DEAR DR. ROACH: Can you get long COVID from symptomless post-vaccine infection? — L.B.

ANSWER: “Long COVID” refers to long-term symptoms following an infection with the novel coronavirus. These symptoms, which may persist for months (at least), include fatigue, difficulty concentrating often called “brain fog,” persistent loss of smell or taste, headache, chest discomfort and palpitations. Approximately 30% of people with persistent symptoms after COVID had them following an asymptomatic case.

There isn’t enough data to answer your question based on evidence. I suspect it is possible to get persistent post-COVID symptoms even after vaccination, since none of the COVID-19 vaccines is perfect (nothing is, in medicine). However, there is certainly reason to be optimistic. The first is that new data show a 70% to 90% drop in asymptomatic infections, which should translate to far fewer people with persistent symptoms. Second, although the initial side effects of the vaccine can be rough for people with long COVID symptoms, there are many case reports of the symptoms improving after vaccination. In one survey, about a third of people improved with vaccination, while 15% to 20% worsened. This has been a bit of a surprise to experts.

Dr. Keith Roach

I am hopeful that the COVID vaccines will be analogous to what we see with the shingles vaccine — it reduces the likelihood of getting shingles, but also reduces the likelihood of long-term complications from shingles, even in those who get shingles despite the vaccine. However, this is a guess until there are good studies.

DEAR DR. ROACH: I had an X-ray for back pain, and was told I had a “10 mm sclerotic bone lesion” in the pelvis. They are sending me for an MRI. What could this be? — P.W.

ANSWER: There are several possibilities when it comes to sclerotic (“stonelike”) bone lesions. Many of these are benign: a “bone island” is a small area of compact bone within the spongy bone; other benign tumors, such as osteomas and enchondromas; and Paget’s disease of bone.

The MRI will help to distinguish between these benign causes and bone cancer. Cancer of the bone can be primary (that is, starting in the bone, which is uncommon) or can have spread from some other place, such as the lung or breast. A single lesion is more likely to be benign.

Hopefully, the MRI will confirm that this is a benign lesion.

DEAR DR. ROACH: At 89 years old, I watch TV, read the papers and struggle to stay awake. I take my meds as instructed, including senior vitamins. Is this part of the aging process? — A.F.

ANSWER: Although everybody ages differently, it is common that older people get tired at earlier hours than they used to when younger. However, a good many medications may cause sleepiness and difficulty concentrating, and it is certainly worth a chat with your pharmacist to see whether any you are taking might be causing this, and with your doctor to see whether any you might be taking could be changed, if appropriate.

Senior vitamins probably have little benefit in keeping older adults awake, and have never been shown to have benefit in keeping people healthy, so long as the person is eating a reasonable diet.
There are many medical conditions that can cause easy fatigue. Obstructive sleep apnea is one that frequently goes undiagnosed for years.

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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.