1/ Covid (@UCSF) Chronicles, Day 287

Today, a brief update on the local situation in SF & CA, and then a few reflections on a series of new failures in the U.S. that, sadly, make clear how difficult it is for our country to get execution right in the fight against Covid-19.
2/ First, a brief update on the local scene. Bottom line: not much change, which is either good or bad news, depending on how you feel about half-filled (or empty) glasses. Personally, I don’t feel great about it, since we’re just starting to see the impact of holiday mingling.
3/ TSA reported 1.3 million people screened at airports Sunday, a 60% decrease from last year but still an awful lot of travel for a country that should be staying home. After 10 months, the urge to be with friends & family is understandable, but the cost will be very high.
4/ @UCSFHospitals, our numbers are still plateaued, but high. Currently 61 Covid pts in hospital, 10 on vents – about same as for last 10 days (Fig L). Test positivity rate is also wiggling around; if anything it's up a bit: 5.1% overall, and 2.5% in asymptomatic people (Fig R).
5/ San Francisco also plateauing & perhaps improving a bit – new cases down to 259, ~10% drop. (Fig L). SF test positivity is also down (3.7, vs. 4.3 last week). Hospitalizations up to 198 (Fig R), reflecting infections that occurred ~2 weeks ago, so this might peak & fall soon.
6/ California continues to struggle, particularly in San Joaquin Valley and LA regions (Fig). LA had 13,661 new cases yesterday, and currently has 6,900 hospitalized Covid patients. Gov @GavinNewsom just extended stay-at-home orders for most of the state tinyurl.com/y7s3uvqr
7/ This graph, from the 5 Univ. of CA Hospitals (@UCLA, @UCSanDiego, @UCIrvine, @UCDavis, @UCSF) illustrates big variation across CA. UCSF is affected the least, w/ ~60 pts in hospital, whereas UCLA has ~200 and UC Irvine ~170. (The hospitals range in size from ~400-700 beds.)
8/ I remain amazed by SF’s low death rate: 182 deaths since March; only 26 in last 60 days. Whereas LA had 77 deaths yesterday & 9,555 deaths since March. (Reminder: LA has 11x the population of SF.) @latimes on what has gone horribly wrong w/ Covid in LA: tinyurl.com/ybtxlyz8
9/ While CA’s surge is very real and tragic, our huge population makes things look worse than they are, comparatively. On per-person basis, even w/ surge, CA ranks 33rd among states in cases/100K (5,595; North Dakota is #1 at 12,051) and 42nd in deaths/100K (62; NJ is #1 at 201).
10/ Nationally, we’re seeing a small overall improvement, w/ Midwest leading the way, & CA, for the first time, having the country’s largest surge (Fig). But again, this may well be the calm before the storm, as it’s too early for the numbers to reflect any holiday-related surge.
11/ We’ve hit another milestone with the national death count: it's now 336,000, which means that we’re approaching the population of Honolulu or Anaheim, having blown past Pittsburgh & St. Louis. Perhaps more vividly, it means that >1 in 1000 Americans have died of this virus…
12/ …and also of our inability to mount & sustain a proper response. It was wishful thinking to believe that remarkable discovery of 2 safe & effective vaccines would demarcate a stark change in our nation’s ability to respond to the political & operational challenges of Covid…
13/ … but, as an eternal optimist, I hoped that the combination of these vaccines, plus Trump moving toward the exit [pause for hilarious video, particularly for those who are not Trump fans: tinyurl.com/y8zoknyq] might put us in a better place…
14/ … when it comes to our Covid response. But I’m afraid we’re continuing to demonstrate that we suck at the execution part of pandemics. 2020 was filled with examples, but here are a few of the most recent ones; not a great omen for 2021:
15/ The vaccine rollout has been fairly abysmal. We thought that the bottleneck would be vaccine production (& it’s still limited) & acceptance (which will be an issue once the supply is plentiful). And, given how poorly we did w/ the production and distribution of tests & PPE…
16 … problems w/ the vaccine rollout might have been predicted. But, as @ashishkjha describes in this thread today tinyurl.com/y8bf3z6r, the rollout has gone even worse than we feared, with only 2.1M doses of vaccine injected so far, which is about 1 out of 155 Americans.
17/ Contrast this w/ Israel, w/ 8.8M people, which has vaccinated ~500K, ~1 in 18 of its citizens tinyurl.com/ybkez9gx How’d they do it? A well executed nat'l plan. Whereas U.S., as usual, has underfunded the effort & left heavy lifting to under-resourced state health depts.
18/ Added to the US's slow pace, I remain terribly worried re: the skirmishes over prioritization – rapidly turning into a Battle of the Interest Groups. I fear that vaccines will be to 2021 what masks were to 2020 – a partisan mess that kills people. More on this in coming days.
19/ Sorry, more bad news: we now have first U.S. case of the UK’s coronavirus variant that appears to be more contagious. The virus was found in Colorado, in a man who has had no international travel, meaning it’s already here & spreading, perhaps widely. tinyurl.com/y8fkndbu
20/ Scientific consensus is that this variant is real & worrisome tinyurl.com/y7umfewx. Why did we just identify our 1st case, when there are likely many? It turns out that we’re far behind the UK – even behind Wales – in looking for genomic variations tinyurl.com/y84sdzmr
21/ Thankfully, while the mutations seem to make the virus more contagious (which means that we'll need to be even more careful with masks & distancing than we were before), it doesn’t seem to be more virulent, or to be resistant to the vaccines. But it all bears close watching.
22/ Given that the virus remains very much with us, it’s crucial that we develop & deploy effective treatments. So another troubling development is limited use of monoclonal antibodies tinyurl.com/ydx4z3sm While not game changers, they do seem to prevent deterioration in…
23/ hi-risk pts, if given early. But – & there’s a theme – monoclonals are tricky to give, requiring rapid testing to identify eligible pts, then ability to infuse them safely into Covid pts, keeping them isolated from other pts.

