Coronavirus (COVID-19) Precautions

Last updated on Jan. 27, 2022.

When the COVID-19 pandemic began two years ago, so little was known about the SARS-CoV-2 virus that all anyone could really do was treat the symptoms.

Today, however, several options are available to treat COVID-19 and fight the underlying virus that causes it. But which ones are best for cancer patients? How do they work? And are some more effective than others?

We sat down with Chief Infection Control Officer Roy Chemaly, M.D., to learn more. Here’s what he wants cancer patients and their caregivers to know.

What treatments are available for cancer patients right now that specifically target COVID-19?

For hospitalized cancer patients with COVID-19 infections, the main drug we use is called remdesivir (Veklury). It’s an antiviral that’s administered through an IV.

Very ill or high-risk patients could receive remdesivir for up to 10 days. But most will receive it between 5 and 10. Patients who have minimal symptoms and are not at high risk for severe illness could receive it for as few as 3 days. But they would still benefit from it. Remdesivir has been shown to be effective against the coronavirus in many studies, and we’ve had access to it for more than a year.

Steroids have also proven beneficial to some hospitalized patients with COVID-19 who require high levels of oxygen or are on breathing machines. Though they don’t specifically target the virus, steroids can block or reduce the inflammatory responses of SARS-CoV-2 in the lungs.

What about COVID-positive cancer patients who aren’t hospitalized?

For outpatients with COVID-19, we may use two oral drugs to help them avoid being hospitalized. They are:

• molnupiravir (from Merck)
• Paxlovid (from Pfizer)

Both are antiviral pills that are taken by mouth, but supplies are very limited.

How do these antiviral medications work?

They all work slightly differently to prevent the virus from replicating itself. Some bind to a specific viral enzyme (RNA-dependent RNA polymerase) and terminate RNA transcription prematurely (remdesivir). Some introduce errors into the SARS-CoV-2 virus’ genetic code (molnupiravir). And some inhibit the function of a particular SARS CoV-2 protein (paxlovid).

What about monoclonal antibodies? How do those work? And are they effective against COVID-19?

Three different monoclonal antibodies have been granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) to try to prevent hospitalization. They are:

• bamlanivimab and etesevimab (made by Eli Lilly)
• casirivimab and imdevimab (made by Regeneron)
• sotrovimab (made by GlaxoSmithKline/Vir)

These monoclonal antibodies target the spike protein of SARS-CoV-2, and are designed to block the virus’ ability to attach to and enter human cells.

Under EUA rules, monoclonal antibodies cannot be used in hospitalized patients or patients who require oxygen. They can only be used in outpatients with mild to moderate COVID-19 who are at high risk of progression to more severe illness.

Unfortunately, only one of these monoclonal antibodies, sotrovimab, has proven somewhat effective against the omicron variant, and that was in a lab. It’s also in very short supply. The other two were helpful against the delta variant. But there have been so many changes in the spike proteins that they’re not as effective against omicron, so the FDA has now limited their use to only when a patient is likely to have a variant that responds to these treatments.

So, the only monoclonal antibody that we can use right now to treat COVID-19 and prevent hospitalization is sotrovimab. And that’s only when it’s available.

Is there anything available that can prevent cancer patients from contracting COVID-19?

Getting a COVID-19 vaccine is still the best way to prevent infection. But for patients who are too sick to get vaccinated or too immunocompromised to benefit much from vaccination, there may be an alternative.

AstraZeneca manufactures some monoclonal antibodies now called Evusheld, which is a combination of cilgavimab and tixagevimab. It has demonstrated some limited efficacy against omicron, and was granted EUA status by the FDA, so it could be used for “pre-exposure” in some high-risk cancer patients.

It’s available right now, but also in limited quantities, so again, patients must meet very specific criteria to qualify for it.

How can patients obtain these medications?

Many of these drugs are in very short supply right now, and they have very strict eligibility guidelines.

At a bare minimum, for instance, to qualify for Pfizer’s paxlovid, cancer patients must:

• have a confirmed case of COVID-19
• have only a mild to moderate infection
• be at high-risk of being hospitalized
• have had symptoms for no longer than 5 days
• be age 12 or older
• weigh at least 40 kg (88 lbs.)

To possibly qualify for Merck’s molnupiravir, cancer patients must:

• have a confirmed case of COVID-19
• have only a mild to moderate infection
• be at high-risk of being hospitalized
• have had symptoms for no more than 5 days
• be age 18 or older
• not be pregnant or trying to conceive
• have no other drug available

So, while there are options, they might not be available to you specifically, or they may not be available yet — either here at MD Anderson or anywhere else. Only certain pharmacies will have them, and physicians must answer many questions about their patients before they can be released. So, it’s very important to stay flexible if you approach your doctor about one.

