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
• Mutation- a change in the genetic code of a living organism, such changes may or may not change function
• 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.

Real News From a Real Country Really Vaccinating

One nation stands out, right now, as way ahead in COVID vaccination.  At this moment, Israel has immunized nearly half of all people who live in the country (44.7%).  For reference, the United States has immunized 7%  our country.  This means we can look at Israel to see, for the very first time, how the COVID vaccines perform, in real life, out in the world, not in a study.

Two trends should give us tremendous hope.

First, Israel studied a group of 128,000 Israelis who had had two (all) doses of Pfizer vaccine.  One week after the second dose, they found 20 of the 128,000 had been diagnosed with COVID-19.  That is a 95% drop in the number who would have gotten sick without the vaccine.   The studies predicted a 95% drop, but now we know it will actually happen in real life, in the complex world of a living country, with problems in delivery and storage.  In short, this means the COVID-19 vaccine works, really!  https://www.timesofisrael.com/week-after-2nd-pfizer-vaccine-shot-only-20-of-128000-israelis-get-covid/

Second, Israel monitored how rapidly the number of people hospitalized for COVID-19 dropped across the country day-by-day, even after the first dose.  What they found was that for any group immunized with the Pfizer COVID-19 vaccine, the numbers hospitalized for COVID-19 began to sharply drop by Day 18 after Dose 1!  That’s right, in only 2-3 weeks after even the first dose, hospitalizations began to drop sharply, which means deaths will drop sharply too.  Even after a few weeks of just Dose #1, Israel has seen the number of people 60 years and older hospitalized for COVID-19 drop 60%.  In short, when the vaccine starts working in a nation, the number hospitalized, and therefore dying, will in fact, drop dramatically!  https://www.timesofisrael.com/israel-sees-60-drop-in-hospitalizations-for-over-60s-in-weeks-after-vaccination/

The Key Race:  Mutations Versus Vaccines

Readers of Real Answers know that a mutation in a living organism, including a virus, is simply a change in that organism’s genetic code, which can alter what all such codes create- the proteins of that organism.  Such changes can have no impact on function, or some, or even dramatic impact, as proteins determine how all functions in life function.

All the facts pouring in demonstrate the COVID-19 vaccines we have in our hands right now, the Pfizer and Moderna vaccines stop the current form of the SARS-CoV-2 virus.  They will stop this virus.  And they will stop any changes in this virus that do not alter its Spike Protein too much.   For the vaccines work by having our cells make the version of the Spike Protein made by the current version of the virus causing COVID-19, SARS-CoV-2 virus.

If we could immunize all 7.7 billion of us today, the pandemic would surely end within a few weeks.  But as we know, that is impossible.  As of today, the planet has immunized 70.8 million of us, total.  A long, long way from 7.7 billion.

That means tonight and tomorrow the SARS-CoV-2 virus will be allowed to infect another 670,000 people, the planet’s current daily new case rate.  Each person makes nearly countless copies in their one infection.  Each copy allows the virus to make mistakes in the copy process, and each mistake is a change in the genetic code, and such a change is a mutation.  The vast majority of such changes render the virus ruined, good news.  Some small number allow the virus to continue to infect, and leave its function unchanged.  But, now and then out of the zillions and zillions of copies around the world, a change will leave the virus more dangerous.

We know that from the UK mutation, which we have known for a few weeks let the virus spread to about 70% more people than before.  This week we were saddened to learn that this UK mutation also will kill 30% more people who get infected than the SARS-Co-V-2 virus that we have lived with to now.    But the Spike Protein of the UK mutation still is recognized by the antibody today’s COVID vaccines help us make, so the vaccines we use still will work.

But the South African mutation changes its Spike Protein enough that the hold of the antibody we will develop after vaccination with today’s Pfizer or Moderna vaccine is weaker.  We think strong enough that the antibody folks already immunized have will stop the South African mutation.

You get the idea.  If we vaccinate all 7.7 billion of us and stop this virus totally, no new mutations will develop, game over.  If we do not vaccinate anyone, every infection becomes a roll of the dice, will the copies of the virus spewing out of the infected carry new forms with different enough Spike Proteins that the current vaccine will not work?

And so yes, at this point in the Pandemic, the core reality is that a great race is on:  Vaccine v. Mutation.

Both are racing ahead, furiously.  If we are lucky, the mutations that occur reliably with ongoing viral infections will not lead to a virus that our current vaccines cannot stop.   If we are lucky, the ramping up of vaccine will happen quickly enough to slow mutation creation.

You and I can do little to get vaccine supply and administration to accelerate, but we can have a real impact on the number of mutations brewing.  And what is it that we can do to slow down the march of the mutations?

1. Do not gather- with friends, with families, at events, at places
2. Do not travel
3. When out of home, stay distant, wear a mask

As to what science can do in this race, there is good news here too.  The extraordinary power of the mRNA vaccine era we now live in now grants science the ability to create new forms of the COVID vaccine to allow it to guide our body to make precise versions of the Spike Protein reflecting the precise version of the Spike Protein in new mutations of the virus.   An amazing demonstration of this power comes with Moderna creating a new COVID-19 vaccine that will have our body produce the exact Spike Protein found on the South African mutation. The plan is in place that should a new form of the COVID-19 vaccine be needed, it can be combined with the current version.

Think of the flu shot.  It contains 4 versions of the influenza virus in each dose now.  So it may be with future COVID-19 vaccines, which may contain instructions for our body to create a number of versions of the virus’ Spike Protein, to protect us from several mutations.

So the race is on, we of course not only hope, but encourage all efforts for the COVID-19 vaccine to win before any mutations emerge that might stop our progress.

