[conspire] Flubbing the vaccine rollout (was: A more-effective face mask as a DIY project)

[Rick Moen]

Quoting Nick Moffitt (nick at zork.net):

> This rigid phasing model seems a lot like a useless trolley problem
> exercise that would best be shelved in favour of getting needles in
> arms as fast as possible.

More of this dynamic at work:

https://www.nytimes.com/2020/12/31/health/heres-why-the-last-mile-of-vaccine-distribution-is-going-so-slowly.html

Wherein lies the problem?  Here's part 1 of 3, the thorniest and the 
least tractible:

   [C]ritically, public health experts say, federal officials have left
   many of the details of the final stage of the vaccine distribution
   process, such as scheduling and staffing, to overstretched local
   health officials and hospitals.

And part 2, inexcusably bad planning but maybe not dose-destroying:

   The holiday season has meant that people are off work and clinics
   have reduced hours, slowing the pace of vaccine administration. 

And part 3, again just a delay:

   States have held back doses to be given out to their nursing homes
   and other long-term-care facilities, an effort that is just gearing up
   and expected to take several months. Across the country, just 8% of the
   doses distributed for use in these facilities have been administered,
   with 2 million yet to be given.


Locally:

  In California, doctors are worried about whether there will be enough
  hospital staff members to both administer vaccines and tend to the
  swelling number of COVID-19 patients.

Gee, thanks, Trump Administration.  Speaking of:

  "We've taken the people with the least amount of resources and
  capacity and asked them to do the hardest part of the vaccination —
  which is actually getting the vaccines administered into people's arms,”
  said Dr. Ashish Jha, dean of Brown University's School of Public Health.

  Federal and state officials have denied they are to blame for the slow
  rollout. Officials behind Operation Warp Speed, the federal effort to
  fast-track vaccines, have said that their job was to ensure that
  vaccines are made available and get shipped out to the states. President
  Donald Trump said in a tweet Tuesday that it was “up to the States to
  distribute the vaccines once brought to the designated areas by the
  Federal Government.”

They're the monarchs of 'Not my job, man.  You want the actual work of
running a country done?  Suck it up, hold bake sales, and substitute for
the missing government.  We'll be superspreader-partying at Mar-a-Lago.'

Experts warn that, as pathetically inept as the Phase 1a rollout had
been across pretty much all US states, it was the -=easiest=- part,
because target front-line medical staff and residents of long-term care
facilities are in fixed known locations and easy to reach.  Things look
likely to get much worse with Phase 1b:

  It may be more difficult, public health officials say, to vaccinate
  the next wave of people, which will most likely include many more older
  Americans as well as younger people with health problems and front-line
  workers.  Among the fresh challenges:  How will these people be scheduled
  for their vaccination appointments?  How will they provide documentation
  that they have a medical condition or a job that makes them eligible to
  get vaccinated?  And how will pharmacies ensure that people show up and
  that they can do so safely?


I've heard MAGA-heads reassure me there's absolutely _no problem_, because 
the Mike Pence-helmed Operation Warp Speed @ HHS reached agreements with
large retail pharmacy chains such as Costco, Rite-Aid, Walgreens,
Walmart, and CVS, comprising 40,000 retail locations, to handle some
vague and unspecified part of rollout.
https://www.hhs.gov/about/news/2020/11/12/trump-administration-partners-chain-independent-community-pharmacies-increase-access-future-covid-19-vaccines.html

Gosh, guys, Adam Smith's invisible hand appears to not be helping much,
and I think it's giving us the finger.


 
Operation Warp Speed's official rollout plan projected 80% coverage of
the country's (330.7M) population by June -- which works out a bit over
3M planned vaccinations per _day_ on average.  Supposedly, they were
going to have the first 20 million shot 1 of 2 vaccinations done by
yesterday.  Instead, it seems they've with difficulty managed about 2
million -- front-line health care workers and some nursing home
residents.  That's 2 million doses out of 11.5 million doses that were
delivered by Pfizer and Moderna -- an inocculation rate of about 65k per
day rather than the planned 2M per day -- i.e., slow by a factor of 30.

What's happening to the other 9.5 million dsses?  I have no idea.  The
Pfizer vaccine can be stored for a medium-long time as long as it
remains in deep freeze (-70 degrees C), but only five days after
transfer to regular freezers.  The Moderna is good for a month in -20
degrees C normal freezers.  So, maybe there aren't further fsck-ups
wasting them.  Maybe.

(That 20M projection was itself a scaled-down promise, at the beginning of
December, of Operation Warp Speed's top _actual_ scientist, Dr. Moncef
Slaoui.  Previous to that, the official supposed plan was the
Toddler-in-Chief's fatuous fantasy promise, in September 2020, that 100
million doses would ship by New Year's Eve.)

NBC News calculated that, if the present rollout rate continues based on
the rate observed for the first three weeks following approval,
inoculating enough Americans to bring the pandemic under control will
take approximately _ten years_.



Comparison:  NYC did this thing right, in 1947.  

On March 1, 1947, a couple stepped off a bus from Mexico City in midtown
Manhattan.  The husband had a headache, rash, and some other symptoms,
but just took a lot of aspirin while doing shopping and sightseeing for
four days.  On March 5, he checked into Bellevue and three days later
was transferred to the city's communicable disease hospital, Willard
Parker along the East River.  The case got the attention of NYC's
commendably alert Commissioner of Health, Dr. Israel Weinstein, who was
very concerned and had four possible disease causes in mind when the
patient suddenly died on March 10.  Autopsy revealed internal
haemorraging, but authorities still weren't sure.  New patients who'd
been in contact with Patient Zero became ill -- and they shared the
trait of not having had smallpox shots.  Oops.  By mid-March, it was
becoming apparent that this was indeed smallpox, and the diagnosis was
confrimed by US Army Medical School Laboratory and Western Reserve
University scientists.  

By early April, Dr. Weinstein had quietly started a serious
contact-tracing effort and started firing up a historically serious
public health campaign.  NYC had last had a smallpox epidemic in 1875,
killing 2,000, but this could be a lot worse.  A vaccine was available.
675,000 doses were immediately available, and several hundred thousand
more were shipped from other parts of the country.  But smallpox is
highly infectious, so substantively the entire population would need the
shot.

Mayor William O’Dwyer called an emergency meeting with vaccine
manufacturers who went into maximum round-the-clock production.
Meanwhile, Dr. Weinstein started long-famous radio addresses, imploring
New Yorkers to line up to get the vaccine.  Half a million doses were
given in the first two weeks, and 6,350,000 New Yorkers had been
immunised by the end of April.  Queues went down the sidewalks in
driving rain, and around the block, waiting for the shot.  

And that was the end of the outbreak -- two deaths, twelve cases.


That's _with_ leadership.