POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”

“Overall, we find states are increasingly diverging from CDC guidance and from each other, suggesting that access to COVID-19 vaccines in these first months of the U.S. vaccine campaign may depend a great deal on where one lives. In addition, timelines vary significantly across states, regardless of priority group, resulting in a vaccine roll-out labyrinth across the country.

CDC ACIP Recommendations for COVID-19 Vaccine Prioritization for Phase 1

Phase 1a:  health care workers and long-term care facility residents

Phase 1b:  persons aged ≥75 years and frontline essential workers (non–health care workers). ACIP classifies the following workers as frontline non–health care essential workers: first responders (including firefighters and police officers), corrections officers, food and agricultural workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit workers, and those who work in the education sector (teachers and support staff members), and child care workers.

Phase 1c: persons aged 65–74 years, persons aged 16–64 years with high-risk medical conditions, and any essential workers not included in Phase 1a or 1b. Essential worker sectors recommended for vaccination in Phase 1c include those in transportation and logistics, water and wastewater, food service, shelter and housing (e.g., construction), finance (e.g., bank tellers), information technology and communications, energy, legal, media, public safety (e.g., engineers), and public health workers.” (A)

“The Centers for Disease Control and Prevention recommended that the Covid-19 vaccine should go to healthcare workers first—guidance most states seem to be following—but many states have indicated they will deviate from the CDC’s suggestion on who gets it next: people 75 and older and essential workers.

States following CDC guidelines: Alabama, Maine, South Carolina

States offering vaccines to essential workers and a wider group of older residents (65+) in the second phase: Delaware, Washington D.C., Georgia, Mississippi, Missouri, Pennsylvania, Utah, Colorado

States prioritizing older residents over essential workers: Texas, Florida, Hawaii, Oklahoma (adults with pre-existing conditions included)

States prioritizing essential workers over older residents: Alaska, Arizona, Arkansas, Idaho, Kentucky, Michigan, Nebraska, New Jersey, New York, Virginia, West Virginia, New Hampshire, Vermont, Massachusetts, and Nevada.

States prioritizing older residents and people with preexisting conditions over essential workers: Hawaii (first responders were included in the first phase), Indiana, Kansas, Tennessee, Texas

States prioritizing people with preexisting conditions over older residents and essential workers: North Carolina    (B)

“All states have released updated prioritization criteria for Phase 1, primarily in response to ACIP deliberations and guidance. Some had planned emergency meetings in anticipation of the FDA’s announcement and ACIP’s follow-on recommendation. Importantly, most indicate that these criteria could change depending on supply, vaccine characteristics, and other factors.

Most states are following ACIP’s Phase 1a recommendation.

45 states are following ACIP’s interim Phase 1a recommendation to prioritize HCWs and LTC residents. Some states will start vaccinating both of these groups together, while others will start with one of these groups first as they await more supply to start vaccinating the other. Still, even with these state criteria, decisions about how to allocate limited initial vaccines to HCWs and LTC residents will mostly be left to facilities.

7 states depart from ACIP’s Phase 1a recommendation in some way. For example, the District of Columbia and Utah include HCWs in Phase 1a but LTC residents in Phase 1b.  In addition to HCWs and LTC residents, Nevada, New Hampshire, and Wyoming also include law enforcement in Phase 1a (per ACIP’s proposed framework, they are in 1b). Massachusetts also includes people incarcerated in prisons and those living in homeless shelters in Phase 1a (neither is explicitly mentioned in ACIP’s Phase 1 framework).

More than 20 states also provide further sub-prioritization rankings or criteria within HCW and/or LTC resident groupings. For example, Alabama segments HCWs into “very-high”, “high”, and “medium” risk. Idaho provides specific rankings within each group. Texas groups Phase 1a into “first” and “second” tier.

The majority of states are still developing criteria for subsequent Phase 1 prioritization, but there are already some differences from ACIP’s preliminary framework.

30 states indicate that they are still developing more specific criteria for these next phases.

Of the 21 with criteria, 8 follow ACIP for Phase 1b and 5 follow ACIP for 1c.

The main differences lie in where states place people ages 65 and older and those with high risk medical conditions, relative to essential workers. For example, Alabama, Delaware, Florida, Maryland, North Carolina, and Tennessee each prioritize those 65+ and/or those with high risk medical conditions over non-health essential workers; North Carolina and Tennessee prioritize those with high risk medical conditions over those ages 65 and older.

In addition, some include other congregate settings (not indicated in ACIP’s framework). Alabama, Nebraska, Nevada, North Carolina and Oklahoma explicitly include those living in homeless shelters and prisons in Phases 1b or c. Delaware and Tennessee explicitly include people incarcerated in prisons in 1c.

Discussion

Our review finds that almost all states hew to ACIP regarding initial allocations of a COVID-19 vaccine (Phase 1a) and have looked specifically at ACIP for decision-making.  Beyond that, a good number of states are still developing criteria for Phases 1b-c.  Given that ACIP has yet to issue recommendations for these phases, states may be waiting for further guidance. However, based on ACIP’s preliminary framework, there are some differences between state priorities and where ACIP is likely to land, primarily related to the prioritization of seniors and/or those with high risk medical conditions relative to non-health essential workers. Moreover, these later prioritization decisions are likely to be more difficult given the large numbers of people in these groups and continued limits on vaccine supply.” (C)

“The rapid expansion of COVID-19 vaccinations to senior citizens across the U.S. has led to bottlenecks, system crashes and hard feelings in many states because of overwhelming demand for the shots.

Mississippi’s Health Department stopped taking new appointments the same day it began accepting them because of a “monumental surge” in requests. People had to wait hours to book vaccinations through a state website or a toll-free number Tuesday and Wednesday, and many were booted off the site because of technical problems and had to start over.

In California, counties begged for more coronavirus vaccine to reach millions of their senior citizens. Hospitals in South Carolina ran out of appointment slots within hours. Phone lines were jammed in Georgia.

“It’s chaos,” said New York City resident Joan Jeffri, 76, who had to deal with broken hospital web links and unanswered phone calls before her daughter helped her secure an appointment. “If they want to vaccinate 80% of the population, good luck, if this is the system. We’ll be here in five years.”

Up until the past few days, health care workers and nursing home patients had been given priority in most places around the U.S. But amid frustration over the slow rollout, states have thrown open the line to many of the nation’s 54 million senior citizens with the blessing of President Donald Trump’s administration, though the minimum age varies from place to place, at 65, 70 or higher.

