Archive for February, 2021

J&J is approved … so, which vaccine to choose?

February 28, 2021

Most “experts” say: “Whichever is available to you first”
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The J&J vaccine was approved yesterday and begins distribution this week.

So, if you haven’t already been vaccinated, you might want to know how the vaccines work and how they stack up against one another.

The topline:

The 3 currently relevant brands (Pfizer, Moderna, J&J) are “well tolerated” (i.e. they exhibit few or no side effects) and provide high levels of protection …  with near total protection against hospitalization or death.

In clinal trials, Pfizer & Moderna scored higher in overall protection (roughly 95% against symptomatic infections) than the J&J vaccine (72%) in the U.S.

Most experts consider the difference in effectiveness rates to be more a function of when and where the clinical trials were done than the relative effectiveness of the vaccines.

Specifically, the J&J trial was done in a more “hostile” Covid environment: a higher prevalence of Covid and emergence of new Covid strains (especially the South African variant).

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Regarding the variants…

“Laboratory studies and clinical-trial data suggest that all of the Covid  vaccines will provide significant protection (i.e. greater than 50% effectiveness) against emerging strains of the Covid virus.”  Source

It’s highly likely that an additional shot — either a booster or a reformulation — will eventually be required for all brands and types of vaccines to combat the variant strains.

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It’s uncertain how effective the vaccines are preventing asymptomatic infections or how long the vaccines provide immunity against serious symptoms.

But, the consensus seems to be that there is very high protection against asymptomatic infections … and that the immunities last for at least several months, maybe longer.

That said, annual shots seem to be likely.

Again, the most compelling immediate effectiveness result to consider: all brands claim near total protection against hospitalization and death with unlikely side effects.

My take: Call it a push on effectiveness.

Convenience

The J&J vaccine is easier to distribute since it requires less demanding refrigeration.

So, once production is ramped up, it will probably be more ubiquitous in rural areas and in low volume vaccination outlets (e.g. doctor’s offices, urgent care clinics and smaller pharmacies).

As well publicized, Pfizer & Moderna are currently administered in 2 doses with the 2nd dose following 3 or 4 weeks after the 1st.

The J&J vaccine only requires a single dose, making it a good fit for, say, high volume mass vaccination sites and for people who want the convenience of one & done (e.g. workers who are schedule constrained or people with limited access to distribution sites).

The Pfizer & Moderna vaccines are likely to be concentrated in, say, public health department vaccination clinics, targeted to high vulnerability populations.

My take: Beggars can’t be choosers. Practically speaking, you may not have a choice.

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That’s probably all that you really need to know, but if you’re interested in the comparative science of the vaccines, keep reading…

(more…)

Feb. 28 COVID VAX Stats

February 28, 2021

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Feb. 28: COVID Tracking Stats

February 28, 2021

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Source: RonaViz.com

Feb. 27: COVID VAX Stats

February 27, 2021

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Feb. 27: COVID Tracking Stats

February 27, 2021

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Source: RonaViz.com

How much have students fallen behind during the school’s shutdown?

February 26, 2021

Spring 2020 Forecast:  The  COVID schools’ shutdown compounded by the inevitable “summer slide”.
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Originally posted on July 20, 2020 … and relevant today!

In his 2008 bestseller Outliers: The Story of Success, Malcolm Gladwell popularized the notion of an educational “summer slide”.

Referencing a tracking study of Baltimore City Public School students, Gladwell highlighted evidence that students’ standardized test scores in the fall were generally lower than their scores in the prior spring.

His observation: “Between school years, students’ accumulated learning is diminished”.

In other words, there is a statistically significant “forget factor” if learning isn’t reinforced and edged forward with summer enrichment activities (think: summer school, educational camps, field trips, parental tutoring).

The summer slide is most pronounced for poor students who lack summer enrichment opportunities … and for all students in math. 

The black line below illustrates the math score drop-off for typical 3rd, 4th and 5th graders. On average, the typical summer slide in math skills is about 2%.  That is, students are 2% less proficient in math after their summer vacations.

