The concentration of SARS-CoV-2 in wastewater is in blue, and publicly reported cases in red. The red curve might lead you to conclude cases are much lower than in January, but the wastewater values are as high or higher than back then!
Also recall that it was February 2022 when San Francisco dropped all mitigation measures including mask mandates -- towards the top of the downward slope on that previous surge.
{Bill Hicks voice} "But there's no connection there! You'd be a fool and a communist to make one!"
Finally the South Bay is better at something than SF

Look for the deaths & long-term incapacitations. Those are hard to conceal in any kind of reasonably open society. Unfortunately they're trailing indicators but perhaps not trailing enough that there's not good data by now.
Excess deaths previously. Vaccinations have definitely caused COVID to be less deadly, but the excess death numbers don't tell us much about Long COVID. And it will be years or maybe decades before the "long term incapacitation" numbers can retrospectively tell us what happened. And maybe never.
Based on the CDC's data excess deaths have been mostly negligible since mid-March (that previously points to an article originally published in November '21). But your point about long COVID is important and underappreciated.
Another even more unappreciated risk is the 3.5x heart attack prevalence persisting more than a year recovery, and probably for the rest of the life of anyone who has had even an asymptomatic case.
Oh, I was assuming long covid would show up sooner. That's naïve though, because I'm assuming the people paying for the statistics want to know, while they really very much want not to know, so they can crow that they 'got the big decisions right' (yeah, Boris, no you didn't, you lying fuck).
Funny old world where "maybe it will be in the financial interest of the insurance industry to tell the truth" is our best hope.
Would be interesting to see a third line with the covid infected hospitalized people. Especially the ones in the intensive care unit.
https://sf.gov/data/covid-19-hospitalizations
One important caveat to this is that different variants apparently shed to differing degrees in poop. For equivalent amounts of infections, delta couldn't be found as much in wastewater as alpha could, and then with the initial omikron it was back to alpha levels. No idea how that goes with the various BAs though...
Do you have a source for that?
Overlaying wastewater concentration on either infection cases or on positivity for various U.S. cities has a varying discrepancy depending on the region. The recent SF discrepancy is quite large, but it's relatively minor for midwest cities. Is the recent variant proportion for SF different than the midwest?
I've been gauging the surge by how many extra coolers my brother needs to keep the bodies on ice. He's an undertaker.