WEBVTT - Signs and Symptoms of COVID-19 0:00:15.356 --> 0:00:22.916 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:22.916 --> 0:00:26.236 where we explored the stories behind the stories in the news. 0:00:26.836 --> 0:00:28.876 And if I sound a little different on this episode, 0:00:29.036 --> 0:00:32.876 it's because, in deference to Corona norms, I'm actually recording 0:00:32.916 --> 0:00:36.996 it myself without the aid of our excellent sound engineers. 0:00:38.436 --> 0:00:41.196 Right now, I think the most immediate question on my mind, 0:00:41.236 --> 0:00:43.636 and it may be on your mind too, is how 0:00:43.676 --> 0:00:46.436 do I know if my symptoms were those of one 0:00:46.476 --> 0:00:51.236 of my loved ones actually correspond to coronavirus. There's tons 0:00:51.236 --> 0:00:53.796 of information going around on the Internet, and it's a 0:00:53.836 --> 0:00:58.196 little hard to know what's reliable and what isn't. I 0:00:58.236 --> 0:01:00.516 thought it would be useful to talk to a frontline 0:01:00.596 --> 0:01:04.836 primary care physician who's actually in charge of programs where 0:01:04.916 --> 0:01:08.076 lots and lots of doctors are seeing patients who are 0:01:08.116 --> 0:01:13.276 presenting with coronavirus. So I called doctor Rebecca Berman, the 0:01:13.356 --> 0:01:17.556 program director at the University of California, San Francisco's Internal 0:01:17.596 --> 0:01:21.596 Medicine Residency program. That means she's the person in charge 0:01:21.596 --> 0:01:24.636 of training the actual doctors who are going to become 0:01:25.156 --> 0:01:29.316 residents in internal medicine. An internal medicine means in a hospital, 0:01:29.636 --> 0:01:34.196 the main job of seeing patients. I asked Rebecca about 0:01:34.196 --> 0:01:38.156 how we should be thinking about symptoms, which symptoms actually 0:01:38.196 --> 0:01:40.156 tell us that we should go to the hospital, what 0:01:40.196 --> 0:01:42.156 we should do if we're not going to the hospital, 0:01:42.476 --> 0:01:47.756 and how preparedness is going inside UCSF. Rebecca, you are 0:01:47.836 --> 0:01:52.836 literally on the front lines facing the current coronavirus situation. 0:01:53.516 --> 0:01:56.836 I wonder if you could start us off by telling 0:01:56.916 --> 0:02:01.716 us how you and your physicians in your training program 0:02:01.756 --> 0:02:05.716 are doing the first line diagnosis. When someone comes in 0:02:05.756 --> 0:02:08.796 to the hospital and says, I'm feeling lousy, I think 0:02:08.796 --> 0:02:12.476 I have coronavirus. What algorithm are you guys using? Well, 0:02:12.516 --> 0:02:15.276 I think something that's challenging about coronavirus is that for 0:02:15.356 --> 0:02:18.636 a lot of people, they functionally have cold symptoms. So 0:02:18.676 --> 0:02:21.356 we're all kind of worried. I have chronic allergies, and 0:02:21.396 --> 0:02:24.116 it makes me worried constantly, like is this running nose 0:02:24.156 --> 0:02:27.116 different than the normal running nose that I always have? 0:02:27.716 --> 0:02:30.916 And so I think for us in the hospital, the 0:02:30.996 --> 0:02:33.396 things we're most worried about, and the people were actually 0:02:33.436 --> 0:02:36.236 testing are those who seem sick, those who are having 0:02:36.276 --> 0:02:41.236 shortness of breath or fever. The presenting symptoms can just 0:02:41.276 --> 0:02:43.916 be cough and running nose, and then some people is asymptomatic. 0:02:43.956 --> 0:02:46.716 So we're also seeing our primary care clinics kind of 0:02:46.756 --> 0:02:49.356 flooded with people who are worried and want testing. But 0:02:49.476 --> 0:02:52.156 right now, given the limited number of test kits that 0:02:52.196 --> 0:02:55.636 we have, we're trying to encourage people not to come 0:02:55.636 --> 0:03:01.196 in if they aren't actively feeling feverish and short of breath, 0:03:01.676 --> 0:03:06.556 because simply testing someone who's not that sick but symptomatic 0:03:06.636 --> 0:03:08.356 is going to result in the same treatment, which is 0:03:08.356 --> 0:03:11.396 to tell them to self quarantine at home for fourteen days. 0:03:11.756 --> 0:03:13.836 It is really hard for people to be stuck at 0:03:13.876 --> 0:03:16.276 home right now, although frankly here in San Francisco most 0:03:16.276 --> 0:03:19.116 people are stuck at home right now, but that is 0:03:19.156 --> 0:03:21.996 what we are doing. In terms of diagnosis. At this point, 0:03:22.076 --> 0:03:25.196 we are trying to triage. We have a COVID nineteen 0:03:25.396 --> 0:03:28.596 infectious disease doctor on call at all times, and we 0:03:28.716 --> 0:03:32.796 run cases by them in order to choose who needs testing. 