COVID-19 Information for Patients

Yes. Regardless of which primary vaccine you received, everyone is eligible for the new bivalent boosters. Those who have recently had a booster vaccine should wait two months after their most recent dose before getting the updated booster. You can receive either the Moderna or Pfizer bivalent booster, regardless of the manufacturer of your prior vaccinations.

People with known current SARS-CoV-2 infection should defer any COVID-19 vaccination, including booster vaccination, at least until recovery from the acute illness (if symptoms were present) and criteria to discontinue isolation have been met.

In addition, people who recently had SARS-CoV-2 infection may consider delaying a primary series dose or booster dose by 3 months from symptom onset or positive test (if infection was asymptomatic). Studies have shown that increased time between infection and vaccination may result in an improved immune response to vaccination. Additionally, a low risk of reinfection has been observed in the weeks to months following infection. 

Individual factors such as risk of COVID-19 severe disease, COVID-19 community level, or characteristics of the predominant SARS-CoV-2 strain should be taken into account when determining whether to delay getting a COVID-19 vaccination after infection.
 

The U.S. Food and Drug Administration, U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and the CDC director have approved updated COVID-19 boosters from Pfizer-BioNTech and Moderna for emergency use. 

The Pfizer-BioNTech booster is available to people ages 12 and older who have: 

• Completed their COVID-19 primary series vaccination at least two months ago; or 
• Received their last booster/additional dose at least two months ago. 

The Moderna booster is available to people ages 18 and older meeting the same criteria. 
 
Boosters are recommended for those who are immunocompromised, such as cancer patients, as data show that boosting is important for protection from COVID-19 complications.  

Those who are immunosuppressed can receive the updated booster in addition to following the previous recommendation and approval receiving the initial vaccine series and two boosters, for a total of three boosters. 

Refer to the CDC’s guidance for people who are moderately to severely immunocompromised for more information. 

Visit the CDC’s visual graphic of vaccine schedules for easy reference. 

No. Reactions to the mRNA bivalent vaccines in studies using the BA.1 omicron strain were similar to the side effect profile of the mRNA monovalent vaccines. 

The updated booster is now a bivalent booster, which targets both the original strain of SARS-CoV-2 and the BA.4 and BA.5 omicron variants. The previous boosters were additional doses of the original — monovalent — mRNA vaccine. 

The bivalent booster contains both the original mRNA vaccine and mRNA targeting a BA.4 and BA.5 omicron variant of SARS-CoV-2 viruses that are currently circulating. Since there have been such major changes in the recent omicron variant SARS-CoV-2 viruses, they have been better at escaping vaccine-induced immunity. In studies of bivalent vaccines, immune responses — or antibody levels — were improved to the bivalent booster. In addition, it appears that those boosted with a bivalent vaccine retain antibody levels for longer.  
 

No. Previously, although the initial series of the vaccine was fully approved by the FDA, monovalent boosters were only authorized for emergency use. The FDA has removed the authorization for the monovalent original mRNA vaccine to be given as a booster. The bivalent booster is currently the only booster authorized for use by the FDA.

As of November 30, 2022, the COVID-19 primary monovalent vaccine series will be available for all patients every Wednesday from 10:30 am to 1:30 pm at the South Lake Union Clinic. Please contact your care team if you are a Fred Hutch patient looking to schedule your primary series of the COVID-19 vaccine. 

To find a vaccine provider in your community or to get the bivalent booster:

• Visit vaccines.gov  
• Call 1-833-VAX-HELP (833-829-4357), then press #. Language assistance is available  
• Text your zip code to 438-829 (GET VAX) or 822-862 (VACUNA)  
• Schedule through UW Medicine: uwmedicine.org/coronavirus/vaccine 
• Contact your local pharmacy

Flu vaccine: We will provide flu vaccinations to patients and caregivers starting October 3. Patients will be able to get their flu vaccine during appointments at all clinical sites. Caregivers may get their vaccine while accompanying a patient to an appointment at all clinical sites.

Yes. The CDC has indicated that it is safe and effective to get the flu vaccine and updated bivalent booster at the same time. It is recommended that one be given in each arm. 

Immune responses wane over time after vaccination with a primary series (2 in immununocompetent people, and 3 in immunocompromised people). The circulating omicron variants require higher levels of antibody to protect against major complications of COVID-19. Boosters help to improve antibody levels and have been shown to be more effective at preventing hospitalization and death due to SARS-CoV-2 infection. Boosters are currently recommended for anyone who has received a primary series of Pfizer, Moderna, Novavax or Janssen/Johnson & Johnson vaccine.

