A nationwide second wave is starting. Hospitalizations are beginning to trend up, which clearly shows this isn't a result of more testing. If this trend continues on Election Day, doctors and nurses from California and New York might be going to swing states to set up field hospitals instead of working get out the vote efforts.This week the US Military's Transportation Command released a study on Covid transmission on airplanes. It showed that transmission is relatively low, mostly due to the number of air changes and filtration. I'm still not jumping at the bit to get on a flight, but it's useful information to have.

The WHO conducted a large scale worldwide trail, called the SOLIDARITY trial, with four existing drugs to test efficacy. Some of these drugs had been hyped early on. They tried hydroxychloroquine, remdesivir, interferon-beta, and lopinavir/ritonavir. Unfortunately, it showed small or no effects in all of them, no silver bullets here.

Let's dig into the state of vaccines. As I've previously noted, I don't track the Russian or Chinese efforts. They don't release much data, and I wouldn't trust them enough to take one. I also no longer follow ones in Phase II because there are too many, which is excellent!

There are five Phase III trials in the west: Moderna, Pfizer, J&J, AstraZeneca, and Novavax.

This week the J&J Phase III trial paused due to an illness with one of the patients. This is not uncommon in trials, and once they complete an investigation, they will determine if they will restart it. This is the system working.

[Side note: Sometimes, it is referred to as the Janssen vaccine. Janssen is a wholly-owned subsidiary of Johnson and Johnson (J&J). All three names are used by various people to refer to this vaccine candidate.]

AstraZeneca had a similar pause for patient illness last month. They have restarted the trial globally but not in the US, for reasons they haven't disclosed.

Novavax recently entered phase III. If successful, they believe they can deliver 100 million doses before the end of Q1 2021.

Our two staking horses continue to be the Pfizer and Moderna ones. Both are RNA vaccines, the first ones ever developed for human use. Both have now stated publicly they won't submit for the EUA until mid-November at the earliest. I think that's great because if, as some were worried, the FDA had approved one right before the election, it would reduce confidence in it.

The downside of RNA is that it's very unstable. As a result, both need to be kept cold, Moderna at -20 C, and Pfizer at -70 C. This dramatically complicates the delivery of it.

From StatNews
"The drugmaker [Pfizer] developed its own thermal shipping boxes that can hold up to 5,000 doses for up to 10 days. But the containers should not be opened more than twice a day and should not remain open for more than one minute at a time.The boxes need dry ice to keep cold — 23 kilograms of dry ice pellets, to be precise, which must be replenished within 24 hours after the shipper is first opened, and then five days after."

Once we have approval [fingers crossed in six weeks], then it's about logistics. The FDA / CDC is still coordinating the rollout, but I suspect that the chaos at the top is hindering it. There has been some discussion about involving the military in distribution, which is reasonable. The US Military is the best logistics organization in the world.

Given the infrastructure and planning required, it seems that large states that take Covid seriously will be in the best position to use the vaccines as they come online. California continues to keep Covid under control effectively, and the test/trace infrastructure we've built continues to pay dividends.

Scott Atlas is a senior advisor to the president on Covid. This week he spouted misinformation and outright lies, including: masks don't work [they do], testing is bad [wrong], and herd immunity is around the corner [it's not].

Atlas would join the ranks of formerly brilliant people who retire to Stanford to spout their insane dribble in another era.  [William Shockley won the Nobel prize for inventing the transistor and was one of the founding fathers of Silicon Valley. He spent his last decades as a tenured professor at Stanford in electrical engineering and preaching eugenics to anyone who would listen.]

But it's 2020, and Atlas's views are influencing policy at the highest levels. There are still hundreds of people dying every day. California is showing that you can keep it under control with masks and policy. There's no reason why this shouldn't be nationwide.Worse yet is that we're nearing the end. If we stand firm now, we can help prevent tens of thousands of additional deaths.

Between monoclonal antibodies and vaccines, the world will be a different place soon. We're likely 100 days away from millions [if not tens of millions] of doses being available. The Black Death was a scourge for 200 years; we're going to beat Covid in 12 months.

We will also come out of this with an arsenal of new tools to fight future pandemics. The monoclonal antibodies that I've been tracking are short-lived and very specific. There is a group in the US that has begun testing for one they call Prometheus. It's designed to be able to fight all Coronaviruses and has a lifetime of six months. We might fight the next epidemic with masks and Prometheus alone.

Stay strong; we can beat this.