UCSF's Department of Medicine Grand Rounds on September 24, 2020 included (from top left): Dr. Bob Wachter, Mayor London Breed, Grant Colfax, Tomas Aragon and Dr. Diane Havlir. Illustration by Molly Oleson; photos from screenshots of live event.

Also: applause for the city’s low death rate, and a reminder that much work remains

Two days after hitting the “grim milestone” of 200,000 Covid-19 deaths in the United States, UCSF Grand Rounds moderator Dr. Bob Wachter brought in key local decision-makers, including Mayor London Breed; Dr. Grant Colfax, director of San Francisco Department of Public Health; and Dr. Tomás Aragón, health officer of San Francisco. 

The speakers’ key takeaways: San Francisco’s low morbidity and case rates are due, in part, to data-driven responses to the pandemic (such as implementing the country’s first shelter-in-place); a collaboration between public health officials, academics and the community; as well as stellar medical care. 

Yet, Breed acknowledged more work needs to be done to address disparities in testing and impact on the Latinx community. She announced late today initial funding of $22 million with plans to grow that to $28 million. 

To analyze the city’s response to the pandemic, several UCSF faculty were also present to discuss the university’s role in Covid response and share lessons from the HIV/AIDS epidemic in the 1980s that still apply today. 

San Francisco’s Pandemic Response 

If you’re wondering how San Francisco’s covid response shapes up compared to the 20 most populated U.S. cities, the answer is quite favorably — especially regarding the morbidity rate. Wachter put this in perspective: If the rest of the country had the same Covid death rate as San Francisco, he said, only 36,000 lives would have been lost thus far to the virus.  

After a laudatory introduction, Breed initially spoke much as she has at previous pressers, giving a speech filled with statistics on San Francisco’s response to the pandemic and ongoing initiatives, as well as addressing its shortcomings and asking San Franciscans to remain vigilant against the virus. 

Breed described how the virus targets disparities in our society, including those with poor health, who who live in crowded conditions, who are leery to speak with government officials because of their immigration status, and communities of color, especially the Latinx community. 

And the city’s efforts she said, had not been adequate. 

“There is still this disparity, which means that we have got to be aggressive and very deliberate about what we should be doing with this particular community in order to change what that disparity is,” she said. 

Colfax also said that San Francisco’s institutional memory of the HIV pandemic led city officials to move quickly in response to the pandemic, noting that “In looking at what was happening internationally at that time, there wasn’t a jurisdiction that appeared to have overreacted. The virus was always ahead of the actions that were taken.” He also credited the city’s strong partnership with UCSF as being “vital to our ongoing efforts to strengthen this work.” 

As Mission Local has reported, the decision to shut down the city early was one made by health officers representing six Bay Area counties, including San Francisco. We reported on the collective decision before it was announced

But while shutting down was (relatively) easy, opening up is a lot harder, Aragón said. Tensions abound between stakeholders who are interested in economic recovery and those who are concerned with public health.

Colfax described a tension between making sure the population understands the risk of covid and prevention fatigue. “We’re in a volatile time, and our message is going to continue to be to use the mask, do the social distancing, take the precautions. And we also know if people take those precautions . . . prevention works,” Colfax said, describing how San Francisco has flattened the curve twice.

Comparisons to HIV Epidemic

Dr. Diane Havlir, chief of the Zuckerberg San Francisco General Hospital’s Division of HIV, was quick to remind everyone that the city should not allow its initial successes to go to our heads. 

“One of the reasons that we’ve been successful in HIV is, we don’t pat ourselves on the back too much and we keep on saying, ‘this is not good enough,’” Havlir said, discussing the disproportionate impact that the coronavirus pandemic has had on the Latinx community since the start. At that time, over 80 percent of those hospitalized were Latinx. “That was a signal that this is a real disparity.” 

Havlir described her team’s work to “expose for actionable steps that we can take to reduce these disparities, to share data real-time with the community, with the health department, to get new strategies for us to really reduce the number of total cases, reduce the suffering” of the Latinx community, who still experience detrimental impacts even if they do not die from the disease. 

Havlir’s April study in the Mission was key in giving the city and health workers the data needed to focus on the Latinx community. That, however, failed to happen, and when she returned to the Mission to do another study in July,  rates remained inordinately high.

Dr. Paul Volberding, director of the UCSF AIDS Research Institute, drew connections between the lack of connection between the medical establishment and the Latinx community today to the lack of connection with the gay community before the AIDS epidemic, noting President Ronald Reagan’s refusal to address the AIDS epidemic publicly for several years. 

“Community engagement and community communications is super important,” Volberding said. Havlir’s team – perhaps because of its experience with HIV –  has been particularly innovative in collaborating as equal partners with local community groups such as the Latino Task Force. 

Wachter also highlighted the powerful activist arm of the AIDS epidemic, and asked Volberding about the lessons from HIV community advocacy. Volberding placed the fault with the medical and political communities, who allowed a gap in understanding with the community to grow so large that they were not being heard.  

“Going forward, that’s going to be really one of the important lessons: ‘how do we do a better job of that? How do we really seriously think about community engagement in ways that we didn’t appropriately in the AIDS epidemic?’” he said. Clearly, the lesson has not entirely sunk in. 

See our previous Grand Rounds coverage here

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FREELANCER. Madison Alvarado was raised in the Bay Area and moved to San Francisco after attending undergrad at Duke University. She fell in love with reporting in high school, and after a brief hiatus is eager to continue learning and growing as a storyteller. She has been covering UCSF's Grand Rounds since the summer of 2020.

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