I Tried to Get a ‘Leftover Dose’ of the Vaccine Last Night
thecut.com
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You have people over 75 years old who were waiting and registering on whatever reservation system was cobbled together on short notice, and then because the public health authorities now risked throwing out doses for want of people to inject them into, they just opened the floodgates to everyone over 65.
So what happens to the people over 75 who were waiting, and now are swamped by the crowds? If they keep on opening up bulk tranches of the population (instead of in small slices) before people of priority are reached, when will the most vulnerable ever get their turn?
This is a known problem. Multiple queues of priority and people on call to be given turns the next day if it looks like there's capacity.
Instead you have people wondering if they should walk in, visit a county next door, or wait around in case some mistake is made and there are actually extra doses at the end of a day. Or try to scheme/figure out the system however they can, out of desperation.
If it can't be done right, let everyone know that it's up to their willingness to wait wherever they can, according to some basic ground rules, and don't make a meaningless (or worse, deceptive) reservations system that gets bypassed at the last minute.
What a shameful clusterfuck.
A lot is really about overall volume. Even a million vaccinations a day means you're looking at well into the summer until you even approach 50% vaccinated.
I think we’ll see R’ start to plunge during summer due to weather and never climb back up from increase in immunity. But “back to normal”. January earliest.
There are also gradations of normal although once you fully open up restaurants, have indoor concerts, packed auditoriums, etc. most things you could do to reduce spread are pretty much theater at that point (other than possibly requiring vaccinations to fly, enter venues, workplaces).
Getting a large swath of people vaccinated is more valuable than perfectly getting prioritization right. Prior to this change, NY was attempting to perfect prioritization, and was discarding many doses as they expired.
Exactly. Any person getting a dose is better than vaccine expiring
This is "once this vaccine is pulled out of the super-cold freezer, it starts breaking down, and you have X hours before it's worthless at best."
Worse than "worthless" is the idea that people might get a useless expired vaccine anyway, think they're protected, and then be a vector for future transmission.
See https://www.jstor.org/stable/4531385?seq=1
In my opinion, the US’s top level goals were wrong (over focus on equity versus utility) and the US bureaucracy is neither flexible nor creative as evidenced by its refusal to buck top level orders and it’s continuing slowness. These are signs of a decaying system.
Yes, and it’s because the priorities rank as follows for each individual:
1) personal liability
2) organizational liability
3) utility
Where liability includes both legal and public relations consequences. It’s exhausting to constantly think about open ended and unintended consequences that you might be held accountable for, with no recourse.
What really helped is a very centralized healthcare system with a very long history of managing public emergencies.
This is because Israel was founded as a socialist welfare state, and the impressive healthcare system is one of the leftovers.
Michigan (my state) is doing about 35,000 doses on weekdays at this point, which is frustratingly slow. But if they had spun up twice as fast, we wouldn't be doing 70,000 doses a day, we'd be out of vaccine.
The most recent shipments have been ~120,000 vaccines/week for 2 weeks and then none for a third week. So if the tempo of Federal allotments is 120,000 a week, the 35,000 a day is not a bottleneck. They should of course be building capacity anyway, with the idea that deliveries will increase (and making a plan for what to do if/when the adenovirus vaccines are approved in the US; fortunately it looks like that can be "send it everywhere").
Anyway, wasting vaccines is obviously stupid, I'm not trying to argue about that.
If somebody is elderly, the chances of them getting an appointment is extremely low without the help (and extreme vigilance) of their tech savvy children/nieces/nephews.
Some states have also opened up their registrations to people 16+ with serious chronic health conditions that put them at high risk of severe COVID-19. In a handful of these states, many of these people have received a vaccine. But, it is first come first serve, which is an absolute disaster along with being inequitable.
That only applies if your application is programmed for it. Good luck scaling even if you had aws if your server had database locks everywhere, for instance.
To me it is a cop-out to blame the feds. There is nothing to stop any state in our union from addressing this pandemic as they see fit. The states making up the Euro aren't blaming Brussels for their problems.
