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.

Yes, Worry.  And, Hope.

With this essay, I venture into domains that normally belong to the political, which I still feel strongly should not be part of Real Answers.  But tragically, the political has intruded into good medical practice this week, putting forward a dangerous perspective that every doctor who cares about our health needs to call out, to re-inforce the basic truth that each of us should always work to help each other be healthy, not sick.

A needless, tragic, and deadly question continues to be peddled by some in power.  The question they are attempting to put in our heads is whether a deadly virus should be of any concern.

As a husband and father who has been a doctor nearly all my adult life, I need to let everyone know the answer is yes, this most deadly virus of our lifetime is of concern.

It is of concern to me, it is of concern to everyone I care for in my family and practice.

It is of concern to me for everyone, everyone who is fine now but may become infected, everyone who is infected and may become sick, everyone who is sick fighting for their lives, and for all those who have lost a loved one or friend or colleague.

We live in a strange time, in a strange nation, when a virus can stalk our land and kill over 210,000 of us, and some still wonder, why worry?

For me, the right response to a potential threat to our lives is to protect ourselves.  And SARS-CoV-2 is a threat to all our lives, and so all of us need to protect ourselves and each other.  It really is no more complicated than that.

But some in power would have it otherwise, strangely seeking to put all of us in harm’s way.  Right now, independent of political party, one must be worried that our own White House has a larger outbreak than nearly 100 other nations (listed by new cases per day- https://www.worldometers.info/coronavirus/).  The super-spreader event at the White House is being managed in a way to maximize suffering and death, an approach I would hope everyone of any party would not accept.

The White House holds enough of a place of honor in our nation that its messages can take hold of many of our citizens, turn heads, hold hearts.  And so as a doctor at this critical time, I feel the obligation to say that this disease, the deadliest of our lifetime’s truly is worrisome.  As a doctor, I believe it is important to say very clearly that I much prefer no one be permanently harmed, or worse, die from this germ.  And that only if we take steps to protect everyone can we stop the needless harm and loss of life.

But first we must worry.   If we choose to pretend, we can avoid worry, but we invite further needless harm and loss of life.

Only if we worry can we get to work to protect ourselves from a danger that is obvious and threatening right now.

Our worry is that powerful people ask us to not worry.  Our hope is that our very natural worry about a very real threat will move us all to take the steps we know can save our lives and the lives of those we care for:

• To end the pandemic’s spread- Identify all Infected and Isolate all Infected until not contagious.   The path taken by every nation that has brought it’s daily death count down to zero.
• To limit the pandemic’s spread- physically distance, wear a mask, avoid indoor gatherings of any sort particularly if 20 or more are in the room and particularly for long times, avoid crowds, wash hands after contacts.

UPDATE on TESTING TECHNIQUES AT ADVANCED PEDIATRICS

Advanced Pediatrics continues to be very pleased to offer our patients testing for COVID-19 at our office.

We early on identified the laboratory, Diatherix, to do our lab tests for COVID-19 and the results have been outstanding.

Diatherix has earned a sterling reputation as a national testing lab, particularly for many years of finding infections by the genetic signature of the germ in question.  So when COVID-19 arrived and the best performing test was for finding traces of its RNA, we knew Diatherix had the experience and expertise to perform at the highest level.

To date, they have performed over 1 million COVID-19 tests nationwide.  They now can assure results within 24 hours of receiving the sample.

Their level of accuracy is very, very high.  Their control data show accuracy over 95%.

High accuracy with rapid results are so very much appreciated during this pandemic.

The accuracy of their testing abilities explains why they can offer excellent results even with throat swabs.  This is why we swab your throat instead of your nose to do our COVID-19 tests, and our results have been very reliable.  We remain happy to swab the upper nose by your request, but advise that we get similar results by throat and nasal swab and so recommend the throat swab technique.   This recommendation is based on real results from this lab with the samples we obtain, it is not generalizable, most labs require high nasal swabs to obtain similar results.

School Risk Update

The pace of COVID-19 spread in our local neighborhoods remains low, but may be on the rise.

Here are some known facts as of now:

• According to the Cuyahoga County Board of Health, our County’s case positivity rate is 2.4% now, which is slightly up.
• There have been few reported outbreaks in private schools that have had fully in-person attendance for over a month.
• There have been few reported outbreaks in public schools that have had hybrid in-person attendance for a few days or weeks.
• In our practice, the surge of positive COVID-19 tests that we saw in August and early September, in which as many as 10% of those we tested coming back positive (the case positivity rate) has dramatically dropped, to nearly 0%.
• At the same time, in our practice, just in the last week or so, we are seeing a dramatic rise in COVID-19 negative, typical, harmless viral illnesses, aka, colds.

Now for our interpretation of the above.

