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.

Children and COVID Today

A major concern focuses on the fate of all the millions of our children who have come to be infected in this most recent wave of COVID, the Omicron epidemic.

The good news remains that the younger you are, the milder COVID infections are.  One way to monitor this is the chance of a child, infected with COVID, will get sick enough to require being admitted to the hospital.  Readers of Real Answers will recall that this number has held steady at 0.8% for over a year.  Data from January 20, 2022, the last reported as of now, show that number is now 0.7%, about the same.  With regard to the most severe outcome, death, this is thankfully quite rare.  Across 50 states, some have no childhood deaths from COVID, and for those that have had such tragedy, the rate of death from COVID infection is at most 0.02%, that means out of 10,000 children with COVID at most 2 in a state have died.

What does this mean?

It means that if 1,000 people got COVID and they were all under 18 years old, about 8 of those 1000 would get so sick they would need a hospital, and that 992 of those 1,000 would have COVID so mild no need for a hospital would happen.

It also means that despite so many more millions of people coming down with COVID, including so many schools, and infants, the severity of COVID for any one individual child remains quite mild.

And finally, it does mean that despite the fact that 992 out of every 1,000 children with COVID having a mild case, 8 did not, and something on the range of 0-0.2 per thousand have died.  Further, there are now reports of these few children who have required hospitalization suffering long term illness requiring rehabilitation.

The main impact of Omicron in childhood has been to spread to so many children, to so many households.  The extreme level of contagiousness means that at least 50%, perhaps many more, of every person of every age in the United States will be infected with Omicron, before the Omicron epidemic fades.  Again, fortunately, the chance of a child developing severe COVID remains unchanged with Omicron, per each case, but so many more cases are happening that there are a total of more severe cases.

COVID remains generally a mild disease, but not always, in childhood, so full vaccination of all ages 5 and up remains an important way to save the lives of our children and all we love.

Perhaps the most deadly aspect of the huge numbers of children mildly infected with COVID (about 25% of American COVID cases currently) is that our children are now a major driver of COVID infections in unimmunized adults where nearly all the death from COVID is coming.  How tragic our children have been put into this position by decisions to not immunize.

After Omicron

As noted in theses posts since Delta first showed itself to be very contagious, viruses that spread extremely rapidly tend to burn through nations rapidly and cease their epidemic faster than slower spreading viruses, like the original COVID virus.

Omicron is showing itself to be true to its character here in the US.  It did so dramatically in South Africa, ceasing to menace the nation as rapidly as it appeared.  And it is showing the same pattern in Great Britain and across Europe.

Here at home in Ohio the number of new cases per day began plummeting on January 19, and we actually noticed a few days after the decline took hold in Ohio that there was a sudden decrease in the number of schools reporting major outbreaks, and in our office, a sudden drop off in illnesses causing fever and cold symptoms.  You may recall that last winter we had the historically striking instance of no viral influenza epidemic.  And so we waited wondering, what would this winter bring- an intense year to catch up?  But no, we are very lucky, the influenza epidemic of 2021-22 is already vanishing.  Influenza was here, it arrived at its usual time of December and peaked at its usual time of New Years, but it is vanishing after only a mild peak, and may no longer be epidemic by early February, instead of April or May, astounding!  This also contributes to our office seeing a dramatic drop in the number of children with colds and viral fevers.

And so the question is a fair one: what will we do about viruses after Omicron?  That answer depends entirely on whether a third major variant arrives or not.  Let us of course hope not.  If not, it is possible that with further vaccination, the mass infection of the country with Omicron and passing of Omicron as a result, and no further variant, MIGHT mean that COVID will recede into a minor threat.

What do we mean by minor threat?  That is entirely up to all of us to decide what danger is minor.  I would suggest our current situation with over 2,000 people in the US dying each day is not minor.  If that pace is kept up for a full year that would mean 730,000 more Americans will be killed by COVID in that one year, nearly double the number that have died in our first two years, each.  That would be catastrophic.

