28 February 2021 – Sunday – #136

I had a dream this week that I wasn’t wearing a mask. Does that mean I can stop wearing a mask?

Let’s review the current Covid-19 situation. A good source of current information is Dr. Tom Frieden. He’s posted Twitter threads through most of the pandemic as a way of compensating for the muzzled CDC. Even after President Biden unleashed the CDC, Frieden’s threads are still a useful public health summary of the past week.

The winter wave is over, but looks like another wave might be on the way. So, until we understand Covid-19 transmission in a post-vaccine world, yes, I need to wear a mask. For what it’s worth, it seems like we still don’t completely understand Covid-19 transmission in a pre-vaccine world, either.

One reason it seems like we don’t understand Covid-19 transmission is that our understanding of Covid-19 transmission keeps changing. I remember last March watching Youtube videos demonstrating meticulously how to decontaminate groceries. I myself never went full grocery decontamination. I got as far as leaving the groceries outside on the rear porch to air for a day or two, assuming any Covid-19 virus on packages or produce would be inactive by then. I washed my hands more frequently then, and still do, but now I don’t worry about touching my face before I wash my hands.

What we do know now that we didn’t know last March is that most Covid-19 transmission is airborne and that superspreader events are the main source of infections. 80% of infections come from 20% of cases. Stop the superspreader events and new cases would drop 80%.

We also understand where superspreader events are likely to occur, namely inside when people don’t wear masks. This chart shows where they are more likely.

Odds Ratios compare for a given type of location the frequency of someone who tests positive for Covid-19 having visited such a location to the frequency of someone who doesn’t test positive. The higher the Odds Ratio, the great chance Covid-19 infections take place in that type of location.

Even though we know all this, we still can’t predict superspreader events. Predicting a Covid-19 superspreader event is as hard as predicting when a Boeing 777 will lose an engine. We know a lot of things that might cause an engine to fall off, but that doesn’t mean we can predict when it will happen. In that sense, masks are to Covid-19 what second engines are to a 777. You probably don’t need a mask 99.99% of the time, but it’s sure great to have one on when you need it.

Another important thing we know now about Covid-19 is that outbreak severity is different from region to region. In a long and ultimately satisfying New Yorker article, Siddhartha Mukherjee explores how much we know and how little we understand about difference in Covid-19 outbreaks. As Mukherjee explains, scientists try to model Covid-19 cases and deaths based on a myriad of factors like demographics, population density, public health systems, and climate. None of the models predicts India and Pakistan accurately. None of them get Nigeria right. So, what is it that makes Covid-19 super deadly around Milan and London while it’s more like a mild flu in Lagos or New Dehli?

It could be environment (e.g., warmer places have more ventilation). Perhaps public health systems and overall fitness of a population explain the differences. Many places misreport Covid-19 by as much as 20% – 30%, so maybe reporting skews differences. Is it age demographics? India has a much lower mean age than Italy. Scientists have started considering whether Covid-19 shares traits with earlier viruses that produce a cross-reactive immune response. Many of these factors have at least some correlation to Covid-19 infections and deaths, but none is the silver bullet the explains the range of viral responses in different places.

The fact is that Covid-19 is a vastly different disease in different communities. That makes it hard to compare, say, the effect of different Covid-19 policies on different local economies because different regions have such different Covid-19 outcomes even when they have similar policies.

As researchers improve their models, parsing all these factors in India, Pakistan, Nigeria, and elsewhere, we will learn things about transmission that contradict public health advice during the pandemic. Already, one study already says that businesses didn’t need to close if they’d followed masking, distancing, and ventilation guidelines. In India, even those restrictions don’t appear to be necessary. Businesses there haven’t closed and, practically speaking, there are no Covid-19 restrictions, yet India’s Covid-19 mortality is low.

