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.

Life in Facts, Danger in Dupes

Tragically, this epidemic of COVID-19 requires frequent reminders that illnesses respond better to realities than pretend.

Pretending has its attractions, no doubt.  In the world of pretend, all problems can feel like they go away.  A leaky roof comes to mind.  It costs so much less to pretend it is not leaking, and take so much less effort, and creates so much less worry.  Just pretend there in no leak and you can go to bed thinking you will safe and dry, until.  Until the pretending fails and the water comes crashing down through the leak that pretending kept us from thinking about but allowed to burst into a failed roof.

And so it is with this disease, COVID-19.  Pretending has been elevated to a national pastime, with consequences far more deadly than the leaky roof.

Pretending for COVID-19 comes in many flavors, including pretending that it is a problem in our past, that gathering together can be done without risk, that masks are for weaklings, don’t work, and aren’t necessary.

Just like the roof, pretending has delivered far more costs, worry, and loss than actually fixing the problem.   For America, the cost is currently up to over 180,000 lives, a staggering loss of life in just 5-6 months, with projections for the next few months pointing to over 300,000 of us dying.  As we did when our nation hit 100,000 of us dying, it is urgent that we pause a moment to think, to stop pretending, and to look at this most stark reality.  My wife and I were born and raised in Canton, Ohio.  The size of 180,000 is well above twice the number of people who live in the city we grew up in, now all gone, with most of them having died for no reason beyond the cost of pretending.

A better future awaits us if could choose to not pretend, but rather deal with facts on the ground as they actually are.  The key facts turn out to be pretty simple, again, like the leaky roof.  In this case the problem is a known virus, and the solution is to identify who is infected and isolate them while contagious, that’s it.  As noted in these posts in the past, many nations have stopped the transmission of the virus, that count is down to 33 nations, but still, 33 nations have achieved and sustained actual stoppage of the virus.

Now the site, www.endcoronavirus.org has created a map of the United States color coding every county’s rate of COVID-19 transmission.  They agree that if we live in a county with active transmission of the virus, you have a leaky roof, and should not open schools, or open for other gatherings as well.

Because if we do, an outbreak will occur, pushing the nation from its current loss of life of 180,000 closer to 300,000.

The site lays out how to stop the transmission and estimates most communities can achieve cessation of transmission to nearly zero cases a day in as little as 5 weeks.  At the end of the 5 weeks, with the testing already available, monitoring for new cases can be conducted and new outbreaks isolated before spread of the virus across communities begins again, allowing us all to go to work, have our children go back to school, and for our play activities to resume, without risk of going to 300,000 deaths.

This is the path of not pretending,  It is the path of actually solving the problem, like so many other nations have awhile ago.

A local example of pretending is being acted out in our State House, where our legislators are trying to impeach Governor DeWine, for attempting to take steps to learn the facts of the pandemic and stop its spread, for the simple purpose of actually saving our lives.   These legislators are so wed to pretending they will actually spend their time trying to stop someone from not pretending, at the cost of many lives.

School Re-Opening In Cuyahoga County

According to www.endcoronavirus.org, the site mentioned above, created and updated regularly by MIT, Cuyahoga County has not achieved zero community transmission yet.  But the good news is that week to week, the number of new cases appears to be decreasing.  Should this trend continue, and community transmission of the virus essentially ceases, meaning the test positivity rate drops below 1 in 100,000, or 0.001%, per Dr. Michael Osterholm, we would be at a level that opening schools would be quite safe– as long as monitoring for new outbreaks allows us to keep our transmission rate this low or lower.  In actual numbers that would be a case rate of 12 or fewer new cases in our County per day.   As of August 28, 2020, our daily rate is down to 75, so we are getting close.

In our office, we are seeing new reports of soccer teams cropping up with COVID-19 cases.  We have had several patients come in to be tested because they had official notice that their school’s soccer team had a teammate test positive.  This is highly suggestive that playing soccer can cause transmission of the virus.

