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Comment by vmception | Hacker News Reader

Which retail job can I get to bump me up the list on vaccination, but doesn't actually increase my exposure possibility?

I would just stick with trying to follow rumors of thawed vaccines about to be thrown out for the day, but all of my group chats are jetsetters and they're often easily swayed by conspiracies or are just Republican and I don't have energy to ask about being vaccinated there.

edit: well its nice that I was able to crowdsource a discussion here! as you see, the energy of doing this in a sequential chat is much greater than a nested thread chat. really great insight into how to get it, thanks lifehackernews!

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The risk of dying for the 70+ crowd is significant and much, much higher than for regular influenza. The risk of dying for the below 50 crowd is negligible and on par with regular influenza.

Prioritizing the elderly literally saves lives.

Jumping the queue if you belong to a group that is not at risk is incredibly selfish and immoral. You can wait a couple of months, it won't kill you.

I have seen this stated before. What is your source please? This is false: SARS-CoV-2 is significantly more lethal than seasonal influenza for all ages past puberty. In fact, at 50 it is almost 15 times more lethal. https://github.com/mbevand/covid19-age-stratified-ifr

If you are below 50, risk factors play a significant role in determining your actual IFR, while if you're above 70, your age is the primary risk factor.

I don't think your graph adjusts for that, and I think the difference in IFR between covid and the flu for healthy people under 50 is smaller. We're already at pretty small risks for those ages, and even if the difference is still 10x, it is - to use a highly scientific term - whatevs.

So if you are healthy and under 50, you won't die from covid, and you shouldn't jump the queue. Better?

Long Covid appears to be fairly common. Mortality isn’t the only relevant metric.

Sure, but that doesn't change the argument. I napkin-mathed the QALY difference between vaccinating a 30yo compared to a 70yo elsewhere in the thread, feel free to continue that by adding long covid into the mix.

If anything, I bet it will strengthen my case, because older people are more likely to get sick from the virus, and therefore more likely to develop long covid than younger people, which means the "QALY utility" of vaccinating an older person becomes even greater, which makes GP an even bigger immoral asshole for skipping the line.

You're moving the goal posts. I'm not saying it's okay to jump the queue, but it's not "old people", it's "old people and people with other health issues that are risk factors".

Of course with a highly transmissible virus the opportunity cost between vaccinating an isolated 70+ person and a young person who comes in contact with many 70+ people is tricky to ascertain. That said, I don’t think here in CA the tiering system is attempting to minimize deaths by accounting for expected transmissions.

Two points:

a) Age is just a confounding variable. Covid seems to be a "cardiovascular" viral disease rather than a "respiratory" one. For the vast majority of people Covid is unpleasant but not at all dangerous. Figuring out the real factors that make Covid dangerous should have been top priority, but unfortunately it isn't.

b) Flu and "common cold" is, in fact, very dangerous and deadly. We just classify those deaths differently, e.g., as deaths from stroke even though strokes can be caused directly by the "common cold".

> “Prioritizing the elderly literally saves lives.”

that’s true, but a bit naive. the utility function shouldn’t simply be a function of age, as that would ignore important other factors, like transmissibility, that affect overall population-level outcomes. QALYs[0], while not impervious to critique, would be a better target for maximization.

but the problem with that, again, is political, not technological or even psycho-social. that prioritization metric would be perceived as too complicated (harder for most politicians to explain without potentially exposing their own ignorance), but moreover, doesn’t serve the interests of the largest political donors.

[0] https://en.wikipedia.org/wiki/Quality-adjusted_life_year

Do the napkin-math calculation of QALYs saved per vaccinated 30yo compared to 70yos.

Hint: The IFR difference between a 30yo and a 70yo is at least 50x.

Wouldn't you also have to add in the second-order effects of the long-term impact on society of that 30yo being able to return to the workforce in a more full capacity? I have no dog in this fight and don't really care who gets vaccinated soon. Just trying to sharpen up your analysis.

that may (or may not) be true, but it likely doesn't matter. you're thinking of the system as essentially static, so you're only solving for a portion of the problem (the naive solution). dynamic systems like pandemics have intertwined higher-order effects, which can often drown out the more obvious direct effects in unintuitive ways.

for instance, you're ignoring the limited flow rate of vaccine production and the significant friction of wide distribution, which at least means there's an inflection point before which it makes more sense to target "superspreaders" first.

the optimal answer to a dynamic system is rarely the static one.