0:03:33.796 --> 0:03:36.916 I completely understand that from the hospital's perspective, you don't 0:03:36.916 --> 0:03:39.516 want to be flooded with people who might be positive 0:03:39.996 --> 0:03:42.796 but can't at present be treated, So it makes sense 0:03:42.836 --> 0:03:46.236 to say only come in if you have the shortness 0:03:46.316 --> 0:03:49.716 of breath and the fever. In terms of people's own 0:03:49.756 --> 0:03:52.356 self diagnosis at home, though, however, there's sort of like 0:03:52.636 --> 0:03:56.836 a plethora of information out there, much of it surely inaccurate. 0:03:56.836 --> 0:03:59.556 And I've heard all kinds of things, you know, people saying, well, 0:03:59.556 --> 0:04:01.676 you know, if you have a running nose, that's not it, 0:04:01.756 --> 0:04:03.756 and others saying, well, if you have a sore throat, 0:04:03.796 --> 0:04:05.676 that's it, but if you're coughing, that's not it. I mean, 0:04:05.836 --> 0:04:07.836 I guess what I'm wondering is, first, just at the 0:04:07.916 --> 0:04:11.036 very basic level of the sis, is this all ridiculous? 0:04:11.036 --> 0:04:13.236 I mean, is it? In the end, the full range 0:04:13.236 --> 0:04:17.396 of cold like symptoms could be indicators of COVID nineteen. Well, 0:04:17.436 --> 0:04:20.796 I think what's hard is in most people, cough is 0:04:20.796 --> 0:04:24.396 the presenting symptom, often a dry cough, but sometimes productive. 0:04:24.796 --> 0:04:27.276 It's true that running nose makes it less likely, but 0:04:27.316 --> 0:04:29.636 it doesn't rule it out. So about fifteen percent of 0:04:29.676 --> 0:04:34.076 people with coronavirus are going to have runny nose. So 0:04:34.396 --> 0:04:35.956 if you have a running nose, it can make you 0:04:35.956 --> 0:04:38.116 feel a little better, but it doesn't mean definitely you 0:04:38.156 --> 0:04:41.996 do not have it. The guidelines that are health occupational 0:04:41.996 --> 0:04:45.276 health is giving us to help us as healthcare workers 0:04:45.276 --> 0:04:47.036 know when not to come in. Are saying, if you 0:04:47.036 --> 0:04:49.676 have two of those symptoms like sore throat and cough 0:04:49.836 --> 0:04:54.116 or cough and runny nose, and they're getting worse over 0:04:54.236 --> 0:04:57.116 two days, than you should stay home. And so I 0:04:57.156 --> 0:04:59.876 think using those guidelines more widely as a wise one. 0:04:59.956 --> 0:05:02.636 I think, did you say fifteen percent of the people 0:05:03.116 --> 0:05:06.916 who are positive for the virus do have a running nose. 0:05:06.916 --> 0:05:08.516 So the running nose is not a guarante. It's not 0:05:08.756 --> 0:05:11.076 necessary an indicator that you have it, but it's certainly 0:05:11.076 --> 0:05:13.356 not a reason to think you don't have it exactly. 0:05:13.396 --> 0:05:15.356 Then what about the sore throat? Where does the sore 0:05:15.396 --> 0:05:19.076 throat fall in? Sore throats also are seen in less 0:05:19.076 --> 0:05:23.156 than fifteen percent of patients, and similarly, GI symptoms like 0:05:23.236 --> 0:05:26.836 nausere vomiting, or diarrhea are seen in a low percentage 0:05:26.836 --> 0:05:30.756 of patients. So it's really a combination of different elements 0:05:30.756 --> 0:05:34.116 that give you clinically an indication that you're probably looking 0:05:34.116 --> 0:05:38.196 at a corona case, with kauf being the most significant 0:05:38.516 --> 0:05:41.836 and fever the next most significant, and then the things 0:05:41.916 --> 0:05:44.996 like running nose or sore throat they don't have a 0:05:45.076 --> 0:05:47.956 huge indicating effect. But their