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Living with diabetes or leukaemia in endemic Covid-19: How high-risk individuals can continue to protect themselves
For the immunocompromised who are unable to be vaccinated or develop an adequate immune response, new treatments may offer added protection against the virus
72-year-old retiree, Mr Jimmy Ong, has lived with Type 1 diabetes for 43 years and remains cautious even as the pandemic blows over.
PHOTO: ASTRAZENECA
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In a world where many have resumed pre-pandemic activities, Mr Jimmy Ong remains cautious.
The 72-year-old retiree, who currently lives with his youngest son and is a grandfather to five, has lived with Type 1 diabetes for 43 years. This puts him in a vulnerable category of individuals who are immunocompromised or have an impaired immune system, and require extra precautions against Covid-19.
Throughout the pandemic, he recalls having to significantly change his health management and daily living, which took a toll on his well-being.
“I had to be extra careful about how I live my life, including avoiding crowded places, continuously wearing a mask, and limiting how often I see my friends and family to protect myself,” says Mr Ong.
Risks for the immunocompromised
Dr Leong Hoe Nam, infectious disease specialist at Mount Elizabeth Novena Hospital, says that while vaccination is the body’s primary defence, as many as 50 per cent or more of immunocompromised individuals may not be able to mount an immune response.
This includes those who have underlying health conditions or are taking immunosuppressive drugs for medical conditions such as blood cancers, and those undergoing active chemotherapy, dialysis or an organ transplant. These conditions can lower immunity and reduce the ability of white cells to fight the infection.
Since 2017, Singapore has over 53,000 immunocompromised patients1, of which about 25,000 are on active chemotherapy2, says Dr Leong. For these individuals, their risk of hospitalisation and developing severe complications such as pneumonia or organ failure is eight to 10 times higher than that of a healthy individual, he adds.
However, Dr Leong says that some immunocompromised patients may be medically unsuitable for the Covid-19 vaccination or may not mount the same level of protective response from the vaccines.
He explains: “Vaccines, which usually contain a weakened form of the organism, are given to train your body to fight against the virus or bacteria.
In immunocompromised people, as their bodies may not be able to manufacture these antibodies, they are still at high risk of hospitalisation and severe complications if they were to contract Covid-19.”
Therapy options for additional protection
Like Mr Ong, Mr Ting Chew Thai is another immunocompromised individual. The 74-year-old retiree was diagnosed with leukaemia at the end of 2021 and had to undergo a bone marrow transplant (BMT) in early 2022.
“As a BMT recipient, I knew that my immune system would weaken further and I would be at increased risk of infections, including Covid-19. However, given the urgency, postponing the transplant was out of the question,” he says.
Although Mr Ting had completed his Covid-19 vaccination prior to the procedure, his doctor believed that the transplant may have compromised his vaccine protection as his bone marrow transplant surgery required him to undergo strong chemotherapy that wiped out all antibodies in his immune system. He was also advised against getting vaccinated immediately after the surgery as his immunity was below the required level to take the vaccine again.
Instead, his doctor prescribed a therapy that would offer him protection for about three to six months. This is just one of the prevention and treatment options that provide an additional layer of protection for individuals like Mr Ting who are immunocompromised and at a higher risk of contracting Covid-19.
Patients (and their caregivers) can speak to their doctor on any new updated measures for further protection against the virus.
Dr Leong says: “As we progress towards an endemic Covid-19 for the general population, we must be mindful that the virus is still living among us and still poses a threat to immunocompromised patients. Therefore, we need to remain vigilant and take preventive measures to continue to protect the vulnerable group.”
For Mr Ting, receiving additional protection helped to alleviate his worry of getting Covid-19. He says: “I was very relieved and slowly felt less afraid to go out.”
Disclaimer: This material is provided as a grant from AstraZeneca to aid in patient/public understanding/education of disease and not meant to replace advice of a qualified healthcare professional. Please consult with, and rely only on the advice of, your physician or healthcare professional for any specific queries.
References:
1. Globocan 2020.
2. Singapore Reneal Registry Annual Report.
