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. 2023 Sep-Oct;138(5):747-755.
doi: 10.1177/00333549231181353. Epub 2023 Jul 5.

San Francisco's Citywide COVID-19 Response: Strategies to Reduce COVID-19 Severity and Health Disparities, March 2020 Through May 2022

Darpun D Sachdev  1 , Maya Petersen  2 , Diane V Havlir  3 , Joshua Schwab  2 , Wayne T A Enanoria  1 , Trang Q Nguyen  1 , Mary P Mercer  4 , Susan Scheer  1 , Ayanna Bennett  1 , Andrea G Tenner  1 , James D Marks  5 , Naveena Bobba  1 , Susan Philip  1 , Grant Colfax  1
Affiliations

San Francisco's Citywide COVID-19 Response: Strategies to Reduce COVID-19 Severity and Health Disparities, March 2020 Through May 2022

Darpun D Sachdev et al. Public Health Rep. 2023 Sep-Oct.

Abstract

San Francisco implemented one of the most intensive, comprehensive, multipronged COVID-19 pandemic responses in the United States using 4 core strategies: (1) aggressive mitigation measures to protect populations at risk for severe disease, (2) prioritization of resources in neighborhoods highly affected by COVID-19, (3) timely and adaptive data-driven policy making, and (4) leveraging of partnerships and public trust. We collected data to describe programmatic and population-level outcomes. The excess all-cause mortality rate in 2020 in San Francisco was half that seen in 2019 in California as a whole (8% vs 16%). In almost all age and race and ethnicity groups, excess mortality from COVID-19 was lower in San Francisco than in California overall, with markedly diminished excess mortality among people aged >65 years. The COVID-19 response in San Francisco highlights crucial lessons, particularly the importance of community responsiveness, joint planning, and collective action, to inform future pandemic response and advance health equity.

Keywords: COVID-19; San Francisco; excess mortality; public health response.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Timeline of policies that focused on preventing COVID-19 disease severity in San Francisco, March 2020 through March 2022. Solid line indicates the effective reproductive number, estimated by using the open-source LEMMA (Local Epidemic Modeling for Management & Action) model version 2.1.2 based on COVID-19 hospital census by day (solid dots), as well as reported COVID-19 cases, intensive care unit census, and COVID-19–related deaths.
Figure 2.
Figure 2.
Percentage of residents who were vaccinated (A) and received a booster vaccine (B) for COVID-19 over time, stratified by race and ethnicity, San Francisco, March 2021 through March 2022. Vaccination rates by race and ethnicity were calculated by dividing the number of San Francisco residents who had completed their primary series (2 doses of the mRNA vaccines or the single-dose vaccine) or booster on that day by the estimated population size. The denominator for booster vaccination results was the number of people who completed the 1- or 2-dose series. Data source: California Immunization Registry.
Figure 3.
Figure 3.
Excess mortality in 2020-2021 compared with 2019, by age group and race and ethnicity, in San Francisco and California. Cases of all-cause mortality in 2019 were used to estimate excess deaths in 2020, both overall and stratified by age and race and ethnicity. Data source: California Department of Public Health, Fusion Center.
See this image and copyright information in PMC

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