UCSF Virtual Community Town Hall on COVID-19 – 04/16/2020

– Good evening and welcome to our virtual town hall on the city and UCSF’s response to COVID-19 My name is Francesca Vega and I am the Vice Chancellor of Community and Government Relations here at UCSF The purpose of this evening’s town hall is to provide members of the community, including our many community partners, with an overview of the COVID-19 pandemic and its impact on San Francisco This evening, we will reflect on this unprecedented global public health crisis I would like to take a moment to acknowledge the devastating toll of the coronavirus pandemic Our hearts go out to those who are sick and have lost loved ones and livelihoods UCSF will continue to work and partner with our community, our elected officials and policymakers, as well as our business partners to address their needs Amidst the challenges we are all facing, there are bright spots We are heartened by the incredible outpouring of support and encouragement of our community during this time, and we salute our heroes, the unbelievable care providers on the front lines across the healthcare system, as well as unsung heroes working behind the scenes to support them We appreciate the critical partnerships with local, state, and national agencies, our elected officials, community-based organizations, academic and industry, and coordinating response efforts It is my pleasure to introduce the agenda and speaker for this evening’s discussion We will begin with an overview of COVID-19 and its impact on San Francisco with the UCSF Chancellor Dr. Sam Hawgood, and Dr. Grant Colfax, director of the San Francisco Department of Public Health We will then follow with a discussion on COVID-19’s impact on patient care with Mark Laret, president and CEO of UCSF Health, and Dr. Susan Ehrlich, CEO of the Zuckerberg San Francisco General Hospital We will then have at least 20 minutes for questions from the audience Please use the Q&A function on Zoom to submit questions And please note that this meeting is being recorded and will be posted on our COVID-19 website Thank you I will turn it over to Chancellor Hawgood – Good afternoon, everyone, and welcome to this town hall on COVID-19 for our neighbors, our friends, and alumni of UCSF I would like to start by giving you just a very brief overview of the CoV-2 virus, what it is, what it does, why we are so worried about it, and how it is that it has spread so remarkably into a global pandemic, and then I will invite my partner, Grant Colfax, director of the Department of Public Health here in San Francisco, to talk a little bit more about the San Francisco response So I know it’s a very diverse audience this afternoon and I apologize if there are any real or budding virologists in the audience, but I’ll just give you a very brief overview of the coronavirus itself We’ve known in the scientific community about coronaviruses since about 1960 They obviously were circulating in the animal and human populations probably for centuries before that, but they got their name coronavirus in the 1960s And we, for the first 50 odd years, we knew them as a cause of the common cold, the sniffles, the sneezes, the watery eyes They cause about 40% of the common cold every year Not a particularly dangerous, although, sometimes annoying, infection But in the early 2000s, in 2002, there was a significant mutation in the common coronavirus that became what was known as SARS, severe acute respiratory syndrome, and unlike the common cold, the mutated virus was able to attack the deep distal lung and cause a severe bilateral pneumonia, and sometimes fatal respiratory distress In fact, of the roughly 8,000 people that were afflicted with the SARS virus in 2002, 2003, around 10% succumbed To put that into some context, the seasonal influenza virus that is in our community each year, the case fatality rate is about .1%, so SARS was 100 times more serious in terms of lethality than seasonal influenza Fortunately, that particular virus only survived

about one year globally It caused a lot of havoc, affecting about 8,000 people, but has disappeared from the global scene In 2012, a new mutation in a coronavirus emerged on the Arabian peninsula and has affected mainly the Middle East population, and that is called MERS, Middle East Respiratory Syndrome Affected a smaller number of people, ’cause it doesn’t seem to be quite as infectious, but very serious, with about a 30% mortality And then, just in December of 2019, so just four short months ago, and as Francesca said, our world, and really, the global world, has been turned on its head over the last four months, when a third mutated coronavirus emerged in a province in China Probably, there was a single human infected that was the very first human infection, but in just four months, that infection has now spread around the world Initially in China, but they got their initial epidemic under reasonable control between the first documented case in December and roughly March of this year, so over a three month period, a horrendous outbreak in China, but then control of the epidemic It probably traveled from initially China to Europe, and then Southeast Asia to the west coast of the U.S., and from Europe to the east coast of the U.S The virus has now spread around the world Initially a major outbreak in Europe, Italy, Spain, France, Germany, England, and other European countries, and more recently, throughout North America Every state in the country and almost all major cities have now been affected We know that this virus is probably more infectious, meaning easier to transmit human to human, than either SARS or MERS, but it’s probably a little less lethal than either of those two earlier serious coronaviruses