Families dealing with chronic conditions prepare for wait

When one person has a highrisk condition during a pandemic, it’s like the whole family does — and that’s why some Coloradans expect they’ll have to stay locked down for months as they wait for the COVID-19 vaccine.

Liz Sanders, of Englewood, said her 14-year-old son could be at higher risk because of Type 1 diabetes and a heart defect he was born with. Her 16year-old son kept learning at home to protect his brother from the virus, but he’d like to go back and experience some of the milestones of his junior year, she said.

Adults who have one highrisk condition are more than twice as likely to be hospitalized if they get COVID-19 as healthy people, and adults with three conditions are five times as likely, according to the Centers for Disease Control and Prevention. The data isn’t as clear for children.

The vaccine is only authorized for people 16 or older, so Sanders’ younger son can’t get it. His older brother and parents will be eligible when healthy people under 60 get their turn, but the Colorado Department of Public Health and Environment

estimates that may not be until summer.

The timeline makes it difficult to decide whether her older son can safely enroll for in-person classes this fall, Sanders said. She’d like to see the state move those who share a home with children who have highrisk conditions up on the priority list.

“The only way to protect a vulnerable child is for the family to get the vaccine,” she said.

The state’s vaccine distribution plan doesn’t include family members of highrisk people, and puts those with chronic conditions in a lower priority group than the CDC, which recommended they follow frontline health care workers, nursing home residents and people 75 and older.

In Colorado, people with two chronic conditions could begin receiving the vaccine in early March, after people ages 65 to 69, teachers and child care workers. Those who have one condition will have to wait until later this spring, after significant numbers of essential workers have been vaccinated.

Colorado classifies 11 conditions as high-risk:

• Cancer

• Chronic kidney disease

• Chronic obstructive pulmonary disease

• Down syndrome

• Some heart conditions, including heart failure, coronary artery disease, cardiomyopathy and severe birth defects

• Having received an organ transplant that requires immune-suppressing medication

• Obesity

• Pregnancy

• Sickle cell disease

• Diabetes

• Being unable to wear a mask, due to a disability

The CDC’s list doesn’t include people with Type 1 diabetes, Down syndrome, or disabilities that make it hard to wear a mask. It does, however, include people whose immune systems are suppressed for any reason, rather than just those who have had an organ transplant.

A unidentified spokeswoman for the state health department, responding to questions from The Denver Post, said the agency used the CDC’s list of conditions, but focused on those with the most evidence of increased risk. The department didn’t include all conditions because of concerns about crowding out people over 65, she said.

“The state’s prioritization is guidance to our providers on how to manage our constrained federal supply of vaccines with demand in order to save the most lives possible and end the pandemic as quickly as possible,” she said in an email.

“Having two or more (conditions) increases your risk; however age is the No. 1 risk factor.”

Daniel Larremore, an assistant professor at the University of Colorado Boulder, was on a team that modeled different vaccination strategies. They found that prioritizing people over 60 saved more lives than focusing on younger age groups. They couldn’t model scenarios for prioritizing people with chronic illnesses, because the data isn’t detailed enough, he said.

“Based on what we know, the prioritization is appropriate,” he said. “Of course, if we knew more, we could do better.”

Some people feel overlooked because of the limited conditions that classify a person as “high-risk.”

The Rev. Maureen White, of Boulder, said she had multiple transient ischemic attacks, commonly referred to as “mini-strokes,” and one larger stroke that caused partial paralysis. The CDC considers the data on outcomes for patients with a history of strokes to be mixed, and they aren’t on Colorado’s priority list.

She’s particularly scared of COVID-19 because some patients have developed blood clots and had strokes, even with no history of cerebrovascular disease.

White said her granddaughter won’t be able to return to in-person school until she gets the vaccine, which could be this summer. She said she’d like to see the state allow doctors the option to recommend patients whose conditions create risks, but who aren’t included on the state’s list.

“My medical history is complicated, but it doesn’t necessarily fit in,” she said. “My frustration is, there’s a lot of people who don’t fit into these categories.”

When leaders decide who to prioritize, they have to balance the odds people in a particular group will get seriously sick or die, the odds they’ll get infected and the risk of transmitting it to others, Larremore said. An older person who is retired might have a high risk of dying if they get the virus, for example, but a lower risk of getting it and spreading it than a younger person working in a grocery store.

Other social priorities, such as reopening schools and getting more people back to work, make the decision even more complicated, he said.

The bigger problem is that, at the moment, there aren’t enough shots for everyone, and states have to make tough choices, Larremore said. It’s better to have even an imperfect framework than to create a free-for-all, where the most vulnerable people would certainly be left behind, he said.

“The perfect here shouldn’t be the enemy of the good,” he said.