Question:
My son lives in Moldova as a diplomat for the U.S. and he would like me to come visit at the end of December. The medical care in that country is subpar. Is it too risky for me to travel?
I’m newly diagnosed, stage zero, Watch and Wait with no sign of lymph, spleen, or liver enlargement. My doctor (hematologist/oncology) told me to “Go live your life.” I caught COVID last year and my body fought it off well. I have not gotten the vaccine as my doctor told me that it doesn’t work well for people with CLL.
Answer: We would not recommend traveling internationally at this time unless absolutely necessary, especially if you are not fully vaccinated. This is because you are immunocompromised and we are still in the midst of a pandemic where numbers are again quickly rising, especially in Europe.
We are thankful to hear that you fought off COVID well last year. It is most likely that any natural immunity has tapered off at this point. It sounds like there might have been a little bit of miscommunication with your healthcare provider. We understand completely the need to live your life, but we are not recommending airline travel at this time due to the continued level of risk involved.
Also, while it is true that the COVID-19 vaccinations may not work well in those with CLL compared to those with a healthy immune system, we are not aware of any CLL expert physicians that would recommend not giving it a try. What we know from recent studies is that 40% of those with CLL who become fully vaccinated do mount a response to the vaccine. And those who have the best chance of doing so are those like you in watch and wait who have not yet received any treatment for their disease.
If you do go ahead and make the decision to travel internationally, here is what we would recommend:
- You become fully vaccinated, possibly even consider getting a third shot if there is time before your trip. Many immunocompromised individuals who have previously had zero response to the first two shots will have a response after a third dose.
- Several weeks after your last dose, request that your doctor draw your Spike Antibody level to see whether or not you were part of the 40% who responded. If your physician will not order the antibody test, you can go to any LabCorp and make the request for your level to be drawn. You just have to create an online account to request it and pay the $10 fee. You can find out more information about that here: https://patient.labcorp.com/covid-19-antibody-test
- Purchase some quality N-95 masks to wear everywhere you go, and make sure they are tightly fitted. You can find them on Amazon. We typically suggest you purchase them from reputable companies such as 3M and read the reviews before you purchase them to make sure the seller is legitimate.
- Have your son and any of his household contacts quarantine for 10 days prior to your arrival.
- Have your son and any of his household contacts obtain a PCR test 48-72 hours prior to your arrival to confirm they are negative.
- Purchase rapid home tests (such as Binax Now, etc.) from local pharmacies and take them with you. Have anyone you are going to be in contact with perform the rapid tests before you and they remove their masks in close proximity. Although it is important to remember that PCR tests are much more effective in detecting COVID-19 infection in those who are not symptomatic just yet (which is also the time in which many are the most infectious).
- Spend as much time outside as possible and increase ventilation when you have to be indoors by opening windows or running air purifiers.
And last, but perhaps most important, create a COVID-19 plan by completing the checklists before you go. Maybe your son could do some calling around over there to see if he can learn if there are any monoclonal antibody clinics nearby that you could go to immediately should you begin to exhibit any symptoms You can read much more about this in the plan which can be found on our website here: https://cllsociety.org/2021/07/covid-19-plan-checklists-for-chronic-lymphocytic-leukemia-cll-preparing-for-pre-and-post-covid-19-exposure/
