COVID-19 FAQs: Medications, Treatments and Vaccines
Get the facts about the novel coronavirus, including possible treatments, vaccines and how it affects people taking arthritis medications.
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: Do the COVID-19 vaccines protect against the variants?
A: Data shows that the vaccines on the market provide strong protection against the COVID-19 variants, including the newest delta variant. However, maximum protection doesn’t kick in until two weeks after the full vaccine regimen is completed.
Immunocompromised individuals may experience a blunted response to current vaccines but will experience some protection and the Arthritis Foundation strongly advocates for vaccination. Fully vaccinated individuals who are immunocompromised may want to stick with a more cautious approach and continue to wear masks in public settings, says Gregory Poland, MD, director of Mayo Clinic's Vaccine Research Group. Likewise, the CDC revised its guidelines stating that even fully vaccinated people should wear a mask in public indoors settings in parts of the country where the virus is surging.
What experts are most concerned with is the spread of the delta variant in areas of the country who have the lowest vaccination rates. This could prompt a surge of cases, hospitalizations and deaths that could otherwise be prevented with vaccines.
Question: Will I need a booster of the vaccine to keep myself protected?
A: At the time, there is no data to support that a booster shot is necessary for adequate protection in the general population, including protection against the highly contagious delta variant, says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
This statement came after a meeting with Pfizer representatives on July 12, who are advocating for the emergency use authorization for a third dose of their vaccine. The meeting happened on the same day Israel began administering third doses of the Pfizer vaccine to immunocompromised patients, including organ transplant recipients and cancer patients.
However, Fauci acknowledges that the need for a booster shot may change depending on how the virus evolves and on a person's health status. Variant-specific booster shots may be necessary in the future if a variant that can evade vaccine protection crops up.
Additionally, immunocompromised individuals and those on immunosuppressive vaccines may experience a blunted vaccine response. As such, "those who are transplant patients, cancer chemotherapy, auto-immune diseases, that are on immunosuppressant regimens, those are the kind of individuals that if there's going to be a third booster, which might likely happen, would be among the first vulnerable," said Fauci during a CNN interview.
Talk to your doctor about any concerns you may have about your response to the COVID-19 vaccine and how to maximize your protection against the virus.
Question: Will my arthritis drug reduce the COVID-19 vaccine response?
A: Although research is limited, there is evidence that disease modifying drugs used for autoimmune arthritis may reduce the response of the mRNA COVID-19 vaccines from Pfizer/BioNTech and Moderna. No research on the adenovirus J&J vaccine has been reported.
Based on a small study of 133 fully vaccinated individuals taking immunosuppressive medications, antibody levels and virus neutralization was three times lower than in individuals not taking these medications. The study has not been peer reviewed.
However, study coauthor Alfred Kim MD, PhD, Assistant Professor, Division of Rheumatology, Washington University School of Medicine noted in an interview with Reuters that, “most patients in the study were able to mount antibody responses in response to SARS-CoV-2 vaccination, which is reassuring."
Study results showed:
- More modest reductions in patients using TNF inhibitors, methotrexate and sulfasalazine, JAK inhibitors and IL-12/23 inhibitors.
- A 10-fold reduction in patients who used corticosteroids regularly.
- A 36-fold reduction in patients who use B cell inhibitors.
Learn more about study results here.
Question: What are the possible side effects of a COVID-19 vaccine?
A: COVID-19 vaccines can cause mild side effects, such as pain, redness or swelling where the shot was given, fever, fatigue, headache, chills and muscle or joint pain. These side effects are normal and signs that your immune system is building protection against the virus. Most side effects occur within the first three days of vaccination and usually only last a day or two.
These side effects can mimic symptoms of COVID-19. Get tested and self-isolate if you experience symptoms more than three days after being vaccinated lasting more than two days.
In its fact sheet about the Johnson and Johnson vaccine, the FDA lists warnings for two serious side effects: blood clots and Guillain-Barre syndrome, a potentially serious neurological condition. Both conditions are very rare. So far, there have been one-hundred cases of Guillain-Barre Syndrome and 28 cases of blood clots (22 of the 28 cases were in women) reported after vaccination. Additionally, there isn’t enough evidence to indicate that these side effects were directly linked to vaccination or had to do with other factors.
Neither the Pfizer nor the Moderna vaccines have reported this risk.
