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.

Bad News from Schools from the UK

At the start of the Pandemic, we waited to find out, will children get sick, will they transmit, what is the real threat to our children?  And the news has been very good.  Children tend not to get ill.  And schools that keep students 6 feet apart, masked, and podded, do not experience outbreaks.  Together with teachers being immunized, schools adopting these measures have opened with confidence knowing that the virus will not likely spread in schools, particularly up through 8th grade.

But this morning I learned from Dr. Osterholm, who serves President Biden as one of the nation’s top COVID experts, and who we were honored to interview for Real Answers, that the UK variant causes outbreaks in schools.   The UK variant erupted in England in the setting of a nation trying to contain a deadly surge, mostly in lockdown, except for schools.  During this period, the new variant technically called B.1.1.7, emerged in Great Britain, first appearing at scale in schools.  In direct contrast to our familiar form of COVID, this variant does cause outbreaks in schools that then cause national outbreaks, causing many people to lose their lives.  This is what happened in Britain, the variant erupted in schools, then spread to the rest of the world.   The fact that this outbreak began in British schools is why we call it the UK variant.

Yesterday the US experienced a total of 54,000 known cases of COVID in one day, the CDC tracks key variants, and reports that as of yesterday, the total number of UK variant COVID cases has reached about 5,500 all together across time.  At this time most places in the US are only seeing about 1% of their cases as UK variant, some 2%, some even more.  Florida is the epicenter of UK variant COVID in the US today.  Dr. Osterholm just communicated with me that the proportion of UK variant cases in FL COVID erupted from 3% to 44% in just 3 weeks.

He communicated to me also that once the ratio of COVID caused by the UK variant hits 50% then exponential increases in COVID hit a community or nation and a deadly surge follows.

Our concern is that the UK variant, as readers of Real Answers know, spreads far more easily and kills more easily, than the regular form of COVID, so in every nation it has appeared, it takes over.  Israel now reports 90% of its COVID is the UK variant.  The only good news here is that in Israel where over 50% of all citizens are immunized, the numbers of COVID cases are dropping, even in the face of the UK variant, so immunization appears to stop people from getting sick from this variant.  (We still do not know if or how well immunization stops spread).

And so the harsh reality of the Pandemic not being over confronts us today.  We are not at the end of the Pandemic, we are squarely in the middle.  And as we have been saying, a race is on, the vaccine v. the variants.  Both have lots of momentum.

But the United States has clearly embraced the joy of saying no more worries.  Masks are coming off in many places, people are gathering in large crowds indoors.  We are doing much in our power to invite this virus, and its variants, to spread widely.  The fact that Florida is the hotbed of the UK variant should worry us all, since right now one of the most powerful sources of COVID spread in the US, college students, is crowding together without masks for spring break, all set to be infected with the UK variant and then come home across the nation to spread it.

Should the UK variant accept our invitation to spread like wildfire, and do so before our rapidly expanding vaccine campaign can stop it, it will be in our schools which are re-opening everywhere.

If the UK variant reaches our schools, then for the first time in this Pandemic, we will see schools, even of young children, become major sources of COVID outbreaks, and spread this more deadly form of COVID to, and threaten the lives of, the unimmunized.  Dr. Osterholm’s communication from the Minnesota Department of Health indicates they are acting now to put a hold on high school sports, to move back to hybrid schooling.  This problem is real.

We should know, that right now, there is a true urgency to keep this virus from spreading. Period.  We can do this by lining up to get vaccinated, stay home, do not travel, do not gather, if out of the home wear a mask and stay 6 feet apart.   If we do this, we might avoid the tragedy of schools becoming centers of COVID outbreak, as has happened in Britain.

A word on travel.  Flying in a plane is perhaps the best action to spread these new variants.  It brings together people from all over the nation and world, and places folks in indoor setting like airports and airplanes, that cannot be avoided.  We know airplanes are efficient vehicles to transmit viruses.  Now is not the time to fly, now is not the time to risk seeding schools with this UK variant and opening the door to a true nightmare, even if you are immunized.