> Jumping the queue if you belong to a group that is not at risk is incredibly selfish and immoral. You can wait a couple of months, it won't kill you.

Per the NYTimes, medical ethicists disagree with this viewpoint.

1. People often are bad at measuring their risk level.

2. If you turn down the chance to get vaccinated, someone even less at risk than you might get it instead.

3. Active folks who are out and about might spread the disease to hundreds of people, many of them at high risk. As we now know that the vaccines do in fact influence spread, prioritizing vaccinations to active individuals can and will save many lives.

4. I care for you and hope you and your loved ones can get vaccinated soon.

"If You’re Offered a Vaccine, Take It", from the NYTimes:

> If you turn down a vaccination based on the belief that you’re not particularly high risk, you might also be fooling yourself. It’s difficult for people to accurately measure their own risk level; research has shown that people underestimate their risk in all kinds of situations. These optimistic biases, as they are called, often lead people to perceive, wrongly, that public health campaigns are more relevant to others than to themselves.

> In other words, the notion that other people need vaccination more than you do may simply be a product of irrationally optimistic thinking. After all, the science on Covid-19 is not yet fully understood, and it is evolving rapidly, especially given the emergence of variants of the virus.

> When you get a vaccination, you’re not the only person who benefits, either. Scientists aren’t yet sure how much vaccination thwarts the transmission of Covid-19, but preliminary data suggests that it reduces spread to a degree. When you get the shot, then, you’re not only protecting your own health; you’re also likely slowing the spread of infection in your community and reducing the chance of overwhelming hospitals. In addition, if you are inoculated and friends or family members fall ill with Covid-19, you are better able to care for them, since you probably won’t get sick.

> Still, people may yell at you for getting a shot when you’re eligible if they feel you don’t deserve it as much as they or their loved ones do. And you may not be able to appease them with rational answers. Deep down, individuals who are angry about unfair vaccine allocation are upset at the system, and understandably so. In that situation, you’re just an easy scapegoat. “I think the best thing to do in a situation like that would be to say that you care for that person and hope they get the chance soon, too,” Dr. Ferguson said.

Source: https://www.nytimes.com/2021/01/21/opinion/covid-vaccine-eth...

Getting a retail job or getting a thawed vaccine about to be thrown out does neither of those things

Save that copypasta for something you understand

The state handles the prioritization and they already prioritize the elderly. When their infrastructure fails at making appointments, a vaccine dose will be destroyed so there is greater utility for someone outside of the queue to use it at that point

> the risk of dying for the below 50 crowd is negligible and on par with regular influenza.

This is indeed a fact yet, many people I know that pride themselves in being informed and progressiv act like they're going to die immediately if they come into contact with the virus. Imagine if these people knew how many viruses and bacteria are all around them, even inside them. People can be really dumb when they are needlessly afraid.

My anecdote is that at my local grocery store the main people not wearing masks are the older folks and teenagers.

I know people who are in their 30s with no pre existing conditions who have already been vaccinated because:

* they work for a hospital system (in IT) * they work at a university (doing research) * their family member has a pre existing condition (but somehow that family member is not the only one to get a vaccine)

In addition to this, smokers and those /who have already recovered from covid/ are lined up to get first /and second/ doses before I get a single dose. I think it's fair to think of the system the politicians have decided on as flawed; to use your rhetoric, it literally ends lives to waste 2 doses on those who have already recovered from the illness. If gp wishes to apply his own sense of rationality to the process, I don't blame him.

You've fallen for the fallacy of believing that sick/vulnerable people are less deserving, and also failed to understand that preventing these people from being sick in hospitals make hospitals more available to you and your family if you should need them, for urgent or non-urgent care. The priority is to prevent system collapse first, then prevent deaths, then disability, and finally overall risk reduction.

Also, people who work in IT in hospitals have significantly higher risk just because if their workplace, and reducing the likelihood of them being carriers protects other patients (some of whom cannot be vaccinated) and their staff. The same applies for family members of vulnerable people.

