Even though it may seem like it, the COVID pandemic is not over. The Omicron variant has more mutations than any of the earlier variants making it more successful at evading our immune system and the protection of vaccines. In spite of this serious challenge, vaccines still offer a degree of protection, especially from hospitalization and death. The newer “bivalent vaccine” actually combines a component derived from the Omicron variant and the original vaccine developed two years ago. However, all individuals do not respond to the vaccine equally.
A clinical study led by Dr. Lannard Lee (University of Oxford, London), found that people with cancer, especially blood cancers affecting the immune system (leukemia, lymphoma), were 36 times less likely to generate protective levels of antibodies from COVID vaccinations than in people without cancer. So Immunocompromised individuals may have a disease like cancer that interferes with the effectiveness of the vaccine.
Alternatively, a person can be on a medication that works by suppressing the immune system or inflammation, which could weaken the response to the vaccine.
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For example, people may be taking a class of drugs called steroids that suppress the immune system to treat a disease like asthma or rheumatoid arthritis.
Many drugs that treat cancers or inflammatory skin conditions use medication that suppress the immune system. Interestingly, patients with HIV infection, an immunocompromised state, appear to be protected by COVID vaccination, particularly if the HIV virus is controlled by medication.
A special medication was developed to prevent COVID-19 disease in people with immunocompromised conditions; a sort of vaccine substitute. This medication called Evusheld consists of a combination of two monoclonal antibodies (tixagevumab and cilgavimab) against coronavirus.
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With a single injection of each medicine, a person would be protected from coronavirus infection for several weeks. While it has been deemed effective for previous variants, unfortunately, Evusheld does not provide protection against developing COVID-19 for individuals who are later exposed to sub-variant XBB.1.5, and possibly other sub-variants of Omicron. So what additional steps can you take to stay healthy?
Take extra precautions
COVID rates are increasing again, especially as people spend more time indoors during the winter months. Large, indoor gatherings should be avoided, or at least, a mask should be worn. Cloth surgical masks do provide some protection but a KN95 or N95 mask provides the best protection.
Masks also protect against other respiratory viruses such as influenza virus (flu vaccines are available) and Respiratory Syncytial Virus (RSV), both viruses are causing increased numbers of infections. Try to maintain 6 feet of distance between yourself and other people who do not live in your home with you. Get tested often. There are a variety of home tests that you can use, or you can visit a local testing clinic and receive instant results.
Talk to your doctor
It is imperative to discuss COVID precautions with your medical provider. Whether they are an oncologist treating cancers or a rheumatologist treating inflammatory conditions like Lupus or arthritis, all medical providers should be well-versed in the guidelines for protection from COVID and the use of vaccines. It is possible that even if the vaccines are less effective because of a disease or medications, being fully vaccinated and boosted could provide some level of protection, even if not optimal.
Get Oral treatments if you test positive
Paxlovid, an oral pill has been available for over a year to treat COVID-19. The treatment is very effective, but it must be started within 5 days of experiencing symptoms. If you have symptoms, take a home test or get tested at a Pharmacy or clinic. If you test positive, ask your medical provider to send a prescription to your pharmacy. Treatment lasts for five days. If you can’t get a prescription, some pharmacies may still be able to provide you the medication if you have a positive test. This treatment is effective against Omicron sub-variants and also for immunocompromised individuals. It may interact with other medications you may be taking so be sure to tell your doctor and pharmacist all medications you are taking, including non-prescription drugs.
The potential for vaccine protection to be lessened in people who are immunocompromised means that other prevention measures must be maximized (e.g. masks, social distancing), and preparations should be in place to initiate COVID treatment if the person becomes infected. Regular home testing is key, especially if COVID symptoms occur (cough, fever, SOB, altered smell or taste, fatigue, sore throat, runny nose, or congestion). If you do not have a medical provider, consult with your county or city health department and see what resources they have available.
