When San Mateo County’s Health Officer on Wednesday announced that businesses would on May 18 be allowed to open for curbside and delivery activities, government officials in other counties were puzzled. But hardly surprised.
As recently as April 28, San Mateo denizens, at their Health Officer’s insistence, were barred from traveling more than five miles for recreational purposes. But, just two weeks later, San Mateo was officially announcing it’d be opening up — and essentially decoupling from the six counties that joined to issue the March 17 shelter-in-place order.
On the day before San Mateo County announced it was loosening restrictions, it recorded nine deaths, its most in three weeks. “The numbers in San Mateo are getting worse; they’re higher than in any other Bay Area county but San Francisco,” noted a Bay Area government official.
Per the website CovidActNow — which our Bay Area leaders do peruse — San Mateo’s R0, its COVID growth rate, remains positive. Every sick person is, currently, infecting 1.06 more people. As of Friday, Santa Clara County, just to its south, had a negative growth rate of 0.86. San Francisco is at 1.08 (the city’s health officials, however, peg us at a tally just below one — down from 3.5 in March).
These differences, while apparently trivial, are far from that. This BBC chart indicates what even a slight difference in R0 means over time.
Officials I spoke to hailing from over bridges and across county lines saw San Mateo’s move to partially reopen as a concession to political and business pressure. And they predicted San Francisco would soon announce a similar plan to open up on May 18.
This actually occurred in the midst of one of our phone conversations.
Closing time at Pancho Villa.
Come Monday some 95 percent of San Francisco businesses will be permitted to reopen, albeit with severe restrictions. Retail establishments will be operating on a curbside and/or delivery basis and warehouse-like facilities will do so on a reduced capacity.
“What this means for the city is incredible,” Mayor London Breed said at a Wednesday press conference. “It’s obviously great news for retailers,” San Mateo County Supervisor David Canepa told Mission Local earlier in that day.
Well, hopefully. But that all depends — it was “incredible” and “great news” for the Warriors when Kevin Durant suited up for Game 5. But it didn’t end well.
The six counties — and California writ large — were supposed to re-open based on statistical measures; as Dr. Anthony Fauci has put it, “the virus sets the timeline.” But Breed has for weeks earmarked May 18 as the date to move things forward.
San Francisco health officials note that we have reached our goals of daily testing two people for every 1,000 city residents (that’d be about 1,600 tests per day). At a Friday UC San Francisco COVID-19 Town Hall, the expert panel spoke highly of the city’s robust contact tracing program, our available hospital capacity, and our ramped-up testing and relatively low instance of positive tests.
But it’d be harder to argue we’re adequately testing heavily enough among some of our most vulnerable populations — nursing home residents and, especially, homeless people or SRO dwellers — who would test positive, at a high clip, and throw off our city’s numbers and narrative.
“San Francisco has put the cart before the horse,” said an out-of-county official. “It has pre-judged the outcome.”
But we’re far from the only ones.
“A few weeks ago [Gov. Gavin] Newsom set up criteria for what it means to re-enter. And that criteria hasn’t been completely followed,” said Dr. John Swartzberg, a UC Berkeley clinical professor emeritus specializing in infectious diseases and vaccinology. “I understand that there’s tremendous political pressure on him but when you set up criteria and don’t follow it, it leads to confusion. And the last thing we want is confusion when dealing with a pandemic.”
But we are a confused nation right now. And with county after California county pushing for variances to the state rules for re-opening, things are confusing here, too.
As for San Francisco, Swartzberg said that he’s concerned: “We may be taking a greater risk than we should be taking.”
Dolores Park, March 16, 2020, 2:43 p.m. Photo by Emma Silvers
Swartzberg is an infectious disease specialist, but he knows that the commonality between death from COVID-19 and death from malnutrition is death.
“If you don’t have any money, that is dangerous to your health, too,” he says. “It’s hard to be hypercritical of what’s going on here. People are trying to do the best they can.”
That’s along the lines of what Canepa said when asked if this was the time to open up San Mateo County.
“Some people who are privileged can work from home. Others are not privileged. They have to work two or three jobs and unemployment is so high right now,” he said. “In my district, food lines are getting longer and people have trouble getting day-to-day necessities. There’s public health and economic health — it’s chicken and egg, right?”
Canepa is right. And San Francisco (and everywhere else) is facing a crippling budget shortfall, in part driven by vanishing sales tax revenue.
But balancing economic health vs. health from a deadly disease as an either-or is a false and destructive choice. And arbitrarily picking a date to re-open the economy is — to use a highly technical term from Stanford School of Medicine assistant clinical professor and infectious disease specialist Dr. Jake Scott — “stupid.”
In the past two months of sheltering-in-place, we haven’t yet developed a medical therapy that’s effective against COVID-19, he says. The city has only just begun to engage in universal testing in skilled nursing facilities — the driver for this state’s Coronavirus casualties — and has, markedly, not yet started systematic testing of congregate living facilities such as homeless shelters, let alone the city’s burgeoning encampments.
As the Public Press reported last month, the city in fact pulled the plug on a plan to test its homeless shelter residents — free of charge, in fact — to instead focus on nursing facilities.
President Trump was rightly mocked for his rambling charge that COVID-19 testing was “overrated” because “When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.”
But as long as San Francisco isn’t testing aggressively among its most vulnerable populations, the city’s prevalence count will be artificially tamped down.
Lights flicker from tent.
And testing is overrated if not coupled with aggressive contact tracing. “It doesn’t make sense to test someone and find out they’re positive if you’re not going to find out who they’ve had contact with and get them into quarantine,” said Swartzberg. “Gavin Newsom has asked for 20,000 people to be trained [as contact tracers] within a short period of time. Well, that’s aspirational. I hope we can do it. But, in the long run, we’ll probably need two to three times that many people.”
San Francisco officials stressed that our growth rate has dropped to the point that a tentative re-opening was prudent. “This is a meaningful step on the gradual path to the new normal,” said Department of Public Health director Dr. Grant Colfax at Wednesday’s press conference. And Breed insisted that now was the time to begin focusing on economic recovery.
But Scott insists that the good work we’ve done in the past two months has not tamped down the prevalence of the virus: “It strikes me as naive to think that just because we’re tired of physical distancing and businesses being closed, okay, we’re done. We don’t have efficacious medical therapies. We don’t have a vaccine.”
Due to the one- to two-week incubation period for COVID-19, it may be some time before we know whether Monday’s move to loosen restrictions was prudent — or merely wishful thinking masquerading as public policy.
Scott, for one, would only feel confident about re-opening the economy “if we could test large swaths of the population and do contact tracing and isolation and ensure the most vulnerable populations were supported if there were outbreaks in long-term care facilities and among the homeless.”
These populations, he notes, “will be hit especially hard. What have we done to ensure they’ll be safe? What do they get out of restaurants reopening?”
He answers his own question: “They’re going to get sick.”
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