►
Description
California Health and Human Services Secretary Dr. Mark Ghaly provides an update on the State of California's response to the COVID-19 pandemic.
Recorded November 4, 2020.
For more information regarding the impact of the COVID-19 outbreak in Cupertino, please visit https://www.cupertino.org/coronavirus.
C
Everyone,
as
always,
it's
nice
to
be
with
you
today
on
a
wednesday
instead
of
the
tuesdays
and
looking
forward
to
giving
you
our
covid19.
C
Update
so
the
last
time
I
was
with
you
was
last
friday
with
the
governor
and
a
number
of
other
leaders
and
public
servants.
Who've
been
working
around
the
clock
for
the
last
two
months
to
bring
to
fruition
a
new
lab
to
do
california,
testing
for
covet
19.
down
in
valencia.
California,
we
cut
the
ribbon
for
a
lab,
which
really
brings
together
our
partnership
with
perkin
elmer
to
do
150
up
to
150
000
new
covid
tests
a
day
for
california
when
we
hit
full
capacity.
C
C
C
In
fact,
just
today,
I've
sent
a
letter
to
our
school
leaders
and
district
leaders
across
the
state,
inviting
them
to
review
a
newly
posted
playbook
that
describes
how
school
districts
and
schools
can
take
advantage
of
the
lab
at
perkin
helmet
with
burke
and
elmer,
to
ensure
that
we
have
all
of
the
different
approaches
in
place
that
we
make
sure
that
schools
understand
what
they
must
do
to
take
advantage
of
this.
How
the
state
is
there
to
support
them
and
then
how
quickly
we
can
make
this
resource
available.
C
I
look
forward
to
the
days
and
weeks
ahead
as
we
bring
in
a
few
schools,
initially
few
school
districts
initially
to
use
the
lab
and
then
expanding
that
by
use
of
this
new
playbook
to
invite
other
school
districts
to
take
advantage
of
this
testing
resource
as
well.
We
know
that
there
are
many
tools
that
help
us
bring
students
back
in
a
safe
way
and
testing
is
one
of
them,
but
we
are
also
working
with
our
school
partners
on
many
others
and
more
to
come
on
those
efforts
later.
C
C
So
to
our
numbers,
today
we
had
5
338
covet
cases
reported
to
the
state.
This
brings
our
seven
day
average
up
to
4471..
C
I'll
also
say
that
this
is
gives
us
an
identical
seven
day,
test
positivity
at
3.3
percent,
and
I
just
for
a
moment
wanted
to
juxtapose
this
to
what
we're
seeing
across
the
rest
of
the
nation.
If
we
had
a
test
positivity
for
the
entirety
of
the
u.s,
it
would
be
6.7
so
just
over
double
what
we're
seeing
here
in
california.
C
C
Again,
these
actions
are
and
I'll
remind
you
again
at
the
end,
wearing
our
face
masks
face
coverings,
limiting
our
mixing
and
avoiding
big
crowds,
washing
our
hands,
practicing
physical
distancing
and
staying
at
home
when
you're,
sick
and
I'll
emphasize
this
last
one,
because,
as
we
get
more
individuals
with
respiratory
illnesses,
even
if
it's
not
covered
just
the
question
of
well
is
that
sore
throat
is
that
mild
fever
covid
encourage
people
to
get
tested,
but
especially,
even
if
you
don't
think
it's
covet
19
to
stay
home,
avoid
getting
others
sick.
C
Because
certainly
we
want
to
keep
not
just
transmission
of
covet
down,
but
all
of
the
respiratory
illnesses
that
we
usually
see
during
the
winter.
In
california,
we
are
starting
to
see
some
increases
of
cases
and
test.
Positivity
you've
been
tracking
that
now
over
the
last
couple
of
weeks,
and
we
continue
to
monitor
our
data
very
closely
as
we
move
into
colder
weather
shorter
days,
so
more
push
to
move
inside
and,
of
course,
the
upcoming
holidays.
That
I
know
many
of
us
are
looking
forward
to.
C
And
just
a
reminder
that
over
the
past
couple
of
weeks,
we've
seen
this
uptick
just
say.
On
october
20th
we
had
a
test
positivity
of
2.6
statewide.
