Life after Covid: The people who will re-enter society last
(CNN)Danielle Seal likens going for a walk during the pandemic to an extreme sport.
"When I go [and walk] the dog I have to ask people to stay two meters
away," she told CNN. "And that's what really upsets me. If you try and
squeeze past me, you are putting my life in danger. Going for a walk is
an adrenaline-seeking extreme sport."
Seal
has Common Variable Immunodeficiency Disorder (CVID), a type of primary
immune deficiency (PID). This means that her body does not produce
protective antibodies to defend itself against pathogens like bacteria
or viruses, leaving Seal and others like her extremely vulnerable to
infections -- even without a global pandemic.
The
45-year-old has taken extreme care during the crisis to avoid
contracting Covid-19, but her situation is unlikely to change in the
long-term, even as governments fixate on the glimmer of hope provided by
vaccines against the coronavirus.
Tentative
optimism has emerged about an exit route from the crisis as multiple
forms of Covid-19 shots are rolled out across the UK and Europe.
UK
Health Secretary Matt Hancock has pledged that every British adult will
be offered a Covid-19 vaccine by the autumn of 2021, following pressure
to ramp up vaccination as cases in the country continue to rise, with
more than 3.7 million infections reported to date.
But
while most people will benefit from Covid-19 vaccines, those with
impaired immune systems, like Seal, may not respond to them in the same
way as their peers.
"Many
individuals who are clinically extremely vulnerable will have some
degree of immunosuppression or be immunocompromised and may not respond
as well to the vaccine," reads the advice from Britain's Joint Committee
on Vaccination and Immunisation (JCVI.)
This
is because vaccines are designed to generate an immune response from
the human body, by causing it to produce antibodies and T-cells that
help fight specific infections. But for people with immune deficiencies,
the body may just make a few of these antibodies or T-cells — or none
at all — leaving them vulnerable to infection.
Seal's
body struggles to make antibodies, meaning vaccines are unlikely to
provide her with enough protection. For this reason, she plans to shield
for the long haul, even as the vaccine rollout intensifies.
The
UK drug regulator MHRA has approved three Covid-19 vaccines, one from
BioNTech/Pfizer, another from Oxford/AstraZeneca and a third from
Moderna. All three vaccines are safe for people with impaired immune
systems to take, but they are advised to continue to shield even after
inoculation given that they may not develop immunity to the coronavirus.
"Those
who are clinically extremely vulnerable should continue to follow
government advice on reducing their risk of infection," the JCVI advice
reads.
"I'm
happy to have the vaccine, 100%. [But] it won't really do much for me,"
Seal told CNN. "It's unlikely I'll get antibodies, looking at other
vaccines [I've had]. But I'll have it."
Doctors
gave Seal the pneumococcal vaccine, also known as the pneumonia shot,
when diagnosing her with CVID to test her body's response to the
vaccine. A blood test four weeks later found she had not created any
antibodies in response to it. She was later diagnosed with CVID.
'I can't give my son a hug'
Due to her condition, Seal has worked from home as an IT consultant since before the pandemic.
Since
March 2020, she has stayed largely indoors in her home in Peterborough
in the UK. Her partner does the grocery shopping and walks their dog.
The
mother of two does visit her allotment, which she says has helped her
cope amid the crisis. "It kept me sane," she told CNN, adding that she
has found it easy to socially distance from others in the outdoor space.
Seal
shares her condition with her 19-year-old daughter Ella Lamy, who lives
with her. Lamy was meant to begin university in September 2020 but
delayed her studies for a year due to the pandemic. She, too, has
largely stayed at home since spring 2020, working remotely in a customer
service role.
"I've
had friends of mine who I don't want to be friends with right now," the
teenager told CNN, explaining that they "try to justify" breaking
social distancing rules. Lamy added that she misses her best friend and
her boyfriend, who she has not seen regularly since last August.
Seal's
21-year-old son used to split his time between her household and that
of her ex-husband, but since March he has been living full time with his
father.
"I
haven't lived with [my son] since March," Seal said. "I see him, and I
can't give him a hug. Even when we're not in lockdown I can't give him a
hug."
