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Dr. Chris Stout: Pandemic Update – March 3, 2021

LinkedIn logo LinkedIn 3/3/2021 Dr. Chris Stout
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Welcome to this Week’s Edition – A Convenient Digest and Curated Collection of Verified News and Studies Related to Global Health and Humanitarian Intervention

The most likely timeline for life to return to normal

At long last, Americans are able to see the relief on the horizon, and the end of the outbreak that’s cost the country more than 500,000 lives.

Here’s the most likely timeline for life to return to normal. The short version, from our staff writer Joe Pinsker: “Life this spring will not be substantially different from the past year; summer could, miraculously, be close to normal; and next fall and winter could bring either continued improvement or a moderate backslide, followed by a near-certain return to something like pre-pandemic life.”

Experts propose a simple rule of thumb for knowing when the outbreak is over. Alexis C. Madrigal explains the “flu test”: When the virus is killing as many Americans as the annual flu, we can start to move away from our emergency posture.

Prepare yourself emotionally for the end. Pandemic-spurred anxieties won’t go away overnight. The writer Lily Meyer is turning to the work of one late philosopher to tackle such fears.

A third Covid-19 vaccine has been approved.

The Food and Drug Administration authorized Johnson & Johnson’s one-shot vaccine for emergency use on Saturday, making a third vaccine available in the U.S. Above, a drive-through vaccine clinic in Scranton, Pa., on Friday.

It’s the first approved vaccine to require one dose instead of two. Shipments are expected to start within days, on top of the millions of doses being churned out by Pfizer-BioNTech and Moderna.

The country’s vaccination numbers have started to increase again after a decline caused by severe weather. But federal health officials warned governors against relaxing pandemic restrictions, saying that the recent drop in cases and deaths could be leveling off.

Roughly one-third of active-duty troops and National Guard members — mostly younger personnel — have declined to take the vaccine, another potential hole in the broad-scale immunity that health experts say is needed for Americans to reclaim their lives.

When do the vaccines begin to work?

In this week's edition of the Covid Q&A, we look at how long it takes for vaccines to provide protection. 

In hopes of making this very confusing time just a little less so, each week Bloomberg Prognosis is picking one question sent in by readers and putting it to an expert in the field. This week's question comes to us from Paul in the U.K. Paul recently received the Pfizer-BioNTech vaccine. He asks:

How long will it take for antibodies to develop in my bloodstream that will give me some protection from Covid-19?

Millions of people around the world are now receiving Covid-19 vaccines, so it's likely this question is on a lot of minds. Vaccines work by preparing the body's immune system to respond to a virus in the wild. But that doesn't happen overnight.

For insight, we turned to Shane Crotty, a professor at the La Jolla Institute for Immunology.

Two vaccines authorized in the U.S., from Pfizer and Moderna, both use a technology called messenger RNA. Recipients receive an initial dose that primes the immune system, followed weeks later by a second shot that kicks the body's defense into gear. In clinical trials, says Crotty, the Pfizer vaccine appeared to protect against Covid-19 more than seven days after a second shot. The Moderna vaccine provided protection after 14 days. 

“Those results are the incredible 95% reduction in Covid-19 cases that everyone has heard about,” says Crotty. “For both RNA vaccines!”

But you don't have to wait even that long to get some protection from the vaccines. 

“Partial protection appeared to occur as early as two weeks” after the first dose, says Crotty. “Since that occurred for both vaccines, it appears to be real protection.”

That detail is part of why some state and local authorities, including New York Mayor Bill de Blasio, have pushed the U.S. government to allow vaccines earmarked for second doses to be used as first shots. The idea is to provide partial protection for the most amount of people, even it it means delaying second doses —and full protection—for others.

Crotty pointed to reports out of Israel, the first country to mass-vaccinate people over 65 with the Pfizer vaccine, that show cases of Covid began to drop two weeks after the first shot.

“All together, those three big data sets suggest partial immunity starts at two weeks after the first immunization, and maximal protection starts at two weeks after the second immunization,” says Crotty. 

If you have any questions, please write to CovidQs@bloomberg.net — Kristen V. Brown 

Coronavirus Restrictions and Mask Mandates for All 50 States

Backed by Google, epidemiologists launch new Covid-19 data platform

Today marks the launch of Global.health, a massive epidemiological data collection that will enable open access to 10 million anonymized Covid-19 records from 160 countries. Each record contains up to 40 data points about the case, including demographics, travel history, testing dates, and outcomes. The project was inspired by just a spreadsheet in the pandemic’s earliest days, an effort born when a group of international epidemiologists decided to collect and openly share granular data on individual Covid-19 cases around the world. “One of the things that we tried to engineer in was the assumption that the data models were going to need to change, because this is an emerging infectious disease and we don’t know what we don’t know,” Samuel Scarpino of Northeastern University tells STAT.

The New York variant

A new variant of the coronavirus has been identified in New York City, and it contains an alarming mutation that may make it less susceptible to vaccines.

