>> we hope we can learn more about the current state of covid-19 variant cases and others. let's get through the housekeeping and get started. recording. today's event is being recorded and being live streamed on facebook on facebook, sfgovtv, comcast 26, and cable 26. we respect all in this meeting, and want to create a safe space for all. all video will be disabled. video will be on for speaker only. the asl interpreter will be on for the duration of this event.

to view the asl interpreter during the slide presentation, please click on view button at the upper right hand portion of your screen and click on slide view. you can also switch from one slide to the other. once the slide comes on, switch to speaker view media. we are prioritizing questions from members of the public during q&a. media are welcome to follow up with additional questions they have -- thank you very much for

joining us. now i would like to hand it over to d.p.h. director of public affairs katy tang. >> thank you very muc and thank you for attending this webinar. as covid-19 is circulating out there, we know there's questions from many of you. so with that said, i'm going to invite dr. colfax to begin his presentation for all of you, but we will reserve a bulk of the time for q&a. so with that, dr. colfax. >> i thank you, katy, and good afternoon, everybody. it's really good to be here and prioritize where we are with regard to covid-19 in our city. thank you, everybody, for joining. looking forward to questions and some discussion. we have some slides that i'll be presenting to let you know

where things stand, and i know that this pandemic is creating greater challenges within our community. next slide, please. so as of today, we have over 41,000 cases of covid-19 diagnosed in our city, and we have 565 deaths. we are now in a fourth surge, and you can see that we now have an average of about 235 cases a day, and unfortunately, we are seeing another surge in hospitalizations as of august 1 with 97 people in the hospital. san francisco has done a great job of vaccinating people, and again, thank you for your collective efforts in supporting vaccination. it is our ticket out of the pandemic. 70% of everyone in san francisco has been vaccinated, and that includes, in that

calculation, people who are under 12 who, as you know, are not eligible for vaccine yet. total number of vaccines yet, you can see 667,000. 84% of people 12 and older, people who have received at least one dose, and 78% of people 12 and over have completed their vaccine period. so this is remarkable. this is one of the highest, if not the highest jurisdiction of any urban jurisdiction in the united states, and because of this work, and because of what people have done in terms of getting vaccinated, while this fourth surge will present challenges, we are in a much better place, and we will have many fewer deaths as a result of this vaccine coverage.

next slide. so on the next slide is the seven-day rolling average of cases, which is 235. in our winter surge, we peaked at 378. you can see the curve is step and almost vertical. this is because the delta variant is raging through our city, especially among those who remain unvaccinated. we are seeing increases across the world. you see here from the new york times the increase in cases across the globe, and as i already mentioned, going back to the local situation, we have nearly 100 people in the hospital and are tracking those hospitalizations very closely.

next slide. in terms of our case rate, so this is our case rates. this rapid increase, really attributable to the delta virus -- delta variant, excuse me, and the fact that we have reopened much of the city, so therefore, there's more activity. so the combination of these factors are what's driving this increase. next slide. so if there's any change in the current rate of vaccine uptake, and there's no change in san francisco's current contact rate, which is how much we're interacting with the public and each other, then we project the

following, and these are just projections. the current surge would end with 257 additional covid deaths in san francisco. and with that last bullet, just to emphasize, the vast majority would be among people who are not fully vaccinated, and with vaccines, 90 to 95% of these deaths are preventible. next slide. as we've seen throughout the pandemic, covid-19 is having a

disproportionate impact on different neighborhoods in the city. in this case, higher rates in the southeastern part of the city. the more the blue shade on this map, the higher the concentration in the city. so you see mission, tenderloin in particular have high rates. so this is, again, something that we've seen throughout the pandemic, which is why during the pandemic, working with community partners, we at d.p.h. have focused our efforts at testing, vaccine efforts, prevention services in neighborhoods most affected. next slide. so there's been a lot of talk about the delta variants, variants in general during the pandemic. i've used the term several times already during this

presentation, so just to be explicit, what is a variant? so viruses constantly change, and this is a normal process of the virus. a variant is a virus that contains changes different from the parent. some viruses have an advantage over the parent and persist or become more common, so this is basic virology, where a virus adapts. through active genomic surveillance, scientists can identify variants that are concerning, requiring further

study, and precautions. public health becomes concerned about a variant when it affects covid-19 transmission, severity, treatment, or effectiveness. we're now focusing on the delta variant, which we believe accounts for 95% of cases in san francisco, is far more transmissible than the original variant, and the clinical research scientists are determining other factors. so the main way to fight the virus is to reduce transmission, so the virus

cannot mutate if it's not reproducing, so this is another reason that vaccination is so key. the faster locally, nationally, and globally we get more people vaccinated, the less likely the virus will be able to infect more hosts, and the more likely it will be that we will be able to slow the spread of the virus. and again, as i've already said, the vast majority of hospitalizations and deaths due to covid-19 are among the unvaccinated here and across the country. so vaccines are highly effective. they are incredibly effective,

but breakthrough cases are possible. but the vaccines are working. they are effective in preventing transmission of covid-19 to totally vaccinated people, and even better, they are effective at reducing hospitalization and death due to covid-19. and, really, you know, i've said this before, it could be the difference -- if you get covid-19 and you're not vaccinated, if you're fully

vaccinated versus not vaccinated -- so if you're fully vaccinated versus not vaccinated, it could be the difference between getting a case of the sniffles versus suffocation and having to go into the hospital with covid-19. i say it's the difference between spending a few days in your bed at home and weeks in the i.c.u. at a hospital. this is not to be taken lightly. these vaccines are life saving and can keep you out of the hospital, and, of course, prevent death. here, an over eight-fold

difference, eight times more likely to be hospitalized if you are not fully vaccinated for covid-19. look at this difference between these two bars. incredible difference showing the effectiveness of these vaccines at the local level. next slide. so i also wanted to touch base on the indoor masking order that our san francisco public [inaudible] issued on august 3,

requiring masks indoors regardless of vaccination status. this is an effort that aligns with c.d.c. guidance to reduce transmission of covid-19 and everyone due to the widespread covid-19 delta variant. so, you know, this delta variant is really covid is steroids, which is why vaccinations are so important, but also protecting ourselves and each other, reducing the rate of transmission by requiring us all to wear a mask in public places will protect everyone, particularly the unvaccinated or those who have not received a vaccine and can help them get protected by availing themselves to a shot.

there's lots of resources here. we are really focusing the health department on the most vulnerable communities to covid-19, reaching out to ensure that people have the right information, the correct information and particularly about the vaccines. know there's a lot of myths out there and misperceptions. we are out there making vaccine available as much as possible. in addition there's information where people can get tested, and for people who want to delve deep into the data, you can see the links to our data and reports. and finally, just to emphasize for further information about covid, the state web side and the c.d.c. -- website and the c.d.c. websites are here to view at your leisure. and i believe that's the end of presentation, and we'll have some question-and-answer now. katy, i'll turn it back to you. >> thank you, dr. colfax, and

if you do have questions, please continue to send them through the chat. we also wanted to welcome two of our incredible community liaisons who have been deployed as what we call disaster service workers throughout the response. these are individuals who have worked in different city departments, and we have called on them to assist with all that's required during this pandemic and want to thank and acknowledge everyone who has been part of that. so today, we have [inaudible] bryant, who normally works at sfmta. has been doing a lot of outreach in the community, and jessica medina, who is also assigned at department of emergency management and has been doing a lot of work. i'll start with [inaudible]. they have been hearing many questions in the community as they've been doing outreach, so

we asked them to relay some of those questions with us today, so we'll start with alfini. >> hello. good afternoon, everyone. the first question that's come in from the community is why is the delta variant so deadly, and why is it so contagious compared to the original strain? >> so can you hear me now? so thank you for the question, and it's a really important one to answer as quickly as possible. we know that the variant is much more contagious than the virus we were dealing with before. as we said, it's covid on steroids, and basically, the virus has mutated so it allows the virus to bind better to our

cells in our body. so basically, it has created a way to bind even more tightly to our cells and do it more quickly to infect us. so that's the key reason why delta is so concerning right now. the -- in terms of its causing more severe disease, there's increasing evidence that it's not only more infectious, but if you get it, you are more likely to have severe illness. that is not concluesive yet, but in talking to our ucsf clinicians and doctors there, there are emerging -- there is emerging evidence that that is the case, and unfortunately, that trend is what we're seeing locally. so it's a series of mutations that allows the virus to enter our bodies more quickly and easily than the prior virus,

and then a series of mutations that are causing the virus to create more -- potentially more serious disease. >> okay. thank you for that. jessica? >> thank you, dr. colfax. another question i have is regarding testing. we're starting to see a lot more people getting tested for covid-19. is the city going to ramp up testing again, especially that the mass testing sites have been closed? >> yes. so we ramped up testing dramatically in both at our al -- alemany sites and [inaudible] and at this point,

that increase in demand has not decreased in supply. we are working with our partners and across our health care system partners, kaiser, ucsf, sutter, and so forth, to expand testing. people who have health care providers are experiencing some delays both in getting some appointments and some delays in getting test results back, so we're working to mitigate that as much as possible. we're also working to access home test kits, which we haven't had in prior times, to help people get rapidly tested. but we acknowledge that testing demand is increasing and, again, are working hard to expand testing options, testing hours for people so that people

can get tested when they need to. >> okay. great. next, we'll go back to fini. >> okay. thanks for that. why do some people who are vaccinated experience symptoms and are being hospitalized despite the small numbers? >> yeah, so i think it's important to look at the broader numbers in san francisco. there are going to be some breakthrough infections, and especially with delta, there are going to be some breakthrough infections. when we talk about breakthrough infections, there are people who, where virus is detected, they don't have any symptoms, but their test would be positive. and then, there are some who have mild to moderate symptoms. but we've all heard of people who got -- did what they were asked to do, stepped up, got full vaccine doses, and they

got pretty sick due to covid-19. and, you know, this is the fact that if they hadn't gotten the vaccine, it's highly likely that they'd be more sick, right? possibly in the i.c.u. and possibly to the extent that they could have died, so i think we just need to look at the numbers and look at the -- the rate of infection and severe infections, and as we keep emphasizing, if people are fully vaccinated, the likelihood of their getting severe illness, the likelihood of getting hospitalized is reduced dramatically, reduced dramatically. i know people who have gotten pretty sick who have gotten fully vaccinated, but we just need to look at the facts, and right now, the facts are because so many people in san francisco are fully vaccinated, many, many fewer people are

also going to get sick. and the fact is, with delta here, it's important, if you're not fully vaccinated, to get fully vaccinated. and if you get covid-19, it is incredibly likely that it will keep you out of the hospital. >> thank you. next question? >> my next question is what is the general guidance with regard to testing currently? what about isolation and quarantine resources if people test positive? >> yeah, so, you know, in terms of getting tested, if you're -- for the -- there are a lot of different circumstances, so i won't go into those details, except to say certainly, if you have symptoms that are consistent with covid-19, you should get tested whether or not you have been fully vaccinated, so really important, and if you are symptomatic, it's important to

wear a mask indoors, even if private settings, until you get that tests. in terms of quarantine, people should quarantine until they get the result of that test as much as possible and isolate for -- for the vast majority of people, isolate if they've had a positive test for at least ten days until they don't have any symptoms. we can continue to provide isolation and quarantine support for people. in some cases, this would mean support -- it's a place where the person is living, providing support for families, resources, or providing a spot where they could go isolate or

quarantine as necessary. and at the same time, we do not have the level of isolation and quarantine hotels that we had for these last three surges, so we're continuing to work with community members and others to ensure that we're prioritizing the isolation and quarantine resources that we do have for the people who are most vulnerable, for the people who don't have another way of managing isolation and quarantine, and again, focusing on providing support for people in other ways so that they can isolate and quarantine as much as possible. >> all right. next question, fini? >> how [inaudible] is the covid-19 vaccine in the long haul? people are scared of the variant, but some people are more scared of the vaccine and the long-term effects, as well? >> yeah, i've heard that concern, and i talk to people

about it. so the covid vaccines were developed and approved quickly, which is actually a great thing because they're our way out of this pandemic. but i also think that while the vaccines were developed quickly, it's important to remember scientists have been studying these covid viruses for over 50 years, half a century. so the science that really drove how it developed has been in existence for many, many years, and this was done quickly because there was an unprecedented support in investment in this scientific research. so right now in the world, the vaccine has been distributed to millions and millions of people, and they are safe and highly effective. you know, we obviously don't

know, ten years out from now, what the effects will be, but all of the indications are that these vaccines are safe, and the long-term risks of covid-19 far outweigh the theoretical risk of any side effects of these vaccines, so just to emphasize that. now, there's also this concern about if i -- when i get a shot, especially if i get a second shot, i get symptoms, i feel fatigued, i feel sore. with the second shot, my arm really hurt for the day. the second day, i had symptoms. you feel achy or like you have a bad case of a cold.

it's not a pleasant situation, but believe me, the symptoms of covid-19 are far worse than from these vaccines. so they're just -- there are also a lot of i think myths out there that are on social immediatea and so forth, you know, the vaccines affecting your re -- media and so forth, you know, the vaccines affecting your reproductive system and so forth. that is not the case. all the experts who specialize in reproductive health are recommending that people get these vaccines. in fact, there was just a study out yesterday that shows for -- unfortunately, for pregnant women who didn't get the vaccine, they were more likely to have their babies early, and the babies were what we call preterm babies, so that was a very negative effect of

covid-19. the benefits of these vaccines far outweigh the bad sides, but we all know someone who got the shot and got sicker than they thought, or my brother got the shot and had an asthma attack a week or two weeks later, and it was, like, did that cause my asthma? no. >> thank you for that. and the last question from jessica? >> the last question is [inaudible] should they then test again. >> so, again, this is this is a

situation where they're fully vaccinated and tested positive, basically, you need to isolate for the ten days until -- until you don't have symptoms, assuming you don't have any symptoms after ten days, and there's no further recommendation to get retested again, and if you do get symptoms similar to covid-19 after that again, the best thing to do is to talk directly to your health care provider. but in general, there's no reason to get tested after the ten days after -- from the day of your positive test. so the most important thing is if you do test positive, to isolate, to wear the mask, and for goodness sake, if you have friends and family that haven't been vaccinated yet, get them vaccinated -- support them

getting vaccinated, i should say. >> all right. thank you so much to jessica and fini for all of your work in the community, as you've heard many similar questions that they all have that they've been fielding in the community, so thank you, fini and jessica. so now, i'm going to get to some of the questions that you've put in the chat. i don't think i'm going to be able to get to one of them, but i'm going to try to combine similar subjects. one thing that has been asked is will the city shutdown again, and will the city take any further efforts to reduce transmission, such as closing restaurants, bars, gyms, or any other place with high risk settings, and do we anticipate going back to the tiered shutdown? so all of these questions have to do with a shutdown?

