Why Obese People Should Get Covid-19 Vaccine Priority

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- 'Why Obese People Should Get COVID-19 Vaccine Priority.' Slate, Nov. 30, 2020. *EXCERPTS:

..Vaccine distribution plans for polio back in the 1950s, and even H1N1 in 2009, focused primarily on age, in part because of the nature of those diseases. While one idea this time around is to focus on immunizing the social butterflies to slow spread, an emerging consensus is that groups who have been hardest hit by COVID-19 should go first. In a vaccine plan laid out by the National Academies of Science, Engineering, and Medicine, which the CDC and in turn most states are expected to follow, health care workers and first responders will be vaccinated as soon as possible. (This includes me, as I’m currently training as a resident physician.) Nursing home residents may also be among the first to be vaccinated. The CDC is meeting Tuesday to vote on the specifics. Next in line for the COVID-19 jab will be people with underlying risk factors.

The largest of those groups, with about 140 million Americans, is folks with a body mass index greater than 30, meeting the clinical definition of obesity.

Prioritizing folks with obesity makes a lot of sense from a purely clinical perspective. Obesity in COVID patients is associated with higher death rates and higher rates of hospital admissions to the ICU. On balance, we know these patients tend to spend more time on ventilators than those with lower BMIs. This is in part because obesity is associated with a host of other diseases, like diabetes and high blood pressure, that put patients at higher risk for COVID-19. But even the biology of obesity facilitates particularly dangerous infections, through SARS-CoV-2’s ability to proliferate in fat cells armed with specific receptors.

The National Academies plan isn’t the only one that recognizes the need for people with obesity to get a vaccine quickly; Great Britain’s plan puts people with morbid obesity toward the front of the line, too.

Obesity is a risk factor for so many health issues in part because it is often implicitly considered a moral failing, and not just in pop culture and judgmental social circles. Patients with obesity frequently encounter weight bias from health care providers, who may brush off their symptoms and delay diagnostic testing. This can diminish the quality of their care and, understandably, lead many to avoid getting medical care. By prioritizing patients with obesity in the line for COVID-19 vaccines, medicine is not only following the data but is also pursuing a form of equity that recognizes obesity as a disease, rather than a character flaw. It recognizes that what someone who is high risk for a deadly virus needs most is medical care—not to be marginalized.

People with obesity are hardly the only high-risk group for COVID-19. In the National Academies plan, the group slated to get the vaccine after health care workers also includes folks with diabetes, sickle cell disease, chronic kidney disease, organ transplants, serious heart conditions, and active cancer. More than 200 million Americans—as plans currently read—would fit into this second category of people to get the vaccine.
Still more vulnerable groups will go in the next phase: teachers, essential workers, people with debilitating mental health diseases, senior citizens not previously covered, and people living in group settings unable to socially distance, where COVID has run rampant—like homeless individuals, people living in group homes, and incarcerated folks. Next will be young adults and children. The remainder of the general public, like healthy, middle-age folks able to work from home throughout the pandemic, will go last.

But even with this structure in place, there will be tough decisions to make about whom to prioritize among those in the earlier phases...

Read More, https://slate.com/technology/2020/11/covid-19-vaccine-priority-obese-people.html