Signs of a blood clot include a severe headache that persists, severe abdominal or leg pain that won’t go away or shortness of breath. If you received the vaccine within the last 30 days and are experiencing any of these symptoms, contact your doctor immediately. If you received the vaccine more than a month ago, the risk for blood clot complications is very low, according to Dr. Anne Schuchat, principal deputy director of the US Centers for Disease Control and Prevention.
Symptoms of Guillain-Barre Syndrome usually appear within 42 days of vaccination. Talk to your doctor right away if you begin to experience weakness or tingling in your arms and legs, double vision or difficulty walking, speaking, chewing, swallowing or controlling your bladder or bowels.
While these side effects can be serious, experts note that they are extremely rare, and that the benefits of getting the J&J vaccine still vastly outweigh the risks. If you are scheduled for this vaccine, contact your doctor to discuss next steps.
Additionally, about 1200 cases of heart inflammation (myocarditis) and pericarditis have been reported following vaccination with one of the mRNA vaccines (Pfizer and Moderna). Young adult males under 30 seem to be most at risk, and most cases occurred after the second dose. Most cases were mild, with symptoms like fatigue, chest pain and abnormal heart rhythm that cleared up on their own.
Experts stress that the benefits of vaccination strongly outweigh the risks and that COVID-19 infection is a major risk factor for heart inflammation and heart damage. In other words, the chances that an unvaccinated person who contracts COVID will experience heart problems is much greater than someone who gets vaccinated with one of the mRNA vaccines. Others who have received mRNA COVID-19 vaccines have experienced severe allergic reactions (anaphylaxis). These events are very rare. The CDC estimates that the rate of anaphylaxis is 11.1 per million doses of the Pfizer-BioNTech vaccine and 2.5 cases per million doses of the Moderna vaccine. Another study, published as a research letter in JAMA, says that the risk of having a severe allergic reaction to the vaccine is “extremely low,” highlighting the overall safety of mRNA vaccines.
Experts urge that the fear of anaphylaxis should not deter people from getting vaccinated. The risk of developing severe outcomes from COVID-19 is much higher than the risk of an allergic reaction from the vaccine.
Still, healthcare workers must be prepared to treat reactions in the rare event they occur. As such, patients are asked to stay for 15 minutes to be monitored after vaccination – which is when most allergic reactions occur.
Those with a history of severe allergic reactions not related to vaccines or injectable medications may still get the vaccine. However, these patients are advised to be monitored for at least 30 minutes after vaccination.
Patients with a history of immediate allergic reactions to vaccines and injectable medications should discuss the risks with their doctor. The CDC advises patients to avoid vaccines containing ingredients that have given them previous severe allergic reactions.
There are two main allergens of concern in the COVID-19 vaccines:
- Polyethylene Glycol (PEG), which is found in the mRNA vaccines. If you are allergic to this ingredient, ask your doctor about getting the J&J vaccine
- Polysorbate, which is found in the J&J vaccine. Ask your doctor if you can get an mRNA COVID-19 vaccine if you are allergic to this ingredient.
Finally, if you have an immediate allergic reaction after getting the first dose of a COVID-19 vaccine, the CDC advises against getting a second dose.
Question: What is the difference between an mRNA vaccine and an adenovirus vaccine?
A: The vaccines from Pfizer/BioNTech and Moderna, Inc. use a genetic molecule called messenger RNA (mRNA), which teaches our cells how to create a version of the coronavirus spike protein. This prompts the immune system to make antibodies against this spike protein so the body can recognize the virus and fend off future infections.
Because mRNA is so fragile, these types of vaccines must wrap mRNA in oily lipids and store them in very cold temperatures.
Like mRNA vaccines, adenovirus vaccines also teach the immune system how to fight the coronavirus by carrying instructions for building the spike protein. But instead of storing the instructions in the form of mRNA, adenovirus vaccines, like the Johnson & Johnson vaccine, use double-stranded DNA. The DNA is “wrapped” and delivered to the body in the form of a virus, called an adenovirus.
Adenoviruses are common – many cause the common cold and flu-like symptoms. However, the Johnson & Johnson vaccine uses a modified adenovirus that cannot copy itself inside your cells and make you sick.
Importantly, mRNA and adenovirus vaccines only carry the instructions to build the coronavirus virus spike protein, not the virus itself. This makes it impossible for these vaccines to give you the coronavirus.
While these vaccine technologies are considered newer, scientists have actually been studying them for many years. And unlike traditional vaccines that use weakened live or dead versions of the entire virus, these vaccines are simpler to produce.