On Thursday, New Jersey expanded vaccinations to people between 16 and 65 with certain medical conditions — including up to 2 million smokers, who are more prone to health complications…

Hard-hit Los Angeles County, the nation’s most populous county with 10 million residents, said it couldn’t immediately provide shots to the elderly because it had inoculated only about a quarter of its 800,000 health care workers….

In Mississippi, officials said new appointments will probably have to wait until a hoped-for shipment of vaccine in mid-February.

In South Carolina, Kershaw Health in Camden implored people not to call its hospitals or doctors to schedule vaccination appointments after receiving more than 1,000 requests in two days. State health authorities said their hot line got 5,000 calls on Wednesday….

Meanwhile, some states, like Minnesota, are waiting before throwing open the doors.

“As we learn more, we will work to make sure everyone who is eligible for a vaccine knows how, where, and when they can get their shots,” the state Health Department said in an email. “Everyone’s opportunity to get vaccinated will come; it will just take some time.”

Arizona, which had the nation’s highest COVID-19 diagnosis rate over the past week, will start signing up people 65 and older next week. It also plans to open a vaccination site at Phoenix Municipal Stadium in addition to the one dispensing thousands of shots daily at the home of the NFL’s Arizona Cardinals.

To step up the pace of vaccinations, South Carolina made a rule change allowing medical students, retired nurses and other certain professionals to administer the shots.” (D)

“NYC has launched a city vaccine finder tool to help the hundreds of thousands of New Yorkers who are now eligible to schedule an appointment for the shot. But a patchwork of scheduling systems between providers and different government websites for making appointments has caused confusion—raising immediate questions about how older, less tech-savvy New Yorkers will gain access.

Comptroller Scott Stringer, a mayoral candidate, called the sign-up process “bewildering” on Sunday evening.

“We should be #1 in vaccinations in the nation from day one—and we should be using every tool at our disposal to vaccinate as many New Yorkers as possible as quickly as possible. Instead we’ve set up a gauntlet that requires tech support,” Stringer wrote in a tweet.

The city has created an aggregated information site for vaccine locations called the NYC vaccine finder. But the Health Department and NYC Health + Hospitals still have sign-up sites for their locations, and clinics or other smaller healthcare centers have their individual sign-up processes as well. Those seeking appointments must fill out a multi-step verification process to set up an account and face about 51 questions or fields to check off on the Health Department’s site, according to Stringer.

“Any barrier to getting shots in arms is only going to prolong the agony of this crisis,” Stringer wrote…

On Monday, the city launched a hotline—877-VAX-4NYC—to make appointments by phone, with 750 customer service reps answering the phones 8 a.m. to 9 p.m. De Blasio said 24/7 hours are coming soon.

New York State will launch its own hotline at 4 p.m. Monday at 1-833-NYS-4VAX.

The state also set up another website for New Yorkers to determine eligibility and schedule an appointment. Demand is expected to outweigh supplies, so Governor Andrew Cuomo’s office noted those eligible should be prepared to schedule an appointment as far as 14 weeks in the future…” (G)

“It’s enraging that after the scientific marvel of inventing Covid-19 vaccines, now there are bureaucratic and technical bottlenecks that have slowed the vaccine rollout. (Feel free to scream out loud with me.) But don’t be angry about botched government technology or direct your fury only at your local officials. Be mad about the broad systemic failure.

As we have seen with other frailties of government programs during the pandemic, botched technology is often a symptom of misguided policy choices, chronic underfunding of public health and the generally dysfunctional and decentralized coronavirus response in the United States.

When I read several tales last week about botched vaccine scheduling in some parts of Florida, I contacted the U.S. Digital Response, an organization I’ve written about before that pairs tech-savvy volunteers with state and local governments needing tech assistance.

Until I spoke with them, I didn’t grasp the complexity of what public health authorities are doing to get people vaccinated. The hard part is not just the scheduling hotlines or websites that you and I see; it’s everything that the public doesn’t see.

Officials at the organization outlined eight or more discrete requirements for local governments to manage their vaccination programs. The steps include keeping tabs on the incoming and outgoing inventory of shots, making sure people meet the eligibility requirements for vaccines, scheduling appointments (twice!) and reminding people of them, collecting patient information, keeping records to report to state and federal health authorities, and potentially billing health insurance programs.

Government officials must also keep the public informed about where and when to get vaccines, make sure health care information is secure and private, and ensure services are accessible for people who don’t have computers or speak languages other than English. Sounds super fun and easy, right?!..

The frustrating thing is that all the bungled vaccination efforts fit a pattern. When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….

When you start to pull your hair out because you can’t register for a vaccine on a local website, remember that it’s not (only) the fault of a bad tech company or misguided choices by government leaders today. It’s a systematic failure years in the making.” (H)

“While bureaucratic snafus, delivery problems and a lack of planning has bogged down the initial rollout of COVID-19 vaccines, more and more states are expanding the list of eligible recipients.

Still, while political figures and celebrities have already received the vaccine, distribution for the public will take more time. Each state has set priorities about who gets the vaccine first, based on recommendations from the federal government. Currently, the states are rolling the vaccine out in categories based on need. Health care workers and people living in nursing homes are highest priority, and they began receiving the vaccine in mid-December. People ages 75 years and older, along with essential workers like first responders, will be next, although several states have lowered that requirement to 65

Adults between 65 and 75 years old, and younger people (between 16 and 64) at high risk, along with other essential workers, will get the vaccine in the next phase. Assuming there is enough of the vaccine to go around after that, everyone else will be able to get one, likely sometime in the late spring or early summer.

Most vaccinations are now taking place at hospitals or public health clinics. But, the vaccine will likely be available to the public at most pharmacy chain stores like CVS, Walgreens, and others; along with in-store pharmacies at Costco, Kroger, Target, Publix, HEB, and other national and regional chains.

Experts suggest regularly checking state public health department websites for information. Some states offer vaccine safety information, details about who qualifies for vaccines now, where to get them, and ways to sign up for COVID-19 and vaccine alerts. Those websites are listed below.” (E)

“It isn’t easy, and it’s probably going to be that way for a while. Right now, there are more eligible people than doses of vaccine. You need diligence and luck.

People are swapping tips in text chains and social media groups to try to gain an edge, and there is a dizzying array of websites and phone numbers to keep track of.

At every turn there are more questions about how best to book a slot, what happens when you arrive for an appointment, and what might happen if you just show up without one. The answers seem to change from moment to moment.

Here’s what we know about the process to get vaccinated in New York City.” https://www.nytimes.com/article/nyc-vaccine-shot.html?referringSource=articleShare (I)

“In its framework for the equitable allocation of the COVID-19 vaccine, the National Academies of Science, Engineering and Medicine offered a bit more detail, explicitly recommending that high-risk health care workers, first responders, people with two or more underlying medical conditions, and older adults in long-term care facilities or other overcrowded settings be prioritized. That rough framework for prioritization was subsequently adopted by the CDC’s vaccine advisory group.

