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North Carolinians 75 or older and front-line health care or essential workers who are 50 or older are next in line to receive the COVID-19 vaccine in early January, according to new guidelines Gov. Roy Cooper announced Wednesday.
Health care workers at high risk of exposure and long-term care facility staff are currently being vaccinated as part of the initial phase of distribution.
The new plan differs from North Carolina’s vaccine plan previously submitted to the national Centers for Disease Control and Prevention in October, which prioritized long-term care residents, people with two or more chronic conditions that increase risk of severity of COVID, people over 65 who live in congregate settings and staff of congregate living settings.
The new plan, like the new recommendations issued by a CDC committee last week, does not prioritize any individuals with medical conditions in the first phase but instead puts individuals over the age of 75 next in line.
The CDC guidance also prioritizes front-line essential workers, but the new North Carolina plan specifically limits the next phase to those over the age of 50.
“Our definition of essential workers follows pretty closely what the CDC says,” Cooper said.
The CDC defines front-line essential workers as “first responders (e.g., firefighters and police officers), corrections officers, food and agricultural workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit workers and those who work in the education sector (teachers and support staff members) as well as child care workers.”
The state has not yet released guidance on how essential worker designations will be made or enforced.
While the state will offer descriptions of who should qualify as a front-line essential worker, Cooper said, there will be some discretion at the local level.
“These are broad categories, and there are going to have to be some decisions made at the local level by people administering this vaccine as to whether someone falls into the category or not,” he said.
“And that’s just something that we know is going to happen because it cannot be perfect and precise.”
Hospitals that received the first doses of the vaccine in the initial phase also received guidelines for distribution.
But at least one major hospital system, Charlotte-based Atrium Health, permitted individuals who did not qualify as critical under phase 1a to schedule a vaccination. The hospital says it has since canceled those appointments, but the situation raised questions about how the prioritization would be enforced.
“I’ve already talked to legislative leaders this morning about this issue and talked with them about the potential of needing some legislative action to allow these boards more authority to enforce these rules,” Cooper said.
Inmates move down the list
The earlier vaccine plan for the state put incarcerated individuals in phase 1b. The decision to give incarcerated people a higher priority relied on a study by a committee of the National Academies of Medicine that “stressed the importance of recognizing their reduced autonomy and the difficulty of preventing spread in such settings should COVID-19 be introduced.”
Under the new guidance, unless they qualify by age, inmates will not be included in the first phase of vaccination.
In the earlier plan, inmates over age 65 or those with two or more comorbidities were scheduled to receive the vaccine after high-risk health care workers and long-term care facility residents and staff.
Under the new rules, the only incarcerated people who will receive the vaccine in phase 1b are those who are 75 or older.
As of Nov. 30, 164 inmates in North Carolina state prisons were 75 or older, according to the Department of Public Safety. The new guidelines delay vaccination for 1,006 people between the ages of 65 and 74, and do not make any provision for those with comorbidities. Under the new plan, all people in prison are scheduled to be vaccinated during phase 2.
The state’s prison staff members are still included in phase 1b for vaccine distribution. At the end of November, more than 1,500 of the state’s 14,000 prison staff members had tested positive for COVID-19, according to Commissioner of Prisons Todd Ishee.
In an ongoing court case, NAACP v. Cooper, a state judge ordered all prison staff to be tested for the virus every two weeks, noting staff infection is one key way the virus is introduced into prisons.
A limited supply
The original plan included between 727,000 and 951,000 individuals in phase 1b. Under the new plan, more than a million and up to 2 million people are in phase 1b, Department of Health and Human Services Secretary Dr. Mandy Cohen said.
The state has received about 460,000 doses of the Pfizer and Moderna vaccines. More than 100,000 doses are designated for distribution to long-term care facilities through CVS and Walgreens in a program administered by the federal government.
The latest report on the department’s dashboard shows 63,571 people in North Carolina have received the vaccine.
Cohen anticipates the state will receive 60,000 doses of the Moderna vaccine and 60,000 doses of the Pfizer vaccine per week in January. The state receives the federal allocation amount every Tuesday, and state officials have until Friday each week to direct where the doses should be delivered.
Some states, including Texas and Florida, did not alter their plans based on the new CDC recommendations and continue to prioritize the elderly and those with medical conditions, according to The Washington Post.