The current masking guidelines are based on the latest medical knowledge. The problem with them is that people who are unlikely to get vaccinated are also unlikely to wear masks. People who are immunocompromised by their illnesses or medications that they take to treat them may continue to be vulnerable to Covid 19 in spite of being vaccinated.
Here are the CDC’s recommendations on immunizing immunocompromised individuals.
Immunocompromised people can receive COVID-19 vaccination. Data are currently insufficient to inform optimal timing of COVID-19 vaccination among people who are planning to receive immunosuppressive therapies. However, based on general best practices for vaccination of immunocompromised people, ideally COVID-19 vaccination should be completed at least two weeks before initiation of immunosuppressive therapies. When it is not possible to administer a complete COVID-19 vaccination series (i.e., two doses of an mRNA vaccine or a single dose of Janssen COVID-19 vaccine) in advance, people on immunosuppressive therapy can still receive COVID-19 vaccination. Decisions to delay immunosuppressive therapy to complete COVID-19 vaccination should consider the person’s risks related to their underlying condition. Consistent with general best practices for immunization for non-live vaccines, COVID-19 vaccines may be administered without regard to timing of corticosteroid treatment, including topical or intraarticular treatment, bursal, or tendon injection.
Antibody testing is not recommended to assess for immunity to SARS-CoV-2 following COVID-19 vaccination. At this time, revaccination is not recommended after people who received COVID-19 vaccines during chemotherapy or treatment with other immunosuppressive drugs regain immune competence. Recommendations on re-vaccination or additional doses of COVID-19 vaccines may be updated when additional information is available.
People should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, the potential for reduced immune responses, and the need to continue to follow current guidance to protect themselves against COVID-19.
Here is a letter in the New York Times from a kidney transplant recipient.
I’m a Vaccinated Transplant Recipient. I Don’t Have Antibodies. Now What?
May 24, 2021
By Candida Moss
Ms. Moss is a professor of theology at the University of Birmingham in the U.K. who is based in New York. She also studies disability theory and is a kidney transplant recipient.
“When can we meet?” As more people are vaccinated, my inbox grows ever more hopeful. Emails from conference organizers, employers, friends, family and businesses promise that we will soon “get back to normal” and put the dark shadow of the pandemic behind us. Now that the Centers for Disease Control and Prevention has determined that masks are no longer necessary for the vaccinated, the spring has brought with it an optimistic news cycle that eagerly anticipates the post-Covid world.
What is receiving considerably less attention, however, is that not everyone who is vaccinated will develop antibodies, and many of those who don’t are at high risk for the most severe consequences of Covid-19. As a kidney transplant recipient, I am one of those people.
Until recently, immunocompromised people were excluded from studies of the mRNA vaccines for Covid-19, but data from clinical trials is beginning to emerge. A study of fully vaccinated kidney transplant patients published in April by researchers at New York- Presbyterian Hospital and Columbia University Medical Center revealed that 75 percent of kidney transplant patients studied did not develop measurable immunity after both doses of the vaccine. A second study published by Johns Hopkins University School of Medicine researchers in May found that only 54 percent of fully vaccinated organ transplant recipients studied had antibodies. The numbers are different, but both studies showed that immunocompromised people had significantly reduced responses to the mRNA vaccines.
Vaccinated people may still catch and transmit the virus, which for most people isn’t dangerous, but the situation is different for the immunocompromised. The New York-Presbyterian and Columbia University team reports that some fully vaccinated transplant patients who contracted the coronavirus required hospitalization, and one was intubated.
The number of immunocompromised people in the United States is not insignificant. Over 700,000 organ transplants have taken place in the United States since 1988. In 2016, more than 4 percent of the U.S. population reported being told by a health professional that they were immunocompromised in some way. While studies show some are able to develop antibodies, the future for many of us is uncertain. After being vaccinated, I was given a spike protein test to see if I had immunity. When I learned I had developed no antibodies, I felt sick to my stomach: How will I persuade others to continue to be careful? How many vulnerable people don’t realize they aren’t protected?
C.D.C. guidelines on masking rely on an honor system, and it’s impossible to know whether people are unmasked because they are vaccinated or because they oppose vaccination and masking. Polls show that many people who plan not to get vaccinated already feel safe going unmasked indoors. The messaging from the C.D.C. suggests that we can choose safety: “You’re protected if you’re vaccinated, you’re not if you’re not vaccinated,” said the C.D.C. director, Dr. Rochelle Walensky. For many Americans that isn’t necessarily true, but there’s no colorful infographic for the immunocompromised about what we can or cannot do, only the statement that we should talk to our doctor. In the meantime, public spaces feel less safe. Only 38 percent of Americans are fully vaccinated, and masking works better when compliance is high. So people like me wait for better medicine and wonder what happens to us if herd immunity remains elusive.
The vaccine passport on my phone is comically meaningless. Yes, I’m vaccinated, but that doesn’t actually protect me. Thankfully, I have been able to spend the pandemic working from home and shielded from danger. Like everyone else, I nurtured dreams of socializing, travel and seeing relatives I have not seen in over a year. I am tired of my apartment. I feel guilty for forcing my immediate family to continue distancing, but the mortality rates for people like me are high. I’m delighted for friends and relatives who have more freedom, but I feel stuck. I’d like to go back to February, when I thought that vaccination meant safety, or even March when I knew others would wear masks at the grocery store.
The pandemic exposed society’s ageism and ableism, with many people in the beginning months arguing that only the sick and the elderly were at risk. I thought we would learn to be more thoughtful about accommodating the vulnerable. But the invitations to large gatherings that I receive, which omit any reference to safety measures or remote attendance, feel like conscious avoidance of any disparities.
After a year of remote working, it’s clear that my privileged, overwhelmingly liberal corner of the world is able to accommodate the vulnerable and organize inclusive events. It’s also clear that most of us don’t want to. We want to forget, to return to “normal,” and to discard the masks that remind us of our frailties. For some of us, though, this isn’t possible. Our ability to survive, to work and to flourish depends on everyone else’s willingness to be honest and to remember.