Today,
we've
come
up
to
3.3
percent
we've
seen
our
hospitalization
numbers
after
enjoying
weeks.
Even
you
know
two
to
three
months
of
steady
decreases.
C
We
have
seen
over
the
past
14
days
a
double
digit
percent
increase
at
13.5
in
our
hospitals
as
it
relates
to
covet
hospitalizations
and
then
in
our
intensive
care
units.
Nearly
a
20
increase
over
the
past
14
days.
We
always
know
when
we
see
increases
in
our
case
numbers
that
roughly
three
three
and
a
half
weeks
later,
we'll
see
that
manifest
in
hospital
increases.
So
these
are
not
surprising.
C
Our
hospital
system
who
did
incredible
jobs,
repairing
over
the
early
the
spring
and
early
summer
months,
to
get
remember
those
conversations
about
surge
capacity
and
surge
beds.
That's
all
still
with
us.
Our
hospitals
are
able
to
utilize
that,
if
need
be
so
even
though
these
increases
are
not
themselves,
the
parts
that
will
overwhelm
our
hospital
system,
certainly
having
this
sustained
double-digit
percentage
increase
over
many
many
weeks
will
put
our
hospitals
in
a
difficult
position
during
flu
season
and
when
we're
trying
to
keep
up
with
all
other
routine
health
care
that
californians
need
and
deserve.
C
I
wanted
now
to
just
take
a
few
minutes,
and
we've
alluded
to
this
concept
of
pandemic
fatigue.
Many
of
the
reporters
that
I
have
a
chance
to
talk
to
mention
this
phrase,
and
it
is
something
that
naturally,
eight
or
nine
months
into
our
response
is
real
and
we
know
that
the
pandemic
has
altered
our
way
of
living.
We've
all
made
sacrifices.
C
Some
we've
been
okay
with
others
have
been
really
hard,
and
each
of
these
sacrifices
has
helped
us
slow.
The
spread
of
covet
in
our
state-
and,
I
would
say,
californians,
have
done
an
incredible
job
throughout
the
state,
whether
you're
in
the
far
north
or
the
far
south
southern
part
of
our
state,
the
easter
eastern
side
or
along
the
coast.
Everyone
has
come
together
to
really
make
a
contribution
to
getting
the
state
to
where
we
are
and
that
work
has
not
come
without
a
cost.
C
C
C
So
what
does
this
mean?
We
must
continue
to
stay
the
course
much
of
california.
Has
you
know
a
mild
weather
change
that
it's
a
little
colder
than
it
was
some
places.
You
know
significantly
more
colder
than
it
had
been
in
the
weeks
and
months
past,
and
hopefully
we
can
bundle
up
and
still
keep
a
lot
of
our
activities
outdoors.
C
We
know
that's
increasingly
difficult,
but
still
something
we
should
try
and
aspire
to,
and
we
know
there's
ways
to
continue
doing
many
of
the
things
you
love,
but
in
a
modified
way
to
reduce
your
risk
and
the
risk
of
those
around
you.
It
isn't
to
say
you
can't
do
many
many
of
the
things
it's
not
just
the
what
we
do,
but
the
how
we
do
it.
C
C
Another
reminder
to
do
these
basic
things
that
you
see
here
listed
and
to
use
this
as
an
opportunity
to
visit
covid19.ca.gov
to
see
the
many
resources
available
to
you
also
encourage
you
in
your
own
counties
to
visit
your
own
local
public
health
websites,
because
they
have
specific
things
to
your
county
help.
You
understand
how
your
public
health
experts
are
thinking
about
transmission
in
your
backyard,
which
will
of
course,
inform
how
you
make
decisions,
not
just
today,
but
in
the
weeks
to
come.
C
Every
county
is
assigned
a
tier
based
on
these
three
different
metrics
test,
positivity
an
adjusted
case
rate
and
a
health
equity
metric,
and
I
will
share
that.
A
few
weeks
ago,
when
we
announced
the
health
activity
metric,
we
had
lots
of
questions
from
californians,
including
our
own
public
health
partners,
asking
about
how
it
would
work
and
how
it's
not
just
a
indicator
of
how
to
slow
movement
forward
through
the
tears
down,
but
that
it
also
created
a
way
to
accelerate
some
movement
through
the
tiers
and
many
counties
have
benefited
from
the
health
equity
metric.
