“Shared expectations lead to predictability.”
206. National COVID-19 Strategic Plan – (Part 3 of 8)
Q: What’s in the new United States strategic plan for controlling this pandemic?
A: On January 21, 2021, Joe Biden released the National Strategy for the COVID-19 Response and Pandemic Preparedness. This week’s summary gives details about
goal 2 – A safe, effective, comprehensive vaccination campaign.
“The United States will spare no effort to ensure Americans can get vaccinated quickly, effectively and equitably.” There will be a strategy to improve allocation, distribution, administration, support and funding to state, local, tribal and territorial governments. The federal government will mount an unprecedented public campaign to build trust in and encourage public health practices including mask use, social distancing, testing and contact tracing. This will be done by:
- Encouraging the availability of vaccines to the public;
- Accelerate in getting shots into arms; making vaccines available to meet needs;
- Create as many venues as needed to administer vaccinations;
- Focus on hard-to-reach and high-risk populations;
- Compensate providers, states and local governments for administering vaccines.;
- Drive demographic equity in the vaccination campaign – and in the broader pandemic response;
- Launch a national vaccination public education campaign;
- Bolster data systems and transparency for vaccinations;
- Monitor vaccine safety and efficacy, and
- Surge the health care workforce to support the vaccination effort.
Next week: details about goal 3 – Mitigating spread through expanding masking, testing, treatment, data, workforce, and clear public health standards.
207. Issues with vaccination registration – as of February 7, 2021
Q. Has anything changed since last week on the vaccination program?
A. It was announced last week that the next two groups eligible to receive vaccinations are soon to be activated. First, those who are in congregate settings would be “blended in” with the current priority group – those aged 75 and older. This means that prisoners, correctional staff and people in group homes would be vaccinated by teams coming to them. After these groups have been visited, the teams will then focus on other places that have a history of COVID infections such as migrant farm worker housing, and inpatient psychiatric facilities.
The other eligible group are those aged 65 to 74. Appointments can now be made. It is recommended that people in this age group plan early to make these appointments. There are two state-level portals to do this. The Connecticut Vaccine Line on the phone is: (877) 918-2224. Also, the official “Vaccination Administration Management System” (VAMS) website[1]
https://dphsubmissions.ct.gov/OnlineVaccine
Several news articles have recently appeared that vaccination clinics had closed because they had run out of vaccine doses. This has been a common problem in several states. At first the headlines appeared in an accusatory way: The “clinics had overbooked.” Defensively, local and other officials rebutted this. On February 6 one of Connecticut senators was quoted in a local newspaper with the headline: “Blumenthal and others say feds to blame for lack of vaccine doses.” This is an example of “reporting” as opposed to “Investigating.” News reporters are encouraged to report controversies. Assigning and rebutting blame sells papers and other media. Shortly after these news reports appeared, a different picture emerged: Local and federal officials working behind the scenes (without the press participating), conducted an investigation. The root problem was identified, and recommendations were jointly released by both parties: States needed to know well in advance what their allocations would be, allowing clinics to limit future appointments to meet the anticipated shipments. The decision was made that Connecticut each week would receive a count of the doses coming for each of the following three weeks. This method of mutual planning to resolve a problem or improve a process by an investigation has long been used by governments, the military and emergency management programs. For example, after an airplane crash, it takes up to a year before the FAA releases its investigative report and the public learns for the fit time the causes and resulting actions taken to resolve the issues identified.
- Based on science, CDC recommends schools should be reopened
Q: Why is the prospect of opening schools so controversial?
A: The newly appointed director of the CDC, Rochelle Walensky, MD, MPH recently recommended that schools should be reopened. An overview report written by three scientists at the CDC outlined the facts leading to this conclusion. In spite of this, however, the issues became more controversial with questions and objections being raised by parents, school boards and teachers across the country. This CDC report was based on a scientific paper published January 26, 2021 in the Journal of the American Medical Association (JAMA). This review finds that as schools have been reopening in areas of the country, “there is little evidence that schools have contributed meaningfully to increased community infection.” Several case studies and analysis of schools being the cause of COVID infections clearly indicated a significant lower cause of infection in schools than for children contacting COVID while at home and in the community.
The resulting controversy over this CDC guidance led to the conclusion that before it would be published as guidance, CDC officials would elaborate on specific standards to uniformly ensure effective protection in schools. For example, ventilation requirements, spacing between desks and people walking in hallways. Many teacher unions have also asked for this guidance to include vaccinations for all teachers and adult school staff. Part of the controversy is based on the lack of explanation of these scientific facts in advance. “The degree to which people will follow regulations is acceptance by the governed to be governed.” The good news is a recognition that while remote K-12 learning is setting students back, and is creating some mental health problems, science is indicating a return to classroom teaching is possible and may soon be acceptable.
- Red vs. blue states– different approaches – and results – to vaccinations
Q: Why did police have to be called for some people wanting to be vaccinated?
A: In New York state, people over the age of 65 can make an appointment and many CVS pharmacies offer vaccinations. A central CVS application is available in NY to make appointments. Several in NY used that CVS application and were scheduled to be vaccinated – at a CVS store in Connecticut! Last Thursday, a group with appointments took the Cross Sound Ferry between Orient, NY and New London, CT. When they arrived at the CVS pharmacy in Waterford, CT, they were denied their vaccinations. After protesting, the local police were summoned. Chief Brett Mahoney had to explain all vaccinations administered in Connecticut were limited to people who lived in or worked in this state. This is justified because doses sent to each state were limited, and each state had to preserve their allocation for its own people. It was reported that everyone who was denied were quite unhappy. In the end, they returned home at their own expense to seek vaccinations within New York. One remembers back when three states – Connecticut, New York and New Jersey agreed to avoid cross-state competition by planning as a consortium. Apparently, this was limited to testing and personal protective equipment (PPE), but not vaccinations. It was also learned that New York and Connecticut have defined their prioritization for vaccinations differently – New York allowed people over age 65 to be vaccinated weeks ago, while in Connecticut it was limited to those over age 75.
A recent examination of the ways states are implementing vaccine policies shows separate degrees of effectiveness correlated between “blue states” and “red states.” States with Democratic governors tend to develop procedures, guidelines, plans and priorities to guide the distribution and giving the shots to people. States with Republican governors tend to focus on the goal: getting as many vaccinations done as soon as possible without creating elaborate plans. A state-by-state analysis shows that many red states often have conflicts such as some sites having to destroy doses which have been thawed and unused beyond the time allowed. Or people waiting in line for hours or longer without being able to be vaccinated. On the other hand, many blue states find their processes are confusing and restrictive. Examples include difficulty making appointments, and groups having to wait until their priority emerges qualifying them for shots. The CVS example above illustrates the restrictive sharing of resources across state lines. While both groups have difficulties with their vaccination programs, the trend is emerging that red states on a per capita basis are vaccinating more people than blue states.
[1] To open this website, copy the entire URL (underlined and in blue), and paste it in your internet browser.