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Source: WSJ

To make matters worse, note the red line on the chart … it illustrates the projected drop-off due to this year’s virus-induced school closings.

It’s estimated that students will be about 5% less proficient in math than they were when the schools closed … the combined effect of lesser learning during the schools’ shut-down period and an extended summer slide (with many schools declaring no mas in early June) .

More specifically…

(more…)

Feb. 26: COVID VAX Stats

February 26, 2021

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Feb. 26: COVID Tracking Stats

February 26, 2021

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Source: RonaViz.com

Herd Immunity: By the Numbers

February 25, 2021

Key: It’s not just people who get vaccinated who are in the immunized part of the “herd”
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Earlier this week, we dissected the WSJ op-ed by Hopkins Dr. Marty Makary who boldly claimed  that “We’ll Have Herd Immunity by April”.

Our basic conclusion: The claim isn’t as far-fetched as it sounds. It’s unlikely, but mathematically possible.

The essence of Makary’s logic is that people develop immunity to COVID in 2 main ways: (1) by surviving a COVID infection or (2) by getting vaccinated.

So, if those 2 groups add up to 200 million (80% of the 225 million adults 18 & over), we’ve reached the promised land: herd immunity.

The catch: Achieving herd immunity in just a couple of months requires two very bold policy shifts and supportive actions.

(more…)

Feb. 25: COVID VAX Stats

February 25, 2021

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Feb. 25: COVID Tracking Stats

February 25, 2021

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Source: RonaViz.com

Connecticut is “de-complicating” and adopting West Virginia’s vaccination model…

February 24, 2021

“Essentiality” and “equity” are hard to administer, get gamed and clog the system.
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Earlier in the month, we asked:

So, why is West Virginia kicking other states butts?
And, why aren’t other states imitating WV’s approach?

The essence of West Virginia’s successful strategy:

  1. Be prepared … anticipate a vaccine sooner rather than later
  2. Set clear objectives … save lives, grow the herd
  3. Own the problem … act instead of complaining
  4. Keep It Simple … prioritize by age; minimize IT dependence
  5. Make bold decisions … be contrarian when necessary

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The WSJ reports that Connecticut is adopting the essence of the West Virginia model.

Concluding that complexity is the enemy of speed, Gov. Ned Lamont declared “We’re going to focus on the old business motto, KISS: Keep it simple, stupid.”

Specifically, Lamont recognized that the more states prioritize work “essentiality” and social “equity,” the more complicated and inequitable vaccine distribution becomes.

So, Connecticut is starting to base Covid-19 vaccine eligibility strictly on age.

See WSJ: Start sequencing vaccinations from oldest to youngest … period!

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Connecticut had planned to vaccinate “essential workers”, younger people with underlying health conditions like diabetes and minorities.

Immediately, definitional creep exploded.

For example, the CDC said grocery and food service workers should get priority.

“So, we started getting calls: What about convenience stores and box stores? They sell food.”

The CDC said that obesity should be a priority.

“So, people started wondering: Should I bulk up on doughnuts to meet the public-health definition of obesity?”

Lamont concluded: “A lot of complications result from trying to finely slice the salami and it got very complicated to administer.”

People of all races develop more health conditions as they age, and their immune systems weaken.

But, decisions about who is or isn’t an “essential worker” are completely arbitrary.

And, while minorities have significantly higher Covid death rates than whites, outcomes differ far more by age than race or underlying conditions.

A 58-year-old black retiree is 10 times more likely to die from the virus than a 40-year-old black worker.

The simple solution: Prioritize by age and set up more inoculation sites in low-income communities to improve vaccine access.

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The WSJ concludes: “Bravo to Mr. Lamont for thinking of the larger public good, and understanding that simple can be smart.”

Now, maybe more “smart” states will concede that they got outsmarted and start following West Virginia’s lead. mitigating  the current vaccine-chase folly: constantly changing eligibility rules, persistent web-checking,  link sharing,  remote venue access, fake IDs, etc.

