[dabigv13]

It will not. It's NYC in March status crisis level of care, all over the country now. We have lots of vents still, but not enough staff, so its all hands on deck.

I feel good about our vaccine distribution plan in the hospital, we just need the shipment.

Try to stay out of the hospital folks.

[dabigv13]

It will not. It's NYC in March status crisis level of care, all over the country now. We have lots of vents still, but not enough staff, so its all hands on deck.

I feel good about our vaccine distribution plan in the hospital, we just need the shipment.

Try to stay out of the hospital folks.

[BostonCard]

Looks like next week I will be working in the COVID ICU, and possibly getting a vaccine. Hopefully the latter before the former!

Good luck out there!

Remember, you won't have protective immunity until about 10 days after you get the vaccine (though officially not until 7 days after the second dose, it looks like the curves separate at day 10).  So, vaccine or no vaccine you will have to act like you are not immune.

BC

[BostonCard]

Looks like next week I will be working in the COVID ICU, and possibly getting a vaccine. Hopefully the latter before the former!

Good luck out there!

Remember, you won't have protective immunity until about 10 days after you get the vaccine (though officially not until 7 days after the second dose, it looks like the curves separate at day 10).  So, vaccine or no vaccine you will have to act like you are not immune.

BC

[M T]

I feel good about our vaccine distribution plan in the hospital, we just need the shipment.

I am SO glad to hear that.  That is the first I've heard about the last mile for anywhere in California.  Out of curiosity, are they going to do everyone on the same day, or try to manage it so at least some of the staff get the shot on a day they aren't trying to care for patients?

I'm crossing my fingers for Monday for you.

[M T]

I feel good about our vaccine distribution plan in the hospital, we just need the shipment.

I am SO glad to hear that.  That is the first I've heard about the last mile for anywhere in California.  Out of curiosity, are they going to do everyone on the same day, or try to manage it so at least some of the staff get the shot on a day they aren't trying to care for patients?

I'm crossing my fingers for Monday for you.

[dabigv13]

They are trying to space it out, so entire departments and units aren't all potentially having side effects at same time. There is priority for units/staff with the most direct covid care, but expectation is everyone who wants a shot will get one soon.

Personally, give me the shot the first day I can get it. I'll take a tylenol and I'm sure I'll be fine. I've got proper PPE, just can't get careless down the home stretch.

‐----

FDA approval just now!!!

Operation Warp Speed, activate!

[dabigv13]

They are trying to space it out, so entire departments and units aren't all potentially having side effects at same time. There is priority for units/staff with the most direct covid care, but expectation is everyone who wants a shot will get one soon.

Personally, give me the shot the first day I can get it. I'll take a tylenol and I'm sure I'll be fine. I've got proper PPE, just can't get careless down the home stretch.

‐----

FDA approval just now!!!

Operation Warp Speed, activate!

[BostonCard]

They are trying to space it out, so entire departments and units aren't all potentially having side effects at same time. There is priority for units/staff with the most direct covid care, but expectation is everyone who wants a shot will get one soon.

Personally, give me the shot the first day I can get it. I'll take a tylenol and I'm sure I'll be fine. I've got proper PPE, just can't get careless down the home stretch.

‐----

FDA approval just now!!!

Operation Warp Speed, activate!

Small nit, it was not an approval, it was an emergency use authorization.  Full approval will come with 6 months of safety data, based on reading the tea leaves.  A distinction without a difference for you, since the EUA will mean that you (and a few million others) can go ahead and get it, but it is still worth keeping in mind that it is not a full marketing authorization.

BC

[BostonCard]

They are trying to space it out, so entire departments and units aren't all potentially having side effects at same time. There is priority for units/staff with the most direct covid care, but expectation is everyone who wants a shot will get one soon.

Personally, give me the shot the first day I can get it. I'll take a tylenol and I'm sure I'll be fine. I've got proper PPE, just can't get careless down the home stretch.

‐----

FDA approval just now!!!

Operation Warp Speed, activate!

Small nit, it was not an approval, it was an emergency use authorization.  Full approval will come with 6 months of safety data, based on reading the tea leaves.  A distinction without a difference for you, since the EUA will mean that you (and a few million others) can go ahead and get it, but it is still worth keeping in mind that it is not a full marketing authorization.

