COVID-19 FAQs: Infection Risk and Prevention

News, scientific understanding and guidelines about COVID-19 are continually evolving. The information on this page was current as of January 3, 2023. 

Question: Can I be infected if I’ve already had COVID-19 or have been vaccinated?

A: The short answer is yes. Vaccines and boosters have helped prevent serious illness and death, even among immunocompromised patients. One computer model suggests they may have saved three million lives. But because new variants are better at dodging immunity from past infections or vaccines, breakthrough infections and reinfections are increasingly common. 

For example, two doses of the original Moderna and Pfizer vaccines didn’t provide much protection against the first omicron subvariant. Both drug makers have since developed a booster that targets the original coronavirus strain as well as omicron subvariants (known as a bivalent booster). Studies published by the Centers for Disease Control and Prevention (CDC) in December 2022 found that adults receiving the bivalent booster were more likely to avoid hospitalization than those who were unvaccinated or had received up to four doses of the original vaccine. 

By the time these studies were published, however, new omicron subvariants had emerged, including XBB.1.5, which accounted for 40% of COVID-19 cases in the U.S. at the end of December 2022. XBB.1.5 seems even better at getting around vaccine immunity than other omicron subvariants. 

Data also continue to suggest that people who are immunocompromised or take immune-suppressing drugs are at a “substantial risk” of reinfection, regardless of vaccination status. And a second or third infection can be more serious than the first. A study involving nearly six million people drawn from a Veterans’ Affairs health database found that reinfection carries a higher risk of severe health complications and death — at least for older white men, who were the largest group in the study. Those risks increase with each reinfection.

Whether reinfection carries a higher risk of developing long COVID is unknown, but health experts agree that the best strategy is to avoid getting another infection as much as possible. This means staying up to date with vaccines and boosters and masking indoors in crowded spaces when COVID cases are high. 

Question: What does the CDC masking guidance mean for people with inflammatory arthritis?

A: CDC masking guidelines have changed over time. No matter what the CDC recommends, many health experts advise people to consider their personal risk of developing severe COVID and talk to their doctor before ditching masks. This includes patients on immunosuppressive medications, says William Hayes Wilson, MD, chief of rheumatology at Piedmont Hospital in Atlanta.

The decision to unmask also depends on the level of risk you're willing to take, as well as your environment, says Liana Fraenkel, MD, an adjunct professor at the Yale School of Medicine. 

“You have to consider your particular level of immunosuppression and ask yourself other questions,” says Dr. Fraenkel. “Who are you going to be surrounded with? Are the rates low in your community? Where are you going? The risks of going to a crowded restaurant are different than going to a park. And lastly, what are your trade-offs? Is this something that’s worth the risk, like a family reunion, or something that can be postponed?”  

There are several helpful online tools to help you calculate your risk, including Georgia Tech’s COVID-19 Event Risk Tool.

“The reality is that COVID will be with us in some form or fashion over the next several years, and all of us are going to have to get used to risk-calculating based on our current environment,” says Michael Saag, MD, a professor and associate dean for global health in the University of Alabama at Birmingham School of Medicine.

“While preventing infection is ideal, the most important thing to do is monitor yourself and get tested right away if you have symptoms, especially if you’re on immunomodulating drugs,” he says. 

Question: How can people with arthritis and autoimmune conditions protect themselves from COVID-19 infection? 

A: Getting vaccinated and boosted is still a good way to protect yourself from infection and from hospitalization or severe outcomes from COVID-19. But vaccine effectiveness wanes after a few months, and people with autoimmune diseases who take immunosuppressive medications may not get full protection to begin with. Evolving viruses are also more resistant to vaccines.

Evusheld, a combination of two monoclonal antibodies, was designed to get around some of these problems and help prevent COVID-19 infection in immunocompromised patients who don’t respond to vaccines. Still, by late December 2022, many rapidly spreading omicron subvariants were able to successfully evade Evusheld, according to a recent analysis, so it’s still important to take practical precautions in situations where you might be exposed, including masking. 

Question: Am I more likely to have complications from the virus if I have autoimmune or inflammatory arthritis?

A: So far, studies don’t seem to show that people with inflammatory arthritis are more likely to have COVID-19 complications but having additional health conditions, like obesity and diabetes, or high disease activity may increase the risk. To help manage arthritis and other health problems, get plenty of sleep and daily exercise and stick to an anti-inflammatory diet as much as possible. 

Question: Do arthritis medications increase infection risks?

A: The risk from arthritis drugs isn’t entirely clear. Higher-dose corticosteroids — more than 10 mg a day — significantly increase the chance of hospitalization. A large study early in the pandemic found an association between poor outcomes and conventional disease-modifying antirheumatic drugs (DMARDs) or combined biologics and conventional DMARDs, but not with methotrexate or TNF blockers alone. Talk to your doctor about the benefits vs. the risks of any drugs you take.