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The Details: Getting the Covid Vaccine in Colorado

The Details: Getting the Covid Vaccine in Colorado

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By Jose Delgado, MD
Internal Medicine Department

With the great demand for the Covid-19 vaccine and the limited supply, an allocation strategy has been created by the Advisory Committee on Immunization Practices (ACIP) and adopted by the Centers for Disease Control and Prevention (CDC). Individual states are employing these guidelines to create their own vaccination programs.

I will review the State of Colorado allocation strategy as of January 1, 2021, focusing on the criteria that determine a “high-risk medical condition.”


What are the vaccination phases in Colorado?

Briefly, the vaccine will be offered in three phases: Phase 1A/1B, which is now in progress, Phase 2 (what CDC is calling Phase 1C), and Phase 3.

PHASE 1A — Highest-risk health care workers and Long-Term Care Facility (LTCF) staff and residents.

  • LTCF includes nursing homes, skilled nursing facilities, and assisted living facilities
  • Independent living facilities are not included in the LTCF designation.

PHASE 1B — Moderate-risk health care workers, frontline essential workers, and people age 70 and older.

Frontline essential workers include:

  • First responders (EMS, Firefighters, Police)
  • Corrections officers
  • Food and agricultural workers
  • U.S. Postal Service workers
  • Manufacturing workers
  • Grocery store workers, public transit workers, education sector (teachers and support staff), and child care workers

Colorado further specifies:

  • Specialized transportation staff
  • Funeral services
  • Frontline essential human service workers
  • Direct care providers for Coloradans experiencing homelessness
  • Essential government officials
  • Essential frontline journalists.

For additional details about what defines frontline essential workers, click here. If you are still unsure if you are in this category, please contact the Boulder County Public Health Department at (303) 441-1100.

Phase 1A/1B is well underway. The Colorado Department of Public Health & Environment (CDPHE) distributed the vaccine to county health departments and select hospitals vaccinating candidates in the 1A and 1B groups. The Federal Pharmacy Partnership for Long-Term Care (CVS and Walgreens) is in charge of reaching out, going to, and vaccinating LCTF residents and staff.

PHASE 2 (or Phase 1C per CDC) — Individuals ages 60-69, age 16-59 with high-risk medical conditions, and other essential workers.

Other essential workers include:

  • Transportation and logistics
  • Water and wastewater
  • Foodservice
  • Housing construction
  • Finance (bank tellers)
  • IT and communications
  • Energy
  • Legal services
  • Media
  • Public safety (engineers)
  • Public health
  • Local government.

PHASE 3 — Individuals 16-59 years old.

During Phases 2 and 3, vaccines will be distributed to doctors’ offices (such as Boulder Medical Center) and many local pharmacies. Pharmacies could vaccinate individuals according to age group, and doctors will likely vaccinate patients with “high-risk medical conditions.”


What is a high-risk medical condition? 

This is where I would like to clarify what qualifies as a high-risk medical condition for the Covid-19 vaccination.

Certain underlying medical conditions increase the risk of severe illness from the virus that causes Covid-19. Severe illness from Covid-19 is defined as hospitalization, admission to the Intensive Care Unit (ICU), intubation or mechanical ventilation, or death. Ninety percent of Covid-19 hospitalizations have had one or more of these medical conditions. The more medical conditions one has, the higher the risk. One high-risk condition increases severe Covid illness risk 2.5-fold while three or more high-risk conditions results in a 5-fold increase of risk.

All of the following conditions qualify as high risk for Covid-19 vaccination purposes. I am listing these according to the strength of the evidence available. For reference, here is the CDC website that details the conditions.

This list is evolving and not written in stone. Some medical conditions not listed may still increase risk, so you should also consult with your doctor. There is also room for interpretation on some of these, so again, check with your doctor.

This is a critical point: although awareness of your own high-risk medical conditions is very important, it would only impact the timing of vaccination for those aged 16-59 and do not meet any of the criteria to be in Phase 1A/1B.


High-risk medical conditions — strongest evidence

The “strongest evidence” designation means that these conditions definitely increase risk:

  • Cancer – If you currently have cancer or have completed treatment within the last three months.
  • Chronic Kidney Disease (CKD) – This is based on your Glomerular Filtration Rate (GFR) obtained from routine blood work. A GFR of < 60 mL/min is considered CKD. Stage 3a (45-59 mL/min), Stage 3b (30-44 mL/min), Stage 4 (15-29 mL/min), and Stage 5 (<15 mL/min). Although GFR can fluctuate some, we are looking for consistent values below 60 mL/min before calling it CKD.
  • Chronic Obstructive Pulmonary Disease (COPD) – Most will know if they have this condition or not. This is based on symptoms and results of spirometry. You would likely be on one or more inhalers and sometimes require supplemental oxygen.
  • Down Syndrome
  • Heart Condition – The specific conditions include:
    • Congestive heart failure (current or prior diagnosis)
    • Coronary artery disease (clinical, i.e., history of a cardiac stent, bypass surgery, heart attack, or angina)
    • Cardiomyopathy or pulmonary hypertension. Based on an echocardiogram (Echo)
      or right heart catheterization
    • Valvular heart disease, such as mitral valve prolapse. Would not qualify unless this has led to CHF or cardiomyopathy
    • Arrhythmias, including atrial fibrillation, would NOT count
    • Aortic stenosis, another valvular condition, would qualify, in my opinion, if the condition is rated as moderate or severe.
  • Immunocompromised – Specifically, those who have had a solid organ transplant.
  • Obesity – This is anyone with a Body Mass Index (BMI) of 30 and above. If you have an elevated BMI due to mostly muscle mass related to bodybuilding or due to your body type, this will NOT qualify, as the designation is for those with an increase in fat mass.
  • Pregnancy
  • Sickle Cell Disease
  • Smoking –This includes current and former tobacco smokers. There is room for interpretation here, but I would say anyone who has smoked one-half pack or more per day for 10 or more years.
  • Type 2 Diabetes – This would be anyone with a hemoglobin a1c of 6.5% or greater, whether they are on treatment or not.

