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1/ Covid ( @UCSF) Chronicles, Day 27
Thankfully, stable @ucsfhospitals, w/ 20 Covid cases, 5 on vents. Of 11 vent pts to date, just 1 has died, 5 were extubated, other 5 still on vents – bit better than published # s. At ZSFG, 34 patients, 12 intubated, mild increase in past wk.
Thankfully, stable @ucsfhospitals, w/ 20 Covid cases, 5 on vents. Of 11 vent pts to date, just 1 has died, 5 were extubated, other 5 still on vents – bit better than published # s. At ZSFG, 34 patients, 12 intubated, mild increase in past wk.
2/ Still awed by my 20 @ucsf colleagues (12 MDs, 8 RNs) now in NYC, most @nyphospital, Queens. Here’s send-off video by @united, https://bit.ly/3ej79XK which flew them gratis (see special guest at 0:20). Utterly heartwarming. Early reports back: it’s still quite terrible in NY.
3/ SF cont. slow rise. 85 new cases today; prob. artifact since only 15 Sunday – trend stable. 15 deaths in SF since start. NYC (10x population) has had 106K cases & ~7000 deaths. Terrific @nytimes piece looks @ remarkable West Coast experience: https://nyti.ms/2V6HQQR I’m quoted
4/ Since (per @IHME_UW), now passed peak in U.S., it’s easy to see why people are eager to shift to more optimistic mindset. Markets shifting too ( @GoldmanSachs less bearish: https://on.mktw.net/2V4JUc3 ). But there are still tough days ahead – hate to be the skunk in the room, but…
5/ There’s zero about the virus that’s changed: it's nasty as ever. In places like SF, <1% of us were infected, meaning 99% are as vulnerable as before.(In NYC, maybe 3-5% infected) & infection=immunity isn’t slam dunk – see great explainer: https://nyti.ms/2ygIhPx by @mlipsitch
6/ No treatment has been proven to work: hint of benefit w/ remdesivir (but nonrandomized study) https://bit.ly/2ydVEQu ; still awaiting data on hydroxychloroquine (studies unimpressive https://bit.ly/2ySDHHC ), minuscule info on others (antithrombotics, convalescent serum, etc)
7/ Vaccine: who knows? No time soon. Gotta figure out the immunity thing first.
8/ Issue of asymptomatic Covid is toughie. Next stage based on identifying pts->finding contacts->testing->quarantine. If 20-40% of pts have no sxs, huge curveball. “Test everybody, daily,” is, of course, a fantasy. See gr8 thread @farzad_MD on challenge https://bit.ly/3acLIV3
9/ Even if we could ID all pts w/ Covid, then contact tracing. Today, Michael Reid @ucsf described how other nations did contact tracing (Figs). Could we do this in U.S.? Not sure. In @statnews https://bit.ly/2RCyL0d , ex @CDCgov head @DrTomFrieden: “need an army of 300K people.”
10/ Re: quarantine, sure, I can do it: I have a house, Zoom, Netflix, a spouse, & a dog. But plenty of people don’t, & can’t. Must help them. Here’s Reid’s proposed package to help folks without means to successfully quarantine. Is anybody prepped to offer this? Haven’t heard so.
11/ Even if we nail logistics, we'll face profound moral choices in “restarting America,” since some will die https://nyti.ms/2VnLt3S But some will die if we stay on lockdown – very tough tradeoffs. Not a question for April (NOT READY!), but it'll dominate May, as case # s fall
12/ Changing gears: @nytimes piece on admin's failure to heed warnings https://nyti.ms/2XxJNYj is compelling & credible (& led to Trump’s wild presser today, as he tried to weave alternative narrative). As bad as administration’s response has been (and it’s been mostly awful)…
13/ … to be fair, over 20 yrs we've failed to gear up for pandemics – see @ddiamond @politico https://politi.co/3a8ktuq While this'll be partisan chum, both things can be (& are) true: long-term failure to prep for outbreaks generally, along w/ poor response to Covid specifically
14/ Now homebound for 1 mth. Like all, I miss lots: hugging kids, visiting parents, &, yes, golf. In 1940, Richmond Golf Club in England faced a different threat, & enacted Temporary Rules. Reminder that we’ve been thru tough times before & we’ll get through this.
Stay safe….
Stay safe….
