Heres our recap of thepast week inthe coronaviruspandemicfrom our tracking, policy analysis, polling, and journalism.
This week marked the one-year anniversary since the first patient with COVID-19 was hospitalized in the United States. At this point, coinciding with President Joe Bidens inauguration and a new administration leading the federal response, the country has surpassed 24.6 million COVID-19 total cases and roughly 410,100 total deaths as of January 21.
On his first day in office, President Biden signed several executive orders including requiring masks and physical distancing in federal buildings and on other federal properties. On Thursday, the President signed an executive order mandating masks for interstate travel in the U.S. and released a national strategy responding to the pandemic. KHN outlines what President Biden promised during the presidential campaign and will be tracking the administrations actions on health and COVID-19 related promises.
The latest COVID-19 Vaccine Monitor reports that half the public expect the vaccine rollout to get better under President Biden. The new report also highlights that a majority of the public, including prioritized groups like older adults and essential workers, say they dont have enough information about where and when to receive a vaccine.
Meanwhile, an update to January 19 data on states COVID-19 vaccine priorities shows 12 states have moved to redefine their priority populations or open vaccine availability to people 65 and older, bringing the total number of states placing this population in the 1a or 1b category to 28. Six states moved those under age 65 with high risk medical conditions up in line as well.
A new analysis explores state-reported data on vaccination by race/ethnicity and will be regularly updated and available on KFFs COVID-19 state data and policy tracker. While it is still early in the vaccine distribution timeline for the general public, the preliminary data provided by 16 states indicate Black and Hispanic peoples share of vaccinations is smaller than their share of cases and deaths in most of these reporting states. The data and our news reporting at KHN have also shown that vaccination is lagging by various measures for people of color.
Media reports indicate some health workers are opting not to be vaccinated, particularly among those working in long-term care facilities. A new data note examines the makeup (by race/ethnicity, income level, age, gender, education, and citizenship status) and health insurance coverage of the estimated 15.5 million health care workers with direct patient contact.
Global Cases and Deaths:Totalcases worldwide stand at 97.5 millionthis week withan increase ofnearly 4.4 million new confirmed cases in the past seven days.There wereapproximately 95,400new confirmed deaths worldwide, bringing the total for confirmed deaths to nearly 2.1 million.
U.S. Cases and Deaths:Total confirmed cases in the U.S. reached 24.6 million this week.Therewas anincrease of about 1.3 millionconfirmed cases between Jan. 14 and Jan. 21.Approximately 21,400confirmed deaths in the past week brought the total in the United States to410,100.
State Social Distancing Actions (includes Washington D.C.) that went into effect this week:
Extensions: AL, ME, MD, MA, MI, NJ, OH, RI, UT, WI
Rollbacks: DC, IL, MA, MI, ND, VT
LONDON All at once, the coronavirus seemed to change.
For months, Dr. Steven Kemp, an infectious disease expert, had been scanning a global library of coronavirus genomes. He was studying how the virus had mutated in the lungs of a patient struggling to shake a raging infection in a nearby Cambridge hospital, and wanted to know if those changes would turn up in other people.
Then in late November, Dr. Kemp made a startling match: Some of the same mutations detected in the patient, along with other changes, were appearing again and again in newly infected people, mostly in Britain.
Worse, the changes were concentrated in the spike protein the virus uses to latch onto human cells, suggesting that a virus already wreaking havoc around the world was evolving in a way that could make it even more contagious.
Theres a load of mutations that occur together at the same frequency, he wrote on Dec. 2 to Dr. Ravindra Gupta, a Cambridge virologist. Listing the most troubling changes, he added: ALL of these sequences have the following spike mutants.
The two researchers did not yet know it, but they had found a new, highly contagious coronavirus variant that has since stampeded across Britain, shaken scientists understanding of the virus and threatened to set back the global recovery from the pandemic.
Word raced through a consortium of British disease scientists, longtime torchbearers in genomics who had helped to track the Ebola and Zika epidemics. They gathered on Slack and on video calls, comparing notes as they chased down clues, among them a tip from scientists in South Africa about yet another new variant there. Still others have since emerged in Brazil.
For nearly a year, scientists had observed only incremental changes in the coronavirus, and expected more of the same. The new variants forced them to change their thinking, portending a new phase in the pandemic in which the virus could evolve enough in time to undermine vaccines effectiveness.
