UCSF Division of Geriatrics Weekly Updates (5/15/2020) from Chief Dr. Louise Walter

May 15

This is our ninth week of sheltering-in-place and much of the Bay Area will start implementing “phase 2 of reopening” on Monday based on six key indicators (see COVID-19 Townhall Summary at the end of this update).  Hospitalizations and COVID-19 cases are flat or decreasing across the Bay Area as I write our ninth Geriatrics Division Weekly Update. (https://www.nationalgeographic.com/science/2020/05/graphic-tracking-coronavirus-infections-us/).  Below is a summary of the updates that have been shared with me this past week.

UPDATES ACROSS THE DIVISION

UCSF outpatient programs:  We have received a lot of positive feedback from the San Francisco Campus for Jewish Living (SFCJL) for our work on the SFCJL COVID Respiratory Unit.  SFCJL staff are happy and proud of their care on the unit and thank our faculty for providing a “wonderful physician support team.”  There have been no issues or concerns from SFCJL, only compliments.  The PPE remains sufficient and the census on the unit has remained at less than 10 patients.  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: We are excited that we will likely restart partial ACE unit duties the day after Memorial Day—Tuesday, May 26th!  Part of 15L will convert back to our ACE unit and a small part will remain a COVID Respiratory Unit.  The plan is to transfer most patients with COVID-19 to the Respiratory Unit at Mt Zion.  ACE rounds will restart May 26th for COVID and non-COVID patients age 65+ on 15L.  Attendings will not see patients with COVID-19 in person (will use video) and we will do interdisciplinary rounds and recommendations for them.  There still will not be any volunteers or non-clinical staff at Moffitt-Long hospital.  Mobile ACE will continue to provide Geriatrics Consultations for all patients age 80+ in Moffitt-Long hospital through May 25th.

San Francisco VA:  National VA has provided an 18-page document about VA’s plan for re-opening (see Anne Fabiny’s 5/14 email for the document).  Each region (VISN) will select one medical center to start re-opening.  Our region (VISN21) has not yet revealed which medical center will be the first to start re-opening but we should know soon.  If San Francisco VA is not selected as a Lead Center, a June 1st re-opening would be unlikely.  The Community Living Center (CLC) continues to test all residents and staff for COVID-19 every two weeks for those who have tested negative (the vast majority).  The SFVA COVID-19 Telehealth Recovery Work Group is collecting data on the impacts of the rapid shift to telehealth.  Francesca Nicosia is conducting interviews of providers to complement the survey that will soon be sent to all SFVA providers.  If you would like to share your experience in a 20-minunte phone interview, please email [email protected].

ZSFG:  Anna Chodos, Edgar Pierliussi, Louise Aronson and Meredith Greene continue to advise, train and educate staff in Long Term Care and RCFEs as well as Department of Public Health leaders.  They are doing site visits to Assisted Living/Board and Care facilities as part of the DPH COVID-19 response.  Candace Kim will be spending part of her time next year working with Edgar Pierluissi on the ZSFG ACE unit. 

EDUCATION:  We are currently making plans for how to celebrate our current fellows’ graduation, while maintaining social distancing.  We will announce plans soon.  UCSF medical students (Jan Grandi and Pooja Lalchandani) thanked our faculty helping them identify outreach activities that help older adults.  They report than many of their classmates volunteered for community organizations, such as Little Brothers Friends of the Elderly, SF Village and Well Connected.  Two students worked with Anne Fabiny to create an ongoing social call program for veterans living at the Colma Veterans House.  Three students worked with Pei Chen to create an Outreach Call Elective for MS3s to screen older patients for resource/access needs, help patients with Zoom set-up and conduct social calls.  The students all felt it was fun, rewarding and inspiring to care for older persons in our communities.

RESEARCH:  The American Geriatrics Society sent an email this week congratulating the 2020 AGS Awardees which included three faculty from UCSF.  Ashwin Kotwal won a Health in Aging Foundation New Investigator Award, Anil Makam (Hospital Medicine) won the Outstanding Junior Research Manuscript Award, and Alex Smith won the Thomas & Catherine Yoshikawa Award for Outstanding Scientific Achievement in Clinical Investigation.  Alex Smith will present his plenary talk at the 2021 AGS Annual Meeting. 

GWEP: We have enhanced our website of Resources for Older Adults During the COVID-19 Pandemic with new information and easy to follow graphics (https://geriatrics.ucsf.edu/patient-care/covid-19/resources-older-adults-during-covid-19-pandemic).  This website compiles Bay Area resources focused on the impact of sheltering-in-place.  For example, Andrea Gonzalez updated the SF Department of Public Health’s information about where to find food and other resources, and shared her updates with DPH.  Our Geriatrics Workforce Enhancement Program (GWEP) also received supplemental funding from HRSA this week to implement and study telehealth for older adults.  

POLICY:  Eric Widera and Leah Witt were authors on the AGS position statement (and companion paper) focused on resource allocation in emergent situations that was published in JAGS on 5/6: “AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond”: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.16537   

STAFF: All Division staff continue working from home unless they are providing direct patient care.  We know staff are working hard so here are some ways to thank folks (tips from Karen Yuan): use UC Recognize (http://recognize.ucsf.edu/) frequently—write meaningful messages about excellent work on a project or send an email to non-UCSF staff; nominate staff for awards; check-in with staff regularly; celebrate Administrative Professionals Day (yes, that is a thing!); and encourage leadership roles given all our staff are leaders too.