I suspect there will be many I-told-you-so’s as transmission is better understood. After all, when all is said and done, California and Florida have arrived at about the same place in terms of Covid-19 cases and deaths even though they adopted significantly different restrictions. It’s too early to say that policy didn’t matter and it’s important to remember the lives lost from throwing public health guidelines out the window for the sake of the economy. The meat packing industry is a good example of an industry that flaunted guidelines, lost many of its employees to Covid-19, and spawned outbreaks in communities around its meatpacking plants.

All this brings me to my main point: Covid-19 misinformation. I’m going to start the Covid-19 misinformation portion of today’s post with a quick story about a diversity training seminar I attended. In one of the exercises, the instructor wrote a sentence on the whiteboard and asked each of us to write down on a piece of paper how many times the letter “e” occurred in the sentence. That seemed stupid, but everyone wrote down the number of times “e” occurred in this sentence.

Then the instructor asked how many participants wrote down “1.” No hands. She asked who wrote down “2.” No hands. Then “3.” A few hands went up. The “4.” Some other hands went up. And so on.

The point was that participants looking at the same sentence saw it in different ways. The subjective experience of the sentence was different from the objective sentence. That’s important in understanding diversity, of course, but also for understanding a key aspect of misinformation. If we were to get invested in our first perception, which we are likely to do, we may end up with a cognitive bias. Even when provided evidence that an initial perception is incorrect, people may continue to advocate it if only to save face.

Social media compounds our initial (mis)perception by reinforcing it with messages we want to hear. Once you have taken a stance and are saving face, sharing stories that support your stance lend credence to your cause. In this way, the propagation of misinformation on social media may be a larger long-term public health problem than Covid-19.

Short-term, it’s likely that social media is keeping some people locked into their Covid-19 vaccine misperceptions. As our understanding of Covid-19 transmission has evolved and as public health policies have changed, it’s easy to assert that no one really knows anything. But public health is changing in response to more and better Covid-19 information (e.g., airborne transmission and superspreader events).

It’s more significant when the people thriving on misinformation are healthcare providers who influence medical decisions. Mother Jones investigated nurses’ social media groups and found rampant sharing of vaccination misinformation.

It’s not hard to find vaccination misinformation online. Even when Youtube and other platforms remove misinformation videos, misinformation purveyors make their videos available on their own websites and leverage social media to drive traffic to those sites. The sales pitch during these videos is akin to an MLM get-rich-quick scheme.

Anti-vaxx is big business. The Centre for Countering Digital Hate estimates that social media companies rake in about US$1 billion in ad revenue for anti-vaxx ads. Two groups fund over half the anti-vaxxer ads on Facebook, the World Mercury Project, chaired by Robert F Kennedy Jr., and Stop Mandatory Vaccinations, owned by Larry Cook.

Who is Larry Cook? He’s a former sound technician and was Executive Director of the California Naturopathic Doctors Association from 2012 to 2016. He is now what I would call a social media influencer, someone who makes his money promoting healthy lifestyles on social media platforms.

Having worked in the social media influencer business, my guess is that Cook raises money for anti-vaxx ads, takes a cut of the donations, and drives traffic to places where he not only provides anti-vaxx misinformation, but also sells merchandise. What separates Cook from someone like Steve Bannon, who misappropriated donations for building a border wall, is that Cook doesn’t promise to deliver anything. Cook’s business model probably looks like the NRA, whose executive staff waves the American flag while it lines its pockets with donations derived from fear mongering gun rights misinformation.

The business model problem is that social media companies don’t want to lose US$1 billion in revenue. I am one of the people who don’t see anti-vaxx ads because they’re targeted for anti-vaxxers, but Cook and others create a self-reinforcing echo chamber of anti-vaxx information. Social media algorithms thrive on targeting anti-vaxx content. The communities they create online have real world consequences.

Anti-vaxxers protest in Melbourne as Australia rolls out Covid-19 vaccination program.

While social media platforms earn US$ billions and a few influencers make bank on Covid-19 misinformation, the social costs are devastating. The Director of the NIH, for instance, says he can make a case the tens of thousands of lives were lost to Covid-19 because of the politicization of masks.