What we do know is it is spread by what we call droplet or contact That means it spreads through droplets that are expressed from the mouth or nose Those droplets drop to the ground through gravity They can probably spread about six to nine feet through the air, and then when they land on a surface, they remain infectious, for a period of hours to perhaps as long as a day, depending on the environmental conditions, such as the temperature and the surface on which they land You can’t contact the virus through the skin itself, but if it’s on your hands or on your arms and then you touch a mucosal membrane, meaning the eyes, the nose, or the mouth, you can get an infection Unlike influenza, where the peak infectious period, meaning your ability to transmit it to someone else, occurs at the time of your maximum symptoms, it appears with coronavirus, you can be infectious to other people when you yourself feel reasonably well The first symptom for most people, but not all, is a fever followed by a cough Fortunately, for 80% of people affected by coronavirus, that persists for about two weeks and then there is full recovery without requiring medications, other than the usual kind of anti-fever medications that you might take for the flu, or without requiring hospitalization or intervention by the medical community But for about 20%, and that is predominately as you get older, those symptoms progress to a bilateral lung infection that does require hospitalization, and in a smaller number, about 5%, that becomes extremely serious and it requires ICU care and all that goes along with ICU care Eventually, your body responds with its own immune response and uses the immune response to clear the virus, and we’re just beginning to understand how long the immunity lasts when you have naturally cleared the virus Those studies are just underway In San Francisco, we noticed the very first number of cases in early March, but I would have to give huge credit to Mayor London Breed and her advisors, including Grant Colfax, who you’ll hear from in just a minute, about the rapid and decisive response that was put in place here in San Francisco

and in the other Bay Area communities, and eventually, the State of California A state of emergency was declared even before the first case was identified in San Francisco, and a shelter in place order was declared before the first death That is unquestionably what we call flatten the curve, and reduces the strain on the hospitals and allowed us to provide world-class care to those patients who do need hospitalization, but we have not been overwhelmed And I’ll let Dr. Colfax talk a little bit more about the decision-making that went into that, and I’m sure there’ll be questions about that during the question period So now it’s my great pleasure to turn the town hall over to Dr. Grant Colfax He is a long-term friend of UCSF, was in San Francisco in the early ’80s when the city led the worldwide response to the AIDS pandemic, so a very experienced public health and infectious disease specialist and a very close partner to UCSF through this entire pandemic Grant – Well, thank you Chancellor, and good evening everybody It’s a real pleasure to join this town hall and to help describe the situation in San Francisco, and to answer questions about this global pandemic Right now in San Francisco, I’ll just go through some numbers and then talk a little bit about our collective approach, and I just wanna start out by saying that UCSF, our partnership with UCSF at the Health Department has always been strong It’s only been strengthened as we take this collective approach The science, the research, the incredible clinical care and leadership shown by UCSF has really provided us at the Health Department with a stronger foundation to respond and best protect our community, and treat the people who, unfortunately, are sickened by this virus So right now in San Francisco, our latest case reports, and I want to encourage people to follow the situation in San Francisco You can go to our city website, our coronavirus dashboard, to see the latest data Those data are updated on a daily basis If you just search for coronavirus City of San Francisco dashboard, it will give you the address But right now, we have 1,019 people who have been diagnosed with coronavirus, 1,019 We’ve unfortunately had 17 people who have died from the disease All of those deaths have been people who have had comorbidities, other conditions, that as we’ve seen across this pandemic, people with other health conditions, cardiovascular disease, diabetes, kidney disease, malignancies, cancers, they unfortunately do worse with this disease And of the 17 people who have died in San Francisco, all of them have had these comorbidities In the San Francisco healthcare system writ large, so across our hospitals, including UCSF hospitals, our Zuckerberg hospital, which is our public hospital, as well as other institutions in the city, we currently have 88 patients with diagnosed COVID-19 in the hospital, and 25 of those are in the intensive care unit So right now, because of the aggressive action that we took with the leadership of our mayor, Mayor Breed, the shelter in place order, the declaration of emergency, even before a case was diagnosed in San Francisco, and further aggressive action and strong partnerships with groups like UCSF, we have flattened that curve of increases in the requirement of our healthcare system to respond Our hospitalizations, and that’s really the number that we’re following very closely, along with our death numbers, those numbers have held relatively steady over the past 10 days, and that has given us more time to more effectively reinforce our response Going forward, our focus has been on, will continue to be slowing the spread of the virus, the so-called flattening of the curve We saw in some countries and some jurisdictions, unfortunately, in the United States where this wasn’t able to be done, the pandemic really overwhelmed the local healthcare systems At this point, we are not seeing that That could certainly change and could change rapidly,

