The Caretaker Advantage

From the newsletter

Yesterday, about 30 minutes before I was about to join a webinar about the pandemic relief for schools, I got a frantic call from my mom. 

She couldn’t figure out how to sign-up for the vaccine. The website at the local hospital asked that my folks attach a picture of their insurance cards. When she handed the phone over to my dad, I told him to take a picture of the card with his cell phone, but he couldn’t manage to send the picture as an attachment to his email. I had to jump off the phone at that point, so my sister took over. 

As it turns out, my folks weren’t even on the right page for the vaccine sign up. Between my sister and I, we were able to get them on some lists. When I’m done with this newsletter, I’m going make sure that I did it all correctly. 

My folks are in their mid-80s, so navigating websites and uploading .jpg images is not their strong suit. (They’re not alone.) After ranting on Facebook, my friends chimed in with their own stories. One friend from New York said that she didn’t act fast enough, so her mom isn’t going to vaccinated until April, even though younger, all-remote workers were already getting vaccinated. Another friend from Jersey said that the smokers were getting vaccinated before seniors here. Most of us didn’t even have a date for our parents yet. Almost of us have had to step in to help our parents, because the sign-up system was too complicated for them. 

This pandemic has exasperated inequities. It’s now a hackneyed observation, but it’s still true. In this case, seniors with support from their children are going to get vaccinated; maybe not as quickly as they should, but it will happen. Those who don’t have that help might get COVID and die, before they can get vaccinated. Seniors with involved and caring children will live through this spring. 

When I wasn’t helping my parents with the tech problems, I had other caretaking responsibilities this week. 

I spent two hours on a Zoom call with Ian’s school district trying to negotiate for more in-person activities during his IEP meeting; he’s been dreadfully isolated since last March, and there’s no way that the school district is meeting his speech and social skills needs this spring. Right now, I’m just pleading for help, but lawyers might be needed down the line. 

Steve and I drove him to various private centers that can offer him some interaction with other human beings. This pandemic has been brutal on people with autism, so we’ve worked really hard to make up for the devastation of remote education with extra family activities and private services. 

The day before, I dragged Jonah to the library with me, where I picked up a book about the history of deaf education. On the ride, we talked through his schedule for the spring semester; his college does a poor job with student advisement, so I’ve taken over that job. We talked about the pros and cons of impeaching Trump now. Wearing my political science professor hat, I used our wide-ranging conversation to remind him about concepts like the weak American party system, the primacy of constituency demands on elections, and how the presidents need to get their most important policy issues done in the first 100 days. With remote education, he has no opportunities to have those spontaneous hallway conversations with his professors, so I filled that gap. 

My family is going to survive this pandemic. We’ll have some bumps and bruises, for sure. But the kids will finish school, and my parents will get vaccinated. They have the Caretaker Advantage. 

I’m not the only person who has been providing this help. Steve’s working from home, so he can drive Ian to his therapist and to SAT tutoring. My sister and my brother are helping my folks, too. There’s an entire team helping the vulnerable people in our extended family. 

When the dust settles, when we assess who struggled and who survived, I’m sure that we’re going to find that the survivors had the Caretaker Advantage. And then we will have to figure out how to build a world where we both reward the efforts of caretakers and, at the same time, provide extra help to those who don’t have that advantage.

34 thoughts on “The Caretaker Advantage

  1. In our city many, many, seniors are not getting vaccinated because they don’t know how to request vaccinations or because they’re not even connected to the internet or have computers. And many have no transportation. There has been a call for the city to initiate contact with them and to send out mobile vans to their homes instead of putting the burden on them.
    Many, (maybe most) don’t have a caretaker like you. Your family is lucky to have you.
    I was in line to get a COVID test a couple days ago and I was one of only a few who hadn’t registered ahead of time. The fire station guy did it for me. I might be one of those old folks who needs a caretaker too.

    Like

  2. “Almost of us have had to step in to help our parents, because the sign-up system was too complicated for them.”

    Yep.

    I have to say that the sign-up for federal surge COVID testing was a lot simpler, but there’s less concern about allergic reactions, prioritization, etc.

