[D66] Notes from UCSF Expert panel - March 10

[A.OUT]

  Notes from UCSF Expert panel - March 10

By
Dr. Jordan Shlain, M.D.
linkedin.com
7 min
View Original 
<https://getpocket.com/redirect?url=https%3A%2F%2Fwww.linkedin.com%2Fpulse%2Fnotes-from-ucsf-expert-panel-march-10-dr-jordan-shlain-m-d->

Published on March 12, 2020

*University of California, San Francisco BioHub Panel on COVID-19*

  * *Panelists*
  * Joe DeRisi: UCSF’s top infectious disease researcher. Co-president
    of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley /
    Stanford). Co-inventor of the chip used in SARS epidemic.
  * Emily Crawford: COVID task force director. Focused on diagnostics
  * Cristina Tato: Rapid Response Director. Immunologist.
  * Patrick Ayescue: Leading outbreak response and surveillance.
    Epidemiologist.
  * Chaz Langelier: UCSF Infectious Disease doc

What’s below are essentially direct quotes from the panelists. I 
bracketed the few things that are not quotes.

  * *Top takeaways *
  * *At this point, we are past containment. Containment is basically
    futile. Our containment efforts won’t reduce the number who get
    infected in the US. *
  * *Now we’re just trying to slow the spread, to help healthcare
    providers deal with the demand peak. In other words, the goal of
    containment is to "flatten the curve", to lower the peak of the
    surge of demand that will hit healthcare providers. And to buy time,
    in hopes a drug can be developed. *
  * *How many in the community already have the virus? No one knows.*
  * *We are moving from containment to care. *
  * *We in the US are currently where at where Italy was a week ago. We
    see nothing to say we will be substantially different.*
  * *40-70% of the US population will be infected over the next 12-18
    months. After that level you can start to get herd immunity. Unlike
    flu this is entirely novel to humans, so there is no latent immunity
    in the global population.*
  * *[We used their numbers to work out a guesstimate of deaths—
    indicating about 1.5 million Americans may die. The panelists did
    not disagree with our estimate. This compares to seasonal flu’s
    average of 50K Americans per year. *Assume 50% of US population,
    that’s 160M people infected. With 1% mortality rate that's 1.6M
    Americans die over the next 12-18 months.*] *
  * *The fatality rate is in the range of 10X flu.*
  * *This assumes no drug is found effective and made available.*
  * *The death rate varies hugely by age. Over age 80 the mortality rate
    could be 10-15%. [*See chart by age Signe found online, attached at
    bottom.] **
  * *Don’t know whether COVID-19 is seasonal but if is and subsides over
    the summer, it is likely to roar back in fall as the 1918 flu did*
  * *I can only tell you two things definitively. Definitively it’s
    going to get worse before it gets better. And we'll be dealing with
    this for the next year at least. Our lives are going to look
    different for the next year.*
  * *What should we do now? What are you doing for your family?*
  * *Appears one can be infectious before being symptomatic. We don’t
    know how infectious before symptomatic, but know that highest level
    of virus prevalence coincides with symptoms. We currently think
    folks are infectious 2 days before through 14 days after onset of
    symptoms (T-2 to T+14 onset).*
  * How long does the virus last?
  * On surfaces, best guess is 4-20 hours depending on surface type
    (maybe a few days) but still no consensus on this
  * The virus is very susceptible to common anti-bacterial cleaning
    agents: bleach, hydrogen peroxide, alcohol-based.
  * Avoid concerts, movies, crowded places.
  * We have cancelled business travel.
  * Do the basic hygiene, eg hand washing and avoiding touching face.
  * *Stockpile your critical prescription medications*. Many pharma
    supply chains run through China. Pharma companies usually hold 2-3
    months of raw materials, so may run out given the disruption in
    China’s manufacturing.
  * Pneumonia shot might be helpful. Not preventative of COVID-19, but
    reduces your chance of being weakened, which makes COVID-19 more
    dangerous.
  * Get a flu shot next fall. Not preventative of COVID-19, but reduces
    your chance of being weakened, which makes COVID-19 more dangerous.
  * *We would say “Anyone over 60 stay at home unless it’s critical”.
    *CDC toyed with idea of saying anyone over 60 not travel on
    commercial airlines.
  * *We at UCSF are moving our “at-risk” parents back from nursing
    homes, etc. to their own homes*. Then are not letting them out of
    the house. The other members of the family are washing hands the
    moment they come in.
  * Three routes of infection
  * Hand to mouth / face
  * Aerosol transmission
  * Fecal oral route
  * *What if someone is sick?*
  * *If someone gets sick, have them stay home and socially isolate.
    There is very little you can do at a hospital that you couldn’t do
    at home. Most cases are mild. But if they are old or have lung or
    cardio-vascular problems, read on.*
  * If someone gets quite sick who is old (70+) or with lung or
    cardio-vascular problems, take them to the ER.
  * There is no accepted treatment for COVID-19. The hospital will give
    supportive care (eg IV fluids, oxygen) to help you stay alive while
    your body fights the disease. ie to prevent sepsis.
  * If someone gets sick who is high risk (eg is both old and has
    lung/cardio-vascular problems), you can try to get them enrolled for
    “compassionate use" of Remdesivir, a drug that is in clinical trial
