DEAR DR. ROACH: I am a 74-year-old woman who is in better-than-average shape for my age. I only take blood pressure meds, walk for exercise, and am only slightly overweight.<\/p>\n
I have had seven COVID vaccinations from February 2021 to September of this year. I asked my primary doctor if I should get more, and he said \u201cno.\u201d His reasoning is that Paxlovid cures COVID, so we don\u2019t have to get vaccinated anymore. He, himself, is not getting any more shots. I never contracted COVID that I know of. Any thoughts? — J.A.<\/p>\n
ANSWER: Yes, I have a strong opinion about this, and I completely disagree with your doctor. It is fantastic that we have Paxlovid as it absolutely helps people get better faster, and it reduces the risk of severe COVID by about half.<\/p>\n
This is most important for people who are at a higher risk of hospitalizations because people who are at a low risk, including most healthy people who are up-to-date with their vaccines, don\u2019t benefit much from Paxlovid. Being 74 and slightly overweight and having high blood pressure puts you at higher-than-average risk for severe COVID — but not as high as a person with lung disease or severe immune system disease.<\/p>\n
Without vaccinations, the risk for serious, even life-threatening cases of COVID increases, and Paxlovid is not completely effective. Also, Paxlovid does not help much at preventing persistent symptoms after a COVID infection (\u201clong COVID\u201d). I have several patients who continue to have long COVID symptoms that are affecting their daily life, despite it being years after their initial infection.<\/p>\n
Finally, it is possible that new variants of COVID will arise that are not susceptible to Paxlovid. While I have confidence that new drugs will be developed, it is far better to prevent COVID than it is to treat it.<\/p>\n
COVID hasn\u2019t gone away; it is here to stay. There will be additional \u201cwaves\u201d of COVID infection, and during these times, it will be wise to once again bring out the surgical masks when in crowded areas, in addition to staying up-to-date with vaccines. I continue to get my COVID vaccines as soon as they are recommended.<\/p>\n
DEAR DR. ROACH: Your recent discussion regarding taking an antibiotic before dental procedures for cardiac issues didn\u2019t mention my situation. I am 86 years old, and four years ago, I had my mitral valve replaced with a porcine valve. I had no history of heart disease and never saw a cardiologist before this.<\/p>\n
I have been told to take 2,000 mg of amoxicillin one hour before any dental procedure for the rest of my life. Is this an appropriate recommendation? — P.H.<\/p>\n
ANSWER: Although antibiotics before certain medical and dental procedures are recommended much less frequently than they were years ago, there are still instances when it is appropriate. A prosthetic valve is one of these times when antibiotics are recommended. Two grams taken orally 30-60 minutes before a dental procedure is the recommended regimen for people who can take penicillin drugs.<\/p>\n
Similarly, people with an assist device or an artificial heart should take antibiotics, as well as those with some types of congenital heart disease. Heart transplant patients with an abnormal valve and people who have had a left atrial appendage occlusion (LAAO) device (such as the WATCHMAN) within the first six months of the device placement are also included in this category.<\/p>\n
Dental procedures such as extractions and oral surgery are riskier than routine dental cleanings. The overall risk for all invasive dental procedures is approximately 10 cases per 10,000 without antibiotics and 4.5 cases per 10,000 with antibiotics. However, good oral hygiene and prompt treatment of any dental problems are probably more important than antibiotics.<\/p>\n