UCSF Division of Geriatrics Weekly Updates (5/22/2020) from Chief Dr. Louise Walter

May 22

It is hard to believe that we are approaching the end of our tenth week of sheltering-in-place as I write our tenth Geriatrics Division Weekly Update.  All Bay Area counties have started “phase 2 of reopening” and hospitalizations and COVID-19 cases in San Francisco continue to decrease.  Here is a helpful graphic to see where infections in the U.S. are increasing/decreasing: (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:  Care at Home continues to slowly ramp up in-person visits.  Decisions about when a home visit is needed is based on this algorithm below.  UCGC is also conducting more in-person visits focused on those who require a physical exam that cannot be done by phone or video visit.  

Graph

We also will continue to staff the San Francisco Campus for Jewish Living (SFCJL) COVID Respiratory Unit through approximately the end of June.  The unit census has remained under 5 patients.

UCSF inpatient Programs: We will be restarting partial ACE unit duties next week, on May 26th.  Part of 15L is being converted back to our ACE unit and our inpatient team has moved back to 15L.  A small part of 15L will remain a COVID Respiratory Unit.  There still will not be any volunteers or non-clinical staff at Moffitt-Long hospital and the City has not changed hospital visitor restrictions at this point.  Surgeries are ramping up to address the large back-log of cases, which means our Ortho-Geriatrics Co-Management Service is picking up as well.

San Francisco VA:  National VA has decided that one VA medical center in each region will being re-opening first and share lessons learned with other VA medical centers who will re-open at a slower pace.  For our region (VISN 21), the North Las Vegas VA Medical Center has been selected as the Lead Center.  Therefore, the pace of re-opening the San Francisco VA medical center will be slow.  Geriatrics clinic will start ramping up in-person visits in mid-June for those who need an in-person visit.  Alex Smith stepped in to cover the Palliative Care Service this week since Sandra Moody remains in Japan.  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).  We also are now recruiting for a 100% VA faculty position to work in the CLC to backfill for Dr. Laura Collins, who left the VA on 5/15/20 after 13 years of working in the CLC.  She will be missed!

ZSFG:  Anna Chodos, Edgar Pierliussi, Louise Aronson and Meredith Greene continue to be deployed as part of DPH COVID-19 response.  Louise Aronson has trained 47 student volunteers from the SOM, SON, SOP and Graduate Division to help with DPH’s SNF response and 13 student volunteers to help with their RCFE and Board & Care response.  Students have learned about these facilities, infection control, behavioral issues, staffing issues, how to conduct phone surveys and a bit about how DPH works.

EDUCATION:  We are currently making plans for a virtual graduation ceremony over Zoom to celebrate our current fellows’ graduation.  The date will be announced soon.  Also, we will be doing remote interviews of fellow candidates in the fall, rather than in-person interviews. Department of Medicine leadership is creating a “welcome to UCSF” video for fellow applicants next year and will be helping all divisions with best practices for interviewing and recruiting fellows over Zoom.  This week Leah Witt gave a community presentation to the Bay Area Physician Assistants Society about COVID-19 and Older Adults, with a focus on chronic lung disease.

RESEARCH:  So far ~140 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.  Tune in to Geriatrics Grand Rounds on 5/27 4-5pm to hear preliminary results from this study.  Also, this week Anna Chodos and Jocelyn Ko launched the 80 over 80 San Francisco project: www.80over80sf.org.  The mission of this project is to celebrate 80 residents in their 80s and older by sharing their stories and highlighting the richness of experience and diversity they bring to our communities. Please reach out to Anna and Jocelyn with your recommendations about adults aged 80 and older who you think should be interviewed for this project.

GWEP: Our Resources for Older Adults During the COVID-19 Pandemic website is getting a lot of page views at 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 and was a team effort to create: Louise Aronson provided guidance on how most elders would access the information and the resources they needed;  Andrea Gonzalez updated DPH information;  Alicia Neumann came up with a smart way to organize the many pieces of information both logically and practically; and Sarah Ngo and Caroline Sou figured out how to make the website look more grandpad-ish and to cut down on the necessary navigation.  Our Geriatrics Workforce Enhancement Program (GWEP) also received our 2nd Year Notice of Grant Award this week to continue our programs. 

STAFF: All Division staff continue working from home unless they are providing direct patient care.  Sarah Ngo received a WINGS Employee Development Grant for SOM Career Staff Employees to support her course fees for a hands-on artificial intelligence course. Related to our GWEP, Sarah is creating a chart review tool to analyze the use of high-risk medications and applying NLP to identify thematically what patients value during their Annual Wellness Visit.

GERIATRICS HALF-DAY is May 27th
1pm: Program Building (discussion about conservatorship and capacity assessment); 2pm: Journal Club; 3pm: Faculty Meeting (Understanding Division Finances); 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 TIP
Maxine recommends checking out free online Stress-Reduction Mindful Compassion Sessions offered by the UCSF Center for Mindfulness and the UCSD Sandford Institute for Empathy and Compassion.

MORE GUIDANCE TO COME

  • Unfortunately, we have received some more difficult news this week.  UC President Napolitano announced a systemwide pay freeze which affects faculty and staff across all University of California schools.  This is difficult to receive on top of everything else.  The further financial uncertainty of the California State Budget and how it may impact us in the future is also unsettling.  We will be sending an email with more information soon.  Please reach out to me, Maxine or Karen if you have any questions or concerns. 
  • The Mission Bay block 33 project team (Wayne and Gladys Vision Center) has resumed construction activities which will continue through June. Additional activities such as furniture and equipment fit-up will continue through August. While the move schedule is still being assessed, moves from Laurel Heights to Mission Bay are tentatively planned to start in August.  We also have sent some suggestions to the project team for how to reinvent our work spaces due to COVID-19. The project team suggests everyone review the Protocol for Employees Working Onsite which has been posted to the UCSF coronavirus website https://coronavirus.ucsf.edu/campus-protocols/working-onsite

UCSF TOWNHALL SUMMARY

  • The number of patients with COVID-19 hospitalized at our 4 UCSF hospitals continues to fall:  There are currently ~14 patients hospitalized at UCSF (8 in the ICU).  Several have been transferred to UCSF from outside hospitals.  In San Francisco, the peak number of patients hospitalized at any one time was 90 and we are now down to ~52.  Re-opening metrics continue to trend in the right direction in San Francisco except our nursing homes need more PPE supplies.   See SF Chronicle COVID-19 Dashboard.
  • All employees entering UCSF buildings need to receive daily health clearance through the digital Conversa Daily Health Screen tool: 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.  UCSF is in the process of developing a patient and visitor digital health screen tool too.
  • We should all be wearing masks when we go outside in public.  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.  There also is a pilot program to reprocess N95 masks starting May 27th.  Read these FAQs to learn more about the pilot. 

We are all in this together and I appreciate the great work everyone is doing!

Thanks!
Louise

PS:  Francesca Nicosia sent me this song from her mom (a retired opera singer who lives in the UK) and a colleague of hers.  They recorded this video for NHS healthcare workers: https://vimeo.com/418902542

Updates from Our Chief During the Initial Phase of the Pandemic