The Atlanta Journal-Constitution
Virus alarms those with weaker immunity
Antiseptic living, social distancing are matter of survival for many folks.
For Susan Prince, being a good daughter during a global pandemic means staying away. She worries that a simple hug could turn deadly for her mother, Nancy Dambach.
Chemotherapy for stage 4 lung cancer crippled Dambach’s ability to fight off germs. Even worse, Dambach is 80, which places her in an age group that has a far greater chance of dying from COVID-19, the respiratory disease caused by the novel coronavirus.
Prince, 48, warned well-meaning neighbors to come no closer than the front yard of Dambach’s Cumming home. She plans to visit by standing outside her mother’s screen porch.
“I don’t want to lose her to this,” said Prince, of Sugar Hill.
“That’s my Susan. I wish I had 10 more of her,” said Dambach, who has lived alone since her husband died in 2014.
The pandemic is turning everyday life upside down for those with poorly functioning immune systems, a wide-ranging group with illnesses that strangers cannot detect with the naked eye. They include cancer patients such as Dambach, cancer survivors, organ transplant recipients, those with conditions related to diabetes, individuals with certain genetic disorders, and people living with HIV.
Each of these diseases is different, and how the virus interacts with them will take years to understand. But people with weakened or malfunctioning immune systems all struggle to fight off infections and may be more likely to have severe symptoms or die.
Even people who seem healthy can carry COVID-19, making staying 6 feet apart from others as the
Centers for Disease Control and Prevention recommends a matter of life and death for these patients.
Some have gone far beyond the agency’s current recommendations by cutting off nearly all face-to-face contact with others, or spraying Lysol on packages and letters that come through the mail. Others have stopped ordering takeout or pass out hand sanitizer, masks and gloves to visitors.
“It may sound extreme, but it sort of makes sense,” said Dr. Richard Schilsky, chief medical officer of the American Society of Clinical Oncology. Patients don’t know if the people who handled their groceries or packed their Amazon deliveries carry the virus or follow CDC hygiene recommendations.
“Every decision point now becomes more complicated,” Schilsky said.
Balancing risk
The risks posed by the coronavirus are so great for certain patients that doctors have decided to halt their treatment.
People with diabetes can have hyperactive immune systems that fight infection badly, but treatments such as dialysis should continue with clinics and patients following CDC guidelines, said Dr. Robert Eckel, a co-president of the American Diabetes Association.
For some cancer patients, pausing chemotherapy can help them build up their immune systems. For others, stopping treatment may end all hope of curing the disease. The Winship Cancer Institute at Emory University issued guidance to its doctors last weekend on how to balance these risks, said Dr. Walter Curran, its executive director.
“We take the point of view of looking at the competing risk of cancer versus getting an infectious disease, and it’s really different for every patient,” Curran said.
Dambach and her family want to press on. An experimental form of chemotherapy shrank her tumors by 75%, and she has only three more weeks of treatment to go.
If she has her way, Dambach will live to see all of her seven grandchildren graduate from high school and maybe even college.
“I love life,” Dambach said. “I don’t care if it’s stormy.”
Keep out
Doctors are keeping patients with malfunctioning immune systems out of clinics and hospitals whenever they can.
At Winship and other treatment centers, some checkups are being done by telephone or are being postponed until it’s safer to come in. Waiting room chairs are being moved 6 feet apart.
After consulting with her doctor, Terri Lynne Willis, 41, a liver transplant survivor, canceled monthly tests to check if her organs are functioning properly. Her immune system remains so fragile nearly three decades after her transplant that it took a year for her to shake off a 2018 fungal infection in her lungs.
“I’d rather be a little bored and alive than in the hospital and unconscious,” the Douglasville resident said.
Patients at the Ponce de Leon Center, one of the largest centers for HIV and AIDS in the country, must stay on their therapy to keep their immune systems strong. But many do not need to come through its doors to do that, said Associate Medical Director Dr. Jonathan Colasanti.
Pharmacists send prescriptions by mail if they can. Some paperwork can be completed remotely. Those who must come in are screened for signs of the disease and have their temperatures taken at the door.
But certain regulations for the federal program that funds nearly all of the center’s services are putting patients at unnecessary risk. Prescription drug assistance rules can require patients to undergo lab work more frequently than they need to for their health or force them to sign paperwork in person instead of online or by mail.
These rules hit the center particularly hard. Its patients are predominantly low-income and must take crowded buses and trains to get to the center. Also, it prides itself in hiring staff who are living with HIV.
“We want to protect them as well,” Colasanti said.