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COVID-19 Update December 7, 2020: On Ending My Quarantine, The Explanation for Europe’s COVID-19 Explosion and Dr. Mina’s Path to Curtail the Pandemic by Christmas

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.
  • 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.

 

On Ending Quarantine

This third of a series of reports on one person experiencing having COVID-19 takes us to the end of being contagious.   To recap, I had a weekly surveillance COVID-19 swab on November 24, and it came back positive.  I had my first symptoms on November 25.  Most studies show an person infected with COVID-19, if they have mild symptoms, will be contagious from 2 days before through 5 days of symptoms, but all studies agree essentially no such person will be contagious after day 10 of symptoms.

For me that has meant that I was contagious from November 23 through December 6, and can be very confident that I will no longer be contagious starting Monday, December 7, or today.

As readers of Real Answers know, my symptoms have been remarkably mild, and I will remain forever grateful that the face of COVID-19 I saw was mild.  This is because we all know how deadly this infection can be, and has for over a million of us, of humanity, to date.  Over the last 10 days, my symptoms have been primarily an achy fatigue, with some amount of abdominal unease, along with the most trivial of coughs.   As far as I know, my body seems to be working quite well.

At this point, I can be also confident that I will not experience the terrifying first phase of sever COVID-19 pneumonia and oxygen dependency.

What lies ahead are the 2-4 week phase of COVID which is not a time of active infection.  As with all viral infections, there is a phase of actual infection in which the virus is actively growing in you, and then some viral infections have a phase of symptoms after all the virus is dead.  Think of chickenpox, you have virus growing in you until all your rash has scabbed over, but even at that time, you have all that rash to deal with.  You are no longer contagious, but you have some residual symptoms to recover from.

And so it is with COVID-19, everyone who avoids the acute pneumonia and oxygen dependency of COVID (80% of all of us infected) stops having live virus in them by 10 days of symptoms.  That is why I am no longer contagious.  But there are all sorts of events or symptoms that can yet happen, all of which derive from one’s own immune system, which can be so strongly activated to wipe out the SARS-CoV-2 virus, that it causes mayhem in the person.

So far, I have had no such events or symptoms, and certainly hope, along with all the rest of us infected with no or mild symptoms, to never have them.

Lastly, there is the specter of long-term impacts.  This is a new disease, the longest ago anyone has had COVID-19 is about a year ago, that’s it.  So no one has any idea what might be coming down the road in 2 years, 5 years, 10 years, or longer.   All we can do is hope that nothing more will happen over the long term.

I hopefully will be closing my account of having COVID-19 with this post.  I am hoping to have no 2-4 week or long-term events, and if my hopes come true, will have nothing else to say about my infection.

So I close these posts by saying once again how grateful I am that I came through this very risky illness, OK so far.  And that I am thrilled to be back at work starting today.   I also want to share the sense of crossing out of one realm and into another.  From the hazy world of being isolated, wondering what symptoms will pop up next, at times feeling mildly ill.  To the world of the healthy, back into being in the world at all.

I also come back to the practice of pediatric medicine with a sense of increased safety to all I care for.  I have had COVID-19, it is really quite unusual to have it twice.  So I am very, very unlikely to get it again, and therefore pose essentially no risk to people I care for when I see you.  That is very comforting to me, and I hope to you as well.

Lessons From Europe- the same lesson taught by America and Asia: DO NOT GATHER

Europe was the second continent to be hit hard by COVID-19.  Remember the scenes of northern Italian hospitals overwhelmed?

But Europe did something we still have never done.  They did smart lockdowns, smart testing, smart contact tracing.  And all across Europe, by the early summer, the SARS-CoV-2 virus had been vanquished.

Take a look at the graphs.  Europe had a big spike, then not much COVID-19 at all.

We talked about the practice of health care in Asia and Europe and how obvious it was that if our own nation had done the same, so many thousands now dead would still be alive.

The summer and fall happened, and Europe is now more deadly than the once worst country, the United States.

What happened?  Europe is now the only continent that had control of COVID, and utterly lost that control.

A recent report in the NY Times now tells us why.  https://nyti.ms/33IjSPI

In this remarkable account we see the results of epidemiologists tracing the European COVID explosion, and geneticists tracing where all the cases originated.

The answer turns out to be remarkably simple, so simple the entire story can be told in one word: gathering!

