UCSF Division of Geriatrics Weekly Updates (5/8/2020) from Chief Dr. Louise Walter

We are now approaching the end of our eighth week of sheltering-in-place.  While the Bay Area continues to see a decline in COVID-19 cases, the number of cases in the California continues to increase (see link https://covid19.healthdata.org/projections).  I’ve added a section at the end of this update to provide a quick summary of the information presented during recent UCSF COVID-19 Townhalls to keep everyone up-to-date.  I also hope this eighth Geriatrics Division Weekly Update helps everyone feel connected across our many programs.  Below is a summary of the updates that have been shared with me this past week.

UPDATES ACROSS THE DIVISION

UCSF outpatient programs:  This week Laura Perry staffed the new COVID Respiratory Unit at the San Francisco Campus for Jewish Living (SFCJL) during the day.  The unit had a successful regulatory visit this week and the unit’s team of nurses and therapy staff have been amazing by all reports.  The PPE is sufficient and facilities for showering and scrubs have been available.  Our faculty are getting credentialed in a speedy fashion and recently completed EMR training today (see zoom shot).  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: Our inpatient workforce remains healthy.  Our Acute Care for Elders (ACE) unit on 15L is still halted as 15L continues as a COVID Respiratory Unit but the plan is to transfer most people with COVID-19 to the new Respiratory Unit 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 continues to perform COVID-19 screening of all patients admitted to the hospital and repeats testing every seven days for hospitalized patients undergoing procedures.  Todd James reports that the Geriatrics Emergency Department is moving forward with Zoom training of ED staff about delirium assessment in the ED.  The training showed how quick and useful an assessment can be in the ED.  There is clear momentum to make the ED more geriatric-friendly.

San Francisco VA:  Our Community Living Center (CLC) has tested all residents and staff for COVID-19 weekly for the past two weeks and is now continuing testing every two weeks for those who have tested negative (the vast majority).  Outpatient Geriatrics Clinic is planning for an incremental re-opening of in-person visits slated to start on Monday June 1^st.  Initially, clinic sessions will be a combination of in-person and telephone visits and providers will have two rooms so patients will wait in a room rather than the waiting room.  Anne Fabiny and Jessica Eng are working on the VA’s visitor policy to allow caregivers to bring frail older adults to their appointments as current policy does not allow anyone to accompany patients.  Kenny Lam continues to frequently volunteer at the VA’s Respiratory Screening Clinic.  Kaitlin Willham and colleagues developed an AGS Geriatrics Evaluation and Management (GEM) Tool for Telehealth.  It is a 2-page clinical guide for conducting telehealth video visits and is available for free here: (https://geriatricscareonline.org/toc/geriatrics-evaluation-management-tools/B007)

ZSFG:  The number of COVID-19 cases in San Francisco jumped on Tuesday after ZSFG Infectious Disease researchers reported preliminary results of a COVID-19 screening program in the Mission District (2% positive rate).  Further results are expected later this week.  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 part of the DPH COVID-19 response.  The inpatient workforce is healthy and ZSFG ACE unit is full as usual. 

EDUCATION:  New Geriatrics and Geri-Pal fellows arrive in July and will have 2 weeks of orientation.  Our current fellows have already started a group e-mail to reach out to our new fellows to lend support and housing suggestions.  Two fellows are coming from out-of-state and three fellows are current UCSF residents.  Louise Aronson’s book, Elderhood, was announced this week as a Pulitzer Prize Finalist in General Non-Fiction: (https://www.pulitzer.org/finalists/louise-aronson).

RESEARCH:  This week we held a symposium for faculty and fellows to present their work that they would have presented at the American Geriatrics Society Annual Meeting, which had been scheduled for this week in Long Beach.  Evie Kalmar presented about the assessment of financial capacity; Ashwin Kotwal presented about loneliness and isolation at the end of life; Sara Nouri (who works with Rebecca Sudore) presented about SES affecting completion of ACP; and Meredith Greene presented about predictors of health service utilization among older adults with HIV.

