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.

Spreadability

The news of a possible vaccine solution to the COVID-19 Pandemic remains the best news in an otherwise bleak moment.

But the moment is indeed bleak.

The SARS-CoV-2 virus is right now rampaging across all states across the nation.

We are now experiencing daily case counts once thought unimaginable.  The idea of over 100,000 cases a day was long hard to imagine.  But yesterday our nation hit nearly 150,000!

Dr. Michael Osterholm, now on the new Coronavirus Task Force, and one of the world’s top epidemiologists on pandemics, stated last night that current trends will almost certainly lead to over 200,000 new cases of COVID-19 a day across the United States.  I believe it will go well beyond that level unless behaviors and policies change.

In just a few days, our nation will have suffered the loss of a quarter of a million lives, with the number of deaths right now accelerating.   We reached 1,500 deaths in our nation in one day just yesterday.

Here at home, Ohio’s numbers are in a word, frightening.   Readers of Real Answers know that life gets very upsetting once a state exceeds its medical capacity to care for too many ill with COVID-19.  That has happened to nearly every state around 10,000 cases a day.   Ohio has gone from 1-1,500 cases a day very recently, now up to 6,000 cases a day!   Such a rise will land us in the danger zone of 10,000 a day soon.

I am deeply concerned about a dramatic change in approach here in Ohio.

In March, Ohio took steps to control the transmission when we only had 3 cases reported in the state.  The result was one of the lower levels of suffering from this dangerous virus for many months.

Now it appears our state is trying out a different path, let the numbers climb to a point where we must act to control the spread because the suffering will be too great to bear.   Instead of our Spring strategy of stopping the numbers from climbing to prevent suffering that would be too great to bear.

Right now, our surge puts in the range of the 4-5 most dangerous states- https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&byDate=0&cumulative=0&logScale=1&perMillion=0&values=cases

It was particularly painful to hear that our truly exponential explosion of COVID-19 infections now underway is being fueled primarily by people seeking to cause the pandemic to explode.  The Governor made clear that we are at about 6,000 cases a day primarily because people have chosen to gather, in large numbers, without masks, for sustained periods of time.

Tragically, these choices do not just infect those at the party.  The virus, once activated to spread wildly, will infect anyone.  And we are seeing it.  We are seeing the emergence of school outbreaks.  We are seeing tragic losses in nursing homes.

The Result of a 50 State Spike in COVID-19

When NY had a spike, or when the South of the US had a spike, doctors and nurses from around the country could flock to help, and they did.

Not this time.

With all states in trouble, no state has any medical staff to spare.  In North Dakota, nurses known to be positive for COVID, contagious and able to spread it, are being mandated to report for work.  The danger to patients is outweighed by the fact they simply have no one else to care for the terribly ill.

Again, Dr. Osterholm, who you will remember from his poignant interview with Advanced Pediatrics, is telling us that soon even with ICU beds, there will be many areas of the country that will have to use doctors and nurses untrained in ICU care to care for ICU patients with COVID, and that the chance of dying from COVID-19 when in the hospital will almost certainly go up.

Thanksgiving

Until we have a government willing to stop the spread of the virus, it will spread.  This has been demonstrated for many months now.

And as long as COVID-19 is spreading so dramatically, we are strongly urging all families to stay home as much as possible.  To pursue virtual learning.

And, not to travel.  Family gatherings are the key source of COVID-19 surges in Ohio right now.  It is hard to imagine how much worse all our lives will be if families gather as usual for Thanksgiving in just 2 weeks.

So please, don’t.

Don’t fly.   Data are now emerging that doing so clearly increases the chance of getting COVID-19 and of spreading it.

Don’t drive to any gatherings for Thanksgiving.  Being indoors with many others is the best recipe to get very ill this Thanksgiving, and if not, to spread to others who will.

Stay home this Thanksgiving, so that next Thanksgiving you can be thankful you did.

BOTTOM LINES

1. Exponential curves rise so rapidly when they get going, and the decision to let the COVID-19 virus run free has allowed sharp, rising exponential curves to appear across the nation.
2. Hospitals are filling across the nation.
3. Medical staff are becoming in short supply across the nation.
4. Family and friend gatherings are the main fuel of the current spike.
5. So it’s easy to know what to do- Do not participate in family and friend gatherings.
6. Now it is important to not travel, and in particular, to not get together for Thanksgiving, unless your group has been isolated for two weeks.

My Takeaway- In One Sentence

We are very sorry to report the Pandemic is worse, getting much worse, and so this is the time to be extra careful- don’t travel, don’t visit, don’t do Thanksgiving in person.

To your health,
Dr. Arthur Lavin