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.

300,000 Lives Now Lost in America

The number is numbing, outrageous, devastating.   The path of a virus has been defined by our choices, and those choices have allowed 300,000 deaths to now have been lost. https://www.worldometers.info/coronavirus/

Every time we post a massive number of deaths from the SARS-CoV-2 virus in America, my heart sinks with grief.

We posted news of 100,000 of us dying on August 8, and it was hard to believe, how could 100,000 of us die when we had the means, the knowledge, and truly, the ability to never let this happen?

We posted news of 200,000 of us dying on September 20, and it was infuriating.  Everyone knew that left alone, this deadly virus could kill 100,000 of us, everyone knew that steps could be taken to make sure the catastrophe of 100,000 dying would not be repeated, and yet it happened again, in full view, with our full knowledge.

And now, we come to our readers with the fact that for a third time, America has decided to let 100,000 of its sons and daughters, mothers and fathers, and grandparents die rather than take known actions to make sure this would never happen again.

Later in this post, good news will be shared on the shipping of vaccine and an end to the nightmare.  But no cure, no end, will ever erase the shocking fact that we essentially did nothing to stop catastrophe before a vaccine could be made available.   I will never forget, and history will keep the memory permanent, that rather than support those in need to allow for businesses to survive, rather than mask and distance to allow for all of us to survive, this nation, my nation, decided to do neither well enough to prevent 300,000 deaths to occur before Christmas.

This time, I share the grim news after recently personally experiencing a brush with danger from the virus.  I will always feel fortunate on so many levels that my experience with COVID was with its mild not deadly face.  But now I will always feel a special pain when I hear of anyone actually suffering, when I hear and read of each person’s loss of life, when I know that over 100,000 Americans need hospitalization today for COVID, that about 3,000 of us will die today from it, that soon hospitals will be so overrun that people in a car accident, or who can’t breathe, or who lose consciousness from hundreds of problems having nothing to do with COVID will come to the ER only to find that no doctor or nurse is available to help.

Lessons from People Around the World

If you doubt we have the knowledge, means, or ability to have a different reality in the United States today, just click here.

This is today’s report from the Financial Times. I have highlighted four regions’ experience with COVID-19 cases from January to today.  The regions are: Singapore, the UK, the European Union, and the United States.  Note that the graphs each show the number of cases each place had, per 100,000 population, so the rates can be comparable despite differences in regional population sizes.

Three of these regions have achieved a dramatic, sharp, nearly complete drop in COVID.  They found a path to stop the spread of the virus.

All four regions experienced an explosion of COVID in March.  Singapore actually had the largest explosion of the four.   Now look at May-August.  Three of the regions mastered the virus, they did something, they took action, they agreed it was best to live, and they succeeded.  England, Europe, and Singapore dropped their case counts, and dramatically.

But not our nation.  We never took these steps, we chose to let people die rather than act, and people died.

Then in August Singapore and the European nations parted paths.

As noted in a recent post in Real Answers the phenomenal success of the EU in the spring, led Europeans to insist on abandoning their control measures, and instead, go on vacation.   The result is visible in the lines for the UK and the EU, COVID when invited to spread accepted greedily, and spread like wildfire.  By October, again proportional to population, COVID case numbers outstripped the US.   But look at November, the UK and EU repented their abandon, and took measures to stop the devastation, and those steps worked, again!

Meanwhile, Singapore never relented, and as a direct result of the choices of people, by the middle of October, they achieved almost zero cases a day.  Not by accident, not by luck, but by choice.  The people of Singapore and their leaders chose to pay attention to stopping the virus, decided to stop the virus, and did in fact, stop the virus.   The outcome is that as of today, Singapore has lost 29 lives.

The Story of our Own People, our United States

Now we must look at the picture of our decisions.   Alone of these four regions, the United States is the only nation to never really fully tame the virus.  We could have, all the world proves this point.  But we did not.  We tamed it a bit, in the spring, and you can see our case count drop, but it did not drop far.  Cases continued at a deadly clip.  You will remember this summer the agonizing surges across our South and Southwest.  We dropped our numbers, but never really stopped the danger.

And now, our decision to let the virus rip puts our nation almost alone in letting cases rise exponentially with no effort to try to slow it down.  Take a look at our numbers now, since October they climb, and climb and climb.

The result is that we now have lost 300,000 lives.  Had we simply taken the steps Singapore did, as of today we would have lost less than 2,000 lives.

And there is the truth of our choices.

Last night, leaders of our nation’s second largest city called out the ultimate alarm, their health director stating: “We’re on a very dangerous track to seeing unprecedented and catastrophic suffering and death, I’m making a request to everyone to stay home.”

Around the nation and here right at home, I see that the catastrophic suffering and death reflects a national choice.   From our current leadership an embrace of letting the virus run wild.  But also in millions of homes and families, small decisions to gather are combining to fire the storm.  The situation is very clear that right now, families across the nation have decided that their gathering, to have a small party, to be together for the holidays, to travel, cannot possibly cause any harm.  We hear of these decisions every day in the office, with most families deciding to begin participation in sports, to attend gatherings, to plan for family get togethers.  After all, it’s just the 4 of us, or just the 10 of us.  How could that lead to millions of cases and thousands of deaths?

But that is how we have reached 300,000 deaths.  No other way.

