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.

Guess who knows more in America than anyone about how COVID-19 spreads?

Take a look at this new report from the CDC: https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7004e2-H.pdf

It talks about an American industry that studied its 11,400 employees with over 600,000 COVID tests, the highest tech contact tracing, and genomic sequencing of found infections- all towards really figuring out, how do you spread, and how do you catch COVID?

Does the 6 foot distance protect, does the fifteen minute rule work, what sort of places does the virus really hop from me to you?

Which industry went to this trouble, which one delivered the best understanding of its spread to date?  Was it Microsoft?  Was it Ford?  Was it Boeing?  Was it the Cleveland Clinic?  Was it the US Army?

No to all  those.

It was football, it was the NFL.

What did the NFL Do?

The NFL had enormous pressure to find a way to keep players and staff from getting infected.  They did not adopt the bubble strategy of the NBA, so all their people were at risk for getting COVID, and many did.

To tackle the problem, football decided to really trace the virus, find out really, how did their people spread it and catch it.

With this goal in mind, the NFL began with mandating use of masks, 6 foot distancing, frequent handwashing, facility disinfection, restricted access to facilities, and frequent testing.  The League also installed a device on all players and staff that could tell where everyone was at any moment in time, including tracking if the 6 foot distance was violated.

Testing was done by PCR 6 days a week on all players and staff.

Any positive case led to intensive contact tracing, using the device trackers and careful interviews.

This monitoring took place in all 32 teams across 24 states, involving 11,400 players and staff.

The testing led to 623,000 PCR tests!

329 players and staff were found to be infected, a rate of about 2.9% overall

What did the NFL find?

The NFL monitored COVID from August 9-November 21, 2020 for this study.  During these nearly 4 months, 329 people of the NFL were found to test positive for COVID-19, that is 2.9% of the total.

During the first few weeks, the NFL saw 10 cases a week, but around September 27 that number began to spike, going as high as nearly 70 cases a week.  The very intense contact tracing revealed that people caught this virus even if more than 6 feet apart and even if less than 15 minutes together.

An analysis of 20 high risk encounters where NFL players and staff were within 6 feet, or longer than 15 minutes, or no mask, or indoors, or dining together found that 8 of the 20 such COVID cases happened at home, 8 outside the home but not work, and only 4 or 25% of the cases at the NFL.   All 8 of the transmissions outside of work and all 4 of the transmissions at work happened indoors and nearly all involved dining together.

The NFL achieved decreased transmission during a period when US cases were surging by insisting on the following steps:

• Meetings- all virtual, or outdoors in a large space
• Weight room training- greatly spaced with no more than 10 people in a room
• Mask wearing- essentially at all times
• PCR COVID testing- daily, cannot go to work unless negative value documented, every day
• Meals- never together
• Locker room- essentially shut down
• Gatherings- all gatherings outside work strictly prohibited

As one can tell, you don’t have to play football to follow these now proven paths to stop or substantially slow the transmission of this virus.

This careful look at how the virus spreads confirms one huge point already well known, this virus is wily, it spreads even when taking precautions.   The NFL was able to slow its spread, but not stop it, and experienced a mini-surge even with many careful steps in place.  This virus spreads.  Right now, if you gather, you give it a chance to spread.

The NFL joins the call for all of us to really follow these guidelines until the pandemic ceases to threaten our lives:

• Do Not Travel
• Do Not Gather
• If you must leave your home:
  • Wear a mask
  • Stay 6 feet apart at the very, very least
• Until High School Sports can Implement NFL level security, including daily COVID testing, Do Not Participate in Team Sports

Easy, Frequent, Comfy Home Testing on Its Way

Finding out where the COVID is has been extremely difficult, with all of us feeling that we are chasing after the virus, not sure where we got it from, where it is now, or will it strike next.  As a result the pandemic remains a troubling cloud, seeming to lurk around every corner.  This is because 50% of everyone infected with COVID-19 has no symptoms, the infected are invisible.

Easy, frequent testing promises to change all that, as dramatized by the NFL study with the CDC noted above.

Imagine a world in which a home kit cheap enough everyone could test every day.  In that world the infected would become visible, and we would know who is not infected too.  One could wake up each morning, test at home, if negative, go to school and work and play confidently.  And if positive, isolate and stop the spread.