>> so we have no plans to quote, unquote, shutdown the city again. i think we are going to mitigate the virus in ways that allow us to resume the activities that we missed so much and love while also trying to slow the spread of the virus and prevent the most serious consequences, hospitalizations and, of course, death. so vaccines are key to this. as i said multiple times here today already, they are key along with people wearing masks indoors. they are not as effective as vaccines, but they are another tool that works to slow the spread of the virus. the other thing that we're doing is mandating vaccines in certain settings, including in health care settings, and i think as people know, the city as a whole, the city is

requiring employees across departments to become vaccinated, so there is effort to make the vaccine as available as possible. we will bring the vaccine to you. in your house, if you have five or more people ready to get vaccinated, we can make that happen. and the other thing is now that we've made it as easy for people to get vaccinated, we support efforts for people not getting vaccinated. we support requirements for vaccine. a lot of businesses are

requiring to show proof of vaccine status. >> we're seeing a lot of questions in the chat about boosters and booster shots, so i'm just going to combine some of the questions here. what are the cost-benefit analysis to get a booster shot if they're ready to get vaccinated? how effective is the pfizer and moderna vaccine against the variant, and what's the criteria if someone wants to get a supplemental shot? they've read the news about

sfdph affiliated facilities accommodating those requests, and do you recommend someone getting a shot from two different companies, so if you got a moderna, getting a shot from pfizer or johnson & johnson. so many questions, similar topics. what are your thoughts about booster shots? >> i'm trying to hold all those topics. so a couple of things. starting with one of the questions that was in the middle there was, you know,

about the second shot, whether it's from pfizer or moderna. it's just really, really important to get that second shot. there is no recommendation from any major health care body in the united states, including the c.d.c. and the f.d.a., that people get boosters. i know there's a lot of questions, a lot of discussions about this. right now, we only need to focus on the support of people who haven't gotten vaccines to get the shot. that one shot is j&j or two shots of the moderna or pfizer vaccine. those are the current guidelines, and the health department has not changed its policy with regard to that. now there's a lot of data -- there's actually some data just out today of moderna. there's a lot of discussion around pfizer with booster

shots, which would be additional shots based on evidence that people may need them. there are some countries that are exploring or planning to start booster shots in certain populations. that is not happening in the united states right now. we don't know yet. it's entirely possible that booster shots would be recommended, but again, in the united states, that's not the case. now there has been some publicity about a comment that the health department made, which is giving -- if people who receive the johnson & johnson vaccine, which is a good vaccine, request an additional shot with a pfizer or moderna vaccine, that we will accommodate that, but it hasn't been a change in our policy. but if people have talked to their health care provider and say, you know, i'd really like

to have an mrna shot in addition to the johnson & johnson shot that i got, we will accommodate that, but we are accommodating that because we heard from communities that people were concerned that they were requesting it. we wanted to be responsive, and we wanted to accommodate what people were asking for in the -- in that regard. but it's not a change in policy, we're not recommending it, and we're not promoting it as a way for people to become more protected. >> okay. i know that's super helpful, just given all the questions rolling around that and the news coverage. question, especially with delta and other variants. you recommend upgraded respiratory protection. for example, n-95 masks for unvaccinated individuals in indoor settings, so again, this

is unvaccinated individuals in indoor settings. >> yeah, what i recommended for all individuals in indoor setting is to get vaccinated. we know the masks work, but they don't work as well as the vaccines. in an indoor setting, i mean, the more we know about them, really, it's both about getting that vaccine with delta here and, you know, if many people can't tolerate wearing an n-95 mask inside, so it's better to wear a surgical mask than certainly no mask at all. but i just -- i know that with the masking, the indoor masking mandate coming back in, that that -- that we focus our attention on masks, but i also

don't want to lose sight of the fact that the vaccines are so much -- so important, so protective, and easy to get right now, so both the mask and vaccine are key to us getting out of this fourth surge. >> okay. great. we have some questions about the new variant, the lambda variant. what do you know about the lambda variant in san francisco, and there's some questions that the lambda and epsilon variants might be vaccine resistant? >> yeah, we're working with scientists and researchers as much as we can to be responsive to further variants emerging.

and i think one of the key issues that we've had across the country, in the region, and, as well, is in -- in san francisco is scaling up our ability to genotype the virus. and thankfully, at ucsf, we have a lab that's leading the state in terms of genotyping. it's plausible that we'll see other variants emerge because we don't have high vaccine rates across the country, and we'll have to wait and see if these variants cause more illness or if they spread or are more crippling than delta. but i go back to -- i sound like a broken record -- the way

to keep these variants from spreading is to get vaccinated so the variants slow down. the less people the virus is able to infect, the more the virus slows down, and the less people we infect. the way to support all of this is to support all people getting vaccinated. >> all right. and we've gotten questions about have we seen any differences in outcomes, for example, hospitalizations, for people who have received different brands of vaccine? >> yeah. locally, i'm not aware of any differences in regard to that.

>> okay. and i know we've had a series of town halls focused on youth and children in schools, but we do have a couple questions here in terms of the delta variant specifically and its impact and everything on specifically three to five year olds. is it specifically safe to allow three to five-year-old children to not wear a mask in child care outdoors? what about the delta variant in pediatric outcomes? any sort of thought on the risk of kids under 12, so questions

on covid and how the delta variant is affecting children? >> so this has come up in questions from our clinical experts, and i think it's really important to emphasize right now that the public health officers, pediatricians, feel that it's incredibly important that we return our kids to in-person learning, and that this is thought that we can do it safely, we can do it safely, and it's so important for the health and wellness of our kids, our families, and our community. the best way that we can ensure that is for family members who are eligible for vaccines to get vaccinated. that can protect the children, and that can protect the school. and we have local data that supports that, so in the last 18 months, of the children who are found to test positive for covid-19 in the schools, all those cases were tracked back to the family, so i just think it's important for us to all do

our part to support that. i was just talking to a number of infectious disease experts at ucsf. you may have read the report from louisiana about children's hospitals being filled with children with respiratory illness. that's obviously a concern, and there's much more covid there, much more than we have locally. there's a much lower vaccination rate, somewhere in the range of 35%, compared to our 75% overall, and there's no confirmation that delta causes more disease among children. right now, the consensus is

that children are expect -- you know, even if children get covid-19, that they will experience milder symptoms compared to adults. but again, as we've seen during these last 18 months, this is an evolving field and we're watching it very carefully. but we want to support schools opening for in-person learning as much as possible. >> okay. thank you. we got a couple of questions about rapid testing and testing as soon as possible, so i don't know if you want to share anything about rapid tests? >> well, i think if people want to avail themselves of rapid testing, that's something we didn't have before, so i encourage them to use it. but i'd say to very carefully follow the instructions, and if you have questions, that you consult your health care provider, so just two important

caveats to the use of home test kits, and again, they should not be a substitute for getting vaccinated. getting tested itself doesn't get you vaccinated. you can test as much as you possibly can, and it's not protecting you from the virus, right? so, you know, if you're tested, get the vaccine. >> maybe just a follow-up question on that. if you can describe for the public quickly the difference between the rapid test and what we have traditionally had out there, where test results are sent to labs? >> yeah. well, i mean, i think there are a lot of different rapid tests out there, but basically, the rapid test allows you to get the results, you know, in as short a time as 15 minutes, and those are being used in many settings across the city and at

d.p.h. we're using them at our shelters right now and certainly at our testing sites so you get that result very quickly. if you -- the traditional -- the traditional test that we used earlier, our tests that take a longer time to conduct, and they can take a turnaround from anywhere from 24 to 72 hours. >> we had a lot of questions about the city shutting down again, but also specific events. we were planning for events to be held outdoors but with a lot of people. should we still hold them? should we cancel them? is there going to be a recommendation that people reduce participating in social gatherings indoors or suspend large gatherings? any advice you have on small

outdoor private gatherings, so in general, i think the questions are along the lines i think we've talked about safety in covid areas on the spectrum, if you could share that. >> yeah, it is on a spectrum. we know that being outdoors helps prevent the transmission of the virus, so that's key, as well, and the more people that you're engaging with, particularly inside, the greater the risk of transmission, especially if there are adults there who have not been fully vaccinated. the other piece is we know that people who are older, particularly 65 and older,

people who have comorbid conditions are more likely to suffer from negative consequences from this virus, so i think we just all need to think through that and do our own risk assessment to make a determination about what we're comfortable doing. there's a big difference between an indoor gathering of 5,000 people whose vaccine status hasn't been checked versus an outdoor gathering of 25 people who are fully vaccinated or, you know, people eating inside either in a group -- in a group setting, in a restaurant -- if they're vaccinated, and the staff are fully vaccinated, there's a big difference in that risk compared to people that are not vaccinated in that setting. so i think it's just really being attentive to your own risk, the risk of the people that you love and who are around you, and making the

determination about what you're comfortable doing while supporting getting vaccines and while wearing those masks indoors. >> and so along those lines, you know, especially given the high vaccination rate of our population, do you any insight of where you're seeing outbreaks in san francisco at least? i think you mentioned earlier, but any specific places or demographics or clusters? >> well yeah, i think we're seeing clusters in the neighborhood map -- on the neighborhood map that i showed. we're also seeing larger numbers the people in the 25 to 35-year-old age group who are not vaccinated. that's our age group in san francisco that is least likely to be vaccinated, so if any of you are 25 to 35 or no 25 to 35 year olds who aren't vaccinated

yet, please support them in getting vaccinated as quickly as possible. along those lines, we are seeing, when we're asking people their activities, we're seeing more outbreaks in indoor settings, including people who are frequenting bars, so that's another place where we're seeing more people. it's basically younger people -- there's a higher risk for younger people, 25 to 35 year olds, who have not been vaccinated, who are going indoors into crowded settings where i think mask wearing is lower than it needs to be at this time. >> all right. well, i know we received many questions, and we apologize we couldn't get to all of them, but we will try to through our

messages out to the public and other venues, as well, try to get as many questions addressed in those ways. our website, of information, as well. i will leave it with one last question. many people are wondering how we can live with this virus in the long run like with the flu, so what are your thoughts on that? >> well, it's hard to project into the future, but we have the tools that work. there's a question, if you get the vaccine, will it work against mutations?

the vaccine is key to keeping us from spreading the virus and from keeping us out of more serious variants, so i just want to emphasize that. i think in terms of where we'll be in the future, hopefully, we'll get more people vaccinated. the masking, indoor masking, will help slow the spread of this surge, and then, we'll have to see where we are in terms of the science around further vaccines and determine, you know, if and when additional shots are necessary. but i think right now, the answer -- the most important thing that we know now is that these vaccines are going to be key and that the more people we get vaccinated now, the more we will be able to mitigate and -- and control the spread of this virus in our community and

prevent people from dying. these are great medicines, and the vaccines are our way out. >> all right. thank you, dr. colfax. thank you to everyone who participated in this event today -- >> and if i could just say one more thing. you know, this has been a long 18 months, and i've said a lot about the virus. there's been a toll on our mental health, our ability to care for ourselves and our families, and in addition to getting the vaccine, please make sure that you're taking care of yourself and your families in the ways that are so important for yourself to be resilient during what is a very challenging time. sorry to cut in, katy, but i

wanted to say that, and thanks, everyone. >> oh, no, thank you to you, dr. colfax, and thank you to everyone who participated and thank you to sfgovtv, as well. if you want to view this again, it'll be available on sfgovtvs youtube channel. so thanks, everyone, and have a wonderful day.

>> it's tuesday, august 3rd, 2021. [roll call] >> i didn't quite hear you. i am calling roll call. [indiscernible] [roll call]. >> i think i got everybody. can you just verbally give us that you are here? okay. i see you, but i need to hear you.

