South Dakota health officials and medical providers have been near the top of the nation in administering COVID-19 vaccines as they become available, but a significant new challenge awaits as the state moves into a much larger, more difficult-to-define population of people who may qualify for a shot.

That upcoming subset of people will include an estimated 80,000 residents with two or more underlying medical conditions as defined by the federal Centers for Disease Control and Prevention.

With that next group potentially in play as early as February, state officials and health providers as of Jan. 20 did not have a firm plan in place to definitively determine how they, and members of the public, will figure out who qualifies for a vaccine in that population group, how potential vaccine recipients will verify their conditions and whether proof of medical diagnoses will be required before shots are administered.

Health providers across the state have increasingly been fielding questions from residents with existing medical conditions who want to be vaccinated as soon as possible and who so far are unable to get clear answers about when they can get shots.

As of mid-January, the state and medical providers had not developed concrete plans on how to determine who qualifies in the Phase 1D subgroup of patients with two or more underlying conditions, said Scott Peterson, director of pharmacy at Monument Health in Rapid City.

“There’s been no decision that has been made on that yet,” said Peterson, who is leading that system’s vaccination efforts. “At this point in time, there is not a definitive plan on that.”

The state recently entered the fourth phase of its long-range, seven-phase vaccination plan after completing initial phases that included front-line health-care workers, long-term care residents and staff, law enforcement, EMS and correctional workers and a few other small groups.

After having success in phases 1A through 1C, the state sped up entry into Phase 1D on Jan. 18 by making shots available to a newly created subset of 1D that includes the highest-risk patients within the group – those 80 and older, people with cancer, those on dialysis and very high-risk people in congregate settings.

In addition to all residents 65 or over, teachers and college staff and funeral service workers, Phase 1D also includes “persons with two or more underlying medical conditions,” a population estimated at roughly 80,000 people.

The state is basing vaccinations in that group on a list developed by the CDC of 23 medical conditions that are known or believed to put someone at higher risk of complications or death if the person becomes infected with the coronavirus.

Verifying if someone qualifies within the two underlying conditions category could be fairly simple for a doctor or practitioner who has extensive experience treating or diagnosing a patient, said Dr. Michael Wilde, vice president and chief medical officer at Sanford Health in Sioux Falls.

But determining whether a person has two of the CDC-listed conditions will be difficult if not impossible for front-line employees who will check in patients at hospitals, clinics or pharmacies where COVID-19 vaccines will be delivered, Wilde said.

Identifying and verifying who qualifies will also be tricky when it comes to patients with rare conditions or those that are not specifically listed on the CDC website but that likely put them at higher risk from COVID-19 complications, experts said.

The underlying-conditions subset will also include people who are at high risk but who do not have a general practitioner, are not affiliated with a hospital system, or who receive medical care only at emergency rooms or urgent-care facilities not affiliated with specific medical systems. That group of people whose numbers are unknown cannot be certain if they qualify and will not be alerted by vaccine providers.

See full story in this week’s Leader-Courier.