Oldsouljer said:

---

packgrad said:

---

I think it's ridiculous to expect the federal government to orchestrate the vaccinations. There is no one size fits all approach for the 50 states. It may be asking too much to expect it of the governors, but i think that's a much more reasonable expectation.

---

Yes, among other things, it begs the question, why do we have states anyway? Of course, in the last one hundred years, states seems to have evolved into departments" of the federal government.

---

No, it doesn't.

The federal government is ideally and uniquely situated to apply massive resources to expensive and complex problems on scale. They are not well suited for highly tailored and local solutions. This was always going to be a blended fed, state, and local solution but it could have been so much better than the feds basically being a vaccine Instacart and just dropping the vaccine off on the front porch of every state.

We suspected months ago that we would begin sticking needles in arms Q4.

There's no reason why the CDC/FDA could not have begun this summer developing a modular game plan for urban, suburban, exurban, and rural distribution that was implantable in every state, with some minor geographical modifications as necessary.

Identify transmission pipelines and downstream distribution networks working outward from all the major airline hubs in every state.

Engage with state and local governments, institutional hospital and health care providers, and industry (FedEx/UPS/DHL and CVS/Walgreens) to drill down from vaccine delivery to each state all the way to end users receiving their second dose.

The feds needed to provide the detailed roadmap, rely on the states and local governments and industry to extend their reach, and make sure the boots on the ground had the resources and full assistance of the federal government to do so.

Instead we've distributed only 20% of the vaccines we were supposed to by this point.

I'm a civil engineer that took a couple of systems classes 20 years ago. I'm a complete amateur thinking about this while unwinding on the couch having a bourbon. In 10 minutes I could rough out a starting point, preliminary goals, and potential next steps.

What could teams of the brightest industrial and systems engineers in the country in industry and at the CDC/FDA have come up with, with several months to prepare and the full weight and resources of the federal government behind them?

Vaccine distribution isn't working because there was no plan for it to work. This is a classic but massive example of "failing to prepare is preparing to fail."

Only 20% may be true but leading the world in numbers per 100k people. If I remember correctly from what was posted here the other day.

Vaccine distribution isn't working? Wow. Interesting theory.

Cthepack said:

---

Only 20% may be true but leading the world in numbers per 100k people. If I remember correctly from what was posted here the other day.

---

That was posted on here earlier today.

For that to be a meaningful indicator of relative distribution performance all countries in the sample would have had to receive equal quantities of vaccine per capita at the exact same time.

That's obviously not the case.

Civilized said:

---

packgrad said:

---

Vaccine distribution isn't working? Wow. Interesting theory.

---

If you tell one of your clients that by the end of December you'll hit a certain construction benchmark, and by the end of December you're 20% of the way of there, how would your client assess that performance?

---

You're just looking for a reason to cry foul about federal government response. It's a predictable response. The federal government with operation warp speed get the vaccines out as soon as they are produced. They do not control vaccinations nor reporting of vaccinations. Im fairly certain the 20% number is inaccurate as reporting has lagged from the start, and moderna wasn't even included in numbers that I've seen.

A customer of mine would understand the nuanced situation.

Civilized said:

---

Cthepack said:

---

Only 20% may be true but leading the world in numbers per 100k people. If I remember correctly from what was posted here the other day.

---

That was posted on here earlier today.

For that to be a meaningful indicator of relative distribution performance all countries in the sample would have had to receive equal quantities of vaccine per capita at the exact same time.

That's obviously not the case.

---

They would only need equal quantities if they have run out of the vaccine. If the countries still have more than zero the data holds true. Have those countries listed run out of vaccine?

I just fail to see how the amount of the vaccine that has been distributed is affecting the fact that what has been distributed hasn't been administered. Surely there are things that could be done better at all levels, but as is pointed out here often, this is a novel virus, and this type of nationwide vaccination effort is also a novel one.

packgrad said:

---

Civilized said:

---

packgrad said:

---

Vaccine distribution isn't working? Wow. Interesting theory.