GWEP: We continue to enhance our COVID site which compiles Bay Area resources focused on the impact of sheltering-in-place.  All my weekly updates can now be found under a new section, “Division of Geriatrics Weekly Updates from Our Chief.”  Also, we also have compiled a list of the incredible number of news stories that have featured Division faculty over the last couple months (https://geriatrics.ucsf.edu/taxonomy/term/25601).

POLICY:  Brie Williams was a panelist on 5/4 for a SciLine Media Briefing about COVID-19: Health Disparities and Vulnerable Populations:  https://www.sciline.org/media-briefings-blog/covid-health-disparities.

STAFF: All Division staff continue working from home unless they are providing direct patient care.  Caroline Sou created a collage of haircuts at home performed by our talented Division members.  Elaine Chow shared a video tutorial that she watched before cutting her husband’s hair: (https://www.youtube.com/watch?v=GsvToVVwzSk).

OPTIONAL WEEKLY GERIATRICS DIVISION CHECK-INS

We will continue our optional division-wide check-ins through May.
Next Check-In:  Wednesday May 13^th from 2:30-3:30pm on Zoom
Future Check-ins: May 20^th 2:30-3:30pm
Geriatrics Half-Day is May 27^th: 1-4pm (everyone is encouraged to attend)
Geriatrics Grand Rounds is in the works so save the date/time: May 27^th 4-5pm.

MAXINE’S WEEKLY TIP

Reminder to try Mid-Day Mindfulness – A Peaceful Pause for All Staff, Faculty, and Learners at UCSF, sponsored by UCSF Spiritual Care Services and the Caring for the Caregiver Program (every weekday, 12 – 12:15 p.m.). 

UCSF TOWNHALL SUMMARY

• COVID-19 Statistics: One third of all COVID cases in the world are in the US.  Most are clustered along the Northeastern Seaboard, but there are concerns about the number of cases increasing in the South and Mid-West.  New projections suggest the number of deaths in the US will increase to 3,000/day by June.  There was a slight uptick in COVID-19 hospitalizations at UCSF due to many factors, including more transfers of complex patients with COVID-19 from outside hospitals.  On Tuesday there were 19 patients hospitalized for COVID-19 across our four hospitals. The positive rate for testing asymptomatic individuals remains low in San Francisco (0.3%).   
• Shelter-in-Place Stages:  Most of California remains in Stage 1 (safety and preparedness) as we prepare for Stage 2 this month (reopen low risk workplaces—retail curbside pickup, manufacturing, more outdoor public spaces; offices when telework is not possible).  Unclear when we will get to Stage 3 (reopen higher risk workplaces) and Stage 4 (end of stay at home orders).
• Recovery Command Center:  UCSF is transitioning to recovery and has developed a new group, the Recovery Command Center, comprised of UCSF Health and School of Medicine Leaders, who will lead recovery planning and future Townhalls (instead of the COVID-19 Preparedness Committee). 
• UCSF Finances/Reopening:  UCSF Health is losing $5M/day and is down $210M since the start of the pandemic.  Expect gradual clinical reopening over the next 2-3 months with the goal to bring back volume, reduce costs, leverage our networks of affiliated health systems to bring care to patients, digital enhancement (e.g. telemedicine) and workforce deployments (e.g., new workflows for testing and monitoring).  Clinical research is also likely to gradually reopen over the next 2-3 months and will need plans for social distancing, staggering work hours to keep density low at workplaces, etc.
• All UCSF Faculty are now considered Essential Workers and are eligible for childcare.  This is no longer restricted to on-site clinicians; it includes clinicians conducting telemedicine visits, educators and researchers.

This truly is a marathon, not a sprint, so please take care of yourselves as shelter-in-place fatigue magnifies.  I appreciate all the great work everyone is doing!
Louise