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.

Biology

A brief note on a new finding from laboratories in Finland and Germany.  Readers of Real Answers will be very familiar with the fact that a virus is a package of information, built to copy itself.  That package is a bit of genetic material wrapped in a protein coat.  The protein of the coat is the key that picks the lock that the cell maintains to keep dangers like viruses out.  Every virus has a select protein coat that has found some sort of protein on some sort of cell to attach to, and that allows it to inject its genetic insides into the inside of the target cell.  Once in the cell, the viral genes go to work making zillions of copies of new viruses to repeat the cycle over and over.

We have known for some time that the protein coat of the SARS-CoV-2 virus found its mark on a protein called the ACE2 receptor, which makes sense, since that receptor is all over lung and blood vessel tissue, two spots COVID-19 attacks.

Now neuropilin has been discovered to be a protein on cells that the virus can connect to and invade through.  This has been demonstrated so far in primates, but it is fully expected to be true in us too.

Neuropilin is an interesting discovery because it is all over the cells that line the nose, and is also found in cells in the brain.  A protein that would allow a virus to stick to the lining of our nose would be a powerful gate for any respiratory virus.  Hang in the air, float into any nose, and voila, you are infecting.  We do not know if the fact that neurolipin is on brain cells might explain the neurological symptoms of COVID-19, but it might.

This discovery re-emphasizes how important protecting our noses from this virus is.

Spreadability

This image, from MSNBC News, was aired on television on the evening of October 22, 2020.  This is a picture worth not only a thousand words, but hundreds of thousands of lives, our lives.

It is important for us all to take a look at this map and consider what reality it reveals.

The explanation of this map includes the following:

• It is a snapshot of one moment in time, namely, October 22, 2020 in America.
• Each color tells us how the COVID-19 disease is raging, in each state, on that day.
• The only good color is green.  That color indicates that a state is “Trending Better”  That means people living in that state are getting less likely to be infected and sicken from COVID-19.  Notice that almost no states are green, just Maine and Vermont.
• The best color to be in trouble with is yellow.  That color indicates that means people living in that state should be aware that “Caution [is] Warranted” which says all those people are at increased risk of getting sick with COVID-19.  Only a few states are yellow, New York, Oregon, and New Hampshire.  All the other states in America are in trouble, serious trouble.
• The first color of trouble, very serious trouble is red.  Red means indicates the state is “Trending Poorly.”  Would you like to live in a state where COVID-19 disease is rising so rapidly that people’s health in that state is trending poorly?  Not me!  Something like 5 states are red.
• And now the most horrible news.  Almost the entire nation, just now, is purple. What does purple mean?  It means this very deadly disease is out of control, in most of America, we are experiencing “Uncontrolled Spread.”

This is a recipe for catastrophe.  And the numbers support real worry.  This week the US topped over 70,000 cases diagnosed a day, the highest ever.  But this was the range at the peak of our pandemic, in the middle of summer.  This is the range we are at at the start of our fall-winter pandemic.  We are at our worst, as we just begin our cold weather surge, meaning this surge will be worse than any set of months we have yet experienced.

The last two surges, which easily will be far milder than this one erupting all around us right now, left over 200,000 of us dead (actually far more, see just below).  It is hard to calculate how many of us will lose our lives, or the lives of those we love and like as this surge, the one we see right now, climbs to its peak.

This is a national catastrophe, the map says it all.  One glance and anyone can tell, the colors that indicate not just some spread, but dangerous spread, are the colors of the United States of America right now.  We are, today, and likely for many months, now a red and purple nation, with very limited areas where COVID-19 is not rising dangerously.

And this national pattern is erupting right here at home.  Ohio has passed the elbow of 1,000, the elbow of the exponential curve.

Readers of Real Answers will recall that exponential curves have two parts, a boring, and an explosive part.  The boring part is when a number, of anything (e.g., dollars, marbles, snowflakes) starts to double.  Such numbers always start with one.  One dollar, one marble, one case of COVID-19.  Then they double to 2, then 4, then 8.  Those numbers are tiny, and stay small for awhile.   If you double the number 1 10 times you get to close to 1,000, by small steps, boring.   But once you get to 1,000 the boring part of going exponential ends, and watch out.  Double the number of snowflakes or cases of COVID-19 10 times and you get a million of each!

So Ohio had hovered at 1000 cases a day for almost two months, and we worried, would it launch up the exponential curve?  To 2,000, then 4,000, then 8,000 cases a day?   Not a theoretical worry, many other states have done exactly that, states like NY, CA, FL, TX, AZ, even MI our neighbor started down this path just a few months ago.  But fortunately, Ohio stayed steady at 1,000.  Until now.  We now have the 5-6th largest numbers of daily cases across the whole country, not per-capita, but total numbers of cases.  We have been sustained at over 2,000 cases a day for several days.

And here at home in Cuyahoga County, we entered the dangerous red zone not long ago, and we are being warned that the out of control designation of purple is drawing near.

COVID-19 is rising rapidly across the nation, across Ohio, and right here in Cuyahoga County.

First Readings from Elementary Schools

Perhaps the only good news comes from the first nearly 2 months of young children going back to school.   There have been no large outbreaks of COVID-19 in grades Kindergarten through 5th grade. Readers of Real Answers will recall how concerned we were at the notion of any gathering before the US achieved control of the spread of the SARS-CoV-2 virus.

Those fears have come tragically true across the nation as noted above, but not in elementary schools.  We have gathered children ages 5-10 into school buildings, taking safeguard of small classrooms, some reduced time together, masks, podding into groups, and so far, it has worked.

