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Are vaccines the light at the end of the tunnel?


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26 minutes ago, TeeRick said:

Yes this has really become an underlying issue.  Our health care officials in government (federal, state, local) and private sector healthcare should have anticipated this trained staffing issue months ago.  And anticipated some HC workers refusing the vaccine and others being sick for a few days post-vaccine.  Personally I am retired but would volunteer in a minute to be trained to inject vaccine doses - and I might also qualify to get the vaccine myself then in the process.

 

I'm not sure they didn't. Local public health has historically been horribly underfunded. Most of their staff are probably contract tracers, food safety, etc. They're competing with CVS and Walgreens to hire or contract for staff to give the vaccines. And probably not paying well, if they even have funding at all. (Not a political statement, but I believe the federal funding assistance was in the original COVID relief packet and scrapped.) And with the allergy advisories, I'm not sure what requirements are in place for emergency management. Unless I'm reading everything wrong, the federal contract with CVS and Walgreens is for long term care facilities only. Various pharmacies are Warp Speed "partners", including CVS and Walgreens, which basically means they're approved recipients of the products, but I don't think they're being funded by the feds for administration, so that's local funding, or charge back to insurance (vaccine is free, but they can charge fees for administration). There's talk about opening up convention centers, sports arenas, etc. as you move to the general public, but trained staff will likely be the rate limiting factor.

 

I think the Israeli example is in the other thread, but they were on Nightly News last night, and one thing they apparently have is a centralized health record, so everyone's already registered and entered into their systems; pull them up, add the vaccine information, and give the shot. Huge time savings on the administrative side of this. We don't (and won't) have that in the US.

 

From what I see, the distribution is going pretty well; CDC shows over 17M doses distributed as of yesterday, so FEDEX and UPS and McKesson seem to be doing pretty well (although it's not clear if that's delivery to point of administration for smaller sites). The last mile is the choke point. That's the actual administration of the vaccine. And it probably didn't help the planning if the state, local, tribal health departments were planning based on the phases in the CDC APIC, and the state governments decided (as we all knew they could) on a different priority.

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27 minutes ago, mimbecky said:

 

California has now authorized dentists to administer the vaccine.  Could help a little bit.

Nope. Nuh uh.  I don't want them stabbing me in the mouth. That HURTS!!

 

 

They seem very well qualified for the job.  If they vaccine were readily available, they should be able to do everyone within 6 months, right?

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1 hour ago, markeb said:

From what I see, the distribution is going pretty well; CDC shows over 17M doses distributed as of yesterday, so FEDEX and UPS and McKesson seem to be doing pretty well (although it's not clear if that's delivery to point of administration for smaller sites). The last mile is the choke point. That's the actual administration of the vaccine. And it probably didn't help the planning if the state, local, tribal health departments were planning based on the phases in the CDC APIC, and the state governments decided (as we all knew they could) on a different priority.

Yes the administration step is not going well in certain states.  That continues to be a very frustrating issue.

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I think it's the requirement to have a second dose in 3-4 weeks, the needing to monitor for 15-30 min, and the surprise random number of doses in each vial is all making a mess of people's poorly thought up plans.  As well as the lack of guidance as to how the heck you are supposed to exactly prioritize different groups.

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Tennessee appears to have a handle as best they can on when you can expect to receive the vaccine.  They have a website that you just fill-in the info and it gives you an approximate time when you should receive your vaccination.  In the county where I live if you are 75 and older you just call the health department and they give you a time/date.  As of now there is basically no waiting, very easy. I will give the state government a thumbs up on this one.

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4 hours ago, markeb said:

 

I'm not sure they didn't. Local public health has historically been horribly underfunded. Most of their staff are probably contract tracers, food safety, etc. They're competing with CVS and Walgreens to hire or contract for staff to give the vaccines. And probably not paying well, if they even have funding at all. (Not a political statement, but I believe the federal funding assistance was in the original COVID relief packet and scrapped.) And with the allergy advisories, I'm not sure what requirements are in place for emergency management. Unless I'm reading everything wrong, the federal contract with CVS and Walgreens is for long term care facilities only. Various pharmacies are Warp Speed "partners", including CVS and Walgreens, which basically means they're approved recipients of the products, but I don't think they're being funded by the feds for administration, so that's local funding, or charge back to insurance (vaccine is free, but they can charge fees for administration). There's talk about opening up convention centers, sports arenas, etc. as you move to the general public, but trained staff will likely be the rate limiting factor.

