BOX. SARS-CoV-2 prevention measures for immunocompromised individuals, their families and close contacts in the context of currently circulating Omicron sublines — United States, January 2023
Because Evusheld is not currently approved for pre-exposure prophylaxis against SARS-CoV-2 infection in the United States, it is important that individuals who are moderately to severely immunocompromised*, those who may have an inadequate immune response to COVID-19 vaccination, and those with contraindications to receiving COVID-19 vaccines, exercise caution and recognize the need for additional preventive measures to protect themselves against SARS-CoV-2 infection. Individuals with weakened immune systems, their family members and close contacts can use the following steps and precautions to help prevent SARS-CoV-2 infection and reduce COVID-19 illness if they become infected.
COVID-19 vaccines, booster doses and staying up to date*
- COVID-19 vaccines remain the best way to protect against severe COVID-19. COVID-19 vaccines help the body develop protection against SARS-CoV-2 infection. While vaccinated individuals sometimes become infected with SARS-CoV-2, staying up-to-date with COVID-19 vaccines significantly lowers the risk of serious illness, hospitalization, or death from COVID-19.
- CDC recommends that all eligible individuals, especially those who are immunocompromised or have a weakened immune system,† receive an updated (bivalent) booster dose and stay informed about their COVID-19 vaccines.
Personal COVID-19 action plan§
- Individuals should think about how to protect themselves and others around them if they become ill with COVID-19 or if the level of transmission of COVID-19 changes in the community. The plan must include the following:
- ways to protect oneself and others, including considerations in the event of illness, such as finding a room in which to self-isolate
- measures to be taken in case of exposure or the appearance of symptoms
- what to do when receiving a positive SARS-CoV-2 test result
- Individuals should share their COVID-19 plan with their family, friends and caregivers so they can support prevention and preparedness steps. CDC suggests that people think about how others can help them when they get sick. It’s important to stick to treatment plans, keep routine care appointments, and make sure prescriptions are filled. Individuals should make alternate plans for work, childcare, and other responsibilities that may cause stress if they become ill.
Masks or respirators¶
- Masks are made to contain droplets and particles that people inhale, cough or sneeze. Various masks are available. Some masks offer a higher level of protection than others. Wearing a mask with the best fit and comfort provides the best protection.**
- Respirators (e.g. N95 and NIOSH-approved KN95) provide higher protection than masks.†† Respirators are made to protect individuals by fitting closely to their face to filter out particles including SARS-CoV-2. They can also block droplets and particles that a person inhales, coughs or sneezes to limit transmission to others. NIOSH approves many types of filter face masks. The most commonly available are N95 respirators, but other types (N99, N100, P95, P99, P100, R95, R99 and R100) provide the same or better protection as an N95 respirator.
Physical distance
- Small particles that people exhale can contain virus particles. The closer a person is to other individuals, the higher the risk of exposure to SARS-CoV-2. Individuals can minimize the risk of exposure by avoiding crowded indoor areas or by maintaining a distance of ≥6 ft (1.8 m) from others. Such actions must be weighed against the risks of avoiding such activities.
Ventilation§§
- Opening windows and doors to bring as much fresh air into the home as possible (weather permitting) can improve ventilation.
- Portable, high-efficiency particulate air purifiers are useful when a home is not equipped with an HVAC system.
- Exhaust fans and other ventilators can improve airflow.
- In homes where HVAC fan operation can be controlled by a thermostat, the fan should be set to “on” rather than “automatic” when others are visiting. This allows the fan to run continuously, even when the heating or air conditioning is not on, to ensure that the HVAC system provides continuous airflow and filtration.
Time outdoors
- Spending time outdoors, if possible, rather than indoors, can also help reduce transmission. Viral particles spread more easily between individuals indoors than outdoors.
Wash hands
- Regular hand washing with soap and water, preferably, or using a hand sanitizer containing ≥60% alcohol can reduce the risk of many diseases, including COVID-19.
Testing for SARS-CoV-2¶¶
- Individuals should get tested if they have symptoms of COVID-19. Viral tests are used for SARS-CoV-2 detection. There are two types of virus tests: rapid tests and laboratory tests. These tests may use nose, throat, or saliva samples. Individuals can take measures to reduce further transmission if they are aware of their SARS-CoV-2 infection.
- Free home tests*** are available. Individuals should contact their health insurance, Medicaid, or Medicare plan to find out what tests are available.††† People with disabilities can get help from the Disability Information and Access Line§§§ to access a test or to identify an accessible test location.
- Individuals should be aware of free or low cost testing sites¶¶¶ that are near their home.
Treatment of covid19****
- Individuals should contact their healthcare provider, health department or community health center†††† to learn more about treatment options. Treatment must be started within 5-7 days of the onset of symptoms to be effective.
- Community Test to treat locations§§§§ can be consulted if individuals cannot reach or have their healthcare provider. These sites offer tests and prescriptions from a healthcare provider (on site or via telehealth) and dispense medications.
- Antiviral treatments are available for individuals with mild to moderate COVID-19 symptoms who are at high risk of progression to serious illness, hospitalization, and death. People are at high risk of disease if they
- be ≥50 years old
- have an underlying health condition,¶¶¶¶ especially moderate to severe immunosuppression
- are not vaccinated
- Individuals who are immunocompromised should discuss a treatment plan with their doctor and determine which COVID-19 treatment is best for them. Some individuals with COVID-19 who are immunocompromised or on immunosuppressive treatment may benefit from convalescent plasma treatment.*****
- CDC recommends that immunocompromised individuals with COVID-19 be isolated for ≥10 days and contact their healthcare provider before ending isolation.†††††
Abbreviations: HVAC = heating, ventilation and air conditioning; NIOSH = National Institute for Occupational Safety and Health.
* https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html
† https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
§ https://www.cdc.gov/coronavirus/2019-ncov/downloads/needs-extra-precautions/FS_COVID_Plan_FINAL.pdf
¶ https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html
** Individuals who are deaf or hard of hearing may request a clear mask to aid in lip reading or seeing facial expressions. Individuals with sensory or intellectual and developmental disabilities may not be able to wear masks and should consider face shields.
†† Individuals with severe breathing impairment (e.g., shortness of breath with minimal exertion or supplemental oxygen consumption) should consult a health care professional regarding the use of an N95 respirator. Some N95 respirators may contain latex. Individuals with allergies to natural rubber latex should refer to the manufacturer’s website for information on the specific model.
§§ https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/Improving-Ventilation-Home.html; https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html
¶¶ https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html
*** https://special.usps.com/testkits
††† https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free
§§§ https://acl.gov/DIAL
¶¶¶ https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html
**** https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html
†††† https://data.hrsa.gov/data/reports/datagrid?gridName=FQHCs
§§§§ https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com/
¶¶¶¶ https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html
***** https://www.fda.gov/media/136798/download
††††† https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html