Archive for the ‘COVID – vaccine’ Category

VAX: What exactly did Biden promise?

March 3, 2021

Is “enough vaccine supply for every adult by the end of May”
a lay-up or a long-shot?

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I commend Biden for putting a quantitative stake in the ground.

That said, let’s parse his announcement to decode what it really means…

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First, how many people are we talking about?

There are 250 million adults 18 & over in the U.S.

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So, how much vaccine is required?

As of today, 26 million have been fully vaccinated (i.e. received 2 shots) … 52 million have received only the 1st of 2 shots.

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An obvious question: Is Biden talking about fully vaccinated or just “in the system” …. having received at least received one shot? More on that later.

As of today, there is over 24 million doses in the government stockpile.

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Presumably, that inventory is intended for the 2nd shots to be given to folks (like me) who have already received their first shots.

So, we can assume that we just need to consider new vaccination candidates.

That means that we need enough new supply to vaccinate just over 200 million people (250 million adults 18 & over less the 52 million already vaccinated and presumed scheduled for their 2nd shots).

The good news: J&J says that it will deliver 20 million 1-shot doses by the end of March and 100 million by summer.

That works out to about 75 million J&J doses by the end of May. (20 million in March plus 2/3s of the 80 million ‘by summer’ balance).

Since J&J is a 1-dose vaccine, that leaves 125 million adults to be vaccinated by the end of May.

So, we need about 250 million doses from Pfizer & Moderna to hit the goal (125 million adults times 2 doses).

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Are 250 million mRNA doses a long-shot or a lay-up?

There were 52.5 million doses delivered to (and from) the Feds in February.

Qunat note: Cumulatively, there were 49.9 million doses delivered as of Feb.1 and 102.4 million delivered as of March 1 … the difference (52.5 million) was delivered in February,  Source  

So, at the February rate, we can expect at least another 150 million doses in the 3-month period March-April-May.

That leaves us about 100 million mRNA  doses short of having enough to have all adults 18 & over fully vaccinated by the end of May.

Said differently, it leaves 50 million adults partially vaccinated (i.e. having on 1 of their 2 shots).

Finishing them off will require another month’s supply (at the current delivery rate.

That pushes us out to June unless there’s a boost in vaccine manufacturing output.

Since the J&J-Merck manufacturing partnership requires a couple of months until it comes on line, it’s not clear where & how the additional supply will materialize.

So, if the goal is “fully vaccinated” , then May is aggressive … June is realistic … and, the difference is, in my opinion, rounding error.

Of course, the goal can be fudged to “at least one dose” … which may be doable by the end of May.

So, there should be enough supply to hit the available supply goal, plus or minus a couple of weeks.

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The big “but…”

Biden’s commitment is “available supply” … which is less daunting than getting all adults 18 & over “vaccinated”.

And, achieving an available supply goal simply requires continuing to deliver vaccines (to & from the government) at current run rates (plus the new incremental J&J supply).

But, converting the supply into “shots in arms” is likely to run into at least 2 challenges: (1) the last mile under-served populations (i.e. rural, inner city), and (2) demand creation among the vaccine hesitants.

These challenges may be more of an impediment than vaccine supply.

We’ll cover them in future posts…

WSJ: Operation Warp Speed’s Triumph

March 3, 2021

In today’s editorial, the WSJ says that Trump’s vaccine bet was government’s best pandemic decision.
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A bold move:

American governments, federal and state, have made many mistakes in the Covid-19 pandemic.

But the great success — the saving grace — was making a financial bet in collaboration with private American industry on the development of vaccines.

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A fast track to normalcy

That effort is now letting the country see the possibility of a return to relatively normal life as early as the spring.

President Biden announced that the U.S. should have enough vaccine supply for every American adult by the end of May.

[That’s months, or years, before Dr. Fauci and other experts said to expect the first doses of a Covid vaccine to be delivered.]

