For people with underlying health conditions, the coronavirus presents ‘all the ingredients’ for danger

An infection from the coronavirus can be a formidable threat to anyone. But it is especially pernicious for people whose health is vulnerable, even in the best of conditions.

For Andrea Pietrowsky, that means her husband is not coming home.

The couple’s daughter, 5½-year-old Louisa, has heart and lung conditions. Andrea’s husband, Tom, is a dietician at a Detroit hospital and the family’s income earner. If he picks up the virus at work and then unknowingly bring it home, he could get Louisa sick. And so he left for work last Monday with plans to not come back.

If he were to come home before the threat of the virus passed, Andrea said, “that’s too risky for Louisa,” who spent the first seven months of her life in the hospital and used to rely on a ventilator to breathe. “She is going to want to cuddle and lay down at night and read stories.”

Overall, the older people are, the greater the danger an infection poses to them. But people of all ages with weakened immune systems or certain diseases also face higher risks and are experiencing the coronavirus pandemic with particular anxieties. Many are taking unprecedented precautions to protect themselves and their families, and depending on a public that some say does not seem fully dedicated to stopping infections and keeping them safe.

“All the ingredients are there for trouble,” said Michael Boyle, the CEO of the Cystic Fibrosis Foundation, which advocates for people with a disease that leaves them especially vulnerable to respiratory infections like Covid-19.

The coronavirus is not known to be any more infectious among people with diabetes or heart or lung or kidney disease than others, though experts are still trying to learn more about how the virus, called SARS-CoV-2, attacks human cells. Rather, when people with these conditions are infected, they are more likely to be hospitalized or be placed on ventilators or die. Otherwise healthy people whose immune systems are suppressed may not be able to fight off the infection as forcefully as others.

Many of the people most at risk also rely on regular visits to health care facilities — places that now present a threat in and of themselves as others seeking tests and treatment for the coronavirus come and go.

For some, the potential consequences of the pandemic extend to seemingly every corner of everyday life. Families of people who are most vulnerable to the virus have set up stations outside their homes to sanitize packages. Trips to the grocery store or the pharmacy have morphed into what feel like perilous excursions — every encounter with another shopper seeming like a potential danger. Appointments at chemotherapy centers are upended, as facilities limit the number of family members allowed to accompany patients.

Certain precautions are familiar. The steps that the public broadly has been urged to take in recent months — like rigorous hand washing and avoiding crowds — have been part of their defensive routines for years. These are people for whom “social distancing” is not a new concept.

“The rest of the country — and the world — are kind of getting a little bit of a taste for what we deal with on a day-to-day basis,” said John Boyle, the president of the Immune Deficiency Foundation.

But many said that because of the speed at which the virus seems to be spreading, and the sheer number of unknowns, they were being more cautious than ever.

Susan Feinberg, 61, who lives on Cape Cod, has a mutation in a BRCA gene that increases her risk for certain cancers, and has been on and off immune-suppressing treatments since she was first diagnosed with cancer more than a decade ago.

Her most recent diagnosis was last summer. She went through intravenous chemotherapy through the fall and is now on an oral chemotherapy.

“It feels different,” she said about protecting herself from the coronavirus. “When I was going through chemo in the summer and fall, if I felt OK and wasn’t having side effects, I would go out and didn’t think twice to go to the supermarket or to the drug store or even occasionally to go clothes shopping or something. I did go to restaurants every once in a while. I’m not doing those things now.” She described her house as “my fortress.”

One day last week, she went to the drug store to pick up a medication she needed immediately, something she couldn’t get through a mail order. She tried to keep six feet away from people, and when a woman came up and stood behind her in line, Feinberg asked her to provide more space.

“She looked at me like I was from another planet,” Feinberg said.

“I’m mad at myself for having gone,” she added. “I have a quite a few friends who would be more than happy to pick something up for me and leave it at the front door. I could have done drive through and I didn’t do that. I don’t want to put myself that position again.”

A trip to the drug store also spiked Laura LeBrun Hatcher’s anxiety. Hatcher, who lives in Maryland, has a 13-year-old son, Simon, with a combination of physical and cognitive disabilities, as well as a form of epilepsy that’s exacerbated by infections. When his immune system gets strained, he is more likely to have life-threatening seizures.

“We are in the scary position of really relying on other people to also take social distancing measures,” Hatcher said. “As I’m there I’m noticing all these people in the pharmacy. I have no idea what their level of social distancing is. It made me feel like when I came home, is it safe for me to be around my kids right now?”

Children who are infected with the coronavirus are believed to have much milder symptoms overall than older groups. A study published last week reported that of 171 children with the virus who were treated at a hospital in Wuhan, China — where the outbreak is believed to have started — only three required intensive care. But all three had existing health conditions. (One child died, though the 10-month-old had other life-threatening conditions.)

“Most of us have been in and out of intensive care units, NICUs, and PICUs since our kids were born,” Hatcher said about families with children with complex medical needs. “We know what that’s like. Having that hanging over our heads is very stress-inducing right now.”

The Cystic Fibrosis Foundation has recommended that people with the condition postpone regular appointments. Boyle, the foundation’s CEO, still sees patients, but last week was the first time in his career he did so virtually.

In addition to being susceptible to respiratory infections, patients with CF already have compromised lung function, so they have less reserve should they get sick. Some have transplanted lungs. Transplant recipients generally have to take drugs that suppress the immune system so their bodies do not attack the donated organs.

“People with CF are more on edge,” Boyle said about how the community was faring. “They’ve been much more willing to quickly say, what do I need to do protect myself?”

For people with kidney disease, some spend a few hours three to four times a week at dialysis clinics. Facilities are adapting so people can safely continue their treatments even if they get sick.

“Every clinic is trying to deal with this,” said Joseph Vassalotti, the chief medical officer of the National Kidney Foundation, which has urged people not to stop their treatments should they get infected with the coronavirus.

Trying to keep people away from health facilities unless necessary poses different risks for different groups of patients. At Zuckerberg San Francisco General Hospital, for example, some patients have to come every day for a dose of methadone, a medication used to treat opioid addiction. With the pandemic, a U.S. health agency that oversees addiction treatment has eased rules and allowed some patients to take home a two-week or month-long supply. But some patients have mental illnesses or are homeless and cannot store such a stock or give themselves the right dose every day.

Last week, the clinic started providing daily doses outside. And if a person is isolated with the virus, “we’re ready to deliver it to a patient’s house if we have to,” said Scott Steiger, the deputy medical director of the hospital’s opiate treatment outpatient program.

Pietrowsky, the Michigan woman whose dietician husband is staying with friends and family, said that despite the sacrifices her family was making, this was not the worst-case scenario. That would occur if Louisa got sick and they wound up in the hospital. It’s why the couple decided they had to stay apart for the duration of the outbreak.

Before Tom left home last Monday, he and Andrea spoke with their kids — in addition to Louisa, they have a “healthy, rowdy 9-year-old” son — about their plan. Since then, Andrea said, Louisa has asked when daddy’s coming home.

Their answer: “We don’t know.”

Eric Boodman contributed reporting.