Vaccination Distribution Plans - the Looming Political Disaster - Printable Version
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RE: Vaccination Distribution Plans - the Looming Political Disaster - BostonCard - 10-24-2020
(10-24-2020, 07:51 PM)old spanish trail Wrote: Good point,Tim. My guess is that minorities are higher in the pyramid for vaccinations because of their higher degree of comorbidities due to lack of good medical care, basic poverty, crowded living conditions, etc. GR, your disdain for these arguments is baffling.
If you read GR's post closely, he doesn't show disdain for those arguments, just for using race as a proxy for these factors. He advocates for using whatever factors are associated with COVID-19 in a race neutral fashion, so that, if poverty is associated with death, then priority can be given to the poor, regardless of race.
One of the points I was trying to make is that there remains an association between race and COVID mortality even if you account for all of these things. That doesn't mean that there is a biological effect of race on mortality, but rather that it is impossible to measure and account for all the factors that could be associated with mortality, a concept known as unmeasured confounder.
By the way, someone asked about genetics. We do know that ABO blood group is associated with severe COVID, with patients with type A blood more at risk than those with type O blood. As it turns out, African Americans are more likely to have type O blood than whites. So, if anything, their ABO blood type should be a bit protective.
BC
RE: Vaccination Distribution Plans - the Looming Political Disaster - akiddoc - 10-24-2020
Yes, GR has crusaded for quite some time for his belief that there is no significant racism left in the United States. He feels insulted if there is any attempt to correct for it. He sees the vaccine distribution plan as somehow tied up in that effort.
RE: Vaccination Distribution Plans - the Looming Political Disaster - dabigv13 - 10-25-2020
https://www.wsj.com/articles/health-agency-scraps-coronavirus-ad-campaign-leaving-santa-claus-in-the-cold-11603630802
Been worrying about the wrong questions here. The true looming political disaster is ensuring enough vaccine supply for the nation's Santas, Mrs. Clauses, and the elves.
If it feels like a joke, then it perfectly sums up the federal response.
[Tweet] https://twitter.com/david_j_roth/status/1320379999984156672?s=20[/tweet]
RE: Vaccination Distribution Plans - the Looming Political Disaster - Genuine Realist - 10-25-2020
(10-24-2020, 10:52 PM)akiddoc Wrote: Yes, GR has crusaded for quite some time for his belief that there is no significant racism left in the United States. He feels insulted if there is any attempt to correct for it. He sees the vaccine distribution plan as somehow tied up in that effort.Any person who thought there was no significant racism left in the US is an idiot, and I don't think I am one. The more relevant question is how you approach the practical problem of how you make the social progress you'd like to make in this society. And there you have some issues, if you're not so wedded to your own hidebound notions of American society from two generations ago. Newsom's easy, erroneous generalization is typical and illustrative.
Background. A century ago, in 1920, race was a fairly easy category for social change. There were segregated schools, racial covenants, laws not often enforced) against interracial marriage, 'passing' , etc. A Black person, no matter how well situated, was restricted in where he or she could live, be educated, etc. But between 1954 and 1980, at the institutional legal level, all that changed. These days the same Black person can live where he or she likes, educate their children where they wish, marry whomever [the percentage of biracial marriages continues to rise], etc. A person looking for statutory reform is likely to be frustrated. It's all been done. Hence the discussions these days of 'systemic racism', the most defining characteristic of which is its vagueness.
So where does racism persist? In the cultural baggage which inflicts the community, and to some extent the Hispanic community - lowered expectations, poorer educational prospects, and so on. A disproportionate number of African-Americans and Hispanics are impoverished and working in lower paying jobs, living in poorer communities, etc. But there are no formal barriers. Win the genetic lottery, with superior intellectual or athletic ability, or the actual lottery, and you can move away, and live where you like.
But the tendency to characterize problems in racial categories persists. Bringing this back to Covid, you read over and over that the virus hits minorities hardest. But why? It's an airborne virus that seems to infect without any specificity based on race. There is no genetic predisposition to be infected. (Spare me the analogy to sickle cell anemia.) Wealth doesn't particularly help - there was a super spreader event in the Rose Garden. It's not related to sanitation like cholera (and the suggestion itself is mildly offensive.) To the extent that there is greater impact, it can only be because of lifestyle (which is also offensive, so will be disregarded) and occupational hazard.
