Archive for February 5th, 2021

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

February 5, 2021

“Basing eligibility on age from now on is the scientific, and least political, method.”
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That’s the WSJ’s recommendation for cleaning up the jurisdictionally variable, logistically complicated and politically charged vaccine rationing system(s) that are currently slowing the rate of vaccinations and frustrating eager vax hunters (like me).

The WSJ’s editorial’s guiding premise:

Workers who interact with the public face a higher risk of getting Covid than those who don’t.

But households are bigger spreaders than workplaces.

And age is the most severely consequential risk factor.

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More specifically, the WSJ editorial asks:

> Who isn’t “essential”?

The list of “essential” workers has grown to virtual meaninglessness, including those who “work in transportation and logistics, food service, housing construction and finance, information technology, communications, energy, law, media, public safety, and public health.

By that definition, who isn’t essential”

See our prior post: What do lawyers, prisoners and ‘the media” have in common? 

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> Got political connections?

Initially, it was just COVID-exposed healthcare workers and 1st responders.

But, it didn’t take long for unions and other occupational groups to start flexing their political muscles.

The SEIU pushed for workers such as janitors to be considered “essential”.

Industry groups including hotels, airlines and ride-share companies began lobbying states to have their workers vaccinated first.

Now, predictably, teachers’ unions are trying to cut to the front of the line and are blackmailing politicians by refusing to reopen schools.

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> How risky is your medical condition?

No question, some comorbidity factors make a person more vulnerable to severe COVID consequences.

But, like the list of essential  occupations, the initial list of meaningful health conditions (e.g. serious heart or pulmonary diseases) quickly expanded.

Now, some of the qualifying criteria are head-scratching (e.g. slightly overweight, habitual smoking)  … while others aren’t considered serious enough (e.g. deficient immune systems, oncological history).

See our prior post: VAX: Eat, drink, smoke … and move to the front of the line.

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> How to verify eligibility?

Age is easy to verify via driver’s licenses, passports, birth certificates, and the like.

But, how to verify a person’s occupational eligibility?

A person may flash a hospital ID, but how to know if they are an ER or COVID-treating nurse or a hospital IT employee who is working from home during the pandemic?

What about teachers who  have been teaching in-person for months, versus those who have no intention of returning to the classroom any time soon?  How to determine whether a teacher is really heading back to the classroom?

Similarly, how to verify a person’s legitimate  comorbidities? Take their word for it? Require a doctor’s note?

Given the stakes, it’s no surprise that stories abound of people claiming eligibility that may pass bureaucratic muster with the letter of the law … but certainly not the spirit of the law

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The WSJ’s bottom line:

Basing eligibility in stages from oldest to youngest from now on is simple, scientific and fair.

As supply increases, this will be the fastest way to inoculate the most people, reduce demands on the health-care system, and allow more businesses to reopen.

Interest groups will complain, but so what?

The public will understand and politicians won’t take the inevitable grief for favoritism.

It’s like music to my ears….

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P.S. West Virginia has been one of the top states re: vaccination efficiency.

One of the foundation principles that WV adopted was age-based prioritization — starting at age 80, then systematically lowering the age threshold.

And, WV only gives priority to “essential workers” who are over 50.

VAX: J&J officially applies for FDA approval !

February 5, 2021

Pivotal question: Is 66% effectiveness good enough ?
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This is an updated and expanded post of my takeaways that draws on several sources, most notably, WSJ analyses and J&J’s press releases.

> Overall, J&J’s vaccine was 66% effective against moderate or severe symptoms … and “appeared to be generally safe and well tolerated”

Note: The Pfizer-BioNTech and Moderna shots were more than 94% effective in late-stage testing.

But, the competitive brands’ results may not be directly comparable.

J&J’s trial occurred as at least one variant (i.e. the South African strain) that appears to have some impact on vaccine efficacy was circulating, while the Moderna and Pfizer-BioNTech trials were completed before variants of concern started transmitting widely. Source

> The vax was 72% effective in the US … lower in Latin America (66%) and South Africa (57%).

Note: The lower effectiveness in South Africa is a red flag re: effectiveness against mutating strains of the virus and probably distorts the comparisons against Pfizer & Moderna

> When considering only severe cases, J&J said its vaccine was 85% effective across all regions studied. 

Note: The J&J study tracked moderate and severe cases of Covid-19, defined as testing positive for the virus and having certain symptoms including shortness of breath, cough, fever or respiratory failure.

