Teresa Evans can't begin to estimate how much money she's spent on cleaning supplies.
For almost a year, she's spent every day trying to keep COVID-19 at bay — scrubbing doorknobs, keys and light switches with Clorox wipes. In the early days of the pandemic when those products were hard to come by, she bought ingredients to make her own sanitizer.
"It's a lot of extra work," Evans said. "At first, I was bleaching everything that came through the door, including our mail. I did it for months. Everything got sanitized."
Since the coronavirus pandemic began nearly a year ago, Evans spent as much time as she could at her home in Spring City, Tennessee, and only left when absolutely necessary.
Every outside contact contains some level of risk as long as the virus is circulating. While not everyone who is infected with COVID-19 gets severely sickened or dies, the disease caused by the virus puts people like Evans in far greater danger.
Evans, 59, was diagnosed with Type 2 diabetes about three years ago. It didn't come as a surprise to her. Her parents, sisters and brothers all had it, too. She worked hard to eat healthier, got her blood sugar well controlled and lost 60 pounds in two years.
When 2020 began, she was enjoying the start of her best year yet as a busy real estate agent in a booming housing market.
Then, Evans' sister who lived in Florida died on March 11, 2020 — the same day the World Health Organization declared the coronavirus outbreak a pandemic. Florida was a major COVID-19 hot spot then. Family members feared it was unsafe to travel. Her sister was cremated, and services were rescheduled several months later.
In the weeks that followed, Evans began to learn more about the effects of COVID-19. People with underlying conditions, particularly diabetes, were dying at much higher rates than others. She couldn't risk traveling and contracting the disease.
Evans stayed home for her sister's funeral.
"To me, one of the worst things regarding COVID is the fact that you can't be with the people you love and need to support, and they can't be with us when we need their support," she said.
Throughout the pandemic, people with underlying conditions had to take extra precautions, making an extra calculation about who they could see and when, what stores they could go into and other safety measures. The increased risk an infection could pose became an additional layer of stress and anxiety in a pandemic that is hurting people physically, emotionally and financially.
Evans now works from home if at all possible, and only she and her husband are allowed inside.
Nearly a year into the pandemic, she still orders all her groceries online using the no-touch pickup service and wears gloves when she pumps gas. She finally ventured out with her husband a few weeks ago.
"Even wearing the mask in the store and sanitizing, I was a nervous wreck. I was not comfortable being in those stores," she said. "Am I paranoid? Maybe."
For nearly a year, area residents like Evans were warned their conditions put them more at risk for severe cases or even death from the coronavirus. They were also told they would get priority for the vaccine when it finally arrived.
In an initial draft of Tennessee's vaccination plan, published Oct. 16, people with high-risk health conditions were the second category in vaccine priority — behind only health care workers and first responders.
Health officials said at the time that the plan was a working document subject to change.
In the months that followed, the state moved individuals with high-risk conditions behind older adults, long-term care facility residents and teachers, among others.
"With a lot of these folks, they're just feeling like they're being forgotten," said Cara Barrett, director of the COVID-19 team at Galen Medical Group. "They're certainly very high on our priority list. It's just things didn't move as fast as we would have loved for them to."
In her role as a physician's assistant, Barrett treats many patients with chronic diseases and said managing those conditions was a major challenge before the coronavirus came along.
"Having chronic conditions is taxing, and then adding into it a pandemic, social isolation and all of those things that really weigh on us emotionally, as well, has been challenging for them," she said.
Starting Monday, people with chronic conditions will be eligible to receive the COVID-19 vaccine in Hamilton County and surrounding counties. The move makes more than 1.1 million Tennessee residents with conditions such as high blood pressure, liver disease, weak immune systems or who are receiving cancer treatment eligible for doses.
The announcement was a cause for celebration for many, even as the effort becomes one of the biggest tests of local vaccine infrastructure, with more people than ever now eligible and fewer guidelines in place to ensure only those who qualify are receiving the vaccine.
'THE ICU IS WORSE'
Channing Muller takes four medications every day. She likely will for the rest of her life.
Until the pandemic hit, though, the 35-year-old did not often think about her heart and the two heart attacks she suffered nearly a decade ago. She ran multiple half marathons on her own last year. She doesn't look like someone with heart disease, she said.
But the past 12 months have been a near-constant reminder that she is at risk, Muller said. Planning a dinner with friends became a complicated calculation, especially after the weather turned cold and outdoor gatherings were not an option.
"There are so many more conversations that have had to happen, hard conversations, asking the awkward, 'Well, who else have you been seeing?'" Muller said.
When the Signal Mountain resident was 26, she had two heart attacks about a month apart. She didn't have lifestyle risk factors or a family history of heart disease, she said. Without being able to say why, doctors determined she had a blockage in her left anterior descending artery, otherwise known as the widow-maker artery because of its high death rate. The medication she was prescribed at first did not help, which led to the second heart attack, Muller said.
When the COVID-19 lockdown started, and even after some restrictions were lifted, Muller did not take any chances. The memory of her time in the intensive care unit still haunts her.
"No matter all the other things here, being in the ICU is worse," she said. "And so I'd rather keep my distance for a little longer because I fully believe this won't be forever."
The change meant putting dating on hold. She got her groceries delivered. Visits to family and friends were scrutinized, skipped and sometimes rescheduled. Getting through the summer was tough, but doable, Muller said. Winter has been more taxing. The loneliness and isolation is hard, Muller said.
"I'm chomping at the bit to get that shot in my arm," Muller said. "If nothing else, it reduces my anxiety and thought process that comes along when friends ask me to go to dinner."
On Friday afternoon, Muller finally got through the website to book a vaccine appointment.
