the city. we know we'll be relying upon those community collaborations in order to get us over the top in terms of vaccine distribution. next slide. so in terms of our community vaccine access planning, you know, the principles that we're working under include equity,

again, we're looking at the data where we see gaps in equitable distribution of vaccine, working with community partners to help figure out what may be the causes of those gaps and then how we jointly come together to develop action plans in order to meet those gaps and get those vaccination rates up within those particular communities. next slide. so we want to share with you in the next few slides community action plans that we've developed for three of our communities where when we looked at the data, it showed that these communities were being underrepresented in terms of vaccine distribution and vaccine uptake rates when compared to other parts of the city. so chinatown is one example of

that. and just as you look at some of the data as of a few weeks ago in march, the chinatown vaccination rates for 65 and older were 67% compared to an overall city rate of 80% and for 75 years and older, chinatown rates were 42% compared to city rates of 72%. so when we looked at this data, it became clear we've got some deficits here and so we've began to implement our community action community strategy by doing targeted media events within the chinese media, working with c.b.o.s within the chinatown area to enlist their ideas, but also their support and also some of their staff to help really figure out how we can vaccinate greater proportion particularly the older residents in

chinatown. we've partnered with many chinatown providers. chinese hospital had been one of our first. we partnered with our own chinatown public health center, northeast medical service and some of the physician groups within chinatown and those that practice at chinese hospital. i want to thank you, dr. chow, for the connections and references you made to us. we followed up on all of those working with groups like c.c.d.c., chinatown korpgsz. nicos and others to really work with the community to help us figure out how we can better meet the needs to get vaccine out. we've done some special events. back on march 24th, rather april 2nd, we did an event at

the ping yuen senior development and we're able to manage there to provide vaccination on site for seniors who didn't feel comfortable leaving to another site for vaccination. next slide. similarly, we developed a community action plan for the tenderloin community. looking at that data as of march 25th in the tenderloin, 65-year-olds and older were at a 73% rate compared to overall 80% in the city and for 75 and older, they were slightly better. 70% compared to 72%. so we're using data to help drive our decision making and our planning and in collaboration. so similar to chinatown, we

worked with various c.b.o.s within the tenderloin. we worked with the board of supervisors staff to really identify key partnerships within the tenderloin and have held special events, for example, there was a community event at glide at the end of march and we've also had several events also currently planned for several shelter-in-place hotels and other supportive housing units within the tenderloin. so we'll be monitoring these rates and hopefully we'll be able to see some progress there. next slide. i want to return

next slide. so, again, focusing on our three-prong approach, high volume communities and quantities. just wanted to share some progress to date across these three strategies. so on yesterday as dr. colfax communicated, we reached 6% of san franciscans who received at least one dose of vaccine.

we reached on april 2nd our peak daily new dose administration of 13,000, almost 14,000 doses per day. we're now doing in san francisco well on our way to 20,000 a day once we have vaccine available. again, we're happy to report that 81% of san francisco residents sixty-five and older have received at least one dose of vaccine and 63% have complete the series. and also as dr. colfax mentioned, within our own san francisco health network, we just last week surpassed having done a 100,000 vaccines since the middle of december which is really when you think about it, 20% of all the vaccines that have been administered within san francisco have been done by

our own health network. and, also, other milestones both our southeast health center, part of our network and the 24th and capp clinic are run by ucsf each surpassed 10,000 vaccines each independently since they first started in january. and, we again mentioned our mobile teams. we've got four teams that are active and we have 19 mobile events planned as of april 4th. and some of those include -- and some of those that we've already done included those launch and glide that we talked about. this past weekend, there were activity -- there was vaccine

-- a vaccine clinic done at the lighthouse for the blind which represents part of our work with the disability community. again, knowing we needed to do something in addition to really provide access to that vulnerable community. and we've also sent our mobile team over to treasure island where they've worked with the fire department and have done vaccine clinics there. and, again, i mentioned we did the senior housing vaccine vaccine clinic at ping yuen center this weekend and there were 3,500 doses of johnson and johnson administered there. looking forward, we've got another event planned in chinatown at ping yuen and we've got four neighborhood sites that will be launching

across the city in terms of trying to increase our penetration within the communities. and those include excelsior at 20 norton on april 7th and then a second mission site on april 15th at 18th and shotwell. and then we've got two visitation valley sites planned to open on april 19th. 1099 sunnidale and 255 sunnydale. next slide. just as we started the presentation with data, i just want to share with you, these are three public tracker sites for our san francisco vaccine initiative. and so these are available on the website for any member of the public just to see what is the latest and greatest in terms of data related to vaccine roll-out in san

francisco. next slide. so, as i said it before, it's my privilege to really be the person here delivering this information, but i represent hundreds of other individuals across the department and the city and i really want to give a special shout-out to my partner in this effort dr. mary mercer who in her normal job is an emergency room physician at san francisco general, but for the last year has devoted her time to covid-19 and for the members of her team, dr. david spear. dr. liv quan and dr. jonathan spears and so many others who have just really come together to i think give us the success that we've seen so far in san francisco. we know that while we have good numbers, we know we still have

gaps in certain areas, certain communities and neighborhoods and so we're committed to working with our community partners can and look forward to when vaccine scarcity will no longer be. so i'll end it there and try to answer any questions you might have. >> president bernal: thank you, mr. pickens. before we go into commissioner comments and questions, mark, do we have any public comment? >> secretary: folks on the line if you'd like to make public comment on this item, press star 3. no hands up, commissioners. no public comment.

>> president bernal: okay. commissioners, any questions for mr. pickens. commissioner chow. >> commissioner chow: yes. i wanted to thank mr. pickens for such a comprehensive report on the vaccine and how the mobile teams are really working and particularly to thank you for the work that you're doing in chinatown also. so i just want to appreciate that the department is responding and that also now you're vaccinating within the s.r.o.s so i think you're going to see with the mobile teams and the ability to get into some of the housing a lot bet your uptick within all the communities. thanks. >> you're welcome. thank you, dr. chow. >> president bernal: thank you commissioner chow.

commissioner green. >> vice president green: i just want to thank everyone for this remarkable work. you know, as a practicioner who takes care of pregnant women, i have quite a few over 65 patients, i've gotten a lot of feedback from numerous patients who live throughout the city and have gone through virtually every vaccine site that you've got listed there and i have not heard a negative comment from anyone. in fact, i've heard multiple compliments and accommodations about how each one of these sites are run. it's frightening for people even to go to a site and i think it's just remarkable the leadership you've all shown and the quality of care that all san franciscans now have really relatively easy access to. i think the department has done a superlative job and i just can't say enough about this and

i think i speak for at least a few hundred people when i give you that feedback. >> president bernal: thank you, commissioner green. >> thank you very much. >> president bernal: commissioners, are there any other comments or questions? all right. mr. pickens, anything else you'd like to add? if not, we can move on to the next item. director colfax. >> director: i'd just like to thank mr. pickens for his effort. he runs the network in his normal job and it's been an incredible effort and to think about where we were in december with so many health systems and the city needing to come together and the fact we have far exceeded our goal of 10,000 vaccines a day capacity in san francisco.

