Everyone’s immune system slips up sometimes. But this doesn’t mean you’re immunocompromised.

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When the Covid-19 pandemic began in 2020, one of the most important goals during state-mandated physical distancing and stay-at-home orders was to protect vulnerable populations from Covid-19.

These days, as we move forward in learning how to live with the virus, we continue to think about how to protect people who are more likely to fall ill, experience more severe symptoms, or require hospitalization.

In particular, this continues to apply to people who have long lasting medical conditions that damage their immune systems, which means they can’t fight off the virus as effectively.

Being immunocompromised is just one of several factors that can predispose someone to become ill with Covid-19 or develop a more severe illness after infection. According to the Centers for Disease Control and Prevention (CDC), other factors include being an older adult, having asthma, being pregnant or recently giving birth, and living with various other medical conditions.

But how will you know if you are immunocompromised?

The CDC considers people immunodeficient if they are living with an autoimmune condition or disease that damages their immune system or are taking medications such as chemotherapy or high dose corticosteroids.

Read on to understand more on how to tell if you or a loved one might be immunocompromised and which steps to take to for protection against Covid-19.

Let’s start by breaking down the word.

“Immuno” refers to your immune system. The immune system’s job is to detect harmful bacteria or viruses and then fight them off. “Compromised” means that this system isn’t working as it should or needs to in order to keep you safe.

Our immune systems are incredibly complex, which is why it’s harder to understand what makes a person immunocompromised.

Everyone becomes ill at times from viruses or bacteria. But this doesn’t mean that everyone is automatically immunocompromised.

Think of your immune system as a coffee filter. You want to eventually have that steaming, rich mug of morning energy, but you don’t want the gritty particles from the coffee beans to end up in there. That’s what the filter is for — to let the good materials through and keep the other stuff out.

If the coffee filter is your immune system, the desirable drink is the strong and healthy cells that you want. But sometimes, the filter doesn’t keep all the undesirable tastes and textures out of your coffee. This causes the development of infected and unhealthy cells.

When your immune system can’t filter out the bacteria or viruses — or if there are simply too many to filter at once — your body responds by feeling sick.

Certified physician assistant Annie McGorry spoke to Healthline about her experiences working with immunocompromised patients during the pandemic.

“In a ‘normal’ person, when their body detects something that is foreign, such as a bacteria or a virus, the immune system should immediately kick into action,” McGorry told Healthline.

“However, when a patient is immunocompromised, their immune system is not able to function at its full capacity, and therefore, it takes much longer for that patient’s body to adequately fight off the infection, which is why when immunocompromised patients fall ill, they — more times than not — have a more serious, longer-lasting infection.”

There are cases, as well, when the immune system cannot function at all.

McGorry works as a certified physician assistant at a private rheumatology practice in New York state — one of the hardest hit areas of COVID-19 at the height of the pandemic when we spoke.

When we asked about certain characteristics that you can look out for to see if you are immunocompromised, she shared that her patients who are immunocompromised usually:

  • get sick more often
  • are sicker longer
  • typically have more severe illness symptoms

“On a ‘regular’ day, [immunocompromised patients] often still do not feel their best,” she explained.

So what does this mean for you? If you find yourself getting a severe cold and/or flu often and are unable to recover as fast as others around you — including that co-worker who didn’t wash their hands after coughing, for example — you might be immunocompromised.

McGorry told Healthline that the best way for you to assess if you are immunocompromised is to take note of your symptoms and communicate with a trusted healthcare professional.

“Know what medications you are on,” McGorry added, saying that the side effects of particularly strong medications can also weaken your immune system without you knowing it.

The truth is that the CDC and medical professionals aren’t exactly sure about the extent of just how many chronic conditions cause weakened immune systems.

Some immunodeficiency disorders are conditions you are born with, while others can develop later in life. Some are primary, which means their origin is in your body.

Others are secondary, which means that the cause is external. People with immunodeficiency disorders may need medical treatments or vaccines to help their immune system work.

There are many types of primary immunodeficiency disorders. They include:

  • DiGeorge syndrome
  • common variable immunodeficiency (CVID)
  • chronic granulomatous disease (CGD)

Secondary causes of immunodeficiency include:

  • human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
  • cancer treatment such as chemotherapy or radiation
  • malnutrition
  • use of immunosuppressing medications chronic such as high dose steroids or immunomodulatory agents.
  • certain autoimmune diseases
  • diabetes
  • cirrhosis
  • previous removal of the spleen
  • undergoing dialysis

Healthline experts add that people with immunodeficiency disorders are at greater risk of various infections.

