[g1313]

Not a great sign if a theoretically elite medical institution can't even get this right:

https://www.propublica.org/article/only-...-residents
https://arstechnica.com/science/2020/12/...residents/

I don't think this is some sort of intentional conspiracy by the hospital administration, but you would think this would be handled a little better.

[g1313]

Not a great sign if a theoretically elite medical institution can't even get this right:

https://www.propublica.org/article/only-...-residents
https://arstechnica.com/science/2020/12/...residents/

I don't think this is some sort of intentional conspiracy by the hospital administration, but you would think this would be handled a little better.

[chrisk]

Not a great sign if a theoretically elite medical institution can't even get this right:

https://www.propublica.org/article/only-...-residents
https://arstechnica.com/science/2020/12/...residents/

I don't think this is some sort of intentional conspiracy by the hospital administration, but you would think this would be handled a little better.

They could compare notes with UCSF.

[chrisk]

Not a great sign if a theoretically elite medical institution can't even get this right:

https://www.propublica.org/article/only-...-residents
https://arstechnica.com/science/2020/12/...residents/

I don't think this is some sort of intentional conspiracy by the hospital administration, but you would think this would be handled a little better.

They could compare notes with UCSF.

[BostonCard]

Not a good look at all...

Another Stanford resident, who asked to remain unidentified because of fear of retaliation, said only seven residents and fellows out of a total of about 1,300 were slated to the receive the vaccine during an initial distribution of 5,000 doses. Some critical care and infectious disease doctors also were passed over, the resident said.

On the other hand, some attending physicians who have been working from home and have not seen a COVID-19 patient in person since the pandemic began were slated to receive the inoculations, the resident said.

BC

[BostonCard]

Not a good look at all...

Another Stanford resident, who asked to remain unidentified because of fear of retaliation, said only seven residents and fellows out of a total of about 1,300 were slated to the receive the vaccine during an initial distribution of 5,000 doses. Some critical care and infectious disease doctors also were passed over, the resident said.

On the other hand, some attending physicians who have been working from home and have not seen a COVID-19 patient in person since the pandemic began were slated to receive the inoculations, the resident said.

BC

[magnus]

Vaccine priorities vary widely from place to place it seems.

In Texas, I know of at least one opthalmologist and one radiologist who have already gotten their shots.

In a prominent hospital in SoCal, at least one high ranking administrator has gotten their shot.  Neurology (or was it Urology...i didn't hear very clealy) also got at least one shot, but the doctors who directly deal with breathing (being vague, but not really) have not.

[magnus]

Vaccine priorities vary widely from place to place it seems.

In Texas, I know of at least one opthalmologist and one radiologist who have already gotten their shots.

In a prominent hospital in SoCal, at least one high ranking administrator has gotten their shot.  Neurology (or was it Urology...i didn't hear very clealy) also got at least one shot, but the doctors who directly deal with breathing (being vague, but not really) have not.

[M T]

While Operation Warp Speed distributed doses to the states based on population numbers, the states were not required to distribute their doses based on population, or even to distribute the first and second deliveries according to the same criteria.  In theory, California could have distributed their first delivery all to SoCal.  (CA didn't, of course.)  

If CA did deliver doses to counties based on population, then I would guess (and it only is a guess) that major medical centers were under-supplied relative to community hospitals in more rural areas if you look at doses to cover the health care workers.

Regarding Stanford Hospital, I heard on the news that someone in a responsible position said they made a mistake and would rectify it immediately.  Of course, the hospital got 1500 doses, which other places (primary & urgent care centers, SNFs, LTCFs) didn't.

I found this at SCC:

Company	Doses for SCC	Date of Arrival
Pfizer	17,550*	Dec 15: 5,850 Dec 18: 11,700
Moderna	39,300	est. Dec. 22

*We may be directed to give a small amount to nearby counties that lack the equipment to receive vaccine themselves.

