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Just when you thought you nailed down the latest type of vaccine — bivalent vaccines — the script is shifting in the effort to prevent COVID-19 infections. 

A panel of advisors for the U.S. Food and Drug Administration (FDA) recently voted unanimously to update the COVID-19 vaccine to target Omicron emerging subvariants. In particular, the new vaccine will target the subvariant XBB.1.5, which currently makes up about 40 percent of new infections in the United States.  

This new vaccine would be a monovalent vaccine (targeting one strain), rather than the currently available bivalent vaccine, which targets both the original strain of the virus and the Omicron subvariants that took over last winter.  

The reasoning: There doesn’t appear to be a particular advantage to the bivalent vaccines now that the original strain is no longer circulating.  

“It makes sense to re-formulate the vaccine to no longer include the ancestral strain,” says Amesh A. Adalja, MD, a Senior Scholar at Johns Hopkins Center for Health Security. “Some of us advocated that they do this with the prior Omicron bivalent booster as well. It’s unclear that there’s any benefit at all by including a strain that is basically extinct.” 

What’s more, including that ancestral strain may negatively affect how the vaccine works in your body. “There is also some evidence that by including the ancestral strain, antibodies against the newer strains may not form as the immune system primarily reacts to the older strain that it has seen before,” says Dr. Adalja.  

FDA scientists said vaccine manufacturer data show that an updated monovalent formulation targeting XBB subvariants elicits stronger neutralizing antibody responses against those strains than current bivalent vaccines, reports NPR.  

In the alphabet soup of COVID-19 variants, XBB.1.5 is currently considered the most transmissible strain so far, per Yale Medicine. That means it’s more efficient and contagious than predecessors, which tends to be the case as variants mutate.  

XBB.1.5 was first identified in New York in October 2022 and is nicknamed “Kraken,” after a mythical, giant sea monster. There’s currently no evidence that it causes more severe disease than other Omicron strains.  

While making this shift ahead of the fall season was a unanimous decision by the committee members, there was debate over whether the COVID-19 vaccine should be treated like the flu vaccine (which is reformulated each year in anticipation of the flu season). 

Although many people already understand the flu shot’s schedule, experts like Dr. Adalja point out the need for more data before a parallel is drawn between the two.  

“I think it is premature to determine what the optimal schedule of boosting or updating may be,” says Dr. Adalja. “While people like to draw comparisons with influenza, coronaviruses are a completely distinct, viral family with different characteristics. It is also unclear if the majority of individuals will benefit from annual shots against COVID-19 as protection against severe disease is intact.” 

Currently, the U.S. Centers for Disease Control and Prevention states that everyone ages 6 and older should get one updated Pfizer or Moderna COVID-19 vaccine to be up to date (referring to the vaccines currently available). People aged 65 or older may get a second dose, while those who are moderately or severely immunocompromised may get additional doses.  

In anticipation of fall demand, Pfizer, Moderna, and Novavax all began developing vaccines targeting XBB.1.5 months before this decision, reports CNBC. Preliminary data shows that their shots produce strong immune responses against all XBB variants.  

As for next steps, the FDA will consider the committee’s decision and likely issue an official recommendation shortly, reports NPR. The new vaccines are on track to become available by late September or early October.  

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When thinking about traveling this year, certain factors may give you pause: for instance, general pain and stiffness that comes from traveling with autoimmune arthritis, plus the risk of COVID-19 that you’ve had to grapple with for the past three years (especially if you’re immunocompromised).  

However, after years of canceling plans during the pandemic, you might be itching to see more of the world again — and we certainly don’t blame you.  

Here, rheumatologists weigh in with their best tips on what to consider before booking your tickets.  

Traveling With Pain

First, rest assured: Our experts largely agreed that there are ways to make travel with autoimmune arthritis possible, even if you experience chronic pain.  

“If patients with rheumatoid arthritis enjoy traveling, they should be open to it,” says Brett Smith, DO, a rheumatologist at Tennessee Direct Rheumatology and East Tennessee Children’s Hospital. “While patients have a disease that alters their daily life, we also want them to enjoy life and not hold back.” 

Prepare In Advance

The key for managing pain on your trip is planning in advance, bringing enough of the medications and supplies you’ll need, and keeping in contact with your doctor. The type of travel you’re embarking on will make a difference in how you manage aches along the way, too.  

“If you’re driving for an hour, that’s different than if you’re taking a plane across the country,” says Lawrence Brent, MD, Professor of Medicine at the Lewis Katz School of Medicine and Associate Director of the Rheumatology Fellowship Program at Temple University Hospital. “Navigating airports can be very challenging for someone not only in terms of pain, but also mobility.”  

Although they’re certainly not impossible to manage, Dr. Brent notes that airports are not always accommodating to those who have difficulty getting around.  

“You can do it, but it’s going to take you much longer,” says Dr. Brent. “It all depends on how much you want to do the trip and what you think you can do — plus your pain tolerance, which is very individual. If you’re going with someone who can help, that makes a big difference.”  

Keep Moving to Avoid Stiffness

During your trip, do your best to continue moving. You already know that with arthritis, particularly rheumatoid arthritis, stiffness is a common occurrence — and the longer you sit still, the more stiffness you’ll experience.  

If you do choose to fly this summer, opt for an aisle seat so you have easier access to get up and walk around during your flight. (Get a head start before your trip with these 30 tips and tricks to prevent arthritis morning stiffness.) You may also find it helpful to bring a pillow to make hard airplane seats a little more comfortable. 

It’s also worth considering the climate of the destination you’re headed to: “Warmer environments can be more beneficial for pain, stiffness, and function, so take that into consideration when choosing a destination,” says Dr. Smith.  

Stock Up On and Pack Medications

Talk to your doctor about getting enough medication ahead of time, so you’re prepared if you experience a flare or are delayed during your travels. 

“I usually offer patients with rheumatoid arthritis [or another type of inflammatory arthritis] a short course of steroids to take with them, just in case they have a flare,” says Dr. Smith.  

Of course, you’ll also want to triple check your luggage before you leave to make sure you have everything you need to take your medication.  

“Oral pills are easy, but if you’re taking a self-injection, make sure you have the appropriate packing materials and enough to last you through the trip — and maybe a couple of weeks extra,” says Nilanjana Bose, MD, MBA, a rheumatologist at Lonestar Rheumatology.  

Create a Communication Plan With Your Doctor

Talk to your doctor about how you’ll stay in touch during your trip. Most physicians have online portals, so even if you’re traveling abroad, all you need is access to the internet to contact them.

Although there are many ways to safely and comfortably travel even if you experience chronic pain, there are a few times in which your doctor may recommend rescheduling the trip: “If you’ve had a recent respiratory illness or a recent flare of your disease, or you’ve had your medicines adjusted, you might consider changing your travel schedule,” says Dr. Brent.  

Likewise, if you’ve just been diagnosed with a new underlying condition, you may want to pause to ensure you can adequately manage it before jetting off.  

