How do physicians verify patients' vaccine eligibility?

Health care workers administering covid vaccines will rely mostly on the honor system to verify that new patients outside of their hospital systems are eligible to get the shot.

Pennsylvania officials have expanded eligibility of those who can move to the front of the vaccination line. The top priority group, called 1A, now includes people older than 65 and people over 16 who have certain underlying health conditions.

The change encompasses a wide swath of people — more than 3.5 million individuals are now eligible — as well as a broad range of conditions. They include cancer, COPD (a lung condition), diabetes, obesity, smoking and many other concerns.

“The impairment comes when people aren’t able to oxygenate appropriately,” said Bridget Calhoun, a public health expert and professor at Duquesne University. “If you have other ways in which you are particularly vulnerable … that kind of adds to the risk profile.”

Logistically speaking, increasing the eligibility group to include such a large category of people without adequate vaccine supply is a significant challenge for vaccine providers, who last week emphatically said there are not enough doses to accommodate the influx of patients.

UPMC is asking patients to attest that they have the underlying conditions included in the guidelines, but has no mechanism for checking, a spokeswoman said.

“People are asked at the time of requesting a covid-19 vaccine, and again when they arrive for vaccination, to answer ‘yes or no’ when asked if they have any of the underlying medical conditions that the CDC lists as placing them at higher risk for severe covid-19 illness,” spokes­woman Taylor Andres said.

But Calhoun noted most of the region’s health systems are focusing heavily on their established patients as a way to manage their vaccine supply and immunize the public most efficiently. In these cases, physicians already have access to patients’ medical history.

“Other times, just sheer observation can tell you,” Calhoun said. “This is an aged or this is a frail-appearing person or this is an obese person. All of which can contribute to some of the co-morbidities that we’re concerned about.”

Some groups have complained Phase 1A now includes such a broad swath of people with conditions that they see as non-life-threatening. The Pennsylvania State Corrections Officers Association, for example, released a scathing statement criticizing the Department of Health for moving people who smoke to 1A while corrections officers remain in 1B.

“It’s one thing to follow CDC guidelines regarding smokers, but that doesn’t prevent the administration from making the vaccination of its own corrections officers a higher priority,” said PSCOA Western Region Vice President John Eckenrode. “Our members are overworked, exhausted and are working massive amounts of overtime due to covid-19 illnesses within their ranks. The mental anguish of passing the virus to their loved ones also takes a tremendous toll.

“That’s why this decision to put smokers ahead of corrections officers is repugnant. It’s time for this administration to use common sense in its vaccination plan.”

The vaccine rollout has been marked by shifting guidelines and a race between at-risk and priority groups to get inoculated.

Some people in Phase 1B have already gotten their vaccines, and some health providers have taken a broad interpretation of what it means to be in 1A (UPMC, for example, has vaccinated corporate leaders and other staff who have worked from home since March 2020).

But health experts note the groups included in the latest expansion have a legitimate risk of poor health outcomes if infected with covid-19, because of the danger posed by their compromised immune systems paired with the virus’s attack on lung function.

Calhoun noted that all of the decisions — often made at the federal level by the Centers for Disease Control and Prevention and the Advisory Committee for Immunization Practice — are data-driven and based in medical fact.

“All of these little things kind of chip away at your ability to survive this infection and to still oxygenate well during this infection,” Calhoun said of the variety of health concerns the Department of Health identified in the eligibility expansion. “None of these additions to this list was really based on opinion. This is based on scientific evidence. It’s based on data. … These are folks who are objectively looking at the data and trying to figure out who is at greater risk for the worst outcome.”