Vaccine distribution - Printable Version
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RE: Vaccine distribution - Genuine Realist - 12-03-2020
(12-02-2020, 11:51 PM)akiddoc Wrote:Manufacturing processes expand exponentially when the need and demand is there. I don't know whether best estimates will be met, but worst wil almost certainly be exceeded in the short term. If I had to bet the over-under on June,I'd pick the 'over' by a country mile.(12-02-2020, 11:21 PM)dabigv13 Wrote: I am as well. This is all supposed to start happening in two weeks apparently? Nobody in my hospital has heard anything about how vaccinations might work. Planning for this is important when you want to tailor schedules and factor in when people might be getting shots and potentially feeling sick enough to not work that day or the next.
And whatever happened to Bill Gates or whoever manufacturing a bunch of vaccines pre-approval to have plenty ready to go? Feel like I read something at the early stages of the pandemic about that but nothing recently...
There is some vaccine available for shipment now. That is part of the US government's "Warp Speed" effort. Not Bill Gates. I think Astra Zeneca has the most. Not hundreds of millions of doses though. And who knows when that vaccine gets to the public.
Many community clinics are used to high volume vaccination drives. My county clinic could vaccinate hundreds of people a day. We do it with influenza. Just our pediatric department has been giving up to 100 vaccines a day this fall. We could do more if we wanted to. Let the community clinics handle this. This is what we do.
RE: Vaccine distribution - akiddoc - 12-03-2020
(12-02-2020, 07:31 PM)Genuine Realist Wrote:(11-27-2020, 12:41 AM)M T Wrote:Keep It Simple, Stupid.(11-26-2020, 10:34 PM)Genuine Realist Wrote:
So I go birthday lottery, in the interest of simplicity. The KISS principle.
What's the 1st S stand for? Surely not simple. Nothing simple about that!!
Suppose you're the single parent of a 4yo, 6yo, and 8yo. How many times do you wait in line with all 3? Four times.
Or are you going to make your rules less simple? If you go with the address line (which is more available & less sensitive - can be off driver's licenses, utility bills, etc) instead of birth date, families can go together.
With addresses, publicity of the event can be focused to the right group, everyone knows that everyone in their area is going (for instance, school could close for the day if needed, rather than 366 different absences), etc. Businesses can expect a slowdown on their neighborhood's day.
Birthday lotteries may not be as simple as you'd like, until you compare it with everything else
.
One obvious problem with neighborhoods or zip codes is fraud, bribery, other types of corruption. You'll have some of that with birthdays, but much less.
Distributing by zip code means sending it to the community clinics in those zip codes. We are equipped to give out a lot of vaccine quickly. In zip codes where there is a lot of Covid, the impact on disease spread would be greatest. Your idea that it should not be distributed to these areas because you think it is a sneaky way to give racial preference is unfounded. It is a way to stop the disease where it is most common. It just so happens that the disease is more rampant generally in neighborhoods of color, and therefore in zip codes of more color, although that "color" in Oakland is in the Latin American immigrant community.
Birthday lotteries are ridiculous. We're not about to cull people from lines based on birthdays. We won't care if a few people show up from other zip codes either. The fact of the matter is that we serve the patients who are catching it and dying from it. Can't imagine the denizens of Piedmont or Atherton descending on our clinic in East Oakland in droves to get the vaccine. Not a ton of Covid in the 94611.
RE: Vaccine distribution - Genuine Realist - 12-03-2020
(12-03-2020, 12:11 AM)akiddoc Wrote:I didn't say a word about race. You have race on the brain. If you'll recall the last time this came up, I was suggesting zip codes and job categories,in lieu of race, and you were in the usual holier-than-thou mode. It turned out that the regulators were thinking along the same lines as me, after which all the faux-liberals stopped posting.(12-02-2020, 07:31 PM)Genuine Realist Wrote:(11-27-2020, 12:41 AM)M T Wrote:Keep It Simple, Stupid.(11-26-2020, 10:34 PM)Genuine Realist Wrote:
So I go birthday lottery, in the interest of simplicity. The KISS principle.
What's the 1st S stand for? Surely not simple. Nothing simple about that!!
Suppose you're the single parent of a 4yo, 6yo, and 8yo. How many times do you wait in line with all 3? Four times.