Traveling During COVID-19

If you’re immunocompromised, there’s no one easy answer to whether you should travel or not in the age of COVID-19. It’s a decision that needs to be made between you and your doctor, but here are a few things to consider:  

• Are you up-to-date on your vaccines?
• Everyone aged 6 years and older should get 1 updated Pfizer-BioNTech or Moderna COVID-19 vaccine to be up to date, but those who are moderately or severely immunocompromised may get additional doses, per the U.S. Centers for Disease Control and Prevention (CDC). 
• Do you have a respiratory condition (rheumatoid arthritis can affect the lungs) or other risk factors for developing issues with COVID-19?
• What medications are you on and how do they affect your immune system?  
• For instance, rituximab is associated with an impaired response to SARS-CoV-2 vaccination in patients with rheumatic diseases, per an Annals of the Rheumatic Diseases report.  

Follow Standard Mitigation Efforts

If you’re immunocompromised and decide to travel, follow all necessary precautions such as spending time outside rather than in indoor public spaces, wearing a mask or respirator (like the N95 mask), and keeping your distance from others, per the CDC.  

“Carrying a bottle of hand sanitizer can also be an easy solution to lower the risk of infection while traveling,” says Dr. Smith. 

These preventive measures are helpful not only for avoiding COVID-19, but other illnesses like cold and flu. And of course, the benefit of traveling during this time of year is that you don’t have to be in crowded indoor spaces quite as much.  

“During the summer, you have the advantage of people being outside more, so you have more fresh air and you’re not cooped together like you are in the winter,” says Dr. Brent.  

Get Up to Date on All Vaccines

In addition to your regular COVID-19 vaccines and boosters, plus those that protect against pneumonia and shingles, consider what other vaccines may protect you from disease during your trip.  

“If you are traveling to an international location, update your vaccines according to public health guidelines and consult your rheumatologist about the potential need to hold any medications prior to or after vaccination,” says Dr. Smith. “Additionally, only eat and drink from reliable food and water sources while traveling.” 

Research the Destination You’re Going To

Consider what viruses might be circulating in the community you’ll be visiting.  

“If there is an endemic infection with an outbreak at the travel location, consider rescheduling the trip,” says Dr. Smith. “If you have an active infection close to travel time, also consider rescheduling your trip just to be cautious, since health care access will depend on the destination.” 

And of course, if you have symptoms of COVID-19 or any other illness, speak to your doctor right away. 

One last piece of advice from Dr. Smith: “Most importantly, try to enjoy life.” If that can include travel for you this summer, bon voyage. If not, still aim to enjoy little moments of adventure in your own community, whether it’s trying a new outdoor fitness class, visiting a park you’ve never been to before, or simply video chatting with a far-away friend.  

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It’s a fact of life: Viruses mutate. But it’s still concerning to see headlines touting the latest COVID-19 variant, especially if you’re high-risk for severe illness.  

You may feel like you were just getting comfortable enough to rejoin previous activities, then you heard about another strain with an ominous name. The latest one in the press is the XBB.1.16 variant, which is another Omicron strain that has been dubbed “arcturus.”  

This variant currently makes up 14.6 percent of cases in the United States, per the U.S. Centers for Disease Control and Prevention (CDC).  

The XBB.1.16 variant has been declared a “variant of interest” by the World Health Organization (WHO) and has had a weekly rise in prevalence globally. However, its global risk assessment has been determined to be low. In India, where XBB.1.16 is most prevalent, there has been a slight increase in hospital bed occupancy numbers, but the levels are still much lower than what was seen in previous waves of new variants.  

Available data doesn’t suggest that XBB.1.16 poses more public health risk compared to other circulating Omicron descendant lineages. However, it could become dominant in certain countries, according to the WHO. This might lead to a surge in case rates due to the variant’s growth advantage and its ability to evade immune responses (though no changes in severity have been reported in countries where it is circulating). 

For those who are immunocompromised, understanding this type of data can be challenging. Here, we break down how worried you should be when a new COVID-19 variant emerges — and what steps you can take to keep yourself safe.  

Why Do Viruses Mutate?

Although a virus mutation sounds like a scary plot in a sci-fi movie, it’s actually a very natural process.  

Virus variants occur when there’s a mutation to the virus’s genes. Mutations in viruses like SARS-CoV-2, the virus that causes COVID-19, are expected — all RNA viruses mutate over time, per Johns Hopkins Medicine. 

“Generally, people should expect this should happen,” says Sydney Ramirez, MD, PhD, an infectious disease doctor and researcher at the University of California San Diego and La Jolla Institute for Immunology. “All of the RNA viruses are pretty prone to having high error rates when making copies of themselves, so it’s not unexpected that we would see mutations in the virus over time.”  

Immunocompromised patients are at risk for prolonged infection with SARS-CoV-2. As such, researchers have found that highly mutated variants — which demonstrate fast, multistage evolutionary jumps — can arise during the course of persistent infection in these patients. Research shows that viral evolution in immunocompromised patients may be an important factor in the emergence of variants of concern, per The New England Journal of Medicine. 

“People who are going to clear the Omicron variant faster are people who have some preexisting immunity to it,” says Dr. Ramirez. “They’re going to be at the highest risk for not only getting infected in the first place, but not being able to clear the virus quickly. The longer you stay infected, the more chances there are for the virus to mutate.”   

How Concerned Should You Be About Virus Mutations?

It’s crucial to be informed and mindful of the potential for virus mutations, but always turn to reliable data to understand how new variants could impact your daily life. 

“I wouldn’t want people to be scared just because there’s a new variant, but I do think that people should be aware that if there is a new variant that’s causing a lot more cases, then that’s something to be concerned about,” says Dr. Ramirez. “The mutation rate that we’ve seen throughout the past three years plus has been much faster than what we would see with more established viruses like the seasonal flu.” 

There’s no need to panic — but it doesn’t hurt to take every measure you can to protect yourself, especially if you have a weakened immune system.  

If you read an article about a new variant, look for clues like how it affects hospitalization rate and how contagious it is (and if research shows it evades current treatments or vaccines). Also talk to your doctor about the overall hospitalization rate (currently, it is less than 10 daily admissions per 100,000 people, according to the U.S. Department of Health and Human Services). 

You should also consider your own risk factors: A slightly more contagious virus could be far more serious for someone who is severely immunocompromised compared to someone who is only slightly immunocompromised. 

“One reassuring thing is that since Omicron has taken over as the dominant variant, we haven’t seen dramatic shifts or changes in a way that’s rendered further resistance to our currently available vaccines or other treatments,” says Zachary Wallace, MD, a rheumatologist at Massachusetts General Hospital. 

Dr. Wallace says he usually tells patients that it’s important to monitor new variants, and to know how new variants affect the therapies and preventive measures currently available to protect you.  

What Steps Should You Take From Here?

Start by talking to your doctor about your risk factors, your vaccination status (and if you’re eligible for any new boosters), and available treatments should you get sick. Here are five questions to ask your doctor for a COVID-19 treatment strategy before infection.  

“The recommendations are going to vary based on what specific medication and condition you may have, but in general, we’re in a much better place now than we were two or three years ago in terms of the treatments we have available,” says Dr. Wallace. “And while for many of our patients the vaccines may be less effective based on certain medications they may be on, they still provide some level of protection for most.” 