 

I think the Israeli example is in the other thread, but they were on Nightly News last night, and one thing they apparently have is a centralized health record, so everyone's already registered and entered into their systems; pull them up, add the vaccine information, and give the shot. Huge time savings on the administrative side of this. We don't (and won't) have that in the US.

 

From what I see, the distribution is going pretty well; CDC shows over 17M doses distributed as of yesterday, so FEDEX and UPS and McKesson seem to be doing pretty well (although it's not clear if that's delivery to point of administration for smaller sites). The last mile is the choke point. That's the actual administration of the vaccine. And it probably didn't help the planning if the state, local, tribal health departments were planning based on the phases in the CDC APIC, and the state governments decided (as we all knew they could) on a different priority.

I tried to respond to TeeRick's quote of my post yesterday, but lost my response.

 

I'm with Dr Fauci on this one. I think you will see the pace of administration go up significantly over the next 3 weeks, hopefully just in time for additional large shipments of vaccine to become available.

There are many reasons that the admin step has hit roadblocks. We are a litigious society - the gov and Pfizer are going to be reluctant to do anything other than follow an exact playbook in these first shots - masks, 6 foot distancing, 15 minute observation, careful registration and tracking with reminders for the second shot - all of that takes time, both to arrange and to happen. But not only because of lawsuits, but because that is safest. Did anyone see the CNN report about the hospital in No California that had a freezer malfunction, likely in the middle of the night, and they had to administer 800 shots in a couple of hours. They did it, in an admirable fashion, including sending out an appeal to the general public to come if you met first group criteria. But, if you look at the accompanying photo from the hospital giving the vaccines emergently, there are at least twice as many people in the conference room as should be, much closer than 6 feet. Needs must.

I know it is frustrating, but think of it as a trial run for a much, much bigger vaccination effort and a way to work out kinks and processes. It is going to be much harder to do this safely on a large scale. People who are the least bit ambivalent about the vaccine are not going to wait 2-3 hours in a line to get vaccinated, even if their risk is higher than their neighbors. It is going to be a balance between getting vaccine into arms ASAP and getting vaccine into high risk people even if they are reluctant to get vaccinated.

The two or so additional weeks in late Nov Dec before the vaccine was approved was a killer. Pushing it into the holidays added 4 weeks instead of 2, because everyone connected to health care is SO tired.

Everyone, even me, is concerned that the second shot is going to make us feel badly enough to take a day off from work, so the vaccinations have been staggered over much more time than initially anticipated, to be sure we have enough staff to get the work done.

Because we can't give it to kids, I don't think we can numerically reach herd immunity without lots of those high risk, less than mobile, reluctant persons getting vaccinated and that will take time.

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Right, but the frustrating thing is the vaccines have been in development for almost a year now.

 

They knew when 3rd phase started in July what the dosing strategy was and what the storage requirements were.

 

Sure they did not know about the anaphylactic reactions.

 

But for 6 months of planning, in this like most-important-thing of the decade+ situation.  They basically spent 6 months talking about theoretical priority groups, throwing money at pharmaceutical companies, and evidently that's it.  Oh, other than giving it the catchy name "operation warp speed"

 

And this is the result we get.  I don't know the details of what's going wrong, and honestly I don't really care.

 

It is completely inexcusable with this much lead time.  This is so important.  If you need new laws, pass new laws, if you need more people, should have trained them months ago. How is there no sense of urgency?  They should have had trial runs.  Spent months educating the populace how the scheduling and timing would work.

 

But instead we have a fragmented system with everyone pointing fingers at everyone else while it's all left on the poor people working the trenches to try to slap something together that will meet requirements with only useless overarching "guidance" and no actual guidance from above.

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40 minutes ago, UnorigionalName said:

Right, but the frustrating thing is the vaccines have been in development for almost a year now.

 

They knew when 3rd phase started in July what the dosing strategy was and what the storage requirements were.

 

Sure they did not know about the anaphylactic reactions.