But what if we return to the days of last June (2021) when COVID seemed quite remote, the number who died in the nation each day then was not 2,000, it was 120.   At that rate, about 44,000 Americans would die of COVID each year.  That turns out to be the number of Americans who are killed by the influenza virus each year.  And it turns out, prior to COVID, we paid no attention to the dying caused by flu in our day-to-day lives.  Nearly everyone was exposed to flu, nearly everyone who got it recovered well, and the flu shot was available for further protection.  If you had a cold, you still traveled, weddings were still held, parties took place, all without testing.  And with all these habits in place, about 44,000 people died of flu every year in the US, and that seemed acceptable.

So the question will be, at what number of COVID deaths per year in the US will we begin to act as though that number is acceptable, and if we begin to gather and travel fully normally again, and that number does not increase, we will be OK with going back to normal?

I do not know the answer to that question, but should Omicron continue to fade and IF no new variants appear, and IF the routine number of cases of COVID remains very low, at time will come when the nation will decide to heave that sigh of relief, and we will learn what number dying with our new routines in place will be OK.  For flu that number is somewhere between 30-50,000.  We will see what it is for COVID.

But keep in mind, we are NOT THERE YET.  We are at an annual death rate today of over 700,000, not 44,000, and so anyone who takes steps to keep COVID from spreading could be saving many lives, and those of us who have decided to not take any steps to keep COVID from spreading are causing many people to die.

The main action that will save lives is getting vaccinated.   Many thanks to the over 200 million Americans who did the simple thing, the thing we have asked our babies and children to do- and they have done- for over 50 years, get the shot.  The problem is that there are 290 million Americans ages 5 and up.  That means something like 80-90 million people in the US who could be vaccinated have chosen, or if children have had the decision made for them, to not get the COVID vaccine.

This is why we are at 2,000 deaths a day.  We know over 100,000 people have been killed directly as the result of the people deciding not to get the COVID vaccine, we hope that all who are not immunized who are 5 and up get immunized ASAP, how can we choose to let so many people die who do not have to?

The Problem of No COVID

Readers of Real Answers will recall in the first years of the COVID pandemic my contrasts of strategies between the US and Europe and East Asia.

The main difference is that in East Asia, the decision was made at the very beginning to try to find every person in the nation with COVID, asymptomatic or not, and truly isolate them, outside the home, truly alone, until no longer contagious.  This was never done in Europe and never done in the US.  In order to achieve such a goal, a nation would have to have massive testing availability, really the ability to test ANYONE who came into contact with COVID, in time before they spread it, trace every contact to test, and be able to have enough rooms for isolation.  Many nations in East Asia were highly successful in doing all these steps, including China and Hong Kong, Japan, Taiwan, Singapore, and South Korea.

We know from our son and his family in Hong Kong that Hong Kong along with all of China continues to follow the zero-case model.  Travel from high COVID nations is cut off, anyone returning from outside must quarantine, currently 3 weeks, before entering the country.

And the results have been spectacular.  In these nations very few people have, or have had COVID, and the number killed by the disease over the last 2 years remains incredibly low.  Taiwan, a nation of 24 million people has only lost 851 people to COVID in the last two years.  If we had done the same, our total would be about 11,000 now instead of nearly 900,000!!!

This strategy was ultimately completely successful against the first SARS virus.  Keep in mind, COVID is caused by SARS-CoV-2, or SARS coronavirus 2.  The first one was in 2003, and isolation techniques such as these really kept it from spreading, it caused a grand total of 8000 cases, mainly in China and Hong Kong, then ceased to be.

I remain very, very upset that we did not take this path.  We could have.  We didn’t, and surely a million of us will pay for that decision with our lives.

But now East Asia faces a problem that it did not face with SARS 1.  The containment of SARS 1 was followed quickly by the complete extinction of that virus.  And so those containing its spread could stop doing so because there were no longer any SARS 1 viruses in existence.   Had the entire planet adopted the East Asian strategy, it is conceivable SARS 2, aka COVID, would have been driven into extinction and the nations of East Asia could look forward to once again sustaining containment until COVID ceased.

