Category Archives: Healthcare

Melbourne madness

The lack of media coverage of the Covid outbreak in Australia is . . . funny.  I mean, back when Trump was in charge, all we heard was how great New Zealand was handling things, and if only Trump was more competent, we, too, could be like New Zealand.  NZ being an ISLAND nation with a population of 4 million and, literally, more sheep than people.

Australia has far more favorable conditions than the US, being a remote island with 1/10th the population density of the US, but it’s still a better comparison than NZ, since it has 25 million people.  (It turns out contagious diseases like larger populations.  In fact, there is a minimum population below which a virus cannot survive, based on its infectiousness and severity.)  In any case, Melbourne is back in Lockdown.  This is, for those who are counting, the FOURTH lockdown.

Now, here in the US, the term lockdown is bandied about, but what it has really meant, even in conservative states like Washington, is restaurant closures and capacity limitations across the board, as well as limitations on gatherings.  Many states explicitly allow demonstrations, a la the George Floyd demonstrations, but also anti-lockdown demonstrations.

In Australia, and in Melbourne in particular (and to a lesser extent in Europe), in means something very different.  People are literally locked down, and not allowed to leave their homes without permission.  Even when one has secured a permit to, say, go to the grocery store, that store must be within 5 KM of your house, if such a store exists.

The current lockdown is not this severe, but it’s still pretty bad.  Last week, people were restricted to staying within 5 KM of their house.  This has been increased to 10 KM this week.  But they are enforcing it.

  • In Melbourne, the five reasons to leave home will remain the same — shopping for food and essential supplies, authorised work or study, care and care-giving, exercise and getting vaccinated.
  • The list of authorised workplaces will also expand to include outdoor jobs like landscaping and painting.
  • After months of concern about QR code compliance, the Service Victoria QR code check-ins will now be mandatory across the whole state for places like supermarkets and shops.
    • I believe this is to verify people are staying within their 10 KM or not exceeding their allowable shopping trips – not sure which but standby for when I have time to Google it.
  • Food and hospitality venues will be open for “seated service only” with the density rule of one person per four square metres.
  • Regional Victorians can only travel to Melbourne for a permitted reason and the Melbourne restrictions apply once they are there.

  • Regional businesses will be compelled to check the IDs of everyone they serve to ensure they are not from Melbourne.
    • In other words – people who live in Melbourne are not allowed to leave, and they are checking IDs to ensure this is enforced.

To put this in perspective, the population of Victoria is 6.7 million.  Yesterday, there were SIX cases detected.  But, because they have put all their marbles in the no Covid ever basket, this is basically catastrophic.

If I lived in Melbourne, I would be in a cold fury over how the virus got in in the first place.  With so much at stake, how could it be allowed to happen?

But lately, I’ve been wondering what Australia’s end game is.  How do they open up?  They would need to have a very high percentage of the population vaccinated to even allow vaccinated individuals in, given that even Pfizer and Moderna are only 90% effective.  And J&J doesn’t necessarily prevent people from transmitting the disease, though it reduces the severity.  So someone with a J&J vaccine isn’t a safe entrant by any stretch.  Once they whole population is vaccinated, do they just let Covid in and let it spread?  God forbid a variant emerges against which the vaccine isn’t effective.  Things have not been looking great in the UK lately, if you’ve been watching the numbers.

vaccines

The rate of vaccination in the US has slowed dramatically, and it’s really concerning.  Based on Israel’s data, if we get to 60% of adults (16+) vaccinated, we’ll be golden.  But we’re not trending towards that any time soon.

Looking at the plot, you can see that the rate of vaccination (slope) for Israel was much steeper at 45% than in the US.  Similarly, the slope was steeper in the UK at 45% vaccinated, though perhaps not as dramatically.  The UK appears to have hit a knee in the curve at 45 to 50% as well.  Israel, by contrast got to 55% before demand dropped off dramatically.  Looking at Israel, you can see that once demand drops, it REALLY drops.  At this rate, the US will be lucky to get to 55% this month.

