>> 5, 4, 3, 2 , 1. cut.

>> we are here to celebrate the opening of this community garden. a place that used to look a lot darker and today is sun is shining and it's beautiful and it's been completely redone and been a gathering place for this community. >> i have been waiting for this garden for 3 decades. that is not a joke. i live in an apartment building three floors up and i have potted plants and have dreamt the whole time i have lived there to have some ability to build this dirt. >> let me tell you handout you -- how to build a community garden. you start with a really good idea and add community support from echo

media and levis and take management and water and sun and this is what we have. this is great. it's about environment and stewardship. it's also for the -- we implemented several practices in our successes of the site. that is made up of the pockets like wool but they are made of recycled plastic bottles. i don't know how they do it. >> there is acres and acres of parkland throughout golden gate park, but not necessarily through golden community garden. we have it right in the middle of

health commission. mark, would you please take the role. >> president bernal: present. >> commissioner green: present. >> commissioner chow: here. >>commissioner christian: present. i saw her on here. i have unmuted you. can you hear me? there are four of you and there is quorum, i will text the commissioner to see if she needs help. >> president bernal: with the

quorum present, we move on to the next item. the approval of the meetings of the minute of september 1st. wrong date, i'm looking at the minutes. the minutes of the meeting of september 15. upon reviewing the minutes and without amendment, do we have a motion to approve or any amendments from the commissioners? >> so moved. >> second. >> before you all vote -- there is nobody on the public comment line, so there is no need to take public comment. i can take a roll call vote, commissioner. >> president bernal: yes. >> commissioner green: yes. >> commissioner chung: yes. >> commissioner chow: yes. and let's see if -- okay, i will call her as we move into the next item.

that looks like the minutes passed. >> the next item is the director's report. director colfax. >> good afternoon. the director report, grant co-colfax. one item of note, september 30, state department of public health released details regarding a health equity metric to help continuing efforts to move effectively as to fight covid-19. and really, in order to move to a tier of lower risk, county will need to meet an equity metric or disparities in covid transmission to advance to the next less restrictive tier. counties with a population greater than 106,000, which

obviously san francisco is one of those -- rates in the most disadvantaged neighborhoods do not fall significantly behind the overall positivity rate and submit a plan that -- disproportionate populations. so we're working with the state in regard to this. we're currently in the orange tier. right now, we're the only bay area county in the orange tier. and to the best of our ability, we determined that our health equity metric is also in the orange tier. in terms of other items related to covid and beyond, i'm pleased to confirm with the commission, the board of supervisors passed the fiscal year 20-21 budget. changes based on the budget that you saw here a number of meetings ago. also with regard to equity

investments, mayor london breed announced $28 million effort to expand covid-19 support for san francisco's latino community. this is work that will include the specific investments on the part of public health and also other city agencies. regard to the public health investments, they'll include increasing testing, increasing more community-based contact tracing and partner notification. and very importantly, prevention efforts, especially around important messages with regard to mask-wearing and other steps, as well as letting people know that help is available, that no one in san francisco will go without help, including and especially during this covid-19 pandemic. and then we continue with the reopening process.

i will provide some additional information with written detail with regard to that in my presentation. finally, just to highlight as a follow-up with the school reopening. -- open online dashboard that is available to school administrators and to parents to determine so they can tell where their school stands in the process of the reopening approval process. it's called our reopening dashboard. that has been positively received by the school administrators and parents. and finally, just to say that one of -- black african-american health initiatives film entitled working to eliminate health daas parities within the disparities has been excepted

for screening during the film festival at the virtual meeting at the end of this month. at the end of the director report, there is a quite a bit of media coverage. i'm available for any commissioners' questions and again, there will be a more detailed covid-19 update. the doctor is here to provide additional details with regard to that. thank you. >> president bernal: thank you, director colfax. before we move on to commissioner questions, mark, any public comment on the director's report? >> there is no one on the line at all. >> any questions or comments for the director? >> commissioner chow: yes. thank you for your report, dr. colfax. and i was curious that the bill that was signed by governor newsome about adult residential

facilities named a number of facilities that here in san francisco and your report was closed. how many remain in san francisco that this might help protect or at least give about a half-year warning about the changes that might occur? >> i don't have that number at my -- committed to memory, commissioner, but we can certainly provide you with that information. i don't know if dr. hammer -- is present and we can follow up with that number very soon. >> thank you. >> we can get that number to you. >> president bernal: commissioners, any other questions? director colfax, one question. i know we had heard from you and dr. aragon in previous presentations even though we meet the criteria here in the state, that some of the numbers

such as our really high degree of testing and the formula that the state use indicate that perhaps we should be taking more of a cautious approach than what is allowed in the state tier we're in. are we still in that posture? >> yes, that's right. and we can talk about that more in the update, but we're using the local data to determine how to report. we've been very much focused on what is needed based on our data. what is the state provide the framework, but remember we can be more restrictive than the state. and in general, we've been more cautious than the state has necessarily permitted. >> president bernal: great. thank you. commissioners, any other questions before we move on? all right. if not, we'll move on to the covid-19 update.