In other words, they require careful execution.
24/ I’m reminded of the great Seinfeld scene when Jerry learns that a rental car he’s reserved isn’t available tinyurl.com/k9gww2d “You know how to take the reservation, you just don’t know how to hold the reservation…and that’s really the most important part, the holding.”
25/ As @PeterbachMD observed today tinyurl.com/y9ng3qfs, we seem to be “all breakthrough & no follow-through.” As we approach 2021, let’s hope that the new team, which takes over in ~500 hrs, can nail the follow-through/execution part. Tens of thousands of lives are at stake.

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Bob Wachter

Bob Wachter Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @Bob_Wachter

31 Dec 20
U.S. is now considering idea of a single vaccination shot, delaying shot #2 until months later. Last wk, I thought that was a bad idea – the trials that found 95% efficacy were 2 shots; why add extra complexity & a new curveball. But facts on the ground demand a rethink. (1/7)
The two main changes are the slower-than-expected vaccine rollout and the new variant virus being found in the U.S. Both demand that we turbocharge the process of getting a large chunk of the population at least partly protected. (2/7)
Here's my back-of-the-envelope math:
- Single shot seems to be about 80% protective after a month
- 2nd shot adds some efficacy (up to 95% protective), and maybe (tho not yet proven) some durability.
- New variant is here, and undoubtedly far more widespread than we know. (3/7)
Read 7 tweets
25 Dec 20
1/ Covid (@UCSF) Chronicles, Day 282