The converse would be to have one world government make decisions for everybody, right? That would work if we all agreed on everything, but we don't. So it is good to have different states try different solutions, and copy what works. Better then having a bad federal solution imposed on everyone.
Except for zero funding...
My state is definitely to blame too, our new governor is an absolute disaster. But, we also have no serious funding left to handle the pandemic. Our last governor started a rainy day fund years ago and exhausted that last year, along with part of our wildfire fund. There is nothing left for us without federal assistance.
There is absolutely a middle ground between putting everything on the state and having one government rule the entire world. The federal government is the best equipped entity in the United States for handling the pandemic. It has the funding, personnel, and logistics management to efficiently distribute vaccines.
The fact that some states are not doing a good job doesn't incline me to want to gamble on the federal government doing better. They don't have a good track record in emergencies.
You might end up punishing the states who are doing ok, and possibly causing a lot of problems forcing everyone into one solution.
At some point politicians need to be held accountable. Passing the buck for everything is not a great answer.
Its only the state's responsibility now because the federal government fumbled hard initially and had to pass blame because it was an election year. When is the last time states had to handle disaster relief on this scale with little to no assistance from the Federal government? A strong central force is crucial to handling crises like this, ours just blew it.
You can have input from local officials on setting up locations and timelines for clinics, but the 12 people making 20$/hr working in my local health department shouldnt have to deal with some of the most complex logistics the country has ever seen.
This is absolutely the best time to mobilize the massive military logistics chain in order to distribute and use vaccines as fast as possible.
If states are truly doing a great job (not many are), they can always decline assistance, but it isnt even being offered in the first place at this point.
> At some point politicians need to be held accountable. Passing the buck for everything is not a great answer.
Are you not just passing the blame onto local politicians and off of the federal level ones that hold most of the power?
I think that it is wishful thinking to believe the military could be re-purposed to make a significant difference. Their job is to blow things up and kill people. It seems the field hospitals deployed were a drop in the bucket, and I assume that all doctors and nurses are already busy. What else would you expect from them, or the rest of the federal government? I'd be afraid of a single bad solution being forced on everyone. The feds have a pretty bad record of moving fast.
Perhaps this is just a difficult situation and is not going to go as smooth as you'd wish? There's no magic bullet here. It's a pandemic. Covid has killed as many people per-capita as the low end of the estimated 1-4 million deaths from the 1968 Hong Kong flu. These things happen.
Also there is no widespread disagreement on what the response should be. i.e. Would our national response follow the NY model or the Florida model?
Yes, I would blame states for local problems. If your state setup a system leaving twelve local $20/hr employees in a bad situation I would say that is your state's fault. What makes you think the feds could do a more effective job?
Not all states are doing a bad job.
I do not know if there is correlation though, based on looking at Bloomberg vaccine tracker. However, it appears so.
That there are multiple candidate vaccines targeting the spike protein without using the virus directly is strong evidence that the science was ready (using mRNA, viral vector and other technologies).
Honestly I don't know how she can be that confident that timing of the second dose doesn't matter, since this doesn't seem to have been tested with COVID vaccines. Perhaps it is a feature of vaccines in general?
Given that this is a completely novel vaccine, and there is zero clinical data to support that statement, there is literally no way she can know that for sure.
However, the Moderna vaccine confers an immunity approximately equivalent to convalescent COVID-19 patients within two weeks of the first dose, so she's probably fine.
So, yes, Pfizer's position is (and should be) this is the data from the tests we ran. Pretty much anything else is speculation.
After all, under total lockdown it's not as though you're likely to be anywhere except at home waiting to get an appointment.
An interesting contrast will be New Zealand. Since they have community elimination they didn't seek emergency use authorisation, why not wait and study what happens to the millions of people from other developed countries who needed urgent vaccination? They will do mass population vaccination during 2021 but this month or next doesn't mean thousands or even handfuls of deaths, so there is no hurry.
This might reduce take up. If you live in New York you probably at least know somebody who got badly sick, maybe died - but if you live in Wellington you likely have stopped even thinking about the pandemic most days unless you work in quarantine or the tourist industry.
