8 ms·

You can tell what kind of pressures the local distribution systems (or lack of) are under, but the missteps are still shameful. You have people over 75 years o

You can tell what kind of pressures the local distribution systems (or lack of) are under, but the missteps are still shameful. You have people over 75 years old who were waiting and registering on whatever reservation system was cobbled together on short notice, and then because the public health authorities now risked throwing out doses for want of people to inject them into, they just opened the floodgates to everyone over 65. So what happens to the people over 75 who were waiting, and now are swamped by the crowds? If they keep on opening up bulk tranches of the population (instead of in small slices) before people of priority are reached, when will the most vulnerable ever get their turn? This is a known problem. Multiple queues of priority and people on call to be given turns the next day if it looks like there's capacity. Instead you have people wondering if they should walk in, visit a county next door, or wait around in case some mistake is made and there are actually extra doses at the end of a day. Or try to scheme/figure out the system however they can, out of desperation. If it can't be done right, let everyone know that it's up to their willingness to wait wherever they can, according to some basic ground rules, and don't make a meaningless (or worse, deceptive) reservations system that gets bypassed at the last minute. What a shameful clusterfuck.

ghaff 6y ago
I'd be less concerned about people over 65 "sneaking in" over people more than 75 than systems that end up being a free for all anyone to get vaccinations because they're in the right place at the right time (and presumably getting second vaccinations as well). A lot is really about overall volume. Even a million vaccinations a day means you're looking at well into the summer until you even approach 50% vaccinated.
- votepaunchy 6y ago
  There are 260 million American adults. Already 12 million receiving a vaccine. Approaching 1,000,000 per day receiving first dose. At that rate we’ll need 118 days to have half the population vaccinated with a first dose in mid-May and the second dose in early/mid-June.
  - ghaff 6y ago
    OK. So early summer. And that's 50% which some would say is not nearly high enough for people to get on with their lives (but may, or may not, be a reasonable target--especially given that a fair number of people will hold off).
    - amalter 6y ago
      Also unknown is the number protected by prior infection. Anywhere from 10-30%. I think we’ll see R’ start to plunge during summer due to weather and never climb back up from increase in immunity. But “back to normal”. January earliest.
      - ghaff 6y ago
        Most events people I know are betting on things being normal-ish by the fall. Doesn't mean they're right of course although they were right enough to shut things down at a time when many people were still thinking it wasn't that big a deal. There are also gradations of normal although once you fully open up restaurants, have indoor concerts, packed auditoriums, etc. most things you could do to reduce spread are pretty much theater at that point (other than possibly requiring vaccinations to fly, enter venues, workplaces).
xwdv 6y ago
It’s a Byzantine Generals problem.
reissbaker 6y ago
Opening vaccine eligibility up, and allowing walk-ins if doses will expire, is part of how Israel was so successful at distribution. Multiple priority queues are nice in computer science, but managing them with time-sensitive vaccine doses is hard. Simple, imperfect and fast is better than perfect, complicated, and slow. Getting a large swath of people vaccinated is more valuable than perfectly getting prioritization right. Prior to this change, NY was attempting to perfect prioritization, and was discarding many doses as they expired.
- FalconSensei 6y ago
  > and allowing walk-ins if doses will expire Exactly. Any person getting a dose is better than vaccine expiring
  - fleetingmoments 6y ago
    We should also open up expired vaccines to whoever wants them. Expiry dates are usually quite pessimistic and medicines often have efficacy long after they're officially expired.
    - objectivetruth 6y ago
      This is a different model of expiration. This isn't "two-year shelf life can be extended to five years w/ stable temperature and humidity and only a 10% loss of efficacy." This is "once this vaccine is pulled out of the super-cold freezer, it starts breaking down, and you have X hours before it's worthless at best." Worse than "worthless" is the idea that people might get a useless expired vaccine anyway, think they're protected, and then be a vector for future transmission.
- babesh 6y ago
  This reminds me of how the Israeli military supposedly works. Top level goals and being flexible and creative at the operational level. See https://www.jstor.org/stable/4531385?seq=1 https://www.jstor.org/stable/4531385?seq=1 In my opinion, the US’s top level goals were wrong (over focus on equity versus utility) and the US bureaucracy is neither flexible nor creative as evidenced by its refusal to buck top level orders and it’s continuing slowness. These are signs of a decaying system.
disabled 6y ago
