Northwest Arkansas Democrat-Gazette
Hope for a dose draws vaccine-site volunteers
Ethicists say reward raises no alarms
SEATTLE — As states ramp up vaccine distribution in the fight against the coronavirus, volunteers are needed for tasks such as directing traffic and checking people in so vaccination sites run smoothly. In return for their work, they’re often given inoculations.
Many people who don’t yet qualify for vaccination — including those who are young and healthy — have been volunteering in hopes of getting a dose they otherwise may not receive for months. Large vaccination clinics across the country have seen thousands of people trying to nab limited numbers of volunteer shifts.
The practice has raised questions at a time when supplies are limited and some Americans have struggled to get vaccinated even if they are eligible. But medical ethicists say volunteers are key to the public health effort and that there’s nothing wrong with them wanting protection from the virus.
Ben Dudden, 35, of Roanoke, Va., volunteered at a mass vaccination clinic in the nearby city of Salem on a day off from his part-time job at the Roanoke Pinball Museum. His wife, a nurse practitioner who was administering doses, encouraged
him to volunteer in case he could get vaccinated.
He spent that January day helping people fill out ques- tionnaires, not knowing if he might get a coveted dose.
“It wasn’t an official thing like, ‘Everybody who needs a vaccine, come this way.’ I kind of had to ask,” Dudden said. “At end of day, I found whoever was in charge of that.”
He got what he was hoping for and still wants to volunteer again.
“It was a little bit of a selfish thing — ‘I’m gonna get the vaccine if I do this’ — but for me, it wasn’t the only factor,” Dudden said.
At a Seattle vaccination clinic, Swedish Health Services considers volunteers part of the state’s Phase 1 vaccination group. About 5,000 have been inoculated, and about 1,000 of them have come back to work again, said Renee Rassilyer-Bomers, chief quality officer for Swedish Health Services and head of its vaccination site at Seattle University.
During their shifts, volunteers are handed colored vests matched to their skill level and experience. The majority wear orange for general tasks, which include sanitizing clipboards, asking people to fill out forms, taking temperatures and monitoring the newly vaccinated to ensure no dangerous side effects.
Some may question whether it’s fair for volunteers to get to the front of the line for what’s often clerical work.
Nancy Berlinger, a bioethicist at the Hastings Center, a research institute in Garrison, N.Y., said the bottom line is that volunteers are interacting with the public and that there’s nothing wrong with them wanting protection.
They also go through training and other obligations.
“There would be easier ways to game the system,” Berlinger said. “If that was really your goal, this could take more work, I think, than some other routes I can think of.”
While many volunteer shifts take several hours on weekdays, Berlinger said, that doesn’t necessarily mean only people of a certain class or demographic can sacrifice that much time.
“That could apply to students, it could apply to people who are unemployed, people who are retired. It could be people who are family caregivers,” Berlinger said.
State Farm Stadium in suburban Phoenix, where the Arizona Cardinals football team plays, and another state-run site in the Phoenix metro area require a combined 3,900 volunteers a week. HandsOn Greater Phoenix, a nonprofit handling online volunteer recruitment, opens 1,400 to 2,000 spots a few times a week, and interest hasn’t waned, CEO Rhonda Oliver said. Between 10,000 and 15,000 people try to sign up every time new spots open, she said.
Volunteers who have nabbed shifts say they shouldn’t be lumped in with those who believe they’re entitled to a vaccination.
In the Seattle area, three King County hospitals came under fire last month after revelations that donors, board members and some hospital volunteers used their connections to get shots. The King County Council approved a measure calling on state lawmakers and Gov. Jay Inslee to make it illegal to grant special access to the vaccines.
Berlinger said there’s a clear delineation between a connected official and a volunteer at a vaccine clinic getting a shot.
“The volunteers we’re talking about at registration centers are people who are part of the public health effort. They are performing a crucial role,” Berlinger said. “It’s easier to help people who already have privilege. The thing about covid is we have to push away from that and we have to say, ‘No, we must allocate vaccine and vaccination.’”
HEALTH CONDITIONS
In the initial months of the covid-19 vaccine rollout, states sought a balance between prioritizing the elderly, who are most likely to die from the virus, and people in professions most likely to be exposed to it. Under recommendations from the Centers for Disease Control and Prevention, people with underlying medical conditions, such as Type 2 diabetes or cancer, which have been associated with an increased risk for severe virus symptoms, were set to come next.
But with demand still outstripping the nation’s vaccine supply, a new skirmish has emerged over which health problems to prioritize. States, which are not bound by the CDC’s recommendations, have set widely varying rules amid a dearth of definitive evidence about how dozens of medical conditions may affect the severity of covid-19.