so we’re continuing to focus on sheltering in place, maintaining physical distancing or social distancing, ensuring that people, whenever possible, wear face coverings, whether that be masks or other facial coverings, like bandanas, and ensuring that we provide testing for the people at highest risk for being diagnosed, people with symptoms, people with high-risk exposures, and other people who have come into close contact with people who are at risk for COVID-19 So that’s really our focus on so-called flattening the curve We’re also focusing on everything we can to protect the most vulnerable populations And those are people over the age of 60, people with comorbid conditions, I already talked about that group, and that has been our focus, both with regard to congregate settings, including nursing homes and skilled nursing facilities, in the homeless population, in incarcerated populations, and in our SRO hotels, making sure that people in those highest-risk vulnerable populations have as much as possible, the education, the materials, the resources, the information they need and their families need to help keep these people as safe as possible Our other priority during this response has been ensuring that our healthcare workers and first responders have the materials and education and protective equipment that they need to stay safe We’re working very hard, and UCSF has been an incredible partner in this, and some of you may have been reading in the news about the shortages in personal protective equipment, or PPE, that have really hampered our response, in some cases, to fully respond to this, but with the partnership with UCSF and others in the city, we have been able to maintain our PPE supply It’s been in short supply sometimes, but on a daily basis, we have found a way, and I just really want to thank UCSF for your generous donations of masks and gowns and face shields, things that we desperately have needed in order to ensure that our Public Health response is as where best as possible And then, another focus of our work has been expanding testing capacity Again, very much in partnership with the researchers and the labs at UCSF, as well as our own public health lab, expanding that capacity, and also having to prioritize, where there are situations right now, where we simply do not have enough materials to expand testing as rapidly as we’d like, so we’re having to make decisions about who gets prioritized for testing, and I talked about those groups just now And then, we continue to focus with hospitals across the city to ensure that our response is prepared for a surge So that curve that we talked about, flattening that curve, in terms of the number of hospital cases, the number of people in the hospital, in the ICU, that’s held relatively steady over the past two weeks, which is incredibly welcome news, but we are still focusing on ensuring that our hospitals have enough capacity Right now, across our systems, we have about 1,200 medical-surgical beds and just over 430 ICU beds that are available, should this surge occur I will also add that we are, along with our testing, we are launching in partnership with UCSF and Dimagi, an app company, an aggressive method to do contact tracing as a key part of public health response in infectious disease So this is not only focusing on the testing part, so when someone tests positive, but having an intervention that is able to reach out to people who may have come into contact with that person to find out if they are at risk for the virus and whether they need to get tested, and to provide them with educational materials to help them understand what exposure may have occurred, and then giving them the information to call the public Health Departments if they have additional questions, or have symptoms, or otherwise need assistance for themselves or their family So the last thing I will say, one of the things we’re concerned about at the health department and we continue to focus on is the issue of health equity In this epidemic, we have issues of health equity

in times of before the pandemic occurred, and we’re very focused on working with community stakeholders, community leaders, to prepare as much as possible with prevention and cure efforts, particularly in communities of color, where health inequities are further worsened by socioeconomic disparities, and then this pandemic is likely to continue to affect those communities even more so So we’re very focused on outreach, and engagement, education, and action with community stakeholders in those communities So I will stop there, and we will go on to the next speaker Thank you – Thank you, Grant Now Mark Laret, the president and CEO of UCSF Health, and my partner at UCSF, will talk a little more about hospital preparedness and what our healthcare workers are experiencing – Well, thank you Chancellor Hawgood, and welcome everybody, to this town hall tonight I just also want to add the thanks of the thousands of UCSF faculty and staff and students to Grant Colfax and to the mayor for their vision and leadership in being first to the plate to put a shelter in place on March 16th, the day before Saint Patrick’s Day, and as a result, we are seeing a much less severe problems than other places around the country I would just say that on the hospitals, when we first became aware of the potential for this issue and the