You can tell what kind of pressures the local distribution systems (or lack of) are under, but the missteps are still shameful.
You have people over 75 years old who were waiting and registering on whatever reservation system was cobbled together on short notice, and then because the public health authorities now risked throwing out doses for want of people to inject them into, they just opened the floodgates to everyone over 65.
So what happens to the people over 75 who were waiting, and now are swamped by the crowds? If they keep on opening up bulk tranches of the population (instead of in small slices) before people of priority are reached, when will the most vulnerable ever get their turn?
This is a known problem. Multiple queues of priority and people on call to be given turns the next day if it looks like there's capacity.
Instead you have people wondering if they should walk in, visit a county next door, or wait around in case some mistake is made and there are actually extra doses at the end of a day. Or try to scheme/figure out the system however they can, out of desperation.
If it can't be done right, let everyone know that it's up to their willingness to wait wherever they can, according to some basic ground rules, and don't make a meaningless (or worse, deceptive) reservations system that gets bypassed at the last minute.
Opening vaccine eligibility up, and allowing walk-ins if doses will expire, is part of how Israel was so successful at distribution. Multiple priority queues are nice in computer science, but managing them with time-sensitive vaccine doses is hard. Simple, imperfect and fast is better than perfect, complicated, and slow.
Getting a large swath of people vaccinated is more valuable than perfectly getting prioritization right. Prior to this change, NY was attempting to perfect prioritization, and was discarding many doses as they expired.
In my opinion, the US’s top level goals were wrong (over focus on equity versus utility) and the US bureaucracy is neither flexible nor creative as evidenced by its refusal to buck top level orders and it’s continuing slowness. These are signs of a decaying system.
> the US bureaucracy is neither flexible nor creative as evidenced by its refusal to buck top level orders and it’s continuing slowness. These are signs of a decaying system.
Yes, and it’s because the priorities rank as follows for each individual:
1) personal liability
2) organizational liability
3) utility
Where liability includes both legal and public relations consequences. It’s exhausting to constantly think about open ended and unintended consequences that you might be held accountable for, with no recourse.
I completely agree with you about the US over-focus on equity with the vaccination effort. By all means attempt a best effort at vaccinating at-risk populations first... But at the end of the day, even the at-risk-but-vaccinated folks are still at risk as long as herd immunity isn't reached (the vaccines are 95% effective, not 100%). Lots of shots in arms, quickly, is more important than being extremely particular about whose arms the shots are in and in what order they are inserted. Israel will eliminate COVID as a serious concern by March; is it more "equitable" that Americans will likely continue dying through the summer, but at least they're dying in the right order?
Also, they paid a lot to have early access to a lot of vaccine.
Michigan (my state) is doing about 35,000 doses on weekdays at this point, which is frustratingly slow. But if they had spun up twice as fast, we wouldn't be doing 70,000 doses a day, we'd be out of vaccine.
The most recent shipments have been ~120,000 vaccines/week for 2 weeks and then none for a third week. So if the tempo of Federal allotments is 120,000 a week, the 35,000 a day is not a bottleneck. They should of course be building capacity anyway, with the idea that deliveries will increase (and making a plan for what to do if/when the adenovirus vaccines are approved in the US; fortunately it looks like that can be "send it everywhere").
Anyway, wasting vaccines is obviously stupid, I'm not trying to argue about that.
We should also open up expired vaccines to whoever wants them. Expiry dates are usually quite pessimistic and medicines often have efficacy long after they're officially expired.
This is a different model of expiration. This isn't "two-year shelf life can be extended to five years w/ stable temperature and humidity and only a 10% loss of efficacy."
This is "once this vaccine is pulled out of the super-cold freezer, it starts breaking down, and you have X hours before it's worthless at best."
Worse than "worthless" is the idea that people might get a useless expired vaccine anyway, think they're protected, and then be a vector for future transmission.
Well, at the begining it caused a lot of mess. And then it was much more controlled.
I wouldn't say this is what help us in the efficient distribution.
What really helped is a very centralized healthcare system with a very long history of managing public emergencies.
This is because Israel was founded as a socialist welfare state, and the impressive healthcare system is one of the leftovers.
I'd be less concerned about people over 65 "sneaking in" over people more than 75 than systems that end up being a free for all anyone to get vaccinations because they're in the right place at the right time (and presumably getting second vaccinations as well).
A lot is really about overall volume. Even a million vaccinations a day means you're looking at well into the summer until you even approach 50% vaccinated.
There are 260 million American adults. Already 12 million receiving a vaccine. Approaching 1,000,000 per day receiving first dose. At that rate we’ll need 118 days to have half the population vaccinated with a first dose in mid-May and the second dose in early/mid-June.
OK. So early summer. And that's 50% which some would say is not nearly high enough for people to get on with their lives (but may, or may not, be a reasonable target--especially given that a fair number of people will hold off).
Also unknown is the number protected by prior infection. Anywhere from 10-30%.
I think we’ll see R’ start to plunge during summer due to weather and never climb back up from increase in immunity. But “back to normal”. January earliest.
Most events people I know are betting on things being normal-ish by the fall. Doesn't mean they're right of course although they were right enough to shut things down at a time when many people were still thinking it wasn't that big a deal.
