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: Which COVID-19 vaccines are available?
A: Two COVID-19 vaccines (Moderna, Inc. and Pfizer/BioNTech) have been given the green light by both the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) for use in the U.S.
So far, data suggests that the vaccines are highly effective – Pfizer/BioNtech’s vaccine is estimated to be about 95% effective, whereas Moderna, Inc.’s is projected to be about 94.5% effective.
A third coronavirus vaccine from Johnson & Johnson is expected to receive emergency use authorization (EUA) from the FDA soon. The Johnson & Johnson vaccine has been shown to be about 72% effective in the U.S. at preventing moderate to severe disease. The company also said that vaccine effectiveness likely increases over time, stating that there were no reported cases in clinical trial participants after 49 days. If granted EUA, Johnson & Johnson said it would be ready to supply 100 million doses by June 2021.
Although Johnson & Johnson’s vaccine effectiveness isn’t shown to be as high as the other two on the market, health experts stress that adding this vaccine to the mix may be a real game-changer in ending the pandemic, keeping people healthy and out of the hospital. Unlike the other two vaccines on the market, Johnson & Johnson’s vaccine is only one dose and doesn't require extra-cold refrigeration for storage, making it much easier to produce, store and distribute.
Most importantly, Johnson & Johnson stated that its vaccine “demonstrated complete protection against COVID-19 related hospitalization and death” 28 days after vaccination.
Currently, there are 54 vaccines in human clinical trials and at least 87 preclinical vaccines being studied in animals. Twelve vaccines have reached the final stages of testing.
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: Do the current vaccines on the market protect against the new COVID-19 variants?
A: Moderna, Inc. and Pfizer/BioNTech both say their vaccines provide protection against new, more contagious variants, including the U.K., South African and Brazilian mutations. There is some evidence to suggest the vaccines may be less effective against the South African and Brazilian variant, but more research is needed.
It’s important to remember that “less effective” does not mean “ineffective.” Health experts, including Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, stress that any decrease in vaccine protection is likely to be small, and that these vaccines are still hugely important in containing the pandemic and protecting oneself from the worst outcomes of disease.
Experts also say that vaccines may be adjusted fairly quickly to accommodate further virus mutations. Likewise, Moderna, Inc. and Pfizer/BioNTech announced that they are working on booster shots to improve vaccine effectiveness against future variants.
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.
However, patients who receive their first COVID-19 vaccine dose may live in states where the supply has yet to keep up with the demand. This may affect the timing of their second shots.
As such, the CDC has updated its 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: Where can I find the latest information about COVID-19 vaccine distribution in my state?
A: This resource provides direct links to all state public health departments. You will be able to find the latest information on distribution, priority groups and whether you’re eligible to receive a vaccine. Currently, the priority groups are healthcare workers, essential workers and people aged 65 years or older.
Here’s what you should know before getting a COVID-19 vaccine. After receiving the vaccine, here are helpful tips if you experience side effects.
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: 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.
Some people who have received a COVID-19 vaccine experienced severe allergic reactions (anaphylaxis). These events are very rare – out of the 1.9 million people who received the first shot of the Pfizer/BioNTech COVID-19 vaccine in December. there were only 21 reported cases of severe allergic reactions. Currently, there is no data examining the rates of allergic reactions in regards to the Moderna, Inc. vaccine, but the risk of anaphylaxis is believed to be just as rare.
Experts urge that the data on anaphylaxis should not scare people away 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. Moreover, do not get a vaccine if you are allergic to polysorbate.
Finally, if you have an immediate allergic reaction after getting the first dose of a COVID-19 vaccine, don’t get the second dose.
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 still spread COVID-19 after getting vaccinated?
A: Scientists aren’t sure. There’s not enough evidence from the clinical trials of the approved Moderna and Pfizer/BioNTech vaccines to confirm whether the vaccines also prevent asymptomatic infection and transmission. The companies say research is ongoing to determine the answer.
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: Can I resume life as normal after getting the vaccine?
A: While vaccines from Pfizer/BioNTech and Moderna, Inc. report strong efficacy rates (95% and 94.5%, respectively) in preventing illness, getting one doesn’t mean you’ll be able to ditch masks and social distancing immediately. That’s because studies of these vaccines only measured if people develop symptoms, not if they can still spread the virus. There’s still a possibility that the virus could live in your respiratory tract, even if you’re generating enough antibodies elsewhere in the body to prevent you from getting sick. In other words, even if you get vaccinated and are protected from the worst effects of the disease, you may be an asymptomatic carrier and still transmit the virus to others without knowing it (though Moderna, Inc. says it can prove that their vaccine also prevents asymptomatic infections).
Based on what is known about the flu vaccine and patients who have had COVID-19, researchers are hopeful that these vaccines will not only prevent illness but will also prevent transmission, too. Still, it’s too early to definitively say that the vaccines stop the spread.
Lastly, even if you get vaccinated, there is still a risk that you will get sick. While both vaccines are shown to be highly effective, they are not 100% effective. Until enough people get vaccinated (about 75% of the population), experts urge that social distancing, mask wearing and meticulous hand hygiene will need to be continue to reduce the risk.
But there is a light at the end of the tunnel. Though experts wrestle with the exact timeline about when “normal life” resume (some say December 2021, while others suggest this summer), many believe that a vaccine will hasten the end of the pandemic and that a mask-free existence will come sooner than later.
Question: Will COVID-19 vaccines interact with DMARDs and biologics used for arthritis?
A: People with rheumatic diseases will not be able to get any of the live vaccines under development for the novel coronavirus. “However, we don’t expect that there will be any issue with non-live vaccines,” explains vaccine researcher William Chen, MD, Chief of the Adult Clinical Studies, Center for Vaccine Development and Global Health, University of Maryland.
“There are 176 COVID vaccines in development worldwide as of October 2020. Five of the seven vaccines that are most likely to be available in the United States in the next 12 months are non-live vaccines,” says Dr. Chen.
Question: How long does natural immunity (the natural development of antibodies) last after a COVID-19 infection?
A: Natural immunity varies from person to person. Since the COVID-19 virus is so new, experts aren’t certain how long it lasts. But current data suggests that reinfection with the virus within 90 days after the first infection is uncommon. Therefore, people with a recent infection may wait until after the 90-day period to get the COVID-19 vaccine.
Question: When will COVID-19 vaccines be available for children younger than 16 years old?
A: The Pfizer/BioNTech vaccine currently has about 1000 participants between ages 12 and 15 years old enrolled in a trial. They plan to assess these participants after their second dose before conducting a larger trial. The vaccine is currently available for people age 16 years and older.
According to CEO Stephane Bancel, Moderna, Inc. is aiming to have the vaccine approval extended to adolescents ages 12 to 17 by this summer. This vaccine is currently available for adults 18 years and older.
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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