One last word about Covid-19 misinformation: privilege. Last week I wrote about how Covid-19 reveals who we are. Those who advocate against Covid-19 vaccines in the face of overwhelming evidence how much disease and suffering they prevent are usually in a position of privilege. Not privilege in the sense of having money, but privilege in the sense of not wearing a motorcycle helmet or seat belt. It’s the privilege of saying, in effect, if my misinformed decision fails me, I expect those who listened to and followed expert advice to take responsibility for my decision.

Covid-19 bits.

I write Covid Diary BCN for my own sanity. If it helps you, please forward a link to friends and family. For more frequent Covid-19 updates, follow me on Twitter.

21 February 2021 – Sunday – #135

History and politics are rich in Barcelona.

Last week’s election was marked by low voter turnout and left Catalonia in essentially the same political configuration. That is to say, while Catalonia’s independence movement probably will control the regional government’s agenda, its voters remains split on the issue of regional independence.

My Catalan friends tell me that after the failure of the 2017 independence referendum, it will take much more than 50% popular support to achieve independence here. I assume the pro-independence parties know this and their actual political agenda is concessions from the central government rather than outright independence. After all, Catalonia has asserted its independence repeatedly since the Bourbon dynasty, so what’s the hurry?

When helicopters first fluttered above Barcelona last week, I thought the police must be monitoring post-election independence protests. However, last week’s street protests were a continuation of the protest that passed by Casa Solar three weeks ago, a protest in support of the rappers Pablo Hasel and Valtònyc. Now Hasel is in jail and Valtònyc in exile for their songs against crown.

Free Hasel graffiti on Passeig Sant Joan bus stop. It’s in English for a reason.

As political as music can be, it never occurred to me that a music conservatory would produce a political action instead of an overtly political concert. The Catalan Academy of Music, in concert with 70 arts organizations and left-leaning political parties, demanded the federal government pardon the rappers. I suppose when the government starts jailing musicians during a pandemic that has closed public stages, the stages move to the street.

Want to know where this evening’s stage is? Look in the sky for a police helicopter.

Covid-19 has more than a cameo in the recent street protests. The looting of the large Decathlon sports store downtown, for instance, has nothing to do with rap lyrics and everything to do with generating cash from stolen goods. All the luxury brands got hit on Passeig de Gracia.

Protesters ransacking stores on Passeig de Gracia.

There’s also a social media angle. How many dumpsters were set ablaze and retail windows smashed to promote street theater with clicks?

Matthew Bennett on the bounty of street protest media coverage.

The pandemic has disrupted life and income for most Barcelonians. As good as social services are here, the protests have been a way to vent the pressure from the public health restrictions and decimated economy Covid-19 hath wrought.

As the political situation simmers outside, I’m reading George Orwell’s Homage to Catalonia. From late 1936 to early 1937, Orwell fought Franco’s Fascists forces near Huesca, about 250 km (150 miles) northwest of Barcelona. Fought might be too strong a word, at least for the half the book I’ve read. Orwell participated in only one actual skirmish. The rest of the time he camped in squalid conditions with POUM militias, holding ground against Fascist forces.

On leave after his time near Huesca, Orwell returned to Barcelona, looking for a black market pistol (the militias provided few arms to soldiers), tobacco (Franco controlled domestic plantations on the Canary Islands), and a way to join the military action closer to Madrid.

On this Barcelona visit, the informal and salud of Orwell’s first visit had been replaced with usted and buenas días. He found a Barcelona where class differences had re-emerged, where indifference to Spain’s Civil War had replaced the socialist camaraderie he experienced nearer the beginning of the conflict.

Orwell also saw more clearly during this visit the agendas and relationships of the various political parties and their militias. He describes party operatives murdering members of other parties during street protests and the subsequent funerals staged for political messaging. The time Orwell spent in Catalonia became fodder not only for the commercial dud Homage to Catalonia, but later for his best-selling Animal Farm and Nineteen Eighty-Four.

Hint: if you want wide readership of your views on political ideology, learn to write fiction.

