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RE: Vaccine distribution - akiddoc - 12-03-2020

(12-03-2020, 01:29 AM)Genuine Realist Wrote:  
(12-03-2020, 12:11 AM)akiddoc Wrote:  
(12-02-2020, 07:31 PM)Genuine Realist Wrote:  
(11-27-2020, 12:41 AM)M T Wrote:  
(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.
Keep It Simple, Stupid.

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.
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. 

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?

I challenge you to find a single post where I said that vaccine should be distributed by race. Because I didn't post that. I posted an explanation of why you didn't like Newsom's suggestion of distributing by racial or ethnic group. I don't remember you suggesting zip codes. If you did, great. But now you don't seem to like the idea.

RE: Vaccine distribution - Goose - 12-03-2020

(12-03-2020, 09:15 PM)BostonCard Wrote:  
(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
I think the product development has been truly outstanding. Even more important, it appears the product works. As Fauci said, the developers have been both lucky and good.

I am glad the DOD is involved in the logistics of the distribution, as they have proven methodologies to accomplish this kind of task. I too am optimistic it will work out fine "in the end". I am a bit concerned about the number of decisions that are being made now, as these decisions do affect how distribution needs to be done. I also worry when you get many different organizations working together for the first time. That usually takes many "engineering readiness runs" to sort out. That may make December a bit rockier in operation than we would hope for, as unexpected problems can crop up. We will get through them, but I would be more calm about this if they had already published a plan that says what happens on D + 7 and had a few full-scale exercises to validate that plan. While the problems that crop up may be "easily solvable", it may take time, and that is what we want to avoid.

RE: Vaccine distribution - Genuine Realist - 12-03-2020

(12-03-2020, 09:55 PM)akiddoc Wrote:  
(12-03-2020, 01:29 AM)Genuine Realist Wrote:  
(12-03-2020, 12:11 AM)akiddoc Wrote:  
(12-02-2020, 07:31 PM)Genuine Realist Wrote:  
(11-27-2020, 12:41 AM)M T Wrote:  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.
Keep It Simple, Stupid.

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.
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. 

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?

I challenge you to find a single post where I said that vaccine should be distributed by race. Because I didn't post that. I posted an explanation of why you didn't like Newsom's suggestion of distributing by racial or ethnic group. I don't remember you suggesting zip codes. If you did, great. But now you don't seem to like the idea.
Precisely what I wrote was:
BC,


At this point I'm going to appeal to your skill as a medical scientist, and then call halt. If there is no biological factor that accounts for the statistical discrepancy, then by process of elimination, we must be talking about socio-econometric factors. (Given the of immense proportions number of persons who classify as ethnic minority, it would be amazing if there were any common factor.) You are getting a closer to the Universal Quantifier fallacy than I think you would like. Acknowledging the apparent reality that a disproportionate number of minorities live or work in high risk environments does not mean that they ALL do - and, similarly, that a significant number of Caucasians and Asians (now a disfavored minority) do not. Thus, at the end of the day, the racial metric will lead to a quantum of arbitrariness that is likely to infuriate people who (rightly) see it as arbitrary and themselves as unfairly treated.

So how would I do it? I mentioned I-A (health workers), I-B (classroom educators), and I-C (persons who work in necessary but high risk jobs). If I haven't run out of early vaccines, I'll add a fourth, I-D, people who live in high risk zip codes. Santa Clara County breaks cases down by zip code, so I'll assume others do, too. I'm going to eliminate the disabled, except those with a linked vulnerability, and the zip code also eliminates the rural/urban divide, which was almost as obnoxious as the racial. If you live in a zip code in a rural area, but one with a low incidence rate, why O why do you get priority? (Other than that Newsom wants your vote.) Prisoners are out, because I can't look law abiding Californians in the face if I do that. More of that anon.

If, as I suspect, the high incidence rates in ethnic minorities reflects disproportionate employment in high risk occupations and residence in high risk areas, that categorization will provide an automatic preference arithmetically. I don't think anyone in the public could take exception to that, except the increasing number of nuts on Twitter.

Prisoners? If there is anything experimental or dangerous about first use vaccines, they are free to volunteer, with sentence reductions and parole dates moved up. You always reward courage. That's what I call paying your debt to society.

