The high-risk groups who need COVID-19 vaccines the most 

Nearly 225 million Americans are now fully vaccinated against COVID-19. That’s according to the Centers for Disease Control and Prevention (CDC). It’s an impressive number. But there are millions more who are still unvaccinated. And this is a dangerous group to be in – especially if you’re older or have an underlying medical condition that raises the risk for severe COVID-19.  

Why? Your immune system – which keeps your body healthy by fighting germs – isn’t as robust. 

“For most people, the risks of getting the vaccine are very small compared to the risks of COVID,” says Cathleen Morrow, MD. She’s a family physician at Dartmouth Hitchcock Clinics Heater Road in Lebanon, New Hampshire. “And for patients with a condition like hypertension, diabetes, or lung disease, the risk-benefit ratio is even more clear. It just doesn’t make any sense not to get the shot.” 

Here’s a look at who’s in these groups and why staying up to date with your vaccines and booster shots is so important. 

If you have lung disease

COVID-19 commonly affects the respiratory system. And it can have devastating effects if you already have a lung problem such as chronic obstructive pulmonary disorder (COPD). That’s an umbrella term that includes emphysema and chronic bronchitis. 

“People with COPD already have impaired breathing, so getting the coronavirus would make that worse,” says Manish Trivedi, MD. He’s the director of infectious diseases at AtlantiCare, a health system in New Jersey. 

How much worse? A study in eClinicalMedicine found that people with this condition who contracted COVID-19 were at significantly higher risk for hospitalization, an ICU stay, and death.  

That may be because those with COPD have poorer immune responses. They also take longer to clear respiratory viruses.  

One important note: This increased risk doesn’t appear to apply to people with asthma. There’s no conclusive evidence that they’ll have a worse COVID-19 illness than someone without asthma, according to the American Academy of Allergy, Asthma and Immunology. 

How to stay safe beyond the shot: Take all your medications to keep your condition under control. A bonus: Evidence suggests that steroid inhalers could offer some protection against COVID-19.  

If you have diabetes 

People with Type 1 or Type 2 diabetes are more likely to develop severe symptoms and complications from any virus, including COVID-19. A likely reason: Diabetes impacts your immune system. 

How? “When people have chronically high sugars, their white blood cells – which attack invading germs – don’t work as well as they do in people without diabetes,” says Dr. Morrow. 

People with diabetes who get COVID-19 may also have a higher risk for developing long COVID, according to a study in Hormone and Metabolic Research. In people with diabetes, the virus can also make rapid heartbeat worse and cause dysfunction of small blood vessels. 

How to stay safe beyond the shot: Check your blood sugar often and keep in close touch with your provider. They can increase your insulin as needed, Dr. Morrow says. You should also eat balanced meals, get enough sleep, and find ways to reduce stress. And if you’re not physically active, talk to your provider about a fitness plan.  

If you have heart disease and high blood pressure

Having heart disease increases the risk of complications from COVID-19. That might be because people with heart trouble often have impaired immune systems, Dr. Trivedi explains.  

Another factor: “The coronavirus can lead to a buildup of fluid in the lungs. That puts greater strain on the heart,” he says. 

Even if your only heart-related risk factor is high blood pressure, COVID-19 is still a threat. High blood pressure makes your heart work harder and damages your arteries. Over time, that can lead to long-term inflammation.  

The inflammation raises your chances of having severe COVID-19. Your immune system may overreact to the virus. This may kick off a dangerous response that can lead to tissue damage. 

How to stay safe beyond the shot: Make sure your blood pressure is in check. Be sure to ask about telehealth appointments too.  

Lifestyle changes can also help lower your blood pressure and reduce chronic inflammation. These include maintaining a healthy weight, eating heart-healthy foods, and getting regular exercise. Deep breathing and yoga can also help. 

If you’re 65 or older 

Since 2020, 75% of COVID-19-related deaths have occurred in people 65 and older, according to the CDC. Aging isn’t a medical condition, of course, but age is the strongest risk factor for severe COVID-19. 

That’s partly because older people are more likely to have chronic medical conditions. Plus, the immune system gets weaker with age. So your defenses are lower against viruses like COVID-19. 

How to stay safe beyond the shot: If you catch COVID-19, check in with your doctor as soon as possible. They may recommend that you take an antiviral medication such as Paxlovid. 

If you’re obese

Carrying extra pounds increases inflammation. This forces the immune system to work harder to fight the virus. 

That may be why a study in Circulation found that obese people with COVID-19 were more likely to have bad outcomes. Compared with people who aren’t obese, they were more likely to be hospitalized or die. Extra weight also puts extra pressure on the lungs.  

How to stay safe beyond the shot: Focus on eating a healthy diet with plenty of fruits and vegetables. If you aren’t exercising regularly, ask your provider for a plan. Moving more can also help your immune system, per the CDC. Also visit your doctor for regular checkups to stay on top of any health conditions. 

If you're pregnant

Pregnant women are at higher risk for getting a severe case of COVID-19 and ending up in the ICU. That might be because pregnancy causes changes to the cardiovascular, respiratory, and immune systems. And they all play a role in how your body responds to an infection.  

COVID-19 can be dangerous to the developing fetus as well, says the CDC. For example, catching the virus during pregnancy increases the risk of delivering a preterm (earlier than 37 weeks) or stillborn infant. 

For these reasons, the American College of Obstetricians and Gynecologists (ACOG) strongly urges anyone who is pregnant or may become pregnant to get vaccinated. 

How to stay safe beyond the shot: ACOG also recommends following current masking guidelines from the CDC and talking to your doctor about COVID-19 concerns. 

If your immune system is compromised

In addition to the conditions listed above, there are many others that involve a compromised immune system, including: 

• Cancer 
• Lupus
• Multiple sclerosis
• Genetic disorders
• Kidney disease
• Crohn’s disease
• HIV 

In some cases, both the condition and the treatment may suppress immune function. For example, chemotherapy and radiation temporarily lower immune function so that those cancer treatments can work. But that could leave patients more susceptible to COVID-19 and other viruses. 

Any bad infection can be life-threatening to someone who is immunocompromised. 

How to stay safe beyond the shot: Wear a mask in public indoor spaces when the infection level is high in your community, says the CDC. And ask your doctor whether you should also mask up at other times. If you do spike a fever or a respiratory illness, call your doctor right away. 

The information in this story is accurate as of press time and posting. Staying up to date with your COVID-19 vaccines is one of the best ways to limit the spread of the coronavirus. This includes getting booster shots such as the new bivalent booster when applicable. It’s also important to wear a mask indoors in public when the infection level is high in your area. According to the CDC’s latest guidance, respirator masks (like an N95 mask) provide the most protection. If you are at high risk of getting sick, keep your distance from others and avoid crowded places. Because the situation surrounding COVID-19 continues to evolve, we encourage readers to follow the news and recommendations for their own communities by using the resources from the CDC, WHO, their local public health department, and our COVID-19 member site.