Millions of Californians with underlying disabilities and health conditions will become eligible for the COVID-19 vaccine on Monday, but the continued shortage of doses, as well as uncertainties about verification and qualification, still represent potential barriers to access.
The expansion marks an important step towards the emergence of the pandemic state, and new guidelines released on Thursday by health officials allow high-risk people to attest to their eligibility – an important victory for advocates who fear that people will not be able to meet. documentation to verify your underlying disability or condition.
But the addition of some 4.4 million Californians to the eligibility list will further strain the supply of vaccines that has grown steadily, but not significantly. California is setting aside 40% of its supply for people in underserved communities and 10% for teachers. And there are still many people aged 65 and over who are also waiting for their vaccines.
Striving to supply even more: The state on Monday is also expanding eligibility for people living or working in high-risk congregated residential environments, such as shelters for the homeless and seclusion facilities, and for public transport employees and airports.
President Biden, expressing confidence in supply projections during his national speech on Thursday night, said he believed that all adults could be vaccinated by the end of May.
The high-risk group of new eligible individuals comprises 10 categories: pregnant or with cancer; chronic kidney disease, stage 4 or higher; chronic lung disease; Down’s syndrome; an immune system compromised by solid organ transplantation; sickle cell anemia; heart diseases, such as heart failure, coronary artery disease and cardiomyopathies (excluding hypertension); severe obesity; and type 2 diabetes mellitus.
With population estimates for Monday’s group ranging from 4 to 5 million, and with other eligible groups totaling around 13 million, almost half of all Californians will be eligible for the vaccine.
For those with disabilities and advocates, who have long been lobbying for access, eligibility could not come soon. In 2020, 86% of people who died of COVID-19 in LA County had an underlying disease, according to the Department of Public Health.
“There is a great sense of urgency for this group, said LA resident Sarah Sultan, 35, who is pregnant and is diabetic. “This group as a whole is much more likely to have severe COVID, to be hospitalized and to die of COVID.”
Still, many members of the high-risk group said they did not know where to go, what to do and how to prove their eligibility. And because of the unclear language about defining some medical conditions, some people are still wondering if they qualify, including people with asthma.
Some of these issues were addressed in guidelines that the California Department of Public Health released Thursday night. The details included some specific examples of people who would qualify for eligibility, but are not explicitly listed, including those using independent living centers, home support services and community-based services for adults.
Permitting the new self-attestation guidance clears up the confusion about how high-risk people can prove their eligibility. Defenders have long pushed for a process that does not create unnecessary barriers, especially for those who are less mobile or intellectually disabled. Under the guidelines, people do not have to reveal their condition, only that they are eligible, said Dr. Paul Simon, director of science for the LA County Department of Public Health, on Friday.
“It’s great news,” said Emma Alvarez-Gibson, 45, who is diabetic and has been quarantined for a year. “High-risk people have been extremely careful from the start. Many of us feel a little uncomfortable, given the way the state has changed. ”
Officials said for weeks that they were working on such an orientation. His absence fueled much anxiety, with many in the community at risk saying they have yet to hear from their doctors or the state’s My Turn system.
“None of the systems that were supposed to keep me informed actually did that,” said Alvarez-Gibson.
Opening hours for people with underlying illnesses are expected to open on Monday, said Simon.
When creating the last eligibility group, the 10 categories that qualify for the vaccine were taken from a list of underlying problems at the Center for Disease Control and Prevention with known evidence of high-risk COVID-19.
The state also includes a broader, non-specific category of “individuals who are likely to develop serious life-threatening illness or death from COVID”. Since this could be applied to a variety of other underlying deficiencies and problems, many people wonder whether they qualify.
Conditions such as asthma are not explicitly named, for example, and although type 2 diabetes is, type 1 diabetes is not. The broad language is intended to allow local health professionals to use their best clinical judgment to determine who qualifies for the injection.
Dr. Jeffrey Luther, a member of the state’s vaccine advisory committee and board member of the California Academy of Family Physicians, said on Wednesday that he answered questions from patients about his eligibility.
“I received a message from a patient saying, ‘I have asthma and I am obese. Does this mean that I am qualified? ‘”Luther said that without clear guidance, it has been difficult to answer that question.
LA has also struggled with vaccine supply levels and is working to address issues related to mobility, accessibility and equity, even when new groups become eligible. Adding to this challenge is the fact that Johnson & Johnson’s single-dose vaccine allocations will almost stop in the next two weeks as the company works to increase production.
“Given the limited supply of vaccine, we will be greatly challenged by expanding eligibility,” said Simon on Friday.
State guidelines for people at risk essentially rely on residents to accurately disclose their eligibility, but some officials have expressed concern that tolerant rules will be abused by people who pretend to underlying conditions. People forged documents and used access codes intended for use in high-risk communities.
Simon, at a news conference on Friday, urged residents not to abuse vague guidelines for people at risk by pretending to be eligible. “We don’t think our front-line team is in a position to select and make decisions about who or who is not eligible,” he said. “We ask people not to take advantage of this.”
The county is creating restricted clinics for people with underlying illnesses in high-capacity settings, Simon said, and the county’s locations will provide vehicle and accommodation routes for people with disabilities.
The authorities asked people to work with their health care professionals to get vaccines as a first step.
In turn, several health groups in the region, including UCLA Health, Kaiser Permanente, Cedars-Sinai and LA County Community Clinic Assn., Said they will use their electronic health records to identify patients in their systems that meet clinical criteria and enter contact them directly.
“Our hope is to vaccinate as many Kaiser Permanente members as possible with underlying diseases,” said Dr. Michael Morris, chief medical officer of Kaiser Permanente Southern California’s COVID-19 Vaccination Program, adding that “they have already begun to reach all our new eligible members with underlying conditions, starting with those at highest risk. ”
While it may be encouraging to see sectors and activities reopening as more and more people are vaccinated, some at-risk community members said it is difficult to avoid the feeling that they have been overlooked.
“Several [disabled and chronically ill people] have been totally isolated in their home for the past year, ”said Sultan. “Many of us hoped that this group would be able to receive the vaccine sooner and that the information about how we make an appointment would be clear…. People with disabilities, at high risk and with chronic illnesses were treated as completely disposable and irrelevant. “
Judy Mark, president of the Los Angeles-based advocacy group, Disability Voices United, said that people with disabilities can feel powerless within the state because they don’t have a union, like agricultural or health workers, and they don’t have paid lobbyists or formal representation as a voting block.
“Most of us are overwhelmed with our own lives,” she said. “We should have been on that list long before.”
Still, Monday’s widening of eligibility gave her reason to hope after a long, difficult and isolated year.
“I have to say that I haven’t felt so optimistic in a long time,” she said.