What’s with the prioritization of “essential” workers?

[jon-nyc]

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.

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.

[Loki]

Maybe Biden can define it. Would his first big win.

[jon-nyc]

Jesus, can we have a conversation now and then without making it Trump v Biden?

[Jolly]

@jon-nyc said in What’s with the prioritization of “essential” workers?:

Jesus, can we have a conversation now and then without making it Trump v Biden?

Says the person with multiple Trump threads...

[jon-nyc]

@jolly

We can have all the Trump/Biden threads you want. But do we have to bring it in when we're talking about unrelated topics?

This one has no partisan valence as far as I know.

[jon-nyc]

Thinking out loud here..

You could imagine a world where some critical task was not being performed or was being critically degraded at high cost to society 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.

[jon-nyc]

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 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.

[Loki]

@jon-nyc said in What’s with the prioritization of “essential” workers?:

Jesus, can we have a conversation now and then without making it Trump v Biden?

Actually it’s very much about what each administration is going to do about this. We either accept Trump or move to Biden’s ideas to debate. There is no other way to look at it.

[Loki]

@jon-nyc said in What’s with the prioritization of “essential” workers?:

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?

Essential worker for what? Vaccine or subject to state lockdowns to a different degree?

[jon-nyc]

I’m talking about vaccine prioritization only.

There seems to be this idea that there’s a thing called “essentialness” with the property such that the more of it you have the higher up you are in the queue.

I think that needs to be defended, and would be hard to defend if anyone tried.

I haven’t even see anyone try.

I have seen a lot of pieces arguing who has more “essentialness” than whom. But none arguing why vaccine prioritization should be based on it.

[Doctor Phibes]

Maybe the argument would be that "essential workers" are obliged to continue working, and therefore put themselves at higher risk of infection?

It's sounds like bollocks to me.

[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.

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.

[Loki]

@jon-nyc said in What’s with the prioritization of “essential” workers?:

I’m talking about vaccine prioritization only.

There seems to be this idea that there’s a thing called “essentialness” with the property such that the more of it you have the higher up you are in the queue.

I think that needs to be defended, and would be hard to defend if anyone tried.

I haven’t even see anyone try.

I have seen a lot of pieces arguing who has more “essentialness” than whom. But none arguing why vaccine prioritization should be based on it.

As a practical matter I think they sent most to hospitals for distribution just to get started. Most hospitals are doing only employees now and by tier. Covid unit, Covid patients first and then possibility of Covid exposure second.

The logistics in doing this is amazing. First you create Health record, then you schedule, then you administer, then you schedule the second and all the while you have to keep track of all this stuf including supply. Oh and all your vaccinating locations need to be certified by the state and maybe the immunization registry.

[Doctor Phibes]

A number of my customers have managed to designate themselves as 'essential'. If you knew them, you'd laugh. I know I did.

[Horace]

As far as I'm aware, all several thousand employees of the company I work for are considered essential.

[jon-nyc]

@doctor-phibes said in What’s with the prioritization of “essential” workers?:

Maybe the argument would be that "essential workers" are obliged to continue working, and therefore put themselves at higher risk of infection?

It's sounds like bollocks to me.

I think that’s the intuition behind it, but note that’s just a justification for why the (political) decision was made.

[George K]

I disagree with her on many things, but she's always struck me as being a reasonable person:

[Aqua Letifer]

[Axtremus]

https://www.politico.com/news/2020/12/22/fauci-azar-receive-coronavirus-vaccines-449845

Anthony Fauci and Alex Azar just got their vaccines.

Do they need to be in front of the line so far ahead of @jon-nyc?

[Horace]

I don’t really think any white male is morally eligible for a vaccine. It is time we, as a country, make some courageous and justified decisions to redress the horrible damage done by those people.