Dee writes:

Dr. Daniel,

My daughter’s college roommate tested positive for malaria on an international service trip this summer. She may have received some initial treatment overseas.  What would be the protocol for re-entry to the U.S.? Would she pose a risk to her roommates in a dorm setting?  What recommendations and/or precautions are advisable?  

Thank you for all the valuable information you provide.          

Regards, Dee

Robert writes:

Why is remdesivir so difficult to find despite being described as such an excellent drug? 

Is it a manufacturing difficulty, licensing, supply, price, or perhaps yet another big pharma mess?


Robert – Berkeley, CA

Nick writes:

My mother in law is a 20 year kidney transplant patient in her late 70s who is still mostly avoiding close contact with people after 3 years of COVID.  Is there any new news about how COVID is affecting immunocompromised transplant patients like her?  According to the Labcorp  COVID-19 Semi-Quantitative antibody test she managed to make decent levels of antibodies after several boosters. 

Thanks for being a light in the darkness!

Nick in Ohio

Anne writes:

I went to an urgent care center on Thanksgiving Day last year with the worst cough of my life.  The doctor took an x-ray and said it was bronchitis, likely caused by RSV which was quite prevalent in our area last fall.  I am 69 years old, recently finished with breast cancer treatment, and eager to avoid getting RSV (at all or again).  However, my doctor is hesitant about my getting this new vaccine and the CDC is equivocal about which elderly persons should get it.  Here’s my question:  If I did have RSV last fall, am I now immune or does it morph like the flu or COVID and attack again?  Should elderly people with compromised immune systems get the RSV vaccine?

Thank you!


Lehigh Valley, PA

Fernando writes:

Hi Daniel & Vincent,

I’ve been a faithful listener/viewer of “Clinical Update” from the very start, who has been able to put your freely shared information into practice to reduce risk for me and my family, often sharing episodes with others when they might help with their concerns. (As a small gesture of thanks, I just made a contribution to the FIMRC fundraiser).

Thanks in part to your advice, I managed to stay COVID-free until now, but my luck ran out last weekend, likely thanks to several busy events at work. Just finished my Paxlovid course, feeling totally normal, testing negative on NAAT, but our (very attentive and knowledgeable) doctor warned me to look out for “Paxlovid rebound.” Knowing your stance on that concept, I wanted to offer a hypothesis on why the concept is sticking even with good clinicians, and certainly with friends and family who experienced it.

Any of us who has had a bad cold or flu can recall the experience of feeling better after a few days, possibly going back to work, and then starting to feel worse again, maybe with a hacking cough and fatigue, for another week or longer. However, the contrast between the first phase and the second one is not extreme in terms of symptom intensity. With an effective antiviral like Paxlovid, the contrast between the first phase’s end — feeling absolutely fine after a few days — and the second is a lot more pronounced, making that “rebound” feel different in quality than those in our earlier viral experiences that did not involve antivirals. 

In other words, post-Paxlovid rebound feels that much worse because Paxlovid was so effective at squashing first phase symptoms.

Just thought I’d put this speculation to your consideration, trying to reconcile the objective data you present with the subjective impressions that dominate the discourse.

Thank you again for your superb educational service.

— F