Known as B.1.526, the variant first appeared in samples collected in November, and it has since been spreading rapidly in the city. By the middle of February, it was present in more than one in four samples in the city’s virus database.

Two studies published online this week by researchers at Caltech and Columbia University found that the variant in New York shared characteristics similar to variants discovered in South Africa and Brazil, which have been shown to weaken the effectiveness of vaccines. One study found that patients infected with the variant were about six years older on average and more likely to have been hospitalized.

The studies also found evidence that the South Africa and Brazil variants had been circulating in the city. And the British variant continues to gain steam in New York City, making up 6.2 percent of cases, up from 2.7 percent in late January.

New York City officials said today that the risks posed by the variant were not yet fully understood. The city is not yet making any major changes to its public health response.

While cases in the city have fallen since the holiday surge, they have been declining more slowly compared to the rest of the nation. Even so, Gov. Andrew Cuomo has begun reopening many sectors, including indoor dining, major sports stadiums, movie theaters and wedding venues.

The city so far has vaccinated about one million people. The positivity rate among people over 75 in New York has dropped quickly, and emergency room visits for people over 65 are falling.

But a new paper from the University of Minnesota’s Center for Infectious Disease Research and Policy argues that as more contagious variants spread, vaccinations needed to speed up.

The paper notes: “A major peak in cases, hospitalizations, and deaths in the near future remains a strong possibility.”

Vaccine corruption in South America

The vaccine rollout in South America has opened the floodgates to a wave of corruption scandals that are exposing how the powerful and well-connected have jumped the line to get doses.

Two government ministers in Peru and one in Argentina have resigned for receiving or giving preferential access to vaccines. A minister in Ecuador is being investigated for doing the same. Prosecutors across the region are examining thousands more accusations of irregularities in inoculation drives, most of them involving local politicians and their families cutting in line.

The region, like other developing areas, has struggled to procure a large number of vaccines, and the scarcity has amplified the public’s anger at the scandals. South America has also been devastated by the virus, accounting for nearly a fifth of all pandemic deaths worldwide, despite representing about 5 percent of the world’s population. 

“They all knew that patients have been dying,” said Robert Campos, 67, a doctor in Peru’s capital, Lima, of the country’s politicians. “And they vaccinated all their little friends.”

Progress in nursing homes

After the pandemic hit they were called “prisons,” “tinderboxes” and “death pits.”

Some of the grimmest chapters of the pandemic were set in nursing homes, where the virus took the lives of residents and staff members with brutal efficiency. More than 163,000 people who lived or worked in nursing homes died, accounting for more than a third of all U.S. virus deaths since the late spring.

But the tide is beginning to turn.

David Leonhardt, who writes the Morning newsletter, took a look at nursing home deaths along with The Times’s graphics team — and found heartening news.

Since the beginning of the vaccine rollout, which prioritized nursing home residents and staff members, new cases and deaths within their walls have fallen steeply, outpacing national declines.

You got the vaccine. What can you do now?

America is inching toward relief. But this moment doesn’t look the same for everyone.

The current chapter—in which some Americans are fully vaccinated, but not enough to protect the wider population against the coronavirus’s spread—is new territory. The rules of pandemic life are changing once again.

Here are a few things to remember in these next, awkward steps toward normal.

One principle can help you—whether you are vaccinated or not—navigate this new phase“When deciding what you can and can’t do, you should think less about your own vaccination status, and more about whether your neighbors, family, grocery clerks, delivery drivers, and friends are still vulnerable to the virus,” Rachel Gutman writes.

Vaccine makers don’t need a perfect dosing regimen. They need an effective one. Vaccination is about data, but also trust, Katherine J. Wu explains: “In the absence of public trust, even an immunologically ideal vaccine-dosing regimen won’t be the one that protects the most people.”  

Vaccines might never bring us to herd immunity, but they can still help end the pandemic. “The role of COVID-19 vaccines may ultimately be more akin to that of the flu shot: reducing hospitalizations and deaths by mitigating the disease’s severity,” Sarah Zhang wrote earlier this month.

Don’t forget about the global picture. As one expert told James Hamblin, many low-income countries may end up far behind in vaccine distribution. That’s dangerous for the world: “Providing the virus with new places to spread will allow it to linger with us indefinitely. The longer it sticks around, the more time it has to mutate—which is bad news for the entire world, Americans included,” James notes.

Fear of a fourth wave

For all the cautious optimism in the U.S. amid the receding third wave of the coronavirus, there was a sobering warning from health officials Friday: it could get very bad again. Citing the increasing spread of mutations both more easily transmitted and potentially more deadly, and infection rates that remain alarmingly high, the head of the Centers for Disease Control and Prevention cautioned states not to make the same deadly errors they made last spring, and to leave in place precautions like mask mandates and capacity restrictions. The fresh danger is in the numbers: While cases have indeed been falling since mid-January, the decrease has now stopped, holding steady at 70,000 new U.S. infections each day. Even worse, Covid-19 deaths have also stopped falling in recent days. On the vaccination front, the Johnson & Johnson single-dose shot is close to approval in the U.S., which would bring to three the number of available vaccines there. Nevertheless, CDC Director Rochelle Walensky urged vigilance: “We may be done with the virus, but clearly the virus is not done with us.” Here’s the latest on the pandemic. —Margaret Sutherlin

Joining the race

Almost a month after the European Union slapped export controls on coronavirus vaccines in a desperate attempt to get its immunization program back on track, its supply outlook finally looks brighter.

