POST 102. January 2, 2020. CORONAVIRUS. “We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health. “Ultimately, the buck seems to stop with no one,”…

“Throughout late summer and fall, in the heat of a re-election campaign that he would go on to lose, and in the face of mounting evidence of a surge in infections and deaths far worse than in the spring, Mr. Trump’s management of the crisis — unsteady, unscientific and colored by politics all year — was in effect reduced to a single question: What would it mean for him?” (M)

to read POSTS 1-102 in chronological order highlight and click on

BACK ON NOVEMBER 18th

As Florida breaks the 900,000 milestone for COVID-19 cases since the pandemic began, a plan to distribute a COVID-19 vaccine in the state is all but imminent.

“We’ve got a solid plan,” Jared Moskowitz, director of emergency management for Florida, told the USA TODAY NETWORK-FLORIDA on Wednesday. His agency will be in charge of distribution of a vaccine once one is approved by the U.S. Food and Drug Administration.

Moskowitz has bought millions of syringes, alcohol swabs, gauze — even freezers for the Pfizer vaccine, which has to be stored at minus 80-100 degrees — in anticipation of the day there would be a vaccine to distribute.

“We’re ready to deploy the vaccine when it comes,” Moskowitz said.

The first doses will go to the hospitals, he said. The big unknown is how many doses Florida will get and who will get them first…

Under the plan the first groups most likely to get the vaccine would be health care and other “essential” workers, persons with medical conditions that place them at high-risk for COVID-19 complications, and adults 65 and older.

According to state records, Florida has over 1.34 million licensed health professionals, including 82,000 medical doctors, 364,000 registered nurses and 194,000 certified nursing assistants.

The state also has over 145,000 residents in long-term care facilities, which employ over 225,00 employees. Census data shows about 4.34 million Floridians 65 and older.

The Department of Health said it would “communicate directly with physicians, nurse practitioners and physician extenders regarding information and resources to vaccinate patients with underlying medical conditions for COVID-19.”

Initially, while supplies are limited, vaccines will be distributed by selection hospitals, according to the draft plan.

Next in line would come long-term care staff and residents, based on guidance includes nursing homes, assisted living facilities and intermediate care facilities for the developmentally disabled, the plan said.

Third would come first responder and critical infrastructure personnel, according to the draft plan. Emergency medical services personnel would vaccinate first responders, law enforcement officers and essential employees.

As the vaccine becomes more available, the state would move to Phase 2 where traditional providers of vaccines, including pediatricians, primary care providers and pharmacies, would receive doses.

“It is likely that in this phase, the (county health departments) will open Public Mass Vaccination Clinics, and the Department and/or Florida’s Division of Emergency Management might open such clinics to ensure there is equitable distribution of the vaccine, in the same way COVID-19 testing was made available,” the report said.” (A)

FAST FORWARD TO DECEMBER 30th

The decision to greenlight Covid-19 inoculations for senior citizens in Florida has spurred long lines at vaccination sites and a deluge of people crashing county computer systems and hospital phone banks to schedule their shots, experts said Thursday.

And it’s clear that the supply isn’t close to keeping up with the extraordinary demand.

Gov. Ron DeSantis “decided that Florida residents over the age of 65 would be given priority over essential workers,” Aubrey Jewett, a longtime Florida politics watcher and associate professor of political science at the University of Central Florida, said by email. “This is a different priority from the federal recommendation but justified by the fact that Florida has the 2nd largest percentage of seniors in the country (about 20%) and that people over the age of 65 make up about 80% of the fatalities from Covid-19.”

But while DeSantis and his administration have taken on a “coordinating role” and made sure that the first doses went to front-line health care workers and nursing home residents, the decisions about how to embark on phase two of vaccine distribution are made on the county level, Jewett said.

Dr. Sadiya Khan, an epidemiologist at the Northwestern University Feinberg School of Medicine, said: “This is such an important point and one where each state and each county left alone as an island is a setup for an unmitigated disaster, inequitable delivery, and inefficiency that could lead to more preventable deaths and hospitalizations. The lack of an infrastructure for a vaccine that we’ve literally been planning and known was coming for months is wholeheartedly disappointing but not unexpected.”..

The first-come, first-served vaccine rollout this week in Lee County, in southwestern Florida, resulted in an embarrassing national spectacle — hundreds of senior citizens, many swaddled in blankets and winter coats, camping out overnight in long lines at testing sites that quickly ran out of vaccines.

“This reminded me of pre-internet days of getting into a long line the night before rock concert tickets for the Prince ‘Purple Rain’ tour went on sale back in the 1980s and hoping they did not sell out before I got to the window to purchase mine,” Jewett said.

“We are not sure just yet, but our goal is to have a reservation system available some time within a week so that we don’t have 2,000 showing up at a site,” he said.

In Broward County, north of Miami, senior citizens seeking to be vaccinated this week swamped phone lines and administrators stopped taking appointments after they announced that they were booked through February.

The website of the state Health Department’s Broward office also crashed because it was unable to keep up with the high volume of inquiries.”  (B)

Florida’s county-by-county plan to vaccinate its elderly population has created a mass scramble for a limited number of doses, leading to hours long lines at vaccination sites and overwhelmed county hotlines and websites.

In southwest Florida, the Lee County Department of Health encouraged anyone 65 and older and high-risk frontline health care workers to come to one of seven vaccination sites. Each site had just 300 vaccine doses, and “no appointment is necessary,” the county said.

The first-come, first-serve plan led to huge lines forming overnight Tuesday as people camped out on lawn chairs and waited for hours…

The long wait is a preview of what looks to be a tumultuous vaccine rollout and reflects the public’s pent-up demand for vaccines as well as the logistical difficulty in administering them in an orderly way.

