Survivor rings bell with husband in view
We continue to monitor the impact of the COVID-19 pandemic and to proactively ensure our patients and workforce remain safe and protected. MD Anderson is asking patients about their recent travel history, exposure, whether they have been tested for COVID-19 by nasal swab and if they exhibit any of the following symptoms:
- Fever greater than 100.4º F/38º C
- Sore throat
- Shortness of breath
- Muscle pain
- New loss of taste or smell
Learn more about the symptoms of COVID-19.
Patients and caregivers with questions or concerns should contact your care team via MyChart message or phone call. Outside of business hours, please call: 1-877-564-1202.
Care teams will work with patients to ensure continuity of care. We are increasing the number of virtual visits.
What patients and caregivers need to know before they arrive
We are open for patient care, with some restrictions in place. If you have fever or symptoms of COVID-19, contact your care team before your appointment. If you have been tested for COVID-19 by nasal swab outside of MD Anderson, share a copy of your results with your team before your appointment. For example, you can attach an image of the result and send it to your team using MyChart.
All patients will receive a MyChart questionnaire four days prior to their scheduled appointments to ask about travel outside Texas, symptoms, exposures, and local COVID-19 testing by nasal swab.
MD Anderson is screening patients for COVID-19 symptoms at entrances to all of our campuses. We have installed plexiglass enclosures around screening personnel at all patient entry points to reduce the risk for exposure.
Patients may enter at the following locations on our Texas Medical Center campus:
- Main Building, The Pavilion valet entrance
- Main Building, The Aquarium valet entrance
- Main Building, Garage 10, Floor 3 skybridge
- Mays Clinic, East Lobby valet entrance
- Faculty Center, Floor 3, near Garage 17 entrance
Employees are being screened at separate designated entrances.
We are requiring self-quarantine for new patients traveling from certain areas outside of Texas.
This restriction applies to patients who live in:
- New Jersey
- New York
- Washington (state)
The quarantine may occur at patients’ homes, with daily monitoring by our staff. New patients who have been approved to travel to MD Anderson will be provided an authorization letter for travel.
Please note all out-of-state new patients will be scheduled for a nasal swab COVID-19 test prior to their first appointment.
Our clinical teams are working with current, out-of-state patients to determine appropriate options for care, whether that means delaying the appointment at MD Anderson, virtual visits, local care coordination or, if necessary, travel to MD Anderson for appointments and treatment. We will try to reduce the number of visits to Houston to keep our patients safe since traveling increases the risk of infection. In addition, we recommend all patients and their families self-isolate as much as possible for their protection.
If you have specific questions related to upcoming appointments or procedures, we encourage you to contact your care team via MyChart. For general questions, our askMDAnderson health information specialists may be reached at 1-877-564-1202.
We no longer allow visitors on any of our campuses.
There will be special circumstances when a single adult visitor will need to accompany a patient.
Limited exceptions for outpatient care include: Pediatric patients, and adult patients with neurocognitive issues and/or who are unable to consent for themselves.
Limited exceptions for inpatient care: Pediatric patients; imminent end-of-life patients based on the clinical team’s assessment; visitors who are already serving in a constant care capacity and who have been at MD Anderson’s inpatient hospital since before the new policy begins; patients with cognitive and physical frailties as submitted by attending physician and nursing.
Visitors authorized to remain must be willing to participate in daily screenings for COVID-19 and to shelter in place and keep a constant presence.
View a map of patient drop-off and pick-up locations, as well as temporary, free “cell phone” garages for caregivers.
If you are driving yourself to our Texas Medical Center and need assistance from the garage into the building, please drive to either The Aquarium Valet entrance or Mays Clinic Valet. Our valet team will direct you on where to park. Then they will meet you at your garage with a wheelchair and help you get into the building. Our Patient Transportation team will take over once you’re in the building.
Arrangements have been made for the safe discharge of surgery and same-day procedure patients. Read more about these arrangements.
We know the important role that support systems play in our patients’ lives. Loved ones are an integral part of the care team. That is why we are committed to ensuring additional support during this time.
- We have additional employees on-site to help our patients travel between appointments.
