Jen writes:

Hi Dr. Griffin,

In your weekly update that dropped on 6/10, you mentioned how useful it would be to have a tool for understanding how bad for one’s health the smoke in the air was, aside from the color coded system. In her recent substack post, Dr. Katelyn Jetelina (“Your Local Epidemiologist”) shared the following image from Berkeley Earth.

Both you and Dr. Jetelina also noted how folks masked up when the smoke plumes were surrounding us and how different that was/is than people’s past and current responses to SARS-CoV-2 levels. Having a visual threat as well as one with relatively immediate adverse effects results in different behaviors. I share in your interest for new communication tools to be developed and used widely which would help people understand the invisible threat of viruses. The resources upon which many of us used to rely have all but disappeared.

Thank you for your continued work keeping us updated on the latest covid-related research and news.



Amy writes:

Hello Daniel and Vincent,

I’m an epidemiologist in a state public health department. Thank you for highlighting the magnitude the long standing (40 years!) HIV pandemic in the May 27 TWIV episode. As you mentioned at least three people in the US acquire HIV every hour, and 13% of people living HIV are not aware of their status. We’ve made progress in reducing HIV transmission – but not for everyone and everywhere –  We’ll need to address the root causes and eliminate stigma and discriminatory systems and policies to end the pandemic.

I’m hoping you can expand a bit more on the comment Vincent made around lack of HIV prevention. Although we don’t yet have a vaccine, we do have other very effective tools up our sleeve, namely PrEP (pre-exposure prophylaxis). (Currently there are daily oral medications, Truvada or Descovy and a new long lasting injectable option, cabotegravir.) When taken as directed, PrEP can reduce the risk of acquiring HIV through sex by more than 99% and can reduce the risk of acquiring HIV among people who inject drugs by up to 74%.

Also, as you mentioned antiretrovirals can have side effects, but this is where provider-patient relationships are so important. Part of the PreP and ART regiment involves monitoring  side effects.. And if issues come up, providers can help manage those – or they may change the treatment plan. The goal is to become undetectable if you’re living with HIV or prevent HIV altogether. 

Thank you for taking my long-winded comment!

Long time listener and fan,


Joel writes:

Hello Dr. Griffin-

After hearing your episode last week, I advised my elderly parents with comorbidities to request Paxlovid from their healthcare provider ahead of a three week trip to Mexico.  We think neither of them have had COVID-19 yet.

They were told “no” by their primary care provider because it can only be prescribed when someone has COVID symptoms or tests positive.

I researched it myself and found an FDA FAQ about the full authorization of Paxlovid (published on 5/25/23) which says to follow the EUA guidance for prescribing and specifically calls out the question about travel.  This also says it can only be prescribed when there are symptoms or a positive test.

My question is, will this ever change?  As a prescriber, is it “off label” to prescribe it for travel?

Please advise.

Thanks for all the great information!


Joel Michels, Nurse Practitioner 

Joyce writes

As a long-time listener, I had a plan for taking Paxlovid while on Eliquis for Afib, should I come down with Covid.  That plan is no longer viable, after having been prescribed Flecainide and Metoprolol for 90 days post cardiac ablation.  My doctor does not want me to worry about that unless/until I were to come down with Covid, but I worry about not being able to reach him quickly, or if he wouldn’t want me to take an anti-viral at that time.  I would very much like to know your thoughts on what my ‘plan’ for dealing with this situation should be?  Thank you for what you are doing to help those of us who just want a plan…Joyce