Gina writes:


I’m writing from Austin Texas. It is too warm for November but I am not complaining about that! I love the podcast, I most often listen when walking my dog at Lake Pflugerville. I may be in Texas but I definitely listen to the end of every episode!

In TWiV 679 the statement was made that everyone should take calcium, and I know that’s not true, at least for me. I cannot take calcium because my body does some weird thing with calcium.

If I take too much, I get kidney stones. If I don’t take enough, my body leaches it from my bones and I feel horrible. I have been on HCTZ + Potassium for decades. My doctor tells me this combo fakes out my system vs. fixes things. I don’t have kidney stones any more so I appreciate that. But I wonder if that puts me at an increased risk for COVID-19?

Also, my mom has been in Austin with us since the end of February. She’s from Northwest Florida and rode back with me after I took a road trip to Mardis Gras this year. I was so lucky not to have been infected!

She is really itching to get back home, and I really would like her to stay put and hunker down for a few more months. Not only has my brother (who lives with her) taken a job in a hospital, I’m not sure she could resist seeing her youngest grandchildren that don’t live with her. I got her hooked on TWiV several months ago, to help relieve her anxiety with real information.

Vincent, she said she will listen to you. Could you please advise her to stay put? Her name is Elaine. 🙂

Thanks for all you do!


Austin, Texas

Neil writes:

Dear TWiV:

I’ve been a TWiV groupie since February and if there were posters of Brianne, Vincent, Dickson, Rich, Kathy and Alan, they would adorn my bedroom.

During your discussion of the case of the new mother who died suddenly, having only a cough before she lay down, Amy Rosenfeld described in clear detail the findings in the heart muscle (myocardium) at autopsy, involving the T tubules and the general meltdown of the synchcium which is the anatomic structure through which the electrical impulses of heart muscle cells transmit.  

Having done a long ago fellowships  in both cardiology and endocrinology, I heard this description and your analysis with different ears.

Everyone seemed to agree the patient died of “heart failure” which has a specific meaning in clinical and pathological practice. The heart’s main function is to pump blood forward in an orderly manner. It is fundamentally a pump. 

To do this it needs electrical physiology.

What you were clearly describing is a situation in which dysrhythmia, (electrical impulse disarray) occurred.  This new mother almost certainly died of a dysrhythmia, not heart failure, which is why her death was so sudden and nearly asymptomatic.

The ultimate end point of heart failure is pulmonary edema in which fluid backs up into the lung alveoli and this would likely have been seen at autopsy. Dysrhythmia is not an anatomic finding and cannot be seen at autopsy.

Your folks commented on how we might detect heart damage from SARS COV-2, and there are many ways: 1/ A resting EKG can see QT intervals which correlate with major disturbances in calcium channels. 2/ Echocardiograms can show “ejection fractions” which are a good correlate with the pump function.  3/There is even such as thing as a  “heart biopsy” which, while is only rarely done, is a technique pioneered by Bernadine Healy when she was at Hopkins.

Calcium physiology is, like most things in biology, not simple, but oral calcium has little or no impact on blood or tissue calcium levels. If it did, we’d probably not survive. There is a very tenacious gatekeeper in the intestine (1,25 vitamin D) which allows only a calibrated amount of calcium to enter the bloodstream from the gut, although this can be overwhelmed by well meaning folks who think they are doing their bones or hearts a favor.

I love TWiV and all you have taught me about T cells, B cells, protein spikes over these past 9 months, but sometimes, when you float into clinical worlds, I wish I had a buzzer to alert you, and interject when you get carried away. 

Keep up the good work. 

As I write today, Pfizer has just announced the early results of its vaccine trials and people are talking about President Elect Joe Biden and there may be, once again, a place for science in these United States of America.

Neil Ravin, MD

(Humble local endocrinologist)

Jaroslava writes:

Dear TWIV team,

I wanted to write you for a long time.

I am (just) a postdoc working on Biophysics of membrane proteins. My heart beats for sodium pump. Since Illinois is hit by covid tsunami – I loved the paper you discussed in TWIV 679 about calcium tsunami. Our lab is working on calcium handling in the heart and I heard about the paper, I had to share it everyone I know in the field.

I love your podcast and your enthusiasm. I follow you since March and I am not going to stop. I may appear mad to the lab, since I am listening to you during microscopy and I am laughing a lot with my mask and headphones on.

I was currently exposed to Covid case, so I am following “TeTrIs”. Most of the things you talked about are perfectly useful now and I seem to be very smart, because I am asking “what is your CT value?”

Unfortunately, my family is in Czech Republic (red Covid spot in the middle of Europe) and my husband works in Richland, Washington state… Despite all complications this year, I am grateful for my family, friends and job. I even started small garden during covid 2020 which would be hard when being in the lab whole day long!

I would love to write a poem and may win one of the books, but I am no poet. But a while ago your video inspired me to make hand made pillow covers with science. See attached photos.

Stay safe, stay grumpy and covid negative!

Thank you,

Jaroslava S.

The structure on the right pillow is “my” sodium-potassium ATPase.

Structure of ATP13A2.

Dirk writes:

Dear Vincent at all.,

A report on SARS2 in Belgium from the top of the second wave. The sun is shining and it will not get above 12°C today, so beautiful autumn …

Since 3 days we are again in a semi-lockdown. Bar, restaurants, non-essential shops and schools are closed. Non-urgent care in hospitals is delayed and ICU is filling up (75% full and increasing). We might be at the top of the new-cases peak. But peak in hospital admissions and deaths are still to come. The hope is that the number of ICU-beds will be enough, work-force is the main bottleneck.

This second wave is ~20% higher than the first, so the main question is: How did we get here??? Again???

There must be natural factors (colder wetter, less sunshine, …). We all want schools open so in September everything started, but only with basic precautions (hand-wash, masks, ventilation, …). This is not enough and the traffic before and after school also has a huge impact. When schools start again (in 2 weeks from now) more measures will be in place (distancing, > 50% online teaching, …). The main cause of the second peak may be the mentality of the population. We were feeling ok during September, there was a gradual increase in cases but we had smaller peaks during the summer as well. We were again negotiating for a  government (Belgian hobby) and nobody wanted to make a strong point about the virus. The government changed the composition of the bureau of advisors towards less biomedicists and more economists (despite strong protest of the biomedical community). And then cases started to increase dramatically in the 20-30 year old’s. It was first the Walloon region and Brussels. We are a tiny country that is further divided and every region can decide stuff themselves. So when one region closes restaurants people just drive to another region. And when one region gets in trouble the other region has the tendency to say “look we are doing better” and not take any measures. Also in Belgium politicians behave like toddlers 😊. One made the comment “Not installing the Corona-app because I don’t trust the national government.” And the leader of the Flemish region “I’m not starting to put out a fire when the house is not burning.” And a few days later the plan for the national lockdown was announced. This was on a Friday but since the lockdown started on a Monday there was a last big shopping weekend in several main cities with crowded streets, people lining up in front of stores … City mayors could have prevented this, but did not. People working in the hospitals were furious …

Anyway very, very, very, frustrating. The virus killed 1/1000 of the population during the first wave. It is unbelievable that we are again at the absolute limit of what our hospitals can do and it may get worse. This wave really took us by surprise but if some politicians would be more realistic we could have prevented a lot. I realize they will not win a prize for being careful (prevention-paradox or self-defeating prophecy) but they have a job to do!

Love the show. It’s a great resource for me, so easy to get updated by just letting it flow into my ears!



Dirk Jochmans, PhD

Research Manager

Laboratory of Virology and Chemotherapy

Rega Institute for Medical Research | University of Leuven | Leuven | Belgium