Vaccines, comorbidities, immunity: Answering your COVID questions

We dive into reader questions about vaccine logistics, supporting health care workers and more.

people inside trailer administering vaccines

City workers administer Covid-19 vaccines by appointment, at a mobile center in West Seattle, February 18, 2021. (Shaminder Dulai/Crosscut)

Since the pandemic came to Washington almost exactly a year ago, Washingtonians have been trapped in a grueling cycle of society shutting down, opening up, seeing cases surge, then shutting down again. But with the introduction of a successful vaccine in December and more than 919,000 Washingtonians getting at least one dose, there is cause for cautious optimism.

As the state opens up more groups to vaccine eligibility priority, and the days get longer and beckon us to stop staying home, readers are eager to learn as much as they can about their place in line for the vaccine, how they can safely bide their time without going (more) nuts and what they can do to help others in the interim. 

To that end, Crosscut will answer a few of your most-asked questions. (To get your questions answered, submit them to our reporters via Northwest Wonders.)

What are considered qualifying “comorbidities” for COVID vaccine?

While the Centers for Disease Control and Prevention released blanket suggestions for how states should prioritize residents for coronavirus vaccination, states individually determine how to process underlying health conditions and comorbidities into different vaccine priority phases. 

In Washington state’s vaccination plan, people older than 16 with two or more underlying conditions and comorbidities become eligible for the vaccine during the third tier of Phase 1B, if they are not already eligible for other reasons. Washington state is currently in the second tier of Phase 1B

In its most recent guidance on phases, Washington is following the CDC’s guidance, linking directly to the CDC’s outline of conditions that put people at greater risk for severe illness from COVID. 

This guidance has changed over time and may change as new data emerges. Washington state’s initial draft vaccination plan, for instance, didn’t include pregnancy or smoking. Now it does. At the moment, these are the health conditions specified by the CDC: 

  • Cancer
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Down syndrome
  • Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Immunocompromised state (weakened immune system) from solid organ transplant
  • Obesity 
  • Severe obesity 
  • Pregnancy
  • Sickle cell disease
  • Smoking
  • Type 2 diabetes mellitus

Why give a second shot when millions of us don't have the first?

Watching other people advance toward a finish while stuck at the starting line may exacerbate feelings of anxiety and Fear of Missing Out. But dosing schedules exist for a reason. 

Vaccines like those from Pfizer and Moderna were designed to work with two doses given within a certain period of time. Without sticking to that schedule — three weeks in between the first and second doses for Pfizer, and four weeks for Moderna — there’s no guarantee that the vaccine will be as effective as it was in clinical trials. 

“The second dose of either the Pfizer or Modern vaccine dramatically increases it and induces the kind of cells that suggest you’ll have longer-term memory, meaning the vaccine would last for a few years,” vaccine expert Dr. Paul Offit said in a recent interview with CNBC’s Shepard Smith. “I think if we have people who just get one dose of the vaccine, which will give you shorter and less complete immunity, that’s only going to create variants.”

“Although the immune response to the first dose is unlikely to degrade quickly, it is incomplete, and there are no data to inform how long a second dose could be delayed without compromising effectiveness,” Dr. Nicole Lurie added in a recent set of Clinical Decision essays in the New England Journal of Medicine. “Suddenly changing dosing recommendations puts public confidence at serious risk and will impede willingness to be vaccinated at all.”

However, in an opposing essay in the New England Journal of Medicine, Dr. Robert Wachter suggested that the benefits of giving more people a first dose sooner are worth the risks, “particularly since the vaccine shortage is likely to ease by late spring. (The Biden administration, following this logic, has advocated using available vaccines to give more first doses.)

To complicate things, we don’t know how long immunity from a full two-dose vaccination scheme lasts, or whether these vaccines work effectively against new coronavirus variants. Booster shots are possible even after we’re fully vaccinated. 

However, new data shows that for people who’ve survived COVID-19, one dose of the Pfizer vaccine may be sufficient not only to kill the novel coronavirus, but also to defend against some variants and even other coronaviruses, like the original SARS. No one should get infected intentionally, but it’s a reason to believe those single doses could go further with the millions of people who have survived COVID in the U.S. so far. 

