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.

The US Update

COVID-19 continues to run rampant, raging across the whole United States, essentially out of control.

Nationally the numbers are horrifying, with the nation approaching 400,000 deaths, the number of American soldiers who died in WWII, Europe and the Pacific.  We have days with over 4,000 Americans dying in one day.  Hospitals in many states are overwhelmed.

In Ohio, the case numbers remain at about 8,000 cases a day, a high number for a state our size, but are trending upward, the situation is bad.

This remains a dangerous time, lots of people are getting COVID-19, and lots of people seem to have let go of concern, exposing themselves, those they care for, and many to potentially deadly infection.

As we will see below, help is on the way.  We only ask that everyone stay careful a few more months, who wants to see someone they care about get terribly ill, even die, a few months before the pandemic ended?

When Should I Get My COVID-19 Vaccine?

Given the terrible spread of this potentially deadly virus, the answer to this question is simple- ASAP.

Of course, there are 320 million Americans, meaning that we will need 640 million doses of COVID-19, 2-dose format, immunizations to give all Americans their immunizations.

That sets up the list of limitations:

1. The United States does not have 640 million doses available of the current vaccines (Pfizer and Moderna).  Once fully delivered, the current orders will total about 250 million doses.
2. The 200-250 million doses on order will be shipped by the end of April, not this week.
3. No vaccine is approved for use in children less than 16 years old.

Where does that leave us as of now?

Number of doses in hand  and how many in arm?

As of January 14, 2021, 29.4 million doses have been shipped and 10.3 million given; and, in one day, nearly 1 million doses have been given, reaching the 1 million shots per day level for the first time.

The number of vaccines being created, shipped, and given is steadily rising.

What is the current plan, who can get them NOW?

The current plan is set by each state.  That means all of us in Ohio will have our access defined by the Ohio Department of Health.

On January 20 at Noon, that could change.  Once Joe Biden becomes President of the United States, he is ready to roll out a national plan to get everyone immunized.  His plan aims to have 50 million people immunized, which would take 100 million doses administered, by April 29, about 100 days from now.  I anticipate the work to accelerate the provision of vaccine will exceed this goal.  The promise of a one shot course from Johnson and Johnson could increase those numbers dramatically too.

But for now, Ohio has a system based on CDC tiered Phases.

The Phase system attempts to get those most likely to die, or whose death would cause most death, immunized first, and then then the next most likely, and then the next most likely, etc.

Right now, in Cuyahoga County, immunizations are only available to those in Phase 1A.

Phase 1A is:  Medical providers of care, congregant living residents and workers, EMS responders.  Check out https://www.ccbh.net/vax/  to see details of who is qualified to be deemed Phase 1A per Cuyahoga County

and https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program/welcome/covid-19-vaccination-program  per the State of Ohio.

Who is Next?

The CDC has organized priorities into 2 overall phases, Phase 1 and Phase 2.

Phase 2 is everyone ages 16 and older not in any Phase 1 category, so the defined priority groups are all in the Phase 1 subphases.

In Ohio- Phase 1A and Phase 1B have been defined.

https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program/welcome/covid-19-vaccination-program

In Cuyahoga County, only Phase 1A, defined above, is getting immunized now, but they anticipate that Phase 1B will be starting in the near future.  The State of Ohio is going to open immunization to 1B, first group (Ohioans 80 years old and older) on Monday, January 19.

Here are the definitions of who qualifies to be in Phase 1B and Phase 1C.

Again, a formal definition for all phases per the State of Ohio, along with up to date places to get immunized is here:  https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program/welcome/covid-19-vaccination-program

Phase 1B:

• Everyone age 65 years old and older
• Adults who are staff or employees and working in a K-12 school
• “Ohioans with severe congenital, developmental, or early onset medical disorders that make them particularly vulnerable. This includes cerebral palsy; spina bifida; congenital heart disease; type 1 diabetes; inherited metabolic disorders; severe neurological disorders. including epilepsy; severe genetic disorders, including Down syndrome, fragile X syndrome, Prader-Willi syndrome, and Turner syndrome; severe lung disease, including cystic fibrosis and severe asthma; sickle cell anemia; and alpha and beta thalassemia.”

