Living in fear of virus
People with weakened immune systems still staying away from crowds, worried that vaccines may not protect them
Slipping into a public swimming pool in Walnut Creek, Rachel Eaton was enveloped by near silence underwater before she kicked off the wall and began freestyle laps.
Swimming is a solitary, heartthumping meditation for Eaton, a 57yearold high school teacher from Concord. Advanced kidney disease once meant she was too fatigued to swim. An organ transplant three years ago had begun to restore her life.
But this swim would be Eaton’s last for a while. As most Californians are stepping out of their pandemic shells, Eaton and other people with weakened immune systems are retreating a little further into theirs.
Eaton is vaccinated against COVID19, but the medicine she takes to prevent her body from attacking her new kidney may also be stopping her immune system from producing a robust enough
response to fully protect her against the coronavirus.
“When we went into fullon shutdown, I was totally relieved,” Eaton said. “I wasn’t the only frightened one. The idea that we’re all in this together was very comforting to me.”
Eaton has lost some of the allforone, oneforall feeling. The success of the vaccines against COVID19 led state leaders to reopen the economy June 15, lifting most pandemic restrictions. Diners now sit elbowtoelbow in restaurants, maskless shoppers browse the shelves in stores and people are returning to movie theaters and baseball stadiums.
That’s because the vaccines are highly effective for the average healthy adult or adolescent. But medical experts worry about how much protection they offer to people like Eaton and others whose immune systems are hampered by illness or medication.
Just under 3% of adults in the U.S. have compromised immune systems that make them more susceptible to serious illness from COVID19, according to the federal Centers for Disease Control and Prevention. They include people with transplanted organs, certain cancers like leukemia and autoimmune diseases such as lupus.
“It is a more challenging situation for immunecompromised people, and that’s because while the vaccine offers protection to them, we just don’t know how much,” said Dr. John Swartzberg, an expert in infectious diseases and vaccines at UC Berkeley. “It’s not as predictable.”
The highly infectious delta variant spreading through the U.S. “ups the ante” for people with weakened immune systems, Swartzberg said, “but it’s not a desperate situation.”
Strong rates of community vaccination can protect vulnerable populations, even against more infectious variants, he said. Nearly 60% of all adult Californians are fully vaccinated against COVID19. Experts vary in their opinions, but reaching herd immunity to dramatically limit or stamp out the virus would require between 70% and 90% of the population to be vaccinated or have immunity through infection.
Some places in the Bay Area have among the highest vaccination rates in the state, such as San Francisco and Marin County where more than 80% of residents 12 and older are fully vaccinated.
Studies are tracking antibody production among immunocompromised populations, although scientists aren’t sure antibodies are the best metric for measuring a person’s defense against COVID19.
Dr. Brian Schwartz, an infectious disease specialist with UCSF, said antibodies are just one part of the body’s disease
fighting response. Another type of white blood cell, called Tcells, can destroy cells infected with the coronavirus. Tests are being developed to determine an individual’s Tcell response, but they are not readily available yet and studies haven’t yet determined how to interpret the results.
Schwartz said antibody and Tcell tests assess immunity at a single point in time. Whether protection wanes more quickly among immunocompromised people who have been vaccinated is unknown.
Eaton is taking part in a study of vaccine response among immunocompromised people conducted by Johns Hopkins University researchers. She was fully vaccinated by late March, and since then tests show her antibody production is below normal.
“I’ve produced some — they just don’t think it’s a level that is protective,” Eaton said. “If I were to contract COVID, they
don’t think I would die and have suggested that I won’t have to be hospitalized if I get it.”
Eaton misses live music and getting on an airplane to explore the world. But she knows she must guard her future by being cautious.
Public health experts are debating whether to recommend that people like Eaton receive an extra vaccine dose to try to boost the body’s immune response.
“This is an area where we’re still learning,” Schwartz said. “Every couple days there’s a new paper that comes out that sheds a little more light on the reduced vaccine response for immunocompromised patients.”
Schwartz said his patients with weakened immune systems worry about what this phase of the pandemic means for them. He advises them to continue wearing masks indoors and to try to avoid people
they aren’t sure are vaccinated.
“We’ve had patients with COVID whose vaccines failed because they are immunecompromised — it’s a real phenomenon,” Schwartz said. “Convince everybody around you to be vaccinated. Create a barrier of vaccinated people. That’s the best thing you can do.”
When California shut down last year and people started adopting practices like wiping down groceries, some organ transplant recipients felt that others were getting a taste of what it’s like to be them.
“All of a sudden everybody was doing what I was already doing,” said Debra Elmore, volunteer executive director of the Bay Area Association of Kidney Patients. “Washing hands all the time, not being around people who were sick. When I traveled I’d wipe down the seat tray and the arms on the plane.”
Elmore, a 64yearold technical writer who lives in Concord, had a kidney transplant in 2014. She’ll meet with vaccinated friends on the patio, but not indoors. They’re planning to see country singer Toby Keith in September in a longdelayed show at an outdoor arena in Reno, though Elmore, who bought her ticket before the pandemic hit last year, isn’t sure she’s ready to be around that many people. “I think I’d have a panic attack.”
“This sounds terrible, but I know that people who aren’t vaccinated are supposed to wear masks, but I don’t trust that they are,” Elmore said.
She’s not alone in taking precautions. Even before the pandemic, Eaton installed a hand sanitizer dispenser at the door of her chemistry classroom at Campolindo High School in Moraga and told her students to use it. She laid down other ground rules, like coughing into your elbow. The front of the classroom was Eaton’s safe zone, and she asked students not to cross a line in the carpet to give her space.
She won’t return to work in August when school resumes and is taking leave, tentatively until December. Eaton said she doesn’t want to be in the classroom “when we figure out when the vaccine wears off.”
“If I were to get COVID it could potentially not go well, so I have to be mindful of my vulnerable state,” Eaton said. “I feel really healthy, I’m super active, I exercise a lot, and yet I just feel that I can’t risk certain things.”