COVID-19 vaccine rollout thoughts:
1) IT'S AMAZING THAT WE HAVE HIGHLY EFFECTIVE VACCINES ALREADY. This kept me from succumbing to despair with the second wave, really.
2) SEEING ADVOCACY to get it earlier is in some ways cheering- people value want, trust this protection
BUT
1/

...every special group I've seen mentioned for earlier access has raised very good points, but the reality is all can't be first, because of a hard limit on supply. We need to agree on principles, such as:
Save lives, avoid excess complexity, be transparent.
Things we know:
2/

-the biggest predictor of hospitalization and death is AGE
-a huge component of risk of disease is CONGREGATE LIVING.
-we need health care to function to look after COVID and everyone else who is sick.
COVID10 deaths in Canada are driven by long term/personal care settings
3/

Vaccine priorities:
Alberta's LTC mortality at 11% is tragic enough but Canadian avg is 21%.
Alberta COVID19 mortality overall is 1%.
Adults 20-70 years comprise 73% of all cases and 14% (171) of deaths
>70 years are only 7.7% of cases but 85.8% (1045) of deaths.
4/

What about health care staff?
About 5% of HCW have tested positive, compared with roughly 2.5% of population. HCW are 5x more likely to be tested. ~1/3 of investigated cases are work acquired.
HCW are 3-4% of COVID-19 cases overall in AB, and there have been 3 deaths in HCW...
5/

So how do we balance this?
Provinces are looking at numbers like this and the thoughtful NACI guidance at https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/guidance-key-populations-early-covid-19-immunization.html...
6/

And trying to apply our common values while creating workable systems is tough: once we start looking at "chronic medical conditions" and any of the many flavours of immune differences in the population, it gets very complex very quickly. Research around risk factors...
7/

shows many "iffy" associations with different medical conditions, so agreeing on "the list" of people at risk beyond age and setting (congregate living, PLUS at risk communities) is hard, and implementing risk based vaccine priorities is maybe impossible with a possibility...
8/

Of creating gaming, perceived disparities, and unhappiness well in excess of the certainties of the risk literature (see https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-risk-factors-for-severe-covid-19-outcomes-rapid-review.pdf and https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-immunosuppression-and-covid-19-risk-rapid-review.pdf for examples
9/

All to say - I see LTC staff and residents as arguably a bigger priority than HCW based on their extremely high risk of death (11 % versus .07%) but also see that illness in HCW is definitely a concern. It feels astonishingly cold blooded to even talk through this, and...
10/

My public health colleagues across Canada are amazing at incorporating many viewpoints, and ethics into their decisions. I hope we get to see more detail and transparency around considerations they are making and I also hope people respect how tough these decisions are.
11/

Everyone:
-is at risk
-counts
-want to protect their loved ones.
So, application of serious kindness and strong Canadian community values
and
doing the right things well as we wait are the way we will get through rollout.
#DistanceHandwashMask, reduce contacts, be safe.
/fin