Coronavirus (COVID-19) Precautions

A new COVID-19 subvariant called XBB1.5 is on the rise across the U.S.  

Early reports indicate that it is much more contagious than previous variants, and may be better at avoiding the immune system’s defenses. To learn more, we went to Chief Infection Control Officer Roy Chemaly, M.D.  

1. How is the XBB1.5 subvariant different from previous strains of COVID-19? 

XBB1.5 contains more mutations that allow it to better avoid the human immune system’s defenses. That means even if you’ve been fully vaccinated and boosted and/or had a previous COVID-19 infection, XBB1.5 may be able to find a way around that to cause an infection anyway. So, it is more transmissible than any other variant. That’s what initially got our attention. 

The XBB1.5 subvariant is able to bind to human cell receptors much more efficiently. So, while previous variants took about 4 to 6 weeks to spread widely enough to become one of the most frequently found strains among confirmed cases, this one only took a couple of weeks.

As of Jan. 9, COVID-19 caused by the XBB1.5 subvariant accounted for about 25% of confirmed new cases in the U.S. 

2. Does the XBB1.5 subvariant make people sicker than previous variants?

It’s too early to say for sure, but XBB1.5 doesn’t appear to cause more severe illness than previous COVID-19 strains. It’s probably not going to be as bad as the delta variant since we’re not seeing higher rates of severe infection or hospitalization so far.

3. Do you anticipate a surge in cases caused by XBB1.5?

It’s too early to tell yet, but there are indications that this one might not be as bad. The worst surge by far was from omicron. I don’t think this one will be the same. 

I suspect that any surge we get from the XBB1.5 subvariant will be closer to the type we had with BA.4 and BA.5 this past summer. Both produced slow increases in the number of cases and then equally slow declines.

4. Do the current COVID-19 vaccines provide protection against XBB1.5? 

Absolutely. Getting a COVID-19 booster is still highly recommended. But remember: the goal of COVID-19 vaccines and boosters is not only to prevent infection. That would be unrealistic. The goal is to prevent severe infections that require hospitalization. And the current vaccines and boosters should still do that against the XBB1.5 subvariant.

5. Why should cancer patients and their caregivers pay particularly close attention to XBB1.5?

XBB1.5 is highly transmissible — and possibly the most transmissible subvariant so far, based on lab studies. That’s due to the specific mutations this one acquired, which make it much more contagious.

That’s why patients should make sure they’re fully vaccinated and boosted. That way, if you do catch it, you may still get sick, but you probably won’t die or be hospitalized. And even partial protection against severe infection and hospitalization is better than none.

6. Do the COVID-19 treatments work against XBB1.5? 

Yes, the oral or IV drugs we use to treat COVID-19, such as paxlovid and remdesivir, still work.

The monoclonal antibodies used to prevent infection, such as EVUSHELD, don’t work as well against XBB1.5. 

7. Any special guidance for immunocompromised people?

Because XBB1.5 is very contagious — and the flu, RSV and other respiratory viruses are still circulating — anyone who is immunocompromised should be extra vigilant about masking right now. Give yourself an added layer of protection by wearing a face mask any time you’re out in the community. 

Your first and best line of defense right now against COVID-19 is the vaccines, including the new bivalent boosters. But your second line of defense is masking. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

You might know that flu season got off to an earlier start than usual this year or that the respiratory syncytial virus (RSV) is making a serious comeback. You may have even heard people call this a “tripledemic” of viruses. But you may be wondering why, or what — if anything — you should do about it.

We checked in with Chief Infection Control Officer Roy Chemaly, M.D., to find out what patients and their families should know about protecting themselves from COVID-19, flu and RSV this year.

Why has there been such an uptick in the number of flu and RSV infections this year? 

It wasn’t unexpected. Any time you have large numbers of people taking effective steps to reduce the spread of one particular disease, you’re going to see much lower rates of other diseases in that same category. 

That’s why we saw so few cases of the flu, RSV and the common cold these past few years. Masking, social distancing, and good hand hygiene don’t just protect you from COVID-19. They protect you from a lot of other things, too.

