I got a robocall last night at 6:30pm from VA-Greater LA that they have the vaccine, for people in Group I (me). The ONLY LOCATION FOR ALL OF LOS ANGELES is the VA hospital in West LA!
The phone line broke down after 2-3 minutes on hold each time I called before I gave up after an hour. I called again at 11pm and spoke to a person. The earliest I could get it is March 8 (for those of you who don't have ready access to a calendar, that is SEVEN WEEKS FROM NOW). I was told I could expect to be there about 90 minutes. That's on top of an hour each way on the world's worst freeway (the 405). I'm a full-time caregiver for a Parkinson's patient who is bedridden while waiting for a hospital bed in the middle of The Worst Medical Crisis In The Country to have her hip replacement repaired. 3.5-4 hours away is just not possible. So maybe in 2-3 weeks the VA location that is 15 minutes away may get the vaccine. So maybe sometime in April, I can get vaccinated.
I just received this warm little note from a good friend in Virginia, also in Group I:
"I called for the first two days once the info was made public. Busy signal (and I called every hour on the hour for 12 hours). Third day, a friend gave me a website. Two days trying it, but with no response when "sending". Fifth day, my email went through and I was placed on an "Emergency" County-wide website-based system that now spits out emails to me daily. Plus, I was allowed to sign-up for a vaccination.
Today's mail (now some 10 days in) said only 40K vaccines were available and I was beyond that initial allocation; so I might have to wait 6-8 weeks.
Meanwhile, on 18 Jan, my wife is eligible as the third group will be 65 and older. She is advised her wait might be to mid-summer.
Lovely. (Oh yes, once we are vaccinated initially, we are to "trust" that the second shot will be available and on time. Are you shitting me!!!!)"
Let's face facts: the US government as currently organized couldn't find its ass with both hands on a clear day with a 12 hour advance notice. And that is not going to change at 12:01
Perhaps the worst aspect of our current hyperpolarization (aside from autocratic violence) is the polarization of the benefit of competence. We are such that not only was the Trump admin grossly incompetent in a way that’s resulted in near WWII level casualties, but that this incompetence isn’t likely have any consequences - electoral or otherwise- because it’s just another one for the partisan slop pile.
i'd be really interested in seeing what the vaccine failure looks like from the inside.
in one of these states or counties where everything is seemingly FUBAR, how do things look to the people in government who are supposed to solve the problem? What are they thinking, what do they see, what are they trying?
I think I share with a lot of people the intuition that if you put me and my dumb friends in charge of vaccinating people, the results would be better than some of the worst states, because we would at least try. Of course this must be wrong -- but I want to know why it's wrong.
It seems like incentivizing the use of low dead-space syringes, for all cases where there isn't a serious medical reason to use a different design, could lead to more efficient use of drugs generally, and could be a long-run spin-off benefit of Operation Warp Speed, similar to how the space race had many spin-off benefits.
Lowest hanging fruit aka biggest immediate impact -- give the vaccine doses that have been distributed. I think the USA has injected 25% of what has been released by the manufacturers? Not good enough.
The low dead volume syringes -- it's a great idea. It's enabled (and limited) by the syringe supply chain. To the extent low dead volume syringes are already available and distributable, it will be easy to do. It will be slower to implement when we get into "we are using all the ones we have available and need to manufacture more."
It has been discussed before although maybe not publicly -- from the comments section of Marginal Revolution:
"This is from an almost 15 year old article.
In the face of an almost unprecedented threat of a global pandemic of influenza it is imperative that stockpiling of appropriate drugs and devices begin now. One vital device is an appropriate syringe for delivering vaccine. With the potential for millions to be infected and the vaccine supply severely stretched it is imperative that the syringe used to vaccinate waste as little vaccine as possible and thus allow for a maximum number of persons to be vaccinated. Our study tested seven leading candidate vaccine syringes for dosing accuracy, dose-capacity per vial, medication wastage and a battery of ergonomic features. One device, the Flu+™ syringe, proved superior to the others in all important categories, possibly due to its low dead-space volume and its dosing accuracy. The data suggest that switching to this device from any of the others tested would provide between 2 and 19% additional vaccine doses per vial if the current 10-dose vials are used. Extrapolations from this data suggest that many thousands to millions of additional persons could be vaccinated in mass campaigns. Use of a syringe of this type, and the vaccine savings that would accrue, would likely be important in reducing morbidity and mortality in the event of a pandemic of influenza.