There are also gradations of normal although once you fully open up restaurants, have indoor concerts, packed auditoriums, etc. most things you could do to reduce spread are pretty much theater at that point (other than possibly requiring vaccinations to fly, enter venues, workplaces).
Make sure to take a screenshot of whatever confirmation you get. Because servers are overloaded, some people in my area did not get confirmation texts or emails.
If somebody is elderly, the chances of them getting an appointment is extremely low without the help (and extreme vigilance) of their tech savvy children/nieces/nephews.
Some states have also opened up their registrations to people 16+ with serious chronic health conditions that put them at high risk of severe COVID-19. In a handful of these states, many of these people have received a vaccine. But, it is first come first serve, which is an absolute disaster along with being inequitable.
>"infinitely scalable for a price" cloud systems like AWS exist.
That only applies if your application is programmed for it. Good luck scaling even if you had aws if your server had database locks everywhere, for instance.
Yeah, the college I went to back in '09 _just_ started teaching version control. All we learned were concepts and common languages from each of the major domains of programming, and math. That's it. (Think like SQL for DB, Java / Python for application development, c and c++ for embedded systems and operating systems, etc.)
And why now? I'm sure it would be much easier than normal to get AWS and some relevantly skilled professionals to donate enough time to make a workable reservation system.
The point of the vaccine is to keep the health system from being overloaded. Over 75s are already being triaged out of intensive care in many countries, so it matters little on a society-wide scale whether they get the vaccine or not. In fact, somewhere in the news today I read an official claiming that it is 60-75 year old people who are the most important vaccination target to begin lifting lockdowns.
As has been often emphasized, the reason that COVID-19 is considered a pandemic of such dangerous degree to require a rapid development of vaccine, is because it overloads hospitals and can deny many others (not just COVID sufferers) access to urgent treatment. Without that factor, the most vulnerable demographic for COVID-19 in terms of mortality rate is e.g. elderly people in care homes who are ordinarily a low priority for innovative medical treatments, and it is hard to imagine a vaccine would have been rushed just for their sake.
It wasn't rushed, the science was ready to go early last year and all they did was accelerate the first trial phases, the Phase 3 trials went quickly because infections were so widespread.
That there are multiple candidate vaccines targeting the spike protein without using the virus directly is strong evidence that the science was ready (using mRNA, viral vector and other technologies).
The missteps suck, but I really dont think it is on the local health departments very much. The federal government shouldve really been taking a lot of the load themselves. My local health department has a dozen workers and has had to handle the pandemic basically on their own the whole way through. The outbreak was so bad in October/November that they literally couldnt finish counting all the cases in a day multiple times. Now, in addition to trying to handle the outbreak, theyre also being tasked with distributing a vaccine in record times. And through all this, theyve been underpaid and harassed by a significant portion of the population
What about your state? They are the ones who are supposed to handle stuff like this.
To me it is a cop-out to blame the feds. There is nothing to stop any state in our union from addressing this pandemic as they see fit. The states making up the Euro aren't blaming Brussels for their problems.
The converse would be to have one world government make decisions for everybody, right? That would work if we all agreed on everything, but we don't. So it is good to have different states try different solutions, and copy what works. Better then having a bad federal solution imposed on everyone.
> There is nothing to stop any state in our union from addressing this pandemic as they see fit
Except for zero funding...
My state is definitely to blame too, our new governor is an absolute disaster. But, we also have no serious funding left to handle the pandemic. Our last governor started a rainy day fund years ago and exhausted that last year, along with part of our wildfire fund. There is nothing left for us without federal assistance.
There is absolutely a middle ground between putting everything on the state and having one government rule the entire world. The federal government is the best equipped entity in the United States for handling the pandemic. It has the funding, personnel, and logistics management to efficiently distribute vaccines.
It is my understanding that it is the states' responsibility to handle situations like this.
The fact that some states are not doing a good job doesn't incline me to want to gamble on the federal government doing better. They don't have a good track record in emergencies.
You might end up punishing the states who are doing ok, and possibly causing a lot of problems forcing everyone into one solution.
At some point politicians need to be held accountable. Passing the buck for everything is not a great answer.
> It is my understanding that it is the states' responsibility to handle situations like this.
Its only the state's responsibility now because the federal government fumbled hard initially and had to pass blame because it was an election year. When is the last time states had to handle disaster relief on this scale with little to no assistance from the Federal government? A strong central force is crucial to handling crises like this, ours just blew it.
You can have input from local officials on setting up locations and timelines for clinics, but the 12 people making 20$/hr working in my local health department shouldnt have to deal with some of the most complex logistics the country has ever seen.
This is absolutely the best time to mobilize the massive military logistics chain in order to distribute and use vaccines as fast as possible.
If states are truly doing a great job (not many are), they can always decline assistance, but it isnt even being offered in the first place at this point.
> At some point politicians need to be held accountable. Passing the buck for everything is not a great answer.
Are you not just passing the blame onto local politicians and off of the federal level ones that hold most of the power?
Handling disasters has always been the states' responsibility. They are the ones with the power to address this. That part of the constitution is still intact. This is why Biden can suggest wearing masks, but is powerless to mandate them, amongst other things.
I think that it is wishful thinking to believe the military could be re-purposed to make a significant difference. Their job is to blow things up and kill people. It seems the field hospitals deployed were a drop in the bucket, and I assume that all doctors and nurses are already busy. What else would you expect from them, or the rest of the federal government? I'd be afraid of a single bad solution being forced on everyone. The feds have a pretty bad record of moving fast.