With that, enough. I'm done with the topic, unless someone comes out of the woodwork to take potshots. (Please .  . . stick to Twitter.)

That summarized a number of earlier replies.

I'd be all for that scheme if I thought it was administratively workable. But I don't think it is, for the reasons stated above. It's too easy for the well off to exploit. I'm sure you know the type.

As for the rest, I didn't write you'd suggested a race based system. I wrote you had race on the brain. It's been nearly 20 years now and I'll stick with that.
(12-03-2020, 09:55 PM)Goose Wrote:  
(12-03-2020, 09:15 PM)BostonCard Wrote:  
(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
I think the product development has been truly outstanding. Even more important, it appears the product works. As Fauci said, the developers have been both lucky and good.

I am glad the DOD is involved in the logistics of the distribution, as they have proven methodologies to accomplish this kind of task. I too am optimistic it will work out fine "in the end". I am a bit concerned about the number of decisions that are being made now, as these decisions do affect how distribution needs to be done. I also worry when you get many different organizations working together for the first time. That usually takes many "engineering readiness runs" to sort out. That may make December a bit rockier in operation than we would hope for, as unexpected problems can crop up. We will get through them, but I would be more calm about this if they had already published a plan that says what happens on D + 7 and had a few full-scale exercises to validate that plan. While the problems that crop up may be "easily solvable", it may take time, and that is what we want to avoid.
There will doubtless be systemic problems early on. That's the nature of human reality. I'm also sure the press will headline every one of them. But in a remarkably short time I think it'll all run quite smoothly, which triumph the press will ignore.

Equitable allocation is another matter. I DON'T think we'll go birthday lottery, and the result will be a lot of unnecessary cynicism and corruption.

RE: Vaccine distribution - teejers1 - 12-03-2020

(12-03-2020, 10:16 PM)Genuine Realist Wrote:  There will doubtless be systemic problems early on. That's the nature of human reality. I'm also sure the press will headline every one of them. But in a remarkably short time I think it'll all run quite smoothly, which triumph the press will ignore.

Equitable allocation is another matter. I DON'T think we'll go birthday lottery, and the result will be a lot of unnecessary cynicism and corruption.

It shouldn't be that controversial:  (i) health care workers, (ii) all old folks' homes/assisted living facilities (and I like the suggestion to get everyone there - residents, staff, etc. - at once), (iii) impacted areas - zip code or nieghborhood (hopefully there are sufficiently usable distribution sites/hospitals (if that's where it has to be) nearby.  If you do that in reasonably timely fashion, I think damage would be greatly mitigated from there on out.

The rest of us can get our vaccines when (i)-(iii) are given theirs.

ADD: and given them their stimulus check at the time of the second shot of vaccine (or single shot, if that's the one administered).

RE: Vaccine distribution - M T - 12-04-2020

The CDC ACIP recommendations of vaccine distribution is available.
It notes there are 21 million health care workers and only 3 million people in LTCF.  Those are the only two groups that the ACIP mentions for their recommendations.  Considering that there were announced plans to have 40 million first doses out within 4 weeks (which would cover those 24 million and 16 million more), I find that woefully short of giving much guidance.

More details about California's initial 327K dose distribution can be found in this Sacramento news article.
Order of priority (Unfortunately, California is not indicating the number of people in each tier)
Tier 1: Tier 2: Tier 3:
It names how many doses go to each of 6 regions in California (total 327,600)

It names 7 hospitals that get the vaccine to distribute
Note that the smaller city to the north of Stanford has two hospitals listed, with neither Stanford nor any in the larger city just to the south.   Weird.

California is scheduled to get 12x as many doses as that within 4 weeks (approximately 571,000 doses for each of those 7 hospitals, if they were the only ones to get the doses).  I surely hope that information will be out before long about who will be allowed to get the vaccine and how they will know they are eligible, how they prove they are eligible, how to make appointments, how those appointments will be allocated.

I am pretty sure the above tiers will have received their doses well before all the December doses are done.  Who's next?  How will they know? Are they going to get a choice of Moderna or Pfizer, or will they be told "It's X or nothing"?

