COVID-19 Digest and Cross-Campus UCSF Task Force Established
With the leadership of ID specialists across all UCSF campuses, Diane Havlir, MD and Brian Schwartz, MD have established a task force to provide education, communication and research updates that will be complimentary and integrated with Hospital, city (San Francisco DPH), state, national and global efforts and hands on guidelines.
We will be providing weekly digests with up-to-date information assessed by our ID specialists. Please see below for our first COVID-19 digest, produced on March 3, 2020.
Task Force Chairs: Diane Havlir, MD and Brian Schwartz, MD
Task Force members: Lisa Winston, MD, Harry Lampiris, MD, Deborah Yokoe, MD,MPH, Annie Luetkemeyer, MD, Sarah Doernberg, MD, MAS, Vivek Jain, MD and Joanne Engel, MD, PhD
Admin support: Chesa Cox, MPH
Update: March 3, 2020
From the Infectious Diseases Divisions at UCSF, ZSFG and VA
There is clear evidence for community transmission in the Bay Area—cases where there is no known direct link to travel or to infected persons. Five new diagnosed patients including two East Bay Health workers were announced over the weekend. This was expected and not surprising, given what is currently known about COVID-19 transmission and circulation. San Francisco’s outstanding Public Health Department is monitoring and responding to our local situation.
Cases of COVID-19 are now being recognized around the United States. There have been 105 cases in 15 states. California is reporting the largest number of new cases (20). Washington State has sadly reported 7 fatalities as of today. Many of these deaths were associated with transmission in a nursing home setting.
Over 90,000 cases of COVID-19 have been reported in > 70 nations. In Europe, cases are now being detected in many countries beyond Italy, and various measures are being taken in these countries to mitigate spread. Some countries have already called for cancelling events where more than 1,000 persons gather; museums, such as the Louvre in Paris, are temporarily closed. Many large meetings—including those in medicine, science and tech—are being cancelled and are choosing to share conference information digitally.An overview of the global situation is updated daily here:
SF Public Health Department lab is actively testing specimens for COVID-19. Each of our campuses are updating their screening algorithms and testing capacity. For information on institution-specific testing, please see contacts and links below at the end of this digest.
The UCSF Task Force can provide updates by ID faculty on COVID-19 to your department, division or team in varying formats: a 15-minute talk, a Grand Rounds, a Q&A session or another format that might suit your group. For more information or to schedule a session, please contact Chesa Cox at [email protected].
Treatments and vaccines are areas of active and intense investigation. There is no proven antiviral treatment for COVID-19. Several antimicrobial agents may have activity against COVID, including both experimental and FDA approved drugs. One promising agent is remdesivir, an investigational nucleotide analogue under active investigation for COVID-19 in two phase 3 randomized open label studies enrolling in Asian countries and a Phase 2 double blinded, placebo controlled NIH-funded study actively enrolling in the US at Univ. of Nebraska Medical Center. This trial has potential to expand to other sites. Remdesivir is also available through compassionate use from Gilead Sciences for qualifying patients on a case-by-case basis.
FREQUENTLY ASKED QUESTIONS
What is the increased risk for disease acquisition or mortality for persons on immune suppression?
Although there are limited data on this, medical comorbidities including malignancy have been associated with higher risks for severe outcomes (data from China). In other coronaviruses, immunocompromised patients may show fewer symptoms at onset but later have more severe disease; it is not known if this is the case with COVID-19. There are no data to determine if people living with HIV specifically are at greater risk of COVID-19 acquisition or more severe disease.
What do we know about COVID-19 spread to children?
In Germany, a schoolteacher fell ill with COVID-19 pneumonia. Of the 114 children exposed to this teacher, 100 were tested. Four children in this classroom have subsequently developed COVID-19 with mild symptoms. There are school closings in Europe where teachers have fallen ill with the disease, but no reported deaths among children.
Can COVID-19 relapse?
There have been reports from China, Japan, and the US of persons who tested positive weeks after recovering from COVID-19 disease. There is insufficient information at the present time to interpret these reports, which could represent assay error, prolonged waxing/waning viral shedding, true reinfection or true relapse. This is an area of active investigation.
If you have any suggested FAQs please send to Chesa Cox at [email protected]
INSTITUTIONAL CONTACTS FOR CLINICAL OPERATIONS
UCSF Health - COVID-19 Preparedness Leadership Team - Infection Prevention Team: Deborah Yokoe, MD, MPH ([email protected]), Lynn Ramirez, MD, MPH ([email protected]), Chaz Langelier, MD, PhD ([email protected]), and Amy Nichols ([email protected])
UCSF Hospital Epidemiology and Infection Prevention COVID-19 webpage: https://infectioncontrol.ucsfmedicalcenter.org/ucsf-health-covid-19-resources
San Francisco DPH link: https://www.sfcdcp.org/infectious-diseases-a-to-z/coronavirus-2019-novel-coronavirus/