Will writes:
Dear Daniel
Once again a huge thank you for all the education you provide us non-medics through your TWiV Clinical Updates.
Thanks to you, I humbly think of myself as reasonably well-informed.
As well as following TWiV I always listen to the two weekly Osterholm Update, and the DataReport.info daily Pandemic Update. While the latter is presented by a complete layperson, he tries to communicate the results of latest reports on Covid activity in the USA as faithfully as possible in order to help his audience stay informed.
However in today’s episode he was asked a question about durability of vaccines and how long they remain protective.
His answer revealed that even he really did NOT understand the way that vaccines protect. He did not differentiate between short-term infection and severe disease.
It is my perception that he represents the vast majority of the public. They ALWAYS assume that vaccine protection is against infection, not against the risk of severe disease. One knock on effect of this is to devalue the wearing of N95 respirators which do give significant protection against inhaling SARS-CoV2.
I’m writing this to request that ANYTIME you mention vaccine efficacy, you make it ABSOLUTELY clear it’s fundamentally against severe infection and death. Protection against infection is a variable short-term benefit.
There’s still a vast amount of education that is needed and as a trusted source, your constant reminder will help.
Thank you and blessings
Will
PS I’m just finishing off reading Fauci’s On Call. Thank God for people like him and all of you at microbe.tv
CHINA
Hunan Province
Changsha
Boris writes:
Esteemed Dr. and Professor:
I have been an avid fan of your series for years. Thank you for your thoughtful guidance and help during these troubled times.
My question regards vaccination strategy for the coming fall (2024). I have dutifully followed your recommendations and those of my physician, and received the mRNA vaccines every year. I am intrigued, however, by the potentially greater durability of the Novovax vaccine, with its upcoming new formulation.
Is there any data for the efficacy of Novovax as a booster on top of mRNAs? I received my sixth shot October 2023 and was infected with my first, mild case of covid exactly 2 months later – paxlovid definitely helped minimize disease progression, but I would like to avoid that in the future.
Thank you again and best regards,
Boris
Matt writes:
Dear TWiV team,
Two items:
1. I recently saw an 88 yo patient who had received only two mRNA vaccines in 2021. She presented on day 7-8 of Covid feeling very sick with fatigue, cough and congestion. In our parking lot/outdoor assessment area, her SaO2 was 92-94%. I triaged the patient to the ER for further assessment and treatment of hypoxic Covid. In the ER, her SaO2 was mostly 95% with one dip to 93%. CXR was clear and cbc/chem panel looked okay. She was discharged from the ER without treatment. When I called her the next day, she reminded quite ill. She survived, but she has felt unwell for several weeks.
How sustained does a low SaO2 need to be before considering steroids and Remdesivir?
2. Is there ample discussion on the pricing and cost of Paxlovid and molnupiravir? Yesterday, I had a patient and pharmacy ask me to switch from molnupiravir to Paxlovid in a renal-compromised patient with multiple Paxlovid drug interactions because the share of cost for molnupiravir was out of reach for the patient, but Paxlovid was apparently covered by insurance at a lower copay. Apparently the two main oral Covid medications are not even covered at the same level!
Sincerely,
Dr Matt Davis
Long Beach, CA
Karen writes:
Dear Dr Griffin,
I’m writing on behalf of a 97-year-old relative who caught her first case of COVID a week ago. She was given PAXLOVID promptly and has a mild case. But COVID seems to have re-triggered the sharp muscle pain in her groin that she’d suffered after breaking her hip in a fall at the beginning of May (the doctors deemed her too old for surgery).
She is eager to know: Why would the return of this pain happen? Is it a recognized possible consequence of COVID? How can it be remedied?
More details: Before breaking her hip, she was extremely fit and despite severe deafness — intellectually/socially active. The fall happened at the end of her usual 3-mi walk, and she astonished the rehab home at how soon she was able to get up and start using a walker. After going home six weeks after the fracture, she still had some groin pain which made sleeping difficult. However, muscle relaxants at bedtime had quelled it, and she had tapered off them completely well before COVID hit. She is not taking Tylenol or other painkillers.
Before COVID symptoms hit on 7/20/24, she had been doing 1.25 mi/day pushing a walker or using Nordic walking poles at a local track and, the day before, had pushed a grocery cart vigorously around the store.
(Needless to say, she is an inspiration to the whole family and neighborhood.)
But now with COVID, even walking a few steps around the house is painful. The isolation is making her stir-crazy, and she is very eager to get back to her daily walks.
We are guessing that her COVID infection most likely came from a neighbor/walking-companion who had had it about 2 weeks previously.
Thank you for any suggestions! And continuing thanks for all that
we’ve learned from you and all your microbe.TV companions!
Karen
Grateful subscriber/donor to microbe.tv/Parasites without Borders since early COVID times.
PS Up to now, my relative has been too busy to watch TWiV via Closed Captions. But I’ll suggest it to her as an all-too-appropriate diversion now.
J writes:
Hi Dr. Griffin,
After having COVID, many things seem gross and contaminated. I can wash the laundry, run the dishwasher on “sanitize,” and clean various surfaces, but what about personal care items? Should the contact lens-wearing COVID patient toss out the lenses they were wearing when they fell ill? If so, when is it safe to start a new pair (they aren’t cheap!)? How about toothbrush and toothpaste? With strep we’re advised to throw out the toothbrush after a few days of antibiotics, but is there any similar advice for viruses? I would not want any of my items reinfecting me (seems unlikely) or somehow infecting those in my household.
J