Medical Discussion of Coronavirus

[fatlittlepig]

I have a simple mind. We have the recipe to solve this problem. Give the recipe to every drug manufacturer. Pay them XXX millions dollars to make the recipe. If we are feeling generous give the recipe to other countries. The time is think outside the box has long passed.

[fatlittlepig]

ya sounds like a lot of waste to me. more concentrated but larger vaccination sites are inherently more efficient when you have x doses per vial that only lasts so long once thawed.

Telling everyone to go to dodgers stadium or Disneyland may sound like a good plan but you will only get the motivated people, for the many many other people you will need to have it in their face and extremely easy to do

[CordMcNally]

Telling everyone to go to dodgers stadium or Disneyland may sound like a good plan but you will only get the motivated people, for the many many other people you will need to have it in their face and extremely easy to do

Considering the demand has outstripped the supply it doesn’t matter at this point.

[Panscan]

Telling everyone to go to dodgers stadium or Disneyland may sound like a good plan but you will only get the motivated people, for the many many other people you will need to have it in their face and extremely easy to do

I really don't think significant amount of people are going to get the vaccine at an apple store vs at the dodgers stadium. I don't think convenience is a significant factor for people to consider getting it or not, I think you either have people who want it or people that wont. Obviously we shouldn't make it necessarily hard for them to do so, but I don't think wasting a ton of doses at apple stores and pharmacies is going to help anyone and probably will net hurt the supply issues.

It's not like we're sitting on 100 million doses waiting for arms here.

[billy]

There's a reason all the candy in stores are either on low laying shelves or near the cash register- no one goes to the store specifically to buy candy, yet somehow it gets bought. Roundabout way of saying I agree with FLP in this one- to get the unmotivated people to get vaccinated, it needs to be super easy and accessible, which it has not been. Its super hard for the motivated in NJ/NY to get a shot right now, so no chance of vaccinating those who are on the fence.

[CordMcNally]

There's a reason all the candy in stores are either on low laying shelves or near the cash register- no one goes to the store specifically to buy candy, yet somehow it gets bought. Roundabout way of saying I agree with FLP in this one- to get the unmotivated people to get vaccinated, it needs to be super easy and accessible, which it has not been. Its super hard for the motivated in NJ/NY to get a shot right now, so no chance of vaccinating those who are on the fence.

Do they currently have a surplus of vaccines or are all the appointments booked like pretty much every other state? It’s not an issue when demand outpaces supply.

[Lordosis]

The time for multiple venues will come. Especially when we get the next couple vaccines that are more stable and single dose. Right now we have an abundance of takers. It might be months before we run out of the willing people. The ambivalent people will come later.

[MaxPower]

I think we need to be much more indiscriminate with vaccinations. Stop spending time on figuring out who’s in what tier, who is cutting off who in line, who has had Covid already and when, and just start jabbing as many arms as possible.

https://www.bmj.com/content/372/bmj.n149

Headline: Covid-19: Norway investigates 23 deaths in frail elderly patients after vaccination

[Tim]

The problem is not having people to put shots in the arm. Hubs, pharmacies or hospitals are available.

The problem is purely and administrative issue.
•The framework is in place to deliver doses.
•The priorities for the population have been decided.

To sign up the population has to has to hunt for thousands of locations that will put them on a list.
The location then needs to wait until they have supply and then confirm appointment.

I don’t care which pharmacy, Hub, or hospital I get the shot. Based on my priority, I might accept an appointment in two days at one location rather than wait two weeks at another.

It’s like shopping online. Available for pickup in two days if I drive across town. Wait for two weeks at the nearest store (none in stock). Each store has its on system for making a list.
A pharmacy, hospital or Hub should be provided customers to vaccinate according to capacity. The vaccine should be delivered to them.
The customer should be provided one sign up and the choose where and when to get the shot. Available sooner if you want to drive.
The interface should not be between the provider and the customer. Providers focus on efficiency of shots and capacity.
Customers deal with convenience of availability. Expand how far you drive and you get it sooner. Makes no difference to or most patients.

My nearest pharmacy (Kroger’s)has a hand written waitlist. What could go wrong?
The wait list by site and county sucks. Three counties within 5 miles.

The customer allocation being matched with supply in appropriate priority is the problem.

Hubs cut out thousands of daily vaccine distribution capacity for what? Now we have all 10,000 in one system. Congratulations. Disney World and a stadium. One big traffic jam as 10,000 people drive an hour or two past 100 or so perfectly good pharmacies that you failed to deliver vaccine and my request. Hubs are great is supply exceeds capacity. Both supply chains provide benefits. Hubs will shut down but should be used as a supplement. This vaccine required a separate order allocation system.

