COVID Vaccine (2)

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I think health-care providers should get the vaccine first for the same reason that flight attendants tell adults to put their own oxygen masks on before putting them on their children.
 
Lindberg said:
...A lot of folks are wanting to blame and shame uncooperative citizens unwilling to have sacrifices. I chose to blame the people whose responsibility it was to be prepared for this who weren't. Someday, the media will move on from shame and fear and tell us what really happened.
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When are you going to move on from blame?
 
Lindberg said:
That's why we flattened the curve. And they did precisely nothing. Trained no new ICU nurses, equipped no new beds. Didn't increase emergency response capability.
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Who's gonna pay for all that? Do the hospitals just print money? Is there a government subsidy program I'm not aware of that pays for taking someone off the street and making them an ER nurse in ~6 months? A puppy mill for nurses? No...

This is a big enough deal, a responsible government would have pushed the constitutional limits on *this* issue to get on top of it. Set up a logistics system to distribute the vaccine nation wide. Set up the National Guard (or equivalent) with vaccination sites. I'd have a schedule in my hand that predicted when my vaccination was scheduled so I could work towards some certainty.

Other than the quick approval of the vaccines, this whole thing has been handled in a terribly irresponsible, haphazard manner. A complete abdication of the government's most fundamental responsibility which is to protect the citizens in times of national emergency. And this is an emergency which continues to spiral downhill.
 
kyleb said:
What if the pharmacy in the hospital "goes down" due to COVID?
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If that hasn't already happened, what makes you think it will? If it has already happened, then it must not have been catastrophic. If it's nonetheless a real, serious contingency, then surely someone came up with a plan to deal with it over the past eight months.
 
Lindberg said:
If that hasn't already happened, what makes you think it will? If it has already happened, then it must not have been catastrophic. If it's nonetheless a real, serious contingency, then surely someone came up with a plan to deal with it over the past eight months.
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Yes. Ignore the possible until it happens. Then respond. That's certainly worked well on the entire pandemic.
 
kyleb said:
Who's gonna pay for all that? Do the hospitals just print money? Is there a government subsidy program I'm not aware of that pays for taking someone off the street and making them an ER nurse in ~6 months? A puppy mill for nurses? No...
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Is this a serious question? Who's going to pay for shutting off our economy to make these "personal sacrifices" being so heartily endorsed? The fed gov has spent literally v trillions on addressing this. Much of it has gone to healthcare. We've heard over and over again that a nurse is not a nurse is not a nurse. That we need "staffed" ICU beds, and though there are plenty of nurses, there aren't plenty of ICU nurses. That's absolutely a problem that could have been solved over the past months.
 
Lindberg said:
If that hasn't already happened, what makes you think it will?...
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There has been a tendency for each peak in infection numbers to be much larger than the last one.
 
kyleb said:
Yes. Ignore the possible until it happens. Then respond. That's certainly worked well on the entire pandemic.
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That's not remotely what I said. I said I'd it was a real problem if should have, and with proper planning, would have, been addressed already. If you're saying it's a real issue and if HASN'T been addressed, then that's a greater problem. There wasn't a vaccine until just over a month ago. What was the plan before that?

Nevermind the fact that immunizing the most vulnerable actually addresses the underlying issue with hospital capacity.
 
Lindberg said:
Is this a serious question? Who's going to pay for shutting off our economy to make these "personal sacrifices" being so heartily endorsed? The fed gov has spent literally v trillions on addressing this. Much of it has gone to healthcare. We've heard over and over again that a nurse is not a nurse is not a nurse. That we need "staffed" ICU beds, and though there are plenty of nurses, there aren't plenty of ICU nurses. That's absolutely a problem that could have been solved over the past months.
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If your point is that things could have been handled better, it would be difficult to disagree.
 
I try and keep this rollout in perspective. Since the availability of a particularly effective vaccine is years ahead of a typical new vaccine development and the distribution to and inoculation of 250000000 or 300000000 people is enormously complex, I’m somewhat surprised over 2500000 people have received their first shot already.

