Pandemic Help for the Immunosuppressed

It’s called Evusheld.

I will share with you the pathway to Evusheld but first let me review the already well-known drill.

Because COVID and its variants easily spread by breathing in other’s oral and nasal expiratory air particles, we do these tasks:

1. Get vaccinated and boosted.

2. When in groups of people, wear a well-fitting N95 mask and ensure the gathering room is well ventilated.

3. Remain six feet apart from others who are not in your household or close social bubble¹ with whom you already have a shared exposure.

4. If you have cold or flu-like COVID symptoms, immediately get tested and call your physician if you test positive.

¹COVID-19: How Big is Your Bubble? | Fairfield Medical Center (fmchealth.org)

That’s a lot to be mindful about but obviously it is too much for many American souls to process.

Throughout the pandemic, the U.S. has had outsize access to lifesaving supplies like vaccines, antiviral treatments, face masks and testing kits. The country has also spent trillions of dollars in pandemic stimulus funds and enacted a raft of policies at the local and national level to combat the coronavirus.

And yet, despite its distinct advantage, the U.S. has had more deaths above normal levels during the pandemic than most other wealthy countries, according to data released by the World Health Organization this month.”

U.S. deaths were 15 percent above normal — a number surpassed by only four other large countries in the same income group: Chile, the Czech Republic, Poland and Romania.²

Ironically, maybe we should add a 5th bullet to what to do about COVID:

5. Don’t live in America.

Obviously, that’s not realistic. But there is another factor many of us should consider in our list of avoiding COVID: immunosuppression. COVID is even more dangerous for the immunocompromised.

What does it mean to be immunocompromised?

If you are physically immunosuppressed, your body’s immune system is not able to fight off an infection. Your body’s protection mechanism can’t tell the difference between your normal cells and the foreign diseased cells. When your immune system isn’t working properly, it cannot keep you from getting sick.³ People who are immunosuppressed are more likely to have serious COVID illness and suffer a higher mortality rate than the general public.

² Where Death Rates Rose the Most During the Pandemic — The New York Times (nytimes.com)

³ “What Does It Mean To Be Immunocompromised?” by Carrie MacMillan in Yale Medicine, May 3, 2022.

Who has a weakened immune system? (You might be surprised)

One can become immunocompromised in many ways:

1. Through a congenital disorder⁴

2. Through acquired autoimmune diseases like diabetes⁵ or HIV⁶

3. Alcohol addiction⁷

4. Age is a factor because when we are over age of 65, our immune system isn’t as good as it was when we were young. When we are over 80, we are immunocompromised. Therefore the well-aged among us are most vulnerable.⁸

5. There are also medications that actually suppress the immune system, such as those used after an organ transplant.⁹

6. Certain, but not all, types of chemotherapy can decrease our immune system.¹⁰

7. The American Autoimmune Related Diseases Association lists over one hundred autoimmune diseases.¹¹ Treatment for these diseases can involve steroids or biologics¹² which suppress the immune system and are also used to treat other common autoimmune disorders like rheumatoid arthritis.¹³ and forms of multiple sclerosis.¹⁴ I receive Ocrevus infusions twice a year for Primary Progressive MS.¹⁵

⁴ Primary immunodeficiency — Symptoms and causes — Mayo Clinic

⁵ Diabetes by Nora Saul, MS, RD, LDN, CDE, CONDITIONS & TREATMENTS in HealthyWomen.

⁶ HIV/AIDS HIV/AIDS — HealthyWomen HIV/AIDS Jeffrey T. Kirchner, DO, FAAFP, AAHIVS.

⁷ Alcohol abuse, alcoholism, and damage to the immune system — a review — PubMed (nih.gov) in National Library of Medicine by RT Cook.

⁸ Amir A Sadighi in National Library of Medicine.

⁹ Table: Drugs Used to Prevent Transplant Rejection — Merck Manuals Consumer Version

¹⁰ Who Counts as Immunocompromised? A Guide for High-Risk Individuals by Jaimie Seaton in YOUR HEALTH Mar 20, 2020. / Coronavirus Came to My Hometown, and I Wanted to Know How to Stay Safe in Healthy Women by Jaimie Seaton Mar 06, 2020.

¹¹ Disease Information — Autoimmune Association

¹² What Are “Biologics” Questions and Answers | FDA

¹³ “Rheumatoid Arthritis” by Arnold Ceponis, MD, PhD.