OPTIONAL WEEKLY GERIATRICS DIVISION CHECK-INS
We will continue our optional division-wide check-ins through May.
Next Check-In:  Wednesday May 20th from 2:30-3pm on Zoom

Geriatrics Half-Day is May 27th:
1pm: Program Building/Re-opening; 2pm: Faculty Development; 3pm: Faculty Meeting; 4pm: Grand Rounds (see below)

UCSF DIVISION OF GERIATRICS GRAND ROUNDS IS BACK (Zoom only)
May 27th 4-5pm   *everyone is encouraged to attend
COVID-19 and Older Adults: What have we learned?  How can we do better?
In this Grand Rounds, faculty from the UCSF Division of Geriatrics will discuss three major gap areas underscored by the COVID-19 pandemic, which has disproportionately affected older persons:

  • Loneliness & Social Isolation
  • Long-Term Care
  • Goal-Concordant Care 

The focus will be on what we have learned during this pandemic and how can we do better to improve the lives of older persons in these areas. (see 5/14 email with details)

Zoom link here:
https://ucsf.zoom.us/j/96816136451?pwd=Z0pKUXpSbWVwVmFXeVRzRWZqTythUT09
Webinar ID: 968 1613 6451
Password: 136390

MAXINE’S WEEKLY TIPS
The UCSF Department of Psychiatry has put together a collection of short videos focused on ways we can protect and enhance our own emotional well-being that can be viewed for free on YouTube.

UCSF HR continues to aggregate COVID-related resources for employees.  Latest information includes:

MORE GUIDANCE TO COME

  • There are no updates about the UCSF Health budget or the UCSF School of Medicine’s salary freeze of next year’s UCSF faculty compensation (FY21) at this year’s level (FY20).  Also, there are no updates about salary actions for UCSF staff.  I know this is difficult, especially the uncertainty.  The Recovery Command Center is figuring out what needs to be done but doesn’t know yet the full economic impact of COVID-19 on UCSF.  Awaiting news from the state budget and UC Office of the President.
  • UCSF announced a gradual restart of research activities goes into effect on Monday, May 18th (research website).  However, non-COVID-19 clinical research that can be performed remotely (e.g., clinical research activities without direct human subject contact) should continue remotely (Category 1 research; no change from current policy).  See Maxine’s 5/15 email.  If your research falls into any other Category, please contact Maxine to discuss the need for you and/or your staff to return to work in the office.
  • The Division is starting to prepare for return to work at our Laurel Heights campus so we will be ready when San Francisco enters Phase 3.  Here are some of the steps:
    • The Division will create a shared Google document to help coordinate who needs to be in the office, which office, on which days, and at what time.
    • The Division will make sure we have the appropriate cleaning supplies (hand soap, disinfectant) to keep our work areas clean.   
    • We will need to use Conversa Daily Health Screen tool which asks questions to determine if a UCSF employee or student is cleared to be onsite each day. The online tool can be accessed via mobile phone or home computer: Text "Screen" to 83973 (easiest) or Access site via https://www.ucsfhealth.org/daily-health-screening and click “Take Screener” on a computer or smartphone.  Everyone will need to receive clearance prior to entering a UCSF building.
    • We will need to adhere to UCSF Social Distancing Protocols.  This includes mandatory face coverings both outside and inside UCSF buildings, except when completely alone in a private office, alone in your private vehicle, or while eating physically distant from others. For details, see the UCSF Face Covering Policy.

UCSF TOWNHALL SUMMARY

  • Indicators for Safe Opening (Phase 2):  Downward projection of diagnosed COVID-19 cases or percentage of positive cases; Hospitals have capacity for testing, contact tracing, PPE, ICU capacity, outbreak response and can protect health/safety of people.

For California this means: <1 case per 10,000 residents in prior 14 days; no deaths in prior 14 days; capacity to conduct at least 1.5 tests per 10,000 residents per day; at least 15 contact tracers per 100,000 residents; be able to temporarily house at least 15% of homeless; and nursing homes must have at least a 2-week supply of PPE.  UCSF is conducting 1,000 tests/day with goal of 1,800 tests/day. 

  • We should all be wearing masks when we go outside in public.  Surgical masks will prevent people with COVID-19 from infecting others.  Modeling suggests if the majority of the US population wears masks when out in public, this would dramatically decrease the percentage of Americans infected by COVID-19.
  • PPE is changing at UCSF.  Washable gowns are arriving in June as is new alcohol gel with higher alcohol content.
  • Expect financial tough times even if UCSF gets clinical volume back up since less revenue is generated by health systems during economic recessions as more people lose private health insurance.
  • UCSF parking begins charging again on Monday May 18th at a discounted rate (after being free for 2 months).  See the UCSF Parking webpage for more info.  UCSF Mobile app displays parking availability at Mission Bay lots/garages under MB Open Spaces.

The pace of information is picking up again as we work to move safely into the next phase of re-opening.  Please reach out to me if you have any questions or concerns.

Thanks!
Louise
PS:  A friend of mine who plays the flute for the Pacific Symphony sent me this link to a “quarantine” rendition of the finale to Beethoven’s jubilant Seventh Symphony:
Watch Video

Updates from Our Chief During the Initial Phase of the Pandemic