That said, there are certain settings in which you may still want to be cautious if you’re immunocompromised, like a very densely crowded space that’s not well ventilated. Or, for instance, you may want to wear a high-quality mask if you’re traveling on a plane, adds Dr. Wallace. 

“Talk to your provider and get specific recommendations based on your treatment, condition, and comorbidities,” says Dr. Wallace. “Hopefully, we’ll continue to see new treatments and preventive strategies emerge for immunosuppressed patients who remain at risk for these things.” 

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Have a runny nose, cough, and other questionable symptoms — but aren’t sure if it’s the flu, COVID-19, or a common cold? You may soon be able to test for both the flu and COVID-19 at once with an at-home test.  

The U.S. Food & Drug Administration (FDA) recently issued an emergency use authorization for the Lucira COVID-19 & Flu Home Test, a single-use, at-home test kit that provides results from your nasal swab samples. Designed for self-collection by those ages 14 years or older, or collected by an adult for those 2 years or older, this test can be purchased without a prescription and performed completely at home, per the FDA.  

Similar to a standard COVID-19 test, the new test works by swirling a sample swab in a vial that’s then placed in a test unit. In 30 minutes, it will show if you’re positive or negative for Influenza A, Influenza B, and COVID-19.  (There are four broad categories of flu: A, B, C, and D. Influenza A, B, and C are the most common, but A and B are seasonal and have more severe symptoms, per the Cleveland Clinic.)  

According to the FDA, the Lucira combination test correctly identified 99.3 percent of negative and 90 percent of positive Influenza A samples — and 100 percent of negative and 88.3 percent of positive COVID-19 samples. 

It also correctly detected 99.9 percent of negative Influenza B samples, but there aren’t currently enough cases of Influenza B circulating to include in a clinical study. Because of that, validation confirmed that the test can detect the virus in contrived specimens. The FDA’s emergency use authorization requires Lucira to continue collecting samples to study the test’s ability to detect Influenza B in real-world settings.  

The emergency authorization came just two days after Lucira Health filed for bankruptcy protection, which the company claimed was partly due to the lengthy FDA approval timeline, per The New York Times. Because of that, it remains unclear when the test will become available to Americans. 

“Lucira is kind of stuck in this ironic position,” says Wilbur A. Lam, MD, PhD, a Pediatric Hematologist and Biomedical Engineer at Emory University and Georgia Institute of Technology, whose team established a National Institutes of Health (NIH)-funded center for fostering the development of point-of-care technologies, including Lucira’s new combination test. His group has helped the NIH and FDA assess not just COVID-19 tests, but also combination COVID and flu tests like Lucira’s.   

“The hope is that once you have one authorization, that opens up the door for other companies as well,” adds Dr. Lam. “We don’t speak for the FDA, but our expectation is that there will be other companies coming around the bend that will also have a combination flu and COVID-19 test.”  

Lucira’s at-home combination test has been available in Canada since August 2022 and currently costs around $70 per test, per CNBC. “I think that they plan to sell it for half that, but we’ll have to wait and see,” says Sarah Farmer, a Research Scientist and Director of Testing and Evaluation at the Center for Advanced Communications Policy at Georgia Tech. Farmer helps the NIH and FDA evaluate usability, accessibility, and human factors for COVID-19 and flu combination tests like Lucira’s.  

“Most of the tests on the market are lateral flow antigen tests, which is much simpler technology,” Farmer adds. “The Lucira technology is molecular, so there’s just more involved there.” 

Molecular tests like PCR tests detect genetic material called RNA from the virus and tend to be more accurate (but usually take longer and have to be sent into a lab), per the FDA. Antigen tests are often referred to as rapid tests and are the standard at-home COVID-19 tests you may think of, but these tend to be less accurate than molecular tests.  

This Lucira combination test requires 30 minutes to process results, which may be longer than the COVID-19 antigen tests you’re used to. “This test has different scientific principles underlying its technology,” says Dr. Lam. “The company says their value proposition is that you have the performance of a PCR test, but the convenience of a rapid test, and therefore it does take a little more time for the chemical reaction to take place.”  

Tips for Using an At-Home COVID-19 and Flu Test

When this test (or a similar one) becomes available for at-home use in the United States, there are a few guidelines you should follow to get the most accurate results. 

“Read the instructions really carefully before you start the test and make sure you understand them,” says Farmer. “Don’t assume a test that’s new to you will be like a test you’ve done in the past. Tests are going to be different in terms of their labeling schemes, time windows, steps, and so forth.”  

Get situated in a space where you can be free of distractions, focus on your test, and read the results with good lighting.  

“Make sure you’re listening, feeling, or looking for feedback mentioned in the instructions, because this will help you know that you’ve done a task correctly,” says Sarah. “Something specific to Lucira is the tactile, audible click into place when you insert that vile into the test unit — and the blinking lights that let you know the test has begun processing.”  

If you take the Lucira at-home combination test, keep in mind that some of the positive results may show up before the test is done processing. However, wait until the test’s light indicates that it’s time to look at your results, since some may appear more slowly.  

“There are a lot of different combinations of results that you may see, so double check the instructions,” says Farmer. “Typically, you’ll see images of all possible results, so make sure you’re matching those up to make sure you understand what your results are.” 

It’s rare that you’ll test positive for both the flu and COVID, but it’s possible. Of course, if you do receive any type of positive result, contact your doctor right away to discuss potential treatments (keep in mind that certain antivirals, including Paxlovid, must be taken within five days of symptom onset). 

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If you’re an immunocompromised patient, you recognize just how important it is to have every mechanism of defense you can against COVID-19. A common treatment is Paxlovid, an antiviral pill that can be prescribed to those high-risk for severe COVID-19.

Its importance is underscored by the fact that Evusheld, a preventive antibody treatment for the infection, is no longer recommended due to its declining efficacy against new variants.

However, some patients have reported doctors not prescribing Paxlovid due to potential side effects or contraindications (circumstances that suggest the drug shouldn’t be used). As with all things, it’s critical to be as informed as possible about your options and to know when it’s worth seeking a second medical opinion.

“There are really very few reasons why doctors should not be prescribing Paxlovid to patients at risk,” says Jeffrey D. Klausner, MD, MPH, Clinical Professor of Medicine, Population, and Public Health Sciences in the Keck School of Medicine of the University of Southern California. “There’s even some data — not the strongest data, but some — suggesting that shortening the duration of infection with Paxlovid may reduce the likelihood of long COVID.”

You should speak to your doctor about Paxlovid because it’s highly likely they’ll prescribe it to you if you’re infected with COVID-19 and are immunocompromised or over the age of 65. However, here are five reasons why you might not be prescribed Paxlovid.

1. Allergic Reactions

Just like with the COVID-19 vaccine, your doctor will consider if you have any allergies to the ingredients used in Paxlovid. According to the U.S. Food and Drug Administration (FDA), contraindications to this drug include a history of clinically significant hypersensitivity reactions to the active ingredients (nirmatrelvir and ritonavir) or any other components.