>> thank you. just for the record, we need to have everyone on record. thank you very much. >> i would note that some commissioners are feeling under weather and will not be on camera with us today, as much as we would like to see them in person. we wish them good health and that they feel better soon. the second item his approval of the minutes of the health commission meeting of july 20th , 2021. commissioners, you have before you before -- before you those minutes. there are no amendments. do we have a motion to approve. >> if i may, commissioner, i did send out or only heard recently three minor corrections. may i read them? >> yes. >> commissioner green and child, thank you for helping me do my job better by pointing out these mistakes. on page six, i'm sorry, on page six, there is a commissioner

comment without a name. it is commissioner guillermo. it should have that name there in the bottom of the page. directly underneath it, commissioner green, it is a second line. the word probably should be probable. the final correction -- final correction is on page seven. it will say commissioner kristian supported the desire, not supports. my call. -- my fold. >> with those corrections, do we have a motion to approve? >> so moved. >> second. >> is there any public comment

on this item? >> there is nobody on the line at the moment. so there is no -- here we go. i'm sorry. there is one caller. if you like to make comment on the minutes, item two, press star three to raise your hands we can acknowledge you. may i do a roll call vote? >> yes, please. [roll call] >> the item passes. thank you. >> thank you. the next item is the director's report with director grant kolfax. mr. director? >> good afternoon,

commissioners. i'm the director of health with the director's report which includes a member of covid related items that i will cover with the update that i will give after this item, with regard to noncovid related issues just to highlight some things. i'm very pleased to announce that the public health department budget was approved by the board of supervisors on july 27th. as you know, lots of work went into the budget. it was a two billion-dollar budget for fiscal year 2021-2022 and 2.76 billion for 22-23. i also wanted to call to your attention that on july 22nd, the d.p.a., in partnership with alameda, contra costa, santa clara, announced # deliverable

justice. a regional public awareness campaign that puts justice for black families front and centre in the fight for racial justice in the bay area. it highlights racism is a crisis that results in the death of an infant and a disproportionate rate compared to other racial groups. for more information about the campaign, i encourage you to visit the website. i also just want to highlight that on july 22nd, the mayor and d.p.h. announced our continued expansion of behavioral treatment beds for behavioral health. in 2021 alone, we are planning to see 140 new beds opened to address the very important needs of our community in regards to behavioral health.

and then there has been a lot of d.p.h. in the news recently. you can find that at the bottom of the director's report. that concludes my summary. i'm happy to take any questions and proceed on with the covid update. >> thank you. commissioners, before we go to commissioners questions or comments, do you have any public comment? >> on the public comment line, let us know if you like to be acknowledged by raising your hand and pressing star three. >> all right. commissioners, any questions or comments on the director's report before we go into the covid-19 update? some of that will also be covered in the equity proposal. >> i see commissioner chow's hand. >> commissioner child? >> thank you, director. my question was in regards to the public health budget and it

was great to see that we were having two additional positions for the case management and case advocacy in 21-22, but then it appears -- does that mean that it's being dropped? there is no budget listed on through their -- there is no budget listed under their. it seems to be it would be an important function. >> commissioner -- can you hear me? >> let me double check on that with our budget people on that. it's possible that it may have been an oversight. let me find out about that and we'll get back to you on those positions. >> thank you. i'm glad that they are there. >> any other questions or comments for director kolfax?

we can go into the covid-19 update. >> thank you. next slide. so commissioners, providing an update on covid-19, i will run through the slides and invest any questions or concerns that i might not have raised during the update. next slide, please just emphasize that the san francisco covid cases continue to rapidly increase. you can see it on the graph here the history of our cases during the pandemic the last 18 months. a very high climbing rate now. almost one per 100,000 in june until now and almost 22 per 100,000. dramatic increase. we're almost halfway to the peak that we were entering the winter

surge. it is also fuelled by the delta variant. this increase is very, very steep. therefore, covid is spreading faster for people who are not vaccinated for covid compared to where we were before. this is a particularly challenging time for people who are not vaccinated. vaccines remain the way out of it. we will get some degree of breakthrough infections, that will be expected, but we need to continue to focus on the importance of that as our ticket out of this serious situation. next slide. in terms of hospitalizations, hospitalizations in san francisco are rising. you can see the steep increase. and as cases rise, it takes two weeks for the rise in cases to go into hospitalizations. we are closing in on 100 people in the hospital due to

covid-19. it is consistent with the numbers that we fell -- felt during the summer surge. they expect us to go higher. given our models, it's possible we will go above the winter surge in terms of hospitalization numbers. the vast majority of these people will be people who were not vaccinated for covid-19. next slide. this is the model that we have been working with since the beginning of the pandemic. this is looking at the scenario, assuming delta is about 80% of our cases as of july first, which is well within the norm of possibility. the vaccine current uptake, delta is 50% more transmissible than the delta variant. the contact rate, the amount of

activity that people are engaging in, is essentially equal to what we are seeing today. and the hospitalization rate is 85% higher than without. this is an important point on the increasing data that supports the fact that delta is not only transmissible, but more berlant in terms of its ability to cause more severe disease resulting in hospitalization and in talking with infectious disease experts, this is not definitive yet, but it's looking more plausible as time goes on from the number of reports in the -- infectious disease journals. it also sees no additional mitigation in terms of any shutdowns in the city or a decrease in our community overall. under these scenarios you can see on the green line that cases work very deeply, just as i told you on the lot. and then actually, it falls pretty quickly that we would see

a peek in case rates of over 500 cases reported a day on august 20th, and then you will see the hospital census piece on september 3rd with 326 people with covid-19 in the hospital. the vast majority of people not fully vaccinated. it really -- there are a couple of things. i try to hold two thoughts. one is that we are in a much better place than we were before the vaccines because san francisco is so relatively well vaccinated. these hospital numbers are not more concerning than they are. the hospital peaks are far, far less than what we were predicting and without further mitigation efforts that we saw in the fall and winter. it is inspiring that we've done such a good job and that many hundreds of lives will be saved because of our vaccine efforts. the sad part of this is 95% of

hospitalizations are preventable with vaccines in this scenario. the vast majority of these people who will be hospitalized will be people who have not been fully vaccinated. were continue to push vaccines out and supporting vaccine efforts across the city, in addition with our partners. the vaccines remain the ticket out. i will say, however, because of the widespread transmission of the delta virus and because there is consensus that people who are fully vaccinated can still transmit the virus, that the health officers across the bay area region issued an indoor mask mandate following up on an indoor masking recommendation that was reduced on july 16th, with the hopes that we will be able to mitigate the spread of delta through indoor masking.

this is being driven -- the spread is being driven by unvaccinated people. vaccinated people can also spread delta. next slide. >> with this model, we folk -- forecast 257 more deaths due to covid-19 due to the delta variant. the assumption here is concerning to us. 95% of the deaths are present -- preventable with vaccination. covid-19 would not spread if we had even more people fully vaccinated against covid-19. so compared to other parts of the country and other parts of the world, we are in considerably better shape. i want to make sure that we take

the big picture into account here. but obviously, obviously with the big picture, we need to be mindful of the death that potentially lays before us. and again, these are mostly people who are not vaccinated. next slide. in terms of hospitalizations, there has been a lot of media attention on the so-called breakthrough cases. people who are already vaccinated, fully vaccinated who do require covid-19. it is an important piece of data to follow. we are following that. the bottom line is, look at the difference between hospitalizations and people who are fully vaccinated versus not fully vaccinated. this is a remarkable graph. these vaccines are remarkable medicine. there are very few things in public health that i can show you, even with the process -- the presence of a pathogen and work covid-19 is right now, we

would have a market difference in hospitalizations. versus not being fully hospitalized. and to date, to my knowledge, we have had nobody fully vaccinated with covid-19 who had died from covid-19 causes. >> this is new vaccine administration and first doses. 550 a day is the rolling average. there was an uptick recently and we're hoping that the slight uptick continues. we are at about 450 a day couple of weeks ago. hopefully more people are getting vaccinated. this afternoon i was pleased to join the mayor in announcing a programme which is basically a

programme by which people contact the health department and if they have somewhere between five and 15 people in one location, we will send a team to their home and whatever locale to provide the shot. this is a programme that we are going to be running tuesday through saturday. it launched and right in -- right after that, we got a number of entities wishing to sign up. we're looking forward to making it even more convenient for people to get fully vaccinated. we know how important it is. next slide. in terms of vaccine administration, 77% are eligible residents. they are 12 years and up and they have received a full dose of vaccine that translates to

70% of the population overall. remarkable numbers compared to other jurisdictions in the united states. the vast majority of jurisdictions in the united states still leave room for delta to spread. particularly among the adults who are eligible and not fully vaccinated. you can see, jerk -- doing some basic arithmetic, we have thousands of people eligible for vaccines in san francisco who have not received the full dosages. next slide. as we have seen through much of the pandemic, new covid cases are proportionately concentrated on the city in the south seas -- in the southeastern parts of the city. these are new covid cases over the last two months. you can see the concentration of cases, the darker shade of blue on the map, the higher the rate of covid-19 cases. you can see in the neighborhoods there with the highest rate of

covid cases per 100,000 residents. and the efforts in d.b.h. and working with the community partners continue to be concentrated in the moment -- in the neighborhood with the highest prevalence. next slide. vaccinations, by race and ethnicity. you can see on this side that our percentages overall are higher than the national metrics. you can also see, particularly among the black and african americans, people identify as white and their rates are lower. we are at 62%. it is not good enough. we are seeing significant improvements there. among the age group vaccination rates -- the 12-18 is the lowest

vaccination right in the city. we need to work with social media and taking other steps to encourage people to get vaccinated. our officers say that we have made it easy. we're supporting efforts to make it hard, not to be vaccinated. so supporting businesses, bars, restaurants and other entities that are requiring proof of vaccination status in order to go into business inside something that we think is a very positive step and we're supporting that as well. as you all know, the health department, the city, and many other providers and businesses across san francisco are increasingly requiring proof of vaccination status for people to work. next slide. i do think from the commission,

for you to be aware that the covid task force is working furiously. many, many hours a day with regard to the targeted response. i also wanted to be sure to share with you that the targeted response will not be at the size and scale of the response that we had during our prior three surges. and just to put it in some context, there is demobilization from the health department and other city departments in june. we plan for 30 new covid cases on that was advised at that point by many infectious disease experts. we were down to as few as five

cases a day. we are now averaging 206 new cases a day. and then in terms of staffing resources, because we have neglected so many other parts of our services and care for people who have multiple other health needs, we can see that the d.p.h. task force numbers in terms of f.t.e. available to do the work has declined significantly. we are now at 275 gsw his currently activated which is less than 25% of the total in 2020. and then you can see, because other city departments have interrupted, there are incredible drivers who are up with so many of the operations, the paramedics who are working with us on so many efforts in getting vaccines. people have gone back to their

other work. and therefore, you can see numbers are much lower. we are in a much better place. we have learned a lot. we can still be effective, but our response cannot be as robust as it has been. we are targeting and focusing our efforts on supporting school reopening, which we think is so key. we know it is so key. our work with the most vulnerable populations, ensuring that shelters have act -- have access for testing and support, in isolation and quarantine hotels, and working with neighborhoods with the highest prevalence of infections. we are focusing our efforts in this regard, shifting the way we are doing things like contact tracing, where we are focusing on these places to help management rather than attempting to focus on everything all at once, in which case we would not be able to be as effective as we are with the new focused strategy. next slide. and then just to emphasize how much we are supporting and

are dedicated to having schools open safely is just an example that we have our team working on this. this week, which we are going to schools safely hosted by d.p.h. and ucsf experts. working in concert with the child you the and families and also with the schools to make sure we are doing everything we can to make sure inprison learning is conducted in a sustainable and safe way for our community. i will stop there and take any questions. >> to be have any public comment? i don't see any hands. >> all right.

thank you. commissioners, any questions or comments for the director? >> thank you. have we seen, in the unvaccinated numbers, the increase within the cohort of folks the number of children? >> yes. we have been asking that question. i will get them the most updated data on that. the last time was not too long. we hadn't seen a significant -- as high as an increase in those numbers as one might have thought. that is good. we would expect potentially that to change since 12 and under are not eligible for vaccinations. i can get you those numbers. there was not a pronounced shift and that percentage, to the best

of my recollection. >> okay. thank you. i think that will be really important as part of the town halls, but also our media and encouraging families to have their children returned to school. >> absolutely. what i can say is we have seen a big change in the average ages of people who are hospitalized in the city, consistent with the severity of the disease. twenty-five% of our hospitalizations are people under the age of 25. >> thank you, commissioner. >> commissioner christian.

