tv Health Commission SFGTV October 20, 2020 7:00am-10:01am PDT
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
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 the prevention services in particular qualified as essential services under health quarters. it was really an effort to clarify and provide clear guidance to the c.b.o. and other prevention providers in particular around how to provide services safely and develop resources for home testing, for example, options for people to minimize clinic visits and looking at low barrier approaches to delivering some of the services. zoom doesn't work for everyone, but are there other ways to continue to provide services in a safeway. next slide. and then off on policies side, there has been, when the shelter
in place occurred, all the clinics closed due to activation many of the people were activated for covid response. and also in response to ensuring that staff are safely in these clinical settings. but as a shelter in place has been lifted, there is a need, in particular because of the prevention services that have been declining, to reopen and provide care for young people particularly and so this curbside care model was discussed at the last meeting around expanding services for youth, including some of the nonclinical services that are essential for a lot of the vulnerable truth in the city. and then there is the task force , the housing task force
addressing homelessness and the differential and disproportionate impact on people experiencing homelessness in san francisco. next slide. i will defer to the commission if they have questions about that section before talk about ending the epidemic. >> commissioners, you have any questions or comments? >> first of all, thank you for your accomplishments. this is incredible work. i guess i had two questions that are more statistical. i was wondering, given this effect of covid-19 on testing and so forth and virus suppression, how you plan on looking at these statistics year-over-year. in other words, have you thought about how you would correct the
unique drops that we see this year so you can see what have been incredibly successful on tread lines trendlines in this condition? i guess, you know, the corlett to that is do you anticipate any increased disease burden and we do know not -- we do not know what the winter holds. >> i think it will be disproportionate among our populations that are are ready at higher risk of having worse outcomes. and many of the prep clinics, for example, prescriptions were extended for another three
months or six months and people miss to the test. but if they stayed on prep, they still maintain high levels of protection. for individuals who might be experiencing difficulty adhering to prep, they might continue to have sexual risk and might discontinue prep. we are seeing that in the clinic there is no question that we will see a decrease in our case findings because the h.i.v. testing, for example, is a cornerstone of our prevention for public health response. it has been negatively impacted by covid. i defer to link for any statistical adjustments that might be made. i also think the high-volume, easy access testing as part of our public health h.i.v. prevention response. that has gone down. there is a concern that it will
undercut these efforts we will really try to counteract that as much as we can buy supporting, encouraging and facilitating testing prevention services to be restarted and reoffered in maybe a different approach. and for people living by h.i.v., ensuring that disruption of care is minimized so, how do we bring -- for whom zoom doesn't work, into the clinic with capacity where they can also -- where they could meet their needs? it will not be businesses usual for anyone post covid. but how do we maintain the success that we have had? i think that we are trying to figure out what the best approach for that is. there is no question it will impact our income.
>> all right. thank you. commissioner christian? >> thank you. thank you for this presentation. looking at the viral suppression , the left bullet point had worse viral suppression but did not change after covid. could you help me understand exactly -- or why you think it might be, or i am understanding this -- did they have worse viral suppression, but it did not change after covid. can you help me understand? >> there was a disparity that we were looking for. and there was a new disparity that arose post covid and there
were disparities that existed that were sent. it existed at ward 86 and it did not worsen. it is about how poverty impacts the ability to maintain adherence in viral suppression and how income and competing needs impacts, particularly for a black individual and for black men in the city. it was present -- precovid. there was a change seen in the data. so, i mean it was deeply distressing that it was so bad
when there were normal health situations and it didn't get any worse after covid. >> yeah. i totally agree. there has been efforts both at ward 86 and to address this through black health and focusing on what are the ways that we need to adjust and change our care model to meet the needs of black patients, and particularly, black male patients given the disparities we have. i am one of the providers there and there is a nurse, as well as another medical provider working on what are the models that we will shift to try to remove these disparities. describing them, i agree, they are not positions. we need to have a proposed solution and monitor our outcomes and be held accountable
for how we do or do not address those disparities. >> right. systemically it is such a nightmare at base level. it could not get any worse after this pandemic started. as someone who is fairly new to hearing about this level of statistics, it is very distressing. >> yeah,. i completely agree. >> i completely agree with commissioner christian and hope this is something we can hear reports back regularly as we get continued data from getting 20. next we will go to commissioner dorado. >> on adolescence?
and whether when the access for the youth in the clinics is going to restart. it is not able to see anybody. and what -- is there a timeline to reopen the clinics and have access for the youth? >> i know there has been discussions around the timeline for reopening. i know that allie is on the line i'm not sure if there are updates on this. but if we don't, we can get the timelines and at the information back to you. >> okay. that's great. i appreciate it. two of the clinics at balboa and burton, i mean those schools are probably not going to open until
at least january or february and -- [indiscernible] thank you. i would appreciate the information. >> i can speak to that a little bit. would you like some information now? >> just follow-up would be great i would appreciate it. >> okay. the long and short is we are slowly reopening clinics that were closed just because of concerns about air circulation and deployment of staff for the activation. we have a timeline now for reopening as we are able to deactivate some of the clinical staff and bring them back to the clinic once we determine that the sight is safe.
