Courtesy of Christina England/
John Livengood, Christina England's husband, and their daughter Juni, are both immunocompromised.
Courtesy of Christina England/
In mid-July, Southwest D.C. resident Lana Duran headed into a CVS to get her third dose of a Pfizer COVID-19 vaccine. It would technically be the fourth COVID-19 vaccine she received — having first received a Johnson & Johnson shot in April.
Duran, 31, has lupus, an autoimmune disease that causes the immune system to attack the body's healthy cells and tissue; she also received a kidney transplant in 2016. This spring, she joined an observational study at Johns Hopkins University examining the effects of booster shots in immunocompromised people.
Three COVID-19 vaccines in, she still has not produced any antibodies, but hopes the third Pfizer dose is the charm. While other vaccinated residents have basked in the safety of their immunizations, attending concerts without masks and gathering at indoor bars and restaurants, Duran's life in July 2021 doesn't look much different than it did a year ago.
"It's kind of a weird game of like, restrictions are loosened and everybody is living life like 2019," Duran says. "On the outside it feels like it's safe, people are relaxed and whatnot, but then inside I feel like I'm going crazy."
Over the past 15 months, immunocompromised residents have faced a higher risk of falling seriously ill from COVID-19 than residents with stronger immune systems. They say the vaccines offered some relief, but immunocompromised people may still face a reduced immune response to inoculation, limiting the protection afforded by the vaccines.
Duran and other immunocompromised residents who spoke with DCist/WAMU say they've been forgotten as officials lifted mask requirements and other pandemic precautions, allowing relatively healthy, fully vaccinated people to exist out in the world with a greater sense of protection and security. Their worries have only increased with the more-transmissible Delta variant spreading, and infection rates ticking up in the D.C. area.
"I honestly feel pretty left behind, like I don't matter," Duran says.
Knowing that she has little protection against the virus beyond Centers for Disease Control and Prevention recommendations — wearing a mask, staying away from others indoors — means that Duran's life looks a lot like how everyone else's did before vaccines were widely available. She doesn't bring friends to her apartment (where she lives alone), she wears a mask indoors around others, and still gets most of her groceries delivered when she can.
On Tuesday, July 27, the CDC reversed its earlier position on masks, recommending that vaccinated individuals resume mask-wearing in parts of the country where virus circulation is "substantial" or "high," per the CDC's definitions. D.C., the city of Alexandria, and Loudoun County have met the CDC's "substantial" transmission threshold, but so far only Alexandria has issued an update recommendation on indoor masking.
"Now that [most people in the D.C. region are] vaccinated, it's kind of like, 'oh well, just stay as safe as you can, just stay home,' and...that's not really an option for all of us. Not everybody's in my situation, some people have to go in person and work," Duran says. "We want our lives back too. I was angry and upset that it seems like they're like, 'alright well too bad for you guys, let's keep doing what you're doing.' If one more person tells me to 'just stay safe,' I might lose it."
For Silver Spring resident Christina England and her family, "just staying home," isn't an option. Her husband, a cancer survivor and liver transplant recipient, has to attend a monthly observational check-up. Her 3-year-old daughter, Junie, has Cartilage Hair Hypoplasia, a rare autoimmune disease that requires frequent doctor's visits. England herself just gave birth in May, five weeks early, after a rough pregnancy.
"A very frustrating perception that I felt is that some people say, 'well if you're immunocompromised, just stay home,'" England says. "But you don't have that option. A lot of times if you're immunocompromised, it's because of conditions that require treatment, which requires you to leave your house. I think that's something that a lot of people don't understand, that if you're in that category, you don't have the luxury of just hiding out in a bunker."
Both England and her husband John are vaccinated, but have yet to get tested for antibodies. She says when she has clarity on how well-protected from the virus they are, she may return to some activities. But for now, her family's life remains fairly isolated: visits with friends are often relegated to grocery drop-offs, and plans to send Junie to school in person have been put on pause.
Like Duran, England says that as soon as vaccinations began to increase and the CDC and local public health bodies dropped mask mandates, the protect-your-neighbor spirit that was pushed throughout the pandemic also fell away.
"We were all together in one mindset in the midst of COVID, to some extent — the idea that everyone understood that you wear a mask, you protect yourself, you protect your family. And on some weird level, it was almost like others got a glimpse into our world, the world of being immunocompromised," England says. "There was kindness and empathy and understanding, and now that's gone."
According to Neil J. Sehgal, an epidemiologist with the University of Maryland, protecting immunocompromised residents or those who aren't eligible for the vaccine yet, like young children, is not something that only immunocompromised people need to think about. He says that vaccines are not replacements for other protective measures, like mask-wearing, even for residents who are fully vaccinated.
"If there's an appeal to be made, it's to the vaccinated public — that if you would consider still wearing a mask when you're indoors and around people whose vaccine status you may not know, you should," Sehgal says. "All of the precautions that we had in place and that we learned were effective earlier in the pandemic still apply."
Vaccines still remain highly effective in preventing serious illness and death from the virus, including the Delta variant, but breakthrough cases can still happen. Per D.C.'s breakthrough dashboard (which includes data up through July 11) only about 1% of the city's cases since January occurred in fully vaccinated individuals.
"Vaccines themselves are not perfect," Sehgal says. "Vaccinated folks can still contract COVID, they can still have symptomatic disease and right now, what we've learned is that in some cases they can actually still transmit the disease. What vaccines do is they minimize that risk, but they don't eliminate it."
For Samantha Reid, a D.C. resident who was diagnosed with Crohn's disease at age 18, the threat of a more-transmissible variant and increasing case numbers is terrifying. She receives an infusion of a medication to treat her Crohn's once a month, and this medication suppresses her immune system.
She knows one person who was fully vaccinated and still contracted COVID-19 recently. Her friend isn't hospitalized, but it made her think about what could happen to her or other vaccinated and immunocompromised people like her if they were to become a "breakthrough" case.
"I think often, those of us who are immunocompromised are in this place of everyone thinking we're just like the fun police, and we just want everyone to stay inside and wear masks and not do anything," Reid says. "But it really is because if everyone is wearing masks, [if] there's a mask mandate, it really expands what we as disabled people can do in the world."
For the majority of the pandemic, before she received her vaccine, Reid stayed almost completely isolated. Her sister and brother-in-law, who also live in D.C, helped out with transportations to infusion appointments, but most of her days passed alone in her apartment. She spent Thanksgiving by herself, and quarantined for two weeks so she could spend Christmas with her sister.
As someone with anxiety and depression, Reid says receiving her vaccine after a year of isolation was "freeing," allowing her to excitedly returned to activities like outdoor dining and spending more time at her sister's house. But when mask restrictions dropped later this spring, she says it felt like her world shrunk again — debating whether or not she should start limiting her grocery trips if other shoppers would be maskless.
Reid acknowledges her privilege in having a job that allows her to work remotely, but knows that this isn't the case for everyone. She wants other people, particularly those with stronger immune systems, to understand that not everyone is afforded the full protection of a vaccine.
"I think that so often when you say 'immunocompromised people,' 'high risk people,' 'vulnerable populations,' however they refer to it on the news, that ends up sounding like this big blob of people you don't know," Reid says. "I think people forget that it's also your coworker who you go out with, and you just don't know that she's dealing with that. We are not a monolith and we are not just a thing you can set aside."
This story is from DCist.com, the local news website of WAMU.