Protecting the Vulnerable—It's Time to Move Beyond the Rhetoric | Opinion

Since the start of the pandemic, medical and public health professionals have highlighted the need to protect the immunocompromised. People who are pregnant, those who have had organ transplants, chemotherapy, immunosuppressive medications and those with chronic health conditions such as diabetes are at great risk of severe complications or death following COVID-19 infection. Many of these people are also unable to mount sufficient antibodies to the vaccine, leaving them at extreme risk. New CDC guidance allows the majority of the population to enjoy pre-pandemic privileges, such as going mask-free in public spaces, while providing disclaimers that vulnerable people must still take precautions.

While talking about how to protect the high-risk members of society, some have offered medical advice. There is hope that multiple rounds of vaccine and the emergence of pre-exposure prophylaxis and monoclonal antibody regimens can afford protections, but this is still speculative—and in limited supply. While scientific advancements improve the outlook, the current status is that many people—an estimated 1 in 37 adults—are still at extreme risk. Missing from the narrative on "protecting the vulnerable" is exactly how to help the immunocompromised with functions of daily living.

Given that vaccinated people can become infected and transmit the virus, many immunocompromised people and their family members cannot risk public outings. Many have faced medical- and pandemic-related unemployment. Their children have not been able to participate in sports or play with other children. If they reside in one of the states that does not have a remote school option, their children have not had formal education in two years. They have skipped necessary dental and medical care, either due to fears of exposure or because they did not have access to telehealth.

I am one of the 7 million Americans who is immunocompromised. I am also a professor of public health at Yale University.

In public health, we quantify health outcomes in a variety of ways, including indices for one's ability to function in daily life. That means the ability to attend school, work, navigate public settings and participate in society. For people whose immune systems are so degraded that they would likely die if infected with COVID-19, going into public among unmasked and potentially unvaccinated people is tantamount to a game of Russian Roulette. Inconsistently enforced or absent mask mandates make this threat more pronounced.

A sign displays mask wearing information
A sign displays mask wearing information. KENA BETANCUR/AFP via Getty Images

To truly "protect the vulnerable," society must make accommodations. That means really examining what daily life is like for the immunocompromised and our families, and problem-solving ways to help and protect us. Unfortunately, a lot of what has been offered has amounted to empty rhetoric with no practical solutions. In fact, many of our lifelines, such as access to remote education and work-from-home arrangements, have been terminated as the rest of society hurtles toward a full return-to-normalcy.

If the larger narrative is that it's time to return to normal, then it is absolutely critical that accommodations be made to protect the vulnerable. If you want to drop the mask mandate for schools, fund remote education. Mandate masks in pharmacies and other vaccine locations—or provide at-home vaccinations. Enforce mask mandates in any office building housing a medical provider, or fund at-home medical visits. Require masks in grocery stores—or pay for delivery services for food, medicines and other essentials. Alternatively, incentivize businesses to schedule "masks-optional" and "masks-required" hours of operation. Provide reliable public internet and extend insurance coverage to reimburse for telehealth. Encourage workplaces to allow telecommuting for vulnerable workers—and consider added precautions such as vaccine passports to protect vulnerable workers who must interact with the public.

It is insufficient to assert that "we must protect the vulnerable" without providing practical strategies, services and education. Otherwise, "protect the vulnerable" reads as an afterthought—because it is.

Marney A. White, PhD, MS, is a professor of social and behavioral sciences at the Yale School of Public Health. She teaches epidemiology, behavioral health and research methods and has twice won the YSPH Teacher of the Year award.

The views expressed in this article are the writer's own.