31 January 2021 – Sunday – #132

Here’s a sample of how Barcelona is suffering during the current Covid-19 restrictions.

Barceloneta beach, 29 January 2021. Low mask compliance on the beach.

This is actually my contribution to Covid-19 misinformation. The photo does not present a typical January day in Barcelona. The weather most of this month has been cloudy and in the single digits (centigrade), so a representative January photo would show an empty beach with a few bundled up souls walking along its border. At the end of last week, though, Mother Nature gave the city a glimpse of the warm beach days that lie ahead.

So, maybe this image isn’t misinformation. Maybe it’s kind of a metaphor. January was not only a stormy month for weather in Barcelona, but also a stormy month for Covid-19 everywhere. It’s not just that the world surpassed 100,000,000 Covid-19 cases. The world’s economies are sick, too. But In the middle of the worst of Covid-19, the world is getting glimpses that better days are ahead, glimpses that Covid-19 vaccines will help both the world’s bad health and its faltering economies.

The US economy had its worst year since WWII, shrinking by 3.5%. There’s no question Covid-19 caused the downturn and no question why President Biden is focused on vaccinations.

“There’s nothing more important to the economy now than people getting vaccinated.”

US Federal Reserve Chairman Jerome Powell

Things were even worse in Spain where the 2020 economy contracted 11%. Covid-19 decimated Spain’s economy in the worst pull back since its Civil War. Because tourism made up nearly 10% of Spain’s economy in 2019, it’s easy to understand the why the 2020 contraction here is so severe compared to the US.

Parenthetically, it’s nice to use decimate in its original sense, to reduce by one tenth.

The good news? Fourth quarter 2020 US results showed growth of 4%, indicating that a properly stimulated world economy is poised to come back strong. The most recent survey from the National Association for Business Economics, for instance, shows optimism in US businesses for healthy growth this year. According to the survey, “69% of panelists [are] expecting GDP to expand by 3.0% or more.”

On the other hand, there is a lot of risk in this predicted economic growth. The pandemic has thrown global supply chains into disarray. During the initial lockdowns last year, trade slowed dramatically. By summer, unpredictability in consumer demand drove unpredictable demand for shipping containers. Work-at-home consumers needed fewer fashions and more computers. In the confusion, container prices have risen as availability dropped, leading to shipping inflation.

At virtual Davos World Economic Forum, bankers said remote work is fraying corporate culture. They were both impressed at how well staff improvised remote work processes last year and concerned whether their at-home organizations will become less effective this year.

“It will increasingly be a challenge to maintain the culture and collaboration that these large financial institutions seek to have and should have.”

Barclays Chief Executive Jes Staley

Then there’s the vaccination forecast risk, the promise that vaccines will restore health this year. Optimistic 2021 economic growth assumptions rely on vaccines to quell Covid-19 outbreaks. The forecasts may end up being correct, but things aren’t off to a great start. There are three big risks. One is whether the world can make enough vaccine, another is the best way to prioritize it until everyone gets their shots, and now, with a plethora of infections driving more mutations, we have to wonder if the virus will obsolete the vaccines.

How bad was Trump’s US Covid-19 vaccine distribution plan? Two weeks after Trump left office, it’s clear he didn’t have one. As a result, vaccine has been going to richer neighborhoods with low infection rates instead of poorer neighborhoods with high infection rates. The evidence in Eric Feigl-Ding’s thread is clear.

Twitter thread about Covid-19 vaccine distribution in US.

The vaccination problems in Spain have been due to reductions in vaccine supply rather than misallocation. Catalonia’s mid-month drop in vaccinations was, as I noted last week, due to supply problems at Pfizer and Moderna. With both those companies ramping up production again, the wild card in Europe right now is AstraZeneca, which just got European approval for its two-dose viral vector vaccine, but already appears far behind on its supply commitments for next month.

Percentage of Catalonia population with first and second doses of Covid-19 vaccine. Source: Catalan News.

The problem with supply unpredictability is that local public health authorities have to speculate on how many doses to allocate for first shots so there will be enough for second doses. In the chart above, it’s clear that first doses of Covid-19 vaccines have slowed down since mid-January, first as CatSalut, Catalonia’s public health authority, managed supply reductions and then, when more supplies arrived, as it prioritized timely second doses.

The world doesn’t need to have vaccine shortages at all. If we re-worked patent law and changed the risk-reward structure of the pharmaceutical industry, we could leverage worldwide manufacturing to produce lots and lots of vaccine right now. This is yet another good example of the problem of relying on existing free market capitalism infrastructure during a pandemic. We’re protecting $US billions of profits of individual firms at the expense of both millions of lives and $US trillions of worldwide GDP.

While it’s great to have the Moderna and Pfizer / BioNTech vaccines in arms, more vaccines would help smooth supply and diversify risk as Covid-19 mutates. Both US approved vaccines use mRNA technology, a new technology that is running into scaling problems in manufacturing.

[Patrick Boyle, an R&D executive at Ginkgo Bioworks,] singles out polymerases, a type of enzyme, that convert DNA to mRNA and ingredients used for making lipid nanoparticles as some of the most critical raw materials for the vaccines. He also says manufacturers need better access to a rare substance called vaccinia capping enzyme (VCE), which helps keep the mRNA from degrading and gives it a deceptively human appearance to prevent cells’ protein-making machinery from rejecting it. Boyle’s team has calculated that making the 10 pounds of VCE needed to generate 100 million mRNA vaccine doses would overwhelm the limited capacity of bioreactors (containers used to carry out biochemical reactions) and cost $1.4 billion.

