How San Francisco reduced its COVID death rate to zero

Every Thursday for the past year, the 700 block of Alabama Street in San Francisco has been closed to traffic. It was the city’s first community-based coronavirus testing site and at its peak, it was testing more than 500 people per day. Things have gotten a lot slower lately. In the meantime, a volunteer walks up the block, sweeping the street by hand.

Almost all of the action moved three blocks away, to a vaccination site set up in a union hall. In his parking lot, residents sit neatly spaced apart on folding chairs, waiting 15 minutes to make sure they haven’t had any adverse reactions. It was the first San Francisco site to offer vaccines to children as young as 12 years old.

“We don’t panic, we pivot,” explains Valérie Tulier-Laiwa, coordinator of the Latino Task Force, which runs the two sites. “We just react and respond continuously. “

The same is true of the city as a whole. Arguably, no city in the country has responded as successfully to COVID-19 as San Francisco. Its per capita death rate throughout the pandemic has been about a quarter of that of Los Angeles and New York. The total number of deaths during the month of May could be counted on the fingers of two hands. Four deaths from COVID-19 were recorded on Sunday, breaking a two-week streak without deaths.

New cases are now less than 2 per 100,000, or about 16 per day. More than 77 percent of the population aged 12 and older has received at least one dose of the vaccine, meaning more people have been vaccinated in the 49-square-mile city than quite a few states.

Alabama Street is closed to cars on COVID-19 test days.

(Alan Greenblatt)

“People’s behavior, which can only be legislated to a certain extent, tended to conform more to major public health recommendations, more than anywhere else in the country,” says Bob Wachter, who chairs the Department of Medicine. University of California, San Francisco (UCSF). “There was a general consensus that this was serious and hardly any hindsight on the types of restrictions that made the most sense from a public health perspective.”

Yellow and blue safety warnings are ubiquitous throughout the city. San Francisco has benefited from a unified political response and a public health service considered to be one of the best in the country. “Frankly, many states don’t have the level of expertise of the San Francisco Department of Health,” says Art Reingold, an epidemiologist at the University of California at Berkeley.

For all of this, Wachter says the city has been lucky again. Citizens could have acted responsibly, but the city could still easily have been “skimmed” by high-profile events, he says.

“This is in part due to very careful policy design and implementation,” says Paulette Cha, a researcher at the Public Policy Institute of California, a think tank in San Francisco, “and part, frankly, didn’t is just chance. “

The many assets of San Francisco

San Francisco is a city of neighborhoods. Along commercial corridors such as West Portal and the Richmond District, apparently half of the parking spaces have been filled with wooden shelters to leave more space for alfresco dining. Thanks to the city’s mild climate, staying outdoors has been an option all year round.

The city has closed many streets to open up recreation space, including the 3.5-mile Great Highway that runs along the Pacific Ocean. Cha says the city has benefited during the pandemic from both its density and “de-densification,” as the city has lost population in the past year.

With nearly 18,000 people per square mile, it’s nearly impossible to get out without bumping into neighbors. This allowed people to make a habit of wearing masks, which city officials first recommended and then made mandatory as early as April 2020.

Even now, it is rare to see someone in public without a mask, even passing cyclists or individuals walking dogs on empty streets at night. “Now there is a social stigma for not wearing a mask,” says Ashwin Kotwal, a doctor at UCSF. “It has become a normal part of the way we act on the outside.”

The city has lost around 2% of its population in the past year. It has also lost a lot of its tourist business. Many of Chinatown’s storefronts are not only closed but barricaded. It is easy to get a parking space in the Golden Gate Bridge Visitors Square, which is decidedly not true during a normal spring.

The city’s army of tech workers have not only been able to work remotely, but in many cases have been ordered to do so, with companies such as Facebook and Twitter sending people home before orders from the city. The office rental business fell by 71% in 2020.

“The business community, which is primarily the tech community, was completely on board,” says Wachter, “and sent signals to their employees that this is something serious.”

Stay in sync

San Francisco has developed an ethics of compliance. The city gave only 12% of its votes last year to Donald Trump. “There has been no cry to liberate San Francisco,” Wachter says. “There was pain, but there was a general consensus that it was the right thing to do.”

Across much of the country, people live in jurisdictions where mask warrants and indoor eating bans are just starting to lift, while restrictions may have ended months ago within a mile. and a half from the road. This is not the case in San Francisco.

