BY now, all of us are familiar with Covid-19 standard operating procedures (SOP). Face masks are part of daily attire, hand sanitisers are carried everywhere and, as a general rule, crowded and enclosed places are avoided.

Despite being fully vaccinated, we know that these SOP are key to preventing disease. But what about those with underlying medical conditions or individuals who are immunocompromised?

The coronavirus poses a higher risk to certain groups. Would standard precautions be adequate for these individuals? Should they avoid leaving home at all and avoid contact with those who are actively going out?

Immunocompromised individuals are those who do not have a properly functioning immune system. Naturally, the fear of contracting Covid-19 weighs heavily on them. They are already prone to acquiring infections that are normally not seen in normal individuals.

Examples of these individuals include those born with immunodeficiency disorders, people who are afflicted with HIV, or those with poorly controlled diabetes mellitus, chronic kidney disease and physiological conditions, such as the elderly.

Universiti Malaya Medical Centre head of rheumatology Professor Dr Sargunan Sockalingam says immunocompromised individuals are a high-risk group for mortality and morbidity where Covid-19 is concerned.

MORE VULNERABLE

These individuals may already have tissue and cellular damage that enables easy entry of the virus, especially in the respiratory tract and alveoli of the lung, he explains.

There is also the risk of their immune system getting "confused" and attacking their own tissues, such as blood cells and blood vessels, as if those tissues are foreign organisms.

This process is called an auto-inflammatory response and can have devastating consequences. This can happen in people with coexisting lung diseases, poorly controlled diabetes, cancer patients on chemotherapy, patients on steroid therapy, the elderly and obese should they contract Covid-19.

Cancer patients are among those who fall in the immunocompromised category. Picture: Created by freepik- www.freepik.com
Cancer patients are among those who fall in the immunocompromised category. Picture: Created by freepik- www.freepik.com

Dr Sargunan adds that at the moment, there is no registry of immunocompromised individuals in Malaysia. To ascertain this, the government should start a nationwide registry and data collection system.

What we have is data from other countries such as South Korea. A recent nationwide study in that country found that 13.5 per cent of Covid-19 patients are immunocompromised.

"We can assume that we have similar numbers in Malaysia. This is a significant proportion. Unfortunately, it is this group that will suffer a higher mortality rate."

The good news is that regular SOP are generally sufficient to protect this group.

However, it is also advisable for them to limit interactions with others to a level that minimises or completely eliminates the potential for transmission, explains Dr Sargunan.

"We do know that prolonged conversations or speaking loudly can transmit the virus more easily. Having access to face masks and sanitisers does not make it all right to stay in crowded places and public events for prolonged periods."

Dr Sargunan says immunocompromised individuals are a high-risk group for mortality and morbidity.
Dr Sargunan says immunocompromised individuals are a high-risk group for mortality and morbidity.

STRIKING A BALANCE

However, isolation can have an effect on mental health. Therefore, there must be a balance, stresses Dr Sargunan. In addition, family members of immunocompromised individuals should take extra precautions themselves and participate in their care.

But should immunocompromised individuals avoid leaving home unless absolutely necessary?

Dr Sargunan says the answer to that is yes. Until we find a way to protect them from the virus, it will be important to limit their interactions with others.

There are a number of things that can be done. One is to ensure that everyone in the family, including the immunocompromised individual, is fully vaccinated against Covid-19.

The next step is to identify their friends and colleagues who are considered high risk (for example healthcare professionals and frontline workers).

As these people can potentially infect them, it's best for the immunocompromised to minimise contact with them although this can be difficult to do sometimes.

Vaccination is also crucial for immunocompromised individuals, adds Dr Sargunan, since it is the only available method (for now) to develop some immunity against Covid-19.

"They may not be able to mount an antibody response as adequate as people who are immunocompetent. Therefore, in my opinion, booster doses (at least one) are also important."

There may be many concerns about the vaccines being harmful to immunocompromised individuals, but experience so far has shown that they are safe and, in fact, may have prevented many more deaths from Covid-19.

Booster doses of Covid-19 vaccines are important for the immunocompromised. Picture: Created by tirachardz - www.freepik.com
Booster doses of Covid-19 vaccines are important for the immunocompromised. Picture: Created by tirachardz - www.freepik.com

PROTECTING YOU

THE human body is equipped with a sophisticated immune system that is able to detect harmful organisms that have gained entry.

After detection, various cells will coordinate to destroy these harmful invaders which could be bacteria, virus, fungi and parasites. The immune system can also inactivate toxins from microorganisms.

Unfortunately, this amazing capability is not always possible in an immunocompromised individual.

The World Health Organisation recommends that those with weaker immune systems be offered an additional dose of authorised Covid-19 vaccines.

Keep yourself masked up. Picture: Created by tirachardz - www.freepik.com
Keep yourself masked up. Picture: Created by tirachardz - www.freepik.com

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