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Colfax: testing and hospital data improving but small rise in R could trigger big surge
Summary
Dr. Colfax told the Health Commission that testing has ramped up, hospitalizations are flat or falling and the reproductive rate estimate is ~0.94 — but models show that a modest rise to R=1.1 or 1.4 could produce substantial hospital surges, so reopening must be gradual and data‑driven.
Dr. Colfax, San Francisco's health director, delivered an extensive COVID‑19 preparedness and recovery update on May 19, reporting continued testing expansion, low citywide hospital occupancy by COVID patients and model‑based warnings about reopening.
"We are a remarkable 37 times lower than New York," Dr. Colfax said, pointing to San Francisco's lower death rate while cautioning that the city must remain vigilant. She said the department has reported 2,179 confirmed COVID‑19 cases and 36 deaths to date and has recorded nearly 46,000 total tests reported to the health department, with an average percent positive of about 7% over time and a more recent drop in positivity to 2%–3% as testing expanded.
Colfax highlighted hospital metrics as the most reliable near‑term indicator of spread: hospital census and ICU numbers have been flat or declining, and the department reports substantial surge capacity. She told commissioners that, among analytic models presented by Dr. Maya Peterson, the estimated reproductive rate (R) for San Francisco is about 0.94; a modest increase to 1.1 would raise hospital patient counts several fold by August, while a rise to 1.4 would create far more severe strain.
The department described targeted testing efforts (low‑barrier mobile testing and neighborhood mapping that shows higher case concentrations in the Mission, Tenderloin, South of Market, and Bayview) and emphasized routine screening of long‑term care facilities; Laguna Honda reported routine two‑week screening of residents and staff and detection of asymptomatic positives.
Commissioners and staff discussed indicators to watch (cases, percent positive, hospital admissions, contact tracing reach and PPE supply) and the cadence for staged reopening. Colfax and staff said the department is tracking mobility and other signals but will rely on hospitalizations, testing rates and contact investigation as gating criteria for moving between reopening phases. The city will take a cautious, two‑to‑four‑week window approach to changes.
Next steps: the department will continue to scale testing to its target range and to report additional modeling and surveillance information to the commission as the city evaluates potential movement into later reopening phases.
