SAN FRANCISCO - The Bay Area was supposed to be exceptional.
It was one of the first metro areas in the United States to fully shut down to slow the spread of the novel coronavirus. Nearly everyone wears masks, in stores and on streets. Its liberal residents generally have been inclined to follow the rules, and there's a high level of trust in public health officials, local governments and the fast-changing science.
But now, more than four months after the region put some of the nation's first shelter-in-place orders in effect, the Bay Area is experiencing a surge in cases and counties are rolling back reopening plans.
The Bay Area, which consists of nine counties and nearly 8 million people, is a cautionary tale for government and health officials. Even though leaders here tried to do everything cautiously and by the book, cases still eventually spiked over a month and a half, to an average of 877 cases a day at the end of July from 217 a day in mid-June.
Medical experts say a slow but steady rise in complacency is worsening the case count. Contact tracers have told public health researchers that people are getting sick after indoor gatherings. And the numbers show that Latino residents and essential workers are being hit the hardest.
Many people who live here say they are worn out - that a hermitlike existence is impossible for months on end. Tired of being stuck at home, friends and families are starting to gather again, and some parents are letting their children use still-closed playgrounds, ducking under the caution tape that has been wrapped around jungle gyms since March.
Gretchen Flores, who works in patient admissions at San Francisco General Hospital, has seen more people with covid-19, the disease caused by the virus, enter the hospital in recent weeks - as well as more and more people out and about near her house in San Bruno, south of the city.
Siva Raj, a tech worker who lives in Pleasanton, has seen an increase in riders on his occasional BART train trips into San Francisco to visit friends.
After months of barely seeing anyone, Natalie Duvalsaint, a tech recruiter who lives in Oakland, has started having small wine gatherings with friends, and visits with other friends outside and at a distance. The rising case counts are absolutely worrying, she said. But staying inside and not seeing anyone can take a toll on mental health.
"We need to shelter in place and [practice] social distancing, but what about people with mental health issues?" she said. "I'm very extroverted, and I get kind of down if I don't see people for a week and a half."
Nurse Jason Harrison emerges from UCSF Hospital after working a 12-hour shift in San Francisco on July 13, 2020. Washington Post photo by Melina Mara
The Bay Area is still in a better place than many parts of California and other large cities. It had reported a total 53,086 positive cases and 817 deaths on July 31.
That's still relatively low in comparison with other large communities such as Miami and Los Angeles. And California itself is experiencing a dramatic surge in cases, mostly concentrated in Southern California. Gov. Gavin Newsom, a Democrat, rolled back reopening plans in mid-July, ordering all bars and indoor dining closed for the entire state, and gyms, hair salons and houses of worship shuttered for at-risk counties.
But one by one, Bay Area counties have all been added to a state watch list, which places additional restrictions on what can be open.
San Francisco Mayor London Breed - heralded early in the pandemic as an example of a public official corralling her city into compliance - issued a reminder to city residents in a public message when the county was recently added to the list.
"We have a small window of time right now to get our cases under control before we could see the large outbreak that we're seeing around this country," the Democrat said, adding that any business reopenings would be paused indefinitely.
The sudden increase in cases comes despite the early and tough steps six counties here took on March 16, locking down businesses and closing schools. Silicon Valley tech companies - the most influential residents - set the tone in early March, sending most of their white-collar employees home to work remotely. And for months, it seemed like it was working.
"What it bought us was 3 1/2 months of relative calm, relatively few cases, astoundingly few deaths, and an opportunity to build up capacity," said Robert Wachter, chair of the University of California at San Francisco's department of medicine. "What it also bought us was a little bit of complacency."
That's something Felix Castillo, a bus operator for San Francisco's MUNI public transit system, sees as more people catch rides every day.
"What's scary about now is no one is scared anymore, everyone is relaxed," Castillo said. "I think it's the most stressed I've been."
