Thread by @Bob_Wachter

Covid (@UCSF) Chronicles, Day 10

1/ Cases cont. to grow slowly @ucsfhospitals. Covid+ pts now 14 (9->11->14 in last 3 d). Now 8 in ICU: change in ICU:floor ratio concerning. Are others seeing this? SF cases continue slow rise (279, up from 223). Still far cry from NYC's horrors

2/ Given modest growth & now-fair supply of PPE/testing/workforce, we’ll restart some surgical cases next wk… carefully, ready to de-escalate if we see surge. But our non-Covid patients also need our services: waiting to have your cancer removed can’t feel all that “elective”…

3/ New today: @ucsfhospitals switch to “universal mask policy”–every HCW/staff will get 1 surgical mask at shift start & wear at all times. While old policy was safe, this may be a bit safer (given [v. small] risk of transmission in asymptomatic pts) & def more comforting to HCWs

4/ Why didn’t we do it sooner? a) Until now, not enough masks to be sure we wouldn’t run out; b) Old policy consistent with nat’l guidelines & good evidence. But people’s concern understandable. A few other places have done this; I suspect it’ll become norm if PPE stock adequate

5/ Great response (38K views) to our grand rounds last wk on Covid clinical/epi/virology bit.ly/2WODDT6

2 new conferences: a) Impact of Covid on @UCSF Medical Education bit.ly/39jByBm & b) UCSF research response to Covid: bit.ly/3dDR1jg Both excellent

6/ This wk, several articles on ethics of Covid in ICU. I especially like @JAMA_current piece by D. White & B. Lo bit.ly/2Jn4yhc It includes @UPMC algorithm for these brutally hard decisions; note it avoids any age cut-off (except as “tiebreaker”)...

7/ To @UPMC algorthm, might add 2 Covid-specific factors: a) v. low survival rate for intubated COVID pts (~10-20%) & b) contagion risks w/ CPR. But (a) is tricky–2nd @JAMA_current paper shows improvmnt in ICU w/ convalescent plasma bit.ly/2QMSERG (Warning: v. small #s!)

8/ A high note: I mentioned in tweet last week that it would be great if we had iPads to help patients & families connect, given no-visit policy. @ddubinsky & Len Shustek have donated 100 of them! So great.

Other ways to help @ucsf covid response here: bit.ly/3ds5T3R

9/ Gotta (try to) Laugh Dept: From my daughter-in-law (happy birthday, Nicole!), this hilarious compilation of all the stuff that happens during video calls bit.ly/3aqmhjA (Actually a Zoom ad, tho happens all the time on Zoom.) So very real.

More tomorrow. Stay safe...

The policy is here:
bit.ly/2QQvycN