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

    COVID-19 Update March 2021: The Door Opens for the Fully Immunized- in Small Gatherings, the Pandemic Continues to Rage and a Particularly Ripe Time for Mutations

    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.

    The Door Opens for the Fully Immunized- In Small Gatherings

    On March 8, 2021 the Centers for Disease Control and Prevention, the CDC, issued its first ever relaxation for gathering, a relaxation strictly limited to the emergence of a new category- the fully immunized.


    COVID vaccination is surging, and, so far, no truly menacing mutations have appeared to stop their impact.

    Fully immunized people have nearly eliminated their risk of dying from COVID-19, no matter what brand of vaccine is given.

    We still do not know if a fully immunized person can spread the disease, so if you are fully immunized, it still a very bad idea to gather in crowds, even medium-sized groups, with unimmunized people.

    Fully immunized means you are at least 2 weeks post getting two doses of the Moderna or Pfizer vaccine or one dose of the Johnson & Johnson vaccine.

    Gathering- Now OK for the immunized and the unimmunized at low risk of severe disease, but keep it small.

    If you are fully immunized here is what you can do now, note that now recommended gatherings are still only recommended in small groups:

    1. You can gather with other fully immunized people no matter their age, indoors or outdoors, with no mask, with no distance.
    2. You can gather with one other household of unimmunized people who are at low risk of severe COVID-19 disease, indoors or outdoors, no matter their age, with no mask, and with no distance.

    On this second point, this means fully immunized grandparents can now visit with one household of their child and grandchildren without restriction.   If another household with unimmunized people joins in, then it can only be outdoors, with masks, at least 6 feet apart.

    Quarantine for the Fully Immunized

    If you are fully immunized and you come into contact with someone infected with COVID-19, you do not have to quarantine, or be tested unless you develop symptoms.

    If you  are fully immunized and you come into contact with someone infected with COVID-19, and you develop symptoms in the following 14 days, you should be tested and quarantine pending test results.  Quarantine ends if the test is negative for COVID, and if positive, on Day 11 where Day 1 is the first day of symptoms.

    The Pandemic Continues to Rage 

    The good news is that the vaccine rollout is moving fast, we are on track to have enough vaccine doses in hand for all adult Americans by Memorial Day.  The further good news is that no new mutations have emerged, yet, that will spread widely across an immunized nation.

    But we remain squarely in the Middle of the Pandemic.  As of this writing, the US is still experiencing about 60,000 new cases a day, and for Ohio that number is 1,500.  For both the US and Ohio, these case numbers are about where we were in mid-October.  This puts our current level of deadly spread at the highest level in Ohio from the start of the pandemic through mid-October, and for the US we are a level that was never this high until mid-October.

    We are much better off, but we still live in a nation where the virus is spreading rampantly.

    The hope is that the spread will continue to drop and in not too, too long, nearly cease.

    That will only happen if enough of us get vaccinated and if enough of us continue to take the basic steps to prevent spread.

    Remember, should we hit 5 million vaccines a day (we are up from 0.5 to 2.0 million a day now), and stay careful about not spreading it, we could see the pandemic essentially come to an end sometime in April-July, still losing 80,000 more lives.

    But if we drop vaccines to 1.5 million a day, drop masks, drop distancing, there will be no end in sight and we will lose over 500,000 more lives.

    And so we celebrate the power of vaccines and taking steps to stop spread, they are why the fully immunized can visit single households without a mask, do not need to quarantine after contact if not symptoms occur.

    We are in the Middle of the Pandemic, but this step tells us we have the End within our grasp.

    The End will come sooner if we continue to do what we can to bring it- get vaccinated, wear masks, do not gather in crowds at all, do not gather in small groups unless fully immunized, do not travel, wash hands, stay distant.

    A Particularly Ripe Time for Mutations

    As readers of Real Answers know, mutations are simply changes in a living system.  In this case, changes in the SARS-CoV-2 virus.  For most respiratory viruses, the virus that comes out of a person is different in some ways than the one that started the infection, that is, the virus tends to mutate during the cold or illness.  So it is with this virus, the dread virus that causes COVID-19.

    For most of the last year, the usual SARS-CoV-2 virus could jump from person to person without having to worry about who was immunized.  Just about anyone it landed on could be infected, copies made, and it lives on.

    But now, more and more people around the world are immunized and if the virus lands on them, it may not even be able to land, copy at all, certainly not copy a ton of copies.  So the virus will be stymied, that is after all the whole idea.

    This now sets a dreadful stage.  Say someone in the world happens to breathe out a SARS-CoV-2 virus that the antibodies made by an old infection or from the vaccine no longer work.  This virus will have a huge advantage in a world where most adults are immunized.  Such a virus would have no advantage last year when no one was immunized.  This now very real advantage means that surges of COVID as lots of people get immunized, are THE time when mutations that no longer are affected by vaccines arise.

    THE POINT is that it is exciting to see vaccines arrive, to get them, to feel the end is here and our troubles are over.  It is SO tempting to fling the masks away, to travel, to gather with friends and family.

    But EVERY time we have done this over the last year, we get a surge.  And surge is too weak a word, we get a tsunami of disease and suffering, now costing well over half a million of our lives.

    If we relax before the actual End of the Pandemic, especially now, we risk letting loose the big mutation and putting all of us, even the immunized at risk.

    Bottom Lines

    1. COVID-19 continues to spread across the United States causing illness and much death in its path.  We remain firmly in the Middle of the Pandemic, only one group is approaching, not in, the End phase of this Catastrophe, the fully immunized.
    2. For the fully immunized, it is now deemed safe to gather, but still under very tight restrictions.  The gathering is limited to one other household in addition to the fully immunized, and cannot include anyone who is at risk of severe COVID disease beyond the low risk level.
    3. The unimmunized can only be deemed at low risk if they have no known risk factors.  The risk factors include being older than 65, and having various medical conditions including high blood pressure, heart disease, obesity, diabetes.
    4. For the fully immunized the door is now open to be together with other fully immunized people.
    5. For everyone (!), even the fully immunized, it is still not yet time to gather in medium or large crowds, no one should be travelling who does not have to, masks and keeping distant remain extremely important.  Failure to continue these basic steps fans the rather considerable remaining flames of this raging Pandemic.   Fanning the flames is the best way to breed major mutations that could nullify all protections from the vaccine.

    My Takeaway – In One Sentence:

    We are so close, the fully immunized can now experience so much more, let us all stay resolved to remain masked and distant, to get immunized, to do all we can to end this nightmare.

    To your health,
    Dr. Arthur Lavin


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