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Friday, February 23, 2024

San Francisco Was Uniquely Prepared for Covid-19

To live in San Francisco for the past 20 years has been to live with outrage that a society so innovative and compassionate can so reliably fail to meet even the most basic challenges of public life.

This city never stopped being pretty—salmon boats on the bay, coyotes in the park—and the local spirit of utopian tolerance feels very much alive. Rainbow flags outnumber Stars and Stripes, teenage runaways dance on the grass at Hippie Hill in Golden Gate Park, and tech entrepreneurs promise to make the world a better place. Still, it gets hard to stomach a place where the world's finest computer engineers design weed-delivery apps while destitute families live in cars and heroin addicts defecate on sidewalks—where a startup like AltSchool can raise nearly $200 million to reinvent education and squander it while public schoolteachers earn so little that the city has to build subsidized apartments for them. The more Black Lives Matter window posters one sees in rich-liberal neighborhoods that consistently oppose public housing, the more clear it becomes that something is wrong with San Francisco progressivism.

So it comes as a welcome surprise that San Francisco executed by far the most successful initial response to Covid-19 of any major American city. As the US federal government humiliated itself with a pandemic response that ranks among the world's worst, and hundreds of health care workers nationwide lost their lives, San Francisco flattened its early infection curve at a blessedly low level. Local hospitals never had more than 100 patients hospitalized with Covid-19. That number dipped into the low 30s in June and, even during a midsummer bump, never became unmanageable.

Caveats are in order, of course. Low-income communities suffered more than their share of infection, and roughly 20 percent of the city's working-age people filed for unemployment in a matter of weeks. The city also has an abundance of affluence, which turns out to be protective against Covid-19, because spacious living quarters and bank accounts insulate people from one another.

Yet, consider the obvious comparison: New York City, where the pandemic hit almost simultaneously. In the first two months of New York's initial outbreak, more than 14,700 residents died of Covid. San Francisco has a tenth of the population, so the comparable death toll would've been 1,470. The actual number was 35. On April 7, New York's single worst day, 597 people died. On San Francisco's worst day, three people died.

New York has a higher population density than San Francisco, but San Francisco is still one of the most dense cities in the country. Yet it maintained a far lower total mortality rate (even through midsummer) than less dense cities nationwide—5.9 deaths per 100,000 residents. The figure for Dallas was more than six times that; for Los Angeles and Boston, 17 times; Chicago, 45. It wasn't just big cities, either. Any county-by-county pandemic map of the United States revealed countless places with lower density and worse outcomes.

So how did San Francisco fare so well? Why such unusual numbers? The answer begins with the city's old utopian tolerance and runs deeply through its experience with the last great global pandemic.

Back in 1977, when a Korean War veteran named Harvey Milk won election to the San Francisco Board of Supervisors, he became California's first openly gay public official. A year later, when a former city supervisor carried a handgun into the beautiful beaux arts City Hall, shot Mayor George Moscone to death, and then did the same to Milk, the citywide trauma stitched LGBTQ identity irrevocably into the fabric of San Francisco public life. Three years later, when the earliest AIDS cases hit San Francisco, the city responded with more compassion and scientific curiosity than ideological judgment.

It helped that San Francisco's major public health institutions had unusually close ties to one another. The sole medical school in town, the superb UCSF School of Medicine, operated its own teaching hospitals and also provided doctors to San Francisco General Hospital, a sprawling brick colossus in the historically working-class Mission District, run by the city's public health department. San Francisco also happens to be both a city and a county, meaning the mayor has direct control of the health department, the health department has direct access to the mayor, and both work with top-line researchers at UCSF.

Throughout the early '80s, as AIDS devastated entire San Francisco neighborhoods, national journalists were still calling AIDS “gay-related immunodeficiency” and describing its risk factors as 4H—as in homosexuals, heroin users, hemophiliacs, and Haitians. UCSF clinicians, meanwhile, were busy launching the world's first dedicated AIDS units, wards 86 and 5b at San Francisco General, and founding the Center for AIDS Prevention Studies, one of the first of its kind. Before President Ronald Reagan managed to say the word “AIDS” in public, UCSF and SF General were developing the San Francisco model of AIDS care—now the global standard—with teams of nurses, social workers, nutritionists, doctors, addiction specialists, and psychiatrists all working together.


