Will Utahns wait their turn after vaccines are opened for those with underlying conditions?

by

The state will rely on the honorary system for coronavirus protection, without the need for evidence that someone meets the new requirements for the underlying conditions.

(Rick Egan | The Salt Lake Tribune) Julyn Shepherd fills syringes for Utah County residents to vaccinate their COVID-19 in a former Shopko store in Spanish Fork, Wednesday, January 27, 2021.

| February 28, 2021, 1:00 p.m.

With the state now offering the COVID-19 vaccine to a large group of people with underlying health conditions, Utahns will not be required to provide a doctor’s note or other evidence that they are eligible.

Instead, the state relies on the system of honor. It is an effort to get shot in the arms as quickly as possible, but it will almost certainly lead to abuse, as people believe that there are relatively few obstacles that prevent them from jumping in line.

“People may be lying about whether or not they have one of these underlying health conditions,” Gov. Spencer Cox told a news conference Thursday, pleading with Utahns to abide by the rules.

But Tom Hudachko, a spokesman for the Utah Department of Health, said in an email that the department has determined that it is more important to make sure the process is simple and effective for the approximately 275,000 Utah residents who have medical conditions than to do so. excessively cumbersome just so that “a few others don’t line up early,” he said.

Asking for documents as proof of eligibility would not only “significantly slow down the process of administering vaccines to these people,” Hudachko said, but would also place an unnecessary burden on health care workers who would be responsible for providing such documentation ”.

This shift to wider access to the vaccine is taking place as the death toll in Utah from coronavirus approaches 2,000. But the seven-day average positive coronavirus test rate has dropped, both below the state’s traditional measure – which still stands at more than 10% last week – and its new methodology, which rose to around 6% last week. . The number of Utahns who are fully vaccinated with two doses exceeded 225,000 weeks, with this total likely to reach 250,000 over the weekend.

What’s going on elsewhere?

As states begin to make larger groups of residents eligible for vaccinations, they have taken different approaches to whether documents are needed to vaccinate people in a priority group.

It can be difficult to find information on the implementation of each state, but Washington, New Jersey, Massachusetts and Alabama have reported so far that they use the honor system.
In Texas, healthcare providers have been told to look at people’s medical records to determine their condition for photos, when possible. In other circumstances, people can reveal their underlying health conditions and receive the vaccine without the need for documents, according to the Dallas Morning News.
At New York State immunization clinics, residents must provide proof of eligibility for the underlying conditions with a doctor’s letter, medical information providing evidence of their health, or a signed certification, according to the coronavirus information website. .

Although it remains to be seen how well the honor system will be implemented here, Margaret Battin, a professor of philosophy at the University of Utah, said she wondered if the influence of the community of The Church of Jesus Christ of Latter-day Saints could affect political success.

“The teachings of the church … I think it would tend to discourage behaviors like cutting in line,” said Battin, who is also an assistant professor. in the program of medical and humanistic ethics of the U. within the Department of Internal Medicine. “All those who ‘do good’ and ‘choose the right’, this kind of moral teaching could play a role in the behavior of many people in this state, which may not be so true in a more heterogeneous state, like New York. ”

Hudachko said the decision was made mainly on the basis of feedback from healthcare and vaccine service providers, which require documents that would create “significant blockages”. He said he had failed to make comparisons on the approach that is more effective and noted that several states have not yet started vaccinating people with underlying health conditions.

Who still gets the vaccine?

Utahns aged 16 and over, with certain serious and chronic health conditions, are now eligible to receive the COVID-19 vaccine. Here is a list of those eligible health conditions, according to the Utah Department of Health:

• Beneficiaries of solid organ transplantation.

• Certain types of cancer.

• People who are immunocompromised (have a weakened immune system) from a blood, bone marrow or organ transplant; HIV; long-term use of corticosteroids or the use of other drugs that weaken long-term immunity.

• Severe kidney disease or dialysis, or with chronic kidney disease in stage 4 or 5.

• Uncontrolled diabetes.

• Severe obesity (body mass index over 40).

• Chronic liver disease, including chronic hepatitis B or C.

• Chronic heart disease (without high blood pressure).

• Severe chronic respiratory disease (other than asthma).

• Neurological conditions that affect respiratory function, including Down syndrome, multiple sclerosis, Parkinson’s disease, cerebral palsy, tetrapllegia or hemiplegia.

• Stroke and dementia (Alzheimer’s, vascular, frontotemporal).

