It’s All In the Delivery
My phone will ring five minutes after sending out this newsletter because my mom is a voracious reader of anything I write (thanks, mom!), but today I am writing about her quest to get scheduled for a coronavirus vaccine (sorry, mom!). I simply have to air the story here, because it is not unique – undoubtedly, it’s replicated across the country – and also, it’s bananas.
The story takes place in LA county where seemingly nothing could top the stunning statistic uttered last week by public health officials that one in 10 Angelinos were potentially infected and infectious… until this week when the LA Times reported one in every three people likely have or have had the virus. By the way, if you don’t live here and you don’t have to come, keep far away. If you do live here: stay home, stay distanced, and wear a dang mask!
Back to my mom. Now, I know better than to spell out her age, so let’s just say when the governor announced yesterday that anyone over 65 was vaccine eligible, she was pretty psyched. Her phone started ringing off the hook, texts flying in with tips from friends about where and how to sign up. Start on CalVax, everyone said, because it taps into the state’s database and points you to where you can get a shot. Logical notion. I am going to take a moment and beg you to click on the link, which is a big nono in the world of blog posts aimed at keeping readers glued to the author’s page, but you’ll see why (and if you’re too lazy to back up a sentence, here it is again: CalVax). The state’s clearing house website looks like it was designed by a fourth grader. No, wait, that’s an insult to fourth graders – I have seen their websites and those run circles around this one. If you like, give the site a try. I’ll see you in 30-60 seconds when you are already frustrated.
The CalVax experience explains why LA seniors found themselves immediately back on the horn trying to find alternate routes to vaccination. This time, though, they began to rope in their offspring, as cries of I can’t work this site! and There’s no way to get a vaccine before they’re all gone! ricocheted across cell phone towers throughout the southland. And beyond, actually, because most of my friends who grew up here but live outside of So Cal found themselves trying to navigate the senior sign-up process in LA from afar.
Then came news that Ventura county, which borders LA county to the north, had opened up spots for anyone 75 and older. Within two hours, the Ventura scheduling site crashed; by the next morning, it had been pulled down entirely. Rumor also had it that people 65 and older could go one county south, to Orange County. Lots of folks signed up, drove an hour either north or south, and received dose #1. Still, I heard from more than a few who were turned around at the door because they were not local residents. Meanwhile, the LA County Department of Public Health held a press conference to say that regardless of what any other counties were doing, LA would only vaccinate seniors once health care workers were through the line.
So let’s recap: the state announced a new tier could be vaccinated; every county was left to determine whether that would hold true; and for LA County residents, living in the epicenter of the epicenter of the pandemic, unless you had a fast internet connection and a car – the have-nots in this equation describes the vast majority of communities that are disproportionately dying of COVID – you would find yourself out of luck.
In an amazing twist, Ralph’s grocery stores to the rescue! By Wednesday night, the pharmacists at this big box-style retailer that stocks sugar cereals over organic ones (how un-LA, I know!) deemed the California state rule dominant. One senior I spoke with quoted her new favorite market-based pharmacist: I don’t really care what the county Department of Health says, you live in California, you are over 65, and so I am going to protect you. It will come as no surprise that I – along with everyone I grew up with whose parents remain local – spent a couple of hours on the intermittently-crashing Ralph’s site trying, trying, and eventually succeeding in scheduling my mom’s first dose of vaccine.
Ten minutes ago, I learned that Ralph’s had a change of heart, which means as soon as I am done writing I will be back at the scramble again.
It’s a long preamble to a wholly predictable story: yes, the race to vaccine development was critical, but ultimately getting protection into bodies is all a function of distribution. So, let’s do better here, Los Angeles. And California. And I am sure I speak to folks across the country. We have got to fix the roll out of vaccines because bungling this for all becomes a death sentence for some. The vaccum of leadership has never been acceptable, but now it may prove fatal. We need a federal plan. Short of that, if there’s a state announcement, the counties cannot be dumped upon to invent the processes that make an announcement actionable. This is especially unfair to county health officials, whose job it is to identify risks and promote interventions. When they don’t have any back up in the form of enforcement, they are left scrambling, their advice castrated. Said another way, the vaccine has to be rolled out in some sort of systematic fashion, because chaos doesn’t work – in order to protect the most vulnerable, they need shots in their arms; in order to protect those at the back of the line, it’s high time this entire country face consequences for not masking, not distancing, and not caring.
