COVID-19 and the Immunocompromised

Creator: Dr. Sneha Mariam Varghese
Published: 2020-07-29T08:00:40-04:00

Written by

and medically reviewed by Dr. Sneha Mariam Varghese

Published on Jul 29, 2020 and last reviewed on Feb 03, 2023 - 6 min read

Abstract

Everyone can get infected by the new coronavirus. But, people with a weak immune system tend to develop severe complications if they get infected. Read the article to know more.

Contents

What Does Being Immunocompromised Mean?

Why Is Immunity Important During This Coronavirus Pandemic?

Who Are Considered Immunocompromised?

How Can Immunocompromised Individuals Protect Themselves From COVID-19?

Can Immunocompromised Patients Visit a Hospital During This Pandemic?

How Can Immunocompromised Individuals Protect Themselves From COVID-19?

Introduction

At the beginning of this pandemic, malls, schools, colleges, and movie theaters were closed, and most countries around the globe were under lockdown to stop the spread of the coronavirus (SARS-CoV-2). Doctors and scientists still urge us to maintain social distancing and stay at home as much as possible in light of the COVID-19 pandemic. These actions are critical and help control the spread of the coronavirus and its more infectious variants.

Early data on patients affected by COVID-19 showed that older adults (people above 65 years), individuals with pre-existing health disorders, and immunocompromised people are more prone to life-threatening complications if infected, while young adults and children showed no to mild symptoms. This data made younger adults violate social distancing norms and accelerated the spread of this deadly virus. Though young people are usually asymptomatic, newer variants like the Delta are known to cause severe COVID, even in young people and children.

Not most of the people are aware that following strict social distancing and respiratory hygiene protects not only them but also other people who are at risk of getting very sick from COVID-19. In vulnerable people, the new coronavirus can lead to severe complications, such as pneumonia, ARDS (acute respiratory distress syndrome), and death. If a person want to prevent vulnerable people at home from getting infected, it is highly recommended to stay home as much as possible, avoid crowds, and get vaccinated.

What Does Being Immunocompromised Mean?

The immune system of an immunocompromised individual, the complex network in the body that fights off pathogens (viruses, bacteria, etc.) that enters the body, does not function properly. The body’s capacity to fight off and recover from infections, including COVID-19, is diminished. Certain chronic medical conditions or medications can affect the immune system also. Drugs that can affect the immune system are drugs used in chemotherapy (cancer treatment) and medicines prescribed after organ transplants and for certain autoimmune conditions.

Why Is Immunity Important During This Coronavirus Pandemic?

As mentioned before, the immune system is the most crucial defense against viruses and various other disease-causing pathogens. When pathogens enter our body, the immune system is programmed to identify them and fight them off. Symptoms such as fever, sneezing, cough, and runny nose are due to the immune system trying to wash out the germs. The immune system is the one that triggers these in response to the invasion.

In people with a strong immune system, the body is able to prevent the virus from spreading further and fights off the virus effectively. But sometimes, the immune system fails. When the immune system fails, the pathogen is successful at invading our body and causing infection.

Similarly, coronavirus (SARS-CoV-2) enters the body via the nose and mouth and gradually moves to the lower respiratory tract. The virus then disables the body’s defense and spreads to adjacent cells. This shows that if the person’s immune system is strong, this deadly virus will not be able to harm the person easily. This is also the reason why most of the deaths due to COVID-19 are reported in old patients or patients with some chronic illness.

Who Are Considered Immunocompromised?

The following people are considered to be at a higher risk of getting infected with the virus due to a compromised immune system:

1) Older Adults - As a person gets older, immunity reduces, and the organs do not function as they once used to. Most older adults have one or more comorbidities too. This makes people 65 years of age or older more vulnerable to severe COVID-19 illness.

2) People With an Underlying Medical Disorder - Individuals with the following health conditions are at an increased risk-

Lung disease, such as COPD (chronic obstructive pulmonary disease).
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Chronic kidney disease.
Type 2 diabetes.
Heart conditions like coronary artery disease, heart failure, etc.
Obesity (people with BMI [body mass index] higher or equal to 30).
Sickle cell anemia.
Hypertension (high blood pressure).
Cancer.
Pregnancy.
HIV (human immunodeficiency virus).

