UDOH announces changes to risk assessment process for accessing scarce COVID-19 treatments

(Salt Lake City) – The Utah Department of Health (UDOH) today announced changes to the state’s risk assessment process used to prioritize access to COVID-19 medical treatments. The changes are in response to extremely limited supplies of these treatments, to ensure that classifications in the risk assessment comply with federal law, and to new guidance issued by the National Institutes of Health.

With the state’s new prioritization process, some people will automatically qualify for treatment, if they meet emergency use authorization criteria (people with severe immunocompromising conditions and unvaccinated individuals age 75 and older). The risk score calculator will then be used to prioritize access to treatment for people who do not automatically qualify.

Last week, at the request of UDOH, the Scarce Resources Subcommittee of the Crisis Standards of Care Workgroup analyzed updated data from Intermountain Healthcare. The analysis examined data from 188,456 Utahns aged 18 and older with COVID-19, of which 6,579 were hospitalized. Some findings from the analysis include:

  • People with certain symptoms are more likely to be hospitalized: shortness of breath (2.3 times more likely), fever (1.7 times more likely), and diarrhea (1.3 times more likely).
  • When analyzing individual underlying medical conditions, obesity and diabetes represented the greatest increased risk of hospitalization, but the risk is compounded in individuals with multiple chronic diseases.
  • Race and ethnicity increased the likelihood of hospitalization for some groups: Compared to the Non-Hispanic White population, Native Hawaiian or Pacific Island people were 2.3 times more likely, American Indian or Alaska Native people were 1.8 times more likely, Asian Americans were 1.5 times more likely, and Latinx people were 1.4 times more likely to be hospitalized for COVID-19.
  • Vaccination status decreased the likelihood of hospitalization: Compared to unvaccinated people, partially vaccinated people were 1.6 times less likely, fully vaccinated people were 2.1 times less likely , and boosted people were 5 times less likely to be hospitalized.

Based on this analysis and recommendations from the Scarce Medications Subcommittee, the UDOH has adopted the following updates to the risk assessment process:

  • Remove race and ethnicity from the risk score calculator. Instead of using race and ethnicity as a factor in determining treatment eligibility, UDOH will work with communities of color to improve access to treatments by placing medications in locations easily accessed by these populations and working to connect members of these communities with available treatments.
  • Remove gender from the calculator. As with the protected class of race, providing additional points based on gender raises legal concerns. Additionally, as the numbers of patients with COVID-19 in Utah has grown, the hospitalization risk associated with male gender, previously included in the risk score calculator, has steadily declined.
  • Remove automatic prioritization for some immunocompromised and pregnant individuals. The risk score calculator will be modified to include certain lower-risk immunocompromised and unvaccinated pregnant individuals in the risk score calculator. Previously, all immunocompromised and pregnant individuals received automatic prioritization without using the risk score calculator. New population-level data allows more stratification of risk for these groups. Now only the highest risk immunocompromising conditions will be prioritized without using the risk score calculator.
  • Add a priority group of unvaccinated people 75 and older to those who receive prioritization without using the risk score calculator. This aligns with current Tier 1 eligibility criteria from the National Institutes of Health and reflects the significantly increased risk of hospitalization associated with advanced age and unvaccinated status above all other factors.
  • Apply the same prioritization methodology used for the general population to long-term care facility residents, incarcerated people, and other residents of congregate settings. Previously, residents of long-term care facilities and other congregate settings were prioritized for treatment and post-exposure prophylaxis without use of the risk score calculator. Previous treatment options for post-exposure prevention no longer work against the Omicron variant.

“We remain committed to a spirit of collaboration, transparency, and flexibility while addressing the impacts of the pandemic,” said Nate Checketts, executive director of the UDOH. “As we adapt to new data and new guidelines while ensuring compliance with federal law, we are committed to making sure our most vulnerable and at-risk populations receive access to these important treatments.”

“While these treatments are promising for people at highest risk of hospitalization, the supply of these treatments is scarce. Vaccination, including booster doses, remains the best path forward out of the pandemic. All of us must do our part to help see our state through this crisis,” added Dr. Michelle Hofmann, deputy director of the UDOH.

For more information on COVID-19 treatments, visit coronavirus.utah.gov/treatments.

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