---

If you tell one of your clients that by the end of December you'll hit a certain construction benchmark, and by the end of December you're 20% of the way of there, how would your client assess that performance?

---

You're just looking for a reason to cry foul about federal government response. It's a predictable response. The federal government with operation warp speed get the vaccines out as soon as they are produced. They do not control vaccinations nor reporting of vaccinations. Im fairly certain the 20% number is inaccurate as reporting has lagged from the start, and moderna wasn't even included in numbers that I've seen.

A customer of mine would understand the nuanced situation. Yours would probably depend on political stance.

---

C'mon man.

There's nothing political about vaccine distribution. I didn't bring up Trump and frankly think Operation Warp speed will be his single greatest presidential achievement.

wilmwolf80 said:

---

I just fail to see how the amount of the vaccine that has been distributed is affecting the fact that what has been distributed hasn't been administered. Surely there are things that could be done better at all levels, but as is pointed out here often, this is a novel virus, and this type of nationwide vaccination effort is also a novel one.

---

This.

Civilized said:

---

packgrad said:

---

Civilized said:

---

packgrad said:

---

Vaccine distribution isn't working? Wow. Interesting theory.

---

If you tell one of your clients that by the end of December you'll hit a certain construction benchmark, and by the end of December you're 20% of the way of there, how would your client assess that performance?

---

You're just looking for a reason to cry foul about federal government response. It's a predictable response. The federal government with operation warp speed get the vaccines out as soon as they are produced. They do not control vaccinations nor reporting of vaccinations. Im fairly certain the 20% number is inaccurate as reporting has lagged from the start, and moderna wasn't even included in numbers that I've seen.

A customer of mine would understand the nuanced situation. Yours would probably depend on political stance.

---

C'mon man.

There's nothing political about vaccine distribution. I didn't bring up Trump and frankly think Operation Warp speed will be his single greatest presidential achievement.

---

A little shy of 21,500,000 have been distributed. A little less than 5,920,000 have been administered.

https://covid.cdc.gov/covid-data-tracker/#vaccinations

Cthepack said:

---

Civilized said:

---

Cthepack said:

---

Only 20% may be true but leading the world in numbers per 100k people. If I remember correctly from what was posted here the other day.

---

That was posted on here earlier today.

For that to be a meaningful indicator of relative distribution performance all countries in the sample would have had to receive equal quantities of vaccine per capita at the exact same time.

That's obviously not the case.

---

They would only need equal quantities if they have run out of the vaccine. If the countries still have more than zero the data holds true. Have those countries listed run out of vaccine?

---

Again, we don't have enough information to know whether other countries are supply-constrained, distribution-constrained, or when they got their supply.

We're seeing a snapshot of race cars on a race track without knowing when each of the the cars was allowed to start the race, or what the relative velocities of the cars are.

If they are operating at the same efficiency we are (distributing roughly 20% of what they receive) and have received less vaccine than us per capita, their total vaccinations administered will be a fraction of ours per capita even though they are operating at the same efficiency.

Or, they could be operating at a much greater distribution efficiency than us and have supply that outpaces distribution, but not have received their first doses until three weeks after us. They'd be behind us in total vaccinations per capita but be operating much more efficiently than us.

Again if a country has not run out the data is valid. Of the countries I remember none have run out yet. So we are the best in the world! That is a good thing.

Edit to add getting the vaccine to the country is part of the distribution.

Cthepack said:

---

Again if a country has not run out the data is valid. Of the countries I remember none have run out yet. So we are the best in the world! That is a good thing.

Edit to add getting the vaccine to the country is part of the distribution.

---

It's valid, you just can't use it to decipher the pace of distribution the way you're trying to without knowing when countries started vaccinating and whether or not they're supply constrained.

Civilized said:

---

Cthepack said:

---

Again if a country has not run out the data is valid. Of the countries I remember none have run out yet. So we are the best in the world! That is a good thing.