So prioritize the occupational hazard. To the extent that the distribution occupations are disproportionately filled by ethnic minorities, you will do your racial remediation automatically - it's built into the formula. But you will not outrage Caucasian workers in the same occupation who take the same risks and presumably have the same higher incidence rate (no one is measuring that), and who are as deserving as their fellow risk-takers.
This in microcosm is what ails the Democratic Party. The wealth initiatives that I would love to see enacted depend on a Big Tent, because the plutocracy is infinitely resourceful and neither of the major parties responsive. But when you examine the social frustrations that arise out of the wealth gap - the endangered middle class, the vanishing economic frontier - and focus only on the racial identity of one group, you infuriate the other. Then, because they know you don't give a damn, they enter the voting booth and vote for Trump.
The classic Nineteenth Century mechanism of the Southern aristocracy for maintaining power was to set have-not Whites against have-not Blacks on a racial basis, when their actual problems were far more alike than different. You may not recognize the same strategy in play in contemporary politics. I see it very clearly. It is strikingly evident in Newsom's naively cynical formula.
RE: Vaccination Distribution Plans - the Looming Political Disaster - BostonCard - 10-25-2020
GR, I think you have too narrow a view.
First, there are two factors that affect minorities. The first one is the likelihood of getting the virus, which is related to things like occupation, living conditions, etc. The second one is the likelihood of dying once they do get the virus, which is also higher. Some of that is due to comorbid conditions, but not all of it is.
Here are some plausible hypotheses:
1) Access to medical care.
2) Willingness to seek medical care for a number of reasons:
a) Distrust of the medical system.
b) Fear of financial impact or other social impact.
c) Lower health literacy.
3) Access to experimental therapy.
4) Quality of care rendered.
5) Limited social support system.
6) Lower socioeconomic status
7) Higher stress (associated with a whole host of adverse medical outcomes)
8) Poorer care for comorbid conditions (for example, not all diabetes is the same, and someone who has well-controlled diabetes is going to do better than someone who has long-standing uncontrolled diabetes).
And I am sure there are a lot of other factors that I haven't even thought of. SOme of those can be measured; others, like distrust of the medical system are harder to measure. Race and ethnicity are poor proxies for many of these factors, but sometimes they are the only measurable proxy, or the only proxy that can, in one fell swoop, account for the hundreds if not thousands of such unmeasured confounders.
BC
RE: Vaccination Distribution Plans - the Looming Political Disaster - Genuine Realist - 10-25-2020
(10-25-2020, 01:29 PM)BostonCard Wrote: GR, I think you have too narrow a view.None of these factors (and I don't quarrel with any of them) reflect governmental policy or the proverbial barriers. All of them reflect the cultural overhang I mentioned.
First, there are two factors that affect minorities. The first one is the likelihood of getting the virus, which is related to things like occupation, living conditions, etc. The second one is the likelihood of dying once they do get the virus, which is also higher. Some of that is due to comorbid conditions, but not all of it is.
Here are some plausible hypotheses:
1) Access to medical care.
2) Willingness to seek medical care for a number of reasons:
a) Distrust of the medical system.
b) Fear of financial impact or other social impact.
c) Lower health literacy.
3) Access to experimental therapy.
4) Quality of care rendered.
5) Limited social support system.
6) Lower socioeconomic status
7) Higher stress (associated with a whole host of adverse medical outcomes)
8) Poorer care for comorbid conditions (for example, not all diabetes is the same, and someone who has well-controlled diabetes is going to do better than someone who has long-standing uncontrolled diabetes).
And I am sure there are a lot of other factors that I haven't even thought of. SOme of those can be measured; others, like distrust of the medical system are harder to measure. Race and ethnicity are poor proxies for many of these factors, but sometimes they are the only measurable proxy, or the only proxy that can, in one fell swoop, account for the hundreds if not thousands of such unmeasured confounders.
BC
More than that, very few of them apply to that sizable fraction of the demographic that stands on the other side of the wealth divide. I'm not going to grant a preference to a wealthy minority resident of Atherton or Los Altos Hills simply on the basis of ethnicity. That is actual racism,
RE: Vaccination Distribution Plans - the Looming Political Disaster - BostonCard - 10-25-2020
(10-25-2020, 02:45 PM)Genuine Realist Wrote: None of these factors (and I don't quarrel with any of them) reflect governmental policy or the proverbial barriers. All of them reflect the cultural overhang I mentioned.
