Information for immunocompromised persons regarding prevention and treatment of SARS-CoV-2 infection in the context of Omicron’s currently circulating substrains – US, January 2023

can. Prevention measures against SARS-CoV-2 for immunocompromised persons, their family members, and close contacts in the context of the currently circulating substrains of Omicron – United States, January 2023

Because Evusheld is not currently authorized for prior exposure prevention against SARS-CoV-2 infection in the United States, it is important that people who are moderately to severely immunocompromised,* those who may have an inadequate immune response to COVID-19 vaccination, 19, and those with a contraindication to receiving COVID-19 vaccines, exercise caution and recognize the need for additional protective measures to protect themselves from SARS-CoV-2 infection. Immunocompromised people, their family members, and close contacts can use the following steps and precautions to help prevent SARS-CoV-2 infection and mitigate COVID-19 disease if they become infected.

COVID-19 Vaccines, Booster Shots, and Staying Up-to-Date*

• COVID-19 vaccines remain the best way to prevent severe COVID-19. COVID-19 vaccines help the body develop protection against SARS-CoV-2 infection. Although vaccinated people sometimes get SARS-CoV-2, staying up to date with COVID-19 vaccines greatly reduces the risk of serious illness, hospitalization, or death from COVID-19.
• The CDC recommends that all eligible persons, especially those who are immunocompromised or have a weakened immune system,^† Have an updated booster dose (bivalent) and keep up to date with their COVID-19 vaccinations.

Personal COVID-19 Action Plan^§

• People should consider how they can protect themselves and others around them if they become ill with COVID-19 or if the level of transmission of COVID-19 in the community changes. The plan must include:
  • Ways to protect yourself and others including considerations in case of illness, such as finding a room for isolation
  • Actions to be taken in the event of exposure or symptoms
  • What to do if you receive a positive SARS-CoV-2 test result
• People should share their COVID-19 plan with their family, friends and healthcare providers so they can support prevention and preparedness steps. The CDC suggests that people think about how others can help them if they get sick. It’s important to stick to treatment plans, keep routine healthcare appointments, and make sure prescriptions are filled. People should make alternate plans for work, child care, and other responsibilities that might cause stress if they get sick.

Masks or masks^¶

• Masks are made to contain droplets and particles that people breathe in, cough out, or sneeze. A variety of masks are available. Some masks provide a higher level of protection than others. Wearing the mask with the best fit and comfort provides the best protection. **
• Respirators (for example, NIOSH-approved N95 and KN95) provide higher protection than masks.^†† Respirators are made to protect people by fitting closely to their face to filter out particles, including SARS-CoV-2. They can also block droplets and particles that a person breathes in, coughs, or sneezes to reduce transmission to others. NIOSH approves many types of facial respirators. The most widely used are N95 respirators, but other types (N99, N100, P95, P99, P100, R95, R99, and R100) provide the same or better protection as the N95 respirator.

physical distancing

• Small particles that people exhale can contain viral particles. The closer a person is to other people, the greater the risk of exposure to SARS-CoV-2. People can reduce exposure risks by avoiding crowded indoor spaces or maintaining a distance of 6 feet (1.8 meters) from others. These actions must be weighed against the risks of avoiding such activities.

Breathing^§§

• Opening windows and doors to bring as much fresh air into the house as possible (weather permitting) can also improve ventilation.
• High-efficiency portable air cleaners are useful if the home is not equipped with an HVAC system.
• Exhaust fans and other fans can improve airflow.
• In homes where HVAC fan operation can be controlled by a thermostat, the fan should be set to “on” instead of “auto” when others are visiting. This allows the fan to run continuously, even when the heating or air conditioning is not running, to ensure that the HVAC system provides continuous air flow and filtration.

Spending time outdoors

• Spending time outdoors, when possible, rather than indoors, can help reduce transmission. Viral particles spread between people more easily indoors than outdoors.

cleaning hands

• Frequent hand washing with soap and water, preferably, or using a hand sanitizer that contains 60% alcohol can reduce the risk of contracting many diseases, including COVID-19.

SARS-CoV-2 test^¶¶

• People should get tested if they have symptoms of COVID-19. Viral tests are used to detect SARS-CoV-2. There are two types of viral tests: rapid tests and lab tests. These tests may use samples from the nose, throat, or saliva. People can take action to reduce further transmission if they are aware of their SARS-CoV-2 infection.
• FREE AT HOME TESTS*** AVAILABLE. People should check with their health insurance, Medicaid or Medicare plan to see what tests are available.^††† People with disabilities can receive assistance from the Disability Information and Access Line^§§§ To access a test or locate an accessible test.
• People should be aware of free or low cost testing sites^¶¶¶ located near their homes.

Treating COVID-19****

• People should contact their healthcare provider, health department, or community health center^†††† To learn about treatment options. Treatment must begin within 5-7 days after the onset of symptoms in order to be effective.
• Community test treatment sites^§§§§ It can be accessed if or when people do not have access to their healthcare provider or do not have one. These sites offer tests and prescriptions from a health care provider (either on-site or via telehealth) and dispense medications.
• Antiviral treatments are available for people with mild to moderate symptoms of COVID-19 who are at high risk of progression to severe illness, hospitalization, and death. People are at risk of contracting diseases if they are
  • They are ≥50 years old
  • have an underlying health condition,^¶¶¶¶ Particularly moderate to severe immunosuppressants
  • Not vaccinated
• People who are immunocompromised should discuss a treatment plan with their doctor and decide which COVID-19 treatment is best for them. Some people with COVID-19 who are immunocompromised or receiving immunosuppressive treatment may benefit from convalescent plasma therapy.
• The CDC recommends that immunocompromised people with COVID-19 isolate for 10 days and check with 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-precisions/people-with-medical-conditions.html

^§ https://www.cdc.gov/coronavirus/2019-ncov/downloads/needs-extra-precisions/FS_COVID_Plan_FINAL.pdf

^¶ https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html

**People who are deaf or hard of hearing may request a clear mask to help with lip reading or seeing facial expressions. People with sensory impairments or intellectual and developmental disabilities may not be able to wear masks and should consider using face shields.

^†† People with severe respiratory impairment (such as shortness of breath with minimal exertion or use of supplemental oxygen) should consult a healthcare provider regarding use of an N95 respirator. Some N95 respirators may contain latex. People allergic to natural rubber 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