"These early doses will be for people in the highest risk categories, as set by the state and federal government. Specifically, they will go to healthcare workers in hospitals, and staff and residents in skilled nursing facilities. "

The Bay Area Health Departments indicated that the Dec. 15 doses would go to healthcare workers. The Dec. 18 shipment will apparently go directly to hospitals. That leaves me wondering how SNF residents and staff will get the doses as SCC claims will happen.

So, it sounds like Stanford got 1/4 of the county's first shipment.

[M T]

While Operation Warp Speed distributed doses to the states based on population numbers, the states were not required to distribute their doses based on population, or even to distribute the first and second deliveries according to the same criteria.  In theory, California could have distributed their first delivery all to SoCal.  (CA didn't, of course.)  

If CA did deliver doses to counties based on population, then I would guess (and it only is a guess) that major medical centers were under-supplied relative to community hospitals in more rural areas if you look at doses to cover the health care workers.

Regarding Stanford Hospital, I heard on the news that someone in a responsible position said they made a mistake and would rectify it immediately.  Of course, the hospital got 1500 doses, which other places (primary & urgent care centers, SNFs, LTCFs) didn't.

I found this at SCC:

Company	Doses for SCC	Date of Arrival
Pfizer	17,550*	Dec 15: 5,850 Dec 18: 11,700
Moderna	39,300	est. Dec. 22

*We may be directed to give a small amount to nearby counties that lack the equipment to receive vaccine themselves.

"These early doses will be for people in the highest risk categories, as set by the state and federal government. Specifically, they will go to healthcare workers in hospitals, and staff and residents in skilled nursing facilities. "

The Bay Area Health Departments indicated that the Dec. 15 doses would go to healthcare workers. The Dec. 18 shipment will apparently go directly to hospitals. That leaves me wondering how SNF residents and staff will get the doses as SCC claims will happen.

So, it sounds like Stanford got 1/4 of the county's first shipment.

[JJJ]

At least they apologized and said they would fix it... :(

https://apple.news/AWIQux384QDm1GJo9d3r-1Q

[JJJ]

At least they apologized and said they would fix it... :(

https://apple.news/AWIQux384QDm1GJo9d3r-1Q

[dabigv13]

Stanford's reputation is taking a beating during the pandemic. Bhattacharya, Atlas, now this? And this may be worst of all. What a boneheaded plan.

Good for the residents for making a fuss.

[dabigv13]

Stanford's reputation is taking a beating during the pandemic. Bhattacharya, Atlas, now this? And this may be worst of all. What a boneheaded plan.

Good for the residents for making a fuss.

[teejers1]

Not a great sign if a theoretically elite medical institution can't even get this right:

https://www.propublica.org/article/only-...-residents
https://arstechnica.com/science/2020/12/...residents/

I don't think this is some sort of intentional conspiracy by the hospital administration, but you would think this would be handled a little better.

Reading the article, the first thing that crossed my mind on the algorithm was "seniority" of medical staff at the hospital.  Could it be that simple?  (That's not a defense to the plan, just a suggestion on why they face the cluster they do).

[teejers1]

Not a great sign if a theoretically elite medical institution can't even get this right:

https://www.propublica.org/article/only-...-residents
https://arstechnica.com/science/2020/12/...residents/

I don't think this is some sort of intentional conspiracy by the hospital administration, but you would think this would be handled a little better.

Reading the article, the first thing that crossed my mind on the algorithm was "seniority" of medical staff at the hospital.  Could it be that simple?  (That's not a defense to the plan, just a suggestion on why they face the cluster they do).

[dabigv13]

A senior ophthalmologist shouldn't get a shot before a resident working in a covid ward, unless the ophthalmologist is working in a covid ward. That didn't really sound like the case though.

[dabigv13]

A senior ophthalmologist shouldn't get a shot before a resident working in a covid ward, unless the ophthalmologist is working in a covid ward. That didn't really sound like the case though.