This week’s protests, at least nominally against the Spanish crown, feel to me like echos of the Barcelona protests 84 years ago that Orwell describes (perhaps should I write eighty-four like Orwell). Certainly last week’s street protests featured neither the murders nor staged funerals that Orwell describes, but there was violence in Barcelona—dumpster fires and physical attacks on police and media.

Trash bins on fire during last week’s protests in Barcelona.

The protests spread, too. There were Hasel protests in Valencia this week. My friend Simon messaged me from Vic, reporting the protests there were “about Hasel and just freedom of expression overall.” Here’s the report from Pamplona last night.

Hasel protests in Pamplona.

The Orwellian echo I’m sensing in Catalonia may be from the way Covid-19 has revealed the region’s class differences. What protest, after all, could be more about classism and hierarchy than a protest over songs against the crown?

Besides being a hideous virus that kills and maims people, Covid-19 impartially reveals us for who we are.

Hint: the entitled are coming out ahead.

As evidence accrues on the safety and benefits of Covid-19 vaccines, the inequality of vaccine distribution was last week’s hot news topic. To start with, it seems that the Pareto Principle got its Covid-19 vaccination—ten wealthy countries have consumed 75% of vaccines produced while 130 countries have none. Not quite the 80-20 rule. Worse, actually.

Dr. Craig Spencer: “I’ve received more vaccine than 130 countries.”

Covid-19 vaccine inequity abounds. Israel, which is going gangbusters on vaccinating its citizens, is still considering whether to provide vaccine for West Bank Palestinians. Scarce front line African healthcare workers are dying from Covid-19 while a US Soulcycle instructor posing an an educator got vaccinated. US anti-immigrant sentiment is preventing immigrants from getting vaccinated, postponing herd immunity.

If you’re rich in the US, your experience of Covid-19 is more comfortable and you’re much less likely to die than if you’re poor. Wealthy Silicon Valley types are flying private jets to shelter in place on Costa Rican beaches while awaiting vaccination. Even though many wealthy New Yorkers have fled to the Hamptons or Palm Beach during the pandemic, New York City vaccinations still favor the rich and white who remain.

NYC Covid-19 vaccine administration maps.

I should mention that Covid-19 has created many inequalities other than who gets a jab. For example, school closures in Europe and elsewhere exacerbate class differences. The Guardian ran a good piece last week about Covid-19 ending relationships. Often, privileged people feel they don’t need to participate in or advocate for public health measures like masking and vaccination.

This week’s virtual G7 is discussing ways to provide Covid-19 vaccines to poor countries. In a reversal of Trump’s America First policy, President Biden committed US$2 billion now and US$2 billion later to WHO’s COVAX vaccination program for poor countries. President Macron wants rich countries to contribute 3%-5% of their vaccine purchases to poor countries as well.

One trade-off the world can make right away? Postpone second doses of vaccines so more people can get first doses. More and more studies show that the the first doses of the Moderna and Pfizer Covid-19 vaccines are highly effective. Not all scientist agree that changing the two course regime is good policy. In Israel, though, which may achieve herd immunity as early as next month, public health officials now believe the first dose of the Pfizer Covid-19 vaccine is at least 84% effective.

So, perhaps the inequalities Covid-19 reveal about ourselves were an impetus for the Barcelona protests. The protesters on the street, after all, probably are last in line for Covid-19 vaccine and have to be as tired of the restrictions as I am. I have to ask myself, though, what else besides Covid-19 might be fanning Barcelona’s protest flames. I believe there is another Orwellian angle to what happened here last week, a kind of death rattle of Franco. I’m going to take you to Texas to explain.

If you have a heartbeat, you know that Texas is in the midst of an energy and water infrastructure catastrophe. After a snow storm last week, energy demand spiked, crippling the state’s power grid. Within days, water systems froze and burst. Scores of Texans are dying from hypothermia and, while idling their cars for warmth, from carbon monoxide poisoning. Photos of Texans waiting in line for water look more like Maduro’s Venezuela covered in snow than like a scene of everyday life in the United States.