That day, that world is not quite at hand, but it is coming much, much closer with the announcement that the company Ellume has been approved to sell a home COVID kit with no prescription needed.  If it was very, very cheap, and if there were millions of kits available, that world would be here.  But Ellume will be selling a test for $30 each, too much for daily testing, and it currently can only ship 100,000 tests a month. But in a few months they will ramp up to 20 million kits shipped a month, and one can hope the costs will plummet.

The test is approved for use in anyone 2 years and older, takes 5 minutes to collect a relatively easy, shallow, nasal swab and 15 minutes to get a result.

Negative tests are very reliable, positive tests need to be repeated to verify.

Here is a recent NPR story on this breakthrough.

https://www.npr.org/sections/health-shots/2020/12/15/946692950/fda-authorizes-first-home-coronavirus-test-that-doesnt-require-a-prescription.

I am very excited about this step, it brings us closer to the day when everyone will be able to test daily or more, and know, am I contagious, or not.  This will help really stop the spread, and help everyone know where they stand.  Both major steps to returning to work, school, and play.

Kids and COVID Vaccine – No Path for Under 16, Yet

The issue of children with serious medical conditions getting approval to get COVID vaccine remains a serious issue.  We know that Pfizer vaccines are approved for use in children ages 16 and up.

We know that Pfizer and Moderna are conducting trials to see if it can work safely in children ages 12-15 years old.

I just checked once more with the American Academy of Pediatrics and was told that as of right now, there are no circumstances in which anyone 15 years old or younger will be approved to receive a COVID vaccine of any brand, no matter the medical need.

As the studies of 12-15 years old determine they work and safely, that age may drop to 12.  As of now, however, no work is being done to prove the vaccines are safe and effective for children 0-11 years old, but that should follow.

Camps – a Very Iffy Idea as the Race Between the Vaccine and the Mutations Continues

Welcome to February, when parents begin to make decisions about summer camp.  The idea of summer camps has been challenged by the danger of COVID-19 and the clear risk that gathering poses for promoting the spread of the virus and its deadly consequences.

As the COVID vaccine rolls out, the prospect of a time without the danger of gathering leading to more COVID rises.   It is quite reasonable to expect that at some point, the vaccine program, expanded testing abilities, and other measures will release us from our current reality that when we gather, the infection spreads and people suffer.

But that moment is not now.  Just take a look at a simple graph, the daily case count of COVID cases in the US since March 1 of last year through January of this year.

The number 1 marks the first US surge, it was so severe it led to a total national lockdown, in March and April, and it killed 122,000 people.   We got tired of being careful and had some fun in the summer, which led to our second surge, killing fewer because the surge affected younger people, but still, our summer fun cost 64,000 lives.  We are now living in the midst of the third American surge, propelled by both cold weather and the great national gatherings of Thanksgiving, Christmas and New Years.  Those travels, meals, and get togethers have so far led to the death of over 182,000 people.

But look at the case count numbers, we were horrified last year when the first surge struck, enough that many camps closed and all open took very stringent measures to attempt to stop the spread.  And that at a daily national case count of 30,000 a day.   We peaked, and just a few days ago, at 240,000 cases a day.  This surge appears to be slowly dropping, we are now at 114,000 cases a day, but 114,000 cases a day, our “slow rate” just now, is a wildfire compared to surges 1 and 2.

If we are lucky and no new virus mutation capable of wiping out any current vaccine efficacy comes along, we could see case counts in the US drop way below 30,000 a day, we could see the end of the threat of serious illness and dying from this virus.  That will only happen if we follow the simple behaviors and all get vaccinated.

But until the spread is halted, and the spread is not currently halted, not by a long shot, then gathering remains a deadly risk, and increasing case counts sets the stage for more mutations.

This means we are literally in a race between the vaccine and the mutations.  Our choices will determine if we win and how soon we do.

One problem we face already is the rapid spread of mutations that spread much more.  This is what might fuel a fourth American surge, one Dr. Fauci fears, if we continue to gather, may be the biggest, as pictured in the graphic above.

That race will not be over by camp time, it simply won’t.   My hope and expectation is that access to immunizations will only ramp up from this day forward.  Next week a million people will be able to get their COVID vaccine at their local drugstore every week.  The US has commitments for delivery of a total of 600 million doses, plenty for every adult in the US to be fully immunized.  By May I anticipate anyone who wants a vaccine will be far likelier to get one, and by September it is reasonable to hope the 80% of Americans who need to be immunized to stop this virus will be immunized.

As you can see the peak camp months of July and August come right in the middle of our reaching to victory over the virus, but I cannot be sure we will have dropped transmission enough to be safe to gather.

