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

    COVID-19 Update March 14, 2021: Every Adult Get Ready to Get COVID Vaccinated; The 4th of July- A Path Opens to Joy, Will We Take It? Tracking The Approach of the End

    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.

    We remain in the Middle of the Pandemic, but the End now seems to be within grasp, this posting presents how we get to the End, and what will keep us in the Middle.

    Every Adult Get Ready, Soon All of Us Can Be Vaccinated

    It is now a solid promise and plan, by May 1, in just a few weeks, every person 18 years old and up, will be able to seek an appointment to get a COVID vaccine.  Everyone!  No more eligibility gates.  No more having to be over a certain age, or a certain occupation, or a certain illness.


    That means the ability to stop this Pandemic, really end it, is coming into the reach of every adult’s hands.  The time to start acting is now.  Start now to watch for how you can get your vaccine:

    • Check this website regularly and often, this is the main CDC page on COVID vaccine.  There is nothing on it now, but soon it will offer a national link to find an open appointment:  https://www.cdc.gov/vaccines/covid-19/index.html
    • Check the Ohio COVID vaccine website regularly and often, it will announce when Ohio lifts all eligibility requirements.  May 1 will be the latest any restrictions remain.  I fully expect that all eligibility requirements will be lifted much, much sooner than May 1.   In Ohio, the terminology for saying the vaccine is open to all over age 16 (for Pfizer) and 18 (all others) will be Phase 2: https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program
    • When you get the green light, which may be now if you meet a current eligibility requirement, but is everyone 16 or 18 and up once we open the gates, get vaccinated.   That means follow all leads:
      • Check the CDC and ODH websites above for how to get an appointment
      • Check the websites of your county Board of Health, here is Cuyahoga’s https://www.ccbh.net/vax/
      • Check the websites of all immunizations sites, for now, these come to mind:
        • The drug stores: Discount Drug Mart, CVS, Rite Aide, Walgreens
        • Walmart
        • Any others you can find or hear about

    The key is to check, and check again, that is how you get immunized.  So starting now, anyone not yet immunized should start looking, finding out a routine that works for you to monitor and checking.   Many of us know right now how much work it takes to find an open slot even now if one is eligible, so it makes sense for all of us to get ready for when everyone can get immunized.

    And also, I highly recommend a sense of relief with this effort.  For the last few weeks seeking an appointment has been a real pain, but the supply is about to gush.  Getting an appointment is going to get much, much easier every week.

    So as you start setting up the websites you will be monitoring, and websites you will be checking, know that getting these paths set now will pay off in not too long with a vaccine appointment.

    The 4th of July- a Path Opens to Hope, Will We Take It?

    It was also announced this week that should we all get vaccinated, and all stay careful until the Pandemic really ends, that this 4th of July, it may be safe already to gather, in small groups, for outdoor barbecues!!

    The key is what we do!

    As readers of Real Answers well know, there are four great forces at work in this Pandemic, two strive to end the nightmare, two will keep the virus raging.

    The two forces that will deliver the End of the Pandemic are the vaccine and our own actions to stay away from each other, both are essential to stop the spread.  And of course, the End will only come once the spread of the virus truly ceases.

    The two forces that will keep us from seeing this Pandemic end for many more dreadful and deadly months are the virus which will strive to mutate to escape the vaccine, and us, who cannot help but throw off all the cautions and gather before the End is achieved.

    The two forces that will keep the Pandemic on our necks, mutation and gathering too early, are tightly connected.

    This is because right now, all of us here in Cleveland, across Ohio and the nation, and around the world, live in a new moment of viral evolution.  Back in August, a virus that could escape the new vaccines and a virus stopped by the new vaccines had equal chances of infecting us and reproducing.  This is because the vaccines were not in use yet.

    But right now, the vaccines are creating millions and millions of people who have been vaccinated.  A virus stopped by these vaccines will fail when it lands on all the vaccinated.  Only viruses that have changed, mutated, to be able to infect and reproduce in people vaccinated.

    So right now, there is enormous evolutionary pressure that favors the SARS-CoV-2 virus mutant that figures out how to live in those immunized.  Or to put it more simply, right now evolution massively favors a virus emerging that will render all our vaccines useless, setting us way back to this winter and beyond.

    How does that really work.   Consider a 19 year old who attends college and who catches COVID.  As we know, everytime anyone gets COVID, the virus changes in them, almost always such a tiny bit it doesn’t matter.  But this 19 year old will surely breathe out SARS-CoV-2 virus that will be different than the handful that infected him.   Now imagine he breathes out a new form of COVID that the vaccine will not stop.  Back in August that virus would be no more successful, as we have noted, than any other regular COVID virus.

    But today, if that 19 year old breathes out a virus that can escape the vaccine, then that virus has a huge advantage over our current forms.   That new mutation can infect the millions who are vaccinated, and as we vaccinate millions more, then at some point only that type of COVID-19 virus will succeed in continuing to live.  That is a massive advantage.

