COVID-19 testing line
On July 20, an hour-long line at Piers 30-32 awaited San Franciscans who had been made to wait perhaps two weeks for a COVID test. Photo by Joe Eskenazi

San Francisco plans massive COVID-19 testing expansion — but still won’t reach capacity Health Department said city had back in April

The masked figures emerge from parts unknown and begin lining up for COVID-19 tests far before sunrise. They are construction workers, cleaners and line cooks — the so-called “essential workers” given a pat on the back for holding society together and then shunted back into lives of crowded, problematic jobs and crowded, problematic living conditions. 

Many are immigrants, and nearly everyone is a Spanish speaker. If you’re fortunate enough to be riding out the pandemic in a comfortable place, these are the folks you only see while undertaking a transaction: They’re building or remodeling your homes and cleaning them; they’re preparing and delivering your food. And they’re here at the Mission Latino Task Force’s weekly pop-up COVID-19 testing site by 7 a.m. 

At a shade before 10 a.m., the members of the task force, along with representatives from the Department of Public Health, the genomic testing outfit Color, and the odd passerby form a circle for a prayer ritual. Bundles of sage are ignited and, at 10, the COVID-19 testing begins.

But that nearly didn’t happen. 

On the eve of July 16, the Latino Task Force organizers said the Department of Public Health informed them they’d be allotted just 100 tests. Argumentation ensued. And, in the end, the Mission site ended up testing more than 350 people before running out of supplies 90 minutes early. 

On the eve of July 23, the Latino Task Force organizers said the Department of Public Health told them they’d be allotted just 200 tests. Argumentation ensued — to the point where the Latino Task Force made it clear that they were willing to hold a highly visible protest instead of running the tests. 

They were given 300 tests. 

One day later, on a bright Thursday morning, men and women sat themselves in white folding chairs set up in the middle of Alabama Street, oblivious of the prior day’s struggle and ultimatum. Organizer Jon Jacobo, outfitted in a black mask complementing his Giants jacket, took it all in. 

“Every week, we have to fight for additional testing capacity,” he said with a sigh. “I understand that, at the federal level, we’re led by a buffoon. What I do not understand is that, in a city like ours, with a $12 billion budget and the brilliant leaders we profess to have, we’ve had seven months and we cannot figure it out: This is Ground Zero. If you want to stop the outbreak, you test here. Put your resources into the city’s Southeast corridor. Especially if you have limited resources.” 

Threatening to “kick up some dust” regarding those tests, Jacobo said, was necessary: It’s the Latino Task Force’s obligation and raison d’être to provide for its community. 

And that’s so. But this is ostensibly the Department of Public Health’s obligation and raison d’être, too. And, while a group of community activists can — and should — be expected to do what they gotta do, this incessant last-minute head-butting and wrangling and drama and bargaining reveals a larger lack of coordination and methodology and organization in how this city disseminates its resources for COVID-19 testing. 

That strategy can be difficult to parse. As can, frankly, the true extent of city resources.

Dr. Kim Rhoads is a UC San Francisco professor of epidemiology and biostatistics, and the director of community engagement for the cancer center. In her efforts to bring equitable testing to the city’s neighborhoods, she’s asked the Department of Public Health — on more than one occasion — just how many tests it can administer and process. And she has not yet received a straight answer. 

She doesn’t assign malignant intent to this, but, “what I’m finding out about the Department of Public Health is, it always depends on who you talk to,” she says. “You get different answers from different people at different times.”  

Latinx residents  account for 15 percent of San Francisco’s population, but 49.4 percent of the city’s cases. The Mission has 149 COVID-19-positive cases per 10,000  residents. Only Bayview-Hunters Point is worse: 198.7 cases per 10,000.

Groups like the Latino Task Force have been able to wade into the morass and obtain at least some of what their communities need. But other groups, serving communities equally afflicted — or perhaps even worse off — have not. 

“What I see is people getting fed up with bureaucracy, so they go around it,” Rhoads continues. “And that is admirable. But it means things are disparate. We are able to bring resources into one area, but not another.” 

And, next week, who knows? 

July 23, 2020. The line for seniors on the left and for others on the right. The line for everyone started at 7 a.m. on Alabama, went to 20th street and wrapped around to Florida Street. Photo by Lydia Chávez.

San Francisco is a city that, even in the best of times, barely manages to hold it together. 

In this way, our approach to testing has a familiar ring to it: We’re spending more and doing more and apparently doing better than most everyone else — but we’re still barely holding it together. 

“We’re doing more testing than neighboring counties by at least 50 percent; we’re doing more testing than 49 of the other 50 states,” gushed Department of Emergency Management director Mary Ellen Carroll in a July 13, 2020, debriefing to the Board of Supervisors. “San Francisco has done more testing per capita than any other city or county in the United States.” 

