Inside a warehouse on the far edge of the Presidio sit dozens of wheelchairs, retired from a service they never fulfilled. Bare hospital beds are piled high with unused linens still wrapped in plastic. Panels of paintings meant to partition and cheer bed-bound patients are perched side-by-side, ready to be transported off-site, and empty oxygen cylinder carts stand at attention like tin soldiers awaiting the order to march.
Combined, the space—somewhere between a ghost-like gallery and an abandoned field hospital—has the feel of some post-apocalyptic aftermath.
Except these are the remnants of a battle that never came, at least to this complex of warehouses originally built in the wake of the Spanish flu pandemic and overlooking the Golden Gate Bridge. As part of San Francisco’s pandemic response, the dual city and county assembled an alternate care site at the Presidio’s Gorgas Rail Warehouse Complex to accommodate non-COVID hospital patients in need of care should San Francisco’s hospitals “surge” with COVID-19 patients. The care site—thankfully—was never needed.
While New York City became an epicenter for the COVID-19 pandemic last spring and Los Angeles hospitals turned parking lots and gift shops into treatment wards last winter, San Francisco stood out among American cities for its proactive and data-driven approach to the pandemic.
As of May, San Francisco has recorded less than 550 COVID-related deaths, and its hospitalization rate has never peaked beyond 259 confirmed COVID patients. As of March, the city’s per-capita mortality rate stood at just 49 deaths per 100,000 residents, compared to 220 deaths per 100,000 in Los Angeles and 354 per 100,000 in New York City. USCF’s Dr. Bob Wachter estimated that if the U.S. had SF’s per-capita death rate, the country would have suffered 364,000 less deaths.
San Francisco’s Director of Health, Dr. Grant Colfax, told Here/Say that “we never came close” to activating the care site. Yet bigger questions loom about what will happen to the art pieces that blossomed out of the city’s doomsday preparation and what lessons can be gleaned for future disaster preparedness.
“We were glad to have it in our proverbial back pocket,” said Dr. Colfax. “Thankfully, our health care systems, our intensive care unit beds were never in danger of being overwhelmed.”
But on the ground at the Presidio, alternate care site clinical coordinator lead Heather Bollinger had to be ready to accept as many as 94 hospital patients with just 72 hours notice and remembers being on high alert three times last year when COVID-19 cases surged.
In July, “we were really mobilizing and trying to get ready to go,” recalled Bollinger, also an emergency room R.N. at Zuckerberg San Francisco General Hospital and Trauma Center. “And then again, in October, it was looking really close, and then again in December, it was looking really sketchy.”
But earlier this spring, Bollinger received word that the site would be disassembled—a testament to the city’s success battling back COVID-19.
Now she is tasked with packing up cots and finding homes for syringes by June 1, when the site will be turned back over to the Presidio Trust.
With vaccination rates high and COVID-19 case rates low, Dr. Colfax told Here/Say that the city felt “comfortable” deactivating the site.
While most of the medical equipment acquired for the site will go into storage, what’s less certain is what will happen to the 97 murals created by 15 volunteer Bay Area artists.
“To not need a disaster site is generally a good thing,” says Bollinger, but “it’s real bittersweet” for her to see the site that so many reassigned city workers, volunteers and artists poured their hearts into like a “start-up” for 10 months come to an end.
“[It’s] hard to see it not be utilized at the end of the day,” she says with a mix of pride and wistfulness.
Lead artist Laura Pacchini, who spearheaded the effort to paint murals on each of the alternate care site’s patient partitions with a team of volunteer artists, had to also contend with the possibility that, in the best-case scenario, the artwork for this project might never be seen widely.
“Hopefully, nobody will ever have to be in these rooms,” she recalls thinking, but painting with acrylics at the Gorgas warehouses with a bunch of socially-distanced artists “almost became this happy addiction” at a time when she, like many during the pandemic, was feeling kind of helpless and lacking a sense of community.
“This gave me a spark to do something because it was in service of others,” says Pacchini. “Amidst the horror, there's this beauty. As we would spend more time [together]… we were also influencing each other. We started really getting into it, and it was fun to start experimenting with a new medium.”
“They came out extraordinarily,” says Bollinger. “It's such a unique, special contribution to everything this year came to represent.”
District 2 Supervisor Catherine Stefani, who helped to facilitate the project, hopes that the artworks could one day be displayed at City Hall or another site in San Francisco “to commemorate everything we learned through the pandemic” and her office is actively exploring exhibition opportunities.
“So although they weren't used and nobody really saw them, I think the feeling that it left both for the artists and everyone involved was a very positive experience for all,” Stefani told Here/Say.
Bollinger is saddened that the artworks won’t be seen where they were created but also hopes that they can be turned into some kind of exhibit to bring closure to families whose loved ones may have died of COVID isolated and alone.
“What I think is really hard is justifying the expense of closure,” she observes, acknowledging that keeping the alternate care site open to display these artworks would likely be a tough sell for taxpayers and city finance officials. (Total rent on the Presidio alternate care site cost just over $1.1 million and additional costs associated with the site added up to $1.7 million.)
Still, “how could we use this art to recreate that experience for some of the people that have suffered losses?,” she muses.
She also wonders how alternate care sites could be maintained year-round for earthquake and wildfire disaster relief and whether they should be erected in stadiums or warehouses or attached to preexisting medical sites to make the model more efficient.
“We're learning a lot from this experience about the best way to handle disasters and how our systems can support people the best,” says Bollinger. “There is need for sites like this... but they're expensive to maintain. It's a very expensive insurance policy.”
Pacchini hopes that the artworks might also get a second life through an exhibition in the city, but takes satisfaction in simply knowing that they were created for the “greater good.”
“I think art is always happiest when it's out in public and in the open,” she says, but “as an artist, you're not always doing work to be seen.”
And perhaps that’s the magic of the Presidio’s alternate care site—that it never had to be used at all.
“We are in a better place to respond to pandemics or other related challenges or natural disasters… as evidenced by our ability to scale this site up and respond,” says Dr. Colfax. “The fact that our prevention efforts were so effective is reflective of what people in San Francisco were able to accomplish together.”