I thought this time I would share with you an internal communication from our Medical Director, Dr. Marjorie Newman, that is sent out weekly to our clinical staff, so that you would see the information we share internally. Dr. Newman outlines the current situation in the County of Santa Barbara and the Clinic.
You’ll note in the demographic data the positivity rate in the different age groups. The lowest rate of positive test results is in the age group over 70, which is 2.1% compared to the positive rate of 9.6% in the 18 to 29 cohort. This is consistent with national trends in which there is more transmission in younger people who, as a group, are less careful about social distancing and mask-wearing than older patients, who are often more concerned with the risks of transmission. You will also note the number of males and females with positive tests are basically equal, though the rate of positive tests is higher in men (6.6%) than in women (4.7%). It makes sense that in our population of patients, the total number of men and women infected would be the same, as the disease infects people equally in terms of gender. Why is the rate of positive tests different? The old stereotype of men having to be dragged off to the doctor to get tested for something for which women are more willing to get tested seems to be, in our data set, true.
In our next email we’ll talk about flu season and Covid and the importance of vaccination for the flu this year. In the meantime, you can learn what is going on here from Dr. Newman.
And, yes, we are still smiling under our masks.
Kurt Ransohoff, MD, FACP
CEO and CMO
August 26, 2020
To: Colleagues
From: Marjorie Newman, MD
Re: Weekly COVID-19 Update
Overview:
The number of COVID-19 positive patients in our county continues to increase but the good news is that the rate of increase continues to drop and the doubling time continues to slow, thereby flattening the curve (as indicated in the graph below from the Santa Barbara County Public Health Department where the doubling time is now 47 days). The Public Health Department reports a 5% increase in total new cases reported in Santa Barbara County from last week, down from 6.5% the prior week and 8% the week before that; with 229 active (still infectious) cases; 51 patients hospitalized throughout the county and 21 in ICU beds. There has been a total of 89 COVID-19 fatalities in the county since the pandemic began. According to the Santa Barbara County Public Health Department dashboard-there was a 5% positive rate based upon all of the tests that were performed throughout the county in the past week with north county (Santa Maria) continuing to have significantly more cases than south county over the past 14 days (316 new cases in Santa Maria vs. 129 new cases in Santa Barbara). The 7 and 14 day positivity rate in California for all tests performed is at 5.8% and 6.1%, respectively. Despite the downward trend in new cases, Santa Barbara County remains on the CDPH monitoring list along with 34 other counties in California, which mean that all indoor operations are to remain closed for certain business sectors in order to continue to slow community transmission.
The next graph below reflects our Sansum Clinic weekly COVID-19 PCR testing data. For the week ending August 30th our percent positive cases remains in the 4% to 5% range at 4.27%, which is inclusive of symptomatic patients as well as asymptomatic pre-op patients. It appears that the percent positive cases is holding fairly steady at a level that precludes the ability to re-open all businesses and services, although we have learned that Governor Newsom will be allowing some businesses across California to open up….including barber shops and hair salons. As we know, it is extremely important that we all adhere to the public health guidance of wearing masks, social distancing, washing hands and avoiding large social gatherings with anyone outside of the immediate household in order to continue to minimize the spread of the virus and continue to bring the percent positive rate down.
In the News:
CDC provides updated testing guidance: On August 24th the CDC released updated COVID-19 testing guidance indicating that testing should be considered in the following circumstances:
People who have symptoms consistent with of COVID-19 (e.g., sore throat, fever, cough, loss of sense of taste /smell, etc).
People who have had a close contact with someone with confirmed COVID-19 infection. A close contact is defined as within 6 feet of an infected person for at least 15 minutes (48 hours prior to symptom onset or during symptomatic period). As we know, anyone who has had a close contact with a person who has confirmed COVID-19 infection should quarantine for 14 days regardless of the outcome of testing.
People who have been asked or referred to get testing by their health care provider, local or state health department.
The CDC indicated that not everyone needs to be tested but if someone does get tested, they should self/quarantine/isolate at home pending test results.
This updated guidance has resulted in a bit of controversy as many still feel that testing anyone at any time is still the best way to identify those who are infected and may be asymptomatic shedders of virus. However, we also know that there have been significant challenges in being able to test even those who have symptoms due to testing resource limitations. As a result, we imagine that these guidelines may evolve as testing resources become more reliable and available.
Cases of Re-infection: As many of you may have seen in the news, there have been a handful of documented cases of COVID-19 re-infection confirmed in Hong Kong, the Netherlands and Belgium. In Hong Kong, a man who previously recovered from COVID-19 in March tested positive at an airport screening site this month while returning from a trip to Europe. According to a paper from researchers at Hong Kong University, viral genome sequencing showed that he was infected with two different genetic variants of SARS-CoV-2 and was therefore authentically re-infected, although he was asymptomatic. Since then, a few more cases of reinfection have been reported in the Netherlands and Belgium, as well as a reported case in Nevada, suggesting that some patients who recover from COVID-19 may have only short lived immunity to re-infection. Currently there is very little evidence to suggest that reinfection is common but these recent reports raise some concerns about the prospect of long term immunity to the virus and what that may mean for vaccination development efforts.
We hope the above information has been helpful and please don’t hesitate to reach out if you have any questions.
Marjorie Newman, MD
Medical Director
Sansum Clinic