Republicans have had trifecta control of Texas (governorship, senate, and house) since 2003. They have controlled Texas government about half the number of years that Franco controlled Spain. That didn’t keep Governor Abbot from blaming Democrats’ Green New Deal for the blackouts.

The real problem isn’t Democrats, though. AOC and Beto O’Rourke are fundraising for victims and working phone banks to help fellow Texans with resources.

The real problem is that Texas Republicans have prioritized profits over regulation. Federal regulators warned Texas a decade ago that it needed to winterize its power infrastructure for climate change. Federal regulators lost to Republicans’ dogged support of short term profits. The cost of winterizing Texas’ power grid would have been inconsequential compared to the cost of the current catastrophe, but it would have required regulation. Republicans don’t know how to do regulation. The cost of the catastrophe won’t be passed on to the power companies that profited.

When I looked at the Texas power grid on a map, it reminded me of something.

US and Canadian power grid map.

The way Texas insulated its power grid reminded me of the way that Franco kept Spain’s train system separate from the rest of Europe.

Train gauges throughout Europe. Source: Jakub Marion’s Language Learning, Science, and Art.

The evidence isn’t complete, but one explanation is that Franco kept Spain’s distinct train gauge because he didn’t want foreign trains invading sovereign Spain. The evidence is clear, on the other hand, that Texas Republicans kept a separate power grid because they didn’t want US Federal regulators touching the state’s sovereign power structure. It’s a weak association, but stay with me. There’s a reason that people keep mentioning Orwell’s Nineteen Eighty-Four when Republicans are in control.

The quandary Texas Republicans now find themselves in is that they are advocating small government and deregulation because they claim the free market always leads to the best outcome. They’re locked into an ideology that puts them at odds with realities of the unusual weather events that climate change brings (not to mention with the realities of Covid-19). I am not an apologist for Franco, but he wasn’t one to lock himself into ideologies.

As the catastrophe unfolded, Senator Ted Cruz hopped on a plane with his family for a vacation at a luxury resort in warm Cancun, Mexico. Chris Hayes has a great explanation of the way Cruz distorted the Republican Matrix by taking this trip.

Both Abbot and Cruz went to Fox News, of course, to present their respective cases. The Fox News echo chamber, of course, is an echo of Franco’s censorship. Fox News won’t acknowledge that climate change has better economic and health outcomes with a government coordinated response (not to mention Covid-19).

Both Abbot and Cruz depend on gerrymandering and voter suppression to maintain the Republican trifecta in Texas, an echo of Franco’s bloody political repression. If you think I’m exaggerating, well, maybe, but check with the people behind Black Lives Matter before you discount that claim entirely.

The Republican ideological intransigence has larger implications than simply, as Hayes points out in his video, having no idea how to use government resources effectively. When President Biden told his G7 counterparts that America is back on the world stage, German Chancellor Merkel and French President Macron weren’t entirely convinced. They know the Republicans may control the White House again. The US may have the world’s largest economy, but it also has the one major political party that puts Jesus and profit in front of climate change and science.

So, you’re asking, what does this have to do with the protests in Barcelona last week? What does this have to do with Franco’s death rattle?

I don’t know what will happen with the US Republican party. If Texas is best the party can offer, the party is starting to look like a Franco regime in which infrastructure is separate and sovereign, in which messaging is controlled to fit the party rather than reality, in which political power is maintained through suppression, physical and otherwise, rather than free and fair elections. The Republicans could end up looking like Franco, but at least Franco knew how to get a few things done.

It also could be curtains for the current Republican party orthodoxy. It’s possible that after the power grid catastrophe, after Cruz pulled back the curtain on how wealthy people sit on the beach while the rest of us figure out how to survive, Texans will figure out that profit isn’t everything, that regulation can be good for business, that sometimes government is the best answer.

