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Bob_Wachter's profile
Bob Wachter
Bob Wachter
Bob Wachter
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@Bob_Wachter

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Bob WachterVerified account

@Bob_Wachter

Chair, UCSF Dept of Medicine. Career: What happens when a poli sci major becomes an academic physician. Author: "The Digital Doctor". Hubby/Dad/Golfer.

San Francisco
medicine.ucsf.edu
Joined January 2011

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    1. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

      1/ Covid (@UCSF) Chronicles, Day 101 This week, it felt like we entered a new phase of Covid. In March & April, we had panic, lockdowns, and surges… in certain places. The next phase (May-early June) saw cases & deaths plateau, we began opening up…and the seeds of complacency.

      38 replies 1,022 retweets 2,162 likes
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    2. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

      2/ And now we’ve entered another phase, with major surges in places that were spared the first time around. Given all we’ve learned in the past few months, it’s all very predictable, and it was at least partly preventable – which makes it especially sad.

      2 replies 96 retweets 590 likes
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    3. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

      3/ Predictable, because the best evidence says that the virus’s essential characteristics – its ease of transmission and virulence – are unchanged. And, unless you’re living in New York (where 15-20% of people have antibodies), the virus's targets – namely, us – are the same too.

      2 replies 44 retweets 339 likes
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    4. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

      4/ In mid-March, @tomaspueyo introduced a powerful metaphor to help guide our response to the threat of Covid: The Hammer & the Dance https://bit.ly/34Ryhsk . The required initial response to the coronavirus was analogous to a hammer: an unyielding, no-nonsense lockdown.

      4 replies 79 retweets 397 likes
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    5. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

      5/ Why? Because the alternative was apocalyptic: massive numbers of sick people overwhelming their healthcare systems – which lacked PPE, testing, ICUs, ventilators, treatments, staff, and experience. The result would have been deaths on a scale not seen since the 1918 pandemic.

      1 reply 31 retweets 256 likes
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    6. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

      6/ The Hammer mostly worked. Some unlucky places, like NYC, locked down late & suffered terribly – because the virus had been spreading, unnoticed, for weeks before anyone learned of its presence. They only became aware of it when critically ill patients swamped their ERs & ICUs.

      4 replies 27 retweets 258 likes
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      Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

      7/ This magnificent @nytimes visualization illustrates how SARS-Co-V-2 spread in those crucial first days https://nyti.ms/2YC3gqN . San Francisco locked down early and kept its curve flat; NY, Boston, Detroit, New Orleans weren’t as fortunate, or as well led, and were brutalized.

      7:41 PM - 26 Jun 2020
      • 77 Retweets
      • 411 Likes
      • Beez 🪄 Social Cali Nonsuch Sam Klein 🌄,🌜,🌌 Demoporgon - Take Up Your Bow: Set Down Your Worry Behrang Pakzad Amanda Montoya Sko Hayes Rosemary Joyce
      4 replies 77 retweets 411 likes
        1. New conversation
        2. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          8/ Some states, mostly red ones w/ libertarian leanings, called the virus’s bluff & got away with it. But they were more lucky than smart – escaping NY’s horrors by being less crowded, warmer in springtime (thus more folks outside), & less apt to have visitors from China & Italy.

          4 replies 44 retweets 337 likes
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        3. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          9/ If you were in these states (eg, TX, FL, & AZ), you may have seen Covid as a blue state-only problem – yet the disruptions to your economy & life felt very real. Moreover, neither federal nor state leaders spoke truthfully re: Covid’s risks or the need to distance and mask.

          3 replies 59 retweets 410 likes
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        4. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          10/ So, when Covid waned in NYC, it was easy – logical even – to think that the U.S. had survived the worst. With summer afoot, thoughts turned to opening up, getting out, saving the economy – and another crisis: the Floyd murder & the racial justice issues it painfully exposed.

          2 replies 24 retweets 275 likes
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        5. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          11/ In fact, we WERE in a better place – we've made enormous progress since March; I’ve listed some of it below. With strong leadership and citizens that believed the science on masking and distancing, we might have entered The Dance poised for success.pic.twitter.com/Vf7ZMGh29y

          4 replies 86 retweets 508 likes
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        6. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          12/ If we had gone to The Dance in the right way, we could have returned to quasi-normal version of life (eating outdoors, outdoor shopping, seeing friends) with a small rise in cases – and each case associated with lower mortality since we're much better prepared.