    I’m thinking Matt Yglesias was correct that pure age prioritization is better in terms of speed.

    “One friend from New York said that she didn’t act fast enough, so her mom isn’t going to vaccinated until April, even though younger, all-remote workers were already getting vaccinated.”

    My guess is that it’s not going to take that long (given the combination of a ramp-up of vaccine supply and the supply of eager beavers not being unlimited), but yeah, that’s unfortunate. Not that I’m putting money down on bets, but I’m kind of expecting to get vaccinated by April myself.

    I see that NJ is moving somewhat more slowly on vaccination than NY:

    https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/

    I’m kind of enjoying watching the vaccine proxy war between the various 2024 hopeful governors. (Florida and NY are neck and neck!)

    “I’m sure that we’re going to find that the survivors had the Caretaker Advantage.”

    Except for the older ones who got COVID from their caretakers…

    Like

  3. I have a parent who is pretty computer literate but am still concerned and still trying to keep track. Our state is still in Phase 1 (nursing homes/congregate settings/medical providers). So, they haven’t rolled out the age based vaccinations yet (which will be 70+). They’ve developed a “find your phase” web site that is supposed to be collecting data and telling you when you are eligible, but so far, all I hear is “ineligible” (though there are more questions now). And, it’s down at this moment. So, I have no idea what happens next.

    They haven’t reached all the nursing homes yet, either. I think health professional vaccinations are going pretty well (though I’m guessing some with limited contact are getting vax).

    Frankly having a date at all, even in April, would make me a lot less anxious than thinking I have to keep monitoring like I’m looking for concert tickets. I prefer random allocation to lines that you have to figure out how to stand in.

    BTW, my parents are independent, careful, and really locked down. They see us occasionally at the doorstep & order all their food & my dad amuses himself endlessly with Mathematica and planning science experiments). So I’m not as worried about them as I might be. And, they have each other.

    Like

  4. I agre–thanks for posting your story. My wife’s and my parents have been dead for some time, but some folks at our church have experienced some of the issues you describe so well. You’d think that states know exactly where everyone lives–they have our tax and voter records, after all–but it seems that no state has been able to reach out to the folks who are supposed to have priority. My wife, a dentist, is supposed to be vaccinated by now, but she’d have to drive to a county halfway across the state that has advertised to its dentists that they have extra vaccine. She’s registering on the VA website today for vaccine access–both of us are retired Army officers, and I am in the Moderna study here in St Louis.

    sociologist Jessica Calarco famously said “Other countries have social safety nets. The U.S. has women.” https://annehelen.substack.com/p/other-countries-have-social-safety

    Like

    1. Because the CDC guidance says “are at increased risk” for Type 2 diabetes and only “might be at increased risk” for Type 1.

      https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/evidence-table.html

      There are apparently about 25 million adults with type 2 diabetes and 1.6 million w/type 1 (of whom 1/8 or so are under 20). It’s easier to be sure that a slightly elevated risk is significant if you have more cases to examine. But, it’s also possible that differing age distributions (more than a quarter of those 65 and older have type 2 diabetes) might also play a role in differing risk.

      Like

      1. bj said, “But, it’s also possible that differing age distributions (more than a quarter of those 65 and older have type 2 diabetes) might also play a role in differing risk.”

        Yeah.

        Like

  5. In happier news, I don’t want to call a peak too early–but I kind of want to call a peak:

    Page way down to the separate charts for “new reported cases by day,” “new reported deaths by day,” and “hospitalized COVID-19 patients by day.”

    They all look like they are flattening or have already peaked.

    Like

    1. You mean under the section where the NY Times writes “Where new cases are higher and staying high” (which includes almost all the states)? I hope we are seeing a flattening, but I think that one needs a week or so worth of data to detect a flattening. We’ve seen dips around the holidays already in this current increase. And, flattening at the current rates is still very high resulting in a death rate of over 3000 deaths per day. We’re going to hit 400,000 dead in less than 4 days and that’s baked in, as probably is another 30 days or so of deaths. But I’m keeping my fingers crossed for the next 30 days.

      Like

      1. bj wrote, “You mean under the section where the NY Times writes “Where new cases are higher and staying high” (which includes almost all the states)?”

