This post is no longer being reviewed. It was first published on March 3, 2020. It received the award of Distinction from the eHealthcare Awards in the Best COVID-19 Pandemic Related Communications category. For other resources on COVID-19, please refer to the resources and information links at the bottom of this post.
Merry Jennifer Markham, MD, FACP, FASCO, is Chief of the University of Florida (UF) Division of Hematology & Oncology, a Clinical Professor in the UF College of Medicine, and the Associate Director for Medical Affairs at the UF Health Cancer Center. She specializes in the treatment of gynecologic cancers. Dr. Markham is the Cancer.Net Associate Editor for Gynecologic Cancers and the past chair of ASCO's Cancer Communications Committee. Follow her on Twitter at @DrMarkham.
The American Society of Clinical Oncology (ASCO) is aware that people with cancer and cancer survivors, particularly those with compromised immune systems, are likely worried about the potential impact of COVID-19 on their health. Patients should talk with their oncologists and health care teams to discuss their options to protect themselves from infection.
What do I need to know about COVID-19 vaccines?
There are several COVID-19 vaccines that are now in use in different parts of the world. In the United States, the 4 vaccines authorized for use are made by Pfizer-BioNTech (Comirnaty), Moderna (Spikevax), Janssen, manufactured by Johnson & Johnson, and Novavax. Globally, other vaccines are available or are in process of receiving Emergency Use Listing by the World Health Organization (WHO).
The available COVID-19 vaccines are effective against most variants of the virus. However, variants can still cause illness in some people who are vaccinated. The Omicron variant, for example, is more infectious than the Delta variant and may cause breakthrough infections in people who are vaccinated. Booster doses are important in helping lower the risk of a breakthrough infection. On August 31, 2022, the U.S. Food and Drug Administration (FDA) authorized the use of bivalent formulations of the Pfizer and Moderna COVID-19 vaccines, called updated boosters, which should provide better protection against COVID-19 caused by the omicron subvariants, BA.4 and BA.5. For people in the United States older than 12, these updated boosters have replaced the original boosters.
There are plenty of vaccine doses available in the United States. You can find COVID-19 vaccines near you by searching vaccines.org, checking with major retail pharmacies, or calling 1-800-232-0233. Vaccine distribution varies from country to country. Check your local or national health department to learn more about how vaccines are being distributed in your area.
Primary vaccination series for most people. COVID-19 vaccines are recommended for everyone 6 months and older, and booster doses are recommended for eligible people aged 5 and older.
Pfizer-BioNTech. In the United States, the Pfizer-BioNTech vaccine, a monovalent mRNA vaccine, is approved as a 3-dose primary series for children aged 6 months to 4 years old and as a 2-dose primary series for people age 5 and older.
Moderna. The Moderna vaccine, a monovalent mRNA vaccine, is authorized for use in people 6 months of age and older. It is administered in 2 doses, 1 month apart.
Johnson & Johnson/Janssen. The Janssen vaccine is given in 1 dose and is authorized for individuals 18 and older who are unable to receive the Pfizer-BioNTech or Moderna vaccine or who otherwise would not receive a COVID-19 vaccine.
Novavax. The Novavax COVID-19 vaccine is approved for people 18 years of age and older and is given in 2 doses, between 3 and 8 weeks apart.
Primary vaccination series for people who are moderately or severely immunocompromised. People who are being treated for blood cancers (such as leukemia or lymphoma) or have had a bone marrow/stem cell or organ transplant are considered moderately or severely immunocompromised. This category includes many people with cancer. People in this situation may not have a powerful immune response to a COVID-19 vaccine, so an additional dose and a booster dose are recommended.
Individuals in this group should receive an extra dose of the COVID vaccine. This means a primary series of 3 doses of the Pfizer-BioNTech or Moderna vaccine or 2 doses of the Janssen vaccine. An additional dose is not the same as a booster dose. Instead, it is part of the primary series of the vaccinations. The additional dose should be given at least 28 days after the previous dose.
Updated booster dose. The FDA has authorized updated, bivalent boosters for most people 12 and older. These updated boosters are different from the original, monovalent boosters that were previously recommended and which you may have already received. The Moderna and Pfizer-BioNTech updated boosters are authorized for use as a single booster dose in individuals 18 years of age and older (for Moderna) and 12 years of age and older (for Pfizer-BioNTech). One of these updated boosters may be given 2 months after finishing the primary series of vaccines or getting one of the original boosters. People ages 12 years and older may only get the updated booster; they can no longer get an original (monovalent) mRNA booster. The FDA and the U.S. Centers for Disease Control and Prevention (CDC) have authorized the use of “mix and match” booster doses, so you may receive either booster (if you are eligible) regardless of which vaccine you received as your primary series. Children ages 5 to 11 will still receive the original Pfizer-BioNTech booster.