Having now secured extra doses from Pfizer and Moderna, the 27-member bloc may be able to inoculate three-quarters of its 450 million people by the end of August, James PatonNikos Chrysoloras and Tim Loh report.

But it has a lot of ground to make up. While the U.K., with Europe’s highest death toll, has administered more than 27 doses per 100 people and the U.S. 20, the EU has so far injected just six.

The cost in human lives is mounting, while failure to achieve vaccination targets also leaves Europe vulnerable to a sputtering economic recovery and at risk of falling behind nations that handle their rollouts more effectively.

With officials in Brussels warning the 75% inoculation rate may not be enough to stop the virus as new variants emerge, the real challenge is fighting both public doubt and logistical hurdles to get needles into people’s arms.

In Bulgaria, where distrust is widespread, one hospital reported only about a third of those scheduled to receive shots showed up. Health workers from Germany to France and Italy are also reluctant to embrace the AstraZeneca shot over concerns of side effects and belief in its potency. German officials are warning of a “traffic jam” at vaccination centers.

Cases are spiking again across the continent. Chancellor Angela Merkel warned yesterday that a third wave of the virus has already arrived in Germany, while officials in neighboring Czech Republic said the health-care system is nearing “total exhaustion.”

The vaccines can’t come soon enough. — Michael Winfrey

Why is Europe doing so much worse than the United States when it comes to vaccine rollout?

Olga Khazan writes, despite lost doses and frustrating vaccine websites, the U.S. is vaccinating its residents faster than any member of the European Union—which may be surprising, given that so many European health-care systems are touted as being more efficient than America’s. …

This story is more about the foibles of the European Union than the triumph of the United States. The EU worried that if it left each of its member countries to acquire vaccines for itself, smaller and poorer nations wouldn’t be able to buy enough. European leaders bet that, by negotiating for vaccines as a bloc, they could match America’s purchasing power. Read Olga’s full story here.

A third vaccine in the pipeline

Some positive news: New analyses found that the Johnson & Johnson vaccine provided strong protection against severe disease and death from Covid-19 and may also reduce the spread of the coronavirus by vaccinated people. 

Over all, the report from the Food and Drug Administration found that the vaccine had an efficacy rate of about 66 percent against moderate to severe Covid cases across all of its global clinical trials. The results mean the F.D.A. could authorize the vaccine as early as Saturday, and Americans may have a third option for a vaccine as early as next week.

Some people may get tripped up on the vaccine’s 66 percent efficacy rate — compared with 95 percent for the Pfizer and Moderna shots — and wonder whether they should pass on the Johnson & Johnson vaccine and hold out for the other doses. But that figure doesn’t tell the whole story. Here are some things to keep in mind.

It’s more effective in the U.S. The 66 percent efficacy rate was calculated across all of the company’s clinical trials in the U.S., Latin America and South Africa. In the U.S., the vaccine fared better, with a 72 percent overall efficacy rate. That number dropped to 64 percent in South Africa, where a highly contagious variant is driving most cases. Even so, it’s the clear winner in South Africa so far, after Novavax’s vaccine showed an efficacy of 49 percent there, and the AstraZeneca-Oxford vaccine showed little protection at all.

It prevents severe disease. The vaccine works well where it really matters, showing 86 percent efficacy against severe forms of Covid-19 in the United States, and 82 percent against severe disease in South Africa. That means that a vaccinated person has a far lower risk of being hospitalized or dying from Covid-19.

It’s easier to take. In some ways, the Johnson & Johnson vaccine has an edge. Its one-dose shot is easier to take and has noticeably milder side effects than vaccines from Pfizer and Moderna, without any reports of severe allergic reactions like anaphylaxis.

It’s easier to distribute. Unlike vaccines from Pfizer and Moderna, which must be stored at ultracold temperatures, Johnson & Johnson’s vaccine can be stored at normal refrigeration temperatures for at least three months, making its considerably easier to distribute to rural areas and far-flung places across the globe.

Americans may not be able to pick and choose vaccines in the early stages of the rollout, and medical experts, including Dr. Anthony Fauci, have made the point that it’s important to take whichever vaccine is offered.

Moderna is ready to test a variant-targeting booster shot

Moderna has designed a Covid-19 vaccine against the worrying viral variant B.1.351 and is ready to start testing it as soon as regulators give the green light, the company said.

The news, disclosed yesterday, is that Moderna has a three-pronged plan for addressing B.1.351, which was first identified in South Africa. The company plans to enroll people who’ve already been vaccinated, testing its novel vaccine on its own and in combination with the one already authorized for use, using a half-strength dose. It also plans to test a third, full-strength dose of the original vaccine.