C
We
have
seen
deepened
engagement
on
how
we
stay
laser
focused
on
making
sure
all
of
our
communities.
The
transmission
in
those
communities
is
addressed
in
an
equitable
way,
and
I
will
say
I
think
california
should
be
really
proud
of
the
wonderful
equity
work.
C
I
wanted
to
put
this
slide
in
today's
presentation
just
to
show
how
far
we
have
come.
When
we
first
announced
our
tier
assignments,
we
had
38
tiers
in
widespread
purple
and
just
two
in
yellow
today,
even
though
we
have
one
more
than
last
week,
we
have
10
nearly
you
know.
75
percent
of
the
counties
have
moved
out
of
purple
tier
into
at
least
the
red
tier
and
then
a
significant
number.
We
have
five
times
the
county,
nearly
in
minimal
or
yellow
than
we
had
when
we
started.
C
So
our
slow
and
stringent
approach
has
allowed
many
counties
to
move
forward
in
our
tier
assignments
and
allow
additional
business
sectors
to
begin
operating
and
some
of
those
other
business
sectors
to
increase
their
level
of
operations.
C
So
what
are
our
new
assignments
today?
We
have
just
one
county
moving
forward,
which
I
think
is
an
important
reminder
that
the
baseline
transmissions
rates
of
covet
across
our
state
are
indeed
going
up
that
it's
not
just
in
one
or
two
counties,
but
it's
widespread
across
the
state.
We
of
course
have
those
counties
in
the
southern
part
of
the
state
that
we've
been
keeping
an
eye
on
four
large
counties
in
purple.
C
A
couple
of
other
large
counties
who
have
been
in
red
and
have
seen
their
data
suggest
that
maybe
they
would
be
moving
back
to
purple
if
things
don't
begin
to
stabilize
and
come
down.
So
this
is
the
first
week
where
we've
only
seen
one
county
move
forward
and
that's
kalusa.
Moving
from
the
red
to
the
orange
tier,
we
have
one
county
moving
to
a
more
restrictive
tier
that
shasta
who's
moving
from
red
to
purple.
C
A
couple
of
weeks
ago,
we
were
talking
about
shasta,
with
many
of
you
working
closely
with
their
county
leadership,
their
public
health
leadership,
watching
the
data
stabilize
in
the
short
run,
looking
at
the
most
recent
10
days
of
data
and
felt
at
that
time,
that
shasta
could
stay
in
the
red
tier.
But
after
having
more
time
continuing
to
look
at
the
data
working
with
the
county.
C
It's
clear
that
the
spread
is
not
just
isolated
to
a
couple
of
venues
or
locations,
but
that
it
is
really
throughout
some
big
parts
of
their
community,
and
it
allows
us
to
say
yes.
Now
is
the
time
to
put
the
brakes
on
a
little
bit:
go
back
to
purple,
stabilize
work
with
the
county
to
make
sure
they
have
enough
testing
contact
tracing
that
we
understand
transmission
as
we
work
to
get
back
into
a
less
less
restrictive
tier
in
the
future.
C
C
So
before
we
open
it
up
to
reporter
questions,
I'll
remind
you
for
a
third
time
and-
and
we
continue
reminding
folks
what
it
is
that
we
hope
and
expect,
because
these
are
indeed
the
tools,
our
best
tools
to
reduce
transmission.
It's
wearing
our
mask
and
doing
it
as
much
as
we
can.
Even
when
we're
around
people
that
are
outside
of
our
household,
but
that
we
know
very
well,
it
doesn't
mean
you
can't
still
transmit
or
get
covered
so
wearing.
C
The
mask
is
still
a
very
powerful
tool:
maintaining
that
physical,
distancing,
washing
your
hands
minimizing
all
mixing
if
you
can
and
or
minimizing
mixing
as
much
as
you
can
and
then
never
miss
a
chance
to
remind
you
that
if
you
haven't
already,
please
get
your
flu
shot,
make
an
appointment,
find
out
where
you
can
get
your
flu
shot
and
do
that
immediately.
C
So
not
only
are
you
protecting
yourself
in
your
immediate
household,
but
your
community,
your
health
care
delivery
system
and
many
others,
as
we
continue
our
fight
with
against
covid
and
keeping
transmission
rates
as
low
as
we
can
in
the
state
of
california.