are we ready with slides. thank you. >> grant colfax. director of health. dr. aragon is available for additional -- any questions and obviously, it's welcome if he would like to add more details. apparently 11,57 -- cases of covid-19 in the city. unfortunately, 111 deaths. this is a population characteristics of our positive cases and, again, highlighting the inequities that i describe

in the director's report with regard to the latino population representing 50% of cases. the age group you can see here that -- this has been somewhat of a shift. we've been getting increasing number of younger people diagnosed with covid-19. i will say that particularly with regard to the less than 18 age group, we may see increases in this one, because children will be returning to school. so there could be more transmission as well as more testing as a result of that. and this week we also announced that our city test sf, pop-up sites testing children under the age of 13, that's been positively received by the community members. so we'll continue to watch those numbers. you see the other characteristics of the cases. a little bit higher among male

prevalence and so far in the homeless -- in the population experiencing homelessness, a relatively small proportion, 3%. and about 50-50 between community transmission and known contact. then the sexual orientation of cases. it's here on the far right bottom of the slide. next slide. again, this is the data comparing our jurisdiction to other similar jurisdictions in terms of cases, death rates per 100,000, testing rates. san francisco continues to do very well. near the top in the things that we'd like to be doing well in terms of tests and near the bottom in terms of deaths

compared to other jurisdictions. our key indicators, these are local health indicators. as of this morning, you can see the hospital indicators, the first three, hospital capacity are low rate of covid-19 hospitalizations. our case rate which has stubbornly high for many weeks, in the red zone, is now down to orange. that's a very much growing in the right direction. testing numbers, 4500 tests over the last seven day average. our contact tracing, this has been slowly climbing. we're at 83 and 85%. then our p.p.e. and d.p.h. remains strong at 100% capacity for 30-day supply.

this is our hospital occupancy curve for people with covid-19. the darker blue lines are the intensive care unit on that given day. the light blue lines are the medical surge beds and the total is located at the top of that. the curve flattened in may and june. we had a peak in late july. we're starting to go down again. things levelled off in september. we're bouncing between 65 and 75. i'm rounding here, cases. and we're seeing a decrease again, so we're watching this carefully. and as we enter the fall and winter, we're concerned about transmission and we're opening more activities, the more

permissive in terms of businesses opening with protocols in place, including the masking, social distancing, masking when possible, but at the same time we know this virus increases when activity increases. so we're watching these metrics carefully. we're also concerned about flu season and ensuring our hospital capaci capacity. i will say in the southern hemisphere, what has been interesting, some of the flu -- the data from the flu has been less concerning than other years and that's because with more precautions that people with taking to prevent covid-19, there is less flu transmission. we are telling everybody, this

is certainly the year to get a flu shot. every year, but this year is more important than ever. so this is our reproductive rate slide. this is again the number for the reproductive rate, if the reproductive rate is two, that means for every one person infected, two people become infected. .5 means for two people infected, only one person becomes infected, so the infection slows down. reproductive rate of 1 means you're in neutral territory for every new person infected, a new person is infected. remember the goal of covid-19 control is to get that reproductive rate less than one. you've seen from other data how important that is. we're at .92. right now, our best estimate --

remember this is an estimate. this is based on thousands of data that we provide to our colleagues at ucsf and u.c. berkeley. that is the average estimate that those simulations come up with. the lighter blue lines are the intervals, you can see up to the 95% conference interval. it's possibly we're slightly above 1 right now, but it's more possible we're at .92. next slide. in terms of our reopening, i just want to make note that dr. aragon and the outstanding team, including the city attorney, the info and guidance people. one of the things that i do want to emphasize here, we're not dealing with the hospital surge, thank goodness, that we were so

concerned about early on. that is certainly a plausible scenario still, but the reopening work is also a tremendous amount of work for the department, for the many people who go through the info, the guidance, the lepehel helpe directives. it's good we're focused on this right now, but it takes hours of time. i would say that the health orders are very detailed and very much based on the best evidence that we have available. so these are some of the highlights with regard to reopening the indoor dining, indoor bars with food. the indoor movies, houses of worship, indoor malls and then we do hope that we will be opening playgrounds in mid october as well. but you will see that there are a number of activities still to be determined and, again, per

commissioner bernal's comment earlier, we are reopening more slowly than the state would currently permit, so we're taking a cautious approach and we're looking carefully for signs of a surge that may overwhelm our health care system. there is a lot of focus on testing. i wanted to give a visual representation of the city and county s.f. testing sites that we expanded. this map looks similar to the map i showed you in terms of the prevalence of covid-19 in the city. really being concentrated in the tenderloin, the mission and then in the southeastern part of the city. you'll see that we have expanded our testing capacity along those

corridors. we have the two city test websites, embarcadero and soma, those have been established since april. we have community clinics in green that many of them do pop-up testing. they have varying capacities. they are not only d.p.h. clinics, but there are other partners in the clinic core -- consortium. we have our mobile sites. these purple dots on the map do not represent sites that are up every day, but they show where we go during the week. we have two sites that have total capacity of doing 500 tests a day in this regard. so quite an expansion of testing and an expansion of testing where the virus is most prevalent, including in the

latino community and neighborhoods. they have high numbers of latino residents. next slide. so i believe you've seen this slide before, but this is data from august. we'll provide you with data from september once it's analyzed, but this is just looking at the pop-up sites, the purple dots on the map, compared to the sick sites. you'll see high rates of participation and positivity among the latino clients at our pop-ups and that's significantly different from the fixed sites in embarcadero and soma. remember, the fixed sites were established early on in the pandemic. the goal was for them to provide barrier testing, especially for city workers and other people who were working during shelter

in place, so they continue to serve a purpose, but the positivity rate is at these two sites and you can see we're focusing our efforts into the pop-up to concentrate our testing efforts going forward in populations with the high positivity rate. and with -- this is also data. these are data from our alternative testing sites. so these are at d.p.h. clinics. you'll recall we set up these sites early on in the pandemic. you see march 7 was when we started the testing sites. and these include the southeast health center, maxine hall health center, san francisco hospital and we'll see that they've done a number of tests over -- over 21,000 tests and