BC

[dabigv13]

Yes, important distinction. Let's hope there's no late side effects. Definitely some horror movie scenarios being hashed out in the breakrooms, but I think most want it as soon as they can get it. Some are happy waiting a couple weeks.

[dabigv13]

Yes, important distinction. Let's hope there's no late side effects. Definitely some horror movie scenarios being hashed out in the breakrooms, but I think most want it as soon as they can get it. Some are happy waiting a couple weeks.

[magnus]

It will not. It's NYC in March status crisis level of care, all over the country now. We have lots of vents still, but not enough staff, so its all hands on deck.

Does this mean elective surgeries have been suspended?

[magnus]

It will not. It's NYC in March status crisis level of care, all over the country now. We have lots of vents still, but not enough staff, so its all hands on deck.

Does this mean elective surgeries have been suspended?

[dabigv13]

At my hospital, they have been for a week, and will be for a while. Only emergency and cancer cases. One of our recovery rooms is now a non covid ICU.

Some hospitals and many ambulatory surgery centers in LA are still doing elective cases.

[dabigv13]

At my hospital, they have been for a week, and will be for a while. Only emergency and cancer cases. One of our recovery rooms is now a non covid ICU.

Some hospitals and many ambulatory surgery centers in LA are still doing elective cases.

[magnus]

At my hospital, they have been for a week, and will be for a while. Only emergency and cancer cases. One of our recovery rooms is now a non covid ICU.

Some hospitals and many ambulatory surgery centers in LA are still doing elective cases.

Thanks for the info and sorry to hear.  That was one of the last things i was hopeful for.  That hospitals still had elective surgeries margin.   Alas.

Hopefully the PPE supplies will still be strong in a week.

[magnus]

At my hospital, they have been for a week, and will be for a while. Only emergency and cancer cases. One of our recovery rooms is now a non covid ICU.

Some hospitals and many ambulatory surgery centers in LA are still doing elective cases.

Thanks for the info and sorry to hear.  That was one of the last things i was hopeful for.  That hospitals still had elective surgeries margin.   Alas.

Hopefully the PPE supplies will still be strong in a week.

[dabigv13]

PPE not the issue generally now, that's in decent shape. CA has a big state backlog too. It's staff and space. OR and PACU nurses are working in the ICU or floor and surgeons and anesthesiologists working in ICUs and ED.

[dabigv13]

PPE not the issue generally now, that's in decent shape. CA has a big state backlog too. It's staff and space. OR and PACU nurses are working in the ICU or floor and surgeons and anesthesiologists working in ICUs and ED.

[BostonCard]

I would add that depending on the place, non-emergency cases can be a surprising number of surgeries.  "Elective" surgery is not just plastic surgeries.  They can be things like heart valve surgeries, non-emergent cardiac bypasses, tumor biopsies, aneurysms that aren't bleeding, etc.  Lots of things that can't be put off indefinitely, but the patient won't die today if they don't get the surgery.

BC

[BostonCard]

I would add that depending on the place, non-emergency cases can be a surprising number of surgeries.  "Elective" surgery is not just plastic surgeries.  They can be things like heart valve surgeries, non-emergent cardiac bypasses, tumor biopsies, aneurysms that aren't bleeding, etc.  Lots of things that can't be put off indefinitely, but the patient won't die today if they don't get the surgery.

BC

[chrisk]

Stanford cancelled 20-30 elective surgeries yesterday.

[chrisk]

Stanford cancelled 20-30 elective surgeries yesterday.

[dabigv13]

This from the NYT is a good overview of the vaccine situation at the moment, and reflective of the on the ground picture I think.

https://www.nytimes.com/2020/12/12/healt...first.html

[dabigv13]

This from the NYT is a good overview of the vaccine situation at the moment, and reflective of the on the ground picture I think.

https://www.nytimes.com/2020/12/12/healt...first.html

[Mick]

I would add that depending on the place, non-emergency cases can be a surprising number of surgeries.  "Elective" surgery is not just plastic surgeries.  They can be things like heart valve surgeries, non-emergent cardiac bypasses, tumor biopsies, aneurysms that aren't bleeding, etc.  Lots of things that can't be put off indefinitely, but the patient won't die today if they don't get the surgery.