As with many other medications, anaphylaxis and other hypersensitivity reactions have been reported even after a single dose of Paxlovid, but they’re rare. Tell your doctor if you’ve experienced any allergic reactions to medication before.

You should stop taking Paxlovid and alert your physician at the first sign of a skin rash, hives or other skin reactions, difficulty with swallowing or breathing, swelling (i.e. of the lips, tongue, face, throat, etc.), or any other symptoms of an allergic reaction, per the FDA.

2. Drug Interactions

Your doctor may tell you that Paxlovid could interfere with a medication you take, but in most cases, this won’t rule out the antiviral pill.

“Some of the more common ones are anticoagulants [blood thinners] like rivaroxaban or apixaban, common blood pressure medications like amlodipine, and some other medications like statins that should be held,” says Alexander R. Peck, DO, a rheumatologist at Pacific Arthritis Care Center in Los Angeles.

In cases like this, your doctor may recommend reducing the dose of your medication. However, among the top 100 prescribed drugs, only two — rivaroxaban and salmeterol (an asthma and COPD medication) — have interactions so severe that Paxlovid should be avoided altogether, per the Infectious Diseases Society of America.

“Common medications like anti-cholesterol drugs can safely be stopped for seven to 10 days,” says Dr. Klausner. “Many people can also have blood thinners stopped for a few days.”

Generally, Paxlovid does not interfere with medications commonly used in the treatment of arthritis. The Infectious Disease Society of America does note that Paxlovid may cause increased toxicity of oral steroids, but in this case, your doctor can consider reducing the dose. (No other specific adjustments are recommended.)

“The real frequency of drug-to-drug interactions is very low and, from a public health perspective, it’d be much, much better to get more people treated with Paxlovid than worry about the rare drug-drug interactions,” says Dr. Klausner.

3. Underlying Conditions

In addition to the medication you take, certain underlying conditions may prevent your doctor from prescribing you Paxlovid.

“Paxlovid does need to be metabolized in the kidneys, so I wouldn’t use it if someone has renal impairment or kidney dysfunction,” says Dr. Peck.  Paxlovid is also not recommended for those with severe liver impairment, since safety data is not available for these patients, per the FDA.

4. Side Effects

It’s possible your doctor may take into account potential adverse reactions of Paxlovid, such as altered taste, diarrhea, hypertension, and muscle pain — but most of these are quite rare and don’t outweigh the benefits of the drug.

“Paxlovid is a very safe medication,” says Dr. Klausner. “The only common side effect is a metallic taste, which goes away after people stop taking the medication.”

5. COVID-19 Severity

If you’re extremely sick with COVID-19, Paxlovid won’t be the right fit for you.

“The current emergency use authorization is only for mild to moderate COVID-19 in the outpatient setting,” says Dr. Peck. “It shouldn’t be used for someone who’s hypoxic [not getting enough oxygen] or who has severe COVID and needs emergency evaluation or hospitalization.”

In this case, a more common treatment route is remdesivir (an intravenous antiviral drug) or dexamethasone (a glucocorticoid medication that reduces inflammation) plus remdesivir, per the National Institutes of Health.

When to Seek a Second Opinion

There may be a number of other, less common reasons a doctor may not prescribe Paxlovid. It’s important to ask for the reasons why and seek a second opinion if needed.

“I could speculate that some doctors might think that if people clear the infection on their own, their post-infection immunity might be stronger, but that hasn’t been proven,” says Dr. Klausner. “There’s no benefit to ‘riding it out’ in anticipation of better immunity.”

You also shouldn’t be denied Paxlovid because of Omicron. Research shows that it’s still effective: In a December 2022 study of nearly 45,000 non-hospitalized adults aged 50 years or older who contracted COVID-19 during the Omicron wave, those who received a Paxlovid prescription were 44 percent less likely to be hospitalized or die from the infection than those who did not. Those who were incompletely vaccinated and took Paxlovid had an 81 percent lower risk.

Although the study didn’t look at Paxlovid’s efficacy against the most recent circulating variants (the research was conducted from January 1, 2022 to July 17, 2022), experts still believe it’s effective — “especially at reducing the progression to severe disease and decreasing hospitalization, which are the main reasons to take it,” says Dr. Peck.

It’s best to speak to your doctor about a Paxlovid game plan before you get infected. If they say they wouldn’t prescribe you Paxlovid and you don’t fully understand the reasons why, speak to a second physician.

“If it’s safe for you to get the medication as a high-risk patient and your doctor doesn’t want to prescribe it, you need to find another doctor,” says Dr. Klausner. “Doctors should be looking out for the best interest of their patients. By potentially denying people safe and effective medication, they’re not doing that.”

If there are valid circumstances that are giving your doctor pause when it comes to prescribing you Paxlovid, talk to your doctor about another option for an antiviral pill for COVID-19.

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The COVID-19 public health emergency and national emergency declared in 2020 have been extended to May 11 — but at that point, both emergencies will expire, per a January 30 announcement from the Biden Administration.  

For context, the Secretary of the U.S. Department of Health and Human Services can declare a public health emergency in cases such as significant outbreaks of an infectious disease or a bioterrorist attack, per the Medicaid and CHIP Payment and Access Commission.  

This allows the Secretary to make grants, modify the practice of telemedicine, enter into contracts, conduct and support investigations into the cause/treatment/prevention of the disease, and more.  

With the expiration of the declaration, a few major health policies will change, while some will remain the same. Here’s what you can expect when the public health emergency ends, per the Kaiser Family Foundation.  

Vaccines

Since the supply of federally purchased vaccines determines the availability, access, and costs of COVID-19 vaccines (including boosters) — not the public health emergency — nothing will change here as long as federally purchased vaccines continue to be available.  

This means that COVID-19 vaccines will remain free to everyone, regardless of their insurance coverage. As long as that federal supply lasts, vaccine providers aren’t allowed to deny anyone a federally purchased vaccine based on their coverage or network status. They also can’t charge out-of-pocket costs.  

Once the federal supply of COVID-19 vaccines is gone, most people with public and private insurance will still be able to get them free of charge, due to the Affordable Care Act and other recent legislation. That said, costs may become a barrier for those who are uninsured or underinsured. Privately insured individuals will need to make sure their provider is in-network. 

At-Home COVID Tests

People with traditional Medicare will no longer receive free at-home tests after May 11. If you have private insurance and Medicare Advantage (private Medicare plans), your insurer may continue to voluntarily cover those tests, but you’ll no longer be guaranteed free at-home tests.  

The tests will be covered at no cost through September 2024 for those on Medicaid, but coverage will vary by state after that point. 

Uninsured people in most states are already paying full price for at-home tests. They may be able to find them at a free clinic, community health center, library, or other local organization. The federal government has also provided tests through the mail, but that supply is declining. 

PCR and Rapid Tests From Health Care Professionals

Most insured people will still have coverage of COVID tests ordered or administered via their doctor, but these tests may no longer be free. Here’s how you may be affected, based on your insurance.  

