PART 113. January 17, 2021. CORONAVIRUS. The Next President Actually Has a Covid Plan… New York City and other places in the state expect to exhaust their supply of doses as early as next week… Charles Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine…..

“After a sluggish first month, the pace of coronavirus vaccinations is accelerating to the point that New York City and other places in the state expect to exhaust their supply of doses as early as next week, officials said on Friday, causing several health facilities to alter their immediate inoculation plans.

On Thursday, Mount Sinai Health System, one of the city’s largest hospital networks, canceled many upcoming vaccination appointments for older patients, saying the doses it had anticipated receiving were no longer likely to arrive.

Northwell Health, the largest health provider in the state, said it had mostly stopped scheduling additional appointments for the next several days given its limited supply.

Around New York, officials in at least one county said they had only enough doses to last through the weekend, echoing a similar sentiment by city officials.

Mayor Bill de Blasio said Friday on Brian Lehrer’s radio show that New York City would run out of doses by next week.

“It makes no sense that we’re being starved of the capacity we need,” the mayor said.

State officials warned this week that they were growing increasingly worried about the supply, pleading with federal officials to increase the number of doses they send every week. Gov. Andrew M. Cuomo has said the state receives only about 300,000 doses per week, although he indicated on Friday that the state had been told its weekly supply would be sliced to 250,000. About 100,000 of them go to New York City, Mr. de Blasio said on Friday.

Across the country, governors have expressed similar frustrations and made similar requests in the wake of federal health officials recommending that anyone over 65 be eligible for vaccination — making tens of millions more people eligible.”

This week, federal officials indicated that more doses from a stockpile would be sent to states. But they have since clarified that the batch is actually from a tranche saved for second doses. (People are considered fully vaccinated after receiving two doses.)

Until recently, New York City had been struggling to quickly administer vaccines, leading to a backlog of doses. But in recent days, the pace of vaccinations has picked up drastically because of expanded eligibility and because many new vaccination sites have opened over the last week.” (A)

“To even get an appointment for the vaccine, New Yorkers must navigate multiple buggy and complex systems,” City Comptroller Scott Stringer tweeted.

“There are widespread reports of vaccine doses languishing in freezers rather than being deployed to the long list of people anxiously waiting their turn. Successful vaccine rollout is essential to our survival as a city. We need to resolve these tech issues ASAP and optimize vaccine access and distribution on the front and back ends.”

Stringer has slammed the “bewildering” complexity of the sign-up process, which has as many questions as the city council has legislators — 51. He said the site is rife with technical issues…

Earlier in the week, Gov. Cuomo announced that around 500 pharmacies statewide would begin offering the shots, and that another 700 have agreed to participate in the future.

But many of the pharmacies that were approved to administer the shots, and were listed on a state website have not received the vaccine.” (B)

“At least 28 states and Washington, D.C., have begun vaccinating older people, a New York Times survey shows, in many cases marking a shift in earlier plans that had put medical workers and nursing home residents at the front of the line for Covid-19 inoculations.

As cases and deaths from the virus reach record levels across the United States, much is in flux when it comes to states’ plans for distributing the vaccine. At least 32 states have expanded their vaccination programs to include critical workers, such as police officers, teachers, grocery store employees and other people at risk of being exposed to the virus on the job. More than a dozen states have said they are expecting to expand their vaccination pools significantly before the end of the month.

More than half the states have begun vaccinations for older adults, in addition to health care workers and residents of long-term care facilities.

The changing vaccine rollout in many states, which matches a new federal appeal this week that all people over 65 — not just those in long-term care facilities — should be prioritized, was embraced by many older people, who have been the most vulnerable to Covid-19 and have been waiting eagerly for vaccinations and a return to normal life. But the sudden availability to so many more people also caused a deluge of problems as people tried to figure out whether their state was now allowing them to get shots, how to sign up, and where to go…

In states across the country, demand for the vaccine has far outweighed supply, leading to crashed websites, long lines outside vaccination clinics and overwhelmed public health departments that are facing a torrent of calls and emails.

