[Genuine Realist]

This morning, I get an email ad from Safeway:

COMING SOON - COVID VACCINE!!! Our specially trained pharmacists, etc.

So I will be able to go to Safeway and get vaccinated between the greengrocer and the bakery.

I think mass vaccinations will occur far sooner and in greater scale than anyone imagines at present.

[Genuine Realist]

This morning, I get an email ad from Safeway:

COMING SOON - COVID VACCINE!!! Our specially trained pharmacists, etc.

So I will be able to go to Safeway and get vaccinated between the greengrocer and the bakery.

I think mass vaccinations will occur far sooner and in greater scale than anyone imagines at present.

[teejers1]

This morning, I get an email ad from Safeway:

COMING SOON - COVID VACCINE!!! Our specially trained pharmacists, etc.

So I will be able to go to Safeway and get vaccinated between the greengrocer and the bakery.

I think mass vaccinations will occur far sooner and in greater scale than anyone imagines at present.

Did you read the small print?  The line that relayed that the vaccinations were the ones "from China and/or Russia?"

Seriously, hope you're correct.  But I'm just looking for a reasonable vaccine rollout (expecting some hiccups) in the coming months.  If we can get old folks (particularly those in LTCFs) and HCWs vaccinated in January, then I think that would go a loooong way to lowering the most alarming hospital numbers.  [I'm not sure what is going on in SCC LTCFs, but the numbers lately have been atrocious - 440 new cases from December 1-18.  I still think that is a big contributor to hospitalizations and capacity constraints.].  A pressure release on hospital capacity, including overworked staff, has to be a top priority.

We shall see . . .

[teejers1]

This morning, I get an email ad from Safeway:

COMING SOON - COVID VACCINE!!! Our specially trained pharmacists, etc.

So I will be able to go to Safeway and get vaccinated between the greengrocer and the bakery.

I think mass vaccinations will occur far sooner and in greater scale than anyone imagines at present.

Did you read the small print?  The line that relayed that the vaccinations were the ones "from China and/or Russia?"

Seriously, hope you're correct.  But I'm just looking for a reasonable vaccine rollout (expecting some hiccups) in the coming months.  If we can get old folks (particularly those in LTCFs) and HCWs vaccinated in January, then I think that would go a loooong way to lowering the most alarming hospital numbers.  [I'm not sure what is going on in SCC LTCFs, but the numbers lately have been atrocious - 440 new cases from December 1-18.  I still think that is a big contributor to hospitalizations and capacity constraints.].  A pressure release on hospital capacity, including overworked staff, has to be a top priority.

We shall see . . .

[M T]

No, Teejers, Safeway is getting the same vaccines that CVS and Walgreens and Stanford Hospital are getting.
 (I suggest you be careful with statements like that.  Someone might think you were speaking a fact.)

In terms of hospitalization and age, the CDC recently published this graph which I think is misleading.
The problem is that the graph doesn't show percentage of patients or of beds, but instead shows a ratio of those in an age group that have been hospitalized.  


To get to what you are looking for, who is in the hospital now, by age group, I took the prevalence of hospitalizations 12/12-12/19, applied the population numbers, getting the number hospitalized, and their percentage of those hospitalized.
Age Prevalence Population  Patients  PerCent
0-4    1.1     19,736,000     217     0.6%
5-17   0.6     54,056,000     324     0.9%
18-29  5.5     52,361,000   1,780     4.7%
30-39  3.4     43,375,000   2,472     6.6%
40-49  8.1     39,929,000   3,234     8.6%
50-64 15.1     62,110,000   9,379    24.9%
65-74 25.5     31,487,000   8,029    21.3%
75-84 51.2     15,407,000   7,888    21.0%
85+   72.9      5,893,000   4,296    11.4%

(Note that the age groups are not equal sized. In particular 50-64 is largest.)

This gives a per cent of hospital admissions.  Length of stay is not given, which will influence how many are in beds on any one day.

So, vaccinations through phases 1a and 1b (estimated 73M shots, up to mid-February for federal distribution of the first round) will only account for 32% of hospital admissions currently.

(The CDC does not have good numbers for the number of cases, hospitalizations, or deaths of HCW, but they are getting the shots first.)

[M T]

No, Teejers, Safeway is getting the same vaccines that CVS and Walgreens and Stanford Hospital are getting.
 (I suggest you be careful with statements like that.  Someone might think you were speaking a fact.)

In terms of hospitalization and age, the CDC recently published this graph which I think is misleading.
The problem is that the graph doesn't show percentage of patients or of beds, but instead shows a ratio of those in an age group that have been hospitalized.  


To get to what you are looking for, who is in the hospital now, by age group, I took the prevalence of hospitalizations 12/12-12/19, applied the population numbers, getting the number hospitalized, and their percentage of those hospitalized.
Age Prevalence Population  Patients  PerCent
0-4    1.1     19,736,000     217     0.6%
5-17   0.6     54,056,000     324     0.9%
18-29  5.5     52,361,000   1,780     4.7%
30-39  3.4     43,375,000   2,472     6.6%
40-49  8.1     39,929,000   3,234     8.6%
50-64 15.1     62,110,000   9,379    24.9%
65-74 25.5     31,487,000   8,029    21.3%
75-84 51.2     15,407,000   7,888    21.0%
85+   72.9      5,893,000   4,296    11.4%

(Note that the age groups are not equal sized. In particular 50-64 is largest.)

This gives a per cent of hospital admissions.  Length of stay is not given, which will influence how many are in beds on any one day.

So, vaccinations through phases 1a and 1b (estimated 73M shots, up to mid-February for federal distribution of the first round) will only account for 32% of hospital admissions currently.

(The CDC does not have good numbers for the number of cases, hospitalizations, or deaths of HCW, but they are getting the shots first.)

[OutsiderFan]

Just looking at this thread, it's hard for me to imagine the board mods wanting this board to be closed this week, but whatever...

My mom got a call from United Health Care today, telling her vaccine is coming and it will be free. At the same time, I'm hearing and seeing reporting that says we are far behind on number of doses and distribution plans. It seems there is some disconnect between what people are expecting and what is actually being executed or can be.

[OutsiderFan]

Just looking at this thread, it's hard for me to imagine the board mods wanting this board to be closed this week, but whatever...

My mom got a call from United Health Care today, telling her vaccine is coming and it will be free. At the same time, I'm hearing and seeing reporting that says we are far behind on number of doses and distribution plans. It seems there is some disconnect between what people are expecting and what is actually being executed or can be.

[M T]

Just looking at this thread, it's hard for me to imagine the board mods wanting this board to be closed this week, but whatever...

My mom got a call from United Health Care today, telling her vaccine is coming and it will be free. At the same time, I'm hearing and seeing reporting that says we are far behind on number of doses and distribution plans. It seems there is some disconnect between what people are expecting and what is actually being executed or can be.

