Dr. Bob Wachter, UCSF’s chief of medicine, hosted his first COVID roundtable discussion since June late last week, aiming to assess the current pandemic trajectory amid a summer wave of infections and hospitalizations in the Bay Area.
For the introductory Grand Rounds of the new academic year, he brought together three well-known UCSF infectious disease experts with “different but mutually respectful perspectives” — Dr. Monica Gandhi, Dr. George Rutherford and Dr. Peter Chin-Hong.
At the forefront of their concerns were challenges in tracking the pandemic, the emergence of highly mutated subvariants of the virus, and who should get the updated COVID-19 vaccine, which was approved by the Food and Drug Administration on Monday.
Tracking the pandemic
Wachter underscored the evolving nature of the pandemic, emphasizing the increasing complexity of tracking its progress. He observed that “many of the numbers we’ve been following for the past three or four years no longer exist.”
Rutherford compared the task to studying astrology. “There’s a lot in the eye of the beholder, and there’s a lot of interpretation that goes on,” he said.
Nevertheless, the consensus emerged that there is “a small COVID surge” underway based on changes in hospitalization metrics and wastewater surveys.
Over the past month, hospitalizations in California jumped by more than 83%, rising from a daily average of 209 admissions to 383, according to state health department data published Friday. The state’s test positivity rate is also up to 13.7% after falling as low as 3.4% at the beginning of the summer. Wastewater samples from Bay Area sewersheds indicated a doubling of the concentration of SARS-CoV-2 virus since July, underscoring a steady upward trajectory.
Chin-Hong said waning immunity, increased travel and gatherings, and extreme heat events that have driven people indoors have all contributed to the summer swell.
Dr. Peter Chin-Hong stands outside UCSF Medical Center on April 3, 2020, in San Francisco. He recommends the antiviral treatment Paxlovid for any of his patients with COVID who are over 65 or immunocompromised.
Noah Berger/Special to the Chronicle 2020Encouragingly, the upswing in hospital admissions has not been accompanied by an increase in deaths.
The experts attributed this shift to the lower case fatality rate associated with omicron strains compared to earlier variants like delta and alpha. The panel concurred that the virus will likely become less virulent as it seeks to infect as many people as possible rather than causing as much damage as possible.
Gandhi said that COVID is unlikely to be eradicated due to presymptomatic transmission, its capacity to evolve and its widespread presence in animal reservoirs. She argued that it’s now endemic, reflected in the World Health Organization’s decision to lift the public health emergency earlier in the year.
“We will never eliminate COVID,” said Gandhi. “It will always be here.”
Considering variant threats
The panelists expressed little concern about the EG.5 variant — an omicron descendent that accounts for about 22% of cases nationwide — because its spike proteins are similar to those on XBB.1.5, which the forthcoming booster shots target. The vaccine could be available as early as Wednesday.
Turning their attention to the latest variant of concern, BA.2.86, Wachter described it as “the scariant of the moment,” noting that if you look at the spike protein, “it looks like it’s mutated up the ying-yang.”
Dr. Monica Gandhi interacts with a patient at Zuckerberg San Francisco General Hospital on Oct. 1, 2021. She was one of the infectious disease experts who participated in Dr. Bob Wachter’s roundtable about COVID last week.
Stephen Lam/The Chronicle 2021Chin-Hong said while the new variant has more than 30 mutations on its spike protein — equivalent to the evolutionary leap between delta to omicron — its prevalence remains low worldwide, and at least four recent international studies have found that existing antibodies can neutralize it.
“People are calling it a paper tiger now because it looks really scary, but it’s just made of paper,” he said, emphasizing that there is still much to learn about the virus.
Weighing booster recommendations
As the conversation shifted toward updated booster shots, the experts agreed that individuals over 65 and those with compromised immune systems should be the priority recipients. However, there was no consensus about whether healthy individuals who had previously been infected or received previous shots should get it.
Chin-Hong recommended that anyone eligible should consider boosting their immunity, especially with a potential winter surge. He added that there is some observational evidence that the vaccine can reduce the risk of long COVID.
Like earlier vaccinations, the single-dose shot is approved for adults and children as young as 6 months.
Gandhi, on the other hand, urged consistency with the World Health Organization and the U.K.’s approach, which primarily recommends new shots for older individuals and those with comorbidities.
“Because when the world does something different, and we do something different … then people stop listening,” she said. “That means we get less trust, and maybe they won’t take their measles vaccine.”
Rutherford echoed Chin-Hong’s stance, advocating for widespread vaccination to protect against severe disease, particularly in children, where the disease ranks as the sixth leading cause of death.
“It’s the No. 1 vaccine-preventable cause of death in children in the United States,” Rutherford said. “People get lost in the data, but there’s some real issues here.”
How they’re dealing with COVID now
When asked about their personal mitigation measures, Rutherford indicated that he primarily adheres to hospital-mandated masking, while Chin-Hong carries a mask for specific situations, such as visiting vulnerable relatives or air travel. Gandhi, who initially supported mask mandates, expressed concerns about their effectiveness, emphasizing the need for properly worn KN95 and N95 masks.
Gandhi also opined that it was time for the U.S. Centers for Disease Control and Prevention to overhaul its advice for those infected with the virus, as many of its recommendations appear outdated. She cited President Biden flouting the agency’s masking advice last week after first lady Jill Biden became infected with COVID.
Chin-Hong said he recommends the antiviral treatment Paxlovid for any of his patients with COVID who are over 65 or immunocompromised, but he said there is insufficient data on its effectiveness for people under 50.
Some observational data shows it may reduce the risk of long COVID, but he was not convinced that would benefit younger, healthier individuals.
“It makes sense, biologically, because you are taking out the virus,” he said, noting that the risk of long COVID has already decreased with the prevalence of omicron.
Reach Aidin Vaziri: avaziri@sfchronicle.com