March 30, 2020

Covid and the Dept. of Medicine: A Brief Message

Dear Colleagues:

I am always proud to be a part of this remarkable department, but the past couple of weeks have taken that pride to a new level. From our clinicians, caring for patients with a disease they’ve never seen before, or demonstrating superhuman flexibility as we reconfigure nearly everything we do – to our researchers, scrambling for insights into the prevention and treatment of Covid-19, or managing a research enterprise that has been turned upside down by unprecedented constraints – to our educators and trainees, developing novel ways to meet our educational mission in the face of massive disruptions – to our staff, managing all of this while building and integrating novel processes and technologies… it is truly awesome. Through it all, I’ve seen nothing but grace, integrity, courage, commitment, empathy, and excellence.

Moreover, many of the command center and work area leaders at all of our sites are DOM members, and they’ve somehow managed to make complex and rapid-fire decisions under conditions of overwhelming uncertainty, while displaying that mix of confidence and humility that breeds trust. They’ve also been transparent about what we know, and don’t, and have been willing to shift directions as conditions change (which they do constantly). I’m quite certain that none of them have slept for 3 weeks – when this thing is over, they really deserve a day off.

A particular shout out to the members of our ID divisions – you are the new rock stars of medicine! 

I’m writing to provide a short general update and thanks… although – as I said two weeks ago – I want everyone to focus on the information coming out of the central command centers and on the more granular updates from your divisions, programs, labs, and practices. If you want a little more of my take on things, I’ve been tweeting every night at Covid (@ucsf) Chronicles, and the tweets have managed to garner a decent-size following. If you want to check it out, today’s tweets are here: https://twitter.com/Bob_Wachter/status/1244812876054843392

The scenes from New York are horrifying and heart-rending, and they are being repeated (or may soon be repeated) around the country and the world. Words don’t do justice to emotions at a time like this. Two days ago, I received this note from a former UCSF trainee, now working in an academic medical center not unlike ours in the New York area:

“… things are incredibly dire. As of today, we have filled all expanded beds and are fully utilizing all available ventilators… We have also deputized the full workforce to serve as adult hospitalists, including ophthalmologists, radiologists, and pediatricians. It is truly terrifying.”

Our hearts go out to our colleagues and their patients in New York and the other hard hit areas. And I’m sure most of you have friends and family in these regions as well, as I do. Let’s hope that things come under control soon.

Though we’re far from out of the woods, San Francisco is one of the bright spots in the pandemic, and a vivid demonstration of the value of forceful public health maneuvers. On March 10th, SF and New York had about the same number of Covid cases. As of today, there have been 374 confirmed Covid cases in San Francisco and five deaths. In contrast, New York has had approximately 38,000 cases and 914 deaths. While the reasons for this are multifactorial (and some of it is undoubtedly luck, which can change), we owe much of our good fortune to a series of wise choices by our political and corporate leaders, and our leaders at UCSF, all of whom embraced shelter-in-place mandates and social distancing recommendations early and aggressively.

This relatively low patient volume in San Francisco is reflected at all of our clinical sites, where we prepared for the worst, but, thankfully, are not seeing it, at least not yet. This is not to minimize the hardship on the patients and families who have been severely ill with the disease, or our clinicians who have been caring for them. But it is to say that we have weathered the initial part of this storm and can – without lowering our guard one bit – begin to let a bit of optimism creep into our swirl of emotions.

The rhythms of the department go on in the midst of Covid. I was pleased to see that we bumped up a notch on the US News ranking of departments of medicine, now to #2 (behind Hopkins). We continue to do amazing things across all of our missions, even though we’re doing them increasingly through Zoom or a face mask. When (not if) we get back to normal, we will find ourselves more resilient and nimble – this experience is teaching us the value of working together, of using technology effectively, and of making the best possible decisions in the face of uncertainty and just getting on with things. Let’s hope the good stuff endures, as we view the bad parts of this scourge through the rear view mirror.

Today is National Doctors’ Day, so I’ll end by saying thank you to the 1,200 or so doctors that I’m proud to call colleagues in the Department of Medicine. This ordeal is an organizational stress test, and I couldn’t be more amazed by what you do and how you do it. And thanks as well to the hundreds of talented DOM staff that allow all of us to do our work.

Be well and stay safe.

Bob
 

Robert M. Wachter, MD
Professor and Chair, UCSF Department of Medicine
Lynne and Marc Benioff Endowed Chair in Hospital Medicine
Holly Smith Distinguished Professor in Science and Medicine