• Traditional Medicare: There won’t be a cost for the test itself, but the associated doctor’s visit could come with cost sharing. 
• Medicare Advantage and Private Insurance: Both the test and associated doctor’s visit may be subject to cost sharing, depending on your plan. You may have a limit on your number of covered tests or may need to have tests done by an in-network provider. 
• Medicaid: Tests will continue to be free through September 2024, but states may limit the number of covered tests or require small cost sharing. 
• Uninsured: If you’re uninsured and in one of the 15 states that have adopted a temporary Medicaid coverage option, you’ll no longer be able to get testing services without cost sharing, since this program ends with the public health emergency. If you’re uninsured, you’ll have to pay full price for tests unless you can get tested through a free clinic or community health center.  

COVID-19 Treatment

Treatments like Paxlovid that are purchased by the federal government will continue to be free to all, regardless of your insurance coverage. This is based on the availability of the federal supply rather than the public health emergency.  

Otherwise, you may start to have new cost-sharing requirements for COVID-19 treatments if you have public coverage. For instance, you may face cost-sharing for certain treatments if you have Medicare.  

Meanwhile, Medicaid and Children’s Health Insurance Program (CHIP) programs will continue to cover any pharmaceutical treatments without cost sharing through September 2024. After that point, states may declare usage limits and nominal cost sharing.  

Private insurers were never mandated to waive cost-sharing for COVID-19 treatments, and even though some did so on their own, most phased out those waivers more than a year ago. Many insured people already have to cost-share for hospitalizations and outpatient visits related to COVID-19 treatment.  

Telemedicine

Providers writing prescriptions for controlled substances were able to do so via telemedicine during the public health emergency, but in-person visits will be required after May 11. Temporary waivers of licensing requirements — and the end of those waivers connected to the expiration of the public health emergency — may mean that certain providers can no longer practice remotely. 

Penalties around providers using technologies that don’t comply with federal privacy and security rules will also tighten, restricting the use of telehealth to “HIPAA compliant” technologies and communication. (For instance, this may limit your doctor from communicating with you through telehealth on your smartphone.)  

What’s the same: Before the pandemic, most private insurers covered telemedicine. And with Medicaid, states have the ability to cover telehealth without federal approval — and most states have made or will make certain Medicaid telehealth flexibilities permanent fixtures.  

The Bottom Line

For many people, the most noticeable change will be the end of 100-percent free testing (this may delay timely COVID-19 diagnoses or treatment for some, if they go without testing due to cost) and the end of telemedicine to prescribe controlled substances.  

Larger changes will come along when the federal government’s supplies of tests, vaccines, and treatments are depleted, but the timing of that is not yet known — and it’s not tied to the public health emergency.  

It’s also important to know that continuous enrollment for Medicaid, which led to record-breaking enrollment, was once connected to the end of the public health emergency. However, new legislation decoupled this provision from the public health emergency and it is set to end on March 31, 2023.  

States can start to disenroll individuals from Medicaid as early as April 1, 2023, though many will take a year to actually complete those disenrollments. It’s estimated that millions will lose Medicaid coverage during that period of time, per KFF.  

How Our Community Feels

We asked our patient community, “How do you feel about the end of the COVID emergency order in the U.S. and its impact on you as someone with chronic disease?” While some members felt “it was about time” others noted that these new emergency orders made them feel “expendable” and left behind. Still, others are taking in stride and continuing to doing their best to stay protected.  

Here are a few of the many responses:

• @donnawayjoan: “It Infuriates me. With the most contagious variants yet circulating freely, I find this the most frightening stage yet.”
• @kristina.ht: “Unfortunately, we are seen as expendable because society deems anyone with chronic health issues as defective, as if we chose this for ourselves. It’s shameful, but doesn’t surprise me.”
• @suzyszasz: “Terrible decision. 500 people dying per day in the US is not an indicator that this is ‘over.’”
• N O’Brien: “It’ll start costing us oodles of money now for testing and treatment, so that makes all that is so difficult even more difficult. I continue to do my best to protect myself and pay attention. It’s never been easy since the beginning, and it won’t get any easier.”
• @ tmorse895: “I want to scream: Wear a mask.”
• @rosaclaire91: “It’s heartbreaking to know we are being completely abandoned. Just because we ignore it doesn’t mean it’s not still happening.”
• @jenzelnick: “Declaring an emergency over does not make it go away. We no longer have Evusheld or monoclonal antibodies approved as treatment. I had to switch careers to WFH (my workplace is hybrid but I have an accommodation). My whole life has changed, as has my family’s.”
• @juliakstarkey: “I’m not ok with moving on — I have enough chronic issues without getting COVID over and over.”
• @celinadennette: “It’s about time.”
• @melissamgibbs: “I’m glad they are ending it; it’s been way too long. Let’s move along.”
• @lagata58 “I’m glad! Let’s start to move on!”
• @aliespice “It’s my responsibility to take care of myself regardless of what any governing body says. I focus on the things that are in my control.”

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.

Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

More than 90 percent of circulating SARS-CoV-2 variants in the United States are now unlikely to be susceptible to Evusheld, per the U.S. Centers for Disease Control and Prevention. As a result, the U.S. Food and Drug Administration recently announced that Evusheld is no longer authorized for pre-exposure prevention.

Because of this, it’s particularly important for those who are moderately to severely immunocompromised to be cautious and recognize the greater need for additional preventive measures during this time. Overall, this includes exercising most of the same practices that have been recommended since the beginning of the pandemic.

According to the CDC, you should be following these prevention measures if you have a weakened immune system or live with someone who does:

• Get an updated COVID-19 vaccine
• Improve ventilation and spend time outdoors when possible
• Learn about testing locations and treatment options before getting exposed or sick
• Get tested if you’ve been exposed or have symptoms (and talk to your doctor about treatment options if you test positive)
• Wash your hands often
• Wear a well-fitting respirator or mask and maintain distance in crowded spaces

In its recent report, the CDC underscored the importance of establishing a care plan that includes rapid access to antivirals like Paxlovid if a COVID-19 infection is detected.

And remember, vaccination is still the most effective way to prevent severe illness, hospitalization, and death from COVID-19. Make sure that not only you, but also your household members and close contacts, are up-to-date with the vaccine. That means receiving the updated bivalent boosters when eligible.

Preliminary data shows that the bivalent booster provides additional protection against symptomatic COVID-19 infection among immunocompetent people who previously received two, three, or four vaccine doses. Despite this, only 15 percent of Americans age 5 or older had received a bivalent booster dose as of January 18, 2023, per the CDC.

The takeaway message: With the loss of Evusheld as a treatment option, it’s particularly important to be vigilant if you’re high-risk for severe COVID.

Based on the minimal changes to the CDC’s guidance, the American College of Rheumatology does not have any additional updates or recommendations to its COVID-19 Vaccine Clinical Guidance at this time.

Already had COVID-19? Learn how to avoid reinfection this winter season.

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.

For some, it may be tempting to throw caution to the wind after they’ve contracted and recovered from COVID-19. However, if you’re immunocompromised, you know things are never quite this simple. Reinfections can still cause severe disease and those with weakened immune systems may be at higher risk. 

Here’s what to know about COVID-19 reinfection and how to stay safe this winter.  

How Soon After Having COVID Can You Get Infected Again?

