30 October Blog Post: COVID-19 and the San Francisco “Miracle”

Returning to a topic I have covered in previous blog posts – the San Francisco COVID-19 response has generally been laudable. But a strange this is happening in the press such that it is now being presented as the paragon of public health response. This week the @latimes published an article entitled “How San Francisco became a COVID-19 success story as other cities stumbled” (link: https://www.latimes.com/california/story/2020-10-25/san-francisco-slow-coronavirus-reopening).

In the article, UCSF Chief of Medicine Dr. Robert Wachter (who writes weekly “COVID Chronicles on his Twitter feed @Bob_Wachter and is an encyclopedia of knowledge – well worth a follow) is quoted saying “We have, at least so far, done everything right.” Dr. Larry Brilliant (@larrybrilliant – also worth a follow), an epidemiologist who was a significant contributing force to the @WHO smallpox eradication effort chimed in saying “San Francisco continues to lead the nations [sic] large cities in effective COVID-19 response. Proof that SF is not just another pretty face!”


While the first bumping and self-congratulation of these two esteemed Bay Area residents seems to be a light in a dark time in our country, their fervor isn’t matched by the data. In addition, they serve only to divide the country further into those who “get” COVID and those who don’t. Mask wearing, hand washing cities of science get to dance after the hammer (analogy is in the LA Times article) while other municipalities do not. Comparing Los Angeles’ pandemic experience with San Francisco’s, Wachter evens wonders aloud whether the difference in Los Angeles’ response as compared to San Francisco stemmed from “leadership or the people.” 


The problem I have is that San Francisco has had the exact same difficulties which have faced every other municipality in the world. They benefit only by comparison to the United States as a whole, which is worst in class. Sort of like saying my Buick Skylark is superior to your Ford Pinto, simply because the Skylark didn’t suffer from an exploding gas tank (apologies to those of you born after 1980 for the reference).

The figure below shows that San Francisco suffered the exact same mid July surge that plagued much of the United States. Case rates, having hovered in the 3-5 new daily cases per 100,000 jumped sharply to over 15. Recovery to baseline rates below 5 was slow. Whereas the acceleration in cases occurred from 6/19/2020 to 7/17/2020 (one month), the recovery extended until 10/9/2020 (three months). Note that since early October, cases are again rising (a pattern we are also seeing in Los Angeles).

Additionally concerning is the recent spike in mortality rates (Figure below).

Unlike many large municipalities, San Francisco has actually had weeks in which the mortality rate was zero. However, since late September, mortality rates have spiked – which is a very different pattern than we have seen in Los Angeles or nationally. Granted, San Francisco is a relatively small population (883,000) so rates can whipsaw in a way not seen in a larger denominator such as Los Angeles.

The Los Angeles Times article further quotes Dr. Wachter explaining that if the entire country had followed San Francisco’s approach, Wachter said, there would be 50,000 dead from the pandemic instead of more than 220,000. Here San Francisco benefits by comparison.

To date, there have been 145 deaths in San Francisco – population under a million. In Seoul, South Korea there have been 57 deaths – population 9.9 million.

So, no San Francisco, you haven’t done “everything” right. And the tough part of the pandemic – the dance – has yet to come.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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