People with chronic diseases don't know if they get COVID-19 vaccine priority

People with chronic medical conditions still don't know for sure where they fall among priority populations getting the COVID-19 vaccine, even as the first shots are administered this week in Ontario.

Dr. Seema Nagpal, vice-president of science and policy for Diabetes Canada, says health-care practitioners need clear guidelines and adults with diabetes should have priority on the list.

"It's a matter of life and death," Nagpal said, because emerging evidence shows adults with diabetes have a higher risk of respiratory distress syndrome, pneumonia and other complications.

When hospitalized forCOVID-19, adults with diabetes are almost three times more likely to die than adults who do not have diabetes, she said in reference to medical journal articles published this year.

"Those poor outcomes can be avoided with priority access to a vaccine," she said.

Nagpalsaidpeople of African, Arab, Hispanic,Asian and Indigenous ancestry are more likely to develop Type 2 diabetes and have also been disproportionately affected by COVID-19. She said identifying people living with diabetes, obesity and cardiovascular illness as key populations could help prioritize a diverse population.

The National Advisory Committee on Immunization (NACI) has said high-risk populations are a priority, but has not listed which chronic illnesses may be designated key populations.

Immunocompromised excluded from trials

However, the situation is not straightforward for everybody with a chronic medical condition.

Dr. Gil Kaplan, a past-chair of the scientific and medical advisory council of Crohn's and Colitis Canada, said people whose immune systems are suppressed due to illness or treatment may want to consider waiting to get the shot.

"Many are keen to be vaccinated and to be protected from the virus, butthey're what I called an understudied population," Kaplan said.

The NACI is cautioningagainst immunosuppressedpeople getting the vaccine because those subjects were excluded from trials. Though it says those people can receive it if they are in priority age groups and if they talk to their doctor about the risks.

Kaplan said he will still recommend the vaccine for people if they cannot self-isolate, they're older or work on the front lines of health care. He said it's also more important that those who can safely receive the vaccine, take it.

"The key thing is if there are enough healthy individuals who are vaccinated throughout our society, then we are actually literally creating a human shield that protects people who can't be vaccinated or mount a lower immune response when they are vaccinated," Kaplan said.

In a statement, Ontario's Ministry of Health says it is working on the difficult decision of who is in key populations with its COVID-19 Vaccine Distribution Task Force, medical experts and ethicists and the National Advisory Committee on Immunization.

It expects the second phase of immunization to begin later, in early2021, when more vaccine doses are secure.