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COVID-19 Update December 4, 2020: Update on Journey, Schools, A Bad Winter and The Vaccines

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.

 

Update on My Journey – All Good News

First of all thank you!  I have been so grateful for the outpouring of concern, hopes for getting well, and just overall good wishes.  Everyone has been so supportive, so nice, and I want you to know it does help, it makes a difference.

Your good wishes seem to have worked, as I remain, essentially well.   In the spirit of sharing real experiences with this most real and dread virus, I will share that I definitely have been more tired than usual, have had a scratchy throat, many aches, have the most mild of coughs, but mostly have experienced this virus through my gut with some mild diarrhea and abdominal unease.  All these symptoms have faded considerably over this week.  I have never lost my sense of taste or smell, or had a fever.

I also wanted to report that as with all positive tests at the office, we report results to the Cuyahoga County Board of Health.  We also contacted everyone I came into contact with the days I was contagious.  And I am fully observing full isolation for the full period of time that I could conceivably be contagious.  According to public health officials my last day of isolation, for the maximum protection of everyone, will be this Sunday.

Which means I cannot possibly transmit the virus starting Monday and therefore will be back in the office this Monday, which I am very excited about.

At this time, I remain extremely grateful that I saw the mild face of this virus.  As posted many times on Real Answers, it is urgently important that everyone come to grips with the deep reality that this virus, the SARS-CoV-2 virus truly has TWO faces.

The first face is the one I saw- a mild, even completely harmless illness.  Fully 50% of us infected have no symptoms at all.   No matter what, you can’t deny that if you have no symptoms, that is a mild infection!   For all of us with mild infections, you can’t help but wonder, is this disease really the same one on the news?

The answer, of course, is a resounding yes, because the second face of this virus is the face of a mass killer.  We are closing in on this virus killing 300,000 of us.  And some hundreds of thousands have endured great suffering, in what all would agree is a quite dangerous, extremely miserable disease.

Everyone should know this is highly unusual.  There are no other known infections that can leave millions and millions unharmed at all, and at the same time kill nearly half a million.  It is hard to hold in our minds that this virus is both, but it really is.

I emphasize this point, because I had the mild version, and so many of us had, to make sure that everyone knows this virus is a killer, and all of us need to especially careful until the vaccine has ended the nightmare.

Schools

Most attention on schools has been focused on very good news: we simply have not seen COVID-19 outbreaks in young elementary schools.

This is excellent news indeed!  I will admit to being surprised this is how it turned out, but am very, very happy to be surprised with good news.

At the same time, the news on schools for young children is totally overshadowed by the far larger reality- that our United States is sinking into what the director of the CDC has called the worst public health disaster in the history of America.

As Real Answers has emphasized since the beginning of the discussion on schools, the real issue for our children, and our schools, is whether our nation will take actions to reduce the transmission of COVID-19, or not.

If we succeed in halting the transmission of COVID-19, then going to school becomes a worry-free activity for children of all ages.  Then playing sports can be done with no worries.  Then seeing friends again and getting together with family can happen without risking lives.

But the simple fact of the matter is that our nation has chosen to not halt the transmission of COVID-19.  In a land where the deadly virus ranges freely, it remains unclear to me if it is safe to go to school.

When millions of us are infected, any gathering becomes a very real possibility for catching COVID.

This is certainly why as our numbers of cases soar, we are seeing city after city close schools.

Ultimately, the school question will follow the national, and local, flow of COVID.  Once it comes under control, schools can be safely attended.  While we experience such massive outbreaks, it seems prudent to be virtual.

Certainly, school sports during heavy outbreaks, need to be avoided.  We have witnessed, here in our office, many outbreaks of COVID across various sports teams.  During this time of danger and the need for special vigilance, a few months more break from sports only makes sense, and will save lives.

A Bad Winter

For now, the news on the state of our nation and state on COVID-19 remains grim, and promises to get only more upsetting.

As will be detailed in the next section, the promise of COVID immunizations means that we are very, very likely facing a grave danger for only a matter of some more months.