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False claims try to diminish the achievement:

Critics scoffed when President Trump set a target of having a vaccine approved by the end of 2020.

Kamala Harris suggested she would not take a shot recommended by the Trump Administration.

The Biden-Harris Administration has now changed to full-throated encouragement — though not before continuing to trash the Trump efforts.

President Biden and White House aides have repeatedly stated that they inherited little vaccine supply and no plan for distribution.

Both claims are false.

The claim that the administration inherited no vaccine program at all, initially propagated through the ministrations of a kindly reporter, is so at odds with the evidence that even the most friendly newspapers were obliged to call it out.

The supply was ramping up fast, and while there were distribution glitches at first, the real problem has been the last mile of distribution controlled by states [at their demand].

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Politically-inflicted complexity:

Governors like New York’s Andrew Cuomo tried to satisfy political constituencies that wanted early access to vaccines, adding complexity and bureaucracy that confused the public.

Mr. Biden is making the same mistake, asking states to give priority to educators (read: teachers unions), school staffers and child-care workers.

That is arbitrary and unfair.

A 30-year-old teacher who may still work remotely until September is at far less risk than a 50-year-old FedEx driver who interacts with customers all day.

The fairest, least political distribution standard is age.

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The big bet:

The Trump Administration’s Operation Warp Speed also contracted most of the vaccine supply for production before approval by the FDA: 200 million doses each of Pfizer and Moderna, and 100 million of J&J.

No one knew which technology would be approved first, if at all, so the Trump administration wisely bet on several [with firm advance orders and contract options to order more once the vaccines were approved and in distribution].

This was a grand strategy and the best money the feds spent in the pandemic.

Mr. Biden ought to give the vaccine credit where it is due — to U.S. drug companies and Operation Warp Speed.

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I couldn’t have said it better myself…

March 3: COVID VAX Stats

March 3, 2021

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March 2: COVID VAX Stats

March 2, 2021

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March 1: COVID VAX Stats

March 1, 2021

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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…

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Feb. 28 COVID VAX Stats

February 28, 2021

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Feb. 27: COVID VAX Stats

February 27, 2021

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Feb. 26: COVID VAX Stats

February 26, 2021

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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.

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Feb. 25: COVID VAX Stats

February 25, 2021

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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?

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Feb. 24: COVID VAX Stats

February 24, 2021

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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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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…

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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. 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?

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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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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.

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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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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.

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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?

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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, 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. 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. 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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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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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 …

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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

VAX: States’ Performance Ranks

February 8, 2021

Vax Rate – Doses Supplied – Supply Utilization
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Vaccination Rate – First Dose % Population

States w/ Highest Vaccination Rates

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States w/ Lowest Vaccination Rates

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More Data Below (including All States data)

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VAX: Some of the unused vaccine inventory has been found!

February 8, 2021

We hate to say that we told you so, but…
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A couple of weeks ago, we pointed out that there were about 25 million “unused” doses of vaccine … and, they were probably being held in inventory by CVS & Walgreens (leftover from the program to vaccinate nursing homes) and hospitals (a “reserve” for 2nd shots and slow adopting medical staffs).

Our advice: claw back that excess inventory and redeploy it to high velocity vaccinators.

For background and details, see VAX Dx: Where the hell is the vaccine inventory?

Well, it took for “the science” and “the data” awhile to catch up, but according to the weekend Washington Post:

The federal government allocated too much vaccine to CVS & Walgreens to vaccinate patients and staff at nursing homes and long-term care facilities.

The doses — which were counted as part of each state’s allotment – over-counted the number of residents to be vaccinated, over-estimated the percentage of staff that would want the vaccine and didn’t realize that a 6th dose could be squeezed out of many vials.

Finally, many states are starting to “repurpose” and redistribute hundreds of thousands of the unused doses to others outlets,

States can defer or cancel subsequent allocations to long-term-care facilities, transfer doses to the states’ general pool for reallocation to other vaccinators or  leave excess vaccine doses with CVS and Walgreens who will soon begin vaccinating the general public in some states.