Which is to say, gathering children ages 5-10 into schools, during a lull in cases, for 6-8 weeks, has not led to outbreaks.

It still remains to be seen, what will be the fate of our young children, and their teachers, and their families, as elementary schools continue to meet in the face of the surging outbreaks surrounding nearly all of the communities that our schools exist in?

Severity

We have long tracked the number of Americans killed by COVID-19, and noted when that number of tragic loss climbed overy 100,000, then 200,000, and now more.

But a recent set of articles in this week’s Journal of the American Medical Association (JAMA), one of the world’s most highly regarded journals of medicine, has delivered a more real set of numbers, the number of us who have actually died of COVID-19.

The problem is that not everyone who dies from COVID-19 is known to die of this disease.  Many, many people die of COVID-19 before they can be tested, or even come to a doctor or hospital.  So how to count the tragedy?

It turns out that every birth and death is recorded in the US and has been for many, many years.  Those two numbers turn out to be very steady.  It’s about 4 million births a year and about 2.8 million deaths a year.  Those numbers climb as our population grows, but gradually.

Not this year.  Instead of the expected 2.8 million deaths this year, the US is pointing to a far bigger number, dramatically bigger.  What in 2020 could have caused a huge number of unexpected deaths to suddenly appear?

This is what the research published this week in JAMA explains.

Here is the link to the summary of these articles, by the Editor-in-Chief of JAMA. https://jamanetwork.com/journals/jama/fullarticle/2771758

The study of the numbers reveals that about two-thirds of the unexplained surge in deaths is explained entirely by being infected with the SARS-CoV-2 virus.  That means for just the period March 1 through the end of July of this year, about 150,000 Americans died of COVID-19, but have not yet been counted.  If we count those killed by COVID-19 we did not know to those we do know, the total is right now at least 370,000.  But this does not count those who have died in the US from COVID-19 that are not counted from August, September and this part of November.

This pandemic has claimed, as of today, not 200,000 lives, but over 370,000, according to careful review of the total numbers dead in America reported in JAMA.

Treatment

In a recent post in Real Answers, we noted that as of today, there are no cures for COVID-19.

The good news is that Remdesivir, which is a medicine to stop the SARS-CoV-2 virus from reproducing, has achieved official approval from the FDA as a treatment for COVID-19, the first medication to treat COVID-19 to have official approval.  But, Remdesivir, is still not a cure.  It is a relatively weak drug, so it offers help in the most extreme situations, those so ill they need a hospital, oxygen, even a ventilator.  Remdesivir offers a slight reduction in days in the hospital and in the number who the disease leads to loss of life, which is very, very valuable.  But will not be used for the majority of people who have mild COVID-19, and even in severe cases is not curative, just helpful.

COVID-19 at Advanced Pediatrics

Given the severity of the current surge, and the availability of testing, all staff including the doctors at Advanced Pediatrics are testing ourselves for COVID-19 once a week.

This week, we are disappointed to report one of our staff turned positive.   The staff person had no close contact with any families and so no direct contacts resulted from this development, but of course the positive result was reported, as we report all positive results to the County Board of Health and she is being quarantined until no longer contagious.

BOTTOM LINES

1. Every virus enters a cell via a particular protein “key” on the surface of that cell.  Researchers have found a second protein on our cells that may allow COVID-19 to begin its infecting.  Neurolipin is that new discovery and it lines our noses.  So, once again, protect your noses, wear a mask!
2. COVID-19 is ominously raging across the entire United States.  Only a handful of states are not experiencing the long anticipated Fall and Winter Surge.  Yesterday the US roared past 80,000 new cases a day, and Ohio past 2,500, neither have happened before.
3. This surge is looking far worse that the first two (Spring and Summer).  That is ominous because the first two led to over 200,000 deaths (or more).   The time is now to protect you and those you love from getting COVID-19, to the best of your ability.
4. But, with the nation failing to contain the spread of COVID-19, we should keep in mind two crucial facts:
   1. As stated, everyone needs to protect themselves and those they care for, and now.
   2. At the same time, we do this with the tragic humility that with the virus let loose, our powers to stop it crossing our paths really are limited.  The steps we can take are important, and will reduce our risk substantially, but no steps can eliminate that risk
5. Which is to say, people of good will, working hard to avoid infection may still become infected.
6. Preliminary data are reassuring that children in Kindergarten through Grade 5 are not apparently spreading COVID-19.  No major outbreaks in the US have yet been traced to children in these grades.  This must be stressed as preliminary, and will have little relevance should the nation’s current storm of COVID-19 overwhelm communities and force schools to go fully virtual once more.
7. The number of Americans who this virus has killed is widely reported now to be roughly 225,000.  But careful study of the numbers reveals that a rather large number of Americans have died, far more than expected or explained, since the pandemic hit.  We now know that from March through July, an additional 150,000 Americans died of COVID-19 and died before they could be diagnosed with it.  That means our current total of fellow Americans lost to this pandemic is over 375,000 people.
8. Remdesivir is now the first officially approved medication to treat COVID-19.  It is NOT a cure. It is weakly effective, but that can make a life-saving difference in severe disease.
9. Advanced Pediatrics is testing all staff every week.  One positive result came back this week, no known exposures resulted.  We will of course keep the practice informed of any further positive results.

My takeaway – in one sentence:

Now is the time to take all the precautions you can, COVID-19 in America is roaring, we are nowhere near the peak of this surge, so wear a mask, avoid crowds, avoid people indoors, pick up our resolve to stay as safe as we can in this dangerous phase of COVID in America.

To your health,
Dr. Arthur Lavin