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.

New Big Numbers:   0  and 5

The New Guidelines for Isolation and Quarantine

The CDC issued new guidance and recommendations for everyone of us when it comes to managing staying away from others to stop the spread of COVID.

Here is the new guidance and its rationale, direct from the CDC: https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html

The key change is that the CDC has dramatically reduced the time people who have COVID, or those exposed, need to be away from everyone.

There are now recommendations that cover THREE key situations:

1. If you are known to have COVID, you must still stay away from others, this is called Isolation.
2. If you are exposed to COVID, your need to stay away from others depends on if you are fully vaccinated, this is called Quarantined. And so there are two groups of the exposed, not known to be infected, each with their own recommendations:
   • The exposed and fully vaccinated
   • The exposed and not fully vaccinated.

Let’s look at these three groups now.

Known to have COVID- How to Isolate

Who is known to have COVID?  Only one way- you test positive- by PCR or rapid test

If you test positive, immunized OR not, the new rules are:

• Stay at home 5 days (not 10)
• Your isolation ends on day 6, where day 1 is the day of your TEST, only if your symptoms have fully ended OR are resolving unless one of your resolving symptoms is fever.  If fever is present you must remain isolated until the fever has fully ended.
• If you leave isolation on day 6, you have to wear a mask around anyone for days 6-10.

Known to be a direct contact AND FULLY VACCINATED- How to Quarantine

Who is known to be a direct contact?

A direct contact is anyone who has spent more than 15 minutes within 6 feet of someone known to have COVID and contagious at that time.  Keep in mind the new guidance above changes who is a direct contact.  You can now be with someone known to have COVID, on day 6 or later from their positive test, who has no symptoms, and no longer be a direct contact.

Who is fully vaccinated?

• Anyone with 3 mRNA (Pfizer/Moderna) vaccines, or boosted J&J vaccine
• Those whose 2nd mRNA vaccine was LESS THAN 6 months ago
• Anyone whose 2nd J&J vaccine was LESS THAN 2 months ago

For anyone ages 5-15 years old the only option is Pfizer, and a 3rd dose is not yet authorized.  So you can only be considered fully vaccinated if you have had 2 Pfizer doses AND your last dose is less than 6 months ago.  Once boosting is approved for your child’s age group, they can enter the realm of fully vaccinated after 6 months of their 2nd dose by getting a booster.

If you are in direct contact with someone known to be in their contagious stage of their COVID infection, AND you are fully vaccinated:

• YOU DO NOT NEED TO QUARANTINE AT ALL
• You HAVE to wear a MASK for 10 days from your last day of contact
• You SHOULD get a test at day 5 to prove you did not get COVID from your contact, but it is not required by the CDC
• If you develop any symptoms, get a test and stay home pending the results.

Known to be a direct contact AND NOT FULLY VACCINATED- How to Quarantine

Who is known to be a direct contact?

A direct contact is anyone who has spent more than 15 minutes within 6 feet of someone known to have COVID and contagious at that time.  Keep in mind the new guidance above changes who is a direct contact.  You can now be with someone known to have COVID, on day 6 or later from their positive test, who has no symptoms, and no longer be a direct contact.

Who is fully vaccinated?

• Anyone with 3 mRNA (Pfizer/Moderna) vaccines, or boosted J&J vaccine
• Those whose 2nd mRNA vaccine was LESS THAN 6 months ago
• Anyone whose 2nd J&J vaccine was LESS THAN 2 months ago

For anyone ages 5-15 years old the only option is Pfizer, and a 3rd dose is not yet authorized.  So you can only be considered fully vaccinated if you have had 2 Pfizer doses AND your last dose is less than 6 months ago.  Once boosting is approved for your child’s age group, they can enter the realm of fully vaccinated after 6 months of their 2nd dose by getting a booster.

If you are in direct contact with someone known to be in their contagious stage of their COVID infection, AND you are NOT fully vaccinated:

• You need to stay home, quarantine, for 5 days
• You HAVE to wear a MASK around everyone for the next 5 days
• The OPTION of not quarantining is recognized as something that might happen, not recommended, but if it happens you should wear a mask around everyone for 10 days
• You SHOULD get a test at day 5 to prove you did not get COVID from your contact, but it is not required by the CDC
• If you develop any symptoms, get a test and stay home pending the results.

Omicron- The Everywhere Difference

In recent posts we presented the rather staggering difference a huge jump in contagiousness brings to a situation.

The jump in contagiousness from Omicron has been known, but now it can be seen.  It can be seen in the numbers of cases which is skyrocketing, and it can be seen in our schools and even neighborhoods, where all sorts of people are finding out they have the Omicron COVID.

