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COVID-19 treatment and vaccine update thread

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Re: COVID-19 treatment and vaccine update thread

Post by Anonymous Bosch »

LordMortis wrote: Tue Jan 05, 2021 1:00 pm Silly ignorant question.

Background: I keep hearing the rollout isn't science problem or politics problem, it's delivery/logistics problem.

Question: Why haven't we gone straight to American Red Cross? If they can do dozens of targeted blood drive in a neighborhood a year, why can't they be leveraged to deliver vaccines? They have the expertise in everything we we need but keeping things cold.
I think Scott Gottlieb's suggestions to speed up vaccine distribution across the US are a more sensible place to start.
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Re: COVID-19 treatment and vaccine update thread

Post by Kurth »

Smoove_B wrote: Tue Jan 05, 2021 12:38 pm
Not sure what the epidemiological implications might be,
There's no realistic way to give people with a fully vaccinated status a "pass" that would allow them to engage in activities or ignore public health orders (like wearing masks). Again, remember that we're still not entirely sure if the vaccination actually stops transmission (lowers/reduces) or is only effective against reducing the potential health impacts (lowering risk of complications) for the person vaccinated. This is why we're all going to be wearing masks (and should be) through at least the Fall of 2021 - we need to stop the spread.
Are you saying that we can't give fully vaccinated people a "pass" to engage in activities because of the health risks or because it's just not practical/feasible?

If it's the risk to public health, I'm not sure I understand. I had read that the Moderna/Pfizer vaccines are 90-95% effective in stopping transmission of the virus. And even if you are among the unlucky 5-10% who get a vaccination and still contract COVID, the already slim chances of having a serious case of COVID are reduced even further:
But even with the slim chance of mild illness, “the vaccine will likely make COVID-19 infections less severe” should you get sick, says Richard Watkins, M.D., infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University.
Given the enormous costs we are incurring as a society from prohibitions on civic, social and economic engagement, does it really matter that much if the vaccine stops/lowers/reduces transmission or instead prevents a vaccinated person from developing a serious case of COVID? Either way, it seems like the health risk of the virus to vaccinated populations would be really low.

But what I'm seeing, almost uniformly, is the message that, even post-vaccination, there's no way to return to something approximating normal life "until COVID-19 cases become nearly nonexistent."

It's hard to get my head around how we've gone from "we must flatten the curve" nearly a year ago to "we must eliminate the virus" now.
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Re: COVID-19 treatment and vaccine update thread

Post by Smoove_B »

LordMortis wrote: Tue Jan 05, 2021 1:19 pmMy question isn't about the emergency response teams but the opposite, the regular community based phlebotomy collection teams. They are ubiquitous, mobile, and have a lot of cross over experience/skill sets.
Right - they're still a limited pool. Many of them are likely working F/T in some type of medical role and volunteer with the Red Cross during emergency events. However, everything is an emergency right now and their paying F/T jobs are likely taking them away from volunteering. Just like how in NJ we have a volunteer medical corp (I suspect other states do as well) and they were asked to help distribute vaccines at the major sites. However these are people that are already dealing with COVID response; the Venn Diagram is a single circle.
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Re: COVID-19 treatment and vaccine update thread

Post by Defiant »

Kurth wrote: Tue Jan 05, 2021 12:31 pm Not sure what the epidemiological implications might be, but wouldn't one way of overcoming resistance to getting the vaccine be to reward those who do get it?
The suggestion I liked was a $2000 stimulus check tied to getting the vaccine.
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Re: COVID-19 treatment and vaccine update thread

Post by Smoove_B »