The governor indicated there were 2.4M health care workers.  I'd guess there are less than 0.5M in LTCF (only 3M in US LTCF).  So that covers less than 2.9M of the 4M first-round doses in December in California.   Who is in line for the next 1M in that last week of December?

One survey found "According to a poll from the American Nurses Association, 34% percent of nurses say they plan to get the vaccine while 36% say no and  31% are unsure."   So maybe there will be more December doses available for those not yet specified.

If at some point there is a category for a particular age group with certain comorbidities, does CVS/Walgreens take your word for it or do you need a note from your doctor?

When one of the multi-million person group becomes next in line, how will appointments be allocated (first to know about it or fastest typist, first served)?  For instance California has 5.85M 65+ residents.  Suppose that 4M of them have comorbidities.  When 65+ with comorbidities gets to the head of the line, will the servers of CVS and Walgreens melt under so many trying for appointments all at once (and that's just from California).  Or do 2,000 cars converge on a neighborhood pharmacy on a Monday morning?

This draft plan for California seems like, well, a draft.


I have a lot more confidence that the vaccines will get to the states promptly than I have confidence that the states, or at least California, will be able to distribute it in an orderly fashion.
I have a relative 65+ in the hospital with a variety of issues, to the point that one MD thought this was about end of life.  He likely will be discharged before the vaccine is out, but to home rather than to a petri dish.   If he is at home, I'm not sure how far down the list he will be before he can get a vaccine.  (If he gets anything but a very mild case of COVID, he won't make it.)

What I need to figure out is what the contraindications are for the Pfizer & Moderna vaccines.  Yeah, I know his doctor should figure this out, but do you think I can trust them to know that?  I think this is all too new and too squishy for me to be able to believe there is solid data to go on.  I want to do my research and then talk to some MD relatives who can help me figure out whether any vaccination might be hazardous to someone in his condition.  Then I can listen to whoever is assigned to him at his hospital.

So, can anyone point me to where to see what kinds of problems were seen in the trials?

Also, Dr. Slaoui was asked if the vaccinations should be given to people who had COVID previously.  He pointed out that those that had known COVID were excluded, but the trials included a number of people who were seropositive for COVID.   So, he said that those that had significant symptoms of COVID were not represented in the trials and that this group needed more trials.

I've lost the link, but I saw a reputable site indicate that people that had COVID should get the vaccine so they wouldn't get COVID again.  I hope these opinions get straightened out.

RE: Vaccine distribution - dabigv13 - 12-04-2020

It seems you are assuming all the December doses will be first doses, and increasing production will account for second doses and the next round of first doses. 

I'm not sure that's how they are planning it, at least initially while production is still ramping up. I'm guessing they will not be putting shots in arms if they don't already have access to the second round shots for those patients. We already saw Pfizer had issues with production, would be a big problem if lots of people only got one dose and couldn't get the second from some snafu. 

Once reliability in the production and delivery is known, maybe they will be putting first shots in while still waiting for delivery of the second one.

---

Here is an interesting interview with the lone CDC ACIP member who voted against including LTCF patients in the initial vaccination stage. Seems a big concern of hers is since LTCF patients are at a high risk of dying and having major health problems in general, if several die or have a stroke or heart attack soon after getting the vaccine, this could scare people into thinking they are related to the vaccination and reduce vaccine confidence.

https://www.statnews.com/2020/12/03/cdc-advisory-panels-lone-dissenter-on-why-long-term-care-residents-shouldnt-receive-covid-19-vaccine-first/

RE: Vaccine distribution - Goose - 12-04-2020

(12-04-2020, 08:12 AM)M T Wrote:  This draft plan for California seems like, well, a draft.




I have a lot more confidence that the vaccines will get to the states promptly than I have confidence that the states, or at least California, will be able to distribute it in an orderly fashion.


Me too. The fact we are at the "draft plan" stage right now is very worrying. Even after the plan is in final stages, you need to run through it completely and at scale to be sure it can be executed. Sometimes the initial plan works perfectly, sometimes it is a disaster, and most times it is in between. I also agree the press will jump on every problem and make them bigger news than they should be. We really don't need that right now with all the previous problems we have had recently.

