RALEIGH, N.C. -- Across the United States, millions of medically vulnerable people who initially were cited as a top vaccination priority group got bumped down the list as the Centers for Disease Control and Prevention modified its guidelines to favor the elderly, regardless of their physical condition, and workers in a variety of sectors.
Twenty-four states currently place people under 65 with "underlying medical conditions" near the bottom of the pack to receive vaccinations, according to Jen Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation. A report she wrote for the foundation last month listed Pennsylvania as the lone state making vaccines available to the medically vulnerable during its first phase of distribution.
When North Carolina unveiled its initial guidance in October, it placed people with multiple chronic conditions near the top of the list. In response to December recommendations from the CDC to prioritize people 75 and older, however, it dropped those with chronic conditions to Phase 2. When the guidance changed again to expand eligibility to those 65 and up, medically vulnerable residents learned in January that they would be dropped to Phase 4 -- to be vaccinated after "frontline essential workers" but before "everyone."
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The state's top public health official, Dr. Mandy Cohen, said residents under 65 with chronic conditions were moved down the list after health officials received data showing elderly residents are far more likely to die of covid-19, though she acknowledged "age is not a perfect proxy for risk."
"When they slid us to Group 4, it was very quiet," said Ann Camden, a 51-year-old mother with Stage 4 breast cancer. "It was like, 'We don't want to talk about it. We're just gonna kind of tuck you over there.' That in itself was kind of insulting."
Camden decided not to wait for the state to qualify her. A friend connected her with a CVS pharmacist in Wilmington, N.C., who had spare doses of the vaccine about to go to waste. Camden received a Moderna shot in the pharmacist's dining room on Feb. 21.
"It's incumbent on all of us to take it when we can get it," Camden said. "I don't want to feel guilty or embarrassed because I was gonna get it whenever I could."
Jon D'Angelo, a 32-year-old Carteret County, N.C., resident who suffers from spinal muscular atrophy, didn't qualify for a vaccine because he doesn't live in a long-term care facility. He said he jumped the line, but he declined to describe where and how he got the vaccine.
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Responding to the frustrations of people like Camden and D'Angelo, states are now revising their guidelines again. As of last week, 28 states had at least partially opened up vaccine eligibility statewide to those with high-risk medical conditions, Kates said. Four additional states are making the vaccines available to medically vulnerable residents living in certain counties.
North Carolina announced last week that on Wednesday, it will start vaccinating people 16 years and older with at least one of 18 at-risk conditions. Earlier this month, the state expanded its eligibility guidelines to include people like D'Angelo who receive at-home care. D'Angelo is now retroactively eligible under Phase 1, which launched in December.
"I'm glad they did it, but the fact that it took three months to correct is outrageous," D'Angelo said.
Last week, South Carolina expanded eligibility to at-risk people and those with disabilities, and Michigan did so for medically vulnerable residents 50 and older. California is opening up vaccinations on Monday to those who are at-risk or have disabilities.
In Georgia, the governor announced last week that those 16 or older with serious health conditions will be eligible starting Monday. Shana Frentz, a 36-year-old with two autoimmune conditions, said she secured an appointment at a Georgia pharmacy that began signing up people a day before the announcement. Before that, she had explored the possibility of going to a neighboring state.
During the months it took before she became eligible in Georgia, she said, she and others like her felt "kind of tossed aside."
STATE ACTIONS
As vaccine priority groups have varied from state to state, so have governors' responses to the pandemic.
Nearly a year after California Gov. Gavin Newsom ordered the nation's first statewide shutdown because of the coronavirus, masks remain mandated, indoor dining and other activities are significantly limited, and Disneyland remains closed.
By contrast, Florida has no statewide restrictions. Gov. Ron DeSantis has prohibited municipalities from fining people who refuse to wear masks. And Disney World has been open since July.
Despite their differing approaches, California and Florida have experienced almost identical outcomes in covid-19 case rates.
Though research has found that mask mandates and limits on group activities such as indoor dining can help slow the spread of the coronavirus, states with greater government-imposed restrictions have not always fared better than those without them.
California and Florida both have a covid-19 case rate of about 8,900 per 100,000 residents since the pandemic began, according to the CDC. And both rank in the middle among states for covid-19 death rates -- Florida was 29th as of Saturday; California was 31st.
Connecticut and South Dakota represent another example. Both rank among the 10 worst states for covid-19 death rates. Yet Connecticut Gov. Ned Lamont, a Democrat, imposed numerous statewide restrictions over the past year after an early surge in deaths, while South Dakota Gov. Kristi Noem, a Republican, issued no mandates as virus deaths soared in the fall.
While Lamont ordered quarantines for certain out-of-state visitors, Noem launched a $5 million tourism advertising campaign and welcomed people to a large motorcycle rally, which some health experts said spread the coronavirus throughout the Midwest.
Both contend their approach is the best.
"Even in a pandemic, public health policy needs to take into account people's economic and social well-being," Noem said during a recent conservative convention.
Lamont recently announced that he is lifting capacity limits at retail stores, restaurants and other facilities, effective next Friday. But bars that don't serve food will remain closed, and a mask mandate will continue.
"This is not Texas. This is not Mississippi. This is Connecticut," Lamont said, referencing other states that recently lifted mask mandates.
"We're finding what works is wearing the mask, social distancing and vaccinations," he said.
EASING RESTRICTIONS
As new covid-19 cases decrease nationally, governors in more than half the states have taken actions during the past two weeks to end or ease coronavirus restrictions, according to an Associated Press tally. Some capacity limits ended Friday in Maryland and Oklahoma. Michigan, Minnesota, New Jersey, New York and Wyoming are relaxing restrictions this week.
In almost all cases, governors have lauded their approach to the pandemic, while critics have accused them of being too stringent or too lax.
California's slow reopening is expected to gain steam in April. But Republicans in California are helping organize a recall effort against Newsom that has drawn nearly 2 million petition signatures from people frustrated over his long-lasting limits on businesses, church gatherings and people's activities. He also faces intense pressure over public school closures and the slow pace of getting them reopened.
Newsom asserted that California has been a leader in combating the virus while delivering his State of the State address last week from Dodger Stadium, where the empty seats roughly equaled the state's 55,000 covid-19 deaths.
"From the earliest days of this pandemic, California trusted in science and data, and we met the moment," Newsom said.
He added: "We're not going to change course just because of a few naysayers and doomsdayers."
In his own State of the State address, DeSantis asserted that Florida was in better shape than others because its businesses and schools are open. Florida's unemployment rate ranked below the national average and was significantly lower than California's at the start of this year.
"While so many other states kept locking people down over these many months, Florida lifted people up," DeSantis said.
Information for this article was contributed by Anila Yoganathan, David A. Lieb, Brendan Farrington, Stephen Groves, Susan Haigh and Kathleen Ronayne of The Associated Press. Anderson is a corps members for the AP/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.
