Covid Update - 25 April 2021

1 billion doses distributed globally. It took 61 days to do the first 100 million doses and only 5 days to do the most recent 100 million. If we can maintain that rate, that would another 5 billion doses out this year, and I suspect the rate will continue to increase significantly.

As I expected, the FDA lifted the pause on the J&J vaccine. After digging into the data more, they have more cases and held an ACIP meeting to determine what to do. The path they chose was to add warnings to the vaccine to make sure those taking it know the rare risk. I think this was a reasonable decision.

Our daily shot count has dropped in the last week, but it's still hovering around 3 million doses a day. Looking at the data, the amount of mRNA doses has held steady, so it seems most of the drop is due to the pause in J&J.

Overall there is evidence we're starting to run out of people who can and want to enthusiastically get their shot. From a Morning Consult survey, "77% of white adults who want a shot have gotten one, compared with 60% of Black adults and 55% of Hispanics who want one." I continue to not be too concerned about the holdouts. Even if we halved the daily doses, we would still hit 60% with their first dose in 6 weeks. Israel is at about 60% dosed, and their case count is trending towards zero.

The big story this week is India. After holding strong throughout the pandemic with a remarkably low case count, the dam has broken, and their case count is rising faster than anywhere else in the world. Due to vaccine supply constraints, only a tiny amount of their population has been vaccinated. It is a truly horrible situation with their hospitals filling up and morgues overflowing.

Some people are pushing the Biden administration to ship vaccines to India or release supplies that go into vaccines. Today the administration agreed. They announced they would be sending medical supplies, including PPE, test kits, and they're looking into emergency oxygen generators. They will also be releasing specific components on the no export list to aid their vaccine manufacturing. Lastly, they announced some loans that will help India build more factories.

This is excellent news. As our pandemic wanes, we need to help out the rest of the world. We're not safe till we're all safe. We've built one of the largest vaccine production capabilities ever seen; let's go use it to save the world.

The question is, why is India being hit so hard now? There's no simple explanation, but the more infectious variants likely have a significant role in the recent surge. 117 and 351, the two ones we're most concerned about, are very prevalent in India now.

They also have a new domestic strain, B.1.617, that has some of the same mutations in 117 and 351 that make it more infectious. Some press refers to 617 as the "double mutant," which is a scare-mongering meaningless name. 617 has many mutations; as all the other strains do, it doesn't seem like 617 is unique in any critical way. There's no reason to believe that our vaccine won't work against it.

We got more data this week on the variants that show that the variants aren't a concern for the mRNA vaccines. Studies were done against two of the newer strains in the US, B.1.1526 [New York origin] and B.1.429 [California origin]. Both respond to the vaccines.

Over the last few months, the US has dramatically improved our ability to quickly sequence large amounts of Covid samples. We're not at the point where we are sequencing 30,000 samples a month. This is key to detecting any new variants. At our current rate, we have a 99% chance of catching a new strain if it's more than 0.02% of the population.

As we move towards summer, we're seeing more and more universities announce they will require Covid vaccines for the fall. This is the correct decision and will help fill in some of the remaining people who have resisted getting dose.

This week, a study showed no adverse effect for women in their third trimester or their baby to getting the vaccine. We don't have data yet on 1st and 2nd trimesters because the vaccine hasn't been out long enough.

All in all, a good week for us. We're on the back half of vaccinations, and case counts are trending down.

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