Physicians point to a pandemic privilege many choose to ignore

Immunocompromised Americans have had little voice in the country's pandemic response, and many physicians are only growing more vocal on their behalf.  

For every time adults with healthy immune systems declare they are "over COVID-19," physicians who are immunocompromised themselves or treating immunocompromised patients suggest a privilege check: Your health. 

"The new privilege right now is being healthy," Vineet Arora, MD, academic hospitalist and dean for medical education at University of Chicago Medicine, told Becker's

Pandemic exhaustion is practically its own news beat as society continues to curb, bend and forgo certain behaviors, conveniences and joys to mitigate the spread of COVID-19. But louder and louder cries for a return to "normal" leave many voices behind.

"What we don't see a lot of in the media is people speaking who are disabled, have chronic conditions, are immunosuppressed. The people we are leaving behind because they can't access care or don't trust care," Dr. Arora said. "One of the challenges right now is that people's capacity to give and be generous has waned. Can you at least wear a mask? Can you not gather? Can you help someone get vaccinated? 'Let's learn to live with the virus' should mean 'let's use the tools we have so we can live with the virus.'"

Officials see an exit to COVID-19's "full-blown pandemic phase," with many states now dropping indoor mask mandates and other mitigation measures. The millions of Americans with suppressed immune systems, however, won't get to fully revel in the more relaxed pandemic phase society is anticipating. 

"Instead of mustering equanimity and compassion, I often feel that the pandemic has tossed me into three-legged races with strangers, headed toward a finish line of normalcy I can only reach if they get there too — and that a lot of them decide after a few strides that they’d rather go to a bar," Lindsay Ryan, MD, an emergency medicine physician at San Francisco General Hospital and San Francisco VA Medical Center who has an autoimmune condition, wrote for JAMA in summer 2021. 

About 3 percent of the U.S. population (7 million people) is considered moderately-to-severely immunocompromised. (This figure stands ready for an update, since it is based on the 2013 National Health Interview Survey and likely an undercount, given that the study excluded children and people living in institutional settings.)

Moderate to severe compromisation places adults at greater risk for serious illness if they contract COVID-19, even post-vaccination, because their immune systems don't mount a strong response to the vaccines. 

Research has shown after two doses of mRNA vaccine (Pfizer or Moderna) some transplant recipients still had an 82-fold higher risk of infection and 485-fold higher risk of hospitalization or death compared to the vaccinated general population. 

"Imagine walking around and being in society and thinking, 'If you give me COVID, I might have a 10 percent risk of dying,'" Dorry Segev, MD, PhD, a physician scientist who treats transplant recipients at Baltimore-based Johns Hopkins University School of Medicine and worked on the aforementioned study, told Ed Young for The Atlantic

This lingering risk is why the CDC recommends this population receive a third dose as part of their primary vaccination series, and a fourth dose as a booster shot. Even then, "full protection" might not be comparable to that of the immune system response a healthy person generates.  Speaking of his transplant patients, Dr. Segev told the Atlantic they're better off than unvaccinated people, "but not by much, despite all we've done."

So as most of society eagerly awaits the point when they can ditch their masks and return to at least some level of pre-pandemic normalcy, many immunocompromised people must hunker down even more as layers of protection are peeled back. 

"There is this idea that people who are vulnerable are these sickly, other people, but they are all around us," N. Seth Trueger, MD, associate professor of emergency medicine with Northwestern Medicine in Chicago, told Becker's. Dr. Trueger has a compromised immune system, due to the immunosuppressants he takes for a cancer complication, he told The Atlantic. The idea that vulnerable people can be protected while the rest of society goes on with business as usual is simply amiss, Dr. Trueger said. 

"How's that supposed to work?" he told the Atlantic. "How am I supposed to provide for my family or live my life if there's a pandemic raging?" It's worth noting that as an emergency physician, he, along with many other immunocompromised people cannot work from home or avoid public settings.

In a guest essay for The New York Times, two physician scientists who treat transplant recipients at Johns Hopkins University School of Medicine said the public has a collective responsibility to protect vulnerable populations. "High-risk people should not be made to feel that they are on their own to protect themselves," wrote Dr. Segev, and Willian Werbel, MD. "People who are going to interact with immunocompromised individuals should take additional precautions, like using masks and getting tested beforehand to avoid infecting them."

Protecting high-risk populations was once the center of the COVID-19 discourse. With the spotlight now on rolling back mask rules and falling cases, physicians are seemingly the only spokespeople left to remind society of the lingering risks the nation's immunocompromised population faces, and their voices are not softening. 

 

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