Starting Monday, adults in Maryland who are hospitalized with certain health conditions will be eligible to receive COVID-19 vaccines, according to the Maryland Department of Health’s latest clinician guidance.
But the list of qualifying conditions is short, and the news comes while vaccine appointments remain difficult to obtain. People who are not hospitalized but are diagnosed with these conditions won’t be able to be vaccinated until Phase 2 of the rollout.
The newly eligible groups are:
- Cancer patients in active treatment
- End-stage renal disease patients requiring hemodialysis
- Chronic Obstructive Pulmonary Disease (COPD) patients, especially those who are oxygen-dependent or steroid-dependent
- Solid organ transplant recipients
- Sickle cell disease patients
- Diabetic patients (Type 1 and Type 2)
When Gov. Larry Hogan first publicized the eligibility expansion Tuesday, he simply said vaccinations for “severely immunocompromised” people could begin Feb. 1, and that they would be administered through “hospital-based providers.” It was not immediately made clear that these immunocompromised groups had to be hospitalized to qualify for vaccinations.
The news that only hospitalized patients would be eligible starting Monday left some groups with a feeling of whiplash. Still other groups, representing immunocompromised patients excluded from the list, were concerned about the lack of vaccine access.
The dismay, several organizational leaders said, is heightened by the overall difficulty of the process to secure a vaccine appointment.
The Maryland Sickle Cell Disease Association sent out a message to its members last week stating that everyone with the disease would be able to seek vaccination appointments Monday. But now, the organization will have to correct the record, said Derek Robertson, its president.
“When we have to say that, ‘Oh, it’s not everybody. It’s just if you’re in the hospital,’ I think there will be disappointment,” Robertson said.
But he’s just as worried about the general confusion surrounding appointments for all eligible Marylanders, he said.
“What’s frustrating is the system where you’re basically being told: ‘Go find an appointment where you can,’” said Robertson, who has scoured websites of providers around the state to try to register his 78-year-old mother-in-law for a vaccine appointment.
Robertson said immunocompromised people should have been wrapped into the vaccine rollout earlier.
“There seems to be an emphasis on who would be most likely to be exposed,” Robertson said, “as opposed to who could probably get the most sick.”
Maryland’s initial priority list of immunocompromised groups also differs a bit from the U.S. Centers for Disease Control and Prevention’s list of people at increased risk for severe COVID-19 cases. That list includes people with heart conditions such as coronary artery disease and people who are pregnant, are obese or smoke. None of these groups are included on Maryland’s list just yet.
Dr. Mariell Jessup, chief science and medical officer for the American Heart Association, said the organization isn’t weighing in on each state’s decision to include or exclude people with certain heart conditions from vaccination. Deciding which immunocompromised people should be first in line raises plenty of thorny questions, she said.
“In the best of all possible worlds, everybody would get a grade,” Jessup said. “But, we just don’t have that ability to do that.”
Also excluded from Maryland’s list are hospitalized patients suffering from conditions like HIV/AIDS and cystic fibrosis, who the CDC says “might be at an increased risk” for severe coronavirus symptoms.
“We are monitoring this closely and await formal guidance from Maryland to see how the state will incorporate all at-risk conditions identified by the CDC, including CF, in their plan,” wrote Ashley Mahoney, a spokesperson for the Cystic Fibrosis Foundation, in a statement.
Seeing Maryland’s list was a frustrating moment for Lynda Dee, executive director of AIDS Action Baltimore.
“It’s very disappointing for the HIV community,” Dee said.
Dee said policymakers could open up vaccination specifically to HIV patients who are severely ill, such as those with at least one comorbidity, or those with fewer CD4 cells — white blood cells that indicate the relative health of a person’s immune system.
“It’s very important for the government and the Maryland Department of Health to distinguish between people who are sick with HIV and people who are not,” she said.
Of the roughly 10 states that have opened up vaccinations to immunocompromised people so far, many have stuck to that CDC plan, said Jennifer Tolbert, the director of state health reform at the Henry J. Kaiser Family Foundation, a national nonprofit that analyzes health issues, although some have excluded smokers.
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Maryland may have chosen to cut down the list because of the limited supply of vaccine available, she said.
“It is a trade-off in terms of how you balance the desire to get as many people vaccinated as possible without completely overwhelming the system, and potentially vaccinating people at slightly lower risk before people at higher risk,” Tolbert said.
Marylanders searching for appointments can check the state vaccination website, and visit the website for their county health department or medical provider. Appointments are difficult to come by, especially for seniors, people without computers and those who lack digital fluency.
Eligible Marylanders have complained about the scarcity. Anyone over 65 is already eligible, as are health care workers, nursing home residents and staff members, and teachers, among others.
The vaccination registration issues have caused considerable consternation, which could be hurting the vaccine effort more than it’s helping, said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security.
“I would have preferred that they not open up vaccine eligibility as quickly as they did,” Toner said. “People who recently have been added … it gives them the misperception that there is vaccine available for them.”
Baltimore Sun reporter Hallie Miller contributed to this article.