California opens coronavirus vaccination to more than 4 million residents with high-risk medical illnesses and disabilities on Monday, allowing those aged 16 to 64 to make appointments if they have a variety of different medical conditions, such as cancer, diabetes, kidney disease and severe obesity.
Although many have worked to document their illnesses so that they can make an appointment as soon as possible, the California Department of Public Health said later this week that the documentation will not be needed. To “protect confidentiality,” vaccination clinics will ask those with qualified conditions to “sign a self-attestation that they meet the criteria for high-risk medical illnesses or disabilities” before receiving the vaccine.
Although San Diego County officials said on Wednesday that special instructions specifying how to document health conditions would be released by the end of the workweek, a spokesman clarified on Friday afternoon that the county’s approach it will be congruent with that of the state.
Vaccines for people with high-risk medical illnesses or disabilities
Vaccination regulations that take effect in California on March 15 provide that those aged 16 to 64 years can be vaccinated if they have any of the following health problems:
- Cancer, with weakened immune system
- Chronic kidney disease, stage 4 or higher
- Chronic, oxygen-dependent lung disease
- Down’s syndrome
- Solid organ transplantation, leading to a weakened immune system
- Pregnancy
- Sickle cell anemia
- Heart problems, such as heart failure, coronary artery disease or cardiomyopathies (but not hypertension)
- Severe obesity (body mass index ≥ 40 kg / m2)
- Type 2 diabetes mellitus with hemoglobin A1c level greater than 7.5%
Those considered to be at high risk for “life-threatening serious illness” or for whom the infection “will limit the individual’s ability to receive ongoing care or services vital to their well-being or survival”, or to those “providing and timely COVID care will be particularly challenging as a result of the individual’s disability ”may also qualify.
Authorities said on Friday that access to the doses received for those who meet the vaccination requirements for disability and medical conditions are more likely to gain access to consultations through their regular medical providers who already have information about their conditions in file.
The largest health systems in San Diego County said this week that they are already preparing to proactively contact those whose records show that they are now approved for vaccination.
“I’m super excited, I’ve been thinking a lot about moving to” the next phase, said Dr. Amy Sitapati, a doctor at UC San Diego Health. “It’s heartbreaking to see and reject people in a younger age group who are really at significant risk, like my patient who has pulmonary fibrosis due to oxygen.”
The change comes at a time when the demand for vaccines far exceeds supply. And as with previous changes in vaccine eligibility, the expansion raises new questions about how to identify, notify and prioritize people with any of the comorbidities identified by the state and county.
Sitapati is part of the UCSD team that is struggling with these issues for patients in the healthcare system, about 50,000 to 80,000 of whom fall into the categories that will soon be eligible. It helped create an eligible patient record that identifies and classifies patients based on electronic patient records. Patients will receive email and text notifications between now and Monday saying they are eligible to receive the vaccine and will gradually receive invitation, call or message texts through UCSD’s MyChart patient portal to schedule a vaccine appointment.
“We really know our patients better than anyone,” said Sitapati. “If I consult a medical director or another doctor, in their mind, they already know their main 1%, the main 5% of those who are sick and who need to be vaccinated.”
Among those most at risk for severe COVID-19, the UCSD registry prioritizes patients living in socioeconomically disadvantaged areas, as measured by the state’s Healthy Places Index.
Several other health systems are also contacting patients or will be in touch soon. On Monday night, Scripps Health began to notify its more than 100,000 eligible patients via the health system’s own electronic system. These patients received a letter that they can take to vaccination centers administered by the county as a check of their eligibility and will be invited to schedule appointments through Scripps from March 15.
Some of the first patients to be invited for consultations will be those with cancer, chronic obstructive pulmonary disease (COPD) or who have received an organ transplant. Dr. Ghazala Sharieff, chief medical director of the health system for clinical excellence and experience, warns that it will take time to overcome this latter group.
“With an unreliable supply chain, we are really going to frustrate people,” she said.
A spokesman for Sharp HealthCare said the system plans to contact its patients by email on Friday, and that they will be encouraged to schedule appointments at any of Sharp’s managed locations across the county – including La Mesa and Chula Vista vaccination overpowers.
Kaiser Permanente also began contacting members with underlying health problems last Friday. The provider looks after 636,000 San Diegans, but a spokesman does not know how many of them will soon be eligible for the vaccine.
A local health care system has already moved on to the next group: The San Diego Veterans Administration. VA spokesman Christopher Menzie confirmed that the system is vaccinating patients 45 and older, as well as those with high-risk conditions defined by the Centers for Disease Control and Prevention, noting that the system has 39,000 of these patients. The VA began offering the vaccine to all patients with severe medical conditions on March 4, and notifies them via text messages, emails, phone calls and letters.
The San Diego Union-Tribune asked county spokesman Mike Workman to clarify why the VA was able to start vaccinating groups of patients who are not yet eligible across the rest of the region.
“They get the direct vaccine and may be able to get through the layers faster,” said Workman by email. “They don’t go through the state. They have a separate allocation system, just like the military. “
Those with serious underlying medical conditions already have a basic level of stress on vital organs and tissues, says Dr. Davey Smith, UCSD’s head of infectious disease research. This makes them particularly vulnerable to COVID-19 complications.
But not all states are weighing the various pre-existing conditions equally, leading to a patchwork of policies, as shown by an investigation by the New York Times.
Do you have type 1 diabetes? So you can be vaccinated in Alaska and Iowa, but not in Idaho, and only in some cases in California. And while patients with cystic fibrosis are not eligible at the Golden State, they can receive a coronavirus vaccine in Illinois and Montana, among other places.
The difference in eligibility from state to state may evaporate until May 1, which is when President Joe Biden plans to make all Americans eligible for the vaccine. Meanwhile, new cases of coronavirus continue to decline in the United States, albeit at a slower pace in recent weeks than in the first few weeks of the new year.