        Yeah, past that and past the colored bars for “cases and deaths by state and county,” where they have separate charts that track total US new cases, total hospitalized, total deaths. I believe the “new case” chart shows a national peak something like Jan. 8. New reported deaths and total hospitalized may just be starting to flatten out.

        Looking at the TX version of this

        new cases have gone at least temporarily flat, hospitalizations are not rising as steeply, but new deaths look like they’re still getting worse.

        I got a morning email from The Dispatch and they had the US with 132k hospitalized Jan. 7 and then nearly 129k on Jan. 14, with some wobbling in between. National COVID hospitalizations are definitely not zooming up this week. They have national positivity trending down, too.

        The US did start nursing home and health care vaccinations a month ago, so it wouldn’t be crazy to start seeing improvements, given how important nursing homes have been in overall fatalities.

        “I think that one needs a week or so worth of data to detect a flattening.”

        Yep.

        Our county’s current wave peaked Nov. 20. On the one hand, yay! On the other hand, it’s been a very slow trip down, and while the holidays have hugely confused things, I believe that the new normal (at least until vaccination levels kick in) is a pretty high winter plateau. The local story has been something like this:

        –less than 1 per 100k from March to early June
        –a summer surge starting in the second week of June and peaking July 2 at around 45 cases daily per 100k
        –nearly universal wearing of masks in indoor public spaces starting from late June and continuing to the present
        –an August/early fall lull with new daily cases averaging about 20-24 per 100k
        –almost all schools open almost all fall (but more closures in the city district)
        –deterioration starting in late October and continuing to a Nov. 20 peak of around 80 new daily cases per 100k (about 3 weeks to get from base to peak)
        –lots of holiday data confusion
        –currently a high plateau of about 60 cases a day per 100k (but it’s still pretty wobbly)

        Like

  6. I’m finding the discussion about the mechanics of distributing vaccine, fascinating.
    We currently have no published plans for vaccine distribution – just have to hope that *someone* in the Powers-That-Be is actively working on this.

    Requiring people to register seems to be the most cumbersome way to deal with initial vaccine distribution. It’s going to prioritize the tech savy, and motivated (or those who can hire someone to do this for them) – not to mention those with English as a first language, and is likely to be overloaded. I can live with website crashes and missing out when it comes to event tickets – not so much with a vaccine.

    My thoughts (and it’s just me – no expertise at all).
    Why not distribute via GPs (General Practitioner – local family doctor)? They already know how many people in the target group are on their books. And let them manage the bookings to get their clients in to be vaccinated. Yes, there would be *some* who’d miss out (no GP) – but they’ll probably miss out on the current system too.
    GP X advises that they have 23 1st priority, 96 2nd priority, 154 3rd priority clients. Get allocated doses for a week (or even daily), and then they make the bookings for their clients to get vaccinated.

    Just so much easier to get a call from Dr X’s office: “Mr & Mrs B, we’d like to book you in to have the Covid vaccine on the 2nd of February at 10.30”; or “Mr B your date is the 2nd of February, Mrs B, your date is the 31st of March.” And then a new meeting time for 2nd dose (and follow up for those people who just don’t get that this is a multi-dose vaccine…..)

    This is the mechanism that we used during the Covid lockdown for ‘flu vaccinations. GP sourced doses for the eligible people on their books and made the bookings with them. You drove to the GP at the time specified, waited in the car, the nurse gave you the injection through the car window & you sat and waited for 10 minutes (to make sure you weren’t going to collapse, come out in purple spots, or start hallucinating)
    Nurse changed gloves, got the next dose, and went to the next car.
    If you travelled by bus – you waited on well-separated seats outside – same process.

    Contrast with the Covid testing …. zoos….. Where everyone and his granny just turned up and queued in cars for hours (not joking – some people waited for 8 hours – and then got turned away as the test station closed).