Side effects. The most common expected side effects of the Pfizer, Moderna, and Novavax vaccines include pain at the injection site, tiredness, muscle pain, headache, chills, joint pain, and fever. Side effects should be expected, and these side effects go away within 3 days. Side effects are sometimes worse with the second dose, but again, these side effects should go away within 3 days. If you still have side effects more than 3 days after your vaccine dose, let your doctor know.
One rare side effect of 2-shot COVID-19 vaccines is swelling of the lymph nodes in the armpit, which could be mistaken as a sign of breast cancer. Because of this unusual side effect, delay your mammogram for at least 1 month after receiving the COVID-19 vaccine.
The most common side effects of the Janssen vaccine were pain at the injection site, headache, fatigue, muscle aches, and nausea. Most of these side effects were mild to moderate in severity and lasted 1 to 2 days.
Safety in people with cancer. Experts agree that the COVID-19 vaccine is recommended for people with cancer, cancer survivors, and those currently on cancer treatment, including chemotherapy and immunotherapy. The best available evidence suggests the odds of dying or experiencing severe complications from COVID-19 are nearly 2 times higher if you are someone with cancer than a person without cancer. The only people who should not be offered the vaccine are those who may have a harmful reaction, such as anaphylaxis, to a specific vaccine component. Talk with your doctor or your cancer care team about whether a COVID-19 vaccine is recommended for you, based on your own medical history.
Even though the original COVID-19 vaccine clinical trials did not specifically include people with cancer, including the pneumococcal pneumonia vaccine and the flu vaccine. Some vaccines are OK to receive during cancer treatment, when the immune system is weak, but some vaccines, such as live virus vaccines, should not be given during cancer treatment. The COVID-19 vaccines are not live virus vaccines and may be given during or after cancer treatment.
After you are fully vaccinated. Once you have been fully vaccinated, and if you live in an area with very low rates of COVID-19, the CDC recommends that you can resume activities that you did before the pandemic, without wearing a mask or physically distancing. However, if you are in an area where the spread is substantial or high, wearing a mask indoors in public is recommended. (You can view the level of community spread in your county on the CDC website.) In most cases, individuals are not fully vaccinated against COVID-19 until 2 weeks after their final dose of the vaccine. In some areas, you may still be required to wear a mask and keep physically distant, such as in hospitals or clinics, public transportation, and others. Also, some local, state, or federal laws may still require these precautions. Be sure to see what precautions will still be required in your area by checking with your local government.
If you have more questions about the COVID-19 vaccines, you can find answers at www.getvaccineanswers.org. (Note that this link will take you to a separate website.)
What is COVID-19?
COVID-19, or coronavirus disease 2019, is an illness caused by a novel (or new) coronavirus that was first identified in an outbreak in Wuhan, China, in December 2019.
Coronaviruses are a large family of viruses that can cause mild illnesses, such as the common cold, to more severe diseases, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Because the novel coronavirus is related to the SARS-associated coronavirus (SARS-CoV), the virus has been named SARS-CoV-2. The exact source of SARS-CoV-2, which causes COVID-19, is not certain but likely originated in bats.
The virus can spread from person to person, through small droplets from the nose or mouth that are produced when a person coughs or sneezes. Another person may catch COVID-19 by breathing in these droplets or by touching a surface that the droplets have landed on and then touching their eyes, nose, or mouth. The virus can spread through close contact, but it mainly spreads by airborne transmission. In an enclosed space, virus particles can remain in the air for minutes to hours and can infect people at distances of more than 6 feet (2 meters).
Symptoms from COVID-19 can be mild to severe and may appear between 2 and 14 days after exposure to the virus. The symptoms may include fever, cough, shortness of breath, chills, headaches, sore throat, and new loss of taste or smell. Other symptoms may include aches and pains, fatigue, nasal congestion or runny nose, or diarrhea. In some people, the illness may cause severe pneumonia and heart problems, and it may lead to death. Other people who are infected may not develop any symptoms.
