Vaccine Logistics
This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of January
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners. We focused this week on the vaccine rollout and the challenges to the production, distribution, and logistics of getting vaccines in people’s arms. We review the roll out today in the US, the problem with a vaccine that were promised to states falling short in supply leaving people with appointments that have to be canceled, and examples of vaccine delivery success that applied a combination of simplicity and pragmatism that used a simple age-based strategy that made sure there was no waste or delay and was fully transparent. Ultimately simplicity is at the core of success.
We review the variants (B117 aka UK variant and the B1351 aka the South African variant) and what the latest science tells us about their impact on our mitigation of the pandemic and discuss COVID19 vaccine scams that have been duping some into paying a fee for ‘early access’ to vaccines. As Craig points out:
Too good to be true then it probably is. It should be free
Listen in to hear the latest news on masks and if an N95 mask or double masking should be in your future
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today, as I am each and every month, I’m joined by Dr. Craig Joseph. He is the Chief Medical Officer of Nordic consulting partners. And we will be reviewing this past month and news you can use Craig, thanks for joining me today.
Craig Joseph
It’s a pleasure as always.
Nick van Terheyden
So I’m pretty busy week, busy month. In fact, a pretty significant month, all of the things that we thought were going to happen happened, including some we probably didn’t think we’re going to happen, certainly, in my domain in Washington, DC. I think there were some surprises there. But we’ve managed to come through to the other side. And we’re obviously trying to roll out these vaccines, but there seems to be a few problems with the vaccine rollout. What have you heard? And what do you think’s going on?
Craig Joseph
Well, apparently, we need more. So that’s the first thing and actually Before that, we need to know how many we have and where they are, and it needs to be transparent. So I think the main thing that we’re seeing is that states of being told, they’re going to get x number of vaccines on on certain weeks or certain days. And then that turns out not to be true. And they’ve relied on that information in order to schedule and to tell, tell, you know, all of their folks who are giving vaccines, hospitals and private groups, what to expect. And when they do that, and you don’t give them what you said you were going to give them. That’s a problem. And so that
Nick van Terheyden
gives you the installations that people are talking about, which of course, is frustrating. But I would say the corollary of that is it would be way worse. And I’ve certainly seen this where they’ve got more vaccines than they’ve got people to actually give them to, and they end up either being stored, or worse actually wasted, because some of these have a very short shelf life, certainly in the case of the super cold version.
Craig Joseph
Sure, absolutely. And but that doesn’t seem to be the main problem. Right? The it certainly we we were worried about it, that they weren’t going to be enough people or organization, that it’s not great. That’s for sure. But that doesn’t seem to be the biggest issue. You know, the biggest issue is having to cancel and after you’ve already set expectations, and that certainly doesn’t raise folks. Excitement, or make them feel that you’re competent at what you’re doing. Right. And
Nick van Terheyden
so all confidence in the services that are being delivered. But as I saw that the US had ordered 200 million more doses. So problem solved, right? Problem solved,
Craig Joseph
nothing could go wrong. And I don’t know why. And where would you even question that. Because if you put an order in Dr. Nick, surely, the product will come
Nick van Terheyden
as it did with toilet paper in the early part of the pandemic crisis, you could order all the time you wanted. But it wasn’t
Craig Joseph
showing up anytime soon. I had ordered some very expensive PRL early on in March. And that also never came. And so your point being that you can order and manufacturers can promise, but sometimes reality hits you in the face and you have factory problems or you have transport problems, or there are other issues that that arise, you know, you need the the ingredients before you can produce the and product. And so there’s lots of places where things can fall. It’s good that they ordered more. And that that’s a great sign. And I think it’s good that more vaccines will hopefully be on their way to approval and administration.
Nick van Terheyden
So we are joking a little bit. But I mean, in fairness, I think you know, what this highlights is it’s a huge logistical challenge, not just producing them, but also distributing cold chain or so a whole piece about transporting these super cold vaccines and what that means from a pilot standpoint and the problems with, you know, escaping gases when you have these super cold storage system. So there’s all sorts of safety concerns. You know, getting it out and then matching people to the doses that are available and trying to match that as, as accurately as possible. A couple of things that I’ve heard that I think currently the case we’re looking to sort of ramp up I think to get to the point of a million and a half doses as an output and I think even more than that, and the other thing, I think The I thought was really interesting is the Israeli experience. I don’t know if you’ve seen this, but they took an entirely pragmatic approach to this and said, we’re just going after this. And we’re going to be open and transparent. But we’re not, you know, absolutely aggressive. This is the list that went by age, mostly. But importantly, they were flexing that when they went to a site, they just said, we’re just going to get everybody in the site. And there was even the interesting story of grabbing the pizza delivery guy when they had a spare dose at the end of the day. And nobody was waiting, they’ve even encouraged people to wait just in case. And they went out found somebody who was delivering pizza and put him in, and they give them their second dose appointment there. And then in an app, and it’s all scheduled, it’s all preset, that feels to me like a more pragmatic approach that has gotten them to, you know, some impressive results and some levels of herd immunity, we ought to be able to do that here.