Kurth wrote: Tue Jan 05, 2021 1:36 pm Are you saying that we can't give fully vaccinated people a "pass" to engage in activities because of the health risks or because it's just not practical/feasible?
Not practical. We can't even get realistic / consistent enforcement on people wearing masks right now in states or communities where it is required. Now imagine a scenario where someone is waving around a piece of paper and yelling "I don't need a mask! I can sing in public! I can hug people - I've been vaccinated!"
Given the enormous costs we are incurring as a society from prohibitions on civic, social and economic engagement, does it really matter that much if the vaccine stops/lowers/reduces transmission or instead prevents a vaccinated person from developing a serious case of COVID? Either way, it seems like the health risk of the virus to vaccinated populations would be really low.
Yes? They're two different things. We're trying to stop spread because it's a numbers game. Higher levels of circulating virus means increased numbers of people being exposed, means more potential illness, death and chronic complications. Until we get some magical unknown (but many have put out reasonable guesses) number of people vaccinated, there is loss. You're never going to win the economic argument with me and many in my profession. We can rebuild the economy; we can't rebuild lives. Above and beyond deaths we still have limited understanding of the chronic impacts of the illness.
It's hard to get my head around how we've gone from "we must flatten the curve" nearly a year ago to "we must eliminate the virus" now.
Again, it's the mixing of two different messages. "Flatten the curve" is about making sure we're not overwhelming front-line medical workers and hospital/clinic infrastructure. This allows them to focus on treating people that need treatment and making sure people aren't dying from car accidents, gun shots and heart attacks.

"Eliminate the virus" I'm not sure on this as "eliminate" has very specific meaning in my circles (Exclusion, Elimination, Suppression, Mitigation, Do nothing).

What we need to be doing right now is suppressing levels of the virus in the communities experiencing uncontrolled spread. I'm not sure if true elimination is a viable strategy, but I'll concede large-scale disease control is not my forte. :D
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Re: COVID-19 treatment and vaccine update thread

Post by Isgrimnur »

Smoove_B wrote: Tue Jan 05, 2021 2:05 pm Not practical. We can't even get realistic / consistent enforcement on people wearing masks right now in states or communities where it is required. Now imagine a scenario where someone is waving around a piece of paper and yelling "I don't need a mask! I can sing in public! I can hug people - I've been vaccinated!"
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Re: COVID-19 treatment and vaccine update thread

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Kurth wrote: Tue Jan 05, 2021 1:21 pm
stessier wrote: Tue Jan 05, 2021 1:10 pm
Kurth wrote: Tue Jan 05, 2021 12:31 pm Not sure what the epidemiological implications might be, but wouldn't one way of overcoming resistance to getting the vaccine be to reward those who do get it? Incentivize good behavior with carrots - vaccinated individuals could: stop wearing masks, start gathering again, attend sporting and other entertainment events, go to school in person, eat out at restaurants and bars etc.
You say that like people aren't already doing those things.
Like so many other things, I guess it's all local. Where I live, no one is doing anything. Masks are mandatory everywhere. Bars and restaurants are closed except for outdoor dining (which is a joke in the Pacific NW in January). Schools are all remote. Sporting and entertainment venues are shuttered. Downtown Portland is like a freaking post-apocalyptic ghost town.
Here in Upstate South Carolina, the city has a mask mandate that is not enforced, but the county has nothing. The public schools sent out a letter on Dec 30th saying that due to failure of people to comply with DHEC recommendations over the holidays and the high rate of spread, school would be 100% in person (all grades), 5 days a week so kids could be kept safe. All businesses are allowed to be open. I drove by my gym last week, that I haven't been to since March, and it was packed with the normal January rush. Mask compliance is probably around 50% most places (very store dependent) and that's really the only indication that something weird is going on.
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Re: COVID-19 treatment and vaccine update thread

Post by Smoove_B »

Isgrimnur wrote: Tue Jan 05, 2021 2:07 pm People lie.
I'm going to create a Parler account and maybe suggest I'm hearing there will be some kind of visible tattoo flair for people that aren't vaccinated.
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Re: COVID-19 treatment and vaccine update thread

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Smoove_B wrote: Tue Jan 05, 2021 2:05 pm
Kurth wrote: Tue Jan 05, 2021 1:36 pm Are you saying that we can't give fully vaccinated people a "pass" to engage in activities because of the health risks or because it's just not practical/feasible?
Not practical. We can't even get realistic / consistent enforcement on people wearing masks right now in states or communities where it is required. Now imagine a scenario where someone is waving around a piece of paper and yelling "I don't need a mask! I can sing in public! I can hug people - I've been vaccinated!"
You can just scan people for the chip embedded with the vaccination. Duh.
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Re: COVID-19 treatment and vaccine update thread

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Smoove_B wrote: Tue Jan 05, 2021 2:05 pmYou're never going to win the economic argument with me and many in my profession. We can rebuild the economy; we can't rebuild lives.
I get much of what you are saying above, and thanks for being a great source of info here throughout all this. But the line quoted above is a tough one for me.

