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Comment by inglor_cz | Hacker News Reader

Israelis give shots to medical workers and oldest citizens first. This should drive down the death rate pretty fast. If this approach works, Covid-related deaths in Israel should visibly drop by the end of January.

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Aren't we doing the same here in the US?

Mostly, each state decides what to do with vaccines though, so it's not as uniform.

Israel's deployment is amazing, they went from 0 to 8% of their population in 10 days. How many doses have they actually physically got?

I just spoke with some people in Israel. None of whom are healthcare workers. They all got the first shot of the vaccine. ~4 people.

Were they older citizens?

Israel has opened up vaccinations for healthcare workers and anyone above the age of 60.

There are a few other groups getting vaccinations as well - I don't know all of them, but I know of some people working in nursing homes or other similar jobs.

In addition, there are people hanging around the vaccine administration centers at the end of their workday, and hoping that they have leftover vaccinations that would otherwise expire. Apparently, some people who otherwise wouldn't get vaccinated are able to get the vaccine that way.

they're also administering these shots out at a much faster rate relative to delivery whereas we've only administered less than 20% of the doses that have been delivered so far (11.4 million delivered, 2.1 million administered). The delivery rate should only increase especially even as there are several more vaccines in the pipeline so being able to actually administer the delivered doses may be the bottleneck moving forward.

Sort of... there are still plenty of healthy people that only didn't die due to intubation.

I'm curious to see the numbers there as well. If we vaccinate the old, then resume life as normal, we're going to overwhelm intubation machines.

I'd read medical studies and news articles over the summer that intubation was causing worse outcomes than things like proning in many cases, with dramatically improved survival rates in hospitals that avoided intubation. I'm wondering if advice on that has changed at this point. There was also an interesting piece on HN about jailbreaking CPAP machines to increase supply, although that might not be necessary now?

The standard of care has evolved based on the data. Unlike other respiratory infections, intubation often provides no benefits and some harm to those COVID patients who are not literally dying of asphyxiation (critically low O2 saturation). Basically intubation is now a last-ditch effort, that can and does save lives. But you'd better hope you don't need it because the likelihood of needing intubation AND surviving it are low.

All countries are doing these groups first, of course Israel is probably the country doing it the fastest so I agree, we should see the results faster.

And I agree with the topic, better 2 people somewhat immune "now" than half with the full vaccine immunity.

> And I agree with the topic, better 2 people somewhat immune "now" than half with the full vaccine immunity.

the 90%+ effectiveness is only with 2 does, who knows how long and if it works with only one dose... it's likely not half and/or not for very long...

Immunity is not binary. Introducing the spike protien to our immune systems now will prime us for a stronger fight later, even if we are not fully immune.

Moderna's phase 3 includes preliminary data on a single dose, and it appears 80-90% effective at/after two weeks. See table 15 on page 28:

https://www.fda.gov/media/144434/download

https://www.wbur.org/commonhealth/2020/12/18/coronavirus-vac...

From the same report:

> The small, non-random sample and short median follow-up time limits the interpretation of these results. There appears to be some protection against COVID-19 disease following one dose; however, these data do not provide sufficient information about longer term protection beyond 28 days after a single dose.

Obviously it'd be great if we can just dose everyone we can once then do a 2nd dose later, but we just don't know enough about how well that would work out long term.

The CDC tried to have non-medical essential workers ahead in line of seniors.

The argument was that, although more people would die (including more African Americans), it would even out black vs white ppl deaths metric.

[edit] source:

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-...

I don’t see any arguments in those slides about trying to “even out black vs white ppl deaths metric.” Social inequality is one of several factors included in their ethical and logistical plan, but interpreting that as an implied black vs white issue seems like a very uncharitable view of the author’s intent.

Page 31, table row "mitigate health inequities" says:

An upside (green) of vaccinating essential workers (non-healthcare) first: "Racial and ethnic minority groups disproportionately represented in many essential industries. ~1/4 of essential workers live in low-income families."

A downside (red) of vaccinating adults age >65 first: "Racial and ethnic minority groups under-represented among adults >65".

The next page (32) concludes that "mitigating health inequities" (what the paper calls Ethics) is the metric with the biggest difference in outcome, in favor of non-essential workers. A bigger difference in outcome than the one for "maximize benefits and minimize harms" i.e. preventing the largest amount of deaths.

Of course, the presentation doesn't define how these two different things are supposed to be compared. But its recommendation is that "Ethics" outweighs "Science" (their terms, not mine), and therefore populations with larger ethnic minority and low income representation should be vaccinated ahead of those at higher risk from the disease.

This is one of the better critiques I’ve found of the CDC’s very absurd position:

https://www.persuasion.community/p/why-im-losing-trust-in-th...

Literally their plan was to kill a greater number of people “because ethics”. It goes against well established pillars of ethical logic against “leveling” outcomes by intentionally making things worse for a group that is better off, and against the most fundamental tenant of medicine to do no harm.

You must apportion a limited supply of life saving medicine to the population most likely to benefit from it. To claim that apportioning the medicine to a population which is orders of magnitudes less likely to benefit from it, knowing that a greater number of people will die as a result, is an abject ethical failure.

