1/ Covid ( @UCSF) Chronicles, Day 22

@UCSFhospitals, 19 Covid pts, stable (Fig), with 9 in ICU, 4 on vents. ZSFG still @ 30 pts, 11 vents. Numbers quite stable overall. Relatively small # of new admissions; the fact that #s haven’t fallen is mostly because patients stay a while

2/ People surprised by 4% rate of + Covid tests @ucsfhospital; SF bit more (11%), CA 12%. NY state 41%; hilights that this % linked to prevalence in region https://politi.co/2UVv8UU . So, if you think you have Covid in SF, strong chance you don’t. In NY, far more likely you do (Fig)

3/ City of SF continues gradual rise, with 676 total cases & 54 new diagnoses in last day. 10 deaths in city, up one today (Figs). Bit larger case bump today, but not enough to call it a trend; overall, last 10 days have been pretty flat. Ditto new cases per day in California.

4/ Many questions re: @GavinNewsom statements that CA peak will be in May https://bit.ly/2xhHaiD  That’s not what I’m hearing ( @IHME_UW predicts CA peak next wk (Fig), w/ very few cases by May). Maybe CA is using different model? Or maybe Gov. N just wants folks to stay vigilant?

5/ I haven’t talked much about $s (too much else to fret about), but it’s increasingly hot issue @ hospitals & MD practices. It’s oft-said "healthcare is recession-proof,” but that’s not quite right, & Covid-19 has some features that’ll lead to major impacts on healthcare systems

6/ For big academic systems like @UCSFHospitals, much of our profit (which we use to support our research & educational missions, along w/ clinical work) comes from procedures: surgeries, transplants & the like. All hospitals' volumes on these are down by 60% or more (by intent)

7/ But then the head-scratching part: we’re down ~50% for ER admits, stuff like MI's, sepsis. I get that people don’t want to come to hospital, but usual pts coming thru ER are desperately ill. @hmkyale (ex- @ucsf-er) is also flummoxed…& concerned @NYtimes https://nyti.ms/3c16Ajc 

8/ Combo of intentional (procedures) & unintentional cuts, plus cost of Covid prep/care, =s huge losses. @NYPHospital estimates $350-750M dip https://bit.ly/3bX659M  @ucsf #s prelim (& we’re a bit smaller than NYP), but our losses will certainly be >$150M when all’s said & done

9/ Places like ours – leading academic health systems – will survive. We have reserves, generous donors, & a diversified portfolio (inc. >$1B in research grants/contracts). But proportional losses of this magnitude may doom many community & rural hospitals

10/ Physician offices also getting hammered, as patients are unable to get, or are deferring, basic care. See this tweet https://bit.ly/3e5Agh1  from @Farzad_MD, CEO of @AledadeACO, which supports primary care practices. Lots of layoffs as offices are shuttered. Some won't reopen

11/ Will the federal bailout money help? Sure, some... the $2 trillion stimulus package allocated $100B for healthcare orgs. But that won’t be nearly enough to support MDs, nurses, and >5000 U.S. hospitals from some pretty dire fates https://bit.ly/2JSMlYS 

12/ Some healthcare belt-tightening would be OK (lots of bloat/waste), esp. if coupled w/ ending crazy incentives & bad regs that block innovation. & telemed’s meteoric growth ( @ucsf went from 2% televisits->58% in past mth) may dampen need to have MDs/hospitals in every zip code

13/ But as we think about backlog of pts who'll need care & planning for uncertain future, potential hit to the healthcare system merits attention, esp since we'll need NEW $s for our long-neglected public health system.

Newman (below) wishes you Happy Passover. More tomorrow…