Monday, October 19, 2020

The Agency Model

Even before COVID shone its ugly light on an extremely fragile and broken aged care system I had flagged the “agency model” of staffing in health care a really bad idea.  Yet in many areas from nursing to aged care it is the system of choice.  In order to explore this topic fully, I’ll start by giving you a short history of my experience with the system, the pros and cons and lastly a few other observations before I give you my summation.


So, where did I first see the agency model in action?  Well, agencies specialising in health care have been around as long as I can remember and they are important.  They were designed to fill gaps in health care facilities when someone is sick, on holidays or there is an sudden and unexpected gap in the staff roster.  But it raised alarm bells for me when I was admitted to a ward in a Sydney hospital 20 years ago for a kidney stone operation and it seemed that all the ward nurses were employed by an agency, not the hospital.  Interestingly enough, this was not the case in the operating theatres, only on the wards and I’ll explain why I believe this the case later.


In terms of pros for the agency model, I have already touched on one and that it makes it easy to keep the roster full in a profession where understaffing is not just problematic, but dangerous.  The second reason is that it is easy.  As any business owner that employs people knows, it is not an easy employing people, there is tax to pay, holiday and sick leave to accrue, superannuation, payroll tax etc…  Outsourcing staffing cuts down on your own administrative needs.


Before COVID, I identified two massive reasons why the agency model was a bad idea.  First, patient care.  This should be the most important thing in the running of any health facility.  Sadly it has taken a back seat to administrative streamlining and bureaucratic workload minimisation.  Now I don’t want to make the point that agency nurses are worse than other nurses.  They aren’t.  They are fully qualified and just as competent but they are almost being sent to work with one hand tied behind their back.  Over any given reporting period they can be working at multiple centres at irregular hours.  Being unfamiliar with the individual procedures at a facility and not knowing anyone else or where anything is means they cannot be as competent as other fulltime staff.  This not only decreases patient care standards but can endanger lives.


The second point is nurse and carer welfare.  Most nurses and carers would love a full time gig but the truth is when you just start out you have to work with an agency.  This can be daunting if you are fresh to the industry with no experience.  The hospital won’t put any time into training you because you probably won’t be there next week and they expect you to hit the ground running because they paid for a health care professional, not a trainee.  Think about what stress and pressure this puts nurses under and what it does to their mental health.  It’s really quite disgusting for what is probably the most vital, skilled and underpaid profession in our society.


However, since COVID another reason has come to light. Infection transmission.  In the age care system, which relies heavily on the agency model, COVID ran through aged care facilities like wildfire because infected workers were working at multiple facilities.  If they had only been working at one, they would have been able to contain the problem far easier if they could limit it to only one or two facilities.  This argument does not stop with COVID either.  Any contagion from flu to staff infections could potentially be spread in this manner.


The big question is what do we do about it?  The solution is easy.  The government needs to install a quota for staff in healthcare.  For example, a hospital has to have 90% of its staff as either permanent or fulltime staff.  It also needs to go further than that by saying that any department has to a minimum of 70% full time staff at any time so the 10% agency staff do not simply get dumped into the most undesirable department and shift.  It would also be advisable to disallow any temp from working in more than 3 facilities over a 30 day period.  There would be a lot of backlash against such measure, but the health industry would adapt and patient care would benefit.


Until next time,


Stay well

Saturday, October 3, 2020

Face Masks

Is it a mouth piece?

Is it a chin strap?

No.  It's a face mask!

It's really not that hard to wear a face mask.  I feel that most people that do not follow the instruction do so out of apathy or laziness.  But just in case, here is a really precise 2 minute video by Victorias Chief Health Officer that should clear up any ambiguity.

I know some of you think that being forced to wear a mask is an invasion of civil rights.  There are strong arguments for both sides but if that is how you feel, try and think of it differently.  Don't think of it as wearing a mask because it is required by law but simply as the right thing to do.  A bit like picking up your litter or surrendering your seat on the train for someone elderly.  By wearing a mask you protect yourself, protect others and safeguard the community.

Stay well:)

Saturday, September 26, 2020

The Dan Andrews Report Card

Just so you know I’m not going to go easy on him.  Dan Andrews (DA) is a politician with a background in marketing.  He is a master of spin and manipulation so let’s pull back the veil of misdirection and see what he has really done under in.


