Matthew Smith’s favorite mask in his colorful collection of COVID face coverings is the forest green Baptist Health-branded one he received in a Christmas stocking from his adult day program.

Smith, 31, was preparing to wear his green mask when he went to get his vaccine at Baptist on Feb. 2. Baptist was the only hospital in South Florida taking appointments for those with underlying health conditions, including Down syndrome. His sister, Rosemary Smith Hoel, snagged him a spot after an hour of refreshing the hospital system’s online portal to grab an appointment the moment one became available.

Gov. Ron DeSantis’ December executive order on who can obtain vaccines included people like Smith, who are under 65 years old but have underlying health conditions that make them considerably more vulnerable to COVID-19 and its effects. Under the executive order, people in that category must get their vaccines through a hospital program like Baptist’s.

When Baptist canceled all first dose appointments last week citing a lack of supply, Smith’s sister, Rosemary Hoel, felt defeated. Baptist was the only place she could find that would vaccinate her brother. Other South Florida sites, like the ones supported by Jackson Health System, Miami-Dade County or the state, are only serving healthcare workers or those 65 and older.

When Baptist ended its vaccine appointments, hundreds of people like Smith were left without an option.

“We have been really, really anxious to protect him,” said Hoel, who lives in Palmetto Bay with her brother, her husband and their two children. Her husband and son are currently sick with COVID-19, and are staying in the family’s camper to isolate themselves.

People with Down syndrome, the most common chromosomal disorder, aren’t more susceptible to catching the virus but if infected, are five times more likely to be hospitalized and 10 times more likely to die than the general population, according to a large U.K. study published in the Annals of Internal Medicine in October. The study concluded that the risks originate from the fact that Down syndrome is associated with pulmonary disease, immune dysfunction and congenital heart disease.

DeSantis’ December executive order says: “during the first phase of the vaccine rollout, all providers administering any COVID-19 vaccine shall only vaccinate the following populations: Long-term care facility residents and staff; persons 65 years of age and older; and health care personnel with direct patient contact.”

It then says that “hospital providers, however, also may vaccinate persons who they deem to be extremely vulnerable to COVID-19.”

But as the vaccine supply from the federal government to hospitals lags while other vaccination sites start to pop up in places like Publix pharmacies, hospitals have had to cancel appointments and scramble to notify patients that they don’t have enough vaccine to make new appointments.

“America’s inability to provide enough vaccines has put hospitals in an intractable position,” said Kenneth Goodman, a professor at University of Miami and director of the school’s Institute for Bioethics and Health Policy.

Goodman said if the state was more forthcoming about how it chose its criteria for vaccinations and perhaps allowed people with underlying conditions to be vaccinated outside a hospital setting, things could be different.

It’s our collective fault for not having been prepared for this,” he said. “Getting it right ethically involves a lot more transparency than we so far experienced.”

Like Smith, Kathleen Eckhart, a 62-year-old cancer patient, had her appointment canceled at Baptist and now has nowhere to turn. She said she’s been told by Broward County that state-supported vaccination sites may change their policy soon. But for now, she waits and limits her time outside her home the best she can. Even so, cancer patients still have to attend doctor’s appointments and pick up medication at pharmacies, which puts them at risk, Eckhart, of Boca Raton, said.

“It would be a death sentence. You just know,” she said. When you go through a cancer treatment, it’s just going to drive down your immune system. We are just more susceptible to getting it.”

Sarah Bramblette, 43, was one of the lucky ones who got into Baptist before they canceled all appointments. Bramblette, who has skin and lymphatic disorders, is a healthcare and insurance advocate and public speaker.

She said since the pandemic hit, it has been hard to have her medical needs met. Her physical therapy treatments were limited and trips to the emergency room due to infections were complicated by COVID-19 precautions.

Seeing the governor’s order including people with underlying conditions gave her hope, but she said that even though she was able to get the initial shot, she still feels the language was mostly “lip service.”

“They want to say we are the priority, but in reality, we are not a priority,” said Bramblette, who lives in Miami Shores.

The shortage and the fallout

After Baptist and Mount Sinai Medical Center, which was not taking patients under 65, canceled thousands of COVID-19 vaccination appointments last week due to lack of supply, Miami-Dade Mayor Daniella Levine Cava signed an emergency order that she says will give the county more control over the vaccination process by ending hospital overbooking.

Baptist issued a statement saying it had been operating under a directive from the state mandating hospitals vaccinate as many eligible people as possible, as quickly as possible, and had been assured by the state that they would receive additional vaccines as needed “without limitation.”

According to the News Service of Florida, Surgeon General Scott Rivkees told hospital officials last week that he does not know when additional first doses of the Pfizer-BioNtech or Moderna vaccines will be sent to the state or how many doses would be in a future shipment.

Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security, said more vaccines will likely correct the supply problems states like Florida are facing but added that the bumpy rollout and competitive nature of securing a vaccination slot stem from a lack of federal coordination among states.

“It is a symptom of the way things have been going and it shows you the limitations of that approach because things are pretty horrible,” she said. “The ultimate goal is to get everybody vaccinated. It’s hard. The more barriers you create, the more challenges you have administering it.”

As Smith’s family hopes for another chance to sign him up for his first shot, they’re trying to live by the mantra on a tie-dye shirt he wears, one he points to if anyone starts to bicker or get stressed.

“Stop. Smile. Deep breath. Relax,” Hoel said. “That’s what we are all trying to hold on to while we are anxiously awaiting.”

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