There are supposed to be QR codes here. I only visit one place, to buy food every 7-9 days, they don't have a QR code and employees seemed confused about what one was or why I might be surprised not to see one. I gave up rather than expend any more time trying to have a conversation through masks with confused people about something they can't fix.
They did, I noticed when I last visited yesterday, begin explicitly telling people that "One adult shopper" does not mean, "What a fun outing, let's all go to the store as a family and increases everyone's exposure for no reason".
What does improve compliance is an actual negative event. The change in public reaction to funeral restrictions in lock down when people attending a funeral got sick (and I think one died?) was noticeable. Reported consequences make the policy much harder to ignore. And if there hasn't been enforcement the way human memory works, if on Tuesday a human decides complying with a rule is good, they are now more likely to remember having complied with it on Monday, and retrospectively they will come to believe "obviously" they always obeyed that policy, it was the sensible thing to do.
That's cheaper and more effective than policing. But it may cost a few lives to provide the example.
This would encourage employees to ask shoppers.
It was striking to me how few masks and how little QR scanning was going on in Wellington when I went there from Auckland.
Auckland has slipped a lot, but it seemed way slacker in Wellington.
It would certainly reduce the urgency of take-up, but I would expect there to be a pretty strong correlation between how well a city/country deals with the pandemic, and the proportion of residents in that region who think that getting the vaccine is important, even if it's a vaccine for a virus that's not directly affecting them right at this moment.
I live in a region that eradicated the virus a long time ago, but I still think about it almost every day because the world's so interconnected. It has had almost zero effect on my personal life since March, but the vast majority of my friends overseas are in unending lockdown cycles, and international news is almost exclusively about the latest death tolls or what the vaccine progress is like. It would be pretty difficult to not know what's going on.
Keeping it out is proving to be quite hard, an exception for quarantine workers, flight crew, returning citizens and anyone connected to them would make it much easier.
It seems like the world is already learning though and countries that have eliminated the virus may find vaccinating the extremely frail to be a net negative and rely on herd immunity to protect this group.
I just recently got my first shot of the Moderna vaccine last week. When I learned that I would be getting it, I went through the same euphoric excitement the author is describing. Then it slowly dawns on you that this is simply a bandaid. Something to stop the massive amounts of deaths. It's not going to miraculously end everything and make the world go back to normal. There is no "escape". You're not going to be hopping on flights, vacationing, and going to bars again any time soon.
This is a real mistaken mindset that I think people are going to have to come to terms with. The vaccine is not a silver bullet. It doesn't just make the virus magically bounce off of you like a force field. You will still get infected if you are exposed, and can very well still transmit it. The vaccine simply keeps you from developing severe disease.
We (the human race) have a long, slow, painful slog ahead of us to return to anything even resembling what things were like in Fall 2019. The virus is going to become endemic. Overall population vaccine uptake will most likely look like Flu vaccine rates (<50%). And that means life will never be quite the same.
Wow. You're entitled to that bleak outlook, but unless you're in a super-high risk group, I would advise you to snap out of it and resume living your life.
I've literally done all of the things you listed in the past month. Additionally, I'm at the gym 5x a week. If you're safe/responsible, there is absolutely no reason you can't do 99% of the things you want.
The reason I'm not doing those things isn't because I can't. I'm at practically zero risk now that I've been vaccinated. The reason I'm not doing it is because I don't want to be around people like you.
In 6 months from now, when there's no excuse to not be vaccinated, that will be a different story. But people going about normal life right now as if nothing were happening are the reason we're seeing 4,000 deaths a day in the US, and they are objectively bad human beings.
Some perceive this as a high risk and would be happy to impose a police state on everyone to stop the pandemic.
Others perceive this as a low risk to themselves and don't want to give up a year or two of their lives to lockdowns.
Who gets to decide?
I'm a big believer on not unnecessarily imposing on other people. I think it's fine that you want to self-isolate. That is not my choice. I hope you can respect that.