First Lockdown


Victoria was the last state to release its lockdown measures and when it did it was the hardest and strictest in the country.  The first lockdown was absolutely necessary but other states with less strict measures managed to deal with the problem just as effectively so was the super strict lockdown really necessary?  The other point I want to make is why were we the last?  For days, Victorians were left in limbo as to what we were going to be able to do and not do.  Is it just me or does it feel like DA simply loves the spotlight and enjoyed the fact that everyone waited for him so he could politically grandstand?


Verdict – 3/10


Hotel Quarantine


What a debacle.  If you live in Victoria and haven’t heard the news you must be in a coma.  What you might not have picked up on is the skill with which DA has masterfully mitigated political damage with well rehearsed rebuttal and spin.  The political manoeuvring he has undertaken would have been enough to save Nixon from the Watergate scandal.  Sure, he set up an inquiry.  But, he kind of had to and it has been his go to answer for all questions regarding hotel quarantine, which is to deflect to the inquiry and avoid giving an answer.  And this inquiry has spent weeks investigating why the system failed.  An answer we already know and giving DA time for the rage to settle and the criticism to dissipate whilst failing to answer the questions that Victoria want answered.  Just for the record, hotel quarantine failed because we had low skilled, low paid and ill-equipped workers with zero chain of accountability being charged with hotel quarantine and the health of Victoria.  The questions needing answered are who’s idea was it to use private security, why it was considered the best alternative and who signed off on it?


Verdict 1/10




I have blogged about this before.  Click here if you’re interested.  Essentially, when we were in the dawn of the second wave the time for testing blew out to five days.  During the first lockdown we had three months to get our testing procedures as accurate and efficient and exhaustive as possible.  When it came to testing we should have prepared for the worst where community transmission was rife like we have seen in other countries.  We needed to aim for 50 thousand tests a day with a 24 hour turn around.  We couldn’t even manage 10 thousand.


Verdict 1/10



Contact Tracing


Just to be clear, this is not a critique of our contact tracing teams that have worked tirelessly and diligently through the pandemic.  This is focused on the DA involvement.  Firstly, with a five day turn around on tests, the contact tracers are on a hiding to nothing as they are starting five days behind.  But, where other states, like NSW, have managed to stay ahead of the curve Victoria has not.  Probably because they are under resourced and DA didn’t accept any federal or interstate help until it was too late.


Verdict 2/10


Second Lockdown


After it was clear that it was impossible to contain the second outbreak and there was too much community transmission to control we had to head back to the only measure that has worked for DA, lockdown.  If you thought the first lockdown was strict, you ain’t seen nothing yet!  No household visits, only groups of two outside of the house, only allowed out for one hour a day, nothing open but the pharmacy and supermarket open, not allowed more than 5 km from home and a curfew of 8pm.  We were threatened with police action and fines for noncompliance.  In some cases, people were virtually imprisoned in their own home.  Victoria was drowning and DA had his foot firmly on our head holding us under water.  The lockdown was necessary, but we, the people of Victoria, were made to feel like criminals.  Like we were the ones at fault when it wasn’t.  We also know that the Victorian chief health officer or the police did not request the curfew.  In fact they both said it was unnecessary.  So why do we have it DA?  The lockdown has worked but at what cost?  The economy is on life support and the community morale is at an all time low.  It could have been handled better. Way better.


Verdict 3/10





DA would have you believe that he has fronted up to the media everyday and answered all questions.  Well, he has rocked up everyday but has he really answered all questions?   You have probably heard him repeatedly say three things.  “I take responsibility”, “It is inappropriate for me answer whilst there is an inquiry going on”, and “I am simply focused on defeating the virus”.  Textbook political answers to deflect difficult questions and leave them unanswered.  


The other thing that has really annoyed me is the timing of his press conferences.  He is constantly late and his really big announcements have been constantly vague on the time of his speech.  On the 6th of September he promised to make an announcement about the easing of restrictions.  He just didn’t tell us what time.  So, we waited all morning for the great and glorious DA to inform us for how much longer he would be suffocating us with restrictions.  You know what, I think he loves it.  I think he enjoys having all of our attention.  I think his only regret is that it is just Victoria waiting for him and not the whole country. 


