Covid Update - 14 Feb 2021

The US had three days over 2 million doses this week. California had its' first day over 250,000 doses. 11.5% (!!!!) of the US has received their first dose.

Our distribution system is finally dialed in; we're just supply limited. The good news is that the weekly supply will keep increasing, and J&J should be approved soon and deliver millions of more doses in March.

As of today, it seems like, in late March or early April, they will open up vaccines to anyone who wants one. We will flip from being supply limited to demand limited. There is still a significant amount of vaccine hesitation, but as more people are vaccinated, it decreases. I expect that in the third quarter, the US will donate a considerable number of vaccines we no longer need.

The bad news this week is that AstraZeneca continues to have issues/concerns. South Africa canceled a study with their vaccine after early results showed extremely poor results against the 351 variant. It seems they may have jumped the gun; there's some data that although it was not effective against infection, it might have effectively prevented severe disease.

Worse still, AZ stated on an earnings call it would take it 6-9 months to retool for a booster shot targeted at B.351. This contrasts with the mRNA companies who think they could target and retool in weeks.

The reality is that there is no downside to taking the AZ vaccine. It's the least effective of our options, but a shots a shot, and it will still save lives. You'd prefer to drive in a car with airbags, but that's no reason not to wear seat belts in ones that don't.

It also has the largest manufacturing capacity by far, and it can't be quickly retooled for the other ones. We should move forward with it and just assume those populations will need a booster, but we should save as many lives as we can in the meantime.

Speaking of boosters, we got more good news this week. In general prior infection is less protective than good vaccines. A study showed that if you have had Covid and get a single shot, it is as effective as having the two-dose vaccination.

This week the Biden administration announced it had signed deals for an additional 100 million doses of each of the Moderna and Pfizer vaccines. This means the US will have a total of 600 million doses [300 million people] by the end of July. There are ~250 million adults in the US and another ~100 million children. This does not count any additional doses from J&J or Novavax, both of which are very likely to be approved.

Let's talk Israel. 42% of the population has had their first shot, and 27% has had their second. Israel has been using the Pfizer mRNA vaccine exclusively. It's important to note that B.117, the more contagious and deadly variant, is the primary strain in Israel.

A study from a major medical group came out and showed just the Pfizer vaccine's incredible effectiveness. Out of 500,000 people who had been vaccinated, there had been only 544 cases of covid. Of those, only 15 were hospitalized, only 4 were in severe condition, and none had died!

Additionally, a second study suggests that the mRNA vaccines are also preventing transmission. The early data on the 351 variants indicates that the mRNA vaccines are still effective, though less so, against them.

This is as good as it gets. Doses in arms are all we need to end this, and we're well on our way. In the US, the race is on. B117 is expected to be over 50% of cases by March 23rd. That gives us five weeks to get ahead of it. We should vaccinate at least another 20% of the population on our current track, taking us to 30% inoculated and significantly more having immunity from prior infection. Fingers crossed, we got this.

Early on, there were concerns about Antibody-Dependent Enhancement [ADE] for Covid. ADE is when you have either had an infection or vaccine, and the virus changes a little, and the second time around, you get sicker than if it was your first time. Famously this occurs with Dengue Fever and SARS. Covid is a close relative of SARS, but after extensive analysis, we have seen no evidence of ADE, with prior infection or with vaccines.

But here's the rub, it seems like a big reason we may not see it with the vaccines is due to the research done post-SARS in the mid-2000s. In animal studies, they found ADE occurred, but only if the vaccine targeted one part of the virus, specifically the nucleoprotein. As a result, it seems not a single one of the vaccines target that; instead, they target the spike protein. Add the scientists who discovered that to the list of people we owe a massive debt of gratitude.

The basic research we do has shown time and time again to be why we have been able to create the vaccines we have today. Some members of congress regularly lament that we spend money on basic research. To be crystal clear, the way we can create Covid vaccines in months is by funding tens of billions of dollars of research over decades on fruit flies, beer yeast, and scientists to study bats. By standing on the shoulders of giants, it let us see the path to create the cure we have today.

In another instance of science is just magic, I read an article this week about the Pfizer manufacturing process. One just mind-blowing fact is that the raw mRNA used in the vaccines is a million doses a gallon. Enough doses for a state can fit in the trunk of your car. Yes, that's in the pure form. It's then sent to be encapsulated with the lipid layer to enter your cells. Then buffer solution is added before they are put in the vaccines but can you imagine holding that gallon knowing the lives it'll save.

Arthur C Clark said that "Any sufficiently advanced technology is indistinguishable from magic." I've been in beer breweries producing more in volume than is required to vaccinate the world from the worst pandemic in 100 years. Mind blown.

Stay safe; we're in the end game now. This is no time to be reckless; every day, we're closer to the end.