Despite breakthrough infections, it's the unvaccinated who are perpetuating the pandemic
DEAR DR. ROACH: You recently replied to a question regarding vaccination among health care workers by saying "they are ethically obligated to get the vaccine in order not to infect their patients." But isn't it true that the vaccinated are getting COVID and also infecting others? It is protection for the vaccinated, but it's not protection for those around them. -- S.C.
ANSWER: You are mistaken that the vaccine does not protect others. While it is true that there can be breakthrough infections among the vaccinated, the risk of an infection is much lower among vaccinated than unvaccinated. Consequently, the risk of spreading the disease is much lower. People who have had a breakthrough infection are infectious for a shorter period than unvaccinated people and have less infectious virus overall. It is the unvaccinated who are continuing this pandemic, and if everyone (or even nearly everyone) were vaccinated with currently available vaccines, there would be no more pandemic.
Many people say that since the vaccine isn't 100% effective, they won't take it. No medical treatment is 100% effective. Even a partially effective vaccine is beneficial, and the currently available vaccines are all very effective.
Another excuse is that mandatory vaccines are an infringement on a person's freedom. This is true. No freedoms are absolute. Other people's freedoms must be considered. Vaccinations have been mandated by public schools for many years. Personal freedoms must be balanced by the responsibility to protect others. Vaccine mandates have been repeatedly found to be legal during a public health emergency. Requiring health care workers, who are at particularly high risk for infecting others, to be vaccinated makes medical and scientific sense.
DEAR DR. ROACH: After I was diagnosed with polycythemia vera, I started to donate blood when my hemoglobin level was elevated. I go every two months to donate a pint of blood. So far, so good. My regular doctor and hematologist are happy with the result. Are there any vitamins I should take? -- P.P.F.
ANSWER: In polycythemia vera, the bone marrow makes too much red blood cells. It is a myeloproliferative neoplasm, which is a type of blood cancer.
P. vera may cause many complications, but the most common is either abnormal blood clotting or bleeding, but it can also transform to a more aggressive blood cancer, such as leukemia. Aspirin is almost always used to reduce abnormal blood clotting in people with P. vera. In more advanced cases, chemotherapy drugs, such as hydroxyurea, are used to control blood production.
Phlebotomy, the therapeutic removal of blood, is a mainstay of people with early or mild P. vera. Historically, phlebotomy was used to treat many diseases, but today it is the standard treatment only in hereditary hemochromatosis and polycythemia vera. The potential that abnormal bone marrow cells will be present in the blood means it's never transfused into another person.
You might think that minerals like iron would be useful in people with P. vera, but iron supplements are not given, because low iron levels help control the excess blood production. Similarly, vitamin B12 and folic acid, necessary for red blood cell production, also may stimulate blood cell production. They should not be taken except under express orders from your hematologist.
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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