The answer to this question depends on your age, underlying medical conditions (including lung or liver disease from Alpha-1), and tolerance for risk which will incorporate the COVID prevalence in your location at the time of your planned visit. As with many questions like this, it’s a risk/benefit decision.

Yes. As with many people who contract COVID, there is a fairly high risk of having symptoms that persist for weeks or months. It is not clear if Alphas are at greater risk for these long-term symptoms but AlphaNet’s data suggest not. Vaccination appears to reduce long term symptoms.

While there are no formal studies of this, it is generally assumed based on our understanding of the role of alpha-1 antitrypsin (AAT) in moderating inflammation and resultant injury, that people with low levels of AAT will likely develop greater lung tissue injury than those with normal levels of AAT. Those on augmentation therapy would be expected to reduce this injury risk.

Yes, you should get tested as the symptoms for COVID are variable in different individuals and we see a lot of stomach complaints.

The typical exposure to symptoms with Omicron is 3 days.

The type of RNA used in mRNA vaccines is destroyed almost immediately in plasma and the mRNA that gets into the cells around the site of injection is destroyed within those cells very quickly. While I don’t know if this has been specifically looked at, there is virtually no possibility that augmentation therapy would contain any vaccine mRNA.

It does not cover for Omicron and so it is not being used now. It was protective for the Delta variant.

We do know that people can get reinfected from COVID and the data does not exist yet to know if your mom would be susceptible to the next variant. That said, recent data suggests that individuals who were infected and then vaccinated or vaccinated and then infected (like your mom) develop antibodies and immunity that is greater than vaccinated or infected alone. Researchers are calling it hybrid immunity and are wondering if individuals who develop hybrid immunity might not need boosters since serum from those individuals can actually neutralize variants that the individual was not yet exposed to. This is not yet proven but it looks very interesting, and the data is strong.

Evusheld is a treatment that is used preventively in immunosuppressed people who have been or might be exposed to COVID. Since Alpha-1 is not a condition that causes immunosuppression, it does not currently have a role in preventing COVID. Alphas who have had a lung transplant or liver transplant and are therefore immunosuppressed are candidates for this drug and it is widely used at transplant centers.

There is a new variant that is a derivative of Omicron, called B1.2. It has just arrived in the United States and may be more contagious that Omicron B1.1 but not thought to be more virulent. The data on Omicron B1.2 is rapidly evolving and in some countries, it is becoming the predominant variant.

Thanks to the Omicron variant, a couple of the available monoclonals are no longer recommended for treatment (namely those from Regeneron and from Lily). The newer Glaxo monoclonal does cover all the currently known strains. Unfortunately, this monoclonal is the newest and is in short supply. A fourth monoclonal is also becoming available as well.

While AlphaNet has lots of data on Alphas receiving augmentation therapy, AlphaNet follows very few patients not receiving augmentation therapy and those not on therapy generally have normal lung function. There is certainly scientific evidence that alpha-1 antitrypsin protein plays a major role in protecting the lungs from the type of inflammation caused by COVID-19.

Paxlovid is benefiting patients but is in limited supply at this point in time and Molnupiravir was just released. It has more side effects than Paxlovid.

For reasons mentioned above, we highly recommend you continue augmentation therapy when hospitalized.

There’s every reason to suspect that augmentation therapy will improve your outcomes from COVID if you have lung disease due to Alpha-1 but there have been no formal studies to confirm this.

From a practical standpoint, this would be extremely difficult to arrange and we don’t have sufficient evidence to recommend this.

Yes, there is a study on augmentation in non-Alphas and that should be published soon.

Yes, there is a study on augmentation in non-Alphas and that should be published soon.

This is a personal decision. It is based on your tolerance for side effects and your concern about the risks for some of the serious COVID effects seen rarely in children, such as myocarditis (inflammation of the heart muscle).

The booster can be given 6 months after the original vaccines. There is some evidence that the booster’s benefit is small compared to the original vaccination in teenagers and young adults.

The primary well-documented effects of mRNA (and other) vaccines against COVID are in preventing serious disease, hospitalization, and death. Vaccines may have a mild effect on the spread of the virus.

Both mRNA vaccines available in the US are effective at reducing hospitalization and death from Omicron.

Unless you are a transplant patient, there is no evidence that you should get a “second” booster. Initial data on fourth shots does not show any benefit but it is too early to know whether they will help.

It is recommended that you discuss this with your transplant physician.

There are not yet known preventative measures for COVID. There are some pharmaceutical companies developing drugs similar to the ones used in flu such that you might be able to take upon exposure, but they are not yet available. Regarding Ivermectin, the data does not show any benefit from Ivermectin, and some people have suffered serious side effects from taking it for COVID.

While the current boosters may have minimal effect at protecting against becoming infected with Omicron, they both have dramatic benefit at protecting against hospitalization and death from Omicron. We are awaiting evidence evaluating whether boosters might make it much more likely that people infected with Omicron will be asymptomatic.

The mRNA vaccines are not created from actual spike protein but by utilizing the published gene sequences of the spike protein from the medical literature and modifying them to make the spike protein generated in the recipient’s cell to be more stable.

All masks have some degree of effectiveness. Cloth masks are least effective. Surgical masks provide better protection. N95 and KN95 masks provide the best available protection available to the public. With any mask, good fit improves the protection provided.

Putting a cloth mask over a surgical mask, an N95, or a KN95 adds to their protection but may also make it more difficult to breath for those with underlying breathing problems.

There is not specific danger to wearing an N95 for those with more severe lung disease but the more effective the mask, the more breathing difficulties may occur. If you are too short of breath to wear an N95, you may have to switch to a surgical mask.

A face shield alone does not provide protection against infection. It’s better to switch from an N95 to a surgical mask, or if necessary to a cloth mask, than to use a face shield alone. A face shield plus a cloth mask increases the protection versus a cloth mask alone. Generally, face shields are used to prevent splatter of bodily fluids from infected individuals in a hospital environment.