In an effort to simplify and speed up California’s troubled coronavirus vaccination rollout, state health officials are considering shifting to a priority system primarily based on age — a move that could preserve access for residents 65 and older, but bump down access for some younger essential workers.
The state’s possible move comes amid a backdrop of falling infections. San Francisco Mayor London Breed said Thursday on Twitter that the city “could start reopening soon,” because its transmission rate had dipped to the point where each person with COVID-19 passes it on to less than one person, on average.
San Francisco opened its first mass vaccination site at City College Friday, where about 500 people received a shot. The site has capacity to give about 3,000 vaccines a day, but the city currently has enough supply to make only a few hundred appointments a day.
Most people getting shots at the City College site on Friday were over 75, reflecting a focus by providers around the state on getting that age group vaccinated first. While the state has said that Californians over 65 can get inoculations, the limited number of shots flowing from the chaotic rollout has meant that counties have had to make hard choices.
Marin County had started vaccinating some teachers on Sunday, but changed course during the week to prioritize by age; moving forward, it is vaccinating people 75 and older first. The strategy makes sense right now given the extremely limited supply of vaccine, and given that older people are much more likely to die from COVID-19, said Marin County health officer Dr. Matt Willis.
“It has clarified and simplified our process significantly to really focus on age,” he said.
Sonoma County is also focusing on vaccinating those over 75 as a top priority, while also getting to those over 65 as much as possible, Sonoma County Health Officer Dr. Sundari Mase said Thursday. The county “put out a call for all teachers 65 and older to get vaccinated ASAP in the next week or two,” Mase said.
On a state level, vaccine advisers are “thinking very seriously about focusing primarily on age and not as much on the sectors,” state health officer Dr. Erica Pan said Wednesday during a meeting of the Community Vaccine Advisory Committee, which advises the state on vaccine policy.
Under the current state system, people 65 and older and essential workers — including teachers, farm workers and grocery store workers — are in the same priority group, Phase 1b. The potential new framework, which has not been finalized or announced, would consider both age and occupation, but put more emphasis on age.
It is potentially a cleaner, simpler way for providers to make fast decisions about who to vaccinate, as it’s often easier to verify someone’s age than it is to verify their occupation. Prioritizing people for underlying health conditions, another possibility, also has challenges in practice.
Vaccinating older people first should also help ease the toll on hospitals, since the majority of COVID-19 intensive care admissions and deaths are people in their 60s or older. Deaths in California remain high even as the infection surge begins to abate, with the state recording another record for coronavirus deaths on Thursday — 735.
“We’re hearing from the public that the system currently as it is feels confusing and is moving more slowly,” said California Surgeon General Dr. Nadine Burke Harris, who chairs the community vaccine advisory committee. “We’re also hearing from our local health officers that … complexity is a barrier to the speed at which we’re getting the vaccine out. … Simplifying saves lives. The simpler it is, the easier it is to implement.”
It is unclear how much a state shift toward age would change the way vaccinations are being done in parts of the state. Counties have handled things differently. Parts of Napa County also started vaccinations for teachers of all ages; in San Francisco, like Sonoma, only teachers over 65 are eligible for the vaccine.
The possible state move raises questions about equity, since many essential workers are low-wage earners and people of color. United Farm Workers Foundation said moving to an exclusively age-based system would be “disconcerting” because farm workers are particularly vulnerable — many are uninsured and work under risky conditions, often with no handwashing stations or masks if they are not provided by employers.
Pan and Burke Harris acknowledged these are difficult decisions.
“We’re in between a rock and a hard place,” Burke Harris said.
The state is also considering ensuring that 20% of vaccines go toward communities that fall within an equity metric that incorporates neighborhoods’ income, education level and access to health care.
The potential shift is being discussed as the state is under increasing pressure to speed up immunizations. California ranks 44 out of 51 states and the District of Columbia in doses administered per capita, according to the U.S. Centers for Disease Control and Prevention. About 44% of the 4 million doses that have been sent to California counties and health care providers have been administered, according to state data.
In San Francisco, the site at City College is the first of three that the city plans to open, in partnership with UCSF, Dignity Health, Kaiser and Sutter Health. On Friday, appointments were mostly limited to UCSF patients. The health care provider will reach out to patients if they are eligible for a vaccine and invite them to the site.
John Cruger-Hansen, a 77-year-old UCSF patient who lives in El Cerrito, said he received a text from UCSF Thursday evening telling him he could make an appointment. A few minutes later, he had one for Friday morning. He thought it was too good to be true.
But everything went smoothly when he arrived, and he got the shot.
While it won’t change anything in his day-to-day routine, he said he will at least have a little more peace of mind when he does little things like going to the grocery store.
“This is one time I wish I was older,” Cruger-Hansen’s 63-year-old wife, who was not eligible for a vaccine, said Friday.
Breed’s plan is to eventually administer 10,000 coronavirus vaccinations per day, with the goal of immunizing all eligible residents by June 30, but the city is a long way from hitting those daily goals because of a vaccine shortage.
“We really are so dependent on vaccine supply,” said UCSF’s Dr. Josh Adler. “We need an ongoing, reliable and predictable supply.”
After the shot, people were directed to a parking spot to sit for about 15 minutes to make sure no symptoms arose. The site is currently drive-in only, but the city has plans to expand it so people can also walk through it, too.
Breed’s comments on a possible reopening gave the city another stirring of hope on Friday. But San Francisco can start to reopen only when the state gives a green light to the entire Bay Area.
California’s guidelines say a region can reopen when its intensive care unit capacity is projected to hit at least 15% availability within a four-week period. The Bay Area’s ICU availability is currently 6.5%.
The California Department of Public Health said it was “unable to predict when an individual region” might hit its ICU goal.
But infections are falling across the region. The seven-day average for new cases in the nine counties was 49.8 per 100,000 people on Jan. 21, down from 60.9 per 100,000 on Jan. 14.
As of Friday, San Francisco had a 4.3% 7-day positivity rate. The city’s 7-day average of new coronavirus cases per 100,000 people fell from 39.4 on Jan. 14 to 30 on Jan. 21. Currently, 234 people are hospitalized, down from a high of 259 on Jan. 12.
Breed said that San Franciscans must remain vigilant.
“We all need to keep doing what we know slows the spread of this virus: wear a mask, avoid indoor gatherings with people you don’t live with, ventilate indoor spaces when you’re around other people, and wash your hands frequently,” she tweeted.
“Let’s keep this up!”