Fight of the unfit: protecting the immunocompromised and those with certain medical conditions during the COVID-19 pandemic

To the editor

In a recent correspondence published in this journal, the authors concluded that face masks are one of the essentials in the recent pandemic as they help to prevent the transmission of COVID-19 and this should be practiced by people of varying age groups.¹ As an update, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases in the Philippines has made it mandatory for people to wear not only face masks but also face shields on top of these masks at least in Metro Manila to effectively lessen the transmission of COVID-19.² This additional health protocol is mandatory for the public every time they leave their homes. The face shield must also be the ‘full’ type where it covers the entire face and not only down to the nose area. These minimum health protocols are indeed effective ways to prevent the spread of the virus as attested by a recent research, which concludes that the double protection, face masks and face shields, the emitter alone reduced much more the level of particles received by 96.7%.³ However, can this be applicable to those who are immunocompromised and with certain underlying medical conditions?

The immunocompromised are the people with weakened immune systems and they are at higher risk of getting severely sick from COVID-19. Examples of persons with weakened immune systems include those with HIV/AIDS, cancer and transplant patients who are taking certain immunosuppressive drugs and those with inherited diseases that affect the immune system.⁴ On the other hand, those with certain underlying medical conditions like chronic obstructive pulmonary disease (COPD), chronic kidney disease, heart conditions, pregnancy and many others are at increased risk to the virus.⁵ Now, what does this condition have something to do with the wearing of face masks and face shields? COVID-19 is a respiratory disease that attacks primarily the lungs. In the early days of an infection, the virus rapidly invades cells in the respiratory system. It is thought to attack the epithelial cells lining the airways—that catch and clear out things like pollen and viruses—flooding our airways with debris and fluids.⁶ The wearing of protective coverings for the nose and mouth is recommended for the immunocompromised and those with medical conditions except those involving previous respiratory diseases with low level of oxygen in the body. Face masks and face shields will definitely block the direct passage of air, which will enable them to breathe with great effort and difficulty.

I therefore conclude that the wearing of face masks and face shields is highly recommended to all as a basic protocol to fight against COVID-19 but not applicable to persons with respiratory or ‘breathing’ conditions. In lieu of this, the best practice for them is to just stay home since the basic protocol might be more detrimental to their health.