I have been trying to figure out what my medium to long-term lifestyle may be once the enforced Covid-19 lockdown in South Africa is lifted.
Logically, it seems that fellow organ donor recipients in South Africa and I must prepare for the long-haul until a vaccine is found – continued self-isolation in our home environments even after the enforced lockdown is lifted for the general public.
And that vaccine is unlikely to be available for at least another year – and with a longer wait likely for the world to be properly stocked.
I have spoken to three cardiothoracic surgeons who confirm my sense that I will not be trawling the highways and byways anytime soon.
As a heart transplant patient, I take a daily cocktail of immunosuppressant drugs which lowers my body’s natural immune system – my ability to fight foreign objects, organisms, viruses which unwittingly enter or are introduced into my body.
Without the suppressant effect of these drugs, my body would constantly be acting against my donor heart, which it treats as a dangerous foreign organism.
The immunosuppressant or anti-rejection tablets suppress the body’s ability to fight any foreign organism, including my new heart, by lowering the amount of white blood cells, integral to the human immune system.
The Covid-19 disease is among the most easily transmitted viruses around, hence the global response to promote social distancing and basic hygiene. Most of those infected will have mild to moderate symptoms and will recover with no long-term negative effects.
But we know that some will be severely ill. High-risk people who must take extra precautions include the elderly, those with chronic comorbidities (other illnesses), and those living with compromised immune systems like HIV patients and organ transplant recipients.
Three cardiothoracic surgeons – Dr Willie Koen at Christian Barnard Memorial Hospital in Cape Town, Dr Robbie Kleinloog at Gateway Hospital in Durban and Dr Martin Sussman at Joburg’s Milpark Hospital – confirm that voluntary self-isolation will be the way of life for organ transplant recipients until a vaccine for Covid-19 is developed and widely available.
Early research from China due to be published in the Journal of Heart and Lung Transplantation, indicates that the experiences of heart transplant recipients who are infected with Covid-19 may be no different to non-heart transplant patients with infection – with one patient having severe illness and another only mild symptoms.
But Dr Koen said that “anyone who falls into the high-risk group will have to go into voluntary lockdown” once the enforced lockdown is lifted.
He said the Covid-19 mortality rate increased to 50-50 odds for high risk patients, although the “baseline” health status of every patient, including an organ recipient, was a crucial factor.
“You get a strong transplant patient who has excellent health, runs a marathon and works a normal day. Then you get a patient who struggles.
“Until we get a vaccine, recipients will have to stay in voluntary lockdown.”
Dr Kleinloog from Gateway said it was “reasonable” for organ recipients to self-isolate regardless of the lifting of the national lockdown.
He said there was “no rule” about what transplant recipients should do to avoid infection apart from the social distancing and basic hygiene protocols which applied to everybody.
“We’re all making our own new rules and theories. It would be a reasonable thing to say that recipients would have to isolate for the duration of this pandemic (until a vaccine is produced).”
He said that, before their transplant procedure, organ recipients were in a similar category of risk as a result of infection, as the elderly or other debilitated patients,
After the transplant, they were at a much higher risk than other high-risk individuals, as the immunosuppressant drugs “rendered them immune incompetent”.
“The transplant patient is suppressed because we don’t want the body to attack the transplanted organ.”
Dr Martin Sussman of Johannesburg’s Milpark Hospital said it was “a safe bet” that transplant recipients must stay at home – “not a strict lockdown but with a lot of precautions” until a vaccine became available.
“But I think it will be a universal situation (for non-transplant recipients) as well,” he added.
In the China study, one male heart transplant recipient, 51, was severely affected by Covid-19 infection, requiring a month-long hospitalisation, intravenous medication, oxygen support and withholding of immunosuppressant drugs for 12 days. Another patient, 43, had mild symptoms including fever for two days, was quarantined at home and then admitted to hospital for a week.
The Chinese doctors point out that further large-scale epidemiological study is required to determine if organ transplant recipients are more susceptible to Covid-19.
Koen said the reports from Asia of a “second wave” of infections was “very scary”. It was not clear if the virus remained “latent” in the body like the HIV infection or if the individual was re-infected.
“If it is latent, it means we will never clear ourselves from this virus. If it is a re-infection, that’s better.”