>> thank you for this update. i apologize if this is something you touched on a bit, and i might have missed it, but can you talk about the department's view in terms of testing and based on the utility of it and whether there will be an expansion of its availability. i understand exactly what you just said about the available resources at this moment and how much they have been decreased, but can you first talk about your view of the utility of testing to understand more of what is going on with this particular variant and the ones that are inevitably coming? and how we might decrease their prevalence? >> thank you, commissioner.

i think the way to decrease the prevalence is to make sure that people get fully vaccinated. i think testing is an important component of that. if people continue to get tested and not get vaccinated, that is not solving the issue. again, we are really focusing on, as we add to -- as we focus our response and strategically deploy with resources, we are integrating the testing and vaccine efforts. so that when people go out to test, they can also avail themselves of the vaccine and vice versa. we are seeing in uptake in testing of numbers as the numbers of covid diagnoses increase. right now we continue to focus on testing at our sites where there are patients and people who don't have health care coverage and the drop-in centres and are working with other

healthcare systems to prepare for potentially more testing demand. right now, d.p.h. has been conducting 40% of all the tests in the city, despite the fact that we provide health care coverage to only about 8% of the people in the city. we will continue -- right now, again, we have not exceeded our capacity. demand has not exceeded the capacity for the test. we're hearing from people's concerns about the ability to turn the test around. there are other healthcare institutions that can be around for 72 hours. we will see this continue to be a challenge as we saw in the fall and winter surge and is more testing ramps up, little -- labs get further behind. the other thing i would add that we are encouraging, and obviously this is costly for people, so this is not a way to

see it, but it is an option for some people. if there are home test kits available where people can self-test, so we are encouraging people to avail themselves of those options if they are available to afford it. testing is focused on combining testing for vulnerable populations, in shift and in shelters and working with clinical partners across the city to encourage and support broader testing implementation as we face the next surge. >> i do wonder how the private works and are entities that can provide testing to their patients and their clients.

they are responding to your request to increase the amount of testing that is available, and i know that many people -- and everyone knows this as well, people who have gotten vaccinated, and as you know, we have a high percentage of people in san francisco of people who have gotten vaccinated and then have gotten -- have contracted this delta variant, and perhaps did not even have any symptoms or not have symptoms if they had contracted a variant of covid. what do you say to them about the level of emphasis that the city is putting at this moment on increasing testing? >> can you just say to the other providers, the c.d.c. just

recently change the recommendation. that they get tested regardless of anything. that would increase the demand in the city. with the other providers in the city, we are working closely with them. >> can you hear me? >> yes. >> commissioner? >> yes, again. >> i am not able to see anybody or hear anybody at this time. >> director kolfax, we can hear and see you. >> should i keep going? >> yes.

>> we see you and hear you. >> okay. can you hear me now? >> yes. now we have lost you. secretary, can you hear me? >> i can. i just text -- tested -- texted dr. kolfax. i am seeing the yellow triangle which shows he has bandwidth issues. i am wondering that if we can give this a minute and see what

happens. if not we can move on to the next item and come back. >> can you hear me? i can hear you now. i apologize. >> it seems like you had a band with it to -- bandwidth issue. >> it's not showing an issue, but, to go back to commissioner christian, the second part of her question in terms of working with providers, we are engaging actively and thinking about how we can collectively expand testing options in the city and basing it on our work with the vaccine access work. i don't know that we would be able to expand to that level, but certainly we are having active conversations in working with them and how we could support these efforts in expanding testing. i would also add again, not that we have some issues, but we are working on potentially expanding

hours at the test site which is continuing, and looking at the possibility of expanding more drop in testing at the testing top up area, which are in communities with the highest numbers of covid-19, and expanding testing at laguna honda hospital and we are working with the shelter partners to encourage and expand more testing there. while i don't have any more specifics to share at this point, i assure commissioners that we are working hard on ensuring that we are supporting our other key healthcare partners in expanding testing to meet demand. at d.p.h. we are testing -- the demand for testing is not outweighed the demand for capacity at this time. >> thank you. i certainly believe completely that you and the department are working overtime and hard as usual. please don't take my questions to go to that issue.

i apologize if my questions haven't been very clear. i'm not feeling well as the commissioner noted. thank you so much. >> thank you. i apologize for the computer issues. i hope it has been resolved. >> thank you, commissioner christian. please do get rest and hydrate and feel better soon. vice president green? >> thank you so much for this update and the information. you talk about the workforce and one was stated and i just wonder what your projection is. first of all, we are all really concerned about the level of work and stress on the individuals that remain at covid command. and i think we would all ask if there's something we can do to support them. we certainly are concerned about them and the amount of additional burdens. the other question involves burden and as we look at the

projections for hospitalization and the concern that individuals could in fact, have the condition, and i think if you work in a healthcare facility and you are positive, you're supposed to stay away from patients. what is your projection about whether we will have an adequate healthcare workforce at a hospital level when the projected peak comes? is there concern there, and are we thinking through what we might do if we are stretched thin during this time? >> absolutely. i think there has been some articles in the press about healthcare workers who have become infected with covid-19. there are a couple of things. we know the people who become infected become infected outside of the healthcare workplace setting, which i think it's critically important to emphasize. we also know percentagewise that

far more people, healthcare workers are not fully vaccinated and are becoming infected compared to otherwise. and in talking with our hospital c.e.o.s and michael phillips, the c.e.o. of laguna honda hospital, while the numbers of infected continue to be tracked and are of concern, we believe, at this time, that we would have adequate staffing to manage the projected numbers of people in the hospital, and we are also working with our hospital partners to ensure we are doing everything we can to prepare for the event of these models translating into over 300 people in the hospital at the peak, that we do have beds and staffing available to care for them. it won't be easy. it will be a huge strain on the

system. it will be more people than we have in the hospital over the winter. again, we are in a better place than we were without the vaccines. >> thank you. thank you to everyone for this excellent work. >> thank you, vice president green. commissioner child? >> yes, thank you, director. the information you are providing is very helpful and tells us that this city and our health department is really working hard to respond to this new delta surge. i have two questions. one was that on your slide of the projection, you had highlighted the word, no waning immunity. i'm not sure -- did you mean that that was part of the assumption, and you could -- could you talk a little bit about what you think might be

happening and from what you might be seeing in your experience? in the second question related to the home testing, do you believe, or is the department considering that home testing actually meets the requirements that are being placed on employees and employers to do testing? i'm hoping that this will not be too consuming of your time to try to respond to those. >> yeah, in terms of the waning immunity. we are working with infectious disease experts to determine if there is any waning in natural immunity, particularly in regard with the delta variant if people were infected before. i can say that i have not heard that that has been a major concern in terms of how the

virus may spread. as we are looking at the decline in cases now in the united kingdom, one of the hypothesis is is that it is a combination of the high vaccine rate, and the high prevalences of prior infection that may be responsible for that decline, which would add on the more optimistic side that prior infection does confer some immunity on the delta variant. that is what that model essentially is assuming. we will continue to watch. in terms of the home testing, we can get to a more specific answer. there are obviously a lot of different home test kits out there. i don't want to make a general statement. some of them are good, some of them are not so good, some of them meet these and some of them

don't. we can certainly get a few more details on that, or at the next health commission meeting. i can provide a more brief update on how we see home test kits being used, not only in the workplace, but in the community as a whole. >> i appreciate that. i think on the home testing, you're exactly right. there are so many different products out there that are being pushed by the pharmacies, and it would be nice to have an expert opinion as to which ones people could most rely on, and perhaps, i know we probably can't say the ones that shouldn't be using, since they are a product that is allowed to be sold, but it would be useful to have some recommendations in regards to that, just from the consumer side, and maybe you

have also worked from an employer side whether any of these meet the requirements that the city and the state are asking for. i appreciate that very much. thank you. >> absolutely, commissioner. >> thank you, commissioner ciao. director kolfax, you can we go back to the slide with the d.p.h. covid task force for a minute, i believe michaela is ready to pull that up. i just wanted to put a double underline and an exclamation point under some of these numbers. they are significant and i would ask you to elaborate on that in any way you would like. we are less than 25% of our total d.p.h. mobilization in 2020, even though we are facing a rapid increase, faster than

any other surgery have experienced, and also that we are 72 known d.p.h. deployed staff compared to 62020. i would like to know, what is the told that that is taking both on our staff who have been working so hard and have been so committed, what toll is that taking on them in terms of the workload, and how hard they are working, particularly in the absence of other stuff you have been deployed or who have been demobilized, and what is the impact on the department and the other critical work that we need to be doing? please elaborate that in any way you would like. >> there are a couple of things. certainly people continue to be deeply dedicated to this work, as well as the other work across d.p.h. and 18 months into the pandemic, we are also seeing the other health effects of the pandemic beyond covid-19.

there are a number of behavioral health issues, a number of physical health conditions, that because of our massive deployment for 18 months, we are seeing really less than positive outcomes for it, in addition to having -- to catch up. for instance, within the health network, being able to remind people that they are due for a cancer screening. it is a concrete example of where we are juggling many competing priorities. i think that while people are incredibly committed, they are also exhausted 18 months into this. and within the covid task force, i'm showing the f.t.e., they don't translate these as working eight hour days. many are working much harder than that. i'm also trying to make sure that we take care of ourselves, both our physical and mental health as we are in this for the

long run. which is why we are really needing to strategically focus our approach, ensuring access to vaccines and testing among communities who are most vulnerable and ensuring that we are working to link resources with other healthcare systems in order to ensure that people have access to care. this is challenging. as you saw from the model, these numbers will peak really fast, and if the model holds, it will go down really fast. so trying to adjust the system while not completely -- while balancing the need to address other issues such as overdose deaths, and other key areas of health and wellness for the city, is the challenge in the next 68 weeks. the staff is dedicated their time. they are committed and brilliant. this looks different in multiple

ways from the last surges. not only because we have the vaccine, but we have delta and we know we have the tools to help address this. we also need to modulate some of our staffing pardoned -- patterns to address the other health needs in the city. >> thank you. i think for all of, this is disheartening that so much of this is preventable. we are grateful that san francisco is in a better position than most other jurisdictions. it's a challenge that must be met. the commission is grateful to all d.p.h. staff for your resilience, your commitment, your hard work, and thank you for continuing to pull through during the next surge. we stand ready to support everyone, including you, director kolfax. thank you. >> thank you. >> other questions or comments from commissioners? all right. seeing no additional comments, we will move on to the next

item. thank you, director kolfax. the next item, which is the land acknowledgement resolution. >> i apologize. but just to jump in, general public comment is first. i don't think we have any, but we need to check. >> thanks. i was shuffling through my papers to find my agenda. i guessed wrong. thank you. >> first of all, if you like to make a comment about anything that is not on the agenda, press start three to raise your hand. thank you. >> thank you. we will move on to the land acknowledgement resolution. before we begin and hand it over to patrick chan and to the commission secretary who have worked hard on this resolution and engage really infect --

effectively with the community, i would like to acknowledge the community members who helped to shape this resolution and make it the excellent resolution that we have before us today. we may have dr. cordero on the line. thank you for joining us again, as with our previous meeting. i will -- we will hand this over to mr. chen and mr. morrow it's. >> hi, everyone. i will read the resolution, and then commissioners and members of the public, if any of you have comments or questions we want to say anything, than that is how we will move forward. is that okay? >> yes. >> health commission acknowledges that these are the

original people of the san francisco peninsula and where is the commission acknowledges that the area comprising the city and county of san francisco was originally inhabited by an independent tribe of the peoples and prior to the arrival of the spanish in 1769, there were 1500 persons and they lived in small travel groups. but the end -- by the end of the mission period, only a few families survived. the health commission acknowledges the association has actively worked to research and expand public awareness for their history and culture, and health commission acknowledges that they are not an unethical population of the past, but an integral and active community the bay area region and beyond, with ongoing exclusion and disability that threatens the greater american indian community with inclusion and

respect in san francisco. [indiscernible] and were as san francisco human rights commission published a report in 2007 title discrimination by omission, issues of concern for native americans in san francisco, detailing the ways in which american indian communities experience exclusion in san francisco and identify numerous recommendations for improved outcomes and processes.

it is important to counter the narrative regarding the doctrine of discovery with the acknowledgement that there always have been communities living on this land prior to the arrival of europeans, and where as the land acknowledgement is a formal statement the recognizes and respects american indians and storages of the land, and enduring relationships between the traditional territories, and where is the health commission recognizes the land acknowledgement resolution is just the first step needed in acknowledging and honouring the land and culture wisdom and contributions of the peoples. be it resolved that the

following land acknowledgement will be read aloud at the start of each health commission and department of public health meeting that is open to the public in accordance to chapter 67 of the administrative code. statement is the san francisco health commission and department of public health staff acknowledges that we are on the unseeded ancestral homeland where the original inhabitants of the san francisco peninsula. as the indigenous stewards of the land and in accordance with their tradition, they have never seated, lost -- [indiscernible] -- we wish to pay our respects by knowledge and the ancestors and relatives of the community and by affirming their sovereign right as first peoples.

>> thank you all for your time and commitment to this. >> commissioners, do you have any questions or comments? folks on the line, if you like to comment on this item, which is item six, please let us know by pressing start three to raise your hand. no public comment, commissioners. any questions or comments from you? commissioner brown i am turning back to you. >> thank you. i see we have a commissioner comment from commissioner chow.

