The is the worst it's ever been. There are over 100,000 Americans hospitalized with Covid and no peak in cases in sight.

If someone gets Covid today, they're more likely to die than ever despite improvements in treatments. Hospitals are reaching their limits. Some states are opening field clinics, but this is just medical theater; there is no medical staff to work them. In March, we surged doctors and nurses from other regions, but right now, no region is unaffected.

Monoclonal antibodies were supposed to help, but the supply can't even begin to meet the demand right now. Worse still is that they are most effective early in the disease and are administered in a hospital. Today someone early in the disease won't be admitted because the beds are needed for more sick people, more or less rendering monoclonal antibodies worthless.

Vaccine rollouts will begin next week, but it takes two doses, one month apart, and immunity doesn't start to kick in until two weeks after the second dose. Ergo people dosed next week will have immunity in late January. As medical staff catch Covid over the next month, it will further strain a system already breaking under pressure.

Given the surge in cases, California is moving into another lockdown. In general, I think this is a good idea, but those in charge have botched the details of it. It was always a stupid idea to open gyms and indoor dining, but closing playgrounds and parks make no sense.

Public policy works best when the people presenting it are transparent and created with an understanding of the realities of the world.

Closing everything and going into a full lockdown is only going to drive people inside, furthering spread. I've yet to see compelling evidence outdoor dining is a big factor in spread [if you've got something that shows otherwise, please send it to me]. Why does it make sense to leave some schools open but close playgrounds? It doesn't.

We're also facing a crisis in trust with our elected officials at exactly the time when we need it the most. It seems every elected leader in California has broken their own rules, including being indoors at the French Laundry.

Newsom and Breed should no longer be giving any updates on Covid.  They lack the moral authority to ask us to take pains for the common good when we know they won't do it themselves. They should step aside and have all briefings done by medical professionals with detailed guidance on why these are the things we're closing.

Vaccine rollouts are expected to begin this week for the Pfizer vaccine. Some have criticized the FDA for taking the time to review the data. I think it's proper for the FDA to dot the i's and cross the t's. We're about to embark on the largest vaccination campaign in human history, in record time, with vaccines that didn't exist a year ago. Let's make sure we double-check the data.

As expected Advisory Committee on Vaccine Practices [ACIP] met this past week and issue initial recommendations. They voted 13-1 to prioritize first responders and the elderly in long term care facilities. The one dissenting vote later stated that the long term care was premature because the Phase III trials had excluded that sub group.

There was some concern earlier that we wouldn't get to herd immunity due to people not getting the vaccine. Surveys show that as more data has come out, there is less hesitation. This week, Barack Obama, George W. Bush, and Bill Clinton said they would get vaccinated on camera to help improve compliance. I suspect we'll see more celebrities and politicians do this, and I don't anticipate long term issues with enough people getting the vaccine.

The biggest open question right now is, "Do the vaccines impart sterilizing immunity?" The current phase III trials all look at efficacy, i.e., does it prevent you from getting sick and dying. This could be what's called functional immunity. In this, you still contract and have the virus replicate in your body, but the immune response prevents it from hurting you. However, you can still transmit the virus.

In sterilizing immunity, your body destroys the pathogen at the onset, and you aren't a carrier. The Phase III trials didn't look at whether or not it was sterilizing.

The other major open question is how long does immunity last. Yes, we've seen rare incidents of people being reinfected, but that happens with all diseases.  A study came out this week showing immunocompromised patients can continue to shed active virus for two months. Based on the data so far, it seems that the vaccine imparts long-lasting immunity, at least a year.

Tony Hsieh, the former CEO of Zappos, died this week. He was famously generous and jovial, always surrounded by people and helping them however he could. After his death, it came out in the last six months the isolation of Covid had taken its' toll on him. He had moved away from his home and became surrounded by enablers. He entered a spiral of alcohol and drugs bad enough that his family and some friends tried to stage an intervention.

As an extrovert, I understand the difficulty of lockdown after lockdown, not seeing your friends/family/community.

If you have moments where you worry you've lost control, just reach out to me or to someone who cares about you.

If you've got someone in your life you're worried about, and you're not sure how to approach it, reach out; I can direct you to resources that can help.

We're so close to Covid being over, but we need to make it through this last, horrid part. Stay strong; we'll get through this together.

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