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.

Boosters for Kids

As we will discuss in the next section, the COVID Pandemic is not over.  And so we all need to continue to take steps to protect everyone we care about from coming to harm.

And the #1 step that changes the chance of real harm happening is to get immunized.  For our youngest children, under 5 years old, that path has been blocked by the lack of an approved vaccine to do just that.  We currently expect that door to open in a month or so, in mid-June.

But on May 19 the door did open for every child ages 5 and up to get a third COVID vaccine, the booster.

Here at our Akron Children’s Hospital-Beachwood office, we will have plenty of COVID vaccine for your 5-11 year old children.  Please call now to book your time to protect your children ages 5 years and older!

Update on the Latest Surge

The COVID Pandemic is certainly not over.  We are clearly in the midst of a significant surge.  One problem in measuring this comes from the wonderful availability of home tests.  These are not reported, so a great number of cases are not known to the agencies that count cases.  Readers of Real Answers will remember that one very useful measure to tell us how cases are rising or falling is the number of new cases per 100,000 in a population.

You may recall that when that number is well below 10 new cases per day per 100,000 population, we don’t see much spread.  As it goes up above 20, we start seeing positive tests in the office.  And when it hits 100-400, you hear about larger outbreaks affecting whole offices and schools.

The current rate in Cuyahoga County is going up a bit, but is not much above the 20 new cases per 100,000 mark, far below the 400 mark of last winter holiday season.

But.

This is the first surge during which we have plenty of home tests, and so a far greater number of cases have been found out via home test than ever before.  And the key point here is that if a test is positive at home, it is not recorded as happening, it doesn’t count in the tally of the number of new cases a day.

This comes to mind as we in this office are hearing of a growing spread of COVID across the community.  One school that had essentially no outbreaks during the last 2 years is now experiencing moderately large outbreaks.  Family after family are reporting that many in the household just came down with COVID.

So the actual experiences on the ground tell us that the surge is bigger than 20 new cases per 100,000 population per day.  But we don’t know how much higher and cannot, unless formal studies of a given population are done.

The sharp increase in what we are seeing also suggests that new subvariants of the main Omicron variant are showing up that are even more contagious than the last subvariant of Omicron.  As many of you read in a recent post in Real Answers, it takes some sort of new variant to spread widely around the world.  That is because between immunizations and recent infections with COVID, a past variant can spread, but not wildly and around the world and rapidly.

The relatively small surges that have happened since the just passed winter holidays have all been subvariants of Omicron.  It remains true today that if you get COVID, you are being infected with the Omicron variant.  But the Omicron variant is making subvariants that are more contagious and different; they can spread amongst the immunized and previously infected.

Right now in our neighborhood, we are seeing about half of the surge from the BA.2 subvariant of Omicron.  And soon the Omicron BA.2.12.1 subvariant will be here, if it isn’t already.

How the Vaccines Are Holding Up

These various versions of Omicron have been around long enough now we can share how they behave.  As we all know, the original COVID virus was amazingly well contained by the COVID vaccines now in use.  If you were immunized you even had your chance of being infected dropped by 95%.  We then saw Delta variant pierce that wall of protection, but the protection against severe disease (which causes hospitalizations and death) remained intact.  With the Omicron and its subvariants, the vaccine remains less helpful in stopping the virus from infecting you than we would hope, but if you are fully immunized, meaning you have had a 2nd or greater number of dose within 4 months, you remain quite well protected from severe disease.

All these facts help explain why we are seeing the current surges act the way they do.  We see real increases in the number of COVID cases, more outbreaks in day care, preschool, and schools.  But the number of people hospitalized, while increased is only slightly increased.  The total number is up 20% but up 20% over a very low level in March or so.   And, the number of deaths continue to hover around 300-400 a day.  That is well below the peak and catastrophic levels of 2000 deaths a day, but 300 deaths a day leaves 100,000 Americans killed by COVID every year still.

In nearly every nation of the world with the exception of China, and perhaps North Korea, every surge of COVID since the surge of the winter of 2020-2021 has been met with less care with regard to masks, distancing, quarantine of infected and contacts, and gathering indoors.  To a large degree that has reflected the increased safety people enjoy who are fully immunized, and to another large degree it reflects a yearning to be past the worry and restrictions.

