UCSF Division of Geriatrics Weekly Updates (4/24/2020) from Chief Dr. Louise Walter
As we are ending our sixth week of sheltering-in-place, COVID-19 cases are decreasing in the Bay Area, but I know for many, mental exhaustion is still peaking. Hopefully our sixth Geriatrics Division Weekly Update helps everyone feel connected about Division happenings. The number of COVID-19 cases in CA is declining (see link https://covid19.healthdata.org/projections). I’m hopeful that thoughtful, incremental relaxation of shelter-in-place restrictions will happen in the next few weeks as we think about what the next phase will look like. Below is a summary of the updates that have been shared with me this past week.
UPDATES ACROSS THE DIVISION
UCSF outpatient programs: Several Care at Home and Inpatient Geriatrics faculty, began staffing a new COVID Respiratory Unit at the San Francisco Campus for Jewish Living (SFCJL). Julia Cremer was our first attending to staff the unit this week. The unit has 30 beds and we will staff up to 20 beds (the other 10 are staffed by Kaiser). This week there have been 2-5 patients on the unit. Faculty taking night/weekend call for Care at Home and UCGC will also cover calls on these SFCJL patients. Also, Leah Witt is providing Geriatrics Consults for a new post-COVID multidisciplinary clinic (OPTIMAL clinic; includes Pulmonary, Geriatrics and Psychiatry). This clinic will be starting soon and plans to see post-ICU patients and those with persistent pulmonary symptoms at 1-2 weeks post-discharge (telemedicine) and then at regular intervals for up to 1 year. Care at Home continues with mostly telemedicine visits as well as mobile COVID-19 testing at home and at assisted living facilities.
UCSF inpatient Programs: Our inpatient workforce remains healthy. While Mt Zion Hospital will open April 29th as a COVID Respiratory Unit, our ACE unit on 15L remains halted as 15L continues as a COVID Respiratory Unit as well. Mobile ACE continues to provide Geriatrics Consultations for all adults age 80 and older on all units of Moffitt-Long hospital. UCSF has implemented COVID-19 screening of all surgical patients and those undergoing invasive procedures who receive their pre-operative evaluation at UCSF. This past week there were no positive COVID-19 tests from screening these patients. On 4/23 UCSF began testing all asymptomatic adult patients admitted to UCSF Health and a select group of already admitted adult inpatients anticipated to have recurring aerosol generating procedures. UCSF has also started in-house testing of plasma IgG antibodies directed against the nucleocapsid protein of COVID-19 to confirm infection in patients with high clinical suspicion, negative COVID-19 test and symptoms > 7 days.
San Francisco VA: Eric, Alex, Rebecca S, Ashwin and Lynn are providing palliative care telemedicine consults to patients in the New York Presbyterian (NYP) Emergency Department as part of a UCSF Professional Service Agreement with NYP. Similar agreements with other New York hospitals are still pending. Alex Smith and Eric Widera created a 5-min video to send lots of UCSF love to Mt Sinai. This video includes ~10 UCSF Geriatrics and Palliative Medicine faculty singing “Don’t Stop Believin” which will be played at Mt. Sinai Medicine Grand Rounds today. On 4/22 the CLC started COVID-19 testing of all CLC residents, staff and providers. Testing all CLC residents was completed yesterday and found one asymptomatic resident who was transferred to the SFVA COVID Unit. The plan is to re-test everyone in the CLC ~every two weeks. The IMPACT team is preparing protocols for COVID-19 testing and care in the community.
ZSFG: ZSFG continues to have the greatest number of hospitalized patients with COVID-19 (~27 patients with ~12 in the ICU) but the number has decreased from a peak of ~35 patients. Inpatient teams are doing well and the ZSFG ACE unit is full as usual. Outpatient Geriatrics is helping primary care to outreach to high-risk older adults and conduct home visits. Many unmet needs are being identified.
EDUCATION: Fellows continue to demonstrate creativity, flexibility, resilience and commitment to providing outstanding care to their patients. While some rotations have been significantly altered due to COVID-related service changes, some continue as before, and some continue with new work processes. Some fellows are doing distance learning. We are checking in with fellows on a weekly basis, which has helped us troubleshoot as challenges arise. Lynn Flint and Eric Widera are also working with all the sub-specialty fellowship directors to plan next steps as we approach a new academic year in a new world. Medical students are working with Pei Chen and Daphne Lo to address needs of homebound and vulnerable older adults, blending wonderful patient care, innovative clinical platforms and medical education that enhances student understanding of the experiences of older adults.