Edit to add getting the vaccine to the country is part of the distribution.

---

It's valid, you just can't use it to decipher the pace of distribution the way you're trying to without knowing when countries started vaccinating and whether or not they're supply constrained.

---

No you can. I do not need to know when the country got the vaccine. Making sure your country got the vaccine as early as possible is part of the distribution. Making sure the supply is not constrained is part of the distribution.

So USA USA USA!!!

Conveying complex emotional communication is challenging in a written format. I was being somewhat sarcastic with the first sentence. Truth is, I think states need to vigorously reclaim their 10th Amendment rights, or given what just happened to our National Election, return to the Articles fm Confederation or something like that which undermines federal power.

This is North Carolina specific, but I've had two different sources tell me within the last week that the bulk of the outbreak right now is largely being spread by those under the age of 30 (which then spreads it to other age groups)... one source is a woman on the coast involved with one of the companies administering tests... and the other is a male in upper level management for a little company based in Burlington.

TheStorm said:

---

This is North Carolina specific, but I've had two different sources tell me within the last week that the bulk of the outbreak right now is largely being spread by those under the age of 30 (which then spreads it to other age groups)... one source is a woman on the coast involved with one of the companies administering tests... and the other is a male in upper level management for a little company based in Burlington.

---

I would tend to agree with this. From my local experience, cases from age 25-49 are exploding which in turn affects the most vulnerable. Thanks for the info.

Some insight on the EU countries (27 countries and 448M citizens, does not include UK), since there have been questions about their supply and vaccination plans:

1. Two vaccine candidates have been approved for all EU countries. Pfizer was approved on 12/21/20 and Moderna was approved on 1/6/21. Pfizer will be supplying 600 million doses and Moderna 160 million doses.

2. Once approved, vaccines will be available to all EU countries at the same time and at the same conditions.

3. First deliveries of the Pfizer vaccine occurred within days of approval. Most of the first vaccinations occurred 12/27 to 12/29.

4. EU countries will be issuing "proof of vaccination" certificates after a person has completed their vaccinations. These will be useful for travel and will identify people who do not need to be tested.

5. Pfizer expected to deliver 12.5M doses across the EU by the end of 2020.

6. Deliveries of the Moderna vaccine are expected to begin next week.

7. AstraZeneca is expected to request authorization for use in the EU next week and it could be approved by the end of January.

8. Rollouts in France seem to be hampered by "bureaucratic obstacles". The French government has a struggle with balancing a mass vaccination campaign in one of the world's most anti-vaccine countries. As such, they have put in additional reviews and patient approval requirements that only delay vaccinations.

9. Denmark appears to be handling vaccinations the best of all the EU countries. They are currently administering 1.09 doses per 100 people.

Outside of the EU and the US, Israel is leading the world with the speed of their vaccinations. They began vaccinations on 12/19 and so far 1.59 million (pop. 8.6M people) have received a vaccination. They have focused first on those over the age of 60 with their vaccination campaign.

The chart below shows vaccinations for all EU countries:

Question for Mormad and PackPA - With regards to the article referenced in the Tweet below, have you seen a similar trend in the practices and hospitals that you work in with regards to a reluctance on the part of healthcare workers to get the vaccine?

My concerns are twofold:

1. It sends a bad message to the general public that is already skeptical of vaccines and could as a result, limit the effectiveness of the Covid vaccine program.
2. If this trend extends to staff working in congregate/LTC facilities, it could lead to a continued exposure risk for the high risk populations in their facilities.

Daviewolf83 said:

---

Question for Mormad and PackPA - With regards to the article referenced in the Tweet below, have you seen a similar trend in the practices and hospitals that you work in with regards to a reluctance on the part of healthcare workers to get the vaccine?

My concerns are twofold:

1. It sends a bad message to the general public that is already skeptical of vaccines and could as a result, limit the effectiveness of the Covid vaccine program.
2. If this trend extends to staff working in congregate/LTC facilities, it could lead to a continued exposure risk for the high risk populations in their facilities.

