I know you’ve been worried about me getting a flu shot. Well, maybe not, but my mother has been and that’s worse. If you haven’t been following along, my private healthcare system said last month that I only could get the flu vaccine from CatSalut, Catalonia’s public health system. But CatSalut wouldn’t let me access public health without paying into its system. Without access, no flu shot. I could have forgone the shot. Since getting a flu shot may be a preview of getting a Covid-19 vaccine, though, it seemed important to figure out how.
I know what you’re thinking. Just pay CatSalut and get the flu shot. I tried. It’s treacherous, practically Kafkaesque. To join CatSalut, I needed dispensation from the INSS, the Spanish Social Security system. Even though I haven’t contributed to Spanish Social Security, Royal Decree 576/2013 allows me to join CatSalut with a Convenio Especial for 60 euros a month. I won’t go in the details, but I’d almost given up finding the right form when Brad and I broke the code.
After a Spanish lawyer couldn’t figure out the right INSS form, I called another medical private practice I use. Maybe they had the flu vaccine. But no, the receptionist said, they also couldn’t get vaccine from CatSalut. Then she suggested buying the vaccine at a pharmacy. A pharmacy? That was news. Brad went online and saw that recently the flu vaccine indeed became available in Catalonia through pharmacies. Magically, the broken vaccine system fixed itself.
I found a flu vaccine. Not right away. The improved system isn’t flawless. The third pharmacy I asked had it. Brad got his flu shot Friday. I’ll get mine next week.
I tell my flu shot story because it’s an example of allocation problems during a pandemic. ICYMI, Covid-19 has created some difficult one-time allocation problems. That is this week’s Covid Diary BCN theme.
Before I get to allocation and scarcity, though, I want to mention (again) that Covid-19 restrictions work. As Covid-19 numbers improve, Catalonia is relaxing more Covid-19 restrictions in front of the holidays. While I’m reading the horrendous Covid-19 news from the US, I’m shopping, exercising, planning a Covid-19 restriction compliant Christmas eve dinner, and traveling up the coast. All without enormous concerns about either getting Covid-19 or accessing good medical care if I do.
The US healthcare system is collapsing in states where (mostly Republican) governors fail to implement Covid-19 restrictions. Hospital and ICU beds are so short that families are appealing for help on social media.
When people resort to social media for hospital beds, it’s a sign free market allocation isn’t working.
The irony, of course–and there seems to be an epidemic of Covid-19 irony–is that leaders advocating against Covid-19 restrictions they claim keep their economies from opening up have created scarcity that keeps many parts of the free markets from functioning. There is scarcity throughout US healthcare, from staff to physical plant to medical supplies, scarcity that can resolve itself in 3-4 weeks with Covid-19 restrictions but can’t be fixed for months without them. Needless to say, healthcare scarcity hurts people who need healthcare for maladies other than Covid-19. Like, say, a heart attack.
Vaccines are creating an entirely different set of allocation issues. It seems like having the first two Covid-19 vaccines coming through the gates at 90% – 95% effective would be great news. It would excellent news if the two companies making them could produce in 2021 the roughly 15 billion doses needed for humankind to achieve herd immunity (both vaccines require two doses).
However, because the first two vaccines are so highly effective, it increases exorbitantly the trial costs of other vaccine candidates which now need to demonstrate similar or better effectiveness. There may be ways to reduce the cost of vaccine trials with new methods, but it looks like most of the 50+ vaccine candidates in human trials won’t be able to afford to move forward even though a few of them may be cheaper, easier to distribute, or provide longer-term protection. A portfolio of Covid-19 vaccines also reduces risk of one-off problems like supply chain anomalies for a specific vaccine.
Allocation of scarce vaccine trial resources is one vaccine problem. Another vaccine problem is ramp up. With two Covid-19 vaccines completing Phase 3 trials and entering various approval cycles, vaccine talk is turning to who gets vaccine first, another scarce resource allocation problem. In the US, if everything goes right, UCSF’s Dr. Bob Wachter expects herd immunity around September 2021.
That’s if everything goes right. This month, every country, state, and region is determining who will get the first Covid-19 vaccine shots. Will the first shots go to healthcare workers and nursing homes, or to essential workers in places like grocery stores where spread risk is high, or to bankers? Wait, bankers? Well, yeah, if you advocate that the economy is more important than people’s lives, if you advocate for opening the economy over Covid-19 restrictions, then wouldn’t you want to protect your banker first? More irony.
I’m waiting for Sarah Palin to trot out her “death panel” resource allocation scare tactics. Regardless of how fair you think socialized medicine is, your public health system is prioritizing life and death this month. The more people wear masks and keep their distance, the less life-and-death these scarce vaccine allocation decisions become. That seems like a pretty easy trade-off to me.
In every country, vaccination is a complex problem. Spain has decided the first 2.5 million people to receive Covid-19 vaccines will either be in nursing homes or be at-risk healthcare workers. After that, it’s essential workers or people with health risks. The devil will be in the detail.
My flu shot story at the top of this post gives me hope that CatSalut eventually will get to me, but I’m not expecting one-time allocation to work well. No matter where you are, you shouldn’t either. I hope the pattern of one-time allocation of scarce resources is becoming clear by now. One-time scarce resource allocation is hard and free markets rarely help. The best outcome for everyone is to avoid getting Covid-19 for the next 6-9 months.
To the best of my knowledge, the Trump administration has no nationwide plan in place to distribute and administer a vaccine in the US. It’s worse than that. In order to make Covid-19 numbers look good, Trump has mismanaged or broken reporting systems. For instance, Covid-19 hospital reports don’t reflect conditions on the ground. The evidence suggests that the only allocation problem Trump knows how to solve is how to allocate other people’s money to his pocket.
