Covid Update - 7 Mar 2021

"What does the end of Covid look like?"

Dr. Jonathan Reiner "It looks like a sunrise, with a little more light every day. The days are getting brighter. Wear your mask, get vaccinated, and help those in need. The 4th of July this year can be incredible."

This week it did get a lot brighter, which some clouds in one part of the sky.

This week, we set a new weekly and daily record for vaccinations; we did almost 3 million doses on Saturday. The J&J one-shot hasn't really started to get administered, so it'll be an extra million shots a day for the rest of the month.

I wanted to thank two groups that have been critical sources of information for Covid that end their efforts this week. The Covid Tracking Project, run by writers at The Atlantic, and Covid19 Projections, run by Youyang Gu.

In the beginning, the Trump appointees at the CDC were withholding vital data. As a result, the Covid Tracking Project began to painstakingly compile data at the state and local level into an easy-to-use dashboard/data source. This was the single best resource for understanding how many people were being infected and hospitalized.

In the new administration, the CDC is now accurately and promptly reporting data. The Atlantic has [reasonably] decided they are currently doing duplicative work. This type of data publication is best left to the authorities.

Early on, the Trump administration used projections from IHME in Seattle as part of their propaganda to "prove" that Covid would go away quickly. IHME is a formerly trusted, now discredited institute that to this day refuses to acknowledge how their misinformation and bungled projections helped to support policies that killed thousands.

An unemployed 26-year-old MIT grad living with his parents stepped in in their place. Youyang Gu is a former high-frequency trader. His projections were so accurate that many top scientists started to rely on them. Ashlee Vance wrote an excellent profile of him. Still, in no uncertain terms, Youyang helped shape our nation's response for the better.

But that's really the story of Covid; brilliant, dedicated individuals stepping in to get the job done in light of governmental failure.

Despite all the good news, we are not out of the woods yet. Texas, Florida, and New York continue to have extremely high levels of Covid, and the 117 variant is, as expected, growing exponentially. On top of that, for all of these places, their R is still nearly at 1. In contrast, the California infection level is a half to one-quarter of these states, and our R is 0.83. All three of these states are aggressively moving towards / already are at full reopening.

As 117 takes over and as many of these places reopen, it's the perfect storm for there to be one last surge. It's like watching a drunk sprint across a busy street. They might not get hit, but if they do, no one should be surprised.

My concern in CA is about vaccine administration. Newsom gave a sweetheart deal to Blue Shield and is requiring all cities and counties to move to their system by the end of the month. Today, the cities and counties appear to have booking and administration under control, setting records every week.

Now is not the time to switch systems, and the cities and counties are begging Newsom to drop the requirement, worried it'll break their systems and cause a gap in vaccination.

Let's talk about the variants:
* 117: More contagious, but vaccines / natural immunity are as effective. It will be the dominant strain in many parts of the US in weeks.
* 351: Has some immune escape, and some of those who previously were infected with normal Covid may be susceptible to reinfection. Not more infectious. Given the US's current level, it's likely it won't spread fast enough to be a concern. Likely a booster for this in the late summer / early fall.
* P.1: Work this week suggests it has less immune escape than 351, meaning that it likely won't be a long-term concern.

Moderna has shipped the first doses of their 351 specific shot for trials. These will be done on flu-like recertification, and I would expect them to start making it in a few months. There is some discussion that a 351 vaccine may be as effective against the common strain and 117. If that's true, they'll move to this new shot as the only shot moving forward.

More good news this week on a couple fronts. The first study on vaccinated breastfeeding mothers shows Covid antibodies in breast milk. This means that the mother is likely passing on immunity to their children. Some early work suggests that some people suffering from long Covid may be cured by receiving the vaccine.

An experimental Covid-19 drug that promises to be like Tamiflu for the pandemic had positive results in a preliminary study. This is a prophylactic, which means that it's something you take if you think you've been exposed or are early in the stages, like the monoclonal antibodies but a pill, not an injection.

Novavax announced that it expects to receive a EUA in May and then dropped that they'll have 100 million doses available then. The Biden administration also announced that even without Novavax, they expect all adults to get their first dose by mid-May, up from late May just last week.

I continue to be blown away by how fast things have gotten better. We erred on the side of caution. By July, we will have enough extra doses to inoculate every adult in North America.

I still expect my first dose to be in early April, and by June, things will be back to normal. The time to start your end of Covid diet is now. It's going to be a great summer.

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