Current Situation Here at Home

Four trends are combining here in the United States:

1. The holidays are over, and so the massive gatherings so many of us sought are over.  This will help decrease the number of new infections.
2. The UK strain is all over the United States and is predicted to be our main form of COVID-19 in a few weeks.  This will greatly increase the number of new infections and deaths.
3. COVID-19 vaccination is taking hold, this will decrease the number of new infections.
4. A rather radical disregard for the danger we live in right now  This will increase the number of new infections.

Let us review each of these trends.

Holidays over

Not much to say here, except that the drop in new cases is visible from this impact.  In the US we peaked at 300,000 cases a day, which is simply staggering.  We once got very, very worried, in the middle of the summer when COVID roared to 70,000 cases a day.   But college, Thanksgiving, Christmas, and New Years gathered so many millions of us that we hit the 300,000 cases a day rate, which is nearly a million every 3 days!

Now that the holidays are over, we have dropped to 200,000 cases a day, a number we never should be happy about.

The UK Strain Becomes the US Strain

The UK mutation spreads to more people per infection than our current form, 70% more.  If you get COVID from the UK strain, you are 30% more likely to die from COVID.  And this UK mutation has been found in 20 states, so all agree it is across the nation, and will be the main form of COVID in America by March.

Jump the spread rate 70% and the number of cases can soar dramatically.  Combine a soaring rise in cases with more deaths per case, and the number of us who can die of COVID will soar dramatically, if nothing is done.  This is a threat happening right now.

The US is Vaccinating

For the first time, our nation has a national plan being put into effect to stop this virus.  On January 26, it was announced that the US has secured an additional 200 million doses of virus.  Once current orders are in hand the US now can reliably count on having 600 million doses, enough to immunize 300 million Americans, plenty to stop the pandemic.

Had we secured this order in November, we could look forward to having enough vaccine to vaccinate all Americans old enough to get vaccine by May.   But we did not until today, so all these doses may not be given until the end of August or September.

Further, our national plan is right now securing all the drugstore chains to be vaccination centers in the coming weeks, COVID Vaccination Centers (CVC).

A true mass immunization program is being born, given the delay of prior months, it will take some months to have it fully in place, but it is coming and when fully implemented, as long as new mutations as noted above do not stymie its 95% efficacy, will really slow or stop the dying.

Our Radical Disregard

Sadly, an almost hypnotic draw to pretend that it is fine to gather and travel continues to exert a tremendous hold on many of us.  It used to be painful to see this disregard directly fuel the heart-breaking tragedy of death, now at 433,000 of us now dead.  It still is.  But now we are in the final race- Vaccine v. Mutation.  And this radical disregard now opens the door to new mutations emerging, every day.   As noted, most mutations are harmless, but now and then, one makes a difference.  We saw that happen in the UK, and South Africa, and Brazil.  But it can happen out of any one person’s case of COVID.

Going to bars and restaurants, shopping, seeing friends, meeting with family, playing sports, traveling now risks breeding dangerous mutations, some of which could neutralize current vaccines and set us back months.   Science can adjust vaccines, but that takes some months.  We can ill afford major setbacks.

Flu Flew

As we approach February, the yearly appearance of the influenza virus continues to be nearly completely absent.  The usual peak of influenza infection is around New Year’s, but so far almost none.

The graph below shows just how absolutely stunning this is.

All the big curves of various colors represent a trace that reflects a measure related to how many cases of influenza virus infection are present at various times.  On the x-axis is the number of weeks of the calendar, the clock.  The number 1 represents the first week after New Year’s Day

Notice all these curves burst upwards.  Except one, the curve described by red triangles.  This line is the line defined by this year’s influenza winter epidemic.

Notice anything different about the red triangle line and all the others?   If you said it is flat, totally flat, you would be right.

The difference is astounding.  And what it means is that this is the first year of my life, certainly of my days as as a doctor that the influenza virus essentially failed to show up during the winter.

Now we still have about 100 days until the influenza virus season typically is over in any year (that would be week 17 on the figure below), so we can’t be sure it won’t appear soon.  But now I am really doubting it will, the difference between this year and prior years is already very well established.

Bottom Lines

1. Israel is closing in on vaccinating half of the nation.  And now we know, out in the real world, the COVID-19 vaccine is working, dramatically well.
2. So now the race is on.  The virus is mutating and we are vaccinating.   If we vaccinate enough of the world before really major mutations emerge, we could stop this pandemic.  If we do not, major mutations could stymie the power of our current vaccines, and the catastrophe can go on.  We are seeing new mutations in place and spreading, the UK mutation is likely to replace our version here in the US by March, and with it will come terrible increases in spread and the chance of dying if infected.
3. As of January 26, 2021, over 70 million people have been immunized, so we now also know this vaccine is safe.  Rumors swirl, but the facts are clear.  Anyone you care about is far, far, far better off, safer, more likely to live, if immunized.  Get immunized as soon as you can.
4. Much remains in my hands and yours.  Each of us have the power to slow the spread of all COVID types, today.  Each of us chooses to gather or not.  Even if everyone simply agreed to wear a mask could save 50,000 lives.  Not gathering, even more.  Until this enemy, the COVID-19 pandemic is actually conquered, it is ranging over our land, and we must each do what we can to stop it from hurting everyone we care for and love.

My Takeaway – In One Sentence:

A race is on with mutations and vaccines bounding ahead, let us hope each of us can take steps to slow this virus, limit mutations emerging, and support the great effort to get all vaccinated.

To your health,
Dr. Arthur Lavin