Dear Sansum Clinic Patients,

COVID-19 has continued to evolve in our community since my last update.  At that time things were heating up in terms of increased cases nationally, and locally our percent-positive rate had been rising exponentially.  Things have continued to be challenging.  Cases in the County remain at a concerning level.  With the amount of infection and transmission occurring in the community, we run the risk of outbreaks in particularly vulnerable populations, like nursing homes.   Despite all that there is to be concerned about, as we will discuss below, our testing may be showing a glimmer of hope locally with regard to ambulatory patients in southern Santa Barbara County.   It is important to recall that even in our County, there is some regional variation, as the problem has been and continues to be worse in the northern part of the County. 

On July 12, Governor Gavin Newsom rolled back the reopening of Santa Barbara County and many other counties throughout the State.  On July 17, Governor Newsom announced that all schools in our County would reopen with full-time remote learning.    

With that background, I thought this time, we would look at things first from a very high level, looking at US data compared to some other countries.  We may be able to learn from that data about the value of following the public health guidelines.  Then we’ll look at a very narrow set of data, the results of Sansum Clinic’s testing, and finally comment on some developments. 

There is still discussion in politics and in the news about whether the US is really just testing more than others and if the COVID-19 situation in the US is somehow a manifestation of our testing and not really a measure of an underlying real problem. As you’ll see in the data below, we have a real problem relative to other countries that is not a manifestation of testing. Looking at mortality data is helpful in this discussion because it removes the important but sometimes-controversial detection of asymptomatic carriers.  It is one of the better “apples to apples” measures we have about the health burden of the pandemic across geographies.  The chart below shows the COVID-19 mortality rate per 100,000 of population for different countries. 
Mortality in the most affected countries
Death rate per 100,000 population
Although not shown here, many other European countries fall between the United Kingdom and the US.Based on the Santa Barbara County Public Health data and estimating the population to be 450,000, our County would be about 7.1 per 100,000, much better than the US average, but worse than many other countries. South Korea, a densely populated country that had its first case about the same time as the US, has a mortality rate of 0.58 per 100,000, a rate about 1/10th of Santa Barbara County and 1/75th of the US average.The South Korea vs US difference in mortality rate is telling – and tells a critical story about the importance of getting and following the advice of public health experts.
Looking at some other data may help understand where we as a country went sideways relative to our peers. The graph below, from the July 20 Wall Street Journal article entitled, “How Europe Kept Coronavirus Cases Low Even After Reopening” explains how in April and May, when Western European countries began phasing out their lockdowns (allowing greater social interactions) the expected surge in new cases didn’t happen.In fact, the number of new cases continued to decline after the reopening.The article credits this largely to changes in three social behaviors all related to the advice of public health officials:social distancing, enhanced hygiene and wearing masks.Those countries adopted those behaviors to a much greater extent than the US did. They did not have special medications or vaccines.They just received and followed public health advice more faithfully than the US did.
The following chart shows what is happening locally, very locally, just looking at the testing done at Sansum Clinic.  While it is a very narrow data set, it is a consistent population in terms of nature of the patients being tests.  Despite the relatively small sample size, we find the consistency of the population tested to be helpful in seeing trends.  You will see the exponential rise from low rates of positive test results with relaxing of restrictions in May and June.  Then, a plateau in the rate of positive tests for a few weeks and now a fall in the positive rate.  Hopefully, that fall is the first step in a trend that reflects the increased carefulness of the population once people realized the risks of ignoring public health advice.  
We’ve now looked at the US compared to other countries, which, as mentioned, don’t have vaccines or medications unavailable to us, but have done much better than our country has.  They have done that by being more diligent about wearing masks, social distancing, hand washing, avoiding crowds and generally following public health advice.  Locally, we’ve seen what happens when we have dropped our level of vigilance, and hopefully are seeing what happens if we start being more careful.  As a large healthcare employer, we are taking infection prevention measures extremely seriously with staff and patients alike. No one wants to be locked down.  No one wants to shutter businesses.  We all want kids to go to school safely.   International data, national data and local data suggest that if we are more careful, those returns to normal are more likely. There has been encouraging progress on vaccines, though much needs to be done before they will be available.  But, the initial data is encouraging in that specific immune responses follow vaccination with some of the vaccines being developed.  There was a story in the news that in Italy there is now an antigen test being used, like a home pregnancy test, which costs less than $20 and returns results in minutes.   It requires a person doing a naso-pharyngeal swab on themselves, inserting a long swab through the nose into the throat.  (That proves how tough Italians are!) Hopefully the technology will prove reliable and less invasive ways of getting a sample – front of the nose, or mouth – will work, but that technology may be a game-changer if it proves reliable, as it would be inexpensive, able to do at home, and provides quick results regarding whether or not someone has an active coronavirus infection.  Still in the future for us, but people are working on it.  Meanwhile, testing locally is getting more challenging because of shortages in swabs – of all things.   It is something we are all watching.    
A few final thoughts I would like to share.   Most medical needs don’t disappear just because we are living through a pandemic.  It is still vitally important to get the medical care you need.  At Sansum Clinic, we have instituted many new practices to ensure our facilities from Carpentaria to Santa Maria are safe for you to visit.   We also offer Telehealth video visits, which you can conduct from the safety of your home.  You can find links for how to request and conduct an appointment via Telehealth here. 

It is gratifying to know how many patients and businesses have contacted us with offers of financial contributions and gifts in-kind.  In response, we established our Pandemic Relief Fund to help cover the costs of personal protective equipment (PPE), our car-based testing site, and other COVID-19 related expenses. If you would like to support this effort, please click here to make a tax-deductible gift and select Pandemic Relief Fund.

As always, thank you for choosing Sansum Clinic for your healthcare. Please stay safe.  We are here for you.  And remember, we are smiling under our masks.

Kurt N. Ransohoff, MD, FACP
CEO and Chief Medical Officer

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