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What’s with the prioritization of “essential” workers?
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Has Achieved Nirvana
Picture of jon-nyc
posted
I can’t think of how that’s justified epidemiologically unless you torque the definition of “essential” beyond recognition.

It seems to be entirely political, but also relatively unquestioned. If there’s an opinion piece out there asking the same question I haven’t seen it.

Am I missing something?


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Posts: 33032 | Location: On the Hudson | Registered: 20 April 2005Reply With QuoteReport This Post
Has Achieved Nirvana
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Not sure I understand what you're asking. Could you drill down a little with more specifics?


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Posts: 30539 | Location: Somewhere in the middle | Registered: 19 January 2010Reply With QuoteReport This Post
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Full disclosure, I haven't really read about this, and it seems like a lot depends on how "essential" is defined here. But, having said that:

quote:
justified epidemiologically


Aren't there other justifications besides epidemiological ones?

If medical personal are defined as essential, then, yes, it makes sense to prioritize them because we need to keep hospitals open and functioning.

What about grocery store workers? Truck drivers? We need food, right?

I'm mostly just thinking out loud here. I don't know what the best approach is, but it gets very complicated very fast!!


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Posts: 15177 | Location: not in Japan any more | Registered: 20 April 2005Reply With QuoteReport This Post
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quote:
Originally posted by wtg:
Not sure I understand what you're asking. Could you drill down a little with more specifics?


It seems to me there are two epidemiologically defensible approaches:

One would be to base it purely on individual risk, and vaccinate those people first. The variable you try to optimize there is deaths - minimizing it obviously. (I'd say "death or serious illness" but its sort of the same thing in practice.

The other would be targeting infection rates with the goal of ending the pandemic as soon as possible. So in this method classes of people who pose high transmission risk would be prioritized even if they individually didn't have much of a risk of death or serious illness. The variable we optimize here is R0.

In both of these case some healthcare workers would be included in the first wave. If we were focused on deaths, it would likely be a smaller number than if we were focused on infection rates.

But in neither case does the 'essentialness' of the tasks they perform come into play. If we are focused on infection rates, a nail salon employee is far more likely to be a transmission risk than (say) a radiologist or a linesman for the power company, yet the latter two are far more "essential". And if we're focused on risk, an older/chronically ill person is more at risk than a younger healthier person, independently of any 'essentialness' of their task.


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Posts: 33032 | Location: On the Hudson | Registered: 20 April 2005Reply With QuoteReport This Post
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Picture of jon-nyc
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quote:
Originally posted by ShiroKuro:
Full disclosure, I haven't really read about this, and it seems like a lot depends on how "essential" is defined here. But, having said that:

quote:
justified epidemiologically


Aren't there other justifications besides epidemiological ones?



Well sure, you can do it based on some form of political favoritism, though you would use different words to describe it like "deserving" "important". "essential". "just", etc.


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Posts: 33032 | Location: On the Hudson | Registered: 20 April 2005Reply With QuoteReport This Post
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Thinking out loud in response to SK's question...

You could imagine a world where some critical task was not being performed or was being critically degraded at large social cost due to high infection rates among the staff. And then there could be economic reasons to prioritize them. But that is a very small subset of "essential".

K-12 education staff might be advantaged in such a scenario. But again, not the food delivery guy or the radiologist or the linesman or the grocery store employee.


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Posts: 33032 | Location: On the Hudson | Registered: 20 April 2005Reply With QuoteReport This Post
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quote:
you can do it based on some form of political favoritism


I mean, yeah, but that's not what I was getting at. Although you did get closer with your comment about "'essentialness' of the tasks" ... so what would it look like to include essential workers in the priority list?

I suspect you've read about this a lot more than I have, is there any merit (perhaps not the best word, benefit maybe?) to including criteria in the definition of essential-ness that address things like groceries?

What would a list that included such criteria look like?

medical workers
elderly and nursing home residents
people with risk factors
grocery store workers
truck drivers for grocery distribution centers
K-12 teachers
postal carriers (??)
restaurant workers
people over 60
people over 50

etc. ?? What are sort of "infrastructure" type jobs that should be included?