Yes and no. The bivalent booster includes the original mRNA monovalent vaccine, which is approved. The new variant included in the updated booster has only been studied in mouse models aimed at understanding immune responses to the vaccine. However, a previous bivalent booster which included a prior omicron strain, BA.1, was studied in humans and found to be safe and effective. As BA.4 and BA.5 became the primary circulating variants, the FDA recommended the booster be updated. With the prior human study with a different but related bivalent vaccine booster and data from animal models which show this vaccine improves the immune response, it is believed that this is the best booster vaccine. 
 
This is a similar approach we take to updated influenza vaccines. Animal models are used to help predict use in humans when the FDA approves updated seasonal influenza vaccines. This is done because of the need to rapidly produce vaccines for influenza. If human studies were required every year, it would slow down the process of making vaccines available. 

We expect that updated boosters might be needed to target changes in circulating variants in the future, similar to influenza vaccines. But currently it isn’t clear if updated boosters will be needed. 

We recommend that all cancer patients get vaccinated and boosted against COVID-19 unless:

• You are a Blood and Marrow Transplant (BMT) Clinic patient. You will need to start the COVID-19 vaccine series at least three months after transplant, even if you have already received one or more doses of the vaccine.
• You are an immunotherapy patient with a hematologic malignancy (blood disease, such as acute lymphocytic leukemia, multiple myeloma, non-Hodgkin lymphoma or chronic lymphocytic leukemia) being treated with CD19, CD20 or BCMA targeted CAR-T cells. You will need to start the COVID-19 vaccine series at least three months after treatment, even if you have already received one or more doses of the vaccine.

If you aren’t sure, ask your care team. 

Just as important: talk to your family, close contacts and caregivers about getting vaccinated. Protecting those around you will help protect you from being exposed to the virus.

Please note:

As of November 30, 2022, the COVID-19 primary monovalent vaccine series will be available for all patients every Wednesday from 10:30 am to 1:30 pm at the South Lake Union Clinic. Please contact your care team if you are a Fred Hutch patient looking to schedule your primary series of the COVID-19 vaccine. 

To find a vaccine provider in your community or to get the bivalent booster:

• Visit vaccines.gov  
• Call 1-833-VAX-HELP (833-829-4357), then press #. Language assistance is available  
• Text your zip code to 438-829 (GET VAX) or 822-862 (VACUNA)  
• Schedule through UW Medicine: uwmedicine.org/coronavirus/vaccine 
• Contact your local pharmacy
  ake a look at this visual vaccine schedule created by the CDC for more information.

Blood and Marrow Transplant (BMT) Clinic and Bezos Family Immunotherapy Clinic patients

If you are a BMT clinic or an Immunotherapy Clinic patient with a hematologic malignancy (ALL, MM, NHL, CLL) being treated with CD19, CD20, or BCMA targeted CAR-T cells, you will need to restart the primary COVID-19 vaccine series at least three months after transplant/treatment, even if you have already received one or more doses of the COVID-19 vaccine. T

We do not recommend checking antibodies because we do not know what level of antibody is considered protective (even in the general population). This is consistent with current guidance from the CDC and the FDA. Antibody tests also do not measure other types of vaccine responses, like T-cell responses, that play a role in immune protection. 

More research is being done to determine the best way to tell if someone is protected from COVID and to understand how well-protected vaccinated cancer patients are.
 

The number of doses you need to be fully vaccinated and boosted depends on your age, the vaccine you first received and if you are immunocompromised. Please reference this CDC vaccine schedule. 

The length of protection for cancer patients is still being researched and may also vary based on new circulating variants. We recommend continuing to mask up, avoid crowds and stay socially distant from those outside your household as extra precautions to help prevent exposure to COVID-19.

Fred Hutch strongly recommends continued vigilance for cancer patients, even those who are fully vaccinated and boosted. Cancer patients are at increased risk for COVID-19 complications and may not be as well protected by vaccines, so we recommend you continue to:

• Wear masks.
• Maintain social distancing.
• Avoid crowds.
• Tell your care team if you:
  • Have symptoms so you can get tested.
  • Were exposed to someone with COVID-19.
  • Were diagnosed with the virus at another facility or using an at-home antigen test.

