Relying on Kaiser--More on Vaccination

 When I wrote before about getting vaccinated, I assumed that Kaiser would notify me when I was eligible and they had the vaccine.  Having revisited their site today I'm not sure that's right.  I've not seen any discussion from either Kaiser or Fairfax.

I see Fairfax County Health Department has a vaccine registration app, which I've completed. A fair number of questions on health--allergies, etc. but it was easy enough to complete in a couple minutes. (I'm a vanilla case, answering "no" to most of the questions.) Notably, they didn't ask for my medical provider so they don't have an obvious way to cross check with Kaiser.

Getting Vaccinated

 I suspect one of the big problems in vaccinating the U.S. is the degree to which it relies on bottom-up action.

What I mean is that presumably you can identify the hospitals, clinics, and long-term care facilities in your state, deliver vaccines to those sites, and rely on their management to get their people vaccinated.  But once you go past that, once you start allowing people who are 65 or 75 and older to be vaccinated, you are essentially asking those people to take some initiative. 

At best, like me, their health care provider, Kaiser Permanente in my case, will notify them when they have vaccine available.  But people who don't have a healthcare provider with resources will have to search out a pharmacy.

As I write I realize the situation is not that different for the flu vaccine. Apparently 60-65 percent have gotten that vaccine in the past.  

Seems as if this is a situation where we don't know until we see the history.

More on Vaccinating

I posted yesterday about a chance un the 1960's to lay the basis for an efficient way to vaccinate the public.

Today a Post article reinforces that--a quote:

Israel’s vaccine success is made possible by its small size (slighter larger than New Jersey) and the efficiencies of its nationalized health system, in which all 9 million citizens hold identity cards and register their electronic medical files with one of the country’s four national health maintenance organizations (HMOs).

Israel also maintains a national vaccination registry, first designed for childhood vaccinations, that will be used in the coming weeks to monitor immediate and long-term progress of the coronavirus vaccine program.

I suspect one of the arguments in the 1960's against a national identity system was the specter of the Holocaust; people being numbered, tattooed, and subject to totalitarian rule, at the whim of the state. 

While I continue to believe that efficiency would have been, and would be, enhanced by a national identity system, I have to concede the disadvantages which are real.  One worth mentioning here: the greater security provided by our dispersion of data--the eggs in one basket proverb--especially in light of the election and the Southwinds hackl 

 

More on Gen Perna and Vaccine

 In addition to points in my previous post, a couple of other things occurred to me:

• doing a checklist, or rather a series of checklists, would have been good.  Even though the decision had been made to allow state and local governments to design the system to do the jabs and report the status, my guess is it would have been possible to specify different parts of the operation in detail.  For example, actually giving the vaccination could start with removing the vial from the deep freeze, warming it, etc. etc.  At some point a recording and reporting process would take place.
• one problem with using past processes for vaccinations is that this one has different parameters.  The flu vaccine is requested by the public so you have a sales effort. For covid the attempt is to ration the jabs.  For me, I'm about to hit my 80th birthday, but I've no underlying health condition.  When and how do I learn VA has reached me in the queue? Or do I just call around to pharmacies or Kaiser until someone tells me to come in.  I don't know. 
• I see a report that WV is doing well, perhaps because they gave the job to the National Guard.  I can see how that could fix the notification problem, and perhaps even the checklist point.

Some Sympathy for Gen. Perna

 General Perna is the chief operating officer for Warp Speed, which is now taking some flak for the seemingly slow progress of vaccinating for covid-19.

I never had to deal with his problem, but I have been involved in rolling out programs affecting thousands of counties and a million or so people on a crash basis. The difference between his problems and mine were great:

• the visibility to modern media.  ASCS/FSA programs were visible to local newspapers, but weren't followed nationally or internationally.
• an organizational structure which reached to the end user, the farmer, and one which had long experience in crash programs, dating back to 1933 when it was first set up.
• a program which usually was similar to previous programs--I can't judge how closely the covid-19 program matches the influenza program but it seems quite different.

Just from my back seat position of almost total ignorance, there's some things which didn't happen which should have:

• a tick-tock time schedule. Perna's already apologized for screwing this up. My impression is that there weren't sit-down meetings thrashing through every minute step, which could then be documented in a schedule to establish a base of understanding.
• implementation training. Because a vaccine is just a "jab" in the arm which everyone knows how to give, and because the implementers of the Warp Speed hadn't done this before, it was easy to assume (I assume) that no training was necessary. The reality is that training sessions get everyone on the same page, allow for the identification of areas where silos create problems, and permit exchange of ideas.
• as a former directives person, I suspect whatever directives were issued weren't really in a system.  Part of the problem seems to be lack of delineated authority, but it's also the human tendency to resist systems--to believe that a memo (or these days an email, etc.) handles the immediate problem, without realizing the proliferation of unsystematic directions can worsen problems.

