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 and THE IMMUNIZED

Readers of Real Answers, and really nearly everyone now, knows that we are in a very upsetting phase of the Pandemic, that the wonderful days of the Pandemic letting go are no longer our days.

This is because of two very unfortunate, and deadly, realities.  The emergence of a COVID variant that changes our world, and the persistence of the large number of people ages 12 and up who are not immunized.  In fact, the nation’s leading person on controlling Pandemics, the head of the world-renowned CDC recently called this terrible time as the Pandemic of the Unimmunized.

Delta 

All cold viruses change as they infect, causing new mutations or variants to emerge.  That process is not over for COVID, and will not be as long as it spreads.  But the Delta variant is already proving to be a terrible, terrible change.

The Delta variant delivers three terrible new realities to all of humanity:

1. It is 50-60 times more contagious.  This alone will jump the number of cases of COVID dramatically.  It also moves our nation from a place with little COVID even though about 50% of us are not immunized at all, to a place where COVID is rising again.  Prior to delta, the COVID variants surprisingly failed to spread well in a nation that was 55% immunized. That was a surprise, but a welcome one, and explains why it felt the Pandemic was ending.  We got to about 45% immunized, and transmission started to halt.  People gathered, masks came off, and still the numbers plummeted.  We had days in America with fewer than 300 deaths from COVID in a day across the nation, despite gathering in ways that once caused 4,000 deaths a day!  But Delta can spread in a nation with 50% unimmunized.  We are such a nation, and Delta is spreading, right now.  It spreads far better than the original COVID.
2. It infects the immunized.  I am not speaking only from my own experience.  This week another roughly 50% immunized nation, Israel, reported half of its new COVID cases were in the immunized!  This is terrible news.  That means right now, the immunized of America can catch COVID.  What remains unknown is if we can spread it.  I suspect we can, normally if you catch a virus you can spread a virus.  But we don’t yet know.
3. It hurts kids.  The most cruel aspect of Delta is that this form of COVID is making kids, even young kids, very ill.  It is still the case that the younger you are the safer, and that the vast majority of children infected with COVID, even Delta variant COVID, do not get very ill.  But as noted in our last post, for the very first time we are seeing a number of previously healthy, even very young children getting seriously ill from their acute COVID infection, not the later onset MIS-C that still exists.  Across the world, when kids get Delta variant COVID they do get more ill than they did from the old COVID viruses.  The fact that this new door, the new reality of children being hospitalized and requiring intensive care more frequently, is awful, but at the same time the vast majority of young children who will be infected with COVID will remain with few if any symptoms.

A fourth point comes from the combination of these Delta facts.  With the dominant COVID virus being one that is dramatically more contagious, can infect the immunized, and is more harmful to kids comes a new reality, that we must once again take actions to keep ourselves and our children safe.  These new facts mean that COVID is once again spreading, so we must act to stop its spread.

The tools to stop its spread are well-known:  Immunize, mask, avoid gathering.  And so this is what we must do- immunize, mask, and once again avoid too much gathering.

Some good news about Delta include the fact that it seems not to harm the immunized very much.  It is still the case that nearly everyone who is dying from COVID right now are unimmunized, and by nearly everyone we mean 98-100% of those dying from COVID.  If you get current COVID immunizations, you remain safe from serious, deadly results from COVID infection.

When Young Kids Can Get the Vaccine

Want to be sure you are not terribly harmed by this virus?  The only sure way is to be COVID vaccinated.

So when can we protect our young children?  Especially now that the Delta variant poses such serious threats, the need to move our young children from the unimmunized to the immunized, is more urgent than ever.

When will our babies, toddlers, pre-schoolers, and grade-schoolers be protected?

For a couple of months, we have shared the sense from Pfizer that they will be seeking FDA authorization for younger children by this September.  Initially they reported they would seek this authorization for children 2 years old and older, but a few weeks later moved that expectation to ages 5-6 years old and up.  This raised my hopes that we would see COVID vaccination become available this fall for children ages 5 or 6 years old and older.

But a clarification today pushes this date substantially into the future.

The good news is that Pfizer is expecting to complete its studies on vaccinating younger children this fall, but its vaccine cannot be given until the FDA issues its authorization and the CDC issues its recommendations.  Even under the pressure of a Pandemic, the FDA needs some months to weigh the data, hold hearings with the manufacturer, and decide if the product is likely to indeed be safe and effective.  The FDA this week announced these actions may be concluded in the early or mid-winter, that is December-February time, not September-October.

Also this week, Pfizer clarified its studies on how the COVID vaccine works in young children will be concluded.  As noted, it expects to complete its trials on children ages 5-6 through 11 years old by this September.  But they also announced they expect to complete these trials for children of all ages by November.  And, Moderna stated it should conclude trials for its COVID vaccine along the same timeline.  This is very good news, by sometime this fall, we could have proof in hand about how effective and safe COVID vaccination is in grade schoolers, pre-schoolers, toddlers, and babies, in short all our children.

When the trials end, two great pressures will confront each other.  The first is the pressure to get our kids vaccinated, but the other is making sure neutral agencies do their job to look at the data on their vaccines’ safety and efficacy.  We need to know, do they work and are they safe in very young children.  And at the same time, if they are safe and effective, we need them now.  Both points are compelling, I hope the FDA and CDC are preparing now to do their reviews as rapidly as they can do so fully.

Bottom Lines

1. The Delta variant of COVID is creating new realities:  it is far more contagious, it infects the immunized, and it makes kids sicker.
2. As a result, our nation, once on the brink of ending the transmission of COVID, is no longer safe from this Pandemic.
3. Questions remain and will determine just what sort of new reality we are in.  Will Delta continue to spread?  Are the many immunized who will be infected by Delta contagious?  How large will the Delta outbreaks be?
4. For right now the indications that the Delta COVID spread is serious and so we must act now to do what we can to halt it:
   1. Everyone 12 and up needs to be fully COVID vaccinated, the need is now and quite seriously urgent.
   2. We need to take actions to slow the spread of Delta:
      1. Wear masks
      2. Reduce time in indoor gatherings
      3. Keep socially distant
      4. Test when you have cold symptoms.
5. Good progress is being made to make vaccine available to all our children of all ages.  The vaccine manufacturer may be able to conclude its studies to see if they are safe and effective for children 5-6 to 11 years of age by September, and for children of all ages by November.
6. Once studies are done we need to have the FDA and CDC act as quickly as the integrity of the data review permits to issue decisions, that if the vaccines are safe and effective for our young children, we can protect them as soon as possible.

My One Takeaway Sentence:

The Pandemic is rising up through the new agent, the Delta variant, we must act now to contain the harm it presents.

To All Our Health,
Dr. Arthur Lavin