we're already at 20,000. so i just thank mr. pickens and the team that he mentioned across the city that has made this a reality. now we just need the vaccines. so thank you. >> president bernal: thank you, director colfax and thank you again, mr. pickens, for that thorough presentation. i received my second vaccine dose yesterday after the city had expanded eligibility for people living with h.i.v. last month. i am experiencing a few small side effects like some fatigue and maybe feeling a little warm, but coupled with that i'm also experiencing gratitude for what this means not just for me but for my family and community and being able to get back to resuming normal life as we continue forward in doing i think really a phenomenal job in vaccinating the people of san francisco. so i'm going to ask vice

president green to take over this meeting and i'm going to sign off for the rest of the evening. thank you to d.p.h. staff, my fellow commissioners and members of the public who are watching and i'll see you all in two weeks. >> feel better. >> commissioner: feel better. >> commissioner green, would you like me to read out the items? >> vice president green: i think we're at general public comment. >> i will check. the folks on the line, please press star 3 if you'd like to make a general comment. star 3. no hands, commissioners. no public comment. >> vice president green: all right. well, then the next item on the agenda is the finance and planning committee update. >> thank you, commissioner green. the finance and planning

committee met right before the commission meetings and we had some pretty robust discussions about some of the contracts and as you see on the consent calendar quite a few of them are covid related and we are hoping that they will have a smooth pass through. so on the consent calendar, you will see like the contract report as well as -- i don't even remember how many contracts there are for your approval. >> secretary: i believe there's seven, commissioner. >> commissioner: thank you. and we also appreciate dr. ianna bennett to come to the committee to do the presentations about racial equity and i think that it was really informing and i think that she will be presenting to

the full commission soon. i'm done. >> secretary: so there we go. >> vice president green: so there's a series of action items we have on the consent calendar. is there any public comment on this item at this point? >> secretary: i will ask. thank you, commissioner. any public comment on item 8 press star 3 please. no public comment. >> vice president green: all right. any commissioner comments or questions on the consent calendar for action items? >> secretary: i don't see any, commissioner. >> vice president green: all right. i guess we should vote on all of these as a bulk. >> secretary: yeah.

we do need a motion and a second. >> vice president green: yes. is there a motion to approve the items on the consent calendar? >> commissioner: i move that we approve the items on the consent calendar. >> commissioner: i'll second. >> vice president green: roll call vote then. >> secretary: [roll call] >> vice president green: thank you. and thank you for this hard work. i know this is a very detailed meeting you had and a lot of items on the calendar. so thank you to the committee members and the presenters for going through all of this and answering our questions. next item is the charity care report. >> secretary: i will give you permission. i'm sorry. i'm late on that. give me 10 seconds to give you that. >> great. thank you, mark. and i'm just checking, can you hear me? >> secretary: sounds good i see you and hear you.

>> wonderful. i'm going to share my screen and full size the presentation. >> secretary: looks good. >> great. thank you, mark. good evening, commissioners. my name is max cara and i'm the program manager with the office of policy and planning. today i'll be presenting the final 2018-2019 charity care report. i'd like to thank members of the committee for their feedback as well as other commissioners who had questions and comments on the report. i shared responses with mark to those questions, but i'm happy to walk through those responses if desired at the end of the presentation. i also want to mention i'm joined today by several hospital representatives who participated in the charity work group and available to answer questions about trends for their hospitals if needed.

so for this presentation, i'll provide background on the charity care landscape. and then i'll go into the annual report and provide information on citywide and hospital trends. this is normally is compiled and presented on an annual basis, but due to delays from covid, this year combines two years worth of data. so the charity care ordinance in san francisco was passed by the board of supervisors in 2001. and, at the time, this law was the first of its kind in the nation. the ordinance has helped to increase transparency and accountability around charity care to report charity care data to the department of public health annually and notify patients of free and discounted services. there are eight reporting hospitals that report their data to d.p.h. annually. these include dignity st. mary's and st. francis

hospitals. chinese hospital. cpmc and mission hospital. these are kaiser, san francisco, ucsf and zuckerberg san francisco general. so with these eight hospitals together, d.p.h. is more able to accurately capture citywide trends. with regards to the notification requirements, every other year d.p.h. staff visit each hospital to conduct a review of the facilities compliance with the requirements. the next onsite review was to take place in 2020, but to reduce risks associated with covid, the review was conducted electronically. all were found to be compliant. so before i dive into the report, i wanted to highlight some of the events that have occurred since the passage of the ordinance that have impacted charities in san francisco. in 2011, the healthy san francisco program was started. this is the city's health

access program that provided uninsured residents access. in 2010, the affordable care act was passed. in 2014, u.c.a. implementation began, and, since then, we have observed an increase through the medical expansion and through covered california. this has been highlighted in previous reports. from 2017 to 2020, there have been continuous reports at the federal level to undermine access. these actions have included the repeal of the individual mandate along with public charge rules. the report presented today covers data from this time period. i'll talk more about the changes on the horizon. but starting in 2020, there have been significant events that are likely to impact the charity care landscape. so moving on to the report itself, the report provides a

high-level overview of charity here in our city and also show cases how transact differently. data is presented on both healthy san francisco and traditional charity care patients. for the report, representatives from each of the eight hospitals are engaged to discuss the draft we're engaged to discuss the draft prior to presenting to the health commission. and, as i mentioned at the start of the presentation, this report combines two years worth of new data. and lastly, for the first time, three years of health coverage and demographic data was collected for traditional charity care patients in order to better understand this population. so this slide highlights the three major citywide key findings that we found based on the analysis of data and i'll go through each of these in subsequent slides. first, the report observed a rise in charity care for the first time since the

implementation of the a.c.a. second, we continued to see distinctions between health san francisco and charity case populations. and, lastly, using new data, the report provides a better understanding of who traditional charity care is serving. so as i just mentioned for the first time since the a.c.a. implementation, there was an increase in charity care patients. the figure on the left shows a number of patients in charity care. over the previous two years, there has been an increase in patients by about 51%. the second figure on the right provides an overview of charity care utilizization.

as the different medi-cal services and the reimbursement received for those services, hospitals will typically absorb these costs. between 2017 and 2019, charity care expenditures increased by 30%. and the increases in medi-cal despite modest decline in medi-cal across the city. health care costs are increasing faster than the previous program. so when we dive deeper into the data for healthy san francisco in compareson to charity care, there are several differences to note. this data supports the contention that healthy san francisco patients have greater access to primary, preventive care services. second, we see that the

observed increases in charity care patients was driven largely by or almost all by traditional charity care patients. during this time, the number of charity care patients remained relatively stable. this suggests there are populations that continue to rely on san francisco for access to health care and for a.c.a. initiated health coverage. so based on an analysis of the data and the report and discussions with san francisco hospital representatives, multiple factors were identified that could be contributing to the increases in charity care observed in san francisco. i do want to note we have limited local data to pinpoint the exact impacts for these factors. first, hospitals are reported as increased overall levels of service in san francisco they have increases in the amount of health care services provided,

the price of health care has also increased. over the past two years, health care prices have increased by about 7%. another potential factor is that hospitals have reported that patients are remaining in acute care beds for longer periods of time. becoming increasingly difficult to obtain. the entire charity care expenditures. lastly, the largest provider of charity care in the city amended its charity care program in 2019. few changes expanded patient eligibility likely increasing the number of patients receiving charity care. so the next section describes who is receiving charity care, receiving traditional charity care. the graph on the left shows reported residents otraditional

charity care. the majority, the data also show that a large number of patients are homeless or have unknown addresses. the figure on the right is a map of charity care patients by supervisorial and in followling with years past, we see that a large number of patients are from districts with lower numbers of incomes. these neighborhoods also have some of the highest preventable emergency room visit rates. so as i noted earlier, new health coverage and demographic data was collected for the first time. almost all hospitals submitted data for their patients. the figure on the left shows the racial ethnic breakdown on the patients. the patients are more likely to

be hispanic latinx or black african american. when examined by coverage type as shown on the figure on the right, we show about 32% were uninsured and 68% have some form of medical coverage this data supports that many of the people receiving charity care are those who have coverage but unable to afford health care expenses. most of these newly collected data. over the past two years, we saw increases in charity care provided to those with medicare. and so stepping back and looking at this new data in tandem with the data that's traditionally collected, we see though these receiving traditional care are also those likely to be experiencing some of the most significant health

inequities and those who have higher needs and people experiencing homelessness and people in the lower socio-economic status. i'm now focused on the hospital-specific data. there are a number of factors that impact charity care patients. personal preferences among others. despite these factors, most hospitals paralleled city wide trends with regards to patients served. for example, as we see in this figure on the right, seven out of the eight reporting hospitals experienced an increase in the number of charity care patients between 2017 and 2019. overall, s.f.g. as the county's

