Jackson Ryan/CNET

How two famous cities flattened the coronavirus curve

Two months in San Francisco and Sydney show how early, decisive actions helped contain COVID-19 outbreaks threatening to overrun the cities.

The best of times feels like a distant memory. 

Wisdom and foolishness, panic and preparedness, information and misinformation, science and pseudoscience. The response to the rapid spread of COVID-19 has been one of stark contrasts. Some countries, like South Korea and New Zealand, have flattened the curve. Singapore and Japan seemed on track, then a second wave hit. 

Others, like the US and Italy, have been overwhelmed.

In this respect, the sister cities of Sydney and San Francisco have a lot in common. Both have world-famous bridges, extreme rental prices and vibrant LGBTQI communities. They also share similar coronavirus trajectories. Case numbers began slowly rising in early March, before beginning a rapid ascent. In the two months since, the harborside cities have responded in a similar fashion, instating sweeping lockdowns, shuttering all but essential stores and preventing public gatherings. 

Doctors and health officials have lauded the cities for flattening their curves, and their success reiterates a valuable lesson in slowing the spread of coronavirus: Act quickly and decisively. 

In the state of New South Wales, where Sydney is situated, 7.6 million citizens lurched from one catastrophe to the next during the first four months of 2020. On New Year's Day, unprecedented bushfires tore through regional communities. Then, just as the last flames were snuffed, another crisis began: New South Wales became the center of Australia's COVID-19 outbreak. 

Across an ocean, 7,500 miles away, it was a cheerier time for San Francisco. The Bay Area, similar in population size to New South Wales but with a much higher density, was celebrating another Super Bowl appearance for the 49ers. But by March it was reeling from a defeat in Super Bowl LIV and the first COVID-19 cases had appeared. Sports became a distant memory. 

By mid-March, everything had changed. The Bay Area announced a strict shelter-in-place order, one of the first areas in the US to do so. New South Wales residents were asked to adhere to a suite of increasingly complex social distancing measures. As the crisis unfolded on opposite sides of the world, confusion reigned. 

San Francisco streets emptied faster than Sydney's. 

James Martin/Ian Knighton

The curve down under

On March 1, New South Wales felt as remote and detached from the coronavirus pandemic as anywhere in the world. Only four people had tested positive for COVID-19. Australia, on the whole, had recorded just 25 cases -- all travelers returning from overseas. By the end of the day, two more cases emerged in Sydney. 

It was a tiny increase in comparison with what some parts of the world were experiencing, but it seemed to send a collective shiver through the populace. 

The Australian government, led by Prime Minister Scott Morrison, formed a national cabinet so leaders from each state could coordinate their response. Every other day the prime minister, flanked by Brendan Murphy, the nation's chief medical officer, fronted the nation for a televised COVID-19 update. As the coronavirus case numbers rose, restrictions on movement became more comprehensive.

The early indications were worrying. Australians, noted for their laid-back attitude, seemed to be taking things a little too easy. Thousands still flouted the restrictive lockdown measures in Sydney and flooded the city's famed beaches. They could still get their morning coffee because the cafes were open. The prime minister was adamant he'd attend a rugby match on the weekend before the first restrictive distancing measures shut sport down.

The messaging, changing from day to day and even hour to hour, was confusing. There was debate over essential and nonessential services. Schools remained open in some parts of the country but not others, while attendance dropped significantly. How far you could wander from home differed state by state. 

And the hairdressing industry, considered "essential," became a microcosm of the uncertainty that lingered as lockdowns began. 

Cut confusion

Al, 28, has run a busy, small barbershop in Sydney's western suburbs for three years. When I visited on a late March afternoon, he was alone, sweeping hair clippings into a pile. He says it was the slowest business had ever been.

"No one's coming in," says Al, who requested his last name not be used. "No one's around."

Hairdressers, barbers and salons became the reluctant battlegrounds at the center of Australia's confusing lockdown guidelines. On March 24, Morrison announced that these services could remain open but customers must only stay for a maximum of 30 minutes. 

"There's no way you can cut someone's hair, blow dry and wash in 30 minutes," Al says. Following complaints from the hairdressing industry, the rule was overturned by the government only hours after it came into practice. However, barbers were still required to adhere to the "one person per 4 square meter" rule the government had instituted -- a physical impossibility.

Al, who runs a small barbershop in Sydney's west, was not ordered to close during lockdowns in Australia. 

Jackson Ryan/CNET

Australia's regulations saw hair salons and barbers lumped in with the same essential services as supermarkets, medical centers and pharmacies. "How is a barbershop essential?" Al laughs. "It's the least essential thing on Earth right now."