It’s not too late and it might happen, but I’m betting the under ….

VAX: So, why is West Virginia kicking other states butts?

February 24, 2021

And, why aren’t other states imitating WV’s approach?
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Originally posted Oct. 10, 2021

Based on all key outcome & efficiency metrics – e.g. percentage of population vaccinated and utilization of available supply —  WV’s performance has been stellar – in absolute terms and relative to other richer and self-proclaimed “smarter” states.

See States’ Performance Ranks

Why is that?

First, let’s stipulate that being a small state has had its advantages:

> Per capita vaccine allocations (from the Feds) have tended to be higher for smaller states – probably a function of logistical rules (think: minimum shipping quantities and critical mass required to “seed” a vaccinator network).

> Smaller states are more accommodative to centralized management. The “sight lines” from the state capitals to the borders are shorter than in large states … i.e. it’s easier to see what’s going on without relying on filtered reports from layers of self-interested politicos and bureaucrats.

> There is less dependency on grandiose scheduling & information systems. Much of business can be transacted via personal relationships using very basic (often manual) legacy processes.

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OK, so the degree of difficulty for WV’s dive is lower than the dive in, say, New York, California or Maryland.

But, based on my analyses, those structural advantages don’t come close to explaining WV’s success.

Urban elites may shudder at the thought, but their states were outcoached and outplayed by a team of rural ragamuffins. (Note: I say that out of respect, not disdain!)

So, how did West Virginia do it?

(more…)

Feb. 24: COVID VAX Stats

February 24, 2021

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Feb. 24: COVID Tracking Stats

February 24, 2021

Cases & Deaths

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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Hospitalizations

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Source: RonaViz.com

Is herd immunity by the end of April possible … or pure folly?

February 23, 2021

The math says that it’s a stretch, but a real possibility.
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In a WSJ op-ed, Hopkins doc Marty Makary boldly asserted the possibility that “We’ll Have Herd Immunity by April”.

Immediately, Dr. Fauci — our nation’s chief political-scientist — hit the talk shows to hose cold water: “Maybe by Christmas, or mid-2022”.

Note: Mid-2022 is right before the mid-term elections. Hmm.

To calibrate Makary’s logic, I went back to re-read the article and run the numbers…

The essence of Makary’s logic is that people develop immunity to COVID in 2 main ways: (1) by surviving a COVID infection or (2) by getting vaccinated.

And, Makary concludes that we’re already approaching herd immunity.

How can that be?

Let’s work the numbers, starting with the herd immunity threshold: How many people have to be immune to achieve herd immunity?

(more…)

Feb. 23: COVID VAX Stats

February 23, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Feb. 23: COVID Tracking Stats

February 23, 2021

Cases & Deaths

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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See Why are COVID deaths continuing
at a high level?

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Hospitalizations

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Source: RonaViz.com

VAX: Should people who have had COVID get vaccinated?

February 22, 2021

If yes, when and how many doses?
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My first reaction: They already have immunity, right?

So, c’mon man, don’t suck up any of the scarce vaccine supply that could otherwise flow to the vulnerables.

But, I can understand why a COVID survivor would want to get vaccinated … especially if their previous bout with the virus was nasty or they are experiencing lingering side-effects.

So, what does “the science” and the data say?

“The science” is unsettled as to whether the infection-generated antibodies are sufficiently potent and long-lasting to provide sufficient immunity.

Worldwide, there are few reported cases of people catching COVID a second time . Source

That makes sense since there is evidence that “important markers of immunity remain strong months after infection.” Source

But, having immunity markers does not necessarily mean that survivors can’t get sick again or spread the virus unwittingly while asymptomatic. Source

So, Tony Fauci — the nation’s Chief Political Scientist, Tony Fauci, has asserted on talk-shows that “COVID-19 survivors should still get vaccinated.”

Case closed, right?

