VACCINES TO EXTEND TO HIGH-RISK PATIENTS

Eligibility starts Monday for those ages 16 to 64 with qualifying medical conditions

California opens coronavirus vaccination to more than 4 million residents with high-risk medical conditions and disabilities Monday, allowing those age 16 to 64 to make appointments if they have a range of different medical conditions, such as cancer, diabetes, kidney disease and severe obesity.

While many have been working to document their illnesses so they will be able to get an appointment as quickly as possible, the California Department of Public Health said late this week that documentation will not be necessary. To “protect confidentiality,” vaccination clinics will ask those with qualifying conditions to “sign a self-attestation that they meet the criteria for high-risk medical conditions or disabilities” before receiving their shot.

Though San Diego County officials said Wednesday that special instructions specifying how to document health conditions would be forthcoming by the end of the workweek, a spokesperson clarified Friday afternoon that the county’s approach will be congruent with the state’s.

Officials said Friday that access to incoming doses for those who meet the disability and medical condition vaccination requirements are most likely to get access to appointments through their regular medical providers who already have information about their conditions on file.

San Diego County’s largest health systems said this week that they are already preparing to proactively contact those whose records show are now approved for vaccination.

“I am super excited, I’ve been thinking a lot about moving to” the next phase, said Dr. Amy Sitapati, a primary care physician at UC San Diego Health. “It’s broken our hearts to

watch and turn away persons that are in a younger age group that are truly at significant risk, like my patient who has pulmonary fibrosis on oxygen.”

The change comes at a time when vaccine demand far exceeds supply. And as with previous changes in vaccine eligibility, the expansion raises fresh questions about how to identify, notify and prioritize people with any of the comorbidities identified by the state and county.

Sitapati is part of the UCSD team that is grappling with these issues for the health system’s patients, about 50,000 to 80,000 of whom fall into the soon-to-be eligible categories. She helped create a registry of eligible patients that identifies and ranks patients based on electronic patient records. Patients will receive email and text notifications between now and Monday saying that they’re eligible to get their shot, and will gradually receive invitations by texts, phone calls or messages through UCSD’s MyChart patient portal to schedule a vaccine appointment.

“We really know our patients

better than anybody else,” Sitapati said. “If I go up to a medical director or other doc, in their mind, they already know their top 1 percent, their top 5 percent of who’s sick and who needs to get vaccine.”

Within those at highest risk of severe COVID-19, UCSD’s registry prioritizes patients living in areas that are socioeconomically disadvantaged, as measured by the state’s Healthy Places Index.

Several other health systems are also contacting patients or will soon. On Monday night, Scripps Health began notifying its more than 100,000 eligible patients through the health system’s own electronic system. Those patients received a letter they can take with them to county-run vaccine sites as verification of their eligibility and will be invited to schedule appointments through Scripps starting March 15.

Some of the first patients to be invited for appointments will be those with cancer or chronic obstructive pulmonary disease (COPD), or who’ve received an organ transplant. Dr. Ghazala Sharieff, the health system’s chief medical officer for clinical excellence and experience, cautions that it’ll take time to get through this latest group.

“With a supply chain that’s very unreliable, we’re going to really frustrate people,” she said.

A spokesperson for Sharp HealthCare said that the system planned to reach out to its patients by email on Friday, and that they’ll be encouraged to schedule appointments at any of the Sharp-run locations throughout the county — including the La Mesa and Chula Vista vaccine superstations.

Kaiser Permanente began reaching out to members

with underlying health conditions last Friday. The provider cares for 636,000 San Diegans, but a spokesperson did not know how many of them will soon be eligible for vaccine.

One local health system has already moved onto the next group: The San Diego Veterans Administration. VA spokesperson Christopher Menzie confirmed that the system is vaccinating patients 45 and older, as well as those with high-risk conditions defined by the Centers for Disease Control and Prevention, noting that the system has 39,000 such patients. The VA began offering vaccine to all patients with serious medical conditions on March 4 and has been notifying them through text messages, emails, phone calls and mailed letters.

The San Diego UnionTribune asked county spokesperson Mike Workman for clarification as to why the VA was able to begin vaccinating patient groups that are not yet eligible throughout the rest of the region.

“They get direct vaccine and may be able to work through the tiers faster,” Workman said in an email. “They do not get it through the state. They have a separate allocation system, just like the military.”

Those with serious underlying medical conditions already have a baseline level of stress on vital organs and tissues, says Dr. Davey Smith, UCSD’s chief of infectious disease research. That makes them particularly vulnerable to complications from COVID-19.

But not all states are weighing the various pre-existing conditions equally, leading to a patchwork of policies, as shown by a New York Times investigation.

Have Type 1 diabetes? Then you can get vaccinated in Alaska and Iowa, but not Idaho, and only in some cases in California. And while cystic fibrosis patients aren’t eligible in the Golden State, they can get a coronavirus vaccine in Illinois and Montana, among other places.

State-to-state eligibility difference may evaporate by May 1, which is when President Joe Biden plans to make all Americans vaccineeligible. In the meantime, new coronavirus cases continue to decline across the U.S., though at a slower rate in recent weeks than in the first weeks of the new year.