So as you make plans, our advice is to know that the situation is in motion, in the right direction, with lots of hope, but just how many Americans will be immunized, how many will get infected with current and new mutations, is unknown.  You might put a deposit down now only to find that it is unsafe to camp this summer.  We do not know.

The Missing Influenza Epidemic

It is now official, for the first time ever, that I am aware of, the winter influenza epidemic has simply not appeared through December and January.  Ever.  It appears this is the result of the steps taken to reduce gathering and highlights how much more contagious COVID is than influenza.  Real Answers has been imploring all of us to not gather and grieving at the nearly half a million deaths following our insistence on still gathering, but credit is due to all of us for the steps we have taken to reduce viral transmission of the influenza virus.  Our current level of reduce gathering has succeeded in snuffing out influenza transmission and disease and that is great.  But sadly it has been woefully inadequate to stop the spread of COVID.  We have been careful, and perhaps are closer to success than we think.

All towards making the extra effort to really snuff out COVID transmission, and all should know what has to happen for this to occur:

• Do Not Travel
• Do Not Gather
• If you must leave your home:
• Wear a mask
• Stay 6 feet apart at the very, very least
• Until High School Sports can Implement NFL level security, including daily COVID testing, Do Not Participate in Team Sports

This includes college students.  The phenomenon of gathering college students in dorms and apartments to study on-line has fueled much of the current COVID outbreaks.  A study just released by the CDC demonstrated that about 18% of all COVID cases in the state of Wisconsin were indeed driven by the spread of COVID on campus.  Despite virtual classrooms, no one should be surprised gathering thousands of young adults will spread the disease.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7004a2.htm

Bottom Lines

1. The NFL met their goal!  Football studied the complexities of COVID transmission as well as anyone and succeeded in stemming a surge.  The secret:  daily testing, NOT gathering especially in a car or indoors, wearing a mask, staying more than 6 feet apart, and staying away from each other for even less than 15 minutes.
2. The essential step of daily testing, proven to make a real difference in stopping the spread of the virus, has taken one step to becoming a reality.  Check out the home test, with results in 20 minutes, for $30 a test, from a company called Ellume, it is now approved and will be available.  Over time it will get cheaper and easier to get too.  Testing before school, work and play could really open up our lives and stop the spread, saving many thousands of lives.
3. COVID Vaccination has now been given to 100 MILLION people around the world, it is now very clearly very safe. EVERYONE should be COVID vaccinated to end this nightmare.   As of right now, you cannot get this vaccine if you are 15 years old or younger.  Studies underway will extend this to age 12 and up in the coming months.  11 and younger will be awhile.  This is the case even if your child has urgent medical needs for protection, as of now no exceptions to the age limit are being allowed.
4. This summer, camps will open very likely as we transition from a pandemic raging out of control to the dream of a pandemic finally coming under control.  Three variables will dictate the pace of our snuffing out the COVID wildfires:  1.  Will we be able to not gather?, 2.  We will vaccinate enough people?  3.  Will the virus mutate to more contagious and deadly forms that evade the vaccine?  July and August will very likely be months the pandemic still threatens, how much depends on the answer to these three questions, I suspect we will not have good enough answers to the three to really see it safe to camp this summer, but the ball is in play, stay tuned.  What we know for sure today is that we do not know what July and August will be like.
5. Keep in mind, the UK and other variants (viral mutations) are here and almost certainly will allow this virus to spread much more widely and easily, now is the time to decide not to travel, not to gather.
6. The Influenza Virus Winter Epidemic of 2020-2021 is now officially totally absent through December and January, a history making first in America!   This likely reflects the good work all of us have done in reducing contacts with each other, and also dramatizes how contagious COVID is.  We isolate enough to completely snuff out influenza virus epidemics, but even so, the COVID virus spreads enough to kill nearly half a million of us.

Putting this all together we once again plead this urgent advice for all of us, including our college students:

• Do Not Travel
• Do Not Gather
• If you must leave your home:
• Wear a mask
• Stay 6 feet apart at the very, very least
• Until High School and College Sports can Implement NFL level security, including daily COVID testing, Do Not Participate in Team Sports

My Takeaway – In One Sentence

With the hope that no horrible mutations will emerge, an end is in sight for the COVID pandemic, but it will take home testing, much less gathering, and a huge boost in COVID immunization, let us be vigilant the final months so that they really can become the final months.

To your health,
Dr. Arthur Lavin