A small lesbian bar in western Massachusetts has become the center of a much larger debate on disability, COVID-19 and what society perceives about individuals with weakened immune systems.

Last Ditch Bar in Greenfield, MA had required customers to wear well-fitted masks to protect immunocompromised individuals, but because of financial struggles, allowed masks to be optional on Saturday nights. This decision created online backlash , particularly from immunocompromised individuals who felt the policy made the bar less accessible to those at higher risk of infectious diseases.

The controversy has shined a light on what it means to be immunocompromised, how that may be different than one who is immunodeficient, and what daily life may look like for these individuals. Here’s what to know about these medical terms.

What Does ‘Immunocompromised’ Mean?

An immunocompromised individual broadly means that one has a weakened immune system that is not functioning at full strength. This weakening can be temporary or long-term, and the severity can vary among individuals.

There are many medical causes for one to be immunocompromised. Common reasons to have a weakened immune system include cancer or being treated for cancer, having HIV infection, being born with a genetic immune disorder, being a recipient of an organ transplant as well as taking certain medications such as steroids to reduce inflammation or methotrexate for some autoimmune diseases.

Most patients with weakened immune systems still retain some level of immune function, but have some limitations. For example, those with weakened immune systems often have greater difficulty preventing infections when exposed to different bacteria and viruses. In addition, immunocompromised individuals may not mount an adequate immune response after getting a vaccine.

Difference Between Immunocompromised And Immunodeficient

There is a difference between the terms immunocompromised and immunodeficient. The former is a broader term describing someone with a weakened immune system which also includes those that are immunodeficient. The term immunodeficiency refers to a specific medical condition where the immune system is impaired or absent. This can be primary, meaning it is inherited and often one is born with a specific disease like AIDS for example; or it can be secondary, which means it has been acquired from another disease, infection or treatment.

Rising Population of Immunocompromised People

The number of individuals in the U.S. who have weakened immune systems has risen over the last decade, according to reports from JAMA Network . About 6.6% of the U.S. population was considered to be immunocompromised in 2021, up from about 2.7% in 2013. This is likely due to a number of factors. Americans are living longer with cancer which can weaken the immune system. Organ transplantation has also allowed more people to live for years with transplanted organs. In addition, modern advancements in some medications such as immune-modifying drugs like methotrexate to treat auto-immune diseases has reduced immune responses in many patients. Finally, better recognition and diagnosis of immune disorders may also mean more people who previously would not have been identified are now recognized as immunocompromised.

What Daily Life Looks Like For The Immunocompromised?

Most individuals with weakened immune systems live ordinary lives. They work, go to school, exercise, eat out at restaurants and spend time with family and friends. Despite this, some activities can require planning and precautions in order to protect their health.

As an example, a crowded indoor sporting event may represent a risk for potentially acquiring an infectious disease as opposed to an outdoor gathering. Immunocompromised individuals may have to forego seeing a relative if they are actively sick. During periods of high respiratory virus activity such as the winter months, many individuals may choose to wear a high quality mask like a N-95 or KN-95 to mitigate their risk of getting infected.

Different immunocompromised individuals also face different risks. An individual with prostate cancer on intensive chemotherapy may take more precautions than a young, otherwise healthy rheumatoid arthritis patient on a low dose methotrexate drug.

As the Massachusetts bar story continues to get national attention, it is also important to understand how communities balance accessibility, social connection, economic survival and protection of people who cannot necessarily choose their level of medical vulnerability.