In a Skilled Nursing Facility in another county in California, they are at this moment calling the families of patients (for authorization) estimating a vaccination for patients on Sunday, January 3.  Every county will be different. 

Of course, I hear there is a COVID outbreak at that SNF, but have not confirmed it.  In that county, a number of older (> 70yo) people showed up in the county's COVID numbers yesterday.  Damn.  If the state & that county had prioritized or even equally prioritized patients on the first dose 2 weeks ago....

[M T]

Just looking at this thread, it's hard for me to imagine the board mods wanting this board to be closed this week, but whatever...

My mom got a call from United Health Care today, telling her vaccine is coming and it will be free. At the same time, I'm hearing and seeing reporting that says we are far behind on number of doses and distribution plans. It seems there is some disconnect between what people are expecting and what is actually being executed or can be.

In a Skilled Nursing Facility in another county in California, they are at this moment calling the families of patients (for authorization) estimating a vaccination for patients on Sunday, January 3.  Every county will be different. 

Of course, I hear there is a COVID outbreak at that SNF, but have not confirmed it.  In that county, a number of older (> 70yo) people showed up in the county's COVID numbers yesterday.  Damn.  If the state & that county had prioritized or even equally prioritized patients on the first dose 2 weeks ago....

[teejers1]

No, Teejers, Safeway is getting the same vaccines that CVS and Walgreens and Stanford Hospital are getting.
 (I suggest you be careful with statements like that.  Someone might think you were speaking a fact.)

In terms of hospitalization and age, the CDC recently published this graph which I think is misleading.
The problem is that the graph doesn't show percentage of patients or of beds, but instead shows a ratio of those in an age group that have been hospitalized.  


To get to what you are looking for, who is in the hospital now, by age group, I took the prevalence of hospitalizations 12/12-12/19, applied the population numbers, getting the number hospitalized, and their percentage of those hospitalized.
Age Prevalence Population  Patients  PerCent
0-4    1.1     19,736,000     217     0.6%
5-17   0.6     54,056,000     324     0.9%
18-29  5.5     52,361,000   1,780     4.7%
30-39  3.4     43,375,000   2,472     6.6%
40-49  8.1     39,929,000   3,234     8.6%
50-64 15.1     62,110,000   9,379    24.9%
65-74 25.5     31,487,000   8,029    21.3%
75-84 51.2     15,407,000   7,888    21.0%
85+   72.9      5,893,000   4,296    11.4%

(Note that the age groups are not equal sized. In particular 50-64 is largest.)

This gives a per cent of hospital admissions.  Length of stay is not given, which will influence how many are in beds on any one day.

So, vaccinations through phases 1a and 1b (estimated 73M shots, up to mid-February for federal distribution of the first round) will only account for 32% of hospital admissions currently.

(The CDC does not have good numbers for the number of cases, hospitalizations, or deaths of HCW, but they are getting the shots first.)

32% isn't a bad pressure relief start.
Plus, I think LTCFs are driving numbers more than we are led to believe, at least in Santa Clara County (which is all I really follow with any regularity).

P.S.  I'm returning to a question I had earlier regarding tabulating Covid deaths.  The below link from North Dakota clearly states that the total deaths (1276) includes (i) cases where Covid is primary cause of death, and (ii) cases where Covid was not primary cause of death.  The latter is only about 1/6th the total (212 of 1276), but it's not insignificant.  So I don't understand those who say that Covid deaths are only those where the death certificate lists Covid as primary cause of death.  The ND site clearly refutes this . . . doesn't it?

https://www.health.nd.gov/diseases-condi...irus-cases

BTW, much-maligned North Dakota's curve appears to be moving in the right direction.  Good for them.

https://www.health.nd.gov/diseases-condi...irus-cases

[teejers1]

No, Teejers, Safeway is getting the same vaccines that CVS and Walgreens and Stanford Hospital are getting.
 (I suggest you be careful with statements like that.  Someone might think you were speaking a fact.)

In terms of hospitalization and age, the CDC recently published this graph which I think is misleading.
The problem is that the graph doesn't show percentage of patients or of beds, but instead shows a ratio of those in an age group that have been hospitalized.  


To get to what you are looking for, who is in the hospital now, by age group, I took the prevalence of hospitalizations 12/12-12/19, applied the population numbers, getting the number hospitalized, and their percentage of those hospitalized.
Age Prevalence Population  Patients  PerCent
0-4    1.1     19,736,000     217     0.6%
5-17   0.6     54,056,000     324     0.9%
18-29  5.5     52,361,000   1,780     4.7%
30-39  3.4     43,375,000   2,472     6.6%
40-49  8.1     39,929,000   3,234     8.6%
50-64 15.1     62,110,000   9,379    24.9%
65-74 25.5     31,487,000   8,029    21.3%
75-84 51.2     15,407,000   7,888    21.0%
85+   72.9      5,893,000   4,296    11.4%

(Note that the age groups are not equal sized. In particular 50-64 is largest.)

This gives a per cent of hospital admissions.  Length of stay is not given, which will influence how many are in beds on any one day.

So, vaccinations through phases 1a and 1b (estimated 73M shots, up to mid-February for federal distribution of the first round) will only account for 32% of hospital admissions currently.

(The CDC does not have good numbers for the number of cases, hospitalizations, or deaths of HCW, but they are getting the shots first.)

32% isn't a bad pressure relief start.
Plus, I think LTCFs are driving numbers more than we are led to believe, at least in Santa Clara County (which is all I really follow with any regularity).

P.S.  I'm returning to a question I had earlier regarding tabulating Covid deaths.  The below link from North Dakota clearly states that the total deaths (1276) includes (i) cases where Covid is primary cause of death, and (ii) cases where Covid was not primary cause of death.  The latter is only about 1/6th the total (212 of 1276), but it's not insignificant.  So I don't understand those who say that Covid deaths are only those where the death certificate lists Covid as primary cause of death.  The ND site clearly refutes this . . . doesn't it?

https://www.health.nd.gov/diseases-condi...irus-cases

BTW, much-maligned North Dakota's curve appears to be moving in the right direction.  Good for them.

https://www.health.nd.gov/diseases-condi...irus-cases

[M T]

BostonCard gave a good answer a while back.  It may be worth your re-reading it.  I remember a longer response but didn't find it right away.



CDC stats are based on "Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1." 

As BC reported, the standard US Death Certificate can be found here, with instructions.   In the US form Item 32, Part I, there is no term "primary cause of death" as used by North Dakota, only "immediate cause of death" and a sequence of conditions starting with "underlying cause".  See also the announcement of that code.

In Item 32, Part II, other "significant conditions contributing to the death" are listed.

As I read it, the CDC would report the death in "Deaths involving coronavirus disease 2019" if either Part I or Part II indicated COVID.

Judging from other non-technical sources, it appears they use the term "primary cause" to apply to the underlying cause in Part I, and "secondary cause(s)" in Part II.

