Town Hall: Research impacts and economic stimulus

[Dean Joe Guglielmo, PharmD]
As I have done in the past halls, I'm going to try to give you the best I can of the general COVID-19. Update. And I'll start really talking about the world and moving to the Bay Area and UCSF Hospital. So, at least as of late morning, if you took the world wide site, which is even a little bit ahead of CDC on their numbers, there were 963,000 people infected with COVID-19 and almost 50,000 deaths. In the United States that total was 216,000 infections, and 5,140 deaths. You're all reading about New York, horribly deaths in New York doubled in the last 72 hours. And you know that the stockpile has been it's essentially drained for especially New York City.

If you move to California, it's a it's a ... at the moment, a more positive outlook. As of the April 1 update, there was a total of 8,155 positive cases and 171 deaths in California. Some interesting statistics of the now roughly 1,900, California COVID hospitalized patients, 774 required ICU care. So that's about 40% of all hospitalizations, reinforcing the morbidity associated with this disease. You if you're interested, I've mentioned to some of you there is a wonderful University of Washington website (COVID-19 Projections) that is giving their best case of projected peak in each of the 50 states, and they project that the peak in California will be April 26. And they predict that day alone, there will be 119 deaths in California. The total California deaths projected by August 4, they project in excess of 5,000. I want to remind you something, it's a big state. And what happens in Northern California is already predicted to be earlier than Southern California, and at the moment, looking to be not quite as severe. Again, take that with a grain of salt. If you take San Francisco and specifically UCSF as of this exact moment, there are 16 patients that are hospitalized at UCSF, 9 of those 16 are in critical care. Five required ventilators, therefore intubated. And I will remind you that this number has gone up by about one or two every day or two now. So on one hand, yes, the totals the highest is spent. On the other hand, the rate of rise is absolutely nowhere what we thought it would be. But I caution you and if you can believe or disbelieve the model from University of Washington I described. But if they are right, the real peak is still three weeks off. I think Northern California, it's going to be much, much earlier peak again to repeat that will be Southern California. A few in the media things to update you on. One I think you're aware of, there have been changes in recommendations for wearing the surgical mask at UCSF, we have adopted that completely. Anybody, any of us that's in any clinical area must wear surgical mask. It's debatable whether or not it makes a difference in getting the disease. But it's felt that if it makes people feel better, and maybe causes them to still use good social distancing then maybe that's okay. And at the moment, there's not a shortage, at least at UCSF. I think you know, while the state has not pulled the trigger, Gavin Newsom is talking about similar sorts of recommendations over and above those that we've adopted at UCSF starting last Sunday. The other in the media that to point out is the director of CDC stated the 25% of people infected with coronavirus may remain asymptomatic for duration of their infection. And so this is one of the reasons coronavirus makes it so contagious is that people can spread it up to 48 hours before they actually feel the symptoms or if they ever experienced symptoms of all. And so that we that that's very early summary and that needs [unintelligible]. And the very last point would be I'm sure you know about the recent trial with hydroxychloroquine that was reported just today essentially suggesting that it might be effective in reducing the time a patient has cough and fever. There was a significant reduction in time with cough and fever in patients and this came out of China. And perhaps, albeit, it was not statistically powered, perhaps reducing the likelihood of progression to more severe disease. To be even-keeled about this is you know, there has been a bit of a panic in terms of acquisitions of not only hydroxychloroquine but chloroquine and other drugs. We have to be very careful. I will point out that pharmacies provided [unintelligible] in the U.S., are prescribing massive amounts of particularly hydroxychloroquine, intended to create stockpiles and then create these inevitable shortages. So those are being addressed as best we can. And I think, you know, from our poison center (California Poison Control System) colleagues that in fact, there was a couple, out of the state who acquired chloroquine phosphate, which was used for fish aquariums and overdosed on the chloroquine phosphate. In the couple of the man died from an arrhythmia, and the woman is still ill. So this reminds me of the importance of evidence-based decision making as a relates to this disease and what you should or should not do with these drugs. And so I think we have to be patient as this data becomes available to them be able to be nimble and appropriately respond. But in the meantime, to not assume that in fact, some of these drugs, in fact, should be used the way that some are using them. Now, flipping a little bit here and switching gears, as I said, I wanted to get a couple of School updates that were specific to a couple of things. The first of which I'm asking for a COVID-19, basic or discovery science School research update. And I've asked Dr. Andrej Sali, who is Associate Dean of research to provide that update. I will say before Andriy has the stage here next week, you can expect a clinical science COVID-19 research update, and that will be taken place by Fran Aweeka, who's vice chair of research and Department of Clinical Pharmacy. So Andrej, the floor is yours.