As thousands of San Franciscans lost their lives to AIDS, this collaboration between a first-rate medical school and a municipal public health department proved a powerful magnet for ambitious researchers all over the country. Diane Havlir, for one, was just out of Duke Medical School in 1984 when she moved to San Francisco, precisely to work on AIDS—“running toward the fire,” as she puts it. She ended up helping to pioneer lifesaving retroviral therapies for AIDS, served on the World Health Organization's HIV guidelines committee, and eventually took over UCSF's HIV and Infectious Disease Division, which included the original Ward 86. “A dream job,” she says.

By the early 2000s, AIDS was the leading cause of death worldwide for people between the ages of 15 and 59, and San Francisco was the world's most mature hub of research and practice addressing the epidemic. At the same time, the first dotcom bust was yielding to the tech boom that gave us Facebook and Google. A new tide of computer scientists and venture capitalists mingled with San Francisco's existing population of medical researchers, and in the late '90s and early 2000s, city government rezoned more than 300 acres of an old industrial district to create the Mission Bay Biotech Cluster. That city within a city, built on landfill atop a former bay inlet, now houses biotech startup incubators and a UCSF children's hospital financed by Salesforce CEO Marc Benioff. It's also the home of the Chan Zuckerberg Biohub, a nonprofit created by Mark Zuckerberg and Priscilla Chan with an endowment of $600 million and the philanthropic goal of eradicating or managing all human disease within the lifetime of today's children. The result has been to make this midsize city, with only a single medical school—run by the state, no less—into the biotech capital of the US, rivaled only by Boston, which has three medical schools, and far exceeding New York City, which has seven.

Put another way, the quality of openness that made San Francisco an early cradle of LGBTQ life inspired a response to HIV/AIDS so vigorous that it transformed this city's entire public health landscape into one of international significance.

On December 31 last year, Chinese health officials released their first official report of a mysterious pneumonia outbreak in the city of Wuhan. Within a day, a Reuters article about that outbreak appeared in one of the many professional daily newsfeeds to which Diane Havlir subscribes.

“Whenever a new epidemic comes out, I'm at the edge of my seat, reading every new fact,” says Havlir. By early January, Havlir's newsfeeds were carrying daily updates, including news of an early epidemiological link to a seafood market in Wuhan.

“I remember it quickly became clear this was no SARS,” says Havlir. “SARS affected 8,000 people, and this virus was taking off and transmitting at a much more rapid pace in a country that responded quickly, where masks were not stigmatized and people would stay home, and they could build a hospital in two weeks.”

The Wuhan outbreak also caught the attention of Grant Colfax, who had done his medical residency at UCSF and served as President Obama's director of national AIDS policy before taking his current job as director of the San Francisco Department of Public Health. “As I was watching the data,” Colfax told me, “there was an increasing consensus that once it got here it would move quickly, and also a foreboding sense that there was not a coordinated federal response. We were going to need to react locally and regionally and create systems without sufficient operational support from the federal side.”

Deciding it was time to tell the mayor, Colfax walked out of his office in San Francisco's Civic Center Plaza, crossed Grove Street, ascended the broad marble steps of City Hall, and made his way up to the second floor. There, he briefed Mayor London Breed, a pragmatic San Francisco native who grew up in low-income housing near City Hall. Breed confesses that she was initially skeptical in the face of Colfax's alarm.

“I was getting a little tired of hearing every day that this thing is going to be big,” says Breed. “I was like, ‘We don't have any cases!’ I don't think I really understood until they explained, ‘Here's the number of hospital beds we have and ICUs and ventilators, and if we do nothing, people are going to die, like a lot of people.’”


On January 21, with only a single confirmed case in the US, and President Trump still insisting he was “not at all” worried about a pandemic and that “we have it totally under control,” emergency preparedness plans were activated simultaneously at three major San Francisco institutions: the teaching hospital at UCSF Medical Center, SF General, and Colfax's office at the Department of Public Health. The two hospitals canceled elective surgeries and cleared entire floors to create surge wards filled with intensive-care beds. Colfax's office streamlined command and control to focus the entire department on the novel coronavirus. Less than a week later, on January 27, Breed activated the city government's own Emergency Operations Center, preparing to coordinate a response across departments, plan outreach efforts, and commandeer city property and resources.