safety net hospital continues to provide a large majority of charity care in the city and county. and about 61% of patients served. so, in this slide, the table shows each hospital's ratio of charity care cost to nit patient revenue and compares them to the state average. the ratio is a useful method for charity care contribution. overall, the ratios for all but one hospital are higher than the state average. csfg which is the largest provider of charity care has the highest rate at 9%. so, moving forward, there are state and federal policy changes along with global events that will influence charity care. the on set of the covid-19 pandemic and its intended economic health affects will

likely effect charity care. in january of 2021, a new federal administration assumed office and based on president biden's platform, restoring, strengthening, and expanding the systems in place will be a major priority. looming over this agenda is the uncertainty of the a.c.a. and whether the supreme court upholds, overturns the law which would have serious consequences for peoples' access to care. san francisco's charity care ordinance has enabled the collection of a long history of data since 2001. the continued collection of this data along with new demographic information will help to provide insight into the impacts of these ongoing and potential future changes. so this concludes my presentation. i'd like to acknowledge our hospital partners who have participated in the work group and thank them for their continued support. i'd also like to thank you them

for providing this new demographic data to help us better understand who our charity care programs are serving. and i'm now available for any questions and, as a reminder, all four representatives are available to answer specific data questions about their charity care programs. >> vice president green: thank you. is there any public comment on this item, mark? >> folks on the line, please press star 3 if you'd like to make public comment on the charity care report which is item 9. star 3. no hands up, commissioners. no public comment requests. >> vice president green: thank you so much, mr. gara and your team. that extensive report was well-detailed and i know how much work went into it and also we want to acknowledge your hospital partners who have not only done a superb job in caring for all residents in san francisco, but also have added this very important demographic data which i think will help as we move forward with equity

efforts. so we're very grateful to all of you for this work and each time you present the report gives us more depth and more understanding. so we're very appreciative. are there any questions or comments from the commissioners? commissioner chow. >> commissioner chow: yes. i want to echo your thanks to both the departments for continuing the report and to our hospital partners. the report of course began with a different perspective many years ago, but i think that the wisdom of actually continuing the report in government started collecting data is the fact that we can here in our own city see what benefits we have from all of our hospitals

and be able to acknowledge that and while it sort of began with an issue of whether or not non-profit hospitals are actually of value to their city, this, of course, shows the tremendous value that the hospital community is giving us. so not only the partnership there with covid administration of our vaccines which we just heard this afternoon, but also in providing basic care. it also helps highlight the amount of work also that our own county does in order to provide those services. and i must say one of the things that is interest i think right now is that we're able to follow a trend that show that with the a.c.a., some of this went down, but now with

insurance also becoming less affordable with a lot of deductibles or coinsurance, we're beginning to see even under medicare that this is now requiring that our hospital partners and our hospital itself needs to accommodate that under a charity type of situation. so it's not only whether medi-cal and medicare itself pay, but now we've got the problem of individuals in all insured categories trying to make due with the coinsurance. it will be interesting also in the coming year to see how covid may have affected this even though numbers of cases into hospitals have declined whether or not with the loss of employment and all while there was some uptick in medi-cal how

many were uninsured that really had to rely upon hospitals and whether emergency room services for the most vulnerable people, i should say, for those who did not have insurance actually be go up. so i think i want to commend the department for continuing the report and for all of our hospital partners who i hope they will continue to find value in this because i would think that this also helps to inform the work that they are going within their own hospitals so thank you. >> vice president green: thank you for those comments, commissioner chow. and thank you, mr. gara, for answering the questions we submitted in advance in such detail. are there any other commissioner comments or questions? commissioner giraudo.

>> commissioner giraudo: i also want to thank you for your excellent and detailed answers to the questions that i raised. i just have a couple of more questions for you. when you are reviewing the applications that charity care application, i am hoping and assuming that you're also very conscious of the reading level. i know in the past, again, in the past, i haven't seen the most recent c.p.m.c. application, but for the families that i have worked with, it was complex and the reading level was difficult. and so just as you are reviewing all the hospitals' applications, i just would suggest that the reading level

be in all languages, you know, looked at. my second comment in your excellent answers, again, is that d.p.h. also verifies that hospital admissions staff at each hospital campus provides patients with verbal notifications of the hospital policy describing charity care. my concern in this process is that when one is filling out information for admission to the hospital, one is not really necessarily in thinking about a charity care application especially if someone is verbally giving that information and whether or not there might be another modality of alerting patients at some

point in time, but i think when people are admitting, are signing papers to admit to the hospital is not necessarily the most emotionally stable time to consider whether or not charity care is something that they need. so it's just a thought and whether or not there's a card or something that can be given to patients rather than something on a verbal basis. just a couple of comments that i do want to thank you for the answers ahead of time. >> vice president green: and thank you for bringing that up, commissioner giraudo. i think it's a really important point about patients and making sure they're informed that this is an option for some. are there any other commissioner questions or comments? i'm not seeing any. are you seeing any, mark?

>> i do not see any, commissioner. >> vice president green: well, thank you very much. i guess we'll go to our next agenda item which is the second quarter financial report. >> and we have given you permission to share your screen. >> thanks. there's a slight delay and i'm just pulling it up now. >> any trouble, i have it as a backup on my computer. >> okay. i think it's -- i think we're good and live right now.

>> so evening commissioners. i'm happy to present the first quarter financials. how it that? >> much better. >> all right. i am pleased to present our second quarter financials. these represent our initial projections based on the actual significant changes over the course of the fiscal year this represents our best expectation of what we believe at the six

month report. and then, as a reminder, the budget and projection of the new covid project that was managed are not but we do discuss them at the end of this presentation and so taking them out of these financials just for clarity so you get a real sense of what our operation looks like. so fiscally we're looking pretty much balanced here with overall an operating surplus of

revenue of $7.5 million as well as a slight projected savings and expenditures of $1.4 million and operation of almost $9 million. in addition to that, as we discussed in our summary budget presentation, we had $51.7 million related to the relief of reserve due to the delay in the reduction to the disproportionate share to hospital reductions that we were expecting congress to implement in december. congress did act at the 11th hour and delayed those cuts for three years and so we are recognizing that additional good news in our financial and so overall, d.p.h. is projected to have a total surplus of

$60.6 million at our six-month board. there is one change in the reporting that i want to talk to the commissioners about because this is different from what i had said in our first quarter financial where i said all of our covid cost would be projected within the covid project, there are existing costs of operating staff that was pre-existing prior to the covid response that we had, but for accounting purposes, we now are reflecting under the public health administration division which actually has a covid project. what this does is it allows us to track the level of operating support that we're putting towards the response that could serve as a potential match for eligible services and this supports some of the reporting

we expect we'll need to do to differentiate new cost versus existing cost as of fema and other federal sources and state sources roll out reporting guidelines of potential reimbursements we have. overall, the reassignments are consistent with the 20-2021 budget with an existing division. for instance, if there was someone deployed at usfg and perhaps not working directly within vsfg operations but focuseded on an area specifically covid, it allows us not to overstate any of our cost within those existing divisions. and so, what happens is the end result of this, because we do have a significant network of people deployed, what we do

show in our financials, is a negative in the salary in spending because we've quote unquote overspent in salary and savings because we're charging existing people from other divisions into the public health administration, but then what you will see in all the other divisions is positive variances within our salaries to reflect that reassignment of cost from all these divisions down below up here. and, right now, our projected salary budget is fairly consistent with prior years at this point and we're right along the positive side of being balanced. these projections will vary over the course of the year and depend on the actual level of deployments and there's also significant reconciliation process as we prepare cost reports. so between changes in

deployments and reconciliation, these numbers may vary in subsequent reports. so just going on within specific divisions, you know, the public health administration division includes positive revenue variances of miner improvements in medi-cal administrative activities, the tcm activity as well as the $600,600,000 benefit that we received. there's positive favorable revenue of $9.1 million and then with and the salary savings of $2.8 million wells some overspending of contracts,

