Susan Philip, the acting health officer of San Francisco, and Manny Yekutiel, the owner of Manny's, engaged in a discussion about the delta variant and the pandemic. Photo by Annika Hom, taken on July 20, 2021.

Dr. Susan Philip, the acting health officer for San Francisco, looked tinier on the couch than I expected. But don’t be fooled. Though she may be small, she’s one of the city’s most powerful people right now. As the acting health officer, she wields the right to pen any health order into law, in the midst of a pandemic, no less.  

That’s precisely why Manny Yekutiel, the owner of Manny’s restaurant and cafe on Valencia Street and 16th, was seated Tuesday night across from her in his cafe’s “civic social gathering space.” Yekutiel, like the dozen or so others in that mirror-filled room slumped in comfy chairs and sipping beers, wanted to pick Philip’s brain. 

The short of it is, the Delta variant is infecting the city’s unvaccinated residents, and contains a higher viral load and appears to be more transmissible than other strains. 

“If people are unvaccinated now, it will find them,” the doctor warned gravely. 

The first question posed to Philip was one we’re all thinking, “Should I be wearing a mask right now?” Yekutiel asked earnestly. 

Philip, already wearing a black mask, said last week the county recommended indoor masking to help slow the surge of Covid-19 cases from the new Delta variant until they can study it more. It’s definitely preferable to shutting down again, she pointed out. “Masking is a relatively easy thing that is effective for us all to do,” Philip said. 

“Okay, thank you for that answer. I’ll put it on,” Yekutiel replied, slipping his on. 

How long will the mask recommendation — not a mandate, Philip emphasized — go on?, Yekutiel asked.  

Ideally, about three to four weeks, Philip said. 

That buys doctors enough time to see how this recent rise in cases will affect hospitalizations, though preliminary data now show nearly all current hospitalizations are from those who are unvaccinated, Philip said. (District 6 Supervisor Matt Haney shared a tweet saying that, out of the nearly 1,800 hospitalizations in the last seven months, only six people were vaccinated.)

Philip pointed to how other countries, like Israel, celebrated high vaccination rates and eliminated all health precautions, only to backpedal and reintroduce masking indoors, too. “So sadly, we’re in good company.”

That led Yekutiel to ask about when the pandemic would end. (Don’t we all?) Would it require the city to get to 100 percent of the population vaccinated?

“We were told that getting vaccinated was going to be the final frontier, most likely, and now we’re being told something else,” Yekutiel said, noting the whiplash sometimes felt “triggering,” a psychological term used to describe the feeling of reliving a trauma. I’m sure almost everyone in the audience empathized. So did Philip.

“I agree with you. We can’t just be like this indefinitely. We do have to come to some kind of equilibrium with this virus,” Philip said, noting how we live in peace with the flu despite the disease killing 3,000 or so people per year. 

But that three to four week monitoring period still needs to be analyzed to study how the Delta variant will affect hospitalizations, as it’s a “new variable.” Moreover, it is hitting underserved communities hard. Kids under 12 also can’t yet receive a shot. “I think when kids are eligible for vaccine, we’ll really be having this conversation much more,” she said. 

Lucky for parents, it appears that the Delta variant doesn’t harm kids more than other coronavirus strains. And, while it is possible, children showed low likelihood of contracting Covid-19 and becoming severely ill. 

I will interrupt to say, though, that the younger crowd — a wide umbrella from anywhere between 48 and early 20s — are the ones with the new Delta variant cases, according to health officials. 

Nevertheless, it seems back-to-school shopping is still on the to-do list, because Philip believes that kids can safely hit the books in person. Last winter, she said, less than five cases were found from open private schools that hosted some 48,000 students and teachers. 

But vaccinating the holdouts may be easier said than done, especially within populations which “rightfully have mistrust” in a vaccine, Philip said. As Yekutiel pointed out, the zip-code 94124 that encompasses the Bayview, is among the neighborhoods getting hit the hardest, and specifically, Census Tract 231.03, city data showed. In the meantime, the Department of Public Health is deploying community groups and doctors to vaccinate residents in hyperlocal efforts. 

Indeed, several vaccination sites are propped up in the city’s southeast, where underserved neighborhoods also became ground-zero for Covid-19 spread. “Equity means that you don’t give everyone the same thing. You actually place more resources into the community that historically have less because they will need that amount to have the same level of good health as everyone else,” Philip said. 

The city’s response “hasn’t been, you know, adequate 100 percent of the time. But I think what I will give us credit for is saying, ‘You’re right. That’s not the best way. Show us to tell us what’s the best way,’” Philip said, referring to the changes the Latino Task Force and University of California, San Francisco doctors achieved after they put pressure on the health department.

Should employers and their workers be required to be inoculated? Depends on your job, which Philip already noted in health orders. “I feel very strongly that we have an obligation that the staff have an obligation to protect the public that they are serving in those settings,” Philip said. “So in jails, hospitals, skilled nursing facilities, shelters, those staff are going to be required to get vaccinated by September 15th.”

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Yekutiel presented one more head-scratcher. “Take us through the next six to nine months. What does she look like?” he said, referring to a meme that personifies non-humans as “she.” 

The doctor gave a “hopeful” sign. Hopeful, she stressed. “The truth is always, the further out you go, the fuzzier your model is.” But, “it’s pretty good in the short term.” Taking it day by day allows her to cope. 

