Nate Silver

Nate Silver @NateSilver538

So, turns out that ACIP revised its vaccine prioritization guidelines in a way puts the elderly higher in the queue and that is much more in line with what most other states and countries are doing. I'm sure there are things to quibble with but this is great news. — PolitiTweet.org

Nate Silver @NateSilver538

Canada has a good vaccine distribution plan that puts quite a bit of priority on age. So does the UK. So do many *US states*, btw. The CDC/AHIP plan is really sort of an outlier in terms of how little priority it gives to age. https://t.co/pzTLQHjj6e https://t.co/twfHtM2Nfm https://t.co/r7bNzauSEp — PolitiTweet.org

Nate Silver @NateSilver538

The research is unambiguous that age is a much bigger risk factor than almost all pre-existing conditions. So it's rather crazy to have this very broad definition of pre-existing conditions (encompassing 100m+ Americans) where you'd get the same vaccine priority as being elderly. — PolitiTweet.org

Nate Silver @NateSilver538

I know a fair bit about COVID. I spent a fairly large part of my life reading research about COVID. And I'm a good reader—it's part of my job. I'm not doing any epidemiology on my own. The problem is that ACIP's recommendations on vaccine prioritization don't match the research. — PolitiTweet.org

Nate Silver @NateSilver538

@kdrum We have disease-blocking vaccines. That's what the Phase 3 trials have been measuring. Though hopefully the vaccines will stop infections, too, and some of the initial data suggests that's likely. https://t.co/hSSEDGas29 — PolitiTweet.org

Nate Silver @NateSilver538

@CT_Bergstrom @CeliaResearch @adam_allouba @adam28143 @adamac @mikeandallie Your complaint seems to be that I'm right but I haven't been nice about it. Which, fair enough. But this is a high-stakes issue and there's not time to be polite. In fact, I sort of want to be provocative because this conversation wasn't happening and it needs to happen. — PolitiTweet.org

Nate Silver @NateSilver538

And the record of the public health community over the course of the pandemic, as opposed to the actual science (amazing!), has been pretty poor at almost every juncture. I bite my tongue a lot but there have been many, many mistakes. — PolitiTweet.org

Nate Silver @NateSilver538

Too many responses to this assume they must possibly have some compelling rationale. They don't. They're recommendations made by a committee, and one making what are intrinsically political decisions about resource allocation. Easy to make bad policy under those circumstances. — PolitiTweet.org

Nate Silver @NateSilver538

@joel_c_miller @zeynep @mattyglesias Also, elderly people have less vaccine resistance according to nearly every survey I've seen, which is another reason to vaccinate them first. — PolitiTweet.org

Nate Silver @NateSilver538

@joel_c_miller @zeynep @mattyglesias I have and I think it's far outweighed by the fact that we could prevent 6.5% of all COVID-related deaths over the next 6 months by vaccinating the elderly first, according to ACIP's own model. — PolitiTweet.org

Nate Silver @NateSilver538

@kdrum You're looking at the wrong slide on averted deaths. Give that we have a disease-blocking vaccine and not just an infection-blocking one, you need to look at slide 21, which shows a lot of lives would be saved by prioritizing the elderly. https://t.co/Frnr4iFSoe — PolitiTweet.org

Nate Silver @NateSilver538

@kdrum I'm not sure what we're arguing about? It's completely insane IMO to not put 65+ ahead of pre-existing conditions (perhaps with some very precise exceptions, but most pre-existing conditions aren't remotely as much of a risk factor for severe disease as age). — PolitiTweet.org

Nate Silver @NateSilver538

@kdrum It isn't in the ACIP recommendations. Some states are sensible enough to be prioritizing age, though. — PolitiTweet.org

Nate Silver @NateSilver538

@kareem_carr Elderly people are also more likely to be hospitalized, so it's actually even worse than the chart I cited implied. They're both more likely to be hospitalized and more likely to die conditional on that. — PolitiTweet.org

Nate Silver @NateSilver538

It's also pretty embarrassing for the public health profession that it's largely outsiders like me and @zeynep and @mattyglesias who are **actually looking at the scientific evidence** and pointing out these obvious problems and that there aren't more critiques from within. — PolitiTweet.org

Nate Silver @NateSilver538

Age needs to be a higher priority than pre-existing conditions in vaccine rollout plans. Or a lot of people are going to die, unnecessarily. It really is that sample. — PolitiTweet.org

Nate Silver @NateSilver538

I am sorry to be a broken record, but it is completely indefensible that ACIP presents data like this showing that age is a FAR bigger risk factor for dying of COVID than pre-existing conditions & yet puts them on the same tier for vaccine prioritization. https://t.co/mdccG7VHXl https://t.co/nzOwim3hMl — PolitiTweet.org

Nate Silver @NateSilver538

Me too — PolitiTweet.org

Nate Silver @NateSilver538

@WesPegden @BallouxFrancois I think it's also recognizing that the vaccine distribution process is intrinsically political (in part). I don't mean that in a pejorative sense. Just that these are complicated resource-allocation decisions, and politics (defined both broadly and narrowly) come to bear on them. — PolitiTweet.org

Nate Silver @NateSilver538

@CT_Bergstrom 3) I think it is pretty close to indefensible for ACIP to define a broad enough group of pre-existing medical conditions to encompass 100+ million people as being on the same pedestal as being age 65+. Even their own data shows the risks aren't remotely comparable. — PolitiTweet.org

Nate Silver @NateSilver538

@CT_Bergstrom 2) I can see various arguments for essential workers based on reducing infections and achieving herd immunity faster. Can also see some ethical and economic arguments. I wish essential workers were defined more precisely though (eg as workers in close contact with other people). — PolitiTweet.org

Nate Silver @NateSilver538

@CT_Bergstrom So, a few things: 1) I do think for age 75+, it's a no-brainer. It's a small percentage of the population so you're not using up too many doses and obviously it's very deadly for that group. Start with healthcare workers & nursing homes, then 75+, then we get harder choices IMO. — PolitiTweet.org

Nate Silver @NateSilver538

But the job categories in gray on this chart—jobs that are "essential" but *not* frontline—tend to be in politically powerful industries. So when guidelines refer to essential rather than frontline/on-site work, they may be a reflection of that power. — PolitiTweet.org

Nate Silver @NateSilver538

Frontline also sets up a more objective test. Have you been required to work on site for the past 9 months? If so, maybe you'd get priority for vaccines. If not, you wouldn't. (If the answer is "sometimes", maybe you're in tier 2a or whatever.) — PolitiTweet.org

Nate Silver @NateSilver538

Another underappreciated distinction is between "essential" and "frontline" workers, with frontline defined as people who can't perform their jobs from home. The case for frontline workers getting vaccine priority >> essential but not frontline. https://t.co/Ix8LfjhKcV https://t.co/mOVBk4xMDH — PolitiTweet.org

Nate Silver @NateSilver538

Again from NYC's data, these are some alarmingly high death rates for Black and Hispanic residents from COVID-19. But especially for Black and Hispanic people aged 65+. https://t.co/wIcwyNpmIU https://t.co/oJFSD9Ruzz — PolitiTweet.org

Nate Silver @NateSilver538

@bendreyfuss That might actually be an argument *for* letting some people buy the vaccine so they don't develop workarounds that fuck up the system for everyone else. Auction off a small fraction of doses, give the proceeds to schools that had their budgets cut & failing small businesses. — PolitiTweet.org

Nate Silver @NateSilver538

Note also from their materials that prioritizing people with pre-existing conditions isn't projected to save nearly as many lives as prioritizing based on age. So they're basically ignoring their own data. — PolitiTweet.org

Nate Silver @NateSilver538

But then in the next slide they say "differences among 3 strategies is minimal". Really? That doesn't sound minimal to me. And (as they note) implementation is easier if you do it based on age because it's a more objective criterion. https://t.co/wPVx5tE3q5 — PolitiTweet.org

Nate Silver @NateSilver538

ACIP estimates that if a vaccine is introduced at a time when cases are rising (i.e. now), prioritizing people aged 65+ would avert approximately 6.5% of COVID-related deaths over the next 6 months. That's quite a lot; maybe ~30k given current death rates. https://t.co/mdccG7VHXl https://t.co/tjJe9ffiEk — PolitiTweet.org