Unmasked

My last post was a round-up of reader questions to the blog inbox, but in the last several weeks since I’ve written a ‘real’ update, so much has happened. The world’s eagerness to get back to life as we knew it pre-pandemic is progressing quickly. Although only about 41% of the U.S. population is fully vaccinated as of May 29, I’m seeing an awful lot of the lower halves of people’s faces.

Coronavirus pandemic: for some, a light at the end of the tunnel; for others, a permanently altered way of life

My colleagues at the consulate received their second COVID-19 vaccine shortly after my return from medical leave, a return that began by my showing up at the office in the afternoons so as not to overcrowd our staffing cap during morning business. In the early days, I got exhausted quickly, and had a hard time focusing. But in fairly short order, I came in earlier and earlier until I could physically and mentally handle full days. And it wasn’t long after that as an organization we finally reached that “2+2” for which we’d waited so long: two weeks after the second dose, the time believed to signify full protection from the vaccine for those who chose to partake in the vaccination program.

Or, at least, for people with normal immune systems. I listened with a start to former Food and Drug Administration commissioner Dr. Scott Gottlieb’s interview on the May 9 edition of “Face the Nation” as he relayed these comments to John Dickerson:

I think we’re at the point in time when we can start lifting these ordinances in a wholesale fashion and people have to take precautions based on their individual risk. They have to judge their own individual risk and decide whether or not they’re going to avoid crowds or wear masks based on their circumstances… I think the only residual risk for someone who’s fully vaccinated is could you have asymptomatic infection that you don’t know about? And if you’re around someone who’s immunocompromised, is vulnerable to COVID, you still want to be careful in those circumstances. But you know when you’re in those circumstances and you always want to be careful in those circumstances because you don’t want to pass an infection to someone who can’t defend against it.

Dr. Scott Gottlieb on “Face the Nation,” May 9, 2021

Oh really? I thought. Do people know when they’re in those circumstances? Maybe with their own families and with people they are close to, but not on the street, and not necessarily in the workplace. People who have suppressed immune systems don’t wear our invisible illness like a badge. We look like everyone else!

John Dickerson then asked Dr. Gottlieb whether people who have been vaccinated, even if they are elderly, should consider the current risks to themselves commensurate with the “regular old flu.” Dr. Gottlieb answered by saying:

Look, I think that’s right. People get uncomfortable when you start comparing the – the rate of, you know, death and the risk of COVID to flu because of some of the comparisons that have been made in the past. But I think for, you know, most consumers who need something to anchor against, I think that that’s a fair assessment that if you’re fully vaccinated against COVID with one of the Western vaccines, your risk of having a bad outcome from COVID is about comparable to flu and maybe less because the vaccines for COVID are more effective than the vaccines for flu… Again, the only residual concern I think a fully vaccinated person should have is, are they- are they themselves immunocompromised? I mean, and you know if you are. If you have a chronic disease that makes you more vulnerable, you’ll know that new vaccines won’t be as effective for you. And are you going to be around people who are immunocompromised? There you want to be more careful. That’s where I would still exercise some caution. But outside of those circumstances, I think we can get back to doing normal things right now against the backdrop of a summer when prevalence is going to decline very quickly.

Dr. Scott Gottlieb on “Face the Nation,” May 9, 2021

Whoa! That was the first time I actually heard an official and medical professional say that we know the COVID-19 vaccines are less effective in immunocompromised people. I mean, it’s not totally surprising. But as I have yet to see any actual data around this, it was slightly shocking the first time I heard that conclusion underlined aloud.

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But it seemed like a new talking point. The following week, when Chuck Todd interviewed director of the Centers for Disease Control and Prevention Dr. Rochelle Walensky for the May 16 edition of “Meet the Press,” Dr. Walensky said that science tells us that it is “safe for vaccinated people to take off their masks.”

So I was elated when Chuck Todd asked her, “And if you’re immunocompromised and fully vaccinated, what would you recommend?”

Dr. Walensky replied:

Thank you very much for that question. Certainly, we know that – and there are emerging data to suggest – that if you don’t have a fully competent immune system from chemotherapy, from transplants, from other immune-modulating agents, that the vaccine may not have worked as well for you. So, please, before you take off your mask, consult your physician.

Dr. Rochelle Walensky on “Meet the Press,” May 16, 2021

Again, yikes. Just that same weekend, my employer decided to lift the mask policy in all its domestic and overseas facilities. And because we understandably cannot inquire as to our colleagues’ vaccination status due to medical privacy, added to the fact that I am living in Mexico where something on the order of just 12% of the general population has received its two doses of vaccine – and our team works with the public – how exactly am I supposed to feel about this? And more importantly, what am I supposed to do?

We have immunocompromised people less protected by the vaccine, most vaccinated Americans easing up on social distancing and removing their masks in celebration that the virus no longer poses a risk to them in most circumstances, and a severely degraded condition of trust between people about whether or not unmasked people are both actually vaccinated and fall into a population where the vaccine is going to be efficacious for them, especially if they are living in a mixed vaccinated household.

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The CDC acknowledges (on a page that at this time was most recently updated on May 16, 2021) that even if you are fully vaccinated, “if you have a condition or are taking medications that weaken your immune system, you may NOT be fully protected… and may need to continue taking all precautions” and people in that category “should talk to their healthcare provider to discuss their activities.”