When it was curtains for Franco, he reverted to the royalist playbook, bringing back the exiled King Juan Carlos. What Franco wanted was a way to stabilize Spain after his death. I assume Franco wanted to preserve his legacy, but who knows. What Spain ended up with is an expensive government. It now supports both a monarch and a democratically elected government.

Spain also fixed its trains after Franco died. There is high speed rail and, in spite of the gauge differences, international travel doesn’t require switching trains. When Simon said the protests were “about Hasel and just freedom of expression overall,” I took that to mean not just an end to royal power, but an end to Franco.

Covid-19 bits.

  • The US will surpass 500,000 confirmed Covid-19 deaths this coming week. According to excess deaths statistics, the actual number of dead is much higher.
  • US life expectancy declined by a year during the Covid-19 pandemic last year, the largest decline since World War II. The impact on minorities was higher.
  • Johnson & Johnson will have only a few million doses of its Covid-19 vaccine ready to ship when it presumably obtains FDA approval this month.
  • Sinovac reported its Phase 3 trial results. In Brazil, no Covid-19 deaths after 14 days.
  • The US CDC says food packaging is an unlikely medium for Covid-19 transmission.
  • WHO investigators found 13 different genetic sequences from Covid-19 cases in Wuhan in December 2019, suggesting that the virus had been circulating for some time. The Biden White House has asked China for more transparency in its early Covid-19 data.
  • Israel is measuring a 94% drop in symptomatic Covid-19 cases in populations that have received the Pfizer Covid-19 vaccine. The real world is aligning with the trial world.
  • It looks like the Moderna Covid-19 vaccine works nearly as well with 1/2 the approved dose. Israel has measured 84%+ efficacy of the Pfizer vaccine with one dose. We also know that even though Johnson & Johnson is testing the effectiveness of using 2 doses of its vaccine, it works fine with one dose. These data points suggest that it’s possible to squeeze 2x more doses out of current production.
  • Denmark is seeing more Covid-19 outbreaks in school children as the new UK strain dominates cases there.
  • Researchers found that Covid-19 vaccines give better protection against emerging strains than natural immunity.
  • UK researchers have started the world’s first Covid-19 human challenge. About 100 young people will be exposed to the virus to study the way it infects people in a controlled setting.
  • Brazil is vaccinating the entire adult population of Serrana, a city of about 45,000 people in the south, to study how vaccinations reduce Covid-19 infections.
  • South Korea is providing Covid-19 tests for pets. If they test positive, they have to quarantine for 14 days. Fido may be dangerous for your health.
  • Researchers believe that high level of Covid-19 in saliva tests may be a good predictor of severe cases.
  • Austria will offer free Covid-19 tests in March to anyone.
  • A leaked study concludes Israel will achieve Covid-19 herd immunity next month.
  • Russia reports seven cases of H5N8 bird flu in humans. So far no reports of human-to-human transmission of this virus.

This is a helpful reminder about staying warm and ignoring Covid-19 disinformation.

14 February 2021 – Sunday – #134

Happy Valentine’s Day! Happy Election Day! Today Catalonia is having an election on the day of love. I hope that doesn’t mean the election is screwed.

Valentine’s Day pastries at Baluard.

Lots more going on this weekend in Barcelona than elections and love. Brad reported seeing Marcel Marceau at the local Merkat. Well, someone who looked like Marcel Marceau.

In fact, shopkeepers in many stores here donned costumes yesterday. With all the local and national festivals it’s hard to keep track of what we’re celebrating in addition to elections and Valentine’s Day. Best guess is the costumes were a prelude to Lent, which starts next week.

During the pandemic, it was encouraging to see “vote early” flyers posted on the entrance to every building. When I walked down Carrer de Venus last week, I noticed a long line at the location where Catsalut administered flu vaccinations last Fall. I assumed the line was for Covid-19 vaccinations, but why were there so few elders in line? Then I realized it was an early voting line.

Early voting poster for 14 February 2021 Catalan election.

Spain and Catalonia have multi-party political systems. I find it difficult enough to choose between two candidates in the US. Here voters have a myriad of choices with pretty much every political niche covered. The fear in liberal Barcelona is that the ultra-conservative Vox party may win seats for the first time today.

