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Provocative @JAMA_current piece on #AMCs by @ClayDellMed bit.ly/2ZwU2d5 For new school like Dell, focusing on new models makes sense. For thriving AMC like @UCSF, hard to disrupt (w/o harming missions) before incentives change. I see my #1 job as balancing these tensions
By the way, this isn't argument that AMCs should just accept the status quo, not work their tails off on innovation/value/pop health, or fight the tendency to prioritize clinical profits over education/research. All are critical and @UCSF we're trying to do our part.
And I'm grateful to Dell and other new schools for blazing paths that are harder for "legacy" orgs. It's what start-ups should do, and the history of start-ups is that they sometimes end up eating the lunch of the old "battleships" that couldn't or wouldn't change. We'll see...
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Bob Wachter
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1/ Covid (@UCSF) Chronicles, Day 79

Grand Rounds: bit.ly/371fGv2. Moment called for wisdom & reflection, so I convened 4 wisest people I know: @SueDHellmann @cuttingforstone @seccurve & Mark Smith. If you can, watch. Per a colleague: “gripping, relevant & transcendent”
2/ Quick local update: @ucsfhospitals, just 8 pts, 3 vented. Lowest # s of both since 3/19. Wow. In SF, we’ve also turned corner: cases still ~20-30/d, but no new deaths in a week. Hospitalizations now 39 (Fig), 18 in ICU – both down ~50% from 1 month ago.

On to Grand Rounds…
3/ @ 5:00: I asked M. Smith how he was feeling as a black man – & dad of another –in America. “Hopeful…because of the depth and breadth of the reaction…to see how many people from all walks of life, all 50 states & around the world [protesting]…Gives me hope that people care.”
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Bob Wachter
@Bob_Wachter
1/ Covid (@UCSF) Chronicles, Day 76

@UCSFHospitals #’s: 10 pts, 5 vented, mild downtrend (Fig on L). In SF, similarly stable, avg of 20-30 new cases/day, with 43 deaths in city. Hospitalizations in SF: total of 52, w/ 22 in ICUs. Down from 90 & 32 one month ago (Fig R).
2/ While SF is stable, CA is seeing more cases (Fig on L). Biggest bumps in Imperial, Kings, & LA counties (Fig R). Highlights logic of county-by-county standards, under broader set of state-wide guidelines – it’s clear there are several different epidemics in our vast state.
3/ While the pandemic continues (see later in thread), the racial violence & protests demand our attention. As a white man, I found it hard to say something that felt useful to my department of nearly 3,000 faculty, staff & trainees. I did my best, here: bit.ly/3eDixNk
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Bob Wachter
@Bob_Wachter
1/ Covid (@UCSF) Chronicles, Day 73

@UCSFHospitals #'s ~same: 11 pts, 4 vents. Test positivity rate <2%; 0.3% in asymptomatics. 6 deaths total.

In SF, also stable, avg ~25 new cases/d (Fig). 41 deaths, 1st new one in 12 days. 55 pts in SF hospitals, 21 ICU. No signs of surge.
2/ They say you should write what you know, and today I did four different Covid Q&A webinars – and was asked a ton of great questions (don't worry, unusual day). So here are a few of the most frequently asked, and my brief answers. Still plenty we – or at least I – don’t know.
3/ Which will come 1st, treatment or vaccine? I'd vote vaccine. We’ve hit key milestones (2 vaccines led to antibodies; safe so far; vaccine prevented infection in monkeys). Many steps ahead but I like odds of vaccine in ‘21, widespread vaccination in hi-risk populations by ’22.
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