So many people are being hurt by the economic impact of the measures we're taking against COVID. I know those measures are (for the most part) necessary and the lesser of two evils, but we can't discount how they are also ruining lives. And it's not so easy to draw a line between preventing "economic" impacts and saving lives. Economic impacts cost lives as well. Businesses close. People lose health care. Mental and emotional health suffers. Domestic violence increases. There are lapses in necessary, non-COVID related health care (especially preventative measures).

And, on top of all that, a whole generation of kids is being set back due to the disruption in education.

I get that experts in epidemiology who are tasked with preventing virus spread are going to focus on that. But, as a society, we need to weigh all costs and benefits, including the economic ones.
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Re: COVID-19 treatment and vaccine update thread

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Kurth wrote: Tue Jan 05, 2021 1:36 pm If it's the risk to public health, I'm not sure I understand. I had read that the Moderna/Pfizer vaccines are 90-95% effective in stopping transmission of the virus.
My understanding is that the vaccines are only known to prevent development of symptomatic COVID-19, and that we still don't know whether any of them prevent transmission of SARS-CoV-2. If a vaccine doesn't prevent transmission of the virus, then if vaccinated people don't continue to take precautions, they are likely to become asymptomatic carriers and contribute to the spread of the virus.
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Re: COVID-19 treatment and vaccine update thread

Post by Smoove_B »

Kurth wrote: Tue Jan 05, 2021 2:33 pm So many people are being hurt by the economic impact of the measures we're taking against COVID. I know those measures are (for the most part) necessary and the lesser of two evils, but we can't discount how they are also ruining lives. And it's not so easy to draw a line between preventing "economic" impacts and saving lives. Economic impacts cost lives as well. Businesses close. People lose health care. Mental and emotional health suffers. Domestic violence increases. There are lapses in necessary, non-COVID related health care (especially preventative measures).
If we had the political leadership, we could have been paying people money to stay home earlier in the pandemic -or- as it was ramping up again in September to try and keep it from going into uncontrollable spread. But it was decided that the economy was more important, so here we are.
And, on top of all that, a whole generation of kids is being set back due to the disruption in education.
It's the same issue. We decided that in the Spring and Summer having bars, restaurants and large public gatherings were more important that being able to re-open schools in September. When that turned out to not be great, people just continued to gather in small groups on their own, continuing community spread. All the studies I've seen and the general consensus seems to be that if community levels of the virus are low, in person schools are likely safe options.

However, when you have teachers and parents part of the school system that aren't engaging in risk-mitigation behaviors and then lying about where they've been, sending sick kids to school and refusing to answer questions about travel, the virus continues to rampage.
I get that experts in epidemiology who are tasked with preventing virus spread are going to focus on that. But, as a society, we need to weigh all costs and benefits, including the economic ones.
We can do both, but it's been politicized here to the point it's toxic. Give money to the poors to sit home? Unacceptable. What was true in April of 2020 is true today - on any given day we're 4-6 weeks from suppressing virus levels to a manageable number. To do so would require significant federal investment (paying people to stay home), additional support from the states (to make sure people have access to basic needs) and individual commitment to do what's being asked (stay home, wear masks, don't socialize with people outside of your household). So instead of 4-6 weeks of intense national focus, we have the 12-18 month slow burn while we do everything we can to vaccinate as many people as possible
Last edited by Smoove_B on Tue Jan 05, 2021 2:46 pm, edited 1 time in total.
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Re: COVID-19 treatment and vaccine update thread

Post by Smoove_B »

ImLawBoy wrote: Tue Jan 05, 2021 2:28 pmYou can just scan people for the chip embedded with the vaccination. Duh.
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Re: COVID-19 treatment and vaccine update thread

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liked a post by Smoove_B
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Re: COVID-19 treatment and vaccine update thread

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Jeff V wrote: Tue Jan 05, 2021 12:00 pm
Ralph-Wiggum wrote: Tue Jan 05, 2021 9:36 am My 100 year old grandmother in a NC assisted living facility got her first dose yesterday. Hopefully once everyone there has gotten their second dose, they can slowly start opening up things a bit. She has been practically isolated to her room for the last nine months.
I wouldn't count on it if the report of a nursing home in Ohio is a common scenario. They said 60% of staff are refusing to get the vaccine, and that's going to mean perpetual lockdown.
I am (for now) mainly hoping that means that my grandmother can interact with other residents. They have completely confined residents to their rooms, so she hasn't been able to talk, eat, or play cards with any of her friends in the facility. Hopefully if they are all vaccinated, regardless of what's going on with the staff, they'll ease up a bit on those restrictions.
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Re: COVID-19 treatment and vaccine update thread

