POST 119. January 27, 2010. CORONAVIRUS. Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines. Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.

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“Former White House coronavirus task force official Dr. Deborah Birx revealed Sunday that Donald Trump used mysterious graphs during presentations on COVID-19 that she did not create, which provided selective, misleading data.

“I saw the president presenting graphs that I never made,” Birx said in an interview on “Face the Nation” on CBS. “I know that someone — someone out there or someone inside — was creating a parallel set of data and graphics that were shown to the president … You can’t do that,” she added. “You have to use the entire database.”

Trump was mocked for a fistful of charts he brought to an Axios interview last summer, which he had difficulty explaining or understanding…

Birx said there were people in the White House who “definitely” believed that COVID — which has now killed more than 400,000 people in the nation — was a “hoax.” (H)

“So how slow was the rollout under the Trump administration?

First target missed

As of 20 January, the day Mr Biden became president, about 16.5 million vaccines had been administered in the US, according to official statistics….

However, the US fell far short of the target set by the Trump administration to vaccinate 20 million people by the end of 2020….

The daily average for the week before Mr Trump left office was less than 900,000, according to Our World in Data, although there could be a slight lag in recording daily vaccination figures…

There are wide variations across different US states – for example, as of 20 January, Alaska had given out more than 9,000 doses per 100,000 people and Alabama less than 3,000…

Mr Trump focused attention on what he saw as slow delivery by individual states, rather than issues at the federal level.

He tweeted on 29 December: “The Federal Government has distributed the vaccines to the states. Now it is up to the states to administer. Get moving!”

There have been issues around co-ordination and preparedness at state level, but local authorities have put this down to a lack of support from the federal government once the vaccines are distributed….

President Biden’s Chief of Staff, Ron Klain has said a plan to distribute vaccines “out into the community as a whole, did not really exist when we came into the White House”.

Experts say significant logistical problems have arisen as well in administering the vaccines once they have been delivered to states.

As of 20 January, more than 35 million vaccines had been distributed across the US, but less than half of these had been put into people’s arms.

Public health professor at George Washington University, Dr Leana Wen said: “The federal government seemed to have ceded its responsibility at the point the vaccines were given to the states.

“The state and local health departments have been asking for months for additional funding, and have not been given the funding that they need,” she added… (A)

“New Jersey officials have conceded there is a disconnect between the state-run online vaccine registration system and the 200-plus COVID-19 vaccination sites run by local and county governments, health care providers and pharmacies.

The gap turns out to be significant, according to a state list updated Tuesday.

Less than 5% of the coronavirus immunization programs now operating in New Jersey are using the state’s registration system, with the vast majority running their own sign-up process through existing corporate or government websites or newly created portals specific to their location. Only one of the six state-overseen vaccine mega-sites — in Gloucester County — is linked to the New Jersey Vaccine Scheduling System, or NJVSS.

This uncoordinated registration system is frustrating the public as New Jersey residents eager to get vaccinated discover they cannot easily make an appointment through the state portal. Instead, the state scheduling system — which officials said has now pre-registered more than 2 million people — is designed to alert individuals when they are eligible and prompt them to make an appointment at a local vaccine clinic, which usually involves additional calls, emails or a separate sign-up process to secure a spot…

There are now 205 vaccine sites established, according to a DOH list updated Tuesday, although not all are operating at full capacity; nine rely on the NJVSS system.

All are connected to the state’s pre-existing vaccine inventory database, the New Jersey Immunization Information System, or NJIIS, which allows DOH to track their “throughput” and make allocation decisions for the week to come. Doses are shipped directly from federal stockpiles to the immunization sites.