absence also doesn't tell you much. 0:05:48.036 --> 0:05:50.076 If it's fifteen or twenty percent of the people have 0:05:50.116 --> 0:05:51.756 that symptom, then the fact that they're not there doesn't 0:05:51.756 --> 0:05:54.196 tell you very much. If they are there, it might 0:05:54.236 --> 0:05:56.596 be indicative as well. I guess. I guess if they 0:05:56.596 --> 0:05:58.636 are there, it's like a little reassuring, but it's not 0:05:58.676 --> 0:06:01.956 a slam dunk. So I think the advice that if 0:06:01.956 --> 0:06:04.636 you're not feeling well, stay home and isolate is a 0:06:04.636 --> 0:06:08.516 good one. And what about the core takeaway question, which 0:06:08.596 --> 0:06:11.756 is I'm at home. I think I have these symptoms. 0:06:11.796 --> 0:06:14.596 I have a fever, it's not terrible, but I don't 0:06:14.596 --> 0:06:17.236 have shortness of breath. And I have let's say, a 0:06:17.596 --> 0:06:21.236 serious cough. Should I come in or should I just 0:06:21.516 --> 0:06:25.716 self isolate? Right away? I would say you should self isolate. 0:06:25.756 --> 0:06:31.276 If you have underlying medical problems like diabetes, or you're immunocompromised, 0:06:31.356 --> 0:06:34.596 or you're pregnant, certainly call your physician. But the last 0:06:34.596 --> 0:06:36.196 thing you want to do is come to a hospital 0:06:36.196 --> 0:06:38.836 where they're going to be other patients who have this 0:06:39.356 --> 0:06:43.276 walking around. You would rather stay at home. So I 0:06:43.276 --> 0:06:45.436 think our biggest fear is that the health system is 0:06:45.436 --> 0:06:48.276 going to be overwhelmed by what we call the worried well, 0:06:48.356 --> 0:06:51.556 people who are relatively asymptomatic or have minor symptoms of 0:06:51.596 --> 0:06:54.036 this disease, who are worried and come in when they 0:06:54.076 --> 0:06:57.116 don't need to, and in this instance, well would just 0:06:57.196 --> 0:06:58.996 mean well enough that they don't have to be admitted, 0:06:58.996 --> 0:07:01.036 because maybe the worried well in this case actually will 0:07:01.076 --> 0:07:04.556 have coronavirus, but they're well enough to stay home. So 0:07:04.596 --> 0:07:06.516 in that sense, they're they're the worried well. They're not 0:07:06.556 --> 0:07:09.556 they're not the irrationally worried well. Under these just then 0:07:09.676 --> 0:07:13.236 not intensely sick. Perhaps we should call them the worried 0:07:13.316 --> 0:07:16.716 mildly sick. That's not as catchy as the worried well, 0:07:16.716 --> 0:07:19.436 but it sounds helpful. So for the rest of us 0:07:19.436 --> 0:07:21.596 will try not to enter the category of the worried 0:07:21.716 --> 0:07:25.036 mildly sick. But those people at this point should stay 0:07:25.076 --> 0:07:28.716 home so as not to overwhelm the system. And when 0:07:28.716 --> 0:07:31.916 you start to feel genuinely sick, that's the time to 0:07:32.316 --> 0:07:36.196 go in correct. So that brings me to the really 0:07:36.276 --> 0:07:38.676 fascinating point that you brought up, that I deflected us 0:07:38.676 --> 0:07:40.556 from because I wanted to know whether we have we 0:07:40.596 --> 0:07:43.236 all hell, we know whether we have the virus, which 0:07:43.316 --> 0:07:45.956 is the idea that is part of your triage. You'd 0:07:45.956 --> 0:07:47.996 have to deal with the fact that we just don't 0:07:47.996 --> 0:07:50.436 have enough tests. And I want to ask you about 0:07:50.436 --> 0:07:53.116 this because you know, one of the forms of criticism 0:07:53.116 --> 0:07:57.156 that one hears of us prepared in this here is well, gee, 0:07:57.156 --> 0:07:58.796 they're just not enough tests here, and there are more 0:07:58.836 --> 0:08:00.996 tests available in other countries and we should have been 0:08:01.156 --> 0:08:03.596 better prepared there. And that seems plausible to me. But 0:08:03.636 --> 0:08:07.756 I've heard a counter argument as well that said something like, well, look, 0:08:07.876 --> 0:08:10.476 if ultimately it could be between forty and seventy percent 0:08:10.476 --> 0:08:13.916 of adults who get this, testing isn't really what's significant 0:08:13.916 --> 0:08:15.236 at this point. And what's more, if we don't have 0:08:15.316 --> 0:08:17.956 a treatment for most people except that they're very, very 0:08:17.956 --> 0:08:20.796 sick and we put them on a ventilator, the testing 0:08:20.956 --> 0:08:23.596 isn't really the key. The lack of tests isn't really 0:08:23.596 --> 0:08:25.276 our problem here, and we should just be more focused 0:08:25.276 --> 0:08:27.996 on the broader public health response. Do you have a 0:08:28.116 --> 0:08:30.156 much more informed view on that debate than I have. 0:08:30.556 --> 0:08:33.916 I mean, to me, there's two different questions, like having 0:08:33.996 --> 0:08:37.436 limited testing is extremely stressful on the health system. It 0:08:37.436 --> 0:08:42.236 actually means we can't test doctors who have been exposed, 0:08:42.716 --> 0:08:44.276 or if we test them, how do we know that 0:08:44.316 --> 0:08:46.356 those tests are correct should they really come back to 0:08:46.396 --> 0:08:49.716 the frontline. So from a workforce perspective, that's very stressful. 0:08:49.996 --> 0:08:52.116 In my ideal world, we would have so many tests 0:08:52.156 --> 0:08:55.156 available that we could swab everyone who comes into the 0:08:55.196 --> 0:08:58.836 hospital every few days and make sure that they are 0:08:58.876 --> 0:09:01.356 being protected and that they're not bringing any virus into 0:09:01.396 --> 0:09:05.196 the hospital. So I do think that there's two different questions. 0:09:05.196 --> 0:09:08.596 One is does your average person at home where we 0:09:08.676 --> 0:09:11.156 can't actually really treat it, is it important for us 0:09:11.196 --> 0:09:16.116 to have that diagnosis versus this second question of healthcare workers. 0:09:16.356 --> 0:09:18.436 And then I think the other problem with not having 0:09:18.476 --> 0:09:21.156 widespread testing. Part of the reason Korea's numbers look so 0:09:21.236 --> 0:09:24.196 great in terms of their number of people who have 0:09:24.316 --> 0:09:28.236 gotten very, very sick is that they've done widespread testing, 0:09:28.276 --> 0:09:30.556 So they're testing a whole bunch of asymptomatic people. They 0:09:30.556 --> 0:09:32.916 have a much better sense of what the denominator is 0:09:32.916 --> 0:09:35.636 of how many people have this virus compared to how 0:09:35.636 --> 0:09:38.756 many gets sick. Here, we're only testing a small portion 0:09:38.796 --> 0:09:42.076 of people, which means that we don't really know what 0:09:42.196 --> 0:09:45.956 percentage of people get very sick from this. It seems 0:09:46.076 --> 0:09:48.956 that it's about three percent of people, but again, we 0:09:49.036 --> 0:09:50.836 just don't know because we have no idea how widely 0:09:50.876 --> 0:09:55.516 spread this is. So to me, I mean defunding our 0:09:55.596 --> 0:10:01.676 pandemic response was a tremendously large error of leadership. And 0:10:01.956 --> 0:10:04.756 I'm grateful to our state and local governments who are 0:10:04.796 --> 0:10:07.356 really trying to step in in this moment. But it 0:10:07.396 --> 0:10:12.236 would be better if testing were more widely available. Rebecca, 0:10:12.236 --> 0:10:14.076 I understand that it's tentative, but tell me again, what 0:10:14.156 --> 0:10:16.476 was that three percent number? That's the number of people 0:10:16.636 --> 0:10:20.236 whom you think of at present who are exposed who 0:10:20.236 --> 0:10:21.796 are getting very sick, or is it the number of 0:10:21.836 --> 0:10:23.956 people who have the coronavirus who are getting very sick? 0:10:24.476 --> 0:10:27.716 I think between two and three percent is the number 0:10:27.796 --> 0:10:31.996 being bandied about of the number of people who will 0:10:32.516 --> 0:10:37.276 die who get the virus. Right. I've heard that number 0:10:37.316 --> 0:10:40.076 as well, and based I think it's largely based on 0:10:40.116 --> 0:10:43.876 the Wuhan statistics, right. Correct. Now, let's move on to 0:10:43.916 --> 0:10:47.756 what happens when you're treating a patient. The patient comes 0:10:47.796 --> 0:10:51.836 in the patient is symptomatic enough for you to give 0:10:51.876 --> 