How San Francisco plans to avoid a winter COVID surge

City jumps ahead of CDC to expand booster shot eligibility for all adults

San Francisco is going all-in on a not-so-secret weapon to prevent another disastrous winter COVID surge: Vaccines and booster shots.

“As people gather and engage in the busy holiday season, contact rates will increase, and there will be more opportunities for the virus to spread,” San Francisco Health Director Dr. Grant Colfax said this week. “As a result, we could see a significant increase in hospitalizations particularly for high-risk people.”

As cases of COVID-19 tick up across the country and state, San Francisco is experiencing a moderate increase in cases as well. Hospitalizations resulting from those cases, however, have remained low with just about 30 people across The City hospitalized for COVID-19 as of Wednesday.

But city and county health officials still say there’s room for concern and are telling adults over 18 who were vaccinated more than six months ago to get a booster, and urging children 5 and up to get vaccinated if they haven’t already. San Francisco currently is in the orange “substantial” category of coronavirus transmission, according to criteria set by the Centers for Disease Control and Prevention.

“We don’t know if this rate will continue at the slope it is now, but it indicates we need to use the tools we have to protect ourselves from COVID-19,” said Colfax. “I ask that during this holiday season, we give ourselves and our loved ones the gift of protection… that gift is best given through vaccines.”

Thousands unvaccinated

Even in San Francisco where more than 80% of the eligible population has received shots, thousands of residents are still unvaccinated.

To prepare for a projected rise in COVID cases this winter, San Francisco health officials recently decided to bypass federal-level debates and expand booster shot eligibility for all adults, which the CDC followed on Friday. California expanded its state guidance last week, and on Thursday, the state updated its MyTurn online vaccine website to include booster shot sign-ups.

Pfizer and Moderna recipients may receive a booster six months after their second dose. San Francisco public health officials said, in particular, seniors 65 and older, people with underlying medical conditions and people who work in high-risk settings should receive a booster as soon as possible.

Additionally, all Johnson & Johnson recipients should receive a booster two months after their previous dose, health officials said.

“I want to emphasize how effective these vaccines are. They are saving lives and keeping people out of the hospital,” said Colfax when asked about jumping ahead of CDC guidance. “There is also data showing immunity to the vaccine wanes after 6 months. We are working to stay ahead of the virus.”

San Francisco is heading into Thanksgiving week in much better shape than a year ago. Nearly 87% of SF residents ages 5 and up have received at least one dose of a COVID-19 vaccine, and 80% of residents 5 and older have a completed series.

More than 30% of children between 5 and 11 who were made eligible for the vaccine only a month ago are vaccinated.

Part of the decision to open up vaccine eligibility was to clear up previous booster guidance that outlined eligibility for only certain groups. The mixed messaging has been frustrating for people like Michael Curtis, who recently experienced a breakthrough case of COVID-19 after attending the Outside Lands music festival over Halloween weekend, which required proof of vaccine or a negative COVID-19 test within 72 hours of the event.

“I was considering getting a booster before the festival because I got my original second dose at the end of March, so I was seven months out. But I didn’t qualify for it, even though a bunch of my friends did get one before we went,” Curtis said, who had a mild case and says none of his friends at the event tested positive.

“I was a little upset that I was misled to believe I should not be taking up a booster shot when now I hear there are plenty to go around,” Curtis said, adding he still had a great time at the event. “If I got a booster shot, I may not have gotten sick.”

Breakthrough cases are to be expected, experts say, and the majority of these cases are mild and do not lead to hospitalizations for vaccinated individuals.

But as the body of research grows showing the strength of the vaccines wanes over time, getting a booster shot ahead of the holidays is the best tool to prevent spreading the virus to those who are at high risk, Colfax said.

“I’m nervous about waning immunity in people over 65. California is one of the lowest states with booster uptake because we sailed through the year with lower cases compared to other states,” said Dr. Peter Chin-Hong, an infectious disease expert at UCSF. “But the silver lining is we can still do a lot now. You can vaccinate your kids and get boosted before the holidays and just be vigilant in general.”

About 43% of San Francisco seniors ages 65 and older, who are among those at the highest risk, have received a booster.

Booster backup

Already, concerns are bubbling as appointments for booster shots get snatched up quickly across The City and private healthcare providers are lagging to align with San Francisco’s booster policy.

“Shutting down five Walgreens across The City doesn’t help; those are in major areas that tons of people rely on,” Chin-Hong said, referring to recent drug store closures in San Francisco.

Health officials say The City is currently delivering about 3,900 booster shots per day. More than 100,000 booster doses have been given in San Francisco since they were authorized starting with higher-risk groups in September.

Vaccine clinics run by SFDPH will not turn anyone away who comes in for a booster, Colfax said. Further guidance on boosters and when to get them can be found here.

Some adults have been able to get a booster while taking their child to get their initial vaccine series. The health department teamed up with San Francisco Unified School District to open four vaccination clinics at schools this fall. The district also sent out text messages, phone calls and emails to families in multiple languages to encourage them to make appointments for children to get vaccinated.

“I encourage every parent and guardian to get their child vaccinated as soon as possible. When your child is fully vaccinated, they won’t have to quarantine if they are considered in close contact with someone who has tested positive for COVID,” said Superintendent Dr. Vincent Matthews. “Let’s keep our students in school and learning in person.”

Laura Dudnick, public relations manager for SFUSD, acknowledged initial demand for pediatric vaccines is high and appointments may be hard to get. “We are letting families know to check back frequently if they don’t see an appointment at first,” she said.

The City’s health order is still in effect, which requires masks indoor in most public settings including retail and grocery stores, and proof of vaccinations at indoor establishments such as restaurants and bars.

San Francisco, along with eight other Bay Area counties, has established criteria for removing mask mandates, and Colfax said he doesn’t anticipate mandate changes to come before the end of the year.

“This holiday season, it’s wonderful to see us resuming the many festivities, gatherings, and travel that make us feel whole again and connected to one another,” said Colfax. “Our best tools to combat the worst of COVID-19 are vaccines, including boosters.”

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