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Province releases updated guidance on ‘next priority’ for COVID-19 vaccines, including seniors over 80, and all Indigenous adults


Province releases updated guidance on ‘next priority’ for COVID-19 vaccines, including seniors over 80, and all Indigenous adults

With the promise of more COVID-19 vaccines on the way in the coming weeks, the province has released updated guidance that moves seniors over age 80 closer to the front of the line.

In a memo sent to Medical Officers of Health and hospital CEOs on Sunday, officials laid out the “next priority” groups for phase 1 of vaccine roll-out.

They include: adults over age 80; staff, residents and caregivers of retirement homes and other congregate senior settings; high priority health care workers; all Indigenous adults; and adults who get chronic home care.

People over age 80 who live independently were previously under the second phase of the province’s vaccine rollout, not expected to begin until March.

But questions were raised about why the province was waiting that long when studies have clearly shown age is by far the biggest risk factor for death from COVID-19, and early data out of Israel — which moved swiftly to vaccinate those over 60 — has seen a dramatic decrease in illness and death among its vulnerable eldest population.

Dr. Samir Sinha, the director of geriatrics at Mount Sinai Hospital in Toronto, speaking before the change in policy, said the previous approach was flawed and would “lead to more deaths that are not necessary.”

After the new guidance was announced Sunday, he tweeted that he wants to thank the government “for reversing its ‘ageist’ decision,” and “reprioritizing 600,000 older Ontarians 80+ to get our forthcoming vaccines instead of having to wait until April.”

“This WILL Save Lives,” he wrote.

A recent U.S. study that analyzed electronic health records to predict COVID-19 mortality found age was the biggest factor even above pre-existing conditions such as lung disease, heart disease or a history of pneumonia, which are not only considered risk factors for older adults but younger adults as well.

“When older people are that much more likely to die if they do have COVID-19, how about we start with them and then think about the people who are at a higher risk of exposure,” said Dr. Hossein Estiri, a professor of medicine at Harvard Medical School and Massachusetts General Hospital and one of the authors of the study.

Phase 1 of the province’s rollout — so far aimed at long-term-care and high-risk retirement home residents and staff, health-care workers and Indigenous populations — has been beset with problems, including a slow start in December and more recently delays in vaccine shipments from both Pfizer-BioNTech and Moderna. As of Feb. 14, 467,626 doses have been administered.

The province’s new memo also states that vaccine clinics need to have processes in place for “no shows” or leftover doses, so that they doesn’t result in people getting the vaccine who are further down the queue.

There had been some criticism last month as some hospital executives and communications staff far from the front lines received vaccines in Toronto.

The “immediate” vaccine priorities are still staff and essential caregivers in long-term-care, high risk retirement homes and First Nations elder care homes — any residents of these settings that have not yet received a first dose of vaccine.

The other “immediate” priority groups are: alternative level of care patients in hospitals who have a confirmed admission to a long-term-care home, retirement home or other congregate care home for seniors; the “highest priority” health care workers, followed by “very high priority” health care workers, according to ministry guidance on this; and Indigenous adults in northern remote and higher risk communities.

Residents in long-term-care homes have been the first focus in recent weeks, given the devastation the disease has caused in these settings. The province said in the memo that all residents in long-term-care homes have now been offered a first dose, after what the minister of health referred to as an internal “miscommunication” resulted in the announcement that this had already been completed on Feb 10.

In Ontario, nearly all of the 6,343 people who have died from COVID-19 since the pandemic began last year were over 60, with 4,541 older than 80, according to Public Health Ontario’s daily epidemiological summary for Feb. 12.

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“There is data coming in from some of the public health units that are starting to see higher death rates in the community,” said Dr. Adalsteinn Brown, co-chair of the Ontario COVID-19 Science Advisory Table, at Thursday’s Queen’s Park briefing. “Again though, this is in older Ontarians and reflects the importance of priority vaccinations where they have the greatest benefit.”

The majority of admissions to hospital intensive care units in the province are people outside long-term settings and over the age of 60. Despite a recent drop in cases and positivity rates in every age group, according to Brown, there is concern that with the presence of more transmissible COVID-19 variants, the burden on ICUs will increase.

“If the B.1.1.7 variant behaves as it did in the United Kingdom, cases will start to grow here again in late February or early March,” he warned.

Sinha believes that a strategy that prioritizes elders, such as Israel’s, makes sense.

“It basically used one clear criteria, and that being age,” said Sinha. “Age trumps all other factors.”

A recent paper from the Science Advisory table outlined lessons that could be learned from Israel’s vaccine rollout: “Similar to Ontario, older people experienced a disproportionately high burden of COVID-related deaths in Israel. To address this disparity, Israel relied on a simple vaccine prioritization process, with age being the only determining factor, with the exception of healthcare providers and first responders.”

It concluded, “Since age is the single greatest risk factor for COVID-19 mortality, simplified distribution plans to maximize upfront administration of vaccines to older adults could avoid unintentionally prioritizing other groups who are at lower risk of death.”

At Thursday’s news conference, Brown said “the decision to prioritize long-term-care homes for vaccination, however challenging, has worked and has saved lives … Daily deaths in these homes are declining.

“If we continue to prioritize a vaccination towards those who are most affected by the pandemic, whether in retirement homes, in shelters, among older Ontarians or in our hardest hit neighbourhoods and communities, we will continue to save lives.”

The new memo also states that all second doses for the Pfizer-BioNTech vaccine will be administered 35 days after the administration of the first dose, and no later than 42 days, except for residents of long-term-care, high-risk retirement and First Nations elder care homes, residents of other types of congregate care homes for seniors, and individuals 80 years of age and older.

Those populations will get the second dose 21 to 27 days after the first.

All second doses of the Moderna vaccine should continue to be provided 28 days after the first dose.

Dr. Stephen Hwang, a professor of medicine at the University of Toronto’s Temerty Faculty of Medicine, speaking before the new prioritization was announced, said there needs to be an equity strategy to target seniors who come from marginalized and racialized communities where populations are at a higher risk of dying from the virus.

“Those who are lower-income, from immigrant or racialized communities who may be socially isolated so they may not have family members, you know to say ‘hey Grandma, we should go get you to go get vaccines’ … are far less likely to get vaccinated,” said Hwang.

“I think focusing on just using very simple selection criteria and then spending our energy on reaching out to those who would be disadvantaged in the process and have barriers to getting vaccinated would be the way to focus our resources.”

Ontario, whose population is 14.5 million, is expecting to receive 600,000 doses by the end of February and 1.2 million doses in March.

On Friday, Prime Minister Justin Trudeau announced that Canada is now on pace to receive 84 million doses over the next seven months.

Urbi Khan is a Toronto-based staff reporter for the Star. Reach her via email: [email protected]

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