Or are you going to make your rules less simple? If you go with the address line (which is more available & less sensitive - can be off driver's licenses, utility bills, etc) instead of birth date, families can go together.
With addresses, publicity of the event can be focused to the right group, everyone knows that everyone in their area is going (for instance, school could close for the day if needed, rather than 366 different absences), etc. Businesses can expect a slowdown on their neighborhood's day.
Birthday lotteries may not be as simple as you'd like, until you compare it with everything else
.
One obvious problem with neighborhoods or zip codes is fraud, bribery, other types of corruption. You'll have some of that with birthdays, but much less.
Distributing by zip code means sending it to the community clinics in those zip codes. We are equipped to give out a lot of vaccine quickly. In zip codes where there is a lot of Covid, the impact on disease spread would be greatest. Your idea that it should not be distributed to these areas because you think it is a sneaky way to give racial preference is unfounded. It is a way to stop the disease where it is most common. It just so happens that the disease is more rampant generally in neighborhoods of color, and therefore in zip codes of more color, although that "color" in Oakland is in the Latin American immigrant community.
Birthday lotteries are ridiculous. We're not about to cull people from lines based on birthdays. We won't care if a few people show up from other zip codes either. The fact of the matter is that we serve the patients who are catching it and dying from it. Can't imagine the denizens of Piedmont or Atherton descending on our clinic in East Oakland in droves to get the vaccine. Not a ton of Covid in the 94611.
But I've gone on thinking. The problem, greater or larger, is in the administration. It's not that easy to define job categories, and it is next to impossible to verify zip codes. Some entrepreneur sublets his home for a day or an hour, and writes a thousand leases in a day. The authorities don't have the resources to check. Then you have simple bribery, and all sorts of other schemes beyond my present imagination.
I don't like racial preferences for reasons that are about a century old, and that everyone knows. It has to do with arbitrariness. I'd love the sociological selectors implied in zip code/job category criteria, which aren't arbitrary. But I don't think you can write regulations subtle enough to cover all the loose ends in the thirty days or so that are available, and I don't know how you can realistically enforce them. You're going to end up with a very demoralizing cesspool of upper class corruption, and no easy way to stop it.
So bite the bullet, go birthday lottery, and do your best to do social equity by setting up distribution centers in high incidence neighborhoods. It's not perfect, but it's likely the best practical option.
KISS,capisce?
RE: Vaccine distribution - fullmetal - 12-03-2020
(12-02-2020, 10:14 PM)washingtonismoney Wrote: I'm pretty skeptical of those estimates -- they really require the engine to be going at full steam, every second. Once you start breaking down the numbers to the second, we're talking pharmacists administering shots every eight seconds (or whatever).
Very true, governors should be calling up their state/national guards right now to see if they can activate trained medical staff for the effort.
RE: Vaccine distribution - M T - 12-03-2020
That is what they said in today's Warp Speed briefing, but they muddied the water, or maybe, revealed that their numbers are double what will actually happen.
Last week:
"That [initial] amount we allocated to the country was 6.4 million doses of vaccine."
"40 million [doses] by the end of the year"
This week:
"We feel very confident we will be able to distribute enough vaccine to immunize 20 million people in the US in December. That's 40 million doses. Then 30 million people, 60 million doses, in January. And 50 million people, or 100 million doses, in [February; Actually said March but corrected himself in the next sentence].
"40 million total doses in December."
12:10 "On 20 Nov, ... we provided the 64 jurisdictions and 5 federal agencies their allocations for the Pfizer vaccine of a total of 6.4 million doses that will be available. A week later, on 27 Nov. we provided the 64 jurisdictions and 5 federal agencies their allocations for the Moderna vaccine at 12.5 million doses that will be available."
13:10 "We are going to send half the doses based on allocation to the jurisdictions and agencies because it is a two dose regimen... So half of the allocation will be sent out and then 21 days later for Pfizer and 28 days later for Moderna, we send out the second half of allocations. Two reasons: To ensure that we don't over-administer and that we have a second dose on hand. And the second reason is to make sure that we don't overwhelm limited storage capability and capacity at the state level."
31:30 "Our responsibility is that we have both doses in hand before we send the first dose out. That way, we're always confident that the second dose will be available.
(A new word for me: "envisualize" Try that next time you need buzz-words, throw this out. But, wait, you might want to see the definition at urbandictionary.com, or the fact that there isn't a definition in most dictionaries.)
