As COVID-19 spreads across the globe, those at highest risk for the illness, experts say, are the elderly and immunocompromised.
But what, exactly, does it mean to be immunocompromised?
Generally, the term refers to anyone with an immune system that does not function the way doctors think it should. It may make someone more susceptible to acquiring an infectious disease, or to developing more severe symptoms once acquired.
The Centers for Disease Control and Prevention has warned that, in addition to older individuals, the most at risk for severe symptoms of COVID-19 are people who have serious chronic medical conditions such as heart disease, diabetes, or lung disease. But because the coronavirus causes respiratory illness, other influences — particularly behavioral or environmental factors that affect your lungs’ ability to function — might increase health risk as well.
“Chronic obstructive pulmonary disease (so emphysema, chronic bronchitis), asthma, cystic fibrosis — these are all chronic diseases of the lungs that essentially make the lungs already somewhat compromised in how they function,” said Anil Vachani, a pulmonologist and associate professor of medicine at the University of Pennsylvania. “And so, if you add on top of it a viral infection [like COVID-19] that directly affects the lungs, these patients generally are going to do more poorly, because their lungs already don’t work as well and their ability to tolerate an infection is going to be worse.”
Vachani said an immunocompromised person with these diseases may or may not be more likely to catch the highly contagious coronavirus; scientists aren’t sure. But one thing is clear: Once it is acquired, their chances of developing severe or even life-threatening symptoms are much higher.
Other lung-related factors could affect your risk, as well. Some experts believe that smoking or vaping may increase individuals’ risk of developing symptoms. Philadelphia has the highest rate of adult smokers of any major U.S. city. A recent report from the city’s Department of Public Health says 18% to 19% of adults smoke cigarettes, compared to 14% nationally.
Experts have already linked long-term exposure to air pollution in cities to higher coronavirus death rates, which doesn’t bode well for Philly either. The American Lung Association has consistently given the city and its surrounding counties a failing grade when it comes to air quality.
Your immune system’s health could even be linked to the neighborhood you live in.
According to a recent study by the Union of Concerned Scientists, census tracts spanning Old City, Northern Liberties, Callowhill, and Chinatown — all areas adjacent to the Vine Street Expressway — have increased risk of exposure to auto-related air pollution.
And it’s not just cars that are to blame. Terri Burgin, a climate justice fellow with Philly POWER working in Nicetown and Germantown, rattles off a list of polluters easily.
“Highways, bus depots, refineries, laundromats,” she said. “In Nicetown, there’s an entire neighborhood… with 312 diesel buses going through, a mall that receives large truck deliveries regularly, two laundromats, two crematoriums … oh, and the Expressway is close.”
Real life reflects pollution’s effects already
Growing up in Philadelphia, Burgin said, she’s seen the real-life effects of that pollution on the health of her neighbors. At the schools she works with, more than half the children have severe asthma; in her circle of activists and organizers, many struggle with autoimmune disease.
“It’s not just random. The rates — the number of people under the age of 40 that I know that have emerged that have [multiple sclerosis], that have lupus, that have diabetes, that have asthma or high blood pressure — the numbers just feel so much higher,” she said. “It’s just a lot higher than even the national average … so I think when you’re looking at all these communities that have such high rates, there’s just a clear connection. And I think it’s probably a combination of environmental factors that are causing it. And it’s part of why climate justice is a poor, Black and brown issue.”
Burgin herself has lupus, a disease that requires her to take immunosuppressant medication regularly.
“It’s not just worrying about the coronavirus itself. It’s not just the environmental impacts that you’re still suffering with that you’ve been dealing with on a regular basis. It’s health insurance … and getting your medication … and these kind of access points that are part of the cycle of health care that we have in our country,” she said. “And just everywhere along that [cycle], there are places for pitfalls to happen for someone who’s immunocompromised right now.”
“When we’re exposed to air pollution, we’re talking about small particles in the air that result in various mechanisms in the lungs that result in injury,” said Vachani. The particles “interact with the epithelial cells in our lungs,” he said. They “alter their normal cellular function,” and “create an environment where it’s easier for infections to hone in.” That includes infections like the coronavirus.
“We’re certainly recognizing that exposure to chronic air pollution results in a number of adverse health outcomes which are increasingly recognized … It may even contribute to a whole host of other illnesses that we’re now understanding the links to, to poor air quality and air pollution,” Vachani said. Still, he was careful to say it’s too early to determine exactly how poor air quality or air pollution affects risk for acquiring coronavirus specifically.
“Certainly for those who are living in areas of poor air quality, we want them to be cautious,” he said. “But I think the bigger message is, we want everyone to be cautious.”
Add the refinery’s legacy
Still, that caution might not work the same way for populations across Philadelphia. Rachel Merriman-Goldring, an organizer for Philly THRIVE, told WHYY that she sees the residents she works with in Grays Ferry at particularly high risk, especially as the city goes on lockdown.
“We’re seeing that a lot of folks are out of work without pay. We’re seeing that a lot of folks don’t have the money they need to get the health care they need. We’re seeing that folks in our community who are lower-income don’t have access to cars to get to the grocery store, or the money to be stocking up on food and other supplies,” she said. And these “conditions of economic injustice” make it that much harder to cope with the conditions of a global pandemic, she said.
The Philadelphia Energy Solutions refinery may be closed, but the air quality conditions it caused are still present.
“Folks in Grays Ferry are living with cancer, heart disease, lung disease and chronic obstructive pulmonary disease at disproportionately higher rates, and they’re living without many of the financial resources that folks in other communities have,” Merriman-Goldring said. “So they are at risk. And that risk is so directly linked to the ways that the refinery polluted these communities for more than a century, and the ways that our economic system prioritizes profit over the health of Black Philadelphians.”
Merriman-Goldring said the city needs to direct its resources to communities like Grays Ferry that are at higher risk.
Burgin agreed: She thinks boosting the resources of local health clinics, which have historically been undersupported, might help her neighborhood and others.
Health centers across the city are scaling back on nonessential services, such as dental care, to lower health risks and ensure that they have additional staff available in the event of a coronavirus-related surge, said city Health Commissioner Thomas Farley in a briefing Wednesday afternoon. But there are currently no plans to prioritize specific neighborhoods or regions, regardless of their environmental risk or existing access to medical care.
“Let me be emphatic about this: This virus is everywhere,” Farley said. “It’s not more in one neighborhood than any other one. It’s in the entire nation, it’s certainly all across the city of Philadelphia. No one should assume that it’s not in their neighborhood. Everybody should take these prevention steps very seriously.”