• Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

    COVID-19 Update February 23, 2021: Half a Million of Us Have Died; Making Choices, and the Numbers You Will Choose; the Color of COVID in America

    By Dr. Arthur Lavin


    • 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.

    Half a Million of Us Have Died

    Our nation has now recorded the death of half a million of us.  This number is far larger than the total number of deaths lost by any other nation.  As we stop, pause, and think about the sheer volume of our losses at moments of landmark, we tragically do so once again.

    This moment is heart-breaking.  Those who have passed deserve our stopping, at the very least, to register the sadness such a mammoth loss brings with it.

    This moment is infuriating.  Scientists are weighing what this number would be had our nation taken basic steps to prevent the spread from being so out-of-control.  We will never know that number, but cautious estimates put it at at least 200,000.  This is worth a moment to pause, too.  Had we as a nation acted to take the very well known threat seriously at its beginning, at least 200,000 of us who have died would be alive today.  This is now a known price for decisions made.

    This moment is a moment of decision.  We as a nation made a series of decisions that led to this number.  We have shied away from public health, we closed our pandemic preparedness office, we did not supply PPE, we did not create a national COVID Pandemic Plan until January of 2021.  And therefore, today we grieve the loss of 500,000.   But we have decisions now to make.  Two are critically important:  How many will be vaccinated each day?  Will we continue to mask, distance, not gather, not travel, until the Pandemic is actually ended?

    Our decisions in 2020 led to massive loss of life, for no good reason.  Those same decisions will lead to at least another 80,000 deaths.  The question for us all, right now, is whether we will take steps to make sure that we do not have to post another notice that another 500,000 have died in the coming months?   Here is the analysis of our choices, choices we face today.

    Making Choices, and the Numbers You Will Choose

    At Real Answers, ever since the serious mutations have emerged and a very safe and effective vaccine has begun to be given to everyone, we have talked about this Middle phase of the Pandemic as a Race.

    And it is.

    We have talked about a two-way race, as the virus works hard to find ways to continue to spread despite our efforts, and we work hard to find ways to snuff it out with the vaccine.

    But it really is a 3 way race.  The third party to the race is me and it’s you.  The third party is how will we, the people, continue to wear masks, distance, not travel, not gather?

    We all know, we will see the end of this Pandemic sooner if we continue to be careful, if we widely vaccinate, and if no very major mutations emerge.

    But do you know how the numbers shake out depending on how these three legs of the race perform?

    If not, the NY Times just issued a truly phenomenal summary of just how soon the Pandemic will end, and how many of us will die, according to how the mutations, the vaccinations, and our choices go.  https://www.nytimes.com/interactive/2021/02/20/us/us-herd-immunity-covid.html?action=click&module=Spotlight&pgtype=Homepage

    Here is a summary of when the Pandemic will end, and how many lives will be lost by the end, according to how these three legs of the Race go:

    Situation. Month the Pandemic could End. Number of us yet to die by that month.


    Current pace 1.7 M/d.      July-November.  100,000 more die.

    Increase to 3 M/d.            May-July.    90,000 more die.

    Increase to 5M/d              April-May.   80,000 more die.


    Mask, Distance, Do not Gather or Travel

    Keep steady                      July-November           100,000 more die.

    Drop measures in the Spring     June-October   170,000 more die.

    Drop measures Now.            May-October            320,000 more die.(earlier because illness gives immunity)



    No new mutations, precautions sustained.    July-November  100,000 more die

    More contagious variant appears, precautions sustained.  July- or NO end.  200,000 more die.

    More contagious variant appears, precautions dropped.   April- or NO end.  530,000 more die.


    Some Notes

    The range of dates given for the Pandemic ending look at the question of immunity from getting COVID.  If you count that as full immunity, that take the first date.  you will see the most awful scenarios have an earlier end to the Pandemic, because so many more get sick.  This ends the Pandemic sooner but the cost of vast numbers of lives.  The second number adds immunity from illness and vaccine.  Note that of the 9 scenarios, two do not end the pandemic, each offer this horrifying possibility only if we stop wearing masks, stop distancing, and keep gathering and travelling before the Pandemic really ends.

    By the time you read this post  the United States, us, will have lost half a million lives.  Even if we are careful, get loads of vaccine, we will lose another 80,000 of our lives, horrifying.  But should we not increase vaccine, drop precautions, and suffer a terrible mutation, we could hit a million lives lost, unimaginable.

    The key here is that we have the power to influence all three Legs of this Race!  We can ramp up vaccines, we can volunteer to get them given, we can get them.   We can ramp up precautions, we can mask, we can distance, we can not gather, we can not travel, we can hold off on high school sports and college dorms for just a few more months.  We can even reduce mutations- the more we are vaccinated, and the more we observe simple precautions, the fewer cases, the fewer mutations- if we do this around the world!

    The choice is in our hands, right now- see another 80,000 or over 500,000 perish?

    The Color of COVID in America

    Nearly every nation designates at least one group to think of as less than fully human.  Our United States is of course no exception.   Our designation has been brutal, leading to the loss of over 20 million lives over the time people from Europe first arrived on this continent.   The main groups designated for destruction or limited lives have been the people who lived here first, and communities of color.