In the same guidance, the CDC also acknowledges that scientists are still learning “how well the vaccines protect people with weakened immune systems, including people who take immunosuppressive medications,” as well as generally “how long COVID-19 vaccines can protect people.”

So since the initial vaccine trials did not include people taking immunosuppressive drugs (in much the same way they did not include children), researchers are trying to fill in the gaps now. So medical professionals are recommending keeping up the masking and physical distancing and “making sure” that people around you are fully vaccinated. That’s a pretty hard ask. Below is a piece of reporting from National Public Radio (NPR) that explains the risks to the immunocompromised population in more detail.

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I’m immunocompromised. What about me?

CDC says that if you are immunocompromised — even if you’re fully vaccinated — you should talk to your doctor about what precautions you need to keep taking. That’s because, in this case, even more than others, you can’t assume that vaccination equals protection, says Dr. Brian Boyarsky, a research fellow at Johns Hopkins who has been studying vaccine efficacy in immunocompromised patients.

“These CDC guidelines are largely for people who have normally functioning immune systems,” he says. “The big takeaway so far is we do not yet know the full effectiveness of the vaccines in immunocompromised people.”

The initial vaccine trials didn’t include people who take immunosuppressive drugs, so research underway is trying to fill in the blanks. The evidence so far suggests that the vaccines may be less effective in some immunocompromised people, depending on the medication they take and their medical condition. That includes people who take immunosuppressive medications such as mycophenolate and rituximab to suppress rejection of transplanted organs or to treat certain cancers or rheumatologic conditions.

If you are immunocompromised, it’s important to keep up the masking and physical distancing and to make sure the people around you are fully vaccinated, too, researchers say. “When everyone around you is getting more reckless, you need to get more safe,” says Dr. Dorry Segev, a transplant surgeon and researcher at Johns Hopkins. “Be careful for the time being,” he advises his patients, “because we don’t know enough to flick the switch like the CDC did for everybody else.”

Maria Godoy, NPR health correspondent, May 15, 2021

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As I discussed in my blog post from March, Tumbleweeds, I have spent the last dozen years being ill with viruses on a regular basis, and what I’ve seen from the past 15 months of this pandemic is a large portion of society not even being willing to mask up to protect themselves. So how could I possibly ask people to wear masks to protect me now that we have finally begun to taste this sweet, unmasked freedom once again? There has been a marked societal shift over the past couple of weeks away from the feeling of masking to protect others.

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The decrease in COVID-19 cases in North America is wonderful. Many people feel safer. They can start to grieve their losses. The economy can start to rebound. I was outside this weekend, and even ate outside at a café with an old, dear friend who is traveling across the southwest. I am just as happy as everyone else that we may see a light at the end of the tunnel of this long, dark pandemic. But do I also have very mixed feelings about being around people all day indoors unmasked and on the honor system as social distancing relaxes? Absolutely. The medical advice is pretty clear. It isn’t time for celebration for me. And it may not be for months. Years? Ever? As happy as I genuinely am for the world, and as much as I don’t mind watching people eat cake in front of me (honestly), I kind of have a problem with them forcing the cake down my throat and forgetting to notice some people are allergic to cake. Or whatever.

And it isn’t because I’m ‘afraid’ of getting sick. Or because I want to sit at home in my jammies. I’ve been physically present in the office for almost 10 months, and I’m not really the dress-down type anyway. Like everyone else since the onset of the pandemic, I am looking for the right thing to do for me, for my family, for my health. The right way to protect myself. The right way to ensure that I can keep showing up every day and being my best. And the right way to not cede any territory back. Because as far as I’m concerned, we aren’t actually going “back” to the way things were before. When people could come to work with three day colds that turned into three weeks of pneumonia for me. When I had to keep wiping out my sick leave because I bore the most severe consequence of people passing viruses around the office like candy. When I was chastised for not taking care of myself and having to call out sick when it was actually other people’s irresponsibility harming my health and I had no way to defend myself. And worst of all, when I didn’t say anything on my behalf because I somehow felt like it was my fault for not being tough enough.

I feel like the past year plus has proven beyond doubt that I can be healthy in the workplace as long as other people are essentially forced (by fear? shame? mitigation measures? good management?) to keep their illnesses and germs at home. For the first time in my life, the pandemic proved that I am tough enough when others behave responsibly.

I went to a going-away party for a departing officer last week and I wore a mask. I was one of the only ones. Almost everyone was unmasked. I felt distinctly uncomfortable, not because it felt threatening, but because I felt like everyone was looking at my mask. Maybe not. Maybe I was projecting. Maybe people were wondering if I’m not vaccinated. Or maybe they were just worried about me. I don’t know.

But saying goodbye to this officer, who was a terrific colleague, was worth the awkwardness. I didn’t want to not go to the party. What judgments people make about why we do the things we do is not something we can control. I can only hope others will understand why I need to keep some aspects of the current regime, and not take it personally when I do decide to keep my distance. I don’t have all the answers. I’m just trying to do a good job and stay safe like everyone else. I’m the one who has to live in my body, so I’m the one who ultimately has to figure it out.

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In my next posts I’ll write more about my recovery from back surgery, my physical therapy, my continued weight loss (down 53 lbs since New Year’s as of now!), and a day trip I took to Las Cruces, NM.

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