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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 October 19, 2020: What Can You Do? Basic Reminders of the Power of One Person; A Fresh Look at the Promise and Limits of New Therapies

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.

 

Spreadability

Sadly all the predictors of a bad fall and winter appear to be coming true.  The largest number of cases ever recorded across the US was 78,943 on July 24.  On October 15 we hit 71,688.

This is not a good time in America for this Pandemic.  Nearly every state is seeing substantial rises.

Over and over again we hear stories of people tired of the Pandemic, or worse, pretending it does not exist, coming down with it and suffering terrible illness, even dying.  Just recently a 33 year old man who was an international star, a big name on social media, whose celebrity rose on his confidence that the Pandemic was a hoax, caught COVID, and despite outstanding health, died.

And so, as our nation continues to decide not to protect its citizens from this very real danger, the question becomes What Can I do To Protect Myself, Protect My Family, right now?

The answer has been given on most of our COVID Update posts, and each step should be familiar by now, but here is a very succinct reminder, of steps that could save your lives:

  1. Avoid Crowds- I would put this at #1.   Every step you can take boils down to one real action- don’t put yourself in a position where the virus can hop on you.  Avoid contact with the virus.  Avoiding crowds is an excellent step to achieve this goal.
  2. Avoid Being with People Indoors- This virus spreads best with crowds that are indoors.  Being outdoors drops your chance of getting COVID by a factor of 20!   Outdoors is protective.  Being with people indoors is where this is caught.
  3. Avoid Being with People for Long Times- This virus spreads best with crowds that are indoors for long times.  Being with a crowd indoors for a few minutes is risky, but for a few hours is very risky.
  4. Avoid Being with People who Are Singing, Yelling, Talking Loudly- Again, the whole idea is to do what you can not to breathe air loaded with the virus.  Singing, yelling, talking loudly punches zillions of viruses into the air if you are contagious.
  5. Wear a Mask- There I said it!  In North Carolina, which treasures the concept that not wearing a mask is a form of freedom, counties that wore masks have 50% less COVID.  When someone chooses to double my risk, or the risk of my child, or the risk of my parent or grandparent of catching a deadly disease, that is not freedom, that is assault.  There is no celebration of freedom when someone stabs another person, we call that assault, and see freedom in not being stabbed.  And so it is with a mask.  Not wearing a mask puts everyone we love in danger, so wear a mask.
  6. Get Real, this Year is not Like Last Year- It is time to accept we are living through a global, historic catastrophe that will last 1, 2, or 3 years.  Not a week, not a month, not even just a year.  This is the Year (or 2-3) of the Pandemic.  When a house is on fire, what do we think of the idea of the firefighters giving up, it’s tiring work, they’ve done enough, let’s give it a break?  Everyone would reject this concept, and fortunately we never hear of firefighters giving up on a fire because it’s so tiring.   We now know that across America and Europe, people are dying because we are getting tired of the Pandemic.  To which I must ask, what plate of food, what social gathering, what event is worth ending your life, or the life of someone you love way too early?  So we say, get real, this catastrophe will be waiting to pounce anytime you let your guard down.  The virus is everywhere.   So if you say to yourself, I’m tired of all this, and go indoors with lots of people for more than a few minutes and talk and sing, all without a mask, the virus will remind you it never tires.  Please, keep up your caution, it really is very doable.  It will not be forever, but it is for now, for sure. 

 

Treatment

Now, when will the Year (or 2-3) of the Pandemic end?  How can I be so sure it will end?

That’s easy, over the last 2000 years of recorded Western history, every single pandemic has ended, without any exception.

One of the 3 most deadly pandemics of Western history lasted 2-3 years.  The virus that caused it never went away, but its deadly killing powers waned.  That was the Influenza Pandemic of 1918-1920, caused by a virus that had never infected humanity before- the H1N1 swine flu.  That very virus comes back to infect us every December-May, it’s on its way to us for sure again.  But it is no longer so deadly.

Other Pandemics ended too, including the Plague of Justinian (541-542) and the Black Death (1346-1353).  Every single one has, this one will too, for sure.

The Black Death’s germ still is around and can cause outbreaks still, but we now have something no one had in 1346, penicillin, which kills it easily.  And smallpox is totally gone because humans invented the vaccine which worked to end this scourge.

Even without any medical treatments we are sure this Pandemic will end, but we are hopeful it will end sooner with treatments that work.

So the question for right now is, do we have any treatments that work?

When it comes to medical treatments, there are four types:

  • The Disproven
  • The Unproven
  • The Proven but Partial
  • The Magic Bullet

The Magic Bullet

The paradigm of a medical magic bullet is penicillin.  The phrase was coined by the great microbe hunter, Paul Ehrlich, who dreamed of a medicine that would destroy a germ and do nothing to the person infected, a magic bullet.   When penicillin was discovered, it met that hope pretty well.  People dying of deadly pneumonias, meningitis, suddenly were cured with no harm done!

