Who’s next? Hoosiers in high-risk groups wait their turn as state follows age-based COVID-19 vaccination schedule

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By Ann Marie Shambaugh and Janelle Morrison

For Lauren Alexander, the wait for the COVID-19 vaccine has felt especially long.

Lauren Alexander, 33, has lung damage and a compromised immune system after battling cancer, but she continues to head to work at Camp Bow Wow in Carmel despite concerns about contracting COVID-19. (Submitted photo)

After being diagnosed with a rare form of lymphoma in 2017, the 33-year-old Carmel resident underwent 60 cycles of radiation to her chest, leaving her immunocompromised and resulting in damage to her lungs.

Both of those long-term effects could make her more susceptible to a severe case of COVID-19, a disease that is particularly dangerous for the elderly but also can wreak havoc on younger people with certain conditions.

That knowledge is with Alexander each day as she heads to work as franchise director at dog-care facility Camp Bow Wow in Carmel, a job impossible to do from home.

“I am now approximately 18 months cancer-free, but I will struggle to regain normal lung function long-term,” Alexander said. “If I get (COVID-19), it’s going to be a huge problem. If I could be vaccinated, that would give me peace of mind. I am not opening my lobby up until I get vaccinated. So, until I get (vaccinated), I won’t be able to do business as usual.”

Alexander is but one of millions of Hoosiers with medical conditions or jobs that — according to guidance from the Centers for Disease Control and Prevention — could put them near the top of the queue for a COVID-19 vaccine. But in Indiana, the state thus far has deviated from the CDC’s advice and primarily taken an age-based approach, opening up the vaccine only to those 65 and older as well as health care workers, first responders and residents of long-term care facilities.

State officials said their strategy has been to vaccinate people most likely to be hospitalized or die from the disease, with age being the strongest contributing factor. In Indiana, those 60 and older have accounted for 22.5 percent of COVID-19 cases and nearly 93 percent of deaths. Those 80 and older make up 4.6 percent of all cases and nearly 53 percent of deaths.

Gov. Eric Holcomb said Feb. 3 that 78,000 Hoosiers died in 2020. On average, the annual total is about 66,000. The higher 2020 total includes approximately 11,000 COVID-19 deaths.

“How do we reduce those deaths that otherwise probably would’ve been more consistent (with past years)?” he said. “That’s where we’re starting. How do we save lives, and who is most at risk, and then we’ll work our way down to the most healthy, strapping 17-year-old that wants (the vaccine).”

According to a database compiled by the New York Times, as of Feb. 9, Indiana and all of its neighbors have given at least one dose of the vaccine to between 8.8 and 9.4 percent of its residents, with 67 to 78 percent of received doses used (although Indiana was at the low end of both).

Weighing the risks

As the pandemic rages on, so does the pressure to begin vaccinating other groups, such as those with comorbidities, teachers and essential workers. All of Indiana’s neighboring states have begun vaccinating teachers, and Ohio is vaccinating people with certain severe congenital and developmental disorders.

“I think there’s many ways to slice this,” said Amesh Adalja, an infectious disease specialist at Johns Hopkins University. “It’s not obviously wrong to do it one way or another (as long as) there is a good faith effort to stick to these priority groups.”

State Sen. J.D. Ford has been helping to lead a push to expand eligibility to teachers, but he’d like to see other high risks groups added, as well.

“Why can’t we have an ‘and’ rather than an ‘or’ situation where we’re vaccinating first responders, health care workers, folks in assisted care facilities, teachers, comorbidities and people of color—who we know are experiencing a very high rate of COVID-19 positivity rates?” he said, adding that he plans to address the issue with state decision makers.

According to the Advisory Committee on Immunization Practices, a CDC committee that provides guidance on vaccines, after health care workers and residents of long-term care facilities, the vaccine should be available to those 75 and older and non-health care front-line essential workers, such as grocery store employees and teachers. In the next phase, it recommends adding those aged 65 to 74, those aged 16 to 64 with comorbidities and the remaining essential workers.

Adalja said some entities that strictly followed the CDC guidance ended up throwing away vaccine doses at the end of the day, which doesn’t benefit anyone. He said an age-based approach simplifies the process and provides the vaccine for the largest at-risk population, which also covers many people with comorbidities.

He said a COVID-19 diagnosis isn’t as dangerous for younger people with certain comorbidities compared to a case in an older person.

“A 30-year-old asthmatic is less likely to be admitted (to the hospital). They might have a tough course at home, but they may not require hospitalization,” Adalja said. “But if you’re a 68-year-old person, even if you’re in good health, you may end up being hospitalized at a higher rate.”

Hamilton County Health Dept. Emergency Preparedness Coordinator Christian Walker said using an age-based approach has ensured that everyone who receives the vaccine is a high-risk individual. He said opening up vaccine eligibility beyond age groups while the vaccine is scarce would make it easier for low-risk Hoosiers to claim certain conditions and jump the line.

