We did 3.5 million doses yesterday and 2.7 million per day for the last week as a country! We’re getting more shots in arms each week, and I expect we’ll continue to improve.

However, we are still not entirely out of the woods. As I’ve been worried about the past few weeks, it looks like parts of the country will be going into a fourth wave. New England and Michigan are spiraling out of control. They should reimplement widespread restrictions, but it doesn’t seem like they will. In the race of vaccinations vs. 117, they lost.

We knew 117 was much more infections. We knew that 117 already had much more penetration on the eastern seaboard. We knew that the baseline infection rate was still extremely high in these areas. Despite that, these places moved forward with reopening. If 50% of your population doesn’t have immunity and you’re in a restaurant with the high spread variant of Covid, you’re going to have issues.

This week there was a mixed bag of news related to the Astra Zeneca vaccine.

The big event was that they released their interim results from their US trial, and they managed to botch the announcement once again.

As Derek Lowe said of the results, “..this has turned into a stupid, needless, mess. Which frankly seems to be AstraZeneca’s pandemic brand so far.”

The good news was that it seems to be effective against the common variant of Covid, with a range of 69%-74%. That puts it better than the J&J one shot but below the mRNA and Novavax.

The bad news is after their press release came out, the Data & Safety Monitoring Board made an unprecedented announcement that AZ used data that was incomplete to make their trial look better than it was. Furthermore, the DSMB had told AZ that it shouldn’t use the incomplete data! The preliminary data made the vaccine look only slightly better [79% effective].  I’m glad the FDA insisted on US-based trials they could oversee.

Time and time again, AZ has cut corners with its data. The board should fire the CEO, and an outsider should be brought in to clean house. If they do this when the world is watching, what do they do for lower profile trials?

The extremely bad news is that the 351 variant is spreading in Europe and the AZ vaccine has little efficacy against it. The UK and Europe basically have only been using the AZ vaccine. They could still be almost as vulnerable as if they hadn’t dosed anyone. The three approved vaccines in the US are likely still effective against 351 but not as effective as they are against the other variants. If Europe has to wait for new vaccines to reopen, it will add months, at least, to their lockdowns.

Contrast this with California. At this point, I’ve seen enough; Covid is on track to be over in California in eight weeks. I don’t mean that there will be zero cases. I mean that we will have achieved a high enough vaccination rate that nearly everything will be open and the danger of outbreak is near zero.

The two things that could derail us would be a new, not yet known variant with immune escape or a variant that significantly impacts kids.

Today our daily infection is the second-lowest of any state and 5-10x less than many states. Our vaccination efforts have kicked into high gear, with ~29% of Californians have had their first shot. Based on my [extremely simplified] calculations, we’re on track to inject the person who represents 75% immunity the second week of May.

New England, Michigan, and possibly parts of Florida will continue to have issues for longer. When you reach herd immunity, it just means the R can’t go above 1, but if you have a high base rate, it’ll still take a bit to get down to reasonable numbers. While these surges are large and scary, I would expect significantly fewer hospitalizations and deaths due to the high-risk people being vaccinated [72% of seniors have had their first shot]. I suspect that by July 4th, the whole country will be in a state of near herd immunity and fully open.

SF announced mobile vaccination sites to try to help improve the vaccination among groups that are hesitant or have difficulty getting to a site. Over the next two months, we’ll see a lot more of this type of reach out to get as much of the state dosed as possible.

I know a lot more people have started to get dosed; congrats! As a reminder, if you get your shot, it’s best to avoid alcohol and NSAIDs [Advil et al.]. If you have a fever as a side effect, grab the Tylenol.

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