However, the reality of vaccine distribution thus far — at a critical moment when COVID-19 cases are surging and vaccination resources are still scarce — has been marred by a patchwork of variable vaccination strategies on the local and state level, logistical inconsistency, and the exploitation of long-standing socioeconomic power structures….

Biden says his administration will work with states to quickly move to the next phase of vaccine distribution — allowing people age 65 and older as well as front-line workers like teachers, first responders and grocery store workers to get immunized. He’s pledged to also work with community-based organizations and trusted health care providers to make sure people in marginalized and medically-underserved communities quickly get access to the vaccine.

But there is still reason to be deeply concerned that over the next few months — as hospital systems, states, and nations begin to distribute vaccines to the wider public — the process could become even more flawed and inequitable…

Already, there are early signs that the privileged and wealthy are eager to access the vaccine before others — once again trying to buy and leverage their connections to achieve a spot at the front of the line.

The scarcity of vaccines combined with the fear and desperation surrounding the pandemic is exposing a true moral tragedy: People are willing to save themselves at the expense of others.

The prioritization of certain groups for early COVID-19 vaccination is not arbitrary. When drafting guidelines about vaccine distribution, the CDC aimed to both reduce illness and deaths by helping those most at risk, and to preserve those integral to the everyday functioning of society to be able to keep doing their essential work…(F)

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

FACEBOOK Jonathan M. Metsch     LINKEDIN Jonathan Metsch 

TWITTER @jonathan_metsch

#CoronavirusTracker   #CoronavirusRapidResponse

(A) The COVID-19 “Vaccination Line”: An Update on State Prioritization Plans, by Jennifer Kates, Jennifer Tolbert, and Josh Michaud, https://www.kff.org/coronavirus-covid-19/issue-brief/the-covid-19-vaccination-line-an-update-on-state-prioritization-plans/

(B)       Here Are The States Breaking From CDC Guidelines On Vaccine Priority, by Jack Brewster, https://www.forbes.com/sites/jackbrewster/2020/12/24/here-are-the-states-breaking-from-cdc-guidelines-on-vaccine-priority/?sh=3093a3493804

(C)       How are States Prioritizing Who Will Get the COVID-19 Vaccine First?, by Jennifer Kates, Josh Michaud, and Jennifer Tolbert, https://www.kff.org/policy-watch/how-are-states-prioritizing-who-will-get-the-covid-19-vaccine-first/?utm_campaign=KFF-2020-Coronavirus&utm_medium=email&_hsmi=102982102&_hsenc=p2ANqtz–mlrIQ1XVng-Pe8RRpOzkCKmbehwMpNp5z2lUYND9Ny9d3ac5ILjMumeP-LtEpagMT484l_JEsEIdPvQNzCV-WXr-ZQw&utm_content=102982102&utm_source=hs_email

(D)       US states where it’s easiest, and most difficult, to get a coronavirus shot, by Aria Bendix, https://www.businessinsider.com/states-easy-hard-coronavirus-vaccine-per-capita-2021-1

(E)        State-by-State Guide to COVID Vaccine Information, By Lane Holman, https://www.webmd.com/vaccines/covid-19-vaccine/news/20201224/state-by-state-guide-to-covid-vaccine-information

(F)        OPINION: Moral Tragedy Looms In Early Chaos Of U.S. COVID-19 Vaccine Distribution, by HAZAR KHIDIR and MELANIE MOLINA,

https://www.npr.org/sections/health-hots/2021/01/16/957236269/opinion-moral-tragedy-looms-in-early-chaos-of-u-s-covid-19-vaccine-distribution

(G)        New Yorkers Eligible For COVID Vaccine Report Frustrations With City Registration Websites, by SYDNEY PEREIRA, https://gothamist.com/news/new-yorkers-eligible-vaccine-report-frustrations-city-registration-websites

(H)        The Problem With Vaccine Websites, By Shira Ovide, https://www.nytimes.com/2021/01/12/technology/the-problem-with-vaccine-websites.html?referringSource=articleShare

(I)          How to Get the Coronavirus Vaccine in New York City, by Ron Lieber, https://www.nytimes.com/article/nyc-vaccine-shot.html?referringSource=articleShare

New York -Phased Distribution of the Vaccine

Phase 1a & Phase 1b

We are currently in Phase 1a and initial groups from Phase 1b.

Eligible New Yorkers in Phase 1a and 1b are:

High-risk hospital workers (emergency room workers, ICU staff and Pulmonary Department staff)

Residents and staff at nursing homes and other congregate care facilities

Federally Qualified Health Center employees

EMS workers

Coroners, medical examiners and certain funeral workers

Staff and residents at OPWDD, OMH and OASAS facilities

Urgent Care providers

Individuals administering COVID-19 vaccines, including local health department staff

All Outpatient/Ambulatory front-line, high-risk health care workers of any age who provide direct in-person patient care

All staff who are in direct contact with patients (i.e., intake staff)

All front-line, high-risk public health workers who have direct contact with patients, including those conducting COVID-19 tests, handling COVID-19 specimens and COVID-19 vaccinations

This includes, but is not limited to,

Doctors who work in private medical practices and their staff

Doctors who work in hospital-affiliated medical practices and their staff

Doctors who work in public health clinics and their staff

Registered Nurses

Specialty medical practices of all types

Dentists and Orthodontists and their staff

Psychiatrists and Psychologists and their staff

Physical Therapists and their staff

Optometrists and their staff

Pharmacists and Pharmacy Aides

Home care workers

Hospice workers

Staff of nursing homes/skilled nursing facilities who did not receive COVID vaccination through the Pharmacy Partnership for Long-Term Care Program

Beginning January 11, 2021:

Individuals Age 65 and older

First Responder and Support Staff for First Responder Agencies

Fire Service

State Fire Service, including firefighters and investigators (professional and volunteer)

Local Fire Services, including firefighters and investigators (professional and volunteer)

Police and Investigators

State Police, including Troopers

State Park Police, DEC Police, Forest Rangers

SUNY Police

Sheriffs’ Offices

County Police Departments and Police Districts

City, Town, and Village Police Departments

Transit of other Public Authority Police Departments

State Field Investigators, including Department of Motor Vehicles, State Commission of Correction, Justice Center, Department of Financial Services, Inspector General, Department of Tax and Finance, Office of Children and Family Services, and State Liquor Authority

