What. A. Week. First day with 4 million doses. Seven day average hit 3 million doses a day. 100 million Americans have received their first shot.

This week shows how robust the vaccination system is now. It’s a train that won’t be stopped at this point, we can now see the end of the pandemic in the US.

However, the epidemic is not yet over. In one of the trackers I follow there are as many states that are red as are yellow. The upper midwest, New England, and Florida are still above 1 for their R and their rates are extremely high. Hospitalizations have not risen as much in the past, likely due to lots of the elderly being vaccinated. However 117 is more infectious and more fatal then the baseline. I think it will take these states much longer to get it under control.

It’s important to remember that immunity takes time to take hold and you don’t have it immediately after your first shot. A friend’s brother was 7 days out from his first shot and did dinner indoors and caught Covid. The data for the mRNA shots show that after two weeks after your first shot immunity starts to set in and is finalized shortly after the second shot.

More research came out this week on the AstraZeneca blood clot issue. It seems like it’s real but it’s still rare, less then 1 in 100,000 people are effected. It seems that given how bad the current spike is, and the fact that Europe doesn’t have access to other vaccines they should still move ahead with it.

Now the horrible news for AZ [and also the Russian vaccine], it seems they are ineffective against the 351 variant. There are now pretty solid theories on why these ones are so impacted and it involves the spike protein.

A vaccine is designed to teach the body what part of the virus looks like to allow it to create defenses against it. All of the vaccines authorized to date due this by getting some bit of code [either mRNA or DNA] into cells to have them create a protein that looks like the spike protein that enters the cell. The spike protein is essentially the key that allows Covid to enter your cells.

However if you just make the spike it looks a little different. Normally it’s attached to the surface of the virus which makes it stand up rigid. If you just make the spike by itself it’s floppy and doesn’t look exactly like the real deal. Well a few years ago someone figured out how to make the stand alone spike protein look like the real deal, which is called a prefusion-stabilized spike.

In a move that I’ll never be able to explain both AstraZeneca and the Russian vaccine don’t use the stabilized, rigid variant. The theory is that the 351 strain looks different enough from the floppy spike that those two create that your body doesn’t recognize it.

Four other companies [Pfizer, Moderna, J&J, and Novavax] all used the prefusion-stabilized spike. The impact of this is pretty catastrophic. Due to early screw ups on their part Europe basically only has the AZ vaccine. If the early data proves out in large populations it means that they will have little to no immunity against the 351 strain, which is already widely spread on mainland Europe.

Worse still AZ was supposed to be the main vaccine in the global fight, with far more pre ordered then any other. The other vaccines work but it will take time for us to manufacture enough for the rest of the world.

Moderna received FDA authorization to put 15 doses per vial, up from 10. This was a critical bottle neck and will only increase supply.

New work this work shows that the mRNA vaccines are essentially sterilizing immunity. This means that not only will you not get sick but you won’t harbor the virus and transmit it. It’s not 100% sterilizing but overall this helps reduce infections, faster.

Pfizer conducted their first study against 351, which is the one with the most immune escape, and it showed great efficacy. Pfizer now has enough data to go for full authorization. They also released early results from a study in 12-15 year olds showing the vaccine was extremely effective.

New surveys came out this week that showed that hesitancy continues to decline across the US. This is great, we’re not safe till we’re all safe. 40%+ of adults have now gotten their first shot. I continue to believe that all adults who want a shot will be able to get one within 6 weeks.

This is the home stretch, we’re so close but not at the end yet.

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