VARIANCE TO STAGE 2 OF CALIFORNIA’S ROADMAP TO MODIFY THE STAY-AT-HOME ORDER COVID-19 VARIANCE ATTESTATION FORM FOR County of San Francisco May 18, 2020 Background On March 4, 2020, Governor Newsom proclaimed a State of Emergency because of the threat of COVID-19, and on March 12, 2020, through Executive Order N-25-20, he directed all residents to heed any orders and guidance of state and local public health officials. Subsequently, on March 19, 2020, Governor Newsom issued Executive Order N-3320 directing all residents to heed the State Public Health Officer’s Stay-at-Home order which requires all residents to stay at home except for work in critical infrastructure sectors or otherwise to facilitate authorized necessary activities. On April 14th, the State presented the Pandemic Roadmap, a four-stage plan for modifying the Stay-at-Home order, and, on May 4th, announced that entry into Stage 2 of the plan would be imminent. Given the size and diversity of California, it is not surprising that the impact and level of county readiness for COVID-19 has differed across the state. On May 7th, as directed by the Governor in Executive Order N-60-20, the State Public Health Officer issued a local variance opportunity through a process of county self-attestation to meet a set of criteria related to county disease prevalence and preparedness. This variance allowed for counties to adopt aspects of Stage 2 at a rate and in an order determined by the County Local Health Officer. Note that counties desiring to be stricter or move at a pace less rapid than the state did not need a variance. In order to protect the public health of the state, and in light of the state’s level of preparedness at the time, more rapid movement through Stage 2 as compared to the state needed to be limited to those counties which were at the very lowest levels of risk. Thus, the first variance had very tight criteria related to disease prevalence and deaths as a result of COVID-19. Now, 11 days after the first variance opportunity announcement, the state has further built up capacity in testing, contact tracing and the availability of PPE. Hospital surge capacity remains strong overall. California has maintained a position of stability with respect to hospitalizations. These data show that the state is now at a higher level of preparedness, and many counties across the state, including those that did not meet the first variance criteria are expected to be, too. For these reasons, the state is issuing a second variance opportunity for certain counties that did not meet the criteria of the first variance attestation. This next round of variance is for counties that can attest to meeting specific criteria indicating local stability of COVID-19 spread and specific levels of county preparedness. The CDPH COVID-19 VARIANCE ATTESTATION FORM criteria and procedures that counties will need to meet in order to attest to this second variance opportunity are outlined below. It is recommended that counties consult with cities, tribes and stakeholders, as well as other counties in their region, as they consider moving through Stage 2 Local Variance A county that has met the criteria in containing COVID-19, as defined in this guidance or in the guidance for the first variance, may consider modifying how the county advances through Stage 2, either to move more quickly or in a different order, of California’s roadmap to modify the Stay-at-Home order. Counties that attest to meeting criteria can only open a sector for which the state has posted sector guidance (see Statewide industry guidance to reduce risk). Counties are encouraged to first review this document in full to consider if a variance from the state’s roadmap is appropriate for the county’s specific circumstances. If a county decides to pursue a variance, the local health officer must: 1. Notify the California Department of Public Health (CDPH), and if requested, engage in a phone consultation regarding the county’s intent to seek a variance. 2. Certify through submission of a written attestation to CDPH that the county has met the readiness criteria (outlined below) designed to mitigate the spread of COVID-19. Attestations should be submitted by the local health officer, and accompanied by a letter of support from the County Board of Supervisors, as well as a letter of support from the health care coalition or health care systems in said county.1 In the event that the county does not have a health care coalition or health care system within its jurisdiction, a letter of support from the relevant regional health system(s) is also acceptable. The full submission must be signed by the local health officer. All county attestations, and submitted plans as outlined below, will be posted publicly on CDPH’s website. CDPH is available to provide consultation to counties as they develop their attestations and COVID-19 containment plans. Please email Jake Hanson at Jake.Hanson@cdph.ca.gov to notify him of your intent to seek a variance and if needed, request a consultation. County Name: San Francisco County Contact: Tomás Aragón, MD, DrPH Public Phone Number: 415-515-5734 (cell---better); 415-554-2898 (office) Readiness for Variance The county’s documentation of its readiness to modify how the county advances through Stage 2, either to move more quickly or in a different order, than the California’s roadmap to modify the Stay-at-Home order, must clearly indicate its preparedness according to the criteria below. This will ensure that individuals who are at heightened risk, including, for If a county previously sought a variance and submitted a letter of support from the health care coalition or health care systems but did not qualify for the variance at that time, it may use the previous version of that letter. In contrast, the County Board of Supervisors must provide a renewed letter of support for an attestation of the second variance. 1 2 CDPH COVID-19 VARIANCE ATTESTATION FORM example, the elderly and those with specific co-morbidities, and those residing in long-term care and locally controlled custody facilities and other congregate settings, continue to be protected as a county progresses through California’s roadmap to modify the Stay-at-Home order, and that risk is minimized for the population at large. As part of the attestation, counties must provide specifics regarding their movement through Stage 2 (e.g., which sectors, in what sequence, at what pace), as well as clearly indicate how their plans differ from the state’s order. As a best practice, if not already created, counties will also attest to plan to develop a county COVID-19 containment strategy by the local health officer in conjunction with the hospitals and health systems in the jurisdiction, as well as input from a broad range of county stakeholders, including the County Board of Supervisors. It is critical that any county that submits an attestation continue to collect and monitor data to demonstrate that the variances are not having a negative impact on individuals or healthcare systems. Counties must also attest that they have identified triggers and have a clear plan and approach if conditions worsen to reinstitute restrictions in advance of any state action. Readiness Criteria To establish readiness for a modification in the pace or order through Stage 2 of California’s roadmap to modify the Stay-at-Home order, a county must attest to the following readiness criteria and provide the requested information as outlined below: • Epidemiologic stability of COVID-19. A determination must be made by the county that the prevalence of COVID-19 cases is low enough to be swiftly contained by reintroducing features of the stay at home order and using capacity within the health care delivery system to provide care to the sick. Given the anticipated increase in cases as a result of modifying the current Stay-At-Home order, this is a foundational parameter that must be met to safely increase the county’s progression through Stage 2. The county must attest to: o Demonstrated stable/decreasing number of patients hospitalized for COVID-19 by a 7-day average of daily percent change in the total number of hospitalized confirmed COVID-19 patients of <+5% -OR- no more than 20 total confirmed COVID-19 patients hospitalized on any single day over the past 14 days. 3 CDPH COVID-19 VARIANCE ATTESTATION FORM San Francisco meets the 7-day running average of daily percent change < 5% in the total number of hospitalized COVID-19 patients. The most recent value is <0.0%. We do NOT meet the “no more than 20 total confirmed COVID-19 patients hospitalized on a single day over the past 14 days.” The most recent value is 31 hospitalized (as of June 18, 2020). Rate of change in total hospitalizations 100.0 250.00% 90.0 200.00% 70.0 150.00% 60.0 50.0 100.00% 40.0 50.00% 30.0 20.0 0.00% 10.0 Actual Covid+ Hospitalizations 6/21/20 6/14/20 6/7/20 5/31/20 5/24/20 5/17/20 5/10/20 5/3/20 4/26/20 4/19/20 4/12/20 4/5/20 3/29/20 3/22/20 -50.00% 3/15/20 0.0 Rate of Change in Hospitali zations Raw data for change in rate of total hospitalizations date Actual Hosp. 6/1/20 6/2/20 6/3/20 6/4/20 6/5/20 6/6/20 6/7/20 6/8/20 6/9/20 6/10/20 6/11/20 6/12/20 6/13/20 6/14/20 6/15/20 6/16/20 6/17/20 6/18/20 43.0 39.0 43.0 43.0 38.0 36.0 36.0 38.0 38.0 37.0 42.0 39.0 38.0 38.0 33.0 35.0 33.0 31.0 3 day Running Hosp. Average Rate of change in Hosp 48.7 -10.98% 44.3 -16.88% 41.7 -23.31% 41.7 -25.60% 41.3 -23.93% 39.0 -26.88% 36.7 -29.03% 36.7 -24.66% 37.3 -15.79% 37.7 -9.60% 39.0 -6.40% 39.3 -4.84% 39.7 1.71% 38.3 4.55% 36.3 -0.91% 35.3 -5.36% 33.7 -10.62% 33.0 -15.38% Week over week change in 3 day rolling average of hospitalizations 4 Percent Change Covid + Total Hospitalizations 80.0 CDPH COVID-19 VARIANCE ATTESTATION FORM 14-day cumulative COVID-19 positive incidence of <25 per 100,000 -OR- testing positivity over the past 7 days of <8%. o San Francisco DOES meet the testing positivity over the past 7 days of <8%. The most recent value is 1.6% (as of June 19, 2020). Running seven day average of Covid-19 Test Positivity Percent of tests that are Covid-19 positive 25.00% 20.00% 15.00% 10.00% 5.00% 15-Jun 8-Jun 1-Jun 25-May 18-May 11-May 4-May 27-Apr 20-Apr 13-Apr 6-Apr 30-Mar 23-Mar 16-Mar 9-Mar 2-Mar 0.00% Raw data for test positivity Date Test number 1-Jun 2-Jun 3-Jun 4-Jun 5-Jun 6-Jun 7-Jun 8-Jun 9-Jun 10-Jun 11-Jun 12-Jun 13-Jun 14-Jun 15-Jun 16-Jun 17-Jun 18-Jun 19-Jun Positives 2457 2695 2210 2440 2485 1816 1866 3217 3470 2926 3288 3089 1757 1438 3249 2708 2708 2692 2462 43 57 38 47 35 21 23 40 43 17 28 34 23 17 39 49 57 38 49 Running seven day average Tests Running seven day average positivesPositive percent 2048.714286 40 2132.285714 39.85714286 2145 38.85714286 2175.857143 41.14285714 2177.142857 40 2213 38.85714286 2281.285714 37.71428571 2389.857143 37.28571429 2500.571429 35.28571429 2602.857143 32.28571429 2724 29.57142857 2810.285714 29.42857143 2801.857143 29.71428571 2740.714286 28.85714286 2745.285714 28.71428571 2636.428571 29.57142857 2605.285714 35.28571429 2520.142857 36.71428571 2430.571429 38.85714286 5 1.95% 1.87% 1.81% 1.89% 1.84% 1.76% 1.65% 1.56% 1.41% 1.24% 1.09% 1.05% 1.06% 1.05% 1.05% 1.12% 1.35% 1.46% 1.60% CDPH COVID-19 VARIANCE ATTESTATION FORM NOTE: State and Federal prison inmate COVID+ cases can be excluded from calculations of case rate in determining qualification for variance. Staff in State and Federal prison facilities are counted in case numbers. Inmates, detainees, and staff in county facilities, such as county jails, must continue to be included in the calculations. Facility staff of jails and prisons, regardless of whether they are run by local, state or federal government, generally reside in the counties in which they work. So, the incidence of COVID-19 positivity is relevant to the variance determination. In contrast, upon release, inmates of State and Federal prisons generally do not return to the counties in which they are incarcerated, so the incidence of their COVID-19 positivity is not relevant to the variance determination. While inmates in state and federal prisons may be removed from calculation for this specific criteria, working to protect inmates in these facilities from COVID-19 is of the highest priority for the State. o Counties using this exception are required to submit case rate details for inmates and the remainder of the community separately. This question does not apply. This question pertains to state or federal prisons and none are in San Francisco. The majority of city workers live out of county. And, in contrast to state prisons, persons released from San Francisco jails (about 80%) list their primary place of residence in San Francisco. • Protection of Stage 1 essential workers. A determination must be made by the county that there is clear guidance and the necessary resources to ensure the safety of Stage 1 essential critical infrastructure workers. The county must attest to: o Guidance for employers and essential critical infrastructure workplaces on how to structure the physical environment to protect essential workers. Please provide, as a separate attachment, copies of the guidance(s). We have developed and provided numerous guidance documents for essential workers. We have general guidance to make physical environments safer, including for employers and essential critical infrastructure workers. We have provided guidance around cleaning, testing, handling positive cases among employees, screening employees, food facilities and delivery, PPE recommendations for different types or personnel, elder and residential care facilities, Emergency Medical Services, Healthcare, curbside pick-up, outdoor dining, and SROs (congregate living residences), and the face covering directive. Links to the guidance documents are in: Appendix A. Guidance SFDPH has created for Stage 1 Workers 6 CDPH COVID-19 VARIANCE ATTESTATION FORM o Availability of supplies (disinfectant, essential protective gear) to protect essential workers. Please describe how this availability is assessed. Availability of supplies such as PPE and disinfectant is assessed through DPH DOC Logistics and EOC Logistics Joint Task force. Both groups manage and account for current warehousing and hospital inventories. San Francisco has multiple warehousing sites. The task force tracks inventories for all critical, scarce, and most used PPE. The task force also looks at burn rates and conducts procurement accordingly. Inventory is reviewed daily against resource requests from the healthcare system and partners. The task force will also allocate scarce PPE during shortages. For the list, please see: Appendix A2. List of supplies for essential workers • Testing capacity. A determination must be made by the county that there is testing capacity to detect active infection that meets the state’s most current testing criteria, (available on CDPH website). The county must attest to: o Minimum daily testing capacity to test 1.5 per 1,000 residents, which can be met through a combination of testing of symptomatic individuals and targeted surveillance. Provide the number of tests conducted in the past week. A county must also provide a plan to reach the level of testing that is required to meet the testing capacity levels, if the county has not already reached the required levels. San Francisco meets the minimum daily testing capacity. San Francisco is currently conducting 2.75 tests per 1,000 (as of June 19, 2020). San Francisco’s laboratory testing dashboard can be found here: https://data.sfgov.org/stories/s/d96w-cdge 7 CDPH COVID-19 VARIANCE ATTESTATION FORM Tests/1000 residents Tests/1000 residents 3.5 3 Tests/1000 residents 2.5 2 1.5 1 0.5 15-Jun 8-Jun 1-Jun 25-May 18-May 11-May 4-May 27-Apr 20-Apr 13-Apr 6-Apr 30-Mar 23-Mar 16-Mar 9-Mar 2-Mar 0 Raw data for tests/1000 population Date Test number 1-Jun 2-Jun 3-Jun 4-Jun 5-Jun 6-Jun 7-Jun 8-Jun 9-Jun 10-Jun 11-Jun 12-Jun 13-Jun 14-Jun 15-Jun 16-Jun 17-Jun 18-Jun 19-Jun 1510 2457 2695 2210 2440 2450 1816 3217 3470 2926 3288 3089 1757 1438 3249 2708 2708 2692 2462 Running seven day averageTests/1000 residents 1912.571429 2.165992558 1962.142857 2.222132341 2045 2.31596829 2043 2.313703284 2037.857143 2.307878984 2164.285714 2.451059699 2225.428571 2.520304158 2469.285714 2.796473063 2614 2.960362401 2647 2.997734994 2801 3.17214043 2893.714286 3.277139621 2794.714286 3.165021841 2740.714286 3.103866688 2745.285714 3.109043844 2636.428571 2.985762822 2605.285714 2.950493448 2520.142857 2.854068921 2430.571429 2.752629024 Population SF County = 883,000 o Testing availability for at least 75% of residents, as measured by the presence of a specimen collection site (including established health care providers) within 30 minutes driving time in urban areas, and 60 minutes in rural areas. Please provide a listing of all specimen collection sites in the county and indicate if there are any geographic areas that do not meet the criteria and plans for filling these gaps if they exist. If the county depends on sites in adjacent counties, please list these sites as well. 8 CDPH COVID-19 VARIANCE ATTESTATION FORM San Francisco meets this criteria. San Francisco has a relatively small geographic footprint of approximately 7 miles by 7 miles. Most areas of the county can be reached within 30 minutes of driving time. There are currently 32 sites offering testing. The most current map of all testing sites can be found at the link and below: https://datasf.org/covid19-testing-locations/ Map of San Francisco COVID-19 Testing Sites o Please provide a COVID-19 Surveillance plan, or a summary of your proposed plan, which should include at least how many tests will be done, at what frequency and how it will be reported to the state, as well as a timeline for rolling out the plan. The surveillance plan will provide the ability for the county to understand the movement of the virus that causes COVID19 in the community through testing. [CDPH has a community sentinel surveillance system that is being implemented in several counties. Counties are welcome to use this protocol and contact covCommunitySurveillance@cdph.ca.gov for any guidance in setting up such systems in their county.] The City and County of San Francisco (CCSF) attests to having a COVID-19 Surveillance Plan. CCSF has been conducting community-wide testing among hospitals, mobile testing sites, skilled nursing facilities, single-room occupancy hotels, jails, shelters, sheltered and unsheltered persons experiencing homelessness, encampments, essential workers, and underserved communities. Currently we are conducting 2.75 tests per 1,000 residents in San Francisco (as of June 19, 2020). On June 8, 2020, our positivity rate was 1% and is being monitored and reported daily. All positive tests are reported to CDPH via electronic laboratory reporting and case information is entered into CalREDIE for reporting. All new positive tests are forwarded to our investigation teams in order to initiate case 9 CDPH COVID-19 VARIANCE ATTESTATION FORM investigations and contact tracing. Case data include demographic characteristics, clinical characteristics, known hospitalization data, and deaths. ELR data include ordering facility, lab performing the test, specimen characteristics, collection data, and test results. For more information on our planning, please see: Appendix B. COVID Surveillance A3_v4_oneslide • Containment capacity. A determination must be made by the county that it has adequate infrastructure, processes, and workforce to reliably detect and safely isolate new cases, as well as follow up with individuals who have been in contact with positive cases. The county must attest to: o Enough contact tracing. There should be at least 15 staff per 100,000 county population trained and available for contact tracing. Please describe the county’s contact tracing plan, including workforce capacity, and why it is sufficient to meet anticipated surge. Indicate which data management platform you will be using for contact tracing (reminder that the State has in place a platform that can be used free-of-charge by any county). San Francisco has 143 active contact investigators and tracers. This is 16 staff for 100,000 population, which exceeds the State expectation of at least 15 per 100,000. Another 157 have been trained and are inactive. San Francisco is using the CommCare software platform created by a company called Dimagi. For more information on the plan, see Appendix C. Transitioning CI-CT to Phase IIB 6.5.20 o Availability of temporary housing units to shelter at least 15% of county residents experiencing homelessness in case of an outbreak among this population requiring isolation and quarantine of affected individuals. Please describe the county’s plans to support individuals, including those experiencing homelessness, who are not able to properly isolate in a home setting by providing them with temporary housing (including access to a separate bathroom, or a process in place that provides the ability to sanitize a shared bathroom between uses), for the duration of the necessary isolation or quarantine period. Rooms acquired as part of Project Roomkey should be utilized. 10 CDPH COVID-19 VARIANCE ATTESTATION FORM San Francisco meets these criteria. The 2019 Homeless Point in Time count estimates that there are 8,011 persons experiencing homelessness (PEH) in San Francisco of which 2,831 who are sheltered. The San Francisco Department of Public Health is collabrating with partner agencies like the Department of Homelessness and Supportive Housing and the Human Services Agency, to support people experiencing homelessness and who are unable to isolate. As of June 14, 2020 San Francisco has 2,373 hotel and RV units for COVID positive and vulnerable persons experiencing homelessness, which is equivalent to 29% of the estimated number of persons experiencing homelessness. For more information on the availability of housing units, see link to the public dashboard: https://data.sfgov.org/stories/s/4nah-suat • Hospital capacity. A determination must be made by the county that hospital capacity, including ICU beds and ventilators, and adequate PPE is available to handle standard health care capacity, current COVID-19 cases, as well as a potential surge due to COVID-19. If the county does not have a hospital within its jurisdiction, the county will need to address how regional hospital and health care systems may be impacted by this request and demonstrate that adequate hospital capacity exists in those systems. The county must attest to: o County (or regional) hospital capacity to accommodate COVID-19 positive patients at a volume of at a minimum surge of 35% of their baseline average daily census across all acute care hospitals in a county. This can be accomplished either through adding additional bed capacity or decreasing hospital census by reducing bed demand from non-COVID-19 related hospitalizations (i.e., cancelling elective surgeries). Please describe how this surge would be accomplished, including surge census by hospital, addressing both physical and workforce capacity. San Francisco Hospitals, in aggregate, have 35% of their pre-COVID-19 average daily census available for COVID-19. SF has, as of June 11, 2020, 31% of 279 ICU beds (87 beds) available and 20% of 1302 Acute Care beds (260 beds) available. SF Hospitals also have an additional 312 Surge ICU beds and 375 Surge Acute Care beds available. A surge of COVID+ patients can currently be accomodated in the remaining ICU/Acute Care capacity and if necessary the ICU/Acute Care bed Surge capacity. 11 CDPH COVID-19 VARIANCE ATTESTATION FORM For the most updated data and to see the N behind each percentage, use the link here: https://data.sfgov.org/stories/s/qtdt-yqr2 o County (or regional) hospital facilities have a robust plan to protect the hospital workforce, both clinical and nonclinical, with PPE. Please describe the process by which this is assessed. In San Francisco, PPE availability is assessed daily at our Joint Logs Task Force. This includes multiple sectors: EOC logs, DPH logs, Med Branch, Finance, Testing, and Advance Planning. We assess current asks from facilities and rates of usage to ensure we have adequate supply. Currently SF is well stocked for more than 30 days for critical PPE should we surge. • Vulnerable populations. A determination must be made by the county that the proposed variance maintains protections for vulnerable populations, particularly those in long-term care settings. The county must attest to ongoing work with Skilled Nursing Facilities within their jurisdiction and describe their plans to work closely with facilities to prevent and mitigate outbreaks and ensure access to PPE: o Describe your plan to prevent and mitigate COVID-19 infections in skilled nursing facilities through regular consultation with CDPH district offices and with leadership from each facility on the following: targeted testing and patient cohorting plans; infection control precautions; access to PPE; staffing shortage contingency 12 CDPH COVID-19 VARIANCE ATTESTATION FORM plans; and facility communication plans. This plan shall describe how the county will (1) engage with each skilled nursing facility on a weekly basis, (2) share best practices, and (3) address urgent matters at skilled nursing facilities in its boundaries. Collaboration with CDPH • SFDPH and CDPH Licensing & Certification District Offices have recently begun biweekly coordination calls. Calls started mid-May with plans to continue on this schedule. Allows for important exchange of information such as clarification of CDPH requirements for SNFs, as well as explanation of SFDPH local policies for SNFs. Plan to further collaborate to allow SFDPH to review SNF’s COVID-19 Mitigation Plans they are currently submitting to the state • SFDPH encourages SNFs to join weekly CDPH SNF conference calls Partnership with Facilities • Each SNF has a dedicated Outbreak Response Nurse assigned to them. Nurses communicate with facilities frequently providing clinical consultation, expertise and guidance • Through close coordination with facilities, Outbreak Response Nurses maintain awareness of: number of COVID+ patients or staff, number of PUIs, and the ability to isolate and cohort patients. The Outbreak Response Team provides guidance on infection control precautions and measures to prevent and mitigate risk of COVID transmission • When facilities experience outbreaks, Outbreak Response Nurses closely monitor the SNF for 28 days (2 COVID-19 incubation periods). SFDPH has defined an outbreak in a SNF as: 1 lab-confirmed COVID case in a resident. This conservative definition allows SFDPH to rapidly assess the situation and urge infection control and cohorting practices early and often • The Outbreak Response Team & SFDPH’s Testing Branch has coordinated baseline surveillance testing at SNFs (both staff and patients). This is in support of San Francisco Health Officer Order C19-13, which requires surveillance testing in SNFs. This required practice is in conjunction with additional response activities included in the Health Officer order, all which promote strategies for SNFs to protect the vulnerable populations they care for • SFDPH is currently developing a contingency staffing plan to support SNFs experiencing severe staffing shortages, with the underlying goal of enabling SNFs to maintain the provision of safe operations • In addition to frequent communication with their assigned nurses, SNFs also join a weekly coordination call run by SFDPH to share best practices, learn about new policies, and become introduced to tools/guidance documents PPE • • SFDPH frequently provides PPE to SNFs; the Medical Resource Unit makes resource allocation decisions with the understanding that those housed in SNFs represent a highly vulnerable population The quantities and types of PPE items that SNFs have received through SFDPH are tracked via the Medical Resource Unit. This provides historical documentation of 13 CDPH COVID-19 VARIANCE ATTESTATION FORM • o PPE provided to SNFs from SFDPH. SNFs have been encouraged to closely monitor their PPE supply levels, to measure and understand their rates of usage, and to establish a threshold quantity level to trigger obtaining more supplies Skilled nursing facilities (SNF) have >14-day supply of PPE on hand for staff, with established process for ongoing procurement from non-state supply chains. Please list the names and contacts of all SNFs in the county along with a description of the system the county must track PPE availability across SNFs. San Francisco meets this criteria. FEMA previously supplied PPE to all 21 SF SNF’s. They should also be receiving more supplies from FEMA moving forward. San Francisco tracks the availability of PPE in the SNF unit and assesses their need. We have a survey in our resource request form to assess their current state and need. San Francisco has a designated point of contact and someone who handles incoming requests and brings it to the supply chain for allocation decisions. SNF Facility Names and Addresses GENERATIONS TUNNELL AND CITYVIEW POST ACUTE HERITAGE ON THE MARINA VICTORIAN POST ACUTE SAN FRANCISCO TOWERS THE SEQUOIAS CENTRAL GARDENS LAUREL HEIGHTS COMMUNITY CARE PACIFIC HEIGHTS TRANSITIONAL CARE KENTFIELD REHAB HOSPITAL (LONG TERM ACUTE CARE) SAN FRANCISCO HEALTH CARE AND REHAB HAYES CONVALESCENT HOSPITAL VAMC SNF WARD ST. ANNES HOME FOR THE AGED/ LITTLE SISTERS OF THE POOR GENERATION LAWTON THE AVENUES TRANSITIONAL CARE CENTER LAGUNA HONDA HOSPITAL AND REHAB CENTER CALIFORNIA PACIFIC MEDICAL CENTER: DAVIES CAMPUS SNF SHEFFIELD CONVALESCENT HOSPITAL ZUCKERBURG SAN FRANCISCO GENERAL HOSPITAL ZSFG 4A SNF JEWISH HOME AND REHAB CENTER SF POST ACUTE • 1359 Pine St 3400 Laguna St 2121 Pine St 1661 Pine St 1400 Geary Blvd 1355 Ellis St 2740 California S 2707 Pine St 450 Stanyan St 1477 Grove St 1250 Hayes St 4150 Clement Street 300 Lake St 1575 7th St 2043 19th Ave 375 Laguna Honda Blvd 601 Duboce Ave 1133 South Van Ness 1001 Potrero Ave 302 Silver Avenue 5767 Mission St Sectors and timelines. Please provide details on the county’s plan to move through Stage 2. These details should include which sectors and spaces will be opened, in what sequence, on what timeline. Please specifically indicate where the plan differs from the state’s order. Any sector that is reflective of Stage 3 should not be included 14 CDPH COVID-19 VARIANCE ATTESTATION FORM in this variance because it is not allowed until the State proceeds into Stage 3. For additional details on sectors and spaces included in Stage 2, please see https://covid19.ca.gov/industry-guidance/ for sectors open statewide and https://covid19.ca.gov/roadmap-counties/ for sectors available to counties with a variance. San Francisco has a plan for moving through Stage 2 that is aligned with the State’s guidelines and based on a San Francisco-specific industry review. The timeline will be adjusted as needed based on public health data. San Francisco’s Plan separates the State’s second stage into three phases – Phase 2A, 2B, and 2C. San Francisco’s Phases 3 and 4 are aligned with the State’s stages. San Francisco has already entered into Phase 2A, which allows curbside pickup permitted for most retail, construction, elective surgeries, and outdoor businesses like carwashes, flea markets, and garden stores to operate. San Francisco’s Stay at Home Health Order does not have an expiration date and will be amended over the coming weeks and months to allow for a gradual and safer reopening. San Francisco Planned Reopening Timeline. The initial plan was posted on . The plan has since been updated and is summarized below. San Francisco will only allow reopening of businesses and activities that are permitted under the State’s guidelines. 