EVCP Expresso – April 2020

Dear Friends,

There’s no way I can send out a regular installment of Expresso today given how the world has changed over the past few months, so I’m going to use this time with you to share thoughts about how to cope, some of the remarkable stories we’re witnessing, and one writer’s compelling view of the meaning of this experience.

The impact of COVID-19 is astounding, and for many, frightening. There’s an overarching unpredictability to life these days that can lead to a sense that things are out of control, but I highly recommend the wise counsel from Elissa Epel described here. Elissa also invites everyone to tune in tomorrow from 12 p.m. to 1 p.m. for Emotional Resilience During the COVID-19 Crisis: Practices for Health Care Providers, co-sponsored by our UCSF Alumni Association.

Brad Monash also offered great advice a couple of weeks ago, during Medicine Grand Rounds, that I endorse wholeheartedly:

  1. Slow down and practice mindfulness: The rush of daily tasks and news updates as well as disruption in our home and work life can make things seem overwhelming. Remind yourself to ease up, go for a walk, play, or just zone out a bit. And devote some time each day to at least a few minutes of mindfulness meditation (there are countless mindfulness videos on the web: here’s a five-minute meditation I especially like).
  2. Connect with as many people in your life as you can: Many of us have been hunkered down in one place for many days now (at home or at work), and whether you’re with family, colleagues or alone, the physical distancing and isolation can take its toll. Make the time to video-chat with family and friends, wherever they may be.
  3. Fill your days with empathy and compassion: Yes, there are a seemingly endless number of things we can’t control, but there’s definitely one thing we can: our capacity to love and care for one another. Rather than expending psychic energy on the frustration and worry, if not anger, that can easily come from following the news (and I realize this can be challenging!), keep focused on what we can all do to help and support one another, one day at a time.

Regarding the “play” I mentioned in point number 1 above, my friend and colleague, Heidi E. Kirsch, wrote with a recommendation for those working from home and looking for “indoor kids” activities. The quizzical minds of the Puzzled Pint volunteers have been assembling a big spreadsheet with lots of things to do such as escape rooms, puzzles, games, streaming platforms, and more! Folks can add suggestions at the bottom. Don’t take the “kid” in the title too literally – many of these are aimed at grown-ups too.

And, everyone should be aware that UCSF’s official COVID-19 website is the place to go for the most up-to-date information about the pandemic and its impact on UCSF. Please sign up to receive alerts by text message by texting “UCSF” to 333111.

If you’ve been paying attention to the website, emails, texts, town halls, and videos that have been part of our communication strategy, or just looking around at what’s been happening within your own UCSF orbit, then you’ve likely been rather amazed by the remarkable response of our community to this pandemic. While those on the frontlines are working around the clock until we overcome this crisis, every single one of us must do our part to help limit community transmission and, ultimately, help ensure our colleagues’ welfare by keeping our distance from each other. Our resources must be focused on their well-being so that they, in turn, can care for our patients.

There are already many other inspiring stories that will come to define how, once again, the people of UCSF rose to the challenge. Here are just a few that I’ve heard:

The countless acts of kindness by the entire health care team: I heard from a friend who was tested for COVID-19 at the Parnassus outpatient screening clinic. They were grateful for everyone they encountered (phone screeners, clinic staff, clinical nurse, physician, and technician) – reporting that all exhibited the utmost professionalism under what is undoubtedly a stressful situation, and worked together to provide great care. The providers expertly balanced efficiency with genuine empathy and concern. (With relief, my friend reported that the test result was negative.) And underlying all of this is the extraordinary courage and commitment of all health care workers who, despite the risks to themselves, are providing direct care to patients with known or possible COVID-19 infections.

Creating an entirely new COVID-19 testing lab from scratch: Joe DeRisi and his colleagues at the CZ BioHub knew right from the start of this crisis that our ability to test for the virus would be a critical determinant of the outcome, and we needed to boost the capacity of our regular Clinical Lab. Working (literally) non-stop, and bringing the focus of the entire team to this problem, they were able to amass the machines, reagents, and personnel (including about 70 grad student and post-doc volunteers known as the “COVID-19 Ninjas”), and receive the bureaucratic approvals, to get on-line in ONE WEEK(!), surely a world record. As of this writing, they’ve increased our testing capacity from about 30 tests per day to well over 1,000 per day.