0:10:55.916 them a test. Let's say you determine their positive for coronavirus, 0:10:56.156 --> 0:10:58.636 but they're not so sick that they need to be 0:10:58.676 --> 0:11:02.196 admitted to the hospital, so you send them home into 0:11:02.236 --> 0:11:07.356 effectively self quarantine. Correct, Correct? And what is that supposed 0:11:07.396 --> 0:11:09.556 to mean in real practical terms? I think a lot 0:11:09.596 --> 0:11:12.436 of listeners out there are wondering. We hear this phrase 0:11:12.596 --> 0:11:14.796 self quarantine or I guess in that case, self isolation, 0:11:15.276 --> 0:11:18.716 but we don't really know how much exposure to other 0:11:18.796 --> 0:11:20.916 humans that entails. I mean, is it literally meant to 0:11:20.916 --> 0:11:24.116 be lock yourself in your room and do not see 0:11:24.236 --> 0:11:25.876 the other people who live in your house, if there 0:11:25.916 --> 0:11:29.076 are any I mean, in an ideal world, yes, right, 0:11:29.156 --> 0:11:32.596 it's ideally have your own room, in your own bathroom, 0:11:33.236 --> 0:11:36.516 and have someone like leave food at the door that 0:11:36.676 --> 0:11:39.076 you then open the door and get the food and 0:11:39.156 --> 0:11:42.676 shut it, recognizing that for some people that's not going 0:11:42.716 --> 0:11:45.676 to be possible. But you know, there was a case 0:11:46.396 --> 0:11:48.716 in Asia of a family of nine who, like one 0:11:48.716 --> 0:11:51.236 of them was on isolation and they all shared hotpot 0:11:51.316 --> 0:11:55.236 and they all got coronavirus. And so certainly I think 0:11:55.356 --> 0:11:58.916 trying to really isolate, I mean, luckily we all have computers. 0:11:58.916 --> 0:12:01.076 I would recommend trying to be in a room with 0:12:01.116 --> 0:12:03.716 a computer so you can still have contact with the 0:12:03.756 --> 0:12:06.276 outside world. I'm hearing lots of creative things that people 0:12:06.276 --> 0:12:10.236 are doing, you know, zoom coffee hours, going to art 0:12:10.276 --> 0:12:12.756 galleries online and things, so you don't go bananas. But 0:12:12.836 --> 0:12:15.036 I do think that it's really important for people to 0:12:15.556 --> 0:12:18.516 take this seriously, especially if you live with old people 0:12:18.596 --> 0:12:22.556 or anyone who's immuno compromised. Well, I think probably everybody 0:12:22.556 --> 0:12:26.356 would take it seriously if they had a positive diagnosis. 0:12:26.356 --> 0:12:28.956 The real question, I think is for people who don't 0:12:28.956 --> 0:12:32.596 have that and are just sort of at home under 0:12:33.116 --> 0:12:37.076 self quarantine or because there's a broad shelter in place 0:12:37.316 --> 0:12:40.796 order in effect, the question that is how precise they 0:12:40.796 --> 0:12:42.996 should be. I mean that it's not recommended that those 0:12:42.996 --> 0:12:45.876 people self isolate. That's only if you are confident or 0:12:45.916 --> 0:12:49.236 you think it's a high probability that you have the virus. Right, yes, So, 0:12:49.356 --> 0:12:51.956 just to be clear, Shelter in place is different than 0:12:51.996 --> 0:12:54.916 self isolation. Shelter in place is saying stay in your 0:12:54.916 --> 0:12:57.316 home and share your germs with your family or the 0:12:57.356 --> 0:12:59.836 people that you live with, but don't go outside and 0:12:59.876 --> 0:13:02.116 share it with other people. Sort of keep your germs 0:13:02.116 --> 0:13:05.916 to your little group. It doesn't matter whether it's you 0:13:05.996 --> 0:13:08.596 and your family, or it's you and your roommates or 0:13:08.636 --> 0:13:10.516 the other people who live in a group house with you. 0:13:10.756 --> 0:13:12.596 You're going to share. You're going to share germs with 0:13:12.636 --> 0:13:15.156 those people in an ordinary shelter in place, right, I 0:13:15.156 --> 0:13:17.236 mean the ideas, try to be a little more cognizant, 0:13:17.316 --> 0:13:19.996 don't share spoons and forks and things, and wash your 0:13:19.996 --> 0:13:23.716 hands a lot. But recognizing that it's impossible for people 0:13:23.756 --> 0:13:28.236 to completely isolate. That being said, if you have