Michele writes:

Hi Dr. Griffin,

First, thank you so much for all that you do to keep us smarter and safer.

My 92 year old mom has not had Covid and told me that if she gets it, she doesn’t even know if she would take Paxlovid.  At 92, she obviously has some underlying health conditions putting her at greater risk, and I told he she should definitely take Paxlovid if she gets sick.  She said several of her friends (also in their 80’s and 90’s) have taken it and struggled with some side effects and that she’d rather have an infusion like some of them had.  I have no idea what infusion she is talking about.  Could a 92 year old with Covid present at an ER in New Jersey and receive an infusion of Remdesivir? Also, is there any research which compares the efficacy of Paxlovid with the renal dose of Paxlovid? Trying to come up with a plan for mom.

Thanks so much!


Carol writes:

Our 38 year old daughter has Type 2 bipolar disorder, ADHD, and PTSD. She has alcohol use disorder, was a heavy drinker for more than 15 years, and developed alcoholic fatty liver disease. Last May she got covid and stopped drinking except for a few short relapses. In November, she got covid again. This time, it was worse, but still not bad enough to require medical attention, in her opinion. A couple months later, she moved back home, because she still couldn’t work. She had a persistent cough, fatigue, diarrhea, and vomiting, eventually became jaundiced, and went to the ER last month. The original prognosis was very worrying, but after 2 weeks in the hospital and several days on prednisone, she’s shown a lot of improvement.

It’s my understanding that alcoholic liver disease is on the rise.  One article I read gives the impression that the cause for that is that more people were drinking more heavily in the first year of the pandemic. I don’t doubt that, but I’m curious as to how a mild to moderate, non-hypoxic but miserable week of covid affects the liver; the mechanisms involved. She also had Hep c several years ago, but it’s been inactive. How common is it for mild covid infections to significantly increase liver damage in patients with compensated steatosis?

I always look forward to Clinical Updates. I’ve also been watching other TWiV programs. There’s a lot I don’t understand, but it’s easier than it used to be. You’ve made it easier, plus I’m learning.



Rhonda writes:
Good morning, Dr. Griffin,

Thank you for sharing your wisdom and knowledge via TWIV!  I am a clinical pharmacist at a free medical clinic in Greenville, SC, and have found the information conveyed through this podcast to be incredibly helpful during the last three years. I am grateful that you continue to share scientific and evidence based insight guiding the medical team in caring for patients.

I am hopeful that you can share your insight with me in guiding my 20 year old nursing student daughter as she prepares for a 4 week summer midwifery internship in Tanzania in June.  She is considering taking PrEP prophylactically due to a much higher rate of HIV exposure during this four week period and anticipating a high level of exposure to bodily fluids by nature of this work.  Her primary care provider has not every prescribed PrEP but is in agreement with this preventative action. I believe the travel clinic that my daughter has consulted is also advising this step although they cannot prescribe it. What is your advice?  As a pharmacist, the antiretroviral drugs seem intimidating but so does HIV.  Rachel is currently in good health, but PMH is most significant for a diagnosis of anorexia about 2 years ago.  She is at a much healthier BMI although on the low side of the desired range and has worked with a team to address the underlying issues.

In addition to the consideration of PrEP, the travel clinic has recommended atovaquone-proguanil for malaria prevention.  They have also advised TDaP, polio booster, yellow fever, and typhoid vaccines as well as receiving these all in one day.

The CDC website has confirmed Marburg virus in Kagera Province.  Rachel’s internship is in Arusha.  No one but me seems to be concerned about this.  

I would greatly appreciate any guidance you could impart. I have heard you broadcast an occasional TWIV episode from Africa and your global health must take you there regularly.

I greatly value and appreciate your input.