Make sure to take a screenshot of whatever confirmation you get. Because servers are overloaded, some people in my area did not get confirmation texts or emails. If somebody is elderly, the chances of them getting an appointment is extremely low without the help (and extreme vigilance) of their tech savvy children/nieces/nephews. Some states have also opened up their registrations to people 16+ with serious chronic health conditions that put them at high risk of severe COVID-19. In a handful of these states, many of these people have received a vaccine. But, it is first come first serve, which is an absolute disaster along with being inequitable.
- ampdepolymerase 6y ago
  Why are healthcare servers still getting overloaded when HIPAA compliant "infinitely scalable for a price" cloud systems like AWS exist.
  - ashtonkem 6y ago
    And why now? I'm sure it would be much easier than normal to get AWS and some relevantly skilled professionals to donate enough time to make a workable reservation system.
  - gruez 6y ago
    >"infinitely scalable for a price" cloud systems like AWS exist. That only applies if your application is programmed for it. Good luck scaling even if you had aws if your server had database locks everywhere, for instance.
    - ampdepolymerase 6y ago
      Or maybe, the developers need to go back to school to learn about horizontal and auto scaling.
      - recursive 6y ago
        Which school would that be? My cs program was all math and data structures. I learned everything I know about software development on my own.
thebigman433 6y ago
The missteps suck, but I really dont think it is on the local health departments very much. The federal government shouldve really been taking a lot of the load themselves. My local health department has a dozen workers and has had to handle the pandemic basically on their own the whole way through. The outbreak was so bad in October/November that they literally couldnt finish counting all the cases in a day multiple times. Now, in addition to trying to handle the outbreak, theyre also being tasked with distributing a vaccine in record times. And through all this, theyve been underpaid and harassed by a significant portion of the population
- mikem170 6y ago
  What about your state? They are the ones who are supposed to handle stuff like this. To me it is a cop-out to blame the feds. There is nothing to stop any state in our union from addressing this pandemic as they see fit. The states making up the Euro aren't blaming Brussels for their problems. The converse would be to have one world government make decisions for everybody, right? That would work if we all agreed on everything, but we don't. So it is good to have different states try different solutions, and copy what works. Better then having a bad federal solution imposed on everyone.
  - thebigman433 6y ago
    > There is nothing to stop any state in our union from addressing this pandemic as they see fit Except for zero funding... My state is definitely to blame too, our new governor is an absolute disaster. But, we also have no serious funding left to handle the pandemic. Our last governor started a rainy day fund years ago and exhausted that last year, along with part of our wildfire fund. There is nothing left for us without federal assistance. There is absolutely a middle ground between putting everything on the state and having one government rule the entire world. The federal government is the best equipped entity in the United States for handling the pandemic. It has the funding, personnel, and logistics management to efficiently distribute vaccines.
    - mikem170 6y ago
Mediterraneo10 6y ago
The point of the vaccine is to keep the health system from being overloaded. Over 75s are already being triaged out of intensive care in many countries, so it matters little on a society-wide scale whether they get the vaccine or not. In fact, somewhere in the news today I read an official claiming that it is 60-75 year old people who are the most important vaccination target to begin lifting lockdowns.
- maxerickson 6y ago
  The point of the vaccine is to end the pandemic. An early benefit of the vaccine is reduced load on the health system.
  - Mediterraneo10 6y ago
    As has been often emphasized, the reason that COVID-19 is considered a pandemic of such dangerous degree to require a rapid development of vaccine, is because it overloads hospitals and can deny many others (not just COVID sufferers) access to urgent treatment. Without that factor, the most vulnerable demographic for COVID-19 in terms of mortality rate is e.g. elderly people in care homes who are ordinarily a low priority for innovative medical treatments, and it is hard to imagine a vaccine would have been rushed just for their sake.
    - maxerickson 6y ago
      It wasn't rushed, the science was ready to go early last year and all they did was accelerate the first trial phases, the Phase 3 trials went quickly because infections were so widespread. That there are multiple candidate vaccines targeting the spike protein without using the virus directly is strong evidence that the science was ready (using mRNA, viral vector and other technologies).
deleted 6y ago
[deleted]
wussboy 6y ago
I mean, it’s not like we knew this was coming or had any time to prepare for it...

