Standing By

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UGH. The tsunami is coming, my friends. The alarms have sounded for so long already.

And we KNOW what to do!  We can brace the shore for it and decrease loss of life.

I just spent all weekend working on operations reorg and mobilization–so proud of the teams who worked around the clock to prepare for the worst.  While we wind down non-essential practice functions, we ramp up in crisis mode.  We will redistribute clinical staff to where they are most needed.

But we need EVERYBODY to pitch in and help out.

Please please please do your part.  LEAD BY EXAMPLE.

I’m already wondering which of my friends will get sick. So many people I admire, dedicated professionals and teachers, people who make the world better, work in our emergency departments and on the hospital floors. They care for the sickest of the sick.

Please do your part to NOT put them in harm’s way.

I am a vector. You are a vector. We are all vectors. That is why we need to keep physically separate right now.

This kind of separation is temporary.

Let us tolerate it and help minimize the kind of separation that is permanent.

***

From Jennifer Leung, MD:
Takeaways from the UCSF COVID-19 town hall [this week]:

1. If you’re exposed to COVID, you’re likely to see symptoms in about 2-9 days, with median of 5 days.

2. The common symptoms are acute respiratory distress and fever, often high, which may be intermittent but can be persistent and last over 10 days.

3. Breakdown of cases: About 80% of those who contract COVID only get mildly ill; 14% get hospital-ill, 6-8% critically ill. The mortality rate seems to be between 1-3%, but that needs to be adjusted for age. Mortality is 10-15% over 80, and drops lower for younger cohorts.

4. The bulk of those who fall ill are aged 40-55, with 50 being the median. But being young and healthy (zero medical problems) does NOT rule out serious illness or death; it may just delay the time course to developing significant respiratory illness by about a week or longer.

5. Findings [suggest] that COVID-19 is spread simply through breathing, even without coughing [edit 3/17: I am still looking for primary source evidence for this; one experimental/model study showed the virus staying aerosolized for three hours; it is unclear what this means in real life]. It seems unlikely that contact with contaminated surfaces is a primary means of spread: “Don’t forget about hand washing, but if you don’t want to get infected, you can’t be in crowds.”

6. The virus spreads by air and in droplets (sneezing and coughing), but also via fecal-oral transmission. This is where hand washing with soap is key. And try to eat only cooked foods if you didn’t prepare them yourself.

7. COVID likely originated in bats. But for those sharing rumors that COVID came from Chinese people eating them, researchers now believe it went from bats to another animal species before jumping to humans, and that fecal-oral transmission was the likely vector. WASH YOUR HANDS.

8. There are no real treatments for COVID yet. Remdesivir has shown signs of reducing mortality but it is still in tests, is in short supply and only available under restriction. Steroids, a common treatment for respiratory illness, may make things worse.

9. The terminal phase of COVID is acute respiratory distress, treated by putting patients on a ventilator. We have 160K ventilators in the US. About 1M will need ventilators. Half will die in the first week; survivors stay on for 4 weeks. “We don’t have enough ventilators.”

10. …Italy is already overwhelmed. Many countries are just days behind Italy on the case curve. The US is actually breaking the curve–[due to severely limited availability of widespread testing].

11. 40-70% of the US is likely to get the virus. Around 150 million is the UCSF estimate, with a 1% rate of mortality. Which means 1.5 million Americans will likely die of this disease in the next 12-18 months.
To put this in context: In 2019, 606,880 Americans died of cancer.

12. We are “past containment” at this point, experts say. The [lack of early unified intervention made] it impossible to stop the spread—we can only slow it so healthcare can catch up. And no matter what anyone says: We won’t have a vaccine for at least 12 months.