In our country there are fragile and fragile. Many of them have the right to be vaccinated against Covid-19 as a matter of priority, to avoid serious or fatal complications of the infection. And others – many others – do not fall into the categories to be vaccinated immediately identified by the Ministry of Health and will have to wait a little longer and hope not to get sick. Not only. Even among the frail officially recognized there are those of series A and those of series B, based on where they have the good fortune or misfortune to live. In fact, some regions have already started to administer anti-Covid vaccines for some time, while in others still nothing.
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But let’s go in order. In the third phase of the vaccination plan, priority immunization of people with “high fragility”, that is extremely vulnerable people and people with severe disabilities, is envisaged. Excluding frail patients in RSA and over 80, who belong to the first categories of priority access to the vaccine, and many of whom have therefore been immunized. Therefore, among the frail in this phase there are patients suffering from respiratory diseases, such as idiopathic pulmonary fibrosis; some patients with cardiovascular diseases; patients with neurological conditions and disabilities; those with diabetes, with some exceptions, and with severe endocrinopathies, such as Addson’s disease; patients with cystic fibrosis; people with renal insufficiency undergoing dialysis, autoimmune patients or those with primary immunodeficiencies; patients with liver cirrhosis; those who have suffered a recent cerebral ischemic-hemorrhagic event or with severe damage; cancer patients and those with some hemoglobinopathies; people with Down syndrome; people who have undergone an organ transplant; those with severe obesity; and people with HIV. It is therefore a long list. But not so much to include all the people who, due to particular health conditions, we know are most at risk from Covid-19.
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For example, among the patients with cardiovascular diseases, only those suffering from heart failure in class IV, the one that expresses the greatest severity, and those in post-cardiogenic shock were included. “There are many other frailties that they have forgotten about”, denounces Pasquale Perrone Filardi, professor at the Federico II of Naples and elected president of the Italian Society of Cardiology. “There are many conditions that require the utmost attention”, he adds, citing only a few: “for example, severe ischemic heart disease, uncontrolled hypertension and diabetes, some congenital heart disease in adults”.
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Even among the frail with neurological diseases there would be great discrimination. For this reason, recently various scientific societies (Sindem, Sin, Sigg, Simg), the Italian Alzheimer’s Disease Association (Aima) and Cittadinanzattiva have signed an appeal to include people with dementia, regardless of age and degree of disease. . “People with dementia – say the signatories of the appeal – are unable to tolerate the use of personal protective equipment, nor do they understand them; they struggle to endure social isolation, change of habits, changed relationships. Hence the hundredfold fatigue of the caregivers, the generalized worsening of patients, the increased risk of contagion and the obligation to a strict prison “.
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And again: the World Association for Infectious Deseases and Immunological Disorders lists an army of vulnerable people excluded from the priority list. To name a few: patients with amyotrophic lateral sclerosis (SMA), those with Duchenne muscular dystrophy, patients with Batten disease, those with metabolic lysosomal storage disorders, patients with Fabry disease, those with the disease of Gaucher and hundreds of other inherited metabolic disorders. The Medical Endocrinologists Association (Ame-Ets), on the other hand, reports both fragile “forgotten” patients and some inconsistencies. “According to the recent protocols for the treatment of type 2 diabetes, the statement ‘being treated with at least 2 hypoglycemic drugs’ cannot represent a suitable criterion for identifying particularly fragile patients with a high disease burden”, he explains. Franco Grimaldi, president of Ame-Ets. “This evaluation should eventually be carried out for all diabetic patients by the specialist who has them in charge,” he adds. Furthermore, Ame-Ets requests that the term “severe endocrinopathies” be used extensively to include the indication for priority vaccination, as well as for patients with Addison’s disease or hypopituitarism, also for those with acromegaly or Cushing’s syndrome.
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In addition to the discrimination between fragile patients who have priority access to vaccines, there is also the serious delay in starting immunization for this category of people. The most virtuous are Campania, Emilia Romagna and Lazio. Lazio is among the regions that moved first as regards the categories most at risk and in Campania the vaccination of the frail began on March 17. In Emilia Romagna, on the other hand, we started on 22 February. In Lombardy, which has vaccinated over 100,000 fragile guests in health facilities, it will proceed with the others only from 15 April. In Tuscany, registrations began on 23 March, while in Liguria and Abruzzo the booking phase should start only in a few days. In Puglia the vaccinations of the frail began a few days ago, in Umbria the reservations will start from 1 April. From today in the Marche the fragile can start booking. In Molise and Basilicata still no administration. In Sardinia, immunization of the frail began today. Sicily, on the other hand, has already started but there are reports of inefficiencies in some provinces. In Calabria the vaccination of the frail has begun, even if it is proceeding slowly.
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“The situation is very uneven and difficult to monitor”, comments Nino Cartabellotta, president of the Gimbe Foundation. “Except over 80 and RSA guests, we do not know the total number of frail people who should be given priority, nor that of vaccinated people in this category in the various Regions. Instead, it would be very useful to have this information also for greater transparency in the use of doses ”.
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