The fact is that once a germ achieves extreme contagiousness, spread takes on a whole new character.  Back when the average person with COVID would spread it, if in contact, to about 2.5 people, we could stop or slow the spread across the unimmunized with careful practices of keeping distant, staying home if in contact, etc.   But now that number is 12.  That means across 10 rounds of one person spreading it to the average number, and then each of them spreading it to the average number, the change from 2.5 to 12 per round, means if left unchecked, the number of cases spreading from one case jumps from 1,000 to 10 billion!!!

Again, we will never see everyone on the planet getting Omicron from one case in only 10 rounds of spread- vaccinations, isolation, avoiding gatherings dramatically slow the spread.

But the point remains, Omicron is crazy contagious, and so I fully expect it to fully blanket the planet.   And, once a germ both achieves high spread and is widely spread, it will of course spread to nearly everyone.  Those who are vaccinated will be protected, those who are not will not.

A good way to understand the situation is the analogy of a forest fire, a painful resemblance these days.   If you think of every COVID infection as a small fire, the question is how to keep it from exploding into a mega forest fire?  Think about water and the forest.  If the forest is pretty dry and the wind is whipping up, a mega forest fire can light.  But if the forest is soaking wet and it is pouring rain, no forest fire will happen.  Again, if the forest fire is raging, pouring water on some trees may save them, but won’t put the fire out, it will spread to even moist timber, only the soaking wet will be spared.

We know this scenario from decades of experience with measles, which also spreads on average to 12 new people for every new case, but for which a vaccine exists to stop it.   What we learn from measles is that about 95% of the forest must be soaking wet, or a forest fire will light up.  In groups where about 10% or more of the population is not vaccinated against measles, we routinely see major epidemics explode.  And here is an important point, when the fire gets that hot, the fire spreads to the immunized.  But, get a population to 95% immunized, and no outbreaks, occur, and if a case happens it will not spread to the immunized.  We have seen this in neighborhoods, colleges, over and over and over.

And so it is with Omicron COVID which spreads very much like measles.  Even as of this week, Montgomery County Maryland, 98% immunized, reports ZERO CASES OF COVID, despite being surrounded by a raging forest fire of COVID.  But drop the immunization rate below 95%, and essentially everywhere, below 85%, and there are now enough trees to sustain a mega forest fire of Omicron COVID.  And once the fire rages, even the immunized are getting burned.

By a great stroke of good fortune, those of us who are fully immunized who are catching the sparks of Omicron COVID, are nearly all saved from severe disease and death, but we can spread it to the unimmunized who are full risk of hospital level disease, and dying.

Bottom Lines

1. We have New Rules for how to stay away from everyone if we have COVID or if we are directly exposed.
2. If you have COVID, isolation drops to 5 days where day 1 is the day of your positive test, IF your symptoms resolve or are resolving by Day 5.  Fever is the one symptom that can be resolving that if present keeps you isolated.
3. If you do not have COVID but are directly contacted AND fully immunized, no quarantine now, should get a test on Day 5 to prove you did not catch it.
4. If you do not have COVID but are directly contacted AND NOT fully immunized, quarantine for 5 days, and should get a test to prove you did not catch it on Day 5.
5. MASK!  With the relaxed guidance on staying away from others comes a strong urging to wear a mask for 10 DAYS, infected OR contact, after your diagnosis or exposure.
6. Forget about cloth masks, they simply do not work.  It is time to step up to surgical masks, and if at all possible N95s, real N95s.  Go to www.projectn95.org to get real N95s which are readily available.
7. The result of a dramatic jump in spreadability is now in full view with Omicron, across the world, it is exploding on the scene, seeping into groups that were able to avoid COVID, until now.  It is everywhere, it is spreading wildly.  The only hope of stopping it now is for essentially everyone ages 5 and up to get FULLY VACCINATED NOW!!!  We know if we hit 98% vaccination, the pandemic ends for that population.   How tragic that so many millions have decided to let this deadly pandemic roar, killing at a rate that will lead to another 400,000 deaths, for no good reason at all!
8. For all our children who are newborns, infants, toddler, and pre-schoolers, the threat is very real.   Omicron is spreading very rapidly amongst them and none are immunized.  Age helps, the younger you are the milder the disease, but so many of our young, unimmunized babies and children are getting Omicron that even the small percentage of those who get very ill is yielding a growing number of pediatric hospitalizations.  Again the hospitalized children are mainly older unimmunized children, but all unimmunized are at risk.  We need to GET ALL WHO CAN VACCINATED NOW, the only way to stop the surge in kids getting hospitalized.
9. Meanwhile, be safe.  The Omicron is everywhere, so in addition to getting immunized, wear masks, follow the CDC guidance, when available test, avoid large gatherings.

My One Takeaway Sentence:

The new CDC guidance eases the strain of staying away from others if infected, but Omicron is raging so let’s ALL GET VACCINATED NOW, the most important thing you can do today!

To your health,
Dr. Arthur Lavin