COVID Transmissions for 2-12-2021

600 million US vaccine doses by July

Feb 12, 2021

Good morning and welcome to COVID Transmissions.

It has been 452 days since the first documented human case of COVID-19. That’s one day for every Fahrenheit degree of temperature it takes to ignite paper, if the paper is slightly wet.

Some headlines today that can give us—at least those of us in the US—an optimistic feeling going into the weekend.

Also, a reader comment that caught a mistake of mine and also made an interesting point.

As usual, bolded terms are linked to the running newsletter glossary.

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Now, let’s talk COVID.

The US government has contracted to purchase an additional 200 million doses of the RNA vaccines

President Biden announced yesterday that this deal has been made: https://www.nbcnews.com/politics/joe-biden/biden-administration-finalizes-deal-200-million-vaccine-doses-pfizer-moderna-n1257560

Apparently, this puts the US on track to have enough supply to be able to vaccinate 300 million people by July—that’s 600 million doses! That should be more than enough for every adult living in the US.

Anthony Fauci predicts April will see wide vaccine availability in the US

In a similar vein, Tony Fauci today predicted that by April the US will have enough vaccine supply to make it it “open season,” or in other words, available to everyone: https://www.latimes.com/california/story/2021-02-11/april-may-see-covid-19-vaccine-open-season-fauci-says

Based on these two stories, I feel like in the US, we might see the end of the pandemic arrive sometime between April and July, but that’s only if everyone does their duty and gets a vaccine. Without good vaccine uptake, we are inviting the virus to continue to proliferate and mutate in a way that could drag out the pandemic. Let’s not be the country that creates a true new strain by wasting the opportunity these vaccines present.

What am I doing to cope with the pandemic? This:

Cooking: Wings!

Yeah, I know, I probably should have shared this before the Super Bowl, but I didn’t want anyone to get any ideas that I was condoning having in-person Super Bowl parties.

Anyway, I keep kosher, and for quite some time, I’ve lamented how hard it can be to get a good chicken wing—particularly a Buffalo wing—from a kosher restaurant. IT’s very hit or miss. So I’ve taken to making my own.

Sometimes I bread and deep-fry them, which guarantees they’ll be crispy, or I just deep fry them without a coating, which lets them take sauces a little bit better. Last night I tried a different approach, though, because dealing with frying oil can be super annoying.

I seared the wings first, in a large skillet, on high heat in a little oil, until they were golden-brown on at least two sides. This wasn’t enough to cook them through, and they needed finishing in an oven at 400F for at least 20 minutes. The combination of searing on high heat followed by baking makes for nice, crispy skin that mimics what you might get out of a restaurant fryer.

Then, it’s easy enough to toss them in whatever sauce you want. I did half barbecue sauce and half buffalo, here:

Image shows two plates of wings, with two different sauces, on top of a wooden board with chopped celery and carrot sticks, and a ramekin of a creamy sauce.

Now, one other challenge is the traditional accompaniment for Buffalo wings, blue cheese dressing, is dairy, and you can’t mix that with meat in kosher cooking. To make up for that, I was able to find an egg-based creamy salad dressing. It’s not quite the same, but it did the job.

Speaking of that, traditional Buffalo sauce usually includes butter. I avoid that by using a premade product that has all the flavor but none of the dairy, sold under the Sweet Baby Ray’s brand. If you’re looking to replicate the above, that’s what you’ll need.

Carl Fink caught a mistake I made, but also had an interesting idea about masks:

That figure of 263 times greater reduction in viral load daily seemed implausibly high. If baseline reduction is 1%, then with interferon, it would be over 100% reduction, or to zero, in one day. If baseline reduction is not as high as 1%, placebo patients would need many months to recover. I'm also dubious about measuring daily reduction in viral genome count, because the underlying assumption there is that this number is constant, and it shouldn't be. As the immune system responds, it would start fairly low, but the rate would naturally increase as B-cells start pouring out antibodies and T-killer cells start multiplying.
I then searched the Lancet paper, and the number 263 does not appear in it. Typo?
The mask recommendations are missing a key thing: ratings for non-medical masks. I can buy any of a hundred "medical style" masks that look like surgical masks, but without actual regulated testing, I have no way to know their actual filtration ability, and without different testing I have no way to know how likely they are to fit tightly. Creating a rating system for this purpose would be one of the best things the FDA (or WHO) could do, in my opinion.

