Bob Wachter, MD, Chair of the Department of Medicine at the University of California, San Francisco (Photo by Noah Berger)

Bob Wachter: You’re not going to be like The Daily and start with some clip of somebody shooing away their dog, right?

Dan Gorenstein: For the last several weeks, we’ve been checking in with Bob Wachter, Chair of the Department of Medicine at the University of California, San Francisco hospital. 

When we first talked back in mid-March, the Bay Area was a hot spot.

BW: It really feels like there is this big wave coming over the horizon, and we can see the peaks of it, but not the full extent of what might be coming. 

DG: About a week later, Bob and his colleagues were still waiting for the wave.

BW: We see reports from and speak to colleagues in New York where it, in fact, has increased cataclysmically. And it leads to this very odd feeling of not knowing whether that’s going to be us in four days or we’re at least partly dodging the bullet.

DG: Now, a week into April, even with cases ticking up, the situation is stable. But there are still hard choices to come. 

From the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein, and this is Tradeoffs.

BW: The projections are maybe another week of continued growth, and then unless people’s behavior changes radically — and I don’t see that — then we should start beginning to come down, as should even the harder hit areas, although their peak is unbelievably higher than ours.

DG: Bob, do you think that this is a victory for early social distancing? What do the folks at UCSF to attribute this to?

BW: Yes, I think there is no question in our minds that San Francisco and California hopped on this thing early. It’s interesting, Dan, because simple narratives often don’t work. I was looking at the data yesterday. Texas was relatively late to orders by the political leaders to stay at home, and Texas has also had a very benign course. So it’s sort of easy to have as a narrative, we did the right things, we did them early and we did well. And these other places reacted later. But there are some other places that reacted later that have also done OK. So I think there’s a fair bit of luck and things that we don’t understand.

DG: What’s been the hardest decision you guys have had to make in the last couple of days, if any at all, Bob?

BW: I guess the decisions that we were talking about last week, which are, do we begin reopening for these other patients that need medical care, but we have deferred because of our surge planning. We’re trying to get patients in who really do need their surgery and it can’t really wait much longer. We’re beginning to open up some of our outpatient capacity as well. I would say the hardest one now is, when are you sure enough you are not going to be overwhelmed that you begin sending resources to harder hit areas? We’ve now reached that point absolutely on PPE, which we have sent away. The governor of California sent back to the federal stockpile a number of ventilators that were supposed to be coming to California and said that we don’t need them, which I think is brave and correct. 

DG: The other big decision they are grappling with: Should they put their faculty and residents on a plane and to go help hospitals in New York City?

BW: We’re trying to decide is that safe and prudent and how to organize that if we do it. I think we’re leaning toward doing it. I think it feels ethically like the right thing to do. But you certainly would hate to do it and see that all of sudden you have a surge that  you misread and you would obviously hate to do it and have one of your people get sick. But these are all folks that are volunteering for this when they see what’s happening with their colleagues. In New York, these are people who have been working nonstop for three weeks. They have to be getting exhausted. Many of them are ill. If we were able to send resources that can help them out, that would probably be a good thing.

DG: Bob says with the Bay Area seemingly avoiding a tsunami-like surge of COVID cases, the question now becomes, what’s next?

BW: If, in fact, we all hit a peak and begin going down, people quite naturally are going to begin thinking about their own life and how it’s been disrupted, the economy. The questions of how you come out of a thing like this when the virus is still around, just as deadly as it ever was. The vast majority of people are not immune. Even if you’ve had it, it’s not 100% clear how good immunity is. So the questions of how you get back to something resembling normal, I think those are tougher questions, more nuanced questions. They’ll be more regional differences as we begin trying to do more aggressive case finding and quarantine, and the quarantines may not be completely voluntary. I was a political science major in college and often wondered, you know, why am I going to medicine when I love politics and thinking about systems and how they work? This is the moment I was studying for where public health and medicine butts up against politics and how people want to live their lives. And I think it’s going to be really, really interesting and in many ways much harder than what we’ve seen already.

DG: You can find our previous conversations with Bob as well as all of our coronavirus coverage on our website at tradeoffs.org.

I’m Dan Gorenstein, this is Tradeoffs.