After decades of steady decline, tuberculosis (TB) is making an unwelcome comeback in San Francisco. Local health officials report a sharp uptick in active cases in 2024, reversing years of progress in eliminating the airborne disease.
Why Is Tuberculosis Rising in San Francisco Again?
Public health experts point to a mix of post-pandemic disruptions and long-standing inequities driving the surge. Decades of underfunding for TB programs left the city ill-prepared to handle a rebound once COVID-19 diverted resources.
Post-Pandemic Healthcare Disruptions
COVID-19 forced San Francisco to shift nearly all public health resources to pandemic response, delaying routine TB testing, contact tracing, and treatment programs. Many latent TB infections went undetected, allowing cases to progress to active, contagious disease.
Vulnerable Population Impact
Marginalized groups are bearing the brunt of the resurgence. Key high-risk groups include:
- Unhoused San Franciscans, who face higher TB exposure risks due to crowded shelters and encampments
- People with compromised immune systems, including HIV patients, who are 20x more likely to develop active TB
- Residents with limited healthcare access, including undocumented immigrants and non-English speakers
What Are the Risks of San Francisco’s TB Resurgence?
Unlike latent TB infection (which has no symptoms and is not contagious), active TB spreads through the air when an infected person coughs, sneezes, or talks loudly. Crowded public transit, shared housing, and busy public spaces all increase transmission risk.
Left untreated, active TB can be fatal. It most commonly attacks the lungs but can spread to the kidneys, spine, and brain.
How Are Local Officials Responding?
The San Francisco Department of Public Health (SFDPH) has launched a multi-pronged response to curb the surge. Initiatives include:
- Free mobile TB testing clinics in high-risk neighborhoods, with results available in 48 hours
- Expanded contact tracing teams to identify and treat people exposed to active TB cases
- Waived all treatment costs for TB patients, regardless of insurance or immigration status
Treatment Is Effective (and Free)
Active TB is curable with a 6–9 month course of antibiotics. SFDPH provides all medication, lab work, and follow-up care at no cost to patients, to prevent skipped doses that can lead to drug-resistant TB strains.
How Can You Protect Yourself?
Most San Franciscans are at low risk, but these steps can help keep you and your community safe:
- Get a TB test if you have a persistent cough (lasting 3+ weeks), fever, night sweats, or unexplained weight loss
- Cover your mouth and nose when coughing or sneezing in public spaces
- Stay home and seek medical care if you have active TB symptoms, until cleared by a doctor
- Encourage high-risk friends or family members to get tested at a local clinic
The return of tuberculosis in San Francisco is a reminder that public health progress is fragile. By staying informed, getting tested if at risk, and supporting local health initiatives, residents can help stop this resurgence before it grows into a larger outbreak.
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