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Why are continued precautions necessary if we’ve had vaccine?

DEAR DR. ROACH: Can you elaborate on how the COVID-19 vaccine is different – or inferior, or maybe just not as fully tested – from other vaccines? As far as I know, we do not need to continue to take precautions for polio, or the Spanish flu or bird flu – those vaccines protect us. Why the need for continued precautions for COVID-19 after being vaccinated? – W.S.

ANSWER: The COVID-19 vaccines are new, but the evidence is mounting that in the real world (as opposed to just studies), these vaccines are very safe and effective. Part of the continued caution in the current COVID-19 pandemic is due to the unknown duration of the effect of the vaccine, but much of the concern has to do with just how many people are infected. There is the possibility of a new variant becoming prevalent that might be more contagious, more deadly, less amenable to our therapies or able to overcome the resistance conferred by the vaccines. In fact, there are variants that are more contagious and perhaps more deadly, but, so far, the treatments and vaccines continue to cover the new variants pretty well.

We certainly hope the vaccines will continue to provide a high level of protection. It’s the emergence of these variants that currently concern our public health officials the most.

I should note that without continued vigilance, there remains the possibility that polio could return, and every year brings the concern of a new influenza strain, such as swine flu or bird flu. This year, social distancing and mask use dropped influenza transmission to historic lows.

DEAR DR. ROACH: My doctor switched me from 20 mg atorvastatin to 20 mg pravastatin because I was having some muscle cramping and some mild neurological issues that might have been a side effect of the atorvastatin. I still had these side effects with the pravastatin, but they were noticeably reduced. I also preferred the pravastatin, as it is supposedly less risky in terms of liver and kidney disease. Several of my friends developed diabetes after starting statin therapy, which also concerns me.

Unfortunately, the pravastatin did not work well enough to lower my LDL. Now I have a decision to make between increasing the pravastatin to 40 mg or going back to the 20 mg atorvastatin. My LDL without statins is very high (150-180), with a total cholesterol of about 230-250. My LDL with 20 mg atorvastatin is 87. While on 20 mg pravastatin it was 149. My doctor thinks either choice is fine. I’m probably making too much of an issue of this, but which do you think is the safer choice? — Anon.

ANSWER: Assuming you do not have known blockages in the arteries of your heart, I would be in favor of less side effects.

In a head-to-head trial in people with very severe blockages, atorvastatin with a goal LDL of less than 70 was more effective at preventing heart attacks than pravastatin with a goal LDL of 100. However, since you are using it for prevention, the additional benefit of atorvastatin probably adds very little benefit for you. I believe strongly that for prevention, it’s particularly important to find a treatment plan that does not cause undue side effects.

Liver and kidney problems due to any statin are quite unusual. All statins can precipitate diabetes in a person predisposed. However, most muscle aches noticed by people taking statins (of any type) are likely not due to the statin. Aches are just about as likely while taking a placebo pill as a statin.

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 or send mail to 628 Virginia Dr., Orlando, FL 32803.

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