[Andrej Sali]
Thank you, Joe. So as many of you very well know, many of us have thought about our research expertise and how we could contribute to the attack on the virus. And so as a result, we actually have quite a large number, and I would say an increasingly large number, of both small and large efforts, and individuals and groups in our departments, that QBI, obviously at UCSF at large.

And we have organized I think, quite rapidly, although there's clearly challenges in that, due to the time demands, the size of the effort, the heterogeneity of the efforts, and so on for obvious reasons. And so what I'll do here is simply list a number of efforts that I'm currently aware of, and although I will no doubt miss many, so forgive me for that. I believe that Susan Levings is collecting a comprehensive list of various efforts called related efforts in the School of Pharmacy, so you could be in touch with her directly, if not through the department chairs. I would perhaps start with what I think is probably a flagship effort of sorts, and maybe even a useful model for how to organize large efforts. And that's the QBI's effort led by Nevin Krogan. It's called as most of you probably know, the QBI Coronavirus Research Group (QCRG). There is a website and pretty informative website (QBI Coronavirus Research Group) just look for QCRG QBI, you'll get it and it at the moment includes approximately 30 research groups, many of which are from Pharm Chem and BTS, and the School of Pharmacy is relevant. As well as of course the entire UCSF gets [unintelligible] from elsewhere. This effort started with Nevan's experimental map of human proteins interacting with each of the viral proteins. There's a paper it came out in bio-archive (bioRxiv) (A SARS-CoV-2-Human Protein-Protein Interaction Map Reveals Drug Targets and Potential Drug-Repurposing) if you wish to look it up, and it now contains 11 or so, over 10 different research subgroups that are focused on different topics, if what each one of which typically includes several research groups, has leaders, includes students, postdocs, technicians, in these labs, meets periodically shares goals and collaborates on the actual research. I'll quickly list their names. I can I think that most of you know about that. So we can go through that real quickly. There's a group on drug discovery, structural biology, bioinformatics and systems biology, modeling and mechanism, protein trafficking, biology, translation, metabolism, epigenetics and chromatin ubiquitination, and mitochondria. There are additional efforts I'm aware of, some of which I'll list right now, as well. And that is just again an incomplete list, I am sure. Jim Wells, for example, is producing recombinant pieces of SARS of the virus, as well as the human host receptor on his working with BioHub (Chan Zuckerberg Biohub) and others in UCSF to develop viral detection and serological assays. And he's also working on the phage display screen or screens to find to find viral protein blockers for casting in the coming weeks elsewhere. Bill DeGrado is similarly designing proteins that bind to the spike protein. He's collaborating with others, including structural biologists to follow up on his studies. Tejal (Desai) and Shuvo (Roy) at the Tejal Desai and Shuvo (Roy) in our department, are part of the engineering consortium including Berkeley, Stanford as well as UCSF (UCSF BioEngineering Students and Faculty Team Up with Johns Hopkins for a Design Challenge to Address the COVID-19 Pandemic) and they work on various related, on various issues related to PPE (personal protective equipment) ranging from new N95 mask material to ventilator design, mask the contamination and so on. Rada Savic is working on translational pharmacology to optimize drug repurposing, and in particular, she's involved in optimizing the regimen for use of this new drug Joe mentioned mentioned, hydroxychloroquine, in collaboration with other institutions. Nadav (Ahituv) is developing a rapid testing method for colleagues to know exactly what's the basis of his effort, but that's the topic. Kathy Giacomini and Nadav Ahituv. Kathy Giacomini is studying the interaction of drugs in clinical trials to treat or prevent COVID-19 infections. Deanna Kroetz is looking at interactions between transporters and viral proteins. Su Guo is looking at the ACE1 and either hypertensive medications relationship in your renal anti-tension expertise. (Todd) McDevitt is looking at effects of COVID infection in human cardiomyocytes. So as you can see, these are all examples of people using their own expertise, adapted very quickly to what may be needed or what would advance our knowledge about the COVID situation and eventually, one way or another, directly, or indirectly help dealing with this problem. I also would note, lastly, that there's a lot of labs who have given supplies to the health center and BioHub as asked, and maybe there's more such supplies and you can give some more. And as the very last point, I know that I'll point out that the website of the office for sponsored research at UCSF has a web page that's dedicated to COVID-19 funding opportunities [link defunct], since obviously at some point, all this research will need to be funded. So you may want to go there for funding opportunities, as well as some other information about COVID-19-related grant related aspects. You'll find it useful probably. Thank you.