    All of which is to say, right now, we live in a moment of huge evolutionary advantage to a mutation emerging that escapes the vaccine.   And so we live in a moment when it is most critical to shut down the spread, really until the spread ceases.

    Failure to do so will multiply the chances a COVID mutation will set us back to start all over, with all the deaths that entails.

    Putting this all together, we have it in our hands right now, to decide how the 4th of July will be.

    Will we all get vaccinated as soon as we can?

    Will we all stay at home as much as possible, when out wear double masks and stay 6 feet apart, will we avoid air travel or any travel with many people, will we avoid gathering except when and where the CDC lets us know is safe?

    If we do both, it will be a real 4th of July of hope and celebration.

    If we do not, I fear for what might come.

    Tracking The Approach of the End

    So now it has been asked, which path will we choose?

    Which means we need to find out, which path did we choose.  Today, are we closer to the End or have we stuck ourselves in an endless Middle?

    The best way to track our direction is by finding a tracking database, and then follow it.

    I really like the one put together by the Financial Times- https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938

    It has a number of great tracking graphics.

    • Vaccine rates. One shows how every nation’s vaccine effort is going, the US is at 30% of us having had at least one dose.  Israel leads the world at over 50% fully vaccinated.
    • Case rates.   This graphic is found is a tiny highlighted phrase “Explore the data here” in the small box titled How your country compares”  This is a very rich set of data that allows you explore all sorts of trends.
      • Case rates by country- you can select any country in the world
      • Case rates by state- you can select any state in the US
      • Case rates by raw numbers- how many actual infections were recorded, total- for any day, or cumulatively.
      • Case rates by per capita- you can track how many COVID infections occurred per day per 100,000 inhabitants.
      • Case rates in a linear graph- this is a good way to see the numbers go up and down.
      • Case rates in a log graph- in this graph the vertical, or y-axis- goes up by multiples of 10, so a straight line up on this graph would actually be an exponential rise.  Such graphs flatten the ups and downs and unless an exponential epidemic is upon us, will tend to underwhelm the observer
      • Death rates are also available, in all the above combinations

    Keep in mind that some numbers that you can now track can tell you if we are reaching the End of the Pandemic or remain stuck in the Middle, or if certain actions are safe.

    One example, when is it safe to open schools?  The answer is when the school is set up for safe gathering, AND the community rate of infection is less than 50 per 100,000 people.

    The marker of the End of the Pandemic is the figure 1 in 100,000.  If only 1 in 100,000 people in the US get COVID on a day, that would mean the number of new cases per day would drop from around 50,000 to 3,500.

    It is estimated that when the number of cases drops below and is held at below 1 in 100,000, the spread will be so close to zero that gathering can happen again, perhaps with masks, but a lot closer to normal.

    The United States, as of March 10 was at 13.8 per 100,000 people, and Ohio was at 12.8.

    So we are at levels that allow for schools to open if schools have the resources and plans to space and mask and pod safely, but we ARE NOT at the End of the Pandemic.

    We should all now be tracking this course of this Pandemic, we can, and if we do, we can know, is our nation, our state, our county below the rate of new cases below 1 in 100,000?  If not we cannot gather safely yet, except for very specific exceptions (e.g., now, the already fully immunized).

    Most importantly, we can look for ourselves and see if the situation is getting better or worse.

    We know this week and going forward, millions of us will feel like the Pandemic is over. Spring break will be packed, states are declaring an end to any steps to stay alive, people are tired of the whole thing.  Will these steps prove premature, will they launch a surge just when a surge, as we noted, is most likely to create the big mutations?   Now you can follow and see, I know I will be!

    Bottom Lines

    1. The time is now for everyone 16-18 years old and older to get ready to be vaccinated.  In the coming weeks, everyone should be.  To do so, everyone not yet immunized against COVID who is 16 (for Pfizer) or 18 (for all other vaccines) should put together their plan on how to monitor for when their appointments will become available.
    2. Keep in mind sometime in the next few months we will be asking everyone 12 and older to be vaccinated.
    3. The Pandemic is slowing, it is responding to vaccines, the vaccines work!  Just look at nursing homes.  BUT IT IS NOT OVER yet.
    4. If we want a fun 4th of July, we need to get vaccinated, and stay distant and masked until the spread actually drops below 1 in 100,000 cases a day.
    5. Should we fail, and gather too much, too soon, then we really do risk breeding major mutations, this is the time that new infections are most likely to create COVID viruses that vaccines do not work against.
    6. There are ways to track the course of this Pandemic, we should all be doing this, everyone should know, are our efforts working, is the End in sight, or is our rush to let go launching a longer Pandemic with so many more deaths?  We can see for ourselves.

    My Takeaway – In One Sentence:

    Let’s put this Pandemic to bed, if we get careless, now is the perfect time to help the virus mutate into a form that neutralizes all the help from the vaccine, setting us back to terrible lonely times.

    To your health,
    Dr. Arthur Lavin


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