The pandemic has made visible lots of major issues with US health infrastructure. One of the most egregious is the inability of our system to report data reliably, from the "edge of the network" 7 days a week. The US healthcare system has a Monday-Wednesday-Friday problem.

For years, those in medicine knew about this with its most clear manifestation being in-center dialysis. Despite lots of data that 5x/week is better than 3x/week, most dialysis regimes were 3x per week (M/W/F) for the convenience of the clinic and not the outcome of patient

Lots of reasons for this: overtime pay needed on weekends without resultant increase in reimbursement, capacity limits of centers.

So now fast-forwarding to the COVID-19 pandemic, why is it that case and death data is unreliable on weekends? Why is it that CDC vaccine tracker only reports data on M/W/F?

Well functioning data systems do not require human intervention M/W/F? Imagine if I couldn't check my bank account on weekends? or on Tuesdays and Thursdays?

Obviously, we don't have a single "healthcare system" - we have a federation of 4000+ hospitals, thousands of county public health officers, and 50 states. All of those need to review, update data.

But the fact remains that in well-functioning data-reporting systems from the edge of the network, reporting isn't reliant on armies of people and their weekday work schedules.

Finally, outside of data in in vaccine administration, why is it that states/hospitals arent running 20 hr a day vaccination campaigns for group 1? Why did state of Maryland report only 1000 vaccinations in last 24 hrs?

I get reporting lag issues (with which I have problems...see above), but why arent members of congress outraged at this pace of administration and reporting? Israelis are vaccinating nearly 10x per capita US rate? My guess, they are running 20 hrs a day, 6 to 7 days a week.

There is $8b of funding in stimulus for vaccine administration at state level - let's hope this gets disbursed smartly and quickly and ROI is measured. If we need to have states pay overtime for administration and reporting to be daily, then lets do that.