Optimizing COVID-19 Vaccine in Florida

The solution to the COVID-19 pandemic is at hand and it could substantially reduce deaths in Florida and the USA.  Both the Pfizer/BioNTech and Moderna vaccines have proven to be highly effective with generally mild side-effects.  One question is how to get them distributed most efficiently to minimize the future death count.  So far healthcare workers and nursing home residents have been the phase 1 recipients.  The CDC has recommended that frontline essential workers such as first responders, teachers, and grocery workers, and those 75 and over should be next in line.  In Florida Governor DeSantis has opted to make those 70 and older go to the front of this second group with the reasoning that they are much more vulnerable than 20-yrs old frontline workers.  I agree.

The overall risk of a population group should determine its order in the line for vaccines.  This means the risk of infection multiplied by the risk of dying after being infected.  Frontline workers could be ten times more likely to get infected since they interact with more people every day.  However, a 75-yrs old has a 200 times greater case fatality rate (CFR = fatality/cases) than a 25-yrs old, with a CFR of 9.0% versus 0.045%, respectively (see blue line in the figure below).  Thus a 75-yrs old would still be 20 times more at risk overall than a 25-yrs old frontline worker.

Moreover, the third wave that is currently raging in Florida which has thus far focused on the young student population is slowly transferring to older adults just as they did in the second wave this past summer (see figure below).  Large family gatherings for Thanksgiving and Christmas will accelerate this transfer and endanger the older more vulnerable population. 

We see this happening in an alarming way in Sumter County which overlaps most of The Villages.  Cases there have been increasing this month (see figure below) and yesterday 76 out of 112 newly confirmed cases were 65+ yrs old.  As noted above this group has a CFR of 9%. 


It could be a close race between the virus and the vaccine to see how many people in The Villages can be vaccinated and saved before they are infected and killed by the novel coronavirus.  To further optimize the effectiveness of the limited supply of vaccines we recommend that those who have acquired natural immunity go to the back of the line of this second group, and to make sure that as many as possible get their first shot of these two-shot vaccines before anyone gets their second shot. 

 

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