That said, we also need to get these vaccines distributed as widely as possible as quickly as possible. Some of the problems in distribution can be "real enough" to cost time in fixing them, and that is what we don't want. That is why "planning overkill" should have been present. We had no vaccines in July. We should have been doing this planning then, not now. Yes, there would have been lots of contingencies that would need to be addressed because we didn't know which vaccines we would get and in what time frame. We had the opportunity and the time to work through all the possibilities well in advance. It appears we haven't done so. Draft plans at this point are unacceptable IMHO.

While I have some concerns about "fairness" (whatever one defines that to mean), I am much more interested in the vaccine being distributed in a manner that will reduce the spread of the disease as rapidly as possible. Some workers are a priority for utilitarian reasons. Health Care workers are a case in point. So are police, fire, and the like. We need them to continue their fight against the disease.  LTCF personnel are health care workers and therefore qualify. Residents of LTCFs are a different story. If we could immunize everybody who could infect these residents, then the resident's themselves won't be at risk. However, we probably can't reliably do that and residents of LTCFs spread the disease rapidly inside the facility because there is no way to isolate them from each other. Arguably, they are a major "spreader", although in a smaller group. For that reason, I can understand making them relatively high priority.

After that point, I would suggest that going to the geographic communities with the highest concentration of cases is for sure the best way to reduce spread. The people who interface with the public and are most at risk will thereby get the vaccine early on by "natural selection". Some people will cheat and cross boundaries to get the vaccine, and we need to minimize that, but it isn't a catastrophe if they do. Eventually, "everybody" will get it. When we reach the point there aren't any identifiable hot spots, then it may not much matter how we distribute to the remainder of the population. They are all equally at risk.

RE: Vaccine distribution - teejers1 - 12-04-2020

(12-04-2020, 10:35 AM)dabigv13 Wrote:  It seems you are assuming all the December doses will be first doses, and increasing production will account for second doses and the next round of first doses. 

I'm not sure that's how they are planning it, at least initially while production is still ramping up. I'm guessing they will not be putting shots in arms if they don't already have access to the second round shots for those patients. We already saw Pfizer had issues with production, would be a big problem if lots of people only got one dose and couldn't get the second from some snafu. 

Once reliability in the production and delivery is known, maybe they will be putting first shots in while still waiting for delivery of the second one.

---

Here is an interesting interview with the lone CDC ACIP member who voted against including LTCF patients in the initial vaccination stage. Seems a big concern of hers is since LTCF patients are at a high risk of dying and having major health problems in general, if several die or have a stroke or heart attack soon after getting the vaccine, this could scare people into thinking they are related to the vaccination and reduce vaccine confidence.

https://www.statnews.com/2020/12/03/cdc-advisory-panels-lone-dissenter-on-why-long-term-care-residents-shouldnt-receive-covid-19-vaccine-first/

Interesting point.
Maybe some LTCF residents don't have much reason to get out (either no family or friends living any longer).  Perhaps for them the risk of negative side-effect trumps the benefit of vaccine.

But I'll bet the majority of residents would knowingly take the risk if it meant being able to get out and see family, in person, for the first time in 9 months.  I know Christmas is probably not gonna happen, but that would be one helluva present for one 97 year old I know.  

Realize this doesn't address the concern raised - namely that any negative reaction/deaths from LTCFs would depress interest in people getting vaccinated - but how would anyone really be able to tie the two together?  Are the death certificates going to say "died of complications from receiving vaccine?"  Or do you think the reporting will just be "LTCF X had residents vaccinated on December 20, and 3 residents reportedly died within a week of that?"  That's a serious question

RE: Vaccine distribution - magnus - 12-04-2020

(12-04-2020, 12:45 PM)teejers1 Wrote:  Or do you think the reporting will just be "LTCF X had residents vaccinated on December 20, and 3 residents reportedly died within a week of that?"  That's a serious question

Probably depends on the agenda of the reporting, unfortunately.

RE: Vaccine distribution - M T - 12-04-2020

(12-04-2020, 10:35 AM)dabigv13 Wrote:  It seems you are assuming all the December doses will be first doses, and increasing production will account for second doses and the next round of first doses. 

