- People with compromised immune systems are facing new fears about COVID-19 as businesses and public facilities begin to reopen.
- Experts say people with heart conditions as well as those who are undergoing treatment for cancer are at high risk for severe illness if they contract the virus.
- They urge people who are immunocompromised to keep their medical appointments and to continue treatments.
Barbara Branaman has been immunocompromised most of her life.
The longtime Silicon Valley tech executive, who is now a healthcare entrepreneur helping run an integrative health clinic, was diagnosed with diabetes at age 9.
Thirty years later, she survived a life threatening kidney and pancreas transplant that left her immune system still weakened.
Branaman, who’s now 64, was understandably nervous when COVID-19 struck. And now that many places in the United States are reopening businesses and public facilities, she’s even more anxious.
“There’s a huge number of Americans like me who are immunocompromised. This reopening could make it worse for us,” she told Healthline.
Branaman says that being immunosuppressed has given her a deeper appreciation for life and taught her how to function safely as well as excel at what she does.
“It’s important for immunocompromised people to take care of themselves, get some sunshine, breathe, take a walk, do things in a safe way that make you feel cared for and help you get out of that fear mentality,” she said.
Branaman doesn’t deny there’s a fear factor right now for her and fellow immunocompromised people.
“Just don’t let the fear control you,” she said. “I’m a super happy person, and I learned early that even if you have a chronic illness and you are scared, you can adapt and still enjoy life.”
Branaman, who received her doctorate in medical qigong from the International Institute of Medical Qigong/Henan University of Traditional Chinese Medicine, is committed to the tenets of both Eastern and Western health and healing modalities.
And right now, she admits that she sometimes gets frustrated by the lack of courtesy she sees.
“I recently saw a doctor in our building talking to a patient, and neither one of them was wearing a mask,” she said. “I want to get the economy running again, too. Let’s please do it safely and with some consideration of others.”
Millions of immunosuppressed people
Branaman is certainly not alone.
There are an estimated 10 million people in the United States who are immunocompromised, according to the Bulletin of Atomic Scientists.
Immunosuppression may arise from conditions such as heart disease, cancer, HIV, diabetes, malnutrition, lupus, and certain genetic disorders.
Certain medications or treatments may also cause immunosuppression.
The heart of the matter
Among those who could be affected by the reopening are people with heart disease and those who are having or have recently had heart surgery or a transplant.
Dr. Brian Lima, director of heart transplantation surgery at Northwell Health, says that in light of the face of the COVID-19 pandemic, “immunocompromised patients, such as heart transplant recipients, must continue to exercise extreme caution and ongoing social distancing measures as states begin to reopen.”
These patients, he told Healthline, will remain vulnerable to infection and severe illness “until a reliable vaccine is available or until effective therapies are developed.”
People with cancer at risk
People who have cancer or who have had cancer are also often immunocompromised from the cancer itself, its treatments, or both. Treatments can include chemotherapy, certain types of immunotherapy, and radiation therapy.
“Cancer patients have to be even more careful and cautious as these reopening plans are launched,” said Dr. Len Lichtenfeld, MACP, the deputy chief medical officer of the American Cancer Society.
An oncologist who’s also worked as a primary care physician, Lichtenfeld tells Healthline that the numbers of cancer patients who are affected by COVID-19 “will be even worse if the country reopens too quickly or irresponsibly.”
Melanie Coward, whose recent treatment for breast cancer was disrupted by the pandemic, says that with the reopening now taking place, she feels even more threatened.
“We will not be dining out anytime soon, nor will we be putting ourselves in any situation with crowds,” Coward told Healthline.
“I am still immunosuppressed for at least 3 months after my last radiation. I need to wear a mask and have hand wipes or sanitizer with me at all times. That is if I go out,” she said.
Coward says her oncologist suggested that she still shelter in place since there’s no proof that it’s safe for her to be out in public.
“So once again I have to be quarantined until further notice,” she said. “This COVID-19 experience has taught me how fragile humans are. Americans don’t take care of their mental health. If only we did — we wouldn’t have people screaming they need a haircut.”
Coward doesn’t need to go shopping, she says, but she does need human interaction.
“I think reopening the country is fine. However, it can be done slowly and mindfully,” she said.
“Besides thinking selfishly of myself, I also worry about our frontline workers, and I worry about my mother who is in her 70s,” she added.
“I think if our population was more educated about immunosuppressed people — people with cancer, lupus, leukemia, asthma, all of it — maybe they would actually understand why it’s important to stop the spread,” she said.
A doctor’s view on how to be safe
Dr. William L. Diehl, FACS, the medical director of the Summit Medical Group Breast Care Center in New Jersey and an attending surgeon at Morristown Medical Center, says many of his patients are at increased risk for infection.
Diehl says that while the most important things for immunocompromised cancer patients to do are still physical distancing and frequent handwashing, there are additional things that can also help.
“Other indirect ways with limited data would include the addition of vitamin D-3, zinc, vitamin C, and long-acting melatonin at night,” he told Healthline. “Exercise, hydration, and adequate rest may be of benefit as well.”
In a survey conducted by the American Society for Radiation Oncology in April, 85 percent of oncology practices surveyed said appointments at their offices had decreased by about a third.
And that’s despite the fact that these practices have remained open throughout the pandemic.
Dr. Charles J. Miller, a neurosurgeon with secondary certification in neurocritical care whose practice is in Richmond, Virginia, says delaying medical care could be as harmful as the virus itself.
“Several primary brain tumor patients as well as at least one patient with metastatic disease delayed being seen either because they were scared to come to the hospital or could not get seen by their primary care physician,” he told Healthline.
“The lockdown is killing people,” he added. “Maybe that’s not what you want to hear. But I truly believe that people have been terrorized by this, doctors included. Cancer patients are at additional risk, of course, but with prudent precautions the risk is mitigated.”
Avoiding treatment for a prolonged period of time “will be far riskier than COVID,” he insisted.
Dr. Sandip Patel, an oncologist, cancer researcher, and associate professor of medicine at Moores Cancer Center at UC San Diego Health, wants patients to know that his cancer hospital is probably a safer place for an immunocompromised person to be than a grocery store.
“We have taken many steps to make this as safe and clean an environment as possible for our cancer patients,” he told Healthline.
Adversity but also opportunity
Meanwhile, Branaman says there’s an opportunity amid this crisis to create 2.0 versions of ourselves.
“We can and should use this time as a way to figure out how we can better take care of ourselves and each other,” she said. “After 9/11, people were kind to each other, for a little bit, and then they forgot. We can still wave to each other with a mask on. We can turn this into something positive.”
In the midst of the grief, economic devastation, and violence, Branaman insists that good things can still happen.
“I learned early that having a chronic illness shows that we can indeed adapt, still enjoy our lives, and make a positive difference,” she said.
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