December 3, 2020

I’VE GIVEN UP ON GOVERNMENT MAKING RATIONAL DECISIONS: Long-Term-Care Residents and Health Workers Should Get Vaccine First, C.D.C. Panel Says. Comment from my friend Kate Litvak:

This is unbelievably stupid. What is the point of prioritizing nursing home residents? They are stationary. They aren’t going anywhere. We should not spend vaccines on them, but instead, we should create safe bubbles around them by prioritizing the people with whom they have contact. That means all workers of nursing homes (not just medical workers). These workers are not only bringing disease into nursing homes, but after work, get on public transit to go home and spread the disease through the community.
We should prioritize people who have the highest number of (necessary) interactions with others — health workers, transportation, supermarket, police, workers of meat processing plants, etc.
And among the first should be TEACHERS!! This will destroy the excuse that the teachers’ unions use to justify not working while getting paid in full. Once we vaccinate all the teachers, we must open the schools. Teachers who will then refuse to show up should be fired for cause. Kids aren’t much at risk and are in low probability to spread the virus. Families who don’t want their kids to attend live classes can continue online, but that will be their choice — not the choice of the teachers’ unions.
When the kids are out at schools, we preserve their education and sanity, and also preserve the ability of their parents to actually work and get the economy back on track.
But instead, we are giving the vaccine to nursing home residents. Who are stationary, can be effectively isolated, and have little impact on the economy, education of kids, and our sane future. Sheer idiocy.

UPDATE: I’ve received some feedback that nursing home residents should be vaccinated early so they can receive visitors after months of isolation from their families. But do we think that the homes are going to let visitors in unless and until those visitors are also vaccinated? The vaccines are 90-94% effective, so given the liability issues involved, the odds that they would allow unvaccinated visitors to see vaccinated residents when a month or two or three later the visitors will also be vaccinated seem low to me. Not to mention that if staff aren’t vaccinated, the visitors could infect the staff.

UPDATE: The CDC has published the underlying report that their panel approved. The report suggests that “health care personnel” is defined very broadly, which means that nursing home staff will be vaccinated–which raises the question as why residents also need to be vaccinated quickly. A dissenting panelist raised an additional objection: Nursing home residents tend to be elderly and unhealthy, and generally safe vaccines might not be safe for that population, and we have no data on that. It’s also not clear to me why pharmacy staff are more of a priority than any other retail worker, unless they work in a medical facility.From the report:

Approximately 21 million U.S. health care personnel work in settings such as hospitals, LTCFs, outpatient clinics, home health care, public health clinical services, emergency medical services, and pharmacies. Health care personnel comprise clinical staff members, including nursing or medical assistants and support staff members (e.g., those who work in food, environmental, and administrative services) (8). Jurisdictions might consider first offering vaccine to health care personnel whose duties require proximity (within 6 feet) to other persons. If vaccine supply remains constrained, additional factors might be considered for subprioritization.*** Public health authorities and health care systems should work together to ensure COVID-19 vaccine access to health care personnel who are not affiliated with hospitals.

Approximately 3 million adults reside in LTCFs, which include skilled nursing facilities, nursing homes, and assisted living facilities. Depending upon the number of initial vaccine doses available, jurisdictions might consider first offering vaccination to residents and health care personnel in skilled nursing facilities because of high medical acuity and COVID-19–associated mortality (6) among residents in these settings.

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