Post by Smoove_B »

After ~3 hours, the state of NJ is asking that only medical workers use the pre-registration site. Because that make sense. If only there was some other way to easily identify people working in the medical field and get them vaccinated.
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Re: COVID-19 treatment and vaccine update thread

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Smoove_B wrote: Tue Jan 05, 2021 2:41 pm
ImLawBoy wrote: Tue Jan 05, 2021 2:28 pmYou can just scan people for the chip embedded with the vaccination. Duh.
Don't give away our secrets!
I know a couple people who have gotten their first vaccination shots already and they were already making embedded chip jokes this weekend.
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Re: COVID-19 treatment and vaccine update thread

Post by LawBeefaroni »

Smoove_B wrote: Tue Jan 05, 2021 3:11 pm After ~3 hours, the state of NJ is asking that only medical workers use the pre-registration site. Because that make sense. If only there was some other way to easily identify people working in the medical field and get them vaccinated.
We're mostly done. Not sure it was state level organization, city, or just our system.


I mentioned earlier that TN was already vaccinating the 65+ but they may just be lack of demand. I can say for sure that's not an issue in Chicago.
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Re: COVID-19 treatment and vaccine update thread

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This is our motivation plan.
Gov. Henry McMaster announced a new deadline he says will increase the speed of the vaccine rollout in South Carolina.

The governor said anyone who qualifies to be vaccinated under Phase 1A of the state’s plan must either get the first dose of the vaccine or make an appointment to do so, by Jan. 15. If they do not do so by that time, they will “go to the back of the line,” McMaster said. The governor clarified, saying those in Phase 1A who don't meet that deadline will go to the back of the line in Phase 1B.

Regarding people who fall under Phase 1A who have not been contacted or notified about getting the vaccine, the governor urged them to call their local hospital.

McMaster said the state has “identified roadblocks” in the rollout and they are going to fix them to speed up the process.

“I will do whatever is necessary to keep our team together and keep them working at maximum efficiency and speed to get the vaccine out to people,” he said.

When asked about rising COVID-19 numbers in the state, the governor said he has no intention of imposing new or stricter limitations on businesses or gatherings. He said other states that have done so are “killing jobs.”
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Re: COVID-19 treatment and vaccine update thread

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In a world where killing jobs is worse than killing people.
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Re: COVID-19 treatment and vaccine update thread

Post by Ralph-Wiggum »

Added benefit of killing people - more jobs for everyone else!

Unless there has been some systematic way of letting people know they are considered to be in Phase 1A, which I don't think there has been?, punishing people who don't get the vaccine by an arbitrary deadline seems counter-productive to me.
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Re: COVID-19 treatment and vaccine update thread

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Ralph-Wiggum wrote: Tue Jan 05, 2021 4:43 pm Added benefit of killing people - more jobs for everyone else!

Unless there has been some systematic way of letting people know they are considered to be in Phase 1A, which I don't think there has been?, punishing people who don't get the vaccine by an arbitrary deadline seems counter-productive to me.
I have no idea. It seems like if you don't seek out the information, you're out of luck. But I could be wrong.
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Re: COVID-19 treatment and vaccine update thread

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I sought out the information. 84% of Texans are in line ahead of me. Apparently working from a large private home and being healthy means no stabby, stabby for me. My avatar is a bit disappointed, but I am not sure he understood fully.
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Re: COVID-19 treatment and vaccine update thread

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stessier wrote: Tue Jan 05, 2021 5:14 pm
Ralph-Wiggum wrote: Tue Jan 05, 2021 4:43 pm Added benefit of killing people - more jobs for everyone else!

Unless there has been some systematic way of letting people know they are considered to be in Phase 1A, which I don't think there has been?, punishing people who don't get the vaccine by an arbitrary deadline seems counter-productive to me.
I have no idea. It seems like if you don't seek out the information, you're out of luck. But I could be wrong.
I felt like I had no information until my PCP emailed me. I don't know he will decide who is essential but I'm OK with that. I don't need to be at the front of line, just that there is a way to know that there is a line and I am in it. If it's April, well that sucks, but I'm 10 months into the shit, I'll make it 14 before being inoculated and 15 before worrying about seeing my fellow man who is willing to see me.

