Town Hall: Layoff freeze, clinical research, and care

[Joe Guglielmo]
Welcome and thanks to all of you to our weekly School of Pharmacy town hall meetings. To let you know we are planning to continue to have these 30 minute town halls on a weekly basis for the foreseeable future. As before, our webinar is hosted by Steven Brewer from OEIS, and the Q&A is moderated by Grant Burningham from communications. I thank both of these gentlemen for their assistance on this webinar.

A few tips for the audience to remind you that your audio and video will be automatically muted. Only the panelists can unmute themselves. Note at the bottom of your zoom feature that your chat will be disabled. But if you want to ask questions, please use the Q&A feature. You can submit your questions at any point beginning now. And as has been the case with all these webinars, we will attempt to answer as many of your questions as possible toward the end of the town hall. And then any outstanding questions will be answered in an email or if the request is sent anonymously, we'll present the answers at the next town hall.

I first want to start to thank you. I can never thank you enough for your continued adaptability, your patience during these trying times. I remain immensely proud of how our faculty, students and staff continue to adjust, they continue to identify and solve problems. And these span from research to administration to patient care and education. So again, I'm very proud to be able to serve you as Dean, with everything that you've done during these times.

That said, I do recognize that there have been emotional challenges working and learning remotely and they are continuing. We know that the impact of this coupled with the uncertainty of the pandemic does affect us all. And I want to remind you this week as I did last week, as well, please do take advantage. Go to the UCSF COVID-19 website. And please do use the emotional health and well being page. You'll find all kinds of opportunities to in fact, take care of yourself in a way that sometimes gets ignored when we're fighting the fires of COVID-19. To that end, you may note, I shared an email forwarded from Dr. Renee Navarro, our vice chancellor. I sent that to you last Friday because we have found that the COVID-19 experience, including the shelter in place, may have had some unintended effects for those who experience relationship or family violence. This is on the upswing including at UCSF. And so I want to remind everybody on the call here, please, anybody that's experiencing anything that is in that arena, that resources and help are available, and please do utilize them.

As I have done on every one of these, I want to give you a more general COVID-19 update, first of all, and I'll start with the following. Last week, I informed you, worldwide, there were some 963,000 infected patients, and there were about 50,000 deaths. Today, literally almost to the minute, there are 1,580,000 cases of COVID-19 infection, and there are 94,567 deaths. If you take the US a week ago, in the US, I informed you there were 216,000 infections and about 5,000 deaths. Today, there are 457,000 cases and 16,250 deaths. In terms of California specifically, as of last week, there were a total of 8,155 positive cases in California. And at that point, there were 171 deaths. Today, there are 19,127 COVID-19 infections, and the death rate is up to 501 total.

If I could give a little bit of good news. Last week, I informed you that the projected peak in California was expected to be April the 26th. And they thought that that peak date on April 26 would be associated with 119 deaths. As of today, the University of Washington website that's been the most utilized site to predict peaks and associated intensity of that peak, they now are saying that that peak will be much earlier, they are predicting that the projected peak In California will be April the 15th. So therefore, what, about 11 days earlier than we thought it was. The second thing that is important here, whereas the peak deaths on April 26 was anticipated to be 119, now, that peak now, April 15, will be 67 deaths. And then lastly, I also informed you last week that the total California deaths were projected to be in excess of 5,000 by August the 4th. Today, that projection is estimated to be 1,600 deaths by August the 4th.

And lastly, I always like finishing with what's going on at UCSF. At UCSF, the situation last week, we had 16 patients who are hospitalized at UCSF in various acute care settings, nine of whom were in critical care, and five of those were intubated. As of today, there are 20 patients in acute care, again with a majority in critical care. But I think as you can see, the last bits of information I've given you strongly suggest that we, in fact, are flattening that curve. It is appearing like the peak is not going to be as significant as before. And both the data very specific to UCSF, as well as the California data, is consistent with that conclusion.

Flipping away from COVID-19 updates, as was the case last week, we are going to have some very specific discussions in three areas. The individuals who are going to be joining the town hall today include Fran Aweeka, and I'll say a little bit more about her, but she's going to talk about COVID-19 clinical research associated with the Department of Clinical Pharmacy. Department chair Lisa Kroon will be talking about a novel pharmaceutical care initiative that she's overseeing also related to COVID-19. And Michael Nordberg will be addressing a couple of the memos we received this week, one from the chancellor and the other from the provost, Dan Lowenstein, relative to layoffs and hiring freeze, specifically.

