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 (genes and protein coat), and on it goes.
• Variant- also known as a mutation, a variant strain of a virus is the same species of virus but with a change in the genetic code.  The change is minor if it has no impact on contagious the new variant is, or how deadly it is, or if it allows the virus to neutralize our vaccines. Variants that substantially increase harm are now listed by Greek letters, the most troublesome one now is Omicron.
• 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.
• PCR Test–  swabs the nose to detect the genes of the COVID virus.  The genes if detected are almost certainly there, but they can persist long after contagion ends.  Very few false positives, positives can be trusted.
• Antigen Test (the home kit)- swabs the nose to detect the proteins on the coating of the COVID virus, the spike proteins.  If it does not detect those proteins, you are almost certainly not infected, negatives can be trusted.  These proteins are also on the coating of many common cold viruses, so one positive test may indicate you have a cold rather than COVID.  Two positive home tests though reliably indicate you have COVID.
• 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.

Updates During the Great Lull of 2022

• Variant Update
• Vaccine Update
• Proof of Choices Saving Lives

We have been profoundly fortunate that the SARS-CoV-2 virus has taken a break from tormenting us so fiercely, at least here in Ohio.  This lull has been very real, with the number of people killed by this virus around the nation and in this state continuing to plummet.  In Ohio the chance of dying from COVID is, for now, at the lowest in the pandemic.

Readers of Real Answers will be familiar with the number that tracks how many get infected each day, that is the number of new cases per 100,000 people in any community.  And you will recall that if that number goes over 20, we have dangerous levels of transmission.  We are right now at 4.6 which is terrifically low.  Here in Cuyahoga County numbers of new cases also are extremely low.  We have seen some reports of a few cases, more than the zero new cases in our practice of the prior 4 weeks, but still quite low.

During this moment of lull, it makes sense to take a look at the situation from 3 perspectives.

Variant Update

As all know, the virus solely responsible for all COVID infections, SARS-CoV-2 changes as it copies itself during every infection, but to date only three types of the virus have been different enough to change the course of  our human experience of this disease.  Those 3 variants have been:  the Original, the Delta, and the Omicron variants.   At this time, the Original and Delta variants have been completely eliminated from circulation by the astounding success of the Omicron variant.

At this time, if you get COVID, you will almost certainly be infected with the Omicron variant.  That does not mean the virus has ceased changing, in fact we are seeing new variants emerge all the time even now.  As you may recall from a recent post in Real Answers, there have only been 3 variants that have dominated infection because to dominate, a new variant has to copy itself far better than the current variant.

Right now, all the types of SARS-CoV-2 virus successfully spreading are still of the Omicron variety.  There are a number of sub-variants in the Omicron variety, and some of these spread even more wildly than the wildly successful Omicron original.  In Europe over the last month or two the dominant sub-variant was the BA.2 variant.  Then a few weeks ago, that BA.2 variant began to cause a mild surge in the NorthEast of America, and just a few days ago we learned that in NYC the BA.2 had spawned a couple of new sub-variants that spread even better than the BA.2, likely causing the mild surge in NYC to stand out.

What this all means is that no variant of the SARS-CoV-2 virus has yet found a way to outperform Omicron.  And it is plausible that none will. Omicron currently ranks as one the most wildly successful viruses at spreading that exists.  Again, readers of Real Answers will recall that the key number here is the average number of people who one person with an infection will tend to infect when ill.  For influenza that number is 1.6, for the common cold that number is around 2 and yet these viruses still find a way to infect everyone.  Keep in mind that this number becomes the base of an exponent that defines how many people will get the infection over any given number of rounds.

So consider that number being 2 .  That means on average each time someone gets the infection they will spread it to 2 others.  And then each new person will spread it to two others.  So one case becomes two, then two becomes four, then 4 becomes 8.  Do this 10 times and one case becomes 1,024 cases.  That’s called spread.   Now make that base number 6, one person now infects 6 each round.  Now one case in ten rounds becomes 60 million cases.  Now, let’s go to BA.2 where that number is 12, now one case after 10 rounds of everyone giving it to 12 people goes to 62 billion cases.   But now come the new BA.2 subvariants, BA.2.12 and BA.2.12.1 whose reproduction number range as high as 15.2, meaning one person with COVID will spread on average to 15.2 people and if that happens 10 times, one case becomes 658 billion!!

There are few known germs that spread so astronomically well.  In fact, the only one I could find is the measles virus whose reproductive number is in the 12-18 range, making some BA.2 subvariants of COVID more contagious than the most contagious of all common viruses, measles.  But at the max, measles spreading on average to 18 people for every one case means after 10 rounds of everyone with it spreading it to 18 people, the one case becomes 3 trillion cases, still topping BA.2.12.1.

