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

COVID-19 Update November 9, 2020: Finally, Major Good News – a Vaccine Promises, a New Task Force Will Deliver Relief – but We Must Remain Vigilant for Now

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-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.

 

Treatment- A Vaccine May Work Safely, and Very, Very Well

Major news in the fight against COVID-19 was announced this morning.

ttps://nyti.ms/35eBHY9

An immunization against COVID-19 is proving to be 90% effective and safe.

These findings announced today by Pfizer could offer extremely good news to the world and each of us.

Many details remain to be learned.  For example, what is the impact of the immunization on not only preventing any COVID-19 illness, but severe illness in vulnerable populations.  The findings are not yet final, and not yet published in peer-reviewed journals.  Publication subjects findings to blistering scrutiny and criticism and publication of claims only happens if the authors can answer such scrutiny and their claims withstand such criticism.

Even so, this announcement does set forth a very real possibility that an immunization against this deadly pandemic will work, and work safely, and to a level that the pandemic could be brought to an end.

What offers this hope?   The number 90% and the claim of safety.

For this virus, any immunization that achieved a 90% chance that the virus could successfully infect an exposed person, could achieve a very dramatic, even a decisive halt to the spread of COVID-19.

We know this from long, long experience with many, many immunizations.  Just ask yourself, when was the last time you knew anyone, or heard of anyone getting smallpox?

Smallpox was a killer that dwarfed COVID-19.   It spread far more aggressively than COVID-19.  When the smallpox virus arrived in North America, it spread across the continent infecting nearly everyone within a very short time.  Before immunization for it was invented, it killed about 5 million (!) people a year.  The smallpox vaccine had a 95% efficacy rate.  That efficacy rate against a far more contagious and deadly germ, ended the threat from smallpox completely.  So completely, the germ no longer exists amongst humanity, only in two nations’ labs.

Measles is one of the most contagious germs known to humanity.   Every person with measles infects and average of 12 others.  For COVID-19 that number is about 2.   One dose of the measles immunization has a well-established efficacy of 93% and two doses about 97%.  When administered to enough people, the measles vaccine works to eradicate measles from humanity, completely.

So what would happen if a COVID-19 vaccine were to be, in fact, 90% effective and safe?  Based on prior immunization experience, and not just with smallpox and measles, but with many, many dread diseases including polio, meningitis, hepatitis, cancer from HPV, we could stop the pandemic.

We are not there yet!  The COVID-19 immunization announced with 90% effectiveness is not yet available.   This vaccine has not yet proven its claim to the broad scientific community.

But this announcement opens the door to a very realistic hope, that the danger that has loomed over all of us nearly all of 2020 may yet be ended.

A word on trust.  Immunizations have been under direct assault by highly organized groups, and suffered suspicion across millions of people.   And so any new immunization will face organized campaigns of distrust, and a bed of suspicion on its arrival no matter what.   But the well has been poisoned by politics too.  What should be calm deliberation of facts has been touched by the roiling politics of America, and any COVID-19 vaccine will be touched by this tumult as well.

None of this colors my own review of any proposed immunization for COVID-19.  As with any proposed treatment, I will remain steadfast in asking two simple questions before passing judgement:

  1. Does the treatment work?
  2. Is the treatment safe?

These questions can be answered with hard data.   We will soon see published hard, deep, extensive data on this Pfizer vaccine for COVID-19, as well as data on the other 10 COVID-19 immunizations also closing in on final study results.

I am fully committed to reviewing these data very, very carefully, and listening to people who have studied these data all their professional careers with nothing but the highest level of integrity and trust.

I will not be offering my support for use of any COVID-19 vaccine without having first seen the numbers and knowing, just how well it works, just how safe it is.   Safety is a question that is being addressed now too.  By the middle of this month, Pfizer will have 2 months of observation of thousands immunized with this COVID vaccine.  Most vaccine side effects become evident within 6 weeks of the immunization, so the 2 month observation mark is eminently reasonable.  If safety is proven in the next weeks, this vaccine could be released for public use, to a very limited, most high risk group even this year.

At the same time, should humanity succeed in inventing an immunization for COVID-19 that can reliably be known to work and work safely, it will be urgently important for all of us to seek that immunization, in an orderly manner.  Immunizing those at greatest risk from the disease first, then those most likely to be exposed, then all adults, then lastly, all children.

If an immunization is indeed effective and safe, it would put the lives of so many we love and care for in danger to decide to sit out getting protected, to sit out ending the pandemic.

The COVID-19 Vaccine at Advanced Pediatrics

Lastly, I will mention that we were notified that any health facility in Ohio must be certified as an authorized COVID-19 immunization facility to offer the immunization.  Advanced Pediatrics has applied for such authorization, and we are pleased to share the news that the Ohio Department of Health has accepted us as an authorized site.

Much remains to be seen before we are anywhere near offering a COVID-19 immunization.  First, this and other candidates must complete their studies and proof working well and working safely.  That is no small step.  And just as importantly, we need to learn how any approved COVID-19 immunization will be made available to America.

We fully expect that children will be the last to be offered the immunization.  This makes urgent good sense.   We have seen ourselves many, many children and youth infected with COVID-19, not one has developed anything more than very mild illness, most have had no symptoms.  This pattern is seen across our community and world.

