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Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

COVID-19 Update April 27, 2021: COVID and the American Experience- A Look Back Over a Year; Updates on Vaccines- Private Pediatric Offices Being Given Vaccine in Ohio

By Dr. Arthur Lavin

Glossary

  • Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
  • Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
  • SARS-CoV-2– the specific name of the new coronavirus
  • COVID-19-the name of the illness that the new coronavirus is causing
  • Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
  • Epidemic– a sudden burst of an illness that comes and goes over a limited time
  • Pandemic– an epidemic that bursts across the world not just one region
  • Spreadability– how contagious is the disease, how many people will end up infected
  • Symptoms- the experience of being ill, for example- fever, cough, headaches, loss of smell etc.
    • Asymptomatic– literally means “without symptoms”.  For COVID-19 it refers a person infected with the virus but has no and will have not symptoms
    • Presymptomatic– This is a person who was infected with SARS-CoV-2, and will feel sick, but hasn’t yet
  • Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
  • Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
  • Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
  • Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
  • Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.
  • Live Virus Swab– this is the swab which attempts to swipe live virus from one’s nose or throat to see if you are currently infected.
  • Antibody Test- (aka serology test) this is the blood test which looks for antibody to the SARS-CoV-2 virus to see if you have been infected in the past.
  • Vaccine Terms
    • Vaccine or Immunization– a dose of a substance that activates your immune system, as if you have the actual infection you are hoping to prevent, leaving you in fact protected from having that infection.
    • Efficacy– the percentage of people immunized with a particular vaccine who will not get infected if exposed to the target infection.  For example, a COVID-19 vaccine will be said to be 95% effective if 95% of people immunized with that particular COVID-19 vaccine will not get COVID-19 if exposed to COVID-19
    • mRNA– DNA works by dictating exactly which proteins your cell will make.  The message on how to construct each protein is delivered to the cell machinery that makes proteins by a piece of genetic material called messenger RNA, or mRNA
    • mRNA vaccine– an mRNA vaccine places a small bit of mRNA code that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected
    • Viral vector vaccine– a viral vector vaccine takes a harmless virus that is known to infect people reliably and places that weakened virus in a person where that virus will in fact infect the person.  The virus is not only weakened, but also attached to a set of genes  that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected.

COVID and the American Experience- A Look Back over A Year, A Panorama of a Pandemic

The United States has struggled to respond to a deadly pandemic for over a year.  Much of our experience of this pandemic has been catastrophic, but some has been outstanding.  As we approach what we all hope is the end of the pandemic, it is a good time to pause and learn what we can from the last year.   And we do this with one key intent in mind- to preserve life in the final phases of this terrible, terrible plague.

Origins

We all know that a new virus, called the second SARS coronavirus or SARS-CoV-2, leapt into humanity starting sometime in 2020.  The earliest known instance of a person infected with SARS-CoV-2 was on November 17, 2019.  The disease caused by this virus came to be called COronaVirus Disease of 2019, or COVID-19.   That first case was in Hubei Province China, and the first outbreak was reported in December 2019 in Hubei’s city of Wuhan.

As of now, no one knows how exactly this brand new virus, SARS-CoV-2 came into existence.  A WHO report from this month concluded it evolved naturally from bats in Yunnan province via an intermediate animal species.  But other experts are not convinced this path has been finally proven.  It is curious that there is a virology lab in Wuhan that was working on the bat-derived coronavirus, and the possibility that this virus leaked from this lab, although not likely, is not yet finally disproven.

Soon after the first outbreaks, Chinese scientists analyzed the 30,000 base pair sequence of the viral genes and made this information available to everyone around the world, by January 2021.

The first proven case of infection with SARS-CoV-2 in the United States was in the state of Washington on January 15, 2021.

Soon after January, COVID-19 had spread to every nation on the planet and proved to be a very contagious and deadly disease.

Tragically, this virus had the very, very rare ability to spread widely, sparing at least half of those infected of any experience of feeling sick at all, and at the same time, being able to kill millions.   Most killer viruses, like Ebola and the first SARS virus, make almost everyone infected sick, so isolating the ill stops the spread.  And most viruses that spread easily and do not make most ill, like the common cold, don’t really kill most anyone.   But not SARS-CoV-2.   Like the influenza virus of 1918, it was a very, very rare rapid spreader that would be hard to contain because so many infected would have no idea they were contagious.

Every Nation’s Choice in January, 2020

For most of 2019 for most of the world, there were no worries or threats from this new virus.  No one was infected before the virus appeared.