 

But for 6 months of planning, in this like most-important-thing of the decade+ situation.  They basically spent 6 months talking about theoretical priority groups, throwing money at pharmaceutical companies, and evidently that's it.  Oh, other than giving it the catchy name "operation warp speed"

 

And this is the result we get.  I don't know the details of what's going wrong, and honestly I don't really care.

 

It is completely inexcusable with this much lead time.  This is so important.  If you need new laws, pass new laws, if you need more people, should have trained them months ago. How is there no sense of urgency?  They should have had trial runs.  Spent months educating the populace how the scheduling and timing would work.

 

But instead we have a fragmented system with everyone pointing fingers at everyone else while it's all left on the poor people working the trenches to try to slap something together that will meet requirements with only useless overarching "guidance" and no actual guidance from above.

I really do agree with everything you have expressed here.  The scientists and doctors and nurses working on the vaccines, and in the clinical trials,  and the people in manufacturing have done their jobs.  All with pride and urgency.  Magnificent job.  The states not being prepared for the final handoff after all this effort is just pathetic.

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1 hour ago, cangelmd said:

I tried to respond to TeeRick's quote of my post yesterday, but lost my response.

 

I'm with Dr Fauci on this one. I think you will see the pace of administration go up significantly over the next 3 weeks, hopefully just in time for additional large shipments of vaccine to become available.

There are many reasons that the admin step has hit roadblocks. We are a litigious society - the gov and Pfizer are going to be reluctant to do anything other than follow an exact playbook in these first shots - masks, 6 foot distancing, 15 minute observation, careful registration and tracking with reminders for the second shot - all of that takes time, both to arrange and to happen. But not only because of lawsuits, but because that is safest. Did anyone see the CNN report about the hospital in No California that had a freezer malfunction, likely in the middle of the night, and they had to administer 800 shots in a couple of hours. They did it, in an admirable fashion, including sending out an appeal to the general public to come if you met first group criteria. But, if you look at the accompanying photo from the hospital giving the vaccines emergently, there are at least twice as many people in the conference room as should be, much closer than 6 feet. Needs must.

I know it is frustrating, but think of it as a trial run for a much, much bigger vaccination effort and a way to work out kinks and processes. It is going to be much harder to do this safely on a large scale. People who are the least bit ambivalent about the vaccine are not going to wait 2-3 hours in a line to get vaccinated, even if their risk is higher than their neighbors. It is going to be a balance between getting vaccine into arms ASAP and getting vaccine into high risk people even if they are reluctant to get vaccinated.

The two or so additional weeks in late Nov Dec before the vaccine was approved was a killer. Pushing it into the holidays added 4 weeks instead of 2, because everyone connected to health care is SO tired.

Everyone, even me, is concerned that the second shot is going to make us feel badly enough to take a day off from work, so the vaccinations have been staggered over much more time than initially anticipated, to be sure we have enough staff to get the work done.

Because we can't give it to kids, I don't think we can numerically reach herd immunity without lots of those high risk, less than mobile, reluctant persons getting vaccinated and that will take time.

Thanks as always for your educated comments and your front line experiences.  Much appreciated.  It is a frustrating situation even from a personal perspective.  Even though I have been in vaccine R&D for about 30 years, I have a member of my extended family (SIL) who works in healthcare (home care) in MA and refused to be vaccinated when her turn came up.  I tried to convince her.  She wants to wait and see how her colleagues "react" to the shot first.  She might reconsider in a few months.  But she also lives with my 90 and 85 year old in-laws who are in poor health.  Exposes them to her risk every day.  And my MIL has flatly stated that she will refuse to get vaccinated because she was convinced by some of our country's leaders a few months ago during the election process not to trust the vaccine.  Even though these same politicians have now all rolled up their sleeves on TV.  I fear that my family situation examples are common and similar situations are happening all over the US.  

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13 minutes ago, TeeRick said:

I really do agree with everything you have expressed here.  The scientists and doctors and nurses working on the vaccines, and in the clinical trials,  and the people in manufacturing have done their jobs.  All with pride and urgency.  Magnificent job.  The states not being prepared for the final handoff after all this effort is just pathetic.

And that chaos and problem lies directly with the state's and counties.  The organization here began months ago.  The only blowup was care facilities and them not having authorizations in a timely fashion.

