In early January, @ashishkjha & I made case for delayed 2nd dose in @washingtonpost tinyurl.com/4gw77p08. In last few weeks, @mtosterholm, Stanley Plotkin, & now @ZekeEmanuel have come out in support of this strategy. To be clear, we appreciate the counterarguments,... (1/4)
...particularly the messaging challenges (will some people forego 2nd dose?). But with the rapid spread of B117, the case for calling an audible for next 2 months & getting more people their 1st dose of Pfizer or Moderna has grown stronger. And this case is now bolstered (2/4)...
...by real-world data from Israel @thelancet (1st dose 85% effective in preventing symptomatic Covid) tinyurl.com/4w4476et & @NEJM (review of original @US_FDA data: 1st dose 92.6% effective) tinyurl.com/55hu7ws5.

Time's a wasting – increasingly clear that...(3/4)
...a big push to get as many people as possible their first doses in next 6 weeks will save lives overall.

In this week's @NEJM, I make this argument in a point/counterpoint nejm.org/doi/full/10.10…. And this was written before the new (& supportive) Lancet/NEJM studies.(4/4)

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More from @Bob_Wachter

12 Feb
1/ Covid (@UCSF) Chronicles, Day 331

Today, UCSF Medicine Grand Rounds. I'll start w/ quick update on local scene & then review the terrific presentation on vaccines and masks by @monicagandhi9. The entire 75 minute conference is here – worth watching:
2/ While I’ll cover Monica’s presentation in this thread, there's more. At 39:30 Marguerita Lightfoot, chief of Division of Prevention Sciences, discussed vaccine hesitancy in communities of color. At 52:00, Robert Rodriguez, @UCSF Prof. of Emergency Medicine, & @DrEricGoosby
3/ @UCSF Professor of Medicine & former UN Special Envoy on TB, discussed their experience on President Biden’s Covid-19 Advisory Board. Just as @Atul_Gawande told me @inthebubblepod
tinyurl.com/13honosl, Rob & Eric were impressed by the Biden team,….
Read 25 tweets
10 Feb
1/ Covid (@UCSF) Chronicles, Day 329

So many competing forces & trends. As dramatic as a thriller, but very decidedly – and tragically – as real as it gets. Everything's leading up to a decisive moment in late March, when we see if we’ve won or lost The Race vs. the variants.
2/ More on that after update on local/nat'l situation. Not bad, tho the usual caveat – while far better than last mth, these are still very high case counts, test positivity rates, & hospitalizations – much higher than the peaks of last summer. Covid-wise, it’s still pretty hot.
3/ @ucsfhospitals, 47 pts, 13 vents (Fig L) – I'm still concerned w/ plateau, but hospitalizations are a lagging indicator. Reassured that test positivity rates are falling – now 2.4% overall, down >50% over last month. Test positivity in asymptomatic pts: down to 1.4% (Fig R).
Read 24 tweets
3 Feb
1/ Covid (@UCSF) Chronicles, Day 322

Today, an update on local situation. Then my take on a few issues of the day. There’s some great news, some good news, & some bad news (in the form of variants, lurking just over our horizon). I think we can win The Race, but it’ll be close.
2/ Let’s start w/ local situation & then move out – themes are pretty consistent across U.S. @UCSFHospitals, 50 pts in hospital, 13 on vents (Fig L). Test positivity 3.8%; 9.3% in pts w/ symptoms, 2.6% in asymptomatics (Fig R). While hospitalizations & test positive rates are...
3/ … down 30-50% over past 2 wks, I worry that the curves are now a bit plateaued. (After past surges, once cases/test positivity rates started falling they continued to do so.) While I think we'll keep getting better, this bears watching.
Read 25 tweets
29 Jan
1/ Covid (@UCSF) Chronicles, Day 317

Today was medical grand rounds: brief summary below but worth watching for latest on vaccine distribution in SF, current state of the pandemic, & the variants – overall & with a specific focus on the UK. It’s here: tinyurl.com/yyzggsmv
2/ We began w/ Susan Philip, acting health officer @SF_DPH, talking about vaccine roll-out in San Francisco. As expected, as distribution has improved the problem is increasingly “supply, supply, supply.” Goal: to vaccinate 10,000 people per day in SF. Three pronged strategy: …
3/ …high-volume vaccination sites, community pharmacies, & smaller community-based sites (mobile hubs, clinics). @UCSFHospitals & other healthcare systems helping (we’re running big site @CityCollegeofSF). Plan is to be provider agnostic (pts can go to any site to get vaccine).
Read 25 tweets
22 Jan
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…
Read 22 tweets
19 Jan
1/ Covid Chronicles, Day 307

One of the most challenging parts of Covid has been grappling with decision-making under uncertainty. It’s natural for MDs to weigh risks & benefits; med school trained us in probabilistic decision-making. But it’s an unnatural act for most people.
2/ And it's even harder w/ Covid. Just as you’ve gotten comfortable with a situation – Should I go to the store? Have a drink outside w/ friends? – the numbers change.

So let’s take a few minutes to go through some math – the kind of math you need to make rational choices.
3/ Let’s start w/ a basic tenet of decision-making in Covid: there is nothing that's perfectly safe, & nothing that's totally risky. Everything is about probabilities. What do I mean? A good cloth mask isn’t 100% effective, but it does lower chances of getting infected by 70-80%.
Read 25 tweets

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