Research suggests that reinfection with COVID-19 — either with the same virus variant as the initial infection or reinfection with a different variant — are both possible, per the U.S. Centers for Disease Control and Prevention (CDC). In fact, even early reinfection within 90 days of the initial infection can occur. 

Being infected with COVID-19 and having up-to-date vaccinations have both been shown to provide some protection against infection, but the immunocompromised may not mount a normal immune response to either. Your risk of reinfection is also affected by the COVID-19 variant circulating in your community.  

“It depends upon the immune status of a person, how well of a response they made from the first infection, and if the virus has evolved away from what that person was infected with,” says infectious disease physician Amesh A. Adalja, MD, a Senior Scholar at Johns Hopkins Center for Health Security. “If you went from Delta to Omicron, there’s not going to be very much protection between those two.”  

While it’s possible to be infected with the same variant of COVID-19, it’s not likely. 

“It’s far less likely than being infected with a new variant, especially since we’re at a point where there are new variants coming out much faster,” says Saahir Khan, MD, PhD, Assistant Clinical Professor of Infectious Diseases at Keck Medicine of USC.  

Are You at Higher Risk of COVID-19 Reinfection?

You could be more susceptible to COVID-19 infection, even after prior exposure, if you’re immunocompromised — since those with weakened immune systems may not mount a robust immune response to being infected.  

“The immunocompromised are not going to build the same level of immunity post-infection as someone whose immune system is not impaired,” says Dr. Adalja. “It all depends on how immunosuppressed that person is and what arm of the immune system is suppressed, so it’s not going to be one size fits all for every immunocompromised person.” 

You can think of it similarly to getting vaccinated: While you may get a certain level of protection from reinfection, it might not be as much protection as an immunocompetent individual.  

“We know from measuring antibodies that immunocompromised people don’t generally mount as strong or as durable of an antibody response to both infection and vaccination,” says Dr. Khan. “There are other aspects of the immune system other than antibodies, but in general, we don’t expect the same strength and durability of immunity in an immunocompromised patient.”  

Are Subsequent COVID-19 Infections Less Severe?

Although many people have anecdotally spoken about COVID-19 reinfections being milder than their primary infections, this isn’t a guarantee — especially if you’re immunocompromised. This statement is not meant to scare you, but to help you understand the research, so you can take precautions to stay protected and communicate the seriousness of COVID for you to loved ones.  

In a population-level observational study published in The Lancet Regional Health – Europe, researchers analyzed COVID-19 reinfections in Serbia from 2020 to 2022 and found that 13,792 reinfections (5 percent) were recorded among 251,104 COVID-19 primary infections. 

Reinfections were mostly mild (99 percent), while hospitalizations were uncommon (1 percent versus 3 percent in primary infection) and COVID-19 deaths were very rare (with a case fatality rate of 0.15 percent).  

In this study, the researchers estimated the risk of reinfection to be:  

• 0.75% at six months 
• 1.36% at nine months 
• 4.96% at 12 months 
• 16.68% at 15 months 
• 18.86% at 18 months 

Most reinfections were recorded in January 2022, as they became more common with the advent of Omicron — but very few reinfections were severe.  

Being over age 70, having one or more comorbidities, and having a severe or critical primary infection were significantly associated with severe reinfections.  

“In general, second infections are milder than first infections — but if you’re someone who has risk factors for severe disease, there’s no guarantee that your second infection is going to be mild,” says Dr. Adalja. “There are still cases that occur in high-risk individuals where the second infection can be severe.”  

Take, for instance, another study in The Journal of Investigative Medicine that looked at 17 cases of COVID-19 reinfection between January 1, 2020 and October 12, 2020. One immunocompromised patient had mild symptoms with the first infection but developed severe symptoms that resulted in death with the second infection. In this study, 68.8 percent of patients had similar severity during their second infection, 18.8 percent had worse symptoms, and 12.5 percent had milder symptoms.  

It’s important to consider that the data was from a different period of the pandemic, in which vaccines were not yet available and the Omicron variant hadn’t emerged yet. Still, the results speak generally to the potentially unpredictable nature of a second infection.  

“Each time you get COVID-19, it’s like a Russian roulette,” says Dr. Khan. “There’s a risk of severe COVID-19 that leads to you being in the hospital and then there’s a risk of longer-term complications like long COVID symptoms, blood clots, or other late complications. The more times you get infected, the more risk there is of one of those outcomes happening.”  

Does Reinfection Increase My Risk of Long COVID?

In a pre-print study (meaning it hasn’t been peer reviewed yet) analyzing a database of 5.4 million patients from the Veterans Health Administration, researchers found that people reinfected with COVID-19 were twice as likely to die or have a heart attack as those who were only infected once. They were also much more likely to experience health issues of all kinds six months later, including those related to their lungs, kidneys, and digestive system. 

This patient population has unique characteristics that may not apply to the general population. For instance, VA patients tend to be older men who have high rates of chronic conditions that may increase the risks for long COVID. Still, the results point toward the potential implications of reinfection on long-term health.  

Meanwhile, more research is needed to determine if having long COVID can affect your risk of subsequent COVID-19 infection.  

“It’s hard to say based on the data we have now,” says Dr. Khan. “There are some people who just have a mild prolonged cough and there are some people who have an extreme case of brain fog or chronic fatigue. It’s really hard to put all of long COVID into one bucket and say all patients have more or less risk of subsequent infection.” 

What Can I Do to Protect Myself?

Rates of reinfection might change as new variants emerge, but vaccination remains the safest way to prevent future COVID-19 infections, hospitalizations, death, and long COVID. It’s key to stay up to date on your vaccines (which may include two or more doses and booster doses).  

“Get the bivalent booster vaccine, if it’s been two months since your last COVID-19 vaccine or infection,” says Dr. Khan. “That’s the best thing you can do to protect yourself. Even though the response may not be as high in immunocompromised patients, it’s still very significant in terms of its reduction of risk.”  

The bivalent booster is designed to target both the original strain of the COVID-19 virus as well as the Omicron variant. Also speak with your doctor about other preventive measures you can take — and what your treatment plan would be should you get infected.  

For instance, AstraZeneca’s Evusheld contains tixagevimab and cilgavimab, two monoclonal antibodies that can be used to prevent COVID-19 before exposure in immunocompromised individuals. Evusheld is now unlikely to be effective against newer strains of COVID-19 in the vast majority of individuals, but your doctor may still recommend it after considering your individual risks and the prevalence of resistant subvariants in your region, per the National Institutes of Health. 

Meanwhile, Paxlovid is an antiviral pill authorized for use in those at high risk for severe outcomes. It must be taken within five days of symptom onset, so it’s important to stay in close communication with your doctor as soon as you detect symptoms.  

You may have heard of “Paxlovid rebound,” which is different from reinfection. The CDC defines COVID-19 rebound as a recurrence of symptoms or a new positive viral test after having tested negative. It has been reported to occur shortly after initial recovery. (Learn more about Paxlovid rebound and what it means for you.)  

In a rebound case, the same virus causes symptoms or a positive test — it just hasn’t quite cleared your body yet. 