San Francisco, which is both a city and a county, has worked with neighboring counties in the Bay Area. They were the first courts in the country to issue stay-at-home orders. California was the first state. “If San Francisco was locked in hard and San Mateo County wasn’t, it wouldn’t be a very successful effort,” says Cha, the research associate at PPIC. “They had a real motivation to work together towards a common goal.”

The city’s public health department benefited from other local partners, forming an advisory committee of scientists from institutions such as UCSF and Berkeley who carried out detailed studies and closely monitored rates of infection and hyperlocalized hospitalization.

UCSF is a huge medical complex. With more than 26,000 teachers and employees, it is one of the largest employers in the city. Its protocols have helped set the tone for a large part of the population. He also has a lot of experience working with community groups. Muscles formed during the height of the HIV / AIDS crisis were ready to be flexed against the coronavirus.

A health worker posing next to a patient who has just been vaccinated.

Camika Robinson, who teaches in the Mission District, felt strong after being vaccinated. (Alan Greenblatt)

Difference between night and day

A serious AIDS response must have been triggered by pressure from activists and the affected community. To some extent, the same was true of COVID-19.

The city’s initial testing center was set up at the Embarcadero – convenient for downtown but not for residents of the southeastern quadrant of San Francisco, where much of its non-English speaking population lives. The Latino Task Force, a coalition of community groups in the Mission District, formed the same week as the town’s shelter-in-place order. “We knew instinctively that the pandemic was going to hit our community,” says Tulier-Laiwa, “so what are we going to do about it?

The task force had to fight City Hall for approval and supplies for its Alabama Street test site. It took months. The city was only willing to provide 100 test kits per week, although coronavirus cases were particularly high in the mission. The task force has launched a media campaign to ask for more help. A resident survey co-sponsored by UCSF and the working group clearly demonstrated the need.

“If you have a 14% infection rate, you’re not just sending buckets of water, you’re sending the whole battalion,” says Jon Jacobo, chair of the Latino Task Force’s health committee. “You send all you’ve got and put out the fire.”

Jacobo is still seething with frustration over the city’s initial response last year, saying it failed the Latin American community at the start of the pandemic. It’s all changed. After the task force secured hall 261 from the local workers’ union as a potential vaccination site, the Department of Public Health (DPH) approved it on the same working day. A DPH official was there a recent afternoon, training volunteers on how to conduct admission interviews.

Although Latinos in general and residents of the Mission District in particular have suffered a much higher number of cases than the city as a whole, their infection and death rates are much lower than comparable neighborhoods in other areas. cities. The three community sites set up by the Latino Task Force have provided more than 27,000 vaccinations. “It’s a difference day and night,” says Jacobo.

A man wearing a face mask standing on a sidewalk in front of a wall painted with cartoon characters.

In San Francisco’s North Beach neighborhood, stores are closed and foot traffic is low, but pedestrians remain masked. (Alan Greenblatt)

The other problems of the city

San Francisco’s relative success in the fight against COVID-19 is not without cost. The San Franciscans of the Mayor of London Breed were frustrated with the school district, which allowed only a few days of classroom learning just at the end of the term, in an apparent effort to secure $ 12 million in reopening funds of State. An effort to recall school board members collected more than 12,000 signatures.

Kotwal, the UCSF doctor, published a study on the pain of social isolation and loneliness among Bay Area seniors during the pandemic. “We are seeing long-term impacts on the health of older people already involved in the community,” he says.

Last year, twice as many people died in San Francisco from drug overdoses as COVID-19. Homelessness has been a major problem for West Coast cities for years, but it has become more visible in San Francisco. Rather than hidden by viaducts, rows of tents now line many of the city’s sidewalks.

San Francisco has been one of the country’s booming cities for the past decade, but along with New York it appears to have been hit particularly hard by the pandemic in terms of population loss and falling commercial and residential rents. . Last year, big companies like Oracle, Hewlett-Packard, and Charles Schwab all moved their headquarters out of the Bay Area.

But rents – and foot traffic – are starting to rise again. San Francisco has never stopped reinventing itself since the days of the 19th century Gold Rush. There is no reason to believe that it will not remain one of the fastest growing cities in the country.

And it will emerge from the pandemic as one of the healthiest cities in the country.

“It hasn’t been a 100% pink story,” Cha says, “but the net effect has been that we’ve done pretty well on COVID.”


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