• 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.

Vaccinating 12 and Up

We are anticipating being given authorization to offer COVID-19 vaccine to all youth in our practice, ages 12 years old and older sometime this week.  The final decision rests entirely in the hands of the first the FDA, then the CDC.

The studies on how safe and effective the Pfizer vaccine is for children 12-15 years old are completed.  What we know is that this vaccine works astoundingly well for children, some reports show 100% effectiveness!  At this moment, the FDA is completing its review, and what we are told is that they are very likely to grant authorization as soon as Monday or Tuesday.   Once the FDA issues its authorization, the vaccine goes to the CDC for consideration on whether they will recommend universal vaccination of all children ages 12 and up.

We can only begin to actually administer COVID vaccine to youth 12-15 years old once both the FDA issues is authorization and the CDC issues its recommendations to do so.  We anticipate the final, CDC signal to proceed may come as early as this Wednesday.

Right now, our schedules are open to book any youth in the practice that is 16 years old or older.  Until the CDC takes this step, we will not even open our schedule to give COVID vaccine to those 12-15 years old.  But the moment the CDC does take this step, we have Tuesdays and Friday afternoons already set aside, to make COVID vaccine available for them.

A note on avoiding wastage.  Each vial of the precious Pfizer COVID vaccine lasts only a few hours after thawing, and each yields 6 doses of COVID vaccine.  This means that should we book say 50 people on a given day for COVID vaccine, we will need to thaw out 9 vials.  If we thaw out only 8 vials, we will have only 48 doses available, not the needed 53 doses.  So we will need to thaw out 9 vials, and will then have 54 doses available, but will only be able to give 50 doses.  That situation will force us to waste 4 doses.

The point is that we will try to the best of our ability to have appointments on any day we give Pfizer COVID vaccine in multiples of 6.  We mention this because some days we will of course find our appointments do not add up to multiples of 6, and we will reach out to some on that day to consider another day so that we can arrange to come as close to multiples of 6 doses given every day we give this vaccine.

Thank you all in advance for your patience and collaboration in getting all our children safe.

A Word on Safety 

As we approach opening the door to protecting more of our children from the dangers of COVID, it is more than appropriate to ask questions specific to the vaccine and children.

Readers of Real Answers will be very familiar with the fact that the technology that created the COVID vaccine, namely mRNA vaccines, is not new.   Many families are concerned that this vaccine is too new to trust.   The actual application of mRNA technology to the COVID crisis at hand is new.  But the technology that defines it is 30 years old.  Science has been looking at mRNA vaccines for 30 years, and during these 3 decades, thousands of hard-working scientists searched for paths to use mRNA that would work and would cause no harm.

They looked directly at how to use the signal of mRNA to protect from an illness and make it work.  That took years and years of trial, observation.

And, they looked directly at where the information mRNA in a vaccine actually goes in a body, in a cell.  Does that information simply lead to the desired result, getting our cells to make the desired protein from the feared virus, in order to make us immune from its harm?  Or does the bit of genetic code stimulate other actions in our cells, unintended actions, unexpected harms.  The teams the developed mRNA vaccines over the last 30 years, looked at this question.

And so the work, the very hard work, the very long work, of seeing, could an mRNA vaccine work, could it really be safe, has been done.  It was done before anyone even thought about making a COVID vaccine.  This is really very good news, because now we have a very, very effective and a very, very safe, new approach to making all vaccines, the mRNA approach.

It just so happens the first virus to come along after the 30 years creating the reliable ability to make mRNA safely and effectively is this COVID vaccine.  I consider us very, very lucky that we have this proven technology at hand.  Otherwise millions more of us would be guaranteed to die.  It is truly a life-saver!

The other worry we hear is that parents, very justly, are asking, how do we know if we give our child a COVID vaccine today, what impact will such an intervention have on this child over the course of their next, hopefully, 100 years of life?  That’s a fair question, and to be very honest, no one knows how anything we do that is new will turn out 20, 40, or 100 years later.  But there are three reasons to reasonably expect this to be easily the best choice to make:

The choice is not whether to give your child the COVID vaccine

As long as COVID sweeps across our world, nation, and community, everyone who is not immunized, is at very real risk of getting COVID.