Borrowing from what I recall from BC's posting, if you are diagnosed with COVID, but die immediately as a result of a car accident, COVID would not appear on the death certificate.   However, if you survived initially, but die eventually because your COVID pneumonia kept your body from recovering, COVID might be listed in Part II.  If you got only a broken leg in the accident and went into the hospital, where you got COVID and died from it, COVID would be listed in Part I.

Edit: Then I found this
"if somebody had a car accident because they fainted and they only fainted because they ran a fever of 105 because they had a horrible pneumonia because of COVID, then actually COVID was an underlying condition that caused their death even though they actually died from crashing the car"

[M T]

BostonCard gave a good answer a while back.  It may be worth your re-reading it.  I remember a longer response but didn't find it right away.



CDC stats are based on "Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1." 

As BC reported, the standard US Death Certificate can be found here, with instructions.   In the US form Item 32, Part I, there is no term "primary cause of death" as used by North Dakota, only "immediate cause of death" and a sequence of conditions starting with "underlying cause".  See also the announcement of that code.

In Item 32, Part II, other "significant conditions contributing to the death" are listed.

As I read it, the CDC would report the death in "Deaths involving coronavirus disease 2019" if either Part I or Part II indicated COVID.

Judging from other non-technical sources, it appears they use the term "primary cause" to apply to the underlying cause in Part I, and "secondary cause(s)" in Part II.

Borrowing from what I recall from BC's posting, if you are diagnosed with COVID, but die immediately as a result of a car accident, COVID would not appear on the death certificate.   However, if you survived initially, but die eventually because your COVID pneumonia kept your body from recovering, COVID might be listed in Part II.  If you got only a broken leg in the accident and went into the hospital, where you got COVID and died from it, COVID would be listed in Part I.

Edit: Then I found this
"if somebody had a car accident because they fainted and they only fainted because they ran a fever of 105 because they had a horrible pneumonia because of COVID, then actually COVID was an underlying condition that caused their death even though they actually died from crashing the car"

[BostonCard]

Right.  In fact there is an example of the "accident caused by COVID-19"...

There was a story going around a while back (I think I saw it in the Daily Mail, but I may be misremembering) about a roofer who fell off the roof and died from his injuries.  He was found to have COVID-19 post-mortem, and was declared by the coroner to be a COVID-19 death.  The Daily Mail's headline (or whoever it was who reported the story) suggested that this was evidence that COVID deaths are being over-reported since this guy clearly died of a injuries sustained from his fall.

However, when you read deeper into the story, it turns out that the guy was sick (because of COVID-19 that day) and his fall was percipitated because he passed out, which was a result of his low oxygen levels due to COVID-19.  Sure, the immediate cause of death was blunt trauma from what we call a "gravitational challenge", but the underlying reason he fell was because of COVID-19; he would not have died but for COVID.  Consequently it is considered a COVID-19 death.

EDIT: Found the article
https://www.dailymail.co.uk/news/article...virus.html
(my recollection of the story was not exactly right, but the main point, which is that death from a fall wound up being attributed to COVID-19 because COVID-19 likely triggered the fall, is correct)

And here is the journal article:
https://www.sciencedirect.com/science/ar...88#bib0015

Herein we are reporting the case of a Caucasian male who apparently died in a workplace allegedly by a fall from height and was found to be SARS-CoV-2 positive just prior to the autopsy. The circumstances of his death required a medicolegal investigation.

Gross autopsy findings included minor external injuries and focal subarachnoid hemorrhage together with ribs and sternum fractures resulting from resuscitation attempt. In addition, visceral congestion was noticed, especially visible in lungs. Traumatic findings suitable to explain sudden death were absent. However, lungs histopathology analysis revealed diffuse alveolar damage with massive capillary congestion. Pathology in other organs included myocardial fibrosis, left ventricular hypertrophy, severe generalized atherosclerosis, glomerulosclerosis, focal liver necrosis, liver microabscesses and intrahepatal cholestasis. Lab test confirmed the presence of SARS-CoV-2 in nasopharygeal swab taken postmortem. Only afterwards, the investigation brought out that he was suffering complaints consistent with respiratory infection in the days before death. Based on all findings, the death was ruled as natural, caused by COVID-19.

Note that now that I am reading the actual journal report, the Daily Mail got the story a bit wrong; on autopsy the extent of his injury did not adequately explain his death, and that the coroner there is suggesting that the immediate cause of death was actually COVID-19, not the fall.

BC

[BostonCard]

Right.  In fact there is an example of the "accident caused by COVID-19"...

There was a story going around a while back (I think I saw it in the Daily Mail, but I may be misremembering) about a roofer who fell off the roof and died from his injuries.  He was found to have COVID-19 post-mortem, and was declared by the coroner to be a COVID-19 death.  The Daily Mail's headline (or whoever it was who reported the story) suggested that this was evidence that COVID deaths are being over-reported since this guy clearly died of a injuries sustained from his fall.

However, when you read deeper into the story, it turns out that the guy was sick (because of COVID-19 that day) and his fall was percipitated because he passed out, which was a result of his low oxygen levels due to COVID-19.  Sure, the immediate cause of death was blunt trauma from what we call a "gravitational challenge", but the underlying reason he fell was because of COVID-19; he would not have died but for COVID.  Consequently it is considered a COVID-19 death.

EDIT: Found the article
https://www.dailymail.co.uk/news/article...virus.html
(my recollection of the story was not exactly right, but the main point, which is that death from a fall wound up being attributed to COVID-19 because COVID-19 likely triggered the fall, is correct)

And here is the journal article:
https://www.sciencedirect.com/science/ar...88#bib0015

Herein we are reporting the case of a Caucasian male who apparently died in a workplace allegedly by a fall from height and was found to be SARS-CoV-2 positive just prior to the autopsy. The circumstances of his death required a medicolegal investigation.

Gross autopsy findings included minor external injuries and focal subarachnoid hemorrhage together with ribs and sternum fractures resulting from resuscitation attempt. In addition, visceral congestion was noticed, especially visible in lungs. Traumatic findings suitable to explain sudden death were absent. However, lungs histopathology analysis revealed diffuse alveolar damage with massive capillary congestion. Pathology in other organs included myocardial fibrosis, left ventricular hypertrophy, severe generalized atherosclerosis, glomerulosclerosis, focal liver necrosis, liver microabscesses and intrahepatal cholestasis. Lab test confirmed the presence of SARS-CoV-2 in nasopharygeal swab taken postmortem. Only afterwards, the investigation brought out that he was suffering complaints consistent with respiratory infection in the days before death. Based on all findings, the death was ruled as natural, caused by COVID-19.

Note that now that I am reading the actual journal report, the Daily Mail got the story a bit wrong; on autopsy the extent of his injury did not adequately explain his death, and that the coroner there is suggesting that the immediate cause of death was actually COVID-19, not the fall.