15 CDPH COVID-19 VARIANCE ATTESTATION FORM 16 CDPH COVID-19 VARIANCE ATTESTATION FORM 17 CDPH COVID-19 VARIANCE ATTESTATION FORM For full information about the City’s plan to reopen in phases, go to: https://sf.gov/step-by-step/reopening-san-francisco The reopening plan and other documents can be found in the appendices: • Appendix D. 05.28.20 Reopening Plan • Appendix E. ERTF01_Economic-Recovery-Task-Force_Membership 18 CDPH COVID-19 VARIANCE ATTESTATION FORM • • • • Appendix F. ERTF02_Economic-Recovery-Task-Force_Meeting1-slides Appendix G. ERTF03_Economic-Recovery-Task-Force_Meeting2-slides Appendix H. ERTF04_Health-Commission-Update_SF-Reopening-Plan Triggers for adjusting modifications. Please share the county metrics that would serve as triggers for either slowing the pace through Stage 2 or tightening modifications, including the frequency of measurement and the specific actions triggered by metric changes. Please include your plan, or a summary of your plan, for how the county will inform the state of emerging concerns and how it will implement early containment measures. San Francisco is using five indicators to assess our program on a four point scale of Red, Orange, Yellow, and Green. The indicators include Cases, Hospital System, Testing, Contact Tracing, and Personal Protective Equipment. • Our cases (status Green) are flat and/or decreasing. • Hospitalizations (status Green) are flat and/or decreasing, and we are over 20% of ICU and over 15% of Acute Care bed capacity. • We are averaging 2,277 tests per day, exceeding the goal of 1,800 tests per day (status Green). • For contact tracing (status Orange), we have reached 80% of cases with contacts identified (a little short of the 90% goal), and 68% of all contacts have been reached (short of 90% goal). • For PPE (status Yellow), we have 85% of PPE more than the 30-day supply. For more information, please see: • Appendix I. 5 Indicators FINAL 6 8 20 .cleaned • Appendix J. Indicators & Trigger Levels_06 11 • COVID-19 Containment Plan Please provide your county COVID-19 containment plan or describe your strategy to create a COVID-19 containment plan with a timeline. San Francisco Department of Public Health is developing a containment plan. Sections below provide information regarding key components of the plan including testing, contact tracing, protecting the vulnerable, living and working in congregate settings, acute care surge, essential workers, community engagement, and relationship with surrounding counties. We will work with hospitals and health systems, the Board of Supervisors, and other stakeholders for input into this plan. Our containment plan will be finalized by July 15th. 19 CDPH COVID-19 VARIANCE ATTESTATION FORM While not exhaustive, the following areas and questions are important to address in any containment plan and may be used for guidance in the plan’s development. This containment plan should be developed by the local health officer in conjunction with the hospitals and health systems in the jurisdiction, as well as input from a broad range of county stakeholders, including the County Board of Supervisors. Under each of the areas below, please indicate how your plan addresses the relevant area. If your plan has not yet been developed or does not include details on the areas below, please describe how you will develop that plan and your timeline for completing it. Testing • • • • • Is there a plan to increase testing to the recommended daily capacity of 2 per 1000 residents? Is the average percentage of positive tests over the past 7 days <8% and stable or declining? Have specimen collection locations been identified that ensure access for all residents? Have contracts/relationships been established with specimen processing labs? Is there a plan for community surveillance? San Francisco currently exceeds the recommended daily testing capacity and is at 2.75 tests per 1,000 population (as of June 19, 2020) and is working to continue expansion of testing. The average percentage if positive tests over the past 7 days is under 8% and remains stable. Specimen collection sites are accessibly located throughout the county. San Francisco’s testing strategy has been to make it relatively simple for the user to access COVID-19 testing. Please see the map below for San Francisco COVID test sites. For the most updated information on testing locations, please see: https://datasf.org/covid19-testing-locations/ For the most updated data on testing, please see: https://data.sfgov.org/stories/s/d96w-cdge For more information, see: • Appendix L. Geolocation Testing Dashboard_Census Tracts and Congregate Testing • Appendix M. Testing Overview and Summary • Appendix N. Testing A3 DPH DOCv6 Map of San Francisco COVID-19 Test Sites 20 CDPH COVID-19 VARIANCE ATTESTATION FORM Contact Tracing • • • • How many staff are currently trained and available to do contact tracing? Are these staff reflective of community racial, ethnic and linguistic diversity? Is there a plan to expand contact tracing staff to the recommended levels to accommodate a three-fold increase in COVID-19 cases, presuming that each case has ten close contacts? Is there a plan for supportive isolation for low income individuals who may not have a safe way to isolate or who may have significant economic challenges as a result of isolation? San Francisco has 300 staff trained to do case investigation (30) and contact tracing (270); 143 are actively working at this time. As of June 10, 2020, 44% of the combined CI/CT team are bilingual, and we will continue to expand our ability to provide culturally and linguistically appropriate services. There is a plan in place to accommodate an increase in COVID-19 cases, as well as a plan for supportive isolation for low income individuals. For more information, see: Appendix C. Transitioning CI-CT to Phase IIB 6.5.20 Living and Working in Congregate Settings • How many congregate care facilities, of what types, are in the county? • How many correctional facilities, of what size, are in the county? • How many homelessness shelters are in the county and what is their capacity? • What is the COVID-19 case rate at each of these facilities? 21 CDPH COVID-19 VARIANCE ATTESTATION FORM • • • • • • • • Is there a plan to track and notify local public health of COVID-19 case rate within local correctional facilities, and to notify any receiving facilities upon the transfer of individuals? Do facilities have the ability to adequately and safely isolate COVID-19 positive individuals? Do facilities have the ability to safely quarantine individuals who have been exposed? Is there sufficient testing capacity to conduct a thorough outbreak investigation at each of these facilities? Do long-term care facilities have sufficient PPE for staff, and do these facilities have access to suppliers for ongoing PPE needs? Do facilities have policies and protocols to appropriately train the workforce in infection prevention and control procedures? Does the workforce have access to locations to safely isolate? Do these facilities (particularly skilled nursing facilities) have access to staffing agencies if and when staff shortages related to COVID-19 occur? San Francisco has 771 congregate facilities. Many facilities have the ability to isolate COVID-19 positive individuals, and if they do not have that capability, those individuals may be moved to an isolation and quarantine site. This is also true if an individual has been exposed. San Francisco maintains sufficient testing capacity to conduct outbreak investigations. PPE in long term care facilities are tracked through our SNF unit which assesses current needs through a survey and incoming resource requests. Facilities have policies and procedures to train their staff in infection prevention and control. The workforce has access to health care worker hotel if they are not able to safely isolate at home. SNFs have access to staffing through staffing registries they are connected to. Type and Census of Congregate Facilities Row Labels Sum of Units/ Beds ARF 458 BHS 1827 Jail 738 RCFCI 246 RCFE 2211 RCFE-CC 859 Respite 75 Shelter - Adult 386 Shelter - Family 316 Shelter - Navigation 339 Shelter - TAY 10 Shelter - Women's 16 Shelter - Youth 20 SNF 2993 Social Rehab 207 SRO 24531 Grand Total 35232 San Francisco has four Correctional Facilities. 22 CDPH COVID-19 VARIANCE ATTESTATION FORM Jail CJ#1 CJ#2 CJ#3 CJ#4 CJ#5 Occupancy 8 170 0 139 399 San Francisco has 26 shelters. Shelter Name Type of Shelter Adult Adult Adult Adult Adult Adult Adult Child Child Family Family Family Family Family Family Family Navigation Navigation Navigation Navigation Navigation Navigation TAY Women's Women's Next Door Sanctuary Hospitality House Dolores Street Adult Shelter MSC South Interfaith Winter Shelter Providence Adult Shelter Diamond Huckleberry House Hamilton Family Emergency Center Buena Vista Horace Mann Compass Family Center First Friendship Hamilton Family Residence Harbor House St. Joseph's Family Center Bayshore Navigation Center Bryant Navigation Center Central Waterfront Navigation Center Embarcadero SAFE Navigation Center Division Circle Navigation Center Civic Center Navigation Center Lark Inn A Woman's Place Bethel AME Location of Shelter 1001 Polk 201 8th 290 Turk 1050 S Van Ness 525 5th 705 Natoma 1601 McKinnon 536 Central 1292 Page 260 Golden Gate 3351 23rd 626 Polk 501 Steinder 260 Golden Gate 407 9th 899 Guerrero 125 Bayshore 680 Bryant 600 25th 555 Beale 224 S Van Ness 20 12th 869 Ellis 1049 Howard 916 Laguna Shelter Capacity 96 98 18 45 0 12 17 0 1 41 28 51 17 62 97 20 58 28 21 84 59 89 10 4 12 Protecting the Vulnerable • • Do resources and interventions intentionally address inequities within these populations being prioritized (i.e. deployment of PPE, testing, etc.)? Are older Californians, people with disabilities, and people with underlying health conditions at greater risk of serious illness, who are living in their own homes, supported so they can continue appropriate physical distancing and maintain wellbeing (i.e. food supports, telehealth, social connections, in home services, etc.)? 23 CDPH COVID-19 VARIANCE ATTESTATION FORM San Francisco Community Mitigation and Engagement Branch focuses on populations that are affected disproportionately by COVID including Latinos, Black/African Americans, and Asian/Pacific Islanders. The branch supports focused testing events for these populations and specific outreach focused on the Mission neighborhood on prevention. Webinars and other information are provided to the San Francisco African American Faith-Based Coalition; food distribution to over 700 households is provided by each congregation to the most vulnerable members of their congregations through partnerships with the food bank and local restaurants. The Branch also partners with the Human Rights Commission Office of Racial Equity and participates in an Equity Action Team to provide an equity lens on all Department Operations Center work. San Francisco’s public and private food programs have also modified their service models to ensure seniors and other vulnerable populations have access to food. The programs provide pick up or delivery of meals at senior centers, and have expanded home delivery of meals and groceries. SF Marin Food Bank expanded their grocery delivery to 12,000 seniors and people with underlying chronic health conditions. San Francisco Unified School District provides to go meals at over 25 locations across San Francisco twice a week. The meal kits contain food for 23 days each. The EOC Feeding Unit provides support to community based food providers, through deployment of disaster workers to provide staff support to the SF Marin Food Bank as well as critical resources to food related community based organizations. Private food initiatives have provided prepared meals to high risk communities by delivering directly to these neighborhoods, and housing sites. The EOC Feeding Unit manages the IQ (Isolation and Quarantine) Feeding Program which provides food to households needing to isolate or quarantine due to COVID+ or close contact throughout the duration of their isolation or quarantine period. San Francisco Department of Disability and Aging Services operates a Benefits and Resource Hub for seniors and people with disabilities to streamline access to social services and maximize service connections. San Francisco also developed a website to integrate services and supports for people during COVID19. For more detail, see: • Appendix O. CommunityMitigation A3_Phase2_v1.4 • Appendix P. DPH OMB A3 V11 Acute Care Surge • • • • Is there daily tracking of hospital capacity including COVID-19 cases, hospital census, ICU census, ventilator availability, staffing and surge capacity? Are hospitals relying on county MHOAC for PPE, or are supply chains sufficient? Are hospitals testing all patients prior to admission to the hospital? Do hospitals have a plan for tracking and addressing occupational exposure? 24 CDPH COVID-19 VARIANCE ATTESTATION FORM • • • • In San Francisco, hospital capacity is tracked daily by DPH DOC Advanced Planning utilizing the CDPH's daily bed poll hospital reports and by the DPH DOC Medical Branch- Hospital Coordination Unit based on noontime capacity polling via ReddiNet system. All Hospitals are able to procure PPE currently but could also rely on the county or MHOAC process to obtain PPE supplies during a shortage or supply chain constraints. Regarding testing all patients prior to admission to the hospital, only ZSFG has confirmed. The level of testing of patients prior to admission varies by hospital. Most hospitals test patients being admitted from their emergency department and scheduled to come in for surgery; in addition some hospitals test patients being admitted to critical care, behavioral health unit and OB, and exposed patients from SNFs. Hospitals established plans early in the response as part of assuring their infection control measures addressed COVID-19. Essential Workers • • • • How many essential workplaces are in the county? What guidance have you provided to your essential workplaces to ensure employees and customers are safe in accordance with state/county guidance for modifications? Do essential workplaces have access to key supplies like hand sanitizer, disinfectant and cleaning supplies, as well as relevant protective equipment? Is there a testing plan for essential workers who are sick or symptomatic? Is there a plan for supportive quarantine/isolation for essential workers? There are 27,613 essential workplaces (essential business establishments) in San Francisco. Guidance documents have been developed for essential workers (see Guidance SFDPH has created for Stage 1 workers.doc). PPE and cleaning supplies have been provided to essential workers. In San Francisco, anyone who is symptomatic and all essential frontline workers is permitted to be tested. Workers at Skilled Nursing Facilities test every 2-4 weeks. There is an essential worker hotel (380 beds) for essential workers who are not able to isolate/quarantine at home. Attachments for this section include: • Appendix Q. Return to Work Requirements for COVID.6.2.2020FINAL • Appendix R. Health Screen Procedures.6.2.2020 FINAL • Appendix S. Health and Safety Plan Template 25 CDPH COVID-19 VARIANCE ATTESTATION FORM Special Considerations • • Are there industries in the county that deserve special consideration in terms of mitigating the risk of COVID-19 transmission, e.g. agriculture or manufacturing? Are there industries in the county that make it more feasible for the county to increase the pace through Stage 2, e.g. technology companies or other companies that have a high percentage of workers who can telework? San Francisco has a large services workforce (include technology companies). Our city economist estimates that about 295,000 people work for SF-based businesses that could telework which is about 40% of the total jobs in the city. Roughly half of these workers live outside of San Francisco. This is significant because it will allow us to decompress mass transportation options to promote physical distancing and mitigate risk. Community Engagement • • • • Has the county engaged with its cities? Which key county stakeholders should be a part of formulating and implementing the proposed variance plan? Have virtual community forums been held to solicit input into the variance plan? Is community engagement reflective of the racial, ethnic, and linguistic diversity of the community? San Francisco is a diverse city and county that values stakeholder engagement. Key county stakeholders should include the Mayor, Board of Supervisors, other City leadership, the Economic Recovery Task Force (established jointly by the Mayor and Board of Supervisors) and the public at-large. The Mayor and President of the San Francisco Board of Supervisors jointly convened an Economic Recovery Task Force (ERTF or Task Force) to guide the City’s efforts through the COVID-19 recovery. The Task Force is comprised of a wide cross section of San Francisco stakeholders, including business, labor, academia, non-profits, foundations, and the public sector. Representation spans across large and small businesses, different industries, diverse neighborhoods, as well as individual businesses and organized professional organizations. The Task Force is co-chaired by San Francisco Assessor Carmen Chu, San Francisco Treasurer José Cisneros, Rodney Fong, President and CEO of the San Francisco Chamber of Commerce, and Rudy Gonzalez, Executive Director of the San Francisco Labor Council. For a full list of Task Force membership, please visit: https://www.onesanfrancisco.org/covid-19-recovery. Through the development of policy ideas and feedback, the goals of the Task Force are to support local businesses and employment, mitigate the economic hardships already affecting the most vulnerable San Franciscans, and build a resilient and equitable future. As of mid-June, close to 1,200 emails and surveys have been received by the Task Force from San 26 CDPH COVID-19 VARIANCE ATTESTATION FORM Franciscans at-large. In addition, over 40 virtual meetings have been convened for public input on reopening including Task Force monthly meetings, Task Force member-led focus groups, Task Force and Office of Economic and Workforce Development joint convenings of industry focus groups. Part of this outreach also involved a joint hearing with the San Francisco Immigrant Rights Commission with over 100 attendees, an Entertainment Commission survey with 107 respondents, an Arts Town Hall with 530 attendees, and engagements with SRO communities, retail store and restaurants in Chinatown. For Task Force public meeting materials, please visit: https://www.onesanfrancisco.org/covid-19-recovery. Relationship to Surrounding Counties • • • • Are surrounding counties experiencing increasing, decreasing or stable case rates? Are surrounding counties also planning to increase the pace through Stage 2 of California’s roadmap to modify the Stay-at-Home order, and if so, on what timeline? How are you coordinating with these counties? What systems or plans are in place to coordinate with surrounding counties (e.g. health care coalitions, shared EOCs, other communication, etc.) to share situational awareness and other emergent issues. How will increased regional and state travel impact the county’s ability to test, isolate, and contact trace? San Francisco is an active member of the Association of Bay Area Health Officials (ABAHO). ABAHO consists of the following health jurisdictions: 1. Alameda County 2. City of Berkeley 3. Contra Costa County 4. Marin County 5. Monterey County 6. Napa County 7. San Benito County 8. San Francisco City & County 9. San Mateo County 10. Santa Clara County 11. Santa Cruz County 12. Sonoma County 13. Solano County ABAHO was created during the HIV/AIDS epidemic to coordinate activites for the region . For COVID-19, we started meeting twice weekly. In early March, 2020, San Francisco started working more closely with Marin, San Mateo, Santa Clara, Alameda, City of Berkeley, and Contra Costa (“ABAHO7”). This resulted in the Shelter in Place order issued on March 17, 2020. For the reopening, we continue to align on principles and core health officer orders. We meet at least weekly to coordinate activities and 27 CDPH COVID-19 VARIANCE ATTESTATION FORM to share situational awareness and other emergent issues. How will increased regional and state travel impact the county’s ability to test, isolate, and contact trace? The ABAHO7 epidemiologists are working together and with the state to share data access in order to improve case investigations and contact tracing. We have developed an internal regional dashboard to improve situational awareness of the regional epidemiology. Surrounding County Case Reports With the exception of San Mateo County cases and Santa Clara County’s increasing hospitalizations, the counties surrounding San Francisco have showed slowing cases of COVID. San Mateo County: COVID cases increasing rapidly Santa Clara County: COVID spreading slowly Alameda County: COVID spreading slowly Contra Costa: COVID spreading slowly 28 CDPH COVID-19 VARIANCE ATTESTATION FORM Solano County: COVID spreading slowly San Francisco County: COVID spreading slowly https://covidactnow.org/us/ca/county/san_francisco_county?s=43246 Please see the document in the appendix: Appendix T. BayAreaHealthOfficerIndicators-042920202 For information on the County Plan for moving through Stage 2, please see: Appendix U. DOC All Hands 6-12-20 In addition to your county’s COVID-19 VARIANCE ATTESTATION FORM, please include: Letter of support from the County Board of Supervisors Letter of support from the local hospitals or health care systems. In the event that the county does not have a hospital or health care system within its jurisdiction, a letter of support from the relevant regional health system(s) is also acceptable. • County Plan for moving through Stage 2 All documents should be emailed to Jake Hanson at Jake.Hanson@cdph.ca.gov. • • 29 CDPH COVID-19 VARIANCE ATTESTATION FORM I Dr. Tomás Aragón, Health Officer of the City and County of San Francisco, hereby attest that I am duly authorized to sign and act on behalf of San Francisco County. I certify that San Francisco County has met the readiness criteria outlined by CDPH designed to mitigate the spread of COVID-19 and that the information provided is true, accurate and complete to the best of my knowledge. If a local COVID-19 Containment Plan is submitted for San Francisco County, I certify that it was developed with input from the County Board of Supervisors/City Council, hospitals, health systems, and a broad range of stakeholders in the jurisdiction. I acknowledge that I remain responsible for implementing the local COVID-19 Containment Plan and that CDPH, by providing technical guidance, is in no way assuming liability for its contents. I understand and consent that the California Department of Public Health (CDPH) will post this information on the CDPH website and is public record. Printed Name Tomás Aragón, MD, DrPH Signature Position/Title Date Health Officer of the City and County of San Francisco June 23, 2020 30 Appendices Contents Appendix A. Guidance SFDPH has created for Stage 1 Workers Appendix A2. List of supplies for essential workers Appendix B. COVID Surveillance A3_v4_oneslide Appendix C. Transitioning CI-CT to Phase IIB 6.5.20  Appendix D. 05.28.20 Reopening Plan Appendix E. ERTF01_Economic-Recovery-Task-Force_Membership Appendix F. ERTF02_Economic-Recovery-Task-Force_Meeting1-slides Appendix G. ERTF03_Economic-Recovery-Task-Force_Meeting2-slides Appendix H. ERTF04_Health-Commission-Update_SF-Reopening-Plan Appendix I. Indicators FINAL 6 8 20 .cleaned Appendix