3) People Taking Certain Medications - The following medications affect the immune system.

Chemotherapy - Drugs to treat cancer.
Immunosuppressants - These drugs are commonly prescribed for patients who recently underwent an organ transplant. Suppressing the immune system prevents the body from rejecting the replaced organ. It is also prescribed for some autoimmune conditions (multiple sclerosis, type 1 diabetes, rheumatoid arthritis, lupus, etc.) to suppress the immune system from attacking healthy cells of the body. Some examples include Sirolimus, Cyclosporine, Rituximab, and Tacrolimus.

4) Genetics - Scientists have found certain evidence that shows how genetics affect the way our immune system responds. Some people are born with immune system deficiencies, for example, selective IgA deficiency, chronic granulomatous disease, and severe combined immunodeficiency.

How Can Immunocompromised Individuals Protect Themselves From COVID-19?

The best way for immunocompromised individuals and others to get COVID-19 is by avoiding exposure to the virus and by getting vaccinated. Whichever vaccine is available an indidiudal can get that vaccinated. It greatly reduces the severity of the disease. It reduces disease morbidity and mortality. In addition to vaccination, a person need to protect themselves from coronavirus exposure by following the following measures.

Wash all surfaces of the hands frequently with warm water and soap for at least 20 seconds. Do it, especially after coming back home, when they are visibly soiled, and after coughing or blowing the nose or sneezing.
Use a hand sanitizer that contains at least or more than 60 % alcohol. Make sure a person should rub the sanitizer on all surfaces of their hands and then leave them to dry.
Be at home as much as possible.
Always cough or sneeze into a tissue or bend the elbow. Do not forget to throw the tissue immediately in a closed bin and wash the hands.
Clean and disinfect all frequently touched surfaces, such as tables, switches, handles, phones, and sinks.
Practice social distancing by maintaining at least 6 feet distance between people. Do not go to large gatherings. Try to order groceries and medicines online, and opt for contactless delivery.
Always cover the nose and mouth using a face mask if social distancing cannot be maintained. Do not let children younger than 2 years and people who will not be able to remove the mask themselves wear a mask.

Special Advice:

For Cancer Patients -

Even if chemotherapy weakens the immune system, it is extremely important to treat cancer. Both cancer patients and survivors should not stop taking these drugs as prescribed.
Never stop chemotherapy before talking to the doctor first.
Talk to a doctor online if a person has any questions or concerns about the chemotherapy.
If an individual develop a fever and are not feeling well, consult a doctor immediately.
Check the white blood cell levels regularly, as low counts make a person extremely prone to infections.

For Organ Transplant Patients -

Patients who had a recent bone marrow transplant, organ transplant, or stem cell therapy for cancer will be prescribed immunosuppressants. Remember not to stop or alter the dosage of these medicines. Stopping or dosage alteration can result in serious health problems and even organ rejection.

For Congenital Immune Deficiencies Patients -

People born with immune deficiencies have to take medicines to boost their immune system. Take these medicines regularly, and do not skip them.

For HIV Patients -

HIV patients with a low CD4 cell count or patients who are not on antiretroviral therapy might be at risk of developing severe COVID-19 illness. So consult the doctor and take antiviral drugs for HIV.

For Patients With Autoimmune Conditions -

Autoimmune conditions are usually treated with steroids. Oral or intravenous steroids lower the immune system’s response. Do not stop taking corticosteroid medicines without consulting the doctor first, as it can result in serious withdrawal symptoms.

Can Immunocompromised Patients Visit a Hospital During This Pandemic?

If a person has already been prescribed medicines for the condition, then continue taking them. If an individual is worried about the effects of COVID-19 on their health, person can call the doctor and talk instead of having an in-person visit.

A person will be exposed to other patients with infectious diseases, including COVID-19, in a hospital setting. So, make sure to avoid going to the hospital during this pandemic as much as possible.

Make sure a person has enough medicines and always get them in bulk so they would not run out if they have to stay home for several weeks. Home delivery options from pharmacies can also be used to avoid frequent pharmacy visits.

