London Breed wasn’t going to wait around for COVID-19.
San Francisco had yet to confirm a single case of the coronavirus when Breed, the city’s 45-year-old first-term mayor, declared a state of emergency in late February. Two weeks later, Breed’s decision to ban gatherings of more than 1,000 people forced the hand of the Bay Area’s beloved Golden State Warriors, who this year moved into San Francisco’s Chase Center after nearly a half century in Oakland. Her decision, along with the NBA’s first positive case of the coronavirus, set in motion a chain of events that effectively shut down all of the nation’s major sports leagues.
At the time, Breed heard criticism that she was moving too quickly.
“Not anymore!” she told me with a chuckle when we spoke by phone this week.
Nearly a month after those initial orders to enforce social distancing, San Francisco and the broader Bay Area have emerged as a national model for how early and aggressive action can prevent the explosive rise in cases that has overwhelmed hospitals in New York, where leaders were slower to respond. San Francisco’s case count of 857 as of April 10—with just 13 recorded deaths due to the coronavirus—is much lower than that in metropolises of comparable size such as New Orleans, Detroit, Boston, and Washington, D.C. The city’s curve is low and flattening, and patients are not flooding into its emergency rooms.
“All evidence suggests that they are doing much better, and the simplest explanation for that is that they did take social-distancing measures very seriously and they did it early,” says Emily Gurley, an epidemiologist at Johns Hopkins University, which has been tracking the global COVID-19 outbreak.
San Francisco and California as a whole have struggled much more than New York to ramp up testing capacity, raising the possibility that the relatively low number of confirmed cases paints an overly rosy picture of the crisis there. But epidemiologists and public-health officials say that while positive cases are surely being undercounted—as they are across the country—San Francisco’s stable public-health system and low death count offer validation of its success so far.
“We’re seeing that our hospital beds are not very full at this point,” Yvonne Maldonado, an epidemiologist at Stanford Medical School, told me. “We’re just not seeing a big spike there.”
“Deaths are hard to hide,” adds Cyrus Shahpar, a San Francisco–based director at Resolve to Save Lives, a nonprofit that combats global epidemics.
Breed ordered businesses closed and issued a citywide shelter-in-place policy effective on March 17, at a point when San Francisco had fewer than 50 confirmed coronavirus cases. (California Governor Gavin Newsom followed with a similar statewide order a few days later.) On that date, New York City already had more than 2,000 positive cases. But New York Governor Andrew Cuomo and New York City Mayor Bill de Blasio, reluctant either to shutter schools or issue a stay-at-home directive for the nation’s largest city, didn’t take similar action for several days. By the time New York City fully shut down on March 22, more than 10,000 cases were reported across its five boroughs.
Breed’s aggressiveness was not initially popular. As she ratcheted up the city’s social-distancing mandates, prominent San Franciscans began calling one of the mayor’s political mentors, Senator Kamala Harris. “London Breed’s about to shut down the city,” they complained, Harris told me. She told them to trust Breed.
“She took incredible political heat and criticism,” Harris said, “and she had the courage to make a decision that she in her gut, based on science and the research she did, told her this was the right thing to do for her people, even when other people couldn’t see it yet.”
The economic hardship a shutdown would cause was not lost on Breed. She was raised in a public-housing project by her grandmother, from whom, Harris said, Breed inherited a practical streak. Breed’s sister died of a drug overdose, while her brother is currently incarcerated on a 44-year sentence for manslaughter. “Her grandmother was a tough lady,” recalled Harris, who has known Breed for years. “She was practical, practical to her core.”
“Hindsight these days is not years later; it’s weeks later,” the senator said. “So hindsight tells us London Breed was really smart. She did the right thing at the right time, even though it’s not what people wanted to hear.”
To some extent, the divergent paths taken by San Francisco and New York, two cities linked by a lack of affordable housing and yawning wealth gaps, mirror a broader divide between the nation’s East and West Coasts. Washington State, where a cluster of coronavirus cases at a nursing home made the state the early epicenter of the disease in America, has had more success than many other states containing the outbreak in the month since it first erupted there. The governors of Oregon and California have even loaned ventilators to New York and the national stockpile since their supplies haven’t been depleted.
Epidemiologists told me that San Francisco and other West Coast cities likely benefited from the Trump administration’s late-January restrictions on travel from China, while the president’s delay in banning flights from Europe, which he didn’t do until mid-March, hit New York hard. (New research backs this up, indicating that most of New York’s early cases came from Europe in mid-February, The New York Times reported on Wednesday.)
“New York was like Italy, and San Francisco and Washington State are more like, not necessarily the South Koreans, but some of the Asian countries that have had slower growth rates,” Shahpar, a former leader of global rapid response at the Centers for Disease Control and Prevention, told me. “Really, it’s about early identification of a problem, saying, ‘We’re going to be more proactive than reactive.’”
It’s that difference in decision making—proactive versus reactive—that has separated leaders at all levels of government during this crisis. “This virus has been ahead of us from day one,” Cuomo lamented on Thursday, as he announced that, once again, New York had seen a daily record—799—in coronavirus deaths.
That may be true for Cuomo and de Blasio, who dragged their feet, not to mention Donald Trump. But it is not true for Breed.
Public-health officials in san francisco began monitoring the coronavirus outbreak around the holidays in December, Mary Ellen Carroll, who runs the city’s Department of Emergency Management, told me. By late January, Breed had activated San Francisco’s emergency-operations center in preparation for an outbreak—the first such move in any major city in the country. The mayor has since relocated the command post to the Moscone Center, a sprawling complex where top city officials can work in-person while social distancing. Everyone, including Breed, wears a mask when they meet, Carroll said.
Breed told me that what got her attention early on was the ghastly photographs and footage coming out of Wuhan, China, showing the region’s hospitals overrun by coronavirus patients. “A picture’s worth a thousand words—seeing the images of what could potentially happen and then hearing your doctors tell you that we may not have the capacity to handle this situation,” the mayor said, recalling a briefing during which her advisers laid out the possibilities for a similar scenario in stark detail. “We have tons of hospitals in San Francisco. What do you mean we don’t have the capacity to handle an outbreak of this capacity?” Breed recalled thinking. “That’s when I was just like, Oh my goodness, this is serious. And we need to basically sound the alarm in a way that helps us to get ready.”