“There’s a higher risk for rebound in immunocompromised people, because many studies have shown that virus tends to circulate longer in these patients,” says Dr. Khan. “The good news is that most rebounds are generally mild.” 

On the other hand, COVID-19 reinfection occurs when you clear the virus but then get infected again (often months later). In this case, a different strain of COVID-19 causes the infection. 

Beyond vaccination and preventive measures like Evusheld, the same tried-and-trued mitigation efforts you’ve followed throughout the pandemic will help to protect you from reinfection, including wearing a properly fitted mask when you’re in public places, cleaning and disinfecting surfaces that are touched a lot, and washing your hands regularly, 

Improving ventilation indoors when you have visitors is also important. The CDC recommends:  

• Opening windows to bring in fresh air from outside
• Setting your thermostat fan to “on” instead of “auto” 
• Turning on a portable HEPA air cleaner 
• Turning on ceiling fans 
• Turning on the fan over your stove 
• Turning on the fan in your bathroom 
• Keeping fans on for an hour after people leave 

“Take the same precautions we have been advised to take throughout COVID,” says Dr. Khan. These will help protect you not only from COVID-19, but also from other respiratory illnesses like the flu.  

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.

Medical experts have encouraged immunocompromised patients to stock up on at-home COVID-19 tests this winter season, which is particularly important if you’ve traveled or been around crowds.

However, with each one costing about $10 over-the-counter (and multiple tests recommended for those who have been exposed to COVID-19), it’s worth pinpointing the ways you can get them for free.

Fortunately, every U.S. household is once again eligible to order four free at-home COVID-19 tests — plus, plans and insurers are required to cover at-home, over-the-counter tests purchased on or after January 15, 2022.

Here’s how you can get your tests, along with tips for taking at-home tests that provide you with accurate results.

How to Order Your Tests

The free COVID-19 tests are part of the Biden Administration’s COVID-⁠19 Winter Preparedness Plan and will only be available for a limited time. The orders began shipping the week of December 19th.

Here’s how to order yours in less than two minutes:

1. Visit www.COVIDTests.gov 
2. Click “Order Free At-Home Tests”
3. Fill out your contact and shipping information
4. Click “Check Out Now”

You can also call 1-800-232-0233 (TTY 1-888-720-7489).

These free at-home tests are available for every residential address in the U.S., including Alaska, Hawaii, Puerto Rico, U.S. Territories, and overseas military and diplomatic addresses (APO/FPO/DPO). You may also request your tests be sent to a POBox, as long as it’s registered as a residential POBox, per the U.S. Department of Health and Human Services (HHS).

Your tests will be delivered via the U.S. Postal Service and all orders within the continental United States will be sent through First Class Package Service (all other shipments will be sent through Priority Mail). You’ll be able to track your order status if you provide an email address to receive notifications with shipping updates.

Although you can’t choose the brand of COVID-19 test you receive as part of the program, they are all FDA-authorized at-home rapid antigen tests.

More Ways to Get Free COVID Tests

Plans and insurers are required to cover the cost of over-the-counter, at-home tests (up to eight at-home tests per month for every person covered by your plan) purchased on or after January 15, 2022, per the HHS. It’s very possible your plan also provides coverage for those purchased before January 15, but this is not a federal law requirement.

On or after January 15, the tests might be free at the point of sale if your health plan provides direct coverage — or you’ll get reimbursed if you’re charged, per the Centers for Medicare & Medicaid Services. Keep your receipt if you need to submit a claim, which you can do through your health plan.

Even if your plan has a network of preferred providers where you can get a test for free, you can still get tests from outside retailers: Insurance companies are required to reimburse you for up to $12 per individual test (or its cost if less than $12).

There are also 15,000 free community-based testing sites, such as pharmacies, across the country. Locate low- or no-cost testing in your state using this tool.

Your local schools, nursing homes, community healthy centers, rural health clinics, and food banks might also offer free at-home tests — call ahead to ask if they’re available.

Scam warning: Be aware that scammers are unfortunately targeting Medicare recipients with fake offers for free COVID tests in an effort to get your Medicare information. They may try to lure you in with websites or online/TV ads, and once you give them your information, they’ll bill the fraudulent charges to Medicare, per the Department of Health and Human Service. You can learn more about these scams via the Federal Trade Commission.

Tips for Taking Your At-Home Test

Follow these four tips to ensure you’re getting accurate results.

Check the Expiration Date

If you’ve rummaged through your bathroom cupboards, only to find you have expired tests, don’t toss them out quite yet. The U.S. Food and Drug Administration (FDA) has extended the expiration dates for most at-home tests.

To find out if yours can still be used, consult this table from the FDA. If the shelf life has been extended, you’ll find a link to updated expiration dates. If the table does not say the shelf life is extended, you should still go by the expiration date on the label of the test’s box.

“Many home tests have had shelf life extension past the expiry date,” says infectious disease physician Amesh A. Adalja, MD, a Senior Scholar at Johns Hopkins Center for Health Security. “In general, an expired test that delivers a positive result can be considered to be reliable. A negative test and a symptomatic individual may need to be followed up with more testing.”

Swab Thoroughly and Correctly

It’s worth reading the pamphlet of test instructions you get, even if you’ve already taken an at-home test, since they can vary by brand. Make sure you keep the swab in your nose for the instructed period of time (and rotate it as the instructions describe) so you can collect a viable sample.

“Some people do not get an adequate specimen,” says Dr. Adalja. This, in turn, can affect your results and lead to a false negative.

Have a small amount of blood in your nose from the dry winter air? Don’t worry — you can still use your swab, as long as you don’t have a major nose bleed. “It should not impact the sensitivity and specificity of a COVID test,” adds Dr. Adalja. (Though some COVID test kits warn against using a swab with excess blood).

You should be careful not to touch the head of the swab (the part that goes in your nose) with anything else, including your fingers. For more information, watch this CDC video on how to use a self-test.

Make Sure They’re Not Damaged

Accidentally left your at-home test package out on the icy porch? The developers of at-home tests have done testing to make sure that performance will stay stable, even when the tests are stored at various temperatures — including shipping during the summer in high-temperature regions and in the winter in very cold regions, per the FDA.

However, you shouldn’t use the test while it’s still cold (i.e. right after it’s been brought in from freezing temperatures) or if you’re in a hotter than expected environment (i.e. outside in the summer), since this can affect test performance.

Bring your package inside and leave it at room temperature for at least two hours before opening it.

Test Again

One of the most common at-home testing mistakes: Testing negative, then not testing again.

“A negative test needs to be followed up with a second test when someone is symptomatic,” says Dr. Adalja. “This is especially true in the immunocompromised. You may need more sophisticated testing because respiratory viruses can be very detrimental to you.”

If you tested negative but are symptomatic, call your doctor. They may ask you to come in for a PCR COVID-19 test or flu test, both of which are especially important if you’re high-risk for complications.

PCR COVID-19 tests are more sensitive than the 15-minute antigen tests you take at home, which don’t always rule out infection. The PCR tests are sent to a lab for results, which can take a few days, but are important to confirm your results if you’re symptomatic.