This is not hard, you're just not trying.

I agree that the priority system is screwed up in many places and that as a result a lot of people were vaccinated who really shouldn't have been at this stage.

But that's the moral choice of the people who designed those systems, and the people who didn't decline even though that was the right choice.

But two wrongs don't make a right. It's still wrong for you to jump the queue, regardless of what everyone else is doing.

Morality is not as objective as you're making it out to be.

If a 70+ that otherwise would not have died from COVID gets vaccinated but on account of not getting vaccinated the OC dies from COVID, is that moral?

Utilitarian maximalism (via statistical predictions) is an approach to morality, not the approach.

Go ahead, find an approach to morality that leads to a healthy 30yo getting vaccinated while a 70+ does not. I’ll wait.

The length to which people with no morals will go to convince themselves they are good never ceases to amaze me.

If the 30 yo works at a nursing home for the elderly while the 70 yo lives alone in a cabin in the woods

If the OC was working in a nursing home, we wouldn’t be having this conversation...

OC has nothing to do with the question you posed an I answered

> Go ahead, find an approach to morality that leads to a healthy 30yo getting vaccinated while a 70+ does not

If the 30 year old is employed in a position with many unavoidable close contacts, the expected number of lives, life-years, or QALYs saved by vaccinating them can be much higher than the 70 year old, if the latter has few unavoidable close contacts.

Why are we trying to maximize human lives saved as opposed to human life-years saved?

Generously assuming people live to 90, saving a 30yo who would have died of covid saves 60 life-years, while saving a 70yo saves 20 life-years, i.e. 3x more.

But the risk of dying is around 50x higher[1] for a 70yo compared to a 30y, which means you have to vaccinate ~15x as many 30yos as 70yos to save the same amount of life-years.

So vaccinating the elderly first both saves lives and more life-years.

[1] https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi...

> Generously assuming people live to 90, saving a 30yo who would have died of covid saves 60 life-years, while saving a 70yo saves 20 life-years, i.e. 3x more.

This makes the fallacious assumption that if life expectance at age X is n years, life expectancy at age X+k is n-k years.

This is very much not true. See, e.g., https://www.ssa.gov/oact/STATS/table4c6.html

Using actual life expectancy by age makes the number of life years saved at age 70 much closer to that at age 30.

Overall good point. Much closer but still significantly different. The life expectancy is 14 years vs 48

> The life expectancy is 14 years vs 48

...which is still a factor of ~3x, which means my napkin math wasn't too shabby, which means this tangent was completely irrelevant, because my main point is unchanged.

But you're giving equal weight to a year lived in the prime of someone's life vs. a year lived in a care home, which might not be a reasonable way to calculate it.

fair enough. "closer" but still significantly different is a support for your position.

Only if they will save more lives by being vaccinated than if the 70 year old was. We should be focusing on people who are higher risk of being transmission vectors, such as grocery store employees etc, at the same time as vaccinating the weak.

Again if the OC was a frontline worker we wouldn’t be having this conversation.

This is less clear-cut than it seems because nearly everyone that's highest risk is retired and doesn't really need to leave the house. Is it better to tell a dozen pensioners that leave the house once a week for grocies to stay home so younger people can get vaccinated and go back to work? Possibly, depending on who you're asking.

Younger people are far more mobile and so contribute greatly to the spread of the virus. The old and sick don't go out much so aren't the ones spreading the virus.

Is it more important to stop the spread as quickly as possible or directly vaccine the more vulnerable? It's hard to know, and it probably depends on how much vaccine you have. Countries like the US with lots of vaccine may be better off vaccinating the most mobile members of society first to drop total infections ASAP. Countries with less are better off focusing on the vulnerable because they're a long way from herd immunity.

If you have enough vaccine supply you will minimize deaths by eliminating transmission quickest which implies vaccinating the most exposed, not the most vulnerable.

Throwing more variables at a question we already have an answer to is a waste of time. We know that older people get it more, die more, and are more at risk under all circumstances.

It is also infinitely easier to find old people than it is to find uninfected super-spreaders, we'll have vaccinated all the elderly long before anyone could develop a system to find the biggest potential spreaders.