Verdict 2/10


The Inquiry


Well the inquiry wrapped up yesterday and from Dans point of view it couldn’t have worked out better.  It bought him time for the rage of the people to soften and he wasn’t implicated and his personal inquisition was decidedly soft.  So let’s look at the facts.  The Honourable Jennifer Coate AO was appointed as the chair of the inquiry.  Was this a politically motivated appointment?  I honestly hope not but you can’t be sure.  She seemed to go surprisingly easy on DA and after three months we failed to get an answer to the number one question.  Who decided on Private Security for hotel quarantine?  At the end of the day, DA now has leeway to bury the whole thing, Jenny Mikakos got thrown under the bus and we didn’t learn anything.  What a complete waste of time.  


If we study what we know there are simply two alternatives.  Either DA told the truth or he didn’t.  If he did tell the truth and he doesn’t know who greenlighted private security it shows incompetent leadership and he should go.  If he lied he has either protected himself or others close to him that have made decisions that have lead to the deaths of almost 800 Victorians.  If that happened in the private sector someone would be going to jail.  Either way he should go.  This inquiry was a sham and did nothing more than serve the political needs of DA.


Verdict 1/10


Other stuff


During the pandemic we have really only had two big pieces of news worth mentioning.  First, branch stacking in the Victorian labor party.  DA is the head of the VLP and he has had the job for 10 years.  There is no way to deflect the blame, it all comes down to you DA, but I guess you are accountable for nothing.


The other piece of news was to silence victims of sexual abuse from speaking out.  Yes, you are the victim and your actions in the aftermath are suppressed.  Fortunately that legislation was removed but it just goes to show the incompetence of the Victorian government.


Verdict 1/10




Personally, I think DA is a very smart man and I refuse to believe that he didn’t know exactly what was going on.  I think he engaged private security to curry favour with the United Workers Union which was a solid political decision but clearly not in the interests of Victoria or Australia.  He has always played a solid political game and some people actually fall for his spin and think he has done a good job.  Even if he has successfully defeated the second wave, praising him is like rewarding someone for extinguishing a fire that they started or paying half a billion dollars to NOT build a road (Yes, DA really did that too).  As a final word I just want to say, Dan Andrews, you would better serve Victoria if you were on the dole.


Total 14/80


Wednesday, September 16, 2020

Civil Rights

 What are civil rights?  According to, civil rights are “guarantees of equal social opportunities and equal protection under the law, regardless of race, religion, or other personal characteristics.”  In a democratic society they include the right to vote, the right to a public education, the right to public facilities and the rule of law.  The rule of law is extremely important as it identifies checks and balances in our political system and means that every citizen governed by the law is equal under it, including government, parliament and the judiciary.


Now, how does this relate to COVID 19?  Well, if you live in Victoria and you haven’t noticed, we have been in lockdown in some form or another since March.  Lockdown has essentially been a massive afront to our freedoms and it is important to debate whether our civil rights have been compromised.  Every lockdown measure is a potential infringement so let’s break it down.


·      Denial of assembly – Right now, we are not allowed to go to anyone elses house, be in public with more than one other person or congregate in public areas.  The right to assembly is to allow for lawful protest and groups to form strategy to challenge political leadership or influence policy in a lawful manner.  This may sound a little insightful or aggressive but it happens all the time.  The federal opposition is always holding the government to account and it is critical in a free society.  Imagine how scary it would be if the opposition was deemed to be unlawful and scrutiny of the government was an offence?  


However, we are fighting a pandemic and the virus loves a large group of people coming together which means a suspension (not a cancellation) of gatherings is a sensible approach but we do need to see an end to it.


It is important though to look at this from a compassionate standpoint.  Imagine you are elderly, have a variety of health concerns, live in an aged care facility and are completely cut off from your family.  The restrictions are there to protect you but would you really care.  You would not have many days ahead of you anyway and your quality of life would also be low and to top it all off you would be cut off from your family.  On your list of priorities spending time with the ones you love would probably be the number one and this basic civil right is being denied to you.  I believe it is perfectly reasonable to postpone political and menial social gatherings, but exceptions have to be made on compassionate grounds.  That is where we are really feeling it.


·      Border closures and 5km exclusion – As far as the virus goes, this makes a lot of sense.  If someone is positive you know that the have not been able to spread it outside a certain area allowing easier contact tracing and containment.  However, you can’t really call it freedom if you can’t go outside a certain area.  Realistically it is a form of incarceration we afford only to criminals.  It is an infringement of rights but probably necessary. 


