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The frozen vaccine distribution also suffers from its own nasty version of the square-cube law, where the larger the land area you need to serve the more strain you end with on the system in a big way that doesn't really scale in a linear fashion. Especially when you compound it with general infrastructure issues.
In countries where community transmission is limited to urban centers, this is counterbalanced by the fact that it's not really that critical to get vaccines out to the middle of nowhere, but the US is loooong past that right now.
That said, something needs to change at the state distribution system, or we're going to rapidly hit the stage where counties around academic medical centers are in "let's vaccinate everyone" phase while other places are still waiting on finishing essential workers. Or maybe we just accept that and hope "vaccine tourism" smooths it out.
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On a somewhat different topic: I had to travel to Los Angeles a couple weeks back. I went by plane. More miserable than usual air travel due to having to sit in an N95 for the whole time on the road, but it'd be reckless not to.
Never seen LAX look like a literal ghost town before. The city was remarkably empty too, with the exception of grocery stores which had a line due to the capacity limit. The story on the ground is about as surreal as the news stories you hear about a city buckling under the weight of a major pandemic.
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Quick and dirty, but cumulative % of population by age for Canada
![[image loading]](https://i.imgur.com/vphNqxQ.png)
By the time you've fully vaccinated the 5% oldest people, the death rate should've dropped precipitously since the 80+ demographic makes up >70% of all covid deaths in canada.
Getting the 70+ demographic (~7.5%) of population protects the demographics responsible for 90% of deaths.
Assuming similar numbers for western societies, the first 10% matters the most for vaccinations as far as preventing deaths. Hospitalizations have a really long tail downwards in age, so it's a less valuable metric. I guess just validates the process everyone's doing to ensure that vaccination of the vulnerable, and then the vaccination of the people who are at risk of spreading/catching it by occupation are the two highest priorities.
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On January 08 2021 01:59 LegalLord wrote:Show nested quote +On January 08 2021 01:54 Lmui wrote:
Covid19 is what the public knows it as, and that's why we call it covid19. Yeah it has a bunch of other names and nicknames but covid 19 is what stuck. Most people call it "covid" or "the coronavirus" around here. The former is catchy enough and less of a mouthful, so it's probably what will stick. Better scientific name than "H1N1" applied to the swine flu pandemic since everyone still just calls it swine flu.
This makes sense and Covid does sound easy to say. Also avoids confusion with earlier SARS but I think it’s still desirable. I must be a public opinion hater 
Yeah but do they need different names? But this does make some sense.
On January 08 2021 03:21 LegalLord wrote:
On a somewhat different topic: I had to travel to Los Angeles a couple weeks back. I went by plane. More miserable than usual air travel due to having to sit in an N95 for the whole time on the road, but it'd be reckless not to.
Never seen LAX look like a literal ghost town before. The city was remarkably empty too, with the exception of grocery stores which had a line due to the capacity limit. The story on the ground is about as surreal as the news stories you hear about a city buckling under the weight of a major pandemic.
What part of LA? I’m in Little tokyo and seems as busy as ever (not proud of this).
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On January 08 2021 09:52 Lmui wrote:
Quick and dirty, but cumulative % of population by age for Canada
By the time you've fully vaccinated the 5% oldest people, the death rate should've dropped precipitously since the 80+ demographic makes up >70% of all covid deaths in canada.
Getting the 70+ demographic (~7.5%) of population protects the demographics responsible for 90% of deaths.
Assuming similar numbers for western societies, the first 10% matters the most for vaccinations as far as preventing deaths. Hospitalizations have a really long tail downwards in age, so it's a less valuable metric. I guess just validates the process everyone's doing to ensure that vaccination of the vulnerable, and then the vaccination of the people who are at risk of spreading/catching it by occupation are the two highest priorities.
Unfortunately, this kind of thinking requires both the general public and policymakers to think not in terms of "what is happening now" and instead "what will have the best results in 2 months" (a month to give vaccines, a month of lag to see deaths go down). And if COVID-19 has taught us anything, it's that the public and policymakers cannot project two weeks into the future, let alone two months, even when the people advising them put those numbers right in their hands.
(that said, looking at national or even state-level vaccine numbers is getting increasingly myopic, just as happened loooong ago to the actual infection numbers-my county is already opening vaccines to everyone 75+ for example, but that's clearly not the case across the US and won't be the case in the state as a whole until next week at the earliest)
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Not being an immunologist, the gist I got from obsessively following a bunch of them on twitter is that vaccine evasion isn't going to be discrete but rather will be on a continuum. As the virus mutates vaccines will become slightly less and less effective, and that it would take years of mutations for the virus to significantly evolve to completely escape the immune response current vaccines generate.
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I just heard on BBC radio scotland, that these percentages of vaccine efficiacy are describing the protection against developing severe symptoms.
And that our knowledge, whether people are actually not infected after a jab or whether they are able to shed the virus and infect others, is rather limited as of yet.
