17 January 2021 – Sunday – #130

Mom got her first Covid-19 vaccination. She reports no side effects. That makes me happy.

I’m starting to notice other signs that Covid-19 vaccinations are happening in the wild. For instance, details are emerging on how each of the counties in the San Franscisco bay area will administer Covid-19 vaccinations. I also got a notice from my previous healthcare provider in New York City that it is giving Covid-19 vaccinations to people over 75 and certain essential workers. Friends are even posting in my social media streams about getting vaccinated.

While these reports are heartening, after a month of vaccinations, the US vaccination rate is still about 3x – 5x slower than it needs to be for herd immunity this year. 25 million doses have been distributed, yet only about 8 million have been administered. The ramp up problems seem to be primarily in Washington, DC. Here are two examples, one about distribution partner problems, the other about vaccine supply problems.

West Virginia has outperformed other states in Covid-19 vaccinations, delivering 90% of the doses it received. It’s also the only state that didn’t follow a federal recommendation to coordinate vaccine distribution and administration for long-term care and assisted living facilities with CVS and Walgreens. Why? Because neither CVS nor Walgreens have a significant footprint in West Virginia.

Instead West Virginia built its Covid-19 vaccine distribution and administration network with small local providers that had existing relationships with these facilities. Because its providers are small, they are more flexible and responsive.

“When [the Covid-19 vaccine] got here, we already had pharmacies matched with long-term care facilities, so we were already ready to have vaccinators and pharmacists ready to go into those facilities and start providing first doses.”

Krista Capehart, Director of Regulation, West Virginia Board of Pharmacy

Other states following the federal recommendation have been slowed down as they negotiate with large corporations to adapt to local needs. The federal recommendation was appropriate for scale and simplicity of state-level contracts, but required many new local business relationships and failed to anticipate idiosyncratic “last mile” issues.

On the supply front, Operation Warp Speed said it was holding doses of Covid-19 vaccine in reserve to make sure there were enough for second doses. The reserve was a prudent way to make sure there would be enough for second doses in case of vaccine manufacturing hiccups.

After the second week of US vaccinations, there had been no vaccine manufacturing hiccups. With manufacturing scaling up, President-elect Biden’s Covid-19 team requested that the Trump administration release its Covid-19 vaccine, allowing states to widen vaccine eligibility and increase vaccine demand. Two weeks ago, the Trump administration balked at Biden’s request and said Biden’s team didn’t know what it was doing.

Then last week the Trump administration reversed itself and said it would release its Covid-19 vaccine reserve. The only problem? Turns out there was no reserve. As the Washington Post was reporting that the Trump administration didn’t realize it already had shipped its Covid-19 vaccine reserve, Pfizer released a statement that it was ready to ship second doses.

If you’re confused about Covid-19 vaccine supplies, imagine public health administrators trying to determine vaccine allocations in their state.

In a nutshell, these examples show how poorly Covid-19 supply chains are being managed. Not that I would expect supply chains to scale to millions of daily doses without a hiccup, but everything in the US seems to be broken from manufacturing predictions to distribution systems to local administration plans. The amount of finger pointing is inversely proportional to the quality of federal coordination.

After his inauguration next week, President-elect Biden will refresh the US Covid-19 vaccine program. He announced the US will set up 100 vaccination centers, deploy FEMA resources, and reimburse states 100% for any National Guard expenses to operate state vaccination programs. In addition, he will invoke the Defense Production Act to ramp up production of not only vaccines, but also vials, needles, and other vaccination items.

I’m optimistic about Biden’s chances for success. Unlike Trump, who promised 100 million doses by the end of 2020, and then promised 20 million doses, and then delivered about 3 million doses, Biden is holding his team accountable for 100 million doses in his first 100 days in office. Biden also got a gift when Twitter closed Trump’s account. Misinformation has dropped by 73% in the week since the closure and that will take friction out of Covid-19 public discourse.

The US isn’t alone in its vaccine woes. Spain’s Covid-19 vaccinations started three weeks ago and most Spanish regions are having trouble administering anywhere close to 100% of the Covid-19 vaccine doses they received. Only five regions have injected more than 80% of doses received.

To its credit, though, the region of Melilla delivered 102% of Covid-19 vaccine doses it received. Before you jump to the conclusion that there is an accounting error, Melilla has found it can get six or seven doses from a vial, one more than the five doses a vial is supposed to contain. These “bonus” doses have been observed elsewhere and are a good sign that, when vaccinations do ramp up, there will be more doses available than predicted.