J. Indicators & Trigger Levels_06 11 Appendix L. Geolocation Testing Dashboad_Census Tracts and Congregate Testing  Appendix M. Testing Overview and Summary  Appendix N. Testing A3 DPH DOCv6 Appendix O. CommunityMitigation  A3_Phase2_v1.4 Appendix P. DPH OMB A3 V11  Appendix Q. Health Screening Procedures.6.2.2020 FINAL Appendix R. Health and Safety Plan Template.docx  Appendix S. Return to Work Requirements for COVID.6.2.2020FINAL Appendix T. BayAreaHealthOfficerIndicators-042920202  Appendix U. DOC All Hands 6-12-20 Appendix V. Hospitals’ Letters of Support Appendix W. Board of Supervisors Letter of Support Appendix A. Guidance SFDPH has created for Stage 1 workers This list does not include CDC, state, or other authorities’ guidance that we link to on our website in addition to guidance we created specific to San Francisco. Main website for guidance: www.sfcdp.org/covid19 Health orders and directives: https://www.sfdph.org/dph/alerts/coronavirus-healthorders.asp Guidance for employers and essential critical infrastructure workplaces on how to structure the physical environment to protect essential workers. Please provide, as a separate attachment, copies of the guidance(s). General guidance to make physical environment safer, including for employers and essential critical infrastructure workers: • • • • • • Health Directive for Pharmacies, Farmers Markets and Stands, Grocers, and other Sellers of Unprepared Foods and Household Consumer Products, and Hardware Stores: https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-DirectiveGroceryStoresPharmaciesFarmersMarkets-FINAL-5.8.2020.pdf o Health and Safety Plan Template: https://www.sfcdcp.org/wpcontent/uploads/2020/05/COVID19-Health-and-Safety-Plan-Template-PharmaciesGrocers-FarmersMkt-Hardware-FINAL-5.82020.docx Restaurants, Food Preparation, And Delivery Health Directive https://www.sfdph.org/dph/alerts/files/2020-05SignedDirectiveReFoodPreparationTakeOutAndDelivery-05152020.pdf o Health and Safety Plan Template: https://www.sfcdcp.org/wpcontent/uploads/2020/05/COVID19-Health-and-Safety-Plan-Template-FoodTakeoutand-Delivery-FINAL-5.8.2020.docx Shipping or Delivery Health Directive: https://www.sfdph.org/dph/alerts/files/2020-06SignedDirectiveReDeliveryServices-05152020.pdf o Health and Safety Plan Template: https://www.sfcdcp.org/wpcontent/uploads/2020/05/COVID19-Health-and-Safety-Plan-Template-DeliveryServicesFINAL-5.8.2020.docx Warehouse and Logistical Support: https://www.sfdph.org/dph/alerts/files/Directive-2020-12Warehousing-05172020.pdf o Health and Safety Plan Template: https://www.sfcdcp.org/wpcontent/uploads/2020/05/COVID19-Health-and-Safety-Plan-Warehousing-05-172020.docx Manufacturing Health Directive: https://www.sfdph.org/dph/alerts/files/Directive-2020-11Manufacturing-05172020.pdf o Health and Safety Plan Template: https://www.sfcdcp.org/wpcontent/uploads/2020/05/COVID19-Health-and-Safety-Plan-Manufacturing05.17.2020.docx Shelter in Place Orders with Info for Essential Businesses and Services o • • • • https://www.sfdph.org/dph/alerts/files/HealthOfficerOrder-C19-07e-UpdatedShelterInPlace-06012020.pdf Congregate Living Settings and SROs o https://www.sfdph.org/dph/alerts/files/OrderC19-04-signed.pdf o https://www.sfdph.org/dph/alerts/files/COVID%E2%80%9019-MinimumEnvironmental-Cleaning-Standards.pdf o https://www.sfcdcp.org/wp-content/uploads/2020/04/COVID19-Guidance-CongregatewFAQ-UPDATE-05.19.2020.pdf Construction o https://www.sfdph.org/dph/alerts/files/DirectiveNo2020-04PublicWorksConstructionProtocol-05052020.pdf Non-Ambulance Transport Vehicles o https://www.sfcdcp.org/wp-content/uploads/2020/04/COVID19NonAmbulanceTransport-FaceMask-Guidance-04.17.2020.pdf Providers working with persons experiencing homelessness (PEH) o https://www.sfcdcp.org/wp-content/uploads/2020/05/Safe-Sleeping-Streets-FINAL2020-05-19.pdf o https://www.sfcdcp.org/wp-content/uploads/2020/05/Safe-Sleeping-Villages-FINAL2020-05-19.pdf o https://www.sfcdcp.org/wp-content/uploads/2020/03/COVID-19-ShelterNav-GuidanceFINAL-05.23.2020.pdf o https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-Framework-PPE-UseSites-Commingling-FINAL-05.23.2020.pdf What guidance have you provided to your essential workplaces to ensure employees and customers are safe in accordance with state/county guidance for modifications? • • • • See all above and bullets below Around Cleaning: o https://www.sfcdcp.org/wp-content/uploads/2020/03/COVID19-Disinfectants-SafetyFINAL-04.18.2020.pdf o https://www.sfcdcp.org/wp-content/uploads/2020/02/COVID-19-NonHCP-CleaningGuidance-FINAL-04.12.2020.pdf Testing o https://www.sfcdcp.org/infectious-diseases-a-to-z/coronavirus-2019-novelcoronavirus/#1585686261571-622b2efc-c9d5 o https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-Health-AdvisoryDxTesting-FINAL-05.05.2020.pdf o Handling positive cases among employees o https://www.sfcdcp.org/wp-content/uploads/2020/04/COVID19-Guidance-BusinessifCOVID-UPDATE-05.17.2020.pdf ▪ https://www.sfcdcp.org/wp-content/uploads/2020/04/COVID19-ExposureGenAdvisory-FINAL-05.15.2020.pdf • • • • • • Screening employees and excluding those who are ill o https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-Screening-QuestionsUPDATE-05.26.2020.pdf o https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-TemperatureMeasurement-UPDATE-05.26.2020.pdf o https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-PersonnelScreeningV2-Handout-FINAL-5.15.2020.pdf Food facilities and food delivery o https://www.sfcdcp.org/wp-content/uploads/2020/04/COVID19-Food-Delivery-FINAL05.28.2020.pdf o https://www.sfcdcp.org/wp-content/uploads/2020/03/COVID19-FoodFacilitiesGuidance-FINAL-3.13.2020.pdf PPE recommendations o Home care providers: https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19Framework-PPE-Home-Care-Providers-FINAL-05-23-2020.pdf ▪ Instructions of how to use: https://www.sfcdcp.org/wpcontent/uploads/2020/05/COVID19-Guidance-PPE-Use-Reuse-Home-CareProviders-FINAL-05-23-2020.pdf o Those working at “Containment” sites and homeless shelters: https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-Framework-PPE-UseSites-Commingling-FINAL-05.23.2020.pdf o Outpatient providers: https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19Guidance-PPE-Reuse-Outpatient-PCP-05.24.2020.pdf o Home healthcare personnel: https://www.sfcdcp.org/infectious-diseases-a-toz/coronavirus-2019-novel-coronavirus/coronavirus-2019-information-for-healthcareproviders/#1590327784088-2a9694df-9017 ▪ Instructions of how to use: https://www.sfcdcp.org/wpcontent/uploads/2020/05/COVID19-Guidance-PPE-Use-Reuse-Home-CareProviders-FINAL-05-23-2020.pdf Elder and Residential Care Facilities o https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-RCFE-FAQ-FINAL05.01.2020.pdf EMS o https://www.sfdph.org/dph/comupg/oservices/emergency/2019_nCoV_Alerts.asp Healthcare o Healthcare exposure: https://www.sfcdcp.org/wp-content/uploads/2020/03/COVID19HCP-Exposed-to-COVID19-Pts-Guidance-4.29.2020.pdf o Long-term Care Facilities ▪ https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-SNF-ToolkitFINAL-05.27.2020.pdf ▪ https://www.sfcdcp.org/wp-content/uploads/2020/03/COVID19-LTCFGuidance-Rev-FINAL-04.19.2020.pdf o Residential treatment: https://www.sfcdcp.org/wp-content/uploads/2020/06/COVID19Residential-Treatment-FINAL-06.02.2020.pdf o • Dialysis centers: https://www.sfcdcp.org/wp-content/uploads/2020/03/COVID19-HDGuidance-FINAL-04.07.2020.pdf o Visitor rules ▪ https://www.sfdph.org/dph/alerts/files/Order-C19-06bLimitingVisitorstoHospitals-05262020.pdf ▪ https://www.sfdph.org/dph/alerts/files/Order-C19-09-ExcludingVisitorstoARFsRCFEs-03192020.pdf ▪ https://www.sfdph.org/dph/alerts/files/OrderExcludingVisitorstoSNFsOrderC19-03-03102020.pdf ▪ https://www.sfdph.org/dph/alerts/files/Order-Excluding-Visitors-to-LHH-ZSFGHOC19-01b.pdf Face Covering Directive o https://www.sfdph.org/dph/alerts/files/Order-No-C19-12b-RequiringFaceCoverings05282020.pdf Appendix A2. List of supplies for essential workers List of Supplies for Essential Workers Category N95s Items Included UOM 1860S + 1860 + 1870 models only Face Masks Isolation + Surgical Masks Eye Protection Face Shields Eye Protection Goggles Gowns Isolation + Surgical Gowns Gloves Nitrile Exam Gloves Disinfectant Disinfectant DPH On-Hand EOC On-Hand EA 420,103 32,520 Grand Total OnHand 452,623 EA 2,586,130 14,153,510 16,739,640 EA EA EA 295,241 13,639 121,472 590,975 316,996 827,483 886,216 330,635 948,955 EA 935,740 2,651,720 3,587,460 GAL 483 10,988 11,471 Data reflects DPH PeopleSoft and EOC AssetWorks inventory as of 9am on 6/17/2020. Only medical-grade items approved by DPH Product Safety for use in medical settings are included in these totals. Overview of the Scarce Allocation Process • Allocation Tool and Incident Commander (IC) approval needed for any requested item that have fewer than 30 days of supply (CRITICAL, CRISIS, or LIMITED level). 30 Days of Supply comes from the DPH PPE Availability, released the day before. • Decision will be made during daily 2pm Logs Meeting (see Appendix A) o Enter [date] of when CRITICAL, CRISIS, or LIMITED requested item needs to be reviewed at the 2pm meeting, into Column D “Allocation TOOL” of Tracking Log. o Update Tracker Log’s Column A “Status” with [On Hold] o Refresh “Allocation Tool” tab of Tracking Log if inputted a CRITICAL, CRISIS, or LIMITED level item o Logs to update inventory daily the mornings of Monday through Friday here. • COVID Testing Supplies (Vials, Swabs, Kits) will be allocated and approved by Testing Branch • Propose allocation based on the following rules of thumbs: o No more than 5% of any item to 1 facility o Not greater than requested amount o For External – Allocate from donated items/State distributed items only, unless there is an outreach/COVID/PUIs at the single-standing facility o Generally, only allocate 1-2 weeks for limited supply items • Note on N95 mask requests - see ICS 213RR Med Resource Template, COMPLETE Survey Questions Tab, Q13 for required Respiratory Protection Program documentation. If no or blank, substitute with isolation/earloop masks. • Reserve level 3/surgical grade items for hospitals/staff dealing directly with COVID patients. Allocate the appropriate level/item suitable to their risk exposure levels/stated objective. Resource Allocation Process Flow Resource Allocation Guidelines. Note that the guidelines are for reference only and subject to change. Appendix B. COVID Surveillance A3_v4_oneslide Monitoring and Early Detection as a Surveillance Focus for COVID-19 I. Background: What problem are you talking about and why focus on it now? IV. Analysis: What don’t we know and what’s not working On March 5, 2020, SFDPH received its first two cases of COVID-19 and the case rate continued to rise rapidly through March, 2020. On March 17, 2020, the Shelter-in-Place (SIP) public health order limited residents’ travel, mandated social distancing, and limited public and private gatherings in an effort to reduce the spread of the virus. We quickly initiated case-based surveillance, i.e., the ongoing, systematic collection, analysis, and dissemination of COVID-19-related information for the prevention and control of disease. As a result of SIP, the case rate plateaued in mid-April and began to decline. In Phase II the protective effects of Shelter in Place will no longer exist and we will have new “baseline” infection rates given the use of face masks, social distancing, mass testing and I&Q among a population that is moving around more and increasing their interactions with one another. We can expect a greater level of risk for transmission that will lead to new infections. With the potential for a surge in cases in Phase II, we must identify new cases early, intervene quickly to decrease the likelihood of transmission to others, and minimize the impacts of disease. A. People B. Method 1. There are many teams throughout the DOC working on various aspects pertaining to surveillance without one unified structure for coordination and communication of information. Our testing resources are not deployed by population at risk. There can be lags in getting test results. Some laboratories are not using a standard message format for sending electronic lab reports that cause data quality issues. Some labs are not sending the necessary information for following up with ndividuals. 1. Early warning surveillance is not built into our current activities partly because we have not defined “early warning”. Our response has largely been reaction-based. There are problems with how we obtain information from mass testing sites, (incomplete rosters, rosters not sent ahead of time), making it difficult to know who attended a mass testing site and overall number tested. 1. 2. 3. 4. 5. 1. II. Current Conditions: What is happening today and what should we be concerned about? Our case-based, passive surveillance system has provided the COVID information to date on cases and deaths in San Francisco (Fig 1) • • Some zip codes in SF have higher test positivity rates than others (Fig 2). Fig 2 Fig 1 • • • • • V4 Testing information reported from labs to DPH enables us to identify new cases. We are currently conducting 2.15 tests/1,000 residents in SF; we do not have the testing capacity to test everyone to identify who has disease. • Some zip codes in SF have higher test positivity rates than others (Fig 2). • There are key subpopulations at the intersection of being at high risk for transmission and vulnerable to severe complications. 2. 3. These subpopulations include people living and working in SNFs, SROs, schools, and unsheltered persons experiencing homelessness. Given their frequent interactions with the public, the essential workforce may provide early warning of transmission in the general community. Although we have many data sources that include individuals from these subpopulations, we don’t have an easy way of harnessing the data to identify infections among these subpopulations for early detection. As we move into Phase II and more people start to interact with each other, we need to reestablish baselines of infection in these populations in order to build an early warning system. Environment Countermeasure Description Establish a method for monitoring each subpopulation with the highest risk for transmission, if they do not exist already. 1. 2. 3. 4. 5. 6. Ensure surveillance data and information are disseminated to those who will take action. 1. 2. 3. 4. 5. Target by July 2020 6. Reduce the time from testing to the time testing results received by those who can take action % change in case rate among each subpopulation under surveillance ? ? 7-day average of COVID-19 case rate in SF ? ? 7-day average of hospitalizations in SF ? ? 4. 2. 3. We do not have a readily available way of knowing what level of transmission is happening in the different subpopulations. The data we are collecting at the time the test is performed is not subpopulation specific. We think we have identified which subpopulations we should test in Phase II, but we do not know which to prioritize, how often to test, how many resources needed to do the testing, and we may not know how to find them. We do not have a sampling strategy for testing in SROs. We cannot test everyone staying in SROs. We do not have a way to readily monitor data on transmission in subpopulations at highest risk for transmission. Data needs are constantly evolving and changing, making it difficult to understand the full scope of data we have. Data systems continue to be modified to accommodate changing needs/objectives, data requests, and the evolving nature of data collection. This makes it difficult to stay up to date with processing and understanding data. E. Tools III. Goals Current 3. WE V. Countermeasures and Action Plan Problem Statement: As we move into Phase II, the DPH DOC does not have surveillance for early detection of COVID-19 cases and monitoring in all subpopulations where there is a high risk for transmission with severe consequences for vulnerable populations. Selected Metrics 2. 6/08/2020 Develop the Public Health Workforce 1. 2. 3. Owner Done? Identify the subpopulations to monitor based on risk for transmission and impact on vulnerable populations based on gaps in current activities. Document the operational definition for each subpopulation. Based on the experiences from Phase I, define baseline infection rates for each subpopulation. If baseline rates do not exist, we must define them. Develop a monitoring protocol for each subpopulation, if it does not exist already. Identify resources needed to monitor each subpopulation. Identify tools required for all surveillance activities for each subpopulation. 1. 2. 3. 4. Y N N par tial 5. 6. N N Identify existing and new data sources for early warning surveillance and ongoing monitoring for each subpopulation. Develop surveillance metrics for each subpopulation for monitoring, including thresholds for public health actions (and specify what the actions are and who will do them). Develop one platform for calling, linking, and merging data across sources that supports and facilitates data analytics and reporting. Define data requirements for surveillance, analytics, and reporting. Develop a dashboard with continuous data feeds to identify new cases* and mitigation in each subpopulation to facilitate ongoing monitoring of transmission in each subpopulation. * At this time, all we can track is new cases. We will need to identify early warning predictor(s) for new cases. Develop a communication protocol for individuals who are responsible for public health actions once a threshold has been achieved in order to ensure actions are done early and in a timely way. 1. 2. 3. 4. N N N N Develop standard work for detection, analysis, reporting, dissemination, and actions as a result of surveillance activities. Determine gaps in the current workforce (skill sets, number of resources needed). Leverage educational institutions (infrastructure, expertise, and their partnerships) for surveillance support. 1. 2. 3. N N N Appendix D. 05.28.20 Reopening Plan Appendix E. ERTF01_Economic-Recovery-Task-Force_Membership Appendix F. ERTF02_Economic-Recovery-Task-Force_Meeting1-slides Appendix G. ERTF03_Economic-Recovery-Task-Force_Meeting2-slides Appendix H. ERTF04_Health-Commission-Update_SF-Reopening-Plan Appendix C. Transitioning CI-CT to Phase IIB 6.5.20 Version Transitioning CI/CT to Phase II DRAFT 6/4/20 Darpun Sachdev IV. Analysis: What don’t we know and what’s not working I. Background: What problem are you talking about and why focus on it now? A. People B. Method Since San Francisco's first positive COVID-19 cases were first diagnosed on March 5, 2020, physician leaders within the Population Health Division of the SFDPH have created a framework and structure for San Francisco's contact investigation team. Dr. Darpun Sachdev was assigned as the Lead for the Case Investigation within the Epidemiology and Surveillance Branch of the Operations Section for the SFDPH Department Operations Center (DOC). A partnership with UCSF's Institute for Global Health Services was created on April 6, 2020, which started the City's Contact Tracing program, led by Dr. Michael Reid and staffed by colleagues from the City's public library, UCSF staff, volunteers, medical students, and retired DPH clinicians. In less than 90 days, and operating 7 days a week, the Case Investigation (CI) and Contact Tracing (CT) Teams trained, onboarded, and are now operating a combined total of approximately 160 staff, with the objectives of: (1) for cases - educating and ensuring capacity for successful isolation and quarantine (I&Q); interviewing to identify exposure settings limited only to workplaces, schools; and eliciting close contacts; and (2) for named contacts – assessing for need and help to get tested and I&Q , and monitoring for 14-day I&Q. As City and the State prepare for Phase 2, the CI/CT Program will also need to plan and transform its current structures, operations, and separate processes to integrate and further innovate to test, trace, isolate and support San Franciscans who are identified as Cases and Contacts. The CI/CT team needs a stable and sustainable plan to follow up positive test, trace, and link people to isolation and quarantine services for at least one more year. 1. Based on modelling, the median estimate is that we need ~100 case investigators and tracers for phase II, but we only have approximately 10 DSW staff committed to work through the end of 2020. 2. We need to develop our people and provide performance feedback with lower supervisor-worker rations (currently 1:25) 3. Leadership (MDs and 2593s) 213RR requests are unfilled. 4. I&Q referrals for cases and contacts are not happening in a timely manner due to 3 unfilled 213RR for social workers. 5. We need financial resources and infrastructure to support the goal of having CBOs do community-based tracing, isolation and support services 1 . We need to a priori define targeted populations for contact tracing so we know how to deploy limited resources during surge 2. We need clear communication and decision-making protocols to understand and anticipate how decisions in Testing and Outbreak Management impact CI/CT workflow and workforce, and to minimize disruption and last minute changes to workflows 3. We need all testing providers to start the tracing, isolation, and support continuum at the time of disclosure with their patients, requiring that we provide adequate guidance and training 4. We need better electronic systems to gather CI/CT data from providers and CBOs and to know if contacts were tested II. Current Conditions: What is happening today and what should we be concerned about? 1. We haven’t identified how we will scale a decentralized, remote culturally-competent workforce, particularly how to leverage non-DPH DSWs 2. We have not identified a reasonable scope of contact tracing. Settings where we have no process to conduct notifications and tracing (eg, schools, gyms, events, transportation, restaurants) 3. We need a mechanism (tech) so that every business, school, and organization can independently conduct contact tracing when there is a case 4. We need SF residents to be masked, socially distanced, mindful of their interactions, and responsive if they receive an exposure notification 5. We don’t know the public health impact of contact tracing, need to define parameters and the “end-game” when the effort can be de-escalated 1. We don’t know if we will gain efficiency to scale (eg, telework, scheduling) by switching CI/CT tools from CommCare to Salesforce. We don’t know if we can how to utilize data from Salesforce. 2. We don’t know how to incentivize or reimburse contact tracing work performed by providers and CBOs 2. We don’t know how to fill gaps created by removal of the SNAP containment resources, which offered critical food and cleaning supplies to cases and contacts 3. We don’t conduct field- based case/contact investigation, which may be necessary to control disease among people experiencing homelessness 4. We need to understand the potential impact of exposure notification apps on public health, as well as SFDPH case/contact investigation attempt and metrics C. Environment D. Tools From 3/5/2020- 6/1/2020, 83% of all eligible cases (N=1560) were successfully interviewed by case investigation. 56% of interviews were completed in Spanish. 72% of cases reported the ability to isolate. 2801 contacts were identified case investigation of which 73% were informed. 100 90 80 70 The median time from test done to contact notified is under evaluation. 60 Evidence suggests that the serial interval (time from symptom onset in infected person to onset of symptoms in a newly infected contact) is about 4 50 days, suggesting that contact notification needs to happen in a narrow 40 window in order to halt secondary transmission. 30 20 10 0 As of 6/1/2020 Cases interviewed 1392 (83% of total) Contacts notified 2559 (73% of total) 100 84 50 38 VI. Plan: What are we going to do about it? Countermeasure Optimize effectiveness of the CI/CT to sustain for one more year or longer Improve alignment with Testing and Outbreak management Leverage tech to conduct CI/CT Problem Statement: As San Francisco enters phase II, DPH does not have the capacity to keep up with the anticipated surge of contact investigation and tracing work. III. Goals: How will we know? Selected Metrics Baseline Target by June 2020 Cases traced and investigated Successfully 83% 90% Cases reporting ability to isolate 73% 90% Contacts reporting ability to quarantine Proportion of contacts that are tested during quarantine Proportion of contacts that test positive for COVID-19 90% Description Owner Date 1. 2. 1. Greg/Jenny 2. Mivic /Christine 3. CI/CT Integration workgroup 4. I&G 1. 2. 3. 4. Y Y N N 3. 4. deploy limited resources during surge 5. Require all health care and testing providers to ensure household contacts are given quarantine instructions and linked to immediate testing during disclosure 1. 2. 3. 4. Map out where current workflows start and stop Clarify role of CI in outbreak management in surge situations Identify the necessary lead time to activate increase resources for surge Identify the reasonable scope of CI/CT among people exp homelessness 1-3. Testing/OMB/ CI/CT 4. Liz/Deb 1. 2. N N 1. Improve process flows and change management around software development with a governance structure and address gaps in informatics resources Rigorously evaluate the benefits and challenges and Commcare and Salesforce Track IT deliverables and timelines to support remote work, turnaround times address workflow problems, and develop data transfer mechanisms for providers/CBOs Prepare to leverage Bluetooth-based CT data to support exposure notifications 1.-4. Liz/IT/UCSF contract 1. 2. 3. 4. 5. N N N N N Capacitate CBOs to conduct CI/CT as part of all community-based testing event Develop CBO-oriented workflows and training Identify how to provide infrastructure, access, training and ongoing IT support for CommCare to CBOs Provide ongoing support to CBOs conducting their work, including QA/QI 1. Community CI/CT group (Thomas, Karen, Liz, UCSF) 1. 2. 3. 4. N N N N Fill 213RR for CI/CT managers who are vital to deploy and manage remote workforce Develop work orders with non-DPH depts to create a surge tracer workforce PDSA provider-based case investigation with health systems 1-2.Greg, Jenny, Logs 3. Jess/Mike 1. 2. 3. N N N FIll 213RRs for 3 additional social worker/linkage specialists to adequately refer cases/contacts to I&Q, food and resource needs 1. Greg, Jenny, Logs 1. 2. 3. N N N 2. 3. 4. Build a racial/ethnically-diverse, community-based, linguistically appropriate CI/CT workforce Create surge capacity to respond to increase cases Ensure low-income individuals are linked to isolation and quarantine support Extend of all DSWs until 12/31/20 and fill 213RRs for manager/SW position Develop and support our people by approving lead pay for investigators to become team leads Determine the most LEAN, integrated workflow for all CT/CT and processes and create standard work for all roles Prioritize targeted populations for contact tracing so we know how to 1. 2. 3. 4. 1. 2. 3. 