Anything else cancer patients should know about possible COVID-19 treatments?

If you’re currently receiving chemotherapy as a part of your cancer treatment, it could be delayed if you’re very sick with COVID-19, especially if you have pneumonia.

Also, every drug has potential side effects. And since one of these antiviral medications is a combination of two agents (Paxlovid), the chances of them interacting with other drugs you’re taking are higher.

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

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.”

Related stories

• At-home COVID-19 tests and the omicron variant
• Breakthrough infections and COVID-19's omicron variant
• Mixing and matching COVID-19 boosters: Should you do it?
  

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

Last updated May 31, 2022

Figuring out how to travel safely has never been more confusing — especially for cancer patients and their families.  

Though most of the United States now has low transmission levels of SARS-CoV-2, the virus that causes COVID-19, at least five sub-variants of omicron are currently circulating around the globe — with more mutations likely. 

Masking is no longer required on airplanes or other forms of public transportation. But summer is right around the corner with all of its weddings, family reunions and vacations. 

So, how can cancer patients stay safe while navigating their summer plans? And what should immunocompromised patients know now, two years into the pandemic? We went to Chief Infection Control Officer Roy Chemaly, M.D., for answers. 

What’s the most important thing for people to know right now?

The main message is that this virus is still circulating. And people can still get infected with SARS CoV-2. So, they can’t just forget about it. They have to stay vigilant and be cautious. 

What should cancer patients do to keep themselves and their loved ones safe?

We’re in a much different place now than we were in 2020, or even in 2021. For one thing, we have several effective, FDA-approved COVID-19 vaccines available. We also have treatment options that weren’t around at the start of the pandemic. 

That being said, COVID-19 is still something that cancer patients and immunocompromised people should try to avoid. Because if they get it, they may not do well, especially if they have other underlying problems. 

That’s why all of the same guidance still applies:

• wear a mask
• avoid large gatherings
• practice physical distancing  
• get tested before and after traveling or if you have symptoms and follow the CDC's guidelines as to how long to stay home 

Also, if you’re not fully vaccinated, get vaccinated. If you’re already fully vaccinated, get boosted. And if your care team says to get a second booster shot, get one. COVID-19 vaccinations have proven their value over and over again in terms of preventing serious illness, hospitalization and death. 

How important is the masking piece right now?

Just because you can do something, doesn’t necessarily mean you should. So, even if it’s not required anymore, I still think it’s smart to wear a mask on public transportation — whether that’s a city bus, a taxi or an airplane. The Centers for Disease Control and Prevention (CDC) still recommends it, too.  

I also think it’s wise to wear a mask at airports and anywhere else you might be exposed to a crowd. Again, it’s not just about protecting yourself. It’s about protecting others, too, including your immunocompromised loved ones. 

Anything else cancer patients and their families should keep in mind?

For cancer patients, prevention of COVID-19 is of the utmost importance. So, talk to your doctor to see if you’re eligible to receive Evusheld (tixagevimab and cilgavimab), the EUA-approved monoclonal antibody combination that’s been somewhat effective in preventing infection by the omicron variant and its sub-variants.

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

With the rise of the omicron variant, a mild cough can have you fearing that you’ve got COVID-19.

And whether it’s a PCR test that you mail to a lab or rapid antigen test that reveals whether you have COVID-19 in minutes, many people are turning to at-home testing options.

Chief Infection Control Officer Roy Chemaly, M.D., shares insights on using at-home tests to detect the omicron variant and what to know to ensure your COVID-19 test results are accurate.

At-home COVID-19 antigen tests aren’t always reliable

While at-home COVID-19 tests can detect the COVID-19’s omicron variant, Chemaly doubts their reliability. “My take on antigen tests — not only for COVID-19 but for other viruses, too — is that they’re not that sensitive to detect the virus consistently,” he says.

There are several factors that influence an antigen test’s accuracy. First, it’s challenging for most people to get a quality sample if they swab themselves.

“The specimen depends on the swabbing and how deep you go in nose,” Chemaly says, calling this “difficult to do on yourself.” The swab should be inserted into the nasal cavity, but it should go deep enough to extract mucus from the sinuses.

That said, Chemaly acknowledges that at-home COVID-19 antigen tests may ease the process for international airline passengers. He cites a situation when a traveler did the antigen test at home while being monitored on a video call by a health care professional contracted with the airline. “It does add a level of quality control and some degree of protection,” Chemaly says.

