Local doctors give advice to high-risk population
Immunocompromised people are wary of the Centers for Disease Control and Prevention’s new mask guidelines, worried that less mask adherence will lead to more COVID-19 cases among vulnerable groups. Some are afraid to be in public again, they expressed in Twitter posts.
Two physicians at Sansum Clinic told the News-Press that patients should be cognizant of their vulnerability but didn’t recommend drastic measures.
The concern follows the publication of John Hopkins Medicine research concluding that immunosuppressed patients are less likely to build a strong immunity to COVID-19 after two doses of vaccine.
The study looked at people with solid organ transplants and compared patients who do and don’t take antimetabolites, a class of drugs that are used to suppress the immune system.
Of participants taking antimetabolites, 57% didn’t have an immune response to dose one or two of a COVID-19 vaccine. And 18% of transplant patients without antimetabolites didn’t form immunity.
Dr. David Fisk, infectious disease expert with Cottage Health and Sansum Clinic, compared the data to the over 90% of Americans developing immunity from vaccines.
He noted that the vaccines approved for use in the United States have the highest rate of responsiveness. The issue may be more prominent in countries using vaccines with lower rates.
He has seen people contract COVID-19 that had already been vaccinated — particularly those with weakened immune systems.
“Conversely, not all groups of people with weakened immune systems have the same risk,” he told the News-Press on Wednesday.
The conversation revolved around the groups studied to have drastic reactions, like those with organ transplants and certain forms of leukemia. But research on immunocompromised patients has only recently started to publish.
Specific antibody tests, often used in critical trials, can be used on patients to determine if they had an immune response. But there is not yet a standard for how strong of a reaction is enough to protect oneself from COVID-19.
Another piece that is yet to be formally studied is changing when patients take their immunosuppressants to form a stronger response to a COVID-19 vaccine.
Dr. Stuart Segal, a rheumatologist at Sansum Clinic, said patients on these medications should consult with their doctors to maximize the vaccine’s effectiveness.
He continues to recommend that patients get vaccinated for COVID-19, despite concerns about side effects and the possibility of reduced immunity in certain patients.
“I am telling my patients to please encourage their friends, neighbors and acquaintances to get vaccinated as soon as possible to help end the pandemic,” he said.
Dr. Fisk had a similar suggestion, saying high-risk individuals can ask their acquaintances to get vaccinated or put on a mask prior to staying in a confined space with them.
He didn’t speak confidently about the CDC’s less strict mask guidelines. He pointed out people who shed the virus even after being vaccinated and vaccinated individuals who have still contracted COVID-19.
“It’s the exceptions, the people out on the edge of that bell curve, that make the pronouncement a little more broad reaching than I think was advisable,” he said.
“Certainly, I can appreciate their sense that when people are vaccinated, they are on average well-protected from this virus, which is great,” he said.
Dr. Segal was less concerned, directing patients to the CDC’s guidance when deciding what precautions to take.
Dr. Anthony Fauci, the president’s chief medical advisor, clarified in an Axios report Wednesday that the CDC’s new guidance was intended to express the importance of a vaccine — not saying to abandon masks.
“I think people are misinterpreting, thinking that this is a removal of a mask mandate for everyone. It’s not,” Dr. Fauci told an Axios reporter. “It’s an assurance to those who are vaccinated that they can feel safe, be they outdoors or indoors.”
One of Dr. Fisk’s concerns is that about half of the U.S. has not been vaccinated. His biggest worry, though, is the potential for more variants.
“My biggest concern, as an infectious disease specialist, would be the arrival of a viral variant that doesn’t respond to the vaccine,” he said.
But thankfully, Santa Barbara County Public Health and UCSB researchers are watching the presence of variants closely, he added at the end of the interview.