1. Appendix D. 05.28.20 Reopening Plan Appendix E. ERTF01_Economic-Recovery-Task-Force_Membership Appendix F. ERTF02_Economic-Recovery-Task-Force_Meeting1-slides Appendix G. ERTF03_Economic-Recovery-Task-Force_Meeting2-slides Appendix H. ERTF04_Health-Commission-Update_SF-Reopening-Plan O F FI C E OF T H E M A Y OR SAN FRANCISCO L ON D ON N. B R E E D M A Y OR FOR IMMEDIATE RELEASE: Thursday, May 28, 2020 Contact: San Francisco Joint Information Center, dempress@sfgov.org *** PRESS RELEASE *** MAYOR LONDON BREED ANNOUNCES TIMELINE AND PLAN FOR SAFELY REOPENING SAN FRANCISCO Plan formulated by the Economic Recovery Task Force allows outdoor dining, indoor retail, and certain outdoor activities to resume on June 15th, assuming they are allowed by the State; additional activities will be permitted to resume with modifications in phases. As part of plan to safely reopen, San Franciscans will need to wear face coverings when around other people not in their household. San Francisco, CA — Mayor London N. Breed today announced a plan for reopening San Francisco that will allow certain businesses and activities to resume with modifications in phases over the coming weeks and months. As long as San Francisco continues to make progress slowing the spread of COVID-19, meets key health indicators, and state guidance continues to allow more activities, San Francisco restaurants will be able to offer outdoor dining, retail businesses will be able to allow customers to shop inside with modifications, and additional outdoor activities can resume on June 15th. The City plans to allow additional activities and businesses to resume in July and August. “Our residents have a lot to be proud of with how we responded to this pandemic, with many people making enormous sacrifices to protect the health and safety of their fellow residents,” said Mayor Breed. “We’re entering a new phase of this crisis and we feel comfortable that we’re at a place that we can begin reopening parts of our economy, but that is not to say that this virus doesn’t continue to threaten our city. As we begin recovering and reopening, all of us are going to have to play our part to adjust to the new normal until we have a vaccine, and we’ll continue to do everything we can to offer clear guidelines and precautions to support residents and businesses with the new adjustments that will be needed moving forward.” San Francisco’s reopening plan is aligned with the State’s guidelines and is based on a San Francisco-specific risk model to control the spread of COVID-19 and protect public health. The plan is also informed by the work of the San Francisco COVID-19 Economic Recovery Task Force. The timeline for allowing certain businesses and activities to resume will be adjusted as needed based on public health data. Part of San Francisco’s plan for safely reopening includes requiring residents to wear face coverings on most occasions when they leave their home and are near other people, both indoors and outdoors. The public also must comply with other health and safety requirements and recommendations such as social distancing, handwashing, and cleaning frequently touched 1 DR. CARLTON B. GOODLETT PLACE, ROOM 200 SAN FRANCISCO, CALIFORNIA 94102-4681 TELEPHONE: (415) 554-6141 O F FI C E OF T H E M A Y OR SAN FRANCISCO L ON D ON N. B R E E D M A Y OR surfaces. The Department of Public Health will issue a new Health Order today with updated requirements regarding face coverings. San Francisco’s Plan separates the State’s second stage into three phases – Phase 2A, 2B, and 2C. San Francisco’s Phases 3 are 4 are aligned with the State’s stages. San Francisco has already entered into Phase 2A, which allows curbside pickup permitted for most retail, construction, elective surgeries, and outdoor businesses like carwashes, flea markets, and garden stores to operate. San Francisco’s current Stay Home Health Order does not have an expiration date and will be amended over the coming weeks and months to allow for a gradual and safer reopening. Today’s plan details the next phases, and provides dates that the City anticipates additional businesses and activities can resume with modifications. The dates in the plan will be finalized through amendments to the Health Order or directives, and will be guided by health indicators. If the City make progress faster than expected, then the timeline outlined below may shift to allow some reopening to occur earlier. For each phase, guidance will be issued to provide businesses and operators with adequate time for planning and compliance with health and safety requirements. Guidance for personal activities and interactions, such as visiting friends, having play dates and dinner parties is forthcoming. The plan and timeline to reopen businesses and activities was created in coordination with the San Francisco Municipal Transportation Agency’s (SFMTA) Transportation Recovery Plan. For each reopening phase, SFMTA will add and adjust services incrementally. “San Francisco’s early and aggressive actions were key to the success we have had fighting the coronavirus,” said Dr. Grant Colfax, Director of Health. “As we move to reopen, continuing to prioritize community health will be essential. Every San Franciscan can and must help if we are going to reach better times ahead. That means, covering your face, keeping social distance and getting tested if you have any symptoms. These actions have saved lives and are going to be more important than ever as we start to move around the city again.” “San Francisco led the way with our public health response and we can lead the way again with a thoughtful and responsible approach to reopening,” said Assessor Carmen Chu, co-chair of the Economic Recovery Task Force. “Through the task force, we heard from hundreds of San Franciscans on the need to balance our public health needs with our ability to make ends meet and today’s announcement provides a roadmap for all of us to plan and prepare for the future.” “As we move to reopen, this framework provides business with the information they need to plan their next steps towards recovery,” said Joaquín Torres, Director of the Office of Economic and Workforce Development. “And as our communities follow good public health practices, we will see an increase in the activities necessary to move San Francisco towards full economic vibrancy.” 1 DR. CARLTON B. GOODLETT PLACE, ROOM 200 SAN FRANCISCO, CALIFORNIA 94102-4681 TELEPHONE: (415) 554-6141 O F FI C E OF T H E M A Y OR SAN FRANCISCO L ON D ON N. B R E E D M A Y OR San Francisco Planed Reopening Timeline The list below does not include all the businesses and activities that the City has included in the plan for reopening. San Francisco will only allow reopening of businesses and activities that are permitted under the State’s guidelines. For full information about the City’s plan to allow additional activities and business to reopen in phases, go to SF.gov/reopening. Phase 2A – June 1st - Child care - Botanical gardens - Outdoor museums and historical sites - Outdoor curbside retail for services with minimal contact (shoe repair, dog grooming, etc.) Phase 2B – June 15th - Most indoor retail - Outdoor dining - Summer camps - Private household indoor services - Religious services and ceremonies - Outdoor exercise classes - Professional sports games, tournaments, and other entertainment venues with no spectators - Non-emergency medical appointments Phase 2C – July 13th - Indoor dining with modifications - Hair salons and barbershops - Real estate open houses (by appointment only) Phase 3 – Mid-August – to be determined, will be more than one sub-phase - Schools with modifications - Bars - Other personal services o Nail salons o Massage parlors o Tattoo parlors - Gyms and fitness centers - Playgrounds - Swimming pools - Indoor Museums Phase 4 – Date to be determined - Concert venues - Live audience sports and performances - Nightclubs 1 DR. CARLTON B. GOODLETT PLACE, ROOM 200 SAN FRANCISCO, CALIFORNIA 94102-4681 TELEPHONE: (415) 554-6141 O F FI C E OF T H E M A Y OR SAN FRANCISCO - L ON D ON N. B R E E D M A Y OR Festivals All hotels and lodging for leisure and tourism The Shared Spaces program, which Mayor Breed announced on Tuesday, May 26th, will allow neighborhood businesses to share a portion of the public right-of-way, such as sidewalks, full or partial streets, or other nearby public spaces like parks and plazas for restaurant pick-up and other neighborhood retail activity. Outdoor dining is permitted to resume locally on June 15th, and if the State allows outdoor dining by that time, restaurants will be able to apply for a permit to set up tables and chairs in the public right-of-way. ### 1 DR. CARLTON B. GOODLETT PLACE, ROOM 200 SAN FRANCISCO, CALIFORNIA 94102-4681 TELEPHONE: (415) 554-6141 6/10/2020 Economic Recovery Task Force Office of Resilience and Capital Planning An official website of the City and County of San Francisco > Task Force Meetings Task Force Members COVID-19 Economic Recovery Task Force Economic Recovery Task Force The Task Force is co-chaired by San Francisco Assessor-Recorder Carmen Chu; San Francisco Treasurer José Cisneros; Rodney Fong, President and CEO of the San Francisco Chamber of Commerce; and Rudy Gonzalez, Executive Director of the San Francisco Labor Council. The Task Force is charged with guiding the City’s efforts through the COVID-19 recovery to sustain and revive local businesses and employment, mitigate the economic hardships already affecting the most vulnerable San Franciscans, and build a resilient and equitable future. Economic Recovery Task Force Members Conveners London Breed, Mayor Norman Yee, President, Board of Supervisors Co-Chairs Carmen Chu, Assessor-Recorder José Cisneros, Treasurer Rodney Fong, President and CEO, San Francisco Chamber of Commerce Rudy Gonzalez, Executive Director, San Francisco Labor Council Board of Supervisors Aaron Peskin, Supervisor, City and County of San Francisco Dean Preston, Supervisor, City and County of San Francisco  Rafael Mandelman, Supervisor, City and County of San Francisco External Sherilyn Adams, Executive Director, Larkin Street Youth Services Matthew Ajiake, President, SF African American Chamber of Commerce Brett Andrews, Executive Director, PRC Tiffany Apczynski, Director of Government Relations, Zendesk Jack Bair, Executive Vice President, SF Giants Danielle Banks, Co-Founder, Project Level Amber Baur, United Food and Commercial Workers Reese Benton, Owner, Posh Green Delivery Jennifer Bielstein, Director, ACT Cammy Blackstone, Director of Government Relations, AT&T Fred Blackwell, Executive Director, SF Foundation Ben Bleiman, Entertainment Commission, Bar Owner Jarie Bolander, JSY Giving and JSY PR & Marketing Ruby Bolaria, Chan Zuckerberg Initiative Jane Bosio, Representative, OPEIU 29 DJ Brookter, Executive Director, Young Community Developers, Police Commission Bivette Brackett, OCII Commissioner Joseph Bryant, President, SEIU 1012 Kathryn Cahill, CEO, Cahill General Contractor Kevin Carroll, Executive Director, Hotel Council Anne Cervantes, Architect Kitman Chan, VP, Chinese Chamber of Commerce Albert Chow, Taraval Merchants Association Juliana Choy, Asian American Contractors Association Sandra Chu, Owner, The Woods Michon Coleman, Regional Vice President, Hospital Council Mariann Costello, Scoma's Deborah Cullinan, Director, Yerba Buena Center for the Arts Naomi Cytron, Regional Manager, Federal Reserve Bank of San Francisco Joe D'Allesandro, Executive Director, SF Travel John Doherty, IBEW Local 6 John Duggan, Jr., Original Joe's Marisela Esparza, Director, SF Immigrant Legal/Education Network https://onesanfrancisco.org/economic-recovery-task-force External (continued) Angus McCarthy, Residential Builders Association Kevin McCracken, Co-Founder, SocialImprint Ingrid Merriwether, President/CEO, Merriweather & Williams Insurance Olga Miranda, Janitors Local 87 Maryo Mogannam, President, SF Council of District Merchants Tomiquia Moss, Executive Director, All Home California Monique Moyer, Sr. Managing Director, CBRE Kathy Nelson, Owner, Kabuki Springs and Spa Michael Pappas, Executive Director, Interfaith Council Paul Pendergast, CEO,  Pendergast Consulting Group William Ortiz-Cartagena, Small Business Commission Rebecca Prozan, Director of Government Affairs, Google Michelle Pusateri, Owner, Nanna-Joe's Maribel Ramirez, Excelsior Action Group Geeta Rao, Deputy Director, Enterprise Community Fund William Rogers, Executive Director, Goodwill Taylor Safford, CEO, Pier 39 Cheree Scarbrough, Owner, Phenix Hair Designs Allen Scott, Vice President, Another Planet Entertainment Randall Scott, President, Fisherman's Wharf CBD Earl Shaddix, Director, Economic Development on Third Zaki Shaheen, Key Food Market, Arab American Democratic Club Doug Shoemaker, President, Mercy Housing Lateefah Simon, President, Akonadi Foundation Anand Singh, Local 2 Unite HERE! Kate So s, Executive Director, SFMADE Carlos Solorzano-Cuadra, Hispanic Chamber of Commerce Laurie Thomas, Executive Director, Golden Gate Restaurant Association Kenny Tse, President, Chinese Chamber of Commerce Francesca Vega, Vice Chancellor for Community and Government Relations, UCSF Debra Walker, Arts Commissioner Monica Walters, Director, Wu Yee Sarah Wan, Executive Director, Community Youth Center Rick Welts, President/CEO, Warriors Keith White, Executive VP, Gap Inc. Jane Willson, Owner, JANE Consignment Bill Witte, Founder, Related Development Chris Wright, Committee on Jobs Carolyn Wysinger, President, PRIDE Board Malcolm Yeung, Chinatown Community Development Center City and County of San Francisco Dr. Grant Colfax, Director, Department of Public Health Sheryl Davis, Director, Human Rights Commission Pegah Faed, Director, Our Children, Our Families Council Rich Hillis, Director, Planning Department 1/2 6/10/2020 Economic Recovery Task Force Office of Resilience and Capital Planning Tyra Fennell, Film Commissioner, Director, Imprint City Peter Finn, Secretary-Treasurer and Principal Of cer, IBT 856 Father Paul Fitzgerald, President, University of San Francisco Dianna Gonzales, Interim Chancellor, City College of San Francisco Jim Green, Senior Vice President, Salesforce Mike Grisso, Senior Vice President Kilroy Roma Guy, Former Health Commissioner Lee Hsu, Owner, West Portal Merchant Cynthia Huie, Clement Merchants Association Marc Intermaggio, Executive Vice President, BOMA San Francisco Michael Janis, General Manager, SF Wholesale Produce Market Alicia John-Baptiste, CEO, SPUR Joel Kaminsky, Owner, Good Vibrations Armand Kilijian, President, O'Brien Mechanical Ashley E. Klein, Partner, Kaufman, Dolowich & Voluck LLP  John Konstin, Owner, John's Grill Sharky Laguana, Small Business Commission Robert Link, Vice President, San Francisco Apartment Association  Regan Long, Co-Founder, Local Brewing Co. Yuka loroi, Owner, Cassava Betty Louie, Chinatown Merchants Association Lynn Mahoney, President, San Francisco State University Shorty Maniace, Owner, JP Kempt Michael Matthews, Director of Public Policy, Facebook Larry Mazzola, Jr., Plumbers, Building and Construction Trades Naomi Kelly, City Administrator Patrick Mulligan, Director, Of ce of Labor Standards Enforcement John Noguchi, Director, Convention Facilities Department Deborah Raphael, Director, Department of Environment Trent Rohrer, Director, Human Services Agency Ben Rosen eld, Controller Ivar Satero, Director, San Francisco International Airport Joaquin Torres, Director, Of ce of Economic and Workforce Development Judson True, Director, Housing Delivery Maggie Weiland, Director, Entertainment Commission Support Staff Melissa Whitehouse, Of ce of the City Administrator (Lead) Theodore Conrad, Of ce of Economic and Workforce Development Heather Green, Of ce of Resilience and Capital Planning  Melissa Higbee, Of ce of Resilience and Capital Planning Sami Iwata, Human Rights Commission  Jillian Johnson, Of ce of the City Administrator Danielle Mieler, Of ce of Resilience and Capital Planning     Marisa Pereira Tully, Controller’s Of ce Tajel Shah, Treasurer and Tax Collector     Brian Strong, Of ce of Resilience and Capital Planning The Of ce of Resilience and Capital Planning is dedicated to creating a strong, sustainable, and resilient San Francisco for generations to come. ONESF, managed by ORCP, is the City’s cross-agency branding for all major capital improvement projects. Contact Us > Contact 311 > Of ce of the City Administrator > SFgov.org > Translate Select Language https://onesanfrancisco.org/economic-recovery-task-force 2/2 City and County of San Francisco Economic Recovery Task Force San Francisco Economic Recovery Task Force (ERTF) MEETING #1 May 14, 2020 ERTF Meeting # 1 Agenda › What we heard › Overview of work plan › Facilitating Safe Reopening - Grounding ○ Social and Economic Considerations ○ Health Considerations ○ State Guidance and Risk Factors ○ Mitigations – how you can help! › Q&A with the Co Chairs + Department Heads 2 Goal for this meeting › Share back what we heard from the Task Force small groups and how it is informing our work plan moving forward › Share latest safe reopening plan considerations for San Francisco › Hear from us on how you can help › Hear from you – Q & A 3 What We Heard: Task Force Small Group Meetings & Public Survey What We Heard: Small Group › 10 Meetings with 100+ members › Discussed: ○ Challenges you are seeing on the ground ○ What success looks like for the Task Force › Expressed numbness, grief and exhaustion coupled with optimism, hope and determination › Uncertainty is hard 5 What We Heard 1. Safe reopening must be our focus ○ Childcare, transportation critical underpinnings of reopening 2. Uncertainty is very hard; need for clear, consistent communication as we have it, so people can plan their lives 3. Desire for longer term, big picture thinking ○ We are all in this together; opportunity to do big things 6 What We Heard: Defining Task Force Success › › › › › › › › FAST: Move at 100x normal speed IMPLEMENTABLE: Real, practical changes in policy BOLD: Big, creative, and long-term changes; think and coordinate regionally JUST: Use a race and equity lens across all efforts CLEAR: Clear communications and transparency in decision-making UNIFIED: Interdependence across sectors; unity of effort COLLABORATIVE: Making connections to deliver needed support DATA-DRIVEN: Use data to provide targeted support 7 What We Heard: On Jobs and Business Support › Support a safe re-opening as soon as possible (PPE a top concern) › Childcare / schools / camps needed for return-to-work › Support re-training and adapting business models › Support existing businesses to survive; think outside the box › Support equitable access to relief programs › Corridor / street-level safety issues › Acute challenge for businesses rooted in gatherings 8 What We Heard: On Vulnerable Populations › Systemic inequalities even more stark; vulnerable most impacted ○ "Everyone is hurting, but some are desperate“ ○ Disparities in black and brown communities exacerbated ○ Disparities in digital access, especially for distance learning › Food insecurity rising › Mental health; people experiencing trauma, violence, anxiety, isolation, and racism / xenophobia (especially in API communities) › Gaps in support for undocumented persons 9 What We Heard: On Economic Development › Make it easier to do business; flexibility, modernize regulations › Long-term impacts to construction and development projects › Uncertain future of commercial corridors and increasing vacancies › Housing instability › Opportunity to shape the future culture of San Francisco › Opportunity to rethink shifts in use of public space › Safe and affordable transportation options needed 10 What We Heard: Public Survey Results › 600+ responses! › 52% reported being business owners › 48% reported their business size to be small (2-49 employees) 11 What We Heard: Public Survey Results 12 Overview of Work Plan Timeline › Kick-off meeting – April 24 from 3:30-4:30pm › Meeting #1 – May 14 from 2-3:30pm › Meeting #2 – June 11 from 2-3:30pm › Meeting #3 – July 9 from 2-3:30pm › Meeting #4 – August 6 from 2-3:30pm - draft recommendations › Meeting #5 – September 10 from 2-3:30pm – final recommendations › Meeting #6 – October 8 from 2-3:30pm - final report Final written report Economic Recovery Task Force Timeline MAY JUNE JULY AUGUST Facilitate a Safe Re-Opening Reopening the economy safely is critical for business survival, employment and City budget. SEPTEMBER OCTOBER Deliverables: • Sector outreach • Document & develop industry specific mitigations • Coordinate creation of toolkits/sample plans for sectors • Develop policy ideas to address immediate challenges to reopening (i.e. access to PPE) Focus on Building Resilience Into Interim Economy Short of a scientific breakthrough we expect COVID-19 to be an ongoing challenge. How can we build resiliency into our economy through the next 1-2 years? Long-Term Ideas COVID-19 will result in permanent changes to how we do business and how we utilize our spaces. It has also accelerated changes in the growth sectors in our economy. What do we want to do to rebuild San Francisco better? Deliverables: • Continued outreach • Develop & analyze policy ideas to encourage resilience for organizations and people Deliverables: • Continued outreach • Develop & analyze policy ideas to encourage resilience for organizations and people Overview of Work Plan: Engagement & Outreach › Launched the public survey in 4 languages (600+ participants) › Completed initial small group member meeting with Task Force members (100+ participants) › Now moving into deeper dives to specific industries and issue areas ○ Immediate concentration on Facilitating Safe Reopening (May/June+) ○ Beginning light touch groundwork on Interim Resiliency and Long-Term Planning in May with concentration of engagement happening in mid/late June+ (expect additional communication from ERTF staff) Task Force Engagement Process Na rro wd ow n e wid Go Na rro wd ow n e wid Go e wid Go Ground Cover Industry Deep Dive Try things Evaluate / Plan Scale Up Broad range Industry groups Testing a range of ideas Report back lessons Expand what’s working - - - - Surveys Qualitative interviews OEWD outreach Taskforce amplified - - - Clusters by industry Round-tables Qualitative interviews - - - Different workspaces City support / infrastructure Different industries - - Plan for scaling Adapt ideas and test again - - Iterate as we scale Report through Taskforce Ongoing Inclusive Listening at every stage 17 Facilitating Safe Reopening Facilitating Safe Reopening (May/June+) › Deliverables: ○ Document and cull best practices for industry specific mitigations (intent to be used to inform DPH moving forward as they consider risk factors – effective mitigations can reduce risk) ○ Coordinate creation of toolkits/sample plans for sectors (helps translate health orders to help sectors understand requirements and at the same time boost compliance) ○ Policy ideas to address macro challenges for phased openings (i.e. access to PPE, sanitation materials, etc.) Facilitating Safe Reopening (May/June+) › What We Need: ○ Best practices, plans, mitigations (you received email Monday): ● Gather information from your networks ● Host roundtable (ERTF may be able to provide facilitation assistance) ● Provide your ideas through 1:1 interview with ERTF staff (if you have written plans, please share) ● ○ OEWD also convening stakeholder meetings that will feed to ERTF Feedback ● Who are we missing, who should we prioritize for a facilitated session relating to Safe Reopening? Facilitating Safe Reopening (May/June+) › What Facilitated Meetings are Happening & Who Have We Heard From? Organized Convenings: Mitigation Ideas Received & Reviewing: OEWD (Joaquin Torres): • Hotels • Retail • Small Business • State of California Industry-Specific Guidance https://covid19.ca.gov/industry-guidance/ (i.e. retail, office workspaces, manufacturing, logistics and warehousing, hotels & lodging, food packing, delivery, childcare) • BOMA – Office Entertainment Commission (Naomi Kelly / Maggie Weiland): • Virtual Nightlife and Entertainment Summit 2020 Task Force Member Initiated Convenings: • Chinatown • Faith Community Grounding – Social and Economic Considerations Safe Reopening – Social & Economic Considerations 23 Safe Reopening – Social & Economic Considerations National Projected March to April Percentage Job Losses by Industry, adjusted Apr Proj % Chg 0.0% 0.0% -0.6% -1.7% -3.1% -3.4% -4.2% -6.0% -10.0% -6.6% -7.3% -8.3% -10.6% -11.2% -12.8% -20 .0 % -30.0% -40 .0 % Accommodations -40.8% -15.2% -18.5% Job losses widespread, but hospitality hardest hit Food Services -48.2% Other Services (except Public Administration) -54.0% -50 .0 % Arts, Entertainment, and Recreation -54.5% -6 0.0% 24 Safe Reopening – Social & Economic Considerations Food services are projected to have biggest job losses – 1 in 3 of the projected jobs lost. 25 Safe Reopening – Social & Economic Considerations Rates of food insecurity have increased dramatically for households with children nationally. 26 Source: Lauren Bauer, The Hamilton Project analysis of COVID Impact Survey April 2020; Brookings Institution Hamilton Project and Future of the Middle Class Initiatives Survey of Mothers and Young Children April 2020 Safe Reopening – Social & Economic Considerations Applications up a 114% over average weekly applications pre-COVID. Families are disproportionately impacted - applications from households with children up from 14% of total to 20%. Source: San Francisco Human Services Agency 27 Safe Reopening – Social & Economic Considerations Child Maltreatment Referrals by Week Since Shelter in Place, Total 140 120 133 referrals to Child Protective 123 116 104 Services are down over 50%. 110 107 Shelter-In-Place as of March 17 100 80 59 53 60 49 62 68 63 52 mandated reporters, of 38 40 Reports primarily come from whom teachers, school staff, 20 and doctors are a large - /20 2/3 0 0/2 2/1 0 7/2 2/1 0 4/2 2/2 /20 3/2 /20 3/9 Source: San Francisco Human Services Agency 0 6/2 3/1 0 3/2 3/2 0 0/2 3/3 /20 4/6 0 3/2 4/1 020 0/2 4/2 020 7/2 4/2 20 /20 5/4 portion. 28 Safe Reopening – Social & Economic Considerations Calls to Crisis Line 1000 The pandemic is offering a shield of sorts for those who use abuse; it’s that much harder for survivors to access support due in large part to their lack of privacy and confidential space. 900 800 700 600 500 400 300 200 100 0 March April 2019 May 1- 8 2020 Source: Domestic violence crisis line operator, grantee of the Department on the Status of Women 29 Safe Reopening – Social & Economic Considerations “I work with small food business owners. Their incomes are down 80-100% and for the most part they've had to lay off all of their workers. It's pretty heartbreaking… They are also worried about having enough money to open back up, especially since this is all going to be due when it's over! Most of our business owners are moms, so the lack of childcare and school has made it hard for them to keep any business going.” –P457 “Income went from very healthy to zero in two months. All my art income streams have vanished and my workplace is closed. There may be hope ahead but little here now.” –P584 “There is a larger sense of community, and our online sales have definitely increased - not nearly enough to cover our rent though.” –P572 30 Grounding - Health Considerations Safe Reopening – Health Considerations › San Francisco led the nation in slowing spread of COVID-19. › Our actions have saved many lives. › We now enter the next recovery stage and… we are led by data and science. 32 Mobility in SF and COVID-19 Replication Rate: Prior to and Following Shelter-in-Place 90 90 Descartes Lab Mobility Index Descartes Labs Mobility Index Safe Reopening – Health Considerations “Mobility Index”: Looks at a collection of mobile devices reporting consistently throughout the day. Calculate the maximum distance moved in kilometers from the first reported location. Using this value, calculate the median across all devices in the sample to generate a mobility metric. Re=3.5 60 60 30 30 Re=2.6 Re=0.94 00 Source: Maya Petersen, UCB Mar 01 Mar 1 Mar 15 Mar 15 Apr 01 Apr 1 Date Apr 15 Apr 15 May 01 May 1 Safe Reopening – Health Considerations Plausible Future Scenarios 1. Because of a longer incubation period, more asymptomatic spread, and a higher reproductive rate, COVID-19 appears to spread more easily than flu. 2. Based on the most recent flu pandemics, this outbreak will likely last 18 to 24 months. 