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

COVID-19 Update January 9, 2021: Advanced Pediatrics Staff and Docs Get the COVID-19 Vaccine, “I Heard This About the COVID Vaccine. . .” and the Story of COVID Mutations

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.
  • 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.

Advanced Pediatrics Staff and Docs Get the COVID-19 Vaccine 

Yesterday, with profound gratitude to the legions of workers who studied science and developed an answer to this plague that threatens all our lives, all those working full-time at Advanced Pediatrics hopped in our cars and got the Moderna COVID-19 vaccine.

Our gratitude also extends to the Cuyahoga County Board of Health, who organized this astoundingly well-managed drive-through COVID-19 immunization system.  Large numbers of professionals were on hand to greet us, verify that we were in fact on schedule, met the current tier requirements (all 1A), gave us the shot, and observed us for 15 minutes following.

Can we all pause for a moment, and offer thanks?

This moment the 7 of us shared in our cars, captured in the photo above, is one for the ages.  This is the very first global pandemic, world-wide plague, that might be stopped in its devastations, by human wit and imagination.

Let us be clear.  That shot I got only existed because people thought about new ways to solve the threat of a new virus killing us.   And because people found smart ways to turn those ideas into an actual vaccine.  The work on this particular invention started 30 years ago, and culminated in 2020.

Take a close look at that syringe.  It contains a bit of clear fluid.  That fluid contains the genetic code to ask my cells to make a protein, the spike protein of a killer, and then my body will make antibody to make sure I never get re-infected.  (I received this vaccine at the recommendation of the public health authorities knowing that I had already had the infection).

It is astounding what was in that syringe in the photo.   Take another look.  In that syringe is the best hope of humanity.  The very notion that any problem we have might have an answer through the combined wit and wisdom of all of us, of people, of humanity.

One thing I know for sure after yesterday, there is not a single problem we face whose solution came from nonsense.  Our  human wit and imagination can concoct any idea, any idea.  Some are nonsense, but some work.  Which is which?  That can only be found out by testing out the idea.  Being sure my idea is great is worthless.  Only when it is tested can we find if my brilliant idea is nonsense or a real solution.

This shot only exists because folks brave enough to have their brilliant ideas tested, to quickly reject any found not to work,  worked so very hard to bring the ideas that work to reality.

If instead all that happened was some people gathered around, posted some ideas on the Internet, and thought that was good enough, there would be no vaccine for COVID, no hope to end this before millions die.

But the work was done, the useful ideas were sorted from the garbage ideas, and a syringe delivering protection to our whole staff was created and given!

We at Advanced Pediatrics are grateful.  Grateful for the power of truth and hard work.  Grateful to be protected.  Grateful to know that none of us will get COVID-19 a first or second time.  Very grateful to know that we can no longer pass along COVID-19 to anyone once our doses take full effect. 

What Did I Hear About the COVID-19 Vaccine…

As this wondrous vaccine becomes available to everyone, the inevitable rumor mill has begun.

We have heard lots of ideas about the COVID vaccine, and so we offer this list and our responses to the incredibly wide range of rumors.  BOTTOM LINE- get the vaccine ASAP.  It works, it is safe, it will save lives.