$5 million and a miner negative variant in materials and supplies. as i mentioned earlier, in addition to these variances, we will also be reflecting $51.7 million of surplus revenue outside of our regular operation. there was a delay of the district action the laguna primary care, the only variances that we're really seeing at this point are really related to the reassignment of deployment of staff of put to the covid projects. that's $3.5 million and $32 million at primary care doctors. behavioral health, there's some improvement as well as a

$20.9 million relief of reserve that we're recognizing due to the prior reconciliation process that the state has been accelerating over the last few years. so this represents a positive revenue balance there and, in addition, there's $13 million due to reassignment of cost, the covid project and the public health administration division. with general health services, there's minimal variances of, again, positive variants in salary and fringe benefits and nothing significant to report at the health and home division. and then, within the health network, you've seen this before where we've seen, we've had below budget revenues related to healthy san francisco and patient employer fees as well as an assumption of city option fund disbursements that were $6.6 million was in our operating budget and there was

an additional revenue that was expected to cover some of the covid sick pay programs. we are still working with the city attorney and the health plan should determine the best way forward in terms of recognizing how we can actually recognize the disbursements of these revenues and so until that legal issue is resolved, we are not going to assume the disbursement at this time. and then, again, same thing on the expenditure side salary and fringe benefits to the public health administration division. within public health, we have some miner revenue loss due to patient revenue loss due to delay in implementing modules at the clinics due to the covid response as well as unseen

potential losses due to reduce activity within environmental health. and then, again, $9.7 million of positive variances within the salary budget, again, being reassigned to the operating covid project. so the balance -- our projected balance is assumed as part of the controller's six months and the mayor's office is using that to offset the financial year. and release the $5.7 million of the reserve. and our current balance is $59.5 million at this time. and then, switching to the covid project that is run citywide and, again, these figures are not represented in the figures that i discussed earlier, but these are

considered a separate project that is managed citywide. this is a pretty complicated table that we have here, but what you see are sort of the major branches within our covid response and then we see what was sort of the original revised budget that we assumed and then an updated projection of costs and so what you'll see is that there's a positive what is actually a negative variant in the expenditures where initially the response would cost $61.7 million but it's increased to $725 million in these areas above most of this is related to the extension of the sip hotels and not sort of stepping them down over the course of a year as originally planned, but continuing them,

as well as continuing the feeding program that is managed by the human services agency. so negative variants of expenditures is offset by increased positive news related to fema and as well an additional revenue special grants and other departments, but this increase in fema is really related to the announcement by the biden administration that would retroactively increase the reimbursement of fema eligible costs of what was expected to be 75% of eligible cost to 100% and it was retroactive which resulted in a positive increase in expected revenue for the city. so when we take into account what is a negative expenditure of and then the positive good

news for fema and other areas, basically what we see is that there's $77.3 million in a positive variant within the city wide covid project that the mayor's office and controller's office will use to apply towards future covid response needs either this year or next year. specific variances related that we saw was really around the revenue side and then the i sort of mentioned this already of the biden administration's order to reimburse fema 75% of the cost and the increased rate that was retroactive to january 2020 and is currently expected to go through september 2021. a portion of the revenue is

also reserved for disallowances. specifically within the d.p.h. branches, some of the variances that we also see is related to vaccinations where we've currently have a projective $6.6 million in the current year and these are the six month financials which we developed probably in early february and so we will be working to revise this projection over the next few months. p.p.e. given the significant acquisitions we've received in the higher fiscal year as well as fema reimbursement, the revised budget is expected to be underspent by $37.4 million and offset some of the expenditures in other areas. within d.p.h. branches, we also were projecting significant winter surge costs related to

the hotels and hospitals. then, we will also revisit these projections in the nine months as we sort of look at where the level of case load is in a hospital capacity moving forward. so that was kind of a lot of information in a short amount of time and i am happy to answer any questions that you may have. >> vice president green: thank you so much unexpected. is there any public comment, mark. >> not on the line, commissioner. so there's no public comment. >> vice president green: okay. any comments or questions from the commissioners. i see commissioner chow has his hand up. >> commissioner chow: i was just going to ask because the

primary care numbers went down so much that they were put into the administration of covid, what has happened to the primary care surfaces? >> so i'm not sure if dr. hammer is still on the line, but there was -- we were running a fairly reduced operation as i understood on the primary care side as a result of the deployments of primary care staff to the covid response, but i know that it's something that we're looking to continue to expand back up to normal levels as we move forward with re-opening the city. >> yeah. this is hali hammer. jenn's right. we did scale back our primary care operation really significantly in order to free up staff who could be deployed

to the new covid related clinical services for which primary care clinical staff are best suited to staff those like testing, vaccination, others. and, also, we scaled back because during the early months of shelter-in-place, we were able to as we reported before, we were able to shift a lot of our in-person services over to telehealth and our ancillary services, we scaled back really tremendously. so very few nutrition visits, pharmacists, our dental services were scaled way back. so that's why i think you see that really significant positive variance for primary care because so much of our staff and we had our podiatrists doing covid tests in the alternate testing sites.

so so much of our primary care clinical staffed were deployed to the command center and to covid clinical services. >> commissioner chow: thank you. very much. are they back up to nearly the -- what level do you think we're back up to now? >> we are scaling back up slowly. it's been challenging because of the need to keep a number of staff deployed especially for, again, testing and vaccination in primary care. we are also continuing to offer a lot of our services over telehealth because of our patient preference and because with social distancing, it's still the safest way to see people when we don't need to do

an in-person visit. i would estimate that we're back up to about -- it's a little hard to know how to measure it because our ancillary services are still scaled pretty far back, but i would say we're probably at about 70%, but closer to 90% just for the primary care provider visits. >> commissioner chow: very good. thank you. >> vice president green: any other commissioner questions or comments? thank you so much, dr. hammer for elaborating on that. that's really very helpful. and no other comments or questions. we'll go to other business. is there any -- do the commissioners have any other business? anything? no. >> looks like [inaudible] >> vice president green: and public comment. >> there's no one on the line still, so there's no public

comment. thanks for asking. >> vice president green: well, we will go to the joint commerce committee as the committee reports. >> i believe dr. chow was going to give the update. >> vice president green: yes. >> commissioner chow: this is the joint conference committee at zuckerberg general. on march 23rd, the committee reviewed the informative presentations of the true north score card and the update and equality core measures update. both are very good providing information regarding the mentions that the hospital is tracking and the associated reimbursement. very nicely done. we also heard from dr. sue carlyell who is the dean of the school of medicine that gave a presentation of the ucsf affiliation agreement. i think, mark, that would be good to distribute that to the commissioners so they can

continue to be updated on the very important affiliation agreement we have with ucsf. >> yes, sir. >> commissioner chow: the committee also did review standard reports including the regulatory fairs report. we're still expecting the joint commission to attend. those of us on the committee are getting daily notes that they have not come yet, but they're expected really any day to do their survey for us, for accreditation. so it's been long overdue and they have said they were coming, so we're still expecting that sometime perhaps before even our next meeting. we also received a human resources report. a good report of good hiring going on and the h.r. department's really doing a great job for not just nurses,

but all our other staff that we need. the medical staff report, we approved the anatomic pathology rules and regulations. the opt apology rules and regulations and standardized and physician assistance in the rate treatment center in child adolescence support advocacy and resource center. and we concluded the report. and the report minutes. i think that concludes our report to you and i'll be happy to answer any questions if any of our colleagues want to add to the report. >> vice president green: are there any questions or comments from the other commissioners? do we ask for public comment as well, mark. >> yes. thank you. there is still no one on the line. >> vice president green: . great, thank you, commissioner

chow, for that thorough report. it really was an excellent meeting. so a lot of progress despite all the covid issues we've had. so thank you so much. the next item i guess is adjournment. so is there a motion to adjourn the meeting. >> commissioner: motion to adjourn. >> vice president green: is there a second? >> commissioner: second. >> vice president green: do a roll call vote. >> [roll call] >> vice president green: thank you all for all of the information you presented and for a very good meeting and we'll see you again in a few weeks. >> and thanks for stepping in, commissioner. >> vice president green: you always give me great guidance. i'm never scared. >> all right. have a good night everyone.