President-elect Biden will take over about a month after vaccines become available. His choice of Ron Klain as chief of staff will help, as will the task force he assembled in his first announcement as President-elect. A lot of his success will depend on Covid-19 vaccine messaging. Biden already has set the tone by asking Americans to wear masks for the hundred days after his inauguration. But getting them to take Covid-19 vaccines is a whole different ballgame.
If you’re in the US and want to see how many doses of Covid-19 vaccines your state will receive, check the Covid-19 Vaccine Allocation Dashboard. I’ve put it on the Resources page. It’s still amazing to me how much Covid-19 information comes from private efforts rather than government portals.
Another aspect of resource allocation during the pandemic is Covid-19 stimulus packages. As Covid-19 distorts markets and capitalist economies fail to provide food and resources to people, governments have to step in. After passing a stimulus package at the beginning of the pandemic, the US has been unable to agree on a new stimulus package. Among other problems, that will leave 2% of US households (representing about 10% of the population) homeless on New Year’s day.
Stimulus packages have highlighted the biases and structural problems in the US. When the current negotiations started before the November election, Republicans demanded a $500 billion package and Democrats demanded a $2 trillion package. Republicans wanted a smaller package because most of the aid would have gone to blue states. But as Covid-19 spreads to more red states and those states run into economic problems, Republicans now are coming around to a $1 trillion bipartisan proposal. Covid-19 is straining the US political system, highlighting the way the structure of the Senate and electoral college work against the financial interest of a majority of Americans during a crisis.
In the new Covid-19 stimulus package, the US congress probably won’t address structural inequality highlighted by its first package. For instance, a study of PPP payments to restaurants shows a payment bias towards restaurants in wealthier communities. The payment bias probably resulted from the way the program was administered by banks through the SBA. Restaurants in places with healthy banking infrastructure had easier access to cash. In this case, Covid-19 has shown that bias in the US system favors those who already have resources during a crisis. It also highlights that “free markets” probably aren’t providing equal access to resources when there isn’t a pandemic. Poor people have to try harder.
Misinformation compounds problems of allocating scarce resources. Regardless of what continent you are on, this is a great Twitter thread on beating the misinformation about Covid-19 vaccines.
Today’s example of Covid-19 misinformation comes from Covid-19 where Dr. Steven LaTulippe spoke at a Republican “Stop the Steal” protest.
It’s pretty easy to pick out the misinformation if you’re paying attention, and even easier to believe what LaTulippe says if you want to rationalize not using a mask. When he says Covid-19 is just like the flu, he’s wrong. When he says that N95 masks don’t filter Covid-19, he’s wrong. Oregon suspended LaTulippe medical license after this talk.
There was also a kind of misinformation about the origins of Covid-19 floating around my social media bubbles last week. Here’s a good Twitter thread challenging the CDC study.
Also, I wrote a Twitter thread addressing why understanding Covid-19 origins is important.
- Sweden has sidelined Anders Tegnell, the public health official responsible for its no-lockdown Covid-19 strategy. This summer, Tegnell suggested his strategy would lead to fewer Swedish deaths this winter compared to other Scandinavian countries that locked down because more Swedes had Covid-19 immunity.
- Dr. Scott Atlas, who advocated letting Covid-19 run free to achieve herd immunity, has left his post as White House advisor. Herd immunity is often viewed as a form of eugenics.
- Daily US Covid-19 deaths surpassed 2,800 per day. In the post-Thanksgiving surge, they are expected to surpass 3,000 and reach as high as 4,000 per day.
- The CDC has reduced the quarantine period after Covid-19 exposure from 14 days to 10 days (and 7 days with a negative test).
- Spain has measured an 8% transmission rate from children infected with Covid-19 to their families.
- American Ballet Theatre has cancelled its 2021 season due to Covid-19. In other cultural news, BookExpo has cancelled its 2021 book fair.
- Researchers repurposed a influenza ribonucleoside for Covid-19 and gave oral doses to ferrets. The ribonucleoside interrupted community transmission of Covid-19 in ferret populations. As previously noted, there also are nasal spray transmission interruption technologies in development at UCSF and Columbia University.
- MIT ML models predict that the Pfizer, Moderna, and AstraZeneca vaccines provide less protection to people of Asian and African heritage. They also suggest the addition of more Covid-19 peptides to vaccines to improve response among a more diverse population.
- Some men who survive Covid-19 develop erectile dysfunction. The good news? If you don’t wear a mask, you may avoid wearing condoms later.
My favorite Covid-19 related story last week comes from Belgium. József Szájer, a Hungarian MEP who helped author Hungary’s 2011 constitution that forbids same sex marriage, was caught escaping a men’s sex party. The party ran past the Covid-19 curfew. After police caught Szájer, he issued a statement: “I apologise to my family, to my colleagues, to my voters. I ask them to evaluate my misstep against a background of 30 years of devoted and hard work.” I understand Szájer. Those gay parties are hard work.
No matter where you are, the best thing is to cancel any holiday travel. If you decide to risk a family gathering, everyone should get a Covid-19 test and quarantine for 10 days before gathering. That’s especially true in the US where hospital and ICU beds are in short supply.
Please wear a mask, keep your distance, and wash your hands this holiday season. I don’t do these things for me, I do them for us.
I write this for my own sanity. If you like it, please pass along to friends and family. For more frequent Covid-19 updates, follow me on Twitter.