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11 hours ago, ALANG said:

They have a website that you just fill-in the info and it gives you an approximate time when you should receive your vaccination.  In the county where I live if you are 75 and older you just call the health department and they give you a time/date.

Totally useless exercise.

I filled one of these in for the predictive date of my vaccine. At first it came out as the end of January, I then did it again when our UK government said that they were extending the space between vaccination so that they could get more people vaccinated more quickly and the prediction was then between mid March to mid May!

We had a phone call last night inviting us for our Vaccine TODAY. I am Clinically Vulnerable (79) and my husband is 77.

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3 hours ago, upwarduk said:

Totally useless exercise.

I filled one of these in for the predictive date of my vaccine. At first it came out as the end of January, I then did it again when our UK government said that they were extending the space between vaccination so that they could get more people vaccinated more quickly and the prediction was then between mid March to mid May!

We had a phone call last night inviting us for our Vaccine TODAY. I am Clinically Vulnerable (79) and my husband is 77.

At least the predictor didn't say tomorrow with the phone call saying May 🙂

 

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5 hours ago, upwarduk said:

Totally useless exercise.

I filled one of these in for the predictive date of my vaccine. At first it came out as the end of January, I then did it again when our UK government said that they were extending the space between vaccination so that they could get more people vaccinated more quickly and the prediction was then between mid March to mid May!

We had a phone call last night inviting us for our Vaccine TODAY. I am Clinically Vulnerable (79) and my husband is 77.

It might help others if people indicated the place where they live (county or shire or ?)  Some places have things well organized and others seem to have never organized anything.

Setting up a system to use contacts first for first responders is pretty simple.  Not much harder to use doctors to get the word out a bit later to those who have comorbidities.  Large employers can set up on site and vaccinate hundreds easily.  But posting a notice to the general public that vaccinations will be offered at X locatio creates the chaos now happening in much of Florida.  My sympathy for that mess.

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27 minutes ago, Arizona Wildcat said:

But posting a notice to the general public that vaccinations will be offered at X locatio creates the chaos now happening in much of Florida.  My sympathy for that mess.

Personal experience in Citrus County, Florida.

 

We have been told that vaccines will be available on a first come, first come basis at one county park starting today (Jan 7) and Saturday (Jan 9).

 

Through word of mouth we hear that there was a soft opening on Wednesday and vaccines were given out. It was suppose to be a trial run and limited to certain groups (Meals on Wheels volunteers, law enforcement, etc). However, residents local to the park also received the vaccines.

 

Hearing this, we decided to take the 45 minute ride from our house to the park yesterday to see if the vaccine was still being given out. It wasn't, but law enforcement was at the park warning those that had already arrived to camp out for today that the residents would be told to leave when the park closed last night and that no parking would be allowed on the road leading to the park entrance.  

 

It was getting ugly with certain loud mouths arguing that they would not be forced to leave the line.

 

We probably will not even attempt to obtain a vaccine today.

 

Instead, we learned that the Publix supermarket chain will have vaccines available in our county and serval other counties. Appointments will be needed.

 

The website is suppose to open today for appointments, There is no announced time for the website opening so we are checking frequently.

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30 minutes ago, Arizona Wildcat said:

It might help others if people indicated the place where they live (county or shire or ?)  Some places have things well organized and others seem to have never organized anything.

Setting up a system to use contacts first for first responders is pretty simple.  Not much harder to use doctors to get the word out a bit later to those who have comorbidities.  Large employers can set up on site and vaccinate hundreds easily.  But posting a notice to the general public that vaccinations will be offered at X locatio creates the chaos now happening in much of Florida.  My sympathy for that mess.

Here is my state's info (Pennsylvania). Going to my state's website (PA Dept. of Health) there is zero information on when any COVID vaccine will be available beyond Phase 1 (front line health care workers).  I know that CVS and Walgreens are starting to vaccinate in nursing homes but no info about that on the website.  Very poor communications.  No online "estimator" of when the vaccine might be available to others.  Local surrounding states like NJ have set this up.

