POST 93. December 20, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?

Colorado officials have said ski industry employees living in congregate settings would be part of the early vaccine rounds.

Vaccine distribution has now entered the political phase. This Post attempts to describe some of these asymmetrical discombobulations!

“Members of the U.S. Congress will be able to get vaccinated for COVID-19 with the distribution of the first tranche of vaccine doses, the congressional physician said on Thursday.

In a letter to members of Congress and their staff, Dr. Brian Monahan said he had been notified by the White House’s National Security Council that Congress “will be provided with a specific number of COVID-19 vaccine doses to meet long-standing requirements for continuity of government operations.”…

“My recommendation to you is absolutely unequivocal: there is no reason why you should defer receiving this vaccine. The benefit far exceeds any small risk,” Monahan said in the letter.

He said once members of Congress are vaccinated, Capitol Hill staff members who are considered essential will be given the vaccine, and then it will be made available to other staff members until the doses run out.” (A)

“Dr Anthony Fauci has said that President Trump ultimately ‘might want to get vaccinated,’ as he praised Mike Pence and the surgeon general, Jerome Adams, for opting to be injected live on television.

Fauci, speaking on CNN on Friday night, said he thought it would be a good idea for Trump to get the vaccination.

Being infected does not mean that you are guaranteed immunity.

But Fauci said that, given Trump was recently infected – his diagnosis was confirmed on October 1 – he may still have a high level of antibodies.

‘That’s a personal choice between the president and his physicians,’ said Fauci…

On Wednesday a White House official told CNN that Trump would not be vaccinated until his doctors told him to.

The official said the president continues to be open to getting vaccinated, but that he also wants to make sure frontline medical workers receive the vaccine first.”  (B)

But it could be because Trump had monoclonal antibody combination therapy?

Former New Jersey Gov. Chris Christie revealed Thursday he spent seven days in an intensive care unit before recovering from Covid-19, and implored Americans to wear masks and take the pandemic “very seriously.”

“The ramifications are wildly random and potentially deadly,” Christie said in a statement. “No one should be happy to get the virus and no one should be cavalier about being infected or infecting others.”

Christie tested positive for Covid-19 earlier this month and checked himself into Morristown Medical Center as a precautionary measure.

“Within 24 hours, I went from feeling absolutely fine to being in the intensive care unit,” Christie said Friday on ABC’s “Good Morning America.” He said he was treated with the antiviral drug remdesivir and Eli Lilly’s monoclonal antibody combination therapy.

News of his positive diagnosis — which came a day after President Donald Trump announced that he and first lady Melania Trump had both contracted the virus — followed his assistance to Trump in preparing for the first presidential debate in a series of sessions where no one wore masks.

Christie, who is overweight and asthmatic, had also attended a Supreme Court nomination ceremony for Judge Amy Coney Barrett on September 26, now believed to have been a superspreader event.”  (C)

“Rudy Giuliani, the public leader of a quixotic effort by Donald Trump to overturn the 2020 presidential election, was released from hospital on Wednesday evening after being treated for Covid-19.

Giuliani received “exactly the same” treatment that Trump received during his own hospitalization in October, the former New York mayor said, apparently including a drug cocktail of monoclonal antibodies that few patients have access to.

“His doctor sent me here; he talked me into it,” Giuliani said of the president in an interview with a local New York radio station. “The minute I took the cocktail yesterday, I felt 100% better. It works very quickly, wow.”

 Giuliani, 76, was admitted to Georgetown University hospital in Washington DC on Monday.

“My treatment by the nurses and staff at Georgetown Med Star hospital was miraculous,” the former New York mayor tweeted on Thursday. “I walked in with serious symptoms. I walked out better than ever.”

That account echoed the experiences of other members of Trump’s inner circle who have fallen grievously ill with coronavirus and been treated with monoclonal antibodies, synthetically manufactured proteins that mimic the immune system’s ability to fight off viruses.

But almost no one has access to the treatments in question: a cocktail manufactured by Regeneron and a similar treatment made by Eli Lilly.