“A lot of autoimmune diseases that we treat in rheumatology take a toll on the patient’s immune system, such as systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, scleroderma, etc,” McGorry explains.

“And it is not simply just the fact that the patient has an autoimmune disease, but also what types of medications they are placed on in order to adequately treat and control the disease state.”

For those with autoimmune disorders, the immune system is often hypersensitive or overactive to what it perceives as dangerous viruses or bacteria but often isn’t actually harmful. In these situations, the immune system attacks itself.

McGorry also explained to Healthline how disease-modifying antirheumatic drugs (DMARDs) that patients with autoimmune disorders often need to take for treatment might further suppress their immune systems.

“Taking these medications comes with the price of suppressing the natural immune response, leaving the patient more susceptible to infection, in order to prevent life threatening complications of autoimmune diseases,” she said.

“It is a complicated and complex balancing act between side effects of the medications and treating the disease state efficiently and adequately.”

A common concern for many people has been whether they are more at risk of becoming severely ill or hospitalized as a result of an infection by Covid-19.

It might feel scary if you know or think you’re immunocompromised. Many immunocompromised people live with anxiety about falling ill under usual circumstances. Add a highly transmittable, highly dangerous virus on top of this, and you’ve got a recipe for stress — rightfully so!

The CDC warns people to assume you are moderately or severely immunocompromised if you are:

  • are undergoing cancer treatments
  • have undergone an organ transplant
  • have a primary immunodeficiency
  • have advanced or untreated HIV
  • are taking high dose corticosteroids or other drugs that suppress the immune system.
  • receiving CAR-T therapy or had a stem cell transplant less than two years prior

The best way to reduce stress is to practice all suggestions in compliance with CDC guidelines and your healthcare professional’s specific recommendations.

It may be challenging to continue protecting yourself at a time when many people no longer do, but ultimately you are doing the best for yourself by keeping yourself safe.

Healthline experts suggest that if you are immunocompromised, you should:

  • Be fully vaccinated (including updated bivalent boosters) against COVID-19. The CDC currently says that anyone over the age of 12 should be boosted to protect them against the most recent variants.
  • Stay away from large crowds and poorly ventilated spaces. If you’re financially, socially, and geographically able to, try to take advantage of delivery services for food, groceries, and medications. When you need to leave the house, be sure to protect yourself with the other suggestions on this list.
  • Wear a mask (as long as it is safe for you to do so), and ask for the people you commonly come in contact with to wear masks as well.
  • Make sure to wash your hands. Even though touching surfaces isn’t the main way the virus spreads, washing your hands still lowers your risk of infection.
  • Avoid touching your face when you are in public areas. Wait until you’ve had a chance to thoroughly clean your hands.
  • Practice social or physical distancing. In fact, stay as far away from people as you possibly can manage, even if others no longer do and general guidelines do not require it.
  • Research from the World Health Organization and the CDC shows that COVID-19 can spread from person-to-person through sneezing, coughing, and speaking. The virus can also remain suspended in indoor air for up to 24 hours.
  • Increase ventilation when you need to be indoors with others if it’s possible to do so. One way to do this is by opening windows.
  • Have a plan for rapid testing in case you are exposed to COVID-19 or develop symptoms. Talk with your doctor about how to get home tests or access to testing.
  • Ask your doctor if you’re a candidate for COVID-19 treatments. According to the CDC, these include oral antivirals, pre-exposure prophylaxis (PrEP), and monoclonal antibodies.

McGorry reminds us that some people can still carry the virus without any symptoms whatsoever. So people who are living with someone who is immunocompromised also “need to go above and beyond with your social distancing protocols,” she said.

“It may be ‘annoying’ or ‘frustrating’ for some people, but it is necessary in order to protect your loved ones who did not choose to be immunocompromised.”

Aryanna Falkner is a disabled writer from Buffalo, New York. She’s an MFA-candidate in fiction at Bowling Green State University in Ohio, where she lives with her fiance and their fluffy black cat. Her writing has appeared or is forthcoming in Blanket Sea and Tule Review. Find her and pictures of her cat on Twitter.