• Asplenia, including splenectomy or a spleen dysfunction, including sickle cell disease.

While the honor system is raising its own issues, Jim Tabery, an associate professor of philosophy in the United States, said he believes the vaccine launch, as planned, is “the right ethical path to follow.”

“Obviously, when you think about it, your mind naturally turns to some kind of vaccine jumper or freeloaders,” he said. “There may be some of this, but the question is: what system do you plan to create that eliminates them? And would it actually be a better system? ”

Asking people to jump in circles to prove they have an underlying health condition could be “terribly invasive” for people with disabilities, he said, and could also raise equity issues in accessing the vaccine. People in severely affected communities of color, for example, may not have access to a health care provider to get proof of their condition or may struggle to get a job to get an appointment.

“If you’re dealing with someone [in that situation] who has diabetes and you say, “To get the vaccine, we also need some kind of confirmation that you have diabetes,” in essence, you ask them to go to a health care provider that they don’t have access to, “he said. . “And most likely, what you’re doing is guaranteeing that someone won’t have access to a vaccine.”

So far, it has been “relatively simple” for vaccination providers to determine eligibility in Utah, Hudachko said.

The first round of vaccinations was largely based on employment and it was easy for health workers, teachers, first responders and long-term care staff to prove that they qualified on the basis of pay slips or badges. . Older adults were also able to “easily provide proof of age with a government-issued ID or document similar to the listed date of birth,” he said.

Even so, Salt Lake County Health Department spokesman Nicholas Rupp said there were several cases where people tried to “cheat the system” and were returned to a vaccination site.

“Fortunately, it’s not a widespread problem,” he said. “I’ve had several people misunderstand their eligibility, but those aren’t widespread either.”

The county has not taken a position on using an honor system, but Rupp said the health department will follow the instructions of the state and the governor “and will encourage people to be honest so that the vaccine reaches those with the most higher risk of disease. “

(Rick Egan | The Salt Lake Tribune) A socially remote waiting area for Utah residents to vaccinate their COVID-19 in a former Shopko store in Spanish Fork, Wednesday, January 27, 2021.

Announcing on Thursday that the vaccines will be opened immediately to people with underlying conditions, rather than the date previously planned for March 1, Cox noted that those who now qualify have the highest risk of hospitalization and death due to COVID-19.

And he urged Utahns who are not eligible not to schedule meetings.

“We have so many vaccines coming and going soon, but we give priority to these people – again depending on their age and the underlying comorbidities – because they have the highest risk of hospitalization or death,” he said. he said. “So, if you jump ahead, it means that there is someone else who will not receive the vaccine as soon as they could have it and it is very possible that they will be hospitalized, or even worse, die.”

Those who follow the rules “can sleep well at night knowing that you did not cheat the system, that you were willing to give it to those who needed it most,” he added.

Hudachko noted that every Utahn who is 16 and older who wants one is expected to have the opportunity to receive a vaccination by the end of May. People who consider system games to shoot themselves a few weeks earlier, he said, need to consider that “the person you jump ahead of is much more likely than you to get seriously ill or even die. if he becomes infected with COVID-19. ”

As the state opens vaccines to more people, Tabery said the most ethical thing those who are not eligible for one can still do is wait their turn.

He noted that there are legitimate questions about the correctness of the vaccine launch. But if, say, a grocery store employee felt he should have been included in the last round of vaccinations, the way to deal with it is to contact state leaders to express that concern – not for someone to take it into account. consider their problems. hands.

The exception to this rule, Tabery said, is a scenario where there are overdoses that must be used and will go wrong if they are not. Both Pfizer and Moderna vaccines must be stored at freezing temperatures and, once thawed, must be used for a certain period of time.

“If someone finds themselves in a situation where they happen to be in the hospital or at the pharmacy and the pharmacist or nurse tells them, ‘Hey, we have an extra dose. This will be lost if you do not use it, then it would be wrong not to take it “, he said.

Many people will probably make these ethical calculations at this stage of the state’s launch, but Battin indicated that social stigma and disapproval of people who break the line will be the main defense against this behavior.

Tabery said he anticipates that there will be times when people will cut the vaccination line and that these cases, when identified, will make the news.

But he is confident that most Utahs will “follow these rules.”

“I think there’s a kind of underlying communal mentality in the state of Utah that serves it well in situations like this,” he said. “And I’m sure there will be line cutters. I’m sorry they found themselves in a situation where they felt they had to or could do it. But I think they will definitely be the exception – not the rule. “

.Source