Forgetting about Covid-19 is easy.
Cases are low. Masks are (mostly) off. Restrictions are largely gone. Warmer weather is coming, and with it – we hope – better times.
But there’s a group of people who can’t simply let it go. Not now, not in the summer breeze. Not ever.
For people who are immunocompromised, living with Covid-19 is a prerequisite for truly living life in the open.
“Those are people who have to still have that additional level of precaution,” said Dr. Brahm Segal, an infectious diseases specialist at Roswell Park Comprehensive Cancer Center, “because they do remain at risk.”
People whose immune systems may not fully respond to vaccination – organ-transplant patients, people with HIV/AIDS or those with blood and bone marrow cancers such as leukemia, lymphoma and myeloma – “should not be maskless” in exposed situations, Segal said.
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Virus cases are low; but they not rare, much less gone. To that point, infectious disease experts around the country and the world are warily watching an Omicron subvariant that has triggered a rise in European cases and could potentially do the same here. That scenario would have broad implications: It would be felt most acutely by people who are immunocompromised, but would impact everyone.
This week’s Pandemic Lessons details the steps each of us can take to help the most vulnerable among us and guard against a dramatic rise in infections.
How careful do people who are immunocompromised need to be?
No more cautious than at other times during the pandemic. But not less cautious, either.
Not yet.
“At this point, my advice to them would be to maintain the level of precautions that they’ve learned about over the last two years,” said Segal, who is quick to point out that patients should speak with their doctors about the specifics of their situations.
Broadly speaking, his advice is to go out and “do what’s important to you, be a part of what’s available,” and do those things while wearing a mask when around people from another household, especially in tighter spaces or indoors.
“I would never say, ‘Stay at home,’” Segal said. “Do things that are enjoyable for you — that’s totally fine. But you have to realize that if you’re in a certain group of patients with cancer, you just can't be exactly like the general public.”
How prevalent is Covid-19 in Western New York today?
We’re in a relatively good place, but there are signals that we shouldn’t get too comfortable.
Western New York’s average daily Covid-19 caseload stood at 100 as of March 17. That’s the lowest since last summer, but it’s no longer a number that is plummeting. After a steep drop in daily cases from mid-January – which peaked at 3,500-plus – the figure hit a plateau locally over the last week.
Another key measurement shows a slight uptick in cases over the last week, both regionally and across the state. The average number of cases per 100,000 people in New York was at 10.64 on March 18, up from 8.18 a week earlier.
In Western New York, that figure inched upward from 6.58 to 7.66 over the last week, while in New York City, the jump was larger: from 7.25 to 10.80.
Context here is vital, because all of these numbers are relatively low. On Jan. 18, for example, Western New York’s average number of cases per 100,000 people was nearly 177, while New York City had a whopping 239.
All told, we’re doing well, but we are not bottoming out. When we do, the recommendations that physicians like Segal give to immunocompromised patients could “be significantly liberalized,” he said. “That’s what we want. It might get to a point where it’s not any different than the advice we give during the flu season.”
Why have we seen a tiny rise in cases?
A mix of factors contribute to it. When Gov. Kathy Hochul lifted most statewide mask mandates, including in schools, people started breathing each other’s air more. That alone will create a small – and hopefully temporary – bump in cases.
An even more contagious Omicron subvariant called BA.2 is creeping in, too. It’s caused a rise in cases in some European countries, which in the past has foreshadowed the same dynamic happening here. BA.2 was responsible for nearly 25% of new Covid-19 cases in the United States earlier this month, according to a New York Times report.
While infectious disease experts are watching the data closely, they are mixed on whether BA.2 will trigger another stateside surge. Dr. Thomas Russo, chief of infectious disease at the University at Buffalo, reflected the hopes of many of his colleagues across the country when he pointed out during an interview for this story that the United States’ significant number of Omicron infections may create an “immunity wall” that helps keep BA.2 at bay.
“We’ll see how it plays out,” Russo said. “It’s all speculative at this point.”
What can we do now?
Take advantage of this period of relative Covid-19 calm and gauge your own immunity level. Practically speaking, there isn’t a way to test for this, but a good guideline is to think in threes:
• If you are fully vaccinated and boosted (and thus, received three shots of Pfizer or Moderna, or a single dose of Johnson & Johnson plus an mRNA booster), then you have likely optimized your protection.
• Likewise, if you have been double vaccinated and had a symptomatic case of Omicron, that in itself serves as a booster of sorts. “If you’ve had a combination – you’ve had two shots and natural infection – that seems to be very, very good,” said Dr. Joseph Khabbaza, a critical care pulmonologist at the Cleveland Clinic. “Some of us in the field are just thinking about each bout of infection almost as a shot in itself.”
• If you’ve had two shots but aren’t boosted, and evaded Omicron during that surge, consider using this quieter time to get that booster shot now. “Really, it’s a three-shot vaccination,” said Russo, noting a chart in a study published last week by the Centers for Disease Control and Prevention. In this particular graphic, one line represented hospitalizations of unvaccinated people. A second line represented people who had initial vaccinations but no booster, and a third line represented those who got boosted.
When the Omicron wave hit, the unvaccinated line shot vertical like a mountain range. The vaccinated-but-unboosted line rolled upward like a hill.
The boosted line swayed up just slightly.
“That third shot really augments the immunity,” Russo said, adding that it may also decrease the chances of dealing with long-term Covid-19 effects – called “long Covid” – “because you’ve optimized protection.”
• Both Pfizer and Moderna are seeking federal approval to make fourth shots available. (Pfizer for older people; Moderna, for all adults.) If those second boosters get the green light, they are worth considering because immunity wanes over time. If you are several months out from your last shot or natural infection, your protection is likely lower.
“The farther away you are from your last immunity episode, whether it’s shot or infection, the more open you are to a breakthrough, symptomatic infection,” Khabbaza said, “but you’re very unlikely to get severely ill if you've got three of those time points.”
What about people who are immunocompromised?
“I strongly advise vaccines, third shots, boosters, et cetera,” said Segal, who is co-leader of the National Comprehensive Cancer Network’s Covid-19 Vaccine Advisory Committee. “Some protection, even if it’s not a robust response, is better than none.”
That level of caution – from vaccination to more conservative masking – also extends to those living and interacting with more vulnerable people.
“I've seen enough cases where a spouse or household member has mild Covid and transmits it to the spouse who has cancer and then it becomes a severe Covid infection,” Segal said. “These things are imprinted in my brain.”