RESEARCH: Mike Steinman chaired a task force about medication management in nursing homes which released its implementation guide, which can be found at:
https://www.pharmacy.umaryland.edu/centers/lamy/optimizing-medication-management-during-covid19-pandemic/. Ashwin Kotwal and Alex Smith presented a Palliative Care Research Cooperative (PCRC) Group Webinar on 4/21 about Palliative Care Research and COVID-19. Also, so far 75 older adults in San Francisco have completed the survey by Carla and Ashwin about the impact of social distancing on well-being and unmet needs.
GWEP: We are working to make our COVID site more accessible to older adults. This site compiles Bay Area resources focused on the impact of sheltering-in-place. Our website has had over 2,000 page-views in March and April with nearly 800 unique visitors, including visitors from China and Canada. The most popular webpages are COVID 19 Resources for Older Adults and Leah Witt’s dot phrase for electronic health records giving guidance about COVID-19 and older adults. See link for more details: Download.
POLICY: Brie Williams’ team released a COVID-19 awareness video for residents in correctional settings. This video features Leah Rorvig and speaks directly to our incarcerated community. It has been distributed within California and Oregon corrections settings. Click here for a short excerpt here.
STAFF: All Division staff continue working from home unless they are providing direct patient care. Karen continues volunteering with Little Brothers Friends of the Elderly by calling Cantonese-speaking older adults weekly. Following this week’s Division Check-In, Sarah Ngo has been collecting photos of things we are doing that bring us joy in our socially distanced workspaces so please send her photos to add to the collage. Here are some pictures that have already been sent to her from Division faculty, staff and trainees:
Also, Brookelle Li, who works with Rebecca Sudore, will be leading a Virtual Yoga Workout on 4/27/20 from 5pm-5:45pm.
CLINICAL UPDATES FROM OUR HEALTH SYSTEMS
San Francisco VA: 1 hospitalized case of COVID-19 at SFVAMC.
UCSF Health: 14 hospitalized cases at UCSF; https://coronavirus.ucsf.edu/
ZSFG: 27 hospitalized cases at ZSFG.
SF Chronicle COVID-19 Dashboard (CA, County and SF#s)
GERIATRICS HALF-DAY
Geriatrics Half-Day is April 29th: 1-4pm (everyone is encouraged to attend)
MAXINE’S WEEKLY TIPS
COPE, is a new program designed for UCSF faculty, staff and trainees to provide additional support to our valued colleagues who are experiencing anxiety, stress and distress related to the COVID-19 pandemic and its impact on their work and family life. Please text COPE to 83972 or visit tiny.ucsf.edu/cope to access on-line coping resources and be directed to in-person resources as appropriate.
WHY ARE ZOOM MEETINGS SO EXHAUSTING?
John Boscardin sent me a link to an article about building in some of the same structure we use for in-person meetings into Zoom meetings (e.g., ending 5-10 minutes before the next meeting, walking between meetings, and using the option to hide your own video (even if others can see it) which is more like normal conversations unless your office has lots of mirrors. Also consider mixing up the style (for some meetings use speaker view; some meetings look at the Hollywood Squares of everyone’s faces; some use audio-only…)
https://www.bbc.com/worklife/article/20200421-why-zoom-video-chats-are-so-exhausting
MORE GUIDANCE TO COME
- I wish I had better news, but UCSF School of Medicine has instituted a salary freeze of next year’s UCSF faculty compensation (FY21) at this year’s level (FY20). This means total negotiated compensation (X+Y) will be the same next year as this year. This freeze affects UCSF and ZSFG salaries. We are not aware of a VA salary freeze although VA salaries generally don’t change much from year to year as compared with UCSF salaries. Salary actions for staff have not yet been determined but we should learn more soon. Please see my email dated 4/23/20 for more details.
If you have other suggestions for maintaining our social connectedness during this time, please email me. Thanks for all you are doing!
Louise
PS: As a former Disney employee, I enjoyed these links Sarah Ngo shared with me to take Virtual tours of the Magic Kingdom, Animal Kingdom, Epcot, etc. There are also unofficial YouTube videos that feel just like you're on famous Disney rides like the Frozen Ever After ride, It's a Small World, and Pirates of the Caribbean.