Covfefe-19 The 12th Part: The Only Thing Worse Than This New Board Is TrumpVirus2020

[leswp1]

California is the 5th largest economy in the world. If they're too poor to do this, we need to just call it a day.

Just like you can't eat money, money can't administer care or staff resources out of nothing.

[dxmnkd316]

What's beautiful is that he's also threatening to fine hospitals $100,000 for not vaccinating people fast enough.

The beatings will continue until morale improves

[leswp1]

Large Numbers Of Health Care And Frontline Workers Are Refusing Covid-19 Vaccine

Great.

Interesting. I don't know anyone who has declined. Lots of my friends are posting 'the picture'. My kid for one. I am in line. Can't wait. NPR had an interview with Liz Walker- previously was a newscaster and now a Presby Minister. She had Fauci come talk to her church in Roxbury (largely African American community) and she described him having to field the Tuskegee thing with her community.

[dxmnkd316]

No one is equipped to handle this until the Feds can work out the supply chain. It is not a question of hand holding. It is a question of giving very clear guidance and developing protocols that are evidence based. Medicine does not work well using a business model or libertarian model where everyone gets to pick what works for them like you are choosing a color of paint. Protocols should have decision trees that take into consideration the different situations each state is in*.

*a lot of the fly over States and southern States have minimal Public Health infrastructure. This has been true since I was in grad school in the mid 80s. No matter what the protocols say, they are incapable of implementing without a whole lot of help- esp in the rural areas decimated from yrs of underfunding and no State support.

This is exactly right.

Oklahoma may be able to vaccinate more people faster. But their Evite County Fair approach is going to get more people killed with the scarcity of the vaccines.

[MichVandal]

Flu vaccine is a whole different animal in multiple ways-
-in general there is no shortage-
-there are different formulations- injection and nasal mist with only one does required.
-the orders and coordination for ordering happen months in advance- you have options of where to obtain and have predictable, scheduled deliveries
-it is distributed in multiple settings- private offices, clinics, pharmacies, various town/county 'clinics', in-patient settings, residential settings
-all settings have protocols set up to encourage people to get the vaccine and most start promoting this months in advance- our practice sent out messages to everyone on the portal.
-storage is pretty basic- regular fridge- in some of the pop up places they put it in a cooler but it is gone so fast it doesn't spoil.

Even when we had H1N1 where they had to work on the fly, we had excellent communication re the supply of vaccine, when it was coming, and who should get it first.

Current vaccine is completely different-
-more than one type- not interchangeable.
-2 doses needed and they have to be the same kind
-limited supply. Usual system of ordering, coordinating what/when/how much is not in control of the people who are attempting to coordinate.
-there was no ramp up preparing people for what would happen creating confusion for everyone at every level. They didn't make recommendations until it was approved and there was all sorts of debate in attempt to predict what the recommendations would be.
- supply chain is not clear/not predictable. It's not delivering as promised which makes planning a cf- you need to give vaccine while rationing what is available hope delivery happens for dose 2
- Most places are getting both types but what and how much is is a roll of the dice. exacerbating planning issues.
- guidance has been given but no real leadership- it is like the wild wild west with different States doing different stuff.
- you need to observe the pt after it is given for at least 15 minutes so you can't just do drive thru- you need to put them somewhere- NH is doing drive thru and holding in parking lot.
- Not available to many of the places who would usually give flu vaccine- private practices, small clinics, pharmacies, various small facilities- the distribution lots are too large and they don't have volume or storage. Storage is an issue for most of the places that pop up to distribute the flu vax.

I know it's not the same, and the supply of the new vaccine is still evolving.

But in terms of distributing it to people, is there a good reason why the existing flu shot system not work? Especially the pharmacies, who have data on their customers, so they could easily get it out to people who meet reasonably specific health criteria.

It would be better than a parking lot out in the middle of Florida.

[leswp1]

I know it's not the same, and the supply of the new vaccine is still evolving.

But in terms of distributing it to people, is there a good reason why the existing flu shot system not work? Especially the pharmacies, who have data on their customers, so they could easily get it out to people who meet reasonably specific health criteria.

