5 ms·

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

by owenmarshall 6y ago

toomuchtodo 6y ago
Doses that go to waste because the prioritization system ignores logistics. Utilization should be optimized for.
- owenmarshall 6y ago
  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.
  - toomuchtodo 6y ago
    (Removed redundant commentary, leaving citations) https://thehill.com/policy/healthcare/533364-fda-chief-urges-states-to-allow-covid-vaccinations-of-lower-priority-groups 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-vaccines-wind-garbage-because-fed-state-guidelines-n1254364 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-facilities-throwing-out-covid-19-vaccines 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 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/90935 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.")
    - owenmarshall 6y ago
      > 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.
- MaxBarraclough 6y ago
  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 https://www.bbc.co.uk/news/world-55841017
  - vmception 6y ago
    same in US except its not a policy just a reality
sneak 6y ago
What is the argument for it that entitles anyone to cut the line?
- owenmarshall 6y ago
  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/investigations-discovery/hospitalization-death-by-age.html https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi...
  - sneak 6y ago
    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.
    - owenmarshall 6y ago
      > 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.
      - deleted 6y ago
        [deleted]
fastball 6y ago
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.
doteka 6y ago
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.
- owenmarshall 6y ago
  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.
  - doteka 6y ago
    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.

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

toomuchtodo 6y ago

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

owenmarshall 6y ago
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.
- toomuchtodo 6y ago
  (Removed redundant commentary, leaving citations) https://thehill.com/policy/healthcare/533364-fda-chief-urges-states-to-allow-covid-vaccinations-of-lower-priority-groups 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-vaccines-wind-garbage-because-fed-state-guidelines-n1254364 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-facilities-throwing-out-covid-19-vaccines 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 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/90935 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.")
  - owenmarshall 6y ago
    > 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.
MaxBarraclough 6y ago
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 https://www.bbc.co.uk/news/world-55841017
- vmception 6y ago
  same in US except its not a policy just a reality

sneak 6y ago

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

owenmarshall 6y ago
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/investigations-discovery/hospitalization-death-by-age.html https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi...
- sneak 6y ago
  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.
  - owenmarshall 6y ago
    > 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.
    - deleted 6y ago
      [deleted]

fastball 6y ago

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.

doteka 6y ago

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.

owenmarshall 6y ago
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.
- doteka 6y ago
  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.