If both tests are negative, you could be symptomatic for other reasons, like the flu, a different respiratory infection, allergies, and so forth — which your doctor can diagnose.

Learn more about at-home COVID tests. 

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.

Experts have been in a race against the clock since the beginning of the pandemic: First, to develop vaccines and treatments, and now to keep up with the rapidly evolving virus.  

That’s why it comes as no surprise that the efficacy of preventive measures such as Evusheld may shrink as the virus changes, too. Evusheld is a drug produced by AstraZeneca that contains tixagevimab and cilgavimab — monoclonal antibodies packaged and administered together, per the U.S. Food and Drug Administration.  

“All viruses can mutate and escape the immune system, which is how they try to get ahead,” says Camille Kotton, MD, Clinical Director of Transplant and Immunocompromised Host Infectious Diseases at Massachusetts General Hospital. “We see this with many different viruses, including COVID-19.” 

In a recent statement, the National Institutes of Health (NIH) noted that the COVID-19 subvariants BA.4.6, BA.2.75.2, BA.5.2.6, BF.7, BQ.1, and BQ.1.1 are likely to be resistant to Evusheld.  

These subvariants are currently estimated to cause more than 45 percent of COVID-19 infections in all regions of the United States. 

“I’m definitely seeing breakthrough infections from people who have been well-vaccinated, on Evusheld, and are immunocompromised,” says Dr. Kotton. “I think it’s going to be a potentially hard winter for immunocompromised patients, especially with the three different viruses circulating — COVID-19, influenza, and RSV.”  

The recent update on Evusheld’s efficacy is of particular importance to those who are immunocompromised, since these individuals may have relied on it as another layer of protection against COVID-19.  

“This news has a big impact, because up until this point, immunocompromised patients had this back-up plan in case their immune systems weren’t robust enough to reflect an effective antibody response against the virus,” says Priya Nori, MD, Associate Professor in the Department of Medicine (Infectious Diseases) at Montefiore Health System. “Although the vaccines exert their impact in a number of ways, not just antibodies, the antibody response is what we can measure — and that’s what Evusheld was providing. It had been doing a great job until very recently.”  

Here’s what this news means for you if you are immunocompromised — and the four steps you should take next.  

Still Talk to Your Doctor About Getting Evusheld

Although the efficacy of Evusheld is waning with the evolution of new variants, some protection is still better than none. The NIH COVID-19 Treatment Guidelines Panel continues to recommend the use of Evusheld for individuals who are eligible — including those with medical conditions or treatments that may result in moderately to severely compromised immune systems.  

This includes patients actively being treated with high-dose corticosteroids (i.e., 20 or more milligrams of prednisone or equivalent per day when administered for two or more weeks), tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory, per the U.S. Centers for Disease Control and Prevention (CDC).  

Here’s how monoclonal antibodies work: The lab-made proteins mirror the immune system’s ability to fight off viruses and other harmful pathogens. In particular, Evusheld targets the spike protein of SARS-CoV-2, blocking the virus’ attachment to and invasion of your cells.  

Currently, Evusheld is the only preventive agent authorized by the FDA for use in those who are not expected to mount an adequate immune response to COVID-19 vaccination (or for those who have contraindications for the vaccines, like an allergy). 

“If I told you your seatbelt in your car was half as effective this week as it was a month ago, you’d still wear your seatbelt, because it seems reasonable,” says Dr. Kotton. “Evusheld still covers some strains.” 

However, depending on your condition and how accessible Evusheld is for you, your doctor can provide more detailed guidance on if it is worth it for you at this time. A health care provider may take into account the regional prevalence of the resistant subvariants, your individual risks, and available resources.  

Get the Bivalent Booster Shot

This year, the FDA authorized bivalent formulations of the COVID-19 vaccine for use as a single booster dose at least two months after a primary or booster vaccination.  

Bivalent means a vaccine works by stimulating an immune response against two different antigens. The bivalent COVID-19 boosters contain the original SARS-CoV-2 strain and another strain common between the BA.4 and BA.5 lineages of the omicron variant, per the FDA.  

The CDC recommends getting the updated COVID-19 bivalent booster from Pfizer (for those ages 12 and older) or Moderna (for those ages 18 and older). Although these booster shots are from Pfizer and Moderna, you can still receive them if you got a Novavax or Johnson & Johnson primary series. 

“If you have not gotten the bivalent booster yet, now is absolutely the time, because we’re looking at a pretty bad winter respiratory viral season,” says Dr. Nori.  

In a new study published in the CDC’s Morbidity and Mortality Weekly Report, researchers looked at symptomatic adults who received testing for SARS-CoV-2 infection at pharmacies nationwide from September 14 to November 11, 2022. They found that bivalent mRNA vaccines provided additional protection against infection compared with previous vaccination with two, three, or four monovalent vaccines alone.  

What’s more, the relative benefits of a bivalent booster (compared to the previous vaccine doses alone) increased with time since the receipt of the last monovalent dose. These results are the first published estimates of vaccine effectiveness for the newly authorized bivalent mRNA booster vaccines. 

“There’s no question in my mind that it’s effective,” says Dr. Kotton. “Everybody who hasn’t had COVID-19 in the past three months or hasn’t had a vaccine in the last two months needs the vaccine.”  

Talk to Your Doctor About Treatment Options

Given you may have less protection from Evusheld as an immunocompromised patient, it’s more important than ever to have a clear plan of action in place with your doctor should you get infected with COVID-19.  

For the treatment of mild to moderate COVID-19 in non-hospitalized adults who are at high risk of progressing to severe COVID-19, the NIH continues to recommend Paxlovid (first preference) and Remdesivir. Paxlovid is an antiviral pill from Pfizer that inhibits the SARS-Cov-2 protein from replicating, while Remdesivir is an intravenous drug that requires infusions for three consecutive days.  

Alternative therapies should only be used when neither Paxlovid or Remdesevir are available, feasible to use, or clinically appropriate, per the NIH. These alternative drugs include bebtelovimab (only for when the majority of circulating Omicrons subvariants in the region are susceptible), which is a monoclonal antibody developed by AbCellera and Eli Lilly, and molnupiravir — an antiviral pill created by Merck.  

Continue Taking Standard COVID-19 Precautions

You still have plenty of control over the individual steps you take to protect yourself from infection this winter — which are the standard mitigation efforts you’ve heard about since the beginning of the pandemic. 

“We’re going to have to stick with the basics for the next couple months to ride out this potentially rough winter with multiple viruses — and hope that newer antibody-based therapies may at some point be available,” says Dr. Nori. 

Continue to wear high-quality face coverings like N95 or KN95 masks (it’s especially important for you to do this on an individual level, since much of the general population is no longer masking), avoid crowded or poorly ventilated spaces, and maintain hand hygiene. Read more about how to protect yourself against COVID-19 during the 2022 holiday season.  

“What immunocompromised individuals now have are the vaccines, including the updated bivalent booster, and their own autonomy to continue to mask and avoid certain crowded situations or conditions,” says Dr. Nori. “You have to fall back on those, especially during a time now in which most other people have abandoned those basic public health interventions.”  

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Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.