>> okay. thank you. >> thank you. commissioner ciao? >> thank you for this presentation. thank you. the first thing i was concerned about was it appears you are still working with the city attorney to try to assist the input for community clinics to be able to feel comfortable in doing h.i.v. and s.t.i. services i am wondering -- and i'm not quite sure they determine to these essential in the beginning and the prevention could be in question. that is just one thing.
when you were describing this in the last few minutes, i became similar -- i have some similar concerns. it is a phenomenon not just that it was h.i.v., but everywhere. there has been, in general, a resurgence of visits back from -- [indiscernible] -- they put this into get to the baseline again. i'm wondering if part of that, and you are starting to convey that some of these people are potentially no longer here. some of them may not need visits because you've extended their medication. and i guess the real bottom line is, how are we going to try to figure out the real impact that
you are discussing here in terms of the fact that, you know, intuitively, it will probably get worse in the sense that there are bound to be some people who don't feel like they will get services or didn't feel like the services were as easy to access as before. there is a factor here in which a number of people had continued my cheek -- medications. others may not need prep perhaps because of social distancing and isolation. and others have moved out of the city. all of this has been confounding any sort of a normal study, and i recognize as you are having a good look at this, whether or not there is some sort of clarity or some sort of timeframe that maybe we can sort
through between people who have stayed on treatment, what haven't actually been followed up by us, people who -- [indiscernible] -- that is not even asking the question of how many people should have been tested that didn't get tested, right? and the complexity of this. i'm wondering what some of your thoughts are in terms of us being able to sort it out. it's something we can take a look again as the commissioners have asked, suggesting they get a follow-up on this. >> we'll be following this closely and be happy to present an update when we have new data. the way that i have been
thinking about it is it's a spectrum from prevention through care for h.i.v. there are individuals whose risks change and they don't need prep anymore so they don't need to be on prep and they decide that they made a decision that they don't want to be on prep and they don't go in for visits. and then there are people who are unable to access prep, for example, because they can't get into their visits and they have continued risk and they have breaks in their medication. i think there are people who have -- who are living with h.i.v. who are adhering and are able to come in every six months to a year anyway, so it hasn't been a disruption. in particular there is a lot of drop in services that have been for people who are on the margin and those really got disrupted. it's not easy to get into any of the buildings or any of the clinics on the hospital campus,
for example. many places providing support are no longer open. i think we will need to make -- take a systematic look. there is already a large outmigration of people living with h.i.v. in san francisco. and i know it was accelerated during covid. it is a densely populated urban centre. people are moving towards more space and suburbs and other more rural areas in response to covid i think we are, particularly from the surveillance team, there is the ability -- i have been following up with individuals. and within the prep clinic, there will be a lot of utility -- i know that is an effort at
magnet to provide outreach and educate people. it has been clarified that prevention and care services are essential and that has been disseminated to the community-based organizations and clinics to provide clarity. it is getting communicated into the community. it will be a big next step. >> thank you. we appreciate getting feedback on this and to see where we are all standing. >> thank thank you. commissioner green? [please stand by]
it appears as looking at the testing data for example, the bigger institutions like the general or ucsf and other hospital systems are bouncing back if terms of their testing. are we seeing a similar bouncing back of the community-based organizations that are engaged in prevention and other kinds of services and if not, is there any kind of support that the department needs to provide to them? >> i think it is going to be
difficult in the spaces and how it's around ensuring staff safety and social distancing and the types of things is going to change the volume that can happen in the clinics. so we are starting to see that and i know that there are efforts to sort of think about doing things differently with home testing for example. so that individuals can do their testing at home. or drop-in testing where there is minimal contact with staff unless there is a need for a discussion for like sexual health or other clinical needs. so, yes, things are opening up. they're not at the same level they were and there are unique barriers i think that community-based organizations have that hospital-based systems can better mitigate. >> thank you. commissioners, any other questions or comments for dr.
