1) The horse race in the U.S. continues between the vaccinations, which are going well, and rising COVID-19 cases, driven by some combination of virus variants, policies (many states are loosening restrictions), and behavior.

I continue to remain optimistic that we’re going to win this race, but I wish people would be patient just for another couple of months!

Here’s the latest chart on vaccinations, showing that we’re now averaging more than three million doses administered per day, with some days exceeding four million, both all-time highs (source):

This chart shows that the positivity rate rose in late March from 3.9% to 4.8% (a 23% increase), but has stabilized there (source):

Lastly, cases and hospitalizations are flat, while deaths continue to fall, now averaging fewer than 800 per day, the lowest since October (source):

2) In light of this mostly good news, why can’t we all rip off our masks and go back to normal? One answer is: look at Chile. As you can see from this chart (source), it’s one of the few countries in the world outpacing the U.S. in vaccinating its citizens:

In spite of this, however, Chile is getting hammered by a resurgence of the virus, as you can see in this chart (source):

How could this be happening? This article explains: Despite Chile’s Speedy Covid-19 Vaccination Drive, Cases Soar. Experts say Chile’s government eased restrictions on travel, business and schools much too early, creating a false sense of confidence that the worst of the pandemic was over. Excerpt:

Having negotiated early access to tens of millions of doses of Covid-19 vaccines, Chile has been inoculating its residents faster than any other country in the Americas and appears poised to be among the first in the world to reach herd immunity.

But experts say the country’s speedy and efficient vaccination drive — only Israel, the United Arab Emirates and Seychelles have vaccinated a larger share of their populations — gave Chileans a false sense of security and contributed to a sharp spike in new infections and deaths that is overloading the health care system.

The surge in cases, even as more than one-third of Chile’s population has received at least the first dose of a Covid-19 vaccine, serves as a cautionary tale for other nations looking to vaccination drives to quickly put an end to the era of beleaguered economies, closed borders and social distancing. The rise in cases prompted a new set of strict lockdown measures that have restricted mobility for much of the country, affecting nearly 14 million people.

“When transmission rates are high, the vaccine does not rein in new infections right away,” said Dr. Denise Garrett, an epidemiologist at the Sabin Vaccine Institute in Washington. “And with the new variants, which are more contagious, we’re not likely to see a big impact until the vast majority of the population is vaccinated.”

Sound familiar???

3) Another reason not to declare victory and get complacent quite yet is the rise of the B.1.1.7 variant, which is now dominant in the U.S.: More Contagious Virus Variant Is Now Dominant in U.S., C.D.C. Chief Says. Excerpt:

A highly infectious variant of the coronavirus that was first identified in Britain has become the most common source of new infections in the United States, the director of the Centers for Disease Control and Prevention said on Wednesday. The worrisome development comes as officials and scientists warn of a possible fourth surge of infections.

Federal health officials said in January that the B.1.1.7 variant, which began surging in Britain in December and has since slammed Europe, could become the dominant source of coronavirus infections in the United States, leading to a huge increase in cases and deaths.

At that point, new cases, hospitalizations and deaths were at an all-time high. From that peak, the numbers all declined until late February, according to a New York Times database. After several weeks at a plateau, new cases and hospitalizations are increasing again. The average number of new cases in the country has reached nearly 65,000 a day as of Tuesday, concentrated mostly in metro areas in Michigan as well as in the New York City region. That is an increase of 19 percent compared with the figure two weeks ago.

Dr. Rochelle Walensky, the C.D.C. director, who warned last week that she felt a recurring sense of “impending doom,” said on Wednesday that 52 of the agency’s 64 jurisdictions — which include states, some major cities and territories — are now reporting cases of these so-called “variants of concern,” including B.1.1.7.

The number of deaths, however, continue to decline — potentially a sign that mass vaccinations are beginning to protect older Americans and other highly vulnerable populations.

“These trends are pointing to two clear truths,” Dr. Walensky said. “One, the virus still has hold on us, infecting people and putting them in harm’s way, and we need to remain vigilant. And two, we need to continue to accelerate our vaccination efforts and to take the individual responsibility to get vaccinated when we can.”

Here’s a chart from the front page of today’s NY Times that shows how the B.1.1.7 variant has become dominant in four states:

4) This article nicely lays out why we’re likely to avoid a fourth wave – if we act sensibly: The Fourth Surge Is Upon Us. This Time, It’s Different. A deadlier and more transmissible variant has taken root, but now we have the tools to stop it if we want. Excerpt:

We appear to be entering our fourth surge.

The good news is that this one is different. We now have an unparalleled supply of astonishingly efficacious vaccines being administered at an incredible clip. If we act quickly, this surge could be merely a blip for the United States. But if we move too slowly, more people will become infected by this terrible new variant, which is acutely dangerous to those who are not yet vaccinated.