More than that, very few of them apply to that sizable fraction of the demographic that stands on the other side of the wealth divide. I'm not going to grant a preference to a wealthy minority resident of Atherton or Los Altos Hills simply on the basis of ethnicity. That is actual racism,
I wasn't saying they did. I was just saying that they are factors that might result in Black and Hispanic victims of COVID-19 dying at a greater rate than whites. If you talk about vaccinating the most vulnerable first, and your research finds that Black and Hispanic patients are disproportionately dying, and you can't find (or measure) the underlying factors that explain that difference, then you will either have to accept using race as a blunt proxy and realize that some otherwise lower risk people might inadvertently be given priority or accept that you will not give a bunch of higher risk people priority.
BC
RE: Vaccination Distribution Plans - the Looming Political Disaster - old spanish trail - 10-25-2020
(10-24-2020, 10:00 PM)BostonCard Wrote:(10-24-2020, 07:51 PM)old spanish trail Wrote: Good point,Tim. My guess is that minorities are higher in the pyramid for vaccinations because of their higher degree of comorbidities due to lack of good medical care, basic poverty, crowded living conditions, etc. GR, your disdain for these arguments is baffling.
If you read GR's post closely, he doesn't show disdain for those arguments, just for using race as a proxy for these factors. He advocates for using whatever factors are associated with COVID-19 in a race neutral fashion, so that, if poverty is associated with death, then priority can be given tothe poor, regardless of race.
One of the points I was trying to make is that there remains an association between race and COVID mortality even if you account for all of these things. That doesn't mean that there is a biological effect of race on mortality, but rather that it is impossible to measure and account for all the factors that could be associated with mortality, a concept known as unmeasured confounder.
By the way, someone asked about genetics. We do know that ABO blood group is associated with severe COVID, with patients with type A blood more at risk than those with type O blood. As it turns out, African Americans are more likely to have type O blood than whites. So, if anything, their ABO blood type should be a bit protective.
BC
Fair enuf re GR, and I agree with your general conclusion.
RE: Vaccination Distribution Plans - the Looming Political Disaster - Genuine Realist - 10-25-2020
(10-25-2020, 02:51 PM)BostonCard Wrote:BC,(10-25-2020, 02:45 PM)Genuine Realist Wrote: None of these factors (and I don't quarrel with any of them) reflect governmental policy or the proverbial barriers. All of them reflect the cultural overhang I mentioned.I wasn't saying they did. I was just saying that they are factors that might result in Black and Hispanic victims of COVID-19 dying at a greater rate than whites. If you talk about vaccinating the most vulnerable first, and your research finds that Black and Hispanic patients are disproportionately dying, and you can't find (or measure) the underlying factors that explain that difference, then you will either have to accept using race as a blunt proxy and realize that some otherwise lower risk people might inadvertently be given priority or accept that you will not give a bunch of higher risk people priority.
More than that, very few of them apply to that sizable fraction of the demographic that stands on the other side of the wealth divide. I'm not going to grant a preference to a wealthy minority resident of Atherton or Los Altos Hills simply on the basis of ethnicity. That is actual racism,
BC
At this point I'm going to appeal to your skill as a medical scientist, and then call halt. If there is no biological factor that accounts for the statistical discrepancy, then by process of elimination, we must be talking about socio-econometric factors. (Given the brobdingnagian number of persons who classify as ethnic minority, it would be amazing if there were any common factor.) You are getting a closer to the Universal Quantifier fallacy than I think you would like. Acknowledging the apparent reality that a disproportionate number of minorities live or work in high risk environments does not mean that they ALL do - and, similarly, that a significant number of Caucasians and Asians (now a disfavored minority) do not. Thus, at the end of the day, the racial metric will lead to a quantum of arbitrariness that is likely to infuriate people who (rightly) see it as arbitrary and themselves as unfairly treated.
