Members of the group that will recommend vaccination priority for Connecticut have agreed on areas where they want to see extended Phase 1b national recommendations for front-line workers and in meeting conditions, such as homeless shelters and prisons, but are still struggling with the place to place people with comorbidities and their carers.
The COVID-19 Vaccine Advisory Group Allocation Subcommittee met on Zoom on Tuesday afternoon to review the Phase 1b recommendations of the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices. The two-hour session can be viewed on ct-n.com.
Connecticut is in Phase 1a, vaccinating health care workers and residents of long-term care facilities. ACIP recommended that people over the age of 75 and key frontline workers be included in Phase 1b, and the State Allocation Subcommittee approved these two groups for Phase 1b at its last two meetings.
On Tuesday, the group recommended adding food service workers and wastewater workers to the ACIP list of key frontline workers for phase 1b, while ACIP had both 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 day and faculty and higher education staff.
The first nurses are already included in phase 1a, while others, such as firefighters and police, would be included in phase 1b. Committee co-chair Nichelle Mullins, chair and CEO of the Oak Health Center Charter, said she believes emergency management will come under the first phase 1b interventions.
The Allocation Subcommittee also recommends that Connecticut include residents as well as staff from the settings gathered in Phase 1b. This includes homeless shelters, correctional facilities, group homes and health care settings. Nursing home residents and staff were included in Phase 1a.
There is no set time for phase 1b to begin.
“As soon as we see that the appointment slots are not filling, we will be able to start planning and move on to the next phase,” said DPH Acting Commissioner Deidre Gifford.
Gifford noted that ACIP has reached its recommendations by balancing mortality and transmission, knowing that the more it is transmitted in the community, “the more vulnerable the virus will eventually reach.”
But some members of the subcommittee noted that they would rather focus on mortality than transmission, because scientists do not yet know if vaccines prevent transmission.
How will the state give priority to people with comorbidities?
ACIP recommends that people between the ages of 65 and 74, as well as those between the ages of 16 and 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 unpaid caregivers – in phase 1b.
Benjamin Bechtolsheim, director of the COVID-19 vaccination program for DPH, said about 360,000 people in Connecticut have one or more underlying conditions.
UConn Health Subcommittee Co-Chair Zita Lazzarini summed up the discussion by asking if the subcommittee could include people with comorbidities through Medicaid or federally qualified health centers 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 believes we can get a big bang for our dollar by focusing on the populations of federally qualified health centers. He noted that these facilities have higher than average state positivity rates, serve people with comorbidities and have a large number of black and Hispanic patients.
Much of the discussion on prioritizing people with comorbidities has been about examining race and ethnicity, as people of color have higher death rates due to COVID-19. Tekisha Dwan Everette, executive director of Health Equity Connecticut, wanted to see death data by age and race.
Dr. Khuram Ghumman, president of the Hartford County Medical Association, said he wants to know how many people fall into the category of uncompensated caregivers for people over 65 and over 75.
Gifford said DPH could get more data, and Mullins said the subcommittee should meet 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 individuals fall into several categories, making the data difficult to interpret, but DPH has tried its best to remove the dismissals from the data.
His hope is that Phase 1b does not include much more than 800,000 people. Bechtolsheim said that if about 60% of eligible people decide to get vaccinated, it should take 9-10 weeks to go through this group if the supply remains the same.
Gifford noted that adding people to one phase “results in a de facto compromise for the other people in that phase,” meaning that some people will receive the vaccine later than if people were not added, and some members of the subcommittee. they agreed.
“Deaths are extremely concentrated in the elderly, in Connecticut and across the country,” she said, “so everything we do to extend 1b means that those at the highest risk of death are subject to a longer period. 1b long, so they will be in line with a lot of other people who have a lower risk of death due to COVID. “
How will we get more clarity in the categories of phase 1b?
Gifford said more work will be needed to define some of the subcategories listed in key frontline workers. “Because there is a kind of endless permutation for some of these categories, our obligation will be to provide some clarity on the intent and to rely on employers to determine who does and who does not meet the definition,” she said.
Regarding people with comorbidities, Ghumman said 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 has warned against blocking doctors, who are already struggling with many things, including their medical records.