The health secretary, Alex Azar, said on Wednesday that a total of 278,000 doses of the two therapies had been distributed in past months. Some states use a lottery system to allocate the drugs, while others rank patients by eligibility, the New York Times reported.

The United States has confirmed 15.5m cases of coronavirus over time, and more than 106,000 people are currently hospitalized in the United States with Covid-19, according to the Covid tracking project.

Giuliani, who has mocked contact tracing on Fox News and said people “overdo the mask”, is not the first member of Trump’s inner circle to credit the hard-to-get treatment with a fast return to health.

After the housing secretary, Ben Carson, 69, emerged from the hospital last month, he wrote on Facebook that he had been “desperately ill” but “President Trump was following my condition and cleared me for the monoclonal antibody therapy that he had previously received, which I am convinced saved my life.”

After being hospitalized in early October at Walter Reed medical center, Trump, 74, told the radio host Rush Limbaugh, “I might not have recovered at all” without the drug cocktail…

Giuliani credited his celebrity status with his successful course of treatment.

“If it wasn’t me, I wouldn’t have been put in a hospital, frankly,” Giuliani told WABC New York. “Sometimes when you’re a celebrity, they’re worried if something happens to you they’re going to examine it more carefully, and do everything right.” (D)

“Red tape, staff shortages, testing delays and strong skepticism are keeping many patients and doctors from these drugs, which supply antibodies to help the immune system fight the coronavirus. Only 5% to 20% of doses the federal government allocated have been used.

Ironically, government advisers met Wednesday and Thursday to plan for the opposite problem: potential future shortages of the drug as COVID-19 cases continue to rise. Many hospitals have set up lottery systems to ration what is expected to be a limited supply, even after taking into account the unused medicines still on hand.

Only 337,000 treatment courses are available and there are 200,000 new COVID-19 cases a day, “so the supply certainly cannot meet the demand,” said Dr. Victor Dzau, president of the National Academy of Medicine, whose experts panel met to discuss the drugs.

Antibodies are made by the body’s immune system to fight the virus but it can take several weeks after infection for the best ones to form. The drugs aim to help right away, by supplying concentrated doses of one or two antibodies that worked best in lab tests. The government is providing them for free, but there’s sometimes a fee for the IV required to administer the drugs.

Eli Lilly and Regeneron Pharmaceuticals have emergency authorization to supply their antibody drugs while studies continue. But the medicines must be used within 10 days of the onset of symptoms to do any good. Confusion over where to find the drugs and delays in coronavirus test results have conspired to keep many away.

“It can take anywhere between two and four days for results to come back and that’s absolutely precious time” for the drugs to have a chance to help, Dr. Keith Boell of Geisinger Health System in Pennsylvania told the experts panel.

“Our clinics have everything from a bus stop to a buggy stop,” serving big cities and horse-driven Amish communities, he said. “We really want to get these into anybody they can help” but it’s hard, he said.

Many states and health centers were not ready for the sudden availability of the drugs, said Dr. Ryan Bariola of the University of Pittsburgh’s 30-hospital system. It can be a nightmare for doctors or urgent care centers to figure out if a patient qualifies.

“How do you get it done? Do you call your local hospital? They may not have an infusion center set up. For a lot of independent physicians, this is very hard,” he said.

The crunch comes as vaccine efforts begin across the United States, monopolizing attention and staff.

States “didn’t see this coming … and have limited bandwidth” to deal with this on top of allocating vaccines, said Connie Sullivan, president of the National Home Infusion Association.

Many hospitals such as the University of Michigan’s quickly set up outpatient infusion centers but a shortage of nurses and other staff has been “the biggest problem we’ve had,” said a pharmacy resident, Megan Klatt.

Skepticism also is hurting use. The evidence that the drugs help is thin, several leading medical groups have not endorsed them, and many patients who feel only mildly ill see them as a risk: Half who have been offered them in the Michigan system have declined, Klatt said.