Maybe, but let’s reframe the issue…

(more…)

Feb. 22: COVID VAX Stats

February 22, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Feb. 22: COVID Tracking Stats

February 22, 2021

Cases & Deaths

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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See Why are COVID deaths continuing
at a high level?

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Hospitalizations

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Source: RonaViz.com

COVID: McKinsey report says…

February 19, 2021

Progress has instilled hope that vaccines may, indeed, save the world.
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McKinsey just released a COVID update that “reviewed the initial results from clinical trials of COVID-19 vaccines and explored several remaining uncertainties”, including:

  • How many doses will we have and by when?
  • How will the logistics work for distribution and administration?
  • And, critically, will consumers agree to be vaccinated?

I thought the article was concisely informative and readable.

Here are my notes from the article…

(more…)

Feb. 19: COVID VAX Stats

February 19, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Why are COVID deaths continuing at a high level?

February 18, 2021

That’s the metric, not cases. that we should stay focused on.
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From the get-go I concluded that “confirmed cases” was a problematic metric (due to false positives, varying testing methods and confirmation criteria, and an uncertain mix of people being tested and their outcomes) …. and that our laser focus should be on “daily new deaths” which, while subject to some definitional variance, is a binary, countable number.

See MUST READ: How will we know when we’ve turned a COVID-19 corner?

Somewhat contrary to my own advice, a couple of weeks ago, I started including the Case Fatality Rate (CFR%) in my morning COVID stats post.

Why is that “somewhat contrary to my own advice”?

Dividing a reasonably reliable number (deaths) by a potentially flakey number (cases) usually results in a potentially flakey “synthetic number” that might be misleading.   

There was a glaring upward trend in the CSR%.

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Noting the upward trend in the CFR%, a couple of readers asked “Why? What’s going on?”

In a prior post, I took a stab at the answer:

The simple arithmetic answer to the question: The CFR% is going up because daily deaths have plateaued (i.e. stabilized at their peak level) … while confirmed cases have fallen sharply.

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While that’s true, it didn’t really answer “why?”, so I started looking at the component number that was exhibiting the greatest variance: confirmed cases.

Why did cases explode, spike and then start declining so steeply?

Were these movements real or just loud statistical noise?

(more…)

MUST READ: How will we know when we’ve turned a COVID-19 corner?

February 18, 2021

Stay focused on the number of Daily New Deaths!
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This is a relevant excerpt from a long ago prior post (May 2020)
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Why have I centered on Daily New Deaths (DND)  as my key metric?

First,  saving lives is our paramount objective, right?  If yes, it should be our focus metric.

Second, I think that most other metrics that are being bandied about are quite problematic.

Counting deaths — while a bit macabre — is a more reliable process than counting, say, the number of infected people.

Sure, I’d like to know the number of people infected with COVID-19.

But, unless everybody — or at lest a large statistical sample — is tested, the number of confirmed cases is subject to lots of statistical issues.

Most notably, who is being tested and who isn’t? What about the asymptomatic “hidden carriers”? What are the criteria for confirming a COVID infection? What about false positives (and false negatives)? How to standardize the reporting processes across states? How to keep governmental units from fudging the numbers?

Importantly, if testing increases, then confirmed cases goes up.

Is that an indication of more virus spread or just a reflection of more testing?

I sure can’t tell.

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Again, counting fatalities is probably the most reliable metric.

Fatalities are discrete events – so they’re countable.

Still, even deaths may have some counting imperfections.

For example, many non-hospitalized people die and are buried without autopsies.  Some may be uncounted COVID victims.

On the other hand, some people may die and be diagnosed with COVID infections. That doesn’t necessarily mean that COVID killed them.  That’s especially true with COVID since it’s  most deadly for people with other health problems.

And, as we stated above, the definition of COVID deaths has changed:

COVID-related” means “COVID present”, not necessarily “COVID caused” … and that, along the way, “present” was redefined from “confirmed” to “presumed”

Further, COVID deaths are a function of two drivers: the incidence of the virus … and, the nature, level and timing of therapeutic healthcare.

