Some medically vulnerable Texans feel left behind as the state returns to normal

Like many people who followed a strict quarantine during the coronavirus pandemic, Kristen Patton hasn’t seen her extended family for more than a year.

But unlike other Texans who, like her, have been fully vaccinated against the virus, Patton’s life is not likely to go back to normal any time soon.

That’s because the vaccine, widely viewed as the ticket back to pre-pandemic life, doesn’t appear to be working for Patton, a 45-year-old Austin heart transplant recipient who takes medicine that suppresses her immune system.

Researchers in a Johns Hopkins University clinical trial Patton is taking part in for transplant patients say it could be that the medicines she takes to keep her body from rejecting the transplanted heart is interfering with antibody production and hindering her ability to become immune to the virus, she said.

For Patton and potentially millions of other medically vulnerable Texans, the possibility that the vaccine won’t work — or that, as some patients fear, it could even hurt them — is a devastating blow after a year of sacrifice, isolation and waiting for protection against a virus that is especially dangerous for them.

“It is a very difficult thing to process,” Patton said. “To get those [antibody test] results was just a punch in the gut.”

Medical experts believe, based on several factors, that the vaccines are safe and effective even for the medically vulnerable. But several studies are in the works, including trials and research happening in Texas, to deepen scientific understanding of how the vaccines affect people with immune disorders, cancer and transplant patients who are taking immunosuppressive medications and people who suffer allergies.

“When you add up the populations between autoimmune, transplants and cancer [patients], that’s a lot of our friends and neighbors,” said Dr. Benjamin Greenberg, professor of neurology at the University of Texas Southwestern Medical Center in Dallas, who is leading studies in collaboration with various specialists on the vaccine in immune-compromised patients. “That’s a lot of people in Texas who fall into one of these categories. So we’re not talking about a rare patient population. This is a lot of folks. So it needs study, and for us to get answers.”

Answers are what Sue Foery, 81, is hoping for as she waits for her doctor to greenlight the vaccine for her.

The Groves resident wanted the vaccine, but her doctor of 30 years advised against it, saying there wasn’t enough data about the safety of the vaccine for people with her autoimmune disorder, myasthenia gravis, which can weaken the muscles required for moving and breathing.

“My doctor said he would be very remiss in telling me it was OK,” she said. “I do have hope that as time goes on, they might perfect the vaccine or get new ones, or that my doctor will have enough information that he’ll say, ‘Well, you know, you can go ahead.’ But at this time he says just don’t.”

Texas, meanwhile, is reopening in the wake of plummeting deaths and hospitalizations, even as only 1 in 3 Texans are fully vaccinated. State and local mask mandates have been dropped, and governments and businesses are forbidden to require customers to be vaccinated.

That leaves people like Patton and Foery to watch the long-awaited return to normal life from a distance, at least for now.

“I have a tremendous respect for individual rights and freedoms,” Patton said of the relaxed health restrictions, “but it is extremely frightening for people like us.”

Health experts say vaccines are safe for medically vulnerable people

In spite of questions over its effectiveness in these patients, scientists and health experts agree that the vaccine is safe for most people, including those with suppressed immune systems or who have suffered allergies to vaccines in the past.

Out of more than 2 billion doses that have been administered worldwide, the few recipients who have reported serious physical reactions or symptoms related to the vaccine don’t fall into any single medical category in terms of preexisting conditions, experts said.

“We’ve become very comfortable with the safety profile of the vaccine, because we have a huge experience with it all at once,” Greenberg said. “One of the things that is amazing about this vaccine campaign is that we have, literally, never before in history had so many people receive a vaccine in a short period of time with such intense monitoring. If there were any serious events happening, we’d be hearing about them.”

The U.S. Centers for Disease Control and Prevention urged caution by these patients in the early days of the vaccine rollout because there was limited data for those populations. The CDC and other health officials encouraged those recipients to check with their doctors or advise the vaccine provider of their condition before being vaccinated.

That caution touched off fear and, in some cases, viral misinformation about the safety of the vaccine for segments of the population who weren’t entirely healthy, creating hesitancy that is now difficult to combat as new information comes to light, Greenberg said.

