Many act like the pandemic has ended. That's not an option for the immunocompromised.

Shari Rudavsky
Indianapolis Star
  • For many people, the pandemic has moved into the rear window.
  • Then there are people whose personal circumstance puts them at increased risk of severe disease should they contract COVID-19.
  • Some resent the limitations placed on them in the name of public health. Others just have COVID fatigue.

INDIANAPOLIS — When Sonya Yoder-Beery learned that her cancer had returned after eight years, the precautions she took against COVID-19 did not change.

Her attitude, however, did.

Since the beginning of the pandemic Yoder-Beery and her family wore masks, social distanced, and got vaccinated once they became eligible.

None of that changed last August when Yoder-Beery was diagnosed for the second time with breast cancer. What did change was her perspective on the divide between those who, like her, take public health recommendations seriously, and those who do not.

Now when she sees someone unmasked in public – or worse if someone mocks her for wearing a mask, as once happened at the gym – their decision has a direct impact on her.

“I feel like I have done everything I can do,” said Yoder-Beery, 50, who lives in Indianapolis. “I think we’re at a point now where there are a lot of people who feel like they’re going to do what they’re going to do and for a lot of us in this category, it’s hard not to take that personally.”

For many people, the pandemic has moved into the rear window. They’ve shed their masks, returned to work and school in person, and life has reverted to the way it was before we ever heard of coronaviruses.

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Then there are those like Yoder-Beery, whose personal circumstance – either because of illness or age – puts them at increased risk of severe disease should they contract COVID-19. For people who fall in this camp, pretending there’s no longer a pandemic is a luxury they just don’t have.

To mask or not to mask at the grocery store or on an airplane, now that's an option? To attend that 150-person wedding or reunion? To gather with your large family or not?

Pondering these questions as the rest of the world blithely returns to normal can lead those at higher risk feeling confused, left out, ignored, and down-right annoyed.

Indiana University Simon Cancer Center oncologist Dr. Attaya Suvannasankha has frequent conversations with her patients about ways they can stay safe. First and foremost, get vaccinated. Once vaccinated, simple steps such as sitting in the back at church or other large gatherings may reduce one’s risk of close contact.

“The hardest thing is for patients who feel like they have already been doing everything right – they got their vaccine, their booster - and yet their risk depends on the rate of infection in the community,” said Suvannasankha, an associate professor of clinical medicine at IU School of Medicine.

In his medical practice, Dr. James L. Gahimer mostly treats patients in their 60s or older. Many of his patients have expressed their confusion and concern over when and how to return safely to activities they used to take for granted.

Many say they’re feeling frustrated and irritated by all the changes the pandemic has wrought. Some looked forward to retirement as a time to travel and now they worry whether they can do that safely. Others resent the limitations placed on them in the name of public health. Others just have COVID fatigue.

“In the geriatric or elderly population, there’s a lot more focus or consternation about those issues,” said Gahimer, a general internist with Franciscan Physician Network Center Grove Internal Medicine. “The potential impact on their health is still very much forefront in their minds at this point in time…. I’m surprised by how many people in the practice are still very very concerned.”

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Someone 'flipped switch' on masking

For doctors who treat cancer patients, however, the calculus is an easier one.

Even before COVID-19, pediatric oncologist Dr. Jamie Renbarger recommended all her immunocompromised patients mask, ideally with an N95, whenever in a crowded space. The decision becomes more complicated, however, for those who are no longer currently immune-compromised but who have been in the past.  

As the founder of Karuna Precision Wellness Center, which offers services for cancer survivors, Renbarger meets many people who have completed treatment for cancer and are trying to regain the lives they had before their illness without knowing what is and is not safe for them. The speed with which people transitioned from being in pandemic mode to return to normal can make these decisions even more fraught, said Renbarger, also a pediatric oncologist at Riley Hospital for Children.

“It’s like someone flipped a switch and one day we were masking and the next day we weren’t,” she said. “I think there are differing levels of residual fear for sure and some anger and resentment… In my mind, it becomes a balance of risks and benefits and that really is something that is a decision that is made on a case by case basis.”

The factors that help shape those decisions can also shift. When the pandemic hit, Amy Hickey was one year past a stem cell transplant at IU Health University Hospital to treat a cancer diagnosed three years earlier. Still on immunosuppressants, the Evansville, Indiana, schoolteacher had just met a new beau. They used a video chat on their initial dates and segued to walks and takeout at home.

In fall 2020, Hickey’s doctor advised her to switch to a virtual position at work. In the ensuing months, vaccines became available and Hickey and her boyfriend got engaged. As many others started shedding their masks, Hickey, 31, kept hers on.

“I always had a mask,” said the Evansville resident. “It was not unusual to be the only one.”

Last summer, after consulting with her IU Health physicians, Hickey and her boyfriend got married in front of about 100 people, most of whom were vaccinated. The invitation encouraged but did not require that people wear masks, though most did. One person who did not wear a mask: Hickey, although she did wear one at the rehearsal.

This fall Hickey returned to work in person. The school where she teaches is mask-optional but Hickey still masks. Pre-pandemic she bought tickets to two concerts –Lauren Daigle in September and Reba McEntire in January. Wary of large crowds, she got a refund for the first as she held out the hope of seeing Reba live. But as January approached with omicron surging, Hickey sold those tickets.

Being careful while balancing life

When her cancer patients do decide to take risks, Suvannasankha understands, though again she’s a strong advocate for vaccination and booster shots. Facing uncertain futures, they may opt to do the things they want to while they can. Others may struggle between wanting to return to pre-pandemic life and staying safe.

“You still want to be careful but you want to balance life,” Suvannasankha said. “There are some folks who are ready yesterday to get back to normal life. I think there’s many that are caught in between.”

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To better determine which patients are at the highest risk should they contract COVID-19, an IU School of Medicine researcher recently led a national study that looked at more than 64,000 cancer patients vaccinated against COVID-19. The study concludes that while breakthrough infections occurred, two doses of vaccine reduced the risk.

Patients with blood cancers, such as leukemia and multiple myeloma, were at a higher risk of getting a breakthrough infection than those with solid tumor cancers, according to the study led by Jing Su, an assistant professor in the IU School of Medicine’s department of biostatistics. The study also found that the Moderna vaccine protected better against COVID-19 for patients with blood cancers, especially multiple myeloma, than its Pfizer competitor.

“That helps physicians to guide specifically which of their patients should pay more attention and take all protections,” Su said.      

Medical testing can also play a role in shaping doctor’s advice, said Dr. Rafat Abonour, Harry and Edith Gladstein Professor of Cancer Research and an oncologist at IU Simon Cancer Center. Cancer treatments often result in suppressed immune system, placing them at higher risk should they be exposed to COVID-19. So Abonour routinely tests his patients with conditions such as bone marrow transplants and multiple myeloma to measure their antibody levels.

If the patient lacks sufficient antibodies to neutralize an infection, Abonour will recommend that patient receive two injections of monoclonal antibodies, a drug combination called Evusheld, that offer protection against COVID-19.

Trying to do all she can to stay safe, Yoder-Beery recently had this treatment. Still, the retired schoolteacher and her family have eased back into life – albeit masked. In February to celebrate her 50th birthday, she and her husband renewed their wedding vows in front of about 300 of her closest friends and family members.

“I’m very aware of wanting to live my best quality life. Being stage 4, I just want to enjoy every day,” she said. “I’m just going to try to take every precaution I can. I just hope other people can see the bigger picture and do those little steps.”

Follow Shari Rudavsky on Twitter: @srudavsky.