ROME — Octogenarians in Tuscany watched in disbelief and indignation as lawyers, magistrates, professors and other younger professionals got vaccinated against COVID-19 before them, despite government pledges of prioritizing Italy’s oldest citizens. Even some of their adult children jumped ahead of them.
By one estimate, the failure to give shots to the over-80s and those in fragile health has cost thousands of lives in a country with Europe’s oldest population and its second-highest loss of life in the pandemic.
As the elderly were elbowed aside, a dozen prominent senior citizens in Tuscany published a letter calling out the authorities, including the region’s governor, for what they said was a violation of their health care rights enshrined in the Italian Constitution.
“We asked ourselves, ‘What’s the reason for this disparity?’” said signatory Enzo Cheli, a retired constitutional court judge who is a month shy of 87. By late March, he still hadn’t been vaccinated, three months into Italy’s inoculation campaign.
“The appeal was born of this idea that errors were being made, abuses,’’ Cheli said in a telephone interview from his country home near Siena. He noted that investigations are underway in Tuscany and other regions where professionals received priority status.
Those over 80 in Tuscany have the lowest vaccination rate nationally.
Another signatory was 85-year-old editorial cartoonist Emilio Giannelli, who hasn’t been vaccinated, while his son, a lawyer, has.
A Giannelli cartoon appeared on the front page of Corriere della Sera depicting a young man in a business jacket kicking an old man leaning on a cane out of a vaccine line.
In a country where many citizens have learned not to count on often weak national governments, outsize influence is wielded by lobbying groups, sometimes derided as “castes.”
Premier Mario Draghi has decried such “contractual clout,” saying last month that the “basic line is the need to vaccinate the most fragile people and the over-80s.” His government insists that vaccinations proceed in descending order by age, with the only exceptions being school and university employees, security forces, prison personnel and inmates, and those in communal residences such as convents.
According to a calculation by the ISPI think-tank , opening vaccination rolls to younger Italians cost 6,500 lives from mid-January through March, a period in which nearly 28,000 died.
ISPI researcher Matteo Villa said any decision to vaccinate non-health care professionals who face infection risks should have been limited to those 50 and older.
“If we give 100 vaccines to people over 90, we save 13 lives,” Villa said in a phone interview, citing mortality rates. “But it takes 100,000 vaccines to 20- to 29-year-olds to save just one life.”
The current average age of pandemic dead in Italy is 81.
Throughout the pandemic, the oldest Italians have made up the majority of deaths, and not just in Tuscany. Just before Draghi sounded the alarm about lobbying groups, journalists in the small region of Molise had been poised to get early vaccinations. In Lombardy, veterinarians were given priority. In Campania, the region including Naples, drug company salespeople got priority status.
Regional leaders blame vaccine delivery delays, alleging the previous government’s vaccine rollout opened the door to lobbying groups.
Some regions like Lazio, which includes Rome, resisted their pressure. By the end of March, nearly 64% of those 80 and older in Lazio had received at least one COVID-19 shot, compared with 40% in Tuscany.
Speaking about society’s most fragile, Lazio Gov. Nicola Zingaretti told the Corriere della Sera newspaper: “It’s true everyone risks getting COVID, but the difference is that they are among those who, if they catch it, risk dying more than others.”
Of Italy’s 4.4 million residents 80 or older, fewer than 29% had been vaccinated, and another 27% had gotten only the first dose by the end of March, said the GIMBE foundation, which monitors health care in Italy.
That compares with 95% of that age group in Malta who have received at least one dose, and 85% in Finland, according to the European Center for Disease Prevention and Control, Italy.
In Britain, where the vaccine rollout began roughly a month before the EU’s, most of the over-50s have received at least one dose.
GIMBE official Renata Gili linked much of Italy’s uneven performance to varying organizational capabilities as well as “an excess of autonomy in regions in the choice of priority categories to vaccinate.”
Some lobbying groups aren’t backing down. The National Magistrates Association, which represents most of Italy’s more than 9,600 magistrates, threatened to further slow down the snail-paced judicial system if they aren’t given priority. On Thursday, the tourism lobby demanded priority vaccines for its workers, describing them as essential to the country’s recovery.
On Friday, a top Health Ministry official, Giovanni Rezza, sought to cut off any more jockeying for priority.
“There was a struggle between categories” to get vaccine priority, Rezza told a news conference when asked if supermarket clerks could get special status. “We said, ‘Let’s finish the teachers, the security forces, but let’s not have any more categories.’ We simply will use criteria of age.”
The army general who was tapped last month by Draghi to shake up Italy’s COVID-19 vaccination campaign acknowledges its widespread problems.
“Is everything going well? No,’’ Gen. Francesco Figliuolo told reporters Wednesday in Milan.
Just how many people in Italy received priority vaccines isn’t known. Tuscany’s health commission office said that before Draghi pulled the plug on special interest groups, 10,319 lawyers, magistrates, courthouse clerks and personnel had received a dose in the region.
Allowing lawyers and others to have quick access to vaccines is “an issue, and everyone is pissed off about it,’’ said Nathan Levi, an antiques dealer in Florence who turns 83 next month and is still waiting. “That’s what Italy is all about. The people who put the pressure” get ahead.
Of the 10.6 million doses so far administered in Italy, around 1.6 million went to people categorized as ’’other,” prompting some politicians to demand to know who they are. When questioned, Figliuolo’s office admitted it has no idea and said it was pressing the regions for specific details.
Italians in their 70s, who are largely out of the workforce, are still waiting for their shots. By March 31, only 8% had received a first dose and fewer than 2% had received both.
