• Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

    COVID Update March 12, 2022: Updated Lessons From the Virus – What People Did That Worked and Did Not to Save Lives

    By Dr. Arthur Lavin


    • 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.

    As with every disease, and certainly every pandemic, the actual suffering- lives lost, prosperity dashed- is largely determined by how well or how poorly communities of people respond to the disease.

    When it comes to viral pandemics, like COVID, the enemy challenging humanity is shockingly small and simple.  The virus that has caused every case of COVID around the world is of course the SARS-CoV-2 virus.  We are all now too familiar with the look of this virus, a tiny sphere studded with spikes. Like every virus, the only function the virus seeks is to copy itself, that is it, period.  In the process of entering or cells to command them to make those copies, there is damage done, the reason why this virus’s quest to make copies kills.

    Our enemy, the SARS-CoV-2 virus is incredibly small, 0.1 micrometer across.  Now, a meter is about one yard.   And a micrometer is one-millionth of a meter long.  So this virus, which has devastated the world and changed our realities for over 2 years, is about a tenth-of-one-millionth of a meter across.  One could feel hopeless trying to conquer something this tiny, this invisible.  Fighting this virus often has felt like fighting the wind.  We may flail about, but the virus always has its ways.  This view suggests that there is not much role for human actions to limit the harm.

    But the story of the COVID Pandemic tells us that we have had great power to save lives.  Some nations have had extraordinary success adopting one of several strategies that have really worked, others have adopted other amazingly successful strategies.  Very few have adopted all of the few strategies that save lives.

    The COVID Pandemic is only the second major global pandemic where we, the people, had the power in our hands to stop the virus from killing massive numbers of people.  And tragically, humanity has failed in both to achieve true victory, victories at hand and available.

    The First Pandemic In Which Humanity Could Have Saved Millions of Lives

    We don’t think of it as a pandemic, but this one has already killed 30 million of us (COVID so far is at 6 million).  The step that could have spared nearly all 30 million lives.  The invention that could have stopped the transmission of this pandemic was created in 1855.

    The pandemic is AIDS, and the action that would have stopped its transmission almost entirely is the condom, first created in 1855 after Goodyear vulcanized rubber in Akron, opening the door to its use in a wide variety of applications.  Studies of partners where one has AIDS and the other does not have demonstrated that if the male(s) wear a condom, the HIV virus fails to transmit almost all the time.  This fact was known well before 30 million died of AIDS.  But humanity made a decision not to take this action and more people died in this pandemic than all but a handful across history.

    HIV deaths are now subdued by use of anti-viral medications, an action that has clearly shown to be more readily adopted than condom use.

    The point is that a tiny virus savaged our human community, and though we had the means to stop it, we chose not to, waiting years for a medication- our preferred choice of action against illness.

    Choices Available, Choices Made, and the Results of our Decisions with COVID

    Prior to the 1800’s there were few choices people could make to avoid the ravages of pandemics, we didn’t even know what caused them, we certainly did not know how to stop their spread, to keep them from killing us.

    But since the rise of modern medical science, we have entered a radically new reality.  Humanity now has profoundly deep knowledge about the germs that kills us, what they are, how they spread, how to develop vaccines against them.  We are no longer helpless against infection.  Germs are not fate, they are just germs, and we have the knowledge and power to stop them, if we choose.

    COVID has confronted humanity with this new reality as never before.  That is because our ability to deeply understand a killer germ that suddenly appears is now stunningly rapid and effective.  One of the great stories of the COVID pandemic will be how humanity’s ability to understand a new viral enemy developed far more rapidly than our interest in acting on that knowledge to save lives.  To be clear, humanity did take actions, and in many nations, those actions were quite dramatic and effective.  But as we will see, very few nations have fully embraced all the few proven steps to keep COVID from killing.  Let’s take a look at the steps that reduced deaths and then how humanity did using these proven protections.  Again, the real measure that matters is keeping people from harm.  Of course the biggest harm any disease can inflict is death, but many also cause agonies that come close to being as harmful but bad outcomes are harder to track than deaths.  So we will focus on which steps humanity took against COVID that kept the number of deaths as close to zero as possible.

    Identify and Isolate

    Prior to the vaccine becoming available, the very, very, very best strategy to  keep COVID from killing anyone was the identify and isolate strategy.

