Hello Patients of Sansum Clinic,
We are now entering the fall season and can reflect on the past few months.  It was a challenging summer due to the pandemic, as infection rates increased both locally and nationally after the Memorial Day weekend. We have been watching the situation closely.  In this email, I am including an update on COVID-19 as well as some important information about the upcoming flu season.  You can skip ahead to the bottom of the email if you are most interested in information about flu vaccinations.
In the last few days, we have read national and international reports on an increase in the numbers of COVID-19 cases, but as you will see later in this letter, it appears we are doing better locally. Let’s start with national data from the September 20 Johns Hopkins COVID Dashboard where we can see how we, as a nation, are faring compared to 10 other highly-affected countries in terms of new cases.  This metric is complicated, because it is dependent on the amount of testing being performed, but assuming there are not big policy changes in the individual countries, it is still helpful to see.
A metric that is less subject to debate about its merits is the COVID-19 death rate per 100,000 in the population of a given country. That does not depend on the amount of testing.  Below is a graph showing where the U.S. is relative to other countries.  It is notable that the graph below chooses representative (not all) countries; so the U.S. does not have the 6th highest rate of all countries.  Actually, the U.S. is 10th between the UK and Italy in terms of the per capita death rate, according to the Johns Hopkins listing of more than 160 countries.
So where are things now more locally?   California had the early summer spike that was seen across much of the US.  We are doing better now, but not good enough. In the graph below, we see California data from the same Johns Hopkins COVID Dashboard.  The vertical lines represent policy decisions about openings and restrictions.  These are available for all states on the site and are fascinating if you have a great deal of time to spend browsing around.  Locally and elsewhere, better control of the contagion has come with more restrictions, greater mask wearing, persistent and greater social distancing and a constant reminder that we still have a long way to go before this will be behind us. 
The County of Santa Barbara is still in the purple category, according to California’s color-coded 4 tier system.  Purple indicates “widespread” transmission within the county based upon the number of cases per capita and the percent positive rate of the testing being done.  We are trying to get into the less-restrictive, red “substantial” transmission category, which will bring loosening of some restrictions.  I thought it would be interesting to see how the cases have been dispersed across the county.  The northern part of the county has been more affected than the southern part.
Let’s look at our most recent data, from last week.  This time period is important.  Since it encompassed days 7 to 14 following the middle of the Labor Day weekend, we worried that if Labor Day weekend resembled the Memorial Day holiday, then we would see evidence in this week’s data.  The incubation period for COVID-19 is considered to be as few as 2, to as many as 14 days, though most people seem to get ill in the 5-to-8-day window following an exposure  Hence our concern about a possible spike this last week.  As noted below, we did not see a blip this last week.  Instead, the week right after Labor Day had a slight blip, which was probably not related to Labor Day, as that would have been too soon.  We will see if next week continues at our low rate; if it does, then it might show that we learned something over the summer. 
If we have made it through Labor Day without a massive spike, what is the next concern?  The seasonal flu and the return of the other seasonal respiratory virus infections (the common cold, for instance) is what has us here concerned the most. 
Let’s talk about the flu in a minute.  Why does the common cold have us concerned?  The common cold viruses should be no worse this year than other years.  However, this year when you get a respiratory infection with a temperature of 99.9 degrees and a cough and congestion that you would have managed without worry last year, many will wonder, appropriately, if it could be COVID-19.  “Should I get tested?  Do I have to notify everyone I have been around that I am sick, in case it is COVID?”  Most docs will probably say “Yes” if asked and the increased demand for testing will create logistical challenges.  While supplies are more reliably available than they were, availability of supplies is still a concern.  So, the common cold this year will not be so common in terms of its impact on patients and the healthcare system.
The flu – influenza – will have the same challenges as above, but with the potential to cause real trouble all on its own.  Recall that in normal times, influenza all by itself takes tens of thousands of lives in the U.S. every year.   Unlike the common cold, influenza will look more like COVID-19 even to experienced doctors. This will create even more demand on all aspects of the healthcare system.  Of greater concern, if someone gets both influenza and COVID-19 at the same time, which is entirely possible, the outcome is apt to be much worse than contracting just one of these viruses, which can be bad on its own.  
