Dave writes:
Hi Dr. Griffin:
Thanks so much for all your advice on TWiV over the years. I have numerous friends who are trying to get advance Paxlovid prescriptions filled so they can take it early, as advised, in case they pop positive while traveling. They are all elderly and definitely fall into high risk categories. Most are getting denied or told useless advice like “call me” if you pop positive in Hungary.
Could you possibly update your covid advice document (https://twiv.s3.amazonaws.com/COVID+treatment+summary+09-14-2023.pdf) with a few lines on Paxlovid travel guidance? It would be useful to have an authority to point to, since the CDC has been woefully silent on the issue. Most docs seem barely aware that the EUA restrictions are no longer in effect. Unfortunately, among the cruise ship set this will probably lead to some preventable deaths.
Regards,
Dave
Ellen writes:
Dear Daniel,
When I suggested to a pharmacist that I might get two flu vaccines this season (I’m 78), he thought that the HD vaccine was more durable and that it might not be advisable to take such a strong dose twice, say 4 months apart. Any thoughts?
Thank you so much for your sage analysis,
Ellen
Jen writes:
Dr. Griffin,
My husband, 7-year-old, and I have been very covid-cautious, but we’re about to have a lot of potential exposure on an early-October trip to Japan with 45 members of our extended family – mainly because there will be no way to avoid indoor dining for all or most meals. We are trying to decide how to time our vaccines with this trip, and I am separately agonizing over whether to go at all since I will be 30 weeks pregnant at the time. Here are my questions:
1. As you’ve discussed, it’s a little early to get covid and flu shots. Ordinarily we wouldn’t rush out for boosters, given our trust in our primary vaccine series. But our main goal is to prevent me, the pregnant person, from contracting covid from this trip, so we are hoping to capitalize on the early protection from *infection* that a booster might offer. Would you recommend that we get these shots now, in advance of our early-October trip, since we will have way more exposure than we want? Or save that protection for later in the season? (I would be 28-29 weeks at the time of a pre-trip booster.)
2. Updated covid vaccines have been slow to arrive in Seattle, and we may not be able to get one until less than a week before our trip. Still worth it, even though we won’t have two weeks between shots and travel? Or at that point should we just wait till later in the fall?
3. Since I’m pregnant, I hope to get a Paxlovid prescription in advance of our trip (although I’m having a hard time finding a provider who recommends Paxlovid during pregnancy at all, much less as an advance prescription). But I’m also considering not going on the trip because of possible risks to the baby. My midwives have said they’re seeing placenta damage when parents contract covid, but they don’t have info on whether vaccination or Paxlovid mitigates that risk. Does research exist on the impact of Paxlovid or a primary vaccine series on the outcomes for a *baby* if a parent contracts covid?
Thank you so much. Your weekly updates have been balm for my soul the last three years.
Jen (in Seattle)
Rick writes:
From your discussion on correctly using the SARS-CoV-2 rapid antigen test, I see this worst case scenario :
Day 0: Start to feel symptoms
Day 1: Perform 1st rapid antigen test. Result is negative.
Day 3: Perform 2nd rapid antigen test. Result is negative.
Day 5: Perform 3rd rapid antigen test. Result is positive. Contact my Kaiser PCP (whom I’ve consulted ahead of time). He orders Paxlovid, and depending on timing…
Day 6 or 7: Start the course of Paxlovid.
Am I too late to catch any active virus?
Is starting Paxlovid this late in the viral replication cycle better than nothing?
Thank you for the time you spend on the various TWIx,
Rick
Anonymous writes:
Dear Dr. Griffin:
I am an old retired pediatrician, who has followed your podcasts regularly for several years. A question has come up in my family in re initial immunization of their two year old daughter, who through misinformation has been unimmunized against Covid. She is expecting a new sibling momentarily, and her mother who has been immunized, but not recently, and also has presumably acquired Covid as well. They wish to start her immunizations ASAP. Should she receive the complete series of the new vaccine just released, or one of the older versions. If she receives the new Moderna version just released does she get two shots. She is in day care. What advice to give her parents about exposure to the new infant. Also what about her exposure to her great grandmother who is 85 y.o. and high risk, and on xarelto.
Michael writes:
Dear Dr. Griffin,
I have had a fair few friends who have had COVID turn negative by lateral flow assay only to turn positive again during the so-called rebound after Paxlovid. I had understood that rebound was not an actual resurgence of viral replication, so I am confused about how/why the assays would turn positive again. Can you help me understand what is going on here and whether there is any risk of transmission from someone who is rebounding in this particular way?
Thank you for all you are doing to help us healthy and sane!
Sincerely,
Michael
Boulder, Colorado
Wendy writes:
Dear Dr. Griffin,
I am in my 27-week pregnancy and entering into my last trimester soon. Healthy 30-year-old without any complications during pregnancy. As a virology Ph.D., I am well aware of the importance of vaccination and want maximum protection for my coming baby. Therefore, I want to get the updated COVID vaccine, flu shot, the newly approved RSV vaccine, and the required Tdap vaccine. My ob only provides Tdap vaccine in her clinic and she says I can get all others from local pharmacy when they are available. I asked her about how should I schedule the vaccination timeline. She only says she can give the Tdap vaccine on my 37-38 week latest. Others I better have at least 4 week intervals apart. What will be your suggestion on the timeline for me? I am thinking getting the covid/flu vaccine on week 29, getting the RSV vaccine on week 33, and getting the Tdap on week 37. Does that sound OK for you?
Second question, I don’t have the RSV vaccine ready in a nearby pharmacy for pregnant women, so far they still provide it only to age 60+ people. I believe the FDA already approved it for pregnant women based on your clinical update, but has the CDC approved it? Do you know when will the RSV vaccine be ready in the pharmacy for pregnant women? Do you know if there are any side effects related to pregnancy that I should be aware of?
Third question, I always have a fever and whole-body pain every time I get the COVID shot. However, I am allergic to acetaminophen so I can not take Tylenol. I used to take ibuprofen before. Now as I am pregnant, ibuprofen is not an option for me. With a baby in my body I can not let my body temperature go too high, what other pregnancy-safe medicine that you recommend for me to prepare for the booster shot? My ob said I could probably take baby aspirin but I am not sure if I am allergic to it since I don’t remember I have taken aspirin before.
Thank you so much for keeping us updated every week and answering our questions every time. I really appreciate all the education you, Vincent and the entire TWIV, microbetv do for us.
Sincerely,
Wendy