Holiday greetings – hope you’re getting a little R&R. I’m on clinical svc @ucsfhospitals – welcome break from a Life of Zoom, leavened by a little Netflix. Today, update on Covid in SF/CA, & lessons from first 2 wks of vaccine distribution.
2/ @UCSFHospitals, 60 pts in hospital, 12 on vents (Fig on L). Curve shows we may have plateaued – at a pretty high # but one that isn’t overly stressing system. Our test positivity rates (Fig R) have inched down a bit in the past week. Maybe things are starting to turn around.
3/ SF cases up to 288/d (Fig L) – low when compared to many regions (incl. SoCal), but 10x SF's Oct cases. Test positivity still inching up, now 4.3%. 176 Covid pts in SF hospitals; perhaps hint of a plateau? (Fig R). Cumulative deaths=178, w/ only 12 in past 30d – amazingly low.
Read 25 tweets
19 Dec 20
1/ Covid (@UCSF) Chronicles, Day 276

Here’s my summary of yesterday’s fascinating grand rounds (sorry it's a day late), here: Far-ranging discussion re: the problems at the CDC, vaccine roll-out @ucsf, and the complex matter of immunity passports.
2/ Session began with a fireside chat w/ Julie Gerberding, a @UCSF adjunct faculty member who ran @CDCgov from 2002-2009, and led @Merck's vaccine development program afterwards. I asked Julie about how the CDC prepared for a pandemic during her tenure as director.
3/ “SARS was a wakeup call,” she said, particularly after post-9/11 anthrax attacks. “After that, we got very serious about influenza… it led to a major investment in pandemic preparedness,” including full scale table-top pandemic preparedness exercises with every state.
Read 25 tweets
15 Dec 20
1/ Covid (@UCSF) Chronicles, Day 272

The juxtaposition is jarring: the first U.S. vaccine recipient on the day we hit 300,000 deaths. So much tragedy amid the hopefulness. Today, after an update on SF, I’ll lay out some complex issues that will play out in the next few months.
2/ San Francisco is now seeing its first big surge, & everybody's asking when the city will turn things around. After having stomped on the curve in March & quickly turned back a surge in June, I thought – if anybody can control this surge – it would be SF. I may have been wrong.
3/ The curve of SF hospitalizations (Fig) shows no signs of plateau after 6 wks, despite stay-at-home orders (note that June surge had plateaued by 6 wks). The combo of pandemic fatigue, colder weather, and the holidays has given the virus the upper hand. We’re losing the battle.
Read 25 tweets
11 Dec 20
1/ Covid (@UCSF) Chronicles, Day 268

Today was Pfizer Vaccine Day @US_FDA, and the expert panel just recommended EUA approval tinyurl.com/y5u84jmx Next: FDA deliberates, but expect an EUA in next 1-2 days. As with All-Things-Covid, nothing is easy; now the hard part begins.
2/ Today: quick state of the pandemic, then potpourri of vaccine-related stuff.

SF still in our first true surge. @ucsfhospitals 39 Covid pts, 10 on vents (Fig). Test pos 11.9% in symptomatic pts, 1.6 in asymptomatics, both way up. In SF, cases now 181/d (vs ~30/d last mth)…
3/ …& 129 Covid pts in SF hospitals (vs ~25 last mth; Fig). Luckily, deaths have not yet ticked up: 165, still lowest rate in U.S. But with this many people in ICUs, more deaths can’t be far behind. SF test positivity rate is 3.4%, rising but still well below CA’s rate of 8.8%.
Read 25 tweets
5 Dec 20
1/ Covid (@UCSF) Chronicles, Day 263

Tonight a brief update on our local situation, as 5 Bay Area counties announce that the region will adopt CA’s stay-at-home orders, even before we hit the state’s 15% ICU capacity threshold. tinyurl.com/y3ou56qq It's a prudent move.
2/ Nobody wants to go backwards – we're all bummed out and exhausted. But in judging the decisions by the governor and our Bay Area leaders, I’m influenced by the words of former @HHSGov secretary @GovMikeLeavitt, below:
3/ The viral dynamics of Covid make it even harder to react in a timely way – we always have a tendency to act late as the hospitalizations we're seeing now reflect the behaviors and conditions of two weeks ago. It’s like looking at a star: what you see now happened a while ago.
Read 21 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!