The Perfect Enemy | The next COVID surge may hit San Francisco’s wealthy neighborhoods the hardest. Here’s why - San Francisco Chronicle
March 29, 2024

The next COVID surge may hit San Francisco’s wealthy neighborhoods the hardest. Here’s why – San Francisco Chronicle

The next COVID surge may hit San Francisco’s wealthy neighborhoods the hardest. Here’s why  San Francisco Chronicle

As COVID-19 case rates once more begin to climb in San Francisco, wealthy neighborhoods are seeing higher case rates than less-wealthy ones — a rare occurrence in a pandemic that has most deeply impacted lower-income people of color.

But unlike the omicron wave last December, which started in wealthy neighborhoods and then quickly migrated to lower-income ones, public health experts say there’s a chance this latest wave could be the first to hit wealthy people harder — thanks both to pandemic fatigue within the demographic, and its relatively lower rates of natural immunity from prior infections.

Using data from the San Francisco Department of Public Health and the U.S. Census Bureau, the Chronicle sorted the city’s neighborhoods into three groups based on their median household incomes, then calculated those groups’ recent COVID-19 case rates.

From mid-February to April 23, the latest date with confirmed data available, the neighborhoods in the wealthiest group — including Noe Valley, Haight-Ashbury and the Marina — experienced higher average case rates than the lowest-income neighborhoods, including Bayview, Chinatown and the Tenderloin. Test-positivity rates, defined as the share of tests that return positive results, are also higher in wealthy neighborhoods right now.

Not all waves are created equal: While cases may have soared several months ago and are climbing once again now, deaths remain low in San Francisco. The number of deaths during the omicron wave, and this latest surge, are far below that of the winter surge of 2021.

The Chronicle previously reported that the omicron wave began with a swell of cases in wealthy and white-majority neighborhoods — for instance, the Marina’s case rate in late December was nearly three times higher than that of the Bayview, which has had the highest cumulative case rate of any neighborhood in the city since the pandemic began.

But in a matter of days, case rates in lower-income neighborhoods overtook those of wealthier ones. The omicron wave then swept through such neighborhoods at far higher rates, once again burdening lower-income San Franciscans — particularly Black and brown ones — with the brunt of the disease.

George Rutherford, a pediatrician and epidemiologist at UCSF, said that this latest surge might spread differently than the last one, though. That’s because in this springtime surge, wealthier neighborhoods’ higher case rates are being driven by two factors working in tandem: increased exposure, and less immunity (relative to lower-income neighborhoods).

In earlier pandemic waves, when case rates in lower-income neighborhoods were higher than wealthy ones from the outset, Rutherford said that higher-income people were going to great lengths to shield themselves from exposure — mostly because they could afford to. They could work from home, order takeout and socially distance much more than people in lower-income neighborhoods, who disproportionately worked “essential” jobs in industries like food service that require in-person labor.

But now, he said, wealthy people are taking fewer pains to shield themselves, and getting exposed to COVID more.

“You have people who are more affluent saying, ‘Oh, I think we’re on the backside of this, we can go out to dinner and all that stuff,’” he said.

Additionally, because the latest uptick began so soon after January’s infection tidal wave, lower-income neighborhoods hit hard by that wave have a higher degree of “natural” or acquired immunity to COVID-19. Nobody knows for sure how long a person stays “immune” to COVID-19 after getting infected, but studies suggest that having antibodies from a past infection can lead to heightened protection for at least three to six months.

Lower-income neighborhoods’ heightened immunity could be protecting them more this time around — and if trends continue, it’s a “distinct possibility” this wave could be the first that infects wealthy people more than the less-wealthy, Rutherford said.

Rutherford added that the gap between rich and poor neighborhoods’ case rates is probably bigger than the current data shows. That’s because people in wealthy neighborhoods have better access to at-home test kits, which are not counted as cases by the Department of Public Health unless the person then confirms their positive result with a lab test.

But Rutherford acknowledged that his beliefs about what is happening are, by necessity, conjecture. That is, nobody knows for sure where the latest wave will go from here.

It’s still possible that lower-income neighborhoods will get more infections than wealthy areas in this wave, too: In the last several days’ worth of confirmed data, middle-income neighborhoods (a group that includes Bernal Heights and the Inner Sunset) have overtaken higher-income neighborhoods, and it appears that lower-income neighborhoods might do the same.

Susie Neilson (she/her) is a San Francisco Chronicle staff writer. Email: susan.neilson@sfchronicle.com