It's been talked about in the programme Lunchtime live at roughly the 1 hour 10 minute mark.
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On January 08 2021 21:54 warding wrote:Not being an immunologist, the gist I got from obsessively following a bunch of them on twitter is that vaccine evasion isn't going to be discrete but rather will be on a continuum. As the virus mutates vaccines will become slightly less and less effective, and that it would take years of mutations for the virus to significantly evolve to completely escape the immune response current vaccines generate.
Yes, it makes sense. But viruses are very different from eachother in that regard, with the worst example being HIV, which we still don't have an effective vaccine for after decades of research because of genetic properties:
https://www.verywellhealth.com/hiv-vaccine-development-4057071. On the flipside are we protected for life by a youth shot from other viruses.
How Covid-19 fares in this spectrum has been a key question unknown until now afaik, so that the Pfizer/BioNTech will work on this mutation is amazing news. I am very curious about how the other ones do.
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On January 08 2021 22:35 Artisreal wrote:I just heard on BBC radio scotland, that these percentages of vaccine efficiacy are describing the protection against developing severe symptoms. And that our knowledge, whether people are actually not infected after a jab or whether they are able to shed the virus and infect others, is rather limited as of yet. It's been talked about in the programme Lunchtime live at roughly the 1 hour 10 minute mark.
Yes, that's the limitation of those trials. Direct evidence of immunity can only be discovered in a human challenge trial, which is only ethical to do with the existence of a treatment to the disease (in this case covid-19) caused by an infection. I'm not aware that such a treatment exists at this point in time, so unfortunately we're still in the dark concerning the level of immunity provided by the covid-19 vaccines. What we do know is their efficacy, but we don't know what exactly causes that efficacy, as there are at least two likely possibilities: the vaccines could provide immunity, or they could treat covid-19. Other possibilities that are quite unlikely also exist.
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On January 08 2021 11:48 Alakaslam wrote:Show nested quote +On January 08 2021 03:21 LegalLord wrote:
On a somewhat different topic: I had to travel to Los Angeles a couple weeks back. I went by plane. More miserable than usual air travel due to having to sit in an N95 for the whole time on the road, but it'd be reckless not to.
Never seen LAX look like a literal ghost town before. The city was remarkably empty too, with the exception of grocery stores which had a line due to the capacity limit. The story on the ground is about as surreal as the news stories you hear about a city buckling under the weight of a major pandemic. What part of LA? I’m in Little tokyo and seems as busy as ever (not proud of this).
Airport, downtown, Pasadena was where I went. Moderate number of cars but the only foot traffic I really saw was dog-walking and food shopping. I assumed it was because everything was closed so there really wasn't anything for anyone to do.
LAX was definitely unmistakably emptied though, and that's not the case with other airports I've seen. It was like something out of two decades ago.
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Good news in Europe today, as 300 million more doses of Pfizer/BioNTech vaccine were purchased, with 75 million arriving in Q1 2021, and EMA saying a decision on AstraZeneca/Oxford expected at the end of January. This should be an important boost to vaccination efforts in the short term.
In Portugal we're entering a third wave. Past three days saw 10 000 new cases (equivalent to 330k cases in the US) and today we had 118 deaths (Uequivalent to 3900 US deaths). It's getting crazy and we need those vaccines asap.
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California's finally relaxing restrictions when not enough people are found to fill appointments according to priority guidelines. NPR. Previously, a hospital that was giving out vaccines rapidly because their freezer had broken and they were set to expire, risking penalties for doing so LA Times
New York, particularly New York City not so good.
Montefiore New Rochelle Hospital was investigated for not following state orders on vaccination priority. Of course, the previous complaint was not about using mandated priorities, but rather failure to administer them quickly enough at 23% doses allocated.
As a reminder, New York healthcare facilities that don't administer all vaccines within a week of delivery can be fined up to $100,000, and their supply confiscated, but failing to follow the governor's priority list in administering vaccines can incur fines of $1,000,000.
This has led to problems across the state where health care workers do not saturate available appointments, but none may be given to seniors over 75, since they have to wait for their government to declare them able to receive them, or cost hospitals that million dollar fine.
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On January 09 2021 01:34 warding wrote:
Good news in Europe today, as 300 million more doses of Pfizer/BioNTech vaccine were purchased, with 75 million arriving in Q1 2021, and EMA saying a decision on AstraZeneca/Oxford expected at the end of January. This should be an important boost to vaccination efforts in the short term.
That sounds glacial. And the logistical challenges of Pfizer make it inevitable that we see another couple of serious bottlenecks as the effort ramps up. We straight up need more vaccines deployed, and I suppose that Oxford is the best chance Europe has on that front.
In other vaccine news, Chinese vaccine efficacy data is... weird and inconsistent. It's somewhere between useless and top tier based on which study result you use. Russian one seems to work well, but it suffers from production bottlenecks as a result of a difficult to produce second dose. This article talks about both of them.