And so, even once a COVID-19 immunization is approved and given to those in greatest need, we will not expect to making this treatment available to children for many, many months after it is released.

Lastly an Urgent Plea

Today is a great day for hope, it is not a day for plans!

We issue this news because it really is very, very big news.  There is a reason to truly hope that an immunization program will end the threat from this pandemic.

But not today!

Even if all goes perfectly well, and a safe COVID-19 immunization is developed that works and can end the pandemic, that is not going to happen for months.  In the meantime, the fact remains, a deadly virus is roaring across our nation, our state, our neighborhoods, right now.  People are getting very sick, and people are dying.

Now is not the time to relax our guard.  It would be particularly tragic to be harmed by this deadly disease in the threshold of its end.  We applaud the steps being taken by our President-Elect to halt the spread of this disease, starting today.  We urge everyone, everyone we know, to continue to avoid other people, to wear masks when with other people, to keep at least 6 feet apart, to guard our eyes, to wash our hands.  Otherwise, today, in Ohio, in our neighborhoods, it will be very easy to catch this virus, to get very sick, to spread it to others who might not survive the exposure.  Cuyahoga County just reached the very dangerous 10% positive rate level.

So yes, this is a very big day, an end is coming into sight, but as in a war, it makes no sense to declare victory and stand up on the battlefield, until after the bullets have stopped flying.  An end to this dread danger is emerging, but the bullets today are still flying furiously.

Let us be hopeful, but also safe as we move towards the endgame.

A Word on the Nation’s New Coronavirus Task Force

When it comes to COVID-19, it is time to put the politics aside and the election behind us.

Today, the United States will welcome a new Coronavirus Task Force, and we wanted to share the news that the group is extraordinarily sharp, seasoned, experienced, and in a position to end much of our suffering.

Let me share what I know about 4 of the members of this Task Force.

Let’s start with 2 of the 3 chairs with whom I am familiar.

Dr. Vivek Murthy-  Vivek and I have known each other for over 11 years.  He is respected across the medical profession to the highest degree.   An internist, he served as the nation’s Surgeon General, and in that role, I met with him to suggest paths for the nation to take to reduce exposure of children to know neurotoxins.  A portrait of Vivek and I at that meeting hangs in our office.  I know Dr. Murthy, I trust Dr. Murthy, I know he will lead a highly trustworthy, extremely effective approach to sharply reducing the suffering from this pandemic.

Dr. David Kessler-  Dr. Kessler was one of the most effective, active, energetic FDA Commissioner’s in its long history.   Dr. Kessler led the fight against the 500,000 deaths a year from tobacco, and led the way in protecting women against harm from faulty breast implants.  He has an established record as one of the nation’s sharpest thinkers in public policy writ large.  He is the right pick to lead the massive effort it will take to bring our cases of COVID down from over 100,000 a day and keep another 100,000 of us from dying from it.  And he is a fellow pediatrician!

And I will also mention two members of our new Task Force.

Dr. Atul Gawande-  Dr. Gawande, a native Ohioan from Youngstown, is widely respected as one of the most incisive thinkers in medicine, in the world.  I read his books and essay avidly, and always learn something important.  I can think of no better thinker of how the world of medicine can save lives than Dr. Gawande.

Dr. Michael Osterholm- With the possible exception of Dr. Tony Fauci, I know of no other leading authority on how germs infect us, how we can stop them from killing us, than Dr. Michael Osterholm.  He has led the fight against other pandemics.  His insights on this one, have always been correct.   Dr. Osterholm is highly valued across the globe as a person who knows how to beat a deadly threat from a germ.  And, we at Advanced Pediatrics will always be grateful he shared his profound expertise with us in an interview for you, our families in the practice.  I emailed Michael this morning to congratulate him on being named to this most urgently important Task Force and he replied already with warm thanks and hopes we all remain well.

Lastly, the real excitement from this Task Force is that America will join other nations that have succeeded in truly interrupting the flow of this virus.  We know it can be done, other nations have done so, now we will!

BOTTOM LINES

  1. There is good reason to hope an immunization will help dramatically protect us all safely from this deadly pandemic.
  2. One candidate, an mRNA COVID vaccine, has announced 90% efficacy, and it appears that it may very well work at that level.  If it does, it really could lift the dread of this terrible threat to our lives.  It is big news.
  3. And yet, for today, we do not have a COVID vaccine in hand.  Reality forces us to know, this virus is roaring across our neighborhoods.  Cuyahoga County is at 10% positivity.  The danger is here, the danger remains real.
  4. WE MUST REMAIN CAREFUL
  5. The other major good news is that the United States of America will have a new Coronavirus Task Force going to work NOW.  This panel is for real.  I can personally vouch for the amazing depth of expertise gathered.  I have NO DOUBT that plans put together, when implemented, will sharply reduce the threat this pandemic has posed to all of us.

My Takeaway – In One Sentence:

COVID-19 threatens us all today severely- we must remain distant and masked- and real hope is showing up with the promise of a vaccine that really works and a Task Force that will open a path to a safer future coming whenever we adopt its recommendations.

To your health,
Dr. Arthur Lavin

 

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