Coronavirus and COVID-19: What People With Cancer Need to Know

August 11, 2022
Merry Jennifer Markham, MD, FACP, FASCO

eHealthcare Leadership Awards 2021 - WinnerThis post is reviewed twice a week and updated as needed. 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.

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 may 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.

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.

Vaccination series for most people. COVID-19 vaccines are recommended for everyone 6 months and older, and booster doses of 3 of the vaccines are recommended for eligible people aged 5 and older. The U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control and Prevention (CDC) authorized the use of “mix and match” booster doses in October 2021. For example, someone who received the initial vaccination series with the Moderna vaccine could receive a booster dose of the Pfizer vaccine.

  • Pfizer-BioNTech. In the United States, the Pfizer-BioNTech vaccine, an 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. For people 50 and older, a second booster dose (a fourth total dose) can be given 4 months after the first booster dose.

  • Moderna. The Moderna vaccine, an mRNA vaccine, is authorized for use in people 6 months of age and older. It is administered in 2 doses, 1 month apart. A booster dose is authorized for people 18 and older and can be administered 5 months after the second dose. For people 50 and older, a second booster dose (a fourth total dose) can be given 4 months after the first booster dose.

  • 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. A booster dose of this vaccine should be given to adults 18 and older at least 2 months after the first dose. The CDC recommends that people who received the Janssen vaccine should consider a booster dose of either Pfizer or Moderna instead, because they are preferred for their effectiveness.

  • 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. For people 18 and older who are moderately or severely immunocompromised, the second dose should be given 3 weeks from the first dose.

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.

  • Additional dose. Individuals in this group should receive an extra dose of the COVID vaccine. This means 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.

  • Booster dose. All people in this group should receive a booster dose of any COVID-19 vaccine. However, mRNA vaccines are preferred. For people who received the Pfizer-BioNTech or Moderna vaccine, the booster should be given at least 3 months after the additional dose. For those who received the Janssen vaccine, the booster dose should be given at least 2 months after the additional dose.

  • Second booster dose. People in this group who are 12 and older may receive a second booster dose of the Pfizer-BioNTech vaccine. If they are 18 and older, they may receive a second booster dose of either the Pfizer-BioNTech vaccine or the Moderna vaccine. This second booster dose should be given at least 4 months after the first booster dose.

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.

Data on unexpected side effects of these vaccines are being collected and monitored. When something uncommon happens, this information is reported to the FDA and CDC so that further investigations may be performed. For example, 6 people (out of more than 6.8 million people) who received the Janssen vaccine were reported to have a rare type of blood clot. Because of this, administration of that vaccine was briefly paused so that these cases could be reviewed and the relationship to the vaccine could be determined. This does not mean that the vaccine is dangerous. Pauses like this are an important and expected safety mechanism in the development of any new medications or vaccines.

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 roughly 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. Read an FAQ about the COVID-19 vaccine and how it relates to people with cancer. (This link takes you to a different ASCO website.)

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, this does not apply in areas where the spread of very infectious variants, such as Delta or Omicron, is substantial or high. In those areas, 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. However, 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.

No vaccine is 100% effective, and sometimes, vaccinated people can still get COVID-19, which is called a “breakthrough infection.” The risk of this is very low, and vaccinated people are unlikely to become very ill. If you have cancer or are receiving cancer treatment or have other medical conditions that put you at high risk for illness from COVID-19, you should consider continuing to wear a mask when you are indoors in public settings. Check with your doctor for specific guidance if you feel you are at higher risk for complications from COVID-19.  

The virus will remain in the community until the majority of residents are vaccinated, so these precautions are critical to preventing continued spread of the virus, especially with more contagious variants circulating.

If you have more questions about the vaccine, 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 spreads 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. Initial reports indicated that children and young adults were not as affected by COVID-19. However, 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.

An analysis of 928 people with cancer and COVID-19 presented during the ASCO20 Virtual Scientific Program 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, but it is not known whether it is more deadly. 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?

Three vaccines have received emergency use authorization from the FDA, and one of those (Pfizer) has received formal FDA approval for ages 16 and up. Data collection from clinical trials to test the effectiveness of COVID-19 vaccines are still ongoing. These trials will give scientists valuable information that can help patients and the general public in the long run. If you would like to participate in a COVID-19 vaccine clinical trial, ClinicalTrials.gov has a full listing of available studies.

