When Connecticut officials announced the state’s most recent COVID-19 vaccination timeline, they also added that young, high-risk residents — previously sidelined by the state’s switch to an age-based rollout — would be given “accelerated access” once vaccinations open to all adults in early April.
But what that will mean for those with illnesses known to aggravate the effects of COVID-19 remains unclear.
Since first publicly discussing the strategy, state officials have clarified that “accelerated access” is not a reversal of the state’s age-based plan. Residents under the age of 45 who qualify under a narrow set of medical conditions will still become eligible for the vaccine along with everyone else on April 1.
But, if health care providers are able to execute the strategy, qualified residents might be able to more easily schedule vaccination appointments or have access to a fixed allocation of doses. One expert compared the idea with the TSA PreCheck line at airport security.
“This is not a change to the rollout strategy,” said Josh Geballe, the state’s chief operating officer. “This is, once we’ve gotten to the point where the age-based rollout is complete and the general population is eligible … we’re encouraging providers to think about providing accelerated access for the people in that under-45 age group who have the most severe risk conditions for COVID-19.”
The state has not set any specific requirements for the program, instead leaving health care providers to work out the plan. Hospital officials said this week that they’ve agreed on five medical conditions that will be eligible for enhanced access, although they have declined to specify the specific conditions. That list, they said, could still expand.
Connecticut’s vaccination appointments are currently open to residents aged 45 and older, along with educators and health care workers. But with expansion to all adults now less than two weeks away, hospital officials say they have not determined exactly how high-risk residents will be pushed to the front of the line.
Regardless of how the vaccine providers actually create “accelerated access,” hospitals officials say that the worst-case scenario would be that different providers open that access to different groups of people.
“You don’t want everyone doing it differently,” said Dr. James Cardon, Hartford HealthCare’s chief integration officer. “Nothing would create even more confusion than people looking around to this person allows me to do it, this doesn’t, [federally qualified health centers] are allowing this and pharmacies are doing that. It’d be utter chaos.”
And already, some health centers have said that they’re not planning to follow the hospitals’ list, because the majority of their patients are already at heightened risk for one reason or another.
So what does “accelerated access” actually mean?
Hospitals taking lead
When state officials in mid-March unveiled the idea of enhanced access for certain residents, they also announced that the state Department of Developmental Services would be holding separate vaccination clinics for people with intellectual or developmental disabilities, at some point after April 5.
But when it comes to “accelerated access” for all other residents, the state has taken a backseat.
The decision-making and the actual implementation of the strategy have been left entirely in the hands of medical officials, according to both Geballe and to hospital officials.
Geballe said the state is “encouraging,” but not requiring, vaccine providers to follow its enhanced access suggestion.
The resulting discussions, convened by the Connecticut Hospital Association, have included Hartford HealthCare, Trinity Health Care of New England and Yale New Haven Health, among other providers.
Dr. Thomas Balcezak, Yale New Haven Health’s chief clinical officer, said the concept is the vaccination equivalent of “a TSA PreCheck line.”
Balcezak said that the group’s primary goal is to reach consensus on the eligible conditions so that residents can have confidence that they’ll be treated the same regardless of where they’re vaccinated.
“It does the state no good for there to be inconsistency and have people vaccine shopping, if you will,” Balcezak said.
But even if the hospitals do reach a final agreement, there are other types of health care providers that have not been directly involved in the discussions.
Some community health centers, such as New Haven’s Cornell Scott-Hill Health Center, say that they plan to follow the hospitals’ lead. Other health centers say that the idea of putting some patients ahead of others doesn’t make much sense for them.
“Most, if not all, of our patients are high-risk: they are presenting with co-occurring chronic medical conditions and behavioral health conditions,” said Sabrina Trocchi, the president and CEO of Wheeler Clinic.
Nichelle Mullins, the president of Hartford’s Charter Oak Health Center, noted that “the state hasn’t mandated” that providers follow the enhanced access concept.
“From our clinical perspective, all of our patients are at high risk and vulnerable, so it’s our priority to make sure all of our patients who want the vaccine receive the vaccine,” Mullins said. “Our priority is to get vaccines in arms of everyone who wants them.”
A targeted list of conditions
Hospital officials say that their agreed-upon list of conditions will be based on three guiding principles, including that the conditions must:
cause increased risk of severe outcomes from COVID-19
be easily verifiable
affect a clear-cut set of patients
At this point, hospital officials say they have agreed on five conditions to add to the list. Balcezak said Wednesday that the list is not yet finalized — it could yet be expanded, he said, although he doesn’t foresee it shrinking.
Balcezak noted that this list of conditions would apply to adults, and that there could be separate prioritizations for teens.
A five-condition list would be significantly shorter than the list of high-risk conditions that was published by the U.S. Centers for Disease Control and Prevention, meaning that a significant number of people who are considered high-risk by the CDC would not qualify for “accelerated access” under the Connecticut hospitals’ list.
In recent weeks, state and hospital officials have criticized that CDC list as overly complex and broad.
At a press briefing last Monday, the same day that the state began talking about “accelerated access” and before the hospitals began to discuss the concept, Geballe said he didn’t expect hospital officials to use the CDC list.
“The CDC was not particularly helpful,” Geballe said at the briefing. Vaccine providers are “probably more focused on the most severe and most high-risk individuals in those groups.”
Dr. Syed Hussain, chief clinical officer for Trinity Health of New England, said that there were clear benefits to focusing on a few medical conditions, as opposed to deferring to the CDC’s long list of comorbidities.
“We don’t want to bog people down in terms of trying to get verifiable data or records from their providers. We want to make it as easy as possible. And I see this as something that can be implemented easily. The goal here is to expand access,” he said.
Setting aside doses, appointments
Balcezak said on Monday that different hospital systems would likely implement the list in different ways — for example, by specifically reaching out to patients with the listed conditions, by reserving appointment slots for those patients or some combination of the two.
“Each vaccine provider I think would have to figure out the mechanism that works for them,” Balcezak said. He added that the Yale New Haven Health system would likely “put special allocation aside for the population.”
Cardon, of Hartford HealthCare, said Friday that it was too early in the process to know how, exactly, the allocation of doses would roll out. Even so, he said he was confident that the hospital system would be able to provide increased access for medically vulnerable patients, so that “it’s not just queue up.”
And Hussain said Trinity Health of New England is considering a number of different ways — including dedicated clinics — to make vaccines more readily available for residents who have the listed conditions.
“It will be a mix, open to all 16 and above, but we will probably have designated clinics or designated special hours or days — a Saturday, or Sunday, or evening hours — for these individuals so that we can accommodate them,” Hussain said.
Allowing accelerated access for people with the specific medical conditions would not interfere with allowing vaccination access for the wider population, Hussain added.
“We will have to ramp up capacity so that we don’t hinder anybody from getting an appointment,” he said.
The date on which all adults in Connecticut will become eligible for the COVID-19 vaccine has been updated in this story to April 1 following a March 25 announcement of an accelerated timeline.
Emily Brindley can be reached at ebrindley@courant.com. Eliza Fawcett can be reached at elfawcett@courant.com.
