Coronavirus update – Are you immunocompromised? – part 1 – explaining the terms

This is an important question and important to know for a variety of reasons, including understanding the current rhetoric about the COVID-19 booster shots.

In this first article I am going to start with the short answer to the question, “Are you immunocompromised?”

The answer for virtually all of us is NO. (See the definition below. Skip the rest if you don’t want to know any more.)

The more long answer is more nuanced and will come in several subsequent articles.

In the medical world Immunocompromised or immune compromised means that your immune system does not work fully and you are at higher risk of getting infections and dying from them. You have something seriously and significantly deficient in your immune system. This may result in common infections or rare ones. It means your immune system does not work as it should to prevent a life-threatening infectious illness that would otherwise have been preventable. The operant word here is life-threatening.

However even the word life-threatening does not in a black-and-white manner mean you are immunocompromised.

If you have a life-threatening infection, we at least have to consider that you may have an immunocompromised condition contributing to your illness. However for the vast majority of us experiencing a life-threatening illness, we are not immunocompromised. We just have a life-threatening illness for other reasons than an immunologic deficiency.

There is a however a very nonspecific way the term immunocompromised is used, particularly in the news and popular press. Many use it to mean anything other than a perfectly functioning immune system. Some use it to just express any condition more likely to result in death. (Cancers can result in death, but rarely from an immunologic deficiency.) Overall that usage is a quite vague and does not reflect our use of that term in medicine.

Less than perfectly functioning immune systems are very common as a good number of us can be found in extensive laboratory testing to have some glitch in the way our immune systems behave. A glitch does not equal being immunocompromised. A glitch does not mean we are more likely to die from the common cold. Truly immunocompromised individuals actually are at risk of dying from the common cold.

You are truly immunocompromised if:

1. You have no spleen.
2. Are currently on or have recently received chemotherapy. Some chemotherapy may damage the immune system permanently. Others’ adverse effects appear to wane over time.
3. You are being treated with immunosuppressive drugs for diseases where the immune system has overreacted and started destroying healthy tissue. These are some drugs used to treat rheumatoid arthritis, systemic lupus, ankylosing spondylitis, Crohn’s disease, multiple sclerosis, psoriasis and other dermatologic conditions. as well as other rare disorders.
4. You are on chronic steroid therapy.
5. You have a transplanted organ for which you need anti-rejection medications.
6. You have a disease of the immune system that you were born with.
7. You have a damaged immune system due to toxic chemical exposure that has left you with a history of more frequent severe infections that were life-threatening.
8. You are severely malnourished.
9. You are very late in life. This basically means you are so frail that you are unable to care for yourself, and possibly in a skilled nursing setting.

Otherwise you are NOT immunocompromised based on the current definitions. If any medical professional tells you otherwise, they are not acting on sound medical and evidence-based understanding and recommendations.