The issue is partly a consequence of the lack of consistent federal guidance in administering vaccines, as President Donald Trump deferred that decision-making to the states. In turn, Florida Gov. Ron DeSantis broke with recommendations from the Centers for Disease Control and Prevention to focus first on vaccinating the elderly rather than essential workers, and he has encouraged each county health department to make its own decisions on administering the vaccines.

Florida is one of the few states that has begun vaccinating people beyond the first wave of health care workers and long-term care facilities. The state has administered over 150,000 vaccines so far, more than all but Texas, according to data from Johns Hopkins University.

Other Florida counties have tried to set up vaccination appointments for those who sign up online or through a hotline…

In Palm Beach County, the department of health directed people 65 and older to call an appointment hotline to get their vaccine. But the hotline can only handle 150 calls at a time and was being overwhelmed, the county said.

“We are working on expanding our infrastructure to handle the high demand we are experiencing,” the site said.

And in South Florida, Broward Health said all of its appointments are booked until February…

A CDC advisory committee recommended that states first vaccinate frontline health care workers and people in long-term care facilities, and Florida has followed that.

The CDC committee then recommended that states vaccinate people older than 75 and “frontline essential workers” such as first responders in a “Phase 1b.” Afterward, in a “Phase 1c,” states should vaccinate adults ages 65-75, people ages 16-64 with high-risk medical conditions, and “other essential workers,” the committee recommended.

As year-end approaches, vaccine rollout remains woefully behind schedule

However, DeSantis said the state is prioritizing everyone over age 65, with young essential workers later.

“Our vaccines are going to be targeted for our elderly population,” he said in a news conference last week at UF Health in The Villages, the central Florida community for people older than 55. “As we get into the general community, the vaccines are going to be targeted where the risk is the greatest, and that is in our elderly population. We are not going to put young healthy workers ahead of our elderly vulnerable population.”

The CDC committee’s recommendations represented a compromise between two strains of thought: preventing Covid-19 spread and preventing Covid-19 deaths. People ages 18-64 make up 75% of all coronavirus infections, while people older than 65 make up 81% of all coronavirus deaths, according to CDC data.

DeSantis, who has repeatedly downplayed the severity of Covid-19 for young people, said he did not agree with the CDC recommendations to vaccinate essential workers.

“If you’re a 22-year-old working in food services, let’s say at a supermarket, you would have preference over a 74-year-old grandmother,” he said. “I don’t think that that is the direction that we want to go.”” (C)

“DeSantis on Tuesday announced that a new batch of Moderna vaccines arriving this week would be directed in part to 54 hospitals throughout the state that had not yet received any doses in a continuing effort to get shots to frontline workers and others.

Yet even as shipments arrive, hospitals have raised questions about what support and guidance they’ll get from the state as they play a key role in vaccine distribution. During a call with Florida Surgeon General Scott Rivkees Tuesday, hospital officials asked for clarification on the state’s plan but did not always get answers, according to a report by the News Service of Florida.

Tampa General, the region’s largest hospital, started Wednesday administering vaccines to some patients 65 and older who receive care through Tampa General Medical Group, the hospital’s primary and specialty care network. Other hospital systems offering primary care in the area, including BayCare Health System, AdventHealth and HCA Healthcare, said there were no plans in place to begin vaccinating patients.

Some hospitals have opted to offer vaccines to virtually any hospital employee working in their building, or even spouses of employees. Others have not.

Florida should have an advantage in that local county health departments are all technically part of one large system, the Florida Department of Health, said Marissa Levine, director of the Center for Leadership in Public Health Practice at the University of South Florida.

Instead, she said, the public health departments are all doing something different, and seem to have been left to “figure this out on their own with not necessarily a lot of guidance” from the state.

Levine said while she does not think that anyone in public health is surprised by the rocky start — “it has been obvious to people in public health all along that we don’t have the infrastructure” — the thing that has been glaringly missing is communication.

“It has been extremely quiet, and people are clamoring for information,” she said.

The logistics of distributing vaccines becomes more complicated as they get administered to the general population, said Jen Kates, a senior vice president at the Kaiser Family Foundation. Distribution also is more difficult now because of the scarcity of available doses, she said.

Kates stressed that the country is early in the vaccine distribution process and it’s too early to make sweeping judgment calls of how different states are handling things. She said other states also are seeing confusing starts to their rollouts.

One major problem all states are experiencing, Kates said, is the lack of funding to handle a major distribution like this.

“Public health at the state and local level has been underfunded for years. Then COVID hit,” Kates said. She noted that the latest coronavirus stimulus bill does include $8.75 billion for vaccine distribution, much of which is slated to go to state and local jurisdictions.

Florida State University professor Leslie Beitsch, a former Oklahoma commissioner of health and former deputy secretary for the Florida Department of Health, said that while state and local officials must “do better” with vaccine rollout and communications, the public must also have patience.

In the meantime, he said, it’s important that people not let their guard down and continue with masking and social distancing so as not to spread the virus and further tax an already overburdened health system.

On Wednesday, the health departments in Pinellas and Hillsborough counties said they plan to begin allowing people 65 and older to begin making appointments for vaccines beginning in January, with Pinellas saying vaccines would be available next Tuesday while Hillsborough could only say early January. Hernando County said it will be able to begin offering the vaccine starting Jan. 4 to people 65 and older who make an appointment. Each of the health departments warned that supplies will be limited and none said how many doses would be available.”  (E)

“”If you’re opening it up to everyone in Florida 65 and older, then you’d better have a plan,” said Dr. William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine in Nashville, Tennessee.