And so as long as COVID transmits, and it is transmitting quite a bit right now here in the US, Ohio, and Greater Cleveland, anyone not immunized faces getting this infection.   One thing we know for sure is that when it comes to unpredictable, potentially terrible problems, getting infected with COVID is pretty risky.  The more we look, the more we see some terrible problems following infection.  There are children who have had months, and still persisting, loss of cognitive ability after being infected with COVID.  There are reports that as many as 70% of adults have suffered persisting psychiatric problems after being infected with COVID.

Also consider, across the course of history, in every single instance, without any exceptions, every serious illness has been so much worse than its vaccine.  The polio vaccine simply is nearly infinitely safer than getting polio, and so it is with the meningitis vaccine, and really all vaccines for all deadly diseases.   I have no doubt that the same is true of these COVID vaccines, they are vastly, vastly safer than having COVID.

At this time the COVID vaccines have been given to over 1 billion people.  This technology is not new.  We now have the experience of over 1 billion people receiving this vaccine in real life, with no real harms seen beyond allergic reactions for the Pfizer and Moderna vaccines.   Many, many 16-17 year olds have received the Pfizer vaccines with no harm too.

So, for any parents of children, it is so important to keep in mind, no one has the choice to simply decide whether to give your child the COVID vaccine, as long as the virus spreads.

The only choice we actually have in front of us as parents is this:  being possibly harmed by COVID, or being vaccinated.   Both of course include some risk, but there is no question that the risk of infection is vastly greater.

Please, do have all your children immunized to keep them from being harmed by COVID, from spreading it to others, as soon as their age allows.

Hope is Here- Only through Vaccination

Anyone seriously following the catastrophe we call the COVID Pandemic knows that this has been a scourge taking countless lives, and that since its appearance, there have been moments of good news, but they keep alternating with more disasters.  One look at the Pandemic raging through South America and India tells us this is the essential nature of this infection.  When allowed to rage, disaster swiftly follows in its path, every time, everywhere.

As a result, readers of Real Answers, have sadly been subjected to very worrisome facts over the last year and more.

Very recently, we have emphasized that we are not at the End of this Pandemic.  Even as life seems safer, we have been warned, while the virus spreads, the danger of loss of life and chronic suffering remains.

As of this writing, our United States, and our community, is not yet safe, we remain squarely in the Middle of the Pandemic.  The virus is still spreading.  Right now in Ohio, we are registering 11.4 cases of COVID per 100,000 Ohioans.  That’s better than it was, but not an End to the Pandemic.   In fact we were at 11.4 at the peak of our terribly horrific summer of ’20 surge.

That rate of 11.4 is very slowly decreasing from 16 in mid-April.

So make no mistake, the danger is not yet over.

But really for the first time since February of 2021, a very long time ago, when these COVID Updates first began, we can see the suffering end.

The reason comes down to one word- Vaccination.

Solely because of the COVID Vaccine, our nation is starting to see agonies on a catastrophic scale finally begin to end.

The example of the most vaccinated nation in the world just now is highly instructive.  That nation remains Israel.

As of today 56% of all of Israel is vaccinated against COVID.  Curiously, Israel exploded into vaccination early this year, and raced past all other nations to reach over 50%, one of the only nations to this day to do so.  But something happened at 56%, the rise halted.   About 44% of Israel appears to have firmly decided not to get vaccinated for COVID.  And yet, despite sitting at 55-56% vaccinated for over a month, it has dropped below 5 cases of COVID per 100,000 citizens since March 31.   It is today at 0.7 cases per 100k people, one of the very lowest in the world.  For the first time in over a year, perhaps since the Pandemic really hit Israel, the nation has days with no cases and no deaths- transmission at epidemic levels has ceased.   And this in spite of the nation essentially dropping most restrictions and nearly half of the nation unimmunized and gathering.

As of today, the United States is at 33% immunized.  In my humble opinion, the drop in cases and deaths in the US is tracking here just as in Israel, suggesting that maybe, when we hit 55% immunized, our transmission will drop below epidemic levels.

That means we await 22% of America to get fully immunized.  If all vaccinations are 2 dose regimens, that would mean we need 144 million more doses given.   We were getting to 4 million doses given a day, but it is dipping sharply and now down to nearly 2 million doses a day.  Which means it will be a longer time than we once thought before we hit 55% immunized for COVID.