Also, with vaccine production ramping up, a lot of countries project that they'll have vaccinated everyone by summer. Who cares if there's a better model? Elderly + frontline healthcare workers is a good enough model, go go go!

"uninfected super-spreaders" That's not a thing.

Less of them may die if we can get R0 under 1.0 faster by vaccinating those spreading the virus. It's absolutely still an open question IMO.

You are wrong about the first part. There are way more under 65 infected than over. And I've seen some preliminary studies that they do 80%+ of the viral spreading.

I have heard signing up as a rideshare driver if your state is prioritizing them as essential workers has worked.

I’ve been thinking about outdoor valet driver in hospitality sector, at a hotel.

I’ll look into the ride share thing I hadn't considered scouring each states “what is an essential worker” list. Or as another person wrote: writing bots to check some appointment list.

Aside from the ethical questions, if I could help it I wouldn’t want my job to be spending all day getting into enclosed spaces only recently vacated by a series of probably unmasked people, as a valet job likely consists of. (Sure you can open the windows so it’s better than say cleaning a capsule hotel.)

Lol wish I had any jetsetters in my social circles. I would probably have a lot more money.

Anyways, how I did it was have a pre existing condition and act like a scalper. Appointments get taken within seconds of opening up, I assume many are writing their own bots.

I wrote something to notify me when a slot opened up and clicked links many times over a period of a week until a managed to get a spot.

I am in group 1B which is getting vaccinated here so I didn't feel it was unethical.

If you don't have a pre existing conditions that raises your risk (and you're rich) I suppose you could look up the US territories and zip codes with highest adminstration rates and travel there. Some are approaching 35% so they will be opening general doses for anyone soon

> I suppose you could look up the US territories and zip codes with highest adminstration rates and travel there

yeah by default I’m very low on the list if I dont get crafty

I could do that, I already travelled to a low covid area and quarantined and didnt bring it with me

I met some ppl that got it through their tribe, so I contacted mine across the country but in that state they arent doing anything for indigenous.

Its a little weird how vaccines are aiming to be apportioned across all states at the same time. When really there is some lower hanging fruit than others. Like in one week you can send a freezer full to Wyoming or Hawaii and be done with those states, and only have temporarily reduced a 6 million allocation for California by 2 million!

Not sure how formal they are at checking employment or pre existing conditions.. Would depend state by state

Pennsylvania (at least at the pharmacies) doesn't verify anything. It's all self certification. You say that you qualify for 1A to make the appointment, and they don't ask you anything when you show up. But Pennsylvania's criteria for 1A is pretty broad, potentially representing 40-60% of the population. So tons of people qualify, but appointments are really hard to come by.

Hadn't considered that, I’m just watching every state mess up their own “phases” and dissatisfied at the federal apportioning

I can get a job, at least then I wouldn’t be pretending that “we’re all in this together” right?

In Texas, they check nothing. You decide yourself if you meet the criteria. I have no problem with this. Each of us knows our circumstances best. (not saying jumping the line is acceptable..)

What makes you think that you are somehow entitled to faster vaccination?

I interpreted his question as how to become entitled to it more quickly.

I just read the question again and I still can't interpret it any differently than someone trying to find out how they can cut the line.

It’s a generous interpretation, but using prioritization to determine how best to help feels at least roughly accurate. We are, as a society right now, being pretty explicit about who we think is most valuable.

How else could it be interpreted?

Oh, I guess they could have meant as a way to pretend to be more valuable than they intended on being.

Signing up as a rideshare driver but offering no real rides, for example.

OP here, thats an odd interpretation

The plan is to actually have the job and its duties and fit in the classification. I dont want it to be counterproductive if I can also just wait. So there exists some essential worker jobs that dont really include being surrounded by aerosol spores all day.

I was asked what other interpretations could be and provided one. I wasn’t suggesting this was your intention, in fact I explained how it probably wasn’t in my comment directly prior.

> Which retail job can I get to bump me up the list on vaccination, but doesn't actually increase my exposure possibility?

Clearly the objective is getting the vaccine and not doing something for the greater good.

why don’t you think those are mutually inclusive?

there exists retail [essential worker] jobs that don’t currently expose you to alot of people

and would fit the categorizations created by the state

the same goes for health care professionals or education workers

surprising to see how much the consensus here is grasping. newsflash remote tech workers, you dont have to keep the same job or only one job and your circumstance may not actually be privileged

> why don’t you think those are mutually inclusive?