Said differently, more effective therapeutic healthcare will dampen the death toll.

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Bottom line:  “Daily New Deaths” is the number we should be watching.

If it shows a consistent downward trend, then we’ll know we’ve turned the corner.

If it stays stable (at a high level) or turns upward, we’ll know that we’re in deep yogurt.

 

Feb. 18: COVID VAX Stats

February 18, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Feb. 18: COVID Tracking Stats

February 18, 2021

Cases & Deaths

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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    See Why is the Case Fatality Rate increasing?

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Hospitalizations

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Source: RonaViz.com

The crazy quilt of vaccine distribution…

February 17, 2021

Unnecessary complexity, unready component parts and politics as usual
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When the dust settles (and it will eventually) the first couple of months of COVID vaccine distribution — nationally and in most (but not all) states — will become a classic textbook case of how not to build a distribution network for a new “must have” product.

There are exceptions, of course, most notably West Virginia, which crafted an efficient delivery system by staying simple and focused.

See: So, why is West Virginia kicking other states butts?

But, most states are dismissive of the West Virginia model and seem intent on rushing to build complex distribution networks cobbled with unready component parts and fraught with political infighting.

Case in point: Maryland, my home state.

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To understand what’s going on, we need to dust off our notes from Distribution 101.

(more…)

Feb. 17: COVID VAX Stats

February 17, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Feb. 17: COVID Tracking Stats

February 17, 2021

Cases & Deaths

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Note:  At the index starting date, cases were
~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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    See Why is the Case Fatality Rate increasing?

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Hospitalizations

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Source: RonaViz.com

VAX: I got mine … and it wasn’t easy!

February 16, 2021

Some hints if you’re still in the hunt.
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For me, last Thursday was like every other day since the COVID vaccines were launched.

Up at 4 a.m. to scan my current set of potential vaccination sites: Maryland state (which controls the 6-Flags mass vaccination site), Anne Arundel County (which controls the sites closest to my home and has us on their digital pre-registration list), local Hospitals (2 of them, also on their “vaccine interest” lists), local grocery chains (2 of them, supplied by AA County) … and, two new additions: CVS and Walgreens.

Conservatively, I estimate that I’ve spent well over 100 hours trying to break through the scheduling sites; have made literally thousands of site visits; and, even learned how to set my browsers to auto-refresh web pages, hoping that trick would supplement my manual click-ons.

Warning: That last hack has a potential downside. You lose your spot in the online queue at some scheduling sites if you refresh their web pages.

Last Thursday, my search priorities were the new additions: Walgreen’s and CVS.

(more…)

Feb. 16: COVID Tracking Stats

February 16, 2021

Cases & Deaths

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Note: For timely relevance, the starting point for this chart is set to November 1 … before the recent surge in cases and deaths. At the index starting date, cases were ~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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    See Why is the Case Fatality Rate increasing?

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Hospitalizations

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Source: RonaViz.com

VAX: Breaking thru the vaccination bottlenecks…

February 15, 2021

“Requires some dramatic, untested, and controversial strategies.”
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That’s the conclusion in a recent Atlantic article that argues:

Building herd immunity requires vaccinating 75 percent of the U.S. population.

Doing so by summer  would require hundreds of millions of doses by June.

To achieve those levels we need to  vaccinate the most Americans we can right now and ramp up quickly to 3 million shots per day.

Doing so requires that we break the existing bottlenecks.

Specifically, the author identifies four main bottlenecks to accelerating vaccinations are:

  1. Authorization: You can’t receive a vaccine that the FDA hasn’t authorized or approved.
  2. Supply: Even with several vaccines authorized, you can’t get vaccinated if there’s a critical shortage of shots.
  3. Distribution: Even with lots of vaccines available, we still need to distribute them to states, cities, hospitals, and clinics and create eligibility rules that people can understand.
  4. Demand: Even if the public-health establishment does everything right, that won’t matter if Americans don’t want a vaccine.

