Does your medical condition put you in the California vaccine line?

With his airways damaged, Kai Levenson-Cupp, 19, lives in fear that COVID-19 could worsen asthma that already leaves him short of breath.

Brooke Vittimberga, 25, has a weakened immune system due to the complications of a bone marrow transplant, so she is also very vulnerable to the virus.

But none of these serious health problems is likely to take them to the forefront of the COVID-19 vaccine line, despite the state’s recently expanded eligibility criteria that will pave the way for millions of Californians to be vaccinated starting March 15. For access to the vaccine, they have the wrong diagnoses.

“I’m terrified,” said Levenson-Cupp of Alameda, whose lungs and windpipe were severely burned in a childhood accident and now uses an inhaler to help breathe during exercise, allergies and even the most common viral illnesses.

With vaccine doses still scarce, California released on Friday a list of high-risk diseases and disabilities that qualify for the next phase of vaccination: cancer, pregnancy, stage 4 kidney disease, oxygen-dependent lung disease, Down’s syndrome, sickle cell disease, heart failure, severe diabetes, type 2 diabetes and a weakened immune system due to a solid organ transplant.

The list of 10 conditions is short, designed to prevent an increase in demand from anyone with a minor illness. Health care providers should check a person’s health status. This next phase will add an additional 4 to 6 million people to the current list of 13 million Californians eligible for the vaccine.

But a number of other serious medical conditions – such as cystic fibrosis, dementia, hypertension, type 1 diabetes and some rare genetic diseases – are not included, although there is initial evidence that they are associated with worse outcomes in patients with COVID-19.

The dilemma is to leave millions of Californians with rare diseases at risk, critics say, as the state tries to balance the needs of those most vulnerable to the pandemic. Californians aged 65 and over, health professionals and frontline rescuers and some teachers and rural workers are qualified for the vaccine. But the announcement of the next phase on Friday would certainly leave many at-risk residents waiting for their turn.

Vittimberga is one of them. The Stanford graduate who dreams of going to medical school is a survivor of acute myeloid leukemia who developed graft vs. graft disease. host, a rare condition when a transplanted immune system attacks the body after a bone marrow transplant.

If she contracts COVID-19, her chances are bleak: 32% mortality, according to a recent study. But the state will prioritize vaccination for those whose immune systems are weakened by solid organ transplants, not – at least not yet – bone marrow transplants.

“My concern is that I will be excluded, although I am at very high risk,” said Vittimberga, who wears two masks and glasses to prevent COVID-19 during his frequent visits to the hospital.

The list of eligible conditions is subject to change as additional, state-specific scientific evidence is reviewed by the California Department of Public Health, according to the state.

The state extracted its recommendations from a document by the United States Centers for Disease Control and Prevention, created in December as a resource for people who may need to take extra precautions to avoid contracting the virus.

The CDC list is also being used as a distribution tool for other states, including Connecticut, Massachusetts, New Hampshire, Maine, New Jersey, North Dakota, Texas, Washington and New York.

States are free to create their own lists of priority vaccines, which are generating different controversies.

In New Jersey, smokers are on the list. Washington, DC, is offering the vaccine to anyone with a body mass index above 25, a measure of obesity; in California, the limit is 40. Unlike California, Tennessee will offer the vaccine to people with type 1 and type 2 diabetes.

One problem is that the CDC list is based on a survey of a large number of COVID-19 patients or smaller study sets. Therefore, to make the list, a condition must be common enough that many people have it – and have become ill from the virus.

This means that people with more rare diseases – such as spinal muscular atrophy, lupus, multiple sclerosis, Crohn’s disease or ankylosing spondylitis – are not included.

The CDC guidelines were never intended to inform the distribution of the vaccine and “may not include all conditions that can increase the risk of someone developing a serious COVID-19 disease,” the agency said.

The lack of data does not mean a lack of risk, said Britt Dorton, 24, whose diagnosis of Ehlers-Danlos, a connective tissue disease, and other conditions can take her to the hospital with a dislocated joint or a sudden change in heart rate.

In some cases, the fear of COVID-19 has shrunk the network of friends and family of patients who help support them, she said. Those who live on disability checks, in overcrowded housing, have the opposite problem – they cannot isolate.