One constant of the COVID pandemic remains so.  That is that the younger your age, the safer you are, even down to very young ages.  This is the one fact that allows us to tolerate the continued exposure of our youngest children to unimmunized COVID disease, but that risk will end we  hope next month for all but the youngest infants, the newborns to 5 month olds.

Clarification on What to Do if You Have or Are Exposed to COVID

Because the Pandemic is not over, because COVID is spreading, because we are right now in a real surge, and because Americans continue to be killed by COVID, currently at the rate of 100,000 per year, we still need to be smart about not spreading it if you are infected or exposed.

The CDC has clarified that all intervals should count the first day as Day 0 not Day 1!

Here is what to do if you have COVID (note that retesting is not in the recommendations)

• Stay home for 5 days if you can wear a mask
• Stay home for 10 days if you cannot wear a mask
• Do not travel for 10 days
• To count, Day 0 is the day your TEST is 1st positive, not the 1st day of symptoms

What to do on Day 6 after you first test positive for COVID

• See how you feel
  • If you feel fine or better and have no fever without meds for 24 hours, then you can leave home, but must wear a mask for Day 6-10
  • If you are not improving, or still have a fever, stay at home until you have no fever for 24 hours AND symptoms are getting better.  Then you can leave home if you wear a mask through Day 10

What to do if you Do NOT have COVID, but been within 6 feet of someone for more than 15 minutes in a 24 hour period, excluding K-12 settings.

• Counts for this guidance define Day 0 as the last day you were in contact.
• Do not travel through Day 10
• Wear a mask around others through Day 10
• Watch for symptoms of COVID through Day 10
• TESTING
  • The test for direct testing is not reliable until or after Day 5
• QUARANTINE
  • If you are fully immunized, including boosters, no quarantine
  • If you had COVID in the last 90 days, no quarantine
  • If your test is negative ON DAY 5 or later, no quarantine, but wear a mask for 10 days
  • If your test is positive OR you have symptoms, quarantine through Day 5

Bottom Lines:

1. Immunization against COVID infection remains FAR AND AWAY the most powerful and the most effective step you can take to avoid being killed by COVID.
2. Even as of November of 2021, the COVID vaccine has been proven to have saved 1 MILLION LIVES.  It is very hard to come up with a reason not to embrace an action that has saved 1 million lives.  Who can honestly have hoped we never had this vaccine and that another 1 million of us would have died?
3. The FDA has approved the boosting of 5-11 year old children.  No doctor in the US can proceed giving this until the CDC issues official recommendations on doing so.
4. It is anticipated the CDC will issue this recommendation on Thursday, May 19.
5. The moment the CDC issues this recommendation every 5-11 year old child who has had 2 Pfizer COVID vaccines should get a third, the booster, whenever 4 months or more has passed since their 2nd dose.
6. Our office at Akron Children’s Hospital Pediatrics-Beachwood, will offer all 5-11 year olds in our practice who have had 2 doses at least 4 months ago the booster as soon as the CDC recommends doing so AND we have the required stocks of the vaccine in the office.
7. The work on providing protection to children 6 months to 4 years old is hopefully coming by mid-June, stay tuned.
8. We ARE in a mild to moderate surge.  The number of COVID infections is clearly and substantially rising RIGHT NOW.
9. It is hard to measure the degree of the rise, because so many cases are now identified at home, off the grid.  But our sense of the infection reveals that many schools and day cares are reporting far more than the usual background of 1-2 cases a day, some reporting over 20, but none so far that we know of, reporting 80 or over 100 in one day.
10. The current surges are certainly still due to Omicron, but from new subvariants that continue to be more contagious enough to spark new surges.  These are milder versions than Delta, but remain on track to kill 100,000 Americans a year.
11. Immunizations are not stopping these wildly contagious Omicron subvariants from infecting, but they are sharply reducing the chance of being hospitalized and dying from COVID.
12. Still, with a real surge rising, we are recommending we all try not to get COVID.  Wear a mask.  Let’s all try to make that a real N95.  Avoid large gatherings indoors.
13. Immunizations are at their most protective for 4 months following the last dose.
14. Check out the clarification on how to manage if you have COVID or are a direct contact above.

My One Takeaway Sentence:
Most Importantly of All: Make Sure You and Those You Love Get Fully Immunized.

To your health,
Dr. Arthur Lavin