1/ Covid (@UCSF) Chronicles, Day 188

Let’s keep things simple today.

200,000 deaths. We’ll hit that number in the next few hours.
2/ That’s the entire population of Salt Lake City…
3/ … and of Montgomery, Alabama...
4/ … and of Grand Rapids, Michigan.
5/ Over the 6 months since the virus first began to hammer the United States, it means 45 deaths an hour – nearly one death every minute.
6/ 200,000 people is the number of people in a packed Darrell Royal/University of Texas Memorial Stadium… twice over.
7/ It’s 83 Pearl Harbors…
8/ … and sixty-seven 9/11’s…
9/ And more than all the deaths from influenza in the United States... over 5 years.
10/ The deaths have included young and old, famous and unsung, rich and poor. They hailed from states Red and Blue. Men and women, black, brown, and white, straight and gay. They were our relatives, friends, and neighbors. Our shopkeepers, farmers, teachers, and nurses.
11/ On top of the deaths, we now know that the virus can cause long-term harm. And there’s also the impact on kids and their education, on jobs, and on at-risk groups forced to foreswear nearly all human contact. Fear, loneliness, depression, overdoses, & suicides are pervasive.
12/ It’s important to acknowledge that even had leaders and citizens acted flawlessly, the toll – in the U.S. and worldwide – was destined to be high. This virus is nasty, and the threat was bound to leave misery in its wake. Some of our rage should be directed at the fates.
13/ But it didn’t have to be 200,000 deaths.
14/ If the U.S. had Canada’s death rate, we’d be at 82,000 deaths, not 200,000. That’s 118,000 Americans who would still be alive.
15/ If the U.S. had Germany’s death rate, we’d be at 37,106 deaths, not 200,000. That’s 162,894 Americans who would still be alive.
16/ Not fair, you say. Those are very different countries, with different laws, cultures, economies, and history.

OK, if the U.S. had San Francisco’s death rate, we’d be at 36,101 deaths, not 200,000. That’s 163,899 Americans who would still be alive.
17/ The successes in places like Canada, Germany, New Zealand, Taiwan & yes, San Francisco, owe to both what leaders did AND what citizens did. In SF, people are wearing masks, keeping 6 ft away, and avoiding crowds. Folks in the Bay Area generally follow the public health recs.
18/ As @edyong209 describes in a great interview with @ASlavitt tinyurl.com/yy2dd5eo, our abysmal performance in the U.S. is partly due to pathetic leadership. Today’s kerfuffle @CDCgov over the role of aerosol transmission is just the latest illustration of the chaos.
19/ But Yong also cites a “failure of empathy.” He's not simply referring to caring – though partly he is. He also means an inability to act until we ourselves feel threatened. It allows folks to think ‘I’m safe. Covid only hits blue states (or black or poor people or cities)…’
20/ Because the virus is invisible, says Yong, it “exploits our inability to look at what is going on outside our personal experience and learn from it.” To do that, you need both empathy and information you trust. And both have been lacking.

“We’re being gaslighted every day."
21/ Yong’s new article in @TheAtlantic describes nine conceptual errors that contributed to America's Covid failure tinyurl.com/yxrpoulh As with all Yong’s Covid pieces, it’s a magnificent tapestry of science, history, sociology, psychology and politics. I hope you'll read it.
22/ The U.S. loves easy fixes for hard problems, & we’ve done that w/ Covid, alighting on them like fruit flies (this month’s: ventilation). But, says Yong, “We’re not thinking about [Covid] at the scale & scope that it demands.” How to turn this around? “Radical introspection.”
23/ The scariest part, adds @ASlavitt, is that Covid is “a starter pandemic.” One can easily imagine a bug that is more contagious, more deadly, or both. And what about even harder problems, like climate change? Nothing in 2020 would lead one to predict an enviable U.S. response.
24/ I’ll end w/ this video tinyurl.com/yxv8gsun of the Washington National Cathedral tolling for our 200,000 lost souls. (And next week we’ll hit 1 million deaths globally.) One can only hope that the sadness of this moment will inspire us to do better.

Or at least to vote.