[Dean Joe Guglielmo, PharmD]
Thank you. Thank you, Andre. That was a fantastic summary. And it is so encouraging to see this kind of big thinking, [unintelligible]. School of Pharmacy always in collaboration with others at a time that we have a lot of firefighting to do. And so it's just a fantastic thing to see such efforts come out that have been recognized nationally. So thank you again, for that fantastic summary. I'd like to now shift gears and as I mentioned earlier, I'm asking Michael Norberg, associate dean of finance and administration, to provide his own general administration updates, but specifically talk about a little bit about the direct pay provision in the stimulus bill, Michael.

[Michael Nordberg]
Thank you Joe. There we go. Okay. So there's various things that people should be aware of if they're not already. So in terms of telecommuting, there is some excellent advice on the COVID-19 website, titled remote work resources, that give some good things about how to forward your phone, how to block your cell phone, and various other things. The departments are willing to reimburse. You should talk to your supervisor, for additional supplies you may need to work at home such as mice, keyboards, etc. We're not reimbursing for furniture, however. If somebody's job, it's not possible for them to do it remotely. There are employee volunteering or redeployment possibilities with UCSF Health but you do have to meet certain requirements in terms of vaccinations and TB tests. That once again is on the COVID site.

The policy I think everybody maybe has seen that there right now has a 128 hour bank of paid administrative leave. This is actually now showing up in HBS in your balances, if you check your leave balances, and there is a specific leave designation to select when you're selecting leave that are COVID-19 selection that would indicate that. Now there are certain conditions in which you would use that leave. And I advise people to talk to their supervisor about any leave that they're planning, whether it meets the criteria. There's also right now a vacation, maximum grace period exception. So if you're at the max, you're not going to lose any hours for the next four months. There's also, for people that have completely run out of all their leave, because maybe they're taking care of a COVID-19 family member. If you've used up all your leave and used up all the administrative leave, there's the emergency voluntary, catastrophic leave sharing program where people can donate to a bank and that can be drawn out of.

And I did get asked to talk about the stimulus. So as you know, you've heard there's going to be money coming. Now it is tied to what your adjusted gross income is. So for instance, if you are single, your adjusted gross income, which is your income after deduction, so after you've taken the standard deduction, has to be under $75,000 equal to or under $75,000 to get the full $1,200 amount. And if you're a married filing jointly couple, that maximum is $150,000. So if you look at the last tax return you filed, you can see what your adjusted gross income is and can fairly easily calculate, what you would potentially get, because once you go over the $75,000 for a single person, each additional $100, they will deduct $5 from that $1200. And if you have filed 2019, or the tax year 2018, they will be using whatever is your most recent return to send that money directly into your bank account. If you have not filed in the last two years, you will have to file a simple tax return to be able to get it and if your address has changed and is not currently on file with the IRS, there will be a portal that will be opened by the Treasury Department where you can register. And that's about it for what I've got.

Back to you Joe.

[Dean Joe Guglielmo, PharmD]
Thank you, Michael.

There was an outstanding question from the last Town Hall and that was how to donate blood. I think you may have noticed or read that the UCSF Medical students organized an appointment only drive on Parnassus. And it's taking place, it started yesterday, today and tomorrow and it will again, April 7 through 9th. But as a reminder, you know, near Parnassus, remember we've got the Irwin Memorial Blood Center right there on Masonic Avenue. So for those that are interested, those opportunities and options are available. So at this time, we've got you know, about seven, eight minutes left, we're going to take questions from the audience, and Eric Davila will be reading them, Eric.

