Here are the new guidelines about who should receive vaccine from the CDC, followed by those from the State of Texas. They are not the same. CDC advises, but states make up their own rules. Then I will comment on local efforts to distribute the vaccine.
Next vaccine priority groups: The CDC on Tuesday recommended that adults aged 75 and older and non-healthcare frontline essential workers be the next groups to be vaccinated against COVID-19. The latter group includes first responders (e.g., firefighters, police officers), corrections officers, food/agricultural workers, postal service employees, manufacturing workers, grocery store employees, public transit workers, childcare workers, and teachers and other school staff. These groups will be inoculated in vaccination phase 1b. In phase 1c, vaccination is recommended for adults aged 65–74, people aged 16–64 with high-risk conditions (e.g., cancer, kidney disease, heart failure, obesity), and essential workers not included in phase 1b (e.g., food-service employees, bank tellers). In phase 2, vaccination will be recommended for everyone else aged 16 years and up. The recommendations are published in MMWR.
Anyone 65 and older and people with chronic health conditions such as, but not limited to, cancer, chronic obstructive pulmonary disease, obesity, and pregnancy will be among the next group to be prioritized for COVID-19 vaccines, state health officials announced today.
The group, known as priority group 1B, is part of the state COVID-19 allocation plan recommended by an Expert Vaccine Allocation Panel that is made up of physicians, health experts, lawmakers, and DSHS officials. THEY CALL IT 1 B BUT IT IS ACTUALLY 1 C IN THE CDC GUIDELINES
Since Dec. 14, vaccines have been administered to people in priority group 1A, which prioritizes essential health care workers and vulnerable populations and is in line with the panel’s guiding principles and health care workers definition.
The Texas Medical Association, along with the Texas Hospital Association, has called on hospitals to include all physicians, medical students, and residents in the priority group for vaccines at this time. It is still unclear when vaccines will be made available to all physicians and practice staff throughout the state.
TMA has been involved in the planning discussions with the vaccine allocation panel and has been advocating for all Texas physicians and their staff to be vaccinated and able to administer the vaccine quickly.
Priority group 1B – which will begin receiving vaccines “in the coming weeks,” DSHS said. – is made up of:
- People 65 years of age and older
- People 16 years of age and older with at least one chronic medical condition such as but not limited to:
- Chronic kidney disease;
- Chronic obstructive pulmonary disease (COPD);
- Heart conditions, such as heart failure, coronary artery disease or cardiomyopathies;
- Solid organ transplantation;
- Obesity and severe obesity (body mass index of 30 kg/m2 or higher);
- Sickle cell disease; and
- Type 2 diabetes mellitus.
“The state will work with vaccine providers and local partners to ensure that people who are 65 and older or have the medical conditions listed below and who also work in front-line and critical industries have access to the vaccine so they will be protected from COVID-19 while on the job,” DSHS said. “Texas equally will strive to ensure vaccine reaches communities with health disparities in accordance with Texas Vaccine Allocation Guiding Principles.”
The role out of the vaccine to healthcare workers was interesting. While we may be 1a there are tiers within that group. Here is Tier 1: Emergency Medicine, Critical Care, and Hospitalist providers, as well as other very high risk providers
(for instance if you work in a Covid unit). The problem was that Methodist Health Care which has the highest market share in the area received only 2,995 doses, a small fraction of the doses needed to immunize those in Tier 1. Christus received more doses than they had employees. Physicians were scrambling to see where they could get the vaccine. The vaccine is supposed to be distributed to physicians at the hospital where they have privileges. Some doctors have privileges within multiple hospitals and systems. I let my privileges at Christus and Baptist lapse years ago as it was impractical to admit patients and attend them at multiple hospitals. You couldn’t even schedule an appointment in the Methodist system if your weren’t Tier 1. I reached out to the Baptist system and discovered that I had Honorary Privileges. So this morning at 0750 I received my first dose of Pfizer vaccine. Upon arriving at the office, I learned that Methodist had had a change of heart and I was now considered a Tier 2 physician and I could be vaccinated tomorrow. Here is Tier 2:
- Pediatric Hospitalists, Pediatric Critical Care, Neonatology, Anesthesiology, ENT, OMF, Gastroenterology, Obstetrics, Interventional Radiology/Cardiology and all physicians and providers who have cared for a COVID patient since 9/1/20
Even though most of my work is office based, I do attend my patients in the hospital and did follow a patient through two different Covid units.
So what happens to office based physicians who do not go to hospitals? The Bexar County Medical Society is working as a liaison between office based physicians and HEB pharmacies. Hopefully, they can get immunized along with their staffs. They have to have groups of ten because that is how many doses are in a vial. At least, it appears that progress is being made.
How was the vaccine? It felt like a flu shot. 12 hours late no side effects. I did feel a slight elation after receiving it. Physicians are used to putting their health on the line while caring for patients. That comes with the job. We do our best to mitigate it. I don’t worry about getting sick itself, but there is always this worry in the background about what the consequences of my illness would be. What would happen to my family, my staff, my patients and my livelihood? That’s why we are compulsive about washing our hands and wearing masks. Guess what? It works! I’ve done hundreds of Covid swabs and when I donated blood 10 days ago I was still negative for antibodies to the virus. My recurring Covid dream is that I am in a public place and I don’t have a mask. It’s the new version of the showing up to the exam late dream.
The next goal will be to get my staff vaccinated and then, when the state gives us the vaccine, my patients. If they can get it sooner at the pharmacy then I will encourage them to do that. Some people won’t want to get it. That’s their choice. They should just get out of the way and let those who want to get it, get it. The next two weeks are going to be especially bad. Don’t let your guard down. Just assume that everyone you encounter has it. They very well may.