In addition to tracking total cases and new cases among San Francisco residents overall, health officials with the San Francisco Department of Public Health (SFDPH) also analyze how the virus has impacted specific groups or communities. Information on the characteristics of those impacted by COVID-19 can highlight disparities, inform the City’s policies and outreach efforts, and enable the City to direct resources to those most heavily impacted.
COVID-19 Risk Factors
While anyone can become ill with COVID-19, there are certain risk factors that may make a resident more likely to get COVID-19, or more likely to need hospitalization or intensive care if they do get it. Some key risk factors for transmitting or becoming infected with COVID-19 that have been identified to date include:
- Spending time with a large number of people while sharing the same enclosed airspace
- Having a large household size, or sharing a bathroom/kitchen with multiple people
- Leaving the house for essential work, or being unable to limit outings
Some risk factors for severe cases and hospitalizations include:
- Being over the age of 60
- Having certain preexisting health conditions
Institutional racism and other structural inequities are closely tied to many of these risk factors and data show that communities of color bear a disproportionate burden of COVID-19 disease and death. Read more on our Race & Ethnicity webpage.
Cisgender men account for the highest percentage of COVID-19 cases and deaths in San Francisco. This trend has been consistent since the beginning of the COVID-19 pandemic in March.
Certain social factors may correlate with gender identity and may contribute to COVID-19 risk. For instance, there may be gendered behaviors, pre-existing conditions, and gender-segregated occupational risks that may explain some of these trends. Read more about this at the GenderSci Lab COVID Project.
Tracking COVID-19 cases among transgender and gender nonconforming (TGNC) San Franciscans is a high priority for SFDPH as these residents may be particularly vulnerable because of structural inequities and other socioeconomic factors. For example, transgender and gender nonconforming individuals are 18 times more likely to experience homelessness than other San Franciscans. Trans women in general, and especially trans women of color, also face much higher rates of HIV than other populations, resulting in increased rates of underlying conditions.
There have been relatively few cases of COVID-19 among trans women, trans men, or gender nonconforming, genderqueer and nonbinary San Franciscans. This may be because the relatively small size of these populations. However, the size of these populations is difficult to estimate because residents may choose not to identify with their gender identity in a medical setting because of the risk of stigma or discrimination. The City continues to work to ensure that TGNC residents have access to the testing, resources, and support they may need during the pandemic. Learn more about transgender community services.
Sexual orientation is missing for a large proportion of cases and deaths. Sexual minorities have faced substantial stigma and discrimination, particularly in medical settings. As a result, they may be reluctant to disclose their sexual orientation in medical settings when tested for or diagnosed with COVID-19. This may explain why so much of the data is missing.
Heterosexual residents account for the majority of COVID-19 cases. Less than 10% of cases are among lesbian, gay, bisexual, queer and other sexual minorities in San Francisco. Among deaths where sexual orientation is known, most are heterosexual residents.
Sexual orientation is critical to track. There are many key overlapping social and health factors that are important to consider for lesbian, gay, bisexual, queer, and other sexual minorities in San Francisco. For example, in San Francisco, gay and other men who have sex with men bear a disproportionate burden of the HIV epidemic; and living with HIV can result in immune suppression which is a risk factor for more severe COVID-19 disease. Read more about this in a recent study. Learn more about COVID impacts on sexual minorities.
The City and the State of California are committed to continuing the programs and community supports for LGBTQIA residents. Read more about LGBTQ community services available during the pandemic.
People experiencing homelessness are vulnerable to COVID-19 because of a high prevalence of underlying conditions and the use of shared accommodations (both sheltered and unsheltered residents are vulnerable). However, the number and proportion of COVID-19 cases and deaths among persons experiencing homelessness is relatively low in San Francisco.
The City is committed to providing prevention and care services for people at risk for and experiencing homelessness to prevent further COVID-19 cases and deaths. On any given night, there are approximately 8,000 residents experiencing homelessness (based on the 2019 Point-In-Time Count). Some of the key COVID-19 resources and responses are outlined below.
- If you are experiencing homelessness, there are resources and services available: https://sf.gov/information/homelessness-and-covid-19
- The City is committed to working with our non-profit partners to provide care for people experiencing homelessness during this public health emergency. Learn more about the City’s response.
- One key aspect of this response has been opening Shelter-in-Place (SIP) hotels for people experiencing homelessness to prevent the spread of COVID-19 and to protect the health of our most vulnerable homeless residents. Learn more about the alternative housing system.
Over three-quarters of COVID-19 related deaths in San Francisco have had underlying conditions (also known as comorbidities). The presence of certain conditions such as chronic lung disease, cardiovascular disease, immune suppression, cancer, chronic kidney disease, obesity, and diabetes are associated with an increased risk of severe illness and death. Learn more.
The most recent month may have more unknown data as the Department of Public Health is continuing to collect this data for recently reported cases. Data will be updated as more information becomes available.
Most San Francisco residents diagnosed with COVID-19 are between the ages of 25 and 50. The youngest age groups (those under 18) and the older age groups (over 60) have relatively few cases, with both groups comprising about a quarter of all cases. Over time, there has been a trend toward younger age at diagnosis. Transitional aged youth (18-24) have some of the highest case rates, meaning that these groups have been heavily impacted by COVID-19 considering the size of this population age group.
The age distribution of COVID-19 deaths is much older: over half of deaths were among persons over the age of 80 and nearly all are over the age of 60.
Older adults are at a higher risk of serious symptoms and outcomes, particularly those with underlying conditions. While research is still ongoing, it seems that even though children do not show symptoms as often as adults, they can still spread the disease to others.
The City has implemented programs and policies to support residents in age groups that are most vulnerable, particularly elderly residents and children and youth.
- Older adults who live in residential care facilities and cannot physically distance with others are at the highest risk for transmission. Read more about the City’s efforts in Single Room Occupancy buildings and in Skilled Nursing Facilities.
- Food security is a critical issue for those who can’t leave their homes. Read more about the City’s food programs.
Children and Youth:
- The City has released guidance and support to ensure that childcare and schools are as safe as possible.
- Read more about school reopening.
- Read more about all the work for children, youth, and their families.
Data Limitations & Notes
Data on COVID-19 cases and deaths are collected from case interviews, laboratories, and medical providers. This data may not be immediately available for recently reported cases and will be updated as more information becomes available.
To protect the privacy of San Francisco residents and minimize the risk of anyone being identified from the data, the dashboards above summarize COVID-19 data by one characteristic at a time only (e.g., gender identity, sexual orientation, age, etc.). Also, data are not shown for any subgroup with fewer than five cumulative cases. As more cases are confirmed, groups with five or more individuals will be added to the dashboards. Learn more.
The data shown above may undercount certain minorities who have faced stigma and discrimination, particularly in medical settings (and therefore may not disclose their gender identity or sexual orientation, for example). There are health inequities and barriers to health access for non-cisgender and non-heterosexual residents. However, at this point we do not have enough data on COVID-19 to understand disparate impacts on these groups. Nonetheless, we aim to continue improving our data quality and analysis to be able to better measure COVID-19’s impacts on these populations.
The spread and severity of COVID-19 is complex and affects residents differently based on overlapping layers of systemic racism and structural inequities in areas such as housing conditions, employment, and other economic and environmental factors. This means that there are often key intersections of populations who are particularly impacted (for example, essential workers in a specific age group of a specific ethnicity). For this reason, all of this data should be interpreted in context, and individual conclusions should be treated with caution.
Data and dashboards are updated daily.
Additional resources that discuss common myths about COVID transmission: