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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 25 Jul 2021

      Covid (@UCSF) Chronicles, Day 495 When I began my tweets 494d ago, it was before we had reliable local, US, or world data. So I focused on data from @UCSFHospitals. Today, we’re awash in data, yet I find my hospital's data still provides a unique lens into our situation. (1/20)

      97 replies 1,553 retweets 3,962 likes
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    2. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

      So today, a few data points from @UCSF, with my interpretation. They reinforce the case that the combo of Delta & relaxed behavior is leading to a powerful & worrisome upsurge that requires a change in approach. I knew things were bad, but it’s even worse than I thought. (2/20)

      10 replies 325 retweets 1,033 likes
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    3. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

      What’s particularly noteworthy about @UCSF experience is that it’s in a city w/ the nation’s highest vax rate. And cases are rising fast in our employees, of whom 93% are vaxxed. (Special thanks to Ralph Gonzales, Bob Kosnik & @saramurrayMD for some of the data.) Here goes:(3/20)

      5 replies 133 retweets 808 likes
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    4. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

      Let’s start w/ context: in SF, 69% of all people (76% >age 12) are fully vaccinated. (Vs CA, 52% of population; U.S. 50%.) So the surge in SF is especially sobering, since it indicates that we’ll need an immunity rate far higher than 70-75% to achieve “local” herd immunity.(4/20)

      24 replies 273 retweets 1,057 likes
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    5. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

      Let's look at hospitalizations. On June 1, we had one Covid patient in our ~700-bed @UCSFHospitals (we never quite got to zero); none were in the ICU. Today we have 28 hospitalized pts @UCSFHospitals: 15 on the floor & 13 in the ICU (7 on vents). A staggering increase. (5/20)pic.twitter.com/kdkD5V9L15

      80 replies 168 retweets 753 likes
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      Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

      I don’t have the vaccinated/unvaxxed breakdown for today's census, but it’s been running >90% unvaxxed in recent wks. When we do see vaccinated patients in the hospital, many are immunocompromised (a group in which vaccine’s effect is attenuated – we need a new approach). (6/20)

      9:30 PM - 25 Jul 2021
      • 138 Retweets
      • 887 Likes
      • Scott Miller 🔬🔭🧪🧬 Just Me Marney Indict 🍑 Trump Barr Pence Javanka 😡 McConnell Pro sanum pecuniam Nens jasperwillem🚜🏗🐟🚖 TJ, #FullMetaJacket Herman #NoMassInfection #LockdownNu Janny Bloemendal “Geniet van het leven ❤️”
      21 replies 138 retweets 887 likes
        1. New conversation
        2. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          My interpretation: even in a city with very high vaccination levels, serious cases have skyrocketed, mostly in unvaccinated people. Now think about what will happen in a region in which 60-70% of the population is unvaccinated, not SF’s 25-30%. Really scary stuff. (7/20)

          23 replies 222 retweets 1,064 likes
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        3. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          In April, I wrote @washingtonpost that “this is the most dangerous moment to be unvaccinated.” https://www.washingtonpost.com/opinions/2021/04/19/this-is-most-dangerous-moment-be-unvaccinated/ …. I was wrong – now is even MORE dangerous since Delta has taken over, caution's been thrown to the wind, and there’s far more virus around. (8/20)

          10 replies 205 retweets 982 likes
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        4. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          How much virus is around? Since early in the pandemic, I’ve used a piece of data available @UCSF (not publicly) to estimate the chances that a person who feels well in SF is carrying the virus. It’s our “asymptomatic test positivity rate” and it comes from the fact … (9/20)

          3 replies 61 retweets 577 likes
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        5. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          … that we test all our hospitalized & ED patients who have no Covid symptoms, as well as people undergoing surgeries or procedures like cardiac caths. That fraction was as low as about 0.1% in early June – which was pretty reassuring – it meant that the chances that…(10/20)

          3 replies 64 retweets 589 likes
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        6. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          … a person near you in a SF store had asymptomatic Covid was ~1-in-1000. Today, it’s 2.14%! So now that asymptomatic person has a ~1-in-50 chance of being positive. (And this % may be an underestimate since our pts are older than avg, a group with a higher vax rate). (11/20)pic.twitter.com/A6vvjFFUNf

          21 replies 196 retweets 955 likes
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        7. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          My interpretation: the risk of getting Covid is related to your vax status, whether you're taking steps to lower risk (masking, etc), & whether you’re exposed to the virus. Even in highly vaccinated SF, the odds of being exposed have gone up ~ 20-fold since June 1. (12/20)

          11 replies 300 retweets 1,015 likes
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        8. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          The point's been made that, if everybody’s vaccinated, all infections will be in vaccinated people (even if vax efficacy stays high). Among @UCSF students/employees, we’re not at 100% but we’re close: 32,550 of our 35,018 people (93%) are vaccinated. (Mandate starts 9/1.) (13/20)

          7 replies 51 retweets 644 likes
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        9. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          Given this vax rate, it shouldn’t surprise that 83% (77/93) of our July cases are in vaccinated folks. This DOESN’T mean vax isn't working – calculated efficacy from these data is 82%. We’d expect 422 cases in our vaccinated population, not 77, if the vaccine didn’t work. (14/20)pic.twitter.com/8fgEROE1aH

          40 replies 135 retweets 828 likes
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        10. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          At least @UCSF, we see no evidence that efficacy is waning: no case uptick in those vaxxed in Dec-Jan vs. more recently. And the vaccines are still >90% effective in preventing severe illness: only 1 these 77 breakthrough infections required a (brief) hospitalization. (15/20)

          11 replies 132 retweets 871 likes
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        11. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          (This always raises the question of why I, as a vaccinated person, still don't want to get a breakthrough case of Covid. If you're interested, I answered that one here: https://www.sfgate.com/bayarea/article/Why-unvaccinated-people-wear-mask-UCSF-Wachter-16327481.php … (16/20)

          16 replies 279 retweets 1,022 likes
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        12. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          Taken together, it’s clear that – even in highly vaccinated SF; it's also a city in which people remained pretty careful despite relaxed rules – we're experiencing a unmistakable surge. The vaccines work great, but, as we now appreciate, they don’t prevent all infections. (17/20)

          11 replies 95 retweets 739 likes
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        13. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          Even w/ surge, we’re not overwhelmed @UCSF, thanks to vaccines. Scary to consider regions where vulnerable % is much higher. I’m glad the U.S. is finally seeing an uptick in vaccination, but it won’t help for a month (since vax efficacy of dose 1 against Delta is so low).(18/20)

          6 replies 56 retweets 670 likes
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        14. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          As @DrLeanaWen convincingly argued @washingtonpost, it's time to add back restrictions, esp. indoor masking. https://www.washingtonpost.com/opinions/2021/07/20/pandemic-has-changed-course-again-biden-administration-urgently-needs-do-same/ … As for me, it’s back to double-masks indoors & N95s on planes. And sadly, that’s it for indoor dining for a while. None of this pleases me.(19/20)

          76 replies 447 retweets 1,648 likes
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        15. Bob Wachter‏Verified account @Bob_Wachter 25 Jul 2021

          Along with renewed restrictions, it’s clear that gentle persuasion did not achieve the vax rate we need to defeat Covid. Yes, the politics are hard, but dying is worse, as is re-tanking the economy. It’s time for vaccine mandates – nothing else gets us where we need to go.(20/20)

          162 replies 701 retweets 3,401 likes
          Show this thread
        16. End of conversation

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