California’s COVID-19 vaccine system usually works on an honor system.
If you make an appointment with a vaccine online, you may be asked to tick a box called ‘food and agriculture’ or ‘chronic lung disease’, which indicates that you fall into one of the eligible groups come. But if you show up at the clinic or pharmacy, you will probably not ask for documentation proving that you are a nurse or have a serious lung disease – an occupation and a medical condition that qualifies you for vaccination. They take your word that you qualify.
Due to the lack of supervision, some people who are not eligible can be easily vaccinated – just tick a box indicating that you are eligible – and this is called skipping the line.
Although the California Department of Public Health has not commented on the issue of skipping the line, health experts seem to agree that anyone who unpacks lies for no good reason is acting unethically.
Exactly who could that person be? “I would say someone who is completely healthy and well and wants to go to Cabo San Lucas for a spring break,” said Dr. George Rutherford, director of the Group for Prevention and Public Health Group at UCSF, said.
Who is not that person? People who may not be eligible, but who hang out outside mass vaccination sites in hopes of getting a dose that would be thrown away if an arm was not available. “It does not bother me at all,” he said.
There is a shortage of COVID-19 vaccines and although it is slightly easier to make appointments compared to a month ago, it remains scarce.
People scramble to get the chance and even those who are eligible may have to spend a few days looking for an appointment.
The state of California has a priority framework, based on the Centers for Disease Control and Prevention guidelines, which recommends for which groups of people public health departments and vaccine providers should give first. The framework is intended to help people at higher risk for severe infection and death from the coronavirus to get the vaccine. But ultimately, provinces and health care providers can decide who to vaccinate.
The state has put health workers and the elderly at the forefront, and vaccine companies, from provinces to providers, are joining this recommendation. But as more groups are added, provinces no longer stand by the state exactly, and the rules vary greatly from place to place. While eight counties in the Bay Area are people over the age of 65, Solano County announced this week that it is opening vaccines for individuals 50 years and older.
What’s more, there are now several occupational groups that are eligible, which broadens the availability of vaccine to a large variety of people. A writer working for a university can get the vaccine as all education workers are eligible. Because she works from home, it may seem unfair. Some may even say morally wrong. But is she technically skipping the line?
As the number of different types of eligible groups increases, the rules become increasingly difficult to follow, creating an unclear line between what can be considered to cut the line and what not. Many are engaged in complicated conversations with friends and family about whether certain situations qualify them for the shot. Some judge those who bend the rules, while others encourage it, probably with good intentions or reason.
“I know there will be people who will frustrate the system,” said Dr. John Swartzberg, an emeritus at the University of Berkeley, a professor of infectious diseases and vaccination said. “I know colleagues who are psychiatrists, who are vaccinated at the same time and doctors are at the forefront. But they see all their patients through Zoom. They say I’m a healthcare provider, I’m entitled I know colleagues in the position who would say : “I would not do it for the world.” I understand the issue on both sides, I feel bumps on both sides, but I come down and think that people with underlying conditions should be vaccinated and that they should be vaccinated as soon as possible, and I think we should be human trust the nature and integrity of the human conscience. ‘
California on Monday expanded access to the ages of 16 to 64 with disabilities or with qualifying health conditions and opened the flood gates to millions of people. Those with high-risk conditions or disabilities do not have to provide documentation to verify their diagnosis to get vaccinations, but they may be asked to sign a self-declaration that they meet the criteria, according to the guidelines of the Department of Public Affairs . Health.
Dr. David Lubarsky, CEO of UC Davis Health in Sacramento, issued a statement expressing concern that with so many people now eligible – and deciding for themselves – patients who are truly ill and poor, further pushed back into the queue. .
“Doctors know, for example, that immunocompromised patients should go before patients at increased risk due to obesity,” Lubarsky wrote in a statement. “Unless providers are involved and allowed to prioritize patients, those critical judgments will not happen. People with manners and means and flexibility will make their appointments first. They may have paid off time from their work, planned flexibility and know what to do. that person may have a condition that they are eligible for, but may not be at risk of catching COVID-19 as someone living in a multi-generation household and higher are at risk of dying from it because they are immune suppressed. ‘
The state lists ten conditions that qualify individuals for vaccines: cancer; chronic kidney disease of stage 4 or higher; chronic lung disease; Down syndrome; weakened immune system due to solid organ transplantation; pregnancy; sickle cell disease; heart disease, such as heart failure, coronary artery disease, or cardiomyopathy (but not hypertension); severe obesity; a type 2 diabetes mellitus.
What if you have a serious medical condition that is not on the list? Do you skip the line if you continue to be vaccinated?
Rutherford pointed out that cystic fibrosis is not on the list and there are very few adults who have it, but those who experience it have a very bad disease. ‘
“Just because it is not listed in the literature does not mean you are at a higher risk for severe COVID,” he said. “If you have cystic fibrosis, should you continue in this round? I think any doctor will say yes.”
Swartzberg said the list of medical conditions in California is based on data from the Centers for Disease Control and Prevention that determines what conditions people who have died from COVID have.
“Whoever is likely to be hospitalized or die is much more nuanced than that,” Swartzberg said. He referred to the conditions referred to as ‘guide plans’ to determine who should be vaccinated first.
Ideally, patients with the highest risk will be vaccinated first and the unique case of each person will be considered, but many experts agree that a system to require people’s health conditions veterinarian requires great human strength and expense.
“I think we have a system of honor that we have, and that a few people have to jump the line is probably a less wasteful system than requiring a prescription or an extensive system to judge people,” he said. Rutherford said, noting that appointments fill up with the current system and doses become depleted rather than spoiled and thrown away.
If there was a system, Swartzberg said it would be difficult to apply and result in inequalities. He pointed out that it is easy to see if it is based on age, but it is challenging for all the different groups.
“You can do this if someone has a driver’s license or an identity card with a date of birth, because someone can show you how old you are,” he said. “But if you need a doctor’s letter, what about all the people who do not have doctors?”
He added: ‘The system of trying to enforce some kind of documentation is breaking out fast because it defeats the purpose. I do not think it would work. ‘
While Lubarsky said it was important to get vaccinations to vulnerable communities, he expressed concern in his statement about the lack of enforcement. “We know people are eager to be vaccinated, but opening the floodgates without a witch’s office will do more harm than good. While vaccine supplies remain limited, we need to make sure that those at greatest risk are one of the first is what is vaccinated. “
The head of UC Davis Health has appealed to the medical community to help direct the effort. “Physicians and health systems are in the best position to do this right and ensure that we move quickly and fairly to use the vaccine and prevent the deaths and hospitalizations of those at greatest risk,” he wrote. “We support the state’s endeavor to achieve equity and reach communities where people do not have access to computers, or are too ill to use them. We have conducted a number of vaccine outpatient clinics in Sacramento, where we work to make sure that people who do not need the vaccine are vaccinated the most, and unfortunately the state is targeting fewer and fewer doses on most healthcare systems each week, undermining the goal of a fast, effective and equitable vaccination program. “