At the beginning of the pandemic, 41-year-old Adam Delorey drove all the way from Calgary, Alta., to Halifax, N.S., with his two kids and a travel trailer to avoid COVID-19.
Delorey had a heart transplant in 2019 and as a result, he has been prescribed immune suppressant meds for life. They work to stop the immune system from damaging the transplanted organ.
“Initially, it was really scary … When COVID-19 began I was seven months post-transplant … and this was before vaccines were out, so it was a bit nerve-wracking,” said Delorey.
He’s now triple vaccinated and will soon be taking his fourth shot.
But vaccination, which some experts say is one of the most crucial tools in preventing COVID-19, isn’t the only thing that’s available to immunocompromised people as the country sees yet another rise in coronavirus cases.
Dr. Sohal Goyal, lead physician at the Mississauga Medical Arts — COVID, Cold and Flu Care Clinic said immunocompromised people need to know what tools are available to better protect themselves against COVID-19, like Paxlovid and the recently approved antibody treatment, Evusheld.
What do the immunocompromised need to know about vaccination?
Goyal said prevention through vaccination is key as there is no better alternative to keep the immunocompromised safe.
“If you’re immunocompromised yourself, you may not realize that you actually qualify for a fourth shot because the fourth shot is what’s considered your booster,” said Goyal.
He explained that most immunocompromised people get three primary COVID-19 vaccine shots, whereas, for a person who is not, it’s recommended to take two primary doses and a third booster.
This is illustrated on the government of Canada’s website where all the information on vaccination for immunocompromised people can be found.
But not all immunocompromised people have the information they need, Goyal said, because they are a minority and most of the information being shared is aimed at Canadians who aren’t immunocompromised.
“The thing with the immunocompromised is that they have to seek out information a little bit more,” he said. “Health-care providers would definitely tell them.”
That was the case with Delorey who did find out through his health-care provider that he needed three vaccines and a fourth as a booster.
“I’m in a different situation than most immunocompromised people or most transplant recipients, whereas I’m so young and I have children in school,” said Delorey. “So like for me, once I received the vaccines, I was mentally prepared to get COVID.”
He said his fear reduced after taking his shots because in his mind he believed “COVID is not going anywhere. It’ll be here till the end of time” so at least now he was protected.
Delorey, who’s a real estate agent and keynote speaker, eventually did get COVID-19 after one of his daughters caught it at school in February. However, he only experienced mild symptoms.
“I was well protected with the vaccine and it wasn’t that bad of an experience,” he said.
During his bout with COVID, he was monitored by his transplant team in Halifax — getting the support he needed.
What is Paxlovid and how can it help?
Goyal said one of the things he and his colleagues are advocating for is to have immunocompromised people reach out to their health-care providers before they get COVID to have a discussion about COVID treatment options, like Paxlovid.
According to Health Canada, Paxlovid can be given to adults 18 and older who are positive for COVID-19 and experiencing mild to moderate illness and are at high risk of becoming seriously ill.
The agency currently recommends prioritizing severely immunocompromised patients, people over 80 who haven’t had all their vaccine shots, and people over 60 living in remote and rural locations, in long-term care homes and First Nations.
The treatment, which has to be prescribed, involves taking three pills of two different drugs — nirmatrelvir and ritonavir — twice a day, for five days. It should be started after a positive COVID-19 test and within five days from the onset of symptoms, according to Goyal.
“One of the things that could be possible is getting a prescription for Paxlovid ahead of time,” Goyal said, so that once an immunocompromised patient tests positive, he or she can start taking Paxlovid right away.
He said this is especially important as Canada continues to see an increase in COVID-19 cases.
Chief Public Health Officer Dr. Theresa Tam confirmed on April 12 that Canada is in the sixth wave of COVID-19.
She said COVID-19 has been surging again across Canada, despite cases being undercounted due to the limited PCR testing in most provinces. There were more than 212,000 active cases across the country as of April 20, according to the government’s figures.
For that reason, Goyal said it’s important for immunocompromised people to plan ahead and get a kidney function test beforehand to know what dose of Paxlovid they’d need when they get sick.
“Unfortunately I say ‘when’ you get sick and not ‘if’ you get sick because the virus is quite widespread with this wave,” said Goyal.
On April 12, Dr. Tam said Canadians who may be at high risk need figure out how to access Paxlovid in their community should they need it because it’s a bit different in each province and territory.
The federal government has distributed about 150,000 courses of Paxlovid across the country, Tam said. Most of the provinces have a centralized distribution system for the drug, often through hospitals and assessment centres. Eligibility varies across the country.
“I think all of us would like to see Paxlovid being mobilized more widely,” Tam said, adding Health Canada is working with various jurisdictions about the issue.
“We will be using these kinds of medications in a more significant way as we have more access to antivirals in the future, which is great news. We just need to know how to get it out to people fast.”
Are there other treatment options available?
Currently, Goyal said the main drug being used to treat immunocompromised people who have COVID-19 is Paxlovid, but there is a new treatment that was approved by Health Canada on April 14 called Evusheld.
The drug is intended for people who cannot receive a typical vaccine or for whom vaccines alone won’t provide enough immunity.
“It’s supposed to prevent COVID for up to six months … even if you’re exposed … But the issue is, as with any medication, we’re concerned about the side effects. And so that’s being reviewed right now,” said Goyal.
While a vaccine effectively teaches the body to make its own antibodies over a short period of time, AstraZeneca’s product delivers ready-made antibodies to immediately start fighting off the virus.
The treatment is given in one go, as two sequential shots in the arm. It’s already being used in the United States.
The only other option being used in Canada other than Paxlovid is Remdesivir, said Goyal, and it’s mostly being used for sicker patients who end up being hospitalized due to COVID-19.
Remdesivir, which is administered intravenously, is a repurposed antiviral medication originally developed to treat hepatitis C.
“Until we get another (treatment option), we’re only using Paxlovid, and in a small percentage of cases we’re using Remdesivir, but that medication is mostly being used for transplant patients who don’t have a lot of options,” said Goyal.
As COVID-19 cases continue to rise, Goyal said the immunocompromised have to be “very vigilant and unfortunately a bit fearful right now.”
But Delorey said that he can’t live in fear anymore.
“I have children in school. So am I supposed to hinder their schooling or homeschool them now? I don’t want to do that. I want them to live normal lives as well,” he said.
“I think everybody has to do what makes them comfortable.”