What do we know about flu in the Southern Hemisphere this year?  This is relevant because, of course, the Southern Hemisphere has just gone through its winter flu season.  The World Health Organization in its update on September 14 notes that most of the reporting sites in countries on the other side of the equator are reporting lower-than-normal rates of influenza.  It is quite possible that social distancing and mask wearing in those places has diminished influenza transmission.  That makes sense.  We can hope that will also be the case on this side of the equator.  Time will tell.
In the meantime, get a flu shot! It will offer protection against the flu alone, lessen the chances of potentially-disastrous simultaneous COVID-19 and influenza infections, and certainly lessen the likelihood of a frightening time of having an illness that will look like COVID-19 and will need testing to sort it out. 
At Sansum Clinic, we began vaccinating this past week.  We are doing it differently this year, to ensure social distancing and to maximize the safety of our patients and staff.  We are offering drive-up options this year. We are also offering patients the chance to receive a flu shot while they are already attending appointments in clinic departments that don’t traditionally offer flu vaccines like orthopedics, urology, ophthalmology and others.  We continue to offer flu shots at our 2 pharmacies and in departments that have always given the vaccinations to their patients at the time of visits.  In the first week of vaccinating for the flu, we have provided more than 2,500 shots to our patients, and expect to do more in the weeks ahead, despite the process looking a bit different than in the past.  
We are concerned about the availability of “high-dose” flu shots, vaccines intended for those over age 65, as there have been supply problems.  We ordered 10,000 high-dose shots, but we are receiving them slowly instead of all at once.  While some patients may want to wait for a high-dose shot, that could mean waiting until flu season has started. For those who are ready to be vaccinated, Sansum Clinic and the CDC recommend another suitable vaccine (a “regular flu shot”) instead of waiting and not getting vaccinated.  It is important to get vaccinated before the flu starts circulating in our community. It can take a few weeks from the time of vaccination to build up antibodies.  As a result, getting a flu shot over these next few weeks is extremely important.  So, we recommend getting a flu shot sooner than later.  Because we’d like everyone in our community to get flu shots, Sansum Clinic is donating 2,000 doses of the vaccine to the Santa Barbara County Public Health Department which will use their mobile outreach units to distribute the vaccinations for free.   
Here are some of the ways Sansum Clinic patients can receive their flu shots:
  • Make an appointment at our drive-up tent, via MyChart*
  • Make an appointment at our drive-up tent by calling the Flu Hotline at (805)681-7805*
  • Make an appointment at the pharmacy by calling (805) 964-4831 for the 215 Pesetas Lane Pharmacy OR (805) 682-6507 for the 317 West Pueblo Street Pharmacy**
  • For patients under age 12, appointments can be scheduled at Hitchcock Pediatrics, by calling (805) 563-6211
  • Get your flu shot during your appointment with a Sansum Clinic provider in most departments.
*Flu shots provided at the drive-up, by-appointment flu tent are for patients age 12 and older
**Flu shots provided at the Pharmacy locations are for patients age 18 and older
Special thanks to Virgil Elings for his very generous support of our flu shot program, as well as Montecito Bank & Trust and Bright Event Rentals.  As we have heard many times over these past few months, we are all in this together and we are so fortunate to have philanthropic support as we navigate these unchartered waters.
Finally, as you all have heard, there are the earliest rumblings about a COVID-19 vaccine, but those early rumblings are still too early for us to be making plans.  We are taking notes however, as we try out different ways to provide flu vaccinations during this pandemic.  What we learn now should be useful in the future.
Wear a mask, get a flu shot, keep trying to socially distance.  We’ll get through this.
We are still smiling under our masks,
Kurt Ransohoff, MD, FACP
Sansum Clinic

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Sansum Clinic · 470 S Patterson Ave · Santa Barbara, CA 93111-2404 · USA