The first 100 million doses took 89 days. The second 100 million doses took just 36 days.

We've made such incredible progress, and we're not even six months past the first vaccine authorization.

The vaccines also are showing just how fantastic they are. The FDA reported only 5,800 breakthrough cases out of 66 million vaccinated people. Truly one of the great feats of humanity.

However, parts of the US continue to struggle. Michigan is as bad as its' ever been in the pandemic. Other areas are slowly increasing, but it seems like they'll avoid a final surge.

This week's big news is that the FDA has paused using the J&J vaccine due to blood clot side effects. It was the correct decision to pause it while they gather more information. There was a lot of controversy around it, partly because the math isn't as straightforward as people want.

The stats most people cited were that there were 6 cases of clots in 6.8 million people dosed. The problem is that both these numbers are wrong.

Let's start with the 6.8 million people dosed. The FDA announced two critical things. 1. Onset of this is typically 1-3 weeks. Let's say two on average. 2. It appears to primarily affect women under the age of 50.

Once you apply those limitations, it goes from 6.8 million [which was the number of doses used in total on the day they announced] to something probably more like 1.4 million, an increase of 5x in cases per dose.

6 cases are also simply the lower limit for a number of cases. You don't find what you're not looking for.

For non-fatal cases, if you are a young woman complaining of headaches or unknown bruising two weeks after their shot, I don't think many doctors would take it seriously or connect it to the vaccine. Also, blood clots are a side effect of some forms of birth control, and a doctor could easily misattribute the cause. So we've likely massively under-counted this side effect.

The FDA made the right call to pause and look into it. Just like when they looked into the rare allergic reactions to the mRNA vaccines. They're being open and transparent, which gives me confidence they're not hiding anything.

There's a subset of people who think that the FDA was wrong to pause because a subset of people will think there are issues even if they later approve it. But we can't take action simply because of how some people willfully misinterpret it. As someone on Twitter said, ""You are not smart enough to be entitled to the truth" is a losing long term strategy."

My guess is that in the end, they'll find it's rare, but still something to look out for. They might change the recommendation on which age groups and genders should get it. I want an FDA that looks into possible issues that pop up and inform us when they do it. This is the correct path.

We don't need the J&J vaccine. It was already a relatively small amount of supply, so this pause won't significantly impact our overall progress.

A month ago, I predicted that Covid would be essentially over in the United States by mid-June. Looking at that prediction today, I stand by it. The big concern I have now is that we're moving from a supply-constrained environment to a demand-constrained one.

Over 130 million adults have now had their first dose in the US, that's over 50%.  In some areas, particularly the south, there is already weak demand. The CDC needs to start to put money and resources into getting doses to the remaining half.

One type of person that hasn't gotten dosed is those that lack access. Either due to a lack of information or schedules/disabilities that hinder their ability to get to the sites. In SF, they deploy mobile teams that set up shop in neighborhoods with low vaccination rates to allow for easy dosing. This is a technique that needs to be deployed nationwide.

We also need to start to push an education campaign to help get those on the fence their shots. There's a small set of common concerns that people in the hesitation camp usually have. We should target those specific questions in PSA's and in community outreach.

Current estimates for herd immunity are about 75%, so we need to get another 65 million protected. The good news is that we're probably almost already there due to prior infections.  There have been ~30 million confirmed cases of Covid in the US, and there are likely 2-3x as many cases that went undetected. I also think we'll do another 100 million shots in the next 30 days.

Natural immunity by itself is not as protective as vaccine immunity, so we still need to get as many people dosed as possible. However, new data suggests that if you had Covid and get the shots, your immunity is even better than if you just get two shots.

Take care out there; we're close to the end.

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