What Does It Mean to Be Immunocompromised During COVID-19?

What Does It Mean to Be Immunocompromised During COVID-19?

What is the definition of “immunocompromised”?

Being immunocompromised means that your immune system is weakened, either by a disease or by a medication. It means you are more likely to get an infection and more likely to have a severe illness if you are infected than someone who has an immune system that is working well (this is known as being immunocompetent). 

You can become immunocompromised in different ways, either through immunosuppression or through an immunodeficiency.

  • Immunosuppression is when your immune system is deliberately weakened with medications, for example, after an organ transplant.  
  • Immunodeficiency is when the body cannot produce enough of certain blood cells to defend against infection. You can be born with an immunodeficiency (also known as a primary immunodeficiency), or you can get an immunodeficiency later in life due to an illness or medication (also known as a secondary immunodeficiency).
What diseases and medications can cause you to become immunocompromised?

Some people are born with a primary immunodeficiency, and a healthcare provider will usually pick this up when the individual is still a child. If this is you, you will know about it. 

Secondary, or acquired, immunodeficiency is the much more common kind in adults. It can be caused by life events, diseases, and medications.  Here’s a pretty complete list of the causes of secondary immunodeficiency:

  1. Any type of cancer can make you immunodeficient, like solid (organ) cancers and blood cancers such as Hodgkin’s disease, leukemias, and myelomas
  2. Chemotherapy or radiation therapy for cancer
  3. Medications that treat autoimmune diseases (for example, corticosteroids, cyclosporine, methotrexate, azathioprine, and biologic therapies like rituximab and etanercept, to name just a few)
  4. Any infections, including bacterial infections, mycobacterial infections (such as tuberculosis), and viral infections (for example, HIV/AIDS, measles, herpes, glandular fever (EBV), CMV, and chickenpox)
  5. Chronic diseases like diabetes type 1 or type 2, kidney failure, liver cirrhosis, and liver failure
  6. Malnutrition
  7. Autoimmune conditions such as lupus (SLE) and rheumatoid arthritis
  8. Extensive burns
  9. Exposure to environmental toxins (like radiation and toxic chemicals)
  10. Having no spleen function due to not having a spleen (asplenia) or reduced spleen function (hyposplenism), which can happen because of physical trauma or sickle cell disease, among other causes   
  11.  Pregnancy
  12.  Aging
  13.  Stress 
  14.  Tobacco smoking and alcoholism

And then there are those medications that are prescribed to deliberately make you immunosuppressed, when you need your immune system to be forgiving. Examples include:

  • Medications that destroy the bone marrow before a transplant
  • Medications to prevent or treat graft-versus-host disease, a rare and serious condition that can happen after bone marrow transplant when donor cells attack the recipient’s cells
  • Medications that prevent or treat rejection after an organ transplant (for example, mycophenolate, tacrolimus, or cyclosporine)