North Beach, May 3, 2020. Photo by Lola M. Chavez

When San Mateo County’s Health Officer announced Wednesday that businesses would be allowed to open for curbside and delivery activities on May 18, government officials in other counties were puzzled. But hardly surprised. 

As recently as April 28, San Mateo denizens, at their Health Officer’s insistence, were barred from traveling more than five miles for recreational purposes. But, just two weeks later, San Mateo was officially announcing it’d be opening up — and essentially decoupling from the six counties that joined to issue the March 17 shelter-in-place order

Has the cohesion between the six counties come undone? It sure looks that way. “This may lead to breakage among the six counties,” San Mateo County Supervisor David Canepa told us on Wednesday. “We don’t know yet.”

What we do know is that on the day before San Mateo County announced it was loosening restrictions, it recorded nine deaths, its most in three weeks. “The numbers in San Mateo are getting worse; they’re higher than in any other Bay Area county but San Francisco,” noted a Bay Area government official.  

Per the website CovidActNow — which our Bay Area leaders do peruse — San Mateo’s R0, its COVID growth rate, remains positive. Every sick person is, currently, infecting 1.06 more people. As of Friday, Santa Clara County, just to its south, had a negative growth rate of 0.86. San Francisco is at 1.08 (the city’s health officials, however, peg us at a tally just below one — down from 3.5 in March).  

These differences, while apparently trivial, are far from that. This BBC chart indicates what even a slight difference in R0 means over time. 

Officials I spoke to hailing from over bridges and across county lines saw San Mateo’s move to partially reopen as a concession to political and business pressure. And they predicted San Francisco would soon announce a similar plan to open up on May 18. 

This actually occurred in the midst of one of our phone conversations. 

Closing time at Pancho Villa.

Come Monday, some 95 percent of San Francisco businesses will be permitted to reopen, albeit with severe restrictions. Retail establishments will be operating on a curbside and/or delivery basis and warehouse-like facilities will do so in a reduced capacity. 

“What this means for the city is incredible,” Mayor London Breed said at a Wednesday press conference. “It’s obviously great news for retailers,” San Mateo County’s Canepa told Mission Local earlier in that day. 

Well, hopefully. But that all depends — it was “incredible” and “great news” for the Warriors when Kevin Durant suited up for Game 5. But it didn’t end well.  

The six counties — and California writ large — were supposed to re-open based on statistical measures; as Dr. Anthony Fauci has put it, “the virus sets the timeline.” But Breed has, for weeks, earmarked May 18 as the date to move things forward. 

San Francisco health officials note that we have reached our goals of daily testing two people for every 1,000 city residents (that’d be about 1,600 tests per day). At a Friday UC San Francisco COVID-19 Town Hall, the expert panel spoke highly of the city’s robust contact tracing program, our available hospital capacity, and our ramped-up testing and relatively low instance of positive tests. 

But it’d be harder to argue we’re adequately testing heavily enough among some of our most vulnerable populations — nursing home residents and, especially, homeless people or SRO dwellers — who would test positive, at a high clip, and throw off our city’s numbers and narrative. 

“San Francisco has put the cart before the horse,” said an out-of-county official. “It has pre-judged the outcome.” 

But we’re far from the only ones. 

“A few weeks ago [Gov. Gavin] Newsom set up criteria for what it means to re-enter. And that criteria hasn’t been completely followed,” said Dr. John Swartzberg, a UC Berkeley clinical professor emeritus specializing in infectious diseases and vaccinology. “I understand that there’s tremendous political pressure on him, but when you set up criteria and don’t follow it, it leads to confusion. And the last thing we want is confusion when dealing with a pandemic.” 

But we are a confused nation right now. And with county after California county pushing for variances to the state rules for re-opening, things are confusing here, too. 

As for San Francisco, Swartzberg said that he’s concerned: “We may be taking a greater risk than we should be taking.” 

Dolores Park, March 16, 2020, 2:43 p.m. Photo by Emma Silvers

Swartzberg is an infectious disease specialist, but he knows that the commonality between death from COVID-19 and death from malnutrition is death. 

“If you don’t have any money, that is dangerous to your health, too,” he says. “It’s hard to be hypercritical of what’s going on here. People are trying to do the best they can.” 