  1. Claim:  It’s not FDA approved.  Reality:  It is FDA approved. There are two approval processes.  One is the emergency approval the other the regular approval.  Is there any surprise that new treatments may get emergency approval before regular approval?  Would anyone seriously want it the other way around?   The COVID vaccines being given are fully approved by the FDA through their emergency path.
  2. Claim:  We don’t know what’s in it.  Reality:  We do know what’s in it.   The active ingredient is a tiny snippet of genetic code,  or viral mRNA, that tells my cells to make the protein that makes those spikes on the virus of COVID-19.  That snippet is wrapped in a tiny, tiny droplet of fat, and the droplet containing the snippet is in a tiny bit of liquid.  That’s what got poked into me in that photo.
  3. Claim:  The COVID vaccine can give you COVID.  Reality:  It simply cannot, ever, at all, in any way.  Everything in that shot is dead.  There are no viruses of any sort in the COVID vaccine, none, not at all.  The tiny snippet of genetic material is destroyed rapidly after telling my cell to make the spike protein.  All that snippet can do before it is destroyed is tell my cell to make one protein.  No cell can make a real virus from this tiny bit of genetic material.  So the materials are all as dead as my carpet or glass.  What they get my body to do is make one protein, which can never live.  You cannot get any infection from this vaccine, of any sort, ever.
  4. Claim:  People who get the COVID-19 vaccine have died.  Reality:  No one has died from this vaccine.   This is very important:  The worst reaction has been severe allergic reactions, no one has died from any of these.  The vaccine has been given to millions and millions of people and NOT ONE PERSON has died because of this vaccine.  Now consider the risk taken when you get your haircut.   Nearly everyone gets a haircut sometime or another.  One day someone will go get a haircut, and later that day, could suddenly die of a heart attack.  Did the hair cut cause the heart attack?  Would the person have had the heart attack anyway if they had skipped the visit for the hair cut?  The answer is of course that getting your haircut does not cause heart attacks, even though this person died after getting one.  There have been people who have died after getting their COVID-19 vaccines, just as there have been people who have died after eating dinner, or watching TV, or getting a haircut.  So far not one person has been found to have died as the actual result of being protected by the COVID-19 vaccine.
  5. Claim:  These COVID-19 vaccines are a new technology rushed to market.  Reality:  The COVID-19 vaccine available in America are all the result of 30 years of steady, careful, very deliberate development.   Nothing quick happened in the development of this new type of vaccine.  Yes the COVID-19 vaccines are the first of their kind, but it took science 30 years to test out the ideas and develop the techniques to create gene-based vaccines.  Thirty years.  Nothing was rushed, quite the contrary, people spent whole careers seeing what would work, making it work, trying out different approaches, honing the technique over, and over, and over again.  It was only after scientists perfected this technology that even the idea of trying it in people was even broached.   The whole point of this 30 years work was to develop the ability to create vaccines for deadly viruses that we know will always continue to appear in our world.  This work would be worthless if it could not open the door to rapid development of vaccines to new viruses that do suddenly appear and cause harm.  So it is not a new concept or technology, and the fact that when this new virus appeared we could act quickly to create a new vaccine is the result of so many decades of careful work, not a rush to market.

Now one thing talked about is very true, lots of people who get a COVID-19 vaccine will get some side effects, all related to the goal of inducing an immune reaction to the SARS-CoV-2 virus spike protein.  It is that very immune reaction that gives me my protection from another bout of COVID-19!  So yes, the vaccine can cause a sore arm, I have one now.  It can also cause fatigue, body aches, fever.  These all go away with no harm done, and leave you, in a word- PROTECTED.

The COVID-19 Mutations

The story of the UK SARS-CoV-2 virus is spreading even faster than the virus, and so now is a good time to talk about this and some other mutations in the virus that is causing COVID-19.

What is a Mutation?

Mutation simply means change from the Latin word mutare which literally means change.

Change is of course an essential feature of the world, all living things, and all non-living things change.

For life, the settings on all the controls are designed with such excruciating complexity, that changing them could mean life ceases.  So every form of life has all sorts of mechanisms to make sure this happens as little as possible.

At the same time, all of life needs to find a way to make copies of itself, or it will go extinct.  No copies, no reproduction, no more of that form of life.

BUT, copying opens the door to error.  Just run a document through a copier over and over and you will see the quality distort.  Error lurks around any act of reproduction.  So, how does life copy itself, and keep changes to a minimum?

The answer is genes.  Genes are the directions that cells and viruses use to assemble all their workings.  Genes are sequences of 5 chemicals, for DNA they are A, T, C, and G, and for RNA they are A, U, C, and G.  The sequence instructs the cell on what proteins to make and it is the set of proteins made at the right time and sequence that create every form of life on Earth.

So, find a way to copy those letters correctly and you have reproduced without change, without error.

Now in us humans, the rate of change is very, very tiny.  If you have kids, you have made copies of your DNA, and our error rate is about one letter wrong in every 100 million letters per generation!  Almost no errors!   We copy our own DNA, we have mechanisms to catch mistakes, it works amazingly well.