While the state’s updated 190-page vaccine plan, submitted to federal officials in December, notes the importance of carefully tracking all doses — something that fell short during the H1N1 vaccine campaign in 2009 — it provides little detail on the public sign-up process and only mentions the NJVSS system once. Dispensing sites are responsible for everything from set-up to vaccine storage to patient registration, the plan notes, and offers various options for scheduling appointments…

“We are also exploring streamlining registration and scheduling at all of our sites that do not currently participate in NJVSS,” Persichilli said Monday. “Our attempt is to make appointment scheduling easier and one-stop shopping.”..

However, the NJVSS system does not currently have the capacity to schedule appointments for second doses, Persichilli noted Monday…

State officials also did not comment on why the registration system was not designed to handle return visits from the start, but stressed it was currently being updated to accommodate this element. The state’s vaccine plan appears to offer multiple suggestions on how clinics can schedule booster shots — including utilizing NJVSS.”  (B)

“The big reason for the slow vaccine rollout in New Jersey “is the federal program with CVS and Walgreens,” Murphy said. “They basically amassed these doses, they schedule visits to long-term care nursing homes, extended living, and they’re punching under their weight, particularly Walgreens, and that’s where most of the yet to be used doses are.”

New Jersey has a population of approximately 8.882 million people, and has distributed 898,550 vaccines, while only administering 432,220 of them, according to the Centers for Disease Control and Prevention.

“There’s no question we have an enormous supply/demand imbalance, that begins, with all due respect, with the federal government, at least up until today, having dropped the ball – over promising and under delivering,” Murphy said.

New Jersey Gov. Phil Murphy (D) blamed Walgreens and the federal government for the Garden State’s sluggish vaccine rollout during a Wednesday evening interview on CNBC’s “The News with Shepard Smith.”

“The big reason is the federal program with CVS and Walgreens,” Murphy said. “They basically amassed these doses, they schedule visits to long-term care nursing homes, extended living, and they’re punching under their weight, particularly Walgreens, and that’s where most of the yet to be used doses are.”

Murphy suggested to host Shepard Smith that Walgreens “put more bodies on the case” in order to solve the rollout problem.

On Tuesday, Murphy said that New Jersey was effectively equipped to dole out the vaccine, but that all the providers were missing “are the vaccine doses.” New Jersey has a population of approximately 8.882 million people, and has distributed 898,550 vaccines, while only administering 432,220 of them, according to the Centers for Disease Control and Prevention.

Murphy pointed to the Covid vaccine doses under state control and said that they are getting into people’s arms more efficiently.

“You can’t find many doses in hospitals or other distribution points that we control directly, that are going unused,” Murphy said. “We’re getting shots into arms with all of the areas that we can control.”  (E)

“President Joe Biden announced a series of measures on Tuesday aimed at ramping up coronavirus vaccine allocation and distribution, including the purchase of 200 million more vaccine doses and increased distribution to states by millions of doses next week.

With those additional doses, Biden said there would be enough to fully vaccinate 300 million Americans — nearly the entire US population — by the end of summer or early fall.

He described efforts to combat Covid-19 as a “wartime undertaking.”

“We now have a national strategy to beat Covid-19. It’s comprehensive. It’s based on science, not politics. It’s based on truth, not denial, and it is detailed,” he said.

As part of the new efforts announced Tuesday, the US will buy 100 million more doses from Pfizer/BioNTech and 100 million more from Moderna — the two-dose vaccines that have been granted emergency use authorization by the US Food and Drug Administration. Pfizer and Moderna are working to step up production, and Biden said that the additional doses will be available this summer.

The new purchase will increase the planned Covid-19 vaccine supply from 400 million to 600 million, an official told reporters on a call on Tuesday ahead of Biden’s remarks.

The President also took action on Tuesday to increase the weekly vaccine supply to states, tribes and territories — upping the current 8.6 million doses to a minimum of 10 million doses weekly. Additionally, the White House will be providing three week vaccine supply look-ahead reports to states as opposed to one week look-aheads.

Biden’s Covid coordinator, Jeff Zients, informed governors on a call Tuesday afternoon that Covid vaccine allocations for states would increase by around 16% starting next week.