Because the question is not “Which retail job can I get to help things going on, but doesn't actually increase my exposure possibility?”.

It seems to me the motivation is only getting the vaccine, OP doesn't mention the will/objective to help.

OP didn't say "I want to help retail, how do I do it without getting exposed ?” ?

His objective is to get bumped on the vaccine list by going retail with the least exposure. That's literally his statement.

There is an argument that the rationing/prioritization scheme that is currently in use is inherently unjust, and that no one is entitled to faster vaccination than anyone else.

Yes; however, prioritization lets us speed up the effects of population-scale vaccination by either...

1. Vaccinating people who are the most likely to get sick

2. Vaccinating people who are the most likely to spread the virus

Option 1 makes the death and hospitalization rates fall quicker, so that anyone we miss is more likely to still have a hospital bed to get treated in. Option 2 reduces the total number of people exposed to the virus.

The whole point of vaccination is to keep people from having to go to the hospital or dying - protecting the weakest first achieves that better than random vaccinations. Someone like me who basically lives in his room and works remotely can afford to wait for shots - someone who works in retail and has 1000s of exposures per day needs their shots yesterday.

Vaccine trials have shown that approved vaccines reduce moderate to severe illness and death. There is no trial-based evidence that they prevent people from catching the virus and spreading it [1]. It's even possible that people who are vaccinated are more likely to be asymptomatic and more likely to unknowingly pass it on.

So "vaccinating people who are the most likely to get sick" is the only option supported by the evidence. Or preferably vaccinate people most likely to become moderately to severey ill, or die.

At this time we should not be "vaccinating people who are the most likely to spread the virus". We don't know if approved vaccines will help with this.

[1] https://www.bbc.com/future/article/20210203-why-vaccinated-p...

It’s arguable the point of the vaccine is secondarily about protecting individuals due to the immunity it confers, and primarily about accelerating herd immunity to kill the virus off, which would counterfactually save thousands of lives per day in perpetuity. (It’s in either case very close between the two.) Given this, it makes prioritization pretty tricky under a supply constraint after you’ve immunized people who are objectively in a revere risk pool. For example, if we knew someone would be a super spreader, but would be at a low risk of severe covid, the margin of lives saved by prioritizing them over others that are at more risk of severe covid may be much higher. (Fwiw, I am skeptical the current prioritization regimes are designed around this optimization problem.)

> Someone like me who basically lives in his room and works remotely can afford to wait for shots - someone who works in retail and has 1000s of exposures per day needs their shots yesterday.

I think this is an oversimplification. We are living in our rooms because we choose to; many who don't work in retail that could be living in their rooms are not, and are voluntarily engaging in 1000s of exposures per day. If those people are young and not in healthcare (mostly true), such potential superspreaders are not priorities for vaccination due to this convoluted priority system.

What is the argument against prioritizing those who are at significantly higher risk of death?

This isn't my stance, but I'll steelman it anyway:

Those at highest risk of death are the 70+. Coincidentally, people 70+ also have already led long lives / have the least utility left to give back to the society that is doing the prioritization. It is therefore more important to give doses to young people first, as someone needlessly dying with 60 years left on their clock is significantly worse than someone who has already had the opportunity to live a full life and statistically would've died within the next 10 years anyway.

Doses that go to waste because the prioritization system ignores logistics. Utilization should be optimized for.

Seems like a false dichotomy. You can have a policy of prioritisation while also allowing vaccination of non-prioritised people if/when there are excess doses available that are approaching expiration. This is the approach currently being taken here in the UK.

https://www.bbc.co.uk/news/world-55841017

same in US except its not a policy just a reality

The “all or nothing” approach many states has built is extremely foolish, yes, but that isn’t inherently part of an approach based on prioritization.

You can prioritize for the sickest while simultaneously optimizing for all doses being used.

