Thread by @UCSFDOM

1/ Welcome back to a COVID #UCSFMGR w/ local experts Drs @Rutherford_UCSF @SDoernberg @PCH_SF abt the latest Omicron surge & the changes in local & national policy. First, Dr. @Rutherford_UCSF will share the latest SF data & then expert panel w/ questions frm @Bob_Wachter to all

2/ Overall good news, but deaths continue to rise. "We have turned the corner nationwide, but make no mistake, there's a TON of infection out there, there are a ton of infectious people, and a ton of disease we're continuing to see." Note the deep purple map.

3/ Still highest cases in LA, ~20k cases per day. Bay Area is lightening. Re down to 0.6-0.7. Cases in Cali are falling but still very high, avg of 2-3K cases/day. Hospitalizations are still rising, not peaked yet in larger counties."65 deaths/day in LA frm COVID is not trivial."

4/ Truly "fully" vaxed w/ boosters is not as high as these "fully vaxed" #s appear. Bay area doing pretty well. Unboosted much more likely to be admitted, need ICU, need vent, or die." Still mostly omicron - 98.5% have been omicron as of latest data. What's the deal w/ BA.2?

5/ Compared to BA.1 somewhat more transmissible, no e/o increased severity. However, if this holds, "we may have a longer tail on Omicron decline." If @IHME_UW estimates hold true, we may have passed our zenith but may have longer tail. His last appeal: Make Epi boring again!

6/ h/t @PheoSurgeon Dr. Roman. Now on to Q&A: Are cases important anymore? @Rutherford_UCSF: The trends in cases & hospitalizations important, look at + rates, +Re, sewage PCR positivity. What abt incidental COVID? Very gray area. @SDoernberg:We don't even know all + home tests

7/Agree important to look at trends."I have immense trust to look at our @SF_DPH guidelines." When evaluating what to do, look at personal risk based on family members based on vax status, indiv risk, trends in cases, etc."Cases are down, which is great,but still a TON of cases."

@SF_DPH 8/ @PCH_SF Definitely more cautious now, need to personalize/individualize risk but also think of the collective. @Rutherford_UCSF: Could there be a more contagious variant? Yes, can't predict the future! Wide-ranging, subtle & nuanced Q&A re: peds vax, 4th dose, boosters, etc

9/ Panelists are emphasizing a few pts: 1) 4th dose is strongly rec'd for immunosuppressed individuals 2) Vax+booster is extraordinarily effective & makes good policy sense 3) Keep schools safe/protected & remember equity - schools =preschool thru college, can't generalize across

10/Panelists emphasized that we can't exactly commit to future policy-change dates for unmasking/deescalation, esp for kids/schools which need nuanced approach & layered/tiered approaches of protection. Testing - Still need more testing availability, new data re:home tests + days

11/ New antiviral paxlovid: Best data for drugs early w/in 5 days - barriers: still hard to get timely testing (but home test is ok!), drug-drug interactions, supply in pharmacies. Nuances of when to use paxlovid vs moln vs monoclonals vs outpt remdesivir - depends on situation.

12/ Fast-paced hour PACKED w/ info with our local UCSF experts.

Check out the video later today on website medicine.ucsf.edu/dom_grand_roun… & YouTube channel youtube.com/channel/UCxZIc….

See you back next week w/ Dr. @meganranney for a special #UCSFMGR at the annual Reza Gandjei Lecture.