As of today, we have no magic bullets for COVID-19.  Not one.  There are lots of candidate therapies, but none have been proved to reliably end the infection, cure the person, with no or little harm.

Of course, we all love a magic bullet, who wouldn’t?  And every week we hear of another.  Some seem promising like an injection of antibodies to the SARS-CoV-2 virus.  Some seem possible, like hydroxychloroquine.  Some seem stupid, like injecting bleach.

But what they all have in common, at least so far today, almost all have been shown to not work at all (hydroxychloroquine, bleach, light, Vitamin D, water, etc.).   And even those that seem plausible (antibodies, convalescent serum), simply are not proven reliable yet.

We have no magic bullets as of today.

The Proven but Partial

Many ideas have proven partial success.  These include Remdesivir, some early vaccine candidates, convalescent serum, steroids like dexamethasone.

The problem is that every single one of these treatments that seem to have helped someone, even some quite dramatically, has not yet been proven to reliably help everyone, or to actually cure anyone.

Even if a COVID-19 vaccine is proven safe and effective, its impact may remain partial.

The familiar example of the flu shot shows us how a partial solution might still be an extremely valuable solution.

Some years the flu shot works about 50% of the time.  But there are two measures of “works.”  The usual one asks, if I walk into a room with people infected with influenza viral infection what is my chance of catching that infection if I had my flu shot already?  And what is the chance of me catching that infection compared to someone who has not gotten the flu shot?  (Keep in mind the influenza virus is not here yet and will not appear until mid-December, so you still have plenty of time, to get your flu shot).

The 50% number means if I get a flu shot, I cut my chances of getting infected in half.

But there is another measure of “works.”  It’s the chance of being hurt by the influenza virus infection, even if infected.  The flu shot, for healthy people, has a huge impact on the chance of the influenza virus really hurting you, including killing one.  So even if the number of people infected by the flu virus drops by only half by getting a flu shot, the chance of being hurt by the infection or dying drops much, much more.

In the case of the COVID-19 vaccine, there are many in the works.  We simply do not know if any will work, and if so how many, and how the ones that work will perform.   We have to wait and see, how do each really perform when given to 30-40,000 people?

  • How much will the chance of even catching COVID-19 be eliminated?
  • If immunized and infected how much will the chance of being hurt by COVID-19 drop?
  • How will the performance vary from the first vaccine made available from the second, third, fourth, and later COVID-19 vaccines?

Unless a COVID-19 vaccine comes along that essentially eliminated the chance of being infected, or if infected, harmed, we will be dealing with a partial, proven solution, not a magic bullet.

The Unproven

There are many treatments being dreamed of, and being tested now, that are as yet unproven, waiting to see if they will ultimately be magic bullets, proven but partial, or proven to be ineffective.

For all these treatments we must wait to see, which way their actual performance will tell us they go.

The Disproven

Sadly, most medical treatment ideas end up in this category.  We never hear about the great majority of the disproven, why waste time on something we know does not work.

But a huge set of treatments sit right here in this category.  These are what I call the Barnum and Bailey products, that make their hawkers lots of money but provide no help, and may cause harm.

We are always surrounded by the Disproven, because they can get to market quickly, why waste time waiting for something proven to work??

And, because if a magic bullet, or even proven but partial, treatment is not yet in hand, at least one can still buy hope, even if we know the product is worthless.  Just buying something can feel good.

We see this everyday in the seemingly endless profusion of chemicals that promise to prevent or cure colds, that every few years finally succumb to the weight of knowing they are fraudulent.

And so it is with COVID-19- Vitamin D, water, light, none of these have impact on the illness, wish they did, but they do not, the list is surely longer.

BOTTOM LINES

  1. COVID-19 continues to spread across the United States causing illness and much death in its path.  All indicators are that this fall and this winter will be the worst round yet.   It is NOT going away yet.
  2. There are NO KNOWN CURES or PROVEN RELIABLE treatments available at this time.  Many show promise, some enough they are used if one is ill enough to take the chance.   But we have not achieved proof, good reliable proof, of treatments yet.
  3. Even so, there are very IMPORTANT steps each of us can take while we wait for good treatments to be proven and available.  They are to avoid:  Crowds, Indoors with people, Talking loudly, Singing, Yelling with people, Doing any of these for more than a few minutes.  And Yes to the Mask- Freedom is the ability to live your life to its best- not wearing a mask takes life away, not really the best.
  4. It is critical to know, this is the Year (or 2-3) of the Pandemic.  It is not the month or season of the pandemic.   We all need to take a deep breath and continue to do all we can to stay well, and make sure those we love do not get infected!
  5. Treatments are hopefully coming

My One Sentence Takeaway:

We are living through a long year or more of Pandemic, stand strong for the duration to take care of yourself and each other, as we await treatments that are proven to help.

To your health,
Dr. Arthur Lavin

 

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