BC

Radical bilateral mastectomies with reconstruction.  As an example.

[Mick]

I would add that depending on the place, non-emergency cases can be a surprising number of surgeries.  "Elective" surgery is not just plastic surgeries.  They can be things like heart valve surgeries, non-emergent cardiac bypasses, tumor biopsies, aneurysms that aren't bleeding, etc.  Lots of things that can't be put off indefinitely, but the patient won't die today if they don't get the surgery.

BC

Radical bilateral mastectomies with reconstruction.  As an example.

[M T]

General Perna indicated on Saturday morning that he expects first shipments to arrive Monday morning.   (I'm disappointed.  He previously said things would be shipped within 24 hours, which should mean arrival Sunday morning.  I can see that some facilities might not be available on the weekend, but each day is thousands of lives.)

He speaks of 636 distribution sites, but then indicates 145 sites will receive them on Monday, 425 on Tuesday, and 66 on Wednesday.  Tick, tick, tick....  (Some of the sites are overseas,  so flight time may be 20+ hours.)

[M T]

General Perna indicated on Saturday morning that he expects first shipments to arrive Monday morning.   (I'm disappointed.  He previously said things would be shipped within 24 hours, which should mean arrival Sunday morning.  I can see that some facilities might not be available on the weekend, but each day is thousands of lives.)

He speaks of 636 distribution sites, but then indicates 145 sites will receive them on Monday, 425 on Tuesday, and 66 on Wednesday.  Tick, tick, tick....  (Some of the sites are overseas,  so flight time may be 20+ hours.)

[Goose]

General Perna indicated on Saturday morning that he expects first shipments to arrive Monday morning.   (I'm disappointed.  He previously said things would be shipped within 24 hours, which should mean arrival Sunday morning.  I can see that some facilities might not be available on the weekend, but each day is thousands of lives.)

He speaks of 636 distribution sites, but then indicates 145 sites will receive them on Monday, 425 on Tuesday, and 66 on Wednesday.  Tick, tick, tick....  (Some of the sites are overseas,  so flight time may be 20+ hours.)

If you send it out UPS or Fedex, you have their service to contend with. I suspect that nobody was prepared for a Friday afternoon EUA. Probably couldn't make the Saturday cutoff for next day shipping to the west coast, especially for a "special handling" shipment.

[Goose]

General Perna indicated on Saturday morning that he expects first shipments to arrive Monday morning.   (I'm disappointed.  He previously said things would be shipped within 24 hours, which should mean arrival Sunday morning.  I can see that some facilities might not be available on the weekend, but each day is thousands of lives.)

He speaks of 636 distribution sites, but then indicates 145 sites will receive them on Monday, 425 on Tuesday, and 66 on Wednesday.  Tick, tick, tick....  (Some of the sites are overseas,  so flight time may be 20+ hours.)

If you send it out UPS or Fedex, you have their service to contend with. I suspect that nobody was prepared for a Friday afternoon EUA. Probably couldn't make the Saturday cutoff for next day shipping to the west coast, especially for a "special handling" shipment.

[M T]

SCC expects 17,550 doses of Pfizer vaccine, presumably this week (and an unknown or, not public, number next week).
and 39,300 doses of Moderna vaccine, hopefully next week.

The first number is 0.595% of the 2.95M Pfizer doses expected to be in the first shipment.

I don't believe we have a good estimate of the Moderna first shipment, but General Perna again reserves 500,000 doses from the 12.5M Moderna doses, and then withholds half the remainder, then SCC would be getting 0.655% of that 6M dose shipment.

If 20M first doses do ship in December, 0.6% of that total would be 120,000 first doses.
As I understand the numbers, the total LTCF number is much smaller than that, so a majority would go to first responders and health care workers, as opposed to those who are more likely to wind up in the ICU.

[M T]

SCC expects 17,550 doses of Pfizer vaccine, presumably this week (and an unknown or, not public, number next week).
and 39,300 doses of Moderna vaccine, hopefully next week.

The first number is 0.595% of the 2.95M Pfizer doses expected to be in the first shipment.

I don't believe we have a good estimate of the Moderna first shipment, but General Perna again reserves 500,000 doses from the 12.5M Moderna doses, and then withholds half the remainder, then SCC would be getting 0.655% of that 6M dose shipment.