…The solution is obvious and doable: We should immediately match variant surges with vaccination surges that target the most vulnerable by going where they are, in the cities and states experiencing active outbreaks—an effort modeled on a public-health tool called “ring vaccination.” Ring vaccination involves vaccinating contacts and potential contacts of cases, essentially smothering the outbreak by surrounding it with immunity. We should do this, but on a surge scale, essentially ring-vaccinating whole cities and even states.

A vaccination surge means setting up vaccination tents in vulnerable, undervaccinated neighborhoods—street by street if necessary—and having mobile vaccination crews knock on doors wherever possible. It means directing supply to places where variants are surging, even if that means fewer vaccine doses for now in places with outbreaks under control. It doesn’t make sense to vaccinate 25-year-olds in places with very low levels of circulation before seniors and frontline workers in places where there is an outbreak.

Another sensible step would be to delay opening up—especially places with surges and especially for high-risk activities that take place indoors—until the next 100 million Americans are vaccinated, which could be done as quickly as in a single month. It makes no sense to rush to open everything now, when waiting a few weeks could protect so many. In the meantime, we need to protect frontline and essential workers by providing high-filtration masks and paid sick leave while targeting their workplaces with vaccination campaigns. We have already asked so much of them, and they have already suffered so much.

I understand the impatience with restrictions—I’m fed up and tired, too—but our restlessness risks creating one last set of victims who could easily be spared. We should not condemn anyone to be the last person to die unnecessarily in a war that we will win, and shortly. The vaccinated can clearly do more, and safely, especially two weeks after their final dose. But it’s a particularly perilous time for the unvaccinated, who deserve our attention, resources, and continued mitigation measures as appropriate.

5) Our rapid rollout of astonishingly effective vaccines are the main reason I’m cautiously optimistic that we’re not on track to follow in Brazil’s tragic footsteps (which I discuss below). But this could all be derailed if the nutty anti-vaxxers are successful in convincing large numbers of Americans not to get vaccinated. To their everlasting shame, they’re doing their best to frighten and mislead us, as this Bloomberg article documents:

A battle cry against vaccines

In October 2020, a who’s who of the the anti-vaccine movement gathered for a virtual conference. Speaker after speaker hit on the same point: The pandemic provided the perfect opportunity to expand the movement—and they didn’t plan to waste it.

In the eighth month of the global pandemic, it was clear the activists had found their moment: The world had never been more receptive to their message.

In the fourth episode of “Doubt,” a new series from the Prognosis podcast that explores vaccine hesitancy, we look at how anti-vaccine extremists have used the pandemic to enlarge their base.

For years, those opposing vaccines had argued that safety issues with vaccines are too often ignored by manufacturers and government regulators who they believed were in league to rush out vaccines for their own gain. Then, suddenly, mainstream scientists were among those arguing a Trump-sponsored vaccine was getting hurried out the door, perhaps too quickly, in time for Election Day.

That month, then-vice presidential candidate Kamala Harris expressed her own skepticism of a Trump-ordered vaccine. Suddenly, confidence in the vaccine dropped significantly among Democrats .

“All of the truths we’ve been trying to broadcast for many, many years—there are people hearing it and the impact and all the seeds are landing on very fertile ground,” Robert F. Kennedy Jr., of the leaders of the anti-vaccine movement, said at the conference.

Kennedy ended his talk with a battle cry.

“Let’s go to war,” he said.

A report by the Center for Countering Digital Hate, or CCDH, says that the roughly 150 leading anti-vaxx social media accounts gained more than 10 million followers, mostly on Instagram and YouTube, between 2019 and December 2020.

Since then, platforms have taken steps to curb misinformation, including removing some of the movements biggest names. Kennedy, the nephew of President John F. Kennedy, was kicked off Instagram in February.

Kennedy responded on his organization’s website that, “Facebook, the pharmaceutical industry and its captive regulators use the term ‘vaccine misinformation’ as a euphemism for any factual assertion that departs from official pronouncements.”

Alternative-health purveyors and QAnon conspiracy theorists, meanwhile, have joined in, as have more and more people concerned about government overreach.

The CCDH says these groups have organized themselves around a master narrative: Covid isn’t dangerous, the vaccine is dangerous and vaccine advocates can’t be trusted.

All of that, of course, is false. But the reality of how vaccines were developed so quickly—mRNA technology already had been under study for years before massive government funding and global research accelerated its progress—is more complicated than the simplistic conspiracy theories anti-vaccine groups are pushing.

“Their message is getting through,” says Imran Ahmed, the head of the CCDH. “We’ve been naive as a society in not understanding that there is an organized opposition.”

