I'm wondering how my 89 year old mom will get the vaccine. She lives in Dallas.

Do we contact her primary care doctor?

If she lives at her own home and not in a nursing home, she should expect to get vaccinated some time in February. Priority is as follows:

1. Healthcare workers and nursing home residents (now through Jan)
2. Essential workers, elderly, those with comorbidities (February and March)
3. Everyone else (April and after)

They expect everyone who wants a vaccine will be able to receive one by late May or early June

Hospital admin? I am public facing healthcare worker and I haven't heard anything yet. We will see many try to jump the line. I hope all of those people get exposed.

is a 40-year old pediatrician who works in a clinic not attached to a hospital with screening procedures and adequate PPE more important to vaccinate than a 80-year old person not institutionalized?

I don't get it

when my kids had to get tested because a positive popped in their class, we weren't allowed into the clinic. it was telemedicine to set up a quick drive-by test in the TMC. you aren't allowed in the clinic if you have covid symptoms - you're screened and do the telemedicine bit.

assume this is just purely anecdotal. but these people have plenty of PPE and it works. you're statistically more likely to catch it outside of work, especially when your job isn't doing invasive procedures.

plus they are not part of the system operating under absolutely crushing strain - i.e. the ER and ICU that doesn't get to pick their in-person patient mix. so if it's PR that's fine - but I'd rather the OP's mom get the jab now and have them wait until Feb.

Roger That said:

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cone said:

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is a 40-year old pediatrician who works in a clinic not attached to a hospital with screening procedures and adequate PPE more important to vaccinate than a 80-year old person not institutionalized?

I don't get it

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That 40yr old sees covid patients every day...

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There are (at least) a few considerations which should be factored into priority level:

1. What is the probability that an individual would experience severe disease and/or death if infected? We know that age, along with certain comorbidities, play a significant role.

2. What is the probability that an individual will contract the disease? This is heavily influenced by career (e.g., front line medical staff) and living situation (e.g., long term care facility).

3. How likely is it for an infected individual to pass the virus to others? Again, this is heavily influenced by career and living situation.

There is likely some benefit to providing politicians early access as well, but I would argue that is more from a public policy and marketing perspective, as politicians (of all stripes) are generally pretty useless.

All that being considered, I think it is appropriate to focus on front line medical staff and LTC facilities currently, followed by other essential staff and the elderly that are not in LTC.

you and I have a different definition of direct facing

but whatever rationalization is needed is whatever rationalization will be used

that's been true from jump in this pandemic

What's your definition of direct facing?

Should the nursing aide at a LTAC unit not get it right away considering they leave the facility and interact with the outside world? Where do we think people in these facilities are getting this from if visitors aren't coming in?

AggieUSMC said:

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1a) politicians

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That's not necessarily a bad thing. I think our elected leaders should be a priority when it comes to things like this. Besides, we're talking about a relatively very few people an it does not put a significant strain on availability to other priority recipients.

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I agree with politians being put near the front....but they should have to it done publicly. I mean like a live broadcast carried on fox, msnbc, oan and newsmax during prime time.

Still think it needs to go
nursing home residents and staff,
front line hospital staff (er, covid ward, doctors, nurses and cleaning crews, emergency services but not cops)
Front line Retail workers (I mean cashier's, not store management) who wore masks
Other old and high risk people

Everyone else on a first come first serve.

aggiederelict said:

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Should the nursing aide at a LTAC unit not get it right away considering they leave the facility and interact with the outside world? Where do we think people in these facilities are getting this from if visitors aren't coming in?

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two things

- the nursing aide is, by all statistical measures, not likely to die from the bug. the residents of the LTAC absolutely are. so the people that die should get it first. the shot seems like a current homerun with regard to preventing any sort of severe course of the disease.

- we don't know if the current shots provide any sort of sterilizing immunity. so even if the nursing aide gets the shot, they still could be exposed and bring the virus in and around their patients. based on the phase 3, they won't get sick or show symptoms, but we don't know if it prevents transmission. more reason for the LTAC residents to get it first.

first principles - what's the objective? to preserve lives? how is that best achieved if all the data shows that the number one risk factor is age? or is it QALYs? in that case, why have we been laser-focused on the death counts?

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However, I don't think we can base need just on deaths. I also have a family friend who is entering his 3rd or 4th week in the ICU due to Covid. He's a 41yo healthy police officer. We hope he won't die due to age and the expert care he is receiving, but his family is facing huge medical bills and an uncertain health outcome.

