Earlier this summer, when i started planning my family’s first real vacation in two years, i carefully chose which national parks we were going to visit. White Sands, Arches, Bryce Canyon, Capitol Reef, Joshua Tree, and Sequoia National Park easily made the cut – lots of outdoor hikes where we could avoid people. We skipped Zion – walking through the crowds and taking the required sardine shuttle seemed too risky. My kids also really wanted to see Roswell and its aliens, but the main draw was an indoor museum. Although my husband and I are vaccinated, our two children are under 12 and are therefore not vaccinated. Since the Centers for Disease Control and Prevention had recklessly backed away his recommendations for masks in May, we kept asking, could it be safe for us to visit? How many people would there be? How many would wear masks?
The main reason for our caution and anxiety was my husband. He takes drugs that weaken his immune system. Throughout the pandemic – and particularly over the past six months, as restrictions have become increasingly relaxed – perhaps no other group has been more overlooked by Covid guidelines or more forgotten by the general public than immunocompromised people. The only reason my husband accepted our road trip was that almost all of the sites were outside. Still, it was hard not to get nervous every time we pulled up to a gas station or walked into a hotel lobby and didn’t find anyone else masked than ourselves.
We wore KN-95s, but we knew that masks offered the best protection when others around you wear them too. While many of my vaccinated friends had returned to visiting places like restaurants, bars, and fitness clubs, our family was still doing curbside delivery or pickup for most of our purchases, and the kids knew that movies or game rooms were out of the question. The change in direction of the CDC masks had made grassroots races riskier for families like ours. Hardly anyone where we live in North Texas wore face masks in stores, and with less than half of our county fully vaccinated, basic math told us not all of them were vaccinated.
This lack of consideration for immunocompromised people, on the part of public health authorities and the general public, is dangerous not only for the more than 10 million people with weakened immune systems, but also for public health in general. The Alpha variant, like Science reported in December, was almost certainly the result of infection in a immunocompromised person whose protracted battle against Covid has provided ample opportunity for the virus to evolve. Emerging evidence suggests that other variants, possibly including Delta, could have evolved in the same way, and a recent report from the UK warns of the potential for more variants to develop in the same way. Our collective national choice not to protect the most vulnerable among us is also probably a choice to prolong the pandemic.
By the time we made our trip in June, preliminary evidence suggested that my husband’s medications probably didn’t stop his immune system from responding to the vaccine, so he probably had antibodies. But we didn’t know how many, how rare breakthrough infections were, or how her body might respond to one.
Fast forward to last week: When new data on Delta transmission among those vaccinated led the CDC to tighten its mask recommendations, we felt more anger than relief. We knew you couldn’t put the genie back in the bottle. We have seen a slight increase in masking, but most people in our area still don’t as stores stopped requiring it in May. When the CDC published data explaining his decision a few days later, worried friends sent me a multitude of messages: what was the likelihood that they would contract an epidemic infection? Should they stop eating in covered restaurants? Was he still safe enough to fly?
the uncertainty and unease many vaccinated people have felt over the past week what our families and millions of others whose members are immunocompromised have experienced over the past year and a half. Except the stakes are higher now for people with compromised immune systems, given how more contagious they are and how much more contagious they are. perhaps more virulent, Delta is.
Despite the CDC messy messaging, vaccines remain highly protective against serious disease for most people. However, “mild” Covid-19 infections are not necessarily to feel gentle on infected people. While many experience something akin to a mild cold or no symptoms, others lie in bed for two to four days with an illness. “on par with debilitating food poisoning”, As Susan Matthews recently wrote in Slate. If this is what some healthy people experience, what does a breakthrough infection look like for people who are immunocompromised? It could be much more serious whether or not they have antibodies to the vaccine.