COVID vaccine data: Drop in asymptomatic cases

DEAR DR. ROACH >> Can you get long COVID from symptomless post-vaccine infection?

DEAR READER >>

“Long COVID” refers to long-term symptoms following an infection with the novel coronavirus. These symptoms, which may persist for months (at least), include fatigue, difficulty concentrating often called “brain fog,” persistent loss of smell or taste, headache, chest discomfort and palpitations. Approximately 30% of people with persistent symptoms after COVID had them following an asymptomatic case.

There isn’t enough data to answer your question based on evidence. I suspect it is possible to get persistent post-COVID symptoms even after vaccination, since none of the COVID-19 vaccines is perfect (nothing is, in medicine). However, there is certainly reason to be optimistic. The first is that new data show a 70% to 90% drop in asymptomatic infections, which should translate to far fewer people with persistent symptoms. Second, although the initial side effects of the vaccine can be rough for people with long COVID symptoms, there are many case reports of the symptoms improving after vaccination. In one survey, about a third of people improved with vaccination, while 15% to 20% worsened. This has been a bit of a surprise to experts.

I am hopeful that the COVID vaccines will be analogous to what we see with the shingles vaccine — it reduces the likelihood of getting shingles, but also reduces the likelihood of long-term complications from shingles, even in those who get shingles despite the vaccine. But, this is a guess until there is more data.

DEAR DR. ROACH >> I had an X-ray for back pain, and was told I had a “10 mm sclerotic bone lesion” in the pelvis. They are sending me for an MRI. What could this be?

— P.W.

DEAR READER >> There are several possibilities when it comes to sclerotic (“stonelike”) bone lesions. Many of these are benign: a “bone island” is a small area of compact bone within the spongy bone; other benign tumors, such as osteomas and enchondromas; and Paget’s disease of bone.

The MRI will help to distinguish between these benign causes and bone cancer. A single lesion is more likely to be benign.

Hopefully, the MRI will confirm that this is a benign lesion.