California’s COVID-19 vaccine system generally works on an honor system.
When you make an online vaccine appointment, you may be asked to check a box, say “food and agriculture” or “chronic lung disease”, which indicates that you fall into one of the groups eligible for inoculation. But when you go to the clinic or pharmacy, you are unlikely to be asked for documentation proving that you are a nurse or have a serious lung disease – a profession and a medical condition that make you eligible for inoculation. They take your word that you qualify.
Due to the lack of supervision, some people who are not eligible can be vaccinated easily – just check a box indicating that you are qualified – and this is called skipping the queue.
Although the California Department of Public Health did not comment on the skip the line issue, health experts seem to agree that anyone who lies to get a vaccine without good reason is acting unethically.
Who exactly can that person be? “I would say that someone is completely healthy and well and wants to go to Cabo San Lucas for spring break,” said Dr. George Rutherford, director of the UCSF Public Health and Prevention Group.
Who is not that person? People who may not be eligible, but who circulate outside of mass vaccination sites in the hope of getting a dose that would be thrown away if an arm was not available. “It doesn’t bother me at all,” he said.
COVID-19 vaccines are scarce and, although it is a little easier to get appointments compared to a month ago, they remain scarce.
People are struggling to get the injection and even those who are eligible may have to spend several days looking for an appointment.
The state of California has a prioritization structure, based on guidelines from the Centers for Disease Control and Prevention, which recommends which groups of people, public health departments and vaccine providers should apply vaccines first. The purpose of the structure is to help people at greater risk of severe infection and death from coronavirus to obtain the vaccine. But ultimately, counties and health care providers can decide who to vaccinate.
The state has placed health professionals and senior citizens on the front lines, and vaccination entities, from counties to providers, in line with this recommendation. But as more groups are added, counties are no longer exactly aligned with the state, and the rules vary widely from place to place. While eight counties in the Bay Area are vaccinating elderly people aged 65 and over, Solano County announced this week that it is opening vaccines for individuals aged 50 and over.
In addition, there are now several eligible occupational groups, expanding the availability of the vaccine to a wide variety of people. A copywriter who works for a university can get the vaccine, as all education workers are eligible. As she works from home, it may seem unfair. Some may even say morally wrong. But is she technically skipping the line?
As the number of different types of eligible groups increases, the rules are becoming increasingly difficult to follow, creating a blurred line between what can be considered to be cutting the line and what may not be. Many are involved in complicated discussions with friends and family about whether certain situations qualify them for the photo. Some judge who breaks the rules, while others encourage him, probably with good intentions or reason.
“I know there will be people who will frustrate the system,” said Dr. John Swartzberg, professor emeritus of infectious diseases and vaccinology at UC Berkeley. “I know colleagues who are psychiatrists who jumped out of line and were vaccinated at the same time as doctors on the front lines. But they are seeing all their patients through Zoom. They say that I am a health care provider, I have a right. I know colleagues in this position who would say: ‘I would not do this for anything in the world’. I understand the issue on both sides, I feel conflicted on both sides, but I think, people with underlying diseases, they need to be vaccinated and they need to be vaccinated as soon as possible and I think we have to trust the human nature and integrity of human conscience. “
On Monday, California increased eligibility for 16- to 64-year-olds with disabilities or qualified health conditions, opening the floodgates for millions of people. People with high-risk conditions or disabilities will not be required to provide documentation to verify their diagnosis for vaccination, but may be asked to sign a self-attestation that they meet the criteria, according to the guidelines of the Department of Publications Health.
Dr. David Lubarsky, CEO of UC Davis Health in Sacramento, released a statement expressing concern that with so many people now becoming eligible – and deciding for themselves that they are eligible – patients who are really sick and poor will be pushed farther in line.
“Doctors know, for example, that patients with immunosuppression should go before patients at increased risk due to obesity,” wrote Lubarsky in a statement. “Unless providers are involved and are allowed to prioritize patients, these critical judgments will not happen. People with manners, means and flexibility will schedule their appointments first. They may have paid time off, scheduled flexibility and know what to say on to jump to the front of the queue. That person may actually have a condition that makes him eligible, but he may not be at risk of contracting COVID-19 as much as someone who lives in a multi-generation home and is at a higher risk level of die because of suppressed immunity. “
The state lists 10 conditions that qualify individuals for vaccines: cancer; chronic kidney disease, stage 4 or higher; chronic lung disease; Down’s syndrome; weakened immune system due to solid organ transplantation; pregnancy; sickle cell anemia; heart disease, such as heart failure, coronary artery disease or cardiomyopathies (but not hypertension); severe obesity; and type 2 diabetes mellitus.
What if you have a serious medical condition that is not on the list? If you go ahead and get vaccinated, are you skipping the line?
Rutherford pointed out that cystic fibrosis is not on the list and there are very few adults who have it, but those who do have it face a “very serious illness”.
“Just because it is not listed in the literature does not mean that you do not have an increased risk of serious COVID,” he said. “If you have cystic fibrosis, should you continue this round? I think any doctor would say yes.”
Swartzberg said California’s list of medical conditions is based on data from the Centers for Disease Control and Prevention, which identified what conditions people who died of COVID had.
“Whoever is most likely to be hospitalized or die is much more subtle than that,” said Swartzberg, referring to the conditions listed as “indicators” to determine who should be vaccinated first.
Ideally, high-risk patients would be vaccinated first and each person’s unique case would be considered, but many experts agree that a system for examining people’s health conditions would require immense human power and expense.
“I think having an honor system that’s what we have and having some people skip the line is probably a less wasteful system than requiring a prescription or an elaborate system for examining people,” said Rutherford, noting that the nominations are going up. filling the system and the current doses are running out, instead of spoiling and being thrown away.
If there were a system, Swartzberg said it would be difficult to apply and would result in inequities. He stressed that checking eligibility based on age is simple, but with all the various groups, it is a challenge.
“You can do this if someone has a driver’s license or any ID with birth date, because someone can show how old you are,” he said. “But if you are demanding a medical certificate, what about all the people who don’t have doctors?”
He added: “The system of trying to impose some kind of documentation breaks down quickly, as it defeats the purpose. I don’t think it would work.”
While Lubarsky said bringing vaccines to vulnerable communities is crucial, he expressed concern about the lack of oversight in his statement. “We know that people are eager to be vaccinated, but opening the floodgates without a public tender will do more harm than good. Although the supply of the vaccine remains limited, we must ensure that those most at risk are among the first to be vaccinated. . “
The head of UC Davis Health called on the medical community to help direct the effort. “Doctors and health systems are in the best position to do this in the right way and to ensure that we move quickly and fairly to use the vaccine and prevent the deaths and hospitalizations of those most at risk,” he wrote. “We strongly support pressure from the state for equity and outreach to underserved communities, where people may not have access to computers or are too sick to use them. We run several vaccination clinics in underserved postal codes in Sacramento, where we work to ensure that the poorest people who need the vaccine most are those being vaccinated. Unfortunately, the state has been targeting fewer and fewer doses to most health systems each week, and this undermines the goal of a fast, effective and effective vaccination program. equitable. “