This finding is in line with reports in Cleveland.Com that 8 suburban schools have reported outbreaks of COVID-19 cases to the Cuyahoga Board of Health, all 8 events were related to exposures during sports play.  https://www.cleveland.com/news/2020/08/at-lease-8-suburban-cuyahoga-county-schools-have-coronavirus-cases-but-county-board-of-health-refuses-to-identify-them.html

This week, Ohio’s governor Mike DeWine had to take the unusual step of mandating that any school that becomes aware of a case of COVID-19 at the school make that information public while protecting the specific identity of the infected individual, and stipulating that guardian and staff need to be informed in writing.  https://www.cincinnati.com/story/news/2020/08/27/coronavirus-ohio-gov-mike-dewine-school-covid-19-case-reporting/3430856001/

It is hard to imagine the Governor had to take his precious time to craft such a mandate unless some schools were planning on not telling anyone outside of the infected child’s family.   Again, the point must be stressed, this wily and deadly virus cannot be stopped by pretending.

Finally, on August 28, Ohio experienced its first significant rise in cases, which the Governor attributed to schools re-opening.  https://www.cleveland.com/open/2020/08/newly-reported-ohio-coronavirus-cases-up-1244-thursday-update.html  This observation will be monitored closely, as it fits with Dr. Osterholm, and www.endcoronavirus.org‘s, and County Health Commissioner Allen’s sense that our County’s transmission rate is not yet low enough to be fully confident that going back to school is safe.

Masks

The news on masks is quite good, and may explain why Cuyahoga County is dropping its community transmission.  In the Carolinas, it was found that counties that mandated use of masks had 50% (!) fewer cases per day than in counties that did not care about masks.  Another demonstration of how much better acting on facts does to save lives than pretending.

Treatment

When it comes to choosing to pretend or do the hard work of finding out the facts, the area of treatment is getting seriously damaged by the invasion of the pretenders.  You know about the danger of pretending that bleach, light, and hydroxychloroquine work when they in fact do not.  Now our minds will be flooded with claims from now through November that one treatment after another and one vaccine after another, works.

Already we have seen the nation’s most admired bastions of drug and infectious disease facts, the FDA and CDC, brow-beaten to pretend.  This level of pretending is so severe, the head of the FDA pretended that convalescent serum (an infusion of antibody to COVID-19 from a patient who has recovered) improved survival a whopping 35%, when the doctors who did the study knew and reported that it was only 2-3% at best.  The embarrassment of the head of the FDA being caught pretending forced him to recant, something I have never seen happen before.

So beware, pretending is big money and big power in COVID-19.  We will do all in our power at Advanced Pediatrics not to fall for the dupe, and stay on the facts.

BOTTOM LINES

1. When it comes to big problems, it is so much easier to pretend they are gone.   Less worry, less money, fewer restrictions.  Until the facts ignored roar into your life.  Like the leaky roof, one can choose to pretend, until your bed is soaked with the rain pouring through a hole too big to ignore.
2. And so it is with COVID-19.  The forces pushing us to pretend it is gone are profound and surround us.  But the virus, like the leaky roof, doesn’t know how to pretend.   And like the leaky roof, will pour through our leaks in our defences.  But unlike the roof, it won’t get us wet, it will kill someone we care for, even maybe me or you.
3. Follow endcoronavirus.org.  It is a very trustworthy site run by top minds at MIT who have decided not to pretend, but have rolled up their sleeves and are working very, very hard, to let us know what is happening.  They have a great page now devoted to tracking which counties in the US have achieved close enough to zero transmission of COVID-19 so that students can return to school safely.  As of today, Cuyahoga County is not one of these counties.
4. Early indicators suggest that this read is accurate.  We are already seeing outbreaks of COVID-19 in school sports teams.  Ohio is reporting an uptick in cases ascribed to schools reopening.  And many colleges are reporting outbreaks even 1 week into getting back together.
5. Masks are looking good.  Use reduces case numbers by at least 50% which is great, but not enough.  We still need to do the hard work of identifying all infected and isolating them outside the home to truly get transmissions sustained at nearly zero, the level that will let us, like a lot of countries, go back to work, to school, and to play safely.

We all know that tragically, management of this infection has been corrupted by the need of some politicians to not only embrace pretending, but push us all to do so too.

We at Advanced Pediatrics intend to remain as true to the facts as possible.   So far, doing the hard work of knowing a situation continues to deliver better results than pretending, and I can think of few situations that call for better results than a deadly pandemic with all our lives on the line.

Take a look at our flu shot post, we will be making these available exclusively to children in our practice starting September 8.

To your health,
Dr. Arthur Lavin