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Members of the group that will recommend the immunization priority for Connecticut have agreed on areas where they want to see national recommendations for phase 1b expanded for frontline workers and in gathering places such as homeless shelters and prisons but are still grappling with where to locate. people with co-morbidities and their caregivers.
The COVID-19 Vaccine Advisory Group Allocation Subcommittee met Tuesday afternoon on Zoom to further review the Phase 1b recommendations of the Centers for Disease Control and Prevention Advisory Committee on Health Practices. ‘immunization. The two-hour meeting can be viewed at ct-n.com.
Connecticut is in phase 1a, immunizing healthcare workers and residents of long-term care facilities. ACIP recommended that people over 75 and essential frontline workers be included in phase 1b, and the state allocation subcommittee approved these two groups for phase 1b during its last two meetings.
On Tuesday, the group recommended adding food service workers and water and wastewater workers to ACIP’s list of essential frontline workers for Phase 1b, while ACIP had the two in phase 1c.
Other frontline workers essential for Phase 1b include education, food and agriculture, manufacturing, corrections, transit, grocery stores, and the US Postal Service. Officials from the State Department of Public Health said the education group includes day care workers and teachers and higher education staff.
Medical first responders are already included in phase 1a, while others, such as firefighters and police, would be included in phase 1b. Committee co-chair Nichelle Mullins, president and CEO of Charter Oak Health Center, said she believes emergency management will be the responsibility of first responders in phase 1b.
The allocation subcommittee also recommends that Connecticut include residents as well as community staff in phase 1b. This includes homeless shelters, correctional facilities, group homes, and inpatient health care facilities. Residents and nursing home staff were included in phase 1a.
There is no time set for the start of phase 1b.
“As soon as we see that the meeting slots don’t fill up, we can start planning and move on to the next phase,” Acting DPH Commissioner Deidre Gifford said.
Gifford noted that ACIP achieved its recommendations by balancing mortality and transmission, knowing that the more community transmission occurs, “the more the virus will eventually reach the most vulnerable individuals.”
But a few members of the subcommittee have indicated that they would prefer to focus on mortality rather than transmission, as scientists do not yet know whether vaccines prevent transmission.
How will the state prioritize people with co-morbidities?
ACIP recommends that people aged 65 to 74, as well as people aged 16 to 64 with high-risk health conditions, be in phase 1c, but some members of the allocation subcommittee of Connecticut want to see high-risk people – and their unpaid caregivers – in phase 1b.
Benjamin Bechtolsheim, COVID-19 vaccine program director for DPH, said about 360,000 people in Connecticut suffered from one or more underlying conditions.
Subcommittee co-chair Zita Lazzarini, UConn Health, summed up the discussion by wondering if the subcommittee could include people with co-morbidities through the prism of Medicaid or qualified health centers at the federal level, or by choosing a number of comorbidities.
Dr Marwan Haddad, medical director of the Center for Key Populations at the Community Health Center, said he believes “we can get our money’s worth” by focusing on federally qualified health center populations. He noted that these facilities have higher test positivity rates than the state average, serve people with co-morbidities, and have a high number of black and Hispanic patients.
Much of the discussion about prioritizing people with co-morbidities has taken place through the prism of considering race and ethnicity, as people of color have higher death rates from COVID. -19. Tekisha Dwan Everette, executive director of Health Equity Connecticut, wanted to see the death data with a breakdown by age and race.
Dr Khuram Ghumman, chairman of the Hartford County Medical Association, said he wanted to know how many people fell into the category of unpaid caretakers for those over 65 and over 75.
Gifford said DPH can get more data, and Mullins said the subcommittee should then meet again relatively soon.
Concern about including too many people in phase 1b
Bechtolsheim said Connecticut has about 275,000 people aged 75 or older and about 530,000 essential frontline workers. He noted that many people fall into multiple categories, making the data difficult to interpret, but DPH has done its best to eliminate redundancies in the data.
He hopes that phase 1b does not include much more than 800,000 people. Bechtolsheim said if around 60% of those eligible decide to get the vaccine, it should take 9-10 weeks to go through that group, if the supply stays as it is.
Gifford noted that adding people to a phase “results in a de facto trade-off for the other people in that phase,” meaning that some people will get the vaccine later than if people weren’t added, and some members of the subcommittee expressed their agreement.
“Deaths are extremely concentrated among older people, in Connecticut and across the country,” she said, “so everything we do to lengthen 1b means that those most at risk of deaths are subject to a longer period 1b. be online with many other people who are at lower risk of dying from COVID. “
How will we get more clarity on the categories in phase 1b?
Gifford said more work will be needed to define some of the subcategories listed under essential frontline workers. “Because there is a kind of endless permutations on some of these categories, our obligation will be to provide some clarity on intent, and to rely on employers to determine who meets and who does not meet the definition. “she said.
As for people with co-morbidities, Ghumman said doctors have codes in their electronic records to identify high-risk patients.
When it comes to implementing the recommendations, Dr Leslie Miller of the Fairfield County Medical Association warned doctors are getting bogged down, who are already struggling with many issues, including their medical records.
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