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Many Californians can’t get back to normal as COVID grip loosens


In summary

Millions of Californians at high risk for diseases such as heart disease, autoimmune diseases and diabetes feel unprotected and forgotten as the state reverses its COVID orders.

Renata Garza-Silva loves movies — she longs to sit in a theater without having to worry about COVID-19 and whether others around her are masked.

Hillary Liber dreams of going back to the gym. She misses her in-person fitness classes, but for now, a makeshift home workout space in the middle of her living room will have to do.

Garza-Silva, who is immunocompromised, and Liber, who is diabetic, are among the millions of Californians most at risk of complications from COVID-19 infection despite being fully vaccinated. Both women fear that the statewide protective measures that had given them some peace of mind during the pandemic are now lifting, increasing their sensitivity and limiting where and what they can go. make.

Across California, people like Garza-Silva and Liber who have health issues, such as heart disease, autoimmune disorders and diabetes, are being forced to reassess their risks. Every day, they wonder if shopping for groceries, going to work, eating out or going to the post office is worth the risk of contracting a virus that could land them in hospital — or worse.

For those at higher risk, the pandemic has meant walking a fine line for two years. “I’m always balancing the fear of missing out with the fear of going out,” Liber said.

“I’m always balancing the fear of missing out with the fear of going out.”

Hillary Liber, San Diego resident with diabetes

Under state guidelines that were relaxed last week, those vaccinated can now go without a mask in indoor public spaces, except for health facilities, schools and prisons. ” normal”.

“People in my position, young children and the elderly are just ignored. We don’t count for anything,” said Garza-Silva, 48, a middle school teacher and La Crescenta resident whose immune system is weakened from medication she takes after a kidney transplant. “I don’t know if people understand how many we are.”

About a third of adults in California — nearly 10 million people — are at high risk for serious complications from COVID-19, according to a 2020 report from the Kaiser Family Foundation. This includes 6 million people aged 65 and over, but also millions more with heart disease, diabetes, lung disorders, obesity and other conditions. (The data did not include elderly people in nursing homes or children.)

Organ transplant patients and those undergoing cancer treatment or taking anti-inflammatory steroids – which are used to treat autoimmune diseases such as rheumatoid arthritis and lupus – are among those considered ” moderately or severely immunocompromised,” according to the US Centers for Disease Control and Prevention. It is estimated that nationally, about 3% of adults take immunosuppressive drugs.

Other people with chronic conditions should also continue to be more cautious, experts say. The CDC lists people with diabetes, chronic obstructive pulmonary disease, heart failure, coronary artery disease and kidney disease, among others, as likely to get very sick from COVID-19.

In California, 2.5 million people have been diagnosed with diabetes, but millions more are estimated to be undiagnosed or prediabetic. And 7% of adults in California — about 2.1 million people — have been diagnosed with heart disease.

Vaccines offer some protection

Many people with health conditions have strong protection from vaccines, but others less so, experts say.

Transplant patients, like Garza-Silva, take immunosuppressive drugs so their immune system doesn’t attack their new organ, making them vulnerable to infection. For some, the first two doses of the vaccine did not provide adequate protection, and in some cases even a third dose was not enough, prompting federal health officials to allow people whose system immune is weakened to receive a fourth dose.

Garza-Silva has had three doses and is talking to her doctor about the fourth.

“Being fully immunized protects you significantly, even if you have a chronic disease,” said Dr. Mark Henderson, internal medicine physician at UC Davis Health.

Yet they face a high risk. At Henderson Hospital, about 20% of people hospitalized with COVID-19 are vaccinated — most of them have a medical condition that makes them susceptible.

Diabetes, for example, is known to affect immune function, Henderson explained. “White blood cells, which are the basis for fighting infection, don’t work the same way in people with diabetes.”

Diabetes has been listed as an underlying condition in 15% of COVID-19 deaths nationwide.