---

Those guys will have more experience to draw from (and comment on), but my wife works at a rural hospital in N.C., and she said that the nurses/employees were very receptive to getting the vaccine.
They lined up for it the first day it was available, etc.

My wife works at Duke and she said only 3 people in her specific department refused. 1) just recently had a baby, 2) is currently pregnant, 3) was already positive for the Coronavirus in the beginning of November and is attempting to get pregnant this year.

Another personal anecdote, a friend who is a nurse in a doctor's office received her first shot yesterday. She reported that her arm was really sore after, but this morning she woke up with nausea and a very bad headache. Seems to be fairly common for what I've seen.

PackMom said:

---

910wolf said:

---

My wife works at Duke and she said only 3 people in her specific department refused. 1) just recently had a baby, 2) is currently pregnant, 3) was already positive for the Coronavirus in the beginning of November and is attempting to get pregnant this year.

---

For the third one, I've seen anecdotal stories that some people who recently had the virus are having more trouble with side effects. Maybe the immune system is saying, "OH, NO, not again!"

---

I have reason to believe I was infected last January. Hopefully come the time to get jacked up, my immune system will say, been there done that, no prob.

We have not seen that at my clinic or hospital system. Most folks are receiving it without any issue. There have been 2 nurses at our clinic whom refused. One is due to having severe reactions to other routine vaccines (which she has been told likely is not an issue with COVID vaccine) and one believes COVID is not a big deal. I will never understand the second one, because she sees those nasty cases at our office, but to each their own.

It does set a very bad example especially in LTC facilities. I did not personally expect that from healthcare workers. I have noticed that it someone is declining it, it is typically not a provider or respiratory personnel. Mostly nurses, CNAs, etc. are refusing.

Grim Day in U.S. as Covid-19 Deaths and Hospitalizations Set Records

The United States on Wednesday recorded its single-worst daily death toll since the pandemic began, and on a day when Covid-19 hospitalizations also hit an all-time high, the pace of loss showed no signs of slowing any time soon.

Not since spring, during the pandemic's first peak, were so many deaths reported. The high point then was 2,752 deaths on April 15. On Wednesday it was at least 2,760.

Hospitalizations from the virus topped 100,000 more than double the number at the beginning of November. That is a clear indicator of what the days ahead may look like, experts say.

"If you tell me the hospitalizations are up this week, I'll tell you that several weeks down the road, the deaths will be up," said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women's Hospital in Boston.

Most docs around here are gladly pulling up their sleeves.

There is hesitation among staff, especially AAs.

I'm not sure that in most cases it's really setting an example since most that could be affected have already formed their opinions, and the only talk i hear around the hospital or office is from people receiving the vaccine. Those opting out seem quiet. Could be wrong here.

At the end of each day, there has been extra vaccine that will go bad if not given and they will accept walk ins. There have been texts that will say, "we have 600 doses that will go bad in 30 minutes. Please send any interested friends or family members who are interested. " Short windows, but great opportunity for those who wouldn't otherwise be candidates yet.

Hospital is filling up. Over 260 admitted, around 35-40 in the unit, 20-25 vented. Predicting 350 by feb 1, so elective surgeries cancelled as of jan 25 because of staffing concerns. Really sucks.

Mormad said:

---

Most docs around here are gladly pulling up their sleeves.

There is hesitation among staff, especially AAs.

I'm not sure that in most cases it's really setting an example since most that could be affected have already formed their opinions, and the only talk i hear around the hospital or office is from people receiving the vaccine. Those opting out seem quiet. Could be wrong here.

At the end of each day, there has been extra vaccine that will go bad if not given and they will accept walk ins. There have been texts that will say, "we have 600 doses that will go bad in 30 minutes. Please send any interested friends or family members who are interested. " Short windows, but great opportunity for those who wouldn't otherwise be candidates yet.