It is very important that your caregivers, household members and other close contacts are vaccinated and boosted to help protect you.

• If you are a Fred Hutch patient and you plan to get vaccinated but have not yet received a dose, you may be eligible for a study. The study measures COVID-19 vaccine responses in patients who are within one year of a blood or marrow transplant or CAR T-cell therapy. Talk with your care team for more information.
• If you are a Fred Hutch patient and you test positive for COVID-19, ask your care team about other studies you may be eligible for.

According to Fred Hutch Medical Director of Infection Prevention, Dr. Steven Pergam, patients with blood malignancies (non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute myeloid leukemia, acute lymphoblastic leukemia and multiple myeloma) and those who have received bone marrow transplants are most vulnerable because they have the most profound immune deficits.

Patients who are in active treatment for any type of cancer are also at risk. Please see the CDC's webpage on COVID-19 and cancer for more information

Patients who are not in active treatment should also be cautious and follow widely distributed public health guidelines that are detailed below under “What can I do to keep myself, my family and friends safe?”

Evusheld is a medicine given to certain people to prevent COVID-19 infection before they have been exposed to the virus. It is a combination of antibodies called tixagevimab and cilgavimab. It is not for people who already have COVID-19 or those who have a recent known close contact with someone who has COVID-19. It is not a substitute for getting vaccinated and boosted.

In immunocompromised people, Evusheld may help protect against COVID-19 for about 6 months.

We continue to prioritize our most immunocompromised patients as defined by the National Institutes of Health: 

• Active pre-transplant/blood or marrow transplant within one year, those with chronic graft-versus-host disease or those who are taking immunosuppressive medications for another indication 
• CAR T-cell recipients
• Hematologic malignancy (blood disease) patients on active therapy  
• Patients who are within one year of receiving B-cell depleting therapies  
• Patients receiving Bruton tyrosine kinase inhibitors  
• Patients with severe combined immunodeficiencies  
• Lung transplant recipients  
• Patients who are within one year of receiving a solid organ transplant (other than lung transplant)  
• Solid organ transplant recipients with recent treatment for acute rejection with T- or B-cell depleting agents  
• Patients with untreated human immunodeficiency virus (HIV) who have a CD4 T lymphocyte cell count <50 cells/mm³  
• Solid tumor patients receiving active chemotherapy
• Patients receiving high-dose corticosteroids (prednisone 20 mg daily or equivalent x 14 or more days) or other immunosuppressive therapy (e.g., tacrolimus, sirolimus, MMF, TNF-alpha-inhibitors, alkylating agents, antimetabolites), or other biologic agents that are immunosuppressive or immunomodulatory (e.g., B-cell depleting agents) 

If you think you might be eligible, talk with your care team. 

Paxlovid is a medicine given to treat people with mild to moderate COVID-19 who are not in the hospital. It is used to reduce the risk of being hospitalized or dying in people who are at high risk. Paxlovid is a combination of antivirals called nirmatrelvir and ritonavir. It is not a substitute for getting vaccinated and boosted.

We continue to prioritize Paxlovid for patients who need it most. To be eligible for Paxlovid, you must:

• Be at least 12 years old (or at least 88 lbs./40 kg).
• Test positive for COVID-19.
• Be at high risk for severe COVID-19.
• Have mild to moderate symptoms.
• Be within five days of the start of symptoms.

If you have symptoms that could be from COVID-19, get tested as soon as possible. Paxlovid may be an option for you — but only if you test positive and can start the medicine within five days of symptom onset. 

If you think you might be eligible, talk with your care team or your primary care provider. 

There may be some drug interactions that need to be reviewed prior to prescribing Paxlovid.

COVID-19 symptoms include:

• Fever
• Chills
• Cough
• Shortness of breath
• Headache
• Fatigue
• Chest tightness
• Sore throat
• Stuffy nose or runny nose
• Loss of taste or smell
• New onset of diarrhea
• Muscle aches and pains

If you have an appointment scheduled and have COVID-19 symptoms, please call your care team before coming to the clinic.

Knowing about symptoms before you come into the clinic helps us keep everyone safe.

The flu and COVID-19 are both contagious illnesses, but they are caused by different viruses. COVID-19 is caused by infection with a new coronavirus (called SARS-CoV-2). The flu is caused by infection with influenza viruses.

It may be hard to tell the difference between the flu and COVID-19 from symptoms alone because some of the symptoms are similar. You should get tested for COVID-19 to help confirm a diagnosis.