The most important way to protect yourself is to be vaccinated against COVID-19. If you are not vaccinated, stay at home as much as possible and avoid areas where people gather. 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 an 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. 

In addition to washing your hands frequently, it’s important to:

  • Avoid touching your eyes, nose, and mouth.

  • If you must cough or sneeze, use a tissue. Then throw the tissue away. Or, cough or sneeze into your elbow rather than your hand.

  • Avoid close contact with people who are sick.

  • Regularly clean frequently touched objects and surfaces.

  • 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, it is important to wear a mask or cloth face covering that covers the 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. Double masking, such as wearing a cloth mask or nylon face covering over a surgical mask, is more effective at limiting transmission of the virus than wearing only 1 mask. The CDC recommends double masking, rather than just wearing 1 mask. If you only wear 1 mask, it should be tight fitting around the nose and mouth.

Wearing a face mask does not replace social or physical distancing. If you are out in public and not vaccinated, you should do both: practice physical distancing of at least 6 feet (2 meters) from other people and wear a mask.

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.

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.

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. The same rules apply for people with cancer as for those without cancer: Be sure to wash your hands well. Avoid touching your face, and avoid close contact with people who are sick.

People who are at higher risk of getting very sick from COVID-19 should think carefully about non-essential travel during the COVID-19 pandemic, especially if the travel will involve areas with high or increasing rates of COVID-19. This is especially important for people who have not yet been fully vaccinated against COVID-19. If you are not vaccinated, stay at home to reduce your exposure to the virus, practice physical distancing, and avoid social gatherings, including smaller gatherings with family or friends who don't live with you. Wear a face covering or mask, and make your trip out as brief as possible. If you have been vaccinated and live in an area with low COVID-19 transmission rates, you are able to return to normal activities. In places with high or increasing rates of COVID-19, masking is still important. Always follow local government guidelines for masking and social distancing.

If you are vaccinated, outdoor activities are generally safe without physical distancing. If you are not vaccinated, walking or exercising outdoors is fine as long as the area is not crowded and you are able to keep a distance of at least 6 feet (2 meters) from other people.

A good rule of thumb during emergency situations such as the pandemic is to keep enough essential medications, both prescription and over-the-counter, to last for at least 1 month. Create and keep updated an emergency contact list that includes family, friends, neighbors, and community or neighborhood resources who may be able to provide information or assistance to you if you need it.

To stay connected to your support system, connect with your family and friends virtually, through video chats or phone calls. Some examples of technology that can be used for video or other live chats are FaceTime, Zoom, Google Hangouts, and social media platforms, such as Instagram and Facebook.

If you are scheduled for cancer treatments, have a discussion with your oncologist about the benefits and risks of continuing or delaying treatment. If you are not scheduled for cancer treatment but are scheduled for an appointment with your oncologist, it may be possible for the doctor to conduct the visit using videoconferencing or telemedicine. 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?

Due to the COVID-19 pandemic and the increased risk of exposure to the virus, most hospitals and clinics have changed their visitation policies. Some may allow 1 visitor per patient, and others may allow no visitors. Masks and physical distancing are still required in health-care settings. 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 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. 

For people who are at high risk of cancer, such as those with a hereditary cancer syndrome like Lynch Syndrome or a BRCA mutation, your doctor may recommend delaying some cancer risk-reducing procedures. They will only recommend this if they feel it's safest for you, based on the virus transmission rates where you live and your own personal risk. It's always best to discuss timing of these tests and procedures with your doctor.

What should I do if I think I may have COVID-19?

If you think you may have COVID-19, you should get tested for the virus. You may get tested for COVID-19 at local testing centers and pharmacies in your community without a doctor’s order. Or, you may get tested by your doctor or health care center. You should call your doctor's office before going in to be evaluated. 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 provider regularly, you may call your primary care provider. However, if you are seeing your oncologist more regularly or are on active cancer treatment, call your oncologist.

