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.
• 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.

A Moment on the Impact of the Pandemic on Families

Yesterday, an article written for The New York Times was published online, devoted to thinking for a moment about what impact the pandemic has had on grandparents, and so on parents and children.

The article is available now at The Times website (https://www.nytimes.com/2020/10/30/well/family/pandemic-grandparents-grandchildren-connection.html), and on November 7 will be available in their print version.

I was honored to be invited to be interviewed, an invitation that was offered to the American Academy of Pediatrics.  It was the AAP who, in turn, invited me to speak on the Academy’s behalf in my position as the Chair of the Committee that helps draft policy on matters pertaining to the psychological and social well-being of children.

Allison Gilbert, the reporter did an outstanding job featuring real families’ experiences with this tragedy, as well as a very broad range of national expertise.

For me, reading this article, thinking about this subject, I continue to mainly be deeply saddened at how very tragic this rare and horrible plague has been.  We will read later in this update on the shocking figures of loss we have all borne across our nation, and truly, across our world.  And this article brings the vastness of the global pandemic, the national tragedy, into each of our homes.

Not all, but many families, are lucky to have living children and grandparents who treasure each others’ company.   Grandparents are a rare event in life.  I suppose single-celled life forms have zillions of generations surrounding them, but as you get to forms of life that are made up of many celled bodies, like ours, and that reproduce one generation at a time, with each generation taking some time to grow up, you of course see fewer and fewer generations surrounding the babies.  In fact, for almost all of life, you only see one, and in most instances, none.  Most life hatches without parents around to help.   And for the minority of animal species that do parent, there aren’t any grandparents around.

People have studied the rather unique instance of human grandparenting, and found it is for real.  Grandparents are a constant feature of all human communities and cultures.  Some studies find we have a measurable utility and that measure is calories.  As human mothers need to take a break from gathering food for the village after birth, here are grandma and grandpa ready to fill the gap!   It seems that evolution has led us to enter our time of life past having babies with an extremely efficient body.  Many folks in their 40’s and beyond bristle at suddenly needing less food.  A slice of cake that used to never matter now reliably adds a pound.  But there is method in this madness.  As we age, we need less food, but our strength persists so we can still gather the same amount.  The result?  People past 50 are net calorie profiteers for their village.  Who knew!

But beyond sheer profit motive (which is enough for evolution), grandparents bring a cultural level of teaching and wisdom that is different in kind than what kids and parents are doing.  Now, the main show is kids and parents, no doubt, that is where the real action of learning life happens.  But because that is the main arena, grandparents have the luxury of being outside the heat of the main event.  They are an outside, but still deeply intimate, place for children to take a break from the struggles of growing up, relax, let their guard down, and ease into having some quiet time and some fun.

And for grandparents, if all goes well, there is only pure joy.  We are relieved from being the main event too, the child is usually not our main responsibility, so we can enter a new phase of playfulness.  And let’s not forget the unmeasurable thrill of seeing your life continued, just as our life draws closer to its end.

This is how it is supposed to be.  But part of life is also tragedy and loss.  Disasters and plagues.  And now it is our misfortune to be living through a plague.  And in one that can strike us down, in unpredictable ways, that puts us all at risk.  And in a nation who has chosen, for reasons beyond acceptance, to not halt the plague, putting us all at the highest risks any nation has chosen to accept.

And so the article tells the stories of families longing to be together, children and parents as well as grandparents wanting to be together.  It tells of the impact of that cloud of risk hanging over our heads, not for days, not for months, but for more than a year soon.  It tells stories of great pluck as families find a path to remain connected and loving time together, without spreading the virus.

I hope you enjoy this article, beyond the honor of being part of it, I learned a lot thinking about the subject, and so much from reading people’s stories.

Spreadability

The news on the spread of COVID-19 in America, in Ohio, and here at home, remains, sadly, very bad.

As a doctor, but really as a person, it pains me to be typing these facts.

Our Nation

We begin with our nation.  On October 30, the United States became the first nation in the world to see over 100,000 of its people become infected with COVID-19 in a single day.  This is a monumental tragedy, and will cost a number of lives I find difficult to discuss.

The reality in our beloved country has now entered a new reality, one that I am sure no one wants to be in.   In the spring and summer we watched hot spots erupt.  First it was New York, with a handful of other spots including Washington and Michigan.  Then in the summer we saw the South and Southwest erupt in places like Florida, Texas, Arizona, and Southern California.  But today, the situation is more grim, almost the entire United States is a hot spot.  We have moved beyond hot spots to a hot nation.

