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
• SARS-CoV-2- the specific name of the new coronavirus
• COVID-2019- 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
• Severity- what harm does the disease cause, in terms of  how sick you get and how many it will kill

Demand Universal Access to Testing and Effective Isolation Now.

Readers of Real Answers have read over and over that the only proven strategy that has stopped the spread of COVID-19 requires a nation take two steps:

1. Testing. Identify all people infected with SARS-CoV-2.  This only happens with very, very widespread screening in all public places for fever, referral of everyone with fever to special, contagion free centers to see if they have COVID-19.  All those not infected are free to leave.  All those infected are isolated out of the home.
2. Isolate. This requires special isolation facilities for those with mild COVID-19 to wait out the contagious period, and special inpatient facilities for those with severe or critical COVID-19.

Why is this strategy so critical?  Only nations that have adopted this approach such as China and its province Hong Kong, Singapore, and now South Korea have actually reduced, even stop the spread of this dangerous, pandemic virus.

A sobering observation on what happens to nations that do not adopt these measures is the situation in Italy.  Italy has indeed pursued universal access to testing, Italy is doing lots of tests.  And yet COVID-19 cases continue to rise exponentially.  It has instituted severe limiting the nation to stay at home, it remains to be seen if this strategy slows the spread of the disease.   Early indications in Germany reported yesterday hint that again widespread testing and social distancing is failing to stop exponential increase in COVID-19 in Germany, it remains to be seen.

The major challenges we face in adopting the only strategy that has been actually demonstrated to work across over a billion people are:

1. A nearly complete failure to make tests available to the American public.  This failure is hard to understand, no one has really explained it, but everyone knows it is an unacceptable failure.
2. Even if we achieve nearly universal access to testing, we do not have facilities in the United States for effective isolation, outside the home.  China built these during its SARS epidemic so they were available.  At this time we do have some facilities in place at our major medical centers for people with fever to go to to see if they have COVID-19 without spreading infection in the process, but if we begin to screen all Americans with fever we will need more such facilities.

With all this in mind, we are now asking everyone to call the White House, Senators Portman and Brown, and our Congressperson to let them know we are insist that our nation take the steps necessary to protect all of us, specifically universal free access to COVID-19 testing for every American with fever. 

Spreadability

I was invited to participate in a special communication from the CDC on the impact of COVID-19 on pregnant women and children.  Here are the highlights on issues relating to contagion and spread:

• We have very limited data on pregnant women with COVID-19.  One study of 34 women found no transmission of the virus, SARS-CoV-2, to the fetus or baby, and no increased risk of miscarriage or malformation.  This is very good news, but too preliminary to be certain such patterns will continue.
• With regard to children, cluster analyses of known cases and their contacts has demonstrated that children get infected mainly from adults.  This is a dramatic shift from the usual viral illnesses in which kids get sick at day care or school, bring home the illness and infect their parents.  Not with COVID-19.  Kids are so less likely to get infected that adults are the source of their infections!

As of March 13, 2020, the total number of cases in the world has reached 138,271 , in the US 1,382 , and in Ohio  5 .   US and Ohio numbers do not reflect the actual number of us infected because we remain the only nation in the world capable of universal screening and testing that has chosen not to.

The spread of this infection seems to be slowed mainly by finding all those infected then isolating them outside of the home.  We are still doing neither in the US.

We hope that handwashing, face masks, shutting schools, cancelling events will help, and we will see if they do.

Even so, we urge our nation to do testing to identify all those infected and take steps to allow them to be isolated outside the home, a proven technique to nearly stop its spread.

Severity

For the 34 pregnant women studied, they all had mild COVID illness as expected for young women.

The situation for children remains astoundingly good.  These are data from the vast experience of COVID-19 in China:

• It is now and still the case that no person 10 year old or younger has died of COVID, on the planet.  This of course includes babies and children quite ill prior to catching COVID.
• Only 1 death is known in children ages 11-19.
• Across the planet, only two known cases of children with COVID-19 getting sick enough to need any ICU care are known of, a 14 month old and a 3 year old.  All other children with COVID-19 had such mild illness no ICU care was needed.  By the way both the children in the ICU survived.
• Symptoms are mild fever and cough, without runny nose.  The vast majority of kids with COVID-19 have no gut problems.
• In China, looking at all positive swabs for SARS-CoV-2, the coronavirus causing COVID-19, only 2.1% of them were in children less than 19 years old.

These data reflect a fairly broad experience across large numbers of COVID-19 cases, but still the virus is new.

We have good reason to hope these trends persist.  If they do, then children may really turn out to be both unlikely to get COVID-19, and unlikely to get seriously ill.

This also means that warnings about the dangers of pre-existing illnesses, such as heart disease, lung disease, diabetes, and cancer just might not pose as great a danger for COVID-19 in children.  We do not know this yet for sure, but the fact that looking at all children across the world, only 2 have required ICU care suggests this may be so.

The nature of the spread of COVID-19 and the severity by age give us hope that most of the damage by infection will spare our children.   At least this has been the case from November 2019 through March 13, 2020.

BOTTOM LINES

1. Despite very limited information on who is infected in the US, there is sufficient data to demonstrate that even today the US remains on an exponential rise in numbers of cases.  Should that continue we will have the same numbers and challenges now seen in Italy within a matter of a week or two.
2.  The current US strategy to slow the rise and prevent an Italian scenario is massive social distancing, highly selective and limited testing, with isolation of known cases and their direct contacts in their homes.
3.  We fervently hope this strategy works.  So far, no nation has seen this strategy slow the spread.
4.  The only strategy that has actually slowed, even stopped the spread of COVID-19 by over 99% has been twofold:  IDENTIFY all those infected using nearly universal screening of everyone everywhere for fever, referral to safe testing sites, and ISOLATION OUTSIDE THE HOME of everyone infected until no longer contagious, in isolation centers and inpatient facilities able to make sure no further spread occurs.
5.   Very, very small numbers of pregnant women studied demonstrate they are at no greater risk from the illness than anyone else their age, and there has been no maternal-fetal or maternal-newborn transmission of COVID-19 in the 34 women studied.
6.  The lack of illness from COVID-19 in children is astounding.  No deaths for anyone 10 and under, 1 for those 10-19 years old.  Only 2 cases requiring ICU care in childhood.  Let us hope these trends continue!

For right now, it is urgent that all Americans ask our nation to get universal screening for fever and access to safe and free testing in place now, AND that those infected be provided facilities outside the home to safely wait until they are no longer contagious.  Please call the White House, Senators Brown and Portman, and your Congressperson today.

Again, let us hope our social distancing works, but let us press forward to demand actions known to work to be taken.

To your health,
Dr. Arthur Lavin