Craig writes:

Can you talk about fever, how important it is to diagnoses, and why some people seem to get infections without fever. Do some people really run lower than 98.6˚F and is that why they seem to not have a fever when they are well above their baseline?

I also invite a rant about Celsius science in a Fahrenheit world.  98.6˚F is just 37˚C translated to Fahrenheit. Giving it as 98.6 makes it seem much more precise a value than it really is, like it has to be 98.6 not 98.5 while it’s really 37.ish and not 37.0.  A friend had surgery and the discharge instructions say to call if you have a fever over 100.4˚F.  But that’s just 38˚C in ˚F, again giving the impression that 100.3 is meaningfully different from 100.5.  This annoys me, please feel free to talk me out of my annoyance or reinforce it so I can spread my annoyance with confidence when ranting to my friends.



Theodore writes:

Dear Dr Griffin and TWIV Team,

Greetings from Athens Greece.

I would like to ask you about a relative of mine concerning covid vaccination. 

As she is 93 years old she is fully vaccinated and boosted (last dose last year bivalent B.A .4-5)

Appart from atrial fibrilation she has no other health issues. She is fully intependent and loves going to taverns on weekends.

Unfortunately she came down with covid 9 days ago , a few days before her XBB 1.5 vaccination. 

Due to extreme weakness ,  she could be officially diagnosed and registered as covid positive a week after the symptoms onset (unfortunately paxlovid still has special Emergency authorisation  status in Greece , is destributed only via hospitals, and a possitive test is required). Of course after a week paxlovid won’t do much. 

Thankfully the “unsung heroes” (call me T cells) must have done their job and she is way better and everything looks that she will be fine.

Taking into account her age and her heart problem what  would you sugest? 

The immunity gained from the dissease is sufficient and doesn’t need vaccination this year?

To  do the XBB1.5 vaccination after 3 months ?

maybe wait a little bit more ? (depending on the covid positivity in society of course)

or to do it after 6+ months ,spring time, in order to be “covered” for the summer ? I know, by spring time  we don’t know what new strains will be out and what  efficacy  a XBB vaccine will have on them ,  but as “earth’s virology professor” says…boosters boost.

Yours Thankfully,


Brian writes:

Dear Drs. Griffin and Racaniello,

I have a patient who underwent a bone marrow transplant for multiple myeloma last year.  She now takes daratumumab, and Revlimid, prescribed by her oncologist.  He has recently advised her not to get either the flu or the COVID vaccines this fall because her therapy will make them ineffective.  Do you agree with this recommendation?  I had advised her to take both because she will likely will get some T cell immunity and perhaps a bit of B cell immunity.  What are your thoughts?

I have enjoyed the last 2000+ clinical updates in TWV.


Brian Robinson, MD

Kim writes:

Here is my pediatric office staff in our Halloween costumes. We had a blast being superheroes and the (younger) kids do believe we can fly. The teens roll their eyes but smile.

As far as GAS, after being in solo rural practice for 34 years and looking into a lot of throats I find that the presence of  petechiae clinically correlates  much more with culture proven strep throat than exudates do but the more recent strains of coxsackievirus causing HFM present with more petechiae than they did it decades ago.

Lastly, would you kindly review any need for outpatient treatment of COVID with antivirals in children?

Thank you.

Kim Burlingham, MD FAAP

Winnsboro, Texas