Al wanted to shut up shop, but his barbering gig is the only source of income for his wife and their four-month-old daughter. He feels like he just has to push forward, noting that there's "no real support for sole traders" and that he still has to pay the rent each month. On top of that, he was concerned a customer might inadvertently spread the disease in his shop, putting his family at risk.

"I'm pissed off I have to be out here trying to make a dollar and I could potentially catch the virus," he says.

The initial confusion and fear caught residents offside, but after an abrupt peak in case numbers through March, slowly the curve flattened. Even if barbers were open, most people remained home. The restrictions had worked.

"The city of Sydney responded quickly to the impacts of the coronavirus pandemic, acting on the direction and advice of our State and Federal Governments," says Clover Moore, lord mayor of Sydney. 

"It is a credit to the people of Australia that we have made a strong response to contain and suppress the pandemic," she says.

In San Francisco, restrictions were more severe -- barbershops had to close. If Al's shop was on the other side of the Pacific, he would have spent the last seven weeks at home. The Bay Area considered hair and nail salons nonessential services and shuttered them when shelter-in-place guidelines went into effect.   

Ahead of the curve

San Francisco's lockdown measures came earlier and were, initially, more restrictive than those in Sydney. At the beginning of May, its case numbers trailed well behind those of its sister city. That prevented hospitals from being overrun and earned San Francisco praise as "the city that flattened the curve." 

The city benefited from the Bay Area's aggressive, early actions, even if outbreaks in some counties continued to rise. The Area's shelter-in-place order went into effect on March 17, one of the earliest in the US, and San Francisco declared a local emergency even earlier, on Feb. 26.

"Mayor Breed declared a local emergency before there was a confirmed case of COVID-19 in the community, which enabled the city to prepare for a surge in cases and respond to outbreaks," notes Sarah Owens, the Mayor's deputy press director.

When San Francisco's mayor, London Breed, announced that the city was going into lockdown, Christopher Eliares was busy cutting hair. His brick-walled barbershop, Dogpatch Barber and Shave, in the city's east, was bustling. The next day he was forced to close.

"We haven't worked since mid-March, and it's been a struggle," he says. 

Eliares (right) and a co-worker before the lockdowns.

Christoper Eliares/Dogpatch Barber and Shave

Like Al in Sydney, Eliares is reliant on the income provided by clients, but he doesn't believe barbershops should remain open during the pandemic. "I can see why we are not considered essential. Front line workers, like nurses, are essential," he says. "No one is going to die if they don't get a haircut."  

Eliares says he's still paying rent on a store that isn't even open, and there's little financial support for independent contractors. He's established a GoFundMe to help pay the bills and getting adjusted to home life and "playing school dad" after six years of running Dogpatch. He's enjoying spending more time with his three daughters. 

Even though it's the first time since high school he's been without a steady stream of income, he harbors no ill will about closing the city down so abruptly.

"I don't think our mayor acted too harshly nor too quickly," he says. "No one knows how to handle an epidemic like this, and that goes for our city officials."

The response hasn't been perfect -- it's been a particularly difficult time for the city's homeless, who are at greater risk of infection and have not been provided with adequate shelter, resulting in at least one outbreak

The lockdown was originally planned for just three weeks, but Bay Area counties have now extended the shelter-in-place order until May 31. Restrictions on construction workers and outdoor retail are easing, and golf courses opened up on May 4. One prominent Bay Area newspaper called it a "gamble" that "threatens lives."

Eliares says a part of him is worried it's too much, too soon. As eager as he is to get back to cutting, he'd much rather go back when it's safe.

"The worst thing that can happen is opening up too soon, the virus spreading even more and then having to close up again," he says.

On the first weekend since the Bay Area's extension of the lockdown, demonstrations swept across California, with protestors flooding beaches and parks to argue for lockdown restrictions to be lifted. San Francisco saw crowds gather outside City Hall with signs shouting "SCAMDEMIC" and "reopen California," It was one of the smaller gatherings across California, with about 150 in attendance.

Left: Gladys Berejiklian, state premier of New South Wales. Right: London Breed, mayor of San Francisco.

Ryan Pierse/Justin Sullivan/Getty

Count on testing

Both cities are close to entering the next phase of their pandemic response: rebooting and returning to normalcy. Doing so will require enhanced testing -- and it's here the sister cities have differed most clearly. 

