Dear Patients,
As the Thanksgiving holiday approaches, I wanted to send a COVID-19 update to remind everyone that there are steps we can all take to keep ourselves and our loved ones safe.  While this will be a different holiday season for all of us, this information might make it easier to adhere to the guidelines.
If you have read my previous COVID-19 updates, you will recall that I periodically share information that our Medical Director, Dr. Marjorie Newman, distributes to physicians and staff.  Her update this week included a wide variety of information that I thought would be of interest to you, too, which I have included in this update.  I have received positive feedback from a number of people on the depth of the information we provide, even though these updates tend to run long.  I hope you will read this and join me and all of us at Sansum Clinic in doing our part to keep you, your family and our community safe.
There continues to be an alarming increase in COVID-19 cases globally and domestically.  This past week the US averaged 140,000 new positive COVID-19 cases per day and in the past 24 hours reported over 166,000 new cases in the US with an 82% increase in cases over the past 2 week period and a 40% increase in the fatality rate.  As of Tuesday, November 17, the total number of fatalities in the US due to COVID-19 since the pandemic began was reported as 247,437.  The number of cases in California, including Santa Barbara County, continues to rise and as a result, on Monday the Governor of California announced a dramatic rollback of reopening of much of the state, resulting in most counties, including Santa Barbara, being placed again in the most restrictive purple tier.  Starting on Tuesday, many businesses have had to suspend or severely limit indoor operations. 
California Confirmed COVID-19 Cases (on the rise):
As of November 16, since the pandemic began there has been a total of 1,029,235 positive COVID-19 cases reported in California and 18,263 deaths.  Of great concern, over the past few weeks we have seen the number of positive cases in California significantly increase. Over the seven day period that ended on Sunday, the state averaged 7,985 cases per day, a rate that has nearly doubled in the past two weeks.  The graph below depicts the number of new cases per day in California. The pink background color indicates that the two week trend of new cases has doubled and if the current trend continues, we will surpass the peak that we had seen in July.
Santa Barbara
According to the Santa Barbara Public Health Department website, there are currently 255 active COVID-19 cases in the county (up from 165 last week) with 13 people hospitalized and 5 in the ICU.  The cumulative death count is at 133 and the death rate is 1%.  It appears that the daily positive COVID-19 case count continues to rise with 40-50 new cases per day in the past week. The positive cases are being reported in both north and south counties. The case rate (7.1 per 100,000) and case positivity metrics (2.7%) have increased and as mentioned above, Santa Barbara County, like most counties in California has been moved into the purple tier indicating widespread infection.  
The first graph below reflects our Sansum Clinic weekly COVID-19 testing data.  For the week ending November 15 our percent positive rate for Sansum Clinic tested patients has remained fairly steady from last week, now at 2.78%. 
The second graph below represents the monthly trend of positive cases since the onset of the pandemic in March, with the surge in cases noted in July, then decreasing over the ensuing months with cases on the rise again in November.
Influenza Vaccine Update: We continue to provide influenza vaccine throughout all of our clinic locations including the influenza immunization tent and the pharmacies.  As of Tuesday morning we have vaccinated 17,533 patients against influenza.  To date there have been 212 in-patients tested for the flu and none has tested positive.  We will continue to provide vaccine throughout the flu season to ensure that all patients age 6 months and older are protected against the flu.
CDC Update-Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2:   As we know, mask wearing is one of the most important ways to prevent the spread of COVID-19 and last week the CDC indicated that wearing a mask not only reduces the emission of virus laden droplets (“source control”) which is especially relevant for asymptomatic or pre-symptomatic infected wearers, but it also helps reduce the inhalation of these droplets by the wearer (filtration for personal protection).  As a result, masking is not only important to help protect others from the mask wearer (source control), but masking also protects the person who is wearing the mask, which makes mask wearing even more important and hopefully more persuasive for those who have been reluctant to do so.
Additionally the California Department of Public Health released updated guidance on Monday regarding the use of face coverings, indicating that face coverings are required at all times when outside of the home, with some limited exceptions (e.g., in a car alone, in an office alone, actively eating or drinking at least 6 feet away from others, etc.).  The full guidance can be found here
COVID-19 Vaccine Update:  In addition to the Pfizer mRNA vaccine, there is another company, Moderna, which issued a press release on Monday indicating that their vaccine reduced the risk of Covid-19 infection by 94.5%. Pfizer has now reported that its efficacy is about the same 95% level.  Each of those vaccines consists of two doses separated in time by weeks.  The Pfizer vaccine will have logistical challenges because it requires very cold (-90 degree Fahrenheit) storage, but it appears as if it will be available in larger amounts sooner.   The Moderna vaccine has the benefit of remaining stable at standard refrigerator temperatures of 2-8 degrees Celsius for 30 days, up from the previous estimate of 7 days. Additionally, shipping and long term storage conditions for 6 months can occur at typical freezer temperatures (-20 degrees Celsius).
Both Moderna and Pfizer’s trials are continuing and efficacy figures could decline by the time the trials are complete. Experts warn that it is often the case that a vaccine performs less well in the real world than it does in the setting of a clinical trial.  Also, data from the two trials do not indicate how long the protection afforded by the vaccines lasts. That can only be determined over time as large numbers of people are vaccinated. The Moderna results, like those from Pfizer, were disclosed in a press release, not a scientific journal, and limited details have been made public. 