34% of those clients have identified as latinx. you can see here that our positivity rate is high among our latinx clients and they are -- we are reaching the population most affected by covid-19 at our alternative testing sites. these sites are for the most part, drop-ins. people can make appointments. they can for the most part tested children from the pandemic. i'm pleased to say we're expanding capacity at these sites very soon, so we will be able to serve even more patients and clients than we've had previously. this is data that do show that within the d.p.h. system we are reaching populations most at risk for covid-19. and this is just emphasizing

that with regard to over time, at our alternate testing sites at d.p.h., our average positivity rate has been 13.5%. you can see it's a bit of a -- lot going on. the lines are the number of tests done a day. the jagged lines are the positivity rate on any given rate. and the blue line is the positivity rate over a 7-day average. you'll notice that in april we had a very high positivity rate that was likely because we were really focusing on people testing who had symptoms, so we obviously had a higher yield there. but you can see that the positivity rates still remains pretty high going into almost the beginning of this month. next slide. and then i did want to -- one of the big efforts that we've focused on is isolation and

quarantine sites. and providing people isolation and quarantine opportunities because we all know, despite the fact that some people in this country are not doing this, isolation and quarantine is very key to ensuring that the person gets the support they need. these are people so who have availed themselves of the hotels free of charge. and nearly half of the clients have of the isolation and quarantine hotels have been identified as latino or latina. a number of people avail themselves of these hotels.

nearly half of them had an apartment or home, suggesting they weren't able to isolate or quarantine safely in their residence. so just what i hope is interesting data for the commissioners to review. finally, i just wanted to -- this is a slide from ja marks, one of our -- in charge of advanced planning at covid command. and this is just looking at the reproductive rate of the virus over that second surge. i'm sorry, that straight blue line, i'm not sure that is as accurate -- that's my arrow. sorry. disregard what i just said. that reproductive rate surged up to almost 1.3 in late june and early july consistent with that concern about the second surge. then we saw the reproductive

rate drop down to .8 where it was in may and early june. then we are seeing it creep up just now to the .92 level. we really demonstrated i think in san francisco with this re productive rate, the decrease in rates, the subsequent decrease in hospitalizations, that we've developed a feedback where when there is high transmission and disease, people who are able -- i want to emphasize this because not everybody is able to do this -- but people who are engage in less risky behavior. and people who are not able to, it's often for socioeconomic reasons or housing reasons. but in general, we think that people are able to engage in less risky behavior do so.

the lower transmission of disease is a result. humans have sometimes challenges in terms of being adherent to all the social distancing and masking requirements that this does demand. we get a higher transmission of disease and the cycle repeats itself. as we reopen, the goal is to keep the risk behavior as low as possible. and we'll continue to hope that if there is a feedback, that we're able to catch it in the rick behavior increased stage -- risk behavior increased stage so we don't overwhelm our health care systems. i think this is going to be our balance that we're going to have to try to hold during the ongoing pandemic. and so we have a vaccine and

more importantly, communities at risk and hopefully entire populations actually receive a safe and effective vaccine. that completes my presentation and dr. aragon is available for questions. >> please raise your hands if you have any questions for director colfax or dr. aragon? commissioner chow? >> commissioner chow: yes. this is more for -- just as a comment. i know we were given the line to the interface consult, meeting that dr. aragon held with the council and i just wanted to commend him for the work he was doing there. i think it demonstrated the enormous work he's been doing in all sectors. and that was just one sector in which he was working with the --

our churches and our communities. there needs to be about a dozen dr. aragons i think. and he certainly has been fulfilling all of the need of a health officer. we can be very proud of that. i wanted him to know that i thought he did a very commendable job with the community in regards to the religious issues that were raised in terms of the worshipping facilities. thank you. >> dr. aragon, i've unmuted him, in case you want to comment back. >> yes, sir. thank you for the feedback. i really appreciate it. sorry i could not be there in person. i had trouble logging into web x

so i had to call in. >> i wanted to say i heard positive reactions to your conversations with the faith community. >> commissioner giraudo: yes. i do have a question. when -- i know we've talked in the past about trying to have a summary of the -- that is readable for the health orders. my concern is that we're moving ahead for health orders that involve children and families, if they can be -- if the communication can be simple. i've had so many questions at our center on the health orders related to going to school, to playgrounds, et cetera. so i just encourage you as the next set of health orders goes

forward, to please help the communication to be a little more clear so that the families aren't reading it just on s.f. gate. i appreciate it and i know so would my staff and many of the parents i deal with. >> just to say we're working with the joint information center in an effort to make these -- to realize what your request and what the commission has requested. >> commissioner giraudo: i appreciate it. thank you. >> commissioner green: i would like to third the compliment of dr. aragon. you've done a great job. two questions. one involves -- by the way,

apropos giving the information to the public, i think the slides show capacity, 10%, i think that is excellent and really clear, but i've been asked by some of the patients i've spoken to what happens if certain organizations or facilities are, in fact, not following the order. i take care of a lot of pregnant women and i think families about to have children are extremely anxious that, you know, if they're going to walk into a restaurant, or a market, that indeed all the distancing orders are being followed to the letter. and i don't know what to tell them about what to do, in fact, if they're concerned that maybe the orders aren't being followed. i wonder if you could elaborate on that. you said something really important about how the public stepped up and if you look at the way it shifted, once the

word is out that we need to dial it back, the community has done that and so have the businesses, working together and pulling together. i was wondering, what lessons can be learned from the little surge we had in july? in other words, some of the restrictions that we began in april or march were still in place in july. and so i'm wondering what lessons we can learn from that as we move forward to this time as you stated is going to be more vulnerable because of confounding issues like schools and the flu season and so forth? so i wonder if you'd elaborate and in particular how the public can redouble the efforts to ensure we stay in the category we are in that multi-city list of terrific outcomes? >> yes, commissioner green, i can start and then maybe dr. aragon can fill in the answers on the enforcement.

so i think there are a couple of things we learned. one, we know that if we educate and get the message out that things are getting worse, not only does the community respond, but the virus responds. right? so we now have several data points that say the messages that go out, people respond and it is -- the virus is actually quite malleable and responsive to changes in behavior. the other thing i think we really focused on in learning about the virus is how important masking is. and there seems to have been a dramatic increase in masking in san francisco. so i think people are getting the messages. now people in crowded conditions and multi-generational households, i think that is a really key piece. and i think as we reopen one of the balances of our messaging is to say, you know, in this new era, it's about reducing risks.

