1/ Covid (@UCSF) Chronicles, Day 268
Today was Pfizer Vaccine Day @US_FDA, and the expert panel just recommended EUA approval https://tinyurl.com/y5u84jmx Next: FDA deliberates, but expect an EUA in next 1-2 days. As with All-Things-Covid, nothing is easy; now the hard part begins.
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2/ Today: quick state of the pandemic, then potpourri of vaccine-related stuff. SF still in our first true surge.
@ucsfhospitals 39 Covid pts, 10 on vents (Fig). Test pos 11.9% in symptomatic pts, 1.6 in asymptomatics, both way up. In SF, cases now 181/d (vs ~30/d last mth)…pic.twitter.com/1gkrSWVMGd
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3/ …& 129 Covid pts in SF hospitals (vs ~25 last mth; Fig). Luckily, deaths have not yet ticked up: 165, still lowest rate in U.S. But with this many people in ICUs, more deaths can’t be far behind. SF test positivity rate is 3.4%, rising but still well below CA’s rate of 8.8%.pic.twitter.com/LKAfO7QCIU
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4/ Nationally: surges everywhere. Midwest cooled a bit but now heating up again (Fig). Any Thanksgiving effect should be evident by now – yet curves haven’t changed much. I think we ARE seeing an effect: 6-8 wks into a surge, media coverage, stern warnings by health officials...pic.twitter.com/kyp4Uq6hXH
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5/ …& various flavors of shutdown would normally result in sharp fall in cases/hospitalizations. The fact that our surges are continuing unabated is due to Thxgiving. Expect same for X-mas; it might not cause a "surge" but will prevent the current one from ending before January.
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6/ Now to vaccines: so much to chew on!
@NEJM fig below is striking: it shows not only the breathtaking effectiveness of Pfizer vaccine, but also that vaccine starts working ~10d after first dose. Expect a lot of talk re: if this means that a one-dose vaccine regimen would be OK.pic.twitter.com/MZuhaEQER5
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7/ Little doubt that 2 doses is optimal, since overall efficacy after one dose seems to be in the 50-85% range. Two doses gets you to 95%, and also likely to more durable immunity. But this thread by
@zeynep captures the pragmatic macro-level question https://tinyurl.com/y5am4kvs …4 replies 3 retweets 59 likesShow this thread -
8/ …namely, given a vaccine shortage, would a 1-dose regimen (which doubles amount of available vaccine) have a positive tradeoff at a societal level. Nobody’s done a detailed risk-benefit analysis or the relevant studies to answer question of 1 dose vs. 2, but it's obvious…
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9/ …that 1 dose would allow more people to be vaccinated sooner, at the price of some loss of efficacy. For now, we should embrace the 2-dose regimen (which is what the FDA will approve); personally, I want 2 doses when it's my turn. But this deserves a detailed analysis, ASAP.
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At a minimum, shouldn't we quickly launch a trial for single-dose—at least for <65? (Age cut-off based on phase II data). Why we aren't doing more trials? Expense should be little barrier since this is already so costly. I wrote up the case for that:https://zeynep.substack.com/p/vaccines-and-decision-making-with …
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