New Haven Register (New Haven, CT)
Advocates: CT’s new COVID vaccine plan could worsen inequities
In an effort to allow those with high-risk medical conditions to jump the COVID vaccine line, advocates say the state may have pushed people in vulnerable communities to the back of the line.
Kenyatta Thompson, director of organizing for the Katal Center for Equity, Health, and Justice, said the state’s shift from a strictly age-based rollout is a “step in
the right direction,” but how high-risk patients will be identified is a question she said needs to be answered.
Gov. Ned Lamont announced this week that everyone age 16 and over would be eligible on April 5, with prioritization for people with medical conditions that put them at a higher risk of COVID complications.
But questions persist if highrisk individuals would need a doctor’s note or medical records to get priority.
“There are communities where access to a primary care physician is difficult, and I think to ignore that would be disingenuous,” Thompson said. “There are people right now who don’t have access to a primary care physician.”
Answers to questions like that will be key, advocates say, if highrisk patients living in vulnerable communities won’t be left behind.
“Even though they are high risk, they might not be prioritized in this plan,” Thompson said.
State officials said Tuesday that vaccine providers would be in charge of the logistics and details. According to Ohm Deshpande, of Yale New Haven Hospital, those details are not yet fleshed out.
“There is no clarity yet,” he said. “The goal is to not have an inequitable process. Any sort of construct that we come up with
will have to be equitable.”
The difficult question is determining what puts someone at higher risk of a severe COVID-19 infection.
The Centers for Disease Control and Prevention has a list of medical conditions that increase a patient’s risk of a severe reaction to the coronavirus infection, but there has been no agreement yet among Connecticut’s vaccine providers if that list will be followed, and how a patient might prove they are at greater risk.
People with pulmonary disorders, obesity, or who smoke cigarettes are considered “at risk,” according to the CDC, but Thompson noted that people of color have borne the brunt of the pandemic from the start, dying at greater rates from the virus than their white neighbors.
“I don’t even think we can take race out of this,” she said. “This is not a race-neutral issue.”
Kathy Flaherty, executive director of the Connecticut Legal Rights Project, said she was not in favor of the state’s initial agebased rollout, but this week’s shift without any “specificity” has raised some ire.
“Going back and forth with no guidance, no specificity about what any of that means,” she said. “I have people asking me what that means, and I’m like, ‘I have no clue, go ask the governor.’ ”
Flaherty said she expects any system designed to help people at risk because of a disability, a medical condition or race to be exploited.
“We have laws to protect us that people with privilege will use to their advantage,” said Flaherty, who advocates for people with disabilities. “People of means will always figure out a way to manipulate a system to their advantage.”
As for how it will work, Deshpande said, “The simple answer is, I don’t know yet,” though equity will be “at the top of our list of priorities.”
“Just because you have a PCP (primary care physician) should not give you a leg up,” he said.
There have been efforts to prioritize ZIP codes in the state with a resident population considered vulnerable, those that fall high on the CDC’s social vulnerability index, and those goals “continue to be a strategic imperative,” Deshpande said.
But as providers now are structuring a system in which people more at risk have easier access to vaccines, those efforts will have to be “redoubled,” he said.
Requiring access to a primary care provider is one way a system could exacerbate existing health care inequities, Thompson said. People “should not be hindered by the fact that they don’t have a regular PCP.”
She and Flaherty suggested a sort of honor system, where a patient would schedule their own vaccine appointments and not be required to prove that they have a high-risk condition.
“What you could have done and what they did in other places is, you literally have people attest,”
Flaherty said. “Will some people cheat? Yes, because some people always cheat.”
Jerry Smart, a community health worker in New Haven working with patients recently released from prison, said that lack of trust is also a concern.
“The Black and brown community really don’t trust the health care system,” he said.
There are issues accessing physicians and transportation, but people like Smart and Latoya Benton, a Bridgeport-based community health worker, often bridge that gap between patient and doctor.
“If you already have a doctor, it’s easy to prove what you have because it’s all in the records,” Benton said.
Another problem is finding those people who fall through the cracks, who have lost trust in the health care system or have no fixed address, and making sure they know they can get vaccinated sooner if they have a preexisting condition.
“Right now they’re trying to get the word out,” Benton said. “It’s harder for the community to know where to get the vaccine, and what days to get the vaccine.”
The solution, according to Smart, is not to ask people to go get a vaccine, but to send vaccines where the people are.
“Some people just don’t have cellphones. Some people don’t have addresses,” he said. “You have to get your troops out there, meet the people where they’re at. That’s how you have to do it.”
