I can’t prove cause and effect, but since @ashishkjha & I published our 2 editorials on vaccine distribution – one @washingtonpost advocating we consider deferring 2nd doses in order to give more people first doses quickly tinyurl.com/y7c6v9hz... and another in the... (1/12)
... @nytimes recommending a much simpler allocation system (age first, then random allocation via lottery) tinyurl.com/y2mqqxae – the Biden administration has made moves to embrace the spirit of both recommendations, which is great. (2/12)
Last week, Biden team announced that they’ll no longer withhold 2nd doses – recognizing (as our WashPo piece advocated) that pushing 2nd dose back a few weeks (which may happen) is likely less risky than giving half as many people their 1st dose tinyurl.com/y3tnn2pr (3/12)
Yesterday, the Trump administration (or whoever is leading this dumpster fire of an administration by the time you read this) announced that they’ll also implement the plan to stop withholding second doses tinyurl.com/yyhcvsnk (4/12)
Also yesterday, the Biden team announced opening up the vaccine pool to people >age 65 tinyurl.com/yxeblcfr It appears that Biden & friends will take a more pragmatic approach to vaccine distribution, which is great – we’ve let the perfect be the enemy of the good… (5/12)
… and created an initial vaccine plan that is confusing & unworkable. Job One remains getting the operations and logistics sorted out – it is scandalous that the U.S. has injected only 1/3rd of its vaccine supply, as of today tinyurl.com/y7y9767j (6/12)
The decisions to release more doses & liberalize the priority groups must also be accompanied by better, more efficient plans to move people through the system much more quickly. I still believe that breaking up large groups into smaller groups… (7/12)
… via the use of a lottery, as we described @nytimes tinyurl.com/y2mqqxae, is likely to work best.

What won’t work: first-come, first-served plans that cause people to be on phone hold for hours or computer systems to crash. Another bad idea: having people line up... (8/12)
… for hours waiting for their shots in the middle of a pandemic. The scenes from Florida, where elderly people – many pushing walkers – camped out on long lines overnight like they were waiting for Springsteen tickets are just horrifying. tinyurl.com/y2fxl5qv (9/12)
Thx Prof. Bill Siembieda (@CalPolyPlanner), who shared his scholarly paper on disaster response w/ me: "The concepts of friction & uncertainty are introduced as barriers to efficient & effective completion of the transactions needed for recovery." tinyurl.com/y69h6ulb (10/12)
While a bit less scholarly than Prof. Siembieda, Mike Tyson also had something useful to say about this matter (below from our WashPo piece).

The original vaccination plans sounded OK in November (kind of), but here we are in January & these plans are failing miserably. (11/12)
If having vaccinated 10M people in one month (when we should be at >25M), a steady stream of 3500 deaths a day, and racing against a new & more infectious variant isn’t being punched in the mouth, I don’t know what is. Simple and pragmatic should be our watchwords. (12/12)

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More from @Bob_Wachter

7 Jan
Today @nytimes, @ashishkjha & I make the case for a more straightforward, less-gameable & (we think) more equitable way to roll out vaccines: older people first, then use a lottery. tinyurl.com/y24vncws. Here's our reasoning: (1/15)
(It's worth noting that ours is part of a set of 4 interesting articles, the others on targeting hot spots, not pressuring the vaccine-hesitant, and a better way of thinking about distribution algorithms. All worth your time.) (2/15)
Our thinking: after we finish healthcare workers & people in nursing homes, question is: who goes next? Efforts to prioritize groups like "essential workers" & people with pre-existing conditions seem reasonable, but we fear that they are devolving into an unworkable mess. (3/15)
Read 15 tweets
7 Jan
How is the person at Walgreens or CVS going to verify that someone is a bus driver, or a grocery store clerk, or a preschool teacher? A note from HR? The honor system? Really?

And preexisting conditions are even harder. Will you need a note from your doctor? What if.... (5/15)
...you don't have a primary care MD? And what's a pre-existing condition? Diabetes, sure. How about diet-controlled diabetes? Pre-diabetes? Cancer, of course. I had a fairly benign type of thyroid cancer in my 20s. 40 yrs later, I'm pretty sure I'm cured. Does that count? (6/15)
In the end, @ashishkjha & I felt that – in a well-intended effort to promote equity thru distribution – we had built a system so complex that it would actually be inequitable. Why? Who figures out how to get ahead in complex systems? The privileged. Exhibit A: the tax code (7/15)
Read 11 tweets
6 Jan
1/ Covid (@UCSF) Chronicles, Day 294

Lots to talk about, so today I’ll do an update on things @UCSFHospitals (now adding vaccine rollout), SF and CA. Then quick takes on a bunch of issues, mostly vaccine-related. The news is coming fast and furious – too much of it bad.
2/ Let’s start @UCSFHospitals, now having our biggest surge yet: 83 pts, 14 on vents (Fig L). It’s busy but it's not yet stressing our capacity in both hospital & ICU. Test positivity rate 5.1% overall – 16% (highest yet) in symptomatic pts; 2% (stable) in asymptomatics (Fig R).
3/ Interesting that our hospital cases keep rising despite fewer new cases in SF – down to 237/day from peak of 290 (Fig L). But a worrisome new uptick – might be holiday/New Year’s effect. Test positivity rate pretty close to @UCSF’s: 4.49%. SF hospitalizations=218 (Fig R), w/…
Read 24 tweets
4 Jan
As expected, our @washingtonpost editorial today on the delayed second dose vaccine strategy has generated a vigorous and interesting dialogue. tinyurl.com/y7c6v9hz Here are my takeaways (a thread): 1/18
The debate is healthy. There are pros and cons to the current strategy and the alternative we present, and there are real uncertainties associated with them both. They should debated thoughtful and studied to the degree possible. 2/18
Many people seem focused on the source of the delays in vaccination, as if it matters whether the bottleneck is from vaccine production or distribution/injection. I don’t think it does. Starting soon, there will be doses available and people to inject them – and... 3/18
Read 18 tweets
31 Dec 20
U.S. is now considering idea of a single vaccination shot, delaying shot #2 until months later. Last wk, I thought that was a bad idea – the trials that found 95% efficacy were 2 shots; why add extra complexity & a new curveball. But facts on the ground demand a rethink. (1/7)
The two main changes are the slower-than-expected vaccine rollout and the new variant virus being found in the U.S. Both demand that we turbocharge the process of getting a large chunk of the population at least partly protected. (2/7)
Here's my back-of-the-envelope math:
- Single shot seems to be about 80% protective after a month
- 2nd shot adds some efficacy (up to 95% protective), and maybe (tho not yet proven) some durability.
- New variant is here, and undoubtedly far more widespread than we know. (3/7)
Read 7 tweets
30 Dec 20
1/ Covid (@UCSF) Chronicles, Day 287

Today, a brief update on the local situation in SF & CA, and then a few reflections on a series of new failures in the U.S. that, sadly, make clear how difficult it is for our country to get execution right in the fight against Covid-19.
2/ First, a brief update on the local scene. Bottom line: not much change, which is either good or bad news, depending on how you feel about half-filled (or empty) glasses. Personally, I don’t feel great about it, since we’re just starting to see the impact of holiday mingling.
3/ TSA reported 1.3 million people screened at airports Sunday, a 60% decrease from last year but still an awful lot of travel for a country that should be staying home. After 10 months, the urge to be with friends & family is understandable, but the cost will be very high.
Read 25 tweets

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