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COVID-19 vaccine discussion


Texas Jeff

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10 hours ago, Neonmoon said:

Anyone have links to Houston vaccine appointments open for the super olds?

The best methods right now are if they are in a nursing/retirement home or if their doctor works directly for one of the major hospital systems and they’ve gone on an appointment in the last 2 years. 

outside of that, sit tight. Just like how testing was a cluster in the beginning, the initial days of the vaccine are probably going to be it’s shakiest. It should do nothing but get better.  The vaccine centers are quickly building experience, improving the mgmt process and hopefully will continue to get more supplies.

one part that sucks is that just because someone is in a tier to get the vaccine ASAP, it doesn’t mean one is available for them today.

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2 hours ago, Nice Guy Eddie said:

The best methods right now are if they are in a nursing/retirement home or if their doctor works directly for one of the major hospital systems and they’ve gone on an appointment in the last 2 years. 

outside of that, sit tight. Just like how testing was a cluster in the beginning, the initial days of the vaccine are probably going to be it’s shakiest. It should do nothing but get better.  The vaccine centers are quickly building experience, improving the mgmt process and hopefully will continue to get more supplies.

one part that sucks is that just because someone is in a tier to get the vaccine ASAP, it doesn’t mean one is available for them today.

Thanks for the info

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2 hours ago, Anastasis said:

Canadian models showing impact of the second dose reserve approach in covid rates. 
 

https://covid19-sciencetable.ca/sciencebrief/rollout-strategy-for-the-pfizer-biontech-covid-19-vaccine-in-ontario/

 

 

00F0A754-956D-4E89-8BAE-09A1E857B943.jpeg

So what this is essentially saying is that if you get as many shots as possible in to arms, the rate of infection goes down?

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2 hours ago, Anastasis said:

Canadian models showing impact of the second dose reserve approach in covid rates. 
 

https://covid19-sciencetable.ca/sciencebrief/rollout-strategy-for-the-pfizer-biontech-covid-19-vaccine-in-ontario/

 

 

00F0A754-956D-4E89-8BAE-09A1E857B943.jpeg

This graph is implying that hospitals receive 1,000 (or whatever) doses, and only vaccinate 500 people. I don't think this is how it's working in the US. The states are telling the hospitals and pharmacies that if they get 1,000 doses today, they guaranteed another 1,000 in 3 weeks for Pfizer and 4 weeks for Moderna.

Maybe Canada is managing this differently but this is proving an irrelevant point, at least for Americans.

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2 minutes ago, Nice Guy Eddie said:

This graph is implying that hospitals receive 1,000 (or whatever) doses, and only vaccinate 500 people. I don't think this is how it's working in the US. The states are telling the hospitals and pharmacies that if they get 1,000 doses today, they guaranteed another 1,000 in 3 weeks for Pfizer and 4 weeks for Moderna.

Maybe Canada is managing this differently but this is proving an irrelevant point, at least for Americans.

We’re holding back 55% of the supply in reserves. We are not pushing it out and letting the supply chain restock. Those are shots that aren’t going into arms. They sit in a freezer. The models are showing the impact of administering all available doses today, and the theoretical impacts of various delays in the second dose if the supply chain cannot keep up with resupply on the recommended schedule. 

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1 minute ago, Anastasis said:

We’re holding back 55% of the supply in reserves. We are not pushing it out and letting the supply chain restock. Those are shots that aren’t going into arms. They sit in a freezer. The models are showing the impact of administering all available doses today, and the theoretical impacts of various delays in the second dose if the supply chain cannot keep up with resupply on the recommended schedule. 

Can you provide a link that healthcare providers are holding back vaccines to give second doses? 

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Just now, Nice Guy Eddie said:

Can you provide a link that healthcare providers are holding back vaccines to give second doses? 

I believe that the reserves are being held by McKesson (or PFE's network), not in the freezers of providers.  But the effect is the same no matter at which point it is being held in cold storage in the distribution chain. 

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Just now, Anastasis said:

I believe that the reserves are being held by McKesson (or PFE's network), not in the freezers of providers.  But the effect is the same no matter at which point it is being held in cold storage in the distribution chain. 

I'm onboard with the vaccine developers that tell us that people need 2 doses for Pfizer and Moderna. Perhaps they should have run a parallel trial with one dose but I don't think they did. Now if the developers and fed govt say that it's better/acceptable to switch dosage strategies, then ok.