Beyond the sheer scale of the increase, why does this matter?   It matters because now people who once were protected may not be anymore.  When so many communities reach such high levels of viral illness, the virus begins to penetrate into areas it couldn’t when there simply were fewer people infected walking around breathing out virus.  We are now hearing of nursing homes that had succeeded brilliantly in keeping the virus out, now finding their highly successful measures no longer work.  One home with 40 residents had zero infections from January to last week, then one resident got infected. Within one week 20 were infected and 12 dead.

We have had reports of people being extremely scrupulous, not going out at all, leaving deliveries outdoors for some hours before getting them, and wiping them off before touching them, coming down with the infection.

When a virus infects millions, there is more of it in the air.  The United States is seeing this happen now in real time.

A Stanford team gives us more evidence of how this virus will take any opportunity we give it to spread.  They looked at the example of perhaps the only large gatherings still taking place with any frequency, in the world.  No matter one’s political leanings, the question can be raised, what happens when thousands of people gather, but outside, packed together for over an hour?  Thanks to Stanford epidemiologists, we now know.   The president’s rallies just since he began them have now been proven to lead directly to 30,000 extra cases of COVID-19, and to the deaths of 700 extra people from this infection.   This is not so much a political observation as a medical one.  As we have been saying in these posts for many months, if you gather, even outdoors, in close contact, for sustained time, the virus is handed the chance to infect, and kill.

Our State

October 30 was a horrible death for our own state Ohio, too.  Keep in mind that when our state entered lockdown in mid-March we were facing, at most, 1,380 cases a day.  And when the surge hit in the summer, Ohio hit a peak of 1,754 cases in one day.  Since just October 14, Ohio has entered its most dangerous surge, and still is climbing rapidly.  On Friday we hit just shy of 4,000 new cases in one day.

Even at 4,000 cases a day, most people do not know someone ill with the disease, but that can change rapidly.  The number of people who get sick from any contagious disease, including mild colds, tends to up in a doubling rate.  That is, one case leads to two, two leads to four, you know how that goes.  Well going from 64 to 128 cases (one doubling) across a state is not noticeable.  But going from 4,000 to 8,000 cases (also just one doubling) is very noticeable.   As you will recall, the most cases that the state of New York has ever experienced, when the news images were so grim, was 11,661 in one day.  So being at 3,826 on Friday is bad news, it brings us to the brink of the 10,000 threshold when the news gets unbearable.

And, just in case you were wondering, once the pandemic rages is there nothing that can be done, let’s look at New York now.  In April it was a deadly mess as noted.   But it took action.  It put together a brilliant testing regimen to catch tiny outbreaks early and end them, and from April to October 27, it kept its levels to at or below 1,000 cases a day, which in a large state made it one of the safest places to be in not just the US, but the world.  But the iron rule of COVID-19, until a vaccine is in place, is that if you gather, you ignite outbreaks, has impacted New York.  It is right now experiencing a surge, all due to people gathering.  And again, with the right measures, New York, Ohio, anywhere, can be safe.

Our home

It is very distressing to report that numbers here in Cuyahoga County are not good too.   To put current trends into perspective, in the mid-March, initial surge, we reached a daily peak of 75 new cases a day.   Then we locked down, until Memorial Day when the great Ohio Re-Opening took place, without a really effective testing regimen in place to snuff out little outbreaks.  The result was our summer surge, hitting nearly 200 new cases a day, in early July.

Cuyahoga responded very well, and we achieved a real drop in COVID from then until September 18 our so, reaching our best minimum so far of about 45 cases a day over some weeks.  But since September 18, our numbers have been climbing.  As of last week, we have hit over 150 a day, threatening to plunge us into the highest infection rate category, purple.  The good news is that the last two days reported saw the numbers drop and we avoided purple.

But here, in our very own neighborhoods, as monitored by our office, we are definitely seeing numbers of infections rise.

Our experience here at home seems to directly mirror our County, our State, our Nation.

Treatment

We close this post with some good news.  All indicators strongly suggest that a vaccine for COVID-19 will end this tragedy, effectively and safely.

We are not there yet, but here is why I am hopeful.

The basic job of an immunization is to convince your immune system that you have had the disease already.  Why does that work so very, very well?

A simple but ironclad rule our immune system is that we can develop memory for an infection.  By definition, there can be no memory for a new germ, for the simple fact that our body has never seen it before.    But once we have an infection, in the vast majority of infections, we create a memory of that disease.