The CDC didn’t provide an estimate of how much excess CVS & Walgreens were holding.

My hunch: at least couple of million doses… a statistically significant amount at current supply rates … at least a couple of days worth of production … maybe more.

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Ok, they’re finally onto one pocket of unused available supply.

Going forward, here’s what to keep your eye on:

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Our morning “VAX stats” post includes a chart showing the U.S. Vaccine Stockpile — the difference between “doses distributed” by the Feds and the “doses administered” by the states and locales.

The number has been hovering around 20 million doses.

Now that the majority of doses are being used as 2nd shots to the folks who got first shots in January, this “reserve” should be deployed and the above curve should quickly start to turn down — steeply as the 2nd dose reserves are being released.

If it doesn’t, you can bet that we’ll be on the case.

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P.S. West Virginia was the only state that didn’t participate in the Federal government’s partnership with CVS & Walgreens.  Rather, WV used a network of local WV pharmacies to service nursing homes and long-term-care facilities.  As a result, WV completed vaccinating those high priority facilities about a month before other states … and, the state has had a high vaccine utilization rate since doses were never stuck the CVS – Walgreen’s inventory.

Feb. 8: COVID VAX Stats

February 8, 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

Feb. 7 COVID VAX Stats

February 7, 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

Feb. 6: COVID VAX Stats

February 6, 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

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

VAX: Again, please quit teasing me !

February 4, 2021

Statistically insignificant, logistically nightmarish.
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According to the WSJ

Team Biden announced a federal program starting Feb. 11 that will deliver vaccines directly to certain pharmacies, including ones operated by Walgreens, CVS, Kroger and Walmart.

Next week, a million doses being allocated to 6,500 stores next week.

If I’ve got the decimal point right, that works out to a whopping 150 doses per store.

Imagine if Apple were to launch a new generation iPhone by allocating 150 per store.

Statistically insignificant …  and logistically nightmarish for both stores (that need to staff up for low scale operations) and consumers (who will need to fight for appointments on the hellish scheduling sites).

Though I’m 24 x 7 on all the stores’ appointment scheduling systems, I think I’m more likely to get struck by lightning in the next couple of weeks than to get a shot at one of these places.

But, I’ll keep trying…

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P.S. I wonder what the shipping container size is for the vaccines…

Given the deep-freeze storage requirements, I thought a shipping container of vax was much bigger than 30 bottles, each with 5 (or 6) doses.

Anybody know?

VAX: Please stop teasing me!

February 4, 2021

Shucks, those are just technical details.
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According to the Baltimore Sun

Here we go again….

Maryland Gov. Hogan announced the opening of two mass vaccination sites at the Baltimore Convention Center and Six Flags America in Prince George’s County.

OK, that makes sense, but …

Details surrounding the mass sites have not been announced:

  • How to get an appointment?
  • How many vaccines a day the state hopes to administer?
  • How fast will the program ramp-up?

I guess those are just technical details.

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P.S. The launch is scheduled for tomorrow, so Team Hogan still has today to sort out the details.

What a way to run railway…

Feb. 4: COVID VAX Stats

February 4, 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

VAX: Working at cross-purposes?

February 3, 2021

Sometimes, it’s easier to just go with the flow…
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I think that practically everybody agrees that Blacks have been disproportionately crushed by COVID … and that, for understandable reasons, Blacks are disproportionately reluctant to get COVID vaccinations.

Preliminary data shows white Marylanders account for most of the inoculations, with Black people receiving about 16% of the total despite making up about 31% of the state’s population. Source

To compensate, Maryland Gov. Hogan has launched the GoVax PR campaign to “address a reluctance some people have to getting the vaccine, particularly those who don’t trust the medical system.” Source

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No quarreling with the objective … and, the approach is a classic marketing mass communications program.