- We encourage patients to bring smart devices to connect with their loved ones by phone or video conference. Get tips here.
Faster medication pickup
Our outpatient pharmacy team has new processes to help our patients and ensure we’re limiting the number of people who come on campus.
For patients and visitors who aren’t allowed inside, the pharmacy now offers curbside medication pickup at the Texas Medical Center Campus at the following locations:
- Main Building: The Pavilion entrance during the week, The Aquarium entrance on the weekend
- Mays Clinic: Mays Clinic Valet
- Rotary House: near the Garage 17 entrance
Patients must call ahead, and the team accepts payment by phone prior to pickup. They should call the pharmacy if they have questions about this process.
For inpatients, our pharmacy team is delivering their medications at the bedside so patients have what they need before they are discharged.
Additional precautions have been implemented to protect our patients who are uniquely vulnerable to the coronavirus disease. These include:
- Making changes to our workforce. Employees whose presence on campus is not deemed essential are working remotely, as determined by local managers.
- Limiting work meetings and social gatherings. Campus events intended for large audiences are canceled or postponed. Learn more about how MD Anderson is following social distancing recommendations.
- Canceling all business travel, domestic and international.
- Canceling all volunteer shifts. All MD Anderson volunteer shifts are canceled until further notice.
In addition, the institution is cancelling Community Relations participation at educational events, like health fairs.
Protection against respiratory illnesses
Our experts say you can protect yourself from respiratory infections by:
- Refraining from touching your eyes, nose or mouth with unwashed hands.
- Washing your hands often for at least 20 seconds with soap and water or using an antiseptic hand gel.
- Avoiding crowded areas and sick people.
Testing for the novel coronavirus (COVID-19) is increasing in many communities. But who actually needs coronavirus testing, and what types of tests are most accurate? What does the COVID-19 nasal swab test involve? And what does it mean if your test results come back negative?
We spoke with Micah Bhatti, M.D., to learn more.
How does COVID-19 nasal swab testing work?
The person conducting the test will insert a long stick with a very soft brush on the end — kind of like a pipe cleaner — up your nose and twirl it around for a few seconds. The soft bristles will collect a sample of secretions there for analysis. The swab has to go pretty far back, because cells and fluids must be collected from along the entire passageway that connects the base of the nose to the back of the throat to get a really good specimen.
The body is not used to having an object in that area, though, so it creates a lot of very odd sensations. For one thing, it activates the lachrymal reflex, which means it’ll bring tears to your eyes if it’s done correctly. Since the swab will also touch the back of the throat, it may also trigger a gag reflex.
Are there any other types of COVID-19 tests available?
Yes, tests can be performed on other specimen types that are less invasive, such as a throat swab. But they are less sensitive than the COVID-19 nasal swab test. Saliva is another specimen type that is being explored, but the jury is still out on that one. The preliminary data look really promising. But we’re still waiting on larger studies to confirm these initial findings.
In addition to nucleic acid testing, which detects a virus’ genetic material, there is also antigen testing, which detects the presence of viral proteins that spur the production of antibodies, or the immune system’s response to invaders.
While antigen tests are quicker, they are also much less sensitive than nucleic acid tests. So, while a positive antigen test is informative, a negative result would need to be confirmed by the more sensitive nucleic acid test.
It’s important to obtain the best possible specimens, so COVID-19 nasal swab testing that includes nucleic acid testing, which is what we do for our patients here at MD Anderson, remains the best option. After all, what’s the point of doing a test, if you can’t get an accurate answer?
What about at-home COVID-19 tests? Are their results reliable?
At-home tests typically involve an individual collecting their own specimen and then shipping it to a testing facility. While the prospect of testing for COVID-19 in the safety and comfort of your own home is quite appealing, the quality and reliability of these at-home test kits is still unknown.
There are concerns about the quality of specimens people collect on themselves, the integrity of the specimens during shipping, and the expertise of the lab where the testing will be performed. Until those concerns can be addressed, it’s best to have specimens collected by trained medical professionals and testing performed in certified labs that are trusted by your primary care physician.
What should I do if I think I need to be tested for COVID-19?
