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Trinity Clinic, 321 SE 29th Place, Suite 102, Ocala, FL (2025)

08/14/2022

Marion County, FL COVID-19 Trends
August 14, 2022

07/31/2022

Marion County, FL COVID-19 Trends
July 31, 2022

Have we peaked for this surge? We are just beginning to see indications that we have. If this does become a true peak, this surge will have lasted more than six months, which is a significant change in pandemic behavior.

As we all have learned over the past 30 months, pandemic behavior is mostly a function of population behavior. This summer marked the first surge where the world was living life mostly back to normal. Travel restrictions and mitigation requirements (masking, distancing, etc) have been lifted. Though many of us remain vigilant, we are basically spreading germs like we always used to. Because of our population behavior, the easily transmissible BA.4/5 variant family is now dominant throughout the world. We're all surging at the same time with the same variants. That's new for COVID.

Thankfully, these variants are less dangerous than previous versions, and the local and global COVID hospitalization burden hasn't come close to being that of the 2021 Delta variant, even though we have significantly more cases.

This long surge seems to be the beginning of COVID shifting to a global seasonal virus. There is still much work to be done, including the development of better vaccines and outpatient oral medications and improving our understanding of the long term effects of COVID and how to help those who still suffer.

Stay safe and cool!
-DK

07/16/2022

Marion County, FL COVID-19 Trends
July 16, 2022

The spread of BA.4 and now especially BA.5 are resulting in this continuing significant COVID surge. Despite broad natural and vaccination immunity within our community, these new variants have proven to evade this immunity in many people, resulting in a large number of symptomatic infections. Immunity seems to be strongest in those with a booster or natural infection within the past 3-4 months. However, the rapidly mutating nature of the virus, with broadly varying immunity and mitigation behavior among the population renders a precise analysis difficult.

What's particularly unusual is the length of this surge. Delta peaked at the 7-week mark, Omicron peaked within 4 weeks. This BA.4/BA.5 has been surging more slowly, but for much longer at 12 weeks, and has not yet peaked. This is new epidemiological behavior that needs further study. This surge is also unique because it is occurring nationwide, rather than regional surges occurring at different times.

Hospitalizations continue to rise, but also more slowly than previously. Take whatever precautions are necessary for your situation. Also a friendly reminder that you are most likely to catch COVID from a friend, relative, or co-worker.

I've changed CDC County View COVID Tracker Map to the CDC County View Community Transmission Map. Blue is low community transmission, yellow is moderate, orange is substantial, and red is high (for reference, the Trinity graphic uses green, orange, and red).

Take care,
-DK

07/02/2022

Marion County, FL COVID-19 Trends
July 1, 2022

This BA.4/BA.5 summer surge is continuing. There was uncertainty previously as to how significant this surge would become. Those questions have been answered. Hospitalizations continue to rise, however the slope of the increase is not as sharp as previous surges, and the total is not as high (so far). I'll remind everyone again that the figures for total new cases and positivity over the past few weeks is certainly an undercount.

As far as vaccination guidance, the standard advice of keeping current on your boosters remains the best option. More research is needed before we can definitively say how effective our current boosters are. As of this moment, the original first double dose plus two boosters is considered up-to-date. Some high-risk folks could consider a 5th shot (speak with your provider).

This summer surge has proven to be a bit more than I expected. Take whatever precautions are necessary for your situation. Also a friendly reminder that you are most likely to catch COVID from a friend, relative, or co-worker.

I've also added today's CDC County View COVID Tracker Map. Green is low community levels, yellow is medium, and orange is high (for reference, the Trinity graphic uses green, orange, and red).