[Griffins78]

Stanford claimed they used an algorithm to prioritize who got the vaccine. But this is what a neurologist said to NPR:

"[A]lgorithms are made by people and the results ... were reviewed multiple times by people," she wrote in an email to NPR. "The ones who ultimately approved the decisions are responsible.

I agree - that is a terrible excuse. Somebody created the algorithm and someone had to approve the results. And several administrators that were prioritized should have known they should not have been. Knowing how important this was and that Stanford was privileged to receive the first vaccine and they waited until there was a massive protest to decide they had to change it. I think it was incredibly irresponsible, arrogant and disrespectful.

[Griffins78]

Stanford claimed they used an algorithm to prioritize who got the vaccine. But this is what a neurologist said to NPR:

"[A]lgorithms are made by people and the results ... were reviewed multiple times by people," she wrote in an email to NPR. "The ones who ultimately approved the decisions are responsible.

I agree - that is a terrible excuse. Somebody created the algorithm and someone had to approve the results. And several administrators that were prioritized should have known they should not have been. Knowing how important this was and that Stanford was privileged to receive the first vaccine and they waited until there was a massive protest to decide they had to change it. I think it was incredibly irresponsible, arrogant and disrespectful.

[chrisk]

The protesters said the problem was identified Tuesday.

[chrisk]

The protesters said the problem was identified Tuesday.

[M T]

“We got it wrong. Let’s get you vaccinated,” President and CEO of Stanford Health David Entwhistle told the crowd. “We’ll correct it.”

So, where do the doses come from that Stanford will use to "correct" the problem?  

I guess some of the LTCF residents whose doses may be hijacked by Stanford Hospital will have a lie-in protest in the ICU beds in a couple of weeks.

[M T]

“We got it wrong. Let’s get you vaccinated,” President and CEO of Stanford Health David Entwhistle told the crowd. “We’ll correct it.”

So, where do the doses come from that Stanford will use to "correct" the problem?  

I guess some of the LTCF residents whose doses may be hijacked by Stanford Hospital will have a lie-in protest in the ICU beds in a couple of weeks.

[dabigv13]

I very much doubt Stanford has that discretion. From one article the Stanford Surgery Dept. chair was encouraging his faculty to forego their shots in place of the frontline residents.

[dabigv13]

I very much doubt Stanford has that discretion. From one article the Stanford Surgery Dept. chair was encouraging his faculty to forego their shots in place of the frontline residents.

[2006alum]

"But officer, the algorithm told me if I drove 93 mph I'd get there faster!"

Beyond pathetic. I'm sure I pay much more attention because it's my alma mater, but truly, has any institution been associated with as many pandemic-related cockups as Stanford has? Even the world's usual moral punching bag, U$C, has seemed to stay out of the news on COVID...

[2006alum]

"But officer, the algorithm told me if I drove 93 mph I'd get there faster!"

Beyond pathetic. I'm sure I pay much more attention because it's my alma mater, but truly, has any institution been associated with as many pandemic-related cockups as Stanford has? Even the world's usual moral punching bag, U$C, has seemed to stay out of the news on COVID...

[Genuine Realist]

I very much doubt Stanford has that discretion. From one article the Stanford Surgery Dept. chair was encouraging his faculty to forego their shots in place of the frontline residents.

That some senior physicians and other notables would usurp the place of others is as inevitable as the sunrise. 

Hopefully, the issue will be mooted in the immediate future. We will see how this works out, but I suspect we will be swimming in the stuff by mid-February.

[Genuine Realist]

I very much doubt Stanford has that discretion. From one article the Stanford Surgery Dept. chair was encouraging his faculty to forego their shots in place of the frontline residents.

That some senior physicians and other notables would usurp the place of others is as inevitable as the sunrise. 

Hopefully, the issue will be mooted in the immediate future. We will see how this works out, but I suspect we will be swimming in the stuff by mid-February.

