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Unsanitized: The COVID-19 Report for Dec. 14, 2020

Vaccination: Just Billions of Dollars Away From Success

A lot of positive signs, but states need money to distribute the doses

 

Sandra Lindsay, left, a nurse at Long Island Jewish Medical Center, is
inoculated with the Pfizer-BioNTech COVID-19 vaccine by Dr. Michelle
Chester, Monday, Dec. 14, 2020, in the Queens borough of New York. (Mark
Lennihan/AP Photo)

First Response

The scenes of frontline healthcare workers taking the Pfizer vaccine
this
morning make me incredibly hopeful that this newsletter will quickly
become obsolete. Getting the emergency use authorization on Friday and
spending the weekend positioning the doses

across the country turned out to be workable, and I'm slowly growing
less concerned about the logistical heavy lift, even though there are
bound to be glitches here and there. In fact, I think there are a lot of
reasons for optimism with this rollout and one big reason for pessimism.
Here they are:

Steady shipments: The expectation is that the Moderna vaccine will be
approved this week and off to the states. At that point you will have
two sets of vaccine doses moving across the country, at a fairly
consistent rate. The Washington Post is tracking distribution

based on state health official estimates; the site Tableau Public

is doing the same in much more concentrated and visually pleasing
fashion. In general, enough shipments for one shot of the two-shot
sequence for about 4-7 percent of the adult population will be rolling
out this month, which could (and should) ramp up in subsequent months,
if for no other reason than this was half a month.

You don't need 100 percent coverage of the adult population to
actually reach herd immunity; the 16 million who have contracted the
disease have antibodies, and that's probably an undercount by at least
a factor of three. Dr. Slaoui of Operation Warp Speed has said 70
percent of the population would be enough; it could be even lower. The
numbers, with even a mild ramp-up, come out to enough doses to eradicate
the virus within about 4-6 months. I'd love to see that sped up to
3-4.

A lot will go wrong. Incorrect refrigeration will cause some spoilage.
If scheduling is mismanaged the Pfizer vaccine may be defrosted too
early, therefore becoming unusable. There are the hurdles associated
with making sure everyone comes back for the second shot. And
vaccinating during a pandemic could lead to exposures and even outbreaks
before the dosage takes effect. Mistakes will be made. But in general
this looks achievable.

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Enough doses: The U.S. purchased an additional 100 million shots

from Moderna, on top of the 100 million they already pre-purchased. Add
that to the 100 million guaranteed from Pfizer and you have enough to
cover 150 million people without any other vaccine being approved. Given
that both of these vaccines are around 95 percent effective in clinical
trials, you're not wasting many of them. Another even mildly effective
shot like AstraZeneca (which the U.S. pre-paid enough for 300 million
doses) should be enough to cover the necessary population. So the
grumbling about the Trump administration not getting enough shots from
Pfizer over the summer should subside.

No twindemic: Fears that flu season would cause a doubled-up rush to the
hospital along with the coronavirus have not materialized
.
Flu activity is "atypically low," according to experts, in all 50
states. Compared to some years, flu is seven times lower. That's a
rare assist to hospitals trying to deal with COVID patients and
vaccinations at the same time.

A presidential-level effort: I think we will take what we can get from a
White House that has checked out of reality. A $250 million public
education campaign

is rolling out, without the celebrity pitchmen once envisioned. Really
any help at the margins to overcome confusion and deliberate
misinformation ought to be welcomed. Surveys show

that enough people want to take the vaccine to reach herd immunity, but
having a cushion would help. And Trump actually did something right:
after news that the White House staff would be quickly vaccinated (which
is arguably not a bad thought, but contains elements of unfairness that
would sap public confidence), the president shut that down
,
saying that staff would get vaccines "somewhat later" in the
process.

We Can't Do This Without You

A virus losing steam: Stay with me on this one. We are in the midst of a
horrible cycle right now. But the wave has crested in some of the
worst-hit areas. In fact, a review of data from the COVID Tracking
Project shows that 24 states are at a plateau
or on the downslope on the key metric of hospitalizations. Five states
in the northern tier-Iowa, Nebraska, North Dakota, South Dakota, and
Wisconsin-all saw hospitalizations peak before Thanksgiving, and
they've gone steadily down since. The Midwest, Rocky Mountains, and
the Ozarks are also down or flatlined, Texas has plateaued, and the
Pacific Northwest is headed in that direction.

Right now we have a big problem in the Northeast (except Vermont), the
Mid-Atlantic, the South, and the Southwest (California and Arizona
specifically). But if the virus does tend to burn itself out,
particularly after protective measures and personal distancing gets put
in place, that could provide a mid-winter bubble concurrent with ramping
up vaccinations.

So this is all good news except for...

Show Me the Money

The bipartisan COVID relief bill that's been prepared for weeks will
finally drop today, and it's in two parts. One $748 billion piece
includes unemployment, hospital, schools, broadband and other
provisions, including a relatively meager $16 billion for vaccine
distribution. The other $160 billion includes state and local government
aid and a liability shield.

The second half was designed to be jettisoned. Mitch McConnell proposed
this last week, to hold out the contentious parts and pass what's able
to be passed relatively non-controversially. That doesn't mean
anything will actually pass-it would only be the 29th bill passed by
Congress

all year-but it does mean that state and local aid is likely dead, at
least for this Congress. And state and local governments are incurring
significant costs

to distribute the vaccine. Once the federal government allocates to the
states, the rest is up to them: shipping to the direct vaccination
point, storing the vaccine on site, hiring people to administer the
doses, community outreach to maximize takeup, even the creation of
pop-up clinics.

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That's not going to be covered by the $16 billion, which as I
understand it is mainly for moving the vaccine into position and
providing the needles and syringes and PPE to administer it. In other
words, at a time when state and local budgets are suffering, this large
and unanticipated cost (at least in budget terms) will be placed on them
entirely. Only a couple hundred million dollars

has been distributed across the entire country to cover vaccine costs.
Previous CARES Act funding to states for COVID-related costs expires on
December 30, meaning all that leftover money will be lost.

States have said they need $8.4 billion, with potential bidding between
localities for workers and supplies driving that up higher. And of
course, that's under the current course of vaccination, which is
unacceptably low. The government should be massively increasing
production and distribution

to finish the course of treatment well ahead of schedule. But without
state funding, that's impossible.

If you want to know what a failed state looks like, this is it. The
entire world, governments and scientists and pharmaceutical companies,
moved mountains to create a vaccine in record time. The federal
government can't pony up to get it into people's arms. The result
will be that states will cut other parts of their budgets to save lives:
education and other forms of health care and public jobs will suffer.
And we'll stunt economic recovery for years, for no reason.

Days Without a Bailout Oversight Chair

262
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Today I Learned

* The Biogen conference in early 2020 spread the virus to as many as
300,000 people
.
(New York Times)

* Germany going deep into lockdown
to
stop spread. (Financial Times)

* A tick-tock on how Pfizer pulled off the vaccine

in record time. (Wall Street Journal)

* The two key CARES Act unemployment programs are already going to lapse
;
it's just a question of whether it'll be temporary or permanent.
(Politico)

* There will be plenty of need for other COVID vaccines

to serve the entire world, I don't buy that there's room for only a
few. (Bloomberg)

* Deaths jumped in college towns
.
The fact that young "invincibles" got the virus doesn't matter;
they spread it to others who can't handle it. (New York Times)

* "Gargling Could Slow COVID-19 Spread, Mouthwash Makers Say":
sounds like an Onion headline but it's real
.
(Wall Street Journal)

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