BC

[Snorlax94]

Another unfortunate sign of the times. Young (41), seemed healthy, was receiving Remdesivir and steroids. Presumably receiving excellent medical care as a Congressman-elect.

Congressman-elect Luke Letlow dies after battling Covid-19

Congressman-elect Luke Letlow, a Republican, has died after being diagnosed with Covid-19, CNN confirmed Tuesday night.

In a statement released on Twitter, Louisiana Democratic Gov. John Bel Edwards wrote, "It is with heavy hearts that @FirstLadyOfLA and I offer our condolences to Congressman-elect Luke Letlow's family on his passing after a battle with COVID-19." Two Republican sources also confirmed Letlow's passing to CNN. 

The News-Star in Monroe, Louisiana, was first to report Letlow's death. Letlow, 41, had announced his diagnosis on his Facebook page on December 18, writing that he was "at home resting, following all CDC guidelines, quarantine protocols, and the recommendations of my doctors."

[Snorlax94]

Another unfortunate sign of the times. Young (41), seemed healthy, was receiving Remdesivir and steroids. Presumably receiving excellent medical care as a Congressman-elect.

Congressman-elect Luke Letlow dies after battling Covid-19

Congressman-elect Luke Letlow, a Republican, has died after being diagnosed with Covid-19, CNN confirmed Tuesday night.

In a statement released on Twitter, Louisiana Democratic Gov. John Bel Edwards wrote, "It is with heavy hearts that @FirstLadyOfLA and I offer our condolences to Congressman-elect Luke Letlow's family on his passing after a battle with COVID-19." Two Republican sources also confirmed Letlow's passing to CNN. 

The News-Star in Monroe, Louisiana, was first to report Letlow's death. Letlow, 41, had announced his diagnosis on his Facebook page on December 18, writing that he was "at home resting, following all CDC guidelines, quarantine protocols, and the recommendations of my doctors."

[teejers1]

BostonCard gave a good answer a while back.  It may be worth your re-reading it.  I remember a longer response but didn't find it right away.



CDC stats are based on "Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1." 

As BC reported, the standard US Death Certificate can be found here, with instructions.   In the US form Item 32, Part I, there is no term "primary cause of death" as used by North Dakota, only "immediate cause of death" and a sequence of conditions starting with "underlying cause".  See also the announcement of that code.

In Item 32, Part II, other "significant conditions contributing to the death" are listed.

As I read it, the CDC would report the death in "Deaths involving coronavirus disease 2019" if either Part I or Part II indicated COVID.

Judging from other non-technical sources, it appears they use the term "primary cause" to apply to the underlying cause in Part I, and "secondary cause(s)" in Part II.

Borrowing from what I recall from BC's posting, if you are diagnosed with COVID, but die immediately as a result of a car accident, COVID would not appear on the death certificate.   However, if you survived initially, but die eventually because your COVID pneumonia kept your body from recovering, COVID might be listed in Part II.  If you got only a broken leg in the accident and went into the hospital, where you got COVID and died from it, COVID would be listed in Part I.

Edit:  Then I found this
"if somebody had a car accident because they fainted and they only fainted because they ran a fever of 105 because they had a horrible pneumonia because of COVID, then actually COVID was an underlying condition that caused their death even though they actually died from crashing the car"

Yes, I remember BC answered it - and I didn't understand it then, and still don't.  So it must be my density.  

So let me ask it this way: do you think the CDC includes all of North Dakota's 1276 tally in its national tally of Covid deaths?  
(Based on about 5 readings of your answer, I believe that if the answer is "yes," it's because ND's non-primary cause of death qualifies for reporting under Part II).

[teejers1]

BostonCard gave a good answer a while back.  It may be worth your re-reading it.  I remember a longer response but didn't find it right away.



CDC stats are based on "Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1." 

As BC reported, the standard US Death Certificate can be found here, with instructions.   In the US form Item 32, Part I, there is no term "primary cause of death" as used by North Dakota, only "immediate cause of death" and a sequence of conditions starting with "underlying cause".  See also the announcement of that code.

In Item 32, Part II, other "significant conditions contributing to the death" are listed.

As I read it, the CDC would report the death in "Deaths involving coronavirus disease 2019" if either Part I or Part II indicated COVID.

Judging from other non-technical sources, it appears they use the term "primary cause" to apply to the underlying cause in Part I, and "secondary cause(s)" in Part II.

Borrowing from what I recall from BC's posting, if you are diagnosed with COVID, but die immediately as a result of a car accident, COVID would not appear on the death certificate.   However, if you survived initially, but die eventually because your COVID pneumonia kept your body from recovering, COVID might be listed in Part II.  If you got only a broken leg in the accident and went into the hospital, where you got COVID and died from it, COVID would be listed in Part I.

Edit:  Then I found this
"if somebody had a car accident because they fainted and they only fainted because they ran a fever of 105 because they had a horrible pneumonia because of COVID, then actually COVID was an underlying condition that caused their death even though they actually died from crashing the car"

Yes, I remember BC answered it - and I didn't understand it then, and still don't.  So it must be my density.  

So let me ask it this way: do you think the CDC includes all of North Dakota's 1276 tally in its national tally of Covid deaths?  
(Based on about 5 readings of your answer, I believe that if the answer is "yes," it's because ND's non-primary cause of death qualifies for reporting under Part II).

[BostonCard]

Here are some real world causes of death in patients who died.  All the patients were admitted to a hospital because of COVID-19.  The causes of death are listed in decreasing order of frequency.

COVID-19 pneumonia
COVID-19
Respiratory failure
Hypoxia
Septic Shock
Cardio-respiratory arrest
Pneumonia
Cardiac arrest
Multiple organ dysfunction syndrome
Acute respiratory failure
Gastric ulcer hemorrhage
Acute respiratory distress syndrome
Aspiration pneumonia
Pneumothorax
Respiratory arrest
Pulmonary sepsis
Staphylococcal pneumonia
Renal failure
Acute kidney injury
Shock

