COVID-19 FAQs: Infection Risk and Prevention

UPDATED 8/2/21

News, scientific understanding and guidelines about COVID-19 are continually evolving. As such, please note that some information on this page may have changed since its original publication date.

Question: What should I know about the COVID-19 virus variants?

A:  The dominant strain and primary variant of concern in the United States is the delta variant (B.1.6 17.2), which originated in India.

It is more than twice as transmissible as the original coronavirus and data from an internal CDC document suggests that the variant is as contagious as chickenpox, one of the most transmissible viruses out there. The document also said the variant likely increases the risk of severe disease and hospitalization in unvaccinated people.

The good news is that current evidence suggests that the vaccines work well against variants, including the delta variant, and that healthy adults who are fully vaccinated are protected again severe disease and hospitalization.

However, vaccine protection may be reduced in people with compromised immune systems, such as those taking immunosuppressive drugs, cautions Gregory Poland, MD, director of Mayo Clinic's Vaccine Research Group. As such, he recommends continuing to wear masks in public indoor settings where it’s hard to tell who’s been vaccinated and talking to your doctor before making the decision to travel. The CDC now also recommends that fully vaccinated people wear masks again in indoor settings in parts of the country where the virus is surging. (Read more about the CDC’s guidelines in the second question, below.)

If you haven’t already done so, talk to your doctor about getting vaccinated and other measures to help protect yourself against these variants. Experts warn that there may be another surge of hospitalizations and deaths from the virus in parts of the country where vaccination rates are lagging.

Q: What does the CDC mask guidance mean for people with inflammatory arthritis?

A: On July 27, the Centers for Disease Control (CDC) revised their masking guidelines that said fully vaccinated Americans can go without masks in indoor settings, with some exceptions. (Masks were and still are recommended in health care facilities, public transportation and crowded, poorly ventilated indoor spaces.)

The new message from the CDC is that fully vaccinated people should wear masks again in public indoor spaces in parts of the country where the virus is surging. (Consult this map to see if you live in a “high” or “substantial” transmission zone). The recommendation is the result of the takeover of the newer, more contagious delta variant of the virus. New data from an internal CDC document suggests that fully vaccinated people with breakthrough infections may be just as contagious as unvaccinated people with infections.

Additionally, although evidence shows that breakthrough infections are still rare in fully vaccinated healthy adults, they are becoming more frequent. This could be because those infected with the newer variant carry a lot more of the virus in their body – up to a 1000-fold more. Exposure to more virus increases infection risk, even among the fully vaccinated. Masking up is a simple way to reduce all infections, breakthrough infections in fully vaccinated individuals included. But importantly, it’s also a way to potentially reduce the spread of infections from vaccinated individuals to unvaccinated people or to those with weakened immune systems. 

Masking recommendations only apply to public indoor settings where the virus is surging, and experts agree that the transmission risk is low outdoors or in indoor settings where everyone has been fully vaccinated.

However, COVID-19 vaccine guidelines from the American College of Rheumatology note that people with autoimmune arthritis are more likely to get infected or experience more severe illness or hospitalization due to a COVID-19 infection. Also, these patients may experience a “blunted response to the vaccines,” meaning vaccines may offer less protection and their effectiveness may not last as long as in the general population.

As such, CDC director, Rochelle Walensky, MD, has always advised that immunocompromised patients or patients on immunosuppressive medications talk to their doctor before changing their masking behavior. Talk to your doctor about the best way to reduce your chances of infection, including when to mask up and social distance.

Question: How does the coronavirus spread?

A: The CDC and the WHO now recognize that COVID-19 is an airborne threat, meaning that the virus can be transmitted by inhaling very fine respiratory droplets as well as aerosolized particles. Data shows that virus particles can linger in the air up to 3 hours. However, experts are divided on how common airborne transmission is and agree that person to person contact, mainly from respiratory droplets when an infected person sneezes, cough and talks is the primary way the virus spreads. Infection occurs when people inhale infected droplets or these droplets land in a person’s mouth, nose or eyes. The risk of exposure to infected droplets is much higher when people are in close contact, hence why keeping at least 6 feet or more space between others is so important.

The virus can also be transmitted through surfaces – but the risk is much lower, and account for less than 6% of cases.

All in all, experts agree infection risk is much higher indoors than outdoors – virus droplets dissolve more easily in fresh air. Wearing a mask, even if you’re fully vaccinated, may give you an added layer of protection in crowded, indoor settings.

Question: Am I more likely to get COVID-19 or have complications from the virus if I have autoimmune or inflammatory arthritis?

A: Current data finds that the risk of infection for people with well-controlled types of inflammatory arthritis is not higher than the general population. While the risk for worse outcomes if infected is higher among rheumatology patients, outcomes are improving. Doctors have a greater understanding of the virus and increased testing helps identify infections earlier. Also, there are improved treatment protocols and effective medication options.

The key to curbing your infection risk is good disease control. Experts believe that high disease activity can increase the risk for complications. They also stress that secondary bacterial infection that occurs after a viral infection is one of the main concerns for people with autoimmune disease. Having a comorbid condition, such as obesity and diabetes also increases the likelihood of having severe disease.

It’s important to keep up with healthy habits to manage your arthritis, such as getting plenty of sleep, exercising regularly, eating a healthy diet and taking medication as prescribed. There is no evidence that medications, including DMARDs and biologics, are associated with a higher risk. However, there is one exception: Patients taking high doses – 10 milligrams or more – of corticosteroids daily have a higher risk of hospitalization. For that reason, talk to your doctor about the risks of taking corticosteroids. 

Rheumatologists continue to analyze the data and publish findings, building a body of knowledge about their patients’ risks and outcomes. In the meantime, call your doctor right away if you think you’ve been exposed or are experiencing symptoms like fever, body chills, muscle aches and a dry cough. And if you haven't already done so, talk to your doctor about getting vaccinated to help protect yourself against the worst outcomes of the disease. 

Question: How can people with arthritis and autoimmune conditions protect themselves from COVID-19 infection? 

A: Getting vaccinated is the best way to protect yourself from infection and severe outcomes from COVID-19. However, people with autoimmune diseases and who take immunosuppressive medications may not get the full protection provided from vaccines.

As such, immunocompromised patients may want to factor in added layers of protection in their daily lives, even if they are fully vaccinated, says Gregory Poland, MD, director of Mayo Clinic's Vaccine Research Group.

This includes continuing to wear a mask,  and limiting time in crowded, indoor spaces. There are also employee protections for people with autoimmune disease, and you may be eligible to apply for medical leave or work from home under these laws.

Question: How deadly is the virus?

A: It’s still unclear, but data suggests that the fatality rate is about 0.5 – 1.0%, which is about five to 10 times deadlier than the flu.

Advanced age, being male and having certain conditions like diabetes and hypertension, are all associated with more severe disease and increased death rates. The risk of dying from COVID-19 also can vary considerably depending on ethnicity, access to healthcare and socioeconomic status.

However, research shows that vaccines are a powerful tool in preventing death and severe disease – preliminary data from the CDC shows that 99.5% of recent deaths from COVID-19 were in unvaccinated individuals. Talk to your doctor about vaccination if you haven’t already done so.