Chief Medical/Digital Officer @UCSDHealth building a highly reliable, learning health system, views=mine, RT≠endorsement #VaccinesWork
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Joe first published "Understanding Academic Medical Centers: Simone’s Maxims" as a Clinical Cancer Research editorial in September 1999 🧵 (2/16)
2/ Staffing continues to be a huge challenge with 730 
2/ According to @NMartinUCSD, who gave me permission to share her latest model, we will hit peak cases soon, but could see 1500-2500 hospitalizations across San Diego. My guess is that we will not exceed the 1800 of last winter, but time will tell 🏥🔮
2/ First, South Africa and the UK saw fewer hospitalizations with their omicron surge, but ~25% of local cases are still delta according to data from @K_G_Andersen, so we are experiencing a twindemic of sorts.
2/ Based on the steep rise and fall of the omicron surge in South Africa, many are predicting the same here. I am less optimistic because the @SanDiegoCounty surge is still ~25% delta, which will drive a longer duration with more hospitalizations 🏥
2/ We are beginning to see a spike in #COVID19 hospitalizations @UCSDHealth, which reflects infections from early or mid-December
2/ We have not seen an impact on hospitalization @UCSDHealth yet, although this is always a lagging indicator. We do expect to see patients with omicron (especially unvaccinated patients) admitted for COVID in the coming days and weeks 
2/ @UCSDHealth will use sotrovimab (VIR-7831) for high risk patients with early Omicron infection based on in vitro studies predicting ↑ effectiveness compared to other mAbs in the setting of all the Omicron mutations (h/t Dr. Shira Abeles)
2/ Our contact tracing team (led by @DrLucyEHorton) found virutally all known exposures were in the household or community. Few @UCSDHealth employees (mediage age 39) required hospitalization, but each is out 10+ days, creating staffing challenges, as well as additional exposures 
2/ Fortunately, the number of patients hospitalized with #COVID19 @UCSDHealth is still relatively low at 22, but the uptick is worrisome, particularly with @SanDiegoCounty hospitalizations >200 again for the first time since March
2/ Contact tracing works great for sexually transmitted infections, but does not scale well for a pandemic caused by a respiratory disease spread by airborne droplets. So what should we do? Hire more contact tracers? 
2/ In a bit of bright news, with just 16 positive PCR results in the last 24 hours, the 7 day rolling average @UCSDHealth decreased to ~21 positive tests/day. This rate of ~2.3% is now the lowest across @UofCAHealth 
2/ The amazing @UCSDHealth #SARSCoV2 results team is monitoring >100 patients at home or in public health temporary housing. This is the highest # of people monitored in home isolation in a single day. It is also 10x higher than baseline monitoring responsibilities 6 weeks ago. 
2/ “It’s amazing how this disease has taught us that borders don’t exist” said Adolphe Edward, @ECRMC CEO, in this thoughtful @washingtonpost article (note @UCSDHealth tele-critical care specialist @VenkteshR in the reflection!)
2/ @UCSDHealth hit a milestone yesterday with over 10k tests performed. Yesterday just 4 of 540 #SARSCoV2 PCR results were positive, and serology results still ~2%. @SanDiegoCounty added 131 new cases for a total of 3,842. 
2/ Now 1209 #COVID patients in @SanDiegoCounty with 228 hospitalizations and 89 patients requiring intensive care - shout out to our colleagues @ScrippsHealth @sharphealthcare @KPSanDiego and elsewhere #HealthcareHeroes sandiegocounty.gov/content/sdc/hh… 
2/ Less than 20% of all variation in EHR user satisfaction was explainable by the EHR in use, with over 50% of variation explained at the physician user level