I don't know what my fellow Michiganders are doing to be informed. I was antsy until my doc reached out to me.
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Re: COVID-19 treatment and vaccine update thread

Post by Ralph-Wiggum »

stessier wrote: Tue Jan 05, 2021 5:14 pm
Ralph-Wiggum wrote: Tue Jan 05, 2021 4:43 pm Added benefit of killing people - more jobs for everyone else!

Unless there has been some systematic way of letting people know they are considered to be in Phase 1A, which I don't think there has been?, punishing people who don't get the vaccine by an arbitrary deadline seems counter-productive to me.
I have no idea. It seems like if you don't seek out the information, you're out of luck. But I could be wrong.
I'm sure you've seen it, but here are the current details about who is in each phase. I wonder if I'm considered law enforcement (Phase 1B) since part of my organization does do law enforcement... :think:
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Re: COVID-19 treatment and vaccine update thread

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Ralph-Wiggum wrote: Tue Jan 05, 2021 5:49 pm
stessier wrote: Tue Jan 05, 2021 5:14 pm
Ralph-Wiggum wrote: Tue Jan 05, 2021 4:43 pm Added benefit of killing people - more jobs for everyone else!

Unless there has been some systematic way of letting people know they are considered to be in Phase 1A, which I don't think there has been?, punishing people who don't get the vaccine by an arbitrary deadline seems counter-productive to me.
I have no idea. It seems like if you don't seek out the information, you're out of luck. But I could be wrong.
I'm sure you've seen it, but here are the current details about who is in each phase. I wonder if I'm considered law enforcement (Phase 1B) since part of my organization does do law enforcement... :think:
Yeah. Apparently I am Phase 1B as I'm in manufacturing. I know I had an official letter from my company during the early lockdown that I was to show police to let them know I was allowed to travel to work - so I'm assuming I'm still essential. (I heartily disagree with this designation, but I can't fight city hall.)
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Re: COVID-19 treatment and vaccine update thread

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I love The Onion so much


CDC Unveils List Of Twitter Accounts You Can Follow To Piece Together Vaccine Information
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Re: COVID-19 treatment and vaccine update thread

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Defiant wrote: Tue Jan 05, 2021 1:55 pm
Kurth wrote: Tue Jan 05, 2021 12:31 pm Not sure what the epidemiological implications might be, but wouldn't one way of overcoming resistance to getting the vaccine be to reward those who do get it?
The suggestion I liked was a $2000 stimulus check tied to getting the vaccine.
I think that would have worked, but I'm not sure how to implement it now. Is there a central database to prove who has already been vaccinated at this point?
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Re: COVID-19 treatment and vaccine update thread

Post by LawBeefaroni »

Blackhawk wrote: Wed Jan 06, 2021 9:50 am
Defiant wrote: Tue Jan 05, 2021 1:55 pm
Kurth wrote: Tue Jan 05, 2021 12:31 pm Not sure what the epidemiological implications might be, but wouldn't one way of overcoming resistance to getting the vaccine be to reward those who do get it?
The suggestion I liked was a $2000 stimulus check tied to getting the vaccine.
I think that would have worked, but I'm not sure how to implement it now. Is there a central database to prove who has already been vaccinated at this point?
Organization and competence at the federal level? Hahhahhahbaahahaha.

No, there is no such database.
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Re: COVID-19 treatment and vaccine update thread

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That was mostly just checking myself to make sure I hadn't missed something. But without any way to know who has already been vaccinated, I don't see any way to retroactively offer checks to those who have. We're currently somewhere around 5 million vaccinated, and that will be a much, much larger number two weeks from now when there is even a chance of such a program being implemented.
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Re: COVID-19 treatment and vaccine update thread

Post by Defiant »

Maybe just offer them to all people in the phase 1 (or whatever) eligible people?

Or let the states handle distribution?
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Re: COVID-19 treatment and vaccine update thread

Post by LawBeefaroni »

Blackhawk wrote: Wed Jan 06, 2021 10:45 am That was mostly just checking myself to make sure I hadn't missed something. But without any way to know who has already been vaccinated, I don't see any way to retroactively offer checks to those who have. We're currently somewhere around 5 million vaccinated, and that will be a much, much larger number two weeks from now when there is even a chance of such a program being implemented.
They give you a paper card with the CDC logo, a "COVID-19 Vaccination Record Card" It's fairly thick stock but anyone with a printer can make one.