Public Safety Communications

Emergency Communication and Public Safety Answering Point Personnel, including dispatchers and technicians

Other Sworn and Civilian Personnel

Court Officers

Other Police or Peace Officers

Support or Civilian Staff for Any of the above services, agencies, or facilities

Corrections

State Department of Corrections and Community Supervision Personnel, including correction and parole officers

Local Correctional Facilities, including correction officers

Local Probation Departments, including probation officers

State Juvenile Detention and Rehabilitation Facilities

Local Juvenile Detention and Rehabilitation Facilities

In-person college instructors

P-12 Schools

P-12 school or school district faculty or staff (includes all teachers, substitute teachers, student teachers, school administrators, paraprofessional staff and support staff including bus drivers)

Contractors working in a P-12 school or school district (including contracted bus drivers)

Licensed, registered, approved or legally exempt group Childcare Providers

Exempt Childcare setting

Grocery store workers

Employees or Support Staff of Licensed or Registered Childcare Setting

Licensed, Registered, Approved or Legally Exempt Childcare Providers

Public Transit

Airline and airport employees

Passenger railroad employees

Subway and mass transit employees (i.e., MTA, LIRR, Metro North, NYC Transit, Upstate transit)

Ferry employees

Port Authority employees

Public bus employees

Individuals living in a homeless shelter where sleeping, bathing or eating accommodations must be shared with individuals and families who are not part of the same household

Individual working (paid or unpaid) in a homeless shelter where sleeping, bathing or eating accommodations must be shared by individuals and families who are not part of the same household, in a position where there is potential for interaction with shelter residents

https://covid19vaccine.health.ny.gov/phased-distribution-vaccine
  •  

Links to POSTS 1-113

CORONAVIRUS TRACKING

Links to POSTS 1-113

Doctor, Did You Wash Your Hands?®

https://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

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

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”

POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…

POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.

PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!

POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”?  “ If Fauci didn’t exist, we’d have to invent him.”

POST 33. June 21, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)

POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!

POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..”  While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”

POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..

POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”

POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)

POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”

POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

POST 42. August 11, 2020. CORONAVIRUS. “I think that if future historians look back on this period, what they will see is a tragedy of denial….

POST 43. August 22, 2020. CORONAVIRUS.”  “we’ve achieved something great as a nation. We’ve created an unyielding market for FAUCI BOBBLEHEADS”!! (W)

POST 44.  September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”

POST 45. September 9, 2020. CORONAVIRUS.  Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’

POST 46.  September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”

POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”

POST 48. October 1, 2020.   “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)

POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”

POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).

POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

POST 52. October 18, 2020.  ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

POST 53. October 20, 2020. CORONAVIRUS. “a…“herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy.”

POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.

POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”

Post 56. October 30, 2020. CORONAVIRUS. “Trump’s now back in charge. It’s not the doctors.”

POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”

POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”

POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..

POST 60. November 7, 2020. “White House chief of staff Mark Meadows has tested positive for the coronavirus….” (A)

POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”

POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”

POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”

POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”

POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…

POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”

POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”

POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”

POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….

POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.

POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”

POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”

POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”

POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.

POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….

POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”

POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”

POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”

POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”

POST 80. November 29, 2020. CORONAVIRUS. Op-Ed in the Jersey Journal. Do you know which hospital is right for you if you have coronavirus? | Opinion

POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”

POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?

POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”

POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”

POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”

POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)

POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”

POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…

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

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

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

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

POST 93. December 19, 2020. CORONAVIRUS.  On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?

POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”

POST 95. December 23, 2020. “The Murphy administration may step in to force (New Jersey) hospitals to report COVID-19 outbreaks among staff.”

POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”

POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”

POST 98. December 28, 2020. CORONAVIRUS. “Governor Andrew Cuomo announced new penalties in order to rein in possible vaccination fraud…

POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”

POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.

POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?

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,”…

POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”

POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”

POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”

POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”

POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine.   South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”

POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.” 

POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.

POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”

POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….

POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.

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…..

January 17, 2021


 [JM1]

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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POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.

the first POST on January 21, 2020.

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PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

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PART 112. January 14, 2021

“Since Jan. 2, Hebei has reported more than 600 new positive cases, 544 of which were from the capital city of Shijiazhuang. To identify all potential patients, health officials have completed one round of mass testing of all the city’s residents, and a second one is being carried out this week.

The province also postponed its annual legislative meeting because of the flare-up. Liaoning province, which has had a small number of new virus cases this month, also postponed its meeting.

Hebei provincial authorities have doubled-down on travel restrictions and quarantine measures, hoping to contain the virus ahead of the Lunar New Year next month. Anyone leaving Hebei province must show a negative COVID test done no more than three days prior.

Public health officials blame lax regulations governing movement in the countryside and frequent visits among friends and family for the Hebei outbreak. On Monday, nearly 20,000 residents from twelve rural villages in the Gaocheng district of Shijiazhuang were bussed to government quarantines.

The Hebei flare-up is the most severe outbreak China has seen in more than five months. Dr. Zhang Wenhong, a prominent doctor who directs the infectious diseases department at a Shanghai hospital, told Chinese media the outbreak would likely continue for another month before it is brought under control….

The Hebei cluster’s first reported case was a man living in Shijiazhuang’s Gaocheng district. Contact tracing revealed he attended a wedding days before being diagnosed on Jan. 2. As the case count climbed, Gaocheng announced a series of lockdown measures, from closing schools to shutting down train stations and taxi services. Ticket sales for trains from Shijiazhuang to Beijing were suspended last week.

The outbreak has alarmed China’s leadership. Hebei directly borders the capital of Beijing on all sides and a large number of its residents commute to nearby cities, including the port city of Tianjin for work. Hebei commuters must now provide negative COVID test results as well as proof of employment in Beijing to enter the capital.” (A)

“Hebei has recorded 183 confirmed cases and an additional 181 asymptomatic cases over the last eight days. China does not include those who test positive but do not show symptoms in its official case count.

Almost all of the cases are in Shijuazhuang, the provincial capital, which is about 260 kilometers (160 miles) southwest of Beijing. A handful have also been found in Xingtai city, 110 kilometers (68 miles) farther south.

Both cities have conducted mass testing of millions of residents, suspended public transportation and restricted residents to their communities or villages for one week.” (B)

‘More than 22 million people in all have been ordered to remain inside their homes — double the number affected last January when China’s central government locked down Wuhan, the central city where the virus was first reported, in a move that was then seen as extraordinary….