symptoms, 0:13:28.716 --> 0:13:30.996 act like you have the virus. It doesn't matter whether 0:13:31.116 --> 0:13:33.916 or not you have a positive test. We don't currently 0:13:33.916 --> 0:13:37.276 have testing capacity, So people should take this seriously. If 0:13:37.276 --> 0:13:40.396 you aren't feeling well, isolate yourself from the other people 0:13:40.396 --> 0:13:42.756 that you live with, and how long should you do 0:13:42.796 --> 0:13:44.396 that before? I mean, again, this is something that I 0:13:44.476 --> 0:13:47.676 think has not really fully trickled down to the general 0:13:47.716 --> 0:13:49.556 listener yet. It certainly hasn't to me. So if you 0:13:49.636 --> 0:13:53.796 have flu like symptoms or cold like symptoms and your 0:13:53.796 --> 0:13:56.076 self diagnosis is like, I don't know if I have coronavirus. 0:13:56.116 --> 0:13:58.716 I didn't go to medical school, but I'm feeling lousy. 0:13:59.316 --> 0:14:02.956 Your recommendation is go into self isolation as though you 0:14:03.036 --> 0:14:05.436 had the virus, correct, And the recommendations are to do 0:14:05.476 --> 0:14:08.316 that for fourteen days. I think if you start feeling 0:14:08.356 --> 0:14:11.276 better after it or two, it's probably not coronavirus, and 0:14:11.316 --> 0:14:14.916 so you can feel better about coming out of isolation. 0:14:15.036 --> 0:14:18.196 But you know, better safe than sorry. But is that 0:14:18.236 --> 0:14:21.036 true that if it's coronavirus it's not going to go 0:14:21.076 --> 0:14:22.916 away that quickly. I mean, what if you just had 0:14:22.916 --> 0:14:25.636 a very mild case of coronavirus. I mean, it's a 0:14:25.676 --> 0:14:27.636 great question. I think in the end it's a little 0:14:27.676 --> 0:14:29.996 bit hard to know. But those are the recommendations that 0:14:30.036 --> 0:14:32.956 occupational health is giving us at this time. I think 0:14:32.956 --> 0:14:35.636 what's hard with coronavirus is there are plenty of people 0:14:35.636 --> 0:14:38.636 who are asymptomatic who have coronavirus. So I think that's 0:14:38.636 --> 0:14:42.676 where the overlap of public health and medicine happens. So 0:14:43.156 --> 0:14:46.036 public health is keeping people from spreading it to others. Right, 0:14:46.196 --> 0:14:49.876 most of us are going to get coronavirus and do fine. 0:14:50.476 --> 0:14:52.796 Some people are not going to do fine, and so 0:14:52.836 --> 0:14:55.796 what we're trying to do is protect those people. And 0:14:55.876 --> 0:15:00.516 so my recommendation to the public would be take this seriously, like, 0:15:01.036 --> 0:15:05.036 don't go out with friends, stay at home, really try 0:15:05.156 --> 0:15:08.196 to limit your interactions with other people. I think that's 0:15:08.236 --> 0:15:10.676 just good practice, whether or not you have a cough 0:15:10.836 --> 0:15:13.956 or anything else. We'll be back in just a moment. 0:15:24.236 --> 0:15:28.516 What's the scene like at UCSF at your hospital right now? 0:15:28.676 --> 0:15:31.236 Is it? You know, I'm sure you're preparing like crazy 0:15:31.356 --> 0:15:34.396 for things to get out of hand. Where are things 0:15:34.476 --> 0:15:36.996 right now in that process? I mean, actually we're still 0:15:37.036 --> 0:15:40.996 in the sort of preparing and waiting, the waiting period 0:15:41.196 --> 0:15:45.956 rather than the storm that we worry is coming. So 0:15:46.436 --> 0:15:50.396 you know, the hospital has enacted our disaster plans in 0:15:50.476 --> 0:15:54.276 terms of canceling elective procedures. So if you were supposed 0:15:54.276 --> 0:15:56.116 to get a hip or a knee replacement, we have 0:15:57.076 --> 0:16:02.316 canceled those procedures things like that to create openings for 0:16:02.436 --> 0:16:04.836 patients in case other patients gets sick. It turns out 0:16:04.836 --> 0:16:06.276 a lot of the people who are in the hospital 0:16:06.556 --> 0:16:11.476 are here for somewhat routine electives, and so by stopping 0:16:11.476 --> 0:16:13.556 those procedures, you open up a lot of space within 0:16:13.636 --> 0:16:16.916 the hospital. So actually our censuses are a little bit 0:16:17.196 --> 0:16:20.036 