The only reason I kept track of mine and didn't just chuck it in a drawer somewhere is because it has the drug name and lot number on the back.
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Re: COVID-19 treatment and vaccine update thread

Post by Blackhawk »

LawBeefaroni wrote: Wed Jan 06, 2021 11:30 am
Blackhawk wrote: Wed Jan 06, 2021 10:45 am That was mostly just checking myself to make sure I hadn't missed something. But without any way to know who has already been vaccinated, I don't see any way to retroactively offer checks to those who have. We're currently somewhere around 5 million vaccinated, and that will be a much, much larger number two weeks from now when there is even a chance of such a program being implemented.
They give you a paper card with the CDC logo, a "COVID-19 Vaccination Record Card" It's fairly thick stock but anyone with a printer can make one.


The only reason I kept track of mine and didn't just chuck it in a drawer somewhere is because it has the drug name and lot number on the back.
I just typed in 'COVID-19 Vaccination Record Card' into Google. Guess what four of the five suggestions implied:
Spoiler:
Image
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Re: COVID-19 treatment and vaccine update thread

Post by Daehawk »

Not sure what the UK is thinking as now they want to skip the 2nd dose or postpone it?..Mmmm ok.
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Re: COVID-19 treatment and vaccine update thread

Post by LawBeefaroni »

Blackhawk wrote: Wed Jan 06, 2021 11:43 am
LawBeefaroni wrote: Wed Jan 06, 2021 11:30 am
Blackhawk wrote: Wed Jan 06, 2021 10:45 am That was mostly just checking myself to make sure I hadn't missed something. But without any way to know who has already been vaccinated, I don't see any way to retroactively offer checks to those who have. We're currently somewhere around 5 million vaccinated, and that will be a much, much larger number two weeks from now when there is even a chance of such a program being implemented.
They give you a paper card with the CDC logo, a "COVID-19 Vaccination Record Card" It's fairly thick stock but anyone with a printer can make one.


The only reason I kept track of mine and didn't just chuck it in a drawer somewhere is because it has the drug name and lot number on the back.
I just typed in 'COVID-19 Vaccination Record Card' into Google. Guess what four of the five suggestions implied:
Spoiler:
Image
Yup.

:grund:
" Hey OP, listen to my advice alright." -Tha General
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Re: COVID-19 treatment and vaccine update thread

Post by Daehawk »

My pharmacy mentions or asks for a flu vacc card when I go to get that shot but I dont have one and they dont seem to care.
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Re: COVID-19 treatment and vaccine update thread

Post by hitbyambulance »

WA state just issued an updated vaccination timetable. it looks like my place in line is approximately one year from now :evil:
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Re: COVID-19 treatment and vaccine update thread

Post by Daehawk »

Novavax is doing phase 3 trials here. They are taking new testers. Im not sure what they pay. I think its $500. Expecting a March FDA approval.
https://www.gofundme.com/please-help-di ... -wife-died ....Help for me to take care of stuff . Wife died Jan 3 2019 after 31 years. My soulmate.
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Re: COVID-19 treatment and vaccine update thread

Post by Daehawk »

TN Representative Chuck 'butt licker' Fleischmann has quarantined himself. Says he came into contact with some follow rep from Florida right before the storming of the Capital and later that guy texted him he had tested positive for COVID.

Yay.
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Re: COVID-19 treatment and vaccine update thread

Post by hitbyambulance »

hitbyambulance wrote: Thu Dec 31, 2020 3:18 pm
The Beijing Institute of Biological Products created an inactivated coronavirus vaccine that was put into clinical trials by the state-owned Chinese company Sinopharm. On Dec. 30, Sinopharm announced that the vaccine had an efficacy of 79.34 percent, leading the Chinese government to give it approval. The company has yet to publish the detailed results of their Phase 3 trial.
78% effective in Brazil... supposedly... https://www.reuters.com/article/us-heal ... SKBN29C1VZ

seems incredibly unlikely the US is getting any Chinese (or Russian) developed vaccine distributed within its borders at this point.
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