False negatives are common with at-home antigen tests

Even with a good sample, an at-home test may not be able to always detect the coronavirus. Chemaly says not all at-home antigen tests are quality products.

“The tests are only accurate 80% of the time, and sometimes less,” he says. That means 20% of people who use an at-home antigen test could get a negative test result, despite being infected with COVID-19.

Because the current infection rate of the coronavirus is so high, he notes that if you have negative antigen test, it could be a false negative. If you have COVID-19 symptoms and test negative with an at-home antigen test, it’s important to follow up with a PCR test since you may well have gotten a false negative result.

A positive at-home test result means you have COVID-19

If you get a positive test result on an at-home antigen test, it does confirm a positive infection. “If it's positive, that's it. You have the coronavirus,” Chemaly says. “But if it's negative, that doesn't mean you don't.”

He suggests that if you get a negative result with an antigen test, you follow it with a PCR test from your care provider to confirm the results. “Repeating the same test is not going to help,” Chemaly says. By chance, you may come back with a positive result, but Chemaly cautions that testing multiple times with an at-home antigen test doesn’t improve the accuracy.

“It's not a great test,” he says.

At-home PCR tests may also yield false negatives

The concerns with at-home PCR tests are similar to those with at-home antigen tests. Chemaly doubts the ability to get a quality sample because of the discomfort with doing your own nasal swab.

Even with a quality sample, the factors with transporting the specimen to the lab make the results unreliable. “If it comes back positive, take it as that. But if it’s negative, it doesn’t rule out COVID-19 , in my opinion,” he says.

Get tested two to three days after COVID-19 exposure

Even if you aren’t showing symptoms, it’s still good to know if you’re infected so that you can prevent spreading it to those who are most vulnerable, like immunocompromised people or children too young to get vaccinated.

Chemaly recommends testing two to three days after exposure. “It’s much quicker than we saw with the delta variant,” he says. While the delta variant took on average five days for symptoms to arise, the omicron variant can show symptoms within 48 to 72 hours.

If you have flu-like symptoms, such as a cough, sore throat, fever and/or headache, Chemaly recommends getting tested right away.

Use an at-home home test as a first step if you can’t get a COVID-19 testing appointment

“If you have symptoms and don’t have access to a PCR through a testing site, test yourself at home,” Chemaly says. “But consider it a first step.”

If your at-home test is negative, Chemaly recommends you follow up with a PCR test as soon as you can to ensure it’s not a false negative.

If you have symptoms but can’t get to a testing site and are unable to find an at-home test, Chemaly recommends isolation. The Centers for Disease Control and Prevention (CDC) recommends individuals infected with COVID-19 isolate five days starting the day after their first symptoms appear. Health care workers should isolate for seven days starting the day after the first sign of symptoms.

If other individuals in your household don’t have symptoms, it’s important to isolate from them and wear a mask to prevent them from getting infected. “If you’re coughing and sneezing, it has to be considered coronavirus until proven otherwise,” Chemaly says.

After your period of isolation, and when you’ve gone 24 hours without a symptom or back to baseline, you are no longer contagious and can go out, Chemaly says. But he advises it’s still important to wear a mask when you’re around others.

 Request a multiplex PCR test if your COVID-19 PCR test is negative and you still feel sick

If you have symptoms and a COVID-19 PCR test shows you’re negative, Chemaly recommends requesting a multiplex PCR test from your health care provider. It looks for 18 other viruses that could be circulating in the community, such as the common cold and the flu.

“There’s other respiratory viruses out there right now, but because the omicron variant is much more prevalent, it’s important to still rule out the coronavirus as number one,” he says.

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

The number of breakthrough COVID-19 infections continues to climb, both in the United States and around the world. Many are now due to the omicron variant, as opposed to the delta variant, which still accounted for more than 90% of all documented COVID-19 infections in the U.S. as recently as mid-December.

So, what does this mean, from a practical standpoint? Is it okay to send your kids back to school after the holiday break? What should you do if you test positive for the virus now? Should you still get a vaccine booster shot, if you become infected with omicron before you can obtain one?

We checked in with Chief Infection Control Officer Roy Chemaly, M.D. for answers. Here’s what he had to say.

Are breakthrough infections more common with omicron than they were with previous strains?

Yes, I think so. We’re definitely seeing more breakthrough infections with omicron than delta, simply because the efficacy of the vaccines is lower against it.

Why is that? Does it mean the vaccines aren’t working?

No. Every variant is going to be at least slightly different from the ones that came before it. That’s just the nature of evolution. But omicron, in particular, has a lot of mutations that make it more transmissible and able to evade the passive immunity acquired from vaccination. So, the vaccines are not going to be as effective against it as they were against delta or other previous variants.

