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Vaccine prioritization in phase II in Ontario: the province has put out a framework, which seems not unreasonable ( https://toronto.ctvnews.ca/ontario-releases-list-of-those-eligible-for-covid-19-vaccine-under-phase-2-1.5264702?cache=ngyhfzxv%3FclipId%3D104066) but is at odds with countries like Israel that have strongly prioritized vaccinating all those over 60.
All the phase 2 groups are groups we'd like to see vaccinated ASAP, but we should ensure elders 60 and over in the community, as well as congregate settings are at the front of the line.
Why?
Why?
3 reasons:
1. Risk of death
2. Impact on vanishing hospital resources
3. High likelihood of being denied access to life saving ICU care in a situation (now highly likely) where there are not sufficient ventilators and related resources to care for those who need critical care.
1. Risk of death
2. Impact on vanishing hospital resources
3. High likelihood of being denied access to life saving ICU care in a situation (now highly likely) where there are not sufficient ventilators and related resources to care for those who need critical care.
Part of the "casedemic" idiocy related to the fact that age distribution of cases is highly predictive of ICU admissions. As cases get older, ICU admissions increase. That is because older individuals are markedly more likely to experience critical illness from SARS-2.
Here's some work we did on that a couple of months ago (it needs some touching up but good enough for this conversation): https://www.medrxiv.org/content/10.1101/2020.11.16.20231399v1
Older people also have worse outcomes and longer lenght-of-stay when admitted to ICU, though many of them could survive if ICU resources were abundant.
We have known this since early days. From last February: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext
We have known this since early days. From last February: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext
Now, of course, we are facing the prospect of having to deny ICU care to individuals with limited prospects of survival in ICU. Risk of death from COVID-19 inflects around age 50, and really takes off after age 60. https://www.iheartradio.ca/newstalk-1010/news/ontario-doctors-being-asked-to-prepare-for-icu-triage-scenario-1.14374417
That's why you saw ICU docs in countries overwhelmed during the spring wave making triage decisions ("who lives? who dies?") based on age. Age is a crude measure, but is highly predictive of mortality, as we showed here (many others have shown too): https://pubmed.ncbi.nlm.nih.gov/33204755/
So in a sense, the "young old" and independent, community-dwelling older individuals are really falling through the cracks with Ontario's proposed vaccination strategy: they're both likely to require intensive care, and be the ones denied ICU in a triage/overflow situation.
We should be pushing them to the front of the line.
Family doctors and public health units know how to immunize older adults: they do it every year for influenza. They should be leading the charge.
Family doctors and public health units know how to immunize older adults: they do it every year for influenza. They should be leading the charge.
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