The downside is that people haven’t been exposed to any of these germs recently, so they’re more vulnerable to them now that people have set aside a lot of those pandemic practices. And when those viruses do come back around, they tend to be more transmissible and cause more severe infection.

Is there any way to distinguish between the symptoms of RSV and those of the flu or COVID-19?

No. All of these viruses can cause many of the same symptoms, including:

• fever
• headache
• body aches
• runny nose
• cough
• sore throat
• sinus congestion

So, you can’t differentiate between them based solely on symptoms. There’s too much overlap.

The only way to definitively diagnose or rule out one of these viruses is to get tested. While you can use an at-home test for COVID-19, you’ll need to see a doctor to be diagnosed with the flu or RSV. You’d also need to be tested by a doctor for strep throat, a bacterial infection that can be treated with antibiotics. It shares some of these same symptoms, too, and is also going around.

What should cancer patients do if they have these symptoms?

Don’t go to the emergency room unless you have to. Many of these facilities are already overwhelmed right now with upper respiratory infection patients. So, you don’t want to go there unless you’re having trouble breathing, feeling short of breath or have a severe cough that’s getting worse instead of better. 

Test yourself at home for COVID-19, and if you test positive, contact your care team to see if they want you to start any anti-viral therapies. We have effective treatment options now for both the flu and COVID-19.

Can people get vaccinated against RSV?

No. Not yet. Maybe by the end of next year. A few companies have vaccines in development right now, but no RSV vaccine has been approved by the Food and Drug Administration (FDA) yet.

How should cancer patients and their families approach the holidays in this tripledemic? Is it safe to travel?

COVID-19 is becoming endemic now, just like the flu and the common cold. But it’s still circulating, along with the flu, strep and RSV, so it’s wise to be cautious.

It’s OK to travel and visit with family and friends, as long as you take reasonable precautions. That means you should get your bivalent COVID-19 booster now, or as soon as you’re eligible if you haven’t already. And get your flu shot, too. The vaccines may not prevent you from getting an infection, but they will reduce your risk of developing a severe infection or needing to be hospitalized.

You should also continue to do whatever you normally would to protect yourself. If you’ve been told to avoid crowds or practice social distancing, for instance, keep doing that. And you should still be wearing a mask at any large gathering, even if you’ve been vaccinated for both the flu and COVID-19. 

Are there any special steps that immunocompromised individuals should take to protect themselves against COVID-19, flu and RSV?

No. We’ve known for years that RSV can hit cancer patients hard, especially those who just received stem cell transplants or are immunocompromised for some other reason. We see it all the time during the winter.

But anyone can get sick from these viruses. Our patients can just get very sick. So, there should be no difference between how they conduct themselves over the holidays and how they live during the rest of the year.

Caregivers can reduce the risk for their immunocompromised loved ones by ensuring they get fully vaccinated and that anyone who comes into close contact with them does, too.

If you have any questions or concerns, talk to your doctor.

Any other advice to help people avoid the flu, COVID-19 and RSV this year?

Don’t get close to anyone with a cough, cold or other flu-like symptoms at holiday functions. Those people shouldn’t be there.

It’s also important to stay home if you’re sick. I know it’s hard to miss out on get-togethers — especially for the holidays — when it feels like forever since they’ve even been an option, but don’t make things worse by going anyway and infecting all your friends and loved ones.

Do your best to protect both yourself and others by getting vaccinated against the flu and COVID-19. Then, make plans based on the amount of risk you’re willing to accept and enjoy yourself.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Last updated on Oct. 13, 2022

You’ve been vaccinated for COVID-19, but is it time for your next booster? Which type of booster should you get, and is there an age limit? What if you’ve recently been infected with the SARS CoV-2 virus that causes COVID-19? And let’s not forget it’s flu vaccination season. Can you get the COVID-19 and flu vaccinations at the same time?

Use these answers from Chief Infection Control Officer Roy Chemaly M.D., and Ann Klopp, M.D., Ph.D., medical director for MD Anderson’s COVID-19 vaccine clinics, to help you decide when and how to schedule your vaccinations.

Am I due for a COVID-19 booster?

