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.

We are In The Middle- of the Plague

Most stories have a beginning, a middle, and an end.  The Pandemic of COVID at its heart is complex.  The virus is novel, the diseases it causes are new, its patterns are still being understood, our responses vary, it is complex.

And so it must be that the story of our experiences with COVID-19 will clearly have a beginning, a middle, and an end.   We are clearly now squarely in the middle.

The beginning of the COVID pandemic in America was that time from the first appearance of this virus in humanity up to the time that tools to end the pandemic began to be widely available.

The end of the COVID pandemic in America will be that time when all Americans, with few exceptions, will any longer need to fear for their lives or for the lives of those they love from this scourge.   That end will come when we stop the transmission of this virus by use of vaccine and behaviors.

We are no longer in the long beginning of COVID and we are not yet at its end.

We are in the very, very frustrating, maddening, middle.

How is this the Middle?

We are in the middle because we are no longer as helpless as we were before a solution arrived, but we are not yet in the place where the danger is passed.

There are some good aspects of leaving the beginning and entering the middle, chief amongst them is the fact that an end is now coming into place.

The middle was ushered in with the arrival of widespread, publicly available, free immunization against COVID, immunizations that offer us a 95% reduction from getting ill, and nearly 100% protection from dying from this awful disease.

But the middle phase is a phase of its own very profound frustrations.  Having the solution in sight but not in hand is not just upsetting, but can be tragic.  Until we reach the end, many of us will continue to die, and how awful to lose our lives now, just as the end comes into sight.

A word on one particular frustration, getting the vaccine.  This concept of a middle phase might help us all understand why so many feel deep frustration getting immunized.

This new, extraordinary, invention, thirty years in the making, a vaccine built on the germ’s genes, was first given to the public only in November, 2020.  By definition, any invention that needs to be delivered to everyone across a vast nation and world cannot be delivered in one day, one week, one month.

And so it is with the COVID vaccine.  It is being given, as noted below our office has been immunized.  But not everyone has the ability to get immunized, not yet.  And that is frustrating.  I feel it, because I have been asked to be immunized and agreed, but my wife is not eligible, and so I live the dread that I am protected but my wife is not.  This is the essence of the frustration of the middle phase we live in now.

But the good news is that the nation is now working furiously hard to end this middle phase, to get us to reach the end phase.  For immunizations, new brands are coming on line, vast distribution centers are opening, tens of thousands of personnel are being rapidly mobilized to give the immunizations.   Unless a vaccine-busting mutation appears, the end may be in hand this summer or fall.

Time to Go Back to School?  Many say Yes, One Hazard Remains

One of the biggest challenges in the middle phase of the COVID Pandemic is knowing when to open schools, and when to attend them.

Are we there yet?

The data in hand are very reassuring.  So much so that the CDC has declared schools safe to open if they follow specific guidelines to sharply limit spread.

And yet, unfortunately, a major question remains, and it comes to us from the United Kingdom and other nations and has clearly arrived in our country.

The Hazard of the Greatly Enhanced Contagion of the New Mutations

As some of our readers will recall, even moderate jumps in rates of contagion can cause very dramatic jumps in spread.  It is worth recalling that without any measures of protection, someone with COVID will infect an average of 2.5 others.  If such spread goes on uninterrupted 10 times, one person will on average infect about 10,000 people.  Now boost that average number just 70%, which is what the UK variant does.  Now each person on average will infect about 4.25 rather than 2.5 people.  Doesn’t sound like much, but if one person infects 4.25 people on average and that happens 10 rounds, that one person has now infected close to 2 million people.

Now, we do limit spread, there are few people with COVID who infect so many 10 rounds later, but the point remains.  A 70% jump in contagiousness of this germ can increase spread two hundred times.

Again, use of masks, space, handwashing, not gathering can seriously blunt these numbers, but here is the hazard going forward for schools.

The UK variant is here, across the US, and so it will be in our schools, likely all of them.  How will the UK variant be contained in the classroom?  Will it not spread very well in schools that space, mask, and pod, like the original version of the SARS-CoV-2 virus?  Or will that 70% jump in contagiousness mean classrooms will become centers of outbreaks and endanger children, their families, and our teachers?

The UK variant is new, so we simply do not know.  But we know for sure that when a nation is hit with it, outbreaks really erupt, so the question is reasonable to ask.

As a result we offer the following advice on going to school in person:

1. Schools with active classrooms need to be strictly adherent to the CDC guidelines.  As I currently understand them, and new ones are being issued in the coming week, schools should have children wear masks, they should sit 6 feet apart, and each class should be podded to avoid contact with other students al day.
2. The threat of an outbreak with the resulting risk of tragic loss of life is greater in high school than elementary schools.  And so attending classes is most risky in high school.
3. This threat is at its peak in high school sports.  We continue to see many, many high school students who almost all look quite well, diagnosed with COVID-19 and caught through all sorts of high school sports.  With the exception of sports that feature big distance such as tennis, we recommend not participating in any until we reach the end of the pandemic.
4. With the UK variant spreading across America and all classrooms, right now, we advise sustaining a virtual option until we know if this variant will substantially increase the risk of COVID-19 outbreaks in classrooms.

