Returning to normal life is an inevitability, however slowly it may arrive. That may happen when enough testing becomes available — especially if that testing is on-demand and can be delivered to your home. (It’s not science fiction and closer than you think).
But then what happens? Would you have the courage to go to the gym or the movies?
You may ask yourself: What would a world-class epidemiologist do?
During a “lightning round” questioning during UCSF’s grand rounds on Thursday afternoon, Dr. Bob Wachter, the head of the university’s Department of Medicine, put these questions to his colleague, Dr. George Rutherford, who is, indeed, a world-class epidemiologist.
“Depends on how many chairs,” Rutherford said.
Rutherford, grossed out, grunted. “Maybe,” he said.
Get a haircut?
“Definitely,” Rutherford said. “If the barber wears a mask, I’m not too worried.”
How about the movies?
“Depends on what’s playing,” Rutherford said, noting that maybe theaters will sell a third of the tickets to create spacing.
Get on an airplane?
Yes, Rutherford said, noting that the best spot in the house would be the window seat halfway into the economy cabin. “Because that’s where the fewest people pass you to get to the bathroom.”
None of this will happen quickly. If it does, a dreaded “second wave” is inevitable with more cases, hospitalizations, and deaths, Rutherford said. It’s a likelihood we may see in the vanguard of states like Georgia and Oklahoma already raring to open businesses.
Or perhaps in San Luis Obispo, which this week announced a phased plan to open up businesses. Rutherford worried it could become a “people magnet.” Even he, upon hearing the news, thought: “That would be a good vacation destination.”
“Just imagine the problems,” Rutherford said.
Speaking on the UCSF Zoom lecture from his East Bay home, Rutherford touched on many topics. He talked about his ongoing study of “seroprevalence” — just how present the new coronavirus is in our community. Whether tracing methods in South Korea — tracing a person’s movement through purchases, mobile tracking, and video surveillance — are a good idea. “That would certainly be effective,” he said with a chuckle. “But it sort of edges up against certain privacy laws in this country.”
And he addressed an important question from Wachter: “When does an epidemic end when there is no vaccine?”
“It exhausts the susceptibles,” Rutherford said matter of factly. “That’s how epidemics end.”
“So it requires herd immunity?” Wachter said. “It requires that you’re getting to 60 or 70 percent of the people infected?”
“That’s how many people were infected around the world with Spanish Flue,” Rutherford said. “I think it was 50-something percent of people were infected, at the end of the day.”
A world with faster testing
The road to faster testing — 10,000 tests a day per lab — may lie in a CRISPR (clustered regularly interspaced short palindromic repeats) test, said Dr. Charles Chiu, a professor in the department of laboratory medicine who was next on after Rutherford. Through blood, swab, or stool samples, the test can produce a result in a little as a half-hour. It does this by “targeting genes or gene editing.”
“The goal is to develop a test that’s faster, cheaper, more portable, and potentially scaleable — while retaining the accuracy of the existing PCR (polymerase chain reaction)-based test,” he said. The new technology could “enable you to develop point-of-care and even at-home tests.”
Rethinking the business model
Although many may be looking to UCSF for answers, and its research may well help solve the COVID-19 crisis, it lost $60 million in March, said Mark Laret, the president and CEO of UCSF Health, and may lose another “$130 million to $150 million, maybe a little bit more” in April. “And we’ll see how May goes and how June goes,” he said.
The reason is, “healthcare operates in a larger ecosystem,” he said, relying on the success of businesses, employed people, and those people having insurance and using it. He noted that UCSF may receive $50 million out of a $1 billion federal hospital bailout fund. And he talked about the possible need to reinvent the hospital system into the future.
“This becomes a point demarkation for us,” he said. “We have to use this to rethink our whole business model in academic medicine — as every company is going to have to rethink its business model.”
“There’s pain associated with that,” he said, “but I think there’s a tremendous opportunity.”
Dr. Susan Smith, chief faculty practices officer, later talked about one way the model may change. For years, UCSF and other hospitals have tried to get patients to embrace video consults but, pre-COVID-19, only 2 percent of consults happened over video. Nowadays, that number has shot up to 50 percent, or 100 percent in some specialties.
Although that level is likely to decrease, video consults are probably here to stay, she said. “It turns out, fear is an incredibly motivating emotion,” she said, explaining that some doctors have been afraid to encounter patients and afraid for them. “And people will really change what they do based on fear.”
Where did all the sick people go?
Emergency rooms have seen a marked decline in visits — not hypochondria cases, but very serious ailments like sepsis, heart attacks and gastrointestinal bleeding. “Where have people gone?” Wachter asked, and later noted, “I’m trying to wrap my head around this one — it defies logic.”
Patient volume is down by half, Wachter said.
Dr. Josh Adler, UCSF’s chief clinical officer and executive vice president for physician services, said he has no good hypothesis as to why.
He said some of it may have to do with the fear of hospitals right now. Or that people are staying home and putting themselves in danger. “Is there a whole new accumulation of illness and fragility that’s accumulating that we will need to attend to once people feel more comfortable coming back?”
“This is one of those unanswered questions that we’ll probably get the answers to pretty soon,” he said.
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