Recently, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) authorized updated, bivalent formulations of the Pfizer and Moderna COVID-19 vaccines for booster doses in the U.S. This bivalent booster replaces the original formulation of the booster vaccine.

That means the bivalent boosters are now the only type of boosters you can get if you are age 5 or older. The good news is the updated bivalent boosters provide the best available protection against the virus circulating most in the U.S. right now, the BA.5 Omicron subvariant.

The previous booster recommendations considered older age, immunocompromised status, and recommended time intervals between the first and second boosters. But these no longer apply. As long as you are age 5 or older, you are eligible to receive the bivalent booster if it has been at least two months since your last COVID-19 booster or primary series vaccination.

You can use the CDC’s schedule for staying up-to-date with your COVID-19 vaccinations.

Should I wait to be vaccinated if I’ve recently had COVID-19?

If you recently recovered from COVID-19, the CDC says you may consider waiting 3 months to be vaccinated from when your symptoms started or, if you had no symptoms, when you first received a positive test. That’s because reinfection may be less likely in the weeks after infection. It depends, however, on personal risk factors such as your risk of severe disease should you get reinfected, the level of COVID-19 in your community, and the transmissibility of the current COVID-19 variant causing infections.

It’s best to follow CDC guidelines for vaccination if you are moderately or severely immunocompromised.

Is it better for me to get an additional primary dose or a booster?

When it comes to COVID-19 vaccines, additional primary doses and boosters are not interchangeable. People who are moderately or severely immunocompromised need an additional primary dose as part of the primary vaccine series. This dose should be administered within a few weeks of the second dose of your primary series, depending on which vaccine product you received (e.g., Pfizer or Moderna). Since it is part of the primary series, it is the same monovalent vaccine formulation as the first two doses of your primary series.

Conversely, all COVID-19 booster vaccinations now are with the updated, bivalent formulations of the Pfizer or Moderna COVID-19 vaccines. So, if you need a booster, you’ll get the bivalent COVID-19 vaccine, regardless of whether you’ve had a booster dose before.

Follow the CDC’s COVID-19 Vaccination Schedule to know when you are eligible for your next dose or use the CDC’s Booster Tool to know when it is time for your first or next booster. If you are moderately or severely immunocompromised, be sure to look at the CDC’s specific vaccine booster recommendations for you.

Can I get my COVID-19 and flu vaccinations at the same time?

Yes, but it also depends on your personal circumstances. For most people, the CDC says it is safe to get your COVID-19 and flu vaccinations at the same visit as long as the injections are at least 1 inch apart.

However, there are additional considerations for those receiving a COVID-19 vaccine and another type of vaccination like a vaccine to protect against monkeypox. Also, some pharmacies in the community are requiring people who are immunocompromised to space out their COVID-19 and flu vaccinations by a few weeks to support the immune system’s response to the vaccinations.

If you’re a patient at MD Anderson, you can schedule your COVID-19 vaccine via MyChart.

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Last updated Jan. 31, 2023

If you or someone you know has had COVID-19 recently, you may have heard of PAXLOVID. Maybe you’ve even heard about a so-called COVID-19 rebound in people who’ve taken this antiviral therapy.

So, what is PAXLOVID and why does the Centers for Disease Control and Prevention (CDC) recommend it for people who are immunocompromised? We asked Chief Infection Control Officer Roy Chemaly, M.D., what patients with cancer need to know about the antiviral treatment for COVID-19.

What is PAXLOVID, and who can receive it?

PAXLOVID is the brand name for a combination antiviral medication that can lessen symptoms in patients who have mild or moderate COVID-19. It is intended for those who are in the early stages of infection and are at risk of getting severely worse.

Patients with cancer are eligible to receive PAXLOVID with a prescription from their doctor and they will need to start it within 5 days of the onset of their COVID-19 symptoms. If you are in the hospital, more aggressive therapy may be needed to help you fight the infection.

How does PAXLOVID work to fight an infection?

