Minnesota health systems to identify at-risk patients for next round of COVID-19 shots

People with health conditions that make them susceptible to COVID-19 complications most likely will be contacted by their health care provider when it's their turn to get the shot.

"We'll use our electronic medical record as well the expertise of our clinicians to help identify patients," said Dr. John Misa, interim chief medical officer for the Allina Health Group.

Once 70% of the state's seniors are vaccinated, perhaps by the end of March, the state's rollout plan calls for the medically vulnerable and essential workers to become the next priority groups.

As health care providers prepare to vaccinate an estimated 1.3 million Minnesotans with qualifying health conditions, new questions were raised Monday by a federal vaccine advisory panel that some states were defining eligibility too narrowly, resulting in differing policies.

For instance, at least 35 states, including Minnesota, consider Type 2 diabetes to be a qualifying condition, while 22 states — but not Minnesota — make the vaccine available to people with Type 1 diabetes, according to the Kaiser Family Foundation.

Hospitals and clinics are already playing a role in distribution, reaching out to their patients 65 and older who are in the current priority group. But each health system is approaching it differently, with some focusing first on those at or older than 70 or 75 first.

It is unclear whether they will do the same for the underlying disease groups, which include common chronic conditions like obesity and Type 2 diabetes, but as the pool gets wider it may be difficult to pick who should go first based on severity of underlying illness.

"At some point it won't be helpful to risk stratify," Misa said. "It will be easier for us to move to broader populations."

The time required to analyze electronic medical records could slow down efforts to make appointments, especially when more doses become available.

"Once you are getting further down the line it gets more and more difficult." said Dr. Libby Brever, a family medicine physician at CentraCare who is helping with vaccine distribution planning. "It feels like we are creating a funnel rather than a wide open river."

With so many people on tap to get vaccinated in the coming months, health systems say it's best for patients to wait to be contacted.

"It is actually helpful for them not to call and inquire," Misa said. "We really try to keep those phone lines as clear as possible for the appointment scheduling."

Minnesota officials have identified 10 health conditions — cancer, chronic kidney disease, chronic obstructive pulmonary disease, Down syndrome, heart conditions, immunocompromised state, obesity, pregnancy, sickle cell disease and Type 2 diabetes — that will be prioritized in the next vaccine distribution phases that closely adhere to the Centers for Disease Control and Prevention guidelines about who is most at risk for severe COVID-19 infection.

At Monday's meeting of the CDC's advisory committee on immunization practices, concerns were raised about states using the CDC guidelines to make prioritization decisions.

CDC officials cautioned that the list was not intended to be exhaustive, especially because researchers have not assessed the association between the new coronavirus and every medical condition or disability, particularly those that are not as prevalent.

"Clinical judgment may determine if rare conditions not on the list confer increased risk of severe COVID-19," the CDC's Dr. Kathleen Dooling told the panel.

The panel took no action on Monday. Some panel members suggested that CDC should issue new guidance to the states about prioritizing those with underlying medical conditions.

"If they provide new info, as always, we are always looking and re-evaluating things," said Kris Ehresmann, state infectious disease director.

A total of 902,242 Minnesotans, or 16.2% of the population, have now received at least one dose of the COVID-19 vaccines, according to the state Health Department.

The weekly pace of shots administered continues to climb, with 242,676 doses given last week, a 28% increase from the previous week.

State officials said last week that vaccine shipments to the state have been increasing 5% each week, with more doses expected with the newly approved COVID-19 vaccine vials coming soon.

"We are incredibly hopeful as Johnson & Johnson is approved that we are going to continually get more doses," Brever said.

In addition to shipping vaccine doses directly to pharmacies, the federal government has opened a new avenue for more doses to flow into Minnesota.

Minnesota Community Care was selected to get 50% more doses on top of what the clinic already receives from the state, growing from 1,000 to 1,500 doses a week with the goal of vaccinating 300 people on the five days it administers shots.

"Those 300 vaccines are going into the arms of community members who have shouldered the greatest burden of COVID," said Paige Anderson Bowen, chief advancement officer.

The largest federally qualified health center in the state, the St. Paul-based clinic serves people of color, recent immigrants, people without access to insurance and the unsheltered population, who test positive for COVID-19 at higher rates.

"With the federal vaccine it stabilizes our supply and allows us to do what health centers do best," Bowen said. "It allows us to meet patients where they are."

State health officials said last week that they are still crafting details on how newly eligible individuals will be notified. Some front-line essential workers, such as food processing plant employees, will be vaccinated at their workplace.

CDC officials said Monday that verification of eligibility "should not hamper" shots administered at large vaccination clinics.

Minnesota health officials announced another 636 new COVID-19 cases Monday, along with three more deaths, bringing the state's totals to 485,230 infections and 6,486 fatalities.

One of the deaths announced Monday was a long-term care resident, one lived in a group home and the other resided in a private home.

Hospitalizations from COVID-19 complications continue to decline, with 230 patients in the state's hospitals, including 47 in intensive care. One week ago, 243 people were hospitalized, with 48 in intensive care.

Staff writer Jeremy Olson contributed to this report.