Craig Joseph
Well, your point is keep it simple. Right. And to some extent, that might not be the most equitable way or the the most. I don’t know, research or academic based way, however, your your points well taken, and that it, it gets the job done. And, and I think, certainly, we can be here in the in the US can be, you know, thought of as being, you know, guilty of saying, well, it’s got to be perfect, and it’s got to be, you know, here we have rules. And if one person violates those rules, then it’s a big deal. And we need to come down with a hammer. And you’re that, you know, pizza delivery thing is, I think a great, great point, you know, sometimes people don’t show and sometimes, as you’ve already mentioned, once these vaccines are, are thought they must be used within a certain amount of time, or they’re wasted. And so certainly it would be wrong if someone purposefully, you know, station, their family outside and didn’t schedule the right number of people, but no one’s alleging that, right? It’s just that, hey, someone didn’t show up, or the right number of people didn’t show up. And we have this and it’s gonna be wasted in an hour. And we’re closed. And so yeah, if there’s a pizza person, they should get it.
Nick van Terheyden
It comes with transparency, I think if you make all of that transparent, so that people can see, and there’s no mal intent. You know, and the other thing I would say about equitable distribution, even though my neighbor gets it before me, that’s a good thing. Because that means he’s less likely to get it and then spread it. So the more people that are getting it, the better around, we don’t all have to get it at the same time to derive value is my sort of attitude to that.
Craig Joseph
I am 100% 100% agree. And I think that what you’re maybe seeing with the Israelis is speed matters. So maybe, sometimes down and dirty, gets the job done. And instead of trying to, you know, micromanage and say, Well, these, this group of people can get it and just hang out, if you’re over 65, just come on, that’s all we need. Well, over 60
Nick van Terheyden
is a pretty easy data point to validate, because everybody has an ID, it has your date of birth on it, you know, with the exception of my mother in law, who protects her age, with, you know, huge security implementations. Almost everybody I know we can determine their age
Craig Joseph
pretty easily. And I have talked with your mother in law, she is 25. And I’ve seen that
Nick van Terheyden
be very grateful to hear that
Craig Joseph
I have seen the proof and I am a licensed physician and I have now decided that she is 25. So she let her know that.
Nick van Terheyden
So pragmatic, simple, get her done kind of approach, I think is really what we need plus, obviously, you know, increasing the supply. There’s some other things that have shown up that I think are concerning people. The variance, we’re talking about lots of different variants at this point. I think they’re mis mis named or inappropriately named we deliberately named SARS COVID to COVID-19 and not named after the place that it was first identified because we’ve seen that with Marburg Ebola, you know, you, you essentially stigmatize a location. Now here we always stigmatizing A variant by saying the UK Oh my god, it’s the UK. But
Craig Joseph
put that to one side because I can’t because I’ve always thought that bad things come from the UK and I I can’t put that aside. Dr. Nick, I feel like that’s accurate and fair. Everything else you said is right. But we should blame the UK for this very bad Your right might not have actually originated in the UK. It’s, you know, here, it’s really your fault, as I understand that, and by you, I mean, the country that you were born into the UK apparently is doing a much, much, much better job of looking for variants, and, and recording them and really trying to understand them. And if they have any clinical significance, much better, like significantly better than everyone else, including the US. And so that’s why I guess when you do look for something, your chances of finding it are much higher.
Nick van Terheyden
Right, I think you bring up an important point about these variants, the idea that, so the UK, and then the other one that’s causing some consternation is the one that’s termed South African variant. It’s, they are likely to be present in the pool of infections that we’ve seen, we’ve certainly seen that based on the tracing back, going back to the origins of this disease, it was present far before, we actually thought detecting it because we weren’t looking for it. We didn’t have tests for it. And we in the US do not have a good genomic surveillance program for COVID-19, or at least not that I’m aware of. There are certain spots where they do have it, but not many, right?
Craig Joseph
Yeah, and I would agree with you if I knew what genomic surveillance was, although I think I do know what it is, but maybe you want to explain it. Why I think it’s very interesting, you know, to kind of understand why we want to look at all of these variants or mutations or whatever you want to call them. So why don’t I kind of bow to you and allow you to explain that?