    What we *will* need is very effective and comprehensive vaccination registers – I understand a new website is being developed here [Ha! Based on my experience in IT development, it will be bug-free by 2024]
    Otherwise I can see some people being vaccinated multiple times, while others miss out altogether. And managing the 2 dose vaccines would be a nightmare.
    Just comparing the situation with the flu vaccine, for example. I’m eligible for vaccinations from 3 sources: GP, work (it’s an H&S benefit & they commission the next-door GP office to administer them), and a volunteer group (in contact with elderly/vulnerable clients). None of them have any way of knowing which of them I’ve got the flu vaccine from (or if I have had one at all).

    Like

    1. Ann said, “just have to hope that *someone* in the Powers-That-Be is actively working on this.”

      https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/

      Hopefully! There have been some high performers among small, US states. As of today, West Virginia (!!!) has done 7.75 shots per 100 residents and Alaska is at 7.51. The Dakotas are also stars, with North Dakota at 6.95 and South Dakota at 6.45. (The US national average is 3.9.)

      If you know anybody important in town or region, you may want to put a bee in their bonnet, because it’s not too soon to think about paperwork, sign-up systems, supplies, mass vaccination sites, etc.

      “My thoughts (and it’s just me – no expertise at all).
      Why not distribute via GPs (General Practitioner – local family doctor)? They already know how many people in the target group are on their books.”

      I’ve heard that voiced by at least one pediatrician online and I think would work really well for older people.

      They’re also just starting to use pharmacies, which typically do A LOT of flu shots in the US.

      I suspect that the main reason that they didn’t bring those resources online before is because up to now the focus has been on scarcity and prioritization, so (as bad as this sounds) the focus has been on gatekeeping people away from the vaccine…We had the governor of NY threatening healthcare providers with million dollar fines if they vaccinated out of order, plus threatening them with fines if they wasted any vaccine.

      “This is the mechanism that we used during the Covid lockdown for ‘flu vaccinations.”

      You guys may be ready to go if you just do the same thing for COVID.

      “Contrast with the Covid testing …. zoos….. Where everyone and his granny just turned up and queued in cars for hours (not joking – some people waited for 8 hours – and then got turned away as the test station closed).”

      I think the US had a lot of zoo scenes with regard to testing in the early spring, but since the summer, we’ve done both drive-thru federal surge testing and hospital-based drive-thru, and both have been really zippy. (We did a pre-surgical COVID test for one of my teens this week and there was literally one car ahead of us in the pre-surgical COVID test drive-thru at the hospital.) In my experience (and we’ve done SO many tests) it’s been very civilized.

      After a fall term in which 10% of the college community was tested every week, my husband and college freshman are bracing for weekly testing. My husband now has a weekly scheduled testing apt. on campus.

      Like

      1. Norway has concerns about vaccinating those over 80: https://www.bloomberg.com/news/articles/2021-01-15/norway-warns-of-vaccination-risks-for-sick-patients-over-80

        Norway said Covid-19 vaccines may be too risky for the very old and terminally ill, the most cautious statement yet from a European health authority as countries assess the real-world side effects of the first shots to gain approval.

        Norwegian officials said 23 people had died in the country a short time after receiving their first dose of the vaccine. Of those deaths, 13 have been autopsied, with the results suggesting that common side effects may have contributed to severe reactions in frail, elderly people, according to the Norwegian Medicines Agency.

        “For those with the most severe frailty, even relatively mild vaccine side effects can have serious consequences,” the Norwegian Institute of Public Health said. “For those who have a very short remaining life span anyway, the benefit of the vaccine may be marginal or irrelevant.”

        Like

    2. “Just so much easier to get a call from Dr X’s office: “Mr & Mrs B, we’d like to book you in to have the Covid vaccine on the 2nd of February at 10.30”

      Oh wouldn’t that be wonderful. First, in the US, about 25% of people don’t have GPs (“primary care physicians”, in our world). It’s higher for young people (and might be lower for old people). Next, we have a health car system that is a maze (for example, uploading one’s insurance card, or the story in the NY times of two people who went to the same COVID testing site and the one with insurance being charged $1000 for her test, while the other, who paid out of pocket, paid $100).

      Many Americans get flu shots at pharmacies, but I don’t think pharmacies are set up to handle the Pfizer vaccine refrigeration requirements (labs/hospitals can be). The Moderna vaccine can be stored in standard lab freezers, so might work better. But, both require refrigeration, which adds logistic challenges to reaching people individually (say, trucks to homes).