The General did not directly answer several questions put to him. If I'd had a question, besides again trying to pin him down that it is actually 3.2 million shipped a day after EUA, I would have asked him how he can have the second doses "in hand" at the time of first shipment, 21 days before the second doses need to be shipped, as last week he indicated the Pfizer vaccine has a shelf life of 20 days once delivered.
That's only 3.2M doses of Pfizer shipped no earlier than Dec. 11. That's 6.25M doses of Moderna no earlier than Dec. 18.
He repeatedly has talked of a weekly shipment. (It isn't clear whether that is on the same day to all places, but he did indicate the first shipments all being made at once.). So, for Pfizer, that's 3 shipments in December: Dec 11, Dec. 18, Dec. 25. Ok, let them have 4 shipments, to make it easier to make their claimed quantity. For Moderna, that's 2 shipments in December, but we'll say it is 3 shipments.
I presume they've been producing vaccine for some time and surely must have more than a week's production ready to roll out. But, let's just assume that they only have one week's production ready at the time of EUA, and that subsequent weekly shipments have about the same number of vaccines. By that, there would be 3.2M * 4 + 6.25M * 3 = 31.55M doses, short of their goal by 30%. So subsequent shipments must be considerably bigger, especially if they are once a week and there isn't a 4th/3rd shipment in December.
The initial shipments announced to California and Washington were about 42% of the allocation based on 6.4M. Now we know they are 84% of an initial total shipment of 3.2M. The reason for the 84% is probably because state populations were reduced by the people in the military, federal prisons, covered by the Bureau of Indian Affairs, Veteran's administration (surely not all vets, but probably those housed in VA hospitals), and Department of State (presumably those housed outside the US).
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It isn't clear to me when the Pfizer and Moderna vaccines confer immunity (time wise). Do deaths rarely occur after the first dose, or only after the 2nd dose? If the first, we may see deaths start to drop around the first week of January. If the second, then late January.
So by end of February, 39% (100M of 255M) of the 18+ people in the US will have their vaccines and should include all the higher risk patients. That's not up to herd immunity status yet, as I understand it. The disease will still be widespread in the young adult group. Any high-risk person who is not immunized will still have a high chance of catching COVID "in the community".
By March we may have alternative vaccines, including single-shot vaccines (so I presume quicker immunity). At worst, we continue the Pfizer and Moderna vaccines at 50M people per month, finishing in late May. At best, we might finish vaccinations in mid-April.
=======
All the jurisdictions are to have their plans for distribution submitted by Friday Dec. 4.
As I understand them, any one (for example, pharmacy, LTCF, doctor's office, hospital) can register for delivery of vaccine to them in multiples of the delivery quantum (975 for Pfizer, 100 for Moderna) if the state approves for them to receive it. Then Operation Warp Speed will deliver directly to them. Apparently some states are having it delivered to hub(s) which will then distribute it further.
=======
Using the 327K doses Governor Newsom announce as a guide, it appears that California will get 10.2% of all doses. That means California should be planning for about 4,087,000 doses of the vaccine during December.
RE: Vaccine distribution - M T - 12-03-2020
(12-02-2020, 11:21 PM)dabigv13 Wrote: I am as well. This is all supposed to start happening in two weeks apparently? Nobody in my hospital has heard anything about how vaccinations might work. Planning for this is important when you want to tailor schedules and factor in when people might be getting shots and potentially feeling sick enough to not work that day or the next.
Dabigv13 (and anyone else who is interested, Akiddoc maybe), I suspect the hospital administrators know about this. Interested potential vaccination providers should be talking to their state and see this CDC page.
These doses are going to be coming fast, estimated enough for 10% of California's population by the end of December. They may come fast enough in these first 3 weeks that those that are in the first groups to be vaccinated won't find doctors prepared to vaccinate them. It seems weird if a hospital has to tell its staff to try to get vaccinations at CVS or Walgreens.
RE: Vaccine distribution - BostonCard - 12-03-2020
All of this is contingent on having enough *checks notes* dry ice.
https://www.wsj.com/articles/covid-19-vaccines-start-a-frenzy-for-dry-ice-its-like-a-herd-of-mustangs-11607007166?reflink=desktopwebshare_twitter
Repeat after me: prior planning prevents piss poor performance.
