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

24 Oct
Covid (@UCSF) Chronicles, Day 220

1/ Yesterday was @UCSF Medicine Grand Rounds– we covered the 3rd wave (w/ particular focus on situation in Wisconsin) and how to assess and manage risk in Covid. The conference (70 min) is available here: tinyurl.com/y2to6y9y Worth watching.
2/ @ 5:00: First, an update by George Rutherford on the current surge. The U.S. is now at >60K cases/d. This map, from @nytimes, shows that while biggest surge is in the Midwest, unlike surges 1 and 2 this is really a national surge, with only a few exceptions (one of them CA). Image
3/ @ 7:30: In California, “no evidence of a 3rd wave…yet.” “I have a feeling that we’re teetering at the precipice, and we need to be absolutely positively clear that we’re doing everything we can to avoid infection.” Image
Read 23 tweets
22 Oct
Covid (@UCSF) Chronicles, Day 218

1/ Excellent @washingtonpost piece today on Operation Warp Speed, & its (likely) success in moving us from discovery of a new virus to having one or more safe & effective vaccines available in about a year, God willing. tinyurl.com/yybpgcat
2/ Yes, that’s really me quoted below, praising the Trump administration for OSW's success. Bestowing such praise was not easy, since I agree with @KamalaHarris that our overall Covid response may well be the greatest failure of any presidential administration in U.S. history.
3/ But on this one, the administration has gotten it right. While some will quibble w/ choices of which vaccines to bet on, the investments made seem sound – particularly the choice to offer funds to decrease the risk of the companies’ vaccine development process (“de-risking”)…
Read 25 tweets
15 Oct
1/ Covid (@UCSF) Chronicles, Day 211

Now 7 months into the U.S. pandemic and 3 weeks from the election, everybody is exhausted and overwhelmed. Everyone's new question seems to be, “are you optimistic or pessimistic?” The question is simple; the answer, of course, is complex.
2/ Today, I’ll start with the view from San Francisco – consumed by The Trump Show, it’s been a while since I presented our local data. I’ll then describe the scary surges elsewhere and add my take on the optimist/pessimist question.
3/ First, @UCSFHospitals, we have only 10 Covid patients in hospital & just 2 on vents, both lowest since May (Figure). Test positivity rate @UCSF is ~4% in patients w/ symptoms, 0.5% in asymptomatic pts. In Aug, these # 's were 10% / 1.5%, so a vast improvement in every metric.
Read 25 tweets
10 Oct
Just watched the @TuckerCarlson segment with Trump interview by @DrMarcSiegel. Takeaway: Trump looks good, his voice is strong, no visible shortness of breath, he's finishing sentences without stopping for air. Mental status and judgment seem unchanged from his usual. (1/9)
Siegel actually did a decent interview – asking questions testing recall, along with others that got at judgment and insight (latter included asking about lessons learned from this experience). I'm not a Trump fan but it's hard to make 25th Amendment case from what we saw. (2/9)
And, while Trump is still not completely out of the woods – there's still a small (<5%) chance of a significant setback – with a patient this stable 8 days into the illness, his most likely course is a relatively uneventful recovery. (3/9)
Read 9 tweets
9 Oct
1/ Covid (@UCSF) Chronicles, Day 205

It’s hard to believe that we first learned of Trump’s Covid diagnosis exactly one week ago tinyurl.com/yxq2vbv3. Here are a bunch of hot takes on today’s issues, which continue to move at hyper-speed.
2/ On Trump’s clinical status. Yesterday, his doc reported that Trump's vital signs were stable, including normal oxygen saturation w/o supplemental O2. Today’s videos show no obvious shortness of breath (he completes sentences without stopping for air): tinyurl.com/y3p9l8lh
3) Based on his @FoxBusiness phone-in today tinyurl.com/y5h5brpe, his mental status & judgment seem to be at his baseline (that's the standard we use). Whatever you think about Trump's mind, there’s no new evidence of lack of capacity to do his job based on Covid or meds.
Read 25 tweets
4 Oct
Impressions of today's Walter Reed presser:

a) Conley's mea culpa: “I was trying to reflect the upbeat attitude of the team. Didn’t want to give any information that would steer the course of his illness.” Trump's fingerprints.

But even so, today was only slightly better. (1/8)
b/ Biggest news is that T had 2 episodes of hypoxia (down to 93-94% O2 saturation), & Conley evaded whether sat was ever <90. "Never in low 80s" is all he offered.

c/ Re: Chest CT: "There were some expected findings but nothing of concern." What the hell does that mean?...(2/8)
...To be clear, the "expected findings" on a chest CT is NORMAL. If it was normal, he should say that. Anything else should have been described.

(The only semi-benign interpretation would be if the prez has a known chronic finding – like a benign nodule – that was seen)...(3/8)
Read 8 tweets

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