Hospital is filling up. Over 260 admitted, around 35-40 in the unit, 20-25 vented. Predicting 350 by feb 1, so elective surgeries cancelled as of jan 25 because of staffing concerns. Really sucks.

---

Interesting.

Remind us what metro area you're in, Mormad?

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774707?&utm_source=BulletinHealthCare&utm_medium=email&utm_term=010821&utm_content=MEMBER&utm_campaign=article_alert-morning_rounds_daily&utm_uid=2361063&utm_effort=MRNRD0

Article about asymptomatic spread of covid based on a simple model. Again, great links to studies within the link.

For those that don't want to read the details, their model predicts about a 50% prevalence of asymptomatic transmission, which is very different from the study Davie has sited. The model has assumptions, but they seem reasonable. Here is to praying the meta-analysis davie has referenced is the more accurate predictor.

The triad

https://www.nejm.org/doi/full/10.1056/NEJMc2026670#.X_a_UyvxfHw.twitter

Some data from Sweden regarding school aged children. I found it interesting. Severe illness rate 1/130000

Received my second dose of the vaccine this morning.

Mormad, I think you make a great point about it not setting am example. For those that have made up their mind, nothing is going to change that.

The asymptomatic spread is frightening for sure. Hopefully, as we learn more, this will decrease.

Mormad said:

---

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774707?&utm_source=BulletinHealthCare&utm_medium=email&utm_term=010821&utm_content=MEMBER&utm_campaign=article_alert-morning_rounds_daily&utm_uid=2361063&utm_effort=MRNRD0

Article about asymptomatic spread of covid based on a simple model. Again, great links to studies within the link.

For those that don't want to read the details, their model predicts about a 50% prevalence of asymptomatic transmission, which is very different from the study Davie has sited. The model has assumptions, but they seem reasonable. Here is to praying the meta-analysis davie has referenced is the more accurate predictor.

---

Mormad - Thanks for the insight on the healthcare vaccines and the link to the study on asymptomatic spread. It is good that most providers in your experience are getting the vaccine. I was quite surprised when I saw the reports of large numbers refusing the vaccine. I hope your experience is also the same for nursing home staff, since 50% of the deaths continues to be from these facilities in NC.

I saw a mention of the asymptomatic study on the news yesterday morning, but have not had time to read it yet. The findings are interesting and a little surprising, since I have seen other studies (the one I referenced and some studies from a few months ago) saying asymptomatic spread is not a major spread vector, particularly spread from asymptomatic young people. It will be interesting to read the peer comments for the new study, since they help to reveal areas the study may have gotten wrong.

With regards to the left-over vaccine usage, it is good they are trying to use all available doses. It would be absolutely horrible for any doses to be wasted. At some point, I would assume the responsibility to perform vaccinations would move out of hospitals and move to other providers (family practices, urgent care, etc). Do agree that this is the case or do you think hospitals will continue to be a significant provider of vaccines to the general public?

PackPA2015 said:

---

We have not seen that at my clinic or hospital system. Most folks are receiving it without any issue. There have been 2 nurses at our clinic whom refused. One is due to having severe reactions to other routine vaccines (which she has been told likely is not an issue with COVID vaccine) and one believes COVID is not a big deal. I will never understand the second one, because she sees those nasty cases at our office, but to each their own.

It does set a very bad example especially in LTC facilities. I did not personally expect that from healthcare workers. I have noticed that it someone is declining it, it is typically not a provider or respiratory personnel. Mostly nurses, CNAs, etc. are refusing.

---

Thanks for the information PackPA. It makes sense to me that some would refuse based on existing health conditions (pregnancy as an example, since the vaccine was not tested on pregnant people), but there should be no reason for a healthy person who meets the FDA's guidelines (over 18 years old as an example) to reject the vaccine. For employees of LTC facilities, it seems like it should be mandatory and a condition for employment, since over half the deaths in NC are still coming from these facilities. The only exception should be religious or health condition.