Perhaps this is just a difficult situation and is not going to go as smooth as you'd wish? There's no magic bullet here. It's a pandemic. Covid has killed as many people per-capita as the low end of the estimated 1-4 million deaths from the 1968 Hong Kong flu. These things happen.
Also there is no widespread disagreement on what the response should be. i.e. Would our national response follow the NY model or the Florida model?
Yes, I would blame states for local problems. If your state setup a system leaving twelve local $20/hr employees in a bad situation I would say that is your state's fault. What makes you think the feds could do a more effective job?
There is no "window" for the second dose. It's a booster; it doesn't really matter when you get it, so long as it is more than 3-ish weeks from the first injection.
My understanding is that it's not especially important to get the second dose within a particular window. A surgeon friend got her first dose and said she was planning to delay the second one for a while so that more first doses could go out to others, and that it would be just as effective for her if she got it later. She's also relatively young (under 40), so she isn't as concerned as some people might be.
Honestly I don't know how she can be that confident that timing of the second dose doesn't matter, since this doesn't seem to have been tested with COVID vaccines. Perhaps it is a feature of vaccines in general?
In terms of individual results, having the second vaccine would be best, but in terms of getting partial immunity to most people, getting the first one only would be better for everyone.
If the population was homogenously vulnerable this might be the case, but with a millionfold difference in mortality between the aged and young and healthy prioritizing a second dose is the ethical choice.
>Honestly I don't know how she can be that confident that timing of the second dose doesn't matter, since this doesn't seem to have been tested with COVID vaccines. Perhaps it is a feature of vaccines in general?
Given that this is a completely novel vaccine, and there is zero clinical data to support that statement, there is literally no way she can know that for sure.
However, the Moderna vaccine confers an immunity approximately equivalent to convalescent COVID-19 patients within two weeks of the first dose, so she's probably fine.
Like quite a few things--for example, whether a vaccinated person can still spread the virus or if there could be long-term effects--the companies are quite correctly saying that they have no data to make a definitive statement. That doesn't mean that health professionals can't have fairly strong suspicions based on their experience with other things.
So, yes, Pfizer's position is (and should be) this is the data from the tests we ran. Pretty much anything else is speculation.
The UK is experimenting with 24 hour clinics which presumably avoids the "left over" phenomenon. If you're never shutting for the day any doses you have right now are for the next patients, if you're vaccinating patients more quickly than anticipated you can bring forward some appointments but you never have this hard cut off.
After all, under total lockdown it's not as though you're likely to be anywhere except at home waiting to get an appointment.
An interesting contrast will be New Zealand. Since they have community elimination they didn't seek emergency use authorisation, why not wait and study what happens to the millions of people from other developed countries who needed urgent vaccination? They will do mass population vaccination during 2021 but this month or next doesn't mean thousands or even handfuls of deaths, so there is no hurry.
This might reduce take up. If you live in New York you probably at least know somebody who got badly sick, maybe died - but if you live in Wellington you likely have stopped even thinking about the pandemic most days unless you work in quarantine or the tourist industry.
In Wellington (I live there) there's a QR code on every shop you're supposed to scan with your phone for contact tracing. Most people don't but they still see them - so yes it's still on our minds.
There are supposed to be QR codes here. I only visit one place, to buy food every 7-9 days, they don't have a QR code and employees seemed confused about what one was or why I might be surprised not to see one. I gave up rather than expend any more time trying to have a conversation through masks with confused people about something they can't fix.
They did, I noticed when I last visited yesterday, begin explicitly telling people that "One adult shopper" does not mean, "What a fun outing, let's all go to the store as a family and increases everyone's exposure for no reason".
Historically New Zealand's government has found that compliance isn't massively improved by empty threats, and police resources aren't available to have an officer at the front door of every shop in the country and enforce such a law, so there isn't one.
What does improve compliance is an actual negative event. The change in public reaction to funeral restrictions in lock down when people attending a funeral got sick (and I think one died?) was noticeable. Reported consequences make the policy much harder to ignore. And if there hasn't been enforcement the way human memory works, if on Tuesday a human decides complying with a rule is good, they are now more likely to remember having complied with it on Monday, and retrospectively they will come to believe "obviously" they always obeyed that policy, it was the sensible thing to do.
That's cheaper and more effective than policing. But it may cost a few lives to provide the example.
Compliance could be easily checked by the mystery shopper method though. If a store gets fined for not enforcing QR codes through a random check, they're more likely to enforce it and deny non-scanning shoppers entry.
> This might reduce take up. [...] if you live in Wellington you likely have stopped even thinking about the pandemic most days
It would certainly reduce the urgency of take-up, but I would expect there to be a pretty strong correlation between how well a city/country deals with the pandemic, and the proportion of residents in that region who think that getting the vaccine is important, even if it's a vaccine for a virus that's not directly affecting them right at this moment.
I live in a region that eradicated the virus a long time ago, but I still think about it almost every day because the world's so interconnected. It has had almost zero effect on my personal life since March, but the vast majority of my friends overseas are in unending lockdown cycles, and international news is almost exclusively about the latest death tolls or what the vaccine progress is like. It would be pretty difficult to not know what's going on.