I'm not saying this is how I think things should be ranked, but just sort of thinking out loud about how non-medical criteria might be mixed in to medical criteria.


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Posts: 15177 | Location: not in Japan any more | Registered: 20 April 2005Reply With QuoteReport This Post
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Jon, just saw your post above mine, I was probably typing while you were posting.

So, what's a linesman?
/probablynotthemostimportantquestion....


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Posts: 15177 | Location: not in Japan any more | Registered: 20 April 2005Reply With QuoteReport This Post
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quote:
then there could be economic reasons to prioritize them


I guess that was what I was thinking about...


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Posts: 15177 | Location: not in Japan any more | Registered: 20 April 2005Reply With QuoteReport This Post
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Yeah but you're begging the question here. You're assuming "essentialness" is a valid prioritization method and just trying to find the right definition.

I mean, that's fine and all. It seems to be what everyone wants to do.

I'm looking for justification as to why "essentialness" is a proper consideration and the only one I can find is political (except for the very narrow case I opined about)


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Posts: 33032 | Location: On the Hudson | Registered: 20 April 2005Reply With QuoteReport This Post
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Why Health Care workers, other than the fact that we think they "deserve" it?


A literature search quick google seems to indicate that healthcare workers infection rates are lower than the general population in hard hit areas (NY was the study I saw). And hospitalizations were associated with the usual suspects of co-morbidities.

If that result is generalizable, there seems to be no 'risk minimization' case for prioritizing health care workers generally. Though some may be significant transmission risks due to the number of people they interact with.


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Posts: 33032 | Location: On the Hudson | Registered: 20 April 2005Reply With QuoteReport This Post
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Ok, I see what you're getting at.

I've been more at the 50,000 foot level and have recently read a couple of documents put out by WHO.

First one is a values framework: https://apps.who.int/iris/bits...-2020.1-eng.pdf?ua=1

The other is a prioritization roadmap based on the values framework, and takes into account vaccine availability and epidemiological settings:

https://www.who.int/docs/defau...vrsn=bf227443_2&ua=1

Really interesting topic and a complex one, as SK said.


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Posts: 30539 | Location: Somewhere in the middle | Registered: 19 January 2010Reply With QuoteReport This Post
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quote:
Originally posted by ShiroKuro:
Jon, just saw your post above mine, I was probably typing while you were posting.

So, what's a linesman?
/probablynotthemostimportantquestion....


The guy that fixes your power after a storm.


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Posts: 33032 | Location: On the Hudson | Registered: 20 April 2005Reply With QuoteReport This Post
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quote:
Yeah but you're begging the question here. You're assuming "essentialness" is a valid prioritization method and just trying to find the right definition.


I'm not really assuming anything, I haven't really thought about this nearly enough. But I was starting from a place of wondering how getting the vaccine out could have the biggest impact in the smallest amount of time...

quote:
I'm looking for justification as to why "essentialness" is a proper consideration and the only one I can find is political (except for the very narrow case I opined about)


This is much closer to what I was wondering about. And I guess the question is, is there any "ranking of essentialness" that's not political... I don't know the answer to that...

Could any of these be "social" or "societal"? Prioritizing vaccinating K-12 teachers could be societal and maybe also justified from a public health standpoint, in that keeping schools open and making sure we don't have a generation of kids with developmental problems would have both a societal and public health benefit.

And why does prioritizing grocery store related stuff have to be political? Everyone has to eat, right?

I guess the bigger question is (maybe this is a bigger question, maybe it's not ... ) Anyway... how many vaccine doses are available right now and how quickly can the distribution and inoculation process get under way? If epidemiological criteria can be met in the first wave of vaccinations and there are still doses available, who gets those doses first?

While we're at it, I just saw a pop-up news flash on my phone that the first dose has been administered in the US. To whom??? How are these doses being decided?

Maybe I should actually read that article...


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Posts: 15177 | Location: not in Japan any more | Registered: 20 April 2005Reply With QuoteReport This Post
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quote:
The guy that fixes your power after a storm.


Ahhh, thanks! I should have known that actually, from the Glen Campbell song!

ROTFLMAO


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Posts: 15177 | Location: not in Japan any more | Registered: 20 April 2005Reply With QuoteReport This Post
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