Thread by @Bob_Wachter

1/ Covid (@UCSF) Chronicles, Day 76

@UCSFHospitals #’s: 10 pts, 5 vented, mild downtrend (Fig on L). In SF, similarly stable, avg of 20-30 new cases/day, with 43 deaths in city. Hospitalizations in SF: total of 52, w/ 22 in ICUs. Down from 90 & 32 one month ago (Fig R).

2/ While SF is stable, CA is seeing more cases (Fig on L). Biggest bumps in Imperial, Kings, & LA counties (Fig R). Highlights logic of county-by-county standards, under broader set of state-wide guidelines – it’s clear there are several different epidemics in our vast state.

3/ While the pandemic continues (see later in thread), the racial violence & protests demand our attention. As a white man, I found it hard to say something that felt useful to my department of nearly 3,000 faculty, staff & trainees. I did my best, here: bit.ly/3eDixNk

4/ Far more powerful are these two statements from African-American leaders.

The first, by the amazing Kimberly Manning @gradydoctor, describes how she is forced to counsel her teenage boys about renting bikes on vacation bit.ly/2ZWKyv5 ...

5/ … and the other by @LeePelton, president of @EmersonCollege bit.ly/3eDWmXm

If you take a minute to think about having to live each day with indignities like this, it’s shattering.

6/ I had some press calls today re: “Should people be out protesting?” My answer: the gatherings aren’t risk-free, but the status quo is dangerous too. While the protests are outside (safer than inside), we’re talking large crowds, jammed together, shouting – a setup for spread.

7/ If everyone masks, risk is tolerable. But it's real: nothing about virus has changed, and 80-99% of protestors are as susceptible to SARS-CoV-2 as they were in 2019. Given the stakes & passion, we can’t & shouldn’t tell people not to protest, but please wear a mask if you can.

8/ As we enter the newest stage of opening up, a couple of new studies offer a sense of the impact of the lockdowns in March... and, by implication, the risks of opening up when the virus is still out there, as infectious and deadly as ever.

9/ One study bit.ly/2XpGCS1, from @JohnsHopkinsSPH, examined case rates before and after lockdowns. Looking state-by-state, the study found a consistent decrease in Covid case rates of about 60% associated with the shelter-in-place rules.

10/ In a 2nd study bit.ly/2ZYylGv, from @UCSanDiego: 49% fewer cases after stay-at-home orders, and 60% fewer deaths in 3 wks after lockdowns. Across the entire U.S., these results indicate that stay-at-home orders saved 41,000 lives in the 3 weeks after they launched.

11/ But we’re past the lockdown stage. Today’s question is what happens w/ opening up. One fear is that we’ll see a more broadly distributed case & death toll, which’ll make it harder to garner public support for doing hard things – including returning to lockdown if we need to.

12/ Sitting here in San Francisco, it’s pretty hard for me to appreciate the impact of mini-surges in the small towns and counties of the heartland. Luckily, my wife @katiehafner, who is wired to chat people up, got some insight today.

13/ This morning, Katie was on the phone w/ a customer support rep. Katie: “How are things where you are?” Answer: “Scary.” The rep said that 2 dozen cases of the virus had shown up in one day in her small town in northern Mississippi, and “she wished the state hadn’t reopened.”

14/ But it did. MS Gov @tatereeves has been steadily relaxing “Safer at Home” orders. Stores, restaurants, gyms, salons, casinos, waterparks now open. See uptick in cases over past 2 wks, w/ sharpest bumps in north MS (~45-fold in rural Webster County; 1.7➙78 new cases/100K).

15/ More: Iowa, famously w/ no SIP order, is also peppered w/ hot spots. Most dramatic: rural Buena Vista County, with a 6-fold rise in cases in 2 wks. Still, @IAGovernor Kim Reynolds has reopened malls, salons, etc, though some now closing for protests bit.ly/3cpvFUX

16/ And more: In Titus County, TX, where Gov @GregAbbott_TX has opened the state w/ a vengeance, they’re at 123 cases/100K people, up from 29 two weeks ago. Numbers are likely to rise as a backlog in test results clears bit.ly/3gJbkgq. (Figs from nyti.ms/39ZbBaG)

17/ The Titus County seat Mt. Pleasant has a Pilgrim’s Pride poultry plant. On its @Facebook page, Pilgrim’s says zilch regarding the city's disquieting rise in Covid cases. Instead, they’re advertising job openings and celebrating #DanceLikeAChicken Day bit.ly/30aAbnR

18/ Worth noting that Covid brought NYC to its knees. The city has 62 acute care hospitals, 1600 ICU beds, and some of the most advanced healthcare in the world. Thinking about rural counties in MS, IA, and TX, it won’t take much of a surge to overwhelm their healthcare systems.

19/ I support opening up, but do it thoughtfully and gradually, with strong masking & distancing; robust testing/tracing programs; and with clear benchmarks to either open more – or close back down. Absent that, I fear that Covid's brutal next phase will be in places like these.

20/ Hard to find good news in anything today, but I loved seeing 103-year-old Jennie Stejna celebrating her recovery from Covid with a cold Bud Light. Let’s take pleasure in small wins, at a time when there are so few.

Stay well, back w/ a very cool Grand Rounds on Thursday.