Then there are people in fragile health, who have a priority category on the government’s rollout chart.
“The situation for the ‘fragile’ is one of huge uncertainty,’’ said Francesca Lorenzi, a 48-year-old lawyer in Milan with breast cancer. She noted that if cancer patients have finished therapy more than six months ago, they are no longer considered “fragile.”
“Meanwhile, they gave doses of Pfizer to 60-year-olds in great health because they have university contracts. I don’t understand why a university professor or a lawyer should get vaccinated before the others,” she said.
Colleen Barry reported from Milan. Pan Pylas in London contributed to this report.
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Frances D’Emilio And Colleen Barry, The Associated Press
Ontario hospitals may have to withhold care as COVID-19 fills ICUs
By Allison Martell and Anna Mehler Paperny
TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.
Canada‘s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.
The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.
Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.
Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.
The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.
“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.
“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”
In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.
Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.
“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”
In COVID-19 vaccination pivot, Canada targets frontline workers
By Anna Mehler Paperny
TORONTO (Reuters) – Canada is shifting its vaccination campaign to target frontline workers, moving away from a largely age-based rollout as the country tries to get a handle on the raging third wave of the pandemic.
Canada‘s approach thus far has left unvaccinated many so-called “essential workers,” like daycare providers, bus drivers and meatpackers, all of whom are among those at higher risk of COVID-19 transmission. Provinces are now trying to adjust their strategy to tackle the surge driven by new variants.
Targeting frontline workers and addressing occupation risk is vital if Canada wants to get its third wave under control, says Simon Fraser University mathematician and epidemiologist Caroline Colijn, who has modelled Canadian immunization strategies and found “the sooner you put essential workers [in the vaccine rollout plan], the better.”
Initially, Canada prioritized long-term care residents and staff for the vaccines, as well as the very elderly, health workers, residents of remote communities and Indigenous people.
Targeting vaccinations by age made sense early on in a pandemic that ravaged Canada‘s long-term care homes, Colijn said. But now, immunizing those at highest risk of transmission brings the greatest benefit.
“If you protect these individuals you also protect someone in their 60s whose only risk is when they go to the store. … The variants are here now. So if we pivot now, but it takes us two months to do it, then we will lose that race.”
Data released on Tuesday from the Institute of Clinical and Evaluative Sciences showed that Toronto’s neighbourhoods with the highest rates of COVID-19 infections had the lowest vaccination rates, underscoring the disparities in vaccination.
‘IT’S A JUGGERNAUT’
On Wednesday, Ontario Premier Doug Ford announced a plan to have mobile vaccine clinics target COVID-19 “hotspots” and high-risk worksites, although he stopped short of giving people paid time off to get the shot.
Karim Kurji, medical officer of health in York Region north of Toronto, characterizes the shift in vaccination priority from age to transmission risk as moving from defence to offence.
“It’s a juggernaut in terms of the immunization machinery, and turning it around takes a lot of effort,” Kurji said.
Meanwhile, officials in the western province of Alberta say they are offering vaccines to more than 2,000 workers at Cargill’s meatpacking plant in High River, site of one of Canada‘s largest workplace COVID-19 outbreaks. Provincial officials said in a statement they are looking to expand the pilot to other plants.
Quebec will start vaccinating essential workers such as those in education, childcare and public safety in Montreal, where neighbourhoods with the highest vaccination rates have been among those with the lowest recorded infection rates.
The people doing the highest-risk jobs, from an infectious disease perspective, are more likely to be poor, non-white and new Canadians, health experts say. They are less likely to have paid leave to get tested or vaccinated or stay home when sick and are more likely to live in crowded or multi-unit housing. They need to be prioritized for vaccination and their vaccination barriers addressed, experts say.
Naheed Dosani, a Toronto palliative care physician and health justice activist, said making vaccines available to high-risk communities is not enough without addressing barriers to access.
“The face of COVID-19 and who was being impacted changed dramatically. The variants seemed to take hold in communities where essential workers live. … This [pivot] is a step in the right direction and will hopefully save lives.”
(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Aurora Ellis)
Canada finance minister: Pandemic an opportunity to bring in national childcare
OTTAWA (Reuters) – The COVID-19 pandemic and its damaging impact on women has underlined the need for a national childcare plan, which would also help the economic recovery, Finance Minister Chrystia Freeland said on Thursday.
Since taking up her job in August, Freeland has repeatedly spoken about a “feminist agenda,” and has said childcare will be part of a stimulus package worth up to C$100 billion ($79.6 billion) over three years. She will unveil details in her April 19 budget.
“I really believe COVID-19 has created a window of political opportunity and maybe an epiphany … on the importance of early learning and childcare,” Freeland told a online convention of Canada‘s ruling Liberal Party.
The budget is set to be a springboard for an election that Liberal insiders say is likely in the second half of the year.
Canadian governments of various stripes have mused about a national childcare program for decades but never acted, thanks in part to the cost and also the need to negotiate with the 10 provinces, which deliver many social programs.
Freeland said a childcare program would help counter “an incredibly dangerous drop” in female employment since the start of the pandemic.
“It is a surefire way to drive jobs and economic growth … you have higher participation of women in the labor force,” Freeland said. “My hope … is that being able to make that economic argument as well is going be to one of the ways that we get this done.”
Freeland, who is taking part this week in meetings of the Group of Seven leading industrialized nations and the International Monetary Fund, said U.S. Vice President Kamala Harris and Treasury Secretary Janet Yellen had told her they saw early learning and child care as a driver for economic recovery.
($1=1.2560 Canadian dollars)
(Reporting by David Ljunggren; Editing by Leslie Adler)