And before we get into those, I want to just make a comment. I want to reiterate something the chancellor has said to all his direct reports, and that is the following. He reiterates, there's little doubt we will be in a severe recession. The question is, how long will it be? He has stated that it's worth looking at what happened the last recession which was 2008, which went into 2009. And he commented to his cabinet yesterday, that at that time, the health care system as well as education in general, he used the word, we're "relatively unaffected" by that recession, unlike the rest of the country. If the same thing happens again, we may have a reasonably good outcome, both in terms of the health issues, as well as the educational side of things at UCSF. However, we don't know for sure. And Michael Clune, who is the chief financial officer, commented that he felt it would be about four to five months before we determine the real risk of this recession, in terms of impact financially on UCSF.

That said, though, we received two emails from the chancellor. The first one was dated April 3, where he stated that he had joined with the UC President and the nine other chancellor's to collectively announced that there will be no COVID-19 related layoffs for all career employees through the fiscal year ending on June 30, 2020. The second workforce update was dated April the 7th, and also from Chancellor Hawgood, who stated that effective April 7, so the day before yesterday, through June 30 also 2021, I will say there's a little bit of silver lining because the was that this was going to be effective through the end of the year December, but I quote him, UCSF will implement a hiring freeze on all open and new positions staff and academic across the campus and in UCSF Health. Before I ask Michael Nordberg, the Associate Dean of finances and administration to comment on these and anything else he wants to bring up, I do want to say that this particular thing he also commented that we must be nimble, once again, we're going to know week by week. how long this is really going to last. And the second thing I want to say to you is, a lot of this is still being worked out. I will say that the direct reports in this case, me as dean of the School of Pharmacy, I will have the ability to provide exclusions to these hires that will allow them to go forward. And there'll be a lot more known in the near future.

So at this point, I want to turn the mic over to associate dean Michael Nordberg. I would like him to comment on both of those communications that came from the chancellor's office and anything else he'd like to bring up as it relates to finance and administration for the school. Michael.

[Michael Nordberg]
So the first thing we can talk about is the no layoff policy. You will notice that it does say career employees, and I think that's to give the health system a little bit of leeway with their workforce, which is not entirely career. Because that, right now, that is where the financial hemorrhaging is happening.

At the control point financial officers meeting today, he told us that hospital currently is losing $4 million per day related to the COVID-19, because we have canceled a lot of elective procedures and only now sort of restarted some other, more life saving procedures that are not related to COVID-19. But since the majority of our employees are career employees, I think the workforce of the School of Pharmacy is relatively safe, but do note that it does goes until June 30, 2020.

The hiring freeze—this is related to the overall financial impact that we're anticipating with the recession, which is verging on something about the scale of the Great Depression at this point. So we're going to look in the school to come up with some criteria to present to Joe as to what we feel like critical positions that might need exceptions. One of the obvious areas is our research engine. As new grants come in that require additional personnel and particular say postdocs that have specific technical skills that are not in our current workforce that we need to accomplish the goals of those research, there will be exceptions for that. We will need to keep our educational mission strong as well. And so critical positions in that workforce will also likely be exempted. On the rest of the administrative front, I think we're going to try as much as possible to stay in the spirit of this and hold the line, because at this point, we really don't know what the impacts the financial impacts are going to be. And that's really about all I have to say, Joe.

[Joe Guglielmo]
Thank you, Michael. And please, please do feel like you can provide questions for Michael that we could answer at the end. And again, if we can't answer them, by the time we're done, we will answer them subsequently. So now, I want to point out again, the scientific mindset that continues to be at play throughout the school and that's all of you during this pandemic, and the focus over the next several minutes is going to be on the Department of Clinical Pharmacy. And the first individual that I'd like to present is Dr. Fran Aweeka. Dr. Aweeka is the director of the Drug Research Unit. She also serves as vice chair of research for the Department of Clinical Pharmacy. She's going to provide the listeners with a COVID-19 clinical science School research update.

