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

COVID-19 Update January 18, 2021: 400,000, What to Do Once Immunized and Still No Influenza

By Dr. Arthur Lavin


  • 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 heartbreak continues across our land, and across the world.  It seems such a short time ago we were sad to report that the number of our fellow Americans who this cruel virus has killed rose to 300,000.

We are very, very sad to report that number has already grown to 400,000.

The numbers are clearly now large enough to cause numbness.  We now routinely hear stories of people spreading this deadly virus through a growing sense that get togethers can’t possibly cause too much harm.

But 400,000 is a number we cannot ignore.

Two looks at this number might help us find a way to pause once more.  To try to take a look at this moment.

First, think of World War II.  And think of the Americans who fought Nazi Germany and Imperial Japan.  We had troops all over the world, we fought in North Africa, across Europe, across the whole Pacific.  It was one of the most deadly wars in our history, and it took almost exactly 400,000 lives.

Now, think of Cleveland.  We live in metro Cleveland and love our city and its people.  The current population of this city, our city, is a bit less than 400,000 people.

And so when we report that right now, our nation, our United States, has lost 400,000 of our lives to this virus, we can now think, we have let this virus destroy more lives in America than Nazi Germany and Imperial Japan together, and more lives than live in our city Cleveland.

Maybe, just maybe, thinking about World War II, and of our city, will give us a feel for the scale of our lives lost.

Let us take yet another moment, to stop and give the thoughts due to those this virus, and our actions, have ended life too early, too cruelly.

The Lesson the 400,000, and 2,000,000 Leave Us With

This moment we mark the loss of 400,000 Americans, but around the world, we now know 2 million have been killed by the combination of a virus and our decisions.

There is no doubt that once the story of COVID-19 comes to an end, and it will certainly end as surely as every plague in human history has ended, we will learn from 3 regions of the world how each decided, and were able, to manage this deadly threat.

First will be the poor nations of the world, places with limited health care infrastructure.  We will once again learn that when certain groups of humanity are designated to be cut off from prosperity, disaster is more disastrous.  The lesson the 2 million lost teach us here is that continued poverty here and across the world remains deadly, remains a choice, remains a deadly choice.

Second will be the wealthy nations of Europe and North America, places with the wealth and power to take care of all their peoples.  When all is said and done, we will see that these nations failed in a most cruel way, and to a dramatic extreme.  And that lesson will be made visible by the lessons from the third region of the world, East Asia.

Third will be the rich and poor countries, the tyrannies and democracies, the large and small nations of East Asia.  From wealthy democratic Taiwan, to more impoverished tyrannical Vietnam, these nations took steps that all of us could have taken, to save vast numbers of lives.  Taiwan, a nation of 24 million people, even as of today, has lost a grand total of 7 lives.   The head of Taiwan’s COVID response team was trained at Johns Hopkins, he used the techniques he learned in Baltimore to keep the loss of life down to 7!  If we had followed the work of Johns Hopkins our loss of life in America today would be less than 100, not 400,000.  If Taiwan had handled COVID the way we did in America, they would have lost 3,000 not 7 lives.

The difference is very real, and very, very stark.  And so the real lesson taught by the second regions- America and Europe, is that our way failed, tragically and dramatically.  How it failed will be described in detail over time and across history.

The Cost of Giving Up, The Imperative to Get Back to Work to Stay Alive

Though we don’t know all the reasons Europe and America failed so spectacularly, there are some differences we know and still can do something about.  Here they are:

  1. First and foremost, we need to start caring about people dying again.  Right now most of America simply does not.  The numbers soar, but they hit numb ears.
  2. If we cared, we would not be doing things that wildly plant the virus into homes, work spaces, nursing homes, all across America.
  3. We would stop gathering
  4. We would all wear masks
  5. We would stay home as much as possible until the pandemic is tamed
  6. We would not travel
  7. We would find a way to stop playing sports until the pandemic is tamed.

Vacations, hockey, soccer, getting together with a few friends, seeing family again after such a long time, flying on planes, saying I don’t need a mask because of I get sick I’m likely to  be fine.

Across America, and Europe too, the decisions have been made.  We would all rather do these things than stop the spread of the virus.

Now that our actions have now cost 400,000 lives, perhaps we will act before we hit 500,000.  If we go along our merry way, we will hit 500,000 lives lost soon.

But like Scrooge seeing the Ghost of Christmas Future, it is not too late for us either.

I remain confident that 2021 will be the year the pandemic is tamed, that we will be able to all these wonderful and important things without hurting anyone.   The only question is how many will we have let die once the pandemic ends.

If we have a heart a big or bigger than Scrooge’s we will listen to the Ghost staring us in the face every day, and stop travel, stop vacationing, stop visiting family, stop doing sports, stop gathering with friends.  And we will start spending time mainly at home, we will support national efforts to immunize everyone, we will keep distant and wear a mask if out of our home or exposed at home, we will support efforts to care for each other during this horrible catastrophe.  And then, if we do all these things, we could not face another post from me that 500,000 have died, then 600,000, then 700,000.  If we do not turn and do these things, current projections are the 1 million of us will be dead from COVID by May.