Engineering solutions: One of our most critical issues has been the severe shortage of vital PPE needed to safeguard providers from COVID-19. With the ingenuity for which she is known, Hana El-Samad is helping organize efforts to address this problem by hacking their way to solutions. Whenever a ventilator requires adjustment, someone has to go into the negative pressure room – this takes, maybe, 30 seconds. Protocol calls for the individual to shed all PPE after the adjustment. You can imagine the impact on our supply. Hana’s colleagues are working on a way to modify the ventilators so they can be controlled remotely, i.e., so no one has to enter the room. From 3D printing and laser cutting of PPE to building electronics that streamline the operation of our essential medical devices, this group is showcasing the ingenuity and community spirit for which our Bay Area is renowned.

Mapping the virus’ path at the cellular level: Using his “silo-busting” approach, Nevan Krogan quickly brought together a global group of scientists. The team fast-tracked efforts to find the proteins in cells that get hijacked by COVID-19. With these data, the team is now testing promising drugs already approved by the U.S. Food and Drug Administration for other conditions, because they could be readily offered to patients with COVID-19. For an overview of more of the COVID-19 related research taking place at UCSF, I encourage you to watch the flash talks given on March 26. Please go to research.ucsf.edu for current research-related updates.

Bridging disparities in care: I am not surprised that our donors have stepped up their support of UCSF during this pandemic – from helping us purchase a huge amount of PPE to expanding our testing capacity to funding research. But I am especially heartened by the generous donation of $2M from the Heising-Simons Foundation to establish a COVID-19 Response Initiative at the Zuckerberg San Francisco General Hospital and Trauma Center. And we’re partnering closely with the SF Department of Public Health to make sure our testing and other surveillance/treatment protocols are applied across our systems.

And, yet again, our students: Our educators and learners had to transition to online instruction quickly and many found they had some time on their hands due to suspension of clinical placements. With lightning speed, a group of UCSF students showed up for the COVID-19 response – from volunteering to provide child care, to collecting PPE, to arranging for blood drives, and sending shout-outs like this one for our Infectious Disease colleagues. We say this all the time, and it’s true: our students are amazing. Photos below – see for yourself!

These are just some of the countless stories of creativity, focus, and hard work pouring out from our community. But I also want to recognize the central campus units working at capacity to ensure that all of us have what we need to carry on with our duties as much as possible. The Facilities Services team has increased cleaning protocols, Supply Chain Management is tracking down vital supplies, HR is developing staff policies to address the disruption of work, IT is making Herculean efforts to maintain and troubleshoot the technology that enables us to connect from home and to each other, and UCSFPD and security have mobilized to ensure our safety and that of our hospitals. No doubt, I’ve forgotten to mention a unit, but I am grateful for the amount of pitching in that has taken place over the past month.

I also need to emphasize two other aspects of this new reality. First, the significant fiscal toll (real or feared) that is felt by many. The added stress over financial welfare and job security will threaten anyone’s emotional and mental well-being. Remember to support the local businesses that remain open within your areas. Second, the association of sheltering in place with an increase in domestic violence. Please check in with as many people as possible and know about the resources available such as the National Domestic Violence Hotline.

My main message is: stay safe, practice physical distancing and tele-socializing, wash your hands, reach out to someone else and ask how they are coping, and one more thing…express your gratitude to someone working on the frontline – a member of our custodial team, security officer, shuttle driver, or health care worker. I thank you for looking out for one another’s well-being.

As I was finishing up this piece over the weekend, I came across last week’s op-ed by David Brooks in the New York Times, which really struck a deep chord. You should read it in its entirety, but I beg your indulgence to read these introductory paragraphs:

Life and death can seem completely arbitrary. Religions and philosophies can seem like cruel jokes. The only thing that matters is survival. Without the inspiration of a higher meaning, selfishness takes over.

This mind-set is the temptation of the hour — but of course it’s wrong. We’ll look back on this as one of the most meaningful periods of our lives.

Viktor Frankl, writing from the madness of the Holocaust, reminded us that we don’t get to choose our difficulties, but we do have the freedom to select our responses. Meaning, he argued, comes from three things: the work we offer in times of crisis, the love we give and our ability to display courage in the face of suffering. The menace may be subhuman or superhuman, but we all have the option of asserting our own dignity, even to the end.

I’d add one other source of meaning. It’s the story we tell about this moment. It’s the way we tie our moment of suffering to a larger narrative of redemption. It’s the way we then go out and stubbornly live out that story. The plague today is an invisible monster, but it gives birth to a better world.

Take care, my friends, and be well,

4 photos of UCSF students collecting masks and other critical items

Photos: @UCSF on Twitter