British lawmakers announced the news on Dec. 14, warning that the variant was spreading faster than previous ones.
But the road to its discovery was laid down to little acclaim in March, when Britain decided to begin sequencing coronavirus samples en masse. The country produces half the worlds inventory of coronavirus genomes, providing an unparalleled view of how the virus changes, and how people brought it into Britain last year and are now carrying the variant out.
For Britain, the discovery came too late to prevent a punishing new wave of Covid-19 that has put its hospitals on the brink of having to deny lifesaving care. The variant was already spreading fast, abetted by the governments lax restrictions during the fall and early winter.
But Britain sounded an alarm for the world, allowing countries to close their borders and start frantically searching for a variant they otherwise might not have noticed for months. British scientists quickly published studies that convinced skeptics of its potency.
The U.K.s got many things wrong about this pandemic, mainly not learning lessons about the importance of reacting early, said Neil Ferguson, an epidemiologist and government adviser. But the U.K. has a fairly unparalleled surveillance system for Covid. We can monitor very small changes in the virus.
Labs around Britain, after testing swabs for the virus, send the leftover material in refrigerated vans to the Wellcome Sanger Institute, a genomics lab, where they are stored in cavernous freezers.
There, robots separate out the positive samples and deposit them into the wells of tiny, muffin-tin-like plates. Machines then map their genomes, said Jeffrey Barrett, who directs the sequencing project, producing 30,000 letter-long genetic codes that are uploaded to an internet library. The task of making sense of mutations falls to biologists like Andrew Rambaut, a professor in Edinburgh, who determine where they fit on the evolutionary tree.
The effort has generated more than 165,000 sequences in Britain. The United States, with five times as many people, has sequenced about 74,000 genomes. Germany has sequenced about 3,400, less than half of what Britain uploaded to the global database on Thursday alone.
Jan. 23, 2021, 10:05 a.m. ET
It has totally revolutionized how were dealing with the virus, said Judith Breuer, a virologist at University College London.
The campaign took shape on March 4, before 100 coronavirus infections had been found in Britain, when a Cambridge microbiologist, Sharon Peacock, sent a flurry of emails to British genomicists, asking each: Can you call me please.
Within two weeks, their newly formed consortium had secured 20 million British pounds, about $27 million, in government funding.
Its a close community here, and in March it effectively put aside any rivalries, any egos, and just said, We can play a critical role in managing the pandemic, said Thomas Connor, a scientist in Wales who built a platform for collating and analyzing genomes.
Among the samples sequenced last summer were those of a man in his 70s with lymphoma, admitted in May to a Cambridge hospital for treatment of Covid-19. Dr. Gupta, a part-time clinician, began treating the patient, whose anticancer drugs had depleted his immune response. Sequestered in an isolation room, the patient struggled to breathe. Even after several rounds of treatment, including plasma with antibodies from recovered patients, the virus did not disappear.
Instead, it mutated. Britains sequencing efforts opened a window into those changes: Over 101 days in the hospital, the viral particles coursing through the mans lungs were sequenced 23 times, a treasure trove of clues.
The patient died in August, seemingly without having infected anyone else. But the mutations in his virus eventually supplied scientists with a leading theory for how the British variant originated: by eluding the immune defenses of someone like the Cambridge patient who had a weakened immune system and a long-lasting infection.
We call this the gold standard patient for assessing different viral populations in a host, Dr. Kemp said.
One mutation the patient had, labeled 69-70del, changes the shape of the spike protein. Another, N501Y, can help the protein bind more tightly to human cells.
Dr. Kemp searched for those changes every few days in the global database, finding scarce reason to worry. Then in late November, abruptly, he noticed many genomes, mostly from Britain, that had those mutations and a host of others that could change how the virus entered human cells. He summoned Dr. Gupta to his computer for a look.
Eventually, British scientists detected 23 mutations that distinguished these genomes from the earliest known version in Wuhan, China enough to be a considered a new variant, since labeled B.1.1.7. On an evolutionary tree that Dr. Kemp made, it stood apart like a lone, spindly branch.
I was not expecting anything like this, Dr. Gupta said. Back at the end of November, it was all about vaccine hope, and there was no whiff of new variants coming along.
