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.

The Meaning of A Quarter of A Million Now Lost

The most urgent observation is grief.  A quarter of a million people is simply a sickening, vast loss.

There is no other word but catastrophe, no matter how it came to pass.

We grieve the loss, and are deeply worried about that many or more likely to die from this Pandemic before a vaccine ends our suffering.

This post has marked the days when 100,000 Americans lost lives to this disease, then 200,000, and now one quarter of a million Americans.  It took 4 months to have 100,000 lives lost, then another 4 months to reach 200,000.

The pace of the disease had been fairly steady, marked by the now familiar concept of hot spots- first the Pacific NW and New York; then the South and Southwest.

But the pace of this catastrophe has quickened, as every single public health expert predicted it would when summer turned to fall.   Now in our nation, the pandemic is literally raging across the land with every state registering sharp increases, and many many states seeing truly exponential growth.

The United States logged one million cases in just 6 days, this last week!

In Ohio, we have seen our daily case numbers literally explode in recent days.  Hovering at the 1000 cases a day level most of the summer, we hit 2000 cases a day in early October, 3000 on October 29, 4000 on November 3, 5000 on November 6, 6000 on November 10, 7000 on November 12, and now 8000 on November 13.  The last two days have seen a retreat to closer to 7000, but national trends almost certainly point to our rise continuing.

As cases climb, all else necessarily follows.  Hospitals in ever increasing numbers of states are filling or filled to capacity.  Case positivity rates are climbing, with some regions seeing that number actually hit 40% (i.e., 40% of people tested have COVID).

At the latest report from our own Cuyahoga County, our testing positivity rate is now 15%, the highest I recall.

Keep in mind that as the Pandemic achieves over 10% case positivity rate, the threat of catching this potentially deadly infection rises to dangerous levels of risk.

In sum, when we hit 100 and 200 thousand deaths in America, it was grim, frightening, and opened the possibility a much more dangerous future could emerge.

This time, with this landmark of tragedy, it is time to say the dangerous future is in full flower all across America, certainly in Ohio, and most definitely here at home.

And the catastrophe continues to harm people according to color, with communities of color still being hospitalized at roughly 4 times the rate of white America.   This has nothing to do with color per se, or genetics, but rather the fact that people unable to work from home have concentrated in communities of color- food service and delivery for example.

Europe and Asia

Surprisingly, Europe, which had achieved remarkable success in crushing the spread of COVID-19, has largely entered our realm of failure to contain its spread.  Coronavirus is right now raging across most nations in Europe with just a few exceptions.  Iceland stands out above all others by continuing to halt the spread.  Denmark, like nearly every nation in Europe experienced an early Fall surge, but is containing it.  The UK, Spain, France, and Germany are fully in the grip of a massive spike.

Across the European Union, which is over 400 million people compared to our 330 million, they too have lost 250,000 lives.

In both America and Europe, and in Israel too, the reason for the loss of control, the vast loss of life, can be traced to people gathering.  Mainly in family and friends settings, weddings, reunions, holidays, and simply seeing each other.   This very normal, very deeply needed sort of contact appears to be the main engine of the Fall Spike that is so deeply dangerous right now.

And yet, across East Asia, we see a radically different story.  With the exception of Japan, whose cases look very much like ours, surging out of control now, most nations in E Asia are not seeing any significant surges.   In areas as diverse as Hong Kong, China, Taiwan, Singapore, South Korea, Thailand, and Vietnam, the case numbers remain amazingly low.  Taiwan, a democratic nation of 24 million people has suffered only 7 deaths to date!

Thanksgiving

If there is anything that the loss of a quarter of a million of us to this deadly Pandemic might offer it is this:  we are in danger, and we all need to take actions to save our lives now.

As Ohio ramps up a thousand cases per day every day or so, we will be, maybe already are, entering a time of rampant spread.

We each must take strong actions to avoid losing someone we care for and love, now.

The first is to avoid contact with other people, trimming exposures down to the greatest possible we can bear.   That means working and schooling from home.   But if that cannot be done, be sure to wear a mask and stay 6 feet from everyone anytime outside the home.

These steps are right now urgent when it comes to Thanksgiving, now only 11 days away.  We are in the Thanksgiving season now.   Look at how the virus rages now, one can only imagine what will happen if we all gather as extended families for Thanksgiving next week.

These facts have not really been accepted by all Americans.  Current trends suggest about 40% of Americans think that getting together with families for Thanksgiving will be fine if we wash our hands and wear masks.   The intensity of exposure from air travel, or sitting with others indoors for many hours, cannot be halted by masks and distance.   Large groups gathering always have and always will spread COVID-19, until a vaccine halts that risk.

Hospitals across America are filling up, current trends may fill them by Thanksgiving, a big surge that will certainly widespread friend and family gathering will lead to unimaginable tragedies as sick loved ones seek care in hospitals unable to offer to any more people infected.

And so we beseech everyone to stay home this Thanksgiving.   It is safe to gather with those in podded households, who when the gather bring no new risk of infection, but otherwise, stay home with just your household.

Now is the time to act so that next Thanksgiving we are thankful, not regretful.

TREATMENT

I am very confident, but not yet certain, that there will be COVID-19 vaccines that will end the pandemic and safely.