there is often not such -- there are few circumstances where there is no risk and people need to think about their own sort of risk tolerance and risk factors for covid-19. and then the last thing i think we have really been focusing on ensuring, where it is allowed for people to gather, it's in very small groups so we avoid as much as possible the large outbreaks. so if somebody is in a particular vulnerable risk group for acquiring covid-19, or for a poor outcome from covid-19, i think that person -- the way that person may think about taking different activities on now that we're reopening, just because we're reopening doesn't mean that people necessarily should throw themselves into every aspect of this, right? so i think it's really trying to

provide the right -- to provide the prevention messages and the education and also understand that this is not sort of a one-size-fits-all approach, that people need to be aware of the risk and make their own decisions. and have the data available to help them make that informed decision. and dr. aragon, i defer to you for any additional insights which i'm sure you'll have and the enforcement question. >> the quickest way for people to report is to call 311. and 311 will take any complaints. and they will -- it will get routed, the information will get routed to the covid command center. at the covid command center we have community education response team. that's a multidisciplinary team that includes law enforcement as well as the city attorney. and they will go ahead and respond to that focusing on

education and supports of the site where this is happening. but that's the quickest way. tell them to call 311. everything gets logged in and tracked so things don't get lost. >> commissioner giraudo: thank you very much. when can they expect to hear back? in other words, is there feedback for the individual concerned about follow-up? >> that, i don't know. i'm not sure how that happens. i'd have to look into that and get back to you. >> commissioner giraudo: great. thank you. >> president bernal: thank you. any other questions? i did have a quick comment and question. first of all, dr. aragon, director colfax, pleased to see the stubborn new cases per population number go lower. i know that's been a challenge for a while as well as our case investigation and contact tracing numbers going up. i did have a question about the

testing sites and particularly the number of folks in the late late latinx community. there is an element of geography for the proportion of people who are tested are from the latinx community. but besides geography, are there other factors that are explored, where driveup is not accessible to people on foot, whether we're providing language. are there other factors that could potentially be contributing to that really significant difference in the proportion of people tested from the latinx community? >> yeah, i think there are a number of things. so as we expand our low barrier focus community testing, it's been clear that the sites south of market and the embarcadero

sites, which you test very large it numbers of people. there are a couple of things. one, they require an online appointment. so there is accessibility question there. there is also been barriers with regard to the language access, which we're working to correct. and so that is a key component. and then there is not the wraparound services approach that we do have at our pop-up sites that has really provided so much by the community partners, right? so i would say that those sites are a very -- you know, they're walk through or drive up and you get your test -- you make your appointment on line, walk up, get out and get the results and there is not that wraparound approach we know is so key for so many people and their families.

so that's why as we expand, we're really driving these low barrier testings in the community. the pop-up sites that are agile and able to follow -- not just follow, but basically go to where the virus is, and then just according to what our data are telling us. so i think -- both of these testing sites -- both of these testing models have value to the overall covid-19 response, but clearly the expansion needs to be more focused on the low barrier, community centred and community driven testing. >> thank you. it appears we do not have any other comments or questions. >> actually, commissioner chow and green put their hands back up. >> president bernal: they did. sorry about that.

>> commissioner chow: sorry. i actually had about two or three questions which don't need to be answered right now. one was to note that -- well, first to note that -- and, therefore, a request, that within the alternative testing sites and i'm pleased to see there were a percent that had increase away from what was the average in the agent and the nay -- asian and native american and pacific islander community. and in these alternative sites, they were like 6-10%, which is above the norm throughout the rest of the city for the community. so actually, that just brought back to my mind, i'm wondering if we actually know any more now

or are trying to find out why our asian death rate is still higher even though there are lower numbers and, therefore, per 100,000, the death is still a little higher. and that also seems to be true in other parts of the country. and so not asking for an answer today, but trying to see if we were also looking into that to see if we are -- we could understand that a little better, especially with the fact that we have about a third of the asians here in the city. and they continue to be interested in this. and there continues to be discussion that we don't test enough asians. i'm not sure that's true, but on the other hand, i think we're in a position in which we probably should be doing a little more studying on that population to try to understand it as it seems

to be a phenomenon -- a little mixed throughout the country, but still in general shows that there is a higher incidence within the asian community and the p.i. community particularly. the second question that i would like some clarification in the future. in regards to the potential coming back and what the city is preparing to do for that -- again, not an answer for today -- but not to lose sight of that, we run a very large airport and the question is whether or not our health department is involved with airport safety and health. and what we might be doing about it. and we certainly have heard what is happening in terms of other airports. and a variety of things that

seemingly is occurring even at san francisco airport, offering direct covid testing in two of the airlines right now. the potential of whether or not like in other places -- i'm not sure that we do temperature testing or anything like that. but wondering if we actually are working with the airport to determine the health policies. i would think we are. and what those might be. so, those are just areas i thought we could help look at in the coming meetings. >> thank you, commissioner. we'll certainly provide answers and more details in the future on those three areas. >> thank you, commissioner chow. commissioner green? >> commissioner green: yes, i think it's a kind of a correlate to what commissioner chow was saying. i would find it helpful to see

the slide presented with the incidences of positive testings in various populations, if we could get more information about out of how many of the asian population -- i realize people are being tested here that work in the city -- but it might be helpful to have that context. along with that, i would be curious to see more granular information. i think what you presented about the latinx was so helpful. more granular information about the populations in general, especially those tested at the permanent site, because the words are out, there are certain sites, pier 30 and 32, people are aware of the sites. yet when you go online for testing, there is a lot of barriers, insurance information, even if you speak english, to getting through that entire series of questions. i don't know that they can be

