Dr. Roach: The best COVID vaccine is the one you can get quickly
Dear Dr. Roach: Could you please explain the science behind the new Johnson & Johnson COVID-19 vaccine? I hear it differs from the Pfizer/Moderna vaccines as it does not contain the mRNA and is only a single dose. I also heard it compared to the flu vaccine. I am a regular flu vaccine recipient and if this is true, that may be the vaccine I am leaning toward.
Dear D.J.: All the available vaccines are very effective at preventing serious illness from COVID-19. The “best” vaccine for virtually everyone is the one they can get the fastest. As vaccines have become more and more available, most states will have opened up vaccination to all adults by the time this publishes.
Although all are excellent vaccines, there is an advantage in that the Johnson & Johnson vaccine is a single dose. It also has less stringent requirements for freezing/refrigeration, so it will likely have a major impact worldwide. But the J&J vaccine is much more similar to the Ebola vaccine than it is to the flu vaccine. It uses the mechanism of adenovirus (a cause of the common cold) to bring DNA into the muscle cells, which then tell the muscle cells to make the COVID-19 spike protein. The vaccine uses an adenovirus that is incapable of replication, so there is no risk of getting a cold from the vaccine.
The vaccine is about 65% effective at reducing moderate-to-severe COVID-19 disease, but it’s extremely effective (100% for those fully vaccinated) against mortality and COVID infections requiring hospitalization in the initial study.
I continue to recommend that my patients get the first available approved vaccine — which I, and my family, have done. It’s particularly important as new variants develop to get as many people vaccinated as quickly as possible.
Dear Dr. Roach: I have to have an umbilical hernia operation and from what I have read, I am concerned about the use of mesh. It seems the case that in so many operations done with mesh as a reinforcing material, the patient later had to have the mesh removed. What is your opinion about the use of mesh, and how do you absolutely know it’s time to have a hernia operation?
Dear L.R.: A wise internist never gives a surgeon advice on how to do surgery, so I defer to the surgeon. They have the expertise to recommend the best type of procedure for an individual, and they must consider success rates as well as complications months and years later.
Many of my own patients have had complications from hernia surgeries using mesh, and I also have read horror stories about mesh complications. I understand why you are concerned. However, multiple studies have confirmed that a tension-free hernia repair (which usually requires mesh) reduces post-operative pain, speeds healing and reduces recurrence rates. Various surgical societies, both in North America and Europe, recommend mesh for surgical repair, but again, a person’s anatomy must be considered by the surgeon uniquely.
Mesh infections and migration can happen after the surgery. However, newer surgical techniques and materials have improved the results from surgery in recent years. I should note that many publicized cases came from the use of counterfeit mesh years ago.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.