1/ Covid (@UCSF) Chronicles, Day 73
@UCSFHospitals #'s ~same: 11 pts, 4 vents. Test positivity rate <2%; 0.3% in asymptomatics. 6 deaths total.
In SF, also stable, avg ~25 new cases/d (Fig). 41 deaths, 1st new one in 12 days. 55 pts in SF hospitals, 21 ICU. No signs of surge.
@UCSFHospitals #'s ~same: 11 pts, 4 vents. Test positivity rate <2%; 0.3% in asymptomatics. 6 deaths total.
In SF, also stable, avg ~25 new cases/d (Fig). 41 deaths, 1st new one in 12 days. 55 pts in SF hospitals, 21 ICU. No signs of surge.
2/ They say you should write what you know, and today I did four different Covid Q&A webinars – and was asked a ton of great questions (don't worry, unusual day). So here are a few of the most frequently asked, and my brief answers. Still plenty we – or at least I – don’t know.
3/ Which will come 1st, treatment or vaccine? I'd vote vaccine. We’ve hit key milestones (2 vaccines led to antibodies; safe so far; vaccine prevented infection in monkeys). Many steps ahead but I like odds of vaccine in ‘21, widespread vaccination in hi-risk populations by ’22.
4/ A major challenge: recent @APNORC poll shows that only 50% of U.S. population would take a Covid vaccine even if were proven to be safe & effective. A bit hard to believe, but we’re going to have to deal with this. cbsn.ws/2zyojkB
5/ Game-changing treatment (to me, >50% mortality drop) seems harder. History of antiviral meds isn't very encouraging. Only Covid med that’s panned out is remdesivir; it's IV-only & modest impact (shorter hospital stays; trend toward lower mortality). bit.ly/2Ak2NzV
6/ Next: Should we open schools? I’d vote yes, partly because one bit of happy Covid news is that kids not only don’t get sick very often but don’t transmit the disease very much either. But hundreds of devilish details: can we get kids to wear masks, how to halve class sizes…?
7/ … To do it, we'll need to do classes in shifts: one group in class, other on-line. Then flip. Need 2x teacher time, bus transport. And all this in the setting of huge budget cuts bit.ly/2XdQQEU Tough to do, but it’s vital for both kids & their parents that we try.
8/ Next Q: Can you explain phenomenon of super-spreaders? Answer, simply, is “no.” As far as I can tell, we have no idea what it is about a person’s anatomy, genes, immune system, or speaking/singing style that enables some to spread virus to 100 people. bit.ly/3cg0Od9
9/ And there’s no way to identify super-spreaders in advance, which makes large group gatherings highly problematic. Of all the parts of “getting back to normal,” big gatherings will likely (and correctly) be the last to come back. Yes, that means churches. And ballparks.
10/ Next Q: What will next stage look like? I think a big city apocalypse a la New York or Wuhan is unlikely, partly because there’s a fairly high level of immunity (I do believe antibodies will equate to immunity, for unknown period) among the most vulnerable population.
11/ More likely than NY-type surges: flares in smaller towns/cities, while may overrun local hospitals. Another risk: smaller outbreaks won't be as dramatic as a huge tsunami. We risk settling into a situation in which a daily U.S. death rate of 1000 is considered new normal.
12/ Q: Will Covid die down in summer? See @mlipsitch analysis bit.ly/36H0gvM: he doesn’t expect much falloff. To me, viral seasonality is mysterious. Even if virus degrades in sun/heat, not obvious why that would lead to summer hiatus, since temp in nose remains ~same.
13/ Going against summer break: surges in cold Detroit & warm New Orleans, Singapore. And now a surge in Brazil, where it’s plenty warm. Summer drop (in flu, for example) might relate to folks spending more time outdoors (lower risk than indoors), and perhaps end of school year.
14/ Always questions re: flying. I’d feel reasonably safe to fly now with universal masking & enhanced cleaning. Would I feel perfectly safe: no, and if it were purely elective I might put it off. But if I needed to get somewhere, I’d do it – with lots of wipes, gel, and a mask.
15/ Finally, on my panel @goforward, privileged to be with Dr. Sara Cody, @HealthySCC health director, whose courage led Santa Clara to be first county to shut down. Also w/ Dr. Jim Kim, co-founder of Partners-in-Health @PIH, past-President @Dartmouth, and past-CEO @WorldBank.
16/ Sara Cody: “Ordering shelter-in-place was a piece of cake, compared to what we have to do now.” Current stage is much more complex & nuanced: how much do you open, what are the guardrails to ensure you didn’t go too far, will it be politically feasible to shut down again...?
17/ Jim Kim described why Korea seems to be doing particularly well with Covid. “They talk about the virus like a person: it’s nasty, it zeroes in on the most vulnerable…” They know that IT is the enemy, not one another. The two keys, he says, are “humility and solidarity.”
18/ Sadly, in a current word cloud on U.S. culture, I don’t think either humility or solidarity would come up high on the list. @EdYong209 wrote below in @TheAtlantic in March – to me, it masterfully captures the problems with American culture as it pertains to this pandemic.
19/ And it’s hard to be anything but sad and outraged at the brutal, senseless and repulsive deaths of African-Americans gripping the nation. At a time when our shared challenge should bring us together, we grow more & more apart, abetted by political leaders stoking the flames.
20/ Humility and solidarity – these may prove to be as important as medicine and science in fighting our shared viral foe. As @BarackObama said today (below), we can and must be better.
Stay safe, be better. Back Monday.
Stay safe, be better. Back Monday.
