Post #896: Has anybody seen our vaccine distribution plan?

Source:  weareteachers.com

I’ve seen it.  I think.  Such as it is.  Maybe.

Before I even try to be amusing about this, take a look at it yourself.  You can read it by following the links on this US DHHS web page.  This is the plan, as released in late September (.pdf).  And this is the “playbook” for executing that plan, released late October (.pdf).

The whole gist of the plan, such as it is, is that vaccines will be distributed through the States.  Presumably, via state public health departments.  You can see an outstanding summary of the status of those State plans via the Kaiser Family Foundation website.   It’s agreed-upon that certain vulnerable or critical populations will get vaccinated first, such as health care workers.  Beyond that, it’s up to the States to determine the distribution routes.

But now, turn to the key table in the Federal plan showing how the vaccine doses will be divided up among the States.  Our allocation plan, as part of the overall distribution plan.  And you will soon find that there is no such table.  Continue reading Post #896: Has anybody seen our vaccine distribution plan?

Post #890: North Dakota acts, using the now-standard playbook.

My last two posts were about the situation in the Dakotas (and much of the upper Midwest), where some governors simply would not take significant actions to reduce spread of COVID-19.

For North Dakota, infections were spreading so fast that (by my estimate) they were going to achieve herd immunity (70% of the population having been infected) by the end of the year.  Merely by keeping up the current rate of infection.  (See just-prior post.)

That seemed like a wonderful natural experiment, and I applauded the people of North Dakota for leading the way.  They would be able to show the entire world just exactly how a policy of “let ‘er rip” (a.k.a. rapid transition to herd immunity) would work out.

Sacrifice in the pursuit of knowledge is a noble thing.  As long as it’s somebody else’s sacrifice.

But, unfortunately, instead of pursuing this natural experiment to its conclusion, they’ve decided to follow the standard Republican-state drill.  (Apologies to sane Republicans like cousin Larry.)  Which is:  Take no significant actions until hospitals are full.  And then, once the hospitals are full, like clockwork, they put all prior rhetoric down the memory hole and start doing what public health experts recommend.

And that’s what happened yesterday in North Dakota.  The Governor of North Dakota announced a mask mandate.  It only runs for one month.   It exempts religious services.  As with Virginia’s mask mandate, there is potentially a stiff fine for non-compliance, but no specified means of enforcement.  (See Post #881).

And it fits the pattern, emphasis mine:

"The order, signed by interim State Health Officer Dirk Wilke, takes effect immediately and runs through Dec. 13. It is intended to help alleviate hospitals overwhelmed by virus patients, a news release from the governor said.

“Our doctors and nurses heroically working on the front lines need our help, and they need it now," Burgum, a Republican, said in a video message announcing the measures.

Source:  Fox News

Per the Washington Post, North Dakota was down to its last nine staffed ICU beds. 

The order does more than just mandate mask use.  It follows the now-standard set of tools for containing spread, including reduced hours and capacity limits for restaurants and bars, and curtailment of extracurricular activities (including) sports at schools.  So it is, in fact, a near-textbook example of following existing public health guidelines for COVID-19 containment.

The exemption of churches may or may not be due to legal issues.  Purely from a public health standpoint, it makes no sense, as churches have been significant sources of super-spreader events throughout this pandemic (see Post #679).  For this and other reasons, some experts place church services just below bars for riskiness (see Post #811, qualitative ranking of COVID-19 transmission risk).  Presumably churches in ND have the good sense to curtail singing (Post #708), even if they don’t have the sense to require masks themselves.


Now a bit of realpolitik:  A policy triggered by hospital capacity limits is simply CYA.

First, we need to admit that the standard Republican-state strategy toward COVID-19 is to get serious only after the hospitals are full.  That has been revealed so often that this clearly should be treated as an explicit policyIt’s not some frequently-repeated accident.  It’s the way health care policy actually functions in most Republican-run states.

So let’s just say that, out loud, and walk it around a bit, to see how it functions, as a policy.

“I propose a policy of containing COVID-19 by imposing mask mandates and other mandatory measures based solely on hospital capacity.  The policy rule is to impose such measures only after hospitals are full of COVID-19 patients, and the state is running out of ICU beds.”

Is that a good policy?  Does it minimize total economic or health damage from COVID-19?