How does memory help?  Because it is not just a simple memory.  Memory for an infection involves a whole population of cells, in this case it’s the wizard of the immune system, a population of T-cells, forming.   As long as those millions of T-cells, 100% and forever devoted to remembering this one infection remain vibrantly alive in our body, then when that unsuspecting germ lands on you a second time, those memory T-cells will sound the alarm, and a storm of cells and antibodies will descend on that germ almost immediately and utterly destroy it before you even get a sniffle.  In a word, you are immune.

So, to know if a new vaccine works against a new disease, we need only prove one thing- did it stimulate creation of a new memory to this new disease sufficient to reliably call out the army if the germ tries to infect you.

And the evidence is great!  Many candidate COVID-19 immunizations appear to cause real memory to form, the sort that will keep us from dying from COVID-19.  I think that is just amazing and so very hopeful

The other job a vaccine needs to prove is that it is safe.  It is not good ending one threat only to be sunk into another, of course.  And the news here is good too, thousands of people have gotten trial COVID-19 vaccines, and, so far, no serious harm done.

Now, we all know there is pressure to get these vaccines out, and that some are applying unethical pressure (none in the drug companies, only some politicians).   But I am highly confident that the drug companies conducting the trials, and who will ultimately be making the COVID-19 vaccines, will not release any vaccine for use before they have good proof that it works and it is safe.

And I am fairly certain that the world will now the actual data on just how often what sort of side effects any released vaccine causes, and the chance of it working.

I will be watching reported data to the best of my ability, and reporting it right here, too.

And I will be sharing whether I think a COVID-19 vaccine made available to all of us works well enough and is safe enough to take.

Again, leading candidates appear to be creating memory for COVID-19 that could prevent serious illness.  That is amazing news.  And, so far, no serious side effects are being seen across thousands of doses.  That is good news.

But it still remains to be seen, will a COVID-19 vaccine actually prove able to protect well enough, and will it in fact not cause many serious problems.  We truly do not know that yet, but we should know in some months.  Perhaps before 2021.  But almost certainly by early 2021.

We take the standard of safety and efficacy extremely seriously and will not recommend a COVID-19 immunization unless the evidence is solid, and compelling.

And so right now, we begin the work of asking all of us, to take a step back from the strong passions of the immunizations battles, on both sides.

We ask all of us who promote vaccines to be sure we take an objective, very careful look.  To scrutinize the evidence for gaps in the proof any recommended COVID-19 vaccine actually works and actually is safe.  This is no time for cheerleading.

We also ask all of us who harbor deep suspicions about the whole idea of immunizations to take an objective, very careful look.  To scrutinize the evidence for gaps in the proof any recommended COVID-19 vaccine actually works and actually is safe.  This is no time for leading charges.

In short, we ask ourselves, and everyone to do exactly the same thing.  To scrutinize the evidence for gaps in the proof any recommended COVID-19 vaccine actually works and actually is safe.

Why?

Because real lives are truly at stake.  We cannot promote a known faulty vaccine because of enthusiasm.  And at the very same time, we cannot depress use of a way out of catastrophe because of suspicion.   Let us wait for the right vaccine to be developed and proven, but if it is, let us all be immunized.  Holding back endangers us all with a proven deadly plague.

BOTTOM LINES

1. We are pleased to share the treat of a major New York Times article on grandparenting in the age of COVID.  I was very honored to be asked to represent the AAP in this article.
2. COVID-19 continues to spread across the United States causing illness and much death in its path.  Again, gathering leads to spread.
3. The spread is being seen in nearly every state, in Ohio, and here at home in Cuyahoga County and in neighborhoods served by Advanced Pediatrics.
4. We continue to test all staff including doctors once a week at Advanced Pediatrics.  We will report any positive events and possible contacts.  So far, we have had only two cases, both in staff, both so far well.   One was near the start of the pandemic back in March and the other in October, neither involved contacts from the office to any families fortunately.
5. Progress on a COVID-19 immunization is proceeding well enough to begin to be hopeful that a COVID-19 immunization may one day in the coming months end this tragedy.  We are NOT there yet, but progress suggests we very well could be.

My takeaway  – in one sentence:

This remains a most dangerous time in the Pandemic, and so we all urge everyone to exercise the greatest caution and take all steps in your hands right now to stay well and protect the ones you love: avoid crowds, keep physically distant, wear a mask.

To your health,
Dr. Arthur Lavin