Thread by @Bob_Wachter

1/ Covid (@UCSF) Chronicles, Day 310

What a joy watching Fauci's press conf. today. Last yr must have been torture for him, a brilliant man of great integrity. How liberating to speak truth w/o looking over his shoulder, & how uplifting to listen to him!

2/ At 11:40, Fauci says, “One of the things that we’re going to do is be completely transparent, open, and honest. If things go wrong, not point fingers but correct them, and to make everything we do based on science and evidence.” Hallelujah! leonardcohen.com/video/halleluj…

3/ Today a brief update on the local & CA situation, and a few comments on the two big issues: the vaccine roll-out and the variants.

The bottom line is that we’re turning a corner on the winter surge, at UCSF, in SF, in CA, and in the U.S. Things are still pretty bad…

4/ …but, for first time in >2 months, the trends are now favorable. @UCSF, 62 pts in hospital, 18 on vents (Fig L). (Hosp census was in mid-80s 2 wks ago.) Test positivity rate: 3.6% (Fig R); was ~5.5% in 2 wks ago. Steep falls in symptomatic (9.3%) & asymptomatic (1.9%) rates.

5/ In San Francisco, 299 cases per day (Fig L), 237 people in hospitals (R), both down. Also down: test positivity rate, now 4.5%. Total deaths: 274, leveling off after fairly big bump (was 201 one month ago). Even so, SF still has lowest per capita death rate (31/100K people)…

6/ …of any large city in the U.S, about 1/4th of U.S. average (122/100,000 people), meaning that ~300,000 people would be alive today if U.S. had mirrored SF’s mortality rate. SF's rate is also ~1/3rd of CA's overall rate (90/100K). tinyurl.com/t9j9fdw

7/ The Bay Area and CA more generally are also improving (Figs). The surge in LA has been absolutely devastating and it's still pretty bad: 262 deaths reported today, about same # of deaths as SF has suffered since last March. (LA is 11x SF’s size.)

8/ Thankfully, hospitalizations have finally starting to fall in LA. On Monday’s @inthebubblepod, I discussed situation in LA with county chief medical officer Hal Yee & ED doc Erika Flores Uribe. After 10 mths, one can hear the exhaustion in Erika’s voice tinyurl.com/yy32mz2k

9/ Another good sign: CA now has lowest Rt in U.S. (Fig; Rt.live), which should predict further falls in cases, hospitalizations & deaths. While my @UCSF colleague @cychiu98 has found a new variant in CA that rapidly became more prevalent tinyurl.com/yxqj9nda…

10/ … (raising the question of increased infectiousness, similar to the UK variant), this fall in Rt in California is reassuring. We need more research, though, to be sure that this variant doesn't spread more readily, which would be a problem.

11/ Nationally, picture is also brighter, w/ a fall in cases seen across all regions (Fig). Since the weather hasn’t warmed, this is likely the result of people being more careful & of more activity restrictions. It's a bit early to see a vaccine effect at a population level…

12/ …even when combined w/ higher fraction of the population having infection-induced immunity. But we may soon get to point where the combination of these two types of immunity (cases plus vaccine) does begin to shift case numbers downward, especially if vaccination speeds up.

13/ A word on the variants, which I also discussed @inthebubblepod last week tinyurl.com/y4ahtc7l Things are moving fast: since the podcast, we've seen reassuring evidence that the UK variant is likely susceptible to the vaccine ...

14/ … but news on South African variant is less comforting. Study shows vaccines may be somewhat less effective (though unlikely to be completely ineffective). tinyurl.com/y5cayv27 Luckily, this variant not yet seen in U.S. Still, all the more reason to get vaccinated ASAP…

15/ … and to do what we can to keep this variant out of the country and to step-up our genetic testing to find it (and others like it). And then to do everything we can to contain these variants before they spread.

16/ After an abysmal start, the U.S. vaccine roll-out is improving tinyurl.com/y7y9767j We’ve now given 18.4M shots in U.S., averaging ~940K per day. Now up to ~50% of distributed doses having been injected, up from woeful ~30% 2 weeks ago. Unfortunately, CA continues...

17/ …to be a laggard, with only 37% of our vaccine supply injected. @UCSF, we’ve now vaccinated ~22K people, nearly done w/ patient-facing workers; we're now vaccinating our pts >75. We’ll be staffing a mass vaccination site @CityCollegeofSF this weekend tinyurl.com/y38ufbfz

18/ Unsurprisingly (since they were developed by competent experts like @ASlavitt & @DavidAKesslerMD), the new plans announced in past 2 days by @JoeBiden are spot on – with robust support for vaccine production, distribution and education.

19/ Regarding vaccine bottlenecks, we need to invoke the Gretzky Rule: skate where puck is going. Today problem is mostly distribution. We’ll fix it, & then we'll have a new problem – supply – probably thru April. And then issue will be vaccine hesitancy. In the end, the virus...

20/ …doesn't care WHY someone's not vaccinated. It just cares that it's found an unvaccinated nose or throat. So we must focus on end-goal: herd immunity. Which, says @DrPaulOffit, means ~60% vaccinated, leading to ~70-75% immune (adding the people immune from past infection).

21/ So we find ourselves viewing life through yet another Covid split-screen. The Surge: improving but still awful. Vaccines: improving but still too slow. Variants: potentially scary (both via increased infectivity & potential vaccine evasion) but still a bit over the horizon.

22/ Yet, even with these challenges, I feel a million times more confident, knowing that there are grow-ups in charge – people who will follow the science, tell the truth, & focus on what the country needs rather than on playing political games. It'll get better. What a relief.