Fred Hutch is taking the following steps:

• We will screen for COVID-19 symptoms when you check in for your appointment.
• All patients, visitors and staff in Fred Hutch clinics must wear a surgical mask. If patients and visitors aren’t wearing a mask upon arrival, we will provide one. Please see CDC guidelines on how to protect yourself for more information.
• Limiting the number of visitors. This includes:
  • Scheduling telehealth appointments for patients when possible.
  • Limiting the number of caregivers that patients can bring to their appointment (one caregiver; no children under 12). Please be aware that the visitor policy at UW Medical Center and Seattle Children's may be different. Click on links for their updated policies.
  • Keeping all non-essential staff out of the clinic.
  • Postponing all patient education events, classes and volunteer opportunities. Some classes are available online on YouTube.
• Increasing the frequency of cleaning high-touch surfaces such as door handles and elevator buttons

Our gift shop is temporarily closed due to the construction of our new South Lake Union clinic building. We look forward to seeing you in our new gift shop in the spring of 2023. 

You can visit Shine, our retail store, at 207 Pontius Ave. N., to find apparel, jewelry, books, housewares, games, oncology items and specialty skin care products. Shine is open Monday-Friday 9 a.m.-6 p.m. and Saturday 10 a.m.-4 p.m.  All oncology fittings require an appointment. Please call (206) 606-7560 or email retail@seattlecca.org. A free shuttle is available from the South Lake Union clinic Monday-Friday.

Fred Hutch has extensive and thorough infection control procedures, and we are doing everything we can to ensure the health and safety of our community. We have protocols and systems in place to keep all patients, visitors and staff safe. However, with highly contagious strains of the virus, full protection isn’t always possible.

Fred Hutch requires that all staff are vaccinated against COVID-19.

The most important steps to take are:

• Get vaccinated according to the CDC.
• Avoid going to gatherings with large numbers of people; follow social distancing guidelines.
• Stay home when you are sick.
• Wear a mask when you are out in public and cannot practice social distancing.
• Wear a mask when in a health care setting, including Fred Hutch clinics.
• Practice good hand hygiene and cough and sneeze etiquette. Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Avoid close contact with people who are sick.
• Avoid touching your eyes, nose and mouth.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
• Currently, there is no evidence to suggest that COVID-19 can be spread through food or water systems. However, you can take extra steps to help protect your health while preparing, cooking and shopping for food. Read more about Food, Nutrition and COVID-19 (PDF).
• Plan how you will take care of sick family members. Make plans for childcare if you are sick or if your child is sick. Have a thermometer at home so you can check for fever if you or a loved one feels ill.
• Stay informed – check the CDC site regularly for new updates.

Tell your care team immediately – it is best to inform them before you visit the clinic. They will let you know what options are available for your visit. 

All who enter Fred Hutch clinics are screened for COVID-19 symptoms. Every person will be given an I’ve been screened sticker. Anyone with symptoms will be given a procedure mask and evaluated during their appointment.

We encourage you to find testing locations in your community by visiting the Washington State Department of Health’s COVID-19 testing locations webpage.

The COVID-19 testing area on our South Lake Union campus has closed due to construction.  If you are a Fred Hutch patient with symptoms and think you need to be tested for COVID-19, please complete a home test or seek out a community testing option (details below.) You can also call your care team, and they can help you find the best option. 

Order free, rapid at-home antigen tests from the Washington State Department of Health at www.sayyescovidhometest.org. You can also buy rapid at-home tests at local stores and pharmacies.

Antigen tests provide rapid results — typically in less than 30 minutes. Although they are less accurate than PCR tests, at-home antigen tests can be a helpful measure to prevent the spread of COVID-19. 

Learn when to self-test at home from King County Public Health’s COVID-19 self-testing webpage and CDC’s guidelines for self-testing. 

Find a COVID-19 testing site from the Washington State Department of Health.
 

In addition to knowing which guidelines to follow, testing is important because many of the current treatment options for cancer patients, such as monoclonal infusions and antiviral pills, require a test before you can get them. As a reminder, if you have cold or flu symptoms, tell your care team — even if you test negative for COVID-19. They may want to change your treatment schedule 

If you took a test because you have symptoms or because you have been exposed but don’t have symptoms, here’s what to do.

• You tested negative: Get a PCR test to confirm your result.
• You tested positive: You have COVID-19. Notify your care team. Isolate at home. Do not seek further testing unless directed by your team. 