As Connecticut prepares for a substantial easing of pandemic restrictions Friday, the state’s COVID positivity rate has fluctuated this week, causing some concern for health experts.
Many of the restrictions, meant to slow new infections, will be lifted from occupancy caps on restaurants, retailers and houses of worship, to an easing on limitations for gatherings in private residences and commercial venues.
On Tuesday, the state reported a positivity rate of 4.96 percent among new tests administered, the highest number since late January. More telling is the seven-day average for the positivity rate has inched up to just below 3 percent.
Summer Johnson McGee, dean of the School of Health Sciences at the University of New Haven, said any increase is “concerning” this close to lifting restrictions.
“This is a precarious time for our state as we attempt to reopen in the midst of a COVID-19 case plateau,” McGee said. “From a public health perspective, I would have preferred for the state to wait to reopen more until we had a higher level of vaccination across the state.”
At least one doctor said he wasn't sure whether early numbers from this week were enough to delay reopening. "I'd hesitate to make an assumption based on a single day," said Dr. Michael Parry, director of infectious disease at Stamford Hospital. "We have to find out if this is a trend or a blip."
On Wednesday, the positivity rate dropped back down to 2.43 percent as 373 new infections were identified out of 15,362 tests. The seven-day positivity rate stood at 2.87 percent.
There was one fewer patient hospitalized, dipping the statewide total to 402. Eight more fatalities attributed to the disease brought Connecticut's official death toll to 7,807.
With COVID numbers not yet stable, some health experts whether the state is reopening too soon.
“It's just a few weeks too soon,” said Dr. Gregory Buller, Bridgeport Hospital's associate chief medical officer and chairman of the department of medicine. “We need more people vaccinated. It seems a little bit premature to me.”
Buller said he understands the need to open things up from a business and social standpoint, but said he felt it was coming with a health risk.
Dr. Howard Selinger, chairman of Family Medicine at the Frank H. Netter MD School of Medicine at Quinnipiac University, said "we're nowhere near" herd immunity, and the state should wait until more people get the vaccine.
“We are still dealing with slightly more than three-quarters of the population who are not vaccinated,” he said. “And we have the potential for variants. It's risky.”
When Gov. Ned Lamont announced on March 4 he would lift or modify restrictions, the positivity rate was 1.84 percent, the lowest since October, according to state COVID-19 statistics. At the time, the sevenday average for positivity rate was 2.19 percent.
Lamont at the time said: “It feels good that we’re able to do this, it feels good that we’ve been slowly reopening since May 20 and we really haven’t had to turn back. I hope to god that we don’t have to turn back this time, that the metrics stay in a positive direction.”
Despite a recent bump in the positivity rate, Lamont’s office said they are not planning to shift course with lifting restrictions.
“The infection rate that we’re seeing now are different than the infection rate we had six months ago,” the governor’s spokesman, Max Reiss said. Young people, he said, are getting sick now.
Hospitalizations, another key measure weighed in decisions about restrictions, had dropped a net of about 50 patients from March 4 to the end of last week. Hospitalizations edged up slightly this week with 20 more hospitalizations reported as of Tuesday. The number of hospitalizations still remains about half what the state saw in early February.
Lamont’s plan on COVID-19 restrictions were conservative compared to other states, such as Texas, which opened everything back up 100 percent and dropped a requirement that people wear masks.
Key to Lamont’s plan was that people were still required to wear masks and socially distance, while businesses and commercial venues continue to sanitize and disinfect to limit the spread of the virus.
But top federal health officials have repeatedly cautioned states from opening too quickly and losing ground against COVID-19 spread.
As recently as last weekend, Dr. Anthony Fauci, the White House chief medical advisor, voiced concerns about states easing restrictions, pointing to an increase in cases in Europe.
“If you wait just a bit longer to give the vaccine program a chance to increase the protection in the community, then it makes pulling back much less risky,” Fauci said on Fox News.
Connecticut has continued to ramp up its vaccination program, relying on commitments from the federal government that supply will increase in the coming weeks to push up the schedule for universal adult eligibility nearly a month to April 5.
When Lamont announced earlier this week that all adults could get vaccinated by April 5, he also moved up the eligibility date for people age 45 to 54 to Friday.
The success of the vaccine program was among the measures that factored into the decision to ease restrictions in Connecticut.
When Lamont announced the plan, Connecticut had already administered 681,488 first doses of the vaccine. With second doses, the number of fully vaccinated people was 361,046.
From these numbers, Lamont said at the time the state was going to have a lot more people vaccinated by March 19.
The latest vaccination statistics released Monday show an additional 237,253 people received a first dose and the number of fully vaccinated increased by 134,960 people.