With more than 150 million Americans now having received at least one dose, including a statistically significant number of patients with autoimmune issues, the data about its safety for those patients is much more robust, he said.

“That language has evolved to now say people with autoimmune conditions have successfully taken the vaccine without adverse events and that it is recommended for individuals with autoimmune conditions,” Greenberg said.

He advises patients to “re-engage” with their doctors if they haven’t talked to them in a while about the safety of the vaccines, and to check in with advocacy groups and researchers that specialize in their conditions for reassurance on the safety of the shots.

In Foery’s case, that might be the Myasthenia Gravis Foundation of America, which posted in late May that its medical team “continues to stress its recommendation that all MG patients get the COVID-19 vaccine as soon as possible,” but that its effectiveness is still in question for people receiving treatments that suppress their immune system.

“Therefore, we will continue to recommend that MG patients follow the CDC guidance for unvaccinated people,” the group posted.

Allergy sufferers were another group subjected to the fear and misinformation stemming from lack of early data, but allergy experts and researchers say those patients — no matter what their allergies are — should also feel safe in taking the vaccine.

“We’ve never been able to confirm any reason why someone can’t get their vaccine” due to an allergy, either to a component of the vaccines or to anything else, said Dr. David Khan, a Dallas allergist-immunologist and professor of Internal Medicine at UT Southwestern Medical Center. “Allergic reactions to this are very rare. It’s not a common thing to begin with. We really feel that it's worth it to get vaccinated.”

Khan is leading a study in partnership with the National Institutes of Health looking at COVID-19 vaccine recipients who have severe allergies to things other than the vaccine components, in hopes of further proving what doctors already believe about the safety of the vaccines and to dispel hesitancy among allergy sufferers, he said.

Anaphylaxis, a reaction that can occur with any type of allergy, including flu shots or food allergies, can be treated quickly and easily with epinephrine that providers are directed to keep at vaccine sites, Khan said.

And they’re a lot easier to treat than COVID-19, he added.

They’re also a lot more rare. Cases of anaphylaxis occur in between 2 and 5 people per million COVID-19 vaccine recipients in the U.S., the CDC says.

“You’re more likely to get in a car accident driving to get the vaccine,” Khan said.

Evidence of decreased effectiveness

The whole point behind the push to vaccinate most of the population is to stop the spread of the virus, lessen its impact and — in the very definition of “herd immunity” — protect those who are not immune to the illness. Experts say anywhere from 70% to 90% of the population must be immune to reach herd immunity.

Meanwhile, recent polling shows that as many as 30% of Americans — and a similar proportion of Texans — say they won’t get the shot. Two-thirds of that group believe they don’t need it and more than half say they usually don’t take vaccines.

Hesitancy is cited as the main, and growing, barrier to reaching herd immunity against COVID-19.

“Coronavirus needs vaccine-hesitant and anti-vaccination individuals like fire needs wood. The only way it’s going to survive is because of that population of individuals allowing susceptible hosts to walk around,” Greenberg said. “And for my patients who are willing to take vaccines but don’t get the benefit of them, they need those other people to step up.”

The most recent research shows that the vaccines are safe for people with autoimmune conditions, but that there are varying degrees of effectiveness. Some medications, such as those commonly taken by patients suffering multiple sclerosis and rheumatoid arthritis, not only seem to increase the severity of COVID-19 infections in some cases but appear to decrease the efficacy of the vaccine, studies suggest.

Trophy Club resident Jennifer Lovinger, 50, has had both of her COVID-19 shots but is waiting until she gets her antibody test later this month before she feels any safer. She says she will likely keep masking and social distancing at least until the virus is completely eradicated.

Lovinger suffers from five different conditions, including lupus, that suppress her immune system or that require her to take medications that have that effect, she said.

“My whole family says, ‘Mom, you’re vaccinated, but we still don't think you should go anywhere,’” Lovinger said. “That’s our big worry. I’m vaccinated, but is it working?”

Disclosure: UT Southwestern Medical Center has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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