Covid Update - 31 Jan 2021

This is one of the best weeks we've had for Covid news in the entire pandemic. Anyone who suggests otherwise is either a clickbait fear monger or a moron.

Top news from this week:

• In the US, our vaccination rate averaged 1.3 million doses a day and continues to rise
• The daily new cases in the US are in free fall. Honestly, it's dropping so fast I wouldn't believe it if several different metrics didn't confirm it
• Two new vaccines reported great results this week
• Initial data suggests our vaccines are less effective against some of the new variants but still extremely protective against severe disease

Before I jump into the data from this week, I want to discuss how we compare how effective the vaccines are.

What does effective actually mean? It means, more or less, that it prevents you from getting sick at all. However, what is more important from many perspectives is how well the vaccine prevents severe disease, hospitalization, and death. The initial results reported from J&J and Novavax strongly suggest they prevent severe disease even in the new variants, which is game-changing news.

Novavax reported the results of its trials abroad, and the results are fantastic. In the UK arm of the trial, it was 89.3% effective. This was split by being ~95% effective against the common variant and 85% effective against the B117 variant.

In the South African arm of the study, most of the participants were infected with B351. The overall effectiveness is ~60% for non-HIV/AIDS patients [South Africa has one of the highest prevalences of HIV / AIDS in the world]. This is huge! The FDA had previously said they would authorize any vaccine that was more than 50% effective, and the Novavax one beats that for the new strain!

Novavax also has less onerous requirements for the cold chain, so it'll be easier to distribute. The US has pre-bought 110 million doses of this one. The big question now is will the FDA authorize based on the UK / SA data or wait for the domestic Novavax trial to finish. It's currently about half enrolled and won't have results for a few months.

Novavax is a protein subunit vaccine and is the third major type of vaccine. The other two are adenovirus [AstraZeneca, J&J] and mRNA [Moderna and Pfizer]. For protein subunit ones, they grow proteins that match the virus in a factory and put them into the shot. This type of vaccine is very stable and also easy to modify.

J&J also reported initial results this week. Their readout was more limited than I would have liked, we'll get full results from the FDA in the next week or so, but the top line looks good.

Overall it is less effective than the mRNA and Novavax ones, but it's one shot, not two. It also can be kept for months at refrigeration temperatures, so it'll be key to widespread distribution. It was 72% effective in the US and 57% effective in South Africa [where most of the patients have the B351 strain]. As one epidemiologist put it, "if this were the first one reported, we'd be jumping for joy."

More importantly, it was 85% effective at preventing severe disease after 28 days! To put it in perspective, at our peak in California, we had ~22,000 people in the hospital with Covid. With the J&J vaccine, that would have been 3,300, and that's the "worst" vaccine we have!

That's why even with the new variants, I'm extremely optimistic about our future. A huge win would be getting Covid to where it's like a bad flu season. In the last decade, the worst year for the flu was the 2017-2018 season. In that year, 45 million Americans contracted the flu, 810,000 were hospitalized, and 61,000 people died. With an 85%+ reduction in severe disease, Covid becomes like the flu overnight.

The bad news from the reports this week is that prior infection may not be fully protective against some of the new variants. Both the B351 and P1 [the one identified in Brazil] have some of the same mutations that we believe contribute to immune escape. Historically, vaccine immunity is significantly stronger than immunity from having had the disease. The data so far suggest the same for Covid.

The US also announced that it is nearing an agreement to buy an additional 100 million each from Pfizer and Moderna to deliver in the summer. This brings the US [with the 100 million from J&J] to 400 million people worth of doses, and we only have 350 million people. This does not yet count the doses from Novavax because it's still a few months from approval.

Pfizer and Novavax are rumored to be in discussions with other Pharma companies to increase their manufacturing capacity. India announced this week they've hit 10 million doses a day. As a global issue, it appears we're scaling up rapidly.

We've still got a way to go, there will be ups and downs ahead of us, but it's important to understand how much better we are than 60 days ago. Vaccine roll out is now progressing in every state; we've got more vaccines in the pipe to be approved shortly, and our case counts are falling rapidly.

Every day counts; we've got to keep new cases down and get as many shots in arms as fast as we can, but we're finally turning the tide.

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