China, a country of 1.4 billion people, has reported an average of 109 new cases a day over the past week, according to a New York Times database. Those would be welcome numbers in countries experiencing far worse — including the United States, which is averaging more than 250,000 new cases a day — but they are the worst in China since last summer.

On Thursday, China’s National Health Commission reported a coronavirus death in the mainland for the first time since May.

In Hebei, the province where the new outbreak has been concentrated, officials last week declared a “wartime state” that shows no sign of lifting soon.

Throughout the pandemic, officials have appeared especially worried about Beijing, home of the Communist Party’s central leadership. Last week, the party secretary in Hebei, Wang Dongfeng, pledged to make sure the province was “the moat to safeguard Beijing’s political security.”…

New cases have also been reported in the northern province of Shanxi and the northeastern provinces of Heilongjiang and Jilin. Shanghai on Wednesday urged residents not to leave the city and announced that people who had traveled to risky areas should quarantine themselves at home for two weeks and leave only after passing two tests, while those who had traveled to the highest-risk areas faced quarantine in government facilities…

The government has moved ahead on plans to vaccinate 50 million people ahead of the Lunar New Year next month, a holiday when hundreds of millions of people traditionally crisscross the country to visit their families. By Wednesday, more than 10 million doses had been distributed.

Even with the vaccinations, officials have already warned people not to travel ahead of the holiday.

The response underscored how quickly the government mobilizes its resources to contain outbreaks…

After the lockdown was announced in Shijiazhuang on Jan. 6, the authorities collected more than 10 million coronavirus test samples over the next three days — nearly one for every resident, officials said at a news conference in the city. Those tests turned up 354 positive results, though some of the cases were asymptomatic.

“Chinese cities enforce a residential system — smaller ones have several hundred residents, big ones have tens of thousands — and by shutting the gates you can lock in tens of thousands of people,” Mr. Chen said in a telephone interview. “Now whenever they run into this kind of problem, they’re sure to apply this method. That would be impossible in Western countries.” (C)

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(A)Province In China On Lockdown After Biggest Coronavirus Spike In Months, by EMILY FENG, https://www.npr.org/sections/coronavirus-live-updates/2021/01/13/956282429/province-in-china-on-lockdown-after-biggest-coronavirus-spike-in-months

(B)The Latest: China sees growing outbreak south of Beijing,  https://apnews.com/article/travel-beijing-coronavirus-pandemic-china-europe-380d2e96aaf415977f46c002058cebd7

(C) Facing New Outbreaks, China Places Over 22 Million on Lockdown, by Steven Lee Myers, https://www.nytimes.com/2021/01/13/world/asia/china-covid-lockdown.html?referringSource=articleShare

POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….

Some of the arrivals are Americans or foreigners who own second homes in the state and reside here part-time. Others are making short-term visits, seizing the opportunity provided by Florida’s decision to make the vaccine available to people age 65 and older, including nonresidents. The practice, which some are calling vaccine tourism, has drawn fire from some officials and residents.

Interest is up sharply from Canadians who are looking to travel to the U.S. for vaccinations, according to Momentum Jets, a private jet service provider in Toronto.

“We’re getting requests now from clients that are willing to fly into Florida, if they have an appointment, and then fly home again on the same day,” said Janelle Brind, a company vice president. Costs for a charter flight range from $25,000 to $80,000 for a same-day round trip, she said.” (A)

“Officials said there’s no statewide residency requirement but since there’s been some confusion on the matter, News 6 contacted health departments across Central Florida to find out what the residency rules are at vaccination sites.

To sum up their answers, you don’t have to be a Florida resident.

Recently, Gov. Ron DeSantis was asked about seasonal Florida residents and weighed in on the matter.

“If you have folks who spend four or five months a year in the state of Florida, I don’t think we want to get in a situation where we’re trying to say, ‘Oh no, you go back to Rhode Island’ or, ‘You go back to Minnesota or wherever.’ So they’re here, they have a residence and they’re not just kind of flying by night for a week or two. I’m totally fine with that,” DeSantis said Monday during a news conference in Miami-Dade County.

He said the concern is people coming from other states just to get the vaccine and then leaving.

“I think if we’re trying to mitigate the disease and the clinical consequences, I think the people who are here that are over 65 — and again that’s much different than someone just showing up and saying, ‘Give me a shot’ and then they’re going to fly back somewhere, we obviously are not going to do that — but for seasonal residents who are going to be here, I think it’s totally fine if they want to do it,” DeSantis said.

After some conflicting answers, a press secretary from the Florida Division of Emergency Management said this applies to seasonal residents from out of the country as well.

“The state is committed to offering vaccines to all Floridians and non-residents, including seasonal residents that may also be a Canadian or Puerto Rico resident,” she said.” (B)

“About 4% of the 650,000 people who have been inoculated in Florida list an out-of-state residence, health department records released this week show. About 2% of both the 1.5 million people who have been diagnosed in Florida with COVID-19 and the nearly 24,000 who have died there of the disease have been nonresidents.

DeSantis said Tuesday that there have been calls to vaccine registration hotlines from foreigners and residents of other states who want to travel to Florida only long enough to get the shots, but they are turned away.

Some short-time visitors do get vaccinated, although it is impossible to say how many. The Washington Post and New York Post reported last week that two wealthy New Jersey developers, brothers David and Bill Mack, used their connections with a nursing home to get themselves and members of their Palm Beach country club vaccinated without having to go through a hotline or website.” (C)

“On Your Side contacted the Florida Department of Health Tuesday asking why there are no residency requirements in Florida and what is being done to ensure people aren’t driving and flying across state lines to take vaccines away from Floridians.

“The state is committed to offering vaccines to all Floridians and non-residents, including seasonal residents,” a state spokesperson said. “It’s also important to note, for either COVID-19 vaccine to be the most effective, a second dose is required. All individuals who reside in the state during the time period between doses are eligible to receive the vaccine. The state is continuing to prioritize vaccine access to frontline health care workers and individuals 65 and older, and the state remains committed to ensuring these populations can easily receive the vaccine.”” (D)

“South Florida hospitals, which have been given considerable leeway in deciding how they deploy vaccine doses in the last few weeks, have just recently pivoted from vaccinating healthcare workers to prioritizing the shots for senior citizens in the general public. The shift came after Gov. Ron DeSantis vowed during a press conference at a retirement community called The Villages last week that seniors would be next in line for the shots.

In Miami-Dade and Broward counties, that change in focus has also come with a new requirement by some hospitals: proof of local residency. That’s been the case at Mount Sinai Medical Center and Jackson Health System, as well as Broward Health.