> An interesting contrast will be New Zealand. Since they have community elimination they didn't seek emergency use authorisation, why not wait and study what happens to the millions of people from other developed countries who needed urgent vaccination?
Keeping it out is proving to be quite hard, an exception for quarantine workers, flight crew, returning citizens and anyone connected to them would make it much easier.
It seems like the world is already learning though and countries that have eliminated the virus may find vaccinating the extremely frail to be a net negative and rely on herd immunity to protect this group.
> As I got closer, though, I started to believe that if the rumor was true, I would never have been able to justify to myself that I had stayed at my desk and turned down an escape from the pandemic.
I just recently got my first shot of the Moderna vaccine last week. When I learned that I would be getting it, I went through the same euphoric excitement the author is describing. Then it slowly dawns on you that this is simply a bandaid. Something to stop the massive amounts of deaths. It's not going to miraculously end everything and make the world go back to normal. There is no "escape". You're not going to be hopping on flights, vacationing, and going to bars again any time soon.
This is a real mistaken mindset that I think people are going to have to come to terms with. The vaccine is not a silver bullet. It doesn't just make the virus magically bounce off of you like a force field. You will still get infected if you are exposed, and can very well still transmit it. The vaccine simply keeps you from developing severe disease.
We (the human race) have a long, slow, painful slog ahead of us to return to anything even resembling what things were like in Fall 2019. The virus is going to become endemic. Overall population vaccine uptake will most likely look like Flu vaccine rates (<50%). And that means life will never be quite the same.
> There is no "escape". You're not going to be hopping on flights, vacationing, and going to bars again any time soon. We (the human race) have a long, slow, painful slog ahead of us to return to anything even resembling what life was like in Fall 2019.
Wow. You're entitled to that bleak outlook, but unless you're in a super-high risk group, I would advise you to snap out of it and resume living your life.
I've literally done all of the things you listed in the past month. Additionally, I'm at the gym 5x a week. If you're safe/responsible, there is absolutely no reason you can't do 99% of the things you want.
>I've literally done all of the things you listed in the past month. Additionally, I'm at the gym 5x a week. If you're safe/responsible, there is absolutely no reason you can't do 99% of the things you want.
The reason I'm not doing those things isn't because I can't. I'm at practically zero risk now that I've been vaccinated. The reason I'm not doing it is because I don't want to be around people like you.
In 6 months from now, when there's no excuse to not be vaccinated, that will be a different story. But people going about normal life right now as if nothing were happening are the reason we're seeing 4,000 deaths a day in the US, and they are objectively bad human beings.
Almost every country in the world is seeing similar per-capita death rates, about 1 in 1000 people so far, skewing much towards the old and/or already unhealthy.
Some perceive this as a high risk and would be happy to impose a police state on everyone to stop the pandemic.
Others perceive this as a low risk to themselves and don't want to give up a year or two of their lives to lockdowns.
Who gets to decide?
I'm a big believer on not unnecessarily imposing on other people. I think it's fine that you want to self-isolate. That is not my choice. I hope you can respect that.
It's not a binary choice between sacrificing the most vulnerable people and long periods of social distancing (the US has not ever really had anything resembling a lockdown, maybe your country has if you are from elsewhere; in the US we have had weakly enforced shelter in place orders and business closures).
In the US, smarter choices could have resulted in less death and a more robust economy. Just some leadership and resources devoted to contact tracing could have made a huge difference in how things went after May.
Were there any states that did real lockdowns or contact tracing? If not, then perhaps the political will did not exist to do so. There certainly is disagreement on such things. If peoples of so many states could not agree on more drastic measures, it would not have been right to impose them from above. Also the constitution limits what the federal government can do in this regard.
The extent to which the mRNA vaccines prevent infection is unstudied, it is not conclusively known in either direction whether they confer sterilizing immunity.
The mechanism of action is reason to believe that they might.
This is shameful - authorities knew the vaccine was en route to being made available towards the end of last year. COVID has been a persistent nightmare for many localities for the past 10 months. Nobody planned for this?
I can't help but feel that the media is responsible for this also - when being informed that vaccines were on the way in the 2nd half of last year, they resoundingly pooh-poohed it and refused to consider the possibility, instead preferring to wallow in the world's misery. It's good for their advertising!
I don't think people realize how bad the distribution problem is. My state is sitting on 800,000 doses. Four times than what they've given out. It's just craziness that after a year of this we can't handle rolling out a vaccine.
My current city has about 1 million people in the metro area. They are only doing doses at one indoor building, and to date done 4,000 shots. It's honestly appalling.
Be aware also that the federal government immediately increments the "doses given to state" number, while states may not report the "doses given" number back to the federal government promptly, so seeing one number being much larger than the other isn't necessarily proof that there's a distribution problem
I'm interested in evidence that the vaccine works. Where should I start?
(I know how this sounds, but it's not like that. It's more like, it's a modern miracle that we have any vaccine at all within a year of an outbreak, and I am extremely keen to understand how this is possible rather than just accepting it as a thing that exists now, like airplanes.)
EDIT: No complaints, but it's fascinating how polarizing this topic is. One wouldn't expect a straightforward request for information to generate such feelings. Thank you to everyone who provided resources!
