there isn't a lot of transparency or accountability in the vax rollout at federal/state/local level, but the US does have enough vax doses to effectively end the pandemic in 45-60 days. here's why, key metrics to observe, and a reminder on how we can do it...
today, pfizer CEO reported producing 70M vax doses as of 12/31 & another 33M doses since start of the year = 103M doses in total! they're making ~100M per month & have reportedly already handed over ~70M doses to Fed govt.…
we have a lot of doses and we don't need to vaccinate everyone to end the pandemic...

fewer people able to transmit the virus (due to infection or vaccination) = fewer new cases/day = cases eventually go to 0 and pandemic ends. goal is reproductive rate (R) < 1.0 ASAP
to get R<1 you don't need to vax everyone, you just need to vax enough ppl. + don't need everyone to receive 2 doses. 1 dose reduces infection/transmission by 52%. thus, if enough ppl get 1 dose, pandemic can end. 1M ppl w one dose = ~500k ppl w 2 doses.…
if we stop thinking about the individual benefit of vax and recognize the group benefit, it's clearer how this gets done. MORE PPL vaccinated FASTER = the pandemic ends faster.

less focus on tiering, more focus on speed

so, how many doses are needed?
seroprevalence studies show 14% of US pop infected as of 11/15. 250k avg new reported cases/day since then, likely missing 2/3 cases, so ~45M new cases = likely 25-35% of US pop has been immunized through infection, as of today.…
some studies estimate we need 67% of US pop immune to achieve R<1 w back-to-normal behavior. thus, we need an add'l 100M ppl (~35% of US) fully vaccinated = ~200M doses…
Fed govt has already received 70M, Pfizer+Moderna delivering ~100M/mo. by feb 28, should have enough doses to immunize enough ppl to let America return to normal as pandemic winds down.

we have doses needed. issue is speed. how fast can we deliver?
given we don't currently have a functioning Federal govt, States are being asked to vaccinate. many are passing doses to local govt, who are asking local doctors/hospitals to administer. hospitals already overburdened. local govt not setup to do this work. it's a mess.
states should take responsibility for last mile delivery. alternative approach, which can be administered by states:
if states took responsibility for delivery (through local sites), supply chain would look like this:
Pfizer->Fed Gov->State Gov->People

provided the delivery rate of State Gov->People is the same as delivery rate of Pfizer->Fed Gov, we can deploy 200M doses in 45-60 days
Pfizer->Fed Gov is 100M/mo or 3M/day

this dose rate, roughly 1% of US population per day, is what's needed to keep up w supply of vax. thus, each state needs to deliver doses to 1% of their population/day. ex. CA needs to be at 400k/day (CA currently targeting ~100k/day)
each state should publish their daily throughput + target, by state and site.

it's also critical that Fed Govt->State Govt achieves 3M doses/day delivered w inventory time <5 days. this should be reported daily, by state.

& states should report delivery to local sites, by day
this approach is a simple framework for top-level goals that can be used to get this done as fast as possible. we can start from these goals - 1% of the population vax/day - to back into how many sites needed + ppl vax'd/day/site.
in SF, for example, we need 8k ppl vax'd/day. assuming 20 vaccinations/hr/nurse, we only need 20-40 nurses (or trained volunteers) working rotating shifts 24/7 to get this done in SF.
residents deserve to know/see where and how this will be done. a specific plan for number of sites, # ppl injecting at each site, and how that allows turnaround times to get 1% of population vax'd/day
we know what we need to achieve. we have the supply to achieve it. with some planning and dedicated execution, we can end this miserable pandemic and return to normal in March. now is the time for govt leaders to step up, be transparent, and be accountable. let's go.

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More from @friedberg

9 Jan
The Pandemic War is an actual war we must fight and win. the virus is surging, and evolving. we must surge back, and evolve faster than the virus. here's my proposed plan and analysis...
first, in general, perfect has been the enemy of good, that's why we're losing this War. perfect test results. perfect vaccine. perfect treatment (no one can die; follow regular standards of care). we must end perfect and get good enough. it's the only way to win.
1) eliminate liability
2) source/staff/operate Covid Care Centers
3) rapid tests for everyone
4) immediate antibody therapy for ALL C19+ patients
5) unrestricted high-volume vaccine rollout
Read 25 tweets
31 Dec 20
BTC has likely created more millionaires (10,000+?) and deca millionaires (1,000+?) than any company or startup in history. these are individual “retail” investors realizing these returns, not institutions, which may drive the Rise of Retail...
1) retail interest in speculative (high-risk/high-reward) investments will continue to sky rocket. BTC’s meteoric USD-denominated value climb sets a new benchmark. everyone is already chasing the next dragon.
2) more speculative public equity is being purchased by retail investors who are increasingly becoming key driver of public offering events (through SPACs, direct listings, and IPOs syndicated to retail investors. instead of a handful of “strong” institutional investors).
Read 12 tweets
29 Dec 20
the US is administering ~250k covid vaccine doses per day. we prob need to get ~100-150M ppl vaccinated = 200-300M doses = 800-1200 days at current rate. last mile clearly a problem as many doses sitting with states, who have discretion over admin process.
states + hospitals don’t know what to do. this likely becoming key issue in coming days. lots of finger pointing. problem may be paperwork burden, process and procedural overhead. or just complete lack of uniform planning. distribute and hope clearly not a great strategy
math for alternative central planning: 10k care providers give 1 dose every 3 minutes for 8 hours/day = 1.6M/day = 4 months to achieve goal...
Read 4 tweets
21 May 20
amazing paper. 40-60% of population that have NOT had SARS-CoV-2 already have activated T Cells to the virus! likely due to cross-reactivity w/ other "common cold coronaviruses". may explain large % having easy time clearing virus and/or mild/no symptoms.…
"... CD4+ T cell responses were detected in 40-60% of unexposed individuals. This may be reflective of some degree of crossreactive, preexisting immunity to SARSCoV-2 in some, but not all, individuals..."
"Whether this immunity is relevant in influencing clinical
outcomes is unknown—and cannot be known without T cell measurements before and after SARSCoV-2 infection of individuals—..."
Read 4 tweets
27 Apr 20
"re-opening" is not a binary thing. People, Places, and Processes (PPP) define our current and future state. which people can go out, where they can go, what processes are in place when they do go out.
we aren't in a binary lockdown today. in sf, for example, anyone can go to the grocery store or "exercise outside". there are some processes in place (i.e. must wear masks to enter the grocery store; but not req'd to do temp checking on entry). our "lockdown" is already nuanced.
thus, it's not ideal to talk abt binary states. and it's non-sensical to believe we can "crush" the virus. even if # infected ppl in US fell to 50 we'd be where we were early March & infected would expand as before w/o a change in PPP. you can't just "return to normal"
Read 15 tweets
3 Apr 20
love @UCSF and @UCSFMedicine grand rounds video,

here are my tl;dw notes if you don't have the time to watch:
- asian response to pandemic was informed by their experience with SARS. already common practice to wear masks in public, knew how to rapidly test & trace, isolation protocol planned & ready; thus, better curve flattening over US
- outbreak now much worse in Europe and US than it ever was in China
- key metric to watch is daily new cases per 1M pop
- china peaked at 10, spain steady over past week at 173, italy steady over past week at 100, US now at 90 rising every day (these are my calcs)
Read 25 tweets

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