Your guide to COVID-19 vaccination for seniors, persons with comorbidities

Across areas seeing high numbers of coronavirus cases in the Philippines, senior citizens and persons with comorbidities have become the latest group eligible to receive COVID-19 vaccines. 

Along with health workers, the two groups form part of the country’s priority populations for the scarce shots. 

The government’s coronavirus task force approved the simultaneous vaccinations of these sectors as it expected more doses to become available, though its schedule of deliveries has so far been delayed.  The move was also part of efforts to speed up the vaccination program after health officials reported record-high infections in recent weeks. 

Medical experts have urged people in the top 3 priority groups to get vaccinated as soon as possible, as they are among those most exposed to COVID-19 and at most risk of developing severe bouts of the disease. 

Who is eligible?

Those 60 years old and above, as well as adult Filipinos aged 18-59 with the following diseases will be prioritized while vaccines remain limited, according to the guidelines of the Department of Health: 

  • Chronic respiratory disease 
  • Hypertension 
  • Cardiovascular disease
  • Chronic kidney disease
  • Cerebrovascular disease
  • Malignancy or cancer 
  • Diabetes
  • Obesity
  • Chronic liver disease
  • Neurologic disease
  • Immunodeficiency state

These listed comorbidities are among the top causes of national morbidity and mortality. The diseases had also been found to increase the risk of hospitalization and death due to COVID-19. 

In a recent forum, epidemiologist Dr John Wong said data from the Department of Health over the past 18 months showed that though most infections were common among the working population, elderly Filipinos who got infected were 5 times more likely to have severe COVID-19 and 10 times more likely to die. 

Citing estimates, Wong said there are about 14.5 million non-elderly adult Filipinos who have at least one underlying condition that increases their risk of having unfavorable COVID-19 outcomes. 

What you need

If you have any one of 11 diseases listed by the DOH, the following documents can be used as proof of comorbidity: 

  • Medical certificate from an attending physician
  • Prescription for medicines
  • Hospital records such as the discharge summary and medical abstract
  • Surgical records 
  • Pathology reports or lab results 

These documents should have been issued within the last 18 months. 

Take note, you will need to secure a physical copy or electronic medical clearance from your doctor prior to vaccination if you fall into the following 6 categories: 

  • Autoimmune disease 
  • HIV 
  • Cancer or malignancy
  • Transplant patients
  • Undergoing steroid treatment 
  • Patients with “poor prognosis” or bed-ridden patients

Medical clearance can be sought through teleconsultation or consultation with your specialist.

If you’re part of these groups, obtaining medical clearance will allow you and your doctor to assess your personal risks and benefits when getting vaccinated, as well as address any specific questions you might have regarding your condition. 

The medical clearance will need the full name of the attending physician and his or her contact details. It should be issued by a licensed doctor and may also come from “referral apex hospitals, through telemedicine, and rural health units,” the DOH said. 

Not sure how to go about getting medical clearance? The DOH said local governments should make sure patients who need this can be directed to nearby hospitals and that officials in primary care facilities are trained on clinical guidelines on providing the clearance. This would be especially useful to people with comorbidities who are unable to consult at hospitals. 

Keep in mind

People with uncontrolled comorbidities or those in “active disease” are not advised to get vaccinated.

Dr Rontgene Solante, an infectious disease specialist and member of the Philippines’ vaccine expert panel, said this is because uncontrolled comorbidities can affect the way a vaccine will work on the body. The stress on the body from diseases, if uncontrolled, can also affect how the immune system will respond to the vaccine. 

On the day of your vaccination, you will be screened in health sites where shots will be administered. The DOH said it’s possible for vaccinations to be deferred if, after screening, you are found with any one of the following: 

  • Symptoms of COVID-19 or their comorbidity 
  • Abnormal vital signs including heart rate, respiratory rate, and blood pressure (BP) even after monitoring for an hour. 
    • Patients indicating hypertensive emergencies (where systolic blood pressure is greater than 180 and/or diastolic blood pressure is greater than 120, with signs and symptoms of organ damage), will not be vaccinated and be referred to the emergency room immediately. Vaccination will be rescheduled. 
  • Had attacks, admissions, or changes in medication in the past 3 months.

The DOH said vaccination will also be allowed in homes or in institutions like nursing homes, infirmaries, and homes for the aged, for bedridden patients.

In these cases, local governments have been directed to schedule on-site vaccination teams, and ensure that processes are in place for the management of adverse events following immunization, such as having ambulances on standby. Medical clearance and consultation with attending doctors is also needed for bedridden patients.

Vaccinations should also be done in a separate venue or separate date for tuberculosis patients and people living with HIV.

What vaccines will be used?

Only AstraZeneca and Sinovac vaccines are currently available in the Philippines. 

In the meantime, the DOH, citing emergency use authorizations (EUA) from the Food and Drug Administration, said Sinovac will be given to 18-59-year-olds with controlled comorbidities, while AstraZeneca will be reserved for senior citizens. 

The FDA’s EUA did not recommend the use of Sinovac on the elderly as there had been insufficient data on this group when the authorization was issued. The Philippines’ vaccine expert panel is currently reviewing data on this after China, Turkey, Indonesia, and Hong Kong decided to use Sinovac on their elderly populations. 

Final guidance may be expected from the National Immunization Technical Advisory Group or NITAG in the coming weeks. 

The DOH likewise said that in case of limited vaccine supply, further sub-prioritization of adults with comorbidities will be done based on “geographic burden of COVID-19 disease and LGU vaccination readiness.”

Why these groups are prioritized

“The impact of giving vaccines and protecting these people is not just in preventing them from getting the infection. The main bottomline here is preventing them from dying,” said Solante, who heads the adult infectious disease department at the San Lazaro Hospital. 

Referring to elderly patients or those with comorbidities the hospital had treated in the past year, Solante said, “It’s like a 50-50 chance that if they develop critical COVID-19, a 50% chance they will live and a 50% chance they will die, because in itself, the presence of the comorbidities and mortalities will really be the difference between life and death.” 

Solante said it's important for senior citizens and persons with comorbidities to get vaccinated because it will have a "significant impact" on their lives. – Rappler.com

Read Rappler's series of explainers on the Duterte government's vaccine program below:

Sofia Tomacruz

Sofia Tomacruz covers foreign affairs and is the lead reporter on the coronavirus pandemic. She also writes stories on the treatment of women and children. Follow her on Twitter via @sofiatomacruz. Email her at sofia.tomacruz@rappler.com.

image