Vaccine distribution

[BostonCard]

You are right, and I suspect there were many things "worked out" in advance.  However, you can't work everything out in advance without knowing vaccine-specific data, such as how many doses will be available and when, what the storage requirements will be, how many doses will need to be given, and even who will be distributing the vaccine and how.  Saying "healthcare workers first" is easy; it is much harder to do so when you have to worry about healthcare workers in rural hospitals getting two shots of a vaccine that needs to be stored at -80.  Not to say it can't be done, of course, but, my guess is that the broad outlines have been in place for a while (in fact, were required by the federal government at least a month ago), but the final details are dependent on exactly which vaccine(s) are approved and when.

BC

[Goose]

You are right, and I suspect there were many things "worked out" in advance.  However, you can't work everything out in advance without knowing vaccine-specific data, such as how many doses will be available and when, what the storage requirements will be, how many doses will need to be given, and even who will be distributing the vaccine and how.  Saying "healthcare workers first" is easy; it is much harder to do so when you have to worry about healthcare workers in rural hospitals getting two shots of a vaccine that needs to be stored at -80.  Not to say it can't be done, of course, but, my guess is that the broad outlines have been in place for a while (in fact, were required by the federal government at least a month ago), but the final details are dependent on exactly which vaccine(s) are approved and when.

BC

BC, I would have thought things like storage at -80 would have been been an issue for a while, as it isn't a "new" requirement for the Pfizer/BioNTech vaccine. That has been known for quite a while, and certainly the two doses has been known at least back to when they filed the clinical trial plan (and probably earlier), has it not? The other issues you point out (rural health care workers, who will distribute the vaccine etc.) are certainly important, but also possible to anticipate and plan for, given the "warp speed" risk funding of production etc. Not to say these things are easy, but all the more reason to figure out how to do them as early as possible. In fact, there should be multiple plans in place, because they couldn't know in advance which vaccines would receive EUAs/full approvals at all, let alone when.
The "final details" certainly do depend on how many doses will be available when and FOB where. These things can be planned but it isn't actionable until it happens. Things do tend to get delayed, even with risk funding and a good production plan. Otherwise, I would expect the overall plan to be totally worked out well in advance. Naturally, some things won't actually happen according to plan, but I am still surprised there are as many unknowns in "the plan" as there appears to be.

[BostonCard]

While the possibility of requiring -80 has always been there, we had no idea which vaccine(s) were going to be safe and effective and thus available and when.  There was a universe where there was a delay in the Pfizer/BioNTech data and Oxford/AZ came in first.  Or, you could imagine circumstances where the first three vaccines came in with subpar efficacy, but that the J&J vaccine, which requires only one dose, works better.  We still don't really know the full spectrum of protection in older adults; your distribution plans have to change if only one of the vaccines is effective in older populations.

There are many more moving pieces than you appreciate because the vaccines are not interchangeable and you have to balance efficacy, convenience, storage requirements, etc.

BC

[DocSavage87]

There was also the issue of side effect profiles for the various vaccines.  The working group that has been analyzing the data is supposed to prioritize vaccines for different groups using the clinical data accumulated.  So if say one vaccine had more side effects for the elderly population, that would be shifted away from nursing homes and used more for younger frontline healthcare workers.  It sounded like there's little side effects, even with the new mRNA vaccines, so that should make things easier, but they didn't know it before the data came out.

[BostonCard]

I think the side effects are not trivial, but they are not long-lasting.  I've heard vaccine trial participants on twitter (warning, not a representative sample) say that they knew they got the active vaccine, because they were flattened the rest of the day.  I think it can cause profound fatigue, headaches, fever, and muscle aches, but that usually goes away in a day or so.  Ironically, that might make it a bad bet for healthcare workers, whose employers can't afford for a substantial proportion of their workforce to be out of commission for a day when they are vaccinated.

BC

[M T]

Ironically, that might make it a bad bet for healthcare workers, whose employers can't afford for a substantial proportion of their workforce to be out of commission for a day when they are vaccinated.

