The covid-19 vaccine rollout

There are over 17 million confirmed covid-19 cases in the US and over 300,000 dead, a staggering number thanks to our idiot president’s refusal to acknowledge the disease and take strong action early on. That works out to about 5% or the population or one in twenty who have tested positive. I read sometime ago that half the population knows at least one person personally who has tested positive and one third knows someone who has died.

Since I live alone and have been able to minimize contact with people, I was not surprised that until recently, I did not know anyone in either category. But last week a friend who lives nearby said that she had tested positive and had been isolating for the required period and then tested negative. She had no idea how she got infected because she had been working from home and only gone in to work about once a week and nobody else in her workplace had tested positive. But of course she has to do some shopping and the like and that may be how she got it.

I received a notification from my health insurance company that said that when the vaccines are available, they will be made available to us through the pharmacy chain that they work with and that it will be free of charge. But of course they do not know at this time when that will be.

Since the supplies are limited, once the people who are top priority get it and it becomes available to the rest of us, there will have to be some decision rules to determine the order. Right now the priority categories are broad but they will have to become more fine-grained. For example, though I am in the high risk category because of age, I am low risk in terms of my lifestyle. While older people who live in nursing’s are very high risk and should get the vaccines as soon as possible, it would make more sense to prioritize people who have to work in grocery stores and the like, whatever their age, over people like me because they are in constant contact with a large number of people and are more likely to both contract and spread the virus.

The rapid rise in infections is because more young people are getting infected. On the other hand, mortality rates rise rapidly with age and for men more than women.

For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die. For people in their fifties and early sixties, about five will die — more men than women. The risk then climbs steeply as the years accrue. For every 1,000 people in their mid-seventies or older who are infected, around 116 will die. These are the stark statistics obtained by some of the first detailed studies into the mortality risk for COVID-19.

So decisions will have to made based on whether the goal should be to minimize the infection rate or the death rate. This is where medical ethicists get to really earn their salaries. Once the high risk categories have been vaccinated, the order of the rest may have to be based on a lottery of some kind, perhaps based on their birthdays, like the Vietnam war draft was. That would be somewhat equitable.

It would help if everyone took as many precautions as possible until everyone is vaccinated. But some still continue to defy common sense. Trump still has not come out strongly urging everyone to get vaccinated but at least his vice president Mike Pence is going to get publicly vaccinated on Friday. It will be interesting to see how the anti-vaxxers respond,


  1. anat says

    There are additional considerations besides death vs infection rates. There is the risk of severe lasting effects such as losing limbs due to blood clots or having a long-haul recovery. There are going to be many people disabled by this disease.

  2. brucegee1962 says

    The number of people you come in contact with in a day seems important. I’d give a high priority to checkout workers in supermarkets, for instance.

  3. Matt G says

    The most serious issue appears to be D&D -- distance and duration around someone who is positive. I don’t get the sense that the short interactions people have in public play a big role in transmission. The dangerous interactions are in bars/restaurants, churches, etc. where people are in close proximity for a prolonged period. And, in the cases of churches, scientifically challenged….

    The mixed messages coming from government officials of a certain *ahem* persuasion is a classic tactic. People loyal to you who are kept confused about your position are more easily manipulated.

  4. says

    I spent hours last night unpacking a disinformation piece by a stealth anti-vaxxer. [stderr] -- I suppose it was inevitable that there would be anti-vaxxers jumping all over the interwebs to try to sow fear, uncertainty, and doubt, but it only serves to confirm my low opinion of the worst of humanity.

  5. billseymour says

    Wouldn’t checkout clerks in supermarkets fall into the general category of “essential workers?”  IIRC, they’re in “phase 1B,” right after front line health care workers and folks in nursing homes.

    I check off two boxes for phase 1C:  I’m an old fart, and I have diabetes.

    I agree that folks like supermarket workers should get prioritized before me.  Although I’m at high risk for getting serious complications from the disease, I’m at low risk for catching it:  I’m fortunate that I can work from home, I live alone, and I hardly ever leave my apartment except for quick runs to the grocery store.

  6. says

    So decisions will have to made based on whether the goal should be to minimize the infection rate or the death rate.

    Does the vaccine protect people from disease or infection? If it protects from disease, a vaccinated person can still get infected (without symptoms of the disease) and potentially spread the infection to those around them who are not yet vaccinated and much more likely to get serious disease symptoms. Such considerations also influence who ought to be vaccinated first. Scientists on TWIV talked about this problem in a recent podcast (I cannot remember if that was the latest one or the one before that).

  7. KG says

    Andreas Avester@6,
    It’s not yet know whether any of the vaccines protect against infection, or transmitting the virus to others, only that some of them protect against disease (and particularly, severe disease). In the UK, the priority order is almost entirely based on protecting those most at risk of severe disease if they get infected (health workers, and staff in care homes, are being vaccinated early, but in the former case at least, a lot of relatively young and healthy nurses and doctors have died, possibly because of getting high viral loads).

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