scott before we move on? >> may i make a comment. >> director colfax, yes, thank you. >> i wanted to thank them for their presentations and i think one of the key pieces about this is that our institutional response to covid-19 has been driven by our institutional memory with h.i.v. and the work we've been doing. the commissioner saw the vaccine presentation two weeks ago. the doctor who has been leading the vaccine efforts, while there are differences, vast differences in how they're transmitted, i think going to the inequity we're seeing here, we need to ensure we're doing everything we can to prevent and mitigate very similar inequities that we're seeing across the nation and to some extent, hopefully. and just a reminder that while
these -- our focus on these infectious diseases is often in the health care system, these are often also socioeconomic and social factors that are at play here with regard to the social determinates of health. at the same time we're talking about getting to zero in san francisco and i'm hopeful we'll be talking about getting to zero covid-19 infections. sort of book ending these departments. >> thank you. thank you, director colfax. commissioner christian? >> commissioner christian: thank you. dr. scott, this is a late question and maybe it might be best answered by dr. seo, but it is kind of a prep question and follows on the last couple. looking back at slide 4 if my notes are correct, where the doctor told us that the slide is
titled trends and new diagnosis in select populations and that for trans-women, it had increased to 13%. and my notes say lower by trans-women. and my question is why. we're talking your thoughts of why, we're talking about the social determineates of health that exist and disparities that drive that. and then you just mentioned the impact of the closing of community-based organizations on people and how obviously people who rely on them and who are at greater disadvantage than many others are suffering because of this. do you think that has something to do with the increase in new diagnosis in trans-women? >> so, i think -- so if i
remember that slide correctly, i think it went from 2% to 7% among trans-women and the absolute number was from 6 to 13. so we have definitely seen a rise in trans-women, new diagnosis among trans-women. this would have been data before the covid-19 impact on all of our care and prevention services. but, yeah, prep is -- prep uptake among trans-individuals has been lower than snm which is the comparative group. it's not about awareness. it's not about knowledge that prep exists, it's about all the other things that are necessary for an individual to take prep, including what is a perspective of prep among peers and other community members. there has been more and more data around the impact of prep
and hormones. so there is a concern among the community that prep can negatively impact gender hormones and there is more and more data coming out that it does not negatively impact hormone levels. actually gender performing hormone levels reduce, but not to the point where we think there is increased risk of h.i.v. and there is also where people access prep and is it available in the clinics where the individual might receive gender affirming care. so there is a lot of, think, going back to the social determinates, there is also high rates of poverty and other social determinates are driving the lower uptick of prep among trans-women compared with other groups. particularly among smn in san
francisco. >> and could you describe some of the efforts that are being made to overcome as much as possible these barriers? >> yeah. so there was a study called the stage study that was really about providing peer-based social support and clinical support for transindividuals, specifically trans-women, to access prep within san francisco. and it was within several of the transclinics, those providing transspecific care and one in the east bay. here at bridge h.i.v., we actually created a clinic here as well for the city, because there were barriers that were people were encountering accessing care that was delaying their ability to initiate prep. so we wanted to provide a very low barrier access strategy for
trans-women to access -- to access prep. so those are some of the efforts. there has been a lot of community-building, community education, provider training, provider support, increasing both provider and client awareness around prep for trans-women and also dissemination of the information that we have about the impact of prep on gender forming hormones and the fact that the data do not indicate there is a negative impact. so making sure that we communicate that. and there is an effort here at bridge h.i.v. to develop a prep clinic specifically for trans-individuals and focus on trans-women. and we'll being doing a study which is focused in supporting prep among trans-women using a peer support and gender-forming
hormone service model. and that will be done here at bridge h.i.v. >> commissioner christian: thank you. can you say a little bit about how the community education, how you're getting the message out there is no negative effect on the gender forming hormones? >> so there was during covid similar to the community education forum we did around sexual health in covid, there was one focused specifically on trans-individuals, highlighting trans-women. and talked about prep and talked about the data that was -- many of the investigators are based this san francisco have done looking at the impact of prep on gender forming hormones. disseminating it through the community, disseminating it through the peers and peer
navigators that worked within the study, that worked within the community as well as the ucsf has a center of excellence, so leveraging that and using social media and strategies to get the word out as the study come out. there was one at aid 2020 by dr. bob grant that also has been communicated through the channels. and the community connections and connections -- peer connections are really driving -- most behavior in general is based on connections to other people. so leveraging those connections have been built to disseminate information from trusted sources. >> commissioner christian: thank you so much for your answers to my question and thank you so much for your work.
