Infections are higher than they've ever been, and the rate of new infections is increasing. We set records for hospitalizations and will soon set records on daily deaths. While there was good news on the vaccine front, it won't come fast enough to change the next few weeks.

As expected, Moderna released their interim data, and their vaccine looks to be 95% effective. The Moderna one is also an mRNA vaccine like the Pfizer one. 10% of their patients experience "Grade 3" reactions after the second shot. That means that they had pain or a fever that kept them in bed for a day or two, not an uncommon side effect for some vaccines.

However, due to how they created it, their vaccine doesn't need to be kept at -70C. As part of their release, they stated it was much more stable than anticipated and can even be kept at fridge temperatures for a month. This is a game-changer because it means that distribution outside major cities and medical centers is relatively straight forward. Many common vaccines require refrigeration, so any clinic will be able to distribute the Moderna one.

Even better is that we expect to get a readout for the next two vaccines before the end of the year. AstraZeneca and J&J make them; both are adenovirus-based vaccines. If approved, these four plus Novavax [expected data in January or February] will be used across the US.

A study was released this week looking at long-term immunity. It showed that previously infected people had robust antibodies and T cells. Immunity is real, which bodes well for the vaccine rollout.

I've previously stated that I'm not really tracking non-Western vaccines. This week SinoVac, a private Chinese firm, released some data on their inactivated virus effort (called CoronaVac vaccine). Inactivated viruses are an older technique, and this data showed why it isn't used much anymore. The antibody response, as with many inactivated viruses, is poor. It looks like we'll have 2-5 vaccines in the west that I'll continue to track closely.

Pfizer hit their final endpoint and revised their effectiveness upward to 95%. Based on that data, they submitted an Emergency Use Authorization to the FDA. It will take about two weeks to review it. I know that seems like a long time, but we're about to inject this into tens of millions of people, so it seems prudent to dot the i's and cross the t's. Expect people to start to receive shots on December 12th.

Where do we go from here? When the vaccines are produced, they will be given to the federal government for distribution. The head of logistics for Operation Warp Speed is General Gustave Perna, head of the Army Material Command. He's the kind of person who is an excellent fit for this role. For a playbook, they are basing this distribution strategy around one developed for H1N1.

The CDC Advisory Committee on Immunization Practices (ACIP) develops the plan for the rollout. After the EUA is approved, they will start with healthcare workers, a group of 17-20 million people. This is the 1A group, and all of them should get their first dose this year. For Pfizer, the vaccine is two doses 28 days apart. About two weeks after your second dose is when you should be near full immunity.

The 1b group contains essential workers, the elderly [65+], and people with high-risk medical conditions. This group is 100-150 million people. After those two sets, then it'll be open for anyone to get one.

The epidemic continues to rage. In almost every state, there are more infected people than at any other point this year. But even with that, it looks like tens of millions of people will still travel and host groups for Thanksgiving. As one paper headline put it

"After Big Thanksgiving Dinners, Plan Small Christmas Funerals, Health Experts Warn"

Nearly 200,000 cases a day are being diagnosed. The daily death count is spiking, and I've lost count of how many states have hit their hospital limits. 1 in 1,000 people in North Dakota have already died of Covid, and they will probably lose 2-3x more in the coming months.

In September, a Swiss man flew from Dubai to New Zealand. Per protocols, he took a PCR test within 48 hours of leaving and tested negative. While in mandatory 14-day quarantine in New Zealand, he developed symptoms of Covid-19.  Even though he had a negative test pre-flight and was not symptomatic on the flight, he still infected four other people.

Don't be part of the problem. Don't travel or cluster in large groups for Thanksgiving. We can just all agree to celebrate Presidents Day like it's Thanksgiving and Easter like it's Christmas. The next 60 days is about how many lives can we collectively save with our actions.

I miss my family deeply. This will be the first Thanksgiving I ever miss, but when I really thought about it, the risk of infecting them just wasn't worth it. Worse yet, even if I could get tested, I would take tests away from those that need them since we're at capacity. I also know several long haulers, and this close to a vaccine, I'm going to do everything I can not to get it. Please think of how your actions could injure and kill others; just stay home.

I know it's going to be a long few weeks for everyone, stay strong.

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