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Govind Persad Profile picture
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20 Dec, 6 tweets, 3 min read
For those following #ACIP vaccine prioritization debate - proposal to have 75+ alongside frontline workers in phase 1B is interesting, and different from prior discussion. But there are still pitfalls with any age cutoff, whether 75 or 65, as I explained in a comment to ACIP /1
Down Syndrome deaths are disparately high and happen before 75. 54%, 61%, and 69% of Black, Hispanic, and AI/AN deaths (respectively) happen before 75. I haven't seen US data on income x age at death, but a similar gradient is plausible, and may help explain the race data. /2
So I continue to think #ACIP should encourage states & localities to look at overlapping risk factors like housing+age as LTCF priority did and @CDCDirector suggested, rather than using age cutoffs that sweep in ppl at very different risk & exclude some /3
Also, as i pointed out to a Twitter luminary yesterday, the public cares about a lot of different values--and doesn't want grocery workers or teachers or ppl w Down Syndrome going behind all people of a given age /4
(If you're wondering why I didn't sign up to give an oral public comment: I did. The ACIP comment lottery didn't pick me. It did pick my co-author, a doc/MPH who'd have been great. But she couldn't answer the email in time-pitfall of allocation-& seems to have lost her spot.) /5
One more thought about how #ACIP could still do better at framework of aligning rather than conflicting values: /6

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More from @GovindPersad

Govind Persad Profile picture
20 Dec
Last (grumpy) thread about #ACIP vax prioritization before bed. Sure, there are some hard tradeoffs, though looking for overlapping risk should make it easier, & ACIP could have had better framing. But critics have been a real mess. Exhibit A, dishonest quoting (aka lying): 1/6
Redfield: need to"demonstrate that we as a Nation also prioritize the elderly (>70 yo) who reside in multi-generation households. Often our Hispanic, Black and Tribal Nations families care for their elderly in multigenerational households and they are also at significant risk."2/
Here, current @CDCDirector Redfield (hardly "Mr. Woke"), after endorsing long term care priority, is sensibly arguing for another multi-factor (age+housing risk) priority similar to LTCF, which would also address disparities for "Hispanic, Black, and Tribal Nations families" 3/6
Read 7 tweets
Govind Persad Profile picture
19 Dec
Thread on interconnected #bioethics problems in #COVID19 vaccine allocation: (1) the Stanford med center allocation debacle, (2) Rupert Murdoch, and (3) high-profile calls for age-only (“oldest first”) allocation policies. If you like (3), unfortunately you get (1) and (2). 1/7
People are right to be upset w/Stanford: see @CarolineYLChen excellent piece . But it’s not “algorithms”, it’s inputs. If your inputs are too simplistic (age-only, ignore exposure or medical risk), you get bad outcomes, e.g. no residents, senior WFH 1st 2/7
Same w/ Murdoch: . People are right to be upset. But age-only priority like the UK (start w/85+ or 90+), ends up prioritizing Murdoch over a 60 yo bus driver. Who lives to 90? We know the answer: more often, wealthier people. Need to consider other risk 3/7
Read 9 tweets
Govind Persad Profile picture
16 Apr
This op-ed by Harald Schmidt @PennMEHP is a hugely valuable contribution to the #bioethics debate over ventilator allocation, & would have applications to other scarce resources as well. Some thoughts /1
Modifying SOFA score w/"weights" based on race would be struck down in federal court (& certainly by this SCOTUS) under #ParentsInvolved precedent scholar.google.com/scholar_case?c…. Not endorsing that precedent, but crucial to recognize it. Area Deprivation Index is better approach /2
Rather than using Area Deprivation Index "weights" to adjust SOFA scores, it would be better to use the Area Deprivation Index as a tiebreaker within each SOFA-score group ("red" to "green"). Would likely save more lives of disadvantaged patients /3
Read 9 tweets
Govind Persad Profile picture
12 Mar
Glad to be able to contribute to growing discussion on a timely and crucial topic--fair health care allocation in the Covid-19 pandemic--alongside Zeke Emanuel & @DrPhillipsMD: nytimes.com/2020/03/12/opi…. A quick summary of our recommendations (mini thread)
1.The group getting first priority should be health care workers and other first responders.
2.For scarce curative interventions, like ICU beds and ventilators, the priority should be (1) saving as many people as possible, and (2) treating those who are likely to benefit most from care. This means treatment should not be allocated on a first-come-first-served basis.
Read 11 tweets

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