BROADER RULES A RELIEF FOR HIGH-RISK PATIENTS
Those with disabilities, serious conditions become eligible for vaccination after months of worry
Before the pandemic, 16-year-old Joshua Espinoza was able to visit his family every weekend, but his interaction with his mother, father and brother has been limited to quick sessions at his group home for the past year to reduce the chances of coronavirus infection.
But the 11th-grader with severe autism is among the estimated 4.4 million statewide with high-risk medical conditions and disabilities who will join the state’s vaccine priority list today, significantly increasing his odds of receiving the doses he needs to once again travel to his family home in Paradise Hills.
It has been heartbreakingly clear for a long time now, said his mother, Maria Espinoza, that her son really, really misses their weekends together.
“He says to me ‘Mommy, home! Mommy, home!’” Espinoza said. “That means to me that he needs to come home, he wants to come home.”
Denying those pleas has only become more difficult as Maria and her husband, Allen, themselves became fully vaccinated. Their local health care jobs put them in the top priority group when doses started arriving in December and January.
Joshua’s weekday residence, run by the East County nonprofit Home of Guiding Hands, includes three other teens with similar diagnoses. These are kids who are more likely than most to give spontaneous hugs and other forms of physical interaction, which, said chief executive Mark Klaus, has required strict visitation restrictions to keep outbreaks at bay.
Over the past year, he said, 22 of the organization’s roughly 4,000 clients have tested positive and one, a man in his mid-60s, had died.
“Our numbers are about one third of what they are statewide,” Klaus said, adding that he believes that fact is owed to a requirement that all group home resi
dents be vaccinated before they resume regular outside activities.
Loved ones are still able to visit their family members at their group homes, but those meetings have been kept short to decrease the chances of transmitting the virus.
Joshua is the only one among the four living in his house that remains unvaccinated. The others, all 18 or older, were able to receive the Moderna vaccine in midJanuary when the county health department started its mobile vaccination effort at nursing homes and other congregative living facilities.
Moderna doses, however, are not approved for anyone under 18, so Joshua missed out. So far, Maria Espinoza said, attempts to obtain Pfizer doses, which can be used in anyone age 16 and older, have been elusive. She said Kaiser, the family’s health provider, has indicated that they are trying to fit him in under the new guidance.
Many more with developmental disabilities of various kinds, Klaus said, are in the same spot, pushing for Pfizer doses. About 2,000 clients, he said, are affected.
The new guidance leaves a little wiggle room as to who, among the disabled, should be vaccinated, only mentioning Down syndrome by name. Otherwise, doctors can use their own judgment to vaccinate those with high-risk illnesses and disabilities that they deem make it more likely that a person will suffer life-threatening illness, be made unable to receive their usual care or would be “particularly challenging” to care for if they did become infected.
Situations like Joshua’s, said Dr. Oliver Brooks, chief medical officer of Watts Health Care Corporation in Los Angeles, are the reason that language was crafted the way it was. He should know, having co-chaired the state’s Drafting Guidelines Workgroup, the body that put together the list of medical categories that are now taking effect.
“We did not want to go down the road of listing every condition out, because you’re invariably going to leave somebody out,” Brooks said. “It makes me feel good, because that language was put in there just for that sort of situation.”
When it first came out, some noted that California’s list of approved medical conditions was significantly more restrictive than similar eligibility approvals, such as New York’s.
That state, which started allowing those with certain medical conditions to begin getting vaccinated on Feb. 14, continues to be more lenient than California’s overall high-risk conditions list, though San Diego County filed an addendum Friday that eliminated some of the key differences between California and other states.
Both California and San Diego continue to be more strict than New York in regards to cancer, for example. Back east, anyone with cancer can line up for a vaccine, even if they’re in remission. Californians must have a current cancer diagnosis “with weakened immune system.”
Anyone with chronic kidney disease qualified in New York, but only those at stage four or above do in California. New York allows anyone with chronic obstructive pulmonary disease to make vaccination appointments, but California, including San Diego, requires COPD patients to be “oxygen dependent” to qualify.
California rules extend vaccination only to Type 2 diabetics with A1C blood sugar levels of greater than 7.5 percent while New York allows all diabetics, regardless of type or blood sugar level, access to vaccination.
Here, San Diego appeared to break with the state, adding in Type 1 diabetics. San Diego’s update also added those with asthma, cystic fibrosis, high blood pressure, neurologic conditions, liver disease, pulmonary fibrosis and Thalassemia, a blood disorder, to its medical condition vaccination list.
San Diego also went with a significantly lower threshold for vaccination of those who are overweight. The state’s threshold is those considered severely obese with body mass indexes greater than or equal to 40. San Diego will allow anyone with a BMI of 25 or greater to get vaccinated starting today.
A county official said Sunday afternoon that the state is expected to adopt similar changes today.
Brooks said ordering the vaccination wait list has not been easy. The workgroup, he said, kept coming back to the basic truth that the whole point of setting priorities is to get to the people who evidence shows are the most likely to benefit.
“It would be better to say all cancer, all chronic kidney disease, all pulmonary disease, but then the number in your cohort will increase quite a bit, which ends up meaning, we felt, that some people with truly the highest risk levels would be getting crowded out,” Brooks said.
It’s possible for two people, he noted, to have the same diagnosis but have different levels of illness.
A recently diagnosed COPD patient, he noted, may be experiencing little reduction in their lung capacity while someone years into living with the disease may require continuous supplemental oxygen and be unable to walk up a flight of stairs.
“They both have the same diagnosis, but one is at a 10 times greater risk of dying from COVID-19,” Brooks said.
The physician added that no one involved in prioritizing vaccine supply is enjoying the work. For nearly the entirety of his career, Brooks said, he and his colleagues have been doing everything in their power to encourage as many people as possible to get vaccinated.
“Usually, we are in the situation where we are begging people to get vaccinated, and they’re saying no,” Brooks said. “We’re in a whole different milieu, and it’s not something we’re happy about, but you do have to make difficult decisions when the supply is limited.”