The confusing morass of rules has set off a free-for-all among people who may be among the most vulnerable to the virus as they seek to persuade health and political officials to add health conditions to an ever-evolving vaccine priority list.
At least 37 states, as well as Washington, D.C., are now allowing some residents with certain health problems to receive vaccinations, according to a New York Times survey of all 50 states. But the health issues granted higher priority differ from state to state, and even county to county.
Some people with Down syndrome may get vaccinations in at least 35 states, for instance, but some of those states are not offering shots to people with other developmental conditions. At least 30 states allow some people with Type 2 diabetes to get vaccinated, but only 23 states include people with Type 1 diabetes. At least 19 states are making the vaccines available to some people with cystic fibrosis; at least 14 have included some people with liver disease; and at least 15 have deemed some smokers eligible.
At least 30 states have prioritized vaccinations for people who are overweight or obese, according to the Times survey. But they vary even there, with some setting the bar at a body mass index of 25, others at 30 or 40.
Some states require people to prove they have medical conditions, although at least 16 states and Washington, D.C., do not. And at least 12 states allow a person to get a recommendation from a health professional to get a shot, even if the person’s medical condition has not been given priority by the state.
In the absence of large, rigorous studies of the coronavirus’s effect on people with other medical problems, medical ethicists said, there are few clear principles to apply to determine a priority sequence among many conditions. Many states are taking their cues from a list of 12 sorts of conditions that the CDC has deemed to have substantial evidence for elevated covid-19 risks, including obesity, Type 2 diabetes, smoking and Down syndrome. CDC officials have said that they regularly review the scientific literature and will expand the list as warranted.
But some medical ethicists argue that the list itself is misleading because it suggests that the risks for all diagnoses have been considered and ranked.
Across the country, the vaccine eligibility requirements are a moving target. Ohio added bone marrow transplant patients to its list last week after initially offering the vaccines only to those who had received a solid organ transplant.
Next week, California, where only some counties have previously offered vaccinations to people with medical conditions, will allow shots statewide to millions of people with health problems. That reversed the state’s earlier plan to prioritize shots based solely on age, which sparked high-profile opposition from disabilities-rights advocates who used a hashtag #HighRiskCA.
State government officials say their decisions on which health conditions to include often come down to some combination of evidence, logistics and political reality.
CHANGING RHYTHMS
As the pandemic enters its second year, there’s a longing for the recent past, especially when it comes to life’s milestones. There are questions of whether the new ways of marking births and deaths, weddings and anniversaries will have any lasting impact when the crisis finally resolves, or whether freshly felt sentiments born of pandemic invention will be fleeting.
Some predict their pandemic celebrations have set a new course. Others still mourn the way their traditions used to be.
Milestones, rituals and traditions help set the rhythm of people’s lives, including annuals such as birthdays and anniversaries and the one-timers such as births and deaths, extending beyond those boundaries to more casual events such as sports’ opening days, drinks out after work with colleagues, and that first swim of the summer.
Jennifer Talarico, a psychology professor at Lafayette College in Pennsylvania who studies memory and personal experience, said certain events shape lives differently — and have been reshaped just as differently during the pandemic. Perhaps most devastatingly affected, she said, are death and dying, sitting at bedsides to comfort, and attending funerals to mourn as the coronavirus has killed more than 2.3 million people around the world.
“That’s being felt the hardest because it’s the hardest to replace,” Talarico said. “That’s probably going to have the most lasting impact.”
While some predict a renaissance once the crisis has ended, “there are going to be a number of people who are changed,” said Daryl Van Tongeren, an associate professor of psychology at Hope College in Michigan. “They’re going to say, ‘I’m going to emerge from this pandemic with a new set of values, and I’m going to live my life according to new priorities.’”
Marking time has changed during the pandemic. There’s the ticking off of months based on trips to the hair salon and the length of pandemic beards. There’s Zoom creativity and socially distanced trips outdoors. Recreating celebrations of the past for major, time-marking events has been difficult as time blurred and safety restrictions took over.
“For those wanting to reminisce years later about important events that happened during the pandemic, there will likely be nostalgia mixed with more than a tinge of trauma,” said Wilfred van Gorp, a past president of the American Academy of Clinical Neuropsychology.
“It may remind us of the loneliness and isolation brought about by the pandemic, our fear of catching the virus, fear of dying, fear of losing loved ones and loss of any we knew who may have died from covid-19,” he said. “And recollections of what we didn’t have, what we missed, and the experiences we couldn’t share together.”