So how would I do it? I mentioned I-A (health workers), I-B (classroom educators), and I-C (persons who work in necessary but high risk jobs). If I haven't run out of early vaccines, I'll add a fourth, I-D, people who live in high risk zip codes. Santa Clara County breaks cases down by zip code, so I'll assume others do, too. I'm going to eliminate the disabled, except those with a linked vulnerability, and the zip code also eliminates the rural/urban divide, which was almost as obnoxious as the racial. If you live in a zip code in a rural area, but one with a low incidence rate, why O why do you get priority? (Other than that Newsom wants your vote.) Prisoners are out, because I can't look law abiding Californians in the face if I do that. More of that anon.
If, as I suspect, the high incidence rates in ethnic minorities reflects disproportionate employment in high risk occupations and residence in high risk areas, that categorization will provide an automatic preference arithmetically. I don't think anyone in the public could take exception to that, except the increasing number of nuts on Twitter.
Prisoners? If there is anything experimental or dangerous about first use vaccines, they are free to volunteer, with sentence reductions and parole dates moved up. You always reward courage. That's what I call paying your debt to society.
With that, enough. I'm done with the topic, unless someone comes out of the woodwork to take potshots. (Please . . . stick to Twitter.)
RE: Vaccination Distribution Plans - the Looming Political Disaster - Goose - 10-25-2020
(10-25-2020, 06:06 PM)Genuine Realist Wrote: If I haven't run out of early vaccines, I'll add a fourth, I-D, people who live in high risk zip codes. Santa Clara County breaks cases down by zip code, so I'll assume others do, too.I think this is a very fair way to distribute the vaccine once the first three groups are served. It also has the advantage of attacking the disease where it is a problem, not where it is not a problem. Reducing spread in "hot spots" is good for everybody, not just the people who live there. It may turn out that changing the requirement to "live or work in a high risk zip code" is better from the public health point of view, but IMHO either criteria is a good one.
RE: Vaccination Distribution Plans - the Looming Political Disaster - BostonCard - 10-25-2020
No question that if things like zip code or income can account for the difference in mortality between Black and white victims of COVID-19, then we ought to use those rather than race. However, my point is what do you do if/when you've accounted for every difference you can reasonably measure and you are still left with a healthcare disparity. This happens rather frequently. Yes, it is more likely than not a socio-economic difference. The problem is that you simply can't measure every socio-economic factor that contributes to adverse health outcomes.
If you are out of socio-economic factors that you can measure to ensure that higher risk patients get priority and the only thing left is the residual effect of race, you have a choice. You can either ignore race, and accept that some higher risk people will not get priority or take into account race, and accept that some lower risk people will get priority.
BC
RE: Vaccination Distribution Plans - the Looming Political Disaster - M T - 10-25-2020
(10-25-2020, 06:06 PM)Genuine Realist Wrote: If there is no biological factor that accounts for the statistical discrepancy, then by process of elimination, we must be talking about socio-econometric factors.
I will posit that statistically Germans per capita play the accordion more than other nationalities. I don't believe that even here anyone would argue that there is a biological factor for that. So, must it be socioeconomic by the process of elimination?
If one found that Europeans had better foot-eye coordination than people in Kansas, is that a biological or socioeconomic factor of one group or the other?
If Hawaiians eat more seafood than do the people in South Dakota, is that a biological or socioeconomic factor of one or the other?
RE: Vaccination Distribution Plans - the Looming Political Disaster - Genuine Realist - 10-25-2020
(10-25-2020, 07:13 PM)BostonCard Wrote: No question that if things like zip code or income can account for the difference in mortality between Black and white victims of COVID-19, then we ought to use those rather than race. However, my point is what do you do if/when you've accounted for every difference you can reasonably measure and you are still left with a healthcare disparity. This happens rather frequently. Yes, it is more likely than not a socio-economic difference. The problem is that you simply can't measure every socio-economic factor that contributes to adverse health outcomes.The problem is that the same issues of quantifiability and non-quantifiability affect other INDIVIDUALS - for in the end, race is only one more category - who are not of the preferred ethnicity, and are likely of equal vulnerability. (That doesn't show up statistically, because when you do racial generalizations, they get thrown into a much larger class so that the particular indicia are obscured.)
If you are out of socio-economic factors that you can measure to ensure that higher risk patients get priority and the only thing left is the residual effect of race, you have a choice. You can either ignore race, and accept that some higher risk people will not get priority or take into account race, and accept that some lower risk people will get priority.