¹⁴ What is MS? | National Multiple Sclerosis Society. (nationalmssociety.org)

¹⁵ Multiple Sclerosis (MS) Treatment for RMS and PPMS | OCREVUS® (ocrelizumab) (ocrevus-hcp.com)

How many of us in the US are immunosuppressed?

Answer: 3% or approximately 11.3 million.¹⁶

Since approximately 3% of the population in the United States is considered moderately-to-severely immunocompromised, that makes for a lot of people who are at a greater risk for serious illness if they contract COVID.

This is why you or a loved one should know about Evusheld.¹⁷

The pharmaceutical maker AstraZeneca has released the COVID antibody treatment called Evusheld. It is designed to stop COVID from infecting people with weakened immune systems. For many of the immune compromised, the COVID vaccines are not as effective. The government has approved Evusheld for emergency use.

Currently, however, there is some disconnect between the amount of Evusheld the government bought and how much of it is getting to patients. For many of us, it is difficult to obtain.¹⁸ Here is my example.

¹⁶ What percentage of Americans are immunocompromised? — AS USA

¹⁷ Evusheld offers COVID protection but is challenging to get — Marketplace

¹⁸ Many searching for COVID-19 treatments find confusion and lack of information in the medical community. Here is an example.

My Circumstance

I am immunosuppressed because I have MS and am treated with Ocrevus¹⁹ infusions twice a year. While I have had two Pfizer vaccinations, one Pfizer booster and one more Moderna booster, that might not be enough for my protection.

Ocrevus is a miracle drug that is preventing me from becoming disabled. The drug accomplishes that feat by destroying all of my body’s “B” cells. These are the cells that help with my immunity but cause nerve damage in MS patients. At the last blood draw, I had a zero measurement of B cells. This stops the progression of nerve damage in my body but, unfortunately, it makes me vulnerable to infections like COVID.

¹⁹Relapsing MS and Primary Progressive MS Treatment | OCREVUS® (ocrelizumab)

For those who are immunosuppressed in Los Angeles, here are the steps patients need to take to obtain Evusheld to ward off COVID. It may be similar to the medical procedures where you reside so speak with your physician.

1. Consult with your family physician and your neurologist if you have one. As our reading indicates, few doctors seem knowledgeable about the Evusheld treatment because it is so new.

2. It may be a different protocol where you live, but here in LA, the primary care physician has to present your case to the Evusheld team to see if you meet the clinical eligibility requirements. You must have a qualifying Tier 1 or Tier 2 immunocompromising condition.

3. After your primary care physician is contacted by the Evusheld team, she or he will be able to make the referral to set up the Evusheld treatment at an infusion center.

Getting the Evusheld treatment

Evusheld is a one-time injection. Because Evusheld is not yet FDA approved (at the time of this writing), they had me sign a form stating that I knew that fact.²⁰

Previously, they had given the “regular” dose and then the people had to come back in 3 months for a second dose. Now, they ordinarily give a “double” dose so that we only have to come back every six months. Because of the volume of the medicine, they give it to you in two shots. It is injected it in your gluteus maximus.

Of course, because I’m a touch neurotic and am generally frightful of even pulse ox gadgets, fearful of it eating my finger, I was nervous about getting the shots in my butt. I hadn’t experienced injections in my backside since my childhood. And since they were talking about a “double dose,” I imagined they would be wheeling a 66 gallon drum in the door with an accompanying gasoline station pump apparatus while wearing a hazmat suit.

None of that happened.

²⁰ COVID-19 Vaccines for People who are Moderately or Severely Immunocompromised | CDC

Evusheld is all good news. The nurse gave me the injections and they were nothing. No pain. No discomfort. No real side effects, no aches, fevers, … nothing. A walk in the park.

Afterward, they had me sit for an hour to see if there was any reaction. Hardly worth mentioning, but I got a small rash on the side of my neck. It was a little pink and it went away almost immediately.

For MS patients, a small rash is a typical mild reaction. When I first started getting Ocrevus chemotherapy infusions, I had a similar small temporary rash but only on the first treatment. I seem to develop the same sort of minor rash from eating a lot of strawberries. No big deal.

Conclusion

I’m grateful that I received Evusheld and now have similar protection that others enjoy from their COVID vaccinations. I and my family have increased peace of mind. We are more out in society and considerably less concerned about being in larger groups. I guess this is as close to normal living as it will be for a while.

It feels good.