Members of the group that will recommend vaccination priority for Connecticut have agreed in areas where they want to see national Phase 1b recommendations expanded to frontline workers and in congregated environments, such as homeless shelters and prisons, but are still struggling to know where to place people with comorbidities and their caregivers.
The allocation subcommittee of the COVID-19 Vaccine Advisory Group met at Zoom on Tuesday afternoon to again review the Phase 1b recommendations of the Center for Disease Control and Prevention Advisory Committee on Immunization. The two-hour meeting can be viewed at ct-n.com.
Connecticut is in Phase 1a, vaccinating health workers and residents of long-term care facilities. ACIP recommended that people over 75 and essential frontline workers be included in Phase 1b, and the state allocation subcommittee endorsed these two groups for Phase 1b in its last two meetings.
On Tuesday, the group recommended adding food service workers and water / sewage workers to ACIP’s list of essential frontline workers for Phase 1b, while ACIP had both in Phase 1c.
Other essential frontline workers for Phase 1b include workers in education, food and agriculture, manufacturing, corrections, public transport, grocery stores and the US Post Office. State Department of Public Health officials said the educational group includes day care centers and teachers and higher education officials.
Medical first aid is already included in Phase 1a, while others, such as firefighters and police, would be included in Phase 1b. Committee co-chairman Nichelle Mullins, chairman and CEO of the Charter Oak Health Center, said she thinks emergency management would go down in Phase 1b first aid.
The allocation subcommittee is also recommending that Connecticut include residents, as well as employees from Phase 1b environments. This includes homeless shelters, correctional facilities, group homes and health care settings for inpatients. Residents and nursing home staff were included in Phase 1a.
There is no set time for the start of Phase 1b.
“As soon as we realize that the commitment slots are not being filled, we can start planning and move on to the next phase,” said DPH acting commissioner Deidre Gifford.
Gifford noted that ACIP reached its recommendations balancing mortality and transmission, with the knowledge that the more transmission in the community happens, “the more the virus will end up reaching the most vulnerable individuals”.
But some members of the subcommittee noted that they prefer to focus on mortality rather than transmission, since scientists still do not know whether vaccines prevent transmission.
How will the state prioritize people with comorbidities?
ACIP recommends that people aged 65-74, as well as those aged 16-64 with high-risk medical conditions, be in Phase 1c, but some members of the Connecticut allocation subcommittee want to see high-risk people – and their caregivers unpaid – in Phase 1b.
Benjamin Bechtolsheim, director of the COVID-19 DPH vaccination program, said that about 360,000 people in Connecticut have one or more underlying diseases.
UConn Health’s subcommittee co-chairwoman Zita Lazzarini summed up the discussion by asking whether the subcommittee could include people with comorbidities through the lens of Medicaid or health centers qualified by the federal government, or by choosing a number of comorbidities.
Dr. Marwan Haddad, medical director of the Center for Key Populations at the Community Health Center, said he thinks “we can get a big bang for our money” by focusing on populations in federally qualified health centers. He noted that these facilities are having test positivity rates higher than the state average, serving people with comorbidities and having a large number of black and Hispanic patients.
Much of the discussion on prioritizing people with comorbidities was done from the perspective of considering race and ethnicity, since people of color have higher mortality rates because of COVID-19. Tekisha Dwan Everette, executive director of Health Equity Connecticut, wanted to see death data broken down by age and race.
Dr. Khuram Ghumman, president of the Hartford County Medical Association, said he wanted to know how many people fall into the category of unpaid caregivers for people over 65 and over 75.
Gifford said DPH could get more data, and Mullins said the subcommittee should meet again soon.
Concern about including many people in Phase 1b
Bechtolsheim said Connecticut has about 275,000 people aged 75 and over and about 530,000 essential frontline workers. He noted that many individuals fall into several categories, which makes the data difficult to interpret, but DPH has done its best to eliminate redundancies in the data.
His hope is that Phase 1b will not include much more than 800,000 people. Bechtolsheim said that if about 60% of eligible people decide to get vaccinated, it will take 9 to 10 weeks to get through that group, if the supply remains the same.
Gifford noted that adding people to a phase “results in a de facto exchange for others in that phase”, which means that some individuals will receive the vaccine later than if people were not added, and some members of the subcommittee expressed their wake up.
“Deaths are extremely concentrated in older individuals, in Connecticut and across the country,” she said, “so everything we do to stretch 1b means that those most at risk of death are subject to a longer period 1b, so they will be contacting many other individuals who are at lower risk of death from COVID. “
How will we get more clarity in the Phase 1b categories?
Gifford said that additional work will be needed to define some of the subcategories listed in essential frontline workers. “As there are a multitude of permutations in some of these categories, our obligation will be to provide some clarity about the intention and to trust employers to determine who meets and who does not meet the definition,” she said.
As for people with comorbidities, Ghumman said that doctors have codes in their electronic records to identify high-risk patients.
When it comes to implementing the recommendations, Dr. Leslie Miller, of the Fairfield County Medical Association, cautioned against overloading doctors, who are already struggling with many things, including their medical records.