1/ Covid (@UCSF) Chronicles, Day 44
Thursday, so it’s Grand Rounds day: bit.ly/35kgYAt @YouTube. I hope you’ll watch whole 100 min: clinical updates, contact tracing, & experience in NYC. If you can spare just 35 min, watch NYC part (@ 1:04:37): fascinating & poignant.
Thursday, so it’s Grand Rounds day: bit.ly/35kgYAt @YouTube. I hope you’ll watch whole 100 min: clinical updates, contact tracing, & experience in NYC. If you can spare just 35 min, watch NYC part (@ 1:04:37): fascinating & poignant.
2/ Still stable @UCSFHospitals: 13 pts in hospital, 5 on vent (Fig on L). In SF: 1499 cases (up only 9), 25 deaths, up 2 (Fig on R). Yesterday, SF announced opening some businesses/recreation; today @GavinNewsom announced CA parks/beaches will stay closed. Will discuss tomorrow. 
3/ Now grand rounds. First, @BSchwartzinSF w/ clinical update. Pic below (@ 8:35, from @jen_babik) highlights varied organ systems that Covid can hit. We’ve come a long way from early March, when we thought “it’s like a really bad flu plus, if patient is unlucky, pneumonia/ARDS.”
4/ @ 15:03, new study bit.ly/2SkAU0M shows saliva, inelegantly collected in a urine cup, works as well as a nasal sample to diagnose SARS-CoV-2. Since swab shortages are a big bottleneck in many places (plus nasal swabbing is unpleasant), could lower barrier to testing.
5/ @ 17:07, Brian reviews 3 new remdesivir studies. While negative @TheLancet study tempers enthusiasm, he notes it was underpowered (as cases in China dried up). Weight of evidence is that remdesivir is likely effective & we may be at point that we no longer randomize to placebo
6/ @ 25:48, Andy Josephson describes @NEJM study bit.ly/2SmmDAA of 5 patients with stroke. Andy highlights that we don’t know much about etiology, & that, in a large health care organization, we might normally see a few young people w/ stroke in a month. Need more detail
7/ In our Q&A @ 34:47 Andy describes challenges, as a reader & editor (he edits @JAMANeuro), of dealing with small case series, such as the 5 pts w/ stroke in @NEJM. “In a high prevalence area like NYC, almost any condition – a broken leg – you can say is associated w/ Covid.”
8/ @ 32:57, Andy reviews key unknowns regarding neurological manifestations of Covid. If SARS-CoV-2 invades the central nervous system (a protected space), we’ll need to keep that in mind since therapies might then need to cross the blood-brain barrier.
9/ Starting @ 36:10, Q&A w/ Brian on many topics, incl. asymptomatic testing, utility of checking temps, ins/outs of serology tests. He agrees that, while not proven, weight of evidence is that pts who've recovered from Covid are, in fact, immune. Big question is: for how long?
10/ @ 43:00, @mikereidmd, @ucsf’s contact tracing maven, describes how it works. Based on expected cases, we’ll need ~100-150 people to do tracing. @ 54:22, Mike describes efforts (in partnership @SF_DPH) to train army of tracers (incl. city attorneys, librarians & med students).
11/ At @ 51:08: Reid describes why the digital case management tool we're using in SF (below) is critical, but he’s fairly skeptical (@ 1:02:45) about the value of the new @google / @apple contact tracing app. @mikereidMD
12/ @ 1:02:00, my Q&A w/ @mikereidmd, incl. what is "a contact": (A: it’s NOT just being in Safeway together), & (@ 1:04:00) how they get people to answer the phone (A: send them well-crafted SMS message first). SF is positioned to be leader in this part of public health response
13/ @ 1:04:37, panel begins w/ Amir Jaffer, CMO @NYPQueens. See 1:06:08-1:0X to get a sense of how it felt to be a hospital leader as the tsunami came ashore. The hospital has 39 ICU beds; at peak it had 112 ICU pts. Wild. @ 1:09:55, how they created 80 more ICU beds @jaffer_amir
14/ @ 1:15:08, Amir describes human toll. They’ve had ~500 pts die, 27% mortality. “We’ve safely discharged 1500 pts, which is what we try to focus on.” They’ve lost colleagues as well. “We remember them, and use that as a source of inspiration to drive us…to focus on our pts.”
15/ @ 1:16:40, Sanjay Reddy, @UCSF hospitalist who’s been @NYPQueens for 2 wks, describes scene when he arrived: 20 pts on ventilators on the floor (“I haven’t seen that before”), some two in a room. But he was mostly struck by how resilient the NYP team is. “I expected zombies.”
16/ Sanjay: “The strength to keep going into work when it’s the worst thing you can imagine–or not even imagine.” @ 1:19:01: “Amir [Jaffer] didn’t talk about this, but he was hospitalized for 7d w/ Covid & returned to work while he was still [short of breath] & needed oxygen.”
17/ @ 1:19:50, Sanjay discusses how overwhelming it was (“add 500 ICU patients @ucsfhospitals; that’s what it looked like”), plus colleagues getting sick all around, plus litigious environment in NYC (much worse than in CA). Sad that these MDs/RNs have to worry about being sued.
18/ @ 1:22:50 @AlexSmithMD & Carly Zapata @ucsf, describe doing palliative care consults w/ pts & families in NYC via telemed. Palliative care service @nyphospital has grown from 20 to 90 patients. Alex: “This is bread & butter palliative care,” under extraordinary circumstances.
19/ Worth watching end, @ 1:35:57, as each speaker discusses lessons they’ve learned from their experience in NYC that they’ll carry with them forever. Entire session bit.ly/35kgYAt was beautiful & poignant – in awe of my colleagues in NYC, whose heroism is remarkable…