The number of mutations on the spike protein particularly rattled him, he said, calling it a Wow moment.
At the same time, Englands public health experts were puzzling over an unexplained outbreak of coronavirus cases. A lockdown had tempered the virus across England, but not in Kent, a county of London commuters and fruit orchards in the southeast. Cases were emerging in schools. One in 328 residents was infected.
Only on Dec. 8, at their regular meeting with genomicists, did the public health officials conclude that the cause was likely a new variant. Looking back through their databases, scientists discovered that it had first been collected in September, and had spread as people returned to offices and patronized restaurants and pubs at the governments urging.
Researchers eventually became persuaded that the variant was, in fact, more transmissible roughly 30 to 50 percent more but only after they had assembled a patchwork of less conclusive clues.
Theres no one totally unambiguous line of evidence science only generates that kind of surety over longer time periods, said Oliver Pybus, an Oxford evolutionary biologist. It was more a case of different, independent lines of evidence coming together.
After scientists presented their conclusion on Dec. 11 to a government advisory body, Dr. Ferguson, the epidemiologist, became concerned that it would almost certainly require us to go into another lockdown. He texted Prime Minister Boris Johnsons chief scientific adviser, warning about the variant.
By Dec. 22, government scientists said that strict measures, including school closures, were needed to suppress the variant. But Mr. Johnson allowed people in parts of England to gather on Christmas, and did not impose an England-wide lockdown until Jan. 4.
The variant is now estimated to account for more than 80 percent of positive cases in London and at least a quarter of infections elsewhere in England, and has turned up in more than 50 countries. American health officials warned on Friday that the British variant could be the dominant source of infection in the United States by March.
In recent days, Dr. Gupta and Dr. Kemp have begun using blood serum from vaccinated people to determine if the variant may weaken the potency of the vaccines.
The world was being told for a long time that mutations dont really matter from the coronavirus, Dr. Gupta said. But we found that mutations did come, and they did have an impact on the viruss fitness.
There are three more deaths from COVID-19 reported this morning in the West Piedmont Health District. The Virginia Department of Health added those three victims -- 2 in Henry County and 1 in Martinsville -- to its database, but they could have happened weeks ago. VDH sometimes waits for death certificates to confirm cause before adding to its database. We don't know much about the specific victims, but VDH does track the data by the person's residence. This is now 67 residents of Henry County and 31 of Martinsville who have died for the disease caused by the novel coronavirus. There have been 6 deaths in the past two days in the district and 157 since the pandemic began. Hospitalizations have been on the climb in the district -- there was 1 each reported this morning in Henry County and Martinsville -- but new cases this week has declined after sharp increases earlier this month. There were 60 new cases reported this morning, and the 7-day average is down to 83 from as high as 107 about a week ago. Henry County had 30 of the new cases and now has surpassed 3,500. Franklin County had 14, Martinsville 11 and Patrick County 5. There have been 8,899 cases and 533 hospitalizations in the district....The health district announced in a release on Friday that those specified under the Virginia Department of Healths Phase 1b starting Monday would be able to access registration links on the WPHD website and Facebook page or find paper copies at the health departments, public libraries, municipal buildings and chambers of commerce in Martinsville, Stuart and Rocky Mount....Advocacy groups are warning thatimmigrants in the U.S.may be some of the most difficult people to reach during the national drive to vaccinate the population against the virus....A group of fortunate Americans are getting pushed to thefront of the line to get their COVID-19 vaccinesas clinics scramble to get rid of extra, perishable doses by the end of the day....TheWhite House is following public health guidelinesfor preventing the coronavirus under President Joe Biden. Testing wristbands are in. Mask-wearing is mandatory. Desks are socially distanced....The U.S. is averaging more than 187,000 new cases and about 3,000 deaths each day. The nations death toll since the start of the pandemic now stands at more than 414,000....A major British doctors' group is says the U.K. government should urgently review it's decision to give people a second dose of the Pfizer-BioNTech coronavirus vaccine up to 12 weeks after the first, rather than the shorter gap recommended by the manufacturer and the World Health Organization.....Larry King, the suspenders-sporting everyman whose broadcast interviews with world leaders, movie stars and ordinary Joes helped define American conversation for a half-century, died Saturday. He was 87. He had been hospitalized with COVID-19 a few weeks ago....The Virginia Department of Health reportsthis morning there have been 468,655 cases and 6,079 deaths statewide -- up by 77 since Thursday. Some 20,654 people have been hospitalized. Henry County has had 3,514 cases, with 246 hospitalizations and 67 deaths. Martinsville has had 1,288 cases, with 110 hospitalizations and 31 deaths. Patrick County has had 981 cases including 75 hospitalizations and 28 deaths. Franklin County has had 3,116 cases, 102 hospitalizations and 31 deaths. Danville has reported 3,273 cases (63 deaths), and Pittsylvania County has had 3,794 (45 deaths).Johns Hopkins University's real-time mapshowed 98,277,828 cases worldwide and 2,109,626 deaths. In the U.S. there have been 24,823,197 cases and 414,124 deaths because of COVID-19.
