CMO Update May 9, 2022
A belated Happy Mother’s Day to all our QualDerm mothers and grandmothers!

I continue to be incredibly impressed by the EMA/Modernizing Medicine transitions that I hear about from the QualDerm support team. North Carolina practices have not yet begun, but it seems like Ohio and Tennessee have successfully integrated the new EMR and Practice Management software with flying colors. Most users report enhanced efficiency, even within days of integration, and I look forward to our own transition later this summer. Many kudos to the IT support team, practice managers and QDP teammates for your hard work and positive attitudes during these potentially stressful times. “Teamwork makes the dream work” couldn’t be truer for this major initiative for our company.

Also, continue to keep an eye out for information regarding our Patient Experience initiative. Dr. Dan Pearce led our kick-off meeting last week and shared this infographic demonstrating how each one of us, in some important way, impacts every patient’s experience with QualDerm. View our Patient Journey map here. It was very eye-opening to appreciate the innumerable opportunities we have to exceed the expectations of our patients and develop lasting and loyal relationships. These are the bonds that healthcare is based upon and makes our group strong and sustainable.

I am very excited to introduce another initiative for our clinical group, Virtual Grand Rounds. You will hear more very soon but I wanted to put this on everyone’s radar. If you have an interesting case to share or a challenging patient to leverage the collective wisdom and experience of our outstanding group of providers, this virtual forum will serve that purpose. It will function like Grand Rounds from our training days, except online through Zoom or Teams. We have so much knowledge to share to benefit our patients and each other. Drs. Kevin Stein and Dave Brodland will be following up with details.

I was hoping to avoid any more updates dedicated primarily to COVID, but I wanted to provide some new information to explain the reasons we are seeing so many recent infections among us, our patients, friends, families and co-workers.

I can now personally attest to the ubiquitous nature, extreme contagiousness, and immune evasiveness of the most recent variant of the coronavirus. Without any known high-risk exposure, and while social distancing and masking in public I developed completely asymptomatic COVID-19 last week, having just routinely tested prior to work. As we see in many studies, my vaccine-immunity from a total of 4 mRNA vaccine doses reduced my severity to the point that I never felt a single symptom of any kind. Without the positive test I would have had no idea. Fortunately, both vaccine and natural immunity from prior infection has been extremely helpful in reducing overall COVID deaths worldwide. 
Although hospitalizations in the United States are overall low, they are rising at a similar rate to the Delta wave.
Obviously, this immunity has NOT been completely effective in preventing infection with the newer Omicron variants (BA2.12.1 and BA.4/BA.5). In the United States, experts estimate that almost 50% of our population has been infected with early Omicron BA.1 wave over the past 6 months, many asymptomatically and untested. Despite widespread vaccination and these innumerable infections, there is a significant drop in neutralizing antibodies over time, so that our immune systems are not able to prevent many initial or re-infections a couple months later. 
Former FDA Commissioner Dr. Scott Gottlieb reports that an ~8-fold drop in neutralizing antibodies against BA.4/BA.5 from recovered BA.1 is likely driving the current Omicron reinfection surge in South Africa. The available mRNA vaccines were not formulated for these newer variants, although both Pfizer and Moderna report that they are developing updated vaccines for distribution this fall, when additional surges and booster recommendations are anticipated. Other companies report work on pan-coronavirus vaccines, which would be effective against all variants. We can only hope!  
For all the science nerds out there (I count myself in this group!), this illustration demonstrates how Omicron’s evolving mutations have allowed it to evade our immune system but also why we see more nasal/pharyngeal symptoms than catastrophic lung disease, like in the initial waves when we were running out of ventilators in the ICU.
So what do we do now?? Everyone is fatigued of COVID and we psychologically need a break. I would recommend returning to normal activity as much as possible, unless you routinely interact with high-risk patients, friends or family members. Otherwise, consider masking and distancing in crowded indoor settings, like public transportation, entertainment, sporting events and especially health-care facilities. We know very small aerosol droplets can remain airborne and infective for extended periods of time indoors and the “6 foot distance, 15 minute” exposure rule is likely insufficient with these newer Omicron variants. Be careful and test frequently for even mild cold symptoms like sore throat and runny nose so that you can identify if you are infected and can avoid exposing others. While monoclonal antibodies no longer show the efficacy they did with earlier coronavirus variants, antiviral medications like Paxlovid when started immediately can help reduce case severity. Both these drugs and rapid antigen tests are widely available, and we should take advantage of them now more than ever.
As a refresher, here are the current CDC recommendations for vaccine booster doses, showing both eligibility criteria and rationale to consider waiting until the fall, which many experts support unless you are at high risk. 
Another reason for women of child-bearing age to consider vaccination is that COVID-19 infection during pregnancy has repeatedly shown worse outcomes. In a recent study conducted in Canada from March 2020 to October 2021, SARS-CoV-2 infection during pregnancy was significantly associated with increased risk of hospitalization, adverse maternal outcomes and preterm birth. This is especially relevant as we celebrate Mother’s Day!

Stay well and be safe,
Dr. A
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