1/ Covid (@UCSF) Chronicles, Day 43
Still stable overall @UCSFHospitals, with 14 patients, 4 on ventilators (Fig on left). New & improved @ucsf dashboard (Fig R): note uptick in positive tests in last few days, a bit of a worrisome signal. There’s still virus out there in SF.
Still stable overall @UCSFHospitals, with 14 patients, 4 on ventilators (Fig on left). New & improved @ucsf dashboard (Fig R): note uptick in positive tests in last few days, a bit of a worrisome signal. There’s still virus out there in SF.
2/ In SF: 1490 cases (↑22), 23 deaths (Fig L). Only 2 deaths in last 10d in SF. One more mildly concerning sign: SF hospitalizations up ~10% in past week. Justifies continued stay-home (partial loosening today by @LondonBreed, incl construction & golf bit.ly/3cZPOBp)
3/ I’ve found myself spending a lot of my days answering questions about Covid, from media, businesses, colleagues, family & friends. It got me thinking: What are the questions I’d most like to have answered? So here are my Top 10. The tweets that follow are my color commentary.
4/ First: Will we have a vaccine, the only true gamechanger. Hopeful signs @JennerInstitute: nyti.ms/2YfVpQ4. Remember: need to invent, be sure it works & is safe, make 300M doses, & inject into 300M arms (just in US!). No realistic hope this’ll happens in '20; ‘21 maybe
5/ 2nd question relates to treatment. Dynamics of Covid are determined by a) How transmissible it is (with no intervention, one person infects ~3 others); and b) How deadly it is (~1% of people with Covid die; higher for older/sicker people [~3% mortality in 60-70 year olds]).
6/ Truly great drug would alter decisions, but by how much? As 62 y.o. man, my fear of Covid won’t vanish if my case-fatality rate falls from 3%→1.5% (& 50% improvement from a drug would be unusual), nor will my choices change. But for society, might change timing of reopening.
7/ Re: treatment, today’s remdesivir news is exciting, but confusing. U.S. trial results touted by Fauci bit.ly/3f1G1g4 found remdesivir led to 31% faster recovery time (15d→11d) & marginally better mortality (11.6%→8%, p=0.06, not quite statistically significant).
8/ While that’s hopeful, a different randomized trial, from China, @TheLancet, showed no benefit bit.ly/2W9ErjD So while nice to have some mildly good news (and definitely give me remdesivir if I’m sick enough to be hospitalized w/ Covid), it's unlikely to be our savior.
9/ My 3rd question – are antibodies protective? – is a big one. If they're not, we're screwed. Not only would it mean that having and recovering from Covid doesn’t protect you from getting it again, but it might also mean that we won’t ever be able to make an effective vaccine.
10/ Herd immunity requires 70% of people have antibodies, but only if antibodies are fully protective. Note that herd immunity isn’t an on-off switch, ie, 70% or nothing. If 35% immune [as they may soon be in NYC], should halve transmission.
11/ We’ve heard from Korea re: patients who went pos→neg→pos, raising fear that antibodies failed. Reassuring new data says “recurrences”=false positive bit.ly/2yateY7 If antibodies truly didn’t work, I assume we’d hear about recovered pts w/ new Covid, and we haven’t.
12/ My 4th Q: how infectious are asymptomatic pts? Asymptomatic infection is Covid's superpower. Weight of today’s data points to asymptomatics being less contagious (if only because they’re not coughing, & might have lower viral load) but not zero risk bit.ly/3f5f6QH
13/ My 5th Q: how effective is our public health strategy? Empirical evidence is very supportive, but as we open up we’ll need more granularity. Is it safe to have friends over w/ masks & 6 ft distance? To sit in restaurant? Inside vs outside? People will need specific guidance.
14/ My 6th question moves into more policy-oriented territory: once the wildfire is out and we’re looking for Covid embers, how effective will our approach be? Yes, I get it: testing→contact tracing→isolation & more testing, repeat. But how well will each element actually work?
15/ For more on testing/contact tracing, another awesome analysis by @tomaspueyo bit.ly/3d0GCgm. Shows that for tech-adjuncts to help w/ tracing, we’ll probably have to accept opt-out, not opt-in (Figs L&R). @voxdotcom video on Korea’s approach: bit.ly/3aPv4ei
16/ 7th: how long before enough tests? Many testing recs out there, mostly focused on #s (need 3M tests in US/wk, per @ashishkjha; @ScottGottliebMD says 750K/wk). Less discussed: who needs testing. @tomaspueyo shows priorities for testing below (also from bit.ly/3d0GCgm)
15/ 8th: Will people follow Covid directives? A region can have rules (masks, shelter-in-place), but will people (esp. those at low personal risk from Covid, but capable of spreading it) follow? I believe SF’s success was partly that our citizens followed health recs early & well
16/ 9th question: among the most worrisome trends: brutally tough health/economic tradeoffs are now partisan chum, lowering chance we’ll make smart, evidence-based decisions. Today, @NYGovCuomo movingly argued for non-partisanship bit.ly/2zDlOwQ (@ 24:30-26:10 on video).
17/ Final Q, re: strong national leadership–sadly, little room for optimism. For what that looks like, see Angela Merkel in Germany bit.ly/2zFTN7T & @jacindaardern in NZ bit.ly/2YijBkU (both @TheAtlantic). Many lives lost in U.S. because we lack such leadership.
18/ Cool part of last 2 mths has been speed of discovery: from scientists, epidemiologists, policy types, historians… My list of Qs would've been twice as long in March, which gives me confidence we’ll answer these 10 soon (though new ones will pop up).
Grand Rounds tomorrow…
Grand Rounds tomorrow…
