Thread by @Bob_Wachter

1/ Covid (@UCSF) Chronicles, Day 303

Exciting day. @UCSF Grand Rounds, we covered our vaccine rollout, vaccine issues more generally (w/ @drpauloffit), & then the new viral variants (w/ Charles Chiu @cychiu98. On youtube here: Worth a watch.

2/ A few highlights. First, the UCSF vaccine experience, w/ Susan Smith & Desi Kotis. We’ve now delivered 20,261 shots, and we’re doing well with just-in-time vaccination –we've injected 84% of supply. We get ~1 week notice of when more is coming, but it’s not always accurate.

3/ Our current dashboard is below. We’ve now offered vaccine to 99% of those in Phase 1A. 77% have received first dose, and 17% have received 2nd dose. 83% of our highest priority group (subgroup a) have been vaccinated; 56% have already received shot #2.

4/ At this point, we’re moving beyond our front-line staff, beginning to invite our patients over 75 (soon 65, but we need to work through the operational details first), as well as opening up to SF physicians and staff who aren’t UCSF affiliated. I’m glad – it’s crucial…

5/ …that we begin vaccinating patients, & I’m glad we’re starting w/ those at highest risk. I’m also pleased that we (& other large healthcare systems in SF) are now ready to help vaccinate physicians & office staffs who lack institutional affiliations; up to now, it’s been…

6/ …unclear who would.

We’ve seen very few vaccine side effects; 2 people had allergic reactions that required Benadryl, none needed epinephrine. And nice to see that relatively few of our people have chosen not to be vaccinated; we suspect that that the 20% of people…

7/ … who were eligible but haven’t been vaccinated have mostly been thwarted by the process (email access, signing into the patient portal, that sort of thing). While there is doubtless some vaccine hesitancy among UCSF people, it doesn't seem to be a major issue – reassuring.

8/ Nice to hear relatively optimistic view from @drpauloffit, who thinks we’ll overcome the slow rollout & reach herd immunity at a lower vaccinated proportion than is the conventional wisdom. Paul thinks it’ll be more like 60% than 80%. Some of this is because the path to …

9/…herd immunity is the combo of vaccinated population & those with prior infections (the latter group already makes up ~20% of U.S. population). Paul also thinks cases will fall as weather warms.

And also: "we’ll have an administration that has a clue, so that’s good.”

10/ Caveat re: lower herd immunity threshold is that it requires that vaccines not only prevent cases of Covid, but also asymptomatic shedding/contagion. He's optimistic: “I believe that, though you may be asymptomatically infected [after vaccination]...you will shed less virus.”

11/ Paul is also quite reassuring about the safety & efficacy of the vaccines. For one thing, he and other vaccine experts cannot think of a historical example of a serious vaccine side effect that emerged more than a couple of months after a vaccine came into general use.

12/ Offit also critiqued the roll-out so far. The U.S. de-risked vaccine development with a $24M investment, he noted. “At the same time we were doing that, we should have put in an infrastructure [to actually deliver vaccinations],” which we did not do. It was a huge error.

13/ Part of the problem is that Operation Warp Speed placed the Defense Dept. in charge of distribution. It was a “clash of cultures;” the DoD was concerned about trucks getting hijacked, but didn’t really think through the problem of getting vaccines from freezers into arms.

14/ Paul is not a fan of the argument (which @ashishkjha and I made in the @washingtonpost tinyurl.com/y7c6v9hz) that 2nd dose should be delayed in order to vaccinate more people w/ first dose more quickly. He worries about the messaging, particularly that people may say,…

15/ ...“I hear 1st dose is 80-90% effective, why should I get 2nd dose?" I respect Paul a lot and this is a reasonable concern. Receiving 2nd dose (at some point) is crucial.

He's fine w/ decision to release 2nd doses from stockpile; he doesn’t think 2-5 wk delay is a problem.

16/ We also heard from Charles Chiu @cychiu98, @UCSF virology expert, who described the new viral variants. His talk reinforced our thinking about the UK variant (more infectious, but not more virulent or able to evade vaccination) & the South African variant…

17/ … which may or may not be more infectious, but has changes that, at least theoretically, may lead to less effective vaccination (though vaccine likely will have some benefit, possibly just less).

Luckily, this variant has not yet been found in the U.S.

18/ Reassuringly, Charles doesn’t think that exponential growth of either variant is inevitable in the U.S. But they could grow fast (as UK variant did in England). The new variants make it even more critical that we get people vaccinated as quickly as possible.

19/ Hope you have a chance to watch, it's here:

Other news today: appointment of @ASlavitt to help lead the administration's Covid response. Andy is one of my heroes – it’s an inspired choice that increases the chance of getting Covid response right.

20/ Biden team also announced its Covid plans today; they seem spot on tinyurl.com/y3nyyp3c Huge investments in testing, vaccination, schools, & supporting people & cities/health depts. Yes, it's expensive, but far less costly than Covid – in lives, anguish, illness, & money.

21/ Overall, I finished the day more optimistic than I started, both that we’re going to turn things around on Covid and on what life may be like under the Biden administration – an administration that will begin in 132 hours, 12 minutes, and 36 seconds. But who’s counting?