The difficulty of determining how to actually deliver the shots to people who live in a place like my winter home in the mountains 3 hours from a major city and my main residence in a large city is not something I would trust a relatively small group of people in Washington DC who probably couldn’t find my winter place if they looked for it for a week, much less figure out how to get it there.

The main job at the end of the process is best left to the States since they should have the best understanding of the needs of their citizens and the resources available to move Vaccines from dry ice boxes to arms. If they have fumbled the ball or a local site can’t figure out who to give it to first, if it was left to the people in DC, I’m sure it would be a bigger mess.

Politicians always promise more that they deliver so whoever promises what is completely immaterial to me. If my local Doc promises something, I can usually count on it just like my local Trial Site who have told me I’ll learn next week if I actually got the Vaccine in Sept like I believe.

Cheers
 
Lindberg said:
That's not remotely what I said. I said I'd it was a real problem if should have, and with proper planning, would have, been addressed already.
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I'm saying that the possibility of a rapidly spreading global pandemic has existed since the 1940's - the advent of real long distance air travel.

And when the **** hit the fan we were caught with our pants down.

Why did you expect our COVID response to be different unless it was managed in a responsible manner from the top down? 'Cause it certainly wasn't gonna get a consistent reasonable response if driven by grass roots efforts?

Going back to the hospital pharmacy. There IS a plan - get those people the vaccine.
 
Lindberg said:
Is this a serious question? Who's going to pay for shutting off our economy to make these "personal sacrifices" being so heartily endorsed?
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Thou shalt not try to make me defend something I haven't said...
 
kyleb said:
I think you have to create priority buckets that include healthcare and first responders. You need those systems to continue functioning. What if the pharmacy in the hospital "goes down" due to COVID? Can't let that happen. So you get those behind the scenes people the vaccine. Same with the janitors cooking staff, administrators, etc. The healthcare system is a system that depends on much more than *just* the doctors and nurses.
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Assuming that vaccination will accomplish the efficacy "they" would have us believe, yeah...I have no problem with administrative, maintenance, or ancillary staff at the hospital getting vaccinated. The hospital has to run. For patients ill from whatever cause...COVID or otherwise. As it is...COVID is directly responsible for only a small portion of the service we render.
 
kyleb said:
I'm saying that the possibility of a rapidly spreading global pandemic has existed since the 1940's - the advent of real long distance air travel.

And when the **** hit the fan we were caught with our pants down.

Why did you expect our COVID response to be different unless it was managed in a responsible manner from the top down? 'Cause it certainly wasn't gonna get a consistent reasonable response if driven by grass roots efforts?

Going back to the hospital pharmacy. There IS a plan - get those people the vaccine.
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The difference here is the political overlay. It has colored the reported data both nationally and internationally and unfortunately it has driven a lot of our hysterical response to it. It's hard to know much about the reality of this disease other that the many distressing anecdotes we keep seeing.
 
X3 Skier said:
The difficulty of determining how to actually deliver the shots to people who live in a place like my winter home in the mountains 3 hours from a major city and my main residence in a large city is not something I would trust a relatively small group of people in Washington DC who probably couldn’t find my winter place if they looked for it for a week, much less figure out how to get it there.
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I've said this will be an incredibly difficult challenge all along. But we've had 6 months to plan it. If serious "feet on the ground" planning and work has been accomplished in the last 6 months, I've missed it. This needed to be a top-down mandate with funding to make it happen. For instance:

Priorities: First responders, people in assisted living, healthcare. After that, by age buckets.

Volumes: Each congressional district (set by population, right) must set up facilities and staffing to inoculate 50,000 individuals/wk for 6 months given 30 day's notification. It is assumed that each inoculation will require an hour's nearby parking for a vehicle, plus 5 minutes of induction time, 5 minutes of inoculation time, and 15 minutes post-inoculation observation for each recipient. Plan for 2% of recipients to have a reaction to the vaccine and to need an epi-pen or other treatment in a nearby facility. Have first responders and transpiration on-site to provide this level of care. This is likely to require a minimum of 20 locations per district, fully staffed 24/7 for the duration of the effort.

