California opening vaccine ‘floodgates’ to line-cutting, UC Davis Health chief warns
A top Sacramento health care provider is warning that California risks harming “the truly sick” by allowing people ages 16 to 64 to get vaccines without proof that they have a qualifying underlying health issue that puts them at high risk for a serious COVID-19 case.
Under new state guidance this week, local health departments have been instructed to vaccinate people in that age group who “attest” that they have a condition such as cancer, kidney disease, pulmonary disease, Down syndrome, pregnancy, heart conditions, severe obesity or Type 2 diabetes.
The state Department of Public Health says “healthcare providers may use their clinical judgment” based on the patients’ treatment histories in choosing who to vaccinate in that age group. The state strongly recommends those people go to their regular health provider for their shot, but does not require it.
If a person goes instead to a pharmacy or public health clinic where they do not have a health history on file, those sites are instructed to take the person’s word that they have an underlying issue. The state suggests those sites ask for some written verification but does not require it, citing the need to protect confidentiality.
Dr. David Lubarsky, head of UC Davis Health in Sacramento, criticized that approach Monday in a statement to The Bee, saying it will allow lower-risk people to slip in front of people who have a more immediate health need for a vaccine.
“We know people are anxious to get vaccinated, but opening the floodgates without a gate tender will cause more harm than good,” Lubarsky wrote. “With so many people now ... deciding for themselves that they are eligible, this will push truly sick and poor patients farther back in line.”
“We are sure that most members of the public will be honest and schedule their vaccine when they are truly eligible. We’d all like to hope that people are generally good.”
Doses still lacking in Sacramento
The potential problem comes, he said, at a time when there still are not enough doses to go around. UC Davis Health is one of many providers in the Sacramento area who have struggled with limited shipments since the vaccine rollout began in late December.
Federal officials in recent days have said they plan to ship more doses nationally in the coming weeks. But so far, thousands of people who qualify in California for vaccines have been told to wait. In some cases, that includes delaying second shots, even though federal drug protocols call for second doses of the Pfizer and Moderna products to be administered in a three-to-four-week time frame after the first dose.
“While vaccine supply remains limited, we must make sure the people who are most at-risk are among the first to get vaccinated,” Lubarsky said.
Instead, he argued, “people with ways and means and flexibility will make their appointments first. They may have paid time off from work, schedule flexibility, and know what to say in order to jump to the front of the line.
“That person may actually have a condition that makes them eligible, but may not be at risk of catching COVID-19 as much as someone who lives in a multi-generational household, and is at higher risk of dying from it because they are immune suppressed.”
“Doctors know, for example, that immune-suppressed patients should go before patients with increased risk due to obesity. Unless providers are involved and are allowed to prioritize patients, those critical judgments will not happen.”
UC Davis Health and other agencies meanwhile have not finished offering doses to other priority groups, including food and agriculture workers, people age 65 and up, teachers, transit workers, janitors and homeless people.
UC Davis on Monday announced it did not have enough doses available as of the start of the week to move forward with vaccinations of high-risk 16- to 64-year-olds.
Sacramento health official: Wait your turn
Other Sacramento-area officials warned the public they are struggling to get vaccines out to the increasingly large group eligible, asking people to be patient and wait their turn.
“Vaccine eligibility does not automatically equal access to an appointment. Sacramento County’s supply is still short of the demand – particularly with expanded eligibility as of today,” county health department spokeswoman Brenda Bongiorno said.
She reiterated that the county and its private clinic partners will not ask people ages 16 to 64 for proof they have a serious underlying condition. They will, however, likely ask the person to sign an attestation saying they believe they have an underlying condition that qualifies them.
“To protect patient confidentiality, we don’t ask for verification” that the person has a qualifying underlying condition, Bongiorno said. “The person just needs to sign to attest that what they are saying is true.
“The whole idea is to get people vaccinated. (Most) people realize the importance of waiting their turn.”
This story was originally published March 16, 2021 at 5:45 AM with the headline "California opening vaccine ‘floodgates’ to line-cutting, UC Davis Health chief warns."