Tuesday, March 9, 2021
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who are the people who will return to society last

The British Danielle Seal has Common Variable Immunodeficiency (IDCV)
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Danielle Seal likens a walk during the pandemic to an extreme sport. “When I go [e passeio] with the dog, I have to ask people to stay two meters away, ”she told CNN. “And that is what really bothers me. If you try to get past me, you are putting my life in danger. Going for a walk is an extreme sport that seeks adrenaline.”

Seal has Common Variable Immunodeficiency (IDCV), a type of primary immunodeficiency (IDP). This means that your body does not produce protective antibodies to defend against pathogens such as bacteria or viruses, leaving Seal and others like it extremely vulnerable to infections – even without a global pandemic.

The 45-year-old took extreme care during the crisis to avoid contracting Covid-19, but her situation is unlikely to change in the long run, even if governments are fixated on the glimmer of hope provided by coronavirus vaccines.

Provisional optimism has emerged about a way out of the crisis, as various forms of Covid-19 immunizers are launched in the UK and Europe.

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UK Health Secretary Matt Hancock has promised that all British adults will receive a vaccine against Covid-19 by the fall of 2021, after pressure to increase vaccination as cases in the country continue to increase, with more than 3.7 million infections reported to date.

But while most people benefit from Covid-19 vaccines, those with weakened immune systems, like Seal, may not respond to them in the same way as their colleagues.

“Many individuals who are clinically vulnerable will have some degree of immunosuppression or become immunocompromised and may not respond as well to the vaccine,” says the board of the Joint Vaccination and Immunization Committee of Great Britain (JCVI).

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This is because vaccines are designed to generate an immune response in the human body, causing it to produce antibodies and T cells that help fight specific infections. But for people with immune deficiencies, the body can produce only a few of these antibodies or T cells – or none – leaving them vulnerable to infections.

Seal’s body struggles to produce antibodies, meaning that vaccines are unlikely to provide sufficient protection. For this reason, it plans protection for the long term, even with the intensification of the vaccine launch.

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 to be taken by people with weakened immune systems, but are advised to continue to protect themselves even after inoculation, as they may not develop immunity to the coronavirus.

“Those who are clinically extremely vulnerable should continue to follow government advice on reducing the risk of infection,” says the JCVI council.

“I am happy to have the vaccine, 100%. [Mas] is not going to do much for me, “Seal told CNN.“ I’m unlikely to get antibodies by looking at other vaccines [que já tomei]. But I will. ”

Doctors gave Seal the pneumococcal vaccine, also known as pneumonia injection, when he diagnosed it with CVID to test his body’s response to the vaccine. A blood test four weeks later found that she had not created an antibody in response to it. She was later diagnosed with CVID.

‘I can’t give my son a hug’

Due to her condition, Seal has worked at home as an IT consultant since before the pandemic.

Since March 2020, she has remained at home in her home in Peterborough, UK. Her partner does the shopping and takes the dog for a walk.

Despite this, the mother of two visits her urban garden, which she says helped her deal with the crisis. “It kept me healthy,” she told CNN, adding that she found it easy to distance herself socially from other people in the outdoor space.

Seal shares his status with his daughter Ella Lamy, 19, who lives with her. Lamy was due to start university in September 2020, but delayed his studies for a year due to the pandemic. She has also stayed at home since spring 2020, working remotely in a customer service role.

“There are people I don’t want to be friends with anymore,” the teenager told CNN, explaining that they “try to justify” breaking the rules of social distance. Lamy added that she misses her best friend and boyfriend, which she hasn’t seen regularly since last August.

Seal’s 21-year-old son used to divide his time between her home and that of her ex-husband, but since March he has lived full time with his father.

“I don’t live with [meu filho] since March, “said Seal.” I see him and I can’t hug him. Even when we’re not in a lockdown, I can’t hug him. “

Seal says that her and her daughter’s ability to return to normal life depends on other people’s willingness to respect the UK’s blocking restrictions and get the vaccine. This will help Covid-19 infection rates to drop in the community, making the pair less likely to be infected.

“We depend on other people who get the vaccine,” Lamy told CNN.

Promising research

According to the British Society for Immunology, about six million people worldwide have an PID, with about 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 facilitated almost 4,000 transplants between 2019 and 2020 alone.

But Beate Kampmann, professor of pediatric infection and immunity at the London School of Hygiene and Tropical Medicine (LSHTM) and director of the LSHTM vaccine center, points out that “not all immunocompromised people will be equal.” This means that some can produce antibodies, while others produce none. “Being immunocompromised is a huge spectrum,” she said.

Kampmann believes that those with weakened immune systems should have their immune responses to other vaccines, such as tetanus, examined, to see if their bodies can produce antibodies across the board.

“Studies [também] need to be done about the immune response to the vaccine [Covid-19] in these groups of people and it can be used to create strategies, “she said.

David Salisbury, a former immunization director for the UK Department of Health and an associate member of Chatham House, points to the potential for other treatments for this group, such as the possible use of monoclonal antibodies against Covid-19. This could allow people like Seal and Lamy to rejoin society, he believes.

“There are things coming that we can hope for,” said Salisbury. “But I think we’ve been in this for a long time. There is still a lot to do.”

Monoclonal antibodies are proteins made artificially in the laboratory that mimic the ability of your immune system to fight pathogens like viruses, offering immediate protection.

Unlike vaccines, which train the immune system itself to produce antibodies, they are injected directly into the blood to fight specific infections, according to researchers at University College London Hospital [UCLH].

Several studies on monoclonal antibodies are underway around the world. In the US, the FDA has also granted emergency use authorization for Eli Lilly’s monoclonal antibody, bamlanivimab, to treat people in the early stages of Covid-19.

In the UK, the country’s leading recovery trial is exploring multiple potential treatments for Covid-19, including monoclonal antibodies, while UCLH teams are conducting two trials focusing on monoclonal antibodies – with one trial including people who may not respond to vaccines .

UCLH is currently recruiting for this trial, called PROVENT, which will research the effect of two monoclonal antibodies under investigation in protecting against Covid-19 in people who may not respond to vaccination or are at increased risk of infection by Covid-19.

“We will be recruiting people who are older or on long-term treatment and who have conditions like cancer and HIV that can affect their immune system’s ability to respond to a vaccine,” said UCLH infectious disease consultant Dr. Nicky Longley . 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 so protective.”

‘Cocooning’ to protect the vulnerable

Fiona Loud, policy director at Kidney Care UK believes that the best way forward for vulnerable patients is: they get the vaccine – as they can generate a partial immune response – as well as the people they are in close contact with.

Loud works with kidney patients and she herself received a kidney transplant 14 years ago. She told CNN that she hadn’t hugged her adult daughter in almost a year and that she hadn’t seen her on Christmas break.

The strategy she suggests is called cocooning, where those around vulnerable individuals are vaccinated in order to provide indirect immunization.

The JCVI said that this strategy could be examined in the future, but that it first needed sufficient evidence 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 launched and the world expects society to reopen. But most people with weakened immune systems will continue to protect themselves, awaiting the findings and depending on the actions and health of those around them.

“What we would say to the public is: please be empathetic,” said Loud.

Ella Lamy had just finished school when the pandemic hit.

“I should start my life,” she told CNN. But now, “my life literally depends on other people’s actions”.


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