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Major US changes in distribution
HHS Secretary Azar announced some major changes to vaccine distribution today:
(I haven't yet watched the press conference.  I may update this posting after I do)

1. On (last) Sunday, all the reserved second doses were released to the jurisdictions.  I don't know whether these are intended to be used as first doses, or held by the jurisdictions for 2nd doses, or whether it is up to the states.  I suspect that the jurisdictions were given the option of asking for them to be delivered rather than having them show up in a shipment.

2. In an effort to accelerate administration, allocation wil begin to be based on how quickly delivered shots are being reported as administered AND how many 65+ people are in the jurisdiction.  The change in allocation begins in 2 weeks.

3. The US government (CDC & HHS) has now said that the states should immediately start vaccinating everyone 65+ and anyone with certain co-morbidities. (Co-morbidity requires medical documentation.)

4. Federal community health centers and the pharmacies (14 chains) are now authorized to start vaccinating the public.
I think these are all good, at least from my perspective.

1. Re 2nd doses. I expected the current administration to release all the 2nd doses so it could take credit for what was produced during its term, rather than the next administration taking credit.

2. I haven't yet seen details of the algorithm. Generally, it makes sense. I can see not releasing doses based on how many stored doses already are in the state. It does cause a problem for scheduling 2+ weeks out. ("We're going to vaccinate 100K at mass vaccination at the Rose Bowl in 2 weeks...if the doses are available.") I expect it will reduce distribution to military destinations (more for the VA, less to active troops).

3. I think this generally is good. In California, it would mean that all of Phase 1B tier 1 and part of tier 2 would now be eligible. BUT, I don't know that California's rules can be changed that quickly. It does mean a 65yo may get a reservation instead of a 75yo (that's bad).

It may cause problems for providers. For instance, my health provider was going to open a reservation line this week, but I presume they were only planning for Phase 1B Tier 1. The extra load could swamp them. They may not be ready to accept all the people.
How many 65+ in a district would be below the severity of the outbreak in an area in my calculus. Vaccinating older counties with low levels of infection will save many less lives than vaccinating younger counties with high levels of infection. Also would seem to bias rural, Republican counties versus urban, Democratic counties. Fishy move on their last days out the door. I imagine the Biden admin will quietly ignore this.
I am not aware of anything at the federal level regarding "districts" or counties. Federal info about states, yes. States could do it at county levels.
% of state population 65+ runs from 11% (Utah) to 20% (Maine).

A better target (IMO) would be a calculation of likely deaths per capita in 1 month considering current levels of infection applied to age, ethnicity, & comorbidity data. OR, a calculation of ICU overrun per capita. But allocating on 65+ population seems better than allocation on 18+ population.

Currently, CA has had more vaccine per capita distributed to it than most other states. 19th among states. (Reported administration rate per capita: 41st)
Alaska is WAY ahead (maybe it was getting both 1st & 2nd doses distributed?) VT is 2nd. Fewest vaccines to SC, IA, KS, TX, NV.

California preloaded 6% (2.5M) of its total vaccination supply to go first to the medical community (as SCC documented and apparently did, "medical staff," not "frontline medical staff"). That puts CA behind other states in getting it to those more likely to die (and, I think, to go into the ICU). This week, enough has been distributed to the state to start on the next category, but CA seemingly still hasn't gotten far in the other half ("other," not second half) of phase 1A (400K LTCF residents)
3.28M distributed to CA; 2.5M estimated in 1A; 0.82M reported first doses
My personal opinion is that it is unethical to withhold doses because an area is having trouble with distribution. The criteria need to be about saving lives. The response to a state or county having trouble with distribution is assistance in the distribution process.
One state is having vaccine sitting in storage while another is getting it in the arms. The one getting it in the arms is ready to use the next delivery. The first state will get their share once they start using up the vaccine from their storage. Think of it as being unethical to order doses that you aren't going to use any time soon when others will use them now to save lives.

The states have the doctors, nurses, facilities, and pharmacies to do the vaccinations. Probably more importantly, all of those are licensed by the state, and report medical info the state. There are business/professional associations that connect them.

California is in the bottom 3rd of states giving vaccinations. SCC was probably in the bottom 3rd of the counties in the state. CA (5th biggest economy in the world) has given 856K first doses and 204K second doses out of 3.5M received, so 2.4M are sitting in storage.
TX has given 1M first doses and 155K second doses out of 2.1M, with about 1M in storage.
I never meant to say that I approve of leaving the stuff in the refrigerator. It enrages me that California is mismanaging this so badly. I said the proper answer was to fix the problem of distribution as opposed to penalizing the state.

I feel the same way about the monoclonal antibody infusions. Estimates are that you can prevent one hospital stay for 10-20 treatments. 20 infusions consumes a lot fewer medical resources than a hospital stay, not to mention bein in the ICU. In California, the "infusion clinic" could be a tent in the parking lot.

This is an emergency and the government has no excuse for it's incompetence.
Yes, I agree about the antibody infusions. The CDC is also frustrated that these aren't being utilized.

I'd love to see a doctor attend the large testing sites and make decisions to offer them immediately as people show up to take their test, basing on symptoms. Effectively, go in for a free test, and get a free doctor's appointment & maybe treatment.

It is too easy to wait until you get the results back to then make an appointment and go in. By then the efficacy of the treatments is way down.

It was about the time that it became clear that the state started getting heat over failure to administer that things have started to speed up. So, maybe the threat of not getting vaccine is having the desired result. However, taking SCC as an example, there are only about 10-20 places to get a vaccination. I believe that NONE of them are giving shots 28% of the week (ie, weekends).

(For Travis County, TX, (pop. 1.3M) about 40 places have received vaccine in weeks 4 & 5.)

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