Unfortunately for me, Catalonia is administering only 66% of the doses it has received. At least that’s better than Madrid at 51%. I have to wonder if the Spanish capital used its political clout to receive proportionately more doses only to find it couldn’t administer them. Color me skeptical.

With Spain and other European countries failing to administer all the doses they receive, it’s probably the right time for Pfizer to reduce its projected European shipments while it adjusts manufacturing processes to boost output.

Parenthetically, it looks like my advice last week to help Madrid reduce Covid-19 worked. I suggested that if Madrid’s conservative government re-branded Covid-19 restrictions as “snow days,” it might get better compliance and drive down its Covid-19 reproduction rate R. Conservatives seem to stomach restrictions due to weather better than restrictions due to a virus. The weather cooperated and Madrid closed schools until tomorrow for “snow.” Time will tell if R drops as a result of “snow days.”

Covid-19 vaccinations are not the end of the pandemic. At a financial conference last Wednesday, Moderna CEO Stephane Bancel noted that Covid-19 will become endemic, saying “SARS-CoV-2 is not going away.” Science Magazine suggests Covid-19 will follow the course of other coronaviruses.

Science Magazine says Covid-19 won’t go away after vaccinations.

Living with Covid-19 requires science and medicine to manage the virus. I’ve noted previously that the current high levels of infection enable significant Covid-19 mutations. By March, experts expect new highly contagious strains of Covid-19 to dominate US cases, driving up total expected deaths in the US to a million. New strains may require adjustments to existing vaccines and may reinfect people previously infected by a different strain.

Even after herd immunity is established worldwide, there will continue to be cases of Covid-19. It is heartening to know that the Biden administration will fund development of Covid-19 treatments.

Dr. David Kessler explains plans for a US antiviral program.

In the years before the entire world achieves herd immunity, air travel continues to provide a good vector for outbreaks in regions that haven’t been vaccinated and for individual cases in regions that have. My friend Nicole returned to Spain from the US recently and said that, while negative Covid-19 tests were required for flights, no one actually checked her paperwork. High tech companies are working on a Vaccination Credential Initiative (VCI) to protect travelers, but it’s anyone’s guess whether the travel industry will adopt the technology.

My friend Shane works in the travel industry. He noted that even if air travel is safe again, business has learned to operate successfully without it. Since business travel subsidizes personal travel, if businesses decide not to resume travel to pre-Covid-19 levels, consumers should expect higher travel prices to compensate. Higher prices, in turn, mean that not only will business travel contract, but personal travel as well.

My friend Deborah works in commercial real estate. As with travel, Deborah noted that even if offices are safe again, many businesses have learned to operate successfully without them. She expects it will take years and a lot of creative deal making to redeploy existing inventory.

Then there’s the issue of what the Covid-19 pandemic has done to women. In the latest US labor report, 140,000 people lost jobs. Well, actually, 156,000 women lost jobs and 16,000 men gained jobs. The Covid-19 pandemic has reversed gains women have made in the labor force. Whether women can regain jobs lost during the pandemic probably depends on how day care and schools evolve as herd immunity is reached.

I have to comment on political developments in the US. Trump has become the first US president to be impeached twice. In my opinion, he should be impeached for allowing 400,000 Americans die from Covid-19, but insurrection at the Capitol is a clearer case for the Senate to adjudicate on a constitutional basis.

One of the political features of the insurrection at the US Capitol was the sequestration of members of congress.

Republican House members refused to wear masks. Many members in the room tested positive for Covid-19 afterwards. Democrats were furious. Here is Representative Marjorie Taylor Greene’s (R-Georgia) response.

I hope Biden finds a way to push Covid-19 past partisanship. Trump made Covid-19 a political issue and it cost 400,000 lives.

Things with Covid-19 are still bad.

Covid-19 is so bad in Los Angeles, it’s taking on toll of reporters.

Sara Sidner reports on Covid-19 parking lot funerals in Los Angeles.

Covid-19 bits.

Here’s some fun advice on stopping the spread of Covid-19 while making speech less dangerous.

I write this for my sanity and to make a record of living in the time of Covid-19. If you find it useful, please pass it on to friends and family. For more frequent Covid-19 updates, follow me on Twitter.

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