August 2022 Newsletter
Welcome to the August 2022 Newsletter for Santa Monica Primary Care. In this issue, we are going to discuss case rates in Los Angeles County and why our Health Department decided against resuming an indoor mask mandate. We will also discuss Paxlovid rebound in the context of President Biden’s SARS-CoV-2 experience.
COVID-19 in the US and LA County during July 2022
COVID-19 cases in our practice have continued at a steady clip of about one new case a day - which has been consistent over the past three months.
 
Nationally, the BA.5 variant has overwhelmed the original Omicron BA.1 and BA.2 variants as well as the BA.2.12.1 and BA.4 sublineages. BA.5 now accounts for 81.9% of the variabnts seen as compared to 54% of the total last month. Link: https://covid.cdc.gov/covid-data-tracker/#variant-proportions 
 
Cases in Los Angeles County after our huge Omicron surge in December and January were lowest the week ending March 22nd when they were at 5.8 new daily cases per 100,000 population (note viral containment is generally defined as under 1 new daily case per 100,000). They have risen steadily since that time and now stand at 59.3 cases/100,000. Note the slow rise as compared with the sharp peak of Omicron.
Similarly, prevalence (the proportion of active cases per 100 individuals) has steadily increased over that time period.  While down as low as 0.05% in late March, the most recent prevalence estimate is 9.6%. This has risen from 8.2% the week prior.
The Health Department based their decision to forego an indoor masking mandate as hospitalizations seem to have plateaued (link: http://dashboard.publichealth.lacounty.gov/covid19_surveillance_dashboard/).
 
We are not seeing a reduction in incidence case rates or prevalence at this point, either in the County or in the practice as a whole
Paxlovid Rebound
We have covered Paxlovid rebound in prior Newsletters and, as mentioned before, Paxlovid rebound has continued to be a thorny issue. To see it occur with President Biden was not a complete surprise. In our aggregate experience, 10 of the 35 patients (28%) we have treated with Paxlovid have experienced a clinically apparent rebound.   
 
Most national estimates discuss a Paxlovid rebound rate between 10% and 40%. While patients taking Paxlovid feel better faster and the rebound infection is typically milder than the initial symptoms, it nevertheless is something to consider before starting treatment.
Similarly, prevalence (the proportion of active cases per 100 individuals) has steadily increased over that time period.  While down as low as 0.05% in late March, the most recent prevalence estimate is 9.6%. This has risen from 8.2% the week prior.
Blogs This Month
Our blog posts this month focused once again on our ongoing COVID-19 pandemic, which has changed in contour since we first began covering it in March of 2020. We specifically discussed the absurdities of the CDC’s 5 day isolation guidance in “Do As I Say, Not As I Do”.  We also covered the population dynamics of the virus as well as what some call the inevitability of acquiring the infection.
 
On The CDC ‘5 Day Rule’:
 
On Population Prevalence and the ‘Luck’ of COVID Acquisition:
 
On The Return of Masking, Summer 2022 Edition:
August’s Epidemiology Definitions
Clinical Trial: A synonym for an epidemiologic experiment which is typically conducted with the aim of evaluating which treatment for a disease is better. 
 
Placebo: A comparison group in a clinical trial intended to have no biologic effect outside of the roffer of treatment itself. The term is from the Latin “I shall please” and placebo pills typically contain sugar or other inert ingredients.
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