[Fran Aweeka]
Fran, thank you very much, Joe. I did take the liberty of focusing primarily on the Department of Clinical Pharmacy. And as you all know, we're an extremely diverse department. We have 45 primary faculty with research areas that span everything from clinician-based inquiry as part of clinical trials, to focused clinical pharmacology studies that are aiming to really optimize the way drugs are used, to pharmaco-epidemiology to public health to pharmaco-economics, and even on to education research. So I wanted to provide a rather balanced view of what the Clinical Pharmacy department does. And as is true for our basic translational scientists in the other departments, our faculty are just as eager to try to apply their expertise to what's going on with COVID. So I'm going to try to provide a snapshot.

I want to make one other point, [which] is that many of our faculty are clinician-scientists. And their priority right now during this very exceptional time is to really be dedicated to their clinics, whether outpatient or inpatient. And so a lot of their effort right now is going on to actual patient care. But having said that, let me give a case in point about that. Let me start with Kathy Yang, who is an infectious disease clinician in our group, and she's really been on the frontlines of participating in the clinical trials relevant to COVID-19. She's participating in what you've probably heard a number of times now on the School of Medicine town halls, there are clinical trials to evaluate remdesivir in many of our inpatients and Cathy's very involved with that. She's also instrumental at developing the logistics in monitoring patients who really aren't eligible for those trials and are requiring to get drug through expanded access or through compassionate use. And examples of patients that wouldn't have availability through the trials would be pregnant women and children. So Kathy is really instrumental in that part.

And then let me move on then to our primary wet lab, which is the drug research unit, which is very active in looking at clinical pharmacology studies. And you've heard of the drug hydroxychloroquine, by now I'm certain, but we are collaborating with Annie Luetkemeyer in School of Medicine as well as Rada Savic in BTS, to evaluate the PK and PD of this compound and are also supporting multicenter clinical trials that are being pursued on a national level. And I have to give a shout out to Liusheng Huang, who's our primary chemist, who has been in the lab now pretty much every day. We had shut down very efficiently originally, but then we got approval through David Morgan and his team to be able to rev up the lab again. And so Lu Xang and Vong Sok from our group has been going in pretty much every day to develop methodologies to support these PK/PD studies that I mentioned.

Erica Wallander is a faculty member in our department as well. And I'm hoping that she'll be involved in that effort along with Rada, and people in School of Medicine. So let me briefly since I only had five minutes, let me move on to a few other things. The department is home to the Medication Outcomes Center that assesses the value of medications and other healthcare interventions. And there's a pharmaco-epi study that's being led by Trang Trinh and Rosa Rodriguez-Monguio, which will evaluate medication use, timing, and outcomes in our COVID-19 patients, and compare this to a case control of patients with other types of viral illnesses. And then there's a few other folks that I would like to mention, other faculty in our department who are pursuing or are very much interested in research related to COVID-19. And that would include Katherine Phillips, who's interested in doing a study related to economic modeling of COVID-19 testing. Dory Appolonio who is very interested in working with her collaborators on public health questions related to shelter in place strategies and other interventions for COVID-19. Akinyemi Oni-Orisan is one of a few faculty with an expertise in pharmacogenetics. And he's interested in looking at COVID-19 genetics and cardiovascular outcomes in patients and he's starting to do that work. Leslie Wilson would like to start a research project related to her field of pharmaco-economics. And then as far as specific faculty doing research, I'll mention the California Poison Control Center Stew Heard was in touch with me yesterday and though they don't have a research project in place at this time, they certainly are seeing a lot of cases relevant to COVID-19 300 so far, and there's certainly a chance for a rather interesting research project to come out from what they're actually collecting data on.

And then the last area I want to mention is educational research. As we all know, our department is extremely instrumental in delivering the curriculum, as are the faculty from BTS and Pharm Chem. And we're very instrumental at now delivering this curriculum remotely. So I've had the opportunity to talk to key faculty who do education research. And we want to make sure we collect the data that's necessary in order to ask some specific questions. How are students doing through this remote learning? But perhaps even more importantly, is what parts of remote learning are we going to want to retain moving forward, because we're obviously having a very good experience. So that's what I wanted to say. And thank you for the chance to represent the department.