streamlined, but there is certainly a lot of data, because they ask birth date, gender, race and zip code. i would be curious to know if there is anything to learn from that information and get a sense of the denominator of our population. >> yeah, thank you, commissioner green. something that the team is working on very much. we have that -- we show that for the a.t.f. sites, because those are our network sites. we have through epoch that data readily available. across the system, it's considerably more challenging, but the team is on it. >> i know some of the sites aren't run by d.p.h. and i wonder if they have the capability of pulling that data, because they do ask for a lot. >> yeah. we can certainly bring that back

once the team -- the data team has completed the analysis and has a better understanding of what the limitations of the data are and what we are able to show. >> commissioner green: thank you. >> commissioners, any other questions or comments for director colfax or dr. aragon? if not, we can move on to the next item. which is resolution honoring tosan boyo. i'd like to recognize dr. susan ehrlich, c.e.o. of the general to present. >> hello, commissioners. president bernal, commissioners, dr. colfax, i am so grateful for this opportunity to celebrate tosan boyo, who until very recently was our wonderful chief operating officer for the past three and a half years. before i read the resolution, i just wanted to say a couple of

things. first, that i've been fortunate to know and to work with tosan boyo for most of the time between 2014 and now. we worked together first at san matteo medical center and then he joined us here about a year after i started. he and i have really grown together as hospital executives and for that, i'm truly grateful, because he is, indeed, a very special person and this is a wonderful recognition for him. what the resolution doesn't say about him and part of what has made him a very special part of d.p.h., he has a very deep sense of purpose. and that purpose grew from his family roots in many nigeria, ae clinic where his father worked. he has that drive to get things accomplished in all areas he's

overseeing and more. with that, those things are outlined here in the resolution. i would just like to read that to you. honoring tosan boyo, m.p.h., whereas tosan boyo, has served the san francisco department of public health at zuckerberg general as the chief operating officer for three and a half years, and whereas mr. boyo has dedicated his career to building and refining population health initiative by providing a unique perspective about the impact of public policy and health care delivery on the wellness of communities, especially vulnerable populations, and whereas mr. boyo has humility, empathy during his tenure, and as chief operating officer, mr. boyo oversaw 12 departments with over 850f.t.e.s and where he

developed implemented and led the strategic initiative to ensure that the hospital's capital program met the needs of the s.f.g. patients and team members, and whereas mr. boyo was a key leader in successfully implementing the electronic health record, epoch, by leading the system during the inaugural period. and whereas mr. boyo led and championed the equity journey by empowering the organization to discuss race, equity, diversity, and inclusion through the hospital's equity council. and whereas mr. boyo's passionately led and built the equity council to address disparities and system racism, by bringing team members across the network. and whereas he has served as chief of operations as san francisco covid-19 command center during the pandemic and successfully deployed disease

prevention, health facility surge management and public health compliance health orders. and whereas mr. boyo was board certified in health care management, and whereas mr. boyo served on the board of directors for the youth center, a 125-year-old non-profit organization providing mental health and social services for families in california, now therefore be it resolved that the san francisco health commission honor tosan boyo for his many years of outstanding services, contributing to the health of all san franciscans and wishes him well in all endeavors. he's a pretty remarkable person. thank you so much for honoring him. >> thank you, dr. ehrlich. do we have any public comment? >> no one on the line, so no public comment. >> president bernal: thank you.

i'd like to recognize any of my colleagues who would like to add to that fitting and thoughtful tribute to tosan boyo. i would like to say in particular with regard the -- the covid-19 command center, the pandemic has asked so much more of all of us and the commission is very, very aware of the incredibly hard work that has been layered on top of the normal work and leadership that the department team has been engaged in, for him to take on this critical role within the command center. we're so grateful for that, for his leadership and for his hard work and commitment. and just as with everyone in the department, he went so far above and beyond in that role. thank you very much. commissioners, would you like

to -- we have commissioner green. >> commissioner green: well, i would just like to add that i have learned so much. one of the most wonderful parts of being on this commission has been watching the team at the general work. and i've watched tosan boyo as a leader, a presenter, a philosopher. as someone who really listens and really responds. as a great consigli tore, educator and partner. everything that has been written about systemic racism, i think he brought about his own personal experience, the piece about his own personal experience was the most moving thing i have read as i've tried to read and educate myself and i've shared it with everyone i can find. it's emblematic of how thoughtful he is, how

beautifully he expresses ideas and how much progress when someone of his caliber leads an organization. i know how much everyone will miss him. and i just want to thank him so much for everything he's taught me. and what a wonderful opportunity it's been to watch him in action and interact with him. i'm really going to miss him. >> thank you. commissioner chow? >> commissioner chow: thank you. i wanted to also add my compliments and certainly my strong commitment to this resolution honoring mr. boyo. as the chair of zuckerberg san francisco general, i recognize that he brought to life the equity council. and he made the question of equity that was added to the pyramid and part of true north, a very real issue.

not just his own person, but how he was taking on the issue for everybody. he made it so that it became as important as, of course, we know it is. and he was able to do that without rancor and always with humility. and yet with a firmness that i think brought out the very best of the people he worked with, his colleagues, to actually continue the journey to equity. he never shrank away from a failure of the system.

