UCSF's Chair of the Department of Medicine, Dr. Bob Wachter, has been a voice of reason and at least a modicum of optimism during UCSF's weekly "Grand Rounds" broadcasts since the pandemic began. And these days, while surging cases in the Bay Area concern him somewhat, he strikes a hopeful note here in mid-July that the city of San Francisco will escape the high mortality rate and overwhelmed healthcare systems being seen elsewhere in the country.
SFist spoke to Dr. Wachter late last week, and on Monday, he was tweeting out some data visualizations to make a similar point.
"Most of the growth [in case numbers] is from the South; now more than [double] the Northeast at its April peak," Wachter writes. "The West is growing too, about half coming from CA. But West's growth is fraction of the South's. The Midwest is on an upward slant as well, not at the height of the West, but nearly matching West's trajectory. Northeast remains blissfully calm, but hopefully not complacent."
12/ Here’s the same data shown another way, highlighting the proportion of the case-load contributed by various regions. This graph vividly shows how much of the overall U.S. surge is coming from the southern states. pic.twitter.com/V02gsi7cFb— Bob Wachter (@Bob_Wachter) July 21, 2020
And he posted the visualization below to illustrate how the mortality rate for COVID cases remains much lower in California compared to other states where cases are surging — half the rate in Texas and one-fifth of the rate in Arizona. "Even though AZ has fewer cases, deaths still rising (maybe a little downturn now), again based on cases caught a few wks ago," Wachter writes. "FL & TX deaths heading up. Looking at case curve, can expect deaths to continue to rise for another wk or more. CA had a small bump and has plateaued."
When we asked Dr. Wachter whether he believed San Francisco had simply had a lucky break, when it comes to our low mortality rate to date (53 deaths overall), or whether there was more to the story, he said it was likely due to a combination of factors.
"I think we've done exceptionally well. When you look at the mortality rates that have been reported from other parts of the country, they are significantly higher than what we're seeing in San Francisco," he said. "Some of that may be due to the population of San Francisco likelier being a little bit healthier than other parts of the country — we have less obesity here, less smoking, probably fewer people with diabetes — and we know that a lot of the outcomes are linked to underlying risk factors that patients have."
But, he adds, "I think the quality of healthcare in San Francisco hospitals is high. We're lucky to have very good hospitals, a very good public health system, a terrific public hospital in the county, and I think that the outcomes at a place like UCSF — even now that we're pretty busy, we have 10 patients on ventilators — have to be different than in a hospital in Houston or New York or now Miami where they might have 50."
He says that in speaking to his colleagues who went to New York to help out in overwhelmed hospitals in April, "It was just night and day, the level of franticness there" compared to what they had seen in the Bay Area. In New York, one nurse might be caring for seven or eight patients on ventilators, and here throughout the pandemic, ICU nurses have only had to care for one patient at a time, maybe two.
"When the system gets overwhelmed, that's when the wheels fall off," he says.
Dr. Wachter also pointed to the "tremendous amount of sharing" going on across the Bay Area medical community as being a great asset when it comes to treating severely ill COVID patients. He also said that UCSF Health had begun sharing PPE and testing kits, in additional to institutional knowledge, across its network of partner hospitals — which includes John Muir Health in the East Bay, Marin Health, and Dignity Hospitals.
"It's been gratifying to see some of the barriers between individual healthcare organizations break down... even when there are more competitive relationships between institutions. We and Stanford have helped each other out several times through this thing, same thing with Kaiser. These places all typically compete with each other but when this thing hit we all said, 'We're all in this together and let's work together.' So that's been a nice thing."
As for looking ahead to the next few months, despite growing case numbers in the city of San Francisco and in cities nearby including Oakland, Wachter says, "I'm pretty confident that we won't be New York in April or Houston or Miami today. I think the combination of good governance — everything from the public health officials to the mayors to the governor, who have basically called it like it is and have not been afraid of making hard choices — and citizens who seem to be following the prescription without that much blowback — at least where I go around in San Francisco you see people wearing masks, you don't see people saying 'Give me liberty or give me death' or pushing back and all that — people are scared, and they should be."
"We really got through the first three months with unbelievable gold stars," he says. "Even today, the fact that there have been 51 deaths [53 as of 7/21] total in San Francisco is a miracle. There was no good reason that San Francisco couldn't have been New York, and New York has had 25,000 deaths. Think about all the travel to Asia and to Europe. It's a pretty crowded city. We had every reason to believe that we could have gotten absolutely crushed. And we haven't and we're still not, but what scares me is we've gone from eight COVID patients at UCSF a month ago to 30, and a couple of people on ventilators to 10. But that is still orders of magnitude different from what I'm hearing from colleagues in Houston and Phoenix and Miami."
Despite some trepidation, he says he "really thinks we won't" see an overwhelming surge in SF, both because of city leadership and because the general population seems to get smart and hunker down when they need to.
"We've had a little bit of a wake-up call in San Francisco and California," Wachter says. "If we believed we were out of the woods, I think it's pretty clear that we are not. But I really do suspect that people will do the right thing and tamp it down."
Photo: Nicholas Bartos