But until the raging pandemic is put out, we all remain in grave danger.  We anticipate our message will remain the same until the vaccine is in place- we are certainly living through the most dangerous time of this catastrophe.

The pandemic was deadly and dangerous when it erupted here in April and May, and again in the South in July, but both those eruptions peaked and quieted.

Our current eruption of COVID is different in kind than any other, it is not peaking, and so as bad as things are now, they are certainly going to get worse.

We anticipate the situation getting far worse for several reasons:

  1. Despite being in our worst ever COVID situation, the nation insists on getting together to spread it some more.
  2. The virus clearly thrives in cold dry air, and it is soon winter, so the conditions push for more cases.
  3. And the cold weather means we are packing indoors, also boosting cases.

These three realities were anticipated all year long, but the numbers from November and now early December completely confirm all worries.

When a pandemic is allowed to rage fully, that means our experience of it dramatically alters, here are the key new realities we will face until a vaccine is at hand:

  1. When so many people are infected, the number of viruses in the air increases, and we have and will continue to see more and more people get COVID-19 with no known contacts.   More infections breed more infections, it has always been true, and we are seeing it right now with COVID-19.
  2. As numbers of people with this infection skyrocket, we will see the number of people with serious disease skyrocket as well.  This is the tragic part of our current reality.  As Dr. Michael Osterholm put it, we will all be more likely to find someone we love or care for very much come to the risk of, or actual, harm, even loss.
  3. As numbers of people with this infection skyrocket, our health care systems will be overwhelmed.  What does “health care system overwhelmed” really mean?  It means that the day will come to many cities and rural areas in America when you or I might have a serious medical problem, and there will be no one available, no medications available, no machines available to help.

On this last point, we need to consider that there are only so many doctors, nurses, respiratory techs, beds, ventilators, available in any nation at any one time.   To put it clearly, take a silly illustration.  Say we only have 100 hospital beds in the nation.  Now imagine 200 people need those beds for life-threatening situations.  You get the picture, if demand exceeds availability, some will be forced to go without help.

This was experienced for real in Italy when they were overwhelmed in the Spring of this year.  Medical teams literally had to choose whose life to save.

And it’s not just about COVID-19.   If all hospital resources are occupied in a region, I could show up with a heart attack, or stroke, or even the need for cancer therapy, and there might be no help available.

The degree to which this nightmare scenario comes true depends entirely on how many of us get infected with COVID-19.   The trend is not reassuring.  In just the US, in October we recorded 730,000 new cases of COVID-19.   But in just November, that number literally exploded to 2 million 300 thousand new cases of COVID-19.

And I am very sad to report that in just the first 3 days of December, we have recorded 608,000 new cases of COVID.  If we just stayed at our current rate of infection and did not increase further, which seems nearly impossible, but if we did just that, we would record 6 million new cases in December alone!

This is why the fact we have not peaked, but are on a steep exponential curve of rising cases, is so urgently important.  We are in full crisis mode, right now.  How painful it is happening with a solution nearly at hand, but it is.

And so, once again, and likely until the vaccine has taken hold, we must, urgently take these measures:

Now is the time to be as careful as possible:

  • Do Not Gather
  • Do Not Travel
  • If Together Stay at Least 6 feet Apart
  • Wear a Mask

Given the extreme urgency of the situation, we really mean all 4 steps.   Do not gather, that means NO get togethers with anyone outside your podded household.  Do not travel, that means NO travel.

Please be careful, this is in fact a very, very dangerous time.  I know that my story is reassuring, and as noted, one of the faces of COVID-19 is mild, perhaps even harmless, illness.  But the other face is just as real.  I was lucky, but not everyone is or will be, so please, please, plan on being extremely careful for a few months, our most dangerous months

The COVID VACCINE

Help is on the way!

The evidence remains convincing that this germ can be stopped with a vaccine.  Given the very grim danger we are all in, right now, this is amazing news.