PAXLOVID contains nirmatrelvir, which works to inhibit the SARS-CoV-2 virus from replicating in the body. It also contains ritonavir, which boosts the effects of nirmatrelvir, helping it work better. The combination of these antiviral medications helps reduce the risk of hospitalization for people who have mild-to-moderate COVID-19.

What are the side effects of PAXLOVID?

Some people report having a metallic or otherwise altered taste in their mouth when taking PAXLOVID. Your doctor also should consider the health of your kidneys and liver before prescribing it. For most people, reported side effects have been mild.

If you have cancer, your doctor will consider all of the medications you are taking to ensure there are no interactions between medicines used to treat COVID-19 (such as PAXLOVID or dexamethasone) and cancer-related therapies like prophylactic antimicrobials and other medicines.

Why do some people need a second round of PAXLOVID treatment?

PAXLOVID is the first oral antiviral medication to be authorized for emergency use by the Food and Drug Administration (FDA) for the treatment of COVID-19. That makes it an investigational medication. Your doctor may prescribe it based on your COVID-19 symptoms and response to the medication.

Some people experience a relapse of COVID-19 – sometimes called a COVID-19 rebound – even after taking an entire course of PAXLOVID. For instance, after Dr. Anthony Fauci tested positive for COVID-19, he received two courses of PAXLOVID to help him stay out of the hospital.

What else can I do to protect myself?

Vaccination should be considered the first line of prevention against COVID-19. However, some patients with cancer may be unable to mount a protective response with COVID-19 vaccines and remain at risk for severe COVID-19 should they become infected.

For people who are eligible to receive it, PAXLOVID should be a treatment option they discuss with their doctor.

Schedule your COVID-19 vaccine or booster at MD Anderson.

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The Omicron subvariants BA.4 and BA.5 are behind an increase in COVID-19 infections and hospitalizations. We spoke with MD Anderson’s Chief Infection Control Officer, Roy Chemaly, M.D., to learn about these new and highly contagious subvariants.

What exactly are the BA.4 and BA.5 Omicron subvariants?

They’re the most transmissible and immune-evasive strains of the COVID-19 virus to date. Today, they’re causing around 80% of COVID-19 cases in the U.S.

BA.5 is the more transmissible of the two and is causing 65% of cases, while BA.4 is causing 17%. They are subvariants of the coronavirus’s Omicron variant.

Variants and subvariants … what’s the difference?

Ever since it first emerged in 2019, the SARS-CoV-2 virus that causes COVID-19 has been shape-shifting, making slightly altered versions of itself. These new versions that keep appearing are called variants. Scientists identify them with Greek names, including Alpha, Beta, Gamma, Delta, and the latest variant – Omicron.

These variants, too, make new versions of themselves, called subvariants. BA.4 and BA.5 are the newest subvariants of the Omicron variant – the most dominant variant today.

What are the symptoms of the Omicron subvariants BA.4 and BA.5?

Based on what we’re seeing so far, the BA.4 and BA.5 subvariants are causing upper-respiratory symptoms, including:

• persistent cough
• fatigue
• runny nose
• sore throat
• headache

This is further testament that vaccines are still effective at preventing severe disease. The current rise in hospitalizations may simply be attributed to the volume of infections in the community, not the severity of the disease.

Why are BA.4 and BA.5 so transmissible?

BA.4 and BA.5 are similar to earlier Omicron subvariants, but they have one important difference:  mutations in their spike proteins make it easier for them to penetrate human cells and cause infection.

These mutations can also help BA.4 and BA.5 escape disease-fighting antibodies created by past COVID-19 vaccines and prior infections.

This, along with the natural waning of vaccine protection and the fact that many communities are lifting COVID-19 restrictions, sets the stage for the virus to spread.

If BA.4 and BA.5 can dodge antibodies, do the COVID-19 vaccines still provide protection?

Even with the mutations in their spike proteins, these variants are still close enough to the original virus to respond to the COVID-19 vaccines. Your immune system may have a harder time identifying BA.4 and BA.5, but it will still red-flag these subvariants.

The current vaccines target the original virus, not the variants. So being vaccinated doesn’t offer as much protection as it once did against infection. But the vaccines do – and this is crucially important – prevent severe illness, hospitalization and death. If you become infected with the COVID-19 virus after being vaccinated, your symptoms are much more likely be mild.