So
with
that
I'll
open
it
up
to
the
first
question.
E
F
B
E
How
can
they
safely
celebrate
the
holiday
season
thanksgiving
this
month
and
quickly
just
around
the
corner.
C
Yeah
excellent
question:
we're
we're
working
hard,
we're
working
with
our
local
public
health
partners
to
make
sure
that
what
we
put
out
is
you
know
that
people
receive
it.
Well,
I
I
think
that
a
lot
like
when
I'm
in
my
clinical
practice,
we
know
that
we
might
be
able
to
diagnose
and
really
pinpoint
what
the
issues
are,
but
really
making
a
plan
that
is
relevant
and
that
people
can
understand
how
how
they
can
put
it
into
play
is
one
of
our
top
objectives.
C
So,
with
our
messaging
and
our
guidance
with
around
the
upcoming
holidays,
we
want
to
be
sure
that
it
really
does
strike
a
chord
with
our
all
californians
that
they
can
imagine
how
they
can
implement
it.
As
we
look
forward
to
a
time
where
we
may
see
people,
we
haven't
seen
in
quite
some
time.
So
that's
coming
very
very
soon.
C
We
have
to
put
some
final
touches
on
it,
but
we
wanted
to
make
sure
that
is
certainly
relevant
and
applicable
to
all
californians,
as
we
put
those
out,
because
we
recognize
that
guidance
that
isn't
put
out
in
that
way
may
not
be
received
as
well
and
may
not.
Actually
achieve
what
we
hope
to
achieve,
which
is
ultimately
allowing
people
to
have
those
tools
and
guidance
to
reduce
risk
while
they
enjoy
the
upcoming
holiday
season.
G
Hi
dr
daley,
thanks
again
for
taking
our
questions,
really
appreciate
it.
I'm
hoping
you
can
again
offer
some
perspective
on
this
kind
of
confusing
picture,
I'm
seeing
with
the
data
it's
kind
of
hard
to
communicate.
So
obviously
there's
something
that's
a
concern.
L.A
county
is
being
stuck
in
purple
for
the
rest
of
this
month,
but
there
are
some
good
times
relatively
speaking.
You
said
that
california
is
not
seeing
the
third
wave
that
the
nation
is
seeing.
G
So
here
are
the
questions:
if
we're
not
seeing
the
national
third
wave
but
we're
seeing
an
uptick
in
cases,
how
would
you
characterize
what
we're
heading
into?
Is
this
actually
a
good
sign
that
california's
next
wave
might
be
modest,
or
are
we
just
delayed
from
getting
into
our
dark
winter?
Some
counties
across
the
state
have
mentioned
gatherings
our
main
problems.
C
Yeah,
I
think,
all
really
excellent
questions,
and-
and
you
know
we
have
seen
an
uptick-
there's-
definitely
more
coveted
transmission
in
our
communities,
but
I
think
part
of
california's
success
is
because
we
have
gone
really
slow
with
our
reopening
that
we've
allowed
ourselves
time
to
see
how
our
reopening
efforts
impact
our
health
care
delivery
system,
that
counties
are
reporting
a
tremendous
capability
to
reach
out
to
identified
cases
and
do
that
contact
tracing
disease
investigation,
make
strong
recommendations
around
isolation
and
really
supporting
people
to
make
that
choice
to
reduce
transmission.
C
So
we
know
that,
as
we
see
cases
come
up
that
it's
not
just
about
counting
the
cases
but
doing
something
about
each
case
so
that
we
don't
have
further
transmission.
I
do
believe
that
californians,
where
we're
seeing
high
use
of
mass
wearing
we're,
going
to
see
one
of
the
most
valuable
tools
at
play
to
reduce
transmission,
so
that
certainly
plays
into
it.
C
Some
and,
as
I
say
and
have
said
before,
just
because
we've
seen
other
parts
of
the
country
experience
a
surge,
it's
not
a
foregone
conclusion
that
we'll
just
see
it
down
the
road.
We
have
a
lot
of
agency.
The
governor
has
talked
about
how
our
choices
matter
a
great
deal.