To me, choosing a candidate in a multi-party system seems like playing 5D chess. I’m mystified. Do people vote for the party that supports their exact point of view that radishes should be banned from salads or do they vote for the pro-radish party that’s more likely to win and also promises to form a coalition with the anti-radish parties? Pass the vinaigrette, please.

If politics isn’t confusing enough, there’s dating during the pandemic. Valentine’s Day only exacerbates the confusion. During the AIDS crisis, I remember friends who tested positive wanting to squeeze an entire lifetime relationship into the final months or days of their lives. The lethal HIV virus made friends crazy to fall in love, move in, and skip right to the “till death do us part” part.

Romance during the time of Covid-19 is different because Covid-19 sex is a different kind of crapshoot from HIV sex. Covid-19 sex isn’t so much about your own mortality like it was with HIV sex. Covid-19 sex is more family oriented. It’s about the likelihood that you could pass it on and kill grandma.

The uncertainty of Covid-19 keeps people stuck in apartments or jobs or relationships for all the wrong reasons. I don’t think I’m alone in deciding to avoid a major romantic commitment until after vaccinations.

I also don’t think France is alone in having a Covid-19 baby bust. The long joked about Lockdown Babies, or bébés du confinement, never came to pass. It’s like nine months ago everyone was playing musical chairs, the music stopped, we sat down, and now we’re waiting for the music to start again.

Covid-19 vaccines seem to be music to everyone’s ears. The main Covid-19 stories last week were vaccines and mutations. Here’s the big picture on vaccines.

World Covid-19 vaccine status, February 2021. Source: The Lancet.

If all the pharmaceuticals hit their 2021 targets, there should be enough Covid-19 vaccine for 7-8 billion people this year. In other words, in a perfect world where manufacturing scales, supply chains deliver, and healthcare systems administer shots (usually two) to every resident, the pandemic could be over this year.

The devil, as they say, is in the details.

It feels right now like vaccines are never coming to Barcelona. Many of my friends here are kvetching that many of their US friends have got the jab already, but they don’t know anyone in Barcelona who’s been vaccinated. It’s clear why. Six weeks into Catalonia’s vaccination drive and only 3% of its population has received a first dose of Covid-19 vaccine. At this rate, everyone in Barcelona will get a shot by 2036.

Percent of Catalan population vaccinated for Covid-19. Source: Catalan News.

The Spanish government predicts, however, that it will vaccinate 70% of Spain’s population by the summer. Like most EU countries, Spain’s vaccine administration capacity is good because of the structure of its single payer health system. With mostly two dose vaccines, the Covid-19 effort requires 2.1 million shots per week to meet its summer goal.

Is that feasible? Well, last Fall the country vaccinated 14 million people for the flu in eight weeks, or 1.75 million shots per week, so, yes, 2.1 million shots per week is credible.

On the supply side, though, none of the EU can hit herd immunity until vaccine shipments ramp up as promised. The good news is that it looks like the requisite supply will arrive as long as the EMA approves Covid-19 vaccines from Johnson & Johnson, Novavax, and Curevax next month.

Because it’s a single-dose vaccine, the Johnson & Johnson vaccine alone should be enough to vaccinate nearly 90% of Spain as soon as it receives its allocation of 40 million doses. At 2.1 million doses per week of the one-dose J&J vaccines, that works out to 19 weeks, or about 4-1/2 months, to get to 90%.

In the US, Trump spent tens of millions of dollars on a no-bid contract for vaccine allocation planning from Palantir and tens of millions more on another no-bid contract for distribution and administration software from Deloitte. None of that really worked.

During his first three weeks in office, Biden has increased vaccine administration from under one million shots per day to over three million—last week the US exceeded three million shots (almost 1% of the population getting a first dose) in three out of seven days. Also, in the midst of Trump’s second impeachment trial, Biden announced the purchase of an additional 200 million doses of Covid-19 vaccine.