But Jared Moskowitz, director of the Florida Division of Emergency Management, told the Miami Herald on Tuesday that no residency requirement has been issued by the state.

“You do not have to be a resident of the county,” Moskowitz said in a text message. “Period.” (E)

“Gov. Ron DeSantis on Monday offered what may be his staunchest defense yet of Northerners who travel to Florida and receive a coveted COVID-19 vaccine.

Speaking to reporters at Jackson Memorial Hospital in Miami, DeSantis contended that many snowbirds — Northerners who relocate to Florida during the warmer winter — are unlike tourists. He asserted that many sun-seekers own property in Florida, have relationships with local doctors and spend considerable time in the Sunshine State.

“We’re a transient state,” DeSantis said. “You’ll have people that will be here and it’s not like they’re just on vacation for two weeks.”

The issue of who should get access to the limited vaccine supply first is a global debate not unique to Florida.

“Some contend that Florida’s broader access may lure Americans into the state’s already long COVID-19 vaccine line.

DeSantis acknowledged the possibility. He drew the line, however, on Florida’s short-term travelers.

“We’re discouraging people who come to Florida just to get a vaccine,” DeSantis said, adding that hospitals should turn away those “flying by night” from elsewhere.”….

“If they get sick over the winter, guess what?” the Governor quipped. “They’re going to come to a hospital in Florida.” (F)

“After learning that Florida has almost a million unused vaccine doses, News4Jax reached out to local health departments who are limiting appointments saying they can’t get enough Pfsizer or Moderna vaccine.

Data released by the Centers for Disease Control and Prevention Monday afternoon shows the state of Florida has 1,661,675 doses of COVID-19 vaccines, but only about 633,440 have been administered.

This means of the vaccines Florida has received, only 38% have been given. That represents roughly 3% of Floridians.” (G)

(A)Florida’s Covid-19 Vaccines Draw Foreigners, Snowbirds, By Arian Campo-Flores and José de Córdoba, https://www.wsj.com/articles/floridas-covid-19-vaccines-draw-foreigners-snowbirds-11610620200

(B)Some snowbirds and other Florida visitors can get the COVID-19 vaccine, health officials say, by Adrienne Cutway, https://www.clickorlando.com/news/local/2020/12/30/some-snowbirds-and-other-florida-visitors-can-get-the-covid-19-vaccine-health-officials-say/

(C)Florida downplays reports of medical tourism for vaccines, by TERRY SPENCER, TAMARA LUSH and BOBBY CAINA CALVAN, https://abcnews.go.com/Health/wireStory/florida-downplays-reports-medical-tourism-vaccines-75232078

(D)No residency rule: Some full-time Floridians upset snowbirds, visitors can get vaccinated in Sunshine State, by Allyson Henning, https://www.wfla.com/news/local-news/manatee-county/no-residency-rule-some-full-time-floridians-upset-snowbirds-visitors-can-get-vaccinated-in-sunshine-state/

(E)Can ‘snowbirds’ get the COVID-19 vaccine in Florida? It’s complicated, By Ben Conarck, https://www.tampabay.com/news/health/2020/12/29/can-snowbirds-get-the-covid-19-vaccine-in-florida-its-complicated/

(F)Gov. DeSantis defends snowbirds who receive COVID-19 vaccine in Florida, By Jason Delgado, https://floridapolitics.com/archives/391922-gov-ron-desantis-defends-snowbirds-who-receive-covid-19-vaccine-in-florida

(G)CDC data show Florida has 1 million unused doses of vaccine, by Jennifer Ready, https://www.news4jax.com/news/local/2021/01/12/cdc-data-shows-florida-has-more-than-a-million-unused-vaccines/

POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”

“The government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”

States will be given two weeks to prepare for the change, Health and Human Services Secretary Alex Azar told reporters during a news briefing.

That should give states enough time to improve their data reporting to the government and ensure all vaccinations are being “promptly” documented, he said.

The federal government is changing the way it allocates coronavirus vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population, Health and Human Services Secretary Alex Azar said Tuesday.

States will be given two weeks to prepare for the change, Azar told reporters during a news briefing. That should give states enough time to improve their data reporting to the government and ensure all vaccinations are being “promptly” documented, he said.

States aren’t currently reporting vaccinations in a timely matter, Azar said, adding that vaccine doses “are sitting in freezers in hospitals.”…

The Trump administration will also stop holding back millions of doses reserved for the second round of shots of Pfizer’s and Moderna’s two-dose vaccines, the official said, adding they’ve released doses that had been held in reserve on Sunday. President-elect Joe Biden’s transition team announced a similar plan Friday.

Some 53 million Americans who are 65 and older and 110 million people between 16 and 64 with comorbid conditions will now be eligible to receive the vaccine if every state adopts the guidelines, according to the CDC.

Vaccine doses were previously allocated based on the number of adults in each state. But U.S. officials are complaining the pace of vaccinations has been too slow as the supply of vaccine doses exceeds demand.

Arkansas and Georgia are the two worst performers, vaccinating 1,355 and 1,346 people, respectively, per 100,000, according to CDC data. Meanwhile, the Dakotas and West Virginia are giving more than 5,000 shots per 100,000 people, according to the agency.

As of Monday morning, more than 25.4 million doses had been distributed across the U.S., but just over 8.9 million shots have been administered, according to CDC data. The number is a far cry from the federal government’s goal of inoculating 20 million Americans by the end of 2020 and 50 million Americans by the end of this month.

State and local health officials have said they are strapped for cash. They blame insufficient funding and inconsistent communication from the federal government for the slow rollout.” (A)

“The Trump administration on Tuesday issued new guidelines that expand coronavirus vaccine eligibility to everyone age 65 and older as well as to those with comorbid conditions, like diabetes.

The states’ focus on vaccinating health-care workers and nursing homes has created a bottleneck, a senior administration official told CNBC, speaking on condition of anonymity in advance of the formal announcement.

“The states are being told immediately they need to expand to 65-plus as well as those under 65 with comorbid conditions,” the official said.

The administration will also stop holding back millions of doses reserved for the second round of shots of Pfizer and Moderna’s two-dose vaccines, the official said, adding they released doses that had been held in reserve on Sunday.

“States should not be waiting to complete phase 1a prioritization before proceeding to broader categories of eligibility,” Azar said Tuesday, explaining the new guidance. “Think of it like boarding an airplane. You might have a sequential order in which you board people. But you don’t wait ’til literally every person from a group is boarded before moving on to the next.”