Throughout the pandemic, Castillo has been crisscrossing the city on different bus lines during his daytime shifts, attempting to enforce the city's mask rule for riders. Most people wear them now, but he recounts tense exchanges with some who would not. His cousin, another MUNI operator, was spit on recently by a rider who refused to use a mask.
In late spring, Bay Area residents' confidence was bolstered by how well the state and local governments seemed to be containing the virus.
"We were dubbed the 'California miracle,'" said Peter Chin-Hong, a medical professor at UCSF who specializes in infectious diseases. "Then Memorial Day hit, and that was probably the turning point in California."
Justin Donnelly used to ride the Caltrain every day from his home in downtown San Francisco to work at a Stanford University chemistry lab. As the shelter-in-place orders took hold, he started driving in, breezing along empty freeways. In the past three weeks, he has noticed a slowdown on the city's roads as he drives home midday.
For about two months the 24-year-old was only seeing two friends whom he dubbed his "quarantine pod." But he has slowly expanded that pod to a few more friends he'll see inside. Everything else is outside only, he said, noting that he is following research indicating that transmission outdoors is rarer than indoors.
"It seems like a better way to manage the risk," he said.
San Franciscans ride a MUNI transit bus through the Mission neighborhood in San Francisco on July 14, 2020. Washington Post photo by Melina Mara
San Francisco MUNI bus driver Felix Castillo workers his route through the Mission neighborhood in San Francisco on July 14, 2020. Washington Post photo by Melina Mara
BART ridership is still 89% below its baseline amount, though it has been rising slightly since the end of May. The number of people boarding San Francisco’s MUNI buses in July is down 70% year-over-year, also a small rise from its low point in May.
But the number of people driving across the Golden Gate Bridge has doubled since its low point in early April, a sign that people returning to work and other activities are choosing driving over public transit.
Residents of San Francisco also travel across the bridge for hiking and beaches in Marin County, just north of the city. Popular outdoor destinations there were packed with cars on a recent weekend as people crowded the hiking trails and picnic areas, some wearing masks.
Some rule-breaking indoor gatherings are also taking place. One couple held a wedding with 100 guests in San Francisco in early July. The couple and several guests tested positive for covid-19, according to the San Francisco Chronicle.
There was also some confusion among residents as the counties, once reassuringly in sync, splintered on reopening strategies and timelines. Marin allowed hair salons to open and indoor dining for groups as large as 10 on June 29. San Mateo stayed with the state-recommended guidelines. Alameda, Contra Costa, San Francisco and Santa Clara allowed some outdoor dining and retail at different points in June.
Demographic data and ongoing research indicate that essential workers here are facing higher risk, especially those such as day laborers, cleaners and home health aides.
"We're the ones out there every day," said Jay Campos, a bus operator in San Francisco who drives the late-night lines from 10 p.m. to 5 a.m. Campos, who lives in the East Bay, says he has relatives in New York who fell ill and worries about keeping his three children healthy.
"We can't ignore the fact that some of this is on the backs of low-wage workers," Kirsten Bibbins-Domingo said of the earlier push to reopen. Bibbins-Domingo leads UCSF's covid-19 community public health initiative, which has been blanket-testing specific San Francisco neighborhoods to study how the virus is spreading.
When the group tested an entire census tract in the city's Mission District for the virus and antibodies, it found Latino residents accounted for 95% of the cases despite representing 40% of the neighborhood. While most people were sheltering, the Latino population was working and sometimes bringing back the virus to more densely populated homes, Bibbins-Domingo said.
Valerie Francisco-Menchavez, an associate professor of sociology at San Francisco State University, is working on research about Filipino home caregivers during the pandemic. The workers are essential, she says, but they're also invisible.
"In the reopening plan, I wished that the question that politicians would ask is not how many deaths can be allowed in Black and Brown communities. Not how many deaths can we live with so people can eat, go play golf, go to SoulCycle," said Francisco-Menchavez.