They had a placebo arm and a vaccine arm. Look at figure 2 on page 30. You can see that new COVID cases in the vaccine group virtually stop on day 12 while the placebo arm continues to grow.
This is the right answer. This is the only reason that we know that it works. The other answers are more like the history of this vaccine (which are really interesting though)
And the reason we have that data in such a short period of time is horrifying for exactly the expected reason.
You are obliged to conduct a natural experiment. We do this thing (vaccination) we expect will work, on some fraction of a test population, and then we wait. Some other tricks could work, in theory but they're often unethical and unlike this experiment they aren't a direct model of the real world. "Does it actually work?" is an incontrovertible test.
But it should take years to do this, because obviously hardly anybody is going to get some horrible deadly infectious disease right?
Unless, as happened in most of the world, you have exponential pandemic case growth as measures to prevent spread are half-arsed or just not implemented at all.
Then it turns out - good news - that's a great environment for proving your vaccine works quickly. Shame about all the dead people though.
Yes, but - playing Devil's advocate here, I'm a solid believer that vaccination is our best chance out of this - the opposite is also true: because the disease is so virulent we are willing to play fast and loose with researching long-term side-effects. And unfortunately, the conspiracy theory circles are already full of bullshit about supposed side-effects of the vaccines (one I've seen a lot is that 'women may become temporarily infertile'), despite every trial not showing any such side-effects.
Do you have any source that on " (one I've seen a lot is that 'women may become temporarily infertile'), despite every trial not showing any such side-effects.". I want to forward it to the ppl I know who heard this. To show this, they need to monitor the conception rate after vaccination with the control group. Is this actually monitored? (what I sometimes found that 'no evidence' means 'we do not have data';like they claim in German trains no transmission has ever been found; spoiler, they didnt register and check names of passengers)
Upvoted. I have same noob questions. Appreciate the many good replies. I'll get my shot(s) asap. Am also trying to persuade family members who are more reluctant.
There’s a great interview of Fauci explaining exactly how we got it done so fast. But basically - years of precursor work had been done on both other coronaviruses and mRNA vaccines. So they were in phase 1 trials in 6 weeks.
You can read up on the background here: https://en.wikipedia.org/wiki/COVID-19_vaccine#Background but the tl;dr is that we were very lucky to be hit with the less serious SARS and MERS diseases years ago, as they got the world started on coronavirus vaccines that ultimately were turned into the covid vaccine.
(Important caveats: I have family and friends who work in healthcare and drug discovery, so I’ve got a tiny bit of layperson background on this, but this is far from my field and I’m far from an expert)
I’m not an expert, so heaping tablespoon of salt and all that, but it seems like we were on the cusp of a revolution in vaccine development due to this mRNA method of making vaccines, and Covid came around at just the right time where a big infusion of cash into mRNA vaccine research could get the technology over the hump.
Again, totally not an expert at all, but from what I’ve gleaned this whole novel mRNA thing is key to understanding why this was so fast and why other vaccines in the future could come really fast as well.
This jibes with my understanding as well. I believe that research into mRNA vaccines began somewhere around the very early 1990's or very late 1980's, so the idea itself is not new. And vaccines (or candidate vaccines) were developed for earlier illnesses like MERS, but none ever made it as far as approval for widespread human use, for various reasons. Mostly, AIUI, because the outbreaks ended before they got that far and so it was no longer economically justifiable to continue the process.
So yeah, basically, COVID came along and suddenly there was money and impetus to push the thing over the finish line, and so here we are. That's my lay-person's understanding anyway.
You are not that keen to figure it out, the information has been readily available for a couple of months, and it was headline news for a week when the info for each approved vaccine was released.
You can see why some people might think the vaccine is somehow fake since people went (and are still going) ape shit over masks even though right on all of the boxes it clearly states that masks do not protect against Covid.
And before I get lynched: I am all for the vaccine since that has been tested to work and I still wear a silly mask even as it does nothing since I'm tired of people complaining.
I’ve never seen anything like that on a box of masks. And we are pretty sure they do provide partial protection from spreading the virus to others, and likely lowers the dose of virus you get from others.
Just read the box. They all say "this is not a respirator, does not protect against airborne bacteria" (this is paraphrased, since I have just seen my local products).
Even my local national health institute says that masks only protect against droplets from coughing, sneezing, or talking when in close proximity. Which I can grant you, but normal people shouldn't be coughing or sneezing into other peoples faces anyway. Which only leaves talking, but I don't see why grocery store is a place to socialize anyway.
IMO masks are only a thing because helpless people had the need to "do something" and masks are visible way of showing you are doing your part. Plus it didn't help that right wing nut jobs started a war against masks.
There is empirical evidence face coverings (of basically any fabric) reduce transmission rates. It's not like a respirator where there's a testing guarantee that if you're in an atmosphere full of infectious agents you'll be fine, but spreading or catching a virus is a game of probabilities and masks reduce those probabilities.
I understand the justification for having restrictions on who can be vaccinated but part of me thinks this is all extremely counterproductive. Yes, old people are at greater risk but also the more young people are vaccinated the harder it is for the virus to spread and the faster we reach herd immunity which also ends up protecting old people. I end up thinking about this great video [1] by CGP Grey where he explains that the most efficient boarding method for an airplane isn't actually front-to-back but just random. Surely if we just said anyone could get a vaccine then we'd be more successful in reaching herd immunity right?