Because Ohio combined the CDC Phase 1B and 1C groups into one phase, Phase 1B, they are still setting priorities as follows:

• The week of Jan. 19: Ohioans 80 years of age and older.
• The week of Jan. 25: Ohioans 75 years of age and older; those with severe congenital or developmental disorders.
• The week of Feb. 1: Ohioans 70 years of age and older; employees of K-12 schools that wish to remain or return to in-person or hybrid models.
• The week of Feb. 8: Ohioans 65 years of age and older.

Please note that as of today, the only people authorized to be immunized in Ohio are those in Phase 1A- essentially medical workers and those who work and live in congregant facilities (e.g., nursing homes, homes for the impaired, inpatient treatment home).

But as of this Monday, add those 80 years and older, and each week thereafter the list grows.

Starting January 25, all people 16 years and older with certain medical conditions will be eligible to get immunized in Phase 1B in Ohio.

(Note: the CDC describes Phase 1 as three levels, 1A, 1B, 1C, and the main difference is that Ohio does not list these non-medical frontline workers  as eligible in their announced Phases 1A and 1B: corrections officers, food and agricultural workers, United States Postal Service workers, manufacturing workers, grocery store workers, public transit workers)

When Can my Child Get the COVID-19 Vaccine?

The Child Under 16 Years Old 

As of this writing, no child under the age of 16 years old will be allowed to get a COVID-19 vaccine because none have yet been proven to be safe or effective for people 15 years old and younger.

Now, I fully anticipate when children under 16 years old are tested, the COVID-19 vaccines currently in use in adults that work so well and so safely will also be safe and effective for them.

But until a COVID-19 vaccine is proven safe and effective in children under age 16, no such vaccines will be given to them.

I have inquired at the American Academy of Pediatrics if efforts are underway to make exceptions pending approval of use of any COVID-19 vaccine prior to age 16, for children with precarious health.  I am told they are looking into such efforts and will report when they occur, but for now, even if a child has a dangerous medical condition, if they are under 16 years old there is no COVID-19 vaccine authorized to be used.

Given the spectacular safety of the Pfizer and Moderna vaccines, trials are right now underway to see if they work and work as safely for kids 12-15 years old.  But these are still underway, not done.

I suspect proof of a COVID-19 vaccine working safely in younger children will go in stages, first 12-15 year olds, then 2-3 subgroups under 12 before we know the minimum age it can be given.

The Child 16 Years Old and Older

For all children 16 years old and older, they will be offered access to COVID-19 vaccine according to the Phase 1A and Phase 1B above.

Since we are speaking about children, the dates for people 65 years and older are not relevant, only the one category of having the listed medical conditions.

So for your child who is 16 years old or older to get a COVID-19 vaccine in Ohio, they will need to either qualify for 1A status (medical provider or resident/staff in congregant living), or have one of these conditions:

“Ohioans with severe congenital, developmental, or early onset medical disorders that make them particularly vulnerable. This includes cerebral palsy; spina bifida; congenital heart disease; type 1 diabetes; inherited metabolic disorders; severe neurological disorders. including epilepsy; severe genetic disorders, including Down syndrome, fragile X syndrome, Prader-Willi syndrome, and Turner syndrome; severe lung disease, including cystic fibrosis and severe asthma; sickle cell anemia; and alpha and beta thalassemia.”

A word on “Medical Disorders that Make Them Particularly Vulnerable”

It is important to note that this definition as written is vague.  It states that those with medical conditions that make them more likely to have bad outcomes from COVID are defined as severe congenital, developmental, or early onset medical disorders that make them particularly vulnerable.” What follows are a list of possible examples, but which really make them particularly vulnerable.

As such it lacks quite a bit of precision.  Here are the key points that really matter when thinking about whether your child (16 and older) should be in Phase 1B.

The main concern should be whether they have a medical condition that increases the chance of them catching COVID-19, or if they catch it, makes the disease more likely to be severe.