Question: How important is the timing between COVID-19 vaccine doses?
The FDA, CDC and other health experts stress that it’s essential to get fully vaccinated as close to the recommended dosing intervals as possible. In other words – don’t delay scheduling your second appointment longer than necessary. If you are able to get the COVID-19 vaccines in the 21-day (Pfizer/BioNTech) or 28-day (Moderna, Inc.) windows, or close to them, do so.
The CDC has guidance for those who are unable to get their second shot at the recommended dosing intervals.
- Second doses received up to four days earlier than the recommended intervals for both vaccines are still considered valid; 17 -21 days for Pfizer/BioNtech and 24-28 days for Moderna, Inc.
- Second doses received six weeks (42 days) after the initial dose for either vaccine are still considered valid.
Question: Are COVID-19 vaccines safe for people with autoimmune disease?
A: There is no advisory against vaccinating people with autoimmune diseases, and experts say there is no reason to believe that the current COVID-19 vaccines on the market will be unsafe for these populations.
Both the Pfizer/BioNTech and Moderna, Inc. vaccines are made with mRNA technology, which contain genetic instructions for one part of the coronavirus instead of the entire virus itself. Experts, including Wilbur Chen, MD, vaccine researcher, professor of medicine at the University of Maryland School of Medicine, and Ted Mikuls, MD, MSPH, Umbach Professor of Rheumatology at the University of Nebraska, expect that vaccines made with this technology to be safe for immunocompromised patients and those on immunosuppressant drugs.
However, Mikuls adds that more data is needed understand whether immunosuppressant medications or unchecked disease activity may reduce vaccine effectiveness. Even so, he anticipates the vaccine will provide protection for the vast majority of patients with arthritis and rheumatic diseases.
By the time the vaccine is rolled out to the public, there will likely be information to better assess the safety and efficacy for those with rheumatic diseases, says Amanda Nelson, MD, Associate Professor, UNC School of Medicine. Still, she emphasizes that it will likely be recommended for all rheumatologic patients.
Rheumatologists Liana Frankel, MD, MPH Professor Adjunct, Yale School of Medicine and Eric Ruderman, MD, Professor, Northwestern Medicine, are recommending that all their patients get the vaccine as soon as it’s available to them. Some DMARDs have been shown to blunt immune responses to other vaccines such as those for influenza, pneumonia and Hepatitis B. Whether holding or delaying DMARD therapies might lead to improved vaccine responses with available and emerging COVID vaccines is currently unknown.
The American College of Rheumatology (ACR), which is set to release COVID-19 vaccine guidance for rheumatologic populations early next year, said in a December 14th statement that they “anticipate recommending that all patients, including rheumatology patients, receive an approved COVID-19 vaccine.” Those who have a history of severe allergic reactions should talk to their doctor about the safety of getting a vaccine at the present time.
As data continues to be collected on the effects of vaccines for patients with autoimmune disease, talk to your health care provider about the considerations about getting vaccinated.
Question: Why do some people feel sick after a COVID-19 vaccine?
A: Some people who received the vaccine have had flu-like symptoms, including, body aches, chills and fever. If you experience these side effects, it's a normal response and a sign that your body is building a protection against the virus. In clinical trials, some participants experienced more side effects after the second dose.
Question: Can the vaccine give me COVID-19?
A: The vaccine cannot give you the virus. This is true of traditional vaccines made from dead viruses, and almost always true of live, attenuated vaccines, which in rare cases, can cause mild illness in some vulnerable populations. What’s more, the current vaccines on the market (Pfizer-BioNtech and Moderna, Inc.) do not contain the entire virus, only genetic instructions for one part of the virus, so it’s impossible for these vaccines to give you COVID-1.
Question: How long does it take to develop immunity after receiving a COVID-19 vaccine?
A: The new COVID-19 vaccines teach your immune system to recognize and fight the virus. This protects you from getting sick with COVID-19. But a vaccine needs time to provide protection after it’s received. COVID-19 vaccines that require 2 shots may not protect you until a week or two after your second shot.
Remember, you could be infected with the SARS-CoV-2 virus just before or just after vaccination and get sick. So, it’s very important to continue the usual risk mitigation activities – wearing a mask, physical distancing, hand hygiene, etc.
Question: Can I get infected with COVID-19 after I get vaccinated?
