For some, pandemic has become worse
LOS ANGELES — For Giancarlo Santos, holiday parties are typically a free-for-all of revelry, with friends and family spilling into every corner of the house, and Christmas decorations twinkling everywhere.
This year, Santos will get to enjoy the decorations as he receives treatment for an aggressive type of cancer called diffuse large B-cell lymphoma. But holiday celebrations at his home in Chino, Calif., will be strictly limited to his wife, Michelle, and their three children, who will be wearing masks and maintaining a safe distance from their 46year-old father.
“I’m not normal; this is all abnormal,” Santos said from his hospital bed at Cedars-Sinai Medical Center in Los Angeles. His children “are ready for the pandemic to be over — hanging out with friends, going out, taking kickboxing classes,” he said. But they’ve met him halfway, getting vaccinated and wearing masks to protect their dad, whose disease has left his immune system unable to protect him from COVID-19’s deadliest ravages.
If only everyone in his life were willing to do the same.
Almost three years into the pandemic, many Americans have decided that the health emergency is over. In late October, when the polling organization Morning Consult gauged Americans’ concern over COVID-19, only 11 percent said they considered it a “severe health risk” within their communities.
But for patients whose immunity is weakened or destroyed by medicines or disease, “it’s not over,” said Dr. Akil Merchant, an oncologist who oversees Santos’ care at Cedars-Sinai.
For these Americans, the pandemic has taken a turn for
the worse.
The omicron strain that is generally considered mild has dealt a significant blow to people with compromised immune systems. Two therapies that have been a mainstay of protection for these patients are no longer believed to be effective against two of the most dominant subvariants, BQ.1 and BQ.1.1 That leaves them with only two effective medications should they get sick.
That, in turn, puts them at the mercy of those around them as COVID-19 cases and deaths are ticking upward, mask use is falling and updated booster shots are going unclaimed.
In a world that’s moved on from precautions, “they’re on their own,” said Dr. Otto Yang, an infectious disease specialist at the University of California at Los Angeles.
That’s not entirely new: Influenza and respiratory syncytial virus have long put these patients in peril as well, but Americans have never been asked to don masks or get vaccinated to help protect them against the viruses that cause those diseases.
Getting Americans to forfeit their perceived freedoms to protect the vulnerable has always been a big ask, said Johns Hopkins University bioethicist Jeffrey Kahn. “We’re more oriented toward individual rights,” he said.
But even if there were broad support for collective measures to protect the immunocompromised, the coronavirus itself hasn’t cooperated, Kahn noted.
At the start of the pandemic, for instance, nearuniversal vaccination was touted as a way to protect the medically fragile by surrounding them entirely with immune people. That goal of creating “herd immunity,” however, has been put out of reach by a virus that continues to undermine vaccines’ protection.
“We find ourselves in a particular moment where the virus and the politics of the time have conspired to make it even harder” to convince Americans that they should make sacrifices for the sake of others, Kahn said.
People with impaired immune systems typically don’t produce a lot of antibodies after getting COVID-19 vaccines, which makes it easier for the coronavirus to sneak past one of the body’s first lines of defenses. Many immunocompromised patients also lack a robust army of B-cells, a second line of defense that blunts infection once a virus has established itself in the body.
The result: Even when they’ve been vaccinated, they’re more vulnerable to infection than their healthy peers. And once infected, they’re more likely to become severely ill or die.
A two-year study found that across 10 states, people with compromised immune systems were overrepresented among hospitalized COVID-19 patients by a factor of four. Even when vaccinated, these hospitalized patients were 40 percent more likely to require intensive care than fellow patients with healthy immune systems, and they were 87 percent more likely to die.
The immunocompromised are people like Louise Lerminiaux, 55, of Thousand Oaks, Calif., an advocate for transplant patients who has spent the pandemic zealously protecting herself and the kidney she was gifted 14 years ago. She shops for groceries at 7 a.m., when traffic is light, goes to movies in the afternoon to avoid crowds and dons full protective gear when traveling to organ transplant conferences. Lerminiaux is never without a mask, and while she wishes others would keep wearing them, she knows her protection is in her own hands now.
“There is eye-rolling, for sure” when she wipes down surfaces on airplanes, she said. There are friends she’s let go because they won’t get vaccinated. She has seen what it’s like to be near death, she said, and “my life is more important.”
The thoughtlessness of fellow Americans has made life harder for Cindi Hilfman, too. A kidney transplant patient who lives in Topanga, Calif., Hilfman, 56, said a man sneered at the face covering she wore when she traveled to Iowa for a funeral this summer.
“You’re clearly not from around here,” he said to her. “You know they don’t work, right?”
Hilfman knows that they do work and that she can’t count on others for protection.
“I do see myself wearing my mask for years,” Hilfman said.
Santos knows that any Christmas party involving his friends and family will include a handful of vaccine skeptics and COVID-19 deniers who’ve taken no steps to protect themselves or others. But with Americans racing to move on, he said another holiday season with face coverings and frequent coronavirus testing feels like too much to ask.
Defending COVID-19 safety measures “can ruin relationships,” Santos said. He tries to be respectful, he said, and his unprotected friends and family have honored his need to keep them at bay.
But he had hoped for a bit more empathy than that. Getting vaccinated and sometimes wearing a mask are “an act of kindness, especially to those who are immunocompromised,” Santos said.