What the New CDC Mask Rules Mean for Immunocompromised People and What They Mean for Everyone Else

When I wrote about what it means to be weakened in early March this year, I was eager to get vaccinated. People have weakened immune systems for a variety of reasons – genetics, age, metabolic diseases such as diabetes, and immunosuppressive drugs taken for conditions such as autoimmune diseases, organ transplants, and cancer – but what we all have in common is weaker the immune system, which makes us more vulnerable to infections like COVID-19. The vaccine can be a lifesaver for us.

I was in high spirits when I received my second dose of Pfizer on April 12, hoping I could end my year or more of almost complete isolation. Before the week was over, however, there were several reports showing that immunocompromised people did not develop antibodies after being vaccinated . Hope suddenly turned into fear.

Less than a month later, on May 13, the CDC issued new masking and distance guidelines . Fully vaccinated people with healthy immune systems (also known as immunocompetent) can now safely resume pre-pandemic behavior indoors and outdoors. On the contrary, the CDC advises immunocompromised people to continue camouflaging and social distancing, even if vaccinated, because we may not have enough immunity to protect us from a severe case of COVID-19. These conflicting recommendations apply to everyone, not just immunocompromised people.

For example, if you have a healthy immune system and accept the new CDC guidelines, you could potentially expose immunocompromised family, friends, colleagues, and clients to COVID-19, even if everyone is vaccinated. Moreover, the best estimate for the number of immunocompromised Americans – roughly 8.5 million – is an underestimate. Thus, you can put someone in your circle at risk who does not realize that they have a weakened immune system. That someone could even be you.

The good news is that science is becoming clearer about which specific immunosuppressive conditions and drugs are most likely to reduce immunity to vaccines, even if the main question is how much immunity is enough to protect someone from severe COVID-19. – remains unknown.

Here’s what science currently says about vaccines and immunocompromised people, and how you can use this knowledge to protect yourself and your immunocompromised friends and family in light of the new CDC guidelines.

There is no test to tell you for sure if your vaccine worked.

Vaccines work by stimulating the immune system to respond to a weakened or benign version of the virus. This response produces antibodies and rallies the virus-killing cells to eliminate the infection before it can cause irreparable damage. Both common sense and science tell us that the stronger your immune system, the more effective a vaccine will give you immunity. Immunity to vaccines is usually measured by testing blood for antibodies, and a recent study concluded that antibody levels are a good indicator of immunity to the COVID-19 vaccine.

However, scientists have consistently urged people not to have COVID-19 antibody tests to test immunity to vaccines for three main reasons. First, the most common antibody test does not look for specific antibodies stimulated by vaccines, but rather a protein produced only by actual COVID-19 infection.

Second, antibodies are not the only marker of immunity to COVID-19. Healthy people extract from COVID-19 infections that do not produce antibodies , as immune cells known as T cells have taken up the slack. One review study , in fact, suggests that a sustained T-cell response not only compensates for a lack of antibodies, but may also be the most important factor in the fight against COVID-19 infection. Unfortunately, many of us with weakened immune systems have fewer or fewer functional T cells, so this news is not entirely encouraging.

Finally, the million dollar question of “how much immunity is enough,” that is, how many antibodies or T cells that destroy COVID-19 you need in your system to defend itself, depends on many variables in our incredibly individualized and complex immune system. that the actual answer remains elusive.

However, on closer inspection, studies of vaccine immunity in immunocompromised individuals are not hopeless.

What do we know about certain diseases

“I strongly believe that many people are unnecessarily worried [about media reports],” Dr. Mina Bjutra, assistant professor of gastroenterology and epidemiology and an IBD specialist at the University of Pennsylvania, told me. As more research emerges, we learn that fears that most immunocompromised people will generally struggle to make antibodies are not justified. Here’s a little of what we know so far:

Inflammatory bowel disease

Dr.Byutra herself is one of the principal investigators of a study that found antibodies to vaccines in 96 percent of nearly 500 Americans with inflammatory bowel disease (IBD), most of whom take some form of immunosuppressive drug. “What we’ve seen here [for IBD patients] is very encouraging,” she said.

Transplant recipients

To date, research has identified several immunocompromised groups that are less likely to develop antibodies after vaccination. One of them is post-transplant patients, especially those taking a drug called mycophenolate (brand name: Cellcept). One study found that only seven percent of kidney recipients have spike protein-specific antibodies created with the Pfizer and Moderna mRNA vaccines that mRNA vaccines are designed to produce, while another study found a more encouraging – but hardly joyful – 54 percent. … Heart and lung transplant recipients showed a similarly low percentage: only 14 percent of heart recipients and 18 to 25 percent of lung recipients had antibodies. People with blood cancers (leukemia and lymphoma) are also less immune, although the percentage of people with antibodies varies considerably – from 39.5 percent to 83 percent – depending on the type of cancer, treatment status, age, and other factors.