>> yes, thank you, mr. president. i wanted to really acknowledge the work that mark has put into this, along with dr. cordero. and the concern and the careful consideration of the american indian community here in san francisco. i will look on your website. i am pleased we are now addressing these issues. i did ask in our last meeting to try and address those if we could. it is my understanding from the department that they have been trying to assess the needs along with working with the american

indian colleagues in doing this. i am looking forward to a future companion resolution that will help the commission also recognize the special needs that the american indians have and that we as a commission and department are dedicated to be sure that we are responding to those in the interest of humanity and health equity. i am supportive of the resolution. i know that my fellow commissioners will be also. thank you. >> thank you for your work, commissioner chow to carry this forward and take next steps for the commission and the department and the community. we look forward to an additional resolution coming back to be calendared at a future date. do we have any other questions or comments from commissioners? seeing men, do we have a --

seeing none, do we have a motion to approve the resolution. >> i will move approval. [please stand by]

>> -- by the harm reduction therapist center is funded through a reallocation of their own funding, and you've already approved their contract, so there's no new contract, but i am presenting to you d.p.h.s [inaudible] for the proposed move. so the d.p.h. is proposing to move start from several locations to a single location at 21 marlin street in san francisco. and specifically, they work on the [inaudible] their transitional youth homeless

outreach team as well as their outpatient 48

attendees, including staff, and staff from harm reduction therapy center presented a powerpoint, and then outlining their program and their plan and their intent to lease the site, which is 3,412 square feet. there were some questions that

were all answered, and there were no objections raised. sometimes if there are so many questions, or there's objections that we need to follow up, then we do schedule a second or third meeting, but that wasn't necessary. so that is -- i'll stop there with my part, which is really to assure you and walk you through the department meeting its obligations to the prop i. i know, i believe, that pat denning is here from harm reduction therapy center, the clinical therapy director. if you did have questions -- i know that commissioner green did ask -- she had four questions in e-mail, and i don't know if the e-mail went back to you in a timely manner, but i can just turn it over to pat, if that's okay. >> well, actually, i did forward those responses, just

so you all know. >> okay. all right. well, then maybe we don't have any questions. >> all right. before we go to commissioner comments or questions, secretary moore, do we have any public comment on the line? >> folks who would like to make public comment on this item, please press star, three to raise your hand. star, three. no hands, commissioners. . >> all right. commissioners, any comments or questions on this item? commissioner chow? >> yes, and i want to thank michelle for forwarding a map, because now i know where merlin street is. and i know there were some questions about on-site services, but it sounded like this was initially or primarily

an administrative move to bring your offices into one site so you could also be more efficient. but could you also describe because there was some talk about trying to see -- i mean, outreaching to this more immediate community, what also you're going to be driving there, versus -- what does get moved, what doesn't get moved, or is this an expansion of services, keeping what we already have and adding the site? >> yes. you know, actually, i believe it will be an expansion of services. we are moving our clinical staff as well as our administrative staff to this one site in order to create a home base for people. our services are provided in a number of community agencies as well as in mobile outreach, and prior to covid, we were actually -- we actually had a

mobile van that would set up in different places and offer treatment services in neighborhoods. since covid, we have been unable to have those gatherings, but we have still maintained a presence in all of those neighborhoods as well as in our brick and mortar community partner sites. we -- what we will be doing even during covid with the merlin street is being able to offer the clients that we are seeing already seeing in our facilities or mobile treatment sites, we will be able to see

them more frequently. i can say, i'll be at the merlin street center on friday if you'd like to meet there. so all of the staff will have a certain amount of time that they'll dedicate to being on-site at merlin, with the commitment to those people that we have been seeing on the streets. we will, hopefully sooner rather than later, create a drop-in time for members of the community and particularly the sixth street corridor and members of the community. >> i certainly thank you for the explanation. it sounds like you're working with a needy group despite

covid, and as dr. colfax noted, with overdoses and substance abuse, so appreciate that, and glad to see that the community seems to feel that you'll be a welcome addition. thank you. >> thank you. >> thank you, commissioner chow, and thank you, also, pat denning. seeing no other questions or comments from commissioners, this is an item for discussion, not action, so we can move onto the next item. thank you very much, and thank you, ms. ruggles. >> thank you. >> our next item is an office of health equity update, and i know we'll have a presentation for this. thank you to dr. ayanna bennett, who will be presenting tonight. i know all the members had an opportunity to do one of the training modules, which was

incredible and so informative and directive of the work we need to do to ensure equity in health in san francisco, so thank you so much for providing that opportunity to all of us, and we look forward to engaging in that and your presentation now. thank you. dr. bennett? >> thank you. [inaudible] is going to do the slide for me. so this is your racial equity action plan update, which we are doing four times this year, but this is an update. i don't want to let the racial equity action plan, which we have many amazing things that we need to do, but was

developed outside the department, to overreach the obligations that we have in the department. we have lots and lots of obligations, but they aren't all encompassed there, so you'll be hearing those. next slide. there i am again. there's the office of health equity, so it's not just me. i used to encompass the entire thing, but now i do not. next slide. and just as an overview of the topics for today, so we're going to talk about d.p.h. health equity overview, expanding resources, the equity a-3 goals and their status, the health commission racial equity action plan items, and then h.r., our new director of h.r., is going to talk about the new directive h.r. related ones. i will do the non-h.r.-related

ones. many will overlap, but you'll see the division. so i've been trying to socialize our way of thinking about this equity work, and that means it comes in four quadrants, and i'm sure that many of them don't fit in any of them, but we're trying to change the way we think about this. we're trying to change the way we do this work with staff and partnerships and skills trainings so that people know what they're doing. we're trying to directly impact health disparities with community engagement, with service quality, and we're trying to deliver accountability on these issues because we have an enormous amount of goodwill, that goodwill doesn't actually make changes all the time, and so we are looking for accountability, and you are a huge part of that. so report, reprint, making sure we're held accountable, and

then data tracking, so we can deliver data to the community so we know what it is we accomplished or not going forward. next slide, thanks. so one of the things that is changing is we are investing again in our equity infrastructure? i will say the fact that we had equity infrastructure at all was very clear during the early part of the pandemic when equity work still continued? we released that training in the middle part of the pandemic because people kept working, so i think we are looking really forward to moving things along as we get even more staffed, so there are ten staff in the office of health equity. once we're done hiring this year, that'll add some trainers and some community based staff? the divisional equity staff, so that's the equity staff at [inaudible] and laguna honda,

and all of the site. that's going to actually be higher than that over the next few years, so that's 27 staff, but not all of them are full time? but if you look at that, many of them are in different areas of the department. funding has increased. we are at about $330,000. there's still a significant chunk in behavioral health that comes out -- that is part of the mhsa package. go forward? so that expansion will accomplish a few things. so it lets us have dedicated functions, and we have succeeded in being jack and jills of all trades, but maybe having a little more specificity will be effective, i'm hoping. so people that do data administration, that includes i.t. workers, administration, those two events that we had this summer, one for antiasian

hate, and the other for black african american workforce issues. those both took very little staff to do, and we wouldn't be able to do them without the existence of the g.i.c., which doesn't exist anymore. health and community, we're going to be having the training for covid staff that are being added on for community, and that same training and framework development will be carried forward into our staff, so we're going to take the opportunity to make sure our staff know the history of the neighborhoods that we're working in and various other things so that they can see the communities as partners. and then, we have the workforce equity that's going to get some staff under him. we found that on-line actually

worked, and there was much debate whether people could talk about this issue or would actually do it, and we got reasonable feedback that it has been rich and people have gotten something out of that, so you'll see more of those based on a set of competency skills that we're developing. next slide? so our 2021 goals and activities, the ones that aren't on the racial equity action plan, some of them do overlap, but they were previously in the chute. we added the health equity learning requirements last july, even though many people were deployed, were actually in regular basis, and our goal was for 80% of staff to complete. we know that several section individuals have gotten 80 or 90% of their staff to complete,

but we still need to get certificates for everybody else. the current learned systems aren't direction at the collection, that's why we need somebody to do that current data collection and analysis. the health equity impact tool, we are still developing that. we want to employ equity action programs, and questions about respect, so we're looking at all of those. the next iteration of the staff engagement survey should come out this fall. so we can't really say whether we succeeded in those things, but we're hoping to see some changes. and then setting up a process for equity so that we have some kind of process so that people understand what's going to happen, what their obligations are so that we can go forward with a plan that hopefully would survive all of us and keep going.

and then, we're preparing a health equity data report for next year. but go forward? next slide. all right. so this is the racial equity action plan overview? so we've done 81% of the activities? a lot of that is because we've done quite a few of the things already? we did not start from zero, as many departments did. we already had equity staff? we modelled our growth on the same thing they modelled theirs on, which are recommendations from dare and some other jurisdictions, and we'd already done some things, the training and everything. so we still have some things we need to work on. you're in here somewhere, the commission. you're about 60% done, but i think rapidly going to get to much higher than that. we still have things that we need to do, but i think the entire package will be done by the end of the year, except for a couple of things that require data -- verp data development

goals? because i can't imagine we're going to hire the staff in time to get those fully done, but i think we'll have made progress. next slide? so i'm not going to go over this in detail, but just a few of the things that are -- activity that's i think are key and have actually had an impact? so we have an equitable inclusive hiring policy that h.r. has put out that they'll talk about? the director of workforce equity produced a guide for hiring managers that i think they can do their part of the process more equitably, and we have seen that piloted by primary care in hiring directors? they had a unique opportunity in a bunch of empty positions that could possible help them rebalance what had been a very skewed group of employees? tracking progression and professional skills development tracking both require a hiring. that's why they're in red, and

what i'd like to highlight internally is 2.1 and 2.34 under retention and promotion? that means there's nine categories [inaudible] by the way. internally investigate classifications for dropoffs, so that was done. one was the health worker and health coordinator series, and those have been long complained about, because staff getted stalled in the program -- staff gets delayed and didn't move up, and that's particularly african american staff and latino staff that stop there, and so we actually have developed a project that's going to be on the union, equity, h.r., are going to look at these and make some concrete plans? and we've been complaining about that for a long time and have not been able to do that, so i think having a set goal

has actually been moving things forward. next slide? so these are your activities. i have almost everything down as done, with the exception of a few things. racial equity training, i think everyone in spirit is committed. i think having the resolution around how you're going to interact with community, i think, actually, is part of that commitment, and then having some decision around whether or not you take my recommendations or want to do something else or want to do more or less or something. some shared agreement, and i think we can fallback on that, as well. expanding diversity through voices. this is something we can say we're already on the path too. i think going to the community has been a really innovative

approach that the commission has had, and i think this will just push it even further, and then, the racial equity assessment tool is coming. all right. go forward? all right. so the availability of training at d.p.h. both impacts you for when you're deciding what kinds of training you want? but just, i think it's a general issue on behalf of the department? we don't have a large number of dedicated trainers outside the hospital, and those are very dedicated to a lot of regulatory needs around nursing and mental health. so we instituted the four hours a year learning requirement this year -- last fiscal year, sorry. we've made four -- there are four equity focused on-line trainings? there are multiple webinars, and there's a printout that i think you should have gotten of that. there's a five-month health equity fellowship. i think it'll be in month

three, and then, there are lots of self-education resources. so what we're going to do is take the competencies that we've developed and then map those things against them and look for where we have critical goals. go forward -- next slide? and the way we're doing that, the competencies, there are 100 of them so far, so we may be getting a little too granular, but they do come in areas, and i think there's a reason that we need each one of them. so structural competence is just explaining the [inaudible] on marginalized communities. extra, within that competency is the ability to extrapolate from that to the experiences of lots of groups which overlap significantly. that is addressed pretty significantly in the training that you took. it was directed to do that, so that's kind of a baseline, do we have all the same

vocabulary? do you actually understand a bit about the history that people hear? so all of those things i think are more or less covered. we still need to flush it out, but we've actually gone there. research and data analytics, program planning, quality improvement, equity policy and law, there are areas that everybody needs, and then there's areas that are more particular to managers. i have seen leadership competencies that we've just gotten to the point of finalizing, and those go to activities. holding management accountable goes with equity in your one-on-ones with your management and on your agenda, so we're trying to map the competency to the behavior and then who's going to check what you've done in your behavior.