[♪♪♪] [♪♪♪] >> so i grew up in cambridge, massachusetts and i was very fortunate to meet my future wife, now my wife while we were both attending graduate school at m.i.t., studying urban planning. so this is her hometown. so, we fell in love and moved to her city. [♪♪♪] [♪♪♪]

>> i was introduced to this part of town while working on a campaign for gavin, who is running for mayor. i was one of the organizers out here and i met the people and i fell in love with them in the neighborhood. so it also was a place in the city that at the time that i could afford to buy a home and i wanted to own my own home. this is where we laid down our roots like many people in this neighborhood and we started our family and this is where we are going to be. i mean we are the part of san francisco. it's the two neighborhoods with the most children under the age of 18. everybody likes to talk about how san francisco is not family-friendly, there are not a lot of children and families. we have predominately single family homes. as i said, people move here to buy their first home, maybe with multiple family members or multiple families in the same home and they laid down their

roots. [♪♪♪] >> it's different because again, we have little small storefronts. we don't have light industrial space or space where you can build high-rises or large office buildings. so the tech boom will never hit our neighborhood in that way when it comes to jobs. >> turkey, cheddar, avocado, lettuce and mayo, and little bit of mustard. that's my usual. >> mike is the owner, born and bred in the neighborhood. he worked in the drugstore forever. he saved his money and opened up his own spot. we're always going to support home grown businesses and he

spent generations living in this part of town, focusing on the family, and the vibe is great and people feel at home. it's like a little community gathering spot. >> this is the part of the city with a small town feel. a lot of mom and pop businesses, a lot of family run businesses. there is a conversation on whether starbucks would come in. i think there are some people that would embrace that. i think there are others that would prefer that not to be. i think we moved beyond that conversation. i think where we are now, we really want to enhance and embrace and encourage the businesses and small businesses that we have here. in fact, it's more of a mom and pop style business. i think at the end of the day, what we're really trying to do is encourage and embrace the

diversity and enhance that diversity of businesses we already have. we're the only supervisor in the city that has a permanent district office. a lot of folks use cafes or use offices or different places, but i want out and was able to raise money and open up a spot that we could pay for. i'm very fortunate to have that. >> hi, good to see you. just wanted to say hi, hi to the owner, see how he's doing. everything okay? >> yeah. >> good. >> we spend the entire day in the district so we can talk to constituents and talk to small businesses. we put money in the budget so you guys could be out here. this is like a commercial corridor, so they focus on

cleaning the streets and it made a significant impact as you can see. what an improvement it has made to have you guys out here. >> for sure. >> we have a significantly diverse neighborhood and population. so i think that's the richness of the mission and it always has been. it's what made me fall in love with this neighborhood and why i love it so much. >> hello everyone. i'm san francisco mayor london breed and i'm really happy to

join you all today. can we believe that it's been over a year now since we've been living in the new world of the covid-19 pandemic. and i know that i'm smiling right now and it has everything to do with the fact that all of what we've done and everything that we've talked about in the past in terms of where we need to get to, we're finally getting there. and so today, as a result of the work from our governor and the state, today is the first official day for those who are over the age of 50 can actually get the vaccine. we've announced before, people over the age of 65, emergency workers, restaurant workers, public safety personnel, essential workers, grocery store clerks, muni drivers and

others are still eligible. but we are now adding an additional group to the eligibility pool. here in san francisco, our efforts have been really incredible and dr. colfax will talk a little bit more about that. but at least 45% of san franciscans have received their first dose. and over 62% of those over the age of 65 have received their second dose as well, they're fully vaccinated. this is higher than the national and state average. san francisco is doing an incredible job with vaccinating people and some of you probably have seen some of the reports that suggest san franciscans in general are those who most likely want the vaccine. that's why our efforts have been so successful.

and, yes, we know it's been challenging with certain communities and we knew that if we didn't embed equity in our outreach efforts to address this pandemic from day one with testing and resources, but also with the vaccine, then we wouldn't be where we are today. this is why in neighborhoods like the bayviewpoint and other places where we are seeing high rates of infection. this is why we have set up pop-up and mobile sites and locations in those neighborhoods and have made it easy for people to access vaccines without an appointment because we knew that was going to be critical to getting those who are a little hesitant about getting the vaccine. it would prevent them from doing it. we knew that especially many of our seniors didn't have access to the internet and may not

understand how to use a computer and it was important to make it easy for them to access the vaccine. and our partnership with people like annie chung who you will hear from in a moment with the seniors, the large senior population we have in chinatown and the work she's done and the outreach she has made to reach those seniors. meeting people where they are and putting equity at the forefront of everything we do is why san francisco has been a leader, not just in the number of case rates and the number of deaths in our very dense city, but a leader on rolling out the vaccine and getting people back to the lives that we know and love. but we're still not there. we expect by this weekend we'll be at 50% of san franciscans

vaccinated. and, by mid may, we expect to be at 80%. so we're moving right along, but we also have to remind ourselves that this is not over. we are still in a pandemic. we still need to be cautious around others, wearing our mask, socially distanced and following the health guidelines in a way that's going to keep us safe and keep our numbers down. we have about twenty people in the hospital right now. one of the lowest numbers we've experienced since this pandemic. we should be proud of what we've been able to accomplish in this city and i can't wait until we're at that point where we are able to socialize without masks. where we are able to go back to events. and that time is coming sooner

rather than later. next friday is opening day. the san francisco giants opening day. and although they are limited in the number of people that they will be able to allow in the ball park, they work with our department of public health to come up with a plan to keep people who are in the ball park safe as they buy concessions and go to the restrooms and interact with one another. they're limiting the number of people who can come to the ball park. you have to have proof of a vaccination or proof that you've been tested within a certain time period, but you know what, that's better than not having opening day allow fans at all. so there will be fans, there will be games. we will see this city start to come alive again one day at a time on this beautiful sunny day where the temperature is expected to be over 82 degrees. let's not get too comfortable

because i know most of us are going to want to go hang out in our parks and enjoy the outdoors on this beautiful day in san francisco, but we still need to be mindful. we're still in the pandemic, and if we want more days like this, if we want more opportunities to open more things in our city, it still requires each and every one of us to do our part. now this sunday is easter sunday. and, i don't know about you, but easter is one of my favorite holidays because what it means is that spring is here. and, when i was growing up, we got to wear our hats and new dresses and that's when we got our new outfits. it was always easter sunday. i look forward to coming together with my family and my community. and this year is going to be a little bit different. so i want to ask you all to be very careful. i know that a lot of you may want to have events and gatherings and so one of the things that dr. colfax will

talk about or the guidelines in what we suggest you to do in order to safely gather with friends and family because we don't want you to do what you might of typically done. we want you to do what's safe to do so that we can continue to get out of this pandemic. with that, i want to introduce dr. grant colfax. >> thank you. hi everybody. and thank you, mayor breed for your ongoing leadership in this unprecedented time. i'm delighted today that we're able to make vaccines available for all san franciscans ages 50 and over. with this expansion and eligibility, thousands of san

