As the rest of us learn to live with the virus, what happens to the 500,000 who are still shielding?
DEBBIE CAROL has left her house twice in 22 months – once for a hospital visit, and once to get married. The 69-year-old former college lecturer from London has not entered a shop, eaten in a restaurant or gone to the cinema in that time. Nor has she hugged her two children or two grandchildren.
‘I rarely even go for walks,’ she says. ‘There’s a school at the end of my road and it’s always so busy out there. Most of the time I feel too terrified to leave the house.’
Debbie suffers from chronic lymphocytic leukaemia, a form of blood cancer that affects the immune system. While her condition is stable – she isn’t currently undergoing treatment – it means she’s prone to infections.
It’s why she, along with about two million other Britons identified by the NHS as being extremely vulnerable to Covid, were told to shield at the start of the pandemic. This was the strictest of stay-at-home orders – they were told not to leave the house, even to exercise. It was a vital step, but psychologically arduous.
Officially, shielding ended in September. Thanks to the vaccines and a better understanding of who Covid hits the hardest, swathes of those previously at high risk are no longer deemed to be so and can breathe a sigh of relief. But there is a group who remain high-risk – the estimated 500,000 Britons with a weakened immune system.
This group, known as immunocompromised, includes, along with cancer patients such as Debbie, transplant patients who rely on medication to suppress their immune system to stop their bodies rejecting donor organs, which renders the Covid vaccine less effective. And with Covid so prevalent – one in 15 people in England, one in 20 in Scotland and Wales, and one in 25 in Northern Ireland have the virus, according to the latest Office for National Statistics data – many of them still don’t feel safe to go outside.
‘I’ve shielded for nearly two years and I’m not going to stop now,’ says Debbie, who lives with her husband Ray Miller, 66, a retired IT technician. ‘I look at the thousands and thousands of cases in London and it makes me scared. They say Omicron is mild but I don’t fancy taking that risk.’
ALSO in a similar position is Dan Baker, 25, from Leamington Spa, Warwickshire, having received a kidney transplant in October. He was told to shield after he suffered kidney failure in December 2020 and began dialysis treatment – which leaves patients more vulnerable to Covid. ‘The doctors say I will have to keep shielding for a while,’ says Dan, who works for an online learning firm.
‘All my colleagues are going back to the office, but I’m still at home. People find it hard to understand that even though I’ve had my vaccines, it’s still not safe for me to go out. My friends keep asking if I want to do something, but I have to say no. Some don’t ask any more.’
According to Kidney Care UK, about a third of the patients it speaks to are still shielding. ‘And another third are still taking precautions, such as avoiding crowds and wearing masks at all times outside the house,’ says Fiona Loud, the charity’s chief executive. ‘It feels like everyone is ready to move on from Covid and return to normal, but people who are clinically vulnerable are not out of the woods yet.’
Doctors agree that Covid still presents a serious risk to many immunocompromised people.
UK studies found that after two doses of the vaccine, just a third of blood-cancer patients developed Covid-fighting antibodies – defensive cells created by the immune system that stop infections from entering the body – leaving them highly vulnerable to the virus.
Doctors were relieved when, late last month, scientists at the Francis Crick Institute and The Royal Marsden NHS Foundation Trust in London found that after a third dose, the protection level rose to nearly three-quarters, and they are hopeful that a fourth dose, which was offered to these patients last month, will increase levels of antibodies further.
Last week a French study found many kidney-transplant patients who had failed to respond to three doses recorded a ‘satisfactory antibody response’ to a fourth. However, experts stress that for many, protection is still weak, and they have not ruled out a fifth jab.
‘This group will almost certainly need additional boosters,’ says Dr Samra Turajlic, consultant medical oncologist at The Royal Marsden. ‘How often and which ones will depend on the data.’
And there are patients who don’t respond, even after four vaccines, says Professor Liz Lightstone, a kidney specialist at Imperial College London. She adds: ‘This means they might be completely unprotected.’
For this reason, the NHS launched a nationwide programme last month that aims to offer immunocompromised people who catch
Covid rapid access to drugs designed to fight the disease and reduce the severity of symptoms.
These include sotrovimab, shown to reduce hospitalisation and death by nearly 80 per cent, and molnupiravir, shown to reduce hospitalisations and death by a third. Those identified by the NHS as eligible are sent a letter confirming their status and a box of PCR tests to be taken if they develop symptoms. If they test positive, they will be contacted by a clinician who will prescribe one of the treatments.
However, many patients who should be eligible report that they have not yet been contacted.
Carol McCullough, 60, from County Armagh, had a kidney transplant last year and has been shielding ever since. The retired nurse took an antibody test after her third Covid vaccine last October, which showed she had not developed any defensive cells capable of fighting off the virus.
She says: ‘I only really ever leave the house to go to my hospital appointments. I get my groceries and drugs delivered to my door.’
Despite this, Carol, who lives alone, has yet to receive any information about access to drug treatments. ‘No one I know in Northern Ireland who should have has had any information,’ she says.
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ROF Lightstone says the problem is that patient lists are not up to date. She adds: ‘People with new transplants or new diseases are not being added to the lists, so there are lots of people out there who are unaware of what to do.’
If immunocompromised patients test positive for the virus but have not received their letter, the advice is to contact their GP.
Doctors also say that some patients have such severely impacted immune systems that they cannot fight off the virus even with the new drugs. Professor Alex Richter, an immunologist at the University of Birmingham, reveals that she has treated several immunocompromised people who are still fighting Covid more than six months after becoming infected.
She says: ‘Their immune systems are too weak to destroy the virus,
so it stays in their body. Most of them are not severely ill but they remain infectious, meaning they have to isolate.’
Doctors now believe the best option for the severely immunocompromised are drugs designed to be taken even before the patient develops Covid.
Experts are particularly excited about one called Evushield, created by vaccine maker AstraZeneca. It is a combination of two drugs that provide the body with artificial antibodies and has been shown in trials to reduce the risk of symptomatic Covid by 77 per cent.
Early US trials, in which immunocompromised patients were tested, reported no severe cases of Covid or any Covid-related deaths. It is already approved for use in the US and France.
Doctors are now rushing to recruit immunocompromised volunteers for a UK trial in the hope it could be rolled out to those who have failed to mount an immune response to vaccines.
‘Drugs like this really are the only feasible way back to normality for these patients,’ says Prof Lightstone. However, she also says the earliest Evushield could be rolled out in the UK is next year.
What should the immunocompromised do in the meantime? Prof Richter says they should ‘take precautions’, adding: ‘This means masking, meeting people outside where possible, and avoiding crowded spaces such as public transport.’
Gemma Peters, chief executive of Blood Cancer UK, believes the Government now needs to consider financial support for immunocompromised people who are still in work.
She says: ‘There are many people with blood cancer who can’t work from home and have to go into busy places such as cafes where they run the risk of catching Covid. It’s not right that they are asked to put their lives at risk at a time when the infection rate is so high, so the Government needs to provide these people with some financial protection, at least in the short run.’
Some doctors believe the arrival of the less-severe Omicron variant will allow the immunocompromised to live more normal lives.
‘At our hospital we had more than 150 kidney-transplant patients catch Omicron in December, and very few were seriously ill,’ says Prof Lightstone. ‘That does not mean everyone is safe, but compared to the horrible number of deaths we saw in the first wave, it’s a step in the right direction.’