A White House document explaining the move says the Biden administration is committing to maintaining this as the minimum supply level for the next three weeks.

The new efforts come one day after the President said he expects the US will soon be able to vaccinate 1.5 million people a day, which is a notable increase from the administration’s previously stated target of 1 million per day. The President said that the US could surpass that initial target in about three weeks, and said that he thinks anyone who wants a vaccine will be able to get it by this spring.

Biden’s official goal on administering vaccines still remains 100 million shots in his first 100 days in office, multiple White House officials told CNN, after Biden raised the new 1.5 million doses a day aspiration. That initial goal is enough to cover 50 million Americans with vaccines that require two doses.” (C)

“Smarter testing, faster vaccinations and health equity are cornerstones of the 200-page COVID-19 strategy released by US President Joe Biden’s administration on 21 January, as the country surpassed 420,000 deaths due to the coronavirus. The plan pledges to “listen to science” — a shift from the approach of former president Donald Trump, who, at times, politicized scientific evidence and ignored public health recommendations.

Many researchers posted messages on Twitter expressing relief that scientific evidence would play a central role in Biden’s plan. They also celebrated the existence of a coordinated national pandemic strategy, complaining that Trump’s failure to enact one impaired testing, tracing and other responses required to tame the outbreak.

Joe Biden’s COVID plan is taking shape — and researchers approve

“This marks a pretty radical shift,” says J. Stephen Morrison, director of global health policy at the Center for Strategic and International Studies in Washington DC, who compares Biden’s strategy to a wartime national mobilization…

The Biden plan aims to ensure that all Americans can be tested regularly for coronavirus infection by increasing the number of testing sites, and by scaling up the production of rapid tests. Helen Chu, an infectious disease researcher at the University of Washington in Seattle, says more testing will help, but it won’t be enough if the tests don’t reach communities hit hardest by the virus. She says the US government must figure out how to expand home testing for people who can’t get to testing sites because of work, childcare duties or a lack of transportation.

Increasing the United States’ surveillance for new, potentially dangerous, variants of SARS-CoV-2 is also part of the Biden administration’s plan. But Chu wants to see a systematic strategy for sequencing the genomes of coronaviruses across the country, as opposed to researchers conducting studies on samples they happen to obtain through fragmented projects. “Right now, surveillance is being led by academic research labs in a piecemeal way,” she says, “and not at the coordinated high-throughput level that you need to identify and act on new variants quickly.”

Biden’s strategy also calls for a better online dashboard for tracking the prevalence of the virus in cities and towns across the United States, so that people and officials can make evidence-based decisions about socializing, or opening offices and schools. His plan also pledges to enhance data analysis at hospitals and health departments, and to modernize data systems used within the US healthcare system, which are often painfully outdated…

Chasing an ambitious goal of administering 100 million shots to US residents in its first 100 days in office, the Biden team proposes 100 new vaccination centers run by the federal government, mobile vaccination units in underserved areas, and using grocery stores and stadiums as vaccination venues. The ramp-up includes growing the ranks of vaccinators with retired or foreign-trained doctors, as well as medical students, and by directing federal staff like nurses, physician assistants and doctors at various federal agencies to assist US states.” (D)

“Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines, while seeking to get its employees inoculated “at the earliest appropriate time.”

In a letter written to Biden and dated Wednesday, Amazon Worldwide Consumer CEO Dave Clark said the e-commerce giant is prepared to leverage its operations to help vaccinate 100 million Americans in the first 100 days of the president’s administration.

“Our scale allows us to make a meaningful impact immediately in the fight against COVID-19, and we stand ready to assist you in this effort,” wrote Clark.” (F)

“Amazon wrote to President Biden on Thursday offering to assist with communication and technology. Microsoft is opening up its largely empty office campus as a vaccination center as part of a broader partnership with the State of Washington. Starbucks is assigning workers from its operations and analytics departments to help design vaccination sites, donating the labor to the same state while continuing to pay employees.

