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Covid (@UCSF) Chronicles, Day 4

Still calm-before-storm feel; NYC makes it seem real-er. Slow rise in #s @UCSFHospitals, but no surge yet. Today: 10 Covid+ pts in house (up 2), 2 ICU. @NewYorker piece by C. Dalton, ED doc @ #MGH, captures zeitgeist bit.ly/2U9QJJ2 (1/6) ImageImage
Speaking of @NewYorker, nice to see @Atul_Gawande get back on the writing saddle. (The med student writing group @Penn calls themselves “The Gawanabees.”) Atul describes how Hong Kong & Singapore flattened their curves bit.ly/2Uw6Dwa The piece is hopeful/reassuring (2/6)
Atul focuses on relatively low risk to HCWs, noting zero HCW infections after major exposures @ucdavis bit.ly/3dn19MO & Singapore bit.ly/2UrjlMP Yet cont concerns, esp in ED docs & in surgical/anesthesia colleagues who do much of their work near mouth/nose (3/6)
Few other updates @UCSF: still short on masks/gowns. Testing: up to 400/d (from 80) as amazing @czbiohub effort kicks in. Swabs still biggest concern–trying to make our own, awaiting batch from somewhere. More ventilators on order, hoping we don’t need, but fearing we will (4/6)
So many acts of charity: @UCSF med students, led by @jhjackson18 (on L) @COVIDAidUCSF, set up donation spot (18th/Dolores; open Sun 10-3). Today got 5700 masks, surgical & N95. On R: 2 students, my daughter @zoemarklyon & @Pooja_L1, w/ the goods. UCSF students are awesome! (5/6) ImageImage
If you have time, a reminder to watch our grand rounds on epi, clinical Dx/Rx, science & @UCSF response bit.ly/2UrKVJF Both clinical & lay viewers have found it useful.

More tomorrow; I'll add some interviews w/ my colleagues at front line. Till then, stay safe (6/6)
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Bob Wachter
@Bob_Wachter
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.”
Read 24 tweets
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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
Read 20 tweets
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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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