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.

Omicron and Kids

The power of a virus suddenly jumping its ability to spread dramatically is in full view across Ohio, across the nation, and across the world.  We have never seen numbers like we are seeing, and in the US none of the case numbers include home tests!

Readers of Real Answers know that Omicron, if left able to, will spread to an average of 12 people for every person infected, every round, and that if that level of spread happened unimpeded, one case would explode to 10 BILLION cases in 10 rounds, or about a month.  Of course we won’t see 10 billion cases:  there are only 7 billion people, vaccinations interrupt spread to some degree, wearing masks and keeping distant slows spread, etc.   But this virus can roar, so we are seeing millions and millions and millions of people get it.

The news continues to be filled with terrifying stories of Omicron COVID threatening children.   The facts are that all of humanity faces infection with Omicron COVID, at every age, immunized or not.  And so yes, more children are getting infected with COVID, just like more adults are getting infected with COVID, than ever before.

But the question every parent faces right now is not how many people will get COVID, but if my child gets COVID, what is the chance she or he will be hurt by it?  What is the chance that my child(ren) if Omicron comes to them, will end up hospitalized?  The news reports are fond of reporting from hospitals and showing scary scenes of kids in the hospital with COVID.  And don’t get me wrong, those reports are all true.  But they skew our perspective.

With the most recent data collected by the American Academy of Pediatrics, concluding with the end of last week, there is no indication that kids with COVID today are any more likely to be hospitalized or worse than a month ago or a year ago.  Thankfully.

The numbers are very much worth looking at in some detail.  https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%2012.30%20FINAL.pdf  Table 2b and following.

The chance any child in the US who develops COVID will have severe enough symptoms to require hospital care has remained at 0.8-0.9% every week for over a year, including the week ending December 30, 2022.  When it comes to the most severe outcomes, the odds are even better news, 99.99% of children who get COVID avoid loss of life, and that ratio has stayed steady for over a year as well.

I see absolutely no change in the risk of one child becoming hospitalized or worse across all ages in childhood, over the last year, or more.

News reports are showing that the total number of children admitted to the hospital, now because of COVID, is truly on the rise.

But that most important question, if my child develops COVID, what is the chance she or he will get seriously ill, has not changed. The chances of not getting seriously ill are fantastic, and have remained steady at over 99% through December 30, 2021.

Boosters and Kids

It is now official, all children ages 12-15 can now get their 3rd, booster, COVID vaccination!

The Pfizer trials proved that 3rd dose works and is safe for kids 12-15.  The FDA has authorized this dose, and today the CDC officially recommended it be done.  And so right now, across the nation, all children ages 12 and up should be fully immunized for COVID, meaning 3 doses.  For everyone 12 and older receiving the Pfizer vaccine the interval for booster is now only 5 months.

Here is a nice AAP update from this morning on new developments on boosters.

https://publications.aap.org/aapnews/news/19011

Highlights:

• The final step in opening the door to the US allowing 12-15 year olds to get COVID boosters is the CDC ACIP meeting, which recommended it happens.  That means across the US, it is now permitted and urged, to have all 12-15 year olds be boosted for COVID, their series will immediately be a standard 3 shot dose.
• The Pfizer booster time interval has changed.  It used to be at least 6 months after Dose 2, it is now 5 months.  The Moderna interval, which is irrelevant to all under 18, remains 6 months.
• As of today, the third change will be for 5-11 year olds who are severely immunocompromised.  That is defined as those who have had organ transplants or the equivalent degree of immunosuppression.  They will be authorized to get a third COVID vaccine dose, as soon as 28 days after Dose 2.

Here at ACHP-Beachwood, we will be offering the 3rd Pfizer COVID vaccine, the COVID booster, to all children ages 12 and up starting sometime this coming week, the week of January 10, 2022.   Again, your children ages 12-15 years old can and should get their COVID booster as soon as 5 months has passed from their Dose 2.

Schools- Open Now or Delay?

The Omicron COVID explosion has changed everyone’s situation, including schools.

Prior to mid-November of 2021, we simply did not see large COVID outbreaks in schools.  Surely we saw some outbreaks, mainly in high school sports teams and around some hot spot activities, but across 2020 and almost all of 2021 we saw no large scale school-wide outbreaks, until COVID.

The Monday before Thanksgiving school outbreaks hit our community like a lightning strike.  That week we saw a high school of 90 students total see 60 of the 90 students come down with COVID within a day of each other!  Day care centers, grade schools, middle schools and high schools all saw major outbreaks, even when many of these facilities were largely vaccinated.  This is the face of Omicron.

The astounding surge of COVID in schools was interrupted only by the winter holiday, when all schools closed for 2 weeks.

Now the holiday is over and all schools and day care centers face a very difficult decision, do they open again and risk further outbreaks, or try to stay closed until the Omicron surge calms?

The problem is that both options, opening and closing, have compelling reasons to pursue.

Let’s take a look at both options.

Open the Schools Now

There are two reasons to go ahead and return to school.

The first is that school is an important part of children’s lives.  Closing schools is truly disruptive to children and their parents.  It interrupts their education and their work routines.  We have seen real harm come from that and so any reason to not open schools must be very compelling.

The second is that Omicron will be spreading to kids no matter what.  When a virus is both this extremely contagious and already present everywhere, one can begin to ask, is it realistic anymore to try to contain it?  The last section of this update will look at this question in more detail, but it is a fair question now because the virus is nearly everywhere right now.

Delay School Opening Just Until Omicron Fades

The main reason to not open schools right now is that with Omicron so red hot, opening just invites a massive increase in cases, and when a school has a major outbreak, with so many teachers and kids out, it has to close anyway.