(127) updates to this series since Updated 1 hr ago
WASHINGTON (Reuters) President Joe Biden on Friday will sign orders to speed the issuance of pandemic stimulus checks to needy families and increase food aid for children who normally rely on school meals for nutrition.
Biden is using the two executive orders to try to ease people's burdens while Congress negotiates the fate of his proposed $1.9 trillion stimulus package.
"The American people are hurting and they can't afford to wait. They need help right now," White House National Economic Council director Brian Deese said at a press briefing.
"We're at a precarious moment for the virus and the economy. Without decisive action, we risk falling into a very serious economic hole, even more serious than the crisis we find ourselves in," said Deese. He said he would speak with lawmakers on Sunday to push for more relief.
Biden's actions were not a substitute for legislative relief, Deese said, with about 16 million people now receiving some type of unemployment benefit and an estimated 29 million who do not have enough to eat. Women, minorities and low-income service workers have been disproportionately hurt, with Black and Hispanic workers facing higher jobless rates than white workers.
In an early test of whether Republicans might support the Democrat Biden's plans for coronavirus relief, infrastructure investment and tax increases, the U.S. Senate Finance Committee voted unanimously on Friday to approve Janet Yellen, Biden's choice for Treasury Secretary, paving the way for her confirmation by the full chamber.
Republican lawmakers have questioned the price tags on pandemic aid and Biden's separate $2 trillion investment proposal for infrastructure, green energy projects, education and research.
Biden's hopes for speedy action on his legislative agenda and Cabinet appointments are complicated by the expected trial of former President Donald Trump in the Senate as early as next week and bipartisan squabbling over operations in an evenly split Senate.
We're at a precarious moment in our economy.Brian Deese, White House National Economic Council
In Canada, Prime Minister Justin Trudeau said he would raise his concerns over the job losses caused by Biden's cancellation of the Keystone XL oil pipeline when they speak on Friday, but added Washington and Ottawa were now "much more aligned" on other matters under Biden, who took office on Wednesday.
In the first executive order on Friday, Biden will ask the Treasury Department to consider taking steps to expand and improve the delivery of stimulus checks, such as by establishing online tools for claiming payments.
"Many Americans faced challenges receiving the first round of direct payments and as many as 8 million eligible households did not receive the payments issued in March," a White House fact sheet said.
Roberto Perli, head of global policy at Cornerstone Macro, said getting stimulus checks out faster would bolster consumer spending but have a "minimal GDP impact."
Biden will also ask the Agriculture Department to consider issuing new guidance to increase the aid given to families who normally rely on schools to provide a daily main meal for their children. It could provide a family with three children more than $100 of additional support every two months.
"This is a bold, common-sense move to address the nation's joint hunger and public health crises," said Joel Berg, CEO of Hunger Free America advocacy group.
Biden's second order will restore collective bargaining power and worker protections by revoking three related orders issued by Trump during his term, which ended on Wednesday. It also promotes a $15-an-hour minimum wage. The federal minimum wage has been at $7.25 an hour since 2009.
(Reporting by Nandita Bose, Jeff Mason, Steve Holland and Ann Saphir; additional reporting by Doina Chiacu, Lucia Mutikani and Howard Schneider; writing by Grant McCool; editing by Heather Timmons)
Just two months ago, North Dakota had the highest death rate in the world from COVID-19. Hospitals were overwhelmed. Then Burgum rightfully imposed the mask mandate. Many more people started wearing masks in the state. Deaths, infections and hospitalizations from the coronavirus dramatically dropped in North Dakota.
