Experts say it’s time to shift our COVID strategy. But is San Francisco ready?

‘COVID is here to stay…it has adapted to us, and we must adapt to it’

As cases and hospitalizations begin to decrease, again, how San Francisco emerges after yet another COVID-19 surge is shaping up to feel different this time around.

Walking downtown and around busy corridors in The City, it’s clear San Francisco is not shedding its COVID adaptations just yet. Pandemic reminders such as plastic dividers on tabletops at Zeitgeist, a popular dive bar in the Mission, or masked e-scooter riders along the open-air Embarcadero paint a uniquely San Franciscan picture of how scientific data, policies and public opinion don’t easily go hand in hand.

“COVID is here to stay. It has adapted to us and we must adapt to it,” San Francisco Health Director Grant Colfax said Feb. 1 at a Health Commission meeting. “There may be future variants and surges. We can learn to live with COVID in ways that do not fully upend our lives.”

California’s statewide indoor mask mandate for vaccinated residents will expire after Tuesday, with the exception of K-12 schools. In San Francisco, which requires a mask indoors regardless of vaccination status in places such as grocery stores, restaurants and large indoor events, public health officials are now evaluating local mask policies following the state announcement.

Some infectious disease experts press that city and state health leaders aren’t going far enough to adapt messaging and strategies to an endemic, rather than the pandemic response that’s been engaged since March 2020.

“We are still in a pandemic strategy mode. There is still an idea in the City of S.F. that we can eradicate the virus, and that’s just not going to happen,” said Monica Gandhi, who leads the Division of HIV, Infectious Diseases, and Global Medicine at UCSF and San Francisco General Hospital.

The City’s public health officials changed their tune on COVID-19 during the most recent surge, which soared past previous case spikes with other variants. But hospitalizations and deaths have remained relatively low even alongside the all-time high in cases in San Francisco, where 82% of individuals are vaccinated and 64% are boosted — far higher than the state and national average.

The goal is no longer to prevent every case of COVID, but instead, to keep hospitalizations and deaths low, Colfax said. “Many people have or will get COVID, and going forward we need to focus on an equity-driven response and prevent hospitalization and deaths.”

San Franciscans who feel skeptical likely remember how the delta and omicron surges unraveled daily life just weeks and months after Gov. Gavin Newsom lifted statewide pandemic orders on June 15.

But San Francisco is now in a much different place with the virus compared with previous surges, according to Peter Chin-Hong, another infectious disease expert at UCSF. With vaccines and boosters, plus widespread testing and therapeutics for those who get sick, omicron’s impact paled in comparison to prior surges and hospital bed capacity remained manageable.

Masks are donned with regularity in San Francisco even though they are not required in certain settings. (Craig Lee/The Examiner)

Masks are donned with regularity in San Francisco even though they are not required in certain settings. (Craig Lee/The Examiner)

“The goal has shifted from preventing infection to preventing serious disease. At the same time, another goal should be just keeping our workforce going, which does impact infections,” said Chin-Hong.

Policy changes for San Francisco are trickling through in response. Mask rules for fully vaccinated and boosted individuals in indoor settings have been lifted, and quarantine rules for children in daycare settings and asymptomatic individuals have been shortened.

But public attitudes remain hesitant, masks are donned with regularity, proof of vaccines are required for adults and children at indoor establishments and public transit ridership remains dismal compared to prepandemic levels.

“There is still a lot of fear about COVID. That fear played into S.F.’s messaging more than any place I’ve seen. That’s why our schools were closed the longest. No wonder people are still terrified,” said Gandhi.

San Franciscans are less likely than the average California resident to spend time outside of their home, according to a January report from the Office of the Controller. And while office attendance has crept up, San Francisco is sticking with remote work more than other major metro areas including Los Angeles, San Jose, New York and Austin, the report shows.