That’s along the lines of what Canepa said when asked if this was the time to open up San Mateo County. 

“Some people who are privileged can work from home. Others are not privileged. They have to work two or three jobs and unemployment is so high right now,” he said. “In my district, food lines are getting longer and people have trouble getting day-to-day necessities. There’s public health and economic health — it’s chicken and egg, right?” 

Canepa is right. And San Francisco (and everywhere else) is facing a devastating budget shortfall, in part driven by vanishing sales tax revenue. 

But balancing economic health vs. health from a deadly disease as an either-or is a false and destructive choice. And arbitrarily picking a date to re-open the economy is — to use a highly technical term from Stanford School of Medicine assistant clinical professor and infectious disease specialist Dr. Jake Scott — “stupid.” 

In the past two months of sheltering-in-place, we haven’t yet developed a medical therapy that’s effective against COVID-19, he says. The city has only just begun to engage in universal testing in skilled nursing facilities — the driver for this state’s coronavirus casualties — and has, markedly, not yet started systematic testing of congregate living facilities such as homeless shelters, let alone the city’s burgeoning encampments. 

As the Public Press reported last month, the city in fact pulled the plug on a plan to test its homeless shelter residents — free of charge, in fact — to instead focus on nursing facilities. 

President Trump was rightly mocked for his rambling charge that COVID-19 testing was “overrated” because, “when you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.” 

But as long as San Francisco isn’t testing aggressively among its most vulnerable populations, the city’s prevalence count will be artificially tamped down. 

Lights flicker from tent.

And testing is overrated if not coupled with aggressive contact tracing. “It doesn’t make sense to test someone and find out they’re positive if you’re not going to find out who they’ve had contact with and get them into quarantine,” said Swartzberg. “Gavin Newsom has asked for 20,000 people to be trained [as contact tracers] within a short period of time. Well, that’s aspirational. I hope we can do it. But, in the long run, we’ll probably need two to three times that many people.” 

San Francisco officials stressed that our growth rate has dropped to the point that a tentative re-opening was prudent. “This is a meaningful step on the gradual path to the new normal,” said Department of Public Health director Dr. Grant Colfax at Wednesday’s press conference. And Breed insisted that now was the time to begin focusing on economic recovery. 

But Scott insists that the good work we’ve done in the past two months has not tamped down the prevalence of the virus: “It strikes me as naive to think that just because we’re tired of physical distancing and businesses being closed, okay, we’re done. We don’t have efficacious medical therapies. We don’t have a vaccine.”  

Due to the one- to two-week incubation period for COVID-19, it may be some time before we know whether Monday’s move to loosen restrictions was prudent — or merely wishful thinking masquerading as public policy. 

Scott, for one, would only feel confident about re-opening the economy “if we could test large swaths of the population and do contact tracing and isolation and ensure the most vulnerable populations were supported if there were outbreaks in long-term care facilities and among the homeless.” 

These populations, he notes, “will be hit especially hard. What have we done to ensure they’ll be safe? What do they get out of restaurants reopening?” 

He answers his own question: “They’re going to get sick.”

If you read us often, please support our reporting. We depend on you.

Joe Eskenazi

Joe was born in San Francisco, raised in the Bay Area, and attended U.C. Berkeley. He never left. “Your humble narrator” was a writer and columnist for SF Weekly from 2007 to 2015, and a senior...

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20 Comments

  1. Joe,

    I am betting on San Francisco.

    Breed will continue to make self-serving decisions based
    upon personal and corporate greed.

    Like Trump, she will bury unfavorable numbers.

    Probably, along with thousands of San Franciscans.

    Whomever of us survive will come back and drive reform.

    It’s the natural way of things around here.

    It’s raining on my triple bay windows.

    In a time of drought.

    No one cheers.

    No one worries.

    It is the other horsemen of the Apocalypse who have center stage.

    Go Giants!

    h.

    1. This crisis has come when we’ve had one of the most incompetent mayors in decades.

  2. To expand on the BBC chart, different R values mean very different outcomes in terms of time and suffering:

    https://link.medium.com/uN26q4O5y6

    While we may have reached a point where we need to reopen parts of the economy, to support priorities other than public health, that only means we should do even more to reduce transmission as well.