 

Here is an article just published today about the lack of information and general confusion in my state.  Very disappointing.  They say that many HC Workers will not get vaccinated until mid-February.   I guess for us in the general population I am now hoping by summer??  it has finally hit me that there will be no cruising for people like me until probably 2022 which is fine- at least I know now.

https://www.inquirer.com/health/coronavirus/pennsylvania-covid-vaccine-registration-coronavirus-20210107.html

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I hope that the fashion that dentists, retired docrors and nurses can sign up for the vaccine program is better in the USA than the UK. In typical NHS style they are expected to do all the usual mandatory training which I usually do online in batches over a couple of months. Then naturally do the specific vaccine, BLS and anaphylaxis training.

 

My wife has been off the nursing register for a year but still works in healthcare (aaccredidation of healthcare facilities including cruise ships med centres). She intends to retire in a year but has a couple of days free when she could help out. Her background is ICU. After applying and not hearing back for a few weeks she has been told to do a mass of online mandatory training including child protection and preventing radicalisation. My dentist told me the same. The rate of pay is equivalent to a newly qualified nurse (hardly enough to get out of bed, but she would for common good).

 

I am sure that most clinical staff would offer a day of their time a week to help the vaccine roll out but red tape will get in the way.

 

My GP Practice is innoculating with the Pfizer (second doses) and Astra Zeneca (first doses) over the next couple of days. Going to complete the online training this afternoon as am planning to help out Saturday morning. Am a locum Advanced Nurse Practitioner and have offered a 40% pay cut to help out as cannot expect them to pay my usual rate for a vaccine clinic (wonder if the locum doctors have??).

 

I had the initial dose three weeks ago. A sore arm and malaise for 24 hours. Not aware of any of our over 80s having side-effects.

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Update on my previous post. My frustration level is high.

 

The Publix website opened for appointments.

 

I tried to make an appointment but had difficulties with the site accepting my birth date.  By the time it was accepted, no appointments were available anywhere in the Publix system.

 

I estimate that the appointments were gone within 5 - 10 minutes  of the site opening.  There were 15,000 vaccines available for Publix and they are gone.  Poof!

 

As someone who remembers the roll out of other vaccines of public health significance (Salk, Sabin, Swine Flu (1976) and the well coordinated nation wide program to have them available, this situation is horrific.

 

I am stuck in a wide open state, Florida (tourist money is more important than health).  New cases in the state were reported for Tuesday (1/5) at around 17,500 (don't remember exact number) and positivity rate at over 12.5%. And again, no well coordinated vaccine effort. 

 

It is every (wo)man for his/her self.

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55 minutes ago, Homosassa said:

Update on my previous post. My frustration level is high.

 

The Publix website opened for appointments.

 

I tried to make an appointment but had difficulties with the site accepting my birth date.  By the time it was accepted, no appointments were available anywhere in the Publix system.

 

I estimate that the appointments were gone within 5 - 10 minutes  of the site opening.  There were 15,000 vaccines available for Publix and they are gone.  Poof!

 

As someone who remembers the roll out of other vaccines of public health significance (Salk, Sabin, Swine Flu (1976) and the well coordinated nation wide program to have them available, this situation is horrific.

 

I am stuck in a wide open state, Florida (tourist money is more important than health).  New cases in the state were reported for Tuesday (1/5) at around 17,500 (don't remember exact number) and positivity rate at over 12.5%. And again, no well coordinated vaccine effort. 

 

It is every (wo)man for his/her self.

However, never before have we had this high of demand with this short of a supply during a vaccine roll out.

 

During the Polo vaccine rollouts the priority went to outbreak areas, followed by a rollout once adequate supply was available. A rollout that was basically geographic area focused using the resources and supply available.  I remember with polio an immunization time was scheduled at the local school gymnasium and everyone would show up and line up.  It was a road show.  They would then pack up and go to the next location.  It was an effort that spanned a couple of years.  If I recall correctly that rollout was run by the State and County Health departments.

 

In the case of swine flu that vaccine production was similar to normal flu vaccine production so supply was fully available.

 

In this case there is a limited supply.  So no matter how it is conducted, it will be the cause of debate and upset.  Especially since people want it now and there is uncertainty when it will be available.

 

If there was a national rollout with all rules being enforced following the CDC priorities, the vaccine would still be in short supply.  

 

Also no other vaccine rollout has had the issues of deep frozen product, COVID distancing issues, etc.

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1 hour ago, nocl said:

However, never before have we had this high of demand with this short of a supply during a vaccine roll out.

