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COVID-19 Update October 2, 2020: The President Has COVID-19; The Pandemic Clearly Rages Across America

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

The President of the United States has been infected and now has COVID-19.  And with him the First Lady, and Hope Hicks have been announced as being infected as well.

Our first thought is the same we have for any person who has come down with this very dangerous disease.  We hope that all have a speedy and complete recovery with no discomfort.

Tragically, the nation is forced to consider other concerns when its top leader comes down with a dangerous disease.  For us, the chief implication is that this event makes as clear as possible just how adept viruses are at leaping from person to person, or in a word, spreading.

Despite the President’s disdain for basic practices that can reduce your risk of getting infected, such as wearing masks, he is one of the most protected people on the planet.  He is tested every day.  Anyone who comes into contact with him is tested first.  He is kept distant from people to a high degree.   The nation’s entire security apparatus, Secret Service, Army, Navy, Air Force, Marine Corps is organized to protect him from any threat, including SARS-CoV-2, and yet SARS-CoV-2 found a way in, and infected the President and his wife.

This tells us all, from President to child, that the COVID-19 Pandemic in America remains in full force.  We have been attempting to deliver the solid evidence of this reality in these essays in Real Answers for many months and as recently as a few days ago.  This event makes this reality all the more clear.

This event also tells us all that while this virus continues to be allowed to rampage across the United States, it will find its way into any one of us at any time.   It spreads, it spreads well, it spreads even into those most protected.

These facts about COVID-19 inform our continued advice about participating in in-person school and sports.

We are at a critical moment to be reminded of the key facts of its spreadability:

  • The top public health data advises that we can rest easy once the number of Americans who test positive drops to below 1 in 100,000 people tested.  That would be a test positivity rate of 0.001%
  • The same data advises that if enough people are spreading this disease such that about 1 in 10 folks tested are positive, a test positivity rate of 10%, then gatherings are very, very likely to spark outbreaks.
  • The latest test positivity rate at UH this week was 1.4%
  • Therefore, our region is well under a level of spread that assures outbreaks, but way above the level under which outbreaks can safely be considered very unlikely.   In a word, we are in between.

While we remain at 1.4%, gatherings such as in school, will likely not result in outbreaks.

But even at 1.4%, which is about 1400 times the level under which we can be very confident gatherings will not lead to outbreaks, outbreaks can clearly still happen.   The shock of our President catching this disease despite all the barriers demonstrates that until we hit the 0.001% rate of spread, danger remains.

Further, all health experts agree, the risk of a new surge will likely peak during cold weather months, of which October is the first.

And finally, across the US, we are seeing surges, there are early indicators of a third surge in America.  The first was when the pandemic first exploded on the American scene, a month or so after we were warned it was coming.  The second was a month or so after we all experienced a pause in the tragedy following a national lockdown in March and April.  We had a lull in May and June, which led to almost celebratory re-openings, in the face of facts showing the pandemic was still around ready to pounce again, and it did.  The second surge caused the deaths of our second 100,000 deaths, with terrible suffering in FL, AZ, TX, and CA.

Now the US is seeing surges in the heartland with WI, MN, AK, IO experiencing tragic outbreaks, in many areas in rural areas that had long believed this was only a disease of the city.

As of today, Ohio remains a fortunately calm area for the infection, but that is only as of now.

Severity

The severity of the infection remains unchanged.

Younger people remain far less likely to become severely ill, but not fully protected by age.  There are a number of people in their 20’s who have died from this disease, as have several hundred children.

At age 75 the chance of dying from COVID-19 rises to 11.6% in recent studies.

It is upsetting to report that the President faces the risk of potentially quite dangerous illness, just as anyone with this infection does.  At his age of 74 with obesity the risk of a tragic course is not trivial.  We again repeat our deepest wishes that he and his wife, and everyone here and around the world infected with COVID-19 experience speedy and full recovery.

Schools

What does this mean for schools?

My answer remains the same as it has been all along, and is the same for any indoor gathering while the pandemic rages across the nation.  It is risky.

The fact that the most protected person in our nation caught this illness brings home the point that I can, you can, our children can.

I continue to support the measures schools take when they decide to ask children to gather in rooms indoors together:  spacing, plexiglass shields, masks, limited exposure across groups, outdoor time.

But the fact remains that the COVID-19 pandemic remains in full force in our nation.  There is no reason that at this moment in time that anyone can be truly confident that children gathered indoors in classrooms will not catch this virus.

Just this week, I have seen children from public and private schools for viral illnesses.   None so far have tested positive for COVID-19, but the fact that we are seeing active viral transmission in schools that are taking every precaution to stop the spread of viruses is proof that these steps simply cannot actually stop all viral transmission.

Our only real protection for our children attending school in person right now is that Ohio, and our immediate neighborhoods, will somehow continue to remain at low levels of COVID-19 numbers.  From a doctor’s point of view, I do not see why anyone could rely on this happening.  We can surely hope, but with states around us seeing upticks, with NY and NYC seeing upticks, it would seem foolhardy to believe that Ohio cannot experience a surge.

Treatment

At this moment in time, we do not have a working vaccine in hand.  And there are no definitive cures once you are infected.  Treatment remains limited to care that can help soften the severity, and these treatments have had a tremendous impact.

BOTTOM LINES

  1. COVID-19 continues to spread across the United States causing illness and much death in its path.
  2. Despite the most extreme measures to prevent the spread of this virus to him, the President of the United States has been infected and now has COVID-19 with the First Lady.
  3. Our own local community is experiencing a lull in the pandemic, but this is a local event that is very likely to be a blip in time, as long as the pandemic rages around the nation as it currently is.
  4. The shock of our most powerful leader being hit by this virus makes clear that I can, you can, our children, are at risk of catching this virus at any time, and remain at risk until the nation takes on the now well-known steps that could stop its spread.  Those steps are summarized as Identifying the Infected & Isolating the Infected.
  5. Until the nation takes these steps, steps successfully achieved in many nations (endcoronavirus.org), everyone in this nation needs to AVOID INDOOR CONTACT, WEAR A MASK, KEEP THEIR DISTANCE, WASH THEIR HANDS.  Note that in this listing the US is listed as the nation with the most COVID-19 risk out of 132 nations in this MIT-led international expert created databank.
  6. For schools, I remain concerned.  We may get away without outbreaks just now, as long as local region remains at 1.4% case positivity or lower.  But even at this low rate, outbreaks in schools can  And there is no assurance that our rates will remain low, they have not in most states lately.  From my perspective, it remains the safest course to learn virtually.  But again, as long as the low rate of cases in our neighborhoods remains low, a hybrid attempt at in-person learning seems a risk that may be reasonable.

Our message today is that our hearts hurt at the pain this virus has inflicted, particularly in communities of color and those afflicted by poverty, but now rising to the highest levels of power.  We are not safe.  We could be, if we Identify and Isolate all Infected and seriously take steps to stop the spread of this virus.  Until we do, please stay safe, avoid contacts indoors, wear masks, keep distance.  I sincerely hope we all make it through this very dangerous time safe and well.

To your health,
Dr. Arthur Lavin

 

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