The next obvious step was to mobilize the city government as a whole and prepare the public for profound disruptions to daily life. Both carried political and economic risks, given that tourism was already cratering in San Francisco's Chinatown; word of an impending epidemic had the potential to spread the damage across the city's entire $10 billion annual tourist industry.

Breed let a few weeks go by, even as Covid-19 patients from outside San Francisco arrived by ambulance at the shadowy concrete entrance to the emergency department at UCSF. In the last week of February, though, Colfax's warnings became more urgent. As he put it to me, “All the expertise in the department is saying to go now.

“My response was, ‘We're in trouble,’” Breed recalls. “If a doctor who was part of what was happening in San Francisco during the AIDS crisis is telling you, ‘You got something to worry about,’ then you got something to worry about.”

On February 25, with only 53 confirmed cases in the US, 10 in California, and still not a single one confirmed to have been contracted by a San Francisco resident, Breed called a press conference in the majestic neoclassical rotunda of City Hall. Wearing a royal-blue suit and with Colfax at her side, and speaking to a small clutch of reporters and photographers, Breed declared a local state of emergency. With the stroke of a pen, she made all 30,000 city employees subject to conversion into emergency workers and eliminated bureaucratic red tape to allow decisive action by a normally sclerotic city bureaucracy.

Less than half a mile from City Hall, in a block-long, 1937 art deco monolith, one particular company was responding with similar speed. Twitter, like most tech firms, likes to ground strategy and decisionmaking in quantitative metrics, but the early days of the pandemic frustrated that impulse. “Where we found ourselves was having to make decisions based on lack of data,” says Jennifer Christie, Twitter's chief in charge of the company's workforce. By mid- to late February, news out of China was already suggesting that Covid-19 spread fast and killed people. By that point, Christie and the rest of the company's executives were trying to figure out how to protect Twitter's 5,000-plus worldwide employees. But the mechanisms of the virus's spread were unclear—whether it was mostly spread through the air or via contact with contaminated surfaces, whether indoors was more dangerous than out. Reports of doctors and nurses in China dying added to the uncertainty about who was most vulnerable. That made it difficult for Christie to know what measures could protect Twitter employees inside company offices, much less in public places or on mass transit to and from work. Looking at preliminary public measures like Breed's emergency declaration, Christie sensed that city officials were struggling with the same uncertainty.

Twitter execs realized they couldn't afford to stand by until the science and official guidance were settled. “If we wait for enough data to present itself for a jurisdiction to make a confident decision,” Christie remembers thinking, “we might be too late for our own people.”

On Wednesday, February 26, the executive team ordered every Twitter employee in Japan to begin working at home immediately. Two days later workers in Korea were told to stay home. A directive for the rest of the company's staff wasn't far behind. On Friday, the 28th, Christie stepped into a conference room with CEO Jack Dorsey and other executives. “We decided that on Monday we had to strongly encourage everybody to stay home,” she says.

By the end of that week, Lyft, Facebook, Google, Apple, and Salesforce had all followed Twitter's example, and San Francisco discovered its first two cases of local residents with Covid-19. Collectively, these companies eventually ordered many tens of thousands of people in the Bay Area to work from home. This had both the powerful practical effect of taking people out of circulation and an arguably greater cultural effect.

“These are global companies, and the reason they have become trillion-dollar companies is that they're really good at taking complex data and doing smart things with it,” says Bob Wachter, the chair of UCSF's Department of Medicine and, on the strength of edifying tweeting, San Francisco's unofficial town crier for the pandemic. “If these companies were taking this seriously, that got me to sit up and take notice, and it got others to sit up and take notice.”

It didn't hurt that city officials were on the same page. On March 2, the very day Twitter encouraged all its employees to work from home—and within hours of a tweet from New York mayor Bill de Blasio encouraging his constituents to “go on with your lives + get out on the town”—Breed encouraged San Franciscans, via Twitter, to “prepare for possible disruption from an outbreak” by keeping medications on hand, making plans for childcare if schools closed or parents got sick, and caring for any family members who fell ill.

Around the same time, Colfax called Diane Havlir at UCSF to ask her and a few colleagues, including an epidemiologist named George Rutherford, yet another veteran local AIDS researcher, to create an informal advisory group—keeping an eye on emerging science and passing along what they learned. The group convened for the first time on March 6. From then on, information about the virus flowed directly from some of the world's leading infectious-disease epidemiologists through Colfax to a mayor in charge of every city and county agency.