Communication: At the arrival of vaccines, communicate to the community at large the approximate vaccination "windows" for various groups. Provide weekly updates.

Responsibilities for each district: Set up 20 or more vaccination locations, complete with parking and appropriate facilities. Follow prescribed communication plan. Etc.

It is a big job and I don't think many locale's have been grinding away to comprehensively solve the "final mile" problem.
 
kyleb said:
Plan for 2% of recipients to have a reaction to the vaccine and to need an epi-pen or other treatment in a nearby facility.
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The severe reaction rate will be far less than 2%, it will be a small fraction of a percent or it never would have made it much past Phase 2 trials. Think of how few severe reactions you've heard about so far, with a couple million doses administered. But, yes, each place administering the vaccine needs to be prepared. The moderate reactions can either be "walked off" or treated with something like Benedryl.
 
kyleb said:
I've said this will be an incredibly difficult challenge all along. But we've had 6 months to plan it. If serious "feet on the ground" planning and work has been accomplished in the last 6 months, I've missed it. This needed to be a top-down mandate with funding to make it happen. For instance:

Priorities: First responders, people in assisted living, healthcare. After that, by age buckets.

Volumes: Each congressional district (set by population, right) must set up facilities and staffing to inoculate 50,000 individuals/wk for 6 months given 30 day's notification. It is assumed that each inoculation will require an hour's nearby parking for a vehicle, plus 5 minutes of induction time, 5 minutes of inoculation time, and 15 minutes post-inoculation observation for each recipient. Plan for 2% of recipients to have a reaction to the vaccine and to need an epi-pen or other treatment in a nearby facility. Have first responders and transpiration on-site to provide this level of care. This is likely to require a minimum of 20 locations per district, fully staffed 24/7 for the duration of the effort.

Communication: At the arrival of vaccines, communicate to the community at large the approximate vaccination "windows" for various groups. Provide weekly updates.

Responsibilities for each district: Set up 20 or more vaccination locations, complete with parking and appropriate facilities. Follow prescribed communication plan. Etc.

It is a big job and I don't think many locale's have been grinding away to comprehensively solve the "final mile" problem.
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This ain’t rocket science and any competent State/Local Public Health Organization should have the brain power to plan and execute. No need for the people in DC to get involved. As you say, “It is a big job and I don't think many locale's have been grinding away to comprehensively solve the "final mile" problem.”

Cheers
 
Jeff Oslick said:
The severe reaction rate will be far less than 2%, it will be a small fraction of a percent or it never would have made it much past Phase 2 trials. Think of how few severe reactions you've heard about so far, with a couple million doses administered. But, yes, each place administering the vaccine needs to be prepared. The moderate reactions can either be "walked off" or treated with something like Benedryl.
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I was listing hypotheticals, and I'm sure there are a ton of 'em. The bigger point I was trying to make is I don't think there is an integrated distribution plan for the huge volume of vaccines that need to be given for this thing to be squashed by mid-year. Seriously, it is 50,000 vaccines/wk for every congressional district for 6 months to inoculate 265 million people, which is ~80% of the population.
 
X3 Skier said:
This ain’t rocket science and any competent Public Health Organization should have the brain power to plan and execute. No need for the people in DC to get involved. As you say, “It is a big job and I don't think many locale's have been grinding away to comprehensively solve the "final mile" problem.”

Cheers
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I'm telling you, there are great people in public office. But how many people with serious distribution, logistics, and planning skills do you think there are in public service at the local level? Maybe I'm underestimating them, but my guess is the number of people in those organizations who have those skills is awfully small.
 