Masks are required in San Francisco at indoor public settings such as in stores, on public transit and at schools, although masks are no longer required in cohort settings such as offices and gyms where everyone is fully vaccinated and boosted.

“I had COVID. It’s a real thing and it knocked me out. But I want to go back to normal,” a traveler named Joey told The Examiner on the Embarcadero. He was visiting from Arizona on a business trip and said San Francisco continues to have among the strictest rules he’s encountered since traveling again for work around the country.

Others are not there yet. San Mateo resident Andrea Lopez was sitting outside the Ferry Building on a recent Friday morning with the child she babysits, who is too young to get vaccinated. “I’m more relaxed now, but I think it’s a good idea to show vaccine cards and keep masks on when we’re inside,” she said.

The City is now beginning to evaluate how shifting health priorities should be reflected in the upcoming budget for longer-term COVID interventions.

On Feb. 1, local public health officials shared that they intend to put a $25 million “down payment” for ongoing COVID operations and expenses. City documents show the latest budget will shift “COVID-19 response functions into operations.” Last year’s budget COVID-19 budget totaled about $98 million through a mixture of city funds, grants and FEMA funds. That included dollars for “enhancing” COVID responses in disease control, data maintenance, community engagement, vaccination and testing efforts and more.

Exact dollar amounts for the upcoming fiscal year’s COVID testing, contact tracing, vaccination efforts and other emergency response initiatives will get hashed out between March and May. Allocations are subject to change in Mayor London Breed’s final budget proposal.

For the upcoming year, Gandhi said, “I would invest in information campaigns about vaccines. I would invest in testing only symptomatic individuals. And I’d ensure those in our municipal health care system, Healthy SF, have access and we purchase Paxlovid and other medications for them.”

Many infectious disease experts agree a shift in COVID protocols is warranted, but differ on when and what strategies and funding allocations should entail.

“We definitely need to invest in testing programs,” Chin-Hong said. “Counting cases gives us a sense of how dynamic (COVID) is in the community and it gives us a sense of when the storm is coming. Wastewater epidemiology has helped us get a glimpse into the future, and I hope these can help us predict another surge in the future.”

Adding complexity to the equation is the fact that other variants could be on the horizon, and those making decisions about The City’s public health response are still grappling with the fallout that took place in December and January when thousands of city workers, transit operators and teachers were out sick.

Policies vary across the Bay Area. Oakland began requiring proof of vaccination for restaurants, concert venues, gyms and other indoor settings as of Feb. 1. Nearby Contra Costa County, however, announced Friday it will drop its indoor proof of vaccination requirement now that 80% of its residents are fully vaccinated.

Meanwhile, other countries and major U.S. cities including Austin and Seattle have seen a much faster rebound for time spent outside of the home, tourism and office attendance.

Denmark, which has vaccination (81%) and booster rates (60%) very similar to that of San Francisco, recently became the first European country to lift all COVID-19 restrictions. Despite still having a high case count, France and Sweden have followed suit.

Top infectious disease experts in the United States however say the county as a whole is not ready to make that pivot. About 64% of Americans are fully vaccinated and 25% are boosted.

“We are not there right now,” Dr. Anthony Fauci said Jan. 26 regarding drastic changes to pandemic responses. The United States had far more deaths from the omicron surge compared with other wealthy nations including Canada, Australia, Japan, France, Britain and Sweden.

In San Francisco, public messaging is walking a fine line of balancing public fears and watching what might come out of other countries shifting to endemic gear. But it doesn’t appear The City is taking a page from Denmark just yet.

Dalia Michelson and her father Yaron Michelson, visiting from Israel, ride bikes near the Ferry building. Travelers say San Francicans tend to be less likely to give up their masks than people in other cities. (Craig Lee/The Examiner)

Dalia Michelson and her father Yaron Michelson, visiting from Israel, ride bikes near the Ferry building. Travelers say San Francicans tend to be less likely to give up their masks than people in other cities. (Craig Lee/The Examiner)

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