Building on Biden’s love of ice cream, I’d like to see some sort of ice cream truck-style mobile vaccination fleet. They can be deployed to communities with less access to transportation/rural areas/marginalized populations of whatever kind, thus helping to address concerns of equitable distribution, and as we get nearer to the stage where younger and healthier people are allowed in the line, they can drive around to sports stadiums, concert venues, Costco parking lots, denser suburbs, etc, and play some kind of vaccination theme song on a loudspeaker (“Shots” by Lil John/LMFAO comes to mind) to let people know they can wander up and get vaccinated with no appointment required, plus free ice cream for anyone who gets the needle or brings a friend. Once we get to the most reluctant part of the herd, throw some gift cards into the mix.
You know, I like this kind of thinking outside the box, but it's really even easier than they are making it.
Without changing the syringe design in the slightest, you can get the same good effects just by flushing the remaining liquid out of the dead space.
All you have to do, is to make sure there's a decent-sized bubble of air in the syringe behind the liquid, and then that bubble will push the remaining vaccine out of the syringe, producing the same efficient delivery as the redesign of the syringe.
Problem solved.
Of course, the air embolism may be fatal for the patient, so that's a drawback. But, let's not make the perfect the enemy of the good, people!
Has the Biden transition provided further clarity on how their 100M doses in 100 days goal squares with Pfizer and Moderna’s commitments to each deliver 100M doses by the end of March? Is there a looming manufacturing issue that will keep us from vaccinating more than 50M people?
Wow! Since the price charged by hospitals and medical practitioners is well above marginal costs of the drugs, there are weak incentives to eliminate such inefficiency. Offering generous discounts to health insurers will not be too painful either.
Our vaccinators have been getting six doses form five-dose vials right along. I was told it happened more frequently with the Pfizer vaccine than the Moderna vaccine. Had not heard it was due to a variable among the syringes. The extra doses create a logistical issue because all of a sudden you've got more doses than people to be vaccinated, and the rush is on to find additional people on whom you can use the extra dose. Building the extra doses into your vaccination program would be terrific, and this would appear quite possible if it is indeed an issue of which syringe is being used.
“Sweating the details is not really the Trump way, but it’s an example of how bringing on a team of competent, experienced, professionals can make a big difference in what is on some level a big logistics problems.”
This is counter factual and disgusting. I don’t think that Donald Trump knows anything about mRNA or lipid nanoparticles or headspace and timing in syringes. But it is patently obvious that there are people who work for the Trump Administration who understand these things. Operation Warp Speed has been, thus far, as far as I can tell, an astounding success. The suggestion that it came about without “a team of competent, experienced, professionals” is calumny.
Neither Tabarrok's post nor the article he links to explains why anyone buys the "high dead-space" model of syringe over the "low dead-space" one. It's got to be cost, right? Is the difference in syringe cost really greater than the cost of producing/buying more medication (I assume this doesn't just apply to Covid vaccines) because some gets wasted in the syringe?
If we were doing distribution similar to testing, then I think we could get a lot more done. But we seem to be going down the path of using existing infrastructure (hospitals, pharmacies, etc). We need people in cars in a line waiting at the local stadium parking lot. Then we could have one low dead-space syringe serving 100x in a day.
I guess we're all so jaded now by politicians that no one can say anything without someone else implying selfish motives. So much for the tiniest acknowledgement of servant leaders. I'm not naive though, so term limits (at all levels of politics, and including higher-level bureaucrats, longer bans on later employment, department hopping or lobbying, and legislating the Citizens case away would eventually wean out some of the power hungry.
On another note, if you think the pharmaceutical companies haven't been aware of the syringe deficiencies for a long time, you don't understand why all those young salespeople bombard the offices with plates of snacks, pens, and speaking gigs. Insurance and/Medicare shouldn't reimburse providers for 20% of drug costs if a wasteful syringe is used. Easy peasy.
In the meantime....
I got a robocall last night at 6:30pm from VA-Greater LA that they have the vaccine, for people in Group I (me). The ONLY LOCATION FOR ALL OF LOS ANGELES is the VA hospital in West LA!
