Peggy Krisch has been hunkering down in her Fort Greene apartment with her boyfriend after she lost work as an in-home pilates instructor, a job no longer possible during the COVID-19 pandemic.
On the surface, the 32-year-old seems like the millions of other New Yorkers eagerly awaiting a COVID-19 vaccine — young enough to be spared the worst risks from the disease and privileged to stay at home. But Krisch suffers from severe asthma on a day-to-day basis. Sometimes, she’ll wake up in the middle of the night with her chest feeling “on fire.”
“It feels like you gotta tread on eggshells,” she said. “You never know what’s gonna quite set it off.”
Governor Andrew Cuomo announced people with underlying conditions would be eligible for the vaccine along with those 65 and up in mid-January, facing criticism his administration was lagging on doling out the shots. But then, supplies started to dry up and no further guidelines were announced.
Krisch doesn’t know if she’ll be eligible soon, or if she’ll have to wait until much later. She and other asthma sufferers sit in this limbo alongside 4 million New Yorkers with a spectrum of underlying conditions thought to increase the risk of severe COVID-19, according to figures cited February 2nd by Governor Cuomo. Their fate depends on scientists trying to decipher which conditions present the most danger amid a constantly evolving pandemic—and state regulators with wide-ranging appetites for following such evidence.
“It's this kind of never ending cycle of could I be doing more? Or am I just supposed to stay put and wait?” Krisch said. “It just feels like we're being skirted under the rug.”
Seven million people are currently eligible in New York state for COVID-19 vaccines, but just 300,000 doses are allocated to the state each week, according to the governor. President Joe Biden has invoked the Defense Production Act to help alleviate supply woes, and Mayor Bill de Blasio is urging pharmaceutical companies to start making vaccines created by other companies, taking advantage of how the DPA overrides typical patent laws so that companies can use “the successful recipes of others,” de Blasio wrote in a recent op-ed.
But for people like Krisch, they’re still waiting on what’s next.
Jack is a 20-something Upper West Sider with multiple sclerosis who has been avoiding contact with nearly everybody in his life for about a year because of the pandemic. (Editor’s note: Jack requested that we not publish his real name due to privacy concerns, as many of his colleagues and family are unaware of his condition.) He was diagnosed with multiple sclerosis in law school—a terrifying moment given the autoimmune disease attacks the nervous system and it has no cure.
The National MS Society says having the condition doesn’t make a person more susceptible to severe COVID-19 except for particular patients, including those who are male, have a progressive form of the disease, are older than 60, are Black or South Asian, or are obese.
Taking certain medications for MS may worsen one’s consequences with the coronavirus, and Jack receives regular infusions of ocrevus, a drug known to suppress the immune system by depleting its B cells. The prospect of catching COVID-19 came with too much risk, so he temporarily relocated upstate a few months ago.
“Who knows?” said Jack. “Maybe if I got COVID, it would wind up being super mild, and I kick it like the common cold, and I'd be fine. But maybe not.”
His drug treatment may also impact the efficacy of the COVID-19 vaccines, but experts insist there is simply not enough data to know. He typically has to schedule his flu shot around infusions each year, making the timing of when he’d be eligible for the COVID-19 vaccine a critical question as he plans his next treatment.
“No one has taken a hard stance on it,” he added.
Columbia University epidemiologist Rupak Shivakoti said the state government faces the complicated reality of balancing supplies with the evidence on which diseases put someone at a higher risk of severe COVID-19. Untangling “messy” data regarding each disease, and the impacts from COVID-19 is difficult, according to Shivakoti.
“Because the data is confusing, we're more sure about certain conditions than others,” Shivakoti said. “I think the reason New York State or any other state isn't being very specific is because they want to see what the vaccine supply is. So if the vaccine supply is more than they think, then they can add in some other conditions that they weren't so sure about. But if the vaccine supply is very limited, then they will have to be pretty picky.”
Data from the peak of the pandemic “is not always collected in the way that you would want for a study,” said Shivakoti, who is currently researching how COVID-19 and diabetes interact with the immune system.
In the face of indecision, New Jersey and other states opted to just match the guidance from the Centers for Disease Control and Prevention and opened up vaccine eligibility to anyone with complicating conditions. New York and city officials are not following these guidelines. But virologist Nischay Mishra, a professor in the Center for Infection and Immunity at Columbia University, said this persistent patchwork of state-by-state decision-making is “very chaotic” for a pandemic response.
Testing, treatment, mask-wearing, and lockdown measures have differed across the nation throughout the pandemic. Now, the same is occurring with vaccines. “There has to be some sense of unified guidelines,” Mishra said.
A day before the presidential inauguration, Cuomo’s spokesperson Rich Azzopardi blamed the outgoing Health and Human Services Secretary Alex Azar for lying to the states about the federal deployment of vaccine doses in the national stockpile. He said it was the Trump administration’s “final act” of “playing April Fools with people with pre-existing conditions just like when he wanted to eliminate health insurance coverage” for them.
He added the state is “working on next steps.” But which conditions would qualify, when, and how people will prove they have a certain condition are still unknown. On Monday, New York State Health Department spokesperson Jill Montag said in an email the state is “encouraged” by the Biden administration’s commitment to upping weekly vaccine supplies after deliveries were cut by his predecessor.
“[W]e hope to continue to receive more doses and guidance on this issue,” Montag said.
Lori Perkins, 61, who has a few weeks left of chemotherapy at the Dubin Breast Center, said her doctors told her she should be cleared for vaccination by the end of the month. Chemotherapy weakens the immune system—and by extension, one’s vaccine response.
She welcomes being able to wait in line with other cancer patients—avoiding crowded lines at sites around the city.
“I literally only go out for my chemo infusions and my once every three week COVID test,” said Perkins, a publisher at Riverdale Avenue Books in the Bronx. “I feel like there's a process for me, and I'm very appreciative of that.”
Retired school teacher and artist Alexandra Zevin says she’ll get the vaccine as long as her oncologist gives her the green light.
With chronic lymphocytic leukemia, her health can deteriorate on a moment’s notice, sending her to the emergency room. She said the vaccine rollout exemplifies growing problems with a for-profit health care system, citing the well-reported costs of profiteering insurance companies and its resulting inequities in coverage.
“People with special needs or underlying conditions deserve to live a full life,” Zevin said. “It’s wrong to have us have to advocate for ourselves so much.”