How can we help hospitals and especially health care workers? Can we volunteer? Are there any organizations offering help to health care staff?

In my discussions and interviews with health care workers, the top request they make of everyday people is simple: Please keep masking and distancing, so they don't have to see you or people you interact with on a gurney. But there are other ways to support doctors, nurses, environmental services professionals and other hospital workers in their communities. 

Dr. Anne Browning, an expert in health care wellness with the University of Washington School of Medicine, suggested to Right as Rain that you can help care for health care workers in your community by making their nonwork lives easier: walking their dogs, watching their kids, doing their grocery shopping. 

Hospital systems are setting up avenues for community support. At UW Medicine, there are ways to donate to a COVID-19 emergency fund (which supports research, medical needs, vaccination and more), as well as donate personal protective equipment like surgical gloves on a large scale. There’s also a public message board where people can send encouraging letters to health care workers. 

Health care workers always need to eat. In Seattle, Ellen Kuwana started the nonprofit We Got This Seattle at the beginning of the pandemic to deliver tens of thousands of meals to health care workers during herculean hospital shifts. Kuwana uses donated funds to procure meals from local restaurants, which also helps keep community businesses afloat. Donors, volunteers and restaurants can sign up to be part of the program at (Full disclosure: I serve on the board of the Northwest Science Writers Association with Kuwana.)

People with crafting skills have been making masks since the beginning of the pandemic. While health care workers need N95 masks, keeping masks circulating in the communities helps keep more people out of hospitals. Organizations like Providence have rounded up places that still need masking help.

People with health care experience, but who are not currently active in the field, may be able to help with vaccinations, removing some responsibility from overwhelmed hospital workers.

What are suggestions for keeping well during the winter months, other than the usual obvious things, please?

What is obvious to some may not be to others. In addition to continuing to employ COVID wellness practices like masking and social distancing, the hardest parts of winter wellness can be simply getting outside to breathe fresh air, get sunshine, be around other humans (at a safe distance) and move your body. But given the outdoors’ well-documented hostility to the virus, it is still the single best place to find safe, accessible mental and physical health benefits.

In December, Crosscut interviewed more than a dozen people who’ve found creative ways to continue motivating themselves to get outside. Their tips ranged from setting interesting fitness goals to looking for motivation in the plants and animals in their neighborhoods to spending time with family in different ways. 

Our lives are complicated in many ways, but even five minutes outside can be rejuvenating. 

 “Nature experiences are fundamental to our well-being — people may be time constrained, yes, but making the effort to go outside isn't a luxury,” Dr. Kathy Wolfe of the University of Washington told Crosscut. 

Is social isolation/quarantining impacting our immunity to other viruses, like colds and flu?

Health care workers say one of the most welcome silver linings of COVID is that they haven’t seen much flu this year because of social distancing and masking. But our new habits of mitigating our microbial contact this way bring their own concerns. 

Generally speaking, early-life exposure to microbes shores up our immune systems for the rest of our lives. Interacting with allergens like pollen, eggs and even peanuts as babies can train our bodies to avoid sending our immune systems into harmful overdrive. In places where people clean and sanitize their living environments more often and spend less time outside, there is often a higher incidence of allergies. Increased use of antibiotics can also eliminate some helpful microbes that, through still-mysterious immune interactions, help our skin and guts keep the rest of us healthy. 

Exposure to some viruses earlier in life can be helpful, too. As Melinda Wenner Moyer noted in a recent piece for the New York Times, catching certain illnesses like chicken pox, mumps and Epstein-Barr virus for the first time later in life can exacerbate the damage they can do. Toddlers typically see few symptoms if they contract Epstein-Barr virus, but older children and adults wind up with mononucleosis, which brings lingering, severe symptoms.

But, as Wenner Moyer describes one physician’s take,“Given that immunity is shaped by so many factors … if isolating our kids for a year or two has any effect, ‘it will probably be subtle.’ ”

Before we start worrying that our children will be irreversibly disadvantaged by less exposure to their peers during the pandemic, it is more important to prioritize opportunities for play, getting them vaccinated against known illnesses and doing all the things that improve the immune system: namely, getting good sleep, eating healthfully, connecting with others and — once again — spending time outside

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