The phone line broke down after 2-3 minutes on hold each time I called before I gave up after an hour. I called again at 11pm and spoke to a person. The earliest I could get it is March 8 (for those of you who don't have ready access to a calendar, that is SEVEN WEEKS FROM NOW). I was told I could expect to be there about 90 minutes. That's on top of an hour each way on the world's worst freeway (the 405). I'm a full-time caregiver for a Parkinson's patient who is bedridden while waiting for a hospital bed in the middle of The Worst Medical Crisis In The Country to have her hip replacement repaired. 3.5-4 hours away is just not possible. So maybe in 2-3 weeks the VA location that is 15 minutes away may get the vaccine. So maybe sometime in April, I can get vaccinated.
I just received this warm little note from a good friend in Virginia, also in Group I:
"I called for the first two days once the info was made public. Busy signal (and I called every hour on the hour for 12 hours). Third day, a friend gave me a website. Two days trying it, but with no response when "sending". Fifth day, my email went through and I was placed on an "Emergency" County-wide website-based system that now spits out emails to me daily. Plus, I was allowed to sign-up for a vaccination.
Today's mail (now some 10 days in) said only 40K vaccines were available and I was beyond that initial allocation; so I might have to wait 6-8 weeks.
Meanwhile, on 18 Jan, my wife is eligible as the third group will be 65 and older. She is advised her wait might be to mid-summer.
Lovely. (Oh yes, once we are vaccinated initially, we are to "trust" that the second shot will be available and on time. Are you shitting me!!!!)"
Let's face facts: the US government as currently organized couldn't find its ass with both hands on a clear day with a 12 hour advance notice. And that is not going to change at 12:01
Perhaps the worst aspect of our current hyperpolarization (aside from autocratic violence) is the polarization of the benefit of competence. We are such that not only was the Trump admin grossly incompetent in a way that’s resulted in near WWII level casualties, but that this incompetence isn’t likely have any consequences - electoral or otherwise- because it’s just another one for the partisan slop pile.
i'd be really interested in seeing what the vaccine failure looks like from the inside.
in one of these states or counties where everything is seemingly FUBAR, how do things look to the people in government who are supposed to solve the problem? What are they thinking, what do they see, what are they trying?
I think I share with a lot of people the intuition that if you put me and my dumb friends in charge of vaccinating people, the results would be better than some of the worst states, because we would at least try. Of course this must be wrong -- but I want to know why it's wrong.
It seems like incentivizing the use of low dead-space syringes, for all cases where there isn't a serious medical reason to use a different design, could lead to more efficient use of drugs generally, and could be a long-run spin-off benefit of Operation Warp Speed, similar to how the space race had many spin-off benefits.
Lowest hanging fruit aka biggest immediate impact -- give the vaccine doses that have been distributed. I think the USA has injected 25% of what has been released by the manufacturers? Not good enough.
The low dead volume syringes -- it's a great idea. It's enabled (and limited) by the syringe supply chain. To the extent low dead volume syringes are already available and distributable, it will be easy to do. It will be slower to implement when we get into "we are using all the ones we have available and need to manufacture more."
It has been discussed before although maybe not publicly -- from the comments section of Marginal Revolution:
"This is from an almost 15 year old article.
In the face of an almost unprecedented threat of a global pandemic of influenza it is imperative that stockpiling of appropriate drugs and devices begin now. One vital device is an appropriate syringe for delivering vaccine. With the potential for millions to be infected and the vaccine supply severely stretched it is imperative that the syringe used to vaccinate waste as little vaccine as possible and thus allow for a maximum number of persons to be vaccinated. Our study tested seven leading candidate vaccine syringes for dosing accuracy, dose-capacity per vial, medication wastage and a battery of ergonomic features. One device, the Flu+™ syringe, proved superior to the others in all important categories, possibly due to its low dead-space volume and its dosing accuracy. The data suggest that switching to this device from any of the others tested would provide between 2 and 19% additional vaccine doses per vial if the current 10-dose vials are used. Extrapolations from this data suggest that many thousands to millions of additional persons could be vaccinated in mass campaigns. Use of a syringe of this type, and the vaccine savings that would accrue, would likely be important in reducing morbidity and mortality in the event of a pandemic of influenza.