Moderna’s move underlines a gathering consensus that Covid-19 will be a global issue for years to come, even after the crisis of the pandemic has subsided. Moderna is scaling up its manufacturing in anticipation of producing low-dose booster shots in large numbers well into 2022, and the company’s quick response to the emergence of B.1.351 could be a model for reacting to the next alarming variant that might arise. Read more.

Pfizer has a variant plan of its own

Pfizer, the other company with a U.S.-authorized Covid-19 vaccine, believes it can combat the rise of worrisome variants by simply upping the ante of immune response.

As STAT’s Matthew Herper reports, the company, along with partner BioNTech, is planning to test a third dose of its vaccine, betting that creating even more antibodies to the original SARS-CoV-2 will help the body fight off mutated forms of the virus. 

In laboratory studies, Pfizer’s vaccine was less effective against the B.1.351 variant but still appeared to offer protection. That suggests the variant is not completely resistant to vaccination and might be susceptible to a booster shot of the same medicine. “It’s somewhat the theory of more is better,” said Ed Walsh, a professor of medicine at the University of Rochester who is running the new Pfizer trial. Read more.

Banking on tech backup, CDC launches nationwide VaccineFinder tool

Late yesterday, federal officials quietly opened up access to VaccineFinder, a site that allows the U.S. public to search nationwide for approved Covid-19 vaccine providers. But don’t get your hopes up yet, unless you live in Alaska, Indiana, Iowa, or Tennessee or you can find providers registered in the federal pharmacy program. On vaccinefinder.org, users can enter an address or ZIP code and get a list of providers with contact information, eligibility criteria, and, when available, a link to a vaccine scheduler. Critically, users will also be able to see whether each provider has doses available. VaccineFinder will eventually be an answer to scattered and siloed systems that have made it difficult for many to find where and when they can get a shot. STAT’s Katie Palmer has more on the rollout.

Fauci outlines a plan to learn more about long Covid — and possibly treat it with current drugs

The nation’s leading infectious disease expert detailed yesterday the questions he hopes research will answer about long Covid, the puzzling syndrome affecting some people who recover from Covid-19 but whose symptoms persist. At a White House briefing on Covid-19, Anthony Fauci said a new NIH initiative would ask what the spectrum of recovery looks like across all ages, how many people continue to have symptoms or develop new ones, what the underlying medical cause is, who is most vulnerable, and whether the infection triggers changes in the body that increase the risk of abnormalities such as chronic heart or brain disorders. With those answers, “we would need to design therapeutic approaches, hopefully, on medications that we already have. We just need to know how to use them.”

What wartime mobilization really means

President Biden has compared the fight against Covid-19 to wartime mobilization. And successful wartime mobilization in the United States has always involved much more than the government. The best example is World War II, when private companies like Ford and General Motors quickly overhauled their operations to contribute to the war effort.

In the fight against Covid, however, the private sector — with the big exception of pharmaceutical companies — has done relatively little so far. It has not made a major push to persuade Americans to remain socially distant, wear masks or get vaccinated as soon as possible.

Later this morning, Biden administration officials and business leaders will announce a plan to change that, White House officials told me. The plan includes some of the country’s largest corporate lobbying groups — like the Chamber of Commerce, the Business Roundtable, the National Association of Manufacturers and groups representing Asian, Black and Latino executives — as well as some big-name companies.

Ford and The Gap will donate more than 100 million masks for free distribution. Pro sports leagues will help set aside more than 100 stadiums and arenas to become mass vaccination sites. Uber, PayPal and Walgreens will provide free rides for people to get to vaccination sites. Best Buy, Dollar General and Target will give their workers paid time off to get a shot. And the White House will urge many more companies to do likewise.

Many of the steps are fairly straightforward, even obvious. That they have not happened already is a reflection of the Trump administration’s disorganized Covid response. Trump officials oversaw a highly successful program to develop vaccines, but otherwise often failed to take basic measures that other countries did take.

“We’ve been overwhelmed with outreach from companies saying, ‘We want to help, we want to help, we want to help,’” Andy Slavitt, a White House pandemic adviser, told me yesterday. “What a missed opportunity the first year of this virus was.”

A potential turning point — good or bad

The new push comes at an important moment in the pandemic. The country has a chance to crush the virus in the coming weeks, through a combination of vaccination, mask wearing and social distancing. Yet the spread of contagious new variants means that virus cases could surge instead, causing tens of thousands of unnecessary deaths.

In a worrisome sign, the number of new cases has stopped falling over the past week, in the U.S. and worldwide. We are now looking at the possibility of a fourth wave, as my colleague Apoorva Mandavilli explains in a new overview of the pandemic.

Private companies can play a big role in avoiding that new wave for two main reasons.

First, the companies have enormous resources at their disposal — buildings, technology and people for vaccination sites; money to spend on public-service messages; and more. A case study: Honeywell worked with local officials in North Carolina to deliver more than 1,500 vaccine shots per hour on two recent weekends.