 

During the Polo vaccine rollouts the priority went to outbreak areas, followed by a rollout once adequate supply was available. A rollout that was basically geographic area focused using the resources and supply available.  I remember with polio an immunization time was scheduled at the local school gymnasium and everyone would show up and line up.  It was a road show.  They would then pack up and go to the next location.  It was an effort that spanned a couple of years.  If I recall correctly that rollout was run by the State and County Health departments.

 

In the case of swine flu that vaccine production was similar to normal flu vaccine production so supply was fully available.

 

In this case there is a limited supply.  So no matter how it is conducted, it will be the cause of debate and upset.  Especially since people want it now and there is uncertainty when it will be available.

 

If there was a national rollout with all rules being enforced following the CDC priorities, the vaccine would still be in short supply.  

 

Also no other vaccine rollout has had the issues of deep frozen product, COVID distancing issues, etc.

 

I agree with your post and I had anticipated their would be a shortage so not everyone could get it when it was first available. I think the frustration of a lot of us is not even that WE aren't getting the vaccine yet....it's that NOBODY is getting it. When you see that your state has only used 20 some percentage of available vaccines....you have to ask why? I totally expected them and really still do expect this SHOULD be happening.... they should be using close to 100% of what they are receiving and just waiting for the next batch....

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2 hours ago, nocl said:

However, never before have we had this high of demand with this short of a supply during a vaccine roll out.

 

During the Polo vaccine rollouts the priority went to outbreak areas, followed by a rollout once adequate supply was available. A rollout that was basically geographic area focused using the resources and supply available.  I remember with polio an immunization time was scheduled at the local school gymnasium and everyone would show up and line up.  It was a road show.  They would then pack up and go to the next location.  It was an effort that spanned a couple of years.  If I recall correctly that rollout was run by the State and County Health departments.

 

 

The Salk vaccine (three dose series) became available in 1955, the year I entered kindergarten.

 

It was given in either your doctor's office or clinics.  I had mine in our doctor's office.  Starting for the fall semester of 1956, my school district required completion of the series for entry into kindergarten or return to other grades.

 

The Sabin Sundays occurred in 1960.  I remember lining up that spring (first Sunday after Easter for the first Sunday) to snake our way through the cafeteria of the local junior high school to receive our dose. The line moved quickly, especially in light of the fact that all the records were kept by hand on cards. 

 

An interesting side note was that the school was across from a catholic church and we made sure to be in line before the last mass of the day let out.  The priest would lead a recessional procession  of the congregation to cross the street and join the line.

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59 minutes ago, dreaminofcruisin said:

 

I agree with your post and I had anticipated their would be a shortage so not everyone could get it when it was first available. I think the frustration of a lot of us is not even that WE aren't getting the vaccine yet....it's that NOBODY is getting it. When you see that your state has only used 20 some percentage of available vaccines....you have to ask why? I totally expected them and really still do expect this SHOULD be happening.... they should be using close to 100% of what they are receiving and just waiting for the next batch....

Exactly.  

If people in line to get vaccinated were having to wait for more vaccines to be produced and shipped, that would be one thing.  What we have is an inability to distribute what amounts to a relatively small quantity of vaccines.  

 

Michigan has ~10 million people. If 40% of them are vaccinated for influenza within a ~6 month period of time, that equates to over 650k vaccines given per month.

 

In the past month, Michigan has received over 650k covid vaccines, and has managed to put only 150k of them into people's arms.  Not a good start given the months available to plan things. 

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On 1/5/2021 at 12:20 PM, ABoatNerd said:

So everyone, amazing analysis.

I am in Ontario, we only have the Pfizer vaccine here. I understand that people with autoimmune condition/disease should not take this specific vaccine.

Does this include Hashimoto thyroid which is a autoimmune condition. I am confirmed with blood work and ultrasound on this.

 

Hashimotos thyroid is the #1 reason for thyroid disease - so this is a Huge potential issue for the vaccine!

 

I need to know as there is a Norway cruise which I may wish to book and now I am hesitant to do so.

 

Any assistance would be gratefully appreciated.

Here is the most recent update from the US CDC on allergic reactions to the Pfizer and Moderna vaccines.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm?s_cid=mm7002e1_w

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