So let us listen this day to the 400,000, let us look at the reality of our lives, of our neighborhoods, of our state, of our nation, today.  Let us take the steps I know that all of us can, because I know many families that have made these decisions and live by them.

We can do this, it is not forever, it is only for a few months.

I think some effort for a few months is well worth saving so many hundreds of thousands of lives, don’t you?

When Can We Return to Normal?

Once Immunized?

Once Infected?

The answer should be clear.  We can gather, travel, play, work, and learn together normally once doing so will not cause tremendous numbers of people to die.

We will all know that day has arrived by the case counts of COVID.  Clearly, once no one catches COVID, being together will not possibly lead to anyone catching it.  And we can start gathering again even before that number is zero.

According to the best science, once the chance a group tested has COVID drops to 0.1% spread really drops to the point danger is distant.  That number could change as more of us get immunized.  But we are nowhere near that number now.  In fact, the chance a person will be + for COVID if tested right here, right now, is about 20-30%, way, way above 0.1%!

Right now the epidemic of COVID is very, very, very hot.  So hot that virus is so thick in the air that people who are isolated are getting infected, not nearly as commonly as those that gather, but still are.

The epidemic is so very hot that people who have COVID and people who have been immunized with two doses are getting infected and spreading it, not many, but it happens.

So if you have had COVID, like me; or if you have been immunized, like me, you must remain as careful as someone who has had neither, until the epidemic stops being so very hot.

Even though I have had COVID and been immunized, I still remain at home at all times except to go to my essential work and to go to the grocery store.  When I am out I wear a mask, and I keep distant.  We have family we are desperate to go see, I won’t travel to do so, not until the pandemic is tamed.

The immunizations offer 95% protection, but that means if you get immunized and you are exposed your chance of getting sick is dropped 95%.  That still means you have a 1 in 20 chance of still getting sick.  When the pandemic is tamed, 95% protection will keep the pandemic tamed, even if we gather.  But while the pandemic is hot, gathering while immunized is a recipe to get those death counts up to a million still.

The answer to when we can gather again safely is only when the pandemic is tamed, when case counts go to near ZERO.  

Vaccine Interval Question

Many people are asking us, if I get my first dose of COVID vaccine and I am told I should get my second at a set interval, for some 3 for some 4 weeks, what happens if my second dose is delayed?

For this vaccine we do not know.  Everyone in the studies got their second dose on time, so we don’t know what happens if you miss your appointment or no vaccine is available at the set time.

We might learn something from all other immunizations.  Take the measles vaccine.   You can get your second dose 1 month after the first one.   But we routinely schedule it for 4 years after.  And many people have received it many years after.  It turns out not to matter at all, as long as you wait a month, getting your second dose works just as well 1 month, 1 year, 4 years later.

The same is true for almost all immunizations.  You need to wait a minimum amount of time, but if you do, waiting longer does not seem to interfere with the second or other doses working well.

Now, two warnings.

First, if you can get your second dose on time, do it!!!  You only rise to 50% protection with the first dose of Moderna and Pfizer vaccines, you need dose #2 to get to 95% and if we want to tame this pandemic, we need everyone at 95% protection ASAP!

Second, we don’t know if waiting longer might drop protection from dose 2 from 95%, likely not, but we don’t know.

Influenza Virus Still Not Here

Not much more to say except it is amazing and wonderful.

Bottom Lines

  1. COVID-19 has now killed as many Americans it took to defeat Nazi Germany and Imperial Japan, and more than all the people who live in my City of Cleveland.
  2. This staggering loss of 400,000 of our fellow Americans could not happen without this awful virus, but could not have happened without our choices, our behaviors.
  3. The virus will be vanquished, but will our choices change?  If they do not, if we go along our merry way gathering, we will be writing a post about 500,000 gone in not too long, and if we really do not change, we will lose a million by May.  It is almost too painful to write.
  4. But like Scrooge when facing his future with the Ghost of Christmas Future, we too can change our behavior.  We can see around us, open our eyes, and really begin to care again.  We will know we care when we stay at home as much as humanly possible.  When we stop playing sports, stop flying, stop getting together with friends, stop seeing family.  We will know.
  5. I will know, because every day, we diagnose someone with COVID and in almost every circumstance, the disease was caught by gathering.  And we know the virus never stops if allowed to spread.
  6. The influenza epidemic of 2020-2021 remains missing.
  7. The end is in sight.  A new Administration will put into place radically different steps starting Wednesday at Noon.
  8. So please:
  • Stay at home as much as possible
  • Do not travel
  • Do not fly
  • Do not gather with friends or family
  • Do not play sports


  • Do wear a mask and stay distant in the home if someone there was exposed or has COVID
  • Do wear a mask and stay distant outside the home
  • Do get immunized ASAP

My Takeaway – In One Sentence:

2021 will be the year the COVID Pandemic is tamed and we can gather again, let us all act right now, to make sure as many of us as possible will live to see this great day!

To your health,
Dr. Arthur Lavin


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