“Oh what a tangled web we weave.”
-Sir Walter Scott
With 2020 in the rearview mirror, we would all love to put Covid behind us. Unfortunately, the virus doesn’t work on a calendar. In fact, based on hospitalizations, this tracker from the Wall Street Journal shows that the virus’s toll is only getting worse.
Since the blog is done in arrears, I’m usually writing based on the previous week’s events, and if it’s current events related, I will consider this the last post covering 2020. As such, it only fits that I end it on a rant.
End of Year Rant – 2020
It was a brutal year from a health standpoint, both physical and mental. The economic toll was devastating for millions of people working in industries that relied on people congregating together and traveling. My (continued) rant will be about the faith put in the vaccines, or more specifically, the ability to roll it out on a massive scale given all of the logistical challenges to do so.
Trump and Operation Warp Speed officials said 20 million people would be vaccinated by year-end. Here is a headline from Bloomberg showing how we are falling way short of the 20 million doses goal by year-end.
Here is a graph showing how far short we are of the 20 million doses by year-end.
Let’s not forget that the 20 million goals were drastically reduced from year-end goals of 100 million stated in October, then slashed to 40 million, then cut in half to 20 million. How many vaccinations have taken place? Approximately 2.7 million. Even if that’s understated, there is no way it’s understated by 17.3 million.
The Vaccination Plan in Israel
If the United States were inoculating people at the same rate as Israel, we would administer the vaccine to over 2 million people per day. Obviously, Israel is a much smaller country so maybe that’s not the fairest comparison. On the other hand, Israel was much better prepared to go immediately into action after procuring the vaccines. Israel is focusing on its oldest citizens first. And this makes sense based on research carried out in the country.
According to one assessment of the Israeli approach, which focuses on protecting the elderly first, vaccinating just the 0.5 percent of people over 90 drops the total fatality risk by 19 percent; vaccinating the 2.5 percent over 80 cuts it fully in half; vaccinating the 7.5 percent over 70, drops it by three-quarters.
As I have written about before, getting these vaccines shipped at incredibly low temperatures and stored at those temperatures and to countless places around the country is a “last mile” challenge that boggles the mind. You then need thousands of people ready and trained to administer the vaccines and, unlike in 1947 when over 6 million people in New York City were vaccinated in one month for smallpox, you can’t aggregate that many people together to create the scale and efficiencies to vaccinate millions of people. In addition, the smallpox vaccine had already been in production for many years so supplies were available, and more could be made relatively quickly. It also did not have the requirement to be stored at very low temperatures for which there was not enough freezer capacity.
Smallpox Vaccine in New York – 1947
Look at these pictures and tell me if you would stand in that line in the Covid age? This doesn’t even factor in that this would not be allowed in any major city in the country. Talk about the ultimate superspreader event! And because the vaccines are given in two doses it’s estimated that the first dose is 50% effective and takes some time for the antibodies to materialize so that if you have been exposed to Covid prior to getting the vaccine or shortly after getting the first dose, you still might get it. Another reason lines like these are an impossibility.
As an aside, according to the New York Times article, smallpox killed an estimated 300 million people during the 20th century.
This cannot happen today in terms of administering the vaccine. There can not be this many people gathered together indoors in confined spaces. With that being said, I have some questions I don’t know the answer to. According to the article, this is how smallpox spreads.
All it takes for smallpox to spread is a cough, a sneeze or a touch. After that, it’s only a matter of days before the virus triggers fever, aches, pains, and nausea. A rash appears on the face and soon covers the body, sprouting into fluid-filled pustules. Three out of 10 cases are fatal. Those who survive are often left deeply scarred, blind, or both.
Wasn’t there a huge risk in gathering so many people together in such close quarters when inevitably large numbers of people would cough, sneeze, or touch others? Wouldn’t this increase the risk of transmission greatly? Or would the vaccine work so quickly that it would neutralize the virus before it could do harm and be transmitted to others? Or was the risk worth taking because they were highly confident that very few people had it so bringing large numbers of people together to get vaccinated was a risk worth taking? I would love to know the answer to these questions.
Compare the above picture to this one from Bloomberg.