    This strategy relied on a combination of the oldest modern public health steps and modern hi-tech tracking.   The way identify and isolate works is to find enough of a nation’s infected people and truly isolate them, to a degree that the virus cannot spread.  It is very clear that if a nation stops the spread of the virus, it cannot kill anyone and the number of deaths from COVID will plummet, dramatically.

    The oldest modern public health step goes back to 1854, 7 years before our Civil War began.  That was when the 19th century’s most famous John Snow observed a pattern of spread of cholera.  He was only able to do this by actually identifying every case of cholera.  The pattern revealed only people who drank from certain wells got cholera, close the wells, stop the epidemic.  COVID does not spread be wells, so closing wells would not work.  But the idea of finding every case remained at the heart of the highly successful identify and isolate strategy.

    The new hi-tech tool in this strategy was the ability to find everyone an identified COVID infected person was with during their period of contagion, and identify every infected contact.  This took a tremendous infrastructure of smartphone connectivity and highly functioning public health apps, that could translate someone with a positive COVID test instantly into alerting every exposed contact and successfully ensuring they got tested.

    Together, this was the identify part of the identify and isolate strategy.  The isolate part was a true isolation of every potentially contagious person.  This is NOT placing exposed people back in their homes, but rather placing them in a room, typically a hotel but really any, room until the threat of them being contagious has ended.

    Identify and isolate strategies were really only fully put into place in the Eastern Hemisphere, in particular, East Asia, New Zealand, and Australia, but primarily in East Asia.  The nations and communities that achieved nearly complete identification of every infected person and their direct contacts and complete isolation during their period of being at risk for contagion were:

    • South Korea- which met days after the virus arrived to organize government, industry, and public health to achieve this
    • Taiwan
    • Singapore
    • Hong Kong
    • Mainland China

    And the result of these communities deciding to do this work was stunning.  Data from China are unfortunately unreliable, but from the other four communities on the list, the number of deaths is truly as close to zero as any human community has achieved in any pandemic in the entire history of humanity.

    This strategy began to falter when Omicron arrived because prior to Omicron, a country had 5 days to find an infected person before they could spread it, with Omicron that time dropped to 2 days, and the virus spread wildly more aggressively.

    But let’s look at the total number of people who died prior to Omicron, per 100,000 people, in four nations:

    South Korea:  4.6 deaths per 100,000 from January 2020 through October 2021

    Taiwan:  3.6 deaths per 100,000 from January 2020 through October 2021

    Singapore:  1.8 deaths per 100,000 from January 2020 through October 2021

    Now, how about our national community, our United State of America, how many Americans were allowed to be killed by COVID here?  Here where there was essentially no ability to identify everyone infected, track every one of their contacts, and isolate all infected, contagious outside their home?

    Here is the American number who died from COVID per 100,000 from January 2020 through October 2021: 211.7.

    Identify and Isolate dropped the number of people killed by COVID by 53 times!

    If we had adopted identify and isolate, instead of COVID killing about 700,000 Americans by October 1, it would have killed only about 13,000.  This single strategy would have saved 99.9% of the lives lost.

    But our human limits to use identify and isolate has met its match in Omicron.  As noted above, its insanely high level of contagiousness, and the fact that it spreads in 2, no longer 5 days, has shattered the identify and isolate strategy across East Asia.

    Hong Kong, which from the start of the pandemic to Omicron, had kept its total case numbers (in a city of 7 million) to always less than about 100 a day, and most days,  no cases, truly an astounding accomplishment.   But with Omicron, the daily case count has exploded, starting on almost exactly January 3, when the daily case count jumped way above 100, to 600.  By February 16th that daily total case count was up to 5,000.  March saw that number take off to 32,000 on the 1st, peaking at 53,000 on the 3rd, and now on the 9th down to 33,000 and hopefully on its way down.

    A similar pattern was seen in South Korea and Singapore.  But not Taiwan, where their normal number of new cases was nearly zero, except for two times both this year.  In May-June there was a burst to about 600 total a day, and now with Omicron the burst has risen to as high as 128 new cases, but this in a nation with 24 million people.

    For Hong Kong, about 50-60% of the population had 2 doses, a lesser number 3, of the COVID vaccine when Omicron first hit.  This suggests that if a nation has excellent identify and isolate strategies in place pre-Omicron, that a vaccine rate of 50-60% will  not protect against an Omicron surge.  This brings us to the 2nd strategy that has saved an enormous number of lives, vaccination.

    COVID Vaccine

    There is absolutely no doubt that COVID vaccines have saved lives.

