Much of San Francisco looked like a ghost town in late April. All but essential services were closed. Few roamed the streets. The mood seemed as gloomy as the gray sky above us.

Now life has returned. Restaurants and shops are open. Last week, pedestrians dressed in masks held bags from stores they had just bought. The guests sat at tables in front of restaurants and cafes. People strolled down the bay on the Embarcadero, and a giant ferris wheel was opened for business in Golden Gate Park.

After months of cautious approach to the pandemic and a slow take on reopening, San Francisco is the first urban center in California to reach the least restrictive reopening level. The risk of infection is considered minimal according to the state’s color-coded levels, despite the fact that San Francisco is the second densest city in the country after New York.

“At least so far, we’ve done everything right,” said Dr. Robert Wachter, professor and chairman of the Department of Medicine at UC San Francisco.

City officials still do not declare victory. Characteristically, they warn, the virus is still lurking around the corner. And as before, they will follow local metrics instead of reopening them just because the state allows it.

A seller wears a mask in City Lights Books in the North Beach neighborhood of San Francisco.

(Luis Sinco / Los Angeles Times)

Experts attribute the success of San Francisco to a long partnership between public health officials and universities, particularly during the AIDS crisis. San Francisco is not monolithic, but its residents largely followed health guidelines. Unlike other counties, which may have dozens of mayors and city councils represented, San Francisco is also a city with only a mayor and a board of directors, and both have largely subscribed to the judgment of health officials.

The prominent tech industry in San Francisco also played a role. Companies ordered their employees to work from home two weeks before the closure of San Francisco and other Bay Area counties, Wachter said. Not only did this keep more people off the streets, but it also signaled to the rest of the region that industry giants were taking the coronavirus threat seriously.

San Francisco followed the “hammer and dance” approach made famous by San Francisco writer Tomas Pueyo on the Medium website, Wachter said. The city hit the hammer by closing early in the pandemic. The dance was more complicated. The city has slowly reopened, making adjustments when cases came up and backing down when necessary.

Of the 20 most populous cities in the United States, San Francisco has the lowest per capita death rate from COVID-19. If the entire country had followed the city’s approach, Wachter said 50,000 people would die from the pandemic, instead of more than 220,000.

Of course, San Francisco has not remained unscathed. Hundreds of companies have closed permanently. Public schools have yet to reopen and the city has a huge budget deficit. Many residents moved away during the pandemic.

Although life has now returned to the city streets, they are nowhere near as crowded as they were before the pandemic, when a crowd of office workers and tourists flocked to the sidewalks. The number of drivers in city buses has decreased along with the revenue.

Mayor of London Breed and Dr. Grant Colfax, director of public health for San Francisco, were instrumental in shaping the city’s response to the health crisis.

Always interested in science, Breed studied chemistry before moving to political science at UC Davis. She grew up on a housing project in San Francisco where deadly gun violence was common. During an online UC San Francisco forum in September, she said she had often pondered what steps might have been taken decades ago to save lives on the projects.

When the coronavirus hit Wuhan in China, she saw it as the “way to get there”. That changed when Colfax and the city’s health officer came to their town hall office earlier this year and warned that the virus could overwhelm the city’s hospitals, which may have to turn away the sick.

That warning “kept me on my trail,” said Breed. She knew that shutting down would damage the economy and worsen economic disparities, but she said she felt there was no other choice. She said she was wondering what her mayor should do. Saving lives was the answer.

One day at the start of the pandemic, she went to a grocery store and quickly withdrew. People didn’t follow health guidelines. “I called Dr. Colfax and said we have to close this grocery store,” she recalled.

Colfax proved to be adept at messaging. During the first few months of the pandemic, Colfax, Breed, and other city officials held online press conferences three times a week. Colfax was usually grim. He warned the virus could quickly spiral out of control.

The Public Health Director began his summaries by stating the number of people infected and dead. In a funeral voice, he addressed the families of the dead and told them about his grief. He warned of serious consequences if the health restrictions were not observed. In July, he was loudly concerned that San Francisco could become the next New York City, Houston, or Florida. San Francisco remained in “a very vulnerable position,” he said.

Wachter recalls seeing some of the “very scary” press conferences and wondering if Colfax had any data he was missing.

Colfax said during the UC San Francisco forum that even if the models represented the worst case scenario, he needed to educate San Franciscans about the possibilities, especially when people were fed up with the limitations.

“When things get a little angry,” Wachter later said in an interview, “it is his job to frighten people.”

For her part, Breed did not hesitate to scold. After more than 1,000 people gathered on Ocean Beach for a Burning Man celebration in early September, the mayor took to Twitter and scourged the gathering, calling it “utterly ruthless and selfish.”

If Breed and Colfax are “a little conservative, I think history will treat them kindly,” said Wachter. “With the way things are going, you won’t hear anyone say they should have opened the restaurants earlier. You will say they saved lives.”

The police also helped enforce health regulations. When long lines popped up outside a store, officials came to make sure people were distancing themselves and wearing masks. The police patrolled the parks on weekends, handing out masks. Quotes were issued to reiterate criminals, but most people gave in after being warned.

San Francisco quickly expanded its coronavirus testing months ago, making the city a leading provider of testing nationwide. It also worked with UC San Francisco to build a strong contact tracing program, devoting time and resources to the city’s strong Latin American mission district, a source of many infections.

John Swartzberg, an infectious disease expert at UC Berkeley, said San Francisco benefited from the bonds made between Bay Area health officials and between the city and its public health officials during the AIDS epidemic.

“The San Francisco experience of AIDS has shaped the San Francisco public health culture tremendously,” he said. “The relationship between SF General [Hospital] and the community was just a nice thing to see. The confidence it generated had a halo effect that affected the entire city. “

Comparing the Los Angeles pandemic experience to that of San Francisco, Wachter wondered aloud whether the difference was from “leadership or the people.” He suspects that the people of San Francisco tended to obey the health rules more than anywhere else. The Bay Area is “very diverse,” he said, “but politically not particularly diverse.”

Restrictions on reopening have been criticized by gym owners and the Catholic Archdiocese, but in San Francisco, “the importance of science is widely recognized by the public,” Wachter said, “and there is not widespread skepticism when executives say this the right things are to be done to save people’s lives. ”

Happiness was important too.

The newlyweds Tulika Jha and Mike Borden enjoy the sunset next to the Golden Gate Bridge.

Newlyweds Tulika Jha and Mike Borden enjoy the sunset on August 22nd from a viewpoint next to the Golden Gate Bridge in San Francisco.

(Luis Sinco / Los Angeles Times)

Given the high density and international travel of San Francisco from Asia and Europe, “this thing could have exploded before anyone was banned,” he said.

During a warm day last week, city residents walking along Embarcadero Bay generally praised the city’s handling of the pandemic, although some complained and complained about the disease threat from homeless camps that the public schools remained closed.

Cynthia Roberts, 66, acting coach, feared the city’s progress was just a break in the pandemic.

“Now that we open up, we can have problems,” she said.