MacFly said:
The difference here is the political overlay. It has colored the reported data both nationally and internationally and unfortunately it has driven a lot of our hysterical response to it. It's hard to know much about the reality of this disease other that the many distressing anecdotes we keep seeing.
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I hear often that the CDC and WHO numbers are wrong. I always ask if one has a better number. Usually there isn’t one but until the “official” numbers are proven wrong, I tend to believe them. Overacting or under reacting is a different question well worth debating. Dead people are dead, politically driven actions are always debatable.

Cheers
 
As the politics fade with time...don't know how much time...we will be more likely to get an accurate retrospective picture that might help us out when the next pandemic comes along. Unfortunately, I fear the those politics have hopelessly poisoned the data we have collected.
 
kyleb said:
I'm telling you, there are great people in public office. But how many people with serious distribution, logistics, and planning skills do you think there are in public service at the local level? Maybe I'm underestimating them, but my guess is the number of people in those organizations who have those skills is awfully small.
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The ability of my local Public Health outfits along with local hospitals and the Guard to set up and operate public test sites almost immediately and administer tests was exemplary. Not in the medical field but instead of sticking swabs up noses vs needles in arms looks to me like a somewhat similar exercise with the exceptions of handling the vaccine and the small chance of an adverse reaction

My point being, having DC in the “last mile” is very likely a bigger hindrance that help. If the State is incompetent, I feel for the folks there. Sometime the Feds do it better, most times they issue a “one size fits all” solution which I think is worse. Just my opinion.

Cheers
 
chemgeek said:
True, as long as your facility is confident of using up all those doses quickly, as it is difficult to store in dry ice indefinitely.
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If you build it, they will come.

Around here, I think it's more of making sure people know when & where it's available, and the does will be used up fairly fast. I haven't heard anything about a schedule, availability, etc. in Colorado. But then, I don't get a daily paper.

Update:
Turns out the State of Colorado Public Health dept has published a list of facilities receiving the vaccines - in fact, the number of Pfizer and Moderna (seems like lots more Moderna).

Next question - how to get the vaccine? I'm in the 1B group - do I call one of the facilities or what?

On the other hand, not getting the vaccine would be a great excuse to not go back to the office when it happens.
 
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kyleb said:
I'm telling you, there are great people in public office. But how many people with serious distribution, logistics, and planning skills do you think there are in public service at the local level? Maybe I'm underestimating them, but my guess is the number of people in those organizations who have those skills is awfully small.
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You’re underestimating them. There are lots of very talented local public health officials and employees who have been distributing vaccines and other medical services to the community for decades without fanfare or recognition.
 
X3 Skier said:
My point being, having DC in the “last mile” is very likely a bigger hindrance that help. If the State is incompetent, I feel for the folks there. Sometime the Feds do it better, most times they issue a “one size fits all” solution which I think is worse. Just my opinion.

Cheers
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I don't know that DC can set up the last mile, but they can provide boundaries and guidance. Or the swiss cheese theory of accident prevention (or avoidance) is likely to come into play.
 
Cervieres said:
You’re underestimating them. There are lots of very talented local public health officials and employees who have been distributing vaccines and other medical services to the community for decades without fanfare or recognition.
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I hope you're right. And then I see that instead of doing 20M vaccinations in December, we got about 60% of that.
 
Somewhere around 40% of the population gets the flu vaccine every year. They just need to double that, maybe not even, since kids get the flu vaccine. I never needed to wait more than a few minutes at the local chain pharmacy for mine. I could also get one from my medical provider, but walking 2 blocks to the pharmacy was easier. When I worked, they had flu shot day, when everyone who wanted one could get one. Seemed like they could do one every couple minutes. I realize that there are more cold storage issues with COVID vaccines, and the need to monitor people for a certain length of time. But simply putting them into arms doesn't seem like it would be such a big logistics problem that would need federal intervention. Not sure what the problem is. Maybe distribution, and everyone wanting it at once, that is, except for the people who don't want it... That said, I have no public health background, so I have no idea.

https://www.cdc.gov/flu/fluvaxview/coverage-1718estimates.htm
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kyleb said:
A complete abdication of the government's most fundamental responsibility which is to protect the citizens in times of national emergency.
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Not much of a history buff?