“It doesn’t help when physicians themselves are not totally convinced,” said Mohammad Kharbat, a pharmacy chief at a hospital system in Madison, Wisconsin, where half of patients also have declined.

At Wake Forest Baptist Health System in North Carolina, “we’ve had very little activity, very few referrals,” and not much interest from patients or doctors, said Dr. John Sanders.

The University of Utah has seen interest from patients and developed a formula to figure out who most needs the drugs, but getting the infusion “requires going to a website, being notified of your test result … doing some of the legwork yourself” and many people can’t manage that, said Dr. Emily Sydnor Spivak.

“We’re going to have to go out and find people” who qualify and offer them the drugs, she said.”  (E)

“New Jersey plans to open six vaccination “mega-sites” in early January, including at the Meadowlands racetrack in East Rutherford, as the campaign to inoculate residents expands beyond hospital employees to other health care and essential workers.

The six sites are expected to provide 2,400 vaccinations per day for health care workers through mid-February, state Health Commissioner Judy Persichilli said Friday…

New Jersey’s vaccine rollout is taking place in phases and began this week with health care workers. Six hospitals that received the first doses of a Pfizer-BioNTech vaccine authorized for emergency use gave first doses to more than 2,100 of their front-line staff. The second of two doses is to be given in three weeks.

Starting December 28, staff and residents of long-term-care facilities will begin to receive vaccines, Gov. Phil Murphy said. Two retail pharmacy chains — CVS and Walgreens — will conduct the vaccinations in nursing homes.

“With each successive wave, we will be closer to offering to general public,” Murphy said. The monthslong campaign is intended to enable any resident who lives, works or studies in New Jersey to receive a vaccine.

The timing of the progression among the groups will depend on the supply of vaccine, Perischilli said.

This week, the state learned that it would be receiving 34% fewer doses of the Pfizer vaccine than it expected next week. And while supplies of a new vaccine by Moderna, which was authorized Friday night, are to arrive next week, the projected amount was also lower than state health officials expected.

That “1a” group will be followed by “1b” — essential front-line workers. This group is expected to include police, firefighters, corrections officers, transportation workers, educators, and food and agriculture workers, according to the federal Centers for Disease Control. Details have not yet been spelled out by the national Advisory Committee on Immunization Practices or the New Jersey Health Department.

Group 1c will include people 65 years old and older and people with medical conditions that make them particularly vulnerable to severe illness with COVID-19.

While the mega-sites continue to operate, the state is also establishing a broad network of local sites to provide vaccines. Among the 215 sites already registered are local and county health departments, health clinics, primary care practices, urgent care centers and some retail pharmacies. That network will expand over time, Persichilli said.

The state plans to open a website in the coming weeks for the public to register, locate a vaccination site and schedule an appointment, the health department has said. Details are not yet available.

New Jersey’s goal is to vaccinate 70% of eligible adults — 4.7 million people — by June.

“Yes, that is aggressive. Yes, it is aspirational,” Persichilli said Friday. “But it’s what we need to do so this virus has no place to go.” (F)

“New York will be setting up regional hubs through local hospital systems to distribute COVID-19 vaccines as early as next month to essential workers and high-risk residents.

Gov. Andrew Cuomo detailed Wednesday that each region will develop its own distribution plan by the first week of January as New York anticipates at least 170,000 doses of the Pfizer/BioNTech vaccine in the near term and the potential for 346,000 doses from Moderna starting Dec. 22.

“It is a medical procedure. It will be handled by medical professionals,” Cuomo said. “There will be no political favoritism.”

The state has received 87,750 doses so far, and those are largely designated for medical staff. Another 80,000 Pfizer doses are scheduled to arrive in the coming days, with those slated for nursing home residents and staff.

Cuomo said all vaccines will be free to New Yorkers, and each region will determine how the doses will be prioritized as part of the Phase II distribution plan.