down right now here at UCSF. At least as of 0:16:20.116 --> 0:16:22.516 last night, we only had two patients in the intensive 0:16:22.516 --> 0:16:26.196 care unit with COVID and none at either of our 0:16:26.236 --> 0:16:30.036 outlying hospitals. So that's great news, and we hope it 0:16:30.076 --> 0:16:33.276 will continue like that, but we worry that it will 0:16:33.356 --> 0:16:38.356 be getting busier. We are upstaffing respiratory urgent care clinics, 0:16:38.916 --> 0:16:44.276 upstaffing our emergency room, and working with across departments to 0:16:44.396 --> 0:16:48.556 upstaff our intensive care units to be ready. I understand 0:16:48.596 --> 0:16:54.116 that at your hospital, then you're postponing surgery that's technically elective. 0:16:54.916 --> 0:16:58.316 Should patients proactively, let's say they're not in San Francisco 0:16:58.396 --> 0:17:01.516 where their hospitals are yet doing the suspension on their own. 0:17:02.036 --> 0:17:05.476 Should patients themselves be trying to judge, Gee, if this 0:17:05.556 --> 0:17:08.036 is elective surgery in the sense that I don't need 0:17:08.076 --> 0:17:11.076 it right away, I should delay it, partly out of 0:17:11.076 --> 0:17:13.716 public service to free up hospital beds, or partly because 0:17:13.716 --> 0:17:15.796 they don't want to be in hospitals because that's where 0:17:15.876 --> 0:17:19.636 sick people are. I think that's reasonable. Frankly, I think 0:17:19.716 --> 0:17:22.076 most hospitals are going to be moving this way, So 0:17:22.356 --> 0:17:25.836 it's more a question of whether you're going to postpone 0:17:25.876 --> 0:17:29.076 your procedure before they start postponing procedures, or whether they'll 0:17:29.076 --> 0:17:31.716 reach out to you. And what about things that the 0:17:31.756 --> 0:17:34.036 hospitals are short on? I mean, are there things where 0:17:34.196 --> 0:17:37.356 ucsfsaid publicly, you know, like we need more ventilators or 0:17:37.556 --> 0:17:40.036 we don't have subsion in protective gear or are you, guys, 0:17:40.556 --> 0:17:42.036 because you're sort of at the front end of this 0:17:42.116 --> 0:17:44.916 and you're also a first class hospital, are you pretty 0:17:44.916 --> 0:17:48.076 well prepared in those regards? I would say both of 0:17:48.116 --> 0:17:50.796 those things. We are well prepared, and we are worried 0:17:50.836 --> 0:17:54.156 about shortages. So we currently have enough protective gear, but 0:17:54.236 --> 0:17:56.756 there is concern that we have, you know, a few 0:17:56.796 --> 0:18:01.316 weeks worth of protective gear on hand. And so another 0:18:01.396 --> 0:18:03.596 public health thing that people can do is not do 0:18:03.716 --> 0:18:06.796 things like hoard and ninety five masks at home. You 0:18:06.836 --> 0:18:09.996 don't need those people who are intibating people with COVID 0:18:10.076 --> 0:18:14.596 need those. You're doing senior administrative work in this moment. 0:18:14.876 --> 0:18:18.156 And so I'm wondering what's the tone like in the meetings? 0:18:18.196 --> 0:18:20.596 I mean, are people managing to sound as calm, cool 0:18:20.636 --> 0:18:22.356 and collected as they sound all the time. I mean, 0:18:22.396 --> 0:18:23.916 I know doctors are all one of the things you 0:18:23.956 --> 0:18:26.356 train people and is to stay calm in situations where 0:18:26.476 --> 0:18:28.836 normal people would be freaking out. Is that sort of 0:18:28.876 --> 0:18:31.116 how it's operating in the meetings. Are there are people 0:18:32.196 --> 0:18:35.676 exaggerating their calmness in order to seem calmer or is 0:18:35.676 --> 0:18:38.756 it sort of business as usual in some sense? It's 0:18:38.756 --> 0:18:42.556 not business as usual in the sense that people are 0:18:42.556 --> 0:18:45.036 really working together in a way that I think is 0:18:45.076 --> 0:18:49.116 actually really admirable. So, you know, UCSF is a big, 0:18:49.156 --> 0:18:53.716 sprawling place with a bureaucracy like any big sprawling institution, 0:18:54.076 --> 0:18:57.196 and I've been really impressed with how things that previously 0:18:57.196 --> 0:19:00.116 would have taken a year to roll