next slide? can you still hear me? >> yes. >> so the ones that are currently available are intro to health equity and sexual orientation and gender identity? both of those, we've just developed in the last few years, and both sort of by borrowing resources from the general and a little bit here and there, so there was not much of a centralized process except we pulled everybody together. i think the production will be much smoother as we go forward? but both of those talk about structural issues, and they're really basic, so 101. knowing the terminology for racial ideology and sexual orientation and gender identity, those are the ones that we want people to know coming in, so those are the ones that i would suggest for

orientation, and those are each about an hour. and then, the standard i would suggest would be two hours for orientation. we may change what we do as we go forward and we determine things may be more appropriate? and then two hours of training for everybody else that's not in orientation. and then, the on-line trainings will change over the years? it will be probably more feasible to pick them every year, to pick ones and have a group agreement, and that'll be your agreement to doing them? and a way to understand what's available to the rest of the department. so at some point in the next two weeks, there'll be hopefully specific trainings for environmental justice and so hopefully, the choices will

get more and moreover the years, but we can always track ourselves through those competencies and see if the ones that you have defined as a commission are the most important. next slide. so that was all i was going to cover today before you hear a lot about h.r. racial equity action plan goals. any questions on any of that? i know i heard some before. >> thank you, dr. bennett. we have commissioner chow? >> yes, thank you, dr. bennett, and i think i really appreciate the clear presentation that you've made, and -- so this

helps with racial equity. when do we get to discussion asian american events? i know you talked about african american events, but is there a section that's going to talk about how we're handling -- that's kind of my mantra here. where are the health disparities? >> so there are a few things i think you should hear about it. first, everyone should be doing equity, so hopefully, the he can -- the equity tool will help them. so primary care has an entire dashboard. everyone needs to develop something in their toolkit that tells them whether they're dealing with equity. the other way is we are finalizing -- there's been a lot of back and forth around the equity dashboard for the department, so we're getting it

down to ten measures as the constant ones, and i think what we're going to do is have population measures, probably hospital based and a few others because that's what we have on at least an annual basis and match those within the process measures of the department. so for example, heart disease hospitalization and hypertension control within the department, so those are -- or tobacco use as a population and our tobacco control equity in terms of who's taking our tobacco control resources. so those kinds of match ups, we should be able to get by the end of the year on a dashboard, at least those ten measures? what i'm hoping we'll do every three years is what has been done with the community health needs assessment in the attachment addendum section, which is to have much more

health data. there were actually over 400 graphs in the 2016 one, which i think is viable, and i loved that thing, but it was too hard for anybody to actually get anything out of, so what we're going to do is bring those down to 50 to 70 measures and talk about them and how people are doing in terms of racial disparities, but also do i would say little supplement assessment for different groups. so instead of having an entire report that's talking about native americans have a report that shows the graph that talk about everybody, and then, one part of the report that does the narrative of what does that mean if you look at those graphs about how the community is doing, so those are hopefully going to come out around the same time as the community health needs assessment next year around summer or fall.

i don't know. i don't have a calendar, but i think we'll finalize the measures by the end of the year. we just need the data lead ins that they're having to match with process measures, which they're happening sometime soon, but that is going to happen one way or the other, and the next year, we will be reporting on how we're doing. so the dashboard, a couple on the dashboard, and then, the d.p.h. and a much larger report. >> well, thank you for that. i appreciate your enthusiasm, and i'm looking forward to those reports. thank you. >> yeah, thank you. >> thank you, commissioner chow. commissioner chung? >> yes. thank you, dr. bennett, for this amazing wonderful --

[inaudible] >> -- you know, to look at beyond just health outcomes, but if we look at the structural health issues that prevent some people from obtaining optimal health. one of the things that i was curious about, like, so these trainings are specifically for the department, and i was wondering, you know, if, at some point, you know, like, other departments such as the planning for events, you know, like, would be inspired, you know, enough to go through some of these training, as well. i think that, you know, in order to really see changes, you know, that are sustainable, we need systemic overhaul, not necessarily overhaul, but, you know, at least some systemic changes need to happen. >> well, i have had opportunity

to share the racial equity things with folks in other counties. we're trying to see if there's something we can do regional because our issues aren't so different that it might be better to pool resources? so we have been sharing those widely. i think we can spread what we're doing to other departments. i'm trying to pull together -- like, the human service departments, we're trying to get together around data at the moment, but i'm hoping we can make some more alliance around on going work, so we're talking about some community engagement shared activities, but part of what's happening with the racial equity action plan is everybody's been mandated to have some kind of training? we have shared our sexual orientation gender identity training. we have earlier given it to the

office of transgender initiatives a while ago, and they shared it for training for some other groups. health disparities are really everybody's problems? so i think they can listen to our training on health disparities because it's got a lot of structural issues that don't impact them or their health area, but i do think that people need to be more aware of that. so yes, i do think we need to share them, and hopefully, we'll get some more coordination and maybe [inaudible] will create the one or maybe even the department of the environment will create the department of the environment one. we're getting better coordinated, but many departments are just starting to put staff in place, so i'm trying to find counterparts and do some shared discussions, but i do think we'll get there,

though. the office of racial equity is doing a great job of bringing everybody together so we can do that kind of thing. >> like i said, thank you so much, and, you know, i'm really excited. and also, you know, like, i got some, you know, history lessons on the training because, like, i've been studying u.s. history for, you know, when -- before i moved to the country, so, you know, it's great, you know, that it really ties back into all these, like, historical contexts. >> well, we will keep that up. i'm hoping that we're going to do the histories of the neighborhood so that people can know a little bit about the neighborhood before we send them out to work in the neighborhood, both about the neighborhood history but also our history there because sometimes you're stepping on relationships you don't know you're on, so that's what we're working on at the moment, so we'll see if we can get that next year, as well. >> thank you.

>> you're welcome. >> thank you, commissioner chung, and i would have to say that the training was really effective in teaching about the long history of structural racism and inequity. i see we have a number of commissioners with questions or comments. next commissioner will be commissioner guillermo. >> thank you, dr. bennett and commission president. i offer my congratulations on the progress that we've made to date, you and your team. i actually had a question that was a good follow on with commissioner chung's that had to do with the training across the department, and the obtain to do that is something that is

hopefully a little less [inaudible] but something that we can definitely strive for sooner rather than later. i had a similar question with regard to the contractors that the department has. we -- you know, we do so much of our work with outside agencies and with community organizations, and, you know, just in really good partnership with some of the -- the different populations that we're concerned about. but given the intersectionality and the cross cuttingness of all of this, i wonder if we would think about extending some of this training to agencies and community contractors that we have that, for now, focus on a particular

population as their target population. particularly for san francisco, and the intersectionality and such, there's a multiplicity. >> we do work with contractors, and that it was made available, but there was something about where we were and everybodies requirements, but i do believe it's available. if it's not, i will look into that and get back to you, or

other agencies. to not honest, i was happy we did it. i really did not look that closely at anybody who did not ask for it, so maybe i'll be a little bit more [inaudible] with them about how useful it might be for them to have it. it's a little bit difficult to figure out how -- actually, they all use peoplesoft, so let me look into that because we certainly could make it more widely available to everyone in the city, so let me talk to h.r., and they can talk to d.h.r. about that. >> absolutely, and many see the same populations that getting served as d.p.h. facilities, as well. it's just in the interests of making sure that this is as

widely diffused and uniformly available as possible. i think -- and part of it is just that i think that the materials that we have that are developing are widely supervisor than most that we would be exposed to. >> thank you. appreciate it. i will also say that it is not the up front message, but part of it is really not about the facts any way. i certainly want them to have that, but part of it is sewing the seed of curiosity that there may be more to the story than you thought? even if people get nothing else, that there's more to this than i thought, and that's a skill that's widely needed. so anybody looking at that, and maybe they just get from it, maybe i don't actually know why they're late, maybe i don't know why everybody is late about this bus stop leaving, but maybe a little bit more about lived experience and

there's my differ, i think we'll get something out of it, so i will try that. let me ask around, and i'll see. i'll let you know. >> great. thank you very much. >> you're welcome. >> thank you, commissioner guillermo. commissioner christian? >> thank you, dr. bennett, for this training that's so clear and informative, and the explanation structural inequality and the impact that it has on people's lives because as commissioner chung said, we're not going to move forward in any substantive

lasting way until the structure is addressed, so just thank you for this important work. and as commissioner guillermo was mentioning, in the contracts with the city, [inaudible] and i absolutely think that -- that some version of this training, if not this one just with no -- maybe people in different uniforms should be required before people can be eligible to do business with the city, and since every department in the city, you've noted with us, i believe, tasked with creating a plan. i know as a city employee, there are multiple trainings that we are mandated to go through each year, sometimes once a year, sometimes, you know, twice a year.

this something should absolutely should be one of them, and what you've created is an extraordinary model, so i just want to thank you and thank you so much for the work. >> thank you. i just wanted to make a point that that would not have happened without putting people in place. i take credit, at least my slides for it. the equity lead at laguna honda, the equity lead at s.f.g., laguna honda, they did a lot of the editing. a lot of people had their hands in it. it's partly why it took so long to develop because we actually didn't have anybody who was their job, but i'm really glad that everybody finds it so useful because there was some debate about whether doing anything on-line where

people -- where you couldn't judge where people were feeling, and you couldn't have dialogue, had enough value, and i think there are value in the data and the facts, so i appreciate that that turned out to be a shared belief. >> yeah, thank you. a lot of the on-line training -- not a lot. on-line trainings can be as you described, but this one was not, and i am, you know, not surprised, again, about the -- your colleagues throughout the department that have such a strong participation in this. you know, once again, we're seeing the people at d.p.h. showing -- showing us their strength. so really excited. again, the structural piece is very good, not overbearing, not too much, not too complicated,

and i think it's a great foundation to build, so thank you so much. >> well, i'm going to see what we can give you all about the -- so we have taken in reporting about what each department is doing, and that's where you'll see a little bit of the health equity, commissioner chow, but i'm not saying they're saying it about themselves. so we've got an annual report that will likely be in the spring in normal years. it'll be late this year, but that'll be a public document, and i'll sent it to you all, and then, we're going to have an annual oral event, which we had last week. it was a test case, but there will be more opportunities for people to hear about what we are doing. >> great. thank you, commissioner. we have commissioner giraudo. commissioner giraudo?

>> yes. computer issues. thank you, dr. bennett. this was excellent. it was just -- first, the training was excellent, and i really second commissioner guillermo's request that others would be able to view that training out of d.p.h., as well. i, for one, have searched high and low for adequate training for my staff, and it's really not out there in what you had put together by far, so it's wonderful. and my -- my very simple question was, on slide 10, and i think you just alluded to it, the activities, there were three different topic activities, and you said that they will be held, and my simple question, are they going to be held probably virtually

now, but in person -- simple question. >> yeah. i think all have converted to being on-line at this point? i think at least some, particularly the discussions, ideally would transfer back to in-person. there was something about being able to talk about race is its own defined skill, especially at work in a not entirely emotional or personal way, so there's going to have to be something of that that we do in person, but all of those are available from h.r. those are h.r. trainings from h.r.s website, so they really have been adding more and more over time. so those are available as trainings, although i think we're going to convert more and

more to that format. >> okay. on the slide, it noted event, and i thought, where are we? it was on slide 10. >> the equity learning requirement on-line training, multiple webinar training. >> on the bottom of that, on the bottom of that slide? >> uh-huh. multiple -- develop multiple training, so -- >> so that's okay. i don't want to take that time. the effective communications for diverse teams, etc., and that it seems that those were going to be, i think, where it said events. >> yeah, those are -- those are still being held. the last one, the next one is august 11. they really are just -- you can get on and schedule it now. >> okay. so [inaudible] it's virtual.

they're live virtual events, though. >> okay. great. that's what i was asking. >> there was a live discussion. if they want to go on and discuss, which is great. okay. thank you very much. >> and we do still have the equity learning series, which now there are dozens of. there's a lot every day. i think there's at least one a week. i think there's multiple a week, where people can get media, sometimes a video, but often a podcast, and people can discuss it. the attendance has gone up now that it's virtual. i did not know that would happen, but now that it's virtual, we get a significant number of people, and we've been able to identify that.

>> it is its own separate definable competency, to be able to talk about it outloud, and it's one of the questions that we ask in the staff engagement survey, do you feel comfortable talking about race and racism at work? >> great. thank you very much. >> you're welcome. >> thank you. vice president green? >> yes, well, i just wanted to add my voice of enthusiasm. this is top notch, it's comprehensive, it's prioritized, and it's characteristic of the team work of the department of public health. i thought the training was superb, and that was not easy. and the way you wove in the

p.b.s. special was so special. i can't say enough about what you've been able to pull together, certainly what people have been saying about disseminating this and proliferating this as soon as possible. as commissioner chow brought up, i think the idea that we're going to be able to measure the progress in both systemic and structural changes that we're going to be able to be doing will be so useful and so valuable and so educational. i know i'm repeating what others have said, but this is a situation where i think it deserves all of our voices. just not able to say about the work and the enthusiasm that we have for what's coming as you move forward. >> thank you. >> director colfax.

