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Dear Doctor: Should I get a COVID-19 vaccine if I just tested strongly positive for antibodies?



DEAR DR. ROACH: I have had regular inoculation tests for COVID-19, which have always been negative. The last one was 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 have been very careful about protecting myself and I have not had any symptoms! I’m planning to get my first dose of vaccine tomorrow. What should I do? – CW

REPLY: With frequent negative vaccination tests and no symptoms, your likelihood of having COVID-1

9 is lower than the average person in your community. However, if your community has been hit hard, as most people have, there is a good chance that you recently had an asymptomatic infection.

The antibody test result you sent showed a strong positive result using a very high specific laboratory test. Although possible, this is a false positive test result, I suspect you had a genuine COVID-19 case so mild that you did not notice any symptoms.

You probably have some immunity to another case of COVID-19, but that immunity can wear off quickly. I recommend that you get your vaccine as planned. It is safe to get the vaccine as long as you have no symptoms. However, people treated with a monoclonal antibody for their case of COVID-19 had to wait 90 days before receiving the vaccine.

DEAR DR. ROACH: I know someone who had the first and now second dose of the Moderna vaccine and did not get any of the side effects from any of them. Does this mean that the vaccine does not work, or does it mean that their system is quite strong? Everyone talks about the side effects, but no one mentions if you do not have side effects. Clarify when I have to get my second vaccine next Saturday. – MJ

REPLY: I often hear doctors and patients explain vaccine reactions, such as arm pain and fever, as evidence that “the vaccine works.” It is natural to worry that no reaction means the vaccine is not working. However, this is not the case. Even people without any side effects (most people have at least a slight pain in the arm) 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 such as fever or fatigue. So I would not say that the person you know, who had no side effects, necessarily had a “strong” immune system. The immune system must be perfectly regulated to both protect you from invaders, but also to avoid 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 the people who have very strong reactions to the vaccine may be the ones most likely to be at risk for serious COVID-19 complications. Apart from speculation, vaccination is effective whether a person has side effects or not.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them into the column whenever possible. Readers can send questions to ToYourGoodHealth@med.cornell.edu or email 628 Virginia Dr., Orlando, FL 32803.

(c) 2021 North America Syndicate Inc.


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