A COVID-19 nasal swab test must be prescribed by a doctor. So, if you think you might need to be tested for COVID-19, contact your primary care physician.
Is MD Anderson testing its cancer patients for COVID-19?
At MD Anderson, all new patients from out of state will be scheduled for a nasal swab COVID-19 test prior to their first appointment. We also take temperatures and ask screening questions of all patients when they arrive at MD Anderson. If we suspect they may have COVID-19, we will test them at that time.
We’re testing inpatients at admission, prior to discharge to a nursing or long-term care facility, and prior to procedures in the operation room, stem cell transplants, certain cellular therapy infusions, and procedures that generate respiratory aerosols or involve the mucous membranes, such as a colonoscopy or a Mohs procedure. We are also providing testing for patients when a household member has tested positive for COVID-19 in the last 14 days.
How accurate is COVID-19 nasal swab testing?
That’s both an easy and a difficult question to answer. The most commonly used test in all clinical laboratories is very sensitive. It’s called a “PCR assay,” which stands for “polymerase chain reaction,” and it is a specific type of nucleic acid test. It looks for traces of the coronavirus’ genetic material, which is what makes a virus do what it does.
In the lab, we can prove a PCR assay can detect very small amounts of the coronavirus. But when we move out into the real world, things get a little more complicated. The two main issues we’ve run into deal with specimen quality and viral load, or how much coronavirus is present in the body.
When you get exposed to COVID-19, it starts replicating in your upper respiratory tract. And the more coronavirus there is, the easier it is to detect. The plateau occurs pretty early on, within a few days of showing symptoms. But if we test you earlier than that, the results aren’t nearly as reliable.
Getting a perfect specimen is a challenge, too, because some collectors don’t feel comfortable inserting the swab as far as they need to go, and patients may jerk back. That’s why we’ve set up swab teams at MD Anderson to improve the quality of the specimens we get. These individuals are highly trained, specifically for the purpose of COVID-19 nasal swab testing.
What happens if my COVID-19 nasal swab test results are negative, but doctors still suspect I have the coronavirus?
First, they would look at your symptoms. Then, they’d consider additional testing, or whether your COVID-19 status could be determined using an alternative method, such as an X-ray.
The coronavirus often starts in the upper respiratory tract — where it causes symptoms like a sore throat, runny nose and dry cough. So, if you’re having those symptoms and they’re being caused by the coronavirus, a COVID-19 nasal swab test should come back positive.
But as it evolves, the coronavirus may move into the lower respiratory tract, where it can cause breathing trouble, a more productive cough and low oxygen levels in your blood. That’s when you might start needing oxygen or a respirator, so your lungs can do their job.
At that point, doctors might order imaging, like a chest X-ray or a CT scan of the lungs, to determine if you have COVID-19. If they see abnormalities that indicate an infectious process, then they’d weigh the risks and benefits of performing a more invasive procedure to obtain samples from inside your lungs.
One of those procedures is a bronchoscopy, where a fiber-optic camera is inserted down the throat and into the lungs to look around and collect samples. That is done only when absolutely necessary, because as with any other medical procedure, there are risks involved.
What are the chances that I might have a false-negative test result?
This is a common question, especially in light of the recent warning from the Food and Drug Administration regarding a high false-negative rate on certain tests.
It’s important to point out that a negative test result may occur in a patient who is in the early stages of the infection and shows no symptoms. A repeat test for this individual may well be positive, as the amount of virus in their body increases to detectable levels. If your physician feels the index of suspicion is high for COVID-19, they may order repeated testing to confirm the initial results.
What is MD Anderson doing to reduce the chances of getting a false-negative when running COVID-19 nasal swab testing for its patients?
The chances of a false negative at MD Anderson in a symptomatic patient due to a COVID-19 infection are very low, provided the lab receives a good-quality specimen.
MD Anderson takes several measures to ensure a low false-negative rate. First, we use a dedicated team of nurses to collect swabs, which ensures a high-quality specimen is collected every time. Second, the tests used in our laboratory have undergone a verification process to confirm that they perform as expected. And finally, we are tracking when repeat tests are positive on individuals who had previously tested negative.
