Your questions on the Delta variant, masking recommendations, and more answered by SF’s health officer

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. 

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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.”

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. 

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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.”