Joe Guglielmo
So thank you, Fran. As we said, now I'm going to move To Lisa Kroon who is the chair of the Department of Clinical Pharmacy, and she's going to talk about a unique patient care initiative that she is overseeing at St. Francis Hospital in San Francisco. Lisa.

[Lisa Kroon]
Terrific. Thank you, Joe. Hi, everyone.

So just to reiterate, what Fran had alluded to, all of the practicing pharmacists are in the Department of Clinical Pharmacy, who provide clinical pharmacy services and those have not changed. Workflows have changed a bit for remote work. But our clinical pharmacists continue with all of their services. Our ambulatory care pharmacists are doing video visits as many other providers are and we heard about the Department of Medicine Grand Rounds earlier that UCSF has converted from 2.5% to about 55% of video visits. So it's a huge change in how we're delivering health care, especially in the ambulatory care setting, but they're doing some of that inpatient. So Joe, a few weeks ago was provided with the opportunity of how a new unit at the St. Francis Memorial Hospital, that's going to be an open it is open now, would be staffed by pharmacists, mainly for Clinical Pharmacy services. So the Department of Clinical Pharmacy said that we would provide that service and fortunately in our clinical faculty, we've been pretty heavy with ID pharmacists, and critical care now too, with Tram Cat, and so they are planning as part of the surge planning for the city, so this is a partnership with Zuckerberg General Hospital, UCSF Health and Dignity Health. So St. Francis, as you may know, is in kind of the lower Nob Hill area on Hyde and Bush there. It's a much smaller hospital, about 200 beds, and they have opened a PUI, or patient under investigation, and COVID floor on the sixth floor which will have about 40 acute care beds. And then they've also designated eight ICU beds for COVID critically ill patients. So as part of this effort, I reached out to all of the licensed faculty pharmacist faculty in the department, I want to thank all of you who responded. Turns out they really don't have operational pharmacy needs, their staff are okay for that, but it's really for having a pharmacist on the floor to provide clinical services such as medication monitoring and therapeutic drug monitoring. So, our ID pharmacists, Katherine Gruenberg, Kathy Yang, even our Dean Joe, Jennifer Cocohoba, and then Tram Cat, who is a critical care pharmacist, have signed up to provide the services. With this, we needed to establish a professional services agreement with Dignity Health, and I've been working with UCSF Health on that. And that's pretty much finalized. We all are going to get trained on their medical record, which unfortunately is not Epic, it's Cerner. So we will have fun using a different electronic medical record to be able to follow patients, provide recommendations, and track our interventions. Along with this, I've been sharing sort of the best practices and workflow changes for our pharmacists that are happening at UCSF Health, how we're treating COVID patients, etc. And so with that, our pharmacy grand rounds on Tuesday was focused on COVID. And so Conan MacDougall and Kathy Yang were two have the three presenters on that. So I was able to share that with the St. Francis pharmacists. And so they've been very grateful to develop this partnership with them during this incredible time. And so perhaps this will continue after. We may not necessarily be needed if this surge doesn't happen as significant as it had been predicted. UCSF Health also opened their own COVID or PUI floor on the 15th floor of Moffitt. Mount Zion is going to be reopening at the end of the month also. So the St. Francis collaboration is just another possibility for where patients may go with the surge. And I'll just close real quickly. So the pharmacy informatics specialist that I've been working with, when I shared the pharmacy grand rounds on Tuesday, she emailed me to say, she actually was a UCSF grad who was one of the first South Bay students. And so seeing Kathy Yang presenting, who had been our South Bay program director, you know, a couple decades ago now, put a smile on her face. So I share that for two reasons. One, students who are on this call, you never know in the future when you may get to interact again with the School of Pharmacy and faculty. And also to hopefully we're all finding a reason or some time in the day, that we're putting a smile on our face with this very difficult time. So that's it, Joe. I'll close there. Thank you.