As the state and the nation seek closure on the pandemic, these patients, along with older residents, need to be more vigilant in following reminders and wearing masks, Henderson said.

“The pandemic has always been about vulnerable people. In terms of the devastation it has wrought, it’s about the elderly, the medically vulnerable, and now the unvaccinated,” Henderson said.

Andy Imparato, director of Disability Rights California, said that unlike conversations about vaccine distribution in which advocates were able to provide input, they were not invited to discuss the state’s SMARTER plan, a plan published last week which will set the stage for the next phase of the pandemic.

The plan sets preparedness goals that state officials say will help them respond quickly and adapt to changing conditions, including new variants. But the 30-page document mentions people with underlying medical conditions only to emphasize that they use masks and keep up to date with their shots.

“The pandemic has always been about vulnerable people. In terms of the devastation it has caused, it’s about the elderly, the medically vulnerable.

Dr. Mark Henderson, UC Davis Health

Under existing state guidelines, vaccinated people can go without a mask in most public places. Unvaccinated people must always wear a mask in all public places, although throughout the pandemic the rules have rarely been enforced, leaving it mainly to businesses to decide whether or not to check vaccination status. And even then, vaccinated people can still transmit the virus.

High-risk people cannot live in a bubble. People with health conditions or disabilities, for example, often depend on others for help. Many people with heart disease or diabetes have to venture out into the world to work.

“We want the state to recognize those who, even after being vaccinated, are at high risk,” Imparato said. “We recognize that the state is trying to balance competing demands, including keeping business afloat and helping people get back to their lives, but we don’t want that to happen prematurely.”

The state is also expected to set a date soon when masks can be removed inside schools.

Renata Garza-Silva, shown at her home in La Crescenta, is among millions of Californians who are at high risk for COVID-19 due to medical conditions. Photo by Lauren Justice for CalMatters

The impending end of indoor masking in schools concerns Garza-Silva, who teaches middle school movie appreciation for the Los Angeles Unified School District. In a sign of easing protections, the district announced on Friday that it was lifting its outdoor mask mandate.

Her students, she said, understand her immunocompromised condition very well and do wear masks in class. She keeps windows and doors open for better air circulation. She doesn’t know what will happen when masks are no longer needed in schools.

“Our principal has been very supportive, and maybe it will be good for students to wear masks at least for my class, I really don’t know,” she said.

Earlier this month, a Placer County high school teacher who was fully vaccinated but had suppressed immunity to prescriptions treating his autoimmune order died of COVID after returning to class.

To look forward

An encouraging sign is that therapeutics, like Remdesivir, are now much more widely available than before – although during the omicron surge, supply still struggled to keep up with demand, said the Dr. Shira Abeles, infectious disease specialist at UC San Diego. Health.

Additionally, another recently approved drug, known as Evusheld, can be used preventively, before infection, for those most at risk, although it is still only available in larger quantities. limited.

Liber, who lives in San Diego, said a friend of hers who is also at high risk was treated with monoclonal antibodies when she caught COVID, “but there’s no guarantee he’ll be available if I need it”.

Her type 1 diabetes is well managed, but she knows that in combination with her age of 68, the “return to normal” for her may still be a long way off. But “I am no longer 15, I no longer have my whole life ahead of me,” she says.

People over the age of 65 account for 71% of COVID-19 deaths in California. About 84% of older Californians are vaccinated with two doses and 72% are boosted.

At the start of the pandemic, Liber and her husband were in total confinement, rarely leaving their house. “We’ve gotten really good at Amazon and Instacart,” she said.

Vaccines and stricter mask guidelines have given her some confidence to resume some of her favorite activities.

When the cases dropped and things started to get a bit better, she went to restaurants to eat outside on patios. It’s happened so rarely in the past two years that she knows exactly how many times she’s dined out – five.

But each push sends her back inside, and she worries that pandemic-weary people will forget about people like her and stop taking precautions.

“I still want to do things,” she said, “I don’t want to give up on life.”