COVID-19 and the Immunocompromised

Malls, schools, colleges, and movie theaters are closed, and most countries around the globe are under lockdown to stop the spread of the new coronavirus (SARS-CoV-2). Doctors and scientists 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 new virus. 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 accelerate the spread of this deadly virus. As young people are usually asymptomatic, there is a higher chance of them spreading the virus unknowingly.

Not most of us are aware that following strict social distancing and respiratory hygiene protects not only you 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 you want to prevent vulnerable people at your home from getting infected, we urge you to stay home as much as possible and avoid crowds.

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 your immune system also. Drugs that can affect the immune system are chemotherapy (cancer treatment), and medicines prescribed after organ transplant 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, the new coronavirus (SARS-CoV-2) enters the body via 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.

Until a vaccine is developed against the new coronavirus, it is up to our immune systems to protect us from this pandemic.

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 genetics to affect how 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 from getting COVID-19 is by avoiding exposure to the virus. This can be achieved by:

1. Washing all surfaces of your 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 your nose or sneezing.

2. Use a hand sanitizer that contains at least or more than 60 % alcohol. Make sure you rub the sanitizer on all surfaces of your hands and then leave them to dry.

3. Be at home as much as possible.

4. Always cough or sneeze into a tissue or your bent elbow. Do not forget to throw the tissue immediately in a closed bin and wash your hands.

5. Clean and disinfect all frequently touched surfaces, such as tables, switches, handles, phones, and sinks.

6. Practice social distancing by maintaining at least 6 feet distance between you and others. Do not go to large gatherings. Try to order groceries and medicines online, and opt for contactless delivery.

7. Always cover your nose and mouth using a cloth face covering if social distancing cannot be maintained. Do not let children younger than 2 years and people who won’t 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 your doctor first.

• Talk to a doctor online if you have any questions or concerns about your chemotherapy.

• If you develop a fever and are not feeling well, consult a doctor immediately.

• Check the white blood cell levels regularly, as low counts make you 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 your 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 your doctor first, as it can result in serious withdrawal symptoms.

Can Immunocompromised Patients Visit a Hospital During This Pandemic?

If you have already been prescribed medicines for your condition, then continue taking them. If you are worried about the effects of COVID-19 on your health, you can call your doctor and talk instead of an in-person visit.

You will be exposed to other patients with infectious diseases, including COVID-19, in a hospital setting. So, make sure you avoid going to the hospital during this pandemic as much as possible. You can also use telemedicine platforms like iCliniq to consult doctors.

Make sure you have enough medicines and always get them in bulk so you won’t run out if you have to stay home for several weeks. This will also reduce frequent pharmacy visits.