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 get infected with COVID-19 after I get vaccinated?

A: The short answer is yes, but all three COVID-19 vaccines on the market provide exceptional protection against severe illness and hospitalization. 

Many people think of vaccines as shields from viruses, but this isn’t always the case. For some, vaccines only protect against symptoms and disease, not necessarily infection. In other words, it’s possible that a vaccinated person may still get infected with a virus but not get sick or only experience mild or moderate symptoms.

Although vaccines don’t always prevent infection, they prime your immune system to quickly fight the virus and protect you from the worst outcomes of disease.

Question: Can I still spread COVID-19 after getting vaccinated?

A: Yes, but getting vaccinated likely reduces your ability to spread the virus. In a recent study, which has yet to be peer reviewed, Israeli researchers tested 2,897 vaccinated people for the coronavirus. While most of the participants tested negative, those who tested positive had a quarter of the amount of virus in their bodies compared to unvaccinated people who also tested positive.

In general, vaccines help reduce how much virus lives in your body and the amount of virus you “shed” from your nose and mouth, but researchers still aren’t sure how much coronavirus it takes to infect another person.

As such, the CDC advises to continue to social distance and wear masks even after you’re vaccinated to protect others.

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 all three COVID-19 vaccines on the market have been shown to be highly protective against severe illness and hospitalization, getting vaccinated doesn’t mean you’ll be able to ditch masks and social distancing right away.

Clinical trials only studied whether vaccines prevented symptoms and illness, not infection. In other words, even if you get vaccinated and are protected from the worst effects of the disease, there’s still a chance you may get a mild or asymptomatic infection and transmit the virus to others without knowing it.

However,evidence has researchers believing these vaccines likely reduce transmission and new data from Israel’s Ministry of Health about the Pfizer/BioNTech vaccine shows that the vaccine is about 94% effective in stopping asymptomatic infections. Still, more data is needed, and the study could not draw any conclusions about transmission rates about the Moderna, Inc. and Johnson & Johnson vaccines.

Even so, as vaccine distribution ramps up, health experts are expanding their definition of safe behaviors for fully vaccinated people. In a guidance released March 8, the CDC updated its recommendations to say that fully vaccinated people can now:

• Gather indoors with fully vaccinated people without wearing a mask.

• Gather indoors with unvaccinated people from one other household without masks, unless any of those people or anyone they live with is at an increased risk for severe illness from COVID-19.

This new guidance is encouraging, but health experts say it’s best to think of the road returning to “normal life” as a light dimmer, not a light switch. Until we know more about how the virus spreads in vaccinated people and vaccine efficacy in new variants, the CDC still recommends wearing a mask in public, avoiding crowds and poorly ventilated spaces. They also advise against gathering indoors with more than one vaccinated household at a time.

It’s also important to remember that these guidances are not hard and fast rules, and what’s safe behavior varies from person to person. Even if you get vaccinated, there is still a risk that you may get sick, so talk to your healthcare provider after vaccination to weigh the pros and cons of expanding your social bubble.

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: Are the COVID-19 vaccines safe for children with JA?

A: So far, the FDA has only issued emergency use authorization for the Pfizer-BioNtech vaccine for children 12 to15 years old. The company’s vaccine was already authorized for teens 16 years and older. Vaccines from Moderna and Johnson & Johnson are only authorized for adults 18 years and older. Clinical trials of the Moderna vaccine in kids and teens began in March.

Experts say that the data suggests the Pfizer vaccine is safe and effective for children in this age group. David Cennimo, MD, Associate Program Director of Internal Medicine and Pediatrics Residency Program at Rugters New Jersey Medical School, says the good track record in adults makes him willing to recommend the vaccine for his patients. Getting COVID-19 is far riskier than any potential side effects of getting the vaccine, says Randy Cron, MD, PhD, pediatric rheumatologist and Professor of Pediatrics and Medicine at the University of Alabama- Birmingham.

It’s important to note that children taking rituximab or daily glucocorticoids may not produce as strong of an immune response to the vaccine, therefore developing less protection against the virus.

Before getting your child vaccinated, discuss your child’s medications with his or her doctor. Your child’s doctor may decide to delay the timing of certain medications to enhance immune response to the vaccine.

Even though the Pfizer vaccine has earned EUA for kids and teens 12 to 15, that doesn’t mean it will immediately available for kids and teens everywhere. Check your state health department for more information.

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.