Getting Ready to Vaccinate our Children for COVID

One of the few positive experiences with this Pandemic has been that the younger you are, the less sick you get, and so this catastrophe has spared our children, a truly profound blessing.

At the same time, the immunizations developed to stop the Pandemic, had to be first tried in adults.  The good news is that 400 million doses have been given to people ages 16 and up, and the vaccines clearly work and are clearly safe.   As of today, no COVID vaccine has been approved for use in anyone younger than 16 years old, and only Pfizer is approved for 16-18.

The testing of safety and efficacy in children has to come first before children can be vaccinated for COVID.  This testing is being done in at least 3 stages, which if all 3 go well, will each take 3-4 months.

The first stage is children 12-18 years old.  Those studies have been fully enrolled for several vaccine brands, most of the children being studied have been immunized.  So we wait for results of their being immunized with placebo v. vaccine.  I anticipate hearing these results soon, in a matter of weeks or one or two months.  If the news is good, that the vaccine works and is safe, like in adults, it will be approved and everyone 12 and up can get immunized.  It seems realistic to hope to see this day come by April or May, or soon thereafter.

As of today, the next group those 6-12 years old, are currently starting their testing.  We are just at the start of this process with those volunteering enrolling now.  Most of these efforts, as noted, take 3 months or so, so we would anticipate the vaccine studies for 6-12 year olds to take through June or so.  If these tests show the COVID vaccines work well and safely for 6-12 year olds, then the FDA may approve their use by June or July, or soon thereafter.  Then everyone 6 years old and up can get COVID vaccine.

Finally will come testing of the vaccines for our youngest children, those up to 6 years old.  No enrollment or studies have begun yet for this group.  But if all goes well with the 6-12 year old trials, enrollment for this last group could begin perhaps by May or June.  And, if these trials go well, they could be completed in another 3 months or so, meaning that we might see COVID vaccine approved for 0-6 year olds by the end of this year, or even earlier.

As the COVID vaccine becomes available to children, stay tuned. Advanced Pediatrics is a registered COVID vaccine center with the Ohio Department of Health, and we stand ready to administer this to your children when and if it is approved, and ODH decides to distribute it to us.

The Risk of Re-Infection

Everyone has wanted to know, is COVID like strep, an infection you can get over and over, even hundreds of times?  Or is it more like chickenpox, mostly one and done?

A new takes a look at this question and we have some answers.  This study looked a nation’s first wave of COVID testing.  A total of 525,339 people were tested across all of Denmark.  Of these tested, 11,068 were positive in this first wave of testing.  The study then asked, how many of these 11,078 would go on to become positive again over time?  The answer is 72.  That means the vast majority of those who had COVID did not get a second infection, making far more like measles than strep.  The actual rate of re-infection was 72 out of 11,078 or 0.64% risk.  That means over 99% of people who got COVID in Denmark did not get re-infected.

A few specifics on this finding:

• This risk of re-infection was for the old, original COVID, not the variants.  The risk may change.  But the trend is against re-infection.
• The risk of re-infection did not go up over a time of observation stretching out to 7 months, so immunity seems to last that long, again, for the original COVID.
• The risk of re-infection goes up a bit if over 65 years old, but the number it goes up to is a risk of roughly 1.1%

One word of warning on statistics.  A change of risk from 0.65 to 0.91% is just that.  That should be all that is said.  But typically, studies and reports use percentages of percentages.  Consider the change from 0.65% to 1.1%, that is of course an increase of 0.45 percentage points.  Now 0.45 divided by 0.65 is nearly .7, again of course.  But here is the trouble, it is therefore true that this change represents a nearly 70% increase in the risk over 0.65%, but reporting the increase as 70% increase of risk exaggerates the sense of the magnitude of the problem.  People over 65 still have only a 1.1% chance of re-infection, still have a nearly 99% chance of not getting re-infected.