I'm not sure that's how they are planning it, at least initially while production is still ramping up. I'm guessing they will not be putting shots in arms if they don't already have access to the second round shots for those patients. We already saw Pfizer had issues with production, would be a big problem if lots of people only got one dose and couldn't get the second from some snafu.

According to Gen. Perna, the Pfizer vaccine only has a 20 day shelf life (at least, that's how long after they deliver it) and requires 21 days between doses.  As the first distribution day will be on or after Dec. 11, no second doses to patients will be given in December.    (The Moderna vaccine has 28 days between doses and starts shipping Dec. 18 at the earliest.)

If problems develop with production in late December, then I can certainly imagine them hanging onto doses.  But I don't see stockpiling 50% and delivering the vaccine with only a couple of days left before it expires, hoping that everybody shows up for 2nd doses on time.

Gen. Perna did say something to the effect of having the second dose in hand when shipping the first dose, but I figured that had to be metaphorically because of the expiration.   Or maybe there is some way to have a dose such that its shelf life doesn't start until a final step.
But even if he was literal, he was still talking of 40M doses delivered in Dec, not 20M.

This does mean that for the Pfizer vaccine,  something like 2/3 of January's shipment will be 2nd doses for people.  For Moderna,  2nd doses will dominate the mid-Jan to mid-Feb shipments.

RE: Vaccine distribution - Goose - 12-04-2020

(12-04-2020, 02:09 PM)M T Wrote:  According to Gen. Perna, the Pfizer vaccine only has a 20 day shelf life (at least, that's how long after they deliver it) and requires 21 days between doses.  As the first distribution day will be on or after Dec. 11, no second doses to patients will be given in December.    (The Moderna vaccine has 28 days between doses and starts shipping Dec. 18 at the earliest.)
The actual situation is this:
Quote:Right now, Pfizer says its vaccine needs to be kept at minus 70 degrees Celsius and can last in a specialty freezer for up to six months. The specialty shippers can hold up to five "pizza box" trays of vials and be refreshed with dry ice every five days for up to 15 days to keep the vaccine at the right frozen temperature.
I would assume the deliveries to places like UCSF would be stored in a "specialty freezer" capable of maintaining them for six months. If not, why not? It wouldn't be hard for 10 places in the State to have such freezers. I suspect they already do. Each individual hospital or pharmacy in the state, no, but big research centers, yes.

RE: Vaccine distribution - dabigv13 - 12-04-2020

I'm not sure General Perna is really going to be that important in this whole deal. Getting the vaccine promptly and safety to the delivery sites will be critical, but the "last mile" of getting vaccine into arms appropriately will be the most important and also where most can go wrong, and it seems that is not really his purview. 

As pointed out by Goose the vaccine is stable for 6 mos. Once you open packaging you start the clock. 

UK has mentioned they are using their first shipment for 1st and 2nd doses because they are not sure when they will get more.

I haven't seen anything definitive for the US, but I'm guessing our distribution will probably be similar at the start.

RE: Vaccine distribution - Goose - 12-04-2020

(12-04-2020, 03:53 PM)dabigv13 Wrote:  I'm not sure General Perna is really going to be that important in this whole deal. Getting the vaccine promptly and safety to the delivery sites will be critical, but the "last mile" of getting vaccine into arms appropriately will be the most important and also where most can go wrong, and it seems that is not really his purview.
For sure the "last mile" is where the most risk exists. I don't know what the "command structure" is. If he is truly "in charge", then he could require the State to demonstrate a working "last mile" distribution system to the command's satisfaction before delivering any clinical grade vaccine. I would hope that is the case, but I suspect that you are correct and his responsibility ends at the distribution points. I certainly support letting the State handle the last mile distribution in conjunction with local officials. They know their situation best and have the best chance of success. I also support expecting a working plan before entrusting the State with the real vaccine. The State should want that too, because nobody here wants to fail.

RE: Vaccine distribution - winflop - 12-04-2020

(12-04-2020, 08:12 AM)M T Wrote:  The CDC ACIP recommendations of vaccine distribution is available.
It notes there are 21 million health care workers and only 3 million people in LTCF.  Those are the only two groups that the ACIP mentions for their recommendations.  Considering that there were announced plans to have 40 million first doses out within 4 weeks (which would cover those 24 million and 16 million more), I find that woefully short of giving much guidance.