3. Depending on control measures and other factors, cases may come in waves of different heights (with high waves signaling major impact) and in different intervals. Source: CIDRAP “The Future of the COVID-19 Pandemic: Lessons from Pandemic Influenza” Safe Reopening – Health Considerations Indicator Definition Surveillance • # new cases/day flat or decreasing • # of hospitalized patients flat or decreasing 14 consecutive days Hospital • <20% COVID+ patients in Capacity staffed, non-surge hospital beds Testing • 2 tests conducted per 1,000 residents/day Contact • Reach 90% of cases, ID Tracing contacts • Reach 90% of all contacts ID’d PPE Supply • SFDPH has 30-day supply Data Metric • COVID+ test result rate Goal • Flat/ decreasing • Flat/ decreasing Status • Flat • Daily count of confirmed COVID+ admitted to all hospitals • Daily count of confirmed • <20% of nonCOVID+ admitted to county surge hospitals capacity • # new lab results/day • 1,600-2,000/ day • % of COVID+ cases reached • 90% • % contacts reached • 90% • Flat • # days on hand for PPE • >30 days • 30 days • 6% • 1,597 average • 77% • 60% Grounding – How State Guidance is Connected to Local Orders & Risk Factors Safe Reopening – State Guidance › California has Pandemic Resilience Roadmap outlining phased approach • • • • › Phase I – Safety & Preparedness (essential functions open) – “Make workplaces safe for our essential workers.” Phase II – Lower-Risk Workplaces – “Gradually reopen retail (curbside only), manufacturing & logistics. Later, relax retail restrictions, adapt & reopen schools, childcare, offices & limited hospitality, personal services.” Phase III – Higher-Risk Workplaces – “Adapt and reopen movie theaters, religious services, & more personal & hospitality services. Phase IV – End Stay Home Order – “Reopen areas of highest risk: e.g. Concerts, conventions, sports arenas.” Each County Must Review and Adjust for Its Specific Experiences/Conditions (i.e. differences in health indicators, urban/rural, ranging density, etc.) ● Generally, State guidance will be less restrictive than local guidance ● Local guidance can “vary” and be less restrictive but conditions are difficult to meet for urban areas Safe Reopening – State Guidance Stage 2 Early Stage 2 Stage 3 Stage 4 Expanded Stage 2 (County-specific plan required to move faster) Lower-risk workplaces Gradually reopen retail (curbside only), manufacturing & logistics. Later, relax retail restrictions, adapt & reopen schools, childcare, offices & limited hospitality, personal services. Higher-risk workplaces Adapt and reopen movie theaters, religious services, & more personal & hospitality services. • Curb-side retail • Manufacturers • Logistics • Childcare for nonessential workforce • Select services: car washes, pet grooming, and landscape gardening • Outdoor museums, and open gallery spaces and other public spaces with modifications • Office-based businesses (telework remains strongly encouraged) • Personal care • Concerts (hair and nail salons, gyms) • Conventions • Entertainment venues • Live audience sports (movie theaters, sports without live audiences) • In-person religious services (churches, weddings) • Destination retail, including shopping malls and swap meets • Dine-in restaurants (other amenities, like bars or gaming areas, are not permitted in Stage 2) • Schools with modifications End of Stay Home Order Reopen areas of highest risk: e.g. Concerts, conventions, sports arenas. 38 Safe Reopening – State Guidance › Before reopening, all facilities must: ○ Perform a detailed risk assessment and implement a site-specific protection plan ○ Train employees on how to limit the spread of COVID-19, including how to screen themselves for symptoms and stay home if they have them ○ Implement individual control measures and screenings ○ Implement disinfecting protocols ○ Implement physical distancing guidelines 39 Review for San Francisco Operationalize OrderHow It’s Connected Communicate Safe Reopening – State Guidance: to Local 3. COMMUNICATE Orders 1. REVIEW FOR SAN FRANCISCO 2. OPERATIONALIZE ORDER Communication from EOC JIC Email Distribution If a change is planned State issues guidance Deliberate implications for San Francisco Bay Area health officers Other city stakeholders ERTF CAT drafts order Health directives Information on SF.gov (City Administrator & DPH websites) ERTF feedback loops Communicate in press conferences Safe Reopening – State Guidance: If Health Metrics Hold Up, Here’s How It’s Connected to Local Orders EVERYONE: Phase I Phase II Phase I Phase IIA Phase IIB Phase IIC, etc. Phase III Phase IV Phase III Phase IV Ongoing Monitoring of Heath Indicators to Inform Move Forward or Pull Back Safe Reopening - San Francisco’s Approach › State guidance as a floor - State guidance good to have; but not regionally specific › Preference for regional coordination – people move throughout › Framework based on risk factors, science and data › Incremental opening with health indicators informing future action ○ i.e. Goal of reproduction rate under 1 - under current SIP, essential service operations, and social adherence gets us to 0.94 ○ Time between increments to truly see impact (2-6 weeks) Safe Reopening - Understanding COVID-19 Transmission Dynamics › Knowledge constantly evolving › Initial published data suggests transmission occurs primarily through: ○ Prolonged close contact ○ Superspreading events ○ Special settings Source: John Hopkins “Public Health Principles for a Phased Reopening During COVID-19: Guidance for Governors” - More Risk Safe Reopening - Risk-Based Approach - Evaluating Risk Factors Prolonged Contact Short Time Exposure Close Physical Contact No Physical Contact Concentration of People Low Concentration Enclosed Spaces (poor ventilation) Open Spaces / Outdoor Mobility – Large Number of Employees or Customers Low Mobility Significant Travel - Widely Disperse Shared Surfaces Vulnerable Populations Questions: • When considering pre-COVID-19 business delivery models or activities, do they have more or less of the risk factors? • Can those business delivery models or activities be modified to remove or reduce risk factors? Less Risk High Vector Populations Safe Reopening – Risk Factors › Risk = Likelihood x Consequence ○ Likelihood of increased transmission – highest risk occurs primarily through prolonged, close contact ○ Consequence – community spread › Mitigation measures can reduce likelihood and consequence ○ Physical distancing, engineering controls, administrative controls, PPE › Lower risk of transmission outdoors than indoors, especially if distance is maintained between individuals. 45 Source: Johns Hopkins Bloomberg School of Public Health, “Public Health Principles for a Phased Reopening During COVID-19: Guidance for Governors.” Mitigations – how you can help! Safe Reopening – Mitigations › Many are trying to solve question of how to help businesses survive and help workers – one clear direct way is by safely reopening › City, along with the rest of the world, is making very real, hard tradeoffs in the coming months related to health and economics ■ Practical / creative mitigations + improved compliance à better health outcomes › This is where we need your help! Help by thinking creatively about how to mitigate the health concerns with lifestyle and business process changes. 47 Safe Reopening – Mitigations - how you can help! › Let’s work together and focus where we can most have an impact: ○ City - Developing and sharing the framework on how we make decisions on safe reopening (state guidance; John Hopkins) ○ City - Providing clear, consistent, up-to-date and accessible information as soon as we have it ○ Task Force members – Helping the City to develop mitigations and creative policy proposals to address the big challenges we face ○ Task Force members - Communicating information to your stakeholders and communicating to the City where we can do better 48 Safe Reopening – Mitigations – how you can help! › Right now the Task Force can help with on the ground operating mitigations to inform development of the Health Directives ○ Please send in your responses today on the “Safe Reopening” request › Problem solve on reopening barriers we need to solve together (access to PPE, creative thinking on use of public space, etc.) › Communicating out the importance of safety protocols / mitigations such as social distancing, wearing PPE, testing, etc. 49 Q&A with the Co Chairs Chat Exercise: › Any other background topics you want ERTF to present for future meetings? Thank you! Email us at RecoverySF@sfgov.org https://www.onesanfrancisco.org/covid-19-recovery Next ERTF Meeting: June 11, 2020 from 2-3:30pm APPENDIX COVID-19 Update Grant Colfax, MD Director of Health May 12, 2020 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH 54 › › › › › › › › › › › › › Feb 25: San Francisco COVID-19 Health Orders, Directives & Executive Orders: • March 24: Labs Conducting COVID-19 Diagnostic Tests to Report Mayor Breed Announces a Local Emergency All Results to Local and State Public Health Authorities March 3: Board of Supervisors Vote to Approve Local Emergency March 6: Declaration of Local Health Emergency March 7: Prohibiting Gatherings at City-Owned Locations March 10: Environmental Cleaning Standards for SROs March 11: Prohibiting Large Gatherings >1,000 Persons March 12: Excluding Visitors to Skilled Nursing Facilities at High Risk March 12: Restricting Visitors and Non-Essential Personnel from Laguna Honda and ZSFG Skilled Nursing Facility • March 24: Protective Quarantine for Laguna Honda Hospital • March 31: Shelter in Place (extended through May 3) • April 2: Businesses Safety Guidance for Construction-Related Essential • April 17: General Requirement of Members of the Workers to Wear Face Coverings Public and • April 29: Shelter in Place (through June 1, with some loosening of restrictions) • May 4: Directive for persons diagnosed with, or likely to have COVID-19 to self-isolate • May 4: Directive for persons exposed to a person have COVID-19 to self-quarantine • May 7: Testing, Reporting and Guidance Requirements for Certain Residential Facilities • May 8: Directive for required best practices for shipping and delivery essential businesses • May 8: Directive for required best practices for restaurants and food services • May 8: Directive for required best practices for sellers of unprepared foods and household consumer products March 13: Prohibiting Large Gatherings >100 Persons March 14: Limitations on Hospital Visitors March 16: Shelter in Place (through April 7) March 18: Moratorium on Routine Medical Appointments and Elective Surgery March 19: Limitations on Residential Facility Visitors with/likely to SF Cases by Zip Code Mobility in SF and COVID-19 Replication Rate: Prior to and Following Shelter-in-Place 90 90 Descartes Lab Mobility Index Descartes Labs Mobility Index Safe Reopening – Health Considerations “Mobility Index”: Looks at a collection of mobile devices reporting consistently throughout the day. Calculate the maximum distance moved in kilometers from the first reported location. Using this value, calculate the median across all devices in the sample to generate a mobility metric. Re=3.5 60 60 30 30 Re=2.6 Re=0.94 00 Source: Maya Petersen, UCB Mar 01 Mar 1 Mar 15 Mar 15 Apr 01 Apr 1 Date Apr 15 Apr 15 May 01 May 1 Plausible Future Scenarios 1. Because of a longer incubation period, more asymptomatic spread, and a higher reproductive rate, COVID-19 appears to spread more easily than flu. 2. Based on the most recent flu pandemics, this outbreak will likely last 18 to 24 months. 3. Depending on control measures and other factors, cases may come in waves of different heights (with high waves signaling major impact) and in different intervals. Source: CIDRAP “The Future of the COVID-19 Pandemic: Lessons from Pandemic Influenza” SFDPH Key COVID-19 Indicators Indicator Definition Surveillance • # new cases/day flat or decreasing • # of hospitalized patients flat or decreasing 14 consecutive days Data Metric Goal Status • COVID+ test result rate • Flat/ decreasing • Flat/ decreasing • Daily count of confirmed COVID+ admitted to all hospitals • Flat • Flat Hospital Capacity • <20% COVID+ patients in staffed, non-surge hospital beds • Daily count of confirmed COVID+ admitted to county hospitals • <20% of nonsurge capacity • 6% Testing • 2 tests conducted per 1,000 residents/day • # new lab results/day • 1,600-2,000/ day • 1,597 average Contact Tracing • Reach 90% of cases, ID contacts • Reach 90% of all contacts ID’d • % of COVID+ cases reached • % contacts reached • 90% • 90% • 77% • 60% PPE Supply • SFDPH has 30-day supply • # days on hand for PPE • 30 days • >30 days State of California Phases for Re-opening Phase 1 • Safety and preparedness • Make workplaces safe for essential workers Phase 2 • 2A) Lower-risk workplaces • Retail: curbside pick-up only • Manufacturing and logistics • 2B) Further relax restrictions • Adapt retail to open for indoor services • Adapt and reopen schools, offices, childcare Phase 3 • Higher-risk workplaces • Movie theaters • Places of worship • Personal and hospitality services (e.g. salons, restaurants) Phase 4 • Highest-risk workplaces • Concert venues • Convention centers • Sports arenas City and County of San Francisco Economic Recovery Task Force San Francisco Economic Recovery Task Force (ERTF) KICK-OFF MEETING April 24, 2020 ERTF Kick Off Meeting Agenda › Kick off and resources › Fiscal context › Health context › Role of Task Force members and process overview › Review of initial survey results › Q&A with Task Force 2 Kick-off and resources Kick-Off and Resources › Welcome and Introductions › Melissa Whitehouse leading the staff support for the effort on the city side – please reach out anytime › You can also email the project team: RecoverySF@sfgov.org › Meeting materials and resources will be posted https://www.onesanfrancisco.org/covid-19-recovery 4 Fiscal context City Economic Outlook CITY & COUNTY OF SAN FRANCISCO Office of the Controller Ted Egan, Ph.D. Chief Economist April 24, 2020 6 Direct Impacts of the Shelter-in-Place Order 7 More than 70,000 SF Unemployment Claims Since MidMarch Weekly Initial Claims for Unemployment in San Francisco Since January 2020 30,000 25,000 20,000 15,000 10,000 5,000 0 1/4 1/11 1/18 1/25 2/1 2/8 2/15 2/22 2/29 3/7 3/14 3/21 3/28 4/4 4/11 8 Mar-20 Nov-19 Jul-19 Mar-19 Nov-18 Jul-18 Mar-18 Nov-17 Jul-17 Mar-17 Nov-16 Jul-16 Mar-16 Nov-15 Jul-15 Mar-15 Nov-14 Jul-14 Mar-14 Nov-13 Jul-13 Mar-13 Nov-12 Jul-12 Mar-12 Nov-11 Jul-11 Mar-11 Nov-10 Jul-10 Mar-10 Total Employemnt in MIllions 130 125 20 120 15 115 10 110 5 105 0 Monthly Initial Claims for Unemployment in Millions Nationally - March Jobless Claims Equaled 10 Years of Job Growth Total U.S. Employment and Monthly Initial Unemployment Claims, Last 10 Years 25 Private Non-Farm Payroll Employment Initial Jobless Claims 9 Forecasts Have Been Changing Quickly Moody's Forecast Change in U.S. Real GDP for 2020 Annualized, Quarter-to-Quarter 15 10 Percentage Change in GDP 5 0 -5 January Forecast -10 March 23 Forecast March 27 Forecast -15 -20 2020Q1 2020Q2 2020Q3 2020Q4 10 April Blue Chip Consensus: Sharp & Short Recession Percentage Drop in Real U.S. GDP, and Recovery Time in Quarters, Great Recession and COVID Recession Forecast: Pre-Recession Peak = 100 102% Real GDP as % of Pre-Recession Quarterly Peak 100% 98% 96% 94% Great Recession 92% COVID Recession Blue Chip consensus forecast (4/1) 90% 88% 0 1 2 3 4 5 6 7 8 Quarters after Pre-Recession Peak 9 10 11 12 13 14 11 The Blue Chip Forecast Applied to San Francisco 2019 2020 2021 SF Real GDP growth 3.0% -3.2% 4.0% SF Employment Growth, Private Non-Farm 2.1% -3.9% 2.6% SF Unemployment Rate 2.2% 6.9% 4.3% SF Nominal GDP growth 4.7% -2.2% 6.1% SF Nominal Wages & Salaries, Private Non-Farm 5.7% -1.0% 6.5% 12 A Big If? Brief virus emergency: Single peak in April or May, abatement in June Long virus emergency: Late peaks (or multiple peaks) until widespread vaccination Mild economic shock: Consumer spending returns quickly; oil price dividend; stimulus fully offsets income shock; no inflation V-shaped recession—real GDP growth U-Shaped recession—with the length in Q3, year-over-year growth from caused by health and not economic 2019 to 2020; "normal" GDP growth factors. in 2021; slower jobs recovery (2022) Severe economic shock: persistent decline in consumer confidence and spending; bankruptcies shake credit markets and raise capital costs; longterm consumer shifts lead to mass unemployment; limited fiscal stimulus. U-Shaped recession- a sharp, short decline followed by a slow recovery: real GDP decline in Q3, slow growth through mid-2021; 2023/4 jobs recovery L-shaped recession - long period of social and economic disruption leads to permanent changes in consumption, slow structural adjustment 4 Health context San Francisco COVID-19 Health Orders & Executive Orders: › › › › › › › › › › › › › › › › › February 25: Mayor Breed Announces a Local Emergency March 6: Declaration of Local Health Emergency March 7: Prohibiting Gatherings at City-Owned Locations March 10: Environmental Cleaning Standards for SROs March 11: Prohibiting Large Gatherings >1,000 Persons March 12: Excluding Visitors to Skilled Nursing Facilities at High Risk March 12: Restricting Visitors and Non-Essential Personnel from Laguna Honda and ZSFG Skilled Nursing Facility March 13: Prohibiting Large Gatherings >100 Persons March 14: Limitations on Hospital Visitors March 16: Shelter in Place (through April 7) March 18: Moratorium on Routine Medical Appointments and Elective Surgery March 19: Limitations on Residential Facility Visitors March 24: Labs Conducting COVID-19 Diagnostic Tests to Report All Results to Local and State Public Health Authorities March 24: Protective Quarantine for Laguna Honda Hospital March 31: Shelter in Place (extended through May 3) April 2: Safety Guidance for Construction-Related Essential Businesses April 17: General Requirement of Members of the Public and Workers to Wear Face Coverings 15 Role of the Task Force members and process overview Task Force Role › Be our thought partner, generate ideas ○ Short, medium, long-term ○ Timely and big picture › Vet and provide feedback on ideas and policy proposals › Outreach: help us to ensure we are hearing from everyone we need to be hearing from; bring different perspectives to the table and bring the work of the Task Force to the community 21 Timeline › Kick-off meeting – April 24, 3:30-4:30pm › Meeting #1 – May 14, 2-3:30pm › Meeting #2 – June 11, 2-3:30pm › Meeting #3 – July 9, 2-3:30pm › Meeting #4 – August 6, 2-3:30pm – draft recommendations › Meeting #5 – September 10, 2-3:30pm – final recommendations › Meeting #6 – October 8, 2-3:30pm – report 22 Engagement : Multi-Faceted Effort Ahead › Task Force members ■ Task Force meetings ■ Small group meetings; sign-up to come through email ■ Please sign up for a small group meeting as soon as you are ready › Constituencies of Task Force members ■ Survey now available: https://bit.ly/sfrecoverysurvey ■ Listening tour › Larger public ■ Engagement planning currently underway 23 Engagement: Initial Task Force Small Groups › Collect initial survey results › Small groups ■ With 1-2 co-chairs in each meeting ■ With facilitator for each meeting › 10 one-hour meetings over the next two weeks (April 30 – May 8) › Initial meeting will be a get to know you, to hear from you, to hear what you want to see out of this process 24 Engagement: What to Expect in Small Groups › Potential discussion for first meeting… ○ What are you seeing? ○ Risks and Challenges for Task Force ○ Opportunities for Task Force ○ How could we do this process well? ○ Who is missing? ○ What could go wrong here? ○ If we were really successful, what would that look like? 25 Policy Development › Share ideas › Context and projections › Research and best practices ○ Strategies ○ Recovery planning › Support from City staff and policy experts › Provide policy makers with analysis and recommendations 26 ERTF Organized around 3 Main Policy Areas: Jobs and Business Support Vulnerable Populations Economic Development › Intentionally broad, need to be further refined with your input › Organizational framework for staff, communications 27 ERTF Policy Areas 1. Jobs and Business Support › How can we ensure existing small and medium sized businesses across San Francisco survive, adapt, and thrive in a post-COVID 19 environment? › What do San Franciscans need to (re)enter the workforce? 28 ERTF Policy Areas 2. Vulnerable Populations › How can we ensure our most vulnerable residents' needs are met? › How do we make it easier for a growing number of people to access and receive the support they need through recovery? 29 ERTF Policy Areas 3. Economic Development › How can we make it easier to start a new business and rebuild our commercial corridors? › How can we promote the growth of our city while protecting existing communities? 30 Initial review of survey results Task Force Members Initial Survey › 60 responses received as of yesterday evening, thank you! › Representatives from all affiliation/sector categories have already responded › Project team will read every single response in detail › Please still go and complete it if you have not yet 32 Initial Survey Summary: Health-Minded Recovery › Re-open safely and honor public health guidance › Provide assistance, PPE, training, testing, protocols › Make clear what re-opening looks like, what’s needed, what metrics we’ll use › Create safe work environments, safe commutes › Address well-being, repair trauma, build healthy communities and families 33 Initial Survey Summary: Jobs & Business Support › Support businesses that already exist, are on the brink of closure › Encourage local spending › Connect the vulnerable who can work to jobs to build stability › Support workers' child care and health/safety needs › Retraining and business model rethinking › Pay attention to the needs of businesses and workers, like sole proprietors with no employees and undocumented workers, who are ineligible for most/all stimulus so far 34 Initial Survey Summary: Vulnerable Populations › Ensure marginalized communities can access relief › Protect folks from displacement, speculation › Address vulnerabilities of those with limited mobility, high risk including persons experiencing homelessness › Make it easy to find and understand resources available › Keep folks connected and encouraged › Sustain non-profits that serve those in need 35 Initial Survey Summary: Economic Development › Reconsider impediments to residential development › Ensure equitable banking › Prevent evictions › Lower barriers to entry and reduce burdens on small business › Invest in equitable infrastructure/building/transit for stimulus › Build a message that will attract business to San Francisco and encourage local spending – "Make San Francisco the cleanest and safest city in the nation" 36 Initial Survey Summary: Big Picture › We are all in this together › Communicate so businesses and residents can plan for the future › We need community outreach and community cooperation › Make sure whatever is done will actually help the most vulnerable/impacted people/businesses › Let’s tackle our biggest challenges together › Prepare for the long haul 37 Q&A http://onesanfrancisco.org/covid-19recovery email: RecoverySF@sfgov.org Thank you! City and County of San Francisco Economic Recovery Task Force San Francisco Economic Recovery Task Force (ERTF) KICK-OFF MEETING April 24, 2020 COVID-19 Update: San Francisco Re-opening Plan Health Commission Meeting June 2, 2020 Tomás J. Aragón, MD, DrPH Health Officer, City & County of San Francisco Director, Population Health Division San Francisco Department of Public Health COVID-19 cases per day (left) and hospitalization census (right), San Francisco 2 San Francisco’s Approach to Reopening • State Resilience Roadmap as a building block • Economic Recovery Task Force (ERTF) • Incremental opening gated with health indicators • Time increments between “gates” (4 weeks) • Considers risks and mitigations • Preference for regional coordination 3 Where might we be going? (if Rt increases moderately with phased re-opening) ~4 week delay to detect loss of epidemic control Assume Rt increases June 1 Median 1.29 (5th 1.15, 95th 1.42) Current Rt: Median 0.85 (5th 0.81, 95th 0.95) • Not a lot of room for error: assumes as we lift Shelter in Place, we are able to keep Rt lower than it was during early March • Hospitalization data are not a good basis for course correction- too much delay 4 California Resilience Roadmap 5 Sample view of risk scoring by the Economic Recovery Task Force Category (San Francisco specific) Contact Risk Modification: Ability to mitigate risk Larger numbers have a higher risk; using Johns Hopkins risk definitions; assuming business are doing the mitigation activities Larger numbers have a higher difficulty; using Johns Hopkins definitions Contact Proximity How close will the contact be Contact Length Contact Volume How long will the contact be? How many people will be at the activity? Difficulty to socially distance Difficulty to disinfect Total Risk Score San Franisco Total Score Contact Risk Score Modification Score (40% of Total Score) (60% of Total Score) [=(0.4*Contact Score)+ (0.6*Modification Score)] Offices 1.0 1.0 1.0 2.0 1.0 1.0 1.5 1.3 Pet Services Botanical gardens & outdoor historical sites Nature, parks, beaches, and other outdoor spaces Non-essential manufacturing Wholesale trade, leasing, & logistics Retailers 2.0 2.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 1.0 2.0 2.0 2.0 2.0 1.3 1.7 1.0 1.5 1.5 2.0 1.4 1.6 1.6 1.0 2.0 2.0 2.0 2.0 1.0 3.0 1.0 2.0 2.0 2.0 2.0 1.0 2.0 2.0 2.0 1.7 1.7 1.5 2.0 2.0 1.7 1.9 1.9 Restaurants 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 6 State Stages are guide SF’s re-opening Phases Phase 2 (State Stage 2) st th Early Phase 2 (2a: June 1 and 2b: June 15 ) Phase 3 th Expanded Phase 2 (2c: July 13 ) (County-specific plan required to move faster) Phase 4 (Mid August) Lower-risk workplaces Gradually reopen retail (curbside only), manufacturing & logistics. Later, relax retail restrictions, adapt & reopen schools, childcare, offices & limited hospitality, personal services. Higher-risk workplaces Adapt and reopen movie theaters, religious services, & more personal & hospitality services. End of Stay Home Order Reopen areas of highest risk: e.g. Concerts, conventions, sports arenas. • Curb-side retail • Manufacturers • Logistics • Childcare for nonessential workforce • Select services: car washes, pet grooming, and landscape gardening • Outdoor museums, and open gallery spaces and other public spaces with modifications • Office-based businesses (telework remains strongly encouraged) • In-person religious services (churches, weddings) • Personal care (hair and nail salons, gyms) • Entertainment venues (movie theaters, sports without live audiences) • Concerts • Conventions • Live audience sports • Destination retail, including shopping malls and swap meets • Dine-in restaurants (other amenities, like bars or gaming areas, are not permitted in Stage 2) • Schools with modifications 7 Summary of San Francisco Re-opening Plan https://sf.gov/information/reopening-san-francisco • Bounded by State phases • Allowable businesses or activities in State phases may change • Pace at which State moves through phases unpredictable • Risk and potential to mitigate risk (risk stratification) • Hard hit sectors • Viewing change in employment numbers • Ability for sectors to continue operating remotely or online • Underlying sectors that are critical for reopening (e.g. childcare, education) • Review pre-COVID employment numbers as marker for possible mobility • Assume return of full workforce to pre-COVID-19 levels may be unlikely 8 How to re-open San Francisco • Businesses and community • • • • Face coverings Physical distancing Hand washing Testing (role of asymptomatics) • City and partners • • • • Universal testing access Early detection systems (cases) Case and contact investigations Orders, directives, best practices 9 Appendix State Stage 2: Lower-risk workplaces Gradually opening some lower risk workplaces with adaptations at a pace designed to protect public health and safety, starting with: • Retail • Manufacturing • Offices (when telework not possible) • Outdoor Museums • Limited Personal Services Limit time outside the home and travel only for permissible activities, such as healthcare, food, outdoor exercise and recreation (individuals and households only). Stage 1 and 2 work, and local shopping or other activities related to open sectors. 