San Francisco Mayor London Breed and Public Health Director Dr. Grant Colfax held a brief press conference Tuesday to add further gravity to the pandemic surge currently occurring in the city, region, and state. And while they did not announce any further restrictions on activities and businesses in the city, they hinted that these would be coming tomorrow or later in the week.

Breed began the press conference by saying this has been a particularly difficult year, and she empathizes with everyone in the city who is living alone like she is through this crisis. She also said it was hard having had the highs of two month ago when SF's COVID response seemed to be working and the possibility of opening things up further was on the horizon.

"I was proud," she said. "We were doing well because almost everyone in this city was doing everything we asked you to do."

But, things have taken a turn.

"Now with the numbers rising here and across the state and the nation, we are seeing how fast this is virus moving," Breed said. "It's not good. Cases are spiking, hospitalizations are increasing quickly... and this isn't just about San Francisco."

The mayor said that while "it's getting bad here, it's even worse in other places," and with San Francisco's hospital capacity still doing OK, the city has taken in several transfer COVID patients from other jurisdictions.

"Our dangerous winter has arrived," she said, and with that, "We are going to have to increase restrictions. It pains me to say that."

Neither Breed nor Colfax got specific about what new restrictions may be imposed on the city. In response to a journalist's question she addressed the possibility that restaurants may be forced to once again revert to takeout only — but she said the city would do everything it can to give fair warning to the restaurant industry if this happens.

"Unfortunately, we can't rule it out," Breed said, noting that the decision would come depending on how the spike in cases looks, with a view toward keeping hospitals from being overrun. "We can't say what [this] will mean, in terms of a timeline," she said, adding that she knows a decision like this will deeply impact many San Franciscans, like those who have come off of unemployment to retake restaurant jobs and may face unemployment again.

Colfax also demurred on the subject of what new restrictions may come, but said they could be announced "as soon as tomorrow," and said that city officials are looking at a number of options — including potentially imposing the difficult-to-enforce 14-day quarantine rule that Santa Clara County recently adopted for inbound travelers from more than 150 miles away.

The city is also likely to tell people to once again cease gathering with people outside of their households

Colfax noted that COVID-positive hospitalizations have doubled in San Francisco since the middle of November, from around 45 to 91 today, including transfer patients. And he shared the chart below showing the rapid rise in the number of new cases per day per 100,000 residents during the past month.

via SF Department of Public Health

"Unfortunately we are in the middle of a major surge... We are all at risk for this virus and we must all take precautions," Colfax said. "As a result of [Thanksgiving] holiday activities, we know, unfortunately that the worst has yet to come."

Colfax noted, much as Governor Gavin Newsom did yesterday for the state as a whole, that, "If we continue on this path, we will start seeing a hospital bed shortage around Christmas."

On Monday, Newsom suggested that a broad stay-at-home order, like the one issued back in March, could be coming this week for all 51 California counties. If that were to happen, it might take the orders out of Breed and Colfax's hands altogether.

Previously: Newsom: 'Red Flags Are Flying' With COVID Hospitalizations, Stricter Stay-at-Home Order Could Be Coming