And so when each nation found its first person with COVID-19, each country faced a choice.  Would that nation learn to stop its spread, or not?

Some did.  Some did not.

Those that did came from many different parts of the world.  They included Hong Kong, New Zealand, Vietnam, Iceland, Bhutan, Tanzania, Singapore, South Korea.  In fact, about 100 nations have held their deaths for COVID to below 100 deaths per million population.  About half of these 100 nations kept their people so safe that 10 or fewer per million have died to date.

Those that did not came from fewer different parts of the world, namely the Americas and Europe.  In fact of the 221 nations of the world, only 37 let the pandemic rage to a level that led to over 1,000 people dying per million population.

America’s Choice in 2020

There is no way around it.  In 2020, our country decided to let the virus spread.

We did try.  Many of us worked very, very hard to stop the spread, to protect ourselves, those we loved, and all people.  Those steps were observable in the historic and total obliteration of the spread of common respiratory viruses.  For the first time ever in the last 10,000 years, there was no influenza epidemic.  Essentially no cases of RSV occurred this winter, the virus that is the #2 killer of children in the poor nations of the world.   HIV cases and hepatitis cases also plummeted.

We locked down, but we did not do the fundamentals that let about 100 other nations really stop this virus from spreading.

The key strategy that worked was to launch massive testing before the virus spread everywhere, to identify first cases, test all of their contacts, and isolate all the infected and direct contacts outside the home so that the spread would stop.  Every nation that took these very obvious steps stopped the spread of the virus well enough to keep the loss of life to a dramatically low level.

Take where our son and his family live, Hong Kong.  A region of 7 million people followed these steps.  Our daughter-in-law was recently found to be a contact and was quarantined outside the home, isolated in one hotel room until the danger of spread ceased.  And so in Hong Kong, only about 200 people have died.   Had our nation joined 100 others, our loss of life would be at about 10,000 today, not nearly 600,000.

And so it really is with a broken-heart and with much shame that we look back and see the devastation that followed the decision of our nation not to identify those infected and isolate them well enough to stop the spread of the virus.

As a result, the SARS-CoV-2 virus spread wildly across our land.  Again, many millions of individuals, so many of us, worked hard to stop the spread.  We stayed home, we kept our kids online, we podded our contacts, we wore masks, we kept distant, we did not travel.   But the United States utterly failed to take any steps to identify cases before they spread everywhere, and isolate all the early infected to stop full-blown national spreads.

The Results of our Choices

I share that as of today, the United States, our country, has lost 1,736 lives to COVID-19 out of every million of us.   There is no way to comprehend massive death.  But we need to try once again:

  • As of now the United States has lost nearly 575,000 lives.  More than any nation on the planet.
  • Across the world 2 in 100 people have been infected with COVID, but here in the US 9 in 100 of us have been infected.
  • About 1% of all American grandparents were killed by COVID-19 by the Spring of 2021.
  • The rate of death of in 2020 in America was 16% higher than in 2019, that’s the biggest leapin chances of dying in the history of America, even bigger than the leap in death rates during the 2018 flu pandemic.
  • Of our nearly 575,000 deaths, 174,000 were those living or working in nursing homes or other congregate care settings.
  • Of the nearly 32 million cases of COVID in America, over 500,000 were in prisons.
    • About 34 out of every 100 prisoners has been infected with COVID
    • One of the hardest hit was here in Ohio at the Pickaway Correctional Institute, where 80 of 100 of the 1900 prisoners got infected with COVID
  • About 250 American children have been killed by COVID but 75% of these deaths occurred in children of color.
  • COVID deaths hit communities of color far harder than other American communities- at or double the chance of dying of COVID than white communities:
    • American Indian communities (2.4x), Latin X communities (2.3x) and Black communities (1.9x)

All these stats are a direct result of our decision not to identify outbreaks when they were small and isolate all those infected before the outbreak becomes large.

With the virus let loose, it devastated those most likely to catch it and those most likely to die once infected.

Who caught COVID in America?

Who was most likely to catch COVID in America?  Those in close, sustained, indoor contact, at any age, at any time.

That included a huge range of the nation:

  • People forced to stay in close indoor contact with large numbers of people
    • Nursing homes and other congregate care facilities
    • Prisons
    • Large scale meat processing plants
    • Large scale outdoor events without masks
      • The Sturges motorcycle event
      • Political rallies with unmasked crowds
    • Youth playing sports
      • High school
      • College
    • People choosing to gather
      • All ages
      • Church choirs
      • Family gatherings
      • Political rallies, esp indoors
    • People choosing not to wear masks or distance

The Game-Changer:  The COVID-19 Vaccines

In true American style, our behavior nationally was reckless, but our science was powerful.