That hasn’t necessarily been the case in the Sunshine State, where the chaotic coronavirus vaccine rollout for people 65 and older may be a lesson for the rest of the nation, as a decentralized, county-based public health system copes with overwhelming demand.

Florida’s latest vaccination data showed 122,881 people received the first dose of a two-part vaccine as of Monday morning; Johns Hopkins University data showed Florida had been allocated 546,400 doses as of Dec. 16.

Immunizing the general population involves much more than most people imagine, said Glen Nowak, director of the University of Georgia’s Center for Health and Risk Communications and a former communication director for the CDC’s National Immunization Program. 

“We know there are broad-stroke ideas of how this is supposed to work,” he said, “but as the vaccine gets distributed deeper and deeper into the system, it’s going to get more complicated.”

That complexity resulted in busy signals and hours of redialing in Miami, where people tried to get through to make vaccination appointments at hospitals in the face of sometimes contradictory information.

At Memorial Regional Hospital in Hollywood, the website read, “At this time, the Pfizer-BioNTech COVID-19 vaccine is not available to the community.” The switchboard told callers vaccine was not being distributed.

However, callers to the hospital’s COVID-19 line who could get through Monday were allowed to book vaccination appointments for people 65 and older until midday. Then a recording declared appointments for the vaccine were no longer being taken. A call to the hospital’s media relations department Monday was not returned.

Mount Sinai Medical Center in Miami began offering vaccine to seniors last week, though getting through to the appointment desk proved difficult for many. Monday, multiple attempts by USA TODAY resulted in busy signals. When the line was answered, staff said vaccine was available only to medical center patients.

That isn’t the case, CEO Steven Sonenreich clarified. The medical center offers vaccine to anyone 75 and older and will drop the age limit to 65 when demand eases. The initial rollout has been “a work in progress,” he acknowledged.

“What occurred has been that the vaccine was not here one day, and then all of the sudden, it was here,” Sonenreich said, adding that the system vaccinated its physicians and as many other medical workers as wanted it, then opened to others.

The hospital hired additional staff members to answer phones and deal with the increase in activity. Though Mount Sinai has always offered immunizations, “no one has a vaccine department,” Sonenreich said.

In Seminole County, the Health Department began administering shots to people 65 and older at a mall Monday. An immunization appointment system crashed repeatedly throughout the day, then immediately filled up through Jan. 9. The county asked for patience as it worked through the issues.

The county level is where such efforts need to be organized, said Dr. Walter Orenstein, associate director of the Emory University Vaccine Center and former director of the U.S. Immunization Program. “It’s the states and counties that know where to send the vaccine and what systems to have in place,” he said. 

Nowak, the former CDC immunization official, said they need money and time. “This is one of the reasons you’ve seen so many of the state and county health departments say how important it is that they get additional resources,” he said. “The complexity is going to do nothing but increase.”

The coronavirus relief and spending package President Donald Trump signed Sunday includes more than $8 billion for states for vaccine distribution. The money should have come much earlier, and with federal support for the effort, Dr. Ashish Jha, dean of the Brown University School of Public Health, tweeted in frustration late Monday.

“There appears to be no investment or plan in the last mile,” Jha wrote. “No effort from Feds to help states launch a real vaccination infrastructure. Did the Feds not know vaccines were coming? Shouldn’t planning around vaccination sites, etc not have happened in October or November?”

Orlando’s Orange County announced Monday it would begin vaccinating seniors Tuesday at the county convention center. At a news conference earlier in the day, county health officer Dr. Raul Pino warned the process wouldn’t go smoothly.

“Should you expect mistakes? Yes! We’re going to have issues,” he said. “We’ll work on those issues as they come.”

They came almost immediately. A website to take appointments went up Monday afternoon but quickly faltered as county residents spent hours refreshing their screens to try to get it to work.”  (F)

“Florida recorded more than 17,000 coronavirus cases Thursday, capping off a year that brought more than a million cases of the virus to Florida and left hundreds of thousands dead nationwide. It is the largest single-day increase in COVID-19 cases Florida has seen.

The Florida Department of Health announced 17,192 cases Thursday, bringing the total to 1,323,315 since the first publicly announced infection in March. The weekly case average increased to about 12,702 cases announced per day.

Over the summer, Florida shattered national records when it recorded more than 15,000 cases in one day. Since then, only California and Texas have reported higher single-day increases.

On Wednesday about 166,000 tests were processed, resulting in a daily positivity rate of 11.57 percent, according to state data which is updated and reported every 24 hours.

“The number we’re getting now is probably an underestimate of the disease,” said Dr. Marissa Levine, a professor of public health and family medicine at the University of South Florida.

Levine said some cases may never be counted by state officials because testing is just not widespread enough. She said she anticipates increases in coronavirus-related hospitalizations and deaths next. With Florida’s lax restrictions, Levine said “it’s just a matter of time” until a variant strain of the coronavirus is identified here, as it was earlier this week in California and Colorado.

Jason Salemi, a professor of epidemiology at USF who updates his own data dashboard, warned people not to be too concerned by what happens in a single day compared to a trend, but said the trends itself were concerning, with numbers increasing since Thanksgiving. Of particular concern, he said, is the pronounced increase in cases of those over 65 years old.

“When community spread is as high as it’s been, it makes it very difficult to protect the vulnerable,” he said. “The best way is to prevent community spread. …After the summer surge, that’s when we saw people participate in mitigatory behavior and that’s when the numbers went down.”

