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We All May Be More Immunosuppressed Than We Realize

COVID-19 is broadening what it means to have a compromised immune system, and that could be what’s causing more and more young people to take a turn for the worse

When Robyn, a 34-year-old nurse in Detroit, started working at a pop-up COVID-19 clinic last week, the patient who terrified her most was her age. A police officer and father of two, he’d already tested positive for coronavirus but his symptoms had only gotten worse after three weeks. He was pale, dizzy and immediately rushed to the emergency room with an oxygen level below 90 percent and plummeting. Terrified through tears, he asked if he needed to call his wife to tell her he might be on a ventilator, or even die. 

“He was scared. And he was this in-shape, young guy who probably just had a weakened immune system from a stressful job,” Robyn says, fearing that her 50-plus hour work weeks — not to mention, the psychological strain of the pandemic — would take the same toll on her ability to fight off the virus.

The one thing scientists have been sure about as they navigate COVID-19 for the first time is that it’s disproportionately deadly for anyone over the age of 65, or with a compromised immune system. While the former is easy to rule out, the latter is difficult to pin down because immunosuppression occurs on a spectrum. People who’ve recovered from cancer, live with HIV or AIDS or take immunosuppressant medications, usually know they’re immunocompromised and at risk. But many people experience immunosuppression to a lesser extent from lack of sleep, drinking too much and chronic stress without even realizing it. And if they contract coronavirus, it’s entirely possible that they may add to the growing number of young, otherwise healthy outliers who are becoming severely/critically ill with COVID-19 — especially health-care workers and first responders

“Immunosuppression can exist at all different levels of severity, but some of those levels may not result in observable symptoms,” explains Chirag Shah, an ER physician. Essentially, a person who has an immune system that’s operating at 90 percent might not know it or may experience mild symptoms like feeling tired. And because immune systems are so individualized and complex, it’s impossible to know how much someone can take before they become immunosuppressed. “There’s no formula to determine how specific lifestyle factors impact any particular person’s immunity as there are many factors at play,” Shah continues. 

The prevalence rates for immunosuppression are around 3 to 4 percent in the U.S., but this is based exclusively on people who know they’re compromised. Cancer patients understand how their disease and chemo treatment impairs their ability to make white blood cells. Those living with HIV realize that their lowered T-cell count makes it harder for their bodies to fight off infections. And folks who take medications that suppress their immune systems, often because they have an autoimmune disease like lupus or have had an organ transplant, are fully cognizant of the fact that they’re vulnerable. 

Steroids taken for allergies also suppress the immune system because they’re meant to curb the response to a benign allergen. However, the human body can also produce steroids naturally in the form of the stress hormone cortisol. As such, when stress triggers a fight-or-flight response in the body (let’s say during a global pandemic), cortisol is secreted to increase energy levels, mostly for survival. “Like steroids given as medications, steroids produced by the body in excess can suppress the immune system,” physician Leann Poston tells me. 

Around 83 percent of Americans suffer from some form of work-related stress, and subsequent sleep loss raises cortisol levels and weakens the immune system further. Coping mechanisms like drinking pile on from there, as alcohol disrupts how the microbes in the gut interact with the immune system, allowing more bacteria to get into the bloodstream. 

Poston and Shah agree that one of the first symptoms of these lesser forms of immunosuppression is excessive sleepiness and fatigue, which is a result of “direct communication between the immune system and the nervous system,” Poston says. Simply put, it’s your body’s way of saying that if it doesn’t rest, there could be a fatal security breach. 

Of course, cancer survivors or people with HIV are significantly more compromised than burnt-out nurses and cops, and normally, these wouldn’t be comparable forms of immunosuppression at all. But given that about a third of the U.S. workforce already dealt with some form of workaholism prior to the pandemic, stress could legitimately contribute to the coronavirus’ toll (especially, again, taken in tandem with the trauma of soaring unemployment, sick and dying friends and family and the psychological impact of staying inside for months on end). “In the context of COVID-19, having a suboptimal immune system can increase the likelihood of getting infected and having worse symptoms after an infection takes hold,” Shah says. 

Robyn doesn’t know what happened with the cop — or what will happen to her. Although she’s working 10- to 12-hour days and her schedule keeps changing, as of now she has two days off a week and an employer who has assured her that she can take more time if she needs it. Better yet, she’s been able to sleep sounder and keep food down more compared to two weeks ago when the crisis started. She was having a dry martini with her boyfriend when she took a call with me on her night off, because despite the risks, she’s still trying to feel normal. 

The bigger struggle for Robyn and her colleagues is that they don’t want to slow down. Not only would she have more time to think about the cop, his kids and her other terrified patients, but she just wants to help as much as possible before she gets sick. “It’s not a matter of if, but when,” she says ominously. “We just have to keep going, though. I’m in robot mode right now, but may not be okay later.”

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