And all of that is true. And yet, at around the time this was being said, an essential worker — with multiple potential COVID-19 symptoms — could click onto the CityTestSF website and find themself being made to wait two weeks for a test. 

Also in this time period, city residents who took COVID-19 tests at neighborhood pop-ups waited nearly two weeks for results — a languid turnaround that rendered the tests useless artifacts. 

We may be testing more than anyone else, but that doesn’t matter when people have to wait aeons for an appointment or a result. 

“If you’re sick, are you going to wait at home for 11 days for a test? No, you’re going to go out and potentially spread it,” says Dr. Jake Scott. 

He is, himself, a Stanford infectious disease specialist whose day job entails treating COVID-19 patients. When he recently came down with a fever and chills, he was told it would take him several days to wrangle an appointment and several more to process the test. He ended up driving to an emergency room to get a rapid test (he’s fine). 

“This is an example of how insanely difficult it is to even get information about getting tested. I have all the resources at my disposal. I am an infectious disease doctor! And I couldn’t even find out.” 

“The failure of our country to adequately test people has been the biggest failure,” he continues. “And it persists.” 

As such, Mayor London Breed and Health Director Dr. Grant Colfax last week announced a massive augmentation of testing capacity, adding some 1,400 daily testing slots to the average of around 3,200 the city has managed for the last several weeks. 

Color, which will process the tests, and also works with Marin and Alameda counties, tells us it can run 10,000 a day in its Burlingame facility, and 10,000 more at its East Coast lab. Carbon Health, which will be staffing the sites, says it has moved, at the city’s behest, to quadruple its workforce. 

At the same time, a health order last week mandated private healthcare facilities undertake more COVID-19 testing, opening up some of those city-provided slots for the people who truly need them. 

Wednesday, July 22, at 1 p.m. at SOMA testing site, virtually no line. Photo by Lydia Chávez

All for the good. And yet, why did the wheels nearly come off of San Francisco’s testing apparatus in July, when we began cracking 3,000-odd tests a day? 

After all, as far back as April, the Department of Public Health stated that our daily testing capacity, between its own facilities and those of partner institutions, was 4,300 — with Color able to add 1,500 more to that. 

These figures were repeated, frequently, both in public and behind closed doors; they were quoted in both the local and national press. 

Again, one needn’t assign malignant intent. But those figures were, clearly, not accurate. 

How is it that public health officials led us to believe that the city had the capacity to collect and process 5,800 tests a day?  

In a nutshell, some of the partnerships the city was counting on in April don’t seem to have quite panned out. 

Mission Bay’s Chan Zuckerberg Biohub — among others — was included in Health Department statements about the 4,300 daily tests. But, at that time, the Biohub did not have an interface in place to expediently record the race and ethnicity of test subjects. That’s a serious matter in a racially stratified place like San Francisco, which has featured such fantastically disproportionate infection rates for Latinxs. And San Francisco hasn’t yet slotted the Biohub into its regular testing rotation.

So what is our capacity right now? That’s hard to say. But, without relying on outside providers, the Department of Public Health claims it can process around 1,050 tests a day between the public health lab (660 a day)  and the General Hospital clinic (390 a day). When these grew overloaded, that led to the maddening delays on recent pop-up testing results. 

Color, meanwhile, has gone from providing 1,500 tests a day in April to 2,000 currently, its managers tell us. With the 1,400 more slots the city is asking of it, Color may soon be processing 3,400 tests a day.

Joe DeRisi, an infectious disease specialist and co-president of the Biohub, said the interface issue has been resolved — but, at present, the Biohub’s capacity of 2,688 tests a day is shared with some 30 of the state’s 58 counties. The processing is free and more than 90 percent of the tests are processed within 24 hours.

He called the situation “very fluid,” and said they talk to counties daily. But, right now, they could only accept an average of 200 tests a day from San Francisco. The Department of Public Health, he said, reached out again last week.

So, in the meantime — and even including the pending expansion — we are still far from the 5,800 figure the Health Department stated so many months ago.

So, San Francisco has tested and tested and tested some more. But this is a numerator without a denominator; it remains to be seen if we’ve tested effectively. “The bigger picture is containment,” said Rhoads — which means applying those tests where they are most needed. 

Here in the Mission, the Latino Task Force has scratched and clawed to get even a portion of the tests the community requires. But, Rhoads notes, down the road in Sunnydale, they’ve never received nearly as many until quite recently. Why? Beats her. 

“If someone said ‘here’s why, and it’s based on the number of cases … ’ that would make sense,” Rhoads continues. “But that hasn’t happened. I just don’t think it’s centrally coordinated.” 

If the doctor had her way, we’d spread out testing equally among the city’s beleaguered communities, monitor the results, and then push the resources where they’re needed. But this, too, isn’t happening, at least not yet. And, as the Mission has demonstrated, even where needed, community workers have had to argue and cajole and agitate for resources every week. 

