Day: May 19, 2021

One afternoon, a couple of months before my mother died of colon cancer, I crowded onto her bed to join her and my aunt where they lay side by side, my 8-month-old daughter playing between them. I pulled out my phone to record the two of them as they talked. 

“What’s something you remember from when you were growing up?” I asked. The two sisters gave each other sideways glances and began to chuckle. In between bouts of laughter, they recounted the time my mother came home drunk one night well past curfew during her typically well-behaved teenage years, and in her highly inebriated state needed the help of my aunt to get into the house without waking up their parents and other siblings. The story was light and hilarious, and one I had heard before, but I hung on every word as if the secret to life itself was being decoded before my eyes. In this moment of laughter and ease it was blissfully easy to forget that there was a killer disease lying in the bed with us. For three years this recording sat untouched on my phone, an anchor I could call upon when and if ready.

This January, 10 months into shelter-in-place and one year post-partum from the birth of my second child, I decided to hire a nutritionist. I need help. I love sugar, which has sent my A1C levels spiking to near pre-Diabetic levels. I also love staying up late when the house is quiet to treat myself to all the podcasts, movies, and TV series I can’t fit into my day. These twin loves do not love me back, and I realize that feeling exhausted and foggy most mornings is the exact opposite of treating myself.

One of the first things that Peta-Gaye Williams, my new nutritionist, instructs me to do is schedule meals and bedtime on my smartphone. I learn about the chicken and egg of sleep and nutrition: My poor sleeping habits fuel my food choices, and my food choices contribute to my sleep habits. “Setting alarms for meals and sleep is like appointments you’re keeping with yourself,” Williams tells me. I set out to dutifully follow these instructions, somewhat skeptical because I have never been great about self-accountability. Scrolling through my apps to find the alarm tone I’ll use, I come across the file of my mother and aunt telling the story of the drunken night out. This recording has remained untouched on my phone for three years, and I feel a jolt when I realize I can plug it into my schedule in lieu of an alarm as my cue for breakfast, lunch, dinner, and bedtime.

Two months into this practice, this recording still catches me off guard. I’ll be working at my desk, or changing a diaper, or in the bathroom when I’ll hear my mother and aunt laughing from some corner of the house. I find my phone by following their voices, listening to the fire, and love pooling from their mouths as the story unfolds. Once I find the phone, feeling it subtly vibrate in my palm as they speak, I head to the fridge and make my meal, or get into bed at my ridiculously early preset time—a time apparently not that ridiculous, as I find myself asleep a few minutes after putting my head to the pillow.

When the breakfast alarm goes off, the story begins: “And you called me and I had to let you in…” my aunt says to my mother as I sit at the kitchen table and eat my spinach and eggs. At lunchtime, they have gotten to the point in the story where my mother tells my aunt to stick a finger down her throat, as she is too drunk to do it herself. I listen to them belly laugh as I eat more greens and a piece of fish. By the time I arrive at my dinner alarm, my mother and aunt are arguing over the details of what happened in the aftermath. “No, Mommy and Daddy never found out.” “Yes, they did.” And by the time my nighttime alarm goes off bidding me to crawl into bed, the story has petered off and my mother and aunt are arguing over whether or not my daughter needs some water. This recording is now like a song whose lyrics I have memorized, keeping time with me over the course of my day.

Research is beginning to make clear that certain groups of people won’t enjoy the same level of highly effective protection provided by covid-19 vaccines as everyone else. Studies are finding that people who are immunocompromised are less likely to develop immunity against the coronavirus after vaccination.

Even before the vaccine rollout began in earnest last late year, experts expected that people with weakened immune systems would be less protected by vaccination. It’s already known that the virus can cause more serious illness and survive far longer in immunocompromised people, thanks to a weaker immune response generated against it. This same weak immune response could also make the immunocompromised more susceptible to reinfection, which is thought to be a rare occurrence among most people. But more real-world evidence is starting to paint a picture of how much less effective vaccine-provided immunity may be for these individuals.

Earlier this month, for instance, a study looking at hundreds of organ transplant recipients found that only 15% produced antibodies to the coronavirus soon after the first dose of a mRNA vaccine. By the second dose, only 54% did. Antibodies aren’t the only indicator of immunity, but plenty of other research has shown that the vast majority of people, after infection or vaccination, do create antibodies and have robust immunity, so the results were unsettling nonetheless.

Organ transplant recipients and people with conditions like certain cancers must take immune-suppressing drugs or treatments like radiation that artificially weaken their immune system. Yet there are also people who are born with or develop immune deficiencies that similarly weaken the body’s ability to mount an effective immune response to infection or vaccination. Estimates vary, but somewhere around 10 million Americans are thought to be immunocompromised in some way, leaving them at higher risk for severe covid-19 even after vaccination.

“Risk is very different for people in my situation,” Maria Hoffman, a kidney transplant recipient, told the Washington Post in an article published Tuesday. “I am 100% acting like I am not immunized.”

It’s possible that booster shots down the line may improve outcomes for immunocompromised people. As the pandemic continues to decline in the U.S., everyone’s absolute risk will decline as well, with fewer cases meaning a lower likelihood of encountering the virus. But many experts have criticized the CDC’s newly relaxed guidelines on mask-wearing for neglecting the impact they could have on immunocompromised people. The guidelines say that only fully vaccinated people can stop wearing masks in most situations, but some states have used the changes to justify lifting nearly all their restrictions altogether. And the lack of a clear way to distinguish the vaccinated from the unvaccinated will likely lead to some people taking off their masks when they shouldn’t, potentially putting other unvaccinated people and vaccinated-but-immunocompromised people at risk.

Most vaccinated Americans will be able to safely enjoy the summer without much needed worry about covid-19, but it’s a luxury that millions of people in the U.S., including the immunocompromised, won’t have.