I’m pretty sure that it does not minimize damage from COVID-19.  State hospital capacity is arbitrary, in the sense that hospitals and ICU beds weren’t built for the purpose of treating COVID-19.  The capacity that a state has is an artifact of total disease burden plus propensity-to-hospitalize within a state.

In other words, the trigger point for this policy has no logical relationship to COVID-19 whatsoever.

So what is this policy?  It’s C-Y-A, pure and simple.  It’s a way for Republican governors to say “it’s out of my hands”.  It’s a way for them to remain true to political principles, and let external events force their hand.  As such, it should be self-evident that this policy has nothing to do with any rational cost-benefit analysis.  It’s just a way to avoid having to take the blame for making a tough-but-needed decision.

It’s clearly not a policy that has been optimized with some forethought.  It’s clearly not even a good policy.  It’s just a way for Republican governors to maintain political correctness within their own orthodoxy and keep their hands clean.

And, to my next point, this approach of allowing hospital capacity to dictate timing of COVID-19 policy interventions should almost certainly lead to higher spikes in infection rates.  That, compared to a policy that (e.g.) imposing mandates and other measures in a more measured and continuous fashion.


But maybe this time it’s different.

Seasonality of human coronaviruses (other than COVID-19) in Stockholm, Sweden.  Source:

Potential impact of seasonal forcing on a SARS-CoV-2 pandemic DOI: https://doi.org/10.4414/smw.2020.20224 Publication Date: 16.03.2020 Swiss Med Wkly. 2020;150:w20224 Neher Richard A., Dyrdak Robert, Druelle Valentin, Hodcroft Emma B. Albert J.

But this time, maybe that wait-until-the-hospitals-are-full policy is going to come back and bite them.  Maybe the experience of US Midwest states this winter will be qualitatively different from that of (e.g.) US Southern states this summer.  Maybe it’ll look like the green line above. 

Maybe this time you can’t stop it with a weak mask mandate and eliminating school sports for a month.  Maybe this time the factors that drive up the green line above are alive and well and working their magic in the upper Midwest.

I’ll say it one more time.  The reason for seasonality of flu in temperate climates is low humidity.  The lower the humidity, the more easily respiratory  viruses spread.  In the lab, COVID-19 shows the same attributes that make flu seasonal, including longer airborne survival times in dry air.  Areas with cold, arid winters and poor COVID-19 public hygiene are in for a very rough ride. And that pretty much describes the high plains states and the eastern slope of the Rockies.

So I suspect that, in this case, the standard Republican strategy of “wait until the hospital are full” is going to turn out to be an exceptionally poor one.  And we’ll know that the first time we see stories of bodies in reefers (Post #888).  Better late than never, and all that.  But better still not to be late.

I have never been so glad to that Virginia has a tradition of reasonably sane state government  And it’s a great time to have an M.D. for governor.

Post #831: Madam Mayor, please step up to save Trick-or-Treating in Vienna this year.

Source: The Patch.

We have a Town government that makes a big deal out of our “small town” nature.  I’m not quite so sure they follow through on that in every instance. But they do enough to give that statement some credibility.

This year, in this pandemic, Town government needs to do something that can only be done by a government, in a small town:  Step up and save trick-or-treating this year, in the Town of Vienna.

So I guess this is a plea to our “One Vienna” Mayor Colbert.  We need a Town of Vienna guideline for what we should be doing.  (Why the italics on should?  That’s the whole point of this posting.)

This year, we need a new tradition that works in the changed world we are in.   We need one recommended, agreed-upon, safe approach that that lets kids go Trick-or-Treating, and that doesn’t end up causing yet more division and strife among the citizenry.  We need one official guide on how to Trick-or-Treat in the Town of Vienna this year.

Why?  Let me cut to the chase:  Are you a bad parent if you take your kids Trick-or-Treating?  Or are you a bad parent if you forbid your kids to go Trick-or-Treating?  How are your kids going to feel if you make them stay home, but other kids on the block went trick-or-treating and brought home gobs of candy?  And what are the respective parents, of those two sets of children, going to say to each other afterwards?

We need some simple, common-sense leadership here, so that we’re all on the same page.  We need an endorsed protocol, for the COVID-19 world.  Without that, as I discuss below, we’re already beginning to squabble over Trick-or-Treating.  And that’s just about the last thing we need.