Edit: You could also just make a portion of the day for older people only and the rest of the time open it up to everyone. I feel like right now we have the worst of all worlds
I think the main function of the vaccine in the initial stage is to lower the amount of people who need hospitalisation after contracting covid. So giving limited doses to the people who are most likeley to develop severe symptoms seems like best strategy to achieve that. Even if it pushes back date of achieving herd immunity a little.
So prioritizing health care workers (they can easily contract and spread) and old people (a lot of them need hospitalisation) seems like a good idea.
I'm 41, Israel opened up the vaccines to people over 40 yesterday. Called my HMO, made a same day appointment for their vaccination center at the local stadium, went there by bus in the rain. swiped in with my card when I got there and was given a number. waited close to an hour for my number to be called, got quickly stabbed in the upper arm an soon left.
It really shouldn't be that hard. My parents (i.e. 70ish) are now scheduled to get the vaccine towards the end of february in maryland.
Having comorbidities like obesity, diabetes, etc increases your risks from the virus by a factor of 2-4. Being old vs young increases your risks by a factor of 1000. You are at more risk than your peers but still at far less risk than even a person in their 60s.
It's complicated and I generally trust the CDC recommendations to be reasonable judgements. But they're not infinitely fine-grained. The rules in lots of places have healthy-ish 64 year old being eligible at the same time as healthy 20 year olds.
If we only vaccinated every one over 65 then we can basically go to normal, while the rest get vaccinated.
That would prevent something like 80% of the deaths and hospitalizations. Some people would do get it but we would have more resources to handle it.
When >42% of Americans are obese, obesity cannot be viewed simply as a matter of personal responsibility. It is decidedly and firmly a public health and public policy issue, and as such arguments about fairness in vaccine distribution don’t hold much weight, in my view.
I think the idea that once a few at-risk populations get vaccinated we can “go back to normal” is pretty naive. You still get it mildly and can spread it once vaccinated. People outside at-risk groups who aren’t vaccinated yet can die. We don’t know how long the vaccine is good for—maybe we have to get it once a year like the flu, who knows? I’m a gambler and I’d bet we’ll be wearing masks for years, and possibly forever, depending on how the thing mutates and behaves.
My parents think they are gonna get jabbed then it’s off to happy hour, and that just seems incredibly simplistic.
How many micromorts do we need to be at for it to be acceptable? If you can't name a probability of death that is acceptable then your opinion is worthless (don't worry, lots of people seem to be in this camp). We accept risks for far dumber stuff every day. Maybe its 1 micromort or 100, but there must be some point at which making everyone wear a mask is more trouble than it is worth.
Because it's an infectious disease your model needs to account for spread. So that's what matters here, it's not that 1000 deaths per year is magically fine while 100 000 per year is not, it's that right now 1000 cases turns into 100 000 cases and deaths accordingly.
So assuming the vaccination programme is able to achieve herd immunity and maintain it either indefinitely or until the pandemic is over or border controls isolate that impact then you don't need to try to pick some number of micro-morts.
This is another reason elimination was obviously the correct strategy. Zero is special. If something doubles every day then no matter your start number you're screwed - unless it was zero in which case you're fine because zero doubled is... zero. Elimination allowed New Zealand to not need to estimate R numbers and weigh up whether to open bars or nurseries, universities or sports stadiums, because zero multiplied by anything is zero.
But if you can achieve herd immunity through vaccination you get to the same place by being assured of the multiplier instead, and that's a more practical option for countries like the US at this point.
Nobody wants to but I don’t think we know enough about this disease yet to declare it will definitely be over soon. I really hope it’s not a seasonal disease that needs a different vaccine every year!
It's also naive to think that, once a vaccination program has been in full swing for four or five months in the US (which is still only going to hit ~50% of the population unless it can be ramped to substantially above one million doses a day), when the warmer weather hits, most people aren't going to be going to the beach, restaurants, flying, etc.
Yes. Due to the severe health risks associated with COVID-19 and the fact that reinfection with COVID-19 is possible, you should be vaccinated regardless of whether you already had COVID-19 infection. If you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Talk to your doctor if you are unsure what treatments you received or if you have more questions about getting a COVID-19 vaccine.
The underlying rationale is that vaccines elicit a more consistent immune response [2] and confer immunity with higher efficacy [3] than being infected with the real coronavirus.
It's still mind boggling to be that this isn't taken into account when deciding on the order of vaccine distribution. The incremental protection conferred to a recovered covid patient is far less than that conferred to someone who hasn't contracted the disease.
> Out of over six thousand who have had the virus, there have been about 42 re-infections. Comparing that to the cohort of people who were never infected, that comes out to 83% efficacy. So there’s your comparison number – which means that being vaccinated with either of the mRNA agents provides better protection than being infected with the real coronavirus can.
The vaccine comes in two doses spaced by a month or two, and the second boosts immune response. Being exposed to the real thing twice should have a similar effect, but it would be hard to precisely dose and schedule another weak exposure.
However, `42/6000 = 0.007` sounds pretty low-risk to me, unless you are elderly and/or in poor health.
The person in the article doesn't seem to be in a high risk group. They state they pedaled their bicycle 5 miles to reach the scene. I get that the virus is dangerous for everyone, but I think those of us who are younger and generally more healthy should allow those in high risks groups / high exposure to get the vaccine first, regardless of whatever "leftover doses" exist or not.