11 Appendix I. 5 Indicators FINAL 6 8 20 .cleaned Wednesday, June 17, 2020 Wednesday, June 17, 2020 Goal: Number of new COVID+ cases is flat or decreasing Current status: Flat and/or decreasing Wednesday, June 17, 2020 Goal: The rate of new COVID+ hospitalizations is flat or decreasing Current status: Flat and/or decreasing Goal: More than 20% of ICU and 15% of Acute Care bed capacity is available. Current status: 43% of ICU and 27% of Acute Care beds are available Wednesday, June 17, 2020 Goal: 1,800 tests per day for San Francisco residents Current status: Average of 2,277 per day Wednesday, June 17, 2020 Goal: 90% of cases reached with contacts identified 90% of contacts reached Current status: 80% of cases reached with contacts identified 68% of all contacts reached Wednesday, June 17, 2020 Goal: 30-day supply of personal protective equipment Current status: 85% of PPE more than 30-day supply Wednesday, June 17, 2020 Wednesday, June 17, 2020 Appendix J. Indicators & Trigger Levels_06 11 SF Covid-19 Indicators and Triggers • To make visible where SF stands with respect to: • Covid-19 disease burden • Ability of the healthcare system to manage a surge • Ability of the system to control the disease • To provide an assessment as to how we are doing with respect to steps taken to reopen the economy • • • • Can we proceed faster than the proposed rate Can we proceed at the proposed rate Should we stay where we are Do we need to go back • Seven indicators; four colors • Green = OK to proceed, perhaps faster, taking into account the other indicators and additional data • Yellow = Evaluate the other indicators and additional data before further reductions in SIP • Orange = Consider slowing reductions in SIP based on the status of the other indicators and additional data • Red = Consider increasing SIP based on the status of the other indicators and additional data Category Disease Situation Health Care System Disease Control Key Question Indicator Triggers to raise to a higher level Triggers to lower level Level 1 New Normal Level 2 Low Alert Level 3 Moderate Alert Level 4 High Alert Are there early indicators of an increase in Covid19 disease Number of new cases per day/100,000 population Increasing to meet new threshold over a 7-day period Decreasing to meet new threshold over a 7-day period <1.8 1.8-4.0 4.0-6.0 `>6 Are there early signs of an increase in hospitalizations Rate of increase in total Covid+ hospitalizations Increasing to meet new threshold over a 7-day period Decreasing to meet new threshold over a 7-day period <10% 10-15% 15-20% >20% Do we have capacity to treat severe cases? Acute care bed available capacity Meet threshold for over 7 days Meet threshold for over 7 days >15% 11-15% 5-10% <5% Do we have capacity to treat severe cases? ICU bed available capacity Meet threshold for over 7 days Meet threshold for over 7 days >20% 15-20% 10-15% <10% Are we protecting health care workers? Percent of essential PPE with greater than a 30 day supply Increasing over a 7-day period Decreasing over a 7-day period 100% 85-99%% 61-84% <60% Are we testing enough to detect cases? Tests per day Meet threshold for over 7 days Meet threshold for over 7 days >1,800 1,799-1,400 1,399-701 <700 Do we have robust contact tracing? 90% of new cases reached and named contacts reached Meet threshold for over 7 days Meet threshold for over 7 days >90% 80-89% 65-79% <65% Comparison of Case indicators 14 day cumulative covid+/100,000 Covid + cases/100,000 25 1.8 Freiden Resolve Green to Yellow 12.3 0.88 Freiden Resolve Yellow to Orange 25 1.8 Freiden Resolve Orange to Red 50 3.6 SF Current 38 3.0 Entity CA Watch Indicator Number of new cases/day Seven day running average of SF Covid+ cases 60 6.8 Orange to Red transition 40 Yellow to Orange transition 3.8 30 2.8 20 Green to Yellow transition 1.8 10 0.8 Running 7 day average Mean 26 -A pr 3M ay 10 -M ay 17 -M ay 24 -M ay 31 -M ay 12 -A pr 19 -A pr 5Ap r ar 29 -M ar 22 -M ar 15 -M 8M ar -0.2 ar 0 1M New Covid + Cases 4.8 -3 SD +3 SD Cases/100,000 Covid-19 cases/100,000 5.8 50 Category Disease Situation Health Care System Disease Control Key Question Indicator Triggers to raise to a higher level Triggers to lower level Level 1 New Normal Level 2 Low Alert Level 3 Moderate Alert Level 4 High Alert Are there early indicators of an increase in Covid19 disease Number of new cases per day/100,000 population Increasing to meet new threshold over a 7-day period Decreasing to meet new threshold over a 7-day period 1.8 1.9-4.0 4.1-6.0 `>6 Are there early signs of an increase in hospitalizations Rate of increase in total Covid+ hospitalizations Increasing to meet new threshold over a 7-day period Decreasing to meet new threshold over a 7-day period <10% 11-15% 16-20% >20% Do we have capacity to treat severe cases? Acute care bed available capacity Meet threshold for over 7 days Meet threshold for over 7 days >15% 11-15% 5-10% <5% Do we have capacity to treat severe cases? ICU bed available capacity Meet threshold for over 7 days Meet threshold for over 7 days >20% 16-20% 11-15% <10% Are we protecting health care workers? Percent of essential PPE with greater than a 30 day supply Increasing over a 7-day period Decreasing over a 7-day period 100% 85-99%% 61-84% <60% Are we testing enough to detect cases? Tests per day Meet threshold for over 7 days Meet threshold for over 7 days >1,800 1,799-1,400 1,399-701 <700 Do we have robust contact tracing? 90% of new cases reached and named contacts reached Meet threshold for over 7 days Meet threshold for over 7 days >90% 80-89% 65-79% <65% SF Covid+ Total Hospitalizations 100000.0 Anticipate an increase in RE effective June 1 due to reopening Reopenings 10000.0 Reopenings Hospital Census 1000.0 100.0 10.0 1.0 3/15/20 4/15/20 5/15/20 6/15/20 7/15/20 0.1 5% 95% Min Median Max Actual SF Covid + 8/15/20 The surge we just went through 100.0 250.00% 90.0 200.00% 70.0 60.0 50.0 100.00% SIP 40.0 50.00% 30.0 20.0 0.00% 10.0 Actual Rate 6/21/20 6/14/20 6/7/20 5/31/20 5/24/20 5/17/20 5/10/20 5/3/20 4/26/20 4/19/20 4/12/20 4/5/20 3/29/20 -50.00% 3/22/20 0.0 Percent Change 150.00% 3/15/20 Covid + Total Hospitalizations 80.0 • Initial RE >3.0 • The associated peak rate of increase in hospitalizations is 250% • It takes three weeks from SIP to hospitalization plateau • Waiting one more week to institute SIP would have yielded > 250-400 hospitalizations • Waiting two more weeks to institute SIP would have yielded > 600-1,600 hospitalizations Moderate Surge Scenario SEIRS modeling at 15% cutoff and relation to Indicator triggers 450.0 25% Hosp. rate of increase 20% 350.0 300.0 10% 250.0 5% 200.0 0% 150.0 -5% 100.0 Total Hospitalizations 15% Percent increase total hospitalizations 9/27/20 9/20/20 9/13/20 9/6/20 8/30/20 8/23/20 8/16/20 8/9/20 8/2/20 7/26/20 7/19/20 7/12/20 7/5/20 6/28/20 -15% 6/21/20 0.0 6/14/20 -10% 6/7/20 50.0 Percent Change 15% 5/31/20 Covid + Total Hospitalizations 400.0 Moderate Surge Scenario Hosp. rate of increase 400.0 25% 350.0 20% 300.0 15% 250.0 10% 200.0 5% 150.0 0% 100.0 -5% Total Hospitalizations 15% Percent increase total hospitalizations 9/27/20 9/20/20 9/13/20 9/6/20 8/30/20 8/23/20 8/16/20 8/9/20 8/2/20 7/26/20 7/19/20 7/12/20 7/5/20 6/28/20 -15% 6/21/20 0.0 6/14/20 -10% 6/7/20 50.0 Acute Care Bed Capacity Acute Bed Capacity Percent Change 450.0 30% 5/31/20 Covid + Total Hospitalizations SEIRS modeling at 15% cutoff and relation to Indicator triggers Moderate Surge SEIRS modeling at 15% cutoff and relation to Indicator triggers Hosp. rate of increase 450.0 35% Acute Bed Capacity 30% ICU Bed Capacity 25% 350.0 15% 250.0 10% 200.0 5% 150.0 0% 100.0 -5% 9/27/20 9/20/20 9/13/20 9/6/20 8/30/20 8/23/20 8/16/20 8/9/20 8/2/20 7/26/20 7/19/20 7/12/20 7/5/20 6/28/20 -15% 6/21/20 0.0 6/14/20 -10% 6/7/20 50.0 Total Hospitalizations 15% Percent increase total hospitalizations Acute Care Bed Capacity ICU Bed Capacity Percent Change 20% 300.0 5/31/20 Covid + Total Hospitalizations 400.0 Major Surge Scenario Hosp. rate of increase 9/27/20 9/20/20 9/13/20 -40% 9/6/20 0.0 8/30/20 -30% 8/23/20 100.0 8/16/20 -20% 8/9/20 200.0 8/2/20 -10% 7/26/20 300.0 7/19/20 0% 7/12/20 400.0 7/5/20 10% 6/28/20 500.0 6/21/20 20% 6/14/20 600.0 6/7/20 30% 5/31/20 Covid + Total Hospitalizations 700.0 Total Hospitalizations 25% Percent increase total hospitalizations Acute Care Bed Capacity ICU Bed Capacity Percent Change Acute Bed Capacity 40% ICU Bed Capacity 800.0 Minimal Surge Scenario Hosp. rate of increase Acute Bed Capacity ICU Bed Capacity 35% 140.0 30% 25% 100.0 20% 80.0 15% 10% 60.0 5% 40.0 0% 20.0 -5% 0.0 5/31/20 -10% 6/30/20 7/31/20 8/31/20 9/30/20 Total Hospitalizations5% Percent increase total hospitalizations Acute Care Bed Capacity ICU Bed Capacity Percent Change Covid + Total Hospitalizations 120.0 Category Disease Situation Health Care System Disease Control Key Question Indicator Triggers to raise to a higher level Triggers to lower level Level 1 New Normal Are there early indicators of an increase in Covid19 disease Number of new cases per day/100,000 population Increasing to meet new threshold over a 7-day period Decreasing to meet new threshold over a 7-day period 1.8 Are there early signs of an increase in hospitalizations Rate of increase in total Covid+ hospitalizations Increasing to meet new threshold over a 7-day period Decreasing to meet new threshold over a 7-day period -15.8% Do we have capacity to treat severe cases? Acute care bed available capacity Meet threshold for over 7 days Meet threshold for over 7 days 25% Do we have capacity to treat severe cases? ICU bed available capacity Are we protecting health care workers? Percent of essential PPE with greater than a 30 day supply Increasing over a 7-day period Are we testing enough to detect cases? Tests per day Meet threshold for over 7 days Do we have robust contact tracing? 90% of new cases reached and named contacts reached Level 2 Low Alert 3.14 Level 3 Moderate Alert Level 4 High Alert 4.1-6.0 `>6 11-15% 16-20% >20% 11-15% 5-10% <5% 16-20% 11-15% <10% 85% 61-84% <60% 1,799-1,400 1,399-701 <700 80-89% 68% <65% 1.9-4.0 <10% >15% Meet threshold for over 7 days Meet threshold for over 7 days 37% >20% Decreasing over a 7-day period 100% 85-99%% Meet threshold for over 7 days 2,190 >1,800 Meet threshold for over 7 days Meet threshold for over 7 days >90% 65-79% A Single Covid Disease Index (CDI) Indicator • • the highest color for indicators 2 to 4 becomes the CDI color if the highest indicator (of 2 to 4) becomes Yellow, the CDI = Yellow • if the highest indicator (of 2 to 4) becomes Orange, the CDI = Orange • if any one indicator (of 2 to 4) becomes Red, the CDI = Red • if one of indicator 2 to 4 are orange and one of the other indicators 2-4 is not green, the highest indicator goes up one level to Red Moderate Surge SEIRS modeling at 15% cutoff and relation to Indicator triggers Hosp. rate of increase 450.0 35% Acute Bed Capacity 30% ICU Bed Capacity 25% 350.0 15% 250.0 10% 200.0 5% 150.0 0% 100.0 -5% 9/27/20 9/20/20 9/13/20 9/6/20 8/30/20 8/23/20 8/16/20 8/9/20 8/2/20 7/26/20 7/19/20 7/12/20 7/5/20 6/28/20 -15% 6/21/20 0.0 6/14/20 -10% 6/7/20 50.0 Total Hospitalizations 15% Percent increase total hospitalizations Acute Care Bed Capacity ICU Bed Capacity Percent Change 20% 300.0 5/31/20 Covid + Total Hospitalizations 400.0 Change in key indicators and CDI under three surge scenarios 5/17/20 6/1/20 Indicator Colors based on Predictive Model at 3 Levels by Date Hospitalization Rate Change MIN Acute Care Capacity SURGE ICU Capacity (5%) CDI GATE 6/15/20 GATE 5/17/20 5/18/20 5/31/20 6/1/20 GATE 6/2/20 6/3/20 -21% -17% -9% -11% -17% -23% 27% 27% 27% 28% 28% 28% 28% 28% 29% 29% 29% 29% MOD SURGE (15%) Hospitalization Rate Change Acute Care Capacity ICU Capacity CDI -21% -17% -9% -11% -17% -23% 27% 27% 27% 28% 28% 28% 28% 28% 29% 29% 29% 29% MAJOR SURGE (25%) Hospitalization Rate Change Acute Care Capacity ICU Capacity CDI -21% -17% -9% -11% -17% -23% 27% 27% 27% 28% 28% 28% 28% 28% 29% 29% 29% 29% 7/15/20 GATE 6/4/20 6/14/20 6/15/20 6/16/20 6/17/20 6/18/20 6/19/20 6/20/20 6/21/20 6/22/20 6/23/20 6/24/20 6/25/20 6/26/20 6/27/20 6/28/20 6/29/20 6/30/20 7/1/20 7/2/20 7/3/20 7/4/20 7/5/20 7/6/20 7/7/20 7/8/20 7/9/20 7/10/20 7/11/20 7/12/20 7/13/20 State Stage 3: Higher-risk workplaces Phase in higher-risk workplaces at a pace designed to protect public health and safety, beginning with limited personal care and recreational venues (with workplace modifications). Travel for permissible activities, such as healthcare, food, stages 1-3 work, and local or activities shopping related to open sectors. Monitor critical indicators and alter scope of reopening if necessary to protect public health and safety. 12 State Stage 4: End of stay at home order Gradually open larger gathering venues at a pace consistent with public health and safety, such as nightclubs, concert venues, and live audience sports. Gradually resume remaining activities and travel. Monitor critical indicators and alter scope of reopening if necessary to protect public health and safety. 13 Appendix L. Geolocation Testing Dashboard_Census Tracts and Congregate Testing 6/8/2020 PosPer1000 by Census Tract Posities Per 1000 Residents By Census Tract CTract 06075018000 06075980900 06075023200 06075020800 06075015300 06075980600 06075020100 06075061200 06075015900 06075012401 06075015500 06075980200 06075022901 06075022802 06075012502 06075026404 06075015802 06075012501 06075026004 06075023400 06075012301 06075025403 06075025900 06075026301 06075026200 06075012201 06075026001 06075026003 06075030500 06075022903 06075017700 06075061400 06075025500 06075023001 Total TestsPer1000 PosPer1000 CT_TotalTests CT_TotalPositive CT_TestsNegative 195.41 290.44 103.85 82.98 122.99 149.57 111.28 103.19 74.51 130.07 110.14 68.85 410.13 562.04 187.78 59.09 58.12 102.45 51.29 78.90 128.07 52.48 58.85 53.56 51.69 87.97 55.17 64.06 450.96 65.71 102.76 57.72 45.93 47 50 12,077.28 30.09 29.41 19.38 17.82 17.44 17.39 16.23 14.68 14.03 13.59 13.59 13.11 12.95 12.45 12.28 10.55 9.64 9.50 8.78 8.74 8.51 7.52 7.49 7.05 6.86 6.68 6.65 6.59 6.28 6.18 6.13 5.86 5.84 5 69 712.85 604.00 79.00 434.00 531.00 275.00 86.00 672.00 443.00 340.00 622.00 389.00 21.00 2,122.00 1,309.00 673.00 168.00 193.00 410.00 257.00 289.00 271.00 265.00 283.00 281.00 392.00 408.00 332.00 321.00 1,508.00 234.00 201.00 345.00 448.00 242 00 66,519.00 93.00 8.00 81.00 114.00 39.00 10.00 98.00 63.00 64.00 65.00 48.00 4.00 67.00 29.00 44.00 30.00 32.00 38.00 44.00 32.00 18.00 38.00 36.00 37.00 52.00 31.00 40.00 33.00 21.00 22.00 12.00 35.00 57.00 29 00 3,414.00 509.00 71.00 350.00 416.00 236.00 76.00 574.00 377.00 276.00 555.00 341.00 17.00 2,047.00 1,278.00 629.00 138.00 161.00 372.00 213.00 257.00 251.00 227.00 247.00 244.00 340.00 377.00 291.00 287.00 1,487.00 212.00 189.00 310.00 387.00 213 00 62,974.00 1/1 6/8/2020 TestsPer1000 by Census Tract Tests Per 1000 Residents By Census Tract CTract 06075018000 06075980900 06075023200 06075020800 06075015300 06075980600 06075020100 06075061200 06075015900 06075012401 06075015500 06075980200 06075022901 06075022802 06075012502 06075026404 06075015802 06075012501 06075026004 06075023400 06075012301 06075025403 06075025900 06075026301 06075026200 06075012201 06075026001 06075026003 06075030500 06075022903 06075017700 06075061400 06075025500 06075023001 Total TestsPer1000 PosPer1000 CT_TotalTests CT_TotalPositive CT_TestsNegative 195.41 290.44 103.85 82.98 122.99 149.57 111.28 103.19 74.51 130.07 110.14 68.85 410.13 562.04 187.78 59.09 58.12 102.45 51.29 78.90 128.07 52.48 58.85 53.56 51.69 87.97 55.17 64.06 450.96 65.71 102.76 57.72 45.93 47 50 12,077.28 30.09 29.41 19.38 17.82 17.44 17.39 16.23 14.68 14.03 13.59 13.59 13.11 12.95 12.45 12.28 10.55 9.64 9.50 8.78 8.74 8.51 7.52 7.49 7.05 6.86 6.68 6.65 6.59 6.28 6.18 6.13 5.86 5.84 5 69 712.85 604.00 79.00 434.00 531.00 275.00 86.00 672.00 443.00 340.00 622.00 389.00 21.00 2,122.00 1,309.00 673.00 168.00 193.00 410.00 257.00 289.00 271.00 265.00 283.00 281.00 392.00 408.00 332.00 321.00 1,508.00 234.00 201.00 345.00 448.00 242 00 66,519.00 93.00 8.00 81.00 114.00 39.00 10.00 98.00 63.00 64.00 65.00 48.00 4.00 67.00 29.00 44.00 30.00 32.00 38.00 44.00 32.00 18.00 38.00 36.00 37.00 52.00 31.00 40.00 33.00 21.00 22.00 12.00 35.00 57.00 29 00 3,414.00 509.00 71.00 350.00 416.00 236.00 76.00 574.00 377.00 276.00 555.00 341.00 17.00 2,047.00 1,278.00 629.00 138.00 161.00 372.00 213.00 257.00 251.00 227.00 247.00 244.00 340.00 377.00 291.00 287.00 1,487.00 212.00 189.00 310.00 387.00 213 00 62,974.00 1/1 6/8/2020 Month FacilityType Test Results by Facility Type March Positives Percent Positives     Adult and Senior Care Facility BHS Health Clinic Jail Medical Respite Other Residential Sites SF CCC Shelter SNF Social Rehab SRO Testing Site Total FacilityType Adult and Senior Care Facility BHS Front Line Worker Health Clinic High Risk Community Worker Jail Medical Respite Other Residential Sites SF CCC Shelter SNF Social Rehab SRO Testing Site Total   457 2 0 7 2   0 1 0 2 0 16 2 489 14.56 % 6.25 % 0.00 % 1.81 % 2.20 %   0.00 % 100.00 % 0.00 % 0.98 % 0.00 % 8.99 % 2.06 % 11.64 % April Total Tests Positives Percent Positives     3138 32 23 387 91   18 1 30 204 1 178 97 4200   1239 78 0 65 10 0 12 8 87 107 0 142 17 1765 7.71 % 23.21 % 0.00 % 4.26 % 3.26 % 0.00 % 7.89 % 66.67 % 28.43 % 10.58 % 0.00 % 12.76 % 3.94 % 8.24 % May Total Tests Positives Percent Positives     16063 336 113 1527 307 16 152 12 306 1011 22 1113 432 21410   1149 24 0 32 6 0 20 0 8 50 0 124 9 1422 2.89 % 2.30 % 0.00 % 0.90 % 0.58 % 0.00 % 3.32 % 0.00 % 3.85 % 2.01 % 0.00 % 4.03 % 1.23 % 2.69 % June Total Tests Positives Percent Positives     39765 1044 275 3547 1034 35 602 14 208 2492 25 3078 731 52850   236 1 0 7 1 0 3 0 1 7 0 17 3 276 2.02 % 0.33 % 0.00 % 0.53 % 0.22 % 0.00 % 1.21 % 0.00 % 2.27 % 0.73 % 0.00 % 2.26 % 1.71 % 1.70 % Total Total Tests Positives Percent Positives Total Tests   11705 305 271 1320 461 3 247 13 44 965 9 751 175 16269 3081 105 0 111 19 0 35 9 96 166 0 299 31 3952 4.36 % 6.12 % 0.00 % 1.64 % 1.00 % 0.00 % 3.43 % 22.50 % 16.33 % 3.55 % 0.00 % 5.84 % 2.16 % 4.17 % 70671 1717 682 6781 1893 54 1019 40 588 4672 57 5120 1435 94729 Count of FacilityType 149 69 1 74 1 3 1 66 11 25 21 17 636 27 1101 1/1 Appendix P. DPH OMB A3 V11 Creating an efficient, timely outbreak response to reduce transmission, protect vulnerable populations I. Background: It is increasingly clear that those living in congregate settings (SNFs, residential care facilities, shelters, SROs and encampments, representing (35,000?) SF residents) are at highest risk for COVID infections, mortality and morbidity. Nationally the death rate from COVID ranges from 22%-42% in residents living in SNFs/residential facilities. In San Francisco, 12 out of 21 SNF have had at least one positive resident case. While +COVID cases in SNFs represent only 5% of the cases, they account for 35% of deaths. An additional 5% of COVID related deaths occur in SROs in SF. Our current response approach brings together expertise from a number of branches: community mitigation, containment, epi and surveillance and med branch. These activities, including remote and on-site care investigation, contact tracing, isolation and quarantine, and infection prevention control, are often sub-optimally coordinated and duplicative. In mid April, the Outbreak Management Branch was created to oversee and manage timely, coordinated responses to outbreaks in congregate settings. In the last 6 weeks, the OMB, in partnership with other branches has on average responded to more than 31 outbreaks and additional site visits. While these efforts have helped the city to flatten the rate of spread of infection, they are not sustainable in the OMB’s present configuration. While the branch is still in its formative stage, bringing the team together, developing roles and responsibilities, ensuring adequate staffing it is clear that DPH needs a broader and more comprehensive strategy for outbreak management to protect those at highest risk and to tackle future outbreaks once shelter in place is lifted. A. People B. Method 1. 1. OMB Org chart is not finalized and many positions in OMB are not filled and only 42% will be filled by July when SIP lifts Staff are on contract or currently “borrowed” from other branches for ad hoc support It is unclear which staff are remaining in OMB, making it difficult to plan and train up staff Staff require multidisciplinary expertise and there are no training materials or curriculum to develop them 2. 3. 4. OMB response is a 7-day operation requiring staff to work weekends and the current staffing does not support this We have not sufficiently leveraged partnerships with other branches and the community well Decision making processes need to take into account the larger social context 2. 3. Environment 1-Jun 62% 1-Jul 42% 4. 5. Complete and communicate outbreak management strategy for assessment, outbreak and post-outbreak scenarios by service-line High Medium 2 Create staffing plan for sustainability, train teams and set up tiered reporting for the branch High High 3 Establish actionable data and visual management to measure progress towards goals High High 4 Coordinate across branches outbreak response and post-testing needs with city-wide mass testing efforts Medium Medium Develop Our People expanding scope of responses in the timely way needed to protect vulnerable populations. VI. Deliverables 2. 1. 2. 3. 4. Data Dev 1. 2. 3. Decrease the %/# of facilities with repeat outbreaks by service line from x to x Increase the % of outbreaks which last less than or equal to 30 days in SNF 36 days (11 resolved) 28 days Com Coord 4. Increase the # of outbreaks responded to within 48 hours from x to x by service line E. Tools 1 1. Target by Oct 2020 4. Challenge Problem Statement: As San Francisco enters phase II, the current outbreak approach is insufficient to efficiently address the Current 2. 3. We do not have an automated resulting approach that puts actionable data in the right hands rapidly Managing linelists are complex, requiring manual manipulation of data We do not have finalized dashboards and tracking tools that provide the necessary data for daily operations and performance measurement The time from outbreak notification to testing is 4-6 days on average Impact 3. Selected Metrics 1. We do not have a coordinated timely, standardized approach to address outbreaks and pre-outbreak situations Field testing workflows are not optimized to maximize testing We have duplicative processes for creating tools, workflows, and protocols across branches Parts of the work are scattered across different branches and teams and unclear which branch owns which activities Each service-line operates independently and does not sufficiently leverage cross team expertise and resources Communication across teams and branches is suboptimal leading to overprocessing and duplication of efforts ] Outbreaks inherently require tailored responses V. Proposed Countermeasures (CM) CM III. Goals LG/AB # Strategic Planning OMB % Staffed 2. 3. 6. 1. I. Current Mitigation Response Workflow: 1. Complex set of processes 2. Interdisciplinary coordination across branches 3. Expertise spread across different groups and report up to different units 6/4/20 IV. Analysis: What don’t we know and what’s not working 7. II. Current Conditions: V5 1. 2. 3. Owner Implement 6 response teams, consisting of: project lead, clinical lead, investigative lead, data tracker, behavioral assistant Define the strategy for each service line response to outbreak: by notification of facility, site visit assessment, testing, results disclosure, isolation and quarantining, cohorting, retesting Create electronic referral process to track and standardize requests for response Golden/Bell Franza Cohen/Imbert /Louie/Cleme nzo Finalize staffing and multidisciplinary strike team structure to provide 7-day coverage, bringing in staff from disparate areas Identify roles are needed for one year, including job descriptions, responsibilities/standard work Establish training curriculum and process to onboard and train up new staff for field work Develop CI/CT internal skillsets and training Tse/Byrne Define and measure set of readily available operational and performance measures which assess progress towards goals Map the current flow of data, define the future state Optimize data flow and results management/disclosure turn around time with PHL/commercial lBs Develop and maintain data dashboards to support real-time decision-making Golden/Bell/T se Trang Trang/Pardo Scarborough Standardize workflows and roles between branches to support pre- and post aspects of surveillance testing Educate and provide technical support to community stakeholders as first responders Define communication and planning process to facilitate post testing follow-up with community partners Skotnes/Gold en Tse/Scott/Coh en Moore/Vitale Taylor Date OMB CURRENT STATE 1. OMB focus on highest risk vulnerable populations in congregate settings OMB FUTURE STATE 3.Outbreak Response Team Partnerships 2. Community Transmission and Positive COVID Cases in Non-Congregate Sites 1. Overall framework: Prevention, Surveillance and Outbreak Mitigation 2. Interplay all 3 areas: the stronger our Prevention /Surveillance, the fewer outbreaks 2. Largely shared work between CM and OMB, with OMB leading the SNFs for all 3 areas 1. 