Though the number of students testing positive for COVID-19 at the University decreased in recent weeks, there remains a population of students that is at high risk of contracting the virus — immunocompromised students.
The immune system is made up of a complicated network of cells and proteins working together to generate an immune response and fight off pathogens. These cells and proteins do not form a particular organ, but are dispersed throughout the body and travel through the bloodstream to target invaders effectively by collaborating and communicating together.
Immunodeficiency arises when there is a malfunction in the immune system, leaving an individual more vulnerable to infection.
Andy Hawkins, a physician in the Student Health and Wellness Medical Services Unit, explained in an email statement to The Cavalier Daily three factors that may result in developing an immunocompromised status — acquiring conditions such as autoimmune diseases, HIV infection, cancer and kidney disease; inheriting disorders such as antibody deficiencies; or using certain chronic medications that serve as immunosuppressants.
“Individuals with immune deficiencies number in the millions within the United States, and certainly represent a portion of our U.Va. family,” Hawkins said.
Madeline, a fourth-year College student, has an autoimmune disease and became immunocompromised from taking immunosuppressant medication. She asked to only provide her first name to maintain her privacy.
“When I was first diagnosed, [medication] really helped me live normally again,” Madeline said.
Although medication helps treat her condition, it also makes Madeline more vulnerable to infection.
“I have about the same chances [as] anyone else who's getting sick from something, like picking up a bug,” Madeline said. “But if I get sick, I have it longer and worse than anyone else.”
Autoimmune disorders result from an overactive immune system that attacks the body’s own healthy tissues instead of fighting off foreign pathogens such as bacteria and viruses. In order to manage the overactive immune system, many patients take immunosuppressive medications, which suppress the immune system so that it does not attack the patient’s healthy cells. There are several different types of medications meant to either treat symptoms and pain or to more specifically target parts of the immune response, thereby preventing an effective immune response.
Due to the increased vulnerability to infection, immunocompromised students must take everyday precautions to take care of their health.
Elyse, a student attending Northern Virginia Community College, is immunocompromised as a result of taking medication for Crohn’s disease, an autoimmune disorder affecting the gastrointestinal system. Elyse asked to provide only her first name to protect her privacy.
Elyse has been isolating since the start of the pandemic to protect herself from possible exposure to COVID-19.
“I haven't gotten a chance to do anything with anybody in person in a year and a half,” Elyse said. “I pick up my groceries through curbside pickup. That's essentially the most interaction in-person I deal with.”
Isolating has meant that managing everyday tasks becomes more difficult as tasks require more strategy and planning. Even grocery trips must be planned out in advance, Elyse said.
“[I have to] plan it out and make myself remember all the things that I've run out of,” Elyse said. “I don’t leave the house to go outside without putting two masks on, one of them being an N-95 [and] the other a fabric mask or surgical mask on top of that.”
Madeline said that she found rules regarding exposure to COVID-19 unclear for immunocompromised students.
“I'm not even totally clear what the policies are in terms of if you're exposed,” Madeline said. “In terms of second degree exposure or if you've been exposed — those kinds of policies have been unclear, especially this semester.”
In an effort to clarify confusions about COVID-19, a team of University doctors — including Dr. Christopher Holstege, Dr. Mitch Rosner and Dr. Costi Sifri — sent an email Sept. 15 answering key questions gathered from social media. The team shared that currently more than 97 percent of the student community is fully vaccinated and that over 93 percent of academic division faculty and staff are as well.
Despite high vaccination rates, immunocompromised students are still at risk of contracting COVID-19. The varied health conditions and combination of medications makes it difficult to test for vaccine efficacy in immunocompromised populations. Moreover, clinical trials tend to focus on more homogenous groups of people — like organ transplant patients — leaving those with specific conditions and treatments unsure of how the vaccine will affect them.
“It's kind of confusing — digging through the literature — because most of the research ... has been done with people [who] are liver transplant patients because that's a more homogenous group,” Elyse said.
Immunocompromised patients have been excluded from large scale clinical trials testing vaccine efficacy. Instead, studies are done by looking at how a broad group of people including cancer patients, organ transplant recipients and people receiving immunosuppressive therapies are affected by the vaccine. Data from real-world studies of immunocompromised persons suggest reduced vaccine effectiveness against COVID-19 infection, as well as symptomatic illness and hospitalization and potential benefit from a third dose of the COVID-19 vaccine.
In an effort to help more vulnerable populations mount a greater antibody response to the COVID-19 vaccine, the Food and Drug Administration authorized the administration of a third dose for people with moderate to severe immunodeficiency who have already received the initial two-dose primary series for the Pfizer COVID-19 vaccine Aug. 12.
The booster dose is identical to the first two doses of the Pfizer vaccine, but is designed to give immunocompromised people another chance to build an antibody response that may not have been established after the first two doses.
Elyse and Madeline said they took the initial two doses of the vaccine without much hesitation. When the booster vaccine was first offered, Elyse said she “got it as soon as possible.”
Madeline said her doctor emphasized the importance of having those around her be vaccinated so that she can be protected through herd immunity. In order to achieve herd immunity, a substantial number of people in a population must be vaccinated, lowering the overall spread of infection. The goal is to protect vulnerable populations by having those around them be immune to COVID-19 through vaccination.
Even though doctors and researchers cannot ascertain the effectiveness of the vaccine for people with immunocompromised status, patients and their relatives are generally encouraged to receive the vaccine.
“For everyone else who does not have an immunocompromising condition, realize that those you meet might either be immunocompromised or have someone they love who is,” Hawkins said. “Encourage everyone you know who has not already been vaccinated to do so. Each vaccination hopefully means one less person who can transmit an infection to a more vulnerable individual.”
Immunocompromised students live with invisible struggles that dictate how they live their lives. Each individual has a unique set of conditions that affect them, and as Madeline shared, these cannot be fully controlled.
“It's more so about having agency for what I can do, and recognizing what [is] controllable,” Madeline said.