The easing phase of the pandemic requires caution from immunocompromised patients

Amid the relaxation of protective measures against the coronavirus, people with compromised immune systems should still not dispense with care taken in the pandemic, experts say. They form a group more susceptible to the most serious forms of the disease and the so-called long Covid.

These issues were discussed at the Covid Risks in Vulnerable Patients seminar, held by the Sheet on August 30th. The meeting was sponsored by the pharmaceutical company AstraZeneca and mediated by Victoria Damasceno, the newspaper’s Equilíbrio editor.

Lígia Camera Pierrotti, an infectious disease specialist at the Hospital das Clínicas at USP, says that individuals with compromised immune systems need to be cautious in the current scenario of flexibility.

“They must have individual protection measures, mainly because, in case of illness, we do not have them available on the SUS network. [Sistema Único de Saúde] antiviral and immune therapies for those who have an infection.”

Antiviral therapies inhibit the replication of the virus that causes Covid, while immunological ones neutralize the virus and prevent it from entering the cell.

The group of vulnerable patients is formed by people undergoing chemotherapy, transplanted, with congenital diseases, on hemodialysis, with leukemia, among others. Because of the treatment or the disease itself, these people have a compromised immune system, which makes them more vulnerable to certain pathologies.

Pierrotti adds that the protection that vaccines provide to immunosuppressed patients is lower than that recorded in the general population.

“This is not to say that vaccination is not good, but [a proteção mais baixa] sends a clear message that this population deserves additional care”, she says. In the case of people undergoing cancer treatment, the risk of death from Covid is six times greater than the global average, according to a study published by the Journal of Clinical Oncology in 2021.

Director of the Hospital do Rim at Unifesp (Federal University of São Paulo), José Osmar Medina says that the fatality rate of the coronavirus among transplanted individuals is ten times higher than that of the general population. “For transplant patients, Covid was a disaster. The situation we faced in hospitals was dramatic.”

In addition, only 15% show an immune response when they receive the first dose of vaccines, while in the rest of the population this rate reaches 90%. The data are from a survey by Hospital do Rim published in the scientific journal Transplantation.

The specialist says that the response to immunizations in this group is lower because of the drugs used to prevent the body from rejecting the transplant.

Watch the full seminar

In addition to a higher risk of death from the disease, vulnerable patients are more susceptible to the so-called long Covid, a condition that occurs when the person has persistent problems after the initial infection.

“These are patients who spend weeks or months with the active virus. They need care for a long time and continue to transmit the virus for a long time”, says Nelson Hamerschlak, a hematologist at Hospital Albert Einstein.

He adds that patients in remission (whose disease is under control) also cannot give up care. The specialist says that, depending on the disease, the person can have a weakened immune system for long periods even after remission.

“An example is the patient who had a bone marrow transplant. He may have recovered his red blood cells, but he may have low immunity for years”, he says. “Even with remission, care must be maintained.”

Hamerschlak adds that, in the case of vulnerable patients, the return to normality needs to happen individually, since each person has a different level of immunosuppression. There are patients who, he says, respond better to vaccines and those who do not have such aggressive treatments for the immune system.

“Each patient should discuss with their doctors whether they should take more or less care. The vulnerable must have some kind of social interaction, but common sense is needed in these situations”, says the doctor.

Germaine Tillwitz, 38, has been treating metastatic breast cancer for about six years. Therefore, she still needs to redouble care against Covid. The lawyer says she has returned to frequenting restaurants, but chooses open and uncrowded environments.

When undergoing chemotherapy, he prefers to go out when he knows his immunity is not so low. “The pandemic exacerbated the feeling of loneliness. When releases began, the vulnerable patient remained in isolation. Many reported depression and increased anxiety.”