Jay Wolfson, senior associate dean of USF’s Morsani College of Medicine, said he doesn’t anticipate numbers improving before February.

“There’s an awful lot of gray, if not dark, news out there,” he said. “But it’s come at a time when some really hard work has created some light at the end of the tunnel that is real: that is the vaccines.”…

The rollout of the vaccine has been a slow and confusing process for many in Florida. Gov. Ron DeSantis said last week that residents 65 and older can get the vaccine, but many have struggled to find information on when and where they can sign up to do so.

If more people are hospitalized because of COVID-19, Levine said that stress on the hospital system could affect the rollout of vaccines.

“If the health care system is overwhelmed, it impacts the ability to adequately and efficiently vaccinate,” she said.

Salemi said he hopes news of the vaccine does not make people less vigilant.

“We’re a long way from the vaccine doing the work for us,” he said.

Hospitalizations: About 6,320 people are hospitalized with a primary diagnosis of coronavirus statewide, according to the Agency for Health Care Administration. About 1,300 are in the Tampa Bay area.

Cases that led to a hospitalization increased by 366 admissions.

Statewide, about 22 percent of hospital beds and 18 percent of intensive care unit beds were available. In Tampa Bay, about 20 percent of hospital beds and 16 percent of ICU beds were available. Tampa General Hospital and regional Medical Center Bayonet Point in Pasco County had only a handful of ICU beds available as of Thursday morning.

Positivity: Florida’s average weekly positivity rate is about 11 percent, according to Johns Hopkins University. It increased after Christmas holiday closures, which led to a dip in testing.

When positivity is too high, it indicates there isn’t enough widespread testing to capture and stop the spread of mild and asymptomatic cases. The World Health Organization set a recommendation for a 5 percent positivity rate or below before loosening movement restrictions. Only five states and the District of Columbia meet that recommendation, according to the university.”  (G)

New York has administered less than a third of the coronavirus vaccine doses it has on hand so far — even as Mayor de Blasio boldly claimed Thursday he’d have a million city residents inoculated within a month.

Around 630,000 vaccine doses have been sent to the Empire State, but just 203,000 doses had actually made their way into New Yorkers’ arms as of Wednesday, state data shows.

The figure, around 32 percent, is slightly higher than the national rate, with around 22.5 percent of the 12.4 million doses distributed being administered as of Wednesday, according to the Centers for Disease Control and Prevention.

In New York City, some 88,000 people have received a first dose over the last three weeks, as the vaccine began being administered to health care workers and nursing home residents.

“We are far, far behind where we need to be,” said Councilman Mark Levine, chairman of the New York City Health Committee.

Levine noted that the Big Apple has 500,000 health care workers alone in the high-risk category.

“We should be vaccinating 400,000 people a week,” he told The Post, calling the inoculation effort “the biggest, highest-stake challenge of the pandemic.”

De Blasio on Thursday vowed that far more people would get the shot next month.

“We’re going to vaccinate 1 million New Yorkers in January,” de Blasio told CNN…

Getting the 500,000 health care workers and the city’s other first responders  vaccinated is “the easiest part,” el-Mohandes added — because they’re captive audiences you can sign up at work.

But moving on to having the elderly and other private citizens vaccinated will be more challenging.

“Everyone of the stages depends on human behavior,” el-Mohandes said. “How are you going to reach these people?”

Even among health care facilities, there seem to have been some snags in getting staffers vaccinated.

Brahim Ardolic, the CEO of Staten Island University Hospital said Thursday that out of 6,500 workers at the hospital, just under 2,000 have been vaccinated.

“We would love to get more doses” from the state, Ardolic said. “I have people who want to get vaccinated.”

“I would love to get 6,500 does on my doorstep, but I’m not expecting it.”…

“New York has had one of the most successful vaccine rollouts compared to other states,” said Gov. Cuomo senior advisor Rich Azzopardi.

“The goal is to make sure nothing sits on the shelf.””  (H)

More than 70% of New Jersey’s supply of COVID-19 vaccine has not been used as of Thursday, echoing a national trend of slow distribution, according to data released by state officials.

Of the 265,000 doses of the Pfizer and Moderna vaccines that have been delivered to New Jersey, 72,657 residents had been given a shot by Thursday afternoon.

Despite months of planning, state officials said Wednesday a lack of personnel, along with logistics and timing issues were to blame.

“We are in the process of setting up hundreds of these [vaccination] locations. Some of them are going to be mega sites, and we have to schedule,” Gov. Phil Murphy said at his briefing. “Remember, you need health care workers to do this. I’m not qualified to deliver these vaccines.”

The slow rollout has been frustrating to a public eager to end a pandemic that has infected at least 477,000 New Jerseyans, killed more than 19,000 and caused vast economic hardship.

About 3 million Americans have gotten shots as of New Year’s Eve well below the 20 million goal set by the Trump Administration.

State Health Commissioner Judy Persichilli said the rollout of the Moderna vaccine in particular has been slow because it was delivered just before Christmas.

“There were no vaccinations on the 25th, and on the other days people didn’t want to be sick, they were concerned they were not going to feel well for the holidays,” she said. “So it’s ticked up again. We look at it, obviously, daily. We need to do some work on Moderna.”

Persichilli said 57% of the state’s stockpile of Pfizer doses had been administered as of Wednesday, calling it “one of the highest percentages that I’ve seen nationally.”

New Jersey is getting almost 100,000 fewer doses this month than officials had been expecting…

Delays or reduced shipments could threaten the state’s goal of inoculating 70% of the population — 4.7 million adults — within six months.” (I)

“A large percentage of front-line workers in hospitals and nursing homes have refused to take the Covid-19 vaccine, a hurdle for public health officials as the country struggles to roll out inoculations around the country.