What about updated vaccines that are in the works?

On June 30, the Food and Drug Administration (FDA) recommended modifying new booster shots for the fall to directly target BA.4 and BA.5.

Manufacturers are already designing and testing the new COVID-19 vaccines, and regulators have already planned how to fast-track the approval process. When they’ll be available is still up in the air, but mid-October to December is the goal.

Should those who haven’t gotten vaccinated or haven’t gotten boosted wait for the updated COVID-19 vaccines?

No. The risk for infection is currently very high, so don’t delay. If you’re eligible to get a vaccine or booster shot, do it now. Though it may not be a perfect match, the original vaccine will still protect you from severe illness.

If I get the current vaccine now, can I also get the updated one in the fall?

Yes, you can. The U.S. has pre-ordered 105 million of the updated shots, so there will be plenty to go around. If you get vaccinated today, you should still be eligible to get the variants-specific vaccine when it becomes available. You can have both vaccines.

In the meantime, what are our best defenses against BA.4 and BA.5?

The best way to stay safe from these subvariants is to follow the COVID-19 precautions that we know work, including:

• Stay up to date with your COVID-19 vaccinations and boosters
• Wear a mask
• Avoid large gatherings, particularly indoors
• Wash your hands and avoiding touching your face

Are there any extra precautions that cancer patients and other immunocompromised individuals should take to protect against BA.4 and BA.5?

The same precautions that benefit everyone apply to cancer patients. But I would add that, to protect people with cancer from COVID-19, it’s important that their family members, loved ones, and caregivers get vaccinated and follow the same recommended COVID-19 precautions.

Will the virus mutate again?

Yes. Viruses automatically reproduce by making carbon copies of themselves. But they aren’t perfect at it. Mistakes occur, resulting in a new version of the virus. If one of these mistakes works to the virus’ advantage and makes it easier for the virus to survive, then this new-and- improved version of the virus thrives while the older version dies.

Already, a new variant, BA.2.75 is emerging. It’s another super-contagious Omicron mutant. Whether it will outcompete BA.5 is yet to be determined. The World Health Organization has not yet named BA.2.75 a variant of concern, but virologists fear it could fuel a new wave of cases around the world. 

Any last thoughts about COVID-19?

We’re all pandemic-weary, but now is not the time to become complacent. The pandemic isn’t over, and these new subvariants are concerning. It’s likely that the COVID-19 virus, in whatever form, will be with us for some years to come.

Schedule your COVID-19 vaccine or booster at MD Anderson.

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At-home COVID-19 antigen tests can be very convenient. A positive result can confirm a COVID-19 infection in minutes and help you protect others from infection. And while a negative antigen test result should be confirmed with a PCR test, rapid antigen tests can be a starting point, especially if you have flu-like symptoms.

“A PCR test is always going to be more accurate, but an antigen test can be an option in a pinch,” says laboratory medicine expert Micah Bhatti, M.D., Ph.D.

Looking back a year ago, Bhatti says many of the logistical issues with antigen tests have improved. “Earlier in the pandemic, we had concerns with the antigen test: how to do it, how to interpret what you get and how to capture results, but we’ve come a long way,” he says.

Consider these eight things to ensure you’re getting the most out of your at-home antigen test.

1. Use an FDA-approved test. “The FDA is making sure that the tests that are out there are appropriate for the variants that are circulating,” Bhatti says. Based on the limited data we have to date, antigen tests can detect COVID-19, including the omicron variant. However, it is important to only use antigen test that have undergone rigorous assessment by the FDA and have been granted emergency use authorization.  To ensure you’re using an accurate antigen test, check the FDA’s list of antigen tests that have received emergency use authorization.

2. Follow instructions for swabbing. Bhatti emphasizes that each test is different, so to get the best sample, you need to follow the manufacturer’s instructions. “The sensitivity of the assay is highly dependent on getting a quality specimen based on the test’s instructions,” he says.

