A brief San Francisco update. As always, SF is a key test case since it's so highly vaxxed (81% of people w/ ≥ 2 shots) & most still follow public health recs (incl. masking). Nevertheless, we see skyrocketing cases; hospitalizations more modest but starting to tick up.(1/12)
Let's look @UCSFHospitals first. Test positivity rates continue to climb, though if you squint you might see a hint of a plateau. As always, my key # is the asymptomatic test pos. rate, now 7d avg of 8.27% – implying 1 in 12 people in SF without Covid symptoms have Covid.(2/12) 
With that prevalence, you have to assume that everybody you come in contact with might have Covid.(Cities experiencing greater surges probably have even higher asymptomatic %.)
This is why I haven't been too critical of the CDC's 5d isolation guideline – the risk of...(3/12)
This is why I haven't been too critical of the CDC's 5d isolation guideline – the risk of...(3/12)
...catching Covid from someone who is carrying it & doesn't know it (& likely isn't masked) is probably no higher than from someone who just had Covid, is on day 6, feels fine, & is masked. Yes, I'd prefer they have a neg. rapid test, but if they're masked they're...(4/12)
... probably no more of a threat than lots of other folks.
Anyway, let's turn to @UCSFHospitals. As I predicted last wk, w/ so much Covid around we were bound to see a hospital surge, and we're now starting to see one: up to 33 pts: 27 on the floor, 6 in ICU. That's up...(5/12)
Anyway, let's turn to @UCSFHospitals. As I predicted last wk, w/ so much Covid around we were bound to see a hospital surge, and we're now starting to see one: up to 33 pts: 27 on the floor, 6 in ICU. That's up...(5/12)
...from ~20 (13 floor, 7 ICU) 10d ago. Given our asymptomatic test positivity rate, at least a few of these are likely pts admitted for other things ("incidental Covid") rather than who are sick FROM Covid, but not all of them – this is real bump. Even so, it's still...(6/12)
...much lower than one would have expected from prior case (see below for SF #'s) & test positivity surges of this magnitude. It says to me that if even in highly vaxxed SF, our hospitals will be stretched. Hospitals in cities w/ lower vax rates are likely to be hammered.(7/12)
Remember that the increase in hospitalized patients is on top of lots of MDs/RNs/other workers out sick. Also, even with no Covid, nearly all hospitals run very full in the winter (with flu & other stuff), so additional volume on top of that can easily exceed our capacity.(8/12)
Let's turn to SF – the case curve continues to head straight north, with no sign of abating. Here you see that it's up 10-fold in a few wks, & this # of 495/d understates the magnitude of the surge for several reasons: 1) there's a lag (it's from a few days ago); 2) with...(9/12)
... a slope like this, a 7d average markedly understates what's happening today; & 3) it's missing tons of positive cases that were diagnosed via rapid tests & not reported.
But even so, it's breathtaking. Is it translating into hospitalizations? The answer is mostly...(10/12)
But even so, it's breathtaking. Is it translating into hospitalizations? The answer is mostly...(10/12)
no, with a caveat: @SF_DPH hospitalization data have a 4d reporting lag. So our @UCSFHospitals uptick (no lag) likely predicts a general uptick in SF; I expect we'll start seeing this in the next 1-2 days.
But even when we do, it's still relatively mild. With cases in...(11/12)
But even when we do, it's still relatively mild. With cases in...(11/12)
... South Africa falling rapidly after 4-6 weeks, it seems like a highly vaccinated city like SF will be able to survive a similarly short surge without being overwhelmed. In less vaccinated (& mask-y) cities/regions, I'd be far more apprehensive.(12/end) nytimes.com/2021/12/30/wor…
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