Jacob Scheier is aToronto-based poet, essayist and journalist and past winner of the Governor-General’s Literary Award.
As an immunocompromised person, the COVID-19 vaccines aren’t as effective for me as most people. And now that I’ve experienced a summer and fall of patio and backyard hangouts that have felt almost like prepandemic times, it’s hard to imagine going back to a more isolated life. But with winter here, I am worried that looking out for my safety means being left behind.
Gatherings with friends, this past summer, had the celebratory quality of reunions after years apart, and we greeted one another as though the hug had just been invented.
This was a far cry from the previous year, when after the first lockdown ended and people began congregating on patios and in parks, I continued to live pretty much as though I were still in lockdown.
Since people with autoimmune diseases, like myself – I have Crohn’s Disease, an inflammatory bowel disease (IBD) – were not included in the initial vaccine trials, it was unknown how effective the vaccine would be for me.
I played it pretty safe after my first dose of Moderna. I didn’t change my cautious behaviour much – I just became a little less vigilant about things such as how close people were standing to me at the grocery store checkout counter.
A couple of months later I read the initial results of the CLARITY study, led by researchers from several universities in the U.K. The study measured antibody response in patients with IBD on the same immune suppressant medication as me: infliximab.
Based on the CLARITY study findings, it turns out there was a good chance that my first jab gave me little to no protection against the virus. I recollected, with a shudder, about everywhere I had been lately – times I found myself, for instance, in a narrow grocery aisle with someone who either didn’t know or didn’t care how to properly wear a mask.
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However, according to the study, the vast majority of IBD patients on infliximab seemed to mount a sufficient antibody response after a second vaccine dose. It appeared safe for me to have a social life for the first time in over a year.
Notably, the CLARITY study only measures a particular kind of antibody, and it’s currently unclear which antibodies and other parts of the immune system are involved in immunity from COVID-19, though the study’s findings seem to correspond well with emerging real-world data.
A couple of times this summer and fall, during gatherings with friends, when it rained or got a bit chilly, the small group moved inside. I felt a little nervous when this happened. Someone would inevitably say something like: “We’re all fully vaxed – it will be fine.” I tried to let that reassure me.
In midfall, after seeing a headline that immunocompromised people in Ontario, including those on infliximab, were being prioritized for third vaccine doses, I immediately went to look at the latest data from the CLARITY study: About three months after the second vaccine dose, the infliximab patients’ antibody response had rapidly waned down to almost nothing. The graph they used to represent this showed a line sharply spiking downward. The image reminded me of a stock market crash.
To my horror, I realized I had spent most of the summer and fall – the hangouts and hugs – with probably very little immunity to the virus.
In retrospect, I was in some denial. Part of me must have suspected that the good news from the CLARITY study was too good to be true (or rather remain true), and that’s probably why I, unconsciously, didn’t seek out the latest scientific info. I suspect what I wanted, even more than a sense of safety, was to feel a sense of “fitting in” with my friends – a desire that goes back to when I was first diagnosed with Crohn’s Disease in adolescence – about 30 years ago.
When I was 12, my mother put me on a very restrictive diet – though the role of diet in Crohn’s is a source of contention between mainstream and alternative medicine.
The social glue of adolescent life, before it becomes sex and drugs (in my experience) is junk food, especially fast food. I recall one afternoon going to a McDonald’s. While my friends enjoyed their Big Macs, I ate tuna salad from a Tupperware container (tuna salad made with olive oil – even mayonnaise was contraband on the diet). I was told by staff I couldn’t eat “outside food.” My friends – not the most sensitive bunch at that age – ignored the situation. I sat by myself on the patio on that windy, cold day, separated by the window, watching them savour their food – that is, enjoy their disease-free lives – from the other side of the glass.
But there is good news for me: the CLARITY study findings suggest with a third dose of the vaccine, my immunity should be stronger and last longer than it had after the second dose.
Or there was good news for me. Enter Omicron.
Dr. Tariq Ahmad, lead researcher of the CLARITY study, tells me that while he can now confirm that “antibody responses following a third primary dose are robust” (though more time is needed to measure durability), “it seems likely that anti-TNF [i.e. drugs such as infliximab] will also impair antibody responses to this new [Omicron] variant.”
I’m getting pretty tired of this movie: Just as I think my level of protection against the virus is the same as most other people, it turns out I’m just as vulnerable as before.
I had been looking forward to connecting with friends and family this winter. I imagine that once heathy people receive the booster, small in-person gatherings, temporarily halted by the new variant, will continue. But for better and worse, I’m too informed, to, with blissful ignorance, join the party this time.
I find myself remembering the junk food-less birthday parties I had as a child. My mother trying to convince my friends that sugarless peanut butter on a rice cake was just as good as actual cake – as though I weren’t unpopular enough already.
I am envisioning my second zoom birthday party: all my triple-vaxed and healthy friends thinking the same thing; if it wasn’t for me or rather my disease – the two sometimes feel inseparable – they could be having a party in real life, sharing bottles of wine and, of course, junk food.
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