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Robert Gehrke: This is how Utah should decide who gets the coronavirus vaccine next

A COVID-19 risk scoring system is the most responsible way to move forward.

(Francisco Kjolseth | The Salt Lake Tribune) Robert Gehrke.

Despite a slow beginning to Utah’s COVID-19 vaccination effort, on Friday the state surpassed its 200,000th dose, with the pace picking up significantly in the past few weeks.

I know several people over the age of 70 who got their first dose last week or have an upcoming appointment to get their shot. It’s encouraging progress.

But what happens when we get into larger population groups? There are, according to data from the University of Utah’s Gardner Policy Institute, about 30% more Utahns between the ages of 60 and 70 than there are in the 70-and-up group currently eligible for vaccination. And the numbers of people climb sharply as you move into younger and younger populations.

So it’s imperative that we have a way to make sure we don’t end up with another land-rush-style rollout that crashed systems for the 70-and-over population and, ideally, prioritizes those who are most at risk.

Gov. Spencer Cox understands the necessity. “Our highest priority has always been to protect those who are most vulnerable, to save lives and increase capacity in our hospitals,” he said Thursday during his first PBS Utah monthly news conference.

But how do we identify who is most vulnerable and get them protected expeditiously?

Certainly age is one component of risk — the data shows us that clear as day. Those in the 65-84 age group are nearly nine times as likely to die from COVID as those in the 45-64 cohort, who are more than six times as likely to die as those in the 25-44 group.

That is, at least in part because there is a correlation to age and the comorbidities that complicate COVID outcomes. But there are also plenty of younger people with severe comorbidities who shouldn’t have to wait in line based solely on age.

It’s hard to argue that a reasonably healthy 70-year-old should be eligible to get the vaccination now while a 69-year-old — or 59-year-old, for that matter — with diabetes and asthma has to wait months.

Trying to identify risk factors can come with pitfalls. New Jersey, for example, made headlines because it classified smokers in a high-risk category, moving them ahead of essential workers, even school teachers (without having to prove they’re smokers).

What makes the most sense is asking Utahns who want the vaccine to go through a website that calculates a simple “risk score.” Johns Hopkins University has formulated a version of it.

Start with age. That’s simple. If you’re 55 years old, you start with 55 points.

Then add 10 points for comorbidities that you can verify with a doctor’s note — chronic pulmonary illness, asthma, hypertension, severe obesity. The qualifying preexisting conditions would have to be limited, since by some estimates there are 700,000 Utahns with some form of comorbidity.

Smokers or former smokers, for example, would have to be excluded because, unlike hypertension, it’s easy to fake.

On top of comorbidities, you could add points for people who can prove they fit into a predetermined list of essential workers.

Then, we vaccinate in levels based on score, not age. Someone who is 55 and an essential worker with asthma could well get vaccinated ahead of someone who is older and healthier, but the point is mitigating as much risk as possible. And anyone could check any time and know exactly where his or her cohort is in line.

Will people try to game the system? Of course. That’s going to happen anyway, especially when we start trying to define what is or is not an essential worker.

Behind the scenes, industries have been lobbying the governor’s office.

Representatives for bus and rail drivers, funeral directors, staff that works with people with developmental disabilities, meat producers and processors, and the biotech industry all contacted the governor’s office asking that they be moved up in the vaccination queue because their industries are essential, according to records I received through an open records request.

Even a representative for DoorDash — the restaurant delivery service — wrote to the then-Gov. Gary Herbert’s chief of staff last month, “advocating for delivery drivers to have access, as they are deemed essential workers.”

On some level, these decisions end up being inherently subjective and it will come down to Rich Lakin, head of the Utah Department of Health’s immunization program, and his team to construct a workable strategy for when the populations eligible grow from the thousands to the hundreds of thousands in the coming months.

Right now, the state’s strategy is vague on how it will work, but I’m told plans are in the works. If we do this right, we’ll be able to get the scarce doses to those most at-risk for severe outcomes from the disease, alleviate hospital crowding and, most importantly, save lives.

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