>> thank you so much. i had the opportunity to attend a training last week, and it's exciting to see everyone working together to bring this together, and how people actually do the work is something that has been challenging, and i just want to acknowledge dr. bennett's work and the team work that has gone

on. it's not that there's not anything else going on in the department, but i think it's that we're starting to see everything that we do needs to be considered through an equity lens and advanced in that regard, so just, again, an appreciation and a commitment across the department to continue to support this work. >> thank you, dr. colfax. i will say, when i got this job, people said, we started this a number of times, and we always stopped it. i think it needs to be told that it's a priority, and i appreciate that you stayed with it and kept it at the top of people's lists. >> thank you, dr. bennett.

i want to acknowledge that you were still the director at the covid command center and managed to get this done. i want to thank hannah for doing the slides, so thank you for that, and thank you for these tools for engagement and learning and a plying what we learned for measures and to hold ourselves accountable, and grateful for the modules that are rolling out. i know that you and your team will also be called onto help increase vaccine uptake in the coming days and weeks, so we acknowledge all the different directions that you're being pulled in, and the great work that still continues, so thank you. >> thanks, everyone. >> thanks. i know we have a companion presentation now, the d.p.h.

human resources racial equity action plan update. director kim? >> thank you for allowing me to be here and present the components of the h.r. racial equity action plan, and i think it'll be one of the most important things that i work on in my career, and i'm really super excited to be working with the commission and dr. bennett and mr. wagner and others would have really supported this work and this effort, so thank you so much. next slide, please. i'm looking at all of you, so i don't know if you can see my presentation. >> we're looking at you, but we'll get the presentation. >> okay. thank you so much. i have my own version of my

presentation, and i realized that me clicking is not going to help you see the presentation. okay. thank you so much, i'm sure you're aware, but a bit about the team. the dphhr team comprises 140 dedicated staff serving 8,000 plus d.p.h. employees and there are seven major functions for h.r. i'm still on the next slide, please. since i returned back to d.p.h., i really have been deeply impressed by the h.r. team. most of us are members of the bipoc community, and we see this as a personal calling. we bring the richness of our own personal lived experiences to the work that we do which adds to the importance of advancing equity because it's not something for others, it's

part of us, as well, that we bring. and so i'm just honored to be part of the team that's so committed to this work, and i want to thank those on my team who are part of this, as well as part of this presentation as well as to answer questions. [names read] >> thank you so much for all the work that you're doing, as well. next slide, please. so although h.r. has been advancing equity through other training and coaching by expediting hiring for specific classifications, h.r.s priorities began with drafting several sections of the racial equity plan under the amazing leadership of dr. bennett and others. so in h.r., we started in 2021 with the creation of h.r. equity council, which has members from each of the h.r.

team. the council strategizes with a racial equity lens through tools and training and finding a not always comfortable but safe place to have these discussions so we can learn and grow. currently, the h.r. council meets monthly and the members meet weekly to ensure that we can present the deliverables in a meaningful way. as we know, this racial equity work, there are a lot of decision points that different h.r. professionals make along the way, and it's really important that we are in alignment and have the right training and the conversations and the tools for us to advance

equity. so we will be having a training conference in the fall to make sure that we are all in alignment and advancing the city's goal in advancing equity. i can say while the racial equity plan has a lot, it's not -- we don't see it as a project, we see it as a paradigm shift on all the decisions that we make, and we make sure that we're a data driven team and look at ways that we can ensure that we're moving in the ways that we need to move. dphhr, even though we are 140 members, we are part of the greater h.r. community, so we do collaborate and work with

other stakeholders, d.h.r. and other stakeholders and others, because we're not able to do this by ourselves. we work with other members of the community. next slide, please. so there are four major h.r. focused areas? so in calendar 19-20 and 20-21, we have multiple stakeholders from a lot of great effort and a lot of work, so i'm going to talk about the key accomplishments and some challenges that we are going through in 2020 and 2021 just as a matter of putting in perspective. we have 15 this year, 15 in 2022, and 11 in 2023, so we have a look to building in future years on this plan.

next slide, please. as you can imagine, 2020 brought many challenges, but it also brought some accomplishments for us. so next slide, please. we defined four of the six parts of the racial equity plan -- i say we, but it's actually the part of many others. the diversity equity inclusion dashboard, it's drafted off 16 metrics, and that is a start, related to looking at key demographics at d.p.h., looking at hirings, terminations, by corrective actions, by salary distribution, by pay equity, covid command activations, and others. and so this goal was really to

continue to build in data sources so that we are, you are, and i am, through of work and all of us are able to actually ask multifaceted data points to help us have an understanding of us moving towards how we're doing and help us measure our accomplishments and our challenges. the dashboard has given us some initial insight regarding equity distribution of pay in some circumstances and started looking at covid command activations, and looking at -- and i'll talk about looking at candidates and the pool selection, as well, so the

dashboard is being reviewed by o.h.g. and h.r., and we plan to make it accessible to d.p.h. and others so that we can look at the different metrics in d.p.h., and we plan to do that soon. in terms of the training environments, i know there's a lot of conversation about the great things that have been done by d.p.h. the team at d.h.r. designed and implemented the work on the equity requirement, requiring d.p.h. employees to complete at least four hours of equity learning and documenting it in their performance appraisals. these are expectations department wide towards advancing equity on teams as they work with clients and patients. on-line data point [inaudible] health equity, 4,757 have completed it thus far.

sexual orientation and gender identity and cultural humility, [inaudible] 1,294 [inaudible]. next slide, please. so these challenges, as you can imagine, we went through a number of challenges because of the pandemic -- and we learned several things because of the pandemic, but one of them was h.r. was really reliant on personal interactions and paper. so during the pandemic, so much of these systems and procedures that didn't necessarily speak to one another halted because

we didn't really have a process that was digitized and didn't move without seeing each other face-to-face. and the d.p.h. did a great job and moved a lot of processes into docusign and there were 1,000 hirings done through the pandemic and others, so the hiring process continued, even though there were challenges regarding the reliance on in-office work. and the transition to remote work was challenging, like for everyone. it was challenging having access to equipment and some systems that needs to have v.p.n. access and things like that. but they are really resilient and they're able to make it. they started their racial

equity action plan in november. some key h.r. staff were deployed, which also impacts a little bit of the way in which core work was done while also helping to serve in the effort. as planned, the racial equity action plan was submitted last november, and while they are h.r. deliverables really rely on the larger h.r. community and others. so it was also having conversations throughout the city on being in alignment on things where we were interconnected, which is appropriate for us to be interconnects, but we also had to do that connection with one another, with d.h.r., with civil service, and when we do hiring, bringing it into alignment. i think h.r. does not have -- h.r. has a lot of data.

we have conversations on how we can store that data, and it's a conversation that's near and dear to my heart, and we continue to have conversations with colleagues to continue to move that forward. just an additional complexity is that much of the data that we need to collect is confidential and private because it contains demographic information, so how do we continue to put other pieces of data together and working with stakeholders that many feel is

highly confidential, so that's just some of the complexities. next slide. so of course 2021 has remained a continuation of some of the challenges in 2020. some of the things that we're coming into 2021, there are -- there is understandably a real tense up, need, and frustration of filling up all of those vacancies that we've had in the last 12 months, and there were things in h.r., like assessments and all those things that were slowed down while continuing to address the vacancies that continued to occur. so we're continuing to have discussions with our stakeholders and finding innovative ways to do things differently. we need to start doing things

differently with the equity lens to move us forward with the realization of the loss of 18 months of time. there have been -- i want to thank very much my finance colleagues and executive leadership by increasing my staff by three to help address this backlog. next slide, please. these are some of the highlights of the different priorities, and really, there are all of these different -- different action items, but in having conversations with other stakeholders, there are some key ones that people have continued to raise and i'm sure you've heard of, as well, the hiring recruitment, the need to have a more fair, diverse, open, and transparent process

of who gets hired and with where do we recruit from? there are some concerns regarding pay and equity. people should get paid the same amount for doing the same work, and really looking at that and finding ways, on setting goals, and we all are aware about collective action and the disproportionality that occurs with this collective action, and then, of course, data is key in my decision and collection making. next slide, please. also trying to be mindful of time. so regarding recruitments,

there's a lot of areas regarding the civil service process and assessment process and recruitment, and as dr. bennett had mentioned, in some of these areas, we received feedback about focusing on five clinical classifications and assessing barriers for bipoc applicants and really creating diverse pathways. so we have -- there are -- you know, the city has thousands of classifications, and we have at least 1,000 classifications, and we need to focus on the ones where we have the greatest issue, so we continue to sort of work on those. in case you are wondering, they are the senior position specialist, nurse manager, nurse practitioner, and health clinician are the ones needing a lot of work and support regarding that. the other part that we continue to work and support is our behavioral health position. need to fill 100 positions in

the upcoming year, so we have dedicated solutions to making sure we fill those positions. next slide, please. on the recruitment, we have drafted a hiring and recommended guidelines, and we continue to work on that on making sure we have concrete deliverables and guidelines and policies so that we -- we are actually making recruitments more diverse, and we are hiring more diverse teammates at all levels. there's a lot of -- there has

been some questions and concerns over the years regarding acting assignment opportunities because many acting assignment opportunities [inaudible] we can get an additional acting assignment which can then lead to another career path, so we are working on a policy to form a professional development opportunity. we know that the pandemic has impacted people in different ways, particularly communities of color, so we looked at updating our lead policies from an equity lens in making our policies clearer so that people understand that they don't have to decide between a job and the -- and providing for their families or caring for their own health, so there are many opportunities that the city has done, and we're working on basically supporting them fully

as those policies can get really complicated. i talked about drafting pay, the standard entrance process so that people coming into d.p.h., we have a common understanding in metrics about what step they're placed at? because one, we understand what salary are you at, but as you progress, it takes time to come to that equal pay, so we are committed to doing that work. this is all being done while we're continuing to support covid hiring through that pandemic. all right. next slide, please. labor relations? so the labor relations staff has unfortunately been understaffed for the last 1.5 years. so while it is a team that is generally about 18 members, it went down to five, and so now, we are staffing up, and that

will help really in providing advice, consultation, helping managers and supervisors and staff for success. as i said, we spent a lot of time and resources on boarding staff. we really need to have that level of effort and support to retain staff and continue to develop them professionally, and so we're looking at ways in which we can build up that team and really provide an equitable inclusive environment. we have started -- i know the department has started collecting information because that is part of the central h.r.s process, and we start looking at what we need to do -- to do, and what we need to do is have data inputted consistently so we can address issues of disproportionality quickly and swiftly and not

waste too much time so we have to come back to it, so that is an area. the people development team has also been working on a management training program and an academy to really provide skills. i read an article regarding people feel a sense of community and inclusion at the supervisor level. that's where you feel that's where you're a member of a team, so we need to work on increasing how all members can feel like they're members of a team. next slide. so payroll. so we have started to putting demographic data behind who gets premium pay, who gets those, like, acting pay, lead pay, right? these are decision making pays about who would get a

[inaudible] assignment, who gets an extended salary, and we're looking at these metrics as it results to pay and pay equity. and then people development team? so the people development team is a pretty small team at d.p.h., comprised of five individuals in an 8,000-person organization. next slide. so they have worked on creating and drafting a d.e.i. dashboard, and one of the things when i came on board, i really looked at building out and increasing the data team so that their workforce analytic

section, so really looking forward to doing that. i already talked about the dashboard, so i'm going to keep going. workshops on cultural humility, respect, how to do an appropriate performance appraisal. i'm going to -- so also, what i have been looking at, h.r. has its traditional functions. it has its silos and traditional functions, and not everyone comes into those traditional functions and buckets, so one thing i've been looking at exploring is how do we create bridges within h.r. so an employee can come to us with an issue and doesn't know automatically where they need to go to get resolution, so we'll have somebody that's a

step advocate, somebody that's a bridge and can help them advocate and navigate. it's someone who will make h.r. work for the end user. h.r. works for h.r., and it also works for others, but really sort of turning that around and making it sort of the end user, and making h.r. functions more relatively simple and that it works together so people don't have to say oh, is it this issue, is it that issue, but more, like, how can we help you navigate? we've been looking at career advancement. i've been having conversations with seiu 1421 to really think about ways -- and i've also had conversations with educational institutions. how can we work together in being able to help our staff

advance professionally in what they choose to do? they shouldn't have to leave d.p.h. to do that. they've made a commitment to us, and so we are looking for ways in which we can make a commitment to them through a partnership, through a modern partnership apprenticeship programs, so looking at people's lived experiences, having that credit towards college, towards some certification, and really having different pathways and finding opportunities for our staff to be able to advance. we can help with existing members of h.r. -- i come from

h.s.a., so i talk a lot about the clients and participation in social services and making that a generational change in life, helping people find ways through training and coaching, and also, we talked about how [inaudible] and leadership and finding ways we can have a formal process by which we have a leadership internship. we talked about other internships in the city, and it would be also great to look at ways in which we can foster that with emerging leaders, so lots more sort of on the great work that's being done on that? i think i have gal -- galloped

through my report, so if you have any questions, i'm happy to answer them. >> thank you, director kim. do we have any public comment on the public comment line? >> clerk: sure, we have several. if you'd like to provide public comment on item 9, press star, three to raise your hand. i don't see any hands. >> all right. commissioner giraudo. commissioner giraudo? >> thank you for -- it was an excellent presentation, and a lot of information in there, but i have just a couple of brief questions as just trying to combine both presentations. my first question is what is

the immediate training for new hires on equity other than new modules that a new hire could access at a point in time? is there a timeline to view the equity, the modules versus someday, sometime? is one of my questions? >> luenna, i'm happy to talk about it. so we added an additional training to the orientation for employees. first for nonhospital employees two years ago and then added the hospital employees in the last year? that section included sexual orientation, gender identity, and trauma informed systems? and it's been a jump between all of them as we tried to find

the compact version we can do all three together, and that is the version same as the orientation -- this is a day that's just designed to be about culture: what is the culture of the organization that you're joining, so it's all of those things together? it is a -- meant as a live powerpoint, and that's what it was precovid, and it will probably go back to that, but at the moment, i believe they were doing it remotely, and then, i believe it fell off at some point from pressure, so that was added at that thing, but the module is for everybody, live one contains that material but in a way that allows people to interact a little bit? >> that's where -- after that additional update day two of the new hire, is, then, for the

new hires any kind of follow up discussion with their manager or supervisor or is it confined to, let's say, day two? >> at the moment, it's confined to that, but that is not true everywhere because there is an equity lead at every site, so i know that they each have done different things about what is happening with new hires and how involved they are? i think we need to look at that list of four competencies and pick the core ones and give people some time to develop them, but we haven't given them the material to go with them, but we will, and then, when we have them in place, i think it will be easy to build out what

