Lisa writes:

Hi Dr. Griffin,

I live in Sarasota County, Florida. We have recently had two confirmed malaria cases in this area. In hearing this news, I’m thinking… malaria?! In the U.S.?! It is reported that this species is less fatal than others, but it is still worrisome to me. I’m wondering if you can shed any helpful thoughts or information.

Thanks as always for you amazing work with your TWIV clinical updates these past three years!

Lisa Patterson, APRN, DNP, PNP-PC

Venice, FL

Russ writes:

Dr. Griffin,

On your 6-16-2023 update one of the questions posed to you was in regards to flecainide and Paxlovid. I thought it would be good to communicate to your listeners some clarification on this matter. You spoke of having a plan however did not specifically address flecainide. This is a medication you can not simply just stop to start Paxlovid as you can with many other interacting medications. Flecainide has too long of a half life to just stop it and start Paxlovid. As you know as well it is an antiarrhythmic and stopping it may allow her to revert to a fib. It is worth noting as well that 3 of the other antiarrhythmic drugs commonly used for a fib; amiodarone, propafenone, and dronedarone make the person taking it to be unable to take Paxlovid. Metoprolol was also mentioned in the question but this medication is OK to take with Paxlovid.

If I were the primary care provider for that patient, I would advise her first and foremost is up to date on vaccinations. Secondly she should look into the possibility of remdesivir to see what that treatment would entail for her (cost and logistical matters). I would advise her regarding molnupiravir as an option. I would encourage her to seek testing at first symptoms perhaps by having home testing kits available.

Also will you please address the benefits of boosters on T-Cell responses.

I have read that there is data indicating T-cell response has a 2-fold increase after an updated booster and that this was the case regardless of prior infection. Will you please address this in your next talk.

Thank you,

Russ Coash, PA-C

Family Practice, Emergency and Hospital Medicine

Brandon writes:

In the above episode you sounded optimistic that those with long COVID who stuck with pacing were more likely to recover, but aren’t patients more likely to stick with pacing if they’re actually recovering? I’m just thinking the causality arrow could easily point the other way.

Thanks for all that you do!

–Brandon