Even accounting for the smaller minority share of the elderly population, you still kill more minorities overall by apportioning the vaccine to essential workers ahead of the elderly, because the death rate is so heavily skewed based on age.

Be warned Yascha has become (or always was, I'm not sure) a grifter hack. He jumped on the cancel culture grift now he's joining in with other armchair epidemiologists such as Matty Yglesias and Nate Silver in misreading slides and propagating a made up controversy about vaccine distribution. The ACIP meeting was recorded and open to journalists. They could go review it, but strangely they didn't. I don't see them reporting video from the meeting where they say anything of the sort your're suggesting.

EDIT: This whole thing is nothing but semi-sophisticated click bait and this is objectively untrue:

> "When the CDC is willing to kill thousands of people in the name of social justice, it's hard to know whom or what to trust.

> So I wrote about its shocking failure of judgment, and my crisis of faith in America’s institutions, for @JoinPersuasion." -- Yascha Mounk, Dec 23, 2020 [1]

Others here have already explained this and shown the priority list from CDC.

[1] https://twitter.com/yascha_mounk/status/1341866668528717824

They don't say ethics outweighs science, do they? They're just two axes on which to evaluate the model. You're coming to some interesting conclusions from those slides, unless I'm misreading something.

I can see where the poster got confused, the powerpoint slides have some sloppy logic. Though whether that’s because of the people or because of the loose thinking caused by slides, or both, is hard to say.

They do not say ethics outweighs science. Dooling simply ignores the science[0] (slide 23) and gives equal "maximize benefits and minimize harms" merit (3 pluses) to vaccinating 65+ and vaccinating essential workers, despite recognizing on slide 21 that with a disease-blocking vaccine, "Initially vaccinating age ≥65 in Phase 1b averts approximately 2–6.5% more deaths, compared to targeting high-risk adults or essential workers".

The tipping point then comes from the equal-weighted (why?) metric of "Mitigate health inequities", where she gives essential workers three pluses but 65+ only one plus. This gives "essential workers" 9 pluses total, greater than the 6 pluses for 65+.

It is frankly shocking that a person can recognize one course of action will clearly save the most lives, then assign an arbitrary score that puts that course of action as equally beneficial as the "woke" course of action--for no reason--and then invent another arbitrary category of equal importance that gives more weight to the "woke" course of action because there aren't enough brown people in the 65+ bucket.

It's even more shocking that this fundamentally irrational and (poorly) racially-motivated reasoning was unanimously approved[1] by the committee.

[0]: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-... [1]: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6950e2-H.pdf

You're right, my comment was partly wrong (and it's too late to edit it). They don't say that Ethics outweighs Science as a subject matter. They say that Science predicts all three proposals are equally good, and therefore Ethics gets the deciding vote.

(I disagree with the claim that the choice of which group to vaccinate first won't strongly affect the total number of infections and deaths. But that's a different argument.)

And then, within the Ethics group, they say that the deciding ethical factor in favor of vaccinating essential workers is that they have a higher proportion of minorities and low-income families than the other groups (of high-risk and of old people).

They don't give any reasoning, so it's hard to argue with this. Unlike the Science section, which links a study that models deaths prevented by targeted vaccination. The Ethics section lists some unsupported and unquantified claims (table on slide 31) and at the same time judges which outcomes are better.

Crucially, the first line of this table says that ethically it's equally good to either "Preserve services essential to the COVID-19 response and overall functioning of society", or to "Reduce morbidity and mortality in persons with highest burden of COVID-19 hospitalization and death". Why? Based on what refutable data or model or ethical theory? Who knows.

Of course, this is a summary presentation; there may have been something behind it that they didn't refer or link to.

Adults in the US get universal single-payer health insurance at age 65, and that group is disproportionately white. They also point out that access to healthcare is required for a diagnosis that would place someone in the high-risk group. This is something you'd want to consider if you are in any way interested in evaluating institutional racism.

I think it is entirely fair to consider whether a policy institutionalizes that a person at high risk because of age is more important to save than person at high risk because of undiagnosed condition. .... or whether the groups that society expects to go to work in person should be protected over groups who have already been given social benefits that are intended to enable them to avoid going to work.

This is, as the powerpoint outlines, a purely ethical, and non-scientific evaluation of the situation. The scientific arguments are in their respective sections.

> But its recommendation is that "Ethics" outweighs "Science" (their terms, not mine)

I don't see this anywhere in the document.

"“Older populations are whiter, ” Harald Schmidt told the New York Times. “Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.”

See https://www.nytimes.com/2020/12/05/health/covid-vaccine-firs...

I thought that the point of vaccinating essential workers first is that they are those that are more likely to spread the virus so by starting with them you stop the virus before it reaches the seniors.

Depending on the factors (% of seniors vs. essential workers, availability of vaccine) I can see either approach being more effective.

Not aware of evidence that vaccination stops or reduces spread. Given that asymptomatic and presymptomatic people are the main spreaders, it's certainly not a given.