To date, this last scenario has occurred in less than 1% of our tests. And, in all cases, the time between the negative and positive test results was more than 72 hours, opening up the possibility for infection to have occurred between the two tests’ administration.
I think I had COVID-19 before testing was available. Is there any way to confirm that I had it or that I’m immune to it now?
Not really. You can be tested for antibodies, but the results aren’t going to change how you’ll be treated if you’re a patient, or how you should conduct yourself out in the world.
Antibody tests, also known as serology testing, detect anti-viral proteins in the blood made by your immune system to neutralize the virus. But viruses have lots of different proteins and the antibody response can be very individualized.
Not everybody makes the same antibodies to a virus. So, a negative test result doesn’t necessarily mean you were not exposed to COVID-19. It could just mean the anti-viral proteins the test was set up to look for might not be the same ones your body made.
Similarly, even if I knew you’d had the coronavirus and generated antibodies, we simply don’t know enough to say that they would protect you against reinfection. We just can’t say that with any confidence yet. And as this coronavirus mutates — which all viruses do — antibodies to previous versions might not be effective anymore.
Finally, there’s the possibility that these tests may actually be detecting antibody responses to related or similar viruses. This coronavirus is just one of a much larger family of viruses that circulate regularly among humans. It’s something we’re still striving to unravel, so it makes interpreting antibody test results challenging.
Request an appointment at MD Anderson online or by calling 1-877-632-6789
As more people recover from the novel coronavirus and seek to resume their normal activities, there’s been a lot of talk about testing for COVID-19 antibodies.
But what are antibody tests, exactly, and how do they differ from diagnostic tests for COVID-19? What do the results indicate for the people who take these tests? And what do they mean for how we should conduct ourselves during the COVID-19 pandemic?
To learn more about COVID-19 antibody testing, we spoke with Micah Bhatti, M.D. Here’s what he had to say.
What is antibody testing, and how does it differ from diagnostic testing used for COVID-19?
Diagnostic testing for COVID-19 involves looking to see whether an active virus is present — in this case, the coronavirus formally known as SARS-CoV-2. Laboratory technologists use a testing process to detect genetic material from the virus in samples swabbed from the very back of the nasal cavity. This testing is based on a common molecular testing technique: polymerase chain reaction (PCR).
By contrast, antibody testing (also called serology testing) is done with blood samples, because you’re looking for evidence of the body’s immune response to the virus.
After your body is exposed to a foreign pathogen, your white blood cells start to learn about it and make antibodies to neutralize it. So, when an antibody test comes back positive for this coronavirus, it means 1) you were exposed to SARS-CoV2 at some point in the past and 2) your immune system was robust enough to launch an antibody-forming immune response.
How long does it usually take people to generate these antibodies?
There are limited data related to antibodies against SARS-CoV2. Some reports suggest most healthy people start making antibodies 11 to 14 days after symptoms first appear.
But there are also other variables to consider, such as malnourishment, having cancer or another chronic health condition, or taking immune suppressing drugs. All of these can affect people’s ability to make antibodies.
What does a positive coronavirus antibody test result mean for someone in terms of immunity?
The short answer is we don’t know.
It may mean someone has full immunity or partial immunity or no immunity at all. Some antibodies decrease over time, so you might be immune for six months to a year, and then maybe not at all later on. Or, it might be like a tetanus immunization, where if you get it once, you’re most likely immune the rest of your life. There’s just no way to give definitive answers right now.
How long will it take before we know for sure what positive COVID-19 antibody test results really mean?
The answer to that question will take lots of research, and probably at least a year of data collection, to figure out. Because first, you need to find people with the COVID-19 antibody. Then, you need to follow them to see if they become infected again if they’re exposed to the virus in the future. And that takes time.
Why is it important for people not to assume they’re immune if they test positive for COVID-19 antibodies?
There’s a big difference between telling someone they have immunity versus that they may have immunity. That’s a really important distinction to make.
Because if someone says that they’re definitely going to give me a million dollars, I may go out and buy a new house. But if they tell me they may give me a million dollars, I probably won’t, because it’s not a promise. It’s only potential.
