Surging COVID, masks, and the view from the ICU

Thanks to strong leadership by our local and state politicians, San Francisco so far has avoided the worst of the COVID epidemic. In particular, Mayor London Breed took early and strong action to issue a shelter in place order and the City has been cautiously reopening. While there has been some grumbling (and genuine pain), most people who live here have been supporting these measures, including mask wearing and social distancing.

Even today, the number of new cases remains low (although it has increased a bit) and the test positivity rate is below 1%.

This is all the more remarkable given that San Francisco is a city known for the value it puts on freedom and self expression.

As I watch what is happening around the country, I have been reflecting back on an amazing perspective on COVID published 7 month ago on April 19, 2020 entitled “Heartfelt thank-you from the ICU” by Richard Wang, a former postdoc who worked with me and is now an attending pulmonary physician in the ICU at San Francisco General Hospital.

Here is how he starts and ends:

In my seven years as a practicing physician, I have never taken care of more and sicker patients than I have now.

Caring for critically ill patients with COVID-19 is demanding and laborious. For many patients, even a ventilator does not provide enough support. Often, these patients can maintain adequate gas exchange only if they are positioned to lie on their fronts.

Everyone has had to endure the exquisite anxiety of not knowing exactly where we might find our next roll of toilet paper.

In your moments of frustration, sadness, anger and despair, I hope you remember this: From my view in the intensive care unit, your daily sacrifice has literally saved lives, especially among the elderly, the frail and the chronically ill.

These saved lives are counted in the number of people who never come to the intensive care unit in the first place, because they were never infected, because the chain of transmission was broken by the humble, heroic acts of social distancing and sheltering in place, which all of us San Franciscans have committed to, as a community.

We will soon enter a new phase of the crisis.

In some ways, what comes next may be even harder than what came before. Life may stutter and syncopate. We may take two steps forward, only to take one step back. And yet — in this city that has played an outsize role in the public health history of the United States — I am confident that we will do the right thing.

As we did before, some decades ago during the darkest years of the AIDS epidemic, so have we pulled together today. We have found — as the slogan goes — our Strength in Numbers. San Francisco, I could not be prouder to serve you and stand alongside you.

We will come out of this together, stronger than ever.

The whole think is worth reading as we move into the fall. It is available on the San Francisco Chronicle website here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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