What do we know about covid in immunocompromised people?

Katharine Lang looks at the continuing dangers of covid for immunocompromised people, the treatments available to them, and how antivirals such as remdesivir may help

### Is covid still a particular risk for people who are immunocompromised?

Although the morbidity and mortality of covid-19 have reduced drastically in highly vaccinated and highly previously exposed populations, the disease is still a threat to the lives of more vulnerable people, particularly those without a functioning immune system. They are the people at “greatest risk,” says Bill Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University in Nashville, Tennessee.

Around 12 000 people died of covid-19 worldwide from 1 to 28 May 2023, show data from the World Health Organization. Schaffner says that the patients who are dying are mainly immunocompromised people who are older—and therefore have weaker immune systems—or have underlying conditions such as cancer or an autoimmune disorder or are taking immunosuppressive drugs.

Alex Richter, professor in clinical immunology and director of the Clinical Immunology Service at the University of Birmingham, UK, reiterates this. “Studies are highlighting that although outcomes have improved for immune vulnerable patients, they remain at higher risk than the general population, and this is now included in risk algorithms such as QCovid,1” she says.

What we don’t know is the difference in risk between different types of immunocompromised states. The evidence is not clear cut, says Arturo Casadevall, professor of molecular microbiology and immunology at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. “The data on [how at risk different immunocompromised people are] is fragmentary, since this group is very heterogeneous,” he says. “For example, a patient on corticosteroids is very different from a transplant recipient, who in turn is very different from a person with leukaemia.” Studies suggest that patients with malignancy or solid organ transplants are at greater risk of severe covid-19 …

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