1/ Covid ( @UCSF) Chronicles, Day 20

Nice dialing down a bit this weekend–important to recharge batteries

Today @UCSFhospitals, 19 Covid+ pts, 4 on vents. Curve w/ gradual rise, but no spike. Now confident enuf that none is coming for us to send PPE (& possibly more) elsewhere

2/ SF cases also continue very slow uptick, now 583, up just 15 since yesterday. Only 9 deaths in city since start. Nice @SFChronicle piece on how SF’s experience with AIDS positioned us to be prepared, including building strong & bold @SF_DPH https://bit.ly/3aPzlPI 

3/ While SoCal raw #s higher, when adjusted by population all of CA doing well, @ ~500 cases/1M people (L fig) (vs NY counties, @ ~10,000 cases/1M, R fig). Thx @atulbutte group @ucsf for great visualization tool, https://covidcounties.org/  Really helps demonstrate local impacts

4/ Is CA out of woods (for Phase I, at least)? Not yet, but @IHME_UW projections https://bit.ly/342fWs1  awfully good. One wk ago (L), projected CA peak Apr 27, with 1896 ICU beds needed. Today’s projection (R), peak Apr 14; 798 ICU beds needed. Our curve is flat, unambiguously

5/ Though little question that early stay-at-home was crucial (Fig L), there must be some wild cards &/or luck. For example, TX was late, yet has also dodged bullet (R), w/ case rates that look more like CA than NY, NJ, MI, or Louisiana. This thing is complicated & multifactorial

6/ Re: Boris Johnson – without data, can’t say too much, though it's quite worrisome to quickly go from not-too-sick->hospital ward->ICU. In terms of prognosis, much depends on whether he is intubated: in studies to date, mortality ranges from 50-90% in intubated pts w/ covid

7/ Brand new @JAMA_current study from Italy shows bit better prognosis for ICU pts than prior reports https://bit.ly/2V55WKQ  In 1581 patients admitted to ICUs, mortality rate=26%, though 58% of pts still in ICU at close of study, so true mortality rate likely to be signif higher

8/ Things I’d want to know: First, was he admitted just for closer observation (vs. ventilator)? Obviously better if former. At 55, Johnson is bit below median age in Italian study (63); age is key prognostic factor (mortality in JAMA study: 36% if over age 63, 15% if younger).

9/ But any way you cut it, we now have a world leader with a not-insignificant chance of dying from this thing. If he does poorly, it’ll undoubtedly change the way we think and talk about it, everywhere, in ways that are hard to foretell. Very sad, and makes it feel even real-er.

10/ A little personal déjà vu: I came to SF in ‘83 as @ucsf intern. I cared for many AIDS pts in ICU @ SF General. All my early studies (such as https://bit.ly/2Rgzwf8 ) were on ICU outcomes for AIDS pts. Accurate prognostication is crucial to guide patient & clinician decisions.

11/ That’s too heavy to end on... If you haven't seen @somegoodnews @johnkrasinski, you must! https://bit.ly/2Rx06kv  16 min of pure joy; if you’re rushed, just start @ 8:26: Aubrey’s special treat. If this doesn't make you feel better, nothing will.

Stay safe, more tomorrow….