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COVID-19 Update October 28, 2020: COVID Comes to School, The Pandemic Rages On and Ohio Improves Contact Tracing

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

COVID Comes To Schools

This update reports solely on anecdotal observations, no official reports from public health officials.  The information is derived from actual reports from families that have come to Advanced Pediatrics this week.

What we are being told is that COVID-19 cases are in fact appearing in schools in our neighborhoods.  Most of the reports involve schools of the Eastern suburban communities.  Three systems have been mentioned, including a small outbreak in an elementary school.  A number of single COVID-19 cases have been reported by families to us over the last week or so across a wide range of schools including private schools.

At the same time, we are experiencing a clear increase in the number of children from day care through high school experiencing the typical colds we see this time of year.  The concern is that if measures taken to stop the flow of SARS-CoV-2 virus were working in our day care centers and schools, we would see a dramatic drop in the number of children and youth with simple colds, too.  We saw colds and fevers nearly vanish in April and May when COVID-19 cases came under fairly good control.  Right now we are seeing and hearing about fewer colds than in a typical October, but far more than being stopped.  This suggests that respiratory viruses are flowing freely in our community, which is not good news for slowing the spread of COVID-19.

Ohio Surges with America

The situation in America continues to get much worse, and sadly Ohio remains worrisome.

As noted in earlier posts in Real Answers, Ohio had a nice lull in June, but by June 24 had hit the 1,000 new cases of COVID-19 a day and remained at the 1,000 level, not crossing 2,000 cases a day until October 14 (2 weeks ago today).

Readers of Real Answers will recall that exponential curves are fairly flat and horizontal until they hit the number 1,000, then doubling causes the curve to go vertical.  In the case of COVID-19 cases, that means the burden of disease in Ohio remained fairly quiet across June, July August, September and into mid-October.  But hovering at 1,000 or more new cases a day always made me worried, for if the virus started really taking off, we could see the case count go up rapidly.

And it has.

In the last two weeks, we have stayed steadily above 2,000 and nearly hitting 3,000 cases a day this weekend!  Keep in mind that Arizona was submerged into the nightmares of packed hospitals, soaring deaths, and full ICU’s when their state hit 5,000 cases a day, which in Ohio would be like us hitting 8,000 cases a day.  And perhaps more, as we have more hospital beds.   But let’s just say jumping up to 10,000 would land us solidly into very upsetting territory- the much larger state of NY with all its vast medical resources was brought to its knees at 10,000 cases per day.

So, we are watching the trends closely, going from 1, to 2, to nearly 3,000 cases a day in the last two weeks opens up the dangerous possibility, not certainty, that the pandemic could hit the danger zone in Ohio, as it currently has done in Utah, Wisconsin, the Dakotas, and many other states.

Ohio Adopts “Reverse” Contact Tracing

In our recent Real Answers posts, we have discussed how the very best way to keep the fires of COVID-19 from erupting into full blown blazes, is to find the small outbreaks, while they are little fires, early, and put them out.

This is the strategy Japan has used so successfully.  It involves asking, when a person appears with COVID-19 two questions.  The usual one is, who might you have spread your infection to, that is asking forward.  Asking backward involves asking the infected person, where did you get this from?

This approach allows public health officials to find the source of outbreaks, find them early before they spread wildly, and put them out by isolating all infected by the outbreak.

Here’s the good news- Ohio has begun tracing outbreaks backwards-in-time, which hopefully will make the difference!

BOTTOM LINES

  1. COVID-19 is starting to appear in our schools.  Not a totally surprising event given how cases are rising in the communities our children live in, but raises the worry of safety of people of any age gathering in day cares and schools during a surge of COVID-19.
  2. The United States surge remains very large and very worrisome.  Nearly all states are experiencing serious increases of actual COVID-19, including the always following rise in those so ill they need a hospital.
  3. Ohio cases are surging more than since June.  Our hover rate of 1,000-1,5000 cases a day has surged past 2,000 a day, almost hitting 3,000 this weekend.  We hope of course that the trend abates.  Should the trend upwards mirror that seen across nearly all states now, we could see the case number go well beyond 3,000 into levels of real danger.

My takeaway – in one sentence:

This week is worrisome, certainly across the nation, but also here right at home; so now remains a time for truly extra caution and safety for you and your family.

To your health,
Dr. Arthur Lavin

 

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