2. Ex, Defined roles by SRO response teams CM leading in prevention and surveillance, OMB in mitigation Appendix Q. Health Screening Procedures.6.2.20 City and County of San Francisco Micki Callahan Human Resources Director Department of Human Resources Connecting People with Purpose www.sfdhr.org Requirements for Conducting Health Screenings for Employees Created 3/30/2020 Updated 6/2/2020 Requirements for conducting health screenings, as outlined below, must be adopted and followed by all City departments unless they adopt a more rigorous requirement, pursuant to health guidance. City employees who are reporting to a City worksite or working in the field must be free from symptoms of COVID-19 infection to prevent further spread of the virus. Symptoms of COVID-19 include fever at or above 100.4 F (38.0C), chills, sweats, cough, shortness of breath, sore throat, persistent sneezing or runny nose different from allergies, difficulty breathing, fatigue, body aches, headache, new loss of smell or taste, or diarrhea. Employees must self-monitor for any symptoms on a daily basis and should continue to engage in regular handwashing, cover all coughs, wear facial coverings, and regularly clean their work areas. Departments must require employees to certify they are free of COVID-19 symptoms before reporting to the workplace each day by reviewing and completing a symptom checklist. Whenever feasible, departments should instruct employees to complete their self-screen and certification at home, before reporting to work, using their own thermometer, if available. In addition to requiring employee self-certification, a subset of departments and positions with particular exposure risk will conduct on-site temperature screenings before each work shift. This is in keeping with CDC guidelines. Confidentiality of the Screening Process and Results Information obtained from an employee in response to health screenings is confidential medical information; therefore, departments should determine only whether an employee has “passed” or was “sent home” after the screening. Departments must not retain screening records or disclose screening results. Employee Refusal to Participate in Screening Screening and self-certification is mandatory. Departments should provide advance notice to employees that failure to participate in screening may subject them to discipline as described below. Managers should explain to reluctant employees that screening is vital to protect all employees (including the employee reluctant to participate in screening) from possible COVID-19 infection. In addition, because local, State, and Federal health authorities have acknowledged community spread of the virus that causes COVID-19, employers are legally permitted to conduct health screenings. Employees who refuse to participate in the screening will not be allowed to enter the workplace. Departments will give that employee a specific notice explaining these mandatory safety requirements, which are essential employment conditions during this pandemic. Should the employee continue to refuse, they may be sent home on accrued leave, other than sick leave (except for any time spent in the One South Van Ness Avenue, 4th Floor ● San Francisco, CA 94103-5413 ● (415) 557-4800 Requirements for Conducting Health Screenings Updated 6/1/2020 workplace prior to the screening). The City will proceed with termination of employment without progressive discipline for employees who refuse to comply with the requirement a second time. Below is a sample, pre-approved procedure departments may use for screening. Departments should ensure that all employees entering the location are subject to the same screening procedure. Screening Screening consists of asking questions (or using a questionnaire) either before the employee’s arrival at the workplace or when the employee first enters the worksite. Where feasible, departments should offer employees the opportunity to complete a questionnaire (online or by other method) before reporting to the worksite. This will allow employees who are experiencing symptoms to remain isolated. Employees may take their own temperature at home using their personal thermometer, if available. But if the employee’s department or position involves an on-site temperature check, a self-check at home does not excuse complying with the on-site screening. The symptom checklist may change based on public health guidance. If the question-phase of screening is conducted at the worksite, screening should be performed, if possible, in a private location outside of the building, but in an area protected from cold weather and wind. Employees should be asked to complete a written form or answer questions orally and to adhere to physical distancing guidelines. Departments must ask employees the following questions: 1. Do you currently have or have you in the past 24 hours had any one of the following symptoms which is new or not explained by another reason: fever at or above 100.40F (380C), chills, cough, shortness of breath, difficulty breathing, sore throat, unusual weakness or fatigue, loss of smell or taste, muscle aches, headache, runny nose different from your allergies, or diarrhea? 2. Have you had close contact with anyone in the last 14 days at home or in the community who has been confirmed to have COVID-19? Close contacts includes people in your home, sex partners, or people who you take care of or who take care of you. It also includes people who were within 6 feet of you for more than 10 minutes while they were not wearing a face cover, or with whom you had contact with their body fluids or secretions while you were not wearing a face cover or sufficient protective equipment. 3. Within the past 10 days, have you been diagnosed or tested positive for COVID-19? If the employee answers all of these inquiries with a “no”, then the employee may enter the worksite if not subject to additional on-site temperature screening. If the employee answers any of these questions with a “yes,” then the department should send the employee home and/or advise them not to report to work until they have complied with the department’s return-to-work protocol, including compliance with the applicable Health Officer’s quarantine and isolation orders. Temperature Screening Departments whose work or activities offer potentially increased chance of exposure must conduct a deeper level of screening than questionnaire only: re-entry temperature screening. If departments require temperature screening, they must apply the procedures consistently for similar workers and Requirements for Conducting Health Screenings Updated 6/1/2020 employees must comply with this requirement. Temperature screening on its own is not considered a reliable indicator of COVID-19 infection, and is therefore not recommended for general usage. However, it may provide value in certain settings in which employees have higher exposure to infection, or where employees cannot physically distance themselves from others. Those departments and activities include: Personnel, visitors, and incarcerated/detained persons at correctional and detention facilities Personnel, residents, and visitors at skilled nursing facilities Custodial staff in all locations 911 call center employees Employees providing patient care at the Department of Public Health Employees in transportation, utilities, and IT Employees who are not able to safely physically distance from coworkers and the public Critical Infrastructure workers who are permitted to continue working after close contact with someone with suspected or confirmed COVID-19, including: o Federal, state, & local law enforcement o Fusion Center employees A detailed step-by-step procedure for administering temperature screening is described on the attached document. Employees Who Do Not Pass Health Screening If an employee does not pass the health screening, they should be sent home, advised to notify their supervisor, advised to monitor their symptoms, and asked to contact their own healthcare provider. Departments should instruct employees that they cannot return to the worksite until they have complied with the department’s return-to-work protocol for returning COVID-19 positive or assumed positive employees. Employees may also contact the City’s Nurse Triage Line at 855-850-2249. Departments may also refer employees to testing for COVID-19. Information for City workers on how to obtain a free test is available here: https://sf.gov/get-tested-covid-19-citytestsf Guidelines for isolation and quarantine of people with COVID-19 developed by the San Francisco Department of Public Health can be found here: https://www.sfcdcp.org/wpcontent/uploads/2020/05/COVID19-IQ-Coverpage-Instructions-FINAL-05.14.2020.pdf Screening guidance link: https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-ScreeningQuestions-UPDATE-05.26.2020.pdf Temp guidance link: https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-TemperatureMeasurement-UPDATE-05.26.2020.pdf Appendix R. Health and Safety Plan Template Site-Specific Health and Safety Plan Template Any department who seeks to have additional employees return to the workplace and/or resume publicfacing services which require in-person transactions must submit a Site-Specific Health and Safety Plan which details how they propose to safely return employees to the workplace and/or resume public-facing services. Departments must also submit the City Offices Safety Protocol Certification confirming that the plan it proposes meets the requirements set forth in the City Offices Safety Protocol. Realizing there is no one size fits all approach, your Site-Specific Health and Safety Plan should at a minimum include the below information needed for the review process. Departments should not proceed with any public announcements or implement resumption of services without approval. Department Information • Department name • Confirmation that the Department Head has reviewed and approved the submitted Plan(s) • Department worksite address(es) • Contact person (with phone and email) for answering questions about department’s submitted Plan(s) • Worksite Safety Plan Monitor contact information for each worksite (if different from above) Employee Information • Total number of employees who worked at each site prior to Shelter in Place order • Approximate number of employees currently telecommuting for each worksite • Average number of employees currently working at each worksite with a breakout by regular shift times and number of employees on site during each shift • Any planned changes to the number of employees planned to work from the site over the next 12 months with a breakout by regular shift times and number of employees on site during each shift • Description of how the worksite will comply with the requirements set forth in the Safety Protocol. The description must include a detailed explanation (with attached floor plans and diagrams if needed) of how physical distancing and cleaning and sanitization requirements will be met Public-facing Services and In-person Transactions • Provide a listing of the public-facing services and/or in-person transactions you want to resume providing from each worksite • Explanation of why each service requires in-person transaction • Average daily number of public (non-worksite employees) expected at the worksite related to each service • If you are proposing a plan to phase in services over a period, provide a detailed description of the plan covering the phase in of services and the expected number of public on site at each stage • Description of the mitigation measures (e.g., touchless systems, appointment scheduling, timed entry, education, signage, cleaning and sanitization, service changes, etc.) planned in accordance with the Safety Protocol for the public-facing services • Additional information needed to understand how the department proposes to safely provide public-facing services specific to each site Appendix S. Return to Work Requirements for COVID.6.2.2020FINAL City and County of San Francisco Micki Callahan Human Resources Director Department of Human Resources Connecting People with Purpose www.sfdhr.org Requirements for Employees Returning to Work Sites after COVID-19 Illness or Exposure Updated 6/2/2020 The San Francisco Department of Public Health (SFDPH) has issued guidance for determining when it is safe for an employee to reenter their worksite after a confirmed or suspected COVID-19 infection or close contact with a person with a known COVID-19 infection. These requirements for City employees reflect the most current guidance from SFDPH and must be followed to ensure individual and collective safety, workplace safety, and public safety. These requirements are in addition to the required daily routine screening for COVID-19 symptoms and certification that all employees must perform before entry into the workplace, as outlined in the health screening requirements document. The procedures and criteria apply to all City employees in all departments who are returning to work after COVID-19 illness or exposure. Certain departments may apply more stringent criteria to employees based on the nature of their work. COVID-19 ILLNESS. Before entering a worksite, all employees with lab confirmed or suspected COVID-19 illness must be: Free of fever over 100.4⁰ F for 72 hours (and without the use of fever reducing medications such as acetaminophen, ibuprofen, naproxen), and Have improving respiratory symptoms such as reduced cough, and Have served a 10-day isolation period from the date of the first symptoms; if the employee never had symptoms then the only criteria is that the employee serves a 10-day isolation period from the date that the employee first took the test for COVID-19 with positive results. Isolation may need to be longer than 10 days if an employee continues to be sick. Employees who do not meet the improving symptom criteria for return to work must continue to isolate longer than 10 days until they meet the required 72 hours free of fever and improving symptoms. COVID-19 EXPOSURE. Employees who have had a close contact with someone with COVID-19 must quarantine for 14 days from the date of the most recent contact. This quarantine period is necessary to cover the incubation period of the virus. Close contact is defined as: living in the same household or being an intimate partner of someone who has confirmed COVID-19 spending more than 10 minutes within six feet of someone with confirmed COVID-19 who was not wearing a face mask, or having direct contact for any amount of time with the bodily fluids and/or secretions of someone with confirmed COVID-19 (e.g., was coughed or sneezed on, shared utensils with, or was provided care by or provided care for them without wearing a mask, gown, and gloves). A close contact does not include employees who are required to work with individuals who may have COVID-19, provided that they are wearing the appropriate PPE during the encounter. One South Van Ness Avenue, 4th Floor ● San Francisco, CA 94103-5413 ● (415) 557-4800 Requirements for Returning To Work after COVID Illness or Exposure Updated 6/1/2020 RETURNING TO WORK PROCESS Employees who believe they are ready to return to work must contact their Department Personnel Officer or other contact designated by their department to receive clearance to return. Consistent with Civil Services Rules, employees must provide a doctor’s note if they are off work for more than 5 days. If an employee is unable to provide a doctor’s note, the Human Resource professional should work with their departmental physician or the Department of Human Resources’ physician, Dr. Fiona Wilson, to provide clearance to return to work. Employees must respond honestly to the return to work questions, and failure to do so may result in disciplinary action up to and including termination. Upon returning to work, employees must follow all workplace safety requirements, including conducting a daily screening for symptoms, wearing facial coverings, and maintaining safe physical distance. Departmental Personnel Officers who have questions about an employee’s individual circumstance or ability to return to work should reach out to Dr. Wilson. Additional Resources: https://www.sfcdcp.org/wp-content/uploads/2020/05/COVID19-Home-IQ-Guidelines-and-DirectivesPacket-FINAL-5.14.2020.pdf Appendix T. BayAreaHealthOfficerIndicators-04292020 BAY AREA HEALTH OFFICERS’ INDICATORS FOR ASSESSING PROGRESS ON CONTAINING COVID-19 The following indicators (“Indicators”) will be tracked by each of the Health Officers in the Bay Area to assess our collective progress in ensuring we have the strategies and infrastructure in place to contain and treat COVID-19. These Indicators are designed to provide measurable goals that will spur action on the part of the community at large, driving us to work together to create this infrastructure and to achieve our strategic goals. These Indicators are complementary to the high-level metrics that are being tracked by the California Department of Public Health and the Governor. The Indicators are important measures of progress as we assess whether and to what extent we can move away from the existing shelter-in-place restrictions that have been required to slow the spread of the virus. However, other factors will also guide the Health Officers’ decision making, including the development of other methods to contain COVID-19, the impact of the staged reopening of various sectors, the level of compliance with social distancing orders and guidance, collective compliance with isolation and quarantine directives for persons who are infected or exposed, and other scientific developments during this rapidly evolving pandemic. Further, decisions to modify existing restrictions will be made based on the totality of the circumstances; substantial progress on several important Indicators and other factors may allow additional activities to resume even if certain goals within the Indicators have not yet been achieved. These Indicators are based on our current understanding of the virus, our assessment of what goals are achievable in the coming weeks and months, and current tools to mitigate and contain the virus. We will be continuously assessing these Indicators as circumstances change; the science regarding COVID-19 (and its spread) continues to grow and evolve week by week. Cases are persons who are contagious with COVID-19 whether or not they have symptoms. We currently lack the testing capacity necessary to know how many cases exist in our community, and to accurately track our progress in reducing both the total number of cases and by how much we are slowing the rate of transmission. We also need to greatly expand our capacity to isolate individuals who have COVID-19 as well as capacity to quarantine their contacts and ensure we break chains of transmission. With this infrastructure in place, we can contain COVID-19 without needing to keep very restrictive shelter-in-place measures in effect. We are asking for help from every sector in the community to quickly resource and stand up this infrastructure. We plan to report publicly on our progress on these local Indicators, so that the community can also track our collective progress. April 29, 2020 1 Indicator 1: The Total Number of Cases in the Community is Flat or Decreasing, and the Number of Hospitalized Patients with COVID-19 is Flat or Decreasing The number of new cases identified per day is flat or decreasing in the coming weeks and months. o We know that as we increase testing, our numbers may temporarily go up. Increased testing will provide a more accurate picture of how many cases exist in our community. We will be closely monitoring and analyzing this information week by week. The number of hospitalized patients with COVID-19, across all hospitals, is flat or decreasing for 14 consecutive days. Indicator 2: We Have Sufficient Hospital Capacity to Meet the Needs of our Residents For at least a week (7-day rolling average), no more than 50% of patients in staffable nonsurge hospital beds are COVID-19 positive. Indicator 3: Sufficient COVID-19 Viral Detection Tests Are Being Conducted Each Day At least 200 COVID-19 viral detection (PCR) tests are being conducted per 100,000 residents per day. o This does not include antibody testing at this time, because the science regarding interpretation and validation of antibody testing is still in flux. o We are focused on tests performed, rather than testing capacity, to ensure we are achieving the level of testing necessary. o Our goal is to ensure everyone in the State’s priority groups in our County is being tested at appropriate intervals. Indicator 4: We Have Sufficient Case Investigation, Contact Tracing, and Isolation/Quarantine Capacity To break chains of transmission, we must rapidly develop the capacity necessary to identify and isolate persons with COVID-19 and those who have been exposed to COVID-19. In communities throughout the Bay Area and around the country, we must do this at an unprecedented scale and speed, many times beyond what public health departments across the country are resourced to do currently. This will require a massive and rapid infusion of April 29, 2020 2 resources, including disease investigators, information management tools, and the combination of housing, food, and income-replacement needed to allow infected and exposed community members to isolate themselves from others. This infrastructure must be designed to accomplish the following: We reach at least 90% of cases and identify their contacts; We ensure 90% of the cases that we reach can safely isolate; We reach at least 90% of all contacts identified; and We ensure at least 90% of identified contacts can safely quarantine. Indicator 5: We Have At Least A 30-Day Supply of Personal Protective Equipment (PPE) Available for All Healthcare Providers All acute care hospitals, outpatient clinics, skilled nursing facilities, and medical first responders (Emergency Medical Services (EMS) and fire agencies) have a 30-day supply of PPE on hand. We will measure this as follows: o Every acute care hospital in the County has certified in writing to the Health Officer that it has access to a 30-day supply of PPE and can independently procure adequate PPE to meet its needs going forward. o No hospital, clinic, skilled nursing facility, other long-term care facility, or first responder agency is struggling to purchase PPE through standard channels, and none have needed to submit a request for assistance in obtaining PPE to the County Emergency Operations Center in the last 14 days. April 29, 2020 3 Appendix U. DOC All Hands 612-20 1 DPH-DOC All-Hands Meeting Friday, June 12, 2020 • Situational Awareness Update • Dr. Ayanna Bennett • Tosan Boyo, MPH, FACHE • Dr. Jim Marks • Phase II Planning Update • Review Unified Command Org Chart • San Francisco Successes • Community A3 • Survey Results: Accomplishments in OP20 • Updates from Sections + Operations Branches • Accomplishments in OP21 • Activities Planned for OP22 Situational Awareness Thank you to all Branches. Remaining vigilant We’re still in a pandemic! Phase II Planning updates Finalizing DPHDOC staffing plan Surge playbook and table top Monday Thursday Unified Command Org Chart Department Heads for Mayor, DPH, HSA, HSH, DEM, CON, ADM, DHR, SFPD, City Attorney. Meet twice a week to discuss elevated concerns and policy decisions on response, re-opening and recovery. Policy Group EOC Department Heads DPH: Dr. Ayanna Bennett HSA: Dariush Kayhan DEM: Adrienne Bechelli Sean Elsbernd Dr. Grant Colfax Trent Rhohr Abigail Stewart-Kahn Mary Ellen Carroll Unified Command Human Rights Commission DPH + HSA + DEM Direct consultation with HRC ensures that equity remains a key component of all policy implementation planning and operations Command Staff Operations Planning Logistics Finance/Admin Joint Information Various Tosan Boyo (DPH) Jim Marks (DPH) TBD TBD – CON Tyrone Jue (MYR) rg charts are DRAFT and are subject to change Unified Command – Bennett, Kayhan, Bechelli Re-Opening Liaison Recovery Liaison Policy Liaison Natasha Mihal (CON) Jodi Traversaro (DEM) Peg Stevenson (CON) Electeds Liaison Jeremy Spitz (DPW) All org charts are DRAFT and are subject to change Human Rights Commission – Simley (HRC) Information and Guidance Communications Officer Rita Nguyen (DPH) Tyrone Jue (MYR) Safety Officer TBD – Various Boxes with gold dashed line are still under major review Operations Chief Tosan Boyo (DPH) Health Operations Branch Jenna Bilinski (DPH) Lisa G & April B (DPH) Donna Adkins (HSA) Transportation Group John Knox-White (MTA) Feeding Group Andrea Jorgensen (DEM) Investigation & Tracing Alternative Housing Feeding Darpun S & Julia D (DPH) Ben Amyes (HSA) Unsheltered Services Group TBD – HSH Housing Group Irene Agustin (HSH) Alternative Housing Management Client Services Cindy Ward (HSA) TBD Medical Group Andi T & Jonathan S (DPH) Public Safety Group TBD – SFFD/SFPD Admin Support Tonji Walker (HSA) Deputy Branch Director Janice Levy (CON) or Mike Pearlman (CON) Testing Group Tobi S & Sheila Z (DPH) Outbreak Management Group Support Services Branch TBD Human Services Branch Doris Barone (HSA) Community Food Coordination Unit Paula Jones (DPH) Unsheltered Feeding TBD Housing Coordinator Kira Barerra (HSA) Q/A Alice Kissinger (CON) Scott Walton (HSH) + 1 FTE for client Q/A RTZ Management Cody Reneua (CON) Site Planning Rod Finetti (HSA) Support Services Healthy Neighborhood Task Force Jocelyn Everroad (HSA) TBD + 2 FTE (DPH and HSH) Referral & Transport Anthony Federico (HSH) Program Managers La’Sheena Sirles (HSA) Data / Analyst Support Ariel Bolingbroke (HSH) Dina Austin (HSA) Steve Lim (HSA) Louis Bracco (HSH) Rachel Evans (HSH) John Patton (HSH) All org charts are DRAFT and are subject to change Encampments TBD + 1 FTE – DPH Safe Sleep TBD Scarlett Lam (MTA) Community Engagement Branch Tracey Packer (DPH) Equity Group TBD – HRC Community Settings Group Supervisors 2 FTE – DPH Infrastructure Group TBD – DPW Community Partners TBD All org charts are DRAFT and are subject to change Logs Chief TBD Facilities Branch Director (Nick EOC) Logs Deputy-Resources (Kris DPH/ Linda EOC) Procurement Branch Director (Libby EOC) Non-scarce Resource Requests Unit Lead (Stephanie DPH) Medical- Scare Resource Requests Unit Lead DPH (Celeste) 1 FTE Procurement Leads (OCA Asst. Director, Daisy DPH) Space Planning & Supplies (Na’Imah DPH ) Inventory & Distribution Branch Director (Babe EOC) Donations Branch Director (Matthew/Brian ADM)) Data and Systems Lead (Nicholas M. ADM) State Liaison (Libby EOC) EOC Warehousing & Inventory Mgmt. Unit Lead (Keigo ) DPH Warehousing Inventory Mgmt Lead (Solomon G) HSA Warehouse Inventory Mgmt Lead Technology & Data Branch Director (DT) Personnel/ Staffing Branch Director (DHR Chief TBD) Disaster Service Worker Unit (DPH/DHR/HSA) Registration Unit (EOC?) Volunteers Unit (DPH, DHR, HSA) Security Unit (SF Sheriff’s Dept.) Contract Staff Unit (HSA TBD) Software Applications & Systems Web Sites (Digital Services) Enterprise Systems (DT, DEM, CON) Medical Non-Scarce Resource Request Unit Staff DPH (Jeannie/ Antoinette) Non-scarce Resource Request Unit Staff (Victoria EOC, HSA TBD) Medical- Scare Resource Requests Staff (Michael/Antoinette DPH Non-Medical Procurement Staff (HSA Contract Staff, OCA) Monetary (Kate EOC DPH TBD) In Kind Goods & Services (Sandra ADM, DPH TBD) Medical Procurement Staff DPH Gloria/Lisa/ Louis Sam/David/ Keith/ Nelson Reporting (Alex M ADM, DPH TBD) Data Analysis & Reporting (Alice EOC, HSA TBD, DPH TBD) Shop Keeping Inventory Control Unit (Zoe ES) EOC Storeroom Manager (Thomas D) Receiving Distribution Staff (Eamonn/Kilifi/Jose/ Adrian) Inventory Mgmt. Specialist (David L) Store room Manager Staging & Support Manager (Ed Trinh EOC) Admin/Data Clerk (Alicia D) Training /Orientation Unit (HSA TBD) Receiving & Distribution Unit Staff Modeling & Data Unit Analyst/Buyer TBD Distribution & Delivery Storekeeper-Receiving & Distribution Staff (William/ Song/Chuck) Driver/ Storekeeper (Jorell) All org charts are DRAFT and are subject to change Shop Keeping Inventory Control Unit Cyber Security (DT) Telecommunica tions (DT) Data Analytics Dashboards (DataSF) Tech Equipment &Help Desk (DT, DPH, HSA) Finance/Admin Section Chief 1 FTE Cost / Financials Timekeeping 1 FTE 1 FTE Burn Rate Procurement / Inventory Support SF People & Pay Projection 1 FTE Cost Recovery 1 FTE Department Liaisons DPH, HSA, DT onsite Receiving and Vouchers Contract Authorization All Finance/Admin staff are tentatively Controller’s Office staff, except for Dept Liaisons. Names currently pending. All org charts are DRAFT and are subject to change EOC Communications Officer Tyrone Jue (MYR) Special Project PIOs 6 FTEs (various) Joint Information Section Chief Francis Zamora (DEM) 4 FTEs Deputy JIC Chief – Strategic Communications (DPH, HSA, OEWD, 311) TBD – 1 FTE Department Liaisons Mikyung Kim-Molina (DEM) Content Development Outreach Nubia Mendoza (DEM) John McKnight (DEM) Translation Kelvin Wu (ADM) All org charts are DRAFT and are subject to change Deputy JIC Chief – Operations Neighborhood Canvassing Jackie Ortiz (DAT) Web/Graphics Virtual Meetings Linda Acosta (DPH) Daniel Homsey (ADM) Media Relations & Services Victor Lim (DEM) Key Next Steps for Phase II 1 2 Orienting leaders to roles, scope, teams and processes Implementing an operating system County Jurisdiction Comparisons City San Francisco Los Angeles Seattle Denver Atlanta Miami Boston DC Baltimore Philadelphia New York City County San Francisco Los Angeles King Denver Fulton Miami-dade Suffolk DC Baltimore City Philadelphia New York City State CA CA WA CO GA FL MA DC MD PA NY Cases/1000 Deaths/100,000 3.2 5.1 6.3 26.1 3.8 25.7 10.0 56.6 4.6 25.6 7.4 28.5 23.7 116.3 13.5 70.5 7.7 34.7 15.0 90.7 24.7 261.0 Tests/1000 2.49 0.96 1.07 1.61 With reopenings, the virus is spreading County RE (transmission rate) Weekly ICU Hospitalization rate increase Test Positivity SAN FRANCISCO 0.98 -10% 1.2% MARIN 1.16 300% 4.0% ALAMEDA 1.08 0% _ CONTRA COSTA 1.10 150% 4.8% IMPERIAL* 1.24 -6% 16.4% ORANGE 1.10 15% 3.7% SAN BERNADINO 1.06 11% 7.4% 6/10: Oregon governor hits pause on lifting coronavirus restrictions with infections on the r Category Disease Situation Health Care System Disease Control Key Question Indicator Triggers to raise to a higher level Triggers to lower level Level 1 New Normal Level 2 Low Alert Level 3 Moderate Alert Level 4 High Alert Are there early indicators of an increase in Covid19 disease Number of new cases per day/100,000 population Increasing to meet new threshold over a 7-day period Decreasing to meet new threshold over a 7-day period 1.8 1.9-4.0 4.1-6.0 `>6 Are there early signs of an increase in hospitalizations Rate of increase in total Covid+ hospitalizations Increasing to meet new threshold over a 7-day period Decreasing to meet new threshold over a 7-day period <10% 11-15% 16-20% >20% Do we have capacity to treat severe cases? Acute care bed available capacity Meet threshold for over 7 days Meet threshold for over 7 days >15% 11-15% 5-10% <5% Do we have capacity to treat severe cases? ICU bed available capacity Meet threshold for over 7 days Meet threshold for over 7 days >20% 16-20% 11-15% <10% Are we protecting health care workers? Percent of essential PPE with greater than a 30 day supply Increasing over a 7-day period Decreasing over a 7-day period 100% 85-99%% 61-84% <60% Are we testing enough to detect cases? Tests per day Meet threshold for over 7 days Meet threshold for over 7 days >1,800 1,799-1,400 1,399-701 <700 Do we have robust contact tracing? 