Some people may remember that in the old Lucille Ball TV series whenever Lucy got into trouble, her husband, Ricky, would inevitably quip, “Lucy, you got some ‘splaining to do.” Despite the fact that Ricky never actually said it, “’splaining” has become a synonym for a questionable explanation. Given the comedy of errors that has accompanied Minnesota’s allocation of the COVID-19 vaccine, ‘splaining perfectly characterizes the response of Gov. Tim Walz and the Health Department.
As someone in the highest risk group for COVID-19, I find the state’s response has been inadequate, misguided, and dangerously secretive. The new state website about vaccine distribution does not tell us which specific facilities have received vaccine and whom they vaccinated. Without these data, judging allocation fairness is impossible, which appears to be what the Walz administration wants. No one knows how many doses were administered in the Twin Cities versus Greater Minnesota or whether more doses went to HMOs than other providers.
When I contacted one of my physicians who is a clinic administrator with a large HMO, he said he had been told nothing about vaccine distribution. Ditto for my Mayo physicians. If those of us with computers and some knowledge of the system do not know what is going on, imagine what will happen to those without resources or connections. That is a recipe for a major disaster. Clearly, there is no plan in place for distribution — at least not one known to physicians and their patients. That will inevitably result in what has taken place in Florida: a huge, out-of-control mass all pushing to the front of the line.
Contrast this with Alaska. Friends in Alaska who are in the highest-risk group signed up to receive the vaccine in early December, when Minnesota officials were still haggling over what to do. They received their first dose the week before Christmas. My friends told me their local clinic expects to have all high-risk people vaccinated by the end of the month. All this on an island whose only supplies must be delivered by boat or plane.
A glance at Alaska’s COVID website explains why my Alaska friends received the vaccine while Minnesotans know nothing. Unlike Minnesota’s byzantine series of bureaucratic categories and its fixation on so-called essential workers, Alaska’s guidelines are straightforward. Vaccine in Alaska is going only to people over 65, health care workers, and long-term care residents. That is it, period.
In Alaska, the “essential workers” Minnesota has been agonizing over will not receive the vaccine until all in the first group have been vaccinated — and even then they are prioritized by age and risk. Right now, if you live in Alaska you can schedule vaccinations through the state we site or one of many local sites that are listed with phone number, address, and insurance information. Anchorage, the state’s largest city, lists 18 possible sites or one site per 16,000 residents!
This simple, transparent strategy has Alaska ranking fifth in terms of vaccine distribution with 5.3% vaccinated. Only 2.9% of Minnesotans have received the vaccine, ranking the state in the bottom tier. Even those numbers are misleading since Alaska’s numbers only include high-risk people while Minnesota’s include others not in these groups. One can go down the demographic rabbit hole by ‘splaining Alaska is different, but that difference includes a state whose remoteness makes it a far bigger challenge than getting vaccine to Fergus Falls and which lacks medical facilities like the Mayo Clinic.
[image_caption]Ralph Brauer[/image_caption]
So how can the state right a rapidly sinking ship? First, it needs to follow Alaska’s example and concentrate on the three highest priority groups: people over 65, health care workers, and nursing home residents. From an epidemiological perspective they are the groups with the highest risk and mortality. Forget “essential workers” until those most at risk of dying are vaccinated. Minutes from the state’s December meeting over COVID vaccine allocation show an inordinate amount of time was spent on essential workers. As several panelists asked, how do we define these occupations and then verify those employed in them? Most important, what is the mortality for various occupations versus that of the high-risk groups?
That a 30-year-old Homer Simpson might get the vaccine in Minnesota before 80-year-old Aunt Martha with several COVID co-morbidities is not merely bad epidemiology, it is also immoral. Yet power plant workers like Homer are in the “essential” category and could receive the vaccine before Aunt Martha.
That there is a not-so-subtle agism in this scheme was amply demonstrated by a Faribault prison administrator who defended vaccinating inmates with the following ‘splanation: “Mom and Dad have the ability to stay home. They get their groceries brought in; they don’t have to interact with people they don’t feel safe interacting with.” Oh, really. Having groceries brought in costs money, not easy on a fixed income. Inevitably we have to go out only to face someone not wearing a mask. And by the way, Mom and Dad committed no crime other than being 85 to earn their lockdown while the Faribault jail was sued for failing to adequately protect inmates from COVID-19.