>> thank you, commissioner christian. thank you very much, dr. scott for your presentation as well. i think we can move on to the next section that dr. philip. >> i think this is still me. >> still you, okay? thank you, dr. scott. >> that's all right. in line with our getting a zero effort, there is a national ending the epidemic initiative and we actually here are thinking about it in ending the epidemic, plural, because we have an epidemic of h.i.v., hep-c that we want to have as one of our guiding principles. the goal is to reduce h.i.v. infections by 75% by 2025 and 90% by 2030. and so this is a cdc planning grant that was implemented for funding on august 1st and there is work to hire new staff.
and the grant is actually five years, so it goes through 2025. and these are the guiding principles so health equity and racial justice eliminating stigma and discrimination, ensuring barriers are as low as possible. and valuing the experience and providing peer-delivered services, so very much in line with what we've done in getting to zero and very much compliments the work that getting to zero has already been doing in the city. so i'm going to go through some highlights and happy to take additional questions. so, this is currently we're finalizing the plan with the community planning council, getting to zero, ending hep-c, as well as several programs. and we said this is inclusive of
sti. and then expanding community engagement with community-based organizations like aids project of the east bay within the latinx community, as well as the trans-community and people who inject drugs and those experiencing homelessness. and this is just a summary that this is the prevention dollars from the cdc. as i said, it started in august 1st. goes for five years. it's about -- there are two sections, component a and component c, totalling about $2.7 million. next slide. and these are some of the planned activities. so it's really organized in these principles of diagnosing individuals, treatment, tracing, and prep.
and so i'm just going to highlight a couple of items for each of these. and talk about them. so the take me home is a home h.i.v. and sti testing program that was done in collaboration with building healthy online communities, which is a group out of the san francisco aids foundation in collaboration with emory university. and this was a home-based h.i.v. testing. there were ads placed for free that ran from april through july. there are about 150 people who ordered a kit. there is over 260 kits selected. 20% never tested for h.i.v. before. these are home h.i.v. self-tests, so these are essentially anonymous tests. and they were an effort to create low barrier. they were mailed to individuals, but date of birth and social
security was not collected, so there was not an opportunity to do a surveillance match, because that would have created a new barrier for individuals. there were no h.i.v. tests reported -- positive tests reported to the health department, but this is an ongoing study and there are surveys done, so we'll hopefully have more and more data about this program and how well it works. so within the treat rubric, it's really around expanding services for people who are coming out of incarceration. and then working with stabilization rooms and a support team for individuals who might be living with h.i.v. and diagnosed and treated for hep-c, or have a recent sti diagnosis.
prevent is really about prep and there is multiple components around prep, including an effort within the san francisco zuckerberg general hospital to increase prep scaleup. and there are a lot of individuals coming in both at risk for -- from injection drug use as well as sexual risk, and there was no prep discussions that were happening in the hospital until there was effort to use that as a moment to educate individuals about prep and to start -- initiate prep in the hospital and then discharge individuals. that program has been ongoing and there is going to be data hopefully available next month or two around the amount of prep
initiations that were able to be initiated, reaching communities that have been relatively low uptake of prep particularly among individuals experiencing homelessness. and then there are several other expansion programs around both prep as well as syringe services. these are focussing on cluster. a big part of this is developing a cluster and outbreak response plan that needs to be multi-jurisdictional. as i tell folks in soma and i can get to west oakland faster than the campus and we're mobile and our communities are overlapping with other jurisdictions and how do we ensure we can respond to
clusters that might cross jurisdictions? so this is really working closely with our local jurisdictions as well. so actually i'll end there. and i'll turn it over to susan philips. if the commissioners have questions, i'm happy to take them. >> thank you, dr. scott. commissioners, any questions before we hear from dr. philip? all right, seeing none, dr. philip? >> thank you, president bernal, commissioners, and thank you so much for the opportunity to present along with my colleagues as part of this really important panel and discussion. and i think it's really important to recognize while we're each speaking from our individual team's perspective in which we have expertise in individual areas, i think you heard from the last portion of the presentation, we're thinking
about this work holistically and understanding there is so much overlap in the work we need to do to improve disparities and improve sexual health overall. next slide. so you heard a little bit about the aids foundation and the great work they do and the clinical services. i wanted to make sure you're also aware that we have have wonderful services as well at city clinic, which is the only municipal clinic run out of the department. and city clinic operates 36 hours a week. it's our sexual health services clinic or the city and county of san francisco. and in 2019, we saw that 15,000 visits, 64% of the visits were by people of color. and really important sexual health work in an integrated way happens with the team at city clinic.
in 2019, there were 741 initiations that happened at the visit. there are 120 patients in 2019 that were served in extremely low barrier and in 2017, they diagnosed about 16% of the overall declining amount. so, again, that sort of comprehensive approach is so important. but as we had heard previously at city clinic, magnet, other care sites, the visit levels decreased and are not back up to pre-shelter in place levels. what the clinics have tried to do is focus on urgent sexual health care needs. have had limited asymptomatic sti screening and that has been a gap. we tried to fill it with creative ways. some of which you heard from dr. scott. extending the refills for prep. and really, moving and pivoting
to telehealth which hadn't been done before and trying to manage syndromes as people describe them to us. so here, this is really just looking at the data from city clinic, but the same pattern we've been talking about. during shelter in place, the visits dropped by two-thirds. even after the shelter-in-place we're seeing half the visits because of the need to have spacing, the ventilation issues and so on in the clinic. next slide, please. and so this is not just a city clinic because chlamydia and gonorrhea tests in all san francisco residents are reported to the health department by law, we see here those reported cases among san francisco residents have dropped -- had dropped as well during shelter-in-place. this is happening in all providers and we see that drop has continued over time.