Second, companies can sometimes break through partisan barriers that politicians cannot. Many Americans who won’t listen to Biden’s advice about mask wearing — or vaccine effectiveness — may listen to a colleague’s or boss’s advice. They may be willing to participate in a shared effort to protect their co-workers and community. Slavitt, the White House adviser, said he was hopeful that employers could make a particular difference in states that have not enacted mask mandates.

The message, he added, should be: “Wear a mask. Avoid crowds. And get vaccinated when it’s your turn.”

During our conversation, I asked Slavitt whether companies could not only influence people’s attitudes but also make a real difference in the speed at which Americans are vaccinated. The country has averaged about 1.5 million shots per day over the past week. My reporting suggests that the right goal is at least three million daily shots by April.

Slavitt didn’t sign on to that goal — “I don’t think we have a perfect answer to that question,” he said — but he didn’t reject it either. He noted that the peak number of flu vaccine shots in a normal year is around three million per day.

He also pointed out that Biden yesterday predicted that any adult who wanted a Covid vaccine would be able to get a shot within 60 to 90 days. That timetable suggests a pace of close to three million shots by early spring. And it will probably take private-sector efforts, like Honeywell’s, to make it happen.

Wartime metaphors are often overused. But in the case of Covid, it feels appropriate: People’s lives are at stake.

Vaccine inequities 

One U.S. State Has Vaccinated 10% of Its Black Population

Early findings point to inequities, with vaccines reaching White and Asian populations faster than Black and Hispanic people. Get the latest here.

Why can’t kids get Covid-19 vaccines?

Is there hope for biotech penny stocks? And when are feces medicine? 

We discuss all that and more this week on “The Readout LOUD,” STAT’s biotech podcast. First, pediatric cancer advocate Nancy Goodman joins us to discuss why she believes Covid-19 vaccine trials need to be sped up for teens and children. Then, Wall Street Journal reporter Greg Zuckerman calls in to explain the unlikely story behind Novavax, a former biotech penny stock now on the verge of making history. Finally, we embark on a lightning round, featuring quick takes on the confirmation process for a new health secretary and the future of therapeutic stool. Listen here.

Get the latest updates here, as well as maps and vaccines in development.

Sharing the vaccine with the world

The global vaccine-sharing program Covax, which aims to make vaccine access more equitable around the world, delivered its first shipment today: 600,000 doses provided by India’s Serum Institute arrived in Accra, the Ghanaian capital.

The goal of the Covax program is to deliver two billion doses this year to 92 low- and middle-income countries, for free. By doing so, Covax hopes to address an unequal system of procurement in which wealthy countries have secured enough doses to vaccinate their populations many times over, while many poorer countries have received nothing.

Even if the Covax rollout goes according to plan, vaccinating the vast majority of the world’s most vulnerable people this year will be a daunting challenge. Ghana, a nation of more than 30 million people, will get enough vaccines to cover only about 20 percent of its population by the end of 2021. It will have to buy millions more doses separately.

The vaccination campaign in Ghana and other West African countries is set to begin in the coming days, and is being rolled out as recent studies suggest that the spread of the virus has been much wider in the region than official numbers show.

Further complicating the rollout, said Dr. Tedros Adhanom Ghebreyesus, the head of the World Health Organization, is that high-income countries are competing with Covax for purchasing contracts, reducing the number of doses the initiative can buy. The pandemic will not end, he added, until everyone is vaccinated.

“This is not a matter of charity,” he said. “It’s a matter of epidemiology.”

Vaccine rollout

Thailand, which has lagged behind some of its Southeast Asian neighbors in obtaining coronavirus vaccines, received its first shipment of 200,000 doses of the CoronaVac shot from China.

New York State opened two large vaccination sites in Brooklyn and Queens, part of an effort to boost inoculations in neighborhoods that have been hit particularly hard by the pandemic.

State Department officials overseas expressed anger and disappointment that diplomats in Washington were being vaccinated before those in more perilous posts.

Two vaccine makers in China have said that their Covid-19 vaccines are effective at preventing serious illness, paving the way for their deployment in China and the developing world over the next few months.

In the U.S., the drugmaker Moderna said that it had created a new, experimental form of its coronavirus vaccine to combat the South African variant, and it has also begun to increase its overall manufacturing capacity. To address concerns about the variants, Pfizer and BioNTech plan to test a third booster shot as well as update their original vaccines.

According to a new study in Israel, the vaccine developed by Pfizer and BioNTech is protecting recipients about as well in the real world as it did in clinical trials.

What Israel's vaccine passport tells us about the future

We've written before about vaccine passports—apps and services that are meant to help you prove whether you've been vaccinated. But one of the first real world tests is happening now in Israel, where the high percentage of shots has led to the beginning of a "green pass."

The vision laid out by government ads—a world in which people are going to restaurants, concerts, and the gym—is enticing. But making such a system work well is not going to happen easily.