[Joe Guglielmo]
Thank you, Lisa. So there were three outstanding questions from the last Town Hall. I'm going to quickly answer them and then go on to Q&A that grant will oversee. First question was what is the status of the vaccine trial going on in Washington state with Kaiser Permanente and is UCSF planning to participate? On March 16, Kaiser Permanente Washington Health Research Institute gave the first ever injection of investigational vaccine for this coronavirus and gave it to four volunteers participating in a phase one federally sponsored clinical trial. That's really where it's going to stay, Kaiser Permanente. UCSF will not be participating in that clinical trial. The second question asked about the update on recent data coming out about SARS, COVID-19 potentially being airborne. I don't think there's anything new there. This is only a droplet associated infectious disease. However, yes, if someone were to sneeze or cough on you, that is probably the only way that this could be a respiratory-borne disease. The reason that all the masks are being recommended these days and public is not so much that you will get sick, it's that if you might be someone who harbors the virus, and as you know, Dr. Fauci, from NIAID has stated that the most recent data suggests that 50% of patients have no symptoms. So if you happen to have the virus, the hope is you don't give it to somebody else. And that's the reason for the masks, not so much that you would get it from a respiratory borne source. And the last question was from students, how will UC SHIP health insurance be impacted if there's a further postponement of the blocks? And this answer, the blocks are in the rotations, the APPEs. And from Cindy Watchmaker, her answer is that arrangements will be made for students who have paid for UC SHIP to retain enrollment in the program. We'll continue to work with students on an individual basis to ensure continuity of insurance. With that Grant Q&A from the audience?

[Grant Burningham]
Yeah. So we have two minutes, Joe, so maybe just time for one or two. Let's start with this one. Much of the financial impact for UCSF is largely based on our clinical revenue and our research enterprise. Wouldn't we need to see clinical revenue come back before we as a healthcare campus can improve financially. And if so this could take a year or longer.

[Joe Guglielmo]
So that's an excellent question, but I think both are in play. It could well be that UCSF Health rebounds all the way and quickly, in which case, we will recoup the losses that we had, we would hope. But I will say it's not just UCSF Health, if in fact, research is not allowed to go forward than all the grants that are sitting out there, rather than spending that money, extensions are going to be requested and new grants will not be secured. So therefore the indirects associated with those grants will not come in. So both are risks. So it's hard to answer that question other than saying our eyes are wide open, and both are significant risks to our financial stability.

[Grant Burningham]
Okay, we'll ask one more. If I could just stretch this a little bit. I'll make it a clinical question. And then we will save these questions and have them answered at the beginning of the next town hall just for people who are asking them. Is there a correlation between patients who are either smokers or have been smokers in COVID-19 cases that end up the most in critical care?

[Joe Guglielmo]
So others may want to answer that. I'm not aware of just smoking being a risk factor. What I am aware is people with coexisting disease, pulmonary disease, it is a risk and we also know the growing body of literature that cardiovascular disease, also probably due to cytokine storm is also impacted by this disease. And it may well be that a smoker is at greater risk for the cardiovascular complications of this as well. But I'm not aware of smoking, yes, no, just smoking being the risk factor. It's always a risk factor for the reasons we talked about all the time, ie its impact on both the lungs and the heart. We can maybe do one more and then I'll close.

[Grant Burningham]
Okay, sure. UCSF housing raised the monthly rent, how is this justified in such a time?

[Joe Guglielmo]
That one I can't answer right now and I guess what I will do let that'll be one that I will be forwarding that to Claire Chanel, who oversees all Campus Life Services. And I will ask for her response on that because that's a campus issue. And I do not have control over those and I probably should stop at this point. Well, we'll try to answer anybody that gives their name. We will individually answer your questions. And those that did not we will lead off the next town hall with answers to those questions.

So a little bit about the next town hall. It is April the 15th. That will be a special Town Hall, it will be a full hour it will be from 3:30 to 4:30, as opposed to the last couple that have been 30 minutes. An outlook invitation has already been sent. This is going to be a little bit unique and this will sound HIPAA non compliant, but I've got her okay. Faculty member and pharmacist and it turns out patient, Dr. Marilyn Stebbins, will be sharing her personal account as a COVID-19 infected patient who ended up in the ICU. She will be talking about her journey, including navigating the healthcare system in sickness and in recovery. So I invite you for that special Town Hall. I will also have the usual announcements, but the majority will really be a Q&A between Grant Burningham and Marilyn Stebbins. So I'll close with that and I'll close as I've done last time. Above all, I thank you again for everything all of you do and I talk about both learners and those that serve the school. And above all, please take care of yourself. Take time for yourself. Once again, enjoy the day, smell the roses. Thanks for your time today.