Category Archives: San Francisco Bay Area

What’s the risk of getting COVID outside? New variants may have changed the answer

A mask-wearing woman stands in the middle of an unmasked crowd at the BottleRock Napa Valley music festival in May. Jungho Kim/Special to The Chronicle

San Francisco Chronicle, by Aidin Vaziri, July 7, 2022

Summer in the Bay Area means outdoor parties, weddings and music festivals, where people can worry a little bit less about catching COVID-19. But will fast-spreading offshoots of the omicron coronavirus variant change the equation this year?

The highly infectious and immune-evasive BA.4 and BA.5 sub-lineages of omicron are now the dominant strains in Northern California, according to data published by the Centers for Disease Control and Prevention. COVID infections are up across the state as the test-positivity rate nears record levels, meaning the risk is higher in nearly all settings.

“We know they’re more transmissible, so the risk is greater inside or outside,” said Dr. John Swartzberg, an infectious disease expert with UC Berkeley.

Health experts agree that outdoor activities are still much safer than indoors, since viral aerosols don’t have a chance to accumulate in the air. But with the most transmissible variants yet, chances are you have less protection in certain situations.

“Being at parks and outdoor sporting events is still what we should turn to,” said Dr. Anne Liu, an infectious disease doctor at Stanford. “But if you are in a dense crowd or in an outdoor space that has been modified to look like an indoor space, then the risk becomes higher.”

In other words, walking on an isolated hiking trail or a breezy beach is a lot safer than standing shoulder-to-shoulder with celebrants under a tent at a wedding or singing and dancing with fans crammed into an outdoor concert.

Summer means outdoor activities, where the risk of getting coronavirus is supposed to be low. But will new new COVID variants change things? An attendee of Stern Grove Festival’s opening concert was one of the few wearing masks for the event at Sigmund Stern Recreation Grove in San Francisco in early June.  Laura Morton/Special to The Chronicle

The omicron sub-lineages are so new that infectious disease experts are still measuring their potential impact, even in outdoor settings.

“The risk outside is going to be substantially less than inside but we don’t know if it’s changed because we haven’t had a lot of experience with BA.4 and BA.5,” said Swartzberg. “We’re basing our assumptions on BA.1 and BA.2.”

Given the high rate of infection across the Bay Area, there is more virus circulating in the air, so it’s better to be cautious in any environment. That means masking, social distancing, and being aware of your surroundings.

“The chances of being around someone outside or inside who is shedding virus is very high,” said Swartzberg.

Even for those who were recently infected, the new variants don’t offer much protection against catching the virus again, according to Dr. Peter Chin-Hong, an infectious disease expert with UCSF.

“The newest kids on the block, BA.4 and BA.5, cause a lot more reinfections,” he said.

There are certain outdoor situations when you should even consider wearing a mask.

“If I was crowded together with other people where I couldn’t keep my distance, or if somebody near me was talking loudly or singing, I would just carry a mask with me and put it on if I feel uncomfortable,” said Swartzberg.

Wedding receptions and concerts are some examples of high-risk environments where you would likely slip on a high-quality mask, such as an KN95 or KF94, especially if you need to go inside to use the restroom or pick up drinks from the bar.

“These are really transmissible variants. It doesn’t take much time to pick up the virus,” Liu said.

Some people wear masks as Kaitlin McGaw and Tommy Soulati Shepherd read “You Are Not Alone” on stage during the Bay Area Book Festival at Martin Luther King Jr. Civic Center Park in Berkeley in May.  Brian Feulner/Special to the Chronicle

So far, the CDC guidance for outdoor masking is unchanged: People generally don’t need masks outdoors, regardless of vaccination status. However, face masks are recommended in areas of high transmission for individuals not fully vaccinated in a crowded outdoor setting, or in situations with sustained close contact with others who are not fully vaccinated.

Testing is also an effective tool in helping catch potential infections when large groups of people gather, especially if attendees are traveling from different locations.

Keep in mind that BA.4 and BA.5 are taking longer to detect than previous strains of the virus, so anyone showing symptoms should stay at home and isolate. Swartzberg said it is not unusual to see tests with negative results up to three days after people become infected.

“If I was having a party outside, I would ask everybody to do a rapid test recognizing that it’s not going to be foolproof but might pick up a few positive cases,” he said. “If you wanted to add a layer of protection, you would ask people to do a PCR test the day before. We’re now getting results back for those within 24 hours.”

People should also test if they plan on spending any time inside.

“Outdoor activities are often associated with indoor activities,” said Liu. “Any time people are staying in close quarters, like an Airbnb, it is advisable to do testing. The antigen testing has proven to help detect the presence of infection even if doesn’t completely rule it out.”

Bay Area COVID cases are sky-high

Entire region at CDC’s high COVID risk level

Registered nurse Navneet Chouhan, left, with Contra Costa Health Services (CCHS), puts a bandage on Venus Basaee, 6, after she got the COVID-19vaccine as her mother Mojgan Deldari looks on during a school-base vaccine clinic at Nystrom Elementary Auditorium in Richmond on Nov. 9. RAY CHAVEZ — BAY AREA NEWS GROUP

Vallejo Times-Herald, By John Woolfolk, July 7, 2022

The entire Bay Area is at the high community risk level for COVID- 19 at which federal regulators recommend everyone wear face masks indoors as newer and more immunity-evasive versions of the omicron variant continue to spread across the country.