The mandate has been working so well, said Dr. Stephen McDonough, a former North Dakota Public Health Officer. Why stop it now? Its just stupid. It defies common sense. North Dakotans were and are in favor of a mask mandate.
Perhaps Burgum has been influenced by crazy anti-maskers, such as Rep. Jeff Hoverson, R-Minot. Hoverson has introduced a dangerous bill that would prohibit all state and local mask mandates. I assume Hoverson will soon try to ban speed limits, traffic lights and stop signs.
This is not the time to drop the mandate. The virus is still surging out of control in the country. The U.S. is seeing record daily highs for infections and deaths from COVID-19. A new highly contagious strain of the virus is rapidly spreading throughout the country. North Dakota is not an island. While the numbers are much improved in the state, dozens of North Dakotans are still dying from the coronavirus every month and hundreds are newly infected every week.
Were nowhere near safe yet. The vaccine rollout has been an epic failure so far. Only about 2% of North Dakotans have been fully vaccinated.
Burgum once again is emphasizing personal responsibility. That slogan was a disaster. Many people were irresponsible and werent wearing masks when it was optional. Thats in large part why North Dakota became the COVID-19 death capital of the world. Sadly, many people will stop wearing their masks now. That means more deaths and infections. Preventable deaths and infections.
Burgum said dropping the mandate provides a chance for us to take a breather. The trouble is, the coronavirus isnt taking a breather. This will just give the virus an opening to strike harder in the state with deadly consequences.
Mask usage will drop quite a bit, McDonough said. We will see more deaths. We need to wait at least another 100 days when most people are immunized. The governor has made a bad calculation. He has demonstrated a profound lack of courage.
Sorry to hear of the recent passing of former longtime North Dakota federal prosecutor Gary Annear. A great guy, Annear was the prosecutor of a drug case in Fargo, in which I was foreman of the jury. I had never met or talked to Annear before then.
I will never forget Annears brilliant closing argument when he said, When the defense has nothing, you get a smokescreen. And thats what you just heard. A smokescreen. It was emotionally draining for us, but we convicted the defendant on all counts.
Shaw is a former WDAY TV reporter and former KVRR TV news director. Email jimshawtv@gmail.com
CHARLESTON, W.Va. The number of workers available to treat some northern West Virginia highways for winter weather are limited after four Monongalia County garage employees tested positive for the coronavirus.
Mike Cronin, the West Virginia Division of Highways District 4 engineer, confirmed the test results to MetroNews affiliate WAJR-AM.
Cronin also shared there are new rules for employees to prevent future absences; workers will not be allowed to work if they are sick.
3. The RNA molecules are fed through roundish, machinelike structures called ribosomes, a type of cellular assembly line where proteins are made. In an infected person, viruses hijack this machinery to make copies of themselves. But in the vaccines, the RNA contains the recipe only for the exterior spikes of a virus particle, not an entire virus. They cannot cause an infection.
CLEVELAND, Ohio - Hospitalizations tied to the coronavirus in Ohio have plummeted from late fall when they were shooting up at such a sharp rate that they raised concerns both of a rapidly growing spread of the virus and that the hospitals could eventually be overrun.
After peaking at 5,308 statewide on Dec. 15, the daily patient count began to trend down, and by Thursday had dropped to 3,406 patients. Thats a decline of 36%, or 1,902 patients, from the peak.
The number of patients in intensive care units across the state also has dropped 36%, dipping from a record of 1,318 on Dec. 15 to 845 on Thursday, the daily survey by the Ohio Hospital Association shows.
Both numbers remain far in excess of where they were at the beginning of the fall on Sept. 22. At that time there were 590 patients overall, including 199 in ICU beds. But the change since the fist half of December marks a dramatic turn from what had been a sharp curve up.
Twenty-seven percent of the states hospital beds were vacant on Thursday, with a vacancy rate of 23% for ICU beds.
One of the reasons the vacancy rate is not higher is that more non-COVID patients are now hospitalized. There were 16,983 people hospitalized Thursday for reasons other than coronavirus, up from 15,373 just 10 days earlier.
Likewise for ICU beds. Non-COVID patients occupied 2,849 ICU beds on Thursday, up from 2,670, on Jan. 11.