About 50 percent of front-line workers in California’s Riverside County have refused to take the vaccine, Riverside Public Health Director Kim Saruwatari told The Los Angeles Times on Thursday. California is currently overwhelmed with cases as hospital staff in Southern California face a shortage of intensive-care units and have created makeshift units…

Anecdotally, an estimated 60 percent of Ohio nursing home employees have refused the vaccine already, Ohio Gov. Mike DeWine said during a news briefing Wednesday. It’s a stark contrast to the number of nursing home residents who have taken the vaccine when offered, which DeWine guessed to be about 85 percent.

“We’re not going to make them, but we wish we had a higher compliance,” DeWine said. “And our message today is: The train may not be coming back for awhile. We’re going to make it available to everyone eventually, but this is the opportunity for you, and you should really think about getting it.”..

It’s unclear how refusal by essential workers, who are prioritized to receive the vaccine in the first phase of administration, could further hamper the distribution efforts.

A survey of 2,053 New York City firefighters found that more than half said they would refuse the Covid-19 vaccine when it became available to them, according to a poll released by the Uniformed Firefighters Association this month.

Some of those firefighters may overlap with those who have already contracted the coronavirus and don’t believe they need to get the inoculation, Andy Ansbro, the union president, said.

“As a union we are encouraging our members to get the vaccine, but we are defending their right to make that choice,” Ansbro said. “I personally feel this vaccine is safe, I’ve done my own research, I will be getting the vaccine and I will be encouraging other members to do so. In the end, it is their own personal choice.””  (J)

“States vary widely in how many of the doses they’ve received have been given out. South Dakota leads the country with more than 48 percent of its doses given, followed by West Virginia, at 38 percent. By contrast, Kansas has given out less than 11 percent of its doses, and Georgia, less than 14 percent. 

Compounding the challenges, federal officials say they do not fully understand the cause of the delays. But state health officials and hospital leaders throughout the country pointed to several factors. States have held back doses to be given out to their nursing homes and other long-term-care facilities, an effort that is just gearing up and expected to take several months. Across the country, just 8 percent of the doses distributed for use in these facilities have been administered, with two million yet to be given.

The holiday season has meant that people are off work and clinics have reduced hours, slowing the pace of vaccine administration. In Florida, for example, the demand for the vaccines dipped over the Christmas holiday and is expected to dip again over New Year’s,  Gov. Ron DeSantis said on Wednesday.

And critically, public health experts say, federal officials have left many of the details of the final stage of the vaccine distribution process, such as scheduling and staffing, to overstretched local health officials and hospitals…

“We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health.

Federal and state officials have denied they are to blame for the slow rollout. Officials behind Operation Warp Speed, the federal effort to fast-track vaccines, have said that their job was to ensure that vaccines are made available and get shipped out to the states. President Trump said in a tweet on Tuesday that it was “up to the States to distribute the vaccines once brought to the designated areas by the Federal Government.”

“Ultimately, the buck seems to stop with no one,” Dr. Jha said…

The $900 billion relief package that Mr. Trump signed into law on Sunday will bring some relief to struggling state and local health departments. The bill sets aside more than $8 billion for vaccine distribution, on top of the $340 million that the C.D.C. sent out to the states in installments in September and earlier in December.

That infusion of money is welcome, if late, said Dr. Bob Wachter, a professor and chair of the department of medicine at the University of California, San Francisco. “Why did that take until now when we knew we were going to have this problem two months ago?”

Michael Pratt, a spokesman for Operation Warp Speed, said that there will always be lags between the number of doses that have been allocated, shipped, injected and reported. “We’re working to make those lags as small as possible,” Mr. Pratt said.

The task of administering thousands of vaccines is daunting for health departments that have already been overburdened by responding to the pandemic. In Montgomery County, Md., the local health department has recruited extra staff to help manage vaccine distribution, said Travis Gayles, the county health officer.

“While we’re trying to roll out vaccinations, we’re also continuing the pandemic response by supporting testing, contact tracing, disease control and all of those other aspects of the Covid response,” Dr. Gayles said.

Complicating matters, the county health department gets just a few days of notice each week of the timing of its vaccine shipments. When the latest batch arrived, Dr. Gayles’s team scrambled to contact people eligible for the vaccine and to set up clinics to give out the doses as fast as possible…

There are bright spots. Some states and hospitals are finding ways to speedily administer the vaccines they have received. West Virginia said on Wednesday that it had finished giving the first round of vaccine doses to willing residents and workers at all of the state’s 214 long-term-care facilities — putting the state far ahead of most other states that began vaccinating at these facilities under a federal program with CVS and Walgreens.

In Los Angeles, Cedars-Sinai Medical Center, which employs some 20,000 people at several facilities, was vaccinating about 800 people a day, said Dr. Jeff Smith, Cedars-Sinai’s chief operating officer. He said Cedars-Sinai expected to vaccinate all of its staff members who have opted for the vaccine within a couple of weeks.

But other communities are falling short of that rapid clip. Dr. Smith said the medical community is worried about staffing shortages when hospitals have to both administer vaccines and treat Covid-19 patients.

In a news conference on Wednesday, Operation Warp Speed officials said they expected the pace of the rollout to accelerate significantly once pharmacies begin offering vaccines in their stores. The federal government has reached agreements with a number of pharmacy chains — including Costco, Walmart and CVS — to administer vaccines once they become more widely available. So far, 40,000 pharmacy locations have enrolled in that program…

Compounding the challenges, federal officials say they do not fully understand the cause of the delays. But state health officials and hospital leaders throughout the country pointed to several factors. States have held back doses to be given out to their nursing homes and other long-term-care facilities, an effort that is just gearing up and expected to take several months. Across the country, just 8 percent of the doses distributed for use in these facilities have been administered, with two million yet to be given.

