Hard Truths about the COVID-Vaccine Timetable

A nurse vaccinates a man as health professionals come out to a farming community to deliver vaccinations in Mecca, Calif., February 1, 2021. (Mike Blake/Rueters)

Happy Groundhog Day. Today we begin with the math that says we probably won’t finish vaccinating the most vulnerable until May, look at vaccination appointment websites that keep crashing and state health officials who apparently forgot about seniors who aren’t tech-savvy, and wonder why hospitals can remain open in bad weather but not vaccination centers.

Why Vaccinating the Vulnerable Will Last Well into Spring

Perhaps the country would be better off if some national leader stood up and said, “Right now, the best case-scenario is that all of the higher-risk Americans get at least one shot by the end of April or early May. Getting them all of their second shots will be three to four weeks later. If you can’t get an appointment right now, that’s not surprising. If you have gotten an appointment that is a month away or two months away, that’s not surprising either. And if you’re not in a higher-risk category, you probably won’t get vaccinated before Mother’s Day.”

People would not like hearing that message. That disappointing message doesn’t align well with past pledges such as “I’m not going to shut down the country, I’m going to shut down the virus,” and with a leader who insisted he had a plan, and who kept reminding us he and his team were “ready from day one.” But that is an accurate layout of the cold, hard numbers — and perhaps even an unrealistically optimistic one.

Roughly 52 million Americans are above age 65, and about 202 million are between 18 and 65. One report estimates that 45 percent of American adults have some comorbidity that puts them at higher risk of serious complications from COVID-19. That would mean about 91 million non-senior Americans should be fairly high on the priority list before healthy adults. When you add up the seniors and those who have comorbidities, that’s nearly half the country, or almost 143 million Americans.

The United States has administered 32.8 million doses so far — and remember that the vaccines being used right now require two doses. Almost 2 percent of Americans have received both doses so far, according to the Bloomberg chart; a bit above 8 percent of Americans have received one dose.

Six million Americans are vaccinated; another 24 million need their second dose. That leaves 113 million Americans who are elderly or in another higher-risk category who need to get vaccinated, and who haven’t received any shot.

Nationally, we’re administering about 1.3 million doses per day. If we maintain this pace, we will have at least one shot in those 113 million Americans in another 86 days (April 29) — and that assumes the pace is maintained on weekends and holidays. (The good news is that the pace on weekends is now only a slight dip from the weekday pace.)

The national pace could increase; we hit 1.7 million vaccinations on January 28, and 1.6 million the following two days. If we could maintain a 1.7 million-per-day pace, the 113 million higher-risk Americans would all have at least one shot by April 10.

But that figure doesn’t include getting the second shot into the 24 million who have gotten one shot. And for those who will need one of the two-shot regimens, they may get their second shot a few weeks later — which is why the vaccination of the highest-risk Americans would really be complete closer to the end of May.

One of the complications of this back-of-the-envelope math is that it assumes every elderly or higher-risk American will get vaccinated. Some won’t want it, obviously, so maybe some appointment slots will open up for the lower-risk Americans who are eager to get vaccinated. But with corporate America and the Ad Council and other groups encouraging Americans to get vaccinated, perhaps vaccine skepticism will wane in the coming weeks and months.

One of my readers in New Jersey is trying to get appointments for two elderly aunts. He describes the process of trying to get them registered in the state’s Kafkaesque system. The locations for vaccination are few and far between, the website is glitchy when it works at all, and the rare open appointments are filled before he can finish filling out the online form. A week ago, he ran the numbers for his state, and calculated that a couple million Garden State residents were competing for about 100,000 appointments per week. You can make a strong argument that most states opened up the eligibility groups too soon. The number of vaccines available, and the number of personnel to administer them, put inherent caps on how many people can get vaccinated in a day, and right now, the number of people who are now eligible for the vaccine make waits of more than a month or two months inevitable.

(Most states have improved their numbers somewhat over the past week. On the Bloomberg chart, New Jersey is now vaccinating almost 35,000 residents per a day, which gets them to 175,000 doses in a week just on weekdays, 245,000 if they can maintain the pace seven days a week. But that’s still going to be a long slow slog through the 4.47 million state residents in the eligible categories. Best-case scenario, that’s 18 weeks — mid May or so.)

With all of that said, even if there weren’t a supply bottleneck, too many states and localities are falling down on the job.