BC
They become angry when you choose another similarly situated person over them on a racial basis, they see the decision as arbitrary, capricious, and racist. And they are correct.
Better stick with the quantifiable factors.
RE: Vaccination Distribution Plans - the Looming Political Disaster - akiddoc - 10-25-2020
Wish I could access some of GR's old CEB posts.
RE: Vaccination Distribution Plans - the Looming Political Disaster - Genuine Realist - 10-25-2020
(10-25-2020, 09:27 PM)akiddoc Wrote: Wish I could access some of GR's old CEB posts.So do I. Squandered a lot of good prose. In the meantime . . .
https://smile.amazon.com/Joseph-Wurtenbaugh/e/B002BLNDCI/ref=sr_ntt_srch_lnk_1?qid=1537743328&sr=8-1
RE: Vaccination Distribution Plans - the Looming Political Disaster - Crafter Artisan - 10-25-2020
(10-25-2020, 09:27 PM)akiddoc Wrote: Wish I could access some of GR's old CEB posts.
Wish I could access some of GR's old CEB avatars . . . .
RE: Vaccination Distribution Plans - the Looming Political Disaster - Genuine Realist - 10-25-2020
(10-25-2020, 09:54 PM)Crafter Artisan Wrote:I lost the gif of the Disney girl in the short skirt. She was something. . .(10-25-2020, 09:27 PM)akiddoc Wrote: Wish I could access some of GR's old CEB posts.
Wish I could access some of GR's old CEB avatars . . . .
RE: Vaccination Distribution Plans - the Looming Political Disaster - teejers1 - 10-25-2020
(10-25-2020, 09:54 PM)Crafter Artisan Wrote:(10-25-2020, 09:27 PM)akiddoc Wrote: Wish I could access some of GR's old CEB posts.
Wish I could access some of GR's old CEB avatars . . . .
Nice pull, Crafter! That one made me chuckle.
(As for the merits of this thread, I don't think there is a whole lot of disagreement, except perhaps GR does not consider BC's theory of "what if?" But on the fundamentals, I'm not seeing a lot of differences).
RE: Vaccination Distribution Plans - the Looming Political Disaster - oregontim - 10-26-2020
This is one of the better threads I’ve seen. I see discussion of issues, with points made well, and disagreements leading to better discussion. This one is the opposite of where we throw talking points around like hammers.
I agree with the GR general solution, as a good direction to take.
RE: Vaccination Distribution Plans - the Looming Political Disaster - murky - 10-26-2020
(10-25-2020, 02:51 PM)BostonCard Wrote:(10-25-2020, 02:45 PM)Genuine Realist Wrote: None of these factors (and I don't quarrel with any of them) reflect governmental policy or the proverbial barriers. All of them reflect the cultural overhang I mentioned.
More than that, very few of them apply to that sizable fraction of the demographic that stands on the other side of the wealth divide. I'm not going to grant a preference to a wealthy minority resident of Atherton or Los Altos Hills simply on the basis of ethnicity. That is actual racism,
I wasn't saying they did. I was just saying that they are factors that might result in Black and Hispanic victims of COVID-19 dying at a greater rate than whites. If you talk about vaccinating the most vulnerable first, and your research finds that Black and Hispanic patients are disproportionately dying, and you can't find (or measure) the underlying factors that explain that difference, then you will either have to accept using race as a blunt proxy and realize that some otherwise lower risk people might inadvertently be given priority or accept that you will not give a bunch of higher risk people priority.
BC
BC, I appreciate your well articulated arguments in this thread, as I generally do.
I'm posting here, but in response to the thread. I wonder if GR takes exception to beginning prostate cancer screenings, or colonoscopy at an earlier age for African Americans compared to others. In many ways, I see that as a parallel to using race in determining vaccination eligbility.
Of course, with an infectious disease, there's also the matter of not just saving individuals, but also disrupting the spread.
I find some perverse humor in imagining the bizarre scenario of the Trump administration telling Black people that they should get vaccinated first. Let's just say there's a severe trust deficit.
(10-25-2020, 09:27 PM)akiddoc Wrote: Wish I could access some of GR's old CEB posts.
As do I.
It may not be a fair recollection, but I shared your general impression that his past arguments left on me.