ghaff 6y ago

I'd be less concerned about people over 65 "sneaking in" over people more than 75 than systems that end up being a free for all anyone to get vaccinations because they're in the right place at the right time (and presumably getting second vaccinations as well). A lot is really about overall volume. Even a million vaccinations a day means you're looking at well into the summer until you even approach 50% vaccinated.

votepaunchy 6y ago
There are 260 million American adults. Already 12 million receiving a vaccine. Approaching 1,000,000 per day receiving first dose. At that rate we’ll need 118 days to have half the population vaccinated with a first dose in mid-May and the second dose in early/mid-June.
- ghaff 6y ago
  OK. So early summer. And that's 50% which some would say is not nearly high enough for people to get on with their lives (but may, or may not, be a reasonable target--especially given that a fair number of people will hold off).
  - amalter 6y ago
    Also unknown is the number protected by prior infection. Anywhere from 10-30%. I think we’ll see R’ start to plunge during summer due to weather and never climb back up from increase in immunity. But “back to normal”. January earliest.
    - ghaff 6y ago
      Most events people I know are betting on things being normal-ish by the fall. Doesn't mean they're right of course although they were right enough to shut things down at a time when many people were still thinking it wasn't that big a deal. There are also gradations of normal although once you fully open up restaurants, have indoor concerts, packed auditoriums, etc. most things you could do to reduce spread are pretty much theater at that point (other than possibly requiring vaccinations to fly, enter venues, workplaces).

xwdv 6y ago

It’s a Byzantine Generals problem.

reissbaker 6y ago

Opening vaccine eligibility up, and allowing walk-ins if doses will expire, is part of how Israel was so successful at distribution. Multiple priority queues are nice in computer science, but managing them with time-sensitive vaccine doses is hard. Simple, imperfect and fast is better than perfect, complicated, and slow. Getting a large swath of people vaccinated is more valuable than perfectly getting prioritization right. Prior to this change, NY was attempting to perfect prioritization, and was discarding many doses as they expired.

FalconSensei 6y ago
> and allowing walk-ins if doses will expire Exactly. Any person getting a dose is better than vaccine expiring
- fleetingmoments 6y ago
  We should also open up expired vaccines to whoever wants them. Expiry dates are usually quite pessimistic and medicines often have efficacy long after they're officially expired.
  - objectivetruth 6y ago
    This is a different model of expiration. This isn't "two-year shelf life can be extended to five years w/ stable temperature and humidity and only a 10% loss of efficacy." This is "once this vaccine is pulled out of the super-cold freezer, it starts breaking down, and you have X hours before it's worthless at best." Worse than "worthless" is the idea that people might get a useless expired vaccine anyway, think they're protected, and then be a vector for future transmission.
babesh 6y ago
This reminds me of how the Israeli military supposedly works. Top level goals and being flexible and creative at the operational level. See https://www.jstor.org/stable/4531385?seq=1 https://www.jstor.org/stable/4531385?seq=1 In my opinion, the US’s top level goals were wrong (over focus on equity versus utility) and the US bureaucracy is neither flexible nor creative as evidenced by its refusal to buck top level orders and it’s continuing slowness. These are signs of a decaying system.

