New vaccine guidelines call for people who are immunocompromised to get their 4th vaccine shot earlier than previously was recommended — but that’s not the only advice one Utah doctor had this week.
“These are people that work in the community. These are students. These are teachers. These are children. They’re really everybody. And it’s very common to have someone in your life with a major immunocompromising condition, especially among patients who may not share that information,” said Dr. Hannah Imlay, a professor of infectious diseases who specializes in immunocompromised patients at University of Utah Health.
That includes patients with illnesses that impair the immune system as well as patients who have received drugs that affect their immune system — for example, chemotherapy, medications for organ transplants, and even steroids, Imlay said.
For the tens of thousands of immunocompromised Utahns, COVID-19 poses a double whammy, Imlay explained: Not only are they more at risk of being hospitalized or dying from the virus, just like others with underlying medical conditions are — they also derive far less immunity from the vaccine than others do.
“This is an important patient population, and to only focus on, ‘Those patients should protect themselves, I’m not going to do anything myself to protect some of our community members,’ is really, really a problem,” Imlay said.
Imlay outlined some new recommendations for immunocompromised Utahns to stay safe, and for the rest of the state to help protect them.
1. Get a fourth vaccine shot even earlier.
The Centers for Disease Control and Prevention this month updated vaccine recommendations for immunocompromised patients. For months, all immunocompromised people ages 5 and older have been advised to get a three-dose initial course of the vaccine, versus the two-dose course recommended for the general population — and a fourth, booster dose has been recommended for patients 12 and older.
But the CDC this month shortened the recommended time between the third vaccine dose and the booster, down to three months as opposed to five months.
That means if you’re immunocompromised and received your third dose mid-November or earlier, “you’re due for your fourth dose now,” Imlay said.
Patients do not need a doctor’s referral to get that booster, Imlay said; they just have to “self-identify” as immunocompromised.
But, she warned, federal recommendations for boosters have shifted as researchers learn more about the virus, and “there’s a lot of information and misinformation and confused information out there about who is due for what, when.”
“So I cannot promise that every commercial pharmacy has updated their ... scheduling so that people can receive that fourth dose. However, they should in in the near future,” Imlay said. University pharmacists have received the updated recommendation and are providing the fourth dose, Imlay said.
At present there isn’t evidence that the general population needs a fourth dose, or that the booster schedule should be accelerated as it has for immunocompromised people, Imlay said. Even people who are at elevated risk of serious illness probably had a sufficient immune response to the vaccine schedule recommended for “immunocompetent,” she said.
But, she noted, “if you are willing to say you’re immunocompromised, I believe you could get the fourth shot.”
2. Speak with a doctor about antibody treatments for immunocompromised people, even if you haven’t tested positive for COVID-19
In December, federal regulators approved Evusheld, a dual-antibody treatment that can protect immunocompromised patients from developing COVID-19 symptoms if they receive it before they’re exposed to the virus. The treatment consists of two shots, each one containing different monoclonal antibodies, and “can provide protection that may last six to 12 months — so a long duration of prevention,” Imlay said.
There are some caveats, Imlay noted. The treatment was largely developed and studied before vaccines were in wide use and also before the omicron variant became the dominant strain of the virus.
“While we know how this works in the test tube against omicron — and we know that it doesn’t work as well as it did against previous variants — we do not know and we have not studied it in people against omicron specifically,” Imlay said. “It looked like it prevented pre-omicron variants to a quite high degree, but what we don’t know is how well will it protect patients in the omicron era — or for variants that may still be coming.
“I still do recommend my immunocompromised patients receive this antibody, and I absolutely recommend that they discuss it with their physician.”
Imlay also noted that the treatment’s federal approval was for “emergency use,” which means doctors and patients together should weigh the risks and benefits of it.
3. Seek monoclonal antibody treatment as soon as possible after testing positive
Utah was increasingly rationing its supply of monoclonal antibodies as coronavirus cases proliferated in January, but cases have declined — and a number of immunocompromising conditions automatically qualified patients for the treatments even when they were at their most scarce.
“Early therapy, which are now more and more widely available, are absolutely what I would recommend for patients who are immunocompromised and patients who are immunocompetent but are at high risk of bad outcomes if they get SARS-CoV-2,” Imlay said.
To check your eligibility and find a provider, visit https://coronavirus.utah.gov/noveltherapeutics/.
4. Update your mask collection — whether you are immunocompromised or not
“There’s more availability of high filtration masks, and so high-grade masking — especially when you’re out in public in an indoor setting with other people is absolutely recommended,” Imlay said.
Look for N95 or KN95 masks, she said, with an eye to three criteria:
“Fit, filtration, and can you actually wear it for a long period of time? Because if it’s uncomfortable and you take it off, it’s giving you no protection whatsoever,” she said.
5. If you are not immunocompromised, consider the risk of COVID to those who are — and act accordingly
“This is truly a vulnerable population that’s out in our community. These patients are working jobs just like everybody. They’re going to school just like everybody,” Imlay said. “But it’s really a population that needs to be protected by the rest of our actions.”
The most crucial of those actions are:
• Getting the COVID-19 vaccine and boosters “to prevent yourself from getting infected and shedding high viral loads,” Imlay said.
• Wearing “high-grade, functioning” masks.
“Using as many layers of protection as we possibly can ... really helps decrease both the incidence of SARS-CoV-2 in our community and also the number of patients who are getting severely sick or dying and who are leaving our community too soon,” Imlay said. “Respect everyone in our community and protect everyone in our community.”
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