Scientific American, “New COVID Vaccines Need Absurd Amounts of Material and Labor,” 4 January 2021.

What other Covid-19 vaccines are in the works? Unfortunately, Merck’s two viral vector vaccines candidates did so poorly in trials that early last week it shut down development entirely and will turn its attention to Covid-19 treatments.

However, by the end of last week, as I was taking photos at the sunny Barceloneta beach, Novavax and Johnson & Johnson announced good results in their phase 3 trials. Both vaccines have mundane refrigeration requirements and well-understood production processes compared to the new mRNA vaccines.

Novavax announced its recombinant protein technology was 89% effective in its Covid-19 vaccine trial. The effectiveness dropped to 60% in South Africa where 90% of cases are the new South African strain of Covid-19. Effectiveness in South Africa dropped more, to 49%, for participants with HIV. The company may need more study results before applying for regulatory approvals.

The J&J Covid-19 vaccine is a one-dose viral vector technology. While its 72% overall effectiveness may seem low compared to other vaccines, whose effectiveness was measured between 89%-95%, no study participants in the J&J trial died or required hospitalization after four weeks of building immunity.

That suggests that while less effective vaccines don’t completely protect against Covid-19 cases, they significantly reduce Covid-19 morbidity and mortality. J&J is studying how much additional protection a booster may provide.

There are many other Covid-19 vaccine candidates from pharmaceutical companies in India and China. Unfortunately, there still is not enough data reported to know how well any of these works. If countries like UAE, which is rolling out at least three different vaccines, collect useful data, it may inform regulators elsewhere about the effectiveness of these vaccines.

AstraZeneca published enough results to win approval in UK and EU last week, but needs to re-run its trial for US approval. As mentioned above, it already has run into production problems and won’t deliver as promised in Europe next month.

Part of the reason Novavax and J&J vaccines may have measured lower effectiveness is that they were tested later than the mRNA vaccines, when there were more strains of Covid-19 in circulation.

New strains of Covid-19 emerging in UK, South Africa, California, and Brazil call into question whether virus virulence will outpace vaccine effectiveness. Moderna has seen the effectiveness of its Covid-19 vaccine drop from 95% to somewhere between 80%-90% against the South African strain of Covid-19. 80%-90% is still good, but may provide fodder to anti-vaccine messaging, something along the lines of, hey, wait for the really good vaccine. While Moderna is working on a third booster shot specifically for this strain, it’s important to point out that 80%-90% is plenty good enough to stop the pandemic.

The uncertainty created by the South African strain is likely to repeat with emerging strains as long as worldwide infection rates are high. For instance, the new Covid-19 strain detected in Manaus, Brazil appears to transmit 3x faster than the UK variant and may be responsible for excess mortality levels in the Amazon city that are significantly higher than excess mortality levels elsewhere.

The uncertainty of vaccine effectiveness will repeat with each new strain. Messaging will get muddled. The important point is that, regardless of strain, even some protection will reduce morbidity and mortality.

This brings me to another problem, the messaging about and reporting on Covid-19 vaccines. J&J stock plunged after it announced its vaccine trial results, presumably because it didn’t meet the 90%-95% effectiveness of the mRNA vaccines. But if all we had was enough J&J vaccine to give everyone in the world one dose, the worst case would be that the Covid-19 pandemic effectively would be over with a smattering of mild cases here and there.

Here’s an excellent thread on the implications of Covid-19 mutations for both vaccines and treatments.

Kai Kupferschmidt thread on how Covid-19 mutations may require adjustments to vaccines and treatments.

Here’s another good thread on why letting a virus run wild is such a bad idea (lots of death, lots of mutations) and why vaccinating everyone in the world is all that matters (no more deaths, no more severe cases, no mutation that shuts down the world again).

Finally, here’s a good report from California last week on how the Biden team is ramping up Covid-19 vaccine administration once supplies come online. FEMA will set up 100 vaccination centers and has requested 10,000 soldiers to staff these centers.

The real problem is that Covid-19 vaccination programs should have geared up six months ago and on a worldwide basis. Vaccinating the US population is a good thing, but if the rest of the world doesn’t get vaccinations, new Covid-19 strains may require new rounds of masking, lockdowns, and vaccinations. Turns out we’re all in this together.

A reminder: we don’t need vaccines to stop Covid-19. Masks, distancing, and hand washing still works. Containment is still important to not only save lives, but to reduce mutations. In fact, China and Taiwan, two countries that contained Covid-19, had positive economic growth in 2020. Covid-19 containment pays off.

We are not out of the woods with vaccines yet, but there is more than a glimmer of hope.

Covid bits.

Remember to wash your hands, keep your distance, and wear a mask. Actually, make that two masks. Experts now are recommending two masks to counter new strains of Covid-19 that are much more contagious and, in some cases, more deadly.

Let’s try that again.

Remember to wash your hands, keep your distance, and wear TWO masks.

Today I’m ending with Caitlin Doughty’s look at Covid-19 in LA. You might know Doughty for her Ask a Mortician channel on Youtube. Here she explains how skyrocketing deaths have affected the funeral business and suggests what the government do to help.

I write this to share a record of living during the Covid-19 pandemic. If you like it, please send a link to friends and family. For more frequent Covid-19 updates, follow me on Twitter.

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