3. Don’t reuse or share a swab. Antigen tests aren’t always readily available, but using a swab more than once won’t help you get more out of a test kit. It will tamper with results and possibly lead to an infection. “The swabs are sterilized when boxed for your safety and to ensure there aren’t any external factors influencing the results,” Bhatti says. Also, if you’re positive and then share a swab, the other individual is highly likely to get infected if they weren’t already.

It’s also important to only use the swab provided in the test kit. While the swab looks like an ordinary cotton swab, it is made of unique material that has been shown to be compatible with the test. Using a different swab for sample collection will lead to an incorrect result.

4. Avoid moving the test around. Bhatti says antigen tests are designed to be sturdy tests, but he recommends you perform yours in a dedicated space to avoid distractions. “If you accidently bump the test, it will likely be fine, but if drops on the floor, the internal test strip may get damaged,” Bhatti says. He says it's best to not move the test card until after you’ve read the results.

5. Check the results at the recommended time – only. Giving the test more time than stated in the instructions won’t help with sensitivity. In fact, it can actually distort the results. Bhatti recommends you read the results when the time is up and don't come back to it later. “We've seen instances of false positives and false negatives when the tests are allowed to overdevelop,” he says.

6.  Dispose of it properly. The materials of an at-home antigen test are safe to be thrown away in your household trash after you’ve read your results, says Bhatti. While the tests materials are safe, make sure not to splash any in your eyes or ingest the contents. “Always read the test kit instructions for proper safety guidance,” Bhatti s.

7.  Know how you’re going to share your results, if needed. If you’re required to take a rapid antigen test and share those results, consider how you’ll do so. “At MD Anderson, we accept outside positive test results,” Bhatti says, noting that outside negative test results will not replace MD Anderson COVID-19 testing if your care team determines you need it. Patients should take a photo of their results with their smartphone and upload them to MyChart to share with their care team.

Patients with a positive result from an antigen or PCR test aren’t retested at MD Anderson for 90-days because they are considered protected from reinfection. In addition, PCR tests are so sensitive, a person who has had COVID-19 can test positive sometimes weeks after being infected, even when they’re no longer contagious.

8. Confirm negative results with a PCR test. If you're experiencing symptoms and a rapid antigen test says you're positive, treat it as a positive result. But if you're symptomatic and you have a negative test, you’ll need a molecular PCR test to be 100% sure, says Bhatti.  

Some at-home rapid antigen tests recommend testing twice. Bhatti says the intent of doubling up on the test is to capture the ideal window of viral load. Early in an infection, you may not have enough virus. But testing again 48 hours later gives the virus the chance to replicate and produce more proteins that would make the test more sensitive

“It may be helpful to test again if you're symptomatic in a day or two, as there may be more viral antigens,” Bhatti says. Even with two or more negative results from antigen tests, you should consider yourself positive until you can confirm you’re negative with a PCR test.

If you’re testing repeatedly without a good indication, the odds of getting a false result are more likely. Bhatti says it’s like throwing darts.

“Eventually, you’ll hit a bullseye, but that doesn't mean you're an expert. It just means you got lucky and in this case, not in a good way,” he says. He worries that routinely screening for infection in asymptomatic individuals with an antigen test, such as before sending your kid to school or before seeing an immunosuppressed loved one, could result in a false sense of security.

“Even with a negative antigen test, you should wear a mask when in indoors, practice social distancing and wash your hands,” Bhatti says.

Request an appointment at MD Anderson online or by calling 1-877-832-6798.

If you’ve caught and recovered from COVID-19, you might be wondering what that means. Are you immune to the virus now? Can you go out in public without wearing a mask? Is it safe to travel or attend large gatherings? Do you still need to practice social distancing?

We checked with our Chief Infection Control Officer Roy Chemaly, M.D. He shared these five Dos and Don’ts to help guide you.

1. DON’T assume you’re immune from COVID-19

The most important thing to do is NOT assume you’re immune to the coronavirus, even if you’ve had a confirmed COVID-19 diagnosis before.