The day of the advisory group's first meeting, Breed and Colfax urged everyone over the age of 60 to work from home, businesses to freeze nonessential employee travel and large in-person meetings, and all concerts and conventions to be canceled. In days to follow, as news broke of a terrifying outbreak at a nursing home in Washington state, Breed and Colfax issued increasingly restrictive public health orders: banning most visits to the enormous Laguna Honda Hospital, a city-run nursing home with 780 residents; ordering deep cleaning of single-room-occupancy hotels where residents often lived in crowded conditions; and shutting down the entire San Francisco Unified School District.

Colfax also convinced Breed to put a moratorium on gatherings—first of more than 1,000 people, then of more than 100 people. “They kept coming to me with arbitrary numbers to reduce events to,” Breed told me. “I was like, ‘What are we doing here? What is your medical advice for what makes the most sense?’” On Friday, March 13, she says, “I got aggressive with Doctor Colfax and said, ‘We need to shut the city down.’” Breed says she reached out to mayors of neighboring cities with the expectation of issuing a joint shelter-at-home order sometime the following week. The next day, though, a Saturday, Santa Clara County, just down the peninsula, reported an alarming acceleration in cases: from 71 to 227 in just five days.

On Sunday afternoon, the city's health officer joined a conference call with six other Bay Area health officers—all of whom, by California law, have the authority to issue legally binding health orders. By the evening, they had decided to shut down the region during a joint press conference the following day.

Breed was taken aback. “I was like, ‘You're just going to do this without the mayors?’” she recalls saying.

She felt it was important for an elected executive to initiate such a dramatic move. So on Sunday afternoon, Breed ordered her staff to prepare a statement and call a press conference of her own, to coincide with the health officers' announcement. On Monday morning, according to her office, two things happened at once: The health officers delayed their press conference, and word of Breed's impending announcement leaked to the local press, effectively making Breed the first elected official in the US to order her jurisdiction's residents to shelter at home.

That afternoon, as foot and car traffic thickened with San Franciscans panic-shopping for all-purpose flour and toilet paper, all those county health officers held their own press conference, closing nonessential businesses across the region and collectively ordering nearly 7 million Bay Area residents to shelter at home.

“You got lucky with your politicians,” says Peter Staley, a longtime AIDS activist who now lives in New York. “New York did not, and obviously the nation did not. It really triggered everybody who survived the early AIDS years, all the early AIDS activists who watched all our friends die because Ronald Reagan didn't do the right thing at the beginning of an epidemic, and to watch Donald Trump not do the right thing has just forced us all to relive that pain and horror, because the whole job of a politician during an epidemic is to do exactly what the experts tell them to do. The ones who appear alarmist at the beginning, because you don't yet see the deaths, they are the politicians who save lives.”

In the first week of March, a UCSF biochemist named Joe DeRisi noticed his phone buzzing with an unfamiliar number. A wiry, white-haired doctor in his early fifties and a longtime colleague of Havlir and Rutherford, DeRisi first made a name for himself by inventing a device called the Virochip that can speedily identify viruses in blood or spinal fluid, and for using it to identify the SARS virus in 2003.

When DeRisi answered the phone that day, he recalls hearing a man's voice say, “Hey, this is Gavin”—as in, Gavin Newsom, governor of California.

“I don't know who gave him my number,” DeRisi says. “He basically said, you know, ‘What can the state do right? What could the state do wrong?’”

As it happened, DeRisi had strong opinions on the matter. In addition to his post at UCSF, DeRisi is also co-president of CZ Biohub, Zuckerberg and Chan's $600 million moon shot in the fight against human disease. Back in January, DeRisi had flown to Cambodia for a project with the Gates Foundation aimed at creating a real-time global pathogen-monitoring system—an open source database of pathogens active worldwide. While there, he spent six days helping local scientists set up a CZ Biohub technology called IDseq that, with enormous cloud-based computing power, can rapidly analyze the genomic makeup of viruses and bacteria around the world. Less than three weeks after he got home, in late January, Cambodia got its first case of Covid-19, and DeRisi's counterparts sequenced its viral genome and posted the result—one of the first outside China—on two open source global health databases.