Conclusion :

Immunocomperomised people are more likely to get infected by a coronavirus. It is highly recommended to be safe, away from the gathering, and work on immunity. A person may have some immunity booster supplements. If a person experiences any symptoms, they may consult a doctor through telemedicine platforms like iCliniq.

Frequently Asked Questions

1. What Should Be Avoided By Immunocompromised Patients?

Immunocompromised patients should avoid unpasteurized drinks and beverages, such as raw milk, yogurt, and fruit juice. They should also avoid raw meat, fish, and undercooked or uncooked eggs. In addition, they should also stop eating homemade mayonnaise and raw cookie dough containing raw eggs.

2. How Long Do Immunocompromised Patients Remain Contagious?

Immunocompromised patients with severe illness may remain contagious for more than ten days. As a result, these people may require hospital admission, ventilation support, and intensive care for complete isolation and recovery.

3. How Do People Identify That They Are Immunocompromised?

Immunocompromised people have weak immune systems and tend to fall sick and catch infections more often. These include older adults (65 years and above) and people suffering from various medical conditions, such as chronic kidney disease, type 2 diabetes, sickle cell anemia, human immunodeficiency virus (HIV), cancer, and heart conditions. In addition, people taking certain drugs in chemotherapy may also have weak immunity and thus are immunocompromised.

4. Do Immunocompromised People Get Sick Faster?

Immunocompromised people have weaker immune systems; therefore, they get sick more often and frequently than healthy people. As a result, these people are more at risk of catching infections and illnesses and usually experience prolonged sickness.

5. How Can Immunocompromised Boost Their Immune System?

An immunocompromised person can boost their immunity in the following ways:
- They should eat healthy food and consume plenty of fruits, vegetables, legumes, healthy fats, and lean protein.
- These people should stay active with regular exercises and reduce anxiety to feel better.
- Limiting alcohol intake and avoiding smoking.
- They should try to maintain a healthy weight.
- An immunocompromised person should take enough rest and sleep properly.

6. What Type of Infections Can Occur In Immunosuppressed Patients?

Immunosuppressed patients usually are susceptible to all types of infections, including bacterial, parasitic, viral, and fungal. These patients are also at a high risk of developing complications from various common infections.

7. How Quickly Do Omicron Variant Symptoms Appear?

According to the CDC (Centers for Disease Control and Prevention), a person infected with the omicron variant develops symptoms one or two days after exposure. However, the person becomes contagious to this variant two to three days before developing the symptoms.

8. When Do COVID-19 Symptoms Get Worse?

The type and severity of COVID-19 symptoms vary from person to person. The symptoms may be mild initially but can aggravate with worsening shortness of breath and cough. A person with severe symptoms may develop pneumonia due to chronic lung infection caused by COVID-19.

9. How Long Does a Person Remain Contagious After Catching COVID-19 Omicron Variant?

A person usually remains contagious for two or three days before the symptoms appear and can remain infected for two to three days once contracting the virus. An asymptomatic patient can also be contagious and spread the infection to other people.

10. How Long Before a Person Tests Positive for COVID?

It would be preferable to wait at least three days to see if a person has turned positive. The CDC advises delaying testing for at least five complete days if the person has been exposed to someone who has Covid but is asymptomatic.

11. Does Fever Appear in Immunocompromised Patients?

Fever is a common symptom in an immunocompromised patient caused due to various infections. However, the actual cause of fever is difficult to diagnose due to broad differential diagnosis and the presence of unexpected and rare pathogens.

12. Are Antibiotics Effective on Immunocompromised Patients?

Antibiotics can be given as a first-line treatment to immunocompromised patients to treat bacterial infections and reduce their severity and frequency. However, the frequent use of these antibiotics can further weaken the immune system of a person. Therefore, antibiotics should be prescribed for immunocompromised patients only when necessary.

13. How Does Immunocompromised Condition Affect Healing?

The immunocompromised conditions can cause an increased risk of hypothermia in a patient. This can further impact the postoperative wound healing process, thus increasing the risk of developing wound infection in a person.

14. Which Is the Strongest Immunosuppressant?

Cyclophosphamide is considered the most potent and strongest immunosuppressant. The compound is effective against various conditions, such as autoimmune hemolytic anemias, erythematosus, and other immune disorders.