This is a useful discussion, and highlights the continuing problem around the conflation of socio-economic inequity with racial inequity. Both are real, but they aren't synonymous, and impact and overlap one another in complicated ways. As noted in the piece, the framework proposed by the National Academies would tackle this in a rational, evidence-based approach. But this won't alleviate the consistent pull toward driving all our efforts thru a racially-tinted lens prior to implementation by government. Here's hoping that as a nation we can address this equitably, efficiently, and without our typical political rancour.
Thank you for an important discussion and a much-needed perspective. I would like to suggest two guiding principles that would lead to similar conclusions but might (!) be an easier point of agreement to start from.
A. Make it voluntary, at least until all those who want it have gotten it. B. Save as many life-years as possible.
Principle B may need defending. But first, I think most would agree with "saving lives." Obviously, that means first of all protecting health-care workers (#2 above). It also means protecting those most likely to get sick (#1 above) and most likely to transmit it (#3 above). Furthermore, it says to ignore ethnicity, income, etc. as direct decision variables -- the main point of this article. (Of course, as pointed out, protecting those most in danger will correlate with ethnicity and income.)
So principle B seems to be the underlying principle of the article, and I think it would help to articulate that, because it seems so easy to agree on, with one exception ...
Older folks are far more at risk once they catch COVID than young people, and this is taken into account by the National Academies proposal mentioned above. But it should be noted that this will tend to overwhelm many other factors. The CDC says someone who is 85+ is 630 times as likely to die as someone who is 18--29. (Full disclosure: I'm only about 80 times more likely...)
The counter-argument to simply using the risk-of-death factor (e.g. 630 times) is that it's more tragic when a 25-year-old dies than when a 90-year-old dies, because many more years of life are lost. I agree with that logic. It would cause bickering to try to fine-tune life expectancy estimates, but the risk to older folks could easily be adjusted using social-security life-expectancy tables. And that's what I have in mind for principle B when I say "life-years."
Zip code is an intriguing idea
This is a useful discussion, and highlights the continuing problem around the conflation of socio-economic inequity with racial inequity. Both are real, but they aren't synonymous, and impact and overlap one another in complicated ways. As noted in the piece, the framework proposed by the National Academies would tackle this in a rational, evidence-based approach. But this won't alleviate the consistent pull toward driving all our efforts thru a racially-tinted lens prior to implementation by government. Here's hoping that as a nation we can address this equitably, efficiently, and without our typical political rancour.
How about doing it by prevalence in particular zip codes? The ones that have the most deaths or hospitalizations or other non-racial metric
Thank you for an important discussion and a much-needed perspective. I would like to suggest two guiding principles that would lead to similar conclusions but might (!) be an easier point of agreement to start from.
A. Make it voluntary, at least until all those who want it have gotten it. B. Save as many life-years as possible.
Principle B may need defending. But first, I think most would agree with "saving lives." Obviously, that means first of all protecting health-care workers (#2 above). It also means protecting those most likely to get sick (#1 above) and most likely to transmit it (#3 above). Furthermore, it says to ignore ethnicity, income, etc. as direct decision variables -- the main point of this article. (Of course, as pointed out, protecting those most in danger will correlate with ethnicity and income.)
So principle B seems to be the underlying principle of the article, and I think it would help to articulate that, because it seems so easy to agree on, with one exception ...
Older folks are far more at risk once they catch COVID than young people, and this is taken into account by the National Academies proposal mentioned above. But it should be noted that this will tend to overwhelm many other factors. The CDC says someone who is 85+ is 630 times as likely to die as someone who is 18--29. (Full disclosure: I'm only about 80 times more likely...)
The counter-argument to simply using the risk-of-death factor (e.g. 630 times) is that it's more tragic when a 25-year-old dies than when a 90-year-old dies, because many more years of life are lost. I agree with that logic. It would cause bickering to try to fine-tune life expectancy estimates, but the risk to older folks could easily be adjusted using social-security life-expectancy tables. And that's what I have in mind for principle B when I say "life-years."
In any case, I think it makes discussions more sensible if they can be based on simple principles, at least when those are easier to agree on than all the ramifications. I hope that could help in this case. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html