      Like

      1. Interesting how different our health care bureaucracies are…. and the language associated with them.

        BJ said:
        “about 25% of people don’t have GPs (“primary care physicians”, in our world). It’s higher for young people (and might be lower for old people).”

        Not everyone in NZ has a primary care physician, either, but older people are much more likely to be registered with a practice. The people who aren’t registered are usually the poorer groups and/or those without English as a first language – and they’d be the ones likely to miss out in an online registration process as well.

        I’d have thought that a 75%+ hit rate would be absolutely worthwhile – especially in States which have identified the elderly as one of the priority vaccine groups. And the health-system-as-a-maze thing [I really don’t envy you that] would also be better catered for in a practice which already has the details of your health insurance, etc.

        Flu shots (and any other immunization) here in NZ have to be supervised by a registered nurse (or doctor, but no-one is wasting doctors on this) – pharmacists don’t qualify. It’s to ensure that anyone demonstrating a reaction (e.g. allergy) has appropriate care. So people are ‘conditioned’ to go to the doctor for a shot.

        Having said that, there is discussion about training a whole group of people to administer vaccines – supervised by a qualified nurse. If/when that happens, I’d say the Govt is likely to re-purpose the mass-testing infrastructure (which, IMHO, is likely to be a massive mistake – with people queuing all night as we saw in Florida)

        We have been repeatedly reassured that (when) the vaccine arrives in NZ – it will be available free-of-charge to everyone (i.e. the Govt will pick up the tab from the manufacturers).
        How is that working in the States?

        Like

      2. Ann said, “And the health-system-as-a-maze thing [I really don’t envy you that] would also be better catered for in a practice which already has the details of your health insurance, etc.”

        That’s exactly right.

        I’ve seen this repeatedly when we do flu shots. There’s a lot less annoying form filling-out at the pediatrician versus at the HEB pharmacy, because we’re already in the computer at the doctor’s office. It’s a lot more streamlined as a process. On the other hand, if you don’t already have a doctor, it’s easier to get a flu shot via the store pharmacy. (We sometimes wind up at the store pharmacy because it’s closer and has more weekend hours–better weekend hours is the big advantage that pharmacies have over doctors’ offices.)

        “If/when that happens, I’d say the Govt is likely to re-purpose the mass-testing infrastructure (which, IMHO, is likely to be a massive mistake – with people queuing all night as we saw in Florida)”

        The repurposing is already happening in the US:

        https://losangeles.cbslocal.com/2021/01/15/covid-vaccination-supersite-opens-at-dodger-stadium-friday/

        Lines may not be that bad if people are given a time window to show up for, as I’ve seen them do for federal surge testing.

        “We have been repeatedly reassured that (when) the vaccine arrives in NZ – it will be available free-of-charge to everyone (i.e. the Govt will pick up the tab from the manufacturers).
        How is that working in the States?”

        I believe it is free–but that’s a bit of a moot point if you can’t get it.

        Like

  7. Another topic which is looming on the horizon.
    We have at least 1 person at work (Worker A) who will currently not be able to have a vaccine (immuno-compromized – and needs further tests to ensure which (if any) vaccine would be safe for her. She is also at high risk of getting complications if she does catch Covid.
    We also have at least 1 person who ‘doesn’t believe in vaccines’ and thinks they cause autism (Worker B) and is highly likely to refuse vaccination.
    What does the employer do to ensure that the workplace is safe for Worker A? Is Worker B required to be vaccinated in order to work in the office? If Worker B refuses, what can the company do?

    Like

    1. Ann said, “What does the employer do to ensure that the workplace is safe for Worker A? Is Worker B required to be vaccinated in order to work in the office? If Worker B refuses, what can the company do?”