(Removed redundant commentary, leaving citations)

https://thehill.com/policy/healthcare/533364-fda-chief-urges... ("FDA chief urges states to allow COVID-19 vaccinations of lower-priority groups")

https://www.nbcnews.com/news/us-news/thousands-covid-19-vacc... ("Thousands of Covid-19 vaccines wind up in the garbage because of fed, state guidelines")

https://www.npr.org/2021/01/28/961722489/why-are-health-care... ("They're A Precious Commodity, So Why Are Some COVID-19 Vaccines Going To Waste?")

https://www.propublica.org/article/covid-vaccine-wastage ("How Many Vaccine Shots Go to Waste? Several States Aren’t Counting.")

https://www.medpagetoday.com/special-reports/exclusives/9093... ("There are vaccines that are being wasted and that is a travesty," Terry Fulmer, president of the John A. Hartford Foundation, told ABC News. "Even one dose wasted is too many.")

> The “all or nothing” approach many states has built is extremely foolish, yes, but that isn’t inherently part of an approach based on prioritization.

You're agreeing with me.

What is the argument for it that entitles anyone to cut the line?

If you start from the assumption that a successful Covid vaccination rollout protects the most people from serious illness and death, it follows pretty quickly. My parents are significantly more likely than I am to be hospitalized and/or die from Covid than I am. My grandparents as well, but their risk is even an order of magnitude higher than my parents face.[1]

A successful vaccination program, then, would aggressively work through the most vulnerable populations first.

[1]: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi...

Yes, that seems to be the consensus, although I don't share it.

I was answering the question posed by someone asking why someone felt entitled to faster vaccination.

> Yes, that seems to be the consensus, although I don't share it.

I know, you said:

>> There is an argument that the rationing/prioritization scheme that is currently in use is inherently unjust, and that no one is entitled to faster vaccination than anyone else.

I'm curious what that argument is.

I’ll bite. There is actually a very simple argument to be made as long as you accept the premise that 1. Death is a natural part of life, and 2. It’s not years of life that should be saved, but _quality_ years of life.

I find it unethical to take away all quality of life for hundreds of millions of young people in the prime of their lives, as well as destroying thousands of small businesses, so that bed ridden 90 year olds can be bed ridden for a couple more years, at best. Yet this is exactly what is happening, at least in Europe, with draconian lockdowns and curfews in place while vaccinating groups that didn’t leave their houses pre-COVID either.

With how things are going currently in my country my peers and I will be lucky if we can be vaccinated in 2021.

If we are going all in on “project cull the old”, we’re missing a few big things.

One that jumps out is a blanket, age-based DNR. A 70 year old who has been refused the shot but subsequently develops Covid is significantly more likely to be hospitalized than your “prime of their life young person”, for whom Covid isn’t nearly as likely to be severe.

This means they’re going to be an overall resource strain on the system. It wouldn’t be logical to refuse vaccinations for those most likely to be seriously sickened by the disease but then to try to provide advanced life support when they need it.

We will need to convert some percentage of hospital staff into “Covid hospice workers” to allow those who are sick to die as peacefully as one can when their lungs are shutting down.

I get that. I don’t think you get my point though. The reason I want young people to get vaccinated is not due to COVID, since they’re very unlikely to have severe complications anyway. In fact, the actual vaccination is not the point at all.

The reason I’d like them to be vaccinated is so that normal life can resume to some degree. All public places save for grocery stores and pharmacies have been closed here since early December. There’s been a 9PM curfew in place for a month with no end in sight. People’s mental health is rapidly deteriorating. I would not be making this argument if we were simply required to wear masks and could go about our business as is the situation in many places around the world. But that is not the case at all here.

That's kind of why I want the vaccine early, because there are a lot of underground things that are happening anyway that I'm avoiding. When I could be socially and having fun.

I don't think just swapping priority from elderly to prime age is a solution. As elderly will still be the ones bogging down emergency services, making relatively benign injuries a huge massive problem for everyone else. When returning to the normal distribution of emergencies after opening everything up, this is still a disaster for the hospitals.

That’s a consumer argument. The public health argument while vaccination is still constrained is that you prioritize vaccination for populations where they are most likely to be hospitalized.

What we’ve seen is that if hospitals aren’t overloaded, they are effectively able to treat people.

In a few weeks, as production ramps, the priority will shift to mass vaccination to everyone. You’ll literally have vans driving around setting up pop up events.

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