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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 1 Dec 2020

      3/ …(like food handlers, police, firefighters, & teachers); and people at high risk for bad outcomes (people over 65 and those w/ preexisting conditions). One can make an argument for all of them to get vaccinated as soon as possible. Alas, we quickly run into a math problem…

      12 replies 53 retweets 787 likes
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    2. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      4/ …Namely, there won’t be enough vaccine for all these groups until spring. Thanks to @AriadneLabs, which did the legwork of removing duplicates (people who fit in multiple categories) to estimate the number of people in each of the possible Phase 1 groups. They add up to 144M.pic.twitter.com/JMZPGpQ1E1

      14 replies 166 retweets 1,126 likes
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    3. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      5/ And here’s my estimate of how many people in U.S. can be vaccinated at various times in 2021. It’s based on statements made by @Pfizer, @moderna_tx & Op Warp Speed, and assumes we have enough vaccine to vaccinate 20M by Jan 2021, 150M by June, & the entire country by December.pic.twitter.com/3zL6xu34Il

      33 replies 327 retweets 1,268 likes
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    4. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      6/ As the graph shows, I estimate it’ll be ~May before we get to all 144M of the high-priority folks. This timeline could shorten if additional vaccines are approved, and lengthen if there are rollout glitches. If demand is low, I assume we’ll just broaden the eligible groups.

      6 replies 80 retweets 800 likes
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    5. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      7/ We'll see how people react to the draft CDC priority list. I’m concerned these decisions will be contentious and – this being Covid – politicized, since it will raise matters of race, homelessness, incarceration, elders, healthcare workers...in other words, myriad hot buttons.

      6 replies 52 retweets 820 likes
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    6. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      8/ Herd immunity, which we should reach at ~70% vaccination, isn’t a magic on-off switch: as we close in on it, there will be fewer cases & fewer severe cases, since there'll be fewer people vulnerable to virus & fewer who'll get very sick if they do get Covid. So, even though…

      7 replies 61 retweets 737 likes
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    7. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      9/ …we might not reach 70% protected until Sept., the impact of widespread vaccination will be felt before that. Also, there are tens of millions who are already immune via prior infection (and millions more each week, sadly), which will shorten the path to herd immunity a bit.

      23 replies 59 retweets 784 likes
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    8. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      10/ Second issue that keeps me awake is the shot itself. We know that a fair # of folks will have symptoms – arm pain, fever, the blahs – that’ll last for 1-2 days. Seems a small price to pay for immunity to a terrible infection. But will this day of discomfort dissuade people…

      12 replies 52 retweets 754 likes
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    9. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      11/ …from getting their shots? Probably some, particularly in lower-risk groups – & we’ll need many to take shots to get to herd immunity. Analogous to the challenge of getting low-risk folks to wear masks & buy health insurance – many are too selfish to accept pain for others.

      15 replies 57 retweets 990 likes
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    10. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      12/ There will also be post-vaccination issues: when somebody has a post-vaccine fever, do we assume it’s the vaccine? Test for Covid if it lasts for >2 days? Should healthcare or essential workers come to work if they feel sick after their shot? We’ll need super-clear guidance.

      5 replies 56 retweets 897 likes
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      Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

      13/ 3rd concern: misinformation. Below: if we vaccinate 10M Americans, how many will develop a serious illness in 2 months after they got their shots. Answer: many thousands (& I’ve only included 4 illnesses, plus death). And the vaccines will have zero to do with any of them.pic.twitter.com/MvuXCI0MHG

      6:48 PM - 1 Dec 2020
      • 549 Retweets
      • 2,038 Likes
      • Christopher Albin-Brooks Christopher Reimers olnool2 alecia lynn eberhardt-smith Alberto Pascual Brian Malow Natasha WhySoSerious? Andrew Siladi
      49 replies 549 retweets 2,038 likes
        1. New conversation
        2. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          14/ Whether it’s anti-vaxxers or Russian bots, if somebody wants to turn every post-vaccine illness into a “See, I warned you” canard, there’ll be ample fodder. We’ll need a strong campaign to combat it, ie this https://tinyurl.com/y5ym92c5  Nothing I’ve seen in 2020 reassures me here.

          13 replies 147 retweets 1,202 likes
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        3. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          15/ I also worry about next 6 mths – will folks let their guards down because vaccines are coming? That would be a terrible mistake – while vaccines will protect the recipients, they’ll do little to protect others in the community until we reach herd immunity levels next summer.

          18 replies 102 retweets 982 likes
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        4. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          16/ Other worries: reviewing Biden’s appointees, from Covid task force to chief of staff Ron Klain, I have great confidence in their ability to pull off the logistics effectively, safely, & with minimum drama. But the first month of distribution will be done by Trump's team…

          9 replies 66 retweets 775 likes
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        5. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          17/ … and, while they’ve managed Operation Warp Speed well, the Trumpers seem poised to throw monkey-wrenches into the handoffs. I doubt this will screw the whole thing up, but even a few weeks’ delay will lead to millions of preventable cases & thousands of preventable deaths.

          7 replies 73 retweets 816 likes
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        6. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          18/ I worry about the impact of approved vaccines on ongoing trials. If we can get EUA’s for Pfizer, Moderna & Astra Zeneca, that’s probably a deep enough bench to vaccinate everybody in the U.S. But more would be better, particularly as we think about the vast worldwide needs.

          8 replies 37 retweets 640 likes
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        7. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          19/ It’s going to get tougher to do placebo-controlled vaccine trials.(Is it ethical to randomize to placebo once 95% effective vaccines are available?). We may be forced to evaluate new vaccine candidates based on their similarities to ones we know work, which is a bit dicey.

          14 replies 49 retweets 671 likes
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        8. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          20/ I worry about kids, since we haven’t even begun to test vaccines in them. But if we can reach herd immunity by vaccinating everybody else (incl. teachers), we may not need to obsess about reaching kids, particularly the youngest ones (who are at low risk for illness/spread).

          18 replies 57 retweets 706 likes
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        9. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          21/ As I’ve said, while I do worry about uptake, I don’t worry too much. Unlike childhood vaccines, many people know friends & family who were sickened or died from Covid, & everybody wants their lives back. I’ll bet that uptake is going to be quite high, esp. in hi-risk groups.

          2 replies 32 retweets 614 likes
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        10. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          22/ I do worry about keeping track of who got which vaccine. Who will remind a pt to come in for a 2nd dose, and be sure that the 2nd dose is the same brand as the first? If we had a national medical record (like the VA or the NHS), this would be easy. But in the U.S., it’s not.

          22 replies 81 retweets 931 likes
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        11. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          23/ I worry a bit about how long immunity lasts, but also not too much. We’re now pretty confident that immunity lasts for >1 yr. If it turns out that we need a booster in 2-3 years, that'll be a small price to pay to save tens of thousands of lives and a return to normal life.

          10 replies 52 retweets 754 likes
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        12. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          24/ So, yes, I do have worries. But let’s not lose sight of the fact that, on November 1st, we didn’t know for sure that we would have ANY effective vaccines. Today we have at least 2-3 highly effective ones, an impressive safety track record, and millions of doses ready to go.

          8 replies 60 retweets 887 likes
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        13. Bob Wachter‏Verified account @Bob_Wachter 1 Dec 2020

          25/ So yes I have worries, but the light at the end of the tunnel is increasingly bright. We just need to get there. How confident am I? First, I’ll get my shot the day I’m eligible. And I just booked a golf trip in Sept. Perhaps living dangerously, I didn’t ask about refunds.

          83 replies 94 retweets 2,228 likes
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        14. End of conversation

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