Despite all the mess, one thing is very clear, if I and others like me die of COVID in the next two months my family and friends will know one awful truth no amount of ‘splaining can cover up: If we had lived in Alaska or assaulted someone so we ended up in the Faribault prison, we would be alive.
Ralph Brauer has written about medical ethics and other issues for the New York Times Magazine, The Nation, Newsweek and other publications. In keeping with a longstanding Stanley Cup tradition and in protest over the state’s vaccine policy he is refusing to shave or cut his hair until vaccinated and urges others in the highest risk groups to also visibly protest the state’s vaccine response.
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Well Ralph, every weekday afternoon on MPR there is an update from the Governor and or the MDH, with a period where folks can ask questions, been going on suspect since March or so, roughly that gives you over 200 times things have been splained! You will also notice that Minnpost’s Walker Orenstein, Greta Kaul, Solomon Gustavo etc. etc. have all wrote numerous pieces, splaining on Covid and Minnesota. What are you looking for a silver tray delivered personal note from the governor co-signed by the director of the MDH?
And the state’s new “find your vaccine” web site opened at noon today and is now shutdown until further notice do to excess demand…
I would side with the prison administrator. I also would prioritize essentially workers – those that have to go out an interact with people – than people who don’t like to order their groceries.
For the record, it is ageist and insulting to tell everyone over age 65 that they should just stay home. There are many of us who have to go out. I have to go out to take care of my 100 year old mother, who also can’t get a vaccine.
Well, I think its insulting to prioritize old people ahead of essential workers. If you have to take care of someone like you do, I would make an exception. But if old people who just don’t want to stay home, get put behind teachers, grocery store workers, etc., there is nothing ageist about it at all.
Do you know how many older people have to go out? They need to see their doctors because they are more likely to have conditions that need in-person treatment. They are more likely to be undergoing cancer treatment, which you can’t do at home. Doctors aren’t making house calls to provide chemotherapy at home. They are more likely to have to go to clinics where there are more sick people. And to the idea that we should just lock up all the elderly, rather than give them vaccines, that’s what happened all around the country in nursing homes. The elderly were locked in, couldn’t see their loved ones, and many ended up dying from the effects of isolation and depression. And despite the nursing home lock-ups, that’s where the highest death rates have occurred. Whether you are in a nursing home or being cared for in your home, someone has to come in and out, bringing with them the possibility of infection. Do you think the people who work in nursing homes wanted to infect the people living there? I don’t think so. Do you think the families who care for the very elderly at home want to infect their loved ones? I don’t think so. Sorry to say, but you can’t lock out the rest of the world from the elderly because it’s impossible.
I don’t suppose it has occurred to the author that there are significant demographic, economic, and geographic differences between Alaska and Minnesota that make reliance on Alaska as a paradigm unworkable.
Someone should tell this guy that facial hair seriously degrades the effectiveness of protective masks. He might want to follow the best practices he can until he gets his vaccine.
Hate to agree with what appears to be a crabby old man, but I’m about the join the ranks of Crabby Old Men. Having heard nothing specific about when, where and how, my query to my own doctor last week got essentially the same response as Mr. Brauer did with his physician – “We don’t know. No one has told us anything.” I’ve seen nothing on local media, gotten no notice from either Medicare or my supplemental health insurance company about when I might even sign up – or if signing up is necessary – and, of course, nothing has been forthcoming about where I might get vaccinated, though I’m in Group 1B, being over 75 and have multiple co-morbidities, so I’m definitely high risk in that regard. My brother-in-law in Colorado has already gotten his first shot, and is on the schedule for the booster in 3 weeks. I haven’t heard a thing…
Ray, if you lived in Hawaii you could be laying a beach right now. Crazy eh?
Same for me, Ray (although I’m thankfully free of co-morbidities).
Oh, and someone should should also point out that comparisons with Alaska are a little daft, for a variety of reasons.
For one thing, like North and South Dakota, Alaska has a fraction of Minnesota’s population, so even though Alaska has actually jabbed less than half the number of arms we have in MN (60k compared to 200k) they will reach a higher percentage of their population. Statistics is big part of epidemiology by the way. Alaska doesn’t have higher rates because they’re doing a better job, they have higher rates because they have over 4 million fewer arms to jab, it’s a math thing.
