DEAR DR. COCKROACH: I did regular smear tests for COVID-19, which always came back negative. The last was a few days ago. I did an antibody test six weeks ago that was also negative, but my antibody test this time was strongly positive. I was very careful to protect myself and I had no symptoms! I am scheduled to receive my first dose of the vaccine tomorrow. What should I do? – CW
ANSWER: With frequent negative smear tests and no symptoms, your likelihood of having COVID-19 is less than the average for a person in your community. But if your community has been hit hard, like most, there is a good chance that you recently had an asymptomatic infection.
The result of the antibody test you sent showed a strongly positive result using a highly specific laboratory test. Although it is possible that this is a false positive test result, I suspect that you have had a true case of COVID-19 so mild that you have not noticed any symptoms.
You probably have some immunity against another case of COVID-19, but that immunity can decrease quickly. I recommend that you get your vaccine as scheduled. It is safe to get the vaccine, as long as it has no symptoms. However, people who have been treated with a monoclonal antibody for their case of COVID-19 must wait 90 days before receiving the vaccine.
DEAR DR. COCKROACH: I know someone who took the first and now the second dose of the Modern vaccine and had none of the side effects of any of them. Does this mean that the vaccine is not working or that their system is very strong? Everyone talks about side effects, but nobody mentions if you don’t have side effects. Clarify, as I will receive my second vaccine next Saturday. – MJ
ANSWER: I often hear doctors and patients explaining reactions to the vaccine, such as arm pain and fever, as evidence that “the vaccine is working”. It is natural to be concerned that no reaction means that the vaccine is not working. However, this is not the case. Even people without any side effects (most people have a little pain in their arm, at least) benefit from the vaccine. The Modern vaccine was 94% effective in preventing infections.
It is true that people with a history of COVID-19 infection are more likely to experience side effects such as fever or fatigue. So, I wouldn’t say that the person you know who had no side effects necessarily had a “strong” immune system. The immune system needs to be perfectly regulated to protect it from invaders and also to prevent autoimmune reactions. But that means they are less likely to have had COVID-19 in the past.
Part of the danger of COVID-19 infection is the body’s immune and inflammatory response to the virus. I could speculate that people who have very strong reactions to the vaccine may be those most likely to have serious complications from COVID-19. Speculation aside, vaccination is effective whether the person has side effects or not.
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Dr. Roach regrets not being able to respond to individual letters, but will incorporate them in the column whenever possible. Readers can email questions to [email protected] or email 628 Virginia Dr., Orlando, FL 32803.
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