THE HONOR SYSTEM
On Monday, the largest population of Hamilton County residents and workers will be eligible for the vaccine. Tennessee has higher rates of obesity, kidney disease, diabetes and chronic obstructive pulmonary disease or COPD than the general American population, according to an analysis by the Sycamore Institute.
Becky Barnes, administrator for the Hamilton County Health Department, asked residents to be patient as vaccine distribution continues to grow. The county expects larger shipments of vaccines from the state each week and its Enterprise South Nature Park site can expand to accommodate more vehicles.
Though other priority groups, such as people 65 and older or health care workers, will need to prove their vaccine eligibility with documents like a pay stub or work badge, that same standard won't be applied to the newly eligible high-risk group.
"It's the honor system, but we don't want a lot of healthy, young individuals presenting because we aren't asking for medical proof," Barnes said during a Thursday afternoon livestream. "We do want to vaccinate our medically fragile people first, because that is, again, where you see the most deaths occur in our community."
Barnes said she trusted area residents to do the right thing and not jump in line if they are not at risk.
A similar hope brought criticism toward Gov. Bill Lee, who so far has not created a statewide mask mandate and left the decision up to individual counties. Instead, the governor said he trusted Tennesseans will do the right thing or use common sense in taking precautions. Studies have shown areas without mask mandates faced greater numbers of hospitalizations from the virus than those with requirements.
R. Alta Charo, professor of law and bioethics at the University of Wisconsin at Madison, said local health departments have to balance protecting vulnerable groups, decreasing virus transmission and keeping society running when building a vaccine distribution plan.
When vaccinations are happening in certain settings, such as a hospital or a nursing home, it is easier to know whether someone fits the eligibility requirements, Charo said. Once vaccination campaigns become more public, it is more difficult to scrutinize for eligibility and doing so becomes a trade-off.
"When you're out in the community, and it's a community center or it's a pharmacy, they're having to deal with people who simply present themselves and say, 'Hi, I'm eligible, according to the state rules,'" Charo said. "Now, how much capacity do they have to actually interview people? To demand documentation? And how much time do you want to take for that if you've actually got a line of people, and you're trying to vaccinate as quickly as possible?"
AWAY FROM FAMILY
Cassi Yost was wearing a mask months before it became a political fight. Nearly three years ago, the 60-year-old was diagnosed with myelofibrosis, a rare cancer that affects the body's ability to produce red blood cells.
Yost, who lives in Cleveland, spent four months living in Nashville in 2019 to recover from a bone marrow transplant. She came home around Thanksgiving in 2019 but had to be careful about who she saw, since her body was still adapting to the transplant.
Wearing a mask was one of the precautions Yost had to follow for around six months after the procedure. She takes two steroids that suppress her immune system to help with the transplant. She celebrated Christmas 2019 with her family and was excited to end her isolation in a few weeks, she said.
"I was just getting to that six-month mark in February of last year when COVID started," Yost said. "And since then, it's just been the same situation. I have my groceries delivered, and I have my mask up. I go outside, but I always wear a mask."
Yost stays physically active, going on hikes or bicycle rides, she said. But she has not been able to spend time with her four sons since the pandemic began.
"I don't really see people," she said. "I haven't seen most of my family, basically, for over a year. It's just me and my husband and my cat."
She said she is "antsy" to get the vaccine but has not been able to get an appointment.
Similar to Yost, Evans has been eager to get a vaccine since it was rolled out. Her only interaction with friends is an occasional, socially-distanced bonfire in her backyard by the lake.
She lost friends and loved ones to COVID-19 or other factors. The grief mixed with the loss of her sister and missing her family.
Her son, a member of the U.S. Navy who's stationed in France, contracted COVID-19 in April and continues to grapple with lingering symptoms. It's been almost two years since Evans last saw him and her grandchildren. She was supposed to visit in July, but the trip had to be canceled, and she gets emotional thinking about it.
"It was just an awful year," she said. "But my husband and I try to keep positive and think we've made it this far — we've made it a year, and amazingly so. I was exposed twice."
GETTING THE CALL
Evans was in a virtual work meeting Thursday when her neighbor began calling her on repeat. A vaccine event was happening at a local doctor's office that day, and the neighbor told Evans to go.
Tennessee announced the expanded eligibility two days earlier. Evans was already on several backup lists to be called if providers had leftover vaccines that would otherwise be wasted, but she didn't expect to get a vaccine so soon. Most appointments didn't open up until next week, and so many people would by vying for a slot.
"When I was driving there, I thought, 'You know what, they're gonna turn me down.' And I thought, 'Well, I'm just going anyway and see if I can get on the list," she recalls, and then pulled up to the doctor's office.
"I said to the girl, 'I'm not 65, but I am diabetic," Evans said. "She said, 'That's all I need to hear.'"
Within 5 minutes, Evans received her first dose of the Moderna vaccine.
"The weight of the world was lifted off my shoulders when that needle went in my arm," she said. "I am so blessed to have gotten this vaccine."
She's most looking forward to the day she can see her son and grandchildren again.
"That's the foremost thought in my mind," Evans said.
She's a month away from being fully vaccinated and remains cautiously optimistic. She plans to keep staying home until after her second shot and continue practicing precautions long after she's gained immunity thanks to her vaccine.
"I hope we've seen the worst of it," she said. "I know our numbers are going down, and people are getting vaccines. But we've got new strains coming around more, more dangerous strains of the virus. And I just hope that we're all protected with these vaccines."
Contact Elizabeth Fite at firstname.lastname@example.org or follow her on Twitter @ecfite. Contact Wyatt Massey at email@example.com or 423-757-6249. Follow him on Twitter @news4mass.