www.ncbi.nlm.nih.gov/pmc/articles/PMC7115405/ "
I hear Eastman Kodak still has underutilized manufacturing capacity
Building on Biden’s love of ice cream, I’d like to see some sort of ice cream truck-style mobile vaccination fleet. They can be deployed to communities with less access to transportation/rural areas/marginalized populations of whatever kind, thus helping to address concerns of equitable distribution, and as we get nearer to the stage where younger and healthier people are allowed in the line, they can drive around to sports stadiums, concert venues, Costco parking lots, denser suburbs, etc, and play some kind of vaccination theme song on a loudspeaker (“Shots” by Lil John/LMFAO comes to mind) to let people know they can wander up and get vaccinated with no appointment required, plus free ice cream for anyone who gets the needle or brings a friend. Once we get to the most reluctant part of the herd, throw some gift cards into the mix.
You know, I like this kind of thinking outside the box, but it's really even easier than they are making it.
Without changing the syringe design in the slightest, you can get the same good effects just by flushing the remaining liquid out of the dead space.
All you have to do, is to make sure there's a decent-sized bubble of air in the syringe behind the liquid, and then that bubble will push the remaining vaccine out of the syringe, producing the same efficient delivery as the redesign of the syringe.
Problem solved.
Of course, the air embolism may be fatal for the patient, so that's a drawback. But, let's not make the perfect the enemy of the good, people!
Has the Biden transition provided further clarity on how their 100M doses in 100 days goal squares with Pfizer and Moderna’s commitments to each deliver 100M doses by the end of March? Is there a looming manufacturing issue that will keep us from vaccinating more than 50M people?
Wow! Since the price charged by hospitals and medical practitioners is well above marginal costs of the drugs, there are weak incentives to eliminate such inefficiency. Offering generous discounts to health insurers will not be too painful either.
Our vaccinators have been getting six doses form five-dose vials right along. I was told it happened more frequently with the Pfizer vaccine than the Moderna vaccine. Had not heard it was due to a variable among the syringes. The extra doses create a logistical issue because all of a sudden you've got more doses than people to be vaccinated, and the rush is on to find additional people on whom you can use the extra dose. Building the extra doses into your vaccination program would be terrific, and this would appear quite possible if it is indeed an issue of which syringe is being used.
“Sweating the details is not really the Trump way, but it’s an example of how bringing on a team of competent, experienced, professionals can make a big difference in what is on some level a big logistics problems.”
This is counter factual and disgusting. I don’t think that Donald Trump knows anything about mRNA or lipid nanoparticles or headspace and timing in syringes. But it is patently obvious that there are people who work for the Trump Administration who understand these things. Operation Warp Speed has been, thus far, as far as I can tell, an astounding success. The suggestion that it came about without “a team of competent, experienced, professionals” is calumny.
Neither Tabarrok's post nor the article he links to explains why anyone buys the "high dead-space" model of syringe over the "low dead-space" one. It's got to be cost, right? Is the difference in syringe cost really greater than the cost of producing/buying more medication (I assume this doesn't just apply to Covid vaccines) because some gets wasted in the syringe?
If we were doing distribution similar to testing, then I think we could get a lot more done. But we seem to be going down the path of using existing infrastructure (hospitals, pharmacies, etc). We need people in cars in a line waiting at the local stadium parking lot. Then we could have one low dead-space syringe serving 100x in a day.
I guess we're all so jaded now by politicians that no one can say anything without someone else implying selfish motives. So much for the tiniest acknowledgement of servant leaders. I'm not naive though, so term limits (at all levels of politics, and including higher-level bureaucrats, longer bans on later employment, department hopping or lobbying, and legislating the Citizens case away would eventually wean out some of the power hungry.
On another note, if you think the pharmaceutical companies haven't been aware of the syringe deficiencies for a long time, you don't understand why all those young salespeople bombard the offices with plates of snacks, pens, and speaking gigs. Insurance and/Medicare shouldn't reimburse providers for 20% of drug costs if a wasteful syringe is used. Easy peasy.
Are we actually throwing away 20% of the vaccine currently?
I'd like to see confirmation of that.