    For me, one of the indicators of just how cruel, how vast, how enduring, the power of these designations have been is one number, the infant mortality number.  Infant mortality asks a terribly tragic number, how many newborns will not live to see their first birthday?  Because of a myriad of genetic disorders, that number is never zero, anywhere, and never will be.  But the question really is, if you are born healthy, are there groups of Americans who will be far more likely to not make it to their first birthday.

    Tragically the answer is yes.  The chance a baby born will not live to be one year old is 2-3 times greater if the baby has color, as defined by the culture of America.  For babies born into communities of color, the chance of dying before your first birthday is 2-3 times greater.  In our city of Cleveland, that number is 6!  That is right, if you are born in the city of Cleveland in a community of color, you are 6 times less likely to live to your first birthday.

    This outrageous reality has been sustained across the entire history of the United States, of Ohio, of our neighborhoods.  The YWCA of Cleveland and a collaboration with CWRU, First Year Cleveland, is working to change this, seriously.  They have found the variable that defines it all is color, not money.  The increased infant mortality is actually higher black v. white in areas of our neighborhoods where people are well off.

    We see these differences in life across nearly every variable you can think of- income, wealth, chance of surviving cancer, even life expectancy.   We used to live in Boston, and right now, in Boston, if you live where many of our friends have lived, Back Bay, you can expect to live to be, on average, 92 years old.  But not far away in the black neighborhoods of Roxbury, your life on average, will only last 58 years. That’s a 34 year difference in how long you will live!

    And so this is the reality of America, before COVID hit.

    And this is the reality that the SARS-CoV-2 virus made visible, once again.

    The CDC released data last week on the chance of you getting COVID, and if infected, ending up in the hospital, or dying.

    What they found was not news, contained no surprises, but broke my heart, again.

    The chance of catching COVID did not vary widely amongst white, black and Hispanic groups, but Native groups had nearly 2 times the chance of getting infected.

    When it came to your chance of getting really sick with COVID if you catch it, sick enough to need oxygen and a hospital, the risks exploded by designated group.  For Natives that risk went up almost 4 times.  For African-Americans and LatinX- 3 times.

    When it came to your chance of dying if you catch COVID, the three groups faced over doubling their chance of dying.

    more detailed analysis on fate by color is updated regularly and shows similar findings.

    All these differences derive from the decision of a majority of Americans to call themselves white and to call others something else- Native, Black, Hispanic, for example.  These designations turn into deadly realities when patterns of opportunity are sharply denied to certain groups and held open for others.  That is the mechanism for getting these results.

    For communities of color, it is the denied opportunities, and the open choice of a large majority of the nation to reject their full humanity, that makes life shorter, jobs harder to find and get to, their economic realities far more crushing.

    COVID is like sand in the wind.  We cannot see the air, but if you drop sand in the wind, you can now see it.

    Racism and its impacts have been carefully designed to not be in the view of white America, but events like COVID are like sand, all of a sudden, the extreme cruelty of our choices become very visible.

    Serious work, serious discussions are underway right now to make these choices visible enough that we do something about them.  Click on the YWCA and First Year Cleveland links above if you’d like to work on changing the realities of infant mortality.  Keep attuned to local, state, and US efforts to end structural racism and get involved.  For COVID, this work can save all lives.

    Bottom Lines

    1. We all know the COVID Pandemic in the United States is getting better, but it is NOT OVER, far from it.  The virus still spreads out-of-control across our nation, and could surge anytime we let our guard down, until it IS over.
    2. Projections of ending the pandemic are now being published.  There are TWO THINGS ALL OF US CAN DO to help end it:
      • GET Immunized.  This is a national effort, but if you can GET IMMUNIZED.
      • KEEP UP THE PRECAUTIONS.   Those should be well known by now, but they are:
        • DO NOT GATHER
        • DO NOT TRAVEL
        • STAY APART
          • Double Mask to keep extra contagious variants out
          • Stay at least 6 feet away from everyone
          • Wash hands frequently
    1. If we do these two things, we will have fewer cases, and could prevent a major mutation from happening.
    2. If we immunize at 5 million doses a day, AND keep up precautions, AND no major mutations happen, we could see the Pandemic end as early as this April, but even in this best case scenario, another 80,000 of us will die.
    3. If we dawdle on immunizations and fail to expand the program, AND we think we can relax and drop masks and isolation, AND new major mutations happen, the Pandemic may have no end in sight and another over 500,000 of us will die.
    4. COVID once again forces us to take a long hard look at how we all designate some as other, not fully human.  This needs to stop, we need to learn how to stop, and we will know if we succeed by the numbers.  When the chance of dying in infancy or across life is the same no matter the color we have, then we will know we have succeeded.

    My Takeaway – In One Sentence:

    Vaccines are helping, and so is masking and not gathering, and if we do both well, we could end this catastrophe, but only if we do both well, failure to do so could cost another half a million lives; so THIS IS THE TIME to be as careful as we ever have, observe the steps that save lives, for real.

    To your health,
    Dr. Arthur Lavin


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