The current wave of covid diagnoses will NOT be impacted by the vaccine. The vaccine needed to be released months earlier for that. People need to change their behavior if we want to put a stop to the current wave. 

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So I took a look at weeks 1-4 of vaccine allocation in Travis County, to see where it was going.

So far, 94 sites have been allocated vaccine.  The top five have 40% of the vaccine and the next five have 20%.  Only 12 of the sites have only received more than one allocation.  About half of the sites have received only one 100 dose allocation.

So there are a lot of sites, but they're not ready for mass distribution.  The top sites are all hospitals and I am sure they are mostly vaccinating their staff.  The small sites may have enough to cover their employees and maybe a few extra folks, but they are not getting regular weekly deliveries.  They do not know when or if they will get more.  There is a regular cadence of deliveries to the states, but not a regular flow of vaccine to the sites.

The top five sites are Seton Medical Center, UT Health Austin (Dell Med), St. Davids Medical Center, North Austin Medical Center, and Dell Children's.  The next five are Dell Seton at UT, South Austin Medical Center, Communitycare North Central, and the DSHS Central Pharmacy Warehouse.  They've got 60% of the vaccine and are some of the only places in Travis Co that have received more than one delivery.

I don't think any of those top ten places have phase 1B clinics or online appointments set up for the public, but I could be wrong.  Right now you have to have some relationship with one of those places or get lucky and find a few doses at a pharmacy.  For most of us, we are going to have to wait for these big locations to get through whatever internal vaccinations they wish to do and then hope that they set up a public-facing vaccination effort.

Travis Co is only giving 2000 shots per day.  This is going to have to scale by about 5x if we want to get everyone over 16 vaccinated in six months.

 

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8 minutes ago, Texas Jeff said:

So I took a look at weeks 1-4 of vaccine allocation in Travis County, to see where it was going.

So far, 94 sites have been allocated vaccine.  The top five have 40% of the vaccine and the next five have 20%.  Only 12 of the sites have only received more than one allocation.  About half of the sites have only received only one 100 dose allocation.

So there are a lot of sites, but they're not ready for mass distribution.  The top sites are all hospitals and I am sure they are mostly vaccinating their staff.  The small sites may have enough to cover their employees and maybe a few extra folks, but they are not getting regular weekly deliveries.  They do not know when or if they will get more.  There is a regular cadence of deliveries to the states, but not a regular flow of vaccine to the sites.

The top five sites in Austin are Seton Medical Center, UT Health Austin (Dell Med), St. Davids Medical Center, North Austin Medical Center, and Dell Children's.  The next five are Dell Seton at UT, South Austin Medical Center, Communitycare North Central, and the DSHS Central Pharmacy Warehouse.  They've got 60% of the vaccine and are some of the only places in Travis Co that have received more than one delivery.

I don't think any of those top ten places have phase 1B clinics or online appointments set up for the public, but I could be wrong.  Right now you have to have some relationship with one of those places or get lucky and find a few doses at a pharmacy.  For most of us, we are going to have to wait for these big locations to get through whatever internal vaccinations they wish to do and then hope that they set up a public-facing vaccination effort.

Travis Co is only giving 2000 shots per day.  This is going to have to scale by about 5x if we want to get everyone over 16 vaccinated in six months.

 

There's a reason that experts have said this could take through the end of summer to vaccinate everyone that wants a vaccine. 

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1 minute ago, Nice Guy Eddie said:

There's a reason that experts have said this could take through the end of summer to vaccinate everyone that wants a vaccine. 

yeah, I get that.  But right now we are on a pace to finish in 2.5 years, which is not great.  Hopefully we can pick up the pace.

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I've been under the assumption that the lowest #s of available vaccines doses will be in the beginning. As in, right now.  If I'm not mistaken, the very first vaccinated people are only getting their second dose this week. Let's hope that that the manufacturers are using every available resources to produce doses as fast as possible.

Now we could decide that no one gets a second dose and allow them to be satisfied with partial immunity so that more people can quickly get partial immunity. I do question how that Canadian study above, can report on Day 50 results of the vaccine rollout when we're not even at Day 30 yet.

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4 minutes ago, Nice Guy Eddie said:

I'm onboard with the vaccine developers that tell us that people need 2 doses for Pfizer and Moderna. Perhaps they should have run a parallel trial with one dose but I don't think they did. Now if the developers and fed govt say that it's better/acceptable to switch dosage strategies, then ok.

