The big news this week:

• First day with 2 million doses administered!
• Case count continues to fall dramatically
• B.117 is rearing its ugly head, something to watch
• J&J filed for their EUA
• FDA says that it will likely authorize variant vaccines under a fast track protocol

Another week, another record number of Covid vaccinations. The week's national average didn't increase much due to a fall in daily doses early in the week. This was due to the closing of most northeast sites for the blizzard, so not something that's an ongoing concern.

The US had its' first 2 million dose day, and California had its' first day over 250,000 doses. The administration announced it would be adding more doses per week in the distribution. Starting next week, pharmacies will get a million doses a week directly.  If we can sustain 2 million doses a day by the end of March, we'll have given a first dose to ~30% of the US [assuming 60% of doses are 1st doses].

Plenty of people are still having trouble booking their appointments. I've now helped three people get booked, and it's a trying, arduous process. We need to do better, but I'm optimistic that these systems will get better quickly. There are also concerns about the supply of second doses. Still, as the distribution chain and communications become more reliable, that should ease.

The federal government stepped in and is opening two mass vaccination sites in California. SF continues to be on top of it and will have the ability [but not supply] to do 25,000 people a day within a week or two. At that rate, we could vaccinate the entire city in 35 days.

8.6% of all Californians have received their first dose. If we can maintain at least 200,000 doses a day, that's an extra 3.5% of the state per week. The new sites should also help us continue to up the number of doses per day.

The variant I'm most concerned with in the US right now is B.117. This one is more contagious, and the vaccines work about as well on it as the common strain. In Denmark, they've concluded that with their current restrictions, the common strain has an R of 0.78 and B.117 is at 1.07. That's not great for us, as the R in many places right now is between 0.75 and 0.85.

I'm most worried about Texas and Florida as they both still have very high levels of new infections, and they aren't falling as fast as elsewhere. There are some estimates that B.117 may already be 5-10% of new cases in Florida, and they have some of the lightest restrictions in the country. The Super Bowl is in Tampa will only exacerbate the situation. This is why it is so imperative that we get as many doses in arms as fast as we can. There is still time to get ahead of it.

Israel continues to lead the world in vaccination. A study conducted showed massive drops in infected and hospitalized for the groups that have received the vaccine. We would expect this, but it's nice to verify the Phase III studies on a country-wide basis. Israel has injected 38% of the population with the first dose, using 5.4 million doses so far.

This week the FDA announced that they would likely authorize new Covid variant shots under a bridging study methodology. This is the process that is used to spin out new flu vaccines every year. In a bridging study, you test the new one on hundreds of people for a few weeks. It bodes incredibly well for us.

Moderna has announced that it is already working on a new vaccine for the B.351 variants. I suspect the extra 100 million doses the US announced it procured for the late summer will be used as new variant booster shots.

As expected, J&J filed for their EUA on their one shot, fridge stable vaccine. It'll be the first adenovirus vaccine approved in the US; AstraZeneca is also an adenovirus but only approved in Europe currently. It'll take a few weeks to get through the process. Some people are upset about the timeline, but a) J&J is still ramping it's production, so it doesn't have many to distribute today, and b) there are enough people who are vaccine-hesitant because it's "rushed" [it's not rushed], so I think being diligent is important.

Less than 60 days ago, the first Covid vaccine was authorized. Since then, we've vaccinated 40+ million Americans, built out infrastructure that does 2 million injections a day, and approved a second vaccine with a third and fourth on their way.

60 days from now, over 100 million people will be vaccinated. I suspect we'll be pushing close to 3 million doses a day by that point. Trials will be underway for rapid authorization of new boosters targeting the variants [but we'll be fine without them]. Reopening will be something we can start to do safely.

We are in the messy middle, it's not yet under control, but it's on the way. We're so close to getting back to normalcy but can't yet drop our guard. Stay strong, and reach out of you want to talk.