Europe has something we do not have in the United States- extended summer vacations.  We are talking about a month at a time.  Everyone goes on holiday.  Everyone goes somewhere they love in Europe.  It is a benefit that is profoundly treasured, and a practice that fuels great gushes of European economy.

And Europe prides itself on having open borders.  Many nations, all open.  This is like our American expectation that we can drive across the open borders of our states.

So when Europe got hit by COVID-19 around March and April, all borders closed and summer vacations looked like they would be ruined.

Then came the phenomenal success in Europe, COVID-19 was crushed.  No one had it anymore.  People started opening schools and restaurants, and given that there were so few cases, such excellent testing and contact tracing, COVID-19 remained crushed.   Now Europe wondered, if we have such excellent control over the situation, how about just our family going on a little vacation in Spain?  And nations began to wonder, if COVID-19 is crushed, how about letting some folks vacation, letting our borders go open?

These two questions led to a flood of vacationing and travel across Europe this summer.  And this alone has led to some of the worst outbreaks of COVID-19 seen on the planet.

This same reality is visible in every corner of the world, and literally in every neighborhood.  When people gather, COVID-19 spreads.

Consider the situation in Hong Kong, an distinct urban region that continues to lead the world in stopping the pandemic.  This region of 7 million people has, as of today, suffered a total of 112 deaths from COVID-19.  If our nation had similar success, our total deaths from COVID would be 6,200 rather than nearly 300,000.   But even in Hong Kong, COVID-19 will erupt if invited to.  Their current surge was created by a group of people insisting on resuming ballroom dance lessons, leading the entire region to go from 100 to 1,000 cases a day.

We see the raging epidemics of COVID-19 here are home propelled by so many of us thinking that a small get-together here, a few friends gathering there, can’t cause that much harm.  But people are people, and people gathering to dance in Hong Kong, to vacation in Europe, just to see each other in America, all lead to the same result.  Devastating outbreaks, and in large enough, health systems about to collapse.

Please, do not gather.

Dr. Mina’s Plan Could Curtail COVID-19 by Christmas

Dr. Michael Mina is a brilliant epidemiologist at Harvard.  He uses epidemiology to craft strategies to beat germs and other threats to health.

And, he has an entirely reasonable, extraordinarily cheap, painless, and quick way to get COVID-19 to retreat, and dramatically.

He presents his case in Time magazine here- https://time.com/5912705/covid-19-stop-spread-christmas/

The concept is simple.  Take a home test for COVID-19 twice a week, using a strip you put in your mouth to detect if the virus is in your saliva, just like a pregnancy test checks for a protein in your urine to see if you are pregnant.

Each strip costs pennies to make and can sell viably on the market for $3.

Now, IF just 50% of Americans tested themselves twice a week, AND went into isolation during any discovered period of contagion, THEN the current surge of COVID-19 would disappear.

The strips exist, ready to go.  So if we did this now, we would end the surge of COVID-19 by Christmas, able to open schools, have a holiday, travel, gather!

It would not end the pandemic, but it would so substantially cut the spread, that our current cloud of imminent danger would be lifted.

The program could include schools and work and travel (planes and trains) to require proof of negative test for entry.

The technology of rapid antigen tests has improved.   They are very, very good at detecting those infected, about 98% of those infected turn positive.  And if a repeat test is done for every positive to handle the one in fifty that are false positives, then these tests’ positive result reliability goes over 99.9%.

BOTTOM LINES

  1. My COVID-19 journal hopefully closes today, time will tell.  But I feel well, my quarantine ends tonight, and I return to helping families tomorrow, safer than before.
  2. The catastrophe of Europe’s terrible explosion of COVID-19 is now traceable to one word: gathering.  It was the urge to vacation and to open borders that caused this continent, once so successful, to fail so severely now.  The same result is on view across our own nation, and happens anywhere we gather for hours or more- the US, Hong Kong, everywhere.
  3. As noted, the COVID-19 vaccines are coming.   They hold out the promise of ending this nightmare, but most Americans will not be COVID-19 immunized for at least many months.
  4. Right now, technology exists to allow anyone in their home to test for $3 a test, cheap enough for the government to issue all homes a packet of tests to allow twice a week rapid testing for COVID-19.  This testing technology, if put into place now, could open the nation up by Christmas.

 

My Takeaway – In One Sentence:

Hope is around the corner, but COVID-19 today continues to surge, we must not gather, or travel, and if we must, we must mask and distance, until we know this foe is indeed vanquished.

To your health,
Dr. Arthur Lavin

 

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