From this plot, you can see that the running average of daily doses per 100 people has dropped by nearly 40% since its peak three weeks ago, and all indications of the trend are that it will continue to drop steadily.

What can we do?

  • Pay people.  $100 to anyone under 50 to get the vax, and $200 to anyone under 35.  Including kids.
  • Mandate vaccines for people who work in nursing homes and in hospitals with patients, or outpatient medical facilities with vulnerable people (eg cancer patients)
  • Nursing home residents should also be mandated to get vaccinated
  • Help employers set up onsite vaccinations for employees
  • Employers should incentivize employees to get vaccinated, preferably financially
  • Lift mask mandates indoors for anyone vaccinated once 50% of state population is fully vaccinated (outside of medical facilities)
  • Lift mask mandate for children of vaccinated parents in school once 50% of state population is fully vaccinated
  • Offer vaccines at ball games and other public venues
  • Offer vaccines at churches.  Have the pastor pitch it during mass / service
  • Go door-to-door vaccinating people over [75].  Some people are housebound and may not be able to get out to get vaccinated.
  • Mandate vaccination in order to fly (except for residents of communities that can only be accessed by air).  Or make nonvaccinated people buy two adjacent seats.  Or even a whole row.
  • All doctors should offer vaccines at EVERY in-person appointment.

In general, I’d like to see people like Fauci and Biden express a little more confidence in the vaccine.  It is *not* necessary to wear a mask outdoors “just to be safe” if you’re vaccinated.  Fauci can go to the movies.  Fence-sitters need to see leaders believing that vaccines actually work.  This isn’t as bad as Trump refusing to wear a mask, but it’s not good.

What else?

Covid plots

I think it’s always helpful to look at the data when it comes to Covid.  Reading the media coverage is highly misleading.  In any case, to me, the numbers look good.   Note that the above is a log plot.

  1. Numbers appear to be plateauing in India.  I think it’s likely they’ll begin to dip soon.
  2. Numbers is Israel have now fallen below South Korea.  That is very good news for vaccine efficacy.
  3. Numbers in the UK also continue to drop.  I hope we will see a sharper drop-off there soon.

Vaccines:

In terms of people vaccinated, Israel’s success has come with about 65% of people vaccinated.  In the US, we are sitting at 45%.  I am hopeful that if we can push up to 60% or so, we’ll start seeing huge drops, just like Israel has.  I am personally strongly in favor of dispensing $100 checks to young people who get vaccinated, as West Virginia has done.  I also hope that being able to just drive to your local pharmacy without an appointment will help.  In Washington, we are at 47% vaccinated, and at current rates, should achieve 60% by the end of May and 70% by the end of June.  Hopefully that will still happen despite dropping demand.

Given dropping demand, I don’t understand why we are still vaccinating people with the J&J vaccine.  It’s just so ineffective compared to Pfizer and Moderna.  I think in limited cases the storage requirements might make J&J the preferred choice, but those cases are truly limited.  You’re almost certainly better off with one Pfizer dose than one J&J dose.

dribs and drabs

If you’ve been a running fan for a long time, or subscribed to Runner’s World a decade or two ago, you’re probably familiar with Team Hoyt.  Dick Hoyt pushed his profoundly physically disabled son in hundreds of races.  If you click the link, you can read their inspirational and moving story.  Sadly, Dick Hoyt passed has just passed away.

The WSJ had an article about how the Covid vaccine may be protecting the old.  I thought a couple of the plots were encouraging.  This plot showing the decline in nursing home deaths as a share of overall deaths since the beginning of the year, even while overall deaths have declined precipitously, is extremely encouraging.

The progress isn’t as obvious on this age chart, but I think it’s still encouraging.

Deaths 85+ have dropped dramatically, while deaths 75+ have remained steady by percentage, but because 85+ deaths have dropped, I believe that really shows an improvement (since you are seeing a constant percentage of a smaller pie).  The share of deaths 55-64 is increasing, which is what you’d expect to see, since that group is more vulnerable to Covid due to age and not protected by the vaccine.  Seattle only opened it’s mass vaccination sites to 65 year olds on March 1st; previously they were open to 70+, and not longer before that, only to 75+.  I’m sure there are other cities doing similarly poorly, and in some other states, vaccine distribution seems rather haphazard, to put it nicely.  In any case, a huge percentage of 65-74 year olds only got the shot in the last month.  I hope that the curve will look even better in another month.

