Visiting my immunocompromised friend safely after my COVID infection
August 30, 2021 12:57 PM Subscribe
I had COVID this past week (I am guessing Delta, since I'm fully vaccinated with a confirmatory positive antibody test in June, but my PCR did not distinguish between Delta or other variants). Today is my last day of quarantine. How safe/risky would it be for me to fly sometime in the next month or two from Seattle to Chicago to visit my (vaccinated) best friend who has lupus and is on outpatient chemo?
I have not seen my best friend since COVID started. We miss each other. Also, her dad just died from cancer and she could use some support. She initially wanted to fly out to visit me after getting her vaccine, but I strongly discouraged her because of her health situation. Now that I've had a COVID infection and recovered, is it (weirdly) safer for *me* to fly to visit *her*? Or is this still a big risk and a bad idea?
I have been pestering her to get an antibody titer to determine if she is producing antibodies to the spike protein, but I don't think she has done that yet. However, I'm happy to entertain different risk/decision scenarios based on what her test results turn out to be.
Citations of journal articles or scientific sources appreciated.
I have not seen my best friend since COVID started. We miss each other. Also, her dad just died from cancer and she could use some support. She initially wanted to fly out to visit me after getting her vaccine, but I strongly discouraged her because of her health situation. Now that I've had a COVID infection and recovered, is it (weirdly) safer for *me* to fly to visit *her*? Or is this still a big risk and a bad idea?
I have been pestering her to get an antibody titer to determine if she is producing antibodies to the spike protein, but I don't think she has done that yet. However, I'm happy to entertain different risk/decision scenarios based on what her test results turn out to be.
Citations of journal articles or scientific sources appreciated.
If I understand your question, you're asking how likely it is for somebody who recently recovered from covid to catch it again? And you think that maybe the period after you're no longer contagious + while your immune system has recently beat it is good timing for a visit?
I think there are two separate questions that you can answer:
1) Can you know for sure that you're no longer contagious?
2) How much does vaccination + infection protect you from repeat infection?
Both of those are different from the generic "I'm vaccinated, what are the odds" that I've seen numbers floating around for, but unfortunately, I'm not familiar with the literature to provide citations for you.
The third question is for your friend -- how badly does she want to see you, and what risk level is she OK with?
And could you modify your visit to be worthwhile even if you're never indoors with her?
posted by Metasyntactic at 2:05 PM on August 30, 2021
I think there are two separate questions that you can answer:
1) Can you know for sure that you're no longer contagious?
2) How much does vaccination + infection protect you from repeat infection?
Both of those are different from the generic "I'm vaccinated, what are the odds" that I've seen numbers floating around for, but unfortunately, I'm not familiar with the literature to provide citations for you.
The third question is for your friend -- how badly does she want to see you, and what risk level is she OK with?
And could you modify your visit to be worthwhile even if you're never indoors with her?
posted by Metasyntactic at 2:05 PM on August 30, 2021
Your friend who is likely eligible for a booster and should get one, should also ask her docs about the scenario you are suggesting, and should make her own decision on risk. BUT if your question is about your own risk, you are correct that per available research, your status as someone who is both fully vaccinated and has recently had a COVID vaccination makes your risk of re-infection very low, especially if you continue to mask when you're in group settings indoors.
The researchers also found that people who had SARS-CoV-2 previously and received one dose of the Pfizer-BioNTech messenger RNA (mRNA) vaccine were more highly protected against reinfection than those who once had the virus and were still unvaccinated. (mostly about people who got infection first then vaccine instead of opposite order).
Antibody testing is not recommended as a method of assessing your risk.
posted by latkes at 3:10 PM on August 30, 2021 [3 favorites]
The researchers also found that people who had SARS-CoV-2 previously and received one dose of the Pfizer-BioNTech messenger RNA (mRNA) vaccine were more highly protected against reinfection than those who once had the virus and were still unvaccinated. (mostly about people who got infection first then vaccine instead of opposite order).
Antibody testing is not recommended as a method of assessing your risk.
posted by latkes at 3:10 PM on August 30, 2021 [3 favorites]
Response by poster: Working through the links, thank you all!
Quick clarification: My question is about *her* risk. She does not have an oncologist, but she does have a nephrologist -- this is lupus, not cancer, but I think the risks are similar. I will suggest she ask her provider for details.
She is the one pushing for a visit but I care about her and don't want to risk making her sick.
posted by cnidaria at 3:33 PM on August 30, 2021 [1 favorite]
Quick clarification: My question is about *her* risk. She does not have an oncologist, but she does have a nephrologist -- this is lupus, not cancer, but I think the risks are similar. I will suggest she ask her provider for details.
She is the one pushing for a visit but I care about her and don't want to risk making her sick.
posted by cnidaria at 3:33 PM on August 30, 2021 [1 favorite]
I am guessing Delta, since ...
Delta is so extremely successful that it's effectively pushed other older variants out of the picture and now accounts for virtually 100% of new infections in the US (whether in Washington or otherwise). (scroll down to the Variants graphs). Your guess is a good one, regardless of your vaccination status.
posted by aubilenon at 3:47 PM on August 30, 2021 [1 favorite]
Delta is so extremely successful that it's effectively pushed other older variants out of the picture and now accounts for virtually 100% of new infections in the US (whether in Washington or otherwise). (scroll down to the Variants graphs). Your guess is a good one, regardless of your vaccination status.
posted by aubilenon at 3:47 PM on August 30, 2021 [1 favorite]
Are you sure it's chemo your friend gets? Rituxan, aka rituximab, is an immunotherapy infusion given in a chemotherapy setting to lupus patients, but it's not chemo per se (according to my understanding).