I suspect, given the overall directive of relying on state and local governments to distribute and vaccinate, leaders assumed that those governments had systems in place.  Ass u me.  

I want see to the after-action reports and analyses of the effort to see how wrong this post is.

I also want to restate my sympathy for Perna (unusual for me to feel for a general): doing something new under scrutiny and a time line is a formula for bad public relations.

How To Distribute the Vaccine

The Volokh Conspiracy had a post urging adoption of a point system to fairly distribute the Covid-19 vaccine.   I like the idea.  The military used a point system for demobilizing troops after World War II which seemed fair.  It's a way to handle cases where multiple factors are at work (i.e., an essential worker with underlying condition).

Covid-19 Impacts on Society

 This FCW article argues that Covid-19 should impact the government's priorities on IT. Ir's part of a larger set of speculations over the long term impacts. Maybe:

• broadband access is more important so everyone can work and study from home?
• people who for the first time were forced into using online services will continue to use them, and expect their availability?
• on-line shopping is growing and the old brick and mortar department stores, and smaller outfits, are obsolete?
• lots of restaurants going out of business, more delivery services, and perhaps more home cooking?
• more family togetherness?

Flak on Reopening USDA DC

USDA's DC area offices are working towards reopening, but catching flak from the employees according to this report.

Chill: My Words for the Country

 I'm reminded of Wouk's "The Caine Mutiny" which I read multiple times in youth.  There was a couplet in it which I remember, notable because I don't remember much poetry.:

When in trouble or in doubt

Run in circles,

Scream and shout.

IIRC it was being applied to the USNavy, as their response to problems, perhaps by Lt. Keefer, but I may be wrong.

Anyhow it's a corollary of the Harshaw Rule--trouble and doubt occurs often when you're doing things for the first time, at least the first time within living memory.  That's what we as a world and a nation are doing now with covid-19.  It's new enough we have no assurance in what we're doing, so we get uptight and snap and fight.

Someone today noted that we have a huge number of different school systems, private, public, parochial, in different jurisdictions, all of which are using different approaches to handling schooling for the fall. Different because we don't know what are "best practices" for sure.

Lots of recriminations among the politicians about whose positions in the first quarter of the year were correct. I'm firm in my belief that the president screwed up, and continues to screw up the response. But, it's true enough we're all screwing up because we don't know now what we'll know in a year from now.  

So I think people should chill, at least a bit, and put more emphasis on who's learned what and what process will be most enlightening and educational. 

At What Point Does Covid-19 Become Another Flu?

President Trump notoriously dismissed Covid-19 early on as just another flu.  That was quickly disproved.  I wonder, though, whether there is a point at which influenza and Covid-19 are really comparable.

Apparently flu kills from 20,000 to 80,000 people a year.  20,000 divided by 50 weeks equals 400 a week, 80,000 would equal 1600 a week.  Deaths are just one metric.  Another consideration is severity of illness and longevity of effects.  My impression is that on both counts Covid-19 has been worse than flu in that regard. 

[Updated:  a senior moment--confusing weeks and days--100 deaths a day would mean 36,500 deaths a year.  If we're currently averaging 5-600 deaths a day, we still have a long way to go.]

The idea of comparing covid-19 and the flu was discredited by its extensive use in the early days of the pandemic to minimize the dangers of the covid-19.  But now it seems to me that we're focusing exclusively on covid-19 and, perhaps, losing some perspective on the overall picture.

How Easily We Panic

I should say, how easily I panic,though I suspect it's true of most humans

Woke during the night with a fever, convinced myself I had covid-19,and panicked over the steps to take next--how to self-quarantine in the house, etc.

In light of day I'm 99 percent convinced it was false alarm--no other symptoms, fever possibly linked to a bit of gastritis (thank you Dr. Google) which happens now and again. 

But it dented my self-image as thoughtful, etc. 

I'm sure I'll forget/deny this episode in a few days.

Pandemic From 30,000 Feet Again

This is based on the NYTimes summary as of June 13.

It seems to me you can categorize states by the shapes of their case graphs:

• States with one defined peak, and a fairly consistent decline from that peak.  This would include the NY/NJ/CT/MA states, with early peaks, and a number of other states which were slower to peak.
• States with two fairly clear peaks, which might include FL, TN, KY
• States which have never reached a peak--i.e., their case load is still climbing. Includes CA, TX,  AL, UT, NC, SC, AR, KY,
• Small states with too few cases to evaluate.
• Mixed cases

Trying to create a story from this data, I go back to my previous pandemic post:  

• the East Coast states were hit early because they are both well networked with Europe and dense.  That meant they weren't prepared and got overwhelmed early, but they learned to take covid-19 seriously and adopted measures which reduced spread.
• other states didn't take the virus that seriously (i.e., even if they were officially locked down, public compliance was less than in the hard hit states), meaning if they were networked like FL, they could have an early peak and then a later one.
• possibly two peaks reflects a matter of luck, the virus hitting nursing homes, etc. once, then a slower spread to the more general population.