There is very little data on how any of these conditions impact COVID-19, but we do know some things:

1. If your child, ages 16 and up (remember under 16 no vaccine is approved), has a medical situation in which their life is daily at risk, then getting an illness like COVID-19 could be very dangerous.  They should be in Phase 1B.
2. It is far from clear that all children ages 16 and up with each of these conditions is really at any greater risk for COVID-19.  Some for sure, others not really.  Some of these conditions a viral illness could make things much worse no matter how severe the illness is, such as in diabetes Type 1.  But some of these conditions include situations where the child is actually rather healthy, with a mild form of the condition.  We see this in mild trait forms of thalassemia, and in mild levels of cerebral palsy and other conditions.
3. A word on asthma.  For older people with emphysema, the risk of severe disease with COVID-19 is very real.  Not so with asthma.  Even with people with moderate to severe asthma, there is no evidence that you would be more likely to catch COVID-19, or that if you did, you would be any more likely to get any sicker than anyone else.  This is per the American Academy of Allergy, Asthma, and Immunology:  ” It is important to know that currently there is no evidence of increased infection rates in those with asthma. And although the Centers for Disease Control and Prevention states that patients with moderate-severe asthma could be at greater risk for more severe disease, there are no published data to support this determination at this time. ”   This is VERY good news, for all of us with asthma, for all kids with asthma, and for all parents of kids with asthma!

Putting all this together, if you have a child ages 16 and up that we are the pediatricians for, unless they qualify to be in Phase 1A, they should not seek a COVID-19 through Phase 1B without checking with us first.  Some will meet the need, particularly those of our children with many of the conditions listed above.  But most of us with asthma should not be considered at higher risk.  To be clear, you can register your child ages 16 and up with moderate to severe asthma for COVID-19 immunization, the State of Ohio allows it in Phase 1B.  But if you ask us, we may find that your child’s risk is not really increased.

On the 2020-2021 Influenza Virus Winter Epidemic

Still has not begun, with every week’s report, it is more striking that we have almost no influenza virus, it is welcome news, and we hope it stays that way!

Bottom Lines

1. COVID-19 continues to spread across the United States causing illness and much death in its path.  We must all:  NOT TRAVEL, NOT GATHER, WEAR A MASK, KEEP DISTANT until the COVID-19 vaccine actually drops our case, hospital, and death numbers.  We anticipate this will happen in the coming months.  So please, please, please, be careful, follow this advice, for just some months more.  Lives hang in the balance.
2. The COVID-19 vaccine is rolling out.  We are up to 10 million immunized with at least one dose.
3. The US needs 640 million doses to protect us all.  There is no way we will have that many available today, tomorrow, or even by May.  So we have to make choices, who should get it now, and who tomorrow?
4. The current plans here are set by Ohio.  That may change soon after January 20 when the President of the United States becomes Joe Biden.  He has a plan to set national standards and be more aggressive about getting the vaccine to more people faster, so stay tuned.
5. But for now, Ohio sets our rules.
6. Right now only health care workers and congregant living residents and their staff, and EMS personnel can get COVID-19 vaccine, this is Phase 1A
7. Phase 1B opens up this Monday, and comes in four steps.  This Monday, just those 80 years old and older.
8. Then on January 25, in Ohio, those 70 years old and people 16 years old and older with certain medical conditions will be eligible to join Phase 1B COVID-19 vaccination.
9. A word on asthma, there is no data to show that it is a lung condition that makes COVID-19 more likely to be caught, or if caught, more likely to make you sick.
10. There are no COVID-19 vaccines approved, and therefore available, for anyone under 16 years old, even with dangerous medical conditions.  The AAP is looking into this.  Pfizer is conducting studies for children 12-15 years old.  I anticipate COVID-19 availability for children 15 and under will come in stages, certainly the older kids first then younger, maybe those with dangerous medical conditions amongst the older ranks, we will see.
11. To register for a COVID-19, if you qualify, go to https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program/welcome/covid-19-vaccination-program to see if you qualify.  You can check on Phase levels, and see where vaccine is available too.

My Takeaway – In One Sentence:

Be careful, the COVID-19 disease is everywhere, now is no time to let guard down, and get ready to be immunized, the vaccine is rolling out!

To your health,
Dr. Arthur Lavin