The Ghost of Healthcare.gov Haunts Us

We are six weeks into the vaccination process. State and local health departments are still having their websites for handling appointments crash — in Western Pennsylvania, in central Ohio, in southern California, in Utah . . .

I would say it is as if no one learned from the experience of Healthcare.gov, but in many ways government institutions do not and cannot learn. All too often, someone new steps into a position of leadership, disregards any institutional memory that exists, and makes a variation of the same mistake, years later. How did the people in charge of these websites not foresee that traffic would be off-the-charts in the first few weeks?

And then there’s the issue of Americans who aren’t on the web at all — a demographic that overlaps a great deal with the group most vulnerable to the virus: the elderly.

The pandemic keeps revealing that the people who design responses to massive problems such as this keep thinking of human beings as precise, obedient automatons, instead of what human beings actually are. The state of Pennsylvania seems to be a particularly egregious example:

In the Pittsburgh region and across the country, young and millennial residents describe dropping everything to help their elderly relatives sign up for the covid-19 vaccine — often available only through online forms. Many older residents in Western Pennsylvania say they don’t have computers or internet access, or aren’t tech literate enough to navigate the process.

“The accessibility for folks that are older and not tech savvy,” Byars said, “really strikes me as lacking.”

Byars said her in-laws have a computer and an iPad, but they are not well-versed in the technology. She said they haven’t even seen the confirmation email for the appointment yet, because her mother-in-law doesn’t know how to access her email.

“I guess it’s just hard for us to do that — it’s a generational thing,” said Tamara Thomas, 70, Byars’ mother-in-law, who said she has been sheltering in place for almost a year. “We can’t navigate the way they want us to.”

Thomas said she is grateful to have children who can help.

“I think they’re forgetting those of us that are older don’t have the same tools,” Thomas said.

The problem goes beyond inconvenience, advocates and family members say. The plethora of providers, each with their own registration system and login, creates a system that’s difficult to navigate for even the most tech-literate of residents. The map of vaccine providers available on the Pennsylvania Department of Health website lists many pharmacies that, upon further investigation, don’t actually have vaccine supply. Family members say they are struggling to balance their own full-time jobs and Covid concerns with calling dozens of vaccine providers, spending hours on hold and getting booted from overcrowded websites.

For older residents with little technology experience, taking on such a task is next to impossible to imagine. Bill Johnson-Walsh, Pennsylvania’s state director for AARP, said there are many residents who don’t have any kind of device access, and if they do, it’s usually just to communicate with their grandchildren or play games.

“It is statewide,” Johnson-Walsh said. “The frustration, the confusion that’s going on. We’ve been seeing several hundred calls in the last couple of weeks, just asking for help.”

In a letter to Gov. Tom Wolf, Johnson-Walsh and AARP recommended a centralized 800 number for people to call to have their questions answered, a system in which a real person can walk them through the process. Johnson-Walsh understands the state’s decentralized approach to vaccine distribution — leaving independent hospitals and other providers to administer doses on their own — but for many of the state’s most at-risk residents, the lack of accessible information puts lifesaving vaccine out of reach.

We hear a lot about “inclusivity,” and at its heart, it’s a good and compassionate notion — to think of people who aren’t like you when making a decision that affects lots of people. How does this architecture work for someone in a wheelchair or who uses a cane or walker? Does this mural designed to represent America feature a wide variety of Americans? When a corporate board is making a decision, did they hear from a wide variety of people, some of whom might have a different set of life experiences and see the issue differently?

But right now, the system for getting a vaccine appointment is not very “inclusive” for not-quite-so-tech-savvy senior citizens, which seems like a really important demographic to think about in this situation.

ADDENDUM: The public discussion about the vaccination process is heated, and justifiably so. This really is a race against time, lives really are at stake, and the decisions made now are likely to have life-and-death consequences in the coming weeks and months. We’re told, with good reason, that vaccinating the vulnerable ought to be and is the single-highest national priority right now.

But the big snowstorm across the northeast canceled vaccination in many locations. No one wants to see cars slipping and sliding off the roads on their way to the vaccination appointment, and many parts north of the mid-Atlantic states got more than a foot . . . but if there’s a way to keep those vaccination sites open in bad weather, the stakes probably justify it. Hospitals manage to stay open in bad weather.

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