I state these facts so starkly because the load of virus in American air is quite heavy.  It is true of any epidemic that the hotter it rages, the more easily it spreads.  Right now we are hearing of cases we never did in the Spring and Summer when there was far less COVID in the air.  Now we hear of people catching it so much more easily.  So minor slips in being careful- those small get togethers- really are causing the outbreak to rage.  The nation reports many stories of older grandchildren helping out grandparents by dropping off packages, and saying hi, only to find out the grandparents died of COVID soon after.

We will read good news about the vaccine below, but that help will not stop the pandemic for months.  And unless we act, and act right now, the fires of COVID will rage.

I recall Smokey the Bear telling us, ONLY YOU CAN PREVENT FOREST FIRES.

Everyone, unless we take action now, unless we cancel all plans for travel, unless we cancel all plans to travel, unless we each decide we will prevent the next loss of life, we will without fail, certainly, lose another 100,000 lives in the next 2 months.

At this point, all of our fates lie in each of our hands.  Only WE CAN PREVENT COVID today.

So please:

1. Do not travel
2. Do not gather 
3. If you must leave your home, wear a mask and keep your distance
4. Do not go to indoor areas with many people

UPDATE ON THE COVID-19 VACCINE

The news on this front is all good.

The Pfizer version of the COVID-19 vaccine, an mRNA vaccine, is shipping.

In the US, 2.5 million doses are ready to ship and are being prepared for delivery.

The first recipients will be nursing home residents and truly front-line health care workers.

Moderna has an mRNA that is ready to ship as well, awaiting final approval which is expected in the next few days.

The US has secured 100 million doses of the Pfizer vaccine with delivery assured by March of 2021.

The US has secured 100 million doses of the Moderna vaccine and recently signed an agreement to secure 100 million more.

That brings the total number of doses of proven vaccine secured to 300 million doses.  The vaccine only provides 95% chance of protection after 2 doses of either vaccine, so the 300 million doses will be able to protect as many as 150 million Americans.  If we just look at the number of adults in the US, 246 million 18 years old and older, then immunizing 150 million would protect about 60% of American adults or 50% of all Americans.

It is estimated that this virus will sharply drop spreading when about 70% of the nation is immunized.

So the current doses will help but not reach the full numbers necessary to truly halt the pandemic.

At the same time, Pfizer and Moderna are ramping up production to provide as many doses to the world as possible, and other vaccines are closing in on proof of efficacy and safety.  Should they prove as effective and safe, many more doses of working vaccine will be available.  Johnson and Johnson’s vaccine is poised to report its performance in the coming month.  If it succeeds well, this company is ready to manufacture 1 billion doses.

So help is on the way, but not for most of us for some 3-6 months.

As far as vaccines are concerned, all of us must decide what to do when the vaccine is offered to us. We urge every American to run to receive it.  It is no exaggeration, it is a grim, grim reality, lives are at stake.  Your life and the lives of those you love are at risk right now, taking the vaccine is for each of us and for all we care about.

An end is in sight.  The responsibility to keep each other alive only has to be borne for 3-6 months.

The question is can we take this responsibility?  I know we can, I hope we will.

INFLUENZA COMING

As of today, the United States has no active centers of influenza activity, but that will certainly change, and likely soon.  Typically, the seasonal influenza virus epidemic arrives in the US around December 15 and leaves in April or May.

We have never experienced our national, annual, December-May, influenza epidemic during a COVID pandemic.  No one knows how the two will interact.

Had we achieved control of COVID spread, we almost certainly would have seen the influenza virus epidemic halted.

But as noted above, the COVID virus ranges freely across the United States right now, so there is no reason the influenza virus will be stopped either, yet.

And so, unless we stop travelling and gathering, and all mask and distance, the influenza virus will be spreading across the nation in the coming days.

Several possibilities await us:

1. The heavy presence of COVID might block influenza, and stop the influenza epidemic from happening.
2.  The presence of COVID will make no difference, and the 2020-21 influenza virus epidemic will spread as usual and cause the usual number of flus.
3. The influenza virus will spread as usual, but could make COVID cases far worse, leading to a combination that only worsens our difficulties.

No one knows yet which of these three will happen, but we will know soon.

In the meantime, we are pleased so many families at Advanced Pediatrics have received their flu shot.

Our supply for flu shots for this season has almost been completely used, but some doses remain in case your child(ren) haven’t received one yet.

BOTTOM LINES

1. This weekend marks a devastating, crushing moment, a moment we all need to pause and consider.  Our decisions have caused 300,000 of us to lose their lives.
2. Nations around the world have shown the way, we can and should take the steps to stop the virus from spreading.
3. Those steps are well known, and work:  Do not travel, Do not gather, if you must go outside the home wear a mask and keep your distance.
4. The vaccine is approved, the vaccine is shipping, the vaccine promises well to end the pandemic, and the US has secured 300 million doses which can protect up to 150 million of us, but not really for 3-6 months.
5. But the end is not here yet.  We have many months to endure this tragedy until the end arrives.  Right now, in our nation, the virus is at our door.  It has crossed my door and entered my home.  It has crossed millions of doors, and right now waits to enter every home.  We only have to be vigilant, responsible, thoughtful for a few months.  I have no doubt that we can do this, I hope that we will.

My Takeaway – In One Sentence:

Our nation is a nation out of control with COVID putting everyone of us in grave danger and ending 300,000 of our lives already, so right now we must all agree to not travel, not gather, wear mask and distance if outside the home, and get ready to seek the vaccine- lives are in our hands, let us save them.

To your health,
Dr. Arthur Lavin