Thread by @AnilMakam

Attended on the Hospitalist #COVID service for 3 days at #ZSFG. Thread on reflections as a safety-net hospitalist

Don't worry, unlike making lemonade from lemons, I will not make evidence out of limited anecdotal experience

2| For context

In SF as of April 5th we have 529 COVID19+ patients with 8 deaths (aka not close to NYC)

At ZSFG, we have 26 admitted patients, with 16 in the ICU

No overt shortages, though we are conserving faceshields & N95 masks between COVID19 patients

3| At SFGH, the county hospital in SF, we are seeing many otherwise healthy Latinos in their 30s & 40s who comprise the backbone of our 'essential' economy: food industry, transportation, construction.

We all lose if we don't support these communities

4| Where did all our patients of Chinese descent go? Seems disproportionately fewer than normal

Did they get the memo earlier or from their personal networks?

Did they start self-isolating/quarantining & closing business sooner?

There's a story here @sfchronicle

5| Though I've read about clinical course, still very humbled by how late in illness people are becoming very ill (1-2 weeks after symptoms begin), & how difficult to tell who recovers after developing pneumonia and hypoxia (low oxygen), and who will deteriorate (often rapidly)

6| For people with COVID19, would be helpful to know what signs, symptoms, & findings rule in or rule out clinical deterioration and when people are out of the woods. From colleagues with more experience, little to go off of

7| Physical distancing & quarantine incredibly hard for many of our patients

@SF_DPH has thankfully set up quarantine hotels

All my patients have 1+ sick contact at home, most never tested

Only intervening for the tip of the iceberg

Contact tracing & isolation needed urgently

8| Doctors & hospitals, including elite academic medical centers, only differ in degrees from POTUS regarding use of hydroxychloroquine in COVID19

Prescribing hydroxychloroquine was the default nudge (not mandated here btw)

9| For one patient, I got 2 pages, discussion in a huddle, & a COVID specialist note with varying language from "consider", "approved if you'd like", to "recommended"

I didn't prescribe. Patient got better on their own. If I prescribed, success would've been attributed to it

10| Several of my patients participated in a trial of remdesivir, an antiviral. Great for our patients in safety-net hospitals to contribute & have access to trials. But once we learn what works, will these drugs be available to them?

11| I doctored thru the glass for young, healthy patients with mild respiratory illness. I acknowledged awkwardness. By seeing them thru the window, speaking by phone, & frequent calls with families, worked decently well

There is a role for telemedicine:
journalofhospitalmedicine.com/jhospmed/artic…