Thread by @LekshmiMD

1/ Wonderful don't-miss hour at #UCSFMGR with a candid COVID convo b/w Drs @ashishkjha & @Bob_Wachter. Dr @ashishkjha was a fmr @UCSFIMChiefs at the VA, a leading policy expert & is now a trusted #SciComm expert on all things COVID-related: the Walter Cronkite of our time.

2/ Boosters: FDA mtg today on Moderna. Jha says "POTUS mostly got it right" re: boosters. We still see v hi levels of protection w/ severe illness but even prevention of milder breakthru is important. Concentrate on high-risk ppl 1st. NOT a tradeoff w/vaxing the world/the unvaxed

3/ "We can do both!" says Jha. We already have ~90 mil doses sitting in states now & have to distribute those, can't rapidly logistically move doses frm your CVS to India. Actual # of booster doses is "drop in the bucket compared to global supply." Still need #GlobalVaccineEquity

4/ Mandates: "As a pub hlth person, I always want to start w/ persuasion," but overall mandates >>> incentives. V small minority likely non-persuadable but mandates will increase uptake. Testing: "No question that rapid testing would've made enormous diff in unvaxed" $30/2 test😱

5/ Great use-case re: testing unvaxed school age kids. Maybe a role as addtl precaution prior to indoor events. Schools: His recent 🔥thread advising schools:

https://twitter.com/ashishkjha/status/1448137700997955587?s=20

As per uje Twitter, predictable ire "frm both sides of the political aisle"🤪 Test-to-stay helps!

6/ "I thought LA did a good job" re: vax school mandate for 2022 (achieve.lausd.net/site/default.a…) Re: Molnupiravir: An addtl tool in the toolbox, still need all the 💉💉💉

7/ Reflections on his new role as Dean: Amazing, though "Zoom is great for maintaining relationships but not necessarily for building them." Re: new rockstar status? "In academia, we're suspicious of TV doctors." Re: ✈️-"Don't love" sitting next to someone unvaxed & barely-masked

8/ Overall not a ton of transmission on ✈️, but decide in the moment re: wearing KF94/N95. Perceived high-risk re: "close encounters w/ ppl whose 💉status I don't know" e.g. 💇‍♂️. Re: hindsight re: federal pandemic response: Overall job VERY well-done but wish #SciComm were better

9/ "Don't mess w/ MMWR or scientists reports" as prior President did, but need more critical coordination on public-facing msging frm FDA/CDC. Re:predictions for future: Poss need more boosters, but hopefully not q6mos. Hopefully not more transmissible variant (lambda/mu fizzled)

10/ I "worry that @trvrb is right" re:pandemic endgame (

https://twitter.com/trvrb/status/1448297954306150401?s=20

) But healthcare system can't take flu+COVID every yr-"that scenario would be intolerable." Structural changes needed: Upgrading ventilation will be key. Culture of "presenteeism" when sick has to end.

11/ Indoor mask mandates might be more like on/off switches related to case #. Natural immunity "is a real thing" but it wanes & is unreliable, vax immunity clearly higher. How do we get the next pandemic right? Will have to manage uncertainty, communicate throughout, be ready.

12/ Personal reflections: Meaningful #SciComm is the best part. Racist comments/harassment/death threats "still catch me off-guard sometimes" 😰 & make you wonder if it's worth it, but "most feedback is helpful & incredibly gratifying." Still not running for Gov...yet 😉@ASlavitt

13/ An extraordinary hour - please do check out medicine.ucsf.edu/covid-19_grand… and the UCSF DOM YouTube channel youtube.com/channel/UCxZIc… if you missed it! Next wk #UCSFMGR is off for the @UCSFChancellor SOTU Address.