<html>
<head>
<meta http-equiv="content-type" content="text/html; charset=UTF-8">
</head>
<body>
<header class="css-d92687">
<h1 class="css-19v093x">Notes from UCSF Expert panel - March 10</h1>
<div class="css-1x1jxeu">
<div class="css-7kp13n">By</div>
<div class="css-7ol5x1"><span class="css-1q5ec3n">Dr. Jordan
Shlain, M.D.</span></div>
<div class="css-8rl9b7">linkedin.com</div>
<div class="css-zskk6u">7 min</div>
</div>
<div class="css-1890bmp"><a
href="https://getpocket.com/redirect?url=https%3A%2F%2Fwww.linkedin.com%2Fpulse%2Fnotes-from-ucsf-expert-panel-march-10-dr-jordan-shlain-m-d-"
target="_blank" class="css-1neb7j1">View Original</a></div>
</header>
<div class="css-429vn2">
<div role="main" class="css-yt2q7e">
<div id="RIL_container">
<div id="RIL_body">
<div id="RIL_less">
<div lang="en">
<header><time>Published on March 12, 2020</time>
<div>
<div
data-impression-id="author_mini-profile_mini-card">
<section></section>
</div>
</div>
</header>
<section
data-redirect-url="https://www.linkedin.com/uas/login?session_redirect=https%3A%2F%2Fwww%2Elinkedin%2Ecom%2Fpulse%2Fnotes-from-ucsf-expert-panel-march-10-dr-jordan-shlain-m-d-">
<p><strong>University of California, San Francisco
BioHub Panel on COVID-19</strong></p>
<ul>
<li><strong>Panelists</strong></li>
<li>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.</li>
<li>Emily Crawford: COVID task force director.
Focused on diagnostics</li>
<li>Cristina Tato: Rapid Response Director.
Immunologist. </li>
<li>Patrick Ayescue: Leading outbreak response and
surveillance. Epidemiologist. </li>
<li>Chaz Langelier: UCSF Infectious Disease doc</li>
</ul>
<p>What’s below are essentially direct quotes from the
panelists. I bracketed the few things that are not
quotes.</p>
<ul>
<li><strong>Top takeaways </strong></li>
<li><strong>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. </strong></li>
<li><strong>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. </strong></li>
<li><strong>How many in the community already have
the virus? No one knows.</strong></li>
<li><strong>We are moving from containment to care.
</strong></li>
<li><strong>We in the US are currently where at
where Italy was a week ago. We see nothing to
say we will be substantially different.</strong></li>
<li><strong>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.</strong></li>
<li><strong>[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. </strong>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.<strong>] </strong></li>
<li><strong>The fatality rate is in the range of 10X
flu.</strong></li>
<li><strong>This assumes no drug is found effective
and made available.</strong></li>
<li><strong>The death rate varies hugely by age.
Over age 80 the mortality rate could be 10-15%.
[</strong>See chart by age Signe found online,
attached at bottom.] <strong> </strong></li>
<li><strong>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</strong></li>
<li><strong>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.</strong></li>
<li><strong>What should we do now? What are you
doing for your family?</strong></li>
<li><strong>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).</strong></li>
<li>How long does the virus last?</li>
<li>On surfaces, best guess is 4-20 hours depending
on surface type (maybe a few days) but still no
consensus on this</li>
<li>The virus is very susceptible to common
anti-bacterial cleaning agents: bleach, hydrogen
peroxide, alcohol-based.</li>
<li>Avoid concerts, movies, crowded places.</li>
<li>We have cancelled business travel. </li>
<li>Do the basic hygiene, eg hand washing and
avoiding touching face.</li>
<li><strong>Stockpile your critical prescription
medications</strong>. 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. </li>
<li>Pneumonia shot might be helpful. Not
preventative of COVID-19, but reduces your chance
of being weakened, which makes COVID-19 more
dangerous.</li>
<li>Get a flu shot next fall. Not preventative of
COVID-19, but reduces your chance of being
weakened, which makes COVID-19 more dangerous.</li>
<li><strong>We would say “Anyone over 60 stay at
home unless it’s critical”. </strong>CDC toyed
with idea of saying anyone over 60 not travel on
commercial airlines.</li>
<li><strong>We at UCSF are moving our “at-risk”
parents back from nursing homes, etc. to their
own homes</strong>. Then are not letting them
out of the house. The other members of the family
are washing hands the moment they come in.</li>
<li>Three routes of infection</li>
<li>Hand to mouth / face</li>
<li>Aerosol transmission</li>
<li>Fecal oral route</li>
<li><strong>What if someone is sick?</strong></li>
<li><strong>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.</strong></li>
<li>If someone gets quite sick who is old (70+) or
with lung or cardio-vascular problems, take them
to the ER.</li>
<li>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.</li>
<li>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. [<a
rel="nofollow noopener"
href="https://news.bloomberglaw.com/pharma-and-life-sciences/hundreds-of-corona-patients-allowed-to-try-gileads-ebola-drug">More</a>
I found online.]</li>
<li>Why is the fatality rate much higher for older
adults?</li>
<li>Your immune system declines past age 50</li>
<li>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. </li>
<li>Risk of pneumonia is higher in older adults. </li>
<li><strong>What about testing to know if someone
has COVID-19? </strong> </li>
<li>Bottom line, there is not enough testing
capacity to be broadly useful. Here’s why.</li>
<li>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”.</li>
<li>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. </li>
<li>The PCR test requires kits with reagents and
requires clinical labs to process the kits. </li>
<li>While the kits are becoming available, the lab
capacity is not growing. </li>
<li>The leading clinical lab firms, Quest and
Labcore have capacity to process 1000 kits per
day. For the nation.</li>
<li>Expanding processing capacity takes “time,
space, and equipment.” And certification. ie it
won’t happen soon.</li>
<li>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.</li>
<li>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.</li>
<li><strong>How well is society preparing for the
impact?</strong></li>
<li>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.</li>
<li>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.</li>
<li>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. </li>
<li>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.</li>
<li>What will we do to handle behavior changes that
can last for months?</li>
<li>Many employees will need to make accommodations
for elderly parents and those with underlying
conditions and immune-suppressed.</li>
<li>Kids home due to school closures</li>
<li>[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.
</li>
<li><strong>Where do you find reliable news?</strong></li>
<li>The John Hopkins Center for Health Security <a
rel="nofollow noopener"
href="http://www.centerforhealthsecurity.org/resources/COVID-19/">site</a>.
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.] </li>
<li>The New York Times is good on scientific
accuracy.</li>
<li><br>
</li>
<li><strong>Observations on China</strong></li>
<li>Unlike during SARS, China’s scientists are
publishing openly and accurately on COVID-19. </li>
<li>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.</li>
<li><strong>Wuhan has 4.3 beds per thousand while US
has 2.8 beds per thousand.</strong> Wuhan built
2 additional hospitals in 2 weeks. Even so, most
patients were sent to gymnasiums to sleep on cots.
</li>
<li>Early on no one had info on COVID-19. So China
reacted in a way unique modern history, except in
wartime. </li>
<li><strong>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?</strong></li>
<li>"We’ve been in a back and forth battle against
viruses for a million years." </li>
<li>But it would sure help if every country would
shut down their wet markets. </li>
<li>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.</li>
</ul>
</section>
</div>
</div>
</div>
</div>
</div>
</div>
<br>
</body>
</html>