San Francisco’s pause in further reopening the city will continue through at least the end of the July 4th holiday weekend, Health Officer Dr. Tomás Aragón said Tuesday as he called for “realistic expectations.”

“Once you have a lot of people infected, it’s really hard to turn that back,” Aragón said. “We don’t know if we’re in that situation. The next several days [are] going to be really critical.”

“Currently we are on high alert,” Aragón said, referring to two of the city’s five key indicators — the number of COVID-related hospitalizations, and the rate of new infections — that have moved into the “red” and “orange” territory on the Health Department’s color-coded system Tuesday.

“Whatever happens in other places actually impacts us,” he added. “The San Quentin outbreak is a really good example of how that’s impacting our hospital system.”

The number of hospitalized patients in San Francisco with COVID-19 had been steadily falling since the beginning of May, and hit just 31 hospitalized patients on June 18, but then started sharply rising.

The most recent data available show 64 hospitalized patients. Of those, Aragón said 13 were patients who were transferred from San Quentin, where an outbreak has infected more than 1,000 inmates. Five patients were also transferred to San Francisco from Imperial County in Southern California.

San Francisco has also seen a sharp rise in the number of new cases this past week. The seven-day moving average of new cases per 100,000 residents rose to 5.8, and briefly went as high as 5.9 one day last week.

“Our goal is to be less than 1.8,” Aragón said. “Just like the hospitalization data, we don’t know whether this is going to be a one-time blip, or whether this is the tip of the iceberg and we’re going to have a rapid increase in cases and hospitalizations. It’s too soon to tell.”

Aragón said San Francisco was likely to be one of the counties added to Gov. Gavin Newsom’s watchlist, but we’ll have to “wait and see.”

There was no specific location or event that accounted for the increased cases, Aragón said, although they did see some general trends. Roughly half of the COVID-19 infections in the city have been in the Latinx community, but Aragón said there had been increases recently in other racial groups.

“In late June, we saw more teenagers becoming infected. In general, it’s going beyond the core group we’ve been seeing. That’s why it’s so important for everyone to take to heart the recommendations,” Aragón said — such as continuing to wear masks.

“When you’re at work with your co-workers, please wear your face coverings — otherwise you’re going to infect your co-workers, and that’s what we’re seeing with the essential workforce,” Aragón said. “This virus is relentless, it is unforgiving. It will lull us into a sense that everything is okay. It is so infectious. Just talking puts infectious aerosols into the air, and it is especially worse if you are indoors.”

Aragón said it was too soon to know if the recent mass protests had contributed to the spike in new cases.

“The important thing to emphasize is the virus doesn’t know why people are gathering,” he said. “If people are coming together, if people are raising their voice, if people are not physically distancing, and people are not wearing face covering, it means it’s going to raise the risk of infection.”

Even though the numbers are looking rather grim, and further reopenings in San Francisco have been paused, Aragón said it was unlikely we would need to roll back recent reopenings that have already taken place. 

“I think right now we’re in a very different situation than we were back in March when we did the shelter-in-place,” Aragón said. At that time the city did not have any contact tracing or sufficient access to testing.

Lastly, Aragón urged people to stay home for their Fourth of July celebrations this year — but if you did feel the urge to celebrate, limit it to outdoor activities. 

“Please choose something safely — as opposed to going into gatherings, going indoors, not wearing your face masks, not social distancing,” he said. “That’s what’s going to get us into trouble this weekend.”