July 2022 Newsletter
Welcome to the July 2022 Newsletter for Santa Monica Primary Care. In this issue, what’s old is new again (unfortunately).  We are going to revisit case rates in Los Angeles County and why Health Department counts are undoubtedly an underestimate. We will also discuss SARS-CoV-2 antibody levels and Evushield, an exciting new pre-COVID exposure preventive tool.
COVID-19 in the Practice during May and June 2022
COVID-19 cases in our practice continued at a steady clip of about one new case a day. In total, we recorded 24 cases of SARS-CoV-2 infection, two of which were second infections. This was down from May when we had 33 cases. 

Nationally, the original Omicron BA.1 and BA.2 variants have given way to the BA.5 (54% of total) and BA.4 (16.5%) sublineages. A third, BA.2.12.1 accounts for about 27% of total cases observed.  As these new subvariants emerge, there exists the possibility that immunologic protection from a prior variant may not protect against a new variant. In fact, there is preliminary evidence that prior infection with BA.1 may not protect against BA.4 or BA.5. Link: https://covid.cdc.gov/covid-data-tracker/#variant-proportions 

There is not yet any evidence that either BA.4 or BA.5 lead to more severe illness as compared to other Omicron strains. In our experience, the currently circulating variants may even be a bit less severe.  We categorized 17 of our 24 cases (71%) in June as ‘mild’ as opposed to 17 of our 33 cases (51%) in May.
COVID-19 in the Community
With the widespread availability of home testing combined with the fact that home test results are no longer reportable to the County of Los Angeles, officially published numbers should be viewed as a significant underestimate of the true impact of infection.

One useful active surveillance tool that might give some insight into community rates are data from Santa Monica Malibu School district which performed weekly PCR testing on students. With the school year ending, the final week of testing was May 31st - June 5th showing a slight decline in prevalence from 1.45% to 1.36% (note that no testing was done in the high school that week).
Paxlovid Rebounds
Dr. Bretsky was one of the first physicians nationally to begin to discuss the impact of Paxlovid rebound on the duration, trajectory, and transmission patterns of SARS-CoV-2 being quoted in a widely publicized Washington Post article at the end of April 2022 (link: https://www.washingtonpost.com/health/2022/04/27/paxlovid-second-case-covid/).
 
Paxlovid rebound has continued to be a thorny issue as 50% of those treated with Paxlovid during the month of June experienced a rebound case (5 rebounds among 10 patients treated). 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. As I tell patients, Paxlovid can turn a 5-7 day illness and isolation into a 3-week extravaganza.
Blogs This Month
Our blog posts this month focused on the public health threat posed to women through the overturning of Roe v. Wade. We also highlighted how maternal mortality rates in the United States showed statistically significant increases during the last two years of the Trump Administration as states began rolling back pregnancy termination access. There are two major factors that significantly modify the risk of maternal mortality: 1. Access to contraception and 2. Access to safe pregnancy termination. This makes it straightforward to protect but also incredibly easy to dismantle.



With the Euro sinking to a 2 decades low against the dollar, and more people electing to travel to Europe this summer, a COVID update for the continent seemed timely.
July’s Epidemiology Definition
Odds Ratio: A statistic that quantifies the strength of association between two events, A and B, or the “odds” of A in the presence of B. An odds ratio of one (1) means that A and B are independent. If the odds ratio is greater than one then A and B are correlated such that the presence of B raises the likelihood of A. If the odds ratio is less than one then the presence of one even reduces the odds of the other event.
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