One might ask, if a virus, after 10 rounds of spreading can go from one infected person to 658 billion infected people, and there are fewer than 8 billion people total, why doesn’t that infection spread to everyone in a month, or faster, across the whole planet?  The answer is that the reproduction number reflects spread unimpeded- no masks, no social distancing, no immunizations, no prior infections, no travel barriers.  Each and all of these slow spread.   But the more contagious, the more wildly a variant can copy itself, the more people will get it, and we have seen that.  By far the most massive surge of COVID across the entire epidemic across the entire world was with Omicron.  Prior to Omicron, a new case rate of 200 new cases per 100,000 population was devastating, Omicron pushed the US to 400!!

But immunizations kept those vaccinated out of the hospital far more than the unimmunized, blunting the harm done by the vast numbers of infected.

Vaccine Update

The main finding when it comes to vaccine remains unchanged.  If you don’t want to die from COVID the only sure path forward is to get vaccinated.  Now we have Paxlovid and perhaps an even more powerful medication to treat serious COVID infection, sabizabulin, will be in use soon too.

The main news on vaccines is all about kids.  The FDA has reported that a booster dose, the third dose, for 5-11 year old children does indeed strongly boost antibody to COVID, quite high.  What has not been published is the impact of a third dose, a booster for 5-11 year olds on their risk of severe illness.  For older adults, the risk of getting COVID without full protection of COVID vaccines still causes nearly 400 deaths a day, but fortunately the disease is milder in younger children.

I look forward to all the data being weighed, and if the booster helps protect 5-11 year olds, I will of course be in full support.

The development of a COVID vaccine for our youngest, our 6 month old to 4 year old children.  This vaccine came close to approval as long ago as last November, then last February, and we eagerly awaited expected news on its development this April.  At this time both Pfizer and Moderna are working hard to complete trials to deliver solid information on how well their vaccines protect our young children from this serious infection.  But there are not dates being discussed for approval of either vaccine for our youngest.  The wait has been maddening, frustrating.  Once the vaccine approach that works and is safe is proven and adopted, of course, these frustrations will end and our youngest can get protected.   But until then, it remains important to do all we can to protect them from COVID infection.

Proof of Choices Saving Lives

The final news in this COVID Update comes from the fact presented by the March 11, 2022 issue of the Journal of the American Medical Association-  https://jamanetwork.com/journals/jama/article-abstract/2790238

In this careful review of how lives fare in various states according to choices made by leaders in various states, it is established that the chance of dying from COVID varied across states mostly by these choices.  In states where steps to save lives from an infection that kills people were taken, the chance of the infection causing death was cut substantially in comparison to states where the leadership opposed taking steps during a deadly pandemic.  And the difference was dramatic.  The chance of dying from COVID was over double in the states that decided to oppose steps compared to states that decided to take steps to save lives.

These sentences declare the obvious.  When danger attacks, when lives are threatened, you are more likely to live if you block the danger.  How tragic that such an obvious reality was crafted into a controversy.  Real Answers presented the comparison with the observation that choosing to ignore the threat cost the lives of 1 million Americans, and choosing to get the vaccine saved the lives of another 1 million Americans.

The proof that choices save lives could not be more striking.

Bottom Lines:

1. We are still living in the longest, safest lull of COVID here in the Cleveland area.
2. Omicron remains the dominant variant of COVID around the world.  Its BA.2 subvariant is causing mild surges around the world, and versions of the BA.2 Omicron subvariant are circulating in the East Coast of America.
3. Omicron is wildly contagious, and its BA.2 subvariants are even more so.  The only common virus exceeding the levels of contagion of BA.2 and its subvariants is measles.
4. Vaccines remain the greatest wall against harm from COVID, including BA.2 and all its currently spreading variants.  These variants still are deadly without vaccination, killing over 400 of us every day.
5. For everyone 12 and up, get 3 COVID vaccines if you want to be protected from real harm.  For everyone over 60 years old the number for protection is 4 vaccines.  And for those 12-60, that number is 4 if you have medical conditions putting you at extra risk.
6. Finally, recent data demonstrate beyond any doubt that choices we make have life and death consequences, most dramatically at the state level.   But it also means if you choose to get vaccinated, you can protect yourself from negligent state policies.

My One Takeaway Sentence:
Enjoy the COVID lull and the Spring, but to do both, you need to get vaccinated, fully, and now.

To your health,
Dr. Arthur Lavin