So, how to break the bottlenecks?

(more…)

Feb. 15: COVID VAX Stats

February 15, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Feb. 15: COVID Tracking Stats

February 15, 2021

Cases & Deaths

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Note: For timely relevance, the starting point for this chart is set to November 1 … before the recent surge in cases and deaths. At the index starting date, cases were ~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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    See Why is the Case Fatality Rate increasing?

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Hospitalizations

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Source: RonaViz.com

Feb. 14: COVID VAX Stats

February 14, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Feb. 14: COVID Tracking Stats

February 14, 2021

Cases & Deaths

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Note: For timely relevance, the starting point for this chart is set to November 1 … before the recent surge in cases and deaths. At the index starting date, cases were ~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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    See Why is the Case Fatality Rate increasing?

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Hospitalizations

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Source: RonaViz.com

Feb, 13: COVID VAX Stats

February 13, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Feb.13: COVID Tracking Stats

February 13, 2021

Cases & Deaths

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Note: For more timely relevance, the starting point for this chart has been advanced to November 1 … before the recent surge in cases and deaths. At this index starting date, cases were ~ 100K and deaths were ~ 1,000 per day.

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Case Fatality Rate

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    See Why is the Case Fatality Rate increasing?

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Hospitalizations

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Source: RonaViz.com

Why is the Case Fatality Rate increasing?

February 12, 2021

That’s a question that a couple of readers have asked, so…
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Daily, we’ve been posting a graph showing the Case Fatality Rate (CFR%): the ratio of COVID deaths to Confirmed COVID cases.

That number has been increasing … and, is now at 2.9%.

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So, what’s going on??

(more…)

Feb. 12: COVID VAX Stats

February 12, 2021

Vaccine Supply & Vaccinations

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Vaccinations per Day

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Vaccine Stockpile    Doses NOT Administered

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Feb. 12: COVID Tracking Stats

February 12, 2021

Cases & Deaths

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Note: The starting point has been advanced to November 1 … before the recent surge in cases and deaths (when cases were ~ 100K and deaths were ~ 1,000)

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Hospitalizations

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Source: RonaViz.com

Feb. 11: COVID VAX Stats

February 11, 2021

Vaccine Supply & Vaccinations

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Vaccine Stockpile    Doses NOT Administered

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Vaccinations per Day

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Feb. 11: COVID Tracking Stats

February 11, 2021

Cases & Deaths

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Case Fatality Rate

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Hospitalizations

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Source: RonaViz.com

VAX: So, why is West Virginia kicking other states butts?

February 10, 2021

And, why aren’t other states imitating WV’s approach?
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Based on all key outcome & efficiency metrics – e.g. percentage of population vaccinated and utilization of available supply —  WV’s performance has been stellar – in absolute terms and relative to other richer and self-proclaimed “smarter” states.

See States’ Performance Ranks

Why is that?

First, let’s stipulate that being a small state has had its advantages:

> Per capita vaccine allocations (from the Feds) have tended to be higher for smaller states – probably a function of logistical rules (think: minimum shipping quantities and critical mass required to “seed” a vaccinator network).

> Smaller states are more accommodative to centralized management. The “sight lines” from the state capitals to the borders are shorter than in large states … i.e. it’s easier to see what’s going on without relying on filtered reports from layers of self-interested politicos and bureaucrats.

> There is less dependency on grandiose scheduling & information systems. Much of business can be transacted via personal relationships using very basic (often manual) legacy processes.

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OK, so the degree of difficulty for WV’s dive is lower than the dive in, say, New York, California or Maryland.

But, based on my analyses, those structural advantages don’t come close to explaining WV’s success.

Urban elites may shudder at the thought, but their states were outcoached and outplayed by a team of rural ragamuffins. (Note: I say that out of respect, not disdain!)

So, how did West Virginia do it?