Love to all and be safe!
-DK

06/23/2022

Marion County, FL COVID-19 Trends
June 23, 2022

This BA.4 and BA.5 summer surge has continued, although we're thankful the impact on the healthcare system has been minimal. As we all know, the new case counts are very likely a significant undercount of the true number of cases in the community. You'll notice that there has been a bit of an increase hospitalizations. However, a majority of the positive cases currently admitted are either asymptomatic, or have recovered and are awaiting placement back in long term care facilities. Severe cases of COVID are becoming increasingly rare over time. This is due to increasing population immunity (natural + vaccination) and weaker variants.

What gives me optimism are these facts:
The U.S. is fully open for business amidst a surge of the most contagious versions of COVID so far. Travel is at or near an all time high, and mitigation measures such as masking, distancing, isolation protocols, and the avoidance of crowds and indoor spaces are rare or non-existent. Despite all of this, we just aren't experiencing the scary increase in severe illness, hospitalizations, and deaths that would certainly have occurred earlier in the pandemic.

All of that being said, COVID is still very much present locally. Take whatever precautions are necessary for your particular situation.

Take care!
-DK

06/05/2022

Marion County, FL COVID-19 Trends
June 2, 2022

With increasing community cases, we go to red themes once again. Take note that although cases have risen significantly, hospitalizations remain flat. This is a very encouraging indicator that the rising BA.4 and BA.5 subvariants are equally or less severe than the original Omicron, and far less severe than Delta.

Anecdotally, we have recently received a significant increase in calls to the clinic by those symptomatic of COVID. The peak of calls occurred between 7-14 days ago. I'm optimistic that we have already peaked for this summer 'surge.' Take whatever precautions necessary for your specific situation.

*Reminder that these case count data are a significant undercount of the true level of community cases due to the use of at-home tests. The hospital figures are directly reported to me and are accurate and up to date.

‼️CALL TO ACTION - COMMUNITY HEALTH SURVEY‼️
Thank you to all who filled out the DoH community health survey two weeks ago. I'm attaching the links once more for those who may have missed it. Marion County has over 370,000 residents, and yet we have fewer than 600 responses so far.

🙏Pretty please (with cherries on top) fill out your survey by clicking the link below. We only have a few days left. (Marion County residents only)

The link to the Community Survey is: tinyurl.com/MarionHealthSurvey
The link to the Healthcare Worker Survey: is tinyurl.com/MarionProviderSurvey

05/21/2022

Marion County, FL COVID-19 Trends
May 21, 2022 - Please Share

Please review the Call To Action below. Local public health decisions are being made, and we need your input!

Notes:
Marion County continues to see increasing new cases and positivity. With all we have been through, that first sentence could feel a bit triggering. I’ll explain why it shouldn’t. Taking a closer look at the trends may reveal what we can expect over the next month or two. The important feature to note when looking at this current spike in cases is the slope of the line in all three graphs. Although we are increasing, we are increasing much more slowly than what occurred at the beginning of the Delta and Omicron surges. That’s an encouraging sign that this current ‘surge’ won’t really be a surge at all, and we may already be near the ‘peak’. This may be answered as soon as our next community update in two weeks. I’m optimistic.

Also of note, despite steadily increasing cases over the last month, our local hospitalizations remain absolutely flat. During the Delta and Omicron surges, when we were at 9% positivity with 400+ new cases, our local hospitalizations were over 50 and rising rapidly with each surge. This is a relieving indicator that this BA.2 subvariant is less dangerous than previous versions, particularly Delta.

‼️Call To Action:
Please fill out the local public health survey below. (Marion County residents only)

Details:
The Marion County Steering Committee for Health, coordinated by the Marion County Department of Health and AdventHealth, has once again been convened. This committee, of which I am a member, renders an analysis of our community health status, defines our community themes and strengths, and identifies key strategic public health priorities for our county over the next several years. Our intent is to create the vision and organize the action plan that will be used to take meaningful action through a diversified network of public and private partnerships. Over the next several months, these partners will meet regularly to develop and implement the formalized Community Health Improvement Plan. This will be the guiding document to improving the health of the citizens of Marion County.

