Top UCSF Doc Says That We Could Be in ‘A Pretty Good Situation in February’ Where COVID Is ‘Like the Flu’


An optimistic but data-rich tweetstorm from UCSF Department of Medicine chair Dr. Bob Wachter — one of several this week — lays out the case that we could be on the verge of finally subduing the COVID-19 menace, albeit after a very rough January.

SFist had the pleasure of interviewing UCSF Department of Medicine chair Dr. Bob Wachter this week, in our analysis of whether we should go to New Year’s Eve parties. (His assessment? “I wouldn’t do it.”) Wachter has become something of a Twitter phenomenon over the course of the pandemic for his insightful tweetstorms that lay out complicated medical theory in digestible language. And a Wednesday Wachter tweetstorm has gone viral in a good way, as the esteemed physician declares, despite the dire current situation with an explosion of Omicron cases and the return of new restrictions, that “I’ll take you to my Happy Place, with some thoughts on why we could be in good shape – and maybe even great shape – in 6-8 weeks.”

The full 24-tweet thread is definitely worth a complete read, but we’ll unpack the highlights. And the “Happy Place” thread begins in a Sad and Terrified Place, noting that “Case rates are skyrocketing”, “hospitalizations are going up fast,” and that “there are shortages of key tools, including testing (both PCR & antigen).”

But Wachter bets his bottom dollar that tomorrow (actually February) there’ll be sun. Around Tweet 8 of 24, he points out that “With Omicron this infectious, many vaxxed people will get mild breakthrough cases,” but that on the flip side, this “should leave them even more protected vs. another infection.” He adds that “virtually all unvaxxed people, unless they’re being uber-careful, will get infected shortly,” which may bring some schadenfreude, but is a scary proposition for hospitals and front-line workers.

Nonetheless, the likely medical outcome here is that “In any case, society’s overall immunity to Omicron should be far higher in 4-6 weeks.”

But a giant (albeit overdue) increase in access to COVID tests, plus the arrival of the treatment pill Paxlovid will further help us through the slog of the, let’s just call it now, post-New Year’s surge. We are likely in for a very awful January, but per Wachter, “in a month we could find ourselves with an outpatient pill that lowers hospitalization & mortality rate of high-risk patients by ~90%.”

He cites credible data that Paxlovid “lowers chance of a severe case to 1/10th of what it would have been”

Which brings us to a pair of run-on sentences that are absolute music to our ears: “By early February, we could be in a place where Covid is, in fact, ‘like the flu’ – with the vast majority of the U.S. protected through vaccines or recent infections, folks at higher risk having ready access to an oral treatment that markedly lowers their risk, and a healthcare system no longer stressed to the point of perilousness – for both Covid patients & others needing our services. At that point, allowing folks to go ‘back to normal’ might be a reasonable posture – while recognizing that higher risk people – or those who have contact with them (eg, parents of unvaxxed toddlers, people who live or work with the immunosuppressed) – may logically choose to continue their cautious behavior, such as masking and avoiding crowded indoor spaces.”

Obviously, we’ve been headfaked before on the supposed “end of COVID.” But Wachter is one of the smartest people in the field, he’s not running for office nor is he partisan, and he makes an excellent case that “I think the likeliest outcome is a pretty good situation in February.” That’s something we would all cheer for.

But you have a part in making the Happy Place happen. As Wachter advises, “It’s time to be more careful – to avoid crowded indoor spaces (sorry, New Year’s Eve).”

Link to tweets:

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