On the negative side, the CFR is roughly the same now as it was last September, so we haven’t made any measurable progress in either detecting minor cases or healing more serious cases in the last six months.

Covid predictions

I thought it might be “fun” to make some Covid predictions.  Many of my past Covid predictions from last year have come to pass – off the top of my head, vaccine availability date is so far right in line with my predictions.  I also predicted that masks were, in fact, useful and important to protect yourself and others.  I was right about thinking that many restrictions were silly and should be lifted, particularly those targeting outdoor activities.  Who can forget the police in Europe chasing some guy who dared jog on the beach?   I didn’t understand why people were talking about opening up too soon and suggesting that if we waited long enough the virus wouldn’t rebound.  Europe and other locations have amply proved that this was a fairy tale, wishful thinking.

I was wrong about the number of deaths.  I was wrong about cloth masks – it turns out that a triple layer, well-fitted cloth mask is nearly as effective as a surgical mask.  Though, since my pediatrician is sticking with surgical masks, I’ll do the same, or a KN95 if I find myself on a plane or similar.

Current predictions:

1.) There were 528,000 deaths in the US in the first year of the pandemic.  I predict 260,000 deaths in the US in the second year of the pandemic.  I predict we will continue to be in family with the largest countries in Europe for deaths per capita.

2.) I predict Washington state will still mandate mask wearing in some situations in March 2022.

3.) I predict Seattle area schools will not open full time in the Fall.  I would not be at all surprised if they close completely again next winter.

4.) I predict that vaccination will be annual.  This means Round 2 must start no later than December 2021.  In reality, since Covid is seasonal, we’ll need a booster for Winter 21-22, which they better have ready to roll out by early fall, like the flu shot.  I predict they’ll be behind the curve, and those of us who aren’t medical workers, old, or government workers or willing to cheat will not have the booster in time for next winter’s surge.

5.) I predict data will show that school closures in Democratic states, particularly Washington, Oregon and California, were devastating for the neediest kids, and caused a greater setback for “equity” than anything else that’s happened in the last decade, by a wide margin.

6.)  This is the third Coronavirus outbreak in 20 years.

  • SARS: 2002-2004
  • MERS: 2012
  • Covid-19: 2019

I predict another novel Coronavirus will emerge in the next ten years.  I predict another pandemic caused by a Coronavirus will occur within the next twenty years.

7.) I predict I will still be very grumpy about all things Covid at this time next year.

What do I think should happen?

1.) I think wealthy governments should focus #1 on infrastructure to vaccinate people with existing supplies.  But #2 and nearly as important, massive funding should go to building vaccine manufacturing capability domestically so that we can roll out the second vaccine round MUCH more quickly.  All wealthy countries should do this, even small ones.  Building up vaccine manufacturing capability takes years.  Start. NOW.  Please.

2.) The vaccine acceptance process needs to be speeded up for  select vaccine developers that have done a good job.  Pfizer, J&J, Moderna.  NOT AZ, obvs.  We can’t afford to wait so many months.  The cost benefit just doesn’t make sense for someone 80+.  Vaccine should be made available on an emergency basis with minimal testing to the most vulnerable.  The emergency is just not the same for old folks as it is for younger folks, even front line workers.  Also, for vaccine boosters, priority should be by age and age only.

3.) Remove all restrictions nationwide on outdoor gatherings and activities immediately, except masking.  This isn’t going away.  We have to figure out how to live our lives with Covid, and outdoors plus masks seems pretty darn safe.  In Washington, you still cannot gather more than two households together outdoors.

4.) The US needs a dedicated agency dedicated to pandemic spying – that is, identifying pandemics in countries that are not transparent about pandemics (eg China), or incapable of identifying pandemics (eg very poor nations).

5.) The mask mandate should be lifted outdoors nationwide by executive order once 50% of American adults are fully vaccinated.