One of the most important tools used in the committee’s decision-making process is the direct input of the general public and healthcare workers. Your input is provided by a digital survey, which I’ll link below. Historically, the public interest in these surveys has been very low. However, this is the first survey this committee has offered since before the start of the pandemic. This survey is your chance to weigh in on local public health issues. And your survey results will matter. In fact, I intend to read as many of your survey responses as possible.

There are two links: the first is for the general public, and second for healthcare workers (doctors, nurses, dentists, PT/OT, etc). My sincerest thanks for your help.
-DK

The link to the Community Survey is: tinyurl.com/MarionHealthSurvey

The link to the online Provider Survey: is tinyurl.com/MarionProviderSurvey

05/10/2022

Marion County, FL COVID-19 Update
May 10, 2022

We have moved back to orange themes this week (barely) with a slowly increasing spike in new cases. It’s possible this may be the beginning of a larger surge, but very likely not on the scale of Delta or Omicron. Or this may be a baseline ‘wobble’ of a small peak, similar to what happened exactly one year ago in May of 2021. I’m hoping our widespread population immunity will suppress any significant spread of this BA.2 variant this summer. Of note, hospitalizations remain low locally.

Notes:
Now that mitigation measures are being fully relaxed nationally, and around the world, there is more uncertainty and the prediction of future trends becomes more difficult. Ending mitigation measures will test the endemic behavior of this virus for the first time. More spread of COVID is certain. How much spread and the timing of this spread is far less clear.

There is another issue becoming more problematic for reporting: the accuracy and reliability of our local figures (new cases and test positivity) are worsening over time. This is due to at least two major factors:
1. An increasing percentage of our population are becoming desensitized to the pandemic, which reduces testing demand
2. Rapid antigen tests are now widely available and commonly used for at-home testing, the results of which are usually not reported

These factors would result in a significant undercounting of the actual real-time prevalence of COVID locally and nationally. This is not a new phenomenon, however. As I’ve discussed in numerous previous posts over the last two years, the figures we have been reporting throughout the pandemic have been significant undercounts. During the peaks of our previous major surges, testing demand exceeded testing capacity. Also, there are large portions of the population who never seek testing, unless forced to during a hospitalization. And there has always been a form of unrecorded ‘proxy testing’ (i.e., a woman tests positive, and her husband is also sick, but doesn’t get tested because he’s already presumed positive). We should interpret the data currently being reported with the assumption that the real count is higher than what is documented.

All of that being said, I believe these data are still reliable enough to be useful for some people as they make mitigation decisions. So, for now, I will continue these updates.

Final Analysis:
COVID (BA.2) is once again spreading within our local community, and it’s probably somewhat worse than the figures suggest. However, I see no global epidemiological indicators to be fearful of a another major surge locally. For those who are higher risk, get boosted if it’s been more than 6-9+ months since your last shot. Take appropriate precautions for your situation, and keep a watchful eye for people around you who seem symptomatic of sinus or upper respiratory infections. And as always, speak with your healthcare provider or pharmacist if you need further guidance.

Take care and stay safe.
-DK

04/27/2022

Marion County, FL COVID-19 Update
April 27, 2022

Thank you for your patience this week!

Although there has been a slight uptick in new cases locally over the past few weeks, this currently does not appear to be the beginning of a new surge. BA.2 is now the dominant variant around the world. The presumption remains that we have strong (but probably waning) natural population immunity from the Delta and Omicron surges, as well as good vaccination coverage.

It's difficult to predict whether this slow uptick will continue, or if our local cases will soon plateau/decrease as we experienced last May/June. Local hospitalizations remain very low, which is always a great indicator. We'll continue to monitor for significant changes locally and around the world and report them to you in real time. At this moment, and at least for the next several weeks, my concern remains low.