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Here’s my take on West Virginia’s key success factors…

Fast start

In mid-2020, “the science” (think Fauci & Friends) were saying that Trump was delusional – that there was no way that a vaccine would be available until mid-2021 at the earlies … and probably not until late 2021 or early 2022.

Many smarty-pants governors (think: leadership icon Cuomo) saluted Fauci’s expert proclamation and put vaccine distribution planning on the backburner (or shoved it completely off the stove).

Rather than doubting, discounting and demeaning Operation Warp Speed, WV Governor Jim Justice adopted a “what if it works?” mindset and laid a foundation so that WV would be ready if the aggressive end of 2020 deadline was achieved.

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Clear objectives

Early on, WV articulated a short set of measurable operating objectives.

  • Reduce the rate of hospitalizations
  • Reduce the death rate
  • Protect the most vulnerable
  • Maintain critical care services

Sorry, but WV kept the lid closed on “Pandora’s Box”.  Concerns  — like “essential workers” and “equity” —   didn’t make (and complicate) the otherwise apolitical list of objectives..

Most important, policies and actions were consistently screened for consistency against those explicit objectives.

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“Ownership”

From the get-go, Gov. Justice accepted responsibility for implementing his state’s vaccination program.

He didn’t spend time whining that it’s the Federal government’s job (not his) and that there wasn’t a turnkey plan provided by the Federal government.

Rather, he and his team accepted ownership of the program and just got to work.

Further, Gov. Justice didn’t cede decision-making to WV’s 55 counties and the state’s bigger cities.

Rather, drawing on a sports analogy: Team Justice developed the game plan and managed the game but relied on the local players to execute the game plan and the plays.

The WSJ has recently noted:

Early evidence suggests that centralizing vaccination policy at the state level works better than devolving it to localities.

Uniform standards can reduce competition among subordinate jurisdictions and confusion among residents.

West Virginia was ahead of the crowd on that realization.

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Bold decisions

The WV government wasn’t afraid to make bold decisions that went against the conventional wisdom

For example, WV was the only state that didn’t rely on the Fed-initiated CVS-Walgreen’s “partnership” to vaccinate nursing homes and long-term-care facilities.

Rather, they utilized WV’s established network of local (often non-chain) pharmacies to service the nursing homes and LTC facilities.

That contrarian decision was bold.

Again, to repeat for emphasis, WV was the only state to opt out of the CVS-Walgreen’s program.

And, the decision turned out to be colossally beneficial.

The local pharmacies were efficient at the task.

That’s understandable since since they were already in place with trained employees, they knew their local market and had skin in the game — protecting their families, friends and neighbors.

Equally important, the pharmacies got their needed doses “just-in-time” from the state’s vaccine inventory.

In other states, the Feds shipped large vaccine allotments directly to CVS & Walgreens.

It’s finally being reported that CVS & Walgreens were grossly over-supplied with vaccine that is still largely being held as unutilized inventory.

See Where the hell is the vaccine inventory? and Some of the unused vaccine inventory has been found!

The bold decision to opt out of the CVS-Walgreen’s program meant that WV’s full inventory of Fed-provided vaccine was always “in play” – available to be “shot in arms.”.

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KISS: Keeping It Simple

Inspired by CDC guidance, most states have adopted complicated, overly inclusive (often politically induced) vaccinating priorities that largely ignored supply constraints and uncertainties, that weren’t supported by game-ready scheduling systems and that provided a plethora of loopholes for line-cutters.

Not so West Virginia.

Initially, WV dutifully gave top priority to nursing home staffs, frontline medical personnel and 1st responders.

Even then, the eligibility list was restricted.  For example, priority was given to “health care workers in high-risk settings such as COVID units, intensive care units and emergency rooms” …  not to every badged healthcare employee or contractor in the state.

The explicit “tight reins” signaled that the state was serious about getting shots into the right arms.

Once the initial phase was completed, the state adopted an age-based vaccination scheme.

See Start sequencing vaccinations from oldest to youngest … period!

