13 October 2022 Blog Post: A Crazy COVID Year

13 October 2022 Blog Post: A Crazy COVID Year

Reflecting on this weekend’s LA Times article headlined “With COVID on the retreat, are Halloween, Thanksgiving and winter holiday gatherings safe?” (link: https://www.latimes.com/california/story/2022-10-10/with-covid-on-the-retreat-how-safe-are-holiday-gatherings), my first question was – “is COVID really on the retreat?”

The short answer is, yes. Although what a year we have had!  Things started out with an Omicron bang in January as both incidence and prevalence rates hit dizzying new heights. Test positivity rates were so high in January that it broke our prevalence calculator which estimated that for the week ending 1/11/2022 that 72% of the County residents had the infection. We are much, much, much lower now with a 0.5% (1 in 200 residents) with active infection – down from a midsummer high of 9.8%. Our best week was that ending 3/22/2022 at 0.05% (1 in 2000 residents). So, yes, depending on your perspective COVID is in retreat. Figure 1 below graphs prevalence rate.

A similar trend is seen in incidence rates – readers will know that I have moved away from this metric as it does not include results from home rapid antigen (lateral flow) tests as the County does not tabulate these or permit reporting of these results. But even looking at only PCR results from accredited laboratories, this rate too is in retreat with 9.97 new daily cases per 100,000 for the week ending 10/4/2022 (most recent week for which complete data are available). This rate was 453.19 new daily cases per 100,000 the week ending 1/11/2022.  Figure 2 below graphs incidence rate.

Mortality follows cases and, as expected, current COVID-19 mortality rates are also “retreating”.  There are currently 0.03 daily deaths per 100,000 population in the County, as compared to our peak of 0.82 daily deaths per 100,000 the week ending 2/8/2022 (note the lag time between peak prevalence/incidence and peak mortality of about 3 weeks – again a pattern we’ve seen time and time again during the pandemic).  Figure 3 below graphs mortality rate.

Historically, October has been a time of relative COVID lull. Interestingly, 2022 (Yellow) had the highest historical midsummer prevalence rate (nearly 10% at maximum) as compared to 2020 (Blue) and 2021 (Red).  Prevalence rates for the week ending October 4th were low in all years:

 

2020:  0.4%

2021: 0.1%

2022: 0.5%

Enjoy the lull, because based on our 2020 and 2021 experiences, it isn’t a great secret about what happens next (Figure 5 below).

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

Dig deeper into the health topics you care about most by signing up for our newsletter.

by submitting this form you indicate you have
read and agree to our Privacy Policy and Terms
of Use. Please contact us to for us for more
information.

11 October 2022 Blog Post: On Colonoscopies

11 October 2022 Blog Post: On Colonoscopies

Interestingly enough, the effectiveness of colonoscopy has never been evaluated using a gold-standard clinical trial wherein one group (treatment) is evaluated for colon cancer with a colonoscopy and a comparison (control) group is not. This week, the New England Journal of Medicine published results from a “pragmatic” clinical trial wherein over 84,000 men and women between the ages of 55 and 64 years of age from Poland, Norway, Sweden and the Netherlands were split (1:2 ratio) between being “invited” to have a colonoscopy versus “usual care” (no colonoscopy or screening offered).  The study recruited patients between 2009 and 2014, and followed them for up to 10 years (Bretthauer et al.  Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2208375). 

The study found a risk of colon cancer at 10 years to be 0.98% in the invited group versus 1.20% in the usual care group. Mortality rates were 0.28% in the invited group versus 0.31% in the usual care group. 

So at face value, colonoscopy seems to be a pretty underwhelming screening tool – but a couple of caveats:

  1. The invited study population was between 55 and 64. Current US recommendations are for colonoscopy to begin at age 45. Earlier screening, in general, has more robust benefits rather than later screening so the older age cohort is a limitation of this study.
  2. Colon cancer itself, generally speaking and exclusive of more aggressive cases, can take many years to progress from polyp to cancer may be greater than the 10 years of follow-up undertaken by this current study. So a longer study period would be preferable.
  3. Of those study participants invited to have a colonoscopy (total of 28,220 individuals) only 42% (11,483) underwent the procedure. This is a significantly lower percentage of colonoscopy uptake than is typically seen in the US where about 70% of those who are offered colonoscopy then have one.

So overall a very interesting study and even when analyzed with ‘intent to treat’ (i.e. considering all 28.220 as having had a colonoscopy even though only 11,483 did), there was an 18% risk reduction effect associated with the procedure. In short:

“I don’t think this should change our practice,” said Dr. Robin Mendelsohn, a gastroenterologist at Memorial Sloan Kettering Cancer Center in New York City. “The bottom line is still get screened, still have the discussions” with your doctor.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

Dig deeper into the health topics you care about most by signing up for our newsletter.

by submitting this form you indicate you have
read and agree to our Privacy Policy and Terms
of Use. Please contact us to for us for more
information.