While the federal government advises states on how best to distribute vaccines, states follow their own plans, and that has created a patchwork of policies. While a few states offered shots to older people in December or early January, most focused their initial vaccination plans on medical workers and those in long-term care facilities. But the rules are changing by the day: At least 14 states and Washington, D.C., opened up vaccinations to older people this week, and some of those changes came after the new federal call on Tuesday to open up vaccines to a wider group.

In Connecticut, people 75 and older are newly eligible for shots. In a few states, including Arizona and North Dakota, which opened up access this week to a far larger group, the rules vary from county to county. In Indiana, people 70 and older were permitted to start signing up for vaccines on Wednesday, and, by that afternoon, nearly 60,000 of them had done so. The state’s call center had long waits.

“You can imagine it’s almost like a gold rush, but it’s a vaccine rush,” Gov. Eric Holcomb of Indiana said.” (C)

“It’s the most massive vaccine rollout in U.S. history, but many local governments are consigning patient appointments to web-based services better known for handling birthday-party RSVPs and online yoga sessions.

Several Florida counties have deployed Eventbrite. Some Oklahoma governments dabbled with SignUpGenius and one New Jersey county was still using the service. Elsewhere, some seekers of Covid-19 protection reported hours-long holds on appointment hotlines — only to be disconnected — or logging on to websites that lock them out.

“Signing up to get a Covid vaccine is like trying to get a Beatles ticket,” said Jacob Saur, public safety director in Florida’s Manatee County, where demand for the shot crashed the web sign-up sheet he had set up.

In its first three weeks, the effort to inoculate 328 million Americans has overwhelmed government websites and left unlucky shutouts fuming in first-come, first-served lines. The difficulty is one reason that distribution of the long-awaited vaccine is taking so long. States have also had to contend with deciding which groups have priority access, confusion over available doses and navigating the daunting logistics of providing shots that must be kept at subzero temperatures.

Overall, the U.S. has administered 4.73 million doses of the Covid-19 vaccine, but that’s just about a third of the doses distributed.

Options are often confusing. A resident of Newark, New Jersey, can sign up for a shot with the city, surrounding Essex County or the state itself. And as elderly people in Florida and Georgia wait overnight in lawn chairs at pop-up sites, other vulnerable Americans — or quite often, their tech-savvy children — are spending hours refreshing computer screens.

Florida is piloting a scheduler of its own in certain counties, Saur said. But many of his peers turned to Eventbrite because it was familiar. It also was free…

In Florida’s Brevard County, the government decided to use Eventbrite on Wednesday when the phone lines stopped working at the local division of the Department of Health, according to Jesi Ray, a county spokeswoman. She said it took the county about three hours to set up the event, run tests, obtain approval and put out a press release…

In Hamilton County, Tennessee, which encompasses Chattanooga, there is no list at all. People eligible for early shots must show up and wait in line at a temporary site.

One 83-year-old heart and lung patient on New Year’s Eve waited in line for five hours in his car with his wife, breathing with the help of a supplemental oxygen tank. Twelve spots from the front, though, the shots ran out…

New Jersey, among the hardest-hit states early in the pandemic, is immunizing only health professionals and residents of long-term care facilities — in all, about 650,000 people — through at least the end of the month.

New Jersey’s statewide scheduling system went live on Tuesday, but the site went down before noon. Even before shots are available to the broad population, the state is struggling to assemble an inoculation-certified workforce, and appealing to medical retirees to help.

Meanwhile, some of the state’s 21 counties, including Essex and Passaic, are operating their own appointment websites. Hunterdon County was offering appointments via SignUpGenius, whose users more typically organize potlucks, carpools and bridal showers…

But states weren’t blindsided by the vaccine rollout in the same way, with the federal Operation Warp Speed announced officially on May 15 — half a year before the vials started arriving.