In the US, smarter choices could have resulted in less death and a more robust economy. Just some leadership and resources devoted to contact tracing could have made a huge difference in how things went after May.
And you don't need to impose something from above to lead.
The mechanism of action is reason to believe that they might.
I can't help but feel that the media is responsible for this also - when being informed that vaccines were on the way in the 2nd half of last year, they resoundingly pooh-poohed it and refused to consider the possibility, instead preferring to wallow in the world's misery. It's good for their advertising!
Really shameful all around.
(I know how this sounds, but it's not like that. It's more like, it's a modern miracle that we have any vaccine at all within a year of an outbreak, and I am extremely keen to understand how this is possible rather than just accepting it as a thing that exists now, like airplanes.)
EDIT: No complaints, but it's fascinating how polarizing this topic is. One wouldn't expect a straightforward request for information to generate such feelings. Thank you to everyone who provided resources!
Again, totally not an expert at all, but from what I’ve gleaned this whole novel mRNA thing is key to understanding why this was so fast and why other vaccines in the future could come really fast as well.
So yeah, basically, COVID came along and suddenly there was money and impetus to push the thing over the finish line, and so here we are. That's my lay-person's understanding anyway.
And before I get lynched: I am all for the vaccine since that has been tested to work and I still wear a silly mask even as it does nothing since I'm tired of people complaining.
No idea where you are buying your masks though.
Even my local national health institute says that masks only protect against droplets from coughing, sneezing, or talking when in close proximity. Which I can grant you, but normal people shouldn't be coughing or sneezing into other peoples faces anyway. Which only leaves talking, but I don't see why grocery store is a place to socialize anyway.
IMO masks are only a thing because helpless people had the need to "do something" and masks are visible way of showing you are doing your part. Plus it didn't help that right wing nut jobs started a war against masks.
They had a placebo arm and a vaccine arm. Look at figure 2 on page 30. You can see that new COVID cases in the vaccine group virtually stop on day 12 while the placebo arm continues to grow.
You are obliged to conduct a natural experiment. We do this thing (vaccination) we expect will work, on some fraction of a test population, and then we wait. Some other tricks could work, in theory but they're often unethical and unlike this experiment they aren't a direct model of the real world. "Does it actually work?" is an incontrovertible test.
But it should take years to do this, because obviously hardly anybody is going to get some horrible deadly infectious disease right?
Unless, as happened in most of the world, you have exponential pandemic case growth as measures to prevent spread are half-arsed or just not implemented at all.
Then it turns out - good news - that's a great environment for proving your vaccine works quickly. Shame about all the dead people though.
I recommend https://www.deepl.com/translator for english translation, as I don't have the time right now unfortunately.
I don't have any background in this, so if anybody can chime in with more knowledge than me it would be appreciated.
But to me the point she is making sounds reasonable.
(1) A video about how the immune system works: https://youtu.be/fSEFXl2XQpc
(2) An infographic from FDA explaining the EUA process: https://www.fda.gov/media/143890/download
(3) Reports from the Advisory Committee on Immunization describing evidence of effectiveness for the various vaccines. For example, Moderna’s: https://www.cdc.gov/mmwr/volumes/69/wr/mm695152e1.htm
(Important caveats: I have family and friends who work in healthcare and drug discovery, so I’ve got a tiny bit of layperson background on this, but this is far from my field and I’m far from an expert)
https://podcasts.apple.com/us/podcast/in-the-bubble-with-and...
https://berthub.eu/articles/posts/reverse-engineering-source...
Edit: You could also just make a portion of the day for older people only and the rest of the time open it up to everyone. I feel like right now we have the worst of all worlds
So prioritizing health care workers (they can easily contract and spread) and old people (a lot of them need hospitalisation) seems like a good idea.
It really shouldn't be that hard. My parents (i.e. 70ish) are now scheduled to get the vaccine towards the end of february in maryland.
I’m in my 30s, but have several of the major comorbidities, including diabetes and asthma.
Should I have to wait at the very end of the line like the healthy 30 year olds?