      A US dollar store (so, very bottom of the retail food chain) is offering 4 hours pay for workers who get vaccinated.

      https://www.freep.com/story/money/business/michigan/2021/01/14/dollar-general-covid-19-vaccine/4160160001/

      Instacart and Trader Joe’s are doing something similar:

      https://www.usatoday.com/story/money/business/2021/01/14/covid-vaccine-dollar-general-instacart-pay-employees-getting-vaccine/4160708001/

      “Trader Joe’s is the latest business to offer an incentive for workers getting the COVID-19 vaccine.
      The Monrovia, California-based grocery chain said Thursday it will give employees two hours of pay per dose for getting the vaccine and will also shift around schedules to make sure employees have time to get vaccinated. Online grocery delivery company Instacart also announced Thursday it will begin paying its workers $25 to offset them taking time to get the COVID-19 vaccine.”

      Like

    2. I have read that it is perfectly legal for private businesses in the US to require employees to get the vaccine.

      Like

      1. gelasticjew wrote, “I have read that it is perfectly legal for private businesses in the US to require employees to get the vaccine.”

        I suspect that low-wage employers are going to have to use a carrot as opposed to a stick, as there’s always going to be a different low-wage employer across the street that doesn’t require it.

        Like

    1. Jay from Big Mouth? He’s a bit young, isn’t he?

      (Hey boomers, my students would understand my reference.)

      Like

  8. Once there’s an under-16 COVID vaccine, I think the smart move will be to primarily vaccinate kids through pediatrician’s offices.

    Like

  9. Alaska is up to 9.44 doses per 100 people–literally double the current US average. That’s only 69k doses total, but I’m still impressed.

    Like

  10. What I love about Israel, is that they are not only rolling out the vaccine at pace (approaching 30%), but actually analysing the efficacy as they go (I know it’s part of a deal with Pfizer – but they’re also publishing the info themselves)

    Latest is that the single dose Pfizer vaccine is significantly less effective than initial trial data (33% instead of 52% in the NEJM study)- which calls into question the UK strategy of giving only a single dose. Vaccine has no observable impact until 14 days. Israel applies the 2nd dose at 21 days (when, presumably it increases the efficacy. UK is proposing to wait up to 3 months for the 2nd dose – in order to maximize the numbers with the first dose – which may end up being a bad call.

    https://news.sky.com/story/covid-19-real-world-analysis-of-vaccine-in-israel-raises-questions-about-uk-strategy-12192751
    https://www.theguardian.com/world/2021/jan/19/single-covid-vaccine-dose-in-israel-less-effective-than-we-hoped

    Like

    1. Ann wrote, ” UK is proposing to wait up to 3 months for the 2nd dose – in order to maximize the numbers with the first dose – which may end up being a bad call.”

      On the other hand:

      –There’s going to be a lot more vaccine soon–I doubt it’s going to be a 3 month wait
      –They’ve been dealing with a monster surge of a more infectious version
      –They are vaccinating faster than any other country over 10 million in population (at least 7 doses per 100 people right now).

      I see the UK’s new case count peaked around Jan. 9.

      US new cases have definitely peaked, by the way–dramatically down since around Jan. 8. Deaths have peaked and hospitalizations are starting to ease down (but both much less dramatically down than new cases).

      Like

  11. I spent a big part of the day yesterday plowing through crappy websites and finally getting my parents a vaccination appointment in February. Tomorrow, I’m going to have to help their friends. This is absolutely insane.

    Like

    1. Laura said, “I spent a big part of the day yesterday plowing through crappy websites and finally getting my parents a vaccination appointment in February. Tomorrow, I’m going to have to help their friends. This is absolutely insane.”

      WHOO!

      Like

    2. That’s great! No appointments yet for the elderly (other than those in retirement homes) in my state or my parents’. Here, after the health care/assisted living people, K-12 educators are next, and my HS teacher friend just got her first dose Monday. So, so exciting.

      Like

    3. I gave myself a break today from clicking through on all the vaccine sites from our county looking for appointments. I hear from someone who might know that my parents are supposed to be contacted by their health care provider soon. But, might spend tomorrow clicking through looking for appointments anyway. It is a mess, and one they are admitting is a mess. After the slow pace, they’ve decided a free-for-all is the best way to get as many vaccines into arms as possible. My usual philosophy is that if I have to stand in a line to get it (restaurants, clubs, shows, concerts, tourist attractions), it’s not worthy it. But, I can’t follow that philosophy for vaccines (especially for my parents).

      Like

Comments are closed.