C
It's
not
often
only
what
we
do,
but
how
we
do
it,
and
I
think
your
question
really
gets
to
the
heart
of
that
which
is
we
can
keep
transmission
low,
even
though
it
goes
up
some
using
our
public
health
tools
and
our
own
personal
choices,
we
can
certainly
keep
transmission
lower.
I
think
your
question
about
family
gatherings.
Private
gatherings
is
a
key
one.
We've
been
talking
about
it
for
months,
most
counties
report
those
gatherings
as
a
significant
source
of
the
spread
that
they
identify
and
to
the
question
earlier
about
thanksgiving
and
other
holidays.
C
I
think
that's
why
it's
so
important
that
we're
working
hard
to
come
up
with
a
message
that
really
resonates
with
californians.
That
says,
we
can
still
do
and
enjoy
many
of
the
things
that
we
expect,
but,
while
keeping
a
close
eye
on
things
that
we
can
actually
apply
to
reduce
risk
and
keep
transmission
low.
So
I
believe
that,
if
we
put
all
of
those
together,
we
might
avoid
some
of
the
really
high
surges
that
we're
seeing
on
other
parts
of
the
country
and
really
get
through
what
will
be
a
difficult
few
months
with.
C
E
Thank
you
so
much.
I
appreciate
taking
our
questions.
You
said
you
believe
that
california's
policies
on
covet
have
helped
keep
the
cases
down
more
than
other
parts
of
the
country.
Can
you
be
more
specific
about
which
sector
guidance
or
which
policies,
and
also
looking
at
san,
diego
and
sacramento
counties?
Can
you
discuss
what
is
driving
infections
in
those
two
counties
and
do
you
anticipate
them
both
returning
to
the
purple
tier
in
light
of
the
numbers
this
week.
C
Yeah,
I
think,
to
the
first
part
of
your
question.
The
specifics
I
think
we
learned
early,
you
know
early
in
the
summer
that
you
know
being
outdoors
and
having
as
many
things
outside
as
possible,
really
does
make
a
difference.
So
I
think
our
approach
to
keeping
as
much
of
our
activities
outdoors
even
in
the
formal
business
sectors
as
much
as
possible,
has
contributed
quite
a
bit
to
keeping
transmission
low
going
along.
That
is
really
clear.
Guidance
on
when
masks
and
face
coverings
should
be
used.
C
I
think
those
go
a
long
way
as
specific
policies
that
are
deeply
ingrained
and
embedded
in
almost
every
sector
guidance
and
then
moving
forward
slowly
early
on
when
we
were
reopening
at
the
late
spring
early
summer,
we
were
making
decisions
based
on
data
that
was
just
two
weeks
old
and
making
changes
much
more
quickly.
Now
we
go
slower
and
we
believe
that
gives
us
significantly
more
time
to
see
how
the
impact
of
certain
sector
changes
play
out
in
our
case
numbers
our
test
positivity,
as
well
as
our
hospitals
and
icus.
C
We
know
that
some
of
the
same
areas
of
concern
are
there
congregate
care
facilities
in
both
these
counties
are
an
important
place
where
we've
seen
spread
and
being
able
to
work
with
local
public
health
partners.
The
operators
of
those
nursing
homes,
skilled
nursing
facilities,
residential
care
facilities
for
the
elders,
elderly
other
congregate
care
facilities
is
a
key
part
of
our
strategy,
which
we
have
improved
and
made
made
augmentations
to
over
time.
C
C
That
gives
me
some
hope
that
any
county
that
is
teetering
on
moving
into
a
more
restrictive
tier
has
the
tools
to
either
avoid
that
by
getting
transmission
down
or
hopefully,
if
they
do
go
to
a
more
restrictive
tier
to
be
able
to
stabilize
bring
transmission
rates
down
and
then
move
into
a
less
restrictive
tier
more
quickly.
I'm
not
sure
if
san
diego
and
sacramento
will
move
back.
G
H
The
chart
this
week
that
says
san
diego
is
both
undergoing
county
tier
and
adjudication
with
cdph,
and
also
that
they
are
entering
into
a
supportive
engagement
with
cdph,
and
I
wonder
if
you
could
explain
a
little
more
about
what
exactly
is
going
on
there.
What
kind
of
things
you
guys
are
counseling
and
then
also.