“We’ve already seen at least four different variants crop up — alpha, delta, mu, and omicron — in the last two years,” says Chemaly. “Some have caused worse disease than others, but one consistent feature of all of them is that they’ve become more adept at evading our bodies’ defenses. So, even if you had a severe case of an earlier strain and made a full recovery with no complications, other circulating variants could still infect you. And brand new variants may still be on the horizon.”

2. DO get vaccinated and boosted against COVID-19

Whether immunity stems from a vaccine or actual exposure to the virus, experts now know that the protection it provides is only partial — and temporary. Scientists have confirmed that antibody response wanes over time, which means that people will continue to need supplemental doses and booster shots to provide on-going protection.

"We actually have data now proving that immune response starts off strong after vaccination and then tapers off after a while,” adds Chemaly. “So, even if you have some immunity built up from a natural infection, it won't last forever.”

The COVID-19 vaccines are still doing exactly what they’re intended to do, though, which is to prevent severe illness and death, in most cases. COVID-19 vaccines won’t necessarily prevent transmission, especially as immunity wanes, but boosting still provides people with the most protection possible. So, it’s important to stay up-to-date with your COVID-19 vaccinations.

You can get a COVID-19 vaccine as soon as you’re eligible to leave isolation, but if you received monoclonal antibodies while you were recovering from a COVID infection, you should wait 90 days first.

It’s also important to remember that cancer patients, survivors, and others who are immunocompromised may not develop any antibodies at all — whether in response to natural infection or to COVID-19 vaccines.

“That makes it even more critical NOT to assume you’re safe from reinfection if you fall into one of these categories,” says Chemaly. “But patients who were fully vaccinated before receiving CAR T cell therapy or a stem cell transplant should still make sure they get revaccinated.”

3. DO keep taking all the recommended COVID-19 precautions

It’s equally important to continue practicing all the behaviors experts recommend to prevent possible reinfection, such as wearing a mask, physical distancing, and washing your hands. This does more than just set a good example for others. It also protects the most vulnerable among us if there’s even the slightest chance you might still be contagious.

How do you determine if that applies to you? According to Centers for Disease Control and Prevention (CDC) guidelines:

• General public/mild or asymptomatic infections: Otherwise healthy individuals who did not have severe infections are deemed safe to be around others if 10 full days have elapsed since the initial onset of symptoms and they’ve been symptom-free for at least 24 hours. Both that group and those who tested positive but remained asymptomatic can leave isolation after 5 days, provided they continue to mask well for an additional 5 days.
• Immunocompromised/severe infections: People who are immunocompromised and/or had a severe infection should wait up to 20 days from the onset of symptoms and be symptom-free for at least 24 hours before being around others.
• Severely immunocompromised: These individuals should consult their care teams before they start socializing again.

Remaining committed to preventive strategies is especially critical if you’re caring for a cancer patient or someone who is immunocompromised. Because even if you have immunity, notes Chemaly, they might not. And, you could still pick up a different strain or other germs in public and then bring them back to your household, inadvertently exposing — and infecting — your loved ones.

“Take the same precautions you would as if you had not had COVID-19,” says Chemaly. “Avoid large gatherings of people, and act as if reinfection is still a possibility. Because we know now that it absolutely is.”

4. DON’T forget to disinfect your home

Be sure to clean and disinfect your home thoroughly after you emerge from isolation. This will help protect the people who live with you from any stray virus droplets that might be lingering on surfaces.

Still, says Chemaly, “You don’t need to wear a mask or stay socially distanced from people living in your own household, once you’ve met the CDC’s criteria for ending isolation.”

5. DO quarantine yourself again if you’re re-exposed to COVID-19

One of the hallmarks of viruses is that they never stop mutating, or changing over time. And just because you’ve developed antibodies to one strain of the coronavirus doesn’t necessarily mean they’ll be effective against later versions.

That’s why it’s still a good idea to quarantine yourself if you think you may have been exposed to someone else who has COVID-19, especially if it’s been more than three months since you recovered from an infection yourself.

“Every mutation changes the landscape again, so there are no guarantees,” says Chemaly. “If you're exposed to someone with COVID-19, follow the CDC's quarantine guidelines, just to be on the safe side.”

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Request an appointment at MD Anderson online or by calling 1-877-632-6789.