Testing for COVID-19 involves inserting a 6-inch-long swab, similar to a Q-tip, deep into the nasal cavity for at least 15 seconds. The swab is inserted into a special container and sent to a laboratory for testing. Saliva tests are also available in some areas. There are several FDA-approved at-home self-collection kits for this virus, approved under an emergency-use authorization. These tests often include a medical screening questionnaire and up-front payment. The FDA has also given emergency use authorization to an over-the-counter, at-home test that can give results in about 20 minutes. This test involves a nasal swab that can detect fragments of the virus if they are present.

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.

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.

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 quarantine 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 must 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 are concerned that you may have been exposed to someone with COVID-19, closely watch for developing symptoms. Check your temperature regularly for fevers. If you have active cancer or are currently in cancer treatment, let your medical team know about your possible exposure.

On June 3, 2020, a study was published in the New England Journal of Medicine that included 821 people with no symptoms of COVID-19 who had a household or work exposure to COVID-19. This study showed that treatment with hydroxychloroquine after an exposure to someone with COVID-19 did not provide any benefit.

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 the coronavirus disease 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 and COVID-19 that is not severe, monoclonal antibodies may be helpful in reducing the chances that the illness becomes severe and reducing the need for hospitalization. The combination of casirivimab and imdevimab (made by Regeneron Pharmaceuticals, Inc.) was given FDA emergency use authorization in November 2020. The combination of bamlanivimab and etesevimab (made by Eli Lilly), another intravenous monoclonal antibody therapy, was also originally given emergency use authorization for the treatment of mild to moderate COVID-19.

However, the authorizations for both combinations were modified in January 2022 to prohibit their use in the United States because of their ineffectiveness against the omicron variant.

Sotrovimab (made by GlaxoSmithKline) received emergency use authorization for use in mild to moderate COVID-19 in people age 12 and older who are at high risk for progression to severe COVID-19. This treatment has been shown to be helpful against the omicron variant.

For people who have just become symptomatic with COVID-19 and are at high risk for progression to severe COVID-19, treatment with monoclonal antibody therapy should be given as soon as possible after the diagnosis.

For outpatient treatment of COVID-19, there is not enough data to support outpatient treatments such as convalescent plasma or dexamethasone. Hydroxychloroquine is not recommended for the treatment of COVID-19, either alone or in combination with any other drugs. Ivermectin should not be used as a treatment for COVID-19.

In December 2021, the FDA gave emergency use authorization to 2 oral medications for the treatment of mild-to-moderate COVID-19 in people who are at high risk for developing severe COVID-19. These treatments must be prescribed by a health-care professional. The goal of both pill treatments is to reduce the risk of hospitalization or death from COVID-19.

  • Paxlovid (made by Pfizer) is a combination of nirmatrelvir and ritonavir and was the first pill treatment of COVID-19 to receive emergency use authorization. Paxlovid is for people 12 and older who are at high risk. Paxlovid should be taken within 3 days after symptoms from the virus start.
  • Molnupiravir (made by Merck) is only for people 18 and older.

For people in the hospital due to COVID-19, treatments may include a variety of measures, depending on the severity of the illness. For example, people in the hospital who are not yet on oxygen may be given the antiviral medication remdesivir. For people who are sick enough to need supplemental oxygen, dexamethasone (a steroid) may be added. Other medications that physicians in the hospital may use for very sick patients include baricitinib (a Janus kinase inhibitor) or tociluzumab (a medication that targets the immune system’s interleukin-6 pathway). The primary treatment is supportive care, including oxygen and supporting breathing through mechanical ventilation, if necessary.

Remdesivir, an antiviral medication, can be helpful in treating COVID-19 infections. The drug received an Emergency Use Authorization from the FDA in May 2020 and became the first FDA-approved treatment for COVID-19 in October 2020. Remdesivir is approved for patients with COVID-19 who require hospitalization, and in January 2022, the drug was approved for use outside of the hospital in people with mild to moderate illness from the virus.

Dexamethasone, a steroid medication, can be beneficial for critically ill patients with COVID-19. A report from the U.K. Recovery Trial found that dexamethasone can help save lives in people who require oxygen therapy or are on a ventilator. In this population of very ill patients, receiving dexamethasone resulted in a lower rate of death at 28 days. The drug unfortunately does not seem to help in cases of mild disease.