- Please consult your primary healthcare professional about your ongoing treatment during and beyond Covid-19.
WOW. Very interesting, thank you for writing this,
Will it be safe for you to be vaccinated as it introduces a weakened virus into an imiunosupressed body?
Of course I don’t know this yet, we will have to take guidance from the clinical experts at the time. I’m sure there might be a need for stricter measures in any case for the entire planet, as Martin Sussman from Milpark hospital says.
stay strong stay healthy keep safe
I really have so much empathy for you Ray, and all other heart transplant recipients and high-risk persons at large. I can only pray with you for you to manage your new life, and wishing you that the peace and protection of our Lord Jesus Christ, be with you all during the waiting period of seeing a supply of a vaccine. Stay safe and be remain vigilant and patient. Excuse the pun. Lol
Ja my dear friend, normal will never be the same for us again. Just grateful that I’ve been afforded this extra time with my new heart, what will be will be, and as a Christian I believe everything happens exactly according to God’s plan, so I’m filled with peace and joy and at no time has fear ruled my thoughts concerning this virus or my time Kraft on earth. Instead I’ve chosen gratitude as an all encompassing thought. My thoughts turn to transplants going forward, and if this virus will affect transplants in any way now or in future. Thanks for putting into words what many of us are thinking. Bless you my friend. Ant B
Thank you and God bless you🙏
Thank you Tirsha
It a good thing for us to stay home but some of us need to work to get money
Hart transplant 2013
Indeed, Deon, I totally get that. See my other comments above. However you can, minimise the risk of going out to work, to run errands, through using protective clothing and equipment, maintaining some social distance and maintaining hygiene – not unlike the things you had to do in the first weeks and months after your transplant.
Please do consult with your primary clinician or your transplant programme on what is the best response for you to Covid-19.
Gooday, my daughter had a liver transplant 2016 now 12 yr old she has 2 sisters 9yrs & 14yrs old so need to find out if she must stay at home what do i do with the 2 sisters that need to return to school? And us as parents need to go out to work? And then we also have grandfather & grandmother staying with us.
Hi Susan
Please see my comments above.
I understand that not everybody can work from home or stop working entirely. There are also family circumstances which must be taken into account and which are difficult to change just like that. The fact that the best option is to self-isolate does not mean that it is the only option. With the right protective gear, with the best precautions, with thinking through all the potential challenges and seeing how best you can limit the risk, it is possible to get through this period. Consider how your family has worked together, fought together, to provide the best life for your daughter? And you’ve succeeded. Nothing has changed. You are simply taking whatever extra measures you can, to keep your entire family safe.
Given our difference, please do consult with your primary clinician or your transplant programme on what is the best response for you to Covid-19.
I’ve being ordered to go back to work at the 4th of May and I’m working at a Provincial Hospital. Not sure how to handle this.
Hi there, I am acutely aware that each transplant recipient is different – our bodies are fascinatingly complext systems and the donor organ or graft we have received makes it just a little bit more complex. But, someone made a very telling comment on another group: “We’ve survived an organ transplant… we realise how absolutely crucial our ultimate gift is and will do anything to protect it. We got this!”
I certainly did not do this post to unsettle anybody but to provide some valid information from the clinicians many of us rely on.
I understand that not everybody can work from home or stop working entirely. There are also family circumstances which must be taken into account and which are difficult to change just like that. The fact that the best option is to self-isolate does not mean that it is the only option. With the right protective gear, with the best precautions, with thinking through all the potential challenges and seeing how best you can limit the risk, it is possible to get through this period.
Given our difference, please do consult with your primary clinician or your transplant programme on what is the best response for you to Covid-19. Be safe.
Hi Ray, thank you for the excellent article. I agree with you but personally I would have changed the headline to “TRANSPLANT RECIPIENTS SHOULD STAY HOME TILL VACCINE ARRIVES” Just my personal opinion, sorry. Must’ and ‘should’ are both modal verbs. MUST is used when expressing obligation or an unavoidable requirement, whereas SHOULD is more of a recommendation, or simply a desirable goal.
Like Dr Sussman said that it was “a safe bet” that transplant recipients must stay at home – “not a strict lockdown but with a lot of precautions” until a vaccine became available.
Thank you for the article, my sentiments as well.
Thanks Hermann.