OK, hold that thought …

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Uh-oh: If you haven’t already scored your 1st vax shot…

February 3, 2021

… the 2nd dose aftershock effect™ may clog schedules and make you wait until March.
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Caution: Keep in mind that we’re frustrated that we haven’t been able to get vaccinated even though we’re officially “vulnerable”.

Earlier this week, the obvious became evident to me.

The chart below displays the number of vax doses administered in our home county.

What pops out at you?

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Yep, the blue section of the bars is getting proportionately bigger from week-to-week.

If you answered: “the 2 bars in the middle are pretty small”, you’re right, too. 

The obvious explanation: National emergencies are only fought Monday thru Friday (preferably 9 to 5)

So, what’s the blue section?

It’s the number of vax doses given as 2nd shots.

Two weeks ago, 2nd shots accounted for about 15% of the total.

Last week, that proportion jumped to over 1/3 … and, is continuing to increase.

That’s completely understandable.

Since January was essentially the first month of vaccinations … and, both Pfizer and Moderna have 2-shot regiments … all of those January 1st shots are coming due for their follow-up 2nd shots.

What’s the practical implication?

BOOM ! The predictable headline:

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While we’re not directly impacted by Baltimore City’s policy, it foreshadows what we can expect to see in my home county (see chart above).

And, the 2nd dose aftershock effect™  is likely to make it to a neighborhood near all folks waiting for first shots.

Case in point: Following Baltimore City’s lead, Maryland’s state health secretary told health care providers that they should” hold in reserve enough COVID-19 vaccine to administer second doses to people who have already received one shot — rather than using their supply to give more people their first inoculation.” Source

The good news: it’s likely to be an alternating month dynamic.

Since there will be proportionately fewer 1st shots in February, there won’t be as many pent-up 2nd shots in March … so, we eager un-vaxed people should a pretty good shot in March (<= pun intended).

And, hopefully, Fauci & Friends won’t drag out the J&J vax approval … which could potentially open the vax floodgates in March.

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P.S. There are some health policy changes that could also mitigate the 2nd dose aftershock effect™

We’ll save those for subsequent posts.

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Feb. 3: COVID VAX Stats

February 3, 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

VAX: Why is West Virginia kicking the butts of richer, allegedly smarter states?

February 2, 2021

Answer: It received disproportionately more vaccine than other states … and it used what it go much more efficiently
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When it comes to vaccinating, West Virginia (WV) has been outperforming other states.

For example …

Before the end of December, all WV’s sweep of nursing homes and long-term care facilities was complete.

Currently, over 10% of WV’s residents have gotten at least 1 dose of vaccine

Why has WV been so successful up to now, while other states (e.g. my home state Maryland) are lagging?

In prior posts, we broached the question:

Why is West Virginia outperforming Maryland?

Starting with this post, we’re going to drill down a bit deeper on WV’s performance factors.

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Today, let’s take a look from 50,000 feet …

Simply put, WV’s performance (and, more broadly, that of any state) is the joint effect of 2 overall factors: the relative amount of scarce vaccine that the state receives … and, the state’s efficiency in utilizing the supply that it does get.

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To get an overview, we sorted states into the consultant’s analytical weapon of choice — 2 dimensional matrix (below):

> On the vertical axis (the rows), the states are sorted by the relative per capita supply of vaccine that they’ve received from the Feds … whether they have received an average amount, at least 5% more than the average or greater than 5% less than the average.

Supply is, by and large, an exogenous variable.  That is, other than by whining & complaining to the Feds, it’s not under the states’ control.

> On the horizontal axis (the columns) states are categorized based on the percentage of the vaccine that they’ve been allotted that they’ve utilized (i.e. that has been administered in vaccinations).

The utilization percentage is a summary measure of the state’s utilization efficiency.  In later posts, we’ll explore factors that drive the utilization percentage.

Here’s the way states sort out (as of Jan. 30) …

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Feb. 2: COVID Vax Metrics

February 2, 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