If we can maintain 2 million doses a day, we will hit that 55% mark no later than 72 days from today, which will be July 20.

If we can get back to 3 million doses a day, we will hit the 55% mark sooner, perhaps as soon as the end of June.

Once daily deaths from COVID cease being an expected occurrence in the US, we can really believe the Pandemic has left this current deadly Middle phase, and we will have entered the End of the Pandemic.

The only path to make that happen sooner is vaccination.  Again, over 1 billion are immunized and doing fine.   China has a vaccine recently authorized by the WHO to be used in large quantities around the world, so not just the rich nations will see the Pandemic end by vaccination.  India today looks as bad as the US did in 2020, both showing us the hideous face of not protecting ourselves.   We fervently hope that Western and Asian vaccines put out the COVID fire across India, parts of South America and wherever this deadly fire burns.

But the main point is that these vaccines work, they work well enough to end the dying, reliably and safely.  The End is in sight, and it is called Vaccination.

How Should the Immunized Gather?

Now that 1/3 of all of America is fully immunized, over 100 million people now have at least a 95% reduction in the chances of getting seriously ill from COVID.

There have been almost no cases of COVID or death from COVID given by a fully immunized person to a fully immunized person.

And therefore, it appears very, very safe for fully immunized people to gather.  Until we are truly in the End of the Pandemic, and as long as we remain in the Middle, it still seems important even for fully immunized people to avoid large groups, particularly indoors.  Who knows who is immunized in public gatherings.   And so wearing masks and staying distant remains important.

On that point, the CDC has found you can catch COVID from the air at distances longer than 6 feet.  The 6 foot distancing remains important, and far better than closer, but the fact that fully immunized people can gather, does not eliminate the chance of deadly disease at a distance for those not immunized.

And so I will remain wary of airplane travel for the time being, and avoid indoor crowds.  And when in public outdoors, wear a mask and keep a good distance, more than 6 feet now.

The one major question of the moment is what about family and friends gathering in small (<25-50 people) groups?

Given the drop in cases in the US, the rising trends of immunization, some relaxation appears to be reasonable.

Our recommendation is that for any small group of family and friends whose adults are fully immunized, it seems safe for them to gather with unimmunized children outdoors and spaced.   If a fully immunized household (one household) visits a partially immunized household (also one household), it remains safe for the two households to gather even indoors, even hug, and not wear masks.

Bottom Lines

1. We remain in the middle of this horrible pandemic.  Yesterday 44,000 of us were known to be infected with COVID and over 650 of us died.
2. Our only hope of ending this pandemic soon is to vaccinate at least 55% of humanity.  But that possibility is within our grasp.
3. It is easily within our grasp in our nation.  All we have to do is agree to be vaccinated.  We are exactly 60% of the way to this goal.
4. Had we reached 5 million doses a day and held, the pandemic could have ended by Memorial Day.   At our current rate it will not really end until late July.  If we go from our current 2 to 3 million doses a day, we can see the epidemic nature of this end by the end of June.
5. Next week we anticipate the FDA and CDC authorizing children ages 12 and up to be COVID vaccinated.  We have the vaccine in our office right now, waiting for the go ahead from the FDA and CDC.  As soon as they give it, we will be able to schedule your children ages 12 and up.
6. We urge all families to have all their children 12 years of age and older to get the protection only a COVID vaccine can give.
7. The technology behind the COVID vaccines is not new, it is 30 years in the making.  Over a billion people have received it, with no harm beyond rare allergic reactions for those getting Pfizer and Moderna.
8. Clearly, the very real dangers of having a COVID infection far, far, far outweigh the risks imagined for the COVID vaccine.
9. One huge benefit of our nation’s success at immunization is that now over 100 million Americans can visit each other without spreading the deadly virus.  As noted above, one fully immunized household can visit a partially immunized household with no restrictions.  And it now is reasonable for fully immunized adults to gather in small groups outdoors with their unimmunized children, distanced and masked.

My Takeaway – In One Sentence:

The Pandemic has been brutal, tragic, deadly and the vaccine offers the only door to end the suffering anytime soon- may we all join the other 100 million of us and vaccinate all who can as soon as we can.

To your health,
Dr. Arthur Lavin