The development over a 30 year period of an entirely new way of thinking about, crafting, and creating vaccines against deadly viruses bore fruit, and just in time.   That 30 year quest was to develop a way to use a short sequence of genes from the virus to get our own body to make the viral protein that, in turn, has our own body make the antibodies that will save our lives.

The very first deadly virus that just happened to come along once this technology was perfected and found to be safe was SARS-CoV-2.   And it proved how radically fantastic this invention is!

The technology uses 5 chemicals that can be combined in any sequence.  Those 5 chemicals are the 5 elements of which all DNA and RNA are made of.   The sequence of all my genes, my DNA, and all yours, comes down to the details of how my 4 elements of my DNA are sequenced across a 3.2 billion long sequence of these 4 elements.   The SARS-CoV-2 virus has 4 elements in a chain that is only 30,000 elements long.  And only some of these are used to code for the viral spike protein.  Take that sequence of 4 elements that ask a cell to make the viral spike protein, and you have your vaccine.

Right now, if any new deadly virus appears, including a deadly new variant of COVID, it will only take 3-4 weeks to create a viral vaccine made out of the viral DNA or RNA.  3-4 weeks, not 4-10 years!!

And this RNA COVID vaccine works amazingly well!!  We are close to 1 billion people immunized on Planet Earth!  And there have only been some allergic reactions in response to the RNA vaccines.  (The clots have occurred in COVID vaccines that are not RNA based).

Across the world, we are seeing, in real life, across whole nations, that the COVID vaccines, including the non-RNA ones (Johnson and Johnson) are eliminating nearly all chances of dying from COVID.   The fact that they do so at nearly a 100% rate makes them far more effective than most, if not all, of the amazing vaccines we have been using for years.

So, we now have the tool in hand to end this deadly pandemic.  Israel continues to demonstrate the magic number is 55%.  Get 55% of your nation fully vaccinated, and COVID-19 cases plummet, reaching close to zero!  We are right now at 27%, leaving about 28% to go.  That’s about 200 million more doses to give of two-shot vaccines.  At 3 million doses a day that will happen in 2 months, or sometime in June, but it may be earlier if we count the 31 million of Americans who have had COVID.

A Word on m-RNA Safety

Many people have asked, how can it be safe to have a bit of genes injected into my body?  Don’t genes control everything, how can such an action be safe?

These are fair questions and good ones.

The key to this issue is that the body goes to extreme lengths to destroy stray bits of m-RNA.   Why is that?  It all rests on the essential nature of m-RNA (i.e., messenger-RNA).  In nature, and in us, m-RNA’s sole task is to take the genetic sequence in our’s cell’s nucleus and transmit it to the part of our cell that assembles proteins.

Consider one of your cells making insulin.  That can only happen when your DNA for insulin is activated.  All our DNA sits in a small sac inside all our cells called the nucleus.  The DNA in our nucleus copies itself into a short string of RNA, called messenger RNA.  That copy of your DNA moves to outside the nucleus to the main part of your cell where a structure called the ribosome sits.  The m-RNA goes to the ribosome which is where proteins are assembled according to the guidance from your DNA to your ribosome, via your m-RNA.

Now imagine the m-RNA for insulin hanging around once it’s sent to have you make insulin.  That would be catastrophic, because now your cell would be stuck making tons of insulin forever.  This is precisely why all cells, really all fluids in the body, are set to destroy any strand of any m-RNA.  This is what took much of the 30 years to develop an m-RNA vaccine, finding a way to get the viral message of RNA into your ribosomes before your powerful systems that destroy all wandering m-RNA to be destroyed instantly.

The Moderna and Pfizer vaccines deliver the COVID m-RNA is a tiny, tiny drop of fat.  The J&J and Astra Zeneca deliver it with a bit of a common cold virus called adenovirus.  Either way, once delivered into my cells, the COVID m-RNA goes straight to my ribosome, and then is utterly destroyed, once my ribosome makes the spike protein of the COVID virus, which in turn is what gets me to make antibody and keep me and those I love, alive.

So, can the COVID m-RNA vaccines change your DNA?  NO, and for these reasons:

  1. The m-RNA is rapidly destroyed
  2. The m-RNA directs the cell to make a protein, it does not alter your DNA.
  3. These facts have been observed and proven.

