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.

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