COVID-19 fears persist for those with weakened immune systems – The San Diego Union-Tribune

The masks are gone. People are free to move about. Vaccines are readily available. And after three years, government officials have declared an end to the public health emergencies that were put in place to prevent the spread of COVID-19.

But all of that is of little solace to the tens of thousands of San Diegans who continue to remain at greater risk of infection, people with compromised or weakened immune systems who are much more likely to have moderate to severe symptoms.

While vaccines have been one of the most effective tools in preventing illness, the shots don’t work for everyone, said Dr. Christian Ramers, chief of population health at Family Health Centers of San Diego.

“Immunocompromised people often will go through a full vaccine series, and then you can actually send a blood test to check whether it worked and often people have like zero response,” he said.

For a while, a monoclonal antibody infusion called Evusheld was used to prevent COVID-19 in this population. But with the rapid evolution of this virus, Ramers — who had overseen an Evusheld clinic — said the treatment quickly became irrelevant.

“I think we were surprised at how quickly the virus would evolve,” he said. “Those changes in the spike protein are really what makes different variants and different strains, and unfortunately, that’s exactly the target of these monoclonal antibodies.”

Because of the lag between the scientific research to develop the monoclonal antibodies and the changes to the virus, Ramers said it is unlikely that a new version of the treatment will become available.

“The rapid evolution of the virus has almost eliminated our usual defenses, especially if you cannot respond to the vaccine at all and you’re immunocompromised, it really leaves people vulnerable,” he said.

In an effort to increase early testing and reduce hospitalizations, Scripps Research is recruiting 10,000 moderately to severely immunocompromised people for a new study.

Scripps’ ImmunoCARE study will look at whether on-demand telemedicine, at-home tests and quick administration of medicines can reduce the severity of COVID-19 infections for those who are immunocompromised.

A portion of participants will be given portable, diagnostic tests for themselves and the members of their households.

Scripps Research Translational Institute program director Julia Moore Vogel said the Cue Health tests being used in the study are more sensitive than typical at-home, rapid antigen tests for COVID-19.

By having regular access to at-home tests that are closer in reliability to the PCR tests administered by health care professionals, researchers theorize immunocompromised people will be able to seek treatment faster. That, in turn, could lower their risk of severe infections and hospitalization, and help folks who have continued social-distancing measures over the past three years to return to more of their pre-pandemic activity levels.

“My hope is that we show a reduction in hospitalizations and other adverse outcomes, and that that can give people a little bit more peace of mind,” Vogel said.

To be a participant, subjects need to have a health condition causing a weakened immune system, including symptomatic HIV, leukemia, lymphoma or immunoglobulin deficiency.

Vogel said the study is also now accepting participants who are age 65 and older due to the increased risk of death from the virus for older adults.

More information about the ImmunoCARE study is available online at immunocare.scripps.edu.

The ineffectiveness of monoclonal antibodies, coupled with a majority of people forgoing masking in public spaces, has prompted many of those with compromised immune systems to continue to alter their lifestyles.

In early 2022, The San Diego Union-Tribune interviewed three San Diegans who were immunocompromised. At a time when many of their friends and neighbors had returned to their normal, pre-COVID lifestyles, those interviewed had remained cautious.

Those precautions didn’t prevent two of them from becoming infected with the virus.

Alyssa Salter at her in San Diego on Friday.

(Nelvin C. Cepeda / The San Diego Union-Tribune)

Alyssa Salter, an immunocompromised Grantville resident, contracted COVID-19 last summer.

Salter has several chronic conditions, in addition to fibromyalgia, asthma, and psoriasis.

Before traveling to Las Vegas last August to attend a close friend’s wedding, Salter said she and her wife took several precautions, such as staying up to date on booster shots, wearing N95 masks and continuing to social distance.

But Salter got COVID-19 anyway, spending several days in the hospital with a fever of 104 degrees.

“It was probably the worst pain I’ve ever been in. So, you know, that was with all the vaccines humanly offered, and it still hit me really hard,” Salter said.

Because of a shortage of Paxlovid at the time, she was unable to receive the medicine that reduces illness in people who are at high risk for severe illness.

More than seven months after her initial infection, Salter is still experiencing brain fog and other symptoms, though it’s hard to distinguish between her baseline health conditions and long COVID. She continues wearing a mask when traveling outside her home, which has become even more infrequent. She worries about contracting the virus again.

“It’s definitely affected my mental health — I definitely feel more agoraphobic, more paranoid.”

Jillian Parramore, pictured in her home in 2022, and many others who are immunocompromised are feeling isolated as health officials advocate for relaxing COVID-19 restrictions.

(Ana Ramirez / The San Diego Union-Tribune)

More than a year after a dual infection of COVID-19 and pneumonia from a four-person, New Year’s Eve gathering at her home, Mount Helix resident Jillian Parramore still experiences lingering symptoms.

With diagnoses of epilepsy, asthma and cerebral palsy — the latter two of which put her at higher risk for respiratory complications from COVID-19 — Parramore had stayed at home for most of 2020 and 2021 to avoid getting the virus.

A year later, the 31-year-old Disability Rights California board member is feeling slightly less fatigued and can walk without getting out of breath, yet she continues to experience migraines, fluid in her lungs and needs to nap for two hours every day.

Because so few people wear masks at places like the grocery store, Parramore gets her groceries delivered.

“Caring about my life is not going to be everybody’s priority, especially in the type of society that we live in,” she said. “I need to be safe not just for me, but for others in my community.”

Chula Vista resident Syreeta L. Nolan, 36, is diagnosed with gastroparesis, fibromyalgia, sciatica, carpal tunnel and tennis elbow, which all contribute to the pain she experiences. She is also undergoing testing for myasthenia gravis, a chronic autoimmune disorder.

Syreeta Nolan, a disabled woman and disability advocate, at UCSD in 2022.

(Nelvin C. Cepeda / The San Diego Union-Tribune)

Over the past year, Nolan served as the family caregiver for her mother, who died from pancreatic cancer last month at 66. She wanted her mom to have opportunities to visit with loved ones during her final months, so she asked visitors to wear masks while in their home.

“Sometimes, some of our visitors weren’t really respectful that COVID was still a thing and would ask, ‘Do I still have to wear a mask?’ ” she said.

She said she will stay home to keep herself safe from the virus, and wear masks whenever she needs to go out.

“It’s so much more dangerous for immunocompromised people now,” she said.

The virus is continuing to spread in the community, albeit at a much reduced rate. Because of that, Ramers at Family Health Centers said it’s vital for those who are immunocompromised to continue wearing N95 masks when they leave the home. It’s also important to get tested to increase early access to antiviral medication.

“The burden of COVID used to be held by all of society, and we all were in it together,” Ramers said.

“The burden of actually getting really sick and hospitalized and dying has really been shifted and concentrated to the elderly, the immunocompromised and the medically vulnerable, and I think people just need to be aware of that.”