COVID-19 can occur in both children and adults. Children with COVID-19 are also at risk for a multisystem inflammatory syndrome, with symptoms such as rash, fever, abdominal pain, vomiting, and diarrhea. People of all ages, including infants, can die from this disease. In addition, deaths seem to occur disproportionately in diverse populations, including Black and Hispanic populations. People who are vaccinated against COVID-19 have a much lower likelihood of dying from the infection.
An analysis of 928 people with cancer and COVID-19 presented at the ASCO20 Virtual Scientific Program, during the early phases of the pandemic, revealed that having active, progressing cancer was associated with a 5 times higher risk of dying within 30 days compared with patients who were in remission from cancer.
Viruses commonly change over time through mutation, and several variants of the SARS-CoV-2 virus have been identified. For example, the Delta variant of the virus was identified in December 2020 in India, then in the United Kingdom, and quickly became dominant in many countries, including the United States. The Omicron variant spreads more easily than the Delta variant. Unvaccinated people are most at risk of getting these variants and are most at risk for severe illness and hospitalization.
What can I do to avoid getting COVID-19?
Four vaccines have received authorization from the FDA in the United States. The most important way to protect yourself is to be vaccinated against COVID-19. If you are not vaccinated, you should consider masking while in public. Follow guidance on travel restrictions issued by the CDC or the World Health Organization (WHO).
On December 8, 2021, the FDA issued an emergency use authorization to Evusheld, a monoclonal antibody treatment containing tixagevimab and cilgavimab, for the prevention of COVID-19. Evusheld is for use in children 12 and older (who weigh at least 40 kilograms, about 88 pounds) and adults who are in a high-risk category. This authorization only applies to individuals who are not currently infected by the virus and have not been recently exposed to someone who tested positive. This drug is authorized for people who have:
a moderate to severely compromised immune system, or
a history of severe adverse reaction to a COVID-19 vaccine and who are unable to receive the complete vaccination series
Evusheld is not a replacement for vaccination, which is the best protection against COVID-19. Evusheld is given as 2 injections and may provide protection for 6 months.
Washing your hands for at least 20 seconds is a simple but important way to protect yourself and prevent transmission of the virus. If soap and water are not available, use hand sanitizer that contains at least 60% alcohol.
Other ways to lower the risk of becoming sick from a virus such as COVID-19, influenza, or even the common cold include:
Avoid touching your eyes, nose, and mouth.
Cough or sneeze into a tissue instead of your hand. Or, cough or sneeze into your elbow rather than your hand if you don't have a tissue available.
Avoid close contact with people who are sick.
If there has been a known COVID-19 exposure, then cleaning with disinfectant wipes or spray is important.
If you are not vaccinated against COVID-19 and are in public, wear a mask that covers your nose and mouth. This can help prevent the spread of COVID-19 in the community, especially because some people with COVID-19 have no symptoms and don’t know they have the virus, or they may not have yet developed symptoms. You should not wear masks with exhalation valves or vents because the vents allow your own respiratory droplets to leave the mask and can put others at risk.
If you are vaccinated but living or traveling in an area with high transmission rates of COVID-19, you should continue to wear a mask when indoors in public settings. If you are at high risk for COVID-19 illness or complications due to your cancer treatment or other medical condition, you should also continue to wear a mask in these settings.
Before vaccines were widely available, social distancing—staying 6 feet (2 meters) away from other people while in public—was recommended. If you are unvaccinated or if you are at high risk for severe infection and live in an area with high community transmission of COVID-19, you may wish to continue social distancing when in public. However, in areas of low community transmission, social distancing is no longer required or recommended.
There is no scientific evidence that taking zinc or vitamin C, even at high doses, can help to prevent COVID-19. Using mouthwash and nasal rinses, or ingesting mouthwash in large amounts, also will not prevent COVID-19 and can be dangerous. Drinking or gargling with betadine or other iodine products is dangerous and does not help prevent or treat COVID-19. Ivermectin will not prevent or cure COVID-19.
Are there special precautions that people with cancer should take?
People with cancer, people who are in active cancer treatment, older patients, and people with other serious chronic medical conditions, such as lung disease, diabetes, or heart disease, are at higher risk for the more severe form of COVID-19 that could lead to death. Studies have shown that people with active or progressing cancer may be at higher risk than those whose cancer is in remission.
COVID-19 vaccination is the most important precaution that people at high risk for severe COVID-19 can take to protect themselves.
