The holiday surge seems to be waning, signaling an end to the largest wave to date. As a country, we continue to improve the vaccine rollout. Within a few weeks, I suspect the limit will be vaccine availability, not our ability to get shots in arms. California continues to have major issues.

Governor Newsom continues to fail Californians every day. Where to start this week with him? First, he went into hiding, and in the middle of the highest death day we’ve ever had has refused to hold any press conferences.

Worse still, the state announced that they would now reopen based on a secret set of metrics they refuse to release. Their stated logic is that it’s too complex for the average Californian to understand. The reality is that many qualified medical experts would likely disagree and that Newsom doesn’t want more bad press. California is now dead last in states in terms of vaccine distribution, and Newsom is responsible.

The cities, on the other hand, seem to be getting distribution figured out. In SF, the city set up a drive-through mass vaccination site that can do 3,000 people a day. Currently, it’s limited to 500 / day due to scarce vaccine supply. I can actually see it from my deck, and I’m excited about my chance in a few months to visit it. Long Beach now has a web portal where you can sign up for appointments.

This week there have been many questions on the new variants of Covid and what that means. Several major ones have cropped up, but the short answer is we still have more questions than answers. Even the naming conventions are in flux. Sometimes they refer to them by country of the first detection, other times by the specific mutation site, and sometimes by the genetic lineage.

There are three that are being closely tracked; they are known as:

The UK / B.1.1.7 / 501Y.V1 variant
The South African / B.1.351 / 501Y.V2 variant
The Brazilian / P.1 / 501Y.V3 variant

Moving forward, I’ll be using the non-country names to refer to them. There are several reasons to do it. Most simply, there will be more mutations, and the first place to detect them isn’t specific enough to differentiate later.

B.1.1.7 is the one we’ve heard the most about and the one that is confirmed to be in the US. It is more contagious, and the CDC currently expects it to be the dominant variant here sometime in March. It appears that the vaccines are fully effective against this variant. This is the race we’re in now. Can we get enough people vaccinated before this spreads and overload our hospitals in March / early April? I think we can; it seems like we’re on track.

B.1.351 is currently mostly spreading in Southern Africa, and no cases have been recorded in the US. This one concerns because, in lab experiments against blood from people who had previously been infected, the antibodies were less effective. It is not known if it is more contagious.

P.1 is currently mostly concentrated in Brazil, though some people on a flight to Japan also have tested positive. It is not known if it is more contagious. The reason scientists are concerned is that the area of Brazil it is spreading through already had one of the worst concentrations of Covid in the world. If it can spread aggressively there, it might mean prior immunity isn’t effective, or it’s more contagious. Data from Brazil has been spotty; they’ve had to update their vaccine trial numbers repeatedly but still worth tracking.

When a virus evolves to get around the immune system, it’s called an immune escape. However, it’s not usually a binary outcome. In the lab tests on B.1.135, there was a variety of responses, with some people fighting it off as well as they did the normal Covid, while others had almost no immunity. The median results were in the middle. The mRNA vaccines are incredibly effective, so even a step down would still put us in a much better position to fight a new variant. Vaccines often provide more robust immunity than naturally acquired infections.

Additionally, mRNA vaccines would be the answer if there was a total immune escape. A year ago, no one had ever made them at scale, and a big blocker for the faster rollout was the lack of factories and distribution channels. We now have factories [and I hope they’re building more] to make even more doses.

Also, a year ago, there had never been a widely deployed mRNA vaccine. Now that we have enough data, there is hope that the FDA will authorize them on a quick turn basis like they do the flu vaccine. Once we’ve identified a new variant, some people think we could turn a new vaccine in weeks.

Test, trace, isolate, and vaccinate. That’s the mantra we need, and today we’re finally in a position to excel at all parts of it.  This is why I’m less worried about a new variant. It’s night and day compared to where we were a year ago.

A couple of quick notes from the last week. There was a lot of confusion about if there was a national stockpile of second doses. This week there was confirmation that yes, there is, but it’s not being rushed out; it’s being held back for second doses. Also, there was a pause in a batch of Moderna vaccines due to higher than normal allergic reactions in San Diego. The medical board met and cleared the batch, and it’s been administered with no further issues. Pfizer announced last week that it has fully enrolled its trial for children ages 12-15.

Overall the trends for vaccination in the US continue to get much better. President Biden’s goal is 100 million vaccinated in the first 100 days; it seems like we are on track to beat that. We’ve done about 20 million doses so far. It took 23 days for the first 5 million, 7 days for the second, 6 days for the third, and 4 days for the most recent. I expect next week we’ll be doing between 1.2-1.4 million doses a day by the end of the week.

There are currently 12-18 million doses delivered every week or 1.7 - 2.5 million every day. A month from now, 20-25% of adults will have been inoculated, and many more will have acquired immunity through infections. We’ll start to see large impacts to the spread by then.

We’re getting Covid under control. This week it felt different that we finally start to turn the corner on vaccine rollout. It’s no time to let up on vigilance, a few weeks of keeping careful will pay huge dividends. Stay safe out there.

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