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Melissa Harris-Perry: During his first state of the union address on Tuesday night, President Joe Biden talked about a rapid national unmasking amid declining COVID infections.

President Joe Biden: Under the new guidelines, most Americans and most of the country can now go mask-free, and based on projections, more of the country will reach a point across that in the next couple of weeks. Thanks for the progress we've made in the past year, COVID-19 no longer need control our lives.

Melissa Harris-Perry: For millions of Americans who are immunocompromised, COVID-19 continues to exert control in their lives. As lawmakers roll back pandemic safety procedures, some are feeling abandoned or ignored as the rest of the country rushes back to normal.

Pat Busher: This is Pat Busher from Portland, Oregon. I have been immunocompromised since 2012. Surviving the pandemic has been old hat to me. However, like everyone else, I'm tired and I wish that people would realize that the world doesn't revolve around them, that there are those of us that need to be protected.

Tasha Cobb: My name is Tasha Cobb, and I am calling from Memphis, Tennessee. Even though the pandemic and Omicron and all that seems to be slowing down a little bit, not totally gone, I will continue to mask up in large crowds and practice social distancing from people who are not masked, only because I am immunocompromised because I have a mask.

Melissa Harris-Perry: We spoke with Dory Segev, a professor of surgery and population health at NYU Langone, and Ed Yong, a staff writer for The Atlantic. We discussed what this stage of the pandemic will mean for immunocompromised people.

Ed Yong: A lot of Americans, a substantial number, are taking drugs that suppress their immune system. Either to help them cope with autoimmune diseases, things like lupus and rheumatoid arthritis, or to prevent their bodies from rejecting transplanted organs or stem cells. There are a lot of people like this, by some estimates, around 3% of the US adult population is immunosuppressed, which roughly is about 7 million. That number doesn't include those with conditions like HIV/AIDS, which also suppress their immune systems or the 450 or so genetic disorders that do the same. It's a substantial sliver of the population around US.

Melissa Harris-Perry: I have this sense here from Ed that it is basically a comorbidity associated with or with a set of illnesses, maybe actually the treatments for those illnesses, but are there other ways that we should be thinking about who this population is?

Dory Segev: We might categorize them as people who have primary immunocompromised, and those are people with medical conditions that directly affect their immune system, and then people who are secondarily immunocompromised. Those are people who take medications to treat something else that then suppress their immune system.

In addition to those with autoimmune and those with transplants trying to avoid rejection, there's also people getting chemotherapy for malignancies, and there are just, in general, millions of people who, because just they are older, have suppressed immune systems as well. We know there's a immunosenescence that happens as you get older. The number of people in the United States whose immune systems are not as vibrant as the general population is quite high.

Melissa Harris-Perry: We heard from the President during his state of the union address, what I think was meant to be a reassuring moment saying, yes we're taking off masks, the population percentage that is vaccinated is not rising at any substantial rate, but don't worry, we've got your back. I'm wondering, Ed, if in fact our new set of policies around the country really do have the back of those who are immunocompromised?

Ed Yong: Certainly the dozens of people who I've spoke to and heard from don't feel that way. A lot of them feel horrifically abandoned by the government and by the rest of society. Even those who've been vaccinated might not have mounted a strong immune response to the vaccine. It might still be at risk despite having ostensibly done everything right. For the administration to lift a lot of the protections that had safeguarded them, like mask mandates, puts them in a really difficult position.

The rest of society is rushing back towards normal and proclaiming their regained freedoms. For many immunosuppressed people, they feel like their freedoms have decreased because public spaces that need to go into like grocery stores are now less safe. This idea that the pandemic is over, that we're in this safer phase and it's all about personal responsibility, really looks past the idea that there is this large group of people who are very dependent on our collective actions, on our collective willingness to make society safer for them.

Melissa Harris-Perry: Dory, I get the point clearly that COVID-19 has raised the anxiety and the realities of potential infection, especially with very contagious variants like Omicron. I'm wondering if it is, in other words, a norm that we typically don't worry very much about this population, even in, for example, cold and flu season, which must also be more dangerous for this population.

Dory Segev: Sure. There are two big differences between what we're dealing with now and what we see in terms of seasonal respiratory infections. One is that this virus still can be transmitted by people who are asymptomatic and unaware of the fact that they're transmitting it. We've already built into our social contract that if you're coughing and sneezing, you're not going to go in a crowded space and cough all over people, and that's already been accepted as not a thing you want to do because you can get other people sick, and sometimes you get people sick who have compromised immune systems.

Today, with COVID, people don't even know that they're spreading it, which is why masks are so important because masks will keep you from spreading it. Then I think the second big difference is that this still has a major impact on people who are immunocompromised. The mortality rate for people who are immunocompromised getting Omicron is orders of magnitude higher than it is in the general population.

