Under the bus

March 30, 2022

It all happened in a flash. Suddenly, there are no more mandates for masking, vaccine certificates, social distancing or isolation requirements, and testing and case reporting are strictly limited. We’re behaving as if Covid were over. But of course, it’s far from over. As of March 29, there were 790 people with Covid in Ontario hospitals, up from 655 the day before, and 9 new deaths. A deadly new wave that has been sweeping through Europe and Asia is just beginning to appear here. In the headlong rush to get back to normal, people don’t want to hear about this. But if you’re immunocompromised, you’re worse off now than ever. Your body may not respond to the vaccine, so you wear a good mask, try to keep your distance and stay home a lot. You used to have more protection when everyone else was wearing a mask, getting vaccinated, and keeping their distance too. But that’s all gone now, and you’re on your own.

Who are the immunocompromised? They’re people with weakened immune systems. People with HIV, organ transplants, blood cancers, diabetes, malnutrition and certain genetic disorders; people receiving chemotherapy, radiation therapy, or high-dose corticosteroids for diseases like rheumatoid arthritis, lupus and vasculitis. Seniors are immunocompromised too, even if we don’t have those disorders. Our immune systems become more and more impaired the older we get. That puts us in double jeopardy: we’re more likely to be hospitalized or die because of Covid, and we’re also less able to mount a robust response to the vaccine. Most of us have happily gone to get booster shots, and then believe we’re protected from severe disease, and many of us may be, but which people? Some older seniors with complex medical conditions living in long-term care might not get enough protection through the vaccine, but what if you’re a younger, community-dwelling senior, maybe with diabetes? There’s no simple algorithm or diagnostic test to determine the status of your immune system. But if you have reason to worry, there are a few things you can do. You can ask your family doctor for a requisition for an immunoglobulin blood test, which helps diagnose immunodeficiency. Once you’ve had your Covid booster, you can wait for a few weeks, then ask your doctor for a requisition for a Covid antibody test; in Ontario, you have to pay for this test.

Don’t assume that you’ll have a mild case of Covid if you catch the omicron variant. Emerging data indicates that, for the immunocompromised, the risk of death from omicron is as high as it was with earlier variants. If you can verify that you are immunocompromised and you come down with Covid symptoms, there are some things you have to do in a hurry. You need to have a positive Covid test, find a clinic that offers monoclonal antibody or oral antiviral treatment, get a referral from your doctor, and get yourself to the clinic within five days of symptom onset. And you have to do all this while you’re sick! There aren’t many clinics; check the referral form for the current list of clinics and figure out in advance where you would go. There’s a new long-acting monoclonal antibody medication called Evusheld that can be used for Covid prevention in immunocompromised people. It was approved in the United States in December 2021, but it is still awaiting approval by Health Canada. Canada has signed a conditional agreement to buy 100,000 doses once it is approved. That won’t go very far, and it’s taking too long, but it’s a step in the right direction.

What would an equitable public health system look like? Its mission would be to protect the health of the whole population, particularly the most vulnerable. It would ensure that monoclonal antibody treatment and prophylaxis for the immunocompromised were approved, and adequate supplies made readily available, before lifting all the Covid mandates. Robust testing, tracking and public reporting would remain in place. Mask mandates would be encouraged during dedicated time slots in essential spaces like grocery stores and pharmacies. Employees across the province would have at least one week of paid sick leave, so they wouldn’t feel obliged to go to work sick. Where possible, people would have the option of continuing to work from home to protect their health, and virtual access to doctors and other service providers would be maintained. Building codes would be amended to provide for a higher standard of ventilation, and windows you can open. An equitable public health system would never simply abandon a vulnerable group like the immunocompromised to their fate, so that younger and healthier people can go back to the way things were.

But everyone is sick and tired of Covid. Businesses are eager to recoup their losses. Nobody wants to see those truckers again. There’s a provincial election coming in June, so the economy has to be booming. The immunocompromised are a minority group, without the clout to sway elections. Many people see us as a burden, one that Covid could neatly eliminate. We are deemed to be disposable, at very little political cost. So they threw us under the bus.