6) The best article I’ve read the thoroughly rebuts the anti-vaxxer nonsense is this one: The Pandemic’s Wrongest Man. In a crowded field of wrongness, one person stands out: Alex Berenson. Excerpt:

In this crowded field of wrongness, one voice stands out. The voice of Alex Berenson: the former New York Times reporter, Yale-educated novelist, avid tweeter, online essayist, and all-around pandemic gadfly. Berenson has been serving up COVID-19 hot takes for the past year, blithely predicting that the United States would not reach 500,000 deaths (we’ve surpassed 550,000) and arguing that cloth and surgical masks can’t protect against the coronavirus (yes, they can).

Berenson has a big megaphone. He has more than 200,000 followers on Twitter and millions of viewers for his frequent appearances on Fox News’ most-watched shows. On Laura Ingraham’s show, he downplayed the vaccines, suggesting that Israel’s experience proved they were considerably less effective than initially claimed. On Tucker Carlson Tonight, he predicted that the vaccines would cause an uptick in cases of COVID-related illness and death in the U.S.

The vaccines have inspired his most troubling comments. For the past few weeks on Twitter, Berenson has mischaracterized just about every detail regarding the vaccines to make the dubious case that most people would be better off avoiding them. As his conspiratorial nonsense accelerates toward the pandemic’s finish line, he has proved himself the Secretariat of being wrong:

He has blamed the vaccines for causing spikes in severe illness, by pointing to data that actually demonstrate their safety and effectiveness.

He has blamed the vaccines for suppressing our immune systems, by misrepresenting normal immune-system behavior.

He has suggested that countries such as Israel have suffered from their early vaccine rollout, even though deaths and hospitalizations among vaccinated groups in Israel have plummeted.

He has implied that for most non-seniors, the side effects of the vaccines are worse than having COVID-19 itself—even though, according to the CDC, the pandemic has killed tens of thousands of people under 50 and the vaccines have not conclusively killed anybody.

Usually, I would refrain from lavishing attention on someone so blatantly incorrect. But with vaccine resistance hovering around 30 percent of the general population, and with 40 percent of Republicans saying they won’t get a shot, debunking vaccine skepticism, particularly in right-wing circles, is a matter of life and death.

The article concludes:

The idea that the vaccine is worse than the disease for the under-70 crowd falls apart utterly when we consider the “side effect” of death. Roughly 100,000 people under 65 have died of COVID-19. Meanwhile, out of more than 145 million vaccines administered in the U.S., a CDC review of clinical information found no evidence that they had caused any deaths. The current score in the competition between non-senior pandemic deaths and conclusive vaccine deaths is 100,000–0.

One hundred thousand to zero. That might be the most important statistic in this whole mess. Berenson doesn’t tweet blatantly falsifiable statements about the vaccines every day. For the most part, he peddles doubt, laced with confusing and expert-sounding jargon, which may seem compelling at first but can’t survive contact with expert opinion.

To be honest, I initially had serious doubts about publishing this piece. The trap of exposing conspiracy theories is obvious: To demonstrate why a theory is wrong, you have to explain it and, in doing so, incur the risk that some people will be convinced by the very theory you’re trying to debunk. But that horse has left the barn. More than half of Republicans under the age of 50 say they simply won’t get a vaccine. Their hesitancy is being fanned by right-wing hacks, Fox News showboats, and vaccine skeptics like Alex Berenson. The case for the vaccines is built upon a firm foundation of scientific discovery, clinical-trial data, and real-world evidence. The case against the vaccines wobbles because it is built upon a steaming pile of bullshit.

7) Pretty much every aspect of responding to the pandemic has, tragically, become politicized, from whether we should worry about the pandemic at all, to steps to slow/eradicate it (lockdowns, mask wearing, etc.), vaccines, vaccine passports, etc.

Truly the stupidest debate is over mask wearing – not because it’s a “magic bullet” (it’s not), but because the cost is so low. In response to those who think it impinges on their freedom, someone named Libby Jones tweeted this beautiful response:

Welcome to the Freedom Cafe!

We trust you to make your own choices if you want to wear a face mask. And, in the same spirit of individual liberty, we allow our staff to make their own choices about the safety procedures they prefer to follow as they prepare and serve your food.

We encourage employees to wash their hands after using the bathroom, but understand that some people may be allergic to certain soaps or may simply prefer not to wash their hands. It is not our place to tell them what to do.

We understand that you may be used to chicken that has been cooked to 165 degrees. We do have to respect that some of our cooks may have seen a meme or a YouTube video saying that 100 degrees is sufficient, and we do not want to encroach on their beliefs.

Some of our cooks may prefer to use the same utensils for multiple ingredients, including ingredients some customers are allergic to. That is a cook’s right to do so.

Some servers may wish to touch your food as they serve it. There is no reason that a healthy person with clean hands can’t touch your food. We will take their word for it that they are healthy and clean.