We should also note that the groups Brauer thinks we should prioritize HAVE been prioritized.
Funny thing is, if you want to vaccinate everyone in MN, you need close to 12 million doses… we got 407k delivered thus far, we’ve jabbed 200k arms with the first dose, and we’re told there is no vaccine left in reserve and right now we’re still waiting for another 200k doses we were supposed to get. I personally wouldn’t gamble on future doses being there given the fact that we’ve never yet gotten the doses we were supposed to get in the first place. Leaving 400k people partially vaccinated could completely sabotage the entire effort, specially among the most vulnerable population. I wouldn’t use up our entire supply of vaccine until we KNOW the second doses are the way in time to be injected when they need to be injected.
Meanwhile, our population of 65 and older in MN is greater than Alaska’s entire population. Combined with the essential workers and others that are prioritized as Mr. Bauer recommends, that’s close to a million people. Again, we have 407k doses so even if we jabbed twice as many arms we’d come up 600k short today. Even if we did everything exactly the way they’re doing it in Alaska, Mr. Bauer would still only have a 40% chance of getting HIS jab statistically.
We actually have a website that describes all of this, I’m not sure how mush more information Mr. Bauer wants? You can find out how much vaccine we have, how many arms have been jabbed, what our policy is, and who our stage 1 priorities are all on the MPH Vaccine dashboard. https://mn.gov/covid19/vaccine/data/index.jsp
I Don’t know if any this splains away Mr. Bauer’s complaints, but sometimes all you get is an explanation. Pandemics suck.
This commentary reveals neither understanding of epidemiology or ethics. Age alone does not determine place in line for the very limited number of vials of vaccine. Think about unavoidable exposure and effectiveness in limiting the spread. Do your homework.
You know, I think one of the most tedious features of this last year (and the last 4 years) has been the more or less constant drone of entitlement and privilege.
We’re in the middle of a pandemic that has killed millions around the world, more than 400k in the US, and almost 6k people here in MN, and here we have people demanding to know where THEIR vaccine is? As if there’s a vaccine dose with their name on it somewhere in the world.
Look, here in MN we have around 800k people in that 1b group, and we’ve got 200k full doses of vaccine… what’s confusing about THAT fact? We’ve jabbed nearly as many arms as we could’ve jabbed, and we’ve jabbed 2 1/2 times as many arms as they have in Colorado or Alaska. But you want to know where YOUR vaccine is? You don’t have to go all the way to Alaska or Colorado find people who’ve already gotten their vaccine… go to MPLS or St. Paul, 200k people in this State got their jab already… what’s your point?
You want to be cranky… whatever. You don’t live in Alaska or Colorado, you live in Minnesota, cowboy up and deal with it, you can’t get a jab of vaccine that doesn’t exist, we all have to wait. This isn’t magic, vaccine has to be manufactured and distributed, and Warp Speed has been a fail… do you really need us to explain this?
Thank you Mr. Brauer. Timely and cogent words that needed to be said. Despite the comments from MnPost’s World’s Foremost Authorities, the vaccine distribution system in Minnesota is opaque, failing, and immoral. Setting 600,000 over 65s to scratch and claw at a process that was not even close to being workable, much less fair, and then joking about it (“This is going to be harder than going to Ticketmaster and trying to get Bruce Springsteen tickets.”) is disgusting. Governor Walz has talked relentlessly on the subject, and said virtually nothing.
I agree entirely with Michale Barnes. Setting up sites so that senior citizens have to compete with each other for a few vaccine spots is insane. Minnesota’s vaccine process is failing and immoral. I wrote a letter directly to Walz, expressing my disgust, and got back a canned response that in no way addressed the concerns I raised. I have a 100-year-old mother who has a heart valve and pacemaker. We are caring for her at home, but, yes, we do have to go in and out of the home to buy groceries, run errands. But because mom isn’t in a nursing home, we can’t get a vaccine for her, and no one can tell me when we can get a vaccine for her. Minnesota is far too obsessed with essential workers. Minnesota is not making decisions based on health outcomes but on favored groups. It is insulting and ageist to state that everyone over 65 should just stay home.