Most people don’t believe fairy tales much past their teen years.

Palmpilot said:
There has been a tendency for each peak in infection numbers to be much larger than the last one.
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Linear math. The entire time. Who’d a thunk it? Multiplication be multiplication, dawg. LOL. :)

“Official” infection numbers are still at 20 million. 300 to go. Just getting started still, a year in. Probably means the vaccine footrace will win.

Depends on what multiplier one chooses for the SWAG of where actual cases are. Choose your favorite fiction...

MacFly said:
It's hard to know much about the reality of this disease other that the many distressing anecdotes we keep seeing.
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Was there some expectation of the majority of “news” not being made up mostly of distressing anecdotes during a pandemic?

That’s what sells ads, even in normal times. We all know this. We all watch the “dangerous light airplane you’re all gonna die” stories. LOL.

I honestly chuckle when people are expecting different human behaviors of organizations during the pandemic than the behaviors they know are entrenched and always there in any other years.

Like some magic switches were thrown because ... Covid... and all of a sudden government was well run and extra effective, or news companies suddenly got serious are weren’t sensationalists for a living. Ha.

Doesn’t work that way. If anything one should expect it should be (and truly has been), stupider. Haha.
 
Funny how some crave the vaccine & others don’t want it.

I’m officially neutral, next Summer will be fine by me.
 
kyleb said:
Don't you need to (roughly) quadruple it to achieve ~80% x 2 doses/ea?
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Good, point, but I still don't think it should be that big a problem. I never see lines at the local pharmacy for shots, even though there is a big sign out in front... even now.
 
murphey said:
Turns out the State of Colorado Public Health dept has published a list of facilities receiving the vaccines - in fact, the number of Pfizer and Moderna (seems like lots more Moderna).
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Hopefully that works better in Colorado than Texas. Almost every site listed here is only providing shots to their own employees. It's useful for knowing who received shipments but not for knowing where to get a shot.
 
Lindberg said:
That's why we flattened the curve. And they did precisely nothing. Trained no new ICU nurses, equipped no new beds.
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I think it takes longer than that to train new ICU staff, so we're pretty-much stuck with the ones we have now for this pandemic. The best we can do is start investing in better healthcare capacity before the next crisis, and hope we have at least 10 years before it hits. The U.S., Canada, and the U.K. have all seriously underinvested in hospital beds for decades (under both left-leaning and right-leaning governments) to keep taxes low, and we're paying the cost now (with loanshark interest). I know this doesn't tell the whole picture—the numbers include all beds, not just critical-care ones, and our three countries invest more in home care as an alternative to hospital care—but consider the number of hospital beds per 1,000 people just before the pandemic hit:

Japan: 13.0
South Korea: 12.3
Germany: 8.0
France: 6.0
US: 2.8
Canada: 2.5
UK: 2.5

Homecare is a better alternative in many ways, but when a pandemic hits, it means that we just don't have the resiliency of many other countries, so we have to take stricter measures to protect the little hospital capacity we do have. It will take many years to fix that, both building new hospitals and training up a new generation of critical-care health professionals. I hope we don't forget and start shortchanging healthcare again as soon as the pandemic is over, or else we'll have the same problem next time. :(
 
David Megginson said:
I hope we don't forget and start shortchanging healthcare again as soon as the pandemic is over, or else we'll have the same problem next time. :(
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You're funny. I've seen no indication (and I could have missed it) that we're investing in more healthcare infrastructure and/or capacity for the long term.

Did I miss something?
 
kyleb said:
You're funny. I've seen no indication (and I could have missed it) that we're investing in more healthcare infrastructure and/or capacity for the long term.

Did I miss something?
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No, we're not, as far as I can see. I hope that will change. Long-term investment isn't a great fit for politics, because politicians take all the blame for higher taxes right now, while their successors get all the credit for the new infrastructure in 10–20 years. In the end, though, that's our fault as voters — in a democracy, we get the politicians we deserve, and no better.
 
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