disabled 6y ago

Make sure to take a screenshot of whatever confirmation you get. Because servers are overloaded, some people in my area did not get confirmation texts or emails. If somebody is elderly, the chances of them getting an appointment is extremely low without the help (and extreme vigilance) of their tech savvy children/nieces/nephews. Some states have also opened up their registrations to people 16+ with serious chronic health conditions that put them at high risk of severe COVID-19. In a handful of these states, many of these people have received a vaccine. But, it is first come first serve, which is an absolute disaster along with being inequitable.

ampdepolymerase 6y ago
Why are healthcare servers still getting overloaded when HIPAA compliant "infinitely scalable for a price" cloud systems like AWS exist.
- ashtonkem 6y ago
  And why now? I'm sure it would be much easier than normal to get AWS and some relevantly skilled professionals to donate enough time to make a workable reservation system.
- gruez 6y ago
  >"infinitely scalable for a price" cloud systems like AWS exist. That only applies if your application is programmed for it. Good luck scaling even if you had aws if your server had database locks everywhere, for instance.
  - ampdepolymerase 6y ago
    Or maybe, the developers need to go back to school to learn about horizontal and auto scaling.
    - recursive 6y ago
      Which school would that be? My cs program was all math and data structures. I learned everything I know about software development on my own.

thebigman433 6y ago

The missteps suck, but I really dont think it is on the local health departments very much. The federal government shouldve really been taking a lot of the load themselves. My local health department has a dozen workers and has had to handle the pandemic basically on their own the whole way through. The outbreak was so bad in October/November that they literally couldnt finish counting all the cases in a day multiple times. Now, in addition to trying to handle the outbreak, theyre also being tasked with distributing a vaccine in record times. And through all this, theyve been underpaid and harassed by a significant portion of the population

mikem170 6y ago
What about your state? They are the ones who are supposed to handle stuff like this. To me it is a cop-out to blame the feds. There is nothing to stop any state in our union from addressing this pandemic as they see fit. The states making up the Euro aren't blaming Brussels for their problems. The converse would be to have one world government make decisions for everybody, right? That would work if we all agreed on everything, but we don't. So it is good to have different states try different solutions, and copy what works. Better then having a bad federal solution imposed on everyone.
- thebigman433 6y ago
  > There is nothing to stop any state in our union from addressing this pandemic as they see fit Except for zero funding... My state is definitely to blame too, our new governor is an absolute disaster. But, we also have no serious funding left to handle the pandemic. Our last governor started a rainy day fund years ago and exhausted that last year, along with part of our wildfire fund. There is nothing left for us without federal assistance. There is absolutely a middle ground between putting everything on the state and having one government rule the entire world. The federal government is the best equipped entity in the United States for handling the pandemic. It has the funding, personnel, and logistics management to efficiently distribute vaccines.
  - mikem170 6y ago

Mediterraneo10 6y ago

The point of the vaccine is to keep the health system from being overloaded. Over 75s are already being triaged out of intensive care in many countries, so it matters little on a society-wide scale whether they get the vaccine or not. In fact, somewhere in the news today I read an official claiming that it is 60-75 year old people who are the most important vaccination target to begin lifting lockdowns.

maxerickson 6y ago
The point of the vaccine is to end the pandemic. An early benefit of the vaccine is reduced load on the health system.
- Mediterraneo10 6y ago
  As has been often emphasized, the reason that COVID-19 is considered a pandemic of such dangerous degree to require a rapid development of vaccine, is because it overloads hospitals and can deny many others (not just COVID sufferers) access to urgent treatment. Without that factor, the most vulnerable demographic for COVID-19 in terms of mortality rate is e.g. elderly people in care homes who are ordinarily a low priority for innovative medical treatments, and it is hard to imagine a vaccine would have been rushed just for their sake.
  - maxerickson 6y ago
    It wasn't rushed, the science was ready to go early last year and all they did was accelerate the first trial phases, the Phase 3 trials went quickly because infections were so widespread. That there are multiple candidate vaccines targeting the spike protein without using the virus directly is strong evidence that the science was ready (using mRNA, viral vector and other technologies).

deleted 6y ago

[deleted]

wussboy 6y ago

I mean, it’s not like we knew this was coming or had any time to prepare for it...