The total number of deaths in the dataset when I looked at it was 56.  Of these, COVID-19 and COVID-19 pneumonia were only the primary cause of death in 17, which left 40 terms other than "COVID-19" or "COVID-19 pneumonia" as the listed primary causes of death (these are the ones "most proximal" to the death).  A bunch are directly a result of COVID-19.  For example, COVID-19 directly causes hypoxia (low oxygen levels), respiratory failure (the lungs aren't doing their job adequately), acute respiratory distress syndrome (a syndrome that involves a combination of low oxygen levels, and fluid in the lungs that is not due to heart failure, and can be triggered by a lot of different things, including COVID-19), etc.  A number of other terms represent the final pathway of dying; either the heart (cardiac arrest) or heart and lungs (cardio-respiratory arrest) give out.  Then there are the terms that are complications of COVID-19.  For example, a staph pneumonia obviously is not a COVID-19 pneumonia, it is a super-infection (infection on top of another infection).  The patient's lungs were weakened by COVID-19 and the normal defense mechanisms which keep Staph out of the lungs failed, and the patient developed a Staph pneumonia.  In this case, the Staph pneumonia was a different process (and different organism) than COVID-19, but, the patient almost certainly wouldn't have developed a random Staph pneumonia but for the fact that they had COVID-19 (Staph super-infections are particularly common in patients with influenza; I don't think it is as common with COVID-19, but a viral pneumonia is a well-known predisposing factor.  Something like renal failure and acute kidney injury (the patient's kidney's failed) are likely not directly due to COVID-19, but downstream effects, sometimes several steps downstream (a patient gets COVID-19 which sends them to the hospital; they develop a secondary pneumonia from the process I described above.  The pneumonia leads to sepsis, an infection in the blood, which in term leads to septic shock and low blood pressure.  The low blood pressure means that the kidneys don't get enough blood and go into kidney failure, which, is ultimately what leads to the patient's death.  Not all kidney failure is due to COVID-19, and not all COVID-19 leads to kidney failure, but in this case, COVID-19 triggered a cascade of events that led to kidney failure, which proved fatal.

None of these patients would have died had they not gotten COVID-19, so they all should count as COVID-19 deaths.

Another way of looking at things is the number of "excess deaths".  The CDC keeps a running count comparing the number of people who died in a given week of the year, compared to historical numbers.

https://www.cdc.gov/nchs/nvss/vsrr/covid...deaths.htm

If you select "Number of Excess Deaths" and select US in the dashboard, you will see that since February 2020 we have had somewhere between 309,000 and 420,000 more deaths of any cause than would be predicted.  If a lot of the deaths that had been attributed to COVID-19 had really been patients who died "with COVID" instead of "of COVID" and were being misattributed to COVID-19 because of a positive test, then the number of excess deaths would trail the number of COVID-19 deaths.  On the other hand, the other possibility (that some deaths were attributed to a heart attack or non-COVID-19 pneumonia, but were really due to COVID that was missed, which may have happened early in the pandemic), then we would see more excess deaths than COVID-19 deaths, also needs to be considered.  The lower bound of the excess deaths (and the uncertainty comes in the fact that it is hard to know exactly how many deaths should have been expected had COVID-19 not happened) is pretty close to the number of COVID-19 deaths (346,000 per Worldometer), especially when you consider that reporting deaths to the CDC can lag a bit (the CDC states that only 60% of deaths are submitted within 10 days of the day of death).  On the other hand, the upper bound of the excess deaths number, if accurate, might suggest that either some COVID-19 deaths are being missed, or that people are dying at an increasing rate due to secondary effects of the pandemic (for example, COVID-19 negative people who die because they don't go to the hospital out of concern about catching COVID-19 or patients involved in a motor vehicle collision who are treated inadequately because the hospital doesn't have the resources (like ICU beds) to treat them adequately).

Anyway, the advantage of the excess deaths number is that it doesn't rely on a physician reporting the cause of death "correctly"; anyone who dies who would not have died but for the pandemic will show up as an "excess" mortality figure (there are also a small number of people who were "saved" due to the pandemic, for example, by not driving home drunk from a bar that is now closed and therefore getting into a fatal motor vehicle collision).

BC

[BostonCard]

Here are some real world causes of death in patients who died.  All the patients were admitted to a hospital because of COVID-19.  The causes of death are listed in decreasing order of frequency.

COVID-19 pneumonia
COVID-19
Respiratory failure
Hypoxia
Septic Shock
Cardio-respiratory arrest
Pneumonia
Cardiac arrest
Multiple organ dysfunction syndrome
Acute respiratory failure
Gastric ulcer hemorrhage
Acute respiratory distress syndrome
Aspiration pneumonia
Pneumothorax
Respiratory arrest
Pulmonary sepsis
Staphylococcal pneumonia
Renal failure
Acute kidney injury
Shock

The total number of deaths in the dataset when I looked at it was 56.  Of these, COVID-19 and COVID-19 pneumonia were only the primary cause of death in 17, which left 40 terms other than "COVID-19" or "COVID-19 pneumonia" as the listed primary causes of death (these are the ones "most proximal" to the death).  A bunch are directly a result of COVID-19.  For example, COVID-19 directly causes hypoxia (low oxygen levels), respiratory failure (the lungs aren't doing their job adequately), acute respiratory distress syndrome (a syndrome that involves a combination of low oxygen levels, and fluid in the lungs that is not due to heart failure, and can be triggered by a lot of different things, including COVID-19), etc.  A number of other terms represent the final pathway of dying; either the heart (cardiac arrest) or heart and lungs (cardio-respiratory arrest) give out.  Then there are the terms that are complications of COVID-19.  For example, a staph pneumonia obviously is not a COVID-19 pneumonia, it is a super-infection (infection on top of another infection).  The patient's lungs were weakened by COVID-19 and the normal defense mechanisms which keep Staph out of the lungs failed, and the patient developed a Staph pneumonia.  In this case, the Staph pneumonia was a different process (and different organism) than COVID-19, but, the patient almost certainly wouldn't have developed a random Staph pneumonia but for the fact that they had COVID-19 (Staph super-infections are particularly common in patients with influenza; I don't think it is as common with COVID-19, but a viral pneumonia is a well-known predisposing factor.  Something like renal failure and acute kidney injury (the patient's kidney's failed) are likely not directly due to COVID-19, but downstream effects, sometimes several steps downstream (a patient gets COVID-19 which sends them to the hospital; they develop a secondary pneumonia from the process I described above.  The pneumonia leads to sepsis, an infection in the blood, which in term leads to septic shock and low blood pressure.  The low blood pressure means that the kidneys don't get enough blood and go into kidney failure, which, is ultimately what leads to the patient's death.  Not all kidney failure is due to COVID-19, and not all COVID-19 leads to kidney failure, but in this case, COVID-19 triggered a cascade of events that led to kidney failure, which proved fatal.

None of these patients would have died had they not gotten COVID-19, so they all should count as COVID-19 deaths.