High-risk medical conditions — mixed evidence

The “mixed evidence” designation means that these conditions might be at increased risk:

  • Asthma – Moderate to severe. You are typically on two or more inhalers and require the use of a rescue inhaler (albuterol) daily. This does not include those with mild intermittent asthma that use an inhaler episodically for exercise; cold air; other outside triggers (smoke, dander, pollen, etc.); or those who develop wheezing with bronchitis. There is definitely room for interpretation here, and you should check with your doctor.
  • Cerebrovascular Disease – Basically, those who have had a stroke or Transient Ischemic Attack (TIA).
  • Hypertension – Anyone who currently has Stage 1 or Stage 2 Hypertension, whether or not you are on medication. See my previous blog post on this subject.
  • Use of Corticosteroids or other Immunosuppressive Medications – The typical definition for this would be Prednisone 20mg or equivalent for at least 2 months continuously. Examples of other immunosuppressive drugs: Methotrexate, Imuran, Plaquenil, Humira, Enbrel, Remicade, etc.

High-risk medical conditions — limited evidence

The “limited evidence” designation means that these conditions might be at increased risk:

  • Bone Marrow Transplant
  • HIV
  • Immune Deficiencies – Example: Common Variable Immune Deficiency.
  • Inherited Metabolic Disorders – These are rare.
  • Liver Disease – This includes alcoholic liver disease, fatty liver, and liver cirrhosis.
  • Neurologic Conditions – Mainly dementia-related disorders.
  • Other Chronic Lung Diseases – Example: cystic fibrosis, pulmonary fibrosis.
  • Overweight – BMI 25-29. Again if this is due to muscle mass, then it doesn’t count.
  • Thalassemia
  • Type 1 Diabetes

Summary

In summary, if you have any of the above high-risk medical conditions, you do not already qualify for Phase 1A/1B, and you are 16 to 59 years old, then you should be included in Phase 2 (Phase 1C per CDC) vaccination. The phases may, and will, overlap some. Hopefully, as the supply of vaccines increases, the medical conditions that qualify for Phase 2 vaccination may expand.


Resources

Remember that we still need to wear face coverings, socially distance, avoid large gatherings, and frequently wash our hands. These strategies are proven to be effective and save lives. We are not out of the woods yet, but we can certainly begin to see some light.


We’ve got you covered — find a primary care doctor

Having a top-quality primary care physician in your corner is more important now than ever. Our Family Medicine and Internal Medicine physicians offer the area’s best care for you and your family.

These doctors are welcoming new patients for in-person and telehealth visits. Boulder Medical Center clinics are located close to home in Boulder, Louisville, Erie, and Longmont.

Harold Johnson, MDHarold Johnson, MD
Location:  Broadway and Foothills in Boulder
Dr. Harold Johnson is board-certified in family medicine and a “Castle Connelly Top Doctor” since 2012. He recently moved back to Colorado from Florida, where he ran a successful clinic for 20 years and was in high demand within the community.
~ Click here for Dr. Johnson’s profile or call (303) 440-3102 for an appointment.

Krista Toomre, MD
Location:  Broadway and Foothills in Boulder
Krista Toomre, MD is a board-certified family medicine physician with over 25 years of experience in the field. She is working towards certification in Functional Medicine via the Institute of Functional Medicine and looks forward to integrating this training into her practice.
~ Click here for Dr. Toomre’s profile or call (303) 440-3102 for an appointment.

Jon Rubright, MD
Location:  Louisville
Dr. Rubright provides the full range of family medicine services, including adult and well-child physicals, sports medicine, injuries, acute illness care, management of chronic conditions, and lifestyle medicine. His special medical interests include lifestyle medicine and disease prevention, hypertension, diabetes, and joint pain.
~ Click here for Dr. Rubright’s profile or call (303) 666-2710 for an appointment.

John Kelley, MD
Location:  Louisville and Erie
Dr. Kelley is a family medicine and Certified Functional Medicine physician. When it comes to preventing and treating illness, he seeks to help his patients by encouraging a healthy diet, natural supplementation, regular exercise, and healthy personal and spiritual lives. He is always looking for ways to get patients safely off medications.
~ Click here for Dr. Kelley’s profile or call (303) 666-2710 for an appointment.

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