As Cat Ferguson and Joshua Mitnick lay out in a new story, there are a lot of thorny questions to answer before we assume that it could work in the US, or even that it's working properly in Israel.

The green pass was released on February 21, to help Israelis emerge from a month-long lockdown. Vaccinated people can download an app that displays their status when they are asked for it, or show proof that they've had covid-19 and recovered. Officials hope the benefits of the green pass will encourage Israelis who are hesitant to get the vaccine, many of whom are young.

“People who get vaccinated need to know that something has changed for them, that they can ease up,’’ said Nadav Eyal, a prominent television journalist. “People want to know that they can have some normalcy back.”

Despite the flashy ads, however, it’s still too early to tell how well Israel’s program will work in practice—or what that means for vaccine passports in general. Some ethicists argue that they may further entrench existing inequalities: this is already happening with Israel’s pass, since few Palestinians in the occupied territories of Gaza and the West Bank have access to vaccines.

Other issues include personal privacy, potential profiteering, and over-engineering solutions based on the needs of technology companies rather than individuals. Read the full story.

Novavax’s variant-specific vaccine is coming mid-year

Much like Covid-19 vaccine leaders Moderna and Pfizer, Novavax has a plan to deal with the rise of worrisome viral variants, with clinical trials slated to start later this year.

Novavax has already crafted strain-specific versions of its original vaccine, the company said yesterday, and is testing them in monkeys. By the middle of this year, Novavax expects to start human studies of its variant-specific vaccines as well as for a multivalent one designed to protect against all known strains of the virus that causes Covid-19. 

It remains to be seen whether dealing with viral variants requires novel vaccines or simply booster shots of those that already exist. But we’ll soon find out. Moderna, like Novavax, is moving forward with a newfangled vaccine meant to protect against the variant known as B.1.351, which appears to weaken vaccine efficacy. Pfizer is planning to test a third dose of its existing vaccine, betting that boosting the immune response will protect against B.1.351.

U.S. vaccine program gets back on track

Severe winter weather is bad enough in any year, but in the middle of the biggest vaccination campaign in U.S. history it's a logistical nightmare.

Before a blast of winter storms hit a large swath of the nation last month, the U.S. had been administering a seven-day average of at least 1.6 million doses a day for 10 straight days. After a rocky start in December, it looked like the nation's massive immunization program was finally on track.

But then came record-breaking low temperatures, ice storms, snow and freezing fog across most of the Great Plains states, including the entire state of Texas.

The impact on the vaccination campaign rippled outward to states that weren't even affected by the weather, as manufacturing and shipping slowed. Immunization programs were upended in about 1 in 5 states, with Arkansas, Indiana, Mississippi and Texas among the worst, according to an analysis by Bloomberg.

Starting Feb. 20, the seven-day average dropped to 1.3 million to 1.4 million doses daily for eight days. That's about 2 million doses delayed, according to the Bloomberg Vaccine Tracker.

But now there are signs that the worst is over. Five days ago, the gap began closing as backlogged doses reached states by the middle of last week.

The biggest gains came through this past weekend with a blockbuster three days of peak doses reported—2.2 million doses delivered on Friday and 2.4 million each on Saturday and Sunday. The push drove the seven-day average back to 1.6 million doses per day.

On Monday, the CDC reported 1.7 million doses administered. It's another good sign, but it still means a shortfall of about 1.1 million doses that hasn’t been made up yet. 

Even so, the rapid rebound bodes well as a test of how states are able to respond to interruptions. And it suggests they have the capacity to administer more shots than they have in the past.

That capacity will be tested in the coming weeks amid an anticipated immunization surge, with the recently authorized Johnson & Johnson vaccine added to the mix

The federal government asked shipping partners to work extra shifts last weekend to dispatch extra doses to states, and encouraged them to get needles into arms by extending hours, working weekends and having more staff on hand. 

Spring may not be in the air yet, but when it comes to vaccinations, the worst of winter may be behind us.—Jill Shah

The Unsolved Mystery of Superspreaders

Superspreader events have long been recognized as a key player in this pandemic.

Lengthy indoor gatherings, poor ventilation, and activities like singing and aerobic exercise help these events along, Nature reports.

But big questions remain on how much individual behavior or biology play into these events:

PNAS study with nearly 200 healthy people found 20% of study participants were responsible for 80% of aerosols emitted.

Using anonymized mobile phone location data of 100 million Americans over 2 months, a Stanford team published a Nature study showing that restaurants, cafes, and gyms can play an outsized role in transmission.

Working Backwards: Japan had big success taking on superspreader events with a cluster-focused “backwards contact tracing,” which focuses on finding the source of an infection, rather than focusing on people who might become infected.

What’s behind Iceland’s success story

While the rest of the world grapples with mass vaccinations and fear of the new coronavirus variants, life in Iceland is getting closer to normal.

Since the beginning of the month, not a single person has been diagnosed with Covid-19 domestically apart from a handful of people who were already in quarantine.

