The virus that causes COVID-19 impacts everyone differently. Most people will experience mild to moderate symptoms, or possibly no symptoms at all. But a large population is more vulnerable than most, and the outcome of infection can be quite devastating.
Older adults, people with chronic illness, people who are immunocompromised, and people with disabilities are most at risk of getting severely sick with COVID-19. They also have a higher risk of becoming hospitalized or dying from the virus. While COVID-19 vaccines help protect the vast majority of people, they may not work as well for these groups.
A suppressed immune system
Immunocompromised patients have some deficiency to their immune system, either because they are taking medication that compromises the immune system or because they have an innate condition. “These patients are at higher risk of not responding to the vaccine,” says Hannah Imlay, MD, an infectious diseases physician who takes care of immunocompromised patients at University of Utah Health. “You need an immune system to help with that, and many of these patients have some deficit.”
COVID-19 vaccines protect
While these groups may not generate a good response to the vaccines or experience a higher rate of breakthrough symptomatic infection, COVID-19 vaccines still offer some protection against the virus. COVID-19 vaccines help decrease disease severity and death. This is why the vaccines are highly recommended for these groups.
Four doses are needed
Early in the pandemic, it was recognized that immunocompromised patients—specifically those with organ transplants, cancer chemotherapy, stem cell transplants, and autoimmune conditions—did not respond as well to the primary two-dose vaccine series as other people. In order to receive a good level of protection, a third dose is now recommended and part of the initial primary series.
“Immunocompromised patients have a higher risk with any vaccine strategy,” Imlay says. “Whether it’s two, three, or four doses, we can’t change that. What we can do is try and change the vaccine strategy to make immunity as good as possible.”
A fourth dose, the booster shot, is also recommended three months following the initial three-dose vaccine series for immunocompromised patients. At this time, anyone age 12 years and older are eligible to receive a booster shot.
Preventive medications for COVID-19 are available for immunocompromised patients. Pre-exposure prophylaxis can help prevent a patient from getting SARS-CoV-2 before they’ve been exposed to the virus. Evusheld, a monoclonal antibody therapy, was recently authorized by the FDA and has shown to prevent patients from getting symptomatic COVID-19 infection. “Evusheld is really targeted at people who don’t get much protection from vaccination,” Imlay says.
Other early COVID-19 therapies are available for immunocompromised patients. Pfizer’s paxlovid antiviral pill and the Sotrovimab antibody infusion are COVID-19 treatments for certain patients who’ve been infected with the virus.
Protecting vulnerable populations
Getting fully vaccinated is the best and easiest thing you can do to protect vulnerable groups. Wearing a well-fitted face mask will also help stop transmission of any respiratory infections circulating in the community.
“These are physicians, students, teachers, children, and people that work in the community just like everybody else,” Imlay says. “It’s a population that needs to be protected and needs to be protected by the rest of our actions.”
It’s especially important for immunocompromised people to invest in high filtration face masks, such as an N95, especially when out in public or in an indoor setting. According to Imlay, fit, filtration, and comfort are the most important elements to an N95 mask.