H
I
had
a
second
question
regarding
hospitalization
rates,
there
have
been
a
lot
of
calls
recently
for
a
stringent,
faster
reopening
pace
due
to
the
fact
that
hospitalizations
have
tended
to
trend
relatively
flat,
and
especially
in
my
area
quite
flat
and
even
down
a
bit,
and
so
you
know,
I
wonder
how
you
feel
about
those
calls
now
that
we're
starting
to
see
hospitalization
rates
really
increase
in
a
lot
of
other
states.
C
Yeah
thanks
for
for
all
of
those
questions,
so
the
the
tier
adjudication
status
that
you
mentioned
really
what
we're
looking
there
is.
The
county
has
asked
us
to
look
at
some
specific
data
to
make
sure
that
it's
complete
and
accurate,
so
that
the
data
that
we
post
is
complete,
because
both
decisions
moving
county
to
a
less
restrictive
tier
as
well
as
moving
to
a
more
restrictive
tier,
are
important
decisions
not
just
between
public
health,
to
public
health,
but
for
the
entirety
of
a
community,
the
business
sectors,
others.
C
So
we
don't
take
these
decisions
or
posting
of
the
data
lightly,
and
we
want
to
make
sure
that
it
is
accurate
and
if
a
county
has
concerns,
we
have
a
process
for
them
to
share
those
concerns
and
us
to
address
them.
The
supportive
engagement
is
what
we
provide
each
county
that
looks
like
they
have
missed
their
current
tiers
thresholds
for
one
week.
C
It
allows
us
to
work
closely
with
the
county
to
understand
what
are
the
supports
and
resources
that
that
county
might
need
in
order
to
better
understand
and
mitigate
any
transmission
increases
that
they're
seen
often,
these
aren't
themselves
the
things
that
will
immediately
stop
a
county
from
meeting
that
second
week
threshold.
But
again
the
whole
blueprint
isn't
just
about
moving
forward
or
moving
back.
C
It's
about
having
the
targeted
interventions
to
ensure
that
we're
reducing
transmission
across
that
county,
so
that
the
public
in
those
counties
can
feel
safer
and
more
confident
as
they
move
about
to
your
question
about
hospitalizations
and
whether
the
calls
to
have
what
I
call
a
hospital
metric
as
part
of
our
tiering
and
our
blueprint.
We
have
heard
those-
and
we
deliberately
chose
not
to
have
a
hospital
measure
because,
as
we've
said
earlier,
it's
a
lagging
indicator
as
cases
begin
to
rise.
C
I
can
almost
predict
three
three
and
a
half
weeks
later,
that
there'll
be
some
increase
in
hospitalizations,
but
between
that
three
and
three
and
a
half
weeks
it
could
be
a
significant
or
an
insignificant
or
smaller
increase.
So
we
have
chosen
not
to
use
the
hospital
metric
as
part
of
the
blueprint
and
tiering
system
for
moving
a
county
forward.
C
Of
course,
as
we
look
to
moving
counties
to
potentially
more
restrictive
tiers,
we
take
into
a
number
of
factors,
including
the
stress
and
tension
on
the
local
healthcare
delivery
system,
including
hospital
and
icu
beds,
ventilators
the
use
of
other
personnel
and
making
sure
that
there's
enough
to
staff
the
beds.
All
of
these
are
factors,
as
we
think
about
case
case
increases.
I
think
at
the
moment,
apropos
your
question.
You,
you
basically
answered
it
in
part
yourself.
C
We
feel
confident,
especially
as
we
see
other
states
quickly
and
sort
of
dramatically
get
overwhelmed
in
their
own
healthcare
delivery
systems,
that
we've
made
the
right
choice
and
that
this
is
where
we'll
be
for
the
foreseeable
future.
E
Hi
secretary
galley,
the
other
day
covered
californian
peter
lee,
says
that
coming
up
with
a
replacement
plan
for
obamacare
was.
E
Ships
to
the
titanic
and
legislative
leaders
have
accessed
the
same
sentiment,
so
I
wanted
to
hear
from
you:
can
california
come
up
with
a
replacement
plan
if
the
high
court
does
strike
down
obamacare,
fully
or
in
part
or
secretary
gallery?
Do
you
think?