Yep, I misread the results there. Here’s the explanation:

Hi Carl--you're right, I misread the results here. The ultimate difference by day 7 was 263 times greater, which I read as a difference in daily change. Specifically, there was a difference of 2.42 logs between the two groups at day 7; 10^2.42 is approximately 263. I gave the strict factor because I did not think most folks are used to thinking logarithmically. I'll correct the newsletter regarding when this difference appeared--nice catch. It seemed strange to me too, to be honest, but I guess the language in the paper was a little confusing.
I agree with you that a rating system for masks and mask fabrics would be great.

Carl had another question for me, that was similar to one shared over email by someone else, so I wanted to share that too:

I don't know virology, but like any Heinlein reader[1] I have developed a decent ability to do orders-of-magnitude sanity checking of numbers. This one really seemed impossible.
The drug actually seems very promising. Very good news, if it pans out. Hey, question for our local Pharma Shill[2]: how expensive are interferon III drugs? Would this be like the monoclonal antibody things (thousands per dose) or like dexamethasone (very inexpensive) or in between (likely)?
[1]I know John through science fiction fandom. For non-fans, Robert A. Heinlein was an engineer turned SF writer, and a lot of engineer thinking can be found especially in his earlier work.
[2]"Pharma shill" is what conspiracy theory/natural medicine cultists call anyone who says a drug or vaccine actually works. Since cultists "know" that pharmaceuticals don't work, the person has to be lying, probably because they were bribed by the pharmaceutical industry. Obviously, I don't think John is lying, so that was a joke that I just ruined by explaining it.

Here are my thoughts on that:

Regarding [2], I used to call myself a "hired gun in the drug world" when I was a consultant, so I take that in the spirit you intended :) I guess now that I'm a permanent headquarters employee I'm a high-level lieutenant in a drug organization.
The order of magnitude calculations in virology are always interesting. Sometimes you do see really staggering numbers, so while this seemed odd to me it wasn't completely implausible enough for me to give it the fourth read it would have taken to catch the error. I'm glad you did, though.
Regarding the cost of delivery, I can't be *too* sure, but I do think that it would perhaps be a bit cheaper than monoclonal antibodies for a few reasons. (1) I don't think IFN lambda has substantial essential post-translational modifications, so it may be something that can be synthesized in a recombinant bacterial system rather than in a eukaryotic hybridoma system like antibodies typically require. Right there, there's a substantial savings in the complexity and finickyness of the bioengineering. (2), it might be possible to lyophilize the peg-IFN-lambda, which would help make it more shelf stable. Currently the REGN-COV2 polyclonal cocktail is delivered as a refrigerated suspension, I believe. So there's a potential logistics savings there too. (3) antibodies are usually delivered by infusion, so you need an infusion specialist or other highly skilled technical medical professional to deliver them; the IFN-lambda preparation used here was a subcutaneous injection, and might even be able to be loaded into an autoinjector, so the skill and infrastructure level required will be lower. The IFN-lambda might be something your primary care provider can easily deliver, while the monoclonal preparation might not be (this also depends on how sophisticated or PCP's office is, so I'm using a lot of qualifiers).
Anyway I do think this will be cheaper than an antibody drug for a variety of reasons, if it does pan out. I would expect it to be more on par with insulin or pegylated-IFN-alpha in its costs, and if I'm not mistaken both of those are in the hundreds of dollars per dose in the US at least. Not that that's a bargain either, but it is less.

You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.

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