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.
• 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.
• 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.
• 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.

A Serious Concern – There Are Some Indications That  COVID May Be Spreading Despite Our Level of Immunization. The Wall May Be Being Breached, More Infection, but Isolated Harm.

The COVID Vaccine was Working, Even with only Half of America Immunized

The data have been consistent and clear, if you are immunized against COVID, you are far, far less likely to get infected and to spread it.

The proof has been experienced around the world, in every nation that achieves rising immunization levels, and here at home too.

Here at Advanced Pediatrics, we have been testing children for COVID infection for over a year.  Since July of 2020, we have done COVID testing almost every weekday, and almost every one of these days, sadly, we have had positive test results.  Until about 5-6 weeks ago.  Right in line with experiences across the nation and the world, as our immunization rates rose, COVID cases began ceasing.  In our office, the drop in COVID cases was so dramatic that every single one of our COVID tests has been negative, 100% negative, not one case of COVID for over a month.

Recent Events suggest a New Wave of COVID Infections is Rising, and Including the Immunized

Until last week.

Last week, we had one COVID test turn positive, and then another.  And then we began hearing reports of grandparents in our practice testing positive, even after being fully immunized.  These events began raising questions in our mind, but the national and state trends were so reassuring, it was hard to interpret.  Then this week we unfortunately found that two of us who work at Advanced Pediatrics tested positive for COVID-19.  One of those two people was me.  Both of us have been fully immunized.

The good news is that the ability of the COVID vaccine to prevent death remains very, very solid.  For the entire month of June, across America, 99.5% of those who died of COVID were not immunized.  The number of people who are fully immunized coming to real harm remains very, very slight.  So both of us in the office are very likely to be just fine.  I can speak for myself, I clearly feel better than during my first bout of COVID, and anticipate being perfectly fine.  My first symptoms were some days ago and they were mild, but Wednesday evening the 14th all symptoms cleared and I have been fine since.  Our other member of our team is feeling better as well. Both of us are observing strict quarantine, and will return to work on Monday, in accordance with public health guidance.

The Questions Raised

The appearance of positive COVID tests in fully immunized people both of whom had the actual COVID infection before raises questions.  Many of them.  When I found out our staff person had been re-infected, I touched base with experts here at home and across the nation.  Here are the questions I raised, and what follows are my current thoughts.  Again, the heart of good science is learning, and we are certainly learning here.  The more we know, the better our answers will be.  Meaning our understanding changes as we learn.  That’s not only a good thing, it’s our only hope of getting through the dread intact.

With all that in mind, here are some questions:

1. Can fully immunized people get COVID?   The answer has been yes, but very unlikely.  In fact, so unlikely the immunized have been considered relatively risk free, and able to not wear masks, travel, gather.  But the delta variant may be changing all that, see below.
2. Can a fully immunized person who still gets infected with COVID spread it?  It still remains the case the if you are fully immunized and not infected, the risk of passing COVID along is quite trivial, but what about those immunized who still get COVID? See below.
3. If the Delta variant has found a way to pierce the immunization shield, can it also cause a fully immunized person to get very ill, even die?  No reason to wait, the answer to this is so far NO.  Details below.
4. If a fully immunized person gets COVID, and is contagious, is the virus they pass along just as harmful to the unimmunized (that includes all kids less than 12 years old).  See below for details, but likely yes.
5. Given all this news, what should we all do differently, see the whole section below.

Answers as of Today (July 15, 2021)

The impact of the Delta variant is just being felt, we simply do not know how it will harm us, but we are finding out now.

We do know this, it is crazy more contagious.  It takes far fewer viruses landing on someone to cause an infection.  Some estimate it is 50 times more contagious that good ‘ol plain COVID!

And we do know this, there are people who have fully immunized who are getting COVID now, when we thought until a few days ago, this was a rare event, people for example, like me.

One expert I spoke with let me know a colleague had shown that if you are immunized, the antibody to protect you against COVID is in your mucus and saliva, so the number of lively COVID viruses there should be far lower.  This suggests that fully immunized people will be less contagious.  But really, who knows.  After much due diligence, I still do not know today if I am contagious or not.