“I want to believe people are honest, but by the same token I’ve got to safeguard the vaccine and the integrity of the process,” he said.

It might not be much longer, however, before state officials expand vaccine eligibility beyond age groups to those with certain medical conditions.

“When the age risk starts to equal the risk of a particular comorbidity, that is how we are starting to add those comorbidities in,” Indiana State Health Commissioner Kristina Box said Feb. 3.

At a Feb. 10 press conference, Box said the next phase will be opening vaccines to those 60 and older, followed by those between 50 and 59 years old along with younger people on dialysis or those that have Down Syndrome, sickle cell disease, organ transplant recipients and those actively being treated for cancer.

‘We just need more vaccines’

States are not required to follow the CDC’s recommendations, but in Indiana counties must heed the state’s guidelines.

Christian Walker, emergency preparedness coordinator for the Hamilton County Health Dept., said local health officials are invited to provide input for the vaccination plan but that decisions are made at the state level. He said HCHD has a bit of leeway if unused vaccine remains at the end of the day but that every effort is made to provide it to someone who is eligible per state guidelines.

“We do try to stay within the confines as much as we can,” Walker said. “I don’t know that we’ve ever really strayed very far from (the state committee’s) guidelines as far as who is authorized and who’s not.”

In Boone County, however, people with certain qualifications — such as chronic kidney disease, obesity, heart conditions and smokers — can be added to a waitlist to be notified if excess vaccine is available. Boone County Health Dept. RN Administrator Lisa Younts said the ISDH in early February authorized but did not require counties to create vaccine waitlists.

When Indiana lowered the vaccine age limit from 70 to 65, an additional 375,000 Hoosiers became eligible. With the state receiving 100,000 doses a week, it will take nearly a month to vaccinate the entire age group.

HCHD has been receiving 1,200 doses per week and has been told it will start receiving 1,600 doses per week later this month or early March. It has the space and resources to administer 3,600 doses per week; it’s only lacking the vaccine.

The same is true for Boone County, which receives 1,300 vaccine doses per week, a number guaranteed through the end of this month.

“We are ready to ramp up and give as many vaccines as we’re allocated,” Younts said. “We’re ready to go. We just need more vaccines.”

The Fishers Health Dept., one of only a handful of municipal health departments in Indiana, did not respond to a request for comment.

Bob and Rose-Marie Goodman are the owners and sole employees at Robert Goodman Jewelers in Zionsville. They both have conditions that could make contracting COVID-19 especially dangerous but are unable to operate their business from home. (Submitted photo)

Online vaccine appointments through the state’s portal are booked through late March. If additional supply becomes available, appointments will be added, but only for those already eligible.

And for those who aren’t, the wait — and uncertainty — continues.

For Bob Goodman, 62, and his wife, Rose-Marie, 63, owners of Robert Goodman Jewelers in Zionsville, each day at work comes with concern about contracting COVID-19. The shop’s only two employees, Bob has a compromised immune system and Rose-Marie is asthmatic. Staying home isn’t an option.

“If we have to shut down because Rose-Marie or I have tested positive, there’s going to be a significant problem,” Bob said. “And there’s a stigma that goes with it when you shut down (due to COVID-19).”

Editor’s note: This story is a result of a collaboration between Current Publishing and Carmel Monthly.

VACCINATION SITES

Eligible Hoosiers without access to a computer can call 2-1-1 to register by phone. Assistance is also available at local senior centers, public libraries and through AARP.

VACCINE Q&A

Who is eligible?

In Indiana, the vaccine is available for health care workers, first responders and those older than 65.

How do I pay for the vaccine?

The vaccine is free, although those with insurance are asked to provide that information. The vaccine provider may bill the insurance company, but there will be no cost to the patient receiving the vaccine. Those without insurance will receive the vaccine for free.

Which vaccine is used in Hamilton County?

The Hamilton County Health Dept. is only using the Moderna vaccine, but some other sites are using Pfizer’s vaccine. Both require two doses and have efficacy rates near 95 percent.

How long does a vaccine appointment take?

Those receiving the vaccine are encouraged to arrive 15 minutes before their scheduled appointment. The appointment consists of a check-in process, vaccination and 15- to 30-minute observation period after receiving the vaccine. The entire process takes less than an hour.

Will I receive proof of vaccination?

Yes, those vaccinated will receive a card that confirms the dates of the first and second vaccination doses.

Will these vaccines work against different variants of the virus?

Maybe. Research studies are under way that show the Pfizer and Moderna vaccines may work against new COVID-19 variants, but more clinical data is needed.

How long will the vaccine protect me?

Clinical trials are being conducted to see how long immunity from the vaccines lasts.

When will herd immunity occur?

Herd immunity is expected to occur when 70 percent of the state’s population has been vaccinated. Less than 10 percent of the population has been vaccinated.


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