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

    COVID-19 Update: March 30, 2020 Clarification on the Illness in Infancy

    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-2019- 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
    • Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill

    Spreadability

    The update on spreadability is that the SARS-CoV-2 virus, as we approach the end of March, remains highly contagious.  It has only infected humans for only 4 months but in that short time has infected people in every nation on the planet.  Like many respiratory viruses, it clearly spreads through the air, and spreads well.  The current number used to describe how contagious it is, the average number of cases one person with COVID-19 will spread it to if not isolated, is now estimated to be somewhere around 2-3.

    The current numbers of cases in the US are hard to understand.  As readers of Real Answers may recall the numbers of cases can reflect trends in new cases but also trends in new testing.  Perhaps a more reliable number to give us an idea of how rapidly it is spreading are the number of deaths which are counted more accurately than cases.  As of today, the number of deaths from COVID-19 in the US is doubling every 3 days, and has for the last 11 days, with a very slight increase in that rate notices over the last week.

    As of today, no slow down in the rate of spreading of this pandemic in the US has been seen.

    In the US regions, the states of Louisiana and NJ show a rising number of deaths parallel to national rates, doubling every 3 days, NY state has a doubling rate at every 2-3 days which is the highest in the world, whereas California, Florida, and Washington states are doubling their deaths every 3-7 days.

    The Hot Spot Phenomena

    One pattern seen across the globe is what some call the hot spot phenomena.  The virus will strike one city or region and explode there, only to do the same, over and over, able to do so eventually everywhere.  Early hot spots included the first, Wuhan, then Iran and Northern Italy, and now NYC which is the Earth’s currently hottest area of pandemic.  Florida, Louisiana, Chicago and Detroit appear to be emerging hot spots.

    The Cleveland Clinic anticipates that Ohio will become a hot spot peaking not until mid-May.  The fact that Chicago and Detroit are ramping up makes me believe we will indeed be experiencing the horrible crush of a hot spot in the not too distant future, too.

    How the Exponential Can Tragically Fool Us

    One would think that a disease climbing exponentially could not hide, but this pandemic proves that all exponential explosions start off invisibly.  How so?

    Every exponentially increasing event must start with just one event.  If its numbers will rise exponentially, it will double in number until stopped.  Let’s say you start with one case of COVID-19 in some city.  If you double it you still have only two cases.  But if you double that one case nine times you still have only 512 cases. Think how many states have only 500 cases, many think that’s not so bad.  But keep doubling, which any infection will do if left alone.  Let it double 20 times, now that one case in that one city has become over 1 million cases.

    We saw above how long it takes for COVID-19 to double.  Let’s say on average every 3 days, that means 1 case becomes one million after 20 doublings, or 60 days, or 2 months.

    But the first 9 doublings only go from 1 to 500 cases and that took 27 days or one of those 2 months.

    This is the danger of a pandemic that doubles regularly, we all get lulled when their are only 2 or 32 or even 500 cases, never really feeling 1 million cases are just a few weeks away.

    It is what happened here in the US.

    Spreadability Can Be Decreased

    But spreadability can be decreased. The virus is very contagious, but only if there are people around for it to spread to.  As noted before in Real Answers, countries that achieve the following:

    1. Screen nationwide for symptoms
    2. Test all those with symptoms
    3. Isolate those testing positive, outside the home

    see their spreadability cease.  The spread can be stopped.  And in democracies as well as in China.

    We hope that the US strategy, which is not this strategy, will at least slow the spread if not stop it.  There are early indicators that the American strategy may be beginning to slow the spread where the American cases began- Washington state.  Our American strategy is as follows:

    1. No screening, cases are diagnosed and treated only by the choice of the individual.
    2. Test only those ill enough to be hospitalized
    3. Reduce person-person contact by everyone who can staying at home, including those infected who do not need hospitalization

    Spread to Newborns from Infected Pregnant Mothers

    We have very little data on this point, but one study from China looked at 33 pregnant women all of whom were infected with the coronavirus, SARS-CoV-2 and studied all 33 of their newborns.  A total of 3 newborns were born infected with SARS-CoV-2.  Of the 33 pregnancies, 30 newborns were not infected.  All 3 newborns born with COVID-19 did well, lived and were healthy.  Interestingly, they were cultured regularly after birth and although all 3 of the newborns infected had positive viral samples from their nose and anus for the first days of life, all were negative for virus by day 6-7 of life.  The article cites other studies showing no newborns from infected pregnant mothers were born infected.

    Putting it all together, it seems that the virus can be transmitted at or prior to delivery, but for over 90% or more of newborns, they are born virus free even if their Mom has COVID-19. And, none of the newborns showed any harm from the infection.