6.) Schools should be opened full time nationwide in the fall by whatever means necessary.  Unions in the West will not permit this unless they are compelled to.

6.) Study how South Korea and Japan managed Covid.  Other than being island nations, were there other things they did that enabled them to be successful in managing Covid?  (Note that NZ and Australia did not *manage* Covid – they eliminated it, at great cost in the case of Australia, and NZ is so low population that I don’t think it’s relevant.  Japan and Korea are much more interesting to me.)  Because of the language barrier, it’s much more difficult to read about what they’ve done and how it’s being managed.

What are your predictions for the next year?  What do you think should be prioritized now?

incompetence

What an absolute fucking diasaster.  Masks have gotten so much attention, but how much more critical was the late test rollout?  46 days it took us longer than Thailand to produce useable tests thanks to CDC hubris an idiocy.  “Lindstrom warned superiors that dropping N3 might lead to missed cases of infection, false negatives. Villanueva told colleagues that the design was of “Nobel quality,” according to those familiar with the matter.”  The lead scientists were worried about getting an f-ing Nobel prize instead of being pragmatic.

We’ll never know what difference it might have made to get tests out in a timely manner.  By the time the US was able to test, Covid was so widespread, particularly in California, Washington, New York, and probably a couple other northeast states, that containment, a la Korea, was out of the question.  “Flattening the curve” was the only remaining option.  We’ll never know how many lives were lost, how much of our country’s reputation, how much negative economic impact was caused by this debacle.

I still believe this is epidemic-light.  There is another, worse epidemic coming.  I sincerely hope we can learn from these errors.  Will the CDC do better next time?  Let’s hope so.  Please don’t forget that the first positive COVID test in the US was *illegally* obtained in Washington against CDC guidelines.  (This is the same CDC, don’t forget, that was, while failing to produce tests, actively advising AGAINST mask-wearing.)

This is a book waiting to be written.  Honestly, there will be a cover-up, but if someone could get to the bottom of this, you could easily write a book JUST covering the testing debacle.

vaccines

Honestly, I think if you work in a long-term care facility and refuse to get vaccinated, you should find another job.  The government should provide financial support and assistance to allow long-term care facilities to increase salaries to replace those to refuse to get vaccinated and support those who do and want to stay.

Nearly 72% of certified nursing assistants say they don’t want to be vaccinated, a recent survey found.

The federal long-term-care vaccination program, led by CVS Health Corp. and Walgreens Boots Alliance Inc., will begin its broad rollout in a dozen states this week, with hundreds of facilities slated for visits during the next few days. But surveys have signaled that many staffers are reluctant to get the shots, and some already have been declining them in the limited number of facilities where vaccinations have been administered.

At the nursing home at John Knox Village, in Pompano Beach, Fla., which became one of the first U.S. facilities to get the vaccine last Wednesday, about one-third of staffers participated, according to Mark Raynor, director of health-care services.

Unbelievable.  The thing is, you have to vaccinate the people working at nursing homes.  The in-and-out is just too rapid for the residents.  I read life expectancy when you enter a nursing home is only five months.  It’s just not practical to assume you can vaccinate all those people with a vaccine that requires to shots a month apart.  I mean, that should happen, too, but it’s imperative that all staffers and all visitors have the vaccine.

I have to admit I was a little squirrely about the vaccine when it first was being developed six to eight months ago, simply because I was concerned about the speed of development, but you can call me a convert.  Got an extra Pfizer or Moderna vaccine?  I’m ready!  Let me know when and where!  Not only that, I feel like that could have / should have been even more aggressive about rolling the vaccine out to the most vulnerable.  The risk / benefit equation is very different for a ninety-year-old nursing home resident than it is for a thirty-year-old nurse, so the former should have gotten approval for the vaccine sooner.

Lawyers have said that employers are generally legally allowed to mandate Covid-19 vaccines for workers, a stance reinforced last week in guidelines released by the Equal Employment Opportunity Commission. But nursing-home owners have said they don’t plan to require the vaccine. Many facilities are already facing staffing squeezes after months of pandemic challenges.