Some 53 million Americans who are 65 and older and 110 million people between 16 and 64 with comorbid conditions will now be eligible to receive the vaccine if every state adopts the guidelines, according to the Centers for Disease Control and Prevention” (B)

“Azar also announced the government will release all available vaccine to states instead of holding back doses for scheduled second shots. Federal officials had been keeping vaccine in reserve to guarantee second doses but Azar said increased vaccine supply and the pace of manufacturing will ensure everyone who gets a first dose will get a second dose on schedule.                       

Both vaccines authorized for use were studied in a two-dose regimen, with the Pfizer-BioNTech doses given 21 days apart and Moderna’s 28 days apart.

“Based on the science and evidence we have it is imperative that people receive their second dose on time,” Azar said. “That’s what the science says and ignoring that would be reckless.”

U.S. officials also are asking states to expand the locations where people can be vaccinated by adding community health centers, pharmacies and mass vaccination sites.

“Hospitals made sense as the early distribution sites when the focus was on health care workers, but they are not where most Americans go to get vaccines,” Azar said. “States should move on.”

He said the federal government will deploy teams to support states doing mass vaccinations efforts. The government has partnered with 19 pharmacy chains and is ready to distribute vaccine to their locations, he added. “ (C)

“Across New York State, medical providers in recent weeks had the same story: They had been forced to throw out precious vaccine doses because of difficulties finding patients who matched precisely with the state’s strict vaccination guidelines — and the steep penalties they would face had they made a mistake.

On Saturday, state health officials responded to the outcry over discarded vaccines by again abruptly loosening guidelines as coronavirus cases continued to rise.

Now, medical providers can administer the vaccine to any of their employees who interact with the public if there are extra doses in a vial and no one from “the priority population can come in before the doses expire,” the new guidelines read. A pharmacy’s “store clerks, cashiers, stock workers and delivery staff” could qualify, the guidelines said. California last week took a similar step.

This is the second time in two days that Gov. Andrew M. Cuomo’s administration has loosened the restrictions around who can get vaccinated in New York State. On Friday, the governor announced that medical providers could vaccinate a wider range of essential workers, including teachers, as well as New Yorkers 75 years and older starting as early as Monday. That same day, the governor also expanded the types of medical professionals that can administer vaccines to include licensed practical nurses, pharmacists, dentists and podiatrists.” (D)

“As many as 7 million New Yorkers are potentially eligible to receive the COVID-19 vaccine immediately under the new Centers for Disease Control and Prevention (CDC) guidelines released Tuesday — and Governor Andrew Cuomo said it’ll take a miracle to make it happen.

New York has struggled to administer the vaccine to high-risk health care workers and essential workers as part of phases 1a and 1b, which covers about 5.3 million people statewide. But the new CDC guidance recommends that all people 65 and older, as well as individuals with compromised immune systems, be vaccinated right away; that change, Cuomo said, adds another at least 1.7 million New Yorkers to the list.

That number could be higher, the governor indicated, because the CDC did not make clear who would be defined as immunocompromised and immediately eligible for the vaccine. A number of conditions could make one immunocompromised — such as cancer, heart disease, hypertension, obesity, asthma, COPD and diabetes.

The challenge is that the federal government, at present, only releases to New York about 300,000 doses of the COVID-19 vaccine per week. Vaccine recipients also need to get two doses of the Pfizer and Moderna vaccines, the only ones currently available for use, to be considered fully immunized.

At the current rate, barring a dramatic uptick in dosage supply, it will take at least six months to vaccinate all the eligible New Yorkers under the new CDC guidance, Cuomo said.

The governor intimated that it seemed that the outgoing Trump administration was setting up the incoming Biden administration to fail.

“I believe this has to be the first thing Biden looks at, because I think it’s going to create national frustration and suggest that the government is not capable” of handling the COVID-19 vaccinations, Cuomo said. “And the last thing we need right now is people losing belief in the competence of government.”

Melissa DeRosa, secretary to the governor, told the press that the federal government has not provided the state with “any additional information” on responding to the CDC change, and said it reminded her of the response received during the start of the first COVID-19 wave in March and April 2020.

“They’re expecting people on the ground to make massive policy changes on a dime,” DeRosa said, “but they’re giving us little to no guidance on how to implement it.” (E)

“New York has already started administering Covid-19 vaccines from Pfizer and Moderna, though the rollout has been slower than planned. Cuomo pushed the state’s hospitals to administer the vaccine faster. He said hospitals are facing fines of up to $100,000 if they don’t administer their allocations of coronavirus vaccines by the end of this week.

The state has received more than 774,000 Covid-19 vaccine doses but has given just 237,000 shots as of Saturday, according to the Centers for Disease Control and Prevention.

Hospitals that have received Covid-19 vaccines over the last three weeks have used only about 46% of the doses on average, according to a slide Cuomo presented at the briefing. While some hospitals have administered nearly all of their doses, others have used as little as 15%, according to the governor.

“This is a management issue of the hospitals. They have to move the vaccine, and they have to move the vaccine faster,” Cuomo said.

Cuomo said the New York State Department of Health sent a letter on Sunday to all hospitals saying if they don’t use their vaccine allocations by the end of this week, they’ll be fined up to $100,000 and they won’t receive any further allocations.

Moving forward, the state’s hospitals will be required to use their doses within a week of receiving them. Providers who fall seriously behind could be issued further sanctions, he said.

“You have the allocation, we want it in people’s arms as soon as possible,” Cuomo said. “We’ll use other hospitals who can administer it better.” (F)

“Hospitals are throwing out doses of Pfizer’s coronavirus vaccine because the federal government is giving some of the facilities syringes that can only extract five doses from vials that often contain more.

Pharmacists discovered early in the U.S. vaccination push that the standard five-dose vials of the vaccine from Pfizer and its German partner BioNTech often contained enough material for six or even seven shots.

Regulators in the U.S. and Europe agreed to allow use of those “overfill” doses to maximize the reach of coronavirus vaccines amid the raging pandemic.

But some syringes distributed by Operation Warp Speed, the federal Covid-19 vaccine program, aren’t efficient enough to extract a sixth dose, according to hospital lobbyists. They say the issue appears to stem from supply chain problems that have troubled the nation’s pandemic response from the start…

Federal officials acknowledged to POLITICO they are aware of the syringe problem. “Operation Warp Speed is quickly evaluating options to reconfigure the accompanying ancillary supply kits to accommodate the potential additional doses,” according to a Department of Health and Human Services spokesperson….

Nancy Foster, the AHA’s vice president of quality and patient safety policy, said the mix of different syringes is raising questions about the ability to deliver a second dose to everyone who’s gotten a first shot.