I hope everyone is having a great spring!
Cheers,
-DK

04/11/2022

Marion County, FL COVID-19 Update
April 10, 2022

Our local COVID situation remains good. We seem to have reached a low baseline with some very low level community spread. Several variants within the Omicron/BA.2 lineage have been identified and are replacing Omicron as the dominant variants, yet no significant surges are occurring at this point. We don't expect any significant local surges for the next several weeks, and likely much longer.

03/26/2022

Marion County, FL COVID-19 Update
March 26, 2022

With fewer than 10 cases per day, this week marks the lowest local COVID figures since the first few months of the pandemic. Hospitalizations remain extremely low. You'll also notice we have removed the vaccination totals from the graphic. With more than 100 Florida zip codes reporting more than 100% of its residents vaccinated, we can no longer report these unreliable data. At this time, the state is not planning on investigating the statistical discrepancy.

We expect continued low local COVID figures for the foreseeable future. Enjoy this beautiful spring!
Love to all.
-DK

03/20/2022

Marion County COVID Update

The state of Florida is now only releasing data every two weeks. No update was provided by DoH this week, so we are expecting another update on Friday, March 23. I hope everyone is having a fun and fulfilling weekend.
-DK

For more information:
https://amp.palmbeachpost.com/amp/7040727001

03/13/2022

Marion County, FL COVID-19 Update
March 10, 2022

With such an unusual and destructive day of local weather, I'm grateful to be able to report good news in the form of great COVID figures. With continuing decreasing trends, we remain solidly with very low community COVID transmission. And as we did previously, now that hospitalizations are so low, we will not report specific admission figures. Enjoy this period of relative safety! And stay warm tonight!
-DK

03/12/2022

Shortly after 8:00am this morning, a tornado (probable EF1) moved through southern Ocala. Dozens of structures have been damaged, numerous downed power lines, and road closures. I-75 has been partially closed northbound. Please avoid these areas (particularly at SR200 and I-75). Thankfully, there have been no reported fatalities. Our hearts go out to everyone in our community that has been impacted by this event.

The graphic below is the approximate path of this tornado. More severe damage has occurred at the western end of this path.

Thank you to law enforcement, emergency responders, and emergency utility crews for your great work this morning!

Please visit these resources for further updates:
Marion County, Florida
Marion County Sheriff's Office
Ocala Police Department
Ocala Fire Rescue
Ocala Gazette
Ocala StarBanner
WESH 2 News

03/05/2022

Marion County, FL COVID-19 Update
March 4, 2022

Great News: We’re back to green!

The CDC has issued a new COVID ‘Community Level by County’ measurement as a simpler way to offer general guidance to counties and states around the country as the COVID pandemic/endemic evolves with time. The new CDC guidance system roughly approximates the color coded themes I’ve been presenting in these local updates. You’ve probably gotten used to the green/orange/red color scheme. The CDC is now using green/yellow/orange.

The CDC Community Level calculation is based on two factors: 1) new cases per 100K people and 2), either COVID admissions as a percent of total hospital bed capacity or new COVID admissions per 100K people (whichever parameter is greater risk). This is also similar to what you are used to, with the ‘Peak Finder’ and the hospitalizations trend graphs. Masking and other mitigation recommendations for a county depend upon whether a community is at ‘low’ (green), medium (yellow), or orange (high). Read more about the updated CDC recommendations here:

https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html

All things considered, I believe this is a good move by the CDC.

Note: The CDC is currently listing Marion County as yellow (medium Community Level), which disagrees with my green themes. Here’s why: According to today’s CDC calculations, Marion County is at 114 cases per 100K. We’re actually down to 63 cases per 100K, per today’s DoH figures. However, both figures fall below the 200 cases per 100K threshold necessary to be in the green (low Community Level). The CDC also calculates that we have had 71 new COVID admissions in Marion County over the most recent seven days of which they have data, which places Marion County in the yellow (medium Community Level). The most current figure is fewer than 40. Once the CDC data lag catches up to our figures, expect to see Marion County change to green on the CDC website soon.

