Once again, we're at the worst point in the pandemic. Hospitals in California are rationing care and running out of oxygen. Although we made stepwise progress in the vaccine roll out it has not been a good week, our leaders continue to fail us. However, it looks like we might finally be on the path we need to get out of this.

Gov Cuomo continues to do everything wrong at every step of the way. New York City has expiring doses because Cuomo has threatened anyone who gives out a dose to someone that isn't on the priority list. Cuomo doesn't actually care about prioritization; he just does the opposite of what the NYC mayor wants. The Mayor of NYC should ignore those regulations at this point; vaccines spoiling is unacceptable.

What's worse is that Cuomo authorized the Buffalo Bills to have thousands of fans in person for their playoff game. There's no justification for allowing that to happen; there's a literal global pandemic, and having people congregate and get drunk is exactly how it spreads.

This past week several people I know, in separate incidents, were all infected with Covid. They all thought they were taking needed precautions. Right now, 4% of all people in California are currently infected. Even if you do everything right, you can still get infected. Covid is the most contagious disease we've faced in our lifetime. It's on us to do our best, but even then, due to bad luck, you can still get hit.

Everyone should be taking Vitamin D; it's one of the few things you can do ahead of and during the disease that seems to help. A study also came out this week that showed that it helped improve the vaccines' response in the elderly.

Mayor Breed said this week that SF doesn't know how many citizens have been inoculated because the state deals directly with health care providers and don't collect the information for the cities. It's infuriating that the state can't keep a simple database up to date. I spoke to one doctor in LA, and they said that many hospitals received the same number of doses, no matter how big or small they were. As a result, some don't have enough for all of their front line workers, and others are vaccinating their valets so the shots don't go to waste.

California continues to fail in vaccine administration. We rank #48 of the states in terms of the percentage of our doses we have put into arms. So far, we've inoculated ~750,000 people. At a press conference on Friday, Newsom said that there would be an additional million people vaccinated in the next 10 days. Given his gross incompetence to date, I'll believe it when I see it.

Let's talk herd immunity. At the high end of estimates, we may need 80% of the population to be immune. In California, about 20% of the population has already had Covid, and at least 5% more will become infected in the next 60 days. If we inoculate people at 100,000 people a day, we will hit herd immunity in mid-August. If we can do 250,000 a day, then we'll hit herd immunity in mid-April. Yesterday California vaccinated 82,000 people, and it's been steadily improving.

We probably will hit the overall vaccine supply limit far before we get to 250,000 doses a day in California. I continue to believe we will be at herd immunity sometime during the summer, with the pandemic being well under control in the spring.

The new variants are concerning. There's a worry that the current vaccines may not be as effective on the South African variant, but there's no hard data either way. Both strains are more contagious, and that has pushed the herd immunity threshold higher.

As expected, the vaccines are exceptionally safe. To date, there have been ~5.5 cases of anaphylaxis per million people vaccinated. There are still minor reactions, as expected, to the second dose; arm pain, fever, and such.

As disappointed as I am with the US rollout of the vaccine, it actually is 4th overall worldwide in doses per person. Only Israel, UAE, and Bahrain are better. In particular, Israel is doing phenomenally, and they have already done about 18% of its population.

This week we also had the incoming administration announce they will no longer hold back a second dose. This is huge and will free up millions of more doses to get people their first shot immediately.

Last week I predicted that we would get to 500-750k doses a day nationwide. Over the last 7 days, we've averaged ~500k doses a day, and late last week, we had a day where we vaccinated 865,000 people! As of today, we've vaccinated 7.75 million people or about 2% of the US population. This week we'll probably have a day where we get over a million doses out, with the 7-day average moving over 750k.

We're on our way to getting close to an inflection point where the vaccinations will start to help suppress the spread.

In an extremely trying week, I know it's easy to only see darkness in the future. However, I remain an optimist.

While we are a few weeks away from the peak of the epidemic, I sincerely believe we've on the road to ending it.

There are also other problems we have as a country. Still, I don't see anything beyond our ability to solve them. It won't be easy, but neither was creating and distributing a vaccine against a novel virus in 10 months. Some of America's best moments have come out of our darkest chapters, and what I've seen in the last few days suggests this time it won't be any different.

Stay strong and stay safe.

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