What You Need to Know About Being Immunocompromised During COVID-19

Man putting on a face mask while looking in the mirror

For many, living with a weakened immune system means a higher chance of illness and infection — and not just during a global pandemic. But with so many unanswered questions about COVID-19 (the disease caused by the new coronavirus), how can you protect yourself?

“It’s still so early on, and there’s lots of information still coming in about what the risks are to patients with various types of immune suppression,” says David Porter, MD, director of cell therapy and transplantation at Penn Medicine. “While we don't know enough yet, we do know that these patients really need to err on the side of caution given the risks.”

Dr. Porter breaks down what you need to know about being immunocompromised during the COVID-19 pandemic.

What Does Immunocompromised Mean?

Think of your immune system as a strong army. Its mission? To protect you from enemies both foreign (viruses and bacteria) and domestic (diseases like cancer). But when you’re immunocompromised, your immune system’s defenses are low, affecting its ability to fight off infections and diseases.

Depending on why your immune system is compromised, this state can be either permanent or temporary. Dr. Porter says these five things can weaken your immune system:

1. Chronic diseases

Certain conditions, such as HIV and AIDS, destroy immune cells, leaving your body vulnerable to other attacks. Autoimmune conditions turn immune cells into double agents that fight against your own healthy tissues. Common autoimmune diseases include:

  • Lupus
  • Rheumatoid arthritis
  • Type 1 diabetes

“Even well-controlled diabetics are immunocompromised to a degree,” says Mark Schutta, MD, an endocrinologist and medical director at Penn Rodebaugh Diabetes Center. “Simply having an infection can also raise blood sugars and give rise to additional infections. And immunity can get disrupted by high blood sugars. It’s a circular problem.”

Conditions like asthma can also affect your immune system because they cause it to dangerously overreact to harmless substances.

“Leukemia or lymphoma are also diseases of the immune system,” notes Dr. Porter. “They are white blood cell diseases, and white blood cells are needed to respond to infections.”

2. Medical treatments

Some cancer treatments weaken your immune system as they destroy cancer cells. And if you have an autoimmune disease, a suppressed immune system is the desired result.

“Since a patient’s own immune system is revved up and attacking various parts of the body, the treatments for autoimmune diseases are often medicines designed to weaken the immune system,” explains Dr. Porter.

This process may spell double-trouble, as it could make you more prone to getting COVID-19 and put you at higher risk for severe illness. It may also limit your body’s ability to make antibodies that could be needed to clear the infection.

Such treatments include long-term use of corticosteroids and therapies like biologics and disease-modifying antirheumatic drugs (DMARDS).

3. Organ or bone marrow transplant

You’re more susceptible to infection in the first weeks after a bone marrow transplant because you don’t have many white blood cells. If you’ve had an organ or bone marrow transplant, you also need to continue to take medication to suppress your immune system. These kinds of medications, also known as anti-rejection drugs and immune suppressants, help your body accept the new cells and prevent the new immune cells from attacking your normal tissues.

4. Age

“People can develop underlying conditions or medical problems as they get older,” Dr. Porter says. “And sometimes, their immune system doesn't respond normally to infections because it doesn’t work as well as a younger person’s. Therefore, they may get sicker when they have the flu or COVID-19.”

5. Smoking

“People who are smokers tend to get sicker from infections,” notes Dr. Porter. “It may be that smoking impacts the immune system’s ability to respond appropriately.”

COVID-19 is a respiratory disease, meaning it attacks the nose, throat, and lungs, in addition to other organs. Smoking damages the lungs, so those who smoke also may not have enough healthy lung tissue to withstand the virus.

How Underlying Conditions Affect Your Coronavirus Risk

A recent report from the U.S. Centers for Disease Control and Prevention (CDC) added fuel to the fire that weakened immune systems are more susceptible to COVID-19. It stated that:

  • Half of COVID-19 patients with diabetes needed hospitalization.
  • 78 percent of patients in intensive care had at least one underlying health problem.
  • 71 percent of those needing hospitalization for COVID-19 (but not intensive care) had at least one underlying health issue.

“People with weak immune systems may not be able to fight COVID-19 as well as others,” notes Dr. Porter. “They may not have the immune response needed to fight it off in its beginning stages. Their ability to make antibodies may also be limited, so they may not be able to clear the virus once they get infected.”

But Dr. Porter emphasizes that we still don’t know enough to be sure. For example, another hypothesis suggests the exact opposite — that an overactive immune system causes the lung damage and pneumonia seen in the sickest COVID-19 patients.

“Called cytokine release or a cytokine storm, it’s when an activated immune system releases chemicals called cytokines. Cytokines are effective when the response is measured. But they can also cause tissue damage when it’s too strong — like the kind that’s causing so many problems and leading to death from lung infections,” relates Dr. Porter.

“There’s a possibility that certain patients whose immune systems aren’t as strong are less susceptible to these complications. It’s also possible that patients are responding and reacting differently, depending on their underlying medical conditions and the strength of their immune systems,” he adds.

How to Protect Yourself From COVID-19 If You’re Immunocompromised

Both Dr. Porter and Dr. Schutta feel your first line of defense should be doing everything you can to avoid exposure and infection. That means it’s critical to follow CDC’s recommendations, including:

  • Staying home and avoiding other people
  • Remaining six feet away from others (social distancing) when you do have to go out in public
  • Washing your hands regularly with soap and water for at least 20 seconds (or using a hand sanitizer that’s at least 60 percent alcohol when hand washing isn’t possible)

Dr. Porter also cautions that people should keep taking their immune-suppressing medications. “If you stop taking them, you leave yourself susceptible to potentially life-threatening medical problems.”

If you do become sick or you just aren’t sure what you should do, Dr. Porter says you should have a conversation with your health care provider. “You can talk to them over the phone or video conference. They can give you advice about your specific situation and next steps if you’re experiencing symptoms.”

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