This morning, Pfizer reports they have concluded the final step before the FDA can reliably determine if their vaccine is effective AND safe enough to be released for use across the public.  That last step is called a Phase 3 trial, and usually tests the new product across 30,000 test people, Pfizer’s Phase 3 completed testing across 41,000 people.   They claim they have established the vaccine works and is safe.  Here are the key points:

• 95% of those immunized were fully protected from being infected with COVID-19.
• The immunization worked well in elderly subjects, so age did not invalidate the immunizations ability to protect.
• There were NO serious side effects observed across the study of 41,000 people.
• In the study, people observed to get seriously ill with COVID-19 were in the placebo, not immunization group, suggesting that even those 1 in 20 immunized people who did get COVID-19 did not get very ill.

These results are literally all that one could have dreamed of.  They suggest that we will have access to a vaccine that can end the Pandemic and end it Safely.

I have not seen these claims published.  The essential step of having the company’s data reviewed and published and then read by doctors such as myself remains to be taken.  But if the published data are convincing that these claims are reliable and true, the end is within reach.

This is combined with the recent news that the other mRNA COVID vaccine, from Moderna, also achieves 95% success, really does make it realistic to plan on COVID vaccines ending the Pandemic.

BUT.

Inventing the solution is necessary, but FAR FROM SUFFICIENT to end the Pandemic.   The vaccine does not good if you cannot get it, of course.

It appears that Pfizer is asking the FDA for emergency approval now, and that the FDA may find the data reliable enough to provide approval in the next days, not weeks.

Once the FDA approves, Pfizer has about 20 million doses available to start administering.  It is a two dose vaccine, with 21 (Moderna’s interval is 28) days between dose 1 and dose 2.  So those 20 million doses can protect 10 million people, which is to say not us.

The question for each of our lives from this day forward now becomes, how long will it take the United States of America to ramp up the manufacture, distribution, and administration of the COVID-19 vaccine?   No one knows the answer to this question, because never in human history has any nation tried to create 660 million doses of a new vaccine, essentially immediately, never.  So we simply do not know how long it will take.

My hope is that the first millions of doses manufactured will go to people at most risk of dying of this infection, which are clearly first the elderly and then those with the most serious risk factors, such as hypertension.  By anyone’s measure, children will be the last to be immunized as they are so very remarkably spared the risk of severe infection.

The promise of this nightmare ending by vaccine appears to be real, but for most people that safety will not be in hand til later in the Spring of 2021, or later.

So outstanding news, vaccines will likely end the nightmare, but now each of us stands facing the very real risk of not surviving to the day the vaccine will be available.

Our task right now is to join together, as a nation, to do all we can together to help as many people as possible survive to the day we are vaccinated.  How awful and outrageous it would be to be one of the many thousands who will die while the end of the danger is being manufactured.

IMMUNITY

A recent study points toward COVID-19 truly being one of those infections that leaves the infected protected from getting it twice, not for months, but years, perhaps a very large number of years.

There is a clear observation that of the 11 million people in the US who have proven COVID-19 infection, almost none have had it twice.  Antibody study after antibody study show that protective levels of antibody and even immune memory persist across the many months of observation in the study.   And, the fact that the first two vaccines tested have shown actual ability to protect those immunized from getting COVID-19, all are strong indications that this disease is more like chickenpox than strep throat.

That is, all indicators, as of today, strongly point to those with COVID-19 being protected from getting it twice, like those who have had chickenpox only getting that infection once.  And not being like strep which you can get over and over again.

FLU SHOTS – Get yours NOW

One step everyone should be taking now, is to make sure all your children have received a flu shot and soon.

The influenza virus, which is what the flu shot protects against, has not yet arrived, but it will in about 3-4 weeks.

That means you are still in plenty of time right now to have your child(ren) get a flu shot.  

We have flu shots available now at Advanced Pediatrics, available to children in the practice.

It remains one of the only steps available, as we try to get through this winter, to add a level of protection as COVID-19 continues to spread.

BOTTOM LINES

1. The COVID-19 Pandemic keeps getting worse, much worse.  Levels of spread right here in Ohio and in our home counties is in a word, frightening and dangerous.
2. Masks and the 6 foot distance help.
3. Outdoors is better than indoors.
4. Nothing works better than avoiding other people.  Now is the time to stay in your home, and not have people over unless you know they do not increase your risk of infection.
5. If Thanksgiving goes as expected and 100 million or more gather against this advice, we could face a very ominous time in December.
6. A vaccine very likely will end this Pandemic, but not this Fall.  We have no choice to survive this threat than to be careful, to avoid other people, to wear masks, to keep at least 6 feet apart, to forget about travel and gathering for holidays.  To look carefully at school and work and minimize gathering there as much as possible.
7. Evidence is growing that the illness COVID-19 is a one time illness.  Infection appears to endow one with lasting immunity to make this so.
8. Making sure everyone has had their flu shot remains a very good idea and this is a very good time to get this done.   Another few weeks remain before the new influenza virus epidemics begin to spread in mid-December.
9. This is a dangerous time.  The lives of the quarter million lost here in America speak to us, we need to listen.  Until you have the vaccine, you are not safe from this disease.   Take the steps to be safe, especially now and especially this Thanksgiving.

My Takeaway – In One Sentence

Our job today is to take action, to protect ourselves and those we love from a rampaging, spreading, dangerous spike in COVID-19- especially urgent as the promise of an end in the coming months might lull us into a deadly now.

To your health,
Dr. Arthur Lavin