The current wave of covid diagnoses will NOT be impacted by the vaccine. The vaccine needed to be released months earlier for that. People need to change their behavior if we want to put a stop to the current wave. 

I would not advocate for a single dose strategy based on the current evidence.  But I am also not sure that, given the current trajectory of cases and deaths, that we should be sitting on 50+% of the available vaccine stock with a full reserve strategy for the second doses.  Seems to me that a much smaller reserve would be sufficient to buffer disruptions in the supply chain. And what that models suggest is that even if there were fairly significant supply chain delays, we come out ahead pushing out the shots as quickly as possible.  Caveat, they are just models and not clinical data. 

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Interesting anecdote.... one of my sons (a South Austin hippie) married an anti-vaxxer. Both their sons (my grandsons) were not given the usual childhood vaccinations before she passed away 7 years ago (breast cancer). 
I still don’t know if my son has ever come to his senses since, but he did say yesterday that they will all get the Covid vaccine as soon as it is available to them. Bravo!!!

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2 hours ago, pearlandhorn said:

So what this is essentially saying is that if you get as many shots as possible in to arms, the rate of infection goes down?


That, and even if there is a delay in the second dose administration to up to 50 days, you come out ahead of a full second dose reserve strategy. Another graph from the full text section.  Get shots in arms. Tend the supply chain. Minimize the amount of reserve to minimum necessary. People are dying at a clip of ~4k per day.

 

Again, lots of caveats to this.  These data are based on models using assumptions based on the clinical data, as described. But right now I am tending towards the fuck around and find out camp.  

Fig1-1024x613.png

 

Figure 2. Predicted Cumulative Incidence of COVID-19 Cases for Days 11 to 60 After First Dose of Pfizer-BioNTech’s COVID-19 Vaccine, by Vaccine Rollout Strategy and Time of Availability of Subsequent Allotments
Predicted incidence of COVID-19 cases after vaccination with Pfizer-BioNTech’s COVID-19 vaccine, per 100,000 individuals included in Polack et al.’s Phase III trial,1 by vaccine rollout strategy and time of availability of subsequent allotments. *Subsequent allotments used to administer the first and second doses to 50% of a population. **Subsequent allotments used to administer second booster doses to 100% of a population. Efficacy of the first dose is assumed to be 85% from day 11 until day 27 after the administration of the first dose (Table 1). Efficacy after the second booster dose is assumed to be 95% from day 8 after the administration of the second dose onwards, based on data by Polack et al.1 As it is unclear how long the efficacy of 85% of the first dose will last, we assumed that the efficacy of the first dose would decrease to 70% from day 28 onwards until 7 days after administering the second booster dose in case of prolongations of the interval between first and second dose to 35 or 50 days. Estimates are for the population of participants included in the Phase III trial by Polack et al.1 and only reflect direct effects of the vaccine on vaccinated individuals but do not reflect indirect effects on unvaccinated individuals through decreased transmission.

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Eight state governors getting down with the Fuck Around and Trust the Manufacturing Supply Chain Plan. Some of these guys (looking at Cuomo in particular) are full of fucking shit and looking to deflect, but if that results in a push to release the reserve I am inclined to be for it. 

https://content.govdelivery.com/attachments/MIEOG/2021/01/07/file_attachments/1642013/Letter to the Federal Government 1.7.21.pdf

According to publicly reported information, the federal government currently has upwards of 50% of currently produced vaccines held back by the administration for reasons unknown.1 While some of these life-saving vaccines are sitting in Pfizer freezers, our nation is losing 2,661 Americans each day, according to the latest seven-day average. The failure to distribute these doses to states who request them is unconscionable and unacceptable. We demand that the federal government begin distributing these reserved doses to states immediately. Reportedly, the holding back of doses has been to prepare to ‘mitigate situations’ in the manufacturing and distribution of vaccines.2 In December, OWS announced agreements with both Pfizer and Moderna to acquire an additional 100 million vaccine doses from each company, bringing the combined allocations expected to the U.S. government to 400 million doses by the second quarter of the year. These agreements, combined with the expected emergency use authorizations of vaccines from Johnson & Johnson and AstraZeneca later this year, should give you the utmost confidence that the manufacturing pipeline is robust, safe, and capable of protecting a majority of the America public in the coming year. Our states are ready to work around the clock to ramp up distribution, get more shots in arms, and save more American lives. General Perna, as you have stated before, “a vaccine sitting on a shelf is not effective.” We couldn’t agree with you more. That’s why we are asking for your help now. When we work together, we can end this pandemic and return to a life of normalcy sooner.