Updates on Vaccines- Private Pediatric Offices being Given Vaccine in Ohio

The Johnson & Johnson Vaccine

As noted above, the Johnson & Johnson (J&J) vaccine works by delivering the tiny bit of COVID m-RNA to our cells via use of a common cold virus, the adenovirus, which knows how to deliver RNA to a cell.  So does the AstraZenica vaccine.  Both have had some recipients develop blood clots after their vaccination.

Only the J&J vaccine of these two is given in the US, and so far, about 15  people out of about 8 million vaccine recipients have experienced clots.  That puts the risk at about 5 in 1 million, which is very low for a problem happening.  No men have had this experience, all 15 so far have been women. And the peak age of risk is 30-39 years old.  Twelve of the 15 clots have been in the brain, which means they suffered strokes.

My take on this risk is two-fold:

  1. It is thankfully very, very rare in the several per million rate of risk.  Interventions with risks in the 1-10 per million range are considered safe.
  2. The devastation from clots makes the handful of such instances potentially catastrophic.

The problem is that if you are one of the one in a million, that risk reassurance is meaningless.

So far no men, no women less than 18 years old, and no women over 50 years old have developed clots from the J&J vaccine.

Putting that all together, I think the J&J vaccine should be used primarily in men, and in young or much older women for now.  I also await the guidance of the CDC on its use in women ages 18-50.

COVID Vaccine for Children- Advanced Pediatrics Is Nearing Approval

NOT YET, but hopefully soon, Advanced Pediatrics will be getting notification that we are going to have COVID-19 vaccine, only Pfizer, delivered to us.

When we get that notice, we will send a special notice out to everyone on this email list, but be sure to share the news with others in the practice you know.

As of now, we will only be able to give COVID vaccine to children in the practice ages 16 and older.   We anticipate being able to give children in the practice COVID vaccine ages 12 and older in the near future, in the coming weeks, not months.

The data on 12-15 year olds, 16-18 year olds, even 6-12 year olds, is very, very encouraging and reassuring.  Already 16-18 years olds have been immunized in large numbers with no serious side effects and good protection and all the data points to the same experience for those 12 and older and 6 and older.

Bottom Lines

  1. We remain in the middle of this horrible pandemic.  Over 50,000 cases still happen in the US.  Across the world mountains of suffering, as in India, erupt.
  2. As we approach 600,000 lives lost here in the US, an incomprehensible number, it is meaningful to pause to look back on what we all have experienced.
  3. On an individual level, millions of us worked hard to stay alive and keep each other alive.   Our efforts were serious enough to cause a once in 10,000 year interruption of the influenza virus annual epidemics, to bring the #2 killer of children- RSV- to nearly zero levels, and to even drop HIV and hepatitis rates.
  4. But our nation was in the tragic group of 37, out of over 200 nations, that chose to not stop widespread transmission early on.  Those that did have suffered few deaths.  We could have kept our loss of life to less than 200,000, and even less than 10,000, but we did not.
  5. The result has been a staggering loss of life, that still continues.
  6. At the same time, we helped develop the astounding m-RNA vaccine for COVID.  The fruit of 30 years of heard work, this vaccine outperforms nearly all others, and is proving able to end the pandemic.
  7. The US is at 27% fully vaccinated.  At 55% we expect to see rates of COVID to plummet.  At that time, which may come as soon as the end of May or June, the only people suffering from COVID will be those unimmunized.  This is the main reason it is so crucial to be immunized, to save your life and the lives of those you care for.
  8. Don’t Shoot the Messenger.  Messenger RNA is safe, it is destroyed very rapidly all across the body, it does not change your DNA.
  9. The clots experienced by the J&J vaccine are rare, but serious.  As of now they are appearing mainly in women and all in the 18-49 year old range. Men, very young women, and older women do not appear to be at much risk of clots from this vaccine.  CDC guidance on use is expected shortly.
  10. The Pfizer vaccine is being distributed to pediatric offices now, we are waiting to hear about our allocation, and once we receive it, will be giving COVID-19 vaccine to all children in our practice 16 years of age and older.  We anticipate doing so for children in our practice ages 12 and up in the coming weeks.  We do not have the vaccine yet, but will announce as soon we do.

My Takeaway – In One Sentence:

The Pandemic has been brutal, tragic, deadly, and the vaccine offers a door to end the suffering- may we all make it to the End of this tragedy, stay careful until it is over.

To your health,
Dr. Arthur Lavin

 

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