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Millions of Californians with disabilities and underlying health conditions will become eligible for the COVID-19 vaccine on Monday, but persistent dose shortages as well as lingering uncertainties over verification and qualification still pose potential barriers to access.
The expansion marks a milestone for the state’s exit from the pandemic, and new guidelines released Thursday by health officials allow people at high risk to self-certify their eligibility – a key victory for defenders who feared people might not be able to come together. documentation to verify their disability or underlying condition.
But adding about 4.4 million Californians to the eligibility list will place an additional burden on a vaccine supply that has grown steadily but not significantly. California reserves 40% of its supply for people in underserved communities and 10% for teachers. And there are still a lot of people 65 and over who are also waiting for their vaccinations.
Even tighter supplies: On Monday, the state is also extending eligibility to people who live or work in high-risk residential environments, such as homeless shelters and jail facilities, as well as employees public transport and airports.
President Biden, expressing confidence in the supply’s projections during his nationwide address Thursday night, said he believed every adult could be vaccinated by the end of May.
The high-risk group of newly eligible people includes 10 categories: those who are pregnant or have cancer; chronic kidney disease stage 4 or higher; chronic lung disease; Down’s syndrome; an immune system weakened by a solid organ transplant; sickle cell anemia; heart disease such as heart failure, coronary artery disease and cardiomyopathies (excluding hypertension); severe obesity; and type 2 diabetes mellitus.
With population estimates for Monday’s group ranging from 4 million to 5 million, and with other eligible groups totaling some 13 million, nearly half of all Californians will be eligible for the vaccine.
For people with disabilities and advocates, who have long lobbied for access, eligibility couldn’t come soon enough. In 2020, 86% of people who died from COVID-19 in LA County had an underlying disease, according to the Department of Public Health.
“There is a tremendous sense of urgency for this group,” said Sarah Sultan, 35, Los Angeles resident, pregnant and diabetic. “This group as a whole is much more likely to have severe COVID, be hospitalized and die from COVID.”
Still, many in the high-risk group said they didn’t know where to go, what to do, and how to prove their eligibility. And due to the unclear language on the definition of certain medical conditions, some people still wonder if they qualify, including people with asthma.
Some of these issues were addressed in guidelines released Thursday night by the California Department of Public Health. The details included specific examples of people who would be eligible but not explicitly listed, including those who use independent living centers, home support services and adult community services.
The new guide’s self-attestation allowance clears up confusion over how high-risk people can prove their eligibility. Advocates have long pressed for a process that would not create unnecessary obstacles, especially for those who are less mobile or intellectually disabled. According to the guidelines, people do not have to disclose their condition, only that they are eligible, said Dr. Paul Simon, scientific director of the LA County Department of Public Health on Friday.
“This is great news,” said Emma Alvarez-Gibson, 45, diabetic and in quarantine for a year. “People at high risk were extremely careful from the start. A lot of us feel a little over-played, given the way the state has flip-flopped. ”
Officials have said for weeks that they are working on such directions. His absence had fueled much anxiety, with many at-risk community members saying they had not yet heard from their doctors or the state’s My Turn system.
“None of the systems that are supposed to keep me informed have done that,” Alvarez-Gibson said.
Appointment slots for people with underlying illnesses are expected to open on Monday, Simon said.
When creating the final eligibility group, the 10 eligible categories for the vaccine were pulled from a Centers for Disease Control and Prevention list of underlying issues with known evidence of high risk of COVID-19.
The state also includes a broader and nonspecific category of “people at risk of developing serious life-threatening illness or dying from COVID.” Since this could apply to a variety of other disabilities and underlying issues, many people wonder if they qualify.
Conditions like asthma are not explicitly named, for example, and while type 2 diabetes is, type 1 diabetes is not. The broad language is intended to allow local health care providers to use their best clinical judgment in determining who is qualified for the vaccine.
Dr. Jeffrey Luther, a member of the state’s vaccine advisory committee and board member of the California Academy of Family Physicians, said Wednesday he had answered questions from patients asking for eligibility.
“I got a message from a patient saying, ‘I have asthma and I’m obese. Does this mean that I am qualified? Luther said that without clear direction it was difficult to answer this question.
LA has also struggled with vaccine supply levels and is working to address issues related to mobility, accessibility and equity even as new groups become eligible. Adding to this challenge is the fact that allocations for the Johnson & Johnson single-dose vaccine will be virtually halted over the next two weeks as the company strives to ramp up production.
“Given the limited supply of vaccines, we will be greatly faced with expanding eligibility,” Simon said on Friday.
State guidelines for those at risk essentially trust residents to accurately disclose their eligibility, but some officials have expressed concern that the lenient rules are being abused by people faking the underlying conditions. People forged documents and used access codes for use in high-risk communities.
Simon, at a press conference on Friday, urged residents not to abuse vague guidelines for those at risk by faking eligibility. “We don’t believe our frontline staff are in a position to select and make decisions about who and who is not eligible,” he said. “We urge people not to take advantage of it.”
The county is in the process of creating restricted clinics for people with underlying illnesses at high capacity sites, Simon said, and the county sites will provide access routes and housing for people with disabilities.
Officials urged people to work with their health care providers to get vaccinated as a first step.
For their part, several healthcare groups in the region, including UCLA Health, Kaiser Permanente, Cedars-Sinai and LA County Community Clinic Assn., Have said they will use their electronic health records to identify patients in their systems. that meet clinical criteria. and reach out to them directly.
“Our hope is to vaccinate as many Kaiser Permanente members with underlying conditions as possible,” said Dr. Michael Morris, physician director of the COVID-19 vaccination program at Kaiser Permanente Southern California, adding that they had ” Already started contacting all of our new eligible members with underlying conditions, starting with those at highest risk. “
While it can be heartwarming to see areas and activities reopen as more people get vaccinated, some at-risk community members said it was difficult to let go of the feeling of having been. forgotten.
“Many [disabled and chronically ill people] remained totally isolated in their home last year, ”Sultan said. “Many of us expected that this group would be able to receive the vaccine sooner and that the information on how we make appointments would be clear…. People with disabilities, at high risk and with chronic illnesses were treated as fully disposable and irrelevant. “
Judy Mark, president of Los Angeles-based advocacy group Disability Voices United, said people with disabilities can feel powerless in the state because they don’t have a union like farm workers or farm workers. health, and that they do not have paid lobbyists or formal representation. as a voting block.
“Most of us are overwhelmed with our own lives,” she said. “We should have been on this list much earlier.”
Yet Monday’s widening of eligibility gave him reason to be hopeful after a long, difficult and isolating year.
“I have to say, I haven’t felt this optimistic for a very long time,” she said.
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