franciscans will be able to get protection from covid, begin to safely interact with vaccinated loved ones, contribute to our collective effort to vaccinate the entire city, to achieve herd immunity, and allow us to more safely open our economy. this expansion and eligibility comes as we are very close to reaching the milestone of 50% of our adult population having received at least one dose of the vaccine. and, for our residents 65 and over who we know are most at risk for complications, hospitalizations and dying from covid-19, an impressive 82% have received at least one dose and 62% are now fully vaccinated. as a city overall, we are doing much better at slowing the spread of this virus. at the peak of our surge,

earlier this year, we were averaging 370 new cases a day. as of last week, that number was down to 33. so i am optimistic for our future, but we also still need to be realistic about where things stand today. by no means are we out of the woods yet and cases in san francisco have slowly started to climb again. now we're still at a low rate, but just in the last week, we've seen an increase of 20% in our case rate. this is not unexpected. we know as cities re-open including in san francisco, cases gradually go up. the virus is again spreading, so we must be vigilant in wearing masks, social distancing, and following the precautions that we know slows the spread. after all, together we have

beaten back three surges. and i know we do not want to see a significant fourth surge here. we are seeing alarming conditions in other parts of the country. as you know, the cdc director and other health care experts are worried. that is why it's so important for us to fully immunize our city. until we reach that all-important herd immunity, the virus will always have the possibility of surging again. and, of course, variants remain a concern. they are here in the bay area and we must remain vigilant. and though the state's expanded eligibility comes as welcome news and i'm grateful for this, we still don't have enough vaccine supply. our ability to serve all those who are eligible depends on that supply and we don't have enough supply yet. so we are ready to go when

those vaccines come. we have the infrastructure in place to vaccinate at least 20,000 san franciscans a day. we are ready to get those vaccine into arms, we just don't have the vaccine. and, if we have sufficient supply to achieve our capacity, we could have over 80% of adults vaccinated with first doses by mid may. now, although the state does now currently allow for fully vaccinated individuals to interact indoors with fully vaccinated people from other households without masks, the san francisco health department agrees with the cdc around small private indoor social gatherings. once the state allows us, and we're hopeful the state will follow the cdc guidelines very soon because they are based in science and evidence and give people fully vaccinated a

chance to engage with others in a way we haven't been able to do so for over a year, we will loosen restrictions so that vaccinated individuals can safely interact indoors and small gatherings unmasked with other household members that are also fully vaccinate or otherwise low risk single households. this is yet another reason to get vaccinated. i have to also include a reminder in this, that even if you get vaccinated and are fully vaccinated, if you get symptoms or are exposed to somebody with covid-19, please get tested. testing remains a key cornerstone to our ability to slow the spread of the virus. these vaccines are excellent and safe, but they aren't perfect. as we expand eligibility to more san franciscans, our admission is to bring vaccines to those communities most impacted by covid-19. and, therefore, we will

continue to prioritize equitable distribution throughout the city. one great example of how we can do this is through our mobile vaccination teams and tomorrow alone, we will be conducting vaccinations at the white house for the blind and at ping u.n. housing site in chinatown. still using our shelter-in-place in town. today i was at next door shelter where i have a clinic and it was amazing to be able to take patients i was see right over to the mobile vaccine team getting vaccine to arms in realtime. as we gradually move forward in the opening of our city, we will do so carefully. we will make sure that as we loosen restrictions to support businesses, bring back jobs, and restore the vibrancy of the

city. we are on the right path, we are making great progress. thank you. keep the mask on. stay strong. get vaccinated when you're eligible and it's your turn and let's hope that vaccine supply to improve. thank you. >> thank you, dr. colfax. and now i want to introduce annie chung with self-help for the elderly. thank you so much for being here today. >> good morning everyone. thank you, mayor breed. and dr. grant colfax. may i thank you really the department of public health and all your teams that are working on the covid response. we feel really proud to be a community partner because every time when our community is facing challenges whether it's with testing or with the

vaccines rolled out, we always feel there's someone at d.p.h. that we can go to and express our concerns and very quickly, i think mayor breed and her team have responded, you know, to our community needs. for example, back in january and february when we found that vaccines are beginning to be available, none of our seniors and none of the community who don't speak english well could navigate those sign-up sites. when we expressed the need for bilingual materials, your team came up with the flyers. yet the sites were still in english. so they couldn't get the vaccines. so i think as we work closely with the response. and we feel that -- it's really important that we bring the

vaccines to the community versus waiting, you know, for those diverse community who don't have the internet nor the language capacity to sign up for a vaccine appointment. so really, thank you, on behalf of all of our seniors for listening and responding to our needs. we work closely with the all-american medical group, the chinese hospital, the chinese health coalition, the ymca chinatown coalition, and also cdc. so as a group, we can go around and do outreach and also education work on how important it is for our community to be vaccinated. when d.p.h. expanded the qualification considering s.r.o. residents to qualify as

congregate housing, we were very happy. so as of tomorrow, you will start to see all the residents in public housing as well as s.r.o. residents in chinatown. we'll get them vaccinated very soon. we work closely with aamg doctors who are all bi-lingual. where the seniors are picking up their daily meals and right there, the community doctors also give the injections and the vaccinations to our seniors. you can see the big smiles on our seniors' faces despite they were worried they would have some side effect, but because they have their own doctors during the i inoculation and they are excited they are really familiar and comfortable, so that lowered the sense of discomfort and fear. so i think that's a good model, director colfax to bring the

vaccines to really where the patients and the clients are and then they get a sense that, you know, the whole city and the whole community is taken care of, their needs. we are thankful for the departments and mayor breed particularly for your team. thank you, really so much. we appreciate the efforts that you're opening up the vaccine to people from 50 years and older, but we're still concerned that there's 10% to 20% of seniors that are still not vaccinated. so we'll work closely with your staff to bring the vaccines to the homebound seniors as our next project. it's a labor of love, but from our experience in doing the covid response work, we're not short of volunteers. i think there are many volunteers who are willing to be drivers, volunteer doctors

and helpers to bring the vaccines to the thousands of homebound seniors and persons with disabilities. so we'll work closely with you on that project. so thank you very much, mayor and dr. colfax. we need our community to be vaccinate. thank you. >> thank you, again, annie, for being here with us today and also the work that you do to take care of so many seniors and i cannot wait until we're open again so i can go visit them and enjoy the entertainment and food and festivities. i know it's especially hard for some of our seniors living in isolation. so having self-help for the elderly and keep that connection with them is so critical in getting people vaccinated is so important

because i know more than anything, they want to come together again. so, with that, thank you all for joining us. and, at this time, we'll take a few questions. >> the reality of people [inaudible] employment right away, what do you think of people who might get frustrated trying to navigate the system? are you concerned for the people who are eligible before this group [inaudible] now that more people are trying to sign on? >> i'm not concerned because of the efforts that we talked about as far as equity because we have mobile sites. we have people who are going to certain neighborhoods where we see high infection rates who are providing the vaccine to people and so we're taking our lead from community based organizations, but we did this from the very beginning. that's why over 62% of people over the age of 65 in san francisco are vaccinated and over 80% of them have already

received their first dose. that's unheard of on a national level. i'm not concerned about reaching those communities. and, keep in mind i don't think we'll ever get to 100% because there are some people who are hesitant and that's why i got the vaccine. i wanted people in the western edition where we had a lot of folks who were saying i'm not going to get the vaccine. i wanted them to see that i got it and that it's safe and that they should get it too and i know there were a few people including one of my friend's mom and she said i'm only here because you're here, mayor, and i'll go ahead and get it. that's really where we are and what we're going to do. i'm not concerned because of the city's efforts and our work and the prioritizization for certain zip codes and the places where people can drop in and get the vaccine, but, you know, we're going to have more

supply on top of that. so it's going to be a lot easier and it just requires people to be a little patient and we're going to get there. >> more than two weeks fully vaccinated. are you feeling any differently? >> i am smiling more, i think. i think, for me, i'm still wearing my mask and doing my part and keeping my distance. and i still -- i think it's now out of habit, but i'm looking forward to maybe before i probably would have never gone to the giants opening day, but now i'll probably stop by and check it out a little bit. so i'm a little bit more comfortable, i think, going out in public. for the most part, i'm hoping we get more san franciscans