Starting Wednesday, the inhabitants of this island nation of 364,000 are allowed to gather in groups of 50, and public venues such as theaters and sporting events may have up to 200 spectators. Pubs and restaurants may open subject to some limitations, while masks are still mandatory in public places.

Iceland’s handling of the pandemic is regarded as one of the best in the world. So what what went right?

For one thing, unlike in some other countries, there was cooperation between the government and scientists. Public information about the outbreak was coordinated in a steady flow through daily televised briefings held jointly by the police and health authorities.

Thorolfur Gudnason, the nation’s chief epidemiologist, said in an interview that he largely attributes its success to the public’s participation in following instructions, such as wearing masks and adhering to two meter (six foot) social distancing.

“The other thing,” he said, “is the measures we have been doing on our borders.” 

Icelanders are well aware that our freedom at home hinges on how well we can prevent infections from slipping through our borders.

Already in June, Iceland launched testing at the borders for arriving passengers as an alternative to undergoing a 14-day self-quarantine, and in August authorities introduced double testing, one upon arrival and the latter following a five-day quarantine. And last week, a new requirement to present a negative test taken within 72 hours of departure to Iceland was added to the mix.

The testing was initially done by DeCODE Genetics, a local company that has become a global pioneer in population genetics. The company has also sequenced every infection diagnosed in Iceland, making it possible to track the spread of the virus and its mutations with extreme precision.

By now, testing is also readily available and free for the general public, who are encouraged to get tested even if they show only the slightest symptoms of the disease.

Still, even as the light at the end of the tunnel becomes more visible for Icelanders, the government doesn’t want to go too far with easing prevention measures.

“We need to keep being cautious. This is a very valuable success, and we know how to guard it,” Health Minister Svandis Svavarsdottir told local media on Tuesday as she announced the easing of rules. “We should be happy. We are Europe’s most open society.”—Ragnhildur Sigurdardottir

What a post-pandemic hospital may look like

When the first wave of Covid-19 patients crashed into New York City hospitals in March, it quickly became clear that this public-health crisis was also a design problem: Without clear signage and sealed rooms and doors to contain infection risk, doctors and nurses could be unwittingly spreading contagion throughout the hospital.

To fix its isolation regime, Mount Sinai Hospital in upper Manhattan turned to Ariadne Labs, a center for health-systems innovation affiliated with Boston’s Brigham and Women’s Hospital and Harvard’s Chan School of Public Health. Working with the nonprofit MASS Design Group, the Ariadne team quickly helped redesign the hospital’s Covid ward with clearly marked doors, bright warning graphics and places to don and doff personal protective equipment. 

That emergency facelift marked the beginning of what has turned out to be a transformational year in health-care infrastructure. Just as the pandemic exposed the fissures in society, so too has it accelerated dramatic reforms in how hospitals look, feel and function.

“Things that advocates have pursued for decades are now happening,” Neel Shah, an obstetrician who heads the Delivery Decisions Initiative at Ariadne Labs, tells Bloomberg CityLab contributor James Russell.

One model for the hospital of the post-Covid era is Rush University Medical Center in Chicago, which has been touted as a pandemic-resistant facility. The building, which opened in 2012, was designed for mass-casualty events, with special ventilation features and a lobby equipped with electrical and medical gas outlets that allow it to accommodate surge beds. That kind of flexibility could be critical for managing future outbreaks.

Going forward, hospitals and clinics built in the wake of coronavirus could bear more subtle marks of the pandemic, as designers increasingly emphasize making them more welcoming spaces.

“Every major health-care facility is moving progressively to include green space and daylight,” says Raj Daswani, who leads health-care projects at the design firm Arup in Northern California. “Research shows these contribute to the healing process.”

Such wellness-oriented design isn’t just for patients. Doctors, nurses and other health-care staff have endured brutally stressful working conditions during the Covid crisis. The architects of tomorrow’s hospitals will be acutely aware of their needs for places of respite, too.– David Dudley

What else you should read:

Biden said there will be enough vaccine doses available for all adults by the end of May.

The governor of Texas says the state can reopen fully next week despite C.D.C. warnings to governors against easing restrictions

A global study found that health care workers faced widespread violence during the pandemic, in which some were beaten, kidnapped or even shot.

California reached an agreement on a school-reopening plan.

Virus tests in the U.S. have dropped 30 percent in recent weeks.

“Vaccines can get us to herd immunity, despite the variants” [The Harvard Gazette]

“How the Covid pandemic could end — and what will make it happen faster” [The Guardian]

“What It Will Take to Get Life Back to Normal” [The New York Times]

“W.H.O.: ‘Premature,’ ‘unrealistic’ COVID-19 will end soon” [The Associated Press]

“The next act for messenger RNA could be bigger than Covid vaccines” [MIT Technology Review]

The E.U. will propose issuing a certificate called a Digital Green Pass that would let people who have been vaccinated against the coronavirus travel more freely.

The pace of U.S. vaccination has begun to rebound after a dip caused by winter storms.

The W.H.O. said new infections in Europe had fallen to half their winter peak.