    at San Francisco General and UCSF, and in China. Need to find a doc
    there in order to ask to enroll. Remdesivir is an anti-viral from
    Gilead that showed effectiveness against MERS in primates and is
    being tried against COVID-19. If the trials succeed it might be
    available for next winter as production scales up far faster for
    drugs than for vaccines. [More
    <https://news.bloomberglaw.com/pharma-and-life-sciences/hundreds-of-corona-patients-allowed-to-try-gileads-ebola-drug>
    I found online.]
  * Why is the fatality rate much higher for older adults?
  * Your immune system declines past age 50
  * Fatality rate tracks closely with “co-morbidity”, ie the presence of
    other conditions that compromise the patient’s hearth, especially
    respiratory or cardio-vascular illness. These conditions are higher
    in older adults.
  * Risk of pneumonia is higher in older adults.
  * *What about testing to know if someone has COVID-19? *
  * Bottom line, there is not enough testing capacity to be broadly
    useful. Here’s why.
  * Currently, there is no way to determine what a person has other than
    a PCR test. No other test can yet distinguish "COVID-19 from flu or
    from the other dozen respiratory bugs that are circulating”.
  * A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA.
    However they still don’t have confidence in the test’s specificity,
    ie they don’t know the rate of false negatives.
  * The PCR test requires kits with reagents and requires clinical labs
    to process the kits.
  * While the kits are becoming available, the lab capacity is not growing.
  * The leading clinical lab firms, Quest and Labcore have capacity to
    process 1000 kits per day. For the nation.
  * Expanding processing capacity takes “time, space, and equipment.”
    And certification. ie it won’t happen soon.
  * UCSF and UCBerkeley have donated their research labs to process
    kits. But each has capacity to process only 20-40 kits per day. And
    are not clinically certified.
  * Novel test methods are on the horizon, but not here now and won’t be
    at any scale to be useful for the present danger.
  * *How well is society preparing for the impact?*
  * Local hospitals are adding capacity as we speak. UCSF’s Parnassus
    campus has erected “triage tents” in a parking lot. They have
    converted a ward to “negative pressure” which is needed to contain
    the virus. They are considering re-opening the shuttered Mt Zion
    facility.
  * If COVID-19 affected children then we would be seeing mass
    departures of families from cities. But thankfully now we know that
    kids are not affected.
  * School closures are one the biggest societal impacts. We need to be
    thoughtful before we close schools, especially elementary schools
    because of the knock-on effects. If elementary kids are not in
    school then some hospital staff can’t come to work, which decreases
    hospital capacity at a time of surging demand for hospital services.
  * Public Health systems are prepared to deal with short-term outbreaks
    that last for weeks, like an outbreak of meningitis. They do not
    have the capacity to sustain for outbreaks that last for months.
    Other solutions will have to be found.
  * What will we do to handle behavior changes that can last for months?
  * Many employees will need to make accommodations for elderly parents
    and those with underlying conditions and immune-suppressed.
  * Kids home due to school closures
  * [Dr. DeRisi had to leave the meeting for a call with the governor’s
    office. When he returned we asked what the call covered.] The
    epidemiological models the state is using to track and trigger
    action. The state is planning at what point they will take certain
    actions. ie what will trigger an order to cease any gatherings of
    over 1000 people.
  * *Where do you find reliable news?*
  * The John Hopkins Center for Health Security site
    <http://www.centerforhealthsecurity.org/resources/COVID-19/>. Which
    posts daily updates. The site says you can sign up to receive a
    daily newsletter on COVID-19 by email. [I tried and the page times
    out due to high demand. After three more tries I was successful in
    registering for the newsletter.]
  * The New York Times is good on scientific accuracy.
  *

  * *Observations on China*
  * Unlike during SARS, China’s scientists are publishing openly and
    accurately on COVID-19.
  * While China’s early reports on incidence were clearly low, that
    seems to trace to their data management systems being overwhelmed,
    not to any bad intent.
  * *Wuhan has 4.3 beds per thousand while US has 2.8 beds per
    thousand.* Wuhan built 2 additional hospitals in 2 weeks. Even so,
    most patients were sent to gymnasiums to sleep on cots.
  * Early on no one had info on COVID-19. So China reacted in a way
    unique modern history, except in wartime.
  * *Every few years there seems another: SARS, Ebola, MERS, H1N1,
    COVID-19. Growing strains of antibiotic resistant bacteria. Are we
    in the twilight of a century of medicine’s great triumph over
    infectious disease?*
  * "We’ve been in a back and forth battle against viruses for a million
    years."
  * But it would sure help if every country would shut down their wet
    markets.
  * As with many things, the worst impact of COVID-19 will likely be in
    the countries with the least resources, eg Africa. See article on
    Wired magazine on sequencing of virus from Cambodia.


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