it's the same story you've been hearing with h.i.v. is true and the others as well. and in addition, to having the challenges of people not being able to get in to be seen, in addition we've had shortages that have recently been announced and noticed. shortages of testing components. so for chlamydia and gonorrhea, the implication test, which are the recommended test sites, have been in short supply and we received a dear colleague letter from cdc about this earlier last month. the reason for this, like the visit changes, are tied to covid-19 as a lot of the national production lines have been moved over to try to accommodate this immense need for covid-19 testing. so we have been able to order
alternate, so the testing we have done at city clinic has not been interrupted or the public health laboratory. and we're working with other self-helps to assess for shortages there as well. cdc has recommended certain priority groups that are higher risk for chlamydia and gonorrhea, including women under the age of 25 and men who have sex with men, and then patients who present. we're in the midst of planning a health advisory as we do assessment of other health systems and what they're experiencing. next slide, please. and the concerns, just as with h.i.v., this decreased access is not going to come back to everyone equally and we'll be worsening the existing health disparaities which are higher rates among h.i.v. in people of color. this graph is looking at chlamydia tests performed over
time. we see that drop off in march and extending into april. it really seemed to affect all racial ethnic groups at the same time, but what we see, we see the orange line which represents tests among white patients increasing above some of the other ethnic groups. so again these are efforts we have to monitor and think about ways to creatively decrease these access and testing gaps. so some of the ways we've been trying to do this is again this telehealth model we had not previously done. self-collection of swabs and specimens in different routes, including new generations health center. people have done a curbside pickup and dropped off their specimens for testing. home testing as we just heard about from dr. scott. and then working with the health
network to really measure the screening in any primary care visits that do occur, so chlamydia screening in women under 26. and cdc has been putting out guidance on management, which ideally, we want to get the test and get a diagnosis, but if not, if people just present with discharge, we have ways of treating them even if we can't get the test we'd like to. our top priority and the last time i was able to present to you, this was also a concern. congenital syphilis. this is the most devastating outcome of the non-h.i.v. stis resulting in neonatal. and these cases are increasing in the united states and california. these are generally among very vulnerable women with history of substance use, people experiencing homelessness and a lack of prenatal care.
the cases are rising among women in san francisco. while cases among men comprise over 90% of the cases, the number in women while still small has been increasing. and from 2017 to 18 we saw they increased 84% among women. and so that led to our activation of the command of structure in 2019 and that was at the point we went from 62 to 114 cases among women. and unfortunately, it's continues to increase. we see racial and ethnic disparities with the women diagnosed with syphilis as well. with black african-american women disproportionately impacted here. the thing about syphilis among women, congenital syphilis, that treatment with penicillin cures
syphilis and prevents genital syphilis. so our primary goal within std and within our disease intervention specialists at the moment for std is to ensure extreme for 100 -- treatment for 100% of effected women. this is showing the bars by year, the numbers in grey of women that were assigned as cases for follow-up for treatment and then the percent in blue that were successfully treated by the link team. the navigation to care, which is a team that works on the syphilis and h.i.v. you can see that as the numbers increased greatly, i can assure you the team did not grow in proportion to the number of cases, but they through really great work, have managed to enable treatment for over 90% of the women. and, of course, our goal is
100%. and we are thinking of new ways to increase that percentage further. so again to reinforce, our cases overall of congenital syphilis are quite low compared particularly to some of our other challenges in california and other areas of the united states, which have very, very high case numbers and case rates. but, again, because each of these is a potentially tragic loss of life or health, we want to do everything we can to prevent all cases of congenital syphilis. we went from zero cases in 2018, to four cases in 2019. and through the period of time we have one case. but we've had three additional cases since then in the third quarter, so it remains a strong concern. next slide, please.
