DEAR DR. ROACH: I have had regular swab tests for COVID-19, which have always been negative. The last one was just a few days ago. I had an antibody test six weeks ago which was also negative, but my antibody test this time was strongly positive. I was very careful to protect myself and had no symptoms! I am due to receive my first dose of vaccine tomorrow. What should I do? – CW
REPLY: With frequent negative swab tests and no symptoms, your likelihood of having had COVID-19 is lower than the average person in your community. But if your community has been hit hard, as most have, there’s a good chance you’ve recently had an asymptomatic infection.
The antibody test result you sent showed a strongly positive result using a very specific lab test. While it’s possible this was a false positive test result, I’m guessing you had a real case of COVID-19 so mild you didn’t notice any symptoms.
You probably have immunity to another case of COVID-19, but that immunity can go away quickly. I recommend that you get vaccinated as scheduled. It is safe to get the vaccine as long as you have no symptoms. However, people who have been treated with a monoclonal antibody for their COVID-19 case should wait 90 days before getting vaccinated.
DEAR DR. ROACH: I know someone who received the first and now the second dose of Moderna vaccine and had no side effects from either of them. Does that mean the vaccine isn’t working or does it mean their system is strong enough? Everyone talks about side effects, but no one mentions if you don’t have side effects. Please clarify, as I will be receiving my second vaccine next Saturday. – MJ
REPLY: I often hear doctors and patients explaining reactions to the vaccine, such as arm pain and fever, as proof that the vaccine is working. It’s natural to worry that no reaction means the vaccine isn’t working. However, this is not the case. Even people without any side effects (most people have a little sore arm, at least) benefit from the vaccine. The Moderna vaccine was 94% effective in preventing infections.
It is true that people who have a history of COVID-19 infection are more likely to have a side effect like fever or fatigue. So, I wouldn’t say that the person you know who didn’t have any side effects necessarily had a strong immune system. The immune system must be perfectly regulated both to protect you from invaders but also to avoid autoimmune reactions. But that does mean they’re 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 might be the ones most likely to be at risk for serious complications from COVID-19. Aside from speculation, vaccination is effective whether or not a person has side effects.
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Dr Roach regrets not being able to respond to individual letters, but will incorporate them into the column whenever possible. Readers can email their questions to [email protected] or email 628 Virginia Dr., Orlando, FL 32803.
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