1/ Covid ( @UCSF) Chronicles, Day 38

Still stable at @UCSFHospitals & in SF. @UCSF, 15 pts, 5 on ventilators (Fig on L). In SF: 38 new cases, 23 deaths overall (up 1)(Fig R). A sad milestone: we passed 50,000 deaths in the U.S. today. Staggering, & tens of thousands more to come.

2/ @UCSF, we’ve cared for 23 Covid pts in ICU, with one death. #ZSFG w/ similar number of ICU patients & not a single death. Amazing outcomes; far better than published reports. Likely highlights value of flat curve: when health system is overwhelmed, mortality must be higher.

3/ Our overall test positivity rate @ucsf running ~3%, and falling as we do more asymptomatic testing (eg, pre-op patients). Of 567 tests on patients with no symptoms (in past 1-2 wks), just two have been positive (0.35%). Obviously, would be higher in regions w/ more virus.

4/ Now testing all hospitalized patients @ucsf. Debate re whether to test asymptomatic healthcare workers. Some systems are starting to do it, likely to reassure patients. Given very low prevalence of virus here, yield would be quite low for virus & well below 1% for antibodies…

5/ And neg viral test today means just that: today. To be convinced your MD or RN (or barber or waiter) doesn’t have Covid, need to test every 3-4 days. Hard to justify unless high priority groups have all tests they need. But if it would make pts feel safer, we may end up there.

6/ A new @NEJM study https://bit.ly/2zuL74f  found 56% of skilled nursing facility residents who tested positive in outbreak had no symptoms (most later developed them). SARS-CoV-2 earns title of “perfect pathogen”: combo of high infectivity, severity & asymptomatic transmission.

7/ Accompanying @NEJM editorial by @UCSF’s Monica Gandhi, Debbie Yokoe, & Diane Havlir https://bit.ly/2S6Un54  strongly recommends Covid (viral) testing in all patients & workers in SNFs…& other high-risk congregate living sites (prisons, homeless shelters, etc). Seems sensible.

8/ Antibody testing remains complex topic. With yesterday’s finding that ~20% of NYC residents tested positive, NYC announced today that no one should mistake antibodies for proven immunity https://bit.ly/3cKnumv  (via @ScottGottliebMD). We hope so, but that's not same as proof.

9/ New study in macaques is a bit reassuring https://bit.ly/3cRB33P  Eight monkeys received potential vaccine. Later, they couldn't be infected w/ SARS-CoV-2, whereas 4 controls could be. Usual caveats: re: animal results don’t = human ones; plus small numbers. But a ray of hope.

10/ I try to steer clear of getting too political, but there has been so much great stuff on Twitter in response to ChloroxGate. First, many version of the Trump Presser-Meets-Curb-Your-Enthusiasm https://bit.ly/2x7tLJZ  God, I miss Curb...

11/ Then there’s comedian @JaneyGodley’s Glaswegian voiceover to the Trump press conference, sent to me by my friend Ian Morrison @seccurve https://bit.ly/2KzxuD0  Ian is also Scottish, & he vouches that the accent is legit.

12/ My fave: @gregggonsalves’ responded to @nytimes both-sides-ism (“…Trump theorized -- dangerously, in the view of SOME EXPERTS…”) by throwing down the Twitter Gauntlet, issuing a “best parody” challenge. Some great entries, & then (?cause-effect?) the Times relented (below).

13/ On uplifting note, watch this clip from @NYGovCuomo’s press conf today, as he reads handwritten letter from a Kansas farmer https://bit.ly/3bBTM31  (letter below). Nice to see leadership that drives us toward our better angels, & to be reminded of the country's true spirit.

14/ I’ll leave you with a short video plea from our dog Newman, who has some choice words to say about what he sees as my wife @katiehafner's & my misguided priorities of late

A reminder not to forget the people and animals you love. Back Monday…