Hi,
So here’s what’s been on my mind this week:
For months now, I’ve told some readers of this newsletter over Zoom or text that I believe that vaccines will be “open season” or “generally available” sometime between March and April.
And suddenly this week:
This…shouldn’t surprise anyone, but somehow it did. I mean, the guy has been saying this for months. So have other folks like Dr. Scott Gottlieb. There’s no magic here, it’s just reading statements about expected timelines for vaccine delivery that Pfizer and Moderna made, and then asking questions, such as:
How many doses have we given out already? As of this writing, at least ~53M doses injected into arms, which is at least 38M people (some with one dose, some with two). Data lags a little, so it’s probably more than that.
“How quickly will vaccine production ramp up?” Well, we expect another couple hundred million doses to be delivered throughout the time between now and May, and weekly allocations have already increased by 20%. Right now, we’re putting about ~1.6M more shots in arms every day, though each day varies a bunch. We were at ~1.3M/day just a week or two ago…
“How many folks are in the highest-risk groups?” Well, as per the CDC, there’s about 101M people who fall into the healthcare worker, long-term care facility, frontline essential worker (e.g., police and fire, education, postal service, grocery workers), and 65+ tiers (once you remove double-counting of things like Dr. Fauci, who is both a doctor and over 65). Then we get to other tiers that are the 16-64s at higher risk, and 16-64s generally.
“Will delays in the current process of getting vaccines from shelves into arms decrease over time, as we learn things?” It’s still a little difficult to say based on data quality issues how much this is the case, but basically no one disagrees that we’re shortening the total end-to-end time from factory to arms.
“Since the current plan doesn’t assume that J&J or Novavax or Oxford-AstraZeneca get approved, and it’s highly likely at least one of them will, what happens when they do?” Well, officially, we’re all pretending that J&J won’t deliver ~100M doses by the end of April. Because, officially, it’s not approved yet. But it will be, by mid-March at the latest, unless we all get hit by an asteroid. Oh, and J&J is a single-dose vaccine, so it’s equivalent to adding ~200M Moderna or Pfizer doses… And maybe Novavax will be too.
So wait, we’re already on track for everyone in the highest-risk groups being vaccinated in…(101-38)/1.6…39 days from now, even if nothing new is approved, and even if doses/day don’t accelerate? Yup. And everyone expects both of those things to happen. Hence why saying “oh yeah, we’ll be in open season in April,” while seeming brave, is actually a really conservative estimate…
So, my prediction for when anyone over 16, in most states at least, might be able to sign up to get a first dose of vaccine…
…March 31, plus or minus a week.
I’m hedging here. I’m tempted to bet March 22, but I don’t want to say that for morale reasons, as any random delay knocks it back to at least March 31 or April 15….
But don’t take my word for it. Look at what already’s happening. In NYC, they expanded today to include all people between 16-64 meeting with a range of pre-existing conditions as per the CDC standards, and carefully observe the bolded items:
People who have:
Cancer (current or in remission, including 9/11-related cancers)
Chronic kidney disease
Pulmonary disease, including but not limited to COPD (chronic obstructive pulmonary disease), asthma (moderate-to-severe), pulmonary fibrosis, cystic fibrosis and 9/11-related pulmonary diseases
Intellectual and developmental disabilities including Down syndrome
Heart conditions, including but not limited to heart failure, coronary artery disease, cardiomyopathies or hypertension (high blood pressure)
Immunocompromised state (weakened immune system), including but not limited to solid organ transplant or from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, use of other immune weakening medicines or other causes
Severe obesity (body mass index of 40 kg/m2 or higher), obesity (body mass index of between 30 kg/m2 and 40 kg/m2)
Pregnancy
Sickle cell disease or thalassemia
Type 1 or 2 diabetes mellitus
Cerebrovascular disease (affects blood vessels and blood supply to the brain)
Neurologic conditions including but not limited to Alzheimer's disease or dementia
Liver disease
Think about what this means. This is, effectively, open season already for a huge chunk of people. How many folks do you know that meet these standards from cancer, childhood asthma, being immunosuppressed due to Crohn’s or some other disease, pregnancy, diabetes, heart conditions or hypertension, or something else?
And if you haven’t calculated your BMI since the quarantine pounds got put on, Your Humble Correspondent suggests that it might be worth doing so…for he discovered that he is, officially, over the BMI standard by 2 kg/m^2 or so. That’s — well, it’s hard to say, since lots of older folks are overweight so double-counting is a risk, but probably another ~30% of the population.
And that’s not, in any way, gaming the system, that’s sincerely and assiduously following the CDC guidelines. I might also note that there’s a rather obvious loophole you can…conceive of…for 50% of the population; I would never encourage any sort of misrepresentation on any government form, and deplore the unavoidable fact that many will take advantage of such a loophole.
These standards will get applied to other states soon, such as California no later than March 15th. One might infer from California’s recent behavior that they may, in fact, announce a speed-up in many counties, but it’s too soon to say for sure.
