San Francisco’s Citywide Response To Covid-19 Spread Resulted In Lower Levels Of Mortality And Illness Across All Ages And Ethnicities, New Study Shows 

San Francisco Department of Public Health experts led study with UCSF partners to detail equity-focused pandemic response measures and outcomes  
July 24, 2023

SAN FRANCISCO, CA – A comprehensive program implementation study, conducted by the San Francisco Department of Public Health (SFDPH) in partnership with researchers at the University of California, San Francisco (UCSF), has revealed San Francisco implemented one of the most intensive, inclusive and multipronged COVID-19 pandemic responses in the United States, resulting in San Francisco experiencing one of the lowest COVID-19 deaths among larger metropolitan cities overall and across all ages and ethnicities. The study, including lead author Darpun D. Sachdev, MD. and senior author Grant Colfax, MD recently published in Public Health Reports, a prominent academic journal, highlights crucial lessons learned including the importance of community responsiveness joint planning, and collective action to inform future pandemic response and advance healthy equity.  


In March 2020, during the onset of the COVID-19 outbreak, San Francisco mounted an aggressive four-prong strategy to mitigate the spread of disease in the community and lower incidents of severe illness. The strategy included:    


  • Aggressive mitigation measures, such as asymptomatic testing of vulnerable populations, masking, and stay-at-home orders. 
  • Using a health equity lens to prioritize neighborhoods and populations disproportionately impacted, resulting in the accessibility of tests, vaccines, and financial support for these populations.
  • Use of timely and adaptive data to determine policy, such as stay-at-home orders and booster recommendations.
  • Partnerships and public trust through engaging and providing expansion funding to community-based organizations (CBOs), holding regular press conferences by the San Francisco Mayor and the SFDPH Director of Health, launching a COVID-19 dashboard, maintaining consistent communications across Bay Area counties, and centralizing resources through partnerships with other hospitals.  


The study mapped population health outcomes to these strategies, showing a strong correlation between pandemic response and lower rates of transmission, reduced number of hospital patients, and lower mortality.  


“The success of San Francisco’s COVID-19 response relied on quickly putting these public health principles into action and adapting to outcomes in real time through the lens of health equity,” said Dr. Colfax, San Francisco Health Director and senior author of the study.  


As 2022, San Francisco had the lowest number of COVID-19 deaths among large metropolitan cities in the United States, with 98 per 100,000 residents, compared to 229 COVID-19 deaths per 100,000 in the state of California and 301 per 100,000 in the entire US population.  


Data gathered for the study involved tracking the number of COVID-19 deaths as well as excess all-cause mortality rates, a measure that looks at increased mortality year-over-year regardless of cause of death. Further, in almost all age, race and ethnicity groups, excess mortality from COVID-19 was lower in San Francisco than in California overall, especially among people more than 65 years old.  


“We know through our experience during the AIDS epidemic as well as the COVID-19 pandemic and mpox outbreak that public trust in health institutions is key to achieving positive health outcomes, slowing the spread of disease, and advancing health equity. I am confident that these strategies and approaches will prove equally successful in addressing future pandemics,” continued Dr. Colfax.  


Though mortality rates remained low, the study notes that Zuckerberg San Francisco General Hospital was significantly impacted by COVID-19, stretching the limits of the hospital’s resources and staff. “Our public safety-net facilities need to fortify their infrastructure to face the next inevitable pandemic,” concluded Dr. Colfax.  


SFDPH remains committed to sustaining vital partnerships with communities to ensure COVID-19 resources, such as testing and vaccinations, remain available to those most in need even as the landscape shifts from an emergency response to long-term recovery.