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1/ Covid ( @UCSF) Chronicles, Day 55
UCSF: 13 pts, 6 on vents (each down 1). Fig on L shows 2 waves; on downslope from 2nd. Test + rate stable at 2.2%.
SF cases stable (Fig R top), w/ day-to-day ups & downs. Hospitalizations down to 71, ICU pts 24 (vs peak of 90 & 32 10d ago).
UCSF: 13 pts, 6 on vents (each down 1). Fig on L shows 2 waves; on downslope from 2nd. Test + rate stable at 2.2%.
SF cases stable (Fig R top), w/ day-to-day ups & downs. Hospitalizations down to 71, ICU pts 24 (vs peak of 90 & 32 10d ago).
2/ If the White House can become a Covid hot spot https://nyti.ms/3bgx6V2 , raises the question of how ANY workplace or business can keep itself safe… and convince others that it has done so. Let’s look at some of the issues around keeping workplaces and schools safe...
3/ While one would think that a single viral particle hitting one’s nose or eye could cause Covid, it just doesn’t work that way (in Covid & most infections). Here is the best description I’ve seen of the importance of infectious dose, by @erinbromage https://bit.ly/2Llutqt
4/ This dose-dependency explains a lot: why risk is lower outdoors; why passersby don’t pose much threat; why contact tracing focuses on >10 minute exposure. Thread by ICU doc @gbosslet re: what his family will/won’t do this summer matches my own thinking https://bit.ly/2SPQ7av
5/ This is all background for the Trillion Dollar Question: since choices by individual consumers will mostly determine Covid’s toll & success of reopening https://nyti.ms/2WRxNiy , what can businesses/schools do to create safe spaces, and to get people to trust that they’re safe?
6/ First task is to keep people w/ Covid out. Some orgs may ask at door re: symptoms, or via app ( @UCSF one below). Of course, need to change questions as symptoms change: new @NatureMedicine article finds loss of taste/smell is most telltale sign of Covid https://go.nature.com/3dAXvyl
7/ Temp checks popular, but – since ~45% have no symptoms, at least early – of limited use. And trust issues for both symptom reports and fever (person might take Tylenol, such as @ meatpacking plant https://nyti.ms/2zpqKFJ ). This argues for generous sick-leave to lower incentive
8/ Which brings us to testing. To know if a worker or customer is safe, most useful data would be negative viral test, done that day. Trump said that 1 of his staffers who was diagnosed w/ Covid had tested negative 4 days ago, a vivid illustration of the limits of a single test.
9/ 4-day neg→pos might be 1st test was false neg, or just bad timing. Given incubation, if goal is to prove a person is Covid-free, most experts say testing 2x/wk is fair balance of safety & feasibility. Thus Cuomo’s new 2x/wk rule for nursing home staff https://bit.ly/2AenNbe
10/ As we’ve discussed, value of positive antibody test (assuming that it isn’t a false +, which happens often enough to fret https://bit.ly/3cpkvQD ) is that it probably means you had Covid at least a week ago and (it’s very likely that) you can’t get it again, at least not soon
11/ Since a recent neg SARS-CoV-2 test is only thing that would be truly reassuring, this elevates goal of finding fast, cheap, simple test. Two promising developments: a) Tests of saliva easier and at least equal to unpleasant nasal or throat swabs https://bit.ly/2An7HMN , and…
12/ b) Newly @US_FDA-approved viral antigen test may be cheaper (<$20, vs. $50-100), faster, & more scalable than PCR https://bloom.bg/2WnnFif Problem: more false negs. Still, duo of saliva plus antigen testing may make quick tests to enter workplace/restaurant/airplane feasible.
13/ Lots of companies are vying to build tools to manage test results, linking them to a pass on a phone that will open doors. One interesting entry: @Clear, which does screening for airports and other venues like concerts, announced “Health Pass” today https://bit.ly/2SSffNB
14/ Are there any models for people doing frequent tests for infections, downloading to phone, & using results to demonstrate they're “safe”? Answer: yes. It’s what the porn industry has done for 2 decades around HIV & STD testing of its actors https://bit.ly/2WERERJ @statnews
15/ Of course, in addition to the worker/customer, the other side of equation is what businesses or schools need to do to convince people they’re safe. In recent weeks, I’ve spoken to several big companies & start-ups trying to find solutions. Much depends on the context.
16/ For example, leaders of a liberal arts college are trying to sort out how to bring students to campus in Aug. Current thoughts are to offer mix of online and in-person classes, partly to limit class size. They worry that college kids won't follow distancing or mask guidelines
17/ I learned: a) schools are very worried re: mental health, esp. of kids in single rooms (of course, also worried re: infection risk of roommates); b) they may divide kids into cohorts of ~30 who’ll take all classes together (to ease contact tracing & prevent wildfire spread).
18/ Restaurants have different headaches. They’re trying to sort out distanced seating, masking of cooks & wait staff, frequent wiping, touchless payments https://nyti.ms/2YUHX4g A toughie: customers can’t keep masks on through the entire seating… it’s a restaurant, after all.
19/ Airlines, staring at billions in losses, are passing out masks & wipes, trying to convince people that it’s safe to fly https://nyti.ms/3fHhgWM But these two pieces @TheAtlantic don’t leave one super psyched to hop onboard https://bit.ly/35RhjuU & https://bit.ly/35WGZGs
20/ Of course, healthcare organizations (including @UCSFHospitals) are also working hard to build trust so that patients will come in for care. This has its own set of nuanced issues, which I’ll cover it in a future thread.
21/ Shifting gears, nice piece by @chrissyfarr on how San Francisco’s experience with HIV in the 1980s may have prepared the city to enact the right Covid policies and, as importantly, to follow them https://cnb.cx/3fGV1jW I’m quoted. @CNBC
22/ Sad re: death of Jerry Stiller – Seinfeld’s Frank Constanza. Festivus, obviously, will get most airplay https://bit.ly/2WPtfJe , but my favorites are bloopers: “You wanna piece of me” https://bit.ly/3cqH0EM & “Del Vista Becco” https://bit.ly/2zwkrjK
RIP. Back Wednesday.
RIP. Back Wednesday.
