Seal has Common Variable Immunodeficiency Disorder (CVID), which is a type of primary immune deficiency (PID). This means that her body does not produce protective antibodies to defend itself against pathogens such as bacteria or viruses, leaving Seal and others like her extremely vulnerable to infection – even without a global pandemic.
The 45-year-old has taken extreme care to contract Covid-19 during the crisis, but her situation is unlikely to change in the long run, even as governments fixate on the ray of hope offered by coronavirus vaccines.
Cautious optimism has emerged about a way out of the crisis as multiple forms of Covid-19 shooting are rolled out across the UK and Europe.
UK Health Secretary Matt Hancock has pledged that every UK adult will receive a Covid-19 vaccine by the fall of 2021, following pressure to ramp up vaccination as the number of cases in the country continues to rise, by more than 3 , 7 million infections reported to date.
But while most people will benefit from Covid-19 vaccines, people with weakened immune systems, such as Seal, may not respond in the same way as their peers.
“Many individuals who are clinically extremely vulnerable will have some degree of immunosuppression or be immunocompromised and may not respond as well to the vaccine,” the UK Joint Committee on Vaccination and Immunization (JCVI) advises.
This is because vaccines are designed to trigger an immune response from the human body by causing it to produce antibodies and T cells that help fight specific infections. But for people with immune deficiencies, the body can make just a few of these antibodies or T cells – or none at all – leaving them vulnerable to infection.
Seal’s body has a hard time making antibodies, which means that vaccines are unlikely to provide her with adequate protection. For this reason, she plans to protect herself for the long term, even as vaccine rollouts intensify.
UK drug regulator MHRA has approved three Covid-19 vaccines, one from BioNTech / Pfizer, another from Oxford / AstraZeneca and a third from Moderna. All three vaccines are safe for people with weakened immune systems, but they are advised to continue to protect even after vaccination, as they may not develop immunity to the coronavirus.
“Those who are clinically extremely vulnerable should continue to follow the government’s advice to reduce their risk of infection,” JCVI advises.
“I am happy to have the vaccine, 100%. [But] it won’t really hurt me, “Seal told CNN.” I am unlikely to get antibodies when looking at other vaccines. [I’ve had]. But I’ll have it. ”
Doctors gave Seal the pneumococcal vaccine, also known as the pneumonia, when they were diagnosed with CVID to test her body’s response to the vaccine. A blood test four weeks later showed that she had made no antibodies to it. She was later diagnosed with CVID.
‘I can’t give my son a hug’
Because of her condition, Seal has worked from home as an IT consultant since before the pandemic.
Since March 2020, she has been living mostly indoors in her home in Peterborough, UK. Her partner does the shopping and walks their dog.
The mother of two visits her allotment, which she says helped her cope in the midst of the crisis. “It kept me sane,” she told CNN, adding that she found it easy to distance themselves socially from others in the outdoor space.
Seal shares her condition with her 19-year-old daughter Ella Lamy, who lives with her. Lamy was due to start college in September 2020, but has postponed her studies for a year due to the pandemic. She too has largely stayed at home since the spring of 2020 and worked remotely in a customer service role.
“I’ve had friends of mine I don’t want to be friends with right now,” the teenager told CNN, explaining that they are “trying to justify” violating social rules for aloofness. Lamy added that she misses her best friend and her boyfriend, whom she hasn’t seen regularly since August.
Seal’s 21-year-old son always split his time between her household and that of her ex-husband, but he has been living with his father full-time since March.
‘I haven’t lived [my son] since March, “Seal said.” I see him and I can’t hug him. Even when we’re not locked up, I can’t give him a hug. ‘
Seal says her and her daughter’s ability to return to normal life depends on others’ willingness to abide by UK lockdown restrictions and take the vaccine. This will help decrease the number of Covid-19 infections in the community, which will make the couple less likely to become infected.
“We have to depend on other people using the vaccine,” Lamy told CNN.
Promising research
According to the British Society of Immunology, about six million people worldwide have a PID, with an estimated 5,000 living in the UK.
Added to this group are others with vulnerable immune systems, such as organ transplant recipients and cancer patients. The UK’s NHS says it has facilitated nearly 4,000 transplants between 2019 and 2020 alone.
But Beate Kampmann, professor of pediatric infection and immunity at the London School of Hygiene & Tropical Medicine (LSHTM) and director of the LSHTM vaccine center, stresses that “not every immunocompromised person will be the same.” This means that some can produce antibodies, while others cannot produce antibodies. “Being immunocompromised is a huge spectrum,” she said.
Kampmann believes that people with weakened immune systems should have their immune response to other vaccines, such as tetanus, examined to see if their bodies can produce antibodies across the board.
Studies [also] must be done on the [Covid-19] vaccine immune response in these groups of people and this could be used to inform strategies, ”she said.
David Salisbury, a former head of immunization at the UK Department of Health and associate fellow at Chatham House, points to the potential of other treatments for this group, such as the potential use of monoclonal antibodies against Covid-19. This would allow people like Seal and Lamy to get back into society, he thinks.
“Things are coming up that we can be hopeful about,” Salisbury said. ‘But I think we’ll do it for the long term. There is still a lot to do. ‘
Monoclonal antibodies are proteins created artificially in the lab that mimic your immune system’s ability to fight off pathogens such as viruses, providing instant protection.
Unlike vaccines, which train the immune system itself to produce antibodies, these are injected directly into the blood to fight certain infections, researchers at University College London Hospital said. [UCLH.]
There are several studies on monoclonal antibodies worldwide. In the US, the FDA has also approved emergency use of Eli Lilly’s monoclonal antibody, bamlanivimab, for the treatment of people in the early stages of Covid-19.
In the UK, the country’s flagship Recovery trial is exploring multiple potential treatments for Covid-19, including monoclonal antibodies, while teams from UCLH are leading two studies targeting monoclonal antibodies – one trial involving people who may not respond to vaccines.
UCLH is currently recruiting people for this study, called PROVENT, which will investigate the effect of two experimental monoclonal antibodies in protecting against Covid-19 in people who may not respond to vaccination or are at increased risk for Covid-19 infection
“We will recruit people who are older or in long-term care with conditions such as cancer and HIV that can affect their immune systems’ ability to respond to a vaccine,” said Dr. Nicky Longley, infectious diseases adviser at UCLH. in a press release in December 2020.
“We want to reassure anyone for whom a vaccine may not work that we can offer an alternative that is just as protective.”
Cocooning to protect the vulnerable
Fiona Loud, policy director at Kidney Care UK believes that the best way forward for vulnerable patients is to get the vaccine – as they can trigger a partial immune response – as well as the people they are in close contact with.
Loud works with kidney patients and had a kidney transplant 14 years ago. She told CNN that she hadn’t cuddled her grown daughter for nearly a year and hadn’t seen her over the Christmas holidays.
The strategy she proposes is called cocooning, which involves vaccinating people around vulnerable individuals to provide indirect immunization.
The JCVI has said that this strategy could be explored in the future, but that sufficient evidence is needed first about the effect of Covid-19 vaccines on transmission. It is currently unclear whether any of the vaccines prevent transmission.
This data will be collected as vaccines are rolled out and the world hopes that society will be reopened. But most people with weakened immune systems will continue to protect themselves, pending the findings and otherwise depending on the actions and health of those around them.
“What we would say to the public is, please be empathetic,” Loud said.
Ella Lamy had just finished school when the pandemic hit.
“I was [meant to] start my life, “she told CNN. But now,” my life literally depends on the actions of other people. “