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I spent a few days before Xmas checking in our mayors in #IL06. Wanted to share some observations on a common theme that came up, and how you all can help: the COVID vaccine distribution process. Thread.
1/ First, the process is heroic, noble, unprecedented and chaotic. Good people trying to scale something massive, building the tools as they build the house in real time.
2/ Seen from some angles, that is awe-inspiring. Seen from others, it looks like a total cluster. As the old metaphor about the blind men feeling and elephant goes, we are all well served to avoid drawing conclusions from incomplete information.
3/ At the top level, public health officials have identified priority populations for distribution. In practice, identifying all those individuals in a given area, contacting them, and recording their data after vaccination and maintaining a global database is really complicated.
4/ Layer onto that a vaccine that needs to be stored at ultra cold temperatures and has a limited shelf-life once warm. What would you do if you exhaust patients in a given cohort but have 100 doses left and 6 hours before it goes bad?
5/ From a purely public health perspective, remember that the small benefit of a vaccine is the person who gets immunized. The big benefit is the hundreds-to-thousands of people who don't get infected when that person doesn't get sick.
6/ So if you're out of patients and have a few doses left, it makes sense to immunize whoever is available with those last few mL. But if that's all you see, it might look an awful lot like political favoritism, even though done for all the right reasons.
7/ And as a separate matter, while we don't WANT this process to be political, we delude ourselves if we think it is possible to be purely scientific.
8/ After all, it's one thing to know what populations are most vulnerable, but what if you can't find every relevant individual? How do you prioritize a young person with one co-morbidity but many years left to live with an old person with 3 co-morbidities?
9/ COVID has been much more deadly for African Americans, and for those without health insurance. Both of those groups also have shorter life spans than rich white people. How should you weight age vs. race in prioritizing groups for vaccination?
10/ There is no purely scientific answer to those questions, or many other of that type. @Noahpinion has written a really thoughtful piece on that specific topic: https://noahpinion.substack.com/p/vaccine-allocation-age-and-race
11/ Another tricky question: who is more worthy of vaccination: a socially-isolated person with a high risk of death if infected or a socially-gregarious person with a low-risk of death? That question can be answered with math... but you'd have to be heartless to stop there.
12/ My point isn't to answer these questions, but to ask everyone to recognize that our public health officials are grappling with all these questions in real time right now. They are doing the best they can with incomplete information. They are under tremendous stress.
13/ And to be clear, I did receive the first dose of the Pfizer vaccine, after the Office of the Attending Physician recommended all members of Congress be vaccinated to ensure continuity of government. https://casten.house.gov/media/press-releases/casten-statement-receiving-covid-19-vaccine
14/ So did my colleagues who were telling people not to wear masks. And I'm OK with that. Not because it's fair but because all of us come into contact with lots of folks every day & have the potential to be super-spreaders.
15/ We will get to the end of this pandemic by wearing masks, socially distancing and getting vaccinated as soon as we can to accelerate the arrival of herd immunity.
16/ But in the meantime, we have more need than doses. And every public official involved has responsibility in excess of their authority. Everyone I've talked to from the local village manager to the top of our federal government is feeling that stress right now.
17/ None of them are perfect. All of them can acknowledge a thousand things they would have done differently if they knew then what they knew now. But overall they are doing a heck of a job under really trying circumstances. Show them some love. Be patient. Stay safe. /fin