[Grant Burningham]
Actually, I'm gonna take it today, Joe, this is Grant.

[Dean Joe Guglielmo, PharmD]
Oh, no, I'm sorry, Grant. I'm sorry. I knew that. Sorry.

[Grant Burningham]
First question. Do you have more information on the testing capabilities at UCSF/CZI?

[Dean Joe Guglielmo, PharmD]
The update on that changes by the day. The testing is a combination both from CZI, this is Joe DeRisi's operation, as well as the UCSF laboratory. Between the two, we have a capacity probably to do as many as 2000 tests. At the moment though, as they ramp up, they've only been able to get more in the neighborhood of a little over 1000. And the reason they've only been able to go a little more than 1000 because of as some of you know, the shortage now are the Q-tips that are used. Long Q-tips that must go into the nose to do the actual culturing for the coronavirus but they are ready to go and they've got the resources and the technicians to be able to do it. So again, we would do a lot more if we could figure out the Q-tip issue but people are moving on that as we speak.

[Grant Burningham]
Okay, next question. Current thoughts on NSAIDs in worsening COVID-19 disease, are there any medications we should be aware of that exacerbate COVID-19 prognosis?

[Dean Joe Guglielmo, PharmD]
There was fake news on the use of non-steroidal anti-inflammatory drugs like ibuprofen. It started entirely fake, claiming that it hurt the immune system of patients infected with coronavirus. That is complete bunk. It's not real. And in fact, there is no data to say that non-steroidal anti-inflammatories cannot be used in patients infected with COVID-19.

[Grant Burningham]
Okay, and this question has been answered, but I just want to ask it in case anybody else also had the question: please repeat the URL for the research website for QBI. And Joe, I don't know if you know that but it's qbi.ucsf.edu/covid-19. Next question. Is the international postdoc also get financial assistance declared by the federal government? Would an international postdoc get financial assistance?

[Dean Joe Guglielmo, PharmD]
Michael, take your best stab at that one, please.

[Michael Nordberg]
I think unless you had filed an income tax report, filing, I don't think you would be eligible for that. But I don't know for sure. We'll look into that and, and post an answer on the website.

[Grant Burningham]
Next question, can you comment on the steps being taken to plan for a potential shortage of drugs associated with the pandemic, ventilator use treatment as well as potential shortage of drugs coming from abroad to treat other chronic conditions?

[Dean Joe Guglielmo, PharmD]
So what the questioner is referring to, it's not just the COVID-19 related Drugs. But the fact that we so much of the creation of our drugs, particularly a lot of our generics comes from overseas, some of which is China based. Everybody is aware this is an issue. But no one really has a good sense whether we have appropriate supply chain organization to, in fact, ensure that we will get these. At least at the moment, other than drugs I alluded to earlier, we have yet to really come into that shortage, but that's a very good question. And it's a risk that we've all been worried about worldwide, let alone the United States.

[Grant Burningham]
Here's another one. The Bay Area shelter in place is currently until May 3. If the projected peak day is April 28, do you think the shelter in place will last and will we be working remotely?

[Dean Joe Guglielmo, PharmD]
Well, I again I can't say for sure. But keep in mind that the April 26 peak that comes from, that is a target that came from essentially University of Washington. I encourage all of you to look at. It's a quite elaborate interesting website out of UW that does every state in the union. What I would repeat though, is I believe that Northern California's peak is going to be much earlier than April 26. For those of you that heard George Rutherford talk at one of many of these COVID-19 discussions, he suggested, and he thought in seven to 10 days, we would have a very good idea if we had flattened the curve and therefore peaked. Now, don't quote me on that. You can quote George Rutherford on that. But I think everything that we see up to this point suggests that his guess is probably a correct one. So therefore, we'll wait and see if in fact the peak is much earlier than April 26. Perhaps the shelter in place will be able to be eliminated on May 3. If on the other hand, it looks more like what University of Washington suggesting, probably not.

