Bob Wachter
Bob Wachter

@Bob_Wachter

15 Tweets 18 reads Apr 18, 2020
1/ Covid (@UCSF) Chronicles, Day 31
Things remain stable here: @UCSFhospitals 17 Covid pts, 2 on vent; ZSFG has 27 pts, 10 on vents. SF overall, 1058 cases, up 39. Sadly, 20 deaths in city, up 3. Still a far cry from NYC's ~9000
2/ It’s been 1 mth since I launched Covid tweets. We were entering a phase I thought would be apocalyptic; I never dreamed I’d be chronicling SF’s remarkably good fortune. For nostalgia’s sake, here’s my 1st post (3/18) bit.ly & 2nd (3/19) bit.ly
3/ @ucsf, we were in crisis mode, scrambling to make scores of weighty decisions daily, from PPE policies to clinical workflow, steeling ourselves for a tsunami – one that, thankfully, never came. I fully expected we were heading into a hell like the one that actually hit NYC.
4/ It’s hard to appreciate NYC’s last mth without being there. Closest I’ve come is @nytimes diary of @drhelenouyang, an ER doc who deftly chronicled her experience nyti.ms. Truly devastating, for the clinicians, patients, families, everyone. Couple of clips below
5/ Predictable that when to lift lock-down would become political football. But so sad: all rational people are trying to balance health w/ economy, even if the relative priorities & strategies vary a bit. Fine piece on Trump plan by Zeke & colleagues: nyti.ms….
6/ …But NOT tough call to realize that opening Florida beaches today, as they have decided to do in Duval County (Jacksonville), is wildly irresponsible. Data from fab @ucsf-built #dataviz site covidcounties.org That’s not a curve that says its time to go back to the beach
7/ Remdesivir data still making news. You’ll recall @statnews obtained leaked video in which @UChicago researchr told early results of trial – sounded promising bit.ly Here’s nice piece on journalistic ethics of the leaks bit.ly by @garyschwitzer
8/ No doubt, as Gary says, we should “slow down our giddyup” on remdesivir. That said, if (as reported) it's true that 113 pts w/ Covid got IV remdesivir (presumably, all sick enough to be in the hospital) & only 2 died, and most left hospital in <6 days, that’s take-notice stuff
9/ 2 new studies add a bit of context. 1) @nejm paper from @nyphospital/@WeillCornell reported outcomes of 383 Covid pts (variety of treatments) admitted to 2 hosps in NY bit.ly Of 383, 130 (33%) had resp. failure &, after 22 d, only 1/3 of them were extubated
10/ Lengths of stay not reportd, but we know @ end of 3 wk study period 260 pts (66%) had been dischargd; rest died (40, 10%) or still in hospital; so few out in <6 d. Again, many caveats viz leaked study (anecdotal/no controls) but contrast betwn those rslts & @nejm # s striking
11/ Second is preprint of @NIH study treating Covid-19 in rhesus monkeys with remdesivir (I didn’t know monkeys got Covid, but there you go) bit.ly Drug prevented disease progression in the lungs. Usual caveats that animal results don’t always equal human ones.
12/ But all this puts remdesivir in pole position viz therapies. Not, as misleading headline @thestreet hawked, “Coronavirus Cure” (@gileadscience stock up 10%, BTW), but maybe Rx that could prevent some ICU/death. If so, might alter risk-benefit calculus for opening up society
13/ You'll recall Olive & Mabel, dogs of @MrAndrewCotter. We met them for an eating contest bit.ly & then in “Game of Bones” bit.ly with best line ever: “Olive, closing in on victory & that coveted prize of being told that she’s a very good dog.”
14/ At 0:48 in Bones, Olive makes move dubbed “high tariff.” Huh? I finally got translation from UK pals. From @marydixonwoods, gr8 quality researchr: High tariff “refers to complex manoeuvres capable of getting you a high score on sports like gymnastics & diving.” I feel better!
15/ Given (slightly) falling volume of news, stability in SF & @ucsf, & fact that writing on deadline is exhausting (I still have a day job), I’ll dial back next wk to posting M-W-F, with 1 more Thurs if we have a grand rounds.
Take time to cherish the good things. More Monday.

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