An early lag in testing across the United States helped drive an undetected spread of COVID-19 through communities, and many experts maintain that the actual number of positive cases described in the US is undercounted. An investigation by The Atlantic shows one in five people tested in the US return a positive result, a "very high" proportion of cases, suggesting there continues to be unseen spread across the country. 

In contrast, an analysis by The Mercury News on May 2 showed just under one in 10 people is positive for COVID-19 in San Francisco. The World Health Organization says this number of positive cases reflects a level of adequate testing. In places like New South Wales, though, only one in 100 patients return positive results.

Bay Area counties greatly improved testing rates throughout April, bucking the trend seen across California. In San Francisco, the total testing rate tipped over 2,100 tests per 100,000 people on the last day of April. That's similar to the rate of testing in New South Wales, which is approaching 3,000 tests per 100,000 people. 

For the lockdowns to end -- and for cities to avoid rolling waves of lockdowns in the future whenever cases spike -- testing needs to be dramatically expanded, according to estimates by scientists at the Harvard Global Health Institute. New South Wales opened up its regime on April 16, with state leader Gladys Berejiklian urging more people to get tested, including any individuals who have mild symptoms or think they may have the disease.

In Australia, the COVIDSafe app is being touted as a way to ease lockdown restrictions

The Australian government has designed an app dubbed COVIDSafe, which it considers one of the most important steps in reopening the economy. Users who install the app are pinged with a notification if they've been in contact with a person who has also installed the app and is found to be positive for coronavirus. So far, it's been downloaded by 5 million Australians, approximately one-fifth of the country's population. 

These smartphone-reliant "contact tracing" measures could be implemented in the Bay Area, too, but security and privacy concerns remain. Whether they work over the long term requires extensive buy-in from the public -- and there's no clear sign that will occur. 

While Sydney appears to be charting a course out, there's an air of uncertainty in the Bay Area. Even with improved testing measures in place, the number of cases seems to suggest the potential for an extreme resurgence in disease if lockdowns are lifted prematurely. 

A way out

When I come back to Al's barbershop in early May, he's in the middle of a cut, sharpening up a customer's fade. Another customer is in line ahead of me, so I flop onto the couch inside. Nobody is wearing a mask, but we all maintain our distance from one another.

Business, he tells me, is beginning to return to normal. 

He asks if I've written a story about the coronavirus. I tell him I haven't. Things have changed so rapidly in the last month. The story I would have written after my first visit is drastically different from the one I'm writing now. If I leave it another week, it will likely change again.

In March, it was easy to feel as if the limited restrictions in Sydney were leaving the city wide open for an unstoppable outbreak. Some cities, particularly in Europe, showed a lack of urgency. Their hospitals were quickly overrun. Others, like San Francisco, were taking aggressive action early, before any cases were confirmed. Residents couldn't even get a haircut. It didn't make sense that, in Sydney, I could. 

But after two months of isolation, confusion has made way for clarity. The numbers tell the tale: Aggressive, early action proved critical in halting the spread. We've also seen, no matter how alike cities and regions might be, there's no single, correct way to combat the virus. It's about adaptation. It's about consultation, with the experts, the scientists, the epidemiologists. 

Like so many times during this pandemic, what comes next is unknown. Citizens on both sides of the Pacific have become used to standing in supermarket queues and skirting each other on running tracks. We've kept our distance at the beaches and the parks. And the success in Sydney and San Francisco looks likely to pave the way for a more rapid return to normalcy than in many other parts of the world. As flat as the curves may be, there is one concession: The coronavirus pandemic is not over. 

Clover Moore, lord mayor of Sydney, says "there's still a long way to go" before a return to any sort of normalcy. The Mayor's office in San Francisco made it clear the city "will be dealing with [coronavirus] for a long time to come." In places like Japan, a second wave of infections hit hard after lockdown measures were eased. Even South Korea, which has been lauded for its response, is seeing an uptick in cases.

As restrictions begin to ease and people start to congregate at coffee shops, bars, clubs and supermarkets, the lessons learnt by two cities on opposite sides of the world are more important than ever. Governments and health authorities will need to be ready to quickly lockdown parts of the community when outbreaks occur. Residents will need to be ready to adapt, again. 

Two months ago, Al was frustrated with having to be at work, potentially putting himself and his family at risk. But as he buzzes the side of my head with his clippers, I ask him whether his opinion has changed. He softens. "I think the government has done a good job," he says. 

Shortly after, a father and son step into the shop asking for a cut. Al tells them to wait outside. He can only have three people in his store at once. 

Update, 4:45 p.m: Added SF response for homeless, clarified Super Bowl paragraph in introduction