out or years 0:19:00.156 --> 0:19:03.196 to roll out or rolling out in days because people 0:19:03.236 --> 0:19:08.356 are really working together. So, for example, telemedicine, we had 0:19:09.236 --> 0:19:12.156 very small percentage of our outpatient visits we're being done 0:19:12.156 --> 0:19:15.476 by video visit. And then a week and a half ago, 0:19:15.476 --> 0:19:18.356 when we had our first sort of disaster planning full 0:19:18.436 --> 0:19:22.316 day retreat, it was decided that telemedicine should convert like 0:19:22.396 --> 0:19:25.436 fifty percent of our ambulatory visits in a matter of days. 0:19:25.876 --> 0:19:28.236 And now we're converting almost one hundred percent of our 0:19:28.356 --> 0:19:31.756 visits to video visits. And that has happened that kind 0:19:31.756 --> 0:19:35.876 of huge change in a complex bureaucracy is usually really 0:19:35.876 --> 0:19:38.516 hard to maneuver, and so I've been super impressed with 0:19:38.596 --> 0:19:43.076 how people are coming together across the organization to make 0:19:43.116 --> 0:19:46.556 these things happen. So every day now within my residency, 0:19:46.716 --> 0:19:50.236 we have a daily planning huddle where we meet for 0:19:50.276 --> 0:19:53.476 thirty minutes and kind of plan out what needs to 0:19:53.556 --> 0:19:56.476 change next. And then in a hospital level, those are happening, 0:19:56.516 --> 0:20:00.116 and then we have a special workforce one where we 0:20:00.156 --> 0:20:02.236 think about how are we going to deploy nurses, what 0:20:02.236 --> 0:20:04.996 do we do with people who are on home furlough, 0:20:05.076 --> 0:20:08.036 how can we help them be useful and help while 0:20:08.076 --> 0:20:13.276 they're in quarantine. So the amount of cross pollination between 0:20:13.916 --> 0:20:18.156 human resources and nursing and the physicians and the administration 0:20:18.236 --> 0:20:21.516 has really been amazing. So I wouldn't say that it 0:20:21.596 --> 0:20:23.956 has been business as usual. I would say it's been 0:20:24.396 --> 0:20:28.316 better than usual. And I think while everyone is stressed, 0:20:28.316 --> 0:20:30.676 people are really working together in a really positive way. 0:20:31.916 --> 0:20:35.076 That's actually extremely heartening and it's exactly what you know. 0:20:35.196 --> 0:20:38.476 You fantasize life is like inside of a big hospital 0:20:38.516 --> 0:20:40.916 and when everyone's preparing for a crisis, But I know 0:20:40.996 --> 0:20:43.156 that in other areas of life, our fantasies of the 0:20:43.196 --> 0:20:44.996 way the planning is supposed to go doesn't always bear 0:20:44.996 --> 0:20:47.116 itself out, So it's nice to hear that that's actually happening. 0:20:47.956 --> 0:20:49.876 Can I ask just a broader question for those of 0:20:49.956 --> 0:20:51.756 us who are not in San Francisco, which is most 0:20:51.756 --> 0:20:55.156 of us right now. San Francisco is presumably a harbinger 0:20:55.196 --> 0:20:57.196 of what it's going to be like for us. So 0:20:57.316 --> 0:21:00.036 what's it like when you get up and come to 0:21:00.076 --> 0:21:03.756 work every day? Given the shelter in place order? How 0:21:03.756 --> 0:21:05.196 many cars are on the road? I mean, I know 0:21:05.236 --> 0:21:06.996 there are lots of people who are exempted from the order, 0:21:07.076 --> 0:21:09.476 people like you healthcare workers, but also the people who 0:21:09.476 --> 0:21:11.956 are doing food service work. And I notice even the 0:21:11.996 --> 0:21:15.036 biotech workers are exempted under the presumably are people on 0:21:15.076 --> 0:21:18.556 the streets, So there are still people on the streets. 0:21:18.556 --> 0:21:20.516 I mean, people are trying to work from home. So 0:21:21.276 --> 0:21:23.996 I'm here at the hospital today and I was in 0:21:24.036 --> 0:21:26.636 clinic yesterday, but the day before I did work from home, 0:21:26.676 --> 0:21:29.556 which I wouldn't usually never do. So I do think 0:21:29.596 --> 0:21:31.956 even amongst the people who are exempted, people are trying 0:21:31.956 --> 0:21:35.636 to kind of honor the idea of self sheltern place 0:21:35.676 --> 0:21:38.036