Thread by @Bob_Wachter

Covid (@UCSF) Chronicles, Day 233

1/ Today was an amazing @UCSF Dept. of Medicine grand rounds. We discussed the election and its impact on Covid & healthcare with an all-star crew: @KBibbinsDomingo, @ASlavitt, and @ZekeEmanuel. The 1 hour video is here:

2/ I’d normally tweet a long summary of the chat, but I’ll be honest: between obsessively watching cable (how does @JohnKingCNN stay awake?) & refreshing this addictive swing-state calculator (tinyurl.com/y5e3lecj try it!), I don’t have the energy. So just a few take-aways.

3/ I hope you’ll find the time to watch the far-ranging discussion. We covered how a President Biden (now a near-certainty, as both PA and GA are poised to flip) will and should handle the transition and the early days of his presidency, both in terms of healthcare and Covid.

4/ If the Dems don’t win the Senate (it seems likely they won’t), there are big limits on what they’ll be able to do on healthcare. Both Andy & Zeke believe that McConnell & friends are more likely to be obstructionist than cooperative – they still see it as a winning strategy.

5/ Even so, there are things that Biden can do – expand open enrollment, for example. But the promise of a big health bill is dead w/ a red Senate. That’s particularly problematic if the Supreme Court chooses to strike down all/part of Obamacare next week tinyurl.com/y5rhrgqz

6/ Kirsten described the impact of disparities in Covid – and made clear that, while there are general issues surrounding minority groups and socioeconomic determinants of health, we will need to be more nuanced in considering such groups, their needs, and how to reach them….

7/ Why? The election clearly showed that thinking of "minorities" as a monolith is wrong. Even thinking of the Latinx community as a monolith is inadequate, a point made clear by the Cuban vote in Miami (where Biden did poorly) vs. the Latino community in AZ (where he did well).

8/ Lots of interesting talk about vaccines: getting them distributed, convincing people to take them, and more. @ 49:30, @ZekeEmanuel described why he's confident that the Biden team will get the distribution part right. “If there’s one thing I know about Joe Biden," said Zeke...

9/ … "it’s that he does know how to put together a team of very competent people… and he’s very practical, he’s not doctrinaire.” [Zeke worked closely with Biden during the Obama administration.]

10/ The entire discussion was terrific, but if your time is limited, I’d highlight the last 10 minutes (starting @ 50:40), in which each of the speakers talked about big picture issues & the future: particularly how to deal with the fundamental mistrust in science and expertise.

11/ I was particularly moved by @ASlavitt's discussion of America's empathy gap (starts @ 51:40): “One of the comments I get every once in a while," he said, "is, ‘Well, I don’t know anybody who has died of Covid-19.

And my response is, ‘you do, but you don’t know their names.”

12/ “These are the people that grow your food…, who work in your store, maybe you know their first name… And you don’t know their parents and those who live with them.’”

While knowing people who died of Covid shouldn’t matter, it does. Somehow, we need to make it matter less.

13/ So many hard things to do, yet the discussion left me hopeful, particularly as I think about having an empathic and competent administration that focuses on unifying the country around fighting a common enemy: the virus. It won’t be easy, but new leadership is a start.

14/ As for me, I’m at Fauci 1.7 (figure). Not ideal, but best I’ve been in mths. I'll be back Monday w/ an update, incl. SF Covid situation (which is reassuringly stable). Till then, stay safe & sane. And try to pull yourself away from the election calculator long enough to eat.