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On January 09 2021 03:28 LegalLord wrote:Show nested quote +On January 09 2021 01:34 warding wrote:
Good news in Europe today, as 300 million more doses of Pfizer/BioNTech vaccine were purchased, with 75 million arriving in Q1 2021, and EMA saying a decision on AstraZeneca/Oxford expected at the end of January. This should be an important boost to vaccination efforts in the short term. That sounds glacial. And the logistical challenges of Pfizer make it inevitable that we see another couple of serious bottlenecks as the effort ramps up. We straight up need more vaccines deployed, and I suppose that Oxford is the best chance Europe has on that front. In other vaccine news, Chinese vaccine efficacy data is... weird and inconsistent. It's somewhere between useless and top tier based on which study result you use. Russian one seems to work well, but it suffers from production bottlenecks as a result of a difficult to produce second dose. This article talks about both of them.
I'm just kinda surprised they were able to pull 75M doses out in Q1, when they've already been allocated.
I don't know if Pfizer is ramping up faster than expected(good), putting another production line (also good) or simply redistributing(bad, for everybody else anyways).
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Probably redistributing. If Israel is any indication, paying more money puts you in the front of the queue. Q1 is now, so there's not a lot of time left to ramp up for immediate delivery.
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On January 09 2021 03:28 LegalLord wrote:Show nested quote +On January 09 2021 01:34 warding wrote:
Good news in Europe today, as 300 million more doses of Pfizer/BioNTech vaccine were purchased, with 75 million arriving in Q1 2021, and EMA saying a decision on AstraZeneca/Oxford expected at the end of January. This should be an important boost to vaccination efforts in the short term. That sounds glacial. And the logistical challenges of Pfizer make it inevitable that we see another couple of serious bottlenecks as the effort ramps up. We straight up need more vaccines deployed, and I suppose that Oxford is the best chance Europe has on that front. In other vaccine news, Chinese vaccine efficacy data is... weird and inconsistent. It's somewhere between useless and top tier based on which study result you use. Russian one seems to work well, but it suffers from production bottlenecks as a result of a difficult to produce second dose. This article talks about both of them.
Ideally we'd be moving faster, but it might still be possible. In early December the PT government released the vaccination plan, stating we'd have 4 million doses in Q1 - I assume that assumed all of Pfizer, Astrazeneca, Moderna and J&J would be approved. The new Pfizer deal should bring in 1.5M doses in that time. In addition, EMA is now probably going to 'allow' taking 6 doses out of vials instead of the 5, so that also increases capacity by 20%. Finally, it might still be possible to get EMA on board with 'first doses first' instead of keeping half of the supply stored for the 2nd dose, which might mean more people vaccinated. (Portugal has 10M people).
With all of the above wishful thinking, it might be possible to get close to 50% of the EU population vaccinated by March-April, if everything goes super well with production, deliveries, pressure is put on every single decision maker and countries get their act together in vaccinating people.
EDIT: BioNTech was building another factory in Germany to produce the vaccine. That might be where the extra doses are coming from:
https://www.politico.eu/article/germany-jens-spahn-new-coronavirus-vaccine-factory-massively-expand-availability/
"German Health Minister Jens Spahn on Wednesday expressed hope that a new BioNTech/Pfizer factory in Germany would "massively" expand the availability of vaccines in the EU as of next month."
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Realistically I expect 70-80% coverage by the end of the year, assuming Oxford gets approved. Maybe 10-30 percent by March, but you're going to have bigger problems as you deploy it more widely. Pfizer is a terrible mass-market vaccine getting pushed out by brute force, Moderna has a two-bit operation when it comes to industrial ramp-up, and J&J doesn't look timely enough to make a difference. Which leaves Oxford as the best mass-market choice.
I definitely would agree with "first doses first" policy, or at least only keeping a fraction of second doses in reserve. The only reason you would keep that many doses sitting around is if your supply chain is a chaotic mess. Which may be true but that's a problem that needs fixing.
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From my perspective, going by what I know and see, it's absolutely worthwhile to pay extra to get the first 10% of your population vaccinated (assuming reasonable vaccination guidelines). Afterwards, supply can trickle in, but that 10% is critical in ensuring that whatever the hell happens to the rest of the supply or population, your healthcare system can handle it.
I'm last in line regardless though, since I work from home and I'm in my late 20s with no health conditions.
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The news story from a few days ago where the hospital freezer broke down and they had hours to give out vaccines before the doses expired and they were able to give out as many doses in a matter of 2 hours that they had given out in the previous 2 weeks just shows how quickly the vaccination can be done. I really can't find much information on the allocation of doses, for example how many doses Pfizer has on hand, how many they will allocate, how many they can produce in a day, etc. I really hope that that's the bottleneck that's keeping a mass vaccination from happening and it's not just so slow because they want to make sure every single dose is given in the exact order of prioritization from A to Z
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EPT
