Thread by @Bob_Wachter

Covid (@UCSF) Chronicles, Day 59

Bit of a slow Covid news day; my highlight is @WSJ article by @Georgia_Wells on MDs/scientists using social media to get the facts our re Covid on.wsj.com/3bv6n7i (firewall). Grateful to be profiled, though I’m only 1 of many doing this /1

Newman, whose pic appears twice, is getting most of the attention. After his prior complaints about the pandemic (bit.ly/3dhOJ8a & bit.ly/3613KJl), he is pretty psyched about being in the Journal. It's been a lifelong dream of his: bit.ly/2LweTbx /2

This weekend marks 2 months (seems like 2 eons) since I launched Covid tweets. Here’s my Day 1 thread, Mar 18 bit.ly/2T9LubA; early ground rules below. When I started, I thought SF was going to be creamed, that my family might die, & that I should do something useful. /3

With Covid news slowing down a bit, & my day job heating up (intense focus @UCSFHospitals on recovery), I’ll dial back tweets to 3x/wk: Mon & Fri for general Covid-related issues; Thurs for usual @UCSF Grand Rounds summary. Of course, I'll tweet newsworthy stuff in between /4

San Francisco & @UCSF numbers remain rock-solid. We're down to 9 patients @UCSFHospitals, the lowest since March 24 (Fig on L). Total SF cases remain low (Fig R), averaging ~20-25/day. One new death. 64 hospitalized patients in all of SF, down from about 90/day last month /5

As we hit the two month mark, it seems like a nice opportunity to reflect a bit. Looking back, I’ve been surprised by many things – some relate to the disease, others to the response. Here are my top 10; a little color commentary on each follows /6

#1: Asymptomatic Covid: 3 mths ago, we thought nearly all Covid pts had symptoms. With testing, it became clear that pts could be asymptomatic. Now we know that ~50% are asymptomatic (or presymptomatic). It’s a Covid superpower that makes case-finding & preventing spread tough /7

#2: Clinically, there were more surprises. Covid could strike the kidneys, the skin, the clotting system, sense of taste and smell, and the toes. There could be strokes, and a bizarre immunologic syndrome in children. For clinicians, Covid teaches multitudes… and humility /8

#3: Mortality: Several surprises here. First, the high mortality of Covid (decidedly not the flu, particularly when it strikes older folks & pts w/ underlying conditions). If it’s ~0.8% (best estimate), then 1/125 people die. In a disease striking millions, that’s a huge deal /9

#3, cont: And, sadly, I’ve been surprised by how quickly we’ve become inured to these staggering numbers. The U.S. is up to 90,000 deaths – that’s a packed Rose Bowl. The toll of Covid is truly devastating; let’s not get used to it. Remember the humanity of every person /10

#3, cont: Last, the mortality of vented pts. Early studies showed 80-90% mortality; made me question wisdom of intubation. More recent # s, incl. @UCSF: ~20-30% mortality. We’ve gotten better as we’ve learned more (remdesivir, proning…), especially when ICU isn’t overwhelmed /11

#4: Telemedicine: @UCSF in Feb, we did 2% of our outpatient visits by telemedicine. In April: 60%. We’re not alone. Growth shows how fast change can happen with a burning platform (& some regulatory/payment changes). This‘ll transform medicine forever, mostly for the better /12

#5: Politicization of Everything: Covid treatments, opening up or not, testing, mortality rates, “like the flu,” China, travel bans, masks… Is there any issue that won’t become chum in our political waters? The virus is foe enough. Why do this to ourselves? Which leads to… /13

#6: The National Response: I’m not a Trump fan, but I couldn't have predicted how dysfunctional the federal response would be. True: even with a thoughtful, grounded, empathic, data-driven leader, this situation would be hard. But the dreadful response has hurt, badly.… /14

#6, cont: Parenthetically, watching Fauci do his best under impossible conditions bit.ly/364O9sj, and governors like Cuomo (though NY was a bit late), Newsom, DeWine, and Hogan vividly demonstrates what wise, data-driven leadership looks like. The absence costs lives /15

#7: SF: on March 18, SF had 1 death, NYC 20 (NYC is 9x larger). Since then, SF has had 36 deaths, NYC >20,000. A testament to wise actions by our political & corporate leaders, and our people. And some luck. bit.ly/2WXxZyc I’m very surprised, & beyond grateful /16

#8: Disparities: Since there are disparities in all of health/healthcare, I was prepared for the same in Covid, but not for the extent. A disquietingly vivid illustration is found in the results of @ucsf’s Mission study… /17

#8, cont:…In a 4x4 block area in SF’s Mission district, of 1,145 Latinos tested for virus 58 (5%) had it. Of 981 Caucasians living in same 4x4 blocks, zero had it. The causes are many and the solutions hard, but we must do everything possible to address these disparities /18

#9: Non-Scientists' Interest: A gratifying part of the past 3 months is that lay people are as interested in the emerging science as clinicians & scientists. As shown by the response to our Grand Rounds bit.ly/2X2N2Fc (and these tweets), we’re all learning as we go /19

#9, cont: For non-scientists, understanding Covid has required learning about clinical trials, Bayesian reasoning, sensitivity/specificity, epidemic modeling… Scientists/MDs had a head start in that the terms/methods are familiar & we can analogize to other things we know… /20

#9, cont: … but Covid is a great equalizer, since, on Jan 1, 2020, no one knew anything about this virus & its harms. People have gotten to see science's iterative process: one step forward…, what we knew yesterday is often wrong today. Frustrating, but it’s called progress /21

#10: Goodness: Covid is a nightmare. But it has also brought out many heartwarming acts. I’ve seen plenty @UCSF, in the people who worked 24/7 to find PPE or clean the rooms or work in the ICU. In my colleagues who went to NYC & the Navajo Nation because “it’s what we do”… /22

#10: And in the Kansas farmer who sent his mask to New York because he simply wanted to help bit.ly/2yRSgfa. There is so much goodness around; it’s sad that it is sometimes drowned out by those seeking to sow division or spread falsehoods /23

#10, cont: The goodness includes humor. My fave: @MrAndrewCotter’s Mabel & Olive videos, incl. the dog bowl competition bit.ly/2RtUcjY & Game of Bones bit.ly/2VBoZwt

Today, the dogs do a Zoom call bit.ly/3fSCCAK Priceless

Stay safe, back Monday. /24