The holiday season has meant that people are off work and clinics have reduced hours, slowing the pace of vaccine administration. In Florida, for example, the demand for the vaccines dipped over the Christmas holiday and is expected to dip again over New Year’s,  Gov. Ron DeSantis said on Wednesday.

And critically, public health experts say, federal officials have left many of the details of the final stage of the vaccine distribution process, such as scheduling and staffing, to overstretched local health officials and hospitals….

“We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health.

Federal and state officials have denied they are to blame for the slow rollout. Officials behind Operation Warp Speed, the federal effort to fast-track vaccines, have said that their job was to ensure that vaccines are made available and get shipped out to the states. President Trump said in a tweet on Tuesday that it was “up to the States to distribute the vaccines once brought to the designated areas by the Federal Government.”

“Ultimately, the buck seems to stop with no one,” Dr. Jha said…

Complicating matters, the county health department gets just a few days of notice each week of the timing of its vaccine shipments. When the latest batch arrived, Dr. Gayles’s team scrambled to contact people eligible for the vaccine and to set up clinics to give out the doses as fast as possible…

In a news conference on Wednesday, Operation Warp Speed officials said they expected the pace of the rollout to accelerate significantly once pharmacies begin offering vaccines in their stores. The federal government has reached agreements with a number of pharmacy chains — including Costco, Walmart and CVS — to administer vaccines once they become more widely available. So far, 40,000 pharmacy locations have enrolled in that program….

It may be more difficult, public health officials say, to vaccinate the next wave of people, which will most likely include many more older Americans as well as younger people with health problems and frontline workers. Among the fresh challenges: How will these people be scheduled for their vaccination appointments? How will they provide documentation that they have a medical condition or a job that makes them eligible to get vaccinated? And how will pharmacies ensure that people show up, and that they can do so safely?

“In the next phase,” said Dr. Jha of Brown University, “we’re going to hit the same wall, where all of a sudden we’re going to have to scramble to start figuring it out.” (K)

It’s been two weeks since U.S. officials launched what ought to be the largest vaccination campaign in the nation’s history. So far, things are going poorly.

How poorly? Untold numbers of vaccine doses will expire before they can be injected into American arms, while communities around the country are reporting more corpses than their mortuaries can handle.

Operation Warp Speed has failed to come anywhere close to its original goal of vaccinating 20 million people against the coronavirus by the end of 2020. Of the 14 million vaccine doses that have been produced and delivered to hospitals and health departments across the country, just an estimated three million people have been vaccinated. The rest of the lifesaving doses, presumably, remain stored in deep freezers — where several million of them could well expire before they can be put to use.

That’s an astonishing failure — one that stands out in a year of astonishing failures. The situation is made grimmer by how familiar the underlying narrative is: Poor coordination at the federal level, combined with a lack of funding and support for state and local entities, has resulted in a string of avoidable missteps and needless delays. We have been here before, in other words. With testing. With shutdowns. With contact tracing. With genomic surveillance.

The vaccine has been billed as the solution to this crisis — an incredible feat of science that would ultimately save us from the government’s widespread incompetence. But in the end, vaccines are a lot like other public health measures. Their success depends on their implementation.

The implementation of these shots is complicated by a number of factors, including cold-storage requirements, which in turn necessitate special training for nurses and doctors. Training takes time and money, both of which are in short supply in most states. Some hospitals have said they don’t know which vaccine they are going to receive, or how many doses, or when. The federal tracking system that monitors vaccine shipments and whereabouts and the chain of communication among federal, state and local health officials have been disorganized…

Other countries are trying to offer the vaccine to as many people as possible. In Britain and Canada, for example, officials are planning to deploy all of their current vaccine supply immediately, rather than reserve half of it so those who get a first shot can quickly get their booster. Modeling has suggested that this approach could avert some 42 percent of symptomatic cases. Ideally, U.S. officials would at least consider similar measures. But more doses won’t make any difference if we can’t even manage the doses we have now.

Whatever the solutions are to the vaccine challenge, the root problem is clear. Officials have long prioritized medicine (in this instance, developing the coronavirus vaccines) while neglecting public health (i.e., developing programs to vaccinate people). It’s much easier to get people excited about miracle shots, produced in record time, than about a dramatic expansion of cold storage, or establishment of vaccine clinics, or adequate training of doctors and nurses. But it takes all of these to stop a pandemic.

It would be heartening if, after this wretched year, there was a decisive shift in that calculus, so that when the next pandemic descends, disease prevention — in all its glorious dullness — is given its due.” (L)

It was a warm summer Wednesday, Election Day was looming and President Trump was even angrier than usual at the relentless focus on the coronavirus pandemic.

“You’re killing me! This whole thing is! We’ve got all the damn cases,” Mr. Trump yelled at Jared Kushner, his son-in-law and senior adviser, during a gathering of top aides in the Oval Office on Aug. 19. “I want to do what Mexico does. They don’t give you a test till you get to the emergency room and you’re vomiting.”

Mexico’s record in fighting the virus was hardly one for the United States to emulate. But the president had long seen testing not as a vital way to track and contain the pandemic but as a mechanism for making him look bad by driving up the number of known cases.

And on that day he was especially furious after being informed by Dr. Francis S. Collins, the head of the National Institutes of Health, that it would be days before the government could give emergency approval to the use of convalescent plasma as a treatment, something Mr. Trump was eager to promote as a personal victory going into the Republican National Convention the following week.