·      Face Masks – I find this one a little ironic.  People who have demanded people should not be allowed to wear face masks (like a burqa or hijab) are now insisting that we do.  Realistically, you can really only demand that if you have the right to not wear a face mask, you also have the right to wear one.  The issue is should you be forced to wear one.  My view is that if face masks supress the transmission of disease it is a small price to pay.


·      Curfew – This one I believe is extremely contentious.  Victorians have had to be back inside their homes by 8.00pm.  This has also meant that everything that is allowed to stay open (which isn’t much) has had to shut at 7.45pm.  Granted, there isn’t much reason for most of us to be out but there is for some.  


I know a guy in the public service that has a critically important job.  He is a widower with two kids 16 and 10.  During the day when his kids are normally at school the 16 year old has had to look after the younger one.  Lockdown has meant his support network of family and friends is not available and as a result he has to do everything himself.  Normally he would try to get home from work, help the kids with homework etc, cook dinner maintain the household and when his youngest was in bed he’d do the groceries about 9.00pm.  Now he has to do the groceries on the way home from work meaning there is little to no time for his kids, he is exhausted and has no support.


What is most unsettling about this is why we even have a curfew?  It has come to light that it was not recommended by the chief health officer, nor did the police request it.  The premier has been uncompromising and unmoved on this issue and when it comes to the curfew has certainly earned his title of dictator Dan.


·      One hour out – Another controversial decision is that Melbournians are only allowed one hour outside every day.  Now this is okay if you have a big house with a garden but what if you live in a unit or apartment.  You can only get one hour of fresh air a day.  You know who else gets one hour of fresh air a day?  US death row inmates.


·      Denial of basic services – For the most part, essential services like water, power, garbage collection etc. have been maintained but other nonessential services, such as childcare, libraries and community services have been sadly lacking.  There was also the case where after some nasty weather, certain suburbs of Melbourne were left without fresh water and power for days.  Nothing was done to help the affected people.  At the very least, certain restrictions should have been eased so family members could help those in trouble and people could access safe drinking water and cooked food.  Every effort also should have been made to get the services back.  I cannot believe that in todays Australia while Victoria is in a state of emergency it took four days to fix the problem.  Completely unacceptable.


·      The right to health and safety – This is the right that the government dangles in our face to justify the lockdown.  Don’t get me wrong, it is extremely important but could be debated for centuries.  Public health and safety is the reason we have speed limits on our roads or smoking bans in our pubs and restaurants.  At the end of the day everyone has a different opinion and who is right is a question that will never be answered.  It is really easy to sit at home, be bored and complain about the lockdown but the 26 thousand+ people and the families of the 816 who have passed away due to the disease would probably think very differently.


The big question is what should we do?  Whether we agree with the lockdown or not, we all need to follow the rules.  We live in a democratic society and any adult has the right to run for office and be involved with the decision making.  We also voted for the decision makers so you have to respect their decisions and if you don’t like it, vote them out at the next election.  It is critical that everyone is compliant because the worst thing we could possibly do is whatever we want.  If everyone did whatever they wanted we would have a massive infection rate, deaths in the thousands and a health care system that would have been pushed past the breaking point and given that the Victorian government has displayed a huge lack of preparedness that would probably be much closer than you think.


I think there is one more thing Dan Andrews could do now.  After all, he has claimed responsibility and he is the one that has instituted all the rules that have attacked the very fabric of our freedom and given himself massive powers to do what is necessary by implementing a state of emergency for at least nine months.  His nickname “Dictator Dan” is justified and right now we don’t know when his reign is going to end.  He needs to confirm that once the crisis is over he will resign as premiere.  He has stated that he will not contest the next election, but that is over two years away.  If he resigns immediately after the crisis abates it will confirm that his motives are purely to see out the pandemic and not rule over Victoria with an iron fist.


It’s up to you Dictator Dan.


Stay well

Saturday, September 12, 2020

Vaccine (Part 3)

The fact is that no matter what happens a workable vaccine is not going to eradicate COVID from the world it will merely be another weapon in the battle against the disease.  What is more important is we don’t become complacent about the disease.  As individuals it will still be extremely important to wear a mask, social distance and maintain proper hygiene.


