Post #732: Looking forward to a COVID-19 vaccine

Posted on June 27, 2020


Distributing vaccine via elephant

I wanted this to be a posting on purely technical matters around vaccines, but strayed off course owing to the political elephant in the room.  That’s the room where the vaccines will be stored.  The supply of any eventual COVID-19 vaccine in the US will be controlled by the Federal government.  And by this time, we all know what that means.  It means the vaccine will be used as a political tool, if it arrives under our current President.

I would therefore expect Virginia to be quite far down the list, in terms of when it begins to receive vaccine, and the amount available.  The upshot is that even if AstraZeneca begins delivering units of the British vaccine this fall (some promised as early as September), you’d need to factor in whatever politically-based time penalty the Federal government chooses to impose on your state, in addition to the actual time required to produce a vaccine.

I got to thinking about this because I think schoolteachers ought to be among those who are first in line to be vaccinated.  See next section.  And for that, timing matters dearly.  It’s starting to look like we might actually have some vaccine in hand (via Oxford University and AstraZeneca) early this fall.  AstraZeneca’s CEO is on the record saying they are on track for September delivery of the first doses

With that as the timing, offering vaccine to our roughly 3M US school teachers doesn’t seem implausible.  Except that, if you live in a blue state, you’d have to factor in additional time, beyond September.  Not for producing the vaccine, but for paying the likely political penalty for living in a blue state.

I think its worth pointing out that a friends-and-family approach to vaccine distribution will do something that Republicans traditionally hate:  It will reward failure.  And failure’s handmaiden, stupidity.  It’s a fair bet that Arizona will be near the top of the list, mostly due to their governor’s reported devotion to the President.  The President didn’t like masks, so the governor of Arizona made sure no locality in his state could require them.  That, based on the newspaper reporting, was the full depth of the thinking behind their ban on local mask ordinances.

We can also expect that vaccine distribution will be done with the current administration’s hallmark lack of transparency.  The usual talking-out-of-both-sides-of-their-mouths.  The usual contradictory statements by various officials.  The usual lack of not merely accountability, but basic accounting.  I’d say, based on prior behavior, that something as obvious as a simple list of which states got how many doses will not be made public.  At the time when it really matters — this fall — I’d say the odds are excellent that we (the US people) won’t even know where the vaccine is.

Just expect more of the same, that’s all I’m trying to say.  Even when it comes to the distribution of potentially life-saving vaccines.  Figure out the details and then just be prepared for it. Just because this is a life-and-death public health issue, where bungling the delivery could greatly harm US interests, well, don’t expect that to result in a change of behavior.

Once you fully grasp that, you realize that the rest of this posting is just a game of lets-pretend.  So, just for the sake of argument, let’s pretend that we could have a discussion about a rational plan for vaccine distribution.  And then carry that out competently.  Neither of those is likely to occur, but I’m going to work through it, just for the sake of argument.

What can we do for FCPS teachers?  Vaccines and high-quality masks, for starters.

But if, by some miracle, we could do this in a non-political manner, and I were king of the world, I would distribute the first few precious vaccine doses based on occupation.  (This assumes that Arizona and other currently spiking states have finally gotten their collective acts together by this fall.)  You might want to imaging yourself King of the World, and figure out where you’d direct the first doses of vaccine.   Because we might actually have some just a few months from now.

If I were running the show, the first 10M doses would go to:

  1. Hospital employees (6M people)
  2. EMTs and other emergency responders (under 1M people)
  3. School teachers (3M people).

And I believe I might put slaughterhouse workers next.  Along with nursing home workers.  Maybe grocery store workers after that.  And then, only after that, would be various groups based on presumed personal health risk, starting with the elderly.  In other words, I’d vaccinate the occupations with a known high risk of infection. And only after we’d taken care of people who have to go to work to keep the country running, then, sure, let geezers like me have some.

The third one on the list above is in response to yesterday’s reporting in the Post, that Fairfax teachers have balked at going back to teaching in person. And I have to say, it’s tough to blame them.  Kids are cute little disease vectors in the best of times.  But normally, they’ll just give you a cold or the flu.  Now, older teachers in particular are more-or-less risking death by returning to their in-person teaching positions.

I have always marveled at the fact that in one of the wealthiest counties in the US, parents are asked to send in classroom supplies with their kids each year.  For one thing, it’s ludicrously inefficient, having 200,000 parents each separately shopping for a defined set of items as part of the supply chain required to run your school system.  For another thing, it’s a regressive tax.  For a third thing, in a county where the schools cost about $15,000 per pupil-year, the amount of money involved is chicken feed.

And finally, what you end up with is a rag-tag collection of whatever citizens could purchase locally.  Not necessarily the best or most appropriate items.

And so it goes for face masks.  Do we really want teachers to show up with whatever rag-tag collection of face masks that they have managed to pick up?  Or do we want to step up and provide them with high-quality masks?

I say, let FCPS supply each teacher with two high-quality masks.  FCPS only has about 25,000 employees.  As I understand it, we in the US now have full access to Chinese-made KN95 respirators.  These are functionally equivalent to the US N95 standard, but quality us subject to some uncertainty because the US cannot guarantee the supply chain. (Translation:  you might be sold a knock-off, not the real thing).  And so, the FDA still frowns on their use in hospitals.  It’s legal, but only just legal, to use them.

We need to get out of the mindset that proper, high-quality masks should not be made available to anybody outside of a hospital.  That made sense some months back.  But that was before hospitals figured out a straightforward approach to re-using respirators (masks).  That was before the FDA backpedaled on its ban on use of Chinese KN95 respirators.  That was before China began offering those respirators in large quantities to US buyers.  Hospital workers are at highest risk, for sure.  But they are not the only ones at high risk.  Their narrow interests should not be allowed to dictate US policy in an era when hospitals no longer have to run out of masks.

I still get email offers to buy large quantities of such masks, owing to the fact that I once owned a small health-care consulting business.  Here’s the offer I got yesterday.

Source:  ALG Health.

So if FCPS decided to buy two masks for every employee (or, roughly 50,000 masks), it would cost the grand sum of $82,500.  (You need two, so you can let one dry out while you wear the other one).  The cost is peanuts, in the context of a $3B annual operating budget.

If you want to see how to send students back to school successfully, you have to start studying what other countries have done.   And in Japan, every picture you see of teaching activity shows everybody in a mask.  And not some weird cloth mask that somebody picked up somewhere.  A real mask.  Like so:

Source:  Washington Post.

Not all countries that have returned their children to school have mandated mask use.  But here, given our generally chaotic approach to dealing with coronavirus, I would think that mandatory mask use would be an obvious first step.

The likelihood that FCPS is going to be able to maintain the sort of student discipline seen in Japanese schools is nil.  So there has to be a backup plan.  And I say, that starts with providing every teacher with a high-quality KN95 respirator.  And making sure that teachers go to the front of the line when we finally have a vaccine against COVID-19.