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When It Comes to Vaccine Eligibility, What Does “High-Risk” Mean?

Kelsey Tyler

With the vaccine rollout chugging along, many states are starting to vaccinate residents considered “high-risk” due to underlying illness. If you have a heart issue or diabetes, you may already know that you’re part of this group and, as a result, allowed to jump the vaccine line. But what if someone has an autoimmune disease or a developmental disorder? Which other conditions, besides the most frequently mentioned ones, affect vaccination eligibility?

While it’s important to know if you have a heightened risk of becoming severely ill from COVID, figuring out if your health status qualifies you for early vaccination for exactly that reason isn’t as simple as you might think. But understanding why that’s the case, and knowing where to look for guidance, can make the situation easier to navigate.

It’s up to the states

The federal government has issued guidelines on the order of priority for vaccination, its health officials periodically chime in with updated recommendations. But they’re only recommendations, not federal mandates. 

Every state has had to come up with its own phased distribution plan to determine how and when to administer the vaccine. People who have underlying medical conditions that put them at an increased risk of severe complications from COVID-19 are considered “high-risk.” These underlying conditions are also called comorbidities. For someone to have severe COVID complications (or illness), per the New York City Department of Health, it means they might need “hospitalization, intensive care or a ventilator to help them breathe, or that they may even die.”

“High-risk” individuals are uniformly treated as a group that gets priority over the general public, but the precise definition of the term varies. While most states are using the CDC’s list of conditions that carry an increased risk of severe illness from COVID in their vaccine plan, other states have yet to define which chronic conditions make people eligible for early vaccination.

“Much of the confusion stems from each state rolling out their plan a little bit differently,” says Dr. Amy Mullins, medical director of quality and science at theAmerican Academy of Family Physicians. “And, within states, each county may be implementing their plan differently.”

Many others are taking a similar approach and relying on the honor system.

For example, New York State won’t start vaccinating people with underlying health conditions until the spring, and has yet to determine which ones make its list. Texas is already vaccinating people with at least one high-risk medical condition. The Texas Department of State Health Services lists qualifications for phase 1B — including cancer, chronic kidney disease and sickle cell disease — yet it also includes language suggesting other chronic conditions might qualify as well.

“The qualifier in the language does imply there are other chronic conditions that certainly put people at risk for developing severe complications from COVID-19,” says Dr. Sherri Onyiego, division director for nutrition and chronic disease prevention at Harris County Public Health in Texas. 

Texas’ list of eligible high-risk conditions is based on the most common health issues doctors have seen with COVID-19, and ones that current data support, she adds. As the science evolves, so too will states’ decisions regarding vaccine priority. Just this past week, Texas added Down’s syndrome to its 1b eligibility criteria. This change came weeks after the CDC updated its own list of conditions that carry an increased risk of severe illness.

A recent study found that people with Down’s syndrome are 10 times more likely to die from COVID-19 because of abnormal immune responses, congenital heart disease and lung abnormalities commonly associated with the disorder.

COVID and autoimmune diseases

People who are immunocompromised are at high risk of developing complications from COVID-19 as well, according to the CDC. Though, on their vaccine priority lists, many states don’t include conditions that can be linked to a weaker immune system like lupus.

Dr. Andres Splenser, an endocrinologist in Houston in private practice, says it’s important to distinguish between having an autoimmune disorder and being immunocompromised. “With an autoimmune disorder, your immune system works too hard,” he says. “It doesn’t mean you’re immunocompromised.”

However, some people with autoimmune diseases do take drugs that suppress their immune function, which could make them immunocompromised. What’s more, evolving research suggests that autoantibodies, which play a role in autoimmune diseases, may also play a part in some of the worst cases of COVID-19. With autoimmune diseases, the immune system misfires, producing antibodies against itself and causing damage to organs throughout the body.

“There is tentative research that people with autoimmune conditions could get sicker from COVID,” says Dr. Natasha Bhuyan, a family physician at One Medical in Phoenix.

Robert Atmar, professor of Medicine at Baylor College of Medicine, says that, ultimately, it will depend on how individual states identify persons at risk and include them for prioritized vaccination.

Where to look to see if you’re eligible for early vaccination

If you have a chronic health condition and you want to know if you’re eligible to receive the vaccine early in your state, you can:

  1. Find your area’s vaccine plan. Look at your county, city or state’s health department website to find information on its vaccine rollout plan and its list of qualifying health conditions.
  2. Check for any CDC updates. Consult the CDC’s website for its most up-to-date list of conditions that carry a heightened risk of severe illness from COVID-19. If the CDC has added a high-risk condition that’s not on your state’s vaccine priority list, you can lobby local officials to update their list.
  3. Talk to your doctor. During routine appointments, Splenser has been making sure his high-risk patients know they’re eligible, and if he’s not sure, he encourages patients with chronic conditions to contact their primary care doctor for guidance. “There are some gray areas,” he says, “so if you’re not sure, definitely ask your healthcare provider.”

Onyiego says Harris County (in Texas) doesn’t currently require documentation to prove an eligible health condition. Many others are taking a similar approach and relying on the honor system. Splenser adds that while many people are eager to get the vaccine, it’s important to let the most vulnerable people go first.

“When there’s low supply, we have to target healthcare workers, front line workers and people who are really at risk of getting a severe infection first. We really have to step back and say, who is it that’s dying of COVID, and those are the people who get it first.”

In the meantime, Mullins says, it’s important to continue practicing the safety measures we’ve followed for months. “As we all await our turn to be vaccinated, it’s more important than ever to wash hands, maintain physical distancing and wear a mask,” she says.

Show Comments (2)
  1. Patricia DeJesus

    I have Lupus. Does this mean I shouldn’t be vaccinated? I had my first vaccine.

  2. jayne c rosenbaum

    I have MS havent had my first vaccine yet where do I get it ?

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