They should do nursing homes and health workers first, then open it up to all. If they're afraid of crowds, divide up days by birth month, etc.
https://i.ebayimg.com/images/g/nJAAAOSwOHpbaWwM/s-l500.jpg
https://www.youtube.com/watch?v=VA1QxJatWng
Why is this public health crisis different?
My parents think they are gonna get jabbed then it’s off to happy hour, and that just seems incredibly simplistic.
So assuming the vaccination programme is able to achieve herd immunity and maintain it either indefinitely or until the pandemic is over or border controls isolate that impact then you don't need to try to pick some number of micro-morts.
This is another reason elimination was obviously the correct strategy. Zero is special. If something doubles every day then no matter your start number you're screwed - unless it was zero in which case you're fine because zero doubled is... zero. Elimination allowed New Zealand to not need to estimate R numbers and weigh up whether to open bars or nurseries, universities or sports stadiums, because zero multiplied by anything is zero.
But if you can achieve herd immunity through vaccination you get to the same place by being assured of the multiplier instead, and that's a more practical option for countries like the US at this point.
Yes. Due to the severe health risks associated with COVID-19 and the fact that reinfection with COVID-19 is possible, you should be vaccinated regardless of whether you already had COVID-19 infection. If you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Talk to your doctor if you are unsure what treatments you received or if you have more questions about getting a COVID-19 vaccine.
[1]: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html
The underlying rationale is that vaccines elicit a more consistent immune response [2] and confer immunity with higher efficacy [3] than being infected with the real coronavirus.
[2]: https://abcnews.go.com/Health/people-covid-19-vaccine-doctor...
[3]: https://blogs.sciencemag.org/pipeline/archives/2021/01/14/jo...
The vaccine comes in two doses spaced by a month or two, and the second boosts immune response. Being exposed to the real thing twice should have a similar effect, but it would be hard to precisely dose and schedule another weak exposure.
However, `42/6000 = 0.007` sounds pretty low-risk to me, unless you are elderly and/or in poor health.
Perhaps this person is in a high exposure group due to their job? I'm doubting it but I guess it is possible.
For some unknown additional reason, doses within that day are supposed to be used up. There seems to be an implied expiration for doses, but a single day doesn't make much sense.
The result of both these together is that they are supposedly letting people not scheduled to get the vaccine get it on some days. The article calls them "walk-ins".
Apparently word of this has been spreading slowly, and in this case went viral and a ton of people showed up to attempt to get some small number of "leftover doses".
It seems like chaos to me and a failing of sensible procedure. I am not though a doctor or involved in the distribution process so what do I know. Perhaps there is good reason this happens.
From the Prepare instructions on:
https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer...
The Israeli system is slow. It's centrally-planned, and even with central-planning taking advantage of pre-existing distribution networks and patient record digitization, the planners still make mistakes with dose distribution. There are four HMOs in this country, one of them has too many doses for the current age tranche and hands them out to younger walk-ins in peripheral areas, two of the HMOs don't have enough and are slowing down the progress of the age tranche for everyone else.
As bad as the Israeli system is, honestly, it's about the best that can be done considering that vaccine distribution in Israel is supply-constrained. They had to stop giving out first doses for about a week until they could negotiate with Pfizer to move up the shipments. What shipments do come in are quickly distributed. As of yesterday, 45+ can make appointments.
The US healthcare system is a nightmare. But for all of the US healthcare system's many, many, many weaknesses, vaccine distribution is supposed to be a strength. Doses are mass-manufactured and cheap, about $15/dose. Private providers are supposed to be able to make their own dosage orders through their own pre-existing suppliers and be distributed through ordinary private logistics networks. Intense competition insures a minimum of dose wastage. The state can minimally regulate to ensure that supply chain participants have adequate refrigeration etc. If the state wants to prioritize frontline workers, the elderly, fine. The state is more than welcome to buy as many (cheap) doses as it wants on the open market, and distribute for free to whoever the state deems to be a priority. But if the state cannot adequately take advantage of the relative supply glut, and efficiently manage the total supply that is available, then the state shouldn't freeze out the private market on the excess!