and this is a busy slide that has a lot of dense important data. this was put together by one of our outstanding epidemiologists. it's looking at cases among pregnant women from 2018 to 2020. there were 27 such cases during this time and you can see by the shading of blue, the grouping by year. and then the most important line is right below that with the circle, the pregnancy outcome. a solid blue circle means there was a case of congenital syphilis averted. the pregnant woman was able to receive treatment in time within 30 days of giving birth, which averts syphilis in the infant. red is unfortunately a case where that did not occur and congenital syphilis was diagnosed in the baby, either
because there was a clinical evidence of congenital syphilis in the child or because it met the definition of being treatment less than 30 days at the time of birth. then grey is where there was either therapeutic or spontaneous abortion. the single circle, that is green with the white inside, means that at this point in time, the mom was treated but had not yet delivered the infant. and if you look at some of the risk factors going down the rows there, lacking prenatal care is overwhelmingly associated with the cases of congenital syphilis seen in san francisco. experiencing homelessness is quite common and using methamphetamine. so again, speaking to the vulnerability of these women and new ways of working and new partnerships that will be needed to avert cases and try and
reverse this trend. so again, this is why we had the activation in 2019. this started as a health alert in may. and we started the activation june 3rd and it went through the end of the year. next slide. and it was truly a partnership between many areas in d.p.h., both in the health network and the population health division, including the offices of health equity. dr. bennett was a leader in this work as well. you can see the many areas within both the network and ph.d. that were involved in trying to do this. it was an unprecedented effort up to that point. now we're seeing a much larger scale activation city-wide, but this was a really important effort to get a lot of key partners together.
so you know, now post activation, i can tell you what we accomplished. so it went -- it was meant to transition into an a-3 process in january, but then covid came along. we did make breakthroughs. we have a result of the work, a new partnership with team lilly. it's led by doctor simon and others and it specializes in prenatal care to women with bare seeking care. through grants, we're funding team lily and working with them. rapid syphilis testing has been rolled out in jail health and street medicine. and that partnership has been wonderful. along with team lily and the
disease investigation specialists, they're going to be instituting case conferences to talk about women and making sure we can offer syphilis screening to women and follow up with prenatal care and medicine. these multidisciplinary case conferences are important because there are so many avenues of care that are needed to ensure treatment in these women. and linking them to the other services they need. and then another thing that was done through the team and jackie mcbright, a very experienced std specialist is testing information and approaches with women experiencing homelessness to see what type of messages appeal to them. we worked very closely with dr.
luke john day at zuckerberg san francisco general hospital and we're making plans to really think about syphilis screening among women that came into the emergency department and care. we were limited about our timing because this was when -- being rolled out. then new reports that look in-depth at syphilis in women are happening every quarter. as i said, we were in the process of switching from a structure that served us well into a more a3 response. i want to switch a little bit to talk about innovation in the last two slides. so really, the reason that we've had such profound success with h.i.v. is because of biomedical
prevention of h.i.v. both with preexposure prophylaxis and the profound imi im impact on the field and getting to zero. we would need that. a vaccine would be wonderful, but other approaches are important. there are preliminary data to say that this medicine seemed to reduce the incidence of chlamydia and syphilis. that was enough of a signal to really warrant trying to do a study, a larger study. so this is a study doxy pep that is going to be done among 780
people who were assigned male at birth. either living with h.i.v. or on h.i.v. prep. men who have sex with men. and they'll be randomized to getting doxy sigh clean after sex oar not. and we're enrolling in san francisco at ward 86 and also at city clinic. and dr. scott, dr. butch binder and the team is led by dr. stefani cohen. dr. connie from washington. this is really exciting. we'll get to see if this biomedical intervention does work to reduce syphilis and chlamydia. and they're going to be evaluating for safety of taking doxy long-term. the reason that women are not being enrolled in the study is
because doxy can have bad impacts on a fetus if a woman happens to be pregnant. so this initial study is limited to people assigned male at birth. and then finally another exciting innovation. i think we'll hear about this more from director armstrong when she speaks in an upcoming system. planned both by leadership and ncah, upsf, population health, and i think it's really very exciting to bring together community members to engage in conversations about how institutions can really enable people in this work of reproductive justice and how we can become client focused and better provide the services and
embrace the goals together. so i'm really looking forward to this and we'll be sure to share information with you commissioners as the date comes a little bit closer and those plans are finalized. i believe that is my last slide. so thank you very much for the opportunity. to be with you and share these information with you and present alongside my colleague. >> thank you, dr. philip. commissioners, questions for dr. philip? commissioner green? >> commissioner green: thank you for this wonderful information. i guess i had two questions. one is, can you -- touch points that brought the pregnant female syphilis patients in. i think out of the five that are the bad outcomes, three were homeless and two were not. and i wonder, you mentioned
clinics and so forth. is there anything you can learn or any information we can gain based on when they actually entered the system? and another system that comes from earlier in the presentation, you talked about telehealth and self-testing, yet, those two elements, you know, have significant barriers. i was wondering if there is a particular population that you think would be most amenable to approach through those means or you know how you're kind of directing your resources to try to get the greatest effect given the limitations of trying to reach populations? >> yes, absolutely. thank you, commissioner green. for the telehealth and self-testing, what has been shown in studies and in other jurisdictions have been that gay men and other men who have sex with men do take up those routes and are able to use them. as i said, we still have over 90% of our syphilis patients among men.
