From AHS’ COVID-19 Scientific Advisory Group (SAG): What Is The Link Between Immunosuppression And COVID-19?

People are asking if being immunosuppressed is associated with COVID-19 risk and /or COVID-19 severity of illness. With schools reopening, another important question is focused on transmission of SARS-CoV-2 from and to children, and how to minimize these risks. AHS’ COVID-19 Scientific Advisory Group (SAG) recently summarized the latest evidence from around the world pertaining to key questions:

Is immunosuppression associated with increased likelihood of recognized COVID-19 and/or increased disease severity?

And, with schools reopening, what role might children play in community SARS-CoV-2 transmission and how might we mitigate risk of transmission?

As Alberta reduces public health restrictions as part of its relaunch strategy, the risk of COVID-19 transmission increases. Evidence so far shows that risk in schools is highly linked to the prevalence of community transmission. Children are more likely to be asymptomatic or mildly ill, and child to adult transmission is comparatively low in data to date, so school reopening is reasonable if community transmission is controlled, and reasonable precautions are in place. A summary of recommendations around school reopening is presented.

In addition, although data on immunosuppressed individuals is somewhat limited, elevated risk appears mainly confined to those on active cancer therapies, on higher doses of steroids and potentially those with uncontrolled autoimmune disease. People on many of the immunomodulating drugs do not, so far, appear to have higher COVID-19 risk. Actual risk to immunosuppressed patients may be underestimated due to the high degree of precautions these patients have taken in their day-to-day lives since the start of the pandemic.

Recommendations arising from the immunosuppressed state review:

1. Immunosuppressed patients should continue close adherence to measures such as distancing, hand and respiratory hygiene.
2. Immunosuppressed patients should continue their prescribed disease therapy, unless otherwise directed by their healthcare provider.
3. Patients on systemic steroids should not abruptly discontinue corticosteroid use. However, healthcare providers should consider additional disease-modification therapy, where necessary, to successfully taper steroid use (to the lowest possible dose without risking a disease flare), with a goal to achieve disease control and reduce possible excess risk of COVID-19 infection and severity.
4. Since age and some comorbidities are associated with severe COVID-19 outcomes, individual assessment of immunosuppressed patients should, whenever possible, include risk of recognized and severe outcomes, taking into account age, underlying illness, co-morbidities and chronic therapy (including corticosteroid use).

The recommendations within the school reopening report are available here. To see the complete list of Rapid Response Reports, please check the COVID-19 Scientific Advisory Group website. New reports and updates appear here on a daily basis.