Thread
🧵Reading this has unearthed a lot of memories I haven't thought about in a while. Here's some commentary on this article on this from my time as a COVID data officer at a California health system:
What's a "COVID data officer"? My formal job title was just "Report Developer", and strictly speaking my job was just to make charts about data. But the meaning of any COVID stuff was constantly changing and relied on the processes of a dozen teams working together.
So I made it my job to sit in all the meanings and know *everything* that was happening, and then follow the news religiously. (Several times we learned about an initiative from Newsom because I saw an article and shared it with the team. There was no privileged info source.)
This clearly provided lots of value so I was given mostly free reign to do what I wanted. I ended up defacto influencing lots of our health system's policy in the form of "oh did you know that X is doing Y?". That's what I mean by "COVID data officer" - rhymes with meaning-worker
The first thing I want to note about Patrick's article is that this point is sort of misguided. In those early days, the official rules for shipping and storage were MUCH more restrictive than they are now. We didn't start at 10wks in the freezer being allowed. 
Those early days were plagued constantly by the fact that we tested under really specific constraints to achieve the warp speed, but then were only comfortable acting in those guidelines. The dosing schedules especially were HUGELY affected by this
So much effort went into the idea of "fully vaccinated" and having different timings for Pfizer and Moderna doses. But those were just artifacts of the initial clinical tests; both vaccines had their second doses WAY too soon anyhow, b/c that made the trials faster
Re: jockeying for who is in what group: we hated it too. It was always understood that we couldn't *really* ask if you were e.g part of a vulnerable pop or not. We just needed a smartsheet with that attestation because, per Patrick's point, people were scared of being sued
Here's something infuriating: our bottleneck was 100% front desk time. We were constantly optimizing it down as much as we could. But we had the constraints of asking for insurance (even tho govt was backstopping) and getting attestations for group (even tho we didn't want to)
re: Pharmacists being ground truth - this extends all the way to morning calls with a nurse saying "we'll do these 5 shots and then I'll drive the other opened doses in my car to this clinic". CANNOT be automated; VaccinateCA's solution is the ONLY one. Can't be stressed enough
MyTurn was totally infuriating. We had our own website already cause we needed it. There was a lot of dick-waving about MyTurn needing to be the ONLY way to get a vax, and governor saying one thing and some big players saying another and no one knew what we really had to do
"The vaccination effort as a grocery store" - all computers everywhere should not let you type the word "equity" until you've signed a document certifying you've read and understood that concept. The single most important idea; lack of understanding it killed people
Everyone on the important teams understood this idea. We had a lot of low-grade contempt for the gatekeeping, we understood it was counter-productive, we wanted shots in arms. But every time I tried to push to act more like it, people responded with regulatory fears
This ties in to his point about the collaborator wanting a "veto proof" solution. Look, this is a feature and not a bug in many aspects of healthcare. If you fuck up once in an important enough way, the Joint Commisison will Show Up, and they will Find Out. This is good!
A healthy person getting a COVID vaccine instead of a sick person is not the same thing as someone dying because they fell out of bed. We all understand this. But to be maximally charitable, it's kind of good hospitals don't have a "this risk is worth it" button they can push
But of course, what this means is that the president should have put out an order that rhymes with "Getting shots in arms is more important than EXACTLY meeting the criteria, close enough is good enough, if someone says otherwise point to this order" and we got the opposite.
Re: Safeway's logistics being good. Maybe, but I was only exposed to their reporting, and Safeway's reporting was *terrible*. Can' t really blame em, they're not a health system, but have to get that off my chest because seeing unqualified praise of them made my eyelids twitch
A note about tier 1A. Healthcare workers got the first doses. Healthcare worker means working at a hospital, which included us remote IT people. Some of my friends got mad at this - we aren't seeing patients, so why the hell are we 1A?
I would usually say "well, we might be called in suddenly to troubleshoot a situation involving patients" but the truth is more about the grocery-store dynamics. Getting everyone in the hospital a shot without gatekeeping is EASY. No appointments, no attestations.
So when we were making the workflows for the public, we all had a vision of how easy it COULD BE, because we had all just experienced it getting our shots via the procedure "they're doing shots in the basement. Show up this week." That's why we all understood the queueing theory
Echoing his point on the "tech debt" of existing hospitals, the fact that we had legal ways where we HAD to report on vaccinations already, but at scales way below what pandemic needed, was a problem. Immunity registries were bad because before they hadn't needed to be good
Deduping was the alpha problem, yes. This was actually worse for test results than vaccines. The single most important thing I did for the pandemic was stop the county from double-counting some negative results in a way that would have depressed positivity rates
I'm talking about COUNTY-wide positivity rates that would have been wrong, except that one dude at one health system made it his job to ask questions. If you ever wonder why techy-healthy people have Atlas complexes about early pandemic, we were literally holding up the world🥴
Final point about vaccine hestiancy: the mixed messaging was so obviously lethal. We all knew we weren't asking and just wanted anything at all in the CYA box, but constantly compromised anyway imagining someone or other coming for us.
The single most important thing the government could have done was just stress the correct priorities in a way we could point to and override whatever bureaucrat. Healthcare can never "move fast and break things" without those assurances, nor should it be able to
In conclusion, I join Patrick in having an abysmal view of public health as an institution after all this, but I worked with tons of talented and visionary people who just never felt they had the agency to do the right thing and spend 1000s of hours checking boxes instead.
Shoutout to Kyle Berry, the life-saving nurse who did the operational side of my data-side full integration. And shout out to @benskuhn for getting me a job at Wave so I could exit healthcare and start to recover from having to deal with all this.
That's it from me, happy to answer questions. If you liked this, why not try my essay that explains why finding meaning in the modern world is so difficult: desystemize.substack.com/p/representation-and-uncertainty