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More from @Bob_Wachter

Nov 24
Covid (@UCSF) Chronicles, Day 982
Today – my Covid (as well as flu & RSV) plans for the Thanksgiving gathering. I’ll walk you through my current assessment of risks and risk mitigation strategies, and why I’m still being moderately careful. (1/25)
We’re having 12 family and friends over this afternoon. Our plan: while there will be some hanging out inside the house, the bulk of the festivities (including the meal) will be outside. And everybody will rapid test beforehand.
Here’s how we came to this strategy: (2/25)
First, case rates are up moderately, though not as high as I thought they’d be, given that the now-dominant BQ variants look to be fairly immune-evasive. But, for reasons we can’t completely fathom, our overall immunity (from vax & infections) is preventing major surges. (3/25)
Read 25 tweets
Nov 1
Covid (@UCSF) Chronicles, Day 958
(I'm Still Here Edition)

Today, a brief update on the numbers (TL;DR: they’re reassuringly stable); my take on new studies of the bivalent booster, Long Covid, Paxlovid, & variants; and what I’m doing Covid-wise during this relative lull. (1/25)
Let’s start with numbers. Nationally, Covid cases, hospitalizations, & deaths all remain stable (Fig). The combined effect of more infectious variants & colder weather, along w/ the big drop in masking & the weak uptake of the new booster, is likely to result in a winter… (2/25) Image
…surge. But little evidence it’ll be a big one. (Note CDC no longer shows case forecasts–theirs or others'–due to “low reliability.”)
CDC data shows that BA.5 is now being outpaced by new variants (mostly BQ.1 & BQ.1.1), which seem poised to become the dominant variants. (3/25) Image
Read 25 tweets
Oct 20
Covid (@UCSF) Chronicles, Day 946
It’s been a while since my last update & now seems like an opportune time. While Covid is still with us, the threat level is fairly low & the last few months offer a window into what our next few years will look like–making it a good time…(1/25)
…to find your behavioral sweet spot. Saying, “I’m not indoor dining now” may imply “I’m not indoor dining ever,” since 23-24 aren't likely to be much safer than now.
On top of that, we’re likely to see a winter surge (modest, I think), so it’s also worth planning for that.(2/25)
Finally, I also think it’s wise for policymakers to shift from emergency mode into a more sustainable stance, as Biden & Newsom have signaled. Covid will remain a real threat – requiring attention & significant investment – but it’s no longer the emergency it once was. (3/25)
Read 25 tweets
Sep 18
Covid (@UCSF) Chronicles, Day 915
As I hoped , cases in the U.S. have dropped steadily. Up until now, I’ve avoided indoor dining and worn a mask in all crowded indoor spaces. I’m now ready to eat indoors & (selectively) remove the mask. Here’s why: (1/25)
As I said recently, my threshold to liberalize my behavior is <5 cases/100K/d in my region. (After accounting for home tests, 5/100K/d is really ~25/100K/d.) U.S. is now at 19, CA is at 12, & SF is at 6 (& fell 64% in past 2 wks). Find your # here:
nytimes.com/interactive/20… (2/25)
Asymptomatic test positivity rate @UCSFHospitals now 1.6% (⬇from 4-6% in early Aug). This means that ~1/60 people who feel OK would test pos. for Covid. We use a PCR-like test, which will stay pos. for ~14 days on average, whereas the avg. period of infectiousness is ~8d. (3/25)
Read 25 tweets
Aug 28
I’m not doing indoor dining, and I still wear a mask in crowded indoor spaces. While most in US have chosen to be less careful, in this 🧵 I’ll review the logic & math behind my decisions, hoping that some of you will find them useful in navigating today’s Covid landscape. (1/25)
Here’s my bottom line (in case this 🧵is TL;DR):
I’ll begin eating inside and removing my mask in most indoor spaces when the local reported case rate falls below 5/100,000/day.

You can find your local rate of cases/100K/day here @nytimes: nytimes.com/interactive/20… (2/25)
US cases have ⬇by 30% in past month, but they're still well above 5/100K/day. Today, the US is at 28. In SF it’s 19; in Marietta, GA (where I was yesterday, visiting my son) it’s 25 (Fig). Barring a bad new variant, I’m guessing we’ll be <5/100K/d in the next 1-2 months.(3/25) Image
Read 25 tweets
Aug 12
Quick 🧵to update SF Covid situation:
If you’re still being careful in SF (as I am), good news is that cases are down by ~50% in last 2 months, now 244 cases/day, down from peak of 537 (Fig L). As usual, hospitalizations lagging (now 117), but starting to trend down (R). (1/4) ImageImage
@UCSFHospitals: 36 pts (6 ICU; ~50/50 “for” vs “with" Covid – Fig L). ⬇~30% in 2 mths; ⬇80% from Jan peak. Asymptomatic test pos. rate=3.6% (R); was ~6% 2 mths ago.
At 3.6%, in group of 20 asymptomatic folks, 52% would test pos – still pretty risky to unmask in big group.(2/4) ImageImage
SF case count translates to 26/100K/d, seemingly close to my indoor dining threshold (<10-20/100K/d).
Except I multiply today’s #’s by 5 to approximate true case rate (accounting for home testing), so ~125/100K/d. That's a lot of Covid around – I’m keeping mask on for now.(3/4)
Read 5 tweets

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