October 2022 Newsletter

October 2022 Newsletter

Welcome to the October 2022 Newsletter for Santa Monica Primary Care. 

In this issue, we are going to try to triangulate the state of COVID-19 in Los Angeles County. We will share the current practice experience with COVID and explain how the bivalent boosters might be so exciting. We will also cover the Blogs posted by Dr. Bretsky this month.

1. COVID-19 in the Practice and in LA County

COVID-19 cases in our practice have slowed dramatically (Figure below) with only 5 cases reported the entire month (2 repeat infections, 3 first time infections).  In August we had 12 cases (3 were 2nd infections).  In July we had 18 cases (3 were  2nd infection), June saw 29 cases (3 were 2nd infections) and in May we managed 33 infections (3 were 2nd infections). I had expected a bit of an uptick in cases with the start of school but this has not occurred, at least in our small sample.

Trying to figure out what is occurring in terms of case rates at the County level is still a bit of a guessing game – most notably hampered by the fact that the overwhelming majority of cases are diagnosed via home testing and, by the County’s case definition, are not reportable. That notwithstanding, incidence case rates have declined steadily since mid July (Figure below).

In previous issues we have discussed how a calculated prevalence rate might be a more accurate representation of the true case frequency. Current prevalence rates are as low as they have been since May at 0.7 active cases per 100 individuals.

2. BA.5 Bivalent Booster Uptake

As most of you likely know, the FDA authorized the use of Moderna and Pfizer Bivalent Vaccines for a single additional booster dose at the end of August. This updated booster is to be given at least 2 months after completion of a primary series or the most recent booster dose of a monovalent (original) COVID-19 vaccine. The Pfizer booster is authorized for individuals 12 years of age and older. The Moderna for those 18 years and older.

According to the latest CDC data (link: https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-additional-dose-totalpop), only 7.6 million individuals – about 3.5% of those eligible for the updated COVID booster – have received one. Of additional concern is that awareness of the new boosters is “modest” according to a recent survey (link: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-september-2022/). One in five people surveyed have heard “nothing at all” about the new booster as compared to 17% who have heard “a lot.”

Personally, I’m pretty pumped (as Parker Schnabel would say – for my fellow Gold Rush fans out there – Discovery Channel Friday nights) about the new booster and am hopeful that it generates more specific and durable immunity than the prior boosters. Why would I feel this way?

Well, firstly, the current booster is matched with the dominant circulating strains as it contains an mRNA component from the BA.4 and BA.5 Omicron variants. The graphic below shows that these account for the overwhelming majority of variants isolated in the United States: BA.5 at 85% and BA.4 at 13%.

Additionally, this is one of the first times that we have not been vaccinating or boosting into the teeth of a case rise. Given such, the relatively slow uptake of the booster dose is less concerning as we do have the luxury of time, for once. With a general rule of thumb being that it takes about two weeks for the booster effect to take hold in our immune system, the continued decline in cases makes it less likely that one will be exposed to the virus soon after the booster dose – perhaps before it takes effect. 

I generally have been advising patients to strongly consider having the booster by the end of October – which is also a guideline for the seasonal influenza vaccine. While you can have both at the same time, it may be more prudent to separate the two. That way in the case of an unlikely, but possible, vaccine reaction – the cause will be apparent.

3. Blogs This Month

Our blog posts this and previous months can be found archived on our website at www.drbretsky.com/blog. This month we had two Blogs covering booster shots. One in the context of the seasonality of COVID (a trend which has clearly emerged) and the other structured as a Q&A session on the boosters itself.

Booster Shots and COVID Seasonality: https://drbretsky.com/9-september-2022-blog-post-new-booster-shot-heralds-covid-seasonality/

Booster Q&A: https://drbretsky.com/13-september-2022-blog-post-fall-2022-covid-boosters/

Our third blog covered more well-trod ground looking at incidence and prevalence rates of COVID-19 in Los Angeles:

https://drbretsky.com/14-september-2022-blog-post-mid-september-covid-case-numbers/ 

And out final monthly blogged looked at the idea that the US ‘follows’ the UK when it comes to COVID case rates (spoiler alert: it sort of does, but not always): https://drbretsky.com/28-september-2022-blog-post-following-the-uks-lead/ 

This final blog garnered some interesting Twitter reactions, namely critiques of the Zoe Health Study which is composed of self-selected participants who record COVID like symptoms into an app along with any COVID testing results.

4. On Patient Reviews

Patients who have seen us in the office recently will know that we have been actively seeking patient feedback about our services on rating sites, including Google, Facebook and Yelp. These have become increasingly important in quality metrics that measure the patient experience. We appreciate the time and effort that you have taken to post your experience.

Follow us on social media
Facebook Twitter WordPress

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

Dig deeper into the health topics you care about most by signing up for our newsletter.

by submitting this form you indicate you have
read and agree to our Privacy Policy and Terms
of Use. Please contact us to for us for more
information.