[StarTrekDoc]

Issue: Production constrained Solution: National defense authorization act -- I would fully anticipate this happening by Jan 21st. If not - shame on Biden
Issue: Primary Distribution constrained (manufacturer to Solution: If Fedex/UPS can't Add Amazon

Issue: Secondary Distribution (shots to arms)
1. Personnel -- State laws : can't just pull a student. Even an MA and pharm techs in most states cannot administer without oversight. Licensed -- Solution: EMTs FEMA: National Guard Medics activated
2. Sites -- Mega sites until vaccine constraint, personnel, and freeze logistics are resolved -- then rollout to secondary sites -- pharmacies -- Issues is tracking for #2 shot. Once J+J available the secondary sites will be a natural area to allow for this.

A large issue that we've encountered is the 15-30min observation time needed. The reaction is real. Getting 2-5 per day at our megasite. Hard to find space at smaller areas to manage this at any scale. It is one of the reasons we've kept the Primary care offices off until sufficient dose supply outstripping centralized operations.

[Tim]

California has injected about only 27% of the vaccines delivered. One of the bottom 5 states.

https://www.beckershospitalreview.co...inistered.html

For sure the supply was allocated by population but supply is not the problem after one month of deliveries to ANY provider (rural vs urban) but left to the state to prioritize distribution within the state. The concept was vaccine would be available to any person Only 5 states have injected over 50% of vaccines delivered.
4 weeks in it seems the turf war and fine tuning the priorities hindered the process. This will work out.
West Virginia is #1. Would never have guessed. I doubt their process could be scaled to large urban areas. Maybe they could.

[Tim]

Considering the demand has outstripped the supply it doesn’t matter at this point.

So far, this has not been the case. Supply delivered but not administered. It is in the possession of the locations to be injected.

[Tim]

Time for the dueling scientific studies to begin.

https://onlinelibrary.wiley.com/doi/10.1111/eci.13484

The narrative is changing in some places.
Chicago

https://www.google.com/amp/s/www.chicagotribune.com/coronavirus/ct-coronavirus-chicago-lightfoot-wants-restaurants-open-pritzker-20210114-mh6chxizsfgnbkwkypf6iyk6mi-story.html%3foutputType=amp

New York

https://www.google.com/amp/s/www.wivb.com/news/restaurants-suing-nys-land-win-in-court/amp/

But politics will continue to interpret data as it sees fit.

https://www.google.com/amp/s/nypost.com/2021/01/12/gov-cuomo-to-expand-rapid-covid-tests-in-bid-to-reopen-eateries/amp/

I seriously doubt we as a country will actually ever progress past our path from a year ago:
Don’t overwhelm the healthcare system.
Find treatments.
Find vaccines.
Those studies would take money and simply place blame.
Different points of view are uncomfortable. Likely two years from now “budget cuts on wasteful covid testing and tracing”
will appear.
I just wish that political factors had not become so important. Goes with a society. Can’t eliminate politics. Live with it.

[StarTrekDoc]

California has injected about only 27% of the vaccines delivered. One of the bottom 5 states.

https://www.beckershospitalreview.co...inistered.html

For sure the supply was allocated by population but supply is not the problem after one month of deliveries to ANY provider (rural vs urban) but left to the state to prioritize distribution within the state. The concept was vaccine would be available to any person Only 5 states have injected over 50% of vaccines delivered.
4 weeks in it seems the turf war and fine tuning the priorities hindered the process. This will work out.
West Virginia is #1. Would never have guessed. I doubt their process could be scaled to large urban areas. Maybe they could.

So this is an interesting stat and point as we talk about releasing the 'reserved' supply of #2 injection. Appears there ISN'T one. So those ahead of their distribution may actually be in a pickle in 2 weeks when the ramp up of 2nd doses really start hitting stride and the whole distribution apparatus stalls out with no vaccine to administer.

This is the trick that we've discussed throughout the ramp up and expansion of sites -- how to count on the supply while expanding sites significantly and ability to draw down and then scale up as that supply changes.

[tailwind225]

A large issue that we've encountered is the 15-30min observation time needed. The reaction is real. Getting 2-5 per day at our megasite. Hard to find space at smaller areas to manage this at any scale. It is one of the reasons we've kept the Primary care offices off until sufficient dose supply outstripping centralized operations.

Interesting, what kinds of reactions are you seeing?