California logged its 50,000th coronavirus death, more than any other state.

The White House said it would send more than 25 million masks to vulnerable communities next month.

The World Food Program warned that the pandemic could spawn a nutrition crisis for children if school meal programs wither.

Israel pledged to give spare coronavirus vaccines to foreign allies, reigniting a debate Get the latest updates here, as well as maps and vaccines in development.

Biden Struggles With Pledge for Vaccine Equity  A persistent racial disparity in the U.S. vaccination campaign remains.

Supreme Court Allows Indoor Church Services The decision may further curb ability of governments to battle the pandemic.

UN Calls for Cease-Fires to Speed Vaccinations Resolution builds support for WHO-backed Covax vaccine program. 

U.K.'s Sunak Plots Tax Raid to Plug Budget Deficit Deficit set to reach 400 billion pounds as economy reels from recession.

Canada Pension Chief Quits After Vaccine Trip Mark Machin quit post after traveling to UAE to receive Covid vaccine.

French Births Drop to World War II Low France risks a demographic slump amid pandemic and repeated lockdowns.

EU Told to Back Vaccine Passports or Google May Bloc-wide vaccine certificates could enable countries to reopen to travel.

Shot Diplomacy: India Beats China at Own Game Huge capacity to make vaccines helps it gain influence in developing world.

Is News of U.S. Variants Too Much, Too Soon? Homegrown strains show again how the virus is adapting in order to survive.

Vaccination Hurdles: Brazil Tops 250,000 Deaths Local governments deal with shortages, struggle to contain Covid spread.

Round-the-World Cruises Sell Out Well in Advance Landlocked travelers try to make up for lost time with multimonth itineraries.

Fauci: No Shot Arbitrage Between Three Choices He pushed back against shopping around, waiting for a preferred vaccine.

Heathrow Passenger Charges Cover Virus Costs Charge of $12.40 an effort to claw back costs as crisis depresses air travel.

Germany Steps Up Virus Checks at French Border It underscores pandemic’s threat to maintaining open borders in the EU. 

Microsoft Says Vaccine Tools Have ‘Fallen Short’  Its vaccine scheduling software blamed for issued in booking appointments.

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A bit of context.

I have noted herein and numerous other places that the current pandemic has spurred what has become a meme of multitudes having become Covid-19 experts. And less funny, the proliferation of many hysterical and inaccurate feeds and posts that get propagated on various social media platforms.  

As I have opined in past articles like How to Protect Yourself from Fad Science and my three part series, The Reproducibility Problem—Can Science be Trusted? , —Shame on us?, and —What’s a Scientist to do? This is a near-and-dear topic and concern of mine. 

This weekly (Wednesday) LinkedIn Newsletter is an experiment to help with the reach of the Center for Global Initiatives in its open-sourcing of humanitarian work by curating and sharing vetted, verified sources. If you would like to see more frequent, daily updates, please join the open Facebook group at: https://www.facebook.com/groups/CenterForGlobalInitiatives

Also, to vet a source, here is a handy fact-checking website to cut through Covid vaccine misinformation. It includes: “Places to go for accurate information include the CDC (which already has a FAQ about Covid vaccines), the FDA, major hospital websites such as Children’s Hospital of Philadelphia’s Vaccine Education Center, and reliable fact-checker websites.” You can find a list of those websites here, courtesy of the University of California.

Please be sure to visit our newly updates website as well: http://www.centerforglobalinitiatives.org/

If you enjoy this newsletter, I suspect you’d enjoy our monthly podcast.

Listen on your favorite platform http://www.alifeinfull.org/podcast.html and for a free subscription: https://tinyurl.com/ALifeInFullSubscription It’s like a gym membership for your brain.

Likewise, if you are not already following my LinkedIn Influencer posts in a group with almost a half-million followers, you may enjoy reading the posts there as well: https://www.linkedin.com/in/drchrisstout/detail/recent-activity/posts/

Finally, Free Research on COVID-19 from APA Journals. APA Publishing is committed to sharing the latest psychological research on COVID-19 with the public. They invite you to browse their free collection of articles published across the APA Journals portfolio. Since the beginning of the COVID-19 pandemic, psychology experts across the field have provided critical guidance and support to communities in need. Many APA editors adopted a rapid review process during this time, to ensure that timely, peer reviewed research was made available to the public as quickly as possible. This is very generous of APA and demonstrates editors’ and scientists’ work and dedication to the field, as well as that of their reviewers and those involved in getting this crucial research published quickly. Their frequently updated collection, you will find articles on the Behavioral and public health, Bias, discrimination, and equity, Economic stress and mental health, Education, training, and distance learning, Healthcare personnel and other frontline workers, International perspectives on COVID-19, Stress, anxiety, and grief, and telework and telepsychology. Click here to see more.

And even though I know our readers are very smart, I nevertheless have to say that this newsletter does not provide medical advice. The best person to advise you on your healthcare in your individual medical situation is your personal physician. As I have said elsewhere, don’t be a knucklehead.

 Cheers,

 Chris

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