it's a remarkable team. and we're going to lose a remarkable person. >> thank you, commissioners, chow and green, who i know have had the opportunity to work with mr. boyo through the general j.c.c. next i'd like to recognize commissioner christian. >>commissioner christian: hi. i just want to say as the newest member of the commission, newest arrival to this team, i am not exaggerating when i say that each time i have an opportunity to speak with or hear about or learn about members of the department of public health, the team at zuckerberg, the doctors and all the executives and the staff, the things that people are doing and the things they have done and the way they've watched through the world. it's just unprecedented. i can't tell you how deeply sorry i am that i'm not going to have the chance to learn more

about you and the work that you've done here personally. but i just did want to say that i regret the chance i'm not going to have to work with you. and i'm going to find that general piece that dr. green mentioned and other things you've written and wish you the best of luck in everything you do. i want to thank as a citizen of the city for all that you have done. >> thank you, commissioner christian. director colfax, anybody else would like to say anything before we have mr. boyo come up and say a few words? >> thank you, commissioner bernal. i actually have been told about tosan boyo's remarkable abilities before i came back to the department. so when i was fortunate enough to rejoin, he was one of the first people i asked to meet with and everything that had

been said about him was what became -- and i think more so as he continued to do such an outstanding job in the hospital and as he responded to covid-19. i think his contributions to the city's response can't be underestimated, both as incident command and also as the leader of the operation -- operations at covid command. he's been in this since the very beginning. and just so pivotal to our response. i'd also say that he an ability to inspire teams to engage, to focus on work, but also maintain a perspective. [please stand by]

>> and the way she raised me to be the man i am today. i am a product of her. and serving san francisco during the past -- it has been a privilege of my career, especially being part of public command and thank you to director colfax for, you know, asking me with air quotes to lead this event centre because it genuinely was a privilege of my career. the privilege of my career to do that. it is the most important thing i have ever done and i hope it is the most important thing i ever do. if it is not, that means the world is going to be very challenging in the future. thank you for everything and i

will never forget any of this. i am tremendously grateful to have served this city. thank you, everyone. >> thank you. we will miss you very much and where we under less challenging or isolated times, will be handing you a framed copy of your resolution and lining up to shake your hand and take a photo and express our appreciation in person. while we can't do that, we hope you are feeling this from all of the scan our appreciation of your leadership and hard work and how much we will miss you. mark will arrange to get the resolution to you as well. thank you again, on behalf of the entire commission. best of luck. please stay in touch. >> thank you, everyone. i appreciate it. >> there is an issue of voting on this resolution. >> thank you, mark.

would you like to go ahead and call the role? >> actually, a motion needs to be put forward and then i need to have a second. then i will be happy to do roll call. >> we are all caught up on this. >> that is my job. >> thank you. >> by so move the resolution. >> i second. >> all right. thank you. i will do a roll call vote. [roll call] have i missed anyone? that is everyone. thank you, all. the item is passed and your comments are very heartening. we will of course, miss you. >> thank you. all right, we will move on to the next item. the laguna honda hospital gift

fund budget. >> sir, you kind of skipped a few. there is general public comment. i can note there is no one on the line. we can skip that. item seven is report back from the finance committee. >> thank you. >> i grabbed the wrong piece of paper. >> it's good that i am backing you up. >> thank you. commissioner ciao, would you like to offer the report back? >> yes, thank you. i had the privilege and in the absence of commissioner chung, to chair the meeting. we undertook the business. the consent calendar included a number of programs, which were basically extensions of already existing programs.

note however there was a large contract to health right 360 for its continuation as providers for the city who receive reimbursement mostly through our behavioral health in direct -- [indiscernible] it is a continuing contract of ours. we will have an additional 5.250 million that will be given for a covid community wellness initiative. this merges very nicely to the discussions that we had earlier in regards to covid. we will be putting out contracts , the proposal for

contracts from community organizations who will be working with the community on covid wellness programs. this is a new program. otherwise, the remainder of the contract are fairly routine and we would ask for a consent of that contract. we have a number of new contracts. i think they are worth noting. one was a contract for security of our assistance. it could be computer systems with data way u.s., which is actually a continuing contract with a previous company before, but now they have now spun off

this as a u.s. company and its scope is to assure security for the d.p.h.'s -- all of the d.p.h. information. so there is the contract for 1.15 million. the second one is, again, related greatly to covid and it is laboratory corporation of america for doing covid testing. in addition to covid testing, hoping they wouldn't need a contract of five years to do covid testing, it also does include the fact that it could be valuable as a backup for its other very large range of testing services that it does.

it is it's a contract before you also. the committee is recommending this. the third contract is very interesting. it precludes services up to six months at laguna honda. it appears that the pouring of the new kitchen that was built as part of the lead buildings that laguna honda actually was built under in order to be a lead building is actually failing and for that reason, it has to be replaced. it has been 10 years. and the replacement, it does require that in order to do this major replacement, they have already done one or two patches and there is still a fourth to go. this one is up to six months.

the kitchen will be out of service and amazingly, then they will have to supplement 800 people's meals three times a day over this period of time. this contractor his foodservice partners and while they apparently were the only bidder, they actually come with very high credentials of serving a number of kaiser hospitals already and they are a local and the fact that their headquarters are in south san francisco. they apparently have a dietitian they can prepare the different meals that are necessary for our residents at laguna honda. that is a contract that while the year and three months is the extension of the contract, the implementation and the time that is thought to be required will

be up to six months and it is a contract for about $3 million including a contingency of $211,000. the latitude are actually part of an as needed contract of maintenance people. in this case, the steam cleaning and it would be for a vendor for steam cleaning under the contract and then a approval of the vendor table. there is actually a vendor table that the department can use for different types of craft services that our own employees are not able to do and we need

to approve that vendor service. that is the fifth item on our new contract list. the committee also was actually able to see evaluations of the previous contract under the contract report, which was a request from the previous meeting, and the department did a wonderful job in being able to show the evaluations that were in place for these continuation contracts under the contract support. the finance and planning committee, therefore, is recommending these for their approval. we are happy to answer any questions at this point in time. >> market, are there any requests for public comment? >> no public comment yet. >> okay. commissioners, any questions or comments? if not, do we have a motion to

approve? >> motion to approve for the consent calendar. >> is there a second? >> yes. [roll call] thank you. it passes. >> all right. we will move onto the next item, which i could not wait for. that is the laguna honda hospital have to fund budget modification. we have mr. fraser. >> hello, commissioners and dr. colfax. i am so happy that you are were looking forward to my presentation. i am the program manager at laguna honda hospital. the hospital's hospital hospitalwide gift fund

management policy requires that the budget be approved by the health commission, as well as any modifications to that budget we call it a special funding request. you may remember you approved our budget back in august. today rerequested $25,000 increase to the budget to fund our holiday gift program. that program is a long-standing tradition and had been funded by the friends of laguna honda through in-kind donations. we are currently prohibited from receiving donations. timelines are very tight and we must proceed immediately.