There will be some states that lag, unfortunately. I suspect, for example, that Massachusetts will continue to lag behind due to their inexplicable focus on vaccinating over-75s only and holding vaccine in reserve until those folks are vaccinated and blocking over-65s from signing up. (It’s not the Holy Grail, Governor, you can take it past the storeroom walls without it losing its power).
On the other hand, there will be some that accelerate and maybe even get there sooner (in addition to NYC, see my note on DC, below). And, of course, even if appointments open up by March 31, that doesn’t mean you’ll be able to get a shot in your arm on that day, you might have to wait a week or two.
So — the end is in sight.
Now that I’ve justly reinforced your hope, let me give you a bit of a cautionary note about the time between now and then.
Burn your power-ups like you’re getting ready for the final boss fight
We know that the new UK and South Africa COVID variants are in the United States. They are likely significantly more transmissible, and possibly more harmful as well. That means that protections you may have used before are no longer giving you the same protection. But, all evidence so far from multiple countries is that the Moderna and Pfizer vaccines protect against serious illness from these strains regardless of your age, and possibly protect you from infection as well. (It’s also likely the case for all-but-certain-to-be-approved J&J and Novavax vaccines, too. AstraZeneca is less clear.)
The best way to reduce the risk of the variants mutating further is to limit their transmission now, until we’re all vaccinated.
So, now is the time to upgrade your defenses, even though the end is in sight. It sure would suck to get COVID right before you can get vaccinated, after a year of being careful, right?
Think of it as buying your final round of upgrades before the final video game boss. I strongly recommend upgrading to at least 3-ply surgical masks for everyday use and having some N95 or KN95s for more-risky situations, like the supermarket, office, or anywhere else with recirculating air. All of them are probably more comfortable than your fabric mask, because it turns out that people who build masks for a living are good at their jobs. Here are some suggestions on where to buy them gathered from my extended “people who obsess about COVID protection” network, though I haven’t purchased most of these directly1:
Surgical masks are now generally available again at CVSes and similar pharmacies
https://www.unitedstatesmask.com/ n95sare made in the US and ship direct from the factory, reducing supply chain risks (though, ironically, their shipping is shut down today due to the Texas storm…)
https://bonafidemasks.com/face-masks/N95-Respirator-Face-Masks/
https://n95maskco.com/pages/shop-all-collections
Kimberly Clark N95 duckbills are recommended by many: https://smile.amazon.com/gp/product/B08NVDFB3R — though treat Amazon products with caution, as there is some risk of faulty or fake products in that chain. (I still got my KN95s from Amazon, but would recommend buying through other supply chains if it’s easy enough for you — why take the risk).
You should also consider splurging on delivery of basically anything instead of going into a store for the next month or two — go contactless to the maximum degree possible.
And then, in June, we’ll all be vaccinated, we’ll have bent the curve, and the drinks are on me.
Special memorandum to residents of the District of Columbia
This newsletter’s current readership, which is entirely known to me except for one random person who signed up online (hi, random dude!), is pretty heavily concentrated in the DC area. So, some notes:
In the short term, be very cautious as the UK and South Africa strains are now present in our community: These will likely become dominant in our community, although DC’s best-in-class mask-wearing practices will slow it down some.
However, in the long run be optimistic, as we are actually doing really well in vaccine distribution as a District: On a per-capita basis, per the CDC, we are now only slightly behind West Virginia, the current best-in-class benchmark.2 My sense — based on what I’ve read of West Virginia (good!), and what I’ve seen in my volunteer work for California (more mixed!) — is that our speed is because DC has adopted a relatively simple-to-navigate distribution plan, and has executed on it okay enough.3
We are likely doing even better in DC than we think, due to government-direct vaccination: The various vaccine trackers definitely do not track military or VA vaccinations by state, as those channels get vaccines separately and assign them as they deem appropriate. I also strongly doubt the Congressional vaccinations (which are not just elected officials, but also several staffers per each official’s office and per each committee) are being counted in this total — which is several thousand more people for the Hill alone.
So, as stated above, burn your power-ups to make it to the far side of the curve. I intend to sit down at a bar again by July 1st. See you there. I’ll buy the champagne.
Okay, now for the palette cleansers! May this birb bless your timeline
May these house floats substitute for your second line
May this buffalo bring your warmth
May these foxes bring you friendship
Our First Gamer President?
Here’s just a really good cover of a song I unreservedly like
Disclosures:
Views are my own and do not represent those of current or former clients, employers, friends, or my cat.
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This excludes states with significant Tribal populations, like Alaska, which receive additional vaccines to those populations directly due to treaty rights related to healthcare. It’s also a state where one of the most famous things about it is a sled dog race explicitly preserving the cultural memory of responding to an epidemic fast and as a community, so maybe this just shouldn’t surprise us generally.
It is the official opinion of this newsletter that the District’s zip-code-based prioritization scheme is a well-intentioned effort to match availability of vaccine with risk, but is stupidly putting poor elderly folks living in rich zip codes at risk. It is even more dumb considering that the District’s policy for supportive housing has — as an explicit policy goal — forcing rich zip codes to welcome the disadvantaged into their neighborhoods! We should use more granular location units, perhaps ANCs.