People who are at higher risk of getting very sick from COVID-19 should think carefully about non-essential travel, especially if the travel will involve areas with high or increasing rates of COVID-19. This is especially important for people who are not vaccinated against COVID-19. If you decide to travel, make sure you are up to date on your COVID-19 vaccination series, check the local COVID-19 rates in your destination, check to make sure whether any COVID-19 testing or vaccination documentation is required, and protect yourself by wearing a mask during travel by airplane or public transportation.
If you are vaccinated, outdoor activities are considered safe without the need for physical distancing.
Speak with your cancer care team about any special precautions to take during cancer treatment or during medical appointments. Telemedicine or videoconferencing may be an option for routine visits. Be sure to check with your cancer care team to see if this is recommended for you.
Finally, it is always important to have your health care wishes in writing, in case you are too sick to make decisions for yourself. This way, your family and your medical team will know what is important to you and what your wishes are. If you have not yet done this, now is a good time. Cancer.Net has valuable information on this topic. Because some hospitals and clinics are limiting visitors, and some are allowing no visitors, having your health care wishes in writing is more important than ever. Here are some examples of important questions to ask yourself, to discuss with your loved ones, and to write down:
What level of quality of life would be unacceptable to me?
What are my most important goals if my health situation worsens?
If I am unable to speak for myself, who is the person in my life who I would want to speak for me?
Who should not be involved in making decisions for me?
If my heart stops, do I want to have CPR (cardiopulmonary resuscitation) done?
Will anything change with my cancer-related medical visits?
Because of the COVID-19 pandemic, most hospitals and clinics modified their visitation policies. Some may allow only 1 visitor per patient, and others may allow no visitors. Masks and physical distancing are generally still required in health-care settings, though this may vary based on the city or town that your hospital is in. Before heading to your medical appointment, check with the clinic or hospital for their current visitor policy.
Your cancer care team may conduct some of your appointments by telemedicine. During a telemedicine appointment, you can stay at home and visit with your doctor or other health care team member through video conferencing using your phone or computer. Your doctor’s office will give you instructions on how to have your visit this way. If you are interested in having a visit by telemedicine rather than in person, ask your doctor’s office staff if this is possible.
If community spread of COVID-19 in your area is very high, your doctor may recommend delaying some treatments for supportive care, such as bone-strengthening treatments, for example, denosumab (Xgeva) or zoledronic acid (Zometa), or intravenous iron supplementation. They will only recommend delaying treatments if they feel it is in your best interest to do so.
Early in the pandemic, cancer screening tests, such as mammograms or colonoscopies, and other tests, such as bone density tests, were often delayed to reduce your risk of exposure to the virus. However, it is still important to receive regular cancer screening, even during a pandemic. The Prevent Cancer Foundation’s Back on the Books website can help you learn more about COVID-19 and safe cancer screening.
What should I do if I think I may have COVID-19?
If you think you may have COVID-19, you should tested for the virus. Testing can be done at local pharmacies, through an at-home test, or in your local health care center. Before heading to a doctor's appointment to be evaluated for COVID-19, call the office first to let them know you think you may have the infection. A common question I hear from patients is about which doctor to call. I recommend calling the doctor who you have the most contact with. If you have been off cancer treatment for more than a year and are seeing your primary care doctor regularly, you may call your primary care doctor. However, if you are seeing your oncologist more regularly or are on active cancer treatment, call your oncologist. If you are receiving cancer treatment that suppresses the immune system and you develop a fever and respiratory symptoms, call your oncologist as you usually would if you develop a fever while on treatment. Be sure to follow their guidance on when to come into the office or hospital and when it’s safer to stay home.
If you take a test for COVID outside of your doctor’s office, be sure to let your medical team know the results of your test.
It is important to note that even if you are vaccinated, you may still develop COVID-19, but the risk is lower and the illness is more likely to be mild.
Severe symptoms could be a medical emergency, and you may need to call 911. If you or your loved one has symptoms such as trouble breathing, persistent pain or pressure in your chest, new confusion, or bluish lips, you should seek medical attention immediately.
If you are concerned you have COVID-19, you should stay at home and isolate yourself while you are waiting for your test results. Staying home when you are sick is the best way to prevent transmitting this and other respiratory viruses, such as the flu, to other people. If you live with someone, you should isolate yourself in one part of the home, if possible, to lower the risk of spreading the virus to the rest of the people who live with you. If you’re not able to isolate yourself in your home, you should wear masks in your home.
If you test positive for COVID-19, you should isolate yourself from other people for at least 5 days. Check with your health-care team on when it is safe to come out of isolation.
