Dr. Roach: We all benefit from vaccines, whether we take them or not

Keith Roach
To Your Health

Dear Dr. Roach: A recent column on vaccines left me unable to complete all the dots.

An 80-year-old who has been sick only once (from a vaccination) stated that he/she will never willingly accept another vaccination. You conclude your column by suggesting that by being 80, this person should look forward to a vaccine for coronavirus. If I were that writer, my immediate question to you would be, “Why?”

It would seem the writer’s immune system has proven successful for an 80-year journey. Is there greater risk beyond 80?

— J.R.

Dear J.R.: A healthy immune system is a large part of why a person has had good health until their 80s, but the writer, like everyone in a modern society, has benefitted from vaccines, even if he didn’t take any.

When the vast majority of a population is vaccinated against an infectious disease, even those who are not medically protected are unlikely to get the disease since it doesn’t have ongoing transmission. This is called “herd immunity.” Although herd immunity can happen through vaccination or natural infection, it may only be maintained through ongoing vaccination. Intermittent outbreaks will occur once the number of unprotected people becomes high enough.

In the case of a new infection, never seen before in the population, there is no herd immunity and the infection can spread rapidly. When, like COVID-19, the infection is both highly infectious and can cause severe disease and death, it is exceptionally dangerous. People over 80 are particularly at risk. That’s why a vaccine is so urgently needed: to protect our most vulnerable, especially those who cannot get vaccinated (due to medical conditions), choose not to (which is unwise) or in whom the vaccine does not work (since no vaccine is perfect).

Dear Dr. Roach: I was started on lisinopril and developed both a cough and hair loss. My doctor finally changed me to losartan and amlodipine. If the medication caused these side effects, how long will it take to go away?

— E.H.

Dear E.H.: If the medication was indeed the cause of the cough, it usually goes away within a few days. It may take up to four weeks. More than 10% of people on an ACE inhibitor like lisinopril will develop a dry cough.

Hair loss from drugs often takes three to six months to reverse itself noticeably, but as long as 18 months before the hair is back to normal.

Dear Dr. Roach: I am on Xarelto after a blood clot in the lung. I am scheduled for a colonoscopy. The colon doctor said I need to be off Xarelto for seven to 10 days before the procedure, but it must be OK’d by my primary doctor. Is this safe?

— D.D.

Dear D.D.: Some people can continue anticoagulants such as apixaban (Xarelto) for GI procedures, but if the gastroenterologist feels anticoagulation needs to be stopped, Xarelto is usually held two days before the procedure, as opposed to warfarin (Coumadin), which requires stopping a week or so before the procedure.

People at very high risk for clot (recent clotting, mechanical valve, active cancer) may need anticoagulation continued as long as possible, so are usually given short-acting anticoagulants, such as heparin. I don’t think you are at high enough risk to require that, but your primary doctor (or hematologist) will determine that.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.