The Effect of Graphics

Both the NYTimes and the Washington Post have graphs showing the deaths due to the covid-19 virus over the days since Mar. 1.  The Post's graph is on the front page, spanning one column, which represents 1/6 of the width of the paper.  The Times' graph is on page 4, in their coronavirus update column, which is double width--two columns. 

I've not measured the height scale, but the general effect is that the Post's graph shows a steep decline after a vertical rise in cases while the Times shows a much more gradual decline.  Same data, different impressions.

US Pandemic from 30,000 Feet

It seems to me the general pattern of the pandemic spread was:

• the first to become ill and those who spread the disease were the well-off.  By definition if you were traveling between China and Europe, or between Europe and the US, or China and the US, you had money and an upper-middle class or upper class lifestyle.  And those you gave the virus to likely shared those characteristics.
• but second to become ill were the parents and grandparents of the travellers, those in nursing homes and assisted living homes.  My assumption is that most people in such homes are from backgrounds with above-average incomes, even though Medicaid may cover care.
• the final tier of victims were the vulnerable, those in meat packing plants, those in congested areas living in crowded homes, immigrants and the poor.

This is just speculation; I hope I live to see some good social research on the subject. 

How Far Do Aerosols Carry?

Josh Marshall at TPM links to an article which seems to take aim at the science behind the 6 foot distance, arguing it's old science and modern instruments can offer more accurate measurements.

I'm no expert--Marshall repeats the suggestion if you're close enough to smoker to smell the tobacco, you're likely too close for covid-19.  That's the sort of layman's measurement which appeals.  Might not be right but appeals.  I'd offer another layman's measurement: in season 3 of the Last King some episodes are set in winter.  It appears they shot in winter, because the exhaled breaths of people and horses are very visible.  Hard to guess the distance traveled, but often likely over 6 feet.

Suppose We Didn't Have Work From Home

There have been a lot of comparisons between the current pandemic and those in the past, particularly in terms of case numbers and deaths.

One thing which isn't accounted for in such comparisons is the existence of the Internet and the enabling of work from home. My point is that in 2020 we had the option of closing offices and working from home, of closing schools and going to remote learning, of moving to tele-medicine.

I don't know how much difference it makes; I don't know the extent to which shelter-in-place was implemented in past pandemics.  But I'm sure it makes a significant difference, which social scientists will be trying to figure out over the next years.

A Note From the Store: Toilet Paper

I was intrigued yesterday by the toilet paper  shelf at Safeway.  Usually they have multi-roll packs of their own toilet paper, plus those of name brands.  There were a few such packs of their own brand yesterday, but the bulk of the shelves were filled with individual rolls of a couple of brands I'd never seen before. They were foreign, I think, but didn't linger to investigate further.

We Do Better by Our Animals Than Humans?

This is a paragraph from a Washington Post article on an OK veterinary lab which got into Covid-19 testing:

The Oklahoma Animal Disease Diagnostic Laboratory’s scrappy, collaborative effort to shift gears amid a crisis was aided by basic biological similarities between humans and other species: Animals’ nasal passages are routinely swabbed for viruses, and nucleic acid is extracted from samples and amplified on state-of-the-art machines identical to those used in human testing for the novel coronavirus. But it also highlights the preparedness of many animal health labs, which — unlike public health labs — have been buttressed by federal grants to be bulwarks against outbreaks that could cripple livestock and poultry industries.

That last sentence struck me.

Upton Sinclair's Jungle

The covid-19 problems in meatpacking plants remind me of Upton Sinclair's Jungle. It had a major impact on the American food system, but much remains the same--especially the use of immigrant labor under what seems to be harsh conditions, at least when looked at through American eyes.

Superspreader Individuals or Situations

Megan McArdle offered this thought in a thread commenting on an elaborate analysis of probabilities (too elaborate for me to even try to follow):

Over the long term, I think this stuff matters less; if you remain open, in any moderate population center, a superspreader will find you. But early in the epidemic, a random walk will make some places look smart and others look dumb, purely by chance.

— Megan McArdle (@asymmetricinfo) May 4, 2020

I can venture to comment on this, however.  The assumption here seems to be that "superspreading" is a function of an individual (think Typhoid Mary perhaps, but not necessarily asymtomatic).  That's certainly been my understanding from the past. 

But in the context of this new pandemic, I ran across an interesting report by someone who tried to assemble worldwide reports of mass contagion and then to analyze common features. I may have mentioned this before.  The features were crowds plus intimate contact and/or a lot of vocal activity--cheers, shouts, etc. 

One would think we could rely on people to avoid such situations, although when you look at the rallies protesting against lock-downs you have to wonder.  But in principle avoiding such situations is easier than identifying potential superspreaders.  It's likely unknowable currently to determine the proportion of total infections occurring from superspreader individuals, versus crowd contagion, versus individual contact.