Immunocompromised are still at risk as COVID-19 cases plummet in the Cleveland area

COVID-19 cases are the lowest they have been in Cuyahoga County in months, and many schools and businesses are no longer requiring masks. But for people with compromised immune systems, like Lakewood resident Robert Toth, this is a difficult environment to navigate.

In addition to living with AIDS for 32 years, which has significantly weakened his immune system, Toth previously had a heart attack, stroke, and has kidney disease.

“We know COVID attacks those specific parts of the body… so that puts me at greater risk,” Toth said. “So all that said, I am double masking.”

Toth said he will personally not feel comfortable going out without a mask on until there no more COVID-19 cases reported in the area.

“I already lived through one epidemic; I’m going to live through this. I’ll wear a mask for another two years, I don’t care,” Toth said.

While many people are celebrating the low case counts and ditching their masks, it is still too early for most immunocompromised individuals to let up on precautions, said Dr. Joseph Khabbaza, pulmonary and critical care specialist at Cleveland Clinic.

“Even with low community rates, they’re still going to be a susceptible group of people doing all of the right things who still may get very ill,” he said. “That group and population is certainly far from … just having that sigh of relief.” 

While the COVID-19 vaccines effectively reduce severe disease and death for most people, they offer less protection for those with weakened immune systems, Dr. Khabbaza said. And some vulnerable populations might not be able to get vaccinated due to a medical condition.

“Many of them feel forgotten about, not heard, and really not thought about,” he said. “A lot of them have felt very alone during this pandemic, but especially during the ‘off periods’ where cases are very low.”

According to the American Medical Association, 2.7 percent of U.S. adults - about 7 million people – are considered immunocompromised. Examples include those who have had organ transplants, are living with HIV, or who have received immunotherapy treatments for cancer.

If someone or their loved one is immune-compromised, there are still plenty of ways to stay protected, Khabbaza added.

The same precautions recommended throughout the pandemic – such as masking up in crowded indoor places – are still great rules of thumb, he said.

If gathering with loved ones, he suggests staying around those who are vaccinated and boosted. It’s also a good idea to have everyone take a rapid test before the event, he added.

“If you’re immunocompromised, it’s really hard to recommend being in indoor places right now, with a lot of unmasked people whose immune status you don’t know,” Khabbaza said.

He also encourages individuals to stay up-to-date with their COVID-19 booster shots. The current guidance is to receive a fourth dose 5 months after the initial booster.

Even before the COVID-19 pandemic, many immune-compromised patients were already used to wearing masks during flu season or in certain settings where they might be at risk of contracting pathogens, he added.

“It’s not new to many of them, but it has not posed the risks that it does now to many of them,” Khabbaza said.

As Cleveland Clinic battled its overwhelming surge of COVID-19 hospitalizations in late December and early January, 80 percent of patients in the intensive care unit were unvaccinated - and the majority of vaccinated patients were immunocompromised, he added.

“Thankfully, still, a lot of them do survive, but some of them have longer courses,” Khabbaza said.

Khabbaza referenced one vaccinated and boosted immunocompromised patient who is still recovering in the hospital a month after developing pneumonia from a COVID-19 illness.

However, COVID-19 spread in Cuyahoga County is now dwindling to levels not seen since last summer, before the delta surge, he added.

Although it is difficult to predict whether another contagious or virulent variant could arise in the coming months, Khabbaza is hopeful that new COVID-19 antiviral treatments, as well as treatments specifically for immunocompromised individuals, are coming down the pike and could help avoid another deadly surge.