A: The short answer is yes, but all three COVID-19 vaccines on the market provide exceptional protection against severe illness and hospitalization.
Many people think of vaccines as shields from viruses, but this isn’t always the case. For some, vaccines only protect against symptoms and disease, not necessarily infection. In other words, it’s possible that a vaccinated person may still get infected with a virus but not get sick or only experience mild or moderate symptoms.
Although vaccines don’t always prevent infection, they prime your immune system to quickly fight the virus and protect you from the worst outcomes of disease.
Question: Can I still spread COVID-19 after getting vaccinated?
A: It’s possible, but unlikely. Vaccines sharply reduce the chance of becoming infected with COVID-19, but in the rare event of breakthrough infections, they also reduce how much virus lives in the body and how much is “shed” from the nose and mouth. As such, the probability that a vaccinated person will spread COVID is low.
Still, it’s not completely impossible, and researchers aren’t sure how much coronavirus it takes to infect another person. Plus, with the newer, more contagious delta variant in the mix, health experts are airing on the side of caution, recommending that vaccinated people wear a mask when they are in large crowds or in areas with low vaccination rates.
Question: Will a COVID-19 vaccine alter my DNA?
A: No. COVID-19 mRNA vaccines do not change your DNA in any way. The term mRNA means messenger RNA vaccines. These vaccines teach your cells how to make a specific protein that triggers your immune system to fight back against the COVID-19 virus and protect against future COVID-19 infections. The mRNA never enters the nucleus of your cells where your DNA is located. Learn more about COVID-19 mRNA vaccines.
Question: Are vaccines recommended for people who have already had the virus or have tested positive for antibodies?
A: The short answer: yes. Researchers say there are still too many unknowns about how long immunity lasts from natural infection. Though immunity from COVID-19 vaccines is yet to be determined, research shows that vaccine immunity tends to be stronger than natural immunity. However, the Mayo Clinic advises that those who have been recently diagnosed or exposed to the virus should delay vaccination or wait about 90 days from the time of diagnosis to get vaccinated.
Question: Are the COVID-19 vaccines safe for children with JA?
A: See: COVID-19 FAQS: Juvenile Arthritis.
Question: Am I at a higher risk for getting COVID-19 because I take immune-suppressing arthritis medications?
A: There is limited data about the effects of immunosuppressant medications on infection risk. However, current evidence shows that people taking disease-modifying antirheumatic drugs (DMARDs), including biologics, are not at a higher risk for getting COVID-19. In fact, experts believe that well-controlled disease activity may help decrease the risk of infection, so in that regard, medication is beneficial.
Additionally, patients taking biologics, JAK inhibitors and conventional DMARDs, such as methotrexate, do not seem to have an increased risk of severe disease or hospitalization, according to findings presented at the virtual European League Against Rheumatism (EULAR) 2020 Congress.
However, a small study published in Annals of the Rheumatic Diseases in January suggests that patients with rheumatic disorders who receive biologics do have an increased risk for severe outcomes. Still, researchers note that more studies are needed to determine how just how large that risk is compared to the general population.
Additionally, people taking corticosteroids (e.g. prednisone) at doses of 10 mg or higher have an increased risk of being hospitalized with any infection, including a COVID-19 infection. But do not stop taking corticosteroids (also called glucocorticoids) suddenly. Talk with your doctor about the risks and benefits of taking these medications. If the decision is to stop, work with your doctor to taper safely.
Question: Should I stop or reduce my arthritis drug even though I don’t have any coronavirus symptoms or a confirmed infection?
A: The short answer is no. Stopping immunosuppressive medications puts you at a higher risk for disease flares, worsening symptoms and developing joint damage.
Recent research from the European League Against Rheumatism (EULAR) suggests that the majority of people with rheumatic diseases who contract COVID-19 have similar outcomes to the general population, regardless of which disease-modifying medication they take.
However, certain medications may need to be temporarily stopped if you have a confirmed infection, have been exposed to someone with a COVID-19 infection or are experiencing common COVID-19 symptoms such as fever, dry cough and shortness of breath. But experts warn patients not to stop or change medication dosage without calling their doctors. This is especially important with corticosteroids, which should never be stopped suddenly. The American College of Rheumatology has issued coronavirus medication guidelines for both adult and pediatric rheumatology patients.
If you have any symptoms of COVID-19 or have been exposed to the virus, contact your doctor immediately. Your doctor will help you decide the best course of action.
