One of our local pandemic-era soothsayers, UCSF Medical School's Dr. Bob Wachter, may soon be dealing with his own bout of COVID-19 for the first time, in a story now increasingly familiar among those who have been extra-cautious and COVID-free up until now.
Dr. Wachter spoke to SFist early in the pandemic, way back in July 2020, about his optimism that San Francisco was going to escape the major, deadly waves of the virus that hit other major cities that year. He was right to be optimistic, with San Franciscans generally well masked and happy to be obedient to pandemic social-distancing rules, especially in that first year. At the time, the city had seen a total of 53 deaths, compared to the thousands who had already died in New York City, so we felt blessed.
Fast-forward almost two years, and Wachter has kept up his generally even-keeled and helpful presence on Twitter, analyzing the latest stats and studies as the story and advice about COVID has changed multiple times. Just last week, he was tweeting about his increased caution and re-masking amid a clear surge in cases locally.
San Francisco has remained a city with an extremely low COVID mortality rate — as of December we were the safest large city in the nation in terms of our per capita death rate, pre-Omicron. And now we remain there, still below triple digits, with about 99 deaths per 100,000 city residents — compared to 124 per 100,000 in Seattle, and 480 per 100,000 in New York City.
That is thanks to high uptake of vaccines and boosters, and the fact that really widespread infection here did not start until the Delta and Omicron waves, after vaccines were readily available.
Both Dr. Wachter and his wife are both double-boosted after their initial two-shot vaccines, but as we've learned, this does not entirely prevent infection — it just prevents severe infection and hospitalization in most cases.
And wouldn't you know it, as Wachter tells us in a Twitter thread, his wife tested positive on Sunday after traveling to a writing conference (she is a writer and went there to teach). And despite his own ongoing caution, the closest person in his life may have finally exposed him to the virus. Similar to his full-transparency mode in talking about his son's Omicron-wave infection this past winter, Wachter narrates the sequence of events and what he sees as the probability of his own infection, and that of two older friends whom he and his wife were visiting in Palm Springs before the positive test occurred.
His wife, Katie Hafner, who is 64 years old like him, flew back from the conference — where she was one of five instructors and 45 students — on Friday and the two met at SFO to fly to Palm Springs to visit friends for the weekend. Hafner was, he says, "hermetically sealed" on the flight now that they're maskless, wearing an N95 mask and pulling a hoodie over her face, which she was doing to protect herself.
On Friday, Katie flew to San Francisco airport, where we met for a flight to Palm Springs. That was the flight on which she was hermetically sealed – more to protect herself from others than vice versa. In Palm Springs, we stayed at the home of older friends and, given… (5/23) pic.twitter.com/FgiHxpi2Oo— Bob Wachter (@Bob_Wachter) May 9, 2022
She took precautions before making this visit, testing negative at SFO and then testing negative again on Saturday morning — and because the friends are older and more vulnerable to severe disease, Wachter says, "When we ate with them, we ate outdoors only." When they were alone, Wachter says he and his wife were unmasked, and they shared a bed both Friday and Saturday.
But then Hafner began feeling ill and tested positive for COVID on Sunday. Deciding not to put anyone at risk on the flight home, where largely everyone would be unmasked, they chose to rent a car and drive back to the Bay Area.
Wachter was still negative himself as of Monday, but he gives his own chance of becoming infected as about 50% — with the average attack rate for household contacts with Omicron being about 35%, and bed-sharing probably driving that higher.
… assess all contacts; one would assume that a bed sharer would have a higher rate than, say, the kids or roommate. On the other hand, she tested neg. on our 1st day together, so I probably was only exposed to her while infectious for ~12 hrs. I’m going with ~50-50 odds. (13/23)— Bob Wachter (@Bob_Wachter) May 9, 2022
Wachter says his wife feels "crummy," and she's upset about possibly having exposed their friends after attending the writing workshop, but he says, "I told her this level of Covid risk is the way the world will be for many years, and making choices like teaching at this course is something we need to learn to live with." (He estimates the probability of exposing the friends, after outdoor-only meals and one night of movie-watching in which his wife sat 20 feet away with an N95 on, at about 5-10%.)
Hafner is starting on Paxlovid today, and Wachter is choosing not to unless he tests positive — a recent Pfizer study found no real benefit to the drug when it comes to avoiding infection once exposed. Between this antiviral and the vaccines, Wachter says there shouldn't be much to worry about for either of them.
"If I turn positive in the next few days, my odds will be similarly favorable," he writes. "So – though getting Covid still sucks – there’s a lot to be grateful for."
Here's hoping he stays negative and that his wife gets through this just fine! But if he ends up with symptoms, it will be fascinating to hear how this local expert evaluates his own Omicron experience — which a great many San Franciscans are also having or just recently had themselves.