possible surge, put an enormous amount of effort into creating extra capacity, all the hospitals in San Francisco have At UCSF, some of you may have noticed, we’ve added some tents in the emergency, the parking lot, emergency room parking lot, to screen patients We took an entire floor of the hospital on Moffitt and, or excuse me, 15 Long, and converted it to a COVID-suspect or COVID-patient unit We’re reopening our Mount Zion hospital on May 1st with about 50 beds that we could serve COVID patients, and we supported the city and county of San Francisco, working with Dignity Health in opening a unit at Saint Francis Hopefully, we won’t need all that capacity Today, our census of COVID patients was 17 at UCSF Couple days ago we were at 23 That was our high water mark, so hopefully, we’re on our way down But as Dr. Colfax said and Chancellor Hawgood said, continued vigilance is going to be the cull of the day Just a few comments about some of the challenges and then a little about UCSF’s role, as Grant Colfax mentioned, the PPE, which wasn’t commonly discussed before this, but everybody knows what PPE is now, was a tremendous problem and we were very frustrated that there was no organized way to get it But in stepped friends, including Marc and Lynne Benioff Salesforce team, who put people on the ground in China to help us source PPE, and with their help, we’ve been able to purchase, hopefully, adequate stores of PPE that we are sharing with the city and county of San Francisco, other public hospitals in the area, other UC medical centers, and so forth So we’re hopeful that we’ve made progress there In the Q&A, you might wanna, I saw there were some questions about testing Chancellor Hawgood can talk about that in detail, but one of the great frustrations about testing is the single biggest challenge we’ve had is to have enough swabs to even collect the samples in the first place Kind of crazy, we’ve developed spectacularly sophisticated testing equipment, but there’s a national shortage of swabs So in the to-do list to remember after this is over, is we’ve got some things to do to make sure we’re better prepared as a country for the next COVID, whenever year that comes I think I’m particularly proud, and I think all of you can be proud that in San Francisco, once again, we’ve shown the way When there were questions about pregnancy and COVID patients,

it’s our team of national leaders, research leaders, who stepped up to do the very first research on that The Chan Zuckerberg Biohub, which has been just a tremendous initiative, offered to help us with the cost, providing free testing for public health departments in the surrounding, or in the nine Bay Area counties, and we’re just so pleased that we’ve been able to do that as as service to our region, something very special about UCSF Some of you may have seen that because our patient activity has been relatively low, we were able to send 20 physicians and nurses to New York last Saturday to spend a month on the front lines, and today, Chancellor Hawgood and I saw some of the feedback from the people on the front lines, and it’s a harrowing experience We not only want to help there, but we also want to learn so that in the event that we have a serious surge in the Bay Area, that we’re completely prepared in that we’ve learned a lessons that others have as well And finally, I’ll just say that the members of Congress and the administration have spent a lot of time talking with Chancellor Hawgood and me and others, Dr. Erlich, who will be speaking in a moment, about what our needs are, what our experiences are here, and we’ve been able to, in our way, help shape public policy Obviously, we’re so proud to have Speaker of the House, Nancy Pelosi representing us and she’s been a tremendous ally, as have our two U.S. senators So we’re feeling good at the moment about our patient volume We’re, like most hospitals, all very nervous about what this means for all of the other patients, the non-COVID patients, how they’re going to get their care, how we’re going to get them cared for, because before this whole COVID-19 thing started, our hospital was operating at absolute capacity So we need to be able to take care of those cancer patients, those GI patients, those orthopedic patients, and that will be on our to-do list in the coming weeks and months But first things first, we need to get through this, this crisis, and I’ll just end by saying that as a public university, we are honored to be partners and partnered with, completely with the city and county of San Francisco in helping fulfill the mission of serving everyone in this community That means all members of the community, including those who are in the most difficult economic circumstances So we want to be here to help everyone, and you can always count on UCSF So Chancellor Hawgood, I’ll turn it back to you – Thank you Mark Now, I’d like to invite Dr. Susan Erlich, who is the CEO of the Zuckerberg San Francisco General Hospital For those of you who may not know, UCSF has been a partner for over a century with San Francisco General Hospital, widely known as the best county hospital in the United States All of the physicians at that hospital are UCSF faculty members, and we are so proud and delighted to be a strong partner for Zuckerberg San Francisco General And we were thrilled when Susan was appointed as the CEO just a couple of years ago now, or maybe longer, as she’s a long-term friend of UCSF, and the partnership has never been stronger Susan – Thank you very much, Chancellor Hawgood I’m so fortunate to be here with all of you this afternoon and to share a little bit about what’s going on here at Zuckerberg San Francisco General Hospital I want to start my remarks by expressing some gratitudes, and some of these are gratitudes that others have shared, but I would like to underscore them First, I feel so fortunate to be in a city in a region where the leaders and the public health professionals have come together to work and ensure the health and safety of all residents through the shelter in place and other orders that have so far, flattened the curve of the COVID pandemic here in San Francisco, and also helped save us, literally, in the healthcare system