Another way of looking at things is the number of "excess deaths".  The CDC keeps a running count comparing the number of people who died in a given week of the year, compared to historical numbers.

https://www.cdc.gov/nchs/nvss/vsrr/covid...deaths.htm

If you select "Number of Excess Deaths" and select US in the dashboard, you will see that since February 2020 we have had somewhere between 309,000 and 420,000 more deaths of any cause than would be predicted.  If a lot of the deaths that had been attributed to COVID-19 had really been patients who died "with COVID" instead of "of COVID" and were being misattributed to COVID-19 because of a positive test, then the number of excess deaths would trail the number of COVID-19 deaths.  On the other hand, the other possibility (that some deaths were attributed to a heart attack or non-COVID-19 pneumonia, but were really due to COVID that was missed, which may have happened early in the pandemic), then we would see more excess deaths than COVID-19 deaths, also needs to be considered.  The lower bound of the excess deaths (and the uncertainty comes in the fact that it is hard to know exactly how many deaths should have been expected had COVID-19 not happened) is pretty close to the number of COVID-19 deaths (346,000 per Worldometer), especially when you consider that reporting deaths to the CDC can lag a bit (the CDC states that only 60% of deaths are submitted within 10 days of the day of death).  On the other hand, the upper bound of the excess deaths number, if accurate, might suggest that either some COVID-19 deaths are being missed, or that people are dying at an increasing rate due to secondary effects of the pandemic (for example, COVID-19 negative people who die because they don't go to the hospital out of concern about catching COVID-19 or patients involved in a motor vehicle collision who are treated inadequately because the hospital doesn't have the resources (like ICU beds) to treat them adequately).

Anyway, the advantage of the excess deaths number is that it doesn't rely on a physician reporting the cause of death "correctly"; anyone who dies who would not have died but for the pandemic will show up as an "excess" mortality figure (there are also a small number of people who were "saved" due to the pandemic, for example, by not driving home drunk from a bar that is now closed and therefore getting into a fatal motor vehicle collision).

BC

[akiddoc]

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

[akiddoc]

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

[Genuine Realist]

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

Akiddoc's post surprises me, as I am personally aware of MD's getting the vaccine who are not front line providers. My daughter in general surgery was offered the vaccine in Pasadena, but declined, as she wants to see a little more experience with it. (She is by no means an anti-vaxxer, quite the contrary, and her attitude is shared by a surprising number of other docs.)

Getting to why I started this line, what interested me was not so much availability at Safeway, as the fact that THE major supermarket chain in northern California would actively solicit business of this type. I'm pretty good at awareness of what I know and what I don't. Safeway marketers are not dummies. Someone is seeing some utility in actively going after this business, which has no profit potential. Curious. Maybe it's simply to restore as much foot traffic as possible as soon as possible.

[Genuine Realist]

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

Akiddoc's post surprises me, as I am personally aware of MD's getting the vaccine who are not front line providers. My daughter in general surgery was offered the vaccine in Pasadena, but declined, as she wants to see a little more experience with it. (She is by no means an anti-vaxxer, quite the contrary, and her attitude is shared by a surprising number of other docs.)

Getting to why I started this line, what interested me was not so much availability at Safeway, as the fact that THE major supermarket chain in northern California would actively solicit business of this type. I'm pretty good at awareness of what I know and what I don't. Safeway marketers are not dummies. Someone is seeing some utility in actively going after this business, which has no profit potential. Curious. Maybe it's simply to restore as much foot traffic as possible as soon as possible.

[chrisk]

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

Akiddoc's post surprises me, as I am personally aware of MD's getting the vaccine who are not front line providers. My daughter in general surgery was offered the vaccine in Pasadena, but declined, as she wants to see a little more experience with it. (She is by no means an anti-vaxxer, quite the contrary, and her attitude is shared by a surprising number of other docs.)

Getting to why I started this line, what interested me was not so much availability at Safeway, as the fact that THE major supermarket chain in northern California would actively solicit business of this type. I'm pretty good at awareness of what I know and what I don't. Safeway marketers are not dummies. Someone is seeing some utility in actively going after this business, which has no profit potential. Curious. Maybe it's simply to restore as much foot traffic as possible as soon as possible.

Foot traffic is the main reason, but they are getting a fee for doing this.

---

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

Stanford Medicine had another smaller vaccine fiasco last weekend. They were giving walk-in vaccines only checking Stanford Medicine ID without checking job status relative to qualifying front-line status. Word spread among lab reasearchers and a number of them were vaccinated ahead of the front-line workers.

[chrisk]

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

Akiddoc's post surprises me, as I am personally aware of MD's getting the vaccine who are not front line providers. My daughter in general surgery was offered the vaccine in Pasadena, but declined, as she wants to see a little more experience with it. (She is by no means an anti-vaxxer, quite the contrary, and her attitude is shared by a surprising number of other docs.)

Getting to why I started this line, what interested me was not so much availability at Safeway, as the fact that THE major supermarket chain in northern California would actively solicit business of this type. I'm pretty good at awareness of what I know and what I don't. Safeway marketers are not dummies. Someone is seeing some utility in actively going after this business, which has no profit potential. Curious. Maybe it's simply to restore as much foot traffic as possible as soon as possible.

Foot traffic is the main reason, but they are getting a fee for doing this.

---

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

Stanford Medicine had another smaller vaccine fiasco last weekend. They were giving walk-in vaccines only checking Stanford Medicine ID without checking job status relative to qualifying front-line status. Word spread among lab reasearchers and a number of them were vaccinated ahead of the front-line workers.

[BostonCard]

Part of it is that it is a real logistical challenge to get the vaccines to all the right people at the right time.  There will be some people who will no-show for their appointment.  There will be others who might get sick at the last minute and will be turned away.  There will be some vials where you get an extra dose out of.  And you probably pad the vaccine doses just in case a vial breaks or has to be rejected for some reason, so you wind up scheduling fewer people than there are doses.  Normally, that's not a big deal; you just put the vial back in the fridge and pick up where you left off the next day.  But in this case, you have five days from when you thaw the vaccine to use it so that there is the very real possibility that if you don't give it to someone, anyone, you will lose it.  It is better to give the vaccine to a researcher with a Stanford ID who might not otherwise qualify than to have to waste the dose.

Up close, this will look messy and imperfect, and make some people mad about unfairness, but on the whole, most of the people who need to get vaccinated will, and this is definitely something where perfect is the enemy of good.

BC

[BostonCard]

Part of it is that it is a real logistical challenge to get the vaccines to all the right people at the right time.  There will be some people who will no-show for their appointment.  There will be others who might get sick at the last minute and will be turned away.  There will be some vials where you get an extra dose out of.  And you probably pad the vaccine doses just in case a vial breaks or has to be rejected for some reason, so you wind up scheduling fewer people than there are doses.  Normally, that's not a big deal; you just put the vial back in the fridge and pick up where you left off the next day.  But in this case, you have five days from when you thaw the vaccine to use it so that there is the very real possibility that if you don't give it to someone, anyone, you will lose it.  It is better to give the vaccine to a researcher with a Stanford ID who might not otherwise qualify than to have to waste the dose.

Up close, this will look messy and imperfect, and make some people mad about unfairness, but on the whole, most of the people who need to get vaccinated will, and this is definitely something where perfect is the enemy of good.

BC

[M T]

Up close, this will look messy and imperfect, and make some people mad about unfairness, but on the whole, most of the people who need to get vaccinated will, and this is definitely something where perfect is the enemy of good.

