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Unsanitized: The COVID-19 Report for Jan. 13, 2021

The Great Race of Vaccination Versus Mutation

Also, the homeless need the vaccine

 

The National Health Service in Great Britain is overwhelmed by a more
transmissible strain of the coronavirus. (Andrew Milligan/Press
Association via AP Images)

First Response

I know there's a lot going on. We have insurrectionists in our midst,
the president is getting impeached today for an unprecedented second
time, the Republican Party is splintering. It's fascinating and
dangerous and infuriating all at once. But we are in a race, a very
deadly race, to get the coronavirus under control before a fire of cases
engulf us, even more than they are now.

The more transmissible variant is in America, albeit at very low levels.
But that won't last for long; after all, it's more transmissible. If
and when it becomes common, it will be a much bigger problem than if the
virus simply mutated to become more deadly. There's no guessing
involved in this prediction. Just check out what's happening in the
United Kingdom
.

There, the B.1.1.7 variant is at an advanced stage, responsible for most
new cases. One in thirty people in London are infected right now, and a
shortage of hospital beds there is expected by next week
.
Hospitalizations have risen even as cases have lowered slightly from
their peak, signaling a possible break in the action amid a near-total
lockdown. Deaths have shot up. The Royal Mail has had to be cut back
because too many postal workers are sick. Ireland, where almost half of
the cases are B.1.1.7, has become the highest per capita case count in
the entire world.

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The only thing that could possibly put a halt to this outbreak at this
point is the vaccination regime. Britain thinks they can vaccinate all
people over 70 and those in high-risk occupations by February 15 with at
least one dose. That may not be effective but there's what amounts to
rationing going on, a desperate effort to get as many shots into arms
and at least some protection as possible as the virus burns.

Since the prospects of another full U.S. lockdown are incredibly remote,
we have to think about the effect of a more transmissible virus here,
with relative freedom of movement. It's a simple math equation.

Claire Felter explains it pretty simply with this chart
.
Even a strain that's just more transmissible and not more deadly will
kill far more people than just a deadlier strain which infects at the
same rate. As you exponentially add

to cases, there's just a bigger universe of people infected and
therefore a bigger pool of deaths. A strain that is 50 percent more
transmissible would lead to five times as many deaths as a strain that
is 50 percent more deadly. This factors in overwhelmed health systems,
as exponential growth in cases right now when the health system is
already stretched would be a catastrophe.

It likely also means that you need more people vaccinated to get to herd
immunity, because a more transmissible virus would spread faster and
more easily through a population. So you'd have to have near-total
coverage with the vaccine to limit the effects.  

As Eric Topol notes
, based on the
numbers out of Ireland and how many B.1.1.7 strains are likely present
in the U.S. right now, we have about 12 weeks before we have roughly the
same number of cases with the transmissible virus as a percentage of
total cases as Ireland.

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Where does 12 weeks put us on the vaccination scale? As noted below,
we're at about 10 million vaccinated now. The 1 million/day metric of
the Biden administration would mean close to 100 million vaccinated in
12 weeks, but there would be less people covered since some would have
received two shots in that period. And since the vaccines are not 100
percent effects, even fewer people would be spared from the worst
effects of the disease.

To truly prevent a B.1.1.7 disaster, a back-of-the-envelope calculation
suggests we'd need twice as many shots out, and coverage at some level
to 100 million people, in that 12-week period. That sounds impossible
right now but impossible is what we'll need. Opening up vaccination to
everyone 65 and older

is a good start; if we focus on that population we can make strides at
avoiding the worst, considering the mortality rates.

That's a tall order. But it's the difference between another 100,000
deaths and maybe another 500,000. Eventually, widespread antibodies
throughout the adult population will turn this into just another
coronavirus
,
similar to the common cold. But we have to engage in monumental effort
to get there.

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Vaccinate the Homeless

Maybe it's because I'm in Los Angeles, one of the homeless capitals
of the world, whose unhoused population is part of the great coronavirus
surge

taking over my city. But you cannot have a more at-risk population than
those who have few options to ride out the crisis. Most of the cases are
coming from shelters, the one refuge for homeless people. Project
Roomkey, an effort to place people in hotels using federal relief funds,
was successful in holding off the spread, but that is no longer as
effective
.

In many areas, homeless shelters
are at
the top of the list

for the vaccine, and if the goal is to minimize death, it's impossible
to argue with that priority. Comorbidities are rampant in this
population, and they increasingly have no safe place to go. And of
course, outbreaks in areas like jails and encampments and homeless
shelters ripple out to the general population through staff. The CDC to
its credit has made this a priority, but it needs to be right up there
among the populations immunized.

Number of Vaccines Given

9.94 million
,
up from 9.27 million when on Tuesday. That's a fallback to around
700,000 doses, compared to 1.2 million the previous day. Connecticut,
Rhode Island, Tennessee, Montana, North and South Dakota, and West
Virginia are the states that have given out more than half their doses.

We Can't Do This Without You

Today I Learned

* All international passengers will need a COVID test

before entering the U.S. (Wall Street Journal)

* Moncef Slaoui, the head of Operation Warp Speed, will step down

amid the transition of power. (CNBC)

* Marco Rubio asks Biden

for a standalone bill on $2,000 checks. I continue to say that
standalone offers the best chance of early success. (Axios)

* Health workers flocking toward unions

as their workplaces face tremendous challenges. (Kaiser Health News)

* Pharmaceutical lobby steps in
to say
"Don't prioritize one-shot vaccination and cut us out of half our
profits!" (Finanical Times)

* Chinese vaccine not as effective

as once thought, according to Brazilian researchers. (CNBC)

* Please don't party in large groups

about your football team's victory right now. (New York Times)

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