COVID-19, Year 2: 📈 Daily US cases reach pre-Thanksgiving levels : Monday 01 February 2021

Both daily cases and hospitalizations continue to decline; 5,927,847 people in the US have been vaccinated (two shots); almost 50M doses have been distributed

On 11 January 2021, daily US cases peaked at 256,663*. By 31 January 2021, daily cases had plummeted to 151,487, a rate we had not seen since mid-November 2020. (*JohnsHopkins, seven-day average)

Coupled with a continued steady decline in hospitalizations, this is good news.

Deaths, however, remain stuck at more than 3,000* a day. Why? Perhaps it’s due to overwhelmed medical facilities, like we experienced early in the pandemic. From The Economist: “When intensive-care wards are full, mortality is a quarter higher than expected.”

Twin short-term unknowns:

First, the B117 strain of SARS-CoV-2 spreads more easily (is more transmissible) than other strains. It quickly became the dominant strain in the United Kingdom, where it was identified. The CDC recently predicted it will be the predominant strain in the US by March.

[A] higher rate of transmission will lead to more cases, increasing the number of persons overall who need clinical care, exacerbating the burden on an already strained health care system, and resulting in more deaths. 

Second, preliminary research implies that there may be some reduction in how effective vaccine-generated antibodies may be against the UK (B117), South Africa (B1351) and Brazil (P1) variants. Emphasis on “some” reduction. Moreover, we do not know what impact the variants may have on T cells, which are also an important part of the body’s immune response. All are present in the United States.

From the Washington Post:

The mutations have complicated and likely extended the timeline for crushing the pandemic. A truism among epidemiologists is that herd immunity from a more transmissible virus requires a higher percentage of immunized people. Early in the pandemic, scientists estimated that around 70 percent of people would need to be vaccinated or have developed natural immunity to reach the threshold at which the virus would not freely circulate. That number now seems too low.

If a more transmissible strain becomes dominant, “that level of coverage needed for herd immunity would become higher, in the 80 to 85 percent range,” Jay Butler, deputy director for infectious diseases at the Centers for Disease Control and Prevention, said Friday.

Non-pharmaceutical interventions (NPI) — masks and economic restrictions — will continue to be important tools to keep the virus in some semblance of control. This past weekend, the CDC mandated masks for flights and public transportation.

I’ve ordered four-ply masks from Korea, as recommended by Dr. Eric Feigl-Ding. Here’s an Amazon affiliate link (10, white; 30, pale pink).

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01 February 2021: managing expectations

When I’m teaching the basic motorcycle training class, there’s a section where I laughingly tell students I’m being “Debbie Downer.” Situation one: slow down. Situation two: slow down. Situation three, four, five …

I’m channeling that persona now. Economists continue to predict that economic “normalcy” (whatever that new definition might be) will not return until late 2022.

Vaccinations (both jabs in a two-shot dose) around the world are hamstrung by logistics: manufacturing the vaccine; producing/delivering the vials to the manufacturer; producing/delivering needles; and distribution to countries, the states, then counties, then facilities (remember super-cold freezers for BioNTech-Pfizer). Then managing a multi-step vaccination process that requires repeated sanitation and enough space for physical distancing.

None of this is easy; none of this is cheap; and the US got a later than optimal start planning for distribution and vaccination.

Currently, the US has vaccinated 5,927,847 individuals. That’s 1.8% of the U.S. population. On Monday, the CDC reported that 1,099,103 people had gotten a shot. In a month and a half, federal government has distributed almost 50,000,000 doses of two different vaccines, which is enough to vaccinate 25,000,000 people or 7.58% of the US population.

To illustrate the challenge, only about half of us were vaccinated against the flu in 2019-20, a larger-than-normal rate. And that’s a straightforward process with a wide number of vaccination options taking place over several months.

This is why researchers argue that containing — or learning to live with — SARS-CoV-2 will mean a journey towards herd immunity developed from infections (naturally-acquired immunity) and vaccinations.

Like most vaccines, those developed for COVID-19 are “more effective at preventing serious infection requiring hospital admission than they are at preventing less severe infections. This is [also] the case for influenza vaccine.” 

We do not know how effective COVID-19 vaccines will be at preventing infection and transmission. We do know that their “primary aim” is to “save lives” which is why vulnerable populations have been prioritized.

The two countries with the most aggressive per capita vaccination rates are Israel (56.28 per 100, BioNTech-Pfizer) and the United Arab Emirates (34.79, primarily the Chinese vaccine). In comparison, the UK is at 14.4 and the US, 9.4. Note: this is one shot, not two, and I don’t know how their math reached 9.4%.

Flipping to a wildly optimistic note: Covid-19: how close is the light at the end of the tunnel (pdf) from the Financial Times, 30 January 2021:

The UK had vaccinated (with first dose) about 1 per cent of its population by Christmas, but funeral directors will not notice the effect of that until Valentine’s Day. It seems wretchedly slow…

We should expect painfully little to happen, until it starts to happen fast. The ARG [Covid-19 Actuaries Response Group] estimates that the vaccination that has already taken place is making deaths in hospital about 5 to 10 per cent lower than they would otherwise be. That is important, but imperceptible in the roar of the second wave. In contrast, by the end of February, vaccination should reduce deaths by two-thirds; by the end of March, they should be reduced by about 85 per cent, relative to a no-vaccine scenario…

The people who are being admitted to hospital and to intensive care units are, on average, a lot younger than the people who are dying. For this reason the vaccine will not protect hospitals as quickly as it will prevent deaths. But the story arc is the same: nothing happens for a while, and then a lot happens. By early March, hospital admissions should be down 60 per cent and ICU admissions down a third, compared to where they would be without a vaccine, according to the ARG’s calculations.

This scenario requires a massive adoption of vaccinations, unrealistic in my opinion. But even at reduced rates, modeling suggests we could see an impact by the spring.

A proposal to postpone the second dose, and get more Americans partially vaccinated, is gaining support in the US. Both UK (Oxford vaccine) and Israel (BioNTech-Pfizer) have used this strategy, according to CIDRP.

“I think this [strategy] is something on which reasonable people could disagree, but saying you should only do something supported by randomized evidence when there's an emergency would have precluded us from using masks, social distancing, from doing all the things we know are good public health practices,” Marc Lipsitch, Harvard University, said…

“The goal of vaccination under the approach we are using is to reduce the morbidity and mortality … With [variants] it's just a stronger reason to try to use get as many people as partially immunized as possible."

It’s still a long haul, my friends. But the weight seems lighter.

Shorts

Where are we today (01 Feb 2021)?

Summary, Johns Hopkins

  • US: 26,317,540 cases; 443,205 deaths

  • Global: 103,318,690 cases; 2,225,305 deaths

Vaccine report, CDC 💉

  • Doses distributed to states: 49,936,450

  • People fully vaccinated: 5,927,847

  • People who have one shot of two: 26,294,555

Context

16 September 2020: “We’ll be able to distribute 100 million doses by the end of 2020 and a large number much sooner than that.”

08 October 2020: “We may have up to 100 million doses by the end of the year, enough to cover especially vulnerable population.” 

15 December 2020: “We expect to have immunized 20 million of our American people” during the month of December. The Administration also pledged to distribute at least 40 million doses.

Vaccine map, Bloomberg

US Positivity rate, Johns Hopkins

On May 12, 2020, the World Health Organization advised governments positivity rates for testing should remain at 5% or lower for at least 14 days before reopening the economy. The White House Task Force set a goal of 10%.

US Hospitalizations, COVID Tracking Project

US Deaths for the past week, Washington Post

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