[dabigv13]

"But officer, the algorithm told me if I drove 93 mph I'd get there faster!"

Beyond pathetic. I'm sure I pay much more attention because it's my alma mater, but truly, has any institution been associated with as many pandemic-related cockups as Stanford has? Even the world's usual moral punching bag, U$C, has seemed to stay out of the news on COVID...

The USC residents certainly were in line to get early shots if in covid adjacent specialties. Haven't heard of other resident staff at other academic centers being disadvantaged either. Stanford really managed to bungle this.

[dabigv13]

"But officer, the algorithm told me if I drove 93 mph I'd get there faster!"

Beyond pathetic. I'm sure I pay much more attention because it's my alma mater, but truly, has any institution been associated with as many pandemic-related cockups as Stanford has? Even the world's usual moral punching bag, U$C, has seemed to stay out of the news on COVID...

The USC residents certainly were in line to get early shots if in covid adjacent specialties. Haven't heard of other resident staff at other academic centers being disadvantaged either. Stanford really managed to bungle this.

[g1313]

I dug into this over the weekend with some friends and family who work at Stanford healthcare, and came away with the impression that this was really more about incompetent administration, not abuse of privilege (although for the more cynical, you can't completely rule out abuse hidden behind incompetence).

As pointed out earlier in the thread, you can't really blame "the algorithm," which is just a set of rules that spits out an ordered list of 3900 (or however many total healthcare workers there are) people to be vaccinated, because it would be impractical for humans to do that manually. However, humans decide the prioritization rules, and humans should be auditing the results to sanity check them. Apparently this second part was not done, or at least not done in time (the articles suggest that the list was generated on Tuesday, and vaccinations started on Friday - this is why they were able to make a quick change after the blowup, because most of the vaccines were planned to be administered over the weekend.)

Stanford also has not provided any specific details of what prioritization decisions they programmed into the algorithm, outside of loosely referencing the CDC guidelines. This seems like a key mistake, because there isn't one right way to prioritize, but if you don't show the details, people will assume the worst. For example, a lot of the coverage seemed to imply that administrators were taking advantage of their position to place themselves higher on the list. From talking to people, this does not seem to have happened - people in purely administrative functions (like the hospital CEO) did not get prioritized (although interestingly, one nurse I talked to said she would be more comfortable if the CEO had gotten the vaccine to show it was safe). Rather, the reason that senior medical staff got priority was because they tend to be significantly older and therefore more at risk. I would also speculate that the employment records might not make it easy to distinguish medical staff who have high degrees of patient contact vs those who don't, although seems like that would be easy to remedy by asking people to self-declare their degree of patient contact in the vaccination survey they sent.

Finally, I heard several anecdotal accounts of vaccination ordering that made no sense to me. For example, on the same unit, a 24-year-old nurse (no known comorbidities) being selected ahead of a 34-year-old. I guess it is possible that they just bucketed everyone under 35 together as low risk and just randomly selected, but again there was no transparency.

[g1313]

I dug into this over the weekend with some friends and family who work at Stanford healthcare, and came away with the impression that this was really more about incompetent administration, not abuse of privilege (although for the more cynical, you can't completely rule out abuse hidden behind incompetence).

As pointed out earlier in the thread, you can't really blame "the algorithm," which is just a set of rules that spits out an ordered list of 3900 (or however many total healthcare workers there are) people to be vaccinated, because it would be impractical for humans to do that manually. However, humans decide the prioritization rules, and humans should be auditing the results to sanity check them. Apparently this second part was not done, or at least not done in time (the articles suggest that the list was generated on Tuesday, and vaccinations started on Friday - this is why they were able to make a quick change after the blowup, because most of the vaccines were planned to be administered over the weekend.)

