It's been 2 weeks since vaccine doses were first reported to be en route to nursing home residents. Pretty much every day since there've been reports that vaccination in LTCFs will begin "soon" in this or that state. I've seen very little reporting re: what the hold ups have been
In this report, from 2 weeks ago, lots of vague statements re: opting into federal programs with different start dates tied to Pfizer vs. Moderna. But even this indicates plans to reach only a small % of the 70K facilities where vax is needed. usatoday.com/story/news/hea…
Yet at the time of this report, the administration was still saying 20 million ppl would be vaxxed by end of calendar year. So much unwarranted optimism. So little planning & investment of needed resources.
Keep this in mind when you see reports suggesting vaccination will be readily available in drugstores, urgent care clinics, docs offices, etc., etc. this spring. It's easy to *say* that will happen. Much harder to actually make it happen. No evidence of real plans to get there.
Another report, from 1 week ago, pointed to informed consent. Utterly predictable. Utterly inexcusable not to have this worked out well before doses were shipped. washingtonpost.com/health/nursing…
From a week ago: "Azar recently said the government has the capacity to inoculate all LTC residents by Christmas. But the retail pharmacies administering the vaccines have indicated the process probably will take several months as a result of logistical and consent challenges."

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More from @ProfLWiley

30 Dec
It’s not (just) fairness. Goal = reduce cases/hospitalizations/deaths as much as possible w/ scarce doses. Haphazard delivery to any readily available arm rather than doing the work to get it right -> running out b4 we reach those whose vax will most improve the situation for all
If we have (or expect very soon to have) enough doses for all, then by all means, take a shotgun approach (while tracking who gets what so appropriate follow up/2nd dose can be ensured) but we don’t have enough doses to do that yet.
If doses have been thawed & need to go somewhere ASAP, better to get them in any available arm than toss them. But even better to plan to avoid that scenario if possible.
Read 5 tweets
24 Dec
We’re likely to be dealing w/ covid in some form for years to come. We’ve basically known this since the beginning. The good news is we have to the tools to save lives in ways that minimize disruption & even have side benefits. The bad news is we’re not good at long-term thinking
Global eradication of a respiratory virus that spreads in the absence of obvious symptoms & has an animal reservoir is extremely unlikely, even with highly effective & widely accepted vaccines. Opposite of smallpox, the only virus to be entirely eradicated through vax.
When I say we have the tools to manage life with covid long-term, I’m not talking about physical distancing & masks for the general population. Those are for when all else fails, as it has in 2020.
Read 6 tweets
22 Dec
K-12 schools, colleges & universities need to be planning for reopening in August/Sept 2021 assuming many staff & faculty will have access to vaccination (though some will decline) but most students will not have the opportunity yet.
3 reasons: 1) even on most ambitious Trump admin timeline (which doesn’t appear to be backed up by purchase agreements or distribution plans) *beginning* to offer vaccination to the general population in late spring doesn’t mean most will actually have access by August.
2) To actually *start* vaccinating the general population by late spring will require everything to go perfectly, as Murthy & others are pointing out. Less than 10% of nursing homes have been able to start vaccinating residents so far.
Read 4 tweets
9 Dec
Here’s the text of Trump’s “America First” vaccine EO. I read it to direct admin officials to allocate vaccines *owned by the federal govt* for use on US residents prior to distributing any US federally-owned doses to other countries. whitehouse.gov/presidential-a…
I don’t read it to invoke export controls to prohibit vaccines produced in the US (eg Pfizer’s Michigan facility) from being sold to other purchasers.
I don’t read it to invoke the Defense Production Act or any other possible authority to “jump the line” of contracts Pfizer has entered into with other countries.
Read 12 tweets
6 Dec
Not sure how an order to stay at home adds much to closure of high-risk settings plus gathering ban when nonessential retail is still open. I assume this is just a messaging tactic, given that the order itself amounts to “stay at home unless you feel like shopping at the mall.”
The prohibition on outdoor dining & closure of outdoor playgrounds, etc. is also an odd move.
I assume part of the thinking is that closure of (low risk) non-essential retail doesn’t provide much benefit & disproportionately harms small businesses b/c most big box stores can stay open by selling some essentials.
Read 4 tweets
25 Nov
@WFrancisEsq @sdbaral Which is why a strategy built on convincing individuals to “do better” - whether by threat of criminal penalties or education/urging - is a concession to defeat. That’s where the social-ecological model comes in...
@WFrancisEsq @sdbaral Effective pandemic response requires governmental & institutional responsibility: 1) strong protections for on-site workers: high-quality PPE, easy-access testing, privacy & whistleblower protections, paid sick leave, income replacement for ppl in higher risk groups to stay home.
@WFrancisEsq @sdbaral 2) strong protections & supports for safer housing: eviction/utility shut-off freeze plus rent-relief for landlords, (rapidly transmitted) positive test results trigger immediate offer of strong supports for isolation from other household members, including hotel accommodation
Read 10 tweets

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