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.

150,000

These COVID-19 Updates have been posted regularly since February 19.  We have focused on the nature of this illness, how it spreads, the harms it causes, as well as approaches that could protect us all from real dangers such as death and permanent disability.

And so it is with a very heavy heart that I focus today’s update on a tragedy so enormous it is nearly impossible to actually comprehend.

Our nation, America, has now suffered over 150,000 of us dying from an infection we could have chosen to stop spreading, but have not.

Take a quick look at the scale of this death, no other nation comes close, https://www.worldometers.info/coronavirus/.

At our first posting on COVID-19 back in February, it appeared this was a disease mostly appearing in China.   But as of today, China, a nation of nearly 1.4 billion people, has seen 4,634 people die from this infection.   China, where the infection began, where it ran rampant before anyone knew about it, has suffered, proportionate to size of population, less than one-hundredth the devastation our United States has.  Given the difference in our populations, if we had suffered the same amount of loss of life as China, our total today would be about 1,000 deaths, instead it is 150,000.

We speak in Real Answers about many facts regarding the SARS-CoV-2 virus and the infection it causes COVID-19.  We have talked about the biology of the virus, how it spreads, the symptoms it causes, leads on new vaccines, issues about using masks, and opening work, and going to school.

But today, we need to focus, completely, with all  the attention we can muster on the one fact that is more important than all the others.

That fact is that this infection runs rampant across our nation, when it does not have to, and because of this tragedy, 150,000 of us have died.  And of the 4 million of us infected, no one knows how many will suffer permanent harm and even disability.

As a doctor, I take my greatest pride in seeing our profession, and our communities, defeat harms by disease.  And so it only makes sense that as a doctor, I would mark this day with the greatest outrage.  I am a citizen of a nation that has chosen to have 150,000 of my fellow citizens die, rather than take the steps widely known that daily prevent deaths around the world from this virus and its infection.

It is urgent at this moment, that our nation, which means each of us, demands that we take the well-known steps to stop the spread of this virus, those steps, outlined many times in these posts are simply put:  Identify the Infected, Isolate the Infected.

If we do this, the spread of this virus will be brought to nearly zero, and deaths will be brought to nearly zero.  We know this from the experience of 46 nations that have done just that.

To Identify the Infected and Isolate the Infected, nations adopt the following actions:

1. Screen the entire nation constantly for any indication that any person might be infected- this may include fever scans, questionnaires for exposure risk, across the whole population in many, many settings.
2. Test everyone who might be infected.
3. For every person whose swab test is positive:
   1. Isolate outside the home in a place where no one can catch their COVID-19, until that person is no longer contagious
   2. Conduct detailed interview to determine as close to everyone the infected person has come within 6 feet of while contagious (this is what contact tracing is)
   3. Test every contact
4. Repeat.

The power of this strategy to work across even very large nations, and to keep infection rates as close to zero as possible for many many months, even years, was confirmed by one of the world’s leading medical detectives, Dr. Michael Osterholm when I asked him if this was true in our interview just a week or two ago.

Please notice nowhere in this strategy is a total lockdown of work, school, and play mentioned.  Nations that effectively do these steps can work, study, play just fine.  Lockdowns happen here because with the infection running rampant, it comes to this as the only option once the fires burn too hotly.  So again, we ask, why let the fires burn, why not put them out?

Saving the next 150,000 of our lives should be reason enough to do this, do this now.  I have to be honest, I fear I may be one of the next 150,000 whose lives will be lost because all indicators show the rampant spread of this disease is coming to Ohio and soon.  So yes, just to stay alive it makes more than just sense for America to do this strategy.

But of course there are other reasons to stop the spread of this virus.   It is only with stopping the spread of this virus that the following activities can occur with any sense that doing so makes real and confident sense: 

1. Opening schools- rampant COVID-19 of course closes schools, imperiling our children’s education, socialization, mental health, nutrition
2. Going to work- rampant COVID-19 of course imperils all of us who want to work
3. The economy- no school, no work, no economy- raising the specter of the economic ruin of tens of millions of us, a specter growing right now
4. Play- Just think Marlins.  Two days into the opening of the baseball season, one team is found riddled with infection.

Can anyone truly believe that if America continues to decide to let this virus run rampant that our schools will be safe, our jobs will be safe, our games will be safe despite even the most elaborate plans to limit the harm from this deadly pandemic laid out by schools, jobs, and play?

We will know when our beloved nation achieves the same level of control of the spread of this virus as Ireland, Norway, Mali, and Thailand, to name just 4 of the 46 nations that have brought their daily new case rates down to close to zero, as of July 28, 2020.  We will know because our American daily case rate will drop from our current rate of 60-75,000 new cases a day to close to zero.

We will also know because we will hear every day what our nation’s leaders have chosen to focus their energy on.  Will it be to adopt strategies to bring our daily new cases down from our current peak of 75,000 to near zero, or will our attention be distracted to actions that cannot achieve this very urgent need?  Examples of distractions include promotion of medications proven to not work, promises of a vaccine very very soon, elaborate plans to manage the spread when the spread is allowed to flare.

We all face a choice.  Today we found that our current choices have in fact cost the lives of 150,000 Americans.  Continue down the same path, and another 150,000 and more will lose their life.  Choose the strategies that work, and we will not lose another 150,000 in another few months.

THE BOTTOM LINE

America has lost 150,000 of our fellow citizens, because we have chosen not to seriously limit the spread of this virus and disease to nearly zero rates.  Ohio has been cited as one of 5 states (also MN, WI, IN, CO) where NY, TX, FL, AZ, and CA-like surges are likely to hit.  I am simply very sad today, frightened for all who I care for, and for myself.  Hoping that our nation can turn its attention to this most urgent need, and soon.   I hesitate to say in the meantime, but in the meantime, wear masks, stay 6 feet apart, avoid crowds especially but only indoors.

History will never forget the choices America made from January through July of 2020.  Let us hope it will remember what we will do from August, 2020 on with more pride than horror.

Despite the dangers, we at Advanced Pediatrics will continue to do all in our power to answer your questions, protect your health, and be with you as we all go through this tragedy together.

To your health,
Dr. Arthur Lavin