“The Department of Public Health cares a lot,” says Rhoads. “But they need a strategy.” 

And that’s the real test. 

*This story has been updated. The Chan Zuckerberg Biohub claims it has since fixed its problematic interface issue — but its heavy capacity would have to be split among many counties, leaving a sliver for San Francisco, not a large slice of the pie.  

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Managing Editor/Columnist. 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 editor at San Francisco Magazine from 2015 to 2017. You may also have read his work in the Guardian (U.S. and U.K.); San Francisco Public Press; San Francisco Chronicle; San Francisco Examiner; Dallas Morning News; and elsewhere.

He resides in the Excelsior with his wife and three (!) kids, 4.3 miles from his birthplace and 5,474 from hers.

The Northern California branch of the Society of Professional Journalists named Eskenazi the 2019 Journalist of the Year.

Founder/Executive Editor. I’ve been a Mission resident since 1998 and a professor emeritus at Berkeley’s J-school since 2019 when I retired. I got my start in newspapers at the Albuquerque Tribune in the city where I was born and raised. Like many local news outlets, The Tribune no longer exists. I left daily newspapers after working at The New York Times for the business, foreign and city desks. Lucky for all of us, it is still there.

As an old friend once pointed out, local has long been in my bones. My Master’s Project at Columbia, later published in New York Magazine, was on New York City’s experiment in community boards.

Right now I'm trying to figure out how you make that long-held interest in local news sustainable. The answer continues to elude me.

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  1. This story is quibbling about problems in testing that are either nationwide or not related to governance in the city, while not giving our city leaders credit for doing a great job in comparison to everywhere else in the US.The one factor that DOES seem to be tied to the city government is its failure to not run with Biohub’s testing capacity early on, even without the ability to enter race categories efficiently. Is it more important to stop the epidemic or know the race of the people who are now, thanks to absurdly long wait times, walking around the city and infecting other people, rendering the tests useless? Other than that, San Francisco has done a much better job of containment, tracing and testing than many other locales. Its just too bad it’s part of the US, meaning its subject to the incompetence and limitations of the national leadership.

    Ultimately, until we get testing that doesn’t require supply-limited reagents, time to process and remote processing, we will not reach suppression levels with this disease — and doing that would require defying FDA and using tests that are not authorized yet. Not fair to expect of a city government. San Francisco is a city of young people, and many are going to be asymptomatic. If we are not doing routine, frequent surveillance testing of all people who interface with others regularly as part of their job, we will not be able to contain a disease that may spread more than 50% of the time when people are completely asymptomatic.

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    1. Yes, you’re right. It is definitely most important to stop the pandemic. But, I beg to differ on what is fair. It is not fair for public officials to tell us the city has the capacity to take and process 4.300 tests day when that is clearly not the case- nor has it ever been, it appears. In a pandemic, we need clear and transparent information. Cities make mistakes – especially so in trying to confront an unprecedented crisis – but people lose faith when public officials fail in fessing up to errors and fail in giving information that is accurate. As a news site, it is our job to point this out. As the article says, we don’t believe there was malign intent, but there are issues with the city’s representation of what its testing capacity has been.

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      1. This is a fantastic article! There was one aspect of covid testing that was described but that deserves a fuller treatment: the time it takes to get an appointment for testing and the turnaround time for testing.

        For covid testing to have any value it has to have the potential to lead to some sort of change in behavior. If the time period between first symptoms and a result from the PCR assay is longer than 2 weeks, it has no value. Realistically, for the testing to have any real value, people need to know whether they are infected or not within no more than a few days.

        In spite of this, everything I hear from the SFDPH revolves around the number of tests being processed. What matters is the value of those tests.

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      2. We don’t know if the city would have had capacity to test 4300 samples a day in a time when other states were not surging. That number was based on Quest and Labcorp likely not having a backlog. In other words, when they stated this, it may indeed have been possible. They did not bank on the rest of the country going up in flames as well

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        1. This was a number that was repeated over and over again. When we asked for the numbers on the city’s processing capacity, they gave us what they have and we have included those in the story. There was never any mention of contracts with Quest or Labcorp – then or now. As far as we know the delays began when the city tried to process 1,000 tests a day in a lab equipped to do 660 a day.

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  2. Thanks, AGAIN, for another issue analytically brought to our attention.
    SF’s response[s] seems similar to the US actions–
    unprepared, under-prepared, un-coordinated, and under-funded.

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  3. Excellent article! One of the usual “strategies” of government is to throw money and resources at a problem prior to properly characterizing what the problem is and then assuring that their resources are utilized effectively. I hope this helps the City get their focus straight and their act together. This is too critical an issue to keep stumbling.

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