Doesn't it just mean the workers need to be vaccinated on a day off (or at the start of 2 days off)?

[BostonCard]

The way this works (at least for influenza) is that there are a handful of set days where nurses come in and vaccinate everyone.  Obviously, you can't do something like that (say, have five days available where 20% of the workforce is vaccinated) if that means that 20% of the workforce will be out of commission the next day.

Obviously, that is not the only way to do it, but that is the most efficienct way.

BC

[dabigv13]

I will say there is a decent level of skepticism even amongst doctors about the vaccine safety. Frankly I hope they opt out in case the initial distribution is limited so I can get some!

That being said, all the shots we're getting will still be considered experimental. As the vaccine scales from 30k to 20 million, it is very possible rare side effects may start to be seen. Also, safety for pregnant women still an unknown, which will impact the vaccination choices of many HCW's as well.

[oldalum]

As the vaccine scales from 30k to 20 million, it is very possible rare side effects may start to be seen.

True, but if rare, may not outweigh the potential benefit depending on one's risk factors and possible exposures. I'd risk a rare severe side effect for 95% efficacy against Covid-19 any day. Would be nice to live more of a normal life again :)

[BostonCard]

Saloui said today that he expects everyone who wants a vaccine to be able to get one by June.  That’s ambitious, but could happen if everything breaks right.

BC

[magnus]

The UK has announced their virus priority plan. 

Nursing home residents and their carers get first priority. The subsequent tiers mainly prioritize the elderly. 

https://www.politico.eu/article/how-the-...s-vaccine/

The first phase of the U.K.’s vaccination program will work through nine groups, beginning with residents in care homes for older adults and their carers. Next, all those over 80 years of age and other front-line health and care workers will be offered the jab.

Over-75s are in the third tier of prioritization, followed by the over-70s and extremely clinical vulnerable younger adults.

[Genuine Realist]

The UK has announced their virus priority plan. 

Nursing home residents and their carers get first priority. The subsequent tiers mainly prioritize the elderly. 

https://www.politico.eu/article/how-the-...s-vaccine/

The first phase of the U.K.’s vaccination program will work through nine groups, beginning with residents in care homes for older adults and their carers. Next, all those over 80 years of age and other front-line health and care workers will be offered the jab.

Over-75s are in the third tier of prioritization, followed by the over-70s and extremely clinical vulnerable younger adults.

I would be in the priority group or close (age 74, with compromised immune system), and I don't agree with it.

Health care workers,obviously, and hands-on educators, i.e., classroom teachers. The elderly can actually self-isolate fairly easily, compared to other sectors.

I want to see society normalize for children, ordinary workers, and so on, far more than I want to see the elderly safeguarded.

[BostonCard]

I think the first priority is specifically for elderly in care homes.  They are by definition in a conjugate setting where they can't isolate, because the care workers come in and out and often jump from one care home to another, where they spread the disease.  Although a fair amount of effort is supposedly being expended to isolate and protect the elderly in these settings, whatever it is, it's not working.

https://www.kff.org/coronavirus-covid-19...ing-homes/

The most recently available data show long-term care facilities account for 8% of all coronavirus cases but more than 40% of all COVID-19 deaths. Overall, COVID-19 has taken a disproportionate toll on communities of color.

Ultimately, you are looking at two risk scales:
1) The risk of getting COVID, which is related to ability to self-isolate.  Here, healthcare workers have the highest risk (because they are directly exposed to patients with COVID-19), and the vaccine is important for them to safely do their job.  Essential workers have moderate risk because they are exposed to large numbers of patients and cannot self-isolate, as are people in congregate settings (elderly in care homes, homeless people in shelters, prisoners, etc.), and then the average person who is in a non-essential worker or can work from home has the highest ability to isolate until vaccination.
2) The risk of severe illness of death if they get COVID.  Here, you are basically looking at age and risk factors, independent of ability to avoid COVID-19.