But he warned it will be a slow process: It could be six to nine months before everyone who wants a vaccine could get one…

The regional vaccine hub coordinators are:

Finger Lakes: University of Rochester Medical Center – Western New York: Catholic Health System – Southern Tier: United Health Services – Central New York: SUNY Upstate Medical Center – Mid-Hudson: Westchester Medical Center – North Country: Champlain Valley Physicians Hospital – Mohawk Valley: Mohawk Valley Medical Center – Capital Region: Albany Medical Center – New York City: Greater New York Hospital Association – Long Island: Northwell Health Systems” (G)

“Tens of thousands of prison inmates in Massachusetts will be among the first to be offered coronavirus vaccines, before home health aides, seniors and medically vulnerable residents of the state.

The inmates, along with people who live in homeless shelters and other congregate settings, will be vaccinated by the end of February, after health care workers, emergency medical workers and residents of long-term care facilities receive the shots.

The state’s high prioritization of inmates is unusual. A dozen states have listed prisoners among those set to receive vaccines in the first round of inoculations, but none ranks inmates so highly. Federal health officials have recommended that corrections officers and staff at state facilities receive high priority but have said nothing about inmates. The federal prison system has said it will vaccinate officers and staff first.” (I)

“Stanford Medicine residents who work in close contact with COVID-19 patients were left out of the first wave of staff members for the new Pfizer vaccine. In their place were higher-ranking doctors who carry a lower risk of patient transmission, according to interviews with six residents and two other staff members and e-mail communications obtained by ProPublica.

“Residents are patient-facing, we’re the ones who have been asked to intubate, yet some attendings who have been face-timing us from home are being vaccinated before us,” said Dr. Sarah Johnson, a third-year OB-GYN resident who has delivered babies from COVID-positive patients during the pandemic. “This is the final straw to say, ‘We don’t actually care about you.’”

Another resident, who asked not to be named, said a nurse who works in an operating room for elective surgeries has been notified she’ll get the vaccine in the first wave. “We test people for COVID before elective surgeries, so by definition, we will know if those patients have COVID,” he said, so to him, it didn’t make sense that that nurse would be prioritized.

“We take complete responsibility for the errors in the execution of our vaccine distribution plan,” said Lisa Kim, a Stanford Medicine spokesperson. “Our intent was to develop an ethical and equitable process for distribution of the vaccine. We apologize to our entire community, including our residents, fellows and other frontline care providers, who have performed heroically during our pandemic response. We are immediately revising our plan to better sequence the distribution of the vaccine.”

An algorithm chose who would be the first 5,000 in line. The residents said they were told they were at a disadvantage because they did not have an assigned “location” to plug into the calculation and because they are young, according to an email sent by a chief resident to his peers. Residents are the lowest-ranking doctors in a hospital. Stanford Medicine has about 1,300 across all disciplines.

Only seven made the priority vaccination list, despite the fact that this week, residents were asked to volunteer for ICU coverage in anticipation of a surge in COVID-19 cases.

Stanford Medicine didn’t respond to a request for comment on how the vaccines were allocated and whether there was a flaw in the algorithm. The tumult reflects the difficulties of ethically parceling out a limited supply of vaccine and weighing competing factors, such as age, risk of contracting the disease and comorbidities. Adding to the challenge is the angst that comes when such decisions are made without all stakeholders involved.” (H)

“Employers can require workers to get a Covid-19 vaccine and bar them from the workplace if they refuse, the federal government said in guidelines issued this week.

Public health experts see employers as playing an important role in vaccinating enough people to reach herd immunity and get a handle on a pandemic that has killed more than 300,000 Americans. Widespread coronavirus vaccinations would keep people from dying, restart the economy and usher a return to some form of normalcy, experts say.

Employers had been waiting for guidance from the U.S. Equal Employment Opportunity Commission, the agency that enforces laws against workplace discrimination, because requiring employees be tested for the coronavirus touches on thorny medical and privacy issues covered by the Americans With Disabilities Act of 1990.

The guidance, issued on Wednesday, confirmed what employment lawyers had expected.

