Your questions, answered "My wife and I are immunocompromised — she is a lymphoma patient and I am on immunosuppressants. We are fully vaccinated, but not fully protected. I do not trust that those without masks are necessarily vaccinated or safe. What do we do? We feel even more isolated and afraid than before. Marginalized. Left behind." —Mitchell in New York It sounds like you and your wife may be among the estimated 3 to 4 percent of people in the United States for which the coronavirus vaccines may not work very well, or at all, because of immune system deficiencies. We certainly feel for you and we understand that this is especially concerning as federal health authorities have started loosening restrictions for those who are fully vaccinated. But given that we've been getting quite a few inquiries from readers about vaccinating people with weakened immune systems, it's probably fair to say many of them empathize with you, too. So first things first: You're not alone. You may already know this, but just because you and your wife are not "fully protected" does not mean that your immune systems have failed you. You two may have made some protective antibodies. And even if you didn't, Charlotte Cunningham-Rundles, an immunologist at the Icahn School of Medicine at Mount Sinai, recently told The Washington Post that the immune system can still enlist protective T cells — white blood cells that help protect against viral infections. "Many people who don't make antibodies at all still have a working T-cell side, and the T-cell side can say: 'Okay, I can do some stuff here. I can help you out. I know how to kill viruses,'" she said. And as time goes on, there may also be other ways to try to boost immunocompromised patients' immune systems, such as boosters or high-dose shots, as well as alternative treatments such as monoclonal antibodies. These laboratory-designed antibodies have been used to treat patients with active covid-19 infections. But several companies that make them are now looking into whether monoclonal antibodies may be used to prevent the disease. AstraZeneca is running a worldwide clinical trial to study whether they would protect people like you and your wife, who are at "increased risk of inadequate response to vaccination." Hang in there. The coronavirus and the vaccines are still new. But we will learn more as things progress. For now, as a precaution, it might not be a bad idea to assume that maskless people are unvaccinated and continue taking the precautions that health experts still recommend for immunocompromised people — hand-washing, mask-wearing and social distancing, particularly from those who are unvaccinated or who have the potential to be. |
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