Four totally different approaches to getting our body to make antibody to block this infection each work dramatically well.  That tells me, convincingly, that vaccination against COVID-19 can very realistically end the pandemic, decisively.

Two of these vaccines, both mRNA based approaches, the Pfizer and Moderna vaccines, have proven safe as well.  Each have been given to over 30,000 adults, with no serious side effects observed.

And, the FDA and CDC have met and laid out a plan for who gets immunized first and then the order for the rest of us.  First will be those at the very highest risk of dying from this infection, older adults in congregant living, and medical folks.

What that means is that after the first phase of COVID-19 immunizations, we will see the experience of the first 20 million Americans to be immunized.  That will tell us what we need to know about very, very rare serious side effects, will tell us if any happen.

So before the rest of America gets COVID immunized, we will know very well if any serious side effects occur.

We will also know the safety of these COVID vaccines for pregnant women and their babies.  Right now no pregnant women have been recruited into studies, but out of the 100,000 thousand or so study participants immunized, some will have turned out to be pregnant when they got the shot.  Those numbers will only balloon when 20 million are immunized.

So before the rest of America gets COVID immunized, we will know very well if any serious side effects occur in pregnant women too.

Once these steps are known, and we know that the COVID vaccines have no serious side effects, the studies on children will begin and if it is proven safe and effective in children, only then will it be offered to children.

So the roll out will begin with elderly in homes and medical workers.  Then people with pre-existing conditions and by age.  Then younger and younger adults.  Pregnant women will be immunized only once it is proven safe for them and their babies.  And all agree, children will be immunized last for two reasons.  First, they will be the last to be studied to prove it works safely. And second, they are thankfully at the very lowest risk of harm from the infection.

COVID-19 immunization will begin in America soon.  By the end of this month, most nursing home residents and medical workers will be immunized.   And then the broader national roll out will take begin in January and take some months to complete.

If the COVID-19 vaccines perform as well in the general population as they did in the many massive studies, we should see a dramatic drop in new COVID-19 cases by the spring of next year, and a return to normal by the fall or end of 2021.

BOTTOM LINES

  1. I was pleased to share my COVID-19 story with everyone, glad it was helpful, and I remain profoundly grateful to all the wonderful notes and hopes for my full and speedy recovery.
  2. Thankfully my case was the mild face of COVID-19, but I took the risk I posed to others quite seriously, and will conclude my CDC-directed 10 days of symptoms isolation this Sunday and back to work Monday.
  3. Younger elementary schools have been proven to not be sources of large outbreaks, which is welcome news, but this news is overshadowed by an epidemic raging out of control across the nation.
  4. The COVID-19 pandemic is indeed raging out of control across the nation.  Numbers of cases are skyrocketing, packing our hospitals now, threatening to overwhelm this system, and causing massive loss of life.
  5. RIGHT NOW is the time to get very, very serious about avoiding catching this disease.  I have to be exposed, but not everyone has to.  If you don’t have to be exposed, please, do not.
  6. This is truly a dangerous time, stay in your podded home as much as possible.  Do not travel, at all.  If you are out of your safe home, wear a mask, stay away from crowds, keep distant from others.
  7. There is no party, there is no shared meal, there is no occasion, there is no holiday, that justifies risking your life, or the life of others.  RIGHT NOW is the time to make up your mind that you will be careful, stay at home, do not travel, do not gather, until the vaccine takes hold.
  8. The urgency of NOW, is not permanent, an end is in sight.  The time to take urgent measures to be safe will be some months, no more.  We can do it, we can slow the spread before the vaccine arrives and keep our hospitals open to all who need help.
  9. COVID-19 immunization will begin soon.  I trust the data.  I will be getting a vaccine if it is recommended to me (likely not since I have natural immunity now).  I urge everyone offered a COVID-19 vaccine to take it, it really is truly a matter of life and death.

My Takeaway – In One Sentence:

Help is on the way, but will not take effect fully for a few more months during which we all need to act MOST carefully as the epidemic is in its most deadly phase, stay well!

To your health,
Dr. Arthur Lavin

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