While infections remain well below the January peak driven by the initial omicron strains, they’re still at February’s elevated levels and show no signs of declining, Bay Area health officials said Tuesday.

“The pattern we’re seeing in our data does make me think a sustained surge is possible,” Santa Clara County Health Officer Dr. Sara Cody said. “Previous patterns were we went up and then down, but we went up and now we’re staying at a high plateau.” Continue reading Bay Area COVID cases are sky-high

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.”

Open Letter to Benicia City Council: Dr. Richard Fleming on mask mandate

Professional perspective and corrections: vaccine, hospitalizations, role of government, Bay Area comparisons

Email, by Richard Fleming, M.D., November 17, 2021, with permission

Hi Benicia City Council members,

Richard Fleming, M.D.

Thank you for taking the time to discuss and consider the safest way forward for our city during the pandemic. I hope you can take a few minutes to consider the following points:

  1. Vaccination rate.  According to publicly available data from the California Department of Public Health, the fully-vaccinated rate for the city of Benicia is 67.7%.  We have never been above 70% and certainly never been above 80%, numbers which have been mentioned in past city council meetings. (If we include those who got only one shot, the percentage is 76.7%, but the more important number is those who are fully vaccinated.) I strongly urge you to use the CDPH-reported fully-vaccinated rate for Benicia in future city council meetings. Also keep in mind that many fully-vaccinated people have not yet gotten boosters, and are beginning to lose some degree of immunity. Thus, the proportion of our city which has good immunity against covid-19 is actually less that 67.7%.
    You can see the state-provided numbers here:
  2. Vaccine availability is not a good measure of our city’s immunity to covid-19.  It is not a good metric to use in making public health safety decisions. Vaccines are equally available throughout the Bay Area, yet our city’s vaccination rate is below the average vaccination rate for the other 8 Bay Area counties. It is clear that availability of the vaccine does not equate to uptake of the vaccine. It is better to make public health decisions based on the actual level of immunity, rather than the potential level of immunity.
  3. Are cases or hospitalizations a better metric to follow? As Councilmember Largaespada noted at last night’s meeting, covid cases can vary depending on how much testing is being done. He correctly pointed out that the hospitalization rate is a better gauge of the virus’ impact on our city. I am unaware of Benicia-specific hospitalization data, so Solano County’s data is a fair proxy. The August City Council decision used cases as the metric to follow. I strongly urge you to change this metric to hospitalizations, since this measure more accurately captures how the pandemic is affecting our residents. Also, it is important to not view ICU capacity as equivalent to hospitalization rates. Councilmember Largaespada interchangeably referred to ICU capacity and hospitalization rates, but those are two very distinct and different measures. Since treatment options for covid-19 have improved dramatically, many covid-19 patients who are quite sick are now being safely managed on standard medical units or step-down units. The only ones needing ICU beds these days are the sickest of the sick. If ICU capacity in our county is going to be used as a metric, we could have stopped all public health precautions several months ago.
  4. Should covid public health policies let those who choose not to be vaccinated live with the consequences of their decision? At your meeting last night, it was said we at some point need to just move on, and accept the fact the virus will be with us for a long time. Since vaccines are now widely available, it is up to individuals to decide whether to get them or not. I have two responses:
    (a) Yes, covid-19 will likely become endemic at some point, like influenza. But we are not there yet. In fact, we are far from that point. In very bad influenza years, the country loses an average of 142 people per day. Covid-19 is still killing over 1,000 people per day. Covid-19 is surging in many areas of the country and the world, and the coming winter months, along with holiday parties, will very likely increase the risk of viral spread. Most public health experts do anticipate covid-19 will become endemic and something we need to manage in our lives. But we are not there yet.
    (b) Government has always had a role and responsibility to help protect people from themselves. That is why, for example, we have seat belt laws. The availability of seat belts does not necessarily mean they will be used, so we have laws which force people to use them. Even more importantly, government has a role to insure people not make individual decision which harm others. That is why why have drunk driving laws. A person may feel they can hold their liquor and drive safely, but the government has decided to not leave that judgment up to each individual. With covid, those who opt to not be vaccinated are both putting themselves at risk and putting others at risk. It is fully appropriate for government to adopt policies to protect both the individual and the community from those who are putting themselves and others at risk.
  5. What other Bay Area counties are doing. At last night’s meeting, I said that the other eight Bay Area counties are all retaining mask mandates. As was correctly pointed out, Marin has lifted their mask mandate, but it is only lifted for fully-vaccinated people. Partially vaccinated and unvaccinated people are still under a mask mandate. Marin has the highest vaccination rate, the lowest hospitalization rate, and the lowest death rate in the Bay Area. Contra Costa has not yet made a decision to lift their mask mandate. They along with several other counties are lifting mask mandates for selected businesses, but only when 100% of employees and customers are fully vaccinated. The other Bay Area counties have fared better during the pandemic than Solano County, and are approaching easing up on precautions very cautiously. I strongly encourage you to follow a similar approach.

Thank you for your work helping safeguard our community.

Richard Fleming, MD


For details on Council’s discussion and outcome, see: “Benicia City Council debates changing mask mandate, decides to keep in place, will review again on Dec. 7