A look back at the last 45 years of San Francisco's history yields several key moments that can be traced directly forward to the city's response to the COVID-19 pandemic. And it's a story about how tolerance for LGBTQ people, and the compassion that tolerance bred during the HIV/AIDS crisis of the 1980s, helped shape a public health infrastructure that was ready for the next pandemic.

There is no denying that there was some luck involved in San Francisco dodging the bullet of the initial, potentially uncontrollable surge of coronavirus cases back in late February and early March. And other factors, including an already established remote-working trend among tech workers, and a general affluence that makes semi-dense living easier than for the average city-dwelling American.

But none of this explains why we had a public health director and a mayor willing to move before any other in the country to declare a state of emergency, or why San Francisco was one of the first cities in the country to order businesses to close and residents to shelter-in-place, buying vital weeks to flatten the curve of hospitalizations — which spiked here nonetheless by April, but not nearly as dramatically as other cities have seen.

In a new piece in Wired, writer Daniel Duane makes the clear case for why the LGBTQ activism of the early 1970s in San Francisco, the hard-won tolerance that activism engendered, and the election and assassination of Supervisor Harvey Milk, set the stage for a stellar pandemic response at the highest levels of state and local government — Governor Gavin Newsom was mayor of the city not so long ago, after all.

The legacy of AIDS, for one thing, led to a tight partnership between the city's main public hospital, SF General, and the city's only medical school UCSF — something that has led UCSF to become a global leader in epidemiological study, and HIV/AIDS in particular. As Duane writes:

Throughout the early '80s, as AIDS devastated entire San Francisco neighborhoods, national journalists were still calling AIDS “gay-related immunodeficiency” and describing its risk factors as 4H—as in homosexuals, heroin users, hemophiliacs, and Haitians. UCSF clinicians, meanwhile, were busy launching the world's first dedicated AIDS units, wards 86 and 5b at San Francisco General, and founding the Center for AIDS Prevention Studies, one of the first of its kind. Before President Ronald Reagan managed to say the word “AIDS” in public, UCSF and SF General were developing the San Francisco model of AIDS care—now the global standard—with teams of nurses, social workers, nutritionists, doctors, addiction specialists, and psychiatrists all working together.

Fast-forward to 2012, when UCSF-trained physician and HIV specialist Dr. Grant Colfax was named President Obama's Director of the Office of National AIDS Policy. And then last year, Mayor London Breed named him the new director of the Department of Public Health — a department where he had worked as Director of HIV Prevention and Research before the Obama appointment.

The brain trust that now exists in San Francisco when it comes to infectious diseases, and the respect that is given to that expertise by local politicians, can't be overstated when it comes to the pandemic narrative we have seen play out.

Colfax was quick to see the brewing pandemic storm, along with colleagues at UCSF, and he helped ring the alarm bells at City Hall in January that led directly to Breed's February 25 emergency declaration — at a time when there were only 10 confirmed cases in California, and 53 in the country. Most other politicians were not so quick to take decisive action.

As Breed says now, in the Wired piece, "If a doctor who was part of what was happening in San Francisco during the AIDS crisis is telling you, ‘You got something to worry about,’ then you got something to worry about."

The medical expertise that surrounds San Francisco — at UCSF, Stanford, and multiple institutions in the region — can't be discounted either. And it remains remarkable how low the death count has stayed, particularly in the city, but also in the region as a whole compared to the rest of the state and the nation.

In a piece published in late April by Kaiser Health News, Angela Hart and Anna Maria Barry-Jester told the story of the formation of the Association of Bay Area Health Officials, a coalition of 13 health officers spanning the nine-county Bay Area and including Santa Cruz, Monterey, and San Benito counties as well (along with the independent health department of the City of Berkeley), that was formed in 1985 to address the growing AIDS crisis. This association was pivotal in the region-wide coordination when the lockdowns began — and it's a region with a particularly well qualified and congenial group of public health officials who deeply trust one another. Those health officers all had the power to shut down the economies in their counties — and Mayor Breed became the face of the sheltering orders in part because she balked at the idea of non-elected officials making such a politically consequential announcement.

There's no doubt that New York City and Los Angeles have suffered for various reasons having to do with density and socio-economic factors that affect how people live and work. But San Francisco's response has been swift, consistent, and stern from the beginning of this crisis, and there's no doubt that has saved lives.

As Duane notes, on March 2, the same day that Twitter told its entire workforce to start working from home and the same day Mayor Breed began telling people to expect a disruption to daily life and to begin stocking up on medications, New York Mayor Bill DeBlasio tweeted to the city that everyone should "go on with your lives + get out on the town." That advice and attitude, for countless New Yorkers, might have meant the difference between life and death.

It still could be that San Francisco will see a surge this fall or winter that it can't so easily control — Colfax warned of such a possibility just two weeks ago. But UCSF's head of the department of medicine, Dr. Bob Wachter, has said he doesn't see that happening for the simple reasons that good governance, politicians who listen to science, and a generally educated and cautious population have been keeping the virus metrics down as long as they have.

"You got lucky with your politicians,” says Peter Staley, an AIDS activist who now lives in New York, speaking to Wired. “New York did not, and obviously the nation did not. It really triggered everybody who survived the early AIDS year... The ones who appear alarmist at the beginning, because you don't yet see the deaths, they are the politicians who save lives.”

Related: UCSF Med School Chair Suggests Hope For San Francisco In Avoiding Explosive COVID Surge

Photo: Max Templeton