COVID-19 FAQs: Infection Risk and Prevention

UPDATED 7/29/22

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: Can I be infected if I’ve already had COVID-19 or have been vaccinated?

A: The short answer is yes. While vaccines and boosters are very effective at preventing severe disease, even among immunocompromised patients, new virus variants are better at dodging immunity from past infections and vaccine immunity. Evidence suggests that earlier versions of the Omicron variant were three times as likely to cause reinfection than past variants. This is likely to be even higher with the arrival of newer subvariants. However, a recent study following long-term care residents did find that a fourth mRNA dose is effective at providing additional protection against infection and complications with Omicron. 

Additionally, data suggests that immunocompromised patients, specifically patients with inflammatory arthritis, HIV, or who have had an organ transplant, are at a “substantial risk” for infection, regardless of vaccination status. But it's important to note that vaccines and boosters still provide these populations significant protection against severe disease, hospitalization and death. 

In a pre-print study (meaning it has not been peer-reviewed or published yet), there is evidence that reinfection carries a higher risk for health complications, especially among immunocompromised or elderly populations. Whether reinfection carries a higher risk of developing long COVID is unknown, but health experts agree that the best strategy is to remain as vigilant as possible to avoid reinfection. This means staying up to date with vaccines and boosters and masking indoors in crowded areas when COVID cases are high. 

Question: What does the CDC masking guidance mean for people with inflammatory arthritis?

A: The CDC revised its guidelines to say only “high” risk counties should require universal masking mandates. However, many health experts advise people to consider their personal risk of developing severe COVID and talk to their doctor before ditching masks for good. This includes patients who have inflammatory types of arthritis and who are on immunosuppressive medications, says William Hayes Wilson, MD, Chief of Rheumatology, Piedmont Hospital in Atlanta.

Patients at high risk of serious infection due to either of those factors would be wise to continue reasonable precautions, such as wearing a [high-quality] mask and hand washing, says Dr. Wilson.

The decision to unmask also depends on the level of risk you're willing to take, as well as your environment, says Liana Fraenkel, MD, MPH, Adjunct Professor, Section of Rheumatology, Yale School of Medicine. 

“You have to consider your particular level of immunosuppression, and ask yourself other questions,” says Dr. Fraenkel. “Who are you going to be surrounded with? Are the rates low in your community? Where are you going? The risks of going to a crowded restaurant are different than going to a park. And lastly, what are your trade-offs? Is this something that’s worth the risk like a family reunion, or something that can be postponed?”  

Lastly, it’s important to understand how the current recommendations are drafted and be able to translate them to you, she says.

The way the CDC determines if a county is “high-risk” isn’t as clear-cut as counting the number of cases circulating in the community. It’s a calculation of three measures - new Covid-related hospital admissions over the previous week and the percentage of hospital beds occupied by COVID patients, as well as new coronavirus cases per 100,000 people over the previous week.

Understanding what case numbers per 100,000 people mean can help patients make an educated decision for themselves, says Mike Saag, MD, Professor, Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. He suggests using Georgia Tech’s COVID-19 Event Risk Tool to help determine the level of risk in your community before attending a large-scale event or deciding to unmask.

"The reality is that COVID will be with us in some form or fashion over the next several years, and all of us are going to have to get used to risk calculating based on our current environment," says Dr. Saag.

“While preventing infection is ideal, the most important thing to do is monitor yourself and get tested right away if you have symptoms, especially if you’re on immunomodulating drugs,” he says. “There are multiple therapies now available that can help protect you from the worst outcomes of infection as long as you receive early diagnosis and treatment.”

For more information about the current state of the pandemic and what it means for patients like you, listen to episode 52 of the Live Yes! with Arthritis podcast, COVID: Two Years Later, here.

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

A:  The dominant strains in the United States are subvariants of the Omicron variant called BA. 4 and BA.5. The CDC says that there is no evidence to suggest that these variants cause more severe disease than other Omicron subvariants. On the whole, data suggests that the Omicron variants tend to produce milder symptoms and less severe disease outcomes in the general population. However, due to the contagiousness of the disease and high rates of infection, rates of death and hospitalization from the variants still remain high, especially among unvaccinated people.

Although vaccines are less effective at preventing infection against this variant, vaccines, especially boosters, provide good protection against severe disease, including hospitalization and death. There is also some evidence to suggest that a fourth mRNA vaccine dose provides higher protection against infection and complications. 

Those who have compromised immune systems or who are taking immunosuppressive drugs may not get the full extent of protection from vaccines. But even among these populations, vaccines are very effective at preventing severe disease outcomes. As such, it’s more important than ever to keep up with vaccination, including additional doses and booster shots.

If you haven’t already done so, talk to your doctor about getting vaccinated and other measures to help protect yourself against variants. 

Q: 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 and boosted, says Gregory Poland, MD, director of Mayo Clinic's Vaccine Research Group.

According to CDC guidelines, this includes ditching your old cloth mask in favor of a high-quality, form-fitting mask, like a certified KN94, KN95 or N95 respirator mask when you are out and limiting time in crowded, indoor spaces. For more tips on to get the most protection out of your mask, click here. 

Additionally, free N95 masks have begun to roll out nationwide in participating pharmacies and convenience stores across the country. For more information on where to find one, click here.  

Immunocompromised patients may also qualify for a monoclonal antibody drug, Evulsheld, to help prevent infection for at least six months. This drug, which has been issued a EUA from the FDA, is NOT a replacement for vaccines. Instead, it should only be issued to patients who are less likely to mount an adequate vaccine response due to health conditions or immunosuppressive medications or who are allergic to vaccine ingredients. Anyone who qualifies for a COVID-19 vaccine should get vaccinated before receiving Evulsheld. Talk to your doctor about if you qualify and where to find the drug, which is in limited supply.

There are also employee protections for people with autoimmune diseases, and you may be eligible to apply for medical leave or work from home under these laws.

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

A:  While the risk for complications is higher among rheumatology patients, outcomes are improving. Doctors now have a greater understanding of the virus than they did at the start of the pandemic, and improved treatment protocols, vaccines and new medications have decreased the likelihood of severe outcomes.

Good disease control is key to curbing your risk for severe disease outcomes. Experts believe that high disease activity can increase the risk for complications. 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, with one exception: Patients taking high doses of corticosteroids daily– 10 milligrams or more– have a higher risk of hospitalization. For that reason, talk to your doctor about the risks of taking corticosteroids.