Recognizing that old people are most vulnerable to consequential COVID outcomes (i.e. hospitalization and death), WV started vaccinating the oldest residents (age 80 and over) … and then systematically opened eligibility to younger age groups … 70, then 65.

Adopting the age-based eligibility scheme really simplified the processes.

> First, it was easy to validate a person’s eligibility at the vaccination sites: require a proof of age and proof of state residency.

That eliminated on-site eligibility debates on whether or not the people showing up were “essential” workers or whether their pre-existing conditions were sufficiently severe.

See What do lawyers, prisoners and ‘the media” have in common? and Eat, drink, smoke … and move to the front of the line.

In West Virginia, you’re either old enough to get a shot or you’re not. Period.

> Second, there was no need for sophisticated scheduling systems and algorithms.

Demand could be “throttled” in aggregate and the flow of patients through vaccination sites could be managed simply via the qualifying age.

Note: Even when WV eventually gave eligibility to some essential jobs, there was an age requirement, e.g. only teachers over 50

The plan was brilliant in its simplicity.

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Bottom line:

West Virginia managed its way to success by:

  • Hitting the ground running when vaccines became available
  • Accepting the state’s responsibility for managing the vaccination process … and running with it
  • Setting (and adhering to) a short list of apolitical objectives
  • Making bold decisions, notably opting out of the CVS-Walgreens program
  • Keeping things simple by adopting an age-based priority scheme

“Smarter” states could learn from the West Virginia experience … but it doesn’t appear that many are.

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Sources: The West Virginia Vaccine Web Site, and a  multitude of articles & interviews that I’ve read or seen … complemented by a heavy dose of my triangulation to  “fill in the blanks” by making reasoned conjectures.

VAX: CDC updates guidance re: 2nd shots…

February 10, 2021

Data says it’s OK to wait 6 weeks
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In yesterday’s post  we channeled two  infectious diseases doctors who advocate that all highly vulnerable people get a 1st dose of vaccine before anybody gets a 2nd dose.

Simplified, their logic is that it’s better to quickly have more highly vulnerable people protected 70% than it is to have a much smaller number of people (some consequentially vulnerable, some not) protected 95%.

To folks who are queued up for their 2nd dose, the idea of delaying 2nd shots is sheer nonsense.

But, to frustrated vax hunters (like me) the idea of pushing out 2nd shots has obvious (selfish) appeal.

So, what does “the science” and the data say?

(more…)

Feb. 10: COVID VAX Stats

February 10, 2021

Vaccine Supply & Vaccinations

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Vaccine Stockpile    Doses NOT Administered

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Vaccinations per Day

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Feb. 10: COVID Tracking Stats

February 10, 2021

Cases & Deaths

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Case Fatality Rate

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Hospitalizations

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Source: RonaViz.com

VAX: “F.D.A.’s guidelines for second doses is misguided.”

February 9, 2021

That’s the conclusion drawn by a couple of docs who specialize in infectious diseases and vaccinology.
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I somewhat subconsciously wrote in last week’s J&J post:

Keeping things in perspective, 70% effectiveness is greater than zero greater than most vaccines that have ever been deployed for other infections… and, roughly the same as the first-dose-only effectiveness of the Moderna vaccine.

On the last point re: Moderna, a loyal reader asked: “Really?”

So, I went back and rechecked my sources.

Turns out, my memory inadvertently lowballed the Moderna 1-dose effectiveness:

According to a document that Moderna submitted to the FDA, the company’s vaccine can provide 80.2% protection after one dose, compared to 95.6% after the second (in people aged 18 to 65) and 86.4% (in those over 65). Source

That doesn’t change my conclusion re: the J&J vaccine … but it did get me thinking.

Then, boom … I spotted a NY Times article headlined:

America’s overly prudent vaccination strategy is killing people.

That certainly caught my eye …

(more…)

Feb. 9: COVID VAX Stats

February 9, 2021

Vaccine Supply & Vaccinations

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Vaccine Stockpile    Doses NOT Administered

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Vaccinations per Day

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Link to State by State Data