1/ Covid (@UCSF) Chronicles, Day 62
Today started as slow news day. Then it wasn’t, as @moderna_tx vaccine results hit. I’m not a vaccine-ologist, so I zoomed my go-to person, Joel Ernst, chief of Experimental Medicine @ucsf. My Q&A w/ Joel here bit.ly/2ycJM1C (17 min)
Today started as slow news day. Then it wasn’t, as @moderna_tx vaccine results hit. I’m not a vaccine-ologist, so I zoomed my go-to person, Joel Ernst, chief of Experimental Medicine @ucsf. My Q&A w/ Joel here bit.ly/2ycJM1C (17 min)
2/ Watch if you can, but here are Joel’s key points: Moderna vaccine is RNA-based, often safer than DNA. Vaccine seemed safe, but side effects seen at highest dose. 8 pts developed neutralizing antibodies, potential evidence of at least some immunity. Verdict: promising but early
3/ Next steps: test more patients to rule out serious but uncommon side effects. Then test for efficacy, either with controlled studies in at-risk communities/populations, or by challenge tests in volunteers who agree to be infected. Latter is very tricky – what if somebody dies?
4/ I came away from the Q&A mildly optimistic – better to find antibodies than not – but with a deeper appreciation of the many hurdles still to be cleared. We’re still talking about traversing a 12-month obstacle course, with no certainty that we’ll get to the finish line.
4/ Other news today is that the President of the United States is taking a drug with no proven efficacy and for which studies have been aborted because of dangerous side effects politi.co/3cPGReA Breathtaking, really, but I’ve lost my capacity to be shocked.
5/ @UCSFHospitals, 12 pts in hospital, 6 on vents. A bit up, but too early to call it a trend (Fig on L). SF data more comforting: new cases in city stable, avg ~30/d. Even better is big drop in overall hospital pts, now low 50s, 19 in ICUs (down ~40% from 2 wks ago; Figs on R). 
6/ Nationally, we’ve entered the calm-before-the-possible-storm phase, as we’re launching 50 experiments in various ways to leave lockdown and open things up. We mostly won’t know the results for 2-3 weeks, when we see if people start getting sick and landing in the hospital.
7/ While the activity of SARS-CoV-2 utterly respects the laws of math, biology & physics, there’s also an element of chance that influences the outcomes. Acting smart gives you the best chance of success, but some states that open up carelessly...
8/ …(Georgia, for example, described here: wapo.st/3dWDBhl) may do fine, while some that do everything right will still get pummeled. That makes the results hard to interpret and gives those with partisan agendas an opportunity to cherry-pick their favorite results.
9/ Obama took the gloves off this weekend nyti.ms/2zR3G2y partly in response to the “Obamagate” silliness. History will show that the Obama administration took the threat of a pandemic seriously bit.ly/2XbCELx. The preparation was largely tossed aside by Trump.
10/ Speaking of prep, terrific @propublica piece bit.ly/368Gjhj explores why NY fared far worse than CA with Covid. The CA story highlights Mayor @LondonBreed & @SF_DPH head Grant Colfax’s no-BS response, an example of which is below.
11/ But the degree to which NY’s response suffered from infighting between De Blasio his own health advisors, and especially between De Blasio & Cuomo, was new to me. The battles set them back a week, an eternity in Covid-time because of the virus’s exponential spread.
12/ As @Atul_Gawande steps down as Haven CEO, good news for us is he’ll write more. He excels at finding the specific case to make a broader point. In @NewYorker, he cleverly highlights one workplace that never shut down yet stayed fairly safe: hospitals bit.ly/2ZijGFQ
13/ While healthcare workers (HCWs) have been infected & some, tragically, have died, this was mostly in overwhelmed hospitals. In those that weren’t, there were relatively few cases of hospital spread. Personally, I feel safer @UCSFHospitals than in the supermarket.
14/ At Mass General/Brigham (where Gawande does surgery), the risk of a HCW being infected is more correlated with his/her home zip code (ie, is their neighborhood “hot”?) than the hospital floor on which they work (incl. Covid floors). Ergo, likely infected outside the hospital.
15/ Gawande highlights four pillars to battling Covid, particularly as we move to end the lockdowns: distancing, frequent hand hygiene, screening, and mask-wearing. But his main point is that there’s a critical fifth ingredient: culture.
16/ Whether the measure is if people clean their hands, or wear their masks, or truthfully answer a symptom questionnaire (below), it’s culture that keeps the hospital safe. HCWs know why we do all these things and the consequences of not doing them. And so we follow the rules.
17/ This is where the mixed messages coming out of D.C. are most harmful. Given the complexity of the science & the recommendations, it doesn’t take much chaos or misdirection for folks to question guidelines or, less charitably, to ask why they should sacrifice to spare others.
18/ We can only keep ourselves safe if we do it communally, working to protect ourselves and one another. In this moment, America’s proclivity for individualism and partisanship work against our own interests. This, frankly, is what scares me the most as we enter our new phase.
19/ To end, a shout out to @UCSFMedicine Class of 2020, who graduated today (grad video: bit.ly/2LRQQnP) Lots of special guests, incl. one @ 51:33. (Charmingly, TF introduces himself, though really didn’t have to).
Congrats to our new MDs. You will change the world!
Congrats to our new MDs. You will change the world!
