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 @ASlavitttinyurl.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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Covid (@UCSF) Chronicles, Day 1371
I haven’t X'ed much about Covid lately, mostly because things are fairly stable. But a lot of folks have asked me what I’m doing, Covid-wise.
So today: how I’m acting, & why. Graphic below shows my general approach; more details follow. (1/25)
How am I acting currently? Given a moderate uptick in Covid over the past two months, I’m back to masking in crowded and poorly ventilated places, particularly when I don’t need to talk. When I do mask, I always use an N95; I see no reason to wear a less effective mask. (2/25)
Examples of where I currently mask: crowded stores, airplanes or trains; elevators; and theaters. But given that today’s uptick is only moderate, I’m still OK with indoor dining (though will opt for outdoor if conditions allow) and for going maskless at holiday parties. (3/25)
Covid (@UCSF) Chronicles, Day 1249
While good data are far harder to come by than in the past, it’s clear that we’re experiencing another Covid uptick. Today: what that means and how you might choose to alter your behavior in response. (1/25)
First, the evidence for the uptick (I don’t say “surge” since I associate that with the massive surges of the past):
This curve of hospitalizations (a reasonable proxy for the amount of Covid in the community) shows a definite, but relatively mild, upward trend. (2/25)
Alas, one can't look at any single measure to quantify an uptick anymore. But all arrows now point in the same direction: up (⬆ wastewater,⬆ hospitalizations,⬆ deaths,⬆test positivity). Even my fave measure, @UCSFHospitals’ asymptomatic test positivity rate, is no… (3/25)
Until this week, I remained a NoVid, which I chalked up to being fairly cautious, fully vaxxed & a bit lucky.
This week my luck ran out. My case is a cautionary tale, particularly for the “just a cold” folks. Mine definitely was not...I literally have scars to show for it. (1/22)
I’ve got my 2nd bivalent in April, so my protection against a severe case was still strong, but the 2-3 month window of protection vs. getting Covid had passed. I've let down my guard a bit: still masking on planes & in crowded rooms, but I do now eat and drink indoors. (2/22)
This week, I was on clinical duty @UCSFHospitals. We are still required to mask in patient areas (good!). I felt fine until Sunday afternoon when, after leaving the hospital, I noticed a dry cough. By Sunday night, I felt flu-ish, with a sore throat, fever, and chills. (3/22)
Covid (@UCSF) Chronicles, Day 1161
With the Pub Health Emergency over, it's a good time to update you on my view of Covid & my current approach to Covid behavior – which is now based on 2 principles: 1) Is the risk worth it? 2) Can I live w/ the behavior for the long haul? (1/25)
First, let’s review today's situation. Since Omicron's emergence in 11/21, the biggest surprise has been the absence of surprises. Yes, we’ve seen a few variants that led to mild surges, but we haven’t had to interrogate our Greek dictionary for a new letter for 18 months. (2/25)
mRNAs still work great in preventing severe infection, and Paxlovid, home tests, & ventilation still work well too. Long Covid remains a concern, but we know that both vax & Pax lower its frequency, that most (though definitely not all) folks… (3/25) jwatch.org/na55957/2023/0…
Important @TheLancet systematic review finds Covid infection confers robust & long-lasting (good at 40 weeks) protection vs both symptomatic & severe Covid infection.(Weaker w/ Omicron, but still good.) thelancet.com/journals/lance…
How will results influence my behavior/thinking?(1/7)
a) I've been considering a Covid infection to be the equivalent of a booster in terms of protection against reinfection & severe disease (hospitalization/death). These study results indicate that it is at least that good, maybe even a bit better... (2/7)
b) We've been headscratching about why XBB variant didn't cause more of a surge, despite low uptake of the bivalent booster. It may be that immunity from all those 2022 Omicron infections kept it at bay (that's informed speculation – Lancet study ended before XBB spike)... (3/7)
Covid (@UCSF) Chronicles, Day 1038
Some folks continue asking what I'm doing viz Covid behavior...
Answer: I'm changing my behavior. In the Bay Area, I'm now OK with indoor dining & removing my mask for small group gatherings.
I haven't changed, the risk has. Here's how: (1/25)
Specifically, I haven't changed my perspective on balancing prudent caution with everyone's (including my) desire for "normal."
But, in the Bay Area at least, the Covid risk has come down considerably, and, by my way of thinking, this allows for a more permissive approach.(2/25)
Where I'm coming from: 1) I'm 65 & haven't had Covid 2) I want to live as fully as I can, but am comfortable taking reasonable steps to avoid infection 3) I'm fully vaxxed & had bivalent in Sept 4) My main fear is Long Covid, which I peg at ~5% probability per Covid case. (3/25)