The Biden administration is working with pharmaceutical companies to figure out how to leverage vaccine manufacturing infrastructure. Tedros Adhanom Ghebreyesus, the head of WHO, is also asking pharmaceuticals to share facilities.

I’m not sure how much companies can leverage each other’s facilities while they’re in the middle of figuring out how to increase production efficiency, but cajoling companies to cooperate in ways that optimize output without regard to profit is exactly what government should be doing during a pandemic. Here’s an example of the kind of problems pharmaceuticals are working out right now.

Example of scaling problems Covid-19 manufacturers face.

Since the US has managed to vaccinate over 10% of its population, I suppose that gives Americans the peace of mind to contemplate whether the world will reach Covid-19 herd immunity. Will Covid-19 go away this year? What about the new mutations?

After conversations with many friends about herd immunity, I’m finding it’s useful to review just what that term means.

The herd immunity threshold is the proportion of a population that need to be immune in order for an infectious disease to become stable in that community. If this is reached, for example through immunisation, then each case leads to a single new case (R=1) and the infection will become stable within the population.

HIT = (R0-1) / R0 , or 1 – (1 / R0)

If the threshold for herd immunity is surpassed, then R<1 and the number of cases of infection decreases.

Health Knowledge

The initial reproduction rate R0 for Covid-19 has been estimated between 1.4 and 3.9. That puts the Covid-19 herd immunity threshold between about 30% and 75%. In other words when somewhere between 30% and 75% of a community cannot transmit the virus either because they can’t get infected or because, if they do get infected, their case is too mild to propagate, the reproduction rate R drops below 1, thwarting community outbreak.

Given the new, more contagious strains from UK, South African, Brazil and California, the Covid-19 herd immunity threshold probably is closer to 75% and perhaps higher. Dr. Fauci has said he believes the US will achieve herd immunity somewhere between a 70% and 85% vaccination rate. Note that vaccines don’t have to be 100% effective at stopping infections in order to reduce transmission rates significantly and that Covid-19 transmission rates appear to be dropping in populations that have been vaccinated.

In spite of the great strides with vaccines, the scientific community is coming to a consensus that even though herd immunity is within reach, the Covid-19 is here to stay.

Even if [wealthy countries] are able to vaccinate large segments of their population by the end of 2021, the virus will keep circulating elsewhere and keep gaining mutations, eventually evolving so much that the original vaccines may become even less effective.

The Atlantic, “What If We Never Reach Herd Immunity?,” 9 February 2021.

Johnson & Johnson CEO Alex Gorsky concurs, saying Covid-19 is likely endemic and people will need annual Covid-19 vaccinations.

It looks like things will get back to some semblance of “normal” by Fall 2021. However, just as with other viruses like HIV, we’ll have to learn to live with Covid-19. Here are two great audio programs about what’s next with herd immunity and Covid-19 long haulers.

First, a great interview about using data to understand the pandemic. MIT trained data scientist Youyang Gu runs a site called Covid-19 Projections (now on the Resources Page). He provided US Covid-19 predictions through Fall 2020 and now is looking at what it will take for the US to achieve herd immunity. I commend his interview with Eric Topol at Medscape as a way of understanding how scientists developed an understanding of the infection and of its resolution.

Second, the long-term impact of Covid-19 after everyone gets vaccinated. Researchers are beginning to see long-term Covid-19 in the same light as diseases like Lyme’s disease. That is to say, there will be some percent of patients who have serious long-term health problems, from fatigue to heart damage. Here is an NPR interview with Eric Topol on the effects of Covid-19 on asymptomatic patients.

Covid-19 bits.

I’m going to end today with a chart Dr. Monica Gandhi from UCSF made. The yellow column is all you really need to know about the significance of Covid-19 vaccines.

Covid-19 vaccine chart. Source: Dr. Monica Gandhi.

I write this for my sanity and to keep a record of living during the Covid-19 pandemic. If you find it useful, please pass on to friends, colleagues, and family. More frequent Covid-19 updates on my Twitter feed.