Is
it
impossible
for
california
to
do
this
sort
of
contingency
planning
for
something
that
you
know
bruce
was
telling
me
would
be
such
a
devastating
blow
to
california.
C
So
thank
you
for
the
question
and
I
think,
as
we
all
look
closely
to
the
the
future
of
the
affordable
care
act,
I'll
remind
you
that
california
has
done
more
than
any
state.
I
would
say,
to
implement
and
build
upon
the
affordable
care
act,
to
really
improve
coverage
and
deepen
our
commitment
to
getting
everybody.
The
coverage
and
access
to
care
in
california.
C
We've
made
dramatic
improvements
in
the
rate
of
those
who
are
uninsured,
and
you
know
that's
the
build-up
to
say
it
would
certainly
be
difficult,
and
I've
used
the
phrase
catastrophic
if
the
aca
were
materially
changed
or
repealed,
and
california,
of
course,
in
the
face
of
a
lot
of
difficult
times
and
catastrophes
to
bring
our
best
thinkers
together,
our
best
minds
to
see
what
we
can
do
to
keep
the
forward
movement
going
and
we
will.
We
will
always
be
prepared
to
do
that.
But
I'll
remind
you
as
you.
C
F
Our
question
this
talk,
especially
in
orange
county-
I
guess
the
health
officer
has
been
speaking
with
some
other
health
officers
and
they
would
like
the
health
equity
metrics
to
be
somewhat
revised.
I
guess
a
little
lower,
so
they
can
potentially
move
to
that
we're
in
the
redshirt
right
now,
so
they
can
move
to
the
orange
tier.
Is
there
any
conversations
or
any
thoughts
on
any
movement
on
that
front?
You
know
maybe
increasing
the
threshold
or
lowering
it
so
counties
can
move
forward.
C
You
know
I
haven't
I
haven't.
I
have
not
been
contacted
with
that
concept
or
idea.
C
I
will
say
that
what
we've
done
with
the
health
equity
metric
is
really
require
and
encourage
counties
to
work
to
get
communities
across
their
county
all
to
a
similarly
low
level
of
transmission
as
based
on
test
positivity,
and
I
would
be
remiss
to
deviate
from
that
in
any
material
way,
because
we
know
that
not
only
is
it
important
that
we
have
transmission
rates
low
throughout
the
communities
for
the
sake
of
those
communities,
but
also
county-wide,
to
ensure
that
we
don't
risk
having
high
transmission
communities
really
have
that
end
up
being
the
entire
county's
transmission
rate.
C
So
we
believe
that
the
way
that
the
health
equity
measure
is
applied
today
is
you
know
the
right
way
at
the
moment.
But
of
course,
as
we've
always
done,
we
take
feedback
from
our
local
partners
trying
to
understand
what
improvements
they
might
suggest
and
if
reasonable,
we
do
end
up
implementing
that.
So
I
look
forward
to
hearing
whatever
opinions
and
thoughts
and
improvements
that
people
might
share,
but
I
haven't
heard
that,
as
of
yet.
E
I
know
you're
still
working
on
the
holiday
guidelines,
but
san
francisco
is
considering
asking
for
two-week
quarantine
for
holiday
visitors.
Is
that
something
you
think
that
perhaps
should
be
considered
by
other
counties
or
maybe
even
65?
Thank
you.
C
Yeah,
I
think
it's
an
excellent
question
and-
and
I
I
think
they
they
aren't
alone.
Other
states
and
other
regions
have
considered
that
and
I'll
just
commend
that
it's,
I
believe,
not
just
san
francisco,
but
the
bay
area
and
and
we've
seen
throughout
this
entire
response
regions
come
together.
The
central
valleys,
southern
california
counties,
different
regions
coming
together
to
plan
together
and
and
the
bay
area
has
certainly
been
a
leader
in
this
throughout
the
response
and
again
are
considering
it
in
this
capacity.
C
Of
course,
I
think
that
it's
a
very
reasonable
thing
to
consider
the
idea
that
rape,
different
geographies
in
different
communities
have
higher
and
lower
rates
of
transmission.
It's
important,
just
as
I
mentioned
in
the
health
equity
measure,
to
consider
how
restricting
or
limiting
the
ability
to
move
from
higher
transmission
areas
into
lower
transmission
areas
may
fit
what
a
community
needs
to
keep
transmission
low
for
themselves.