Rheumatic disorders

Two studies in the UK found fewer vaccine antibodies in people with rheumatic and musculoskeletal disorders taking rituximab (brand name: Rituxan) and patients with IBD taking infliximab (brand name: Remicade). However, in these UK studies, antibodies were only measured after one of two doses of the vaccine, because the vaccination program decided to delay the second doses in order to vaccinate more of the population. It is encouraging that the people in the Remicade study who received the second dose had antibody levels similar to those in the general population.

Other

However, these studies cover only a subset of immunosuppressive conditions and treatments and therefore provide definitive data for only a subset of immunosuppressed people. Both Pfizer and the National Institutes of Health (NIH) are conducting broader research on immunity to vaccines and immunocompromised people, but the results will likely not be available until next year. This is why the CDC’s advice – that you might need to continue masking because you may not have immunity – is so frustrating and unhelpful.

As Professor Candida Moss, who recently wrote about the difficulties of navigating the new guidelines as a kidney transplant recipient, told me, “There is simply not enough information, even among transplant surgeons, even more so when you read the CDC infographic, which is clearly not true.” does not apply to you. “

What immunocompromised people can do to protect themselves

The most important thing we immunosuppressed people can do to protect ourselves from COVID-19 is to be healthy, which means continuing to take immunosuppressants. (You thought I’d say get vaccinated, right?)

Don’t get me wrong, vaccinations are the second most important thing we can do. However, both Dr Buetra and Professor Moss have mentioned anecdotal evidence of people considering stopping their immune system medications prior to COVID-19 vaccination – which I briefly reviewed.

In short, the answer is no; Not only does active illness burden our already weakened immune system, but we can also be exposed to COVID-19 if we are admitted to hospital or if we take much more aggressive immunosuppressive drugs than we currently take. (However, the American College of Rheumatology has guidelines for skipping or delaying certain medications if you are relatively healthy.)

Regardless of your medical condition and vaccinations, you should see a doctor, especially any specialist who is treating your specific condition or prescribing immunosuppressants for you. (If you are unsure if a drug you are taking is immunosuppressive, see this list .)

Admittedly, this advice is often easier said than done. Until the earliest meeting with my specialist, I could get in a month later. Moreover, many immunocompromised people lack access to specialists or even primary care physicians due to systemic problems that disproportionately affect people with disabilities, minorities, the poor and rural America.

However, if you have an Internet connection, many non-profit organizations regularly update vaccine immunity information and guidelines for specific conditions. On sites like the Leukemia and Lymphoma Society , Crohn’s and Colitis Foundation of America , Creaky Joints (for arthritis patients) or the American Transplant Society , you can find links to the latest research, detailed answers to frequently asked questions, and even opportunities to join ongoing research. to help you take this elusive vaccine-specific antibody test for free.

What can everyone else do to protect immunocompromised people?

The best thing healthy people can do to support an immunocompromised population is to get vaccinated. Period.

However, continuing to wear the mask and practice social distancing in most areas is almost as important, whether you are vaccinated or not.

“I don’t think everyone should continue to disguise everywhere and forever,” said Moss, who works from home in New York, “[but] it would be nice if basic services like grocery stores, public transportation, doctors’ offices , pharmacies … places to go – could have been disguised. “

Disguises in public areas such as hotel and apartment lobbies also protect personnel who cannot leave their posts. “You don’t know what health problems the people working in these places have,” Moss said. While science suggests that fully vaccinated people transmit less virus when exposed to COVID-19 than unvaccinated people, being careful is the surest way to prevent immunocompromised people from being hospitalized in your life, suffering long-term consequences, or even death.

Finally, a little more intention in scheduling informal and formal meetings can make a huge difference. Determine if the activity will require masks, distancing, or vaccinations so people can make the right decisions for their personal safety. If possible, go outside or crossbreed. “While I don’t think everyone has a responsibility to create accessible spaces for immunocompromised people in every case,” Moss said, “I think they have a responsibility to communicate.”

The biggest challenge is getting the message across to the people who need it.

In the process of writing this article, I went from despair, believing that I probably had almost no immunity to vaccines, to overwhelming relief that the odds were actually in my favor. During my conversation with Dr. Butera, I instilled hope in my personal health, and my conversation with Professor Moss reminded me that my behavior affects not only my immediate environment. When I re-enter society, I want to do it with compassion, knowing that not everyone can move safely in this brave new world.

Therefore, I will disguise myself indoors in important places, around key workers and children. (I’ll probably camouflage in the open air, too, but this is my concern, not science.) I will not make assumptions about why those around me are wearing or not wearing masks, although I withdraw from space if I need to feel protected …

First of all, I will be more frank about this invisible disorder of immunosuppression. If the pandemic has taught us anything, it is how interconnected we are. What is not so successful in spreading is information to the people who need it. This article cannot fill those gaps, even if it goes viral (pun intended). However, like the COVID-19 vaccine itself, the information it contains can save you.