we want you to know. >> so that's great. that was just really, i guess my concern was someone would say okay, great. smr in the system, you know, that there is follow up, too, which is in the required modules, but i've just -- i just have a little bit of sensitivity to over and done with, so thank you for those questions. >> this is why we did structure first, so that is why we put that structure first, so we can take the position that it can't go away. >> okay. thank you so much. i appreciate it. >> thank you, and i just want to say thank you so much, director bennett, for that. and [inaudible] with the people development team, do you have

any [inaudible]. >> no, thank you. we initiated with dr. bennett's leadership about two years ago, the workshops. they were live, and we had some great discussions from folks coming from the various aspects of their journey. they were ready to dive in and making it a priority around their work at d.p.h., and others were just wrapping their head around inequality, and unfortunately due to covid, we were not able to extend that work. just like most of the spaces, we saw a part of our team activated, and we really struggled with how do we make this a reality? but certainly, we're looking forward to going back to in person when conditions allow. in the meantime, before staff

completing the on-line modules, we have a virtual on-line session with them where we prioritize that [inaudible] with advancing racial equity. >> great. thank you. all three of you were very helpful. i very much appreciate it. >> thank you, commissioner giraudo. commissioner chow? >> yes, thank you for, obviously, an extremely enthusiastic presentation. however, on the page under operations, and this goes to our issue for many years, decreased wait time, you don't have a delivery until 2023, when -- i know during our emergency period of time, we were able to actually reduce that considerably, so i'm not

sure why we could not try to find a more permanent fix sooner than what looks like another 18 months. i think you know, as we all do, the problems of that wait time in terms of a very competent candidate. >> thank you, commissioner chow, for raising that question. one of the things that i've spent, when i assumed the roll of h.r. director when i was at h.s.a., i focused heavily on decreasing wait times because i know the impact it has on an organization. every time you delay by one day a new hire, you decrease the services that are being provided. so while that is a date of 2023, please know that we are consistently and constantly, and i am dedicated and

committed to decreasing the wait time. we've had conversations within h.r. and with my colleagues in the city and each other on how we can decrease wait times. i'm part of the conversation that said i know the city can hire in one day. i know we can hire in a day. it might be a city day, which can be two or three days, but i know we can hire in a day. 'cause i had said, we do things the same way, we're going to get the same result. we're going to get 100 to 200-day term to hire, but i know that we can get it down significantly, so when we have positions open, we can fill them quickly with a robust candidate pool. so we are not waiting, and i will not allow us to wait until

2023 to address this. i look forward to answering this with you because i know this is a critical issue that has a lot of impact. >> thank you. i'm glad to hear that you're going to continue to work on that. i understand perhaps the goal that you're going to get measured white be in the 2023 range, but that we haven't lost sight of the need to do this as quickly as possible. thank you. >> i don't think anyone would let us -- there are a lot of stakeholders who are interested or impacts by this, and that is a core function of h.r. i see this as a core function of the work that we do and the value we bring is the way in which we are able to on board people. i speak on behalf of myself and my team where we speak daily about this issue. >> i commend you, and i urge you to keep up your enthusiasm, and i'm sure that you're going to make it happen. thank you. >> thank you. >> thank you. i believe that is it for our

commissioner questions and comments. thank you again, director kim. we're very happy to have you on board. certainly, something that resonates in your presentation is that this work happens in a space that's not always comfortable but safe, so thank you for providing this work and thank you to you and others for your presentation today. >> thank you so very much. >> okay. our next item on the agenda is the finance and planning committee update. we have chair commissioner cecelia chung. >> hi. good evening, commissioners. we -- the finance and planning committee met prior to the commission meetings, and it was pretty short meeting because everything was pretty straightforward, and we have heard presentations of, like, the contract reports for august, you know, which, like,

includes some contract extensions and also one in particular i think that's worth mentioning -- actually two -- is with the san francisco community house venture and also the san francisco aids foundations. there is a one year new contract and the hope is that, you know, by the end of this [inaudible] cycle for that, the department would be able to, like, release, like -- would be -- would release the r.f.p. you know, a lot of things have been delayed due to covid, and i think, like, you know, that it's understandable, and so we are recommending that we approve the august 2021 contracts report. and there's also a new contract

for approval, and it is with the united auto systems, which is a coding service. >> secretary morwitz, do we have any comment on the line? >> if you would like to make public comment on this item, please press star, three to raise your hand. >> no hands. >> okay. also do not see any commissioner comments or questions, so we can move onto the next item for action, which is the consent calendar. >> clerk: so for this, all we need is a motion and we can move forward. >> do we have a motion? >> i so move to accept the consent calendar. >> is there a second? >> second. >> clerk: great.

and i just called public comment for that, and we don't have public comment, so i can do roll call. [roll call] >> clerk: great. the item passes. thank you. >> our next item is other business. commissioners, do we have any other business? seeing none, our next item is the joint conference committee and other committee reports. we'll hear a report from the sfgjcc meeting and its chair, commissioner chow. >> thank you. i'll try to condense this, but i thought it was important to at least discuss the presentation we had on the caddy project, and the name actually will tell you what the project is. it's a centralized ambulance

determination for low acuity 911 transports. using this to try to see if there was a way to handle a diversion, and while that is a mixed result through two phases, the attempt to try to bring people to emergency rooms that are less impacted than other emergency rooms is essentially what this is for low acuity patients. and so they seem to have had a good satisfaction in being able to also bring people to the

right locations related to the type of health systems they might be in. however, there has been some reactions that health providers were feeling they weren't being properly recognized in the course of the delivery of the advice, which is by way of a centralized system that looked to see which emergency rooms are impacted, and therefore, if they can more appropriately and earlier be seen in a nonimpacted or nondiverted, then that would be a preferable location, but it would finally be up to the paramedics to see if that would be true or not. but that's got to be worked out and see if we can get a better rapport with the central station. the other complaint is on the other side, patients who want to go to a particular facility and aren't able to do so, even

though one of our rubricks for the low acuity -- again, there needs to be education and working out with the patients. if we didn't have this, then patients might have to wait longer in order to be seen in an impacted emergency room. so all of this requires some work with the ambulance services, and dr. brown is committed to working with this to enable people getting quicker care, and also they

were able to get to the right place. so more to come on that, but this is an on going issue of ambulances, and so i thought that it would be good for you to know that. otherwise, we are working on this, and we look forward to another presentation in his next phase, phase three. we then also did our usually regulatory [inaudible] report, which is the service we've gone through in the interim. again, well -- i would say that we scored well. we had, of course, a good c.e.o. report, the human resource report which brought up the issue again of timely hiring, and the medical staff report. and in closed session, we approved two other reports. so i don't know if commissioner green might want to add any

things that i might have left out, but otherwise, that is my report, and i'll be happy to answer questions. >> you were very thorough, commissioner chow, and i think the committee report was fascinating, and hopefully, that will continue to go forward, and all of the reports that we've received, we are all pleased. >> commissioners, any questions or comments for commissioner chow? i do not see any public comment, either. all right. thank you, commissioner chow. our next item is adjournment. do we have a motion to adjourn? >> i so move to adjourn. >> and if i could add, i would appreciate if we could adjourn in memory of janice mercatani

from glide memorial. her contributions to san franciscans most in need are legendary and beyond measure, and we miss her artistry, her tenacity, her compassion, and she'll be very missed in san francisco. >> i so move to do so. >> i second that. >> clerk: a roll call vote. [roll call] >> clerk: i believe that's it. >> thank you, secretary morwitz, again, for managing an excellent meeting. thanks to d.p.h. staff, thank you, commissioners. for those of you under the weather, i hope you're feeling better, and we will see you in two weeks. >> thank you, commissioner.

>> thank you, director colfax.

shop and dine in the 49 promotes local businesses and challenges residents to do their shopping and dining within the 49 square miles of san francisco. by supporting local services within our neighborhoods, we help san francisco remain unique, successful, and vibrant. so where will you shop and dine in the 49? >> my name is ray behr. i am the owner of chief plus.

it's a destination specialty foods store, and it's also a corner grocery store, as well. we call it cheese plus because there's a lot of additions in addition to cheese here. from fresh flowers, to wine, past a, chocolate, our dining area and espresso bar. you can have a casual meeting if you want to. it's a real community gathering place. what makes little polk unique, i think, first of all, it's a great pedestrian street. there's people out and about all day, meeting this neighbor and coming out and supporting the businesses. the businesses here are almost all exclusively independent owned small businesses. it harkens back to supporting local. polk street doesn't look like anywhere u.s.a. it has its own businesses and

personality. we have clothing stores to gallerys, to personal service stores, where you can get your hsus repaired, luggage repaired. there's a music studio across the street. it's raily a diverse and unique offering on this really great street. i think san franciscans should shop local as much as they can because they can discover things that they may not be familiar with. again, the marketplace is changing, and, you know, you look at a screen, and you click a mouse, and you order something, and it shows up, but to have a tangible experience, to be able to come in to taste things, to see things, to smell things, all those things, it's very important that you do so.

>> i try to start every day not looking at my phone by doing something that is grounding. that is usually meditation. i have a gym set up in my garage, and that is usually breathing and movement and putting my mind towards something else. surfing is my absolute favorite thing to do. it is the most cleansing thing that i'm able to do. i live near the beach, so whenever i can get out, i do. unfortunately, surfing isn't a daily practice for me, but i've

been able to get out weekly, and it's something that i've been incredibly grateful for. [♪♪♪] >> i started working for the city in 2005. at the time, my kids were pretty young but i think had started school. i was offered a temporarily position as an analyst to work on some of the programs that were funded through homeland security. i ultimately spent almost five years at the health department coordinating emergency programs. it was something that i really enjoyed and turned out i was pretty good at. thinking about glass ceiling, some of that is really related to being a mother and self-supposed in some ways that i did not feel that i could allow myself to pursue

responsibility; that i accepted treading water in my career when my kids were young. and as they got older, i felt more comfortable, i suppose, moving forward. in my career, i have been asked to step forward. i wish that i had earlier stepped forward myself, and i feel really strongly, like i am 100% the right person for this job. i cannot imagine a harder time to be in this role. i'm humbled and privileged but also very confident. so here at moscone center, this is the covid command center, or the c.c.c. here is what we calledun -- call unified command. this is where we have physically been since march, and then, in july, we developed this unified structure. so it's the department of

emergency management, the department of public health, and our human services hughesing partners, so primarily the department of homelessness and supportive housing and human services agency. so it's sort of a three-headed command in which we are coordinating and operating everything related to covid response. and now, of course, in this final phase, it's mass vaccination. the first year was before the pandemic was extremely busy. the fires, obviously, that both we were able to provide mutual support but also the impact of air quality. we had, in 2018, the worst air quality ten or 11 days here in the city. i'm sure you all remember it, and then, finally, the day the sun didn't come out in san

francisco, which was in october. the orange skies, it felt apocalyptic, super scary for people. you know, all of those things, people depend on government to say what's happening. are we safe? what do i do? and that's a lot of what department of emergency management's role is. public service is truly that. it is such an incredible and effective way that we can make change for the most vulnerable. i spend a lot of my day in problem solving mode, so there's a lot of conversations with people making connections, identifying gaps in resources or whatever it might be, and trying to adjust that. the pace of the pandemic has been nonstop for 11 months. it is unrelenting, long days,

more than what we're used to, most of us. honestly, i'm not sure how we're getting through it. this is beyond what any of us ever expected to experience in our lifetime. what we discover is how strong we are, and really, the depth of our resilience, and i say that for every single city employee that has been working around the clock for the last 11 months, and i also speak about myself. every day, i have to sort of have that moment of, like, okay, i'm really tired, i'm weary, but we've got to keep going. it is, i would say, the biggest challenge that i have had personally and professionally to be the best mom that i can be but also the best public certify chant in whatever role i'm in. i just wish that i, as my younger self, could have had

someone tell me you can give it and to give a little more nudge. so indirectly, people have helped me because they have seen something in me that i did not see in myself. there's clear data that women have lost their jobs and their income because they had to take care of their safety nets. all of those things that we depend on, schools and daycare and sharing, you know, being together with other kids isn't available. i've often thought oh, if my kids were younger, i couldn't do this job, but that's unacceptable. a person that's younger than me that has three children, we want them in leadership positions, so it shouldn't be limiting. women need to assume that they're more capable than they think they are. men will go for a job whether

they're qualified or not. we tend to want to be 110% qualified before we tend to step forward. i think we need to be a little more brave, a little more exploratory in stepping up for positions. the other thing is, when given an opportunity, really think twice before you put in front of you the reasons why you should not take that leadership position. we all need to step up so that we can show the person behind us that it's doable and so that we have the power to make the changes for other women that is going to make the possibility for their paths easier than ours. other women see me in it, and i hope that they see me, and they understand, like, if i can do it, they can do it because the higher you get, the more

leadership you have, and power. the more power and leadership we have that we ca volunteers. >> my name is mark a proud grand date i didn't all over san francisco residents are adopt rains to keep our sewer system healthy i'm adopted a grain draining i thought of a simple illusion to a big problem it will help out the neighborhood and be responsible for the places we live i want or apparent to the web site and

. >> clerk: thank you, mr. president. [roll call]