Since the start of the pandemic, medical and public health professionals have highlighted the need to protect the immunocompromised. People who have had organ transplants, chemotherapy, immunosuppressive medications, and chronic health conditions such as diabetes are at great risk of severe complications or death following Covid-19 infection. Many of these people are also unable to mount sufficient antibodies following vaccination, leaving them extremely vulnerable.
While talking about how to protect the high-risk members of society, some have offered medical advice. There is hope that multiple rounds of vaccine and the emergence of pre-exposure monoclonal antibody regimens can afford protections, but this is still speculative. While scientific advancements improve the outlook, the current status is that many people – an estimated 1 in 37 adults – are still at extreme risk. Missing from the narrative on “protecting the vulnerable” is exactly how to help the immunocompromised with functions of daily living.
Given that vaccinated people can become infected and transmit the virus, many immunocompromised people and their family members cannot risk public outings. Many have faced medical- and pandemic-related unemployment. Their children have not been able to participate in sports or play with other children. Because Connecticut did not require districts to provide a remote school option for the 2021-22 school year, their children have not had formal education in two years.
I am one of the 7 million Americans who is immunocompromised. I am also a professor of public health at Yale.
In public health, we quantify health outcomes in a variety of ways, including indices for one’s ability to function in daily life. That means the ability to attend school, work, navigate public settings, and participate in society. For people whose immune systems are so degraded that they would likely die if infected with Covid-19, going into public among unmasked and potentially unvaccinated people is tantamount to a game of Russian Roulette. Inconsistently enforced or absent mask mandates make this threat more pronounced.
To truly “protect the vulnerable,” society must make accommodations. That means really examining what daily life is like for the immunocompromised and our families, and problem-solving ways to help and protect us. Unfortunately a lot of what has been offered has amounted to empty rhetoric with no practical solutions. In fact many of our lifelines, such as access to remote education, have been terminated as the rest of society hurtles toward a full return-to-normalcy.
If the larger narrative is that it’s time to return to normal, then it is absolutely critical that accommodations be made to protect the vulnerable. If you want to drop the mask mandate for schools, fund remote education. Mandate masks in pharmacies and other vaccine locations – or provide at-home vaccinations. Require masks in grocery stores – or pay for delivery services for food, medicines, and other essentials. Enforce mask mandates in any office building housing a medical provider, or fund at-home medical visits.
It is insufficient to assert that “we must protect the vulnerable” without providing practical strategies, services, and education. Otherwise, “protect the vulnerable” reads as an afterthought – because it is.
Marney White of Fairfield is a Professor at the Yale School of Public Health