I feel incredibly fortunate to be working with a team of people at ZSFG, including our UCSF partners, but so many people here, including the people who feed us, the people who take care of our buildings, our nurses, so many people who have stepped up in truly extraordinary ways to serve the community here, and especially the most vulnerable who we serve here in the community And then, lastly, we are fortunate here to be supported by the entire community to do the important work of caring that we do here There have been tremendous philanthropists who have stepped up to support us and support many of the things that we’re doing during this pandemic So let me say that the planning for meeting the challenges of the pandemic started weeks ago here at ZSFG, both internally, and as Mark was saying, with other hospitals in the city And the way I would characterize that planning is that it’s been robust, it’s been data-driven, and it’s been truly collaborative in many ways And because of that and because of our team here and our team in the city, we are ready, and we are serving the community well Just to say a bit about the way a surge plan works and the way our clinical operations work here, it’s best described by what we call the four Cs And those four Cs are first co-boarding patients in all areas of the hospital, urgent and emergent care in the ICU, and in medical-surgical areas, co-boarding the patients who are COVID-positive and who are awaiting test results in very specific areas They are cared for by dedicated care teams so that we can ensure that the fewest people possible are exposed, that we are conserving PPE as well as possible, and that people become expert in that care We’ve also really changed our capacity to be able to care for this population We’re in a very interesting time where overall, the capacity in the hospital is really changed We’re seeing far fewer patients overall, and yet, there are certain parts of the hospital, in particular, the ICU, which have been greatly impacted, and serving more people than they typically do because of the pandemic And then, we work very hard on containment of spread, and that includes restricting visitors and staff only to the most essential, and making sure that there are the fewest number of people possible here, but enough people to be able to take care of the patients we need to take care of This plan, of course, has been implemented in conjunction with the city, with the Department of Public Health, and with all hospitals and with our internal teams The way we do this is we meet twice every day with our incident command team to understand the situation and remove barriers for our care teams And then, we meet twice weekly with hospitals in the city to better understand the citywide capacity and make sure that we’re all able to meet the demands So where are we now? Well, Grant mentioned that the overall caseloads in the city, they’ve been slowly rising We’re at about 1,019 today We’ve had 17 deaths Our hospitalizations have, across the city, have been basically flat There were 88 as of two days ago, and slightly fewer than a week ago when there were 93 Today, at ZSFG, we have 25 COVID-positive patients, 12 of whom are in the ICU, and 10 of those who are on ventilators, and 20 people with tests pending, for a total of 45 This puts us at a level orange in our surge plan, which has been fairly steady over the past three weeks What I’ll say is at ZSFG, we’re serving about a third of the patients who are hospitalized in the city, and there’s a reason for that, because we are serving and we always have served the most vulnerable in the city And there are really two populations that we’re concerned about here who are among the most vulnerable First is the Latinx population, who have been greatly disproportionately affected by this pandemic About a quarter of those tested in the city are Latinx, tested and positive are Latinx, and that compares with about 15% representation in the population overall The other very vulnerable population that we’re concerned with is the homeless population And many of you probably read about the number of people who were positive in the MSC Shelter South Some of those we’ve seen hospitalized,

very few, but we wouldn’t have fully expected to see all of those positive at that shelter need hospitalization so far That might happen over the next week or two So overall, we’re cautiously optimistic, as I think has been expressed by other speakers here this evening We remain prepared, we remain ready to take care of all of the community, and here at ZSFG, especially those who are the most vulnerable Thank you very much – Thank you Dr. Erlich, thank you all I will now turn it over to Lisa Cisneros, senior director of Communications, who will serve as our moderator for the Q&A portion of our program Lisa? – Thanks, Francesca So question for Dr. Erlich About how many of the thousand patients have totally recovered? – Speak to that for the thousand patients, or for the thousand people overall, and that’s likely because most of them have not required hospitalization We have seen good recovery here, even among the people who have been in the ICU I heard of a story today of a person who had been in our ICU, has been actually hospitalized for the