“They’re Democrats! They’re against me!” he said, convinced that the government’s top doctors and scientists were conspiring to undermine him. “They want to wait!”

Throughout late summer and fall, in the heat of a re-election campaign that he would go on to lose, and in the face of mounting evidence of a surge in infections and deaths far worse than in the spring, Mr. Trump’s management of the crisis — unsteady, unscientific and colored by politics all year — was in effect reduced to a single question: What would it mean for him?..

His explicit demand for a vaccine by Election Day — a push that came to a head in a contentious Oval Office meeting with top health aides in late September — became a misguided substitute for warning the nation that failure to adhere to social distancing and other mitigation efforts would contribute to a slow-rolling disaster this winter.

His concern? That the man he called “Sleepy Joe” Biden, who was leading him in the polls, would get credit for a vaccine, not him.” (M)

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

FACEBOOK Jonathan M. Metsch     LINKEDIN Jonathan Metsch    TWITTER @jonathan_metsch

#CoronavirusTracker   #CoronavirusRapidResponse

APPENDIX

“As of Dec. 31, the following counties in Central Florida have shared information to help people register for appointments and get more information on vaccine availability. This story will be updated as more counties release vaccination plan details.

Brevard County | Appointment only

Brevard County is inoculating frontline healthcare workers and residents and staff of long term care facilities and will begin vaccinating people 65 and older on Jan. 4.

People who qualify under these priority groups must make an appointment. As of Dec. 30 all appointments were full. The county plans to reopen the registration portal soon.

The county opened a phone line on Dec. 29 for appointments but a day later switched to an online registration system due to demand. Appointments previously made by phone will still be honored. Here is the link to register online.

The vaccine site will be a drive-thru located at 2555 Judge Fran Jamieson Way in Viera.

Vaccinations will be provided between the hours of 8:30-11:30 a.m. beginning Jan. 5, and will continue for morning appointments through Friday and then Monday through Friday through the end of January. Afternoon appointments previously made by phone, will begin Monday Jan. 4, and continue Monday through Friday from 1:15 to 4:15 p.m. until further notice.

A driver’s license or healthcare badge is required at the time of the appointment.

Brevard Public School officials said the district will work with staff over 65 and healthcare specialists who work with students to make sure they have the time needed to get vaccinated.

People are asked to review the Moderna COVID-19 vaccine fact sheet. Residents are also asked to bring the COVID-19 vaccine consent form and the facts and privacy form.

Flagler County | Appointment only

The Florida Department of Health in Flagler County received its first round COVID-19 vaccine Dec. 28 and is working with Flagler County Emergency Management to finalize distribution.

Emergency Management Director Jonathan Lord said doses in this initial shipment have been earmarked specifically for healthcare providers in our community. It is anticipated that other priority groups, particularly those over the age of 65, can begin to receive vaccinations in the coming weeks, as additional doses are delivered.

Healthcare professionals who do not work directly for a hospital, nursing home or long-term care facility can receive the vaccination Saturday, Jan. 2 at a one-day event from 10 a.m. to 1 p.m. at the Flagler County Fairgrounds in Bunnell.

Flagler County residents 65 and older will be able to make appointments to be vaccinated starting in early January. Once the county is ready to start making reservations for those residents it will share a phone number. The timing will depend on when the health department receives the next allotment of vaccine but possibly as early as Jan. 4.

Lake County | Appointment only

Lake County will begin vaccinating people over 65 on Dec. 30 at two locations. Vaccines are free but appointments were required for the first few days.

There are two locations for the vaccines: the Clermont Arts and Recreation Center at 3700 S. Highway 27 and Lake Sumter College on U.S. 441.

Both locations are open Monday-Saturday from 9 a.m. to 4 p.m.

Vaccine immunizations will be available to seniors by appointment only at Clermont Arts and Recreation Center. Walk-ups will not be accepted.

Please bring identification and, if you are a health care worker, a copy of your medical license, ID badge or a current paystub.

Scheduled appointments at the Cooper Library, which was open prior to Friday but has since closed, will be honored at the Clermont Arts and Recreation Center beginning Jan. 1.

Lake County health officials said on Friday that only previously scheduled appointments were being honored at the Clermont Arts and Recreation Center for Friday and Saturday.

Officials with the Florida Department of Health in Lake County said on Friday they are not sure when the next shipment of vaccines will arrive, but once they do have them, they will inform the community. Officials said when they receive the second shipment, all immunization sites wil be walk-in.

“The Florida Department of Health in Lake County is no longer scheduling COVID-19 immunization appointments but will honor previously scheduled appointments,” a news release from Lake County officials read. “Currently, the Florida Department of Health is only distributing the first dose. Persons who have received their first dose will be contacted to complete the two-dose series.”

Once the sites start operating first-come-first-serve people over 65 will need to present identification and frontline workers will need to present a copy of their medical license, employee badge or current paystub.

For more information about vaccine sites in Lake County click here.

Marion County | Appointment only

The Department of Health in Marion County is slated to receive its first shipment of COVID-19 Moderna vaccine for residents ages 65 and older during the last week of December.

To request a vaccination appointment, go to this link https://tinyurl.com/y98cxp6s and complete the form. For those without access to a computer or smart phone, call the Marion County COVID-19 hotline at 352-644-2590 Monday through Friday from 8 a.m. to 5 p.m., and staff will submit the form online for you.

Once eligible residents submit their information on DOH-Marion’s website, they will be placed in line for a call-back by staff to set an appointment. Staff will call to schedule a vaccination appointment as vaccine becomes available.