    Experts elsewhere in the world talk about R values way below 1, and taking steps to make that possible. Other countries like Germany have shown this is a faster path to reopening more of the economy.

    Just barely getting below 1 is an odd place to stay. If we as a community plan to stay here, our leaders need to express why and what this leads to in the long term.

    If we aim to go lower, that would be good to hear as well.

  3. Wasn’t the whole point of flatten the curve, to prevent the hospitals and ICU’s from getting crazy busy. That from the beginning the expectation was that people would still get sick, but FTC would spread out the hospital visits over more time so there wasn’t a violation of peak capacity. And that has been achieved.

    Then the politician authorities would apply the thermostat analogy, with the revision to tweak for who has actually been sick and dying. That is turn up the thermostat heat – here open for business, until the point where the hospital beds get filled with old people and other less counted people in the community. When that rate is reached, readjust the societal controlling rules to turn the heat down, just like a thermostat would

    1. I agree completely with Sus’ analysis. It seems people have a short memory of the purpose for flattening the curve. Or more likely, they see the pandemic crisis as opportunity, a vehicle and wedge to justify funding and implementing political/social policies they advocated long before covid existed.

      “And testing is overrated if not coupled with aggressive contact tracing.”

      That’s not true. Large scale provides much better data of the prevalence of covid in the population than only data from testing just people with symptoms. Having a better estimate of the actual infection rate is important to understand the actual virulence/mortality rate of covid when creating reopening guidlines. It also improves planning for health care resources Those reasons are why mass testing experiments were done in Bolinas, Santa Clara County. and part of the Mission.

      1. “And testing is overrated if not coupled with aggressive contact tracing.”

        No disrespect sir, but I’m gonna go with Dr. John Swartzberg from Cal over Not a Native from the Internet.

        JE

        1. Couldn’t care less what a blogger “goes with” I relate verifiable facts so those who form their opinions based on facts are made aware.

          1. Sir or madam — 

            You can call me a blogger if that makes you feel good, but that just makes you a commenter on a blog.

            You seem confused: This is a reported column, and these are the beliefs of Dr. Swartzberg, as relayed by me. Again, I’m going to value and report the views of the infectious disease specialist more than random denizens of the Internet.

            Yours,

            JE

          2. Joe says, “You can call me a blogger if that makes you feel good, but that just makes you a commenter on a blog.” But in this case, you both are right. 😉

          3. ISTM feathers are ruffled over semantics of “overrated”. I think all can agree that more testing is good, and more testing plus contact tracing is better. If nothing else, more testing would find asymptomatic / pre-symptomatic cases and have them self-quarantine to limit further infection.

          4. The new confirmed case count per day in SF has been fluctuating around 30 cases for last several weeks. Since we are already re-opening, the average daily case count will not decrease significantly to the average 6.3 new cases per day state criteria for stage 2 reopening. We are not going to do the more draconian lockdown as in China and highly impacted European countries (Italy, Spain, et al) to reduce case count unless things get really bad.

            As article states, contact tracing and testing those contacted would stop additional further infections before they can occur. This might be the only way we have to possibly reduce the average daily case count. The article states “the expert panel spoke highly of the city’s robust contact tracing program.” Later, it talks about 20,000 contact tracers and that number being aspirational, and further that two to three times that many will be required. The latter context is for entire state. So how is SF specifically doing in this regard? Is there a public metric on how many cases today are being contact traced, and how many cases are being found by contact tracing?

          5. Journalists don’t “go with” a particular view. They report without injecting personal opinions or advocating viewpoints. You sir, express/promote personal opinions/viewpoints and moreover claim they have particular merit that commenters should value. That makes you a blogger and blog commenter.

          6. Sir — 

            Lecture me more about journalism. I’m sure you’ve spent many days in the newsroom. You seem like a deeply knowledgeable person, and highly intelligent to boot.

            JE

  4. I’ve been alarmed at how few people have been wearing masks. Yesterday I was at Duboce Park area and literally 1 in 10 people were wearing masks. Same today up at Bernal Heights. A woman was openly sneezing without a mask on up there today. In my hood on 24th St the same.

