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.
Even if we grant Minnesota is not Alaska, there is a huge difference between the states that cannot be ‘splained away. Everyone in Alaska who fits into one of the three qualifying groups knows exactly when they will be vaccinated. Contrast that with Minnesota where doctors don’t know what to tell their patients.
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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