Some immunocompromised Canadians face anxious future with lifting of COVID-19 restrictions

Joel Bhikoo has multiple sclerosis, needs an IV infusion of medication every six months and for the most part has been isolating himself since the COVID-19 pandemic hit nearly two years ago.

The Drumheller, Alta., resident is immunocompromised and said he has had to be "extremely careful" to avoid getting infected, a situation that has also led to some psychological counselling to deal with the isolation.

But with his province's announcement that it would be lifting some COVID-19 restrictions, he said he feels that despite acting responsibly, he's now being treated as a "second-class citizen."

"I enjoyed going out for lunch with my brother once a week. And we can't even do that because I don't know if the person in the next table is carrying COVID," he said.

"And now people that aren't immunized are being able to do things and [it's] putting me into jail again."

Bhikoo is just one of thousands of Canadians whose medical condition has put them more at risk for developing complications in case of infection from COVID-19. And some of them are now facing a more anxious future as many provinces, in an attempt to get things back to normal or learn to live with COVID-19, announce the lifting of measures.

Easing restrictions shifts burden

Alberta has announced a three-step plan to ease public health measures in the province, including the scrapping of the vaccine passport and an intention to remove the mask mandate and lift capacity limits at all venues by March.

Saskatchewan ended its vaccine passport and will scuttle its indoor masking requirement by the end of the month. 

Quebec will drop its vaccine passport Mar. 14, while Manitoba is looking to end all restrictions in mid-March. P.E.I. is hoping to phase out most of its COVID-19 restrictions in the next two months.

Meanwhile, Ontario is planning on keeping masking requirements in place but end the vaccine passport by March 1.

B.C. has lifted many restrictions but is keeping indoor mask requirements and vaccine passports in place for now.

"With restrictions being lifted, it changes the dynamic where instead of it being sort of society's job to help these people live as normal life as they possibly can, it [falls] on them," said Dawn Bowdish, Canada Research Chair in aging and immunity and assistant professor at McMaster University in Hamilton.

I feel like this society is incredibly ableist and is just forgetting about a lot of people.- Kath Stevenson, mother of seven-year old who is immunocompromised

According to Statistics Canada data in 2020, around 14 per cent of Canadians aged 15 years or older have a compromised immune system that increases their risk of adverse outcomes from COVID-19.

Around 38 per cent of Canadian adults living in private households reported having one or more underlying health conditions that could put them at elevated risk of complications following COVID-19 infection, StatsCan found.

Vaccination helps ease that risk, but not completely. According to the Public Health Agency of Canada, nearly 80 per cent of Canadians have been vaccinated twice, while just over 40 per cent have an additional dose.

"The more vaccination the better for the general public to protect the vulnerable," said Bowdish. 

"Three doses does reduce the risk of becoming infected with Omicron in the healthy public but you can still carry it and spread to an immunocompromised person."

Bhikoo said he understands that some restrictions could be lifted, but wishes measures such as vaccine passports would remain in place.

"I'm being punished now for doing the right thing," said Bhikoo, who has received four shots of vaccine.

Risk depends on the individual

Dr. Lynora Saxinger, an infectious diseases specialist and associate professor at the University of Alberta in Edmonton, said public health officials have fallen short at helping immunocompromised people evaluate their risk if infected.

"Give them an idea. Are you at extreme risk or maybe mild risk or maybe no risk," she said. "I think that that would be a useful thing to start working on right now." 

"We do have [COVID-19] treatments that are available for people who are at high risk of progression if they get infected."

Not all immunocompromised people are in the same boat, said Bowdish.

Some, who have been vaccinated with three of four doses and have more mild suppression to their immune system might be able to mount a response against COVID.

But others who have very weak immune systems even when vaccinated are at greater risk.

"If let's say I was undergoing cancer therapy, I would absolutely not be dining in indoor restaurants because we know the airborne nature of Omicron means it's a really high-risk activity. I would not be having indoor visits with people who had any symptoms," she said.

'Feel anxious'

The lifting of restrictions is also causing concern for some whose family members are immunocompromised. 

Saskatoon parent Kath Stevenson has a seven-year-old son who is immunocompromised because he has primary B-cell deficiency.

"I feel anxious. I feel like this society is incredibly ableist and is just forgetting about a lot of people."

Stevenson said she understands the lifting of some restrictions, but what distresses her the most will be the end of requiring people to mask in indoor public spaces, she said. 

"I think masking is not a restriction, it's a protection," said Stevenson. "The removal of masking is devastating for us.... It just makes us feel like we can't go anywhere, do anything at all."

The Public Health Agency of Canada (PHAC) says that when layered with other recommended public health measures, a well-constructed, well-fitting and properly worn mask can help prevent the spread of COVID-19. Respirators (such as N-95 and KN-95 masks) are considered the highest level of mask protection.

Eric Glass, a 65-year-old retired paramedic from Winnipeg who has multiple myeloma, a blood cancer, has been through three rounds of chemotherapy and a couple of stem cell transplants. His wife is an insulin-dependent diabetic and has leukemia.

Glass said they, too, have been "extremely careful" during the pandemic, meaning very little contact with neighbours, and switching to shopping online.

"We definitely are very hesitant to go to anybody's place or to have anybody over here." 

He said he's not sure whether lifting restrictions will really change the way they live their life and that they will still be "extremely cautious," continuing to avoid large public areas and wearing masks in public areas.

"It doesn't scare me because I have no intention of going to a restaurant in the near future. I have no intention of going to the grocery store and going to a big box store. We'll continue with our online purchase practices because that's how we feel safer."

But Glass fears there could be indirect health ramifications for him and his wife if the restrictions are lifted as he is concerned about the pressure on the health-care system if there's a spike in COVID-19 cases.

"We are both fragile enough that we do need that health-care system to be available to us," he said. "It scares me to think that the lifting of restrictions too early could result in health-care services not being available that we would need." 

New treatments showing promise

Bowdish said new treatments like monoclonal antibodies have shown great success in protecting those who cannot make their own antibodies should they get sick.

But the patient must get tested early for any symptom and needs to let their health care provider know so they can be referred to treatment, she said

"They are incredibly effective but only very early in infection."

Because risk can vary depending on the individual and condition, most immunocompromised people can't know what their risk of serious illness will be if they do get infected. 

"So it is safer to assume that they are vulnerable. Until community rates are lower, they will likely want to continue to avoid large crowds and any situation where the masks are off," she said.