March 2022 Newsletter

social@drbretsky.com
social@drbretsky.com

Welcome to the March 2022 Newsletter for Santa Monica Primary Care. In this issue, we are going to highlight the (expected) hasty retreat #Omicron variant outbreak in Los Angeles County as well as review the potential impact of lifting indoor mask mandates. We will also bring you up to speed on some 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 in the incidence (new daily cases) and prevalence (proportion of the population with active infection) rates. As with most epidemics that have rapid growth, we also expect to see very steep declines.Omicron is no exception. We are now at 10.3 new daily cases per 100,000, we last saw an incidence rate this low in October of 2021.

Test positivity rates have continued their freefall – at the time of our February 2022 newsletter they remained high at 16% (down from 22% the week ending 1/11/2022) but now only 2% of tests return positive. We can expect continued declines as the weeks progress.

Prevalence rates (the proportion of active infections in the County) have also returned to pre-Delta levels, now at 2 in 1000 population. In other words, a fully packed Dodgers stadium would have 112 active cases. At the peak of Omicron (week of 1/18/2022) that number would have been 38,024 (although I think that this positivity rate was significantly overestimated due to the number of unreported home test results).

2. Loosening of masking guidelines – what impact can we expect?

With the good news that Omicron is being seen less frequently in the population, it may still feel risky to some of us to begin relaxing mitigation protocols, such as indoor masking. There has been some concern that removing these safeguards will lead to increased rates. I’m not entirely sure that we would see an increase in rates at the population level, however, simply because Omicron rates are in the midst of collapsing upon themselves. Much as a rising tide lifts all boats, a rapidly decreasing case rate might hide pockets of increased transmission.

For those interested in more detail, there is a more detailed blog post available on our website (link: https://drbretsky.com/23-february-2022-blog-post-making-sense-of-lifting-mandates/). But from my vantage point the current incidence rate of 10.3 new daily cases per 100,000 population is about 10 fold higher than my personal comfort level. Viral containment, by convention, is defined as <1 new daily case per 100,000.

3. What’s new in the office – measuring quality of care 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 initially on Women’s Health, specifically mammogram referrals. 

We are simultaneously piloting in 2022 a more extensive quality of care effort among our Medicare patients, one which will ultimately go live in 2023. This project will permit us to look more comprehensively at our data analytics and identify areas for improvement. While it is only in the first few months, we are already finding ways to better engage our patients and promote overall wellness. So if you have phone calls from us asking for you to schedule an Annual Wellness Examination, you now know why!

For more information on Aledade see their website – https://www.aledade.com

4. March’s Epidemiology Lesson:  Vaccine Efficacy.

Following up on more Epidemiology terms used in the popular press (and not always correctly), here is one more to consider

Vaccine Efficacy:  The proportionate reduction in disease among the vaccinated group as compared to the expectation of disease frequency from a non-vaccinated (or placebo) group. So a 95% vaccine efficacy indicates a 95% reduction in disease occurrence among the vaccinated group. Often this is represented to mean that a vaccine has a 95% chance of working for the individual – or a person is “95% protected” – which is not the case. Vaccination is a collaborative effort, a group project if you will.

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