Not only does the hospital trend provide a glimpse into the number of serious cases, and concerns over whether hospital capacity is in danger of being reached, from the onset of the virus in the spring it has been the most steady way to track trends.
Early on, younger people were being told not to even get tested if they werent sick enough to go to the hospital. Tests were being rationed for the oldest, the sickest and health care workers. Then late in 2020, daily reports for cases overall at best provided a murky look at the trends as reporting was erratic, often delayed, and some criteria changed for counting cases.
Hospitalizations often occur a week or so after the onset of symptoms. Data from deaths to illustrate trends often isnt available until weeks later.
Among the possible factors for the change in the trend: the beginning of vaccinations, though limited to date; the closing of many schools for in-person instruction late last year; a 10 p.m. curfew instituted by Gov. Mike DeWine in mid-November; a public awareness effort to encourage people to avoid large holiday gatherings; and possible changes by some hospitals in considering when to admit and keep patients.
Thursdays count of 3,406 patients might be adjusted in the coming days as the hospital association receives more data. But the changes from the initial daily reports are usually small.
Rich Exner, data analysis editor for cleveland.com, writes about numbers on a variety of topics. Follow on Twitter @RichExner. See other data-related stories at cleveland.com/datacentral.
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It's been a full week since fewer than a fifth of South Carolina's daily coronavirus tests came back positive.
For seven days in a row, the S.C. Department of Health and Environmental Control has logged positive results for at least 22 percent of the test results it reports each day. On Friday, 28.4 percent of the results were positive.
High percent positives indicate that the novel coronavirus' spread isn't slowing, experts say, and they hope to see a number below 5 percent.
New cases reported:3,528, which is 2,133 percent higher than the 158 tallied on March 31, the day Gov. Henry McMaster ordered nonessential businesses to close.
Total cases in S.C.:369,782, plus39,406 probable cases
New deaths reported:23
Total deaths in S.C.:5,791 confirmed, 613 probable
Total tests in S.C.:4,555,905
Hospitalized patients:2,293
Percent of positive tests, seven-day average:24.4 percent. Five percent of tests or fewer returning positive results is a good sign the virus' spread is slowing, researchers say.
According to DHEC data, the top counties for new coronavirus cases reported Friday were Greenville, 494; Spartanburg, 336; and Charleston, 234.
On Friday, Charleston County reported 234 new cases while Berkeley had 77 and Dorchester logged 111.
Five of the 23 deaths that DHEC confirmed Friday were victims aged 35 to 64 and the rest were 65 or older.
They lived in Aiken, Berkeley, Colleton, Florence, Georgetown, Greenville, Horry, Lexington, Marlboro, Oconee, Orangeburg, Pickens, Richland, Union and York counties.
Of the 2,293 patients hospitalized with COVID-19 on Friday, 460 were in intensive care and 311 were on ventilators.
Authorities continue to urge South Carolinians to take precautions, such as wearing masks or other face coverings, social distancing and frequently washing hands.
They also urge anyone who believes theyve been exposed to the virus or who is developing symptoms to get tested. Those out in the community or not able to socially distance should get tested monthly, DHEC advised.
A COVID-19 vaccine hub taking appointments only stands in Brooklyn as New York City begins to run low on doses Friday. Spencer Platt/Getty Images hide caption
A COVID-19 vaccine hub taking appointments only stands in Brooklyn as New York City begins to run low on doses Friday.
With a spotlight on COVID-19 vaccine distribution shortcomings, there's another bottleneck that could prevent inoculations from significantly speeding up in the near future: Pfizer's and Moderna's ability to scale up manufacturing and deliver doses to the U.S. government.
The companies promised to deliver 100 million doses apiece to the United States by the end of March. But they'll need to make huge leaps in a short time to meet that goal.
In the last few weeks, they've each been steadily delivering about 4.3 million doses a week, according to an NPR examination of vaccine allocation data. But to hit their targets of 100 million doses on time, they each need to deliver 7.5 million doses a week for the next nine weeks.
"I think it is going to be a real challenge for them to hit that contracted target. There's just no question about that," said consultant John Avellanet, who's advised pharmaceutical companies since the 1990s on manufacturing and compliance issues.
The companies would need everything to go right.