By the time the governor called, DeRisi was focused on yet another way that CZ Biohub could help with the worsening pandemic. Testing resources were in dangerously short supply in San Francisco, especially the lab capacity needed to process a lot of tests quickly. This was partly because the CDC had distributed faulty test kits early on, and required that all test processing be done at CDC headquarters in Atlanta. On top of that, the Food and Drug Administration's rigid approvals process prevented many local and private labs and hospitals from using their own tests. By early March, the federal government had backed down on some of those requirements, and UCSF had developed its own kits, but local labs still only had the capacity to process a limited number of them.

“It was beginning to get panicky,” DeRisi says. But he knew that CZ Biohub's facility, in a glass and stone office tower across the street from the Golden State Warriors' new basketball arena, could help get the job done. The building had an entire floor—16,000 square feet—sitting empty under lease to UCSF. CZ Biohub also had access to scores of UCSF grad students and researchers who could analyze these tests in their sleep. What DeRisi's colleagues did not have was the necessary California state certification to process clinical test samples and tell patients the results.

DeRisi says he mentioned this to Newsom and was surprised when, the following week, on the morning of March 12, the governor issued Executive Order N-25-20, suspending those regulations. Within hours, DeRisi and UCSF chancellor Sam Hawgood were on a conference call with their university lawyers, talking about transforming that empty floor into a Covid-19 test-processing facility. With clearance in hand and help from the dean of the graduate division, DeRisi recruited dozens of UCSF postdoc and graduate students as volunteers and divided them into 11 working groups, each tasked with a different part of the problem: equipment supply, data management, how to get patient samples into the building. DeRisi himself pitched in wherever he was needed, like on the rainy morning of Saturday, March 14, when a colleague offered to lend DeRisi's team an additional Agilent Bravo liquid-handling robot, a boxy contraption that costs about $80,000. At that point, the clinic had just four and could have used several more.

So DeRisi and his colleague walked out the front doors, crossed busy Third Street, and marched quickly past Benioff Children's Hospital to the UCSF Center for Advanced Technology. There, they loaded that fifth Agilent Bravo onto a gray Rubbermaid cart. Rolling the robot to the front door, the two realized it was raining.

“You know, normally you have professional movers who handle this very sensitive automation,” DeRisi told me, chuckling. “These $80,000 robots are touchy. So we go dumpster-diving in the trash for plastic and cardboard and tape it all over into this very sketchy umbrella-like contraption,” DeRisi says, “and then roll it down 16th Street.”

On March 20, exactly eight days after Newsom's executive order and at a cost of about $4 million, DeRisi's new clinical lab, a joint UCSF/Biohub operation, was open for business, ready to process more than a thousand Covid-19 samples a day, for free. Not a moment too soon, either: During the last week of that month, the number of San Franciscans hospitalized with confirmed Covid-19 leapt from 12 to 57, with 21 of them in intensive care. By the first week of April, those numbers had jumped yet again. The pandemic's first proper wave was looming over San Francisco.

One of the lessons of the so-called San Francisco model of AIDS care is that experts can be a lot more effective against an epidemic if they join hands with community leaders who already have the trust of populations at high risk of getting infected. Valerie Tulier-Laiwa, a longtime community advocate who grew up in the Mission District, knew that her community was uniquely vulnerable to Covid-19. “It felt to me it was people who were affluent, who had money, who could travel, who were predominantly white, that were getting sick at first,” she said. “But I knew eventually it was going to filter down into communities of color and poor communities, and that it was going to hit Latinos hard because of congregate living, because they still had to work in the service industry.”

Tulier-Laiwa had already gathered the leaders of several dozen Latinx community groups to form what they called the Latino Task Force on Covid-19, educating residents about handwashing and masks, and establishing a food bank, when they got a call from a woman named Diane Jones, a former Ward 86 nurse turned AIDS activist.

At the nearby Zuckerberg San Francisco General Hospital, it turned out, Havlir's team in the HIV and Infectious Disease division had noticed that 80 percent of their Covid-19 inpatients were Latinx, a clear indication that the virus, as Havlir puts it, “was spreading in the community that's right in the backyard of our hospital.”