Perhaps this person is in a high exposure group due to their job? I'm doubting it but I guess it is possible.
What is the chance of actually having left over doses in a densely populated area? The logistics are pretty simple with great numbers of consumers. It's another mater in a sparsely populated area.
The claim in the article, which is believable, is that many people either don't want to get the vaccine or don't show for some other reason during a single day.
For some unknown additional reason, doses within that day are supposed to be used up. There seems to be an implied expiration for doses, but a single day doesn't make much sense.
The result of both these together is that they are supposedly letting people not scheduled to get the vaccine get it on some days. The article calls them "walk-ins".
Apparently word of this has been spreading slowly, and in this case went viral and a ton of people showed up to attempt to get some small number of "leftover doses".
It seems like chaos to me and a failing of sensible procedure. I am not though a doctor or involved in the distribution process so what do I know. Perhaps there is good reason this happens.
For the Pfizer vaccine, once a vial is mixed with the diluent, there is a 6 hour window to use the 6 doses in it. Shouldn't be creating a huge amount of waste because of that, but it isn't unreasonable to expect that more than 1 vial would be prepared at a given time.
Surely it’s better to give doses to low risk groups than to throw them away. The main hurdles with vaccine rollouts seem to be logistics problem rather than scarcity of the vaccine itself
I think the vaccine should go to people who want it the most. That way, on-lookers can sit back and take it once they realize that it's safe and effective.
I think it's exactly how it's done, but those "who want it the most" vastly outnumber the supply so you still have to prioritize and left overs come from failure of specific people to show at specific placed and specific time.
The Israeli system is slow. It's centrally-planned, and even with central-planning taking advantage of pre-existing distribution networks and patient record digitization, the planners still make mistakes with dose distribution. There are four HMOs in this country, one of them has too many doses for the current age tranche and hands them out to younger walk-ins in peripheral areas, two of the HMOs don't have enough and are slowing down the progress of the age tranche for everyone else.
As bad as the Israeli system is, honestly, it's about the best that can be done considering that vaccine distribution in Israel is supply-constrained. They had to stop giving out first doses for about a week until they could negotiate with Pfizer to move up the shipments. What shipments do come in are quickly distributed. As of yesterday, 45+ can make appointments.
The US healthcare system is a nightmare. But for all of the US healthcare system's many, many, many weaknesses, vaccine distribution is supposed to be a strength. Doses are mass-manufactured and cheap, about $15/dose. Private providers are supposed to be able to make their own dosage orders through their own pre-existing suppliers and be distributed through ordinary private logistics networks. Intense competition insures a minimum of dose wastage. The state can minimally regulate to ensure that supply chain participants have adequate refrigeration etc. If the state wants to prioritize frontline workers, the elderly, fine. The state is more than welcome to buy as many (cheap) doses as it wants on the open market, and distribute for free to whoever the state deems to be a priority. But if the state cannot adequately take advantage of the relative supply glut, and efficiently manage the total supply that is available, then the state shouldn't freeze out the private market on the excess!
What's the goal here? The goal is not to immunize the elderly, or frontline workers. The goal is to end the pandemic. That means getting R under 1.0, and that means mass immunizations. That frontline workers or the elderly represent theoretical optimizations in pursuit of that goal is clearly demonstrating to not work out in reality. Let the free market work!
100-150k a day is not that slow in my opinion, especially when you consider the yearly flu shot mess. Honestly, the fact we reached ~2 million in a few weeks is insane. I thought vaccines would be delayed, then deployment would lag behind, then HMO systems would absolutely crash for weeks on end, but they didn't (except the first 2-3 days) and we indeed started in December.
If the current schedule holds, I could be vaccinated in March. Given my friends' experiences in the US and UK, I consider that very fast and fast enough, at least. Would I be happier if supply sped up and we doubled vaccinations per day? Of course, but given other countries, this is very acceptable.
Look, I think that it's acceptable considering the fact that the whole system is supply-constrained. Prioritizing healthcare workers, teachers, the elderly isn't just a theoretical optimization in Israel - it's a working one too. The only way it would be faster is if there wasn't a supply constraint. The fact that the whole world is mucking up doesn't mean that our model is some kind of ideal, and I certainly don't think that it's the right model for the US, for the reasons I listed.
Right, I agree. If countries had no supply issues I would definitely agree with opening it up for everyone, with maybe a subset of reservations for specific risk populations (or with the option of bumping someone back in their place).
Yeah I know that. Israel can be, at the same time, both the relatively fastest vaccinating country (relative to everyone else) and still be, in objective terms, slow.
I’d done exactly the same, even against the particular absurdity that tightly controlled vaccine doses could be found by word-of-mouth and the general New York knowledge that, no matter how early you think you are, there will always be masses of your neighbors that beat you to the punch.
Though the circumstances of the rush gave it an apocalyptic flavor, there didn’t seem to be any real human descent into chaos. No fistfights or shouting matches about who was in line, no storming of the gates. Just a lot of cold people, all desperate enough to chase down a lead so unlikely it could have been — and actually was — real.
That’s the spirit of my city alright. The “general new york knowledge” line strikes very true.