According to this article, safety factors could depend on when your friend got the vaccination:
"In the vaccine clinical guidance by the ACR [5], patients with a low or mitigatable risk of COVID-19 should have their vaccination scheduled ∼4 weeks before their next scheduled rituximab cycle; and after the completion of vaccination, should delay rituximab for 2–4 weeks after the second vaccine dose, if disease activity allows."
https://academic.oup.com/rheumap/article/5/2/rkab038/6290723
posted by Leontine at 4:58 PM on August 30, 2021 [1 favorite]
According to this article, safety factors could depend on when your friend got the vaccination:
"In the vaccine clinical guidance by the ACR [5], patients with a low or mitigatable risk of COVID-19 should have their vaccination scheduled ∼4 weeks before their next scheduled rituximab cycle; and after the completion of vaccination, should delay rituximab for 2–4 weeks after the second vaccine dose, if disease activity allows."
https://academic.oup.com/rheumap/article/5/2/rkab038/6290723
posted by Leontine at 4:58 PM on August 30, 2021 [1 favorite]
cnidaria, Covid-19 and your best friend's vaccine effectiveness/timing/dosing aside, I think there's a risk to her health in general if you visit in the next couple of months?
She's already immunocompromised, and undergoing infusions for lupus. Whether she's receiving, say, Rituxan (generic: rituximab; a monoclonal antibody also used in the treatment of lymphoma, leukemia, and transplant rejection), Cytoxan (cyclophosphamide; first developed as a chemotherapy drug), Cellcept (mycophenolate mofetil; another anti-transplant-rejection drug, it's infused if it's not tolerated orally) or Benlysta (belimumab; the first drug developed specifically for lupus, it's a monoclonal antibody treatment), they're immunosuppressant drugs, and all immunosuppressant drugs carry the serious risk of infection, even though rx for autoimmune disease differs from cancer therapy. The nephrologist prescribed this course of treatment because of specific lupus activity. Yes, please ask her to get more details from her provider, and you need more information from your friend. Best wishes.
posted by Iris Gambol at 7:30 PM on August 30, 2021 [1 favorite]
She's already immunocompromised, and undergoing infusions for lupus. Whether she's receiving, say, Rituxan (generic: rituximab; a monoclonal antibody also used in the treatment of lymphoma, leukemia, and transplant rejection), Cytoxan (cyclophosphamide; first developed as a chemotherapy drug), Cellcept (mycophenolate mofetil; another anti-transplant-rejection drug, it's infused if it's not tolerated orally) or Benlysta (belimumab; the first drug developed specifically for lupus, it's a monoclonal antibody treatment), they're immunosuppressant drugs, and all immunosuppressant drugs carry the serious risk of infection, even though rx for autoimmune disease differs from cancer therapy. The nephrologist prescribed this course of treatment because of specific lupus activity. Yes, please ask her to get more details from her provider, and you need more information from your friend. Best wishes.
posted by Iris Gambol at 7:30 PM on August 30, 2021 [1 favorite]
Response by poster: Iris Gambol -- she's been on outpatient chemo for a year and a half and has at least another six months to go, possibly another 18 months depending on how it goes. She works from home, but goes out to eat and lives with her girlfriend, and regularly visits unmasked with her large multi-generational family. Early in COVID she very isolated and locked down, but I think she's gotten tired of restrictions. It's complicated :-/ Hopefully her provider will have more info.
posted by cnidaria at 8:24 PM on August 30, 2021 [1 favorite]
posted by cnidaria at 8:24 PM on August 30, 2021 [1 favorite]
Yeah ultimately your friend decides her own risk. There are many unknowns and even the rheumatologists and pharmacists are making informed conjectures. I would consider releasing yourself of being responsible for her choice, as good as your intent is.
posted by latkes at 8:48 PM on August 30, 2021 [1 favorite]
posted by latkes at 8:48 PM on August 30, 2021 [1 favorite]
If your friend is doing the social activities you say she is, I don't think you going to visit is going to increase her risk of getting covid very much at all. If you want to be extra safe, take a covid test before you visit her. I just saw some for sale at the CVS by me. In general, the people on metafilter are very risk-averse to the point that they discount the mental health aspects of lockdown. I'm sure I am not alone in feeling the hopelessness of the situation we are in. My mental health cannot stand not seeing my friends. You can keep asking yourself, when will it be safe? I think the answer is never. We are going to have to assume a certain degree of risk at some point. This internet stranger says go see your friend, sooner rather than later while you can still spend time outside for a little added safety (and you are recently recovered from the 'vid, so you are highly unlikely to catch it again).
posted by DEiBnL13 at 9:07 PM on August 30, 2021 [13 favorites]
posted by DEiBnL13 at 9:07 PM on August 30, 2021 [13 favorites]
This thread is closed to new comments.
I'm in a similarly vulnerable group and my doctors have been super forthcoming about determining activity risk based on my risk level and theirs. fwiw, I'm being told by my infectious diseases dept not to worry about getting antibody testing done at this point, as they say it's not entirely clear yet just how much antibody/tcell activity is actually helpful for patients like me.
As a datapoint (transplant and on immunosuppressants, just got third moderna dose) I'm only able to see people distanced, outdoors, in small gatherings. I'm able to make quick, infrequent visits to uncrowded shops in an N95 at off-hours. I'm able have a relative indoors, but only when this relative has been isolating/fully masked around anyone else and taking on only low risk activities themselves. Again, the guidance I'm being given here from my hospital system, in Colorado, and to me specifically may or may not be the guidance your best friend is receiving, but I'm mentioning it just to give you an idea of the advice being given to a medically vulnerable patient as of this month. All the best.
posted by mochapickle at 1:48 PM on August 30, 2021 [15 favorites]