The @CDCgov ACIP move toward priortizing frontline workers is premised on "only slightly" more deaths compared to prioritizing by age &/or comorbidity. But that finding depends on the vaccine blocking transmission very efficiently, which we don't know.
In my opinion prioritizing by risk of death is the most robust strategy in the sense of being optimal or near-optimal whatever we find out about transmission blocking and the like. #ACIP
Notwithstanding misinterpretations and deliberate trolling from many the last few days, I have been saying for some time that in my view the most lifesaving strategy, and likely the one that will return us to functioning fastest, would be
1) Congregate settings including LTCF prisons jails shelters AND frontline HCW (incl custodial, foodserv, etc)
2)those at highest risk of dying
3) teachers because bringing them back to classrooms would help us all, and 3d priority should prep us for September
4) other frontline
Technical note: not sure why CDC slides from Dr. Dooling highlight comorbidity risks adjusted for age. Seems for prediction purposes the q is comparison of unadjusted death risk is higher with 1,2,3+ comorbidities vs various age groups

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More from @mlipsitch

6 Dec
I'm quoted in this article as saying that prioritizing vaccines for teachers is not a way to reduce health inequities. Primary & secondary teachers are not the most disadvantaged in US - they have college degrees, middle-class salaries, health insurance. nytimes.com/2020/12/05/hea…
79% are white nces.ed.gov/programs/coe/i…. Those are facts. I support putting teachers above most other same-age adults because they perform a truly essential function in person that is much harder to perform remotely. Have said so publicly statnews.com/2020/12/02/how…
And was early to refer to them as essential workers nejm.org/doi/full/10.10… along with my coauthor and spouse @meiralevinson , who was a middle school teacher for 8y
Read 8 tweets
4 Dec
This is not a done deal but could happen (teachers would likely be in the same tier). If you object, make your views known to federal and state officials. States do not have to follow federal guidance, and if this is included in federal guidance, states should decline this part.
This is not animus against financial workers, and the industry is indeed essential, even if not all its activities are. The reason to prioritize many essential workers (grocery, transit) is that they are essential and THEREFORE highly exposed. Financial services much less so.
The goal of vaccinating essential workers in this instance should be to offer protection 2 those who can't work from home and are exposed to many other people in their workday, often with no or inadequate PPE. Teachers, grocery, transit are; financial svc can often work from home
Read 7 tweets
16 Nov
24h update. They don't know what is going on. On the upside, I have learned the fascinating details of @FedEx corporate structure, that the people at @FedExHelp are helpless if you are trying to deliver to a home. Obviously it is my job to route the problem to the right person.
Since for them to do it is quite challenging. Probably requires computers and stuff, and who would expect them to be good at that?
Their customer service rep wrote: I have advised the management team on the Express side that is responsible for the pick up and the Home Delivery side that is responsible for transporting and delivering the package of the issue so it can be handled as quickly as possible.
Read 7 tweets
14 Nov
From giving advice recently to a friend who was symptomatic, got tested and was told to expect a 3-5d delay, I've come to realize a gap in our prevention approach. The advice on preventing transmission if you are infected is mainly provided through contact tracing.
That's good but it's not enough. Especially with these kinds of delays, it could be almost a week from the time someone feels the need to get tested (symptoms, poss contact, whatever) until they might get a call from contact tracers if positive.
In the interim, if they were truly a SARS-CoV-2 infection, they would likely have passed through their peak period of infectiousness, the 4-6 days or so immediately before and after symptom onset we believe.
Read 7 tweets
7 Nov
The @aier, the Libertarian think tank on an estate in Massachusetts that offered @MartinKulldorff @SunetraGupta and Jay Bhattacharya a comfy country retreat to write the Great Barrington Declaration clearly states the contents of same:
It advocates MAXIMIZING infection among the allegedly low-risk. aier.org/article/lockdo…. They should ask for their money back from Dr. Bhattacharya who argued today that it recommends trying to slow the spread. It advocates trying to speed it, as is clear from GBD's text.
This is just simply saying one thing when trying to influence policy and the opposite when trying to deflect criticism from scientists.
Read 9 tweets
7 Nov
I think @realDonaldTrump and @SWAtlasHoover were committed to a policy with no scientific basis and would have dragged the country there regardless. But GBD provided a veneer of respectability for this deliberate subversion of public health
The GBD is an extreme fringe view repudiated by a dozen public health organizations apha.org/news-and-media… and....
Read 4 tweets

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