California’s new COVID vaccine plan leaves behind vulnerable homeless residents, inmates
In a major change to California’s COVID-19 vaccine distribution program this week, two high-risk groups — incarcerated individuals and homeless residents living in congregate shelters — have been dropped from prioritization plans.
The announcement made by Gov. Gavin Newsom on Monday has left advocates scrambling for answers, and deeply concerned about the potentially deadly consequences of further delaying vaccines for individuals who are particularly susceptible to catching the virus because of where they live and what their health conditions are.
“It’s shocking that they’re not prioritized but it’s not surprising,” said Anthony Menacho, executive director of Sacramento Street Medicine, a program that offers medical services to homeless residents.
California had initially put out a complicated phased system ranking priority for inoculation based on factors such as age, industry and risk of exposure. Homeless residents in shelters and incarcerated individuals — people who live in close quarters with others and have limited ability to social distance and quarantine — were in the second tier of Phase 1B to receive doses.
In an effort to speed up the vaccine rollout, California will simplify its eligibility. People over 65, and workers in healthcare, education and child care, emergency services, and food and agriculture will be able to secure appointments for the vaccine statewide.
After that, future groups will become eligible based on age, according to state officials, scrapping its previous phased approach and leaving incarcerated individuals and homeless residents in limbo.
“We certainly are listening to a lot of feedback, making what I would say are difficult decisions, but trying to make sure that they’re clear and simple to follow,” California Health and Human Services Secretary Dr. Mark Ghaly said during a press conference Tuesday. “Using an age-based framework helps us get there.”
Advocates for both groups have emphasized that homeless and incarcerated individuals have higher rates of chronic health issues, making them vulnerable to the worst symptoms of COVID-19. Correctional facilities and homeless shelters have also seen high rates of transmission among inhabitants.
Many homeless and incarcerated individuals could very well be eligible to receive the vaccine based on their age, but advocates worry that the change in prioritization will make it even more difficult for county health departments to make the time and resources available to distribute doses to these groups.
“Particularly when they have a compromised immune system, when 70 percent are outside and now it’s cold and rainy, couple that with flu season and poor nutrition — I don’t think it’s very thought out,” said Bob Erlenbusch of the Sacramento Regional Coalition to End Homelessness.
More than 46,000 inmates in California have been infected with the virus so far, and 191 have been killed, according to the California Department of Corrections and Rehabilitation. And while the most dire predictions about outbreaks among the state’s homeless population have been avoided, community advocates and health professionals emphasized that most homeless residents have serious underlying health conditions that could result in severe symptoms.
As of mid-January, at least 205 inmates inside the Sacramento County Main Jail tested positive for the virus, according to figures provided to defense lawyers by the U.S. Marshals Service. The Sheriff’s Office reported last week that 306 inmates currently in custody between the county’s two jails have COVID-19.
The outbreaks spurred the Sacramento County Superior Court to order the release of “all confined persons who are serving county jail commitments with 90 actual days or less remaining on their sentence” to reduce the jail population. The court issued a similar order last March at the start of the pandemic.
“The horror stories we’re hearing inside are heartbreaking,” said Liz Blum of the inmate advocacy group Decarcerate Sacramento.
Starting last month, some state prisons began vaccinating inmates and employees based on risk factors such as age and health conditions. That had given some inmates in Sacramento hope, said Liz Blum of the inmate advocacy group Decarcerate Sacramento.
“Judges and the DA and the Sheriff’s should see this as even more pressure to release folks,” said Blum, who is advocating for Sacramento County to half its current jail population of roughly 3,200 inmates to prevent additional COVID-19 outbreaks.
Homeless individuals — at greater risk to infection, chronic illness, poor mental health, substance abuse and heat and cold stress from weather conditions — have an average life expectancy of around 50 years old, said Sacramento Street Medicine managing director Kim Lau.
“Just putting everyone on the same scale isn’t actually an equitable measure,” Lau said. “We know already this is a population with chronic conditions at higher rates.”
A January 2019 count estimated 5,570 homeless people were living in the county, with most of them sleeping outdoors. About 30 percent of those sleeping outdoors were over the age of 50. Sacramento has largely avoided major COVID-19 outbreaks among homeless residents, in part because the shelters that are still open are operating at limited capacity to avoid further spread.
“At the end of the day, the inability (of the city and county) to provide a lot of shelter to people may have protected them from major outbreaks,” said Joe Smith, Loaves and Fishes’s advocacy director. “But that’s not going to last forever.”
State officials have said that making vaccine distribution equitable is a top priority, and have sketched out early plans to distribute vaccines to underserved neighborhoods where residents have a lower life expectancy — largely low income areas and communities of color.
In a statement, the California Department of Public Health said that “equity continues to be our North Star, and we can achieve that by allocating vaccines to communities that have been hit hardest by COVID, and collecting demographic data on who is receiving the vaccine.
Should data show that certain groups are not being vaccinated, the department stated, “we will be able to make adjustments and make sure those groups are reached.”
“There of course are going to be some sectors of our population that don’t come to the front of the line as quickly as some others and we’re working through to make sure that communication is simple and well understood,” Ghaly said Tuesday. “The worst thing is when people don’t know where they are in the line.”
This story was originally published January 27, 2021 at 4:04 PM.