It would be better than a parking lot out in the middle of Florida.

yes all the reasons stated. This isn't as simple as just stabbing people. there are multiple issues beyond availability of supply. They need to give 2 doses so that means they have to track and coordinate dose 2.

We aren't like most developed countries. We have a fragmented, uncoordinated, decentralized system that has no consistent way to communicate between parties*. Pharmacies are only a small part of flu vaccination. Can't speak for other places but here we have multiple outlets including but not limited to- town clinics, hospitals, private practices, specialists, pharmacies, community health centers, places of employment, healthcare facilities, daycares, schools (I know I am forgetting some). Many of them are walk up so no way to track other than a document it was given. There is no database for who got it and more importantly many of the places have no access to medical history that would help them stratify. The focus is to get people vaccinated any way possible- throw enough options at someone and maybe they will get it. This vaccine we don't have enough supply to do it this way even without storage issues or dealing with tracking dose 2

Even if you were going to use pharmacy data bases- the pharmacy system where I am has been dismantled- many insurances force use of mail pharmacies so pts may not be in a local system. People use multiple pharmacies to get meds cheaper. They often go to a different pharm for flu shot because of convenience.

*we can't even get consistent communication between the PCPs, hospitalists, specialists and various facilities and that is on way less volume of pts.

Take home- our system has absolutely no coordination. Unlike other developed countries we have capitalism medicine which is not set up to be efficient or to care for everyone. It is only set up to work for paying customers. With the business model there is no need to make sure everyone is under the roof. There is no easy way to deal with this short of actually creating a system that is inclusive and how much motivation for that is there?

[leswp1]

For those with FB- this is someone I know. https://www.facebook.com/rhonda.wojt...16284910669208
Using laser to treat post-covid lung issues.

[Deutsche Gopher Fan]

To add to what les said- covid is a perfect example of why our system is so terrible.

I had to pay 3k out of pocket the last two months of 2020 because of our terrible high deductible plans, and now have my deductible set back to zero and likely need more specialist visits in the coming months which will cost additional thousands. I’m not rich by any means but at least I can pull that out of my hsa . Imagine how the millions of people who can’t afford that will fare

[dxmnkd316]

Want to sh-t your pants? Read this thread:
https://twitter.com/tomaspueyo/statu...054881280?s=20

Then follow-it up with this thread:
https://twitter.com/tomaspueyo/statu...076616192?s=20

Countries that stopped the virus from spreading got R from 2.7 to 1, a reduction of ~60%. Now, they need to reduce R by ~75%. But remember: all the low-hanging fruit is already used (masks, social distancing...). The next measures are all more expensive.

[Deutsche Gopher Fan]

I think it’s gonna be really bad later this month.

good thing Boris let people mix households for Xmas.

minnnesota relaxing indoor dining rules on Wednesday, perfect timing

[dxmnkd316]

It's here and in several states. This feels like January and February all over again. Luckily my wife's contacts are going to be multiple, multiple generations down the line for infections; not many international travelers or contacts with them. I'm desperately hoping the spike holds off for another few weeks here...

[dxmnkd316]

And Walz is kowtowing to political pressure instead of committing political suicide to help save lives. I get it's a hard decision, but the facts are:
1. We know it's here
2. We know it's significantly more easy to spread
3. It's worse to have a more rapidly spreading virus than a more deadly one (“If the fatality rate increased by 50 percent, that would lead to 193 deaths. In contrast, a 50 percent increase in transmissibility would lead to a whopping 978 deaths in just one month—assuming, in both scenarios, a six-day infection-generation time.” - from The Atlantic article published about a week ago)

This is like watching a really bad horror movie unfold.

[Deutsche Gopher Fan]

Yes, it’s def here and it’s gonna spread fast.

I have two colleagues in iowa who just found out they have it with little to no symptoms and seem surprised after they’ve been hanging out with friends for months.

[dxmnkd316]

Yes, it’s def here and it’s gonna spread fast.

I have two colleagues in iowa who just found out they have it with little to no symptoms and seem surprised after they’ve been hanging out with friends for months.

They have B117?

[Deutsche Gopher Fan]

They have B117?

Covid, sorry. You think Iowa is sequencing lol