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After over two and a half years of dealing and coping with COVID-19—from lockdowns brought about by a pandemic, to more manageable but sporadic community surges—everyone is looking for simpler and more effective guidance to stay as safe as possible and to lessen anxiety in social settings. 

On Thursday, August 11, the Center for Disease Control and Prevention (CDC) issued streamlined COVID-19 guidance  “to help people better understand their risk, how to protect themselves and others, what actions to take if exposed to COVID-19, and what actions to take if they are sick or test positive for the virus,” states the CDC’s press release.  

Among the new CDC guidelines are updates on exposure links, factors that raise the risk of getting very sick from COVID-19, what to do if you’re exposed to COVID-19, and isolation and precautions for people with COVID-19. 

As Greta Massetti, PhD, MPH, MMWR author expressed: “This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”

Unfortunately, since we are not quite at that “point” yet, many rather complicated recommendations remain, and much is left to personal choice and guidance from the local community.  

Additionally, CDC Director Rochelle Walensky made a statement on Wednesday, August 17 saying that “the agency was undertaking a series of changes designed to make [the CDC] more nimble at responding, quicker at providing data and less focused on publishing fully vetted scientific papers,” as reported by Reuters. 

“For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations,” Director Walensky told CDC staff, adding that the CDC’s focus will be on “creating an ‘action-oriented’ culture that emphasizes accountability, collaboration, communication, and timeliness,” Reuters further reported. 

Based on the background briefing document shared by the CDC with Reuters, modernization plans will include providing the CDC “new authority to require states to report data and changes” to allow the agency to “hire staff more quickly and offer competitive salaries.” According to Reuters, both actions “will require authorization from Congress.”


Implications of Recommendations vs Mandates

The current assumption is that developing COVID-19 infection is no longer a big deal. Most infections will be mild, and guidance can be given to reduce spread to others as much as possible. Thus, strong mandates are no longer required, and a much more casual approach is now acceptable.

However, the situation is different for myeloma patients in two major ways:

1. Exposure to COVID-19 still poses increased risks and serious medical problems for the immunocompromised. 

Avoiding exposure to COVID-19 is still STRONGLY advised for myeloma patients, immunocompromised individuals, and those who have medical conditions that put them at increased risk. Serious medical problems as well as chronic COVID-19 re-infection are consequences which may emerge, if proper precautions are not exercised. 

2. Strategies and best practices to prevent COVID-19 infections still reduce risks and improve outcomes.

Best practices to fight COVID-19 infections such as vaccines, boosters, mask-wearing, getting tested, isolation and antiviral treatments such as Evusheld™ and Paxlovid™ are still HIGHLY RECOMMENDED for myeloma patients, especially as community levels of infection remain high and new variants continue to emerge. 

 

Adapting CDC COVID-19 Guidance for Myeloma Patients

Vaccination

It is extremely important for myeloma patients to stay up to date with their COVID-19 vaccinations and booster shots. The very good news is that omicron-specific boosters from both Pfizer and Moderna will become available soon—possibly, three weeks from now. Myeloma patients should sign up to receive these boosters as soon as they become available .

Follow-up data indicates that being vaccinated and boosted significantly reduces the risks of serious disease. Omicron-specific boosters will provide additional protection as new variants emerge.

Testing

If a patient is exposed to COVID-19, early testing is recommended. The anti-viral Paxlovid works best if administered right away, so it would be good to act quickly for treatment to become effective. Note that the CDC does not recommend this type of early testing broadly—not for exposed individuals without symptoms.

For individuals who test positive, isolation for at least 5 days is required. This is the closest there is to a mandate, in terms of the CDC’s new guidelines. Wearing a high-quality mask for a total of 10 days is also recommended, since it can take that long to become clear of infection. Testing along the way is more controversial, but two negative tests 48 hours apart can get you out of isolation sooner.

Quarantine is no longer required for individuals with a history of exposure, so it would be worth checking if new contacts have recently traveled or have had a history or the possibility of being exposed to COVID-19, since contact tracing is no longer occurring. These details are important to consider with respect to individuals you encounter in a social setting.

Evusheld

This intramuscular COVID antibody shot treatment is still recommended for the immunocompromised, such as myeloma patients. I have discussed this matter several times in the past. 

Community level of infection 

The level of infection in the community has become much more difficult to assess. The widespread us of at-home rapid antigen testing means that a majority of local infections are NOT being included in community statistics. It has been estimated that actual infections are about five times higher than reported community levels. 

Wastewater analyses may become the new standard of assessment as a more accurate indicator since it is also being used to monitor the occurrence of new variants. 

However, tracking community levels is still extremely important when it comes to assessing your risk in social settings. These levels determine if it is safe, for example, to stay indoors—whether a restaurant, an in-person meeting, a church service, or a celebration with a sizable crowd. 

Community standards

Since many CDC guidelines are flexible, what happens in many community settings—ranging from schools to summer camps to church services—is up to the discretion of local organizers. 

This really stresses the system since many groups do not have a reliable resource. A recent article from the L.A.Times discusses these dilemmas.

To make things more complicated, broad COVID-19 testing has become a costly expense—the major reason why schools have stopped mandatory testing programs. 

Additionally, checking of vaccination status is also no longer required although some unvaccinated individuals may still be subject to test-to-stay rules in some settings. 

That said, myeloma patients should most certainly be wary of making contact with the unvaccinated and those who may be seriously infected with COVID-19. I still strongly recommend masking up for optimum safety. 

Bottom Line

Despite concerns and cautions and the few prudent steps noted above, myeloma patients can still stay very safe.  

Stay strong and resilient by avoiding carelessness and complacency. The more protected you are from COVID-19, the better! 
 


Image of Dr. Brian G.M. DurieProfessor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels, Dr. Brian G.M. Durie is the Chairman of the Board and Chief Scientific Officer of the IMF. Dr. Durie is also the Chairman of the International Myeloma Working Group (IMWG)—a consortium of more than 250 myeloma experts from around the world—and leads the IMF’s Black Swan Research Initiative® (BSRI). 

 

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