Is there still any value in getting vaccinated or getting a booster shot now?

Absolutely. Even with something like the flu, the goal is to reduce the overall number of infections, as well as the severity of the infections that still occur.

The existing, FDA-approved COVID-19 vaccines are still very effective at preventing serious illness. And that’s the most important thing. Because the milder your symptoms are, the less likely it is that you’re going to need hospitalization, or die from the underlying infection.

With a booster shot, your chances of getting COVID-19 are much lower than if you’re only fully vaccinated. That’s why it’s also very important for everyone who is eligible to get a booster.

Is omicron causing milder symptoms in people than previous variants did?

Anecdotally, I would say yes. In general, the symptoms people are presenting with appear to be less severe with omicron than with delta.

What are the primary symptoms of people infected with omicron? Do they differ from previous variants?

Most of the infections we’re seeing now are in people who are symptomatic rather than asymptomatic, meaning that infected people are showing symptoms more often than not. Their symptoms are generally flu-like and similar to those of previous variants. But in many cases, the headache, fever and coughing are milder.

The loss of taste and smell may also be much less prevalent with omicron than it was with delta. But again, this is all strictly anecdotal, not based on formal study.

What should someone do if they develop a breakthrough infection now?

If you’re asymptomatic, stay home for 5 days, then wear a mask for 5 days, per the Centers for Disease Control’s new quarantine guidelines.

If it’s a mild infection, quarantine yourself for 5 days. If your symptoms are resolving or you’re asymptomatic and/or back to your normal baseline after that, you can leave your house, but wear a mask for another 5 days. It is always recommended to wear a mask in the community and at any gathering.

If it’s a severe infection, monitor yourself carefully. And if you’re getting progressively worse instead of better, seek help. This is particularly true if you start experiencing shortness of breath, a severe cough, breathing problems, or other concerning symptoms of COVID-19.

If you’re an MD Anderson patient, I’d also suggest checking with your doctor for guidance that’s specific to you. We can use the FDA-approved anti-viral drug veklury (Remdesivir) or steroids in cancer patients who are sick enough to be hospitalized, whether it’s due to pneumonia, low oxygen levels, or some other issue.

But the two anti-viral drugs recently granted emergency use authorization by the Food and Drug Administration for use against COVID-19 are not available yet. And most available monoclonal antibodies don’t work against omicron, except for one kind called sotrovimab, which is very hard to get right now.

If someone develops a breakthrough infection after being fully vaccinated, but before receiving the booster shot, should they still try to get one?

Yes. My recommendation is to get a booster shot, even if you’ve already been infected. You’ll have to wait until you get better, of course, and be out of quarantine and not symptomatic. But I still recommend getting a booster as soon as you’re eligible, because natural immunity is not going to be as effective as what you’ll have if you get boosted.

Are there any special measures cancer patients or immunocompromised people should be taking to protect themselves right now?

Other than getting boosted or an additional dose, no. Talk to your doctor to be sure, of course, but generally speaking, cancer patients and other immunocompromised people should be taking the same public health measures right now that we’ve all been following to some degree for the past two years:

• masking all the time
• avoiding large gatherings
• practicing social distancing.

What guidance do you have for parents about sending their kids back to school after the holidays?

First, if your children are eligible, get them vaccinated. If they are 16 or older, get them boosted as soon as they are eligible. I would also have them keep wearing masks at school, especially during the first month of 2022, because we really don’t know how this pandemic is going to evolve. Will there be a sharp decline in cases or will this variant linger for months?

Based on what’s happening in South Africa, it may not linger very long. It may get better more quickly than it did with delta. But that’s impossible to predict, so I would still take all precautions until we know more.

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

To help reduce the spread of the novel coronavirus (COVID-19) and make it easier for patients to see a doctor without leaving home, MD Anderson and many other health care providers are offering virtual visits for many patients.

Existing MD Anderson patients who have a clinic follow-up visit or a consult visit with a new MD Anderson provider may be eligible for a video visit, depending on where they live. Each state has different regulations regarding video visits and the practice of medicine by out-of-state clinicians. Talk to your care team to learn what may be available and best for you.

“Virtual visits offer a convenient way for our cancer patients to continue receiving the outstanding care they have always experienced from their MD Anderson care team, with the added benefit of not having to leave their homes,” says Neema Navai, M.D.

If you’ve never had a virtual visit before, here’s what you should know to get the most out of your virtual visit.

Plan ahead ensure a productive conversation

“Virtual visits offer tremendous convenience since they can be done from anywhere with the click of a button,” says Navai. “But they do require a little bit of planning ahead to ensure you and your provider have a productive visit.”