Nick van Terheyden
Well, so viruses mutate, they, they don’t have a spell checker built in? Well, that some of them do. But the spell checker doesn’t work perfectly. And in fact, in the case of Coronavirus, their mutations or their typing capabilities are very similar to mine. I’m a terrible typist, I’m not a touch typist, I have a tendency to look at my fingers and make all sorts of mistakes. Thankfully, there are correction mechanisms to get me correct. In the case of Coronavirus, very likely those more mistakes for a variety of reasons. And those mistakes mostly just sort of disappear into all the variations that occur that don’t matter, because nothing really happens to them. Or in fact, they cause such a problem for the virus that that strand or thread dies out. But in the case of these variants that we’ve seen, they’ve changed some specific elements within the virus that allows it to bind quicker. So it seems we certainly believe that it’s more effective in the case of the UK variant. And in the case of the South African variant, it’s actually more virulent, to the extent that it causes or reduces the effectiveness of the vaccine induced response by about a factor of six, which, you know, sounds like a lot. But relatively speaking, the vaccines that we have the messenger RNA vaccines that have been produced, produce a very high level of response. So we’ve still got space to allow for that drop. And this is part of the natural innovation of viruses. They’re constantly changing, partly to survive. Partly it’s the nature of the mechanisms that they’re made up of. And we keep seeing them, some die, some reappear, these ones are showing up. There are obviously things to watch. But my view, not a major concern at this point. It’s just something we’ve got to focus on and keep doing all of the things that we’re doing.
Craig Joseph
I agree 100%. And really is evolution right that these random changes happen, as you say, and the vast majority of time, they’re either inconsequential or are bad in terms of the virus, and every now and then something happens that makes it a little bit better at infecting us and reproducing. And those are the things like you say we’re so far worse we’re skating by but the longer this goes on, the more mutations will occur. Right. And, you know, I read I think yesterday that the magenta vaccine, the magenta, that magenta is looking to tweak some of the components of their vaccine adjusting case. So not to say that they need to do that immediately. But starting the work to say while we’re assuming that this one variance does become the variance, the most common way of the most common, you know, view of the virus that we see will be ready with as we produce more vaccine.
Nick van Terheyden
So for those of you just listening, I’m Dr. Nick the incrementalist and today I’m talking to Dr. Craig Joseph. You The Chief Medical Officer at Northern consulting partners, we were just talking about the variants. And as Greg rightly said, you know, there was some tweaking going on of the RNA based vaccinations. And that’s one of the positives out of that is that that’s possible, it’s not possible with some of the other vaccine platforms to be able to go, oh, we’re just gonna tweak this. It’s just the nature of the way. If you look back in time to when that vaccine was first developed, from the point of the genome being published to them having a test subject vaccine was one week, that’s an incredible piece of science right there. And we can modify that neighbor attacking about the several specific targets within the virus that are targeted for production of antibodies that are stimulated by the vaccine. And these variants produced slightly different than the the totality of the response, the neutralizing antibody response is still sufficient. So it is in the abundance of caution, that they’re thinking about changing it, we may have to be doing that in the future. But I think we’re in good shape. Moving on. One of the things that’s happening with this vaccine rollout, obviously, people are desperate. There’s a lot of scams going on. Unfortunately, people offering vaccination and saying, hey, for a small fee, we’ve seen some questionable vaccination systems, I think people have gotten caught out in the rush. And mostly people do good. But there are obviously some bad actors out there. The thing that really strikes me about this is that it’s just right for problems of abuse of you know, people that are most vulnerable, those that need the vaccine, that’s the elderly, they tend to be more subject of scams and security failures. Any thoughts on how we can try and prevent that? What would you be advising people to do to prevent them from getting caught out?
Craig Joseph
Yeah, well, I think the general rule if it seems too good to be true, and I hate it, it most likely is. So if someone is advertising that you can beat the lines, no reason to stand in line or wait your turn, for $100, I can get you what you need. likely not the case. In fact, money shouldn’t should really not exchange hands. For anyone that has insurance, it should be free. And my understanding is that some healthcare organizations are charging an administration fee. But again, if you have insurance that that goes to the insurance company, and they’re required to cover that, so the vast, vast majority of us should not be paying any money, not one cent. And so yeah, if it sounds too good, if it allows you to jump the line or other features, that sounds like that’s really something I wish everyone did, it’s probably not real. And it is unfortunate, as you say, elderly tend to be more trusting. And if someone looks like a doctor or acts like a doctor, then they might follow that advice. But I think that you know, your best bet is to look to the to the your local government, your local health department about where you should be going and what you should be doing.