The Moderna COVID-19 vaccine is a 2-shot series, with the second shot being provided 28 days after the first shot.

Orange County | Appointment only

The Orange County Department of Health began administering shots to EMTS and paramedics at the Orange County Convention Center on Dec. 26.

Beginning Dec. 29, people 65 and older can begin getting their vaccines at the Orange County at the Convention Center between 8 a.m. and 9 pm. Appointments are required.

This vaccine location is also open to people who live outside of Orange County.

Residents can register at OCFL.net/vaccines where they can also sign up for email updates to learn more about vaccine distribution. Here is the direct link to register.

After the first day the online registration portal was closed after more than 30,000 appointments were made within 24 hours. The county department of health has not yet announced when it will reopen the portal.

“At this time, the Department is closing the CDR HealthPRO portal to further appointments,” an email from the Orange County DOH read. “The Department will provide an update when the system reopens.”

The County will also provide updates via text if people text OCFLCOVID to 888777.

For those without smart phones or computers, community centers will also offer registration for the vaccine. The East Orange, Taft, Holden Heights and Center Hills community centers will have staff available to help people 65 and older register for vaccine appointments. Within the city of Orlando, the Beardall Senior Center on Delaney Avenue and L. Claudia Allen Senior Center on Mable Butler Avenue will be available to help residents register.

This link has step-by-step registration instructions.

Osceola County | Appointment only

The Florida Department of Health in Osceola County received its first allocation of the Moderna vaccine on Dec. 28.

As of Dec. 30, all appointments were full. The county plans to reopen registration soon.

Persons 65 years and older and health care personnel interested in receiving a COVID-19 vaccination may call 407-343-2000 to register. Once connected, callers should follow the prompts to receive more information on COVID-19 and remain on the line for the next available agent.

Due to call demand, the county also added an email option to register. Residents can email osceola.health@flhealth.gov and put “Vaccine” in the subject line. In the body of the email include your full name and phone number.

People who register will have the option to receive updates on vaccine availability via email. Health department staff will call to schedule appointments based on vaccine availability.

Osceola is coordinating with Osceola County Emergency Management and community partners to offer community-based and mass vaccination clinics as the COVID-19 vaccine becomes more readily available. Residents should continue to check osceola.floridahealth.gov for updates.

The department’s COVID-19 call center is available 24/7 at 1-866-779-6121 or via email at COVID-19@flhealth.gov.

Polk County | TBD

The Florida Department of Health in Polk County has not yet provided its plans.

“At this time, we are currently developing a plan for distribution as quickly as possible that meets the requirements of the governor’s executive order. As more doses become available, we will be working with our community partners to notify the community when the COVID-19 vaccine will become available,” a department spokeswoman said.

Seminole County | Appointment only

The Seminole County Office of the Emergency Management in conjunction with the health department began administering shots to people 65 and older on Dec. 28 by appointment only at the Oviedo Mall. Health care workers can also go to this site for the vaccine.

People can make an appointment by going to prepareseminole.org or by calling the citizens’ hotline at 407-665-0000 or go directly to Eventbrite to book an appointment. However, all appointments are currently booked as of Dec. 31 but people can continue to check back on the Eventbrite for cancellations until more appointments become available.

This vaccine location is open to people who live outside of Seminole County and the criteria were recently expanded to include non-hospital health care workers.

Residents can also text COVID19INFO to 888-777 to receive notifications when the vaccine becomes available to more groups and/or when more appointments are available.

Sumter County | Appointment only

Sumter County received 2,500 doses of the Moderna vaccine the week of Dec. 30. Those doses will first go to medical workers who will inoculate the rest of the community and those caring for COVID-19 patients.

The Sumter County Health Department will offer a “small block of appointments” at the Bushnell office to vaccinate people 65 and older. Appointments can be made starting Jan. 4 by calling 352-569-3102. Before signing up residents are asked to review the pre-vaccination checklist provided by the CDC. Officials did not disclose how many appointments would be available.

The county is planning a “mass vaccination event” at a future date but could not provide details. The health department estimates there are about 130,000 people in the county who are eligible for priority vaccinations and it will need more doses before that can happen.

Volusia County | No appointments required

Volusia County has been vaccinating health care workers as well as long term care facilities but will begin inoculating people 65 and older on Jan. 4.

The first drive-through vaccination clinic will run from 9 a.m. to 4 p.m., Jan. 4 and 5 at Daytona Stadium at 3917 LPGA Boulevard.

There are no appointments necessary but vaccine supply is limited and will be offered first come, first serve. Vaccinations are free.

Those who come to the stadium for a vaccine must bring a photo ID. Individuals also will be required to complete a medical screening form and sign an informed consent form before receiving a vaccination.

People who have had COVID-19 in the past two weeks or had a COVID-19 vaccine shot in the past two weeks will not be eligible to receive a vaccine at this event.

Only the Moderna vaccine will be provided at this initial community vaccination event which requires a second dose 28 days after the first shot. DOH-Volusia will return to this location in 28 days to offer the second dose to those who are due.

Prior to receiving a vaccination, individuals will receive the Moderna Fact Sheet on the Emergency Use Authorization and information on what to expect during and after the injection. Individuals are encouraged to contact their primary care provider with questions about whether they should receive the vaccine before presenting to a vaccination site.

After receiving a vaccination, recipients will be required to remain on site for 15-30 minutes for medical monitoring.

Future vaccination dates in several locations across the county will be based on vaccine availability. Notifications will be provided to the news media. Information also will be posted online at Volusia.org/coronavirus.” (D)

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