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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?

To a nurse in NYC apparently. Seems like a good place to start.

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Originally posted by ShiroKuro:

quote:

then there could be economic reasons to prioritize them

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

But this would be such a tiny subset. For there to be a big social benefit the task under consideration would have to fit two criteria:

1). It would have to be *currently degraded at large public cost*.

2) It would have to be subject to remediation by vaccinating a small, well-defined set of people.



The whole economy fits definition 1, pretty much. But we can't prioritize "consumers".

That's why #2 is there. #1 means "its a huge problem" and #2 means "and we can actually solve it through prioritization"

Imagine if we kept elementary schools closed in low-SES areas because the risk to staff was really high. (not far fetched). The social cost of keeping those kids out of school is quite high. So yeah, in that case there would be a huge benefit in prioritizing them.


I could easily make a case why they should be vaccinated before all but a tiny tiny subset of health care workers.



But there isn't a single part of the food chain or even health care provision or utilities or sanitation, etc. that would qualify that I' aware of.

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And I guess the question is, is there any "ranking of essentialness" that's not political

Again, I view that as question begging.


I think the idea that "essentialness" is a thing such that if you have more of it you get higher in line is flawed. At the very least it needs to be defended rather than assumed.


I can't find a single instance of someone defending it.


On the other hand, the internet is filled with the brim with pieces arguing who has more "essentialness" than whom.

quote:

Originally posted by jon-nyc:
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.

I would think not just number of people they interact with, but the vulnerability of the type of the population they interact with.

An additional thing to consider re: healthcare workers would be how likely they are to contract the virus *as a result of their profession* vs they went to a large family gathering without masks. Anecdotally, the nurses/Dr's I know are more likely to follow basic mask/social distance recommendations than non-medical types. This would point to a prioritizing them for vaccine to make sense from both a lives saved and reduced transmission perspective.

It's be interesting to see if there's a study that would verify (or not) my observation.

As I mentioned above, health care workers in NY have significantly lower infection rates than the general public. If anything, there's a "risk reduction bonus" received by working in a setting with lots of PPE and strict rules about using it.

(again assuming that generalizes)

So I don't see how you'd make the case for them based on personal risk. But yeah, as transmission vectors some of them could be problems, especially if they deal with high risk patients.

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I view that as question begging.

I promise you I'm not!! I truly have not been thinking about this stuff until today (cuz I have been grading... :P

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I think the idea that "essentialness" is a thing such that if you have more of it you get higher in line is flawed. At the very least it needs to be defended rather than assumed.

Good point indeed.

CTPianotech,

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Anecdotally, the nurses/Dr's I know are more likely to follow basic mask/social distance recommendations than non-medical types. This would point to a prioritizing them for vaccine to make sense from both a lives saved and reduced transmission perspective.

Wait, in this case, wouldn't it be better from a reducing transmissions perspective to start vaccinating people who don't wear masks?

I'm not saying I agree with the idea of starting with anti-maskers, but aren't mask-wearers already helping reduce transmission such that starting with some other group would have a bigger (short-term?) impact?

Thats a good question SK.


If your goal was to optimize transmission reduction then yeah, poorly behaved people would get a boost. (can you say college kids?)

I get why it would make people uncomfortable, because at some basic human level we view the vaccine as a precious gift and can't help but think about who "deserves' it.


I think that's what is behind the fact that we just accept that medical and essential workers get priority.

Gotcha.

I think another practical reason (rather than political) to prioritize healthcare workers would be the societal consequences of a nurse or Dr becoming sick and having to take weeks or months off during a pandemic are much more significant than for other professions..

(apparently checking for run-on sentences is not considered 'essential work' in my household

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If your goal was to optimize transmission reduction then yeah, poorly behaved people would get a boost. (can you say college kids?)

Yeah, that's what I was thinking, I wondered if there was something I was missing, but apparently now. Other than this:

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I get why it would make people uncomfortable, because at some basic human level we view the vaccine as a precious gift and can't help but think about who "deserves' it.


I think that's what is behind the fact that we just accept that medical and essential workers get priority.

Yes, on both counts.

Hopefully, the speed with which vaccinations can be distributed will make some of these questions irrelevant.

/wishfulthinking

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apparently checking for run-on sentences is not considered 'essential work' in my household

This article discusses some of the issues through interviews with healthcare workers, including whether or not to inoculate health care workers who have already had the virus and recovered.

quote:

Originally posted by CTPianotech:
Gotcha.

I think another practical reason (rather than political) to prioritize healthcare workers would be the societal consequences of a nurse or Dr becoming sick and having to take weeks or months off during a pandemic are much more significant than for other professions..

To be fair, I conceded in the first post that, whether you are trying to minimize deaths or minimize R0, some number of healthcare workers would be included.


As for the the threat to the health care system as a whole based on absences, I think that’s a good point. However, if that were truly a focus (and not a political justification) then it too would be tightly defined to only cover workers in health systems with (say) capacity above x% AND growing case counts in the local community. It certainly wouldn’t be a blanket reason for prioritizing the whole industry.

quote:

Originally posted by CTPianotech:
(apparently checking for run-on sentences is not considered 'essential work' in my household

Oh man, nobody here needs an editor more than me.

Maybe there is a class of workers who the nation cannot do without if, say, more than x% of them have to not work on any given day. Then you vaccinate them to the extent that you are actuarially comfortable that not more more than x% of them will be forced off work on any given day.

I think that would still preserve the usual definition of the term "essential".

Beyond that, I would intersect 'frontline' and 'essential' to prioritize, basically for people who (1) have to do essential work and (2) have to do it in a way or an environment that makes them interact with lots of other people.