    The use of COVID vaccine here in the US, tragically limited by inane political chicanery, still saved 1 million American lives already by November 2021.  https://www.commonwealthfund.org/publications/issue-briefs/2021/dec/us-covid-19-vaccination-program-one-year-how-many-deaths-and

    As of November of 2021, about 700,000 of us had been killed by COVID, as noted above nearly entirely based on our stubborn decision not to identify and isolate.  But without the vaccine, that number would have been 1.7 million Americans killed by COVID!

    And, we do have numbers for severe disease.  The vaccines kept over 10 million Americans from having to be hospitalized with agonizingly severe COVID infections.  10 million!!

    But vaccinations alone have not stopped COVID completely, only 4 nations in the world have achieved complete COVID vaccination for over 90% of their populations:  the UAE, Brunei, Chile, and Portugal.  The UAE and Brunei, both small nations, have kept death rates very, very low, but Chile and Portugal are not far off from the terrible US rates.

    The Winning Formula

    As noted above, many nations, mainly in East Asia, have adopted isolate and identify which worked spectacularly, prior to Omicron, which has left this strategy alone in tatters.

    A handful of nations have achieved over 90% immunization rates, and COVID vaccines have stopped the virus literally from killing millions of people.  Still in many nations that rely primarily on vaccinations, has the COVID virus truly been stopped?  The answer is no, again, because of population choices to not get vaccinated and the emergence of Omicron, which needs 3 shots to get maximal protection.

    But have there been any nations that have used the combination of identify and isolate AND vaccination, along with careful masking and distancing and kept the number of deaths from COVID consistently very, very low?

    Two nations meet this terribly important standard:

    New Zealand and Taiwan.

    We know Taiwan identified and isolated well, but it also achieved complete immunization rates of over 75% rapidly.  That combination along with nearly 100% mask and distancing compliance has allowed Taiwan to keep its death count to 3.6 per 100,000 to this day.  In a nation of 24 million people, only 853 people have been killed by COVID there.  Had they not bothered with identifying and isolating all infected and  contagious, and suffered the deadly anti-vax campaigns we endure here, that death count would not be about 800, but rather about 66,000!

    New Zealand also used identify and isolate, and as an island nation they could really isolate nationally from the world.  Their total death rate through today is at an astoundingly low 1.8 per 100,000.  The nation of New Zealand has suffered a total of 81 deaths out of a total population of 5 million or so.  They achieved a national fully vaccinated rate of 78%.  Had they gone the American way, their total dead would not be 81, it would be about 12,000.

    It appears that humanity could have saved itself from losing 6 million lives to COVID.  And the path forward, for this pandemic, was a truly effective combination of identify and isolate and nearly universal vaccination, along with population willingness to mask and distance during surges.

    Bottom Lines

    1. For all but the last 200 years of humanity’s 200,000 years being attacked by killer viral pandemics, we have been entirely helpless to keep the virus from killing millions of us.
    2. But not now.
    3. Now we have the tools to understand the nature of  a new killer virus.
    4. Since 1854, we know that each germ has a pattern of spread, and we can devise strategies to contain that spread.
    5. For COVID the spread could be, until Omicron, almost entirely stopped by the strategy of identify and isolate, which seeks to find everyone in a community infected or at risk of contagion and truly isolating them from everyone until no longer possibly contagious.
    6. COVID is the 2nd pandemic virus for which a mass vaccination program was developed to stop the pandemic.  The first was the far milder 2009 swine flu pandemic.
    7. The COVID vaccine works astoundingly well, too, already saving over 1 million lives just here in America.  1 MILLION LIVES!
    8. But vaccine alone could not stop Omicron, at least when 90% or fewer of a nation is vaccinated.  It remains to be seen if any COVID virus spreads in a community that is 100% immunized.
    9. But what we do know is that the combination of a true identify and isolate strategy, with nearly 100% mask and distancing compliance, with rates of complete immunization over 75%, keeps a nation nearly free of death by COVID.


    My One Takeaway Sentence:

    From now on, when a deadly virus attacks, humanity will find out if it has the moral fiber to stop it from killing- we can, now we will see, if we will.

    URGENT PLEA- Yes COVID is in a very welcome, very real lull here in America and in NE Ohio, but do not let your guard down, GET EVERYONE 5-12 years old TWO DOSES OF COVID vaccine, GET EVERYONE 12 years old and up THREE DOSES OF COVID, NOW, NOW, NOW.

    To your health,
    Dr. Arthur Lavin




    No comments yet.

    Leave a Reply