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Unsanitized: The COVID-19 Report for Jan. 18, 2021

Biden's Vaccine Plan v. The COVID Variant

The biggest problem right now is getting shots into arms before the
mutation takes over and surges cases

 

Is that a low dead-space or a high dead-space syringe? (Rolf
Vennenbernd/picture-alliance/dpa/AP Images)

First Response

There are two parts to Joe Biden's COVID response plans. The first,
the American Rescue Plan
,
is a legislative action for economic relief and funding support. The
second involves taking over what has been an uneven vaccine rollout.
While this also requires funding-Biden has asked for well over $150
billion in the ARP-there's also plenty of executive prerogative to
shape the rollout and maximize distribution. In the past couple days the
Biden team has been explaining their plans.

The urgency here has never been greater, for two reasons. First, the
Trump administration really didn't create a national vaccination
strategy and apparently lied about what little role they did play.
Second and far more important, the timeline for getting shots into arms
has rapidly narrowed, due to the more transmissible variant B.1.1.7,
which will become the predominant strain in the country

by March, according to the CDC.

Despite all the bumps in the road, the U.S. has hit a seven-day rolling
average

of just under 900,000 daily doses, not far off of Biden's stated 1
million per day pace. But with B.1.1.7 looming

along with a certain surge of cases, we probably need something more
like 2 million per day to really make a dent in the crisis.

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There's going to be a false dawn
over
the next month. Cases and hospitalizations
have peaked and are coming down, while
deaths have hit a plateau. But that will only last as long as B.1.1.7 is
in the background. As soon as that becomes more of the primary way the
virus is transmitted, those numbers will shoot back up. The only escape
from that terrifying reality is either something like a lockdown,
everyone being requisitioned N95 masks (which they use), or a mass
mobilization of vaccines.

So what is Biden planning to do? He has outlined a plan

that includes opening up mobile clinics in undeserved communities and
increasing availability of vaccines at local pharmacies, the combination
of which would put access within geographical reach of almost everyone.
He would deploy FEMA and the National Guard

to help put this distribution network together.

The National Association of Chain Drug Stores claims that they could
administer 100 million shots

in a month, blowing away Biden's benchmark of 100 million in 100 days.
I was on a call with the NACDS the other day, where officials stressed
their "deep experience with vaccinating America." But looking at the
one program that has been entrusted to chain drug stores so far, an
effort with CVS and Walgreens to vaccinate nursing homes, I have to be
skeptical in their abilities to rapidly turn their for-profit stores
into free vaccination clinics. The CVS/Walgreens plan stalled out of the
gate, yet NACDS senior vice president Kathleen Yeager had the gall to
say that they were doing a "phenomenal job" at nursing homes.

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Distribution is clearly something Biden's team has thought a lot
about, and that's been the main bottleneck to this point, though
it's in the process of untangling. But we're about to hit a bigger
bottleneck with supply. As of a little over a week ago, states had only
used about 29 percent of their supply. That number is now up to 46
percent
,
and with more efficient delivery networks coming on line, we're going
to hit a supply squeeze without some new stockpile of doses on the way.

Hopes were dashed on this a couple times over the past few days. It
became clear that there was no federal reserve

of vaccines like the Trump administration had been intimating, letting
down states

that were relying on a big release of doses. I've heard from people
who've received their first shot and been told that they cannot
schedule the second because of uncertainty with supply.

A much bigger issue is the apparent slowdown at Moderna. In the new
year, production has dropped 36 percent
. If Moderna were
to hit its promised allocation for the U.S. of 100 million doses by the
end of March, it would need to be making 1.1 million doses per day.
It's making about 303,000 in January. There appear to be supply chain
issues with some of the materials that go into the vaccine.

Incoming CDC director Rochelle Walensky expressed confidence that there
would be enough supply to meet the 100 million in 100 days goal. But
again, that's not going to be enough to prevent a severely dangerous
and economically ruinous situation in the spring, thanks to B.1.1.7. We
need twice that, and supplies are short.

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The Biden administration will be using the Defense Production Act to try
to alleviate some supply problems, though that will take time to ramp
up. One possible ray of hope on the supply side is the ability to
squeeze an extra dose out of Pfizer's shipment of vaccine vials. But
that only works if you use "low dead-space" syringes that don't
waste medicine, and the government's shipments of syringes are often
"high dead-space." It's unclear which company is supplying high
dead-space syringes; the government has contracted with several supply
firms, like Smiths Medical

and Retractable
.

But this leads to two problems. First, getting the high dead-space
syringes out of production so that every Pfizer vial can yield six doses
instead of five, instantly increasing supply by 20 percent; second,
making sure all distributors have enough low dead-space syringes, since
the government has only been giving out five syringes per vial. This is
one place the Defense Production Act can come in, to make syringes.

So it's a scramble. We knew that the Trump administration would leave
a mess; that was built in. The B.1.1.7 variant added a severe degree of
urgency to the Biden team to really get this completely fixed,
streamlined, and moving at double speed, in a matter of weeks.

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Number of Vaccines Given

14.3 million

as of Sunday, up from 11.9 million on Friday. See above.

We Can't Do This Without You

Today I Learned

* Finally it is stated clearly: premature reopening in late spring
led to a
surge in cases and our current predicament. Unsaid: the lack of state
and local aid in the CARES Act was a major factor in this. (New York
Times)

* Conventions will likely return, but quotidian business travel

probably isn't coming back. (Wall Street Journal)

* Trader Joe's is now paying staff

to get the vaccine. (USA Today)

* Fatalities from the vaccine seem confined to Norway
;
maybe it's a bad batch. (Bloomberg)

* Speaking of which, anti-vaxxer groups got PPP loans. (Washington Post)

* It would be very positive if banks loosened lending

in an equitable fashion, anticipating a brighter economic outlook. (New
York Times)

* The recent COVID relief bill gave banks a break

on problem loans anyway. (American Banker)

* What has the pandemic and all the screen time done to our eyes
?
(New York Magazine)

* Check out the absolutely terrible $300 rich guy PPE helmet
.
(SF Gate)

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