BC
RE: Vaccine distribution - M T - 12-03-2020
(12-03-2020, 11:02 AM)BostonCard Wrote: All of this is contingent on having enough *checks notes* dry ice.
General Parmar indicated they had arranged for the dry ice (but exactly what that means isn't clear). He mention no details in the briefing. Last week, he talked about how he had gone through the process of removing a dose from the tray. It seemed that the timing of how long the 975-dose tray is opened (in its storage container with dry ice) was important and he felt that it was doable even for someone like him.
I don't know more about dry ice - whether or how often the suitcase-sized crates need to have the dry ice replenished. (It was mentioned that the doses have to be removed and allowed to warm up before administration to the patient.).
At 975 doses per tray, and, say, 80M (some unknown fraction of 200M doses) Pfizer doses between Dec 15 end of Feb, that's 80,000 trays. It doesn't seem to me that 80K more uses of dry ice over 2.5 months across the entirety of the US is going to be a big supply problem.
https://www.freightwaves.com/news/breaking-down-the-logistical-mission-of-operation-warp-speed
"During an OWS weekly distribution working group call with McKesson, UPS and FedEx, we learned the FAA has established a dry ice shipping working network. FedEx is a part of that working network."
https://www.michigan.gov/documents/mdhhs/Playbook_Supplement_1_11.20.20_708520_7.pdf
"Along with vaccine, each site will receive ancillary kits and an initial dry ice resupply:
•...
•OWS will provide an initial dry ice resupply to facilitate storage in coordination with each vaccine shipment. Jurisdictions will have the option to allow sites to opt out of the initial dry ice resupply if desired. Sites will receive this initial dry ice resupply in coordination with receipt of the product, as they will need to replenish the dry ice upon product receipt. Further details about shipping and receipt of dry ice will be forthcoming.
I'm not sure what "initial dry ice resupply" means. My guess is they deliver some dry ice with it to replace what it was shipped with upon or after arrival. After that, it may be up to the distributor to either have freezer units that can keep the supply at the proper temperature or the dry ice has to be replaced periodically depending upon the temperature of the freezer (ie, less often in a -20F freezer than a 0F freezer).
RE: Vaccine distribution - dabigv13 - 12-03-2020
[Tweet]https://twitter.com/DiMartinoBooth/status/1334599075367432193?s=20[/tweet]
No bueno.
RE: Vaccine distribution - M T - 12-03-2020
A headline with nothing behind it is so much my image of twitter. Useless, possibly false or faked or foolish. We can't know.
General Perna did make it very clear that he chose the estimate of the amount that would be available for the initial shipment based upon the day he thought the EUA would go out, and presumably based on what Pfizer told him.
A week ago, the 6.4M doses was spoken of as "initial allocation". I spent a long time last night reviewing last week's briefing and today's. As you saw, I had trouble putting the two together. We all took it as doses to be sent out. Two states gave their allocation at a level that was a better match for the 3.2M doses. My impression yesterday was one of evasion, half-baked reasoning, confusing statements, and avoiding answering questions. (At one point, he indicated he couldn't remember the 2nd half of a question and asked to be reminded. Then he answered a different question (not the one asked) related to this point).
If Pfizer did cut back, this may be the mysterious "headline" he mentioned. (Something like "People shouldn't get distracted by a single headline" when it comes to getting the vaccine. It seemed odd that he spent a fair amount of time telling people to look at the data, make up their minds, and then do what is best for them.). For this to make sense, I'm would guess they likely had to cut back based on product quality control issues (rather than something worse such as different efficacy or safety indications).
There was no change yesterday in the expectation of 40M doses in December (shared between Pfizer and Moderna).
RE: Vaccine distribution - dabigv13 - 12-03-2020
Ok, here's the WSJ with the story, doubting MT. Twitter will usually be fastest with the news, but not always correct. Important to check sources etc. This was a reputable poster.
Looks like the UK has adjusted their expectations downwards by half for doses delivered by end of month. The article says nothing about the US allocation.
https://www.wsj.com/articles/pfizer-slashed-its-covid-19-vaccine-rollout-target-after-facing-supply-chain-obstacles-11607027787
RE: Vaccine distribution - BostonCard - 12-03-2020
Here's UCSF's FAQ about vaccine distribution.
https://coronavirus.ucsf.edu/frequently-asked-questions-vaccines#Are-research-teams-working-with-COVID19-included-in-the-first-round-of-vaccinations
I found it very informative (including info on the Pfizer vaccine's handling).
