What to Do If You’re Immunocompromised and Were Around Crowds for the Holidays

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You may try to take every step possible to mitigate your risk of contracting COVID-19 or the flu if you’re immunocompromised and high-risk for complications, but sometimes, certain risky situations are inevitable — especially during the holiday season.  

Perhaps a loved one you celebrated with tested negative for COVID-19 before seeing you, but later developed symptoms during or shortly after your visit. Or maybe your flight home got canceled and you spent more time waiting around crowds than you anticipated. 

“We do expect some people who’ve been traveling to have acquired infection during their holiday sojourn,” says William Schaffner, MD, professor of infectious disease at Vanderbilt University Medical Center.  

However, there are four simple steps you can take to protect yourself. Importantly, don’t be hard on yourself: It’s difficult to avoid all COVID-19 or flu risks, especially as the general population continues to shed masks and largely returns to the normalcy of pre-COVID times.  

Simply by reading this article, you’re taking steps to keep yourself (and those around you) healthy, and that’s something to be proud of.   

Step 1: Evaluate Your Layers of Protection

Ideally, you already received all of your COVID-19 vaccines, booster shots, and the flu shot — plus Evusheld, a monoclonal antibody treatment meant to prevent COVID-19. But if you haven’t already, now is the time to do so.  

“At the current time, there is not really a post-exposure prophylactic available for COVID-19,” says infectious disease physician Amesh A. Adalja, MD, a Senior Scholar at Johns Hopkins Center for Health Security. “Evusheld may have some benefit if administered immediately, however, newer variants have diminished its potency.”  

It’s worth noting that Evusheld is not currently authorized to treat COVID-19 or for post-exposure prevention, so it’s best to get it before you encounter someone who’s infected. Plus, in November, the National Institutes of Health (NIH) noted that the COVID-19 subvariants BA.4.6, BA.2.75.2, BA.5.2.6, BF.7, BQ.1, and BQ.1.1 are likely to be resistant to Evusheld. The circulation of these Omicron subvariants has been increasing in the United States, per the NIH.  

Still, some protection is better than none — and Evusheld is the only agent authorized by the Food and Drug Administration for use as pre-exposure prevention of COVID-19 in people who are not expected to mount an adequate immune response to vaccination or those who have contraindications. 

This includes patients actively being treated with high-dose corticosteroids (i.e., 20 or more milligrams of prednisone or equivalent per day when administered for two or more weeks), tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory, per the U.S. Centers for Disease Control and Prevention (CDC).   

Evusheld is given as two separate consecutive injections — one per monoclonal antibody, in which one is given immediately after the other. The two monoclonal antibodies, tixagevimab and cilgavimab, are meant to directly target the spike protein of SARS-CoV-2 and block the virus’ attachment to your cells.  

They bind to different sites (which don’t overlap) on the spike protein of the virus — and they can help neutralize the virus and block it from infecting the cells in your body. Learn more about Evusheld.  

Step 2: Test Yourself for COVID-19 Liberally

Stock up on at-home COVID tests if you can (every U.S. household is now eligible to order four free at-home COVID-19 tests; you can do so here).  

“I would recommend that you have a very low threshold to test yourself for COVID-19,” says Dr. Adalja.  

In other words, test yourself if it’s at all possible you were exposed — and continue to test. If you were exposed to someone with COVID-19, test at least five days after exposure. If you test negative, consider testing again in one two days, per the CDC.  

If you develop any symptoms of COVID-19, test yourself immediately or contact your doctor. Symptoms may include: 

• Fever or chills 
• Cough 
• Shortness of breath or difficulty breathing 
• Fatigue 
• Muscle or body aches 
• Headache 
• New loss of taste or smell 
• Sore throat 
• Congestion or runny nose 
• Nausea or vomiting 
• Diarrhea 

Keep in mind that you can’t tell the difference between the seasonal flu and COVID-19 based on symptoms alone, since some of the symptoms are the same, per the CDC. When in doubt, call your doctor to get tested or at least test yourself at home for COVID-19. 