COVID was not contained across the world of course.  And we all know now that the SARS-CoV-2 virus shows no signs of ever actually disappearing.   All indications are that people will come down with COVID for years to come, perhaps many, many years, even lifetimes, to come.

As a result the nations of East Asia that currently have nearly completely stopped the transmission of the SARS-CoV-2 virus cannot wait for COVID to go away to open up their nations.  And so they are faced with a unique problem- how to allow, to choose, to have a deadly virus to spread.

One path forward could be for them to sustain their zero-case policy until over 95%, essentially everyone, is fully immunized with a proven mRNA vaccine- at least ages 5 and up, but maybe wait til all 6 months old and up are fully immunized.  This could allow the COVID virus to spread across the nation but cost few lives, as we have seen in the US where Omicron has spread to every corner of the nation, as detailed above, but only those choosing to not immunize are suffering mass harm.

Another path forward would be to slowly let loose the control over the virus, while still keeping it slow.  That might entail sustaining nearly universal access to testing, central coordination of all testing results, and less intense, but still sustained quarantine.  It seems difficult to me to decide how much death from COVID should be allowed.  Imagine a national COVID spigot, and the nations of East Asia have it turned off.  How much do they turn it on, if their populations are not yet fully immunized?

The answers to these questions are not known, humanity has never had this choice before.  But the nations of South Korea, Japan, Taiwan, Singapore, and China face this challenge right now, including our family in Hong Kong- whose adults at least are fortunately immunized (children 5-11 are only now being authorized to be immunized).

Bottom Lines

1. COVID continues to rage across the United States with Omicron reaching all corners and neighborhoods, expected to infect at least 50% of the entire nation.
2. We are suffering the death of over 2,000 fellow Americans every dayright now, almost entirely by the choice of over 80 million Americans to not protect themselves and others from COVID.  Should this rate continue we will see over 700,000 Americans die by choosing to not be immunized in the coming year.
3. Fortunately, COVID, even under Omicron, remains dramatically milder in childhood.  In fact, the chance a single child with COVID becoming so ill that they will need to be hospitalized remains about 8 in a thousand, the same chance as a year ago and across all of 2021.
4. Even so, the COVID epidemic of the unimmunized sweeps children in its wake as children, like adults, are getting infected with COVID at record rates.  Fortunately, all of our children ages 5 and up can now be fully immunized.  Only about 25% of our children ages 5-11 have been immunized.  The time is NOW for this to become 100%, lives are truly at stake, NOW.
5. Omicron in the US is showing signs of acting like Omicron in South Africa and Europe, bursting on the scene infecting everyone then no longer spreading as intensely.  We are seeing early glimmerings of the rage of Omicron receding right here in our Cleveland neighborhoods as of this just past week.
6. We all hope of course that Omicron really does retreat fully and NO new variants appear, that the intense Pandemic phase of COVID finally come to an end.  I know that it will, every Pandemic in history has ended, this one will of course, too, but hopefully soon.
7. An interesting question faces all humanity.  Under what number of deaths a year will COVID cause will lead humanity to declare the Pandemic is over, that COVID is now endemic, that precautions can be lifted and the number of deaths accepted as normal background of our routines.  We did this with influenza, when deaths remaining under 50,000 a year were accepted as the norm, calling for no serious attempt to stop the spread beyond the flu shot.  What will that number be for COVID?
8. East Asia succeeded where no one else did- it stopped the transmission of the SARS-CoV-2 virus, almost entirely, inside their nation’s borders.  Now that COVID is clearly going to be around for a very long time, each of these nations face the difficult decision of how to open up their nations knowing that COVID will then flow in their borders.

My One Takeaway Sentence:

GET VACCINATED NOW:  Everyone 5 years old and up need to get fully vaccinated right now to save lives facing an early end right now.

To your health,
Dr. Arthur Lavin