Since the start of the pandemic, Dr Bob Wachter has been a voice of reason and science, both through UCSF’s “Medical Grand Rounds” video series as well as interviews with the New York Times, the San Francisco Chronicle, and J. the Jewish News of Northern California.
When J. spoke with Wachter in May 2020, there was no vaccine and the shelter orders were still new. At that time, he discussed the number of cases and the city’s public health response, and the severity of the issues.
A year and a half later, Wachter, who chairs the Department of Medicine at UCSF, sat down again (virtually) with J. to talk about how long we’re going to be dealing with Covid and how it takes. his own personal decisions about how to live and work.
J .: I know you were quoted recently saying that we are in a kind of “new normal”. Tell me what you mean by that.
Dr Bob Wachter: I think we are entering a period where the forces of good and evil are sort of balancing out. As more and more people get vaccinated, this is the main force for good. On the other hand, when that happens, people usually let their guard down, and it’s a force that will drive business up.
It’s time to embrace a mindset that maybe this is what our lives are like. The things that make us happy – giving it up for a year was one thing. Giving it up forever is a different thing, and I think it leads to a different set of decisions. This leads me to making choices that are probably a bit riskier than what I would have made a year ago, because I don’t think the cavalry is coming.
I will now eat indoors in a restaurant. I went to see James Taylor last week, inside. I wouldn’t have done these things six or eight months ago. But I still do them [now] – with a mask. If you told me that there is no compulsory vaccine [at the venue], I probably wouldn’t go. When I go shopping at the supermarket, I will still wear a mask, even if the rules change and say you don’t have to, because to me a mask is nothing.
But this is not a binary decision. It’s like, “OK, we’re in a new normal, throw caution to the wind, you know you’ve been vaccinated, you’re as protected as you’re going to be, now don’t worry about that.” “
I always act on the mantra that I still don’t want to have Covid. So I’m going to be as careful as I can, but not with the “back off, six months from now you won’t need to do this because things are going to get better.” My mindset is that I am now making choices that I need to be really comfortable with for the next five years.
So we’re going to live with this for a long time. The Covid is not going away?
We will never achieve this mythical goal of collective immunity that we had. That if we get to that number of immune people, the virus will disappear from our lives. If it’s on your wishlist, you can remove it. It just won’t happen.
I can understand that once we get to a very low case rate, [people] just say, “I want the simplifying assumption that life is back to 2019. I’m going to live like it was before.” But you know, they take a little chance to get Covid. And a little more luck, that it is a case of Covid that they will regret having contracted.
We owe a lot of our protection to immunity, but immunity is unstable. [In the Bay Area] we have a very, very high level of immunity largely thanks to the vaccinations. But we know that over time, vaccine protection weakens. We are therefore going to be more and more dependent on the return of these people and another injection. And I would say the vast majority of them will, but it will take time.
The analogy I used is the “repaint the Golden Gate Bridge” analogy, like the minute you’re done you have to start all over again.
There could be a game changer. One is the virus which mutates into something much more benign. It seems rather improbable. The second is that we are releasing a pill that you take once you have Covid that is massively effective. The Merck pill that just got a lot of press two weeks ago cuts the hospital death rate by 50 percent, but the game changer would be the one to cut it by 90 percent, 95 percent.
If you look at the case curve in the United States, it peaked about a month ago, six weeks ago. It’s come down pretty well and now it’s a plateau. I think this plateau is probably those kind of forces pushing against each other.
If I had to bet, would things probably be a little worse or a little better? – I would probably put “worse” because of the waning immunity issues that will impact over time.
What about the vaccination of children? Do you see this making a big change?
I think it helps. Of course, it totally depends on how many kids get it. The best way to think about it is that the higher the level of immunity in the community, the harder it is for the virus to take hold and the less likely it is that there will be major outbreaks.
How do institutions or workplaces decide what is safe? Same counties have different masking requirements.
It is very difficult to have national policies because there are [always] will be major regional differences. But even local policies are tricky.
You know, the synagogue might say, “We’re open and you don’t have to wear your mask! But if I’m 75, I might still want to wear my mask. Certainly, if I was immunocompromised, I would like to wear my mask. You weigh the risks and rewards of everything. For doctors, we are used to this. In terms of [giving a patient] a drug or a test is our way of thinking about making a decision. I think for ordinary people it’s relatively new and really boring and exhausting.
How has the Bay Area performed throughout the pandemic, in your opinion?
Thinking of 2020, I considered the Bay Area to be the least dysfunctional area in the country. When the issues were straightforward – we need a mandatory mask, people need to get vaccinated – there was almost no setback in the Bay Area. The schools were tricky because the problems weren’t simple at all. It’s easy to look back and criticize and say we’ve really hurt kids by keeping schools closed for too long. But there was no way to find out exactly at first.
I look at San Francisco and see that we’re not even at 600 citywide deaths yet, a per capita death rate that’s about a quarter of the national rate. If the country had mirrored the performances of San Francisco and the Bay Area, there would likely be half a million people alive today who are now dead. So I see very little to criticize, and a lot to celebrate.
Do you have any recommendations on how to handle Thanksgiving, when people get together often with family that they haven’t seen in a long time?
If you’re going to say, “I’m not going to visit family on Thanksgiving because I don’t feel safe enough,” first of all, that’s a rational thing to say. I think we have to be very careful not to criticize individual decisions, when they are truly individual and do not harm the community. But if you really want to reunite with your family and say the conditions aren’t safe enough for that, I don’t see any good reason to think they’ll get any better by the next Thanksgiving, or Thanksgiving Day. ‘after. this.
I fly to visit my 91 and 85 year old parents in Florida. I will wear an N95 [mask] on the plane. My wife and I are vaccinated, my parents are vaccinated. I’ll be as careful as possible. But the thought of saying I’m not going to do this – there’s a pretty high chance my dad won’t be alive in a year. It seems too high a cost.