vaccinated. >> [inaudible] >> yeah. i just think that it's unfortunate and it's another distraction from getting our kids back in school. i think, you know, when the grown-ups all of a sudden become the story and become the distraction and this case and many other things that have sadly happened at the school board, then it takes away from what's most important and no one person should be more important than protecting and supporting our kids and getting them back in school. >> [inaudible] >> i'm not prepared to provide any updates as to where we are. i mean, this is a pending lawsuit, so we want to make sure what's appropriate to say and what isn't appropriate to say before we start talking specifically about things that we plan to do. i do know this is one of the reasons, you know, not necessarily a lawsuit, but the

lack of movement by the school district is one of the reasons why we're developing this program "summer together" because we can't just wait for them to sit around and get their stuff together. we have kids struggling now. and if you think about it the achievement gap was problematic and it's gotten worse. and you think about what's going to happen to these kids if they don't get the kind of education they deserve to get within the next couple of years, then we're going to have a problems. i'm focusing on what they're going to do. the kids will have the ability to participate in a program that will help with the learning loss that they i'm sure experienced over the course of this past year during the pandemic >> [inaudible] >> as i said, i am not prepared to talk about that at this time. i want to make sure that i

understand the legalities. it just happened yesterday. so before i make any public statements or comments, i want to make sure i understand fully what this could mean and what the city can do to participate or be involved in this in any kind of way. it is a lawsuit that's geared towards specific members and the school district and we know that the school district is its own entity. we also know that the city stands ready and willing to help to support our kids in any way we possibly can. and, as i said, this is another, you know, unfortunate failure of, you know, a particular individual in this case as it relates to our children. if you really care about kids, then there are things you just will do or will not do to impact their lives and i think it's unfortunate we're at this state of affairs. >> [inaudible]

>> well, the appetite, you mean of the people once folks are in a better place of being vaccinated? well, i know that most people are going to want to come together with people that they may have not been able to come together with before especially those who have elderly parents. i'm hearing a lot about people who had babies and they wanted the babies to meet their grandparents. and so i'm seeing a lot more of that where people are feeling a lot more comfortable and less afraid of possibly having an impact on someone who is more vulnerable. i think that people are going

to want to get together more. i want to go see a play or a concert or -- i'll take anything at this point, but i'm going to be more interested in doing things that we haven't been able to do as a result of this pandemic. i'm looking forward to seeing people singing. like, right now, there's a prohibition right now on those who can go out and entertainment, there's some limitations here because we are still in this, but we have to proceed with caution because the last thing i want to do is come to the people of san francisco and say, yes, we're at 80%, first vaccinations of all san franciscans, but, guess what, we're seeing a surge and i have to shut the city down again. like that's the last thing i want us to do. so i think we're still going to need to proceed with caution. we're going to have to ride this wave and continue to do our very best.

>> [inaudible] >> i can't hear you at all. i'm sorry. >> [inaudible] >> the advice to find an appointment for the seniors? we're going to be doing a lot of outreach not just with self-help for the elderly, but we have aging and adult services. a lot of our programs to be able to identify seniors in those hardest hit communities through outreach and the various programs we fund and offering, you know, rides to seniors and letting them know about the specific locations and being able to walk with the seniors and i'll give you an example. so maxine hall where i got my vaccine in the wherein district location. you don't need maxine hall. so folks that are part of an organization of seniors like people at the senior service center there are people there

who offered to walk them or use the vans to drive them around the corner if they want to get their vaccine are canning them every single day and there's just another of organic outreach everett that's happening with a number of agencies that serve senior communities throughout san francisco. >> i was going to ask more about the following [inaudible] >> okay. anything else? >> [inaudible] >> i can commit to san francisco's what? >> you can commit [inaudible] >> no. i can't commit that. all right. thank you.

>> we have private and public gardens throughout the garden tour. all of the gardens are volunteers. the only requirement is you're willing to show your garden for a day. so we have gardens that vary from all stages of development and all gardens, family gardens, private gardens, some of them as

small as postage stamps and others pretty expansive. it's a variety -- all of the world is represented in our gardens here in the portola. >> i have been coming to the portola garden tour for the past seven or eight years ever since i learned about it because it is the most important event of the neighborhood, and the reason it is so important is because it links this neighborhood back to its history. in the early 1800s the portola was farmland. the region's flowers were grown in this neighborhood. if you wanted flowers anywhere future bay area, you would come to this area to get them. in the past decade, the area has tried to reclaim its roots as the garden district. one of the ways it has done that is through the portola garden

tour, where neighbors open their gardens open their gardens to people of san francisco so they can share that history. >> when i started meeting with the neighbors and seeing their gardens, i came up with this idea that it would be a great idea to fundraise. we started doing this as a fund-raiser. since we established it, we awarded 23 scholarships and six work projects for the students. >> the scholarship programs that we have developed in association with the portola is just a win-win-win situation all around. >> the scholarship program is important because it helps people to be able to tin in their situation and afford to take classes. >> i was not sure how i would

stay in san francisco. it is so expensive here. i prayed so i would receive enough so i could stay in san francisco and finish my school, which is fantastic, because i don't know where else i would have gone to finish. >> the scholarships make the difference between students being able to stay here in the city and take classes and having to go somewhere else. [♪♪♪] [♪♪♪] >> you come into someone's home and it's they're private and personal space. it's all about them and really their garden and in the city and urban environment, the garden is the extension of their indoor environment, their outdoor living room. >> why are you here at this garden core? it's amazing and i volunteer here every year. this is fantastic. it's a beautiful day.

you walk around and look at gardens. you meet people that love gardens. it's fantastic. >> the portola garden tour is the last saturday in september every year. mark your calendars every year. you can see us on the website

my name is doctor ellen moffett, i am an assistant medical examiner for the city and county of san francisco. i perform autopsy, review medical records and write reports. also integrate other sorts of testing data to determine cause and manner of death. i have been here at this facility since i moved here in november, and previous to that at the old facility. i was worried when we moved here that because this building is so much larger that i wouldn't see people every day. i would miss my personal interactions with the other employees, but that hasn't been the case. this building is very nice.

we have lovely autopsy tables and i do get to go upstairs and down stairs several times a day to see everyone else i work with. we have a bond like any other group of employees that work for a specific agency in san francisco. we work closely on each case to determine the best cause of death, and we also interact with family members of the diseased. that brings us closer together also. >> i am an investigator two at the office of the chief until examiner in san francisco. as an investigator here i investigate all manners of death that come through our jurisdiction. i go to the field interview police officers, detectives, family members, physicians, anyone who might be involved with the death. additionally i take any property with the deceased individual and take care and custody of that. i maintain the chain and custody

for court purposes if that becomes an issue later and notify next of kin and make any additional follow up phone callsness with that particular death. i am dealing with people at the worst possible time in their lives delivering the worst news they could get. i work with the family to help them through the grieving process. >> i am ricky moore, a clerk at the san francisco medical examiner's office. i assist the pathology and toxicology and investigative team around work close with the families, loved ones and funeral establishment. >> i started at the old facility. the building was old, vintage. we had issues with plumbing and things like that. i had a tiny desk. i feet very happy to be here in the new digs where i actually

have room to do my work. >> i am sue pairing, the toxicologist supervisor. we test for alcohol, drugs and poisons and biological substances. i oversee all of the lab operations. the forensic operation here we perform the toxicology testing for the human performance and the case in the city of san francisco. we collect evidence at the scene. a woman was killed after a robbery homicide, and the dna collected from the zip ties she was bound with ended up being a cold hit to the suspect. that was the only investigative link collecting the scene to the suspect. it is nice to get the feedback. we do a lot of work and you don't hear the result. once in a while you heard it had an impact on somebody.