No one in Denmark across this national surveillance was found to have contracted COVID more than twice.

The study reported testing results from people with no or very mild symptoms, so it cannot comment on the risk of serious illness with re-infection.

Lessons from the Nation Most Fully Immunized

Israel continues to have more of its citizens immunized than any other nations.  As of now, roughly 55% of the nation is fully immunized.  So it remains the one nation in the world that can tell us, what is life like in an immunized nation?

At 55%, the nation is not yet at the level we have tended to set as a goal during the Pandemic with the original variant which was about 66-70% immunized.  The new UK variant spreading so much better, pushes the estimate of need for immunization to stop the Pandemic up towards 80%.

And, the UK strain has taken over Israel, reporting that about 90% of COVID cases are due to this new variant.

So it is with great interest that the trends are already encouraging.  Israel hit it peak around January 16, with a per capita rate of COVID cases of 95.3 per 100,000 people per day.  Immunizations began to take hold after that peak, and the rates dropped to about 40 cases per 100,000 people per day by February 24.  These rates did not change much from Feb 24 to March 6.  Then when immunization rates rose to their current level of about 55% fully immunized, the rates of COVID cases began to drop again, to 20 cases/per100k/per day.

We do not know for sure that the massive national immunization progress in this nation is why the rates are dropping so dramatically, but if they are, it means the vaccine is working across a nation, and against the UK variant, and gives hope to us here in the US and around the world, as we strive to reach the number immunized that will protect the whole nation.

The Status of Immunization and COVID Here at Home

The good news here is that the United States is doing an excellent job rolling out the COVID-19 vaccine.

We have immunized more people than any other nation, and our current rate of vaccination, even per capita, is on top of the world!

Our situation is that right now about 115 million Americans have had at least one dose.  If these are all Pfizer or Moderna, then about 18% of the total population of the United States is immunized.  If these are all Johnson & Johnson, then about 36% of the total population of the United States is immunized.  Most of our COVID vaccine has been the two dose versions, so a good estimate is that 20% of the total nation is immunized.

That is not enough to stop the Pandemic, as demonstrated by Israel.

And as noted above, variants are spreading in the US.

So the urgency is to get our percentage up from 20% to 80% ASAP.  And, in the meantime, do not gather, do not travel, avoid crowds, stay at home, and if out of the home, wear a mask and stay 6 feet apart.

Bottom Lines

1. The news on the UK variant is the big news today.  This virus has now been proven to convert safe schools to sites of COVID outbreak that can cause a community, even a nation, to a deadly surge.
2. The US load of the UK variant is low right now, but is changing, Florida went from 3% of cases due to this variant to 44% in 3 weeks!
3. The tilt level for the UK variant is 50% of COVID cases, once that level is hit, surges follow.
4. Minnesota is taking the threat of UK variant COVID seriously, right now putting a hold on high school sports, and moving schools back to hybrid.  We need to monitor levels of UK variant in Ohio, which are low now, and act if they should rise.
5. COVID vaccines in use now stop the UK variant from causing hospitalization and death.
6. COVID vaccines for children, if all the studies prove they are truly safe and work, will roll out for children in at least 3 phases, starting with 12 years old and up, then 6-12, and the third phase may open immunizations up to all ages.
7. The current strain of COVID appears to be more like chickenpox than strep in its low rate of re-infection.
8. Israel leads the world with 55% of its people fully immunized and though 90% of its COVID is the UK variant, case rates are currently dropping there, offering hope that even with the UK variant we might see some protection sooner than expected.  We will see.
9. Here at home we are likely at about 20% of the nation fully immunized, with Americans over age 65 perhaps as much as 60% immunized or more.

My Takeaway – In One Sentence:

All the above makes this clear: we face a real challenge from variants, our only hope is to get vaccinated ASAP, and please, please, please stay at home as much as possible, do not gather, do not fly, and if out, wear a mask and distance.

To your health,
Dr. Arthur Lavin