The Pfizer vaccine requires two doses, so 40 million doesn't even cover the 24 million people in groups 1a & 1b. It only gives them the first dose. Not sure how long after that they are supposed to get the second dose.

RE: Vaccine distribution - M T - 12-04-2020

(12-04-2020, 07:40 PM)winflop Wrote:  
(12-04-2020, 08:12 AM)M T Wrote:  The CDC ACIP recommendations of vaccine distribution is available.
It notes there are 21 million health care workers and only 3 million people in LTCF.  Those are the only two groups that the ACIP mentions for their recommendations.  Considering that there were announced plans to have 40 million first doses out within 4 weeks (which would cover those 24 million and 16 million more), I find that woefully short of giving much guidance.

The Pfizer vaccine requires two doses, so 40 million doesn't even cover the 24 million people in groups 1a & 1b. It only gives them the first dose. Not sure how long after that they are supposed to get the second dose.

The Operation Warp Speed (OWS) officials have indicated (as recently as Dec. 2) they expect to DELIVER 40 million doses to the states (etc) in December.  In January, another 60 million doses are expected to be delivered to the states (etc).  And another 100 million doses in February.   (Dr. Slaoui referred to as vaccines for 20 million people in December, 30 million in January, 50 million in February, for a total 100 million people by end of February.  I think that is confusing as NO person will get the full vaccine in December because the second dose is 3 weeks after the first.)

If you're thinking OWS are delivering two doses for each person in December, that is not the case.  They have made it very clear that the second dose of Pfizer will be delivered 21 days after the first dose is administered.  They even claimed that if you got your first dose in February but were in NY 21 days later, your second dose would be delivered there.   (I hope that database is by dose, not name:  "Jurisdiction: California; Mfgr: Pfizer; Dose: 13234435",  not "John Q. NonCitizen, 111 Main St, 555-555-1212, JohnQ@sample.com"  which will be on a card.  How they get in contact with you is a whole 'nother question.)

So, the 40 million first-doses delivered in December will cover the first doses for 24 million HCW+LTCF  and some 16 million more people.  All those people will be getting second doses delivered in January, from a later OWS shipment.

As pointed out by Dabigv, the last mile is less certain as to its ability to quickly deal with this much vaccine.   If OWS is able to ship 4M doses to California in December, it doesn't mean that California will be able to administer it to 4M people.  Especially if California is focused on some particular order of delivery and creates a shortage by not getting that order established, the individuals identified and then notified, and the appointments (or walk-ins) set up.


Do I really think 40M doses will ship in December?  No.  Even if they do ship weekly (as they described), including Christmas, there are at most 4 deliveries of Pfizer and 3 deliveries of Moderna.  I think that maybe it will ship by January 5.  I expect any particular dose will spend one day in transit to the state and 2 days in transit to the point at which it will be administered.  If these aren't walk in shots, there will be another day or two to get the person in to get the shot.
That's assuming that the administration site knows who should get the doses in what order, have their contact info, and can contact them.


Oh damn, I just realized all this is going to be another opportunity for phishing!   "Hi, this is John from the California COVID Vaccination team.  Congratulations, we've got a shot for you.  Please confirm your SSN"

RE: Vaccine distribution - BostonCard - 12-04-2020

(12-04-2020, 07:40 PM)winflop Wrote:  
(12-04-2020, 08:12 AM)M T Wrote:  The CDC ACIP recommendations of vaccine distribution is available.
It notes there are 21 million health care workers and only 3 million people in LTCF.  Those are the only two groups that the ACIP mentions for their recommendations.  Considering that there were announced plans to have 40 million first doses out within 4 weeks (which would cover those 24 million and 16 million more), I find that woefully short of giving much guidance.

The Pfizer vaccine requires two doses, so 40 million doesn't even cover the 24 million people in groups 1a & 1b. It only gives them the first dose. Not sure how long after that they are supposed to get the second dose.

21 days after the first dose.  But remember, Pfizer/BioNTech are manufacturing more all the time.  Come next year, they are expecting to be producing 100 million doses a month.

BC

RE: Vaccine distribution - JustAnotherFan - 12-05-2020

I really appreciate this thread. Thanks everyone.