We realize that patients are anxious to learn more about the vaccines and when they may be available to the public.  At this point, a vaccine still needs to be authorized (Emergency Use Authorization) by the FDA and distribution plans need to be implemented by the local public health departments.  We have heard that the hope is to have vaccine distributed to high priority groups (e.g., health care workers and first responders) prior to the end of the year and we will continue to provide updates as they become available.

Thanksgiving:  As indicated above, California, along with much of the United States, is experiencing a sharp increase in COVID-19 cases.  Travel and mixing households increases the chance of contracting and spreading the virus that causes COVID-19. As a result, the Santa Barbara County Public Health Department does not recommend travel during the pandemic and the current Health Officer Order does not allow for private gatherings.  Also, on Friday, November 13, Governor Newsom issued a travel advisory encouraging people to stay home or in their region and avoid non-essential travel to other states or countries.  The advisory also recommends that persons arriving in California from another state or country should practice self-quarantine for 14 days after arrival.
As a result, it is clear that despite the holiday season and Thanksgiving, which is fast approaching, celebrations will need to be different this year in order to do all we can to keep each other safe and healthy and minimize the spread of infection.  While gathering with those outside of your home is prohibited in Santa Barbara County, there is recognition that some may have plans for travel to visit family elsewhere.  As a result, here is some information from the Public Health Department regarding the upcoming holidays and ways to stay safe.  

Public Health Guidelines and Questions About COVID Testing:
To keep yourself and your loved ones safe as colder weather drives more people indoors, follow the guidelines for small gatherings from the California Department of Public Health, some of which will be hard to implement, but all of which will give you an idea of things to consider in these odd times.
We have been hearing questions from patients about getting tested for COVID-19 prior to visiting with relatives, so I thought I would provide some FAQs which may be helpful:
If I test negative for COVID-19 it means I am not infected and can’t infect anyone else, right?  Not necessarily.  The incubation period for Covid-19 is up to 14 days. And before that, you can be testing negative, and have no symptoms, yet you could actually be harboring the virus and be able to transmit it to others.
If I got infected yesterday, would a test today pick that up? No. The virus takes time to replicate in the body to detectable levels.  Although you can get infected by just a few viral particles, your infection will not be detectable until the virus has had time to replicate to adequate levels to be detected. 
So how many days should a person wait after possible exposure to get tested?  There is no hard and fast rule, but the evidence suggests getting tested before the third day after exposure is not of much use and most recommend waiting till day 5-7 to get tested, in the absence of symptoms.  If symptoms are present, earlier testing makes sense, with the knowledge that a negative test does not mean you will not become positive later. 
Could I be contagious while testing negative? Yes, symptoms can take up to two weeks to appear after being exposed but the average time is approximately 5 days.  It is generally thought that you are most infectious the two days before symptoms appear and two days after that. That is the reason the virus spreads so easily-because people can be infectious without having any symptoms (pre-symptomatic). The CDC estimates that 50% of transmissions happen before symptoms begin.
So what should I do if I want to see friends or relatives during the holidays? If you insist on seeing anyone who doesn't live with you, self-quarantining for 14 days beforehand is the safest (though very hard to accomplish) approach. See self-quarantining instructions here.
Can we provide testing for people who will be visiting with relatives?  Unfortunately we don’t have enough testing capacity and are only able to test patients who are symptomatic or have had a close contact exposure. 
The following community sites are open 5 days per week (except the Isla Vista Site which has limited days/hours).  To make an appointment, register on line at or call (888) 634-1123.
  • Santa Maria Fairpark
  • Goleta Valley Community Center - 5679 Hollister
  • Buellton AMR Conference Room - 240 CA-246 Buellton
We hope the above information has been helpful.  Again, we can’t emphasize enough that as we enter the colder weather and the holidays with more indoor activities, it is extremely important that we not become complacent and let our guards down.  As healthcare providers, we hold our staff and physicians to the highest level of public health guidance of wearing masks, social distancing, washing hands and avoiding social gatherings with anyone outside of the immediate household in order to keep the infection rate down and continue to protect each other, our patients and our families.  We hope you will do the same.
The support we have received from our donors as well as local businesses has been gratifying.  They believe in the critical role we play in providing healthcare to our community and value the work we do for our patients.  Their interest in supporting our work at this critical time warranted us establishing the Pandemic Relief Fund.  This fund will help us purchase additional personal protective equipment (PPE) and testing supplies so that we may continue performing essential testing.  We will use some of the funds to deal with the unique challenges the pandemic has caused in terms of our regular operations – for instance the increased costs associated with providing large scale vaccinations – for the flu first, and hopefully for the novel coronavirus one day soon.  If you would like to support this effort, please click here to make a tax deductible gift. 
On a personal note, all of us at Sansum Clinic and Ridley-Tree Cancer Center wish you a wonderful, happy and safe Thanksgiving holiday, hoping and increasingly believing that by this time next year, we may be able to once again surround ourselves with our loved ones.
We’re here for you, and we are all 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