Quote:How much capacity does UCSF have for storing the Pfizer vaccines?
UCSF has enough freezer capacity for hundreds of thousands of doses. Each two-milliliter vial holds five doses of dry vaccine. For injection, it must be thawed, reconstituted and administered within 48 hours of that thaw. The Pfizer vaccine is stable for five days in the refrigerator and six hours at room temperature.
BC
RE: Vaccine distribution - M T - 12-03-2020
(12-03-2020, 02:59 PM)dabigv13 Wrote: Ok, here's the WSJ with the story, doubting MT. Twitter will usually be fastest with the news, but not always correct. Important to check sources etc. This was a reputable poster.
Looks like the UK has adjusted their expectations downwards by half for doses delivered by end of month. The article says nothing about the US allocation.
https://www.wsj.com/articles/pfizer-slashed-its-covid-19-vaccine-rollout-target-after-facing-supply-chain-obstacles-11607027787
"Pfizer and Germany-based partner BioNTech SE had hoped to roll out 100 million vaccines world-wide by the end of this year, a plan that has now been reduced to 50 million. ... Pfizer had its 100-million dose goal in place until mid-November, when it became clear the supply-chain hurdles were too great for the end-of-the-year timeline."
The numbers estimate for initial delivery of Pfizer vaccine in Operation Warp Speed was set on November 20. Perhaps Pfizer had informed the OWS people of the changes in expectation by that date. (The expected 40M doses in December are a combination of Pfizer & Moderna. It is odd that no one asked how many doses of each.)
RE: Vaccine distribution - Goose - 12-03-2020
It shouldn't shock anyone that there will be changes in the delivery quantities available. Things are always harder than they are estimated to be originally. That is one reason I have been expressing some concerns about the fact we are seeing dry runs only now. There will be problems, and if you have already seen the problems and have contingency plans that you can confidently execute, you can get through it. If you have not, things can get messy fast.
There are lots of companies, institutions and organizations working to deliver this vaccine to the public. Many of these groups have never worked together before. Others in this group are operating at a scale greater than their "normal" operations. Expect some problems. Hopefully the participants have.
RE: Vaccine distribution - teejers1 - 12-03-2020
(12-03-2020, 05:48 PM)Goose Wrote: It shouldn't shock anyone that there will be changes in the delivery quantities available. Things are always harder than they are estimated to be originally. That is one reason I have been expressing some concerns about the fact we are seeing dry runs only now. There will be problems, and if you have already seen the problems and have contingency plans that you can confidently execute, you can get through it. If you have not, things can get messy fast.
There are lots of companies, institutions and organizations working to deliver this vaccine to the public. Many of these groups have never worked together before. Others in this group are operating at a scale greater than their "normal" operations. Expect some problems. Hopefully the participants have.
Agree. But otoh, I'm not down with the kvetching and critiques of the vaccination effort not being all it was cracked up to be. I'd just as soon get it rolling, even if we all know distribution will not be peak performance from the jump.
RE: Vaccine distribution - BostonCard - 12-03-2020
We will see what happens when the actual rollout is instituted. I suspect it will be a bit like the early voting was, with lots of stories of mishaps and people waiting in long lines and panic, but (hopefully) when we take a step back, it will turn out to be one of the most successful vaccination efforts ever.
Already, a 10 month development process is damned near miraculous. Early on, I think it might have been Fauci who said it could be done in 12 - 18 months "if everything broke right". Optimists said it would be great if the efficacy could be better than 70%; it will hit over 90%. I have been down on a lot of things about how the pandemic has been handled, but the vaccine development process has not been one, and I am pretty sanguine about the distribution process. It won't be flawless, but I think people are underestimating how much will be moved to manufacture and distribute it.
BC
RE: Vaccine distribution - Genuine Realist - 12-03-2020
(12-03-2020, 07:01 PM)BostonCard Wrote: We will see what happens when the actual rollout is instituted. I suspect it will be a bit like the early voting was, with lots of stories of mishaps and people waiting in long lines and panic, but (hopefully) when we take a step back, it will turn out to be one of the most successful vaccination efforts ever.I value the medical wisdom of the md's who post here, even those with whom I am in complete disagreement.