If you learn that you were exposed to someone with COVID-19, closely watch for developing symptoms, such as fever (100.4°F/38°C or higher), cough, or shortness of breath. You should wear a mask as soon as you find out you were exposed. If you develop any symptoms, get tested immediately.
Is there a way to find out if I have already had COVID-19?
Antibody tests, also known as serologic tests, have been developed, and these tests may be able to find out if you have already had a COVID-19 infection by identifying whether there are antibodies in the blood. Antibodies are specific proteins made by the body in response to an infection.
Antibody tests are not perfect. Some people who get COVID-19 may not make antibodies. Or they may make very low levels of antibodies. Some people may have a “false positive” antibody test, meaning the test finds antibodies, but the antibodies are related to a different coronavirus and not COVID-19.
Antibody tests should not be used to make a current diagnosis of COVID-19. It can take between 1 and 3 weeks after the infection for the body to make antibodies.
If you have had a COVID-19 infection, whether diagnosed through a test for the virus or through an antibody test, it is possible (but not certain) that you may have immunity for about 3 months. However, if suspicious symptoms develop within that 3-month period after the COVID-19 infection, another test for COVID-19 is recommended, unless there is another obvious cause for those symptoms.
If I have had COVID-19, will I be able to continue cancer treatment?
If you have tested positive for COVID-19, you should have a discussion with your oncologist about the impact of this on your cancer treatment. Some cancer treatment centers may require a negative COVID-19 test before chemotherapy or other cancer treatment starts again. However, some patients with COVID-19 continue to test positive even after recovering from their symptoms. In this situation, your health care team will consider the risks and benefits of restarting cancer treatment despite the positive test. Some treatments, especially those that do not impair the immune system, may be able to continue, especially if you have tested positive for the virus but do not have symptoms or have only mild symptoms.
When your cancer treatment resumes or continues after COVID-19, it is important to wear a mask when coming to the infusion clinic or cancer treatment center and to practice good hand hygiene by using hand sanitizer or handwashing before and after visits.
Are there any treatments available for COVID-19?
There are no cures for COVID-19. Scientists continue to work hard to develop and test treatments for COVID-19. Clinical trials are research studies that involve people. Clinical trials for potential COVID-19 treatments are now open in many locations in the United States and in other countries. If you have been diagnosed with COVID-19 and you join a clinical trial for patients with COVID-19, you may be able to receive these medications. Also, by joining a clinical trial, your participation will help scientists find the most effective and safe treatment for the illness. The NCI COVID-19 in Cancer Patients Study (NCCAPS) and a study at Stanford, for example, are designed to collect symptoms from people who may have COVID-19 to help researchers learn the course of the disease and help find a treatment.
For people with cancer who develop mild to moderate COVID-19 that is not severe, the FDA has authorized certain monoclonal antibodies and antiviral treatments that may be helpful in reducing the chances that the illness becomes severe and reducing the need for hospitalization. These treatments have changed since 2020, so you should speak with your doctor about what treatment, if any, is best for you. Learn more about treatments for COVID-19 on the CDC website.
Treatments that are not effective for treating COVID-19 include hydroxychloroquine and ivermectin. These can be dangerous if used inappropriately.
How do we attend school or work safely?
When attending school or going to work, it is important to be aware of your local community transmission rate of COVID-19. If you or your children are not vaccinated against COVID-19 or if you are vaccinated but at higher risk for severe COVID due to immunosuppression or other medical conditions, wear a face mask that covers the nose and mouth. Use hand sanitizer frequently and wash hands whenever possible.
Stay home from work and keep children at home if you or they are sick with any symptoms that may indicate an infection.
Be sure to get a flu shot during flu season. This can help protect you and those around you.
When will things return to normal?
The rates of infection from the virus have fluctuated since early 2020, but the virus has not gone away and it may become endemic. Masking will continue to be important, especially indoors in areas of high COVID-19 transmission, for those who are at higher risk because of medical conditions or immune suppression, and for those who are unvaccinated.
Masking and social distancing restrictions are now lifted in many parts of the world. People who are vaccinated and not at a higher risk of severe COVID-19 are able to participate in normal daily activities, including shopping, dining out, and traveling.
If you have questions about your personal risk due to your cancer or cancer treatment, be sure to speak with your doctor for their guidance.
Where can I get the latest information about COVID-19?
Staying up to date on the latest information on the COVID-19 outbreak is important. The CDC and your local and state health departments will have ongoing information about whether the disease has been diagnosed in your community.