past two to three weeks, has been in the ICU more than once, and is ready to go home So we’ve definitely seen recovery, even of the sickest patients we’ve seen here, but I’m sorry, I can’t address the thousand patients overall – Okay, thank you – Perhaps I could just briefly I think the experience we’re seeing in San Francisco is similar to the worldwide experience Again, over 80% of the patients recover on their own without needing significant medical care It’s that smaller subsection that need hospitalization Again, the majority of those survive and go home, and it’s truly only the vulnerable populations that Dr. Colfax mentioned, particularly those with what we call comorbid disease, preexisting heart disease or lung disease, that we really are concerned about – Okay, great Here’s a question for any of the physicians As a senior citizen who is still working, can I expect additional protections in terms of returning to work after the general population? – Grant, do you wanna tackle that one? – I’m sorry, I’m tryin’ to, let me, I think that if you’re a member of a vulnerable population, those are the six, one of the questions is as we flatten the curve and ensure that people take proper precautions, I’m taking the question is after the most restrictive shelter in place is lifted, what sort of protections will be in place for people at higher risk, such as people over the age of 60? I think it’s, I can’t be specific, but I think it’s likely as we move forward that taking general precautions, including wearing masks, ensuring that basic, good infection control hygiene, such as washing your hands, ensuring that you don’t go to work where people, or engage in the areas where people are sick if you can avoid that Those are likely to be some of the broader public health measures that we need to take And I think it’s important to realize that it’s going to be awhile for all of us before (chuckles) life returns to what we might think of as normal before the pandemic, and especially for people in those vulnerable populations, as it sounds like this person may be There are going to need to be specific interventions to help protect them after the shelter in place orders are lifted, when they are lifted It’s hard to speculate exactly when that would happen, but I would expect a period of time where doing things, like wearing masks, reinforcing those general public health infectious disease control measures, and then doing some degree of the physical distancing for the people who are particularly high-risk could be something that would be looked at in the future – Okay, great I guess also, for you Dr. Colfax, now that it has been four weeks since shelter in place orders were instituted, how do you think most newly diagnosed patients are contracting the disease? – So I think that there are a number of ways

Unfortunately, some people are not able to fully shelter in place, and that there is transmission from known contacts, other people who have become infected, and we’ve seen clusters of infection, so in places, in congregate settings that Dr. Erlich mentioned, in places where there are multiple multi-generational families living together, and in places where there’s been apparently sustained contact despite the physical distancing So I think that the key message here is that the shelter in place order, it was meant to slow the spread of the virus Very few people, if anybody in the public health field thought that it would stop it So this is really a measure to slow the spread so we can prepare as we have, and for our healthcare system not to be overwhelmed, as we saw, unfortunately, in New York But we do expect to see more cases over time We especially expect to see more cases as more people get tested over time The thing to really watch are the number of people in the hospital, with regard to the fact that they are the most seriously ill, and to follow that trend over time – Okay There’s a question, how can folks volunteer for contact tracing efforts? – So maybe I could take that Our Department of Epidemiology and our Global Health Science Department are taking this on in a very serious fashion Dr. George Rutherford has put together a curriculum to train people who otherwise were not trained public health officials in the skills of contact tracing And Dr. Colfax can comment more, but we anticipate we’ll need more than 100 such individuals to manage just San Francisco, and then you amplify that across the state It’s a large workforce that has to be trained Fortunately, the training is relatively straightforward We have about 40 to 50 volunteers from the UCSF community who are either trained up or are being trained right now to join Dr. Colfax’s team to get out there to do the contact tracing, ’cause it is the key issue I think of it a little bit like post forest fire, when the fire has gone through but there’s still brush that hasn’t yet burned What you have to do is identify the embers, the places where there can be a flareup, and very quickly, get out there in a public health workforce, do the contact tracing, do the testing, and do the quarantining so that we acknowledge that likely four months, if not longer, we will have flareups in the community, but the key is to recognize them early, do the contact tracing, and contain them, put out that ember before it becomes yet another raging forest fire So there are volunteer efforts through either the Department of Public Health or through UCSF, and we will need to stand up a significant workforce – This question is about testing Will there be a time in the next three months or by fall when it will be feasible for everyone to get tested? – So we have ramped up our testing capacity greatly We have gone from being able to do less than 100 tests