So, it is somewhat logical to prioritize people who have a high risk of COVID-19 and conditional on getting COVID-19 are at high risk of severe disease or death, which is why the elderly in care homes are among the highest priority for vaccination.  After that, you would look to vaccinate people who are at either high risk of getting COVID-19 (essential workers) or high risk of severe illness if they get COVID-19 (people with risk factors or advanced age, like you), and then the lowest priority should be people like me (those with none or minimal risk factors who can generally protect themselves.

BC

[dabigv13]

I believe LTCF are responsible for something like 30-40% of mortality and ICU bed usage in the US pandemic. By vaccinating those folks you create a lot more slack in the system.

Vaccinating essential workers first versus old/sick people first is an interesting conundrum. Perhaps if you vaccinate healthy essential workers, you could cut a lot of transmission and end pandemic sooner as opposed to vaccinating the old/sick people first. But this would be very difficult I think to accurately predict, and luckily it seems the vaccines will be coming quick enough that it will mostly be academic, which I suspect is what will happen with the idea of immunity passports and the like.

I think likely scenario is by mid spring enough people will be vaccinated/previously infected, that routine mask wearing will be enough to keep R below one and the pandemic will be mostly over in US apart from sporadic outbreaks.

[M T]

I believe LTCF are responsible for something like 30-40% of mortality and ICU bed usage in the US pandemic. By vaccinating those folks you create a lot more slack in the system.

Vaccinating essential workers first versus old/sick people first is an interesting conundrum. Perhaps if you vaccinate healthy essential workers, you could cut a lot of transmission and end pandemic sooner as opposed to vaccinating the old/sick people first. But this would be very difficult I think to accurately predict, and luckily it seems the vaccines will be coming quick enough that it will mostly be academic, which I suspect is what will happen with the idea of immunity passports and the like.

If I were directing it, I'd send crews & vaccine to the LTCFs and vaccinate anyone there that was willing to get it: residents, nurses, cleaning crew, kitchen staff, drivers, etc.  No sense making two trips or getting the staff to come to you.  No sense risking the person that enters the LTCF next week because the LTCF's driver got sick.   Nearly instant herd immunity for that herd, even if some are subsequently added to the herd.

"Essential workers" is too general.  Risk of exposure and risk of direct or indirect harm has to be involved in the determination.  I am an essential worker for two separate reasons and I'm older than 65 and have comorbidities (as does my spouse).  But I'm not at much risk because I rarely leave my house (and neither does my spouse).  I will selfishly sit back and let others test out these novel vaccines.  You could view it as stepping back because I believe my risk of exposure is low and letting others with higher risk step forward.

This 2019 Mercury News article indicated

Nearly 6 million Californians are over the age of 65...
While the most common living arrangement for seniors is still to cohabitate with a spouse, about 36% of women and 20% of men over 65 currently live alone, according to census data.
Assisted living facilities — housing communities that can provide daily living assistance to seniors outside of a medical setting — are pretty popular in California. But only 2% of California seniors live in nursing homes — facilities in a medical setting.

That indicates about 120K seniors in LTCFs in California (I couldn't find the number directly).  That's easily covered by the roughly 700,000 doses expected to arrive in about 2 weeks, or even the 377K mentioned by the governor.  And dwarfed by the 40M * 0.12 = 4.8M doses by the end of the year for California.  (The number of different people getting a first dose of vaccine by the end of the year should be about 4.8M doses - 0.8M doses for 2nd dose of those getting the very first doses = 4.0M first-round doses, which is about 10% of California's residents.)

The rest of us seniors have risk of direct harm but maybe a large chunk of us living only with our spouses can maintain a low risk of exposure.  (Yes, I do want to visit our grandkids, but I will continue to wait another 6 months if needed.  Thank you, Facetime.)

[Genuine Realist]

 
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.

[BostonCard]

If this is right (big if), between infections and vaccinations, maybe half the country will be immune by March, and Slaoui's prediction of herd immunity by May might prove correct.

Not getting the vaccine immediately is not going to mean a long wait.

BC

[washingtonismoney]

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). It's just a tough business. And that's assuming that there's no rare side effects, misinformation about side effects, other stuff.

[dabigv13]

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...

[akiddoc]

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.