“so that senior citizens have to compete with each other” Really, perhaps you can explain where all those extra doses are suppose to com from, magically appear? Sorry you have a 100 yr old mother that needs tending to, or perhaps you should be happy that she hasn’t got covid yet? Do you think perhaps you should sacrifice your place in line for her? As one of those > 70 crowd, I have no problem waiting my turn, and letting those that the CDC deems most in need or most vulnerable to get theirs first. Isn’t that what being an American is all about, looking out for those with more need than you? It would be one hell of a spread sheet with 5.64M people on it getting a perfect line of who is first and who is # 5640,000! And how do you think they should do that, when folks are going me first? Yes, and we need to go out for groceries, prescriptions and life tonic. You are also aware the departed administration blew up all the state plans on distribution with BS information, what’s new, should be use to that after 4 years. But this is America you got the right to complain even if you are #2 and not # 1.
Well said, sir.
It seems to be that’s exactly what I am doing–looking out for those more at need than I am. For the record, I am in the 70+ crowd myself, and I have said nothing about the fact that I can’t get a vaccine either. I am wondering how a 100 year old would be cutting in line for a shot for a disease that is most deadly to those her age? Shouldn’t the people most likely to become seriously ill and die be prioritized for shots? This is what the writer of the article is talking about–becoming seriously ill and dying! You seem to be totally unaware of all the people in the state who are getting shots through the auspices of the state who are much younger and are not necessarily “on the front line”. In the meantime, I am hearing from friends and relatives around the country my age or younger who have already received their first vaccines. My mother would need to be in a nursing home without the care we provide for her. Clearly, based on your comments you have no appreciation for those of us who care for the elderly. She is just as vulnerable as a person the same age in the nursing home. So in a sane world, the very elderly who are cared for at home who would need nursing home care should be treated the same as those in the nursing home. There is no difference in their needs! Why would you penalize families for caring for their elderly at home? We have to go in and out, as much as nursing home workers. Just today I saw a post from someone I know who is younger than I am. The state of Minnesota provided her first dose of Moderna because she is a “provider” for students. But she isn’t doing any in-person work with students right now. She is working with students virtually from home–zero risk. But yet she gets a vaccine. This is the insane system operating in Minnesota. A 60-something virtual provider of services gets a shot before the very elderly (over age 85) who are being cared for at home. For the record, I supported the first doses going to front-line health care workers and people in nursing homes, but those who need nursing home level care at home should not be discriminated against. And that’s what the great state of Minnesota is doing.
And what do we think the CDC guidelines are all about? Setting the priorities. If not them then who? Kind of the crux of the discussion don’t you think?
Spot on, Dennis.
I also agree with Mr. Barnes. The state’s “dashboard” is useless. Information there is blurred or buried, so there’s no way to find out when those of us who are most likely to DIE of this virus can get vaccinated.
Or where. it’s fantastic to know that if you live in St. Paul or Minneapolis and are not in a nursing home, there is no way you can get vaccinated in your city! All 12,000 of the ostensibly “available” vaccinations for for outstate or suburban folks.
I’m a Democrat, but can’t help concluding that this vaccine project is being very, very badly mishandled by our MN Department of Health.
At least I notice that they’re finally starting to vaccinate EVEN ON WEEKENDS! Way to go, Minnesota!
If vaccine supply is not the rate limiting factor, then state management is at fault.
The state had months to develop a plan , and test it.
Unfortunately Alaska is getting a lot of good press it does not deserve! Vaccine distribution in Fairbanks and Anchorage is much as you describe it in Minnesota. A large percentage of Alaska’s population is either military or Alaska Native and those groups got separate shipments and administration of the vaccine–yet count in the total. Your friends who live on an island probably fell into one of the bush communities that were given priority–even teenagers are getting the vaccine there! If you are a senior citizen living in Fairbanks or Anchorage the vaccine goes into the black hole of a few pharmacies and small clinics where it’s impossible to navigate the individual websites each provider uses, let alone get an appointment. Rumors abound about vaccine being used quickly before it spoils regardless of priority status. In Fairbanks, there was one large scale administration (about 1200 shots) organized for an arena, but the appointments for those were gone in an hour.