> The J&J vaccine prevented 100% of hospitalizations and deaths — all hospitalizations and deaths in the study group occurred among people who got the placebo. Bloomberg

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> Good news: the J&J vaccine is a single dose and only requires refrigeration, not sub-zero freezer storage, making broad-scale distribution more practical.

> More good news: The J&J vax is already in high volume production, awaiting regulatory approval. J&J says that is has “millions of doses available for shipment immediately upon authorization … will deliver 100 million in the U.S. by mid-year … and expects to make more than one billion doses in total this year globally.” Source

> Bad news:  If the FDA follows the same timeline as for the Pfizer & Moderna vaccines, regulatory approval won’t come until the end of February or early March. For eager vax chasers (like me), that’s an eternity.

Open issue: J&J is an adenovirus vaccine that attacks the COVID virus using double-stranded DNA;  Pfizer and Moderna vaccines uses single-stranded “messenger” RNA (mRNA).  The long-term health effects of these specific vaccines (both types) are uncertain and potentially significant since they “involve” a person’s natural DNA structures.  Only time will tell.

More immediate: The J&J vaccine was only marginally effective against the spreading South African COVID strain, suggesting that a 2nd “booster” shot may eventually be required.  The Pfizer’s & Moderna’s clinical trials were conducted before the South African strain was evident, so their potency against that strain is uncertain Early early indications are that they may be more effective, but still may eventually also require an additional booster shot.

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> J&J reminder:

“It’s a pandemic vaccine preventing death and hospitalization and severe disease in an acute situation, now in the middle of a pandemic.”

Said differently, these vaccines are intended to prevent severe consequences (i.e. hospitalization or death), not necessarily to stop infections.

> WSJ conclusion:

Even though it wasn’t as effective as the (Pfizer & Moderna) vaccines, J&J’s vaccine performance would be strong enough to protect many people and help build the community immunity.

> My take:

Disappointed that effectiveness rate isn’t higher.  If it were, brand choice would be a no-brainer (save for potential longer-run health consequences — which haven’t been evaluated for any of the vaccines) 

Keeping things in perspective, 72% effectiveness in the U.S. 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 vaccineSource

And, keeping an eye on the goal line, J&J’s vaccine was 100% preventative of hospitalization and deaths. 

So, barring any  differentiating long-term health consequences that could be significant (and haven’t been studied yet for any of the vaccines), I plan to take the first vax that I can get my hands on.

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DISCLAIMER: I’m not a medical professional or scientist — just a curious, self-interested guy.  So, don’t take anything that I say or write as medical advice. Get that from your doctor! 

VAX: Eat, drink, smoke … and move to the front of the line.

February 5, 2021

According to the Washington Post

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DC has announced that it will offer vaccines to people whose weight (BMI > 25)  or medical history (including “habitual smoking”) would not otherwise qualify them for early access to the vaccine in almost any state in the country.

The rationale: Those persons might suffer serious outcomes if they contract the virus.

Again, DC’s obesity criteria: a BMI greater than 25.

By that measure, half of DC’s adult population qualifies as obese.

For example, a person 5’6” weighing more than 155 has a BMI > 25.

So does a person who is 6 feet tall and weighs more than 185 pounds

Click here to calculate your BMI.

The consensus of health experts: DC’s criteria are set too low … that the cut-off should be a BMI of 40 (extreme risk) or 30 (significant risk).

Proponents of the weight criteria argue that it provides wider access for poorer DC residents who tend towards obesity, with 72% having BMIs over 25.

But, opponents point out that DC is already controlling vax distribution by zip code residency — with explicit preference given to poorer neighborhoods.

Teaching point: there’s no need for a proxy measure (like BMI) if there’s a direct control variable (like preferential zip code restrictions).

So, why announce a silly sounding policy?

If everybody is a priority, then nobody is a priority.

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To be fair

DC is also trying to close some loopholes.

For example,  vaccination appointments are available for teachers and staff at DC Public Schools but … only those who are already working in person or who will be returning in person for Term 3.

That policy will be tough to enforce, but the intention is good.

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Related post:

What do lawyers, prisoners and ‘the media” have in common?
Answer: They’re all ahead of me in line for COVID vax shots

Feb, 5: COVID VAX Stats

February 5, 2021

Vaccine Supply & Vaccinations

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Supply Utilization

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Vaccinations per Day

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Link to State by State Data

Feb. 5: COVID Tracking Stats

February 5, 2021

Cases & Deaths

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Case Fatality Rate

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Hospitalizations

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Source: RonaViz.com