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you're dealing with a scarce resource and statistically a 40-year-old is at low risk

what you're describing sucks, absolutely. but what's the objective? saved lives or QALY or rewarding those who didn't hide in their houses when work had to be done?

i'm receptive to all three, but it's going to be near impossible to address all three at the same time in the sort of non-functional low-trust bureaucracy that will live in

I understand that age group is low risk, but I also wonder whether that's based on deaths or risk of serious illness. I'm sure the answer is out there, but I haven't looked.
Hmmm... now I'm digging into QALY. I wasn't familiar with that acronym before. It's going to take more time than I currently have.

The more we have these conversations here, the more I agree with the assertion you made previously, about us being friends in real life. Not sure if you were being sarcastic at the time, but I do appreciate the way you challenge my thinking. We'd probably have some good discussions.

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1a) politicians

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AggieUSMC said:
That's not necessarily a bad thing. I think our elected leaders should be a priority when it comes to things like this. Besides, we're talking about a relatively very few people an it does not put a significant strain on availability to other priority recipients.

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I agree with politians being put near the front....but they should have to it done publicly. I mean like a live broadcast carried on fox, msnbc, oan and newsmax during prime time.

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They are. VP Pence, his wife, and SG Adams, did it last week. Biden and his wife are doing it today. Many politicians have posted pics of themselves getting it on social media.

"the nursing aide is, by all statistical measures, not likely to die from the bug. the residents of the LTAC absolutely are. so the people that die should get it first. the shot seems like a current homerun with regard to preventing any sort of severe course of the disease.

- we don't know if the current shots provide any sort of sterilizing immunity. so even if the nursing aide gets the shot, they still could be exposed and bring the virus in and around their patients. based on the phase 3, they won't get sick or show symptoms, but we don't know if it prevents transmission. more reason for the LTAC residents to get it first."

So you think the 80 year old living at home should get the vaccine before the nursing aide in a LTAC unit? I think they should both the nursing aide and resident at the LTAC should both get since it they interact with each other every single day.

The 80 year old at home should be isolated but the very nature of their risk level. I like how we assume that all of front line healthcare workers have to wear proper PPE, but we can't ask that 80 year olds stay away from those who present a risk to their health. Again, the 80 year old has the option to stay at home, the nursing aide does not by the nature of their work.

And are we assuming that getting the vaccine provides no change in transmission of a virus? What about other vaccines with respect to viruses? Do they not reduce transmission in any way? According this line of thought, the vaccine will do nothing to slow the spread of the virus.

Duncan Idaho said:

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Still think it needs to go
nursing home residents and staff,
front line hospital staff (er, covid ward, doctors, nurses and cleaning crews, emergency services but not cops)
Front line Retail workers (I mean cashier's, not store management) who wore masks
Other old and high risk people

Everyone else on a first come first serve.

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I'm well aware of the challenges the elderly face in their homes. My wife is a home health physical therapist who is dealing with medically fragile people all the time in their homes and in nursing homes.

I totally understand needing services and even access to care that may extend outside the home. That obviously has to get done.

What I do found odd about that dynamic is that she is expected to wear her PPE in their homes but there is no expectation of even wearing a mask for the patient and many will refuse to do so. But if she showed up not wearing her gear they would freak out. Rules for thee not for me situation.

I would totally understand if these people couldn't wear a mask due to respiratory issues, but in most cases this isn't the issue at all.

The challenge of isolating the vulnerable is indeed real.

Early on in the pandemic, and even today, many people say something along the lines of "if you're too afraid to go out, then just stay home and let me live my life." It isn't so simple right? Or at the very least it is incredibly inconsiderate and callous.

I understand the struggle, and I'm constantly worried about my mom in her 70's who has a business where she comes into contact with lots of people daily.

There are significant logistical challenges to distribution of this vaccine, so the ability to drive around and give it to the elderly isn't there. Even having neighborhood vaccine days can't happen yet. And I'm pretty sure this is the reason we're not seeing it go to more of the elderly before some of the lower risk healthcare workers - they're still figuring out how to distribute without having a rush of hundreds of people to hospitals for a vaccine in very short supply.

Some vaccines can shelf stable for up to 5 days at regular, low 30'sF, refrigerated temperatures. But they'd need to be delivered to doctors offices within dry ice coolers. But do you drop of 20 at a time to all the doctors offices at once? Or 100 to a 5th of doctors offices, and then 100 to the next 5th, etc.

Or maybe your doctor contacts the vaccine distributors (military?) and says here's a list of patients over 75 that I think are high risk, here are there addresses, and the military uses a refrigerated truck to deliver? Or maybe have a series of centralized popup vaccine centers at hospitals that have cold storage capabilities.

I'm just throwing random thoughts out there. But my point is, this isn't easy, and I think they chose to kill two birds with one stone in 1) getting as many people vaccinated as possible and 2) worrying about more complicated logistical vaccinations later.