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Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

COVID Update August 16, 2021: Delta Update; Vaccine for Children Update; Schools; Masks; Get Vaccinated Now!

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.
  • Variant- also known as a mutation, a variant strain of a virus is the same species of virus but with a change in the genetic code.  The change is minor if it has no impact on contagious the new variant is, or how deadly it is, or if it allows the virus to neutralize our vaccines. Variants that substantially increase harm are now listed by Greek letters, the most troublesome one now is Delta.
  • 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.
  • Vaccine Terms
  • Vaccine or Immunization– a dose of a substance that activates your immune system, as if you have the actual infection you are hoping to prevent, leaving you in fact protected from having that infection.
  • Efficacy– the percentage of people immunized with a particular vaccine who will not get infected if exposed to the target infection.  For example, a COVID-19 vaccine will be said to be 95% effective if 95% of people immunized with that particular COVID-19 vaccine will not get COVID-19 if exposed to COVID-19
  • mRNA– DNA works by dictating exactly which proteins your cell will make.  The message on how to construct each protein is delivered to the cell machinery that makes proteins by a piece of genetic material called messenger RNA, or mRNA
  • mRNA vaccine– an mRNA vaccine places a small bit of mRNA code that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected
  • Viral vector vaccine– a viral vector vaccine takes a harmless virus that is known to infect people reliably and places that weakened virus in a person where that virus will in fact infect the person.  The virus is not only weakened, but also attached to a set of genes  that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected.

Delta Update

The Delta variant has dramatically proven all we have said about it.  The three key differences remain tragically in strong force:

  • It is vastly more contagious.  Many numbers are floating about, 2 (twice as contagious), 1000 (a thousand more viruses), and now 10 (how many people does a person with Delta infect).  But this is all we need to know, if you are unimmunized, chances are Delta will find you, unless very significant precautions are taken.  This is devastating news.  Particularly for all our children 12 and under.
  • It infects the immunized and they are contagious.  Also very bad news.  Now the 137 million Americans who are fully immunized become possible sources of spreading Delta.
  • It infects and sickens children.  Perhaps the most tragic of all the differences.  In areas of the nation where enough people have decided not to get vaccinated, Delta is spreading quite explosively, and we are hearing directly from colleagues who work in pediatric ICUs that children are filling these ICUs, scenes simply not seen with the old COVID virus.

The one thing that is not different is that the immunized remain vastly protected from serious illness from COVID, even with Delta. Delta has broken through the wall of immunization for getting infected, but not for getting dangerously ill.  The wall of immunization to stay safe remains intact.

Delta in America: The Tale of Two Americas

Delta is exploding across all of America, but a yawning gap remains across those states where people are over 50% vaccinated, and those that are not.

https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areas=isr&areasRegional=usny&areasRegional=usla&areasRegional=usoh&areasRegional=usfl&cumulative=0&logScale=0&per100K=1&startDate=2020-09-01&values=cases

Check out these graphs.  Louisiana leads the way for the lower vaccinated world of America, and its Delta epidemic is totally out of control, exceeding 120 cases per 100,000 population.  Keep in mind, when that number is less than 5, we experience almost no transmission of COVID, that’s where all of America was back in May and June.  At our worst, we say that number hit 100 in the winter, now Louisiana is over 120 and still soaring.  Florida too is over 100.

Ohio is climbing, and just now topped 20, not a good sign.   But we are nowhere near the levels of over 100 seen across the South.

What we do not know is if we will remain around 20.  The trends suggest our numbers will climb, and I fear the opening of schools right now will shift us into those higher numbers.

Vaccine for Children Update

The timeline for the next group of children still shows the next set of trials to be completed will be by Pfizer, and that is expected to happen next month, in September.  That reporting will cover at least children 9-11 years old, but also hopefully children ages 5-11.

Keep in mind for me or any drug store to give COVID vaccination, we need a manufacturer to report a trial that shows it is safe and effective, but we also need the FDA to challenge the manufacturer’s claims to the point that they are convinced the vaccine is in fact proven to be safe and effective.  The FDA does that before issuing authorization (the EUA).  Then the CDC must form its official recommendations for use- dosage, timing, etc.

Once Pfizer formally announces it trials are ended and the data are in the hands of the FDA, in September, the time it will take before we can give the vaccine to younger children will depend entirely on how long the FDA and CDC take to review.

We want them to review to assure us the proof is reliable.  We also want them to authorize if it’s safe and reliable ASAP so our kids can get protected.  To that end the American Academy of Pediatrics has taken the very unusual step of calling on the FDA to move to approve use of COVID vaccine in children ages 5-11 with currently available data.

I support the call of the AAP for the FDA to act fast when Pfizer releases its data to them.  The world has seen these vaccines given to over 4.5 billion people!  We know the safety record of these vaccines and how well they work.  A real danger looms with schools opening, we need to get our KGN-middle school kids vaccinated, and soon.

But I will continue to advise parents not to go to drugstores and falsify their child’s birthdate, wait until the FDA has authorized and the CDC recommended before proceeding for those 5-11 years old.

