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Dr. Roach: Natural immunity versus vaccination

DEAR DR. ROACH: I was sick for two weeks at home with the coronavirus and made a complete recovery. Why wouldn’t recovering from the virus be at least as good as getting the vaccine? I’ve heard that I’m probably safe for three to eight months. Surely, they don’t expect the vaccine to be good for only three to eight months, although I know that no one really knows. — L.J.

ANSWER: If you want to be protected from COVID-19, the vaccine is much better than getting infected. The first reason is that infection with the virus is dangerous. Even though only a small proportion of people die from COVID-19, a small percentage of the entire population means many, many people have died — over half a million in the United States.

But there are other problems that some people can have for a prolonged period after acute infection. Lung and heart damage lead to shortness of breath, easy fatigue and inability to exercise. Kidney damage, loss of taste and smell, and difficulties with thinking are not uncommon.

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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There are many others. How long these will last, or whether some may be permanent, is not known. I’m glad you appear to have made a full recovery, but we just don’t know how many people will develop problems after a COVID-19 infection, even if they had mild or no symptoms during their acute infection.

The second is that protection after natural COVID-19 infection is not very good. While it is true that people have some protection for about three months, we saw from the vaccine study data that the degree of protection after infection was not very good at all. Some infections do not give protection from subsequent infections, and others, like COVID-19 appears to, give only partial and short-lived protection.

You are correct that we don’t know how long protection will last from the vaccine, but early data suggests at least a year of protection. It is possible we will need vaccinations every year and this may need to be changed as new variants arise, but that is pure speculation.

What is clear is that getting vaccinated is far, far safer than getting COVID-19.

DEAR DR. ROACH: I had my prostate removed one year ago. The nurse recommended I use tadalafil for a while after surgery to help the nerves grow back. I have not had any erections. However, my wife cannot have intercourse, so that is not a problem for me. So, if that is not an issue, is there any reason for me to be taking this medication? — D.A.

ANSWER: Erectile dysfunction is common after prostate surgery, especially prostate cancer surgery. The pudendal nerve can be damaged by both the cancer and the surgery. In time, the nerve function can return for many men, partially or fully. However, going a long period of time without an erection can lead to changes in the penis.

Fibrosis can develop, which can affect the ability to ever have a normal erection again. This is thought to be due to an erection causing improved oxygen to the tissues. Many urologists recommend preventive treatment, such as the tadalafil (Cialis) you took, and studies have shown that this can help preserve sexual function. Tadalafil and similar medicines help allow normal nighttime erections, which are key to preserving the health and sexual function of the penis.

The most important time to take the medication is the first year after surgery. If you are truly not interested in any kind of sexual function, you do not need to keep taking the tadalafil.