February Newsletter

social@drbretsky.com
social@drbretsky.com

Welcome to the February Newsletter for Santa Monica Primary Care. In this issue, we are going to highlight the #Omicron variant outbreak in Los Angeles County as well as review the most current quarantine and isolation guidelines. We will also bring you up to speed on some new initiatives going on in the office for 2022.

1. Omicron COVID-19 update in Los Angeles County

Omicron is most certainly on the decline as evidenced both by daily and weekly case rates. As with most epidemics that have rapid growth, we also expect to see very steep declines. Omicron is no exception.

Daily cases show

The increased infectivity of Omicron in comparison to Delta (Summer/Fall 2021) as well as Mu and Lambda (Winter 2020/2021) is seen graphically by the sharp peak, which has now passed.  A week by week graph shows this process a bit more clearly.

Test positivity rates remain high at 16% but these are down from a high of 22% the week ending 1/11/2022. We can expect continued declines as the weeks progress.

2. Current quarantine and isolation guidelines, COVID confusion

With the good news that Omicron is being seen less frequently in the population, it is still important to reiterate the current recommendations for isolation (the process that occurs when you have a positive test) and for quarantine (what happens when you are exposed to somebody who has tested positive). These are among the most common questions we get in the office, and the CDC’s changes to these guidelines has only added to the confusion.

Isolation (“I’ve tested positive, now what?”): Everybody, no matter what, has to isolate for at least 5 days. As I tend to take a more conservative approach in general, I define the start of isolation as the date of the first positive test although some define the start of the isolation period with the first symptoms. I recommend people stay home entirely during isolation and stay apart from others in the home as well. If you must go out (groceries, healthcare appointments), wear an N95 mask both indoors and outdoors. Tell others you have been around of your positive test. Because symptoms can be vague with Omicron and often lack an objective (measurable) fever, I start with the date of the first positive test. I recommend a ‘test out’ strategy for isolation, by using a rapid antigen test at Day 5 (if there are no symptoms) and, if negative, one can test out of quarantine. An additional negative test in 24 hours can be used to double check the first test and allow for release on Day 6. In reality, most of our patients have been testing negative between Day 7 and Day 10. A PCR is not an appropriate test to use as it can (but doesn’t usually) stay positive for weeks afterwards.

Quarantine (“I’ve been around somebody, now what?”): Interestingly, in Los Angeles County, if you are without symptoms and up-to-date on your vaccination (including booster), then there is no requirement to quarantine. With a variant as infectious as Omicron, this simply does not make a lot of sense to me. While certainly some measures can be relaxed (no mask outdoors, can be around household contacts), ideally we would want close contacts to not be out at bars, restaurants or clubs. So be prudent, even if that means ignoring the County’s advice. No infectious disease ever has thrived with a little discretion. The best and most accurate time to test is 5-7 days after you last came in contact with the known case. Again, a rapid antigen test will suffice permitting a ‘test in’ strategy for return to work, school or congregate setting. If that test is negative, then you are free to move about the cabin. If it is positive, see ‘quarantine’, above.

3. What’s new in the office – shared space

We have made an effort during the Omicron outbreak to keep our office open for routine care. While this has posed some challenges (and a brief shutdown from December 27th-December 31st), we have largely been able to keep up with routine preventive visits. You will notice that appointments are widely spaced and upon coming back to the examination rooms that you will rarely, if ever, see another patient.

On the other hand, you will notice that our office space is now shared with another group of physicians. This group, consisting primarily of OB/GYNs but also including a Urologist, General Surgeon and an Ultrasonographer, is entirely independent from Santa Monica Primary Care. As we have significantly reduced our patient volume since the start of the pandemic, we were no longer in need of the larger amount of space we had accrued over the years. After a very quiet 2020 and 2021, it is nice to have more activity in the office in 2022.

4. Highlighting Telehealth and Video health 

One of the patient care methods that was pressed into service during the first several months of the pandemic, and then refined over time, was telemedicine and video health medicine visits. Although these took some time to get used to – both for patients and physicians alike – they are now an indispensable part of the healthcare landscape. At Santa Monica Primary Care, we have noticed that patients are not only spending longer periods out of town but many are now embarking on previously only wished for extended stays at vacation homes, RV trips, or home share opportunities. Some have noted that they feel even more comfortable doing so knowing that they can access their care remotely. While some instances necessitate an in office visit, we are finding that quite often concerns can be addressed with a telephone or video visit all of which can be done remotely.

5. What’s also  new – our collaboration with Aledade. 

In January we launched two new quality of care efforts in collaboration with Aledade Solutions, a Maryland based company that partners with independent primary care practices to emphasize quality of care and value based care. We are beginning this effort among our Anthem Blue Cross patients, focusing on a variety of outcome measures such as diabetes care and routine cancer screenings. We are simultaneously piloting in 2022 a more extensive effort among our Medicare patients, one which will ultimately go live in 2023. This effort will permit us to look more comprehensively at our data analytics and identify areas for improvement. While it is only in the first few weeks, we are already finding ways to better engage our patients and promote overall wellness.

6. February’s Epidemiology Lesson:  Prevalence and Incidence.

Many of you know at this point that I also have a PhD in Epidemiology – something which I did not think would become so useful in primary care. But as more terms from this field are used in the popular press (and not always correctly), I thought I would begin highlighting some of the more common terminology.

  • Incidence (Rate):  The number of new cases of disease during a specified time interval per average population during the time interval.

Prevalence (Rate):  The number of current cases (new and pre-existing) over a specified period of time.

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