Der Untergang

not so much "downfall" as "under-going..."

A friend’s mother is an long-term care hospital. I have visited her on a few occasions to answer questions for her. Recently I offered to go explain the vaccine news to her. My friend waved me off telling me she had “already shared the ‘good news’ about the vaccines.” My heart sank, but I let her believe good news is all there is.

So what’s the bad news?

Our society is not prepared for the most effective distribution of this vaccine. There are a huge number of conflicting interests, many unseen, and the thin tatters that still tie the US together as a people are going to be shredded when push literally comes to shove as a limited amount of very expensive resources are rationed and ultimately deployed.

Right now there is a cautious optimism in the US because very soon mentally-stable adults will be back in control of most of our government. This optimism steps around the known fact that they will be assuming control of a government that is hollowed-out, demoralized by rampant curruption, and empty of the people who made it work a few short years ago. Even absent a pandemic, it would likely take years to just get the figurative trains back to running on time.

Pharmaceutical companies are desparate to get a piece of the massive amount of funds that have been flooded into the equity markets by the Federal Reserve, so they release press statements that pretend there’s an important difference between 90% and 94% effectiveness.

Pfizer and Moderna are out front on this because they know hard times are ahead for their products. Once a single-dose vaccine from Johnson and Johnson (aka J&J) or a inexpensive double-dose vaccine from AstraZeneca become available, the Moderna and Pfizer products will be rapidly relegated to special-use, slashing their revenue and profitability. Time is short for the corporate managers at Pfizer, so they will pour utterly heroic levels of corporate resources into early deployment of their products.

This will be made to look like they’ve utterly given themselves over to public service in the near term, and it wouldn’t be too much to expect some corporate cheerleading ala Nike vs. Adidas with hats, koozies, and t-shirts emblazoned with corporate vaccine logos. But watch what they do, not what they say.

Once the AstraZeneca or J&J vaccines are approved that alturism from Pfizer and Moderna will vanish. After the J&J and AstraZeneca vaccines are avaialable if you still want the mRNA vaccine you’ll have to come to a major urban center, make a reservation online (or buy one at auction off of Ebay), and bring your plastic. Your health insurance ain’t gonna cover the mRNA vaccine when a cheaper one is as safe and effective.

There isn’t widespread deployment of the freezers that would be needed to actually distribute mRNA vaccines equitably. Existing freezers are being adapted, perhaps a few added to places that already had them, but there’s not any real effort build an infrastructure for long-term distribution. This is the difference between someone bringing over some BBQ and installing a BBQ.

Nope, these companies have a financial moon-shot to make, and a limited time window in which to make it, they know full well they will be licking their wounds after that no matter how successful they are in early 2021. That’s good news, but not unreservedly good news.

The next problem is that there’s no distribution plans at all after “group 1a” (get used to that new term) gets a few jabs. Group 1a is “front-line health-care workers” and nursing home residents. Health-care workers can immunize themselves and they also are likely to pass within range of a facitlity with a deep freeze already installed. There isn’t enough doses on planet earth currently for all of them. The vaccines will have to be rationed.

So, what’s “front-line?” The virus doesn’t care if you work with a scalpel or a mop. Don’t tell me that ICU intensivists (ICU Doctors, Lords All Mighty of the ICU) are not going to be placed in line in front of ICU porters and cleaning people.

If you have twelve doses to give to twenty people, your part-time nurses aide isn’t going to be at the head of the line, yet that person probably spends more time outside of the hospital in more exposure scenarios. From a public health perspective, they should get it long before the intensivists. The intensivists in-and-out of rooms and they go home in private cars to nicely-quarantined lives with people who follow the rules. That nurses’ aide rides a public bus to a house with three generations living in eight rooms, one not speaking English. That nurses aide primarily works *in* the patients’ rooms, right alongside reserviors of covid-19. Who should be at the head of the “front-line heroes” line again?

Nursing home residents will be easier to prioritize. Walgreens and CVS Pharmacists are being mobilized to go innoculate them because we only have the Pfizer and Moderna products at hand. They need access to deep freezers. Not all pharmacies have them, of course, but they are connected to somewhere that will.

Nursing homes are left to fend for themselves with residents who refuse to be vaccinated. Thought has not yet been given to what to do with nursing home residents who refuse. They present a danger to their visitors and staff. That is one sticky wicket.

So, you know what the news is likely to be in mid-February when another wave of death and despair have swept across the land even after vaccines have been going into people’s arms for months? Nursing homes are still super-spreading and rich doctors are taking advantage of vacation deals because they’ve been vaccinated and can go on with their lives. And woe to the Big Pharma executives who will be discovered to have gotten vaccinated themselves with or ahead of group 1a.

So, I fear that all of this hope that we’re just about “turn the corner” on this pandemic is going to collapse in a heap of despair, futher alienating the already disenfranchised, who need innoculation first to keep the rest of us safe. Getting through this is going to take trust in each other that has been demonstrably lost already.

So, this was the news I was going to take to my friend’s mom in the hospital. She’s a physician, she can appreciate all this nuance, but I won’t be giving her the benefit of my perspective because she’s “already heard the good news about the vaccine.”

I predict 2021 is going to have some of us longing for the innocence of 2020. That’s not good news. It’s better than it could have been, deploying these expenisive, rationed and hard-to distribute vaccines with the current US government would likely turn quickly to civil unrest. I think the adults who will take office on January 20th can keep the lid on and quell all but outlier violence.

But, it’s not one big happy hug in mid summer. We can’t do that in the US. We aren’t well-integrated enough as a people for shared sacrifice and compassion. It’s not there.

Wear your mask, wash your hands, keep your distance. Make your back-to-normal plans for 2022.