Stanford also has not provided any specific details of what prioritization decisions they programmed into the algorithm, outside of loosely referencing the CDC guidelines. This seems like a key mistake, because there isn't one right way to prioritize, but if you don't show the details, people will assume the worst. For example, a lot of the coverage seemed to imply that administrators were taking advantage of their position to place themselves higher on the list. From talking to people, this does not seem to have happened - people in purely administrative functions (like the hospital CEO) did not get prioritized (although interestingly, one nurse I talked to said she would be more comfortable if the CEO had gotten the vaccine to show it was safe). Rather, the reason that senior medical staff got priority was because they tend to be significantly older and therefore more at risk. I would also speculate that the employment records might not make it easy to distinguish medical staff who have high degrees of patient contact vs those who don't, although seems like that would be easy to remedy by asking people to self-declare their degree of patient contact in the vaccination survey they sent.

Finally, I heard several anecdotal accounts of vaccination ordering that made no sense to me. For example, on the same unit, a 24-year-old nurse (no known comorbidities) being selected ahead of a 34-year-old. I guess it is possible that they just bucketed everyone under 35 together as low risk and just randomly selected, but again there was no transparency.

[Goose]

I would be interested in an explanation of why an organization with as many smart people in it who have known for months that they would eventually get a vaccine to administer are putting together a priority list less than a week before they needed to start administering vaccine. We hear lots of wailing about consistent messaging and leadership, which are indeed big issues. However, I would argue that failing to do the obvious and having a priority list ready to go (and well vetted) well before you are actually going to need it is a failure of such large proportions it boggles the mind. This is the "easy" part and we can't even do that????

[Goose]

I would be interested in an explanation of why an organization with as many smart people in it who have known for months that they would eventually get a vaccine to administer are putting together a priority list less than a week before they needed to start administering vaccine. We hear lots of wailing about consistent messaging and leadership, which are indeed big issues. However, I would argue that failing to do the obvious and having a priority list ready to go (and well vetted) well before you are actually going to need it is a failure of such large proportions it boggles the mind. This is the "easy" part and we can't even do that????

[g1313]

This article has a leak of the specific rules that Stanford used: https://www.technologyreview.com/2020/12...algorithm/

It explains the anecdote I could not previously explain, which is that for some reason they gave extra weight to both those over 65, but also those under 25. The only reason I can think of for giving priority to younger workers is perhaps they are more likely to engage in risky behaviors?

[g1313]

This article has a leak of the specific rules that Stanford used: https://www.technologyreview.com/2020/12...algorithm/

It explains the anecdote I could not previously explain, which is that for some reason they gave extra weight to both those over 65, but also those under 25. The only reason I can think of for giving priority to younger workers is perhaps they are more likely to engage in risky behaviors?

[82lsju]

from an email from Stanford

"The health and safety of our frontline providers and other health care workers remain our top priority. As of this morning, we have vaccinated more than 2,000 frontline health care workers. We are optimistic that all our frontline health care workers will be offered the vaccine by the end of the month—with our remaining workforce to follow as soon as possible. At every stage, we will monitor distribution and remain compliant with the California Department of Public Health (CDPH) guidelines.

Acting on our commitment to transparency, we have created a Vaccine Distribution Dashboard that will provide a daily snapshot of our progress to our teams. You can find this dashboard here"

the dashboard is here

https://medicalgiving.stanford.edu/conte...-20-20.pdf

[82lsju]

from an email from Stanford

"The health and safety of our frontline providers and other health care workers remain our top priority. As of this morning, we have vaccinated more than 2,000 frontline health care workers. We are optimistic that all our frontline health care workers will be offered the vaccine by the end of the month—with our remaining workforce to follow as soon as possible. At every stage, we will monitor distribution and remain compliant with the California Department of Public Health (CDPH) guidelines.

Acting on our commitment to transparency, we have created a Vaccine Distribution Dashboard that will provide a daily snapshot of our progress to our teams. You can find this dashboard here"

the dashboard is here

https://medicalgiving.stanford.edu/conte...-20-20.pdf