Homeless, incarcerated among ‘losers’ in race for vaccine in California

When the California Department of Public Health released its complicated priority system to guide the state’s coronavirus vaccination efforts in December, people with disabilities and underlying risk factors had their place in Phase 1B, Tier 2. They weren’t at the top. But they were on the list.

Then suddenly, on Jan. 25, they weren’t. On Feb. 12, they were back, reinstated by the state after more than two weeks of public outcry. Those with underlying conditions that make them especially susceptible to COVID-19 will become eligible statewide on March 15.

HolLynn D’Lil, who lives in Graton, moves about in a wheelchair and has spent much of her life fighting for disability rights. She has followed each twist and turn in the saga. The feeling she is left with, she said, is anger.

“Why do we have to continually fight, I mean literally go to battle with officials to be recognized as people?” D’Lil asked. “Why such an extraordinary effort on our behalf just to be included and considered? It seems prejudice against people with disabilities is deeply ingrained.”

Advocates for the homeless and the incarcerated share that indignation. Those groups also were erased from the tiers. And unlike Californians with disabilities, they still don’t have a place in line.

“Obviously, we’re advocating this is a highly vulnerable population in need of this support. Especially when you look at those in congregate programs,” said Jennielynn Holmes, chief program manager for Catholic Charities in Santa Rosa, one of the area’s most prominent providers of outreach to the unsheltered. “And the alternative is to sleep outdoors and be vulnerable to other emergencies.

“It’s imperative we get individuals in there vaccinated, so they don’t have to choose between worries — COVID-19 and staying out in the cold and wet.”

The homeless, incarcerated and essential workers in transportation, industry, commerce, residential and manufacturing all were in Phase 1B, Tier 2, of the state’s original vaccine priority guidelines. The disabled were in Phase 1C. But Gov. Gavin Newsom announced Jan. 25 that once seniors, food and agricultural workers, teachers, child care providers and emergency services employees were immunized in Phase 1B, Tier 1, the state would move to a strictly age-based system.

The shift was generally applauded. Compared to other states, California’s vaccine rollout had been inefficient, and the frequently baffling tier system was the most common target for criticism. Under huge political pressure, including a vocal recall campaign, Newsom acted to simplify the state’s priorities.

But with supply perpetually lagging behind demand for this lifesaving resource, vaccination has become a zero-sum game. The homeless, jailed and disabled, among others, fell out of the system. Those people must wait for age-group eligibility, like most of us.

Some observers insist that’s shortsighted.

The Harvard Chan School of Public Health asked some of its campus experts why we should be vaccinating the incarcerated. It published their answers on the school website on Dec. 18. The panel talked about the poor ventilation and occupant density of correctional facilities, which make them extremely dangerous during this pandemic, and a general lack of personal protective equipment and testing in those settings. Emma Accorsi, a Ph.D. candidate in epidemiology at the Center for Communicable Disease Dynamics, noted “a rate of infection in state and federal prisons that is 5.5 times higher than that in the general population.”

Locally, at least 18 inmates at the Sonoma County Jail, and at least 68 inmates and staff members at the Mendocino County Jail, tested positive for the virus in December.

Many of those being housed at the county jails are serving modest sentences and will soon rejoin the public. That’s one reason Christine Castillo, executive director of Verity, an organization that works with survivors of sexual abuse — including those who are locked up and those who have been at some point of their lives — believes inmates should be immunized.

“It will lessen the likelihood of spread when they’re there and when they’re released, and lessen the likelihood of transmitting it to those who work there, who can transmit it to their families,” Castillo said. “Get those people vaccinated. It’s the smart move.”

The same can be said of the unsheltered. Their advocates may be driven by compassion. But the fact is that, during a pandemic, one person’s vulnerability makes others in the community vulnerable, too.

“A person with severe complications means they’re more likely to be hospitalized and take up a valuable bed,” said Holmes, the Catholic Charities manager. “It puts a burden on the whole medical system.”

Holmes said the unsheltered tend to have higher rates of emphysema and pneumonia, and worse long-term respiratory health in general. All of those are considered co-morbidities with the coronavirus.

“There’s a ton of studies around the health effects of homelessness,” Holmes said. “An unhoused person is three to four times as likely to die as a housed counterpart. And with COVID-19, they’re at even greater risk.”

Kathleen Finigan, who works with the nonprofit Homeless Action!, said the county currently offers about 1,000 beds to the unsheltered, leaving another 2,000 or so to life on the streets.

Outdoor encampments are considered safer than congregant settings when it comes to COVID-19 transmission, but that doesn’t mean tent cities are risk-free.

“They are living very close together,” Finigan said. “They have no hand-washing stations, no toilets, no trash collection. I went over to Industrial Drive a couple weeks ago. Most people were not wearing masks. It’s a situation that is ripe for disease, and it always has been. It’s unforgivable that human beings are being treated in this way.”

As for the employment positions that disappeared along with Phase 1B, Tier 2, it was hard to pin down what they were. The original wording in California’s “Vaccinate All 58” counties campaign read: “Those at risk of exposure at work in the following sectors: transportation and logistics; industrial, commercial, residential, and sheltering facilities and services; critical manufacturing.”

Asked to define the jobs more precisely, a California Department of Public Health representative said, “Generally definitions are provided as the groups become eligible. It had not yet happened for potential future phases.”

Meanwhile, people with disabilities are celebrating their return to the tiers, but many remain displeased with how the process was handled, and with their prospects of being vaccinated.

The disabled often lack access to the computer connections necessary for making vaccination appointments, said Connie Arnold, a former Cotati resident and Sonoma State master’s degree holder who has used a wheelchair for mobility for decades. Even if they are able to book a slot, transportation issues can make it hard to reach the site.

“If a bus doesn’t take you there, or you can’t use a bus, that’s a problem,” said Arnold, who now lives in Elk Grove. “If you’re eligible for paratransit, you need an advanced reservation. And that doesn’t mean they’ll wait for you outside as you wait in line for a vaccination.”

Sonoma County is waiving bus fare for local residents to travel to vaccination sites, as long as they can show proof of their appointment. The offer is good on Sonoma County Transit, Santa Rosa CityBus, Petaluma Transit and their respective paratransit services. To accommodate this offer, the city of Santa Rosa made sure its bus drivers got vaccinated. In a twist of irony, those same drivers were among the groups that had been bounced out of Phase 1B, Tier 2 in January. This was their path back.

Arnold’s biggest beef was with the state’s timeline. By the time those with disabilities regain eligibility, more than a month will have passed since state Health and Human Services Secretary Dr. Mark Ghaly announced the move. That’s 31 days of living without the vaccine for some of California’s most at-risk citizens. They carry a wide range of debilitating preconditions, and many are highly dependent on in-home health workers — some of whom are declining the vaccine.

“I wouldn’t necessarily call March 15 a prioritization for vulnerable populations,” said Arnold, who has been unable to find a vaccination appointment. “It allows people with disabilities to die before that date.”

The coronavirus vaccines were developed in record time, giving the states little time to build an infrastructure for their delivery. That’s one reason California’s priority guidelines have changed along the way — and why they could always change again. If the fluidity of the system proves anything, it’s the relationship between political power and health care access.

People with disabilities, long pushed to the back of the line, have successfully organized for change in recent years. Populations like the homeless and the incarcerated still have less of a voice.

“Less of a voice? No voice,” Finigan corrected. “It’s very frustrating. A lot of our electeds have good hearts. But they’re scared to death of NIMBYs.”

You can reach Staff Writer Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.