It seems that the vaccination issue is going to go through two phases. We will be starting out with rationing, but then we will be in a mode of encouraging as many people as possible to get the jab.

So I think the optics of the priorities given now matter.

If we focus just on most vulnerable, and most likely to transmit the disease, we could give priority to immensely fat people, then ignorant asshats.

Although I have probably been part of both groups at one time or another, I’m not sure this is the best PR for the long-term success of the vaccination program.

quote:

Originally posted by Axtremus:
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.

That's sort of generalizing the point that Rich made about healthcare. I think if that were the actual reason it would have much more tightly defined criteria defining where we think such staffing shortages are truly a risk.

quote:

Originally posted by Axtremus:
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.

That seems to be the general intuition, but again, I don't see how you could anchor that in epidemiology. If you are worried about transmission, the guy doing non-essential work that interacts with a lot of people is precisely as much of a public health threat as the one doing essential stuff.



I think to a large extent this is what is actually going on: The policies are written by (and reported on) by people who have the ability to shield themselves from virus risk by working at home and ordering things to be delivered. We all realize that huge segments of society don't have that luxury, at least en mass. We also recognize they are under appreciated and underpaid. Their placement in the queue then becomes sort of a token of our appreciation.

Yay, some states are prioritizing lives saved, putting the elderly population above the vast majority of "essential workers".



https://www.washingtonpost.com...ority-group-elderly/

Shame its only a few.

McMegan has a piece in the Post today talking about this.

She agrees with Jon.

Her piece:

https://www.washingtonpost.com...b8815a66d_story.html

In my professional circles, the hot groups are seniors in residential facilities, educators and prison employees and those incarcerated.

There's a heated debate on both sides for these two groups.

Interesting, a guy I know in Texas with my underlying condition (alpha 1) got his vaccine yesterday. He's under 65 but has emphysema (he's pre-transplant).

If the CDC had had its way he'd be waiting while we got all the 25 year old stock boys at Kroger vaccinated first.

Healthcare workers pose interesting issues

a) They frequently and knowingly come in contact with COVID positive patients, symptomatic and asymptomatic.

But,

b) They're often the most protected by protocols and PPE.

It's a big empirical question to determine if healthcare workers are any more "deserving" or "essential" by either the personal or societal risk metrics.

And the issues are different across the healthcare industry. The problems of an ER or ICU are likely more acute than the issues faced in the average internist's office or clinic. An ER or ICU nurse is likely bathed in virus all day long, wearing PPE that should have been changed six times during the day, but can't be for a wide variety of reasons. An ER or an ICU can collapse if an infection sweeps through its personnel. That can pose a big risk to a city/town. Shutting down a physician's office, or an optometrist for three weeks doesn't create a hazard for an entire community.

Agreed, p*d. My daughter has several friends from high school who are ICU nurses and have been 100% COVID for months. One of their big problems is when any of the nursing staff tests positive. Even a false positive will trigger contact tracing, quarantines, etc., for several nurses at once. The "at once" part is due to the fact that the hospital has several apartments for medical staff (docs, nurses, etc.) who are working daily with COVID patients and don't want to go home to their families at night. So if anyone in that apartment tests positive, the whole apartment must quarantine. So it's not just one nurse at a time, at least in this hospital setting.

That's not the issue with an optometrist (not to pick on optometrists).

quote:

It's a big empirical question to determine if healthcare workers are any more "deserving" or "essential" by either the personal or societal risk metrics.

“Deserving” and “essential” are political questions.

Where empirics come in is how the increased risk of lots of exposure and the risk reduction practices of PPE and associated protocols net out. The NYC serology study I mentioned above showed health care workers to be less at risk than the general public, but I’m not sure what work has been done beyond NYC. But doing it city wide well after the first peak is not an insignificant data point.



As I said above, I have no doubt that *some* healthcare workers would be in the first group if this were done entirely scientifically, whether we were trying to minimize deaths or end the pandemic as soon as possible.

But not all 21MM of them that the CDC wants vaccinated before the first 80 year old living at home.

Two weeks ago Mount Sinai vaccinated a 20-something marketing employee, who posted it on Instagram.

Surely somebody’s grandmother would have been better served with that shot.

quote:

“Deserving” and “essential” are political questions.

Which is why I put them in quotes.

Essential can be depoliticized if you state a clear metric based on objective criteria, like R0 goals or minimizing morbidity/mortality, or even using economic metrics.

Indonesia's approach.

quote:

As Indonesia prepares to begin mass inoculations against COVID-19, its plan to prioritise working age adults over the elderly, aiming to reach herd immunity fast and revive the economy, will be closely watched by other countries.

Several countries such as the United States and Britain that have already begun vaccinations are giving priority to elderly people who are more vulnerable to the respiratory disease.

The following are experts’ views on merits and risks of the Indonesian approach, under which working age adults will be vaccinated after frontline health workers and public servants.

https://cn.reuters.com/article...rticle/idUSKBN2990MX

Doctor wife scheduled for vaccination (first dose) on Saturday. Second dose will be scheduled when she gets the first dose.

So the CDC just yesterday did a last minute about face and added 65+ and immunocompromised to the 1b list.



But in practice it's too late. At least in NY and likely other places.

THey've had the scheduling system open for the essential worker category for a while now so every 18 year old grocery store employee (yeah, really) has already reserved a spot, while the earliest their 74 year old grandmothers on chemotherapy can get an appointment if they go online today is (literally) April.