Vaccinating front line health and care workers does make sense for two reasons

1) Far more likely to catch it

2) Far more problematic if they catch it and are off ill because of it

Other front line workers like police probably less important -- less likely to catch it, and not as problematic if large numbers are off ill as the people who fix it. Saving lives and reducing load on hospitals by vaccinating the over 70s is likely more beneficial.

There's a 3rd reason. Healthcare workers are frequently working directly with high risk people.

An asymptomatic infection of a healthcare worker could lead to a typhoid mary situation. Especially if they are in the right area of interaction (geriatric care, oncology).

Firstly healthcare workers should be being tested on a very frequent basis to catch for asymptomatic cases (as well as tons of PPE), secondly there's no evidence the vaccine will stop that type of transmission.

> Firstly healthcare workers should be being tested on a very frequent basis to catch for asymptomatic cases.

Agreed. It's a good idea even if they have been vaccinated until community spread is way down.

> secondly there's no evidence the vaccine will stop that type of transmission.

Why do you say that? The vaccine should trigger a strong immune response which should keep most people from getting infected. That's my assumption anyways.

Seems like the multi-prong approach here is the most helpful anyways. Vaccine + testing + masks to eliminate spread as much as possible in vulnerable communities.

> Not aware of evidence that vaccination stops or reduces spread.

There isn't any evidence for the opposite, either. There is no evidence either way. You can't just choose between two unknown options based on which one you like, and then defend your position by saying that there is no evidence against it.

There is no evidence the sun will rise tomorrow either.

But it is still rational to use logic and experience and assume that sunrise will probably happen as usual tomorrow, and these vaccines probably behave like other vaccines.

You think there is no evidence the sun will rise tomorrow?

I'm really trying to make the point that there is evidence that vaccination reduces spread, if you open your mind a little.

My use of sarcasm is maybe not the best way to convey that, but I am who I am.

I think the near eradication of multiple devastating diseases like polio, smallpox, and the measles is evidence that vaccination works and reduces spread.

Seems that HN Doesn't like the idea that there is no evidence about how the vaccine works with spread

https://www.huffingtonpost.co.uk/entry/getting-the-vaccine-d...

Professor Chris Whitty, England’s chief medical officer, recently told a press conference that true herd immunity will only occur if we have vaccines that can reduce transmission between people. At the moment, we don’t know if they do.

https://www.abc.net.au/radio/programs/pm/who-warns-vaccines-...

But the World Health Organisation says even though vaccines have been created.. none of those will necessarily stop the spread of the virus, rather - only stop the virus from becoming a serious disease inside our bodies.

https://www.independent.co.uk/news/world/americas/coronaviru...

"They do not show that they prevent you from potentially carrying this virus transiently and infecting others," Moderna Chief Medical Officer Tal Zaks told Axios, adding the public should not “over-interpret the results” of the vaccine yet.

I'd defer to Moderna's CMO, Englands CMO, and the WHO, but it does make sense -- after all the vaccine helps you fight the virus, but it seems people are spreaders before they even have symptoms (which I believe is a sign of the body engaging it)

Aiming a vaccination program at spreaders rather than those most likely to suffer seems a risky move.

Here's a more recent presentation from the ACIP working group: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-...

The order the working group currently proposes:

1a: health care personnel, long-term care facility residents

1b: frontline essential workers, persons aged 75 years and older

1c: persons aged 65-74 years, persons aged 16-64 years with high-risk conditions, essential workers not recommended in phase 1b

2: all people aged 16 years and older not in phase 1, who are recommended for vaccination

The parent comment is also mischaracterizing the reasons the presentation gives for putting essential workers at the same priority as persons aged 65-74. Here's what it says (page 33):

* Essential Workers are at high risk of exposure. Prevention of disease will reduce transmission

* Preserves services essential to the COVID-19 response and overall functioning of society. “Multiplier effect”

* Workers unable to work from home

* High level of interaction with public or others in the workplace

* May be unable to control social distancing

* Frequently interact with others in the workplace

* Racial and ethnic minority groups disproportionately represented in many essential industries

* ~1/4 of essential workers live in low-income families

There’s actually a lot of variety in the priority order. Other than healthcare workers the following groups will be prioritized above age 65+ in Massachusetts

1. First responders

2. Nursing home residents

3. Homeless

4. Incarcerated

5. 2+ comorbidities

6. Top priority essential workers

7. Teachers

8. One comorbidity

(Check out your state here https://www.washingtonpost.com/graphics/2020/health/covid-va...)

40% of all deaths in the US have been nursing home residents.

I've seen this number around for a long time, but since I never saw a source posted, I don't know if this is still true.

Edit: I found https://covidtracking.com/analysis-updates/ltc-deaths-pass-1... for December 2, which shows about 100,000 deaths from "long-term care facilities". Not all states report differences between staff and residents dying, but I think it's reasonable to estimate it's mostly residents. On that day they show a total of 265,000 deaths in the USA, so about 37% from LTC.

My mother got her first vaccination shot yesterday. She's in a nursing home in Virginia. She's already had one COVID exposure (luckily she didn't get it), and it's just scary there.

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