Whether your appointment is virtual or in person, it can be hard to remember everything you want to discuss with your health care provider.

So, before your appointment, write down your questions, as well as new symptoms and concerns. This will help ensure you don’t forget anything important that you want to discuss during your visit.

Before your virtual visit with your MD Anderson provider, it’s also important to complete the eUpdate process to update your information in MyChart. You can verify your personal details, medications and insurance information up to 7 days before your virtual visit. We recommend doing this 2-3 days before your appointment so these details can be shared with your clinical team in advance. A member of your care team will call you before your appointment to review your list of medications and ensure you’re ready for your video visit.

Download the apps you need in advance

Before your appointment, download the apps you need on the device you plan to use and make sure you can access them correctly.

MD Anderson patients are encouraged to use the MyChart mobile app on a smartphone or tablet for the best video visit experience. You can download the free MyChart mobile app from the App Store or Google Play. You will also need to download the ZOOM Cloud Meetings app to the same device. Newer smartphone and tablets will be able to download the ZOOM Cloud Meetings app; see a list of operating systems that support the ZOOM Cloud Meetings app.

You must use the MyChart mobile app to join a video visit on your smartphone or tablet. You cannot go to our MyChart website from your smartphone or tablet and start your video visit.

While you can use a computer to access your MyChart account at MyChart.mdanderson.org, you may have more technical problems than if you use the MyChart app on a smartphone or tablet. Use our MyChart Video Visit Instructions or call 1-877-632-6789 if you need assistance. You also can watch a video with MyChart Video Visit instructions.

Set the stage for your virtual visit

Just as you’d do for a video call with colleagues, find a quiet, well-lit space for your virtual visit. Be sure to check the background noise and any visuals that may appear around you while you’re on screen.

Test where to direct your gaze on your webcam setup. Look into the camera so your doctor can have a more engaged conversation with you.

Use headphones, if possible

Plan to use headphones or a headset, if you have them. This will make it easier to hear your provider and may improve the sound quality.

If you’re including a household member in your virtual visit or don’t have headphones or a headset, check for background noise and move to a quieter space, if necessary, to eliminate distractions during your virtual visit.

Do a tech check

Before your visit, make sure your device is charged and that you have a strong internet signal or WiFi connection. A higher speed internet connection will help to increase the overall quality of the video and audio during your virtual visit.

It’s also important to confirm that your audio, video and headphones are working at least an hour before your virtual visit. They should work if you’ve recently used your device for other video chats.

“As with any new technology, you may encounter technical issues, but to ensure we can provide a timely and high quality experience, it’s a good idea to test everything before your visit,” says Navai. “You’ll have a better, more focused conversation with your provider if you don’t have to worry about technical difficulties.”

Your virtual visit will last as long as an in-person appointment

Your virtual visit will run a lot like an in-person visit and last about as long. Your provider will ask you questions, covering topics such as new symptoms, side effects and other concerns you may be having, as well as next steps for your treatment or follow-up care.

Use this time to ask questions and share concerns with your provider, just as you would in person.

You can include family members in your virtual visit

Just as you might have brought family members to appointments before visitor restrictions were put into place to prevent the spread of COVID-19, you can include family members in your virtual visit. A family member or loved one can provide a second set of ears, take notes and ask questions you might not think of.

If your family member if participating from your home, have them in the same room as you and make sure they can appear on the screen, too, if possible. If you try to include them from another device in the same home, there may be a distracting echo.

Want to include a loved one in your virtual visit from another location? If you're an MD Anderson patient, you can add them through the ZOOM app by following these instructions. 

Plan to pay the same co-pay that you would for an in-person visit

You will be charged the same co-pay for your virtual visit as you would for an in-person appointment. But you will not be asked to pay during your virtual visit. Instead, the balance will be listed in your eUpdate after your visit. Your insurance company determines the cost of this co-pay. If you have questions about charges, payments and balances, send a message in MyChart or call 1-800-527-2318.

Know what to do if the connection is lost

Sometimes things don’t go exactly as planned. Here’s what to do if you lose your connection during your video visit:

• If you can still see your video, keep the video connection active and don’t close the video window. Your provider may be able to rejoin soon.
• If you lose your connection, restart the video visit following these steps. You may be placed in the virtual waiting room until your provider is able to restart the video visit.
• If the video visit can’t be restarted, your provider will call you to complete the visit or provide more instructions. Your provider will call you at the phone number you listed in your eUpdate, so be sure to keep that phone close by.

Learn more about virtual visits at MD Anderson.

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