To Your Good Health: COVID vaccination is still recommended for those over age 65
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DEAR DR. ROACH: I’m a 78-year old man who was diagnosed with asthma about 10 years ago, after a severe coughing attack left me unable to breathe. Since then, everything has been pretty much under control with Symbicort or Singulair. While I assumed that it’d be a good idea to get a COVID vaccination each year due to my asthma, both my general physician and pharmacist have recommended against it.
Along with the reasoning that COVID isn’t as deadly as it was a few years ago, they’ve pointed out that the medications to treat it are highly effective if I do happen to catch it. Even though I’ve decided to follow their advice and hold off on the vaccination, I’m curious about your thoughts on the matter. — D.M.
ANSWER: This isn’t the advice that I’m giving my patients. You have two good reasons to be wary of COVID: being 78 and having asthma. The most recent data show that vaccines reduce the risk of emergency visits, hospitalization and critical illness in people over the age of 65 by 24%, even if they’ve been vaccinated multiple times. Previous data showed that even though the risk of death from COVID is much lower than it was before, vaccinations reduce the risk of death by 70%.
Although the data are no longer being collected as carefully as it were previously, it’s still estimated that 1,000 Americans die from COVID a week on average, nearly all of whom are over 65. As I write this column, COVID rates are rising in nearly all states.
I’m very grateful that we have good options for treatment, and I certainly prescribe them when appropriate for my patients who get COVID. Still, prevention is better than a cure. Ultimately, you have to decide whether the benefits mentioned above are worth the risks of vaccination, which are extremely small and generally limited to a sore arm. You might experience a day or so of fatigue, muscle aches, headache, and possibly fever and chills. Serious adverse effects are possible but rare.
In my opinion, the significant reduction in severe disease greatly outweighs the mild side effects of a COVID vaccination. There are long-term effects of a COVID infection, which are more likely in a person with preexisting asthma. The World Health Organization and the Global Initiative for Asthma — along with specialty groups such as the American College of Allergy, Asthma and Immunology — also recommend vaccination for a person of your age with asthma.
DEAR DR. ROACH: When I was under a great deal of stress, I started taking melatonin occasionally, only to realize that I was beginning to bruise. I was told to cease it as it has some blood-thinning properties. Could you elaborate? — N.G.
ANSWER: Although melatonin can cause small changes in laboratory-measured bleeding times, there isn’t an increase in clinically relevant bleeding when compared to a placebo in safety trials of melatonin in healthy adults.
Some caution may be advisable for people who are taking medications that affect bleeding, such as anti-platelet drugs (aspirin, clopidogrel and others) or anticoagulants (warfarin, apixaban and others). Warfarin can, in theory, interact with melatonin and increase bleeding. However, the safety results from the clinical data are reassuring.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.