Lots of links today. Be well everyone!
VACCINE…
Breaking news! The most preliminary Johnson & Johnson vaccine data is out, and looking promising. More robust data is expected in the next couple of weeks, but news of lagging production has tempered enthusiasm. The vaccine works by using a harmless adenovirus – a virus that commonly infects humans but has been modified to not cause illness in this particular form – in combination with some Sars-CoV-2 genes to trick the immune system into producing antibodies to coronavirus. The pros: recipients may only require one dose; the early data suggest that within 2 months everyone in the study made antibodies; and perhaps most promising, this vaccine doesn’t have to be stored in super cold freezers like the Moderna and Pfizer offerings.
There’s a run on extra doses that have magically appeared in bottles from both Pfizer and Moderna
Britain announced last week that they would be distributing vaccine wildly off label, ignoring the manufacturer’s dosing recommendations by giving the second dose of vaccine as late as three months after the first – and possibly not at all. They’ve also suggested they might mix and match vaccine types, so if you get a Pfizer vaccine on round one, no guarantee you won’t receive Moderna when you return for the follow up.
If you are wondering why the US rollout is moving at a snail’s pace, this piece takes a stab at explaining.
Reports of anaphylaxis to vaccines are mounting, with new data suggesting that the Pfizer and Moderna vaccines both carry a risk of severe allergic reaction that is 10 times greater than the same risk for flu vaccine. Plan to stick around for 15 – 30 minutes after receiving the shot so that you can be monitored for signs of allergic reaction.
Exactly how protective is the first dose of either the Pfizer or Moderna vaccine? Clearly not as protective as many would hope.
There’s an ongoing trial of Moderna vaccine for 12-17 year olds, but enrollment has been much slower than anticipated. If you’d like more info including how to enroll your kid, here’s the study link.
SCHOOL REOPENINGS…
This study followed 11 school districts in North Carolina, approximately 100,000 students and teachers. If school and community transmission were the same, there should have been 800-900 cases documented; but impressively, there were only 32 transmissions on campuses. Most notably, not one case reflected infection passed from a student to a teacher.
Meanwhile, with viral surges in communities coast to coast and no coordinated rollout of teacher vaccinations yet, school systems across the US continue to vacillate in their reopening plans.
VIRAL MUTATION…
Over the past few weeks, you likely heard about the strain of coronavirus called B.1.1.7, also known as “the UK strain” containing a mutation that makes this strain of coronavirus up to 70% more infectious. It does not, however, seem to cause more severe disease or result in higher death rates.
B.1.1.7 seems to have an easier time infecting children by getting around their innate defenses.
If you aren’t sure which is worse – a virus that’s more transmissible or one that’s more lethal – take a look at this post from The Methods Man to break down the math (Spoiler alert: a more transmissible variant, even if not more lethal, will kill many more people).
LINGERING COVID…
Long hauler’s syndrome has been appreciated for a while now, but new research out of China suggests that up to ¾ of all COVID patients still have at least one symptom six months after diagnosis.
This is much higher than the one-in-three figure reported by CDC in July or the one-in-five figure out of the UK in November.
NEW COVID TESTS ON THE HORIZON…
Like this one that may be able to turn around accurate results in just 5 minutes – but don’t get too excited because the tests runs on lab equipment, so they can’t be done at home.
THE CURRENT MOMENT… In a week sandwiched between a capitol siege and an inauguration, as most of us hold our collective breath, it helps a little bit to process the events going on around us through a highly objective lens. So here’s a read about the science of mob thinking. The article’s thesis – that the way people determine what's true and what's false, especially online, relies heavily on people trusting sources of information over substance – really applies to every corner of our lives, from politics to pandemic and beyond.