Nick van Terheyden
So I’m going to push back a little on that where you say that it should be free. And I I agree that that’s, for the most part, the principle, but I’m gonna cite a personal story of testing, which is supposed to be free. But in the case of a test administered through one of these pop up clinics, showed up as a $385 fee for a COVID-19 text. And, as best as I can tell, nothing was done, you know, incorrectly, that just seems to be either bad actors or something that I’m missing in all this, because I should be free. I mean, if you’re going to get the population vaccinated and tested, you need to make this widely available. You can’t tie it to people’s ability to pay for it because they won’t
Craig Joseph
know I agree and for the people that are listening and cursing both of us now, I think we acknowledge is not free. It’s it’s a no charge. So the person on the receiving end, someone’s paying for it, and it’s the government, which is all of us with our taxes. And so certainly we acknowledge that it costs money, it’s just right. If people are going to be charged lots of money to get vaccinated or to get tested, then most likely many of us are not are going to choose not to do that. So totally agree. One of the scams I’d heard of was with respect to testing, that was vaccination was physician who thought it would be a great idea, you know, for testing for COVID. Maybe we do in a respiratory screen. And so testing for seven or eight other, you know, respiratory viruses, hey, you have a cough in a cold, maybe that’s COVID. Maybe that’s influenza, maybe that’s Rhino virus. And so, you know, doing the, you know, charging your insurance company for that, well, that’s gonna cost money. And that is I don’t think ethical, and that’s certainly a scam. And in my book, and so, yeah, those those folks are out there, and they’re looking for money.
Nick van Terheyden
And if you find them report them, absolutely. All right, so we got a few minutes left. There’s been talk about masking, maybe updated masks. What are your thoughts?
Craig Joseph
Well, that, you know, Dr. Fauci was asked this a couple days ago about, should I be wearing two masks now? And his answer was, it probably won’t hurt. And I think that’s, that’s right, it probably won’t hurt. And again, the idea being, hey, if everyone could have a well fitted, and 95, professional health care mask, and wear it whenever they were around anyone else, that would be awesome. So let’s first say that that would be great. Now we know that, a, you can’t just go out and buy those. And we do need to reserve those for people who are healthcare workers, and to the best that we can, and then be, again, those need to be well fitted for those to actually work to 95%, where they reduced 95% of the particles going through. And so that’s also not very straightforward. The idea with the cloth masks are with masks that are not, you know, professional grade, is that they block some of the virus and I think, you know, that’s a common misperception about how things how these are supposed to work. I know when I first heard about wearing a mask, a cough mask that you could buy from Etsy as like, that’s, what’s that gonna do, that’s not going to keep out everything. And so, and the idea was, at least in my mind, hey, if you if one virus particle gets through, that’s that’s it, game over? What’s the difference between one and a million? And the answer with this particular virus is a lot, there’s a lot different. And so one theory, although not proven, is that the severity of the illness may be related to the number of particles of vaccine, the number of virus particles that you’re getting exposed to or getting into your lungs, and how far down your respiratory system they go. And so anything you can do to decrease that number helps protect you. And so the idea is, well, if you have one, cloth mask, and it at best, it sounds like can can stop maybe 50%, adding another cloth mask, that takes you to 75% reduction. And that’s pretty good. If it’s well fitting, and you have to now, I saw a physician, I don’t recall his name, who said, that’s all well and good. If you’re going to put two masks on, and you’re going to be uncomfortable, and they’re not going to fit right and you’re going to fidget with them, then it’s not helpful. And you should only wear one, you need one that the best one that you can get if you’re not going to be comfortable in it. And I think that’s the you know, it really comes down to common sense. If I’m in a if I’m forced to be in a small enclosed place with other people. That’s really my nightmare right now. But if I were forced to do that, for whatever reason, I think that makes sense to do everything you can for that short amount of time if if it is short to two Yeah, I’ve considered putting on two cloth masks. I think that that makes complete sense to me wearing it all the time. I don’t know, I’m not sure the benefits there.
Nick van Terheyden
So I actually think it’s not to cloth masks, I think the ideal or the optimum of the tumor strategy is cloth mask with a surgical style mask on the outside that approach is the sort of N 95. But I think your principles are entirely correct. You know, what’s practical, and applying it when it makes sense. You know, I have an N 95 for when I was, you know, actually allowed to do testing before they said you had to have a medical license to be able to do the testing in our state. And I reuse that when I feel there’s an appropriate purpose for that. So you know, I think the same instance but you’re exactly right, if if you can’t wear one mask, you’re not definitely not gonna wear and then 95 because if you’ve ever put one of those on properly, and had it sit down The you know, including this note that, you know, that’s bloody uncomfortable.
Craig Joseph
Right. I you know, and I think that’s, that’s one of the main things people don’t understand about a fit test in the hospital, pre pandemic, when people had to deal with a patient who had, you know, TB or something like that. Yeah, you had to go and have these tests to make sure that you couldn’t get exposed. And yeah, it was super uncomfortable. Yeah.
Nick van Terheyden
Unfortunately, as usual, we’ve run out of time, so just remains for me to thank you for joining me today. Greg. It’s always a pleasure. Until next next month, thanks for joining me.
Craig Joseph
Thank you.