Our Office is Fully Immunized

Thanks to our outstanding Cuyahoga County Board of Health, we are pleased to let all families in our practice know that all our doctors, staff, and psychologists at Advanced Pediatrics have received COVID-19 vaccination, and all but one of us have received both.  Pictured below are some of us getting our COVID vaccine this Sunday.

Ms. Tina Hadden

Dr. Julie Hertzer

Ms. Tina Parks

With this level of protection we can now even more confidently provide care to your child(ren) knowing that our chance of getting symptomatic illness from this virus has just dropped by at least 95% (even more for those of us like me who are past recovery of the actual infection too).

As noted above, this is an awkward time.  As with all major advances in life, there is a beginning, middle, and end, always.  For immunization, the middle phase is marked by some being immunized, but not all.  Our focus at Advanced Pediatrics on COVID vaccination begins with a commitment towards universal vaccination against COVID-19, really our only true path to ending the catastrophic loss of life and living, and that commitment continues through today and going forward.  We fully realize that it is grossly unfair that some have been immunized and others not, but again as noted above, the US government is going full tilt to change that, completely.  And so we stand together with all our families and across all our communities to work hard to make sure all who can (right now, ages 16 and up) get immunized when they are called on to do so.

Immunized? Already Infected? Both? No Matter, Stay Careful Until the Plague Passes  

We can feel it, the sense, if you’ve had COVID, or you’ve been immunized, or both, that there must be some relief from being careful that comes along with the added immunity that comes with either or both.

And that sense is true in that getting immunized does offer protection, why else go through with it?  But now we know, you can live in a nation well immunized and still be in danger.

Which nation is that and what is the story they teach each of us today?

The nation is Israel, which right now has immunized 60% of its nation, a proportion vastly higher than all other nations.  The US is in the ranks of the top ten, but we have immunized 11%.

And the vaccine works!  In the group of Israeli’s immunized, the chance of dying, and even of being hospitalized is visibly starting to plummet.

To celebrate their brilliant victory, the people of Israel are finally relaxing, getting together, gathering, dropping their guard, the pandemic is finally ending in Israel, what a victory!

But Israel is not at the End of the Pandemic, they are still in the Middle, as described above.  And here is the cruelty of the Middle.

If you drop your guard before the Plague is truly vanquished, it will roar, and it will kill, just as well as before the vaccine arrived.

So yes, the number of elderly in Israel’s hospitals is dropping, but not the number in Israel’s hospitals from COVID.  In fact, rates across the whole population for this highly immunized nation are as high as ever.  Again, this is not a vaccine failure, it is a people failure.  It is what will happen if you declare the end before the end, if you gather thinking, wow vaccines are taking hold, now we can travel, gather, relax.

If Israel is in the middle of the story of this pandemic at 60% of the nation immunized, where are we America at our current level of 11%?  If you said, in the middle, you would be correct.

So yes, we all feel the end coming.  We see so many people immunized, we will see immunization roar up across America in the coming weeks.  We will feel the end of this nightmare is coming, maybe even here.

But only one fact will tell us the End of the Pandemic is here- when the number of cases drops to close to zero.  We are nowhere near that fact today, and so we must remain as careful as we were in 2020, until that fact is true.

This means, specifically, for everyone, even if you are fully immunized, even if you have had COVID-19, right now:

1. Do not travel
2. Do not gather
3. Stay at home as much as possible
4. If you must leave home, wear a mask and stay at least 6′ distant
5. Avoid crowds, avoid indoor gatherings in particular
6. High school and college sports are great ways to catch COVID and spread it to people who can be gravely harmed, so it is not yet time to participate.
7. As noted above, it remains optimal until we know how the new variants spread in school to seek virtual teaching.

Bottom Lines

1. A new page is turned in the COVID Pandemic in America.  We are in the Middle phase, no longer the beginning.  Vaccinations are taking root, and growing, but we are NOT at the end of the Pandemic.
2. The Middle phase is good, closer to the End.  But the Middle phase is hard, because we cannot relax, during the Middle phase, COVID still rages across the land, until the End of it is here.
3. For the original COVID-19 virus, the data are strong that in-person teaching for K-6, with desks spaced 6 feet apart, children masked, and each class carefully podded (isolated for other groups), there are so few outbreaks, this setting seems safer than any others in the community.  BUT, the UK and other variants are just now taking hold in the US, and we know they spread a lot more.  So we don’t know if safe schooling will continue to not spread the virus.  We need to know what a classroom with kids with the UK and other variants, is like for all the children, teachers and staff before we say we can go back to school safely.
4. All those who work at Advanced Pediatrics are immunized, with 7 of 8 of us having had our 2nd dose.  We have sharply reduced our chances of spreading this virus to anyone, and we are very pleased to report this.  We also want everyone to know we are fine, it is a safe vaccine, and we urge everyone who can to get immunized.
5. As more and more of us get immunized, or get over a case of our own COVID infection, please know that if our nation has not dropped its new case count down to near zero, we cannot relax our guard.  Israel teaches us that if we do, we will see the virus rage, hospitals fill, and deaths soar, even as immunizations climb.

My Takeaway – In One Sentence:

The COVID vaccines work and they are safe so as long as we remain careful about spreading it, we will see COVID retreat as we all get vaccinated, but until the retreat has truly triumphed, please still do not travel, gather, and keep wearing masks, staying distant, avoid crowds, avoid being with others indoors.

To your health,
Dr. Arthur Lavin