Seal
says that her and her daughter's ability to return to normal life
depends on the willingness of others to abide by the UK's lockdown
restrictions and to take the vaccine. This will help Covid-19 infection
rates fall in the community, making the pair less likely to become
infected.
"We need to depend on other people taking the vaccine," Lamy told CNN.
Promising research
According
to the British Society of Immunology around six million people
worldwide have a PID, with around 5,000 estimated to be living in the
UK.
Added
to this group are others with vulnerable immune systems, such as organ
transplant recipients and cancer patients. The UK's NHS says it
facilitated nearly 4,000 transplants between 2019 and 2020 alone.
But
Beate Kampmann, professor of pediatric infection & immunity at the
London School of Hygiene & Tropical Medicine (LSHTM) and director of
LSHTM's vaccine center, highlights that "not every immunocompromised
person will be the same." This means some may produce antibodies while
others do not produce any. "Being immunocompromised is a huge spectrum,"
she said.
Kampmann
believes that those with impaired immune systems should have their
immune responses to other vaccines such as tetanus examined, to see
whether their bodies manage to produce antibodies across the board.
"Studies
[also] need to be done on the [Covid-19] vaccine immune response in
these groups of people and this could be used to inform strategies," she
said.
David
Salisbury, a former director of immunisation at the UK's Department of
Health and associate fellow at Chatham House, points to the potential of
other treatments for this group, such as the possible use of monoclonal
antibodies against Covid-19. These could enable people like Seal and
Lamy to re-enter society, he believes.
"There
are things coming that we can be hopeful about," Salisbury said. "But I
think we are in it for the long haul. There's still a lot to do."
Monoclonal
antibodies are proteins made artificially in the lab that mimic the
ability of your immune system to fight off pathogens like viruses,
offering immediate protection.
Unlike
vaccines, which train the immune system itself to produce antibodies,
these are injected directly into the blood to fight off particular
infections, according to researchers at University College London
Hospital [UCLH.]
Several
studies on monoclonal antibodies are underway worldwide. In the US, the
FDA has also granted emergency use authorization for Eli Lilly's
monoclonal antibody, bamlanivimab, for the treatment of people in the
early stages of Covid-19.
In
the UK, the country's flagship Recovery trial is exploring multiple
potential treatments for Covid-19, including monoclonal antibodies,
while teams at UCLH are leading two trials focused on monoclonal
antibodies — with one trial including people who may not respond to
vaccines.
UCLH
is currently recruiting for this trial, called PROVENT, which will
research the effect of two investigational monoclonal antibodies in
protecting against Covid-19 in people who may not respond to vaccination
or are at increased risk of Covid-19 infection
"We
will be recruiting people who are older or in long-term care, and who
have conditions such as cancer and HIV which may affect the ability of
their immune system to respond to a vaccine," UCLH infectious diseases
consultant Dr. Nicky Longley said in a press release in December 2020.
"We want to reassure anyone for whom a vaccine may not work that we can offer an alternative which is just as protective."
'Cocooning' to protect the vulnerable
Fiona
Loud, policy director of Kidney Care UK believes that the best way
forward for vulnerable patients is for them to have the vaccine — as
they may generate a partial immune response — as well as the people they
are in close contact with.
Loud
works with kidney patients and herself received a kidney transplant 14
years ago. She told CNN that she hadn't hugged her adult daughter for
nearly a year, and did not see her over the Christmas break.
The
strategy she suggests is called cocooning, where those around
vulnerable individuals are vaccinated in order to provide indirect
immunization.
The
JCVI has said that this strategy may be examined in the future, but
that it first needs sufficient evidence on the effect of Covid-19
vaccines on transmission. It is currently unclear if any of the vaccines
prevent transmission.
This
data will be gathered as vaccines are rolled out and the world hopes
for society to reopen. But most of those with impaired immune systems
will continue to shield, awaiting the findings and otherwise dependent
on the actions and health of those around them.
"What we would say to the public is: Please be empathetic," said Loud.
Ella Lamy had just finished school when the pandemic struck.
"I was [meant to] start my life," she told CNN. But now, "my life literally depends on the actions of other people.
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