The issue you missed is timeliness.
Sure, most of the people in the US will get vaccinated, so I'd have to agree with that.  But there is a big difference between December & June.
There are all sorts of orderings that could be put on the vaccine distribution.
Obviously, those that will get sick now & die, needed the vaccine & didn't get it.

I'm not surprised that CDC put their colleagues first.  I imagine people on a sports discussion group would think sports deserves special considerations.  It is a matter of the priorities of the group setting the priority.  And, yes, the way I see priorities is influenced by my priorities.

California, and SCC, seemed to order the vaccine distribution unequally among the 1A group, prioritizing the HCW over the LTCF residents. 

IIUC, Utah is choosing a different order than the CDC for group 1B (splitting 1B, vaccinating 75+ (and I think those with comorbidities) before frontline essential workers).
Texas is likewise choosing a different order (65+ are in 1B). Apparently 65+ can in Florida, but appointments in one county are filled until February.
As I understand it, I could get a vaccination in Texas now, even though I can't expect to get it in California for 7 weeks, with 50% chance of getting it in 11 weeks or so.

9 months down, 4 months to go....  Someone say Hi to Punxsutawney Phil because I (like so many others) will be stuck in my lair.

---

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

As I pointed out awhile back, the frontline medical population ranges from 0.8% to 5% in different counties.  Those counties with larger medical populations will take longer to finish group 1A if vaccine is distributed by overall population.

I believe there is no restriction that you can only get your vaccination from your employer.   Try the county health department or other medical organizations (Stanford, etc.).  You might even appeal to the CDPH for advice.   From what you've said, you are in group 1A.  The intent of the state is that you should get the vaccine within that group, even if your employer can't manage it.  If you've got a connection in a county with lower medical population (typically rural), you might pursue that angle.   (NOTE: Per OWS, the 2nd dose will get to you where you are, not where you were when you got your first shot.  However, that doesn't mean that the state end will get it to the right spot.)

Also, I believe the CA priorities had those that give vaccinations to group 1A are to get the vaccine before they give shots.  So, if you were to offer to the health department (or your employer) to give vaccinations (to LTCF residents, for instance), you should be eligible to get one yourself that day.


OWS isn't distributing 20M doses until roughly January 7.  The CDC estimated group 1A had 24M people.  So it will be mid-January when they distribute enough.  Even then, OWS is distributing based on overall population, not population in 1A.  States with more frontline medical personnel and LTCF population will take longer to get enough doses.

[M T]

Up close, this will look messy and imperfect, and make some people mad about unfairness, but on the whole, most of the people who need to get vaccinated will, and this is definitely something where perfect is the enemy of good.

The issue you missed is timeliness.
Sure, most of the people in the US will get vaccinated, so I'd have to agree with that.  But there is a big difference between December & June.
There are all sorts of orderings that could be put on the vaccine distribution.
Obviously, those that will get sick now & die, needed the vaccine & didn't get it.

I'm not surprised that CDC put their colleagues first.  I imagine people on a sports discussion group would think sports deserves special considerations.  It is a matter of the priorities of the group setting the priority.  And, yes, the way I see priorities is influenced by my priorities.

California, and SCC, seemed to order the vaccine distribution unequally among the 1A group, prioritizing the HCW over the LTCF residents. 

IIUC, Utah is choosing a different order than the CDC for group 1B (splitting 1B, vaccinating 75+ (and I think those with comorbidities) before frontline essential workers).
Texas is likewise choosing a different order (65+ are in 1B). Apparently 65+ can in Florida, but appointments in one county are filled until February.
As I understand it, I could get a vaccination in Texas now, even though I can't expect to get it in California for 7 weeks, with 50% chance of getting it in 11 weeks or so.

9 months down, 4 months to go....  Someone say Hi to Punxsutawney Phil because I (like so many others) will be stuck in my lair.

---

I was just notified by my employer that they will not have vaccine for me until late January. I see COVID positive patients every week. They don’t expect enough vaccine for all of the county medical workers until the end of January.

As I pointed out awhile back, the frontline medical population ranges from 0.8% to 5% in different counties.  Those counties with larger medical populations will take longer to finish group 1A if vaccine is distributed by overall population.

I believe there is no restriction that you can only get your vaccination from your employer.   Try the county health department or other medical organizations (Stanford, etc.).  You might even appeal to the CDPH for advice.   From what you've said, you are in group 1A.  The intent of the state is that you should get the vaccine within that group, even if your employer can't manage it.  If you've got a connection in a county with lower medical population (typically rural), you might pursue that angle.   (NOTE: Per OWS, the 2nd dose will get to you where you are, not where you were when you got your first shot.  However, that doesn't mean that the state end will get it to the right spot.)

Also, I believe the CA priorities had those that give vaccinations to group 1A are to get the vaccine before they give shots.  So, if you were to offer to the health department (or your employer) to give vaccinations (to LTCF residents, for instance), you should be eligible to get one yourself that day.


OWS isn't distributing 20M doses until roughly January 7.  The CDC estimated group 1A had 24M people.  So it will be mid-January when they distribute enough.  Even then, OWS is distributing based on overall population, not population in 1A.  States with more frontline medical personnel and LTCF population will take longer to get enough doses.

[BostonCard]

It was reported today that the LA congressman elect died from "complications of COVID-19", which is a short way of saying that his death certificate probably doesn't list the primary cause of death as COVID-19, but that somewhere up the chain COVID-19 is listed.  His would qualify as a COVID death since the 41-year old wasn't going to die of something else had he not had COVID-19.  I believe that this is like those cases in North Dakota where COVID-19 is not the primary cause of death.

BC

[BostonCard]

It was reported today that the LA congressman elect died from "complications of COVID-19", which is a short way of saying that his death certificate probably doesn't list the primary cause of death as COVID-19, but that somewhere up the chain COVID-19 is listed.  His would qualify as a COVID death since the 41-year old wasn't going to die of something else had he not had COVID-19.  I believe that this is like those cases in North Dakota where COVID-19 is not the primary cause of death.

BC

[Goose]

Part of it is that it is a real logistical challenge to get the vaccines to all the right people at the right time.  There will be some people who will no-show for their appointment.  There will be others who might get sick at the last minute and will be turned away.  There will be some vials where you get an extra dose out of.  And you probably pad the vaccine doses just in case a vial breaks or has to be rejected for some reason, so you wind up scheduling fewer people than there are doses.  Normally, that's not a big deal; you just put the vial back in the fridge and pick up where you left off the next day.  But in this case, you have five days from when you thaw the vaccine to use it so that there is the very real possibility that if you don't give it to someone, anyone, you will lose it.  It is better to give the vaccine to a researcher with a Stanford ID who might not otherwise qualify than to have to waste the dose.

Up close, this will look messy and imperfect, and make some people mad about unfairness, but on the whole, most of the people who need to get vaccinated will, and this is definitely something where perfect is the enemy of good.

