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.

Spreadability

A recent study tracked just how many COVID-19 illnesses emanated from one event, and how that one event led to as much as 20% of all the cases of COVID-19 across the United States during a period of August, 2020.  https://www.iza.org/publications/dp/13670/the-contagion-externality-of-a-superspreading-event-the-sturgis-motorcycle-rally-and-covid-19

The one event was a rather massive rally of hundreds of thousands gathered in the small town of Sturgis, South Dakota.  Use of cell phone data (made anonymous), the researchers were able to find that those hundreds of thousands attending the rally went home and spread COVID-19 across the nation.

Excess cases topped over 250,000 cases, or about 20% of all the cases of COVID-19 in the US during that time. 

These observations support our last post that shared the observations from Dr. Atul Gawande that the SARS-CoV-2 virus creates large outbreaks, in unpredictable patterns, the so-called super-spreader effect.

This event is one of the largest super-spreader events on record in the world.

It features four features that seem common to all situations that invite COVID-19 outbreaks:

1. Crowding, especially indoor, but not necessarily
2. Close contact with others
3. No masks
4. Sustained time of contact

This rally featured all four of these features, and demonstrated they work.

So the point is that not every gathering of people indoors, over time, without distancing or masks will lead to an outbreak, but sometimes it does and sometimes it does explosively.

There really is a reason that those who succeed in protecting themselves from getting COVID-19 avoid being around lots of people indoors for more than a few minutes, keep at least 6 feet apart from everyone, wear masks- unless with a group they are confident is not infected and will remain uninfected.

COVID-19 In Childhood and College

The update on this front is not promising.

The hope that this pandemic would altogether skip childhood was dashed some time ago, but as of today, over 500,000 American children have been diagnosed with COVID-19.  That now constitutes nearly 10% of all cases in the US.  There is no doubt that children can catch this disease and can and do spread it.   It still remains very true that the younger you are the milder the disease is.

However, the threshold for very deadly disease continues to drop.  Very recently an otherwise completely healthy 20 year old young adult died of COVID-19.

College Update

Curious about how gathering over 20 million young adults onto college campuses is affecting the course of the American COVID-19 pandemic, check out the NY Times College Tracker:  https://www.nytimes.com/interactive/2020/us/covid-college-cases-tracker.html

This guide offers state-by-state and college-by-college information.  Colleges have really just started gathering millions of students across the nation so it is still to early to say what will happen, but early signs point to outbreaks already cropping up across the nation, with 100 colleges already reporting over 100 cases each.

Keep in mind that even a handful of cases, if put into a crowded indoor space with no masks for long enough, can spark very large outbreaks as noted in the tiny village of Sturgis, SD.

For those who like the OSU- U of Michigan rivalry, OSU is slipping with an early tracking increase in numbers of people tested coming out positive for COVID-19, and U of M holding steady at a very low rate.

School Update

The K-12 scene is much larger than college since everyone goes.  That means schools can gather as many as 55 million students into classrooms.  Many have either moved to virtual learning to avoid outbreaks, or taken measures to reduce spread including spacing, masking and creating sub-pods.

As with college it is too early to tell, but we have seen outbreaks in soccer teams, and heard of them in football and hockey teams.

In our own Cleveland and surrounding county communities, we will be watching for trends in testing positivity rates by age, reports of school outbreaks and how they are connected.  The concern is that an outbreak will launch a community spike in cases that could cost lives.

Treatment

As discussed in just the last post, over 100 vaccine candidates are at various stages of investigation and development with as many as 9 in what are called Phase Three trials, the last stop before approval for wide use is even considered. https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

Now we learn that one of the 9 in the last laps of development has hit a glitch.  Is is a viral vector vaccine that uses a harmless virus to deliver genes that direct our body to make a limited number of harmless SARS-CoV-2 proteins, that the body reacts to that in turn gives you immunity.  The company developing this vaccine is Astra Zeneca, and the vaccine is often called the Oxford vaccine.  Unfortunately, someone in the trial has developed a major side effect, so the trials of the Oxford vaccine are now on hold across all trials of this vaccine, around the world.

As we have advised all along, developing a new medical treatment is never guaranteed.  The wealth of so many successful inventions- X-ray, antibiotics, and yes- many vaccines that really do work and really are safe,- gives us all a sense that success in developing a treatment for any disease is guaranteed.  But it is not.

The situation on the vaccine front remains pretty much the same as it has been for some months.  There are promising leads, which is a far better situation than if all leads were failing.  We have many candidate vaccines for COVID-19, which is a far better situation than if there were only one or two.

But.

• No vaccine for COVID-19 has been yet developed that we know will work and will be safe.
• The Oxford vaccine story is common in vaccine development, and reminds us that even under the best of circumstances, we might not have a safe and effective vaccine for COVID-19 when all is said and done.

There is reason to hope a vaccine will stop the harm of COVID-19, and reason to worry that one will not.

One thing is for sure, good people of the highest integrity are working very, very hard to find a real, a safe, a working solution.

BOTTOM LINES

1. The very bizarre property of this disease, COVID-19, to not spread from this person and situation, only to spread like wildfire from that person and situation was on full display following a rally in Sturgis, SD infected Americans across the nation, at one point causing up to 20% of all known cases!
2. Therefore- avoid crowds, avoid indoor crowds, always wear a mask, always stay at least 6 feet away from everyone, unless you are in a group that is isolated enough you can be confident there will be  on exposure.
3. Over 70 million children and young adults are enrolled in school and college now.  More in college than school they have physically gathered.  Early reports heighten concern for outbreaks erupting given that the virus still spreads well across the US.  Time and careful tracking will tell.
4. Hopes for a COVID-19 vaccine remain realistic and strong.  Not for it being available by say, November 3, but sometime in 2021.  But they are just that realistic hopes.  The pause in a  major COVID-19 vaccine trial reminds us all that there is a very wide gap between a realistic hope and a real vaccine.

To your health,
Dr. Arthur Lavin