i don't want to down play offering services to gay men in san francisco. and that is very important. and speaking of some of these creative avenues to do that will be help. ful. we also want to see if young women, adolescent women will be amenable to vaginal swabs and taking that route. as you said, the intensive work we want to do in person, in conjunction with street medicine, our colleagues at general hospital and other will most likely be best served in working with a very vulnerable population of women that have limited prenatal care before delivering. in fact, for a large portion of those individuals that did end up being diagnosed with syphilis and having an infant that was diagnosed with congenital syphilis, there was not touches
to the system ahead of time. like during their pregnancy. we're doing case conferences to try and look for opportunities, you know, to intervene and make sure that providers throughout the city know about this. of women with syphilis, about a third of them are served by our own san francisco health network, so it's really wonderful that our colleagues there are as engaged as they are. because we need to look together for any opportunity to do that. we're hoping that street medicine because they're so proactive and have relationships and out in communities of unsheltered people, might be able to enable us to try to offer screening if we know that someone is -- might be pregnant or others know people that might be pregnant within their social networks or nearby. and then having lily be able to
really offer that client-centred prenatal care to whatever extent the person is able to engage in it is also wonderful. so we're hoping that this model will be helpful in preventing what is happening before that people present in labor and we don't have a chance to do anything before. >> thank you. commissioner chow? >> commissioner chow: yes. dr. philip, thank you for your presentation and also wanted to ask as you mentioned that you're still emphasizing obviously the stds that are in males and gay males, but at the same time as we heard earlier in previous years, the rise of std was also in the young. and so the project that was
described, the integrated h.i.v. program, would seem to be targeting the h.i.v. population. how are you looking at also being part of that as -- and at the same time also as you did with the congenital program, how would you then continue to also concentrate on the black and young male std rise? >> absolutely, commissioner chow. yes, so we are -- we are trying to understand what the best ways are to continue to deliver services so that young people have access. and you know, we have also been watching to see if youth are going to -- which clinics
they're going to. and i think that the plan we've heard about from dr. hammer to roll out or to reopen the clinics will be helpful in that regard. and i think, again, these ideas of non-traditional ways of doing screening and low barrier ways of doing screening are also important. i previously talked about our great work with our amazing partners at services and pratt and her team. they have been also really champions of trying to do rapid gonorrhea and chlamydia testing within jail populations as well. so i think there are several ways in which we're trying to move the work forward. it becomes much more challenging in the time of covid, as all of our work is. and so we're continuing to refine and try to improve that within the limitations, spacing
and needing to have patients per hour at clinic. we don't have all the answers and we're trying to work with partners with expertise and also hear from community as to how they would like us to... >> thank you. i know that we'll continue to look forward to not only this collaboration, but also the emphasis of trying to reduce overall std rates in the city. with the new innovative ways that you're thinking of, and some of that will come from the experience working with the h.i.v. project there, too. so we'll look forward to additional information as we get more reports. thank you. >> thank you. >> thank you, dr. philip. commissioner chow. any other questions from commissioners? dr. philip, i did have a question. it's for you and all of your colleagues.
i view san francisco as having the best -- second to none health and surveillance. and every year, particularly when we get these reports from you and your colleagues, we find encouraging things. we find evidence of the great work that they're doing and areas that we need to refocus our efforts. given we're nine months into 2020 and this is no year like any other, is there an inflection point where we will use the data collected from this year and what is happening in terms of risk behaviors and other things so we can adjust our strategies accordingly but do it more quickly and more in realtime? >> yes. i think that is very much -- very much needed. and you know finding exactly what the behavioral changes have been, i think we may also need to rely on some of our academic colleagues and others who are
able to dig into that more. i will tell you that my team and i we've been focussed on what we know the structural barriers are as a result of covid. i think all of the pieces, as you said, have to come together. and without sort of all those pieces, we won't know if we see the decline in syphilis for 2020 or 2019 what that means. and i think none of us would feel reassured by that and i think we'd want to really understand -- dive more into the different aspects of the data you have. knowing that is going to be somewhat limited by the data that was reported to us and the fact that a lot of our leadership is involved in the covid response, which is really important. our epidemiologists are community experts. and our disease intervention specialists as well are leadership. so it's balancing all of those things which is a constant challenge, but we're -- our team is up to it, so we're going to
keep working at it. >> i know you are. it ties back to one of the points made in dr. scott's presentation, which is a great concern, that black patients have worse viral suppression, but it has not changed in covid. so what can we learn from that and how that may provide useful ways to address the fact that black patients do much worse in the suppression. because as we know, viral suppression is not just an issue of patient outcomes, but community outcomes. >> absolutely. and i think that, you know, understanding that all the sexual health outcomes and hep-c, they're all tied together. they're the same structural barriers and underpinning of racism throughout, that we are all going to be working together