This does not look very scalable to me.
Unlike the smallpox vaccine, both the Pfizer and Moderna vaccines need to be stored in extremely cold temperatures before they can be used. Surprise, surprise, we’re already having issues with that as another article from Bloomberg shows.
At least three shipments of Moderna Inc.’s Covid-19 vaccine arrived in Texas last week with signs that the shots had strayed from their required temperature range, prompting a delay in other deliveries, according to the state hospital association.
Some Moderna vaccine shipments that were scheduled for delivery last week, before the Christmas holiday, were held back over the temperature problems, said Carrie Kroll, vice president of advocacy, quality, and public health at the Texas Hospital Association. It was unclear how many doses were affected overall.
And then there is this concerning table.
Why is the table above so concerning? Because most places don’t have ultracold storage capacity they have to rely on regular refrigeration to store the vaccines until they are used. This can only be done for 30 days before they can no longer be considered effective or safe. Thus, it is extremely important to get the first shots administered very quickly. And while the elderly would be the optimal recipients, it’s better to get it to others if necessary rather than let the unused vaccine go to waste. According to an article in the Intelligencer section of New York Magazine,
Canadian Vaccine Rollout
As a whole, the country has administered barely 10 percent of even the first doses allotted — and 20 million (identical) doses are being reserved for a second shot. A group modeling the Canadian rollout suggested that rushing to get as many first doses as possible out, and waiting for a new supply to deliver second doses, could avert as many as 34 to 42 percent of new infections, which is why Canada has now embraced that approach — as has the U.K.
In a sad deja vu reminder of the slow development and implementation of accurate tests, personal protection equipment, and contact tracing, we’re failing miserably at mass vaccinations and running a great risk that huge quantities of the vaccine go to waste.
Here in the U.S., we are continuing to hold back half of the vaccine doses we have, and hardly any state in the country is significantly above 10 percent of that initial allotment — which is to say, 5 percent of available doses. Though refrigeration capacity varies from location to location, vaccines are only cleared for 30 days of storage in the most common units (including those in which they have been shipped). States have been rushing to build out their storage capacity, but have been warned of monthslong waits for ultracold freezers that could extend shelf life to about six months. That means that, in many places, this first batch of vaccine is set to expire in late January, around the time Joe Biden, who has been criticizing the rollout and promising to accelerate it, is set to take office. Presumably, the American pace will accelerate somewhat even before then. By that point, about 6 million Americans — perhaps 10 million — would have been vaccinated on the current paced. And, depending on local bureaucracy and storage capacity, perhaps many million doses will be set to expire.
The rush to get dose one out and then deal with dose two at a later date makes sense, on the surface. Unfortunately, the clinical trials for Pfizer’s vaccine were based on the second dose being administered 21 days after the first one and Pfizer is very concerned that administering the second dose after 21 days may not be effective.
US pharmaceutical company Pfizer Inc. said that it has no data to establish that a single dose of its Covid-19 vaccine would provide protection against the virus after more than 21 days, undercutting the observation of the UK’s Joint Committee on Vaccination and Immunisation (JCVI). The UK government announced a new immunization strategy after the committee recommended inoculating as many people as possible with the first dose before offering others their second dose.
Not only do we have the enormous logistical challenge of manufacturing sufficient quantities safely and then distributing the vaccine to locations all across the country and then having enough trained healthcare workers to administer the vaccine quickly but we also need willing recipients. That last requirement cannot be overstated because even if everything else goes according to plan but people don’t want to take the vaccine, then it’s sorry Charlie. And right now there is still great skepticism. According to Bloomberg,
In long-term care facilities, few workers want the shot. About 60% of those who have been offered a vaccine have refused it, DeWine said.
I don’t want to end on such a pessimistic note. As a country, we sometimes get off to a slow start but eventually get our act together. Pearl Harbor and 9/11 come to mind. We put a concerted effort into ramping up our industrial might and translated that into military strength that won World War II. In spite of a more perilous world and more infringement on our time via greater security precautions at airports and office buildings, we have been remarkably effective at keeping the country safe from terrorist attacks.
Hopefully, over time we will be equally successful in our war against Covid.
Happy New Year!