Tell your care team immediately. They will discuss any changes in your treatment, as well as COVID-19 treatment options that may be available to you.

Tell your care team before your visit so they can advise you about the best time to come for your visit or if they want you to get additional testing.

Yes. In line with CDC guidance, all patients, visitors and staff in Fred Hutch clinics must wear a mask. If you’re coming for an appointment, please wear a mask. If someone comes with you, they must wear one, too. A mask will be provided to those who aren’t wearing one.

By covering your mouth and nose, you are less likely to spread the virus when you are not showing symptoms (asymptomatic) or have early symptoms.

In Washington state, masks are no longer required in most public places. However, they are required in health care facilities (and some other facilities), and businesses may choose to continue requiring masks. 

Masks are still a good way to help limit the spread of COVID-19. CDC continues to recommend masks in some settings and for some people. In particular, CDC recommends masks for people who are at high risk for getting very sick from COVID-19, including people with cancer, if the level of COVID-19 in their community is medium or high. Learn more on the CDC website. 

To put on a mask:

• Wash your hands with soap and water or hand gel (if soap and water aren’t available).
• Without touching the front of your face covering, stretch the bands around your ears or secure the ties around your head (depending on the type of face covering you have).
• Cover the area from the bridge of your nose to under your chin.
• Fit the mask snugly but comfortably against the side of your face.
• Make sure you can breathe without restriction.
• Wash your hands.

To remove your mask:

• Wash your hands with soap and water or hand gel (if soap and water aren’t available).
• Untie the ties from your head or remove the bands from your ears.
• Remove the mask by the straps. Do not touch the front or inside of the mask (the part over your nose and mouth). It may be contaminated from your breathing, coughing or sneezing. If you touch the mask, wash your hands.
• Wash your hands.

Important tips:

• Wash your hands each time you put on and take off your mask.
• Avoid touching the front of your mask while you’re wearing it. If you do, wash your hands.
• Do NOT pull the mask down to expose your nose or mouth. Adjust the mask using the ties on your head or cords around your ears.

In general, the closer you are to others and the longer the time you are with them, the higher the risk of spreading COVID-19. If you decide to go out in public, protect yourself by following the guidelines under "What can I do to keep myself, my family and friends safe?"

Visit the CDC's webpage, How to Protect Yourself & Others, for information on each of these topics and more.

Some authorities consider you fully vaccinated right after vaccination or within two weeks after the last dose in your primary series, depending on the vaccine maker. However, you are best protected from highly transmissible strains if you are fully boosted. CDC considers you up to date with your COVID-19 vaccines if you have had all doses in your primary series and all boosters you are eligible for. 

If you are a cancer patient, we recommend you remain cautious, even if you are fully vaccinated or up to date. This includes people who:

• Have not yet started treatment.
• Are in active treatment.
• Have recently completed treatment.
• Have weakened immune systems; for example, blood and marrow transplant patients.

Although you may hear that others are gathering together after getting vaccinated, people with cancer are more vulnerable. We don’t know how well the vaccines work in people with cancer, particularly those who are on active treatment.

Until we know more about the effectiveness of vaccines in cancer patients, fully vaccinated people with cancer should continue to:

• Wear a well-fitted mask and practice physical distancing when in public.
• Avoid in-person gatherings with those outside your household.
• If you do visit with unvaccinated people outside of your household, wear masks, practice physical distancing and follow other prevention measures.
• Avoid airline travel. 
• Get tested if you have COVID-19 symptoms.
• Perform regular hand hygiene

Blood supply in the region is low due to cancellations of blood drives and COVID-related closures of schools, businesses and events. A healthy blood supply is vital to cancer treatment. If you are healthy and able, please consider donating blood or spreading the word about our current need. Find out more about donating blood at Bloodworks Northwest.

• Centers for Disease Control and Prevention
• Washington State Department of Health
• Washington State COVID-19 information
• Fred Hutch patient education handouts
• American Cancer Society (ACS): Coronavirus, COVID-19, and Cancer
• CancerCare: Coronavirus (COVID-19) Resources
• Cancer.Net: Coronavirus 2019, What People With Cancer Need to Know
• Leukemia & Lymphoma Society (LLS): COVID-19 Response Program: Resources for Patients and Caregivers
• Pancreatic Cancer Action Network (PanCan): Frequently Asked Questions About Coronavirus Disease (COVID-19) and Pancreatic Cancer