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.

The Child Variant Takes Hold

Recently, Real Answers shared the very upsetting news that one of the dominant variant of COVID-19 in Europe and America, the UK variant, aka B1.1.7, was changing how COVID is experienced by children and the nation.

A recent report from a state where this is playing out now, Minnesota, was brought to my attention by a highly regarded colleague, Dr. Sharon Berry, a nationally recognized leader in pediatric psychology.

The report includes key quotations from our friend, Dr. Michael Osterholm, who currently advised President Biden on how to end the Pandemic.

In short, the report tells us that the UK variant is starting to dominate COVID in several states, and wherever is does, three things happen, each affect our children:

1. Children quickly become the center of the Pandemic
2. Children begin to get sicker from COVID than they did before the UK variant appeared
3. Elementary and middle schools begin to experience real outbreaks of COVID far more frequently

A great site to monitor the emergence of worrisome variants is provided by our CDC here:  https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html

Take a look, you will see it tracks all the variants the CDC has deemed concerning.  So far there are only 3, the UK variant (B.1.1.7), the Brazilian variant (P.1) and the South African variant (B.1.351).  And, the UK variant covers well over 99% of the variant of concern cases.  Now, take a look at the map, green indicates variant presence, the darker the green the more the presence.  And compared to last week, more states are green and more are darker green.  Right now the UK variant is most intense in Florida, Colorado, California, Massachusetts, and our neighbor, Michigan.  Just behind these states in spread are MN, TX, GA, and then NJ, CN, TN, PA, and Ohio.

The article I am referencing details current experiences in Minnesota, Michigan, and Massachusetts, and given the history of this variant, it seems very likely we will have the same experiences soon.

Key findings from these experiences are as follows:

• “Public health officials in the Midwest and Northeast are sounding the alarm about steep new increases in COVID-19 cases in children.”
• “Cases among younger children — infants through 9-year-olds — are also going up, increasing by more than 230% since February 19, according to data from the Michigan Department of Health and Human Services.”
• It is too early to say whether the experience of COVID-19 with the UK variant in children, in our nation, will be like it has been in Israel and Europe- but in both Israel and Europe, kids with this variant of COVID definitely were a higher risk of significant illness from COVID than the usual strain that has been around for a year.
• In Israel, the UK variant appeared around New Year’s.  By the end of January, a major hospital had opened a pediatric COVID ICU unit and had four patients in it, ages 13 days to 2 years old.
• Osterholm fully anticipates the rise of the UK variant and its accompanying greater risk of elementary and middle school outbreaks will play out across much of the nation soon.
• The opening of schools, the full embrace of school sports and extracurricular gatherings is clearly fueling the current threat of a major surge of COVID now.

Two Reminders:  The Race and The Middle

The Race

Readers of Real Answers know of our emphasis on the race between the variants and the vaccines.

Right now, vaccines are winning the race amongst our elderly, those 65 and up.

And in nations with the most widespread COVID vaccination in place, numbers of COVID cases continue to plummet.  Israel continues to see dramatic declines in COVID nationwide at about 55% of the nation immunized.  Since February 20, the US has remained steady at about 20 cases per 100,000 Americans.  During that same period, Israel dropped from 40 to 5 (!) per 100,000, one of the lowest rates in the world.  And this in a nation where the vast majority of COVID is UK variant.  The point here is that our current vaccines can stop the Pandemic, even with the UK variant dominating.  The vaccine can win this race.

In America, we are vaccinating at a great clip, one of the fastest, and clearly the largest, in the world.  We are quickly approaching 25% of the nation fully immunized, roughly half-way to the 55% mark that has worked so well in Israel.  Right now we are at the 3 million doses a day mark.  At that rate we will reach the 55% mark in about 2 months, by early June.  But our rate of vaccine administration is climbing, so let’s say we hit 5 million doses a day, then we could hit the 55% mark within one month, and see serious drops in COVID sometime in May.

But the race in America is of concern.  Right now the variants and the vaccine are even.  Vaccines slow the spread, but gathering accelerates it, and the result is that a healthy drop in COVID seen from mid-January to the end of February has ceased all together!  As noted above our rate on February 20 was about 20 cases per 100,000, and that is our rate today.  And given that the UK variant is rapidly expanding its grip across the US right now, that means the race between variants and vaccine in the US is being played out in schools and colleges.

Take a moment to consider, if we remain active in slowing the spread, vaccines can deliver a victory soon, by June, maybe if we are really good, by May!   A truly needless tragedy is unfolding across America right now.  Our excitement is unbearably wonderful and so we are gathering, and the UK variant is spreading as a result.

The Middle

Readers of Real Answers know we are not at the End of the Pandemic, we are very squarely in the Middle.  Vaccines really do give us a glimpse into a future where the Pandemic Ends, but that’s all we have right now, the glimpse.

The Middle means the deadly virus still is spreading.  It means gathering can still kill.  It means we could, if careless enough, cause a real explosion of COVID that could affect opening of schools and kill many thousands more, all truly on the brink of ending it all.

If we continue to celebrate our gains, we will delay the End of the pandemic to well past June, and even risk breeding more dangerous variants.

Bottom Lines

1. The UK variant is here, and in every state it erupts, the same scene is seen- children are leading the outbreaks.
2. And, the UK variant is already causing K-8 grade schools to experience serious outbreaks for the first time.
3. It is too early to know for sure if the American experience of the UK variant will lead to more serious COVID in children, but it has across Europe and in Israel.
4. The Race between Variant and Vaccine is fully on.   Vaccines have proven their ability to win in Israel, even at a 55% fully immunized rate.
5. Here in the US we are 25% fully immunized and vaccination rates are soaring, we could hit the 55% mark by June, maybe even sometime in May.
6. THAT MEANS RIGHT NOW, WE WILL ALL DECIDE WHAT HAPPENS BY MEMORIAL DAY.  Will we stay at home, will we not travel, will we not gather for a few more weeks?  Will we wear masks and stay distant for some handful of days?  Will we consider slowing the intensity of close contact by sports?
7. IF WE DO, we can slow the emergence of the UK variant and keep our schools from seeding the next tragic surge.  We can protect our children from a variant that poses real risks to them.  If we do, we can give our surging vaccination program to End the Pandemic.
8. IF WE DO NOT, we will see a major surge.  The internationally highly regarded head of the CDC put down her script, looked us in the eye, and let us know she feels doom approaching.  The word surge is too mild.  Each one cost at least 100,000 lives.  Can we really ignore that another 100,000 lives hang in the balance, right now?
9. IF WE DO NOT, a surge with the UK variant could see a bubbling up of outbreaks in young grades, forcing schools once again to close.
10. The only exceptions to this stark choice is for the fully immunized, who still need to act with caution, whose protection only allows for a very narrow set of gathering situations.

My Takeaway – In One Sentence

All of America, each of us, stands on a decision point: will we stay home, not travel, not gather, wear masks, stay distant, or will we let go and delay the End of this nightmare with all the deaths such a decision entails?

To your health,
Dr. Arthur Lavin