Our leaders will also have a big part to play.  Not only will they need to get society moving again it is still really important to that they keep working on other methods to control the disease.  They need to make sure that international travellers are not spreading the virus into or out of the country, public areas are cleaned and maintained to a COVID safe level, all public servants (especially health and aged care workers) are afforded every opportunity to work in the safest possible environment, testing and contact tracing is maintained to the highest standards and other medical research opportunities are explored.


I’ll even give you a couple of research avenues that should be explored.  First, a treatment that is given to people suffering from COVID to ease their symptoms which would also hopefully decrease the mortality rate.  There is anecdotal evidence to show that inhaled corticosteroids reduce the severity of symptoms of COVID-19. These drugs are widely available for treatment of a wide variety of diseases including emphysema and asthma.  This is being explored overseas:


We need to explore it here in Australia.  I just want to add that so far the evidence is anecdotal based on observations of people who should be badly effected by COVID skirting through the disease relatively unscathed and the most obvious reason is corticosteroids.  It does not prove the correlation and proper studies need to be conducted in order to find out if it is ae effective treatment or not.


The second piece of research is something I have touched on before and that is the development of a one hour COVID-19 test and guess what, this is something that we can rush as there is no safety concerns as the test requires nothing more than spitting in a cup and the research is being developed right here in Australia at the Hunter Medical Research Institute.  Can you imagine how much more effective our contact tracers would be if we could actively start contact tracing in positive cases after an hour as opposed to the 5 days some people have had to wait?


Don’t get me wrong, a vaccine will be a powerful tool in the arsenal of weapons against COVID but it is just one battle that will be won in a long and protracted war.  It is extremely unlikely that a vaccine will eliminate the disease from a country or region completely, let alone have global eradication.  Even with highly effective vaccines, eradication of any disease has been extremely difficult.  In fact, in human diseases we have only managed it once.  Smallpox, and it took almost 200 years from the development of the first vaccine in 1796.  Polio is also on the chopping block but a yearly low of 22 wild cases in 2017 to an increase of 125 cases in 2019 shows that the disease is infuriatingly stubborn.  We can expect nothing less from COVID-19.


Until next time,


Stay well :) 

Friday, September 11, 2020

Vaccines (Part 2)

 In my last post I went through the clinical trial process and why it is a stretch for are pollies to be promising to answer all our prayers, defeat the virus and return our lives to normality with a vaccine.  Here I will expand on that.


As they get closer and closer to the releasing a vaccine, you’ll hear two words more and more.  They are safety and efficacy.  The problem is that those words are not absolutes.  In regards to safety, there is not a medical treatment that is 100% safe. Even putting on a band aid could have risk (you might be allergic to the adhesive).  Essentially, it comes down risk versus benefit and both these change depending on the ailment being treated.  For example, if you’re treating cancer, you would be prepared to endure a much higher risk treatment than if you had a cold.  With a vaccine, you are treating a disease that the patient does not have.  Therefore you could argue that there is no benefit to the patient so the risk has to be zero.  But there is a benefit in preventing the disease if the patient is exposed and the public benefit of herd immunity is massive.  Essentially, it is complicated.


The way that our society sees it is that vaccines do need to have very low risk and with a very short development and clinical trial length can that safety be guaranteed?  The answer is both yes and no.  We can comfortably prove short term safety, but can we guarantee long term safety.  For example, the Dengue fever vaccination, where even after exhaustive trials and signing off from the WHO, it was found that vaccinated people were suffering from severe bouts of the disease.  Essentially, they had vaccine enhanced disease.  You can read more about it here:


It is also important to note that even with the cases of vaccine enhanced disease, the benefits to the community as a whole were extremely high as there was a marked decrease in deaths and hospitalisations.  The other thing we have to be very concerned about is the fact that the Oxford vaccine is a live vaccine meaning that vaccine is actually a living virus.  Now, we don’t need to stress too much, live vaccines have been used for ages.  The first vaccines were live viruses including the smallpox vaccine which used the cowpox virus to give you immunity.


In any case, live vaccines need to be carefully monitored and scrutinised during the trial process as there is a small chance that the vaccine could cause disease.  Live vaccines also provide an extra hurdle as people who are immunocompromised are advised against having live vaccines.  This includes people with certain diseases (such as HIV), cancer patients, bone marrow transplant recipients, people who take steroids or other immune suppression or modulating drugs and the elderly.  That’s a real problem as the people most vulnerable and liable to suffer from serious complications or death from COVID cannot be vaccinated.  Yes, they will have to rely on herd immunity and realistically that all relies on at least 90% of the country being vaccinated.  Approximately 22 million doses to everyone, including people that don’t want to get vaccinated.  See the problem?