“With the second dose of Pfizer that is now going into people’s arms, we’ve been given different syringes, less efficient, so you need to draw up a little bit of extra vaccine, to get the right amount of dose into the person’s arm,” Foster said. “We don’t have that sixth dose now.”

Pfizer ships its vaccine in trays of 195 vials — each designed to contain five doses. Hospitals that squeezed out the extra doses initially were able to vaccinate an extra 195 people per container of the Pfizer shot, Foster said. Now they need to make sure they can administer the second round of shots.

But Mitchel Rothholz, the immunization policy lead for the American Pharmacists Association, said that ensuring second doses for everyone who’s been vaccinated so far should not be difficult. That’s because the number of second, or booster, shots that are sent to vaccination sites are based on the number of initial inoculations at each site.

“The way they’re tracking is not by the vials, it’s by the doses given,” Rothholz said.” (G)

“Operation Warp Speed chief advisor Dr. Moncef Slaoui has submitted his resignation at the request of the incoming Biden team under a plan that would see him stay in the role for a month to help with the transition, according to two people familiar with the situation.

Slaoui’s role leading vaccine development for the unprecedented government effort is expected to be diminished after next Wednesday’s inauguration, said the people, who spoke on condition of anonymity because the plan wasn’t announced. It would end by Feb. 12.

It’s not clear who will take scientific lead for the Biden team focused on Covid vaccines or if someone will be appointed to that role. Two vaccines are already authorized in the U.S. and three more are in late-stage clinical trials. Jeff Zients is Biden’s coordinator of the Covid-19 response, while Bechara Choucair will be Covid vaccine coordinator, focused on speeding inoculations.

Slaoui’s contract includes 30 days’ notice before termination, and the Biden team has not asked Slaoui to stay on past that, one of the people said.” (H)

“Last week, after finishing inoculations of some front-line hospital staff, Jupiter Medical Center was left with 40 doses of precious covid vaccine. So, officials offered shots to the South Florida hospital’s board of directors and their spouses over age 65.

But that decision sparked outrage among workers left unvaccinated, including those at one of the hospital’s urgent care clinics, or who believe the hospital was currying favor with wealthy insiders before getting all its staffers protected, according to a hospital employee who spoke on the condition of not being named.

The move also prompted dozens of calls from donors looking to get vaccinated.

The hospital received 1,000 doses of the Moderna vaccine two days before Christmas, fewer than half of what it requested from the state to cover its workforce. Officials prioritized delivering the vaccine to front-line medical workers who requested it, performing inoculations on Christmas Eve or the holiday weekends.

Patti Patrick, a hospital vice president, said the hospital acted appropriately in its offerings of the vaccine, which has a short shelf life once vials are opened. Neither she nor other administrators who don’t work directly with patients were included in this first round of shots.

“This was a simple way to move 40 doses very quickly” before it spoiled, she said.

She added that all front-line staff from the health system, including the clinics, were given the opportunity to get the shots.

Jupiter is not the only hospital in the nation facing questions about its handling of the vaccines. The initial rollout — aimed at health care workers and nursing home residents — has been uneven at best because of a lack of a federal strategy on how it should work, with states, hospitals, nursing homes and pharmacies often making decisions on their own about who gets vaccinated and when.

In some hospitals, administrators and other personnel who have no contact with patients or face no risk at work from the virus are getting shots, while patients — and even front-line staff — who are at heightened risk for covid complications are being passed by. Some administrators who have been working remotely throughout the pandemic have been vaccinated, especially at hospitals that decided to allocate doses by age group rather than exposure risk.

Although states and federal health groups laid out broad guidelines on how to prioritize who gets the vaccine, in practice what’s mattered most was who controlled the vaccine and where the vaccine distribution was handled….”

Arthur Caplan, a bioethicist at NYU Langone Medical Center in New York City, said hospitals should not be inoculating board members ahead of hospital workers unless those people have a crucial role in running the hospital.

“That seems, to me, jostling to the head of the line and trying to reward those who may be potential donors,” he said. But he acknowledged that the hospitals’ vaccination systems are not always rational or equitable.

Covid vaccines need to get out as quickly as possible, he added, but hospitals can give them only to people they are connected with.

Caplan noted he was vaccinated at an NYU outpatient site last week, even though his primary care doctor hadn’t yet gotten the vaccine because his clinic had not received any doses.” (I)

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Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

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

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”

POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…

POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.

PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!

POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”?  “ If Fauci didn’t exist, we’d have to invent him.”

POST 33. June 21, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)

POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!

POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..”  While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”

POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..

POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”

POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)

POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”

POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

POST 42. August 11, 2020. CORONAVIRUS. “I think that if future historians look back on this period, what they will see is a tragedy of denial….

POST 43. August 22, 2020. CORONAVIRUS.”  “we’ve achieved something great as a nation. We’ve created an unyielding market for FAUCI BOBBLEHEADS”!! (W)

POST 44.  September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”

POST 45. September 9, 2020. CORONAVIRUS.  Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’

POST 46.  September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”

POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”

POST 48. October 1, 2020.   “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)

POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”

POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).

POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

POST 52. October 18, 2020.  ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

POST 53. October 20, 2020. CORONAVIRUS. “a…“herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy.”

POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.

POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”

Post 56. October 30, 2020. CORONAVIRUS. “Trump’s now back in charge. It’s not the doctors.”

POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”

POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”

POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..

POST 60. November 7, 2020. “White House chief of staff Mark Meadows has tested positive for the coronavirus….” (A)

POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”

POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”

POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”

POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”

POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…

POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”

POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”

POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”

POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….

POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.

POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”

POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”

POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”

POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.

POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….

POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”

POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”

POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”

POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”

POST 80. November 29, 2020. CORONAVIRUS. Op-Ed in the Jersey Journal. Do you know which hospital is right for you if you have coronavirus? | Opinion

POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”

POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?

POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”

POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”

POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”

POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)

POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”

POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…

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

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

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

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

POST 93. December 19, 2020. CORONAVIRUS.  On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?

POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”

POST 95. December 23, 2020. “The Murphy administration may step in to force (New Jersey) hospitals to report COVID-19 outbreaks among staff.”

POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”

POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”

POST 98. December 28, 2020. CORONAVIRUS. “Governor Andrew Cuomo announced new penalties in order to rein in possible vaccination fraud…

POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”

POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.

POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?

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,”…

POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”

POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”

POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”

POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”

POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine.   South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”

POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.” 

POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.

POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”

January 13, 2021


 [JM1]