Immunocompromised should take action

Back in March, I wrote a blogpost about the precarious situation of immunocompromised people in Ontario and elsewhere. Many of them are seniors with aging immune systems. Now they’re in even more danger, with the protection mandates nearly all stripped away, COVID hospitalizations climbing and new variants looming. The unstated policy is simply that people should go back to business as usual, and the immunocompromised should get out of the way.

The onus is on this high-risk, vulnerable population to protect themselves: wear masks, stay away from crowds, curtail their social activities, and muddle through on their own. Why is it up to the victims to come up with the solutions and make all the sacrifices? Government policies are restricting their freedom of action and endangering their health. Yet Canada has a Charter of Rights and Freedoms, and equality rights are at the core of it. They are intended to ensure that everyone is treated with the same respect, dignity and consideration, regardless of personal characteristics such as race, national or ethnic origin, colour, religion, sex, age, mental or physical disability, sexual orientation, residency, marital status or citizenship. Immunocompromised people are entitled to the same respect, dignity and consideration as everyone else.

Immunocompromised people are a small minority group, and a diverse one. Maybe it’s time to make them harder to ignore. Here are some concrete actions they could take or lobby for:

• Create an advocacy group, to speak with one voice. Then people with lupus and multiple sclerosis and leukemia and transplants don’t have to fight separately for the same protections.
• Lobby for mask mandates in all healthcare facilities. Immunocompromised people have to go to these places, and should not be put at risk when they do.
• Mask mandates should be strictly enforced wherever they are in place. If a patient enters the doctor’s waiting room holding a Kleenex over his face, or wearing a mask under his chin – both of which I’ve seen in my own doctor’s waiting room – he should be handed a proper mask and told to put it on immediately and keep it on. If he refuses, his appointment should be cancelled and he should be sent out of the waiting room.
• In healthcare facilities, HEPA filters should be running in all the patient areas, including the waiting rooms.
• Social distancing should be maintained in waiting rooms; bookings should be carefully arranged to accommodate this.
• Immunocompromised patients should have access to free antibody testing, so they can find out if they’re getting any benefit from vaccines.
• Authentic, approved N95 and KN95 masks should be readily available at low cost to all immunocompromised patients. They should be classified as an assistive device, since they enable mobility, and they should qualify under existing programs like Ontario’s Assistive Devices Program, or the one operated by the March of Dimes. Alternatively, they should be made available on prescription.
• Evusheld provides ready-made antibodies to immunocompromised people on a short-term basis. Ontario guidelines are still following the original FDA guidelines for 150 mg of tixagevimab and 150 mg of cilgavimab. But back in February, the FDA found evidence that this dosage was insufficient, and doubled it to 300 mg of each drug. Ontario still has not upgraded the dosage and should do so immediately. Further, the FDA now recommends that Evusheld should be administered every 6 months. Ontario needs to upgrade its guidelines to accommodate the new evidence.
• Evusheld should be made available to all leukemia patients, not just patients in active treatment. The action of the disease itself makes leukemia patients just as vulnerable as those in active treatment.
• Cancer centres and other facilities treating immunocompromised patients should be proactively advising their patients what they need to do, when, and where to get the treatments they need. Patients should not have to call around to find a source for Paxlovid, a medication to treat immunocompromised patients with COVID symptoms; it has to be administered in the first few days after symptoms appear.
• If new variants emerge which evade Paxlovid and Evusheld, and replacement medications are developed, Health Canada should act promptly to approve them. Health Canada does not run tests on these medications; they just review the existing evidence, usually the same evidence that the FDA has reviewed. Vulnerable immunocompromised patients should not have to wait for months for Health Canada to approve what the FDA has already approved.
• Try a Charter challenge. It’s a matter of social justice.