It would seem that among those who are prioritized for the coronavirus vaccine, people with serious lung diseases, such as asthma, cystic fibrosis, and chronic obstructive pulmonary disease, would be near the top of the list.
But for the most part, that is not the case.
Over the weekend, the Advisory Committee on Immunization Practices, the federal committee tasked with prioritizing vaccinations, decided that people with chronic illnesses, including those with lung diseases, would not be the next group to be immunized after healthcare workers and long-term care residents and staff. Instead, ACIP recommended that certain essential workers and those age 75 and older would be next. While ACIPs recommendations do not have the force of law, most states are expected to follow them.
Since COVID-19 triggers a respiratory tract infection, patients with lung diseases would seem to be at particular risk. Indeed, the Centers for Disease Control and Prevention lists chronic obstructive pulmonary disease as a condition that puts one at increased risk of severe illness from COVID-19. Asthma and cystic fibrosis are listed as conditions that might put one at increased risk of severe illness from COVID-19.
But a lung disease might not be as risky as it seems.
Dr. Mitchell Grayson, the chairman of the Asthma and Allergy Foundation of America’s Medical Scientific Council, said that asthma does not seem to be a high-risk factor for COVID-19.
“The vast majority of research suggests that most people with asthma are at no increased risk of getting COVID-19 when compared to the general population, and they are not likely to have more severe disease if they do get infected,” he said.
Grayson agrees with ACIP’s decision to prioritize essential workers and those age 75 and older.
“Given the tightrope they are walking, I most certainly agree with their prioritization,” he said.
So does Dr. David Mannino, the medical director and co-founder of the COPD Foundation. “I think it makes sense,” he said.
Research has shown that people with COPD are at high risk of severe illness due to COVID-19. The Cleveland Clinic has found that people with COPD who get COVID-19 have higher rates of hospitalization, intensive care unit admission, and ventilation, while a meta-analysis showed that COPD patients face a threefold greater risk of mortality from COVID-19.
Despite this, Mannino argued that essential workers should take priority.
“Patients with COPD and other chronic diseases do not need to be out in public,” he said. “They can isolate, have groceries delivered, visit their doctors via telephone or video call, etc. Essential workers have to be out in public — so they do not really have an option to stay isolated.”
The Cystic Fibrosis Foundation has cited research showing that those with cystic fibrosis do not have increased morbidity or mortality from COVID-19.
“Information on the impact of COVID-19 on those living with CF is still limited,” said Ashley Mahoney, the external communications director for the CFF.
Mahoney noted that there may be a good reason why those with cystic fibrosis are not at increased risk.
“The precautions that society is taking today — regularly washing hands, maintaining their distance, and wearing masks — have been a part of daily life for people with CF for many years,” she said.
Yet, one group with higher rates of respiratory infections, those with Down syndrome, are being prioritized — in the United Kingdom. Research published in the Annals of Internal Medicine in October showed that those with Down syndrome infected with the coronavirus are five times more likely to be hospitalized and 10 times more likely to die. In December, the U.K.’s Joint Committee on Vaccination and Immunisation recommended prioritizing people with Down syndrome for vaccination.
The National Down Syndrome Society would also like Down syndrome patients to be prioritized in the United States.
“We think that people with Down syndrome should be included with essential workers and those over age 75 in the vaccine allocation plans,” said Margot Rhondeau, a senior adviser for the NDSS.
Michelle Sagan, the manager of digital media for the National Down Syndrome Society in the U.S., says there are a host of factors that put people with Down syndrome at risk, such as their living conditions.
“Many adults with Down syndrome live in community-based congregate settings such as group homes, which share many of the same risk factors as long-term care facilities where a significant portion of COVID-19 deaths have occurred,” Sagan said.