“It just seems there’s a general lack of preparedness, even though we knew that there was a vaccine coming in the near future that would be a game changer,” said Salemi, the Florida epidemiologist. “Because of the lack of a national coordinated effort, we’re finding that we can’t get these vaccines into people’s arms.”” (D)

“In December, the Centers for Disease Control and Prevention announced guidelines establishing priorities of who should get the vaccines first as the rollout began. Although the guidelines were broad, medical students learned that they could be included among the first wave of health care workers, especially those involved with care of Covid patients. But the rollout has varied widely across the country’s 155 medical schools, which have each set priorities based on the availability of vaccine doses in their state.

This has caused stress for some medical students continuing their clinical rotations. Although some schools bar students from treating Covid patients, that rule can be difficult to enforce, especially with asymptomatic cases.

At some institutions, like Duke School of Medicine, students working in intensive care units and emergency departments were placed in the highest level priority group, 1A, while all others were told they would be vaccinated under group 1B. At Yale School of Medicine, all medical students, regardless of their level of patient exposure, were told they would be vaccinated in reverse alphabetical order (“by the first letter of their last name, starting at the end of the alphabet”).

“Those who were at the later stages of the alphabet were happy but a bit confused as to how arbitrary it was,” said Sumun Khetpal, a fourth-year student.

Students at Texas College of Osteopathic Medicine in Fort Worth said that for weeks they had received no communication from the school about when they would receive their vaccines, so some drove hours across the state looking for private pharmacists who would give them shots. And at the University of Pittsburgh School of Medicine, students said they also had to “take matters into their own hands,” and reach out to private pharmacies to inquire about getting vaccinated because until last weekend, they were not told how to receive vaccines from their school.

“The C.D.C. guidelines did not have the level of granularity needed for hospitals and schools to make decisions,” said Dr. Alison Whelan, chief academic officer of the Association of American Medical Colleges. “There’s been a fair amount of variability because of the lack of a national plan.”

Adding to the confusion, the vaccines were allocated to states according to their populations, which do not always reflect their populations of health care workers, added Dr. Janis Orlowski, chief health care officer of the association. There are 21,000 med students in the country.” (E)

“As the pandemic continues to rage nationwide and a vaccine program to control it struggles, governors are increasingly turning to the National Guard to help expedite the process. At least 16 states and territories are using Guard members to give shots, drawing on doctors, nurses, medics and others skilled in injections.

Many more states are using thousands more Guard personnel for logistical tasks, like putting together vaccine kits and moving them around, logging in patients and controlling lines at state vaccination sites. In West Virginia, for example, about 100 Guard troops are assisting with distribution across the state.

“We are a logistical operation here,” said Maj. Holli Nelson, a spokeswoman for the Guard there. “That is what the military does best.””  (F)

“The incoming Biden administration plans to retire the name for the coronavirus vaccine effort under President Donald Trump — Operation Warp Speed — with a transition official for the incoming president telling CNN they are “moving to a new phase” of the coronavirus response.

“Operation Warp Speed was the Trump administration’s name for their response. We are structuring it differently and ours will have a new name,” said an official, who added that many of the “people who are working for Warp Speed who were critical to that operation will be critical to our response, too.”

As part of that effort, Biden has picked Dr. David Kessler, a former head of the US Food and Drug Administration, to be the chief scientific officer of Covid response, Biden’s presidential transition team announced Friday.

Kessler, who is currently the co-chair of the Biden transition’s coronavirus task force, will work out of the US Department of Health and Human Services under HHS secretary-designee Xavier Becerra, the official said, and his role will focus primarily on maximizing the supply of vaccines that are authorized or approved, and getting other vaccines online. The process of getting shots in arms will be run out of the White House and the team led by Jeff Zients, the official said.

Operation Warp Speed has been successful in rapidly manufacturing a safe and effective Covid-19 vaccine but has failed to meet expectations in administering doses to Americans. Biden has laid out a timeline for 100 million shots in the first 100 days of his term.

