Why experts are ‘not concerned’ San Francisco Bay Area’s COVID rate is highest in California

Solano is only Bay Area County not among highest rates in the state

SFGATE, By Amy Graff, April 6, 2022
San Francisco has the highest COVID-19 case rate of any other county in California, but experts aren’t concerned as cases and hospitalizations are still extremely low compared to what they were amid the winter surge. In this file photo, people wearing masks walk along at path in front of the “Painted Ladies,” a row of historical Victorian homes, and the San Francisco skyline at Alamo Square Park during the coronavirus pandemic in San Francisco. | Jeff Chiu/Associated Press

San Francisco County has the highest COVID-19 case rate of any other county in California with a seven-day average of 13 cases per 100,000 residents, state data showed on Tuesday. By comparison, Los Angeles is reporting 5 cases per 100,000 residents. And San Francisco isn’t the only Bay Area spot sitting at the top of the list. All counties in the region except Solano have among the highest rates in the state.

But multiple experts say this news isn’t alarming, and does not warrant any policy changes. Despite the region’s ranking, cases are extremely low compared to what they were amid the winter surge when the city’s seven-day average soared above 250 cases per 100,000 at the peak.

“No I’m not concerned,” said Dr. George Rutherford, director of UCSF’s Prevention and Public Health Group. “I don’t think it’s any reason to go back to putting the brakes on and our masks back on. We have lots of hospital capacity.”

“I am not too concerned as our hospitals remain eerily quiet — only 2 patients with COVID hospitalized today at the main UCSF Health hospital on Parnassus, compared to close to a 100 in this hospital on January 25,” UCSF infectious diseases expert Dr. Peter Chin-Hong wrote in an email.

“I don’t anticipate any lockdowns, and I am not even sure any restrictions will be re-implemented as long as our hospitals remain protected.” Chin-Hong continued. “There may be disruptions in the community in the workplace and schools as people need to be taken out to isolate for at least 5 days if infected. Is it interesting that countries like the UK, Denmark and South Africa have removed the mandate for a compulsory isolation when infected and this softens the potential disruptions to life in this way.”

While San Francisco’s case rate may not be concerning, you may still be wondering why it’s higher than other places. UCSF’s Dr. Monica Gandhi believes a primary reason is the city’s robust testing apparatus.

“We do a lot of testing in San Francisco with mass community testing sites established via a collaboration between UCSF and the San Francisco Department of Public Health,” Gandhi said. “This allows us to detect slight increases in cases better than other counties in the setting of BA.2 (now 72% of strains in the U.S.) and with increased movement of the population.”

Rutherford agreed that testing is playing into the city’s higher rate and added that the city is a medical hub and people are coming to the city for care that requires testing. “Theoretically, positive tests should be reported back to the county of residence, but that might not always be happening,” he said.

The highly transmissible BA.2 variant — that’s spreading at a time when more people are traveling and society is reopening — is another likely factor, said Chin-Hong.

“A combination of spring break travel, visitors from lots of other parts of the country and world (Asia, Europe), reopening and the resumption of large indoor events like sports and concerts,” Chin-Hong wrote in an email. “This is all fueled by BA.2, which is more transmissible in a city that is compact. There may be more susceptible people to infection in San Francisco and the Bay Area (compared to other parts of the state) who haven’t gotten breakthrough infection with BA.1 and whose immunity to infection has waned. Strategies that have been used in the past to avoid infection may not work quite as well with COVID.”

Could the Bay Area be at the start of a BA.2-driven surge?

The experts that SFGATE talked to all said they don’t expect cases to skyrocket.

“There’s going to be some sort of a sawtooth pattern and it’s not surprising that things are going to be up and down,” said Rutherford. “We’ll see some clusters and bumps from BA2, but I think the overall pattern is it’s going to broaden the base of that curve as it comes down.”

Chin-Hong emphasized that the region has high vaccination rates and this combined with immunity people infected with COVID gained during the original omicron surge “will provide enough immunity ammunition to protect people from getting seriously ill and so protect our hospital resources so we can continue to take care of the spectrum of non-COVID illnesses without interruption.”