What's the goal here? The goal is not to immunize the elderly, or frontline workers. The goal is to end the pandemic. That means getting R under 1.0, and that means mass immunizations. That frontline workers or the elderly represent theoretical optimizations in pursuit of that goal is clearly demonstrating to not work out in reality. Let the free market work!
https://ourworldindata.org/covid-vaccinations#country-by-cou...
100-150k a day is not that slow in my opinion, especially when you consider the yearly flu shot mess. Honestly, the fact we reached ~2 million in a few weeks is insane. I thought vaccines would be delayed, then deployment would lag behind, then HMO systems would absolutely crash for weeks on end, but they didn't (except the first 2-3 days) and we indeed started in December.
If the current schedule holds, I could be vaccinated in March. Given my friends' experiences in the US and UK, I consider that very fast and fast enough, at least. Would I be happier if supply sped up and we doubled vaccinations per day? Of course, but given other countries, this is very acceptable.
Though the circumstances of the rush gave it an apocalyptic flavor, there didn’t seem to be any real human descent into chaos. No fistfights or shouting matches about who was in line, no storming of the gates. Just a lot of cold people, all desperate enough to chase down a lead so unlikely it could have been — and actually was — real.
That’s the spirit of my city alright. The “general new york knowledge” line strikes very true.
Being under-40 with no kids or seniors in my home, easily working from home, I expect to get vax sometime this summer. This is fine, I’m happy to let seniors, medical and frontline workers get it first. This of course includes teachers so they can open schools for good come August.
Glad to see it’s been opened to most of these prioritized people now, and it is intelligent to have a mix of appointments & walk-ins to take out the excess inventory daily.
That said, the whole distribution is a shitshow. And this started even before it moved beyond initial phase of medical workers getting it at work from their employers. I know a lot of non-patient facing people in medical or medical-adjacent jobs who got it well before most nurses, EMTs, etc got it. It seems if you are in management or have a PHD you could jump all the way to the front.. of course.
Is it local/state officials' colossal incompetence, something that they are quite known for? For a state with one of the highest tax rates, you would expect better from them.
At least there's a somewhat-coherent PR response, but that doesn't help get jabs in arms.
Secondly, this is a national issue. As much as NY is a basket case.. the state by state stats are quite similar. Depending on the week NY is outperforming lots of states in the vax distribution. Relative to Feds, State governments are not that big and do not have a lot of idle capacity. Whatever idle capacity we did have has been taken out by PPE distribution, testing roll out and dealing with all the sick.
Realistically this is a FEMA/NatGuard issue at this point. We can’t expect to have any nurse capacity for vax considering hospitals are all full. It’s a shame there was no planning for that in advance, but par for the course with DJT. Fortunately it sounds like Biden is going to pull the trigger on that in first 100 days.
How is the federal government supposed to magically increase hospital capacity? Nobody ever wanted to pay for a bunch more idle and unused hospital capacity. It's a pandemic with lots of victims, you do the best you can, and that's how it goes.
And if NY is a basket case (I'm not arguing) the federal government may be even more so. They don't exactly have a good record of responding to emergencies, either.
I'd probably pay $29.95 per month to participate in a social network where the average comment is as normal as this paragraph.
Call it sensiblepeoplewhowearmasks.com or perhaps lowerbloodpressure.org
“Pfizer Inc has been holding on to second doses for each of its COVID-19 vaccinations at the request of the federal government and anticipates no problems supplying them to Americans, a spokeswoman said in a statement on Friday.
Pfizer’s comments run counter to a report in the Washington Post that the federal government ran down its vaccine reserve in late December and has no remaining reserves of doses on hand.”
https://www.reuters.com/article/us-health-coronavirus-vaccin...
https://www.washingtonpost.com/health/2021/01/15/trump-vacci...
If Pfizer is indeed storing the doses at the request of the government, something stupid is going on, because it is reasonable to call that a Federal stockpile.