UCSF Division of Geriatrics Weekly Updates (5/1/2020) from Chief Dr. Louise Walter
As we end our seventh week of sheltering-in-place, it is heartening to see we are on the downslope of this pandemic in California (see link https://covid19.healthdata.org/projections). UCSF and SFVAMC are now screening large numbers of asymptomatic people across SF and have found about 1 in 300 people are testing positive for COVID-19, suggesting prevalence of COVID-19 in asymptomatic people in SF is now << 1%. As we embark on the recovery phase, I hope this seventh Geriatrics Division Weekly Update helps everyone feel connected and united in our multi-pronged Division response to this pandemic across health systems. Below is a summary of the updates that have been shared with me this past week.
UPDATES ACROSS THE DIVISION
UCSF outpatient programs: For the past two weeks, Julia Cremer has staffed the new COVID Respiratory Unit at the San Francisco Campus for Jewish Living (SFCJL) during the day and Leah Rorvig and Candace Kim have provided night-time/weekend phone coverage. The census on the unit has remained at less than 10 patients. We are able to staff up to 20 beds there. Care at Home continues with mostly telemedicine visits as well as mobile COVID-19 testing at home and at assisted living facilities. Laura Perry and Jessica Eng have developed algorithms for prioritizing which older patients need in-person visits versus a telemedicine/telephone visit and shared these during our Geriatrics Half-Day 1pm Program Building session. In ambulatory settings we are assessing which patients must have a caregiver with them during visits and facilitating telemedicine for those not used to technology. Geriatric content about Care of Older Adults During COVID-19 is also now being included in COVID-19 General Update emails from UCSF Health.
UCSF inpatient Programs: Our inpatient workforce remains healthy. Our ACE unit on 15L remains halted as 15L continues as a COVID Respiratory Unit in addition to the new COVID Respiratory Unit that has now opened at Mt Zion. Mobile ACE continues to provide Geriatrics Consultations for Moffitt-Long hospital and our Ortho-Geriatrics Co-Management Service is picking up now that orthopedic surgeries are increasing. UCSF is now performing COVID-19 screening of all patients admitted to UCSF hospitals.
San Francisco VA: Testing all CLC residents and staff for COVID-19 continues every two weeks and SFVAMC is now screening all patients admitted to the hospital for COVID-19. Any CLC resident or VA patient who tests positive is transferred to the VA inpatient Respiratory Unit. SFVAMC is also building up PPE in preparation for the fall. The IMPACT team continues to refine protocols for COVID-19 testing and care in the community. Many Geriatrics faculty were featured in this week’s VA DOM Newsletter (Sublime to Ridiculous SPRING 2020). Eric, Alex, Rebecca S, Ashwin and Lynn continue to provide telemedicine consults to New York Presbyterian (NYP) hospitalized patients whom they follow longitudinally, keeping patients and their families informed and helping with decision-making. Last week, Alex and Eric organized a group of UCSF Geriatrics and Palliative Medicine faculty to create a 10-min video to send lots of UCSF love to Mt Sinai and the link to the video was posted this week: https://www.geripal.org/2020/04/love-letter-to-mt-sinai.html. This video brought lots of laughs and tears and the feeling that Mt Sinai and UCSF are two campuses of one big bi-coastal Division.
ZSFG: The number of hospitalized patients with COVID-19 continues to decline at ZSFG, similar to other hospitals in San Francisco. Anna Chodos, Edgar Pierliussi, Louise Aronson and Meredith Greene have been formally activated to the SF Department of Public Health (DPH) COVID-19 response. They are advising, training, and educating staff in Long Term Care and RCFEs as well as DPH leaders as they develop San Francisco’s recovery response and respond to outbreaks. The ZSFG ACE unit is full as usual.
EDUCATION: We continue to check-in with fellows on a weekly basis. Anna Chang reports that through the new COVID Response Elective ~100 medical students were matched into helpful roles and are making a difference all over the Bay Area. For example, 4 students are working with Anna Chodos to reach out to high-risk patients in SFHN primary care to assess unmet needs around food, income, medical issues and disruptions in caregiver support and then make the appropriate referrals.
RESEARCH: Alex was a discussant during UCSF Medicine Grand Rounds on 4/29. Alex talked about his experience performing teleconsults in New York. Stephanie Rogers is leading a study to identify and characterize all ACE units across the country in order to understand the ACE landscape in the US. And thanks to advocacy by Carla Perissinotto, on 4/28 a message was sent to all UCSF MyChart users encouraging them to complete Rebecca Sudore’s “Prepare for your Care.” The following was included in the message:
Advance planning resources: Many of us are reflecting on the tragedy occurring in our country and across the world, and that unplanned severe illness can impact people of all ages. Advance care planning is an important element of routine medical care. Now is an opportunity to tell your loved ones and health care providers your wishes if you were to get sick. We encourage you to complete the "Prepare for Your Care" in order to create a plan today.