If 20M first doses do ship in December, 0.6% of that total would be 120,000 first doses.
As I understand the numbers, the total LTCF number is much smaller than that, so a majority would go to first responders and health care workers, as opposed to those who are more likely to wind up in the ICU.

[BostonCard]

[tweet]https://twitter.com/kylegriffin1/status/1338241133940408320?s=20[/tweet]

Funny that the same people who thought COVID-19 was a hoax are now first in line to get it.  I don't disagree with prioritizing our national security apparatus and our executive, legislative and judicial bodies; we need the work of government to continue.  Plus, vaccinating the administration might help convince many of its followers to get vaccines as well?  But maybe the powers that be shouldn't have spent the last nine months minimizing the severity of the disease?

BC

[BostonCard]

[tweet]https://twitter.com/kylegriffin1/status/1338241133940408320?s=20[/tweet]

Funny that the same people who thought COVID-19 was a hoax are now first in line to get it.  I don't disagree with prioritizing our national security apparatus and our executive, legislative and judicial bodies; we need the work of government to continue.  Plus, vaccinating the administration might help convince many of its followers to get vaccines as well?  But maybe the powers that be shouldn't have spent the last nine months minimizing the severity of the disease?

BC

[M T]

As for US Executive Branch getting the vaccine, I think it is a good idea.  If they didn't, some portion of the US might feel that meant the vaccine was not to be trusted.

Bay Area's NBC channel's article suggests that pregnant women will be prioritized [Edit: I misread it].  But I thought they were not in the trials, and therefore should not be getting the vaccine.  We don't want another thalidomide disaster.  Pregnancy wasn't mentioned in this Dec. 3 CDC advice.

Did that news agency get it wrong?

They refer to a recommendation supposedly made on "Saturday", presumably Dec. 12.  I don't find any "allowed" recommendation in the Dec. 13 ACIP info.


Youch... I'm old enough to remember the problems with thalidomide.  I didn't realize that in the intervening years, conspiracy theorists invented a way to blame it on the Nazis!  As is so typical of today's world, if you Google thalidomide, most of the hits are that B.S.  I suggest you read this report by the company that invented & patented it in 1954. (See also this[.)

[M T]

As for US Executive Branch getting the vaccine, I think it is a good idea.  If they didn't, some portion of the US might feel that meant the vaccine was not to be trusted.

Bay Area's NBC channel's article suggests that pregnant women will be prioritized [Edit: I misread it].  But I thought they were not in the trials, and therefore should not be getting the vaccine.  We don't want another thalidomide disaster.  Pregnancy wasn't mentioned in this Dec. 3 CDC advice.

Did that news agency get it wrong?

They refer to a recommendation supposedly made on "Saturday", presumably Dec. 12.  I don't find any "allowed" recommendation in the Dec. 13 ACIP info.


Youch... I'm old enough to remember the problems with thalidomide.  I didn't realize that in the intervening years, conspiracy theorists invented a way to blame it on the Nazis!  As is so typical of today's world, if you Google thalidomide, most of the hits are that B.S.  I suggest you read this report by the company that invented & patented it in 1954. (See also this[.)

[dabigv13]

I didn't get the sense from reading the article that pregnant women are being prioritized, just that for the first time they are mentioned in guidance, which is that they may be vaccinated, but should discuss it with their healthcare provider. 

This is happening now in the context of pregnant healthcare workers. No clear guidance as they were supposed to be excluded from the trials, but from the few (I think 20-30) cases that got into the trials somehow, no ill effects have been seen thus far. I think OB's are saying it should be safe, like most vaccines, though we don't have enough real human data to know for sure at this time.

[dabigv13]

I didn't get the sense from reading the article that pregnant women are being prioritized, just that for the first time they are mentioned in guidance, which is that they may be vaccinated, but should discuss it with their healthcare provider. 

This is happening now in the context of pregnant healthcare workers. No clear guidance as they were supposed to be excluded from the trials, but from the few (I think 20-30) cases that got into the trials somehow, no ill effects have been seen thus far. I think OB's are saying it should be safe, like most vaccines, though we don't have enough real human data to know for sure at this time.