During an epidemic like Covid-19 in which symptoms can be mild or nonexistent, hospitalized patients are a fraction of the people infected in a community, so it becomes critical to find the others and isolate them before they pass the virus on. Without a vaccine or proven treatment, Havlir thought her best chance at saving lives was to test widely in the Mission and support everyone who tested positive with the food and resources necessary to isolate themselves. It wouldn't be cheap—test processing alone might cost hundreds of thousands of dollars—and it might not even be workable, given uncertainty about whether any public or commercial lab could process the requisite number of samples fast enough to break the chain of infection. So Havlir called DeRisi, whom she'd known for 20 years.

DeRisi was delighted. “I thought, ‘Man, now we're talking. This is a great study. Let's do this thing!’”

With the full support of CZ Biohub and its new clinical lab, Havlir reached out to Jones, the AIDS activist, who well understood the stigma associated with disease and how it can make people reluctant to get tested. As Jones put it, “You'll just find out you're positive and lose your job and get kicked out of your house and die alone.” Similar fears, related to Covid-19, were acute among Mission District residents who supported large households and couldn't isolate themselves, much less feed the kids, without a paycheck.


Working closely with Jones and Havlir, the Latino Task Force mobilized hundreds of volunteers, including many who spoke Spanish and a few who spoke the Mayan language common among undocumented day laborers. By the time those volunteers went door to door encouraging people to get tested, the citywide mood of fear had worsened. A small outbreak of Covid-19 at Laguna Honda Hospital, the city's big nursing home, prompted Colfax to lock down the entire facility in protective quarantine. Then, on April 5, at San Francisco's largest homeless shelter, MSC South, two residents tested positive. Advocates for the homeless had been warning for more than a month that people living on the streets and in shelters were at high risk—both of getting infected and of severe illness, due to cramped and unclean living conditions and chronic health problems. Those warnings were borne out on April 10, when a new round of testing at MSC South found 68 residents positive. So the Public Health Department announced that the entire shelter would be converted into a Covid-19 ward and all noninfected residents moved into hotel rooms.

By late April, with citywide hospitalizations of confirmed cases relatively stable at around 90—an apparent flattening of the curve—Tulier-Laiwa and other Latino Task Force members joined Havlir and her UCSF colleagues, plus volunteers from CZ Biohub, at open-air testing sites in parks and public spaces in the Mission District. Over a four-day stretch, and a few additional days in May testing homebound residents, they drew blood from nearly 4,000 adults and kids. A colleague of Havlir and DeRisi drove the samples across town in his own car. “Nothing fancy about it, no guys in uniforms with special biohazard suits,” says DeRisi. “It's like, Brian, in his Honda Accord with the Coleman cooler.”

The UCSF/CZ Biohub lab processed 90 percent of the samples within 24 hours. It found 2 percent of them positive, about 80 people. Community wellness workers then offered to visit each one of those people with food, grocery vouchers, cleaning supplies, and face masks. Those who couldn't self-isolate at home were connected to the Public Health Department for help in securing a hotel room.

The pandemic's initial surge began to recede from San Francisco on May 3, as the total number of confirmed hospitalized Covid patients fell to 86. The local economy was still in tatters, with countless restaurants closed and for-rent signs in apartment windows. By mid-June, as California's overall infection rate began inching upward again, hospitalizations in San Francisco bottomed out in the mid-30s. Between June 19 and July 13, New York City saw 464 people succumb to Covid-19; in that same three weeks in San Francisco the death toll was exactly one.

Every expert I spoke with credited a measure of dumb luck. San Francisco appeared not to have had any of the so-called super-spreader events at which a single infected person unwittingly infects dozens of others—like those that occurred at a church in South Korea or a funeral in Albany, Georgia. The San Francisco 49ers may also have done their part, back in early February, by losing the Super Bowl to the Kansas City Chiefs. A victory parade could have triggered a mass outbreak the way Mardi Gras seems to have done in Louisiana.

Still, experts also credited widespread compliance with social-distancing and mask-wearing rules by San Franciscans of all backgrounds—what Wachter calls “the receptor arm of this region.” He'd been doing a call-in radio show and was impressed by the scientific literacy of callers. “Their questions have been spectacular,” he said. “Really, really interesting, about stuff like characteristics of different antibody tests. It's a very sophisticated and curious citizenry that doesn't completely mistrust its government.” Wachter didn't see San Franciscans as having blind faith in government—just a general confidence that, as he put it, “we're governed at the local and state levels by people who want to get the balance between capitalism and taking care of people right.”