Convalescent plasma is the liquid portion of blood that can be collected from people who have recovered from COVID-19. This plasma may have antibodies to SARS-CoV-2. Convalescent plasma is being studied in clinical trials as a possible treatment, and the FDA issued an Emergency Use Authorization for it on August 23, 2020. However, its benefits and risks still have not been confirmed in randomized clinical trials.

Hydroxychloroquine (Plaquenil) initially seemed promising as a possible treatment for COVID-19, but after various clinical trials reported data on its safety and effectiveness, this medication was not found to be helpful.

A version of chloroquine (chloroquine phosphate) is used as an additive to clean fish aquariums. Consuming this fish tank additive has led to at least 1 death and other overdoses. Do not consume this product—it can kill you.

Drinking bleach or injecting bleach or other household disinfectants is very dangerous and can kill you. Another proposed treatment to avoid is oleandrin, an extract that comes from a toxic shrub. Ingesting even a small amount of the plant can kill you. These are not treatments for COVID-19, and they will not help prevent it.

Do not take ivermectin, a drug used to treat parasites and head lice. Ivermectin products are made differently for animals and for humans. Ivermectin is not an antiviral medication. Taking this medication has not been shown to be helpful in treating COVID-19. Consuming it, especially at doses recommended for animals, can be dangerous and may result in overdose, hospitalization, and death.

How do we attend school or work safely?

Around the world, there is variation in whether or not schools and offices are open for in-person attendance. In the United States, local and state officials have worked with school systems to plan school openings. Some schools are offering only in-person education, a small number of schools are completely virtual, and others still are offering some blend of the two.

If you or your children are returning to school in person, and especially if you are not vaccinated against COVID-19, wearing a face covering or mask that covers the nose and mouth at all times is important to lower the risk of spread. If physical distancing is possible, please do so. Use hand sanitizer frequently and wash hands whenever possible. Stay home or keep children at home if they are sick or have a fever.

When returning to in-person work, the same rules apply. Being vaccinated against COVID-19 is the safest approach. If you are not vaccinated, avoid large gatherings of people, physical distance as much as possible, and wear a mask at all times. Regularly clean desks and other frequently touched surfaces. If there has been a known exposure to COVID-19 in the space, then cleaning with disinfectant wipes is important. Do not go to work when you are sick or if you have a fever.

Finally, 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 likely won’t anytime soon. Overall, in the United States, the number of cases of COVID-19 and the number of deaths from the virus have continued to increase, though rates fluctuate in various communities and countries. With COVID-19 vaccines now widely available in the United States, a return to normal is expected, but access to vaccines varies from country to country. Also, unless a high percentage of people choose to be vaccinated, a return to normal will be significantly delayed and new variants, such as Omicron, will likely continue to appear. Masking and physical distancing 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 not yet vaccinated or not fully vaccinated. Masks will likely continue to be required in health-care settings.

If your local community, county, or state allows nonessential businesses to be open and if you are not vaccinated against COVID-19, the safest approach is to continue to stay at home and avoid being in public as much as possible. Wear face masks and consider double masking when you leave your home. Stay at least 6 feet (2 meters) away from other people.

If you decide to eat at a restaurant, it’s safest to eat outside, and you should still wear a mask if you are not vaccinated, unless you are eating or drinking. People who are vaccinated can feel more comfortable resuming pre-pandemic activities, such as dining in a restaurant and shopping.

Many people believe that a negative COVID-19 test means that it’s safe to gather with friends or family members outside of your household. However, this is not true. It is important to remember that a negative COVID-19 test only means that the person was negative at the moment of that test. The test only gives information about the level of virus at the exact time of the test. Someone could have COVID-19 but not yet have enough virus to test positive. Also, these tests are not 100% accurate.

The safest approach, especially if you are considered high risk and if you are not vaccinated, is to continue living as if the stay-at-home restrictions are still in place. If you have been vaccinated, it is now possible to ease back into social events. But if you are in an area of high COVID-19 transmission, wearing a mask indoors is recommended.

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.

This information is also available in Spanish and Portuguese.

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