May 27, 2021

With new, much more relaxed guidelines from the CDC (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html), it is important to assess how myeloma patients can continue to stay safe. A number of cautions are still required as we head into the Memorial Day holiday weekend.

COVID-19 vaccination 

• EXCELLENT NEWS
  • More than 50% of the U.S. population is fully vaccinated (https://www.reuters.com/business/healthcare-pharmaceuticals/us-closes-50-adult-vaccination-rate-covid-cases-ebb-2021-05-25/).
  • In Canada, our neighbors to the north, there is a similar trend with 50% partially vaccinated (https://www.cnn.com/2021/05/25/americas/canada-third-wave-reopenings/index.html). This means that we are moving toward “herd immunity,” the level at which the risk of new COVID infections in the community becomes very low. 
• CONTINUED CAUTION 
  • The not so good news is that even with full COVID-19 vaccination the levels of neutralizing antibodies (the ones providing immunity) are sub-optimal in myeloma patients, particularly in patients with active disease in the newly diagnosed or relapsed settings. The exact role of various treatments in further reducing the antibody responses remains unclear. Despite this there have been only very rare COVID-19 infections in vaccinated myeloma patients. 
• BOTTOM LINE 
  • Even fully vaccinated myeloma patients remain at some risk of COVID-19 infection. Fortunately, the level of that risk is very low, especially in an outdoor setting. In Los Angeles County for example, the L.A. Times reports (https://www.latimes.com/california/story/2021-05-21/breakthrough-coronavirus-infections-of-vaccinated-people-exceedingly-rare-in-l-a-county) that out of 3.3 million residents who were fully vaccinated, just 0.003% later tested positive for COVID-19 infection. In total, just 71 fully vaccinated residents were hospitalized, and 12 residents (0.00036%) died. Just 4 of those 12 had weakened immune systems like myeloma patients – that is 0.00012% — in other words, a really low percentage (one in a million chance).

    This means as we approach herd immunity, vaccination is providing major protections across the board. And even for myeloma patients there is most likely a prevention of severe illness, except in a few exceptional circumstances of severe disease. 

Are masks still needed? 

My suggestion is that myeloma patients should not throw away their masks just yet, especially for indoor settings. Masks clearly work well in stopping the spread of infection, dating all the way back to the pioneering work of Dr. Wu Lien-Teh (https://www.nytimes.com/2021/05/19/health/wu-lien-teh-china-masks.html), who helped change the course of a plague epidemic in the early 20th century and promoted the use of masks as a public health tool. The ongoing use of masks is also discussed in a recent New Yorker article (https://www.newyorker.com/science/medical-dispatch/the-beginning-of-the-end-of-the-american-pandemic). 

Even if severe infection is unlikely, any infection can be problematic for a myeloma patient. We have learned from “long haulers” (those with chronic symptoms lasting many months), the COVID-19 virus can be difficult to fully eradicate. This may be particularly true for those with compromised immunity, such as myeloma patients. 

It is best to avoid any risk of infection. In indoor settings and/or any situations where people are not wearing masks and are potentially not vaccinated (vaccination status unknown), wearing a mask is the safe thing to do. 

• BOTTOM LINE 
  • Obviously, if the community level of COVID-19 is low (such as in Los Angeles, where it is currently less than 1%) then the risks are low. For a few more weeks it is better to be safe than sorry, though, and wear a mask in situations of concern. 
  • By the Fourth of July, our next major holiday, many situations – including in- person patient group meetings – will become safer and may become practical once again. 
  • Please note, masks are still required on planes, trains and other communal transport due to uncertainty about vaccination status of others, as well as risks from travelers coming from areas with high levels of COVID-19 infection and those arriving from outside the U.S. 

Enjoy the holiday weekend! 

As they say, laughter is the best medicine. With so many activities opening up it is definitely time to seek out our friends and family and get together in safe ways and have an opportunity to laugh a little or a lot, if possible. Playing and laughing, it turns out, are things many animals need. According to a recent study (https://arstechnica.com/science/2021/05/from-apes-to-birds-there-are-65-animal-species-that-laugh/), at least 65 animals, including gorillas, birds like the kea parrot, and even killer whales, laugh!

So, whether you are spending time at an outdoor restaurant, barbecue or ball game, or quietly in the backyard or in the countryside, let’s all laugh, enjoy ourselves and get through this pandemic together with a bit more sanity. Stress reduction leads to better health and improved resilience for all life’s challenges. 

Translations

Arabic (https://www.myeloma.org/sites/default/files/Translations/Durie-Blog-052721-ARB.pdf)  Dutch (https://www.myeloma.org/sites/default/files/Translations/Durie-Blog-052721-Dutch.pdf)  German (https://www.myeloma.org/sites/default/files/Translations/Durie-Blog-052721-GER.pdf)  Italian (https://www.myeloma.org/sites/default/files/Translations/Durie-Blog-052721-ITA.pdf)  Russian (https://www.myeloma.org/sites/default/files/Translations/Durie-Blog-052721-RUS.pdf)  Spanish (https://www.myeloma.org/sites/default/files/Translations/Durie-Blog-052721-ESP.pdf)