Detail follows. Continue reading Post #831: Madam Mayor, please step up to save Trick-or-Treating in Vienna this year.

Post #822: CDC: Just kidding, we take it all back

Source:  CDC

Just this morning, I posted the new CDC guidance to citizens on COVID-19 (Post #820).  The CDC finally mentioned aerosol (airborne) transmission of the disease.

Half-jokingly, I said:

In particular, I would not be surprised to see this language disappear, once those in power do realize the implications.  Hence the snapshot, above.

Well, as of about 1 PM, the A-words have been tossed down the memory hole.  I’m not holding my breath, waiting for them to return.

So, for one bright shining moment, CDC told the entire story to Americans.  Until somebody got wind of it, and put a stop to that.  Sometimes it’s hard to believe what a total crap show our Federal government has become.

In memorium.

Source:  CDC, but long longer posted.

Post #820: The CDC finally says the A-words.

Source:  US CDC. I added the red lines.

The A-words would be aerosol and airborne.  The difference being that, up to this time, the CDC had only said COVID-19 was spread by droplets.  Droplets are (conventionally) larger than 5 microns, rapidly fall out of the air (so-called “ballistic trajectory”),  and are the basis for our 6′ social distancing rule.  By contrast, aerosols are small (under 5 microns), can hang in the air for a long time, can travel far more than 6′, and can be inhaled.

The news here isn’t that aerosol transmission matters.  The news is that, as of last Friday, the CDC is (finally) explicitly saying that.  And that, in turn, has a lot of implications for Federal, state, and local policies for dealing with COVID-19.

You can read some news writeups at MSN, or CNN.  Someone in those organizations must have been keeping an eye out for this, because I don’t see this being reported elsewhere.  Yet. Continue reading Post #820: The CDC finally says the A-words.

Post #818: Well, turns out, this *is* as good as it gets.

Three days ago, the head of the US CDC said, more-or-less, that you’re going to get more protection from wearing a mask than you are from the forthcoming US vaccine.  He’s had to recant, publicly, since then.  But my guess is the he got it right the first time.

I summarized that in Post #815, What if this is as good as it gets?  With the title being my take on that testimony.  We’ve been expecting a vaccine to make a radical change in the situation.  But, taken at face value, the US CDC director basically just told us, that’s not going to happen.  Presumably, the implication of what he said is that it’ll do no more than mask wearing and social distancing have done.

Today I stumbled across a recent interview with Dr. Fauci where he said that if we adhere to all the current public health measures, and we get a “good” vaccine, we might be able to return to normalcy as early as the end of 2021.  Apparently, he’s been saying 2021 for some time.  This is the first time I’d seen it stated as the end of 2021.  And seen that conditional on having a “good” vaccine.

So, twice in the last couple of days, responsible public health leaders have told us that this is about as good as it gets, for the time being.  Vaccines really won’t alter the situation in any material way, for quite some time.  Even with a “good” vaccine, the situation we are in right now — with the shutdowns and social distancing and all of that — that’s as good as it gets, until at least the end of 2021.  And that’s only projected to end if we have a “good” vaccine, and everybody adheres to the other public health measures like social distancing and mask use.

At this point, I feel like I’ve been sleepwalking through this.  I need slap myself across the face, wake up, and start listening to the people who know what they’re talking about, and plan accordingly. 

The smartest people in the room are trying to tell us that we’re going to be in this semi-lockdown, socially-distanced, mask-wearing limbo for … a year or years to come.  Vaccine or no vaccine.

And now that I’m waking up, I realize just how many things I’d let slide because I unconsciously assumed that there was a chance that we could return to normalcy soon.  Particularly with numerous vaccines on the way.  No sense in doing things that incur a risk of COVID-19 infection if US society is likely to be COVID-free in the near future.

Should I list a few?  I’ve been slacking off on exercise, thinking, well, I’ll be able to get back to the gym soon enough.  Nope.  No I won’t.  So I’ve been putting on weight accordingly, but you know, that’ll come off when I can get back to the gym three days a week.  Nope, that’s not going happen any time soon.  I’ve put off seeing the doctor, figuring, it can wait until things are back to normal.  No sense being around a lot of sick people during a pandemic.  I’ve put off a major home repair because I don’t want workmen in the house, figuring things won’t have rotted out completely by the time we’re over this COVID thing.  Again, wrong, wrong, wrong.  And so on.