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In practice, that meant San Franciscans and their neighbors around the Bay Area did as told, at least for a while. They stayed home, wore masks, washed hands. All those early actions by public health officials and industry leaders, making sure that local hospitals never got overwhelmed, also preserved resources for areas more vulnerable to an outbreak, like in the Mission. In fact, earlier this spring, UCSF was able to send 24 nurses and doctors to volunteer at hard-hit hospitals in New York and another 40 to the Navajo Nation. The CZ Biohub/UCSF lab, the one built in eight days, can now process up to 2,600 tests daily and offers its services free to every county in California.

George Rutherford, meanwhile, the epidemiologist from Colfax's informal advisory group, emerged as the state leader in contact tracing. Back in March, international travel bans had grounded dozens of Rutherford's colleagues at the UCSF Institute for Global Health Sciences. Public health experts, in essence, were prevented from visiting their HIV and Ebola projects overseas. Rutherford sent one of them down to the city's Emergency Operations Center.

“He confirmed that what they really needed help with was contact tracing,” Rutherford says. “So we said, ‘OK, we got all these people sitting around, let's put 'em to work.’” A few members of Rutherford's team then created an online curriculum to teach contact tracing. In the course of two days, they trained 40 of their colleagues. In just over a week, they'd trained 65 city employees, including personnel from the city attorney's and assessor's offices. Pretty soon, Rutherford's team had also trained almost every librarian in town. That operation has since trained 200 contact tracers and case investigators in San Francisco alone—plenty to do the job properly by interviewing every infected person, figuring out who they've been close to in recent days, contacting and testing all those people, and connecting the ones who can't self-isolate at home to people who can help them get food and cash and hotel rooms.

One day, Rutherford told me, he was sitting around minding his own business and got a call asking, “Why don't we do this for the whole state?” His team then partnered with UCLA to create an online academy used by the Newsom administration to retrain at least 7,000 additional civil servants, across California, into a statewide army of contact tracers.

San Francisco still feels incomprehensible and contradictory in all the ways it did before Covid-19. While school districts elsewhere, including New York City, pivoted to distance learning in a matter of days, San Francisco's public schools flat-out shut down for four weeks in the early days of the pandemic. Many unhoused San Franciscans still have no shelter, and zoning restrictions still make it nearly impossible to build the high-density housing that could truly ease rents and real estate prices.

This city's collective response to Covid-19 in those early months, however, feels deeply hopeful. Somehow or other, the SARS-CoV-2 virus cut through the decades-old cultural paralysis of the city's competing worldviews: an old-line progressivism that does a great job fighting for individual freedoms but less so creating a better future for anyone's kids, a techno-libertarianism that treats government as irrelevant to the creation of healthy society, and a prevailing attitude that mostly just values getting rich enough to buy a piece of paradise, and then making sure newcomers don't screw it up with unsightly apartment buildings or mass transit.

Walking these abnormally quiet streets in midsummer, with traffic at historic lows and air clear enough to see from midcity hilltops to the green Santa Cruz Mountains behind San Jose, east to conical Mount Diablo and north into the wine country of Napa Valley, it was hard not to feel something new in the atmosphere—a sense that San Francisco might yet turn a positive corner. Tech still has all the money and power, and both still corrupt the way they have from time immemorial, but tech's money and power depend on trust in data and respect for science. In the case of Covid-19, the relevant data happened to be epidemiological. The relevant scientists were public health experts whose discipline lies in treating entire societies as singular patients—which, of course, they are. Key to the playbook of these experts is recognition that you cannot truly save anybody without at least partly saving everybody. And you can't do the latter without help from activists in the LGBTQ, Latinx, and Black communities.

Covid-19 taught every San Franciscan an object lesson in the degree to which the fate of the individual remains bound up with the fate of the group. That was evident in early-summer protest marches, when people of all skin colors wore masks that were thought to do little for their wearers but quite a lot to protect everyone else. It was evident in late July, too, as California's infection rate skyrocketed into frightening territory, San Francisco's climbed just enough to be worrisome, and San Franciscans retreated dutifully into their homes for yet another round of sacrifice.

DANIEL DUANE (@Danielduane) is the author of six books. He's at work on the next, about California. His last story for WIRED, about San Francisco public schools, was in issue 26.07.

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