San Francisco health chief says Delta surge easing, readies for boosters and pediatric shots

Director of Health Grant Colfax told the San Francisco Health Commission on Sept. 7 that San Francisco’s fourth COVID-19 surge is receding and that the department is preparing for possible booster recommendations and pediatric authorizations while focusing on equity and maintaining hospital capacity.

Colfax said the city’s case rate has fallen to about 14.4 cases per 100,000 residents and that the estimated reproductive number has dropped to roughly 0.77. He noted the city has reported more than 40,000 cases since the start of the pandemic and “almost 600 San Franciscans have died of COVID-19,” and he emphasized that hospitalizations — which peaked near 123–124 patients in the last surge — had declined to about 92 at the time of the update.

The director highlighted testing and vaccination trends: testing averaged nearly 6,500 per day in July and positivity on the city slide declined from a 6.2% peak to about 2.2%. Colfax said vaccination remains central to the city’s strategy: roughly 80% of eligible San Franciscans were reported fully vaccinated, with 88% of residents 65 and older fully vaccinated. “The vaccines work,” he said, adding that among fully vaccinated people who contract COVID-19, “the vast majority of these cases are mild or moderate” compared with unvaccinated people.

Why it matters: the presentation framed San Francisco as better protected than many parts of the country because of high vaccination coverage, but officials warned of uneven coverage across communities and that testing and care access fell during the pandemic.

Commissioners pressed DPH on operational details. Commissioner Gerardo asked whether the department tracks test reasons (exposure vs. travel or workplace requirements); Colfax replied that DPH does not have that breakdown and is encouraging people with coverage to use their providers while maintaining testing access for symptomatic people and those without other options. Vice President Green asked how planning will work if federal or state booster recommendations and pediatric approvals overlap; Colfax said the city’s vaccine collaborative and COVID task force are coordinating across health systems and providers, and noted the FDA was scheduled to meet Sept. 17 on booster questions with potential effects around Sept. 20.

On pharmacies, Colfax said they are expected to “play a key role” in booster delivery but cautioned that a prior Federal Pharmacy Partnership Program that helped vaccinate skilled-nursing residents may not be available in the same form this time, so DPH is assessing capacity and staffing with health-system partners. He also described efforts to place vaccines at mobile and homebound sites and to sign up private pediatricians through systems such as CalVax.

Colfax emphasized ongoing equity work: case concentrations remained highest in southeastern San Francisco, and the department is targeting testing, vaccination and support services neighborhood by neighborhood. He warned that unvaccinated individuals continue to face substantially higher risks for severe disease and hospitalization.

The update concluded with Colfax urging continued focus on protecting vulnerable populations in shelters, skilled-nursing facilities and schools and with DPH preparing operational plans for potential booster rollouts and pediatric vaccinations. Commissioners asked DPH to provide follow-up details on testing patterns, provider capacity and operational plans for boosters and school-based efforts. No formal action was taken on the COVID update.

Ending: DPH said it will continue to monitor trends, coordinate with health systems through the vaccine collaborative, and return with more implementation details as federal and state guidance evolves.