Members of the group that will recommend the priority of vaccination for Connecticut have agreed on areas where they want to expand the national recommendations for Phase 1b for front-line workers and in congregated settings, such as homeless shelters and prisons, but they are still trying to position themselves. people with comorbidities and their caregivers.
The COVID-19 Vaccine Advisory Group Assignment Subcommittee met in Zoom on Tuesday afternoon to review the Phase 1b recommendations of the Immunization Control and Prevention Centers Practice Advisory Committee. The two-hour meeting can be viewed at ct-n.com.
Connecticut is in Phase 1, vaccinating health care workers and long-term care center residents. ACIP has recommended that people over the age of 75 and essential front-line workers be included in phase 1b, and the state allocation subcommittee approved these two groups for phase 1b in its last two meetings.
On Tuesday, the group recommended adding food service workers and water / wastewater workers to ACIP’s list of essential front-line workers for phase 1b, while ACIP had them in phase 1c .
Other key frontline workers for Phase 1b include workers in education, food and agriculture, manufacturing, corrections, public transportation, grocery stores, and the U.S. Postal Service. State Department of Public Health officials said the education group includes workers and daycares and higher education teachers.
First aid is already included in phase 1a, while others, such as firefighters and police, would be included in phase 1b. Committee co-chair Nichelle Mullins, president and CEO of the Charter Oak Health Center, said she believes emergency management would fall under Phase 1b first aid.
The Allocation Subcommittee also recommends that Connecticut include residents as well as meeting place staff in Phase 1b. This includes shelters for the homeless, prisons, collective homes and inpatient health care centers. 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 see that the time slots are not filled, we will be able to start planning and move on to the next phase,” said DPH Acting Commissioner Deidre Gifford.
Gifford noted that ACIP reached its recommendations by balancing mortality and transmission, knowing that the more community transmission happens, “the more the virus will reach the most vulnerable people.”
But some members of the subcommittee noted that they would rather focus on mortality than transmission, as scientists do not yet know if vaccines prevent transmission.
How will the state prioritize people with comorbidities?
ACIP recommends that people ages 65 to 74, as well as people ages 16 to 64 with high-risk medical conditions, be in Phase 1c, but some members of the Connecticut Allocation Subcommittee want to see ‘high risk (and their unpaid caregivers) in phase 1b.
Benjamin Bechtolsheim, director of the COVID-19 vaccination program against DPH, said about 360,000 people in Connecticut have one or more underlying conditions.
UConn Health subcommittee co-chair Zita Lazzarini summed up the debate by asking whether the subcommittee could include people with comorbidities through the lens of Medicaid or federally qualified health centers, or by choosing a certain number of comorbidities.
Dr. Marwan Haddad, medical director of the Center for Key Populations at the Community Health Center, said he believes “we can get a big bang for our investment” by focusing on the populations of federally qualified health centers. . He noted that these facilities have higher test positivity rates than the state average, serve people with comorbidities, and have a high number of black and Hispanic patients.
Much of the discussion about prioritizing people with comorbidities was through the goal of considering race and ethnicity, as people of color have higher mortality rates for COVID-19. Tekisha Dwan Everette, executive director of Health Equity Connecticut, wanted to see the death toll with a breakdown 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 uncompensated caregivers for people over 65 and over 75.
Gifford said DPH can get more data and Mullins said the subcommittee should meet again relatively soon.
Concern for including too many people in phase 1b
Bechtolsheim said Connecticut has about 275,000 people aged 75 and over, and about 530,000 essential front-line workers. He noted that many people fall into several categories, making it difficult to interpret the data, but DPH has tried its best to eliminate data redundancies.
His hope is that phase 1b will not include much more than 800,000 people. Bechtolsheim said that if approximately 60% of eligible people decide to get vaccinated, it would take 9 to 10 weeks to pass that group, if the supply remains what it is.
Gifford noted that adding people to one phase “results in de facto compensation for the rest of the people in that phase,” meaning some people will receive the vaccine later than if people were not added to it, and some members of the subcommittee expressed their agreement.
“Deaths are extremely concentrated in older individuals, in Connecticut and across the country,” he said, “so everything we do to lengthen 1b means people at higher risk of death are subject to a longer period. of 1b, so that you are in line with many other individuals who have a lower risk of death from COVID “.
How will we get more clarity on Phase 1b categories?
Gifford said more work will be needed to define some of the subcategories listed for front-line essential workers. “Because there is a kind of endless permutation in some of these categories, our obligation will be to provide some clarity about the intent and trust employers to determine who meets and does not meet the definition,” he said.
As for people with comorbidities, Ghumman said doctors have codes in their electronic records to identify patients at high risk.
When it comes to implementing recommendations, Dr. Leslie Miller of the Fairfield County Medical Association warned against attacking doctors, who are already struggling with many things, including their medical records.