But viruses are different.  They don’t even copy their own genes, they insert their genes into our gene mechanisms and force our cells to make their copies.  Also, they make zillions upon zillions of copies, if many of their copies are wrong and don’t work, who cares, others of the zillions will work.

So viruses change a lot.  One that changes like crazy is the influenza virus (which remains oddly and thankfully absent so far this season).  When it invades our cells and forces them to make copies, about 99% of the copies are so riddled with error they don’t work at all!   That means they make many letter errors every time their 10,000’s of letters are copied.   In a word, they mutate a ton.

A mutation then is a change in the sequence of the letters of an animal, plant, bacteria, or viruses genes.

The Mutations of SARS-CoV-2

The SARS-CoV-2 virus, like all of life, copies itself, and like many viruses, makes lots of mistakes.  But again, it can, because it makes zillions of copies every hour or so.  So even if only a few copies work, it is fine.

But this virus makes copies a lot more accurately than the influenza virus, so it does NOT mutate as wildly as that virus.  Of course, as note, like all viruses, it makes more mistakes in its copies than our cells do.

So far there have been a variety of mutations, I classify them into three types of mutation of the SARS-CoV-2 virus- thankfully the third category is not yet seen.

Here they are:

  1. Minor– Minor mutations are changes in the letters of the virus’ genes that have no impact on the function of the virus or on the COVID-19 it causes, or on how well the vaccine will work.  There are many of these around.
  2. Major– Major mutations, in my categories, are changes in the letters of the virus’ genes that change the function of the virus and/or the experience of the disease it causes, COVID-19.  At least 3 of these mutations have been identified.  Hopefully none affect how well the vaccine will work.
  3. Major and Vaccine Impacted–  NO MUTATION HAS YET BEEN SHOWN TO CREATE A NEW ENOUGH SARS-CoV-2 VIRUS TO RENDER THE VACCINE USELESS.   Mutations in this category, therefore, are theoretical, and would occur should the sequence of letters in the genes of this virus be altered enough that the proteins it makes are different enough that the antibody created by the vaccine will not recognize the live virus.

Minor Mutations

As stated minor mutations are small changes that change the sequence of letters in the virus’ genes that can cause the viral proteins to be a little different, but leaves the virus essentially unchanged in how well it spreads, how sick it makes you, really any property at all.  These minor mutations happen all the time as COVID-19 spreads.   It is these tiny changes that allow science to trace the virus and know that this set of infections came from this set of people.  For example, looking at minor mutations we found that the virus that afflicted NYC in the spring of 2020 came from Europe, not China.

Major Mutations

These mutations change our actual experience of the vaccine, but still are prevented by COVID-19 vaccines in use now.

There are four known major mutations as of today:

  1. South Africa- the new mutation of SARS-CoV-2 virus in South Africa appears to cause young adults in their 20’s and 30’s to be more likely to suffer serious illness when they get COVID-19.   This is a very worrisome change, as it puts so many more millions of people at risk from this disease, and opens the possibility that young children may one day experience serious illness more often too, from COVID-19.  Fortunately this mutation has not spread around the world, as far as we know.  We hope that it is prevented by current vaccines, and that it does not lead to children being at increased risk.
  2. Denmark- Denmark has more minks on farms  than any nation in the world.  Recently new mutations in the SARS-CoV-2 virus have been found in Danish minks, and some of these changed viruses have appeared in Danish people.  This means the virus has gone from people, to minks, and back to people.  This is a very dangerous development because viruses evolve, mutate, change much more rapidly going to and from different animals.  So far all the mutations in Denmark have not affected how well the virus spreads or how sick it makes anyone.  Some might lead to less efficacy of vaccines.  Given these concerns, Denmark is poised to kill all 17 million of its minks, so these mutations are very likely not to spread to more people.
  3. UK-  This is the major COVID-19 mutation in the world.  It is a major mutation because it changes how people experience COVID-19.  If you get the UK mutation of COVID-19, you will be spread it, on average, to 70% more people.  But you and those who get it from you will be no more likely to have severe illness than with the original SARS-CoV-2 virus.  Let’s take a close look at that information.
    • First- the 70% increase in spread.   How well a virus spreads is measured by the average number of people someone infected with the virus will catch it from that one person.  For COVID-19 that number is about 2.5  That means when I had COVID-19, if I got together with a bunch of people in close contact without a mask, about 2.5 on average would get it from me. (I didn’t do that, and of all tested after contact with me, we found 0 transmission).  But take that number 2.5, and say a person spreads it to 2.5 on average, and each of them spread it to 2.5, after 10 rounds of such spread, that one infection becomes 9,500 infections!   Now boost that 2.5 number by 70%, now the average number catching it each round goes up to 4.25.  Now have 1 person give it to 4.5 people, and each of them to 4.5 people, 10 times, and that one infection now causes 3.4 million infections!   Jumping the spread rate, and taking no precautions and no vaccine takes one case from causing 9,500 to 3.4 million infections in 10 rounds!  This is the threat of the UK mutation.   Transmission going up 70% can be catastrophic.
    • Second- the fact that it does not make you sicker.  This is very good news, sort of.  Yes, it is very, very good news that if you catch the UK COVID-19 mutation you are no more likely to get ill.  Overall, about 80% of people with COVID-19 are fine, either have no symptoms, or only mild symptoms, that rate remains the same for the UK mutation.  Imagine if that wasn’t so, imagine if the chance of serious disease (hospitalization or death) rose from 20% to 30% or more, that would truly be catastrophic.  SO thankfully, it so far has not done so.
    • Putting it together.   Yes, it’s good the UK mutation does not make people more likely to get sicker, but if the same chance of getting very ill happens to more people, more people will get very ill.   Consider our nation, which has recorded about 22 million cases, leading to about 375,000 deaths.  Those numbers mean about 1.7% of all known infected Americans have died of COVID-19.   Let’s say the UK mutation takes over, then that number of 1.7% stays the same, good news for sure.  But if it does take over, we will see many more people infected.  Let’s say an extra 1 million people get infected, that would mean the same chance of dying from COVID, 1.7% would stay unchanged, but the extra 1 million infected people would mean an extra 17,000 people dying!  Very bad news.  This is why the UK mutation is so profoundly upsetting.

So far, the UK mutation of COVID-19 appears to be prevented by vaccination.

Major Mutations that Impact How Well Vaccines Work

So far NO KNOWN mutations of the SARS-CoV-2 virus are known to have outfoxed the COVID vaccine.  Should that hold true, the vaccine will continue to hold out hope of quashing this nightmare.

But clearly this virus changes, or mutates, and the chance that one day a new change, or mutation could be different enough in the right way that current COVID-19 vaccines will not work, is a worry worth watching for.  Let us hope that day never comes.

Bottom Lines

  1. All your doctors and full-time staff at Advanced Pediatrics have received their first COVID-19 vaccine dose.   We are pleased to ensure we are safe and we keep you safe when you are here with us.
  2. The COVID-19 vaccine is SAFE and EFFECTIVE.  It offers the ONLY path to end the devastating deaths, soon to hit 400,000 in the US alone.  Soon we will lose more Americans to this virus than to World War II!   We call on everyone to get their COVID-19 vaccine, to save lives, to protect those we love, to end this nightmare.
  3. Many rumors are floating around now that the vaccine is becoming available, check out our mythbusters above.
  4. The vaccine can cause soreness, even whole body aches and fatigue, it is designed to cause inflammation.  The inflammation is the immune response that leaves you protected from getting the real infection, which this shot cannot give you.
  5. The SARS-CoV-2 virus, like all viruses, is changing, or mutating.  The top worry is the UK mutation which spreads faster, which means case numbers could rise dramatically.  So far all known changes in the virus that causes COVID-19 are prevented by the vaccine.

My Takeaway – In One Sentence:

We are grateful to the brilliance of human wit and imagination and the hard work over many decades turning great ideas into a vaccine that can end this new plague, we hope you join us in becoming safe and protecting others.

To your health, and a Better New Year!
Dr. Arthur Lavin

 

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