With this virus, we just don’t know the answer yet. We can only advise patients that they may have immunity if the antibody test is positive. So, even if I were to test positive for antibodies to the coronavirus, I wouldn’t change my behavior. I’d still wear personal protective equipment at work, wash my hands a lot and practice social distancing.
How accurate are the tests currently available?
The jury is still out on how good serology tests are for this coronavirus. They’re not used widely enough to have good answers yet.
A lot of companies are trying to market their tests right now. And some are making false claims to the point that the Food and Drug Administration may have to take action. It’s important to note that just because someone is saying they have a serology test, doesn’t necessarily mean you can trust that test to provide accurate results.
Here at MD Anderson, we’re looking at bringing in serology tests from some of the bigger, more established diagnostic equipment suppliers. We’re hoping to have those available in the coming weeks.
Where can people obtain antibody testing? And who should?
At MD Anderson, an antibody lab test requires orders from a physician. Antibody testing primarily reveals if you were exposed to SARS-CoV2 in the past and generated an antibody-forming immune response.
Until we know how antibody test results relate to immunity, the tests are mainly useful for epidemiologists and researchers. But as always, you should discuss your medical needs and any questions with your physician.
Learn more about COVID-19 and the precautions MD Anderson is taking.
“Cancer patients should also wear a medical face mask or fabric mask anywhere they go,” says our infectious diseases and infection control expert, Roy Chemaly, M.D. “Everyone else should wear a cloth face mask when going out in public as an added precaution.” That’s because social distancing can be harder to maintain in these spaces.
“Wearing a mask can also provide a visual cue, reminding others to keep their distance,” says Chemaly. “This can be especially important for cancer patients, who are uniquely vulnerable to COVID-19.”
Wearing a fabric mask won’t necessarily keep you from breathing in droplets that cause COVID-19 and other viruses. But, according to the Centers for Disease Control and Prevention (CDC), wearing a mask can help slow the spread of the coronavirus, especially from those who may have COVID-19 and not realize it.
“Wearing a mask can also keep you from touching your face and mouth, which can help reduce the spread of COVID-19 germs,” says Chemaly.
Here’s what to know about wearing a face mask.
Make sure your fabric mask fits properly
There are a lot of fabric face masks available for purchase, and many people are making their own. “There’s no guarantee these fabric masks work to prevent COVID-19 exposure and infection,” Chemaly says. But to increase the chances that your fabric mask can help prevent the spread of COVID-19, the CDC recommends you wear one that:
- includes multiple layers of fabric
- fits snugly but comfortably against the side of the face
- secures with ear loops or ties
- allows you to breath easily
Wash your fabric mask after use
After wearing your cloth mask, be sure to clean it. You can do this by putting it in the washing machine.
But make sure that your mask can be machine washed and dried without damage or change to its shape. “If there is damage or the mask no longer fits snugly, it’s no longer serving its purpose and shouldn’t be worn again,” says Chemaly.
Unless you’re a cancer patient, don’t use medical face masks or N-95 respirators when going out in public
When healthy individuals use face masks or N-95 respirators when they’re out and about, this takes away from the supply needed and used by hospitals.
“Only cancer patients and those with compromised immune systems should use medical face masks, when available to them, in public,” Chemaly says. “Everyone else should use a fabric mask.”
Cancer patients visiting one of MD Anderson’s campuses will receive a medical face mask to wear at our screening entry points.
Some people shouldn’t use any type of face mask
Because masks cover up your nose and mouth, they’re not right for everyone.
Avoid using face masks:
- on kids younger than 2
- you have trouble breathing
- on anyone who can’t remove the mask unless help to do so is available
A fabric mask is only one part of your COVID-19 protection toolkit
A mask alone may not keep you from getting COVID-19.
“But, if you do it along with conjunction with practicing social distancing, staying home whenever possible and regular handwashing, it can help protect others and reduce the spread of COVID-19,” Chemaly says.
“It’ll also set a good example for others when you’re out, reminding them to practice social distancing and do their part to help reduce the spread of the coronavirus.”
Learn about COVID-19 precautions that MD Anderson is taking.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
This article was last updated on May 22, 2020.
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