Melissa Harris-Perry: Can you say one more word on the science that you're giving us here? You've told us the correlation that those variants are more likely to happen for those who are holding the virus longer. Do you have a sense of why? Does science have a sense of why?

Dory Segev: For a new variant to arise, the virus had to have mutated. If, for example, somebody with a completely healthy immune system gets the virus, sees the virus for two days, by that point, their immune system has destroyed it, that virus is not going to have time to replicate and with each replication to have new mutations and potentially one of those mutations will stick.

If you are harboring the virus for a long time and it's replicating, and your immune system is trying to fight it off, but really doesn't have a good way to fight it off, it will keep replicating and you will keep shedding it. It's during that time that these new mutations will stick. The new mutations will form, and then they'll stick, and then they'll get transmitted to others.

Melissa Harris-Perry: Ed, given what the doctor is saying, why do you think we're so ready to simply remove the mask in so much of the country?

Ed Yong: Obviously, a lot of people are tired, but I think that immunocompromised people and disabled people, elderly people have always been shunted to the margins of society.

We, our policymakers, and our press are disproportionately full of people who are able-bodied and don't bear these substantial vulnerabilities and are thinking about the pandemic from this point of view of individual risks. They're vaccinated, they're safer, and so the assumption is that everyone is safe, but that is very much not the case. The question of the pandemic that I think matters the most is not just what my risk is, but who bears the risk that remains. As we've said, this is a lot of people.

You mentioned that immunocompromised people already had a higher risk from infectious diseases before the pandemic. That is true. A lot of them managed that risk, a lot of the people I spoke to were fastidious about things like hand washing, getting their flu vaccines, avoiding crowded places during the high flu season. The thing is, a lot of them then got sick, they got colds that turned into bad bouts of pneumonia. They got very sick from mild infections, and a lot of them just thought that's how the world worked, but during COVID, it became clear that the world doesn't actually need to work like that.

Through a variety of different protections, the world proved that it could actually handle things like respiratory infections, and flu cases and deaths plummeted. There's often this straw man that, so does that mean that we go into lockdown forever? Well, of course not. No immunocompromised person I spoke to was asking for that. What a lot of them want are things that would do everyone good, better ventilation, easier access to testing, equitable access to treatments.

It's really not the case that immunocompromised people are holding the rest of society back as some people often say. It is, in fact, exactly the opposite. Society is dragging immunocompromised people back towards this old normal that wasn't really great for them in the first place with no consideration for the massive residual risk that they are now being forced to individually bear.

Melissa Harris-Perry: Is there a way that we can talk about this differently, Ed, that moves us? I'm so captured by your framing of, it's not the risk that I bear, it's who bears the risk that remains. The doctor was talking about this notion that we already have, in our social contract, don't go out when you're sick, at least cough into your elbow or whatever it is we're meant to socialize one another into. Is there a way to alter our social contract that actually does put the immunocompromised at the center of our policymaking in the midst of a global pandemic that continues?

Ed Yong: I would love to hope so, but I think that requires our leaders, our public voices to continue putting forth this message that we are still all in this together. There was never a point in which the pandemic became entirely about individual risk. I don't hear that message coming out. If you look at the new CDC guidelines, the recommendations for immunocompromised people are things like go talk to your doctor about wearing a mask. That's just completely inadequate, especially when you consider that some of the poorest people who therefore have extra risks on top of what everything we've described, don't have a doctor to talk to, or maybe just can't afford to continue buying masks all the time. The reasons we have things like mandates and collective solutions is that it shifts some of the burden of the most vulnerable.

You asked about ways of portraying this conversation differently that maybe aren't just about appealing to the better sides of everyone's nature. Well, Dr. Segev talked about one selfish reason to take this seriously and I'll give another one, which is that age weakens immunity. As we've already heard, the older you get, the weaker your immune system gets, and they may never weaken to the same degree as someone who's just had a kidney transplant or is on a chemotherapy drug, but they were weakened nonetheless.

The immunocompromised people are not this other, this alien group who are on the fringes of society. They're all of us years and decades into the future, and trying to put in policies that will protect them and that will treat them with the humanity and dignity that they deserve is really just about empathizing with our future selves. As one immunocompromised person put it to me, disability is in your future. Do you not want a better world when that time comes for you?

Melissa Harris-Perry: Ed Yong is a staff writer at The Atlantic, and Dory Segev is professor of surgery and population health at NYU Langone. Thanks to both of you for joining The Takeaway.

Dory Segev: Thank you.

Ed Yong: Thank you.

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