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0/n The biggest puzzle in the last few days of 2020 is this: Why is COVID-19 vaccine rollout so slow in the US?
To see how slow it is, a Bloomberg chat ( http://bloom.bg/34X1Jyj ) shows 19.3% of @pfizer and @moderna_tx vaccines have been administered:
To see how slow it is, a Bloomberg chat ( http://bloom.bg/34X1Jyj ) shows 19.3% of @pfizer and @moderna_tx vaccines have been administered:
1/n In Maryland, where I live, only 10% of doses have been administered.
Surely there may be time lag in reporting and hence undercount, but, to quote Dr. Anthony Fauci, "how much undercount could it be?" ( http://cnn.it/3pFJiX3 )
Surely there may be time lag in reporting and hence undercount, but, to quote Dr. Anthony Fauci, "how much undercount could it be?" ( http://cnn.it/3pFJiX3 )
2/n So what's going on? Here are several possible contributors to the delay.
**A. Some hospitals are holding the second doses **
**A. Some hospitals are holding the second doses **
3/n Currently, the vast majority of vaccine doses have been given to healthcare workers.
Both @pfizer and @moderna_tx vaccines require two doses.
It is plausible that many hospitals want to keep the second doses so that healthcare workers can get them later.
Both @pfizer and @moderna_tx vaccines require two doses.
It is plausible that many hospitals want to keep the second doses so that healthcare workers can get them later.
4/n But healthcare workers will need to wait for weeks before getting their 2nd doses — 3 weeks for @pfizer vaccine and 4 weeks for @moderna_tx vaccine
Suppose all hospitals do the same, an up to 50% of doses can be administered
Suppose all hospitals do the same, an up to 50% of doses can be administered
5/n While hospitals hold the doses, those in the 1b group, including essential workers and people with underlying conditions, are getting infected, even dying, every day
And we know the vaccine supply can only speed up over the time, so what's the point of holding vaccines?
And we know the vaccine supply can only speed up over the time, so what's the point of holding vaccines?
6/n And the timing of the second dose doesn't have to be exact: https://www.usatoday.com/story/news/health/2020/12/09/covid-vaccine-timing-second-pfizer-and-moderna-shots-not-critical/3867521001/
Ontario, Canada decided not to hold any vaccines for 2nd doses:
https://www.theglobeandmail.com/amp/canada/article-ontario-changes-covid-19-vaccination-plans-after-slowing-rollout/
U.S. should be doing the same.
Ontario, Canada decided not to hold any vaccines for 2nd doses:
https://www.theglobeandmail.com/amp/canada/article-ontario-changes-covid-19-vaccination-plans-after-slowing-rollout/
U.S. should be doing the same.
7/n ** B. Unnecessary and unfortunate delay in vaccinating nursing homes due to bureaucratic reasons and lack of planning effort **
Nursing home residents are supposed to enjoy the same priority status as healthcare workers, yet they are much behind. Why?
Nursing home residents are supposed to enjoy the same priority status as healthcare workers, yet they are much behind. Why?
8/n It's certainly not because they can afford to wait. No, they really can't wait — in the past few weeks, nursing home deaths have skyrocket: https://www.aarp.org/caregiving/health/info-2020/nursing-homes-thanksgiving-covid-deaths.html
9/n The reason nursing homes are so behind hospitals is simple: Hospitals have the means and resources required for vaccination.
Most nursing home residents, unfortunately, are at the mercy of @cvspharmacy and @Walgreens to figure out things: https://www.hhs.gov/about/news/2020/10/16/trump-aministration-partners-cvs-walgreens-provide-covid-19-vaccine-protect-vulnerable-americans-long-term-care-facilities-nationwide.html
Most nursing home residents, unfortunately, are at the mercy of @cvspharmacy and @Walgreens to figure out things: https://www.hhs.gov/about/news/2020/10/16/trump-aministration-partners-cvs-walgreens-provide-covid-19-vaccine-protect-vulnerable-americans-long-term-care-facilities-nationwide.html
10/n But @cvspharmacy and @Walgreens seem to get lost about questions as basic as "Can residents and staff orally agree to receive the vaccine or will they have to sign something?"
And they have received little help from Federal and state agencies: https://www.nytimes.com/2020/12/16/business/covid-coronavirus-vaccine-nursing-homes.html
And they have received little help from Federal and state agencies: https://www.nytimes.com/2020/12/16/business/covid-coronavirus-vaccine-nursing-homes.html
11/n As recent as December 13, @HHSGov Secretary @SecAzar promised, "we can have every nursing home patient vaccinated in the United States by Christmas." https://www.cbsnews.com/news/covid-19-vaccine-alex-azar-face-the-nation/
12/n Was @SecAzar too ambitious?
No, not at all. This administration's agreements with @cvspharmacy and @Walgreens were signed in October, so both companies have months to figure out all the logistics. The confusion in logistics is in itself confusing: https://www.usatoday.com/story/news/health/2020/12/14/covid-19-nursing-homes-vaccine-dec-21-28-cdc/6547781002/
No, not at all. This administration's agreements with @cvspharmacy and @Walgreens were signed in October, so both companies have months to figure out all the logistics. The confusion in logistics is in itself confusing: https://www.usatoday.com/story/news/health/2020/12/14/covid-19-nursing-homes-vaccine-dec-21-28-cdc/6547781002/
13/n U.S. gives 1.5 million flu shots every day, among other vaccines. And we have fewer than 2 million nursing home residents (compared to 17 million healthcare workers).
At the pace of flu vaccination, all the nursing home residents can get vaccinated in just over one day
At the pace of flu vaccination, all the nursing home residents can get vaccinated in just over one day
14/n Distributing COVID-19 vaccines is slower than flu vaccines. But it's not supposed to take >3 weeks to vaccinate all the residents.
Nursing homes vs hospitals is a textbook example of inequity in vaccine distribution.
Nursing homes vs hospitals is a textbook example of inequity in vaccine distribution.
15/n This just came out: “states have set aside many doses to be given out to their long-term care facilities, a drive that is just gearing up and expected to take ***several months***.” According to an Operation Warp Speed official ( https://www.nytimes.com/live/2020/12/30/world/covid-19-coronavirus-updates#officials-with-operation-warp-speed-acknowledge-the-slow-pace-of-initial-vaccinations)
Seriously?
Seriously?
16/n CVS & Walgreen are not solely responsible for the delays with NH. Federal, state, and local governments are not helping them, either. We have seen insistence on bureaucratic routines, a sense of indifference, and failure to appreciate what's obvious: https://www.wsj.com/livecoverage/covid-2020-12-30/card/XdU19K5ObKhUpkcXTmSf?mod=e2tw
17/n ** C. Lack of a national (or state/local) vaccine waitlist **
In UK, residents are notified by @NHSuk about when will be their turn to get vaccine
The same is true for Belgium
Where is our vaccine waitlist? The closest thing is the following: https://amp.cnn.com/cnn/2020/12/30/us/florida-coronavirus-vaccine-line/index.html
In UK, residents are notified by @NHSuk about when will be their turn to get vaccine
The same is true for Belgium
Where is our vaccine waitlist? The closest thing is the following: https://amp.cnn.com/cnn/2020/12/30/us/florida-coronavirus-vaccine-line/index.html