 

 

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2 hours ago, Anastasis said:

Eight state governors getting down with the Fuck Around and Trust the Manufacturing Supply Chain Plan. Some of these guys (looking at Cuomo in particular) are full of fucking shit and looking to deflect, but if that results in a push to release the reserve I am inclined to be for it. 

https://content.govdelivery.com/attachments/MIEOG/2021/01/07/file_attachments/1642013/Letter to the Federal Government 1.7.21.pdf

According to publicly reported information, the federal government currently has upwards of 50% of currently produced vaccines held back by the administration for reasons unknown.1 While some of these life-saving vaccines are sitting in Pfizer freezers, our nation is losing 2,661 Americans each day, according to the latest seven-day average. The failure to distribute these doses to states who request them is unconscionable and unacceptable. We demand that the federal government begin distributing these reserved doses to states immediately. Reportedly, the holding back of doses has been to prepare to ‘mitigate situations’ in the manufacturing and distribution of vaccines.2 In December, OWS announced agreements with both Pfizer and Moderna to acquire an additional 100 million vaccine doses from each company, bringing the combined allocations expected to the U.S. government to 400 million doses by the second quarter of the year. These agreements, combined with the expected emergency use authorizations of vaccines from Johnson & Johnson and AstraZeneca later this year, should give you the utmost confidence that the manufacturing pipeline is robust, safe, and capable of protecting a majority of the America public in the coming year. Our states are ready to work around the clock to ramp up distribution, get more shots in arms, and save more American lives. General Perna, as you have stated before, “a vaccine sitting on a shelf is not effective.” We couldn’t agree with you more. That’s why we are asking for your help now. When we work together, we can end this pandemic and return to a life of normalcy sooner.

 

 

Like who didn't think this roll out was going to be a worse experience than Walmart on Black Friday

 

 

 

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Next week, Texas DSHS will focus on getting vaccine to large distribution hubs instead of smaller sites.  The idea is to make it simpler to find the vax and sign up for an appointment.  Next week is also the last week that reservations are required for long term care facilities, so more vax should go to either these hubs or other locations starting in a few weeks.

Happy to see them trying to adjust in real time to what is and isn't working...

 

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On 1/4/2021 at 9:58 AM, InkaUtexas said:

Why we have not figured out a way to do drive through vaccinations amazes me. Apply online, they send you a confirmation, go to the nearest place and get the damn vaccine while listening to your favorite music. My father and MiL (who has stage 4 cancer) are very hesitant about going anywhere to get the vaccine.   

They have.  In Tyler of all places.  I am getting my first shot tomorrow. I am a 1a. 

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Eight state governors getting down with the Fuck Around and Trust the Manufacturing Supply Chain Plan. Some of these guys (looking at Cuomo in particular) are full of fucking shit and looking to deflect, but if that results in a push to release the reserve I am inclined to be for it. 
https://content.govdelivery.com/attachments/MIEOG/2021/01/07/file_attachments/1642013/Letter to the Federal Government 1.7.21.pdf
According to publicly reported information, the federal government currently has upwards of 50% of currently produced vaccines held back by the administration for reasons unknown.1 While some of these life-saving vaccines are sitting in Pfizer freezers, our nation is losing 2,661 Americans each day, according to the latest seven-day average. The failure to distribute these doses to states who request them is unconscionable and unacceptable. We demand that the federal government begin distributing these reserved doses to states immediately. Reportedly, the holding back of doses has been to prepare to ‘mitigate situations’ in the manufacturing and distribution of vaccines.2 In December, OWS announced agreements with both Pfizer and Moderna to acquire an additional 100 million vaccine doses from each company, bringing the combined allocations expected to the U.S. government to 400 million doses by the second quarter of the year. These agreements, combined with the expected emergency use authorizations of vaccines from Johnson & Johnson and AstraZeneca later this year, should give you the utmost confidence that the manufacturing pipeline is robust, safe, and capable of protecting a majority of the America public in the coming year. Our states are ready to work around the clock to ramp up distribution, get more shots in arms, and save more American lives. General Perna, as you have stated before, “a vaccine sitting on a shelf is not effective.” We couldn’t agree with you more. That’s why we are asking for your help now. When we work together, we can end this pandemic and return to a life of normalcy sooner.
 
 

The Biden team announced they’ll be releasing available supply. Basically betting we can get manufacturing and distribution up to speed.
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