[Grant Burningham]
And this is a comment, maybe you could further comment on this. Most donation centers for blood and plasma, including IVIG and albumin come from college students who, as we know are no longer on college campuses. So many are worried that we will have a shortage in the coming months as college students are at home.

[Dean Joe Guglielmo, PharmD]
A shortage, not sure what they meant by a shortage, shortage of blood. Is that what you're saying? I guess.

[Grant Burningham]
I think it's a shortage of blood.

[Dean Joe Guglielmo, PharmD]
Yeah, I don't know what to say. All I know is, I think, you know, there's been enormous encouragement and advertisement that all of us including all of us on this call, consider donating. So I really, but I really can't comment.

[Grant Burningham]
Okay, The news came out that the Boston Medical Center has furloughed 700 employees, do you expect to see this trend at medical centers across the country? At UCSF?

[Dean Joe Guglielmo, PharmD]
I have no idea. Here's what I will say to everybody listening. Yeah, the Chancellor made it clear. Let's take a step back. You all know we're talking about the virus, but perhaps the biggest risk is going to be the economic downfall that already exists. And the assessment is probably we'll have 30% unemployment rates in the United States as a result of this. There's little doubt that every single industry will be impacted by that. And so in answer to the question, there has been absolutely nothing discussed as it relates to UCSF Health or UCSF the campus side or the individual schools on furloughing. I've mentioned this before, for those of you that to actually do your timesheets and turn them in, there is in the drop down menu where it says vacation or sick or whatever, it has the word furlough. And people said, Hey, where did that come from? And my answer to that is that word has been there for at least 10 years. So don't read into it. And so on one hand, I want everybody to realize it seems impossible that we will not be impacted by the economic downfall with the virus. On the other hand, I will tell you with complete honesty, there is not one discussion that has taken place regarding furlough at UCSF.

[Grant Burningham]
Okay, I know you were planning on leaving at 330. We got a couple more questions. I don't know how many more you want to take. I could tend to prioritize them for you.

[Dean Joe Guglielmo, PharmD]
Well, and I want to make sure I am respectful to others in the call. Maybe let's just do one more and then we will do our best to answer the others via email if we know who the questioners are.

[Grant Burningham]
Okay. There's been a couple of questions asking for the website for COVID updates. So maybe we could just provide that really quick and then I'll ask this last one. You can get more information on the COVID response at UCSF at it believe it's ucsf.edu/covid19. And the School of Pharmacy website also has updates.

And then this last question, are pharmacy students going to be backtracked academically due to this.

[Dean Joe Guglielmo, PharmD]
So I don't know what backtrack academically means. If the question is, and I don't know which class we're talking about. We fully are planning on the class of 2020 graduating on time even though we do not have a commencement ceremony at the moment. We are doing our best to get two classes, the two classes of 2021, to get them ready and rolling, as we already know, there's a delay of six weeks before we get those started. And we're just going to have to take it a day at a time. And then and then for those that are not in experiential, we are doing, what every school of pharmacy and every school of medicine is doing in the United States. and that is doing the best we can to ensure the quality of the education is absolutely first cabin.

I want to remind everybody a student don't go to school anyway anymore to listen to us lecture and in some ways COVID-19 turned the corner for us and made us in fact, change the way we do things. Hopefully when we get back together we'll start problem solving again in person. I really hope and pray that the education of our students is not impacted in any way.

So I think I'm going to close by reminding you of a few things. There will be another town hall, April 9, from 3 to 3:30pm. The Outlook invitation has already been sent. And there'll be another one the week after that. I will say I'll give you a hint. I told you the April 9th one, in addition to my usual updates, you'll be hearing as I said, from Fran Aweeka, regarding the clinical science taking place in the school. You also will be hearing from Lisa Kroon on a couple of new patient care initiatives that she will summarize for us as well. And the week after that, I will say, will be a special town hall, I'll [unintelligible] intentionally and to make sure that you participate in that one the week after next. In the meantime, I just want to say to each and every one of you and sometimes I have to look in the mirror and say this to myself. Slow down. Enjoy the now COVID-19 induced clear sky and water. Appreciate your loved ones. Take a nap. Stay safe and well. Thanks for listening.