It’s truly a great feeling to be back to very low COVID levels within our community. This is the first time since the beginning of the pandemic that new cases are declining or already very low across the entire country at the same time. Additionally, we expect no significant surges for the foreseeable future (which is only about 8-12 weeks with COVID), and hopefully much longer. This may signal the beginning of an epidemiological shift from pandemic to endemic behavior of COVID-19. Time will tell.

Final analysis:
COVID isn’t gone from our lives. But it’s certainly not all around us. Now is the time to feel a sense of ease and relative safety. Take precautions if necessary, but don’t let COVID stop you from fully living your life.

I’ll also take a moment to acknowledge the many lives lost, the heartbroken families and friends, our heroic healthcare workers, those who have suffered economic hardship, and those who continue to suffer long-term effects of COVID. We can best honor these souls by sharing love with everyone we can. And for those we can’t, we should at least have compassion. Hug your loved ones a little tighter next time. Even with all that we’ve lost, there is still so much for which to feel grateful.

Love to all,
-DK

P.S. I’ll keep up weekly updates for now.

02/26/2022

Marion County, FL COVID-19 Update
February 26, 2022

Note: We'll be releasing updates on Saturdays for the next few weeks. Sorry for the poor notice on this change. 😬

Brief COVID Update:
With the continued rapid decline in new cases locally, we go back to orange themes this week (and very likely green next week). Hospitalizations continue to drop rapidly as well, which is wonderful news.

Subvariant BA.2 is becoming the dominant variant around the world, yet new cases continue to decline globally. South Africa and Denmark are good examples to monitor. BA.2 has been dominant in these countries for several weeks, yet they continue to experience decreasing cases. This is a very encouraging sign. With no other significant variants on the horizon (at least for now), I believe we have now entered an extended period of very low community COVID exposure risk.

Thank you, stay safe, and love to all
-DK

02/19/2022

Marion County, FL COVID-19 Update
February 18, 2022

I'm sorry again for the late post. I'm a coach for my son's football team and the spring league has started, including Friday night practices. Our Friday updates may come a little later than usual for a while. 🏈

Brief COVID Update:
What is there to say? Omicron is leaving us as fast as it came. So far, BA.2 has not taken strong hold in places that have already experienced an Omicron surge. The best example can be seen in South Africa. They were the first country to experience an Omicron surge beginning in late-November. The BA.2 variant has already replaced Omicron as the dominant variant there, yet their new daily cases continue to slowly decline (although they have not quite yet reached a very low baseline). The assumption could be made that a previous recent Omicron infection offers very good immunity against BA.2 variant, which would strengthen local herd immunity against both variants. My hope has been that BA.2 would 'blend' with Omicron within communities. The data seem to be pointing that way, which would be a great thing.

If local trends continue, we will likely return to orange themes next week, and hopefully green shortly after. Spring is still looking good. 👍
-DK

02/13/2022

Marion County, FL COVID-19 Update
February 11, 2022

Thanks to all for your kindness and patience. 🙏

Brief COVID Update:
It's another week of rapid decline in all indicators. It seems Omicron is quickly running out of available targets. Thankfully, local hospitals are now beginning to feel the reprieve.

I've been keeping a close eye on the 'stealth Omicron' BA.2 variant. Early data out of Denmark suggest BA.2 is 1.5x more transmissible than the original Omicron (illness severity and vaccination effectiveness are similar to the original). At this point, there are only a few thousand cases of BA.2 in the whole of the US. What is clear: we can expect to find many more cases nationally over the next few weeks. What is unclear: will BA.2 result in another surge?

My best guess is probably not. If BA.2 were 2-3x more transmissible, or had significant structural differences with Omicron v1, another surge would be probable. Neither are true. However, we need a few more weeks of observation to make any confident predictions.

For now, I remain optimistic and am looking forward to a great spring.
-DK

Trinity Clinic

08/14/2022

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04/27/2022

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