Question: Is there an approved treatment for COVID-19?
A: Currently, there is only one FDA-approved treatment for COVID-19, the antiviral drug remdesivir. The drug may be used to treat adults and children ages 12 and older and weighing at least 88 pounds and who have been hospitalized for COVID-19. Clinical trials suggest that in these patients, remdesivir may modestly speed up recovery time. At the time, there is no information specific to how remdesivir impacts recovery for patients with autoimmune or inflammatory arthritis.
However, doctors may try other medications approved for other uses to treat the coronavirus, and the FDA has issued emergency use authorization (EUA) for several treatments. EUAs are granted during public health emergencies and allow the use of unapproved drugs or unapproved uses of approved drugs when no other approved option exists.
On February 9th, the FDA granted EUA to a monoclonal antibody drug combo from Eli Lilly. The authorized combo, which consists of a drug already granted EUA, bamlanivimab, and etesevimab, has been approved for use together to treat mild-to-moderate COVID-19 in patients 12 and older weighing at least 88 pounds and who are at-risk of suffering a serious course of COVID-19.
Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off viruses. These therapies must be given intravenously (by IV) soon after developing symptoms.
The FDA said that in a clinical trial of patients with COVID-19 at high risk for disease progression, a single intravenous infusion of bamlanivimab and etesevimab administered together significantly reduced COVID-19-related hospitalization and death during 29 days of follow-up compared to placebo. Still, the safety and effectiveness of this investigational therapy continues to be evaluated.
Bamlanivimab and etesevimab are not authorized for patients who are hospitalized due to COVID-19 or require oxygen therapy due to COVID-19. Treatment with bamlanivimab and etesevimab has not been studied in patients hospitalized due to COVID-19. Monoclonal antibodies, such as bamlanivimab and etesevimab, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation.
Another monoclonal antibody treatment from Regeneron, a combination of casirivimab and imdevimab, has also been granted EUA. It is approved to treat non-hospitalized adults and children over age 12 with mild to moderate symptoms and who are at risk for developing severe outcomes.
The FDA has also issued an EUA for the use of convalescent plasma. After recovering from illness, the blood produces antibodies which help fight the virus. These antibodies are found in plasma, a component of blood.
Using convalescent plasma — or plasma from recovered patients — isn’t new. It’s been used for more than 100 years to treat a variety of illnesses and widely believed to be safe. However, little is known about the effectiveness for treating coronavirus, and studies are mixed.
Some doctors may also choose to use the corticosteroid, dexamethasone. According to the World Health Organization, the national UK clincial trial, RECOVERY, showed that the drug had benefits in critically ill patients. Other preliminary findings shared with the WHO found that the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth.
Lastly, earlier hype about the effectiveness of the malaria drug, hydroxychloroquine, has been debunked. Several studies show no benefits of using the drug. And due to potential risks associated with use, including heart, kidney and liver problems, the CDC recommends against the use of hydroxychloroquine unless it is being prescribed in the hospital or as part of a clinical trial.
Ultimately, the decision to treat COVID-19 with any drug depends on the judgment of the physician and the health status of the patient. In general, doctors will proceed with caution if patients have poor liver or kidney function, unless the potential benefits of using the drug outweigh potential risks.
Question: I heard taking NSAIDs can worsen the coronavirus. Should I stop taking NSAIDs in case I get sick?
A: There is no evidence that taking NSAIDs worsens the coronavirus or increases infection risk. Health experts recommend that people who need NSAIDs for pain relief or disease management continue to use them as directed. However, if you develop a COVID-19 infection, contact your doctor immediately for advice.
Question: Is the biologic that I take protective against COVID-19 since some biologics are being tested as COVID treatments?
A: There is no evidence yet in the studies completed so far that being on a biologic is protective against COVID. “We’re still in the early phases and the story may change over time, “explains Laura Lewandowski, MD, Clinical Fellow, Systemic Autoimmunity Branch, National Institutes of Arthritis and Musculoskeletal Skin Diseases, National Institutes of Health. “However, all of them are not being studied as protective measures. In one study so far, rheumatology patients do not seem to be at an increased risk for COVID illness or hospitalization, but it doesn’t seem as if they have any special protection.”
There have been small studies of hydroxychloroquine (Plaquenil) as a preventative medicine in areas with limited personal protective equipment for health care workers. It has not been shown to prevent virus transmission. So, it’s very important to wear a mask and be vigilant about hand hygiene.
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