We know from top public health experts that we can only be confident that a major surge of COVID-19 illness and spread will not happen once only 1 in 100,000, or 0.001%, of tests are positive.   We are at 2.4% which is way above that mark.  Further, NYC schools have set the standard of 1% case positivity, meaning that should NYC creep above 1% of its tests being positive they will shut down the schools.  We are at 2.4%.

COVID-19, far, far more deadly than colds, still travels just like colds.  Contagious people breathe out the virus and those who can catch it get sick when the virus lands on our eyes, in our nose, in our mouth, in our lungs.  We all know that when COVID-19 spread is halted, all colds are halted.  So colds are a very useful early warning system.  If we see colds spreading a lot, we know right now that COVID-19 surges are now more likely.

Well, our spread rate starts with about 2.4% of us testing positive when tested.  Colds in our office are clearly on the rise.  More than half the states in the US are seeing COVID-19 infections jumping up.  Ohio remains tipping this way and that around 1,000 cases a day, but yesterday hit 1,300.

And so our sense is that our lull is highly unstable.  It may continue, we may get lucky.  But our sense is that no one should be surprised if we see major surges in COVID-19 in our community, particularly if you factor in the arrival of cold weather, the end of playing outdoors all day, and soon.

FLU SHOT UPDATE at Advanced Pediatrics

We know there has been deep frustration with the availability of flu shots in the office, we share your frustration.

The good news is that this summer we ordered 33% more doses of flu shot this year than last, and all those doses will be shipped to us.

More good news, the virus the flu shot protects against is NOT here, and will not appear in our neighborhoods until mid-December.  Therefore, whether you get your flu shot in September, October, or November, you will get the same level of protection against the influenza virus.

Finally, flu shot manufacturers have always shipped our doses to us mainly in October even though we order our doses every spring and summer.  Drug stores of course have more power and get them in August.  So we are not experiencing any change in their shipping timing.

The only difference this year is that we suspended the Flu Fest to keep crowding down during the pandemic, and decided to offer flu shots in our office, as they arrived.  You should know the vast number of doses we get are shipped in many smaller shipments, always  have been.  We decided to shift to making them available as they arrive in deference to the urgency felt by all to get protection ASAP.  But that means we will only have the relatively small number of each shipment available, shipment by shipment.

We let people know when those shipments arrive, but of course, we can only administer doses we have in the office, we can’t give a flu shot that we have not received yet.

This is the reason for the frustration, we get a shipment, we offer to the practice, the requests quickly speak for those  doses, and everyone else is left waiting for the next shipment.

It is not how I would run a distribution system, I would ship all doses out to all doctors early in the process, but sadly our office is not in charge of the flu shot company distribution system.

But given our decision to get flu shots out as early as possible, to offer them shipment-by-shipment, all should be very much assured, that we will be getting very large numbers of flu shots, plenty for everyone who wants one.  AND MOST IMPORTANTLY, in plenty of time to be as fully protected against the influenza virus as anyone who gets a flu shot in September or even October.

BOTTOM LINES

1. Tragically, we face a moment when we all need to be reminded that the COVID-19 Pandemic is, in fact, dangerous.
2. The Pandemic is dangerous to everyone, in our neighborhoods, in Ohio, in our nation, and around the world.
3. The Pandemic is not contained in the US or here in our community.   Ohio had experienced a lull, but there are early indications of some uptick.
4. Our entire nation has the tools to stop the uncontrolled spread of this Pandemic- Identify and Isolate the Infected.  And we all have the tools to slow the spread- Physically Distance, Wear a Mask, Avoid Crowds, Avoid Indoor time spent with others, especially in groups over 20.
5. The testing procedures at our office, at Advanced Pediatrics, have turned out to be highly reliable, deliver results within 1-2 days, and can be done as effectively with a throat swab as with a high nasal sample.   Our lab has completed over 1 million tests with accuracy sustained well over 95%.
6. Schools remain operating with few reports of spread of COVID-19, but that fact is highly unstable.  Indicators suggest the risk of COVID-19 in our community, and therefore, in our schools may be on the rise.  We are monitoring the situation closely.
7. Flu shots are available at Advanced Pediatrics and will remain available through the month.  We have enough ordered and to be delivered to our office to provide a flu shot to all who want one.  In order to make them available ASAP we are offering them as each shipment arrives, purely on a first-come, first-served basis.  We apologize for all the inconvenience of trying to get in for that flu shot as the shipments arrive, but we are confident that we will get all our doses, reduce the frustration, in plenty of time to give your children full protection well before the influenza virus arrives in mid-December.

All of us need to ignore deadly bravado that invites us all to embrace danger and terrible loss.  Let us instead choose life, a choice well within our reach.  We at Advanced Pediatrics remain very eager to help, to remain available, to keep the information and facts available, to immunize against influenza in plenty of time.

To your health,
Dr. Arthur Lavin