And then there’s efficacy.  Some vaccines can be amazing.  The smallpox vaccine offered life long immunity and was the main reason that smallpox was eradicated from the planet.  However, other vaccines can only be partially effective or have a limited lifespan like the flu virus that only lasts six months.  We simply don’t know how effective this vaccine is going to be.  Even if the phase 3 trials prove efficacy, we will only know that it remains effective for a maximum of six months because that is how long the trial will have been active for.

In my next post, I'll wrap up my thoughts on vaccinations

Until next time,

Stay well:)


Wednesday, September 9, 2020

Vaccines (Part 1)

Halleluiah.  Praise Dan Andrews.  Praise Scott Morrison.  Praise Oxford University and the University of Queensland because we are going to have a COVID-19 vaccine by the end of the year and everyone is going to be able to get their lives back to normal.  In case you hadn’t noticed, I was being sarcastic.


The rosy, triumphant spin that the politicians give you is a big old pile of bull****.  The chances of it all working the way they want it to is a million to one.  Stay with me and I’ll tell you why.


The first reason is because it is bloody difficult.  Not running a marathon difficult but accomplishing something that has never been done before difficult.  Think Hillary or Armstrong not your Sunday afternoon fun runner.  Let’s face it, corona viruses have been around as long as humans.  Afterall, the common cold is a corona virus and we haven’t found a vaccine for that but the fact that a cold is not much more than an annoyance means that the desire has not outweighed the necessity.  SARS and MERS are also corona viruses and we started trying to develop a vaccine for them but luckily, the problems seemed to peter out by themselves.  Unfortunately, when they did, so did the necessity for a vaccine.  


When it comes to COVID-19, even with an abundance of necessity the task is monumental.  I don’t think that our politicians realise that there is an extremely high chance that the first few attempts won’t work.  It’s really important that we don’t look at these as failures though.  Every attempt is a learning experience and one step further to the result we so desperately need.  I have no doubt there will eventually be a safe effective vaccine, just don’t expect it straight away.


Part of developing a vaccine is the trial process.  With any drug or treatment there are a number of phases that needed to be completed in order for a new treatment to be approved.  First is the pre-clinical work.  This normally involves having a hypothesis.  This hypothesis needs to be tested which normally happens by benchtop research or during animal models.  I’ll use the example of a trial I know quite well, HSCT for Multiple Sclerosis, very similar to my HSCT that was for CIDP.  They started with animal models and guess what.  The first experiments failed.  This was due to the selection criteria and once this was resolved, the experiment succeeded. 


After this we can move to phase one, which is where we test a small number of people (Anywhere from 5 to 80) normally one at a time to gage safety.  Phase two is a larger cohort and starts to look at the efficacy of the treatment.  If both these trials are successful then a phase three trial would be conducted scrutinising both safety and efficacy.  If that is successful, we have a new treatment that can be marketed to the people.  In the case of HSCT for MS, this process took 20 years.


What worries me is that a process that normally takes years is now taking months and that means cutting corners.  When I was a participant it the phase two trial of HSCT for CIDP I had follow up studies every year for five years.  There is simply no way to test the safety and efficacy of a treatment over time, other than to test it over time.  I understand that it is possible to speed up the clinical trial process by increasing sample size, increasing staff to help with lab work and processing results but all the money and resources in the world cannot speed up time.  We’ll effectively be finishing these trials on approved vaccines and if we find any nasty surprises we’ll be in real trouble.


Assuming we do tick all the boxes, we then have to worry about mass producing the thing.  If we want to get any vaccine to everyone in the world, we need to make at least 7.5 billion doses.  We can’t even get fresh drinking water to that many people.  In Australia we will need at least 25 million doses and don’t think that we can administer this easily.  We still don’t even have antibiotics available to every Australian community.


We also have to acknowledge that we’re not just baking bread.  Developing a vaccine is difficult and upscaling manufacturing to meet demand is even harder, then there are logistical and distribution issues to consider.


Next time I’ll be talking about other issues of vaccines.


Until then,


Stay well