So I think I finally am getting my mind around this.  This really is as good as it gets.  For quite some time, anyway.  That’s what the smartest people in the business are telling us.  If you try to live your life in a reality-based fashion, plan accordingly.

 

Post #817: Vaccine and sins of omission.

I’ve had a series of posts arguing that Russia (and now the China) are doing the right thing by deploying their vaccines before they know their effectiveness.  That was stated most recently in Post #814.  Both countries are already providing those vaccines to high-risk populations such as health care workers, before they know how effective the vaccines are (or aren’t) in preventing (or lessening severity of) COVID-19 infection.

Today’s twist is that they are also winning allies and gaining international influence by supplying vaccines, now, to other countries that need them.  That’s written up in this Washington Post article.  So not only are they ahead in their own country, but they are gaining influence around the world by being first-to-market in a number of countries that need help right now.  (And, in an odd twist, they’ve decided to pool some efforts on their vaccines. )

In this post, I’m going to review the logic behind this one last time, and then do the grade-school arithmetic that validates that logic.  Something that, apparently, neither our elected officials nor our public health bureaucracy seems willing or able to do.  Or at least, to admit to doing, in public.

My best guess, using some quite conservative estimates, is that providing 10 million doses of vaccine now, instead of six months from now, would save just under 10,000 hospitalizations (worth about a quarter-billion dollars), and about 2800 lives.  This doesn’t even count other costs saved, such costs saved by avoidance permanent organ damage from COVID-19, or economic losses from work or school time not missed due to COVID-19 illness and quarantine.    Not only would the avoided hospital costs more than pay for the vaccine itself, these numbers are vastly higher than any plausible health or economic damage from any as-yet-undiscovered rare side effects of the vaccines.

Details follow.
Continue reading Post #817: Vaccine and sins of omission.

Post #816: We actually did have a rational, national plan for mask use?

Source:  The Daily Beast, from an article on the demonization of masks in Trump world.

Yep, we did.  We had a national mask initiative in the works.  It’s just that the President killed it.  As you can read in this famously not-liberal publication, Business Insider.  You can also see the same information buried inside this Washington Post article.  You can also see that the bare bones of this story were reported back in April, when the mask initiative was killed.

I just wanted to document this here, as it really didn’t get much play on its own and it’s already slipping out of the news. Continue reading Post #816: We actually did have a rational, national plan for mask use?

Post #815: What if this is as good as it gets?

Source:  Immunogenicity and protective efficacy of influenza vaccination
Claude Hannouna, Francoise Megas,  James Piercy,  Virus Research 103 (2004) 133–138.

The importance of this graph will be clear about five paragraphs down.

At this point, with the Phase III trials of coronavirus vaccines well underway, even if they don’t have enough “statistical power” to do the formal statistical test, our public health bureaucracy ought to have a fairly good indication of how things are shaping up.

I’ve been waiting for any US public health leader to start leaking information on the likely effectiveness of the coronavirus vaccines.   Informally tossing some numbers out there, to get us prepped for the eventual formal announcement.

We just got our first indication today.  And, although the CDC Director broke the news gently, and indirectly, and with spin, if you paid attention, the news was clearly not good. Continue reading Post #815: What if this is as good as it gets?

Post #807: A vastly simpler mask liner using Filtrete ™

Source for base data: 3M, ASHRAE.  See Post #593 for writeup of these and other filtration standards.

I’ve done several posts about making masks out of Filtrete ™ home air-filter material.  Each time I return to that task, I find simpler ways to work with Filtrete ™.

In this post, I’m going to show just how easy it is to take a Filtrete ™ home air filter and make some simple, flat, easy-to-handle, fiber-free pieces for use inside cloth masks.  In a nutshell, extract the Filtrete ™ fabric from the air filter and hot-glue it between two layers of the thinnest synthetic fabric you can find.

Then end-user can then cut it to size, for use as a liner for a cloth mask.  That seems to work just fine, and nothing more labor-intensive is needed.  The materials run well under $0.25 per mask liner, depending on what size filter you buy, and how large you cut your mask liners.

A few tips and tricks for doing that are given below.  Of which, the only one that might not occur to you is to use kitchen “parchment paper” as a non-stick surface as you are gluing.

Continue reading Post #807: A vastly simpler mask liner using Filtrete ™