While some retailers and pharmacy chains have been directly involved in the rollout of coronavirus vaccinations, more surprising is the number of companies that have offered help despite having little to do with health care.

What these companies do have are vast national footprints, significant manpower, huge distribution warehouses and, in some cases, empty office buildings. And they have the money to spare for a public service effort that could boost both their public image and their bottom line.

“Big companies can think big,” said Arthur Herman, senior fellow at the Hudson Institute, a think tank in Washington, D.C. “They can afford to step back and think about their role as a social force in their state and in the country. They also have enormous supply chains and logistical connections.”

As Mr. Biden tries to ramp up vaccination efforts, he will need all the help he can get. The president has asked Congress for $20 billion to help fund vaccinations at stadiums, pharmacies and the like. He said Friday that he had tapped the Federal Emergency Management Agency to operate up to 100 mass vaccination sites.

But the private sector could assist the administration’s efforts with data storage, appointment scheduling, the delivery of supplies to clinics and hospitals, and more.

“Amazon, Google, Microsoft, these guys are consumer-facing people who can deal with billions of transactions on a daily basis,” said Suketu Gandhi, a partner Kearney, a management and consulting firm.

Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.

“We are not a health care company,” Kevin Johnson, the chief executive of Starbucks, said at a news conference announcing the partnership on Monday, “but Starbucks does operate 33,000 stores at scale, serving 100 million customers a week. And we have a world-class team of human-centered-design engineers who are working under the direction of the state, and health care providers like Swedish, Kaiser Permanente and others.”

The coffee chain will lend its expertise in “operational efficiency,” among other things, Governor Inslee said in a news release.

Microsoft will open up an empty building on its campus in Redmond to vaccinations in partnership with the state and health care providers. It is also offering its technology, building on abilities it has already offered to the government, including artificial intelligence to the State Department of Health to help track hospitalizations and tests.

“Certainly technology plays a role in the distribution of vaccines, as it basically does in the distribution of everything in the world,” Microsoft’s president and chief legal officer, Brad Smith, said at the event announcing the rollout.

Amazon is holding a pop-up vaccine clinic in Seattle on Sunday, through a partnership with Virginia Mason Medical Center; they hope to vaccinate 2,000 people. The company has also offered to vaccinate its own employees in the state, many of whom it says are essential workers — an offer it has made to Tennessee as well.” (G)

“As many as 90,000 Americans are projected to die from the coronavirus in the next four weeks, the Biden administration warned in its first science briefing on the COVID-19 pandemic, as experts outlined efforts to improve the delivery and injection of COVID-19 vaccines.

The hourlong briefing Wednesday by the team charged by President Joe Biden with ending the pandemic, was meant to deliver on his promise of “leveling” with the American people about the state of the outbreak that has already claimed more than 425,000 U.S. lives. It marked a sharp contrast from what had become the Trump show, in the last administration, when public health officials were repeatedly undermined by a president who shared his unproven ideas without hesitation.

The striking deaths projection wasn’t much different from what Biden himself has said, but nonetheless served as a stark reminder of the brutal road ahead.

Wednesday’s briefing was conducted virtually, rather than in person at the White House, to allow for questions from health journalists and to maintain a set timing no matter the situation in the West Wing. But it was not without technical glitches.

It featured Jeff Zients, the Biden administration’s coordinator for pandemic response; his deputy, Andy Slavitt; Dr. Anthony Fauci, the nation’s top infectious disease expert; Dr. Marcella Nunez-Smith, the chair of Biden’s COVID-19 equality task force, and Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention.

“The White House respects and will follow the science, and the scientists will speak independently,” said Slavitt.” (I)

Contemporaneous Case Study methodology

Jonathan M. Metsch, Dr.P.H.

https://www.mountsinai.org/profiles/jonathan-m-metsch
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