Already, a 10 month development process is damned near miraculous. Early on, I think it might have been Fauci who said it could be done in 12 - 18 months "if everything broke right". Optimists said it would be great if the efficacy could be better than 70%; it will hit over 90%. I have been down on a lot of things about how the pandemic has been handled, but the vaccine development process has not been one, and I am pretty sanguine about the distribution process. It won't be flawless, but I think people are underestimating how much will be moved to manufacture and distribute it.
BC
But when it comes to the logistics and management of vaccine distribution, I believe we have drifted into the area of operations research, a wholly separate field of study, with its own mathematics and expertise. Solving problems that may seem difficult or even insuperable to a lawyer or doctor is the way some people make a pretty good living. With a product for which there is universal demand, and in the distribution of which most major institutions will cooperate completely, the problems are likely to be very easily solvable, for those who know how to approach them.
RE: Vaccine distribution - dabigv13 - 12-03-2020
I agree that the rapid development of the vaccines has been a near miracle and that we will likely have two highly effective vaccines in arms in less than a year is an immense accomplishment.
One brobdingnagian part of this achievement, a fundamental one, was the release of the genome of the SARS-Cov2 virus, by Chinese researcher Yong-Zhen Zhang, through the twitter account of an Australian collaborator on Jan 11th (see MT, the medium has some merit).
Without that Moderna and Pfizer/BioNTech would not have been able to design these mRNA vaccines, which were designed within days of that release, and without those companies having any virus themselves. This was a brave decision made by an individual in a totalitarian state. His lab did face some repercussions for acting without authorization from above, but thankfully that seems all in the past.
This from Zeynep Tufecki is excellent on his story.
https://zeynep.substack.com/p/the-pandemic-heroes-who-gave-us-the
What a true hero, who saved countless lives through his research and bravery in sharing it.
RE: Vaccine distribution - dabigv13 - 12-03-2020
(12-03-2020, 05:03 PM)M T Wrote:(12-03-2020, 02:59 PM)dabigv13 Wrote: Ok, here's the WSJ with the story, doubting MT. Twitter will usually be fastest with the news, but not always correct. Important to check sources etc. This was a reputable poster.
Looks like the UK has adjusted their expectations downwards by half for doses delivered by end of month. The article says nothing about the US allocation.
https://www.wsj.com/articles/pfizer-slashed-its-covid-19-vaccine-rollout-target-after-facing-supply-chain-obstacles-11607027787
"Pfizer and Germany-based partner BioNTech SE had hoped to roll out 100 million vaccines world-wide by the end of this year, a plan that has now been reduced to 50 million. ... Pfizer had its 100-million dose goal in place until mid-November, when it became clear the supply-chain hurdles were too great for the end-of-the-year timeline."
The numbers estimate for initial delivery of Pfizer vaccine in Operation Warp Speed was set on November 20. Perhaps Pfizer had informed the OWS people of the changes in expectation by that date. (The expected 40M doses in December are a combination of Pfizer & Moderna. It is odd that no one asked how many doses of each.)
This may be correct. My understanding was the 40m figure was 20m from Moderna and 20m from Pfizer. If so 20m out of the total 50m Pfizer has for this month is plausible....EU, who has ordered 200m doses, double the US' 100m may get short end of stick. Japan has ordered 120m but with delivery of 2021. We don't know where everybody stands in the queue necessarily though.
https://www.newsweek.com/which-countries-secured-coronavirus-covid-vaccines-pfizer-biontech-moderna-1548366
RE: Vaccine distribution - BostonCard - 12-03-2020
(12-03-2020, 07:40 PM)Genuine Realist Wrote: But when it comes to the logistics and management of vaccine distribution, I believe we have drifted into the area of operations research, a wholly separate field of study, with its own mathematics and expertise. Solving problems that may seem difficult or even insuperable to a lawyer or doctor is the way some people make a pretty good living. With a product for which there is universal demand, and in the distribution of which most major institutions will cooperate completely, the problems are likely to be very easily solvable, for those who know how to approach them.
Point humbly taken. Operations is indeed a whole different kettle of fish, and I don't mean to trivialize it. I am still optimistic, but it is not an particularly informed optimism.
BC