RE: Vaccine distribution - dabigv13 - 12-05-2020

When looking at the 7 hospitals in California getting the vaccine, it's interesting that they are mostly academic or  children's hospitals, presumably because they have active research programs and thus access to the super cold freezers necessary for the Pfizer vaccine.

A bit curious to me how Cedars ended up as the LA hospital, but they are well funded and do some research so I'm sure they have what's necessary. I know of one other LA area hospital, not my own, that is converting an ambulatory surgery center into a vaccine distribution area, with freezers and the like, so I imagine that while Cedars will be giving out shots on site, they will also be distributing to other properly equipped LA facilities for December vaccinations. And of course they can be kept out of the freezers for several days for distribution at other facilities that lack them for shorter duration vaccine drives. Hopefully very soon after FDA approval we will hear more details on this process (or even before, conditional on approval).

RE: Vaccine distribution - M T - 12-05-2020

If you look at the Operation Warp Speed site, you can see the push that's been going on behind the scenes.  Yes, there's a lot of stuff right now about getting the vaccine to the states (etc), but OWS has been kicking the states to get their act together.  There were deadlines for draft plans (apparently based on questions to be answered), and the deadline to get final state micro-plans in for Pfizer distribution was (I think) Dec. 3 and for Moderna a week later.  The states were given the anticipated number of first-day doses (possibly Dec. 12) on Nov 20.  OWS has been distributing freezers, but I don't know how many.  I expect places like Guam and South Dakota needed them more than California.

California has had commissions & studies about the vaccine.  I just hope they've got their detailed plans ready for the distribution but have been withholding it from the public.  I may be wrong, but I fear such a commission may have spent their time debating whether the homeless and the jail population get their vaccination before or after cancer patients, rather than deciding that the three groups can get theirs within 2 weeks of each other if they just get started.  I expect they're hand-wringing over how people may get lost (for instance, if they don't have a drivers license, aren't registered to vote, and aren't in the tax system).

The first week's vaccinations should be easy.  The state will know who is in what LTCF (state tax return or voting registration addresses, etc.) and who works at various medical facilities (state tax returns).  They can probably send out teams to the various facilities to vaccinate.

But, after that, it is going to be a lot harder, I think.  And, if they aren't a month into the planning down to the details, I don't see how they'll be able to get it ready to go in < 2 weeks.

I don't know how the state would know whether I have the comorbidities that put me in one group or another. They many know roughly how many in the state have diabetes or HBP or whatever, but I'm not aware of any state or federal data collection that ties someone's name to their condition.  For a large proportion of the population the aggregate of the insurance companies know, and the aggregate of the medical companies know, while the aggregate of the pharmacies know what meds people take.

As I see it, the state doesn't have the info to be in a position to mail me a notice saying I'm eligible for this or that vaccination on such-and-such day at such-and-such time.   I also think it would be wasteful of time (and, thus, lives) to try to set up a distribution at this time to the physician facilities that residents may already be using.

It seems more likely they will (someday) say people with such-and-such age and conditions can make an appointment with CVS & Walgreens for their first dose.   Then, it will be pushed onto CVS & Walgreens to try to validate the conditions, or not bother.   But this distribution won't get the vaccine to invalids ("shut-ins" back in the 50s & 60s).

I hope I'm wrong and they've got this worked out, with all the administrators and workers (Customer service) to explain it & deal with problems) already in position with phone lines, and with printed mailers explaining the whole process ready to be mailed on Dec. 10 or so.

RE: Vaccine distribution - Goose - 12-05-2020

(12-05-2020, 06:52 PM)M T Wrote:  The first week's vaccinations should be easy.
Compared to what? No activity you haven't done before is ever "easy". Plenty of things that you never imagined can go wrong. The Health Care Workers should be easier than the general public, but that doesn't mean "easy". Figuring out who "qualifies" is perhaps an important part of the problem, but people in LTCF will probably receive their vaccines in that facility. How that will be made to happen isn't trivial.

All this stuff can be done, and if properly planned, properly resourced, and properly validated can go very well. We will soon see to what extent it has been. We can't afford anything but a "good" performance, because the performance we have managed up to now in containing this disease is horrid, IMHO.