    Severity

    The COVID-19 infection remains primarily a mild infection for about 80% of those infected.  But a fairly worrisome 20% of those infected end up in the hospital.

    It remains true that age is the single largest determinant of severity.  People over 80 still have a much higher chance of very severe illness than young adults who are more likely to have very severe illness than children.

    The US is currently reporting many tragic stories of very healthy young adults succumbing to this pandemic.  It is hard for me at this moment to know if this reflects a different pattern of severity in the US than seen in the rest of the world, or if these stories are so dramatic they seem to dominate our sense of who is getting sick without actually reflecting a shift in severity to the young adult.  I suspect that young adults even in the US are far less likely to come to harm than the elderly.  We continue to hear of whole nursing homes being infected with many hospitalized.

    COVID-19 in Infants

    The data remain quite firm that the younger you are, the less severe the illness as you approach childhood.

    A dramatic story was released on March 28, 2020 from Illinois describing the tragic death of an infant infected with SARS-CoV-2.  The key observation in every news report on this death as of March 29 was that the cause of death was unknown.  No report describes the infant’s age, either.  All we know is that this child is under 1 year old, tested positive, and did pass away.  It remains possible the cause of death was not the infection.

    Reports describing this death of an infant in Illinois also cite a letter published in The New England Journal of Medicine, that the news report claims reports the death of a 10 month old infant from COVID-19.  But if you read that letter, https://www.nejm.org/doi/full/10.1056/NEJMc2003717, you will find 6 cases of children infected with SARS-CoV-2 are described in a hospital in China, and none of them died.

    So, with the possible exception of this infant in Illinois, it remains the case that no deaths from COVID-19 are proven to have occurred in children under 10 years old, and very few ages 10-19.

    Current Estimates of Loss of Life in the United States from Dr. Tony Fauci

    Readers of Real Answers may recall a detailed review of the findings of the world’s top epidemiological academic program, the one at the Imperial College of London- https://drlavinrealanswers.com/covid-19-update-march-22-2020-new-strategy-new-patterns-report-imperial-college-london/

    That study from London has been accepted as the gold standard of epidemiologic forecasting around the world, and by all top doctors and scientists in the US as well, of course.

    This weekend, the president appeared to begin to accept and understand its findings.

    The salient point here is that the study estimated that should the US do nothing, which is already not the case, we would likely suffer about 2.2 million deaths, which would be a catastrophic loss of life way beyond any our nation has ever suffered since the great pandemic loss of life of those who lived here before we arrived.  This 2.2 million number was finally mentioned in the White House briefing yesterday.

    Should we control the pandemic for 3 months and then lift our efforts and cease isolating, the Imperial College estimates we would suffer about 1 million deaths.  This is a number few people are talking about, but we should.  If London is correct, and their credibility is very, very good, then this means that we need to continue our current, severe, level of isolation for much longer than 3 months.

    Now, Dr. Fauci has shared his estimates that should we do all that we are currently doing and sustain it, we will still suffer about 100,000-200,000, which would be catastrophic.

    BOTTOM LINES

    1. COVID-19 remains highly contagious.  Only a very effective medication and/or vaccine will stop it.  But nations can take steps to slow the spread and even bring it to a halt while measures are imposed.
    2. Areas around Cleveland are emerging as hot spots with likely large flares of infection, and our Governor anticipates Ohio will also surge, peaking by mid-May. Our own sense is that the virus will spread until a medication or vaccine is developed.  That measures we take to isolate will help, but surges and flares will continue until real treatments become available.  And that the time course is highly, highly unpredictable.
    1. Severity remains worse with age, though young adults clearly can succumb.  Young children are particularly protected from very severe illness.
    2. Newborns seem to be unlikely to be born with COVID-19 if their Mom’s have it, and those that are born infected have all done very well, but the numbers are small.
    3. Estimates of loss of life from COVID-19 are profoundly disturbing.  The lowest estimate is from Dr. Fauci this weekend and ranges from 100,000-200,000.  These are truly staggering numbers.  And these are the numbers if we do everything right.
    4. The extreme measures of staying home, no school, no work will need to continue if we are to limit our loss of life to 100,000-200,000 people.  The possibility remains open that should American strategy remain widely complied with, the number of deaths could be much less than 100,000.

     

    We are no doubt in a serious pandemic, we can only hope all our efforts, here, across the country, around the world will save lives and we wish everyone and those they care for come through this well,
    Dr. Arthur Lavin

     

    ,

    No comments yet.

    Leave a Reply