Live in NY and have been tracking the slow jab rate with disappointment to now find we are running up against inventory&deliveries now. Though our daily jabs have gone from appallingly low to only embarrassingly low, we are actually going to go backwards now that it turns out the “strategic reserve” Trump promised to release last week is a phantom.
Being under-40 with no kids or seniors in my home, easily working from home, I expect to get vax sometime this summer. This is fine, I’m happy to let seniors, medical and frontline workers get it first. This of course includes teachers so they can open schools for good come August.
Glad to see it’s been opened to most of these prioritized people now, and it is intelligent to have a mix of appointments & walk-ins to take out the excess inventory daily.
That said, the whole distribution is a shitshow. And this started even before it moved beyond initial phase of medical workers getting it at work from their employers. I know a lot of non-patient facing people in medical or medical-adjacent jobs who got it well before most nurses, EMTs, etc got it. It seems if you are in management or have a PHD you could jump all the way to the front.. of course.
I don't live in NY so I am curious. NY is one of the worst hit states in the country and had 8 months to prepare for this. What do you think went wrong?
Is it local/state officials' colossal incompetence, something that they are quite known for? For a state with one of the highest tax rates, you would expect better from them.
The constant infighting between de Blasio and Cuomo certainly isn't helping things. Cuomo has a very "my way or the highway" style of management but then doesn't release details fast enough for there to be an effective ground game, so individual institutions or counties are stuck to do their own planning.
At least there's a somewhat-coherent PR response, but that doesn't help get jabs in arms.
I think you have 2 factors.
Governor Cuomo & Mayor DeBlasio hate each other.
BdB is all rhetoric and mildly incompetent but means well.
Cuomo is a very clever political machine, and doesn’t want BdB to get any wins.
Additionally there’s a lot of state vs local control issues for NYC where NYC either doesn’t have authority or the authority is nebulous so Cuomo can claim things aren’t BdB’s call.
There have been numerous times during the pandemic where BdB called for something like closing schools, etc where Cuomo issued a stinging rebuke and then made the call himself 2-3 days later.
Secondly, this is a national issue.
As much as NY is a basket case.. the state by state stats are quite similar. Depending on the week NY is outperforming lots of states in the vax distribution. Relative to Feds, State governments are not that big and do not have a lot of idle capacity. Whatever idle capacity we did have has been taken out by PPE distribution, testing roll out and dealing with all the sick.
Realistically this is a FEMA/NatGuard issue at this point. We can’t expect to have any nurse capacity for vax considering hospitals are all full. It’s a shame there was no planning for that in advance, but par for the course with DJT.
Fortunately it sounds like Biden is going to pull the trigger on that in first 100 days.
I don't understand why you think the states shouldn't be able to handle this. It's their responsibility.
How is the federal government supposed to magically increase hospital capacity? Nobody ever wanted to pay for a bunch more idle and unused hospital capacity. It's a pandemic with lots of victims, you do the best you can, and that's how it goes.
And if NY is a basket case (I'm not arguing) the federal government may be even more so. They don't exactly have a good record of responding to emergencies, either.
> Being under-40 with no kids or seniors in my home, easily working from home, I expect to get vax sometime this summer. This is fine, I’m happy to let seniors, medical and frontline workers get it first. This of course includes teachers so they can open schools for good come August.
I'd probably pay $29.95 per month to participate in a social network where the average comment is as normal as this paragraph.
Call it sensiblepeoplewhowearmasks.com or perhaps lowerbloodpressure.org
The “strategic reserve” falsely reported to not exist is stored at the manufactures:
“Pfizer Inc has been holding on to second doses for each of its COVID-19 vaccinations at the request of the federal government and anticipates no problems supplying them to Americans, a spokeswoman said in a statement on Friday.
Pfizer’s comments run counter to a report in the Washington Post that the federal government ran down its vaccine reserve in late December and has no remaining reserves of doses on hand.”
The reporting was about things that Alex Azar said. Is he just stupid and doesn't understand what everyone else is talking about? Here's the article where he is quoted saying there is no Federal reserve:
If Pfizer is indeed storing the doses at the request of the government, something stupid is going on, because it is reasonable to call that a Federal stockpile.
I'm also happy to wait. I just want my parents and older relatives (all 75+) vaccinated sooner than later. That will make me worry less. If for some reason I can get an appointment sooner, I'll obviously take it, but I'm not counting on it. Unless the pace really picks up it's going to be a while...
You have people over 75 years old who were waiting and registering on whatever reservation system was cobbled together on short notice, and then because the public health authorities now risked throwing out doses for want of people to inject them into, they just opened the floodgates to everyone over 65.
So what happens to the people over 75 who were waiting, and now are swamped by the crowds? If they keep on opening up bulk tranches of the population (instead of in small slices) before people of priority are reached, when will the most vulnerable ever get their turn?
This is a known problem. Multiple queues of priority and people on call to be given turns the next day if it looks like there's capacity.
Instead you have people wondering if they should walk in, visit a county next door, or wait around in case some mistake is made and there are actually extra doses at the end of a day. Or try to scheme/figure out the system however they can, out of desperation.
If it can't be done right, let everyone know that it's up to their willingness to wait wherever they can, according to some basic ground rules, and don't make a meaningless (or worse, deceptive) reservations system that gets bypassed at the last minute.
What a shameful clusterfuck.