For many, UCSF Medicine Chair Dr. Bob Wachter’s Covid-19 panels over the past 18 months have become as much of a pandemic staple as case count maps, masks and Chlorox wipes. In today’s Grand Rounds, of which there have been more than 50 episodes, Wachter told viewers that the covid series — barring any breaking news — was concluding for the summer. Regular sessions of Grand Rounds will resume virtually after Labor Day, following some “retool[ing].”
Worldwide updates and the delta variant
UCSF epidemiology professor Dr. George Rutherford, who needs no introduction at this point, returned one last time to discuss covid developments globally.
Cases are down nearly everywhere, even in India, which still leads the world with over 600,000 cases last week, followed by Brazil, Argentina, Columbia, and the United States.
The United States recently crossed the milestone for 600,000 deaths. There have been almost 33.5 million covid cases here, though cases, hospitalizations and deaths are declining nationally.
Variants remain a concern as the alpha variant (the B117/UK variant) now accounts for almost 70 percent of all cases nationally over the past 14 days. Rutherford said the delta variant (one of the two Indian variants) may account for 70 percent of cases in California by the end of the summer, because it is more transmissible. However, mRNA vaccines appear to be effective against the delta variant.
Cases in California are “leveling out” to around 800 to 900 cases per day as hospitalizations continue to fall and deaths “kind of bounce up and down,” Rutherford said. California is “still quite in the vanguard of states that are doing really well.”
The state has administered over 39 million vaccines, and is averaging over 100,000 doses per day, “so I guess the lottery is working,” Rutherford quipped. Some 56.6 percent of all Californians have received at least one dose, and 47.7 percent are fully vaccinated. In San Francisco, rates are even higher, with 73.2 percent of people with at least one dose, and 64.5 percent fully vaccinated.
Communities of color and poor communities still lag in vaccination rates, Rutherford said.
He said some California counties that struggle with lower vaccination rates and high case rates will be somewhat protected by the combination of naturally acquired immunity and vaccines.
Is the pandemic over? Rutherford says no. Lower vaccination coverage in some areas and more transmissible variants will mean some small outbreaks, but there will be regional herd immunity by this summer and possibly statewide. Schools should reopen, he said.
Conversation with Andy Slavitt
To conclude Grand Rounds, Wachter brought on Andy Slavitt, President Joseph Biden’s senior Covid-19 advisor from January to June, to discuss his new book about the United State’s pandemic response, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response. Slavitt was the head of Medicare and Medicaid under President Obama and oversaw the Affordable Care Act, in addition to founding United States of Care, a nonprofit health advocacy organization.
Wachter described Slavitt as a man with “the pedigree of a profit-maximizing capitalist” on his resume — until you look at the last 10 years, when he appears more like a community organizer with a Masters in Public Health. Slavitt credits his transition, from Goldman Sachs to healthcare equity, to his roommate dying at age 31 from a brain tumor.
Slavitt believes we are all victims of multi-billion dollar industries in healthcare that prioritize company bottom lines and market caps over patient care. In the pandemic, this was made clear when “the president didn’t want to do anything that would get in anybody’s way of making money because he believed that if the stock market went up, even if people were dying, that was his best chance to get reelected,” Slavitt said.
He elaborated on the issues of U.S. healthcare when describing a schism among two populations, what he calls the “peloton crowd” and the “take the bus crowd.”
“If you live in the wrong zip code, if you’re black or brown, if you live in a rural community, if your income or job is different, your life expectancy at birth is 10 years shorter. And everything about your experience with the health care system is worse,” Slavitt said, also citing multigenerational poverty, lack of access to resources, and structural racism.
The biggest difference Slavitt sees between former President Donald Trump’s and Biden’s pandemic responses was Biden’s willingness to take accountability for the crisis. Trump committed three deadly sins, Slavitt said: denying the seriousness of the pandemic, quashing dissenting voices, and politicizing topics such as masks. “Having a populist, having someone try to be popular and play to the crowd while managing a pandemic: not a great combination,” Slavitt said.
He recounted an anecdote wherein Biden told him, “I don’t want you making me look good. I want you telling the public what they need to hear.” Instead of looking for someone to blame when things went wrong, or overpromising, Biden’s team focused on execution, communication and accountability.
Discussing Biden’s strategy for vaccine hesitancy, Slavitt described early meetings with behavioral economists, pollsters and researchers, though some of the group’s initial predictions were wrong. They thought communities of color would be the most resistant to the vaccine. Slavitt said that the most hesitant group is actually young people, and within that group education level as opposed to political party or race is the larger factor.
Another discovery is that the most trusted source for individuals regarding vaccine hesitancy is one’s doctor — not Jay-Z or Trump or Dr. Fauci, Slavitt said. “I think there are some people that [think] this is just the more considered decision. They’re not anti-vaccine. But they have questions that they want answered and we need to treat those questions as legitimate,” he said.
Wachter noted that Slavitt’s book is “a powerful indictment of Trump, but it’s actually a much more powerful indictment of all of us in our society and what we’ve become.” He asked how removing Trump from the equation would have, if at all, impacted the fundamental problems revealed by the pandemic.
Slavitt responded that a Republican like Romney or Bush would have had a solid pandemic response, but said “if we just think about this as Trump, we’re probably missing a couple of points.”
One point is our willingness to discard the words of experts who are needed during a crisis. A second point is the undeniable way in which inequality and race and the structure of our jobs impacted things.
He noted that many Americans who were not essential workers and spent the pandemic inside did not experience the impacts of death in the same way essential workers did. You might not know the name of someone who had died from covid, but you certainly know people who have died, Slavitt said. They are the farmers, meatpackers, grocery store clerks, and delivery people who work for you.
He critiqued the willingness of privileged people to isolate themselves from suffering, as well as the healthcare system’s unwillingness to make decisions to serve the collective unless there was a large sum of money involved.
“My sense is, solving this for the next time isn’t about buying a bunch of masks and a bunch of ventilators so we’re quote-unquote ready next time. It’s also about a dialogue about what kind of country we want to be,” he said. “And, further to that, if we wait till the next pandemic to solve these problems, I think we missed kind of the point.”
See our previous Grand Rounds coverage here.