our ask is for $25,000 and i want to explain to you that the gift fund is a continuing fund. it's different from your normal government appropriated funds. you can think of it more as like a savings account. we have a balance of 2.5's million. the budget request would bring the budget to the year at $465,000 i am prepared to take any questions you may have. >> there is no public comment. >> are there any questions or comments? >> no public comment. >> commissioners, any questions or comments?

if not, seeing no public comment thank you, mr. fraser. do we have a motion to approve the budget modification? >> so moved. >> i make the motion to approve the modification to the fund. >> is there a second? >> second. >> great. mark, call the role. >> yes, sure. [roll call] commissioner ciao, can you give me your answer, please? >> yes. [roll call] thank you. the item passes. >> thank you. and thank you to mr. fraser and everyone for all of the comfort you bring to our residents at laguna honda through your work

on the gift fund. >> thank you very much. >> all right. moving on to the next item, we have our annual report with dr. susan philip. dr. philip? >> everyone can introduce themselves. they will start. and then dr. scott and dr. philip. >> thank you, yes. >> good afternoon. i am the director of h.i.v. surveillance. and fideli -- and for today's presentation, the report was released last month and then -- [indiscernible] they will provide an s.t.d. update.

next will be the live feed. there are a number of new diagnoses in 2019 that climbed to 166 which would present a decline compared to the 13% decline in the previous year. since 2010, the diagnoses have declined by 65%. it fluctuated but remained relatively stable. about 16,000 people are living with h.i.v. at the end of 2019. and almost 70 are over the age of 50. these are san francisco residents. many of them have moved out of san francisco. we estimated there are about 13,000 who live with h.i.v. and

live in san francisco. based on their most recently available address information, we are aware -- they were not aware they were initially diagnosed. the h.i.v. diagnosis rate per 100,000 population. the lines here are four men and the other lines are for women. women have much lower h.i.v. diagnosis rates than men and black men have the highest rates closely followed by latino men. black women also have the highest diagnosis right among women. the rates for black women are similar to black -- white men. for asian-pacific islander men, the rates increased but remains low.

next, please. we closely monitor trends and new diagnoses for select populations. [indiscernible] these populations have a decline in new diagnoses in 2019 after an increasing or leveling trend between 2015 and 2018, which is encouraging. however, two populations, people over 50 and trans women had an increase in both the number of diagnoses. the number for people over 50 increased from 27 to 34. and for trans women, it increased from seven to 13.

and for people over 50 diagnosed in 2019, there appears to be more trans women, men who have sex with men, and asian-pacific islanders than those diagnosed in previous years. the increase could be due to the increase age in h.i.v. populations or lower crack use, especially among trans women. next, please. the causes among that for those with h.i.v. is the leading cause of death. it includes overdose and -- [indiscernible] -- the proportion of h.i.v. related deaths has been declining over time from 40 9% to 35%. in 2018, 29% of deaths are due

to h.i.v. related causes. next, please. for multiple causes of death, which include both the underlining and the contributory causes of death, individuals may have more than one cause of death. poverty is the second most common cause of death after h.i.v. and in transmission category, we see that black people who ingest drugs are disproportionately affected by these common causes of death. next, please. so this slide shows the continuing of care among purses -- persons newly diagnosed. care is defined as having the h.i.v. test.

[indiscernible] this is a brave achievement. 81% people diagnosed were suppressed. the majority were suppressed within six months of diagnosis. next, please. we see that time continues to improve. from diagnosis, to first care, from initiation and from art to virus suppression. this is calculated by the%

starting art within seven days of diagnosis. increased from 16% in 2014 to 50 9% in 2018. it decreased from 54 days in 2015 to 35 days in 2018, which is likely due to improved art management and increasing use of the inhibitor-based regimen that lead to faster virus suppression overall, they will increase from 2015 to 46 days in 2018. next, please. by race and ethnicity. virus suppression has decreased

badly among white and asian-pacific islanders. black had the highest median virus suppression in 2017, which is 103 days. it decreased by more than half in 2018 to 47 days, which is similar to that. people who ingest drugs took much longer to achieve virus suppression and in other risk categories. remains high in 2018, which is 133 days. people experiencing homelessness have a high, median high virus suppression in 2016, but it drops significantly in 2016 and continued to decline at a slower pace, similar to nonholistic people. next. we also want to look at virus

suppression among people living with h.i.v., which is a larger population than the new diagnosis. overall, 75 people living with h.i.v. were suppressed in 2019. virus suppression rates are lower among women, black, latin x., middle aged groups and people who inject drugs. people don't -- born outside of the u.s. and only 39% of the homeless were suppressed in 2019 next. in this report, we added new data to adding these rates as social determinants of health. we did not have individual indicators for these.

they had the highest diagnosis rates in 2018. these rates are associated with these social determinants of health. this population accounted for 21