Then they passed the ball to the audience.  

So how dangerous is the Delta variant to vaccinated people, and what are long term effects? 

Essentially, while it’s possible to get infected if you’re vaccinated, the shots overall “are outstandingly good at the things you care most about, which is keeping people from getting very sick and dying.” But what it isn’t is 100 percent perfect, so there will still be people who test positive,” she explained. “And when you hear about that or see that, it doesn’t mean that the vaccines fail. It just means that there’s enough virus circulating out there that if you come into contact with it, you might test positive and you might get symptoms.”

Borrowing a quote from her colleague Director of Health Grant Colfax, she said the effects of those who are vaccinated versus those who aren’t is the difference between sniffles and suffocating.

“That’s a great image,” Yekutiel dead-panned. 

An artist wondered if performers should be required to mask up indoors if they know their vaccination status, because friends in Florida were asking him for advice. Philip clarified that mask rules are generally designed for parties where you don’t know people’s status. So in that instance, perhaps the audience should be required to cover up.

“They may not do it in Florida. I’m from Florida, so I could say that,” she said. In the state, any “mega” group with 5,000 people or more, such as some concerts or very important business conferences at Moscone, presently need proof of vaccination. 

Will we or should we have digital vaccination certificates, like France? She said it can be helpful, and there’s already a registry online for California, and Yekutiel jumped in to say he’s been asked before to show his. (Recent rumblings show that hundreds of San Francisco bars are going to require that, possibly as soon as this weekend.)

Then Philip got Yekutiel’s “rapid-fire” questions. She delivered, no sweat.

Will we go back to colored tiers? What about limiting how many people can hang in a group? Unlikely and nope. 

Does the vaccine prevent transmission? Yup, in a way. “The main way in which being vaccinated reduces transmission is that you don’t become infected and then become able to transmit those around you,” Philip explained. 

Should people get “boosters?” An elderly man, who already planned his trip to South Africa later this year, inquired. Because each person has different health histories, it’s up to your primary care doctor, though Philip doesn’t see a real harm in doing so. 

At the end, Yekutiel lobbied for one thing. It is his cafe after all. 

“If it comes time for you to make decisions about whether or not we should be forcing places to require a vaccination or get a Covid test versus restricting what business can actually do, I’ll just say that we need to have an opportunity to recover,” he said. “And if it’s all the same in terms of safety, I think a lot of establishments would be more comfortable just requiring people to show that they’d be vaccinated.” 

Like all public figures must, Philip nodded in consideration without promising anything. She seemed to understand. Earlier, she expressed the frustration caused by shelter-in-place unintended consequences — mental health and businesses, primarily. 

Finally, Yekutiel turned to the crowd and thanked them. He said to Philip, “let’s hope I never have to talk to you again.” 

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Annika Hom

Annika Hom is our inequality reporter through our partnership with Report for America. Annika was born and raised in the Bay Area. She previously interned at SF Weekly and the Boston Globe where she focused...

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10 Comments

  1. I am hearing about more people getting covid who are vaccinated. True, they don’t get very sick: but those of us who do not have normal immune systems could get very sick or die if exposed, even if vaccinated. This subgroup of “high risk” individuals includes elderly, folks who have a history of cancer, steroid use, autoimmune disease etc etc. So, in summary, even if you are vaccinated, if you do not mask and socially distance-especially in indoor environments we all must be in, like grocery stores, you could hurt someone. This is simply not being emphasized enough: San Francisco isn’t just a city of young perfectly healthy people.

    1. What also isn’t being said about the current surge is the chance of Long Covid in the mildly ill.

      It happened before (to people like me, my spouse, my neighbor) and no one is saying it cannot happen now. We all had different symptoms that took ages to recover from, but it was pretty awful all around.

    2. The odds of a breakthrough infection are the same as getting struck by lightning. The odds of it happening to an extremely immune compromised individual are therefore *incredibly* remote, by even the most remote of measurements. The odds of it resulting in death are… almost incomprehensible to the human mind. Just a bit of perspective to keep in mind.

  2. I think you misquoted Matt Haney–he said only six people were vaccinated, not unvaccinated.

  3. I think there’s a typo:

    “(District 6 Supervisor Matt Haney shared a tweet that said out of the nearly 1,800 hospitalizations in the last seven months, only six people were unvaccinated.”

    That should say “only six were *vaccinated*” right?

  4. Thanks Annika. Seems the City is taking a wait-and-see approach. While waiting, why not fill up the time by actually trying to put together something which has been shown to be effective in real world trials. It is unfortunate there was no discussion of test-trace-quarantine programs. I know it sounds so 2020, but nowhere in the U.S. including SF, despite big talk, was a credible program put in place. Although cases are up in countries which have these programs (and low vaccination rates) the Delta does not seem to be advancing as quickly as it appears to be right now in SF and around the state. It’s been over a year, and this city, so advanced in technology and so compliant with public health directives, still has only a barely functioning (to the best one can tell; the City is quite opaque on this) test-trace-quarantine regime which in other places have been shown to contain or moderate the spread of the virus. The City has put all its eggs into the vaccination basket, like last year the only “solution” was to close things down. Shut downs don’t seem to be an option at this point, so we will probably see some kind of “vaccination passport” thing, like the one the bar owners are currently contemplating. Obviously, this has the potential to make the fights (physical and political) over masking pale in comparison.

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