C
So
really
looking
forward
to
see
how
the
bay
area
counties
come
together
on
this
to
see,
if
there's
something
that's
applicable,
that
should
be
considered
in
other
regions
or
statewide.
F
Good
afternoon
in
july,
of
course,
it
was
announced
by
your
office
that
sexual
orientation
and
gender
identity
data
would
be
collected
for
over
19
patients
and
at
least
at
some
test
providers.
This
hasn't
happened
it's
city
test,
for
example,
here
in
san
francisco.
F
C
Yeah,
I
I
don't
know
the
specifics,
you
know
again
it's
it's
a
fairly
new
new
order
and
and
expectation,
and
I
think
we
can
certainly
always
find
those
exceptions,
and
I
don't
want
to
minimize
it
in
any
way,
we'll
look
into
that
specific
issue
and
always
interested
to
hear
from
those
who
are
asked
to
put
into
practice
some
of
these
changes.
What
the
difficulties
are,
whether
there's
reasons
that
it's
delayed,
that
we
can
at
the
state
level
or
the
local
level,
help
intervene
and
support.
C
So
I
will
just
highlight
that
we
are
getting
more
and
more
of
the
sexual
orientation
gender
identity
data
attached
to
our
cases.
It
was
not
just
something
we
expected
of
the
test
collection
sites,
but
the
labs
reporting
on
the
data
as
well
so
we'll
see,
as
we
have
seen
with
many
other
things,
some
steady
increases
and
improvements
here.
But,
of
course,
there's
going
to
be
some
entities
that
we
know
either
didn't
put
in
play
into
practice.
The
expectations
and
those
are
all
worth
following
up.
E
Hi
thanks
for
taking
my
question,
given
that
the
possibility
of
mass
protests
are
kind
of
quickly
upon
us,
I'm
wondering
if
there's
any
concern
that
that
sort
of
activity
you
know
could
cause
a
greater
spread
of
the
virus
as
transmission
is
rising
or
if
that
is
not
a
concern
given
that
that
does
not
seem
to
be
a
problem
earlier
this
summer.
C
You
know
I'll
say:
there's
always
concern
when
we
have
random
large-scale
mixing.
C
I
think
we
have
tried
and
continued
to
provide
ways
to
reduce
risk
in
all
of
these
different
environments,
and
certainly
my
hope
is
that
we
don't
pinpoint
any
any
transmission
to
the
activities
that
that
come
together,
whether
they're
in
the
the
protests
that
you're
mentioning
or
even
the
family
gatherings
that
we
anticipate
as
we
enter
the
holidays.
C
But
I
I
feel
more
confident
that,
with
the
right
tools
in
place
that
some
of
these
things,
where
we
know
the
risk
is
higher,
can
be
at
least
mitigate
that
risk
be
mitigated
some.
So
we'll
we'll
see.
As
with
everything
we
talk
about
the
different
holidays,
the
different
events.
C
We
talk
about
upcoming
sector
openings
and
and
those
places
where
we
see
some
transmission
increase,
but
we
always
hope
that,
through
our
choices
and
the
way
that
we
do
things,
not
just
what
we
do,
but
how
we
do
it,
we
can
reduce
some
of
that
transmission
risk
and
ultimately
transmission.
Overall.
C
So
with
that,
I
thank
you
for
bearing
with
me
on
what
was
a
longer
than
usual
presentation.
I
really
hope
and
expect
that
we'll
continue
to
do
the
work
that
we've
been
good
at
for
the
last
eight
months,
that
we'll
do
our
part
to
keep
transmission
in
our
communities
low.
We
know
that
there's
some
changes
ahead
and,
and
that
we'll
be
doing
all
we
can
to
not
have
that
second
or
third
wave.
C
Whichever
way
you
want
to
look
at
it,
the
rest
of
the
nation's
experiencing
and
try
to
tampen
that
down
as
much
as
possible
here
in
california,
and
to
do
that,
we
need
and
enlist
all
of
you
to
work
with
us
and
I'm
just
grateful
in
advance
for
all
the
work
that
you
will
do
and,
of
course,
for
all
the
work
that
you've
done
to
help.
California
do
well
as
it
relates
to
profit
19
and
our
response.