My Covid Story:

I began to feel ill the night of my eighth birthday. Less than a month later, I was diagnosed with Crohn’s disease. Having just barely finished second grade, I didn’t know what this disease meant or its severity — let alone what the condition had in store for me. Since my diagnosis nearly a decade ago, I have luckily required relatively minimal treatment and experienced no subsequent flare-ups. Now, living through the COVID-19 pandemic as a high-school senior, the potential implications of the virus have caused newfound worry for me and my loved ones.
Both curiosity and necessity have expanded my knowledge about Crohn’s disease. Crohn’s is a type of inflammatory bowel disease (IBD) where the immune system of the gastrointestinal tract becomes overactive, thereby attacking healthy tissue and giving rise to chronic inflammation. Patients with active IBD typically take immunosuppressant medication to help subdue inflammation; once their immune system is compromised, so too is its ability to fight against other illnesses like COVID-19. This same concept applies to hundreds of other inflammatory conditions that similarly require immunosuppressors.

Assessing the Risk for those with IBD

Scientists have been researching the impact of COVID-19 on those with immunodeficiencies, and as the United States sees a dramatic resurgence of COVID-19 cases, more information has become publicly available to address rising concerns including the risks of contracting the virus. According to the Centers for Disease Control and Prevention (CDC), those who are moderately to severely immunocompromised are particularly vulnerable to COVID-19. On a more positive note, however, a study published in the Journal of Clinical Medicine, concluded that IBD patients are not at higher risk of severe illness. To break it down, they appear to be more susceptible, yet the effects of the virus are no worse than those of the general public should they become infected. 

Nonetheless, I hope everyone would do their part to reduce the risks of contracting and spreading COVID-19, masks and vaccines being the most effective methods we have thus far. Paradoxically, as vaccines become more accessible, vaccine hesitancy seems to become more widespread as well, even, disconcertingly, amongst immunocompromised patients. A survey conducted at the start of vaccine distribution revealed that 70% of IBD patients were concerned about the side effects of COVID vaccines.

Vaccines and IBD

For some, the belief that the vaccine may transmit the virus causes apprehension. While significantly immunocompromised patients should not receive live vaccines, none of the COVID-19 vaccines currently distributed in the US contain the live SARS-CoV-2 virus, meaning that it is impossible to get COVID-19 from the vaccines. It is well-known, though, that the vaccine often causes side effects such as swelling, headache, muscle pain, and fever. Thankfully, the risk of side effects from either Pfizer or Moderna vaccines is no greater for IBD patients according to researchers from Cedars-Sinai Medical Center, who published these results in the American Journal of Gastroenterology. In fact, according to Gil Melmed, MD, corresponding author of the study and Director of Cedars-Sinai IBD Clinical Research, “If you’re being treated with advanced therapies such as biologics, these side effects might even be milder.” Of the 246 patients in the study, 80% being treated with methods such as biologics or Janus kinase inhibitor therapies (both of which suppress the immune system) reported fewer side effects.

Although vaccines have shown no additional negative effects in immunocompromised patients, some have struggled to recognize the positive effects. To work properly, COVID-19 vaccines require an immune response. For some taking immunosuppressant medications, reports have shown little to no detectable antibodies against the virus after completing the two-dose vaccine regimen. In such cases, the CDC has officially recommended additional mRNA doses after studies indicated enhanced immune response, albeit with certain qualifications:

“The clinical benefit of an additional mRNA vaccine dose after an initial 2-dose primary mRNA COVID-19 vaccine series for immunocompromised people is not precisely known. However, for people with moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, the potential to increase immune response coupled with an acceptable safety profile, support the recommendation for an additional mRNA vaccine dose after an initial 2-dose primary mRNA COVID-19 vaccine series.”

Importantly, antibody presence is not the only aspect that could indicate defense against the virus.

“There are other types of immunity which may provide protection,” according to a statement from the Leukemia & Lymphoma Society. “Immune cells known as T cells play a role in the ability of our immune system to protect us against COVID-19.”

My Outcome May Have Been Different

As noted, it has been almost a decade since my Crohn’s diagnosis. I am incredibly grateful that my life has essentially been normal and that I have not contracted COVID-19. However, if this pandemic had occurred over a different timeline, I may not have been so lucky. Both while hospitalized at the age of eight and for months afterwards, I was on high doses of anti-inflammatory steroids, which would have rendered me at higher risk to the virus and my immune system weak if I had to fight it. In addition, along the course of my condition, the doctors considered prescribing a biologic, either Remicade or Humira; that, too, would have put me at higher risk. If my IBD flares up again, especially in the midst of a resurgence, I will be at higher risk from both my underlying condition and its possible treatments. While these scenarios represent hypotheticals, I know many people who experience such circumstances in actuality. For those whose immune systems are resistant to the vaccine, they rely on the rest of us to get vaccinated.

Written by Eric Chen

Edited by Dr. Jacki Hart

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