People with Type 1 diabetes and some high-risk rare medical conditions, such as ALS and cystic fibrosis, were added to the state's next phase of COVID-19 vaccine priority groups by health officials Tuesday.

Those diseases were not initially included when the qualifying medical conditions were announced last Thursday. Minnesota Health Commissioner Jan Malcolm said the changes were made to align the state with federal guidance.

The state also added workers in the court system and some public health jobs that were not included in earlier phases as it published seven pages of detailed guidance on who qualifies for COVID-19 shots after the 70% of those 65 and older are vaccinated by the end of the month.

State health officials also announced that 45,200 doses of the newly approved Johnson & Johnson vaccine are being shipped to Minnesota this week. The vaccine is considered easier to work with because it doesn't need extreme cold storage and requires only one dose to be effective.

"Future allocations of Johnson & Johnson are uncertain for the next week or so, but we are optimistic about the long-term outlook," state infectious disease director Kris Ehresmann said.

Allocation of COVID-19 doses to Walmart, Sam's Club and Thrifty White pharmacies will be changed to better meet demand. Those vials are sent by the federal government and are not part of the state's allocation.

The change comes after reports that pharmacies in northwest Minnesota had many unfilled appointments, while others were fully booked.

"There are some locations where the uptake has slowed so they are going to be redirecting vaccines to other parts of the state where there is greater demand," Ehresmann said. "We are working to even that out."

The Type 1 diabetes community welcomed the policy change, putting Minnesota in line with 22 other states. Minnesota had already said that Type 2 diabetes would qualify.

"The advocates are super excited. It is about time," said Nicole Smith-Holt, who became an advocate after her son Alec died because he couldn't afford his insulin.

"Within the Type 1 community we have heard of people getting COVID-19 and having some really severe medical complications," she said. "Now it's been added to the priority list and hopefully will decrease the chances of somebody passing away or having severe complications."

The are 7,000 medical conditions that the Food and Drug Administration considers to be rare because each affects fewer than 200,000 people. But when added together, rare diseases afflict 8 to 10% of the population.

"Many of the rare diseases can result in being immunocompromised or having susceptibility to infection and yet there is not a lot of formal data and protocols out there," said Erica Barnes, administrator of the Chloe Barnes Advisory Council on Rare Diseases, which advises Minnesota officials.

Research on rare diseases can often be limited and there is not much published information on whether some are considered to be COVID-19 risk factors, such as sickle cell disease, Down syndrome, cancer, heart conditions and obesity.

State health officials said they will leave it up to doctors to decide who is most at risk.

"We are prepared to give some flexibility there to clinicians," Malcolm said.

Among essential workers, vaccine access will be expanded first to employees of food processing plants, which have seen some of the largest coronavirus outbreaks.

But eligibility will move on to other groups that interact with the public, including legally nonlicensed child care, including family, friends and neighbors. Foster care parents will also qualify.

Eventually vaccines will expand to sectors that help keep the economy moving, including finance, energy, housing construction, legal and wastewater treatment, among others.

But people who are employed in essential industries should not get vaccinated if they primarily work from home, the health agency said, until the general public is eligible in the summer.

State health officials reported Tuesday that 53% of Minnesota seniors have received at least one dose of a COVID-19 vaccine.

They hope to get that number up to 70% by the end of the month in order to move on to the next phases of vaccinations that are expected to begin in April and run through May.

A total of 908,590 Minnesotans have received at least one dose, with 472,789 getting the two doses recommended for the vaccines in use.

Another 443 new confirmed cases were announced Tuesday for a pandemic total of 485,655.

Testing volume was low with 10,915 reports made to state health officials Monday, reflecting lower testing volume on the weekends.

Four more people have died of coronavirus complications.

The number of COVID-19 related fatalities has dropped significantly in Minnesota, with 284 deaths reported in February, a 68% decrease from the 877 deaths in January.

December saw the highest number of deaths with 1,729, which accounted for 27% of the 6,490 fatalities since the pandemic was first detected in the state one year ago.

About 63% of the deaths have been among residents of long-term care facilities, including one reported Tuesday.

The number of Minnesotans hospitalized with COVID-19 complications remained at 243 on Monday, but there were 57 patients in intensive care units, a one-day increase of nine.

Of about 10,000 patients studied by the Minnesota Department of Health over the course of the pandemic, 76% of those admitted had at least one underlying health condition, including hypertension, obesity, diabetes, heart conditions and chronic lung diseases.

For those 75 and older, 97% had at least one underlying condition, while the number for those younger than 18 was 36%.

Glenn Howatt • 612-673-7192