Water temperature and detergent are highly personal choices, and we allow our dishwashing team to decide how they’d prefer to wash the silverware you will put in your mouth.

Some of you may get sick, but almost everyone survives food poisoning. We think you’ll agree that it’s a small price to pay for the sweet freedom of no one ever being told what to do – and especially not for the silly reason of keeping strangers healthy.

8) Some great news, especially for developing countries: Researchers Are Hatching a Low-Cost Coronavirus Vaccine. Excerpt:

A new vaccine for Covid-19 that is entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic. The vaccine, called NVD-HXP-S, is the first in clinical trials to use a new molecular design that is widely expected to create more potent antibodies than the current generation of vaccines. And the new vaccine could be far easier to make.

Existing vaccines from companies like Pfizer and Johnson & Johnson must be produced in specialized factories using hard-to-acquire ingredients. In contrast, the new vaccine can be mass-produced in chicken eggs — the same eggs that produce billions of influenza vaccines every year in factories around the world.

If NVD-HXP-S proves safe and effective, flu vaccine manufacturers could potentially produce well over a billion doses of it a year. Low- and middle-income countries currently struggling to obtain vaccines from wealthier countries may be able to make NVD-HXP-S for themselves or acquire it at low cost from neighbors.

“That’s staggering — it would be a game-changer,” said Andrea Taylor, assistant director of the Duke Global Health Innovation Center.

First, however, clinical trials must establish that NVD-HXP-S actually works in people. The first phase of clinical trials will conclude in July, and the final phase will take several months more. But experiments with vaccinated animals have raised hopes for the vaccine’s prospects.

“It’s a home run for protection,” said Dr. Bruce Innes of the PATH Center for Vaccine Innovation and Access, which has coordinated the development of NVD-HXP-S. “I think it’s a world-class vaccine.”

9) The new low-cost vaccine may come too late to help Brazil, which has the world’s second-greatest number of COVID cases and deaths, after only the U.S. But, unlike the U.S., it’s going in the wrong direction right now, with daily deaths exceeding 4,000 on Tuesday for the first time:

Here’s a Bloomberg article on the disaster unfolding there:

While most of the world pushes vaccinations and gets back to business, the pandemic has taken a scary turn in Brazil.

It’s not surprising that the South American nation, home to 212 million people and rife with income inequality, would have high numbers of infections. Last year it emerged as a global hot spot, ranking second in cases and deaths.

But the savageness of this new wave seems different. Patients are younger, and they are getting sicker. If at last year’s peak many still didn’t know anyone who had been infected, now every conversation seems to include mention of a friend or relative who’s ill, in search of a hospital bed or has died. In March the daily death record was 1,972. Now it’s 4,195.

It’s been hard to keep track of so many grim milestones reached and then surpassed in such a short span. Every new mark fuels hopes that the ensuing outrage will spark change: Vaccinations will speed up, people will respect social-distancing orders. And yet, not much happens.

Mask-wearing is still by no means the rule, and local news is packed with images of parties. Officials continue to publicly bicker over what to do, and President Jair Bolsonaro hasn’t changed his Trump-like stance that the economic toll of lockdowns is worse than the virus.

There’s some good news, though. The government has resumed cash handouts, which should help ease the economic blow, and Brazil recently administered 1 million vaccines a day as pledged by the health minister—the fourth to occupy the post in a year.

But it’s unclear if the progress is sustainable. There’s only so much money in government coffers, and expectations of how many doses will be available in the short term keep getting cut. It could be months before Brazil finishes immunizing even priority groups.

So while vaccines remain unavailable to most, the virus keeps spreading, boosted by a low adherence to social distancing—either because of quarantine fatigue or simple economic need—and a more contagious variant that emerged in the Amazon rain forest and has since spread.

Fiocruz, a renowned local health institution, said the virus is still “intensely circulating.” High rates of contagion mixed with overwhelmed hospitals have caused the mortality rate to jump to 4.2% from 2% in late 2020. All that signals a difficult month ahead for Brazil.

Hmmmm… An authoritarian leader who downplays the virus, ignores the advice of public health experts, resists steps to increase social distancing, mocks mask wearing, etc. Sound familiar???

Is it any wonder that, among large countries (population 12 million or more), the deaths/million rankings are as follows:

1) UK: 1,862

2) Italy: 1,861

3) U.S.: 1,723

4) Spain: 1,626

5) Peru: 1,612

6) Brazil: 1,596

7) Mexico: 1,582

8) Poland: 1,498

9) France: 1,495

10) Romania: 1,292

(I’ll bet Brazil’s current death toll is significantly understated and, in light of current trends, that the country be much higher on this list by the time the pandemic is over…)

10) Lastly, here are some other articles of interest:

Best regards,

Whitney