One point seems very likely.  The virus in my system right now, the SARS-CoV-2 virus, if it copies itself into my breath well enough to hop onto someone else, will almost certainly be very much like the virus that landed on me.  So even though I, as a fully immunized person am very confident of not getting very ill, if I transmit this virus to someone who is not immunized, it will likely cause the same level of trouble as COVID caught from an unimmunized person.  That means it could put an unimmunized person in the hospital or worse.

Another point remains quite clear.  You are more likely to live through this new phase if you are COVID vaccinated, period.  How do we know. This fact says it all, 99.5-100% of those dying in the hospital from COVID across the whole USA, across all of June, were not immunized.  

NO DOUBT, COVID Vaccination has saved millions of lives, it very well may have just saved mine, and could very well save yours.

What Should We all Do Now Given that COVID is now once more Loose?

• FIRST, Get Immunized Now.
• SECOND, Get Immunized Now.  Only 1 in 3 12-18 year olds are immunized in America.  This tragedy is clearly fueling this current surge.  Getting all our 12 and up kids COVID vaccinated could make the difference to stop COVID from surging now.
• THIRD, It is Time to Be Careful Again.  We will see if this comes all the way to fruition, but since early signs I am seeing point to spread amongst the immunized, I am going to start wearing a mask whenever indoor again, and I am recommending all do so too.  Masks outdoors seem helpful only in packed, sustained crowds.  I am also going to advise being careful about going to indoor settings for awhile now.
• FOURTH, The Unimmunized are at Very Serious Risk, Protect them.  If can become an immunized, as already said, do it.  But if you are 11 or younger you cannot, and so we are recommending that all children 11 and under begin to be more careful.  COVID is surging, I do think if anyone catches COVID from anyone, even an immunized source, they can get very ill.  So that means if you are unimmunized, you should avoid contacts that could give you COVID.  Stay away from indoor events, stay away from outdoor crowds.  We used to say if you are with the immunized you are safe, but that is less true than it was, and until we know the risk, we are recommending that families be very careful.

A Terrible Gift from the Unimmunized Adults and the Variants

Writing this post is profoundly upsetting.

Mainly because the deadly tragedies this virus causes are profoundly upsetting, including its ability to change, to mutate, to create variants, one of which may be allowing the vaccinated to spread this Pandemic.

It is also upsetting, because even the Delta variant was slowed by COVID immunization.  Had our nation truly embraced the ONE ACTION that could have ended the Pandemic in our lives, it really could have been over for our communities this summer.  The choice of half of part of America to say I will not stop this Pandemic is upsetting.  Particularly for our children 11 and younger who cannot choose, and who now face a new level of harm because half of part of our American community consciously decided to put us all at risk.

Bottom Lines:

1. GET VACCINATED:  COVID is surging amongst the unimmunized.  Deaths are rising amongst the unimmunized.  Even in the face of this surge, the immunized remain OK even if infected.  In fact, almost none of the immunized are dying of COVID now.
2. The Delta variant is giving early indications that it might be spreading in the immunized more than we hoped.  The immunized remain safe, but it may be the case that they are now spreading it.
3. If you are not immunized, and you catch COVID from an immunized person, even though the immunized person may be confident their disease will be mild, the unimmunized person remains at risk for the same level of danger as if they caught it from another unimmunized person.
4. As a result, as of now, and we hope new information points us away from concern, but as of now, we are recommending that everyone wear masks in public indoor settings.  It remains more risky, but still reasonable to take masks off when visiting immunized family in small groups, such as one or two households.
5. We are resuming our recommendation of testing all kids who have cold symptoms or fevers.  We had paused on this since all our tests ran negative for so long, but for now, we recommend testing again, to try to stop this new surge.
6. Parents of children 12 and older, please have your child COVID vaccinated.  There are not side effects from the vaccine that are more likely than if you get COVID. With the COVID virus spreading right now, the choice is no longer give your child the vaccine or spare them the vaccine.  It is give the COVID vaccine, or risk your child getting COVID with hazards that could last a lifetime appearing only in older age.

My One Takeaway Sentence:
Get vaccinated, once again be careful, once again get tested when wondering.

Let us all come together to hope that we can take the actions to put an end to this deadly catastrophe, and all see the end of it soon.

To your health,
Dr. Arthur Lavin