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Those with underlying conditions not clear where they'll fall on vaccine list

Dr. Collin Brathwaite, chairman of surgery at NYU

Dr. Collin Brathwaite, chairman of surgery at NYU Langone Hospital-Long Island and a bariatric surgery specialist, spoke to Newsday on Wednesday about the importance of everyone getting the COVID-19 vaccine, especially those with preexisting conditions. Credit: Debbie Egan-Chin

Smokers and people with coronary artery disease may be among those on the next priority list for a COVID-19 vaccine, but those with high blood pressure and asthma might not.

Gov. Andrew M. Cuomo said people who are immunocompromised because of certain medical conditions will be in the next group eligible for vaccinations, but it's unclear when they will be added and which conditions will qualify. The move could add millions more New Yorkers to the 7 million now authorized to receive the vaccine.

State officials said they are consulting with the Centers for Disease Control and Prevention to determine which conditions will be eligible — even though the CDC for months has had a list of which medical conditions put people "at increased risk of severe illness" or death from the coronavirus.

Nationwide, at least 56% of those ages 16 to 64 — 110 million Americans — have at least one of 11 medical conditions on the CDC list, although some already are eligible for vaccinations because of their age or job. Obesity is the most common: More than 42% of U.S. adults are considered obese.

The CDC’s Advisory Committee on Immunization Practices recommended last month that people with any of these conditions be put in the same priority group as those 65 to 74. Cuomo, citing the limited number of vaccines, on Jan. 12 added people 65 and older, but not those with underlying conditions.

"I think that’s a big mistake," said Dr. Anil Mattoo, a pulmonologist at Long Island Community Hospital in Patchogue.

"I want to be sensitive to people 65 and older, but there is a whole host of people who are not 65 and have such life-altering medical conditions that, if they get COVID, they’re done," he said.

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Mattoo said that, for example, a 25-year-old who is immunocompromised because he is receiving chemotherapy for lymphoma likely would be at higher risk than a 65- or 70-year-old with no medical issues.

He said the state should find some way — such as a physician's certification — to prioritize the most vulnerable people with underlying conditions so, for example, a smoker with severely damaged lungs is prioritized over a smoker with relatively normal lung function.

Cuomo administration officials did not respond to questions on when people with underlying medical conditions would be eligible for vaccinations and whether the state would use the same eligibility list as the CDC.

Health department spokeswoman Jill Montag reiterated in an email that the problem is a shortage of vaccines: "We are encouraged by the [Biden] administration’s announcement that we will get a 16 percent greater allocation, and we hope to continue to receive more doses and guidance on this issue."

Dr. Henry Bernstein, a professor of pediatrics at the Zucker School of Medicine at Hofstra/Northwell and one of 15 voting members of the CDC advisory committee, said that, with a limited supply of vaccine, New York’s decision to separate people with underlying conditions from those 65 and older was understandable.

"The [COVID-19] morbidity and mortality for people 65 years of age and older is higher than the younger age groups, even those with certain chronic medical conditions," Bernstein said, although there may be some cases of people with severe underlying conditions who are more vulnerable.

In addition, he said, the chance of having an underlying condition rises with age.

Experts said that, in those with high-risk medical conditions, the coronavirus attacks the body in a way that exacerbates existing problems.

For sickle cell disease, a blood disorder on the high-risk list, the virus "magnifies what’s already there," said Dr. Lewis Hsu, chief medical officer for the Sickle Cell Disease Association of America. "COVID can involve low oxygen, clotting, increased inflammation that’s out of control, and problems with blood flow, and these are all things that basically are also part of sickle cell disease, too."

Obesity decreases lung capacity and is linked to a weakened immune response, the CDC said.

Dr. Collin Brathwaite, chairman of surgery at NYU Langone Hospital-Long Island and a specialist in weight-loss surgery, said his obese patients are aware of their increased vulnerability, and some have told him one factor in wanting surgery is fear of COVID-19.

"They want to mitigate that risk as soon as possible," he said. "They want to have surgery and start improving their health."

In addition to creating a list of eligible conditions, the CDC also grouped together conditions, such as high blood pressure and liver disease, that the agency said "might" put people at higher risk for severe COVID-19, but for which there may not yet be enough supporting data.

CDC spokeswoman Kristen Nordlund said the eligibility list likely will be updated again, "as the science evolves."

Obesity wasn’t added to the eligibility list until June. In the most recent update, on Dec. 23, the CDC added Down syndrome "to reflect recent data supporting increased risk of severe illness."

Mattoo said asthma is one condition on that second list that belongs on the first, because it clearly can be exacerbated by COVID-19. He has seen asthma patients struggle to breathe because of the coronavirus, which can cause inflammation of the body’s airways, just as asthma does.

"If somebody has COVID, their asthma will flare up," he said.

HIGHER COVID-19 RISK

The Centers for Disease Control and Prevention lists the following conditions as putting adults at increased risk of severe cases of COVID-19:

  • Cancer (the CDC says it is unclear if past cancer increases risk)
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Down syndrome
  • Heart conditions such as heart failure, coronary artery disease and cardiomyopathies
  • A weakened immune system from a solid organ transplant
  • Obesity, defined as a body mass index of 30 or higher
  • Pregnancy
  • Sickle cell disease
  • Smoking
  • Type 2 diabetes

SOURCE: Centers for Disease Control and Prevention

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