a day, four weeks ago, to now being able to do over 2,000 tests a day As Mark Laret mentioned, we have a supply chain issue with the swabs, but we are working very hard on that I think the larger question is does it make sense to test every single person? We do need to test a cohort with people that we can follow over time to understand how the virus is moving around in the community But that is not testing everybody, because just if you have a negative test today, you’re just as much at risk of becoming positive tomorrow And clearly, it’s not feasible to test everybody, every day So we have a program that we are developing that we’re working closely with Dr. Colfax and his colleagues where we can start to do what is called sentinel testing, testing of groups in the community to understand the incidence of the virus in the community, and also understand what we call a prevalence of COVID-19, that is, how many people have had an infection that may not have been tested for,

but we can now look for antibodies But that is a epidemiological population screening level to help our public policy officials make good decisions It’s not about testing every single person, every single day – This one is also for you, Chancellor What forms of COVID-related research are currently being conducted? – At a time of high anxiety and some very dark pictures that we’re seeing from other cities and other countries around the world, the research response by our UCSF faculty and students has been truly heartwarming We shut down what is the second largest biomedical research effort in the country, if not the world, in order to do appropriate social distancing with one exception, that is labs who pivoted to do COVID-19 research I would say that there are three major areas of investigation that we’re pursuing literally around the clock One is better diagnostics, more specific tests, both viral tests and antibody tests, that have shorter turnaround time so we can get the results back quickly One of the antibody tests that we’re working on is there are a very special antibodies that we call neutralizing antibodies that are important to know about, ’cause what they do is give us an assurance that the person who has neutralizing antibodies is, in fact, immune There are not commercial tests for those at the moment, so we have labs working aggressively to come up with those specific tests We’re also looking for drugs that could interfere with the viral replication, drugs that are already FDA-approved for other purposes that could be repurposed in the timeframe of this particular seasonal cycle And then the third, of course, is vaccines That’s what we need to truly get community immunity It’s not going to happen by enough people being naturally infected to get community immunity That is have to come from vaccination, just as it does with seasonal flu So they’re the three areas It’s incredibly exciting to see the teams just devoted to this, and the other thing I would say that is exciting, we’re not filing any intellectual property on COVID-19 research We don’t want this to be about patents, we want this to be about cures And the collaboration is enormous I’ve been on the phone four times in the last two days with colleagues at Stanford and Berkeley, standing up research teams, and we’re reaching out to colleagues in the Pasteur Institute in France, universities in New York, and that’s happening everywhere around the world At a dark time, there is a very shiny, bright light that I’m excited that UCSF is playing its role – Great Now for Dr. Colfax, after already one month of shelter in place, I am concerned about patients with semi-urgent medical care needs When should community physicians expect to be able to open their offices for semi-urgent patients, assuming offices abide by social distancing guidelines? – Yes, and I appreciate the question and I just want to thank everybody in the city for adhering to the shelter in place order and doing the physical distancing, also known as social distancing I think we are taking a hard look at the data There’s a real challenge here, because we know from the research that if we back away from the social distancing orders too quickly, that the virus can surge very, very quickly So we’re working with researchers at UCSF, modelers at UC Berkeley, talking to global health experts who are watching situations in places like South Korea and other places to figure out in an evidence-based way, based on the facts and the science, what are the steps that we would recommend to ensure that people with semi-urgent health conditions, chronic health conditions, can get the care that they need while not putting unnecessary risk to them or to the public at large that will put us at risk for a coronavirus surge So I think it’s too early to be as specific as perhaps the questioner would like us to be, but we’re certainly looking at it and the decisions will be iterative, but they will also be based on science, data, and facts, and on collective input, including from many people at UCSF and the health department – Okay

