^NY and IL have entered the vicinity of functional herd immunity with vaccines coming. In NYC, positivity rates have levelled and are recently trending down (but still high). IL and the Chicago area had a huge second wave that peaked in late November and early December and all numbers (cases, positivity, hospitalizations and deaths) are significantly trending down.
In my jurisdiction (CDN province), it appears that only a small minority (less than 1-3%?) of vaccines are given to people not belonging to pre-defined priority groups.
In my jurisdiction (like elsewhere including the US), there is a clear movement to move away from the pre-defined two-doses regimen in order to postpone the second dose with the goal to reach an optimal number of people with the first dose. This outcome has been the result of constructive discussions between people sitting in offices and people on the ground with some kind of expertise. There is some uneasiness with this adapted strategy because the vaccine studies were devised with a fixed schedule. However, at the group level, this is likely to help reach herd immunity faster. Looking at the groups at risk in the next few weeks (similar to a threshold analysis in a bankruptcy according to priority rules), the sub-groups most likely to benefit will be the 60-69 and 70-79 living in the community. These two groups compose lower proportions of people reaching hospitals, ICUs and the morgue but numbers are still significant and this group is clearly at risk for quality-life years lost. At the individual level, postponing the second dose has positive and negative aspects. The negative aspects include that this adapted protocol was not studied and means that there will be less protection in between doses. The positive aspects include that efficacy reaches about 90% with the first dose at day 14 to 15 with the mRNA vaccines, immunity has been shown not to decline significantly for a few months and, from previous vaccine knowledge, a delayed second dose may very well result in a stronger 'boost' (longer lasting immunity).