And a lot can go wrong. Equipment breaks and needs repair. Doses need to pass quality tests before they can be shipped. And the production process depends on companies maintaining a steady supply of chemical ingredients, glass vials and skilled labor.
"In some ways, it's almost a miracle that they've been able to produce what they've been able to produce," Avellanet said.
Pfizer and Moderna vaccines both rely on messenger RNA, or mRNA, to protect against the virus. Although mRNA vaccines have been studied for a decade, it's the first time they've been used on a massive scale.
"It's one thing to make 300 vials or let's say even for a clinical trial, 3,000 vials. It's a whole other game to make 4 million, 7 million," Avellanet said. "And all of a sudden, the demands are huge. And so you're going to end up with machinery that gets out of calibration, that breaks down ... and so forth and so on. And so that can slow the process dramatically."
What's more, RNA is fragile, said David Gortler, who until Wednesday afternoon was the senior adviser to the now-former Food and Drug Administration Commissioner Stephen Hahn.
"Going back to my Yale days when I was a lowly fellow inside of a molecular biology lab, I had to work with RNA myself," he told NPR. "And RNA is something which is very, very delicate and it can be inactivated, just like we used to joke just by looking at it the wrong way."
Gortler is a pharmacist and pharmacologist who specializes in drug quality and supply chain issues. He said he understands that Pfizer and Moderna are already working at "maximal capacity" with existing facilities. Building new facilities would require FDA inspections and "take a very long time."
When it comes to COVID-19 vaccines, he said quality is even more important than speed.
"I'd rather hear the companies have fallen short of their production goal, but managed to maintain their quality control because all of this really depends on the quality control," he said. "It's really the case for all drugs. So like I said before, but in this case, just because of the particular nature of this drug and the specific fragility of dealing with anything RNA-related, it's important to take a step back."
Asked about why vaccine delivery appeared to be behind and what's being done to speed it up, Operation Warp Speed spokesperson Michael Pratt in the Trump administration sent NPR the following statement just before the Biden administration took over:
Both companies continue to scale up production, and current forecasts indicate we are on track to allocate 200 million doses by the end of March across the vaccine portfolio. Operation Warp Speed continues to assess all available avenues to assist manufacturers to optimize and maximize their production processes as requested/required.
The new administration has said it plans to use the Defense Production Act to increase production. The Trump administration used the Defense Production Act 18 times as part of Operation Warp Speed, according to a Dec. 29 statement from the White House press secretary.
Moderna said it hasn't been releasing weekly or monthly production estimates, so it couldn't provide more details about how it will deliver significantly more doses to the United States in the coming weeks to meet its first-quarter goal.
"We continue to be on track with our expectations of delivering 100 million doses of vaccine by the end of Q1, and 200 million doses by the end of Q2," Moderna spokesperson Ray Jordan wrote in an email to NPR. "Production and releases are not linear and we have explained that we have been successfully scaling up our production yields over time."
On Dec. 15, Vice President Pence visited the Catalent contract manufacturing facility making finished vaccine doses for Moderna, where leadership told him they were completing 500,000 doses a day and hoped to double production to meet delivery goals. They described employees working "tirelessly" and volunteering to work Thanksgiving and Christmas.
Pfizer didn't respond to NPR's request for comment. But it slashed vaccine deliveries for some European Union countries this week, according to Reuters.
Gortler said he worked at Pfizer for several years, and if it's running behind, it's probably because of its attention to quality. "I'm sure that if they're rejecting things, that's actually what you want to hear," he said. "So in my mind, it's a good thing."
To hit their goals, Moderna and Pfizer each need to increase shipments to 7.5 million doses from 4.3 million per week in a hurry.
The task is difficult but not impossible.
John McShane, a managing partner at the health care product consulting firm Validant, said he's "guardedly optimistic" that the companies will be able to scale up manufacturing drastically and deliver 100 million doses each by March 31.
He said there are three main "levers" the companies can pull to increase production: add equipment, increase the yield per batch and find ways to shorten the time it takes to go from raw materials to finished, internally approved product.
"Those are three pretty big levers," McShane said. And outsourcing could help, too. "One CMO [contract manufacturing organization] with the right capacity could double your throughput overnight," he added.
What's more, he said, it's likely that the doses Moderna and Pfizer plan to deliver on March 31 are already somewhere in the production process.
