Miami’s Jackson on cusp of expanding COVID vaccine to include some of those 55 and up
After more than a month of frenzied online lotteries and ad hoc partnerships with faith leaders, Miami’s public hospital has finally seen a slackening of demand among people 65 and older for the two federally authorized COVID vaccines.
That’s led to internal conversations at Jackson Health System about whether it’s time to shift the focus to those 55 and older who have underlying medical conditions that put them at risk for severe COVID-19 — a bucket of people already eligible under Gov. Ron DeSantis’ late December executive order on vaccines, but who have struggled to find appointment slots.
Jackson Health has already been vaccinating that age bracket of existing patients, but hasn’t yet opened the appointments up to the public — no South Florida hospital has.
“We’re trying to orchestrate what that looks like,” Jackson CEO Carlos Migoya told the Miami Herald on Wednesday. “I don’t think we have an answer [from state officials] on how to do that just yet. We might by the end of the week.”
On Friday, Jackson announced it was opening up its vaccines to those 55 and over who have at least one of 13 medical conditions that are at high-risk for COVID-19, as outlined by the Centers for Disease Control and Prevention.
Issue of verifying medical conditions for those over 55
Aside from vaccine appointments for seniors disappearing in mere minutes — a measure that has now expanded into hours — the major obstacle that has prevented hospitals from delving into that age group has been the daunting task of verifying claimed medical conditions.
As of yet, neither DeSantis nor the Florida Department of Health have told hospitals how they would do that, Migoya said. Last week, the hospital CEO noted that, especially in Miami, it would be feasible for someone to obtain a doctor’s note that was either fudged or altogether fraudulent.
A spokesperson for DeSantis did not directly answer questions about whether DeSantis thinks local officials should refocus efforts on people over 55 with medical conditions.
The lack of clarity on how to grapple with those decisions has led hospital systems like Jackson and Baptist Health South Florida to administer vaccines to people under 65 only if they are their own patients — receiving treatment for cancer or organ transplants, as two examples.
But worrying about whether or not people are truthful about their medical conditions might be a distraction. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security, said there’s no proven method to verify a stated medical issue, and it would be prudent for hospitals to follow an honor system, knowing that some people could be less than honorable.
“You’re not going to check their blood sugar; you’re not going to ask for their medical records,” Toner said. “You may or may not even want to bother with a doctor’s note.”
‘Competing priorities’ led to slower roll out for Miami seniors
Though demand for COVID vaccines among those 65 and older may be lessening, Miami-Dade County has still trailed behind others in vaccinating a large chunk of its senior citizens, prompting county Mayor Daniella Levine Cava to write a letter to DeSantis asking for more vaccine doses.
On Friday, state officials said that Miami-Dade’s lagging behind was due to “competing priorities” among healthcare workers, seniors and people with underlying conditions. The county also has a much larger healthcare infrastructure than other parts of the state, including its two major hospital systems, Jackson and Baptist, officials said.
As of Tuesday, about 12,600 Baptist employees and medical staff members received at least one dose of the COVID vaccines, a hospital spokesperson said. At Jackson, about 6,442 employees received the vaccine out of the 12,000 or so deemed to be eligible, a spokesperson said on Friday.
Jared Moskowitz, director of the Florida Division of Emergency management, said on Friday that “Miami-Dade has gotten the same equitable amount of distribution as any other county,” explaining that vaccines were allocated to each county based on its 65-and-over population, not overall population.
“I think having the largest county, largest medical system, a lot of people with co-morbidities: There were a lot of competing priorities in Dade County,” Moskowitz said. “So they’ve had to vaccinate lots of different groups, but that does not mean they received less vaccine.”
Good time to pivot
Migoya, the Jackson CEO, said that the county has made some progress in the last week or so since Levine Cava sent the letter to DeSantis. Demand hasn’t dried up among seniors, he said, but it certainly has lessened, to an extent.
“Maybe we are reaching that point where we are — I wouldn’t say exhausted, but exhausting — the number of people over 65 who are willing to get the vaccine,” Migoya said.
Toner, the infectious disease expert at Johns Hopkins, said now would be an appropriate time to focus on other groups in the current tier of vaccine candidates.
But he said officials shouldn’t get too caught up in worrying about how that will work, and should instead focus on speed, especially considering the mutated versions of the virus. Florida leads the nation in confirmed cases of B.1.1.7, known as the “U.K. variant.”
“We just need to get as many vaccines in arms as we can and we shouldn’t let the perfect be the enemy of the good,” he said. “If some people skirt the rules, jump the queue, I’m not going to worry too much about that.”
This story was originally published February 17, 2021 at 5:02 PM.