          2 replies 43 retweets 315 likes
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        7. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          13/ But that Dance would have included wearing masks & distancing. Unfortunately, too many people didn't follow this part of the playbook. The result was massive surges, mostly in states that dodged the first bullet, where people and leaders saw The Dance as a chance to party.pic.twitter.com/IwXEweDeay

          4 replies 87 retweets 451 likes
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        8. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          14/ This time around, lots of cases in young people (Fig: CA data) due to riskier behavior by them (and, one hopes, less risky behavior by high-risk elders). Young folks are less likely to get very sick and die, which partly accounts for fewer deaths than we'd expect... for now.pic.twitter.com/dC9rHpHxkd

          7 replies 66 retweets 301 likes
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        9. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          15/ But young folks with Covid are still a problem. First, a fair # will get very sick. More importantly, as Fauci said today https://bit.ly/2Vko2co , “you will infect someone else… and ultimately infect someone who is vulnerable… on chemotherapy, or a child who has leukemia…”

          3 replies 89 retweets 395 likes
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        10. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          16/ Another difference this time: places that got slammed in March are doing OK now – because their citizens know to be careful, leaders have learned the fatal risk of BS’ing, and, in some cases, their most vulnerable people have been infected and are immune (or, sadly, died).

          2 replies 37 retweets 287 likes
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        11. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          17/ But the overall U.S. picture is grim and getting grimmer. One key component of The Dance is iteration: close monitoring of the situation (testing, contact tracing, tracking ICU/hospital capacity) & a willingness to tighten things up – even to return to The Hammer if needed.pic.twitter.com/dxFjAuK6Mu

          2 replies 71 retweets 330 likes
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        12. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          18/ That's starting to happen. Today, @GavinNewsom urged surging Imperial County to return to shelter-in-place https://bit.ly/2COozxb  If other regions surge, I don't doubt they'll also be forced into SIP – in CA, & other states with leaders like @NYGovCuomo and @GovMikeDeWine.

          4 replies 46 retweets 278 likes
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        13. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          19/ Bay Area not too worrisome yet, but troubling trends. @UCSFHospitals: 14 pts, 4 on vents, both double two weeks ago (Fig L). In SF, case counts trending up, as are hospitalizations (Fig R) – latter mostly via transfers from other counties, including from San Quentin prison.pic.twitter.com/sBb8HsKdRW

          4 replies 58 retweets 273 likes
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        14. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          20/ In California more generally, the numbers are worse than in SF – not as bad as AZ, TX, FL, but bad –particularly (but not exclusively) in SoCal. Overall state figures: uptick in the effective transmission rate, % positive tests, and hospitalizations (Figs below).pic.twitter.com/kHms19Hsi4

          5 replies 66 retweets 290 likes
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        15. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          21/ With huge surges in TX, FL, and AZ, the question is: will @GregAbbott_TX, DeSantis, & Ducey – who have been both complacent & complicit – now make hard choices? Hard to know. Nice to see Abbott now supports masks and a pause in reopening https://bit.ly/3i8aw5q  Better late…

          6 replies 60 retweets 320 likes
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        16. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          22/ In Bay Area, leaders are closely watching series of indicators (Fig). I have no doubt that if we enter the red zone, they'll scale back our opening or return to SIP, accepting the blow to morale and the economy. It won’t be easy, but neither was the initial shutdown in March.pic.twitter.com/SFLoobokSX

          3 replies 44 retweets 283 likes
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        17. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          23/ Masking & distancing – combo is remarkably effective (Fig from https://bit.ly/2VosEOZ ). If there was clear and consistent messaging & widespread adherence, cases, hospitalizations & deaths would fall, we’d buy more time for better therapies & a vaccine. Then we'd be Dancing!pic.twitter.com/WRNHIu2apO

          13 replies 229 retweets 596 likes
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        18. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          24/ America is good at many things. But handling a pandemic – at least in our current political atmosphere – isn't one of them. In fact, we suck. We’re too individualistic, too spoiled, too vain, too partisan, and too willing to believe misinformation, conspiracies, or craziness.

          43 replies 1,014 retweets 3,146 likes
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        19. Bob Wachter‏Verified account @Bob_Wachter 26 Jun 2020

          25/ Many people have died, & many more will die...but we still have the power to save tens of thousands of lives if we – both leaders and citizens – make better choices. We can no longer claim we didn’t know. At this point, many Americans will die because not enough people cared.

          44 replies 345 retweets 1,384 likes
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        20. End of conversation

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