While much of the country is bracing for a winter surge in new COVID cases, hospitalizations, and deaths, the Bay Area has seen only the slightest hints of an uptick in new cases — primarily among the unvaccinated, of whom there are fewer every day. And local hospitals are not yet seeing a rise in severe cases either.

The Delta-variant surge that drove the wave in new COVID cases across California and much of the country beginning in early July led to a consequent wave of hospitalizations, and in the Bay Area we saw those begin to rise around early July — two to three weeks after the state lifted all mask orders and capacity limits on businesses.

But the story right now seems to be that daily new cases and hospitalizations may be leveling off at a higher base rate than we saw in May and June. Public health experts say this is to be expected with most of life and commerce back to normal, and masks only being worn in certain indoor settings.

Hospitalizations across the nine-county Bay Area have just dropped as of Thursday to their lowest point in four months, reflecting the relatively low number of cases that have been recorded in recent weeks. There were 329 confirmed and suspected COVID patients in Bay Area hospitals as of Thursday — a lower number than has been recorded on any day since July 11, when hospitalizations were ticking up from the start of the Delta wave. It's also a similar number to what the region saw in late April and early May, as vaccination eligibility opened up to all adults.

This is a positive sign given the wide availability of at-home tests and the probability that some vaccinated people with breakthrough cases are riding out their mild illnesses without their cases going into an official record, which means official case counts are likely undercounts. Hospitalizations remain the clearest gauge of a region's COVID picture, reflecting the ongoing pandemic of the unvaccinated and waning immunity among those who were vaccinated early or previously infected.

Statewide, the hospitalization picture also shows signs of leveling off or continuing to decline — and similarly to the Bay Area, the leveling off is just happening at a higher base rate than in the spring. As of Thursday, there were 3,313 COVID-positive patients in California hospitals — the lowest number since July 26, but not as low as in mid-June when hospitalizations dipped briefly below 1,000.

Daily new cases in San Francisco were ticking slightly up in the last two weeks, prompting this ominous headline from the Chronicle — however the data has not yet been looking much like last winter's surge, and daily new cases have actually started declining again in the last few days. San Francisco saw 22 new cases on November 14, which is the most recent day for which case data has been made available, and 30 cases the previous day — though there were several days in early November when the daily count climbed above 100.

Via the CDC's metrics, San Francisco is back in the orange or "substantial" tier for COVID spread, and as SFist has noted previously, the city has bounced between the yellow and orange tiers for at least a month now. Qualifying for the yellow tier requires a seven-day total of new cases to be under 50 per 100,000 residents, and as of Friday SF was at 53.66.

Still, experts say we will likely see a surge of some kind as a result of holiday travel and gatherings, and it will be driven by the unvaccinated. Therefore, in regions with high vaccination rates like the Bay Area, it is likely to be a much less dramatic surge in cases and hospitalizations than we saw last December and January.

"We are still in a risky situation even though we are in a much better situation than we were before," said SF Public Health Director Dr. Grant Colfax in a Wednesday briefing. "We are doing well in terms of our booster uptake, but we need to do better," he added.

The upper Midwest is seeing dramatic upticks in COVID cases that are being driven by unvaccinated children and teens, leading to school outbreaks that spread to the broader community, as the Chicago Tribune reports.

76% of all San Franciscans, of all ages, have been fully vaccinated as of Friday, and 87% of residents age 5 and older have received at least one dose of a vaccine. 90% of teens and tweens (ages 12 to 17) have received at least one dose in San Francisco, and so have 34% of kids 5 to 11, which is more than triple the national average.

"We should expect increasing cases in the coming weeks and months,” said Stanford infectious disease expert Jorge Luis Salinas, speaking to the Chronicle.

But, Salinas added, "I don’t think the Bay Area is in critical condition at the moment."

Previously: Winter COVID Surge Already Starting In California, But Bay Area Could Be Spared