You serious, bro?

His point is simple enough. For months to come, even with thousands of people being vaccinated every day, it’ll nonetheless be true that Americans who aren’t immune from COVID greatly outnumber those who are. It *may* also be true that those who’ve been vaccinated are still capable of passing along the virus to others even though they’re protected from serious illness themselves. (I say “may” because Moderna’s data suggests that the vaccine might make recipients less infectious, which would be fantastic if confirmed.) So if you’re vaccinated and you’re drinking at a bar with a bunch of people who aren’t, it’s conceivable that you might carry the virus in there with you and infect everyone in the joint. The way to protect those around you is to continue to take precautions until either (a) science confirms that vaccine recipients don’t transmit the virus to others or (b) the great majority of the country has been vaccinated, making the risk of infection negligible.

It’s a sensible, cautious approach. Annnnnnnnd literally about two percent of people who get vaccinated, I’d guess, will actually follow that approach instead of tearing off their masks on the day of their second dose and spinning around in a crowd like Julie Andrews on the hilltop in “The Sound of Music,” spewing particles in every direction. This country can’t convince people to stop going to restaurants now, when there are 200,000 new cases a day. Good luck trying to convince them after they’ve been immunized that they need to keep masking up and avoiding gatherings for another three, four, five months.

Honestly, I’m expecting this coming April and May to look like one big national block party. A keg on every corner. Watch, then read on.

MSNBC’s @VinGuptaMD: "Just because you get vaccinated after the second dose does not mean you should be … traveling … or that you’re liberated from masks." pic.twitter.com/DqT134hrBp

— Tom Elliott (@tomselliott) December 15, 2020

I wonder if there’ll be a surprise surge of infections in March or April as we reach a moment in which a lot of people have already been vaccinated and are flinging off their masks with the arrival of spring but most of the population still has yet to be immunized. If — if — those who’ve been vaccinated can still get infected and transmit the virus, we could have a burst of new cases as the first group abandons precautions, mingles freely with the second, and ends up seeding new outbreaks.

Relatedly, because the data from Pfizer and Moderna suggest that the first dose alone provides a decent amount of immunity, scientists are debating whether the U.S. should use its entire initial supply of the vaccine to administer first doses to many people or whether it should hold back half that supply to make sure that a smaller number of people get both doses in the three- to four-week window, as the manufacturers advise. A few days ago a data scientist at MIT calculated that if we maximize the number of people who get doses early by distributing the initial supply instead of holding half of it back, we could reach herd immunity months sooner than everyone expects:

This involves allocating the initial (limited) supply of vaccines based on two main criteria:

1) Each individual receives only one dose instead of two.
2) We prioritize individuals who have not had a prior infection.

This would be temporary, until supply catches up.

— Youyang Gu (@youyanggu) December 11, 2020

With the existing approach, my model estimates that by the time the US reaches herd immunity in summer 2021, we would've distributed ~300M doses.

That's an "efficiency" of 100M / 300M = 33%

If we follow the two criteria from above, I believe we can double the efficiency to 70%.

— Youyang Gu (@youyanggu) December 11, 2020

Of course, I'm not necessarily advocating for this approach. More studies would need to be carried out first. But I do feel like this is not being talked about enough.@michaelmina_lab and @zeynep have also raised this issue (I recommend the thread).https://t.co/yKhaic7zOZ

— Youyang Gu (@youyanggu) December 11, 2020

The catch is what happens if the supply can’t be replenished quickly enough to make sure people get their second doses in a timely way. If you get your first dose on January 1 and then, due to manufacturing hiccups, don’t get your second until March 1, does that mean your immunity going forward won’t be as durable? Might the side effects from the second dose be more severe than expected (or less severe) on that timeline? That’s a hell of an experiment to run on tens of millions of people.

I’ll leave you with Scott Gottlieb, who supports the idea. Get as many first doses as possible into the population, then worry about the second doses. The partial immunity from the wave of first doses will help slow down community spread more quickly than if we held back half the supply for second doses.

"We know the first dose is partially protective," says @ScottGottliebMD on effective distribution. "This pandemic is going to play out, the acute phase of it, in the next 6-8 weeks in this country. We need to get as much protective immunity as possible into the general public. pic.twitter.com/UfZE1bHfp8

— Squawk Box (@SquawkCNBC) December 11, 2020