you can bring justice to what happened. we are able to take what we due to the next level. many of our counterparts in other states, cities or countries don't have the resources and don't have the beautiful building and the equipmentness to really advance what we are doing. >> sometimes we go to court. whoever is on call may be called out of the office to go to various portions of the city to investigate suspicious deaths. we do whatever we can to get our job done. >> when we think that a case has a natural cause of death and it turns out to be another natural cause of death. unexpected findings are fun. >> i have a prior background in law enforcement. i was a police officer for 8 years. i handled homicides and

suicides. i had been around death investigation type scenes. as a police officer we only handled minimal components then it was turned over to the coroner or the detective division. i am intrigued with those types of calls. i wondered why someone died. i have an extremely supportive family. older children say, mom, how was your day. i can give minor details and i have an amazing spouse always willing to listen to any and all details of my day. without that it would be really hard to deal with the negative components of this job. >> being i am a native of san francisco and grew up in the community. i come across that a lot where i may know a loved one coming from the back way or a loved one seeking answers for their

deceased. there are a lot of cases where i may feel affected by it. if from is a child involved or things like that. i try to not bring it home and not let it affect me. when i tell people i work at the medical examiners office. what do you do? the autopsy? i deal with the enough and -- with the administrative and the families. >> most of the time work here is very enjoyable. >> after i started working with dead people, i had just gotten married and one night i woke up in a cold sweat. i thought there was somebody dead? my bed. i rolled over and poked the body. sure enough, it was my husband who grumbled and went back to sleep. this job does have lingering

effects. in terms of why did you want to go into this? i loved science growing up but i didn't want to be a doctor and didn't want to be a pharmacist. the more i learned about forensics how interested i was of the perfect combination between applied science and criminal justice. if you are interested in finding out the facts and truth seeking to find out what happened, anybody interested in that has a place in this field. >> being a woman we just need to go for it and don't let anyone fail you, you can't be. >> with regard to this position in comparison to crime dramas out there, i would say there might be some minor correlations. let's face it, we aren't hollywood, we are real world.

yes we collect evidence. we want to preserve that. we are not scanning fingerprints in the field like a hollywood television show. >> families say thank you for what you do, for me that is extremely fulfilling. somebody has to do my job. if i can make a situation that is really negative for someone more positive, then i feel like i am doing the right thing for the city of san francisco. ?oo hi, i'm holly lee. i love cooking and you are watching quick bites. san francisco is a foodie town. we san franciscoans love our food and desserts are no exceptions. there are places that specialize in any and every dessert your heart desires, from hand made ice cream to organic cakes, artisan

chocolate and cupcakes galore, the options are endless. anyone out there with a sweet tooth? then i have a great stop for you. i've been searching high and low for some great cookies and the buzz around town that anthony's are those cookies. with rave reviews like this i have to experience these cookies for myself and see what the fuss was all about. so let's see. while attending san francisco state university as an accountinging major, anthony's friend jokingly suggested he make cookies to make ends make. with no formal culinary training he opened his own bakery and is now the no. 1 producer of gourmet cookies in the biarea and thank you for

joining us on quick bites. how do you feel? >> i feel great. >> so i want to get to the bottom of some very burning questions. why cookies? >> it was a recommendation from a friend. hard to believe that's how it all started. >> why not pies and cakes? what do you have against pies and cakes, anthony. >> i have nothing against pies and cakes. however, that was the recommendation. >> you were on the road to be an account apblt. >> actually, an engineer. >> even better. and it led to making cookies. >> in delicious ways. >> delicious ways.

>> this is where the magic goes down and we're going to be getting to the truth behind cookies and cream. >> this is what is behind cookies and cream. >> where were you when the idea came to your mind. >> i was in my apartment eating ice cream, cookies and cream ice cream. how much fun, cookies and cream cookies. their cookies and cream is not even -- it took a lot of time, a lot of fun. >> a lot of butter. >> a lot, a lot, a lot. but it was one of those things. all right, now behold. you know what that is? >> what is that?

>> cookies and cream. >> oh, they are beautiful. >> yes, so we got to get --. >> all right, all right. we treat the cookies like wine tasting. i don't ever want anybody to bite into a cookie and not get what they want to get. we're training staff because they can look at the cookie and tell if it's wrong. >> oh, here we go. >> you smell it and then you taste it, clean the plat palate with the milk. >> i could be a professional painter because i know how to do this. >> i can tell that it's a really nice shell, that nice crunch. >> but inside. >> oh, my god. so you are going to -- cheat a

little bit. i had to give you a heads up on that. >> what's happening tomorrow? these cookies, there's a lot of love in these cookies. i don't know how else to say it. it really just makes me so happy. man, you bake a mean cookie, anthony. >> i know. people really know if they are getting something made with love. >> aww >> you know, you can't fool people. they know if you are taking shortcuts here and there. they can eat something and tell the care that went into it. they get what they expect. >> uh-huh. >> system development and things like that. >> sounds so technical. >> i'm an engineer. >> that's right, that's right. cookies are so good, drove all

other thoughts out of my head. thank you for taking time out it talk to us about what you do and the love with which you do it. we appreciate your time here on quick bites. i hope you've enjoyed our delicious tale of defendant 93 and dessert. as for me, my search is over. those reviews did not lie. in fact, i'm thinking of one of my very own. some things you just have it experience for yourself. to learn more about anthony's cookies, visit him on the web at anthoniescookies.com. if you want to watch some of our other episodes at

sfquickbites/tumbler.com. see >> hi, i'm chris manus is sfgov tv and you're watching "coping with covid-19." today i'm going to the gas station. [music playing] now, these are just my stories. i'm not a medical professional of any kind. i'm a video guy. and the reason i'm getting gas so we can go to the doctors. if you want to get the most up-to-date and definitive information about the coronavirus pandemic, i highly recommend the f.a.q. that is available at sfgov. there's great info there. today i'm taking two plastic bags and a hair tie and following the new bay area guidelines and i'm wearing a mask. i'm taking the smallest number of items with me. just my car key, credit card, i.d., the bags and the hair tie. i don't want too many items to wipe down later.

as aleave, i put on the outside shoes i've left on the porch. can i track the virus inside with my shoes? i honestly don't know. but my floors are cleaner now. when i get to the gas station, i get out of the car, remove the gas cap and put the big plastic bag on my right hand and secure it with a hair tie. there are three main share surfaces here i'm concerned about touching. the p.i.n. pad, the pump handle and the button to select my gas. after i use my card, i put it into the smaller bag and stash it. most gas stations have a paper towel dispenser or maybe there is a piece of paper already in your car that you can use. once i fill my tank and replace the pump, i walk to the trash can, roll the hair tie up my arm and let the plastic bag fall into the can. on my drive home, i'm careful not to touch my face. i leave my outside shoes on the porch and as soon as i get

through the door, i wash my hands for at least 20 seconds. next i wipe down my credit card, i.d. and my car key and, as an extra precaution, i wipe down the front door nob and clean the sink taps. finally, wash my hands again. that's it for this episode, i hope you found it helpful. thank you for watching. >> 5, 4, 3, 2 , 1. cut. >> we are here to celebrate the opening of this community garden. a place that used to look a lot darker and today is sun is shining and it's beautiful and it's been completely redone and been a gathering place for this community. >> i have been waiting for

this garden for 3 decades. that is not a joke. i live in an apartment building three floors up and i have potted plants and have dreamt the whole time i have lived there to have some ability to build this dirt. >> let me tell you handout you -- how to build a community garden. you start with a really good idea and add community support from echo media and levis and take management and water and sun and this is what we have. this is great. it's about environment and stewardship. it's also for the -- we implemented several practices

in our successes of the site. that is made up of the pockets like wool but they are made of recycled plastic bottles. i don't know how they do it. >> there is acres and acres of parkland throughout golden gate park, but not necessarily through golden community garden. we have it right in the middle of