November 2022 Newsletter
Welcome to the November 2022 Newsletter for Santa Monica Primary Care.
In this issue, we are going to cover the alphabet soup of COVID variants and try to predict what may happen as we enter the Holiday Season. We will share our current practice experience with COVID cases as well as trends we are seeing in LA County at large. Lastly, we cover this month’s Blog posts, including one on the utility of colonoscopies in reducing colon cancer mortality rates.
COVID-19 in the Practice and in LA County
COVID-19 cases in our practice have shown a slight rebound as compared to the dramatic slowing of September (Figure below). The month of October left us with 10 cases, one of which was a repeat infection and the remaining 9 all initial infections. Cases were generally mild (5 of the 10 were characterized as such) but one did lead to hospitalization. Of the three cases treated with Paxlovid, one led to a rebound phenomenon.
Cases in Los Angeles County, on the other hand, continue to be on the decline, and are now the lowest levels since March of this year (Figure below). The most recent daily incidence rate is 7.4 new daily cases per 100,000 population down from 7.9 the week prior.
This trend runs in direct opposition to comments from the LA County Health Department which notes that ‘coronavirus cases are no longer declining at the rate seen over the summer and appear to have plateaued.’ LA County Health Department Director Dr. Ferrer commented, “We’re no longer seeing a steady decline in cases” as LA County’s case rate began showing week-over-week increases just after mid-October (link: https://www.latimes.com/california/story/2022-11-01/new-coronavirus-omicron-subvariants-bq1-bq11-ba5).
The prevalence rate is also the lowest it has been in many months at 3 active cases per 1000 residents (Figure below).
Lastly, mortality rates have shown a steady decline since mid-summer and are now as low as they have been since April 2022.
BA.4/BA.5 Bivalent Booster Uptake Remains Slow
In August, the FDA authorized the use of Moderna and Pfizer Bivalent Vaccines for a single additional booster dose 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 22 million – or 7.3% of those eligible – have received a bivalent booster dose. This has increased from 7.6 million (3.5%) last month at this time.
Blogs This Month
Our blog posts this and previous months can be found archived on our website at www.drbretsky.com/blog. As a bit of a departure, we covered a recent report suggesting that colonoscopies were not as effective in reducing colon cancer mortality. While this generated a fair amount of press coverage, the study itself was actually not all that compelling and certainly was not enough to change clinical recommendations of colonoscopy as a screening tool
On Colonoscopies: https://drbretsky.com/11-october-2022-blog-post-on-colonoscopies/
We also covered COVID-19 in 2022 as compared to 2020 and 2021 in our second blog:
https://drbretsky.com/13-october-2022-blog-post-a-crazy-covid-year/
The Alphabet Soup of Variants
BA.5, BQ.1, and BQ.1.1 are among the ever growing population of variants of concern. But, in reality, tried and true BA.4.6 and BA.5 make up 84.6% of the variants sequenced across the United States (link: https://covid.cdc.gov/covid-data-tracker/#variant-proportions) and 83.3% of the variants seen in HHS Region 9 which includes California, Arizona, Nevada and Hawaii. While the proportion of BA.4 and BA.5 is decreasing over time (Figure below), they are nevertheless the overwhelming majority of variants seen both regionally and nationally. With booster vaccines that are directly matched to these variants, we should continue to see decreasing case rates and mortality rates.
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