A panel of doctors at UCSF have been broadcasting their "Grand Rounds" for the world to watch and listen to since the early days of the pandemic, and their sober and insightful take on COVID-19 has been something of a comfort as San Francisco weathered multiple surges.
On this week's edition, the panel looked back on the past year, discussed the moment when they each realized this pandemic was going to upend the world, and what the next year may hold as more Americans get their vaccines.
For Dr. Peter Chin-Hong, professor of medicine in UCSF’s Division of Infectious Diseases, it was when the Grand Princess came to dock in Oakland. "Literally, it was on our shores," he said.
Dr. Kirsten Bibbins-Domingo, chair of UCSF’s Department of Epidemiology and Biostatistics, pointed to the first cancellation of an NBA game. And epidemiology professor Dr. George Rutherford said it was when "the first [DNA] sequence came out and you could tell that it was a beta coronavirus [like SARS and MERS]. I thought ‘ruh-roh,’ in the immortal words of Astro."
Dr. Bob Wachter, whom SFist spoke to last summer as the second big surge was occurring, spoke during the Grand Rounds and in a Twitter thread this week about the reasons behind San Francisco's remarkable success in keeping COVID patients alive.
"SF may well reach the end of Covid [with less than] 500 deaths," he writes. "If [the] U.S. had SF’s per capita death rate, we would have suffered 162,000 deaths, instead of 526,000."
San Francisco's per-capita mortality rate from COVID-19 stands at 49 per 100,000 people. Compare that to New York's rate of 354 per 100,000, or Los Angeles' rate of 220 per 100,000. The New York Times ran a piece this week talking about how Seattle was the all-star among cities with a mortality rate of 64 per 100,000 for its metro area — but it's all in how you do the math, and if we do a mortality rate comparison of just the two counties proper, San Francisco's mortality rate has been 23% lower than Seattle's. (1,437 have died in King County, Washington, which has a population of 2.25 million, giving Seattle a mortality rate of 64/100,000.)
Wachter and others cite San Francisco's world-class hospitals and the relatively un-crowdedness of our ICUs even during last year's surges, which allowed doctors and nurses to provide more attentive care to each COVID patient.
But the reasons for SF's low mortality are "multifactorial," as Bibbins-Domingo noted in the Thursday talk — and, like Seattle, San Francisco boasts a fairly healthy population with a high prevalence of workers who can do their jobs from home. And she noted that there have been disparities here as there were elsewhere in the country — it was "pretty clear" there were going to be racial and socio-economic disparities in how the pandemic impacted San Franciscans, she said, when early on "all the patients we were seeing [at SF General] with COVID were Latino patients."
As for whether we should be fearful of the variants, multiple experts have come forward this week to suggest the media has overhyped the possibilities for disaster.
Dr. Chin-Hong was the most pessimistic of the UCSF bunch, in terms of what the variants will mean around the globe. But when he was asked by one of the other doctors how much he should be worried about needing a third vaccine shot, Chin-Hong replied, "Zero."
"The quickening pace of the vaccine rollout means that, while we’re still far from herd immunity, we now have enough population immunity to exert a significant downward pressure on cases," Wachter said. He estimates that combined with people who have previously had COVID and aren't yet vaccinated, the relatively immune population is now 60% of American adults, and 45% of the population as a whole.
And all the doctors say that the decision by Texas Governor Greg Abbott to lift the mask mandate statewide is unforgivable and ridiculously dumb. We'll see if it results in a near immediate uptick in cases there.