This is a two-part question for UCSF and Zuckerberg San Francisco General Are you seeing large numbers of staff getting sick? How many are tested versus those who are able to stay at home versus those who are admitted into the hospital? – Well, this is Mark Laret, I’ll just answer The answer is no, we’re not seeing large numbers getting sick I think our total numbers today across, that we’ve had reported to us, are in the 50 to 60 range across the entire campus In most of those cases, we believe, are individuals who have picked up the virus in the community In some cases, there’s a concern that healthcare workers working side-by-side may even be transmitting it to each other, even more than getting it from patients So it’s something we’re watching very, very closely We’re collecting that data The state wants that data, the city is asking for that data, and I think it’s a very important for us to make sure that we’re protecting our healthcare workers They’re obviously, when we talk about being ready for a surge, it isn’t the hospital beds that are going to matter, it’s whether we have the doctors and the nurses and the respiratory therapists there That’s what really matters most – Dr. Erlich? – Yes, so here at Zuckerberg San Francisco General, we have a very similar circumstance On a typical day, we have 5,500 people who work here and we’ve had fewer than 10 people that we know of who have tested positive And just as Mark says, it’s really important for us to be sure that we’re doing everything possible to protect our workforce So, for example, not just making PPE available where it is appropriate for patient care, but also, now, we have a policy just as UCSF and other hospitals do of universal isolation masking so that each of us is not spreading disease to others So we’re doing everything we can with PPE, also with contact tracing So we have a very active occupational health team here who is testing our workforce as appropriate for symptomatic workers, who is doing contact tracing then, once we have a positive case, and also advising our workers about being here or being at home and making sure that they are as healthy as possible – Okay, here’s a question I think perhaps for Dr Colfax or Dr. Erlich, what is the breakdown of gender and ethnicity for COVID-19 cases and fatalities in San Francisco? – So I can provide some general information there So again, if you go to our COVID-19 dashboard for the city, it some rises, the data, with regard to that question Generally, what we are seeing is what we’re seeing nationally, in terms of the gender distribution It’s about 60% male, 40% female Those numbers are updated on a daily basis as test results come in In terms of the deaths, we haven’t released that information Thankfully, the numbers of deaths have been relatively small in San Francisco Those will increase over time, but because of confidentiality issues, we need to have those numbers larger before we show those specific breakdowns But I will say, with gender, it’s consistent with the national and international data that, unfortunately, oh, that males are more likely to die from the disease than females – Can you speak to the ethnicity part? – Oh, so the ethnicity numbers, again, those are up on our dashboard As Dr. Erlich mentioned, we are seeing, and as I mentioned in my earlier remarks, we are seeing signs that communities of color are being disproportionately affected, and again, that’s a deep concern to us and we’re working with stakeholders in those communities to ensure that they are supported and have the materials they need to better prevent the disease where possible, and that they have access to healthcare And again, those numbers are updated every day

at the COVID-19 dashboard website – Another question for you Dr. Colfax Would you mind sharing more details on how we will preserve the privacy of patients as we partner with the contact tracing app? – Sure, so privacy is incredibly important in these situations, and I just think one of the key things in contact tracing that we need to earn the trust and the endorsement of stakeholders who are using the app that they see and feel the value for themselves, their family, and their communities We do have a team, again, that’s working with UCSF, but a team that knows how to this well They did it well before the pandemic for other infectious diseases, like tuberculosis and HIV A lot of our contact tracing work is going to be based on our legacy of doing this well with HIV, and privacy is paramount So the information that will be collected will be protected We will only collect information based on public health need I wanna emphasize that immigration status is not something that will determine how or where somebody would be cared for, and we’re not collecting some highly sensitive information, like social security numbers, or asking people about income So it’s vitally important that we earn the trust and that people see this as a resource, and it is a resource One of the main goals of this contact tracing is that people know, one, that they have potentially been exposed, that they have someone to reach out to and to talk to in a consistent way This is not just gonna be a one-time tax, this is going to be establishing a conversation and hopefully, a relationship so we can make sure that those people and their families get the information, the care, and the testing that they potentially need to ensure that they stay as healthy and protected as possible, as well as their community I would also add that the app is gonna be done in multiple languages, and approaching this from a culturally humble and culturally confident way is the foundation of our work going forward – Thank you so much With that, I will turn it back to Vice Chancellor Vega, for her closing remarks – Thank you, Lisa I would like to thank all of today’s speakers, Chancellor Sam Hawgood, Dr. Grant Colfax, Mark Laret, and Dr. Susan Erlich, and I would like to thank everyone that participated in this evening’s discussion It’s important to realize that we are truly a global community We are all in this together, and through continued collaboration, we will get through this public health challenge as we’ve done before As you’ve heard tonight, this current crisis underscores the importance of academic research, public health expertise, and collective decisions and actions based on science Thank you again for your time this evening Be well