“The single most important thing you can do is immediately contact your health care provider, because given that you’re immunocompromised and high-risk, they’ll want to do testing to see if you have flu or COVID,” says Dr. Schaffner. “We have medicines like Paxlovid for COVID-19 and Tamiflu and other antivirals for influenza that can help reduce the severity of your illness.”  

If you have symptoms like trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, or pale/gray/blue-colored skin, lips, or nail beds (this will vary depending on your skin tone), call 911 or head to a local emergency room right away. 

Step 3: Speak to Your Doctor About Paxlovid

If you test positive for COVID-19, immediately speak to your doctor about Paxlovid. There is a short window to take this antiviral pill: within five days after symptom onset.  

In fact, it’s a good idea to speak with your doctor about how you’ll get Paxlovid before you even test positive. For instance, will you need a local pharmacy to deliver it to you if you’re quarantining, and how long will that take?

“Have a plan to have early access to Paxlovid if you do test positive,” says Dr. Adalja.  

Paxlovid comes in a total of 30 pills — three taken twice daily for five days. Each three-pill dose includes nirmatrelvir (two pills) and ritonavir (one pill).  

Nirmatrelvir prevents the SARS-Cov-2 protein from replicating, while ritonavir helps to boost levels of antiviral medicines and thwarts nirmatrelvir’s metabolism in the liver, per Yale Medicine. This helps nirmatrelvir stay in your body for longer and extends the amount of time it works for, giving you extra potency in fighting the infection. (Here’s everything you need to know if you’re prescribed Paxlovid as an immunocompromised patient.)  

The same goes for antivirals like Tamiflu: Talk to your doctor about what your course of action will be if you get sick and need medication for the flu.  

Step 4: Maintain Your Overall Health

Although there’s no magic pill for avoiding COVID-19, managing underlying conditions and maintaining healthy habits that support your immune system may help you fare better if you do get infected.  

Taking your medications as instructed and staying up-to-date on your vaccines will help fortify your immune system this winter. Even if you’re immunocompromised and may not mount a full response to vaccines, experts agree that vaccines may offer protection in a variety of ways — and that some protection is better than none.  

According to Houston Methodist, simple everyday routines can also boost your immune system, including: 

• Exercising, which mobilizes immune cells and helps them to better detect and react to infection 
• Getting enough sleep, which promotes your immune system’s homeostasis 
• Minimizing stress, which can otherwise hamper your healthy habits like sleeping or eating well 
• Choosing healthy foods like vegetables, fruits, legumes, whole grains, lean proteins, and healthy fats, which support your immune system with micronutrients like vitamin B6, vitamin C, vitamin E, zinc, and magnesium 
• Staying hydrated, which improves the circulation of immune cell-filled blood and lymph  

“This is a good time to keep your fluids up,” says Dr. Schaffner. “It’s important whether you’re feeling symptoms or not, but if you’re not feeling well, it’ll help prevent the development of complicating pneumonia.” 

And although a nutritious diet is an important part of your overall health, be wary of supplements that claim to ward off COVID-19 or other infections more than a healthy diet would. “There is no convincing data that supplementation of any sort has an impact on COVID-19,” says Dr. Adalja.  

Some data has shown that vitamin D status could impact one’s susceptibility to respiratory viruses, but the results are varied and more research is needed.  

Patients with a “likely deficient” vitamin D status had nearly twice the likelihood of testing positive for COVID-19 compared to those with a “likely sufficient” vitamin D status, per a 2020 study on a single testing center published in the journal JAMA Network Open. 

However, in a 2022 study published in The BMJ, researchers found that vitamin D supplementation was not associated with a reduction in risk of all-cause acute respiratory tract infection or COVID-19.   

“There are some studies to show that taking vitamin D tablets will not prevent or ameliorate your COVID infection,” says Dr. Schaffner. “Don’t think that’s going to give you a coat of armor.”  

You should speak to your doctor before starting any new supplements to ensure they don’t interact with your current medications (and that you actually need them — supplements can be expensive, and oftentimes the research behind them is inconclusive).  

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