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San Francisco's Health Director Dr. Grant Colfax addressed the city's surge in COVID-19 infections at a Wednesday press conference and the decision to extend the pause on reopening. Colfax encouraged residents to limit gatherings as much as possible to help suppress transmission of the virus.

The uptick in cases is the result of a combination of factors and he said gatherings with family and friends are among them.

"These visits are hard to resist but the truth is that they are spreading COVID," Colfax said. "Those birthday parties, visits with grandparents, the barbecues, they are contributing to a delay or rollback in businesses, or even a return to school."

He added, "At this time, we are encouraging people to minimize gathering as much as possible, and if they do gather, to gather outside and to wear masks and socially distance," he said. We know there’s a lot of room to improve that adherence."

As of this morning, San Francisco has recorded 4,696 cases of COVID-19 and 50 deaths. Several of the key indicators the city looks at to measure the severity of the pandemic are in the "orange" or "red zone." Hospitalizations are up 33% and the goal is to keep that figure below 10%. The number of patients in intensive care units is up 27%.

The city's case rate has increased to 7.7, meaning that for every 100,000 residents, 7.7 have COVID-19. At the start of the reopening in May, the number stood at 3.5. "Our goal is to keep that case rate at around 1.8," said Colfax.

What's more, the "reproductive rate,"  or Rt, is a key metric in measuring how fast a virus is growing, and SF's currently stands at 1.3. The reproductive rate was below 1.0 through April and May and began to climb in June. The goal is to bring it below 1.0 as that is the point when a virus can begin to die off.

“If our current surge continues, San Francisco hospitals could be overwhelmed in a few months, with 10 times as many cases as we saw in the April surge,” said Dr. Colfax. “We crushed that curve, and we can do it again if we redouble our commitment to the safety measures we know work: staying home whenever possible, staying physically distant whenever we go out, consistently wearing face coverings and frequently washing our hands. Let’s take care of each other and our City so we can be healthy and begin to reopen again.”

Some indicators are more promising. The city is implementing 2,950 tests a day and the goal is 1,800.  To reduce the delays that some residents are experiencing in testing appointments and in receiving results, the city is encouraging private health care providers to expand their testing services.

Another piece of encouraging data: 27% of the ICU beds in the city are still available. The goal is to ensure at least 15% availability in acute care beds.

In addition to gatherings, Colfax said transmission in those workplaces where safety precautions aren't followed and crowded living conditions are contributing to the spread. More effort needs to be made to connect with multigenerational households and make sure they’re taking precautions and getting tested, he said.

As a result of the increased transmission, the city announced it's continuing to delay the reopening of higher-risk businesses and activities such as hair and nail salons, tattoo parlors, massage establishments, indoor dining and indoor swimming pools and museums. (Find the city's complete reopening plan here.)

Colfax encouraged residents to follow safety precautions. "Wear a mask, do not gather and wash your hands," he said.

To help residents assess the riskiness of an activity and decide whether to engage, the city released a list of questions for people to ask themselves.

1. Is the activity indoors or outdoors? Outdoors is much safer.
2. Does it involve gathering with people outside your household? That is riskier and should be avoided.
3. Can you wear face coverings at all times?
4. Can you maintain at least six feet of physical distancing?
5. Can you easily wash your hands, and is the environment properly cleaned?

Amy Graff is the news editor for SFGATE. Email her: