Thread by @WhitneyEpi

Some observations from reactions to my thread from last wkend (thank you all. I really appreciate all of you): 1/

https://twitter.com/WhitneyEpi/status/1340854715068891136?s=20

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1. Great question from @drjenndowd: Let’s say one is open to idea that some exposure & infection differentials in the population (left & right circles) are as great as age-susceptibility differentials (bottom circle):
How can I calculate this all out?

https://twitter.com/drjenndowd/status/1341395257313865733?s=20

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Similar point addressed by the author of a great modeling paper on #COVID19 vaccination: we don’t have the data! 3/

https://twitter.com/bubar_kate/status/1341479807310163968?s=20

Some settings-prisons, long-term care facilities-so clearly super-spreaders (intersection of left & right circles) & have high enough % of vulnerable (bottom circle) that it’s impossible to ignore that people living there at extremely high risk of #COVID19 death (dark green). 4/

But why don’t we have precise data? And why data limited for other settings? There’s rich history of exposure & risk assessment in occupational #epitwitter. Indexing #SARSCoV2 infection risk by occupation & social context totally doable by experts at @CDCgov, @NIOSH, etc... 5/

And we even have charts like this based on old @USDOL data [*Warning: this chart says “COVID-19”, but data about other infectious diseases. X-axis generally indicates high #SARSCoV2 exposure (left circle in Venn) but not infection risk (right circle)] 6/

https://twitter.com/WhitneyEpi/status/1280280299524538368?s=20

(Here’s more detail about the source of that figure: 7/
nytimes.com/interactive/20… )

Anyway, these data are knowable. If fed govt wanted studies on occupational & social factors for #SARSCoV2 infection, we'd have good calcs to identify 1) those in dark green (highest death risk) & 2) light green (exp & infection risk so high may counteract lower risk from age)8/

But, to my knowledge, US doesn’t have stats, I think bc some powerful business interests don’t want the their workers' #COVID19 infection risk (intersection of left & right circle) quantified 9/
(*this ultimately didn't become law--yet)
vox.com/2020/7/29/2134…

2) Other feedback! Several people pointed me to the work of @bubar_kate with colleagues @StephenKissler @mlipsitch @sarahcobey @yhgrad
@DanLarremore (all these folks are doing great work!):

https://twitter.com/bubar_kate/status/1304472235214741504?s=20

2a)Their preprint reminded me that #COVID19 death not only outcome to optimize; also stopping #SARSCoV2 transmission. Since not clear how well US-approved vaccines reduce transmission, I didn’t comment on this. But, for curious, light green is who you’d target first for that: 11/

2b) Preprint concludes that targeting 60yo+ reduces deaths most, but acknowledges that models didn’t account for heterogeneity of exposure & infection risk in popn. Maybe it wouldn’t make difference in results but maybe it could (thrust of Point 1): 12/

https://twitter.com/bubar_kate/status/1304472253640269825?s=20

2c) Preprint also reminded me of important factor I totally left out of my diagram: previous #SARSCoV2 infection! This is MAJOR factor *dramatically* reduces risk of being infected. Label for right circle should also include “no recent #SARSCoV2 infection”
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Impact of previous infection is an important but complicated topic, esp considering that communities already hit hard by virus may still have many high-infection-risk folks. I appreciate the consideration of this topic in the paper’s Discussion medrxiv.org/content/10.110… 14/

3. The last thing I want to discuss is Power. Another explanation (besides young age) for front-line Standard residents being de-prioritized for #COVID19 vaccine: database didn’t have info on them for 3 important job variables that went into algorithm 15/

https://twitter.com/_KarenHao/status/1341025052242964488?s=20

This would be laughable if it weren’t so serious. But it’s also a dodge. If senior executives were subject to same kind of data error, would have been fixed before rollout. At least, that’s my opinion based on studying health inequities for past 19 yrs. It’s so predictable...16/

For more on issues of power among employees in health care systems, I liked this paper from the spring: 17/

https://twitter.com/WhitneyEpi/status/1283393187961344000

My final point on power and how it drives inequities in health comes courtesy of Florida’s governor: 18/

Two days ago, the governor issued an executive order overriding his state’s Dept of Health and federal guidance about vaccine distribution. Essential workers are out, anyone 65+ is in:
19/ flgov.com/wp-content/upl…

Me: This seems fine, right? Older people are great majority of #COVID19 deaths. So it’s fine..

Me:

Me:

Me: You’re 20 tweets deep into this! You know where this is going! This is DeSantis giving first dibs to folks at the bottom of diagram instead of old in dark green! 20/

How many people in Florida are over age 65? ~4.5 million

How many doses of vaccine does Florida have? getting 367,000 doses next week

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But why would the governor give priority to such a huge group of people for such a small number of doses if the goal is to reserve limited vaccine for the very highest risk people?

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What will be the effect of the governor overriding public health guidance to make such a *huge* prioritization group?

Who do you think will get these precious doses of vaccine?

I hope it’s the highest risk folks in the dark green part of the Venn diagram!
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Well, let’s take a look! As Governor made the big announcement, a new group were getting vaccinated! “DeSantis did not say why the residents who were vaccinated Tuesday were chosen. But some were longtime leaders in the local Republican party.” 24/
dailycommercial.com/story/news/202…

Those lucky folks live in The Villages. I’ve never been there, but it looks lovely! It’s even been called “Disneyland for adults”!
southeastdiscovery.com/blog/2017/05/t…
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Meanwhile, in Seminole county, vaccination appts filled up within hours. Who do you think got those appointments? Do you think it was the high-risk 80yo who lives in a townhouse in Sanford with her nurse daughter & 29yo waitress granddaughter? 26/

https://twitter.com/WDBONews/status/1342045141180116993?s=20

I am tired. I am tired of all the death. I am tired of people in power shoving our loved ones off the cliff & telling us they are doing us a favor. I am tired of waking up every day worried that I’m going to get another phone call that someone I love is dead from #COVID19
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So anyway... Merry Christmas. So many of you are striving to do the right thing. You are tired & lonely but still doing your best and sacrificing for the greater good. I see you. And I am praying for all of us. 28/28