    It would be nice to see more reporting on why EVERYONE should be wearing masks while out on the streets and in the parks. Also, how to properly wear them – I see many people wearing them below their noses, which makes little sense.

    1. I agree with Adam. We need more talk about the benefits of masks. Lots of people not wearing them correctly. OSHA requires n95 masks to be fitted to the individual. This is an OSHA requirement. No business should be open unless all employees are fitted for a mask. All residents in to be fitted for a mask to leave home. Police need to start enforcing OSHA laws immediately, if not sooner. Everyone needs properly fitted masks. Not these cloth sheets that due nothing.

    2. I completely agree with Adam. I too am alarmed at how many people are not wearing masks here in SF on the streets or in the common areas in my apartment building (eg. lobby, mail area, laundry room etc). I’ve also noticed that, while it is mandated that a mask must be worn to enter into a grocer, once entered,many of the patrons (nor staff for that matter) are not wearing them correctly, either by exposing their nose or mouth. which renders the mask totally useless really. I’m not sure whether they think they’re just being cavalier or brave, but as the principle is that WE’RE WEARING MASKS TO PROTECT THE HEALTH OF THE OTHER PERSON, they’re literally drag-racing with our lives, not theirs. Until the public is fully educated regarding our civic responsibility to continue wearing masks (correctly) and social-distancing, this is a nightmare in the making.

    3. I walked through Stockton St in Chinatown over weekend, and it was fairly crowded. But almost everyone I saw was wearing a mask or face covering. Perhaps 1 in 20 or 30 people was NOT wearing a mask or face covering. Further along in Washington Square, it looked to me like 6 to 7 in 10 people were NOT wearing mask or face covering. The people I see wearing masks in Chinatown are mostly Asian. Seems to me Caucasians are braver in taking risk of not getting infected or not suffering serious consequences after getting infected.

      Another comment noted N95 masks. N95 meets individual objective of reducing risk to oneself regardless of others around them but are currently more difficult to get for many people. If everyone (or some high percentage >70%) were to wear the cheaper easier to get surgical masks or even cloth face coverings, the social objective of reducing infection rate in population can be met. The latter requires cooperation.

  5. Joe,

    It would be interesting to know the number of cases and deaths that are generated in senior living or adult care homes versus the general public. It seems the data shows significant spikes whenever it is reported that there was an outbreak at a senior living or care facility. This data along with hospitalization and ICU capacity data would provide insights regarding disease spread and deaths among the general population versus centralized areas of the most vulnerable populations.

    Nice article, as always!

  6. Opening too soon? “Let the virus determine the timetable” paraphrasing Dr. Fauci

    “Encourage social distancing by increasing spacing of passengers and employees, closing every other row of seats and using bus rear door entry/ exit” If this is not done, do not expand service, CDC guidelines (Centers for Disease Control and Prevention)

    Identical advice from the APTA (American Public Transit Association) on mass transit social distancing.

    Has Muni complied? 3 guesses, first 2 don’t count. They advise people to do it on their own, no physical structure in place.

    Recent MIT published study says… mass transit was the No.1 culprit in New York’s (epicenter of this disease) Coronavirus transmission.
    Why would our Mass Transit be any different…

    https://www.cdc.gov/coronavirus/2019-ncov/community/pdf/MassTransit-DecisionTree.pdf
    Screen Shot 2020-05-17 at 10.05.02 PM.jpeg

  7. Thank you for the article, and others with a level of insight needed in complicated times (both on covid-19 and City corruption). Lots of thoughtful comments from readers, too, and I definitely would stick with the Public Health people on this. Luckily they are not as pressured by politics, and as we know, heath data and scientific inquiry have a lot to offer. But not in the time frame of politicians.
    And WE elect the politicians. Let’s ask them to really think about the economy: is it a healthy economy only because it grows, or are there other measures? Should we really be engaging is massive globalization, or is local/regional safer and more healthy. Whether the Warriors contribute to the economy or not, do we really need them for community health? And let’s not forget the saying “The economy is a wholly-owned subsidiary of the environment.” Our planet has benefited from less human activity of the fossil-fuel-consuming kind. How do we rebuild with values and practices that are truly sustainable?

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