Cristine writes:

Good morning,

I just listened to episode 698, which like all other TWIV episodes, was filled with important and interesting information. I have a question that my local doctors thus far haven’t known the answer to (though I haven’t asked them since Dec 20th), which is who exactly is in the high risk group? Dr. Griffin read off a list that presumably is derived from this CDC document here:

However, this document actually divides at risk people into two groups: those who definitely “are at risk” and those who “might be at increased risk”. The footnote on the CDC update page only references the definitely “are at risk” group. So does that mean everyone in the “might be at increased risk” is essentially delegated to the back of the line in Phase 2? Asking on behalf of my friends with severe asthma, my friends with type I diabetes, my friends with autoimmune diseases or MS taking immunosuppressants, and myself, a healthcare worker who has been on medical leave for several months (and thus not getting vaccinated with my colleagues) and will likely be resigning until I can better manage my condition of POTS. POTS is a form of dysautonomia rather than a cardiac condition so I am assuming I might only fall into an “increased risk” category because of my chronic fludrocortisone use rather than the cardiac medication I also take to manage my POTS symptoms. 

Thanks for any light you can shed on this from all of us. 

Cristine and friends

Sara writes:

Hi Dr Griffin,

Is it safe to vaccinate patients with long covid, long haulers, or whatever they are calling us unfortunate souls these days?


Sara in Tallahassee, FL

Suellen writes:

Dear Daniel, my expert on all things COVID — 

I was talking to some friends yesterday, discussing the COVID vaccines that have just come out. One friend says she will not get the vaccine, and does not even get the flu vaccine, because she is immune-compromised. She has some hereditary disorder that caused her to have her spleen removed several years ago. I have at least two other friends I know of who are also missing their spleens. (Well, whether they miss them or not, I can’t really say, but they have had them removed!)

My question is: What is the impact of having no spleen, with regard to both COVID and the vaccine(s)? It sounds like one of those Prisoner’s Dilemma type logic problems to me: If you don’t have a spleen, I would think you are immune-compromised, which should make you more liable to get more severe COVID-19. So that should mean you should definitely get the vaccine. But according to my friend, she can’t even get the flu vaccine because of her immune-compromised status, so she figures the COVID vaccine is not for her, either.

You must have patients who have had their spleens removed, so what is your recommendation with regard to the vaccine? Just curious, and I know you have all the answers!

Suellen in Roswell, Georgia

where it’s about 50 degrees F today

and we have a LOT of COVID