PREPARE for Your Care is an online resource that helps people learn about and prepare for medical decision-making. This evidenced-based tool features video stories in English and Spanish and guides users as they explore their wishes and learn how to discuss them with family, friends, and medical providers. The website also offers PREPARE written pamphlets as well as a Toolkit to help put on a PREPARE Group Movie Event. These Movie Events can be used in group medical visits or in the community. PREPARE also offers easy-to-read, legally-binding advance directives for all 50 states in English and Spanish. Check out PREPARE here: prepareforyourcare.org.
GWEP: We continue to enhance our COVID site which compiles Bay Area resources focused on the impact of sheltering-in-place. Also, Anna Chodos was a featured speaker for a national GWEP webinar “Your State & Institutional Geriatric Policy Makers During COVID-19” on 4/27.
POLICY: Patrice Villars and Eric Widera published a Health Affairs Blog on 4/26 titled “To Protect Palliative Care Patients During the COVID-19 Pandemic, Allow More Flexibility To Prescribe Controlled Substances by Phone.” Here is the link: https://www.healthaffairs.org/do/10.1377/hblog20200422.989316/full/
STAFF: All Division staff continue working from home unless they are providing direct patient care. Sarah Ngo hosted a creative mask show-and-tell on 4/30. Here are pictures from that event.
Also, our Pilates Instructor, Nikita Shirsat, and our Yoga Instructor, Brookelle Li, will be leading a Virtual Workout: Pilates and Yoga on 5/4 from 5-6pm.
CLINICAL UPDATES FROM OUR HEALTH SYSTEMS
San Francisco VA: 0 hospitalized cases of COVID-19 at SFVAMC.
UCSF Health: 19 hospitalized cases at UCSF; https://coronavirus.ucsf.edu/
ZSFG: Decreasing hospitalized cases at ZSFG.
SF Chronicle COVID-19 Dashboard (CA, County and SF#s)
OPTIONAL WEEKLY GERIATRICS DIVISION CHECK-INS
We will continue our optional division-wide check-ins through May.
Next Check-In: Wednesday May 6th from 1-2pm on Zoom (note change in time)
Future Check-ins: May 13th and May 20th 2:30-3:30pm
Geriatrics Half-Day is May 27th: 1-4pm (everyone is encouraged to attend)
MAXINE’S WEEKLY TIPS
Take a look at https://projectcovid19.org/ which was created by UCSF postdoctoral scholar, Nouf Al-Rashid, to share stories of resilience and hope in response to the pandemic from individuals all over the world. Both of these are from the Department of Psychiatry Emotional Well-Being and Coping During COVID-19 website. Also, Psychiatry has a page on Maintaining Wellness for Older Adults and Caregivers!
We also should encourage each other to switch the phrase “social distancing” to “physical distancing.” Social distancing is a misnomer, since we are encouraging physical distancing while we work hard to stay socially connected.
SELF-CARE
Leah Rorvig led an inspirational session during Geriatrics Half-Day 4/29 focused on “Gratitude as Medicine: Three Good Things” based on materials from the Greater Good Science Center at UC Berkeley (https://greatergood.berkeley.edu/profile/eve_ekman). The experience of gratitude encourages us to appreciate what is good in our lives and compels us to pay this goodness forward. It was uplifting to hear participants share good things that have happened: 1) with a patient; 2) with a colleague; and 3) at home.
Kindness and empathy help us thrive. During a crisis, try to offer yourself the same kindness and compassion as you would to a loved one. And when people act kindly, they feel better too. Here are four ways to start.
SUPPORTING DIVISION PARENTS
We are developing a Division list of faculty and staff with kids who would either like support or want to be supports for other Geriatrics faculty and staff with kids. If you would like to join this list please complete this qualtrics survey with your name and approximate age/age-range of your kids by 5/8/20. Caroline will then share the list with everyone who volunteered to participate in this. This will give parents the option to reach out to parents with kids around their kids' age and/or be a resource for parents with kids younger than their kids.
I know this pandemic is stressful for everyone, and it is a particularly stressful time for parents, so please let me know if there are other ways the Division can be supportive.
Thanks for everything you are doing!
Louise
PS: I was sent this video link of Ellen discussing the kid-interrupted BBC Zoom interview, which definitely made me laugh: https://www.youtube.com/watch?v=dmeBMvGhf1g&fbclid=IwAR3V4kyyWx3crTROZ8uF48qLmafO4WeG6Z84Ma2OV36XCyhoAOOPFxy5RcA