90% of new cases reached and named contacts reached Meet threshold for over 7 days Meet threshold for over 7 days >90% 80-89% 65-79% <65% A Single Covid Disease Index (CDI) Indicator • • the highest color for indicators 2 to 4 becomes the CDI color if the highest indicator (of 2 to 4) becomes Yellow, the CDI = Yellow • if the highest indicator (of 2 to 4) becomes Orange, the CDI = Orange • if any one indicator (of 2 to 4) becomes Red, the CDI = Red • if one of indicator 2 to 4 are orange and one of the other indicators 2-4 is not green, the highest indicator goes up one level to Red The surge we just went through 100.0 250.00% 90.0 200.00% 70.0 60.0 50.0 100.00% SIP 40.0 50.00% 30.0 20.0 0.00% 10.0 Actual Rate 6/21/20 6/14/20 6/7/20 5/31/20 5/24/20 5/17/20 5/10/20 5/3/20 4/26/20 4/19/20 4/12/20 4/5/20 3/29/20 -50.00% 3/22/20 0.0 Percent Change 150.00% 3/15/20 Covid + Total Hospitalizations 80.0 • Initial RE >3.0 • The associated peak rate of increase in hospitalizations is 250% • It takes three weeks from SIP to hospitalization plateau • Waiting one more week to institute SIP would have yielded > 250-400 hospitalizations • Waiting two more weeks to institute SIP would have yielded > 600-1,600 hospitalizations Impact of surge scenarios on hospitalization rate Re-opening Gates 30.00% 25.00% Rate of hospital census increase 20.00% 15.00% 10.00% 5.00% 0.00% 6/1/20 7/1/20 8/1/20 9/1/20 -5.00% -10.00% -15.00% Minimal Surge Moderate surge Large Surge 10/1/20 Impact of surge scenarios on Acute bed capacity Re-opening Gates 30.00% Percent Available Hospital Capacity 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 5/17/20 6/17/20 7/17/20 8/17/20 -5.00% -10.00% Minimal Surge Moderate Surge Large Surge 9/17/20 Impact of surge scenarios on ICU bed capacity Re-opening Gates 40.0% Percent Remaining ICU Capacity 30.0% 20.0% 10.0% 0.0% 5/17/20 6/17/20 7/17/20 8/17/20 -10.0% -20.0% -30.0% -40.0% Minimal Surge Moderate Surge Large Surge 9/17/20 Title: Community Voice and Equity Driving San Francisco’s COVID-19 Response Version: 4 I. Background: What problem are you talking about and why focus on it now? IV. Analysis: What don’t we know and what’s not working? In January, the SFDPH DOC was activated to protect vulnerable populations at greater risk for COVID-19 morbidity and mortality, minimize surge, and mitigate transmission of COVID-19. Community Engagement Branch was formed to focused on community engagement, COVID-19+ site exposure, guidance dissemination, and prevention education in key priority settings. This branch consists of 2 focus areas of population and food security, and 7 hubs: Childcare-Schools, Workplace-Business, Seniors, CBOs/Faith-Based Organizations, HomecareResidential (including Behavioral Health), Unsheltered People Experiencing Homelessness (PEH), and SROs. As this pandemic has evolved, SF communities have experienced varying levels of access to health education and COVID-19 resources, with certain populations disproportionately impacted. DPH holds a core mission to address health inequities and owns a responsibility to focus on serving populations disproportionately affected by COVID-19. To address this health inequity, we are utilizing data, problem-solving with community, and putting equity in the forefront. Community Engagement Branch must work in partnership with community members and organizations, through elevating the voices and concerns of SF residents in COVID-19 problem-solving to inform decision making. This will be essential to the success of effective implementation of COVID-19 activities and interventions in the city. With the gradual lifting and re-opening of society, DPH DOC must prepare to address the risk of increased infection and spread of COVID19 in the SF community. Operational focuses include: 1) Increasing the dissemination of information and guidance to community members; 2) Outbreak prevention; 3) Case investigation/contact tracing (CI/CT) site exposure work in both congregate and non-congregate settings; and 4) Training and building the capacity of community-based agencies to assist DPH in CI/CT efforts. Additionally, the DPH DOC is shifting towards Unified Command, with the need to put equity at the center and increase integration with EOC partners to expand the capacity and sustain COVID-19 work through Phase II of activation. A. People B. Method 1. Branch structure is not flexible to emergent needs of hubs Lack of bilingual, bicultural staffing for adequate response to community needs for field work and outbreak response EOC/DOC branch resources are not sufficiently leveraged EOC/DOC Community Branch staffing does not adequately reflect Equity and community members of desired engagement Branch staff has been activated since beginning with very little to no time off COVID-19 Staffing inadequate to meet the needs of a 7-day operation model for outreach and exposure work Gaps in relationships between community and EOC/DOC 1. 2. SF community is engaged too late in process of operations 2. Community trust in government is lost without inclusion of community in planning 3. Influence of EOC/DOC external city influences shifts priorities and create ever-changing focus 4. Activation environment leaves no time for breaks and/or responding to needs 5. Process for webinars/ town hall subject matter experts (SMEs) is complicated, resulting in over processing 6. EOC/DOC future state structure unclear 7. Branch focused on health, lacks social determinants of CM healthI E VI. Plan & Deliverables 1. Populati on Focus PEH (Unshelte red) 1.1 # Webinars… Seniors CBOs/… 0 2. Responses To Public Inquiry 1.2 PEH (Unsheltered) Outreach 456 # Individuals… 10 679 856 0 500 PEH: N/A Seniors 0 1000 3. Site Exposure Cases Engaged In Priority Settings: 520 CBOs/FBOs:… Phone Line Calls: 1140 Homecare-… Workplace-… 364 339 320 200 400 4. Support Outbreak Response In Priority Settings # Senior… Childcare-… Seniors: 26 SROs: 87 117 # SRO Sites… 0 89 13 12 50 100 *Current Conditions pending EOC Community data Problem Statement: As San Francisco enters Phase II, community mitigation and engagement efforts to reduce transmission, protect vulnerable populations, and prevent surge are currently limited in ability to meet the diverse range of community member and community partner needs with an equity lens in a coordinated manner. III. Targets and Goals: What specific measurable outcomes are desired and by when? Selected Metrics Baseline Target by Oct 2020 Decrease COVID-19 transmission rate in vulnerable San Francisco communities that experience structural barriers to health in COVID-19 care response. Pending Pending Increase % of high-risk congregate sites (Seniors, Residential, SROs) receiving outbreak prevention technical assistance out of total sites experiencing an outbreak. Pending Pending Increase % of events where majority of staffing reflect the culture and language of the community. Pending Pending Decrease call volume of public inquiry calls into hub phone lines (Schools, Workplace, General/Citizen, Seniors). Pending Pending 7. 1. C. Environment H H 1. H H H H 2. 3. H M 1. M H M M 2. 3. H M 1. M M 2. H H 3. M H L M M H L H H H L M H M H H EQUITY & COMMUNITY INTEGRATION DPH DOC Branch Structure Workpl aceBusines s SF Cases by Zip Code CBOsFaith Based Food Security Focus 1. Dissemination of COVID-19 Info & Guidance In Priority Settings 6. DATA SYSTEMS Homeca reResiden tial 5. WORKFORCE DEVELOPMENT DPH DOC Community Engagement Branch Core Functions SROs Childcar eSchools 3. 4. UNIFIED COMMAND COORDINATION II. Current Conditions: What is happening today and what should we be concerned about? 2. 1. 2. 3. 4. 5. 6. 7. 8. 3. 4. 5. 6. 7. 2. 3. 4. 5. 6. DATE: 6/11/2020 Owners: TP, JM, PE, MG Equity is not positioned centrally in EOC/DOC org structure Communication challenges between EOC and DOC Community Branches impact engagement and messaging to community Lack of clarity on Community Branch role start/end in relation to JIC, OMB, CI/CT, Testing, I&G, and Policy Community Branch is ineffectively leveraged to ensure community voices inform planning, resulting in responsive operations Communication across branches is suboptimal leading to over processing and duplication of efforts Health orders not written in plain language, creating a burden for branches to respond to community inquiries for interpretation Emergency Support Function (ESF) #16 – Community Support Annex not included in current DOC branch structure Community Branch does not have adequate, timely tracking tools for performance measurements and branch impact Lack of community-level daily data to inform operational work Dimagi Commcare technology limitations hinders hub ability to quickly respond to site exposure, with ongoing challenges Translations turnaround does not meet community language needs Limited ability to quickly finalize content for outreach and dissemination Inadequate diversity in communications materials and resources to effectively reach the public regarding masking and social distancing Owner Date 1. VF, NU, SS, RN 1. _ 2. 3. SS, VF, SS TP, JM, PE, SS, ESF16 2. 3. _ _ Develop user-friendly data management system w/ process & outcome metrics to track and project manage performance progress Establish data visualization to easily tell the story of Community Branch Establish internal & public daily metrics dashboard for decision-making 1. MG 1. _ 2. 3. MG MG 2. 3. _ _ Increase Community Branch staffing to include bilingual/bicultural staffing that reflects communities engaged Understand clear scope of work and reasonable workloads for staffing roles with clear back-ups identified in a 7-day operation model Establish and implement plan to leverage citywide resources to create conditions for recovery (i.e. Voluntary Organizations Active in Disaster) 1. PE 1. _ 2. PE, MG 2. _ 3. ESF16 3. _ Develop RACI with: Adv Planning, JIC, OMB, CI/CT, Testing, I&G, Policy Finalize outbreak prevention structure with OMB for congregate & non-congregate settings Align hub exposure work with Case Investigation & Contact Tracing Set priorities for mobile testing sites with Testing branch to design the process with and for community Continue I&G collaboration to ensure guidance meets community needs Strengthen community relationships to inform Policy decision making and explain policy to community partners, members and city influences Develop communication strategy and workflow to sustain public engagement on social distancing and mitigation with JIC Work with HSA & HSH to collaborate on community engagement efforts 1. 2. 1. 2. _ _ 3. 4. TP, JM, PE, MG JM, PE, MG, LG, AB JM, DS JM, TP, NU, TS 3. 4. _ _ 5. 6. PE, RN TP, JM, PE, MG 5. 6. _ _ 7. TP, JM, PE, MG, TJ TP, EL 7. _ 8. _ D. Tools/Materials Develop community equity checklist & standard work to apply at front-end of every EOC/DOC COVID-19 activity planning & guidance development Equity Action Team informs every key EOC/DOC community intervention Develop community advisory committee to center community in work and develop community partnership opportunities 8. Title: Community Voice and Equity Driving San Francisco’s COVID-19 Response DPH DOC Branch Structure ChildcareSchools CBOs-Faith Based HomecareResidential Population Focus Seniors WorkplaceBusiness PEH 1. Dissemination of COVID-19 Info & Guidance In Priority Settings 1.1 # Webinars Held Seniors Schools/C… CBOs/FBOs 0 (Unsheltere d) 4 5 6 #… 5 10 0 1.2 PEH (Unsheltered) Outreach Owners: TP, JM, PE, MG 679 856 500 CBOs/FBO… 2. Responses To Public Inquiry Phone Line Calls: 1140 Workplace Seniors PEH: N/A HomecareResidential &… 117 4. Support Outbreak Response In Priority Settings # Senior… Childcare… Seniors: 26 WorkplaceBusiness:… SROs: 87 364 339 320 0 200 400 1000 3. Site Exposure Cases Engaged In Priority Settings: 520 SF Cases by Zip Code DATE: 6/11/2020 DPH DOC Community Engagement Branch Core Functions SROs Food Security Focus Version: 4 89 # Youth… 13 # SRO… 12 0 50 100 *Current Conditions pending EOC Community data Survey Summary 64 respondents (9% of the DOC) Stress Level 6.4/10 Finance 1% Plans 3% Logistics 16% JIC 2% Command 8% SECTION Site Location 27% 8% Moscone Operations 70% 65% 25 van Ness Field Accomplishments & Shout-outs Use of A3 for problem solving The staff! Welcoming & positive Excellent collaboration in Med Branch Excellent huddle structure Kelly Hiramoto leading Containment Phase II planning I feel valued by Ayanna, Jim, Tosan Dedicated and fabulous SNF staff Finding donations for the Wellness room Collaborative nature of Logistics Erica & Rita on the I&G Team Kris Leonoudakis Having conversations about race Daily huddles & team spirit at the CI team Working with DOC leadership team who so beautifully allowed for a human acknowledgement of the pain of the George Floyd murder Transparent communication Deputy Dawg! Operations Branches • Information and Guidance (Rita Nguyen) • Containment (Kelly Hiramoto) • Community Outreach and Mitigation (Tracey Packer) Operational Period 21 Accomplishments and Operational Period 22 Planned Activities and Potential Barriers • Medical Health (Tiffany Rivera) • Environmental Health (Karen Yu) • Epidemiology and Surveillance (Trang Nguyen) • Testing (Tobi Skotnes) • Outbreak Management (Lisa Golden) Plans (Gary Naja-Riese) Advanced Planning (Lizzy Connelly) Logistics (Kris Leonoudakis-Watts) Finance (Heidi Burbage) LHH (Nawz Talai) ZSFG (Susan Ehrlich) Policy (Dr. Tomás Aragón) DOC Management (Natalie Pojman) EOC Management (Bijan Karimi) I&G Request Volume and Documents Produced Accurate data since mid-March Current Active Requests: Reopening: 16 Other: 33 15 9 Completed Requests: 345 2 7 63 1 5 0 4 2 47 9 4 9 10 5 1 2 1 9 1 3 *Incomplete Data – I&G created document tracking sheet in Mid March ** Does not include documents that are in progress for translation 32 1 Shout Out for Re-Opening Society! Outdoor Dining • June Weintraub • Dale Jenne • Kenya Wheeler Indoor Retail • June Weintraub • Willi McFarland • Kenya Wheeler Offices • June Weintraub • Evan (Wenxu) Xu • Kenya Wheeler Social Interactions • Jan Gurley • Courtney Liebi • Betsy Gran Outdoor/Religious Gatherings • Phillip Coffin • Alan Gelb • Kenya Wheeler Outdoor Fitness • Phillip Coffin • Dale Jenne • Glynis Startz Household Services • Jan Gurley • Marla Bergman • Glynis Startz Transportation • June Weintraub • Muki LokUng • Kenya Wheeler Dentistry • David Stier • Al Liu • Prasanthi Patel Healthcare • David Stier • Susan Buchbinder • Prasanthi Patel Childcare, Camps • Jeanne Lee • Richard Feng • Erica Eilenberg Operational Support • Alice Kurniadi • Jocelyn Highsmith Web Support: Kacy Diouf Cathleen Beliveau Translation: Melissa Mendiola Holding down the fort • Alecia Martin • Josephine Ayankoya • Emily Lisker Appendix V. Hospitals’ Letters of Support               Administration     500 Parnassus Avenue, MUE5  San Francisco, CA 94143    tel: 415‐353‐2733  fax: 415‐353‐2765    www.ucsfhealth.org    Mark R. Laret   President and   Chief Executive Officer   June 15, 2020        Tomás J. Aragón, MD, DrPH    Health Officer, City & County of San Francisco  Director, Population Health Division (PHD)    San Francisco Department of Public Health    101 Grove St., Rm 308, SF CA 94102      Dr. Aragón,    In response to your request, UCSF Health, through our medical centers located at    Parnassus Heights, Mission Bay and Mt. Zion:        Is prepared to accommodate a surge of 35% due to COVID‐19 cases in addition to  providing care to non COVID‐19 patients, as outlined in the surge plan submitted  to the State of California, and  Has adequate PPE to protect our employees and clinicians.    We understand that the City & County of San Francisco will use this letter to support their    application for a variance to move through the stages to re‐open.    Sincerely,            Mark R. Laret  President and CEO             UCSF Health                 June 15, 2020 Tomás J. Aragón, MD, DrPH Public Health Officer, City and County of San Francisco 101 Grove Street, Room 308 San Francisco, CA 94102 Dr. Aragón, In response to your request, Sutter Health’s integrated health delivery system: • Is prepared to accommodate a surge of 35% due to COVID-19 cases in addition to providing care to non COVID-19 patients, as outlined in the surge plan submitted to the State of California, and • Has adequate PPE to protect our employees and clinicians. We understand that the City and County of San Francisco will use this letter to support their application for a variance to move through the stages to re-open. Sincerely, Stephen H. Lockhart, MD, PhD Chief Medical Officer, Sutter Health Appendix W. Board of Supervisors Letter of Support BOARD of SUPERVISORS City Hall 1 Dr. Carlton B. Goodlett Place, Room 244 San Francisco, CA 94102-4689 Tel. No. 554-5184 Fax No. 554-5163 TDD/TTY No. 554-5227 June 18, 2020 The Honorable Gavin Newsom Governor of the State of California 1303-10th Street, Suite 1173 Sacramento, CA 95814 Dr. Sonia Y. Angell State Public Health Officer and Director California Department of Public Health P.O. Box 997377, MS 0500 Sacramento, CA 95899-7377 Re: Letter of Support for the Public Health Officer’s Variance Attestation Dear Governor Newsom: The San Francisco Board of Supervisors thanks you for your leadership and support during the COVID-19 pandemic. As one of the first counties in the country to issue Shelter in Place Health Officer orders, San Francisco’s swift and decisive actions prevented thousands of COVID-19 cases and hundreds of deaths. The Public Health Officer’s Variance Attestation is a broad look at the COVID-19 response thus far. It demonstrates that San Francisco meets the State’s benchmarks and plans for: epidemiologic stability of COVID-19, protection of Stage 1 essential workers, testing capacity, containment capacity, hospital capacity, vulnerable populations, sectors and timelines, triggers for adjusting modification, and the plan for moving through Stage 2. Please accept this letter of support from San Francisco’s Board of Supervisors as an endorsement of the Public Health Officer’s Variance Attestation for advancement through Stage 2 of the State of California’s Pandemic Roadmap, along with a copy of Motion No. M20-17 (File No. 200633). We welcome the opportunity to continue working with the State to safely re-open society. Respectfully, Angela Calvillo Clerk of the Board of Supervisors City and County of San Francisco (Attachment - Motion No. M20-17) Letter of Support for the Public Health Officer’s Variance Attestation June 18, 2020 Page 2 c. Members of the Board of Supervisors Sophia Kittler, Mayor’s Liaison to the Board of Supervisors Eddie McCaffrey, Mayor's Manager of State and Federal Legislative Affairs Andres Power, Mayor's Policy Director Rebecca Peacock, Mayor’s Office Dr. Grant Colfax, Director, Department of Public Health Dr. Naveena Bobba, Deputy Director, Department of Public Health Dr. Tomas Aragon, Health Officer, Department of Public Health Greg Wagner, Chief Financial Officer, Department of Public Health Sneha Patil, Director of Policy and Planning, Department of Public Health FILE NO. 200633 1 MOTION NO. [Supporting Variance to Progress Further into State’s COVID-19 Resilience Roadmap] 2 3 Motion supporting the Health Officer’s attestation for a local variance to allow San 4 Francisco to progress further into California’s COVID-19 Resilience Roadmap as the 5 Health Officer determines is appropriate based on local health conditions and directing 6 Clerk of the Board to prepare a letter of support. 7 8 9 WHEREAS, On February 25, 2020, the Mayor issued a Proclamation declaring a local emergency to exist in connection with the imminent spread within the City of a novel (new) 10 coronavirus (“COVID-19”), and on March 3, 2020, the Board of Supervisors concurred in the 11 Proclamation; and 12 13 WHEREAS, On March 4, 2020, Governor Gavin Newsom proclaimed a state of emergency to exist within the State due to the threat posed by COVID-19; and 14 WHEREAS, On March 6, 2020, the Local Health Officer declared a local health 15 emergency under Section 101080 of the California Health and Safety Code, and the Board of 16 Supervisors concurred in that declaration on March 10, 2020; and 17 WHEREAS, On March 16, 2020, the Local Health Officer issued a stay safe at home 18 order, requiring most people to remain in their homes subject to certain exceptions including 19 obtaining essential goods such as food and necessary supplies, and requiring the closure of 20 non-essential businesses; the Health Officer has amended the order to modify the ongoing 21 restrictions and resume certain businesses and other activities in a phased and measured 22 way, based on health data and local COVID-19 indicators, to help keep San Francisco 23 residents safer and healthier; and 24 25 WHEREAS, In coordination with the Health Officer and consistent with that phased and measured approach, the City has prepared a plan for recovery Supervisor Yee BOARD OF SUPERVISORS Page 1 1 (https://sf.gov/information/reopening-san-francisco), as that plan may be modified by the 2 Health Officer depending on local public health indicators and guidance from the State; and 3 WHEREAS, On March 19, 2020, Governor Newsom issued Executive Order N-33-20, 4 directing residents to heed the State Public Health Officer’s stay at home order, which 5 requires residents to stay at home except for work in critical infrastructure sectors or otherwise 6 to facility authorized necessary activities; and on April 14, 2020, the State presented the 7 Resilience Roadmap, a four-stage plan to modifying the State’s stay at home order; and 8 WHEREAS, On May 7, 2020, as directed by Governor Newson’s Executive Order N- 9 60-20, the State Public Health Officer issued a process for seeking a local variance from the 10 Resilience Roadmap; the process requires a county self-attestation submitted at the discretion 11 of the county’s Local Health Officer based on a set of criteria related to county disease 12 prevalence and preparedness; this variance allows counties to move through the roadmap at 13 a rate and an order determined by the Local Health Officer; and 14 WHEREAS, The readiness criteria that the state requires to submit this attestation 15 include: stable hospitalization of COVID-19 patients on a 7-day average of daily percent 16 change of less than 5% or no more than 20 COVID-19 hospitalizations on any single day in 17 the past 14 days; no more than 25 new cases per 100,000 residents in the past 14 days or 18 less than 8% positive test results in the past 7 days; daily testing volume of 1.5 per 1,000 19 residents per day; testing availability for at least 75% of residents within 30 minutes driving 20 time; hospital capacity to accommodate a 35% surge in COVID-19 cases while maintaining 21 care to non-COVID-19 patients; sufficient protective supplies for essential workers, including 22 having a more than 14-day supply of personal protective equipment for skilled nursing 23 facilities; and availability of temporary housing for 15% of homeless residents; and 24 25 WHEREAS, The process further provides that the Local Health Officer’s attestation be accompanied by a letter of support from the county’s board of supervisors; and Supervisor Yee BOARD OF SUPERVISORS Page 2 1 WHEREAS, San Francisco’s Health Officer, Dr. Tomás Aragón, has indicated that San 2 Francisco meets the readiness criteria and other factors required to apply for a variance 3 seeking to progress further into the Resilience Roadmap, and Dr. Aragón is in the process of 4 preparing an attestation in support of the variance; now, therefore, be it 5 MOVED, That the Board of Supervisors supports the Health Officer’s decision to 6 prepare and submit an attestation seeking a variance to allow San Francisco to progress 7 further into the Resilience Roadmap as the Health Officer determines appropriate and 8 consistent with the City’s phased and measured approach to help keep San Francisco 9 residents safer and healthier; and, be it 10 FURTHER MOVED, That the Clerk of the Board shall prepare a letter of support from 11 the Board of Supervisors to accompany the attestation of the Health Officer, and transmit that 12 letter to the Health Officer within 48 hours of the effective date of this motion for submission to 13 the California Department of Public Health. 14 15 16 17 18 19 20 21 22 23 24 25 Supervisor Yee BOARD OF SUPERVISORS Page 3 City and County of San Francisco Tails Motion: M20-070 File Number: 200633 City Hall 1 Dr. Carlton B. Goodlett Place San Francisco, CA 94102-4689 Date Passed: June 16, 2020 Motion supporting the Health Officer’s attestation for a local variance to allow San Francisco to progress further into California’s COVID-19 Resilience Roadmap as the Health Officer determines is appropriate based on local health conditions and directing Clerk of the Board to prepare a letter of support. June 16, 2020 Board of Supervisors - APPROVED Ayes: 11 - Fewer, Haney, Mandelman, Mar, Peskin, Preston, Ronen, Safai, Stefani, Walton and Yee File No. 200633 I hereby certify that the foregoing Motion was APPROVED on 6/16/2020 by the Board of Supervisors of the City and County of San Francisco. Angela Calvillo Clerk of the Board City and County of San Francisco Page 1 Printed at 12:09 pm on 6/17/20