Bob Wachter on the End of California's COVID-19 Miracle

June 30, 2020

"I don't know about you, but in March I was scared; now I'm mostly depressed..."

Bob Wachter, M.D., has been a bright spot during the often-dark days of the COVID-19 pandemic. A professor and chair of the department of medicine at the University of California-San Francisco (UCSF), Wachter took to Twitter early on to tell the world what was happening at UCSF — and about the disease more generally. He is a gifted communicator who has opinions but doesn't get nasty, writes well, and untangles complicated matters without dumbing them down — all within the confines of Twitter. The UCSF grand rounds on COVID-19 that he hosts are excellent if your appetite runs toward longforms and more in-depth information.

Part of the reason Wachter has been a fresh of air is that California has, until now, been a relative COVID-19 success story. Not quite Krasinkian SGN, but the news out of California has been better than the tidings out of a lot of places. In a worth-your-time, 24-tweet thread that he posted last night, Wachter referenced the state’s track record.

“We made it through 3 months remarkably unscathed,” he tweeted. “On June 1, CA had ≈100,000 cases & 4,000 deaths. In contrast, NY State, with half our population, had ≈370k cases & 30,000 deaths. “The California Miracle” narrative was born; I contributed to it.” Wachter included a link to a Q&A he did with the New York Times.

In the thread, Wachter said that Calfornia Gov. Gavin Newsom, other California officials, and the state’s tech company leaders deserve credit for acting early and having people stay at home. He also noted that California got lucky because it didn’t have a super-spreader event or outbreak at a nursing home or prison.

But now cases are surging in California (and in other states). Here's Wachter:

“While it is easy to pin the new surges on feckless politicians, CA offers a bit of a controlled experiment; even in a state with mandatory masking & a sound re-opening plan, things went sour. Covid wins again.”

Wachter also makes the provocative point that the COVID-19 case and death trends are similar in California (“the star pupil”) and Texas. He slams Texas Gov. Greg Abbott’s COVID-19 leadership as being awful but also says the California-Texas similarity “is an inconvenient truth for those who prefer a simple narrative that attributes everything to clueless, right-wing politicians or to a caricatured view of the populace that says everybody in CA acts perfectly & everybody in TX is a careless ignoramus.”

San Francisco is not surging, noted Wachter, who said that UCSF hospitals have 16 patients, five on ventilators. But he said the uptick in patients at the hospitals is a warning sign. He also noted the that number of infected prisoners at the San Quentin prison (which is about 20 miles north of San Francisco) was over 1,000: “Our lucky streak came to a screeching halt.” The California health system is prepared with hospital, ICU, and PPE capacity, and the state is catching surges early, said Wachter, adding a note of optimism to pretty gloomy series of tweets.

#23 of his 24-tweet thread perhaps reflects the mood of many in Calfornia (and elsewhere):

“I don’t know about you, but in March I was scared; now I’m mostly depressed – depressed that we’ve collectively allowed this to happen, depressed that the light at the end of the tunnel may prove to be an oncoming train. But if any state can turn this around, I’d bet on CA."