People and a pooch walk on Mission Street in San Francisco on July 13, 2020. Washington Post photo by Melina Mara
Rosalie Amacan is a nurse in a covid-19 unit at a hospital and a caretaker for a special-needs child. She also owns two Bay Area care homes for developmentally delayed adults. She’s kept working, and is strict about following safety precautions. But she’s constantly worried. She said reopenings happened too soon, putting workers like her at risk.
"For Filipinos, most of us are health-care workers and we go to several jobs," said Amacan, who lives in San Francisco. "It's because the demand is there, and I feel like I have to. It's hard to say no."
An increase in cases was always part of the bargain for reopening - an unspoken trade-off for some in exchange for restarting the economy. But the speed and size of the increase has created a challenge for some government officials.
"There's always a balance between trying to protect public health and trying to get the economy running again and get people back to some semblance of normal lives," said Nick Moss, interim health officer for Alameda County.
The county of 1.67 million people, which encompasses Oakland, has the most cases in the area. It had 11,324 confirmed cases of the virus as of July 31, up from 4,271 June 15. Like the rest of the Bay Area, Alameda's low-income neighborhoods have been hit hardest. Just over half of the positive cases are Latino residents, despite the county's population being 22% Latino.
It's also where the Tesla auto plant is located - which reopened before the county gave the OK and has had workers fall ill.
Alameda County made it to Stage 2 reopening, allowing some outdoor dining. Just as it was about to allow "high risk" business activity such as indoor dining, salons and barbershops at the start of July, Alameda hit the brakes.
Across the bay, San Francisco Mayor Breed hit pause on June 26, delaying the scheduled reopening of hair salons, gyms, museums, indoor dining at restaurants and outdoor drinking at bars.
Pushing the numbers up in Marin County was a major outbreak at San Quentin State Prison, where 2,170 prisoners got sick and 19 died.
To make matters worse, the surge has again stressed the mass testing apparatus, prompting delays in getting test slots and receiving results.
Veterinarian Steven Randle, who frequently interacts with people for his job, got tested on June 27 in San Francisco. His negative test results came 16 days later.
"It became completely pointless by that point in time, because I would have technically done my 14 day quarantine if it was positive," Randle said.
Many white collar workers here have now been working from home for roughly five months, and sheltering in place almost as long.
Melinda Byerley recently saw friends in person for the first time since March. In the backyard of the friends' Mountain View home, she carefully measured out 10 feet of space. She brought her own food, used a bathroom that had an outdoor entrance and wore a mask except when eating or drinking.
Byerley, a start-up founder, knows she is being highly cautious, usually only leaving her San Francisco home to run or go grocery shopping. But even as she stays sheltered, the region is starting to change around her.
"If you're in your 20s and don't have kids, the calculus is different," said the 50-year-old. "You miss your friends. I almost can't blame them in some ways. You move to the city for that excitement, and it's gone for now."
Location data from firm SafeGraph, which collects pings from cellphones, shows that people in the region were staying at home more, earlier, than much of the rest of the state.
At about the last week of April, San Francisco seemed to be the most careful, with 50% of the population staying home, according to Aref Darzi, research associate at the Maryland Transportation Institute, which uses location data from phones to track human movement across the U.S. By the end of May, as reopenings began, people started going out more. It's now 44%.
"I think as things opened we didn't have enough clarity of message that opening brings risks and shared responsibility," said Srija Srinivasan, the deputy chief of health for San Mateo County. "It brings a need for more adherence, not less."
Jason Harrison, an emergency room nurse at UCSF Health who has seen an uptick in cases, says he knows it's hard to fathom how destructive and real the disease is when you don't personally know someone who has had it.
He tries to make it as real as possible for the people in his circle. He tries to keep his family and friends informed about what's safe as much as possible without coming off as a "nag."
“To the average person, unless it’s actually affecting their friends and family, it’s still just a news story,” he said.
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