San Francisco loves to bask in how wonderful it is, and just last month, it had good reason to feel smug about nearly quashing coronavirus transmission.
In early October, just 27 people a day tested positive in the city, which sat in the state’s yellow tier, meaning the virus risk was “minimal.” That allowed the city to open restaurants for indoor dining at 25% capacity and loosen other restrictions.
But a few weeks can bring a dramatic change of fate — especially in the miserable year that is 2020.
Now, San Francisco sits in the red tier, meaning the virus spread is “substantial,” and 105 people in the city receive a positive test result every day. Dr. Grant Colfax, director of the city’s Department of Public Health, warned the city could slip into the purple tier by Sunday, signifying the virus is “widespread.” That would shutter churches, gyms, movie theaters and museums and subject us to the state’s new curfew.
So what happened? Despite the city’s repeated insistence on following data, science and facts, we don’t have the data, science or facts to identify the exact problem spots. The city’s contact tracing system isn’t good enough to pinpoint specific events, gatherings, businesses or other places that are fueling the surge.
Was Halloween a problem? The parties in the streets to celebrate Joe Biden’s presidential victory? Are certain indoor businesses OK, but not others? We just don’t know — and that’s problematic as our pandemic woes drag on.
“We don’t have the level of precision to say this one activity versus another specific activity has fueled the spread,” Colfax said.
Many people who test positive for the virus in San Francisco aren’t sure how they got it, and the city’s contact tracing team often can’t help them figure it out. The 244 city workers on the team use a system created in the spring that doesn’t lend itself to much specificity. Wisely, the city just switched to the state’s system, Cal Connect, which will enable contact tracers to share data between counties and give a better idea of hot spots.
Becca Camping is almost certain how she got the virus, though. The 24-year-old Tenderloin resident works as a server at International Smoke, the barbecue restaurant opened by Michael Mina and Ayesha Curry in the Millennium Tower.
Camping rarely went anywhere other than the grocery store until the restaurant opened for indoor service in mid-October. She worked five dinner shifts a week, often serving people who had their masks off the entire time they were at their tables.
She’s been getting tested every two weeks. On Tuesday, she tested positive. On Wednesday, she started developing symptoms. By Thursday, she couldn’t taste anything — ironic for a server of delicious smoked ribs and macaroni and cheese. She’s exhausted with a brutal headache and back pain.
“You can do everything right and wear a mask and not go out, and you can still get it,” she said, noting she did have to leave her home to work, but didn’t go out socially.
Camping said contact tracers, who try to call everyone who tests positive in San Francisco and their close contacts, notified her co-workers and nobody else has tested positive so far.
Plenty of San Franciscans just aren’t behaving as well as we should. Public health officials say widespread fatigue with the COVID-19 pandemic and pride over how well the city had done combined to prompt people to stop being so careful and start mixing with lots of friends and family again. That, coupled with more places to go — restaurants, gyms, movie theaters, offices — meant more chances for the virus to spread.
“It’s that we’re not doing the things that we know prevent transmission,” said Dr. Susan Philip, deputy health officer in charge of contact tracing. “We’re not wearing our masks all the time. We’re not limiting our gatherings. We’re gathering indoors. Those are the things that make the most difference.”
It’s easy to infer from city data that white people and young adults are a big part of the problem. Throughout much of the pandemic, it was Latinos in San Francisco who were getting the virus in huge numbers — largely because they tend to be essential workers and live in crowded apartments.
But from Oct. 21 to Nov. 10, 30% of San Franciscans who tested positive for the coronavirus were white, compared with 18% throughout the pandemic. In that same time span, 34% of San Franciscans who tested positive were age 18 to 30, compared with 26% throughout the pandemic.
No longer is it just Bayview-Hunters Point, the Mission and the Tenderloin — all home to many essential workers — seeing virus surges. Now white, wealthy neighborhoods are, too — with, incredibly, the Marina and Presidio Heights showing similar rates as the Tenderloin.
And it’s not just people in large households getting sick, but people who live alone or with just one other person.
Dr. George Rutherford, a UCSF infectious disease expert, said people who test positive are reporting far more close contacts to contact tracers than they used to.
“People are out and about mixing more than they were,” he said, noting gatherings in other people’s homes is a main driver in fueling the surge.
A young San Francisco man posted on Twitter on Nov. 6, “yo if you have nothing to do tonight and find yourself by nob hill hit me up. we have a house and a bar.” Eleven days later, he tweeted, “COVID is about to ravage SF. All of my friends and most of my roomies are sick ... everyone in my house is dead man walking.”
There was no indication he saw the connection.
Jon Jacobo, a co-chair of the Latino Task Force, helps run a weekly test site in the Mission and said it’s clear indoor dining and casual gatherings have led to a rise in cases. He said the fact that the health department allowed indoor dining — without masks as people ate and drank — led some people to assume it was safe to have friends and family over for dinner in their own homes without masks.
He said people have asked for a free test at his site, which is intended for Latino essential workers, to show at the airport on their way to Hawaii.
“They’re not even bashful about it!” he said. “You’re taking it away from somebody who would actually need it.”
So what about other activities that have prompted hand-wringing among many San Franciscans? Some of them, it turns out, are just fine.
Philip said playgrounds, which were closed until this fall to the frustration of many parents, don’t seem to be a problem. Neither do the opening of scores of private and parochial schools around the city or community hubs to help public schoolkids with distance learning. While cases have sometimes popped up at schools, they’ve been contained, and there haven’t been outbreaks.
“It has not risen to the level that we have had concerns or felt we needed to rethink our strategy with younger children,” she said.
In fact, kids younger than 18 constituted 9.6% of positive coronavirus tests from Oct. 21 to Nov. 10, compared with 11% during the entire pandemic — a reassuring dip considering so many went back to school in recent weeks.
There still aren’t many cases in the homeless community either, a signal that keeping unhoused people in their current hotel rooms for the coming months is crucial.
Whether San Francisco continues to outshine other cities when it comes to COVID-19 will hinge on all of our behavior in the coming weeks. We know what to do: Wear masks, practice social distancing, wash our hands, avoid indoor gatherings that are just for fun.
Camping wishes all nonessential businesses, including indoor restaurants, would shut down and that the government would pay staff to stay home. That’s what a responsible federal government would do, but we don’t have one. So it’s up to us.
“I wish people could stay home so we could nip it in the bud instead of halfway doing it, halfway not,” she said.
We halfway did it through mid-October. Now let’s finish the job.
San Francisco Chronicle columnist Heather Knight appears Sundays and Tuesdays. Email: hknight@sfchronicle.com Twitter: @hknightsf Instagram: @heatherknightsf
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S.F. was flattening the curve — until our urge to gather spiked it. Now we need to reverse the surge - San Francisco Chronicle
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