% of new diagnosis in 2018 and 18% in 2019. it is a sickness of it -- significant proportion of new diagnosis. [indiscernible] they have lower aids survival rates and lower linkage to virus suppression. next. this is my last slide. in summary of care incomes by health and status -- by the way,

the animation feature is disabled. it may look very busy to see all the information together. the first four indicators are among people newly diagnosed with h.i.v. and the last three indicators are among people living with h.i.v. in general, people experiencing homelessness have worse care outcomes compared to -- [indiscernible] -- these care outcomes improve from 2017 to 2018 and 19 for both groups. we see more improvement among the homeless. this requires review in the

collection of follow-up information. we may not have updated housing information in 2018 or 2019, specifically for those who are homeless in 2017. but we know at a population level that those who were housed have better h.i.v. care outcomes than the homeless. linkage to care and receiving art among new diagnosis, which are the indicators with the checkmark are similar between the homeless and nonhomeless. viral suppression is considerably lower among the homeless, even among people living with h.i.v. in care, the last indicator, which includes people who have one lab test during the year, for example, 71% of virus suppression among

the homeless. this suggests that the care and the compliance and comorbidities there are challenges for people living with h.i.v. who experience homelessness to achieve virus suppression. in conclusion, we see new diagnoses continuing to decline. there is linkage to care and virus suppression continues to improve. the disparities remain, but to a lesser degree compared to previous years. this is all very encouraging. however, due to covid-19, we face these challenges in maintaining h.i.v. testing and managing h.i.v. care. we will continue to monitor the trends using h.i.v. surveillance data to see how this affects new

diagnosis and viral suppression in 2020. dr. scott will talk more about the impact of covid-19 on prevention and tried -- care services. >> thank you so much for your presentation. just a note to our commissioners and anyone viewing in the public , we will be taking questions and comments from commissioners between each section, then we will take any public comment at the end of the full presentation. commissioners, do you have any questions or comments on her presentation? >> i would like to say that looking at the progress that has been made, particularly since 2010 is extraordinary and there are so many people across the department who are responsible for that. thank you, dr. sue for your work and leadership. we keep expecting to see a leveling off of our reduction in

new cases every year, but it seems we still are seeing significant reductions well disparity while disparity still exists, particularly concerning transgender women. thank you so much for your presentation. if we do not have any comments or questions, we can move on to dr. scott. >> thank you. >> thank you. >> thank you for allowing us to come and give an update. it will really focus on what has happened during covid because it has changed so much for our h.i.v. care and prevention. next slide. so one shelter in place went into effect, most of the clinical and c.b.o. sites shut

down and moved to a more virtual platform. there was a big disconnect between a lot of the support that our patients get in the community and from clinical settings that was significantly impacted. experiences -- it was an impact on covid-19 and on prep. and overall, there was a dramatic decline on h.i.v. testing for people living with h.i.v. a decrease in viral suppression as an example and a strong concern particularly for homeless individuals who already have a disparate outcome of it becoming worse. we have seen some rebound of

these indicators, but hasn't come back to where it was year-over-year. we still have more work to do, but i wanted to give you a sense of where we are currently. next slide. this is for the laboratory-based h.i.v. testing from four labs that reported positive and negative test results. as you can see, between 2019 and 2020, there was essentially a stable in february and then there was a drop with the largest drop in april at 54%. half the number of tests were done the year prior. next slide. we also saw that the number of positive tests remain about the same, but we were seeing about half to a third the number of positive tests that we had in the past. i think we also saw this in city

clinic for s.t.i. where the individuals who might have had a risk or an exposure might be more likely to come into care, with the overall number of positive tests has gone down, even though the percentage is about the same. next slide. and then when we look at community, there is a lot of testing in our communities. unlike laboratory testing, we saw a peak in the decline. there was a 91% decline in the point-of-care h.i.v. testing that happened april of this year after the shelter in place orders went into effect, and as of july, it's still about half the number of tests that were done the year prior. next slide. and then when we look at different facilities, we can see that across the city, both within the d.p.h. and others,

which is our large community setting in the castro that you saw the massive dip in h.i.v. testing, and then you saw this rebound at a shelter in place order. it hasn't gone back to where it was year-over-year. a sort of flattened out so we haven't seen the same level of increases. overall, we are still 20-40% lower than we were last year in terms of testing. next slide. we have seen a similar, but not a profound dip that occurred in april and there has been more of a rebound unless of an overall reduction number of tests year-over-year. we saw this peak in june where there's a lot of ketchup --

catch up that was happening and people who were due for laboratory testing. it's still maintain -- was maintained at a lower level compared to what we have seen in the last year. next slide. and at ward 86 specifically, they looked at an analysis of all the patients and the virtual visits model and worked at looking at -- [indiscernible] it accounted for some of the demographic and clinical factors associated with viral suppression. the odds of not being viral suppressed were about 30% higher post covid compared to precovid period, particularly the vulnerable or those who are homeless, and they were more likely to be on suppressed post

covid as well. we also had the worst viral suppression among black patients , but this did not change after covid. next slide. at magnet, they have one of the largest prep clinics in the country and this slide is just in blue -- emblematic of the decrease of services that happened in april of this year in response to shelter in place. there was approximately a 90% drop in the testing prep services and not as much of a change, other than a much lower proportion of services for people living with h.i.v. but really, it is a significant hit for the prevention services that were not clear initially whether they qualified as essential services, as well as a

need for social distancing and clinical settings. it really drove down a lot of the testing and prep follow-ups that were happening at magnet in particular. next slide. as part of the response to covid , there has been a lot of effort to increase communication and so since march, there were daily bulletins posted onto the homepage. initially outlining a lot of the impact of covid from other people living with h.i.v. are at risk for h.i.v. these were distributed widely through electronic means. there was a community forum on safer sex and covid that was organized with bridge h.i.v. and several local community-based organizations. and then there was a virtual

town hall in collaboration with ward 86 for people living with h.i.v. to address concerns in the community, particularly around care, access to care and the impact of covid on people living with h.i.v. given the concerns around increased complications with people who are immunocompromised. next slide. there is a subcommittee that is working to address the provider concerns of the epidemic evolves and as i mentioned, it was not clear whether or not initially