Advanced Pediatrics is very excited to announce that Dr. Michael Osterholm, one of the world’s top experts on pandemic viruses, has agreed to be interviewed by Dr. Arthur Lavin.  The in-depth interview will take place in mid-July, and Advanced Pediatrics will be releasing it in three parts.

Dr. Osterholm has achieved a thorough mastery in the field of infectious diseases, understanding how they work, how they spread, what can be done to control harm done.   His career includes solving the mystery of what caused toxic shock syndrome, how infections spread in day care centers, as well as major threats to human lives such as the Ebola epidemic.   He has been invited to serve on some of the world’s leading agencies that are responsible for managing pandemics, published in the world’s top medical journals, and recognized with top awards.

The result of this lifetime of care to the science of germs and pandemics is that he offers us one of the clearest and most informed voices on this subject, at time we all dearly need such depth of knowing, really wisdom.

We are very, very honored to have someone of Dr. Osterholm’s mastery agree to be interviewed by Dr. Lavin.   In response to my invitation to the interview, he gave recognition to the work we do here on your behalf at Advanced Pediatrics:  “… you are exactly the kind of expert and voice in our communities I so much want to support however I can.”

So stay tuned, we will have 3 posts in Real Answers with Dr. Lavin in the coming weeks to introduce the 3 segments of my upcoming interview with Dr. Michael Osterholm.  And then following the release of these 3 segments, posts will follow to discuss what Dr. Osterholm has taught us.

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.

Spreadability

Last week we observed that there was now clear evidence that this virus, the SARS-CoV-2 virus did not go seasonal, remained very active throughout the Spring, and this week we can observe it is picking up speed of spread now that it is Summer.  Once again, we can say that this virus is not seasonal, meaning it will not go away simply because it’s a new season.

Worse, for us in the United States, there is no natural inclination to slow down on its own.  Slowing the spread of this virus appears to only happen with great effort.  The story in the United States right now is that spread is happening, in accelerating scales, throughout the American South and the West Coast.   There are more modest, but detectable increases in spread of this virus right here in Ohio, and not much increase in the New England states and NY and NJ.

The fact that there is such a difference between the American South and West, and the Northeast, is not currently explainable.  One might conjecture that NY and NJ had a horrible outbreak leaving them more immune, that the South has been more eager to re-open and less likely to use masks.  But California has been a model of careful isolation, as well as a state with some of the earliest outbreaks, and yet it still has one of the fastest rises in the US.

As noted, Advanced Pediatrics is deeply honored to be granted an interview by the extraordinary Dr. Michael Osterholm, one of the world’s great medical detectives.  I will be asking him how best to understand the patchwork sort of quality of outbreaks with this virus.

The mystery extends to the rest of the world.   The United States never really came close to achieving zero spread, and so we cannot say we ever ended our “first wave,” but nearly 50 nations have achieved this landmark, and now many of them are seeing rises in cases, including Israel, Sweden, and Costa Rica.  Those with new rises can be said to be entering a “second wave,” why these nations and not others?  We do not know.

Brazil, India, Mexico, Bangladesh, Colombia, and many other nations are seeing striking explosions of new cases, still in their first wave, again why in these nations, we do not know.

But the point is that across the world, many nations are experiencing true, extensive, spread of this potentially very dangerous virus.  The pandemic is not over, not even close.

Keep in mind that about 5-10% of our nation has been infected with SARS-CoV-2, without a vaccine, the pandemic will continue to rage until enough people have had so that the virus will not have new, uninfected people handy enough to allow it jump from person to person.  Most experts guess that will happen once about 60-70% of a nation has been infected.  We are at 5-10%, 60-70% is a very, very long way from now.

Severity

The virus continues to present the two faces readers of Real Answers know of already:

The benign face of those infected who have few or no symptoms.  For so many, this virus will seem a very mild enemy.

But for many, many people, even young adults, and in about 1 in a million children, this virus can be devastating.  Particularly for adults, it can cause so many agonies, and such danger, it must be considered a deadly virus.

Sadly, the outbreaks in the US still feature this second face, the deadly face of this virus quite dramatically.  There is no indication here in the USA that this virus has become milder.

Diagnosis

The main tests for COVID-19 remain the same:

1. A swab to find the active and current presence of the SARS-CoV-2 virus
2. A blood test to see if  you have antibodies proving you once had the infection COVID-19.

The swab continues to be imperfect, turning up negative in about 30% of people with the infection, but it is the only test for active virus present.

The antibody blood test is made by many, hundreds, of companies, with little quality control, so unless one knows the company doing the test has excellent result quality, the result will not reliable.  We have not identified reliable companies yet, but are looking for such proofs.

Treatment

No medication or vaccine that can reliably stop this virus completely has been made available to date.  The hope for a vaccine grows but again, there is often a gap between hopes and realizations.  We are not there yet.

BOTTOM LINES

1. The COVID-19 Pandemic of 2019- , continues to rage.  Hot spots are now all over the world. In our nation the South and West are most active, with NY, NJ and New England quiet.   Ohio is beginning to see greater spread, stay tuned.
2. The SARS-CoV-2 virus remains dangerous.  It has not yet become less severe.
3. The swab remains the key way to find out if you are currently infected.  The antibody test to determine if you had the infection is not reliable from one company to another yet, so beware use of that test.
4. THE MAIN POINT:  The virus is very much spreading, this is no time to let down one’s guard.  Be careful. Stay 6 feet apart, avoid crowds, wear a mask!

To your health,
Dr. Arthur Lavin