and using these federal dollars to find new ways of improving our work and that's our constant mission and pledge. >> great. thank you, dr. philip. >> commissioners, do you have other questions or comments? mark, any public comment? >> there still remains no one on the public comment line. >> i've remained hopeful, that, unfortunately we do not have anyone. dr. philip, dr. scott, dr. hsu, thank you for your presentation. i look forward every year. thank you so much for that. all right. moving on to the next item. other business. commissioners, any other business? all right. seeing no other business, welcome move on to item 12,
which is a brief update on the joints conference committee from zuckerberg san francisco general hospital. >> pardon me, did i miss somebody? or if not, commissioner chow? >> commissioner chow: thank you. briefly, we did do a routine study, routine reports on the regulatory affairs. we also received a very comprehensive presentation on zuckerberg's quality programs and data. the' enormity of over greater than 100 measures that we have with maybe six or seven different types of reporting agencies that they go to. and its implications. it was a very good presentation and i think that we might be
able to distribute that to our commissioners here. action items included the approval of the laboratory medicine rules and regulations, intervention radiology, standardized procedures and we had a closed session where we did review our work and passed the credentials report. so put that into my report. >> president bernal: thank you. mark, any public comment? >> no public comment, sir. >> president bernal: commissioners, any questions for commissioner chow? if not, the next item which is consideration of a closed session. do we have a motion to move into a closed session? >> so moved. >> second. commissioner, roll call vote.
>> commissioner chow: yes. >> commissioner green: yes. >> commissioner christian: yes. >> commissioner giraudo: yes. >> president bernal: yes. before we move out of open session, i want to thank all of the d.p.h. staff that joined us and provided excellent presentations today because we may not be seeing you when we reopen briefly to adjourn. so thank you. >> if everyone wil closed or not disclose the discussions from the closed session. >> i move not to disclose the discussions during the closed session. >> do we have a second? >> second. >> thank you. all right, roll call. >> commissioner green: yes. >> president bernal: yes. >> commissioner christian: yes.
>> commissioner giraudo: yes. >> commissioner chow: yes. >> thank you. >> president bernal: moving on to the next item, 14 which is adjournment. we will enter a motion to adjourn. >> so moved. >> second. >> commissioner christian: yes. >> commissioner green: yes. >> commissioner chow: yes. >> president bernal: yes. thank you, everyone. >> thank you.
>> the bicycle coalition was giving away 33 bicycles so i applied. i was happy to receive one of them. >> the community bike build program is the san francisco coalition's way of spreading the joy of biking and freedom of biking to residents who may not have access to affordable transportation. the city has an ordinance that we worked with them on back in 2014 that requires city agency goes to give organizations like the san francisco bicycle organization a chance to take
bicycles abandoned and put them to good use or find new homes for them. the partnerships with organizations generally with organizations that are working with low income individuals or families or people who are transportation dependent. we ask them to identify individuals who would greatly benefit from a bicycle. we make a list of people and their heights to match them to a bicycle that would suit their lifestyle and age and height. >> bicycle i received has impacted my life so greatly. it is not only a form of recreation. it is also a means of getting connected with the community through bike rides and it is also just a feeling of freedom. i really appreciate it. i am very thankful.
>> we teach a class. they have to attend a one hour class. things like how to change lanes, how to make a left turn, right turn, how to ride around cars. after that class, then we would give everyone a test chance -- chance to test ride. >> we are giving them as a way to get around the city. >> just the joy of like seeing people test drive the bicycles in the small area, there is no real word. i guess enjoyable is a word i could use. that doesn't describe the kind of warm feelings you feel in your heart giving someone that sense of freedom and maybe they haven't ridden a bike in years. these folks are older than the normal crowd of people we give bicycles away to.
take my picture on my bike. that was a great experience. there were smiles all around. the recipients, myself, supervisor, everyone was happy to be a part of this joyous occasion. at the end we normally do a group ride to see people ride off with these huge smiles on their faces is a great experience. >> if someone is interested in volunteering, we have a special section on the website sf bike.org/volunteer you can sign up for both events. we have given away 855 bicycles, 376 last year. we are growing each and every year. i hope to top that 376 this year. we frequently do events in bayview. the spaces are for people to
come and work on their own bikes or learn skills and give them access to something that they may not have had access to. >> for me this is a fun way to get outside and be active. most of the time the kids will be in the house. this is a fun way to do something. >> you get fresh air and you don't just stay in the house all day. iit is a good way to exercise. >> the bicycle coalition has a bicycle program for every community in san francisco. it is connecting the young, older community. it is a wonderful outlet for the community to come together to have some good clean fun. it has opened to many doors to the young people that will usually might not have a bicycle. i have seen them and they are