Gen. Gustave Perna, who is currently the chief operating officer of Operation Warp Speed, will stay on in the Biden administration, the official said, but under its “new structure.”” (G)

“This week, in an attempt to speed things up, the outgoing administration abandoned its own prioritization guidelines, and deemed some 152 million more people immediately eligible for vaccination. Officials also indicated that they would release an untold number of additional doses to the states quickly, rather than holding them in reserve as was originally planned. But those pronouncements have only made matters worse. Health departments have been overrun, web portals and phone lines have crashed, and consumers scrambling to secure appointments have been outraged to find that the vaccine is still not widely available. As The Washington Post has since reported, there are no reserve doses to be had.

To get more people vaccinated, states need trained vaccinators. They also need the technical capacity to schedule appointments for hundreds of thousands of people and public messaging campaigns to combat hesitancy. Officials need to inform people of where they stand in line and tell them when and how they should sign up to be inoculated.

President-elect Biden has vowed to get those measures in place quickly, and to vaccinate 100 million people in his first 100 days. That’s a worthy goal. But to succeed, he’ll have to do a much better job than his predecessor of communicating with and supporting states. The mass vaccination sites the Biden administration plans to establish will work great in some places, but support for community clinics will be the wiser course in others, and pharmacies will have a much bigger role to play in yet others.

The incoming president can help keep the overall effort on track by adhering to a clear national vaccination strategy: Is the goal to save as many lives as possible or to reopen businesses? Is the goal to vaccinate as quickly as possible or to ensure that precious shots are equitably distributed?” (H)

“Especially in this current phase, when we have an enormous vaccine supply sitting in freezers, instead of focusing on how to prevent some people from getting vaccinated, we should get the vaccine to the priority groups even if it sometimes means that people nearby who are not on the priority list get vaccinated, too.

Simpler schemas are less likely to be gamed by the privileged. The C.D.C. has recommended that everyone over 65 be eligible for vaccination, and that requires nothing more than an ID or a declaration required for proof — we’re not going to get overrun by 20-year-olds showing up pretending they are 65.” (L)

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“The U.S. secretary of health and human services, Alex M. Azar II, excoriated China on Thursday for its “bullying of international experts and scientists” and acknowledged for the first time that a top official at the Centers for Disease Control and Prevention was correct when she warned in February that the novel coronavirus might cause a severe disruption to American lives.

The official, Dr. Nancy Messonnier, was muzzled for nine months after issuing the Feb. 25 warning, which threw the stock market into a nosedive and infuriated President Trump, who was on his way back from India at the time. But she was merely repeating what she had learned from a White House Task Force meeting days earlier, Mr. Azar recalled.

“She got a little ahead of the briefing of the president and the official announcement,” Mr. Azar said. “But she and we were correct.”” (I)

“Amid a sputtering vaccine rollout and fears of a new and potentially more transmissible variant of the coronavirus, Britain has quietly updated its vaccination playbook to allow for a mix-and-match vaccine regimen. If a second dose of the vaccine a patient originally received isn’t available, or if the manufacturer of the first shot isn’t known, another vaccine may be substituted, health officials said.

The new guidance contradicts guidelines in the United States, where the Centers for Disease Control and Prevention has noted that the authorized Covid-19 vaccines “are not interchangeable,” and that “the safety and efficacy of a mixed-product series have not been evaluated. Both doses of the series should be completed with the same product.”

Some scientists say Britain is gambling with its new guidance. “There are no data on this idea whatsoever,” said John Moore, a vaccine expert at Cornell University. Officials in Britain “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”” (J)

“Health care workers, first responders and the elderly are all in line to get the initial doses of the coronavirus vaccine first, but Charles Barkley offered a different idea Thursday.

Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine.

“I think they should let NBA players and coaches all get the vaccine. That’s just my personal opinion. We need 300 million shots. Give some thousand to NBA players … NFL players, hockey players … As much taxes as these players pay, let me repeat that, as much taxes as these players pay, they deserve some preferential treatment,” Barkley said.

His co-hosts Ernie Johnson and Kenny Smith didn’t think that was a good idea. He didn’t really find any people on his side of the argument on social media, either.

NBA Commissioner Adam Silver told NBA teams last month the league “would not jump the line” to obtain the vaccines early, ESPN reported.” (K)

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