Making the Choice

The fact is that schools are in an impossible position.  Both choices, open now, delay a few days/weeks, make powerful sense.  And, as a result, in our community, and across the nation, some schools are now open and some are closed.  Some schools that are closed chose to delay opening a day, a week, or two weeks.

From a medical view, I am actually fine with either decision.  I respect the child’s need to go to school and that Omicron is already loose, and I obviously respect the fact that opening schools right now in the teeth of a red hot surge may not make sense.

Since the return to school option is still only a day or two old, we have no idea if the massive outbreaks in schools of mid-November to December will ramp up again, but we will know soon.

Either way, if the schools open or not, Omicron is spreading dramatically and everyone should agree that we need to have every person ages 5 and up fully COVID vaccinated ASAP.

Being Safe in a Storm

As noted, the Omicron surge is astounding.  A very, very bad day for COVID spread in the US was 200,000 new cases in one day.

This week we approach half a million new cases in a day, and that doesn’t count the millions of home tests being done!

When a virus gets as contagious as measles or TB or Omicron COVID, the level of spread enters new realms.  People who have been very careful, who have avoided getting COVID this whole time suddenly find they have caught it.  As discussed above, for the first time, whole schools are experiencing outbreaks, whole industries are seeing large scale outbreaks causing them to have interrupted function (airplane trips, football games, etc, etc.)

Long ago, before COVID, we used to talk about colds this way, because that’s how they were, everyone got colds and it was next to impossible to avoid them.  The analogy made was to a group of people playing in the ocean and worrying about a new person joining them for fear they would get them wet.  We do in fact live in an ocean of virus and before COVID there was not way not to get wet.   But COVID, at least original COVID and Delta offered the chance of not getting it by being careful.  Staying away from indoor gatherings, not traveling, wearing a mask, and staying 6 feet away from everyone did cut down your risk of getting COVID, substantially.  States that were careful had much less COVID, careless states had lots of COVID.

But Omicron has changed the landscape, dramatically.  It simply spreads so, so, so much more easily, and rapidly.

At this moment, in the eye of the storm, it is good to take one pause and give thanks to the COVID vaccine.  I truly dread to imagine what our world, what our neighborhood would be like today with the Omicron everywhere, with no vaccine.  It reminds me of the 1918 flu pandemic where the first year was terrible, but after a short lull, a second wave truly killed off tens of millions of people.  This Omicron surge, without any immunization, though milder, could have caused unimaginable waves of death.  I am so grateful that we have a vaccine that is so safe and works so well to keep even this Omicron COVID from costing our lives.

And that describes our moment, storms of Omicron COVID are covering the entire planet, across the North and South of the US, all parts of Ohio, and all our neighborhoods.

What does it mean to try to keep your family safe, especially our unimmunized young children, safe from exposure to a virus that is spreading nearly everywhere?

There are steps that can be taken still:

1. Get immunized.  First and foremost, get everyone in your family who is 5 years old and older immunized.  Immunization will NOT stop the spread of Omicron, but it WILL stop the killing from Omicron.  As the numbers of people with Omicron skyrocket, unimmunized adults face a very, very grave danger, that only getting vaccinated will keep them from serious harm.
2. Wear a mask.  And again, don’t settle for cloth masks they will not work very well at all.  Get an actual N95 mask, they are easily available, get them, wear them, let’s do all we can to protect each other.
3. Avoid indoor gatherings.  During a crazy surge, getting together with others indoors, whether that be family, concerts, sporting events, parties, travel gatherings.  For right now, until Omicron cools, it is very, very prudent to avoid gatherings indoors.
4. Keep your distance.  If indoors, if masked, still stay 6 feet apart.

And one last point here, to be repeated.  The COVID illness in the immunized, particularly with 3 doses, tends to be mild.  If you should contract COVID after being immunized, chances are you will be OK, and may even be less contagious than the unimmunized.  But even so, it is wise to avoid infection, because someone could get ill even if immunized, and could be contagious.

Bottom Lines:

1. Omicron thankfully remains a milder disease, like all COVID variants, the younger you are.  Total numbers of COVID infection are rising dramatically, but if your child gets COVID, even Omicron COVID, the chance they will get seriously ill remains very, very, very low, and no higher than last year.
2. It is now OFFICIAL.  All children 12-15 years old are approved to get their 3rd dose (Booster) COVID vaccine.  For everyone 12 years and older receiving the Pfizer vaccine they can get their COVID booster now 5 months or more after their 2nd COVID dose.
3. For 5-11 year olds, the third dose of COVID, the booster, is not yet permitted with one exception:  children with organ transplants or the same severe level of immunosuppression can get their 3rd dose, and theirs can be as soon as 28 days after their 2nd COVID dose.
4. Given that Omicron is spreading so aggressively and widely, it is not clear what the best option is for schools.  It is reasonable for them to delay opening a few weeks until the very, very hot Omicron explosion fades.  It is also reasonable for them to open, particularly if the K-12 students and teachers are immunized.  Each community faces a difficult choice as both options are reasonable and also carry risk.
5. What to do in a storm?  GET VACCINATED, GET EVERYONE YOU LOVE VACCINATED, MAKE SURE EVERYONE 12 and UP GETS 3 DOSES, and ALL 5-11 YEARS OLD 2 DOSES ASAP.
6. In addition, while the Omicron storm rages, let’s try to stay apart as much as possible, we hope only for a few weeks.

My One Takeaway Sentence: 
It is time for this COVID scourge to end, but the virus is not ending yet, the Omicron storm is on, let’s be careful right now for a few weeks, and take this time GET FULLY VACCINATED!!

To your health,
Dr. Arthur Lavin