While COVID-19 cases rise the concern is even greater for people dealing with compromised immune systems.
Federal health agencies are monitoring data on whether an additional COVID-19 vaccine is needed for these patients. But in the meantime, families are having to adjust their life to the rise in cases again.
Patrick and Patsy Nielsen are just over a year since Patrick received a life-changing kidney.
He said, "It's been a roller coaster. Going from the lowest low to getting a new kidney. And dealing with the issues of COVID, easing up a little bit and now going back up.
His wife, Patsy, said, "Once we got it we were looking forward to living life and doing things like we had dreamed of doing, but now that COVID's back on a surge we've had to rethink everything we're doing on a daily basis."
People who are immunocompromised are especially vulnerable to COVID-19. The virus is at a high transmission level where the Nielsens live in Florida and across nearly 60 percent of U.S. counties.
Dr. Layal Abdel Rahman is a transplant nephrologist at Largo Medical Center in the Tampa Bay region. She said, "The concern is we always push our patients to take precautions – even before the COVID-19 pandemic – but the concern right now is their caregivers and the people they are in contact with who are not vaccinated and not wearing a mask.
The CDC says studies have shown immunocompromised people appear to have reduced immune responses to COVID-19 vaccines and are more likely to have breakthrough infections, but could be helped by a third shot. The CDC hasn't recommended that yet.
Other countries like Israel and France are already recommending additional shots.
Dr. Dorry Segev, is a transplant surgeon and researcher with Johns Hopkins. He said, "A third dose is not part of the FDA EUA here in the U.S., but there are people going out there and getting third doses for themselves."
He said people sent them their blood and they looked to see immune responses to third doses, finding an enhanced response in some patients. However, there is still a question of how much antibody is needed to correlate with protection.
"All of this is sort of carefully walking that line between the benefits of giving somebody an improved immune response and the risk to them of whatever it is we’re doing," said Segev.
He said they're launching an NIH-funded clinical trial for transplant patients to receive a third dose.
"I'm very anxious to get to an answer," Segev said. "I'm very anxious for us to gather as much data as we can to understand: What is the right way to boost immunity for transplant patients and is that right way safe? So this is going to be a personalized thing."
Patrick said: "I know the whole world's working on it as best as they can so I'd rather wait for the right information then throw out some false quickly and not be one hundred percent certain."
The FDA and CDC are monitoring data from studies. An advisory panel discussed the issue last week but it remains to be seen if and when they issue any new recommendations.