BC

It will look messy and imperfect because it will inevitably be messy and imperfect, but the main thing is to get vaccine into the "targeted groups" arms ASAP. The real issue here is that we are going agonizingly slowly. As many have pointed out it will take YEARS at the rate we are going. At some point the perfect is very much the enemy of good enough, but we are even real short of good enough.

I expected the State to be pretty messed up because they really didn't figure this out in advance at all. However, it boggles my mind that there seems to be no sense of urgency. I certainly don't want vaccine wasted because of "undue haste", but the idea it would take a month to immunize all the phase 1a people is just unsatisfactory IMHO.

[Goose]

Part of it is that it is a real logistical challenge to get the vaccines to all the right people at the right time.  There will be some people who will no-show for their appointment.  There will be others who might get sick at the last minute and will be turned away.  There will be some vials where you get an extra dose out of.  And you probably pad the vaccine doses just in case a vial breaks or has to be rejected for some reason, so you wind up scheduling fewer people than there are doses.  Normally, that's not a big deal; you just put the vial back in the fridge and pick up where you left off the next day.  But in this case, you have five days from when you thaw the vaccine to use it so that there is the very real possibility that if you don't give it to someone, anyone, you will lose it.  It is better to give the vaccine to a researcher with a Stanford ID who might not otherwise qualify than to have to waste the dose.

Up close, this will look messy and imperfect, and make some people mad about unfairness, but on the whole, most of the people who need to get vaccinated will, and this is definitely something where perfect is the enemy of good.

BC

It will look messy and imperfect because it will inevitably be messy and imperfect, but the main thing is to get vaccine into the "targeted groups" arms ASAP. The real issue here is that we are going agonizingly slowly. As many have pointed out it will take YEARS at the rate we are going. At some point the perfect is very much the enemy of good enough, but we are even real short of good enough.

I expected the State to be pretty messed up because they really didn't figure this out in advance at all. However, it boggles my mind that there seems to be no sense of urgency. I certainly don't want vaccine wasted because of "undue haste", but the idea it would take a month to immunize all the phase 1a people is just unsatisfactory IMHO.

[dabigv13]

My wife was able to be vaccinated at the hospital where she takes call, but getting her small, private practice office staff vaccinated has been very difficult. It's done through a CA state public health agency, and when she called she got some call center person who knew nothing and was no help. As a specialty clinic her nurses and staff should be in the third phase of the tier 1a HCW allocation. Why ENT, which does aerosol generating procedures, is behind primary care clinics is a bit strange but in any case her staff should still be getting vaccines in arms now or very soon if our target is all of tier 1 in a month. Clearly that is not happening. Large hospitals certainly have leg up on early distribution, but if we can't even figure out how to vaccinate the relatively small number of HCWs, hard to see how this will scale quickly to the many more numerous groups in the next tier.

[dabigv13]

My wife was able to be vaccinated at the hospital where she takes call, but getting her small, private practice office staff vaccinated has been very difficult. It's done through a CA state public health agency, and when she called she got some call center person who knew nothing and was no help. As a specialty clinic her nurses and staff should be in the third phase of the tier 1a HCW allocation. Why ENT, which does aerosol generating procedures, is behind primary care clinics is a bit strange but in any case her staff should still be getting vaccines in arms now or very soon if our target is all of tier 1 in a month. Clearly that is not happening. Large hospitals certainly have leg up on early distribution, but if we can't even figure out how to vaccinate the relatively small number of HCWs, hard to see how this will scale quickly to the many more numerous groups in the next tier.

[chrisk]

Part of it is that it is a real logistical challenge to get the vaccines to all the right people at the right time.  There will be some people who will no-show for their appointment.  There will be others who might get sick at the last minute and will be turned away.  There will be some vials where you get an extra dose out of.  And you probably pad the vaccine doses just in case a vial breaks or has to be rejected for some reason, so you wind up scheduling fewer people than there are doses.  Normally, that's not a big deal; you just put the vial back in the fridge and pick up where you left off the next day.  But in this case, you have five days from when you thaw the vaccine to use it so that there is the very real possibility that if you don't give it to someone, anyone, you will lose it.  It is better to give the vaccine to a researcher with a Stanford ID who might not otherwise qualify than to have to waste the dose.

Up close, this will look messy and imperfect, and make some people mad about unfairness, but on the whole, most of the people who need to get vaccinated will, and this is definitely something where perfect is the enemy of good.

BC

It will look messy and imperfect because it will inevitably be messy and imperfect, but the main thing is to get vaccine into the "targeted groups" arms ASAP. The real issue here is that we are going agonizingly slowly. As many have pointed out it will take YEARS at the rate we are going. At some point the perfect is very much the enemy of good enough, but we are even real short of good enough.

I expected the State to be pretty messed up because they really didn't figure this out in advance at all. However, it boggles my mind that there seems to be no sense of urgency. I certainly don't want vaccine wasted because of "undue haste", but the idea it would take a month to immunize all the phase 1a people is just unsatisfactory IMHO.

Do you think the state has a working data base set up yet to keep track of the massive volumes of residents who will be vaccinated? Won’t they need all sorts of interfaces with lots of EMRs and provisions for manual tracking?

[chrisk]

Part of it is that it is a real logistical challenge to get the vaccines to all the right people at the right time.  There will be some people who will no-show for their appointment.  There will be others who might get sick at the last minute and will be turned away.  There will be some vials where you get an extra dose out of.  And you probably pad the vaccine doses just in case a vial breaks or has to be rejected for some reason, so you wind up scheduling fewer people than there are doses.  Normally, that's not a big deal; you just put the vial back in the fridge and pick up where you left off the next day.  But in this case, you have five days from when you thaw the vaccine to use it so that there is the very real possibility that if you don't give it to someone, anyone, you will lose it.  It is better to give the vaccine to a researcher with a Stanford ID who might not otherwise qualify than to have to waste the dose.

Up close, this will look messy and imperfect, and make some people mad about unfairness, but on the whole, most of the people who need to get vaccinated will, and this is definitely something where perfect is the enemy of good.

BC

It will look messy and imperfect because it will inevitably be messy and imperfect, but the main thing is to get vaccine into the "targeted groups" arms ASAP. The real issue here is that we are going agonizingly slowly. As many have pointed out it will take YEARS at the rate we are going. At some point the perfect is very much the enemy of good enough, but we are even real short of good enough.

I expected the State to be pretty messed up because they really didn't figure this out in advance at all. However, it boggles my mind that there seems to be no sense of urgency. I certainly don't want vaccine wasted because of "undue haste", but the idea it would take a month to immunize all the phase 1a people is just unsatisfactory IMHO.

Do you think the state has a working data base set up yet to keep track of the massive volumes of residents who will be vaccinated? Won’t they need all sorts of interfaces with lots of EMRs and provisions for manual tracking?