Businesses and employers are uniquely positioned to require large numbers of Americans who otherwise would not receive a vaccination to do so because their employment depends on it.” (J)

“The chief executive of Uber, the ride-hailing company whose six New York lobbying firms include Albany’s best connected, wrote last week to Gov. Andrew M. Cuomo with an ask: priority for its drivers in the next round of coronavirus vaccinations.

Days later, the president of New York’s largest transit union spoke about the same topic with the chairman of the state transit authority, a Cuomo appointee. Not to be outdone, the Hotel Trades Council, a hospitality labor group with an aggressive political arm, urged the state’s health commissioner in a letter on Tuesday to give priority to its members.

Even a presidential elector had hoped to chat with the governor about who was getting vaccine priority — after they both took part in New York’s Electoral College vote.

Among state capitals, New York’s has long stood apart as a venue for favor trading and behind-the-scenes deals. Now, as the coronavirus rages and vaccines remain in short supply, the pandemic has been thrust squarely into the maw of Albany politics.

“Everyone is chasing the same thing now, and it really is remarkable,” said James E. McMahon, a veteran Albany lobbyist who represents a school bus company and other firms interested in early vaccination. “The need was there and then there’s the vaccine and all of a sudden, people are saying, ‘Oh Jesus, we’ve got to get in line now.’”

Apparently attuned to the atmosphere, Mr. Cuomo made several pronouncements this past week that his administration would not be swayed by interest groups.

“There will be no political favoritism,” the governor said in a news conference on Wednesday, a message he repeated on Friday.

The question of where groups of workers stand in the line for vaccines has yet to be resolved in New York or in a majority of other states, according to a review by the nonprofit Kaiser Family Foundation. The federal government is expected to issue final recommendations on who should be deemed essential soon. But it is largely up to states to prioritize vaccine distribution among those workers.

Some states, like Illinois, are awaiting further federal guidance for allocation beyond the initial vaccine supplies.

Others have provided some details. Colorado officials have said ski industry employees living in congregate settings would be part of the early vaccine rounds. Health officials in Georgia and Arkansas are including workers in meatpacking or food processing plants.

In New York, emergency responders like police officers, transit workers and those who maintain power grids and other critical infrastructure will almost certainly be part of the next wave, according to a state plan.

But the remaining uncertainty has led to clamoring for consideration in state capitols and in Washington from a wide array of businesses and workers. Tens of millions of Americans, designated as essential, continue to toil amid the pandemic’s dangers while others work from home.

The list of those who qualified as essential in New York, in order to continue working through virus-related shutdowns, stretched from chiropractors to landscapers to bicycle mechanics. That long list has allowed all sorts of industries to claim they should also be among the first for the vaccine.”  (K)

POSTSCRIPT

“Striking a compromise between two high-risk population groups, a panel advising the Centers for Disease Control and Prevention voted Sunday to recommend that people 75 and older be next in line to receive the coronavirus vaccine in the United States, along with about 30 million “frontline essential workers,” including emergency responders, teachers and grocery store employees… 

The panel of doctors and public health experts had previously indicated it would recommend a much broader group of Americans defined as essential workers — about 87 million people with jobs designated by a division of the Department of Homeland Security as critical to keeping society functioning — as the next priority population and that elderly people who live independently should come later.

But in hours of discussion on Sunday,  the committee members concluded that given the limited initial supply of vaccine and the higher Covid-19 death rate among elderly Americans, it made more sense to allow the oldest among them to go next along with workers at the highest risk of exposure to the virus.

Groups of essential workers, such as construction and food service workers, the committee said, would be eligible for the next wave. Members did clarify that local organizations had great flexibility to make those determinations.” (L)

Doctor, Did You Wash Your Hands?®  at  http://doctordidyouwashyourhands.com/

FACEBOOK Jonathan M. Metsch     LINKEDIN Jonathan Metsch    TWITTER @jonathan_metsch

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PREQUELS

PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill

POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”

POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”

POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)

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