28 Time March 1/March 8, 2021
SHOOTING FOR
A HIGHER NUMBERShare of Americans who have
received at least one dose
of a COVID-19 vaccine10%Share of Americans over the
age of 65 living in the U.S.15%Share of Americans with
chronic health conditions60%Number of Americans
without health insurance28.5
MILLIONthat person higher on the list than some-
one whose disease is better managed.
At UCLA Health, this system gen-
erates an invitation list based on a risk
score that weaves in not just the pa-
tient’s medical condition but also data
from social determinants as well, such
as poverty, income, education, housing
and geographic residence. These are part
of the CDC’s Social Vulnerability Index,
created to identify medically vulnerable
people and target health resources to
them after natural disasters such as hur-
ricanes and infectious- disease outbreaks
like COVID-19. The index includes cen-
sus data on 15 factors that help stratify
people’s overall health risk by acknowl-
edging that some contributors to their
health status have to do not with their
medical condition but rather with their
living conditions, which in turn drive
their access, or lack thereof, to health
services.
“To identify our most vulnerable
patients, we have an elaborate point
system that incorporates age, clini-
cal and social risk data from the med-
ical record to risk-stratify our pa-
tients,” says Dr. Eve Glazier, president
of the faculty practice group at UCLA
Health and an associate clinical profes-
sor at the David Geffen School of Med-
icine at UCLA. The formula weighs
factors such as age and, say, whether
a cancer patient is in remission or cur-
rently under going chemotherapy.
Glazier says that in their health system,
there are 120,000 patients over age 65
with chronic health conditions who
are being prioritized over those over
age 65 without health issues. “We are
really trying to avoid the Ticketmaster
free-for-all approach,” she says. “The
first-come, first-served strategy is antithetical to any ap-
proach that we would consider is fair and equitable.”
At Orlando Health, a private health system in central Flor-
ida, officials formed a committee to come up with broad guide-
lines for helping doctors navigate the difficult decisions they
might have to make as demand for vaccine doses continues to
outstrip supply. “We recently received 2,000 doses for medi-
cally vulnerable patients we are serving here,” says Dr. George
Ralls, senior vice president and chief medical officer of Orlando
Health. “We have 400,000 people over 65 in our network who
qualify for vaccination. So 2,000 doesn’t go very far. We’re try-
ing to find the riskiest patients and trying to give them the vac-
cine first.” The system starts with age: “We fine-tuned it to pull
people out who we thought were at higher risk, starting with
age as the main differentiator,” Ralls
says. “We stratified the group of people
aged 65 to 70, pulled up patients with
certain diseases and then looked at peo-
ple aged 60 to 65, and worked through
it like that.” Patients with chronic con-
ditions who aren’t able to get vacci-
nated if there aren’t enough doses in
one round of vaccinations will be next
in line and notified when more vaccines
are shipped. “It’s going to go like that for
a while,” he says. “As we continue to get
small allocations of vaccine, we will apply them the best we can
to patients who fit the highest-risk profile.”What’s becoming clear is that highest risk won’t mean the
same from hospital to hospital, or county to county, or state to
state. And that can lead to misunderstanding and frustration, as
people with the same health condition, living in the same part
of the country, might not be able to get their shots at the same
time. UCLA Health officials are trying to head off any potential
conflict by sending regular emails to their patient population
outlining the system’s triaging plan, how they came up with
it, and which people are getting vaccinated at any given time.
Still, some patients desperate for a shot are opting to game the
system and find a hospital—even if it isn’t the one at which theyHealth
ALL NUMBERS APPROXIMATE.
SOURCES: U.S. CDC, U.S. CENSUS BUREAU