Schools

Last year, I wrote in Real Answers that our nation was about to embark on a dangerous experiment, gather millions of children together into indoor spaces for 8 hours a day, 5 days a week in the midst of a deadly historic Pandemic.  We did that experiment, and lucky for us, the old COVID virus did not infect children very well, and major school outbreaks did not happen. There was a rather substantial spread of deadly COVID through high school sports and college, but not the classrooms of K-12.

Now we are at the moment of bringing 32 million unimmunized children back together, into indoor rooms for hours a day, every workday, but this time it will be the Delta variant that threatens them, and as noted, this time the COVID virus is known to infect children, and spread from children more easily.  And once again, we do not know what will happen.

I join every parent, and American, in the hope that nothing will happen, that there won’t be major outbreaks, that children will be safe.

But I enter this school year with trepidation, knowing how much more contagious the Delta variant is, how it infects children more readily.  Some early indicators are worrisome.  The reports from the South of school districts closing days after opening due to significant outbreaks.

At the same time, these reports do not establish that trouble is going to happen.  One hope is that the far lower amount of COVID transmitting in Ohio right now in Ohio (20 v. 120 rate) continues to remain relatively lower, as more and more people get vaccinated and restrict the flow of the virus.

That is at this point a hope, what we know for sure is that Delta is right here, it is spreading now, amongst adults, the immunized, the children, everyone.

And so schools must take measures to truly reduce the chance our children will get infected with Delta COVID.

Those steps are well known, they work, and they include:

  1. Making sure every person in a school 12 and up is vaccinated, period.
  2. Making sure every person in a school, immunized or not, wears a mask, period.
  3. Children are kept a safe distance from each other.
  4. Rooms are podded to restrict outbreaks to one pod of kids at a time.
  5. Air flow blows out virus.  The best way to know if your child’s room is well ventilated is to have the school have a CO2 monitor in the room.  They are available on Amazon for <$100.  Outdoor CO2 levels are about 300.  Up to 600 in a room means its well-ventilated enough to reduce viral exposure.  Much over that, get a fan near an open window going, move that air!

Masks

Masks are mentioned above, and normally that would all we need to say.

But we live in a time when children’s lives, which normally decide the best course to take, are not always the #1 priority.

When it comes to masks, the verdict is in and it’s clear, wearing a mask slows viral flow and can save kids from getting COVID.  Prior to Delta a study in NC found in 1.2 million kids, groups that wore masks suffered far less COVID.

Now last year the gold standard, the N95 was not available, now it is.  We now know that the type of mask matters.  The N95 reduces risk of COVID infection by about 80%, the surgical masks by about 40%, and the popular cloth masks by about 20%.  You can shop for certified N95 masks at n95project.org.  Any mask is a lot better than none, and every parent should insist their child’s classroom and school mandate their use.

At a time when we are facing a very possibly major outbreak of COVID in young children, with serious consequences, it is hard to come up with a reason to argue against doing all we can to avert a tragedy.

Get Vaccinated!

Of all the advice ever given in Real Answers, one stands out as more urgent than any ever given:

Get Vaccinated

Get Vaccinated Today

Get Vaccinate Now

This advice is very much for real, with schools opening, we have to ask anyone choosing not to be vaccinated, are you aware of the terrible risk our children face and that your getting a COVID vaccine is the best hope they have?

For parents concerned about giving COVID vaccine to their 12-21 year old child, know this.  The choice is no longer vaccine or no vaccine.  The choice is now vaccine or Delta COVID disease.  The vast majority of unvaccinated Americans will be getting infected with COVID Delta, so there is no longer any real option of no vaccine and no disease.  The choice is vaccine or infection, and the real experiences of real people prove beyond a shadow of a doubt that the vaccine is so much safer than the disease.  Easy choice.

Bottom Lines:

  1. Delta is soaring.  More in the South than here, but our numbers are climbing.  Ohio is now higher than it was on St Patrick’s Day 2020 when we locked down, it is at the same level we were at in October 2020 before our winter holiday peak.
  2. Delta is hugely more contagious, it spreads very very well.  It infects but does not seriously sicken the immunized who then are contagious.  It infects kids better than the old COVID virus.
  3. 32 million unimmunized children are gathering in school, a recipe for outbreaks.  We do not know if they will happen, but they very well could.
  4. As we gather our children our schools need to mask, to immunize, to distance, to pod, to ventilate to CO2 levels below 600.
  5. We really should be thinking about sports, too.  High school sports were a major source of outbreaks last school year, Delta only makes that scenario more likely.
  6. Vaccine for children 5-11 years old is coming closer, but not here yet.  How frustrating!  Pfizer is due to report out their proof of safety and efficacy in September, the FDA and CDC should issue authorization and recommendation ASAP after that.

My One Takeaway Sentence:

Please, Please, Please get vaccinated TODAY, it is by far the most powerful thing you and your children 12 and older can do to save real lives.

To All Our Health,
Dr. Arthur Lavin

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